Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
335 Cards in this Set
- Front
- Back
Menstrual cycle length
|
28 days
|
|
Proliferation (follicular) Phase
|
Follicle matures
FSH active hormone Estrogen High Day 5-14 (ovulation) |
|
Secretory (Luteal) Phase
|
Corpus Luteum Develops
LH active hormone Progesterone high when pregnant Day 14 to three days prior to ovulation |
|
Sperm livespan
|
3-5 days
|
|
Eggs lifespan
|
24 hours
|
|
Fetal Development
Week 4 |
Heart begins to beat
|
|
Fetal Heart Tones detected:
|
by doppler between 8-12 weeks
|
|
Embryo becomes a fetus at:
|
12 weeks
|
|
Can tell sex of fetus at:
|
16 weeks
|
|
Heart beat detected by fetoscope:
|
at 20 weeks
|
|
Feel fetal movement at:
|
20 weeks
|
|
Fetus is viable at:
|
24 weeks
|
|
Fetus can breath at:
|
28 weeks
|
|
L/S ration 2:1
|
at 38 weeks
|
|
Full term:
|
40 weeks
|
|
Fetal Environment:
Amniotic fluid: |
500-1000mL
cusions and protects fetus maintains the body temp. |
|
Fetus use of amniotic fluid:
|
drinks, swallows and urinates into the fluid.
Renal function determined by testing fluid Fetus breathes amniotic fluid into lungs |
|
Placenta:
|
allows for exchange of nutrients and wastes.
REMEMBER: always provides nutrients. Any placental problems affect the baby |
|
Fetal circulation:
|
through umbilical cord:
AVA: two arteries, one vein Arteries: deoxygenated blood Vein: oxygentated blood |
|
Foramen Ovale:
|
Opening between right and left atria:
Closes after birth |
|
Nagele's Rule:
|
Gestation calculation:
based on 28 day cycle: 1st day last period -3 months + 7 days |
|
Gravida:
|
number of times pregnant
|
|
Para:
|
Number of pregnancies after 20 wks.
|
|
TPAL
|
T = term birfs
P = preterm birfs A = abortions/ elective or spontaneous after 20 wks L = living children |
|
Presumptive signs of pregnancy:
|
No periods
N&V Fatigue Inc. urination Breath changes Quickening Inc. pigmentation |
|
Probable signs of pregnancy:
|
+ test 4-10 wks @ missed period
Enlarged abdomen Chadwick's sign: blue vagina (4 wks) Hegar's sign: softened uterus (8 wks) Goodell's sign: softened cervical lip: (8 wks.) Ballottment Palpable fetal outline Braxton-Hicks |
|
Positive signs of pregnancy:
|
FHT (fetal heart tones)
Fetal Movement Fetal skeleton on x-ray Fetal sonography |
|
Fetal Ultrasound:
|
provides accurate age of gestation when done early in pregnancy
|
|
Fundal Height:
|
Palpable after 12 wks
Fundus at Umbilicus: 20-22 wks At the xiphoid process: 36 wks |
|
Measuring fundal height:
|
turn pt. onto the left side.
Also could elevate the left buttocks with a pillow |
|
Multiple births:
|
anemia is common complication for mother due to inc. iron need of fetuses.
Multiples are often premature Hemorroids and Gestational DM are NOT complications |
|
PIH:
pregnancy induced hypertension |
complication during labor is seizure
complaints of HA or blurred vision indicate worsening |
|
Signs of preeclampsia and eclampsia:
|
Vision changes
Severe, continued HA Persistent vomiting Infection: chills, temp.> 100.4 dysuria pain in abdomen Fluid discharge other than white Change in fetal movement or fetal tachycardia |
|
Gestational Diabetes screening:
|
give 50 grams of glucose
draw blood sugar if > 135, do a 3 hr glucose tolerance test |
|
Gestational Diabetes risks:
|
High risk when mother is >30 yrs
Unexplained stillbirths or miscarriages Once developed, inc. risk with each subsequent pregnancy those with Gest. D increased risk for Diabetes Mellitus |
|
Gestational Diabetes TX:
|
******ONLY INSULIN DURING PREGNANCY . . . NO ORAL HYPOGLYCEMICS
|
|
Gestational Diabetes delivery:
|
pt. more prone to preeclampsia
hemorrhage and infection SCHEDULED DELIVERY 37-38 wks |
|
German Measles: RUBELLA
|
Infection in mother can be serious
If within 1st 20 wks: infant may be born with Congenital Rubella Sydrome, (a range of serious, incurable illnesses) |
|
German Measles can cause:
|
Spontaneous abortion in up to 20% of cases.
Infants may have virus persisting for up to 2 months These infants are a major source of infection to other infants and pregnant women |
|
Syphylis:
|
crosses the placental barrier and leads to spontaneous abortion or deformities in fetus
|
|
Genital herpes
|
can cross placenta and be x-mitted during delivery.
If active pt. needs C-section Acyclovir used with caution during pregnancy |
|
Gonorrhea:
|
can be contracted at deliery and lead to sepsis in the newborn
|
|
HIV
|
can be x-mitted to newborn
Screen mom to help baby 30-50% transmit unless Mom is treated before delivery and baby after delivery Then it decreases to 4-8% Breast milk can transmit virus, do not allow or encourage breast feeding to HIV positive mom. |
|
Toxoplasmosis:
|
related to exposure to cats/ gardening and eating raw meat.
NO GARDENING NO LITTER BOX SCOOPING |
|
Substance abuse:
|
may be transmitted to infant
Inc. risk for abruptio placenta and growth retardation. |
|
Adolescent pregnancy:
|
Low birth weight for baby
Nutrition problems for mother |
|
Hot tubs, sauna, steam rooms:
|
can lead to neural tube defects and hypotension
|
|
Prenatal period office visit:
|
Once a month until 28 wks
Every 2 weeks until 36 wks Once a week until delivery up to 42 wks |
|
Prental period physiological chgs:
|
Circulating blood volume inc,.
Pulse inc. by 10 bpm Diaphragm is eleveated Dysnea due to enlarged uterus Respiratory rate unchanges Skin changes: linea ligra, chloasma and striae |
|
Prenatal period weight gain:
|
Up to 5 lbs 1st trimester
One pound a week after that. H2O retention contributes to wt. TTL WT: 25-35 pounds |
|
Bonding signs:
|
mother talkes to fetus,
massages belly has nicknames for baby |
|
Discomforts during pregnancy:
|
Nausea and vomitting:
give: dry carbs upon waking High protein snack before bed COMMON IN 1st TRIMESTER: due to hormone changes and carb metabolism changes |
|
Hyperemesis:
|
linked to H.Pylori
First pregnancy Multiple fetuses age: <24 HX with other pregnancies obesity High fat diet |
|
Hyperemesis TX:
|
may need to be admitted for dehydration
Antihistamines B6 phenothiazines for nausea Reglan Deficies include: thiamin, riboflavin, B6, Vit. A, and retinol proteins |
|
Dizziness and syncope:
|
change positions slowly
Vena Cava syndrome can occur while laying flat in bed 1st intervention: Knee to chest to inc. perfusion to uterus, placenta and fetus then side lying position second Not a major concern. Usually resolves with position change |
|
Urinary urgency and frequency:
|
Push fluids and empty bladder as necessary, don't ignore urge!
Most common in 1st and 3rd Avoid anything that would cause urinary statis Push fluids: 2000 mL's a day |
|
Breast tenderness:
|
expected due to levels of estrogen and progesterone
|
|
Vaginal discharge:
|
expected and should be clear and slightly white
|
|
Nasal stuffiness:
|
Humidy air
No antihistamines because safety in pregnancy not established |
|
Fatigue:
|
expected due to inc. physiological demans
|
|
Hearburn:
|
eat small meals
avoid fatty and spicy foods Milk between meals sit upright after meals drink 2000 mL's fluid per day Antacids only as prescribed |
|
Ankle edema:
|
common due to dec. venous return
not a concern as long as proteinuria or HTN not present elevate legts, frequent rest periods wear support hose avoid standing in one position for prolonged time |
|
Varicose veins:
|
due to pressure in the pelvic cavity
elevate legs and wear suppport hose |
|
Headaches:
|
change position slowly
cool cloth to forehead use tylenol sparingly if prescribed |
|
Hemorrhoids and Constipation:
|
increase fiber and fluids
|
|
Backache:
|
most common in 2nd and 3rd trimester
pelvic tilt or rock to tuck pelvis under the baby. POSTURE IMPORTANT |
|
Leg Cramps:
|
increase calcium
exercise legs |
|
Exercise during pregnancy:
|
always good just not to point of exhaustion
|
|
Shortness of breath:
|
most common in 2nd and 3rd trimester
tripid position helpful |
|
Blood type and Rh factor:
|
RhoGam considered a blood product
Given IM: ventral gluteal |
|
Rhogam given:
|
if Rh negative give at 28 wks.
If baby is positive at birth, repeat RhoGAM within 48 hrs. If mother positive Coombs, no need for RhoGAM |
|
Rubella titer:
|
if negative, susceptible to Rubella,
Needs immunization postpartum and SHOULD NOT become pregnant for at least 3 months after immunization Mom can still breast feed if she gets vaccine |
|
RhoGAM and Rubella titer both given then:
|
recheck rubella titer in 3 months.
RhoGAM suppresses the immunity and the femal may not be protected against Rubella |
|
Hemoglobin and Hematocrit: H&H
|
will decrease during pregnancy.If it is below 11 and 33, mother has anemia.
Increased Hematocrit can indicate PIH |
|
STD screening:
|
VCRL is screen for syphilis.
TX: antibiotics Can cause abortion or premature delivery Passed to the fetus after the 4th month |
|
Sickle Cell screening:
|
if at risk:
L & D can induce a Sickle Cell Crisis. Oxygen on during L & D |
|
Hepatitis B vaccine:
|
give if at risk
screen performed to detect antigens If antigens present, mother and neonate need to receive hep vaccine and hep B immunu globulin within 12 hrs of delivery. All other vaccines follow to provide immunity Can breast feed as long as infant receives prophylaxis at birth and remains on vaccine schedule |
|
Urinalysis to evaluate for:
|
glucose and protein
|
|
Sugar:
|
common in urine due to dec. threshold of kidneys.
Acceptable level: 1+ or less |
|
Ketones:
|
indicate insufficient dietary intake
|
|
Protein:
|
2+ to 4+ may indicate infection or PIH
Acceptable level: < or = to a trace |
|
WBC:
|
usually higher: up to 15,000
May inc. to 25,000 within the first 10-12 days after delivery |
|
Elevated WBC:
|
if temp is increased:
assess for Fundal height perineal area symptoms of DVT burning on urination other possible sources of infection |
|
HELLP:
|
Hemolysis
Elevated Liver function tests Low Platetes |
|
Monitor for HELPP:
|
in severe preeclampsia
If present: MUST DELIVERY IMMEDIATELY |
|
Non-Stress Test positive:
|
positive is good
15/15 acceleration is active and healthy |
|
Non-Stress Test negative:
|
Negative is bad:
N= Non-reactive N=Non-stress N=Not good |
|
Non-Stress test monitoring:
|
Assess fetus and placenta
Lack of fetal movement for short periods (20-40) mins. no concern usually baby sleeping |
|
Non-stress test non-reactive:
|
abnormal.
Shows fetal movement without inc. in fetal HR. Not necessarily bad, requires further testing |
|
Contraction Stress Test:
|
Do
Something Now NEGATIVE RESULT IS GOOD NEGATIVE IS NORMAL Decels ( positive late decels) Stress Test Not Good POSITIVE RESULT IS BAD |
|
Contraction Stress Test process:
|
Done with pitocin or nipple stimulation.
Nipple method may overstimulate post. pituitary and release too much pitocin Assesses for placental perfusion, placental function and fetus well being Determines ability of fetus to withstand labor Done if non-stress test is abnormal or negative Positve CST: will see late or variable decels of FHR with contractions |
|
Fetal Amniotomy: rupture of membranes
|
check the well being of the baby before and after the procedue
FHR checks the babies well being |
|
Amniocentesis purpose:
|
can identify chromosomal and neural tube defects and can determine the sex of the fetus
|
|
Amniocentesis process:
|
done early in pregnancy
Need to have a full bladder to push uterus up in the abdomen for easy access In the 3rd trimester: may be used to evaluate lung maturity. Best indicator of survival. When done late: bladder must be empty Can be used to TX: polyhydramnois by removing excess fluid. |
|
Percutaneous umbilical blood sampling: (PUBS)
|
can be done during pregnancy under ultrasound. Used to detect blood disorders, sepsis, and some genetic abnomalities
|
|
Biophysical Profile: BPP
|
evaluates the well being of the fetus and identifies abnormalities.
THE BEST TEST FOR FETAL EVALUATION |
|
Biophysical Profile (BPP) assesses the following:
|
Fetal movement
Muscle tone Amniotic fluid volume Reactivity of FHR Breathing movements Each gets a score of 2 if normal Max score 10 means baby is health Score less that 4 needs immediate delivery: baby in trouble |
|
Induction of Labor meds:
|
Oxytocin (Pitocin)
Ran with Lactated Ringers ! |
|
Pitocin infusion:
|
titrated to get 3-5 contractions in a 10 min. period with cervical dilation
Watch for water intoxication with this med. S&S: tachycardia cardiac dysrhythmias dyspnea nausea & vomiting |
|
Leopold's Maneuvers
|
when the baby is felt to determine positioning.
Warm hands and have mother empty bladder before performing |
|
Longitudinal lie:
|
fetal spine is parallel to the mother.
Baby is cephalic or breech |
|
Transverse or horizontal lie:
|
sping is at right angle to mom and there is shoulder presentation
C-section is needed |
|
Oblique lie:
|
baby is at a slight angle from true horizontal
C-section needed if not corrected |
|
Cephalic presentation
|
head down: MOST DESIRABLE FOR DELIVERY
|
|
Breech presentation:
|
some may delivery vaginally
|
|
Zero Station:
|
engagement: baby is located at the ischial spine
|
|
Minus Station:
|
baby is above the ischial spine.
|
|
Plus station:
|
baby is below the ischial spine
REMEMBER: PLUS 4 ON THE FLOOR ! |
|
External monitoring of fetus:
|
noninvasive
Transducer is places over the fetal back. |
|
Internal monitoring:
|
invasive
Reputure of membranes and dilation of 2-3 cm is required |
|
Normal FHR:
|
110-160 bpm over 10 minutes
|
|
Fetal Bradycardia:
|
FHR < 110 bpm
|
|
Fetal Bradycardia interventions:
|
change mother's position
give oxygen notify physician Assess between contractions for 10 minutes |
|
Fetal Bradycardia cause:
|
late manifestation off fetal hypoxia
medication induced via narcotics and magnesium Maternal hypotension fetal heat block prolonged cord compression |
|
Fetal Tachycardia:
|
FHR > 160 bpm
|
|
Fetal Tachycardia interventions:
|
change mothers position
give oxygen notify physician |
|
Fetal Tachycardia causes:
|
early sign of fetal hypoxia
fetal anemia dehydration maternal infection maternal hyperthyroid medication induced via atropine, terbutaline or hydroxyzine (Vystaril) |
|
Variability:
|
a change in HR in response to sleep, wake, meds. and hypoxia
6-25 bpm fluctuation is okay |
|
Acceration:
|
is a rise of the HR by more than 15 for 15 seconds. Marked acceleration is > 180.
Could be caused by infections, prematurity or hypoxia |
|
Early decelerations:
|
transient decrease in HR
Possible head compression or fetal descent. Does not indicate fetal distress usually seen at 4-7 cm. dilation |
|
Variable deceleration;
|
can be cord compression
baby may be rapidly declining Put Mom in knee to chest May need C-section to resolve If after a gush of fluid, do a sterile vaginal exam and check for cord compression The decels are not related to the timing of contractions. May drop 10-60 bpm below baseline |
|
Late Decelerations:
|
due to uteroplacental insufficiency
Rarely below 110 bpm Associated with postmaturity preeclampsia DM, Cardiac Disease and abruption of placenta severe is <70 BPM lasting longer than 30-60 seconds and a slow return to baseline |
|
TO REMEMBER DECELS:
|
Decels are acceptable in labor but "NEVER BE LATE"
late decels means baby is in trouble |
|
True Labor:
|
pain in lower back to abdomen
pain with regular contractions contraction more intense with ambulation cervix is dilating |
|
False Labor:
|
discomfort only in the abdomen
no lower back pain contractions decrease with ambulation |
|
Normal findings for laboring pt:
|
FHR 110-160
Mothers bp: <140/90 Mothers pulse: < 100 Mothers temp. < 100.4 slight temp elevation occurs due to dehydration and work of labor. Anything higher thatn 100.4 can indicate infection and must report immediately |
|
Stage 1 of Labor:
|
Cervical dilation
Latent-Active-transitional Excitement and apprehension for the mother during this stage |
|
Stage 2 of Labor & Delivery:
|
Delivery of the baby
Exhaustion is common for the mother at this stage |
|
Stage 3 of Labor and Delivery:
|
Delivery of the placenta
Mother focuses on the neonate's condition |
|
Stage 4 of Labor and Delivery:
|
First 4 hours after delivery of the placenta
|
|
STAGE 1 PHASES:
|
phases are sequential and progressive: Latent, Active, Transitional
First sign of labor is passage of mucous plug. Signs of active labor is the onset of regular or progressive contractions |
|
Latent phase of Stage 1:
|
0-4 cm dilation
mild intensity in contractions contractions every 5-30 minutes use this time to review relaxation techniques to be used when labor becomes stronger |
|
Active phase of Stage 1 :
|
4 - 7 cm dilation
moderate intensity contractions contractions every 3-5 minutes and last 45-60 seconds |
|
Transitional phase of Stage 1:
|
8 - 10 cm dilation
Strong intensity contractions contractions every minute lasting one minute stop the regional block at this time if present |
|
Assessment of contractions:q
|
fequency is the beginning of one to the beginning of next
Duration is from the beginning of one contraction to the end of that contractions Intensity is mild, moderate, intense 3-5 contractions must be measured |
|
Pain meds in labor:
|
IV meds are best in labor
give at beginning of contractions so less reach the baby butophanol (Stadol) or Nalbuphine (Nubain) better in labor. Wathc for withdrawal if mom is narcotic dependent |
|
Avoid these meds in labor:
|
Demerol and Morphine avoided due to increased respiratory depression in baby
|
|
To decrease amount of narcotics needed, use:
|
Phenergan and Vistaril
|
|
Multigravida can IV pain meds:
|
up to 5 cm dilation
|
|
Paragravida can IV pain meds:
|
up to 7 cm dilation
|
|
Narcan given to woman in labor:
|
block the effects of any narcotics present and prevent CNS and Respiratory depression in baby
|
|
Regional Blocks:
|
Peridural and epidural can be used in all stages of labor
|
|
Pudendal block and Subarachnoid (Saddle) blocks:
|
used only in the second stage of labor.
|
|
Pudendal block location:
|
infection between vagina and anus
|
|
Saddle Block location:
|
spinal and provides instant pain relief
Stop the continuous infusion at the end of stage 1 or during transition to inc. effectiveness of pushing. |
|
Pudendal and Saddle blocks SE:
|
cause hypotension
Give fluids before (1000 mLs) LR monitor B/P and FHR q 15 min If hypotension develops, turn to the side, give 10 liters 02 by mask and inc. IV (LR) rates |
|
Delivery of Baby (Stage 2)
|
Deliver the head and stop
Suction mouth and nose check for cord around neck Delivery the rest of baby Hold baby at level of the uterus until the cord stops pulsating Clamp the cord Apgar Score |
|
Apgar Scoring:
|
Score: 7 - 10 good
Score: 4 - 6 needs moderate resuscitation Score 0 - 3 severe needs for resuscitation Scores of 6 or lower at 5 minutes require an add'l score at 10 minutes Do not wait until a 1 min. apgar is assigned before resuscitation is started |
|
Meconium staining:
|
yellow green or gold yellow which may indicate fetal distress
thorough suctioning via an endotracheal tube to see if meconium is below the vocal cords Aspiraiton of meconium can lead to pneumonitis and meconium aspiration syndrome Do a septic work up include: CXR |
|
Erythromycin eye ointment or 1% Silver Nitrate:
|
protects neonates eyes from gonorrhea (blindness) and
chlamydia (conjunctivitis) |
|
Vitamin K:
|
due to absence of intestinal bacteria at birth
|
|
Delivery of Placenta checks:
|
Check cord for AVA
( 2 arteries, 1 vein) Abnormalities can indicate cardiac or renal issues Check the placenta to make sure it is intact ! |
|
C-section prep:
|
place mother on table with wedge under right hip to prevent vena cava conmpression
|
|
Monitoring after delivery:
|
assess:
VS, Fundus, Peripad q 15 minutes X4 Then every 30 min. X4 Then q 1 hr x 4 the q 4 for 24 hours |
|
Fundus check:
|
should be firm and midline
should be at the level of umbilicus after delivery If above umbilicus, may indicate blood clots which need to be expelled If lateral displacement of the uterus is present, empty the bladder |
|
Vaginal hematoma:
|
can display as hypovolemic shock
If pt. had epidural she wont feel pain associated with hematoma |
|
Medications to stop bleeding after delivery monitoring:
|
giving too early may result in retained placenta
Hypertension can be a significant SE Care with pre-eclamptic pt. due to HTN |
|
Meds used to stop bleeding:
|
Methylergonovine maleate (Methergine)
Ergonovine (Ergotrate) Carboprost (Hemabate) |
|
Precipitous labor:
|
less than 3 hours.
Gentle pressure of the fetal head upward toward the vagina to prevent damange to head and to vaginal lacerations Deliver between contractions |
|
Painful back labor:
|
may be relieved by counter pressure or knee to chest postion
|
|
Prolapsed cord risks / interventions:
|
those with reputed membranes and negative station of baby
Get hips higher than the shoulder (trendelenburg or knee chest) Check FHR Check the perineum and push the head off the cord |
|
Uterine atony or hemmorhage causes:
|
full bladder is most common reason in the immediate period following delivery
thank retained placenta in the first 24 hours |
|
Uterine atony or hemmorhage tx:
|
massage fundas
Then empty bladder Recheck evvery 15 min. x 4 then every 30 min. x 4 |
|
1st degree vaginal tear
|
epidermis
|
|
2nd degree vaginal tear
|
dermis, muscle and fascia
|
|
3rd degree vaginal tear
|
into anal sphincter
|
|
4th degree vaginal tear:
|
extends up to the rectal mucosa
|
|
Symptoms of vaginal tears:
|
cause pain and swelling:
NOTE: AVOID RECTAL MANIPULATIONS |
|
Abruptio placenta is highest in:
|
women who smoke
use alcohol cocaine caffeine during pregnancy More than 5 pregnancies advanced age and heavy physical labor |
|
Abruption and uterine rupture:
|
prepare for surgery.
NO abdominal manipulation No vaginal or rectal insertions No vaginal exams No rectal exams No internal monitoring No suppositories, etc. |
|
Laboring mother CPR:
|
place her on left side by 15-30 degrees to shift the fetus off of the vena cava
|
|
Disseminated Intervascular Coagulation: (DIC)
|
abnormal clotting using up the clotting factors especially figrinogen
realted to fetal demise infection sepsis PIH Abruption |
|
Small for gestational age:
causes: |
often have intrauterine hypoxia due to meconium staining.
Be sure to suction carefully |
|
Risk for impaired parenting due to small gestational age:
|
do an intervention to increase bonding between parents and child
|
|
Risk for respiratory distress syndrome due to small gestational age:
|
Hyperglycemia during pregnancy delays fetal lung maturity.
An L/S ratio of 2:1 is need to predict sufficient sufactant |
|
L/S ratio:
|
Lechitin / Sphingomyelin levels in amniotic fluid: gives indicator of surfactant production
|
|
Large for gestational age:
causes and symptoms: |
High risk for hypoglycemia which can lead to brain damage
Postmature infants May have bruising from delivery due to large size |
|
Postmature infants:
|
after 42 weeks: at risk for poloycythemia due to placental insufficiency.
Leads to high billirubin levels |
|
Polycythemia:
|
can contribute to bruising but does not cause bruising.
If severe, infant may need transfusions |
|
Hypothermia:
|
leads to hypoglycemia
child has high pitched cry due to lack of glucose to brain |
|
Newborn optimal temp:
|
37 degrees C or
98.6 degrees F |
|
Standing interventions for all complications:
|
Lateral positioning on either side
Never put her on her back due to supine Hypotensive syndrome caused by pressure on the Vena Cava and descending aorta O2 per standing order IV fluids should be inc. per standing order. Notify physician prepare or possible C-Section |
|
Increasing fluids during labor:
|
remember:
FLUIDS STOP LABOR |
|
Post-partum assessment:
|
Pain
Breast Uterine fundus Lochia Observe episiotomy Monitor urine output Monitor bowel movements Careful with ambulation Compare extremities for DVT Assess for affect Assess for mental state H& H |
|
Breast engorgement:
|
feed frequently at least every 2 1/2 hrs. for 15 -20 min per side
Moist heat to breast 20 min. before feeding Wear supportive bra during feeding, massage the breast toward the nipple to stimulate letdown of milk Block milk sinuses may occur. Milk baby close to lump and rotate baby on the breast |
|
Uterine fundus and position:
|
number of days postpartum, fundus should be one finger below umbilicus:
ie: 3 days postpartum, 3 fingers below umbilicus |
|
Lochia changes:
|
from serous pink to alba-white
two pads placed on after delivery check for fragments which could indicate retained placenta After first post partum day, retained placenta the most common cause of uterine atony |
|
Observe episiotomy:
|
It should be clean, dry and intact
|
|
Monitoring urine output:
|
can have up to 3.000 ml per day
should void within 4 hours of delivery < 100 ml per voiding and frequent, suspect urinary retention |
|
Bowel movement:
|
need to have by 3rd day post partum
|
|
Careful with ambulation:
|
often a syncopal episode with the first ambulation
Can have blood running down leg due to pooling in the vagina and uterus while on bedrest |
|
Assessment of affect and mental state:
|
in order to ascertain post-partum blues.
Normal esp. 5-7 days after delivery Unexplained tearfulness,. feeling down, dec. appetite Encourage use of support persons to help with household chores for 2 weeks. Refer to community resources |
|
Hemoglobin and Hematocrit:
|
10 and 30
|
|
Phases of post partum period:
|
Taking in
Taking hold Letting go |
|
Taking in phase:
|
mother feels overwhelmed by the responsibilities of newborn care and is still exhausted from delivery
|
|
Taking hold phase:
|
client has rested and can learn mothering skills with confidence
|
|
Letting go phase:
|
has adapted to parenthood, the new role as caregiver, and the new baby as a separate entity
|
|
Kegel exercises:
|
important to do after delivery to strengthen pelvic floor.
Begin simple and increase to do more strenuous exercises |
|
Nursing mothers needs:
|
8-10 eight ounce glasses of water daily
500 additional calories per day |
|
Milk production is controlled by:
|
the hormone prolactin
|
|
To prevent high billiruben levels:
|
hydration is important for infants.
Water, Milk and formula all important |
|
High billirubin levels require:
|
phototherapy
NOTE: cover infants eyes and genitals when they are under the phototherapy lights |
|
Mastitis is:
|
unilateral inflammation of breast
|
|
Mastitis symptoms:
|
shaking, chills and fever.
caused by milk stagnation can be due to not offering both breasts while feeding infant Can continue to breast feed if no infection is present or not on antibiotics If not feeding, express milk and discard until feeding can begin again. |
|
Endometritis:
|
presents as fever on 3rd or 4th day post delivery
Risk for infection high if any problems during pregnancy including anemia and diabetes Trauma during delivery also a factor |
|
Cardiac disorders in mother:
|
HX of HF or valvular disease.
Extra fluid returns to blood stream resulting in inc. cardiac output and blood volume monitor intake and signs of fluid volume overload. Coughing can indicate pulmonary edema |
|
Pre-term infant:
|
between 24 - 37 weeks
Thick vernix covering body smooth soles without creases lanugo covering entire body |
|
Post Term infant:
|
After 42nd weeks of gestation
Dry, peeling, cracked, leather like skin (desquamation) Prone to meconium aspiration and cord compression Motor function not as mature Has trouble with quiet alert state work on bonding due to possible bruising of face Gentle touch to soothe baby |
|
Meconium aspiration signs:
|
Tachypnea
grunting retractions nasal flaring |
|
Acrocyanosis:
|
bluish discoloration of the hands and feet. Associated with immature peripheral circulation
Common in first few hours of life |
|
Respiratory distress syndrome:
|
Presents with signs of cyanosis, tachypnea or apnea, grunting, nasal flaring and chest wall retractions
Seen more in c-section babies since they do not experience the vaginal squeeze that dec. fluid in lungs of infant |
|
Hypoxia in children Signs:
|
nasal flaring
expiratory grunting inspiratory stridor feeding problems sternal retractions |
|
Never feed baby if Respiratory rate is:
|
greater than 60
|
|
Silverman-Anderson Index of Respiratory Distress
|
The lower the score the better the baby.
A score of 10 is severe distress This is opposite scoring of Apgar |
|
Vital signs in infants:
|
Heart Rate: 100- 170 bpm
Respiratory rate: 30 - 60 per min. Temp. 37 or 98.6 is optimal |
|
Temperature regulation in infants:
|
NEED TO KEEP INFANT WARM
Make heat by nonshivering thermogenesis. Shivering in infants causes them to burn brown fat which can lead to metabolic acidosis warm slowly over 2 - 4 hours if cold. Rapid warming can produce apnea |
|
Infants that are too cold will present with:
|
acrocyanosis
mottling tachycardia tachypnea |
|
Stomach capacity of infant:
|
Newborn: 10 - 20 ml
week 1: 30 - 90 ml weeks 2 - 3 : 75 - 100mls |
|
Nutrition in infants:
|
need 50 calories per pound of weight per day
Most formula is 20 calories per ounce Need glucose due to little glycogen stores they have |
|
Gavage feedings:
|
tube inserted into esophagus and feeds ran straight into stomach
|
|
Stop gavage feedings if:
|
tube is in trachea
infant will not be able to make sounds, no crying may gag cough or become cyanotic |
|
Cord care:
|
keep clean and dry to decrease baterial growth
Dries up and falls off between 7-14 days |
|
Circumcision care and observations:
|
Observe for bleeding q 1 hr for 8 - 12 hours post op
Assess voiding. If none in 24 hrs notify physcian due to possible swelling or damage Vaseline guaze reapplied with the diaper changer Water used for cleaning. No baby wipes, may irritate skin. |
|
Physiological jaundice:
|
occurs at 2-3 days
Pathological if befor 24 hours and after 7 days Immature live inability to keep up with destruction of RBC's Unconjugated bilirubin will be high |
|
Assessment for jaundice:
|
apply pressure with thumb over boney prominences to blanch skin
Area blanched will appear yellow before returning to skin tone Nose, forehead and sternum good places to check In darker skin: observe eyes and oral mucosa |
|
Phototherapy risks and uses:
|
Increases risk for dehydration
Used when bilirubin is > 12 |
|
Congenital hypothyroidism:
|
most common preventable cause of mental retardation
Infant is described as a good quite baby Neonatal screening only means of detection. Screen before discharge from nursery and before 7 days of life. |
|
PKU:
|
Genetic disorder when body cannot metabolize phenylalanine which is a protein found in most foods.
If level gets too high, can cause brain damage and severe mental retardation AUTOSOMAL RECESSIVE: BOTH PARENTS MUST CARRY Screen at birth and 3 weeks |
|
PKU signs and symptoms:
|
Frequent vomitting
irritable musty odor smell to urine |
|
PKU: test
|
performed at birth and 3 weeks
Guthrie Test: positive result Serum phenylalanine of 4 or greater |
|
PKU DIET:
|
Logenalac or Phenex - 1 formulate
Low protein diet until age 6 - 8 when brain growth is completed NO NUTRASWEET !! Older children and adults diet should be low protein and many fruits and veggies. |
|
Milia:
|
Know as baby acne:
normal for infants to have |
|
Epstein pearls:
|
calus on gum line.
appear as small teeth but are not |
|
Mongolian spots
|
sacral area of darkening.
often misinterpreted as bruising on the child |
|
Hemangioma:
|
tumors of blood vessels appearing as small, flat, dark red spots
|
|
Cephalohematomas:
|
Asymmetrical collection of blood under the periosteum which develops a few hours after birth and goes away in 2 months. Danger is increase in bilirubin due to excess RBC destruction
|
|
Caput succedaneum (cone head)
|
Collection of fluid under the scalp which crosses the suture line and goes away in 2 wks. Present at birth
|
|
Fetal Alcohol Syndrome:
|
Physical, mental and behavioral abnormalities. Poor prognosis
|
|
Fetal Alcohol Syndrome symptoms:
|
Withdrawal with tremors
sleeplessness seizures abdominal distention hyperactivity crying. Occurs 6-12 hours after birth Hyperactive with speech and language problems Mild to severe retardation Growth deficient at birth |
|
Challenges in hospital for pediatric patients:
|
Child's separation anxiety
|
|
Stages of separation anxiety:
|
protest
despair (crying & kicking) detachment |
|
Temper tantrums:
|
best to ignore if child is safe
Best way to discourage behavior is by ignoring that behavior |
|
Erickson:
|
Ego development influenced by family, social and developmental factors.
|
|
Erickson stage of Infancy:
|
Infancy: 0m - 18 months
TRUST VS. MISTRUST attachment to mother is prevelant |
|
Erickson stage of early childhood
|
Early childhood: 18 mos. to 3 yrs
AUTONOMY VS. SHAME AND DOUBT gaining basic control over self and environment Temper tantrums common Security items (blankie) Expect regressions (bedwetting) Learning to name body parts Provide choices to support autonomy |
|
Erickson stage of late childhood
|
Late childhood: 3 yrs to 6 yrs
INITIATIVE VS. GUILT Becoming purposeful and directive Explain that pain from illness or procedures is not punishment Use simple words to explain Fear of mutilation is common Allow choices to promote sense of control |
|
Erickson stage of School Age
|
6 years to 12 years of age
INDUSTRY VS. INFERIORITY Developing social, physical and school skills. Need parental support. Contact with peers and school activities when ill and in hospital is important |
|
Erickson stage of Adolescent:
|
From 12 to 20 years of age
IDENTITY VS. ROLE CONFUSION Developing sense of self. Withdrawal from peers is sign of identity crisis. Rebellion again family values is normal and common |
|
Erickson stage of Early Adulthood
|
from 20 to 35 yrs. of age
INTIMACY VS. ISOLATION Establishment of intimate bonds, love and friendship. **Spinal cord injured clients at this point have difficult time establishing intimacy |
|
Erickson stage of Middle Adulthood
|
From ages 35 to 65
GENERATIVITY VS. STAGNATION Fulfilling life goals that involve family, career and society. |
|
Ericksons stage of Later years
|
65 to death
INTEGRITY VS. DESPAIR Review of one's own life and accepting its meaning. |
|
PAIN IN CHILDREN:
|
Infants: pain after 6 months
Toddlers: Fear intrusive procedures Preschoolers: fear body mutilation School age: fear loss of control Age 9 and up: can use number pain scale Adolescents: fear change in body image |
|
Developmental tasks at 1 - 3 months
|
cooing sounds
social smile head turns to sound |
|
Developmental tasks at 3 - 4 months
|
cooing and babbling
Moro reflex disappears at 4 mos. ** if NOT: R/O CP |
|
Developmental tasks 6 - 8 months
|
constant babbling
Birth weight Doubles Plays peek a boo Sits unsupported by 8 months |
|
Developmental tasks 9 - 12 months
|
simple words and gestures
Crawls by 10 months and walks with assistance Birth weight triples by 1 Length increases by 50% |
|
Developmental tasks: 15 months
|
builds a tower of two blocks
|
|
Two year olds
|
can open door knobs
unzip bag speak in 2 - 3 word sentences |
|
Three year olds:
|
talk constantly
put on simple clothes by themselves can first and last name rides a tricycle |
|
Four year olds:
|
copy simple shapes
often reverse letters capitalize incorrectly |
|
Five year olds:
|
tie shoelaces
draw stick men with 7 - 9 body parts |
|
Teaching children:
|
Use Piaget's stages of intellectual development
|
|
Piagets Stages of Development
0 -2 years of age: |
0 - 2 years SENSORIMOTOR
Present oriented, Thank about what they are sensing and moving forwrd. Teach by talking Simple, brief explanations before procedures |
|
Piagets Stages of Development
2 to 7 years of age: |
2 to 7
PREOPERATIONAL STAGE Fantasy oriented illogical Thinks about past, present and future No rules to conform them Teach by playing with them |
|
Piagets Stages of Development
7 to 11 years of age: |
7 to 11 years
CONCRETE OPERATIONS Easily taught by the rules. No abstract thinking Solves problems via logic Teachg with videos and written material, not by playing with them. Allow them to handle equipment |
|
Piagets Stages of Development
11 to adult : |
11 to adult:
FORMAL OPERATIONS Abstract thinking Teach them like an adult Teach them to manage own illnesss Direct information to the child, not the parents Have time with the adolescent without the parents for Q & A |
|
Toys for children safety:
|
No small toys under 4
Supervise toddlers. SAFETY !!! No metal or electric toys with O2 use No toys/items that can harbor germs. Stuffed toys not good Throw away toothbrush after on Antibiotics for 24 hrs for strep |
|
Toys for infants to 1
|
soft toys
blocks balls musical mobiles play peek-a- boo Read from large picture book |
|
Toys for toddlers ( 1 - 3)
|
push and pull toys
Play side by side with others Read from large picture book |
|
Toys for preschoolers ( 3 - 6 )
|
Like to pretend play
Work on fine motor and balance Play is simple and imaginative |
|
Toys for school age (7 - 11)
|
Children competitive and creative
They like doing with their hands, drawing, coloring, etc. |
|
Toys for adolescents ( 12 - 18)
|
Associate with their peers
They don't need anything to play with Listening to music is usual |
|
Care of chronically ill child:
|
focus on developmental age not
chronological age Assist child/family to return to normal Determine how child is cared for at home Promote max. growth and development Assess family response to illness Involve family in care Encourage self care Maintain routine if possible |
|
Respiratory distress in children:
|
Resp. disorders are the most common reason children seek medical care
* Pediatric pt. go into respiratory failure before cardiac failure |
|
Respiratory distress manifestations:
|
Agitation
restlessness Inc. HR Inc. RR Diaphoresis Nasal flaring Retractions Grunting Stridor Use of accessory muscles head bobbing Cyanosis and pallor Feeding problems |
|
Normal vital signs readings:
|
RR and HR must be measured
Document child's behavior: crying, febrile,or distress |
|
Normal values for children:
|
AGE PULSE RESPIRS
0-1 100 - 160 30 - 60 1-2 100 - 150 25 - 35 2-3 80 - 130 20 - 30 3-5 80 - 120 20- 25 5-10 70 - 110 18 - 22 10-16 60 - 90 16 - 20 |
|
Temperature monitoring:
|
Axillary monitoring acceptable
Rectal per MD request Leave thermometer in for 5 mins for both |
|
Use of 02 in children:
|
Oxygen hood for infants
NC to provide low to moderate flow Tent to provide mist and O2. Keep child dry, monitor temp. keep edges tucked in. |
|
Congenital heart defects:
|
Affects 4 - 10 children per 1,000 live births
All kids will have a murmur whether serious or not |
|
Ventricular Septal defect:
|
a heart defect that may not be serious and often closes on own by 1 year of age.
|
|
Serious heart defects cause:
|
growth and development delays
|
|
Acyanotic heart defects:
|
all blood is oxygenated
Increased fatigue Inc. risk of endocarditis Heart failure usually present Higher risk with acyanotic defects Growth retardation |
|
VSD
Ventricular Septal defect: |
Small ones close spontaneously
|
|
ASD
Atrial septal defect: |
Surgical closure needed before school age
|
|
PDA:
Patent Ductus Arteriosus |
Usually closes withing 72 hrs after birth
Give Indocin or surgical closure Most common congenital heart defect Artery that connects aorta with pulmonary artery is supposed to close If remains open and is small, no problem, larger openings can develop into ventricular failure Premature delivery is risk factor |
|
AS
Aortic stenosis |
May require surgery
Obstructive |
|
COA
coarctation of the aorta |
May require surgery
Considered a serious defect Obstructive |
|
Cyanotic heart defects:
|
have a right to left shunt and UN oxygenated blood enters the systemic circulation
Decreased pulmonary flow Polycythemia and prone to thrombus formation Will see squatting or knee chest positioning due to hypoxia: known as "TET" spells Poor feeding due to hypoxia. Tube feeding may be necessary to conserve energy Clubbing after 2 yrs. of age Syncope Respiratory infections common Monitory pulses bilaterally and Blood Pressure in Upper and lower extremeties Maternal infection may be causative factor |
|
Cyanotic Heart Defect Conditions:
|
Tetralogy of Fallot
Truncus Arteriosus Transposition of the Great Vessels Tricupsid Artresia THE T'S ARE CYANOTIC AND SERIOUS |
|
Tetralogy of Fallot:
|
Ventricular septal defect
Pulomnic stenosis Overriding Aorta Right Ventricular Hypertrophy |
|
Truncus Arteriosus:
|
Pulmonary artery and aorta do not seperate
Large VSD allows for survival at birth. Surgical correction |
|
Transposition of the Great Vessles:
|
VSD, ASD or PDA allow for survival at birth.
Medical emergency Prostaglandin E given at birth to keep PDA open |
|
Tricuspid Atresia:
|
Tricuspid valve does not form,
Prostglandin E at birth to keep PDA open |
|
Heart surgery:
|
No school until 3 weeks after discharge from hospital
Half days initially No outside play for several weeks |
|
In children with heart failure:
|
implement measures to decrease workload of th heart:
limit time for bottle or breast feed Elevate HOB Allow for uninterrupted rest periods Provide O2 during stressful periods. |
|
Spina Bifida:
|
a malformation of the vertebrae and spinal cord resulting in varying degrees of disability and deformity. Meningeocele and meningomyelocele type, a sac present.
Occulta does not have a sac. |
|
Spina Bifida nursing interventions:
|
watch for hydrocephalus and signs of ICP
In an infant a bulging anterior fontanel is indicative of ICP Risk for infection before procedure to correct is big concern. Normal saline dressing over site will maintain moisture and prevents tearing or breakdown of skin integrity Elevate foot of bed and position baby on belly |
|
Gastroschisis:
|
Abdominal defect where viscera is outside the abdominal wall and cavity and not covered with a sac.
Vaginal birth of these babies is permitted. Repair is done immediately with a 90% success rate. May be genetic and counseling may be indicated |
|
Cleft lip and cleft palate:
|
Cleft lip repair at 10 lbs with a Heme of 10.
Cleft palate repair usually done between 12 - 18 months to minimize speech impairment Risk for lack of bonding due to defect. Observe Mom and Dad during feeding to provide helpful suggestions |
|
Cleft lip and cleft palate post surgical interventions:
|
Clean with dilute hydrogen peroxide or sterile water using cotton swab after feeding and as prescribed.
Use a rolling motion starting at the suture line and rolling out. Always rinse after if using Hydrogen Peroxide Logan bar is used to maintain suture integrity Elbow restraint used to prevent child from touching repair. Only remove one at a time No pacifier use after surgery Packing in place for 2 - 3 days after palate repair If a cleft lip is repaired, need to put on opposite side of surgery in a side lying positon. If palate repair only, the belly position is acceptable or right side lying to reduce risk of aspiraiton. At risk for hearing loss as a long term complication of the cleft lip and palate. |
|
Mumps:
|
disease caused by virus that spreads through saliva and can infect many body parts, especially the parotid gland. Swelling occurs in these areas.
Mumps transmitted by droplets, saliva and possible urine |
|
Rubeola ( Measles)
|
serious disease that causes:
fever rash, Measles is a virus and spreads easily from person to person DO NOT CONFUSE WITH RUBELLA !! airborn precautions needed Infectious for 1-2 days before and 4 days after rash appears Koplich spots appear 2 days before rash: small blue/white spots with red base on the buccal mucosa. last @ 3 days then slough off. Can lead to ear infections, diarrhea, prneumonia and encephalitis which can lead to convulsions, deafness, mental retardation and rarely, death can cause miscarriages or premature delivery in pregnant woman |
|
Rubella (German Measles)
|
common childhood infection
Airborn and contact precautions Lasts 1 to 5 days Children recover more quickly than adults When contracted in first trimester, the fetus is at high risk for congenital abnormalities. No risk to fetus with exposure to individuals who has it unless the mother contracts it. |
|
Fifths Disease (Erythema infectiousum)
|
Slapped Cheek Disease
rash on cheeks and spreads to back of arms and legs Rash can come and go. Itchy! No long infectious once rash appears Airborn transmission and through blood transfusion Infection in first trimester of pregnancy has been linked to hydrops fetalis, causing spontaneous abortion |
|
RSV:
Respiratory Syncytial Virus |
most common of lower respiratory tract infections (pneumonia and bronchioloitis) in children worldwide. Virtually all children contract it by the age of three.
|
|
RSV: TX and Interventions:
|
contact precautions
No airborn precautions virus can live on paper or skin for up tone hour and on other surfaces for up to six hours Treat with ribavirin (Virazole) in severe cases Wear goggles and mask whenever given. Causes headache, burning nasal passages and eyes. Can crystallize soft contact lenses. Can damage fetus in a pregnant woman. Those pregnant should not be around the child. Palivizumab (Synagis) may be given to high risk children to provide passive immunity. Includes children with prematurity, lung disease or congential heart disease It may play a major role in the pathogenesis of asthma and COPD |
|
Kawasaki Disease:
|
known as Mucocutaneous lumph node syndrome.
febrile vasculitis of unknown etiology occurs. Occurs in children under 5 Cardiac complications in 5-20% May last 2 - 12 weeks MANIFESTATIONS: fever > 102.2 red lips strawberry tongue conjunctiva red pallor of proximal fingers and toes superficial skin layers desquamate easily rush over trunk and perineal area Occasional intermittent colicky red sores on palms lethargy irritiability |
|
Celiac Disease:
|
life long disorder
Watery pale stool foul odor. Signs of malnutrition inc: abd. pain wasting extremeties anemia NEED GLUTEN FREE DIET |
|
Gluten:
|
common name for proteins in specific cereal grains that are harmful to those with Celiacs.
Proteins are in all forms of wheat, (durum, semolina, spelt, kamut, einkorn and faro) and related grains incl: rye, barley and triticale |
|
Hypospadias:
|
congenital defect with the urethral opening on the ventral side of penis. Correct with urethroplasty before preschool to maintain self image.
|
|
Intussusception
|
telescoping of the bowel like a sleeve over itself. The ileum moves into the colon. Necrosis can occur due to trapped blood vessels. Usually affects infants under 1 year
|
|
Intussusception manifestations:
|
clinically appears with bile emesis, currant colored stoles, and screams with any movement of the GI tract.
Will feel a sausage type mass in the mid abdomen Barium enema is given to reduce. works 2 out of 3 times Normal bowel movements means reduction is complete |
|
Gastroenteritis or diarrhea:
|
encourage clear liquids and high starch foods because they are easily absorbed
Avoid milk and milk products except for active culture yogurt Raw fruits and vegetables and spices can cause loose stoles PH increases due to loss of acid resulting in metabolic alkalosis |
|
Esophageal Atresia:
|
congenital defect with the esophagus ending in a blind pouch.
It is clinical and surgical emergency Need to be NPO, have a G-tube, placed by nutrition and pacifier to provide sucking gratification 3 C'S: choking, coughing, cyanotic 30 degrees HOB prevents reflux |
|
Pyloric Stenosis:
|
usually affects first born males
Will feel mass in RUQ Vomiting after 14 days of life for up to 1 hr after each feeding Need quite time after feeding to reduce risk of aspiration feed slowly and burp frequently At risk for altered nutrition Surgical repair is: pyloromyotomy once done, the problem is likely cured. The procedure splits the hypertrophied muscle. After surgery, place infant prone with HOB elevated |
|
Umbilical hernia:
|
Teach signs of strangulation which include vomiting, pain and irreducible mass at the umbilicus
Contact physician if suspected |
|
Aganglionic megacolon:
Hirschprung's Disease |
congenital absense of parasympathetic ganglion in the distal portion of the colon and rectum
Failure to pass meconium within 24 hours of birth suggestive of disorder. In order children, ribbon like stools, distended abdomen, with alternating diarrhea and constipation Can result in performation of colon if not repaired in time Do not take rectal temps Surgery at 9 kg of weight (19.8 lbs) Teach about surgery using doll. Don't point to abdomen Will create a temp. colostomy NG tube after surgery |
|
Wilm's tumor:
encapsulated nephroblastoma |
Peaks at age of 3
Can be one or both kidneys Tumor is encapsulated within the kidney Urinary retention or bloody urine from tumor may be seen. Blood loss can lead to anemia. Child will be pale and fatigued On exam, mass may be felt. put sign above bed: DO NOT PALPATE ABDOMEN TX with surgery, chemo and radiation. Good prognosis with early intervention |
|
Hemophilia:
|
Hemophilia A only appears in males.
It is an X linked disorder Women are only carriers. If one parent is a carrier, any male child has a 50% chance of getting it. Factor 8 or 9 is missing in the blood. PTT is increased. Give FFP or cryoprecipitate to replace the clotting factors Need safe activities and environment. watch for sharp edges on toys look for activities that are safe Badminton is good. Contact sports, not good |
|
Otitis media:
|
Tx with myringotomy. Incision into the tympanic membrane.
Allows for drainage and relieves pain. Drainage should NOT be bloody or purulent after procedure. tubes may be inserted. not an emergency if they fall out, just notify physician |
|
Tonsillectomy:
|
give clear, cool liquids
No citrus, carbonated or extreme hot or cold drinks Milk and milk products avoided. Due to need to clear throat since they are thick Bleed is most common complication. Ask of HX of bleeding or bleeding disorders in family check Pt and PTT prior to procedure |
|
Reyes Syndrome:
|
Acute, rapidly progressing encephalopathy which affects school aged children
Cerebral edema is progressive No hearing loss in this disease Problem with ICP. Provide for rest and quite environment Liver complications resulting in jaundice are common Associated with viral infections and the use of aspirin. |
|
Brain Tumors:
|
Headache upon awakening is most common symptom
Most are infratentorial and difficult to operate on Most intratentorial tumors are presribed to lie flat or turn to either side. If a large tumor, stay off the operative side Gliomas most commom type of childhood brain tumors: These have a bad prognosis! |
|
Cerebral Palsy:
|
damage to motor centers in brain causing spasticity and involuntary movements
Caused by anoxic injury, maternal infections, kernicterus, and low birth weight Persistent reflexes in babies Moro reflex still present after 4 months is an indicator of possibility Delayed development with preference to one hand Sucking difficulties Tongue thrust present Prone to aspiration Feed upright Support lower jaw May have a seizure disorder |
|
Cerebral Palsy:
|
damage to motor centers in brain causing spasticity and involuntary movements
Caused by anoxic injury, maternal infections, kernicterus, and low birth weight Persistent reflexes in babies Moro reflex still present after 4 months is an indicator of possibility Delayed development with preference to one hand Sucking difficulties Tongue thrust present Prone to aspiration Feed upright Support lower jaw May have a seizure disorder |
|
Varicella:
|
if a undisagnosed rash and exposure,put client in strict isolation.
Incubation is 14 - 21 days |
|
Varicella:
|
if a undisagnosed rash and exposure,put client in strict isolation.
Incubation is 14 - 21 days |
|
Autism:
|
safety is priority
child unable to anticipate danger has tendancy of self-mutilation Sensory preceptual deficits are also seen |
|
Autism:
|
safety is priority
child unable to anticipate danger has tendancy of self-mutilation Sensory preceptual deficits are also seen |
|
Croup:
|
no cough syrup
cool mist humidifier sips of warm fluid will relax vocal cords and thin mucus Acetminophen (TylenoL) for fever |
|
Croup:
|
no cough syrup
cool mist humidifier sips of warm fluid will relax vocal cords and thin mucus Acetminophen (TylenoL) for fever |
|
Pertussis:
|
Copious, thick secretions occur
Ineffective airway clearance a priority diagnosis due to th small airway of the infant |
|
Pertussis:
|
Copious, thick secretions occur
Ineffective airway clearance a priority diagnosis due to th small airway of the infant |
|
Scoliosis:
|
most common in females
ages 10-15 Milwaukee brace 23 hrs a day helps slow or stop progression but does not correct the problem Surgical correction by spinal fusion. Log roll for 5 days post-surgery |