270 Final

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

energy production

CO is tied to

It inhibits the activity of osteoclasts .It can also decrease the resorption of calcium in the kidneys again leading to lower blood calcium levels

Calcitonin reduces calcium levels in the blood by what two main mechanisms:

Nevus flammeus

Capillary angioma below the surface of the skin that is purple or red, caries in size and shape, is commonly seen on the face, and does not blanch or disappear

umbilical cord vein

Carries oxygenated blood to embryo

atherosclerosis

Characterized by a focal deposit of cholesterol and lipids within the intimal wall of the artery. Inflammation and endothelial injury play a central role in the development

Unstable Angina

Chest pain that is new in onset, occurs at rest, or has a worsening pattern. It is unpredictable and is an emergency.

CABG (Coronary Artery Bypass Graft)

Creation of a new blood supply to an area of the heart with a clotted/blocked artery.

Hypercalcemic crisis

Definition: calcium >15mg/dL can result in life-threatening neuro, cardio, and renal problems Treatment: saline, diuretics, antiarrhythmic agents, calcitonin, phosphate replacement

Subinvolution

Delayed return of the uterus to its nonpregnant size and consistency. placental site does not heal lochia persists brisk periods of lochia rubra D&C may be necessary

wheezing

Difficult breathing with a high-pitched whistling or sighing sound during expiration

tampon-like; 10mg gradually released over 12 hours; continuous fetal monitoring - softens cervix, cervical ripening - if mom is having too many contractions take it out - give second dose if bishop score doesn't change

Dinoprostone (Cervidil)

beneficence

Doing good or causing good to be done; kindly action

maternal serum alpha- fetoprotein (MSAFP)

Done between 15-22 weeks to test for neural tube defects If positive ultrasound and amniocentesis ordered

avanafil; sildenafil; tadalafil; vardenafil causes smooth muscle relaxation and increased blood flow into the corpus cavernosum side effects - headache - leg/back pain -flushing -blurred vision -priapism contradicted if taking nitrates

Drug therapy for ED

notify HCP of any symptoms of bleeding no contact sports blow nose gently dont bend down with your head lower than your waist prevent constipation electric razor dont use tweezers no aspirin or NSAIDs soft bristle toothbrush count menstraul pads

Educational Facts for Thrombocytopenia

• Hemodilution • Decreased peripheral resistance • Increased cardiac circulation and turbulence - May have murmur - May lead to cardiac failure • Cyanosis • Growth retardation

Effects of Anemia on Circulatory System

Clomiphene

Estrogen partial agonist: synthetic used in infertility to induce ovulation

• X-linked recessive trait • Males are affected • Females may be carriers • Degree of bleeding depends on amount of clotting factor and severity of a given injury

Etiology of Hemophilia A

Decreased: chest wall movement, deep breathing, vital capacity, Pa O2, Sa O2, cough effectiveness, response to hypoxia

Gerontologic Considerations: Effects of Aging on Respiratory System

· 4%-6%

Glycosylated hemoglobin level

Fetal effects - opthalmia neonatorum -sepsis Tx -PCN, erythromycin and ceftriaxone

Gonorrhea fetal effects Tx

fetal effects -possible chronic respiratory papillomatosis Tx - laser ablation or cryotherapy -possible c- section

HPV fetal effects Tx

mild anemia

Hgb 10-12 g/dL

- removal of cause - no aspirin - corticosteroids - IV immunoglobulins - splenectomy - immunosuppressive therapy -plasma exchange HIT - stop heparin, go on argatroban

How is Thrombocytopenia Treated?

gravida

How many times a woman has been pregnant including current pregnancy

• Monitor constantly • risk of nosocomial infection • Conserve energy and stress • O2 sats • O2 - Hood - CPAP - NC - ET - ECMO (NICU only) • Labs • Peripheral or Umbilical line • Prepare for transfer to NICU

Immediate Care High Risk Infant

Cafe au lait spots

In neurofibromatosis, a common clinical feature is the presence of several smooth-edged tan-to-brown pigmentations on the skin called -6 or more is considered pathognomonic for neurofibromatosis

become completely numb used for C- sec highly associated with maternal hypotension client must remain flat for 6 to 8 hrs after delivery

Indications for spinal block

cardiac angiography

Invasive procedure to image the heart and blood vessels using radiopaque medium

- Over 4000 grams (8-13) - Usually DM - Assess for birth injury and hypoglycemia

LGA

most common fetal position

LOA (left occiput anterior)

non-reactive stress test

Less than 2 accelerations of 15 BPM within a 20 minute period. may indicate hypoxemia and acidosis

cardiac ischemia as well as other organs.

Low cardiac output can cause

right

MI with HR of 30 is affecting what coronary artery?

Easy bruising • Epistaxis • Gingival bleeding • Excessive bleeding with lacerations or surgeries • Menorrhagia

Manifestations of Von Willebrand Disease

1st day of last period + 7 days - 3 months

Nagele rule

Diabetic neuropathy

Nerve damage due to metabolic derangements of diabetes - Sensory versus autonomic neuropathy

Brain Natriuretic Peptide (BNP)

Normal: <100 Elevated levels indicate CHF

Fatigue, weakness wt loss, n/v postural hypotension hypoglycemia hyponatremia hyperkalemia hyperpigmentation of mucous membranes and skin loss of body hair hypovolemia

Nursing assessment for Addison's disease

- causes due to ovarian function= hormones replacement therapy ART -IVF -GIFT -ZIFT -ICSI

Nursing care for female infertility

Discover if its a side effect to medication is it reversible androgen replacement therapy emotional support educate on drug therapy

Nursing care r/t ED

VS and FHR supine position with hands across chest maternal blood sample label samples after - wash abdomen - assist to bathroom - monitor FHR 1 hour after procedure - watch for contraction or fluid leaking from vagina

Nursing care r/t amniocentesis

- identify type of abortion - VS, LOC every hour - save all peripads, linens - start IV 18 gauge - Give RhoGAM - grief protocol - Teach client to notify nurse of the following .Temp above 100.4, foul smelling vaginal discharge, bright red bleeding with tissue larger than a dime

Nursing interventions for miscarriage

Hypoglycemia

Occurs when • Too much insulin in proportion to glucose in the blood • Blood glucose level less than 70 mg/dl

preterm labor

Onset of labor between 20 to 37 weeks gestation

32-48

PaCo2

80-100

PaO2

• Coagulation process is abnormally stimulated • Excessive amounts of thrombin are generated • Fibrinolytic mechanisms are activated and cause extensive destruction of clotting factors

Pathophysiology of DIC

Electronic Medical Record (EMR)

Patient medical record from a single medical practice, hospital, or pharmacy that is not shared

Cheyne-Stokes

Periods of difficult breathing (dyspnea) followed by periods of no respirations (apnea)

• Many Blood Cells • Increased blood viscosity • Can crowd out clotting factors • May cause anemia if hemoglobin is not available. • Clubbing of fingers and toes

Polycythemia

Decreased interest in surroundings Unable to feel pleasure or joy for infant Feels unworthy Sleep disturbances

Postpartum Depression

◦ Suicidal or Homicidal tendancies ◦ 2/1000 ◦ 50% chance of recurrence ◦ Can experience bipolar disorder or major depression

Postpartum Psychosis

TORCH infections

Prenatal infex that lead to severe abnormalities = most common HEARING IMPAIRMENT & MR Toxoplasmosis Other = syphillis, varicella, HIV Rubella Cytomegalovirus Herpes Simplex

GnRh antagonists -cetrorelix -ganirelix

Prevents premature LH surges and premature ovulation in women undergoing ovarian stimulation

b,c

Pt teaching is not effective when pt states what about IPT (select all that apply) A. I should use a soft bristle toothbrush B. It is okay to play contact sports as long as all members of each team know my condition C. I can take aspirin if I have a headache D. I need to take caution when using knifes or other sharp materials.

• Usually within 1-2 hrs • Alveoli collapse with expiration; inadequate gas exchange • SIN (substernal retractions, inspiratory grunting, nasal flaring)

RDS

Biot's respirations

Rapid and deep respirations followed by 10 to 30 seconds of apnea

Chronic Stable Angina

Refers to chest pain that occurs intermittently over a long period of time with the same pattern of onset, duration, and intensity of symptoms.

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched lasts until 1 year

Diastole

Relaxation of the heart

Cushing's disease

Results from excessive adrenocortical activity May be related to excessive use of corticosteroid medications or due to hyperplasia of the adrenal cortex Over secretion of corticosteroids can also be caused by pituitary tumor Can be caused by bronchogenic carcinoma or other malignancy

sexual abuse

STDs in infants and kids indicates

above 95%

SaO2

Vacuum erection device (VED)

Second line therapy. Vacuum causes blood to be drawn into corpora. Can be used in combination with constriction bands to prolong effect.

description: fever, abdominal pain and tenderness, foul- smelling vaginal discharge, bleeding Tx: termination of pregnancy, antibiotic therapy, monitoring for septic shock

Septic miscarriage description and Tx

Acne, Blurred vision, Cataracts or glaucoma ,Easy bruising, Muscle weakness, difficulty sleeping, high bp, insomnia, increased body hair, swollen puffy face, sudden mood swings, water retention, swelling

Steroid medication side effects

Cephalohematoma

Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.

gestational trophoblastic disease (Hydatidiform Mole)

Swollen, fluid-filled grape like clusters in the placenta. Associated with choriocarcinoma which is a rapidly metastasizing malignancy. an embryo rarely present

signs of ovulation should be taught - cervical mucus assessment - basal body temp - mittelschmerz

Symptothermal, prothermal, or fertility awareness

DIC

Syndrome of abnormal clotting that is systematic and pathologic. Large amounts of clotting factors are depleted, causing widespread external and internal bleeding. Related to fetal demise, infection and sepsis, pregnancy induced hypertension and abruption placentae

fetal effects - still birth - congenital syphilis -hydrocephaly -congenital cataracts -copper-colored rash - cracks around the mouth - hypothermia Tx - Tx before 16 wks to prevent transmission -PCN -erythromycin

Syphilis fetal effects Tx

sputum studies

Test obtained by coughing deeply and producing mucus from the lung itself. Mucus is then sent to lab for analysis. Used to test for bronchitis, TB, lung abscess, or pneumonia

Fasting plasma glucose level >126 mg/dl - Random or casual plasma glucose measurement ≥200 mg/dl plus symptoms - Two-hour OGTT level ≥200 mg/dl using a glucose load of 75 g

Tests to Diagnose Diabetes Mellitus

stroke volume

The amount of blood ejected from the heart in one contraction.

I statement= insufficient evidence to recommend for or against

The current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined

pituitary gland

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.

thoracic expansion

The expansion of the chest wall palpated when the person takes a deep breath; should be bilateral and symmetric; never want thumb to move more than an 1 inch

take iodine, and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body which can absorb iodine.

The function of the thyroid gland is to

Preload

The precontraction pressure in the heart as the volume of blood builds up.

ethical delimma

This is the choice between two or more equally justifiable alternatives.

lymph system

This system is part of the circulatory system. It produces lymphocytes to fight infection that may be found in the blood stream. It also collects, filters (lymph nodes), and transports fluids from around the tissues back to the veins of the circulatory system.

fetal effects - still birth - microcephaly -hydrocephalus - blindess -deafness Tx - sulfadrugs

Toxoplasmosis fetal effects Tx

can be applied to lower abdomen, upper outer arm, buttock, or upper torso delivers continuous progesterone and estrogen be applied on the same day once a wk for 3 wks, followed by 1 wk w/out patch

Transdermal contraceptive patch

-fluids -pain management -folic acid daily supplements -blood transfusions (during crisis) -Hydroxyurea (an anti-sickling agent) -bone marrow transplant.

Treatment for Sick Cell Anemia

TB skin test

Tuberculin hypersensitivity test to detect a current or past infection with Mycobacterium tuberculosis. positive with induration of 11 or more

Turbutaline

Used for external cephalic version *Helps relax the uterus* Monitor lung sounds & baby Can cause jittery & rapid heart rate (also used for asthma)

bronchophony, egophony, whispered pectoriloquy

Vocal resonance is tested via these three things:

Fatigue - Shortness of breath - Glossitis - Muscle weakness - Weight loss - Tachycardia - Difficulty breathing

What are symptoms of megaloblastic anemia?

nose bleeds, increased intracranial pressure, leaking of CSF, stroke

What are the complication for trans sphenoidal surgery?-

is a type of vitamin B that helps your body produce and maintain new red blood cells. It is found in ● Dried beans ● Whole Wheat ● Oranges

What is Folic Acid?

whispered pectoriloquy

a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue (123)

Mittelschmerz

abdominal pain that occurs midway between the menstrual periods at ovulation

orthopnea

ability to breathe only in an upright position

10 months

able to crawl at

5-6 months

able to roll from belly to back at

8 months

able to sit unsupported at

cardiac temponade

acute compression of the heart caused by fluid accumulation in the pericardial cavity

headache flushing hypotension

adverse effects of nitrates

thyroid gland

affects metabolism

high platelets low immune function

affects of splenectomy

24 hrs

after ovulation how long do you have for fertilization

boys= 14 girls= 10

age of growth spurt

coma seizure no ketonuria blood glucose above 600

assessment finding r/t HHS

Inspection -prolonged expiration -tripod position - pursed lips Percussion -Hyperresonance Auscultation - Wheezes -decreased breath sounds

assessment of an asthma exacerbation inspection, percussion, auscultation

fatigue and pallor Hgb < 11, Hct < 37% 1st tri Hgb < 10.5, Hct< 35% 2nd tri Hgb < 10, Hct < 32% in 3rd tri noncompliance with prenatals

assessment of anemia throughout pregnancy

Inspection -no change Palpation -decreased movement -decreased fremitus Percussion -dull Auscultation -fine crackles - absent sounds

assessment of atelectasis inspection, palpation, percussion, auscultation

audible air escaping from chest wound cough cyanosis decreased breath sounds on side of injury decreased O2 dyspnea frothy secretion's tracheal deviation Asymmetrical BP in arms Chest pain decreased BP distended neck veins dysthymias muffled heart sounds rapid thready pulse asymmetrical chest movement subcutaneous emphysema

assessment of chest trauma

5000 Ml

average CO

5th grade

average reading level

normal 110- 160 round to 5 BPM between contractions within 10 min of strip big box= 1 min, little box= 10 sec

baseline of fetal heart rate

Contraction frequency

beginning of one contraction to the beginning of the next contraction (measured inminutes)

preformed earlier than amniocentesis (usually 10- 12 wks) look for genetic defects

benefits of chorionic villus sampling

leiomyomas fibroids, myomas, fibromyomas, fibromas

benign tumors arising from the muscle tissue of the uterus

6 months 12 months

birth wt doubles by and triple by

Von Willebrand Disease

bleeding disorder caused by a deficiency of von Willebrand factor, a "sticky" protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation

Peripheral Arterial Disease

blockage of arteries carrying blood to the legs, arms, kidneys and other organs

hemothorax

blood in the pleural cavity

lochia rubra

blood-tinged discharge, includes tissue and decidua; lasts 1 to 3 days postpartum

Acroyanosis

blue hands and feet in a newborn. NORMAL FINDING for first 24 hrs

central cyanosis

bluish discoloration of the skin or mucous membranes due to hemoglobin carrying reduced amounts of oxygen

wear shields, to help infant latch

breastfeeding with inverted and retracted nipples

Infertility

can't conceive for 1 year of unprotected sex

minimize crying to prevent strain on lip suture line maintain logan bow to lip if applied care with restraints cleanse suture site with sterile water after feeding

care of surgical site post op for cleft lip or palate

Erythrocytes

carry O2 and CO2 concaved

child abuse and neglect bullying youth violence Intimate partner violence elder abuse and neglect

categories for IPV

Research Education Practice Community

categories of mission statements

Trauma pulmonary infection/ aspiration prolonged ventilator assistance shock fat emboli spesis

cause of acute respiratory distress syndrome

pneumothorax

cause of asymmetrical chest in newborn

congenital hip dislocation

cause of hip click, unequal limb length, and asymmetrical gluteal folds in newborn

Genetic disposition (young Jewish men); smoking; tobacco allergy; autoimmune response

causes of buergers

can put head to ear can rap arm around chest can barely bend wrist sticky friable transparent skin no lanugo no creases on feet no breast pina of ear stays folded

characteristics of preterm infant

Aplastic Anemia

characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow

angina

chest discomfort or pain that occurs when myocardial O2 demands exceed supply

acreta

chorionic villi attach directly to myometrium

peripheral vascular disease

circulatory problems that can be due to arterial or venous pathology

1: medication , specific diseases, inherited 2: left sided HF 3: lungs and hypoxemia 4: cardiovascular system and thromboembolic occlusion 5: multifactorial orgins with hematologic or metabolic

classes of pulmonary hypertension

hypertension in the upper extremities and decreased or absent pulses in the lower extremities

classic finding of coaraction of the aorta

remain active sit with feet elevated avoid pressure on lower thighs dorsiflex foot to relive leg cramps cool- air vaporizer or saline nasal spray to help with nasal stuffiness

comfort measures for 20 wks

tension, battering incident, honey moon phase

cycle of battery

fetal effects - still birth - congenital CMV -microcephaly -IUGR -cerebral palsy - mental retardation - rash - jaundice Tx - none

cytomegalovirus fetal effects Tx

restrictive respiratory disorders

decreased expansion of lungs attributable to alterations in the lung parenchyma, pleura, chest wall, or neuromuscular function. cant fully expand

breastfeeding jaundice

decreased milk intake r/t fezer calories consumed by infant before mothers milk is well established

hypoparathyroidism

deficient production of parathyroid hormone

preload

degree of stretch of the cardiac muscle fibers at the end of diastole

Partial: placenta lies over part of cervical os complete: placenta lies over entire cervical os marginal: edge of placenta meets the rim of the cervical os Low lying: placenta implants in lower uterine segment with a placental edge lying near the cervical os

degrees of previas

• RBCs appear large • Abnormal shapes • Structure contributes to erythrocyte destruction • Decreased serum cobalamin levels • Normal serum folate levels and decreased cobalamin levels suggest megaloblastic anemia due to cobalamin deficiency

diagnostics for cobalamin deficiency

chest X-ray ECG monitoring ABGs Spiral CT scan D-dimer troponin level

diagnostics for pulmonary embolism

- 12-lead ECG - CXR - Oxygen saturation - Cardiac enzymes - CBC with differential - Metabolic profile - PT/PTT/INR

diagnostics for unstable angina

Chest X- ray sputum pule ox CBC blood cultures

diagnostics r/t pneumonia

avoid dieting add 500 calories to pregnancy intake 8 glassess of water a day

diet during breastfeeding

Gradual onset= physiologic factors sudden onset= psychologic issues

difference between a gradual and rapid on set of ED

Caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days

angiopathy

disease of blood vessels

Acromegaly and giantism

diseases caused by too much growth hormone

- Diuretics ( ie: Lasix) - Adrenergic inhibitors-relax muscles keep sm vessels open as with Raynauds (ie: Cardura, Minipress, Flomax) - Direct vasodilators-widen vessels (ie: Nitrobid, Apresoline) - Angiotensin inhibitors-potent vasoconstriction (ie: Capoten, Lisinopril, Catopril) - Calcium channel blockers-decreases ca entering cardia muscle which leads to decreased muscle contraction maintains b/p (Norvasc, Plendil)

drugs used for hypertension

Pulmonary hypertension

elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles.

plantar reflex

elicited touching the soles of the feet. toes curl downward. (birth to 8 months)

temperature pulse above 100 malaise, anorexia excess fundal tenderness uterine subinvolution lochia returning to rubra from serosa foul- smelling lochia

endometritis assessment

BP - 140/90 or increases of 30/15 above baseline Labs - Tr to 1+ proteinuria

explain BP and labs r/t mild preeclampsia

polydactyly

extra fingers or toes

justice

fairness; rightfulness

fluids and corticosteroids

first treatment for thrombocytopenia with platelets at 50,000

- Obesity with increased waist circumference - Elevated triglycerides - Hypertension - Abnormal serum lipids - Elevated fasting blood sugar

five risk factors referred to as metabolic syndrome which is thought to be related to insulin resistance?

manifestations -paradoxical movement of chest wall -respiratory distress interventions -O2 -analgesia -positive pressure ventilation

flail chest manifestations and intervention

amniotic fluid

fluid within the amniotic sac that surrounds and protects the fetus; made of water and urine

limit tampon use avoid douching refrain from intercourse avoid heavy lifting 3L of fluids a day

follow up care after hysterectomy

meat, raisins, spinach, beets, beans, peanut butter, whole grains, iron fortified cereals, eggs

food high in iron

meat dairy aspartame

foods eliminated with PKU

vegetables fruits juices cereals bread starches

foods with low phenylaline levels

mom can't pus baby past a certain spot vacum used more often -Mighty vac -kiwi

forceps of vacum extraction

BP = CO X SVR

formula for BP

12-23 wka

fundus rises above symphysis

• Pallor • Jaundice • Pruritus palpations tachycardia fatigue dyspnea mummers angina MI blurred vision hepatomegaly splenomegaly sensitive to cold glossitis bone pain headache vertigo

general manifestations of anemia

rapid pulse rapid, shallow respirations and dyspnea increased restlessness flaring of nares retractions cyanosis

general signs of hypoxia

no nipple bud vernix over entire body lanugo over entire body full extension of extremities in resting posture testes in the inguinal canal or labia majora widely separated

gestational age assessment around 28 wks

raised nipple with a tissue bud descended testes with large rugae on the scrotum labia majora large and covering the minora vernix only in the creases lanugo only on shoulders hypertonic flexion of extremities in resting posture

gestational age assessment around 40 wks

3 months

head turns to locate sounds by

absolute bed resr wt daily test urine for protein daily high protein diet could be hospitalized and tx with magnesium sulfate

home management for preeclampsia

Adrenocorticotrophic hormone (ACTH) Thyroid-stimulating hormone (TSH) Luteinizing hormone (LH) Follicle-stimulating hormone (FSH) Prolactin (PRL) Growth hormone (GH)

hormones released by the anterior pituitary gland

Oxytocin Antidiuretic hormone (ADH)- (vasopressin)

hormones released by the posterior pituitary gland

over 65, disabled, and end- stage renal disease

how do you get medicare

As treatment, the goal is a) to replace the blood volume to prevent shock and b) to find the source of acute blood loss, and stopping the bleeding. IV fluids are used to prevent hypovolemia and maintain fluid volume. -Packed red blood cells (pRBCs) are the primary treatment used in acute anemia to restore the blood lost. Each unit of RBCs is expected to increase the hematocrit by 3 points

how is acute blood loss treated

heavy, squeezing, pressing, burning substernal, radiating to left arm or jaw

how is angina often described

Necrotizing enterocolitis

hypoxic- ischemic injury to the mucosa of the intestinal tract results in abdominal distention, sepsis, and nutritional impairment

≤6.5%

ideal goal for A1C

secondary prevention

identifying and treating psychological disorders in the early stages, before they become serious screening recommended for a specific group

turn client of left side increase IV fluids 02 Notify HCp assess FHR

if hypotension occurs during admin of epidural what do you do

clots

if you have high platelets you are at risk for

bleeding

if you have low platelets you are at risk for

placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus bleeding usually being in 3rd tri A MEDICAL EMERGENCY

pre-term birth

inadequate wt gain late in pregnancy causes

Description: moderate to heavy bleeding with tissue and products of conception present; open cervical os Tx: hospitalization; D&C

incomplete miscarriage description and Tx

used for pain relief during episiotomy and perineal repair

indication for local anesthesia during labor

Mastitis

inflammation of the breast with redness; most commonly occurs in women who are breastfeeding 2-3 weeks postpartum treat with antibiotcs

endocarditis

inflammation of the inner lining of the heart

endometritis

inflammation of the inner lining of the uterus

◦ Chart review ◦ Rh and Rubella status ◦ Head to toe ◦ VS BP - orthostatic hypotension Pulse - bradycardic ok, tachycardic abnormal Resp - breathsounds Temp -- >100.4 F (38C) abnormal fundal ht lochia

initial post partum assessment

Long-acting (basal) once a day - Rapid/short-acting (bolus) before meals

insulin Regimen that closely mimics endogenous insulin production is

apply pressure

intervention after lymph/ bone marrow biopsy

IV glucose]parental hydrocortisone fluids

interventions during Addison's crisis

• Nursing intervention for the victim of abuse or neglect is to provide shelter and promote reassurance of his or her safety. - Tending to physical injuries - Staying with the client to provide security - Assisting the client to recognize options - Promoting trust - Reporting to authorities when there is "reason to suspect" child abuse or neglect

interventions for victim of abuse

- Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent hypoglycemia - Best done after meals - Exercise plans should be started • After medical clearance • Slowly with gradual progression

interventions needed during exercise for diabetic patients

place in incubator or some sort of isolation cultures admin antibiotics

interventions when newborn develops sepsis

cardiac catheterization

introducing a catheter into a vein or artery to measure pressure and flow patterns of blood

Health Care Economics

is a behavioral science that addresses how to allocate limited resources among unlimited demands and how to pay for these resources.

oxygen-hemoglobin dissociation curve

is a curve that plots the proportion of hemoglobin in its saturated (oxygen-laden) form on the vertical axis against the prevailing oxygentension on the horizontal axis.

D-dimer test

is a global marker of coagulation activation and measures fibrin degradation products produced from fibrinolysis (clot breakdown). The test is used for the diagnosis of DVT when the patient has few clinical signs and stratifies patients into a high-risk category for reoccurrence.

Acromegaly

is a hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood

Calcitonin

is a hormone that is produced in humans by the parafollicular cells (commonly known as C-cells) of the thyroid gland it acts to reduce calcium levels in the blood.

Ferrous Sulfate (Iron)

is a iron preparation used to treat anemia. -Increase fiber and iron, take on empty stomach, spread throughout day. -Vitamin C increases absorption. - stools will turn dark green to black

Hypophysectomy

is a procedure to access and remove the pituitary gland. To access it, an incision is made beneath the patient's upper lip to enter the nasal cavity. A speculum is inserted, and special forceps are used to remove the pituitary tumor

DIC

is a serious condition in which your body will create many blood clots, using up all your clotting factors and can lead to a hemorrhage that cannot be controlled.

Thalassemia

is an inherited disease of blood abnormalities characterized by a lower than normal amount of hemoglobin made and fewer than normal red blood cells in the body. It consists of a group of disorders ranging from barely detectable in the blood to severe or fatal anemia.

sickle cell anemia

is an inherited, autosomal recessive disorder. The presence of abnormal hemoglobin (Hgb S) causes the red blood cells to stiffen and elongate into a crescent shape. The decrease in O2 causes the cell to sickle in shape. This genetic disorder is incurable and is often fatal. It is usually found during routine neonatal screening. patients will have exacerbations triggered by things like dehydration and hypoxia

uterine prolapse

is downward displacement of the uterus

O2 saturation

is the extent to which hemoglobin is saturated with oxygen

Technology

is the knowledge and use of tools, machines, materials, and processes to help solve human problems.

Plasma

is the main component of blood and consists of 90% water, and 10% proteins, ions, nutrients, dissolved gases, and wastes. It functions in maintaining blood pH and osmotic balance. makes up 55% of blood volume.

paO2

is the measurement of oxygen in arterial blood

cystocele

is the relaxation of the anterior vaginal wall with prolapse of the bladder

rectocele

is the relaxation of the posterior vaginal wall with prolapse of the rectum

tissue culture chlamydiazyme microTrak

lab dx for chlamydia

wet slide

lab dx for trichomoniasis

viral culture

lab dx for yeast infection

elevated levels of fibrin, PT, and PTT platelet count decreased reduced fibrinogen reduced clotting factors increased D dimers

lab r/t DIC

low RBCs, low Hgb, and low Hct.

lab values r/t anemia

A D-dimer test is done a n d would be elevated for a pt with a blood clot

lab values r/t blood clot

hyperpigmentation hypernatremia hypokalemia decreased WBCs increased plasma cortisol

labs r/t crushing's disease

prolonged bleeding time due to defective platelets deficiency in factor vWF prolonged PTT

labs r/t von Willebrand disease

Pernicious anemia

lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream due to a lack of intrinsic factor in stomach secretions.

epigastric pain or clonus

last symptoms before a seizure in preeclampsia

ASD VSD PDA coarctation of aorta

list acyanotic CHD

retinopathy, nephropathy, neuropathy

list microvascular complications

neutrophil- high infection eosinophil- high= allergies basophil monocyte- high = parasites lymphocyte

list types of leukocytes and what abnormalities indicate

Threatened Incomplete Complete Septic Missed Recurrent. habitual

list types of miscarriages

spina bifida occulta meningocele myelomeningocele

list types of spine bifida

teach catechization program admin propantheline or bethanachol to improve continence dev bowl program assess skin frequently assess ROM and ambulation

long term care for spina bifida

mental retardation hyperactivity dev delays attention deficits poor coordination facial abnormalities cardiac and joint problems

long term complications of FAS

NST (non-stress test)

looks at FHR in response to fetal movements and/or uterine contractions doesn't stimulate contractions reactive vs non reactive

miscarriage (spontaneous abortion)

loss of pregnancy by 20th week (fertilization age) usually r/t chromosomal defects

blood clots

main concern with polycythemia

cleft lip: place client on side or upright in infant seat cleft palate: place client on side or abdomen remove oral secretions carefully with bulb syringe or Yankauer suction set

maintaining patent airway and proper positioning post op for cleft lip/ palate

• Purpose: - To help others, regardless of the profit status of the ownership arrangements. - Is determined by the organization's mission, vision, and values. Specialized healthcare workforce public trust

major attributes of health care organizations

2 arteries, 1 vein, Wharton's jelly= protects AVA, keeps them from being compressed

make up of the umbilical cord

spina bifida

malformation of the vertebrae and spinal cord resulting in varying degrees of disability and deformity depending on the location of the malformation (neural tube defect)

O2 monitoring ABGs beta 2 adrenergic agonisits anticholinergics steriods IV fluids IV mag intubation

management for asthma attack

• Improve cardiac function: Medications, digoxin, ace inhibitors • Remove accumulated Fluid and sodium: diuretics, fluid restrictions, low salt diets • Decrease cardiac demands: limiting activity, preserving body temperature, treating infections, reduce effort of breathing, • Improve tissue oxygenation

management for congenital heart defects

- Minimizing risk factors -Sodium restriction, weight reduction, moderation of alcohol intake, exercise, smoking cessation, drug therapy.

management for hypertension

Fetal - Body fairly well proportioned; skin red and wrinkled; sweat glands forming - Blood formation increases in bone marrow and decreases in liver - Alveolar ducts and sac present - Lecithin begins to appear in amniotic fluid - Can hear - Testes in descent to scrotum - Wt 600 g/ 1.3 lb Maternal - Uterus rises to the level of the umbilicus - Diastolic bp gradually increases

maternal and fetal changes 24 wks

Ejection fraction

measurement of the volume percentage of left ventricular contents ejected with each contraction

ejection fraction

measurement of the volume percentage of left ventricular contents ejected with each contraction

Silverman-Andersen

measures how bad reparatory distress is in infants want zeros

Radioactive iodine uptake test

measures rate of iodine uptake Patients with hyperthyroidism exhibit a high uptake, hypothyroidism will have low uptake

thrombolytic agents IABP CABG PCI with stenting

medical interventions for MI

isoniazid, rifampin, pyrazinamide, ethambutol

medication used to treat TB

Rho (D) immune globulin rubella vaccine

medication/ vaccines that may be needed postpartum

NST CST BPP AFI VAS Kich counts

methods of fetal surveillance

congestive heart failure

more often associated with acyanotic defects condition in which the heart is unable to pump effectively

more saturation

more pressure to oxygen =

adolescents and young adults

most cases of STDs occur in

lung cancer

most common cause of SIADH

Hashimoto's thyroiditis

most common cause of hypothyroidism

Down Syndrome (Trisomy 21)

most common chromosomal abnormality occurs when cell division is abnormal, there is extra genic material from chromosome 21

preeclampsia

most common hypertensive disorder, develops during pregnancy and is characterized by elevated BP and proteinuria

NO BRUSHING TEETH for 10 days silk floss suction toothets swish warm water

mouth care after hypophysectomy

ventilation

movement of air into and out of the lungs; CO2

Arterial -stop smoking -topical antibiotics -saline dressing -bed rest -fibrinolytic agents Venous -systemic antibiotics -compression dressing -limb elevation -fibrinolytic agents and anticoagulants

noninvasive treatment for PVD

pacifiers, holding, rocking

nonphamrgolic pain management for infants

distraction

nonpharm pain management for toddlers

supportive bra or binder ice packs avoid breast stimulation

nonpharmacologic measures of milk suppression

20-40 sec on heparin= 45-70

normal aPTT

Euthroid

normal functioning thyroid

awake flexed extremities strong lusty cry obvious presence of subcutaneous fat

normal general appearance after birth

13-17 g/dL (men) 12-15 g/dL (women)

normal hgb

nasal mucosa pink, moist with no edema, exudate, blood, or polyps nasal septum straight; nares patent bilaterally light pink, moist, with no exudate or ulcerations smooth, moist, and pink trachea midline AP diameter 1:2 breath sounds clear without crackles, rhonchi, or wheezes excursion equal bilaterally with no increase in tactile fremitus

normal physical assessment of the respiratory system

150-400 x 10^9/L

normal platelet count

150, 000 to 300, 000

normal platelet levels

1.010- 1.030

normal specific gravity

T3 = 0.9-1.95 T4 = 4.4-12.5 TSH= 0.4 to 4.0

normal thyroid levels

below 150

normal triglycerides

postpartum blues

normal, 5-7 days after delivery unexplained tearfulness, feeling down, and having decreased appetite

Pack history

number of packs a day times the number of years

Para

number of pregnancies of 20 wks

check FHR for cord prolapse/ cord compression check color to see if its meconium stained do vaginal exam to check for cord

nurses responsibility after any time membranes are ruptured

assess BP and pulse every 5 to 15 minutes determine FHR with every contraction observe perineal area for the following -increase in bloody show -bulging perineum and anus -visibility of the presenting part palpate bladder for distention assess amitotic fluid for color and consistency

nursing assessment during second stage of labor

bleeding: concealed or dark read uterine tenderness persistent abdominal pain rigid, boardlike abdomen FHR abnormalities

nursing assessment for abruptio placentae

menorrhagia dysmenorrhea uterine enlargement low back pain and pelvic pain

nursing assessment for benign tumors of the uterus

possible absence of early symptoms of pregnancy missed period; full feeling in lower abdomen, lower quadrant tenderness positive pregnancy test

nursing assessment for ectopic pregnancy

keep bulb syringe or suction immediately available: suction mouth then nose turn neonate on side or stomach and pa firmly on the back, holding head 10 to 15 degrees lower than feet

nursing care of newborn for aspiration

rest take VS record ECG nitroglycerin

nursing during anginal attack

check BP dont use with mag = hypotension rise slowly

nursing implications for nifedipine

monitor apical HR assess for hypoxia auscultate lungs for crackles admin O2 elevate head of bed daily wt I and O limit sodium elevate lower extremities check apical pulse before giving digoxin admin diuretics in the morning

nursing interventions for heart failure

apply ice pack to perineum to decrease swelling and pain monitor VS if severe hemorrhage and hypovolemic shock occur: -increase IV infusion wide open -give O2 -VS -lower head of bed; supine -insert foley

nursing interventions for hematoma development

phototherapy - mask over eyes -monitor skin temp - small diaper - no other clothes -turn every 2 hrs - turn off the lights for 5-15 minutes every 8 hours to assess for conjunctivitis - monitor for signs of dehydration maintain hydration: nipple, gavage, and IV fluids

nursing interventions for hyperbilirubunemia

swaddle and minimize handling decrease stimuli pacifier place prone keep bulb syringe close at hand

nursing interventions for infants of mothers that used narcotics

ventilations done over mouth and nose using a size 1 or 0 40 to 60 per minute if heart rate is under 60 compressions are done with thumbs side by side 3: 1 start IV fluids admin sodium bicarbonate or epinephrine admin glucose

nursing interventions for newborn resuscitation

bed rest admin antibiotics inform dentist

nursing interventions for rheumatic fever

constant bubbling = leak don't lift off floor use occlusive dressing if tubing falls out put tube in sterile water if it gets disconnected

nursing priorities for chest tubes

Avoidance of vigorous coughing, sneezing, and straining at stool to prevent CSF fluid leakage at entry site. HOB elevated 30 degrees at all times Frequent neurological assessment Mild analgesics for headache No tooth brushing for 10 days

nursing r/t hypophysectomy

obtain in the morning use tongue blade to start gag reflex

nursing r/t sputum test

monitor VS, LOC, ECG, O2, urine output assess for fluid overload monitor glucose and potassium give potassium for hypokalemia add dextrose to IV fluid for blood glucose below 250

ongoing monitoring for DKA

Merperidine (Demerol)

opioid - don't exceed 48 hours to avoid toxic metabolite normeperidine. do not inhibit uterine contractions

Syndrome of Inappropriate Antidiuretic Hormone

overproduction of the antidiuretic hormone ADH, leading to bloating, water retention, and electrolyte imbalance

FACES

pain scale for preschool aged kids

Aplastic Anemia

patient will have pancytopenia, decrease of all blood cell types and is mostly caused by autoimmune activity

acreta, increta, percreta, vase previa typically results in hysterotomy

placenta abnormalities

increta

placenta invades myometrium

previous uterine scars, surgery, and fibroid tumors

placenta previa is associated with

audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of fetus

positive signs of pregnancy

prone position assess incision for drainage and infection assess neuro function

post op nursing care for spina bifida

Keep head up, brushing teeth with soft bristle toothbrush, keep incision clean and dry. ( must keep calcium gluconate at bedside) thyroid replacement such as Levythroxine or Synthroid, possible Ca replacement 1200mg- Calcium a day and Vit D 400iu-800iu per day.

post op teaching for thyroidectomy

right coronary artery = SA node

posterior coronary artery blood supply

monitor respiratory status remove excess secretions elevate 30 degrees provide oxygen as prescribed maintain NPO admin IV fluids

pre op care for TEF

informed consent empty bladder (full if before 20 wks) supine with wedge under hip VS Surgical asepsis

preparing mom for invasive fetal Dx test

assess for allergies to contrast dye VS NPO flushed feeling when dye is injected

preprocedural nursing for cardiac catherization

up to 90 days postexposure chancre highly infectious

primary syphilis

always admin O2 at the lowest concertation possible when correcting hypoxia

principle of oxygen therapy for newborn

- At the first sign • Check blood glucose - If less than 60 mg/dl, investigate further for cause of signs/symptoms - If monitoring equipment not available, treatment should be initiated

protocol with suspected hypoglycemia

Precipitous labor

quick labor without a dr present

vs, discharge, labial or vulvar redness, and pruritus for possible infection complaints of hot flashes , mood swings, and night swears dysparunia

reproductive assessment for older women

meds, people, equipment, time

resources in a healthcare organization

Thrombotic Thrombocytopenic Purpura (TTP)

results from impaired funciton of ADAMTS13, a von-willebrand factor cleaving protease. Thus, large vWF multimers build and cause a prothrombotic state resulting in microvascular thrombosis. Thrombocytopenia and hemoltic anemia with shcistocyte formation occur as erythrocytes are sheared by platelet rich thrombi.

turtle sign

retraction of the fetal head against the mother's perineum after it emerges

less oxygen in blood causing HYPOXEMIA Causes: fever, hypoventilation, decrease in pH , increase CO2 oxygen goes to tissues causing respiratory acidosis

right shift on oxygen- hemoglobin dissociation curve

no hot tubs, saunas, and steam rooms through out pregnancy

safety concerns during first 8 wks of pregnancy

chorionic villus sampling

sampling of placental tissue for microscopic and chemical examination to detect fetal abnormalities

pineal gland

secretes melatonin

Cor pulmonale

serious cardiac disease associated with chronic lung disorders, such as emphysema enlargement of the right ventricle caused by a primary disorder of the respiratory system. most common cause is COPD

corneal light reflex

shine a light toward a child's eye. the light should be reflected in the same spot in the two corneas. Used to assess brain swelling.

persistent neonatal reflexes after 6 months delayed dev milestones apparent early reference for one hand poor suck, tongue thrust spasticity scissoring of legs involuntary movements seizures

signs of cerebral palsy

Unexplained injuries • Child is frightened of adults • Child reports injury by parent or caregiver • Conflicting or unconvincing explanation for injuries • Extremes of behavior • Delayed physical or emotional development • Lack of attachment to parent

signs of child abuse

Is frequently absent from school • Begs or steals food or money • Lacks needed medical or dental care, immunizations, or glasses • Is consistently dirty and has severe body odor • Lacks sufficient clothing for the weather • Abuses alcohol or other drugs • States that there is no one at home to provide care

signs of child neglect

bright- red, flank vaginal bleeding temp over 100.4 F foul smelling vaginal dischage

signs of complications to D&C to report

intense perineal pain swelling and blue-black discoloration on perineum pallor, tachycardia, and hypotension; feeling of pressure in vagina, urethra, and bladder urinary retention, uterine displacement

signs of hematomas developing in perineum

chest pain tachycardia hypotension SOB

signs of hemothorax

Increased -co2 -acidity -dpg -exercise -temperature

signs of right shift

• Has difficulty walking or sitting • Suddenly refuses to change for gym or to participate in physical activities • Reports nightmares or bedwetting • Experiences a sudden change in appetite • Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior • Becomes pregnant or contracts an STD

signs of sexual abuse in children

occult: dimple with or without hair tuft at base of spine presence of a sac flaccid paralysis and limited or no feeling below the defect head circumference abnormal

signs of spina bifida

parathyroid glands

small pea-like organs that regulate calcium and phosphate balance in blood, bones, and other tissues

milia

small raised white spots on nose, chin, and forehead

2 months

social smile by

1: from the beginning of regular contractions or ROM to 10 cm dilation and 100% effacement 2: 10 cm to delivery of the fetus 3: Delivery of the fetus to delivery of the placenta 4: Arbitrarily lasts about 2 hrs after delivery of the placenta

stages of labor

•Nose •Pharynx, • Adenoids, •Tonsils, •Larynx, • Trachea •Epiglottis

structures in the upper respiratory tract

GnRH agonists -leuprolide -nafarelin

suppresses release of LH and FSH with continuous use. May be used in the treatment of endometriosis

microcephaly growth retardation short palpebral fissures maxillary hypoplasia strabismus abnormal palmar creases, irregular hair poor suck, cleft lip, cleft palate, small teeth

symptoms for FAS

multiple strains some of which are implicated in cervical cancer alarming rate increase in adolescent pop lesions may be small, warlike or clustered may be flat or raised

symptoms for HPV

Dilation of the cervix

the expansion or stretching of the cervix during labor 0-10 cm

atrial septal defect (ASD)

there is a hole between the atria oxygenated blood from the left atrium is shunted to the right atrium and lungs

ventricular septal defect (VSD)

there is a hole between the ventricles oxygenated blood from left ventricle is shunted to the ventricle and recirculated t the lungs

surgery and lifelong hormone replacement

treatment for hypopituitarism

ACE inhibitors

way to decrease proteinuria in patients with nephropathy

elevate legs one or two times per day for around an hour

ways to decrease edema during pregnancy

syndactyly

webbed fingers or toes

Presumptive, probable, and positive signs of pregnancy

what's required for a confirmation of pregnancy

normal maternal blood flow and vol to placenta Normal O2 in maternal blood adequate exchange of O2 and CO2 in placenta open circulatory path between placenta and fetus through vessels and umbilical cord normal fetal circulatory and O2 carrying function

what's required to maintain fetal oxygenation

Thalassemia Major

•Life-threatening form of thalassemia •Physical & mental growth restriction •Pale & jaundiced, splenomegaly, hepatomegaly, cardiomegaly •Symptoms develop in childhood

positive contraction stress test

(Abnormal) A positive result is represented by late decelerations of FHR, with 50% or more of the contractions in the absence of hyperstimulation of the uterus.

negative contraction stress test

(Normal) A negative result is represented by no late decelerations of fetal heart rate (FHR).

tertiary prevention

*Minimize the effects of the disease through treatment modalities* -manage gestational diabetes, nutrition counseling for someone with HTN

Yellow zone peak flow

- 50-79% of personal best/baseline - indicates caution - something is triggering asthma - quick relief meds

cardiac output

- Amount of blood ejected by the left ventricle in one minute. - Normal is 4-8 Liters/minute - Can increase up to 2.5 Liters per minute during strenuous activity

Hemodynamic measurements

- Heart - pump - Blood - volume for the pump to move - Vascular tone - resistance against the pump

ABO incompatibility Type O mother with Type A, B, or AB fetus

- Maternal antibodies cross placenta and attack fetal RBCs - Causes hemolysis and fetal anemia - Less severe than

Cardiomyopathy

- Myocardium around left ventricle is altered, altering cardiac function, resulting in decreased cardiac output - Increased heart rate and increased heart muscle mass compensates in early stages. In later stages, heart failure develops

Alpha-fetoprotein screening

-fetal serum protein used to predict neural tube defects -performed between 16-18 weeks -high incidence of false positives

Red zone peak flow

-severe airway narrowing, take action Peak flow below 50%

hgb to increase by 1 hct to increase by 3%

1 unit of blood causes

Iron Metabolism

1) Very tightly controlled metabolic pathways 2) active absorption by small intestine a) 2-35% of it eaten b) stored in liver, marrow, special proteins

zygote

12-14 days after fertilization from the time the ovum is fertilized until it is implanted into the uterus

Patient Protection and Affordable Care Act

2010 legislation aimed at reducing the number of uninsured individuals and decreasing health care costs

heart pump blood vol vascular tissue

3 elements needed for heart function

determine fetal health and compromise decrease perinatal morbidity and mortality guide interventions of OB team

3 goals of fetal surveillance

JVD, hepatomegaly, peripheral edema

3 main signs of right sided HF

1. VSD 2. Aorta placed over and above the VSD 3. Pulmonary stenosis 4. Right ventricular hypertrophy

4 defects of tetraolgy of fallot

fetal breathing fetal body movement fetal muscle tone reactivity of FHR amniotic fluid index 0 or 2= 10

5 factors of BPP

partners practices number of pregnancies' protection past STDs

5 p's of a sexual hx

1. powers -passive: contractions -Active: pushing 2. passage -soft tissue: cervix, bladder -Bony pelvis: shape 3. Passenger (baby) -head molding -baby too big - hyydrocephils - gastroschisis 4. Psyche - mom is too tired - she gives up 5. Position of mom - need to keep mom moving

5 ps of the birthing process (contributing factors to whether mom can deliver )

fetus

9 weeks after fertilization to term fewer anomalies caused by teratogens

DIC(disseminated intravascular coagulation)

A STATE OF DIFFUSE CLOTTING IN WHICH FACTORS ARE CONSUMED WHICH LEAD TO WIDE SPREAD BLEEDING

Egophony

A change in vocal resonance in the presence of a lung consolidation condition in which the transmission of the "eee" sound becomes a nasal "ay" sound.

Diabetes

A chronic multisystem disease related to - Abnormal insulin production - Impaired insulin utilization - Or both

Acquired Hemolytic Anemia

A condition caused by the destruction, or hemolysis, of red blood cells faster than they can be produced.

Placenta

A structure that allows an embryo to be nourished with the mother's blood supply attaches inside the uterus has a maternal and fetal side

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

Brazelton Neonatal Behavioral Assessment Scale

A test often administered to newborns that measures responsiveness and records 46 behaviors, including 20 reflexes.

low pH and PaO2 High PaCO2 and HCO-3

ABGs in COPD

(saturated solution of potassium chloride)- suppresses release of hormones and decreases vascularity of thyroid. Puts patient in euthyroid state before surgery.

Administer sodium iodide-suppresses release of thyroid hormone SSKI

Maintenance inhaler

Advair Diskus (fluticasone/salmeterol) Advair HFA (fluticasone/salmeterol) AirDuo RespiClick (fluticasone/salmeterol) Breo Ellipta (fluticasone/vilanterol) Dulera (mometasone/formoterol) Symbicort (budesonide/formoterol)

CNS depression depressed DTRs decreased urinary output decreased respirations

Adverse reactions of magnesium

rescue inhaler

Albuterol

Idiopathic Thrombocytopenia Purpura

An acquired hemorrhagic disorder characterized by excessive destruction of platelets and a discoloration caused by petechiae beneath the skin with normal bone marrow. usually an acute condition in kids and chronic in adults

palmar grasp

An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object. lessens by 3-4 months

Pancreas

An organs in the abdominal cavity that works to secrete insulin and glucagon into the bloodstream to help regulate blood glucose levels.

- ↑ Serum ferritin - ↑ Iron stores - Normal folate and cobalamin levels

Anemia of chronic disease findings

• Gradual development • Symptoms caused by suppression of any or all bone marrow elements • General manifestations of anemia - Fatigue, dyspnea

Aplastic Anemia Clinical Manifestations

• Preventing complications from infection and hemorrhage • Untreated prognosis is poor - 75% fatal • Treatment options - Bone marrow transplantation - Immunosuppressive therapy

Aplastic Anemia Nursing Management

augmentation of labor

Artificial stimulation of uterine contractions that have become ineffective.

Fluid deprivation test—withhold fluids for 8-12 hours. Weigh patient frequently. Inability to slow down the urinary output and fail to concentrate urine are diagnostic. Stop test if patient is tachycardic or hypotensive Trial of desmopressin and IV hypertonic saline Monitor serum and urine osmolality and ADH levels

Assessment and Diagnostic Findings of DI:

G and P Gestational age FHR Maternal VS Contraction frequency, intensity, and duration vaginal exam -fetal position and presentation -cervical dilation, effacement, position, and consistently -fetal station statues of membranes urine glucose and albumin data

Assessment with suspected start of labor

Diabetic nephropathy

Associated with damage to small blood vessels that supply the glomeruli of the kidney Leading cause of end stage renal disease Critical factors for prevention/delay • Tight glucose control • Blood pressure management

erthema toxicum

BENIGN RASH OF UNKOWN CAUSE IN NEWBORNS BLOTCHY RED AREAS MAY HAVE WHITE OR YELLOW PAPULES OR VESICLES IN CENTER comes and goes

Regurgitation

Backflow of blood through a valve that cannot close properly due to damage or disease (valvular incompetence or insufficiency)

Fetal effects - neonatal sepsis and death Tx -treated with clindamycin or ampicillin or metrondazole(not 1st tri)

Bacterial vaginosis fetal effects Tx

Mongolian spots

Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates

Accelerations

Brief, temporary increases in FHR of at least 15 beats more than baseline and lasting at least 15 second- (same parameters as Nonstress Test)

Adverse reactions -woman with a preexisting narcotic dependency will experience withdrawal symptoms immediately Nursing Implications -Give IV or IM -Obtain drug Hx before admin -monitor resp, pulse

Butorphanol and Nalbuphine adverse reactions nursing implications

• If pituitary damaged, ADH, cortisol and thyroid replacement may be needed. • Drug Therapy —Somatostatin analogs, GH receptor antagonists, and dopamine agonists

complications of hypophysectomy

air leak airway obstruction aspiration bleeding fistuala impaired cough infection subcutaneous emphysema tracheal necrosis tube displacement

complications of tracheostomy

infection fetal injury rupture water

complications r/t amniocentesis

fetal distress active herpes placenta previa high risk after c- section/ V-back ?

contraindications for induction

known CPD fetal stress placenta previa prior classical incision on uterus active herpes unripe cervix

contraindications to use Pitocin

sab cord with alcohol at each diaper change, or keep clean with mild soap and water

cord care

assess FHR for variables vaginal exam - keep hand inside until C-sec putting pressure on baby's head knee to chest position don't move cord= blood cords

interventions for prolapsed cord

head of bed down mcroberts superbaric pressure

interventions for shoulder dystocia

surgical -hysterectomy -anterior and posterior vaginal repair nonsurgical -kegal exercises - knee- chest position - pessary use

interventions for uterine prolapse, cystocele, and rectocele

Rh incompatibility ABO incompatibility Prematurity Sepsis Perinatal asphyxia Maternal diabetes mellitus or intrauterine infections cephalohematoma

predisposing risk factors for hyperbilirubunemia

heals better

why do drs typically let you tear

. Excess GH stimulates gluconeogenesis and lipolysis, causing hyperglycemia and elevated free fatty acid levels

why dose acromegaly cause diabetes mellitus

prevent proteinuria

why give ace inhibitors to diabetics

lipodystrophy

with subq injections you rotate sites to prevent what

Rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.

Adverse reactions - fetal narcosis, distress -hypotension -Itching -urinary retention -Respiratory depression Nursing Indications -Record use accurately -Don't admin if resp below 12 -Have narcan -monitor resp, pulse, and BP

Fentanyl and hydromorphone adverse reactions nursing implications

ectopic pregnancy

Fertilized ovum implanted outside the uterine cavity commonly a result of tubular obstruction medical emergency

tanner stages

Five stages of sexual development in adolescence evaluating pubic hair, genitals and breast development

Nevus simplex

Flat, pink area on the nape of the neck, on the mid-forehead, or over the eyelids resulting from dilation of the capillaries; also called stork bites, salmon patches, or telangiectatic nevi.

gravida, term births( past 38 wks), preterm births (20 wks to 37), abortions, living children

GTPAL stand for

Identification of issues through assessment Patient and family teaching Referrals for appropriate resources, such as ◦ Mental health ◦ Social work ◦ Nutritional support ◦ Caregiver support

General interventions for family dynamics

everyone will have health insurance expansion of Medicaid requirement for employers to cover their employees or pay penalties, with exceptions for employers with few employees cover all individuals regardless of health status increase in payments for primary care services greater support for prevention, wellness, and public health activities

Goals of the patient protection and affordable care act

Hypopituitarism

Growth hormone deficiency — Occurs in children — Presenting complaint is short stature Most involve GH and gonadotropins due to tumor

expectorants

Guaifenesin

22-26

HCO3-

Variable decelerations

HR up or down, cord compression = VERY BAD Prolapsed cord= push head up, change mom position

stidor

Harsh or high-pitched respiratory sound, caused by an obstruction of the air passages

Early decelerations

Head pressed on. This is ok.

- Diuretics • Daily weight, I & O, decreased dependent edema, decrease in SOB, crackles, decrease in JVD - ACE inhibitors/angiotensin-receptor blockers • Prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Results in systemic vasodilation, reducing preload and afterload. - Digoxin - Beta blockers (Coreg) - Nesiritide citrate (Natrecor)

Heart Failure Treatment

Intraventricular hemorrhage

Hypoxia causes vessel damage in the tiny periventricular capillaries, resulting in symptoms of ICP

not hormonal interuterine device still ovulate creates hostile environment high association with dysmenorrhea and infection

IUD

A, D, E. Garlic should not be encouraged as it promotes bleeding, and wrestling is a contact sport that should be avoided. All of the other responses are correct.

In order to reduce the risks associated with hemophilia, a patient should engage in which of these following measures. Select all that apply A. Use a soft-bristle toothbrush B. Incorporate liver and garlic in their diet C. Select wrestling as their sport of choice D. Wear a Medic-Alert tag E. Practice good hand hygiene

injections of salt, fluids, and glucocorticoid hormones immediately

In patients suspected of having an addisonian crisis, the doctor must begin treatment with

Stenosis

Inability of the leaflets to open and close properly (constriction or narrowing)

Moro reflex

Infant reflex where a baby will startle in response to a loud sound or sudden movement. last till 3-4 months

Primary polycythemia (polycythemia vera) is diagnosed due to high levels of Hgb, RBC, WBC, platelets, leukocyte alkaline phosphatase, uric acid, cobalamin levels and histamine levels. Primary polycythemia has low to normal EPO level. Secondary polycythemia has a high EPO level.

Lab r/t polycythemia

direct combs test

Laboratory blood test to detect auto anti-bodies against red blood cells, which can cause cellular damage. These anti-bodies result in hemolytic anemia. normal findings: negative, no agglutination.

Labs - 2+ to 4+ proteinuria -increased HCT, BUN, Uriic acid, AST& ALT, creatine - decreased RBCs - hemolysis - increased liver enzymes - thrombocytopenia Considerations -significant risk for hemorrhage, abruption, renal failure, pulmonary edema, hepatic rupture, and death - DO NOT PALPTE THE LIVER

Labs and considerations r/t HELLP syndrome

chronic idiopathic thrombocytopenic purpura

Lasts 6 months or longer and mainly occurs in adults. The body produces autoantibodies and specialized white blood cells that target their own platelets which leads to thrombocytopenia from damage to megakaryocytes.

blood more saturated ( not in tissues) HYPOXIA Causes: cold, decreased co2 in blood , hyperventilation causing a decrease in CO2 and rise in pH which is known as RESPIRATORY ALKALOSIS

Left Shift on oxygen- hemoglobin dissociation curve

Angiopathy

Macrovascular-Diseases of large and medium sized blood vessels Occur with greater frequency and with an earlier onset in diabetics Development promoted by altered lipid metabolism common to diabetes

Cataracts glaucoma Hypertension heart failure Truncal obesity moon face buffalo hump sodium retention hypokalemia, hyperglycemia negative nitrogen balance altered calcium metabolism Decreased inflammatory responses, impaired wound healing increased susceptibility to infections Osteoporosis compression fractures Peptic ulcers pancreatitis Thinning of skin striae

Manifestations of Cushing's syndrome

• Bleeding tendencies range from mild to severe • Symptoms may not occur until 6 mos of age - Mobility leads to injuries from falls and accidents • Hemarthrosis - Bleeding into joint spaces of knee, ankle, elbow leading to impaired mobility • Ecchymosis • Epistaxis • Bleeding after procedures - Minor trauma, tooth extraction, minor surgeries - Large subcutaneous and intramuscular hemorrhages may occur - Bleeding into neck, chest, mouth may compromise airway

Manifestations of Hemophilia

Fetal - Brown fat deposits develop beneath skin - Fetus is 15 - 17 inch - Fetus begins storing iron, calcium, and phosphorus - Wt 1800 to 2200 g/ 4.9 lb Maternal - Fundus reaches xiphoid process - Breast and full and tender - Urinary frequency - Swollen ankles - Dyspnea

Maternal and Fetal changes 32 wks

Fetal - Fetus occupies entire uterus - Maternal antibodies are transferred to fetus - L/S ratio is 2:1 and phosphatidylglycerol (PG) is present - Wt 3200 g + / 7.1 lb Maternal - Lightening - Burst of energy - Backaches increase - Urinary frequency - Braxton Hicks intensify

Maternal and Fetal changes 36- 40 wks

Biophysical Profile (BPP)

Method for evaluating fetal status during the antepartum period based on five variables originating with the fetus most accurate predictors of fetal- well being

Contraction Stress Test (CST)

Method for evaluating fetal status during the antepartum period by observing response of the fetal heart to the stress of uterine contractions that may induce recurrent episodes of fetal hypoxia. contractions induced with oxytocin or nipple stimulation

Prostaglandin insert into vagina softens cervix

Misoprostol (Cytotec)

description: fetus dead, placenta atrophied but passage of the products of conception has not occurred, cervix closed Tx: watchful waiting, check clotting factors and possible terminate pregnancy to lessen the chances of developing DIC

Missed miscarriage description and Tx

What it tests: needed for induction; control induction How to do it: intensity calculated with IUCP total of all contraction intensities in 10 min acme-resting tone Goal= 200-300 Warning: over 400 is excessive uterine activity and increases the risk for uterine rupture

Montevideo units (MVUs) What it test How to do it Goal warning

MONA for MI

Morphine Oxygen Nitroglycerin Aspirin

D because blood is much thicker than normal.

Polycythemia can result in which of the following adverse outcomes in a patient? A. Excessive bleeding B. Urticaria C. Nausea/Vomiting D. Blood clots

Hypoglycemia Allergic reactions Lipodystrophy Somogyi effect Dawn phenomenon

Problems with insulin therapy

Percutaneous Umbilical Blood Sampling (PUBS)

Procedure for obtaining fetal blood through ultrasound-guided puncture of an umbilical cord vessel to detect fetal problems such as inherited blood disorders, acidosis, or infection; also called cordocentesis. Can be used to give a blood transfusion

• Typical patient is asymptomatic except during sickling episodes • Symptoms can be - Pain and swelling - Pallor of mucous membranes - Fatigue

Sickle Cell Disease Clinical Manifestations

- Avoid high altitudes, maintain fluid intake, treat infections, pain control • O2 for hypoxia and to control sickling • Pain management • Acute chest syndrome - Antibiotics - O2 therapy - Fluid therapy • Folic acid daily supplements • Blood transfusions in crisis • Hydroxyurea: Antisickling agent - Erythropoietin in patients unresponsive to hydroxyurea • Bone marrow transplant

Sickle Cell Disease Nursing Management

● Hypertension * one of the first signs ● Headache ● Vertigo ● Dizziness ● Tinnitus ● Visual changes ● pruritus (itching) ● Paresthesias (abnormal tingling in hands and feet) ● Erythromelalgia (redness on hands and feet and is often made worse in hot water) ● Angina ● heart failure ● intermittent claudication (pain in legs) ● thrombophlebitis

Signs and Symptoms of Polycythemia

a, b, d, f

The nurse is teaching a client diagnosed with primary polycythemia about possible complications from the disease. What complications would the nurse present in a teaching plan? Select all that apply. a. Visual disturbance b. Orthopnea c. Hearing loss d. Gout e. Weight loss f. Headache

Grade A= strongly recommends

There is high certainty that the net benefit is substantial

Grade D= Recommends Against

There is moderate or high certainty that the intervention has not net benefit or that the harms outweigh the benefits

Grade C= No recommendations for or against

There may be considerations that support providing the intervention for an individual patient but not for the general population. There is at least moderate certainty that the net benefit is small

lochia alba

Thicker, whitish yellowish discharge with leukocytes and degenerated cells; lasts up to 6 weeks

Hypercyanosis Spell

Transient period when there is an increase in right to left shunting of blood - Hypoxia, pallor, and tachypnea - Precipitated by crying, defecation and feeding - Older children will assume a squatting position to decrease blood return from the lower extremities

• Infusion of Von Willebrand's protein concentrate • DDAVP infusion prior to surgery or to treat bleeding episode • Aminocaproic acid to treat bleeding in mucous membranes (in some cases) • Avoid aspirin or NSAIDs (increased bleeding time and inhibit platelet function) • Manage bleeding episodes with prompt infusion therapy

Treatment and interventions of Von Willebrand Disease

DDAVP—intranasal bid Can also use Diabenese and thiazide diuretics in mild disease as they potentiate the action of ADH If renal in origin—thiazide diuretics, NSAIDs (prostaglandin inhibition) and salt depletion may help Educate patient about actions of medications, how to administer meds, wear medic alert bracelet

Treatment for DI

• It varies depending on the cause of the anemia. • Treatment involves supportive care until causative agent can be resolved. -hydration -electrolyte replacement -blood products -folate replacement -glucocorticoids -plasma exchange

Treatments for Acquired Hemolytic Anemia

Monitor HR, BP, RR (respiratory failure...may need mechanical ventilation), EKG, Temperature Keep environment quiet and patient cool (cooling blankets and sedatives as prescribed) No foods containing iodine (seafood...seaweed, dairy, eggs) Decrease fever Antithyroid medications (block synthesis) : Methimazole PTU "Propylthiouracil" Steroids Betablockers

Tx for thyroid storm

Opioids -Fentanyl -Hydromorphone Opiod agonist/ antagonist - Butorphanol -Nalbuphine Regional Block -Local -Pudendal block -paracervical -Epidural -Spinal

Type of pain management during labor

class 1: unrestricted physical activity class 2: ordinary activity causes fatigue, palpations, angina class 3: with less- than- ordinary activity, cardiac decompensation symptoms ensue class 4: cardiac insufficiency even with rest

Types and extend of cardiac disease

- Sickle cell anemia • Most severe • Homozygous for hemoglobin S (HbSS) - Sickle cell thalassemia - Sickle cell HbC disease - Sickle cell trait (HbAS)

Types of SCD

USPSTF

U.S Preventative Services Task Force, has five levels of of evidence with a recommended grade A-D and I

b

When providing education to a patient on how to take their iron supplement, which statement made by the patient requires you to give them more information? A) "I will take this iron supplement on an empty stomach." B) "I will not take this iron supplement with orange juice." C) "I will wait 2 hours after taking my iron supplement before I take my calcium supplements." D) "Since the iron supplement causes constipation, I will drink plenty of fluids and take a stool softener as needed."

pursed lip breathing

a technique of exhaling against pursed lips to prolong exhalation, preventing bronchiolar collapse and air trapping; done to increase expiratory airway pressure, improve oxygenation of the blood, and help prevent early airway closure. help to decrease anxiety

tension pneumothorax

a type of pneumothorax in which air that enters the chest cavity is prevented from escaping

Cobalamin Deficiency

also known as Vitamin B12 deficiency, is a condition resulting from insufficient dietary intake or poor gastrointestinal absorption of vitamin B12. This causes lower than normal amounts of vitamin B12 to be absorbed by the bloodstream and tissues. Inadequate absorption can result in anemia or nervous system damage

healthcare organization

are a purposefully designed, structured social system developed for the delivery of health care services by specialized workforces to defined communities, populations, or markets.

normal= 31-33 cm tape measure is stretched around scapula and over nipple line

assessing chest circumference after birth

normal= 6-9 lb weigh at birth and daily normally lose 5-15% of birth wt in first wk of life

assessing wt after birth

lethargy temperature instability difficulty feeding subtle color changes respiratory distress hyperbilirubinemia

assessment for newborn with sepsis

UTI pneumonia sepsis acute illness newly diagnosed type 2 diabetes

causes of HHS

evolution of antibodies against multiple platelet antigens , leading to reduced platelet survival and impaired production

causes of Idiopathic Thrombocytopenia Purpura

blood incompatibilities sepsis drug reactions

causes of Jaunice w/in first 24 hrs

thrombus or clotting shock or hemorrage

causes of MI

- End-stage renal disease • Primary factor: ↓ Erythropoietin - Chronic liver disease - Chronic inflammation - Malignant tumors - Chronic endocrine diseases

causes of anemia due to Chronic Disease

atherosclerotic heart disease HTN coronary artery spasm cardiopathy physical exertion, cold temperatures

causes of angina

➢ Chemical agents and toxins ➢ Drugs (alkylating agents, antiseizure, antimicrobials, gold, nsaids, antithyroid) ➢ Immune suppression of stem cells by autoreactive t-lymphocytes ➢ Radiation ➢ Toxic injury to bone marrow stem cells ➢ Viral and bacterial infections

causes of aplastic anemia

down syndrome

causes of brushfield spots in iris, epucanthal folds, and low set ears

Anoxic Injury before, during, or after birth maternal infections kernicterus low birth wt

causes of cerebral palsy

- Pernicious anemia • Insidious onset - Nutritional deficiencies - Hereditary enzymatic defects

causes of cobalamin deficiency

rubella rheumatic fever smoking FAS diabetic mom down syndrome CMV toxoplasmosis IDM

causes of congenital heart defects

trauma DIC uterine atony retained placenta

causes of early post partum hemorrhage

- problems with ovulation, fallopian tubes, or conditions that affect the uterus or cervix - chronic diseases -genital infection

causes of female infertility

- Poor nutrition - Malabsorption syndromes - Drugs - Alcohol abuse and anorexia - Lost during hemodialysis

causes of folic acid deficiency

TB trauma Pulmonary embolism with infarction. Torn pleural adhesions in association with spontaneous pneumothorax. Bullous emphysema. Necrotizing infections.

causes of hemothorax

CNS damage Hypoglycemia Drug withdrawal

causes of high pitched cry in an infant

Hashimoto's thyroiditis Common in those previously treated for hyperthyroidism Atrophy of gland with aging Medications like lithium, iodine compounds, antithyroid meds can cause Radiation treatments to head and neck Infiltrative diseases like amyloidosis, scleroderma Iodine deficiency and excess Hypothalamic or pituitary abnormality

causes of hypothyroidism

PCOS endometrioses stress Hx of mumps low sperm count STDs low testosterone PID medication

causes of infertility

• Inadequate dietary intake - 5% to 10% of ingested iron is absorbed • Malabsorption • Blood loss • Hemolysis

causes of iron deficiency anemia

Subinvolution - 4-6 wks postpartum -lochia rubra over 2 wks retained placental fragments

causes of late post partum hemorrhage

infection cold exposure stroke meds

causes of myxedema

chronic hypoxia sleep apnea kidney tumors releasing erythropoietin performance-enhancing drug EPO

causes of polycythemia

ARDS aspiration, inhaled toxins, pneumonia, sever hypoxia anaphylactic reaction hypoalbuminemia left ventricular heart failure overhydration with IV fluids O2 toxicity

causes of pulmonary edema

Autoimmune disorders; genetic tendency woman); unknown etiology

causes of raynauds

- Renovascular disease - Pheochromocytoma - Primary hyperaldosteronism - Cushing's syndrome - Diabetes - Dysfunction of the thyroid, pituitary or parathyroid gland - Coarctation of the aorta - Pregnancy - Neurologic disorders

causes of secondary hypertension

- Injury to vessel wall - Venous stasis -Hypercoagulability

causes of thrombophlebitis

Childbirth, CHF, DKA, infection, PE, stress, trauma, surgery

causes of thyroid storm

hydrocephalus

causes of widely separated sutures in newborns

used with spermicide contraindicated if cervical anomalies exist associated with cervical changes

cervical cap

cervix can be directly anterior and palpated easily or can be posterior and difficult to palpate

cervical position

fetal effects - still birth or neonatal death - preterm birth = pneumonia -opthalmia neonatorum Tx - erythromycin

chlamydai fetal effects Tx

change in LOC irritability vomiting headache on awakening motor dysfunction unequal pupil response seizures change in personality

classic signs of intracranial pressure in toddlers and older children

Classic - Polyuria, Polydipsia, Polyphagia, Weight loss • Weakness • Fatigue • Nonspecific symptoms - May have classic symptoms of type 1 • Fatigue • Recurrent infections • Recurrent vaginal yeast or monilia infections • Prolonged wound healing • Visual changes

classic symptoms of type 2 DM and nonspecific symptoms

• History of recent, sudden weight loss • Classic symptoms - Polydipsia - Polyuria - Polyphagia

classic symptoms r/t recent onset of type 1 DM

• Parenteral administration of cobalamin • Increase in dietary co

collaborative care for cobalamin deficiency

• No specific drug or diet is effective in treating thalassemia • Thalassemia minor - Body adapts to decreased Hb • Thalassemia major - Blood transfusions with IV deferoxamine

collaborative care for thalassemia

atelectasis

collapsed lung; incomplete expansion of alveoli

wear well- fitting supportive bra maintain proper posture use semi- flower position at night for dyspnea

comfort measures for women 32 wks pregnant

cardiac defects respiratory infections feeding difficulties delayed development skills mental retardation skeletal defects altered immune function endocrine dysfunction

common associated problems with down syndrome

small head flat, wide nasal bridge upward, outward slant of eyes white spots on iris low set ears small mouth and protruding tongue short neck single crease in palms short in stature hypotonic flexibility atlantoaxial instability

common physical characteristics r/t down syndrome

CO= amount of blood ejected by the left ventricle in 1 min SV/ Ejection fraction= amount of blood ejected each beat

compare CO and SV/ ejection fraction

description: all products of conception passed; cervix closed Tx: none

complete miscarriage description and Tx

polycythemia vera

condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels

congenital hypothyroidism

condition present at birth that results in lack of thyroid hormones; results in poor physical and mental development; formerly called cretinism

live, motile, normal sperm present in cervical mucus fallopian tubes patent adequate progesterone and secretory endometrium semen is supportive to pregnancy

conditions required for fertilization to occur

only way to prevent STDs used with spermicide penis must be withdrawn while erect water- soluble jelly used only

condom

Esophageal Atresia and Tracheoesophageal Fistula

congenital anomaly in which the esophagus does not fully develop is an emergency

foramen ovale

connects the two atria in the fetal heart

ductus venosus

connects the umbilical vein to the inferior vena cava, bypassing the liver; get cut

Troponin

contractile proteins released after MI. draw 3 sets 3-5 hrs apart

inspiration

contracting inspiratory muscles to move air into lungs

asthma

contradiction for carboprost

hypertention

contradictions for methylergonovine

STD (herpes)

contraindications for CVS

Hx of coagulation problems thromboembolism liver disease reproductive cancer CAD

contraindications for birth control

bleeding disorder antepartum hemorrhage causing acute hypovolemia infection or tumor at injection site allergy to -caine drugs CNS disorders

contraindications for epidural and spinal blocks

Sexual, health and psychosocial Hx IIEF Physical exam focusing on secondary sex characteristics DRE for prostate size, consistency and presence of nodules Assessment of BP and peripheral pulses and femoral arteries Rule out diabetes Hormonal levels for endocrine related problems PSA and CBC Nocturnal penile tumescence and rigidity testing vascular studies

diagnostics used for ED

Promotes hypertriglyceridemia - Detrimental effects on liver - Can cause severe hypoglycemia because of inhibitory effect on glucose production by the liver

effects of alcohol on pts with diabetes

calcium effects the contractions of the heart to make each beat more effective. Calcium is needed with each heart contraction. Remember calcium channel blockers......calcium causes constriction. With hypertension sometimes calcium channel blockers are administered to dilate vessels.

effects of calcium on the heart

small IUGR

effects of cigarette smoking on infants

decrease -pain meds -beta-blockers -antidepressants cause cough -ace inhibitors

effects of different medications on the respiratory system

hepatic dysfunction - cirrhosis= jaundice spleen enlarged cataracts cerebral damage V/D all with in first month of life

effects of galactosemia

magnesium= depressed respirations, hypocalcemia, and hypotonia narcosis= decreased respirations and hypotonia

effects of medicine used during labor on infant

irritability, hyperactivity high pitched cry coarse flapping tremors poor feeding, frantic sucking, vomiting, and diarrhea nasal stuffiness

effects of narcotic use on infants

asthma

episodes of breathing difficulty due to narrowed or obstructed airways causes trapped air leading to wheezing

• Hemolysis also occurs • Problem with globulin protein - Abnormal Hb synthesis • One thalassemic gene - Thalassemia minor • Two thalassemic genes - Thalassemia major

etiology for Thalassemia

• Absence of IF • Acid environment required for IF secretion • GI surgery • Long-term users of H2 -histamine receptor blockers

etiology of cobalamin deficiency

ask patient for return demonstration use open ended questions (what will you do if...) involve caregiver

evaluating patient learning

Assault with blunt object crush injury explosion fall sports injury

examples of blunt chest trauma

Arrow Gunshot knife stick

examples of penetrating trauma

hyperbilirubunemia

excessive accumulation of bilirubin in the blood due to RBC hemolysis

BP - above 160/ 110 Labs - 2+ to 4+ proteinuria -increased HCT, BUN, Uriic acid, AST& ALT, creatine - decreased RBCs

explain BP and labs r/t severe preeclampsia

• Pain: Intermittent claudication • Pulse: Diminished or absent • Ulcer: Deep, pale, located on toes, feet or other areas of skin • Skin: Dependent rubor, pallor upon elevation; dry, shiny skin; cool or cold temp; • Complications: Gangrene

explain arterial Insufficiency pain pulse ulcer skin complications

wake up with hyperglycemia check at 2-3 am and its high caused by high hormones at night, body makes to much

explain dawn effect

wake up with hyperglycemia check at 2-3 am and its low caused by taking too much insulin or not having a night time snack man made error

explain somogi effect

radiation: baby near something cold evaporation: moisture on babies body convection: cool airflow conduction: body touching cool objects

explain the different types of heat loss after baby is born

begins immediately after ovulation and ends with menstruation postovulatory phase requires 13-25 days corpus luteum reaches its peal of function activity 8 days after ovulation, secreting estrogen and progesterone the fertilized ovum is implanted in the endometrium

explain the luteal phase

days 1-5 of cycle shedding of the endometrium occurs in the form of uterine bleeding

explain the menstrual phase

periodic vasoconstriction in upper layers of endometrium initiates shedding of functional 2/3 of the endometrium

explain the menstrual phase of the endometrial cycle

about 3 days prior to ovulation, there is marked rise in LH and FSH, slight decrease in production of follicular estrogen, and a rise in progesterone finale maturation of a single follicle and release of its mature ovum ovulation marked be day 14 a mature mature follicle ruptures and the ovum is released from the ovary the ovum is picked up by the fimbriated end the the fallopian tube and transported to the uterus

explain the ovulatory phase

increment= going up acme= peak decrement= going down resting tone= time in-between

explain the parts of a contraction

day 5 to ovulation begins the first day of menstruation and ends 14 days later in the preovulatroy phase FSH is secreted by the antertior pituitary preovulatory surge of LH converts follicle to a corpus luteum, which produces progesterone

explain the proliferation (follicular) phase

depends on estrogen

explain the proliferative phase of the endometrial cycle

Pain: Aching, cramping, relieved by elevation • Pulse: Present • Ulcer: Superficial, pink; over inner or outer ankle • Skin: Thick and tough; brawny pigment, normal temp; may have edema • Complications: Poor healing

explain venous insufficiency

Myxedema coma

extreme hypothyroidism(abrupt med cessation), rare with a high mortality rate = decreased cardiac output leads to decreased tissue perfusion which leads to brain and organ depletion leading to multi-organ failure

artificial tears sunglasses when in bright light annual eye examinations

eye care for exophthalmos

- Resolution of enclosed hemorrhage (cephalhematoma, large amt of bruising) - Infection - Dehydration - Sepsis

factors that increase risk for physiologic jaundice

abuse

family dynamic that is always negative

feed in upright position feed slowly, with frequent burping use soft, large nipples; prosthetic palate; or rubber tipped asepto syringe ESSR method: -Enlarged nipple opening - stimulate child to Suck -Swallow normally - Rest

feeding with cleft lip and palate

ovarian function decreases breast tissue involutes ovaries and the uterus atrophy, nether may be palpable atrophy of vulva vaginal mucous membrane becomes fry dyspareunia

female reproductive changes r/t age

Fetal - Embryo becomes a fetus - Heart found through ultrasound - Lower body develops - Determine sex - Kidneys produce urine - Wt 14 g/ 0.03 lb Maternal - Uterus rises above pelvic brim - Braxton Hicks - Risk for UTI ^ - Fully functioning placenta - Wt gain 2- 4 lb during 1 st trimester

fetal and maternal changes 12 wks

Fetal - Major divisions of brain - Heart begins to pump blood - Limb buds - Ears Dev - Wt 1-2 g Maternal - Nausea - Uterus becomes globular shape - Hegar sign - Goodell sign - Cervical flexes - Chad wick sign - Leukorrhea - No noticeable wt. changes

fetal and maternal changes 8 wks

The part of the fetus that presents to the inlet Vertex= head/ cephalic shoulder= acromion Breech= buttocks

fetal presentation

Location of presenting part in relation to midpelvis or ischial spines expressed as cm above or below the spines station 0 is engaged station -2 is 2 cm above ischial spines

fetal station

liver

filters toxins and dead red blood cells from the blood where clotting factors are made

10-12 months

fine pincer grasp appears at

lanugo

fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.

fluids

first intervention for DIC

wt loss

first sign of type 1 diabetes

petechia, tachycardia

first signs and symptoms of DIC

restlessness anxiety tachycardia

first signs of hypoxia

extreme thirst

first signs of type 2 diabets

Green leafy vegetables such as lettuce, cabbage, spinach, peas, asparagus, meat, milk, and soybean oil

foods high in vitamin K

- Cardiac ouput = stroke volume X heart rate - CO = SV X HR

formula for CO

flail chest

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

ethical committees

groups of persons who provide structure and guidelines for potential healthcare problems, serve as an open forum for discussion, and function as patient advocates; provide education, policy and guideline recommendations, and case review

giantism

growth hormone (GH) excess that occurs before fusion of the epiphyseal growth plates. Therefore, by definition the condition is only seen in growing children.

Torticollis

head tilt due to shortening or spasm of one sternomastoid muscle

optimization of health evidence (uspstf) Patient/ community centered enculturation

health promotion is characterized as

systolic heart failure

heart can't contract and eject

have lower hgb during infections WBC wont increase very much

hematologic differences in older adults

manifestations -dyspnea -decreased or absent breath sounds -dullness to percussion -decreased Hgb -shock Interventions -chest tube insertion -iv fluids -packed red blood cells

hemothorax manifestation and interventions

Cytomegalovirus

herpes-type virus that usually causes disease when the immune system is compromised

secondary hypertension

high blood pressure caused by the effects of another disease

Epinephrine: rapidly responds to stress by increasing your heart rate and rushing blood to the muscles and brain. It also spikes your blood sugar level by helping convert glycogen to glucose in the liver. Norepinephrine: works with epinephrine in responding to stress. can cause vasoconstriction (the narrowing of blood vessels). This results in high blood pressure.

hormones released by the adrenal medulla and what they do

monitor LOC, BP, VS every 4 hrs external fetal monitor assess for vaginal bleeding and abdominal pain bed rest in left lying position 16-18 guage IV indwelling urinary catheter I&O decrease stimuli admin MgSO4 assess DTRs and assess for clonus

hospital management for preeclampsia

bed rest is side lying external fetal monitoring meds: mag, betamethasone monitor FHR

hospital management of preterm labor

identifying the source of bleeding and stopping it. Supplemental iron If blood loss is extreme, blood transfusion may be necessary. -Foods such as lean red meat, poultry, fish, leafy green vegetables, brown rice, lentils and beans can all boost your haemoglobin. Vitamin C helps with iron

how is chronic blood loss treated

- The initial evaluation includes a CBC and a review of peripheral blood smear. - Serum cobalamin and serum folate levels are reviewed. If cobalamin levels are low, megaloblastic anemia may be caused by cobalamin deficiency.

how is megaloblastic anemias diagnosed

Negative feedback glands respond by increasing or decreasing the secretion of a hormone based on feedback from various factors (glucose/insulin) Positive feedback- feedback increases the target organ action beyond normal (ie: breastfeeding)

how is the endocrine system regulated

1-3 times

how many times can you suction at a time

with insertion of little finger into the baby's mouth

how to break baby's suctioning to breast

1st letter= moms R or L 2nd letter= Baby Occipital or Sacrum 3rd letter= moms Anterior, Posterior, or Transverse Heart tones - O= below umbilics -S= above umbilicus -L or R-= which quadrant

how to describe position of baby and where heart rate is

place a thin line along entire lower lid in conjunctival sac use only one tuber per baby and discard after 1 min wipe away excess

how to give erythromycin ointments

admin via endotracheal tube as an adjunct to O2 and ventilation therapy to prevent and treat RDS

how to give surfactant to newborns

● Beef, liver, and chicken ● Fish and shellfish such as trout, salmon, tuna fish, and clams ● Fortified breakfast cereal ● Low-fat milk, yogurt, and cheese ● Eggs

how to increase vitamin B12 in your diet

vaginal = support uterus c-section= support insision

how to massage uterus with vaginal and c-sec delivery

Take BP between contractions, in side-lying position

how to take BP during labor

change pad as needed and with every voiding and defecation instruct t wipe front to back good handwashing use ice packs, sitz baths, using a squeeze bottle for perineal lavage, and topical application of anesthetic spray and pads

hygiene and comfort measures for perineum and episiotomy

duration of contractions lasting longer than 90 sec= tetanic frequency of contraction lasting over 2 min= tachysystole increased uterine resting rate

hyperactive uterine activity

Emphysema

hyperinflation of air sacs with destruction of alveolar walls r/t lost alveoli recoil, and increased CO2 retention

Essential part of diabetes management - ↑ Insulin receptor sites - Lowers blood glucose levels - Contributes to weight loss

importance of exercise with pts that have diabetes

An adult's previous experiences can be used as a resource for learning. An adult is more oriented to learning when the material is useful immediately, not sometime in the future. Learning is reinforced by application and prompt feedback.

important things to know about andragogy

Effective pedagogy have various teaching and learning tools that can be drawn upon or used in the classroom. use props and a lot explanation

important things to know about pedagogy

insufficient subcutaneous fat larger ratio of body surface area to body wt extended, open body position immature hypothalamus

in preterm infants temperature instability r/t

poorly developed suck small stomach immature digestion process hypoglycemia anemia hyperbilirubinemia

in preterm infants there are nutrition problems r/t

lung immaturity lack of surfactant lining alveoli PDA, r/t hypoxia results in RDS

in preterm infants there is respiratory distress due to

heart failure

inability of the heart to pump enough blood to meet the tissues O2 demands

secondary infertility

inability to conceive after a previous pregnancy

small baby

inadequate early wt gain during pregnancy causes

obstructive respiratory disorders

increase the resistance within air passages hard to exhale (asthma, COPD, emphysema)

watch VS (bp for hypotension) Watch FHR sitting, leaning forward, feet dangling perhydrate with IV fluids to prevent hypotension with test dose check for side effects (weird taste in mouth ringing in ears)

indications for epidural block

COPD CF IPAH

indications for lung transplant

drop in temp preovulatory and postovulatory mucus is thick at ovulation cervical mucus is abundant, watery, thin, and clear cervical os dilates slightly, softens, and rises in the vagina

indications of ovulation

Human Chorionic Gonadatropin (hCG) - Novarel -Pregnyl -Profasi

induces ovulation by stimulating release of eggs from follicles

Myocarditis

inflammation of the myocardium

pericarditis

inflammation of the pericardium

Antihistamines

inhibit allergic reactions of inflammation, redness, and itching caused by the release of histamine

establish IV access give NS continuous regular insulin identify hx of diabetes, time of last food, time and amount of last insulin injection

initial interventions for DKA

Remove the cap from the MDI and shake well. Breathe out all the way. Place the mouthpiece of the inhaler between your teeth and seal your lips tightly around it. As you start to breathe in slowly, press down on the canister one time. Keep breathing in as slowly and deeply as you can. (It should take about 5 seconds for you to completely breathe in.) Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung. Repeat the above steps for each puff ordered by your doctor. Wait about 1 minute between puffs. Replace the cap on the MDI when finished. If you are using a corticosteroid MDI, you should use a valved holding chamber as described above.

instructions when using MDI

analgesics for pain bed rest in semi flower position for comfort and promote drainage antibiotics to reduce inflammation and pain

interventions for PID

assess circulation airway and breathing establish IV access remove clothing cover sucking chest wound with nonporous dressing tapped on 3 sides stabilize impaled objects with bulky dressing, do not remove prepare for emergency needle decompression if tension pneumothorax or cardiac tamponade present

interventions for chest trauma

7-10 good 4-6 needs moderate resuscitative effort 0-3 severe need for resuscitation

interventions for different Apgar scores

Bed rest with bathroom privileges palpate fundus and abdomen to assess pain and involution admin antibiotics

interventions for endometritis

stay warm assess site daily for decrease in redness, pain, and discharge assist with sitz bath and perineal lamp antibiotics and analgesics

interventions for perineal infection

• assess uterus and bladder • IVF • O2 • notify healthcare provider • labs • bedrest • close monitoring • medications • (oxytocin, methylergonovine, carboprost, misoprostol) • support • ? prepare for surgery

interventions for postpartum hemorrhage

give ice water orange juice

interventions to stimulate fetus for NST

spina bifida occulta

is a defect of vertebrae only. no sac is presented and it is usually a benign condition, although bowel and bladder problems may occur

Health informatics

is a discipline in which health data are stored, analyzed, and disseminated through the application of information and communication technology

Empowerment

is an approach to clinical practice that emphasizes helping people discover and use their innate abilities to gain mastery over their own condition. They have the tools such as knowledge control and resources and experience to implement and evaluate their self management.

Informatics

is the science that encompasses information science and computer science to study the process, management, and retrieval of information.

Chronic blood loss

is typically caused by slow bleeding related to an underlying cause (Bleeding ulcers, hemorrhoids, menstrual bleeding, etc).

blood supply to the function endometrium is blocked and necrosis occurs functional layer separates from basal layer and mensuration begins day 1 of next cycle

ischemic phase of endometrial cycle

• Clinical manifestations are similar to those of cobalamin deficiency • Insidious onset • Absence of neurologic problems • Treated by replacement therapy • Encourage patient to eat foods with large amounts of folic acid

key points of folic acid deficiency

Acute idiopathic Thrombocytopenic purpura (ITP)

kids 2-6; IgG antibodies against GpIIb-IIIa (Type II HSR) abrupt onset 1-3 wks viral infection Epistaxis, easy bruising, petechiae Rx: corticosteroids, IVIg

smears, cultures nucleic acid amplification testing (NAAT)

lab dx for gonorrhea

labwork of patients suffering from acute blood loss may not reflect low hemoglobin of hematocrit levels for 36-48 hours.

lab work for acute blood loss

VDRL and FTA-ABS

laboratory dx for syphilis

hgb increase by 1 and hct increase by 3%

labs after 1 unit of blood

➢ Decreased hgb, wbc, platelets, and reticulocytes ➢ Increased MCV, serum iron and tibc ➢ Bone marrow biopsy, aspiration, and pathologic examination may be done

labs r/t aplastic anemia

normal bleeding time reduction in factor VIII (A) reduction in factor IX (B) prolonged PTT

labs r/t hemophilia A and B

hypoglycemia hyponatremia hypoxia prolonged QT pericardial effusion

labs r/t myxedema

fasting BG= 100-125 HbA1C= 5.7-6.4

labs r/t prediabetes

restlessness, rapid/ shallow breathing, bradycardia

late signs of hypoxia

lethargy combativeness coma dyspnea at rest use of accessory muscles retraction of intercoastal spaces on inspiration pause for breath between sentences, words dysrhythmias hypotension cyanosis cool, clammy skin diaphoresis decreased urine output unexplained fatigue

late signs of inadequate oxygenation

glucagon, epinephrine, growth hormone, cortisol

list Counterregulatory hormones - Oppose effects of insulin - Increase blood glucose levels

1. Trust v Mistrust: Infancy 2.Autonomy v Shame and Doubt: Early Childhood 3. Initiative v Guilt: Play Age 4. Industry v Inferiority: School Age 5. Identity v Role Confusion: Adolescence 6. Intimacy v Isolation: Young Adult 7. Generativity v Stagnation: Adulthood 8. Integrity v Despair: Mature Age

list Erikson stages of dev

Cognitive- used to increase knowledge via lectures, discussion, or written material. Psychomotor- kinesthetic learning whereas the student is touching and manipulating equipment to learn a skill. Affective- Changing attitudes dealing with feelings

list and explain the three domain of education

nitrates, beta blockers, calcium channel blockers, Ranolazine

list antianginals

Sociocultural- language, value system, educational background, support system. Psychological- emotions such as anxiety, fear, anger and depression, decreased coping. Physiological- pain, fatigue, oxygen deprivation

list barrier to education

SVC (unoxygenated) --> Rt atria --> Tricuspid --> Rt ventricle --> Pulmonic valve --> Lungs (Oxygenated) --> Lt atria --> Mitral valve --> Lt ventricle --> aortic valve --> aorta --> Body

list blood flow through the heart

deficient in iron, cobalamin, folic acid decreased erythropoietin decreased iron availability chronic ulcers, colon cancer, liver disease acute trauma, aneurysm, gi bleed sickle cell disease, medications, incompatible blood, trauma

list causes of anemia

Drug induced - alcohol -antiandrogens -antihypertensive -TCA -antianxiety - drugs Endocrine -diabetes -hypogonadism -obesity Genitourinary -Radical prostatectomy -renal failure Neurologic -CVD -parkisons Psychologic Vascular -hypertension -peripheral vascular disease Agining

list common risk factors r/t erectile dysfunction

Tetralogy TGA TA

list cyanotic CHD

Autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, accountability, confidentiality

list ethical principles

Age and developmental stage, motivation, readiness, active involvement, relevance, feedback, nonjudgmental support, simple to complex learning, repetition, timing, environment, emotions, physiological events, cultural aspects, psychomotor ability (muscle strength, motor coordination, energy, sensory activity)

list factors effecting education

- Promotes glucose transport from bloodstream across cell membrane to cytoplasm of cell • Decreases glucose in the bloodstream - ↑ Insulin after a meal Stimulates storage of glucose as glycogen in liver and muscle • Inhibits gluconeogenesis • Enhances fat deposition • ↑ Protein synthesis

list functions of glucose

Oral contraceptives transdermal patch hormone injections hormone implants vaginal ring

list hormonal birth control methods

Internal • Organizational culture—values, beliefs, and practices • Role responsibility, rules, and practices External • Economic trends • New laws • Government regulations

list internal and external minor attributes

caerebrovascular, cardiovascular, and peripheral vascular disease

list macrovascular complications of DM

Glands- organs of the endocrine (produce hormones to secrete in blood to affect target cells.) Target cells are cell specific that affect their specific organ. Hormones- chemical substances produced by the endocrine glands (lipid vs water soluble) Lipid soluble dissolve in lipids and emerge inside the cell. (ie: estrogen, steroids, thyroid) Water soluble hormones dissolve in water and and binds to surface of cell. (ie: FSH, Insulin) Target tissue - body tissue or organ that the hormone has its effect on.

list part of the endocrine system

menstrual phase proliferation (follicular phase) ovulatory phase luteal phase

list phases of menstrual cycle

Surfactant Blood supply Bronchi Bronchioles Alveolar

list structures in the lower respiratory tract

menstrual, proliferative,secretory, ishemic

list the phases of the endometrial cycle

bronchial= over trachea bronchovesicular= over main bronchi vesicular= over lesser bronchi, bronchioles, lobes

list the three different lung sounds and their locations

acquired immune thrombocytopenia thrombotic thrombocytopenia purpura HIT

list the types of thrombocytopenia

condoms, diaphragm, and cervical cap

list types of barrier methods

Follicle- stimulating hormone agonists -follitropin - urofollitropin GnRH agonists -leuprolide -nafarelin GnRh antagonists -cetrorelix -ganirelix Human Chorionic Gonadatropin (hCG) - Novarel -Pregnyl -Profasi Menotropins - Humegon -Peragonal -Repronex Selective Estragon receptor Modulator - clomiphene

list types of drug therapy for female infertility

Rapid acting: Lispro (Humalog), aspart (Novolog), and glulisine (Apidra) Short-acting: Regular - Intermediate-acting: NPH Longacting: Glargine (Lantus), detemir (Levemir)

list types of insulin

testes atrophy, lose wt, and soften erection changes prostate enlargemt

male reproductive changes r/t age

stopping cigarette smoking drug therapies airway clearance techniques breathing exercises increased fluids immunizations long term O2 exercise plan nutritional supplemtation

management of COPD

murmur cyanosis, clubbing poor feeding frequent regurgitation frequent respiratory infections activity intolerance

manifestation of congenital heart disease

Muscle weakness Anorexia Dark pigmentation Hypotension Hypoglycemia Low sodium levels High potassium levels Can result in Addisonian crisis

manifestations of addison disease

• General manifestations of anemia • Pallor is the most common finding • Glossitis is the second most common - Inflammation of the tongue

manifestations of iron deficiency anemia

sore, cracked nipples flulike symptoms: malaise, chills, and fever red, warm lump in breast

mastitis assessment

Fetal - Head is still dominant, face looks human and arm/ leg ratio is proportionate - Scalp hair appears - Meconium in bowel and anus open - Most bones and joint cavities seen on ultrasound and muscular movement - Heart muscle well dev and blood formation active in spleen - Respiratory bronchioles appear - Kidneys in position - Cerebral lobes in position and cerebellum assumes some prominence - General sense organs differentiated - Testes in position for descent or vagina open - Wt 100g / 0.22 lb Maternal - Quickening - Colostrum - Serum cholesterol increases - Placenta is clearly defined - Insulin resistance - Wt gain of 1 lb per week until birth

maternal and fetal changes 16 wks

Fetal - Vernix protects the body - Lanugo - Eyebrows, eyelashes, and head hair - Fetus sleeps, sucks, and kicks - Wt 200- 400g/ 0.44- 0.88 lb Maternal - Fundus reaches level of umbilicus - Breasts secret colostrum; areolae darken - Amniotic sac= 400 mL fluid - Postural hypotension - Quickening= pregnancy becomes REAL - Nasal stuffiness - Leg cramps - Varicose veins - Constipation

maternal and fetal changes 20 wks

elevated= open neural tube defects and multiple gestations low= down syndrome

maternal serum alpha- fetoprotein (MSAFP) results

eat high calorie food fist limit liquids at meal time rest before meals more frequent meals and snacks

maximizing food intake in COPD

elevated Hct= polycythemia thick blood makes it harder for heart to pump give IV fluids to thin blood can end up causing jaundice

meaning when baby has is a red color

erythrocyte sedimentation rate

measures time it takes for erythrocytes to settle to the bottom of a test tube used to assess inflammation

encourage to eat raw fruits, veg, cereals with bran drink 3 L of fluid per day exercise frequently

measures to avoid constipation during pregnancy

eat small frequent meals, avoid spicy/greasy foods, don't lie down after avoid sodium bicarbonate

measures to avoid heartburn

PTCA arthrotomy CABG coronary laser therapy coronary artery stent

medical interventions for angina

Vasopressin(ADH replacement) Levothyroxine(thyroid replacement) somatrotropin (growth hormone) glucocorticoids?(glucose)

medications given after the removal of the pituitary and why

Cephalosporins (a class of antibiotics), most common cause Dapsone Levodopa Levofloxacin Methyldopa Nitrofurantoin Nonsteroidal anti-inflammatory drugs (NSAIDs) Penicillin and its derivatives Phenazopyridine (pyridium) Quinidine

medications that cause anemia

amnion= inner chorion= outer

membranes of the placenta

cerebral palsy

nonprogressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia

above 60

normal HDL

40%-52% (men) 36%-47%

normal Hct

40-80 mg/dL

normal High-density lipoprotein (HDL)

1-3

normal INR

below 100

normal LDL

85-125 mg/dL

normal Low-density lipoprotein (LDL)

11-14 sec

normal PT time

4.7-6.1 million

normal RBCs level

· 3-5.5 mmol/L

normal Total cholesterol

50-150

normal Triglycerides

Respiration= 30-60 HR= 110-160 Temp= 36.5-37.5 C BP= 80/50

normal VS for newborn

5,000-10,000

normal WBC count

700- 800 mL

normal amount of amniotic fluid by end of term

7.35- 7.45

normal blood pH

7.35-7.45

normal blood pH

9.5-10

normal calcium level

below 200

normal cholesterol

round or slightly molded caput succedaneum open, flat anterior and posterior fontanels, sutures slightly separated or overlapping due to molding

normal condition of an infants head after birth

elastic turgor and subcu fat milia, vernix increases lanugo, mottling harlequin sign erythema toxicum monogolian spots telangiectatic nevi

normal condition of skin after birth

symmetrically placed pseudostrabismus chemical conjunctivitis subconjunctival hemorrhage from pressure absence of tears dolls eye movement

normal condition of the eyes after birth

intact lip and palate epstain pearls sucking pads in cheeks presence of rooting, sucking, swallowing, and gagging reflexes

normal condition of the mouth and chin after birth

below 100

normal d dimer

50-75%

normal ejection fraction

Females: 60-160 Males: 80-180

normal iron level

2.5-4.5

normal phosphorus level

Temp= elevated due to dehydration (100.4) Pulse= drop to 50 blood pressure= should be normal respirations= normal

normal postpartum vital signs

moon face truncal obesity buffalo hump abdominal striae muscle atrophy thinning of the skin hirsutism in females hyperpigmentation amenorrhea edema, poor wound healing bruises easily HTN susceptible to infections osteoporosis peptic ulcer formation

nursing assessment for Cushing's disease

Vaginal bleeding, usually in 1st tri size and date discrepancy abnormal fundal hight anemia excessive N/V abdominal cramping early symptoms of preeclampsia

nursing assessment for Hydatidiform Mole

(3 C's) Chocking Coughing Cyanosis Excess salivation Respiratory Distress Aspiration Pneumonia

nursing assessment for TEF

Jaundice total bilirubin level increasing more than 5 mg/day positive direct combs test increased reticulocyte count anemia urine and stools may be dark

nursing assessment for hyperbilirubunemia

painless, bright- red vaginal bleeding in 3rd tri soft uterus possible signs of shock placenta in lower uterine segment FHR is usually normal

nursing assessment for placenta previa

signs of placental separation -lengthening of the umbilical cord outside vagina -gush of blood Uterus changes from oval to globular mother describes a full feeling in vagina firm uterine contractions continue

nursing assessment for placental separation and third stage of labor

fatigue thin, dry hair, dry skin thick, brittle nails constipation bradycardia, hypotension goiter periorbital edema, facial puffiness cold intolerance wt gain T3 below 70 T4 below 5 husky voice slow speech

nursing assessment r/t hypothyroidism

gestational age of 20 wks or less fetal viability absent uterine cramping, backache, and pelvic pressure bright- red vaginal bleeding - note number a perineal pads per hour - note symptoms of shock - assess need for emotional support look for IPV

nursing assessment r/t miscarriage

Poor staffing Lack of time and resources Lack of confidence Frequent Interruptions Lack of privacy

nursing barriers to education

monitor for bleeding monitor VS monitor PT and INR gentle oral care minimize needle sticks turn client frequently decrease taking BP pressure to any oozing site Heparin during first phase

nursing care for DIC

stop bleeding as quickly as possible -pressure -ice give coagulation factor joint bleeding -RICE -rest - no ice - copmpression -elevate no contact sports use protective equipment soft toothbrush avoid subq and IM injections no asprin

nursing care for hemophilia

evaluate for Rh isoimmunization and for ABO incompatibility promote stooling by early feedings of milk assess at birth and daily for presence of jaundice monitor bilirubin levels assist with phototherapy if needed

nursing care for hyperbilirubinemia

perform a heelstick glucose assessment on all SGA or LGA babies or infants of diabetic mothers, jittery babies and babies with high-pitched cries report any blood glucose levels under 40 feed baby early prevent cold stress which leads to hypoglycemia

nursing care for hypoglycemia in newborns

monitor O2 therapy monitor thermoregulation monitor fluid and electrolytes report wt loss over 12% weigh diapers daily maintain nutrition

nursing care for preterm infant

instruct the woman to drink 3- 4 glasses of water before coming for exam and not to urinate late in the 3rd tri place wedge under the right hip to displace uterus to the left

nursing care r/t ultrasounds

keep newborn dry and warm place cap on head take temp every 4 hours if temp falls below 36.4 place in radiant warmer or put skin to skin

nursing care to prevent hypothermia for newborns

nurse controls whether to increase, decrease, or stop observe fetal and maternal response every 15 min if there are non reassuring FHR= turn Pitocin off piggyback at lowest port infuse slowly and increase in 20-30 increments always controlled by pump

nursing considerations for oxytocin

NPO after midnight post op -watch for gag reflex -have patient sitting up

nursing for bronchoscopy

before: obtain signed consent. have pt be NPO 6-12 hrs before the test After: Keep patient NPO until gag reflex returns. If biopsy was done watch for hemorrhage and pneumothorax

nursing for bronchoscopy

have client rest monitor VS protect from light dont give with ED drugs watch for tingling under tongue

nursing for nitrates

Before: avoid scheduling immediately after mealtime. avoid admin of inhaled bronchodilator 6 hrs before During: assess for respiratory distress After: Assess for respiratory distress. provide rest

nursing for pulmonary function test

Before: get signed consent During: position pt upright with elbows on an overbed table and feet supported. Don't talk or cough during procedure After: watch for signs of hypoxia and pneumothorax, and verify breath sounds in all fields. Encourage deep breaths

nursing for thoracentesis

• Dietary and lifestyle changes • Blood or blood product transfusions • Drug therapy • Oxygen therapy • Patient teaching - Nutrition intake - Compliance with drug therapy

nursing implications for anemia

give in the mornings before meals check serum hormones levels routinely check BP and pulse regularly wt daily avoid foods high in iodine

nursing implications for thyroid replacement drugs

institute bed rest with no vaginal or rectal manipulation and notify health care provider immediately monitor BP and pulse every 15 min; apply electric BP monitor if available apply external uterine and fetal monitor place client in side-lying position to increase uterine perfusion closely monitor contractions and FHR begin IV with 16- 18 gauge review CBC, clotting studies, Rh factor, and type and type/ cross match watch for signs of DIC prepare for immediate emergency C- section monitor for blood loss; save pads and linens

nursing intervention for abruptio placentae

teach prevention UTIs -void frequently -void before and after sex - wipe front to back stress regular exercise

nursing interventions during 12 wks of pregnancy

Explain the screening test and obtain blood sample for maternal serum alpha- fetoprotein (MSAFP) between 15-22 wks explain the multiple- marker, or triple, screen blood test, and obtain a specimen fro screening around 16- 18 wks to measure the MAAFP, hCG, and unconjugated estriol

nursing interventions during 16 wks of pregancy

explain and obtain a blood sample for a glucose challenge (24-28 wks) between 24- 32 wks two or three ultrasound measurement may be taken 2 wks apart to compare against standard fetal growth curve

nursing interventions for 24 wks

safety measures - wear low healed shoes or flats - avoid heavy lifting - sleep on side to relieve bladder pressure preparation for delivery -do pelvic tilt exercises - pack a suitcase -discuss postpartum circumstances

nursing interventions for 36- 40 wks

pre op and post op D&C care assess vs, vaginal discharge, uterine cramping discharge instructions - prevent pregnancy for 1 year - obtain monthly serum hCG levelss for 6 mo, then every 2 mo for 6 mo

nursing interventions for Hydatidiform Mole

medications -morphine -nitrates -ACE inhibitors -Beta blockers -Calcium channel blockers -aspirin VS, ECG admin O2 obtain cardiac enzymes IV keep in semi flowers bed rest for 12 hrs

nursing interventions for MI

admin enema and douche as prescribed pre op note amount and character of vaginal discharge. post op there should be less than one saturated pad in 4 hours check for blood clots encourage ambulation as soon as possible I and O assess voiding patterns observe incision for bleeding gradually increase diet provide stool softeners for first bowel movement

nursing interventions for a hysterectomy

dry infant under warmer or skin to skin with mom suction mouth then nose with bulb syringe keep head slightly lower than body assess airway status obtain APGAR score at 1 and 5 minutes keep head covered gestational age assessment assess cord for 3 vessels collect cord blood (Rh, blood type, Hct, cord blood gas) doc passage of meconium and urine check for gross anormlities

nursing interventions for baby immediately after birth

Multidisciplinary (OT, speech, neurologist, RT, ect) feed in a way that prevents aspiration - sit upright -support lower jaw admin anticonvulsants and diazepam

nursing interventions for cerebral palsy

elevate HOB admin O2 admin digoxin and diuretics daily wt I and O low sodium diet

nursing interventions for congestive heart failure (kids)

monitor VS, fundus, lochia every 15 min monitor LOC keep bladder empty anticiapte increasing oxytocin and admin of ergot preparation IM count pads saturated monitor I&O

nursing interventions for early postpartum hemorrhage

VS check for vaginal bleeding start IV notify HCP abdominal ultrasound possible laparotomy type and cross match

nursing interventions for ectopic pregnancy

Nurse more frequently and manually express milk before feeding wear supportive bra take warm or hot showers watch for symptoms of mastitis to reduce possibility of breasts engorgement, start breastfeeding as soon as possible after birth to prevent use breast pump alleviate pain by wearing supportive bra, taking analgesics, applying warm compresses it ice packs or washed cabbage leaves

nursing interventions for engorgement of breasts

teach home glucose monitoring teach signs of hypo and hyperglycemia dietochian teach signs and symptoms of ketocaidosis possible induction 38 - 40 wks

nursing interventions for gestational diabetes

• Close supervision and safe environment • Dental procedures in controlled situation • Shave only with electric razor • Superficial bleeding—apply pressure for at least 15 minutes + ice to vasoconstrict • If significant bleeding occurs, transfuse for factor replacement

nursing interventions for hemophilia

monitor for signs of ICP maintain seizure precautions elevate head of bed pre pare for surgery to drain the excess fluid off brain (ventricular shunt placement)

nursing interventions for hydrocephalus

culture and sensitivity of breast milk breastfeed every 2-3 hrs and to make sure breasts are emptied with each feed do not let mom cease breastfeeding abruptly may have to discontinue breastfeeding if there is pus in breast milk or if antibiotic is contraindicated for breastfeeding if the baby starts having diarrhea contact HCP bed rest 48 hrs

nursing interventions for mastitis

do not perform Leopold maneuvers, vaginal examination, rectal manipulation, or internal monitoring use bed rest to extend the period of gestation until fetal lung maturity is achieved monitor BP and pulse every 15 min start IV obtain blood specimen for CBC, clotting studies, Rh factor, and type/ cross match monitor contractions and FHR, place external monitor on client place in side- lying position monitor blood loss and save pads

nursing interventions for placenta previa

monitor growth and dev teach use of bulb syringe for suctioning naras teach signs of respiratory infections assist with feeding problems feed to back and side of mouth monitor for signs of cardiac difficulty or respiratory infection

nursing interventions r/t down syndrome

increased cal by 300 increase protein by 30g/day increase intake of iron and folic acid increase intake of vit A,C, and calcium drink 8-10 glasses of fluid per day

nutritional interventions during pregnancy

RBCs hematocrit hemoglobin

o2 carrying capacity expressed by

Aortic Stenosis

obstructive narrowing immediately before, at, or after the aortic valve oxygenated blood flow from the left ventricle into the systemic circulation is diminished symptoms caused by low cardiac output

estrogen in pills prevents secretion of FSH, preventing ovulation woman still menstruates lowest failure rate of methods

oral contraceptives

lochia serosa

pale pinkish to brownish discharge lasting up to 10 days postpartum

1. monitors calcium blood levels 2. make more or less PTH in response to calcium blood levels

parathyroid function

F= facial expression L= leg movements A= Activity C= Cry C= Consolabiluty

parts of FLACC pain scale

*A*ppearance: pink all over = 2 *P*ulse: > 100 bpm = 2, < 60 = 0 *G*rimace: sneeze, cough, loud cry = 2 *A*ctivity: active movement = 2 *R*espiration: strength, not rate

parts of an apgar score

Enlarged thyroid gland acceleration of body process -wt loss -increased appetite -Diarrhea -Heat intolerance -Tachycardia, Palpations, Increased BP Exopthalos T3 above 220 T3 above 12 Low TSH Radioactive iodine uptake increased

parts of an assessment for hyperthyroidism

sole creases breast tissue bud skin, vessels, and peeling genitalia resting posture

parts of gestational age assessment after delivery

Progressive destruction of pancreatic cells by body's own T cells - Autoantibodies cause a reduction of 80% to 90% of normal cell function before manifestations occur - Genetic predisposition Long preclinical period Antibodies present for months to years before symptoms occur Manifestations develop when pancreas can no longer produce insulin Rapid onset of symptoms Present at ER with ketoacidosis

pathophysiology of Type 1 diabetes

• Pancreas continues to produce some endogenous insulin •Insulin produced is either insufficient or poorly utilized by tissue

pathophysiology of type 2 DM

To prevent oxygen loss, avoid: - Demanding physical activity - Emotional stress - Environments with low oxygen (high altitudes, nonpressurized airplane flights) - Smoking - Known sources of infection To make sure you're getting enough fluids: - Avoid too much exposure to the sun - Have fluids on hand, both at home and away - Recognize signs of dehydration To avoid infection: - You or your child should be vaccinated - Seek emergency medical attention for temperature of 101.5 0 F or higher - Practice good hand hygiene

patient and family education for sickle cell anemia

Rest as much as possible ➢ Avoid people who are sick ➢ Try to avoid large groups of people ➢ Wash hands often ➢ Clean your mouth and gums every day ➢ Avoid doing thinks that could cause you to bump or cut yourself

patient education for aplastic anemia

inhale slowly and deeply through nose exhale slowly through pursed lip, as if whistling breath out 3 times longer than breathing in do 8-10 repetitions 304 times a day

patient teaching on pursed lip breathing

- Premenopausal women - Pregnant women - Persons from low socioeconomic backgrounds - Older adults - Individuals experiencing blood loss

people at risk for iron deficiency anemia

Amniotomy (AROM)

performed by a physician or midwife during a vaginal exam, amnihook makes small hole in membrane, observe fluid for color and amount (important bc meconium)

temp above 100.4 red, swollen, very tender perineum purulent drainage, induration

perineal infection assessment

Variable -> Chord compression Early decelerations ->Head compression Accelerations -> O2 good (happy baby) Late decelerations -> Pelvic insufficiency

periodic episodic changes in FHR and what they mean

right sided heart failure

peripheral edema Results in peripheral congestion due to the inability of the right ventricle to pump blood out to the lungs; often results from left sided failure or pulmonary disease

hypertension

persistent BP greater than 140/90

manifestations -dyspnea -decreased movement of involved chest wall -decreased or absent breath sounds on the affected side -hyperresonace to percussion Interventions -chest tube insertion

pneumothorax manifestations and interventions

• Establishment of national policies and standards have been developed to outline how technology is applied and used. Must demonstrate: • Meaningful use criteria (evolving) • Certification standards • Practices to reduce barriers for information exchange

policies for T&I

crackles (rales)

popping sounds heard on auscultation of the lung when air enters diseased airways and alveoli; occurs in disorders such as bronchiectasis or atelectasis

assess for signs of shunt malfunction - buldging of fontanels - change is size of head - change in LOC - headache assess for signs of infection - fever -shun tract appears reddened, tender, and swollen - decreased feeding/ vomiting -stiff neck and headache monitor I and O

post op care for hydrocephalus

maintain NPO admin IV fluids monitor I and O provide gastrotomy tube care and feedings as prescribed monitor doe post op stricture of the esophagus

post op for TEF

VS LOC compression device over arterial site observe insertions site for hematoma maintain bedrest

post op for cardiac catherization

8 wks

posterior fontanel closes by

uterine atony lacerations of the vagina hematoma development in the cervix, perineum, or labia retained placental fragments full bladder

postpartum hemorrhage can be caused by

keep sac and stool and urine cover sac with moist sterile dressing elevate foot of bed and position child on his or her abdomen, with legs abducted measure head circumference at least every 8 hrs and check fontanels assess neurological function empty bladder

pre op nursing interventions for spina bifida

Addisonian crisis

precipitated by physical or emotional stress, sudden withdrawal of steriods.

multiparity pelvic tearing during childbirth vaginal muscle weakness with aging and obesity

predisposing conditions r/t uterine prolapse, cystocele, and rectocele

Arterial -Atherosclerosis -advanced age Venous -hx of DVT -valvular incompetence

predisposing factors for PVS

family hx Hx of more than two spontaneous abortions hydramnios previous baby weighing over 8 lb 13.5 oz high parity obesity recurrent monilia vaginitis glycosuria

predisposing factors for diabetes during pregnancy

high parity dystocia, prolonged labor operative delivery overdistention of the uterus abruptio placentae infection placenta previa

predisposing factors for postpartum hemorrhage

BP of above 140/90 on two occasions at least 4 hrs apart after 20 wks gestation - proteinuria - it occurs predominantly in primigravida and in multigravida who previously had preeclampsia

preeclampsia is characterized by

abruptio placentae

premature separation of the placenta from the uterine wall usually in 3rd tri A MEDICAL EMERGENCY

changes that might make a woman think she is pregnant. such as amenorrhea, fatigue, nausea, vomiting, polyuria, breast changes(darkened areolae, enlarged Montgomery glands), quickening(slight fluttering movements of the fetus felt by the women, usually between 16-20 wks of gestation).

presumptive signs of pregnancy

early ambulation foot paddling and ankle rolling after general anesthesia examine legs daily for pain, warmth, and tenderness or a swollen vein

preventing thrombophlebitis postpartum

postpartum perineal exercises spaced pregnancies wt control

prevention of uterine prolapse, cystocele, and rectocele

Ischemic heart attack MI Cardiomyopathy valvular heart disease HTN

primary causes of heart failure

examiner suspects a women is pregnant. such as abdominal enlargement hegar's sign(softening and compressibility of the lower uterus) chadwick's sign (deepened violet-bluish color of the cervix and vaginal mucosa) goodell's sign(softening of the cervical tip) ballottement braxton hicks positive pregnancy test

probable signs of pregnancy

respiratory acidosis organ damage - NEC -PDA -IVH monitor hematocrit levels

problems r/t neonatal hypoxia

based on opinion of patients limits dr. choices do what patient wants and not what they need

problems with pay for performance programs

lightening braxtonhicks cervical softening and slight effacement Bloody show or expulsion of mucus plug burst of energy

prodromal signs of labor

B cells

produce antibodies

bone marrow

produces RBCs contains immature RBCs

Menotropins - Humegon -Peragonal -Repronex

product made of FSH and LH to promote the development and maturation of follicles in ovaries

subdermal, progestin- only contraceptive subq in upper arm effective 24 hrs after insertion; good for 3 yrs suppress ovulation and thickens cervical mucus

progestin implant

Truncus arteriosus

pulmonary artery and aorta do not separate; one artery, rather than two arteries, arises from both ventricles one main vessel receives blood from the left and right ventricle together. blood mixes in the right right and left ventricles through large VSD= cyansus

left sided heart failure

pulmonary edema, results in pulmonary congestion due to the inability of the left ventricle to pump blood to the periphery

confirm pregnancy number a fetuses growth placement heartbeat

reason for ultrasound during 1st tri

position gender size heartbeat abnormalities placenta placement amniotic fluid vol

reason for ultrasound during 2nd and 3rd tri

done at 14- 20 wks for genetic defects 3rd tri for lung maturity and rH factor collected in brown tubes

reasons for amniocentesis

Galactosemia

recessive genetic disorder; characterized by body's inability to tolerate galactose. as galactose accumulates in the blood, several organs are affected.

25- 35 lb in total 1st tri= 1-4 lb 2nd and 3rd tri= 1 lb each wk

recommendations for wt gain during pregnancy

technology and media reliable websites education materials that are brief and easy to read

recommended teaching for Gen X (1965-1980)

lecture patient education TV channels printed materials

recommended teaching for baby boomers

technology and media apps and websites group teaching active learning approaches

recommended teaching strategies for millennials

lecture pictures and printed materials

recommended teaching strategies for veterans

Reactive non-stress test

recording of a minimum of 2 FHR accelerations (15bpm for at least 15 sec per episode) w/ fetal movement w/in a 20 min period

D&C

refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping.

low potassium

regular insulin can lead to what electrolyte imbalance

Station of baby

related to position in relationship to the ischial spines= 0

lung biopsy

removal of lung tissue followed by microscopic examination

complaints of urinary problems, prostate enlargement testosterone levels

reproductive assessment for older men

autonomy

right to make own decisions

Elevated serum lipids, hypertension, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states and homocysteine level.

risk factors for CAD

heredity male African Americans age hyperlipidemia HTN smoking obesity inactivity metabolic syndrome stress substance abuse

risk factors for angina

family hx men increased age African Americans use of alcohol, tobacco, caffeine obesity high salt and fat diet use of oral contraceptives stress

risk factors for hypertension

obesity smoking hypertension high fat intake sedentary lifestyle

risk factors for macrovascular complications of DM

hypertension genetic predisposition smoking chronic hyperglycemia

risk factors for nephropathy

abdominal or chest surgery air pollution altered consciousness prolonged bed rest chronic lung disease HV aspiration NG tube IV drug use malnutrition resident of long term care facility smoking trach

risk factors for pneumonia

poor protein intake previous hypertension diabetes multiple gestations hydatidiform mole prior pregnancy w/ preeclampsia family Hx

risk factors for preeclampsia

Obesity (abdominal/visceral) sedentary lifestyle urbanization certain ethnicities

risk factors for type 2 DM

gonorrheal conjunctivitis neonatal herpes congenital syphilis oral candidiasis

risks to newborns r/t STDs

taking in- mom focused on themselves, observing taking hold- good time for teaching letting go feels confident as the role of mom, looses fears and fantasies

rubins psychologic adaptions

women often have a syncopal spell on first ambulation nurse should check Hgb and Hct for anemia and BP sitting and lying down to look for orthostatic hypotension

safety concern after delivery

6 weeks to 6 months postexposure influenza- type symptoms generalized rash that affects palms of hands and soles of feet lesions contagious

secondary syphilis

includes the day of ovulation to 3 days prior to next menstrual period

secretory phase of endometrial cycle

Dry and peeling of skin

seen in postterm infants, dry crackly skin, white cracks

CK/CKMB, TROPONIN

serum cardiac markers after MI

clubbing; above 160 normal is 160

sign of long term hypoxia

• Signs and Symptoms: redwhite-blue syndrome of digits; pallor or cyanosis that is bilateral or unilateral; normal pulse; sensory changes in extremities; pain. Triggers long-term exposure to cold, stress, lesions can progress to gangrene

signs and symptoms / triggers of raynauds

bleeding tendencies range from mild to severe and symptoms may not occur until around 6 months of age when mobility leads to injuries from falls and accidents. Manifestations of Christmas disease include hemarthrosis, ecchymosis (bruising), epistaxis (nosebleeds), and bleeding after procedures such as minor trauma, tooth extraction, minor surgeries.

signs and symptoms of Christmas disease (Hemophilia B) and type A

Excessive thirst large volumes of dilute urine low ADH hypernatremia dehydration lose too much fluid

signs and symptoms of DI

sudden onset of pain in the lower sternal region pain not relieved by rest or nitroglycerin n/v anxiety pain persists for hours r days rapid, irregular, and thready pulse decreased LOC dysrhythmias narrowed pulse pressure bowel sounds absent or high pitched ECG changes cool, pale, diaphoretic skin dizziness, fatigue, syncope

signs and symptoms of MI

low urine output High levels of ADH hyponatremia over hydrated retain too much fluid excessive thirst

signs and symptoms of SIADH

SOB Tachycardia Hypoxia Hemoptysis

signs and symptoms of a pulmonary embolism

lethargy or difficulty waking temp above 37.8 C vomiting green, liquid stools refusal of two feedings in a row presence of fever

signs and symptoms of a sick newborn who needs medical attention

Enlargement of hands and feet thickening and enlargement of face and head bony and soft tissues sleep apnea signs of DM cardiomegaly hypertension

signs and symptoms of acromegaly

tachycardia poor circulation wt gain tachypnea SOB cyanosis pulmonary congestion hepatomegaly edema

signs and symptoms of congestive heart failure (kids)

intolerance of heat fine straight hair budging eyes facial flushing enlarged thyroid tachycardia high BP wt loss muscle wasting clubbing diarrhea tremors

signs and symptoms of hyperthyroidism

Irritability of neuromuscular system Tetany hypertonic muscle contractions numbness, tingling cramps in extremities laryngeal spasm bronchospasm carpopedal spasm ( flexion of the elbows and wrists, dorsiflexion of the feet) seizures

signs and symptoms of hypoparathyroidism

fatigue hair loss dry skin brittle nails numbness and tingling of the fingers, amenorrhea weight gain decreased heart rate and temperature lassitude cognitive changes, elevated cholesterol levels constipation hypotension

signs and symptoms of hypothyroidism

pallor unexplained fever poor feeding enlarged liver or spleen headache anorexia decreased growth facial deformities bronzed colored skin splenomegaly hepatomegaly

signs and symptoms of thalassemia

easy bruising, epistaxis (nosebleeds), bleeding from the gums, excessive bleeding with lacerations or surgeries, and menorrhagia (heavy menstrual bleeding), hemarthrosis

signs and symptoms of von Willebrand disease

Signs and Symptoms: pain at rest, intermittent claudication; decreased or absent pulses; rubor and cyanosis of extremities; signs of decreased circulation Triggered by smoking, cold, and emotional stress. Affects hands and feet. Has periods of exacerbations and remissions; gangrene is a complication.

signs and symptoms/ triggers of buergers

bleeding gums or nose reduced lab values of platelets, fibrogen, and prothrombin bleeding from injection sites, IV sites ecchymosis

signs of DIC

progressive fatigue malasia wt loss chronic cough night sweats hemoptysis low grade fever chest pain

signs of TB

bad cough that last longer than 3 wks pain in the chest cough up blood or sputum weakness or fatigue wt loss chills fever sweating at night

signs of active TB

tachypnea dyspnea retractions hypoxia tachycardia

signs of acute respiratory distress syndrome

vaginal bleeding adnexal or abdominal mass sharp, unilateral or bilateral pelvic pain, abdominal pain referred shoulder pain syncope; shock

signs of acute rupture r/t ectopic pregnancy

missed period full feeling in lower abdomen lower quadrant tenderness positive pregnancy test vaginal bleeding sharp, unilateral or bilateral pelvic pain referred shoulder pain shock

signs of an ectopic pregnancy

black, tarry BM bruising or small purple spots on skin confusion and weakness headache and change in vision

signs of bleeding

continuous trickle from vagina bleeding in spurts bleeding in presence on contracted fundus

signs of bleeding from unrepaired laceration

soft, boggy uterus usually above umbilicus fundus that does not firm up with massage

signs of bleeding from uterine atony

swollen, firm, and painful breasts then more swollen, hard, shiny, and slightly lumpy when palpated, nipple may retract into the areola

signs of breast engorgement

cyanotic increased sputum leads to right sided heart failure hypoxia hypercapnia polycythemia tachypnea dyspnea clubbing tripod position accessory muscles cardiac enlargement

signs of chronic brochities

increased CO2 retention minimal cyanosis pursed lip breathing dyspnea very thin hyperpresence orthopneic barrel chest dyspnea prolonged expiratory time jerky sentences anxious thin accessory muscles

signs of emphysema

discomfort localized in abdomen no lower back pain cervix does not progressively change contractions decrease in intensity or frequency with ambulation

signs of false labor

hypoglycemia: jitteriness, tremors, lethargy, hypotonia, apnea, weak or high pitched cry, seizures hypocalcemia: jitteriness, apnea, increased muscle tone, edema, abdominal distention, feeding intolerance, and chvostek sign EFV: edema, tachycardia, buldging fontanels, and rales in lungs DFV: sunken fontanels, poor skin turgor, and dry mucous membranes

signs of fluid and electrolyte imbalances in preterm infants

• Diastolic pressure 140 or greater • Retinal hemorrhages, exudates or papilledema • Restless, confusion, stupor, and/or coma • Blurred vision • Headache • Nausea/vomiting

signs of hypertensive crisis

• Confusion • Irritability • Diaphoresis • Tremors • Hunger Acute Complications • Hypoglycemia • Weakness • Visual disturbances • Can mimic alcohol intoxication Untreated can progress to loss of consciousness, seizures, coma, and death

signs of hypoglycemia

Tachycardia (early) BP Tachypnea Vasoconstriction pale & cool cold & clammy CNS changes—anxious, confused, lethargic when blood loss reaches 30-40% (late) urine output

signs of hypovolemic shock

decreased BP weak, rapid pulse cool, clammy skin, colored ashen or gray

signs of hypovolemic shock

irritability, lethargy increased head circumference bulging fontanels widening suture lines "sunset" eyes high pitched cry feeding difficulties decreased muscle tone and strength

signs of increased ICP in infants

decreased -co2 -acidity -dpg -exercise -temperature

signs of left shift

hypoventilation hypotension hypothermia hyponatremia hypoglycemia lactic acidosis respiratory failure

signs of myxedema coma

umbilical cord lengthens blood changed shape of uterus to globular shape

signs of placental separation

JVD, hepatosplenomegaly, pitting edema

signs of right sided heart failure

poor feeding dysphagia drooling regurgitating undigested food

signs of stricture of the esophagus

pain in the lower back that radiates to abdomen pain accompanied by regular rhythmic contractions contractions that intensify with ambulation Progressive cervical dilation and effacement

signs of true labor

irtitabilty seizures tremors high pitched cry poor feeding fever nasal stuffiness tachypnea temp instability

signs of withdrawal in neonates

Goodell's sign

softening of the cervix

Hegar's sign

softening of the lower uterine segment

fetal circulation

special vessels and circulation present in fetus; includes de-O2 blood in umbilical arteries coursing to placenta, and O2 nutrient-rich blood via umbilical veins

1st degree= epidermis 2nd degree= dermis, muscle, fascia 3rd degree= anal sphincter 4th degree= rectal mucosa

stages of tears

4 months

steady head control by

amniocentesis

sterile procedure; needle puncture of the amniotic sac to withdraw amniotic fluid for analysis

Follicle- stimulating hormone agonists -follitropin - urofollitropin

stimulates follicle growth and maturation by mimicking the body's natural FSH

Selective Estragon receptor Modulator - clomiphene

stimulates hypothalamus to increases production of GnRH, with increases release of LH and FSH. End results in stimulation of ovulation

primary prevention

strategies aimed at preventing health problems immunizations, exercise, safe living

Suction when secretions cannot be cleared with coughing or possibly before performing trach care Will insert the suction catheter about 4-5 inches or until resistance is felt. Pull back a little before applying suction DO NOT SUCTION LONGER THAN 10 SECONDS Pre-oxygenate before, during and after

suctioning a trach

• Impaired myocardial function - Tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine output • Pulmonary congestion - Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis •Systemic venous congestion - Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention

symptoms of CHF in kids

Dyspnea Orthopnea Crackles Cough Fatigue Tachycardia Anxiety restlessness Confusion Paroxysmal nocturnal dyspnea

symptoms of Left sided HF

fever, tachycardia, agination, anxiety, and HTN

symptoms of Thyroid storm

General manifestations of anemia, neutropenia, and thrombocytopenia. ○ fatigue ○ Pale skin ○ Bleeding of the nose or gums ○ Rash of small purplish or red spots ○ Rapid heart rate ○ Shortness of breath ○ Chest pain ○ Bruising of unidentified origin ○ Among more

symptoms of aplastic anemia

- Chest pain - Cough - Crackles - Enlarged heart - Dependent edema - Dyspnea - Enlarged liver - Fatigue - JVD - syncope

symptoms of cardiomyopathy

• Acute: valves become red, swollen and inflamed with lesions developing on leaflets • Chronic: scar tissue develops, leaflets become rigid and deformed, stenosis or regurgitation develops

symptoms of chronic and acute rheumatic fever

● Glossitis ● Fatigue ● Numbness ● Poor balance ● Reduced sensation of touch ● Memory loss ● Shortness of breath

symptoms of cobalamin deficiency

- Arthralgias - Myalgias - Back pain - Abdominal discomfort - Weight loss - Headache - Clubbing of fingers - Splinter hemorrhages in nail beds - Petechiae - Osler's nodes on fingers or toes-painful tender, red or purple pea-sized lesions - Janeway's lesions on palms or soles-flat, painless, small, red spots - Roth's spots

symptoms of endocarditis

• Jaundice - Destroyed RBCs cause increased bilirubin • Enlarged spleen and liver - Hyperactive with macrophage phagocytosis of the defective RBCs • Accumulation of hemoglobin molecules can obstruct renal tubules - Tubular necrosis

symptoms of hemolytic anemia

peripheral edema wt gain distended neck veins nausea nocturia weakness hepatomegaly ascites

symptoms of right sided HF

gradual onset no fever mild fatigue stuffy nose sneezing sore throat cough

symptoms of the common cold (Viral Rhinitis)

abrupt onset high fever headache aches and pain fatigue symptoms of cold

symptoms of the flu

1. Sudden onset of intense abd. pain - momentarily pain w/ diffuse pain thereafter 2. vaginal bleed: spotting-severe hemorrhage 3. Hyperventilation 4. Restlessness 5. Agitation 6. Tachycardia 7. no contractions

symptoms of uterine rupture

Easy bruising Bleeding Purpura (small red dots under the skin as a result of small bleeds) Nosebleeds Bleeding in the mouth or around the gums Heavy menstrual periods Blood in vomit, urine, or stool Bleeding in the head

symptoms r/t ITP

- Asymptomatic frequently - Moderate anemia • Splenomegaly • Mild jaundice

symptoms r/t Thalassemia minor

F= many asymptomatic, dysuria, urgency, vaginal discharge, uterine tenderness M= leading cause of nongonococcal urethritis

symptoms r/t chlamydia

• General symptoms of anemia • Sore tongue • Anorexia • Nausea • Vomiting • Abdominal pain • Neuromuscular manifestations - Weakness - Paresthesias of the feet and hands - ↓ Vibratory and position senses - Ataxia - Muscle weakness - Impaired thought process

symptoms r/t cobalamin deficiency

incontinence or stress incontinence urinary retention bladder infections

symptoms r/t cystocele

F= majority are asymptomatic M= dysuria, yellowish-green discharge, urinary frequency

symptoms r/t gonorrhea

vesicles in clusters that rupture and leave painful erosions that cause painful urination remission and excaberations may be contagious when asymptomatic

symptoms r/t herpes

constipation hemorrhoids sense of pressure or need to defecate

symptoms r/t rectocele

retractions tachypnea (above 60) circumoral cyanosis expiratory grunting flaring nares

symptoms r/t respiratory distress in an infant after delivery

- Life-threatening - Physical and mental growth often retarded - Pale - Symptoms develop in childhood - Splenomegaly - Hepatomegaly - Jaundice - Chronic bone marrow hyperplasia • Expansion of bone marrow space

symptoms r/t thalassemia major

F= green, yellow, or white frothy foul- smelling discharge with itching M= asymptomatic

symptoms r/t trichomoniasis

dysmenorrhea pulling and dragging sensations in pelvis and back dyspareunia pressure, protrusions fatigue low backache

symptoms r/t uterine prolapse

F= odorless, white or yellow, cheesy discharge with itching M= asymptomatic

symptoms r/t yeast infections

1. Prepubertal 2. Enlargement of Scrotum/Testes, Reddening/Texture change of scrotum 3. Enlargement of Penis (length) 4. Enlargement of Penile diameter 5. Adult Size

tanner stages for boys

1. prepuberty 2. breast budding 3. full enlargement of breast 4. menarche occurs, pubic hair darkens

tanner stages for girls

feet should be checked daily for changes wash daily with mild soap (dont soak) dry well don't go barefoot professional should remove calluses nails cut straight across

teaching about foot care with diabetes

after treatment pts will need daily hormone replacement signs of overdose are same as hyperthyroidism

teaching for hyperthyroidism

sit eye to eye with patient use assistive listening devices speak slowly and clearly quiet environment

teaching patients with hearing loss

use simple wording present 1 instruction at a time ask yes or no questions avoid open ended questions reinforce instructions often minimize distractions

teaching patients with mild cognitive impairment

use read to text electronic tablets large print good lighting provide verbal instructions

teaching patients with vision loss

signs and symptoms of STDs Mode of transmission of STDs sexual contact should be avoided with anyone while infected

teaching r/t STDs

heavy vaginal bleeding with clots temperature of 100.4 or higher lasting more than 24 hrs a red, warm lump in breast pain on urination tenderness in calf

tell mom to call HCP if ______ happens post partum

IABP (intra-aortic balloon pump)

temporary Catheter balloon threaded up through descending aorta, synchronized with person's heart rhythm Improves coronary perfusion and perfusion of organs

manifestations -cyanosis -air hunger -extreme agitation - subcutaneous emphysema -neck vein distension - hyperresonance to percussion - tracheal deviation away from the affected side intervention - needle decompression - chest tube insertion

tension pneumothorax manifestations and interventions

10-30 years postexposure cardiac and neurological destruction

tertiary syphilis

tactile fermitus

test feeling vibrations from saying 99 to see if there is consolidation or liquid in lungs

Fluid Deprivation test no fluid for 8-12hrs frequent wts if urine is still not concentrated and pts has polyuria= DI STOP test if pt has tachycardia and hypotension

tests for DI and nursing interventions

CK-MB

tests for myocardial injury. increase 3-6hrs after MI

Blood transfusions Iron Chelation therapy—for iron overload Splenectomy may be required Moderate cases survive into their 30s

thalassemia treatment

afterload

the amount of resistance to ejection of blood from the ventricle

purpura

the appearance of multiple purple discolorations on the skin caused by bleeding underneath the skin

mean arterial pressure

the average pressure in a patient's arteries during one cardiac cycle

primary infertility

the couple has never achieved pregnancy

myocardial infarction

the disruption in or deficiency of coronary artery blood supply, resulting in necrosis of myocardial tissue

impaired fecundity

the experience of difficulty conceiving or carrying a pregnancy to term

Levine's sign

the global position of heart attack; a fist clenched over the chest

cardiomyopathy

the term used to describe all diseases of the heart muscle

Down Syndrome (Trisomy 21), older moms

things associated with low MSAFP

It is up to the nurse that knows the patient and determines the appropriateness of education Nurse plans the teaching to meet learning outcome Learning outcomes are goal oriented Outcome is to change behavior or attitude Patient has to be motivated to learn

things that need to be planned r/t patient education

visual disturbances swelling of face, fingers, or sacrum severe, continuous headache persistent vomiting epigastric pain infection (chills, temp, dysuria, pain in abdomen) fluid discharge or bleeding from vagina change in fetal movement

things to report immediately during pregnancy

effacement

thinning of the cervix during labor 0--100%

Description: spotting w/out cervical changes Tx: bed rest for 24 hrs - 48 hrs; no sex for 2 wks

threatened miscarriage description and Tx.

Oligohydramnios

too little amniotic fluid; less than 400 mL

Polyhydramnios

too much amniotic fluid; above 2000 mL often seen in diabetic women

O2 therapy Low sodium diet bronchodilators diuretics vasodilators calcium channel blockers inotropic agents

treatment for Cor pulmonale

diagnosis quickly stabilize patient treat cause control thrombi's and bleeding blood transfusions/ FFP cryopreceitate - given for low fibrogen heparin for thrombi

treatment for DIC

IV admin of insulin NS fluid replacement add dextrose to IV wen glucose goes below 250 electrolyte replacement recording I and O ECG monitoring assess LOC assess blood glucose

treatment for HHS

corticosteroids IV immunoglobulins Ritimab splenectomy immunosuppressive platelet transfusion anti- D antibody

treatment for ITP

eliminate cause, give diuretics (Lasix), fluid restriction, I&O, daily wt., lab chemistries

treatment for SIADH

D&C endometrial ablation

treatment for abnormal uterine bleeding

focuses on returning GH levels to normal by surgical, radiation or drug therapy

treatment for acromegaly

Restore circulatory status—fluids, steroids May need lifelong steroid therapy and mineralocorticoid therapy additional salt intake Check orthostatics Daily weights Aware that stressors can precipitate crises Medic alert bracelet or similar identification of history

treatment for addisons disease

➔ Bone Marrow transfusion/transplant ➔ Immunosuppressive Therapy ➔ High dose cyclophosphamide ➔ Long term cvc If left Untreated there is a 75% chance of Fatality

treatment for aplastic anemia

blood thinners Ace diuretics' - Surgery - Heart transplant (dilated)

treatment for cardiomyopathy

doxycycline or azithromycin cefoxitin gentamycin

treatment for chlamydia

- Nitrates-dilate peripheral blood vessels, coronary arteries, and collateral vessels. - Beta blockers-decrease myocardial contractility, HR, SVR, and BP - Calcium channel blockers-systemic vasodilation with decreased SVR, decreased myocardial contractility and coronary vasodilation

treatment for chronic stable angina

Include foods like liver, fortified breakfast cereals, fish, yogurt, and milk in your diet to bring vitamin B12 levels up. Treatment may also include oral supplements or B12 injections.

treatment for cobalamin deficiency

rest hydration decongestants acetaminophen

treatment for common cold (Viral Rhinitis)

lifelong thyroid replacement

treatment for congenital hypothyroidism

If pituitary source transphenoidal hypophysectomy Radiation of pituitary also appropriate Adrenalectomy may be needed in case of adrenal hypertrophy Temporary replacement therapy with hydrocortisone or Florinef Adrenal enzyme reducers may be indicated if source if ectopic and inoperable. If cause is r/t excessive steroid therapy, tapering slowly to a minimum dosage

treatment for crushing's disease

1. diuretics 2. digoxin 3. ACE inhibitors

treatment for end stage heart failure (refectory)

eliminating milk and lactose containing formula

treatment for galactosemia

ceftriaxone plus doxycycline or azithromycin

treatment for gonorrhea

prevent and treat bleeding replacement therapy for clotting factors (a and VW) desmopressin acetate- stimulate an increase in factor VIII and vWF antifibrinolytic therapy- inhibits fibrolysis

treatment for hemophilia

• DDAVP (Desomopressin Acetate) - IV - Causes 2-4 X increase in factor VIII activity - Used for mild hemophilia • Replace missing clotting factors • Transfusions - At home with prompt intervention to reduce complications - Following major or minor hemorrhages

treatment for hemophilia

Acyclovir, famciclovir, valacyclovir

treatment for herpes

Radioactive iodine- permanent and cure for hyperthyroidism. Destroys all or part of thyroid- usually one dose cure their hyperthyroidism - have to be careful not to put in hypothyroid state. Antithyroid Medications- PTU (propylthiouracil) and Methimazole or Tapazole Beta blockers

treatment for hyperthyroidism

Thyroid ablation medication Radioactive iodine therapy Thyroidectomy

treatment for hyperthyroidism

Administer 1 mg of glucagon IM or subcutaneously » Side effect: Rebound hypoglycemia - Have patient ingest a complex carbohydrate after recovery - In acute care settings » 20 to 50 ml of 50% dextrose IV push

treatment for hypoglycemia if not alert enough to swallow

15 to 20 g of a simple carbohydrate » 4 to 6 oz fruit juice » Regular soft drink - Avoid foods with fat » Decrease absorption of sugar • Recheck BS in 15 minutes - If above 70 give a snack or meal

treatment for hypoglycemia when the pt is alert enough to swallow

Steroids' levothyroxine

treatment for myxedema

transfusion

treatment for platelets below 50,000

● therapeutic phlebotomy to reduce the patient's hematocrit levels to a normal level ● antiplatelet agents to reduce the risk of blood clotting due to their thick blood viscosity ○ Ex. hydroxyurea can slow down the growth of cells in the body, especially RBCs and platelets.

treatment for polycythemia

O2 intubation assess for bleeding monitor PTT and INR inferior vena cava filter fibrinolytic agent heparin enoxaparin warfarin analgesia

treatment for pulmonary embolism

Penicillin G IM 2.4 million units if allergic= tetracycline, doxycycline, cefriaxone

treatment for syphilis

1. knee to chest position 2. give O2 3. give morphine 4. act calm

treatment for tet spells

antiviral drugs if given within 24-48 hrs of onset rest hydration acetaminophen

treatment for the flu

Metronidazole

treatment for trich

• M - Morphine • O - Oxygen • N - Nitroglycerin • A - Aspirin: Why would you give non-enteric coated?

treatment for unstable angina

myomectomy ( removal of fibroids without removal of the uterus) hysterectomy hormonal regimens uterine artery embolization of the blood vessels supplying the fibroid tumor cryosurgery

treatment for uterine fibroids with menorrhagia

miconazole and clotrimazole nystatin fluconazole PO single dose

treatment for yeast infections

- Meal plan based on individual's usual food intake and is balanced with insulin and exercise patterns - Insulin regimen managed day to day •

treatment regimen based on what for type 1

Emphasis based on achieving glucose, lipid, and blood pressure goals - Calorie reduction

treatment regimen based on what for type 2

aerosol sprays smoke animals mold aspirin NSAIDS occupation URI

triggers for asthma attacks

Any event that can lead to acidosis, such as infection or extreme dehydration. Also , fatigue, exposure to cold, strenuous exercise, high altitudes, and psychosocial stress.

triggers for sickle cell anemia

eclampsia

true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma

uterine inversion

turning of the uterus inside out after birth of the fetus

tonic neck reflex

turning the head to one side, extending the arm and leg on that side, and flexing the limbs on the opposite side lasts until 3-4 months

Acyanotic (L to R shunt) -increased pulmonary blood flow or obstruction Cyanotic (R to L shunt) -decreased blood flow or mixed-blood flow

two categories of congenital heart defects

I would ask the patient of her LMP and I would also ask the patient when did she have sexual intercourse.

two most important questions to determine possible pregnancy

taychardia and hypotension

two signs of blood loss/ shock

Emphysema/Chronic Bronchitis

two types of COPD

ultrasound transducer= fetal HR toco= fundus

types of external fetal monitors

ultrasound transducer (fetal HR) Tocotrasducer (toco) (fundus)

types of external fetal monitors and were they are places

For profit Not for profit

types of financial categories

• Hemophilia A - "Classic hemophilia" - Deficiency of factor VIII - Accounts for 80% of cases of hemophilia • Hemophilia B - Also known as Christmas disease - Caused by deficiency of factor IX - Accounts for 15% of cases of hemophilia

types of hemophilia

after water breaks; sterile fetal or internal scalp electrode (FSE) - drilled into babies head or butt -measures beat to beat -more accurate Intrauterine pressure catheter (IUCP) -measures how strong contractions are -intensity of contractions - can be used to NS for meconium stained fluids or oligohydramnios

types of internal fetal monitors and considerations

Kinesthetic- Visual Auditory

types of learners

- Cobalamin (vitamin B12) deficiency - Folic acid deficiency - Drug-induced suppression of DNA synthesis - Inborn errors - Erythroleukemia

types of megaloblastic anemias

private and public

types of ownership

- Immune thrombocytopenic purpura - Thrombotic thrombocytopenic purpura - Heparin-induced thrombocytopenia and thrombosis syndrome - Acquired thrombocytopenia from decreased platelet production

types of thrombocytopenia

low transverse (best) low vertical classical = doesnt heal as well, no V-back

types of uterine incisions during c-section - which is best

absent= undetectable minimal= under 5 BPM moderate= 6- 25 bpm marked= above 25 bpm

types of variability

Usually occurs in people over 35 years of age • 80% to 90% of patients are overweight Greater in some ethnic populations - Increased rate in African Americans, Asian Americans, Hispanic Americans, and Native Americans - Native Americans and Alaskan Natives: Highest rate of diabetes in the world

typical populations with type 2 DM

Acute blood loss

typically occurs because of sudden hemorrhage as a result of trauma, complications of surgery, or conditions/diseases that disrupt vascular integrity

echocardiogram

ultrasound of the heart

NT-proBNP

used for diagnosis of impaired left ventricular ejection fraction.

pulmonary function tests

used to evaluate lung function. Involves use of spirometer to assess air movement as patient performs prescribed respiratory maneuvers

Thoracentis

used to obtain specimen of pleural fluid for diagnosis, used to remove pleural fluid, or instill medication.

CRIES

used with infants 32- 60 wks for assessment of pain

Mechanical dilation

uses Catheter with 2 balloons to stretch out cervix usually falls out around 5cm

pre op - do not drink alcohol, smoke, take aspirin or anticoagulant meds 24 hrs before during procedure - expect cramping post op - pelvic pain -fever -malaise - n/v - PCA pump - check for bleeding, VS, pain level, neurovascular assessment

uterine artery embolization

- Manually place back; anesthesia for pain control; IVFs & oxytocin

uterine inversion Tx

Late decelerations

uteroplacental insufficiency

contractions occur 12 to 24 hrs post-delivery involution occurs (1 to 2 cm/day) - 1st day: at if 1 to 2 cm above umbilicus - 7 to 10 days: under symphysis pubis

uterus changes after birth

Concerned with efficiency and distribution. Linked to access. Greatest among individuals with multimorbid chronic conditions.

utilization of resources depends on

diastolic heart failure

ventricles can't relax and fill

S3

ventricular gallop- 'kentucky' • occurs during rapid ventricular phase of diastole • commonly associated with left ventricular failure and is caused by blood from the left atrium slamming into an already overfilled ventricle during early diastolic filling.

BP should rise no more than 30 points sytolic and 15 points diastolic - average is 90- 140 S and 60- 90 D pulse= 60-90 resp= 16- 24

vital signs during pregnancy

people with low socioeconomic status and members of ethic and racial minorities

vulnerable populations

Uterine contractions every 10 minutes or more often menstrualike cramps; low, dull backache; and pelvic pressure increase or change in vaginal discharge ROM (rupture of membranes)

warning signs of preterm labor

controlling hypertension loosing wt not smoking low fat diet exercise

ways to decrease risk for macrovascular complications of DM

MSAFP (maternal serum) and AFAFP ( amniotic fluid)

ways to gain alpha- fetoprotein screenig

eating dry crackers before getting out of bed small frequent meals no fatty food no skipping meals

ways to prevent nausea during first 8 wks of pregnancy

1. planning is involved 2. the outcomes are goal oriented 3. the patient is motivated to learn

what are the three main attributes of patient education

congestive heart failure

what can VSD lead to

uterine rupture or abruption

what can hyperactive uterine activity cause

hyper inflated lungs

what causes hyperresonace with percussion of chest

caused by high levels of circulating ACTH that bind to the melanocortin 1 receptor on the surface of dermal melanocytes

what causes the hyperpigmentation in addisons disease

full bladder

what could cause the uterus to be higher than the umbilics after delivery

stridor low pitched snoring during inhalation

what do you hear with partial airway breathing

T= Thienopyridines (clopiogrel) H= Heparin R= Renin angiotensin inhibitors - ACE O= Oxygen M= morphine B= Bete blockers I= interventions (stent) N= Ntroglycerin S= Statin S= salcyate Aspin

what does THROMBINS 2

- number of sexual partners -religious beliefs allergies -previous methods -cost -side effects - adherence

what factors influence the choice of the most appropriate method of birth control

- with each contraction blood flow from mom to baby ceases as the uterine myometrial veins are compressed -mother and baby physiologically separated -pushes baby into the cervix= thinning of cervix

what happens during a contraction

fertilization takes place in ampulla (outer third) section of the fallopian tube the zygote takes 3-4 days to enter uterus it takes 7-10 days to complete the process

what happens during implantation

it may cause in a retained placenta, which predisoposes the client to hemorrhage and infection

what happens if you give oxytocin before the placenta is delivered

the corpus luteum regresses, estrogen and progesterone levels decrease and the endometrium is shed via menstruation

what happens in the absence of implantation

Hct rises WBC count is elevated ( hard to dictate infection) blood- clotting factors are elevated; increases risk for DVT

what happens to hematologic system postpartum

nonlactating -nodules are palpable - engorgement may occur 2-3 day post partum lactating - milk sinuses palpable - colostrum expressed then milk

what happens to the breast after delivery nonlactating and lactating

diuresis occurs bladder distention and incomplete emptying are common increased risk for UTIs

what happens to uterine system postpartum

b

what is a possible cause of aplastic anemia? a: blood loss b: viral/bacterial infections c: jaundice d: vitamin B12 deficiency

assessment of the patients ability and readiness to learn identification of teaching methods development of learning goals with the patient implementation of the teaching evaluation of the patient learning

what is part of a teaching plan

Hct is low, anemia can be caused by blood loss= abruptio placenta, placenta previa, rupture

what it means when baby is pale

PO

what route for medication is not used during labor

vitamin K

what to admin to prevent hemorrhagic disorders in newborns

vital signs fundal ht and firmness lochia urination perineum bowel sounds presence of thrombophlebitis bonding

what to assess postpartum

palpate for spongy, full feeling over symphysis check urge to void when bladder is palpated assist client to ambulate for first void (OH) should void w/in 4 hrs of delivery watch for urine retention catharize only if necessary Kegel exercises

what to assess r/t bladder and urine output postpartum

smoking, drugs, alcohol, and caffeine , stress

what to avoid while breastfeeding

check apical pulse (must be above 60) check dig level (normal 0.8-2)

what to do before giving digitoxin

wear boxers chart basal temp track ovulation take prenatals good diet decrease stress

what to do when having a hard time concieving

Nitrazine paper turns black or dark blue assess FHR vaginal exam for prolapsed cord color and amount of amniotic fluid should be noted check pts temperature every hour

what to do when membranes rupture

reposition stop pictocin increase IV fluids O2 vaginal exam tocolysis- stop contractions put on FSE and IUPC amniofusion

what to do when there are nonreassuring patterns on a fetal monitor

Anticoagalant

what to give for a fib

more common in black women and women who have never bean pregnant most common symptom is abnormal uterine bleeding tend to disappear after menopause

what to know about benign tumors of the uterus

how baby tolerated labor mom on any drugs meconium stained amniotic fluid prenatal care mom have active herpes gestational age mom blood type any abnormalities

what to know about newborn before they are born

reduce the number of sexual contacts avoid sex with those who have multiple partners examine genital area and avoid sexual contact if anything is abnormal wash hands and genital area before and after sexual contact use condom as a barrier use water based lubricants rather than oil-based lubricants use a vaginal spermicidal gel avoid douching

what to teach about safe sex

pneumothorax

what to watch for after lung biopsy

patients needing care

what's in unlimited demand in health care organizations

sexual orientation sexual practices type of protection contraceptive practices previous STDs

what's included in a sexual history

Mineralocorticoid—aldosterone which effects blood pressure and sodium absorption, loss of potassium by kidney Glucocorticoids—cortisol. Affects metabolism, regulates blood sugar levels, affects growth, antiinflammatory action, decreases effects of stress Adrenal androgens—sex hormones

what's released by the adrenal cortex and what are they responsible for? (Salt, Sugar, Sex)

Open neural tube defects

whats associated with high MSAFP

- past 39 wks or - medical reasons GD, preeclampsia, baby getting too big

when a mom would be induced

Before analgesia and anesthesia to determine the progress of labor to determine whether second stage pushing can begin

when are vaginal exams preformed

they are taken at night, most cholesterol is synthesised when dietary intake is at its lowest

when do you give satins and why

2 year

when does a child speak 2-3 word sentences

18 months

when does a child throw ball overhand

5 years

when does a child tie their own shoes

4 years

when does a child use scissors

4 years

when does birth length double

2 years

when does child achieve 50% of adult ht

8 months

when does the child sit unsupported

after 16 wks

when is PUBS done

secondary polycythemia

when less O2 is available (high altitude) or when EPO production increases

Paraxysmal nocturnal dyspnea

when lying for a long time, the heart cant compensate for increased volume. pulmonary congestion results dangle legs to relieve

around 28 wks

when should women start childbirth classes

During contraction since mom and baby are separated

when to give pain meds during labor

first hour of life

when to give vitamin K injection

after 24hrs of breast milk or formula ingestion

when to screen for PKU

umbilics

where fundus is 1st 24 hrs after delivery

a, b, d, e

which of the following are clinical manifestations of aplastic anemia? (select all that apply) a: pale skin b: rash of small purplish or red spots c: bleeding of the nose or gums d: brittle nails e: fatigue

It was first discovered in populations around the Mediterranean Sea but also affects populations in the Middle East, Africa, and Asia.

who is affects by thalassemia

self pay Medicare Medicaid private insurance

who pays for healthcare services

Doctors Nurses Managers Boards/directors head= chapplen

whos part of an ethical comittee

can lead to lactic acidosis

why do you discontinue metformin when giving contrast

stroke, fractured hip, fractured knee

why would a patient be a blood thinners

Vitamin D must be given to absorb calcium phosphate binding drugs such as Renagel or or Sevelamar . They help prevent hypocalcemia. phosphate binders reduce absorption of phosphates as they can't rid phosphates . People with renal failure take phosphate binding drugs such as Renagel or Sevelamer. These medications prevent hypocalcemia caused by the elevated phosphorous. Normal phosphorous level-is 3.0-5.5.

with hypoparathyroidism why would a pt take vit D and phosphate binding drugs

HIV CMV Gonorrhea syphilis

with what STDs can moms not nurse

ROM > 24 hrs any laceration or operative incision Hemorrhage Hematomas Anemia or poor physical health before delivery intauterine manipulation, manual removal of placentae, retained placental fragments

women predisposed to postpartum infection

Fetal effects - oral thrush or perineal rash Tx -treated with miconazole nitrate cream or nystatin cream in pregnancy

yeast infection fetal effects Tx

Idiopathic Thrombocytopenic Purpura (ITP)

• An acquired hemorrhagic disorder characterized by - Thrombocytopenia: excessive destruction of platelets - Purpura: discoloration caused by petechiae beneath the skin

Thalassemia

• An autosomal recessive genetic disorder of inadequate production of normal hemoglobin - Common in ethnic groups near the Mediterranean Sea and equatorial regions of Asia and Africa

S2

• Associated with aortic and pulmonic valve closure • (dub)

S1

• Associated with tricuspid and mitral valve closure • (lub)

Physiologic Jaundice

• Begins after 24 hours • Immature liver has impaired ability to conjugate bilirubin

Pathologic Jaundice

• Begins within 1st 24 hours • Rh incompatiblity - Rh- mom antibodies attack RBCs of Rh +fetus - Hydrops fetalis

Hemolytic Anemia

• Destruction or hemolysis of RBCs at a rate that exceeds production • Third major cause of anemia

Type 1 Diabetes Mellitus

• Formerly known as "juvenile onset" or "insulin-dependent" diabetes • Most often occurs in people under 30 years of age • Peak onset between 11 and 13 years of age

Sickle Cell Disease (SCD)

• Group of inherited, autosomal recessive disorders • Presence of an abnormal form of hemoglobin in the erythrocyte • Hemoglobin S (HbS), abnormal

- Under 2500 grams (5-8) - Placental insufficiencies, smoking, infections, HTN, malnutrition - Maintain temp and BS

• SGA and IUGR

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

protamine sulfate

antidote for heparin

vitamin K

antidote for warfarin

increase fluid intake O2 therapy physiotherapy antibiotics if not viral NSAIDS antipyretics

treatment for pneumonia

becomes parous with a transverse slit heals within 6 wks

what happens to the cervix after delivery

heart, thymus, digestive tract, kidneys, gonads

list organs with secondary endocrine functions

baby will have swelling, decreased O2, increased bilirubin, anemia

what happens when mom has negative blood and baby is positive and mom has antibodies

Betamethasone and dexamethasone

* Corticosteroids that increase the production of surfactant to accelerate fetal lung maturity & reduce the incidence or severity of RDS. * Used for a client in preterm labor between 28-32 weeks' gestation whose labor can be inhibited for 48 hrs without jeopardizing the mother or fetus.

Anemia

- Number of erythrocytes (red blood cells [RBCs]) - Quantity of hemoglobin - Volume of packed RBCs (hematocrit)

- Insulin from an outside source

- Required for type 1 diabetes - Prescribed for patient with type 2 diabetes who cannot control blood glucose by other means

Hemoglobin A1C test

- Useful in determining glycemic levels over time - Not diagnostic, but monitors success of treatment - Shows the amount of glucose attached to hemoglobin molecules over RBC life span • 90 to 120 day

S4

- atrial gallop 'tennessee' • Linked to resistance to ventricular filling It's most frequently associated with left ventricular hypertrophy that is the result of long standing hypertension

Green zone peak flow

-good control Peak flow 80-100%

rheumatic fever

A bacterial infection that can be carried in the blood to the joints. injures the heart, blood vessels, joints, and subq tissue

first day postpartum fundus is 1 cm below umbilicus and midline and firm massage the fundus if it is soft or boggy

assessing fundal ht and firmness post partum

normal= 33-35 cm (2 cm larger than chest) tape measured placed above eyebrows and stretched around fullest part of occiput, at posterior fontanel

assessing head circumference after birth

Fetal - Fetus can breathe, swallow, and regulate temperature - Surfactant forms in lungs - Fetus's eyelids open - Wt 1005 g/ 2.2 lb Maternal - Fundus is halfway between umbilicus and xiphoid process - Thoracic breathing replaces abdominal breathing - Fetal outline is palpable - Heartburn - Hemorrhoids

Maternal and fetal changes 28 wks

normal= 46-52.2 cm measured from crown to rump and rump to heel, or from crown to heel

assessing length after birth

•Hydrocortisone: cortisol, it regulates how the body converts fats, proteins, and carbohydrates to energy. It also helps regulate blood pressure and cardiovascular function. •Corticosterone: This hormone works with hydrocortisone to regulate immune response and suppress inflammatory reactions

2 specific glucocorticoids released by the adrenal cortex include:

Peak Expiratory Flow Rate (PEFR)

Maximal flow rate, measured in liters, that can be generated during a forced expiratory maneuver. used to check control of asthma.

BP risk factors proteinuria wt gain edema headache irritability IUGR increased DTRs and clonus oliguria blurred vision

nursing assessment for preeclampsia

chest pain SOB tachycardia joint pain chorea rash subq nodulea fever

nursing assessment for rheumatic fever

embryo

3-8 wks after fertilization embryo most vulnerable to teratogens= congenital anomalies

chronic bronchitis

a condition in which the bronchi in the lungs are constantly swollen and clogged with mucus r/t increased sputum production and inflammation in the lining of the bronchials

Thrombocytopenia

a condition in which there is an abnormally small number of platelets circulating in the blood

multiple kids polyhydramnios older patient

predisposing factors for postpartum hemorrhage

diabetes cardiac disease preeclampsia placenta previa infection ( UTI) stress smoking

predisposing factors r/t preterm labor

12.87

the mean age of menarche

Tetralogy of fallot

a congenital malformation of the heart involving four distinct defects child experiences tet spells r hypoxic episodes that are relieved by a squatting position

Fecundability

the monthly probability of conception

foreign body pulmonary embolism pneumonia pump failure pneumothorax pulmonary bronchial constrictions

6 reasons for dyspnea

Echymosis

a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.

Phenylketonuria (PKU)

a disorder related to a defective recessive gene on chromosome 12 that prevents metabolism of phenylalanine

hypoxic drive

A "backup system" to control respiration; senses drops in the oxygen level in the blood.

port-wine stain

a flat vascular birthmark made up of dilated blood capillaries, creating a large, reddish-purple discoloration on the face or neck doesn't fade, can effect organs it covers

vernix

a greasy substance that protects the fetus in utero and can still be present at birth

C

A couple has just found out their baby has hemophilia. The nurse is explaining how to safely take care of the child at home. Which of the following statements shows effective family teaching? a. "We will keep the baby inside at all times." b. "We will go to the ER every time the baby has a superficial cut" c. "We will buy a medical alert bracelet in case something happens later in life and we are not around". d. "We will give our baby some aspirin after her vaccinations if she is fussy."

puerperal morbidity

A maternal temperature of 38 degrees C (100.4 degrees F) or higher on any 2 of the first 10 postpartal days, excluding the first 24 hours. The temperature is to be taken by mouth at least four times per day.

Dawn phenomenon

A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in the client with diabetes mellitus. Treatment includes administering an evening dose of intermediate acting insulin at 10 pm.

Vibroacoustic stimulation (VAS)

A noninvasive method of evoking a reactive NST in fetuses found to be in a low activity state via a device that emits vibration and sound

3

A patient comes into the ED with pain, swelling, redness in leg and warm to touch. They have a sudden onset of shortness of breath, chest pains, and cough. What are these signs and symptoms most common in? 1) Anemia 2) Hemophilia 3) Blood clot 4) Blood Cancer

b, c, d

A patient newly diagnosed with Cobalamin Deficiency needs guidance on selecting foods high in Vitamin B12. You are helping the patient choose foods high in this vitamin. What foods will you guide the patient to choose? (SATA) a. Spinach b. Yogurt c. Liver d. Fish

the day before ovulation and the day of ovulation

the most fertile days of pregnancy

Megaloblastic Anemias

a group of disorders caused by impaired DNA synthesis and characterized by the presence of large red blood cells. • Majority result from deficiency in - Cobalamin (vitamin B12) - Folic acid

stepping reflex

a neonatal reflex in which an infant lifts first one leg and then the other in a coordinated pattern like walking lasts until 3-4 months

P50

the partial pressure of oxygen when hemoglobin is 50% saturated

Systolic blood pressure

the pressure created in the arteries when the left ventricle contracts and forces blood out into circulation

Hypothalamus

a neural structure lying below the thalamus; directs eating, drinking, body temperature; helps govern the endocrine system via the pituitary gland, and is linked to emotion

Diastolic blood pressure

the pressure in the arteries when the left ventricle is refilling

adrenal glands

a pair of endocrine glands that sit just above the kidneys and secrete hormones (epinephrine and norepinephrine) that help arouse the body in times of stress.

it reduces the amount of urine produced in the body at night by the kidneys. The bladder then fills will less urine. Also has vasoconstriction qualities.

Describe the action and administration of DDAVP (Vasopressin)

Toxoplasmosis

a parasite which is most commonly transmitted from animals to humans by contact with contaminated feces

small baby injury card compression amniotic banding respiratory destress

the problem with too little amniotic fluid

vacuum erection device intraurethral devices and intracavernosal injections penile implants

Devices and implants used for erectile dysfunction

cough suppressants

Dextromethorphan Codeine Benzonatate Diphenhydramine

an analysis of the nasal fluid for a protein called beta-2 transferrin CT and MRI scans may also be require to determine the location and severity

Diagnosing a CSF leak r/t hypophysectomy includes

cord prolapse pre term labor respiratory destress

the problem with too much amniotic fluid

• Decreased Von Willebrand factor levels • Von Willebrand antigen levels • Decreased platelet agglutination • Prolonged bleeding time • PTT may be normal or prolonged

Diagnosis Laboratory Findings for von willebrand disease

health history - age -occupation -past injury - surgery -infections -sexual practices -stress -medication Hx serum analysis - sperm concetration - motility -morphology Hormone studies -tesosterone -LH -FSH

Diagnostics for male infertility

used with spermicide must be fitted left in 6 hrs after intercourse refitted with wt changes and pregnancy

Diaphragm

DASH eating plan

Dietary Approach to Stop Hypertension; good diet for reducing sodium intake

CHF atrial dysthymias

ASD can lead to

Mucolytics

Acetylcysteine (Mucomyst)

• Replacing blood volume to prevent shock • Identifying the source of the hemorrhage • Stopping blood loss • Correcting RBC loss

Acute Blood Loss Collaborative Care

bilirubin encephalopathy

Acute manifestation of bilirubin toxicity occurring in the first weeks after birth.

Pedagogy

the profession or principles of teaching, or instructing kids

Growth hormone (GH) or somatotropin

a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in human development.

percutaneous transluminal coronary angioplasty

a procedure in which a small balloon on the end of a catheter is used to open a partially blocked coronary artery by flattening the plaque deposit and stretching the lumen (AKA angioplasty)

Members of the family Relationships among family members Other individuals that influence the family Use of a genogram or ecomap helps to illustrate family members and social relationships Considers concurrent development of individuals within the family (life cycle) Assessment of family member interactions and behaviors toward one another

Family Assessment

The forces at work within a family that produce particular behaviors or symptoms

Family dynamics is defined as

coronary angiogram

a recording of an x-ray of the heart's circulation detects coronary artery spasms

thyroid storm

a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism

vitamin K

Helps blood clot, not to be ingested in high amount when on warfarin

Heparin induced thrombocytopenia

Heparin causes a decrease in platelet count because of the formation of a complex with platelet factor 4, IgG antibodies against platelet-heparin complex that the spleen proceeds to destroy

meningocele

a sac is present at some point on the spine contains only meninges and spinal fluid and has less neurologic involvement than a myelomeningocele

myelomeningocele

a sac is present at some point on the spine is more sever than meningocele because the sac contains spinal fluid, meninges, and nerves

opthalmia neonatorum

a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia

mission statement

a statement of the organization's purpose - what it wants to accomplish in the larger environment

Chadwick's sign

Bluish-purple coloration of the vaginal mucosa and cervix

determine whether cervix will respond to induction score above 5 shows success factors -dilation -effacement -station -cervical consitency -cervical position

Bishop score

● Easy or excessive bruising (purpura) ● Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs ● Prolonged bleeding from cuts ● Bleeding from your gums or nose ● Blood in urine or stools ● Unusually heavy menstrual flows ● Fatigue ● Enlarged spleen

Signs and Symptoms of Thrombocytopenia

pay for performance

a strategy using financial incentives to reward providers for achieving a range of payer objectives, including delivery efficiencies, submission of data and measures to the payer, and improved quality and patient safety

uterine rupture

a tear in the wall of the uterus

abdominal pain fruity breath dry mouth sunken eyes fever flushed, dry skin ketonuria, glucosuria restlessness kussmaul respirations n/v rapid, weak pulse glucose above 250 urinary frequency

assessment findings of DKA

Magnesium Sulfate

CNS depressant administered to a preeclamptic client to prevent seizures, may be used as a tocolytic to stop preterm labor contractions

umbilical cord arteries

Carry deoxygenated blood from embryo

● Alcoholism ● Vegetarian diets ● Long term use of antacids ● Crohn's Disease ● Celiac Disease ● Atrophic gastritis

Causes of cobalamin deficiency

T cells

Cells created in the thymus that produce substances that attack infected cells in the body.

Raynaud's

Condition of small arteries and arterioles of the fingers and skin; constriction in response to cold or emotional upsets

systole

Contraction of the heart

abnormal glucose screen ( 1 hour ar 24- 26 wks) polyphagia polydipsia polyuria

assessment for diabetes during pregnancy

Thrombophlebitis

Inflammation of vein with a clot formation made up of various elements in blood supply trapped in a fibrin mesh.

stress echocardiogram

a test that combines an exercise stress test with an echocardiogram to assess left ventricular wall motion both before and immediately after exercise

Im injection every 3 mo admin during 1st 5 days of cycle wt gain, irregular or unpredictable periods no periods for some increases risk for osteoporosis

Depo-provera

using endoscope with surgical instrument inserted into part of the brain by going through the nose and the sphenoid bone into the sphenoidal sinus cavity.

Explain trans sphenoidal pituitary surgery

Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP)

a variant of severe preeclampsia

second stage of labor

Heralded by the involuntary need to push, 10 cm of cervical dilation, rapid fetal descent, and birth averages 1 hr for a primigravida, 15 min for a multipara

moderate anemia

Hgb 6-10

severe anemia

Hgb <6

Indomethacin

NSAID for premature babies with certain heart disorders-given to PDA because it causes to constrict and close the vessel.

continuous slow absorption of estrogen/ progestin placed deep in vagina once every 3 wks and is removed on day 21, after 7 days free a new one is inserted additional contraction for first 7 days

NuvaRing

spleen

Organ near the stomach that produces, stores, and eliminates blood cells

metformin day of surgery and 48 hours

Patients undergoing surgery or radiologic procedures requiring contrast medium should hold their

anti- D antibody

Plasma derived immunoglobulin Causes transient anemia by clearing the antibody coated RBC -Since this causes transient anemia you don't want to give it to a child who is already anemic

◦ Mild depression, early onset, no longer than 2 weeks ◦ Fatigue, weeping, mood swings, anxiety ◦ Continues infant care ◦ Cause unknown - hormone related possibly ◦ Usually Self-limiting

Postpartum blues

Peripheral Vascular Disease

Results in interference to blood flow - Arterial: Compromises oxygen supply and alters demand - Venous: Blockage within venous system

involution

Return of the uterus to a nonpregnant state after birth

a, c, d

Risk Factors for disseminated intravascular coagulation include: A) Septic abortion B) Pregnancy C) HELLP syndrome D) Infection E) Congestive heart failure

Nevus vasculosus

Rough, red collection of capillaries with a raised surface that disappears with time; also called strawberry hemangioma.

Fetal effects - congenital heart defects -IUGR -Congenital cataracts - hearing or vision problems may arise in later childhood Tx - no Tx

Rubella fetal effects Tx

Anaphylactoid syndrome of pregnancy (amniotic fluid embolism)

Rupture of amniotic sac causing infiltration of amniotic fluid into the maternal circulation. Amniotic fluid travels to and obstructs pulmonary vessels

• Gradual involvement of all body systems • Usually fatal by middle age from renal and pulmonary failure • Prone to infection - Pneumonia, most common infection

Sickle Cell Disease Complications

Frequent infections - Chronic pain - Fatigue - Swelling of hands and feet - Delayed physical growth - Vision problems - Leg ulcers - dilute urine -hematuria -gallstones -splenomegaly -hepatomegaly - Shortness of breath - Jaundice or pallor - Vasoocclusive crisis

Symptoms of Sickle cell Anemia

electronic health record

Systematic collection of a patient's health care and treatment in a digital format that can be shared

b

Thalassemia is a/an A. acquired virus B. inherited disorder C. fungal infection D. none of the above

Endometrial cycle

The 28 days of the menstrual cycle as they apply to the events in the uterus. also known as the uterine cycle, and has the three subphases: menstruation, the proliferative phase, and the secretory phase.

Type 1 - sudden -anytime under the age of 21 Type 2 - gradual -mostly in adulthood

compare and contrast onset of type 1 and 2

Assessment and Diagnostic Findings Trousseau's sign—can check with a BP cuff Chvostek's sign—tapping over facial nerve causes spasm of the mouth, nose and eye Lab studies may reveal calcium levels of 5-6 mg/dL or lower Serum phosphate levels will be decreased

assessing tetany with hypoparathyroidism

exhalation

The passive part of the breathing process in which the diaphragm and the intercostal muscles relax, forcing air out of the lungs.

aldosterone, which maintains the right balance of salt and water while helping control blood pressure

The principle mineralcorticoid is

contraction duration

The time of the contraction Measured from the beginning to the end of one contraction measured in seconds

patent ductus arteriosus (PDA)

There is a return to fetal circulation in an attempt to provide O2 to brain large organs; it results in worsening respiratory distress and pulmonary edema due to increased blood flow to lungs

patent ductus arteriosus (PDA)

There is an abnormal opening between the aorta and the pulmonary artery usually closes 72 hours after birth oxygenated blood from the aorta return to the pulmonary artery causes pulmonary hypertension causes a characteristic machine like murmur

coarctation of the aorta

There is an obstructive narrowing of the aorta

Grade B= Recommends

There is high certainty that the benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial

Non pregnant - 5-10,000 Pregnant - 12-15,000 Labor and PP - can go to 25-30,000 common Usually back to normal 4-7 days

WBCs throughout pregnancy

HYPERTHYROIDISM

WHEN TSH IS DECREASED THEN T3 AND T4 ARE INCREASED

HYPOTHYROIDISM

WHEN TSH IS ELEVATED AND T3 AND T4 ARE DECREASED =

Exercise Testing

Want to reach it in short amount of time (20-30 min) Need to choose protocol that fits patient (enough discrimination to determine VO2peak) Looking for when HR can no longer level off after 3 minutes.

cancers drugs (chemo) ITP infections alcoholism radiation hemodlysis HIT DIC

What Causes Thrombocytopenia

D; antifibrinolytic medications are used to slow down the process of fibrinolysis, which is the breakdown of blood clots

What are antifibrinolytic medications used for? A. To speed up the process of fibrinolysis B. To supplement clotting factors C. To be used so hemophiliacs may play sports D. To slow down the process of fibrinolysis

a, c,e

What are physical findings of ITP (Select all that apply) A. Petechia B. Diarrhea C. Bleeding from GI & urinary tract D. Blurry vision E. Gingival bleeding

b,c,d

What are some causes of Vitamin B12 Deficiency? (SATA) a. Paleo diet b. Alcoholism c. Atrophic Gastritis d. Long-term antacid use e. Long-term use of NSAIDs

- Patients may not have symptoms of acute blood loss until after 500 mL is lost, except for vasovagal syncope. - Vital signs may reflect tachycardia and then hypotension. - Patients may experience shortness of breath, generalized weakness, dizziness or lightheadedness.

What physical assessments might you expect with you patient with blood loss?

Thyroid Stimulating Hormone (TSH)

When the level of thyroid hormones (T3 & T4) drops too low, the pituitary gland produces

1,2,5

Which lab values could be a possible sign of anemia? 1) Low rbc count 2) Low Hgb 3) Elevated Hct 4) Elevated A1c 5) Low Hct

B

Which of the following is not a clinical manifestation of hemophilia? a. Excessive bruising b. aPTT of 35 c. Hemarthrosis d. Spontaneous hematuria

c

Which of the following is not an example of acute blood loss? A. cutting a finger while cooking B. gunshot wound C. gastrointestinal bleed D. hematoma from surgery complications

Mastitis, abscess

You continue to breast feed with_____ but stop is there is a _____

Angina

______can occur when thyroid replacement is initiated as it enhances effects of cardiovascular catecholamine

rooting reflex

a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple lasts until 3-4 months

Megaloblastic Anemia

a blood disorder characterized by anemia in which the red blood cells are larger than normal

ductus arteriosus

a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta

circumoral cyanosis

a bluish discoloration around the mouth; normal first 24 hrs

friction rub

a coarse, grating, adventitious lung sound heard when the pleurae are inflamed

Prediabetes

a condition in which the blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes

Pudendal block

an anesthetic administered to block sensation around the lower vagina and perineum

Graves disease

an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos

Buerger's

an inflammatory occlusive vascular disease involving the medium-sized arteries and veins

10- 12 months

able to walk with help at

Disseminated Intravascular Coagulation (DIC)

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues

hypertensive disorders high gravidity abdominal trauma short umbilical cord cocaine use

abruptio placentae is r/t

hydrocephalus

accumulation of cerebrospinal fluid within the ventricles of the brain that does not drain properly from the cranium

Myxedema

accumulation of mucopolysaccharides in sc and interstitial tissues. Is the extreme form of hypothyroidism. Can progress to shock

retained placental fragments

after the first postpartum day, the most common cause of uterine atony is

pneumothorax

air in the pleural cavity

Cobalamin Deficiency

aka vitamin B12 Megaloblastic anemia • Intrinsic factor (IF) - Protein secreted by the parietal cells of the gastric mucosa • IF is required for cobalamin absorption in the small intestine

3

all teeth dev by

Addison's disease

also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesn't produce enough of certain hormones. you produce too little cortisol and, aldosterone and sex hormones.

left coronary artery= AV node

anterior coronary artery blood supply

18 months

anterior fontanel closed by

excessive uterine bleeding during the first hour after delivery - more than 1 saturated pad every 15 min excessive bleeding during the postpartum period - more than one saturated pad per hour hypovolemic shock hematomas developing in perineum bleeding from unrepaired laceration bleeding from uterine atony

assessment for postpartum hemorrhage

Inspection -barrel chest -cyanosis -tripod position -use of accessory muscles Percussion -Hyperresonant or dull if consolidation Auscultation -crackles -wheezes distant breath sounds

assessment of COPD inspection, percussion, auscultation

failure of fusion of the lip, palate, or both difficulty sucking and swallowing

assessment of cleft lip or palate

Inspection -tachypnea -use of accessory muscles Palpation -increased fremitus above effusion -absent fremitus over effusion Percussion -Dull Auscultation -decreased or absent over effusion -egophony above effusion

assessment of pleural effusion inspection, palpation, percussion, auscultation

Inspection -tachypnea -use of accessory muscles -duskiness or cyanosis Palpation -increased fremitus over affected area Percussion -dull over affected area Auscultation -early: bronchial sounds -Later: fine or coarse crackles, egophony, whispered pectoriloquy

assessment of pneumonia inspection, palpation, percussion, auscultation

Inspect gland Observe for goiter-enlargement of thyroid due generally to lack of iodine. (not common in US as we are BIG salt lovers) Check TSH, serum T3 and T4 Estrogens, Dilantin, Tagamet, Heparin, amiodarone, PTU,steroids and Lithium can cloud the accuracy T3 more accurate indicator of hyperthyroidism according to text

assessment of the thyroid

pain dyspnea n/v fatigue Diaphoresis, pallor, weakness syncope dysrhythmias

assessment with angina

renal failure COPD cardiac problems dyslipidemia diabetes steroids use estrogen use

associated physical problems with HTN

hydrocephalus neurogenic bladder, poor anal sphincter tone congenital dislocated hips club feet skin problems scoliosis

associated problems with spina bifida

Thalassemia minor

asymptomatic silent carrier of thalassemia

Coronary Artery Disease

atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle

• Price and Cost • Supply and Demand • Basis for price determination • Cost effectiveness • Efficient and equitable decisions are made about the allocation of resources. • Efficiency • Is determined by how resources are used. • Value

attributes of economics

nocturnal penile tumescence

avg male has 5 erections a night --> NPT is preserved if impotence is due to a psychogenic cause

peliv inflammatory disease

complication of untreated STDs, involves one or more of the pelvic structures can cause adhesions and eventually sterility

Type 1 DM

beta-cell destruction leading to absolute insulin deficiency

Bronchophony

the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue 99

Disorders of the CNS like head injury brain surgery tumors infections or medications like vincristine phenothiazines TCAs or thiazide diuretics

causes of SIADH

Andragogy

the study of teaching adults

-The body producing antibodies that target RBC -drugs -infections -trauma -idiopathic -DIC -HELLP syndrome -prosthetic heart values -cancer

causes of acquired hemolytic anemia

Nifedipine

calcium channel blocker; relaxes smooth muscles of uterus by blocking calcium

contraction intensity

can only be measure with an internal monitor after ROM acme- resting tone

40 -50 % increase in blood vol = have physiologic anemia do to blood dilution increase RBCs and WBCs Hgb decreases to 10 -14 superior venacava and arteries can get compressed when lying on bac = decreased BP ( supine hypotension)

cardiovascular changes that happen during birth

a petrolatum gauze dressing or a generous amount of petroleum may be applied with each diaper change for 1 to 2 days to prevent the diaper from adhering to the site

care after circumcision

• Prophylactic treatment for patients having - Removal or drainage of infected tissue - Renal dialysis - Ventriculoatrial shunts • Antibiotic administration - Monitor antibiotic serum levels - Subsequent blood cultures - Renal function monitored

care for endocarditis

newborn should remain on first breast 10 min, then switch to second breast and suckle until satisfied use warm water, no drying soap on nipples let nipples air dry for 15 mins 2-3 times daily

care of breasts and nipples r/t breastfeeding

gynecoid pelvis

categorized as a typical female pelvis (although only about half of all women have this type of pelvis); the rounded shape of the gynecoid inlet allows the fetus room to negotiate the dimensions of the bony passageway

imperforate anus Gi obstruction

cause of no stool first 24hrs after birth

patent ductus arteriosus (PDA)

cause of persistent mummer after birth

OP

causes back labor

problems of the hypothalamic pituitary system tresticular disorders= 50 % of the time problems of the ejaculatory system infection ( mumps, STIs, bacterial infections) congenital anomales drugs radiation substance use

causes for male infertility

withdrawal of steroids stressful event

causes of Addison's crisis

Can occur secondary to brain tumors, head trauma, infections of the CNS, and surgical ablation or radiation Nephrogenic DI—relates to failure of the renal tubules to respond to ADH. Can be related to hypokalemia, hypercalcemia and to medications (lithium demeocycline

causes of DI

SEPSIS cancers transfusion of mismatched blood abruptio placentae amniotic fluid embolism HELLP syndrome septic abortion extensive burns heatstroke

causes of DIC

undiagnosed diabetes inadequate tx of existing diabetes insulin not taken as prescribed malfunction of insulin pump infection

causes of DKA

bronchoscopy

the visual examination of the bronchi using a bronchoscope

Autonomic neuropathy

damage to nerves supplying the internal body structures that regulate functions such as blood pressure, heart rate, bowel and bladder emptying, and digestion

vaginal bleeding facial edema extreme wt gain or loss pounding headache abdominal/ epigastric pain chills and fever painful urination change of frequency or strength of fetal movement

danger signs of pregnancy

primary hypertension

denotes high blood pressure from an unidentified cause; also called essential hypertension

magnet organization

designates organizations worldwide where nursing leaders successfully align their nursing strategic goals to improve the organization's patient outcomes. provides a roadmap to nursing excellence, which benefits the whole of an organization. means education and development through every career stage, which leads to greater autonomy at the bedside.

- *Labs: Low levels of factor VIII or IX, prolonged PTT - *Normal: platelet count, PT, and fibrinogen

diagnosis for hemophilia

Assessment and Diagnostic Findings Overnight dexamethasone suppression test

diagnosis of Cushing disease

ABGs O2 electrolytes ECG Chest x-ray echocardiography CT scan MRI cardiac catherization

diagnostic for cor pulmonale

- Hx and physical exam of both partners - review of menstrual and gynecologic Hx -STDs -Hormone levels . FSH, LH, prolactin . urinary LH - Pap test and HPV test - ovulatory study -tubal patency study - pelvic ultrasound

diagnostic studies for female infertility

TB skin test Chest X-ray sputum smear and culture

diagnostics for TB

ECG Exercise stress test stress echocardiogram coronary angiogram cardiac catheterization

diagnostics for angina

race and ethnicity socioeconomic geographical regions

disparities that lead to inability for healthcare services

antibiotics. antidepressants. anti-seizure drugs. blood thinners. heart rhythm drugs. nonsteroidal anti-inflammatory drugs (NSAIDs) sedatives.

drugs that cause petechia

Nonmaleficence

duty to do no harm

restlessness lethargy tachypnea dyspnea on exertion tachycardia mild hypertension dysrhythmias diaphoresis decreased urine output unexplained fatigue

early signs of inadequate oxygenation

Somogyi effect

early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes

● avoid iron supplements ● encourage hydration therapy ● side effects of myelosuppressive drugs ● healthy and proper diet ● exercise especially leg exercises to prevent DVT

education for polycythemia

fidelity

faithfulness; loyalty

LMP

first day of last menstrual period

physiological, safety, love/belonging, esteem, self-actualization

list parts of Maslow's hierarchy of needs

perineal infection endometritis DVT UTI pyelonephritis mastitis

list puerperal infections

structure organizational environment • Is the formal rules and policies that govern organizational practices. • Is necessary for the integration of diverse functions and activities across the organization

minor attributes of healthcare organizations

petchia

minute, pinpoint hemorrhage under the skin

upper esophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea

most common TEF

variability

most important indicator of fetal well - being means baby has automatic neuro system and adequate oxygenation with good variability (moderate 10 -15 bpm- jagged appearance)

kids, elderly, disabled

must report what types of abuse

folic acid

need to prevent tubule defects; take before pregnant

BNP (brain natriuretic peptide)

peptide that causes natriuresis. High in HF.

infection, dislodged placenta, hemorrhage

risks with PUBS

wet lungs

signs of left sided heart failure

veracity

truthfulness

key to open cells to allow nutrients in

what is the biggest thing insulin does


Kaugnay na mga set ng pag-aaral

Corporate Finance Midterm Review

View Set

Chapter 14 overview of shock and sepsis

View Set

Psych notes - correct answers ch1-9

View Set

สูตรคูณแม่8, สูตรคูณแม่ 7, สูตรคูณแม่ 3

View Set