Medications

Question 1

morphine sulfate

Answer 1

• opioid
• s/e resp depression
• cautious in 2nd stage
• used during labor

Question 2

butorphanol

Answer 2

opioid agonist-antagonist

• 2-4mg IM, .5-2mg IV
• s/e no resp depress in mom + bb
• dont give to drug dependent woman>possible suddent withdrawal of bb or mom

Question 3

nalbuphine (Nubain)

Answer 3

opioid agonist-antagonist

• 10mg IM or IV
• s/e no resp depress in mom + bb
• dont give to drug dependent woman>possible suddent withdrawal of bb or mom

Question 4

sublimaze (Fentanyl)

Answer 4

short acting opioid

• 50-100 mg IM, 25-50 mg IM
• s/e cross placent, synth opioid, FHR changes, hypotension, mom/bb CNS depress, resp depress
• monitor s/e like sedation, n/v, itch, resp effort

Question 5

local anesthesia used during labor is given during ____ for ____but puts mom at risk for _____ so monitor _____

Answer 5

> 2nd stage of labor or immediately before delivery
anesthesize episiotomy/repair
risk for hematoma/infection
monitor returnof sensation or incr swellign at injection site

Question 6

pudendal block

Answer 6

anesthetic injected to pudendal nerve close to ischial spine via trumpet needle

Question 7

pudendal block is admin during ____ for ____

Answer 7

2nd stage or before labor

>to anesthesize vulva, lower vagina, part of perineum, or to use low forceps

Question 8

pudendal block risks + nursing implicaitons

Answer 8

toxicity, hematoma, infection

monitor for retun of sensation, s/s infection, urinary retension

Question 9

epidural block

Answer 9

anesthetic injected to epidural space

• outside of dura bw dura + spinal canal
• bw 4th -5th vertebrae

via epidural catheter

Question 10

when is epidural given

Answer 10

1st or 2nd stage of labor

• for both vaginal + c section
• potl for 100% block of pain
• can be used w opioids like sublimaze to allow walking + effective pushing

Question 11

epidural adverse effects

Answer 11

hypotension is most common

• n/v
• pruritis
• resp depress
• alt FHR
• decr mom hypervent
• reduced sweat
• alt thermoregulatory

Question 12

pre-epidural care

Answer 12

-assess pain lvl
-contact HCP is epidural is requested
-assess/doc baseline VS
-assess/confirm norm FHR
obtain consent
-check lab val esp bleeding/clotting
-IV bolus w norm saline or lactated ringer
-ensure emergency equipment is available
do time-out procedure verification

Question 13

walking epidural

Answer 13

combined spinal epidural analgesia

-injection into subarachnoid space

Question 14

do nurses manage the care of pt receiving epidural?

Answer 14

no, they can monitor, but DO NOT MANAGE

Question 15

actions OUTSIDE of nursing scope re epidural

Answer 15

• managing care
• dosing, cont infusion
• insertion, injection, manage rate changes

Question 16

responsibilities of nurses caring for epidural pt

Answer 16

• monitor stable VS, mobility, LOC, pain perception, fetal status
• assess, monitor + intervene

Question 17

during epidural care

Answer 17

-assist anesthesia provider w placement of pt in lateral position w head flexed towards chin or sitting w head flexed + elbows on knees

Question 18

nursing care after epidural

Answer 18

• VS + FHR Q5-15min
• assess hypotension or resp depress
• assess level of motor blockage
• monitor for s/s of intravascular injection

Question 19

s/s of intravascular injection

Answer 19

• occurs during placement
• tachy/bradycardia
• HTN
• dizzy
• tinnitus
• metallic taste
• loss of consciousness

Question 20

folic acid for chilbearing age

Answer 20

0.4-0.8 mg

Question 21

folic acid for pregnancy W/O hx of NTD

Answer 21

0.6 mg

Question 22

folic acid for women w hx of NTD

Answer 22

4mg for 1st month,

>then .4mg

Question 23

prenatal vitamins

Answer 23

• calcium
• magnesium
• vitamin D
• iron

Question 24

terbutaline indication + MOA

Answer 24

• decr UC + delay delivery

- beta adrenergic agonist> relax smooth muscles

Question 25

terbutaline CI + SE

Answer 25

CI: arrythmia, pulmo edema, MI, hypotn SE: tremor, tachy, anxiety

Question 26

procardia inidcation + MOA

Answer 26

- decr UC | - blcks Ca fr entering smooth muscle> relaxed uterus

Question 27

procardia CI + SE

Answer 27

CI: cardiac disease, renal disease, hypotension SE: headache, flushing, dizzy

Question 28

oxytocin indication + MOA

Answer 28

-prevent PPH after placental expulsion, mgmt of 3rd stage labor MOA: stim UC

Question 29

methergine indication + MOA

Answer 29

- prevent PPH; for uterine atony | - ergot alkaloid act on smooth muscles to stimulate contraction

Question 30

methergine CI

Answer 30

HTN, heart problems

Question 31

hemabate indication + MOA

Answer 31

for uterine atony -prostaglandin> stim smooth muscle contraction

Question 32

hemabate CI

Answer 32

asthma