Peds/OB Exam I
What combination of veins and arteries make up the umbilical cord?
1 Vein 2 Arteries
(Success Book) Once oogenesis is complete, the resultant gamete cell contains how many chromosomes? 1. 23 2. 46 3. 47 4. 92
1. 23
(Success Book) What can a nurse do to reinforce a 5 year olds intellectual initiative when he asks about his upcoming surgery? 1. Answer the childs questions about his upcoming surgery in simple terms 2. Provide the child with a book that has vivid illustrations about his surgery 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will answer his questions at a later time.
1. Answer the childs questions about his upcoming surgery in simple terms
(Success Book) A client as just had an amniocentesis to determine whether er baby has an inheritable genetic disease. Which of the following interventions is highest priority at this time? 1. Assess fetal HR 2. Check the client's temp 3. Acknowledge the client's anxiety about the possible findings 4. Answer questions regarding the genetic abnormality
1. Assess fetal HR
(Success Book) Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? 1. Avoid eating greasy foods 2. Drink orange juice before rising 3. Consume 1 teaspoon of nutmeg each morning 4. Eat 3 large meals plus a bedtime snack
1. Avoid eating greasy foods
A client enters the prenatal clinic. She states that she believes she is pregnant. Which of the following hormone elevations will indicate a high probability that the client is pregnant? 1. Chorionic gonadotropin 2. Oxytocin 3. Prolactin 4. LH
1. Chorionic gonadotropin
The nurse notes each of the following findings in a 10 week gestation client. Which of the findings would enable the nurse to tell the client that she is positively pregnant? 1. Fetal HR via doppler 2. Positive pregnancy test 3. Positive Chadwicks Sign 4. Montgomery gland enlargements
1. Fetal HR via doppler
(Success Book) Which statement by the mother of an 18 month old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. My child is able to stand but is not yet taking steps independently 2. My child has a vocabulary of approximately 15 words 3. My child is still sucking his thumb 4. My child seems to be quite weary of strangers.
1. My child is able to stand but is not yet taking steps independently
(Success Book) Which finding would the nurse consider abnormal when performing a physical assessment on a 6 month old? 1. Posterior fontanel is open 2. Anterior fontanel is open 3. Beginning signs of tooth eruption 4. Able to track and follow objects
1. Posterior fontanel is open
(Success Book) A 4 year old hospitalized with FTT has orders for daily weights, strict I and O's, and calorie counts. Which action by the nurse would be a concern? 1. The nurse weighs the child every morning after breakfast. 2. The nurse weighs the child with no clothing except for undergarments 3. The nurse sits with the child while the child eats her meals 4. The nurse weighs the child using the same scale every morning.
1. The nurse weighs the child every morning after breakfast.
(Success Book) A 3 year old is hospitalized for an ASD repair. Te parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is: 1. They will be back after your nap 2. They will be back at 6pm 3. They will be back later this evening 4. They will be back in 3 hours
1. They will be back after your nap
(Success Book) At her first prenatal visit, a woman relates that her maternal aunt has CF, and autosomal recessive illness. Which of the following comments is appropriate for the nurse to make at this time? 1. We can check to see whether or not you are a carrier for CF 2. It is unnecessary for you to worry since your aunt is not a direct relation. 3. You should have an amniocentesis to see whether or not your child has the disease. 4. Please ask your mother whether she has ever had any symptoms of CF.
1. We can check to see whether or not you are a carrier for CF
What is the chronological age of a toddler?
12 to 36 months
When does ossification of bone tissue begin?
12 weeks
How much sleep should a toddler receive?
12-14 hours
(Success Book) A first time mother brings her 5 day old baby in for a well child visit. The nurse weighs the infant and reports a weight of 7lb 5 oz to the mother. The mother looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she was discharged 4 days ago. The nurses best response to the mother is: 1. I will let the doc know, and he will talk with you about possible causes of your infants weight loss 2. A weight loss of a few ounces is common among newborns, especially for breastfeeding mothers. 3. I can tell you are a first time mom. Don't worry; we will find out why she is losing weight 4. Maybe she isn't getting enough milk. How often are you breastfeeding her?
2. A weight loss of a few ounces is common among new borns, especially for breastfeeding mothers.
(Success Books) A 3 year old boy has been hospitalized because he fell down the stairs. his mother is crying and states, 'this is all my fault'. Which is the nurses best response? 1. Accidents happen. You shouldn't blame yourself. 2. Falls are one of the most common injuries in this age group 3. It may be a good idea to put a baby gate on the stairs 4. Your son should be proficient at walking down the stairs by now.
2. Falls are one of the most common injuries in this age group
(Success Book) The nurse is assessing the laboratory report of a 40 week gestation client. Which of the following values would the nurse expect to find elevated above prepregnancy levels? Select all that apply: 1. Glucose 2. Fibrinogen 3. Hematocrit 4. Bilirubin 5. White blood cells
2. Fibrinogen 5. White Blood Cells
(Success Book) A 5 year old boy has always been one of the shortest children in class. His mother tells the school nurse that her husband is 6 feet talk and she is 5 foot 7 inches. What should the nurse tell the childs mother? 1. He is expected to grow about 3 inches every year from ages 6 to 9 years. 2. He is expected to grow about 2 inches every year from ages 6 to 9 years. 3. He should be seen by an endocrinologist for growth-hormone injections 4. His growth should be re-evaluated when he is 7 years old.
2. He is expected to grow about 2 inches every year from ages 6 to 9 years.
(Success Book) Which statement by an infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month old? 1. I will continue to breastfeed my son and will give him rice cereal three times a day 2. I will start my son on fruits and gradually introduce vegetables 3. I will start my son on carrots and will introduce on new vegetable every few days 4. I will not give my son any more than 8 oz of baby juice per day
2. I will start my son on fruits and gradually introduce vegetables
(Success Book) Which stressor is common in hospitalized toddlers? Select all that apply: 1. Social Isolation 2. Interrupted routine 3. Sleep disturbances 4. Self-concept disturbances 5. fear of being hurt
2. Interrupted routine 3. Sleep disturbances 5. fear of being hurt
(Success Book) Which foods would the nurse recommend to the mother of a 2 year old with anemia? 1. 32 oz of whole cows milk per day 2. Meats, eggs, and green vegetables 3. Fruits, whole grains, and rice 4. 8oz of juice, three times per day
2. Meats, eggs, and green vegetables
(Success Book) Which toy is the best choice for a 12 month old? 1. Baby doll 2. Musical Rattle 3. Board Book 4. Colorful beads
2. Musical Rattle
(Success Book) The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which statement reflects a need for further education in the new mother? 1. I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months. 2. My baby will need to have iron supplements introduces when she is 4 months old. 3. I will need to add iron supplements to my babys diet when she is 2 months old 4. When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet.
2. My baby will need to have iron supplements introduced when she is 4 months old Rational: Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months of age. Full-term infants have iron stores that last approximately 4 to 6 months.
What is the visual acuity of a preschooler?
20/30 at best
What is the age of viability?
22-24 weeks or greater than 500g
What are the fetal nervous system milestones?
3 weeks: Neural plate is apparent 3-4 weeks: Active formation of the nervous system has begun 8th week: Brain waives can be seen on an EEG 24 Weeks: Ear is capable of sound and eyes exhibit pupillary reaction
How long does it take for a zygote to reach the uterus?
3-4 days
What is the chronological age of a preschooler?
3-5 years
(Success Book) A 12 month old boy weighed 8 lb 2 oz at birth. Understanding developmental milestones, what should the nurse caring for the child expect the current weight to be? 1. 16lb 4 oz 2. 20 lb 5 oz 3. 24 lb 6 oz 4. 32 lb 8 oz
3. 24 lb 6 oz
(Success Book) Which nursing action would help foster a hospitalized 3 year old's sense of autonomy? 1. Let the child choose what time to take the oral antibiotics 2. Allow the child to have a doll for medical play 3. Allow the child to administer her own dose of Keflex via oral syringe. 4. Let the child watch age-appropriate videos
3. Allow the child to administer her own dose of Keflex via oral syringe.
(Success Book) Which action is a developmentally appropriate method for eliciting a 4 year olds cooperation in obtaining the blood pressure? 1. Have the childs parents help put on the BP cuff. 2. Tell the child that if he sits still, the BP machine will go quickly 3. Ask the child if he feels it squeezing his arm 4. Tell the child that measuring the BP will not hurt.
3. Ask the child if he feels it squeezing his arm
(Success Book) What should parents understand is one of the most common causes of injury and death for a 7 month old infant? 1. Poisoning 2. Child abuse 3. Aspiration 4. Dog bites
3. Aspiration
(Success Book) A 6-month old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurses best response is: 1. At 6 months his weight should be approximately three times his birth weight" 2. Each child gains weight as his or her own pace 3. At 6 months his weight should be approximately twice his birth weight 4. At 6 months a child should weigh about 10 lb more than his or her birth weight
3. At 6 months his weight should be approximately twice his birth weight
(Success Book) The parents of a newborn are asking the nurse how to use the infant care seat and where it should be placed in their vehicle. Which is the next most appropriate action by the nurse? 1. Give the parents a pamphlet explaining how to install the care seat 2. Accompany the parents to the car, and show them how to install the car seat. 3. Contact the hospitals car seat safety officer, and ask the officer to accompany the parents to the car for car seat installation 4. Show the parents a video on car seat installation and safety and ask if they are comfortable with the information.
3. Contact the hospitals car seat safety officer, and ask the officer to accompany the parents to the car for car seat installation
(Success Book) The best method to explain a procedure to a hospitalized preschool-age child is to: 1. Show the child a pamphlet with pictures showing the procedure 2. Have the 5 year old next door tell the 4 year old about the experience 3. Demonstrate the procedure on a doll 4. Show the child a video of the procedure
3. Demonstrate the procedure on a doll
(Success Book) When analyzing the need for health teaching of a prenatal multigravida, the nurse should ask which of the following questions? 1. What are the ages of your children 2. What is your marital status 3. Do you ever drink alcohol 4. Do you have any allergies
3. Do you ever drink alcohol
(Success Book) The nurse is using the FLACC scale to rate the pain level of a 9 month old. Which is the nurses best response to the fathers question of what the FLACC scale is? 1. It estimates a childs level of pain utilizing vital sign informaiton. 2. It estimates a childs level of pain based on parents perception 3. It estimates a childs level of pain utilizing behavioral and physical responses 4. It estimates a childs level of pain utilizing a numeric scale from 0 to 5.
3. It estimates a childs level of pain utilizing behavioral and physical responses
(Success Book) A client asks the nurse what was meant when the physician told her she had a positive chadwicks sign. Which of the following information about the finding would be appropriate for the nurse to convey at this time? 1. It is a purplish stretch mark on your abdomen 2. It means that you are having heart palpitations. 3. It is a bluish coloration of your cervix and vagina. 4. It means the doctor heard abnormal sounds with you breathed in.
3. It is a bluish coloration of your cervix and vagina.
(Success Book) The mother of a child 2 years and 6 months has arranged a play date with the neighbor and her child 2 years 9 months. During the play date the two mothers should expect that the children will do which of the following? 1. Share and trade their toys while playing 2. play with one another with little or no conflict 3. Play alongside one another but not actively with one another. 4. Only play with one or two items, ignoring most of the other toys.
3. Play alongside one another but not actively with one another.
(Success Book) The nurse is assessing the pain level in an infant who just had surgery. The infants parent asks which vital sign changes are expected in a child experiencing pain. The nurses best response is: 1. We exepect to see a childs HR decrease and respiratory rate increase 2. We expect to see a childs HR and BP decrease 3. We expect to see a childs HR and BP increase 4. We expect to see a childs HR increase and BP decrease
3. We expect to see a childs HR and BP increase
(Success Book) A 3 year old admitted to the hospital with croup has the following VS: HR is 90, RR 44, BP 100/52, and temp is 98.8F. The parents ask the nurse if these VS are normal. The nurse's best response is: 1. Your son's BP is elevated, but the other VS are within normal range 2. Your son's temp is elevated, but the other VS are within normal limits. 3. Your son's RR is elevated, but the other VS are within the normal range 4. Your sons HR is elevated, but the other VS are within the normal range.
3. Your son's RR is elevated, but the other VS are within the normal range
What are the normal blood losses that occur during delivery?
300-500 mL in vaginal delivery 800-1,000 mL in C-Section
When are sucking/swallowing reflexes mature in a fetus?
32 weeks or weighs about 1500 g
What is late preterm pregnancy?
34 to 36 6/7 weeks
When do testes drop in a male fetus?
34-38 weeks
When does the GI tract start secreting enzymes essential for carb and protein digestion?
36 weeks
What is a term pregnancy?
38 to 42 weeks
What are fetal respiratory milestones?
3rd week: respiratory and digestive tracts exist as a single tube 4th week: Septum divides esophagus from trachea, and lung buds start to appear on trachea 7th week: Diaphragm is complete 24 weeks: Surfactant is formed and excreted 24 to 28 weeks: Alveoli and capillaries begin to form 3 months: Spontaneous respiratory movements occur up through birth
(Success Book) A woman asks the nurse, ' my nuchal fold scan results were abnormal. What does that mean?' Which of the following comments is appropriate for the nurse to make at this time? 1. I am sorry to tell you that your baby will be born with a serious deformity 2. The results show that your child will have cri du chat syndrome. 3. The test is done to see if you are high risk for preterm labor 4. An abnormal test indicates that your baby may have Down syndrome.
4. An abnormal test indicates that your baby may have Down syndrome.
(Success Book) Which comment should the parent of a 2 year old expect from the toddler about a new baby brother? 1. When the baby takes a nap, will you play with me? 2. Can I play with the baby? 3. The baby is so cute. I love him. 4. Its time to put him away so we can play.
4. Its time to put him away so we can play.
The nurse takes the history of a client at her first prenatal visit. Which of the following statements would indicate that the client should be referred to a genetic counselor? 1. My first child had cerebral palsy 2. My first child has hypertension 3. My first child has asthma 4. My first child has cystic fibrosis
4. My first child has cystic fibrosis
(Success Book) Which approach should the nurse use to gather information from a child brought to the ED for suspected child abuse? 1. Promise the child that her parents will not know what she tells the nurse 2. Promise the child that she will not have to see the suspected abuser again 3. Use correct anatomical terms to discuss body parts. 4. Tell the child that the abuse is not her fault and that she is a good person.
4. Tell the child that the abuse is not her fault and that she is a good person.
(Success Book) According to developmental theories, which important event is essential to the development of the toddler? 1. The child learns to feed self 2. the child develops friendships 3. The child learns to walk 4. The child participates in being potty-trained.
4. The child participates in being potty-trained.
(Success Book) An 8 day old was admitted to the hospital with vomiting and dehydration. The newborns heart rate is 170, respiratory rate is 44, BP is 85/52 and temperature is 99F. What is the nurses best response to the parents who ask if the vital signs are normal? 1. The BP is elevated, but the other vital signs are within normal limits 2. The temp is elevated, but the other vital signs are within normal limits. 3. The respiratory rate is elevated, but the other vital signs are within normal limits 4. The heart rate is elevated, but the other vital signs are within normal limits
4. The heart rate is elevated, but the other vital signs are within normal limits
(Success Book) Which statement accurately descries the best method for assessing a 12-month old? 1. The nurse should assess the child on the examining table 2. The nurse should assess the child in a head to toe sequence 3. The nurse should have the childs mother assist in holding her down 4. The nurse should assess the child while she is in her mothers lap.
4. The nurse should assess the child while she is in her mothers lap
At what level of lead in the blood do they start thinking of chelation therapy?
45-69 ug/dL
When can the fetal heart beat be seen?
6 weeks
When do the gonads form?
6 weeks
What is the incubation period for pertussis?
6-20 days
How long does it take for implantation to occur?
8 to 10 days
When is the earliest sex can be determined?
8 weeks by chromosomal analysis
What is scarlet fever?
A disease caused by the strep bacteria causing a rash on the body
What are autosomal dominant disorders?
A disease that only requires one affected gene in order for the disease to manifest. These are a lot less common and has a corresponding healthy recessive gene
What is X-Linked recessive inheritance?
A mode of inheritance in which there is a mutation on the x chromosome.
What is an amniocentesis?
A procedure in which amniotic fluid is drawn from the mother to help diagnose genetic disorders
What is fifth disease (Erythema Infectiosum)?
A rash that occurs in three stages Usually will clear up on its own, but pregnant women in their first trimester should seek medical attention if exposed.
What is McDonald's rule?
A way to determine that the fetus is growing by measuring fundal height. The distance of the top of the fundus to the pubic symphysis in cm is equal to the week of gestation
What is Nageles rule?
A way to determine the estimated date of delivery. Count backwards 3 calendar months from the 1st day of the last menstrual period and add 7 days.
What is the main purpose of the placenta?
Acts as the fetal lungs, kidneys, and GI tract as a separate endocrine organ during pregnancy
What is an AFP test?
Alpha Feta Protein, draws blood from the mother at about 15-20 weeks of pregnancy
What is rubella?
Also called German Measles Rash that starts on face and spreads to the rest of the body There are few complications with this Low grade fever (usually lower than 101)
What is Melasma?
Also called the pregancy mask. Because of an increase in pigmentation the woman can have darkened areas of the face, cheeks, and nose.
What are autosomal recessive disorders?
An inherited disease in which 2 recessive genes are required for manifestation. These are a lot more common because it can be phased out by one healthy gene.
What is X-Linked dominant inheritance?
An inherited disorder that dominant on the X sex chromosome. Only requires one X chromosome to be manifested. This can affect boys and girls equally
What are some common causes of hearing impairment in children?
Anatomical malformation LBW (Low Birth Weight) Ototoxic drugs Chronic Ear Infections (scar tissue can build up)
What are some mild to severe effects of lead poisoning?
Anorexia Abdominal Pain Vomiting Hyperactivity
What is the treatment for scarlet fever?
Antibiotics
How is enterobiasis treated?
Antiparasitic (mebendazole)
What is cognitive impairment?
Any type of mental difficulty or deficiency
When does the heart start beating in a fetus?
Around 24 days of life
When can meconium form in the fetus?
Around the 16th week of gestation
When does the septum that divides the heart into chambers develop?
Around the 6th or 7th week of gestation
What is AROM?
Artificial rupture of membranes (done by a physician)
When can movement of the fetus be seen on an ultrasound?
As early as 11 weeks
When can the fetal heart rate be heard with a doppler?
As early as the 10th to 12th week
What are some major complications that can arise with rubeolla?
As many as 1 out of every 20 children with measles get pneumonia (leading cause of death from measles in young children) 1 out of every 1,000 kids who get measles will develop encephalitis which can lead to convulsions and leave the child deaf or mentally retarded. 1-2 out of every 1,000 children will die from measles
How is play with a preschooler?
Associative meaning they play together They also start picking up on gender specific roles during this age They do domestic mimicry and dramatic play
When is the sex of the fetus determined?
At the moment of conception
What phase of psychosocial development is the toddler in?
Autonomy vs shame and doubt
What are fears and stressors for preschoolers?
Being left alone Objects or persons associated with pain (hospitals) They are also scared of things they aren't familiar with like dogs
What med type is the number one ER visit for medicine ingestion?
Blood Pressure Medications
What are probable signs of pregnancy?
Blood and urine tests. Chadwicks Sign. Goodell's Sign. Hegars Sign. Sonograph of gestational sac. Ballotement. Braxton hicks. Fetal outline felt by examiner.
What does red amniotic fluid indicate?
Blood in the amniotic fluid, which could indicate a placental bleed
What type of blood pressure changes can occur during pregnancy?
Blood pressure should not increase during pregnancy. A blood pressure of 140/90 and above is considered abnormal
What are the blood changes that can occur during pregnancy?
Blood volume increases by 40-45% Physiological anemia Mom requires about 800 mg of extra iron to help restore blood loss
What is the best nutrition for an infant?
Breast milk is the first choice for the first 6 months (mom should supplement iron after 4 months of breast feeding, if formula fed the baby should get an iron fortified formula)
What are some 1st trimester discomforts?
Breast tenderness. Nausea and vomiting. Palmar erythema. Fatigue. Frequent urination. Leukorrhea. Stuffiness. Epistaxis. Excessive salivation.
What do you do if someone has ingested medication?
Call poison control first before inducing vomiting
What heart changes can occur during pregnancy?
Cardiac output will increase about 30-50%. Heart rate increases about 10-15 bpm. Heart palpitations can occur.
What are complications that can arise from scarlet fever?
Carditis Peritonsillar abscess Glomernephritis (acute kidney injury)
What does multipara mean?
Carried 2 or more pregnancies to viability
What is the purpose of the umbilical arteries?
Carries blood from fetus back to the placental villi
What are chromosomal abnormalities?
Caused through a fault in the number or structure of chromosomes
How can a hearing impaired child have developmental set backs?
Children often use hearing to learn language, and to learn about their environment.
What is a CVS and when is it usually preformed?
Chorionic Villi Sampling Procedure that takes a part of the placenta Considered high risk because its done so early in the pregnancy
What are deletion abnormalities?
Chromosome disorder in which part of a chromosome breaks during cell division, causing the affected person to have the normal number of chromosomes plus or minus an extra portion of a chromosome
What are some common coexisting comorbidities associated with down syndrome?
Congenital Heart Defects (Most common comorbidity) Vision Defects Hypothyroid Problems Oncologic Problems
How does language develop with a preschooler?
Continues to develop Should be able to speak in complete sentences and be understandable (understandable by 5 yrs) They should ask a ton of questions during this age Should be able to count to 10
What are Braxton Hick's contractions?
Contractions of the uterus that causes no cervical changes. Usually starts around 12th week of gestation
What are some important things to know about injury prevention in infants?
Crib guidelines Car seat guidelines Never leave child unattended in a high place Support the infants head Temperature of bath water Temperature of formula/food Aspiration of foreign objects
What is an example of an autosomal recessive disorder?
Cystic Fybrosis
What is linea nigra?
Darn line that vertically goes down the abdomen
What type of blood flow changes can occur during pregnancy?
Decreased flow can occur in lower extremities because uterus expands and presses on vessels (3rd trimester). Edema of the vulva, rectum and legs can also occur.
What are the clinical manifestations of lead poisoning?
Depends on blood levels Higher levels cause major complications
What could cause polyhydramnios?
Diabetics (polyuria)
If we report child abuse/maltreatment what is the most important thing we can do at that point to help the child?
Documentation Include a very thorough history and physical
What is the most common genetic cause of intellectual disability (cognitive impairment)?
Down Syndrome (Trisomy 21)
What can a low AFP test indicate?
Down syndrome
What type of precautions would someone be on if they had scarlet fever?
Droplet Contact
What type of precautions would someone who has pertussis be put on?
Droplet Contact
What are the 2 sides of the placenta called?
Duncan - maternal side Shutlz - fetal side
What are the temperature changes that can occur during pregnancy?
Early in pregnancy the temp will increase slightly. At about 16 weeks, the temperature gradually goes back to normal
What are the germ layers for fetal development?
Ectoderm Mesoderm Entoderm
What other characteristics are present in a toddler?
Egocentric Negative attitude Very ritualistic Follows parents Separation anxiety Transition objects
What can we do to prevent supine hypotension syndrome?
Encourage mother to lay on her side (preferably her left side)
What is the primary nursing care intervention when dealing with a down syndrome child?
Encouraging self-care skills
The placenta is considered an endocrine organ during pregnancy, what does the placenta produce during pregnancy that is vital to maintain a pregnancy?
Estrogen Progesterone hCG Human Placental Lactogen Relaxin Prostaglandins
What is the cardinal symptom of enterobiasis?
Extreme anal itching
What should be assessed for the presence of genetic disorders?
Family history Physical assessment (we can sometimes see a genetic disorder by simply looking at the parents, such as a cleft lip repair) Diagnostic testing can also assist
What are positive signs of pregnancy?
Fetal heart rate separate from the mom. Fetal movement felt by the examiner. Visualization of fetus by ultrasound.
What are the blood coaguability changes that can occur during pregnancy?
Fibrinogen increases 50%. Factors 7, 8, 9, 10, and platelets increase WBC increase Women become high DVT risk Blood lipids increase Total protein decreases Cholesterol serum level increases 90-100%
What is the neural tube?
Forms the central nervous system (ear and eyes develop as projections off of the neural tube)
What is the neural crest?
Forms the peripheral nervous system
Which 2 disorders are big safety risks?
Fragile X Syndrome Autism Spectrum Disorders
What are dizygotic twins?
Fraternal Twins 2 eggs, 2 sperm
How is amniotic fluid produced?
From the amniotic membrane and urine from the fetus at about 15-16 weeks
What are the breast changes that occur during pregnancy?
Fullness (increase in size) Tingling Tenderness Areola darkens and widens Blue veins are visible Sebaceous glands protrude Colostrum is produced (around 16th week and is the precursor to milk)
What is down syndrome?
Genetic disorder resulting in an extra copy of the 21 chromosome
What are the fine motor development norms for an infant?
Grasping objects at 2-3 months Transferring objects between hands at 7 months Pincer grasp at 10 months Remove objects from a container at 11 months Should be ale to build a tower of 2 blocks at 12 months
What is GTPAL?
Gravida Term Preterm Abortions Living
How do we prevent the spread of disease in toddlers?
Hand washing is huge, usually these kids enjoy being taught how to properly wash their hands Immunizations Infection control policies Precautions
What does multigravida mean?
Has been pregnant previously
What does primipara mean?
Has given birth to 1 child past the age of viability
What are some ways to promote health during pregnancy?
Have the mom wear a good supportive bra. Be cautious with medications, avoid alcohol, smoking, caffeine and drugs.
What are the gross motor development norms for an infant?
Head control: 1 month will have total head lag 2 months will have partial head lag 4 months should have no head lag Rolling over should happen at 5 to 6 months Should be able to sit alone at 7 months Should be able to sit up on their own at 10 months Should be able to crawl at about 6 to 7 months Should be able to walk with assistance at 11 months Should be able to walk independently about 12 to 13 months
What are the developmental height norms for an infant?
Height should increase by 1 inch per month for the first 6 months Growth occurs in spurts rather than a gradual pattern
What are some signs and symptoms of rubeolla?
High Fever Cough Runny Nose Red, watery eyes
What is important to know about hyperbilirubinemia in high elevations like colorado springs?
Higher incidence of jaundice because we produce more red blood cells for increased oxygen
Describe fetal circulation
Highly oxygenated blood enters through the umbilical vein and is carried to the IVC through the ductus venosus. Blood then enters the RA and most is shunted into the LA through the foramen ovale. The blood that does go to the right ventricle and into the pulmonary artery is then shunted away from the lungs and into the aorta and out to the rest of the vital organs. Blood is then carried to the umbilical cord and oxygenated in the placenta
How is shaken baby diagnosed?
History and physical Labs (cbc, coagulation studies, LFTs, and amylase) Radiologic (Skeletal survey and head CT Ophthalmology consult
What are some examples of autosomal dominant disorders?
Huntington Disease Osteogenesis Imperfecta
What are some common behavioral traits associated with autism spectrum disorders?
Hypersensitivity Don't like to be touched They usually have no filter (can't see what is appropriate)
What are monozygotic twins?
Identical twins 1 egg, 1 sperm
How is FTT usually diagnosed?
If the child falls below the 5th percentile on the growth chart If a child falls below the 10th percentile they will usually schedule the well child check up sooner than normal to make sure they aren't trending toward the 5th percentile
When do we hold immunizations in general?
If the child is febrile (often the dr will advise ibu before appointment so there isn't as much pain or soreness after but it is important to instruct caregiver to check temp before administration of ibu)
Why are x-linked recessive inheritances more common in males versus females?
If the mom is a carrier for the disorder and passes it onto her son, he only has the one x chromosome from his mom and there for is technically homozygous for the mutation. If the mom were to have had a girl, the normal x chromosome she got from the father would cancel out the inheritance mutation. The only way it would be passed onto a female is if the mother were homozygous for the disorder.
What is important to know about the liver at birth?
Immature at birth which can lead to hypoglycemia and hyperbilirubinemia
What are the fine motor norms for the toddler?
Improved manual dexterity should occur between 12-15 months (feeding self finger foods) Should be able to throw a ball by about 18 months Left/right handed should sprat atomic 24 months
What are the vaginal changes that occur during pregnancy?
Increased white discharge (leukorrhea). Chadwicks Sign
What are the uterine changes that occur with pregnancy?
Increases in size, length, depth, width, weight, wall thickness, and volume. Lightening Primigravida Hagars sign Ballotement Braxton Hicks Contractions Amenorrhea
What is multifactorial (polygenic) inheritance?
Inheritance of disorders such as heart disease, diabetes, pyloric stenosis, cleft lip etc There are often more than 1 gene involved in these types of inheritance Environmental factors can also cause birth defects
What is Fragile X Syndrome?
Inherited condition in which the X chromosome is abnormally susceptible to damage, especially by folic acid deficiency 2nd most common genetic cause of cognitive impairment after down syndrome More common in males than females
What phase of psychosocial development are preschoolers in?
Initiative vs guilt
What does gravida mean?
Is currently or has been pregnant
What is the purpose of the umbilical vein?
It carries blood from the placental villi to the fetus
What is supine hypotension syndrome?
It decreases blood return to the heart of the pregnant woman. Decreases CO and hypotension. Mom can experience lightheadedness, faintness, palpitations. Can cause fetal hypoxia
How is play during the toddler age?
It is parallel which means a group of toddlers will do the same activity but not necessarily together
Why is prenatal care so important?
It is the single most important indicator of a good fetal and maternal outcome.
What is important to do when caring for a child who has fragile x syndrome and why?
Keep with the same nurse as much as possible because they do not like a disruption in routine
What is of huge importance when caring for someone who has an autism spectrum disorder?
Know how they communicate best
How can a hearing impairment be noticed in infants?
Lack the startle reflex Don't track sounds No vocalization
What are the classic physical appearances of fragile x syndrome?
Large head circumference Long Face Strabismus Prognathism (enlarged jaw) Large Ears
What are signs that labor is near?
Lightening. Operculum loss. Rupture of membranes. Excess energy (nesting). Consistent uterine contractions.
Where is the foramen ovale located and what is its purpose?
Located between the left and right atria Takes most of the oxygenated blood to the left atrium to go to the brain and body
Where is the ductus venosus located and what is its purpose?
Located in the liver Shunts a portion of the blood directly to the IVC
Where is the ductus arteriosus located and what is its purpose?
Located in the pulmonary artery Shunts away most of the blood from going to the lungs.
What is Rubeolla?
Measles Symptoms appear 7-14 days after person is infected.
What are some behavior characteristics associated with fragile x syndrome?
Mild to severe cognitive impairment Delayed speech and language Hyperactivity Hypersensitivity Autistic-like behaviors Intolerance to change in routine
How do new moms and dads adapt to pregnancy?
Mom - accept the pregnancy, create a relationship with the fetus, and prepare for childbirth. Dad - Accept pregnancy and they will often have couvade syndrome (cravings etc.)
What are the skeletal system changes that can occur during pregnancy?
Mom needs more calcium and phosphorus to support fetus. Gradual softening of pelvic ligaments and joints. Excessive movement of joints can cause discomfort. Wide separation of symphysis which causes waddling. Bachaches are common
What immune system changes occur during pregnancy?
Moms immune response decreases, making her more prone to infection. WBC increases
How mature are the physiological systems during toddlerhood?
Most physiologic systems are mature Respiratory tracts are still smaller and less mature than an adult Vision is not fully developed here either, vision is 20/40 at best Voluntary control of elimination occurs during this timeframe also
What can a high AFP test indicate?
Neural tube defects
What are early behavioral signs of cognitive impairment?
No response to contact, voice or movement Irritability Poor or slow feeding Poor eye contact during feeding Diminished spontaneous activity Developmental delays (physical growth)
Do all down syndrome children look and act the same? Explain
No there are different levels of down syndrome. Some kids can be extremely high functioning while others may not be nearly as functional
What are nondisjunction abnormalities?
Normally sperm and ova divide equally during cell division. In nondisjunction abnormalities, the division is uneven
When should solid foods be introduced to an infant's diet and why?
Not before 6 months because their GI cannot tolerate it. They don't produce the proper enzymes to break down solid foods
What does nulligravida mean?
Not currently pregnant
How do we promote health during the preschool years?
Nutrition Injury prevention Sleep and activity Dental health
What is important to know about Piaget's sensorimotor phase?
Occurs from birth to 2 years of age Object permanence occurs in this phase, when a child realizes that things and people exist even when they're out of sight
What is it called when a mom has low amniotic fluid levels?
Oligohydramnios
When does the zygote become an embryo?
Once the zygote implants in the uterus
What are the ovarian changes that occur during pregnancy?
Ovulation stops. FSH and LH production is halted.
What changes in the endocrine system occur during pregnancy?
Oxytocin is produced. Prolactin is produced. The thyroid and parathyroid gland enlarges. Iodine levels increase Increased corticosteroids and aldosterone are produced. Diabetics need more insulin during pregnancy
What is Enterobiasis (pin-worms)?
Parasites that hatch in the upper intestine and them mature through the GI tract
What nursing assessment must we preform with parents and children?
Parents and children: ask if they are afraid of anyone at home Child only: Who can you tell if someone is hurting you Parent only: Encourage parents to share their frustrations
What is PUBS?
Percutaneous umbilical blood sampling OR procedure that takes blood from the umbilical cord to test for chromosomal abnormalities such as down syndrome and blood disorders such as hemolytic disease of the newborn.
What is the main complication of pertussis?
Pneumonia
What is it called when a mom has excess amniotic fluid levels?
Polyhydramnios
What are factors predisposing to physical abuse?
Poor coping mechanisms Poor access to resources for respit care for the caregiver Cognitive disorders
What are some signs and symptoms of shaken baby syndrome?
Poor feeding Vomiting Apnea Decreased muscle tone Decreased LOC Seizures Irritability Retinal Hemorrhage (biggest indicator of shaken baby) Bradycardia Bulging fontanelles (increased ICP) Posturing
What are the 3 stages of fetal development?
Pre-embryonic 1st 2 weeks Embryonic 2 weeks to 8 weeks Fetus 8 weeks to birth
What does primigravida mean?
Pregnant for the first time
What are some complications of polyhydramnios?
Premature rupture of membranes Prolapse of the uterus Prolapse of the umbilical cord
What is PROM?
Premature rupture of membranes (greater than 37 weeks)
What phase of cognitive development are the preschoolers in?
Preoperational
What is PPROM?
Preterm premature rupture of membranes (less than 37 weeks)
What is the importance of chorionic villi?
Produce placental hormones Protect embryo from certain infectious organism
What is the function of amniotic fluid?
Protects the baby from injury Helps with symmetrical growth Acts as a stable thermal environment
Why is it important to teach parents about not propping the bottle during feedings?
Reduces the risk for aspiration (biggest risk) Bad teeth development can occur Feeding time is supposed to be a bonding time
What is visual impairment?
Refers to a visual loss that cannot be corrected with regular prescription lenses
What are some feeding difficulties that parents can encounter?
Regurgitation and spitting up Colic (upset stomach) FTT Reflux, GERD
What could cause oligohydramnios?
Renal problems with mom Mom isn't profusing well
What phase of cognitive development are the toddlers in?
Sensorimotor and preoperational
What phase of cognitive development is an infant in?
Sensorimotor phase
What is the classic symptom of pertussis?
Short rapid coughs following by crowing or a 'whoop' sound
How should communication be with a toddler?
Short, sweet and simple Make sure to give them 2 choices and try to avoid yes or no questions
What are the respiratory changes that can occur during pregnancy?
Shortness of breath Chronic Respiratory alkalosis Mom draws in extra volume to increase effectiveness of air exchange. Oxygen consumption increases by 20%. Nasal, sinus, and ear stuffiness Epistaxis (nose bleeds) can occur.
What is the normal color of amniotic fluid?
Should be a clear beige-ish color
What are the norms for a preschooler and getting dressed?
Should be able to dress themselves and also pick out what they are going to wear
What fine motor skills should be present in a preschooler?
Should be able use scissors, learn to tie shoes, button clothes, brushes own teeth, draw circles, squares and crosses
What are the developmental weight norms for an infant?
Should gain 5-7 oz per week Should double birth weight at 6 months Should triple birth weight at 12 months
How should solid foods be introduced to an infant?
Should introduce new foods 4-7 days apart to prevent allergies Should start with strained/puréed veggies then fruits, then meats 4-6 months Finger foods (Cheerios etc.) 6 months Chopped table foods 9-12 months (kid should have teeth)
If a parent is requesting a vegetarian diet for themselves and their child, what is important to ensure the parents know?
Should know where to get essential fatty acids and proteins Educate on resources on where to find this information also, such as choosemyplate.org
What is presumptive signs of pregnancy?
Signs and symptoms that as a whole would indicate pregnancy but when taken one at a time could indicate something else.
What are the 3 stages of rash in fifth disease (Erythema Infectiosum)?
Slapped face - appearance disappears between 1 to 4 days Maculopapular rash on extremities - lasts 7 days or more, strawberry like in appearance. Rash then subsides but reappears if skin is irritated or traumatized by heat, cold, or friction.
How is physical growth during the preschool age?
Slows and stabilizes
What are some manifestations of down syndrome?
Small head, flattened forehead Wide, short neck Simian Line (most common, one transverse line on the palm) Hypotonia (floppy myo tone)
What is Goodell's sign?
Softening of the cervix
What is Hagar's sign?
Softening of the lower uterine segment
What is organic FTT?
Something the child is born with or has inside the body
What is nonorganic FTT?
Something usually in the child's environment that causes this such as poverty, lack of information, neglect, postpartum depression etc.
How can hearing impairment be noticed in older children?
Speaking too loudly Need directions repeated multiple times (These are cues for the need for additional screenings)
What is SROM?
Spontaneous rupture of membranes (occurs on its own)
What is strabismus and how is it treated? What can occur if left untreated?
Strabismus is when one eye doesn't have proper eye muscles built up Usually treated by putting an eye patch over the strong eye to try to build up muscle strength in the weak eye If left untreated it can turn into amblyopia or lazy eye
What is striae gravidarum?
Stretch Marks
What are the skin changes that occur during pregnancy?
Striae gravidarum Extra pigmentation Linea Nigra Melasma
If someone is considered to have a cognitive impairment, what criteria must be met?
Sub-average intellectual function (IQ <75) Functional capacity impaired in 2 of 10 (at least) adaptive skill areas Onset before 18
What is SIDS?
Sudden Infant Death Syndrome Defined as the sudden death of an infant younger than 1 year that remains unexplained even after total postmortem examination
How is enterobiasis diagnosed?
Tape test first thing in the morning before bowel movement (put a piece of tape over anus and then remove it and you can usually see worms come off onto the tape)
What does green amniotic fluid indicate?
That the baby pooped in utero which can lead to meconium aspiration syndrome
What does dark yellow amniotic fluid indicate?
That there could be a potential rH problem
What is important to know about abnormal AFP tests?
That they don't diagnose, but may indicate that further genetic testing is required
What are some complications of oligohydramnios?
The baby could bump into umbilical cord which can cause the baby stress because of lack of blood flow which can ultimately lead to hypoxia
What is important to know about the adverse effects of immunizations?
The benefit of the immunization far outweighs adverse effects
What is heavy metal poisoning?
The breathing in of or ingestion of lead usually
What is important to know about the endocrine system of a fetus?
The fetal pancreas produces insulin needed by the fetus. So if mom is hyperglycemic we need to watch baby closely for rebound hypoglycemia after birth.
What does para mean?
The number of pregnancies that reached viability, regardless of whether infants were born alive or not
What is the mucus plug called?
The operculum
What is shaken baby syndrome?
The shaking of a baby in a violent manor resulting in injury to the baby that is usually under 6 months old
What is important to know about nutrition and the toddler?
They are often super picky eaters They like to feed themselves so be sure to give them a safe nutritious snack Should try to limit milk intake to 700 ml per day to allow room for other foods
How do preschoolers demonstrate initiative vs guilt?
They develop a sense of purpose (initiative) They feel the need to assert control in their world (initiative) They start developing a conscious (guilt)
How does the toddler develop body image?
They have discovered their genitalia and often explore it. This freaks adults out but it is a normal part of development
What gross motor skills should be present in a preschooler?
They learn to climb and ride tricycles (safety education is a huge teaching opportunity)
What is important to know about dental health with a preschooler?
They should have some type of Fluoride source when baby teeth start coming in
How is the preschooler developing body image?
They think that everyone should look a certain desirable way This age is prone to masterbation be sure to not same them if they are doing it at an inappropriate time
What does fetal skin look like?
Thin and translucent until subcutaneous fat deposits around 36 weeks
Why does coaguability of a pregnant womans blood increase during pregnancy?
To prevent postpartum hemorrhage.
How does fluid retention change during pregnancy?
Total body water increases to 7.5L which requires the body to increase sodium reabsorption in the tubules to maintain osmolarity
What is an example of a chromosomal abnormality?
Trisomy 21 (extra copy of chromosome 21)
What tissue does the placenta form from?
Trophoblast tissue
What psychosocial development stage occurs in the infant year?
Trust vs Mistrust
What are the causes of down syndrome?
Unknown cause Some say it can be older maternal age is higher risk for down and there is said to be a familial link
What are the ureter and bladder changes that can occur during pregnancy?
Ureter diameter increases. Bladder capacity increases to 1500 mL. Pressure on the ureters can lead to urinary stasis, UTI and pyelonephritis. Urinary frequency (early and late in pregnancy)
What are renal function changes that can occur during pregnancy?
Urinary output increases about 60-80%. Specific gravity decreases GFR and renal plasma flow increase, which causes lower BUN and creatinine levels in maternal plasma.
When is urine formed in a fetus and when is it excreted?
Urine is formed in the 12th week Excreted around 15-16 weeks (which is why an amniocentesis is done at this time because the urine becomes part of the amniotic fluid)
Where is enterobiasis more common and why?
Usually more common in southern states because they have a warmer humid environment which is conducive for these parasites.
When is it suspected that a child may present on the autism spectrum?
Usually suspected by toddler years, but may not be recognized until school year age.
What is primigravida?
Uterus height drops from 38 to 36
What are the GI changes that can occur during pregnancy?
Uterus moves stomach and intestines to the back of the abdomen. Peristalsis slows causing heartburn, constipation, and flatulence. Nausea and vomiting are common early in pregnancy (1st trimester) Decreased ability to empty bile, causing an increase of bilirubin reabsorption resulting in general itching. Hypertrophy of gumlines High risk of galstones because increase serum cholesterol levels.
What are danger signs of pregnancy?
Vaginal bleeding. Passing of operculum. persistant vomiting. Chills and fever. Sudden escape of clear fluid from vagina. Abdominal or chest pain. Hypertension. Increase or decrease in fetal movement.
What are the cervical changes that occur with pregnancy?
Vascular and edematous from the increase in estrogen. Increased fluid causes cervix to soften and the increased vascularity causes it to darken to a violet color. The mucus plug forms in cervix to protect the area. Goodell's Sign
What is important to know about the nutrition of a preschooler?
Very picky with Strong preferences Should have about 85 calories per kg daily Should get 500-800 mg of calcium and 10 mg of iron Try to avoid mixing food
What are the gross developmental norms for the toddler?
Walking independently should occur between 12-15 months Improved coordination occurs between 2-3 years (less clumsy)
What do we as nurses do if we suspect child maltreatment?
We are required by law to report suspected child abuse/neglect
What is checked when the umbilical cord is cut from the baby?
We check to make sure the umbilical cord has 1 vein and 2 arteries
What is important to remember with communication about procedures and a preschooler?
We should verbalize and explain procedures Allow child to handle equipment and ask questions Be aware of metaphors and similes
When is an amniocentesis usually done and why?
Week 15-16 because that is when the fetus starts urinating, contributing to extra amniotic fluid It can also be done later in pregnancy to check for levels of lung enzymes (LS ratio should be 2:1 or 3:1 in diabetics)
Describe biological development of a toddler for height and weight
Weight gain slows to 2-3 kg/year The birth weight should be quadrupled by 2 1/2 years Height increases about 3 in/year Growth is slower than an infant but still steady
What are translocation abnormalities?
When a child gains an additional chromosome through another route
What can cause supine hypotension syndrome?
When a mom lays flat on her back causing the weight of the uterus to compress the IVC obstructing blood flow
What is lightening in pregnancy?
When the baby drops down starting the birthing process
When do we not give a live immunization?
When the child is immune compromised
When is the most appropriate time to start potty training?
When the child shows an interest Usually occurs at age 2-3 They should be able to stay dry for 2 hours at a time They should also have the gross motor skills to physically get to a toilet and the fine motor skills to undress themselves
What is Chadwicks sign?
When the vagina changes color to a deep violet (because of increased vascularity to the area)
What is male and female genetic makeup?
XX is female XY is male
When are rudimentary kidneys present in a fetus?
as early as the end of the 4th week
What is post term pregnancy?
greater than 42 weeks
What is preterm pregancy?
under 37 weeks