...The following guidelines are intended only as a general educational resource for hospitals and clinicians, and are not intended to reflect or establish a standard of care or to replace individual clinician judgment and medical decision making for specific healthcare environments and patient situations. Guideline for the Use of Oxytocin December 2012 INTRODUCTION The benefits of labor induction and augmentation must be weighed against the potential maternal and fetal risks associated with this procedure (1). The induction or augmentation of labor may increase the likelihood of neonatal complications or result in unnecessary cesarean section. These risks may be necessary to assume in complicated pregnancies, in which prolongation of gestation presents further risk to the mother or fetus. Prior to initiating oxytocin, the patient should be counseled about the indications for the use of oxytocin, the methods of administration to be employed, and the risks of failure, cesarean delivery, or fetal compromise. A physician capable of performing cesarean section should be readily available during the induction or augmentation of labor (2). UNIT STRUCTURE Each hospital’s department of obstetrics should develop a standardized, single, universal written protocol for the use of oxytocin for labor induction or augmentation. Standardization of an oxytocin infusion protocol is recommended to reduce medication dosing error and improve patient assessment. Elements of a protocol should include (2):...
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...refills less than 3secs, upper/lower extremities. Bilateral radial pulses strong and equal. Bilateral dorsalis pedis pulses strong and equal. Apical pulse regular rate and rhythm. Integumentary: Warm and dry. Color appropriate for ethnicity. Neurological: Awake, alert and oriented X3 (person, place, time). Speech clear and appropriate. Denies headache. PERRLA-2mm. Gastrointestinal: Last BM 9/12/13. Easily passed, soft, formed. Bowel sounds active X 4. Genitourinary: Self-void with BRP. Denies any pain or bleeding. “Clear and light yellow.” Musculoskeletal: Active ROM in bed. Upper and lower extremities equally strong. Currently on MD ordered bed rest with BRP. Fetal heart tones (baseline, accelerations, decelerations, internal or external monitoring): External Fetal Monior-10 min strip: Baseline:150, 10X10 accelerations. Contraction pattern (frequency, duration, intensity, internal or external monitoring): External Toco monitor: No contractions noted at this time. IV site and...
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...primarily responsible for the development of coronary artery disease. Reducing LDL cholesterol levels retards progression and may even reverse coronary artery disease. Atorvastatin also raises the concentrations of HDL ("good") cholesterol that protects against coronary artery disease and reduces the concentration of triglycerides in the blood. Indications Reduce risk of stroke & heart attack in type 2 diabetes patients without evidence of heart disease but with other risk CV factors Reduce risk of stroke, heart attack and revascularizations procedures in patients without evidence of coronary heart disease (CHD) but with multiple risk factors other than diabetes (eg, smoking, HTN, low HDL-C, family history of early CHD) Patients with CHD to reduce risks of MI, stroke, revascularization procedures, hospitalization for CHF, and angina CONTRAINDICATIONS Active liver disease, which may include unexplained persistent elevations in hepatic transaminase levels Hypersensitivity to any component of this medication Pregnancy Women who are pregnant or may become pregnant. LIPITOR may cause fetal harm when administered to a pregnant woman. Serum cholesterol and triglycerides increase during normal...
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...DEMOGRAPHIC DETAILS Name: Madam SY Age: 29 years old Ethnic Group: Malay Occupation: Primary School Teacher R/N: SB 00442720 Date of admission: 21st of July 2016 Date of discharge : - GENERAL REPRODUCTIVE HISTORY Parity 3 Day 1 post vaginal delivery Last menstrual period (LMP): Not sure of LMP. Hence, ultrasound scan was done at 10 weeks period of gestation during her booking. PRESENTING COMPLAINT(S) Madam SY, a 29 year old Malay Primary School Teacher, Parity 3, day 1 post vaginal delivery was admitted to referred to Hospital Sungai Buloh from Tanjung Karang a day ago which she was 39 weeks+3 days period of gestations with chief complaint of reduce in fetal movement. She was unsure of her last menstrual period. Thus, Ultrasound scan...
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...The mother could be in danger of developing intracerebral hemorrhage, which is the most common cause of death to women related to preeclampsia. For those who do develop this and survive could be permanently disabled (Davidson et al., 2012, p. 463). The possibly of developing disseminated intravascular coagulation (DIC), placental abruption and possibly experiencing a fetal death adds to the stress the mothers and families are facing. After delivery, the threat of most of the complications will go away (HELLP syndrome). When a mom is presenting with symptoms of preeclampsia it is important to keep her safe and get her and her baby ready for a possible soon delivery. The mother might be given corticosteroids to help the baby’s lungs mature. She may also be given medications for her high blood pressure and some form of blood product to keep her vital signs as stable as possible (Barnett & Kendrick 2010). There is no cure for preeclampsia or HELLP syndrome but delivery of the baby will help the mother return to her...
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...Cardiotocograph (CTG) is one form of fetal assessment that simultaneously records fetal heart rate (FHR), fetal movements and uterine contraction patterns (Nielson & Mistry 2000). Spencer (1992) also describes cardiotocography (CTG) as a composite record of fetal heart rate and uterine activity, which act as a diagnostic test of fetal condition whenever acute or chronic complications arise. Monitoring of fetal heart rate became a widespread practice during the 1970s and has remained an accepted technique for assessing fetal well being in labour until relatively recently (Gauge & Henderson 2005). However, MacLennan (1999) and Thacker et al (2001) argue that the widespread use of CTG in the clinical practice has not been supported by substantial evidence. The introduction of the Electronic Fetal Monitoring (EFM) ‘has been accompanied by confusion and difficulties with interpretation’ (Saling 1996) and ‘despite the fact that no clear evidence exists for its efficacy, especially in low-risk women’ (Murphy et al 1990) it has been integrated into maternity care, and uncertainty about its value remains (Neilson & Mistry 2000). Nevertheless, the aim of the introduction of CTG is to reduce the incidence of cerebral palsy and reduction of childhood neurological handicap caused by fetal asphyxia (Impey et al 2003). It also provides continuous indication of fetal response to uterine contractions and intervention (Spencer 1992) Moreover, it provides baseline information for the midwife...
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...Obstetrics and Gynecology Director: Sangeeta Jain MD Coordinator: Brandie Davis Overview: The Galveston Obstetrics and Gynecology clerkship consists of 1 week Labor and Delivery Days, 1 week of Labor and Delivery Nights, I week of Antepartum, 1 week of Post-partum 1 week of Gynecology, and 1 week of Out-patient clinic. However, the structure of the course is often changed in response to student feedback, so please refer to your syllabus for details! The obstetrics portion focuses on labor and delivery, antepartum, and postpartum aspects of patient care. The weeks that you spend in gynecology vary widely and can range from community clinics to gynecologic surgery. This clerkship is highly dependent on how much effort you put into it, as evaluations from residents and faculty make up a significant portion of your grade. The clerkship is generally VERY organized, which you will learn to appreciate as you go through other clerkships. Didactics: There are lectures one day per week, which are mandatory. You will be excused from all clinical duties on your didactic day. Apart from the lectures, you will have quizzes over certain topics in Ob-Gyn (refer to syllabus for schedule). The course textbook (Beckman) is an excellent study guide for these quizzes, but make sure you have the latest edition! Other helpful study resources are the online APGO quizzes, Blue Prints, First Aid and Case Files. You are allowed to wear casual clothes on didactic days. Small Groups: ...
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...Obstetric Anecdotal Assignment G.D. Leilani Fuller N250: Obstetric and Pediatric Nursing Professor Gahan El Camino College May 14, 2013 Obstetric History G.D. In the midst of an empty Labor and Delivery floor on May 9, 2013, there was a lone laboring mother-to-be with the name of G.D. This individual was of Hispanic descent, Costa Rican to be exact, and was a twenty-five year old female with a religious background in Catholicism. G.D. was in room 10 and eagerly anticipated the vaginal birth of her first child, as were her husband’s parents’ for their first grandchild. She had been laboring since her admission at midnight on May 8, 2013. While G.D. is technically a gravida 2, she is only para 1 as she had an elective abortion in 2009. When the room was empty, all that G.D. had to say about this abortion was that the timing was not right in her life for a child then and now she is prepared to be a mother with her new husband at her side. While G.D. originally planned to labor in the most natural manner possible despite being induced, she quickly changed her mind and accepted the epidural. According to Talbot (2012), the labor pain G.D. was experiencing was based on several factors such as cultural, psychological and physiological. She tried to maintain a natural labor with no rush in delivery as is common with Central American countries like Costa Rica, however this fetus called for a more immediate delivery. She had plans to breastfeed once this baby...
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...Pre-Clinical Assignment- OB Labor and Delivery Medication List Drug Name Typical dose amount Route (for adult OB client) Most common side effects Expected patient response of the female PREGNANT client Magnesium Sulfate Pg 808 diarrhea Pitocin Pg 968 Induction of labor: 0.5-2 milliunits/min; increase by 1-2 milliunits/min q 15-60 mins until pattern established, then decrease dose Postpartum Hemorrhage: 10 units infused at 20-40 milliunits/min. IV or IM (postpartum) (maternal) coma, seizures, (fetal) intracranial hemorrhage, (fetal) asphyxia, increase uterine motility, painful contractions Indications: Induction of labor at term. Facilitation of threatened abortion. Postpartum control of bleeding after expulsion of the placenta. Outcomes: Onset of effective contractions. Increase in uterine tone. Reduction of postpartum bleeding. Cytotec Pg 870 Termination of pregnancy: 400 mcg single dose 2 days after mifepristone if abortion has not occurred. Intravaginally: 25 mcg (1/4 of 100 mcg tablet); may repeat q 3-4 hr, if needed PO or intravaginally abdominal pain, diarrhea, miscarriage Outcomes: Prevention of gastric ulcers in patients receiving chronic NSAID therapy. Termination of pregnancy. Cervical ripening and induction of labor. Brethine C5 2.5-10 mcg/min infusion; increase by 5 mcg/min q 10 min until contractions stop (not to exceed 30 mcg/min), decrease infusion rate to lowest effective amount and maintain for 4-8 hr IV nervousness, restlessness, tremor...
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...lumbar vertebrae. The purpose of this placement during labor is to block the T10 to S5 required for pain relief of all body areas involved in labor without suppressing organ function and decreasing LOC (Wong, Perry, Hockenberry, & Deitra Leonard Lowdermilk, 2006). The quantity and type of medication used determines the inhibitory effects on motor function and activity. This is a consented procedure which requires adequate education. Assessment Upon admission to the labor and delivery unit, the nurse should be attentive to any surgical history, allergies, obstetrics history, current medications, renal function, last meal eaten and at what time, contraction pattern, progression status of labor, and current maternal and fetal vital signs. The nurse knows that these are all significant factors in the administration of epidural medication. Surgical history involves the use of general anesthesia and gives the nurse clues as to the patient’s physiological reaction and...
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...Nursing 202: Scheduled Induction Mindy C. Grenade Bucks County Community College Spring, 2014 Ms. Bobbie Table of Contents Abstract 3 Body of paper Introduction 4 History 4 Techniques 6 The Bishop Scoring System 7 Indications 8 Contraindications 10 Risks 12 Nursing 12 Conclusion 15 References Abstract Inducing labor has been occurring since before our time. There are two types of labor inductions, scheduled and elective. For purposes of this paper scheduled inductions will be focused on. A scheduled induction is defined as using artificial methods to start the labor process at a specific time. Inductions are performed for many reasons. In most cases scheduled induction are performed because of medical complications to the baby and/or mother. In healthcare, there has been an increase in incidence regarding scheduled inductions related to convenience for the mother as well as for the doctors. To better understand the complexity of scheduled induction the history has to be addressed. What is the reasoning behind changing the natural birthing process? This paper will explain the methods of induction: pharmacological vs. mechanical, and the indications thereof. Nurse’s play a key role in labor and delivery. They have to be prepared to address and treat their patients’ condition, as well as be knowledgeable on the contraindications of this delicate...
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...weeks with a SAB. 2nd pregnancy ended by C-section at 37 weeks due fetal intolerance. Her 3rd pregnancy ended at 38 weeks with a repeat C-section and her 4th pregnancy ended at 11 weeks with a SAB. Bringing us to this pregnancy number 5. J.B. chose to have a repeat C-section, because her physician recommended it due to a prior C-section. Multiple scars on uterus increase the risk for several serious problems for women and fetus. These risks include: scar rupture, placenta previa, placental abruption, and placenta accrete (Tobah, 2015). A high-risk pregnancy involves at least one of the following; the woman or baby is more likely to become ill or die more than usual. Complications before or after delivery are more likely to occur than usual. High-risk pregnancies must be closely monitored. Some risk factors are present before women become pregnant. These risk factors include certain physical and social characteristics of women, problems that have occurred in previous pregnancies, and certain disorders women already have. In J.B.’s case she had a high-risk pregnancy due to several reasons, she has advanced maternal age > 35, prior miscarriages, obesity, and prior C-section. Advanced maternal age, which is described as age 35 or more for the mother at the time of delivery of her baby. Pathophysiology of a high-risk pregnancy can include; placental abruption, dysfunctional labor, congenital anomalies, fetal malpresentation, hypertension, preeclampsia, diabetes, preterm...
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...Betty’s Unfolding Case Betty is a 20 year old single black female. She has never been pregnant, and she does not have a history of any health conditions. Her family history includes HTN on her father’s side (PGF and F). Her MGM had breast cancer, and is now deceased. She does smoke, but states that she plans to quit when she stops being so “stressed out from school”. She presents in the health clinic complaining of a foul-smelling vaginal discharge. Which questions would you ask to elicit thorough information about her history? 1. Is she sexually active? (If so, at what age did she become sexually active?) 2. Has she had sex recently (with multiple partners or received oral intercourse)? 3. How many sexual partners has she had? 4. How many packs of cigarettes does she smoke a week? How long has she smoked? 5. Does she use street drugs or alcohol? 6. What is her diet like? 7. Does she exercise? 8. What color is the discharge? When did it start? Is she experiencing any vaginal itching or burning? 9. When did her last menstrual period start? What is her usual menstrual cycle like? What is her normal amount of menstrual discharge? 10. Does she do regular breast self-exams? What is the likely cause of the discharge? • Foul-smelling vaginal discharge is a sign of infection, such as bacterial vaginosis, which is caused by an overgrowth of bacteria and produces a white, gray, or milky discharge. It could...
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...Pain Assessment and Management G u i d e l i n e f o r Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP P r a c t i c e , 2 n d E d i t i o n Pain Assessment and Management Guideline for Practice, 2nd Edition This guideline is an outline of the pain assessment and management practices that currently are accepted and documented by experts in the field of neonatal care. In addition, it summarizes and recommends pain assessment and management practices based on the best evidence for the nursing care of infants. This guideline does not preclude the use of manufacturers’ recommendations or other acceptable methods of assessing and managing pain in infants. The use of other practices known to improve the quality of neonatal care is encouraged and not restricted by this document. The National Association of Neonatal Nurses (NANN) developed this guideline in response to members’ requests. Broad in scope, it can provide a foundation for specific nursing protocols, policies, and procedures developed by individual institutions. Authors Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP Reviewers Daniel Batton, MD, American Academy of Pediatrics Sandra Sundquist Beauman, MSN RNC Jim Couto, MA, American Academy of Pediatrics Mary Ann Gibbons, BSN RN Melinda Porter, RNC CNS NNP Ann Stark, MD FAAP, Chair of AAP Committee on Fetus and Newborn Carol Wallman, RNC NNP MS, NANN/AWHONN Liaison to AAP Committee on Fetus and...
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...INSTRUCTOR GUIDE Human Anatomy & Physiology Laboratory Manual MAIN VERSION, Eighth Edition Update CAT VERSION, Ninth Edition Update FETAL PIG VERSION, Ninth Edition Update ELAINE N. MARIEB, R.N., Ph.D Holyoke Community College SUSAN T. BAXLEY, M.A. Troy University, Montgomery Campus NANCY G. KINCAID, Ph.D Troy University, Montgomery Campus PhysioEx™ Exercises authored by Peter Z. Zao, North Idaho College Timothy Stabler, Indiana University Northwest Lori Smith, American River College Greta Peterson, Middlesex Community College Andrew Lokuta, University of Wisconsin—Madison San Francisco • Boston • New York Cape Town • Hong Kong • London • Madrid • Mexico City Montreal • Munich • Paris • Singapore • Sydney • Tokyo • Toronto Editor-in-Chief: Serina Beauparlant Project Editor: Sabrina Larson PhysioEx Project Editor: Erik Fortier Editorial Assistant: Nicole Graziano Managing Editor: Wendy Earl Production Editor: Leslie Austin Composition: Cecelia G. Morales Cover Design: Riezebos Holzbaur Design Group Senior Manufacturing Buyer: Stacey Weinberger Marketing Manager: Gordon Lee Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings, 1301 Sansome St., San Francisco, CA 94111. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means...
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