Cumulative Review 2 Flashcards
3 Medications for:
Post-Partum Hemorrhage
OMM
Oxytocin (if contractions ↑ 90 seconds = tachysystole, d/c )
Methylergonovine - Ø give if HTN, SFX diarrhea
Misprostol - uterus contraction/ulcer prevention
IF for ulcers, do a pregnancy test first
FX: Uterine Atony
2 R/F
Non-firm (loss of tone)
Mag Sulate or retained placenta
S/S Mastitis
EDUCATION: hands, drying nipples, infant position, when to break suction.
Each feeding should... 2 What packs? Pump OK? Analgesic/Antibiotics ok? Type of bra?
Unilateral, pain, warm, tender boobs Wash before feeding Air dry Proper for latch Empty the breast, frequent on affected side Ice/Warm PUMP OK Analgesics/Antibiotics OK Well-fitted
FX: Post-Partum Depression
Length = Blues
Tearful insomnia
Feeling let down
Ø intervene
+10 days
S/S Post-Partum:
Depression
Psychosis
2 Nurse Roles:
Persistent sadness/mood swings Ø resolving w/ intervention
Attempting to harm self/infant
Monitor mom/baby and administer anti-depressants/anti-psychotics
APGAR
Scoring:
0 - 10, 2 points each A2, acrocyanosis = 1, pale blue = 0 P2, HR ↓100 = 1, Ø HR = 0 G2, reflex grimace = 1, Ø grimace = 0 A2, some flex = 1, Ø flex = 0 R2, weak cry = 1, Ø cry = 0
Normal Length and Wt Range for a Baby (kg and lbs)
Length: 45 - 65 cm
Wt: 2.5 - 4kg (5.5 - 8.8 lbs)
Infant Reflex end times
Sucking/Rooting/Moro
Babinski
4 months
1 year
4 S/S Baby Hypoglycemia Cry Type: Skin Color R/R Muscle Tone TX:
High pitched cry
↓ 40 RR
Cyanosis
Irritatble, twitching, flaccid muscle tone
↑ Breast feeding frequency
Milk Storage Timings: On table Fridge Freezer Deep Freezer
8 hours
8 days
6 months
12 months
How to Thaw milk:
EDUCATION:
Re-usable milk?
Thaw in fridge for 24 hours
DO NOT refreeze
DO NOT save used portions.
Mix w/: Baby Formula
Fridge life
Tap water
48 hours
Barlow Test
Audible click w/ aduction/shorter flexion of leg
Ortonali Test
Reduces hip back into socket by manipulation of the joint
Baby Weights
When to double? Triple? Quadruple?
6 months
1 year
2 1/2 years
Average Diapers/day for a newborn
6 - 8
Circumcision: TX of crust Use of petroleum jelly Clean with...? Diaper change q?
Leave crust, mucus fulm
Apply to prevent sticking to diaper
Warm trickling water
q4hrs
Circumcision:
When to bathe
What NOT to use to clean
NOT until healed
Moistened towelettes/alcohol
Cord Care: When is clamp removed Keep diaper...? Time to fall off How to bathe Watch for, REPORT?
Before d/c Dry and folded below 10 - 14 days Sponge bath ONLY Infection
Babies: 20 second apnea
Totaaally OK
Pre-term Baby S/S Weight Lanugo Creases Grasp Muscles
Low, ↓ fat ALOT of lanugo NO creases WEAK grasp Hypotonic muscles
Pre-term Baby S/S
Affect
Sucking/Feeding
↑ R/F
Lethargic
Trouble with…
Necrotizing Entero Colitis
FX: Hyperbilirubemia in Children
Persistence length
TX
Jaundice in sclera/mucus membranes.
Birth - Day 7, 8+ = jaundice
Phototherapy
Children Phototherapy Nurse Roles: Eyes Clothing Genitals of male Lotion use Removal/Turning timings
Cover eyes Undress baby COVER genitals NO lotion/ointments as they can cause burns from absorbing heat Remove q4hrs, turn q2hrs
Children Phototherapy:
Monitor…?
Mucular Papular Rash?
Complicaiton?
2 TX:
Temperature q4hrs
OK
Dehydration
↑ Feeds to promote excretion of bilirubin + supplement
S/S Post-Term Babies: Appearance: Skin texture: Hair/Nails: Feet: Fat: Vernix/Lanugo:
Glycemia?
Leathery Dry/Cracked Long Many creases Loss of fat Sparse vernix/lanugo
HYPOglycemia
Fibroids FX on contractions
Poor contractions
Cephalo Hematoma vs. Caput Seccededum
Cephalo - DOES NOT cross the suture line
Resolves on own, but ↑ r/o jaundice
Caput - CROSSES suture line
Often due to vaccum assisted birth
Resolves on own, but ↑ r/o jaundice
Mild - Sever Fever in Children vs. Vaccinations
Mild, low fever, congestion = OK!
Severe = Uhh… NOPE!
S/S Small for Gestational Age: Skin Abdomen Umbilical Cord Sutures
Loose, dry
Sunken
Thin, yellowish
Wide
BRAT Diet:
Diet Contraindicated in…?
Bananas, Rice, Applesauce, Toast
diarrhea
Assault vs. Battery
Threatening vs. Doing it
Beneficence Autonomy Justice Fidelity Veracity
Do good Pt knows self Fair Loyalty to patient Honesty/truth
Repression Suppression Sublimation Displacement Reaction Formation
Unconscious forgetting Voluntary avoiding Convert into appropriate behavior Emotions towards one to another Feeling against, doing anyways
Disassociation
Splitting
Denial
Rape
ALL GOOD or ALL BAD
Refusing to accept truth
Levels of Anxiety Mild Moderate Severe Panic
perform better, figety
↑ HR/RR ↓ perception
↓↓ perception, tachycardia, impending doom
HEART ATTACK
Stages of a Therapeutic Relationship
Orientation
Working
Termination
Frequency, duration, confidentiality
▲behavior, dealing w/ problems
Summarizing goals, reviewing memories, expressing feelings
Transference vs. Countertransference
Patient associates nurse w/ someone they know VS. nurse doing it
Behavioral Therapy Systematic Desensitization Aversion Therapy Operant Condition Biofeedback Guided Imagery Medication
↑ exposure until not afraid
punishment
rewards
controlling body responses (breathing, like for OB pts)
S/S Electro Convulsive Therapy
Pre-procedure Diet?
How often/number of TX:
3 Nurse Roles:
Short term memory loss
NPO
3x/week for 6 - 12 TX
Ensure gag reflex works
Position on side
TX with Succinylcholine (Anectine) which is a muscle relaxant afterwards
Psychotic Disorders:
Positive vs. Negative S/S (5As)
Affect Alogia Anergia Anhedonia Avolition
Positive = presence of extra things (behavior, speech, hallucinations) Negative = Missing something
Affect (blunt) Alogia (speech poverty) Anergia (Ø energy) Anhedonia (Ø pleasure) Avolition (Ø motivation)
Personality Disorders: Antisocial Borderline Hsitrionic Narcissistic Schizotypical Schizoid
Asshole (no leading) All good/bad (watch for self-injury) flirtatious attention seeker Grandiose views of self Magical thinking Ø interest, emotional detachement
S/S Delirium vs. Dementia
Quick onset, temporary
Electrolyte imabalances r/in confusion, ↑ ICP r/in restlesness, ↓ LoC
Progresive, long term
Substance Abuse:
Peak hours
Delirium timing
Medication for:
24 - 48 hours
2 - 3 days
Benzodiazepines
FX: Disulfiram (Antebuse)
2 Nurse Roles:
Causes people to get sick if they drink
Ask when was last drink
First a benzo… then a mood stabilizer
Substance Abuse medication FXs: Lorzepam (Ativan) Chlorodiazaproxide/Librium Carbamazapine (Tregratol)/Clonidine Propranolol Disulfiram
Anti-seizure Anti-anxiety Anti-seizure Decrease cravings Aversion Therapy
3 Key S/S Heroin
TX:
Pinpoint pupils
Dental Caries
Yawning/Insomnia
Methadone
6 Key S/S Cocaine
Dilated pupils
Hypotension
Depression, fatigue, and apathy
FX: Benzos Abuse
Monitor for (2)
Antidote:
Withdraw ↑ R/F?
Sedation
Respiratory depression/↓ LoC
Flumenazil (Romazicon)
↑ Seizure activity
FX: Cocaine/Amphetamine Abuse
Rush of euphoria which r/in HTN and tachycardia (could r/in DEATH)
FX: Opiods
Antidote
3 S/S Withdrawal
Euphoria
Naloxone
Pupil Dilation, tremors, and N/V
S/S Anorexia: Menstruation Hair Temperature Weight Heart Rate
Nurse Role:
Amenorrhea Hair loss Low temperature Loss of 30% in 6 months Bradycardia
Reward for CALORIES consumed
S/S Bulemia:
Weight
Parotid Gland
Teeth
Nurse Role:
Normal/Slightly increased
Swollen
Messed up due to stomach acid
Don’t leave alone w/ meals
For Anxiety: Benzodiazepines (ex: Diazepam) Length of TX: 3 TX: 4 Examples: How to end:
Short term (long = addictions)
DiaZEPAM, LoraZEPAM, ChlorDIAZEpoxide, ClonaZEPAM
Taper off
Alcohol withdrawal, seizures, insomnia
For Anxiety: Buspar (Busparone)
Length of TX:
R/T Sedation?
What fruit to avoid:
Long term (not addicting)
Does NOT sedate
Grapefruit
FX: Benzodiazepines
3 SFX:
ANTIDOTE:
Sedation
Dizziness, drowsiness, ↓ RR
Flumenazil
4 SFX: Tricyclic Antidepressants
REPORT SFX:
Orthostatic Hypotension
Anticholinergic
Sedation
↑ r/o seizures
URINARY RETENTION
A.C.E. Inhibitor (-pril) mneumonic
Angioedema
Coughing
Excessive Potassium
Anticholinergic mneumonic
Can’t see
Can’t pee
Can’t spit
Can’t SHIT
TX: SSRIs
4 Examples (SEFF)
Time to take FX
Monitor for…?
Depression Sertaline Escitalopram Fluoxetine Fluvoxamine
Serotonine Syndrome