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Nur 404 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

most frequently occurring pancreatic d/o

A

DM T1

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2
Q

tx for T1 DM

A

-insulin
-diet
-exercise

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3
Q

T2 DM tx

A

-dietary intake
-exercise
-oral antiglycemic

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4
Q

T2 DM in children

A

on rise in children, especially those who are obese

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5
Q

DM T1 typical onset

A

-5-7 y.o. or at puberty
-onset is abrupt
-initial sx is marked weight loss

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6
Q

DM T1 sx

A

-marked weight loss
-become acidotic
-polydipsia and polyphagia
-polyuria (often bed-wetting)
-fatigue
-grades drop
-blurry vision
-mood changes (possible behavioral concerns)
-period of remission for 1-12 months

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7
Q

DM T2

A

-gradual onset
-obesity
-become acidotic
-polydipsia and polyphagia
-polyuria (often bed-wetting)
-fatigue
-grades drop
-blurry vision
-mood changes (possible behavioral concerns)
-require meticulous skin and foot care
-no period of remission

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8
Q

T1 DM insulin production

A

deficient

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9
Q

T2 DM insulin production

A

reduced

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10
Q

DM T1 etiology

A
  • immunologic damage to islet cells
    -genetic (probably)
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11
Q

insulin fx

A

-opens cells to glucose absorption

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12
Q

deficient insulin effects (physiology)

A

glucose builds up in the bloodstream because not absorbed by cells
-kidneys detect hyperglycemia (over renal threshold of 160 mg/dL, then excrete glucose into the urine causing glycosuria and polyuria

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13
Q

ketosis from low insulin

A

-high BG resulting from low insulin starves cells of energy
-cells compensate by breaking down energy and fat
-this causes abnormal levels of ketones, a product of fat breakdown, which leaves the body in the urine
-potassium and phosphate try to act as buffers and go into blood stream; they then leave the body in the urine, causing low electrolytes

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14
Q

children with untreated diabetes

A

-very susceptible to low electrolytes
-growth impacted by not having energy

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15
Q

cardinal sx of DM

A

-polyuria (excessive urination)
-polydipsia (excessive thirst)
-hyperglycemia

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16
Q

Tx T1DM (5)

A

-insulin
-nutrition
-exercise
-stress management
-monitor BG and ketones

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17
Q

new DM diagnosis in children

A

-3 day hospital admit
-extensive pt. and family education

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18
Q

BG range for children with T1 DM before meal

A

70 - 110

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19
Q

BG range for children with T1 DM 1 hr. after meal

A

90 - 180

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20
Q

BG range for children with T1 DM 2 hours after meal

A

80 - 150

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21
Q

BG range for children with T1 DM between 2AM and 4 AM

A

70 - 120

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22
Q

Somogyi effect

A

-rebound hyperglycemic response caused by insulin overuse
-suspected when children have hypoglycemia at 2 or 3 AM followed by early morning hyperglycemia

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23
Q

teach these ketoacidosis signs

A

-very thirsty
-polyuria
-nausea
-stomach pain
-fatigue
-shortness of breath
-fruity breath
-confusion

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24
Q

nursing care for DM

A

-support child and family
-listen to concerns
-support their goals
-care coordination

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25
Q

etiology of precocious puberty

A

-GnRH release is suppressed because hypothalamus is very sensitive to small amount of estrogen produced by the adrenal glands
-in puberty, the hypothalamus is becomes less sensitive to estrogen feedback
-if hypothalamus is damaged, can lead to early or late puberty and activation of GnRH

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26
Q

GH Deficiency is a d/o of the _____ and causes ______

A

-pituitary
-very short stature

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27
Q

GH deficiency tx

A

injection of synthetic GH

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28
Q

GH excess

A

-overgrowth of body tissues

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29
Q

diabetes insipidus physiology and tx

A

-decreased release of ADH leading to polyuria
-tx is DDAVP (an arginine vasopressin)

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30
Q

Pituitary hormones: ADH

A

-source: neurohypophysis
-target: kidneys
-regulates fluid volume through urine output (decreases), increasing ECF
-low ADH causes polyuria
-high ADH from trauma, pain, anxiety, exposure to high temps

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31
Q

Pituitary hormones: ACTH (corticotropin)

A

-source: adenohypophysis
-target: adrenal glands
-stimulates adrenal glands to produce glucocorticoid and mineralocorticoid hormones.
-increased production of adrenal gland secretions decreases ACTH production and vice versa

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32
Q

Pituitary hormones: somatropin (Growth Hormone, or GH)

A

-source: adenohypophysis
-target: acts on all body cells
-GH increases bone and cartilage growth by increasing GI absorption of calcium
-if GH production is inhibited, undergrowth will occur, and overgrowth if excessive GH production

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33
Q

Pituitary hormones: thyrotropin (TSH, thyroid stimulating hormone)

A

-source: adenohypophysis
-target: thyroid
-TSH stimulates thyroid gland to produce hormones (thyroxine and triiodothyronine)
-too little TSH leads to atrophy and inactivity of the thyroid gland; too much TSH causes hypertrophy (increased size) and hyperplasia (increase in number of cells) of the gland

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34
Q

paroxysmal d/o

A

-d/o that occurs suddenly and recurrently
-ex.: seizures, headaches, breath-holding spells are most common in childhood

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35
Q

seizure

A

-involuntary contraction of muscle by abnormal electrical brain discharges
-all seizures need to be investigated

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36
Q

common types of seizures in children

A

-febrile,
-infantile spasms
-partial (focal) seizures
-absence seizures
-tonic-clonic seizures

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37
Q

tx for seizure d/o

A

-antiseizure drugs

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38
Q

antiseizure drugs

A

-carbamazapine (levels needed, LFTs needed, CBC needed)
-valproic acid

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39
Q

febrile seizures

A

-associated with high fever (102 to 104); sudden spike, not gradual increase
-usually preschool, but can occur as late as age 7
-generally tonic-clonic for 15-20 seconds
-EEG usually normal afterwards

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40
Q

febrile seizure tx

A

-antipyretics to prevent
-look for cause of fever and treat it (OM, strep)

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41
Q

tonsillectomy

A

-removal of palatine tonsils
-done if frequent throat infections or tonsilar hypertrophy that cause breathing problems
-danger of hemorrhage after surgery, which is then an aspiration risk; general anesthesia compounds the risk

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42
Q

tonsillectomy after care

A

-very painful procedure
-liquid analgesics are better tolerated; may need rectal admin
-offer ice chips, popsicles, frequent sips of clear liquids
-after 24 - 48 hrs. can have soft food
-be certain parents know who to call if problems after discharge

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43
Q

CF defined

A

-inherited disease of the secretory glands
-thick mucus secretions (esp. in pancreas and lungs)
-electrolyte abnormalities in sweat glands
-genetic (abnormality of chromosome 7 causes inability to transport small molecules across cell membranes leading to dehydration of epithelial cells of airway and pancreas)
-also affects reproduction

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44
Q

CF in pancreas

A

-enzyme secretions of pancreas too thick, clogging ducts
-results in atrophy of acinar cells and inability to produce enzymes
-islets of Langerhans and insulin production are affected much later because they are ductless

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45
Q

CF GI implications

A

-come from effects on pancreas
-inability to digest fat, protein, sugars result in large, bulky, greasy BMs (steatorrhea)
-increase in intestinal flora and fats causes very foul odor
-protuberant abdomen from large stool volume
-malnutrition from not digesting food
-fat-soluble vitamins (A, D, E, K) are deficient

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46
Q

CF in newborn with CF

A

-meconium can obstruct intestine because extra thick (aka meconium ileus)
-if newborn develops abdominal distension with no passage of stool within 24 hours of birth should be further evaluated

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47
Q

CF other

A

-anteroposterior diameter enlarged
-frequent infections from pooled mucus (staph aureus, pseudomonas aeruginosa, H. influenzae)
-atelectasis may occur as result of absorption of air from alveoli behind blocked bronchioles
-clubbed fingers may occur due to inadequate perfusion

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48
Q

fracture def:

A

a break in the structure or continuity or structure of bone

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49
Q

structure of childhood bones compared to adults

A

more porous, so bend instead of break

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50
Q

periosteum

A

thick so may not break all the way through

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51
Q

epiphyseal lines in children

A

may cushion a blow so bone does not break

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52
Q

healing of broken bones in children

A

rapid because of increased bone growth

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53
Q

plastic deformation

A

-bent
-microscopic fracture line that does not cross bone
-most common in ulna and fibula

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54
Q

buckle (torus)

A

fracture on the tension side of the bone near the softened metaphyseal bone, causing a buckling and raised area on the harder diaphyseal bone (opposite side)

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55
Q

greenstick

A

-bone bent with fracture beginning but not crossing through the bone

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56
Q

complete fracture

A

-bone divided (transversely, obliquely, or spirally)
-bone remnants possibly attached by a periosteal hinge

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57
Q

types of fractures

A

-forearm fractures
-Volkmann ischemic contracture
-epiphyseal separation of the radius
-clavicle fractures
-dislocation of the radius
-fracture of femur

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58
Q

Volkmann ischemic contracture

A

a complication that occurs when an arm is casted in a bent position, which causes the radial artery and nerve to become compressed at the elbow. Frequent assessments of the fingers for normal color and warmth are assessments used to identify this condition when an arm cast is in place).

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59
Q

why greenstick most common in children

A

high resilience of immature bone

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60
Q

fractures at epiphyseal line

A

-can be serious because bone growth occurs at this point;
-damage to the area can lead to undergrowth, overgrowth, or uneven growth, resulting in angulation
-observation: deformity, edema, pain, hx of accident
-rule out maltreatment in all unintentional injuries

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61
Q

fracture complications

A

-fat emboli
-PE

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62
Q

Fracture Tx

A

-x-ray to confirm dx and determine alignment and apposition (amount of end to end contact)
-if skin broken over fracture, tetanus prophylaxis and IV antibiotics
-HCT determination to determine blood loss
-crossmatching for replacement tx if long bone fractured
-analgesia, immobilize fracture site
-unless bone crushed, can be healed

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63
Q

cast used for:

A

-fractures
-congenital structural bone d/o
-other musculoskeletal d/o

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64
Q

2 casting materials

A

-fiberglass : better because lighter and can be made waterproof
-plaster of Paris

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65
Q

how to apply cast

A

-may need to gently pull on the body part being casted to correctly align
-may use traction table for positioning/tension
-first layer is stockinet stretched over the area with soft cotton padding over bony prominences
-after cast set, stockinet is pulled up and over the edges of the cast
-warn pt. that plaster of Paris strips will feel cool at first, then warm; will not burn

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66
Q

pt. care if casted

A

-keep cast elevated to prevent edema
-regular neurovascular checks

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67
Q

common neurobiological conditions in childhood that can also persist into adulthood

A

ADHD

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68
Q

ADHD sx

A

impairment in fx caused by
-inattention
-hyperactivity
-impulsivity

presents differently by age

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69
Q

ADHD causes

A

-environmental
-genetic
-physiological

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70
Q

ADHD: inattention

A

-difficulty organizing tasks
-reluctance to do tasks that require mental effort over time

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71
Q

ADHD: impulsivity

A

-acting before thinking
-difficulty taking turns
-blurting answers before ? completed
-interrupting others
-excessive shifting between activities

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72
Q

criteria for ADHD diagnosis

A

-thorough initial hx
-physical exam
-completion of evidenced-based rating scale by adult familiar to the child

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73
Q

Wechsler Intelligence Scale for Children (WISC) purpose and 2 sections

A

-intelligence test
-verbal scale and performance scale
-3 final scores: verbal IQ, performance IQ, combination/full-scale IQ

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74
Q

Children with language difficulties on WISC test

A

-typically poor scores on verbal scale, but average or greater on performance scale

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75
Q

Therapeutic management of ADHD

A

-environmental modification
*structure
*reward system
*504 plan
-family support
*counseling
-medication

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76
Q

Dysfunctional First Stage of Labor caused by _____(3)

A

-Prolonged Latent Phase
-Protracted Active Phase
-Secondary Arrest of Dilation

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77
Q

Prolonged Latent Phase defined as:

A
  • > 20 hours nulliparous
  • > 14 hours in multiparous
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78
Q

Protracted Active Phase defined as:

A
  • <1.2cm/hr nulliparous
  • <1.5 cm/hr multiparous
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79
Q

Secondary Arrest of Dilation defined as

A

No dilation for >2 hours

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80
Q

Dysfunctional Second Stage of Labor caused by ________ (2)

A
  • Prolonged Descent
  • Arrest of Descent
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81
Q

Prolonged Descent defined as:

A
  • <1cm/hr in nulliparous
  • <2cm/hr in multiparous
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82
Q

Arrest of Descent defined as

A

-No descent for 2 hours in nulliparous
-No descent for 1 hour in multiparous

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83
Q

Complications related to labor caused by: (3)

A

-power
-passenger
-passage

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84
Q

how power relates to labor complications

A

-dysfunctional labor

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85
Q

how passenger relates to labor complications

A

-umbilical cord prolapse
-fetal position, presentation, size
-shoulder dystocia

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86
Q

what is done if passage relates to labor complications

A

-forceps birth
-vacuum extraction

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87
Q

complications with power of labor caused by

A

-ineffective uterine force (infrequent or mild contractions)
-hypertonic contractions (frequent contractions with no resting tone)
-uncoordinated contractions (contractions initiated from more than one part of the uterus)

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88
Q

ineffective uterine force

A

infrequent or mild contractions

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89
Q

hypertonic contractions

A

frequent contractions with no resting tone

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90
Q

uncoordinated contractions

A

contractions initiated from more than one part of the uterus

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91
Q

tx for complications of labor related to power (3)

A

-artificial rupture of membrane (AROM)
-oxytocin (pitocin)
-C-section

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92
Q

Precipitous labor

A

labor is that completed in 3 hrs. or less

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93
Q

Precipitous birth

A

-second stage that lasts 15 minutes or less

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94
Q

risk factors for Precipitous labor & birth

A

-hypertonic uterine contractions
-oxytocin
-multiparous client
-hypertensive d/o
-prior precipitous labor or birth

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95
Q

Nursing Care for Precipitous labor & birth

A

-DON’T LEAVE THE PATIENT
-reposition on their side
-encourage panting
-MONITOR for complications
-MAY need Terbutaline

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96
Q

Augmentation of labor def

A

-progress labor that has already started

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97
Q

Augmentation of labor tasks

A

-AROM (artificial rupture of membrane)
-oxytocin

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98
Q

Induction of Labor defined

A

artificially start labor

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99
Q

Methods of labor induction

A

-Cervical ripening (prostaglandin gel, cervadil, cytotec, foley balloon)
-oxytocin
-stripping membranes (may be done to naturally stimulate birth because stimulate contractions and prostaglandins; must be at least 39 weeks

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100
Q

Uterine Rupture risk factors (4)

A

-prior C-section
-overdistended uterus
-uterine hyperstimulation
-prior uterine scar

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101
Q

Bishop score

A

-done by provider after vaginal exam
-Bishop score >6 will get oxytocin
-Bishop score <6 will get something for cervical ripening

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102
Q

Uterine rupture physical assessment findings (5)

A

-ripping or tearing sensation
-abdominal pain and tenderness
- non-reassuring FHR
-Change in uterine shape
-signs of shock

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103
Q

how often can cytotec be given

A

-every 4 hrs
-max # of doses is 6

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104
Q

uterine rupture nursing care (6)

A

-notify provider
-prepare for emergent C-section
-admin IV fluid
-admin O2
-Admin blood as ordered
-educate/support client

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105
Q

-stripping membranes

A
  • may be done to naturally stimulate birth because stimulate contractions and prostaglandins;
  • must be at least 39 weeks
    -may cause minor bleeding
    -if had classical c-section, cannot have membranes stripped
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106
Q

Amniotic fluid embolism risk factors (7)

A

-advanced age
-placenta previa
-placental abruption
-preeclampsia
-oxytocin
- C-section
-uterine rupture

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107
Q

Amniotic fluid embolism sx (4)

A

-sudden chest pain or sudden shortness of breath
-indications of respiratory distress
-indications of coagulation failure
-indications of circulatory failure

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108
Q

amniotic fluid embolism (7)

A
  • O2 (81-10 L)
    -assist with intubation / ventilation as needed
    -CPR as necessary
    -IV fluids
    -Blood as ordered
    -Prepare for emergent C-section
    -prepare for transfer to the ICU
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109
Q

umbilical cord prolapse risk factors (6)

A

-PROM (premature rupture of membrane)
- non-cephalic presentation
-placenta previa
-small fetus
-polyhydramnios
-multiples

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110
Q

umbilical cord prolapse findings

A

-visualization or palpitations of the umbilical cord
-FHR with variable or prolonged descent
-Excessive fetal activity followed by cessation of movement

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111
Q

umbilical cord prolapse nursing care

A

-call for assistance immediately / notify provider (YELL!!!)
-vaginal exam to elevate presenting part of fetus off the cord
-reposition to Knee-Chest or Trendelenburg position
-Admin O2
-Admin IV fluids
-prepare for delivery

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112
Q

Shoulder Dystocia risk factors

A

-large fetus (over 4000 g)
-diabetes
-postdates

113
Q

Shoulder dystocia nursing interventions

A

-documentation
-McRoberts maneuver (open legs and push towards chest)
-Suprapubic pressure (nurse stands on stool and pushes fist against pubic bone)
-provider will do other maneuvers if above not effective

114
Q

Multiple gestation def:

A

pregnancy w/ 2 or more fetuses

115
Q

multiple gestation considerations (6)

A

-concerns for cord entanglement
-difficult to find multiple heart rates
-engagement may not occur
-risk for cord prolapse
-risk for PPH (post partum hemorrhage)
-risk for c-sections

116
Q

abnormal fetal presentations (4)

A

-face
-brow
-breech
-shoulder

117
Q

birth methods if problems with passage

A

-forceps birth
-vacuum extraction
-trial of labor with C-section (TOLAC)
-external cephalic version

118
Q

describe forceps birth

A

spoon like instrument to assist in fetal delivery

119
Q

vacuum extraction

A

cup like suction to assist in fetal head delivery

120
Q

trial of labor after c-section (TOLAC) described

A

-attempt for vaginal delivery after a previous c-section;
-if successful, vaginal birth after cesarean (VBAC)

121
Q

external cephalic version

A

-procedure used to turn in utero to vertex

122
Q

anomalies of the placenta (4)

A

-placenta succenturiate
-battledore placenta (marginal)
-velamentous cord insertion
-vasa previa

123
Q

Placenta Succenturiate described

A

accessory lobe

124
Q

Battledore Placenta (marginal)
described

A

cord inserted near the edge

125
Q

Velamentous Cord Insertion

A

cord inserted into the membranes not the body of the placenta

126
Q

Vasa Previa

A

fetal blood vessels run across the OS

127
Q

anomalies of the cord (2)

A
  • 2-vessel cord
    -nuchal cord
128
Q

two vessel cord described

A

1 vein
1 artery

129
Q

nuchal cord described

A

cord wrapped around the fetal neck

130
Q

A pregnant client who is carrying triplets is concerned when their obstetrician suggested that they give birth by cesarean delivery. What is the most accurate statement that the nurse can make to the client regarding this?

A

A cesarean delivery helps to prevent complications due to cord prolapse or premature placental separation.

131
Q

You assess that the fetus of a client is in an occiput posterior position. You know that their labor most likely will be different from a client whose fetus is in an anterior position in that the client

A

May experience more pronounced back pain

132
Q

Affects four or fewer joints, typically the large ones (knees, ankles, elbows). Most common subtype of JIA.

A

Oligoarthritis

133
Q

Affects five or more joints, often on both sides of the body (both knees, both wrists, etc.). May affect large and small joints. Affects about 25% of children with JIA.

A

Polyarthritis

134
Q

Affects the entire body (joints, skin and internal organs). Symptoms may include a high spiking fever (103°F or higher) that lasts at least two weeks and rash. Affects about 10% of children with JIA.

A

Systemic

135
Q

Joint symptoms and a scaly rash behind the ears and/or on the eyelids, elbows, knees, belly button and scalp. Skin symptoms may occur before or after joint symptoms appear. May affect one or more joints, often the wrists, knees, ankles, fingers or toes.

A

Psoriatic arthritis (PsA)

136
Q

Also known as spondyloarthritis. Affects where the muscles, ligaments or tendons attach to the bone (entheses). Commonly affects the hips, knees and feet, but may also affect the fingers, elbows, pelvis, chest, digestive tract (Crohn’s disease or ulcerative colitis) and lower back (ankylosing spondylitis). More common in boys; typically appears in children between the ages of eight and 15.

A

Enthesitis-related

137
Q

Symptoms don’t match up perfectly with any of the subtypes, but inflammation is present in one or more joints.

A

Undifferentiated

138
Q

JIA sx

A

-Joint pain or stiffness; may get worse after waking up or staying in one position too long.
-Red, swollen, tender or warm joints.
-Feeling very tired or rundown (fatigue).
-Blurry vision or dry, gritty eyes.
-Rash.
-Appetite loss.
-High fever.

139
Q

complications to eyes if JIA untreated

A

Eyes. Dryness, pain, redness, sensitivity to light and trouble seeing properly caused by uveitis (chronic eye inflammation). More common with oligoarthritis.

140
Q

complications to bones if JIA untreated

A

Bones. Chronic inflammation and use of corticosteroids may cause growth delay in some children with JIA. Bones may get thinner and break more easily (osteoporosis).
Mouth/Jaw. Difficulty chewing, brushing or flossing. More than half of children with JIA have jaw involvement.

141
Q

complications to neck if JIA untreated

A

Neck. Inflammation of the cervical spine can cause neck pain or stiffness. Swollen neck glands could also signal an infection for kids with SJIA or who take immunosuppressing drugs.
Ankles/feet. Foot pain and difficulty walking. More common in polyarthritis and enthesitis-related arthritis.

142
Q

complications to skin if JIA untreated

A

Skin. Symptoms can range from a faint salmon colored rash (SJIA) to a red, scaly rash (psoriatic arthritis).
Lungs. Inflammation and scarring that can lead to shortness of breath and lung disease. May occur in SJIA.

143
Q

complications to heart if JIA untreated

A

Heart. Inflammation may cause damage to the heart muscle. May occur in SJIA.
Digestive Tract. Abdominal pain and diarrhea. More common in children with spine arthritis or ankylosing spondylitis.

144
Q

complications to reproductive organs if JIA untreated

A

Reproductive organs. Late onset of puberty. Certain drugs such as cyclophosphamide may lead to fertility problems later.

145
Q

complications re: weight if JIA untreated

A

Weight loss or gain. Due to changes in appetite, jaw involvement or difficulty exercising. Being overweight puts extra stress on the joints.

146
Q

most common pediatric rheumatic disease that affects teens and children under the age of 16

A

Juvenile Idiopathic arthritis

147
Q

Adolescents age

A

13-20

148
Q

adolescent growth and development

A

-onset to completion of puberty (secondary sex characteristics)
-cessation of physical growth

149
Q

Tanner stages

A
150
Q

adolescent nutrition

A

-must consume adequate calories
-especially need protein, iron, calcium, and zinc to meet growth needs

151
Q

puberty defined

A

time at which an individual first becomes capable of reproduction

152
Q

biological details of onset of puberty for both sexes

A

F: menstruation begins
M: produce spermatozoa

153
Q

usual age for puberty

A

11-14

154
Q

age of menstruation in females

A

11.9 (gradually decreasing from 12); probably related to overall increase in weight

155
Q

teenage reaction to puberty

A

questions about what is normal and not

156
Q

Erickson developmental task in adolescence

A

establish independence from parents by gaining a sense of identity vs role confusion

157
Q

Piaget on adolescence

A

formal operations: reach cognitive development termed formal operational thought (abstract and rational thoughts)

158
Q

adolescent health promotion

A

-challenging period of development; stressful; need guidance in making lifestyle choices that promote health and avoidance of behaviors that detract from achieving optimal health

159
Q

nurse role in adolescent behavior

A

promote safe behavior:
-motor vehicle accidents, homicide, and suicide are leading causes of death
-risk of substance abuse; affected by tobacco/vapes
-refer to specialist sooner than later

160
Q

nursing care activities in adolescents

A

-poor lifestyle choices can lead to health problems in adulthood like hypertension, diabetes, heart disease
-important to identify problems and refer for care
-adolescents usually respond best to healthcare personnel who respect their attempts of independence and who allow them as many choices as possible in care

161
Q

screen time

A

-teens spend 8.5 hrs/day on screen
-linked to vision problems including myopia, dry eyes at closer distances because tendency to blink less
-digital eye-strain headaches
-eye muscle problems (esotropia with eyes turned inwards, which may need surgical correction)

162
Q

how to manage screens

A

-elbow rule: keep an elbow to wrist distance from anything viewed
-20/20 rule: take a break from reading or screen work every 20 minutes for 20 seconds (during break, look across the room to relax eye focus)
-2 hour rule: limit recreational screen time to 2 hrs

163
Q

current concerns of teens (8)

A

-physical activity
-depression/anxiety
-drugs/ alcohol
-bullying
-obesity
-peer pressure
-social media
-violence

164
Q

Physical activity adolescence

A

-recommended activity to 60 min/day to reduce obesity, CHD, diabetes
-determine activities they like
-find classes/events with those activities they like
-plan family vacation and day trips that incorporate hiking and walking

165
Q

depression and anxiety in adolescence

A

-cited as major problem with seven out of ten teens say anxiety and depression are a problem among peers
-according to the National Institute of Mental Health: an estimated 3m teens had at least one major depressive episode in 2017
-too much time on electronic devices may be preventing teens from in person activities

166
Q

bullying in adolescence

A

-55% found bullying was a major problem among their peers
-current anti-bullying programs seem ineffective
-suggest that parents talk to their teens about the topic and be proactive in helping their child deal with a bully
-parents need to work closely with schools and clubs to ensure they have anti-bullying policies in place
-may engage in self-harm

167
Q

obesity in adolescence

A

-according to CDC, 20% of 12-19 year olds are obese
-often targeted by bullies, greater risk of lifelong health problems like diabetes, arthritis, cancer, liver, heart disease
-may impact self esteem
-educate on healthy diet

168
Q

drug and alcohol use

A

-daily marijuana use has increased in recent years; more than cigarette use now
-33% of HS seniors report drinking in the past month
-talk to teens to educate them about dangers of alcohol and prescription drugs

169
Q

peer pressure in adolescents

A

-magnified by social media
-sexting can be consequence of online peer pressure
-pressure to have sex, do drugs, bullying others

170
Q

talking to teens about peer pressure

A

-do not give lengthy lectures
-make expectation and opinion clear

171
Q

social media

A

-connection can be beneficial or not
-exposure to unwanted people, content
-educate teens on risks and disadvantages
-enforce barriers of use/know what apps, websites, and media pages teens use

172
Q

if meningitis suspected, nursing action is

A

-place on droplet precautions
-watch I/O
-quiet environment
-HOB 45 degrees to help reduce swelling

173
Q

violence (adolescence)

A

-watching violence linked to lack of empathy and aggressive behavior
-parents reaction to media is the #1 factor determining how children react
-talk to teens about impact of watching violence

174
Q

acne

A

-inflammatory condition of skin with blocked sebaceous glands activated by androgenic hormones
-sebum (from sebaceous gland) moisturizes skin
-acne from hormone changes
-risk factors: puberty, family hx
-lesions: open comedones (blackheads), closed comedones (white heads), papules, pustules, & nodules

175
Q

things that make acne worse

A

-diet (certain foods make acne worse)
-stress
-pressure from sports helmets, tight clothes
-environmental irritants (pollution, high humidity)
-scrubbing skin too hard
-squeezing blemishes

176
Q

acne tx

A

-benzoyl peroxide wash with OTC retinoid, BCP, antibiotics
-see dermatologist for nodule tx
- 6-8 weeks to see improvement

177
Q

Acne meds

A

-retin-A prescribed with comedones; prevent sebum plugs; caution with sun exposure
-benzoyl peroxide may make skin worse at first
-systemic antibiotics taken 2-4 weeks for any improvement; doxycycline can cause stomach upset; may diminish effects of OCPs
-oral contraceptives: watch for signs of clotting, closure of epiphyseal centers
-isotretinoin very dry to skin, teratogenic

178
Q

HTN in adolescents: risk factors

A

-being overweight
-genetics
-males
-lifestyle
-higher incidence in Hispanic/African American
-underlying disease

179
Q

adolescent HTN possible complication

A

HTN in adolescent correlated with HTN in adulthood

180
Q

Adult CVD linked to

A

-teenage smoking
-overweight teens
-inadequate fruit/veg in diet
-exercise 1/3 to 1/2 meet exercise guidelines

181
Q

normal BP for 13-18

A

<120/<180

182
Q

elevated BP 13-18

A

120/<80 to 129/<80

183
Q

Stage 1 HTN for Children 13-18

A

130/80 to 139/89

184
Q

Stage 2 HTN for 13-18 years

A

> or = to 140/90

185
Q

4 normal uterine positions

A

-anteversion
-anteflexion
-retroversion
-retroflexion

186
Q

deviations in the uterus

A

A) normal
B) bicornuate
C) uterine septum
D) double uterus (didelphys)

187
Q

menstrual cycle

A
188
Q

ovarian cycles

A

-primary follicle
-theca
-antrum
-ovulation
-corpus luteum
-mature corpus luteum
-corpus albicans

189
Q

pregnancy hormone

A

HCG

190
Q

uterine cycle

A

-menses
-proliferative phase
-secretory phase

191
Q

basal body temp during menstrual cycle

A

-lowest at ovulation
-secretory phase/luteal phase is higher

192
Q

phases of ovarian cycle

A

-follicular phase
-luteal phase
-divided by ovulation

193
Q

menarche

A

-first menstrual cycle

194
Q

menarche average age

A

12.4 yrs, average range 9-17

195
Q

interval between cycles

A

21-35 days, 28 days on average

196
Q

dysmenorrhea def, cause

A

painful periods caused by prostaglandins increasing tone in uterus

197
Q

tx for dysmenorrhea

A

prostaglandin inhibitor: Motrin, NSAIDS

198
Q

abnormal uterine bleeding

A

-longer than 9 days
-more often than every 21 days
-abnormally heavy bleeding

199
Q

menstrual migranes

A

-caused by decline in estrogen just before period

200
Q

tx for menstrual migraines

A

birth control pills (have estrogen)

201
Q

premenstrual syndrome

A

luteal phase; tired, irritable

202
Q

premenstrual dysphoric d/o (PMDD)

A

-physical s/s, emotional s/s
-abnormal
-must have at least 5 severe sx
-tx w/ antidepressant or birth control

203
Q

endometriosis

A

-overgrowth of endometrial tissue; in places other than the uterus (ie. fallopian tube, cervix, lungs)
-cause unknown, but there are many theories, none of which seem to be 100% correct
-pain in any area where endometrial tissue is present; sometimes asymptomatic
-can affect fertility

204
Q

menstrual health education

A

-exercise is good unless excessive;
-sexual activity not contraindicated
-ADLs: no contraindications
-pain relief: ibuprofen most effective
-rest: may be helpful if sleep affected by dysmenorrhea
-nutrition: may need iron supplement

205
Q

sexually transmitted infections (pt. interactions)

A

-be nonjudgmental
-do not assume partner’s gender
-ask past hx

206
Q

chlamydia

A

-bacterial infection of genitals
-if untreated, can cause infertility (by pelvic inflammatory disease)
-often asymptomatic; (female may have pain or change in bleeding standard); (male may have watery or thick discharge from penis)
-doxycycline 100 mg BID for 7 days
-patients’ recent partners also should be treated; no intercourse for 7 days

207
Q

Gonorrhea

A

-bacterial infection of genitals, throat, or anus
-sx: discharge from infected area, pain
-tx: ceftriaxone 500 mg IM once

208
Q

syphilis

A

-bacterial infection entering the body through breaks in the skin or linings of the genitals
-damages internal organs including heart, brain, spinal cord
-painless ulcer (chancre) usually on genitals; later swollen glands, rash, hair loss
-blood test RPR or VDRL)
-tx penicillin G

209
Q

genital warts (low risk HPV virus)

A

-fleshy or flat lumps on or around genitals, anus, groin, thigh
-diagnosis: visual inspection/biopsy
-tx: cryotherapy or pt. applied creams

210
Q

HSV

A

-HSV 1 (usually oral)
-HSV 2 (usually genital)
-painful red blisters than can ooze; flu-like sx w/ 1st infections
-diagnose: PCR of lesion
-tx: antivirals (valtrex, acyclovir)

211
Q

trichomoniasis

A

-parasite
-sx: yellow/green vaginal discharge, strawberry cervix; males usually asymptomatic
-dx: uterine swab, urethral swab
-tx: females: 500 mg BID 7 days; males: flagyl 2 grams once

212
Q

reproductive life planning

A

-highly individualized
-preference may depend on variety of factors including medical contraindications, desire for children, religious, cultural, personal beliefs, financial means, ability to choose

213
Q

4 methods of contraception

A

-natural family planning
-barrier methods
-hormonal methods
-surgical methods

214
Q

birth control tier 1 (most effective)

A

-implant
-vasectomy
-tubal occlusion
-IUD

215
Q

Tier 2 birth control methods (middle tier)

A

-injectable
-pill
-patch
-ring

216
Q

Tier 3 birth control (least effective)

A

-male condom
-fertility awareness based methods
-diaphragm
-sponge
-withdrawal
-female condom
-spermicides

217
Q

natural family planning method

A

-abstinence
-fertility awareness method
-lactational amenorrhea (use of breast feeding to prevent pregnancy; under 6 months of age, menses not restarted, exclusive breastfeeding)
-coitus interruptus (withdrawal of penis prior to ejaculation)
-calendar method (aka rhythm method; monitor cycle for 6 months, minus 18 from shortest cycle, minus 11 from longest cycle, update every month with the most recent 6 months)
-basal body temperature (BTT): daily monitoring of BTT, temperature measured first thing in morning, BBT will drop 0.5 degrees F just before ovulation, then increase 1 degree F at time of ovulation until menses
-cervical mucus method: check mucus daily; increases before ovulation; on day of ovulation, becomes thin, watery, stretchy (Spinbarkheit)
-symptothermal method : combine BBT and cervical mucus method
-ovulation awareness: ovulation predictor kits; assessing LH surge in the first morning urine; expensive

218
Q

barrier methods of contraception (condoms)

A

-condoms: best defense against STI;
-natural condoms are porous and allow STIs through
-male condoms are external
-female condoms are internal
-water based lubricant only

219
Q

barrier methods of contraception: diaphragms

A

-must be fit by provider
-must be replaced every 2 years
-must be refit every time person gains or loses 10 lbs
-need spermicide
-leave in place for 6 hrs after
-can stay in 24 hours total
-can cause UTIs
-risk of toxic shock syndrome

220
Q

barrier methods of contraception: cervical caps

A

-fit by provider like diaphragm, but replaced yearly
-need spermicide
-left in place for 6 hrs after intercourse
-can stay in place for 24 hrs
-risk of toxic shock syndrome

221
Q

Combined Oral Contraceptive (COC)

A

-One pill every day of the month
-contains estrogen and progesterone
-prevent pregnancy by inhibiting ovulation, alter cervical mucus, alter endometrial lining
-efficacy: perfect use: 99.7% effective; typical use 93% effective

222
Q

monophasic vs multiphasic COCs

A

-monophasic: same dose of active pill for 3 weeks; may help depression, breakthrough bleeding may occur
-multiphasic: altered dose of active pill each week; simulates normal hormonal cycle; less risk of breakthrough bleeding

223
Q

Contraindications to estrogen

A

-35 or older, smoking 15 or more cigarettes/day
-elevated BP =>160/or=>100
-multiple risk factors for arterial cardiovascular disease: smoking, diabetes, older w/HTN
-diabetes accompanied by nephropathy, neuropathy, retinopathy, vascular disease, diabetes > 20 yrs(risk of vascular damage)
-less than 6 weeks postpartum
-major surgery, prolonged immobilization
-current or hx of DVT (or family hx of unprovoked DVT), PE, ischemic heart disease, migraine w/focal neurologic sx/aura, liver tumors or cirrhosis, current breast cancer, valvular heart disease

224
Q

common s/e of estrogen

A

-nausea
-altered menstrual cycle (breakthrough bleeding, amenorrhea)
-water weight gain
-breast fullness/tenderness
-increased vaginal discharge
-mild hypertension
-depression

225
Q

serious complications of estrogen

A

-Abdominal pain
-Chest pain/shortness of breath
-Headaches (sudden/persistent), CVA or HTN
-Eye problems (vascular accident or high BP)
-Severe leg pain (DVT?)

226
Q

Additional Combined Hormonal Methods: transdermal patch

A

-same contraindications as the combined pill except additional contraindication of BMI>=30
-new patch weekly for 3 weeks, then one week w/out patch

227
Q

Additional Combined Hormonal Methods: vaginal ring

A

-same contraindications as combined pill
-insert ring into vagina for 3 weeks, then ring free for one week

228
Q

Progesterone only pills (POPs)

A

-good if contraindications for estrogen
-can use while breastfeeding or postpartum
-take at same time daily
-s/e: increased appetite, fatigue, depression, hirsutism, breast tenderness
-if more than 3 hours late taking pill, must use backup birth control method for 5 days

229
Q

Progesterone only IM injection

A

-1 injection every 11-13 weeks
-good if contraindication to estrogen
-can use while breastfeeding/postpartum
-fertility can take up to 18 mos. after discontinuation
-s/e: weight gain, depression/emotional lability, vaginal dryness, altered menses, headaches, acne, decreased bone mineral density

230
Q

progesterone only contraceptive method: subdermal implant

A

-good if contraindication to estrogen
-can use while breastfeeding/postpartum
-implant inserted into the rod, good for 3 years
-s/e: similar to IM injection

231
Q

IUD

A

-hormonal: mirena, skyla, kyleena, liletta last 3-8 years
-nonhormonal: paragard lasts 3-10 years (or 12 years)
-contraindications: active cervical or uterine cancer, active STI/pelvic inflammatory disease, uterine distortion
-s/e: irregular bleeding, cramping, both lasting 3-6 months

232
Q

emergency contraception

A

-“morning after pill”
-contraception given after unprotected intercourse
-can be taken 120 hrs post
-disrupts timing of ovulation
-single dose of med
-copper IUD can also be used as emergency contraception

233
Q

how emergency contraception works

A

-prevents pregnancy by inhibiting ovulation, altering endometrial lining, thickens cervical mucus
-does not cause an abortion
-will not disrupt an implanted pregnancy
-no major contraindications
-most effective the sooner taken
-typically alters next period, cause nausea

234
Q

surgical contraceptive methods: female

A

-tubal ligation
-common, esp. postpartum
-blocks the passage of sperm through the fallopian tube
-abdominal surgery

235
Q

surgical contraceptive methods: males

A

-vasectomy
-only male contraception
-prevents passage of spermatozoa
-outpatient procedure
-does not work immediately (takes about 3 months)

236
Q

termination of pregnancy: medical

A

-up to 9 weeks after LMP
-methotrexate and misoprostol (IM or oral methotrexate followed 3-7 days after misoprostol placed)

237
Q

termination of pregnancy: surgical

A

-aspiration
-dilation and curettage (D&C)
-dilation and evacuation (D&E)
-prostaglandin or saline induction
-Rhogam to be given within 72 hrs in all terminations with - Rh blood type

238
Q

subfertility def:

A

-inability to sustain pregnancy to childbirth
-inability of a couple of reproductive age to conceive after 12 months or more of regular coitus w/out using contraception

239
Q

causes of subfertility (female)

A

-unknown
-anovulation
-anatomic defects of female reproductive tract

240
Q

causes of subfertility (male)

A

unknown
abnormal spermatogenesis:
-abnormal count
-morphology
-motility
-volume

241
Q

evaluation of the infertile couple: male and female hx

A

-age of couple
-duration of infertility
-previous infertility in other relationships
-frequency of coitus
-use of lubricants
-mumps (male)
-renal disease
-exercise habits
-previous surgery
-radiation tx
-STIs
-chronic disease
major stress/fatigue
-recent hx of acute viral or febrile illness
-exposure to chemicals, excessive heat

242
Q

female specific eval of subfertility

A

-pelvic inflammatory disease
-previous pregnancies
-douching
-work exposures
-alcohol or drugs
-exercise
-eating d/o
-menstrual cycle length, regularity
-indirect indicators of ovulation (mittelschmerz, mid-cycle cervical mucus change, premenstrual sx)
-v/s, height, weight
-HTN
-hair distribution
-acne
-hirsutism
-thyromegaly
-enlarged lymph nodes
-abdominal masses/scars
-galactorrhea
-pelvic exam

243
Q

fertility assessment and testing

A

semen analysis:
-#of sperm
-appearance of sperm
-motility of sperm
-sperm penetration
-sample must be kept at body temp
-pt. must abstain from ejaculation for 2-4 days
-can be changed
-semen matures in 90 days

ovulation monitoring
-record basal body temperature
-ovulation by test strip
-assess upsurge of LH that occurs before ovulation

tubal patency assessment
-sonohysterography: ultrasound to inspect uterus
-hysterisalpingography: radiologic exam of fallopian tubes

244
Q

sonohysterography

A

-ultrasound with saline to inspect uterus
-a secondary test

245
Q

hysterosalpinography

A

-radiologic exam of fallopian tubes w/dye to find obstructions
-a secondary test

246
Q

uterine endometrial bioposy

A

-tissue abnormalities
-a secondary test

247
Q

hysteroscopy

A

-direct visualization into uterus via vagina and cervix
-pt. may have shoulder pain after (normal)
-a secondary test

248
Q

laparoscopy

A

-via abdominal wall under general anesthesia during follicular phase
-shoulder pain from CO2 getting under diaphragm is normal

249
Q

management of subfertility (4)

A

-increasing sperm count
-infection tx
-medical management
-surgery

250
Q

assisted reproduction technology (ART): AI/TDI

A

-Artificial insemination or Therapeutic donor insemination
-multiples common
-sperm introducd directly into the vagina or cervix

251
Q

assisted reproduction technology (ART): IUI

A

intrauterine insemination: sperm inserted directly into the intrauterine cavity (past cervix so more likely to reach an egg)

252
Q

assisted reproduction technology (ART): IVF/ET

A

in vitro fertilization with embryo transfer: egg fertilized by sperm in dish, then transferred into the fallopian tubes

253
Q

assisted reproduction technology (ART): ZIFT

A

Zygote Intrafallopian Transfer (rare)

254
Q

assisted reproduction technology (ART): other

A

-surrogate embryo transfer (donor egg used)
-preimplantation genetic diagnosis (screening zygote to be used for ZIFT for chromosomal abnormalities)

255
Q

Subfertility alternate options

A

-surrogacy
-adoption
-child-free living

256
Q

genetic counseling: genes

A

-homozygous
-heterozygous
-dominant
-recessive

257
Q

homozygous:

A

2 like genes lead to a trait

258
Q

heterozygous

A

2 different genes lead to a trait

259
Q

dominant

A

only 1 gene needed to be expressed

260
Q

recessive gene

A

both parents need to have the gene for it to be expressed

261
Q

chromosomes (in each gene)

A

-46 chromosomes
-23 from each parent
-44 autosomes
-2 sex chromosomes (male determines sex)

262
Q

phenotype

A

outward expression of genes

263
Q

genotype

A

actual gene composition

264
Q

single gene analysis

A

-not diagnosed by chromosomal analysis
-transmitted by mendelian principle

265
Q

causes of chromosomal abnormality

A

-monosomy, trisomy
-autosomal chromosome abnormality:
dominant -mutation or recessive
-sex chromosome abnormality: (X-linked dominant or X linked recessive)
-known intrauterine environmental factors

266
Q

Mendelian inheritance: autosomal dominant

A

-a dominant gene is the one gene of a pair that is expressed
-if heterozygous parent has an infant with a homozygous parent without the trait there are four ways to combine the four genes (see image); 50% chance child will express the trait
-ex. Huntington’s Disease

267
Q

Mendelian inheritance: autosomal recessive

A

-genes expressed only if homozygous
ex: PKU, Tay-Sachs, CF, sickle cell anemia
-if both parents have gene, 25% chance of expression in child, 50% chance child will be a carrier, 25% chance child will not inherit gene at all

268
Q

X-linked dominant genes

A

-XX female
-XY male
-if mother affected 50% chance daughter affected, 50% chance son is affected
-if father affected, 100% daughters affected, 0% of sons affected
-ex: vitamin D resistant rickets, Rett Syndrome

269
Q

X-linked recessive genes

A

-carried only on X chromosome
-theoretically only males get disease
-no male-to-male transmission
-if mother is carrier, 50% chance son is affected, 50% chance daughter is carrier
-ex colorblindness, muscular dystrophy, hemophilia A and B

270
Q

genetic counseling: nursing responsibilities

A

-assess for s/s of genetic d/o
-offer support
-assist in value clarification
-educate on procedures, tests

271
Q

genetic counseling: Assessment

A

-hx
-physical assessment
-diagnostic testing:
–karyotyping
–maternal serum screening (MSAFP)
–Chorionic villi sampling
–amniocentesis
–fetal imaging
–preimplantation diagnosis

272
Q

genetic counseling: legal and ethicl issues

A

-participation must be elective
-informed consent
-results must be interpreted correctly
-confidentiality must be maintained
-participation must be free, individual decision

273
Q

Trisomy 13 syndrome

A

-severe ID
-midline body d/o (VSD, cleft lip & palate)
-microcephaly
-rarely survive past first year

274
Q

Trisomy 18 syndrome

A

-severe ID
-congenital heart defects
-Small for Gestational Age (SGA)
-low set ears
-rocker bottom feet
-rarely survive past infancy

275
Q

Down Syndrome (Trisomy 21)

A

-most common (1 in 800 pregnancies)
-varying degrees of ID
-congenital heart disease
-hypotonia
-low set ears
-one transverse palmar crease instead of two
-protruding tongue

276
Q

Cri-du-Chat syndrome

A

-severe ID
-abnormal “cat-like cry”
-small head
-wide set eyes

277
Q

Turner’s syndrome

A

-gonadal dysgenesis
-one functional X chromosome
-ID
-1 in 10,000 live births

278
Q

Klinefelter syndrome

A

-males w/ extra X chromosome
-secondary sex characteristics do not develop
-1 in 1000 live births

279
Q

Fragile X syndrome

A

-X link d/o
-inadequate protein synaptic responses
-1 in 1000 live births
-ID
-boys before puberty, maladaptive behavior, autism

Nur 404 (5 decks)

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