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Anticoagulant therapy and monitoring
Maternity normals
Coumadin (sodium warfarin) PT: 10–12 sec. (control). - FHR:120–160 BPM. Serum electrolytes
Antidote: The antidote for Coumadin is vitamin K. - Contractions: Normal frequency 2-5min, duration Heparin/Lovenox/Dalteparin PTT: 30–45 sec. (control). Antidote: The antidote for Heparin is protamine sulfate. - Amniotic fluid: 500–1200 ml (nitrozine urine-litmus Therapeutic level: 1.5–2 times the control. paper green/amniotic fluid-litmus paper blue). Therapeutic drug levels
Apgar scoring: A = appearance, P = pulses, G =
grimace, A = activity, R = reflexes (Done at 1 and 5 minutes with a score of 0 for absent, 1 for decreased, Hematology values
- AVA: The umbilical cord has two arteries and one vein. (Arteries car y deoxygenated blood. The vein Ectrode placement
carries oxygenated blood.)
Abnormalities in the laboring obstetric client—
RA On the right arm, avoiding thick muscle. Decelerations are abnormal findings on the fetal LA In the same location where RA was placed, but monitoring strip. Decelerations are classified as Chemistry values
Early decelerations—Begin prior to the peak of the
RLOn the right leg, lateral calf muscle. LL In the same location where RL was placed, but compression. There is no need for intervention if the variability is within normal range (that is, there is a V1 In the fourth intercostal space (between ribs 4 rapid return to the baseline fetal heart rate) and Serum creatinine: 0.6–1 .35 mg/dL and 5) just to the right of the sternum (breastbone). the fetal heart rate is within normal range. V2 In the fourth intercostal space (between ribs 4 Variable decelerations—Are noted as V-shaped
on the monitoring strip. Variable decelerations can occur anytime during monitoring of the fetus. They are caused by cord compression. The intervention V4 In the fifth intercostal space (between ribs 5 and is to change the mother’s position; if pitocin is infusing, stop the infusion; apply oxygen; and V5 Horizontally even with V4, in the left anterior increase the rate of IV fluids. Contact the doctor if the Late decelerations—Occur after the peak of the
V6 Horizontally even with V4 and V5 in the contraction and mirror the contraction in length and intensity. These are caused by uteroplacental insuf iency. The intervention is to change the mother’s position; if pitocin is infusing, stop the infusion; apply oxygen;, and increase the rate of IV fluids. Contact the STOP—This is the treatment for maternal
hypotension after an epidural anesthesia: 4. If hypovolemia is present, push IV fluids. is the HCO3 (respiratory opposite). In metabolic Types of drugs
Valsartan (Diovan), candesartan (Altacand), CULTURAL AND RELIGIOUS CONSIDERATIONS
disorders, the components of the lab values are the losartan (Cozaar), telmisartan (Micardis) *The generic name is listed first with the IN HEALTH CARE
same. An example of this is metabolic acidosis. . Cox 2 enzyme blocker drugs: Celecoxib
In metabolic acidosis, the pH is below normal and Arab American cultural attributes—Females
the CO2 is decreased, as is the HCO3. This is true in . Angiotensin-converting agents:
. Histamine 2 antagonist drugs:
avoid eye contact with males; touch is accepted if Benazepril (Lotensin), lisinopril (Zestril), done by same-sex healthcare providers; most captopril (Capoten), enalapril (Vasotec), 2 up, and HCO3 up = respiratory acidosis decisions are made by males; Muslims (Sunni) , fosinopril (Monopril), moexipril (Univas), refuse organ donation; most Arabs do not eat pH down, CO2 down, and HCO3 down = metabolic . Proton pump inhibitors: Esomeprazole
pork; they avoid icy drinks when sick or hot/cold . Beta adrenergic blockers: Acebutolol
drinks together; colostrum is considered harmful to Asian American cultural attributes—They
. Anticoagulant drugs: Heparin sodium
avoid direct eye contact; feet are considered dirty Addison’s versus Cushing’s
Diseases of the endocrine system involving either overproduction or inadequate production of . Anti-infective drugs: Gentamicin
decisions; they usual y refuse organ donation; cortisol: Treatment for the client with Addison’s: increase Drug schedules
they generaly do not prefer cold drinks, believe in sodium intake; medications include cortisone kanamycin (Kantrex), neomycin (Mycifradin), Schedule I—Research use only (example LSD)
preparations.Treatment for the client with Cushing’s: Schedule I —Requires a writ en prescription (example
Native American cultural attributes—They
restrict sodium; observe for signs of infection. sustain eye contact; blood and organ donation is Treatment for spider bites/bleeding—RICE (rest,
. Benzodiazepine drugs: Clonazepam
Schedule I I—Requires a new prescription after
general y refused; they might refuse circumcision; ice, compression, and elevate extremity) six months or five refil s (example codeine) may prefer care from the tribal shaman rather Treatment for sickle cel crises—HHOP (heat,
Schedule IV—Requires a new prescription after six
Mexican American cultural at ributes—They
. Phenothiazine drugs: Chlopromazine
Schedule V—Dispensed as any other prescription or
might avoid direct eye contact with authorities; they Five Ps of fractures and compartment syndrome—
without prescription if state law alows (example might refuse organ donation; most are very These are symptoms of fractures and compartment (Compazine), trifluoperazine (Stelazine), emotional during bereavement; believe in the Medication classifications commonly used in a
medical/surgical setting
Religions beliefs
Hip fractures—Hip fractures commonly
. Glucocorticoid drugs: Prednisolone
Antacids—Reduce hydrochloric acid in the stomach
hemor hage, whereas femur fractures are at risk (Delta-Cortef, Prednisol, Prednisolone), Antianemics—Increase red blood cel production
Jehovah’s Witness—No blood products should
Anticholenergics—Decrease oral secretions
Profile of gal bladder disease—Fair, fat, forty, five
Hindu—No beef or items containing gelatin
Anticoagulants—Prevent clot formation
pregnancies, flatulent (actual y gal bladder Jewish—Special dietary restrictions, use of
disease can occur in all ages and both sexes). Anticonvulsants—Used for management of
cortisone (Cortone), hydrocortisone (Cortef, Antidiarrheals—Decrease gastric motility and reduce
Therapeutic diets
Renal diet—High calorie, high carbohydrate, low
Review common legal terms: tort, negligence, Antihistamines—Block the release of histamine
protein, low potassium, low sodium, and fluid Antihypertensives—Lower blood pressure and
triamcinolone (Amcort, Aristocort, Atolone, Legalities—The RN and the physician institute Gout diet—Low purine; omit poultry (“cold chicken”)
Anti-infectives—Used for the treatment of infections
seclusion protection. The MD or the hospice medication for acute episodes: Colchicine; . Antivirals: Acyclovir (Zovirax), ritonavir
Bronchodilators—Dilate large air passages in
(Norvir), saquinavir (Invirase, Fortovase), indinavir (Crixivan), abacavir (Ziagen), Heart healthy diet—Low fat (less than 30% of
Diuretics—Decrease water/sodium from the Loop of
cidofovir (Vistide), ganciclovir (Cytovene, Acid/base balance
Laxatives—Promote the passage of stool
. Cholesterol-lowering drugs: Atorvastatin
ROME (respiratory opposite/metabolic equal) is a Miotics—Constrict the pupils
(Lipitor), fluvastatin (Lescol), lovastatin quick way of remembering that in respiratory Mydriatics—Dilate the pupils
acid/base disorders the pH is opposite to the other simvastatin (Zocar), rosuvastatin (Crestor) Narcotics/analgesics—Relieve moderate to severe
components. For example, in respiratory acidosis, . Angiotensin receptor blocker drugs:


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