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Flashcards in Ms. Harmons focused review Deck (66)
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1

Pulmonary changes in reference to inhalation agents

-MV is increased by 50% TV by 40% and RR by 10% the increased MV and decreased FRC => causes rapid increased alveolar concentrations of inhaled anesthestics basically gas uptake is faster!!!

2

uterine blood flow is up to how much mL/min

500-700 mL/min

3

Is the uterus autoregulated

no, it depends on the mothers BP

4

what causes decreases in uterine blood flow?

mothers hypotension

5

do epidurals or spinal anesthesia alter uterine blood flow?

not if maternal hypotension is avoided

6

what do contractions do to uterine blood flow?

Decreases it

7

An Anesthetic consideration is that which pressor is NOT associated with significant decreases in uterine blood flow?

Ephedrine

8

Placental exchange occurs primarily by what?

diffusion

9

1st stage Pain what type of pain? what causes the pain? what type of nerve fibers? where to the fibers origionate? pain characteristics?

-VISCERAL -caused by uterine contractions an ddilation of cervix -Autonomic C fibers -enter the dorsal horn of the spinal cord T10-L1 -dull- aching pain (how to remember For Jake) know the C visCeral pain caused by Contractions and dilation Cervix autonomic C fibers

10

2nd stage Pain what type of pain? what causes the pain? what type of nerve fibers? name of the nerves? where to the fibers origionate?

-SOMATIC -caused by the stretching of the vagina and perineum by desecent of the fetus -A-Delta -pudendal nerves -enter spinal cord at posterior roots S2-4 (how to remember Somatic Seecond stage remember the S)

11

what is the treatment for aspiration prophylaxis for all pregnant women? give doses and route!

Reglan 10mg IV Zantac 50mg IV Bicitra 30 mL PO

12

what is Beat to beat variability? Is it normal? what does it indicate?

FHR that varies 5-20 BPM yes (completly normal) nothing no worries

13

what is early decelerations? is it normal? what does it indicate?

-the slowing of the FHF that begins with the onset of uterine contraction -yep (no worries no problems) -nothing NOT indicative of fetal distress

14

what is a late deceleration is it normal? what does it indicate? what test is recomended?

-slowing of FHF that begins 10-30 seconds after the onset of uteine contractions. -nope never - fetal distress - fetal scalp pH

15

what are variable decelerations? they are generally characterized by what? thought to be caused by what? are the bad? how can you fix it?

- variable in magnitude, duration and time of onset - generally characterized by a steep descent of FHR -umbilical cord compression -unless prolonged, they are usually benign - changing maternal position (all caused by compression of the cord)

16

what is it and what are the 6 defining characteristics?

early decelerations have the following characteristics:

• Occur with each uterine contraction

• Start and end with the contraction

• Gradually decrease in rate and then end in a return to baseline

• Are uniform in appearance

• Are associated with a mild decrease in FHR (20 bpm or less)

• Are accompanied by a loss in beat-to-beat variability during the deceleration (Plaus 1112)

 

17

what is this and what are the 4 defining characteristics

variable decelerations have the following characteristics:

• Vary in appearance, duration, depth, and shape

• Demonstrate abrupt onset and recovery

• Maintain beat-to-beat variability with the deceleration

• Are classified as severe if the FHR decreases by 60 bpm, if the FHR decreases to less than 60 bpm, or if the decelerations last 60 seconds or longer (Plaus 1112)
 

18

what is this and what are it's 7 defining characteristics

 late decelerations have the following characteristics:

• Occur with each uterine contraction

• Start between 10 and 30 seconds after the uterine contraction

• Gradually decrease in rate and end in a return to baseline

• Are uniform in appearance

• Vary in depth according to the strength of the uterine contraction

• May or may not be accompanied by beat-to-beat variability

• Are classified as severe if the FHR decreases by more than 45 bpm

Late decelerations are probably caused by a problem in the uteroplacental interface that results in fetal hypoxia and acidosis. Any late deceleration is a reason for concern. Even small (Plaus 1112)
 

19

WHat is this

normal beat-to-beat and long-term variability with fetal heart rate (FHR) of 150 to 160 beats per minute (bpm). The distance between the heavy vertical lines represents 60 seconds. The lighter vertical lines are 10 seconds apart (Plaus 1110)
 

20

What is this?

Poor beat-to-beat and long-term variability. The fetal heart rate was measured with a scalp electrode. (Plaus)
Plaus, Nagelhout and. Nurse Anesthesia, 4th Edition. W.B. Saunders Company, 022009. .
 

21

are VAA's teratogens? and why or why not?

yes (potentially)
b/c unethical to test in prego

22

LA, VAAs, induction agents, opioids, and MR are all safe for the fetus when?

in clicical circumstances

23

Name14 teratogenic drugs?

ACEi's
ETOH
COCAINE
COUMADIN
androgens
antithyroid
chemo
Diethystibesterol
Lead
Lithium
Mercury
Phenytoin
Streptomycin
Thalidomide
Trimethadione
Valproic acid

24

Pregnancy cat A

no risk identified in well controlled studies

25

Pregnancy Cat B

no  adequate and well controlled studies in PREGNANT WOMEN, however animal studies have revealed no fetus harm

26

Pregnancy Cat C

no  adequate and well controlled studies in PREGNANT WOMEN, however an adverse effect has been shown in animals
or
Adequate and well controlled studies in PREGNANT WOMENhave failed to show a risk to the fetus; but an adverse effect has been shown in an animal

27

Pregnancy Cat D

a risk to the fetus has been demonstrated in adequate, well controlled or observational studies in pregnant women; however the benefits of therapy may outweigh the potential risk

28

Pregnancy cat X

positive evidence of fetal abnormalities has been demonstrated in adequate well controlled studies or observational studies in pregnant woman or animals, the drug is contraindicated in women who are or may became pregnant

29

what teratogenic effect do benzo's cause

cleft anomalies

30

what teratogenic effects does cocain how

vasoconstriction

hypoxia

abruption