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Preeclampsia Assessment
After 20 Weeks of Pregnancy
Mild
Hypertension > 140/90
Proteinuria or End-Organ Dysfunction
Severe
Hypertension > 160/110
Progressive Renal Insufficiency
Vision Changes
HELLP Syndrome
Pulmonary Edema
2 mins
Eclampsia
Mechanism of Action
Increased Central Nervous System Irritability
Signs and Symptoms
Hyperreflexia
Positive Ankle Clonus
Headaches
Visual Disturbances
Epigastric or RUQ Pain
Seizures
Coma
Considerations
Don't Leave Bedside
Magnesium Sulfate
2 mins
RhoGam [Rho(D) Immune Globulin]
Indications
Antepartum Prevention at 28 weeks
Suppress Antibody Production
Mechanism of Action
Lysis of Fetal RBC in Maternal Bloodstream
Side Effects
Myalgia and Lethargy
Considerations
Negative Coombs Test
Standard Dose 300 mcg
Microdose 50 mcg
Blood Product
2 mins
Severe Preeclampsia
Mechanism of Action
Vasospasm and Decreased Organ Perfusion
Intravascular Coagulation
Increased Permeability and Capillary Leakage
Signs and Symptoms
Hypertension
Proteinuria or End-Organ Dysfunction
HELLP Syndrome
Hepatic Dysfunction and Hemolysis
Elevated Liver Enzymes
Low Platelet Counts
3 mins
Preeclampsia Interventions
Side Lying Position and Bedrest
Antihypertensives
Magnesium Sulfate
Labor Induction
1 min
Spontaneous Abortion Overview
Assessment
Bleeding < 20 weeks Gestation
Interventions
Identify Type
Bed Rest
Monitor for Hemorrhage
Save Pads and Linens
RhoGAM
Dilation and Curettage (DandC)
Cerclage
Emotional Support
2 mins
Abruptio Placentae
Mechanism
Premature Separation of Placenta
Assessment
Tearing Pain
Bleeding (Often Concealed)
Rigid Uterus
Contractions
Interventions
Corticosteroids as Needed
Emergent Delivery
Considerations
Increased Risks for Neonate
Rh (Rhesus) Incompatibilities
Increased Risk for Shock
Monitor Fetal Heart Rate
3 mins
Amniocentesis
Mechanism
Transabdominal Puncture
> 14 weeks gestation
Indications
Genetic and Congenital Anomalies
Fetal Hemolytic Disease
Fetal Lung Maturity
Complications
Miscarriage
Hemorrhage
Infection
Considerations
RhoGAM (Rh Immune Globulin)
2 mins
Blood Types and Compatibilities
ABO Compatibility
No Antigens (Type O Blood)
Universal Donor
A Antigen (Type A Blood)
B Antigen (Type B Blood)
AB Antigen (Type AB Blood)
Universal Recipient
Rhesus (Rh) Compatibility
Rh (Rhesus) Antigen
Never Rh+ to Rh-
Considerations
Blood Transfusion
Obstetric Patient
2 mins
Staphylococcus aureus Characteristics
Characteristics
Gram-Positive
Cocci
Catalase-Positive
Coagulase-Positive
Beta-Hemolytic
Protein A Virulence Factor
Inhibits Phagocytosis
MRSA
Resistant to Beta Lactams Due to Altered Penicillin Binding Proteins (PBPs)
2 mins
Methylergonovine (Methergine) and Ergotamine (Ergot Alkaloids)
Mechanism
Smooth Muscle Contraction
Vasoconstriction
Indications
Migraine
Postpartum Hemorrhage
Side Effects
Nausea and Vomiting
Severe Hypertension
Tachycardia
Considerations
2nd Line Agent
2 mins
Neonatal Respiratory Distress Syndrome
Cause/Mechanism
Fetal Lung Immaturity
Lack of Surfactant
Assessment
Respiratory Distress
Nasal Flaring
Retractions
Grunting
Interventions
Surfactant
Oxygen
Mechanical Ventilation
Considerations
Total Parenteral Nutrition (TPN)
2 mins
Vitamin K1 (Phytonadione)
Mechanism
Synthesizes Clotting Factors II, VII, IX, X
Indications
Hypoprothrombinemia
Newborn Prophylaxis
Bleeding from Warfarin Overdose
Side Effects
Shock
Kernicterus
Cardiac Arrest
Considerations
Bile Salts required for Intestinal Absorption
Increased Risks with IV Administration
2 mins
Hyperbilirubinemia
Cause/Mechanism
Increased Unconjugated Bilirubin
Assessment
Jaundice
Kernicterus
Interventions
Early Feedings
Heme Oxygenase Inhibitors
Phototherapy
Protect Eyes
Monitor for Dehydration
Considerations
Monitor Bilirubin Levels
3 mins
Breastfeeding
Benefits
Complete Nutrition
Antibody Protection
Bonding
Convenient
SIDS Risk Reduced
Possible Enhanced Cognitive Development
Long-Term Health Benefits
2 mins
Bilirubin Lab Value
0.2-1.2 mg/dL
Increased Bilirubin Causes Jaundice
54 secs
Phenylketonuria (PKU)
Cause
Autosomal Recessive Genetic Disorder
Enzyme Deficiency
Assessment
Failure to Thrive
Irritability
Musty or Mousy Odor
Cognitive Impairment
Interventions
Low Phenylalanine Diet
Low Protein Foods (Diet)
Avoid Aspartame
Sapropterin (Kuvan)
Considerations
Guthrie Blood Test
2 mins
Hirschsprung's Disease
Mechanism
Congenital Aganglionic Megacolon
No Peristalsis
Assessment
No Meconium Within 24 Hours
Refusal to Feed
Abdominal Distention
No Stool on Rectal Exam
Forceful Expulsion of Fecal Material After Exam
Interventions
Surgical Resection
Colostomy
2 mins
TORCHeS Screening
TORCHES
Toxoplasmosis
Other
Rubella
Cytomegalovirus (CMV)
Herpes Simplex Virus (HSV)
Syphilis
Considerations
Diagnostic Testing
3 mins
Presumptive Signs of Pregnancy
Amenorrhea
Fatigue
Urinary Frequency
Nausea and Vomiting
Breast Changes
Quickening
1 min
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