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Nur 404 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

toddler age

A

1-3

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2
Q

how many deciduous teeth for toddler?

A

20

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3
Q

how to measure toddler during exam

A

supine for height, weight, head circumference

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4
Q

toddler weight gain (same, slow, or fast?)

A

slows

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5
Q

toddler posture

A

lordosis until abdomen tone increases at 2 yo

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6
Q

toddler hr

A

90-110

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7
Q

toddler respiration

A

20-40; belly breathing still

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8
Q

toddler BP

A

99/64 if you can take it

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9
Q

toddler brain growth has reached what proportion of adult size

A

90% of adult size

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10
Q

why can toddlers tolerate 3 meals a day?

A

increased stomach acid

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11
Q

how to know child is ready to toilet train

A

when shows interest and stays dry for 2 hours; DO NOT RUSH

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12
Q

toddler well child visit schedule

A

15, 18, 24, and 30 months

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13
Q

immunization schedule for toddler

A

15 & 18 months

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14
Q

screenings @ well child (7)

A

*vision
*health
*ASD
*height
*weight
*BMI
*observe speech, interactions, nutrition, home life

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15
Q

toddler lab screenings

A

*lead
*H and H at 15 and 30 months
*TB, UA, Dyslipidemia

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16
Q

Anticipatory guidance for parents of toddlers (5)

A

*safety
*poison / unintentional injury
*G&D
*play
*tantrums/behavior

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17
Q

age of separation anxiety

A

6 months - preschool

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18
Q

chain of infection

A
  1. reservoir
  2. portal of exit
  3. mode of transmission
  4. portal of entry
  5. susceptible host
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19
Q

incubation

A

time period between exposure to infectious agent and symptoms manifesting

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20
Q

prodromal period

A

early signs and nonspecific symptoms of infection before diagnostic symptoms present

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21
Q

5 stages of infection

A
  1. incubation
  2. prodromal
  3. illness
  4. decline
  5. convalescence
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22
Q

incubation period for hepatitis A

A

25 days

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23
Q

when is hepatitis A communicable

A

about 2 weeks before symptoms appear

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24
Q

3 common reservoirs of hepatitis A

A
  1. fecal contaminated water
  2. shellfish
  3. daycare (changing tables)
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25
Q

how to acquire immunity from HAV (2)

A
  1. natural (one past infection)
  2. artificial (HAV vaccine)
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26
Q

when HAV recommended (3)

A

*12-23 months
*daycare employees
*international travelers

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27
Q

where in body pinworms live at first

A

cecum

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28
Q

where pinworms lay eggs, causing itching

A

anal and perineal area

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29
Q

treatment for pinworms

A

one dose of anthelmintic

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30
Q

examples of anthelmintic meds (3)

A

*mebendazole
*albendazole
*pyantel

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31
Q

acute otitis media (AOM) age most likely to occur

A

6-36 months

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32
Q

default goal of labor & delivery

A

vaginal delivery

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33
Q

factors that increase incidence of otitis media (5)

A

*more likely with males
*Alaskan and Native Americans
*children w/ cleft palate
*formula fed infant
*smokers in household

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34
Q

separates false pelvis from true pelvis

A

brim/inlet

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35
Q

labor typically starts when

A

37 - 42 weeks

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36
Q

guidelines for inducement

A

41 weeks

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37
Q

the 5 Ps (factors affecting vaginal birth)

A

passageway
passenger
power
position
psyche

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38
Q

passageway

A

path for baby to be delivered

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39
Q

passenger

A

baby and placenta

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40
Q

psyche

A

if mother believes she can do it

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41
Q

true pelvis

A

where baby actually goes through to be delivered

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42
Q

parts of uterus

A

*upper uterine segment
*physiologic retraction ring
*lower uterine segment

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43
Q

upper uterine segment

A

where baby is during pregnancy

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44
Q

physiologic retraction ring

A

separates upper and lower uterine segment

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45
Q

lower uterine segment

A

baby moves into during quickening

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46
Q

introitus

A

where baby actually comes out

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47
Q

cervix def

A

narrow opening to uterus

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48
Q

fontanelle shape in front

A

diamond

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49
Q

fontanelle shape in the back

A

triangle

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50
Q

ideal baby position to be delivered

A

vertex (head first, chin tucked)

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51
Q

molding

A

overlap/sliding of bones to change shape of baby’s head during vaginal delivery

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52
Q

fetal attitude

A

position of baby’s head

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53
Q

ideal fetal lie

A

longitudinal lie

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54
Q

breech birth

A

baby’s bum comes out first

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55
Q

frank breech

A

baby is tucked, but coming out breech

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56
Q

fetal position (3 letters)

A
  1. right or left of mother’s pelvis
  2. specific presenting part of fetus
  3. anterior, posterior, or transverse
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57
Q

fetal station

A
  1. assessed on vaginal exam
  2. how many cm above or below presenting part is to ischial spines
  3. 0 is at ischial spines, +1 cm is 1 cm below
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58
Q

3 parts of vaginal exam

A
  1. dilation
  2. effacement
  3. fetal station
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59
Q

engagement

A

fetal station is 0 (at ischial spines

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60
Q

the power related to uterine contractions

A

frequency
duration

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61
Q

the power related to cervical changes

A
  1. effacement
  2. dilation
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62
Q

effacement measured

A

0-100% (a subjective measurement)

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63
Q

dilation

A

widening of cervical canal

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64
Q

opening of the cervix

A

the os (there’s an external os and an internal os)

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65
Q

dilation is measured how

A

0-10 cm

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66
Q

frequency of contractions

A

start of one contraction to start of the next contraction

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67
Q

duration measured

A

start to end of one contraction

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68
Q

contraction strength

A

felt by feeling fundus

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69
Q

cardinal movements of labor

A

*descent
*flexion
*internal rotation
*extension
*external rotation
*expulsion

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70
Q

descent

A

head touches vaginal floor

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71
Q

flexion

A

head is tucked

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72
Q

internal rotation

A

rotation to get through pelvis

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73
Q

extension

A

head goes under pubic bone and extends out of introitus

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74
Q

external rotation

A

provider can tell where shoulders are

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75
Q

expulsion of torso

A

providers pull top shoulder out first by pulling down, then pull up to get posterior shoulder out

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76
Q

false contractions

A

irregular and stay irregular

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77
Q

hallmark of labor

A

active cervical change

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78
Q

number of stages of labor

A

3

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79
Q

first stage of labor

A
  1. latent phase (0-3 cm dilated)
  2. active phase (4-7 cm dilated; admission to unit; )
  3. transition phase (8-10 cm dilated); increased bloody show
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80
Q

second stage of labor

A

period from full dilation and cervical effacement to crowning and birth of infant

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81
Q

third stage of labor

A

*placental separation
*placental expulsion

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82
Q

cervix less than 10 cm

A

do not push until 10 cm; can tear and bleed profusely

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83
Q

placenta out in how long and why

A

within 30 minutes to get it out before cervix begins to close

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84
Q

done once placenta is delivered

A

start Pitocin

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85
Q

effects of labor on cardiac output

A

increases by 40-50%

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86
Q

effects of labor on BP

A

increase about 15 pts.

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87
Q

epidurals effect on BP

A

possible hypotension

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88
Q

effects of labor on hematopoietic system

A

increase in WBC

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89
Q

effects of labor on respiratory system

A

increased rate like exercise

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90
Q

effects of labor on temp

A

slight increase

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91
Q

effects of labor on fluid

A

npo because of risk of aspiration if c section; lots of fluid loss

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92
Q

effects of labor urinary system

A

won’t know if have to urinate if epidural, may need cath; should go to bathroom every 2 hrs. if no epidural

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93
Q

effects of labor on musculoskeletal

A

relaxin

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94
Q

effects of labor on GI

A

constipation

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95
Q

effects of labor neurological and sensory systems

A

pain

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96
Q

psychological effects of labor

A

pain
fatigue
fear

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97
Q

fetal response to labor cardiovascular

A

reduced blood flow; if cannot compensate well, something is wrong

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98
Q

fetal response to labor integumentary

A

bruising or petticciae possible

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99
Q

fetal response to labor respiratory

A

*baby’s chest is squeezed during birth, clearing the lungs and signaling to baby that will have to breath on own
*c-section does not get the squeeze

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100
Q

measuring progress of labor

A

VS
pain
fetal HR
contraction freq
cervical dilation
rupture of membranes

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101
Q

if water breaks in hospital

A

immediately check fetal HR because umbilical cord can come out through vagina (cord prolapse) causing fetal HR to drop

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102
Q

Danger signs of labor for pregnant person (3)

A

*systolic BP>140, or diastolic BP >90
*tachycardia (may just be pain)
*inadequate or prolonged contraction (can cause fetal stress)

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103
Q

Fetal danger signs (4)

A

*HR should be 110-160
*meconium staining (should not be in utero)
*hyperactivity (sudden abnormal movement) may be sign of hypoxia
*low O2 sat (not usually checked)

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104
Q

leopold maneuver

A

check position of baby

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105
Q

pregnant person labs

A

CBC
urine

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106
Q

assessment of uterine contractions

A

length
intensity
frequency

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107
Q

fetal assessment in labor

A

*fetal hr
*monitor for variability
*periodic changes occur in response to contractions and fetal movement

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108
Q

external monitoring tools

A

*tocodynamometer (freq and duration of contractions)
*ultrasound (hr)

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109
Q

must happen before internal monitoring

A

water broken

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110
Q

tools for internal monitoring

A

*spiral electrode
*intruterine pressure cath (IUPC) (measures pressure of contraction)

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111
Q

length of time to get hr baseline

A

10 minutes

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112
Q

variability can be _____ (4)

A

*absent
*minimal (+/- 5bps)
*moderate (+/- 6-25 bps; desirable)
*marked (>25 beat change)

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113
Q

variability can be caused by

A

sleep (minimal)
narcotics (minimal)
hypoxia

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114
Q

cause of variable deceleration

A

cord compression

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115
Q

early decelerations

A

occur with contractions from compression of the head

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116
Q

late deceleration

A

after each contraction; placental deficiency; very bad

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117
Q

fetal deceleration and acceleration mnemonic

A
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118
Q

Fetal Heart tracing
Category 1

A

ALL criteria must be met
*baseline hr: 110-160
*moderate baseline FHR variability
*no late or variable decelerations
*early decelerations may or may not be present
*accelerations may be present or absent

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119
Q

Fetal Heart tracing
Category II

A

does not meet criteria for either category I or Category III

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120
Q

Fetal Heart tracing
Category III

A

Predict abnormal fetal acid-base status and requires immediate intervention
*absent baseline FHR variability and any of the following: recurrent decelerations, recent variable decelerations, bradycardia
*sinusoidal pattern

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121
Q

Nurse interventions for decelerations (7)

A

*Change person’s position
*Stop Oxytocin
*O2
*IV fluids
*monitor
*notify MD
*prepare for C-section if FHR does not return to normal

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122
Q

nursing assessment during 1st and 2nd stage of labor (7)

A

temp
pulse
respirations
BP
voiding
FHR
contractions
perineum

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123
Q

nursing during first stage of labor: provide ____ (5)

A

*ambulation / position change
*support
*encourage to void every 2 hrs.
*pain management
*amniotomy (breaking the water)

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124
Q

Second stage of labor tasks (7)

A

*prepare for birth
*positioning for birth
*pushing
*perineal cleaning
*episiotomy
*birth
*cutting and clamping cord

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125
Q

3rd and 4th stages of labor nurse/ provider tasks

A

*give oxytocin
*placental delivery
*perineal repair
*assessment
*immediate postpartum

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126
Q

if ear drainage

A

culture

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127
Q

% of AOM that resolve w/out antibiotics

A

80

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128
Q

S/S of AOM

A

*Upper Respiratory Infection
*pain
*fever
*nasal discharge
*tugging at ear
*infants may have difficulty feeding

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129
Q

otoscope technique for <2 y.o.

A

down and back

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130
Q

otoscope technique for child over 2

A

up and back

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131
Q

seen in otoscopic exam of AOM

A

*hyperemia
*bulging tympanic membrane

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132
Q

if conductive hearing loss

A

evaluate for ear infection or OME (otitis media with effusion

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133
Q

typanic membrane color if healthy

A

blue or yellow

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134
Q

Management of AOM/OME

A

-steroids
-allergy tx
-surgery if hearing loss of 25-40 dB
-tubal myringotomy for hearing loss of 12 dB

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135
Q

hearing loss that indicates likely surgery

A

25-40 dB

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136
Q

hearing loss that indicates likely tubal myringotomy

A

12 dB

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137
Q

tympanostomy tube in what situation

A

fluid in ear >6 months

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138
Q

at risk from AOM/OME

A

language development

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139
Q

adjunct tx to enhance TT effectiveness

A

adenoidectomy

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140
Q

can you use hydrocortisone while patch testing?

A

no. can skew results

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141
Q

to do if allergens causing contact dermatitis found (4)

A

-remove the allergen from child’s environment
-use topical creams/ointments to reduce itch
-oatmeal or baking soda baths
-document sensitivities in chart

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142
Q

possible allergic responses

A

-allergic rhinitis
-eczema
-asthma

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143
Q

allergic rhinitis and asthma are ______

A

often diagnosed together (especially older children)

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144
Q

eczema or atopic dermatitis may indicate __________

A

food allergies

145
Q

therapeutic management of atopic dermatitis

A

-decrease exposure to allergen
-trim nails (reduce damage from scratching)
-topical meds
-rarely steroids

146
Q

germs that cause impetigo

A
  • beta-hemolytic streptococcus, Group A
  • Staphylococcus aureus (including MRSA)
147
Q

how impetigo looks

A

scabby, honey -crusted infection on face and hands

148
Q

impetigo incubation

A

7-10 days

149
Q

communicability of impetigo

A

from outbreak of lesions until healed

150
Q

impetigo mode of transmission

A

direct contact with lesions

151
Q

most common age of infection

A

2-5 yeas old

152
Q

medication tx of impetigo

A

-mupirocin for 7-10 days

or

-retapamulin BID for 5 days for kids >9 months old

or

-oral antibiotics for severe cases

153
Q

home ed for impetigo

A

-not sharing towels
-bathing children alone
-not sharing tub water

154
Q

coxsackievirus (A6 & A16) (HFMD, or hand, foot, and mouth disease) presentation

A

-rash with erythematous papules on hands, feet, and mouth w/ sore throat
-can be confused with herpangina virus, which causes oral lesions and fever

155
Q

pediculosis

A

lice

156
Q

pediculosis ed

A

teach children not to share combs, barrettes, etc

157
Q

pediculosis tx

A

1) permethrin wash
2) comb nits
3) wash and vacuum room

158
Q

Lyme disease causative agent

A

Borrelia burgdorferi

159
Q

Lyme disease incubation period

A

3-5 days

160
Q

mode of transmission

A

deer tick

161
Q

artificial and passive immunity

A

artificial: none
passive: immune globulin

162
Q

deer tick bite presentation

A

large target like erythematous papule

163
Q

3 stages of Lyme disease

A

1) early localized Lyme disease: bullseye rash around bite, flu like sx within one month
2) early disseminated Lyme disease: malaise, pain, flu sx days to weeks after infection
3) late disseminated Lyme disease: long term joint inflammation, other serious complications

164
Q

implications of untreated Lyme disease

A

skin d/o
joint d/o
nervous system d/o
heart d/o

165
Q

dx of Lyme disease

A

1) Enzyme Linked Immunosorbent Assay (ELSA)
2) confirmatory Western Blot

166
Q

Lyme disease tx

A

< 8: amoxycillin
> 8: doxycycline

167
Q

Lyme disease prevention (6)

A

-wear protective clothing in the woods
-tuck bottom of pants in socks
-wear light colored clothes
-inspect skin daily
-remove ticks with tweezers at head
-report inflammation to HCP

168
Q

congenital heart defects classified as (3)

A

-embryonic
-structural
-physiological

169
Q

leading cause of Acquired Heart disease

A

Kawasaki disease aka mucocutaneous lymph node syndrome

170
Q

how Kawasaki disease causes heart disease

A

1) fever and inflammation of blood vessels/vasculitis
2) vasculitis affects all body’s blood vessels
3) vasculitis can cause coronary aneurysm and thrombus formation, leading to MI

171
Q

risk factors for Kawasaki disease

A

-no person to person transmission
-more males
-occurs more often in spring and fall
-Asian and Pacific Islander descent
-not diagnosed with labs or imaging

172
Q

Kawasaki disease criteria

A

1) acute (week 1) and subacute phases (weeks 2 & 3)
2) fever of 100.4 for 5 or more days
3) 4 or more from below list:
-changes to feet & hands, redness, edema, peeling
-polymorphous exanthem (diffuse maculopapular rash of trunk & extremities
-bilateral conjunctivitis w/out exudates
-changes to lips, mouth, erythema, strawberry tongue, cracked lips
4) cervical lymphedema >1.5 cm
5) lab changes are possible: thrombocytosis, leukocytosis, elevated ESR, CRP, liver enzymes, mild anemia

173
Q

rule out to diagnose Kawasaki (5)

A

-viral illness
-scarlet fever
-JRA (juvenile rheumatoid arthritis)
-staphylococcus scaled skin syndrome
-Rocky Mountain spotted fever

174
Q

Kawasaki disease phases

A

1) acute (first 10 days): fever, irritability, discomfort
2) subacute (after about 10 days): peeling hands and feet (watch platelet count)

175
Q

Tx of Kawasaki disease

A

-mostly supportive: IV fluids, antipyretic, IV immunoglobin, aspirin therapy
-cardiology referral

176
Q

sickle cell disease microbiolgy

A

amino acid valine present in hemoglobin instead of glutamic acid, causing elongated, sickle shaped RBCs

177
Q

sickle cell implications

A

-low blood pH, increased blood viscosity like in hypoxia or dehydration
-when the RBC sickle, they can get stuck causing a sickle cell crisis

178
Q

sickle cell does not present until 6 months because ____

A

fetal hemoglobin contains alpha chain instead of beta (where sickle cells are)

179
Q

why no contact sports with sickle cell

A

spleen is enlarged

180
Q

medical specialty that treats sickle cell anemia

A

hematology

181
Q

often first sign of respiratory distress

A

tachypnea

182
Q

respiratory check (3)

A

-retractions
-restlessness
-cyanosis

183
Q

longterm hypoxia signs

A

-pigeon chest
-clubbing

184
Q

causes of epiglotitis (4)

A

-influenza
-pneumococci
-streptococci
-RSV

185
Q

vaccine that has decreased incidence of epiglotitis

A

HIB vaccine

186
Q

croup physiology

A

inflammation of larynx, trachea, and major bronchi

187
Q

croup tx

A

-corticoid steroids
-racemic epinephrine via nebulizer (in healthcare setting only)

188
Q

GI assessment (7)

A

-skin turgor
-dry mucous membranes
-lack of tears
-look at amount of diapers wet in last 24 hrs or # of times child voided
-clarify spitting or vomiting
-diarrhea, # of stools, observation of stools
-weight

189
Q

giardia caused by

A

protozoan

190
Q

common viral infections that cause diarrhea

A

rotavirus
adenovirus

191
Q

common bacterial infection that cause diarrhea

A

-campylobacter jejuni
-salmonella
- c.dif
-e. coli

192
Q

when should stool culture be done for diarrhea

A

after 24 hrs

193
Q

assess pt w/diarrhea

A
  • lab work
  • weight
  • I/O
    -weigh diapers
    -1g stool = 1 mL fluid
194
Q

check stool for ________ (5)

A

ph<7.0
sugar
color
volume
form

195
Q

nephrotic syndrome def

A

an immunological d/o resulting in altered glomeruli permeability

196
Q

nephrotic syndrome sx

A

proteinuria
edema
decreased albumin
high cholesterol

197
Q

nephrotic syndrome risk factors (2)

A

-age 3 y.o.
-boys more likely

198
Q

nephrotic syndrome most common type

A

mostly ideopathic

199
Q

vesicoureteral reflux def

A

urine flows from the ureters to the bladder with no flow backs because a valve obscures the end of the ureters

200
Q

non-medical professionals who provide comfort and pain relief measures

A

Doula
Labor Coach

201
Q

complementary / alternative birthing tx (8)

A

-relaxation
-focusing and imagery
-prayer
-breathing techniques
-heat or cold applications
-hydrotherapy
-massage
-hypnosis

202
Q

pharma pain relief for labor (6)

A

-opioid analgesics
-nitrous oxide
-local anesthesia (local/pudendal nerve block
-epidural anesthesia
-spinal anesthesia
-general anesthesia

203
Q

method of administration for butorphanol tartrate (for labor) (2)

A

IM or IV

204
Q

effect on mother from butorphanol tartrate (for labor) (2)

A

-effective analgesia
-if woman is opioid dependent, then withdrawal possible

205
Q

effect on labor progress from butorphanol tartrate (for labor)

A

may slow progress of labor if given early

206
Q

effect on fetus from butorphanol tartrate (for labor)

A

some respiratory depression

207
Q

Nalbuphine method of admin (labor) (2)

A

IM or IV

208
Q

nalbuphine effect on mother (labor) (2)

A

-effective analgesic
-slows respiration rate

209
Q

nalbuphine effect on labor progress

A

mild maternal sedation

210
Q

nalbuphine effect on fetus or newborn

A

some respiratory depression

211
Q

morphine (labor) route of administration

A

intrathecal prior to anesthesia

212
Q

effect of morphine on mother (labor) (2)

A

-effective analgesia
-pruritis

213
Q

effect of morphine on progress of labor

A

may slow contractions

214
Q

fetal heart tracing variability level that is good

A

moderate

215
Q

variability level in Category 3

A

absent

216
Q

variable decelerations look like ________ on fetal heart tracing

A

V

217
Q

acceptable decelerations

A

early (happen with contractions)

218
Q

O2 level needed if Category 2

A

8-10 liters

219
Q

causes variable decelerations

A

cord compression

220
Q

pattern for pushing during birth

A

deep breath
push
wait 10 seconds
repeat

221
Q

third stage begins _____ and ends______

A

-delivery of baby
-delivery of placenta

222
Q

third stage of birth should last _________ long max

A

30 minutes

223
Q

oxytocin after birth given what route

A

IV over 2 hrs or IM

224
Q

opioids must be given at least _____ (amount of time) from delivery

A

3 hours

225
Q

most common pain relief measure for labor & delivery

A

epidural

226
Q

epidural affects what part of body typically

A

umbilicus down

227
Q

spinal anesthesia numbs what part of body

A

nipple down

228
Q

when general anesthesia

A

emergency or c-section with contradictions to spinal

229
Q

nurse role in epidural

A

-educate pt.
-position pt
-documentation
-pregnant person assessment
-fetal assessment
-IV hydration (1 liter PREVENT HYPOTENSION)
-labs (watch platelets: should be at least 70k)
-monitor pain labs

230
Q

nurse role during spinal

A

-education
-positioning (arch back usually
-documentation
-pregnant person assessment
-fetal assessment
-IV hydration (1 liter to PREVENT HYPOTENSION)
-labs
-monitor pain levels
-monitor for CSF leak (very bad headache, will feel fine lying flat and terrible if upright)

231
Q

CSF leak headache treatment

A

blood patch

232
Q

concerns with spinal anesthesia (3)

A

-hypotension
-headache
-respiratory depression (increased risk if duramorph (24 hour-acting morphine, cannot get more opioid until wears off)

233
Q

general anesthesia for

A

emergency or spinal or contraindication

234
Q

Risk for delivery with general anesthesia

A

aspiration

235
Q

risk postpartum if general anesthesia used for delivery (2)

A

-uterus not contracting
-fetal respiratory depression

236
Q

define postpartal period

A

6 weeks after birth

237
Q

internal electronic monitoring devices for fetus

A

-intrauterine pressure monitor
-FSE: fetal scalp electrode

238
Q

2 kinds of C-section

A

-scheduled
-emergent/unplanned due to issue with pregnant person, labor, or baby

239
Q

ASAP vs STAT

A

-ASAP is as soon as possble, can wait for next room
-STAT is now

240
Q

Emergent C-section issues

A

-increased risk of complications
—post-op
—emotional
—bonding

241
Q

C-section increased risk of

A

-infection
-injury to surrounding organs
-amniotic embolism
-bleeding
-risk of complications for future pregnancies (invasive placenta)
-risk to infant

242
Q

Risk to infant from C-section (2)

A

-cuts
-respiratory depression

243
Q

nurse tasks immediate preop (9)

A

-informed consent
-hygiene
-GI tract preparation
-baseline I/O
-hydration
-preoperative medication
-surgical checklist
-transport
-support person

244
Q

preoperative meds for c-section

A

-antibiotic iv
-anesthesia

245
Q

types of surgical incision on uterus for c-section

A

-transverse (horizontal, most common)
-classical incision (vertical)

246
Q

if classical incision, can never have __________

A

vaginal birth because can dehisce

247
Q

why classical incision usually done

A

preterm baby and lower uterus not firm enough still

248
Q

primary dressing after C-section for how long

A

24 hours

249
Q

how to remove dressing after 24 hours

A

allow patient to shower so dressing comes off easy

250
Q

REEDA

A

Redness
Edema
Echymosis
Discharge
Approximation

251
Q

Post Op care for c-section

A

-Pain management
-Incision (REEDA)
-fundus
-bleeding
-I/O
-circulation
-VS
-Ambulation
-Parenting/Bonding

252
Q

Pt. ed warning signs (pt. should call (5)

A

-Redness or drainage at incision site
-Lochia heavier than normal period
-severe abdominal pain
-temp > 100.4
-urinary frequency or burning

253
Q

preschool age group

A

3-5

254
Q

preschool weight development

A

4.5-6.5 lbs (2-3 kg) per year

255
Q

preschool height development

A

2.5 - 3.5 inches (6.5 -9 cm) per year

256
Q

key factor in preschool

A

growth and coordination

257
Q

Toddler fine motor ability (3)

A

dress, color, copy figures

258
Q

3 year old new motor skills

A

-ride tricycle
-jumps off steps or step
-balance on one foot for short time

259
Q

4 year-old new motor skills

A

-hops and skips
-throws a ball
-can catch a ball

260
Q

5 year old motor skills

A

-jump ropes
-walk backwards
-able to throw and catch ball

261
Q

Erickson for preschool

A

initiative vs. guilt: love to learn, try new things
-guilt may come if non-mastery

262
Q

Piaget stage

A

preoperational

263
Q

preoperational stage (Piaget)

A

-understand world around them, begin to understand other view points
-magical thinking (Santa, etc)
-time
-animism
-centration (focus on one point)

264
Q

preschool language

A

-sentences, increasing to 4-5 words per sentence by age 5
-2100 words by age 5
- like talking

265
Q

preschool self concept (5)

A

-allow for independence, self-care, praise talents
-compares self to peers
-keep a schedule
-pretend play
-less fear of strangers

266
Q

preschool activities

A

puzzles, puppets, books, musical instruments, dress up, playing ball, coloring, drawings, tricycle riding, sand boxes, kiddie pools

267
Q

preschool immunizations

A

-4 - 6 years of age: DTap, MMR, Varicella, IPV;
-yearly flu vaccine

268
Q

preschool nutrition

A

-all 5 food groups
-limit fruit juices (water, milk instead)

269
Q

preschool sleep needs

A

12 hours plus nap (which decreases);
-night light, favorite toy
-ROUTINE

270
Q

preschool dental

A

-all deciduous teeth present
-supervise brushing and flossing
-bruxism may happen

271
Q

preschool hygiene

A

tub or shower, always supervised

272
Q

common fears preschooler

A

-darkness
-bleeding
-physical exams
-separation anxiety

273
Q

safety for preschooler

A

-lock cabinets
-firearms locked at all times
-helmets for bike riding
-stranger danger
-car seat
-street safety

274
Q

common safety issues preschool (3)

A

-burns
-drownings
-motor vehicle accidents

275
Q

broken fluency in preschool

A

secondary stuttering, resolves on its own

276
Q

potty talk

A

correct and move on

277
Q

school and guidance

A

-help family find approriate school
-screen for developmental lags

278
Q

components of physical exam (9)

A

-vital signs
-general appearance
-MS assessment
-body measurements
-head to toe sequence
-vision
-hearing
-Denver developmental or Bright Futures AAP tool
-Goodenough-Harris Drawing test which can be used to assess intelligence in 3-10 year old

279
Q

Postpartum Hemorrhage (PPH)

A

-leading cause of pregnancy related mortality and morbidity
-life threatening complication
-no universally accepted definition of PPH

280
Q

definitions of Post Partum Hemorrhage

A

-loss of over 500 cc of blood following vaginal birth
-loss of 1000 cc of blood following C-section
-unresponsive to massage or medication
-10% decrease in HCT between admission and postpartum

281
Q

time period considered early PPH

A

first 24 hrs

282
Q

time period considered late PPH

A

between 24 hrs. and 6 weeks

283
Q

4 T’s of PPH

A

Tone: uterine atony
Trauma: to Genital track
Thrombin: coagulation disorder
Tissue: retained placental tissue

284
Q

what happens in uterine atony

A

uterus fails to contract

285
Q

risk factors for uterine atony (9)

A

-overdistension
-traumatic birth
-MgSO4
-precipitous labor
-augmented labor-oxytocin
-infection: chorioamnionitis
-retained placental fragments
-high parity (multiple babies)
-hx of uterine atony

286
Q

MgSO4 as related to uterine atony

A

Magnesium sulfate used to inhibit contractions and delay delivery

287
Q

high parity def:

A

multiple previous births

288
Q

Tx of uterine atony (5)

A

-firm massage
-manual expression of bladder distension
-IV infusion of oxytocin and LR or NS (see process on next card)
-Bi-manual compression and exploration for fragments (sterile technique with antibiotics after expulsion

289
Q

Bi-manual compression and exploration for fragments

A

sterile technique with antibiotics after expulsion

290
Q

if IV oxytocin and LR or NS fails

A

-methergine 0.2 mg IM OR hemabate (contraindicated if pt. has asthma)(carboprost tromethamine) 0.25 mg IM
-if that is ineffective or if HTN, prostaglandin E2 (cytotec) rectal suppository (800-1000 mg)
-crystalloid solution and blood products
-O2, urinary cath, labs, VS, and repeated fundal assessment

291
Q

Trauma to the Genital Tract common ex.

A

Lacerations to the cervix, vagina, or perineum

292
Q

Risk Factors for trauma to genital tract (7)

A

-precipitous birth
-congenital abnormalities
-contracted pelvis
-infant size
-abnormal presentation/position
-previous scars from infection, injury, operations
-vulvar, perineal, or vaginal varicosities

293
Q

1st degree perineal laceration

A

vaginal mucosa torn

294
Q

2nd degree perineal laceration

A

perineal muscles torn

295
Q

3rd degree perineal lacerations

A

anal sphincter torn

296
Q

4the degree perineal laceration

A

rectum torn

297
Q

Tx of trauma to genital tract (7)

A

-identify site of bleeding
-control of bleeding
-analgesia
-monitor hemodynamics
-ice
-diet
-stool softeners

298
Q

how serious is uterine inversion

A

life threatening

299
Q

risk factors for uterine inversion

A

-fundal pressure
-short cord
-cord traction
-uterine atony
-fibroids
-multips.
-Hx placenta accreta/increta
-hx past inversion

300
Q

how many degrees of uterine inversion (and what they are like)

A

-1st degree: still inside, but small dent
-2nd degree: still inside, larger dent
-3rd degree: inverted enough to stick out al little
-4th degree: fully inverted

301
Q

Tx of uterine inversion

A

-emergency management necessary
-LR and blood products for shock
-monitor hemodynamics
-fundus repositioned after placenta separated (MgSO4 and analgesia to relax uterus- d/c after repositioned)
-oxytocin medications and bimanual compression
-antiobiotics

302
Q

Disseminated intravascular Coagulation (DIC) def:

A

over-activation of clotting and anti-clotting processes

303
Q

Disseminated intravascular Coagulation (DIC) causes (7)

A

disease or injury:
-septicemia
-acute hypotension
-snake bites
-neoplasm
-OB emergencies
-severe trauma
-extensive surgery

304
Q

course of Disseminated Intravascular Coagulation

A

-initial hypercoagulability
-then deficiency in clotting factors

305
Q

s/s of DIC

A

-widespread internal and external bleeding (gums, nose, petechiae around pressure sites)
-Lab values
-low platelets
-low fibrinogen and other clotting factors
-prolonged Pt and PTT
-abnormal RBC morphology

306
Q

Tx of DIC

A

-removal of underlying cause
-volume replacement and blood component therapy
-optimization of O2 and perfusion status

307
Q

Nursing assessment/tasks for DIC (7)

A

-VS
-insert 2nd line
-observe for s/s of bleeding
-observe for adverse blood reactions
-monitor urinary output
-O2 admin
-Maintain quiet non-stressful environment

308
Q

4 categories of retained placenta

A

-non-adherent retained placenta (partial separation, entrapped by uterus)
-placenta accreta: adherent to uterus
-placenta increta: adherent and integrated into uterine wall
-placenta percreta: integrated and pierced through other side of uterine wall

309
Q

risk factors for retained placenta

A

-prior uterine surgery
-mismanagement of 3rd stage of labor

310
Q

Tx of retained placenta if non-adherent (3)

A

-manual separation and removal
-IV analgesia
-still at risk for PPH and infection

311
Q

Tx of retained placenta if adherent (4)

A

-attempts to remove may not be successful
-may result in lacerations of the uterus
-blood replacement
-possible hysterectomy

312
Q

subinvolution def:

A

delayed return of enlarged uterus to normal size and fx

313
Q

subinvolution risk factors (2)

A

-retained placental fragments
-pelvic infection

314
Q

subinvolution s/s (3)

A

-prolonged, irregular, or excessive vaginal bleeding
-enlarged uterus by exam
-boggy uterus

315
Q

retained placenta aftercare

A

hysterectomy strongly recommended because further invasion of placenta through uterus into bladder and other organs very probable

316
Q

subinvolution def

A

delayed return of enlarged uterus to normal size and function

317
Q

subinvolution risk factors (2)

A

-retained placental fragments
-pelvic infection

318
Q

subinvolution s/s (3)

A

-prolonged, irregular, or excessive vaginal bleeding
-enlarged uterus by exam
-boggy uterus

319
Q

TX of subinvolution

A

-dependent on cause
-methergine 0.2 mg Q 4 hrs for 2-3 days
-antibiotics
-dilation and curette (D&C) for retained placenta

320
Q

postpartum infection def:

A

-any clinical infection in the first 28 days postpartum

321
Q

common postpartum infections (4)

A

-endometritis
-wound infections
-cystitis
-mastitis

322
Q

postpartum infection (PPI) risk factors include (18)

A

-hx of thrombosis, UTI, mastitis, pneumonia
-DM
-alcoholism
-immunosuppression
-anemia
-malnutrition
-C-section or operative vaginal birth
-prolonged ROM (rupture of membrane)
-chorioamnionitis
-prolonged labor
-catheterization
-intrauterine monitoring
-epidural anesthesia
-retained fragments
-PPH
-episiotomy/lacerations
-hematomas

323
Q

endometritis def.

A

infection of uterine cavity muscle

324
Q

endometritis prevalance

A
  • 2% of vaginal births
  • 10-20% of C-sections
  • elective C-sections have lower rates than non-elective
325
Q

endometritis s/s (9)

A

-tachycardia
-jagged temp elevation
-chills possible
-uterine tenderness (feeling fundus hurts abnormally)
-prolonged/recurrent afterbirth pains
-subinvolution
-slight abdominal distention
-scanty, odorous lochia, or mod. heavy, foul smelling, bloody seropurulent lochia
-elevated WBC (labor stress normally increases WBC)

326
Q

endometritis nursing interventions

A

-VS, monito hemodynamics
-obtain blood cultures (anaerobic and aerobic (results in 36-48 hrs))
-pharmacologic tx (broad spectrum antibiotics via IV until afebrile and pain free for 24-48 hrs)
-analgesia

327
Q

Wound infections nursing assessment (3)

A

-VS
-Wound assessment (red, irritated, warm, tender, oozing, foul smelling, poorly healing, splitting)
-pain assessment- localized

328
Q

Wound infection nursing interventions

A

-open and cleanse
-antibiotic tx

329
Q

wound infections patient self-care (5)

A

-hydration
-monitor cesarean incisions, cleanse daily in shower
-increase roughage in diet if 4th degree perineal laceration
-clean perineum from front to back with peri-bottle
-report increases in temperature, drainage, increased pain

330
Q

cystitis def and prevalance

A

-bladder infection
-occurs in 2-4 %

331
Q

cystitis risk factors (9)

A

-distension
-dehydration
-poor hygiene
-catheterization
-pelvic exams
-epidural anesthesia
-genital tract injury
-hx of UTIs
- C-section

332
Q

cystitis s/s

A

-frequency, urgency, burning
-suprapubic discomfort
-CVA tenderness if pyelonephritis
-fever in pyelonephritis
-tachycardia
-n/v

333
Q

cystitis nursing interventions

A

-notify provider, get orders for UA/UCx
-monitor v/s, hemodynamics
-pharmacologic management (antibiotics as ordered, analgesics as ordered, NSAIDs)
-encourage fluid intake
-encourage frequent voiding
-routine peri-care

334
Q

mastitis def

A

infection of breast tissue, especially from organisms on postpartum person’s skin or infant

335
Q

when mastitis occurs

A

-typically 2 days - 2 weeks postpartum
-can occur anytime

336
Q

mastitis nursing assessment (6)

A

-flu like sx first
-breast pain, swelling, tenderness
-elevated temp (102-104 typically)
-axillary adenopathy
-usually unilateral, may be bilateral
-possible purulent drainage

337
Q

mastitis nursing interventions

A

-antibiotics admin (usually dicloxacillin for almost always staph aureus infection)
-continue to pump/feed/express q 2-4 hrs
-analgesics if ordered
-pump breast milk (baby can have)

338
Q

thrombosis def and location postpartum

A

formation of blood clots inside blood vessel caused by inflammation or partial obstruction of blood vessels in legs or pelvis;
(increased risk in pregnancy and 6 weeks post partum)

339
Q

2 types of thrombosis of concern postpartum

A

-DVT
-PE

340
Q

prevalence of thromboembolic disease postpartum

A

1:1000

341
Q

thromboembolic disease causes (2)

A

-stasis
-hypercoagulation

342
Q

thromboembolic disease other risk factors

A

-C/S
-previous history
-obesity
-AMA
-multiparity
-tobacco
-laboring position
-immobility

343
Q

clinical manifestations of PE (6)

A

-shortness of breath
-chest pain
-anxiety
-cough
-hypoxia
-tachycardia

344
Q

clinical manifestations of deep thromboembolism

A

-reduced peripheral pulse on affected side
-assess for PE

345
Q

Diagnostic imaging for thromboembolism

A

-doppler ultrasound for DVT
-CT scan for PE

346
Q

management of DVT

A

-anticoagulant
-bedrest
-elevation of leg
-analgesia

347
Q

continued evaluation of DVT

A

-inspect
-palpate
-measurement
-pulses
-DO NOT PERFORM HOMAN’S SIGN
-monitor for PE
-labs
coordinate follow up post hospitalization

348
Q

postpartum sadness prevalance

A

up to 85% of postpartum women

349
Q

postpartum sadness nursing interventions (6)

A

-let postpartum person/partners know blues are normal 1-2 days after delivery through 2 weeks postpartum
-encourage communication of needs and fears
-praise them on feeding, assessing infant needs, etc
-encourage rest when baby is sleeping
-continue to monitor parent/infant bonding
-educate re: what is normal, and who to call if postpartum depression

350
Q

postpartum depression prevalence

A

20% of postpartum women

351
Q

nursing assessment for postpartum depression

A

-risk greatest during 1st month post delivery
-can occur anytime in 1st year
-check for s/s

352
Q

s/s of postpartum depression

A

-insomnia
-crying and prolonged sadness
-poor concentration and difficulty making decisions
-obsessive thoughts, not being able to care for baby
-decline in personal hygiene
-SI or HI

353
Q

postpartum nursing interventions

A

-early assessment and education
-home visitation if possible
-stress rest, especially first few weeks
-provide info on meds and complimentary tx (yoga, aromatherapy, acupressure, massage, ECT, psychotherapy)
-provide contact # for mental health provider
-provider may consider restarting previous meds if stopped during pregnancy
-discharge planning should include info and appropriate contact #s

354
Q

postpartum psychosis prevalence

A

1-2 per 1000 births

355
Q

postpartum psychosis assessment (4)

A

-agitation, confusion
-irrational statements or behavior
-delusions, hallucinations
-insomnia and hyperactivity

356
Q

Which of the following is the most frequent reason for postpartum hemorrhage?

A

Uterine atony

357
Q
A
358
Q
A

Nur 404 (5 decks)

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