Milestone study Flashcards
● Reorient them to reality
● Ensure medication adherence
● Help family recognize early signs and symptoms
Schizophrenia care
● If needed, refer to grief counseling or a support group.
● Encourage activities that allow the individual to use past coping strategies
that will promote a feeling of self-worth and increased self-esteem.
● Encourage the individual to share his or her feelings.
● Encourage socialization with family peers and reminiscing about significant
life experiences.
Grief therapeutic response
● Address the underlying issue
● Safety
● Monitor vitals
● Keep patient oriented to environment as much as possible
● Reduce environmental stimuli (Keep environment calm and quiet and well
lit)
● Explain procedures
● Excellent table in this module
● Safety is priority
● Respond quickly to calls for assistance
Delirium care
● Middle to late stage of the disease
● Have patient close to nurse’s station
● Reorientate the person
● Safety
● Part of the neurodegenerative disease process in advance of dementia
during the mild cognitive impairment stage or even earlier
Alzheimer’s hallucinations
Develops 48 to 72 hours after cessation of alcohol and decrease within 4 to 5 days
● Elevated vitals
● Delirium tremens (DTs); may appear 12 to 36 hours after last drink
● Transient visual, auditory, or tactile hallucinations or illusions
● CIWA will determine if medication and what kind is needed
● Symptoms of withdrawal usually begin 4 to 12 hours after cessation or
marked reduction of alcohol intake
● Alcohol withdrawal usually peaks on the second day and is over in about 5
days. This can vary, however, and withdrawal may take 1 to 2 weeks.
● Safe withdrawal is usually accomplished with the administration of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium),
or diazepam (Valium), to suppress the withdrawal symptoms
Alcohol withdrawal
may appear 12 to 36 hours after last drink
Delirium tremens (DTs)
● is an opioid
● Also used to treat addiction & withdrawl
● can be used as a replacement for opioids, and the dosage is
then decreased over 2 weeks. Substitution of methadone during
detoxification reduces symptoms to no worse than a mild case of flu
● Treat narcotic drug addiction
Methadone
decreased level of consciousness respiratory depression constricted pupils
Methadone OD signs
● Assess verbal and nonverbal cues for escalating behavior
● Have patient talk about about what triggered them
● Use seclusion or have others leave the room
Aggression response
● Tort law
● A patient has communicated an explicit threat of imminent serious physical
harm or death to a clearly identified or identifiable victim or victims, and the patient has the apparent intent and ability to carry out such a threat
Duty to warn
● Antipsychotic medication is first-line treatment
● Safety
● Are they able to successfully function in society
Schizophrenia- treatment evaluation
● Never stop taking abruptly
● Must taper before a new medication can be started
● Sedation
● Respiratory decline
● Seizure
● Loss of consciousness
Anxiety drugs risk
● Reports mainly by family and teacher
● Vision and hearing test will be conducted too
● Failure to listen to and follow instructions
● Difficulty playing quietly and sitting still
● Disruptive, impulsive behavior
● Distractibility to external stimuli
● Excessive talking
● Shifting from one unfinished task to another
● Underachievement in school performance
ADHD exam
● Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function. The person knows these thoughts are excessive or unreasonable but believes he or she has no control over them. But still acts on them
● CBT help along with medications
Obsessive compulsive disorder
● Gain trust
● Show no judgement
● Do not give advice
● Offer support
Therapeutic communication abuse victim
● Complete baseline vitals.
● NPO eating and drinking at least 8hrs before the surgery.
● Education about expectations, incentive spirometry q2h
● Continued pain assessment
Appendicitis pre op prep
● Physical assessment
● Growth milestones reached
● Oral
● Ask about food
● Ask about self image
● Vitals signs are low
● Forced vomiting or use of diuretics and laxatives
Anorexia report findings
● Alcohol
● Diabetes
● Cholesterol
● Preexisting heart condition
● Obesity
● Sedentary lifestyle
● Smoking
● Target organ disease (brain, heart, peripheral artery disease, kidneys, eyes
Complication hypertension high risk
●Extreme fatigue, hair loss, brittle nails, and dry skin are common, and numbness and tingling of the fingers may occur. The voice may become husky, and the patient may complain of hoarseness.
● Hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, and hypothermia
Hypothyroidism
●Used to treat hypothyroidism.
●People should take in the morning on an empty stomach.
● If the pulse rate prior to administering the drug is more than 100 beats/min, it is important to notify the prescriber.
●Therapeutic Effects: Increased energy and decreased sleep
Levothyroxine (Synthroid)
● Some patients may have mild signs and symptoms that include bowel irregularity with intervals of alternating constipation and diarrhea, with nausea, anorexia, and bloating or abdominal distention.
● up to 70% of patients report an acute onset of mild to severe pain in the left lower quadrant. This may be accompanied by a change in bowel habits, most typically constipation, with nausea, fever, and leukocytosis
Diverticulosis signs and symptoms
● Rest, oral fluids, and analgesic medications are recommended. Initially, a clear liquid diet is consumed until the inflammation subsides; then, a high- fiber, low-fat diet is recommended.
● Keep NPO until pain resolved
● Allows bowels to rest
● If there is a blockage nothing can get past the blocked or swollen area
Diverticulosis interventions
● Failure to take more than two doses of anti-diabetic medication over a period of last 15 days
● Target organ damage
● Coma
● Amputation
● Death
Diabetes poor compliance
● Pulmonary congestion
● Dyspnea
● Orthopnea
● Crackles
● Cough
● Fatigue
● Tachycardia
● Anxiety
● Restlessness
● Confusion
● Paroxysmal nocturnal dyspnea
● Peripheral edema
● Weight gain
● JVD
● Anorexia
● Nausea
● Nocturia
● Weakness
● Hepatomegaly
● Ascites
● Dyspnea
● Orthopnea
● Paroxysmal nocturnal dyspnea
● Cough (recumbent or exertional)
● Pulmonary crackles that do not clear with cough
● Weight gain (rapid)
● Dependent edema
● Abdominal bloating or discomfort
● Ascites
● Jugular venous distention
● Sleep disturbance (anxiety or air hunger)
● Fatigue
Heart Failure symptoms
● NPO
● Decompression
● Monitor I&O
● Decompression of the bowel through an NG tube is necessary for all patients with small bowel obstruction; this may be tried for up to 3 days for patients with partial obstructions; resting the bowel in this manner can result in resolution of the obstruction.
● Nursing management of the patient with a small bowel obstruction who does not require surgery includes maintaining the function of the NG tube, assessing and measuring the NG output, assessing for fluid and electrolyte imbalance, monitoring nutritional status, and assessing for manifestations consistent with resolution (e.g., return of normal bowel sounds, decreased abdominal distention, subjective improvement in abdominal pain and tenderness, passage of flatus or stool).
● Maintaining fluid and electrolyte balance is a priority area to monitor in the patient with a small bowel obstruction.
● The presence of the NG tube in conjunction with the patient’s nothing-by-mouth (NPO) status places the patient at significant risk of fluid imbalance.
●measures to promote fluid balance are critically important.
● The nurse reports discrepancies in I&O, worsening of pain or abdominal distention, and increased NG output. If the patient’s condition does not improve, the nurse prepares him or her for surgery. Nursing care of the patient after surgical repair of a small bowel obstruction is similar to that for
other abdominal surgeries
Small bowel obstruction actions
● Airway patency
● Increase fluid intake
● Encourage effective cough and deep-breathing techniques
● Vitals
● Focused respiratory assessment
Pneumonia action
● Administer O2 at 1 to 2 L per nasal cannula
● Know the patients baseline 02 status
COPD oxygen flow rate
● Do not give if HR lower than 60
● Used for atrial fibrillation
● Toxicity causes anorexia, nausea, vomiting and neurological symptoms.
● Clinical manifestations of toxicity include anorexia, nausea, visual
disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. A serum digoxin level is obtained if the patient’s renal function changes or there are symptoms of toxicity.
HF digoxin
● improves cardiac contractility and decreases signs and symptoms of HF.
● Patients with renal dysfunction and older patients should receive smaller doses as it is excreted through the kidneys
Digoxin (Lanoxin)
● 3% Normal Saline
● Treatment of sodium deficiency (severe hyponatremia)
● Hypertonic solutions exert an osmotic pressure greater than that of the
ECF.
● When normal saline solution or lactated Ringer solution contains 5%
dextrose, the total osmolality exceeds that of the ECF
● Saline 3% or 5%
IV fluids hypertonic
● Morning stiffness lasting more than 30mins
● Bilateral joint swelling
● Low grade fever
● Rheumatoid factor (RF)
● Anti-citrullinated peptide antibody (ACPA)
● treated with NSAIDs and specifically the cyclo-oxygenase 2 (COX-2)
enzyme blockers are used for pain and inflammation relief. NSAIDs, such as ibuprofen (Motrin) and naproxen (Naprosyn), are commonly prescribed because of their low cost and analgesic properties.
Rheumatoid arthritis diagnosis
the nurse monitors fluid and electrolyte balance and assesses the patient for localized infection or peritonitis (increased temperature, abdominal pain, paralytic ileus, increased or absent bowel sounds, abdominal distention). Antibiotic therapy is given as prescribed.
Peptic ulcer disease NG tube
● TURP: surgical procedure of clearing the swelling
● Increased frequency of voiding, with a decrease in amount of each voiding
● Nocturia
● Hesitancy
● Terminal dribbling
● Decrease in size and force of stream
● Acute urinary retention
● Bladder distention
● Recurrent UTIs
Prostatic hyperplasia
● Rescue inhalers and inhaled or oral steroids can help control symptoms and minimize further damage.
Type I diabetes tight control
● Teach diaphragmatic and pursed-lip breathing
● Administer O2 at 1 to 2 L per nasal cannula
● Teach prevention of secondary infections.
● Teach about medication regimen
● Smoking cessation is imperative.
● The goal of supplemental oxygen therapy is to increase the baseline
resting partial pressure of arterial oxygen (PaO2) to at least 60 mm Hg at
sea level and an arterial oxygen saturation (SaO2) to at least 90%
● Long-term oxygen therapy (more than 15 hours per day) has also been
shown to improve quality of life, reduce pulmonary arterial pressure and dyspnea, and improve survival. Long-term oxygen therapy is usually introduced in very severe COPD, and indications generally include a PaO2 of 55 mm Hg or less or evidence of tissue hypoxia and organ damage such as cor pulmonale, secondary polycythemia, edema from right-sided heart failure, or impaired mental status.
● Although the hypoxic drive is often cited as a concern in administering supplemental oxygen to patients with COPD, in actuality it is a very small part of the overall stimulus driving the respiratory system
● Therapeutic strategies for the patient with COPD include promoting smoking cessation as appropriate, prescribing medications that typically include bronchodilators and may include corticosteroids, managing exacerbations, and providing supplemental oxygen therapy as indicated
● When the patient arrives in an ED, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. A short-acting inhaled bronchodilator may be used to assess response to treatment. Oral or intravenous (IV) corticosteroids, in addition to bronchodilators, are recommended in the hospital management of a COPD exacerbation. Antibiotics also benefit patients with COPD because bacterial infections often follow viral infections.
● Administer O2 at 1 to 2 L per nasal cannula
● Know the patients baseline 02 status
COPD treatment
tenderness, Distension, Rigidity, Anorexia, Nausea, Vomiting, Fever
IBD peritonitis symptoms
Long term inflammation from IBD can put the patient at risk of a bowel perforation and therefore peritonitis.
Long-term inflammation and ulcers in the colon can weaken the intestinal wall. Over time, these weaknesses may develop into a perforation. A perforation can allow bacteria and other intestinal contents to leak out into the abdomen, causing a serious condition called peritonitis.
IBD peritonitis
● Infections like sinusitis, colds, and the flu
● Allergens such as pollens, mold, pet dander, and dust mites
● Cockroaches
● Irritants like strong odors from
perfumes or cleaning solutions
● Air pollution
● Tobacco smoke
● Exercise
● Cold air or changes in the weather,
such as temperature or humidity
● Gastroesophageal reflux disease
(GERD)
● Strong emotions such as anxiety,
laughter, sadness, or stress
Asthma triggers
● Blood or Pus with diarrhea followed by a period of constipation
● LLQ abdominal pain
● Pseudopolyps that resemble stilagtes
Ulcerative colitis symptoms
● Peripheral arterial disease (PAD) happens when buildup on the walls of blood vessels causes them to narrow.
○ Most likely to develop in the legs
○ Asymptomatic.
○ Claudication.
○ Critical limb ischemia.
○ Acute limb ischemia
○ Cause for amputation if not
treated
Arterial insufficiency diabetic
● Stay at a healthy weight
● Don’t lie down after meals.
● Don’t eat late at night.
● Raisetheheadofyourbedby4to6
inches
● Don’t wear tight-fitting clothes.
● Don’t eat foods that cause GERD
● Encourage small, frequent meals
● Management begins with educating the patient to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation. The patient is instructed to eat a low-fat diet; avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages; avoid eating or drinking 2 hours before bedtime; maintain normal body weight; avoid tight-fitting clothes; and elevate the head of the bed by at least 30 degrees
GERD instructions
● Blood
● Electrolytes
● Urinalysis
● ECG
Pre op labs
● Maintain airway (roll on side)
● Cushion head
● Loosen restrictive clothing
● Suction ready
● Keep them safe away from objects
● Document seizure (time and behavior)
Seizure unconscious client
● A procedure that uses shock waves to break up stones in the kidney and parts of the ureter
● Monitor urine after (see stone particles amount or urine and blood)
● Administer pain medication
Uroliathiasis lithotripsy
● Neurological Assessment ● Vitals
● LOC
● Pain management
General anesthesia – post anesthesia care
Low platelet count- less than 150,000 platelets per microliter of blood.
thrombocytopenia
● A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.
Bleeding and petechiae usually do not occur with platelet counts greater than 50,000/mm3, although excessive bleeding can follow surgery or other trauma. When the platelet count drops to less than 20,000/mm3, petechiae can appear, along with nasal and gingival bleeding, excessive menstrual bleeding, and excessive bleeding after surgery or dental extractions. When the platelet count is less than 5000/mm3, spontaneous, potentially fatal central
● nervous system or GI hemorrhage can occur
Thrombocytopenia labs
● Alternative treatments in exercise- induced asthma
● Preventing leukotriene release from mast cells and eosinophils or by blocking the specific leukotriene receptors on bronchial tissues
● Oral asthma medication
Asthma-leukotriene inhibitors
● 1. Shake well immediately before each use.
● 2. Remove the cap from the mouthpiece.
● 3. Exhale to the end of a normal breath.
● 4. With the inhaler in the upright position, place the mouthpiece just inside the mouth, and use the lips to form a tight seal or hold the mouthpiece approximately two finger widths from the open mouth.
● 5. While pressing down on the inhaler, take a slow, deep breath for 3 to 5 seconds, hold the breath for approximately 10 seconds, and exhale slowly.
● 6. Wait 3 to 5 minutes before taking a second inhalation of the drug.
● 7. Rinse the mouth with water after each use.
● 8. Rinse the mouthpiece and store the inhaler away from heat.
asthma inhaler
● Obtain tested and approved blood
● Take baseline vitals - 15 minutes after
● 2 person verifier
● Obtain consent
● Transfusion must be done within 4
hours
Transfusion action (blood)
● Pain
● Edema
● Decreased SPO2
● Low grade fever
● Sickling may be triggered by any
stress or traumatic event, such as infection, fever, dehydration, physical exertion, excessive cold exposure, or hypoxia
● Immediately report symmetric swelling of the hands and feet in the infant or toddler
sickle cell signs of crisis
● Murmur (present or absent; thrill or rub)
● Cyanosis, clubbing of digits (usually after age 2)
● Poor feeding, poor weight gain, failure to thrive
● Frequent regurgitation
● Frequent respiratory infections
● Activity intolerance, fatigue
● The following are assessed:
○ Heart rate and rhythm and heart sounds
○ Respiratory status/difficulty
○ Pulses (quality and symmetry)
○ Blood pressure (upper and
lower)
○ Feeding difficulties; tires easily
infant congenital heart defect assessment
● Irritable, distressed infant
● Paroxysmal coughing
● Poor eating
● Nasal congestion
● Nasal flaring
● Prolonged expiratory phase of
respiration
● Wheezing, rales can be auscultated
● Deteriorating condition that is often
indicated by shallow, rapid respirations
RSV distress
● Weight loss.
● Ravenously hungry despite vomiting.
● Lack of energy.
● Fewer bowel movements.
● Constipation
● Projectile vomiting occurs within
minutes after eating.
● Frequent, mucous stools
● Palpate for a hard, moveable “olive” in
the right upper quadrant
● Forceful, non bilious vomiting,
unrelated to feeding position
● Hunger soon after vomiting episode
● Weight loss due to vomiting
● Progressive dehydration with
subsequent lethargy
Pyloric stenosis symptoms
● is a process that occurs when a proximal segment of bowel “telescopes” into a more distal segment, causing edema, vascular compromise, and, ultimately, partial or total bowel obstruction. A barium enema is successful at reducing a large percentage of intussusception cases; other cases are reduced surgically.
● Disorder where the intestine telescopes (folding into self)
● Disorder in infants and children
● Bloody jelly like stool
● Diarrhea
● Vomiting
● Fatigue, lethargy, or loss of appetite
● Cramping or lump in the abdomen
Intussusception
● Premature separation of the placenta from the wall of the uterus
● Fetus is in jeopardy due to lack of O2
supplied placental connection
● Bedrest or C-section
● Uterine contraction
● Uterine tenderness
● Vaginal bleeding
● Fetal distress, or premature labor
● Separation of the placenta from the
uterine wall
● Emergency measures include starting
two large-bore IV lines with normal saline or lactated Ringer’s solution to combat hypovolemia, obtaining blood specimens for evaluating hemodynamic status values and for typing and cross-matching, and frequently monitoring fetal and maternal well-being
● Depending on severity the women can be monitored through a vaginal birth but if it is a risk they will do c-section
Placenta abruption
painful, dark-red vaginal bleeding (port-wine color) because the bleeding comes from the clot that was formed behind the placenta; “knife-like” abdominal pain; uterine tenderness; contractions; and decreased fetal movement. Rapid assessment is essential to ensure prompt, effective interventions to prevent maternal and fetal morbidity and mortality
Placenta abruption manifestations
● Above 160 bpm after a contraction
● Caused by decreased fetal oxygen
supply
● Turn client onto left side
● Discontinue oxytocin (Pitocin) if
infusing.
● Administer O2 at 10 L by tight
facemask.
● Maintain intravenous (IV) line
● Notify health care provider
Fetal heart rates tachycardia
● Any type of fetal or maternal distress that cannot be relieved by medication or maneuvering fetus or mother.
● Prolonged/obstructed labour
● Postpartum hemorrhage
● Fetal distress
● Severe pregnancy-induced
hypertension/eclampsia
● Antepartum hemorrhage
Obstetrical emergencies
● Fracture of the collarbone or upper arm
● Nerve damage affecting the shoulders, arms, hands or fingers
● Brain damage or speech disability
● May need to be used vacuum extractor
or forceps during delivery
● McRoberts Manuver and Superpubic
● The technique is performed by flexing
the mother’s thighs toward her shoulders while she is lying on her back. No specific degree of elevation or flexion of the patient’s legs has been defined for the McRoberts maneuver.
Shoulder dystocia
● V variable decelerations
● E early deceleration
● A acceleration
● L Late deceleration
● C Cord Compression
● H Head Compression
● O O- okay!
● P- Placental insufficiency
Fetal heart rate patterns - deceleration
● Tone: uterine atony, distended bladder
● Tissue: retained placenta and clots;
uterine subinvolution
● Trauma: lacerations, hematoma,
inversion, rupture
● Thrombin: coagulopathy (preexisting or acquired)
● Traction: too much pulling on umbilical
cord
● 1000mL for C-section
● 500mL for vaginal
Post-partum hemorrhage
● Try to determine the underlying cause
● Slowly rehydrate
● Rehydrate with items rich in calories
water may not be enough
● Do not give antidiarrheal medication
want the virus run its course and not stay inside
Vomiting and diarrhea- infant
● Will detect if the fetus has proper growth in accordance to amount of blood and oxygen supply
● low oxygen levels
● High level of distress during labor and
delivery
● Increased risk of infectious disease
after birth
● intrauterine growth restriction
● Currently, an NST is recommended
twice weekly (after 28 weeks’ gestation) for clients with diabetes and other high-risk conditions, such as intrauterine growth restriction (IUGR), preeclampsia, post-term pregnancy, renal disease, and multifetal pregnancies
● A nonreactive test has been correlated with a higher incidence of fetal distress during labor, fetal mortality, and IUGR. Additional testing, such as a biophysical profile, should be considered
IUGR ultrasound
● Breasts feel very full, hard, swollen and painful
● Occurs shortly after mother has given birth
● Can lead to mastitis
● Slightly swollen and tender lymph nodes in your armpits
● Resolve:
○ Using a warm compress, or taking a warm shower to encourage milk let down.
○ Feeding more regularly, or at least every one to three hours.
○ Nursing for as long as the baby is hungry.
○ Massaging your breasts while nursing.
○ Applying a cold compress or ice pack to relieve pain and swelling.
Engorgement
● Respiratory (Infections, hemoptysis, pneumothorax, pulmonary hypertension, and chronic hypoxic and hypercapnic respiratory failure)
● Malabsorption of protein, fat, & fat- soluble vitamins
● Salt losses in sweat
Cystic fibrosis complications
● For the first pregnancy: The mother receives two doses of RhoGAM, one at 28 weeks’ gestation and the second dose within 72 hours after childbirth
● For any subsequent pregnancies, RhoGAM is administered regularly during the second half of the pregnancy
Rhogam
● usually clears up within 2 weeks in formula-fed babies
● more than 2 to 3 weeks in breastfed babies
● Close monitoring - lab draws
● Billi lights or blanket
● No clothes only diaper when using
therapy devices
● Physiologic jaundice is very common
in newborns, with the majority demonstrating yellowish skin, mucous membranes, and sclera within the first 3 days of life.
● Advise mothers to nurse their infants at
least eight to 12 times per day for the first several days
24-hour jaundice
● primary goal of managing hemophilia is to prevent bleeding. This is best accomplished by instructing the child to avoid activities with a high potential for injury (e.g., football, riding motorcycles, skateboarding). Instead, encourage the child to participate in activities with the least amount of contact (e.g., swimming, running, tennis)
● No contact sports
● Exercise to strengthen joint and protect
● Soft bristle toothbrushes
● Medical alert bracelet
● Medication administration routine
Hemophilia safety
● Blood clots (which may be in the brain causing stroke)
● Infection in the lining of the heart and heart valves (bacterial endocarditis)
● Abnormal heart rhythms (arrhythmias)
● Heart failure.
● Death
● From Google:
● Blood clots (which may be in the brain causing stroke)
● Infection in the lining of the heart and heart valves (bacterial endocarditis)
● Abnormal heart rhythms (arrhythmias)
● Heart failure.
● Death.
Tetralogy of fallot complications
● Body does not make insulin at all
● Only injection insulin no pill form
● Education is important for children
● Insulin pump may be an option to
manage DM 1
● DKA can cause coma
Type I DM- Hyperglycemia
● Large for gestation age
● Will be born hypoglycemic
● Could cause still-birth, abortion,
premature
● Delivery complications due to large size
Diabetes- fetal risk
● Tearfulness
● Insomnia
● Lack of appetite
● Sleep disturbances
● Anxiety
● Crying
● Over obsession with the baby
● Typically resolve in 10 days without
intervention
Postpartum blues
● Decreased blood flow to the placenta
● Lower the head of the bed and turn the
mom on her left side to take the
pressure off the vena cava
● NS bolus
● Turn off Pitocin
● Give o2
Late decelerations
● Fetus has swallowed first stool and it has gotten lodged in airway or lung(s)
● Lack of first birth will decrease O2 and fetal heart rate
● Acute or chronic hypoxic event (fetal distress makes them pass meconium)
Meconium stain- decreased FHR
● Fetal distress
● Prolapsed cord
● Active genital herpes
● malposition or malpresentation of fetus
Pitocin contraindication
● Assess lochia
● How many perineal pads she has used
in the past 1 to 2 hours and how much
drainage was on each pad
● Massage the uterus to help contract
● Check bladder for distention
● May be placenta left preventing
contractions
● Check for large blood clots that may prevent atony
● Oxytocin (Pitocin) (help the uterus to contract down)
Postpartum bleeding- action
● Counseling/therapy
● SSRIs (selective serotonin reuptake
inhibitors) first line
● Medication management is similar to
major depression: a combination of antidepressant medication, antianxiety and or antidepressants medication, adequate sleep and rest, and psychotherapy in an outpatient or inpatient setting
● Ask about SI and harming baby
● Secure bond with your baby
● Self-care : reconnect with friends and
family
Postpartum depression- action
● Low bicarbonate levels in the blood are a sign of metabolic acidosis
● Slows the rate of progression of renal failure to ESRD
● Improves nutritional status
CKD metabolic acidosis; decreased bicarb level
