Final stuff Flashcards
Once the umbilical cord is clamped and the infant takes the first breath…..what happens
the transition from intrauterine to extrauterine life begins.
S/s of pregnancy dangers
severe, persistent vomiting Abdominal pain and vaginal bleeding Indicators of infection Preeclampsia Premature rupture of membranes Preterm labor Decreased fundal height Absence of fetal movement after quickening
- Nursing Care for Pediatrics (Illness and Non-illness)
The best historian for pediatric people- are
PARENTS
- Born with, slows everything down-tired, sluggish, poor feeding, cold extremities, constipation, loose WT due to not eating
s/s-Feeding problems, decreased activity, constipation, prolonged jaundice, skin mottling, umbilical hernia
Congenital Hypothyroidism
- Skin Infections
- caused by B-hemolytic streptococci or staphylococci or both bacteria infection-spreads like WILF FIRE- contagious when crusty and weeping. Tx- bacterial cream
Diaper rash-candaditis
Yeast infection
———bacterial infection-gets under skin tissues, causes inflammation
———- red (slap baby face) a virus- get it from contact-drooling on toys/rattles
Fungal infection- tinea capitus- ring worm on head, tinea corpus-ring worm on the body
Tx of ring worm-
Eczema (Dermatitis)
Scabies
Impetigo
Cellulitis
Fifths disease
antifungals -Do not cover it up because heat makes it spread. Check animals if not in sports such as wrestling.
- ERICKSONs Theory— KNOW what Stage of growth and development they are in. 16 year old in hospital- don’t chose what they like to do (such as video games, choose what supports their growth and development)
Yes
- Growth and Development (Fine Motor/Gross motor)
FINE motor skills:
6 months of age- pincher grasp
6-12 months- able to pick up stuff
2 years of age- putting blocks in a bucket, using a spoon
5 years of age- cutting with a scissors
17 years old- playing instrument, detailed art, knitting, crocheting, beading
Girls develop fine motor skills before boys
GROSS motor skills:
6months- roll and sit
9-12 months- crawling, pulling self-up, maybe standing with hands on couch
9-15 months- trying to walk
ALL CHILDREN IS DIFFERENT
Boys develop gross motor skills before girls
H
- Post-Surgical Care for Maternal and Pediatric Patients
PRIORITY care:
Pain Management
Obstetrics what is priority- Hemorrhage, uterine contractility whether its vaginal or cesarean
Infection- would find about 2 days after surgery. Fever not unusual postpartum- why? It’s the inflammatory response to a vaginal/cesarean delivery.
Pediatric patient post care- Airway first priority NO MATTER WHAT
H
- Preterm Labor/Birth
Below 37 weeks is preterm labor
s/s of preterm labor- bright red bleeding, regular contractions that do not go away with hydration and rest
-if contracting- drink some water, lay down, wait an hour. Go in if not changing
32 weeks- plan of care:
Figure out exactly how far along they are, what meds we can give, IV and hydrate, if contracting give trebuterline-smooth muscle relaxant-stops labor by relaxing the muscles. Side effect to mom= adrenaline-heart rate goes up- many cant tolerate well. Know what cervical dilation is. Is not working can also give betamethasone IM to make sure baby is able to breath on its own, magnesium sulfate-helps with uterine contractility- good sign if contractions are stopping (most common reason it is used) Normal mag sulfate level= 1-3?
I
- Preterm Newborn
What to give if baby comes out at 32 weeks- give surfactant- helps with movement in lungs (alveoli)- matures lungs
B
- Maternal Diabetes
Gestational diabetes- shoulder dystocia, broken clavicle, hypoglycemia for the baby following delivery due to mom receiving insulin through out pregnancy. Babies pancreas is still producing insulin after birth from mom.
How to treat low BS in newborn? Breast food, give sucrose
Big baby-macrocosmic baby- if mom gives birth to one we are concerned about- potential lacerations, stretched uterus very large= possible post-partum hemorrhage
Diabetic moms may have polyhydramnios- too much amniotic fluid-common in diabetic moms.
Y
- Triad of Newborn needs (Breathing, Nutrition, Warmth)
If a baby is born from a diabetic mom-what is it going to be working on? Concerned about blood sugar, be cold (using body heat), and going to struggle for oxygen. This is why we need to warm/ dry them, suction/clear airway, bread feed, or baby will use all of their sugar as well as struggle to breath.
H
- Pain assessments in newborns, pediatrics, and women
FLACC or CRIES scale
Look at crying grimacing, facial expressions, flexed position, grunting, nasal flaring
Pediatrics- faces wonker scale, body, interaction, asking them, using language they use at home (ouwie)
17-year-old pain- numeric pain scale. Ask them how they feel. Ask Where, describe the pain to me.
N
- Pregnancy Changes
First trimester 0-23 weeks expecting to occur? Nausea, breast tenderness, urination increase, mood swings
Normal urination? Ask does it hurt when you pee
Chadwiks sign, other signs?
2nd trimester 12-24- gains the most weight, all previous s/s should go away unless have hyperemesis, 20 weeks fundus is at belly button, GI slows-due to hormone relaxin, harder to breath because lungs are displaced due to diaphragm being pushed up. SOB is common in this stage, edema is normal in feet but NOT face. Carpel tunnel in the wrist is common due to increased pressure on the nerves. Blood pressure during pregnancy should stay about the same- look at history to see if it is normal for them.
3rd trimester 25-40 weeks- if gains a lot of weight what to be concerned about? HTN, preeclampsia, Polyhydramnios, (should not have large WT gain)
U
- Mental Health Assessments maternal and pediatric
How to assess for behavioral issues in pediatrics- ask questions. How to know if physical abuse is occurring? May have bruising on areas such as wrists, chest, flank, face, burns, UTI, may be resistant to things. Emotional abuse- maybe withdrawn, others answering questions for them- may have emotional abuse or trauma
Types- mental, physical, emotional, sexual- UTI, neglect, financial, lynchalphybroxia?? Make your children sick, Premature infants/ females are at risk
(
- Hematologic Conditions
Ion deficiency anemia s/s- physical well-being-
Sickle cell anemia-cant carry all the oxygen due to being crescent shaped. Crisis means cells get jammed up in joints may have increased pain, decreased perfusion because oxygen is unable to diffuse to extremities. How to tx crisis- pain management, oxygenation, hydration. Warm pack to get blood flowing.
Hemophilia- unable to clot blood- bleeding precautions put in to place. Life expectancy- depends on state of condition and lifestyle they live.
Cold pack with inflammation
I
- ICP- Intercranial pressure- can happen due to meningitis, brain tumor, stroke, abuse head trauma, brain injury. How to know they have it? Hyperactivity, increased restlessness, inability to stay awake, sunseeting eyes, bulging fontinales, fluid inside head with change VS and go into hypovolemic shock state (low BP..???) Inability to concentrate, HEADACHE, confusion. Tx of ICP- mannitol- (hypertonic solution)
Spinabifida- can have chronic ICP. Tx- includes shunt from brain to abdominal cavity and absorbed into circulatory system.
Shunt issues with ICP- should NOT have swelling such as buldging foltenals, infection, fever, ect.
I
- Postpartum Assessments
What does it include after post-labor? BUBBLEHE
Breasts- day 1- colostrum, D2-3, milk come in, lactating moms education on engorgement- feed baby-put to breast, not breast feeding and engorgement teachings? Don’t touch, cabbage leaves, don’t stand under hot water-will lactate, empty both breasts (either by pumping or feeding)
Uterus- contract- firm, shrink-want little discharge, what is consider PPH post op- frequently soaked pad (every hour), over 1000 ML
B- Bladder- mom should be able to urinate- if she had an ISN, a narcotic, or epidural she may have delayed voiding abilities because of muscle tones.
Bowels- Constipation? Due to moms being afraid to have BM because of known or expected pain, laceration, episiotomy. Tx- increase water intake, fiber intake, stool softener, tux pads. May have hemmoroids.
Lochia- Types- Rubra- lasts 2-3 days, serosa-bloody mucusy discharge that should occur before they go home, Alba-discharge once mom ovulates again. Mucusy discharge.
Episiotomy- done for shoulder dystocia to be able to get in there and manipulate. Lacerations-infection, Hematoma- may be bulging shiny grey perineum, all blood in moving into cavity, hypovolemic shock state, BP down, pulse increase, s/o pain, may not be able to feel if epidural. Within first 24 hours
Homans- don’t do any more- Blood clot s/s- calf or thigh enlargement, warmth, pain, redness, decrease pulse to extremity, may go to lungs if dislodged- (pulmonary embolism)- s/s: SOB, dyspnea, anxiety.
I
- KUBLER-ROSSs stages of Grief
Anger, denial, bargaining, acceptance
Abnormal condition dx- parents may be in denial
Drown, dead child, initial reaction to trauma** ???
H
- Musculoskeletal Conditions in Pediatrics
Scoliosis- identified in school age population- most common- clubfoot tx- casting, 23 hours a day should be left on, 1 hour for ROM and rest hour, should be changed every? ** in 3 years????? Idk if you do not change cast size leg should stay the same size and cause major constriction to leg.
Most common after born??- hip dysplagia, cerebal palsy, CLAVICAL- broken bones is #1- assess for compartment syndrome- CMS- check circulation, motion and sensation. Include everytime a bones breaks-expeciialy in long bones. Compartment syndrome s/s- pallor skin, can loose extremity, cold….??
H
- Neurological Conditions
Spina bifida-spinal defect when they are born
Cerebral palsy-
Meningitis- nuchal rigitidy, headache, photophobia. Viral and bacterial differences, bacterial can KILL
I
- Pediatric Caner
Issues it creates for families- stress, fighting, family instability, care giver burn out,
J
- Prenatal Substance use
Tobacco- low birth WT, children have long term resp issues even if in womb, can cause allergies, can cause preterm labor due to decreased perfusion
Illicit drugs such as cocaine- cause placental abruption- dark red painful bleeding
Alcohol- long term use- fetal alcohol syndrome
Y
- Obstetrical Emergencies
Shoulder dystocia- how do you know one has it? The head comes but nothing else comes with it, head turns/curdling, purple/blue looking. 5 minutes to get out or neurological issues may occur.
Cord prolapse- cord presents first( hang out of vagina or due to amiotomy-broke water and cord fell first) sudden decrease in FHR after amniotomy, what to do? Find out what is up inside vagina.
Uterine rupture- decrease in FHR, pain, loose mom if not observant
Pre-eclampsia
Placental abruption
H
- Obstetric Prioritization
How to know who to see first? ABC’s Always look at the person who has not been assessed yet that are postpartum. (may have post-partum hemmorage= #1 killer in the world for women) ALWAYS CHECK UTERINE AFTER DELIVERY
G
- Vaccinations (types, route, frequency)
REVIEW GRID-ages- newborn, school age, etc.
H
- Cervical Examinations
What are we looking for? Dialation, station of baby, defacement (thickness of the cervix)
I
- Stages of Labor
1st stage: 0-10 CM
Phases:
Latent- dilated 0-3, contractions are 5-10 minutes about, no pain, feelings crampy, happy, don’t keep at hospital
Active- 4-6cm pain, serious, notice contraction
Transition-7-10 cm- demeaner- anxious, shake, throw up, demand pain meds
2nd stage- complete to pushing baby out- up to 3 hours
3rd stage- baby to placenta- 30ish minutes? If retained placenta = PPH
4th stage- postpartum- up to 6 weeks- 1 year
H
- Amniotic Fluid
Purpose- cushion/protection, temp regulation in baby, allows baby for movement, supports fetal lung development. Made of urine and lung secretion. Normal amount? Too much? Polyhydramnios. Diabetic, peeing,Too little?? Renal issue- oligohydramnios What happens to baby?
H
- Labor Induction
How to induce labor- #1 way- Pitocin- if mom isn’t dilated at all? Give Cytotec, sevedol, miscodol, gymnocystal?????
Non medication way to induce labor? Cervical stripping-stretch cervix- painful.
Amniotomy-breaking the water will help bring the babies head down into the cervix and help increase dialation.
J
- Mononucleosis
Caused by the Epstein Barr? Virus (kissing disease)
s/s – tired, lethargy, increased organ (spleen) growth, no contact sports or pressure on spleen
J
- Hypertensive Maternal Conditions
Headache, decreased urination- why? Decreased perfusion, protein due to inflammation. Proteinuria, blurred vision, anxiety, seizures- due decreased perfusion???? Pre-eclampsia, perfusion to liver they have upper Rt quadrant pain
Deep tendon reflexes- are hyper.
Tx- give mag sulfate
Consequences of too much mag sulfate= respiratory depression, decreased reflexes?????
How to hook up mag sulfate- IV- how to set up pumps? Primary line set up. Mag is piggy bagged into matenience line by the hand. NEVER PIGGY BACK ON THE PUMP. Closest port in hand. If mom is toxic what to do? Disconnect it from hand.
When to d/c mag sulfate (toxicity): low respirations in mom- resp-6/min.
How to know she is coming out of her mag toxicity? She can breath, return of deep tendon reflexes, increase respirations.
What happens to baby during mag toxicity? Decreased variability, small gestational baby if chronic problem
Antidote for mag sulfate- calcium gluconate
H
- Fetal Heart Tracings – VEAL CHOP
a. V- variability- caused by cord compression- how to fix? Reposition
b. E- early decelerations- caused by head compressions, fix? NO.
c. A- accelerations- are OKAY! not necessary. Movement?
d. L- late- caused by placental insufficiency- fix by hydration, reposition, and oxygenate.
C-ord compression
H-ead compression
O-okay
P-placental insufficiency
e. Variability -above
f. Baseline ??
g. Acceleration- OKAY
h. Deceleration - above
i. Duration- beginning of contraction to end, Frequency- beginning to beginning of contraction- Fetal HR traces.
Rate rate goes down and just continues- prolonged deceleration- PROBLEM- hydration, repo, oxygen, then if don’t resolve- may need emergency c-section
HR- absent- FETAL compromise! Do something fast!!
HR- minimal- kind of moves- SLEEPING
HR- anywhere from five to 25 beats- moderate
HR- all over place-marked- will distress baby
U
- Blood Administration
Include consent, infuse with in 30 minutes, infuse max of 4 hours. If person is not tolerating blood infusion? Slow rate down- how to know to slow it down- do math to figure it out.
What to hang blood with? Normal Saline
s/s of blood infection? Initial reactions? Fever, flank pain, rash, crackles in lungs, anaphylactic reaction (usually in first 15 minutes) (decrease airway), watch patient, don’t leave them, frequent vitals.
What to do if one had anaphylactic reaction to blood? Stop infusion, run NS, call DR.
H
- Hyperbilirubinemia
Jaundice, increase risk with breastfed babies or babies that are not eating at all. They are at risk due to low volume but better nutrients-takes longer to get rid of meconium. Tx- light therapy, wear ete and genital protection, no lotion, can take feeding breaks.
I
- Intrauterine Growth Restriction
Not good, due to nutrient or placental perfusion problem,
how to know if one had it? If not measuring uterus correctly- at 30 weeks and measuring at 24.
Small for Gestational age- can be due to IUGR- are smaller than piers are at same time of age. (at least 2-4 weeks difference??)
H
39. APGAR Appearance Pulse Grimace Activity Reflex
B
- LATCH Score
How well the baby is latching onto breast
Included in scoring?
L-latch
A-amount of swallowing- clicking noise when swallowing
T-type of nipple (all nipples can nurse) inverted, flat, exverted??
C-comfort- should not hurt to nurse baby- if pain-baby is not latched properly.
H-hold- hold baby to breast, in football type hold, depending on how large breasts are or if baby has brace on legs.
H
- Orthopedic Conditions
- Pediatric Burns
Superficial, superficial partial, partial, full burn
How to care? First step to burn care? Airway first -Resuscitate them. How? IV fluids is most important, address infection, nutrition, and PAIN.
Most common burn- sunburn- most damage to skin before age 18- sunscreen! reapply
H
- Childhood behaviors
Depends on development stage- ERIKSONS
H
- Respiratory Acid Base
Cord blood- PH level to be concerned- less than 7.1
PaCo2 is above 60= resp problem- always r/t resp
Metabolic= same as adult acid base
H
- Bleeding Disorders in Pregnancy
- Placenta previa- placenta is covering uterus- c-sections are at increased risk -bright red painless bleeding, the side that should be connected to the uterine wall is now exposed and blood is leaking out. Tx- depends of dialating? How much is she bleeding? Betamethasone – mom should get 2 injections 12 hours apart to help with fetal lung development
Placental abruption- dark red painful bleeding. Tx?
H
- Dietary needs for fetus, women, and pediatrics
Folic acid, calcium, iron- when do moms develop all calcium stores? Want them BEFORE pregnancy because it helps with bone formation in fetus.
Iron- helps with blood/oxygen compacity, decrease anemia (moms are chronic anemia because of increased circulating blood volume. Increase oxygen compacities.
J
Antibiotics for mom in labor- given IV- if allergic to penicillin give ampicillin
H
KNOW VETAL HEART STRIPS Absent-BAD Minimal-okay Moderate- look at Marked-BAD
Late decelerations- STOP PITOCIN- repo, fluids, o2
Normal HR- 110-160 bpm
And vitals
Temp? in Celsius
Position for cord prolapse- hands and kneeds
Counter pressure- (press on uterus with contractions)
Nygals rule
Bilirubin labs, WBCs
PKU
Increased vernix= premie
Increased lanugo= premie
Aminoscentesis- massage uterus first, then Pitocin
Fontenals- front diamond? 12-18 months closes
Back- triangle? 2 months closes
H
34 weeks- be alerted to: water breaking, no movement, continuous regular contractions, dark red bleeding, or bright red bleeding.
J
Slight increase in BP: epigastric pain (abnormal) swelling, blurred vision, headache, headache
J
If child needs blood transfusion post-op? Need parents consent Only hang blood with NS Need to have another nurse with Run for 2-4 hours
N
Greatest risk for PPH: large baby (uterus has hard time shrinking), multiple pregnancies, multiple gestations (twins)
B
Makes baby breathe for first time- cutting/clamping umbellical cord
Hypertensive s/s: seizures-mag sulfate
labetolol for HTN
hyperventilation in labor: breath into bag- no need to call dr.
Call Dr. if:
Cord prolapse, intense abd pain, bright red bleeding, dark red bleeding
7 month old food- finger food cherios, teething, crackers, DO NOT GIVE HOTDOGS, PASTA, BANANAS
Peds- post tonsillectomy-
Coughing a lot= bad- may bust stitches , swallowing a lot= bleeding, want to be calm, not scared.
# 1 congentital heart defects? Ventricular septal defect
J
Dehydration-
Sunken fontalels, decreased urine output, concentrated d/t v/d.????
Triage- if child hasent peed all day? Tell mom to give water
FLACC- face, legs, activity, crying, ,consolability.
When baby born suction?
Suction: mouth before nose
APGAR: Acrocyanosis = 1 for scoring
Umbelical cord: AVA= 2 arteries & 1 vein
Breastfed babies have increased likelihood of jaundice
What vitamins need more of when pregnant?
IRON- anemia, take with OJ, cause black tarry stools
FOLIC ACID and CALCIUM- vitD Cant absorb with out
H
Post partum depression?
Leading cause of death in children = injuries
Maltx in child is often caused by proxy/parent
Lumbar puncture after delivery- LAY ON SIDE
10 yo lumbar puncture- use distraction, education, support
Smoking and weed may cause: IUGR, LBW, premature rupture, miscarriage
H
RH factor: mom NEGATIVE, baby POSITIVE
All NEGATIVE moms get RhoGAM at 28 weeks or if there is any chance that mom or babies’ blood could mix (car accident, amniocentesis) Give again in 72 hours after birth if baby is positive
J
Cord blood gases: need to evaluate PH less than 7.1 AKA look at pcO2=resp and base excess (metabolic)
Example: PH- 7.0
CO2: 78= increase problem
PH: 7.0
Base 40 = metabolic problem
H
Probable s/s of preg: + preg test, chadwicks sign-purple cervix, goodalls sign, quickening, quickening )12-16 weeks), preg mask (choasma), line from pubic bone to line of scar.
J
