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44 Cards in this Set
- Front
- Back
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• Critical pathways or Clinical pathways
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Care maps; collaborative guidelines that define multidisciplinary care in terms of outcomes within a timeline
expected progress of patient is standard of care improves quality of care and length of hospital stay focuses on patient, not nurse |
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• Factors that affect infertility
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male: abnormal sperm, too few sperm (high scrotal temp, abnormal hormones, infections, varicocele, medication, drugs, excessive alcohol, toxins), abnormal erections, abnormal ejaculation, abnormal seminal fluid
female: disorders of ovulation, abnormalities of the fallopian tubes (Chlamydia, gonorrhea, endometriosis, pelvic surgery, appendicitis, peritonitis, ovarian cysts), abnormalities of uterus, cervix, or ovaries (myomas), hormone abnormalities) also: coital frequency, age, cigarette smoking, exercise/diet/weight, emotional factors, medical problems, drugs, |
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progesterone
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produced by corpus luteum and placenta; maintains uterine lining, reduces uterine contractions to prevent abortion, prepares glands of breast for lactation, stimulates male fetus testes to produce testosterone, may be given to stimulate implantation if there are fertility problems
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estrogen
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stimulates uterine growth, increased blood flow to uterine vessels, stimulates development of breast ducts, increased skin pigmentation, vascular changes in skin and mucous membranes around mouth, increased salivation
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hCG
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signal to corpus luteum to continue to produce estrogen and progesterone,
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FSH
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follicle stimulating hormone; maturation of follicle in the ovary that contains a single ovum; stimulates increase in progesterone and estrogen
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LH
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Lutenizing hormone; stimulates final maturation and release of ovum
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• Signs of Pregnancy, tests to confirm pregnancy
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presumptive: amenorrhea, nausea, breast tenderness, deepening pigmentation, urinary frequency, quickening
probable: Goodell's sign (cervix softens), chadwick's sign (blue cervix), hegar's sign (softening of lower uterine segment), mcdonald's sign (easy to flex body of uterus against cervix), abdominal enlargement, braxton hicks contractions, ballottement (fetus can be displaced and rebounds), striae, positive pregnancy test (measure for hCG) positive: audible fetal heart beat, fetal movement felt by examiner, ultrasound of fetus |
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• TPAL system grading
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number of term, preterm, abortions, living children, (m = multiples)
Gravida may procede = number of pregnancy's, including current |
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• Chadwick’s, Goodell’s
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Chadwicks: blue cervix
Goodells: cervix softens |
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• Naegele’s rule and be able to apply
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• Naegele’s rule and be able to apply
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• Assessment of the mother at a prenatal visit
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hx = obstretic hx, menstural hx, contraceptive hx, medical/surgical hx, family hx, woman's and partner's health hx, psychosocial hx
complete physical exam pelvic exam - size, adequacy, condition of pelvis and reproductive organs EDD routine: vitals, risk factors, weight, urinalysis, blood glucose screening (24-28 weeks), fundal height, leopold's maneuvers, fetal hr, nutrition, discomfort/problems |
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• Hyperemesis gravidarum
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excessive N/V, may cause dehydration
weight loss of more than 5%, dehydration, acid/base imbalance, stress treat: rule out other causes, may need TPN, antiemetic, care: teach pt. to reduce trigger foods, avoid food odors, I&O, small/frequent meals, easily digested carbs, liquids between meals, upright after meals, reduce stress |
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• Differentiate between the types of abortions
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spontaneous: threatened (cervix is closed, no tissue passed), inevitable (cervix dilates), incomplete (passage of tissue, uterus may need to be emptied), missed (fetus dies in utero, is not expelled), recurrent (2+ spontaneous, may need to reinforce cervix)
induced: therapeutic (mother's health), elective (reasons other than mother's health) |
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• Rh negative mothers- considerations
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can cause blood incompatibility with fetus (isoimmunization by her body) = erythroblastosis fetalis (mother's blood destroys babies RBC)
need RhoGAM at 28 wks, within 72 hrs of birth, after amniocentesis, if woman experiences bleeding during pregnancy monitor during pregnancy, can do intrauterine transfusion |
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• Pregnancy-induced Hypertension/Gestational Hypertension
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GH (BP >140/90 after 20 wks), preeclampsia (+ proteinuria), eclampsia (+tonic-clonic seizures; visual disturbances, decreased urinary production); edema may be present (above the waist, sudden and excessive)
birth is cure may be related to abruptio placenta, fetal growth restriction, preeclampsia, prematurity, stillbirth methyldopa, alpha/beta blockers, Ca channel blockers (hydralazine, labealolnifedipine); diuretics/sodium restriction not effective; magnesium sulfate HELLP syndrome (hemolysis = broken erythrocytes, elevated liver enzymes, low platelets) |
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• Magnesium Sulfate therapy
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anticonvulsant; also inhibits contractions, increased risk of bleeding IV
continue 12-24 hours after birth because seizures are still possible excreted by kidneys = toxicity evidenced by loss of reflexes, depressed respirations calcium gluconate counteracts therapeutic levels of 4-8 mg/dl cannot treat newborn with aminoglycosides = paralysis |
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• Stages of Labor
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First stage: dilation and effacement; latent (1-4 cm dilated), bloody show, contractions to every 5 minutes, mother cooperative; active (4-7 cm) ruptured membranes, effacement, contractions 2-5 minutes apart, mother nervous; transition (7-10 cm) contractions 2-3 minutes apart; mother irritable
Second Stage: expulsion; cervix dilated Third Stage: expulsion of placenta (shiny schultze or dull duncan's) Fourth Stage: recovery, lochia rubra, uterus @ midline |
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• Apgar-review
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ranked at 1 and 5 minutes
heart rate, respiratory effort, muscle tone, reflect irritability, color 8-10 good 4-7 gentle stimulations lower than 3 active resuscitation |
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• Respiratory distress in an infant
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support after birth: remove mucus and excess amniotic fluid, clamp cord, evaluate color, may apply oxygen
Signs of rd: persistent cyanosis, grunting respirations, flaring nostrils, retractions, sustained respiratory rate higher than 60, sustained heart rate greater than 160 or less than 110 |
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• Cleft Lip/Palate
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fissure or opening in lip, occurs between weeks 7 and 8 of gestation
cheiloplasty = repair by 3 months; palate between 1 year and 18 months care: elbow restrains, Asepto syringe for feeding to reduce sucking, prevent from sucking/crying, do not place on abdomen, prevent infections/scaring, provide cuddling, provide pain relief, no straws, no hot foods/liquids, follow feedings with water, good mouth hygiene, speech therapy may be needed risk for ear infections |
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• Considerations for newborns of Diabetic mothers
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mother must keep diabetes under good control
hyperglycemia in the mothers causes hypergylcemia in the fetus = macrosomia may have low blood glucose after birth; increased sub-q fat, RDS, may cause brain damage infant s & s of hypoglycemia: irritability, tremors, respiratory distress |
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• Piaget’s stages and ages
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sensorimotor (birth to 2 years)
preoperational (2-7 years): egocentric; not yet logical perceptual (4-7 years): some reasoning, just one aspect of situation at a time concrete operations (7-11 years) logical reasoning limited to own experience, understands cause and effect formal operational (11-16 years) acquires ability to develop abstract concepts for self |
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• Erickson’s stages and ages
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trust vs. mistrust (infant)
autonomy vs. shame and doubt (toddler) initiative vs. guilt (preschool), different sexes industry vs. inferiority (school age) identity vs. role confusion (adolescent) |
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• Separation anxiety- Ages, stages, nursing interventions
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stages: protest, despairs, attachment
most pronounced with toddlers important to be honest, clear, understandable about when parents are coming back |
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• Conversion- Weighing diapers
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grams = mL, subtract weight of dry diaper
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• Hearing impairment- signs
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lack of response by infant to sounds or music; lack of startle reflex
discover when child enters school - behavior/attention problems |
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• Hirschsprung’s
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aka aganglionic megacolon = absence of ganglionic innervation to the muscle of a segments of the bowel = lack of normal peristalsis
S&S: failure to pass meconium, constipation, ribbon like stools, abdominal distention, N/V, FTT, complications: enterocolitis (inflammation of small bowel and colon) - fever, explosive stools, depletion of strength diagnose with barium enema and rectal biopsy care: temporary colostomy, repair at 12-18 months, enemas at home (normal saline - not tap water) |
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roundworms
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asymptomatic or cause abdominal pain; warm climates, results from unsanitary disposal of feces and poor hygiene, eggs can survive from weeks, chronic cough without fever characteristics, treat same as pinworms
etiology: egg develops into larva in intestine, penetrate intestine enters liver, circulates to lungs and heart, symptoms occur when larva reach glottis, are coughed up and swallowed |
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Giardiasis (p
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intestinal protozoan that causes diarrhea
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hypospadias, epispadias
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hypospadias: urinary meatus is not at the end of the penis, but is on lower shaft
epispadias: opening of urinary meatus is on upper surface of penis |
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• Opportunistic infections
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acquired when immune system is suppressed
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• Rash-describing- Know terms: (i.e Macular, Papular, Vesicular, Pustular, etc)
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macule: circular reddened area on skin
papular: circular reddened area on skin that is elevated vesicular: circular reddened area on skin that is elevated and contains fluid pustular: circular reddened area on the skin that is elevated and contains pus |
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• Explaining immunizations/types of immunity
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natural immunity: inborn resistance
acquired immunity: results from having the disease or receiving vaccine active immunity: produce own immunity after receiving vaccine or having disease passive immunity: get antibodies from serum, more immediate but not long lasting because system does not produce own antibodies |
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• Anorexia
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failure to maintain normal weight for age and height (less than 85% of expected)
overachievers, low self-esteem, obedient, nonassertive, rigid families concerns: electrolyte imbalance, malnutrition, stabilize weight antidepressents may help |
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• Bulimia
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compulsive eating, followed by vomiting or laxative use
depression and alcoholism, distant mother-daughter relationship = coping mechanism erosion of tooth enamel concern, electrolyte imbalance too may use contracts |
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• OCD
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not usually part of obsessive personality in children - related to depression and tourettes
may start as early as 4 years of age - inhibits function may be genetic meds: clomipramine, fluoxetine, fluvoaxamine behavior therapy = exposure and response prevention; follow-up care |
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• Autism, including medications & therapy
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diagnosed by 3 years - failure to make eye contact, poor attention, poor orientation to own name, not interested in other children, no pretend play
treat: well-structured home environment, behavior modification, specific drugs drug therapy to reduce behavioral symptoms; haloperidol, amphetamines |
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• RICE for soft-tissue injury
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rest, ice (30 minutes), compression (neuro checks), elevation (above heart to reduce edema)
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• Different types of Traction
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Bryants: Under 2 years or 20 lbs; legs extended vertically, weight of child is counter traction
Buck's skin traction: counter traction supplied by body; pulls hip and leg into extension, child must not slip down, bed must not be placed in high fowlers, usually post-op Russell skin traction: like buck's but sling is under knee, pull is into directions, preventions subluxation of tibia on femur skeletal traction: steinmann pin or wire is inserted into bone; traction applied to the pin; daily care of pin site important to prevent osteomyelitis |
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• Foramen Ovale/PDA in the Newborn-Review
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ducutus arteriosis (avoids lungs) fails to close
blood goes from aorta to pulmonary artery and returns to lungs; forces hear t o pump harder due to overburdened pulmonary circulation S&S: dyspnea, full and bounding pulse on exertion, , wide pulse pressure, machinery type murmur usually surgery is done |
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• Congenital heart Defects
increase pulmonary flow |
atrial septal defect (blood returns from lift atria to right, murmur is heard, dacron patch to fix) ventricular septal defect,(opening between ventricles, loud/harsh murmur, systolic thrill, antibiotic prophylaxis to prevent bacterial endocarditis)
patent ductus arteriosis |
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• Congenital heart Defects
obstructive defects |
coartactaion of the aorta (narrowing of aortic arch; difference in BP between upper and lower extremities, complications include hypertension, CHF, infective endocarditis; may use balloon angioplasty)
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• Congenital heart Defects
decrease pulmonary flow: tetralogy of fallot |
stenosis of pulmonary artery; hypertrophy of rt ventricle (must work harder to pump blood), dextroposition of aorta (moved to right, blood from both ventricles enters), VSD
S&S cyanosis, clubbing ,rests in squatting position; polycythemia to compensate for lack of oxygen, FTT, tet spells (cyanosis,RD, weakness, syncope) goal is usually to relieve hypoxia complications include CHF |
