OB/Ped's Exam and Pharm 1
embryonic period week 5
large head, upper limb buds, heart beating
7 month fetus
lean body, less wrinkled and red, nails appear
informed consent
accept or reject treatment options as part of their right to function autonomy
20 lbs child maintenance fluids twice as much. hourly rate
20lbs to kg 20 divided by 2.2 is 9.09kg 9.09kg x 100 is 909 909 x 2 is 1818 1818 divided by 24 hours is 75ml/hr
maintenance fluid requirements in severely dehydrated pt fluid bolus
20ml/kg then maintenance fluids requirements exp- 25kg 20ml x 24kg = 480ml bolus then 1580ml maintenance fluids
surfactant production begins
21-24 weeks 24 weeks
monozygotic
1 ovum 1 sperm, identical genes, same sex, no hereditary influence know, 2 amnions, 1 chorion
suggest three strategies the nurse could use when caring for a child who is deaf
1- assess the child's self-help skills. 2- identify how the family communicates. 3- encourage the parents to stay with the child. 4- develop a communication board. 5- always face the child when speaking. 6- do not exaggerate speech. 7- be aware of your body language and nonverbal communication
suggest three strategies the nurse could use when caring for a child who has a severe visual impairment
1- assess the child's self-help skills. 2- orient the child to landmarks in the room and typical environmental sounds. 3- encourage parents to stay with child. 4- keep objects in the immediate environment in the same place. 5- explain all procedures
list three behaviors that are warning signs of a nurses overinvolvement
1- buying gifts. 2- giving out home a phone number. 3- accepting invitations to family gatherings. 4- visiting the child on days off. 5- lending or borrowing money. 6- sharing personal information. 7- making decisions for the family
to provide appropriate care for the child and family, during the initial interview, the nurse should gather information about the following five areas
1- decision making practices. 2- child rearing practices. 3- extent of family support. 4- communication practices. 5- health and illness practices
list five key component of open communication in a family centered care environment
1- establish a rapport with the family. 2- encourage questions. 3- empower the parents to care for their children through education and support. 4- effectively manage conflict with families. 5- solicit feedback from families
identify seven strategies to manage conflict that may occur between parents and the nurse
1- understand the parents perspective. 2- determine a mutually agreed upon goal. 3- look for win-win solution. 4- actively listen. 5- openly express feelings. 6- avoid blaming. 7- summarize the discussion
what is a family
a social group whose members share common goals and values and whose members are committed to each other, may or may not be biologically related
teh embryo is fully implanted in the uterus on which day after comception
10
maintenance fluid requirements in 24 hour for 10 to 20 Kg child
1000ml + 50ml/kg for each additional kg between 10 to 20 kg exp- 14kg pt (10kg = 1000ml) (1000) + (50ml x 4kg) = 1000 + 200 = 1200ml
dizygotic
2 ova 2 sperm, not identical genes, maybe same sex, maybe different, hereditary and or ethnic tendency often found, 1 amnion, 2 chorions
What was identified in the chapter as a societal issue that affects maternity and pediatric nursing
families are the fastest growing group of homeless people
medication classification for pregnancy
A- best no harm to fetus B- animals say safe (Tylenol) C- benefit for mom D- risk for baby x-do not use
toxic ingestion primary assessment
A-airway B-breathing C-circulation D-disability: neurological assessment E-exposure
fundus is at xiphoid process
36 weeks
heart contains four chambers
8 weeks
maintenance fluid for an 8kg baby
8 x 100ml is 800ml
all abdominal organs are within the abdominal cavity
9-12 weeks 10 weeks
iron deficiency anemia side effects
consitpation, stained teeth, tar stool.
amniotic membranes and fluid
constant body temperature. oral fluid and repository for waste. cushion for fetus from trauma. freedom of movement for musculoskeletal development. facilitates symmetrical growth
violence
constant stressor. abuse of the child may be physical, sexual, emotional, form of neglect
explain the bowel expected adaptation involved in elimination that occur during pregnancy
constipation and hemorrhoids; effect of increase progesterone, which decreases peristalsis and intestinal displacement by enlarging uterus
toxic ingestion secondary assessment
F-full set of vital signs G-give comfort measures H-head to toe assessment I-inspect posterior surfaces
Special supplemental nutrition program for women, infants and children (WIC) provides supplemental food supplies to bottle fed children but no to breastfeeding mothers
False
Throughout history, children have been valued and protected by society
False
adults have a greater body surface area in relation to body mass, resulting in greater potential for fluid loss
False- pediatric dehydration very quick process, children have increased metabolic rate, respiratory distress- insensible fluid loss Neonate apx 40% of body water is ECF
most of potassium is housed extracellularly and Na intracellularly?
False- potassium is housed intracellularly and Sodium is housed extracellularly
antepartum history
GTPAL
gastroesophageal reflux disease (GERD) pharm
H2 antagonists to reduce gastric acid levels. Mucosal protectants proton pump inhibitors to block acid production. prokinetics to stimulate the gastric emptying and improve tone
cleft palate post operative care
I/O's, monitoring packing, ESSR (enlarge nipple, swallowing, sucking, rest), speech therapy, position in a supine position- unless secretions then elevate the HOB, suction at bedside (nothing in mouth). elbow restraints (unless supervised during baths, arm exercises, circulation checks- neurovascular, skin) maintain Logan bow at all times after lip repair, reapplying as necessary, keep mouth free from everything!, adequate hydration- oral fluids (NO straws), rinse mouth with water after each feeding, perform lip care to incision site, monitor s/s infection and pain
IV bolus in a 63lbs child
IV bolus rule: 20ml/kg first change 63lb to kg 63 divided by 2.2 is 28.6kg 28.6kg x 20 ml is 572ml/hr
corrosives tx toxin ingestion
IV fluids, NPO, analgesics, steroids, antibiotics, NG tube
tylenol
Mucomyst binds to Tylenol to decrease toxicity in blood
an infant has undergone repair of the cleft lip. which of the following would not be part of the post op care
NG feedings until sutures are removed
failure to thrive- goals for nutrition
NG tube enteral feedings at night, normalized weight, correct deficiencies in nutrition, catch up growth, establish adequate eating patterns and intake. (concentrate formula, adding formula power to breastmilk, high calorie and protein foods, avoid giving juice, add instant breakfast to milk drinks, add vegetable oil or butter to foods when cooking and high fat foods, give tube feedings)
pyloric stenosis pre op
NPO, IV fluids, Labs- electrolytes WNL, NG tube- reduce pressure (respiratory distress)
elective abortion
Roe vs wade- women rights to abort 1st trimester, state rights 2nd trimester and 3rd unless mothers life might be jeopardized by continuing the pregnancy
cleft palate BAD post op signs
SOB, respiratory distress, more than 10ml post bleeding (mouth, lip, nose)- surgical packing dislodged
advocacy
Speaking or arguing in support of a policy or person's right
lead (plumpish) medication toxin ingestion
Succimer (chemet), hydration, calcium, phosphorus, vit C and D, anticonvulsants, iron
TORCH
T- toxoplasmosis >256 antibodies- recent infection. dont change the litter box O-other (syphilis, hepatitis, HIV) R-Rubella> 20 immune to rubella C-Cytomegalovirus (CMV)- no CMV antibodies H-herpes simplex (HSV)- no HSV antibodies
infants (developmental approaches)
developing a sense of trust vs mistrust
Placenta (auxiliary structures)
Thick, disk shaped
Hospital policies have changed in response to an awareness of children's emotional and psychologic needs
True
The first public health program for mothers and children was initiated by Lillian Wald
True
during the 19th century, the most serious child health problem were directly related to poverty and overcrowding
True
corporal punishment (discipline measures)
a controversial form of discipline usually involving spanking
trimester
a division of pregnancy; one of three equal parts of approx. 13 weeks each
ductus arteriosus
a small amount of blood from the right ventricle is circulated to the lungs to nourish the lung tissue. the rest of the blood from the right ventricle joins oxygenated blood in the aorta through the third shunt- the head and upper body receive the greatest amount of oxygenated blood
gliadin
a protein found in rye, oats, barley, wheat
esophageal atresia with tracheoesophageal fistula (TEF) management
a surgical emergency includes- ligation of fistula (present) / end-side anastomosis of the esophagus requiring a thoracotomy.
behavior modifications (discipline measure)
a technique that rewards positive behavior and ignores negative behavior
primipara
a woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation or more
multipara
a woman who has completed two or more pregnancies to 20 weeks of gestation or more
psychosocial adaption- 2nd trimester week 14 to 26
acceptance- fetus "feels real", excitement- experiences fetal movement, concern if no fetal movement by 20 weeks, fetus is primary focus- prenatal visit every 4 weeks, screening test- diabetes, neural tube defects
biliary atresia s/s
acholic stool (first sign in infancy) and bile stained urine, as it progresses ascites, hypertension, growth and development failure, jaundice, prurtus
Biliary atresia s/s
acholic stools (pale, white, clay color due to the bile not getting down to the intestines), bile stained urine. progression- ascites, hypertension, growth and development failure, jaundice and pruritus (due to the increase level of bile), glowing yellow eyes
empowerment
actions taken to enable another person to fully participate in the decision making
herpesvirus serotypes 1 and 2 tx
acyclovir orally
tuberculosis
aerosolized droplets screened- + xray (protect abd) s/s-general malaise, fatigue, loss of appetite, weight loss, fever infant- amniotic fluid or umbilical vein tx- isoniazid, rifampin, ethambutol
yolk sac
aids in transferring maternal nutrients and oxygen. blood cells and plasma are manufactured in the sac during the second and third week while uteroplacental circulation is extablished
esophageal atresia with tracheoesophageal fistula pre op
airway patency. prevention of pneumonia and gastric or blind pouch decompression
8 weeks fetal development- parent know
all body organs are formed
lead free MD
all children born on or after jan 1 2015 must be tested at 12 and 24 months. all children born before jan 1 2015 should be screened up to 6 years of age
presumptive indications of pregnancy
amenorrhea, nausea and vomiting, urinary frequency and urgency, breast enlargement and tenderness, fatigue, quickening (may be gas), chadwick's sign (change of color in vag), intensified skin pigmentation, missed period
chlamydia tx
antibiotics in infants eyes after birth (erythromycin amonicillin or azithromycin to mother during pregnancy
acetaminophen (Tylenol) toxin ingestion
antidote Mucomyst
salicylate (aspirin) toxin ingestion
antidote vit K, activated charcoal to decrease absorption, sodium bicarbonate, potassium replacement, glucose, hemodialysis for severe cases. Vit K
cytomegalovirus (CMV) tx
antiviral: ganciclovir
gravida
any pregnancy, regardless of duration
stress
any situation, positive or negative, requiring an adjustment on the part of individuals, families, or groups
Bioethics
application of ethics to health care
communal families
are groups of people who have chosen to live together as extended family groups. relationships motivated by social value or financial necessity. spiritually
types of perinatal loss nurse side
are you ok to take care of them because of self issues, be there for the family "get them through the worse day of their life" acknowledge the baby was real, use babies name, allow family time alone with the baby
dizygotic twins (fraternal)
arise from two separate ova fertilized by two separate sperm. two placentas, two chorions, two amnions. may be same sex or different sex. may not have similar physical traits. incidence may be increased by genetic predisposition, maternal age, or gentility drugs.
lead (plumbish) toxin ingestion treatment
around 45mcg/dl- oral chelation therapy, dimercaptosuccinic acid (DMSA) succimer greater than 45mcg/dl- IV injected chelation therapy, ethylenediaminetetraacetic acid (EDTA) recommend screening- lead level of 5mcg/fl considered unsafe
foramen ovale
as infant breathes, resistance to blood flow to lungs falls and the foramen ovale closes, tissue proliferation cause it to fill in the septum between the right and left atria
biliary atresia
bile back up into live- scaring, need for new liver. refers to the obstruction or absence of the extrahepatic bilde duct. at birth, liver normal then the structrual problems lead to significant cellular damage and eventual live failure and death.
adolescent (developmental approaches)
ask questions, use technology, HUGE body image issues, privacy, some what parents with them, some want independence, control is important, striving for identiy, concerned more about the here and now, peers are very important and separation causes anxiety- support groups, provide activities to interact, concerned how things will impact their body appearance, believe they are invincible and things wont happen to them
when esophagus is closed off from trachea and the stomach is connected to the trachea (TEF)
aspiration
herpesvirus serotypes 1 and 2 s/s in infant
asymptomatic during incubation period of 2 to 12 days. local infection of skin, mouth, eyes, encephalitis or disseminated disease c/s prevent fetus from infection / avoid outbreak at birth no outbreak- vag / outbreak- C/S greater then 35 weeks- mom given antiviral for herpes
cytomegalovirus (CMV)
asymptomatic, leading cause of neonatal hearing loss herpes virus most serious effects occur in fetus and immunocompromised people isolated in urine, saliva, blood, cervical mucus, semen, breast milk, feces
RBC volume
blood pressure
Jehovah's witness
blood transfusion not allowed. respect the physician bur trust god more
chadwick's sign
bluish color that often extends to the vagina and labia; cause is hyperemia
fetal period week 9 to 12
body grows faster than the head, face is broad, intestines enter abdomen, gender becomes more differentiated
2 month fetus
body well formed, nose flat eyes far apart, digits well formed, head elevating, tail almost disappeared, eye/ear/nose/mouth recognizable
failure to thrive- nonorganic
bonding issues between mother and baby such as, internal and external stressors (financial/marriage/mental illness). inability to provide adequate calories and lack of knowledge on feeding issues. absence of history contributing to a psychosocial causes
pyloric stenosis post op
bowel sounds, NG tube out, diet- clears to 1/2 formula to full formula
a mother brings her 7 month old infant to the well baby clinic for a check up. she is concerned that the baby is overweight. she feeds the infant formula that has 20 cal/oz whenever the infant is hungry the nurse should instruck the mother too
bring a 3 day record of the infants intake back from further evaluation
Goodell's sign
cervical, uterine and vaginal softening with increased vascularity of the connective tissue
Chadwick sign
cervix has a change in color
goodell sign
cervix has a change in consistency
mucus plug formation
cervix, forms early on in pregnancy to form a barrier from infection
ductus venosus
cessation of umbilical cord blood flow with birth causes it to become nonfunctional; becomes a ligament
same sex parent families
challenges from a community that is unaccustomed to alternative lifestyles. children's adaptive depends on the parents psychological adjustment
Varicella zoster virus
chicken pox, herpes virus family direct contact or respiratory tract, may persist in a latent state in nerve ganglia, reactivation resulting in herps zoster (shingles). 90% of women are immune greatest risk for congenital varicella syndrome is between 13- 20 weeks maternal antibodies protect fetus live vaccine- cant get if pregnate
potential problems in families with substance abuse
child neglect, risk taking behaviors, possible criminal activities
failure to thrive mixed causes
combination of organic and inorganic factors
healthy families
communicate openly, flexible roles, agree on basic principles, adaptable, not overwhelmed, volunteer assistance, spend time together/facilitate autonomy, seek appropriate resources for support, transmit cultural and expectations to children
school age communication
communicate thoughts and appreciate viewpoint of others. understands rules, attention span 30 min
coping strategies of families external
community strategies- maintaining active linkages with the community social support strategies- extended family, friends, neighbors, self help groups, formal social support. spiritual strategies- seek advice or clergy, becoming more involved in religious activities, having faith in god, prayer
intracellular fluid (ICF)
compartment is more difficult to dehydrate
nontraditional
complex households, single parent families, blended families, adoptive families, unmarried couples with children, multigenerational families, homosexual parent families
sonogram
confirmation of pregnancy measure gestational age 8 weeks heart seen
Umbilical cord
contains two arteries and one vein which are surrounded by Wharton's jelly. 2 artery's have deoxygenated blood/ 1 vein has oxygenated blood. Wharton's jelly- specialized connective tissue (protects blood vessels). provides circulatory pathway to embryo
nursing communication with Hispanics
conversational methods- polite with preliminary small talk
toxoplasmosis precautions
cook meat thoroughly, avoid touching mouth or eyes while handling meat, wash surfaces that come contact with uncooked meat, avoid uncooked eggs and unpasteurized milk, wash fruit and veggies prior to eating, wash hands well after working with soil or handing animal, avoid direct or indirect contact with cat feces
what breast changes occur during pregnancy
darkening of the areolae, increased nipple and areolae size, areolae become more erect, montgomery tubercles become more prominent
diarrhea factors to fluid loss
deadly to children if not fixed, roto virus, Norwalk, e coli, salmonella, shigella, antibiotics (need probiotic), gastro bug, emotional/stress, IBS, food poisoning, allergies, increase in the frequency, fluidity, and volume of stool, accompanies acute and chronic disorders, inflammatory or noninflammatory, gastroenteritis, norovirus, rotavirus lead to electrolyte imbalance, hypovolemic shock manifestations- dry hot skin, change in skin texture/turgor, dry mucous membranes, cramps, nausea, vomiting, large volume stools, increased heart rate, increased RR, decreased tearing, fever
early childhood death concept
death as a reversible and temporary separation
adolescence death concept
death as inevitable and irreversible but of a distant event
infancy-toddler death concept
death as loss of the caregiver
hypernatremic
dehydration with a sodium concentration greater than normal. slow fluid infusion not to shift. adding potassium (make sure they have urinated for adequate kidney function) before giving K (PICC line for greater than 30K water loss is greater than the electrolyte loss, resulting in a serum sodium greater than normal
hyponatremic
dehydration with a sodium concentration of less than normal- cystic fibrosis electrolyte loss is greater then the water loss, resulting in a serum sodium less then normal
correct injection technique for infants of mothers who are known carriers of hepatitis b virus is to
delay all injections until the infant has been bathed
failure to thrive
demonstrated failure of growth for a period of time, delay in developmental milestones
gastroesophageal reflux disease (GERD) management
depends on severity- no therapy needed for infant who is thriving and has no respiratory infection. changes in feeding- (upright for 30) small frequent feedings, thickened feedings with rice cereal (if approved by MD). surgical interventions- nissen fundoplication
lactose intolerance s/s
diarrhea, bloating, abdominal pain
types of teratogens
diseases, drugs, alcohol, cigarettes, environmental hazards
redirection (discipline measure)
distract the child with another object
marital conflict and divorce
divorce is loss that needs to be grieved therapeutic play age appropriate, active listening
Single parent families
divorced, widowhood, childbirth, adoption among unmarried women
what are the four elements of negligence/malpractice
duty, breach of duty, damage, proximate cause
fetal monitoring
electronic fetal monitoring external and internal
separation anxiety
emerges around 6 months, can last 30 months (2.5 years)
parvovirus B19
erythema infectiosum, lace like rash, s/s- fever, malaise, joing pain, death to infant- failure of fetal red blood cell production followed by severe fetal anemia, hydrops (edema), heart failure tx- starch bath, pain meds
chlamydia pharm
erythromycin- babys eyes, azithromycin, amoxicillin, clindamycin
communication with children
establish a comfortable setting, introduce yourself, clarify your role and explain your role. use open ended questions when first conducting the assessment, maintain privacy and confidentiality, therapeutic communication techniques (verbal and nonverbal responses)
EDC
estimated date of confinement
nagels rule from EDD
estimated date of deliver subtract 7 days add 3 months subtract 1 year
EDD
estimated date of delivery
a nurse reacts with anger because a woman who did not have prenatal care explains that she does not see pregnancy as an illness requiring medical care. the nurses reaction demonstrates
ethnocentrism
reasoning (discipline measure)
explain why a behavior is not permitted
anemia s/s
fatigue, pale skin, muscles weakness, jaundice, polycythemia, petechia, purpura- polycythemia response to hypoxia caused increased RBC and HCT, jaundice suggests hemolysis, petechiae and purpura suggest bleeding tendency. failure to thrive suggest chronic disease or organ failure
Extracellular Fluid (ECF)
fluid is in intersitial space (surrounding the cells: lymph fluid), intravascularly (within the blood vessels or plasma), and Transcellularly (cerebrospinal fluid, pericardial fluid, pleural fluid, synovial fluid, sweat, digestive secretions). Child more likely to lose ECF than ICF throw illness, trauma, fever
planning for baby
folic acid, preconception care, progesterone
the mother of a child with celiac disease asks, "how long must he stay on this diet?" which response by the nurse is best
for the rest of his life
embryonic period week 4
forth week- embryo shape changes, neural tube close, face and upper respiratory tract begins
human papillomavirus (HPV)
gential warts (condylomas). direct sexual contact or perinatally through birth process. warts can resolve spontaneously. can occur during birth epithelial tumors of larynx in children, cervical dysplasia, cancer has zero effect on baby
ampicillin
group b streb (GBS)
carbon monoxide toxic ingestion s/s
headache, nausea, angina, seizure, coma
carbon monoxide s/s toxin ingestion
headache, nausea, angina, seizures, coma, hypoxia, visual disturbances, altered level of consciousness, cherry red lips and cheeks
Christian science
healing is divinely natural, not miraculous. use physician or midwife, may refuse medical tx, spiritual framework, exemptions from immunization
infant communication
hearing, seeing, smelling, tasting, touch. crying, babbling and cooing, single word production, name simple objects. high need for cuddling and security. happy vs angry voice, family vs stranger voice, separeation anxiety
ultrasound
high frequency sound waves allows observer to detect movement emtional responses- expectant mother, expectant father
adoptive families
high standards, lack of knowledge of the child's health history, when and how do you tell about adoption
placental hormones
human chorionic gonadotropin human placental lactogen estrogen progesterone relaxin
hormones
human chorionic gonadotropin (hCG), estrogen, progesterone, Human placental lactogen (hLG), relaxin
esophageal atresia with tracheoesophageal fistula (TEF) assessment findings
hx of polyhydramnios- mom too much amniotic fluid. may have other congenital defects. excessive salivation and drooling- respiratory distress. 3 C's- coughing, choking, cyanosis. increased respiratory distress after feeding. (has to be fixed or death)
Gastroesophageal reflux disease (GERD) assessment findings
hx of premature birth, BPD, CP, TEF, CF. excessive spitting up or forceful vomiting. irritability, heartburn. hematemesis, blood in stool. dysphagia. recurrent pneumonia. apnea or apparent life threatening event (ALTE)
fever, hyperventilation, burns, trauma, hemorrhage, diabetes factors to fluid loss
hyperpyrexia, WOB (work of breathing)
amniocentesis 2nd trimester
identify chromosomal or biochemical abnormalities done between 15-20 weeks
breasts body changes
increase in size- stretch marks may develop, highly vascular, nipple changes- increase in size, darken colostrum production
Failure to thrive
infant and child who falls below 5th percentile in weight. children whose weight or rate of weight gain is significantly below that of comparably aged children. can result from numerous organic or medical causes: chromosomal abnormalities, defects in the heart or lungs, CNS damage, exposure to toxins. also may result from multifunctional interplay between child temperament, parental expectations, maternal emotional state and sociodemographic factors
Neonatal mortality
infant deaths that occur in the first 28 days of life
sensory information
information obtained form sight, taste, touch, smell, and hearing
gastroesophageal reflux s/s in preschool/older children
intermittent emesis. chronic heartburn. regurgitation. esophagitis.
nursing communication with middle easterners
interpreters- should be from an acceptable region: information is typically shared only with friends and family, paternalism- a male's opinion or permission is often required
lactose intolerance
intolerance to lactose, a sensitivity disorder resulting in the inability to digest lactose from milk products, caused by inadequate production of or defect in the enzyme lactase
chronic illness- nursing
involve sibling or family in education about ill child, condition, treatment, physical changes, disabilities, expected diease progression
braxton hicks contractions
irregular contractions that occur throughout the pregnancy. contractions are infrequent and less noticeable during the first two trimesters. contractions are more frequent and more intense during the third trimester
failure to thrive- postnatal causes (nonorganic)
lack of maternal support, family conflict, poor parenting, difficult child, child abuse, feeding disorders
goals of chronic care family
keep normal, social, remain intact, achieve and maintain normalizaiton, maximize function throughout the course of the illness
a patient is in her third trimester of pregnancy. she tells the nurse that her posture seems to have changed and that she occasionally experiences low back pain
lordosis occurs as a result of the enlargement of the uterus, which decreases abdominal muscle tone and increase mobility of the pelvic joints, tilting the pelvis forward and resulting in lower back pain, a change in her posture, and shifting forward the center of gravity
hagar's sign
lower uterine segment can be flexed against the cervix
corrosive toxic ingestion
lye, bleach, ammonia, household cleaners edema RDS visible burns difficulty swallowing do not induce vomiting
endocrine changes to the body- parathyroid hormone
maintains calcium hemostasis, decreased during 1st trimester- normal during remainder of pregnancy
antepartum assessment and care- subsequent visits
maternal hearts and lungs as indicated, vital signs, weight, urinalysis (always), uterine size/fundal height (baby growing), Leopold's maneuvers- determines fetal position, fetal heart rate and activity, warning signs, ultrasound as indicated, lab testing- glucose screening, isoimmunization, group b strep, pelvic exams as indicated- usually first visit
separation anxiety- protest
may cry, scream, physical, searches for parents with their eyes and clings to parents, child is agitated, resist caregivers, cries, inconsolable
less interventional care
more choices for birth, low risk- no monitors, eating, family centered care, less moving the patient, mother and baby together.
cleft palate assessment findings
more common in females, usually occurs with cleft lip, palpate the newborns palate and ability to suck. opening not always detected in newborns
hypertrophic pyloric stenosis assessment finding
more common in males and twin males, projectile emesis
fetal period week 25 to 28
more likely to survive if born after 24th week, assumes a head down position
multigravida
more than one pregnancy
acetaminophen (Tylenol) toxic ingestion
most common medication poisoning in children
estimated date of delivery (EDD)
nagels rule sonogram
a nurse is assessing a pregnant woman during a prenatal visit. several presumptive indicators of pregnancy are documented.
nausea and vomiting, quickening, amenorrhea
salicylate (aspirin) s/s toxin ingestion
nausea, vomiting, thirst, hyperventilation, tinnitus, confusion, seizures, coma, respiratory failure, circulatory collapse, oliguria, bleeding tendencies, sweating, dehydration, fever, hyponatremia, hypokalemia, dehydration, hypoglycemia
substance abuse in pregnancy
negligence
malpractice
negligence of a professional person
nursing process and perinatal infections outcomes
neonate vital signs remain within normal range, neonate is free from signs and symptoms of infection
embryonic period germ layer- ectoderm
nervous system, skin, hair
dehydration
no tears, sunken fontanels/eyes, irritable, dark urine, increased heart rate, decreased blood pressure, prolonged cap refill
lead (plumpish) Tx toxin ingestion
oral/IV chelation, DMSA (succimer), EDTA
Roman Catholic
organ donation permitted
child with special needs
parent grieving may be long term, financial hardship, strain on marriage or partnership. need coping skills
Reduce the rising cost of health care costs
patient satisfaction, outcomes from falls (with injury), diagnosis related groups for fixed amount of money to cover services for specific Dx. HMO's PPO's Health insureance
competency
patients able to think through a situation and make rational decisions
identify the four requirements of informed consent
patients competence to consent, full disclosure of information, patients understanding of information, patient's voluntary consent
ultrasound 2nd and 3rd trimester- transabdominal
position on back, need full bladder during 2nd trimester, allow to urinate soon after structures located confirmation of fetal viability, evaluation of fetal anatomy, estimation of gestational age, assessment and comparison of fetal growth, determine location of placenta and umbilical, determine of fetal position, guide needle placement for procedures
list the positive indications of pregnancy
positive- fetal heart sounds, fetal movement felt by examiner, visualization of fetus
potential problems with adolescent parents
poverty, inability to seek higher educations, high infant mortality rates
potential problems of single parents
poverty, overwhelming child rearing responsibilities
how does the woman's perception of the baby change during pregnancy- 2nd trimester
preceives fetus as real and needing her protection
failure to thrive- prenatal causes
prematurity with or without complications, exposure to toxins, environmental influences, infection, placental abnormalities, maternal illness- HTN, preeclampsia, heart disease, anemia
gonorrhea tx
prenattally is ceftriaxone and azithromycin with test to cure amoxicillin ceftriaxone also given to infants to prevent ophthalmia neonatorum
a toddler is brought to the emergency room after ingesting an undetermined amount of drain cleaner. the nurse should expect to assist with which of the following first
prepare for intubation
stages of separation anxiety
protest, despair, detachment
Toxoplasmosis
protozoal infections- ingestion of raw or under cooked mean, contact with infected car feces (good hand washing), crosses placental barrier to the fetus. highest transmission in 3rd trimester, more severe effects in 1st trimester
birth centers
provided maternity care outside acute care settings for low risk pregnant women
external fetal monitoring advatages
provides more data than auscultation, provides a permanent reord that is printed or stored electonically, strip provides a graphic record for review, shows fetal response before, during, and after every contraction
nursing care for dying child/family
provind adequate pain control, care, privacy, information of the signs of imminent death and waht to expect in the immediate postmortem period, keep communicating with family, siblings need time and attention, respect privacy, allow the family to remain with the child
preparation
provision of information before procedures, treatments, or events
Maryland children's health programs (MCHP)
public health insurance programs, preventive health with Medicaid, CHIP program
fetal period week 13 to 16
rapid growth in length, head becomes smaller
alpha-fetoprotein screening (AFP)
rare, main protein in fetal plasma, increases with advancing gestational age of fetus but decrease after birth, screen for chromosomal anomalies or neural tube defects, should be done 15-22 week (most accurate 16-18 weeks 2nd trimester), screening only- abnormal results must be followed up with ultrasound and amniocentesis
Morbidity
ration of sick to well persons in a defined population
positive changes
signs that can be attributed only to the presence of the fetus
the primary benefit of a preconception class is to
reduce the risk of having a baby with a birth defect
external fetal monitoring limitations
reduced mobility, frequent maternal changes, may ne uncomfortable for patient, difficult to trace for women with thick abdominal fat pad, may divert attention from keeping herself from being confortable
coping strategies of families internal
relationship strategies- family group reliance, greater sharing together, role flexibility. cognitive strategies- normalizing, controlling the meaning of the problem by reframing ad passive appraisal, joint problem solving, gaining of information and knowledge. communication strategies- being open and honest, use of humor or laughter
ethics
rules or principles that govern conduct
TEF surgical complication
scaring, reflux, long recovery
empathy
seeing a situation from another persons perspective while remaining objective
Group B Streptococcus (GBS) infant complications
sepsis, pneumonia, meningitis (all can be late onset) C/S- wont pass to baby
the developmentally appropriate strategy for the nurse to use when performing preoperative teaching with a 10-year old is to
sequentially organize information
reactions in the family
situation crisis, stages of grief
fetal period week 29 to 32
skin pigmentaed according to race, had more subcutaneous fat, survival is good if born during this time, feel baby kick
Wharton's jelly
specialized connective tissue that protects blood vessels. prevents obstruction cause by pressure
fertilization
sperm enters ovum chemical signal prompts secondary oocyte to complete second meiotic division true moment of fertilization occurs as nuclei unite chromosomes pair up to produce diploid zygote each nucleus has 23 chromosomes = 46 total union of nuclei creates zygote
types of perinatal loss
spontaneous abortion (miscarriage), ectopic pregnancy, intrauterine fetal death (IUFD/stillbirth), fetal condition not compatible with life, neonatal death, maternal death
syphilis s/s
spontaneous abortion, still birth, prematurity, congential syphilis, enlarged liver/spleen, skin lesions, rash, osteitis, pneumonia, hepatitis
High risk families
substance abuse, teen parents, what support system? experiencing martial conflict, divorce, adolescent parents, affected by violence against one or more of the family members, involved with substance abuse, chronically ill child
substance abuse
substance has strong pull over parent, substance interrupts a child's normal growth and development. child at risk for emotional and health problems. child most likely to follow in parents path
rights of fetus vs right of mother
support mother. give all resources available
hydrocarbon tx toxin ingestion
support ventilation, administer O2, IV fluids
cleft palate management
surgical correction, identify alternate feeding devices- special nipple for a bottle, frequent burping, enlarged nipples. monitor for ear infections (more prone) 2 to 3 days after surgery should e able to take fluids. correct lip then palate
biliary atresia management
surgical intervention called the kasai procedure to divert bile flow to jejunum
pyloric stenosis management
surgical relief to the pyloric obstruction
placenta- metabolic
synthesis of glycogen, cholesterol, and fatty acids
which example describes how a nurse can display an open body posture
talking while the hands are freely moving
the purpose of discipline is to
teach a child how to effectively function in a society
cleft lip surgical S/S infection
temp, pain scale- flacc, o reeda, salt
the optimal time to prepare a toddler for a painful procedure is just before the procedure is performed
true
to listen with impartiality, nurses must hold their personal beliefs and values in abeyance
true
unintentional injuries are the leading cause of death in children aged 1-19 years
true
foramen ovale
the blood enters the right atrium. most of the blood passes directly into the left atrium through the second shunt. mixes with the small amount of blood returning from the lungs
what we say is often less important than how we say it
true
what is the difference among the three classifications: presumptive, probable, and positive indications or pregnancy
the difference among the indications is that presumptive indicators are least reliable because they can often be caused by other conditions; probable indicators are stronger evidence but still may have other causes; positive indicators are those caused only by pregnancy
4 weeks fetal development- parent know
the fetal heart begins to beat
parity
the number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation, not the nubmer of fetuses (twins) born. the numeric designation is not affected by whether the fetus is born alive or stillborn (showing no signs of life a birth
which nursing action indicates that the nurse understand the components of effective communications
the nurse asks an adolescent whether she can give her a hug
Christian
the way of Jesus
vernix caseosa
thick cheese substance. protects the body, covers skin to protect baby from constant exposure to amniotic fluid
hypertrophic pyloric stenosis definition
thickening and tightening of pylorus muscle causing an obstruction
basic guidelines for communication with children and families
touch, physical proximity and environment, listening, visual communication, tone of voice, body language, timing.
family structures
traditional, nontraditional, high risk
amniotic membranes and fluid
two fetal membranes, amnion (inner) and chorion (outer). protection growing fetus, derived from two sources. fetal urine and fluid transported from maternal blood (shock absorber) "bag of water" protects the growing fetus and promotes normal prenatal development. providing a stable temperature
fetal membranes and amniotic fluid
two fetal membranes- amnion (inner) and chorion (outer). protects growing fetus. derived from two sources- feta urine, fluid transported from maternal blood. shock absorber
Vomiting factors to fluid loss
viral, food intoleracnce, bacteria, illness, gerd, cold, gi obstruction, concussion, migraine, infections, obstructions, motion sickness, metabolic alterations, psycholgical alterations, association with diarreah, gastroenteritis, allergic reaction, side effects of medications, green emesis- bile, fecal odor indicates lower intestinal obstruction or peritonitis, bright red- blood has not been in contact with gastric juices. DX- CBC, rad, blood cx, abg
aspirin
vit k to stop bleeding
24 weeks fetal development- parent know
weight 1 lb, 10 oz. activity is increasing. fetal respiratory movement begins
BMI equations
weight in lbs x 703 divided by height in inches squared kg divided by meters squared (1 inch = 2.54cm) (cm divided by 100 = meters)
high maternal mortality rates
early recognition of pregnancy
research shows that the verbal content of a message conveys more than nonverbal communication
false
the nurse expresses empathy using similar words to restate what the speaker has just said
false
there is no link between children living in poverty and poorer health outcomes
false
touch communicates more meaning to a younger child than to an older child
false
when talking with toddlers, nurses should use proper technical terms for body parts and processes
false
communicating with families
family centered care emphasizes that the family is intimately involved in the care of the child. nurse respects the fmaily diversity, identify the foundational strengths, establish rapport, availability and openness to questions, family education and empowerment
an example of a family that is classified as high risk
family headed by adolescents
nuclear family
family headed by two parents who are motivated to learn about parenting
iron deficiency anemia s/s
fatigue, pale skin, weakness, jaundice (hemolysis), polycythemia (response to hypoxia causes increased RBC and HCT), petechiae/purpura (bleeding tendeny), failure to thrive (chronic diseases or organ failure)
conception
fertilization of ovum must occur within 24 hours after ovulation (14 days before start of next period) most sperm survive 1 to 2 days
12 weeks fetal development- parent know
fetal heartbeat may be heard by doppler device
fetal period week 17 to 20
fetal movement can be felt, changes in skin and hair- vernix, lanugo, brown fat, can see gender
how does the woman's perception of the baby change during pregnancy- 1st trimester
fetus seems vague and unreal, rather than seeming like a baby to her
potential problems in families with special needs children
financial hardship, marital stress, sibling resentment
assessment of influences on fetal development
genetic factors (DNA), teratogens, interaction of genetic and environmental factors
rubella
german measles airborne droplet or direct contact with nasopharyngeal secretions greatest risk in 1st trimester crosses placenta test for immunity and vaccinate live vaccine
Bad food for celiac disease
gluten: breads, rolls, bagels, bran, broth, cakes, cereal, cookies, hotdogs, pasta, pastries, pizza, enriched flour, white flour, matzo flour/meal, rye, fried chicken
minimum urinary output by age- preschooler and young school age
greater than 1 to 2 ml/kg/hr
minimum urinary output by age- infants and tolddlers
greater than 2 to 3 ml/kg/hr
auxiliary structures
grow simultaneously with fetus- placenta (gas exchange, waste), fetal membranes (sac of fluid), umbilical cord (life line)
fetal period week 21 to 24
growing and gaining weight, little subcutaneous fat, lungs producing surfactant, some gas exchange is possible
obesity
growing epidemic concern in the US. contributing factors- latch key kids (both parents working, kids alone at home), parental fear of increasing rate of abduction and abuse, more fast food restaurants and processed foods then ever. results- increase in diseases and conditions we've never seen before.
embryonic period week 7
growth and refinemet of all systems occur, face human looking, rudimentary skeleton
fetal period week 33 to 38
growth of all body systems continues, lots of subcutaneous fat, testes in scrotum, breast are enlarged, considered full term at 38 weeks gestation
gastrointestinal body changes
gum swelling- increased vascularity displacement of intestines-lateral and posterior (constipation) displacement of stomach- superior and lateral hemorrhoids- venous pressure/ congestion constipation- delayed intestinal motility, increased progesterone levels gallstone formation- delayed gallbladder emptying
a pregnant woman at 10 weeks of gestation exhibits the following signs of pregnancy during a routine prenatal check up. which ones would be categorized as probable signs of pregnancy
hCG in the urine, beast tenderness, hegar's sign
placenta- endocrine
hCG, progesterone (hormones), human chorionic somatomammotropin
embryonic period week 8
had definite human form, external genitalia begin to differentiate
lanugo
hair (fine hair) keeps oil on skin. help vernix caseosa adhere to the skin
a Muslim woman is admitted to the postpartum unit after delivering a baby girl. considering the cultural needs of this patient, what should be included in her plan of care
having only female nurses care for the patient
toddler communication
hearing, seeing, smelling, tasting, touch. two word combinations, turn talking in communication, "NO" security object separation/stranger anxiety high. dependent . short attention span.
cardiovascular system
heart and blood volume
nursing process and perinatal infections intervention
review prenatal and delivery record, provide eye prophylaxis, observe neonate for signs and symptoms of infection, monitor labs
which of the following foods would be appropriate for a 12 month old child with celiac disease
rice cereal
goals of chronic care child
keep normal, social, achieve and maintain normalizaiton, obtain the highest level of health and function possible (physically, emotionally, psychosocially)
gastroesophageal reflux complication of GER
malnourishment- failure to thrive. aspiration. pneumonia- wheezing, crackles. fluid/electrolyte imbalance. Barrett's- diplegia- cancer. FTT, apnea or ALTE (call 911). wheezing/asthma. pneumonias. Barrett's esophagus cancer surgical interventions- gastric fundus wrap around esophagus. avoid-spice, citrus, greasy
psychosocial adaption- 3rd trimester week 27 to 40+ teaching
managing symptoms- backpain, round ligament pain, indigestion, braxton hicks (not real labor), exercise and rest, traveling- after 36 weeks stay home, childbirth classes, hospital tour
when teaching the mother of a toddler diagnosed with lead poisoning, which of the following should the nurse include as the most serious complication if the condition goes untreated
neurologic deficits
Labor, Delivery, Postpartum room (LDRP)
one room for all care, infant and mother always together
gastroesophageal reflux in children
retrograde passage of gastric material into the esophagus. allergies, positioning, stress, coughing, impairment, disease, infection, after meals, GERD is a more severe and chronic from-irritability, back arching, esophagitis, failure to thrive
TEF surgical ER/ Pharm
thoracotomy, pre op- airway patency, prevention of pneumoina and gastric or blind pouch decompression. Post op- NG tube, pt/ot for feedings broad spectrum antibiotics- aspiration pneumonia
choose the appropriate infant care teaching for the woman who gave birth by cesarean because of active herpes
thoroughly wash your hands before handling the infant
a newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. the physician has prescribed IV fluids of dextrose water with sodium and potassium. the baby's admitting potassium level Is 3.4 mEq/l. the nurse should
verify the infant has urinated
5 month fetus
vernix and lanugo appear, legs lengthen, sebaceous glands appear
nursing communication with southeast Asians
voice tone- soft voice, eye contact- no prolonged eye contact
moderate dehydration
5 to 10% of body weight (50-100ml/kg of fluid loss) exp 80lbs (80lbs x 5%) = 4lbs to (80lbs x 10%)= 8lbs
minimum urinary output by age- school age and adolescents
0.5 to 1 ml/kg/hr
third trimester
13 weeks
maintenance fluid requirements in 24 hour for less than 10 kg child.
100ml/kg
change in body systems- reproductive- uterus
10ml to 5000ml growth pattern- weeks gestation roughly equal to uterine height blood flow- increases dramatically 450 to 650 ml/min up too 1200ml/min Braxton hicks contractions- irregular contraction throughout pregnancy
at what point in gestation is it possible to hear fetal heart sounds using a doppler
12 weeks
fetal sex apparent by external genitalia
12 weeks
second trimester
12 weeks
uterus can first be palpated above the symphysis pubis
12 weeks
first trimester
13 weeks
maintenance fluid requirements in 24 hour for greater than 20 kg child
1500ml + 20ml/kg for each additional kg over 20kg exp- 24kg pt (20kg = 1500ml) (1500) + (20ml x 4kg) = 1500 + 80 = 1580ml
fundus can be palpated about halfway between symphysis pubis and umbilicus
16 weeks
acetaminophen (Tylenol) toxin ingestion s/s
1st 24 hours: malaise, nausea, vomiting, sweating, pallor, weakness 2nd 24 hours: rise in liver enzymes/ bilirubin, right upper quadrant pain, prolonged prothrombin time 3 to 7 days: jaundice, liver necrosis, signs of hepatic failure 5 to 7 days: recovery or progression to death, sodium restricted high calorie, high protein diet.
Gastroesophageal reflux pharm
H2 antagonist to reduce gastric acid level- tagament (cimetidine), Pepcid (famotidine), zantac (ranitidine) PPI mucosal protectants proton pump inhibitors to block acid production- protonix (pantoeprazole), Maalox (calcium carbonate) prokinetics to stimulate the gastric emptying and improve tone
use nageles rule to calc the EDD of Feb 4, 2014 last normal menstrual cycle date
2/4/14 + 7 days = 2/11/14 - 3 months = 11/11/13 + 1 year = 11/11/14 Nov. 11, 2014
fundus is at the level of umbilicus
20 weeks
fetal movements felt by mother
20 weeks 16-24 weeks
5 month pregnant fetus development
20 weeks. can see gender. fetal movement can be felt. changes in skin and heir (vernix- thick cheese substance/ lanugo- hair/ brown fat) mother feels movement (quickening). baby develops a regular schedule of sleeping, sucking, kicking. hands can grasp. baby assumes a fav position in utero. vernix protects the body and lanugo keeps oil on skin. head, hair, eyebrows, eyelashes present. size of a banana fetal movement feels like fluttering or butterflies. brown fat is heat producing fat deposited on the back of the neck, behind the sternum, around kidneys- maintain temp
fetal circulatory shunts to close after birth
3 holes keep blood form lungs and liver. divert blood. 1st- ductus venosus. 2nd- foramen ovale. 3rd- ductus arteriosus
umbilical cord- fetal circulatory circuit
3 holes to keep blood from lungs and liver, three shunts divert blood
trimesters
3 total first trimester- 13 weeks second trimester- 12 weeks third trimester- 13 weeks
7 months pregnant fetal development
28 weeks. more likely to survive if born after 24 weeks. assumes a head down position. eyes begin to open and close. baby can breathe at this time. surfactant needed for breathing at birth is formed. baby is two thirds its final size. size of an eggplant. with maturation of the lungs, pulmonary capillaries, central nervous system. plumper/smoother skin. blood formation shifts from the spleen to the bone marrow
closure of the neural tube
4 weeks
consent vs assent
7 to 12 year old research study/aware of what is going to happen to them descent 13-18 years old- not to continue on with care
40lb child urinated 15 ml in 3 hours. is this enough
40lb to kg 40 divided by 2.2 is 18.18kg 15ml divided by 3 hours is 5 ml of urine per hour. average is 1-2 ml/kg 18.18(1) to 18.18(2) for range 18.18 to 36ml per hour. child need fluids. not enough urine output.
Toxic ingestion assessments
5 W (Who, what, when, where, why). A- airway B-Breathing C-circulation D-disability neurological assessment E-exposure F-full set of vitals G-give comfort measures H-head to toe assessment I-inspect posterior surfaces
toxic ingestion assessment
5 W's- who, what, when, where, why symptoms may be difficult to recognize, but can be life threatening primary assessment- ABCDE secondary assessment- FGHI
varicella zoster immune globulin (VZIG)
5 days before birth or 2 days after birth- needs to be given within 72 hours live vaccine- mother cant get while pregnate
anemia: iron deficiency
6 months, 2 years, adolescents, multisystem effects, decreased oxygen carrying capacity of blood- decreased oxygen to cells
iron deficiency anemia in children
6 months- baby starts to eat 2 years- no phase, picky eater adolescents- body image, puberty, standards is the most common cause of anemia during infancy, childhood, adolescense
external ear development begins
6 weeks
toxin ingestion
6 years of age most susceptible, prepare for intubation with most toxins
2 months pregnant fetus development
8 weeks, has definite human form, external genitalia begin to differentiate. all body organs are formed. size of a raspberry embryo has a definite human form, refinements to all systems continues. ears are low set. external genitalia begin to differentiate
use nageles rule to calc the EDD of Aug 2, 2013 last normal menstrual cycle date
9/2/13 + 7 days = 9/9/13 - 3 months = 5/9/13 + 1 year = 5/9/14 May 9 2014
vomiting and diarrhea assessment
ACCT (amount, color, consistency, time/duration), is it think? weight of a diaper. stool and urine counts. teach S/S of diarrhea and dehydration- PEWS (pediatric early warning score) how is the kid doing, q4 hour vitals, q4 hour pews
common chronic conditions of childhood
ADHD, ADD, asthma (reactive airway disease), autism, bleeding disorders (hemophilia), bronchopulmonary dysplasia, cancer, cardiac disorders, cerebral palsy, chronic renal failure, congenital heart disease, cystic fibrosis, developmental delay, DM, Downs, hepatitis, HIV, Aids, hydrocephalus, inborn error of metabolism, juvenile arthritis, lupus, intellectual impairments, muscular dystrophy, neural tube defects, phenylketonuria, seizure disorders, sickle cell disease
best for celiac disease
CORN! whole family participate in diet, high protein, fresh veggies
Mormon (the church of Jesus Christ or latter day saints
Call clergy, abortion opposed unless mom's life is threatened, natural birth control
obesity related disease in children
DM type 1 and 2 (type 2 increasing), dyslipidemia, HTN, cardiovascular disease, obstructive sleep apnea, fatty liver, orthopedic complications, osteoarthritis of the joints
obesity associated comorbidities
DM type 1 and 2 (type 2 increasing), dyslipidemia, HTN, cardiovascular disease, obstructive sleep apnea, fatty liver, orthopedic complications, osteoarthritis of the joints. DM, dyslipidemia, HTN, CV disease, obstructive sleep apnea, pulmonary embolism, hepatic steatosis (fatty liver), orthopedic complications
a pregnant woman with four children reports the following obstetric history: a stillbirth at 32 weeks of gestation, triplets (2 sons and a daughter) born via cesarean section at 30 weeks gestation, a spontaneous abortion at 8 weeks of gestation, a daughter born vaginally at 39 weeks gestation. GTPAL
G-5 T-1 P-2 A-1 L-4
salicylate (aspirin) toxin ingestion
GI, CNS, hematopoietic, metabolic, risk for bleeding to death, antidote vit k
Dehydration from systems
GI- vomiting, diarrhea, pyloric stenosis, malabsorption Endocrine- fever, DM, cystic fibrosis Skin- burns, sweating Lungs- tachypnea Kidney-renal failure Heart- heart failure Mild vs moderate vs severe
confidentiality
HIPAA
esophageal atresia with tracheoesophageal fistula (TEF)
HX of polyhydramnios (mom too much amniotic fluid) excessive salivation and drooling can lead to respiratory distress. increased respiratory distress after feeding. atresia- absence or narrow opening. fistula- abnormal connection between organs. congenital malformation in which the esophagus terminates before it reaches the stomach and or a fistula is present that forms an unnatural connection between the esophagus and the trachea. esophagus ends in a blind pouch and there is a distal tracheoesophageal fistula
hypertrophic pyloric stenosis nursing side
HX- infants feeding schedule with type, amount, frequency of fluid taken compare to vomiting assessment which includes frequency, amount, color, consistency, as well as projection
out of the 3 types of dehydration, which is most common in children
Isonatremic dehydration occurs as a result of equal solute and water losses, thus maintaining a normal sodium concentration of 135-145 electrolytes and water loss happens in the same proportions as they exist in the body. serum sodium stays normal
authoritarian parents permit compromises about rules
false
multigravida
a woman who has had two or more pregnancies
nulligravida
a woman who has never been pregnant
nullipara
a woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks of gestation or more
gravidity
a woman who is or has been pregnant regardless of duration of the pregnancy
primigravida
a woman who is pregnant for the first time
it is better not to tell a child how long a painful or invasive procedure will take
false
probable indications of pregnancy
abdominal enlargement, goodell's sign (soft cervix), uterine changes- ballottement (feel fetus), Braxton hicks contractions, palpable fetal outline, positive pregnancy test, chadwick's sign on cervix
fistula
abnormal connection between organs
fistula (TEF)
abnormal connection between organs
infertility pregnancy loss
abnormalities of fetal chromosomes, abnormalities of the cervix or uterus, congenital, trauma/surgery, lesions, endocrine abnormalities, immunologic factors, environmental agents, infections, STD's, advance age greater than 35, miscarriage, get pregnant cant hold
mens factors contributing to infertility
abnormalities of the sperm, abnormal erections, abnormal ejaculations, abnormal seminal fluid
failure to thrive nonorganic
absence of history contributing to a psychosocial cause
which of the following would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration
absence of tear formation
atresia
absence or narrow opening
atresia (TEF)
absence or narrow opening
potential complication of amniocentesis
amniotic fluid embolism, hemorrhage, infection, abruption placentae, placenta or umbilical cord trauma, premature labor, bladder or intestinal puncture (of baby), RH isoimmunization, intrauterine fetal death, amnionitis, injury from needle puncture, amniotic fluid leakage, bleeding, spontaneous abortion, premature birth
amniocentesis
amniotic fluid obtained by inserting a needle through the abdominal and uterine walls indicated for woman 35 and older and women with family history of chromosomal or neural tube defect or inborn errors of metabolism contraindicated in anterior uterine wall is completely covered by placenta or amniotic fluid level Is insufficient
celiac disease
an inborn error of metabolism characterized by the inability to break down gliadin gliadin is a protein found in rye, oats, barley, wheat
the parents report that their 1 day old is drooling and having choking episodes with excessive amount of mucus and skin color changes during feedings. the nurse should contact the primary care provider to further assess the baby and request an order for which of the following
an x-ray with orogastric catheter placement
cleft lip post op
apply elbow restraints to prevent infant pulling at repair site- neurovascular, skin, rom assessments needed. keep incision clean and dry- NS, peroxide, antibiotics. maintain airway patency- aspirate excessive secretions. pain management (FLACC scale) and prevent crying. s/s of infection- O REEDA, SALT, Temp,
once a procedure is completed, it should not be discussed with the child
false
Home births
at home, familiar setting with family support
active listening
attending to another person to gain an understanding of the actual and implied message
positive indications of pregnancy
auscultation of fetal heart sounds, fetal movement felt by provider- abd assessment, ultrasound- see baby
professional boundaries- signs of under involvement
avoiding child or family, calling in sick to avoid taking care of family or child, trading assignments to avoid taking care of a child or family, spending less time with a particular child (know your limits)
esophageal atresia with tracheoesophageal fistula pharm
broad spectrum antibiotics since aspiration pneumonia is inevitable
38+ weeks fetal development- parent know
baby fills total uterus. baby gets antibodies from mother
increased interventions improving mother infant bonding
baby friendly- encourage breast feeding, skin to skin faster, delayed bathing
32 weeks fetal development- parent know
baby has fingernails and toenails. subcutaneous fat is being laid down. baby appears less red and wrinkled
16 weeks fetal development- parent know
baby's sex can be seen. although thin, the fetus looks like a baby
decreasing infant mortality rates
back to sleep campaign
Group B streptococcus (GBS)
bacterial infection found in lower GI or urogenital tract. swab rectum and vag at first apt. transmitted during delivery. IV antibiotics (ampicillin) recommended before delivery if GBS + or status unknown- protect baby first. (4 hours prior to delivery)
gentamicin
bacterial infections (used in combination with penicillin)
therapeutic relationship
balance between appropriate involvement and professional separation when relating to children and their families
evaluating fetal monitoring strips
baseline fetal heart rate baseline fetal heart rate variability peridic patters- accelerations and decelerations (early, late, variable)
separation anxiety- despair
become inactive, withdraws from others, quiet, uncommunicative, may regress to earlier behavior or apathetic. child feels hopeless and becomes quiet, withdrawn, apathetic.
separation anxiety- detachment
becomes interested in environment, interacts with strangers or familiar caregivers, appears happy, and if parents reappear, the child may ignore them. child becomes interested in the environment, plays and seems to form relationships with caregivers and other children
the parent of an infant with a cleft palate asks when the palate will be repaired. the nurse responds by stating the repair is done at the following times
before speech development
a nurse is caring for a 10 month old weighing 8.0kg, who was admitted for dehydration. the infant has vomited five times in the last three hours and has had no wet diapers in the last 8 hours. which of the following orders received should the nurse question
begin an IV line and administer a fluid bolus with dextrose 10%
fatalism
belief that events are predestined
Four of the most important ethical principles are
beneficence, nonmaleficence, autonomy, justice
syphilis tx
benzathine penicillin G
ethical concepts
best course of action in a certain situation, right and reasonable, ANA
documentation
best evidence that a standard of care had been maintained
para
birth after 20 weeks gestation, regardless if live birth or stillborn, not number of fetuses can be broken into term, preterm, abortion, living
foods bad for celiac disease
breads/rolls, bagels, bran, broth, cakes, cereal, cookies, hotdogs, pasta, pastries, pizza, enriched flour, white flour, matzo flour/meal, rye, fried chicken
professional boundaries- signs of over involvement
buying gifts for individual children or families, providing home or cell numbers, lending or borrowing money, visiting or spending time with the child or family during off duty time, competing with other staff members for the child's or families affection
how can family center care be achieved
by creating partnerships with families and by recognizing that families have the right to fully participate in planning, implementing, and evaluating a child's care
closed off parents (communication)
can just be tired, need a break, need to eat, need someone to listen to them, to vent
ultrasound disadvantages
cannot identify all fetal structural defects cost if no insurance
musculoskeletal changes to the body
calcium storage- increase absorption, high fetal demands, no loss of bone density. separation of rectus abdominus muscles- varies from slight to severe postural changes- increased mobility of pelvic ligaments, pelvic instability (wide stance), lumbosacral curvature, stooped shoulder appearance (weight of breasts pull shoulders forward)
cardiovascular body changes
cardiac hypertrophy and displacement vascular resistance changes increased blood volume blood pressure- supine hypotension (baby weight on vena cava) increased cardiac output- increased heart rate increased fibrinogen levels- hypercoagulable state (great for delivery, bad after- risk for DVT, PE, Clots) heart dose enlarge- 50% more blood volume not normal to have high BP during pregnancy
which statement about family centered care maternity care is correct
care is adapted to meet the physical and psychologic needs of the family
umbilical arteries (2)
carries deoxygenated blood two arteries that carry blood high in carbon dioxide and other waste products away from the fetus to the placenta
umbilical arteries (2)
carries deoxygenated blood and waste products from the fetus to the placenta
umbilical vein
carries oxygenated blood carries freshly oxygenated and nutrient rich blood from the placenta back to the fetus
umbilical vein
carries oxygenated blood and nutrients from the placenta to the fetus
a practice model that uses a systematic approach to identify specific patients and manage patient care is
case management
Family centered maternity care
childbirth is usually a normal, healthy event. childbirth affects the entire family/ family restructuring is required. families involved in making decisions about care, given adequate information and professional support
placenta- fetal component
circulation- fetal heart
esophageal atresia with tracheoesophageal fistula (TEF) assessment finding
classic signs: 3 C's- couching, choking, cyanosis. excessive oral secretions, coughing, choking, and respiratory distress. may have congenital heart disease, GU analomies, possible Vater syndrome (vertebral defects), anorectal, TEF, esophageal atresia and renal analomies
potential problems of same sex parents
conflicts with community values
rubella s/s
congenital heart disease, IUGR, cataracts, mental retardation, hearing impairments
5 leading causes of infant mortality
congenital malformations, deformations, chromosome abnormalities, disorders related to low birthweights, sudden infant death syndrome, unintentional injury
Wharton's jelly
connective tissue that prevents compression of the blood vessels to ensure continued nourishment of the embryo or fetus
the pregnant woman who becomes infected with chickenpox should be taught to report promptly
cough or dyspnea
When esophagus is closed off from trachea and stomach (TEF)
coughing, chocking, cyanosis
Human papillomavirus (HPV)
cream or gel, cryotherapy, electrocautery, vaccine,
adolescents communication
create theories and generate many explanations for situations. communicate like adults. "imaginary audience" need independence.
middle childhood death concept
death as sad and irreversible but not necessarily inevitable
failure to thrive- adverse outcomes
decreased cognitive function, developmental delays, social problems, lower IQ score related to poor nutrition
endocrine changes to the body- pancreas
decreased glucose levels- 10 to 20% lower, hypoglycemia precautions, decreased insulin sensitivity-later half of pregnancy
discipline
designed to teach a child how to effectively function in a society
placental hormones- relaxin
detectable in maternal serum by time of first missed menses, inhibits uterine activity, aids in softening of cervix, relaxes pelvic joints
amniocentesis 3rd trimester
determine fetal lung maturity L/S ration "lacithin/sphingomyelin" test for fetal lung maturation >2:1 surfactant adequate phosphatidylglycerol (PG)- another phospholipid surfactant evaluate fetal hemolytic disease
monozygotic twins (identical)
develop from one single fertilized ovum- zygote divides into two separate cells (embryos) at first cleavage division. same sex hand have same appearance. placenta and sac vary by timing of division. occurs randomly. not affected by reproductive techniques.
Toddlers (developmental approaches)
developing a sense of autonomy, egocentric, control is a major issues- need rituals/routine, obtain childs routine from parents, give choices
placenta- maternal component
development- 3 decidual layers, circulation- exchange of substances between mother and baby in intervillous space
lead (plumbism) toxic ingestion s/s
developmental delays, abdominal pain, neurologic changes, irritability, impair cognitive function
lead (plumpish) s/s toxin ingestion
developmental delays, abdominal pains, neurologic changes, irritability, impaired cognitive functions, lethargy, hyperactivity, cognitive and perceptual motor difficulties, clumsiness, death, anemia, anorexia, N/V, constipation,
potential problems of blended families
differences in parenting styles, values, discipline
embryonic period
differentiation of cells (function), development of specialized structures, teratogens can damage developing structures, prenatal growth and development proceed in patterns
embryonic period germ layer- endoderm
digestive system, lungs, urinary tract, vital organs (pancreas, liver)
urinary body changes
dilated ureters and renal pelvis increased glomerular filtration rate and renal plasma flow- increased glycosuria, medium for bacteria growth urinary frequency- stress incontinence, nocturia prone to UTI
parental reaction depends on how acute/serious the situation is
disbelief- when illness is serious or sudden, anger, guilt, both. demonstrate fear, anxiety, frustration, signs or depression- when acute phase is over
a patient is 14 weeks pregnant. she calls the prenatal clinic to report that she noticed slight, painless spotting this more. she reveals that she did have intercourse with her partner the night before
discuss cervical and vaginal friability and increased vascularity; makes the vagina and cervix softer and more dilcate so spotting after intercourse is expected; caution that any bleeding should be reported so it can be evaluated
a patient is 3 months pregnant. she tells the nurse that she is worried because a friend told her that vaginal and bladder infections are more common during pregnancy. she wants to know if this could be true and if so why
discuss impact of increased vaginal secretions and impact of stasis of urine that contains nutrients and has a high pH; review prevention measures at this time
cleft lip surgical correction
done early in the first few months of life. can be prolonged several months (24 hour recovery) keep incision clean and dry with NS, peroxide, antibiotics. maintain airway patency- aspirate excessive secretions. pain management and prevent crying. NONO elbow restraints- neurovascular, skin, ROM assessments
chorionic villus sampling (CVS)
dx fetal chromosome or metabolic abnormalities, indicated for woman who are at high risk for genetic anomalies dx from fetal cells, preformed transcervical or transabdominal between 10-13 weeks, does not detect neural tube defects, test can detect more than 200 disorders (downs, tay sachs, sickle cell), lithotomy position
embryonic period Germ layers
ectoderm (outer layer) mesoderm (middle layer) endoderm (inner layer)
corrosives s/s toxin ingestion
edema, visible burns, difficulty swallowing, severe chemical burns of mouth, throat, esophagus. splash burns to eyes and skin. whitish burns of mouth and pharynx, edema, difficulty swallowing, drooling, respiratory distress, pain, residual difficulty swallowing, severe burns causing perforation can lead to vascular collapse and shock
teratogens
effects most serious when structure is forming, susceptibility to harm is influenced by genetic makeup of mother and embryo, same defect can be caused by differnet teratogens, one teratogen can cause different defects, embryo can be affected by fathers exposure to teratogen, some effects not apparent until later in life
Coping
efforts directed toward managing or solving various events, problems, or stressors
how do we facilitate family centered care
empower mother, include family in teaching
gonorrhea side effects
endocervicitis and weakness of fetal membrane increase risk for premature rupture, preterm labor
cytomegalovirus (CMV) infant s/s
enlarged spleen and liver, CNS abnormalities, jaundice, chorioretinitis, growth restrictions, hearing loss
endocrine changes to the body- thyroid gland
enlarges, increased basal metabolic rate- up to 25%, increased T4- return to normal in later pregnancy, essential for fetal brain development check thyroid level when dx with pregnancy
an appropriate time to teach a 4-year old about surgery is immediately after the parents have gone home
false
an authoritarian parent discusses the household rules with the child
false
psychosocial adaptation- 1st trimester week 1 to 13 teaching
exercise and rest (ran before can run still), nutrition- manageing nausea and vomiting, managing heartburn, avoid teratogen exposure- smoking, drugs, alcohol, include prescription medicaitons, fetal growth and development, sexual activity- ok unless complications, danger signs- bleeding, cramping, pain, s/s dehydration
hydrocarbons toxin ingestion
exp- gasoline, mineral oil detect: suspected base on odor of breath and clothing
multigenerational families
extended family consists of members from three or more generations living under one roof. boomerang familie
28 weeks fetal development- parent know
eyes begin to open and close. baby can breathe at this time. surfactant needed for breathing at birth is formed. baby is two thirds its final size
embryonic period week 6
eyes continue to develop, heart finishes development
a child with a hearing impairment needs to have an arm cast. what can the nurse do to facilitate communication with the child throughout the cast application process
face the child when speaking
cleft palate
failure of the palate to fuse during embryonic development. the defect may be unilateral or bilateral and varies from a split uvula to a complete opening of the hard and soft palate.
cleft lip
failure of the upper lip to fuse during embryonic development. can be unilateral or bilateral and varies from notching or one side of the lip to a compete opening between the lip and nose. the more extensive the defect the more oral facial and related structures are involved.
Negligence
failure to act in the way a reasonable, prudent person of a similar background would act in a similar circumstance
obstetrical nurse legal ethical issues
failure to follow standards of care, to communicate, follow the chain of command
failure to thrive organic
failure to gain weight secondary to physical factors/ diseases
African American women have lower maternal mortality rates than Caucasian women
false
Nagel's rule from LMP
first day of LMP (last menstrual period) add 7 days subtract 3 months add 1 year
yolk sac
first few weeks of life, nourished by the sac. provides nutrients and blood cells until the placenta fully forms
primigravida
first pregnancy
hypertrophic pyloric stenosis
first thought- reflux but persistent. results when the circular area of muscle surrounding the pylorus hypertrophies and obstructs gastric emptying.
pyloric stenosis assessment finding
forceful vomiting- occurring 30 to 60 minutes after feedings. constant hunger. olive shaped mass palpated when stomach is empty. colicky pain. abdominal distention
Blended families
formed when single, divorced, or widowed parents bring children from a previous union into their new relationship. contemporary family- yours/mine/ours. discipline often causes family conflict
Birth center
freestanding, antepartum, intrapartum, postpartum, newborn care- low risk mothers, midwifes
fertilization is complete when
fusion of the sperm and ovum nuclei occurs
placenta
gas exchage and waste. thick, disk shaped, major function: metabolic synthesis of glycogen, cholesterol, fatty acids Transfer of substances between mother and fetus- gas exchange, nutrient transfer, waste removal (carbon dioxide, urea, uric acid, bilirubin), antibody transfer, transfer of maternal hormones, glucose, fatty acids, electrolytes, vitamins endocrine- HCG, progesterone (hormones)/ if male testosterone, human chorionic somatomammotropin. no blood mixing. maternal component- development: 3 decidual layers. circulation: exchange of substance between mother and baby in intervillous space fetal component- circulation fetal heart
surfactant
gas exchange in lungs. needed for breathing at birth
placenta- transfer of substances between mother and fetus
gas exchange, nutrient transfer, waste removal, antibody transfer, transfer of maternal hormones
hydrocarbons toxic ingestion
gasoline, kerosene, mineral oil detection- suspected base on odor of breath and clothing s/s- will display signs of respiratory distress or may vomit
potential problems of multigenerational families
generational conflicts
consequences (discipline measure)
helps children see the direct result of their misbehavior
hep B + tx
hep B immune globulin given with in 12 hours of birth and hep B vaccine at birth then 1 month then 6 months early bath before injections and procedures
hep B - tx
hep B vacine at birth then 1 month then 6 months
common for cleft lip/palate due to
heredity, decreased folic acid, smoking, ETOH
common to cleft lip and cleft palate
heredity, dietary factors- decreased folic acid, risk factors- exposure to teratogens, maternal intake of Dilantin, alcohol, cocaine, smoking
narcotic overdoses- heroin and opioid epidemic toxic ingestions
heroin and fentanyl- a powerful synthetic opioid
carbon monoxide toxic ingestion source
household fires, improperly vented automobiles, furnaces
psychosocial adaptions- 2nd trimester week 14 to 26 teaching
hygiene, activing and sleep- sleep positions, comfortable positions increasingly difficult, sexual activing- complications, body changes- 14 to 26 weeks
integumentary body changes
hyperactive sweat glands- feel warmer and perspire more hyperactive sebaceous glands- increased acne hair growth- grows more rapidly, less hair loss hyperpigmentation- nipples, areola, cervix, vagina, vulva change color, melasma, linea nigra striae gravidarum- stretch marks- dna
obesity precursor
hyperlipidemia, sleep apnea, cholelithiasis (gallstones), orthopedic problems, hypertension, diabetes, psychosocial difficulties- self esteem, body image
antepartum assessment and care- preconception
idnetifies any problems before pregnancy occurs- appropriate treatment if necessary, exposure to teratogens, teach health behaviors that result in successful pregnancy, obtain complete history and physical-offers baseline, initiate folic acid- 400 to 800 mcg daily in all women of childbearing age, decreases risk of neural tube defects in the fetus
embryonic period week 2
implantation complete
placenta
implantation. endocrine gland produces four hormones to maintain the fetus. metabolic function for respiration, nutrition, excretion, storage
lead (plumbism) toxic ingestion- source
imported objects (toys, meds, candy), foods, paint,
failure to thrive- organic
in addition to an underlying condition it can be due to inadequate caloric intake, inability to retain calories or increased losses (emesis/diarrhea), faiure to gain weight secondary to physical factors/ disease
Erythromycin
in infant eyes to prevent infection of chlamydia and gonorrhea
infertility
inability to conceive after 1 year of regular intercourse without contraception
communicating with families
include all family members- facilitate family centered care and trust. encourage the families to keep a journal or write down questions to ask. remain nonjudegmental- respect diversity. encourage feedback, follow through with actions or requests. define and problem solve together.
full disclosure and understanding
includes the treatment purpose and expected results, risks, side effects, benefits, other treatments
endocrine changes to the body-adrenal glands
increased cortisol level- regulate protein and carbohydrate metabolism, increased secretion of aldosterone- reabsorption of excess sodium
Hep B s/s
increased incidence of prematurity, low birth weight, neonatal death, at risk for acute infection in mother has hep B during preg. or is chronic carrier for hep B surface antigen.
respiratory body changes
increased oxygen consumption- hyperventilation decreased airway resistance increased vascularity- nasal stuffiness, epistaxis, decreased lung capacity- upward displacement of diaphragm increased chest circumference thoracic breathing deeper breathes
psychosocial adaptions- 3rd trimester week 27 to 40+
increased vulnerability, increased dependency (on support), preparation for children (natural vs drugs)- nesting, birth plan, danger signs- preterm labor, UTI, vaginal bleeding, severe n/v, severe edema
placental hormones- human placental lactogen
increases availability of glucose for fetus- reduces maternal metabolism of glucose allowing transport to the fetus
an 8-year-old child hit by a car has been in the intensive care unit (ICU) for a week. she has a lengthy recovery ahead. both parents have been at her side since the injury. they have not been properly eating and look exhausted. an appropriate nursing diagnosis for this family would be
ineffective family health maintenance management related to the situational crisis.
impaired nutrition possible dx
ineffective infant feeding pattern- failure to thrive. imbalance nutrition- decreased electrolytes/ dehydration. acute pain. impaired skin integrity. caregiver role strain- teaching, support groups. knowledge deficit- lots of learning: preop post op
legal concepts
informed consent- age of consent, competence, full disclosure and understanding, appropriate interpretation services
toxic ingestion
ingestion of or exposure to toxic substances, most occur in the child's home or homes of relatives/friends, toxic substance are ingested (most common) or inhaled, children less than 6 years of age most susceptible
gluten- celiac disease
is a general term that refers to the storage proteins found in wheat, barley, rye. requires dietary modifications to prevent chronic maldigestion and malabsorption
torch infections
is a medical acronym for a set of perinatal infections. infections can lead to severe fetal anomalies or even fetal loss. group of viral, bacterial, and protozoan infections that enter the fetal bloodstream trans placentally via the chrionic villi
effective communication
is based on honesty , caring, respect, and a direct approach. can empower children in situations where children are experiencing a loss of control and diminished autonomy
severe dehydration
is greater than 10% body weight loss, tachycardic, bradycardic in most severe cases, thread pulses, rapid and deep RR, markedly decreased BP as a sign of Hypovolemic shock, apathetic, lethargic, unconscious, drinks poorly or unable to drink. parched mucosa, markedly depressed anterior fontanel, markedly sunken eyes with absent tears, prolonged cap refill minimal; extremities cold, mottled or cyanotic, tenting for skin turgor, minimal urine output
minimal to no dehydration
is less than 3% weight loss with no S/S
mild to moderate dehydration
is less than 5 to 10% of weight loss with normal to increased weak pulses, normal to fast RR, fatigued, restless, irritable, thristy and eager to drink, dry mucosa, sunken anterior fontanel, slightly sunken eyes with decreased tears, prolonged cap refill with cold extremities, prolonged skin turgor recoil, decreased/concentrated urine
Chronic illness
is long term, persisting more than 3 months, does not spontaneously resolve, usually without complete cure, frequently has residual characteristics that limit activities of daily living, requires adaptation or special assistance
cleft palate surgical correction
is typically done after the lip repair, during the first year or life. older children who have not had cleft lip or palate repair is early childhood sometimes have both lip and palate repair done simultaneously
the mother tells the nurse that the diagnosis of colic upsets her because she knows her infant will continue to have colicky pain which of the following responses by the nurse would be most appropriate
it can be difficult to listen to your baby cry so long and so long, so try to make sure that you get some free time away
a woman's last menstrual period (LMP) began on September 10, 2013 and it ends on September 15, 2013. use nageles rule, the estimated date of birth would be
june 14, 2014
biliary atresia- surgical interventions
kasai procedure that diverts flow of bile to jejunum. temporary fix until the child grows and develops or when a liver transplant is needed. can use adult liver in children.
perinatal loss nursing considerations
keep pt and family informed, recognize meaning of loss to family, provide support, manage own feelings of loss, prepare the family about the babies look, separate loss family from newborn families, use univeral sign for loss, pictures of the baby for parents, memory box, assisting with the grieving process
BMI 70 kg and 157 cm
kg divided by meters squared first change 157 cm into meters by dividing by 100. 157 divided by 100 is 1.57 70kg divided by 1.57 squared is 28.3 or 28
BMI calculation
kg divided by meters squared (1 in = 2.54cm) (cm divided by 100 = meters)
Labor and Delivery Room (LDR)
labor, birth, recovery in one room. transfer to postpartum when ready, keep mom and baby together
dysfunctional families
lack of financial resources, absence of adequate family support, birth of an infant who needs specialized care, ill children, unhealthy habits, smoking, abuse of other substance, inability to make mature decisions, "sandwich generation"
umbilical cord
life line. contains two arteries and one vein which are surrounded by Wharton's jelly. provides circulatory pathway to embryo. 2 artery's carry deoxygenated blood. vein carried oxygenated blood
ultrasound 1st trimester- transvaginal
lithotomy position, probe with disposable cover inserted into vagina determining the presence and location of pregnancy, detecting multifetal gestations, estimating gestational age, confirming viability, identifying need for follow up testing, identifying characteristics of fetal abnormalities, as an adjunct for trans cervical or transabdominal chorionic villus sampling
potential problems of adoptive families
little time to prepare for the birth, little support after
Acetaminophen (Tylenol) toxin ingestion
liver, most common, antidote Mucomyst
factors that affect sibling reactions
loneliness, fear, worry, anger, resentment, jealousy, guilt (address concers directly/counseling). older then 10- can be emotionally close to hospital child, fear of getting illness, perceiving that their parents are acting differently toward them
what is "supine hypotensive syndrome"? what signs and symptoms might a woman with this syndrome display? what should the nurse do to prevent or relieve it?
lying in the supine position places the heavy uterus over the aorta and inferior vena cava, which temporarily occludes these vessels. signs and symptoms include lightheadedness, dizziness, agitation, and sometimes brief unconsciousness. this position can reduce placental blood flow. preventions/treatment is to position woman on her side or with a pillow under one hip
preschoolers (developmental approaches)
magic thinking, weird body image, striving for initiative- separation anxiety from parents, fear bodily harm/mutilation- don't understand body integrity/ painful things preformed in a treatment room to keep hosptial room safe, thinking is egocentric, magical and view illness or hospitalization as a punishment
psychosocial issues that affect nutrition in infants, children, adolescents- failure to thrive
manifested as inadequate growth resulting from inability to obtain or use calories required for growth. usually described in an infant or child who falls below the 5th percentile for weight. cluster of concurrent symptoms
Traditional hospital setting
many different rooms for each part of delivery, delay of parent to infant contact
infertility treatments
medications- progesterone, surgical procedures- scar tissue, therapeutic insemination, egg donation-age, surrogate parenting, advanced reproduction techniques- IVF, GIFT, ZIFT (sperm donation
Placenta major functions
metabolic, transfer of substances between mother and fetus, endocrine
lactose intolerance management
milk products are restricted, diet is supplemented with commercial lactase preparations (lactaid, dairy ease) to alleviate symptoms
embryonic period week 3
missed menstrual period, central nervous system begins developing
cleft lip surgical pre op
modify feedings and use tools, bottle, or nipple feeds- add strength, frequent burping- more air in with feedings
abortion
mom up until 22 to 24 weeks has the rights over the fetus. after 24 weeks the fetus takes on its own rights
cleft palate post op
monitor I/O. monitor packing- usually removed in 2 to 3 days. avoid objects that can harm the palate repair. avoid pacifiers or tongue depressors. monitor for infection. supine position. elbow restraints speech therapy
impaired nutrition nursing interventions
monitor for complications, pain management, monitor fluid and electrolytes, monitor intake and output, record daily weights- same time same scale same method, observe family coping and support systems, observe family interaction with infant- rejection denial anger or bond with baby- holding, consult with other disciplines as necessary- OT PT nutrition case management
carbon monoxide toxin ingestion
most common and fatal inhalation poisoning source: household fires, improperly vented automobiles, improperly ventilated heaters or vehicles. odorless, colorless gas that binds to hemoglobin more effectively than does oxygen
placental hormones- progesterone
most important to maintain pregnancy- inhibits spontaneous contractility of uterus, prevents tissue rejection of fetus, preparation for lactation- develops lobes and lobules in the breast, facilitates maternal fat deposits to provide energy reserves for pregnancy and lactation
20 weeks fetal development- parent know
mother feels movement (quickening). baby develops a regular schedule of sleeping, sucking, and kicking. hands can grasp. baby assumes a favorite position in utero. vernix (lanolin- like covering) protects the body, and lanugo (fine hair) keeps oil on skin. Head hair, eyebrows, and eyelashes present.
hepatitis b immunoglobulin (HBIG)
mother hep b + 12 hours post birth bath first with hep b vaccine
hepatitis b vaccine
mother hep b + then given with immunoglobulin mother hep b - given at birth then 1 month then 6 months
human immunodeficiency virus (HIV)
mother to infant antiviral therapy- no cure prevention, testing
school aged (developmental approaches)
movers and shakers- ask a lot of questions, know Dx, why questions, ask relevant questions about illness, understand cause and effect, coping stratages- sleeping, talking with others, distractions. friends are important. striving for industry, concerned with body disability and death, more relaxed with physical examination but very uncomfortable with any type of genital examination
salicylate/aspirin toxin ingestion
multi system effects- GI, CNS, hematopoietic and metabolic
embryonic period germ layer- mesoderm
muscles, bones, circulatory system
Carbon monoxide toxic ingestion
one of the most common and fatal inhalation poisonings, dangerous as its colorless and odorless,
lactose intolerance
no lactase enzyme, the inability to tolerate lactose, the sugar found in dairy products, is the result of an absence or deficiency of lactase, an enzyme found in the secretions of the small intestines that is required for the digestion of lactose
antepartum fetal surveillance
non stress test contraction stress test biophysical profile maternal assessment of fetal movement
traditional
nuclear families- two parents who view parenting as the major priority in their lives. single or dual income. motivated to learn
living
number of currently living children
term
number of pregnancies ended 38 weeks and beyond
perterm
number of pregnancies ended between 20 to 38 weeks
abortion
number of pregnancies ended prior to 20 weeks
antepartum assessment and care- initial visit
obstetric hx, menstrual hx, contraceptive hx, medical and surgical hx (reprodutive parts), family hx (both parents)- birth defects, genetic diseases, include partner health and family hx, baseline lab studies (anemia, std), psychosocial hx- smoking, alcohol, drug use, abuse assessment, support system, physical exam, vaginal exam, fundal height, confirmation of pregnancy- fetal heart rate, sonogram
biliary atresia
obstruction or absence of the extrahepatic ducts, if not treated, can lead to liver failure or death
an infant is admitted with dehydration. what is the most accurate intervention to monitor the patients intake and output
obtain daily weights
psychosocial issues that affect nutrition- nursing care
obtain health and nutritional hx. measure baseline wt and ht. monitor activity level. assess developmental milestones. assess interaction patterns of primary caregiver. observe for negative interactions with others. observe for indications of hunger and satiety, assess the child's ability to be soothed. observe feeding and eating patterns
primipara
one birth at more than 20 weeks (first baby full term)
healthy families
open communication. accurate perceptions about the nature and degree of conflict. constructive efforts to resolve the conflict, such as willingness to consider the view of the other, consider alternate solutions and compromise
Cleft palate assessment
opening not always detected in newborns, can occur with cleft lip (correct lip then palate), palpate the newborns palate and ability to suck.
failure to thrive causes
organic, nonorganic, mixed
maintenance fluids for an 24 kg child
over 20 kg is 1500 + 20ml/kg 1500+ 4 x 20ml 1500+ 80 1580ml in a day
gastroesophageal reflux in infants
over feeding, feedings they should have. upright position 30 min after feedings. GERD related to- amount, frequency, formula change, positions.
woman factors contributing to infertility
ovulation disorders, fallopian tubes abnormalities, cervical abnormalities
carbon monoxide toxic ingestions tx
oxygen or hyperbaric chamber
carbon monoxide tx toxin ingestion
oxygen or hyperbaric chamber, 100% oxygen by NRB
ductus venosus
oxygenated blood from the placenta enters the fetal body through the umbilical vein. appx half the oxygenated venous blood goes through the liver during early pregnancy and the rest bypasses the liver and enters the inferior vena cava through the first shunt
Gonorrhea
perinatally during birth process or premature rupture of membrane, sexual abuse, sexual intercourse. ophthalmia neonatorum most common trans during vag birth chlamydia infection common with
self esteem
personal value that individuals place on themselves
Endocrine system
pituitary gland, thyroid gland, pancreas, placental hormones,
Time out (discipline measures)
placing child in a non-stimulating environment for approximately 1 minute per years of age
antepartum assessment and care
preconception care initial visit subsequent assessments
why is progesterone essential in pregnancy
pregnancy cannot be maintained without progesterone
presumptive changes
pregnancy related changes felt by the woman
probable changes
pregnancy related changes that can be observed by an examiner
confirmation of pregnancy
presumptive indication probable indications positive indicaions
confirmation of pregnancy
presumptive indications- subjective symptoms the women feels probable indications- seen by provider (objective) positive indications- it is pregnancy and nothing else (see baby on sono)
list the presumptive indication of pregnancy.
presumptive- some signs are amenorrhea, nausea, vomiting, fatigue, urinary frequency, breast, and skin changes
esophageal atresia with tracheoesophageal fistula (TEF) goal
prevent pneumonia and respiratory distress until surgery can be done
infertility types
primary- never conceived secondary- conceived at least once before
list the probable indications of pregnancy
probable- some signs are abdominal enlargement, cervical softening, ballottement, Braxton hicks contractions, and pregnancy test
placental hormones- estrogen
produced primarily by placenta- about 7 weeks, creates "favorable" environment in uterus, preparation for lactation- assists in development of ductal system in the breast
Ovaries body changes
progesterone secretion- pregnancy maintenance (placenta takes over around 7 weeks), ovulation ceases
chronic illness- impact on family
require many resources, stressful, situational crisis, physical/social/financial support, coping, open communicaiton, flexibility, ongoing education, fear, anxiety, guilt
win-win solution
resolution of conflict that both parties can support
3 components of family centered care
respect, collaboration, support
religious beliefs affecting health care
respect, perception, resources
salicylate (aspirin) manifestation toxin ingestion
respiratory alkalosis to loss of potassium, increased metabolic rate, ketones to metabolic acidosis hypokalemia, dehydration, decreased platelet level
when esophagus is connected to trachea and not stomach (TEF)
respiratory distress
corrosives toxin ingestion
respiratory distress syndrome, DO NOT INDUCE VOMITING. exp- lye, bleach, ammonia
hydrocarbons s/s toxin ingestion
respiratory distress, vomiting, chemical pneumonitis from aspiration, pneumonia and acute hemorrhagic necrotizing disease in 24 hours, burning sensation in mouth and pharynx, characteristic petroleum breathe odor, N/V, anorexia,
celiac disease- physiologic effects on small intestine
result of inflammation to the small intestine due to a permanent sensitivity to gluten. immune system damages the villi in the small intestine. villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. villi become flattened and useless thus contributing to the malnutrition
ductus arteriosus
rising arterial oxygen levels cause constriction; becomes a ligament
nursing process and perinatal infections assessment
risk factors, gestational age, maternal infection, s/s of neonatal infection
Chorionic villus sampling (CVS) risk to baby
risk for damage to placenta, miscarriage, damage to baby stucture
internal family coping strategy's
role flexibility, being open and honest, joint (family) problem solving, using humor
ultrasound advantages
safe, clear visulaiztion non invasice results are immediate
family centered care
safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family including those of the newborn and older children. respects the pivotal role of the family. supportive
increased in ambulatory and community based care setting
same day surgery, urgent care, home care, community care- school based health centers
factors that affect parents reactions
seriousness of threat, previous experience with illness and hospitalization, medical procedures involving diagnosis and treatment, available support system, personal ego strengths, previous coping abilities, additional stresses on the family, cultural and religious beliefs, communication patterns among family members
varicella zoster virus interventions needed
severity of newborn illness increases greatly if maternal infection occurs 5 days before delivery or 2 days after birth- varicella zoster immune globin (VZIG) must be given with in 72 hours after birth separate baby until sore heal
syphilis
sexual transmission. crosses placenta to fetus- infection via amniotic fluid may occur. lab test in first trimester or first antenatal visit.
herpesvirus serotypes 1 and 2
sexullay- HSV 1, non sexually HSV2, transmission after rupture of membranes, fetus expose to the virus through indirect contact with infected genitals or direct contact with those tissues furing delivery
Lillian Wald is recognized for which contribution to nursing
she initiated public health nursing at the Henry Street settlement
rubella infants
shead virus up to one year abortion recommended if exposed 1st trimester
How as cost containment affected maternity and pediatric care
shortened length of stay after delivery. vaginal birth 48 hours, C/S 4 days
umbilical cord- changes in blood circulation after birth
shunts no longer needed- close as respiratory is initiated.
Barbiturates toxin ingestion
similar to those associated with ETOH, often use in conjunction with stimulants, may have a paradoxical effect of hyperactivity in children exp- amytal, butisol, caffeine
endocrine changes to the body- pituitary gland
slightly enlarged, increased prolactin production- preparation for breastmilk production, oxytocin production- stimulates contractions, stimulates milk ejection reflex
explain the renal expected adaptations involved in elimination that occur during pregnancy
slowed passage of more alkaline urine and dilation of the ureters as a result of progesterone increases the risk for UTI's, bladder irritability, nocturia, urinary frequency, and urgency (first and third trimester after lightening)
an adolescent tells the nurse. I don't like this hospital room. an active listening response to this child's statement is
so would you prefer a different room
amniocentesis teaching
sob, bleeding, fever, cramping, s/s complications, need to rest, need to hydrate
external family comping strategy's
social support systems, seeking information from clergy, seeing spiritual meaning in events, joining self help groups
potential problems of dual income families
stress- child care
brown fat
subcutaneous fat layer for warmth outside mother at birth. heat producing fat deposited on the back of the neck, behind the sternum, around the kidneys. helps the neonate maintain temperature stability after birth
hypertrophic pyloric stenosis management
surgical interventions- pre op- NPO, IV fluids, labs (electrolytes), NG tube (pressure on diaphragm- respiratory distress). Post op- bowel sounds. NG out. clear liquid diet then 1/2 formula then full formula
cleft lip management
surgical repair occurs early in infancy- staged. identify alternate feeding devices- special nipple for bottle, frequent burping. breast feeding- strengthens facial muscle in baby
Wharton's jelly
surrounds the arteries and vein. specialized connective tissue, protects blood vessels cord cushioning, soft substance, prevent obstruction caused by pressure
biliary atresia
the obstruction or absence of the extrahepatic ducts. if not treated, can lead to liver failure or death
ethnocentrism
the opinion that the beliefs and customs of one's own ethnic group are superior to those of others
culture
the sum of the values, beliefs, and practices of a group of people that are transmitted from one generation to the next
Hepatitis B
transmitted through saliva, blood, vag secretions, semen. crosses placental barrier
chlamydia
transmitted to infant through birth process if mother infected. common cause of ophthalmia neonatorum. usullay asymptomatic. cause premature rupture of membranes, premature labor, chorioamnionitis
anemia management
treat the underlying condition- nutrition supplements, blood products, medications to restore iron and RBC production. iron administration- take with meal to prevent nausea, vit C will increase absorption
iron deficiency anemia treatment
treat underlying conditions, supplement, blood, medications, eat with iron to prevent nausea (some people take on empty stomach), take with vit C to increase absorption, mile will decrease absorption, eat spinach, dried fruit, red meats
placental hormones- human chorionic gonadotropin
trophoblasts secrete hCG in early pregnancy- stimulates progesterone and estrogen production, causes positive pregnancy test
Premature births have increased in the past two decades
true
active listening requires attentiveness, empathy, an open mind, and clarifying what the speaker says
true
children of authoritarian parents tend to lack self confidence
true
communication involves more than expressing words from one person to another
true
cultural differences are particularly important to consider with regard to touch and personal space
true
evaluation of the family's understanding is an ongoing process
true
explanations should include what the child will experience through the senses
true
infant mortality rates have continued to drop since 1950 as a result of better neonatal care
true
permissive parents tent to inconsistently discipline their children
true
talking to a child with your hands on your hips is an example of a closed body posture
true
the child or family members may feel intimidated when the nurse stands over then while talking
true
the nurse can demonstrate attentiveness by maintaining eye contact
true
1 g of body weight = 1ml of body fluid?
true- exp gain 2.5kg in 24 hours will equal 2500ml
children have a greater proportion of water (ICF and ECF) and water turnover than adults do
true- pediatric dehydration very quick
a 5-year old is schedule for a computed tomography (CT) scan of her head. what is the best time for her mother to initiate a discussion about the procedure
two hours before the procedure
multipara
two or more births at more than 20 weeks
which fetal circulatory structure carries blood with the highest oxygen concentraction
umbilical vein
psychosocial adaptation- 1st trimester week 1 to 13
uncertainty- miscarrage, ambivalence- conflicted feelings if unexpected, primary focus is self, not fetus- fetus remains vague and unreal, emotional lability- teach how to manage moods, reassure about normalcy
The nurse is administering gastrostomy feedings to an infant after surgery to correct a tracheoesophageal fistula to prevent air from entering the stomach once that syringe barrel is attached to the gastrostomy tube the nurses should
unclamp the tube after pouring the complete amount of formula to be administered into the syringe barrel
age of consent
under 18 but pregnant- right to consent for pregnancy related issues, parents right to consent to health issues. under 18 delivered- all rights to baby and self
when obtaining a history from the parents of a child diagnosed with salmonella, the nurse should ask the parents if the child has been exposed to which of the following possible sources of infection
undercooked eggs
Cleft lip assessment findings
unilateral or bilateral, assess infants ability to suck or eat, assess family and infant interactions, challenges- feeding (breast feeding strengthens the muscles of the face- better for baby)
cleft lip assessment findings
unilateral or bilateral. more common in males. assess infants ability to suck or eat. assess family and infant interaction.
adolescent parenting
unlikely to attain a high level of education
preschooler communication
use words they dont fully understand. expansion of word combination- speak in full sentences. strive for independence. clearly set limits and boundaries. attention span 5 to 10min.
chlamydia s/s
usually asymptomatic pneumonia, ophthalmia neonatorum
reproductive system
uterus and cervix
vagina and vulva body changes
vaginal secretions increase- thick and acidic (prevent infection), may increase growth of yeast
pre embryonic period
week 1 to 3 initiation of cell division entry of the zygote into the uterus (3 to 4 days after conception) implantation in the decidua maintaining the decidua location of implantation mechanism of implantation fundus of uterus- blood flow, muscle, placenta
the health care team determines that the family of an infant with failure to thrive who is to be discharged will need follow up care. which of the following would be the most effective method of follow up
weekly visits by a community health nurse
endocrine changes to the body- metabolism
weight gain- adequate weight gain encouraged (not to exceed x amount), water retention- dependent edema, carpal tunnel syndrome, carbohydrate metabolism changes- secondary to increased insulin demands
celiac disease
weight loss, diarrhea- for a few weeks (no absorption, alveoli flat or dead), constipation with abdominal pain, delayed puberty, iron- anemia, anxiety, depression. also known as gluten enteropathy or tropical sprue, results from the inability to digest gluten.
chronic illness- impact on sibling
what are the needs of the sibling? are they being met? fear, anxiety, guilt,
gastroesophageal reflux questions for parents
what are you feeding the child? how often? when did it start? any cough? weight loss? gagging? does baby burp and cry in pain? does baby swallow a lot when not feeding? does baby gag/cough a lot for no reason? does baby seem constantly congested? weight loss? any arching/discomfort when feeding?
how does the woman's perception of the baby change during pregnancy- 3rd trimester
whats to see her baby on the outside and as a separate being
Obesity
when intake of food exceeds expenditure, the excess is stored as fat. is an excessive accumulation of fat in the body and is assessed in children through a body mass index (BMI) that exceeds the 95th percentile for age. as equal to or greater than the 95th %
federal projects for maternal child care
wic
BMI calculation
wt in lbs x 703 divided by ht in inches sqaured
BMI is 60 lbs and 50 inches
wt in lbs x 703 divided by inches squared. 60x703 divided by 50 squared. 42180 divided by 50 squared 16.8 or 17
celiac disease s/s
wt loss, diarrhea for weeks, constipation, abdominal pain, dental enamel, hydroplagia, delayed puberty, iron anemia, anxiety, depression.
a mother tells the nurse that she puts her 3-year-old son in a time out chair in a corner for 3 minutes when he misbehaves. she asked the nurse if this is correct. the nurse responds
you are correctly using the time out
a statement that uses effective reasoning techniques is
you are not being very nice when you throw toys at your friend
a child has just been diagnosed with diabetes. the child's father tells the nurse, my wife will be back in the morning. before she left, she told me that she has a lot of questions about what to do. what is the most appropriate response for the nurse to make at this time
your wire might want to write down her questions so she wont forget anything when she comes back tomorrow