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318 Cards in this Set
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Discomfort from cervical changes and uterine ischemia; Visceral pain felt over lower abdomen
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1st stage of labor. Usually pain free between contractions Table 18-2 p450
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MGMT OF DISCOMFORT; Neurologic origins m247
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A stage of labor; perineal (somatic) pain; pressure of presenting part; pain may be local or referred
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2nd stage of labor
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Mgmt of Discomfort; Neurologic Origins m247
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↑ BP, RR, HR, hyperventilation, diaphoresis, N/V, ↓placental perfusion, uterine activity
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Physiologic or affective changes of pain
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Mgmt of Discomfort; Expression of Pain m248
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May be affected by culture
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Perception of Pain
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Mgmt of Discomfort; Physiologic or affective changes m248; p396
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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
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Cultural reactions to pain
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Mgmt of Discomfort; Expressions of Pain m248
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Previous experience; culture; anxiety; preparation; comfort; support system; environment; magnified by fatigue/lack of sleep
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Things perception of pain is affected by
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Mgmt of Discomfort; Perception of Pain m248
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Physical exercises to prepare for labor, conscious relaxation, and breathing patterns
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Dick-Read Method
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Mgmt of Discomfort m248
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Deep abd breathing (most of labor); shallow breathing (end of 1st stage); breath holding in 2nd stage
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Dick-Read breathing patterns
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Mgmt of Discomfort m248
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Conditioned response; use of coping strategies during UC's; must pratice; chest breathing most common
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Lamaze Method
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Mgmt of Discomfort m249
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In harmony w body; abd breathing; quiet, dark atmosphere; deep mental relaxation; may appear asleep
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Bradley Method
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Mgmt of Discomfort m249
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Counterpressure; effleurage (light massage); therapeutic touch and massage; walking; rocking; changing positions
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Cutaneous stimulation strategies
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Nonpharmacologic Strategies to Encourage relaxation and Relieve Pain m249;p399; box 16-2
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Heat or cold; transcutaeous electrical nerve stimulation; acupressure; water therapy (hydrotherapy); intradermal water block
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Cutaneous stimulation
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Nonpharmacologic Strategies to Encourage relaxation and Relieve Pain m249 p399; box 16-2
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Aromatherapy; breathing techniques; music; imagery; use of focal points
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Sensory stimulation
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Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain m249;p399; box 16-2
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Childbirth edu; hypnosis; biofeedback
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Cognitive Strategies
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Nonpharmacologic Strategies to Encourage relaxation and Relieve Pain m249;p399; box 16-2
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A massage technique that employs gentle hand movements along mom's abds.
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Effleurage (light massage); Cutaneous Stimulation Strategies
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Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain p399 box 16-2
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TENS unit
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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
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Nonpharmacologic Strategies to encourage relaxation and relieve pain m249
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Relieve anxiety, induce sleep; May cause resp, vasomotor depression in mom & newborn; use w caution; therapeutic rest
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Barbiturates
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Pro-dromal/Early Labor Use of Sedatives m250
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For moderate to severe labor pain; postop pain aftr csection. Epidural or lintrathecal (within spinal canal) analgesics, alone or comb w a local anesthetic
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Demerol; Fentanyl
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Systemic Analgesia; Narcotic compounds IM or IV;Takes the edge off of pain so mom can relax and sleep m250; p407-409
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Indicated for labor pain; postoperative pain after cesarean birth; Systemic Analgesics; Mixed narcotic agonist-antagonist compunds IM or IV
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Nubain; Stadol
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m250; p407-409
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Analgesic potentiators
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Pheergan; Vistaril
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Systemic Analgesia m250; p406
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Narcotic antagonists
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Narcan
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Systemic Analgesia m250; p409
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Once mom reaches 7-8 cm she will no longer be able to get __ bc it crosses the placenta and affects baby → resp depression
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Narcotics
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Audio lec
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Give port nearest pt; giv in sml divided doses at beginning of 3-5 contractions
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IV (preferred)
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Adm of Med in Labor m250
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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
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IM route
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Adm of Med in Labor m250
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Simple, safe, high success rate, does not depress fetus
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Advantages of local infiltration pudendal block
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Nerve Block Analgesia and Anesthesia m251
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Does not relieve pain w UC's, only discomfort from perineal distention & for episiotomies [əˌpiːzɪˈɒtəmɪ]; Bearing down reflex may be lessened or lost
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Disadvantages of local infiltration pudendal block
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Nerve Block Anesthesia m251
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Inj into spinal fluid; effects in 1-2 mins, lasts 1-3 hrs; used for c-section;
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Spinal/saddle block
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Regional blocks m251
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Need adequate pre-hydration LR 500-1000cc within 20 min bf this procedure to prevent hypotension
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Spinal/saddle block
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Regional blocks m251
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SE spinal HA (teach mom to report); hypo-tension; ↓CO (mom & baby); resp paralysis Tx: meds; laying flat; blood patch; caffein: coke, coffee
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Spinal/saddle block
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Regional blocks m251
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Inj into epidural space; local inj given first then test dose; then catheter connected to pump until baby's birth; may have PCA bolus
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Epidural analgesia/anesthesia
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Regional blocks m252
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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
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Regional blocks
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Epidural analgesia, anesthesiam m252 r3000
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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
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Epidural nursing care (once the epidural is in)
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Regional Blocks m253 r2700
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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
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Pudendal block
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Pudedal: The human external genital organs, especially of a woman.
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Surgical incision of the perineum during childbirth to facilitate delivery
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Episiotomy
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Procedure with regards to Nerve Block Anesthesia m251
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A type of spinal anaesthesia producing sensory loss in the buttocks, inner sides of the thighs, and perineum
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Saddle Block
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Regional Blocks m251
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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.
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Spinal Block
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Nerve Block Anesthesia m251
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If the spinal block reaches too high __ may stop
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Breathing
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Audio Lec
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__ can only be used for c-section
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Spinal Block
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Audio Lec
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__ cause temp loss of sensation to affected nerves. Need adequate pre-hydration to prevent hypotension. Bolus with IV LR 500-1000cc
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Spinal/saddle block
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Regional anesthesia; Audio Lec
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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
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Epidural Pt teaching
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Audio lec
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Mom is awake and can participate in the c-section.
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Advantage of epidural
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Audio Lec r3016
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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
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Wet tap
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Epidural complications
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Remain w pt; Side lying or sitting up; Frequent VS and O2 sat, Monitor for bladder distension
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Epidural nursing care
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Regional Blocks m253 r3326
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Blocks the pain transmission of the pain receptors in the spine without affecting motor ability
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Intraspinal/epidural narcotics (Fentanyl) for labor/postop pain, also known as a walking epidural
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Regional Blocks m253 r3350
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N/V, itching, urinary retention, respiratory depression
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SE of Intraspinal/epidural narcotics
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Regional Blocks m253 r3510
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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
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Contraindication of intraspial/epidural narcotics
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Regional Blocks m253 r3535
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Another term for laughing gas. With this form of ansethesia the pt can medicate themselves.
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Nitrous oxide
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Inhalation anesthesia during pregnancy m253 r3750
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Indicated in stat situations when a c-section is required, but it may be used where regional anesthesia is contraindicated, unavailable, or not working
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General anesthesia
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Types of Anesthesia m253 r3828
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Indicated during general anesthesia to ↓acidity of mom's gastric contents
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Sodium citrate
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General Anesthesia m253 r3828
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Cricoid pressure may be indicated during __ to help get the tube in
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General anesthesia
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NI after general anesthesia r3900
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Meds may cross the placeta so make sure NSY is ready for a __ baby
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sleepy
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NI after general anesthesia r4000
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↑risk for reflux, aspriation, and aortial cable compression → ↓blood supply to the uterus; stressed resp function
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Obese women
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Types of anesthesia m253 r4020
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Interview includes last meal; resp conditions; Hx of scoliosis; substance abuse; check labs for anemia, coagulopathy; infection
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Nursing care for obese women; Coagulopathy - a defect in blood-clotting mechanisms
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Types of anesthesia m253 r4020
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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
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scoliosis
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Typed of anesthesia m253 r4114
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__ is used for pre-term labor
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Brethine
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Study Guide for labor & Birth at Risk ch19 m239
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↑HR (mom & baby); shaking; SOB; ↓O2; palpitations; N/V; hot flashes; hyperglycemia
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SE of Brethine
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Study Guide for labor & Birth at Risk ch19 m239
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What is the therapeutic level for MagSO4 therapy?
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4-8 mEq/l
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Study Guide for labor & Birth at Risk ch19 m240 r4500
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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.
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SE of MagSO4
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Study Guide for labor & Birth at Risk ch19 m240 r4623
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Used to ↑duration of labor; CNS depressant; relaxes smooth muscles, including uterus; Monitor for resp depression, I & O
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Indicated when adm MagSO4
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Study Guide for labor; Birth at Risk ch19; MEDICATION GUIDE Box p495
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When using MagSO4 you must have this at the bedside?
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Calcium gluconate
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Study Guide for labor & Birth at Risk ch19 Audio lec r4730
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Why is the glucocorticoid Betamethasone given to some women in preterm labor?
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Speed maturation of the fetal lungs
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Study Guide for labor & Birth at Risk ch19 m241 r4742
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Two shots IM. Adm 2nd shot 12-14hr after the first to speed maturation fetal lungs
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Betamethasone adm
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Study Guide for labor & Birth at Risk ch19 m241
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What is dystocia?
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Anything that ↓effectiveness of labor eg, fetal position, weak contractions, shap of mom's pelvis
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Study Guide for labor & Birth at Risk ch19 m241 r4859
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The process of causing or producing labor with oxytocic (agent that stimulates uterine contractions) drugs in cases of uterine dysfunction.
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Induction
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Study Guide for labor; Birth at Risk ch19
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Use of pharmacological or surgical interventions to help the progression of a previously dysfunctional labor.
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Augmentation
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Study Guide for labor & Birth at Risk ch19
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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
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NI for uterine hyperstimulation
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Study Guide for labor & birth; Birth at Risk ch19 m242 Emergency Box p510 r5033
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What station is the fetal head when outlet forceps are used?
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+3
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Study Guide for labor & Birth at Risk ch19 m243 r5141
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Bruising; scratches/scrapes; nerve compression and/or bleeding in the brain w use of excessive force; skull fracture, cephalohematoma
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Forcep use potetial for newborn injuries
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Study Guide for labor & Birth at Risk ch19 m243
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What are the risks to the newborn of vacuum extraction?
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Bruise atop of head; bleeding in the brain
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Study Guide for labor & Birth at Risk ch19 m243
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When is the fetus considered to be postdate (postterm)?
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42 wks
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Study Guide for labor & Birth at Risk ch19 m244
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What are fetal/neonatal risks?
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Meconium aspiration; calsifaction in the placenta, hypoglycemia, malnurishment
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Study Guide for labor & Birth at Risk ch19 m244 r5505
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Wht is a shoulder dystocia?
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Baby's shoulder gets stuck on mom's pubic bone
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Study Guide for labor & Birth at Risk ch19 m244 r5540
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What two maneuvers are most frequently described to free the anterior shoulder when shoulder dystocia occurs?
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McRoberts maneuver; Super pubic pressure
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Study Guide for labor & Birth at Risk ch19 m244 r5603
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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
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McRoberts maneuver
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Study Guide for labor & Birth at Risk ch19 m244
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Push against side of pubic bone
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Super pubic pressure
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Study Guide for labor & Birth at Risk ch19 m244
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What are the signs of a prolapsed cord?
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Umbilical cord falls out in front of the presenting part
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Study Guide for labor & Birth at Risk ch19 m244
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Wht immediate actions should be taken whn the umbilical cord prolapses?
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Push baby back into the vigina
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Study Guide for labor & Birth at Risk ch19 m244 r5808
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Trouble breathing; ↑HR; death; chest pain
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Sx of amniotic fluid embolism (AFE)?
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Study Guide for labor & Birth at Risk ch19 m245 m10040
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A collection of blood under the scalp of a newborn; caused by pressure during birth
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Cephalohematoma
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Medical dictionary
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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.
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Block
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Tabor's Med Dict
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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
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Nubain; Stadol
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m250; p407-409
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Adjunct to anesthesia and analgesia; doesn’t relieve pain but ↓anxiety & apprehension, ^ sedation, can be used to ↓n/v that often accompany opioid use
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Phenergan
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Davis Drug Guide
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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
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Vistaril
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Davis's Drug Guide
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Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression.
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Demerol; At 7-8 cm can no longer receive bc can cause resp depression to baby (has longer half life stays longer in sys)
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Systemic Analgesia; Narcotic compounds IM or IV;Takes the edge off of pain so mom can relax and sleep m250; p407-409
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Opioid analgesic that binds to opiate receptors in the CNS, altering the response to and the perception of pain; watch for resp depression
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Demerol; At 7-8 cm can no longer receive bc can cause resp depression to baby (has longer half life stays longer in sys)
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Systemic Analgesia; Narcotic compounds IM or IV;Takes the edge off of pain so mom can relax and sleep m250; p407-409
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Passageway (birth canal); passenger; powers; position of mother; psychologic response
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Five essential factors that include the processes of labor (5 P's)
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Essential Factors and Processes of Labor ch15
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Above pelvic brim; has nothing to do with childbearing
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False Pelvis
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Essential Factors and Processes of Labor; Bony Pelvis ch15
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3 planes: brim/inlet (upper boarder); midpelvis (pelvic cavity); outlet (lowest border)
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True Pelvis
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Essential Factors and Processes of Labor; Bony Pelvis ch15 p383
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Classic female pelvis; 50% of women have; round; spontaneous vaginal delivery in the OA position
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Gynecoid
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Essential Factors and Processes of Labor; Types of pelvis'; Bony Pelvis ch15 r25220
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Similar to male pelvis; heart shaped; deliver by c-section or difficult forceps delivery
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Android
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Essential Factors and Processes of Labor; Types of pelvis' ch15 r25303
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Oval shaped; delivery vaginally w or w/o forceps; baby is usually in an OP or OA position
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Anthropoid
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Essential Factors and Processes of Labor; Types of pelvis' ch15
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Flat; spontanious vaginal delivery
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Platypelloid
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Essential Factors and Processes of Labor; Types of pelvis' ch15 r25404
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↓uterine segment; pelvic floor mus; vigina; Cervix: dilation, effacement; introitus; Bandl's ring: patho ring; pelvic floor
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Soft Tissues
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Essential Factors and Processes of Labor; Passageway ch15 r25427
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Separates the upper and lower uterine segments
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Psysiological retraction ring
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Essential Factors and Processes of Labor; Soft Tissues ch15 r25441
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Thickening and indentation at the junction of the upper and lower uterine segments; can obstruct fetus delivery
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Bandl's ring
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Essential Factors and Processes of Labor; Soft Tissues ch15 r25503
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Mus layer helps fetus rotate anteriorly
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Pelvic floor
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Essential Factors and Processes of Labor; Passageway; Soft Tissues m211 r25545
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2 parietal bones; 2 temporal bones; 1 frontal bone; 1 occipital bone (our reference point); suture lines; Fontanels: anterior, posterior; molding
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Fetal Head
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Essential Factors and Processes of Labor; Passenger; m211 r25626
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Membrane filled spaces where the sutures meet
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Fontanels
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Essential Factors and Processes of Labor; Passenger; m211 r25626
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Diamond shaped; Should be facing mom's bottom for easiest delivery
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Anterior Fontanel
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Essential Factors and Processes of Labor; Passenger; m211 r25626
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Triangular shaped
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Posterior Fontanel
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Essential Factors and Processes of Labor; Passenger; m211 r25626
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Part of fetus entering pelvic inlet first: caphalic most common at __%, breech (bottom first) __%, shoulder __%
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Presentation 96; 3; 1
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Essential Factors and Processes of Labor; Passenger; m212 r25840
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Caphalic, vertex, crown, brow, occiput, synciput
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Head first
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Essential Factors and Processes of Labor; Passenger; Presentation m212 r25840
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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
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Types of breeches
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Essential Factors and Processes of Labor; Passenger; Presentation m212 r30000
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Relationship of the long axis of the fetus to the long axis of the mom eg, longitudial or transverse
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Lie
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Essential Factors and Processes of Labor; Passenger; Presentation m212 r30200
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Babies' lying vertical; either caphalic or breech
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Longitudial Lie
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Essential Factors and Processes of Labor; Passenger; Presentation m212 r30240
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Position in which baby lying horizontal or oblique eg, shoulder presentation. Can turn either breech or cephalic during labor
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Transverse Lie
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Essential Factors and Processes of Labor; Passenger; Presentation m212 r30249
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Relationship of fetal body parts to each other eg, flexion, extension, military
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Attitude
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Essential Factors and Processes of Labor; Passenger; Presentation m212 r30347
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Head tucked, back round, thighs flexed at knees eg, chin to chest. Most babies present this way
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Flexion
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Essential Factors and Processes of Labor; Passenger; Presentation m212
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Head extended back and body not round eg, face or brow presentation; delivery by c-section; face gets brusing and swelling during contractions
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Extension
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Essential Factors and Processes of Labor; Passenger; Presentation m212 r32440
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Head is straight like a solider
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Military
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Essential Factors and Processes of Labor; Passenger; Presentation m212
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Relationship of presenting part to front, back, sides of mom's pelvis eg, anterior (OA,ROA,LOA); posterior (OP,ROP,LOP); transverse (ROT,LOT)
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Position
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r30700
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Occiput (back of head) of baby is to mom's anterior eg, looking down at floor. Easiest way for baby to deliver
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Anterior position
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Essential Factors and Processes of Labor; Passenger; Presentation m213
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ROA, LOA
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Right occiput anterior; Left occiput anterior
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r30750
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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
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Posterior; Occiput posterior; Right occiput posterior; Left occiput posterior
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r30810
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Position in which head is sideways, more difficult to fit through birth canal; HCP has to rotate
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Transverse position
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r30935
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Largest transverse diameter of the presenting part has passed through the maternal inlet into the true pelvis
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Egagement
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r31042
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Relationship of presenting part to imaginary line drawn between maternal ischial spines
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Station
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r31107
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The ↑(-)__ the further up the pelvis the baby is eg, -4 (4cm above ischial spine) to 4 (4cm below ischial spine)
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Station
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r31107
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The hardest part for the baby to fit through in the pelvis
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0 station
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Essential Factors and Processes of Labor; Passenger; Presentation m213 r31107
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If the __ is implanted low or over the cervial os (bone) or is placenta previa that can impede labor
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Placenta
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Essential Factors and Processes of Labor; Passenger; Presentation m213 31300
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Contractions eg, involuntary, frequency, duration, intensity → cervical effacement (thinning) and dilation (opening).
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Powers
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Essential Factors and Processes of Labor; Powers; Presentation m214 r31350
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Talked about in terms of % eg, 0% still very thick, 50% thick, 100% thickness (in labor) = thickness is size of a sheet of paper
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Effacement
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Essential Factors and Processes of Labor; Powers; Presentation m214 r31555
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__ usually happens before dilation in nullips and at the same time as dilation in multips. 2cm = 0%, 1cm – 50%, paper thin = 100%
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Effacement (thinning of the cervix as the internal os is slowly pulled up into the lower uterine segment)
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Essential Factors and Processes of Labor; Powers; Presentation m214 r31717
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__ 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
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Dilation (opening); Dilation
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Essential Factors and Processes of Labor; Powers; Presentation m214 r31757
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Bearing down effort
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Pushing
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Essential Factors and Processes of Labor; Secondary Powers; Presentation m214 32045
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Felt when presenting part of fetus presses on stretch receptors in mom's pelvis; involuntary
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Urge to push
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Essential Factors and Processes of Labor; Secondary Powers; Presentation m214
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Tell the mom to __ when she feels the urge to push but the cervix is not completely dilated
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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
|
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|
Straightens long axis of birth canal; widens pelvis
|
Squatting
|
Position of Mother m215
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|
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
|
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|
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 & 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
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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
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Shopping for HCP's; refusing to believe the dx or test results; delay tx; may be optimistic dispite dx
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Examples of shock and denial of chronic illness or disability
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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
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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
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Adjustment to chronic illness or disability
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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
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Benevolent overraction and/or overprotection of child; rejection-emotional neglect w physical care; denial-parents ignore disorder; gradual acceptance-realistic goals and abilities
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Four types of parental reactions to chronic illness or disability
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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
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Realistic expectations of child and integration of family life w illness or disability in proper perspective
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Reintegration & acknowledgement of chronic illness or disability
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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
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May be necessary if unable to integrate family life to include execptional problem
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Out-of-home placement
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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
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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
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Impact of child's chronic illness or disability on family members
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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
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Frequently having a child with a disability leads to __ if coping is innapropreiate
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Divorce
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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
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Negative effect whn compared w/sibiling of healthy children; no ↑risk for severe psychiatric prob; many diff result of nature of sibiling relationship
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Siblings reaction to chronic illness or disability
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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
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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
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Siblings reaction to chronic illness or disability
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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
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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
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NI for one w a chronic illness or disability
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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
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Can have marked dependency on other; may use illness to control other in family
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Child with exceptional problems
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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
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Support sys; emotional & edu resources; realistic expectation; competing demands for family members' time and energy
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Factors affecting family's adjustment
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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
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Children w life-threatening conditions must face possibility of death. Impact greatly influenced by dev age & child's experience w the dx
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Meaning of death in childhood
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287 r4635
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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
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Meaning of death in childhood
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287
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Influenced by ideas about the meaning of life and death; socialization into particular cultural patterns of bereavement; amt of direct exposure
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Child's concept of death
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287 r4712
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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
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Meaning of death in childhood < 3 yrs
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m287
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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
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Meaning of death in childhood ages 3-5
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
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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
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Meaning of death in childhood ages 6-12
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
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More likely to see as final; more of an adult concept
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Meaning of death in childhood ages 9 & 10
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
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Understand the universality and pemanency; hv mature understanding; may feel guilt and/or responsibility for death
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Meaning of death to adolescents
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m288
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Denial, anger, and guilt; shock & disbelief; guilt and look for answers; bargaining; seeks hope & answers
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Reactions of parents to death in childhood
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m289 r5228
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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
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Coping resolution to death in childhood
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Chronic Illness, Disability, or End-of-Life care for the Child and Family; Meaning of Death in Childhood m289
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↓20% from preblock level or <100 mm Hg systolic; fetal bradycardia; ↓beat-to-beat fetal HR variability
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s/s of maternal hypotension with ↓placental perfusion
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Emergency Box p411
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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
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NI for maternal hypothnsion with ↓placental perfusion
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Emergency Box p411
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CO __ 10-15% 1st stage & 30-50% 2nd stage
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↑
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Maternal Physiologic Chages During Labor Box 15-2 p391
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HR __ slightly 1st & 2nd stages
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↑
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Maternal Physiologic Chages During Labor Box 15-2 p391
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SBP __ during uterine contractions in 1st stage; SBP & DBP __ during uterine contractions in 2nd stage
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↑
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Maternal Physiologic Chages During Labor Box 15-2 p391
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WBC count __ during labor.
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↑
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Maternal Physiologic Chages During Labor Box 15-2 p391
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T may be slightly __ during labor.
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↑
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Maternal Physiologic Chages During Labor Box 15-2 p391
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Proteinuria (__) may occur during labor.
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+1
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Maternal Physiologic Chages During Labor Box 15-2 p391
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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
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lower back pain
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Be very careful to be watching baby/mom for signs of infections__. How are we going to recognize infection?
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(HR, fever); Maternal temperature and vaginal discharge are assessed frequently (1-2hrs).
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With ocytocin (Petocin) adm., how close do we want contractions?
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>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
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p508
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Uterine tachysysole; abnormal FHR and pattern; suspected uterine rupture; inadequate uterine response at 20 mU/min
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With ocytocin (Petocin) adm., what tells us there’s a problem?
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p509 Box 19-11
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Labor that begins before completion of 37 weeks from the last menstrual period.
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Preterm Labor
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Taber's Medical Dictionary
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Delivery occurring between 20 and 38 weeks' gestation.
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Preterm Birth
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Taber's Medical Dictionary
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Abnormally ↓wt of a newborn, usually < 2500 g. or 5.5 lbs, regardless of gestational age.
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LBW
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Taber's Medical Dictionary
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Hazards of lead-based paint in older housing; ways to control lead hazards safely; hazards accompanying repainting and renovation of hm's built <1978
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Poison Teaching
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p1435
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Interaction of parental (abuse, lack of supportive relationship, ↓self-esteem & maternal function); child (difficult temperament, unwanted pregnancy, disabilities) and environmental (stressful) characteristics
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What situations make kids more prone to child abuse, what do you see with family or child?
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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).
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Child abuse
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Caretaker harms child for attention.
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Munchausen Syndrome by Proxy
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Child has hx of coming into ER clumsy; Child with head injury
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Possible red flags of child abuse
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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
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Turner syndrome
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MVA is #1 (pedestrian or passenger), then bikes/skateboards/skates, sports equipment.
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School-age kids
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Firearms, MVAs, (risk for homicide/suicide)
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Adolescents
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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
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General; Know NI for family going thru grief of death and anticipatory grief of kid going to die.
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p1173 Box (Guidelines)
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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
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General; Know NI for family going thru grief of death and anticipatory grief of kid going to die.
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p1173 Box (Guidelines)
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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
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General; Know NI for family going thru grief of death and anticipatory grief of kid going to die.
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p1173 Box (Guidelines)
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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
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At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
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p1173 Box (Guidelines)
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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
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At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
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p1173 Box (Guidelines)
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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
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At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
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p1173 Box (Guidelines)
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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
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At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
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p1173 Box (Guidelines)
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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
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At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
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p1173 Box (Guidelines)
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Allow the fam to stay w the dead child for as long as they wish and to rock, hold, or bathe the child;
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At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
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p1173 Box (Guidelines)
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Arrange for spiritual support, based on the fam religious beliefs; pray w the fam if no one else can stay w them
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At the Time of Death; Know NI for family going thru grief of death. What can you do to help them?
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p1173 Box (Guidelines)
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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
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After Death; Know interventions for family going thru grief of death
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p1173 Box (Guidelines)
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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
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After Death; Know interventions for family going thru grief of death
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p1173 Box (Guidelines)
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Encourage all fam mem to communicate their feelings rather than remaining silent to avoid upsetting another mem
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After Death; Know interventions for family going thru grief of death
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p1173 Box (Guidelines)
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Emphasize tht grieving is a painful process that often takes years to resolve
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After Death; Know interventions for family going thru grief of death
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p1173 Box (Guidelines)
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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
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mild retardation
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35-40 to 50-55; speech difficulty, incapable of self-maintenance, in group home
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moderate retardation
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20-25 to 35-40; significant delays in motor dev, little/no communication skills, simple tasks only, mentally a toddler
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severe retardation
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< 20-25; total nursing care needed, basic emotional, physical responses, infant mental age.
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profound retardation
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Toys are selected for recreational and educational value. Should be simple in design. __ is the major consideration.
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Safety
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Term used for the stages a grieving parent(s) of a dying child goes through
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DABDA - denial, anger, bargaining, depression, acceptance
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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
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Down’s syndrome nursing responsibilities
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Cardiac is the most common, with respiratory infections prevalent and sensory problems
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Down’s Syndrome and associated anomalies
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__ middle ear hearing loss. __ perceptive or nerve deafness, distortion of sound and discrimination problems. __ both of the aforementioned.
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Conductive; Sensorineural; Mixed;
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Hearing loss, know the different types
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__ (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).
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Central auditory imperceptions; aphasia-can't communicate through speech, writing, or signs; agnosia-can't interpret sounds or images
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Hearing loss, know the different types
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Severe burning, white swollen mucous membranes, mouth edema, vomiting, drooling, inability to clear secretions, signs of shock, anxiety, confusion.
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Corrosive poisoning Sx
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No vomiting, dilute with h2o only, watch airway, give analgesics, no PO intake, possible dilation/surgery of esophageal strictures.
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Corrosives poisoning Tx
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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).
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Lead poisoning Sx (w main prob as CNS, renal, & hematologic)
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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.
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Lead poisoning Tx; Chelation therapy - bind heavy metals in the body in order to treat heavy metal toxicity
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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.
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ASA poisoning Sx
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Induce V, lavage, charcoal (all 3). 24 hr observation, & tx sx ^ calories, externally cool for fever, dialysis in severe cases, alkalosis/acidosis, crisis intervention
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ASA poisoning Tx
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