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60 Cards in this Set
- Front
- Back
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CHAPTER TWELVE
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(Ignore this card)
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First stage pain is
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internal visceral pain
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Second stage pain is
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somatic pain
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Third stage pain is
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similar to the pain experienced during the first stage
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When are sedatives effective
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first stage latent phase
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When is spinal block effective
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second and third stages
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When are opioids effective
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first stage active phase
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When is epidural effective
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first stage active phase through third stage
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When is pudendal nerve block effective
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second and third stages
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When is local infiltration pain relief effective
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second and third stages
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Before administering analgesics, the nurse needs to ensure that labor is progressing; this is done by performing a vaginal examination that reveals a cervical dilation of ___ cm with a fetus that is
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4 cm; fetus engaged
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Adverse effects of sedatives (3)
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neonatal respiratory depression, unsteady maternal ambulation, inhibition of maternal ability to cope with pain
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Examples of sedatives
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secobarbital (Seconal), Pentobarbital (Nembutal), phenobarbital (Luminal)
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Examples of opioid analgesics
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meperidine hydrochloride (Demerol), fentanyl (Sublimaze), butorphanol (Stadol), and nalbuphine (Nubain)
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Whenich route is recommended when giving opioid analgesics
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IV route
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which opioid analgesics provide pain relief without causing significant respiratory dpression - i.e., are agonist-antagonists?
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Butorphanol (Stadol) and Nalbuphine (Nubain) - remember the ancient Roman stadium
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opioid analgesic A. E.
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potential neonatal respiratory depression, N/V, sedation, tachycardia, hypotension, decreased FHR variability, allergic reaction
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Which drug counteracts the effects of respiratory depression in the newborn resulting from opioids
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Naloxone (Narcan)
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Which drugs can control anusea and anxiety but do not relieve pain and are used as an adjunct with opioids
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phenothiazine medications
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Examples of phenothiazine medications
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promethazine (Phenergan) and hydroxyzine (Vistaril)
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A. E. of phenothiazine medications
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dry mouth, sedation - provide ice chips or mouth swabs
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What analgesics are used for epidural or spinal regional analgesia
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fentanyl (Sublimaze) and sufentanil (Sufenta)
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A. E. of epidural and spinal anesthesia
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N/V, inhibited bowel and bladder sensations, bradycardia or tachycardia, hypotension, respiratory depression, allergic reaction and pruritus
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Examples of regional blocks
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pudendal block, epidural block, spinal block, and paracervical nerve block
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When is a pudendal block administered
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second stage, 10-20 minutes before delivery
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What medications may be used for a pudendal block
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lidocaine (Xylocaine) or bupivacaine (Marcaine)
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A. E. of pudendal block
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broad ligament hematoma, compromise of maternal bearing down reflex
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An epidural block consists of what medicationss
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bupivacaine (Marcaine) along with an analgesic morphine (Duramorph) or fentanyl (Sublimaze)
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an epidural block is injected at what level
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4th or 5th vertebrae
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When is an epidural block administed
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active labor, first stage
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A. E. of epidural block
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maternal hypotension, fetal bradycardia, inability to feel the urge to void, loss of the bearing down reflex
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spinal block is injected into what space
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subarachnoid space at 3rd, 4th, or 5th lumbar interspace
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the spinal block eliminates all sensations from the level of
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nipples to toes
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low spinal block may be used for
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vaginal birth but not labor
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spinal block is administered in the
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late second stage or before C-section
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When administering general anesthesia, which medications should also be administered
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H2 receptor blocker such as ranitidine (Zantac) to decrease gastric acid production; metoclopramide (Reglan) to increase gastric emptying; short-acting barbiturate such as thiopental sodium (Pentothal) to render the client unconscious; succinylcholine chloride (Anectine), a muscle relaxant to facilitate passage of endotracheal tube
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CHAPTER THIRTEEN
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(Ignore this card)
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What should the patient do before Leopold's maneuvers?
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empty the bladder
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How often should IA be performed on low-risk women during latent phase
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every 60 minutes
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How often should IA be performed on low-risk women during active phase
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every 30 minutes
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How often should IA be performed on low-risk women during second stage
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every 15 minutes
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How often should IA be performed on high-risk women during latent phase
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every 30 minutes
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How often should IA be performed on high-risk women during active phase
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every 15 minutes
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How often should IA be performed on high-risk women during second stage
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every 5 minutes
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IA should be performed following expulsion of an enema, if IA is used
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(Please ignore this side of the card)
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When using IA, how long should you count the FHR and how long should you listen after a ctx?
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FHR for 30-60 seconds; auscultate ctx and followinng 30 seconds
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Normal FHR accels should return to baselin in less than
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2 minutes
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Fetal bradycardia may be caused by
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uteroplacental insufficiency, umbilical cord prolapse, maternal hypotension
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Fetal tachycardia may be caused by
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maternal infection, fetal anemia, fetal heart failure, fetal cardiac dysrhythmias, use of cocaine or meth, maternal dehydration
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Decrease or loss of FHR variability may be caused by
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meds that depress the CNS, fetal hypoxemia with resulting acidosis, fetal sleep cycle, congenital abnormality
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How do you resond to decreased FHR variability
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stimulate fetal scalp, position in left-lateral position.
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Average IUPC pressure is
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50-85 mm Hg
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What will happen to pH in fetal hypoxia
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will decrease
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normal fetal scalp pH is
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7.25
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fetal scalp blood pH of < 7.20 indicates
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fetal distress
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FSpO2
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fetal oxygen saturation
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The infant must be how old to use FSpO2
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36 weeks gestation
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The cervix must be dilated to at least what to use FSpO2
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2 cm
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The fetal station must be at least what to use FSpO2
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-2
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Normal FSpO2 is
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30-70%
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