406 1 Flashcards
most important role of the nurse is
educator
Common Side Effects of vaccinations
Fever – low grade
Local discomfort
Lasting 24 hrs or less
vaccination side effect tx: Administer ____ as per health practitioner directions
Tylenol
vaccination side effect tx: Apply ___ compress to affected site
cool
vaccination side effect tx: activity level?
they should rest
vaccination Contraindication:
anyone who is immunosuppressed or has a fever/infection
If you’re immunosuppressed you should esp avoid the ___ vaccines
varicella (because it’s a live virus)
Vaccines have no link to
No link to autism
No link to getting the disease
Autosomal Dominant
One gene for character
Autosomal Recessive
2-genes for character
Or one as carrier
X-link Dominant
Character on X chromosome
X-link Recessive
Character on X chromosome and displayed & carrier
Rh factor in blood is Autosomal ___
Dominant
Autosomal Dominant is non
gender specific
Autosomal Recessive is also non
gender specific
Sickle Cell Disease and Cystic Fibrosis are Autosomal ___
Recessive
X-Linked Inheritance: Dominant: X chromosome ___ ___
displays character
X-Linked Inheritance: Recessive: Carried on
1 X chromosome
X-Linked Inheritance: Males with affected X __ ___
display character
X-Linked Inheritance: Females are ____
carriers
Genetic Mutation is more common in what ages
female over 40, male over 65
common Chromosomal disorder
Down Syndrome
blood test done for all newborns
PKU
Teratogens are most harmful during
2-6 wks gestation
TORCH
toxoplasmosis, other, (like HIV) rubella, cytomalovirus, herpes
Pregnancy can be detected at this time
2 – 8 weeks gestation
Embryo
2 – 8 weeks gestation
Organ systems form
Heart, lungs, skin, gut, neural tube
2 – 8 weeks gestation
Fetus
8-38 weeks gestation
During this time, you can perform genetic testing
Chronic villi sampling
Amniocentesis
Sonogram
Fetus (8-38 weeks gestation)
___ weeks is premature
21 to 37
____ weeks is full term
38-40
___ weeks is postmature
over 40
Rhogam
prevents antibody formation if Rh negative at 28 wks. Or within 72 hrs post-partum each pregnancy
Genetic screening is best done at ___ weeks
15 to 18 weeks
Coombs Test
Rh factor
Amniocentesis: Extraction of __ __ cells in amniotic fluid
fetal skin cells
Amniocentesis time
Week 15-20
2 complications of Amniocentesis
Preterm birth
Fetal demise
(among others, like bleeding)
the chorion is the ___ side of the placenta
fetal side
Chorionic Villi Sampling time
10 to 12 weeks
Chorionic Villi Sampling complications
same as Amniocentesis
POSSIBLE sign of pregnancy: Positive URINE test for
HCG
PROBABLE sign of pregnancy: Positive Blood test for
HCG
Sonogram, US, and Leopold’s are ___ signs of pregnancy
positive signs
Nagel’s Rule
(Date of LMP) - (3 months) + (7 days)
less than 20 wks. gestation
Abortion
Miscarriage:
spontaneous abortion
Live Births:
full or pre-term
Gravida
pregnant woman
Multigravida
pregnant more than once
Para
births after 20 wks either live or stillborn
Multipara
2 or more births live or stillborn
Nullipara
no births past 20 wks. gestation
A woman is 28 weeks pregnant tells the nurse that she has three children, one set of twin boys who were born at 35 weeks and one daughter born at 40 wks. She had a miscarriage at 12 weeks after the boys were born.
The nurse would document Gravida:
4
A woman is 28 weeks pregnant tells the nurse that she has three children, one set of twin boys who were born at 35 weeks and one daughter born at 40 wks. She had a miscarriage at 12 weeks after the boys were born.
The nurse would document Para:
2
A woman is 28 weeks pregnant tells the nurse that she has three children, one set of twin boys who were born at 35 weeks and one daughter born at 40 wks. She had a miscarriage at 12 weeks after the boys were born.
The nurse would document Term:
1
A woman is 28 weeks pregnant tells the nurse that she has three children, one set of twin boys who were born at 35 weeks and one daughter born at 40 wks. She had a miscarriage at 12 weeks after the boys were born.
The nurse would document Pre-term:
1
A woman is 28 weeks pregnant tells the nurse that she has three children, one set of twin boys who were born at 35 weeks and one daughter born at 40 wks. She had a miscarriage at 12 weeks after the boys were born.
The nurse would document Abortions:
1
A woman is 28 weeks pregnant tells the nurse that she has three children, one set of twin boys who were born at 35 weeks and one daughter born at 40 wks. She had a miscarriage at 12 weeks after the boys were born.
The nurse would document Living:
3
Rhogam- to prevent antibody formation:
Give at 28 wks. Or within 72 hrs post-partum
Weight during the 1st trimester
common to lose 5 or 10 pounds
Appetite increasing during the __ trimester
2nd
pregnancy starts to show at
20th week
besides weight gain, manifestations of 2nd trimester
lordosis
skin color changes
manifestations of 3rd trimester
broader hips
diaphragm displaced (makes it hard to breath)
foot swelling at the END of the day
3 things you definitely want in your diet
folic acid,
calcium,
iron
3 good types of exercise
Walking
Cycling
Swimming
Four Ps of L&D
Position
Presentation
Powers
Psychological
Four Ps of L&D: Position
maternal pelvic measurements and fetal position in the womb (fetal lie)
Four Ps of L&D: Presentation
vertex, breech
Four Ps of L&D: Powers
woman’s abdominal, uterine and vaginal muscles
– descent of fetal presenting part in relation to ischial spine
Station
largest diameter of fetal presenting part passes thru pelvic inlet and into pelvic cavity. Prior to or during labor
Engagement
False Pelvis –
above the brim
True Pelvis –
below the brim
Pelvic Inlet –
brim of the true pelvis
Pelvic Outlet –
ischial spine and symphysis pubis
3-phases
Latent
Active
Complete dilation and effacement of cervix
3-phases: Latent – slow cervical dilation for
several days
3-phases: water breaks.
latent phase
3-phases: contractions have become regular
Active phase (and at the very end of the latent phase I guess)
3-phases: Transition happens in
Active phase
Transition
8-10 cm dilation,
intense, frequent contractions,
effacement 95%
3-phases: latent phase, the cervix is __ cm
0 to 3 cm
3-phases: latent phase time period
Nullipara: 8-10 hrs
Multipara: 6-7 hrs
3-phases: Active phase, before transition the cervix is __ cm
4 to 7 cm
3-phases: Woman may lose focus & control
transition phase of the active phase
Placental Delivery: check both sides, the Amnion/maternal side will be
rough
Placental Delivery: check both sides, the Chorion/fetal side will be
shiny
4 stages of L&D: 1
onset of labor to full cervical dilation
4 stages of L&D: 2
cervical dilation to delivery of newborn
4 stages of L&D: 3
newborn delivery to placental delivery
4 stages of L&D: 4
first 2-hrs post partum
L&D time varies depending on primpara or multipara. Average time is
12 hours
After the delivery, the placenta comes out __ min later
5
Contractions: onset of one to end of contraction (how long lasting)
Duration
Contractions: period between one contraction and the next contractions (How far apart)
timing
Post Partum: Assess Lochia for RAS
Rubra
Serosa
Alba
Post Partum: Watch for ___ Uterus
Boggy
Post Partum: assess the f___
fundus
Instruct family to time contractions and come to hosp in ___ ___ phase.
later latent
Instruct woman in labor push with contractions and
rest in between
Assess placenta for
intactness
Apgar Score: highest score
10
Apgar Score: 2 points for HR
above 100
Apgar Score: 2 points for cry that is
lusty
Apgar Score: 2 points for legs that
recoil
Apgar Score: 2 points for a reflex
the baby startles
Apgar Score: 2 points for color
pink
when is Apgar Score done
1 to 5 min after birth
Care of the Newborn: Feeding – breast milk or
glucose water
Meconium stool
black & tarry in 24 hrs
Apgar Score: bluish extremities
1 (0 is pallor or cyanotic)
Newborn Feeding: How much to feed?
2-3 oz Q 3-4 hrs
Eyes get prophylactic tx of
Erythromycin
Newborn Care: given to promote clotting
Vit K
Physiologic Jaundice: rapid breakdown of
fetal RBCs in neonatal period
Physiologic Jaundice: Liver cannot
metabolize quickly in some newborns
Physiologic Jaundice: GI tract
does not uptake and excrete bilirubin from the bloodstream fast enough
Physiologic Jaundice: there will be an increase in
unconjugated bilirubin (Normal range 4-6mg/dL)
Neonatal Jaundice: bilirubin levels elevated to
greater than 10-15mg/dL
Kernicterus
a bilirubin induced brain problem
Phototherapy
Fluorescent lighting to encourage the breakdown of bilirubin
Phototherapy: protect the
eyes
Phototherapy: prevent
dehydration
toddlers are struggling for
autonomy
Magical thinking limits their ability to understand things
pre schoolers
Cognitively, presechoolers are in the ___ stage
pre operational
fear of the physical nature of illness surface at this time
school age
school age children define illness by
concrete symptoms
adolescents can describe their pain but
may be reluctant to admit it
incision made at the perineum before delivery
Episiotomy
Hemorrhoids tx:
diet & exercise to promote normal BM, stool softeners
Colostrum appearance
thick, yellow
Transitional milk quality:
thinner
Mature breast milk is present at
2 wks
nutrition: newborn needs __ kcal/kg
120 kcal/kg
Lactation Diet: ___ additional calories/day
500
Lactation Diet: avoid ___ and __ foods
spicy and gasy
Deal with breast engorgement by
pumping or breasting feeding
approx how long should you breast feed
15 to 20 min
postpartum exercise: day 1
Walking
postpartum exercise: day 2
Stretching
postpartum exercise: day 3
Kegel
postpartum exercise: sit ups
starting at 1 to 2 weeks (with provider approval)
smoking is harmful because it
vasoconstricts
the biggest cause of birth defects
congenital defects
LBW
less than 6 pounds
Average birth weight
7.5
15 y/o and abortion
doesn’t need parental consent, but would need parental consent for non-reproductive things
most birth defects are autosomal
recessive
down syndrome is not considered a
genetically INHERITED disorder (rather it’s a genetic mutation)
Which can be done first, chorionic villi or amniocentesis
chorionic
Which is more risky, chorionic villi or amniocentesis
chorionic
embryo becomes fetus when
all organ systems are present (just need to keep developing)
The heart first beats at
3 weeks
The earliest you can do leopolds is
6 weeks
How far a long is a woman by the time she comes to the doc
4 to 6 weeks
How does maternal exercise affect fetal HR
increases it
Rhogam is a short term IG given if the mother is
Rh negative
Rhogam is given because
we don’t want the mother making antibodies that attack the Rh positive baby (almost everyone is Rh positive)
Stress test is to evaluate
how the baby responds (does it move; can the HR stabilize)
Stress test could be
nipple stimulation which causes contraction
Swelling is only normal in the
feet (not other body parts)
average woman should gain __ pounds during pregnancy
28 or 30
Torch is a __ __ series
blood test
Eating eggs during pregnancy
should be soft cooked, not well done
Exercise that prevents tearing
kegel
during contractions, the abd feels
board like
after birth, check the umbilical cord for
2 arteries and 1 vein
If the infant doesn’t breast feed in the delivery room
might need to bottle feed in the nursery to keep the blood sugar up
length of a newborn
21 inches (50 cm)
newborn head circumference
13.5 in (34 cm)
newborn chest circumference
13 in (33 cm) just under head
anterior fontanels close around __ to 18 months
15
posterior fontanels close around __ to __ months
2 to 3
the first stool is
dark and sticky
The umbilical cord must be kept
dry
umbilical cord falls off around
10 to 14 days
Umbilical cord should be kept
outside the diaper
Before it falls off the umbilical cord becomes
black
until the cord falls off, do not do this to the baby:
dunk in water
cord drainage
shouldn’t be draining much at all
during breast feeding, you can use __ but should be in moderation
caffiene
The nursery is only for __ babies
healthy
parents can help “__” for the child
translate
baby assessment: doesn’t really matter what position you
take the BP in
