• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/318

Click to flip

318 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Discomfort from cervical changes and uterine ischemia; Visceral pain felt over lower abdomen
1st stage of labor. Usually pain free between contractions Table 18-2 p450
MGMT OF DISCOMFORT; Neurologic origins m247
A stage of labor; perineal (somatic) pain; pressure of presenting part; pain may be local or referred
2nd stage of labor
Mgmt of Discomfort; Neurologic Origins m247
↑ BP, RR, HR, hyperventilation, diaphoresis, N/V, ↓placental perfusion, uterine activity
Physiologic or affective changes of pain
Mgmt of Discomfort; Expression of Pain m248
May be affected by culture
Perception of Pain
Mgmt of Discomfort; Physiologic or affective changes m248; p396
Chinese may not react; Arab or Middle Eastern may be vocal; Japanese may be stoic; SW Asian may endure; Native American may use indigenous plants; African-America may express openly
Cultural reactions to pain
Mgmt of Discomfort; Expressions of Pain m248
Previous experience; culture; anxiety; preparation; comfort; support system; environment; magnified by fatigue/lack of sleep
Things perception of pain is affected by
Mgmt of Discomfort; Perception of Pain m248
Physical exercises to prepare for labor, conscious relaxation, and breathing patterns
Dick-Read Method
Mgmt of Discomfort m248
Deep abd breathing (most of labor); shallow breathing (end of 1st stage); breath holding in 2nd stage
Dick-Read breathing patterns
Mgmt of Discomfort m248
Conditioned response; use of coping strategies during UC's; must pratice; chest breathing most common
Lamaze Method
Mgmt of Discomfort m249
In harmony w body; abd breathing; quiet, dark atmosphere; deep mental relaxation; may appear asleep
Bradley Method
Mgmt of Discomfort m249
Counterpressure; effleurage (light massage); therapeutic touch and massage; walking; rocking; changing positions
Cutaneous stimulation strategies
Nonpharmacologic Strategies to Encourage relaxation and Relieve Pain m249;p399; box 16-2
Heat or cold; transcutaeous electrical nerve stimulation; acupressure; water therapy (hydrotherapy); intradermal water block
Cutaneous stimulation
Nonpharmacologic Strategies to Encourage relaxation and Relieve Pain m249 p399; box 16-2
Aromatherapy; breathing techniques; music; imagery; use of focal points
Sensory stimulation
Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain m249;p399; box 16-2
Childbirth edu; hypnosis; biofeedback
Cognitive Strategies
Nonpharmacologic Strategies to Encourage relaxation and Relieve Pain m249;p399; box 16-2
A massage technique that employs gentle hand movements along mom's abds.
Effleurage (light massage); Cutaneous Stimulation Strategies
Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain p399 box 16-2
TENS unit
Transcutaneous Elect Nerve Stimulation. A pocket size, portable, battery-operated device that sends electrical impulses to certain parts of the body to block pain signals
Nonpharmacologic Strategies to encourage relaxation and relieve pain m249
Relieve anxiety, induce sleep; May cause resp, vasomotor depression in mom & newborn; use w caution; therapeutic rest
Barbiturates
Pro-dromal/Early Labor Use of Sedatives m250
For moderate to severe labor pain; postop pain aftr csection. Epidural or lintrathecal (within spinal canal) analgesics, alone or comb w a local anesthetic
Demerol; Fentanyl
Systemic Analgesia; Narcotic compounds IM or IV;Takes the edge off of pain so mom can relax and sleep m250; p407-409
Indicated for labor pain; postoperative pain after cesarean birth; Systemic Analgesics; Mixed narcotic agonist-antagonist compunds IM or IV
Nubain; Stadol
m250; p407-409
Analgesic potentiators
Pheergan; Vistaril
Systemic Analgesia m250; p406
Narcotic antagonists
Narcan
Systemic Analgesia m250; p409
Once mom reaches 7-8 cm she will no longer be able to get __ bc it crosses the placenta and affects baby → resp depression
Narcotics
Audio lec
Give port nearest pt; giv in sml divided doses at beginning of 3-5 contractions
IV (preferred)
Adm of Med in Labor m250
Give in upper arm if later epidural is planned; less predictable; more crosses to fetus; stays in mom's sys longer and takes longer to wrk
IM route
Adm of Med in Labor m250
Simple, safe, high success rate, does not depress fetus
Advantages of local infiltration pudendal block
Nerve Block Analgesia and Anesthesia m251
Does not relieve pain w UC's, only discomfort from perineal distention & for episiotomies [əˌpiːzɪˈɒtəmɪ]; Bearing down reflex may be lessened or lost
Disadvantages of local infiltration pudendal block
Nerve Block Anesthesia m251
Inj into spinal fluid; effects in 1-2 mins, lasts 1-3 hrs; used for c-section;
Spinal/saddle block
Regional blocks m251
Need adequate pre-hydration LR 500-1000cc within 20 min bf this procedure to prevent hypotension
Spinal/saddle block
Regional blocks m251
SE spinal HA (teach mom to report); hypo-tension; ↓CO (mom & baby); resp paralysis Tx: meds; laying flat; blood patch; caffein: coke, coffee
Spinal/saddle block
Regional blocks m251
Inj into epidural space; local inj given first then test dose; then catheter connected to pump until baby's birth; may have PCA bolus
Epidural analgesia/anesthesia
Regional blocks m252
Indicated for labor/c-section; SE: hypotn; ↓labor and/or fetal descent; loss of bladder sensation; ↑of maternal temp ≤ 0.5º; wet tap; loss of urge to push → ↑use of forceps, vacuum extractor
Regional blocks
Epidural analgesia, anesthesiam m252 r3000
Remain w pt initially; side lying or sitting up; Monitor BP q15-30min; Hv pt change positions frequently to keep med evenly distributed; VS & O2 sat; bladder distension
Epidural nursing care (once the epidural is in)
Regional Blocks m253 r2700
Regional anesthesia resulting from the use of a local anesthetic to deaden the pudendal nerves in the region of the vulva and labia majora; used to ease discomfort during childbirth
Pudendal block
Pudedal: The human external genital organs, especially of a woman.
Surgical incision of the perineum during childbirth to facilitate delivery
Episiotomy
Procedure with regards to Nerve Block Anesthesia m251
A type of spinal anaesthesia producing sensory loss in the buttocks, inner sides of the thighs, and perineum
Saddle Block
Regional Blocks m251
A method of regional anesthesia used to stop the passage of sensory impulses in the spinal cord, thus depriving a patient of sensation in the area involved.
Spinal Block
Nerve Block Anesthesia m251
If the spinal block reaches too high __ may stop
Breathing
Audio Lec
__ can only be used for c-section
Spinal Block
Audio Lec
__ cause temp loss of sensation to affected nerves. Need adequate pre-hydration to prevent hypotension. Bolus with IV LR 500-1000cc
Spinal/saddle block
Regional anesthesia; Audio Lec
Mom can move her legs, they will feel asleep, need help changing position; she will feel tugging, pulling, and pressure but no pain w c-section
Epidural Pt teaching
Audio lec
Mom is awake and can participate in the c-section.
Advantage of epidural
Audio Lec r3016
Caused by nicking the dura of the spinal canal resulting in spinal fluid leakage. Spinal block may be indicated; Sx Spinal HA, loss of urge to push
Wet tap
Epidural complications
Remain w pt; Side lying or sitting up; Frequent VS and O2 sat, Monitor for bladder distension
Epidural nursing care
Regional Blocks m253 r3326
Blocks the pain transmission of the pain receptors in the spine without affecting motor ability
Intraspinal/epidural narcotics (Fentanyl) for labor/postop pain, also known as a walking epidural
Regional Blocks m253 r3350
N/V, itching, urinary retention, respiratory depression
SE of Intraspinal/epidural narcotics
Regional Blocks m253 r3510
Pt refusal; Antepartum hemorrhage w hypovolemia; anticoagulant therapy eg, ↑PT or PTT; infection at the site; tumor; allergy to "cain" drugs; hx of spinal injury, disease or surgery; marked hypotension
Contraindication of intraspial/epidural narcotics
Regional Blocks m253 r3535
Another term for laughing gas. With this form of ansethesia the pt can medicate themselves.
Nitrous oxide
Inhalation anesthesia during pregnancy m253 r3750
Indicated in stat situations when a c-section is required, but it may be used where regional anesthesia is contraindicated, unavailable, or not working
General anesthesia
Types of Anesthesia m253 r3828
Indicated during general anesthesia to ↓acidity of mom's gastric contents
Sodium citrate
General Anesthesia m253 r3828
Cricoid pressure may be indicated during __ to help get the tube in
General anesthesia
NI after general anesthesia r3900
Meds may cross the placeta so make sure NSY is ready for a __ baby
sleepy
NI after general anesthesia r4000
↑risk for reflux, aspriation, and aortial cable compression → ↓blood supply to the uterus; stressed resp function
Obese women
Types of anesthesia m253 r4020
Interview includes last meal; resp conditions; Hx of scoliosis; substance abuse; check labs for anemia, coagulopathy; infection
Nursing care for obese women; Coagulopathy - a defect in blood-clotting mechanisms
Types of anesthesia m253 r4020
If preg mom has really bad __ HCP may not be able to get a epidural or spinal in depending on where it is and how bad
scoliosis
Typed of anesthesia m253 r4114
__ is used for pre-term labor
Brethine
Study Guide for labor & Birth at Risk ch19 m239
↑HR (mom & baby); shaking; SOB; ↓O2; palpitations; N/V; hot flashes; hyperglycemia
SE of Brethine
Study Guide for labor & Birth at Risk ch19 m239
What is the therapeutic level for MagSO4 therapy?
4-8 mEq/l
Study Guide for labor & Birth at Risk ch19 m240 r4500
N/V, hot flashes, diplopia (two images of an object seen at once), mus weakness, ↓DTR's (deep tendon reflex), resp depression; Monitor I&O; Adm calcium gluconate for OD.
SE of MagSO4
Study Guide for labor & Birth at Risk ch19 m240 r4623
Used to ↑duration of labor; CNS depressant; relaxes smooth muscles, including uterus; Monitor for resp depression, I & O
Indicated when adm MagSO4
Study Guide for labor; Birth at Risk ch19; MEDICATION GUIDE Box p495
When using MagSO4 you must have this at the bedside?
Calcium gluconate
Study Guide for labor & Birth at Risk ch19 Audio lec r4730
Why is the glucocorticoid Betamethasone given to some women in preterm labor?
Speed maturation of the fetal lungs
Study Guide for labor & Birth at Risk ch19 m241 r4742
Two shots IM. Adm 2nd shot 12-14hr after the first to speed maturation fetal lungs
Betamethasone adm
Study Guide for labor & Birth at Risk ch19 m241
What is dystocia?
Anything that ↓effectiveness of labor eg, fetal position, weak contractions, shap of mom's pelvis
Study Guide for labor & Birth at Risk ch19 m241 r4859
The process of causing or producing labor with oxytocic (agent that stimulates uterine contractions) drugs in cases of uterine dysfunction.
Induction
Study Guide for labor; Birth at Risk ch19
Use of pharmacological or surgical interventions to help the progression of a previously dysfunctional labor.
Augmentation
Study Guide for labor & Birth at Risk ch19
Maintain mom in side lying → ↓contractions; Turn off pitocin (oxytocin) infusion; Keep IV line open ↑rate; As per HCP adm brethine 0.25 mg sq → ↓uterine activity; Continue monitoring FHR, pattern, uterine activity; document
NI for uterine hyperstimulation
Study Guide for labor & birth; Birth at Risk ch19 m242 Emergency Box p510 r5033
What station is the fetal head when outlet forceps are used?
+3
Study Guide for labor & Birth at Risk ch19 m243 r5141
Bruising; scratches/scrapes; nerve compression and/or bleeding in the brain w use of excessive force; skull fracture, cephalohematoma
Forcep use potetial for newborn injuries
Study Guide for labor & Birth at Risk ch19 m243
What are the risks to the newborn of vacuum extraction?
Bruise atop of head; bleeding in the brain
Study Guide for labor & Birth at Risk ch19 m243
When is the fetus considered to be postdate (postterm)?
42 wks
Study Guide for labor & Birth at Risk ch19 m244
What are fetal/neonatal risks?
Meconium aspiration; calsifaction in the placenta, hypoglycemia, malnurishment
Study Guide for labor & Birth at Risk ch19 m244 r5505
Wht is a shoulder dystocia?
Baby's shoulder gets stuck on mom's pubic bone
Study Guide for labor & Birth at Risk ch19 m244 r5540
What two maneuvers are most frequently described to free the anterior shoulder when shoulder dystocia occurs?
McRoberts maneuver; Super pubic pressure
Study Guide for labor & Birth at Risk ch19 m244 r5603
Flex apart mom's legs w her knees on abds→ straightened sacrum, the symphysis pubis rotates toward the mom's head → ↓angle of the pelvic inclination → freed shoulder
McRoberts maneuver
Study Guide for labor & Birth at Risk ch19 m244
Push against side of pubic bone
Super pubic pressure
Study Guide for labor & Birth at Risk ch19 m244
What are the signs of a prolapsed cord?
Umbilical cord falls out in front of the presenting part
Study Guide for labor & Birth at Risk ch19 m244
Wht immediate actions should be taken whn the umbilical cord prolapses?
Push baby back into the vigina
Study Guide for labor & Birth at Risk ch19 m244 r5808
Trouble breathing; ↑HR; death; chest pain
Sx of amniotic fluid embolism (AFE)?
Study Guide for labor & Birth at Risk ch19 m245 m10040
A collection of blood under the scalp of a newborn; caused by pressure during birth
Cephalohematoma
Medical dictionary
Regional anesthesia used to stop passage of sensory impulses in a nerve, a nerve trunk, the dorsal root of a spinal nerve, or the spinal cord, thus depriving a pt of sensation in the area involved.
Block
Tabor's Med Dict
Analgesia during labor; Indicated for labor pain; postop pain after c-section; Give in sml divided doses at beg of 3-5 contactions so ↓med will get to fetus; IV rout preferred; Systemic Analgesia; Mixed narcotic agonist-antagonist compunds IM or IV
Nubain; Stadol
m250; p407-409
Adjunct to anesthesia and analgesia; doesn’t relieve pain but ↓anxiety & apprehension, ^ sedation, can be used to ↓n/v that often accompany opioid use
Phenergan
Davis Drug Guide
Acts as a CNS depressant at the subcortical level of the CNS; doesn’t relieve pain but ↓anxiety, apprehension, ^ sedation, can ↓N/V that often accompany opioid use
Vistaril
Davis's Drug Guide
Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression.
Demerol; At 7-8 cm can no longer receive bc can cause resp depression to baby (has longer half life stays longer in sys)
Systemic Analgesia; Narcotic compounds IM or IV;Takes the edge off of pain so mom can relax and sleep m250; p407-409
Opioid analgesic that binds to opiate receptors in the CNS, altering the response to and the perception of pain; watch for resp depression
Demerol; At 7-8 cm can no longer receive bc can cause resp depression to baby (has longer half life stays longer in sys)
Systemic Analgesia; Narcotic compounds IM or IV;Takes the edge off of pain so mom can relax and sleep m250; p407-409
Passageway (birth canal); passenger; powers; position of mother; psychologic response
Five essential factors that include the processes of labor (5 P's)
Essential Factors and Processes of Labor ch15
Above pelvic brim; has nothing to do with childbearing
False Pelvis
Essential Factors and Processes of Labor; Bony Pelvis ch15
3 planes: brim/inlet (upper boarder); midpelvis (pelvic cavity); outlet (lowest border)
True Pelvis
Essential Factors and Processes of Labor; Bony Pelvis ch15 p383
Classic female pelvis; 50% of women have; round; spontaneous vaginal delivery in the OA position
Gynecoid
Essential Factors and Processes of Labor; Types of pelvis'; Bony Pelvis ch15 r25220
Similar to male pelvis; heart shaped; deliver by c-section or difficult forceps delivery
Android
Essential Factors and Processes of Labor; Types of pelvis' ch15 r25303
Oval shaped; delivery vaginally w or w/o forceps; baby is usually in an OP or OA position
Anthropoid
Essential Factors and Processes of Labor; Types of pelvis' ch15
Flat; spontanious vaginal delivery
Platypelloid
Essential Factors and Processes of Labor; Types of pelvis' ch15 r25404
↓uterine segment; pelvic floor mus; vigina; Cervix: dilation, effacement; introitus; Bandl's ring: patho ring; pelvic floor
Soft Tissues
Essential Factors and Processes of Labor; Passageway ch15 r25427
Separates the upper and lower uterine segments
Psysiological retraction ring
Essential Factors and Processes of Labor; Soft Tissues ch15 r25441
Thickening and indentation at the junction of the upper and lower uterine segments; can obstruct fetus delivery
Bandl's ring
Essential Factors and Processes of Labor; Soft Tissues ch15 r25503
Mus layer helps fetus rotate anteriorly
Pelvic floor
Essential Factors and Processes of Labor; Passageway; Soft Tissues m211 r25545
2 parietal bones; 2 temporal bones; 1 frontal bone; 1 occipital bone (our reference point); suture lines; Fontanels: anterior, posterior; molding
Fetal Head
Essential Factors and Processes of Labor; Passenger; m211 r25626
Membrane filled spaces where the sutures meet
Fontanels
Essential Factors and Processes of Labor; Passenger; m211 r25626
Diamond shaped; Should be facing mom's bottom for easiest delivery
Anterior Fontanel
Essential Factors and Processes of Labor; Passenger; m211 r25626
Triangular shaped
Posterior Fontanel
Essential Factors and Processes of Labor; Passenger; m211 r25626
Part of fetus entering pelvic inlet first: caphalic most common at __%, breech (bottom first) __%, shoulder __%
Presentation 96; 3; 1
Essential Factors and Processes of Labor; Passenger; m212 r25840
Caphalic, vertex, crown, brow, occiput, synciput
Head first
Essential Factors and Processes of Labor; Passenger; Presentation m212 r25840
Footling breech (one or both feet first); Frank breech (folded in half eg, feet up against face); Complete – bottom first legs crossed; Shoulder – out first – laying sideways
Types of breeches
Essential Factors and Processes of Labor; Passenger; Presentation m212 r30000
Relationship of the long axis of the fetus to the long axis of the mom eg, longitudial or transverse
Lie
Essential Factors and Processes of Labor; Passenger; Presentation m212 r30200
Babies' lying vertical; either caphalic or breech
Longitudial Lie
Essential Factors and Processes of Labor; Passenger; Presentation m212 r30240
Position in which baby lying horizontal or oblique eg, shoulder presentation. Can turn either breech or cephalic during labor
Transverse Lie
Essential Factors and Processes of Labor; Passenger; Presentation m212 r30249
Relationship of fetal body parts to each other eg, flexion, extension, military
Attitude
Essential Factors and Processes of Labor; Passenger; Presentation m212 r30347
Head tucked, back round, thighs flexed at knees eg, chin to chest. Most babies present this way
Flexion
Essential Factors and Processes of Labor; Passenger; Presentation m212
Head extended back and body not round eg, face or brow presentation; delivery by c-section; face gets brusing and swelling during contractions
Extension
Essential Factors and Processes of Labor; Passenger; Presentation m212 r32440
Head is straight like a solider
Military
Essential Factors and Processes of Labor; Passenger; Presentation m212
Relationship of presenting part to front, back, sides of mom's pelvis eg, anterior (OA,ROA,LOA); posterior (OP,ROP,LOP); transverse (ROT,LOT)
Position
Essential Factors and Processes of Labor; Passenger; Presentation m213 r30700
Occiput (back of head) of baby is to mom's anterior eg, looking down at floor. Easiest way for baby to deliver
Anterior position
Essential Factors and Processes of Labor; Passenger; Presentation m213
ROA, LOA
Right occiput anterior; Left occiput anterior
Essential Factors and Processes of Labor; Passenger; Presentation m213 r30750
Baby looking up; baby's head toward mom's bottom eg, OP, ROP,LOP; Difficult for baby to deliver; mom c/o back pain; counter pressure indicated
Posterior; Occiput posterior; Right occiput posterior; Left occiput posterior
Essential Factors and Processes of Labor; Passenger; Presentation m213 r30810
Position in which head is sideways, more difficult to fit through birth canal; HCP has to rotate
Transverse position
Essential Factors and Processes of Labor; Passenger; Presentation m213 r30935
Largest transverse diameter of the presenting part has passed through the maternal inlet into the true pelvis
Egagement
Essential Factors and Processes of Labor; Passenger; Presentation m213 r31042
Relationship of presenting part to imaginary line drawn between maternal ischial spines
Station
Essential Factors and Processes of Labor; Passenger; Presentation m213 r31107
The ↑(-)__ the further up the pelvis the baby is eg, -4 (4cm above ischial spine) to 4 (4cm below ischial spine)
Station
Essential Factors and Processes of Labor; Passenger; Presentation m213 r31107
The hardest part for the baby to fit through in the pelvis
0 station
Essential Factors and Processes of Labor; Passenger; Presentation m213 r31107
If the __ is implanted low or over the cervial os (bone) or is placenta previa that can impede labor
Placenta
Essential Factors and Processes of Labor; Passenger; Presentation m213 31300
Contractions eg, involuntary, frequency, duration, intensity → cervical effacement (thinning) and dilation (opening).
Powers
Essential Factors and Processes of Labor; Powers; Presentation m214 r31350
Talked about in terms of % eg, 0% still very thick, 50% thick, 100% thickness (in labor) = thickness is size of a sheet of paper
Effacement
Essential Factors and Processes of Labor; Powers; Presentation m214 r31555
__ usually happens before dilation in nullips and at the same time as dilation in multips. 2cm = 0%, 1cm – 50%, paper thin = 100%
Effacement (thinning of the cervix as the internal os is slowly pulled up into the lower uterine segment)
Essential Factors and Processes of Labor; Powers; Presentation m214 r31717
__ caused by contractions → widening of the cervical os; by pressure from the presenting part & the amniotic sac. __ 0-10 cm (complete) eg, can no longer feel cervix around babys' head
Dilation (opening); Dilation
Essential Factors and Processes of Labor; Powers; Presentation m214 r31757
Bearing down effort
Pushing
Essential Factors and Processes of Labor; Secondary Powers; Presentation m214 32045
Felt when presenting part of fetus presses on stretch receptors in mom's pelvis; involuntary
Urge to push
Essential Factors and Processes of Labor; Secondary Powers; Presentation m214
Tell the mom to __ when she feels the urge to push but the cervix is not completely dilated
pant
Essential Factors and Processes of Labor; Secondary Powers; Presentation m214
Helps ↑strength of UC's; puts pressure on cervix
Gravity (standing, walking, or squatting)
Position of Mother m215 r408
↑CO & placental perfusion
Left or Right side lying position
Position of Mother m215
Straightens long axis of birth canal; widens pelvis
Squatting
Position of Mother m215
Previous birth/hospt experiences; emotional readiness; preparation; cultural/ethnic heritage; support systems; environment
Psychological Response
Essential Factors and Processes of Labor; m216 r430
Lightening (dropping) approx 2 wks bf onset of labor
Nulliparas
Essential Factors and Processes of Labor; Signs Preceding Labor m216 Box 15-1 p387 r1108
↑in vaginal mucous and bloody show; slight ↓wt.; Braxton Hicks contractions; surge of energy (nesting)
Nullips and Multips
Essential Factors and Processes of Labor; Signs Preceding Labor m216 Box 15-1
Onset: Fetal hormones; uterine distension/pressure; aging placenta; ↑estrogen and prostagiandin
Labor initiation
Essential Factors and Processes of Labor m216 r1534
Entry of the largest diameter of the fetal presenting part into the pelvic inlet
Engagement
Essential Factors and Processes of Labor; Cardinal Movements of the Mechanism of Labor m217 p388 r1558
Progressive dilation and effacement of the cervix with __ of the presenting part
descent, as in normal labor
Essential Factors and Processes of Labor; Cardinal Movements of the Mechanism of Labor m217 p388
Begins at the level of the ischial spines but is not completed until the presenting part reaches the lower pelvis
Internal rotation
Essential Factors and Processes of Labor; Cardinal Movements of the Mechanism of Labor m217 p390
The occiput then the face then the chin
extension
Essential Factors and Processes of Labor; Cardinal Movements of the Mechanism of Labor m217 r1950
Head meets resistance from cervix & pelvic wall as the baby moves down. Presents a smaller diameter to the pelvic outlet → chin tucks to chest → smallest diameter of fetal head meets the pelvic outlet
Descent
Essential Factors and Processes of Labor; Cardinal Movements of the Mechanism of Labor m217 r1756
The time written in on the delivery record
Explusion
Essential Factors and Processes of Labor; Cardinal Movements of the Mechanism of Labor m217
Changes occuring in FHR, fetal circulation, respiratory movements, and other behaviors
Fetal Adaptation
Essential Factors and Processes of Labor; Physiologic Adptation to Labor p390-392
At term is 160 bpm; 160 bpm at 20 wks; temp acels & slight early decels can be expected
FHR
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Fetal Adaptation p390-392
Affected by many factors: mom's position, contractions (↓circulation), BP, and umbilical cord blood flow
Fetal Circulation
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Fetal Adaptation p390-392
Lung fluid is cleared from air passages as infant passes through birth canal; ↓Po2, pH, HCO3, & resp movements during labor; ↑Pco2
Fetal Respiration
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Fetal Adaptation p390-392
Various body sys adaptations through the stages of labor cause the woman to exhibit objective/subjective symptoms
Maternal Adaptation
Essential Factors and Processes of Labor; Physiologic Adptation to Labor p390-392
↑CO (12-31%) in 1st stage & 50% in 2nd; ↑BP 10% in 1st stage & contractions during 2nd stage → ↑SBP 25 & DBP 25; Valsalva maneuver → fetal hypoxia
Cardiovascular Changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
Supine hypotension; Valsalva maneuver → fetal hypoxia; ↑WBC; Vascular changes → flushed cheeks, hot/cold feet, & eversion of hemorrhoids
Cardiovascular Changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
↑RR (anxiety can be a cause); Hyperventilation may → respiratory alkalosis (↑pH), hypoxia, & hypocapnia (↓CO2)
Respiratory changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
Spontaneous voiding may be difficult; Proteinuria up to +1
Renal changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
Stretching → minute tears in skin around vaginal introitus (An opening or entrance into a space or cavity) occur
Integumentary chages
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
The labor process & pointing toes → leg cramps; marked ↑mus activity; ↑joint laxity at term → backache & joint ache
Musculoskeletal changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
Euphoric→seriousness → amnesia b/t contractions in 2nd stage → elation or fatigue after birth
Neurologic changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
Endogenous endorphins ↑pain threshold→sedation; Pressure by presenting part→ physio-logic anesthesia of perineal tissues ↓perception of pain
Neurologic changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
↓motility, absorption of foods, and stomach-emptying time; N/V belching; With onset of gestation diarrhea or hard or impacted stool
Gastrointestinal changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
↑metabolism, estrogen, prostaglandins, and oxytocin; ↓progesterone, and BS with work of labor
Endocrine changes
Essential Factors/Processes of Labor; Physiologic Adaptation to Labor; Maternal Adaptation p390-392
The lower, posterior portion of the hip bone, fully fused with the pubis and ilium
Ischium
Processes of Labor; Passenger; Presentation m213 r31107
A clot of a pt's blood placed over the dura to repair a cerebrospinal fluid leak that may be caused by a lumbar puncture, used to treat post–lumbar puncture headache
blood patch
Regional blocks m251
Lightening; return of urinary frequency; backache; stronger Braxton Hicks contractions; 0.5-1.5 kg ↓wt.; surge of energy; ↑vaginal discharge; bloody show; cervical ripening; possible membrane rupture
Signs Preceding Labor
Box 15-1
Onset of regular uterine contractions until complete effacement and full dilation
1st stage
The First Stage of Labor; General Notes m219 r02515
Latent or early phase: 0 - 3 cm; Active phase: 4-7 cm; Transition phase: 8-10 cm
Elements of 1st stage
The First Stage of Labor; General Notes m219
Contractions: Irregular, or regular only temp;often stop w walk/position change; Cervix: may be soft, but no significant change in effacement/dilation; Fetus: presenting part not usually engaged
False labor
The First Stage of Labor; General Notes m219 p442
Contractions:regular→stronger, lasting longer, occurring closer together; w ↑intensity whn walking;Cervix: shows pregressive changes & moves more anterior; Fetus: presenting part bc's engaged
True Labor
The First Stage of Labor m220 r2936
Interview; physical exam; general systems assessment; auscultation of FHR; assess contraction pattern; vaginal exam; lab/diagnostic tests
Assessment
Nursing Assessment on Adm m220 r3106
Rupture of membrane; color (clear or yellowish), character (watery), & amt of fluid; Infection of amniotic fluid (stinks)
AROM or SROM
Nursing Assessment on Adm m220 p445
What to look at when water bags break
TACO - time, amt, color , odor; color: (clear or yellowish, may have white spects; if thick may be meconium, infection); odor (stinks)
Nursing Assessment on Adm m220 p445
Differentiates amniotic fluid, which is slightly alkaline, from urine and purulent material [pus], which are acidic
Nitrazine Test for pH
Nursing Assessment on Adm m220 p445 Box 18-2
Yellow pH 5.0; Olive-yellow pH 5.5; Olive-green pH 6.0
Nitazine test results = acidic (membranes intact)
Nursing Assessment on Adm m220 p445
Blue-green pH 6.5; Blue-gray pH 7.0; Deep blue pH 7.5
Nitazine test results = alkaline (membranes ruptured)
Nursing Assessment on Adm m220 p445
The appearance of a fernlike pattern in a dried specimen of vaginal fluid, an indication of the presence of estrogen signifying water breakage
Test for Ferning or Fern Pattern
Nursing Assessment on Adm m220 p445
General hygiene; fluid intake; elimination; ambulation and positioning
Nursing Care
Physical Nursing Care During labor m221 p457 Table 18-4 r3600
Assess for progress in labor; Supervise showers closely if mom is in true labor; suggest allowing warm water to flow over back
Showers/bed baths, Jacuzzi bath:
Determines appropriateness of activity; Prevents injury from fall, labor may be accelerated; Aids relaxation, ↑comfort
Cleanse frequently, especially after reupture of membranes and when show increases
Perineum
Enhances comfort and reduces risk of infection
Offer toothvrush or mouthwash or wash the teeth with an ice-cold, wet washcloth as needed
Oral hypiene
Refreshes mouth; helps counteract dry, thirsty feeling
Brush, braid per mom's wishes
Hair
Improves morale; increases comfort
Offer washcloths before ad after voiding ad as needed
Handwashing
Maintains cleanliness; prevents infection
Offer cool washcloth
Face
Provides relief from diaphoresis; cools an drefreshes
Change prn; fluff pillows
Gowns/linens
Improves comfort; enhances relaxation
Offer fluids and solid foods, following orders of primary HCP and desires of laboring mom
Oral
Provides hydration and calories; enhances positive emotional experience and maternal control
Establish and maintain IV as ordered
IV
maintains hydration; provides venous access for medications
Encourage voiding at least every 2hr
Elimination voiding
A full bladder may impede descent of presenting part; overdistention may cause bladder atony and injury and postpartum voiding difficulty
Allow ambulation to bathroom as per HCP if presenting part is engaged, membranes aren't ruptured,mom's not medicated
Ambulatory mom
Reinforces normal process of urination; precautionary measure to protect against prolapse of umbilical cord, & protect against injury
Offer bedpan; allow tap water to run; pour warm water over vulva; give positive suggestion; provide privacy; put up side rails on bed; place call bell within reach; offer washcloth for hands; wash vulvar area
Mom on bed rest
Prevents complications of bladder distention and ambulation; encourages voiding; shows mom respect; prevents injury frm fall; prevent infection; maintains cleaness; enhances comfort & asepsis
Indicated if measures to facilitate voiding are ineffective; insert catheter b/t contractions; avoid force if obstacle to insertion is noted
Catheterization
Prevents complications of bladder distention; minimizes discomfort; obstacle may be caused by compression of urethra by presenting part
Help mom ambulate to bathroom or offer bedpan after careful assessment; perform vaginal examination; cleanse perineum immediately after passage of stool
Bowel elimination-sensation of rectal pressure
Prevents misinterpretation of rectal pressure from the presenting part as need to defecate; determines degree of descent of presenting part; ↓risk of infection/embarrassnt
The nurse should be an advocate for the partner as well as the pt; Father participation may be influenced by culture
Supporting the Father
The Father/Partner During Labor m221 p465 Box 18-7
Orient to place; edu of smells; respect °of involvemnt; tell whn helpful; teach comfort measure; tell of mom's needs, progress, behavior & look; Offer blanket, food; acknwldge stress; modify bad stimuli
Supporting the Father
The Father/Partner During Labor m221 p465 Box 18-7
Are often involved in labor and may attend the delivery; nurses may need to offer emotional support
Grandparents/Siblings
Nursing Care During Labor m221 p465
Should be prepared for sights and sounds of labor/delivery; children should have a support person who is not the mom's
Children
Nursing Care During Labor m221 p465
Extends from full cervical dilation through delivery of baby
The Second stage of Labor
The Second and Third
Stages of Labor m223 r4145
Pressure of presenting part on stretch receptors of pelvic floor stimulates release of oxytocin → ↑intense contractions & ↑urgency to bear down
Ferguson's Reflex
The Second and Third
Stages of Labor m223
Burning sensation as vagina stretches and fetal head crowns
Ring of Fire
The Second and Third
Stages of Labor m223 r4252
Sudden appearance of sweat on the upper lip; V; ↑bloody show; shaking of extremities; ↑restlessness; involuntary bearing down
Assessment
Second Stage of Labor; Sx of approaching the pushing stage m224 r4325
Contractions & FHR should be monitored continuously if EFM is used; mild, brief decels and bradycardia may occur; Monitor for ↑bleeding, change in color/ordor of fluid, bladder, VS & energy level
Assessment
Second Stage of Labor m224
Abnormal, report to HCP: >2hrs in 1st preg or 1 1/2hrs in subsequent preg; give 20min breaks q1hrs; may be prolonged by epidural
Duration of Second Stage
Second Stage of Labor m224 r4730
Considerations: Mom's position (squatting best); bearing down efforts; support of coach; xfer to delivery rm if u hv to move bf baby crowns
Second stage pre-birth considerations
The Second Stage of Labor m225
Episiotmy:midline/mediolateral L or R; Lacerations: perineal 1st-4th (1st through skin, 2nd mus involvement, 3rd approaching or at rectum, 4th through rectal wall) cervical injury; vaginal, peri-urethral
Interruption in Skin Integrity r/t Childbirth
Interruption in Skin Integrity r/t Childbirth m255 r5039
Invdividal by hospital; Another option is for sibling to be in waiting room with someone he/she trusts and come in soon after the birth to blend family
Sibling Presence During 2nd Stage
m226
Birth of baby through delivery of placenta; 5-7 min after birth; may be shorter or longer
3rd stage
Third Stage of Labor m226 r5406
Firmly contracted fundus; Uterus: discoid (disk-like) → ovoid (egg shaped); gush of dark blood; lengthening of umbilical cord; vaginal fullness
Sx of placental separation
Signs of Placental Separation m226
Changes of LOC eg, lethargy, synope; changes in VS; ↓CO; ↑bleeding; boggy uterus; missing placental fragments
Sx of placental problems
Signs of Placental Separation m227 r5550
Skin to skin contact - helps bonding & regulate body temp; or wrap baby in blanket & cap for holding; breastfeed ASAP - helps w bonding & uterus contraction
Family relationships after birth
Family Relationships m227
Most common cause of severe injury and death in sch age child; Pedestrian; Passenger
MVA
Health Problems of School-Age children and Adolescents; Accidents m272 Ch39,40
Restraints; door locks; seating locations (back)
Safety measures
Health Problems of School-Age children and Adolescents; Accidents m272 Ch39,40
Improper driving instruction; poor judgment; alcohol and drug use; poor use of seat belts
MVA
Health Problems of School-Age children and Adolescents; Accidents m272 Ch39,40
Firearms (leading cause of death in adolescents); skateboard; roller-skates; roller-blades
Types of accidents
Health Problems of School-Age children and Adolescents m273 ch39,40
Most effective prevention of accidents
Edu of child and parent
Health Problems of School-Age children and Adolescents m273 ch39,40
Match to child's abilities & physical/emotional constitution; teach appropriate technique; proper equipment; suitable environment
Sports
Health Problems of School-Age children and Adolescents m273 ch39,40
Female 46XX; Male 46XY
Normal
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation m273 r555 ch39,40
Webbed neck; low posterior hairline; widely spaced nipples; edema hands/feet; short stature; sexual infantilism (under dev); amenorrhea; infertility; dx during puberty
Turner's syndrome; Female XO (absence of one of the X chromosome eg, 45X); 1 in 2500 or 1 in 800
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation m274 r611 ch39,40
Negative sex chromatin test
Turner's syndrome Diagnosis
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Turner's syndrome m274 r820 ch39,40
Psychologic counseling; growth hormone (helps linear growth); estrogen therapy (promote dev of secondary sex characteristics)
Turner's syndrome TX
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Turner's syndrome m274 r828 ch39,40
Prone to cardiovascular, kidney, thyriod, skeletal problems eg, scoliosis, hip dislocation
Females with Turner's syndrome
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Turner's syndrome Audio lec r938 ch39,40
Sterility; sml testes; gynecomastia; tall c long legs; learning disabilities; behavioral prob; gross motor skill difficulty
Klinefelter's syndrome clinical manifestations; Male XXY (one or more additional X chromosomes) 1 in 500 live male births
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Klinefelter's syndrome m274 r1015
Tx: Male hormones eg, testosterone to enchance masculine charastics; Cosmetic surgery to correct gynecomastia
Klinefelter's syndrome
Health Problems of School-Age children/Adolescents; Altered Growth, Maturation; Klinefelter's syndrome m275 r1122
Unilateral or bilateral ↑breast in males, usually subsides spontaneously; may be assoc w Klinefelter's Syndrome or endocrine dysfunction; cosmetic surgery if extensive; testosterone may aggravate
Gynecomastia
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation m275 r1152
Early sexual dev (<10 yrs in M, <8 1/2 yrs in F); Cause: disorder of gonad, adrenal gland, or hypothalmic-pituitary-gonadal axis; 9x's more common in F
Precocious Puberty
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation m275 r1303
↑of linear growth; early epiphyseal fusion eg, ↓height
Precocious Puberty
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation m276 r1508
Tx cause, if central origin adm LHRH-Lupron(regulate pituitary secretions); discontinued when chronologically appropriate
Precocious Puberty Mgmt
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation m276
Availability of ↑kcal foods; sedentary lifestyle; underlying disease (hyperthyroidism, adrenal-hypercorticoidism, and hyper-insulinsim)
Obesity contributing factors; usually night eaters; eat more rapidly; frequently skip meals usually breakfast
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m276 r1706
Child looks too fat; skinfold measurements; height/wt. comparison to growth chart; hx: eating habits; appetite; physical activity;Psychosocial impact on child
Obesity dx
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m276 r1907
Motivation is key; diet planning that restrict kcals, nutritionally sound; exercise regularly, support and encouragement; behavioral therapy
Obesity tx
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m277 r1942
Severe ↓wt in absence of physical cause; predominant in adolescent and young adult females
Anorexia Nervosa
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m277 r2041
Peaks at 13, 17, & 20yrs; mid→upper socioeconomic group; high achiever; confirm to society, ↑dependent on parents
Anorexia Nervosa
Health Problems of School-Age children/Adolescents; Altered Growth &amp; Maturation; Eating disorders m277 r2041
Severe ↓wt; amenorrhea; bradycardia; ↓T, BP; cold intolerence; dry skin and brittle nails; appearance of lanugo
Clinical manifestations of anorexia nervosa
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m277 r2214
Refusal to maintain body wt.; intense fear of wt. gain or becoming fat; disturbance of self perception; absence ≥ 3 consecutive menstrual cycles
Dx of anorexia nervosa
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m278 r2241
Malnutrition: IV, tube feedings; Operant conditioning: positive reinforcement for wt. gain eg, behavior modification
Tx of anorexia nervosa
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m278 r2308
UTI; VS instability; bradycardia; hypothermia → cardiac arrest
SE of anorexia nervosa
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; Eating disorders m278 r2344
Use of drugs or alcohol, for other than medical purposes, causing physical or psychological harm
Drugs and Alcohol Abuse
Health Problems of School-Age children/Adolescents; Altered Growth & Maturation; m278 r2424
Socially accepted depressant; responsible for acts of violence, suicide, accidental injury, and death; inexpensive; ↑use by elmnt sch age child
Alcohol Abuse
Health Problems of School-Age children/Adolescents; Serious Health Problems m279 r2512
CNS: incoordination; emotional lability; ↓judgment, memory,perception & learning
Effects of Alcohol Abuse
Health Problems of School-Age children/Adolescents; Serious Health Problems m279 r2608
↑more rapidly than any other substance bc available, affordable, false perception of safe use; Creates sense of euphoria; Snob appeal; Reputation of sexually enhancing
Cocaine Abuse
Health Problems of School-Age children/Adolescents; Serious Health Problems m279 r2640
Depression; lack of energy and motivation; irritability; appetite changes; psychomotor retardation; irregular sleep patterns; CV manifestations; seizures
Cocaine withdrawal symptoms
Health Problems of School-Age children/Adolescents; Serious Health Problems; Cocaine Abuse m280 r2804
Familiarity w s/s; behavioral characteristics; assessment of HTN; include family; prevention, edu, legislation
Cocaine abuse nursing responsibilities
Health Problems of School-Age children/Adolescents; Serious Health Problems m280 r2823
3rd leading cause of death in adolescents d/t turmoil; ↑emotions; mood variation; limited problem solving capacity; perception of control
Suicide
Health Problems of School-Age children/Adolescents; Serious Health Problems m280 r3008
Family disturbances; alcoholism; hx of suicide in family; depression; chemical dependency; psychosis
Suicide factors
Health Problems of School-Age children/Adolescents; Serious Health Problems m281 r3117
Take threats seriously; gather info; convey attitude of caring eg, listen; Local support groups eg, The Anchor, Wichita Cancer League
Suicide therapeutic mgmt
Health Problems of School-Age children/Adolescents; Serious Health Problems m281 r3205
Focus is on the child and family; families of children w exceptional problems
Long-Term Health Problems
Chronic Illness, Disability, or End-of-Life care for the Child and Family m283 r3357
Condition or barrier imposed by society, environment or self; not a synonym for disability
Handicap
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Common terms m283 r3428
condition interfering w daily function for > 3 mo/yr; causes haositalization more than 1 mo/yr
Chronic illness
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Common terms m283 r3428
Any illness, of long or short duration, w a life threatening outcome
Terminal illness
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Common terms m283 r3428
View child in r/t handicap, not by perception of handicap; Healthy nurturing attitudes not sterotypical; sensitive to parents reactions, help them to express their emotions; accept feelings as normal
Role of the nurse
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems m283 r3541
When diagnosis of disability or chronic illness is made, family progresses through fairly predictable sequence of stages; families will mourn loss of perfect child in order to fully accept child
Reaction of families to a chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems m284 r3624
Initial stage; intense emotion; denial occurs as defense mech in order to allow family to adjust; disintegration may occur if defect is significant
Shock & Denial
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m284 r3647
Shopping for HCP's; refusing to believe the dx or test results; delay tx; may be optimistic dispite dx
Examples of shock and denial of chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability; audio lec m284
After initial shock and denial; able to admit handicap or disability exists; can be partial acceptance; manifested by guilt and anger; need to find rationale occurs; self-accusation; parents feel failure
Adjustment to chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m284 r3804
Benevolent overraction and/or overprotection of child; rejection-emotional neglect w physical care; denial-parents ignore disorder; gradual acceptance-realistic goals and abilities
Four types of parental reactions to chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m285 r3857
Realistic expectations of child and integration of family life w illness or disability in proper perspective
Reintegration & acknowledgement of chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m285 r4042
May be necessary if unable to integrate family life to include execptional problem
Out-of-home placement
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability; Audio lec m285
Parents mourn loss of perfect child; reactions depend on severity; denial stage→unable to visit child, or show emotional attachment; parenting may be frustrating;unresolved feelings, anger expressed to spouse
Impact of child's chronic illness or disability on family members
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m285 r4129
Frequently having a child with a disability leads to __ if coping is innapropreiate
Divorce
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability; Audio lec m285
Negative effect whn compared w/sibiling of healthy children; no ↑risk for severe psychiatric prob; many diff result of nature of sibiling relationship
Siblings reaction to chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m286 r4245
Contradictory feelings; feel left out, sad whn disabled sibling cannot participate in activity or event; embarrassed having disabled sibling; worry bout own health & health of sibling
Siblings reaction to chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m286 r4245
Pro's can help fam cope w stress-provide anticipatory guidance; emotional support; assist fam to ID stressors; Aid fam dev copng mech,prob solv & concurrent stressors; wrk w parents; referrals, support sys
NI for one w a chronic illness or disability
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m286
Can have marked dependency on other; may use illness to control other in family
Child with exceptional problems
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m286
Support sys; emotional & edu resources; realistic expectation; competing demands for family members' time and energy
Factors affecting family's adjustment
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Long-Term Health Problems; Reaction of families to a chronic illness or disability m286
Children w life-threatening conditions must face possibility of death. Impact greatly influenced by dev age & child's experience w the dx
Meaning of death in childhood
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287 r4635
Child's reactions are affected by those around him/her. Final experience of living depends on how parents & significant others come to terms w child's forthcoming death
Meaning of death in childhood
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287
Influenced by ideas about the meaning of life and death; socialization into particular cultural patterns of bereavement; amt of direct exposure
Child's concept of death
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287 r4712
Does not distinguish b/t death and absence or separation or sleep; once parent-child attachment and dev of trust well estabilshed, loss, even temp, elicits profound resistance
Meaning of death in childhood < 3 yrs
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287
Usually hv heard of; may hv some idea of meaning; seen as temp; happens to others; separations remains big factor; greatest fear is separation from parents
Meaning of death in childhood ages 3-5
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
Deeper understanding in concrete; moves closer to death as personal; caused by external; prone to associate injury and mutilation w death; unable to differentiate b/t in the mind & the wish of a deed
Meaning of death in childhood ages 6-12
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
More likely to see as final; more of an adult concept
Meaning of death in childhood ages 9 & 10
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
Understand the universality and pemanency; hv mature understanding; may feel guilt and/or responsibility for death
Meaning of death to adolescents
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
Denial, anger, and guilt; shock & disbelief; guilt and look for answers; bargaining; seeks hope & answers
Reactions of parents to death in childhood
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m289 r5228
Reorganization of relations w others; anticipatory grieving; live w ambiguities of uncertain future; want return to normal life; often feel guilty about their feelings bc they want a normal life; needs lots of support
Coping resolution to death in childhood
Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m289
↓20% from preblock level or <100 mm Hg systolic; fetal bradycardia; ↓beat-to-beat fetal HR variability
s/s of maternal hypotension with ↓placental perfusion
Emergency Box p411
Turn mom lateral position or place pillow or wedge under hip to deflect uterus; maintain IV, or ↑prn; adm O2 by face mask 10-12 L/min; ↑legs; notify HCP; adm IV vasopressor; remain with mom; continue to monitor moms BP,FHR q5 min
NI for maternal hypothnsion with ↓placental perfusion
Emergency Box p411
CO __ 10-15% 1st stage & 30-50% 2nd stage
Maternal Physiologic Chages During Labor Box 15-2 p391
HR __ slightly 1st & 2nd stages
Maternal Physiologic Chages During Labor Box 15-2 p391
SBP __ during uterine contractions in 1st stage; SBP & DBP __ during uterine contractions in 2nd stage
Maternal Physiologic Chages During Labor Box 15-2 p391
WBC count __ during labor.
Maternal Physiologic Chages During Labor Box 15-2 p391
T may be slightly __ during labor.
Maternal Physiologic Chages During Labor Box 15-2 p391
Proteinuria (__) may occur during labor.
+1
Maternal Physiologic Chages During Labor Box 15-2 p391
TENS most useful for __ during early 1st stage of labor. Cold/heat applications, on all-fours, applying sacral pressure to mom's back with fist, (effleurage) & water therapy
lower back pain
Be very careful to be watching baby/mom for signs of infections__. How are we going to recognize infection?
(HR, fever); Maternal temperature and vaginal discharge are assessed frequently (1-2hrs).
With ocytocin (Petocin) adm., how close do we want contractions?
>5 uterine contractions per 10min avg over 30min or < 2min apart and are >50-65mm Hg or last ≥60-90→↓blood flow through placenta →FHR (bradycardia, tachycardia, ↓ or absent baseline variability, late decel
p508
Uterine tachysysole; abnormal FHR and pattern; suspected uterine rupture; inadequate uterine response at 20 mU/min
With ocytocin (Petocin) adm., what tells us there’s a problem?
p509 Box 19-11
Labor that begins before completion of 37 weeks from the last menstrual period.
Preterm Labor
Taber's Medical Dictionary
Delivery occurring between 20 and 38 weeks' gestation.
Preterm Birth
Taber's Medical Dictionary
Abnormally ↓wt of a newborn, usually < 2500 g. or 5.5 lbs, regardless of gestational age.
LBW
Taber's Medical Dictionary
Hazards of lead-based paint in older housing; ways to control lead hazards safely; hazards accompanying repainting and renovation of hm's built <1978
Poison Teaching
p1435
Interaction of parental (abuse, lack of supportive relationship, ↓self-esteem & maternal function); child (difficult temperament, unwanted pregnancy, disabilities) and environmental (stressful) characteristics
What situations make kids more prone to child abuse, what do you see with family or child?
Can be physical (violates norms, is deliberate, warrants intervention), emotional (to destroy self-esteem) or sexual (related to victim’s age, act, age of perpetrator, intent).
Child abuse
Caretaker harms child for attention.
Munchausen Syndrome by Proxy
Child has hx of coming into ER clumsy; Child with head injury
Possible red flags of child abuse
Female gender (XO) 45 in female missing X chromosom; webbed neck, ↓posterior headline, widely spaced nipples, edema of hands/feet, short stature, infertility, sexual infantilism, amenorrhea
Turner syndrome
MVA is #1 (pedestrian or passenger), then bikes/skateboards/skates, sports equipment.
School-age kids
Firearms, MVAs, (risk for homicide/suicide)
Adolescents
Stay w fam; sit quietly if they prefer not to talk; cry w them if desired; Accept the fam grief reactions; avoid judg statements eg, you should be feeling better by now
General; Know NI for family going thru grief of death and anticipatory grief of kid going to die.
p1173 Box (Guidelines)
Avoid offering rationalizations for the child's death eg, your child isn't suffering anymore; avoid artificial consolation eg, I know how you feel, you are still young enough to hv another baby
General; Know NI for family going thru grief of death and anticipatory grief of kid going to die.
p1173 Box (Guidelines)
Deal openly w feeling such as guilt, anger, and loss of self-esteem; Focus on feeling by using a feeling word in the statement eg, you're still feeling all the pain of losing a child; Refer fam to self-help group or prof if needed
General; Know NI for family going thru grief of death and anticipatory grief of kid going to die.
p1173 Box (Guidelines)
Reassure fam tht evrythng possible is being done for the child, if they want lifesaving interventions; Do evrythng possible to ensure the child's comfort, especially relieving pain
At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
p1173 Box (Guidelines)
Provide the child/fam w the opportunity to review special experiences or memories in their lives; Provide info tht the fam requests and be honest
At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
p1173 Box (Guidelines)
Express personal feelings of loss or frustrations eg, we will miss him so much, we tried everything, we feel so sorry that we couldn't save her
At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
p1173 Box (Guidelines)
Respect emotional needs of fam eg, siblings, who may need brief respites frm dying child; Provide practical help whn possible eg, collecting the child's belongings
At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
p1173 Box (Guidelines)
Make evry effort to arrange for fam mem, esp parents, to be w the child at the moment of death, if they want to be present
At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
p1173 Box (Guidelines)
Allow the fam to stay w the dead child for as long as they wish and to rock, hold, or bathe the child;
At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
p1173 Box (Guidelines)
Arrange for spiritual support, based on the fam religious beliefs; pray w the fam if no one else can stay w them
At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
p1173 Box (Guidelines)
Attend the funeral or visitation if there was a special closeness w the fam; Initiate and maintain contact eg, sending cards, ph, inviting them bck to the unit, make hm visit
After Death; Know interventions for family going thru grief of death
p1173 Box (Guidelines)
Refer to the dead child by name; discuss shared memories w the fam; discourage the use of drugs or alcohol as a method of escaping grief
After Death; Know interventions for family going thru grief of death
p1173 Box (Guidelines)
Encourage all fam mem to communicate their feelings rather than remaining silent to avoid upsetting another mem
After Death; Know interventions for family going thru grief of death
p1173 Box (Guidelines)
Emphasize tht grieving is a painful process that often takes years to resolve
After Death; Know interventions for family going thru grief of death
p1173 Box (Guidelines)
50-55 to approx 70; slow dev, mental age 8-12, basic math/reading w/special edu, may marry, skilled labor, ↓stress, not good w childrearing
mild retardation
35-40 to 50-55; speech difficulty, incapable of self-maintenance, in group home
moderate retardation
20-25 to 35-40; significant delays in motor dev, little/no communication skills, simple tasks only, mentally a toddler
severe retardation
< 20-25; total nursing care needed, basic emotional, physical responses, infant mental age.
profound retardation
Toys are selected for recreational and educational value. Should be simple in design. __ is the major consideration.
Safety
Term used for the stages a grieving parent(s) of a dying child goes through
DABDA - denial, anger, bargaining, depression, acceptance
Inform parents: assurance, edu, support; Prevent physical prob: exercise r/t hypertonicity & mobility of joints – use caution; Nutrition – difficult to eat d/t protruding tongue; Promote dev progress: sch, exercise, socialize
Down’s syndrome nursing responsibilities
Cardiac is the most common, with respiratory infections prevalent and sensory problems
Down’s Syndrome and associated anomalies
__ middle ear hearing loss. __ perceptive or nerve deafness, distortion of sound and discrimination problems. __ both of the aforementioned.
Conductive; Sensorineural; Mixed;
Hearing loss, know the different types
__ (all not linked to conductive or sensorineural structures) can be organic (aphasia, agnosia, dysacusis-not measurable in decibels, but in discrimination of speech) or functional (childhood schizophrenia).
Central auditory imperceptions; aphasia-can't communicate through speech, writing, or signs; agnosia-can't interpret sounds or images
Hearing loss, know the different types
Severe burning, white swollen mucous membranes, mouth edema, vomiting, drooling, inability to clear secretions, signs of shock, anxiety, confusion.
Corrosive poisoning Sx
No vomiting, dilute with h2o only, watch airway, give analgesics, no PO intake, possible dilation/surgery of esophageal strictures.
Corrosives poisoning Tx
Abd cramps, V, constipation, anorexia, fever, H/A, renal (abnormal excretion), blood (anemia); CNS lethargy, clumsiness, ↓motor skills < 6yo, serious/irreversible). ↓(hear, learn, attention, concentrate; ↑(encephalopathy, convulsions, MR, paralysis, blindness, coma, death).
Lead poisoning Sx (w main prob as CNS, renal, & hematologic)
Remove source, ^ nutrition, chelation therapy like EDTA (watch I&O carefully), BAL (assess allergies to peanuts) or Succimer (peanut allergy). Tx Sx during chelation like seizures, hepatic/renal function, I&O, enemas, serum electrolytes, infections, hydration, N/V. Slowly cleared by kidneys, GI tract, sweat, retained in bone, attaches to RBCs, continued effects after poison gone.
Lead poisoning Tx; Chelation therapy - bind heavy metals in the body in order to treat heavy metal toxicity
Sx 1st resp (hyperpnea) → resp alkalosis, confusion, coma, death. ^ T, metabolism, o2 consumption; convulsions, metabolic acidosis; tinnitus, petechiae; (ketones d/t interference w carb/fat metabolism→anorexia, V, sweating). Tx bleeding w Vit K.
ASA poisoning Sx
Induce V, lavage, charcoal (all 3). 24 hr observation, & tx sx ^ calories, externally cool for fever, dialysis in severe cases, alkalosis/acidosis, crisis intervention
ASA poisoning Tx