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134 Cards in this Set

  • Front
  • Back
List two possible reasons why you should let the cord stop pulsating before cutting it? (p. 197)
* Infant receives all the placental blood
* Less need for the Vitamin K injection (? possibly)
What is the purpose of giving Vitamin K injections? (p. 197)
Increases clotting factor (concern regarding hemorrhage)
What is the purpose of treating a newborn's eyes with Erythromycin? (p. 197)
To prevent neonatal eye infection due to mom having gonorrhea or chlamydia
What are the risks associated with circumcision? (p. 197)
Risk of bleeding, infection and scarring
What are the advantages associated with circumcision? (p. 197)
May decrease risk of UTI, STDs, and penile cancer
When should a woman be at the "birthplace" with the caregiver (with regard to contractions)? (p. 199)
When the contractions are:
*Less than 5 minutes apart
*Lasting for 1 minute
*For an hour
What makes uterine muscle fibers unique, unlike any other muscle in the body? (p. 199)
After the uterus contracts, the muscle fibers stay shortened during the relaxation phase

This process is called "retraction"
What does retraction do? (p. 199)
Causes effacement and dilation of the cervix
As contractions progress and the cervix thins, the internal os is retracted up the sides of the uterus. The external os is loosened and begins to dilate allowing the __________ to dislodge. (P. 200)
Operculum ("Bloody show")
When is the cervix considered to be fully dilated? (p. 200)
10 cm
Why should the care provider not check dilation too frequently? (P. 200)
Can cause an infection
The bulging fluid-filled amniotic membrane presenting in front of the fetal head. - Helps dilate the cervix and cushions the baby's head (p. 200)
Forewaters or "Hydrostatic dilator"
Begins with the onset of regular contractions and ends with the full dilation of the cervix. (p. 200)
First stage
Stage that has dilation of 0-3cm and lasts approximately 7-10 hours (p. 200)
Latent First Stage
Stage that has dilation of 4-7cm and lasts approximately 3-5 hours (p. 201)
Active First Stage
During this stage, patient may feel excited, anxious or may over-react. (p. 200)
Latent First Stage
During this stage, patient may feel in pain, quiet, withdrawn, discouraged or "trapped." She may feel the need to be mobile and to feel "safe," and may develop a ritual and may bath or shower. (p. 201)
Active First Stage
Stage that has dilation of 8-10 cm and last approximately 30-90 minutes. This is the most physically and emotionally taxing phase. (p. 201)
Transition (last phase of First Stage)
During what stage may the patient develop a routine in an effort to regain control? (p. 201)
Transition
Stage that begins with full dilation of the cervix...descent, crowning & ends with the birth of the baby. Lasts approximately 30 minutes to 3+ hours (p. 201)
Second Stage
A natural lull that occurs during Second Stage. Contractions that had been right on top of each other stop. The baby drops lower then contractions start again. Active pushing should only occur once descent has happened. (p. 201)
"Labor Down"
During this stage she may have renewed energy, be mentally clear, optimistic, she may have alarm over pressure, may be excited or discouraged, may feel burning and want to "get it over with quickly" and due to fear of tearing may hold back. (P. 201)
Second stage
Describe the mechanism of birth (Cardinal movements) (p. 201)
I Flexion
II Descent
III Internal Rotation
IV Delivery of the Head
V Restitution
VI External Rotation
Stage that begins with the birth of the baby and ends with the birth of the placenta. Generally takes 5-50 minutes (p. 202)
Third Stage
Used to identify placental detachment - Press on the fundus while pulling on cord then release the fundus. Either the cord will remained lengthened indicating it has detached, or it will pull back in indicating it has not detached. (p. 202)
Credes' Method
What is the normal blood loss associated with placental delivery? (p. 202)
250 ml
What are the risks associated with retention of placental parts? How is it managed? (p. 202)
*Hemorrhage (may be severe enough to cause death)
*If parts are retained for a period of time - infection or immune reaction, uterus may not "involute" as expected
** Management: D&C (dilatation & curettage)
What are the different placental types? (p.202)
Disperse
Battledore
Circumvallate
Succenturiate
Bipartite/Tripartite
Magistral
Fenestrate
Duplex
Vellamentosa
Which placental types are at higher risk for retention of placental parts? (p. 202)
Circumvallate
Succenturiate
Bipartite/Tripartite
Duplex
What placental type is considered normal (common)? (p. 202)
Battledore
Stage that begins with the birth of the placenta and ends with the recovery of the new mother. Lasts approximately 4-6 hours. (p. 202)
Fourth Stage - Aftercare
What is the nature of labor pain in the 1st stage? (p. 203)
*Visceral pain
- Diffuse abdominal cramping
- Uterine contractions
What is the nature of labor pain in the 2nd stage? (p. 203)
* Somatic pain
- Perineum (sharper and more continuous)
- Pressure or nerve entrapment (caused by the fetus' head) may cause severe back or leg pain
What is the trend in labor pain with regards to Nulliparous or Multiparous moms? (p. 203)
*Nulliparous - More sensory pain during early labor
*Multiparous - More intense pain during late 1st stage and the 2nd stage due to more rapid fetal descent
What are the major factors that determine maternal satisfaction during delivery? (p. 204)
* Quality of relationship with caregiver
*Participation in decision making
* Home-like birth environment
* Caregivers with whom they are acquainted personally

Note that pain relief does not play a major role in satisfaction
Continuous labor support provided by a ______ decreases the use of obstetric interventions. (p. 204)
doula
______________ decreased operative vaginal deliveries, cesarean deliveries and requests for pain medication. (p. 204)
Continuous labor support
This nonpharmacological pain relief has no effect on the usage of epidural analgesia and provides only a short duration of pain relief. (p. 204)
Warm water baths (laboring in tub, not a water birth)
What is a sterile water injection? (p. 205)
Intradermal injections of sterile water in the sacral area.
- Causes a burning sensation (counterirritation)
- Decreases back pain for 45-90 mins.
- No decrease in request for pain medications, short duration
- No effect on abdominal labor pain
This nonpharmacological pain relief has limited evidence to show there may be a decrease in the use of analgesia, and has no side-effects. (p. 205)
Positions, Touch & Massage
What is the theory of "Natural Birth" (unmedicated)? (p. 206)
*Body produces endorphins to cope with pain, medications decrease natural endorphins for mom and baby
* Stimulates the baby's adrenal glands - "fight or flight" helps to adapt to life outside of the uterus (helps baby breathe, increases blood flow, stimulates immune system, baby is more alert)
* Oxytocin peaks just after an unmedicated birth - stimulates maternal behaviors
What are possible effects of Parenteral Opioids? (p. 207)
*Subsequent use of epidural analgesia
* Adverse symptoms - Nausea and drowsiness
* Inability to urinate
* Inability to participate in labor
* Cesarian
* Instrument-assisted vaginal delivery
How does Parenteral Opioids compare to Epidural? (p. 207)
* Opioids offer less pain relief and satisfaction with pain relief (all stages)
* Lower rate of oxytocin augmentation
* Shorter stages of labor
*Fewer cases of malposition
*Fewer instrument-assisted deliveries
What effect could parental opioids have on the infant? (p. 207)
* neonatal respiratory depression
* Decreased alertness
* Inhibition of sucking
* Lower neurobehavioral scores
* Delay in effective feeding
(Long term effects cannot be excluded)
*Intrathecal opioid injection before continuous epidural infusion
- Often are unable to walk...
--Substantial motor blockade
--Need continuous fetal monitoring
* Has a rapid onset of pain relief
* Potential for the intrathecal medication to suffice (p. 208)
"Walking Epidural"
What are the possible effects of an epidural? (p. 208)
* Slows labor (1st and 2nd stages)
* Increases use of pitocin
* Increased perineal tears
* Increased instrument-assisted deliveries
* Increased cesarean, especially when administered early
* Maternal fever
What are the concerns with epidural-induced maternal fever? (p. 208)
*Unnecessarily increases work ups for neonatal sepsis
* Increased neonatal antibiotics
What are the possible side-effects of an epidural? (p. 208)
Common:
- Hypotension
- Impaired motor function (inability to walk)
- Need for catherization
Uncommon (<10%):
- Pruritis
- Nausea and vomiting
- Sedation
What alternative pain relief is used in other countries (>60% in Finland and UK) as an alternative to epidural? (p. 208)
Nitrous Oxide
What are the possible side effects of Nitrous Oxide? (p. 209)
* Nausea
* Vomiting
* Poor recall of labor
What do "Polarity," "Passenger" and "Passage" refer to in regards to complications of labor? (p. 210)
Polarity = Power
Passenger = Baby
Passage = Pelvis
What effect can chiropractic care have on mom to avoid complications of labor? (p. 210)
*Maintain neuromuscular harmony (polarity)
*Proper nutrition, proper placement (Passenger)
*Pelvis is un-subluxated (passage)
What is the normal polarity of the uterus {lower pole and upper pole}? (p. 210)
*Lower pole (above the cervix)
--Retracts the myometrium upward
--Pulls the cervical tissue into the lower uterine body to remove the obstruction and allow for fetal descent
* Upper pole (fundus)
--pushes the fetus toward the cervix
If preeclampsia is present in the 1st trimester, you should suspect ________ (1 of 5 most missed exam questions on Exam 1, WILL be on Exam 2!)
Hydatidiform mole
Patient is 32 weeks pregnant, has vaginal bleeding and low back pain. You should suspect _________ (1 of 5 most missed exam questions on Exam 1, WILL be on Exam 2!)
Abruptio Placentae
Supplementation with calcium may be helpful for _________ (1 of 5 most missed exam questions on Exam 1, WILL be on Exam 2!)
High Blood Pressure
Currently pregnant for the 2nd time, delivered twin boys with her 1st pregnancy (1 of 5 most missed exam questions on Exam 1, WILL be on Exam 2!)
Gravida 2, Para 1
Patient is 36 weeks pregnant, is having headaches and right upper quadrant pain. You should suspect ______ (1 of 5 most missed exam questions on Exam 1, WILL be on Exam 2!)
Preeclampsia
With regard to polarity and weak contractions:
- Longer labor but NOT exhausting
- fetus NOT at risk
- may increase hemorrhage in 3rd stage (p. 211)
Primary or hypotonic inertia
With regard to polarity and weak contractions:
- may become dangerous if obstructive
- causes fetal distress (p. 211)
Secondary inertia or exhaustion
Abnormal polarity:
- irregular contractions; painful & unproductive
- poor retraction and dilation of the cervix (prolonged labor) (p. 211)
Disordered uterine contraction
Abnormal polarity:
- a 'battle of forces' between the upper & lower poles
- NO progress (p. 211)
Hypertonic lower pole
Abnormal polarity:
- hypertonic & disorganized contractions
- prolonged dilation with irregular contraction phases
- painful (p. 211)
Colicky uterus
Abnormal polarity:
- abnormal retraction ring
-- 'hour glass' shape to the uterus
- too tight to allow easy downward progression of the fetus (p. 211)
Constriction ring aka Bandl's Pathological Ring
Abnormal polarity:
- Rigid cervix
-- rare, slow dilation even in a normal contraction state
- Edematous cervix
-- early bearing down before the cervix is softened & dilated causes 'trauma' to the cervix at the anterior lip and it swells
- Annular detachment
-- pressure of the fetal head causes ischemia and necrosis to the cervical ring which detaches and is expelled (p. 211)
Cervical Dystocia
What complicating factors are associated with the passenger with regard to labor complications? (p. 211)
* Malposition
* Malpresentation
* Multiple Pregnancy
* Excessively large or post maturity baby
What pelvis types are a deterrent to labor? (p. 211)
*Gynecoid (50%) - female
*Anthropoid (25%) - ape
*Android (25%) - male
*Platypelloid (5%) - flat, wide or bowl
What complicating factors are associated with the passage with regard to labor complications? (p. 212)
* contracted pelvis
* tumors
* uterine fibroids
* Cysts
* Fractures
* Physiological changes: DJD/TB/rickets/osteomalacia
*Flat pelvis/android
*Subluxation
What complications are associated with Occiput Posterior (OP)? (p. 212)
* Back labor
-- Head of the fetus presses on the sacrum
-- Pressure on the sacral plexus
-- When the SI's open to permit baby's passage, if there is sacral/SI subluxation, the presence of the head can cause significant back pain
* May produce Caput succedaneum ("cone head")
What complications are associated with Breech presentation? (p. 213)
*Intracranial hemorrhage
*Dislocation of the neck (damage to SCM, Erb's palsy)
*Shoulder dislocation
*Fractured clavicle
*Dislocation of the hip
*Prolapsed cord
*Rupture of internal organs
*Genital edema
*Uterine rupture
*Premature placental rupture/apnea
What complications are associated with face presentation? (p. 213)
*Lax uterus
*Flat pelvis
*Multiple fetus
*Anencephaly
*Neck spasm (fetus)
*extreme extension of the cervical spine
*SCM is stretched
*Anterior neck musculature is affected
What complications are associated with a brow presentation? (p. 213)
*Unstable; A-P diameter is too large to pass
If persistent:
*Significant compression on C spine
*Subluxation of C spine and/or upper T spine
What complications are associated with parietal presentation? (p. 213)
*Unusual; flat/platypelloid pelvis
*Asynclitic
-- Head is forced into extreme lateral flexion
-- Parietal bone is pushed against pubic bone or sacrum
* Traction and/or compression of brachial plexus
What are the risk factors of a shoulder presentation? (p. 214)
*Twins
*Hydramnios
*Placenta previa
*Multiparity
*Sub-septae uterus
What are the risk factors involved in a compound presentation? (p. 214)
*Malposition
*Malpresentation
*Small infant
*Multiparous

(Compound presentation = Nuchal arm: arm alongside of head)
What traumas are associated with a forceps delivery? (p. 214)
* Depression fractures
* Birth marks
* Iatrogenic torticollis
* Brachial plexus damage
* Subluxation (facet subluxation on a medical scale)
What traumas are associated with a vacuum extractions? (p. 214)
* Subluxation of the parietal bones "cone head"
* Scalp, cranium, and C spine undergo significant stress
What are some of the reasons a pregnancy ends with a C-section? (p. 214)
* Placenta previa
* Fetal distress
* Maternal distress
* Failure for labor to progress
* Breech
* Pelvic distortion
What advantages of a vaginal birth do c-section babies not get? (p. 214)
Do not experience:
*Proper head molding
--Activation of respiratory centers of the brain
*Expulsion of the contents of the lungs
The time from the delivery of the placenta through the first few weeks after the delivery
--Usually considered to be 6 weeks
-- Body returns to the nonpregnant state (p. 215)
Puerperium
Where can the uterus be palpated immediately after the delivery? 2 weeks postpartum? (p. 215)
* immediately after the delivery, the uterus can be palpated at or near the umbilicus
*2 weeks postpartum, the uterus should be located in the true pelvis
Vaginal discharge that lasts about 5 weeks postpartum (p. 215)
Lochia

Lochia rubra - red, duration is variable
Lochia serosa - brownish red, more watery consistency, continues to decrease in amount
Lochia alba - yellow
1st "milk" 2-4 days after delivery. High in protein and immune factors. (p. 216)
Colostrum
Excessive blood loss during or after the 3rd stage of labor. Average blood loss is 500 ml. Vaginal birth 3.9%, cesarean 6.4% Responsible for 5% of maternal deaths. (p. 217)
Postpartum hemorrhage
What are the most common causes of postpartum hemorrhage? (p. 217)
Uterine atony and lower genital tract lacerations
Lack of closure of the spinal arteries and venous sinuses (p. 217)
Uterine atony
What are common causes of lower genital tract lacerations? (p. 217)
* Result of obstetrical trauma
--More common with operative vaginal deliveries (forceps, vacuum extraction)
* Macrosomia
* Precipitous delivery (very rapid)
* Episiotomy
Clinical presentation is fever, chills, lower abdominal pain, malodorous lochia, increased vaginal bleeding, anorexia and malaise. Exam findings are fever, tachycardia and fundal tenderness. Treat with antibiotics. (p. 218)
Endometritis
Bacterial inflammation of the bladder or urethra. 3-34% of patients (p. 218)
Urinary tract infection
Inflammation of the mammary gland. Milk stasis & cracked nipples contribute to the influx of skin flora. Clinical presentation is fever, chills, myalgias, warmth, swelling and breast tenderness. (p. 219)
Mastitis
Clinical presentation is fatigue, palpitations, heat intolerance, tremulousness, nervousness and emotion liability. Can be confused with normal new mom worries. Exam findings are tachycardia, mild exopthalmos, painless goiter. (p. 220)
Postpartum Thyroiditis (PPT)
*Autoimmune disorder
*Diffuse hyperplasia of the thyroid gland
*increased thyroid hormone production and release
*accounts for 15% of postpartum thyrotoxicosis (p. 220)
Postpartum Graves Disease
* Transient disorder
- lasts hours to weeks
* Bouts of crying and sadness (p. 221)
Postpartum Blues
* More prolonged affective disorder
- Weeks to months
* Signs & symptoms of depression (p. 221)
Postpartum Depression
* First postpartum year
* Group of severe and varied disorders (psychotic symptoms) (p. 221)
Postpartum Psychosis
What percentage of mothers develop postpartum blues? Depression? Psychosis? (p. 221)
Postpartum Blues = 50-70%
Postpartum Depression = 10-15%
Postpartum Psychosis = 0.14-0.26%
What are signs and symptoms of Postpartum Blues? (p. 221)
* Sadness
* Crying
* Anxiety
* Irritation
* Restlessness
* Mood lability (changes)
* Headache
* Confusion
* Forgetfullness
* Insomnia
What are signs & symptoms of Postpartum Depression? (p. 222)
* Insomnia
* Lethargy
* Loss of libido
* Diminished appetite
* Pessimism
* Incapacity for familial love
* Feelings of inadequacy
* Ambivalence or negative feelings towards the infant
* Inability to cope
When should a psychiatrist be consulted in postpartum depression? (p. 222)
* Comorbid drug abuse
* Lack of interest in the infant
* Excessive concern for the infant's health
* Suicidal or homicidal ideations
* Hallucinations
* Psychotic behavior
* Overall impairment of function
What are signs and symptoms of Postpartum Psychosis? (p. 222)
* Acute psychosis
- Schizophrenia
- Manic depression
What is the treatment for postpartum blues? (p. 222)
Provide support and education
What is the treatment for postpartum depression? (p. 222)
* Supportive care and reassurance (healthcare professionals and family)
* Pharmacological treatment for depression
* Electroconvulsive therapy
What is the treatment for postpartum psychosis? (p. 222)
* Therapy should be targeted to the patient's specific symptoms
* Psychiatrist
* Hospitalization
What are the current recommendations with regards to feeding infants for the first year? (p. 223)
* Promote exclusive breastfeeding of all babies for the first 6 months (rare exceptions)
- vitamin supplements or prescribed medications
* 6 months - 1 year
- Breastfeeding should continue with the addition of complementary foods
What are the health effects of not breastfeeding babies? (p. 224)
* Babies who are not breastfed may also develop lower antibody titers in response to immunization
* Babies who are not breastfed have a higher risk of hospitalization in the 1st year of life due to increased risk of bacterial illness (bacterial meningitis, bacteremia, diarrhea)
*Higher rates of otitis media, allergies, respiratory tract infection, necrotizing enterocolitis, urinary tract infection, gastroenteritis
What are the advantages of breastfeeding (for the infant)? (p. 224)
* Lower incidences of certain health problems that may develop later in life such as Type I and II diabetes, allergic disease, asthma, lymphomas, inflammatory bowel disease
* Slightly higher IQ and development scores
What are the advantages of breastfeeding (for the mother)? (p. 225)
* suckling stimulates the release of oxytocin - causes contractions which reduces size of the uterus and helps prevent postpartum hemorrhage
* Assists in the natural spacing of pregnancies
* Lowers risk of iron-deficiency anemia (due to lack of menstruation)
* Breastfeeding burns 200-500 calories a day (easier weight loss)
* Decreased rates of ovarian, endometrial and breast cancer
* Possible decreased risk of postmenopausal osteoporosis
* Women with Type I diabetes prior to pregnancy tend to need less insulin while breastfeeding
What are some contraindications to breastfeeding? (p. 226)
* Infants who have galactosemia
* Mothers who have active (untreated) TB
* Mothers who are using "street drugs"
* Mothers with HIV ( in the USA)
* The presence of a herpes simplex lesion on the breast
-infants may feed from the opposite breast if it is lesion free
* Mothers receiving radiation or chemotherapy
* A small number of medications taken by the mother (until they have cleared the milk)
In the first few weeks, how frequently should the infant be breastfed? (p. 227)
* Mothers are encouraged to have 8 to 12 feedings every 24 hours
* Offer the breast anytime the infant shows early signs of hunger:
- Increased alertness
- Physical activity
- Rooting
What are some specific advantages to breastfeeding a preterm infant? (p. 228)
* Reduced rates of sepsis and necrotizing enterocolitis
* Retinal development and visual acuity
* Greater cardiac and respiratory stability
When should solid foods be introduced? (p. 228)
Around the middle of the first year ( >6 months)

If weaning occurs before 12 months infant should receive iron-fortified formula, NOT cow's milk
What should the first semi-solid foods be? (p. 229)
* Cereals without gluten
* Vegetables and fruits with low allergenic potential
- withhold foods with high allergenic risk until after 8-12 months
What are the top food allergies? (p. 229)
1. Egg
2. Milk
3. Soy
4. Wheat
5. Peanut
6. Tree nuts
7. Fish & Shellfish
8. Citrus, strawberries

90% of childhood food allergies come from the first 6 listed
What nutritional deficiencies have been found in children drinking rice milk or soy milk? (p. 229)
Rice milk = kwashiorkor
Soy milk = rickets (vit D)
What signs of physical readiness for food may be present? (p. 229)
* interested in food; sees the rest of the family eating
* Can move foods from the front of his mouth to the back with his tongue (no tongue thrust reflex)
* Can sit up with support
* Can control his head and upper body movements
* is at least 4 months old
* Has doubled his birthweight
* Wants to breastfeed more than 8-10 times during a 24 hour period
* If formula fed, drinks more than 32 oz. in a 24 hour period
If the tongue thrust reflex is present, is the infant ready for solid foods? (p. 229)
NO! The tongue thrust reflex assists with nursing and indicates the infant has not developed sufficiently for solid foods yet
What concerns are there with early introduction of solid foods? (p. 230)
* Concerns about renal solute load, obesity, celiac disease, food allergy
* research has shown links to:
- respiratory illness
- eczema
- allergies
- asthma
- diabetes
What is the current recommendation regarding fruit juice? (p. 230)
* No nutritional indication to feed juice to infants younger than 6 months
* 4-6 oz. of juice per day is more than adequate ( 1 food serving of fruit)
* May cause dental caries, chronic diarrhea, excessive flatulence, abdominal pain, and bloating
* Drinks that contain ascorbic acid consumed simultaneously with food can increase iron absorption by twofold, therefore, juice should be used as part of a meal or snack, not sipped throughout the day
What guidelines should be followed when introducing solid foods? (p. 230)
* introduce only 1 food at a time
- wait 1 week before introducing another food
* always watch to see if the baby has any reaction; vomiting, diarrhea, wheezing, skin rash
* remember that breast milk or formula is still the main source of nutrition for the first year
* Respect baby's signals for being full
- starting to play
- blowing bubbles
- pushing the spoon away
- turning the head away
As the baby gets teeth they may be offered finger foods. Which foods present a choking hazard and should not be offered? (p. 231)
*berries, grapes, cherries
*raw vegetables, peas and carrots, whole kernel corn
*nuts, raisins, adult dry cereals
*hot dogs
*chips, pretzels and popcorn
What are some red flags when trying to recognize the seriously ill child? (p. 232)
*Core body temperature elevated
*State of arousal
- observe for signs of drowsiness, hypotonia, lack of response to stimulation
*Breathing effort
*State of peripheral circulation
*Dehydration
- fluids taken in and excreted (24 hours)
- acute weight loss
What signs of dyspnea may be present in a seriously ill child? (p. 232)
* Recession of the sternum and chest wall
* Nasal flaring
* Respiratory grunting
* central cyanosis
What signs of peripheral circulation problems may be present in a seriously ill child? (p. 233)
* Generalized pallor
* Cold lower legs (knee down)

** NOTE: cold hands & feet and mottling of the skin have little or no relationship to serious illness
What are serious signs of illness with regard to fluid intake? (p. 233)
* Ingesting <50% of the normal fluid intake
* < 4 wet diapers in a 24 hour period
How do you compare current weight to expected weight? (p. 233)
Look at an anthropometric chart (percentile) to determine their expected weight, then subtract current weight from expected weight, divide by expected weight and multiply by 100

Weight loss of > 7.5% indicates dehydration and should be referred to the hospital
What are signs of dehydration? (p. 233)
* dry mucous membranes and skin
* rapid, weak pulse
* pallor or ashen/grey discoloration of the skin
* soft, sunken eyeballs
* depressed fontanel
* poor tissue turgor (tenting)
* lethargy
* seizures
What are some uncommon high risk signs of illness? (p. 233)
* Bile-staining vomit
* Convulsions (especially 1st time)
* Lump > 2cm in diameter in the abdomen (except hydrocele or umbilical hernia)
* Petechial rash
* Fecal blood without visible cause
What observations are used in assessing the febrile child? (p. 234)
1. Quality of cry
2. Reaction to parent stimulation
3. State variation
4. Color
5. Hydration
6. Response to social overtures

A score of > 12 should be referred for evaluation
A score of 10...2.7% are serious illness
A score of 16...92.3% are serious illness
How do you score the quality of cry when assessing the febrile child? (p. 234)
1 - strong with normal tone; content and not crying
3 - whimpering or sobbing
5 - weak or moaning or high pitched
How do you score the reaction to parent stimulation when assessing the febrile child? (p. 234)
1 - cries briefly then stops; content and not crying
3 - cries off and on
5 - continuous cry or hardly responds
How do you score the state variation when assessing the febrile child? (p. 234)
1 - if awake, stays awake; wakes up quickly if stimulated
3 - eyes close briefly, awake; awakens with prolonged stimulation
5 - falls to sleep; will not rouse
How do you score the color when assessing the febrile child? (p. 234)
1 - pink
3 - pale extremities; acrocyanosis
5 - pale, cyanotic, or ashen
How do you score the hydration when assessing the febrile child? (p. 234)
1 - skin and eyes normal, mucous membranes moist
3 - skin and eyes normal and mouth slightly dry
5 - skin doughy or tented and dry mucous membranes +/- sunken eyes
How do you score the response to social overtures when assessing the febrile child? (p. 235)
1 - smiles or alerts ( <2 months)
3 - brief smile or alerts briefly ( <2 months)
5 - no smile; face anxious, dull, or no alerting ( <2 months)