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ATI comprehensive

Terms in this set (310)

Do not delegate

What you can EAT E-evaluate A-assess T-teach

Addison's & Cushings

Addison's = down down down up down
Cushings= up up up down up
hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia, hypo/hyperglycemia

Better peripheral perfusion?

EleVate Veins, DAngle Arteries

Appearance (all pink, pink and blue, blue (pale)
Pulse (>100, <100, absent)
Grimace (cough, grimace, no response)
Activity (flexed, flaccid, limp)
Respirations (strong cry, weak cry, absent)

Airborne precautions

My chicken hez tb (measles, chickenpox (varicella) Herpes zoster/shingles TB

Airborne precautions protective equip

private room, neg pressure with 6-12 air exchanges/hr mask N95 for TB

Droplet precautions

spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis,
influenza,
diptheria,
epiglottitis,
rubella,
mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room or cohort mask!)

Contact precaution

MRS WEE
Multidrug resistant organism
Rresiratory infection
Skin infection
Wound infection
Enteric infection (C diff)
Eye infection (conjunctivitis)

VCHIPS
Varicella zoster
Cutaneous diptheria
Herpes simplez
Impetigo
Peduculosis
Scabies

Air or Pulmonary Embolism

S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt to LEFT side and LOWER the head of bed.)

Woman in labor (un-reassuring FHR)

(late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2, stop pitocin, Increase IV fluids!

Tube feeding with decreased LOC

Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent aspiration)

After lumbar puncture and oil based myelogram

pt is flat SUPINE (prevent headache and leaking of CSF)

Pt with heat stroke

flat with legs elevated

during Continuous Bladder Irrigation (CBI)

catheter is taped to the thigh. leg must be kept straight.

After Myringotomy

position on the side of AFFECTED ear, allows drainage.

After Cateract surgery

pt sleep on UNAFFECTED side with a night shield for 1-4 weeks

after Thyroidectomy

low or semi-fowler's position, support head, neck and shoulders.

Infant with Spina Bifida

Prone so that sac does not rupture

Buck's Traction (skin)

elevate foot of bed for counter traction

After total hip replacement

don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with pillows.

Knee to chest or Trendelenburg
oxygen 8 to 10 L

position on back or in infant seat to prevent trauma to the suture line. while feeding hold in upright position.

To prevent dumping syndrome

(post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent meals.

AKA (above knee amputation)

elevate for first 24 hours on pillow. position prone daily to maintain hip extension.

BKA (below knee amputation)

foot of bed elevated for first 24 hours. position prone to provide hip extension.

detached retina

area of detachment should be in the dependent position

administration of enema

pt should be left side lying (Sim's) with knee flexed.

After supratentorial surgery

(incision behind hairline on forhead) elevate HOB 30-40 degrees

After infratentorial surgery

(incision at the nape of neck) position pt flat and lateral on either side.

During internal radiation

on bed rest while implant in place

Autonomic Dysreflexia/Hyperreflexia

S/S pounding headache, profuse sweating, nasal congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB) FIRST!

bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated (modified Trendelenberg)

elevate HOB 30 degrees to decrease ICP

Peritoneal Dialysis (when outflow is inadequate)

turn pt from side to side BEFORE checking for kinks in tubing

Lumbar Puncture

After the procedure, the pt should be supine for 4-12 hours as prescribed.

Myesthenia Gravis

worsens with exercise and improves with rest

Myesthenia Gravis

a positive reaction to Tensilon---will improve symptoms

Cholinergic Crisis

Caused by excessive medication ---stop giving Tensilon...will make it worse.

Liver biopsy (prior)

must have lab results for prothrombin time

Myxedema/ hypothyroidism

slowed physical and mental function, sensitivity to cold, dry skin and hair.

Grave's Disease/ hyperthyroidism

accelerated physical and mental function. Sensitivity to heat. Fine/soft hair.

increased temp, pulse and HTN

Post-Thyroidectomy

semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside

Hypo-parathyroid

CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give high calcium, low phosphorus diet

Hyper-parathyroid

fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a low calcium high phosphorous diet

increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine specific gravity >1.030

bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific gravity <1.010. semi fowler's

Diabetes insipidus (decreased ADH)

excessive urine output and thirst, dehydration, weakness, administer Pitressin

SIADH (increased ADH)

change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer Declomycin, diuretics

muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans, potatoes, carrots, celery)

MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac contractility, ECG changes, reflexes

nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic diuretics (Mannitol) and fluids

increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give hypotonic solution.

CATS Convulsions, Arrythmias, Tetany, spasms and stridor

muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency!

Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig toxicity)

depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations. EMERGENCY

Hypo Na, Hyper K, Hypoglycemia, dark pigmentation, decreased resistance to stress fx, alopecia, weight loss. GI stress.

Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump

Addesonian crisis

N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP

Pheochromocytoma

hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor)

Tetrology of Fallot

DROP (Defect, septal, Right ventricular hypertrophy, Overriding aortas, Pulmonary stenosis)

Autonomic Dysreflexia

(potentially life threatening emergency!) HOB elevate 90 degrees, loosen constrictive clothing, assess for full bladder or bowel impaction, (trigger) administer antihypertensives (may cause stroke, MI, seizure)

FHR patterns for OB

Think VEAL CHOP!
V-variable decels; C- cord compression caused
E-early decels; H- head compression caused
A-accels; O-okay, no problem
L- late decels; P- placental insufficiency, can't fill

what to check with pregnancy

Never check the monitor or machine as a first action. Always assess the patient first. Ex.. listen to fetal heart tones with stethoscope.

Position of the baby by fetal heart sounds

Posterior --heard at sides
Anterior---midline by unbilicus and side
Breech- high up in the fundus near umbilicus
Vertex- by the symphysis pubis.

Ventilatory alarms

HOLD
High alarm--Obstruction due to secretions, kink, pt cough etc
Low alarm--Disconnection, leak, etc

ICP- Increased BP, decreased pulse, decreased resp
Shock--Decreased BP, increased pulse, increased resp

Right sided heart failure caused by left ventricular failure (edema, jugular vein distention)

Heroin withdrawal neonate

irritable, poor sucking

pulse area on an infant

test at 12 months of age

Before starting IV antibiotics

obtain cultures!

pt with leukemia may have

epistaxis due to low platelets

when a pt comes in and is in active labor

first action of nurse is to listen to fetal heart tones/rate

use systematic desensitization

NCLEX answer tips

choose assessment first! (assess, collect, auscultate, monitor, palpate) only choose intervention in an emergency or stress situation. If the answer has an absolute, discard it. Give priority to the answers that deal with the patient's body, not machines, or equipment.

are always secondary to another disease or trauma

In an emergency

patients with a greater chance to live are treated first

Cardinal sign of ARDS

Edema is located

in the interstitial space, not the cardiovascular space (outside of the circulatory system)

the best indicator of dehydration?

weight---and skin turgor

hot for chronic pain; cold for accute pain (sprain etc)

When pt is in distress....medication administration

is rarely a good choice

fever and chills are usually present. For the elderly confusion is often present.

before IV antibiotics?

check allergies (esp. penicillin) make sure cultures and sensitivity has been done before first dose.

with COPD baroreceptors that detect CO2 level are destroyed, therefore, O2 must be low because high O2 concentration takes away the pt's stimulation to breathe.

Prednisone toxicity

Cushings (buffalo hump, moon face, high blood sugar, HTN)

Neutropenic pts

no fresh fruits or flowers

Chest tubes are placed

in the pleural space

Preload/Afterload

Preload affects the amount of blood going into Right ventricle. Afterload is the systemic resistance after leaving the heart.

Great Saphenous vein in leg is taken and turned inside out (because of valves inside) . Used for bypass surgery of the heart.

Unstable Angina

not relieved by nitro

can turn into V fib.

centigrade to Fahrenheit conversion

F= C+40 multiply 5/9 and subtract 40
C=F+40 multiply 9/5 and subtract 40

In the lungs...potent vasodialator, aldosterone attracts sodium.

Iron toxicity reversal

normal in CHF. Not normal in MI

After endoscopy

check gag reflex

subclavian line

pain with diverticulitis

appendicitis pain

Trousseau and Chvostek's signs observed in

never give K+ in

in DM II (there is enough insulin to prevent fat breakdown)

Glaucoma patients lose

peripheral vision.

Autonomic dysreflexia

patients with spinal cord injuries are at risk for developing autonomic dyreflexia (T-7 or above)

Spinal shock occurs

immediately after injury

multiple sclerosis

myelin sheath destruction. disruptions in nerve impulse conduction

Myasthenia gravis

decrease in receptor sites for acetylcholine. weakness observed in muscles, eyes mastication and pharyngeal musles. watch for aspiration.

Gullian -Barre syndrome

ascending paralysis. watch for respiratory problems.

transient ischemic attack....mini stroke, no dead tissue.

cerebriovascular accident. brain tissue dies.

Hodgkin's disease

cancer of the lymph. very curable in early stages

burns rule of Nines

head and neck 9%
each upper ext 9%
each lower ext 9%
front trunk 18%
back trunk 18%
genitalia 1%

doubles by 6 months
triples by 1 year

if HR is <100 (children)

early sign of cystic fibrosis

meconium in ileus at birth

Meningitis--check for

Kernig's/ brudinski's signs

encapsulated above kidneys...causes flank pain

hemophilia is x linked

passed from mother to son

when phenylaline increases

brain problems occur

buck's traction

knee immobility

russell traction

femur or lower leg

dunlap traction

skeletal or skin

bryant's traction

children <3 y <35 lbs with femur fx

perform amniocentesis

before 20 weeks to check for cardiac and pulmonary abnormalities

Rh mothers receive Rhogam

to protect next baby

anterior fontanelle closes by...posterior by..

18 months, 6-8 weeks

caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days

pathological jaundice occurs:
physiological jaundice occurs:

before 24 hours (lasts 7 days)
after 24 hours

placenta previa s/s
placental abrution s/s

there is no pain, but there is bleeding
there is pain, but no bleeding (board like abd)

bethamethasone (celestone)

surfactant. premature babies

taking care of pt and environmental therapy

cognitive therapy

five interventions for psych patients

safety
setting limits
establish trusting relationship
meds
least restrictive methods/environment

take about 3 weeks to work

patients with hallucinations
patients with delusions

redirect them
distract them

Thorazine and Haldol

60% of all dementias, chronic, progressive degenerative cognitive disorder.

draw up regular and NHP?

Air into NHP, air into Regular. Draw regular, then NHP

S=sensory M=motor B=both
Oh (Olfactory I) Some
Oh (Optic II ) Say
Oh (Oculomotor III) Marry
To (trochlear IV) Money
Touch (trigeminal V) But
And (Abducens VI ) My
Feel (facial VII) Brother
A (auditory VIII) Says
Girl's (glossopharyngeal IX) Big
Vagina (vagus X) Bras
And (accessory XI) Matter
Hymen (Hypoglossal XII) More

S (Skin flushed)
A (agitation)
L (low grade fever )
T (thirst)

2-3 months: turns head side to side
4-5 months: grasps, switch and roll
6-7 months: sit at 6 and waves bye bye
8-9 months: stands straight at 8
10-11 months: belly to butt
12-13 months: 12 and up, drink from a cup

Ends in a vowel, comes from the bowel

B= blood and body fluids (hep c is the same)

HR RR Muscle tone, reflexes, skin color.
Each 0-2 points. 8-10 ok, 0-3 resuscitate

Glasgow coma scale

eyes, verbal, motor
Max- 15 pts, below 8= coma

Addison's disease:
Cushing's syndrome:

"add" hormone
have extra "cushion" of hormone

Dumping syndrome

increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis. Wait 1 hr after meals to drink

Disseminated herpes zoster
localized herpes zoster

Disseminated herpes=airborne precautions
Localized herpes= contact precautions. A nurse with localized may take care of patients as long as pts are not immunosuppressed and the lesions must be covered!

causes peripheral neuritis

Weighted NI (naso intestinal tubes)

Must float from stomach to intestine. Don't tape right away after placement. May leave coiled next to pt on HOB. Position pt on RIGHT to facilitate movement through pyloris

Cushings ulcers

r/t brain injury

Cushing's triad

r/t ICP (HTN, bradycardia, irritability, sleep, widening pulse pressure)

HOT (hyperthermia)

COLD (hypothermia)

Non Dairy calcium

Rhubarb sardines collard greens

Koplick's spots

prodomal stage of measles. Red spots with blue center, in the mouth--think kopLICK in the mouth

INH can cause peripheral neuritis

Take vitamin B6 to prevent. Hepatotoxic

pancreatitis pts

put them in fetal position, NPO, gut rest, Prepare anticubital site for PICC, they are probably going to get TPN/Lipids

Pain with palplation of gall bladder (seen with cholecystitis)

ecchymosis in umbilical area, seen with pancreatitis

Flank--greyish blue. (turn around to see your flanks) Seen with pancreatitis

McBurney's point

Pain in RLQ with appendicitis

appendicitis watch for peritonitis

Tests for PKU. Baby should have eaten protein first

Test for pernicious anemia

Peritoneal dialysis

Its ok to have abd cramps, blood tinged outflow and leaking around site if the cath (tenkoff) was placed in the last 1-2 weeks. Cloudy outflow is never ok

Hyper reflexes
absent reflexes

upper motor neuron issue (your reflexes are over the top)
Lower motor neuron issue

Latex allergies

assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes and peaches

used in myesthenia gravis to confirm diagnosis

(amyotrophic lateral sclerosis) degeneration of motor neurons in both upper and lower motor neuron systems

Transesophageal fistula

esophagus doesn't fully develop. This is a surgical emergency (3 signs in newborn: choking, coughing, cyanosis)

is given SQ not IM

codes for pt care

Red- unstable, ie.. occluded airway, actively bleeding...see first
Yellow--stable, can wait up to an hour for treatment
Green--stable can wait even longer to be seen---walking wounded
Black--unstable, probably will not make it, need comfort care
DOA--dead on arrival

Contraindication for Hep B vaccine

anaphylactic reaction to baker's yeast

what to ask before flu shot

allergy to eggs

what to ask before MMR

allergy to eggs or neomycin

when on nitroprusside monitor:

cyanide. normal value should be 1.

William's position

semi Fowler's with knees flexed to reduce low back pain

External rotation, shortening adduction

blood tinged sputum r/t inflammations. Increase ESR, respiratory alkalosis. Hypocalcemia, increased serum lipids.

complications of mechanical ventilation

pneumothorax, ulcers

Paget's disease

tinnitus, bone pain, elnargement of bone, thick bones

with allopurinol

no vitamin C or warfarin!

bowel prep so bladder can be visualized

cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread

milk, veggies, rhubarb, salmon

orange tag in psych

is emergent psych

thyroid med side effects

insomnia. body metabolism increases

Tidal volume is

COPD patients and O2

2LNC or less. They are chronic CO2 retainers expect sats to be 90% or less

Kidney glucose threshold

Stranger anxiety is greatest at what age?

7-9 months..separation anxiety peaks in toddlerhood

when drawing an ABG

put in heparinized tube. Ice immediately, be sure there are no bubbles and label if pt was on O2

Munchausen syndrome vs munchausen by proxy

Munchausen will self inflict injury or illness to fabricate symptoms of physical or mental illness to receive medical care or hospitalization. by proxy mother or other care taker fabricates illness in child

multiple sclerosis

motor s/s limb weakness, paralysis, slow speech. sensory s/s numbness, tingling, tinnitis cerebral s/s nystagmus, atazia, dysphagia, dysarthia

50% genetic autosomal dominanat disorder.. s/s uncontrolled muscle movements of face, limbs and body. no cure

pt with pyelo. neutrophils kick in to fight infections

pancreatic enzymes are taken

with each meal!

infants IM site

Vastus lateralis

Toddler 18 months+ IM site

IM site for children

deltoid and gluteus maximus

position pt on side or over bed table. no more than 1000 cc removed at a time. Listen for bilateral breath sounds, V.S, check leakage, sterile dressing

NPO 8-12 hours. empty bladder, pulses, tell pt may feel heat, palpitations or desire to cough with injection of dye. Post: V.S.--keep leg straight. bedrest for 6-8 hr

Cerebral angio prep

well hydrated, lie flat, site shaved, pulses marked. Post--keep flat for 12-14 hr. check site, pulses, force fluids.

lumbar puncture

fetal position. post-neuro assess q15-30 until stable. flat 2-3 hour. encourage fluids, oral analgesics for headache.

no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. may be asked to hyperventilate 3-4 min and watch a bright flashing light. watch for seizures after the procedure.

NPO for 4-6 hours. allergy hx phenothiazines, cns depressants and stimulants withheld 48 hours prior. Table moved to various positions during test. Post--neuro assessment q2-4 hours, water soluble HOB UP. oil soluble HOB down. oralanalgesics for HA. No po fluids. assess for distended bladder. Inspect site

administer Vitamin K, NPO morning of exam 6 hrs. Give sedative. Teach pt to expect to be asked to hold breath for 5-10 sec. supide position, lateral with upper arms elevated. Post--position on RIGHT side. frequent VS. report severe ab pain STAT. no heavy lifting 1 wk

semi fowler's or upright on edge of bed. Empty bladder. post VS--report elevated temp. watch for hypovolemia

CO2 used to enhance visual. general anesthesia. foley. post--ambulate to decrease CO2 buildup

low grade afternoon fever

wheezing on expiration

kawasaki syndrome

strawberry tongue

pernicious anemia

red beefy tongue

protruding tongue

rice watery stool

stepladder like fever--with chills

rose spots on the abdomen

pseudo membrane formation

koplick's spots

sle (systemic lupus)

pyloric stenosis

olive like mass

bronze like skin pigmentation

moon face, buffalo hump

hyperthyroidism/ grave's disease

myasthenia gravis

descending musle weakness

gullian-barre syndrome

ascending muscle weakness

crushing, stabbing chest pain relieved by nitro

crushing stabbing chest pain unrelieved by nitro

cystic fibrosis

polyuria, polydipsia,polyphagia

kussmal's breathing (deep rapid)

painless hematuria

reduced size and force of urine

retinal detachment

floaters and flashes of light. curtain vision

painful vision loss. tunnel vision. halo

retino blastoma

cat's eye reflex

hypertension, bradypnea,, bradycarday (cushing's triad)

Hypotension, tachypnea, tachycardia

intraosseous infusion

often used in peds when venous access can't be obtained. hand drilled through tibia where cryatalloids, colloids, blood products and meds are administered into the marrow. one med that CANNOT be administered IO is isoproterenol, a beta agonist.

sickle cell crisis

two interventions to prioritize: fluids and pain relief.

glomuloneprhitis

the most important assessment is blood pressure

children 5 and up

should have an explanation of what will happen a week before surgery

Kawasaki disease

(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms.

ventriculoperitoneal shunt

watch for abdominal distention. watch for s/s of ICP such as high pitch cry, irritability and bulging fontanels. In a toddler watch for loss of appetite and headache. After shunt is placed bed position is FLAT so fluid doesn't reduce too rapidly. If presenting s/s of ICP then raise the HOB 15-30 degrees

3-4 cups of milk a day for a child?

NO too much milk can reduce the intake of other nutrients especially iron. Watch for ANEMIA

MMR and varicella immunizaions

after 15 months!

undescended testicles! risk factor for testicular cancer later in life. Teach self exam for boys around age 12--most cases occur in adolescence

HIGH protein LOW glucose

Head injury or skull fx

no nasotracheal suctioning

feed upright to avoid otitis media!

positioning for pneumonia

lay on affected side, this will splint and reduce pain. However, if you are trying to reduce congestion, the sick lung goes up! (like when you have a stuffy nose and you lay with that side up, it clears!)

for neutropenic pts

no fresh flowers, fresh fruits or veggies and no milk

antiplatelet drug hypersensitivity

bowel obstruction

more important to maintain fluid balance than to establish a normal bowel pattern (they cant take in oral fluids)

Basophils reliease histamine

during an allergic response

means it was caused by treatment, procedure or medication

watch for visual changes--indicates toxicity

post spelectomy

pneumovax 23 is administered to prevent pneumococcal sepsis

Alkalosis/ Acidosis and K+

ALKalosis=al K= low sis. Acidosis (K+ high)

No phenylalanine

to a kid with PKU. No meat, dairy or aspartame

never give potassium

to a pt who has low urine output!

nephrotic syndrome

characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay

the first sign of ARDS

increased respirations! followed by dyspnea and tachypnea

normal PCWC (pulmonary capillary wedge pressure)

is 8-13 readings 18-20 are considered high

first sign of PE

sudden chest pain followed by dyspnea and tachypnea

increases ventricular irritability ----could convert a rhythm to v-fib following cardioversion

Cold stress and the newborn

biggest concern resp. distress

Parathyroid relies on

vitamin D to work

Glucagon increases the effects of?

Sucking stab wound

cover wound and tape on 3 sides to allow air to escape. If you cover and occlude it--it could turn into a closed pneumo or tension pneumo!

chest tube pulled out?

occlusive dressing

acetone and keytones increase! once treated expect postassium to drop! have K+ ready

diagnosed with rectal biopsy. S/S infant-failure to pass meconium and later the classic ribbon-like/foul smelling stools

Intussusception

Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools. enema---resolution=bowel movements

laboring mom's water breaks?

first thing--worry about prolapsed cord!

Toddlers need to express

causes sever hypotension!

first pain relief, second cough and deep breathe

CF chief concern?

Respiratory problems

a nurse makes a mistake?

take it to him/her first then take up the chain

nitrazine paper

turns blue with alkaline amniotic fluid. turns pink with other fluids

up stairs with crutches?

crutches first followed by good leg

dumping syndrome?

use low fowler's to avoid. limit fluids

clozapine, Clozaril

antipsychotic
anticholinergic

weight gain, hypotension, hyperglycemia, agranulocytosis

-hypovolemia
- elevated urine specific gravity

flumazenil, Romazicon

umbilical cord compression

reposition side to side or knee-chest

discontinue pictocin

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