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401 1st Exam > n401 > Flashcards

n401 Flashcards

1
Q

what are the benefits of breast feeding?

A
  1. enhances GI tract maturation and contains immune factors that contributes to a lower incidence of gastroenteritis, child obesity, chrons and celiac
  2. has specific antibodies and cell mediated immunological factors to protect against ear infection, respiratory illness, pneumonia, bacteremia, and UTI.
  3. Less likely to die from SIDS.
  4. lower incidence of allergies.
  5. May enhance cognitive development in term and preterm.
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2
Q

Maternal benefits of breast feeding.

A
  1. decreases risk of ovarian, rheumatoid, and breast cancer.
  2. loose weight faster
  3. promotes uterine involution and decreases risk of hemorrhage
  4. unique bonding experience and can provide protection against postpartum depression.
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3
Q

family and social benefits of breast feeding

A
  1. decreased parenteral absenteeism

2. saves money (formula $ and lower incidence of illness and infection)

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4
Q

contraindications of breast feeding

A 
1. maternal ca therapy/ radioactive
galactosemia
2. herpes lesion on breast
3. some medications. 
4. maternal infection w hep cab, cmv, tb with no tx.
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5
Q

12 DOH that determine risk of health outcomes {disability, disease and death}*

A
  1. INCOME + SOCIAL STATUS: as income and social status rises health status improves. with income, healthy and affordable housing as well as healthier food.
  2. Social support networks
  3. Education and literacy
  4. Employment/ working conditions
  5. social environments
  6. physical environments
  7. personal health practices and coping skills: include lifestyle choices and the ability to cope with health outcomes
  8. healthy child development
  9. biology and genetic endowment
  10. health series: must be accessible for all for health maintenance promotion, protection and disease prevention
  11. gender: (men die from heart disease and women are more likely to experience sexual assault).
  12. culture
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6
Q

the implications of the social and economic DOH for canadians in the pursuit of health equity

A

Engage with indigenous peoples perspectives, strengthening care for people with disabilities, providing reproductive health care services and making HIV/ AIDS treatment accessible are examples of the application of human rights approach to community health

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7
Q

Apply the 5 principles of primary health care to community health nursing practice in Canada

A
  1. Accessibility: essential health services should be equitably distributed to all populations to provide access to health services for all, including those living rural, remote and urban communities. Essential health services must be equitably shared among all persons.
  2. Health promotion: services that are preventative and promotive rather than curative: health education and immunization. Health maintenance rather than curative. (grocery store tours)
  3. Public participation: individuals and communities should be involved in the planning and design of health services. communities need to be encouraged and supported to participate in developing and managing their health care through community partnerships and empowerment (no smoking in public places).
  4. Intersectoral collaboration: emphasizes the integration of health development with social and economic development. it involves different professionals across sectors working together to identify and develop suitable health programs supported by policy. Professionals from the health sector work interdependently with professionals from other sectors such as agriculture, food industry and housing as well as community members to promote community.
  5. appropriate technology: appropriate use of health care resources including human resources equipment and technology. cost effective ways to care for everyone. (reduce and prevent and treat chronic health conditions in northern communities).
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8
Q

what are the core competencies? of public health*

A
  1. core public health sciences- know FN views of health
  2. assessment + analysis- create culturally appropriate and holistic recommendations
  3. policies + program planning, implementation and evaluation- use resources to achieve maximum outcomes
  4. partnership, collaboration, advocacy- advocate to decrease inequities
  5. diversity and inclusiveness - DOH perspective, cult safety and competency
  6. communication (and relationship building, large barriers)- verbal and non verbal, cult safety and relationship centered
  7. Leadership (skills enhancement for PH)- share visions etc.
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9
Q

how to assess a episiotomy?

A 
REEDA
Redness
Edema
Ecchymosis
Discharge
Approximation
pain
nursing interventions:
1. assess site and pain
2. assess pt knowledge of site care
3. teaching application of ice/ tea bags for 1st 24h)
4. peri bottle while voiding
5. wipe clean to dirty
6. kegals
7. sitz bath
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10
Q

physiologic changes of the uterus

A

its initially down and the pubis sympathies but in 6-12 hours its at the umbilicus and then it will descend 1cm/ day

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11
Q

Lochia types

A

day 1-3 rubra- bloody, small clots for 1-2h after birth, similar to heavy menstruation and then slowly decline
day 4-10 serosa - decreased amount, serosang, pinkish/ brown, consists of old blood, serum, leukocytes and tissue debris
day 10-24 alba - white cream, yellow color, consists of leukocytes, decide, epithelial cells, mucus, serum and bacteria, decreasing amount (can be >6wks)
normal deception is: increased flow w BF, multi parity, exertion and in AM

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12
Q

tearing degrees

A

1st degree: superficial vaginal mucosa, perineal skin

2nd: above and fascia and muscles of perineum
3rd: same and anal sphincter
4th: extends through anal sphincter into rectal mucosa and lumen of rectum

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13
Q

PP RF for hemorrhage

A
  1. brand multi parity
  2. over distension of uterus (large babies, hydramnios, twins)
  3. precipitous labour
  4. prolonged labour
  5. retained placenta
  6. placenta previa/ abrupto placentae
  7. induction/ augmentation of labour
  8. admin of tocolytics to stop uterine contractions
  9. operative procedures / difficult birth (c birth, vacuum, forecasts)
  10. GA
  11. excessive analgesia
  12. full bladder
  13. infection
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14
Q

concerned with excessive lochia?

A
  1. assess funds flow, episiotomy site, bladder, output, bp and pulse (VS)
  2. place new pad and observe for one hour
  3. VS
  4. weigh pads
  5. give oxytocin for boggy uterus
  6. start iv call dr
  7. catheterize.
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15
Q

sexual activities after birth?

A
  1. after lochia serosa
  2. decreased pain
  3. alternate positions (on top)
  4. use of lube
  5. contraception (because ovulation returns before br feeding and br feeding is not a form of contracetption
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16
Q

what are the 3 psychosocial dimensions robin theory PP

A
  1. taking in phase: 1st 1-2 days, passive somewhat dependent and preoccupied with own needs, needs to talk about L and D, food and sleep major focuses
  2. taking hold phase: 2-3 days, becomes concerned with care of baby, ready to learn and become more independent
  3. letting go phase: defines new role and gives up old, some grief work, readjustment of relationships
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17
Q

what is pp blues?

A

transient, non problematic experienced in 50-80% lasts 10-14 days. presentation: mood swings, anger, teary, anorexia, difficulty sleeping, let down feeling

cause: changes in hormonal and psychological adjustment, insecurity, unsupportive environment, fatigue, discomfort, over stimulation
nursing: assess, teach when to ask for assistance, teach others what to watch for.

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18
Q

public health definition

A

an organized activity of society to promote, protect, improve and when necessary restore health of individuals. a combination of science skills and values.
ph is: population focused, community as a context, health promotion and prevention focused, consider influencing DOH of clients

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19
Q

how are ph goals accomplished?

A

through activities of health protection, health surveillance–> trends, disease and injury prevention, health promotion, population health assessment + emergency preparation and response

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20
Q

Challenges in PHN?

A
  1. regain visibility of early PHN and demonstrate the capacity of nurses to provide leadership in the community health systems of the future
  2. reduced funding and increased demands i.e.) early PP dc programs, increased immunization schedules, increased acuity
  3. loss of capacity for surveillance attributed as a major reason for the resurgence of TB and new diseases…
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21
Q

Mandate/ role of PHAC*

A
  1. promote health
  2. prevent and control chronic diseases and injury
  3. prevent and control infectious diseases
  4. prepare and respond to public health emergencies
  5. share canada’s expertise with the world
  6. apply international research + development to Canada’s PH programs
  7. Strengthen intergovernmental collaboration
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22
Q

key recommended elements for ph system renewal

A
  1. clearly defined essential functions
  2. defined roles/ responsibility at each level
  3. appropriate number of well trained staff
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23
Q

building the ph workforce: core competencies blurb*

A

need knowledge of existing health disparities need to consider spiritual events. recognize barriers, and inequities that decrease communities ability to cope and adjust programs accordingly

24
Q

whats the PHO?

A

monitors PH in BC, works w BC centre for disease control
annual report and inquiries about ph issues, and population health
independently advises public, minister and gov officials and health issues to minister and MOH
recommends actions to improve health and wellness and reports on progress

25
Q

MHO?

A

designated for a specific area to monitor PH and conduct investigations
independently advise PH issues and local gov, and schools and provides annual reports.
advises and consults on prevention
liscencing
infection control… i.e. can mandate a TB clt to recieve tx.

26
Q

CHN of canada standards of practice

A
  1. health promotion
  2. prevention + health protection
  3. health maintenance restoration + palliation
  4. (looks at relationship building for the rest:) (professional relationships)
  5. capacity building
  6. access + equity
  7. Professional responsibility and accountability
27
Q

ethical principles in PH

A
  1. harm principle (prevent harm to greater population)
  2. least restrictive or coercive means ( protect the community but help the person in their decision making by providing informed consent and giving information 1st)
  3. reciprocity (support patients choice by providing resources i.e.) food for someone who is isolated)
  4. transparency ( pt needs proper and due information to make a choice; i.e. how do we install info, no coercion)
  5. relational autonomy and social justice (ensure everyone has equal access to resources)
28
Q

ethics process:

A 
situation
facts
ethical principles
values
options
29
Q

telehealth principles

A
  1. nurses are responsible for practicing within standards of practice and all relevant policies
  2. nurses engaging in telehealth are practicing nurses regardless of where client is located.
    (nrs - clt relationship, competencies and scope, clt safety)
30
Q

e nursing*? purpose & 3 requirements

A

promote and ensure changes that support quality nursing practice. 3 requirements: access ( to user friendly communication technology), competency (acquire competency in communication technology), participation (active role in selection + utilization of systems) and collaboration

31
Q

applying ICTS (information and communication technology) to PH

A

surveillance evidence of program effectiveness, e records, phone assessment and counselling, improve standard of practice

32
Q

6 ways PH keep community and population health and safe*

A
  1. health protection: concerned with prevention of physical, psychological, environmental and sociological conditions that may put health at risk… i.e. food water safety
  2. health promotion: changing societal views re: lifestyle choices, sex ed, nutrition, smoking
  3. population health assessment: includes a range of methods of scanning needs and strengths of community
  4. health surveillance program: aimed at early detection of illness for specific asymptomatic inidivudals… i.e.) screening in CHC
  5. disease and injury prevention: decrease risks/ threats to health and promoting resilience against these threats to health and promoting resilience against these threats (i.e. ban toxic product)
  6. emergency preparation and response: delivery of emergency health care services in communities at all points of the continuum: prevent, prepare, response, recovery (i.e. ) prep for flu season)
33
Q

4 stages of disaster management*

A
  1. prevention + mitigation
    PHN: educate and define hazards research and advocate for legislation
    (ongoing activities aimed at mitigating or eradicating potential risks, disaster vulnerability)
  2. disaster preparedness
    PHN: plan educate and know about resources and collaborate
    ( looking at readiness to respond, how health, wellness and safety are going to be maintained)
  3. Diaster Response / crises Management
    PHN: work with other HCP, triaging, ongoing assessment, look at what resources are needed
    (activities carried out by emergency response teams)
  4. Disaster Recovery/ consequence management
    PHN: partner with community and evaluate consequence
    (consequence management focus on recovery of community from damages)
34
Q

PTL
RF
management
nursing care

A

management:
A) prevent those at risk i.e.) progesterone injections
B) if PTL take fibronectin assay (24-34 wks)
C) will not stop prematurely labour if complications
D) meds: tocolytics (up to 32/33 gestation)
nursing care:
1. assess contractions & PV loss
2. monitor fetus
3. assess for side effects of meds
4. give corticosteroid to increase lung maturity if baby is < 34 wks)
5. prepare for preme birth if labour continues

35
Q

potential causes of post term labour & and potential problems as a result for mom & baby
and medical interventions

A

error in determining ovulation & conception
deficiency in placental estrogen (decreased prostaglandin and decreased formation of oxytocin receptors in myometrium and continued secretion of progesterone)
(deficiency estrogen: not as sensitive to start contractions and not enough prostaglandins which help starts contraction
and decreased oxytocin )
potential maternal problems:
psychological stress, induction?, dystocia, assisted delivery, perineal trauma, increased risk of infection and hemorrhage, increased CD and DVTS
fetal:
decreased placenta profusion, fetal demise, oligohydramnios, macrosomia, MAS, low apgar, SIDS, injury, CP
Med interventions
daily fetal movement counts, follow up 2x/ wk, & AFI and US. elective before 42 wk

36
Q

MAS

A

r/t to fetal stress. i.e. ) infections, or difficulties during birth, or cord compression, placenta insufficiency, maternal fetal, placenta disease.
distressed baby may have hypoxia, which can make the baby intestinal activity increase and relax the anal sphincter and the meconium mixes with the AFI

37
Q

what is a unripe vs ripe cx?

A 
1. unripe cs: bishops <6
peg2- intercervical intravaginal
cervidil vag insert
cervical ripening balloon
2. ripe cs: >/=6
sweep of the membranes
amniotomy/ AROM
intravag peg2 gel or iv oxytocin
38
Q

induction

nrsg care

A

baseline assessment (VC, leopards (assess position of fetus in uterus), Bag exam, EFM)

39
Q

fetal distress:
warning sings:
nrsing interventions

A

warning signs: mecum stained liquor (and serious/ ominous FHR patterns)
nursing interventions: dc induction/ stop contractions, change position to help fetal heart rate normalize/ increase blood flow) , IV bolus, VE, o2, decrease maternal anxiety, EFM, internal monitor, fetal scalp sample, consider amnioinfusion

40
Q

Dx shoulder dystocia: activate ALARMER

complications for mom and baby*

A 
ALARMER:
ask for help
lift/ hyper flex pts has (mcroberts maneuver)
anterior shoulder disimpaction
rotation of posterior shoulder 
manual removal of posterior shoulder
episiotomy
roll woman over onto all fours.
complications:
maternal:
pph, trauma, infection
neonatal: brachial plexus injury fx (classical and humerus), asphyxia, neurological damage, fetal demise
41
Q

causes of hemorrhage 4 T’s*

A

tone trauma tissue thrombin

uterine atony, lacerations of genital tract, retained placenta or membranes, coagulation problems

42
Q

associated factors of hemorrhage***

A 
over distension of uterus (polyhdramnious large baby), grand multi parity, anesthetics, prolonged or rapid labour, induction/ augmentation, distortions of uterus, distended bladder, hx of pph (tone)
uterine surgery (trauma), hip anemia infection (tissue) (asian hispanic heritage)
nursing: cross match and IV), void 2-3h, rn to massage uterus, express clots, apply pressure pro and give oxytoxic dugs.  (clot fibrous- placenta tissue), is it infection so determine cause.
43
Q

medical intervention for uterine atony

A

get help
md to explore uterine cavity and lower genitals
may perform uterine compression/ massage
md may repair lacerations/ remove tissue/ pack/ perform arterial ligation/ b lynch suture, last resort hysterectomy

44
Q

associated factors w dvt

A

hydramnios, preeclampsia, operative births, hx of clot, varicose veins, obesity, hip
ethology: hyper coagulability, venous stasis, injury to epithelium

45
Q

physiology of breasts

A

increased progesterone promotes development of lobules and alveoli, but also surpasses lactation.
delivery of placenta: decrease progesterone.
prolactin is then rose form anterior pituitary in response to breast stimulation, causes lactocytes to produce milk
stretching of nipple and compression of areola signals hypothalamus to release oxytocin from posterior pituitary. oxytocin causes myoepithelial cells to contract + eject milk into the ducts(let down reflex)
delivery of placenta and br stimulation causes anterior pituitary gland to rls prolactin.
stretching and compression stimulates the hypothalamus post pituitary to rls oxytocin.
so prolactin makes the milk which causes oxytocin to be released and then eject milk
first endocrine regulation then supply and demand.

46
Q

what is colostrum comprised of *

A

high immunologloubins yellow/ clear/ creamy/ increased protein/ fat soluble vitamins and minerals/ IGA 1-4 days

47
Q

2nd stage of milk

3rd stage of milk

A

2nd: transitional milk: has increased calories, lactose, h2o soluble vitamins and fat (more than colostrum) until 2 wk pp
3rd: mature milk: CHO, protein, fat and remainder is h20.
foremilk: has increased h20 via and protein 1-2% and fat
hind milk: rose after let down: high fat 10%
(2wk onward)

48
Q

SGA baby symmetric vs assymetric

A

symmetric: chronic hen, severe malnutrition, chronic intrauterine viral infection, substance abuse, genetic anomalies (decreased cells will never allow it to grow)
-long term maternal condition: noted in 2nd trimester/ prolonged restriction. will always be compromised
asymmetric: placenta infarcts, preeclampsia, poor wt gain in pregnancy (has all the cells it needs, just needs to put on the weight 3-6mo; decreased size of cells)
noted in 3rd trimester/ restriction
wt decreased but not head and length
associated with acute compromise

49
Q

what are some physical findings of SGA babies (term) (baby is smaller than usual for its age)

A
  1. small size, decreased fat and muscle mass
  2. poor skin turgor, loss of vernix
  3. full term nails, dull hair, separate skull bones, sunken and, small liver,
  4. developed creases& carriage
  5. often a thin, meconium stained cord (green)
  6. alert wide eyed developed reflexes
50
Q

LGA baby

A

appearance: increased body fat, macrocosmic, rudy, large placenta and cord
cause: poorly controlled DM, multi parity, male

51
Q

IDM & LGA:

A

mom: high bg
- fetus high g, muscle and fat
- fetus converts fat to glycogen
- fetus becomes macrosomic
- fetus produces increased level of insulin and is then later at risk for hypoglycaemia.

52
Q

obj data of hypoglycemia

A
  • lethargy, apathy, hypotonia
  • poor feeding/ sucking reflex, vomitting
  • pallor cyanosis, hypothermia, temp instability
  • apnea, irreg respirations, rds (tahcypnea>60)
  • tremors, jerkiness, seizure, jittery
  • weak / high pitched cry
53
Q

post term infant >42 wk

behaviour and appearance

A

wide eyed / alert/ mature and responsive
appearance: long thin, wasting (decreased sc tissue), skin loose, dry cracking, parchment like, absence of lanugo and vernix, long fingernails and profuse hair
meconium stained nails and cord… b/c placenta stopped working

54
Q

3 cardinal signs of RDS

A
  1. Indrawing or retractions with breaths
  2. nasal flaring
  3. grunting.
55
Q

newborn maturity and classification stuff.

A 
posture: flexion of extermities
square window (wrist) (> flexible)
recoil of legs or arms (not with preme)
scarf sign (elbow across chest more w preme)
heal to ear (more w preme)
plantar surface (no creases)
breast (less developed areola)
ear (less cartilage)
genitals (major not cover minor and less rug for men)

401 1st Exam (3 decks)

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