Hesi: Maternity/Ob Study Guide

HESI: MATERNITY/OB STUDY GUIDE Medication Guide: Antenatal Glucocorticoid Therapy with Betamethasone, Dexamethasone Action Stimulates fetal lung maturation by promoting release of enzymes that induce production or release of lung surfactant NOTE: The Food and Drug Administration has not approved these medications for this use (i.e., this is an unlabeled use for obstetrics). Indication To prevent or reduce the severity of respiratory distress syndrome in preterm infants between 24 and 34 weeks of gestation Dosage and Route Betamethasone: 12 mg IM 2 doses 24 hours apart Dexamethasone: 6 mg IM 4 doses 12 hours apart Adverse Reactions Possible maternal infection, pulmonary edema (if given with -adrenergic medications), may worsen maternal condition (diabetes, hypertension) Nursing Considerations Give deep intramuscular injection. Teach signs of pulmonary edema. Assess blood glucose levels and lung sounds. Do not give if woman has infection. Use in women with PPROM not universally recommended. IM, Intramuscularly; PPROM, preterm premature rupture of membranes. Apgar Score Ear Maturation Test A, The nurse folds the ears and notes how quickly they return to position. B, Ears in the full-term infant are well formed and have instant recoil. C, In the preterm infant, ears show less curving of the pinna and recoil slowly or not at all. Changes in Circulation After Birth Patent Ductus Arteriosus: Give Indomethacin (Indocin) to promote closure of the ductus by inhibiting prostaglandin synthesis Premature Infant Location of the heart within the thorax in the infant and the older child, showing landmarks and areas of auscultation Signs & symptoms of NEC/HERNIA/INTUSSUSCEPTION: • Delayed gastric emptying will result in increased amounts of gastric residuals as one of the first indications of feeding intolerance and malabsorption of NEC (Nectrotizing enterocolitits) • Temperature instability is likely to present in early NEC, while the threat of sepsis is a late symtematic manifestation of NEC • Scaphoid addomen is most characteristic of diaphragmatic hernia • Currant-jelly stools is a manifestation typically related to intussusception. PREECLAMPSIA: • Diuretics decrease blood flow to the placenta by decreasing blood volume. In the case of preeclampsia, using diuretics is dangerous because the disease already caused a volume deficit. The patient has severe edema but diuretics disrupt normal electrolyte balance and stress kidneys that are already compromised by preeclampsia. The only time they are used is if the preeclamptic client also has heart failure.