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YEAR 3 > NURS 330 FINAL > Flashcards

NURS 330 FINAL Flashcards

1
Q

Genetic Disorders

A

Disease caused by a genetic mutation that is either inherited or arises spontaneously

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2
Q

Autosomal Dominant

A

Each child has a 50% chance of showing the disease (Huntington’s, braca breast cancer gene)

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3
Q

Autosomal Recessive

A

Each child has 50% chance of being a carrier and 25% chance of showing (Cystic fibrosis)

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4
Q

X-Linked Recessive

A

Males at risk - Each male has 50% risk of showing (color blindness, hemophilia a, duchene muscular dystropyh)

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5
Q

Numerical Chromosome Abnormality

A

Entire single chromosome added or missing

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6
Q

Structural Chromosome Abnormality

A

Part of chromosome missing or added OR abnormal rearrangement of material within the chromosome

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7
Q

Trisomy

A

Extra copy of one chromosome (47)

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8
Q

Trisomy 21

A

Down Syndrome = most common

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8
Q

Trisomy 13

A

Less common, severe (don’t live past infancy)

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8
Q

Klinefelter’s Syndrome

A

Boys have an extra X chromosome (XXY)

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8
Q

Turner’s Syndrome

A

Only monosomy compatible with life (girls - single X)

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8
Q

Monosomy

A

Missing chromosome (45)

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8
Q

Bowlby’s Attachment Theory

A
  1. Pre-attachment (birth-6wk)
  2. Attachment in making (6wk - 6-8mos)
  3. Clear-Cut attachment (6-8mos - 18-24mos)
  4. Formation of Reciprocal Relationships (24mos +)
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9
Q

Erickson’s Psychosocial Theory

A
  1. Trust vs Mistrust (infant - 18mos)
  2. Autonomy vs Shame/Doubt (18mos - 3yrs)
  3. Initiative vs Guilt (3-5yrs)
  4. Industry vs Inferiority (5-13yrs)
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10
Q

Piaget’s Theory of Cognitive Development

A
  1. Sensorimotor (infant - 18/24mos)
  2. Preoperational (2-7yrs)
  3. Concrete operational (7-13yrs)
  4. Formal Operation (adolescence - adulthood)
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11
Q

Freud’s Theory of Psychosexual Development

A
  1. Oral stage (birth-1yr)
  2. Anal stage (1-3yrs)
  3. Phallic stage (3-6yrs)
  4. Latency stage (6yr-puberty)
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12
Q

Kohlberg’s Theory of Moral Development

A
  1. Pre-Conventional
    a) obedience & mortality
    b) individualism & exchange
  2. Conventional Mortality
    a) good interpersonal relationships
    b) social order
  3. Individualism & Exchange
    a) social contract & individual rights
    b) universal principles
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13
Q

Respiratory Differences in PEDS

A

Nose breathers
Larger tongue
Decreased lung capacity and IC muscles
Increased RR and O2 demand
Short airway
Barrel-chested
Rely on diaphragm
Prone to retractions

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14
Q

Asthma

A

Chronic airway inflammation (infiltration of T cells, mast cells, basophils, macrophages, and eosinophils)

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15
Q

Characteristics of Asthma

A
  1. Bronchial (airway) hyperresponsiveness
  2. Airway edema
  3. Mucous production
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16
Q

Silent Asthma

A

coughing at night when mucous settles

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17
Q

Prevalence of Asthma in Canadian children

A

10-20%

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18
Q

Most common cause of asthma exacerbation

A

Respiratory viral infections

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19
Q

S&S of Asthma

A

Wheezing, increased RR and air entry, increased work of breathing, coughing/sputum

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20
Q

Pediatric Respiratory Assessment Measure (PRAM)

A

O2 sats, use of accessory muscles, air entry in both longs
Mild = 0-3
Mod = 4-7
Severe = 8-12

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21
Q

SABA

A

Ventolin - Rescue Med

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22
Q

LABA

A

Salmeterol - Pre-exercise

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23
Q

Anticholinergic

A

Ipratropium or atrovent - inhibits bronchoconstriction and decrease mucous production

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24
Q

Inhaled Corticosteroid

A

Budenoside and fluticasone

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25
Q

Oral Corticosteroid

A

“Bursts” for uncontrolled asthma

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26
Q

Treatment for mild PRAM

A

Keep O2 > 92%, salbutamol, consider oral steroids

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27
Q

Treatment for mod PRAM

A

Keep O2 > 92%, salbutamol, oral steroids, consider ipratropium

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28
Q

Treatment for severe PRAM

A

Keep O2 > 92%, salbutamol & ipratropium, PO steroids, IV methylprednisolone, continuous SAB, IV mag sulf

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29
Q

Respiratory Syncytial Virus (RSV)

A

Most common lower resp tract infections in children, leading cause of pneumonia and bronchitis in infants

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29
Q

S&S of RSV

A

Coughing, rhinorrhea, wheezing, irritability, low fever, nasal flaring & retractions, palpable liver & spleen

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30
Q

Management of RSV

A

Airway = #1, position/O2/Suction, ventolin & ribovarin

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31
Q

Influenza/Parainfluenza

A

Virus that can cause upper/lower resp infection (bronchitis, croup & pneumonia)

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32
Q

S&S of Influenza

A

Fever, cough, runny nose, sore throat, SOB, wheezing

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33
Q

Croup-Laryngotracheobronchitis

A

VIRAL - swelling in trachea and larynx

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34
Q

S&S of Croup

A

Tachypnea, stridor, seal-like barking cough

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35
Q

Management of Croup

A

O2, racemic epinephrine, corticosteroids

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36
Q

Pertussis-Whooping Cough

A

Bacterial

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37
Q

S&S of Pertussis-whooping cough

A

Runny nose, fever, mild cough, high-pitched whoop/crowing sound & gasp for air, vomiting after coughing spell

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38
Q

Necrotizing Enterocolitis (NEC)

A

Most common and serious GI disorders in hospitalized preterm neonates - bowel dying

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39
Q

S&S of NEC

A

Vomiting, bloody diarrhea, ABD distention, feeding intolerance, irritability OR lethargy

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40
Q

Management of NEC

A

Surgical resection

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41
Q

Long-Term complications of NEC

A

Malabsorption, short bowel, scarring/narrowing of bowel, scarring in abdomen

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42
Q

S&S of Dehydration

A

Irritable, sunken fontanels, sunken eyes, no tears, tenting of skin, bradycardia, hypotension, urine output < 1ml/kg/hr

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43
Q

Dehydration Management

A

IV fluids - NS bolus, then D5NS for sugar

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44
Q

Hirschsprung (Congenital anianglionic megacolon)

A

Absence of autonomic parasympathetic ganglion cells of the colon that prevent peristalsis

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45
Q

S&S of Hirschsprung

A

Vomiting, ABD distention, constipation, no MEC

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46
Q

Management of TEF

A

Surgery to close fistula

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46
Q

Management of Hirschsprung

A

Surgical resection of dysfunctional portion

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46
Q

Tracheoesophageal Fistula (TEF)

A

Abnormal opening between trachea and esophagus

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46
Q

Diagnosis of TEF

A

Barium Swallow test

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46
Q

Imperforate Anus

A

Passage of fecal material obstructed

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46
Q

Management of imperforate anus

A

Surgery to create anal opening

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47
Q

Intussuseption

A

One portion of bowel slides/invaginates into next

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48
Q

S&S of Intussuseption

A

vomiting, currant jelly, pain

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49
Q

Management of Intussuseption

A

Barium Enema

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50
Q

Pyloric Stenosis

A

Hypertrophy of circular pyloris muscle - stenosis of passage between stomach and duodenum

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51
Q

S&S of Pyloric Stenosis

A

Projectile vomiting, FTT, dehydration, appears hungry

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52
Q

Nissen Fundoplication

A

For bad acid reflex to tighten stomach

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53
Q

Formation of Cavity

A

Bacteria + sugar = acid
Acid + tooth = cavity

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54
Q

Early Lesions

A

White/chalky, seen at gum line

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55
Q

Progressing/Advanced lesions

A

Light brown, wet

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56
Q

Inactive/Arrested Lesions

A

Dark brown/black, leathery

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57
Q

Extra-oral exam

A

general appearance, asymmetry/swelling

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58
Q

Intra-oral exam

A

count teeth, note dark staining (D), fillings (F), broken (B), swellings (A)

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59
Q

Diabetes in Children

A

Most common metabolic disease in children

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60
Q

Type 1 Diabetes

A

Autoimmune destruction of insulin producing cells (beta-cella) resulting in COMPLETE INSULIN DEFICIENCY

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61
Q

Type 2 Diabetes

A

Obesity - biggest risk factor - insufficient production of insulin causing high blood sugar

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62
Q

Complications of Type 2 Diabetes

A

Kidney disease, retinopathy, neuropathy, dyslipidemia, HTN

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63
Q

Hemoglobin A1C

A

Objective measurement of glycemic control

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64
Q

Diabetic Ketoacidosis (DKA)

A

Complex metabolic state of hyperglcemia, ketosis and acidosis

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65
Q

HYPERglycemia

A

Hot & dry, sugar high - polyphagia, polydipsia, polyuria, dry skin, blurred vision

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66
Q

HYPOglycemia

A

Cool & clammy, need a candy
Tachycardia, Irritability, Restlessness, Excessive hunger, Dizziness, pallor/clammy

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67
Q

Insulin

A

Anabolic hormone made in beta cells of islets in pancreas - allows entrance of glucose into cells

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68
Q

Spinal Cord Injury (SCI)

A

Mechanism of injury & direction of forces determines the type of lesion that occurs

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69
Q

Complete SCI

A

Total loss of all motor/sensory function below level of injury

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70
Q

Incomplete SCI

A

Some function below level of injury

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71
Q

SCI at C3

A

Ventilator required

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72
Q

SCI at C5

A

No wrist/hand control, diaphragm function present

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73
Q

SCI at C6-C7

A

Quadriplegia, some function of upper extremities

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74
Q

SCI at T1-T8

A

Hand control, poor trunk control, lack of ABD muscles

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75
Q

SCI at T9-T12

A

Good trunk and ABD muscle control

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76
Q

Concussion

A

Most common head injury

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77
Q

S&S of Concussion

A

Confusion, N/V, dizziness, unusual emotions, slurred speech, headache, slow response, decreased coordination, loss of consciousness

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78
Q

Post-concussive Syndrome

A

2-12 hours after concussion

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79
Q

Causes of Increased Intracranial Pressure

A

Meningitis, encephalitis, trauma

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80
Q

Prevalence of Post-Traumatic seizures

A

10% of head injuries

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81
Q

Head injury complications

A

Ischemia, death of tissues, deficits, hearing/vision problems, speech and learning problems, behavioral changes

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82
Q

Epidural hematoma

A

Bleeding between dura and cranium -fast onset

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83
Q

Subdural hematoma

A

Bleeding right against the brain - slow onset

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84
Q

Nociceptive Pain

A

Damage to underlying soft & bone tissues by disease

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85
Q

Somatic Pain

A

Well localized, sharp, throbbing, squeezing, aching

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86
Q

Visceral Pain

A

Diffuse, poorly localized, dull, crampy, colichy

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87
Q

Neuropathic Pain

A

Invasion of or traction on nerves arising from injury to CNS and PNS - burning, stinging, lancinating, tingling, stabbing, prickly, shock-like

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88
Q

Pain Assessment tools for Neonates

A

CRIES

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89
Q

Pain assessment tools for FLACC

A

Face
Legs
Activity
Cry
Consolability
2mos-7yrs

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90
Q

Wong-Baker FACES

A

> 3-4yrs

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91
Q

Nervous system at birth

A

Complete, but immature
Myelination incomplete until 4 years and brain 1/4 size of adult (full mass by age 7-10)

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92
Q

Pediatric Coma Scale

A
  1. Eye opening
  2. Best motor response
  3. Best response to auditory and/or verbal response
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93
Q

S&S of increased ICP

A

Bradycardia, wide pulse pressure, irregular resps, irritability, bulging fontanels, increased head circ, seizure, vomiting

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94
Q

Most important indicator of neurologic dysfunction

A

Level of Consciousness!

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95
Q

Meningitis

A

Inflammation of the meninges

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96
Q

S&S of Meningitis

A

Headache, fever, lethargy, rashes, seizures

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97
Q

Most common source of Meningitis

A

Resp Infection

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98
Q

Diagnosis of Meningitis

A

Brudzinski’s sign = neck stiffness
Kernig’s sign = hamstring stiffness
1. LP
2. BW
3. Antibiotics

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99
Q

Bacterial Meningitis

A

Less common, more severe

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100
Q

Aseptic Meningitis

A

Headache, fever, and inflammation - usually viral

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101
Q

Encephalitis

A

Inflammation of the brain caused by infection or toxin - edema and neuro dysfunction

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102
Q

S&S of Encephalitis

A

headache, fever, N/V, stiff neck, dizziness, ataxia, convulsions (seizures), sensory disturbances, drowsiness

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103
Q

Causes of Encephalitis

A

HSV, ticks, mosquitoes, measles, mumps, chickenpox, rubella, mononucleosis

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104
Q

Herpes Encephalitis

A

Untreated infants with HSV have 85% mortality rate

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105
Q

Prevention of Herpes Encephalitis

A

C/S, contact dressing, secretion precautions

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106
Q

Treatment of Herpes Encephalitis

A

Antiviral meds, corticosteroids (decrease head growth), anticonvulsants PRN, antipyretics

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107
Q

Seizures

A

Involuntary contraction of muscle caused by abnormal electrical brain discharges

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108
Q

Status Epilepticus

A

Prolonged and clustered seizures in which consciousness does not return between

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109
Q

Intractable Seizures

A

Seizures that continue to occur even with optimal medication management

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110
Q

Epilepsity

A

Recurring seizures that have no immediate underlying cause/problem that cannot be corrected

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111
Q

Partial (focal) seizures

A

Electrical disturbance is limited to a specific area of one cerebral hemisphere (with or without loss of consciousness)

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112
Q

Partial Seizures WITH loss of consciousness

A

with or without aura, tonic clonic movement on one side, followed by confusion and lethargy

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113
Q

Partial seizures without loss of consciousness

A

motor, autonomic, or sensory symptoms - aware and conscious

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114
Q

Generalized Seizure

A

Affect both cerebral hemispheres - impair consciousness

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115
Q

Absence Seizures

A

Lapses of awareness that begin and end abruptly, lasting a few seconds (<30 seconds)

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116
Q

Atonic Seizures

A

Abrupt loss of muscle tone - head drops, loss of posture, sudden collapse, loss of consciousness

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117
Q

Myoclonic Seizures

A

Rapid, brief contractions of muscles - both sides of the body (may or may not lose consciousness)

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118
Q

Tonic Clonic Seizures

A

Most common - begin with stiff limbs (tonic phase) and then jerking of limbs and face (clonic phase)

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119
Q

Infantile Spasms

A

Starts at 3-12mos, increase in intensity and duration with age

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120
Q

Causes of Infantile Spasms

A

Fever, genetics, cerebral lesions, brain disease, trauma, infection

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121
Q

Treatment of Infantile Spasms

A

meds, ketogenic diet (90% fat and low carb), extratemporal cortical resection, functional hemospherectomy

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122
Q

Spina Bifida

A

Any congenital defect involving insufficient closure of the spin - neural tube defect

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123
Q

Meningomyelocele

A

Spine damage (sac breaks skin)

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124
Q

Meningocele

A

No damage to spinal cord (75%)

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125
Q

S&S of Spina Bifida

A

Paralysis, lack of sensation, hydrocephalus, visible protrusion in the back

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126
Q

Treatment of Spina Bifida

A

Surgical repair

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127
Q

Hydrocephalus

A

Result of imbalance between production and absorption of CSF - Increased CSF in brain causes abnormal enlargement of brain ventricles

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128
Q

S&S of Hydrocephalus

A

Large head, rapid growth of head, bulging anterior fontanels, N/V, sleepiness, irritability, seizures, eyes fixed down, blurred/double vision

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129
Q

Causes of Hydrocephalus

A

Obstructive (noncommunicating) - prevents CSF flow and Non-obstructive (communicating) - problem with producing or absorbing CSF

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130
Q

Types of Shunts

A

Ventricular Peritoneal (VP) - drains into peritoneal cavity
Ommaya Reservoir - can give meds and drain come
External Ventricular Device (EVD) - stay laying at all time

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131
Q

Cardiopulmonary bypass (CPB)

A

Artificial blood pump continuously propels blood forward into artificial oxygenator then to patient tissues

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132
Q

Cardioplegia pump

A

Introduce a high potassium solution directly to the heart to induce and maintain cardiac arrest

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133
Q

Cardiac Hemodynamic Parameters

A

Systole, diastole, ESV, EDV, CO

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134
Q

Systole

A

Heart contracts with ejection of blood

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135
Q

Diastole

A

Heart relaxes and fills with blood

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136
Q

End-Systolic Volume (ESV)

A

Volume of blood left in heart after contraction

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137
Q

End-Diastolic Volume (EDV)

A

Volume of blood in heart after filling

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138
Q

Preload

A

Volume of blood in ventricles at end of diastole

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139
Q

Afterload

A

Resistance left ventricle must overcome to circulate blood

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140
Q

Contractility

A

Force of contraction

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141
Q

Ductus Venosus

A

Gradually closes after birth

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142
Q

Ductus Arteriosus

A

Gradually constricts after birth

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143
Q

Foramen Ovale

A

Increased BF to lungs closes this after birth

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144
Q

Causes of Heart defects

A

Teratogenic, chance, familial link, chromosomal abnormalities

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145
Q

DiGeorge

A

Deletion at 22

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146
Q

S&S of CHD

A

Cyanosis, resp distress, CHF, decreased CO, abnormal cardiac rhythms, cardiac murmur, FTT

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147
Q

Cardiac Catheterization Monitoring

A
  1. Pressures within the heart
  2. O2 sats
  3. BF patterns
  4. Structural info (valves , chambers, great vessels)
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148
Q

Tetrology of Fallot

A
  1. Ventricular septal defect
  2. Pulmonary stenosis
  3. Overriding aorta
  4. Right ventricular hypertrophy
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149
Q

S&S of TOF

A

Clubbing, central cyanosis

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150
Q

Treatment of TOF

A

Beta blockers, morphine, prostaglandin EI, surgery, +/- BT shunt, subclavian artery to PA

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151
Q

Tricuspid Atresia (TA)

A

Absent of imperforate tricuspid valve

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152
Q

S&S of TA

A

Cyanosis, acute resp failure, hypoxemia, acidosis

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153
Q

Treatment of TA

A

Creation of shunts

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154
Q

Complications of Catheterization

A

Arrhythmias, bleeding, cardiac perforation, CVA, hypercyanotic spells, vascular complications, infection

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155
Q

Post-Cath nursing care

A
  1. Arterial perfusion: pallor, mottling, decreased pulses, cool skin, decreased cap refill
  2. Venous obstruction: edema,infection
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156
Q

Components of Blood

A

Plasma (55%), WBC & Platelets (4%) and RBC (41%)

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157
Q

Plasma

A

For coagulation (clotting)

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158
Q

WBC and Pletelets

A

Fight infection, stop bleeding

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159
Q

RBC

A

Carry oxygen

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160
Q

RBC count

A

Actual RBC count

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161
Q

Hemoglobin (Hgb)

A

Measure of heme & globin protein

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162
Q

Hematocrit (Hct)

A

Indirect measure of RBC’s

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163
Q

Mean Corpuscular Volume (MCV)

A

Size of RBC’s

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164
Q

WBC count

A

Actual number of WBCs

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165
Q
A
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166
Q

Differentials

A

WBC types

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167
Q

Platelet Count

A

Number of platelets per blood volume

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168
Q

Anemia

A

Decreased production and increased destruction/blood loss, sequestration

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169
Q

Sizes of RBC’s

A

Microcytic (small)
Normocytic (normal)
Macrocytic (large)

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170
Q

Anemia r/t decreased production

A

Marrow infiltration/injury, nutritional deficiency, erythropoietic deficiency, ineffective erythropoiesis

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171
Q

Hemolysis - Extrinsic

A

Acquired

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172
Q

Hemolysis – Intrinsic

A

Inherited

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173
Q

Iron Deficiency Anemia

A

Excessive blood loss, inadequate intake, increased demand, impaired absorption

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174
Q

Management of Anemia

A

Dietary education - iron rich foods, decrease milk intake
Iron supplementation

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175
Q

Sickle Cell Anemia

A

Qualitative defect of Hgb that is insoluble at low O2 concentration and forms “sickles” that are sticky and cause hemolysis and vasoocclusion in vessels

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176
Q

Manifestation of Sickle Cell Anemia

A

Acute pain, stroke, acute-chest syndrome, chronic infection, splenic infarction, renal impairment, dactylitis, priapism, retinal damage

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177
Q

ABCDEF of Sickle Cell

A

A) Assess and reassess pain
B) Believe child’s report of pain
C) Complications/Cause of pain
D) Drugs and distraction
E) Environment
F) Fluids - avoid overload

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178
Q

Decreased WBC’s

A

Increased risk of infection

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179
Q

Increased WBC’s

A

Infection, inflammation, tissue damage, leukemia

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180
Q

S&S of decreased Platelets

A

Bruising, nose bleed, bleeding gums, petichiae, purpura

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181
Q

Causes of decreased platelets

A

Infection, idiopathic thrombocytopenia purpura, DIC, meds, platelet disorders

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182
Q

Hemophilia a and b

A

X-linked recessive

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183
Q

Von WIllebrand Disease

A

Autosomal recessive/dominant

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184
Q

Common Sites for Childhood Cancers

A

CNS, bone, muscles, endothelial tissue, connective tissue, blood, lymph tissue

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185
Q

Leukemia

A

WBC grow out of control

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185
Q

Prevalence of Leukemia

A

32% of childhood cancer

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186
Q

Lymphoma

A

Tumour of the lymph tissue
- Hodgkins and Non-Hodgkins

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187
Q

S&S of Pediatric Brain Tumours

A

Headaches, N/V, visual/hearing problems, seizures, slurred speech, dysphagia, memory problems, difficulty concentrating

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188
Q

Posterior Fossa

A

60%
- Medullablastoma
- Astrocytoma
- Ependymoma
- Diffuse intrinsic pontineglioma
- atypical teratoid rhabdoid tumour (ATRT)

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189
Q

Cerebral Hemisphere

A

40%
- Astrocytoma
- ganglioma, craniopharyngiomas
- Supratentioal primitive neuroectodermal tumors (PNET)

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190
Q

Osteosarcoma

A

Increased risk in males, near growth plates, in long bones

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191
Q

Rhabdomyosarcoma

A

Soft-tissue tumour, increased head and neck, increased risk in males

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192
Q

Wilm’s Tumour (nephroblastoma)

A

In kidney cells - can grow out of it!

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193
Q

S&S of Wilms

A

“dancing eyes”, diarrhea

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194
Q

AE of Chemotherapy

A

Kills healthy cells, bone marrow suppression, mucositis, N/V, wt loss, constipation, diarrhea, immunosuppression, myelosuppression, alopecia, organ dysfunction

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195
Q

AE of Alkylating

A

Hemorrhagic cystitis, nephrotoxicity, neurotoxicity

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196
Q

AE of Antiometabolites

A

Hepatotoxicity, dermatitis, neurotoxicity, fever

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197
Q

AE of Steroids

A

Immune suppression, mood changes, diabetes, HTN

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198
Q

AE of Asparginase

A

Clots, pancreatitis

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199
Q

AE of antitumour antibiotics

A

Heart issues

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200
Q

Radiation

A

Breaks bonds within cells to damage/kill

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201
Q

AE of Radiation

A

Fatigue, memory loss, decreased development/grotwh, N/V, skin burning, myelosuppression, organ dysfunction

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202
Q

Stages of Grief

A

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

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203
Q

Underweight BMI for children

A

< 18.5

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203
Q

Normal BMI for children

A

18.5-24.9

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203
Q

Overweight BMI for children

A

25-29.0

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204
Q

Obese BMI in children

A

> 30

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205
Q

How much physical activity should children get

A

1 hour per day

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206
Q

Wellness Assessment for Children

A

Social, psychological, spiritual, physical

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207
Q

Preconception care

A

Wt/nutrition/exercise, modifiable risk factors, folic acid & iron, oral health, immunizations, screening for diseases/STI’s, genetic counselling, family planning, social risk factors, optimize mental health

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208
Q

Routine screening in pregnancy

A

Blood group, Rh and Hgb, infectious diseases, gestational diabetes, perinatal serum, group B strep (35-37wk), asymptomatic bacteriuria

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209
Q

Non-Routine Screening in pregnancy

A

more ultrasounds, doppler flow studies, marker tests, nuchal translucency, amniocentesis, chorionicvillus, non-stress test, biophysical profile (BPP), measurement of amniotic fluid

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210
Q

Role of Amniotic Fluid

A

Cushions fetus, temp control, infection control, lung & GI development, muscle & bone development, umbilical cord support

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211
Q

Oligohydramnios

A

Too little amniotic fluid

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212
Q

Polyhydramnios

A

Too much amniotic fluid

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213
Q

1st Trimester Screening

A

11-14wks. PAPP-A, BetahCG, r/o chromosome disorders

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214
Q

2nd Trimester Screening

A

15-20wks. Quad screen - AFP, E3, Inhibin A and Betahcg

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215
Q

5 P’s of Labour

A
  1. Passage(way)
  2. Passenger
  3. Powers
  4. Position
  5. Psychosocial
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216
Q

Passage(way)

A

Ability of pelvis and cervix to accommodate passage of fetus
- Optimal Pelvis = gynecoid, arthropoid
- Less Optimal = android & platypelloid

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217
Q

Passenger

A

Ability of fetus to complete birth process

218
Q

Molding

A

Cranial bones overlap under pressure of the powers of labour and demands unyielding pelvis

219
Q

Suboccipitobregmatic

A

Smallest diameter of fetus’ head

220
Q

Passenger Characteristics

A

a) Attitude
b) Lie
c) Presentation
d) Position
e) Station

221
Q

Fetal Attitude

A

Relationship of fetal parts to one another
- optimal = flexed
- less optimal = extended or brow

222
Q

Fetal Lie

A

Relationship fetal spine to maternal spine
- Optimal = longitudinal
- less optimal = transverse, oblique

223
Q

Fetal Presentation

A

Determined by fetal lie and body part of fetus that enters pelvic passage first (presenting part)

224
Q

Cephalic presentation

225
Q

Breech presentation

226
Q

Shoulder presentation

A

Dystocia - requires C/S

227
Q

Compound presentation

A

> 1 fetal part presenting (ex. hand on head)

228
Q

Fetal Position

A

Position of fetus in relation to the pelvis
- Optimal = ROA or LOA
- less optimal = ROT, ROP, OP, LOP, LOT, OA

229
Q

Fetal Station

A

Relationship of presenting part to imaginary line drawn between ischial spines of pelvis

230
Q

Engaged station

A

“0” = engaged OR largest diameter of presenting part passes through pelvic inlet

231
Q

Powers

A

Contractions and effectiveness of expulsion methods

232
Q

Primary Powers

A

Uterine muscular contractions

233
Q

Secondary Powers

A

Abdominal muscles used to push during 2nd stage

234
Q

Assessing Contractions

A

Frequency
Duration
Intensity
Resting Tone

235
Q

Position

A

Maternal - reposition is helpful

236
Q

Premonitory Signs of Labour

A

Lightening, Braxton hicks, increased vaginal mucous, cervical changes, bloody show, rupture of membranes, sudden burst of energy, loss of 0.5-1kg, diarrhea/indigestion/NV

237
Q

Braxton Hicks

A

Contractions that don’t progress, “tight” feeling, intermittent

238
Q

1st Stage of Labour

A

a) Early or latent phase (0-3cm)
b) Active phase (4-7cm)
c) Transition phase (7-10cm)

239
Q

2nd Stage of Labour

A

Pushing - up to 3hrs

240
Q

3rd Stage of Labour

A

Delivery of Fetus to delivery of placenta

241
Q

4th Stage of Labour

A

1-4 hours after placental delivery

242
Q

Baseline Assessment in Labour

A

FHR, VS, cervix, membranes, bleeding, edema, weight change, urine (glucose, ketones, protein, UTI), other anomalies

243
Q

Lab Test Pre-Labour

A

CBC, infection/blood dyscrasia/coags, serologic testing, blood type/Rh/antibodies, HIV/Hep B&C, Ultrasounds, GBS/diabetes

244
Q

Tachysystole

A

Frequency = >6 in 10, duration > 90sec, <30 sec resting tone

245
Q

How to Determine Dilation and Effacement

A

Sterile Vaginal Exam (SVE)

246
Q

SROM

A

Spontaneous Rupture of Membranes

247
Q

AROM

A

Artificial Rupture of Membranes

248
Q

PROM

A

Premature Rupture of Membranes

249
Q

PPROM

A

Preterm Premature Rupture of Membranes

250
Q

What to Assess for ROM

A

Time, amount, color, odor

251
Q

Characteristics of amniotic fluid

A

800-100mls
Clear/white
Earthy smell (not foul)

252
Q

Green Amniotic fluid

A

Meconium (thick, thin or particulate)

253
Q

Blood Amniotic fluid

A

Streaks/brown/pink = normal
Bright red is NOT normal

254
Q

Nitrazine Test

A

To confirm ROM
Yellow = negative
Blue = positive

255
Q

Fetal Health Surveillance

A
  1. Intermittent Auscultation (IA)
  2. Electronic Fetal Monitoring (EFM)
256
Q

FHR basline

A

110-160bpm

257
Q

Fetal tachycardia

A

> 160bpm for >10mins

258
Q

Fetal bradycardia

A

<110 for >10mins

259
Q

Variability

A

Fluctuations in FHR/min
Absent = A
Minimal = MN = <5bpm
Moderate = MD = 6-25bpm
Marked = MK = >25bpm

260
Q

Normal Variability in FHR

A

Moderate (6-25)

261
Q

Sinusoidal FHR pattern

A

Smooth, repetitive sine wave like pattern that persists for > 20mins , amplitude is 5-15, and 3-5cycles per min

262
Q

Accelerations

A

Increase in FHR at least 15bpm above BL for at least 15 seconds (if <34 weeks, 10x10)

263
Q

Decelerations

A

Decrease in FHR, abrupt or gradual

264
Q

Variable Decelerations

A

Cord Compression - periodic or episodic, uncomplicated or complicated

265
Q

Early Decelerations

A

Head compression (gradual decrease) that mirrors contraction pattern

266
Q

Late Decelerations

A

Uteroplacental Insufficiency (gradual decrease) AFTER contraction - always ATYPICAL (intermittent) or ABNORMAL (recurrent)

267
Q

Prolonged Decelerations

A

Profound Changes - apparent decrease lasting > 2min but <10min

268
Q

Normal EFM Patterns

A

Normal Contraction Pattern
Rate: 110-160bpm
Moderate Variability
Accelerations Present (not required)
Decelerations absent, early, or variable (if uncomplicated)

269
Q

Umbilical Cord

A

Delay clamping for 60 sec
2 arteries, 1 vein

270
Q

5 Categories of Labour Comfort Measures

A

Physical, Emotional, Instructional/Informational, Advocacy, Partner/Coach care

271
Q

Spinal Block

A

Local anesthetic injected into spinal canal, quick onset, longer duration - for C/S or vag

272
Q

Pudenal Block

A

Injected into pudenal nerve near end of labour

273
Q

Local Infiltration

A

Injected into Perineum

274
Q

General Anesthetic

A

Used in emergent situations, increase risks

275
Q

BUBBLEES

A

Breasts, Uterus, Bowels, Bladder, Lochia, Episiotomy, Emotions, Signs

276
Q

(B)UBBLEES

A

Breasts - BF or formula?
Nipples - cracking, soreness, latch
Breasts - filling, engorged, softness
NOT BF - avoid stimulation

277
Q

B(U)BBLEES

A

Uterus - involution
- firmness
- position
- incision
- musculature
- interventions

278
Q

Involution

A

Rapid decrease in size of uterus to non-pregnancy stage
1. Sealing off placental site
2. Return of uterus to pre-pregnancy state

279
Q

Involution is Impeded by:

A

Overdistenstion, exhaustion, retained placental fragments

280
Q

Involution is Enhanced by:

A

Oxytocin, fundal massage, placental expulsion, breastfeeding

281
Q

BU(B)BLEES

A

Bladder - assess r/o retention
- Color, Odor, Consistency, Amount

282
Q

BUB(B)LEES

A

Bowels
- Last BM, increased risk of complication
- hemorrhoids, constipation, flatulence

283
Q

BUBB(L)EES

A

Lochia
- Rubra: 1-3days (red & bloody, small clots)
- Serosa: 3-10days (pink/brown)
- Alba: 10-24 days (yellow/white)
Type, quantity, odor, clots, hygiene, interventions

284
Q

BUBBL(E)ES

A

Episiotomy/Perineum
4H - Healing, Hemorrhage, Hematoma, Hemorrhoids
- intact, episiotomy, laceration, hemorrhoids, hematoma, hygiene, interventions

285
Q

BUBBLE(E)S

A

Emotions
- Taking-in (1-2days)
- Taking Hold (3-4 days)
- Letting Go
Assess for PP blues and depression screening

286
Q

BUBBLEE(S)

A

Signs
- VS, pain, 5P’s r/t DVT

287
Q

C Section monitoring includes all BUBBLEES but adds…

A

Foley, IV, DB&C, early ambulation, sedation score, analgesia

288
Q

WinRho

A

If mom is Rh negative and baby is Rh positive

289
Q

How many calls to add to diet when BF

290
Q

Newborn Care Immediately after birth

A

Term gestation, breathing/crying, muscle tone

291
Q

APGAR scoring

A

1, 5 and 10 mins
HR: >100 = 2, <100 = 1, absent = 0
Resp: good cry = 2, slow/irregular = 1, absent = 0
Muscle Tone: well-flexed = 2, some flexion = 1, flaccid = 0
Reflex Irritability: vigorous cry =2, grimace = 1, none = 0
Color: Completely pink = 2, acrocyanosis = 1, pale/blue = 0

292
Q

Umbilical Artery

A

2 - Unoxygenated

293
Q

Umbilical Vein

A

1 - Oxygenated

294
Q

Venous pH

295
Q

Arterial pH

296
Q

Venous PO2

297
Q

Arterial PO2

298
Q

Venous PCO2

299
Q

Arterial PCO2

300
Q

Venous Base Deficit

301
Q

Arterial Base Deficit

302
Q

Normal Newborn VS

A

T: 36.5-37.5
HR: 110-160bpm
RR: 30-60rpm
BP: 50-75/30-45

303
Q

Signs of Neonatal Resp distress

A

tachypnea, cyanosis, grunting/cooing, nasal flaring, retraction/indrawing, accessory muscle use

304
Q

Why are newborn at risk for inadequate thermoregulation?

A

Large head, increase SA, less adipose tissue, brown fat, decreased ability to shiver

305
Q

BAT

A

Brown Adipose Tissue
Primary source of heat in hypothermic newborn

306
Q

Example of Evaporation

A

Wet with amniotic fluid

307
Q

Example of Convection

A

Body heat moves to cold air

308
Q

Example of Radiation

A

Cold objects near bed absorb heat

309
Q

Example of Conduction

A

Cold stethoscope

310
Q

Risks for altered thermoregulation

A

8-12hrs old, prematurity, SGA, CNS problems, sepsis.

311
Q

S&S of Cold stress

A

acrocyanosis, pallor, tachypnea, tachycardia, fussiness, hyperactive, irritable

312
Q

Risks of Neonatal Hypoglycemia

A

no glucose = neuro complications

313
Q

Normal Blood glucose in newborns

A

2.2-6mmol/L

314
Q

When to test newborn for hypoglycemia

A

SGA (decreased glycogen stores), LGA (hyperinsulinism), diabetic parent, premature, stressed/sick/cold

315
Q

S&S of Hypoglycemia in newborn

A

tremor, apathy, cyanosis, apneic spells, tachypnea, weak cry, limpness/lethargy, difficulty feeding, eye rolling, sweating

316
Q

Treatment for hypoglycemia in newborns

A

if asymptomatic - increase feeds
if symptomatic or <2 - infuse glucose

317
Q

Vitamin K

A

Give 1mg IM within 6hrs of birth due to risk of hemorrhage (low prothrombin levels)

318
Q

Erythromycin

A

Give ointment into eyes within 1 hour to prevent opthalmia neonatum from gonorrhea, clamydia, etc.

319
Q

Newborn Regular Behavior

A
  1. Pd of reactivity for 30-120mins
  2. pd of sleepiness after the 30-120mins
  3. 2nd pd of reactivity
320
Q

Overall Assessment of Newborn

A

Color, skin, tone, cord, fontanelles & sutures, hip dysplasia, reflexes

321
Q

Cephalohematoma

A

Blood between cranial bone and periosteal membrane - does not cross suture lines

322
Q

Caput Seccedaneum

A

Fluid and edema on scale from trauma or pressure, crosses suture lines

323
Q

Vernix Cerosa

A

NORMAL - white fluid, especially in creases

324
Q

Lanugo

A

Hair, normal

325
Q

Milia

A

White dots - sebaccious glands

326
Q

Erythema toxicum

A

Newborn rash - normal

327
Q

Dermal Melanocytosis

A

Mongolian spots, normal

328
Q

Telangietctatic nevi

A

Stork bite

329
Q

Newborn EYE assessment

A

Placement, tears, follow stimuli, decreased muscle control

330
Q

Newborn MOUTH assessment

A

Palate, tongue (frenulum - ankyloglossia, TOT), teeth/epstien’s pearls, response to tastes

331
Q

Newborn EARS assessment

A

Cartilage recoild, skin tags, react to stimuli, hearing screen

332
Q

Newborn NOSE assessment

A

Nose breather, patency, identify people by smell

333
Q

Normal Progression of newborn stools

A

Meconium - 48hrs
Transitional - thin, brown-green

334
Q

Breast fed baby stools

A

yellow, gold, seedy, soft/mushy

335
Q

Formula fed baby stool

A

pale yellow, formed, pasty

336
Q

Brick urine

A

urine crystals, normal for 1week

337
Q

Normal newborn urine

A

6 times per day after day 6, pale/clear

338
Q

Plagiocephaly

339
Q

Induction

A

Initiation of contraction of client NOT in labour

340
Q

Augmentation

A

Enhancement of contractions in client already in labour

341
Q

Cervical Ripening

A

Use of pharmacological means to soften, efface, and/or dilate cervix to increase likelihood of vag delivery

342
Q

Indications for induction

A

Postterm, HTN, DM, maternal disease, antepartum bleeding, chorioamnionitis, oligohydramnios, fetal compromise, Rh, IUGR, PROM (if GBS positive), IU death, Increased maternal age

343
Q

Post dates

A

> 40 weeks

344
Q

Post term

A

> 42 weeks

345
Q

Maternal Risks for Post term

A

Placental “expiry date”

346
Q

Fetal Risks for post term

A

large baby, complicated labour

347
Q

Cautions for Induction

A

grand multiparity, vertex not fixed, unfavourable/unripe cervix, brow/face presentation, overdistension of uterus, lower segment uterine scar, pre-existing hypertonus, history of difficult labour, availability of C/S

348
Q

Contraindications for Induction

A

Complete placental previa
Cord presentation/prolapse
Fetal malpresentation (transverse lie, breech)
Hx of uterine surgery, pelvic abnormalities, genital herpes, medical conditions

349
Q

Optimal Bishops score

350
Q

Unfavourable Bishops score

351
Q

Bishops Score

A

Dilation, Cervix position, effacement (%), Station, Consistency

352
Q

Bishops - Dilation

A

0 = closed
1 = 1-2cm
2 = 3-4cm
3 = 5-6cm

353
Q

Bishops - Cervix position

A

0 = posterior
1 = mid position
2 = anterior

354
Q

Bishops - Effacement

A

0 = 30%
1 = 40-50%
2 = 60-70%
3 = 80%

355
Q

Bishops - Station

A

0 = -3
1 = -2
2 = -1,0
3 = +1, +2

356
Q

Bishops - Consistency

A

0 = firm
1 = medium
2 = soft

357
Q

Stripping/Sweeping of Membranes

A

Mechanical separation of membranes from cervix to uterus

358
Q

Mechanical Dilation

A

Foley, cervical ripening balloon (CRP), amniotomy

359
Q

Prostin Gel

A

Into posterior fornix of vaginal

360
Q

Cervidil

A

Into posterior fornix of vaginal to continuously slow release

361
Q

Misoprostol/Cytotec

A

Oral or Vaginal - can go home with it inserted

362
Q

Prostaglandin Advantage

A

Minimal invasion, simple admin, induction (not augmentation)

363
Q

Oxytocin Infusion

A

Syntocin/pitocin
Induction & Augmentation
Gradual increase in 30 min increments

364
Q

Tachysystole Risks

A

Uterine hyperstimulation - can cause placenta abruption, fetal hypoxia, precipitous delivery, PP hemorrhage, uterine atony

365
Q

Oxytocin Complications

A

Failture establishing labour, tachysystole, chorioamnionitis, uterine rupture, PPH, hysterectomy, placenta implantation abnormalities in future pregnancy, longer hospital stay, risk of assisted birth or C/S, adverse neonatal outcomes

366
Q

Causes of Dystocia

A

P - Problems with powers
P - Problems with passageway
P - Problems with passenger
P - Problems with Psyche

367
Q

Labour Dystociaa

A

non-progression in active labour

368
Q

HTN disorders in pregnancy

A

Pregnancy induced HTN (PIH)
Gestational HTN (GH)
Pre-eclampsia
Toxemia

369
Q

Risks factors that increase HTN in pregnancy

A

Nullipara, hx of HTN, SLE or CKD, poor nutrition, obesity, advanced maternal age, multiples, pre-gestational diabetes, hx of stillbirth or IUGR

370
Q

Chronic HTN

A

Develops before pregnancy or > 20weeks gest

371
Q

Gestational HTN

A

Sys >140 and/or dias >90 - After 20wks and up to 12 weeks PP

372
Q

Severe HTN

A

Sys > 160 and/or dias >110

373
Q

Preeclampsia

A

Sys > 140 and/or Dias >90 + proteinuria (2+) and other adverse conditions

374
Q

Eclampsia

375
Q

Maternal Consequences of preeclampsia

A

Stroke, pulmonary edema, hepatic failure, jaundice, seizures, placental abruption, acute renal failure, HELLP, DIC

376
Q

Fetal Consequences of preeclampsia

A

IUGR, oligohydramnios, prematurity, fetal compromise, IU death

377
Q

Prevention of Vasospasms and Hypoperfusion

A

ASA if increase risk starting at 16wks until delivery
Calcium supplements

378
Q

Management of Vasospasms and hypoperfusion

A

decrease stress, treat BP, wt loss, NST’s, hourly I&O, BP, pulse, resp, BW (Liver, platelets, Hct), fetal movement and blood flow

379
Q

Meds for vasospasms and hypoperfusion

A

labetolol, nifedipine, hydralazine, aldomet

380
Q

What HTN meds are NOT allowed in pregnancy

A

ACE - inhibitors

381
Q

Magnesium Sulfate

A

Anti-convulsant

382
Q

Magnesium toxicity

A

CNS depression (RR <12, oligouria = <30ml/hr, decreased DTR)

383
Q

Mag sulf monitoring

A

tachycardia, NB reflexes, urine output, slow labour, muscle weakness, decreased energy, resp depression, low BP

384
Q

What to do if suspected eclampsia

A

Bolus of mag sulf - possible dilantin, lasix (for edema), digitalis (for circulatory failure)

385
Q

What to do if early delivery is required for preeclampsia

A

Give corticosteroids to increase fetal lung maturity

386
Q

HELLP Syndrome

A

Hemolysis Elevated Liver enzymes Low Platelets

387
Q

DIC

A

Disseminated Intravascular Coagulation - overactivation of normal clotting mechanism - mini clots develop and EXCESS BLEEDING

388
Q

DIC causes

A

Preeclampsia, hemorrhage, IU fetal demise, fluid embolism, sepsis, HELLP

389
Q

Gestational Diabetes Prevalence

390
Q

Causes of Gest Diabetes

A
  1. Fetus continually takes glucose from mother
  2. Placenta creates hormones which alter effects of resistance to insulin and glucose tolerance
391
Q

Carbohydrate Metabolism in pregnancy - 1st trimester

A

increased hormones stimulate insulin production and tissue response (sensitivity)

392
Q

Carbohydrate Metabolism in pregnancy - 2nd trimester

A

Placenta secretes hPL and increases resistance to insulin

393
Q

Pregnancy/Maternal Effects of Gest diabetes

A

Preeclampsia risk increases due to vascular changes
Polyhydramnios, PROM, PPROM
Preterm labour risk increases, increased risk of dystocia and C/S
Worsening myopathies (vascular, renal, retinal)
Increased risk of HTN and T2DM later in life

394
Q

Fetal Effects of Gest diabetes

A

Macrosomnia/LGA, IUGR, fetal demise, congential anomalies

395
Q

Neonatal Effects of gest diabetes

A

hypoglycemia, hyperbilirubinemia, RDS

396
Q

Normal result of non-fasting glucose test

A

24-28wks
<7.8mml/L

397
Q

Abnormal result of non-fasting glucose test

A

7.8-11 = fasting glucose required
>11.0 = gest diabetes diagnosis

398
Q

Multiples birth risks

A

Increase risk of preterm labour, anemia, HTN, abnormal presentation, twin-twin transfusion syndrome, uterine dysfunction, abruptio placenta/placenta previa, prolapsed cord, PPH

399
Q

Singleton Stats

A

Gest age - 38.7wks, 6.3% weigh < 2500g, 7% < 34wks, mortality 4.1/1000

400
Q

Twin Stats

A

Gest age - 35.2wks, 56.6% weigh < 2500g, mortality 25.7/1000

401
Q

Triplet Stats

A

Gest age - 32.1wks, 94.1% weigh <2500g, mortality 62.2/1000

402
Q

Twin-to-Twin Transfusion Syndrome

A

Blood in umbilical cord flows unequally between twins that share a placenta

403
Q

Complications of Obesity in Pregnancy

A

Spontaneous abortion/stillbirth, HTN, diabetes, preterm or postterm

404
Q

Complications of Obesity in Intrapartum

A

Still birth, macrosomia/shoulder dystocia

405
Q

Complications of Obesity in Neonatal

A

Macrosomia, hypoglycemia, BF issues, congenital anomalies

406
Q

Complications of Obesity in Post Partum

A

Depression, PPH, Infection, Thrombosis

407
Q

Risks of Adolescent Pregnancy

A

Physical: preterm birth, LGA, CPD, anemia, HGTN
Psychosocial: Interruption of development, substance use, poverty, interruption or cessation of education, less prenatal visits

408
Q

Risks of Advanced maternal age in pregnancy

A

> 35
Decline in fertility, increased chronic diseases, increased difficulty in pregnancy, increased risk of C/S and induction, increased genetic conditions, congenital anomalies

409
Q

Methadone

A

Most commonly used for women dependent on opioids - heroin
- blocks withdrawal symptoms
- reduces cravings for narcotics
- crosses placenta

410
Q

Methadone use in pregnancy

A

Associated with pregnancy complications and abnormal fetal presentation

411
Q

Prenatal exposure to methadone

A

Reduced head circumference and low birth weight, withdrawal symptoms

412
Q

Cannabis in Pregnancy

A

Can negatively impact fertility, crosses placenta (can harm fetus - birth defects, preterm delivery, cognition and behavioral problems), passes into breastmilk

413
Q

Teratogens

A

Alcohol, drugs, prescribed medications, pathogens

414
Q

CHEAP TORCHES

A

C: Chickenpox and shingles
H: Hepatitis B/C/D/E
E: Enteroviruses
A: AIDS
P: Parvovirus B19
T: Toxoplasmosis
O: Other (GBS, listeria, candida)
R: Rubella
C: Cytomegalovirus
H: Herpes Simplex Virus
E: Every STI (gonorrhea, chlamydia)
S: Syphilis

415
Q

Syphilis problems in newborn

A

Issues with eyes, ears, teeth, bones and may cause death

416
Q

Urinary, vaginal, sexually transmitted infections, PID, Bacterial vaginosis (BV)

A

10-25% of all women, 50% asymptomatic
May cause spontaneous abortion, preterm delivery, maternal and fetal morbidity and mortality

417
Q

COVID in pregnancy

A

May cause preterm delivery and infant morbidity

418
Q

Group B Streptococcus (GBS)

A

Common bacteria which are often found in the vagina, rectum, or bladder of 15-40% of people
- screen at 35-37wks

419
Q

HIV and AIDS in pregnancy

A

Modes of pregnant client client to child:
- in utero (placenta)
- during childbirth and delivery
- PP through BF

420
Q

HIV Chance of transmission

A

WITHOUT treatment = 25% chance
WITH treatment = <2% chance

421
Q

Treatment of HIV in pregnancy

A

Combination anti-retroviral therapy (cART) (pregnancy)
Add IV ZDV during labour until birth/3hrs before C/S
Infant - ZDV oral suspension for 6wks, no BF

422
Q

HIV care following birth

A

Positive antibody titer, reflects passive transfer of maternal antibodies rather than HIV infection
NO BF

423
Q

Biggest risk of preterm labour

A

PREVIOUS PTB

424
Q

Common symptoms of preterm labour

A

Low ABD pain/cramps/backache, bleeding/spotting/show/ROM, pelvic pressure, increased amount/changes in vag delivery, contractions every 10 mins

425
Q

Fetal Fibronectin fFN

A

Glycoprotein released into cervical/vaginal fluid in response to inflammation or separation of amniotic membranes
Normal until 22wks gest and reappears before labour

426
Q

Negative fFN

A

pregnancy is likely to continue for at least another 2 wks (95-98%)

427
Q

Positive fFN

A

Present 24 through 34 wks gest indicates high risk of preterm delivery

428
Q

Management of preterm labour

A

Should it be stopped?
Assess and monitor VS, contractions and fetus
Avoid stimulation (no vag exams, no sex, no nipple stimulation)

429
Q

Tocolytics for preterm labour: Indomethacin

A

anti-prostaglandin inhibits uterine activity, effective in delaying delivery for 48 hrs - NOT for long term

430
Q

Tocolytics for preterm labour: Calcium channel blockers

A

nifedipine (adalat) - not very effective

431
Q

Tocolytics for preterm labour: Vaginal Progesterone

A

May prevent and reduce incidence of PTB if previous hx of PTB or short cervical length

432
Q

Cervical Insufficiency

A

Premature painless dilation of cervix (20-28wks)
- 2nd trimester abortions because cervix can’t handle the weight

433
Q

Cervical Insufficiency Treatment

A

Bedrest, pelvic rest, avoid heavy lifting
Cervical cerclage (suture)

434
Q

Risks of cervical cerclage

A

Infection, blood loss, PPROM, preterm labour, damage to cervix

435
Q

Corticosteroids in Preterm Labour

A

All pregnant clients between 14-34 weeks gestation who are at risk of preterm delivery within 7 days
- single course reduces perinatal mortality, resp distress syndrome, and intraventricular hemorrhage

436
Q

MgSO4 for Fetal Neuroprotection

A

Prevent seizures in newborn
Use if preterm <31+6weeks (active labour <4cm dilation, planned preterm)

437
Q

Abortion

A

Expulsion of fetus before 20wks gestation OR expulsion of fetus < 500g

438
Q

Spontaneous abortion

A

occur naturally

439
Q

Therapeutic/induced abortion

A

medical or surgical means

440
Q

If minimal bleeding in spontaneous abortion

A

bed rest and abstinence from sex

441
Q

If persistent/heavy bleeding/pain/fever in spontaneous abortion

A

Cytotec (misoprostol)/cervidil
WinRho
IV therapy
Surgical dilation and currettage (D&C) or suction evacuation (D&E)

442
Q

Ectopic Pregnancy

A

Implantation of fertilized ovum outside the uterus

443
Q

S&S of ectopic pregnancy

A

rupture and bleeding into abd cavity: sharp unilateral pain and decreased BP and syncope, referred shoulder pain, vaginal bleeding, hypovolemic shock

444
Q

Gestational trophoblastic disease

A

RARE (1/1000) pathologic tumour of childbearing age client
- abnormal development of placenta
- trophoblastic cells that obliterate in pregnancy

445
Q

S&S of Gestational trophoblastic disease

A

Uterine enlargement greater than gest age, vaginal bleeding, passage of clots, hyperemesis gravidarum, preeclampsia before 24 wks

446
Q

Antepartum hemorrhage

A

Vaginal bleeding > 20wks -delivery

447
Q

Causes of antepartum hemorrhage

A
  • Placenta previa
  • Abruptio Placentae
448
Q

Placenta previa

A

Implantation of the placenta - total/complete, partial, marginal, low-lying placenta

449
Q

Placenta previa detection

A

routine ultrasound, ultrasound at start of bleeding, frequent monitorig
Goal: 36-37wks

450
Q

Placenta previa risk factors

A

previous placenta previa
uterine abnormalities/endometrial scarring
impeded endometrial vascularization
large placental mass

451
Q

Abruptio placentae

A

Premature separation of normally implanted placenta from uterine wall
Total/complete - hemorrhage, fetal death
Partial - fetus can tolerate 30-50% abruption

452
Q

Abruptio placentae risk factors

A

Previous abruption, HTN blunt abdominal trauma, overdistended uterus, PPROM, previous C/S, cocaine/crack use, smoking, short umbilical cord, uterine abnormalities (fibroids at implantation site), advanced age in pregnancy or high parity

453
Q

Implications of abrupto placentae in pregnant client

A

antepartum/intrapartum hemorrhage, PPH, DIC, hemorrhagic shock

454
Q

Implications of abrupto placentae in fetal-neonate

A

Sequelae of prematurity, hypoxia, anemia, brain damage, fetal demise

455
Q

Manifestation summary of placenta previa

A

insidious, visible bleeding, bright red blood, no pain, soft and relaxed uterine tone, FHR normal, may be breech or transverse, no engagement

456
Q

Manifestation summary of abruptio placentae

A

sudden onset, concealed or visible bleeding, dark red blood, constant pain in uterus, firm to rigid uterine tone, fetal distress or absent

457
Q

Placenta accreta

A

Placenta attaches itself too deeply into surface of the myometrium

458
Q

Placenta increta

A

Penetrates into the myometrium

459
Q

Placenta percreta

A

WORST - placenta through myometrium and into tissues or organs

460
Q

Velamentous insertion of cord

A

Vessels of umbilical cord divide some distance from placenta in placental membranes
Torn vessels lead to fetal hemorrhage

461
Q

Uterine Rupture

A

Spontaneous rupture or rupture of previous scar

462
Q

Risk factors for uterine rupture

A

Previous uterine surgery or C/S, short inter delivery interval (less than 18 months), grand multiparity, trauma, IU manipulation, midforcep rotation of fetus

463
Q

Presentation of Uterine Rupture

A

ABD pain, decreased uterine activity, N/V, vaginal bleeding, fetal tachycardia, pallor, shape of abdomen changes, fetal parts palpable through ABD wall

464
Q

Primary (early) PPH

A

birth to 24 hours

465
Q

Secondary (late) PPH

A

24hours - 6wks

466
Q

EBL

A

Estimated blood loss

467
Q

PPH blood loss

A

> 500mls vaginal
1000 C/S

468
Q

Prompt recognition of PPH

A

Rise in level of fundus, boggy fundus, abnormal clots, persistent lochia rubra, bright red bleeding, increased pulse, decreased BP, bleeding with firmly contracted uterus, pelvic discomfort, decreased LOC

469
Q

4 T’s of PPH

A

Tone (70%)
Trauma (20%)
Tissue (10%)
Thrombin (<1%)

470
Q

Tone - Uterine Atony

A

Lack of uterine muscle tone
- overdistended uterus
- exhausted
- infection
- abnormalities

471
Q

Trauma - Uterine atony

A

Cervical, vaginal, perineal lacerations suspected when BRIGHT RED BLEEDING with contracted uterus, hematoma, uterine inversion, uterine rupture

472
Q

Tissue - Uterine atony

A

Common in LATE PPH
Retained placental lobes, membranes
Retained blood clots

473
Q

Retained placenta

A

Retention of placenta beyond 30 mins after birth - requires manual removal

474
Q

Thrombin - uterine atony

A

Pre-existing or acquired bleeding disorders

475
Q

Treatment for PPH

A

Prompt attention to resuscitation (ABC’s), identify cause of bleeding, appropriate based on etilogy, multidisciplinary approach, fundal assessment massage, empty bladder, admin uterine stimulus, admin antifibrinolytic

476
Q

If PPH persists after initial treatment

A

Large bore IV - crystalloid bolus
foley and oxygen

477
Q

Interventions/Thrombosis prevention

A

Avoid: smoking, sitting/standing in one position, oral contraceptives
encourage: early activity, leg exercises
consider: compression devices, anticoags

478
Q

Metritis

A

Inflammation of the uterus

479
Q

S&S of Metritis

A

ABD pain, fever, foul lochia, N/V, fatigue, increased WBC

480
Q

Wound infection

A

Surgical, laceration, episiotomy

481
Q

S&S of wound infection

A

REEDA, pain/tenderness at site, fever, increased WBC

482
Q

Mastitis

A

Inflammation of breasts

483
Q

Post partum danger signs

A

fever >38 degrees
foul odor to lochia/unexpected change
large blood clots or saturating >1pad per hr
visual changes or severe headaches
calfe pain
swelling, redness, discharge at site
dysuria, burning on voiding
SOB or difficulty breathing
depression or mood swings

484
Q

Risk factors for PP mental health problems

A

Female, hx of depression/dc of antidepressants, low income/education, single, age, relationship issues (IPV), lack of social support, stress, substance use, ethnic minority, unplanned pregnancy, difficult and delivery

485
Q

S&S of PP mental health problems

A

Depressed mood, anhedonia, wt changes, insomnia/hypersomnia, restless, agitated, slowed, low energy, guilt

486
Q

Antenatal depression

A

Melancholia in pregnancy: in 20 % of women

487
Q

PINKS in PP

A

elation after, happy and excited, early dc, sleep, bipolar, expectations of pregnancy

488
Q

Postpartum Blues

A

“normal” transient, emotional response, up to 85%

489
Q

Postpartum Psychosis

A

0.1-0.2% - insomnia, agitation, hallucinations, self-hard, infanticide, homicide, mood swings

490
Q

PP Anxiety

A

24% in pregnancy, fearful/phobic, over-concerned, high expectations, panic attacks

491
Q

Obsessive Compulsive disorder (OCD)

A

Intrusive, repetitive thoughts, guilt, worry, shame, hypervigilant

492
Q

T-ACE

A

Problems with Alcohol
T- tolerance (2pts)
A - annoyed (1 pt)
C - cut down (1pt)
E - Eye opener (1pt)
At-risk = 2-5

493
Q

Preterm infant resp

A

lack of surfactant, RDS, BPD

494
Q

Preterm infant Cardio

A

patent ductus arteriosis (PDA), increased resp effort, CO2 retention

495
Q

Preterm infant GI

A

Small stomach, immature feeding reflexes, NEC

496
Q

Preterm infant Renal

A

Decreased ability to concentrate urine, decreased ability to excrete drugs

497
Q

Preterm infant hepatic/hematologic

A

immature liver (decreased ability to conjugate bilirubin - increase jaundice)
R/O hypoglycemia
Limited iron stores - anemia

498
Q

Preterm infant neurological

A

IVH, hydrocephalus, hearing loss, ROP

499
Q

Preterm infant temp regulation

A

no subcutaneous fat, poor muscle tone, thin skin, no adipose tissue (brown fat only), no liver glycogen, resuscitation efforts, LDR or ambient temps

500
Q

Preterm infant minimize heat loss

A

<28 weeks placed in food grade polyethylene bag

501
Q

Late preterm infant

A

brain size only 60% compared to normal fetus
Largest proportion of preterm births

502
Q

common causes of neonatal resp distress

A

RDS, Meconium aspiration (MSAF, MAS), transient tachypnea of the newborn (TTN)

503
Q

RDS risk factors

A

Prematurity, C/S without labour, males, hx of RD, cold stress, maternal diabetes, perinatal asphyxia

504
Q

RDS protective factors

A

Prolonged ROM, GHTN, donor twin, physiological stress, use of corticosteroids

505
Q

Management of RDS

A

Antenatal corticosteroids, exogenous surfactant, continuous positive airway pressure (CPAP), positive end-expiratory pressure (PEEP)

506
Q

Meconium-Stained Amniotic Fluid (MSAF)

A

12% of live births
can cause fetal compromise

507
Q

Care with Mec aspiration

A

Prevent: avoid postmaturity, amniotic infusion, endotracheal suction by trained individual
Assisted ventilation
Surfaxin (exogenous surfactant), steroids
Close observation

508
Q

Transient Tachypnea of Newborn

A

Excess fluid in the lungs or delayed re-absorption of fetal lung fluid (“wet lung”)
resolves self in 72hrs

509
Q

Perventricular hemorrhage

A

occurs in 50% of neonates <1500g and/or <35 wks
Due to weak ventricular capillaries, immature cerebral vascular development

510
Q

Hyperbilirubinemia

A

Excessive concentration of bilirubin in the blood

511
Q

Jaundice

A

Bile pigment deposited in the skin, mucous membranes, and sclera

512
Q

Kernicterus

A

Bilirubin levels rise > accepted levels at a given age or rate of rise is high enough - deposits in brain and causes encephalopathy

513
Q

Physiological jaundice

A

most common cause
increase in RBC, short life span of RBC and RBC hemolysis after birth
Resolves by day 8

514
Q

Pathological jaundice

A

excessive erythrocyte destruction, increased extravascular blood, polycythemia
within first 24 hours of life = pathological

515
Q

TcB

A

Transutaneous Bilirubin

516
Q

TSB

A

Total Serum Bilirubin

517
Q

Critical hyperbilirubinemia

A

> 425 in first 28 days

518
Q

Severe hyperbilirubinemia

A

> 340 at any time in the first 28 days

519
Q

Coomb’s test

A

For ABO incompatibility

520
Q

Phototherapy

A

Additional light helping to breakdown bilirubin
Naked (except diaper)
Eye protection
Phototherapy blankets
Continue BF

521
Q

Neonatal abstaining/withdrawing from drugs

A

Eat, sleep, console
Look for signs of withdrawal
Decrease stimulation, swaddle, c-position

522
Q

Cocaine in pregnancy

A

Risk of placental problems, risk of miscarriage, risk of preterm labour, risk of SIDS

523
Q

Meds to treat withdrawal

A

Opium, morphine, methadone, phenobarbital

524
Q

Naloxone (narcan)

A

for resp depression, can cause rapid withdrawal and seizures

525
Q

Neonatal sepsis

A

Infection = major cause of neonatal illness and death

526
Q

S&S of Neonatal sepsis

A

SUBTLE behavior changes, temp instability, tachycardia, seizures - hypotonia, poor peripheral circulation, resp distress, hyperbilirubinemia

527
Q

IPV during pregnancy

A

Increase up to 7-11% in pregnancy

528
Q

Impact of domestic violence on pregnancy

A

delayed/less prenatal care, increased stress & depression, financial effects, inadequate weight gain, complications

529
Q

Impact of domestic violence on fetus

A

direct physical trauma causing injury or miscarriage, negative behavioral effects, preterm labour/birth, low birth weight/SGA

530
Q

Impact of domestic violence postnatal

A

decreased likelihood of BF, maternal mental health issues, r/o aggression and hyperactivity in child, increased r/o child abuse

531
Q

Complications in L&D

A

Dystocia
Precipitous L&D
Malpresentation/position (POP, breeach, ECV)
Operative and assisted deliveries (C/S, Forceps/vacuum), TOLAC/VBAC, obstetrical emergencies (shoulder dystocia, cord prolapse)

532
Q

Breech presentation

A

3-4% of all term pregnancies
Frank 50-70%
Footling 10-30%
Complete 5-10%

533
Q

Diagnosis of Breech

A

Maternal perception of movement, leopold’s maneuver’s, FH auscultated above umbilicus, vag exam, ultrasound, passage of thick mec

534
Q

characteristics for breech delivery

A

Vaginal delivery is optimal if uncomplicated TERM, frank or complete breech, singleton, >2500 and <4000g with flexed head

535
Q

External Cephalic version

A

Flipping baby from breech to cephalic

536
Q

Indiction of C/S

A

non-reassuring FHR findings, active genital herpes, multiple gestation, umbilical cord prolapse, pelvic size, lack of labour progression/failed induction, maternal infection, placenta previa, previous C/S, fetal anomalies or extremities in size

537
Q

Inta-operative risk for C/S

A

Aspiration, difficult airway management, PPH

538
Q

Post-op risk for C/S

A

Endometritis/infection, hemorrhage, poor bladder emptying, paralytic ileus, thrombophlebitis

539
Q

Trial of Labour After Cesarean Section (TOLAC)

A

Depends on indication and type of 1st section and maternal heatlh

540
Q

Risks of TOLAC

A

Hemorrhage, uterine rupture, infant death or neuro complications

541
Q

Successful TOLAC

542
Q

TOLAC Care

A

Continuous EFM - uterine contractions, avoid oxytocin if possible (increases risk of rupture), avoid cervical ripening methods, have C/S available

543
Q

Indications for Vacuum and Forceps

A

Fetal indications (+4 but not coming out, decreased FHR)
Maternal - inability to push, lack of rotation, disease

544
Q

Vacuum Extractor

A

Suction applied to fetal head (occiput)
Pull with contractions
Should be progressive descent with first two pulls (with contractions)

545
Q

Common complications of vacuum or forceps delivery (newborn)

A

bruising, laceration, edema (caput)

546
Q

Uncommon complications of vacuum or forceps delivery (newborn)

A

Retinal hemorrhage, nerve injury, cephalohematoma, cerebral hemorrhage, skull fracture, intracranial pressure, subgaleal hemorrhage

547
Q

Complications of vacuum or forceps delivery (maternal)

A

genital tract trauma, increased bleeding (risk for PPH), bruising and edema, shoulder dystocia

548
Q

Obstetrical emergencies

A

shoulder dystocia
Cord prolapse

549
Q

Shoulder Dystocia Interventions

A

Ask for help
Lift/hyperflex legs (mcroberts manoeuvre)
Anterior shoulder disimpaction (subrapubic pressure)
Rotate posterior shouldre
Manual removal of posterior arm
Episiotomy
Roll over onto all fours

550
Q

Shoulder Dystocia complications maternal

A

Episiotomy, extended lacerations, hematomas, uterine atony, hemorrhage, bladder injury, rectal injury

551
Q

Shoulder dystocia complications fetal

A

Clavicle or humerus fracture, brachial plxus injury or spinal nerve damage, erb’s palsy, asphyxia, death

552
Q

Cord prolapse

A

sudden, severe, variable decels or no FHR

553
Q

Cord prolapse causes

A

polyhydramnios, long cord, malpresentation, premature ROM, amniotomy before engaged vertex

554
Q

Cord Prolapse interventions

A

check FHR, get help and prepare for C/S
Hold presenting part OFF cord (trandelnburg, knee-chest, keep gloved hand in vagina, decrease contractions

555
Q

Perinatal Loss - Early Loss

A

Ectopic pregnancy, miscarriage/abortion, medical interruption of pregnancy, infertility/multi-fetal reduction

556
Q

Perinatal loss - late

A

Stillbirth, newborn death, loss of baby (adoption, relinquishment or apprehension)

557
Q

Attachment during pregnancy and childbirth

A

planning, confirming and accepting pregnancy, feeling fetal movements, seeing US, accepting fetus as individual, giving birth, hearing and seeing baby, touching and holding baby, caring for baby

558
Q

4 Tasks of Mourning

A

Accept reality of the loss
Work through pain and grief
Adjust to a world without the deceased
Find an enduring connection while moving forward with life

559
Q

Breaking Bad news to Paretns

A

Provide “warning shot”
Allow support to be present
Use private setting
Sit down near family and maintain eye contact
Be unhurried
Be specific

560
Q

Guidelines for intervention during fetal loss delivery

A

provide optimal analgesia while in labour, respect privacy and time with baby (unrushed), support of and for family, take lead from parents, provide information, care of the infant), provide PP information, follow up

561
Q

Providing memories for loss of baby

A

memory boxes, lock of hair, footprints, photos, ultrasound pictures, fetal monitor strips, crib card with wt and measurement, items of significance

YEAR 3 (14 decks)

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