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53 Cards in this Set

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BP >160/110 x2, 6hrs apart; preteinuria >2+ on dipstick, >2gm in 24 hrs urine; severe H/A; hyperreflexia >3+ and possible clonus (count, chart); visual or cerebral disturbance c/o spots, specks, floaties; ↑serum creatinine; N/V; oliguria; ↓placental perfusion; sml placenta c infarcts
Severe Preeclampsia Characteristics; The ↑# of beats pt has ↑nervous sys irritability
m344 r741
Pregnancy-specific syndrome tht usually occurs >20 wks of gestation and is determined by gestational HTN plus proteinuria
Preeclampsia
p335 Table 14-1 Classification of HTN states of preg
One of the important goals of care for the mom w preeclampsia is prevention or control of convulsions. This drug is the drug of choice in the prevention and tx of convulsions caused by preeclampsia or eclampsia.
Magnesium Sulfate (MgSO4)
Severe Preeclampsia or HELLP Syndrome p343
Loss of patellar reflexes, resp and mus depression, oliguria, and ↓LOC are signs toxicity from this.
MgSO4 toxicity
Severe Preeclampsia or HELLP Syndrome p346
NI: discontinue immediately and adm calcium gluconate per HCP (10 ml of a 10% solution, or 1 g) given slowly IV push (usually by the HCP) over at least 3 min to avoid undesirable reactions such as dysrhythmias, bradycardia, v-fib
MgSO4 toxicity
Severe Preeclampsia or HELLP Syndrome p346
This drug is a tocolytic. It's use can ↑duration of labor. The labor of a mom c preeclampsia receiving this may need augmentation c oxytocin/pitocin. The amt of oxytocin needed to stimulate labor > for mom who is not receiving this drug.
MgSO4
Severe Preeclampsia or HELLP Syndrome p346
Nursing Diagnosis: Risk for FVE r/t ↑Na retention secondary to adm of MgSO4; Risk for impaired gas exchange r/t pulmonary edema secondary to ↑vascular resistance; Risk for ↓CO r/t use of antiHTN drugs; Risk for injury to fetus r/t uteroplacental insufficiency secondary to use of antiHTN meds...
Severe Preeclampsia
p345
Risk for injury to mom and fetus r/t CNS irritability; Ineffective tissue perfusion r/t preeclampsia secondary to arteriolar vasospasm...
Severe Preeclampsia Nursing Diagnosis
p345
Triggers: allergens (dust mold), irritants (smoke, sprays), exercise, cold air, weather changes, animals, certain meds, strong emotions, food additives, certain foods (nuts, dairy), endocrine factors.
Asthma
MOD4 Study Guide
In infants, there is a strong relationship to viral infection and this
Asthma
MOD4 Study Guide
S/S of asthma—labored breathing, bilateral wheezing (high-pitched musical sounds), prolonged expiration, irritative tight cough (caused by reduction of airways)
Asthma
MOD4 Study Guide
What’s the nurse going to do? The main goals are continuous care approach with reg visits to the HCP, prevention of exacerbations including avoiding triggers, allergens, and using meds as needed, therapeutic efforts to decrease inflammation and relieve/prevent airway narrowing, patient education (environmental control, pharm management, and the use of objective measures to monitor the severity of disease and guide the course of therapy)
Asthma
MOD4 Study Guide
Bronchodilators (serevent) - long term symptom prevention; B-adrenergic agonists (short acting) - Albuterol, Xopenex, terbutaline - used to tx acute exacerbations, for prevention of exercise induced bronchospasm. Can cause ↑HR, GI disturbance, irritability, tremor, nervousness, insomnia.
Asthma Meds and SE
MOD4 Study Guide
Meds and SE: Methylxanthines (Theophylline and Aminophylline)-smooth muscle relaxant, bronchodilator, frequent blood levels, don’t mix with other meds and calculate doses carefully. Monitor P, BP, RR b/f, during, & after tx. S/E-n/v, tachycardia, hypotension, restlessness, hyperactivity
Asthma
MOD4 Study Guide
Inhalers (a lot of them have steroids or Nsaids); NSAID inhalers (Cromolyn sodium);
Epi commonly used for acute attacks-rapid effect, short acting, vasodilation, and decreases mucous production. Dosage 0.01 mL/Kg-may repeat 4xs. S/E-tachycardia, pallor, weakness, nausea, tremors
Asthma Meds and SE
MOD4 Study Guide
Supsphrine-type of epi c fast effect, but is slower acting, lasts longer. S/e-tachycardia, pallor, weakness, nausea, tremors; Isuprel-same effects as epi; Nursing alert-avoid ASA administration b/c 2-6% of children with asthma are sensitive to ASA.
Asthma Meds and SE
MOD4 Study Guide
Most common serious pulm/gastric disease of children. Primarily affects exocrine glands (mucous production).
Cystic Fibrosis
Read Box 46-17 on pg 1347 for clinical manifestations (she mentioned this)
Autosomal recessive trait. Both parents have to pass on the gene. Have 1 in 4 chance of getting disease if both parents have genes.
Cystic Fibrosis
Read Box 46-17 on pg 1347 for clinical manifestations (she mentioned this)
Early Sx-meconium ileus in the NB (tenacious meconium is blocking illeus). Normally, baby should have BM within first 24 hrs of life.
Cystic Fibrosis
Read Box 46-17 on pg 1347 for clinical manifestations (she mentioned this)
Patho- ↑viscosity of mucous gland secretions, ↑of sweat electrolytes (Na and Cl), ↑enzymatic elements of saliva (parents may say infant tastes salty when they kiss them), abnormalities of autonomic NS, ↑sweat electrolytes (Na and Cl)
Cystic Fibrosis
Read Box 46-17 on pg 1347 for clinical manifestations (she mentioned this)
Diet-maintenance of nutrition to promote normal growth, dev; Well balanced diet (↑protein, calorie diet); Vit replacement (esp A, D, E, K); ↑protein; Fe supplement (are often anemic); Don’t recommend restriction on fats; May need to drink ensure, pedisure; May require ↑Na in diet (loose a lot thru sweat and saliva); Watch them if they’re sick or it’s hot, may loose more Na; Pancreatic enzyme replacement (give c meals, snacks)
Cystic Fibrosis
Read Box 46-17 on pg 1347 for clinical manifestations (she mentioned this) p1347
Meds-nebulized epi (vasoconstrict, ↓ edema), steroids, expectorants, bronchodilators, antihistamines, for bacterial infection-amphocyllin 150 mg/kg/day
Acute tracheitis
MOD 4 Study Guide
Meds-nebulized epi (vasoconstrict and decrease edema),steroids, expectorants, bronchodilators, antihistamines, for bacterial infection-amphocyllin 150 mg/kg/day
Acute tracheitis
MOD 4 Study Guide
Timing of diagnostic tests
C.A.A.P. Q.T.
CVS 10-12wks; amniocentesis >14wks; AFP 15-21wks; PUBS 2nd-3rd tri; Quad/Triple Screen 16-18wks
Metabolic effects: CNS damage, mental retardation, and ↓melanin
PKU
h224
Formulas prescribed for infants: Lorenalac and Phenex-1
PKU
h224
Syndrome in males that is characterized by small testes, long legs, enlarged breasts, reduced sperm production, mental retardation; a genetic defect in which an extra X chromosome (XXY) is present in the male
Klinefelter's syndrome
TFD
CNS depressant; relaxes smooth mus, including the uterus; used to halt preterm labor contractions; used for preeclamptic pts to prevent seizures
MgSO4
Med used in preterm labor s392t,393,394f,394t
↓RR, DTRs, urine output; hypotension; extreme mus weakness; flushing; pulmonary edema serum levels > 9 mg/dl
MgSO4
Med used in preterm labor s392t,393,394f,394t
Use controller pump for adm; follow agency protocol for adm; discontinue infusion and notify HCP if adverse reactions occur; monitor RR < 12/min, urine output < 100 ml/4 hr (25-30 ml/hr, DTRs, levels outside 4-8 mg/dl; keep calcium gluconate at bedside
MgSO4
Med used in preterm labor s392t,393,394f,394t
Newborn risks: hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, large birth rate, congenital anomalies
Diabetic mom
s304t c307
Bradycardia; tachycardia; late, prolonged decels; hypertonic uterine activity; ↓, absent variability; variable decels falling to < 70 beats/min > 60 sec
Nonreassuring Patterns
s326
Fluctuations in FHR may include irregular fluctuations of two or more cycles/min; ↓can result from fetal hypoxemia, acidosis, or certain meds; a temporary↓ can occur when the fetus in in a sleep state, not usually lasting longer then 30 min
Variability
s324
Brief, temporary↑ in FHR of ≥ 15 beats more than the baseline and lasting ≥15 sec; Usually reassuring sign, reflecting a responsive, nonacidotic fetus; usually occur c fetal movement; May hv no relation to contractions or be periodic; May occur c uterine contractions, vaginal examinations, or mild cord compression, or when fetus is in a breech presentation
Accelerations
s324
↓FHR below baseline; rate at lowest point usually remains > 100 beats/min; Occur during contractions as fetal head is pressed against mom's pelvis, soft tissues eg, cervix; return to baseline FHR by end of contractions; not associated c fetal compromise, require no intervention
Early decelerations
s325
Nonreassuring patterns reflect impaired placental exchange or uteroplacental insufficiency; begins well after contraction begins and return to baseline after the contraction ends; degree of fall in FHR from baseline is not r/t amt of uteroplacental insufficiency; NI include improving placental blood flow, fetal oxygenation
Late decelerations
s325
Caused by conditions that restrict flow through umbilical cord; do not hv uniform appearance; shape, duration, degree of fall below baseline FHR are variable; fall/rise abruptly c onset, relief of cord compression; may be nonperiodic, occurring at x's not r/t contractions; baseline rate/variability are considered when evaluating this; significant when FHR repeatedly↓ to <70 beats/min and persists at that level ≥60 sec a returning to baseline
Variable decelerations
s325
Effacement, dilation of cervix; 3 stages - latent, active, transition; mom is sociable, excited in latent phase, becoming more inwardly focused as labor intensifies
1st stage of labor
s326
Expulsion of fetus; pushing stage; mom has intense concentration on pushing c contractions; may doze between contractions
2nd stage of labor
s326
Separation of placenta; expulsion of placenta; mom is excited, releaved after baby's birth; usually very tired
3rd stage of labor
s326
Physical recovery; 1-4 hr after expulsion of placenta; tired, but may find it difficult to rest bc of excitement; eager to become acquainted c newborn
4th stage of labor
s326
Longest for both nulliparous, multiparous moms/ cervical dilation is 1-4 cm; uterine contractions occur q15-30 min, are 15-30 sec in duration, and are of mild intensity; encourage mom/partner to participate in care; assist c comfort measures, changes of position, ambulation; keep mom/partner informed of progress; offer fluids/ice chips; encourage voiding q 1-2 hrs
Latent phase
s326
Cervical dilation 4-7 cm; uterine contractions occur q305 min, are 30-60 sec in duration, are of moderate intensity; mom may experience feelings of helplessness; mom bc restless/anxious as contractions bc stronger
Active phase
s326
NI: Encourage maintenance of effective breathing patterns; provide a quiet environment; keep mom/partner informed of progress; promote comfort c back rubs, sacral pressure, pillow support, position changes; instruct partener in effleurage (light stroking of abd); offer fluids/ice chips, ointment for dry lips; encourage voiding q1-2 hrs
Active phase
s326
Cervical dilation is 8-10 cm; uterine contractions occur q2-3 min, are 45-90 sec in duration, are of strong intensity; mom bc tired, is restless, irritable, feels out of control
Transition phase
s326
Encourage rest between contractions; wake mom at beginning of contractions so she can begin breathing pattern; keep mom/partner informed of progress; provide privacy; offer fluids/ice chips, ointment for dry lips; encourage voiding q1-2 hrs
Transition phase
s326
NI: Monitor moms VS, FHR via US doppler, fetoscope, or EFM, uterine contractions by palpation or monitor, determining frequency, duration, intensity; assess FHR a, during, p any contractions, noting normal FHR is 120-160 beats/min; asses status of cervical dilation cm, effacement %; fetal station eg, -4, position by leopold's maneuver; assist c pelvic exam, prepare for fern test; assess color of amniotic fluid if membranes hv ruptured, bc meconium stained fluid can indicate fetal distress
Throughout stage 1
s327
S/s: Breast changes; amenorrhea; N/V; urinary frequency; fatigue; quickening
Presumptive sign of pregnancy
Table 10-2 p213
S/s: Goodell, Chadwick, Hegar signs; Positive serum/urine pregnancy tests; braxton hicks contractions; ballottement
Probable signs of pregnancy
Table 10-2 p213
S/s: Visualization of fetus, FHR tones, by real-time US exam; visualization of fetus by radiographic study; FHR tones detected by Doppler, stethoscope; fetal movements palpated, visible
Positive signs of pregnancy
Table 10-2 p213
Changes: ↑blood volume, plasma, P (10 beats/min), and total RBCs (by 40-50%); ↓BP slightly in 2nd trimester
Prenatal Period; Physiological maternal changes
s286
This count may ↑ to 15,000/µl (or even higher during labour and following delivery). The total mass ↑ to fill increased blood volume. The reason for the increase is unknown but is probably a hormonal response. If you have no fever, sore throat, urinary problem or other sx suggestive of an infection, these counts are normal
WBC count during pregancy
Online reference
A numerical formula for estimating the date labor will begin; by subtracting 3 months from the first day of the LMP and adding 7 days to that date, a provisional date of delivery is identified
Naegele's rule
TMD