Pharmakokinetics and pharmacodynamic

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introduction absorption distribution metabolism excretion pharmacodynamic-mechanism of action factor

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Pharmacodynamics is the study of the biochemical and physiological effects of drugs and their mechanisms of action. Pharmacodynamics is often referred to as “what the drug does to the body”. In order to exert their effects, drugs usually interact in a structurally specific way with a protein receptor or act on physiological processes within the body. This activates a secondary messenger system that produces a physiological effect. Drugs do not create new action but they can only modify (alter) the functions of cells or tissues in body. The drug–receptor complex initiates alterations in biochemical and/or molecular activity of a cell by a process called signal transduction.

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DEFINITION OR MEANING OF MENSTRUAL (REPRODUCTIVE) CYCLE:- Menstruation (Greek word, men-month) is monthly uterine bleeding out flowing through vagina into vulva for 4-5 days every 28 days (24-35 days)during reproductive life of a woman from menarche to menopause. The Menstrual cycle of 28 days starts on day of onset of menstruation and ends at day 28 on start of next mens. The cycle consists of a series of changes taking place concurrently in the ovaries and uterine lining, stimulated by changes in blood concentration of hormones.

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introduction Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. The estrogen levels in non lactating women begin to increase by 2 weeks after birth, and higher by postpartum day 17. If trauma to the urethra and bladder occur during the birth process, the bladder wall becomes edematous, often with small areas of hemorrhage. Birth-induced trauma increased bladder capacity and the effects of anesthesia combine to cause a decrease in the urge to void.

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INTRODUCTION DEFINITION TYPES CAUSES MANAGEMENT-Management of 3rd stage bleeding Actual management MANAGEMENT OF 3RD STAGE BLEEDING Steps of management 1. Placental site bleeding- To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front. To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary. Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously. To catheterize the bladder. To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV) 2. Management of traumatic bleed The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites. STEPS OF MANUAL REMOVAL OF PLACENTA The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized. One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand. Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.

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Taking-In Phase It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food). The woman reacts passively, mostly dependent on others to meet her needs. She is quite talkative during this phase about every detail of her labor and delivery experience Taking-Hold Phase (Taking Responsibility as a Mother) It starts the 3rd day postpartum She progresses from the passive individual to the one who is in command of the situation. This phase lasts about 10 days. Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children. Letting-go Phase This generally occurs when the mother returns home. In this phase there are two separations that the mother must accomplish. One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation. Letting-go Phase This generally occurs when the mother returns home. In this phase there are two separations that the mother must accomplish. One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation. Physical Assessment is necessary to identify individual needs or potential problems Explain to pt purposes of the examination. Obtain her consent. Record your findings and report results to the mother. Ensure privacy and environment where the mother can lie on her back with her head supported. Ensure bladder is empty & lay patient supine with legs flexed. The midwives hands should be clean and warm

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Definition- The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal types Craniotomy Eviceration Decapitation Cleidotomy CRANIOTOMY Definition It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus DECAPITATION Definition It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam CLEIDOTOMY Definition The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles Indications Dead fetus with shoulder dystocia Procedure The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina

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AMNIOINFUSION-- definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios. INDICATIONS Fetal heart rate abnormalities APGAR scores for those with low scores Asphyxia during time of birth Decreasing the rates of cesarean birth related with FHR problem PROCEDURE The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC. The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period. It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus. An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead. Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative Assisting Physician with Amnioinfusion Explain the procedure to the patient. Assist in dorsal recumbent position. Assist with draping and exposing vaginal area. Connect IUPC tubing to IV fluid, flush Connect the catheter to the monitor cable Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.

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Obsterics and Gynaecology- introduction-Preventive obstetrics is the concept of prevention or early detection of particular health deviations through routine periodic examinations and screening . The concept of preventive obstetrics concerns with the concepts of the health & wellbeing of the mother her baby during the antenatal,intranatal & postnatal period. The goal of the preventive obstetrics is the delivery of a healthy infant by a healthy mother at the end of a healthy pregnancy. Pregnancy & child birth normal physiological process that change from conception to delivery. Objectives To promote , protect and maintain the health of the mother during pregnancy. To detect “high risk” cases and give them special attention To foresee complications and prevent them. To remove anxiety and dread associated with delivery

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OBSTETRICS & GYNAECOLOGICAL NURSING- MINOR AILMENT DURING PREGNANCY- INTRODUCTION-Many women experience some minor disorder during pregnancy. These disorder should be treated adequately as they may escalate and become life-threatening. DEFINITION-“The minor complaints of pregnant women that occur due to physiological alterations of hormones and other causative factors which can be managed without medical interventions.” - Every system of body may affected by pregnancy.

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OBSTETRICS & GYNAECOLOGICAL NURSING GENETIC COUNSELLING DURING PREGNANC INTRODUCTION- COUNSELLING-Counselling is consultation, mutual interchange of opinions, deliberating together.A process in which the counsellor assist the counselee . Provides concrete, accurate information about inherited disorders. Provides information about prognosis and follow up. Discuss ways in which disease can be prevented.

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