Midterm Prep Flashcards
What is the acronym for a post-partum assessment and what does each letter stand for?
BUBBLERS Breasts Uterus Bladder Bowels Lochia Episiotomy (lacerations or perineum) Reaction (emotions) Signs (homan's, vitals, pain)
What should be assessed about the breasts during a post-partum assessment?
-if the mother is breast of formula feeding
-if breastfeeding assess
nipples (soreness, bruising, blisters, inverted nipples), breasts (softness, filing, full, engorged//anticipate milk to come in at 3 days)
for signs of mastitis (red mark or streak, warmth, fever, firm lump in breast)
-if not breastfeeding assess
comfort
avoid stimulation of the nipples
still need to assess breasts
What is mastitis and what are symptoms of it?
mastitis occurs when a milk duct in the breast becomes plugged
signs may include: red mark or streak, warm/hot area on breast, fever, firm lump in breast
what needs to be assessed about the uterus on a postpartum assessment?
- assessing involution (the contraction of the uterus)
- should decrease to the size of non-pregnant state within several days postpartum
- should be palpated to feel size and firmness
- assess pain - shouldn’t be super painful when palpated. this could indicate infection
- a boggy uterus indicates that contraction has not occurred. this can be a result of the bladder impeding it’s ability to contract, clots or pieces of membrane being in the uterus, or because the uterus is stretched/tired (this is usually in a mom who has just had multiples, has had more than 3 births, or had a large volume of amniotic fluid)
- anticipate uterus shrinks by 1cm per day post-partum
- need to note height of uterus, firmness, positions
what can aid the uterus in contracting postpartum and why is this important?
- contraction of the uterus helps to seal off where placenta attached and can help to prevent postpartum hemorrhage
- fundal massage immediately following birth and when mother arrives on postpartum unit can aid in contraction
- emptying bladder can help make space for uterus to contract
- breastfeeding can help uterus to contract because of oxytocin
- giving oxytocin (usually started when anterior shoulder is delivered)
what should be assessed in a postpartum woman who has had a cesarean delivery or a tubal ligation?
- palpate abdomen to assess involution (palpate fundus)
- check peripads
- assess pain (naproxen commonly given for pain
what should be assessed about a postpartum woman’s abdomen?
- fundal height
- firmness of the uterus
- position of the uterus
- any incisions
- musculature
what are afterpains?
pains caused by involution contraction
- more common after 2nd or later deliveries than for 1st time moms
- occur often during breastfeeding because of oxytocin causing contractions
- painful during contractions but should not be painful on palpation - this could indicate infection
what is diastasis recti abdominus and how is it assessed for?
- the separation of the rectus abdominus muscle
- should be assessed by visualizing and
- can be improved using the Tupler Technique
what are some of the normal developmental markers of a 2 month old?
weight of 4-6.5kg has a strong suck and gag reflex may lift head and hold object plays with fingers follows objects begins to smile
how are the fluid requirements for infants calculated?
100 ml/kg for first 10 kg
50 ml/kg for the next 10 kg
20 ml/kg for anything over 20kg
what are the anatomical and physical differences in the airways of infants?
- infant is 4mm in diameter (5x less than the size of an adults)
- during first 5 years airway increases in length but not diameter
- infants are obligate nose breathers until 4 weeks of age
- bronchioles are fewer in number and don’t increase until about 8 years of age
- infants have a higher metabolic rate which uses more oxygen
what is a major way that uncontrolled asthma can disrupt normal development?
causing a child to miss school
what is asthma
- a chronic inflammatory disease of the lungs that makes it difficult to breath
- cannot be cured but can be managed
- inflammation of the airway occurs and an increase in mucus production
- constriction of bronchial smooth muscle causes spasm
what age does asthma generally develop prior to?
the age of 6
can children grow out of asthma?
-yes, but it may reappear in adulthood
what is the operational diagnostic criteria for 1-5 year olds?
recurrent asthma-like symptoms or exacerbations with documentation of:
- airflow obstruction
- reversibility of airflow obstruction
- no clinical evidence of an alternative diagnosis
what are factors that increase the risk of developing asthma?
- family history of allergy or allergic disorders
- passive smoke exposure
- indoor air contaminants
- outdoor air pollutants
- recurrent viral infections
- low birth weight and respiratory distress syndrome
- obesity
what are the two factors that provoke asthma?
triggers (cause tightening of airways // bronchoconstriction)
inducers (cause inflammation of airways)
what are asthma triggers?
- things that when someone with asthma are exposed to, leads to exacerbation
- they DO NOT cause inflammation and therefore don’t cause asthma
what are some asthma triggers?
Indoor Air Trigger Strong fumes Scents Dust Mold Emotional upsets Smoke, 2nd and 3rd hand Cold Pets – often people will be told to get rid of pet, but this can cause emotional stress
Additional Triggers
Exercise
Aggravating conditions: rhinitis, GERD
o Post nasal drip can trigger coughing and drainage can settle into bronchioles
o May be more susceptible to pneumonia developing quickly
Menstrual cycle
what are asthma inducers?
- they are things that cause inflammation and airway hyper-responsiveness
- things like allergens and respiratory viral infections
what is meant by persistent asthma?
-symptoms that occur at least twice a week during the day and twice a month during the night
For children 6 years and older what are common medications for asthma?
for intermittent: short acting beta-agonist (bronchodilator)
for persistent: low dose inhaled corticosteroid and a long acting beta-agonist if needed
in more serious cases may introduce leukotriene receptor and systemic corticosteroid
for children between 1 and 5, what are common medications for asthma?
for mild exacerbations: short acting beta-agonists
for moderate to severe exacerbations: a short acting beta-agonist and a corticosteroid
what are the goals of asthma management?
- control symptoms so that there is no sleep disruption, missed school, need to visit ER
- be able to maintain normal activities, have near normal lung function and avoid side effects of medications
what is ventolin?
a bronchodilator used for prevention and relief of bronchospasm in those with asthma
why use a spacer for inhalers?
to make it easier for someone to take in the dose (hard to do if you have small lungs or impaired capacity so spacer hold the dose while you take it in over a few breaths)
- less coordination is required
- oropharyngeal deposition is decreased
- more drug is deposited in lungs!
why are inhaled medications used for asthma and generally prefered over oral?
- have a rapid onset of action
- less drug can be used
- often better tolerated with less side effects
- useful for acute symptoms treatment
- if someone is having trouble breathing, swallowing is probably really difficult
what is flovent
a corticosteroid
used to reduce inflammation and swelling
used for long-term control of asthma (not used for rescue)
-side effects can be a sore throat, hoarseness, thrush
what is methyprednisone
- an anti-inflammatory, immunosuppressant agent used to treat allergic, inflammatory, and autoimmune disorders
- usually given IV if quick onset needed (not given orally if you are having trouble breathing)
what is RSV
respiratory syncytial virus
- most common cause of lower respiratory tract infection in children worldwide
- virtually all children have had it by age of 3
- leading cause of pneumonia and bronchiolitis in infants
- may play a role in pathogenesis of asthma
what are symptoms of RSV?
- runny nose (rhinorrhea)
- wheezing and coughing
- irritability and restlessness
- low grade fever (but can get high temp)
- nasal flaring and retractions
- enlarged liver and spleen
how is RSV managed?
- hydration
- relief of symptoms (like giving bronchodilator)
- antiviral medication (ribavirin)
- oxygen therapy
- treatment of other infections
- humidity
what is para influenza?
- causes many pediatric respiratory infections, including upper respiratory tract infections, croup (laryngotracheobronchitis), bronchiolitis, pneumonia
- this virus is the major cause of croup
- virus that colonizes nose and nasopharynx then invades epithelium causing cell damage, edema, and loss of cilia
- fibrinous exudate develops with downward spread of cell damage and edema causing airway obstruction and laryngeal muscle spasm
what are symptoms of para influenza?
- low-grade fever
- nasal congestion
- sneezing
- sore throat
- cough (barking)
- inspiratory stridor
what is hemophilus influenza b?
- a bacterial infection that affects several body tissues and organs
- can cause meningitis and severe throat and/or lung infections
- 1 in 20 children who get it will die and 20-50% will suffer deafness and/or permanent brain damage
what are symptoms of hemophilus influenza b?
- meningitis
- fever
- stiff neck
- drowsiness
- extreme irritability
- sudden vomiting
- symptoms at a site of infection (can be skin or joint for example)
how can hemophilus influenza b be prevented?
vaccination
what is pertussis?
- a highly contagious bacterial infection
- affects respiratory system and produces coughing spasms that usually end in a high-pitched sounding deep inspiration (which is why it is called whooping cough)
- causes very thick sputum
how is pertussis diagnosed?
- a culture of secretions from mouth and nose
- a throat swab culture
- a CBC (usually elevated WBC and large number of lymphocytes)
- serologic (blood) test for Bordetella pertussis
- immunological tests
how can pertussis be prevented?
-vaccination
how is pertussis treated?
- if diagnosed very early, erythromycin may be used, but usually patients are only diagnosed after period of time when this would be effective
- oxygen tent with high humidity
- IV fluid
- suctioning of secretions
should cough suppressants be used in those with pertussis?
NO! cough suppressants can cause airway obstructions as secretions build
-secretions are often very thick and young patients may even need NG tube feeding because of how much it can impair swallowing
what is prevnar pneumococcal conjugate
- a bacterial infection spread by nasal droplets
- it is the leading cause of pneumonia and acute middle ear infections as well as childhood meningitis
- approximately 15 children under the age of 5 die in Canada each year because of this disease
what is the difference between active and passive immunization?
active is immunization with the bacteria/virus (even an inactivated form) that triggers an immune response
passive is protection against certain infections that is created by administration of antibodies derived from humans or animals
what is immune globulin?
- it is obtained from human plasma
- contains mainly IgG and small amounts of IgA and IgM
- contains antibodies that protect from disease
What are the BMI ranges and corresponding recommended weight gains for women during pregnancy?
<18.5 12.5-18kg//28-40lb
18.5-24.9 11.5-16kg//25-35lb
25-29.9 7-11.5kg//15-25lb
>30 5-9kg//11-20lb
