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FINAL 250 Flashcards

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1
Q

Fundus at 15 hr should be..

A

at the U, midline, bladder should be empty, with moderate rubra

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2
Q

Cardio changes during pregnancy

A

CO increase, BP decreases, stroke volume increases, physiologic anemia, after delivery the HR decreases

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3
Q

what to do when a fundus is boggy..

A

have them empty bladder, massage fundus, gice oxytocin, check bp

no methergine for cardiac mom

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4
Q

thermoregulation of newborn

A

prevent heat loss by evaporation- dry baby completely, put hat on them, dont give bath until stable temp at 97 degrees.

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5
Q

Rubin stages

A

taking in- mom focused on self

taking hold- regaining control and taking interest in baby

letting go- bonding with baby

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6
Q

capat succedaneum

A

swelling crosses the sutures line

happens immediately, resolves in few days.

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7
Q

cephalhematoma

A

bleeding between peritineum and skull - buldging fontanels

doesnt happen immediately, longer to heal.

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8
Q

what to do for pre term labor

A

hydrate

meds to stop labor - (tocolytics) trabutaline, mag sulfate, calcium channel blockers

look for infections - UA (urine analysis)

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9
Q

Risks for a prolapsed cord

and what to do

A

baby malpositioned - breech, baby not engaged - head not down low

Get mom in knee chest position, ER c-section (sometimes nurse or person doing exam that notices this, goes into surgery hold the head off the cord), 100% 02 by mask

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10
Q

s/s and tx for abruptio

A

dark blood, hard rigid abd, pain

ER- c-section

can cause DIC or fetal demise

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11
Q

s/s and tx of placenta previa

A

bright blood, soft abd, no pain

pad cont, contractions, fetal heart tone, no vag exam (do US), risk for PPH (especially if mag sulfate used)

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12
Q

Uterine atony

A

most common cause of PPH

massage fundus, empty bladder, oxytocin then methergine- cn cause hypotension, 02

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13
Q

Augmenting labor

A

massage the nipples (releases oxytocin), walk, change positions, give oxytocin

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14
Q

Resp distress syndrom (RDS)

A

number 1 complication of preterm or diabetic baby

lack of surfactant

grunting, cyanosis

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15
Q

Atraumatic care

A

explain on childs level of development

pain not a reason to stop care

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16
Q

health people 2010

A

easy access to health care, nutrition, decrease health disparities

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17
Q

Care in pediatric is..

A

family centered, open system

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18
Q

manifestations of pyloric stenosis

A

projectile vomiting after eating - no bile, dehydration - sunken fontanels, lytes imblances, in metabolic akalosis

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19
Q

Rheumatic fever tx

A

PCN for up to 5 years and with and surgery, ASA

cultures done for any sore throat

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20
Q

wilms tumor

A

monitor for HTN, DO NOT palpate abd, treat with chemo with or without radiation

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21
Q

TEF

A

coughing, chocking, cyanosis

regurge/ aspiration - suction !

NPO - straight to surgery

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22
Q

Hemophilia

A

factor VIII - most common

RICE

bleeding in joints - ROM and PT after, can give replacement factor VIII

non-contact sports

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23
Q

PKU diet

A

no protein, no milk - lolfenac for infants

unlimited fruits and veggies

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24
Q

serpation anxiety beings around

A

6 months, can last until about 2

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25
Q

car seats

A

must be used for all children

middle back seat, rear facing

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26
Q

Med admin

A

add 5ml of sweetener

no mixing with formula or primary foods

along side of mouth, upright, not when crying, if put syringe in infant mouth they will tend to stop crying and suck on syringe.

oral syringe

injections - 25 gauge, 5/8 in needle, vastus lateralis

check IV site every hour

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27
Q

Accidental poison..what to do..

A

call poison control

dont induce vomiting

take EVERYTHING with you (what was ingested, urine, vomit, etc)

Go to ER

have meds locked and up high.

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28
Q

Management of nephrotic syndrome

A

prednisone - usually high doses

albumin

protect from injection - room with non infectious child

check urine for protein

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29
Q

s/s pf sepsis

A

behavioral changes, feeding problems, elevated temp

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30
Q

asthma triggers

A

mold, pets, carpets, upholstered furniture, smoking in household

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31
Q

Kawasaki’s

A

tx with ASA high doses and IVIG

autoimmune

can lead to coronary artery aneurysm

s/s- strawberry tongue, red hands and feet, cracked lips

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32
Q

post op cleft lip and palate

A

LIP- elbow restraints, position supine or side lying, logans bar to decrease manipulation, cuddle to soothe baby- dont want to cry and put strain on sutures, NO utensils, feed upright - formula and soft foods only, allow breaks - have difficulty adjusting to nose breathing.

PALATE- position prone to promote drainage, can have hearing and speech problems

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33
Q

complications of leukemia

A

infection, fractures, bone pain, bleeding, anemia

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34
Q

AGN complcations, at risk for

A

acute renal failure- check bun, cr, I&O, daily weight, VS

stroke - give no added salt diet, diuretics, and HTN meds

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35
Q

s/s of bact meningitis

A

increase temp, increase WBCs, HA, nuchal rigidity

newborn - poor sucking, high pitched cry, lethargy

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36
Q

CP goals of care

A

to function as normally as possible

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37
Q

Tetralogy of fallot

A

4 defects: VSD, pulmonic stenosis, overring aorta, hypertrophy of right ventricle

may have tet spells

risk for emboli, seizures, loss of consciousness or sudden death following anoxic spell

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38
Q

home care pre op cardio surgery

A

teach parents to watch for tachycardia, tachypnea

most teaching abour surgery is done out of hosp

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39
Q

Coarcatation of the aorta

A

Assess BP - higher in upper extermities, lower in lower exterm

EKG, MRI will show - left sided heart enlargement due to bac pressure and also notching of the ribs from the enlarged collateral vessels

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40
Q

DM type 1 are at risk for what..

A

DKA - kussmaul resp, ketonuria, polyuria, excessive thirst, dry mucous membranes, acetone breath, are in metabolic acidosis.

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41
Q

Common cause of death in infants (0-12 months)

A

suffocation - most common

dall down stairs, pick things up and eat them, can burn easily

42
Q

injury in toddlers (1-3 yr)

and preschoolers (3-5yr(

A

Poisons, dart into streets, can drown in even 2 in of water, can open doors while driving, will put anything in their mouths.

43
Q

injury in school age (6-12yrs)

A

Motor vehicle accidents, sport injuries, drugs, firearms, walking to school - avoid unsafe areas

44
Q

injury of adolescents (13-18yrs)

A

motor vehicle, firearm, drugs, alcohol, suicides

45
Q

sources of lead poisoning

A

older cities - lead based paint used in houses, peels off and children eat it

can also be inhaled

46
Q

trust vs mistrust

A

birth to 1 year

infants need consisten, loving care by a mothering person

mistrust results when their is deficient or lacking of trust in the infants life, or their basic needs are not met.

47
Q

autonomy vs shame and doubt

A

1 to 3 years

autonomy- the child is able to control their new physical abilities as well as mental abitilies

shame and doubt happens when they are made to feel small, forced to be dependent in ares they capable of being in control

48
Q

initative vs guilt

A

3 to 6 years

initative- children are able to have their own mind and control their actions with being aware of threats

If they are made to feel their actions are bad, they will start to feel a sense of guilt

49
Q

industry vs inferiority

A

6 to 12 yrs

industry- feel the need to work, want to carry out activities that they can finish or complete. Start to compete and cooperate with others and learn rules

if too much is expected of them or they feel they cant measure up they have feelings of inferiority

50
Q

identity vs role confusion

A

12 to 18 yrs

start to become very concerned with their apperances and discovering their role in life

if they have trouble discovering their rold they end up in role confusion

51
Q

normal VS for newborn

A

BP - not taken on a newborn

P 120-160, apical for 1 min, 110-160 for fetal HR

R 30 -60, periods of apnea less then 20 sec is normal

T 97.7 - 99.1 (F) 36.5 - 37.2 , anything lower than 97.7 or 36.5, intervene, could be infection

52
Q

normal assessment of newborn

A

flexed, with some vernix and lanugo, newborn rash (sometimes seen), milia, iris-deep blue, sclera white, ears should recoil, small white dots on palate, breast engorgement is common and will subside, labia majora cover minora and clit - white or blood tinged fluid normal, closer the creases come to heel more mature they are, testes should be descended.

53
Q

LGA

A

90th precentile, above 8 lbs

at risk for hypoglycemia and birth trauma

Problems: more likely to go thru a longer labor, suffer injury at birth, or need to be delivered by C-section, shoulder dystocia, fx of clavicle, damage to cervical or brachial plexus, or facial or phrenic nerves, cephalhematoma, subdural hematoma, bruising , congenital heart defects, higher mortality rate

54
Q

ductus venosus

A

shunts 20-30% of blood f/umbilical vein to inferior vena cava & away f/immature liver; closes by 7-14 days after birth

55
Q

Foramen Ovale

A

provides opening btwn RA & LA so blood can bypass nonfunctioning lungs & go directly to LV & aorta; opens only in R-to-L direction b/c of high RA pressure & low LA pressure; closed by 3rd month

56
Q

ductus arteriosus

A

widely dilated to carry blood f/PA to aorta & avoid nonfunctioning lungs; functional closure by 10-96 hrs. & permanent closure within 2-3 mos.

57
Q

physiologic changes in pregnancy

A

Uterus increases in size and the walls thin, vaginal secretions increase and ph decreases, breasts and nipples increase in size - colostrum is produced, hyperpigmentation, hair grows, resp are faster and deeper, N&V due to high hcg levels first 6-12weeks, frequent urination in 1st and 3rd trimester, kindeys enlarge, center of gravity changes.

58
Q

SGA

A

problems- fetal distress, asphyxia, higher morbidity & mortality rates, low Apgar scores, meconium aspiration, polycythemia, hypoglycemia (b/c of inadequate storage of glycogen by liver), inadequate thermoregulation

59
Q

first prenatal first

A

Comprehensive Health History
Reasons for seeking care
History-OB, Menstrual, Contraceptive, Med/Surg
Physical Exam- Head to Toe
Pelvic Exam-external, internal, shape and measurements
Lab Tests

60
Q

prenatal blood work

A

Initial
Blood type and RH, Antibody screen, CBC-H&H, VDRL or RPR, HIV, Hep B Surf antigen, Tb, Rubella

15-16 weeks
MSAFP or triple or quad screen, Ultrasound

 **24-28 weeks**  Glucose challenge test or glucose tolerance, CBC, Rhogam if indicated

36 weeks
GBS

61
Q

Follow up prenatal visits

A

**Maternal assessment **
Vital signs, weight, urine-glucose, protein, ketones
Common discomforts, nutrition
Warning signs
Appropriate lab tests, u/s etc

Fetal assessment
Fetal heart tones
Fetal movement
Fundal height measurement
Leopold’s

62
Q

Stages of labor

A

1ST STAGE: Onset of Labor → 10cm
Latent- 0-3 cm, Active 4-7 cm, Transition 8-10cm
2nd STAGE: 10cm→Birth
3rd Stage: Birth of Baby →Delivery of Placenta
4th Stage: Delivery of Placenta →1-4hours post-partum

63
Q

True labor

A

CONTRACTIONS:
REGULAR, STRONGER, LONGER, MORE INTENSE, Back to Front

CERVIX:
PROGRESSIVE CERVICAL DILATATION, MORE ANTERIOR

LABOR: MAY BEGIN WITH ROM

64
Q

False labor

A

Contractions: Inconsistent in frequency, duration & intensity, Don’t change or may decrease w/activity (such as walking)

Pain: Felt in abd. & groin
May be more annoying than painful

Cervix Doesn’t significantly change in effacement or dilation

65
Q

maternal physiologic responses to labor

A

with contractions- increase BP and P

WBC: 14,000-25,000 cells/mm³

Resp rate nd 02 consumption increase

increase metabolism

increase temp

may have N&V,

muscle cramps and aches

66
Q

Fetal heart rate variablities

A

Baseline variability: we like to see some variability, its reassuring ex. Goes from 115, 120, 122, 130 etc.

Absent-no variability
Minimal-less than, equal to 5bpm
****Moderate-6-25 bpm(we love this!!)
Marked-over 25 bpm
Long term: Fluctuations of 6-10bpm
Short term: One beat to the next. Must have internal monitor.
No variability: Fetal sleep pattern or distress

67
Q

2nd stage of labor - fully dialated- interventions

A

Check labor progress to see if shes completely dilated

Continue to monitor mom and baby: FHT’s, Vital Signs, Contractions

Support for mom and dad

Turn radiant warmer on, have O2, ambu bag, (if resp depression)

Put bed in delivery position if needed

Perineal prep if requested (vag delivery is clean technique)

Assist nurse-midwife or MD as needed

Call NICU if required – if thick meconium, or a pre-me, or resp. depression,

68
Q

2nd stage - the birth

A

Crowning
Nurse Midwife or Physician will:push baby a lil to Control speed of delivery of head. (face down LOA, ROA)
Watch perineum
Episiotomy: only if needed
Check for nuchal cord
Clear mucous from baby’s mouth then nose
Deliver shoulders: light traction down and
then up
Clamp cord. Usually significant other cuts cord, ONCE THE BABY IS OUT

69
Q

Stage 3 of labor - birth of baby has happened - ends with delievery of placenta

A

Bonding taking place: Place warmed blanket over mom’s abdomen so baby may be given to mom
Assess baby
Apgar score at 1 and 5 minutes, color, breathing, even if moms holding baby
Weight, length, head circumference of baby in the warmer
Footprints
Identification bands, HUGS security band , 2 on baby 1 on mom 1 on dad

70
Q

3rd stage - expolsion of placenta

A

Nurse-midwife or MD will usually hold slight traction on cord, Too much traction could result in tearing of the cord.

Inspect placenta

Check for lacerations after delivery

Nursing Interventions:  Administer Oxytocin after delivery of placenta if ordered  Fundus, watch for excessive bleeding, Massage it  Vital Signs  Assist with laceration/episiotomy repair

DIRTY DUNCAN= MATERNAL, Shiny Shultz- fetal (baby)

71
Q

4th stage of labor - placenta is delievered to 4 hours post partum

A

VS q 15 minutes x 1 hour
Fundus: location in relation to umbilicus. One hour after delivery right at umbilicus (back up from the 3 cm down @ delivery) One sonometer down q day!! (3 days post partum= 3; 2 days =2)
Bladder - have them void
Lochia: Rubra (Red) first bleeding they have
Perineum- put ice on everyones perineum that gives birth first 24 hr
Pain management-ibuprofen! or Motrin
Bonding

72
Q

signs of an ectopic preg

A

Classic signs
Missed period****
Vaginal bleeding****
Abdominal pain****
Shock s/s are possible
Exam
+ pregnancy test
Adnexal fullness or tenderness or both on ovaries
+ Champaign sign (cervical motion tenderness)

73
Q

Medical management of ectopic

A

Labs:
B Hcg and Serum Progesterone
Transvaginal u/s
Surgical removal (Ruptured Ectopic, Tube ruptured) Taking tube out is salpingectomy
methotrexate - for a intact ectopic the tube has not yet ruptured, this is a chemp drug it’s a folic acid that makes cells stop growing

74
Q

pre and post of care of surgical removal of ectopic preg

A

Have blood products available
Pre-op labs generally include CBC, Type & Rh, Serum quantitative B Hcg

Post-op Care:
Verify Rh and antibody status
Rhogam if indicated
Grief counseling
Fertility counseling

75
Q

mild preeclampsia

A

BP 140/90

proteinuria- +1 or +2

edema- dependent, eyes, face, fingers

reflexes- normal +2

urine output- 30ml/hr

76
Q

severe preeclampsia

A

bp 160/110

proteinruria - +3 or +4

edema- generalized with pulmonary

hyperreflexia - +3 or +4 -clonus

urine - >20ml/hr

headache

blurred vision

irritability

77
Q

hyperemesis gravidarum

A

Monitor:
Wt & VS’s, Urine dipstick for ketones, Labs as ordered
liver function, electrolytes

Environment: quiet, dark, no odors

 Medications:  Phenergan, Benedryl, Zantac, Pepcid, Prilosec, Reglan, Zofran, Methyprednisolone

Diet progresses slowly
Must have no N/V for 48Hrs

IV fluids and may need TPN

Psychosocial Assessment
Emotional support

78
Q

risk for cardiac moms

A

miscarriage & PTL & PTD (preterm)
IUGR
risk of congenital heart lesions in NB
maternal mortality rate (in some cases 50% or >)

79
Q

DM mom post part care

A

Check BS q 2hr

Insulin requirements substantially decrease after delivery so BS values are tracked closely, lower insulin med given
IV of D5W initiated
Risks of preeclampsia/eclampsia, PPH (b/c a big baby their uterus cant contract as much), and infection exist
Breastfeeding is advised and encouraged
it decreases insulin needs significantly

80
Q

problems with the passenger

A 
Anomalies = gross ascities, lg tumor, open neural tube deficits
 Excessive Size (diabetics)= cephlo-pelvic disproportion (CPD), usually \>4000 gms
 Associated with maternal DM, obesity, multiparity, lg wt gain, lg parents
 Malposition = 25% have persistent occiput posterior (back labor) \*\*\*Reposition her on all fours\*\*\*
 Malpresentation = breech is most common
 Frank = thigh flexed, knees extended
 Complete = thigh and knees flexed
 Incomplete breech =foot extends below buttocks and knee extends below buttocks
 Multifetal pregnancy = overdistention of uterus leading to dysfunctional patterns
81
Q

Prolapse cord tx

A

Carefully assess during/after ROM

Immediate identification since fetal hypoxia can result & even death can occur w/o tx

SVE to lift presenting part

Maternal position changes****

Emotional support and information
O2 & IV fluids

Prepare for emergency delivery

82
Q

hypotonic uterine dysfunction

A

Definition: Normal progress is made initially then changes in the active phase of labor
ctx’s become weak & inefficient or stop altogether

Common causes-CPD cephalopelvic disproportions & malpresentations

Tx- assess fetal size and status
if normal-ambulation, hydrotherapy, an enema, stripping membranes, nipple stim, and oxytocin or ptocin-can be used

if abnormal -c/section

**Hypotonic uterine dysfunction is more common than hypertonic.

83
Q

Bishop score

A

Means to predict inducibility of the cx

Score includes-Cx dilation, effacement, fetal station, cx consistency, & cx position
Each category is scored 0-3
A score > or = to 8- means a successful induction is likely

84
Q

augmentation/induction of labor

A

Oxytocin - produced in posterior pituitary gland
It stimulates uterine ctxs
It is given IVPB as a 2nd line on a pump to induce or augment labor

Indications- IUGR, PROM, dysfunctional ctxs, postterm pregnancy, chorioamnionitis, maternal medical conditions (DM, pulmonary Dx), PIH, Fetal demise, Hx precipitous delivery

85
Q

GEST DM post part care

A

After delivery:
>90% of these women return to normal glucose levels
6 weeks PP/ After BF stop
75 gm 2hr glucose challenge test is done to assure a return to normal

***The infants of these women are at greater risk of obesity & DM in childhood or adolescence***

86
Q

puerperal infections

A

Bacterial infection after childbirth

Temp of 100.4 of ↑ after the 1st 24 hrs. & occurring on at least 2 of the 1st 10 days following childbirth

87
Q

Endometritis care

A

Goal: confine infectious process to uterus & prevent spread of infection throughout body

Abx until afebrile & asymptomatic for 24-48 hrs.
Prophylactic dose of Abx IV to any woman having a C/S

Comfort measures: warm blankets, cool compresses, cold/warm drinks, heating pad

Foods high in Vit. C & protein to aid healing

88
Q

endometritis s/s

A

Temp of 100.4 or higher within 36 hrs. of birth, chills, malaise, anorexia

Abd. pain & cramping, uterine tenderness, purulent, foul-smelling lochia

Tachycardia, subinvolution

Elevation in leukocytes

89
Q

wound infection care

A

Cultured & broad-spectrum Abx

Analgesics
Warm compresses or sitz baths may provide comfort & promote healting by increasing circulation to area

Surgical debridement for necrotizing fasciitis

90
Q

wound infection s.s

A

Edema, warmth, redness, tenderness, pain

Edges of wound may pull apart, seropurulent drainage

Fever & malaise

91
Q

UTI care

A

ABX - Pt. instructed to take med for entire time prescribed & not to stop when symptoms subside

2500-3000mL fluid/day

92
Q

UTI s/s

A

Begin on 1st or 2nd PP day

Dysuria frequency, urgency, suprapubic pain

Hematuria, low-grade fever

Pyelonephritis: chills, spiking fever, costovertebral angle tenderness, flank pain, N&V

93
Q

mastitis care

A

Supportive measures: moist heat or ice packs, breast support, bed rest, analgesics

Measures to prevent mastitis: position infant correctly & avoid nipple trauma & milk stasis, breastfeed q2-3h & avoid formula supps, nsg pads changed as soon as wet, avoid continuous pressure on breasts f/tight bras or infant carriers

Breast should be completely emptied at each feeding to prevent stasis, which can result in abscess

Massage over affected area before & during feeding helps ensure complete emptying

94
Q

mastitis s/s

A

May think she has flu b/c of fatigue & aching MM

Temp of 102.2 of higher, chills, malaise, HA

Characterized by localized lump or wedge-shaped area of pain, redness, heat, inflammation, & enlarged axillary Lymph node

Hard, tender area may be palpated

95
Q

Septic Pelvic Thrombophlebitis care

A

Readmission to hospital

Anticoagulation therapy w/IV heparin & IV abx

Warfarin may be given when heparin is d/c

96
Q

septic pelvic thrombophebitis s.s

A

Occurs when infection spreads along venous system & thrombophlebitis develops

Clinical S/S
Ovarian vein syndrome: pain in groin, abd., or flank
Fever, tachycardia, N, V, bloating, decreased or absent bowel sounds

97
Q

effects of substance abuse

A

Tobacco-↓O2, LBW vasoconstriction

Alcohol-IUGR, CNS, Facial Features

marijuana-Tremors, ↑Moro Reflex

Cocaine-Abruptio, low birth weight

Amphetamines-Vasoconstriction

Anti-depressants-unknown long-term

98
Q
A
99
Q

animism

A

Ascribing lifelike attributes to inanimate objects.

Fear a toilet because in a cartoon it ate a child.

100
Q

Shaken baby syndrome

A

Characteristic injuries: intracranial bleeding, retinal hemorrhages, fx of ribs/long bones

Severe forms: seizures, posturing, alterations in LOC, apnea, bradycardia, death

Long-term outcomes: seizure, blindness, developmental delays, hearing loss, cerebral palsy, mild to profound mental, cognitive, motor impairments

101
Q

signs of abuse

A

Conflicting stories about “accident” or injury

Cause of injury blamed on sibling/other party

Injury inconsistent w/hx (concussion & broken arm f/falling off bed)

Inappropriate response of caregiver (exaggerated/absent emotional response, refusal to sign for added tests or agree to necessary treatment, excessive delay in seeking treatment, absence of parents for questioning)

Inappropriate response of child (little/no response to pain, fear of being touched, excessive/lack of separation anxiety, indiscriminate friendliness to strangers)

102
Q

prevention of otitis media

A

pneumococcal conjugate vaccine (PCV); reduce RF (breastfeed for 1st 6 mos., avoid propping bottle, ↓ or D/C pacifier, prevent exposure to tobacco smoke)

Nursing 250-255 (6 decks)

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