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OB/Peds > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the recommended therapies for small children with nasopharyngitis?

A

Supportive tx with antipyretics, nasal saline irrigation, and adequate fluid hydration. Elevating HOB to drain secretions and suctioning with a bulb syringe.

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2
Q

Why shouldn’t cough suppressants be used for nasopharyngitis?

A

Because cough is a protective way to clear secretions. They may be prescribed for a dry hacking cough at night.

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3
Q

What do you teach families about URIs?

A

They usually resolve within 4-10 days. They’re frequent in children younger than 3 and by 5 their children will have developed immunity to many viruses.

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4
Q

What causes strep throat?

A

Group A Beta-Hemolytic Streptococcus

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5
Q

Children with strep throat are at risk for what for 10 days?

A

Acute glomerulonephritis

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6
Q

Children with strep throat are at risk for what for 18 days?

A

Acute rheumatic fever

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7
Q

Incubation period for strep throat

A

2-4 days

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8
Q

When does strep throat usually subside?

A

3-5 days

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9
Q

How is strep throat treated?

A

With oral penicillin for 10 days or IM Pen G (very painful, can cause local skin reactions or rash)

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10
Q

How to care for tonsillectomy patient

A

Placed on side or abdomen to facilitate drainage, suction cautiously, ice collar to provide relief, prevent coughing/crying/blowing nose

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11
Q

Signs of airway obstruction after tonsillectomy

A

Stridor, drooling, restlessness

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12
Q

Where is dark brown blood usually found after a tonsillectomy?

A

Nose, emesis, teeth

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13
Q

Diet for post-tonsillectomy

A

No fluids with red or brown color, avoid citrus, need soft or liquid diet

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14
Q

Signs of post-op bleeding after tonsillectomy

A

High HR, frequent clearing of throat or swallowing, vomiting bright red blood

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15
Q

How long will pts have bad breath after a tonsillectomy?

A

5-10 days

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16
Q

Highest incidence of otitis media

A

Ages 6-20 months and in winter months

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17
Q

Bacterial OM is usually preceded by what?

A

A viral respiratory infection (RSV, Influenza)

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18
Q

What causes OM?

A

Malfunctioning eustachian tube. Obstruction of tube causes accumulation of secretions
Can eventually produce an effusion

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19
Q

Acute OM

A

Visual inspection shows a purulent
discolored effusion and a bulging
reddened membrane, abrupt onset

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20
Q

OM with effusion

A

Inflammation and fluid in the middle ear without s/s of acute infection
- immobile membrane or orange discolored
membrane
Symptoms may be absent, nonspecific
symptoms present (rhinitis, cough, diarrhea)

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21
Q

When do pts need hearing evaluations with OM effusion?

A

Every 3-6 months until resolved

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22
Q

When are antibiotics given for OM?

A

Less than 6 months, severe s/s of AOM (ear pain for at least 48 hours or temp >102.2F), bilateral AOM without s/s,

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23
Q

Tx for unilateral AOM without severe s/s & for 24 months without s/s

A

Either give abx or watch for 48-72 hours for improvement

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24
Q

Tx of OME

A

Abx given if fluid present for > 3mo

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25
Q

What is IM Rocephin for with OM?

A

Highly resistant bacteria or noncompliance

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26
Q

What is the abx of choice for OM?

A

Amoxicillin for 10 days (n/v, diarrhea)
Do not give if have PCN allergy
Other abx – augmentin, azithromycin, cephalosporin

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27
Q

Myringotomy

A

Surgical incision of eardrum to provide drainage and relieve pain

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28
Q

Tympanostomy tube placement

A

Tx recurrent chronic AOM (3 bouts in 6 mo, 6 in 12 mo, 6 by 6 years old)

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29
Q

Nursing care after a tympanostomy tube placement

A

Facilitate continued drainage of fluid and allow ventilation of middle ear

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30
Q

Prevention of OM

A 
Pneumococcal vaccine (PCV7), annual flu vaccine
reduce risk factors - breast feed for at least 6 mo, avoid propping bottle, decrease pacifier use after 6 months, avoid exposure to tobacco smoke
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31
Q

What to teach family for OM

A

If tubes in place need earplugs for swimming, avoid getting bathwater and shampoo in ears, show them what tube looks like so can recognize if falls out

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32
Q

Nursing care for OM

A

Relieve pain, facilitate drainage – clean external canal with cotton swabs and antibiotic ointment and protective barrier if skin breaks down, prevent complications and recurrence – complete abx tx

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33
Q

Croup

A

Swelling or obstruction in region of the larynx, barking or brassy cough, stridor

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34
Q

Prevention of acute epi

A

Beginning at two months all children should receive the HIB vaccine

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35
Q

Tx of acute epi

A

Lateral neck x-ray, elective intubation before any procedures, humidified oxygen, IV antibiotics then oral for 7-10 days, Corticosteriods for reducing edema, Airway swelling decreases after 24 hours of abx tx

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36
Q

S/s of acute LTB

A

low grade fever, inspiratory stridor, suprasternal retractions
Develops classic barking (seal-like) cough
Worse at night and crying exacerbates

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37
Q

Tx for acute LTB

A

Maintain airway
High humidity with cool mist (take child outside, stand in front of open freezer, cool basement), cool air vaporizer
Continue fluid intake with mild croup (RR

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38
Q

Nursing management of acute LTB

A

Continuous, vigilant observation and accurate assessment of respiratory status – pulse ox
What are s/s of respiratory distress and airway obstruction?

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39
Q

Bronchiolitis

A

Acute viral infection with maximum effect at the bronchiolar level
Occurs in winter and spring – incubation period 2-8 days
RSV responsible for 80% or more of the cases during epidemic periods
RSV makes epithelial cells of resp tract swell, fill with mucus and exudate
Causes obstruction (expiration) and atelectasis
Hyperinflation and progressive overinflation (emphysema)
Transmission is through direct contact with secretions – can live on surfaces for several hours and hands for 30 minutes
Can cause a secondary bacterial infection (OM, pneumonia)

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40
Q

How long does pertussis last?

A

6-10 weeks

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41
Q

What is the definite dx of a foreign body ingestion?

A

Bronchoscopy

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42
Q

Tx of foreign body ingestion

A

-Heimlich Maneuver
1 yo: abdominal thrusts
-No finger sweeps
-Removed through endoscopy under sedation

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43
Q

What do you watch for after endoscopy?

A

For laryngeal edema afterwards

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44
Q

Peak Expiratory Flow Rate (PEFR)

A

Used to measure max flow of air forcefully exhaled in 1 second using flow meter
Find child’s best value as a baseline to compare

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45
Q

PFT for asthma

A

Evaluating the presence and degree of lung disease, response to tx, can be used once child is 5-6 yo
Used on initial dx, after treatment started, and every 1-2 years

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46
Q

MDI

A

Always attach to a spacer to prevent yeast

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47
Q

Spacer

A

Helps increase availability of med

48
Q

Nebulizer

A

For children who have difficulty using MDI, administers med via compressed air

49
Q

Patho of CF

A

Increased viscosity of mucous gland secretions
Elevation of sweat electrolytes
Increase in enzymes in saliva
Abnormalities in autonomic nervous system
Obstruction of the pancreas and bronchioles

50
Q

How to dx CF

A

Sweat chloride test – normal 60 mEq/L is diagnostic of CF
Absence of pancreatic enzymes
X-ray – shows patchy atelectasis and obstructive emphysema
Family history
Newborn screening – required by law
DNA ID of gene following + NB screening
Stool analysis for fat and enzyme analysis

51
Q

GI S/S of CF

A 
Meconium ileus 
Large, bulky, frothy, foul-smelling stools
Wt loss, growth failure
Distended abd
Vitamin ADEK deficiency
52
Q

Salty taste to skin occurs with what disorder?

A

CF

53
Q

Respiratory S/S of CF

A 
Wheezing respirations
Dry, non-prod cough
Increased dyspnea
Obstructive emphysema and atelectasis
Barrel-shaped chest
Cyanosis
Clubbing of fingers and toes
Repeated episodes of bronchitis and bronchopneumonia
54
Q

Complications of CF

A

Restricted growth and development - FTT
Cystic-fibrosis related diabetes (CFRD)
Rectal prolapse
Reproductive system – highly viscous cervical secretion can cause infertility in females, 95% of males with CF are sterile

55
Q

Nursing management of CF

A

Thorough resp and GI assessment
Maintaining a patent airway
Preventing infection – standard precautions and high alert for hospital acquired infections, avoid contact with other CF patients
Maintaining growth – consult with dietician, may have to teach enteral feeds
Promoting family coping – encourage compliance with complicated regimen
Case management – O2, IV abx, Nebs/Meds, CPT supplies
Preparing family and child for adulthood

56
Q

Trach care

A

What do you need to know about the pt’s trach?
Suction prn – when?
Supplies needed??
Steps to suction:
100% O2 before suctioning begins
Sterile at the hospital/ aseptic at home
Each pass only 5 seconds
Rest 30-60 sec after each pass
Parent education- change tubes, ties, suctioning, when to call an MD
Daily care – skin assessment, trach ties changed daily, weekly trach changes (2 hours after meals), use 2 people at all times
How to we give oxygen through trach?

57
Q

What are the five factors affecting the process of labor and birth?

A
  1. Passenger
  2. Passageway
  3. Powers
  4. Position of mother
  5. Psychological response
58
Q

Refers to the part of the fetus that enters the pelvic inlet first and leaves through the birth canal during labor

A

Fetal presentation

59
Q

Refers to the part of the fetal body first felt by the examining finger

A

Fetal presentation

60
Q

The relation of the spine of the fetus to the spine of the mother

A

Fetal lie

61
Q

The relation of the fetal body parts to one another

A

Fetal attitude

62
Q

The largest transverse diameter and an important indicator of fetal head size

A

Biparietal diameter

63
Q

The relationship of a reference point on the presenting part of the fetus to the four quadrants of the mother’s pelvis

A

Fetal position

64
Q

First letter of fetal position abbreviation

A

The location of the presenting part in the right or left side of the mother’s pelvis. (R or L)

65
Q

Second letter of fetal position abbreviation

A

The specific presenting part of the fetus (Occiput, sacrum, or mentum..O S or M)

66
Q

Third letter of fetal position abbreviation

A

The location of the presenting part of the fetus in relation to the portion of the maternal pelvis (anterior, posterior, transverse… A P or T)

67
Q

How do you measure the diagonal conjugate?

A

Insert 2 fingers into the vagina until they reach the sacral promontory.

68
Q

How long should the diagonal conjugate be?

A

Greater than 11.5 cm

69
Q

The distance from the sacral promontory to the exterior portion of the symphysis

A

The diagonal conjugate

70
Q

The bony pelvis is divided into what?

A

True and false portions

71
Q

The upper flared parts of the two iliac bones and the base of the sacrum

A

The false portions

72
Q

Bony passageway through which the fetus must travel

A

True portions

73
Q

Allows entrance into the true pelvis

A

Pelvic inlet

74
Q

Occupies the space between the inlet and the outlet

A

Mid-pelvis

75
Q

Bound by the ischial tuberosities and lower rim of the symphysis pubis and the tip of the coccyx

A

Pelvic outlet

76
Q

Classic female pelvic shape

A

Gynecoid

77
Q

Resembles the male pelvis

A

Android

78
Q

Resembles the pelvis of anthropoid apes, adequate for vertex birth, oval shape

A

Anthropoid

79
Q

Flat pelvis, rectangular

A

Platypelloid

80
Q

The relation of the presenting part of the fetus to an imaginary line drawn between the maternal ischial spines

A

Station

81
Q

A measure of the degree of descent of the presenting part of the fetus through the birth canal

A

Station

82
Q

How to measure the placement of the presenting part of the fetus?

A

In cm above or below the ischial spines

83
Q

The largest transverse diameter of the presenting part that has passes through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to 0 station

A

Engagement

84
Q

The presenting part of the fetus is usually which diameter?

A

Biparietal

85
Q

The fetal head is positioned in the pelvic cavity at an angle

A

Asynclitism

86
Q

Soft tissues include what?

A

Distensible lower uterine segment, cervix, pelvic floor muscles, vagina, and introitus

87
Q

After labor begins uterine contractions cause the uterine body to have what?

A

A thick muscular upper segment and a thin-walled, passive, muscular lower segment

88
Q

Primary contractions

A

Involuntary, responsible for effacement, dilation, and descent

89
Q

Secondary contractions

A

Augment the force of the involuntary contractions, mother bears down, have no effect on dilation or expulsion

90
Q

When the presenting part of the fetus descends into the true pelvis

A

Lightening

91
Q

Hormones at onset of labor

A

Increasing estrogen and prostaglandin and decreasing progesterone

92
Q

First stage of labor phases

A

Latent, active, transition

93
Q

When does the 1st stage of labor occur

A

From the onset of regular uterine contractions to full dilation of the cervix

94
Q

Latent phase

A

0-3 cm dilated

95
Q

Active phase

A

3-7 cm dilated

96
Q

Transition phase

A

8-10 cm dilated

97
Q

When does the 2nd stage of labor occur

A

Begins with full cervical dilation and complete effacement and eggs with the baby’s birth

98
Q

When does the 3rd stage of labor occur

A

From the birth of the baby until the placenta is expelled

99
Q

Placental separation is indicated by what?

A

Firmly contracting fundus, changing uterus from discoid to globular shape, placenta moves into the lower uterine segment, a gush of dark blood, lengthening of the cord

100
Q

When does the 4th stage of labor occur

A

Begins with the delivery of eh placenta to the first 1-2 hours after birth

101
Q

How should the uterus be during the 4th stage of labor

A

Firm and well contracted, hypotonic bladder

102
Q

What to monitor for with hemodynamic changes

A

Blood loss ranging to 250-500mL, blood redistributed into venous beds, moderate drop in both systolic and diastolic BP, increase pulse pressure, moderate tachycardia

103
Q

The turns and other adjustments necessary in the human birth process

A

Mechanism of labor (cardinal movements)

104
Q

Cardinal movements

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
    (restitution)
  7. Expulsion
105
Q

Bradley Method

A

?

106
Q

Sedatives given during labor

A

Seconal, phenergan, valium, vistaril

107
Q

Narcotics given during labor

A

Demreol, dilaudid, fentanyl, nubain, stadol

108
Q

Pudendal block

A

Injected directly into the pudendal nerve

109
Q

When is the pudendal block used?

A

Second stage of labor, birth, forceps or vacuum assisted delivery, episiotomy repair

110
Q

When is a spinal block used?

A

For C-sections or difficult forceps delivery

111
Q

Disadvantages to spinal blocks

A

Hypotension, total spinal block, drug reaction, spinal HA

112
Q

Epidural contraindications

A

Infection, coagulation dx, drug allergy

113
Q

How do you treat epidural induced maternal hypotension?

A

IV bolus and ephedrine

114
Q

Disadvantages to epidurals

A

Pruritus, slowed pushing efforts, increased use of vacuum and forceps, delay in return of bladder sensation

115
Q

Combined spinal and epidural

A

Involves inserting the epidural needle into the epidural space and subsequently inserting a smaller gauge spinal needle through the epidural needle into the subarachnoid space, rapid onset and duration of pain relief, allows motor function and pushing efforts to remain active

OB/Peds (11 decks)

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