Nurse 122 Final Exam

Preop Teaching / Education

-Pt satisfaction → decrease fear, anxiety, and stress. -Reduce post op complications. -Decrease length of stay / hospital recovery time. -Usually done w/ Dr + reinforced day of surgery. -Use of simple language. -Discharge teaching → verbal + written -Deep breathing, coughing -Danger signs → when to come back -Pain management -Make sure they understand / can demonstrate back. -NPO, may drink liquids up to 2 hours before surgery.

HIPPA + Confidentiality

-Protects the privacy and security of patients' health information. -If discussing pt info make sure it is with a member of the healthcare team in a proper setting. -Nurses must be aware of HIPPA to protect patient info. -Respect and support patients in exercising their privacy rights and provide information about how their health information is used and disclosed. -Patients will have access to their own healthcare. -Nurses must get proper authorization to share health info.

APGAR

-Appearance, pulse, grimace, activity, respiration -Done at 1 min and 5 min after birth-need 8-10 normal score 1 point -cyanosis on feet -<100 pulse -grimace or weak cry when stimulated -some flexion -slow, irregular breathing Neonatal Resuscitation -suction first!! -give O2 -stimulate by rubbing or flicking feet or rubbing baby all over w/ towel.

Safety with Newborns

-Car seat use -Safe sleeping -Feed & changing -Clothing -bathing -cord care -Immunizations

HELLP syndrome (preeclampsia complication)

-Hemolysis = RBC's become damaged after passing through small, damaged blood vessels. -Elevated -Liver enzymes = (x2 normal levels) -Low -Platelets = <150,000 S&S -N&V -epigastric pain

Jaundice Types

-Hyperbilirubinemia → too much bile in blood, causes jaundice. Physiologic -After first 24 hrs -too many RBC's → polycythemia -breast-feeding → gets rid of jaundice quicker b/c babies will poo the bilirubin out. -cephalohematoma Pathologic -within first 24 hours -ABO compatibility factors, blood issues. -Rh+, not given rhogam Interventions -phototherapy, blankets, bili lights -skin care → monitor temp and reposition every 2 hours -dehydration risk so give fluids -eye care, cover infants eyes w/ protective pads

Placenta Previa

-Occurs when the placenta abnormally implants in the lower segment of the uterus, near or over the cervical opening instead of attaching to the fundus. -The abnormal implantation results in bleeding during the third trimester of pregnancy, as cervix begins to dilate, and efface. · Causes = Scar tissue, hx of C-section, abortion, uterine surgery, multiparity (twins). Age 35+ , smoking. · S&S = Painless vaginal bleeding, bright red,↓ H&H · Interventions = Anticipate blood transfusion, pad counts (measure blood), C-Section, Betamethasone (med for preemie lungs to develop) , NO vaginal digital exams. (Why? Because we can hemorrhage if we poke it.)

Vaccines in Pregnancy

Alive vaccines →BIG NO NO Include → Alive virus → Mumps, measles, varicella/chicken pox, nasal spray flu. Dead Vaccines → OK in Pregnancy→ Dead virus → IM injection flu, Tdap, hepatitis

Nitroglycerine

-Sublingual or patch -If you give nitro sublingual → get ECG -Stop what you are doing and sit down when you take it. -Remove @ bed time so you don't develop tolerance. -Can place patch place is closer to ♥ for better effect or farther so you can avoid headaches since it is vasodilating. -Check BP trends b/c of vasodilation -3 dose max, 5 min apart -Side effects → headache, fainting, dizziness, lightheadedness, nausea. -Contraindications → orthostatic BP, ED → Erectile dysfunction meds

Sick day rules diabetics

-Take insulin, and medication as usual. -Check Blood sugar and ketones Q3-4 hrs. -Report elevated glucose levels as specified or urine ketones to PCP. -Take supplemental doses of regular insulin Q 3-4 hrs (if needed/ you take insulin) -Substitute soft foods → 6-8 times a day if you can't follow normal meal plan. -Take liquids every 1/2 - 1 hour to prevent dehydration + provide calories if V/D persists. -Report N/V/D to PCP b/c fluid loss can be dangerous. -If unable to retain oral fluids, may require hospitalization to avoid DKA & and possible coma.

Family Types

-Traditional → Two parents + kids. -Extended → includes other relatives like uncles, grandma, aunts. -Non traditional → one parent, kids raising kids

Nurses and Development

-What can we do that can lead to max functional level of independence? -Identify problems related to growth/development. -Screening children early. -Recognize deviations from normal by using milestones. -Make collaborative interventions + referrals to supportive resources. -Make care plans based on infant + family needs. -Watch the interrelationship w/ growth, differentiation, maturation. -Promote development through play, promote early learning, promote language development, promote safety.

Life Cycle theory

-Who is central person in cycle of life. -Are there stressors affecting the family dynamics? Can they move to next stage? Single Adult , New Couple, Couple w/ children, Couple with teens, Launching children, family later in life

Signs of Sepsis → Worst Infection phase

-tachycardia → ♥ compensating for ↓ BP. - ↓ BP → leaking fluid in tissues. - ↓ urine output → organ failure sign. Monitor -Vitals -WBC's -Lactate levels -I's + O's

Anemia Goals

-↓ Fatigue -Nutrition -Adequate Tissue Perfusion -Compliance with meds

5 T's of PPH

1. Tone ➝ bleeding, boggy uterus -uterine atony, distended bladder -#1 cause of PP hemorrhage. 2. Tissue ➝ pieces of tissue falling off, large clots -retained placenta and clots; uterine subinvolution 3. Trauma ➝ can't urinate, visible laceration, trickling of blood after fundal massage. -lacerations, hematoma, inversion, rupture 4. Thrombin ➝failure to clot, INR / PTT abnormal labs - coagulopathy (preexisting or acquired) 5. Traction ➝ can't locate / palpitate fundus , prolapsed uterus -traction = pulling on cord / weak uterine muscles -placenta pulls uterus in on itself ➝ uterine inversion (Relax with terbutaline/mag sulfate.)

Nursing Process + Next Gen terminology

A → Assessment → Recognizing cues D → Diagnosis → Prioritizing hypothesis + analyzing cues P → Planning → Generating Solutions I → Implementation → Taking action E → Evaluation → Reflection

Placental Abruption

Abruptio placenta = Placenta prematurely detaches from uterine wall while baby is inside. · Partial detachment, complete, or concealed. · Fetus can suffer hypoxia because it has no means of getting O2 or nutrients. · Causes = Trauma, hypertension, stimulants (cocaine/smoking), hx of previous abruption. · S&S = Dark red vaginal bleeding, severe continuous abdominal pain, rigid + tender uterus, ↓ H&H, hypovolemic shock. For baby = abnormal fetal HR, uterine tachysystole. · Interventions = C section, external fetal monitoring, IV access to draw blood, monitor S&S of hypovolemic shock. (pallor, tachycardia, hypotension).

Nutrition

Asses → physical exam (hair, nails skin), BMI -Underweight ↓ 18.5 ↔ Overweight ↑25 -30 + → extreme obesity -18.5 to 24.9 is a healthy weight Interventions → TPN , more/less of certain foods depending on dx, add vitamins + supplements, food pyramid teaching. Expected outcomes → labs good, no deficits of hyper/hypo

Preoperative Assessment

Assess -Risk factors of surgery -Pt safety -Baseline data → VS, respiratory/cardiac status. -Review labs -Cultural/ethnic considerations -All consents are taken care of. -Review pt understanding. -Site of procedure that will be operated on.

Sleep

Assess -Hx physical exam → obesity, enlarged tonsils, or nasal congestion? -Meds -Sleep study habits -Stimulants -Diet S&S -Difficulty falling asleep -Insomnia -Frequent awakenings -Restless legs -Snoring -Apnea -Excessive daytime sleepiness. Interventions -Medications → Melatonin -Comfort measures → Lavender, white noise, blackout curtains. Expected outcomes → Better rest and no effect on ADL's.

Communication

Assess -Verbal communication →Speaking, phone calls, writing. -Nonverbal communication → Facial expressions, body language, eye contact, gestures. -Effective → Active listening, open ended questions, empathy, cultural respect, finding common ground, understanding one another, getting interpreter if needed. -Noneffective → Asking yes/no questions, assuming, bad body language, rolling eyes, monotone or careless voice. Interventions → No judgment, listening to patient, asking open ended questions, using effective communication. Expected outcomes → better communication with pt/ pt family, decreased stress and anxiety, understanding of education nurse gives.

Pain

Assess → PQRST, objective vs subjective data. -Objective → Measurable data → vital signs, labs, physical assessments. -Subjective → Unmeasurable data → experiences, feelings, symptoms. Interventions → Analgesics, NSAIDs, Opiods + education (constipation) , distraction/comfort measures if nonpharmacological. Expected outcomes → decreased pain and happier or calmer pt.

Tissue Integrity

Assess → Physical exam, cap refill, ulcers, rashes, healing, pulses, cap refill, turgor, pressure ulcer stages. Interventions → Creams, lotions, antibiotics, dressings, wound vac, turn q2, cultures. Expected outcomes → after tx, better skin function, warm + dry, healing improved, pulse and cap refill normal.

Assessment of Mom in Labor

Assessment -VS -Pain (pudendal nerve can be damaged or inflamed, pain on genitalia and anus) -Vag exam -Rupture of membranes -Contractions -Leopold's maneuver -Labor risk assessment →C-Section hx, GDM, HTN, AMA, Risk Factors 5 P's -Passenger → baby breeched -Pathway → uterine rupture -Position → mom is in supine and putting pressure on superior vena cava -Psyche → not emotionally ready, fear, anxiety, pain -Powers → problems w/ inconsistent contractions, too intense

BPH TURP Prostate Cancer

BPH = Benign Prostate Hyperplasia -lots of tissue -swelling in tissue and prostate -difficulty voiding -might need TURP → (transurethral resection of prostate) , going through urethra to prostate, helps pt void. → like plunger. -men 50+ usually have prostate issues -bilateral growth → both sides Prostate Cancer S&S -unilateral growth → one side

BPP → Biophysical Profile

BPP= (bio physical profile) measures the health of your baby during your pregnancy. -Real time ultrasound and NST to allow assessment of various parameters of fetal well-being that are sensitive to hypoxia. What does it check? -FHR -Muscle tone -Regular fetal movement -Breathing + swallowing -Amount of amniotic fluid around your baby -Non stress test → check w/ high risk pregnancy or if passed due date.

HIV in Pregnancy + PP

Can it cross placenta? → Yes if the mom is not actively taking her anti-virals. Can also pass in breast milk. -Anti virals helps to suppress the replication of the virus in the mother's body, reducing the amount of virus in her blood. -Want to plan C-section to reduce risk of transmission. Post partum, how does it affect baby? → Can progress to AIDS, neurological complications, suspectable to infection, chronic illnesses, and growth + developmental delays.

Inflammation is precursor to

Cancer

Hypercalcemia ( ↑ Ca+) -Function → Ca+ (Calcium)= Keep strong → Blood (clotting), bones, beats ❤

Causes → Gain of Ca+ -Hyperparathyroidism -Malignant disease → cancers -Vitamin D excess -Overuse of Ca+ -↓ PO -Prolonged bed rest Labs -↑ Electrolyte panel Ca+ -↑ PTH level S&S -♥ → HTN, bradycardia, arrhythmias -Neuromuscular → Muscle weakness, ↓ DTR's, lethargic, coma. -GI/ other→ Constipation, N/V, polyuria, polydipsia, bone pain, fractures, hypercalcemic crisis. Interventions Meds→ 0.9 NS, IV phosphate, calcitonin. -Chemotherapy -Radiation -Monitor → ♥, neuro, safety, pt taking digoxin. -Encourage hydration & ambulation. -Monitor Ca+ & PO levels. Diet -Avoid Ca+

Hyperkalemia ( ↑ K+) -Function → K+ (Pottassium) = ♥ + muscle contraction. Maintains fluid balance + BP.

Causes → Gain of K+ -Medications →ACE, NSAIDs, K+ sparing diuretics → Spironolactone. -Renal dx -Addison's dx -Acidosis -Burns Labs -↑ Electrolyte panel K+ S&S -♥ → Peaked T-waves, arrhythmias, ♥ arrest. -Neuromuscular → Tingling, burning, numbness, muscle weakness, paralysis. -GI/Other → Cramping, hyperactive bowel sounds, diarrhea. Interventions -K+ restriction. -Dialysis -Medications → K+ wasting diuretics, D50, IV Na+ Bicarbonate, IV Ca+ gluconate, insulins. -Monitor ♥ & renal status. -Educate on restricting in diet. -I's + O's -Daily weights. Diet -Avoid K+

Hypermagnesemia (↑ Mg) -Function → Mag (Magnesium) = Keep order in muscles + nerve function→ ❤ , DTR, and uterine. Required for Ca + Vitamin D absorption.

Causes → Gain of Mg -Overuse of mag → antacids + laxatives -Renal injury -DKA Labs -↑ Electrolyte panel Mg -Heart block -Peaked T waves S&S -♥ → Hypotension, bradycardia, cardiac arrest. -Neuro → Muscle weakness, ↓ DTR's, drowsiness, coma. RR → Respiratory depression. Interventions Monitor → ♥, nuero, renal, safety -I's + O's -Ca+ , K+ , Mg levels -Mg restriction -Fluids → 0.9 NS/LR, IV Ca+ Gluconate -Meds → Diuretics -Dialysis Diet -Avoid Mg in diet, antacids, and laxatives.

Hypernatremia (↑ Na +) -Function → Na+ (Sodium) = Maintain BV + fluid balance

Causes → Gain of Na+ -Dehydration -Increase Na+ intake -Aldosterone overload -DM -Heatstroke -Burns -Diaphoresis Labs -↑ Electrolyte panel Na+ -↑ Urine Specific Gravity -↑ Osmolity S&S -Mental status → Confused, agitated. -Skin/Other → Flushed, dry mucosa, edema (may be present), thirst, fever. -GU → △'s in urine output. Interventions -Na+ restriction. -Fluids / meds → Hypotonic/isotonic solutions, diuretics -I's + O's -Daily weights -Safety precautions -Monitor labs + vitals → temp Diet -Avoid Na+ foods

Hypocalcemia (↓ Ca+) -Function → Ca+ (Calcium)= Keep strong → Blood (clotting), bones, beats ❤

Causes → Loss of Ca+ -Hypoparathyroidism -Pancreatitis -Vitamin D deficiency -Malabsorption -↑ pH → basic -Low Mg Labs -↓ Electrolyte panel Ca+ -Prolonged clotting time -Prolonged QT/ST S&S -♥ → ↓ BP, tachycardia, bleeding, v-tach. -Nueromuscular→Numbness, tingling, muscle spasms, (+) Chvostek/Trosseu's sign, ↑ DTR's, confusion, severe seizures. -GI→ hyperactive bowel sounds, diarrhea -RR → dyspnea Interventions -Ca+ replacement oral + IV -Vitamin D -Mg -Monitor → ♥, RR, neruomuscular, GI -Monitor pt taking digoxin. -Dilute IV Ca+ & give slowly. Diet -Dairy products -Green leafy veggies -Sardines -Salmon -Tofu

Hypokalemia (↓ K+) -Function → K+ (Pottassium) = ♥ + muscle contraction. Maintains fluid balance + BP.

Causes → Loss of K+ -Meds → K+ sparing diuretics →Hydrocholrothiazide & Furosemide. -GI loss → NG suction -Alkalosis -Low Mg -Digoxin toxicity Labs -↓ Electrolyte panel K+ -↓ Urine K+ S&S -♥ → BP ↓, flattened T-waves, arrhythmias, cardiac arrest. -Musculoskeletal → Muscle weakness, fatigue, respiratory arrest. -GI/ Other → Anorexia, N/V, ↓ bowel sounds/ (ileus). Interventions -K+ Replacement oral/IV. → give slow in IV drip or can cause death. NEVER IVBP or PUSH. -NEVER infuse faster than 10 mEq/hr -Put on telemetry b/c arrythmias. -K replacement diet -Monitor ♥, respiratory, lungs, renal, GI. -Monitor pt taking digoxin Diet -Banana -Oranges -Spinach -Potato

Hypomagnesemia (↓ Mg) -Function → Mag (Magnesium) = Keep order in muscles + nerve function → ❤ , DTR, and uterine. Required for Ca + Vitamin D absorption.

Causes → Loss of Mg -Chronic alcoholism -GI loss -Renal loss -Malabsorption -Medications → gentamicin, cisplatin, cyclosporine, chronic laxative use. -Hyperparathyroidism Labs -↓ Electrolyte panel Mg -↓ Ca+ & K+ -Flat T-waves -Short ST segment S&S -♥ → ↑ BP, tachycardia, torsade's de points → life-threatening arrhythmia. -Neuro → ↑ DTR's, (+) Chvostek & Trosseau sign, agitation, confusion, seizures. -GI/Other → Anorexia, N/V, dysphagia. Interventions -Mag replacement supplements + IV & diet. -Monitor → ♥, nueromuscular, RR, renal staus, pt taking digoxin. -Monitor Mg, K+, Ca+ -Educate on sources for diet. Diet -Green leafy veggies -Legumes -Nuts -Whole grains

Hyponatremia (↓ Na+ ) -Function →Na+ (Sodium) = Maintain BV + fluid balance

Causes → Loss of Na+ -Diuretics -GI fluid loss → V/D -Renal disease -Adrenal insufficiency -Hypotonic solution overload →salt goes bye -Extra H2O supplements -SIADH → Antidiuretic hormone insufficiency -Meds associated w/ water retention -Hyperglycemia -Heart Failure -No Na+ in diet Labs - ↓ Electrolyte panel Na+ -↓ Urine specific gravity -↓ Osmolity S&S -Mental Status → HA, lethargy, confused, stupor (ALOC's), seizures, coma. -GI → Abdominal cramps, N/V -Other → Orthostatic BP, muscle weakness, shallow breathing (late). Interventions -Water restriction -Encourage/Educate Na+ intake in moderation. -Monitor I's + O's -Daily weights -Give Na+ PO/IV → Hypertonic Solution -Safety precautions -Monitor pt taking lithium -Monitor neuro, GI, renal, vitals, and safety. Diet -Salty foods in moderation -Canned foods -Salty crackers -Lunch meat

Respiratory Distress Infants

Causes/Risks -↓ surfactant production -genetic problems w/ lung development -higher incidence <28 weeks -diabetic mother -C-section -delivery complications that ↓ blood flow to baby → placenta detachment / problems, cord compression, placental problems, DM, HTN S/Sx -apnea -cyanosis -retracting/grunting/nasal flaring -tachypnea (fast breathing) -shallow RR -↓ urine output → baby body focused on vital organs for survival. Interventions -Supportive care - close monitoring -Respiratory modalities -ventilation (CPAP, PEEP) -exogenous surfactant -oxygen therapy -Antibiotics for positive cultures -correction of metabolic acidosis -Fluids and vasopressors; gavage or IV feedings -Blood glucose level monitoring -Clustering of care; -Prone or side-lying position -Parental support and education -Handle the newborn as little as possible, because stimulation often increases the oxygen requirement

HTN in Pregnancy

Chronic HTN -Before 6 weeks pregnant -no protein -140/90 -can turn into gestational HTN or Preeclampsia Superimposed (there 2+-3+ protein) Gestational HTN -6-20 weeks -no protein - ^ 20mmHg Preeclampsia superimposed → leads to eeclampsia -comes from chronic HTN → unless regular preeclamppsia -20-40 weeks pregnant - 2+-3+ protein in urine -140/90 -2 separate readings, 4 hours apart. Eclampsia -which is a more serious form of preeclampsia, is characterized by convulsions (seizures) - >160/110 -baby comes out c-section -Give mag sulfate What do nurses anticipate? -Safety precautions -Meds mag sulfate and calcium gluconate for antidote. -Talking in low, soft voice S&S -HTN , 140-90 , increase +20mmHg -proteinuria -peripheral edema = swelling in face/fingers -weight gain -epigastric pain (liver enzymes) -headache -blurry vision

Postop complications -Infection can happen in any of these systems

Circulatory → Cardiac #1 Priority, ABC's -P.E -Hypovolemic shock -Hypotension -HTN -Arrhythmias Respiratory → # 1 Priority ,ABC's -Hypoxia -Atelectasis -Pneumonia Integumentary -Dihessence -Evisceration GI/GU -Paralytic ileus -Urinary retention -Gastric dilation

♥ Classes

Class 1 = ordinary activity doesn't cause fatigue, dyspnea, or angina. Class 2 = slight limitation of physical activity, comfortable @ rest, ordinary activity results in fatigue, angina, dyspnea. Class 3 = marked limitation of physical activity, comfortable @ rest, less than ordinary activity angina, fatigue, dyspnea. Class 4 = inability to carry on with physical activity, symptoms of HF are seen @ rest. can't do any physical activity without discomfort.

DVT → Deep Vein Thrombosis

Complications -Pulmonary embolism Diagnostics -D-dimer → protein fragment produced when blood clot breaks down in body. → will be increased. -CBC -PT -PTT -INR -CRP -Factor V -Genetic studies -Duplex ultrasonography → vein is larger than normal & thrombus inconcompressible. S&S -C → Calf pain & cramping -O → One sided "unilateral" edema -W → Warm, red leg Interventions -Prevent → CALF, -Monitor → labs, S&S -Assess → Bleeding risk & management -Tx → Pain, anxiety, medications.

Reasons to go to NICU

Delivery Factors → What happened @ birth? -born before 37 6/7 weeks (preterm) -SGA → low birth weight → >5.5 lbs -has health condition that needs special care -heart, breathing, infections, STI's, birth defects, drug babies, seizure, hypoglycemia, extra O2 needed, IV therapy -post term babies -resuscitation of baby -breeched -fetal distress → cord compression -forceps or C-section injury -umbilical cord wrapped Maternal factors → What was wrong w/ mom? -apruption -AMA 35+, YMA >16 -drug/alcohol use -HTN -DM -STI's -Multiple gestation -↑↓ amniotic fluid

Pneumonia Education + Meds

Education -Drink lots of fluids & maintain good nutrition for healing. -Prevent dx by coughing, deep breathing, ambulating early, using IS. -How to use incentive spirometer → Take a deep breath and inhale, hold breath and get it to the blue line. Practice 10X an hour. -Health promotion by smoking cessation, washing hands, vaccines, avoid sick people. -Avoid antitussives b/c want to cough secretions. -Cough into tissue and let nurse assess sputum, then throw in nearby trashcan. Meds -Antibiotics → Finish whole course or infection will come back & possibly be stronger. -Analgesics → pain & fever -Steroids → reduce swelling but can ↓ activity of immune system.

Pulmonary Embolism → Education & Meds

Education -Explain dx, risk factors, meds -How to prevent DVT / PE→ CALF C → Calf exercises A → Ambulate early & frequently. Avoid smoking. Avoid sitting for too long. Avoid crossing legs. L → Leg compression w/ TED hose or SCD's. F → Increase fluids (2-3 L per day) -Call for medical assistance Meds -Antiplatelet→ stop platelet aggregation → Asprin, Clopidogrel, Heparin (Lovenox). -Anticoagulant → prevent clots from forming (clotting factors) → Warfarin, Apixaban -Thrombolytics → breaks down clots → TPA/Activase

Pancreatitis Education + Meds

Education -Pancreas is involved in the regulation of calcium balance. When inflamed, will be low (hypocalcemia). -Calcium sources in food → dairy, fish, nuts, seeds, leafy greens. -When pancreas is inflamed, can cause hypoglycemia b/c its ability to produce insulin is affected. -How / when to check BS. -What NG tube is used for → alleviates symptoms by reducing gastric acid secretions, distension, minimizing risk of aspiration. Meds -PPI's -H2 receptor antagonist -Opioids (acute) -Insulin -Pancreatic enzymes (chronic)

DVT → Education + Meds

Education -S&S → COW -Tx if you already have DVT D → Don't walk / massage legs! V → Venous return, elevate legs above ♥ T → NO TOUCH LEGS, only rest!! -How to prevent DVT → CALF C → Calf exercises A → Ambulate early & frequently. Avoid smoking. Avoid sitting for too long. Avoid crossing legs. L → Leg compression w/ TED hose or SCD's. F → Increase fluids (2-3 L per day) -Bleeding risk after surgery / meds → soft toothbrush, apply pressure to cuts, call Dr. if can't stop bleeding. -Antidote for Warfarin = Vitamin K -Antidote for Heparin= Protamine sulfate -Heparin acts quickly, but Warfarin takes time to be effective, which is why a patient can be on both at the same time. Meds -Antiplatelet→ stop platelet aggregation → Asprin, Clopidogrel, Heparin (Lovenox). -Anticoagulant → prevent clots from forming (clotting factors) → Warfarin, Apixaban -Thrombolytics → breaks down clots → TPA/Activase

Newborn Assessment

Head = feel for suture lines, shape, any puffiness on crown. Face = symmetry, top of ear where it is connected at or above line from other of eye. Rooting reflex = put finger on mouth and baby turns head to the side. Suck reflex = check palate with pink finger for solidity or gaps. Clavicles + upper arms = check for breakage Lung sounds = bilaterally, HR, mummers Abdomen = sounds, check for cord (how many vessels?) drying, dried, crusts, no infection? Genitalia = -Females might be swollen, discharge, a bit of blood -Males, descended testicles, 2 present Back = count all vertebra (33) , no dimples on crevice of buttocks, Mongolian spots are normal Ortolani's maneuver = Flex the hips and knees to 90 degree, then apply an anterior pressure over the greater trochanter and gently adduct the leg with your thumbs. Feet = Babinski's reflex, draw 7 across toes to outside of toes to curl. Absent can indicate brain damage or spina bifida. Stepping reflex = pick baby up and let try to walk, will touch toes to surface.

Healthy VVS Dysfunctional Family

Healthy = A family that has communication, structure, works together. -Open communication , listening properly and receiving within conversation. Going both ways. -Assist and help one another, as needed. -Roles and responsibilities are flexible. In conjunction working together. -Respect for one another, respect for roles, responsibilities + boundaries. Dysfunctional = Families that have unstable family dynamic. -Violence (usually unreported) Spousal/child/sexual -Emotional abuse -Substance abuse -Neglect

Nagele's Rule

LMP → -3 months + 7 days LMP = June 7, 2023 March 14, 2024 EDD

Medications in Pregnancy

Mag Sulfate -Reason → Preterm labor, Relax uterine muscles + contractions, eclampsia seizures. -Contraindications → Excessive Mg levels, (Toxicity) ↓ RR (under 12), ↓ urine (30ml/hr) , ↓ BP/HR, absent or diminished reflexes. -Antidote is Calcium Gluconate Terbutaline -Reason → Preterm labor, prevent and slow contractions of the uterus. -Contraindications → Hypokalemia, ↓ K+ levels Oxytocin (Pitocin) -Reason → PP hemorrhage, Contracts the uterus for induction of labor, Uterine atony, enhancement of milk. -Contraindications →Fetal distress, placenta previa, placental abruption, umbilical cord prolapse, polyhydramnios. -When do we stop? → Contractions last longer than 90 seconds/ less than 2 minutes apart, and when FHR has late decels. Methergine (Methylergonovine) -Reason → PP hemorrhage, Controls bleeding from uterus by vasoconstricting, working on smooth muscle, assists on involution. -Involution → going back to normal (GOOD) -Subinvolution → not going back to normal -Contraindications →HTN, Preeclampsia, Eclampsia, CVI, Renal dx. Cytotec (Misoprostol) -Reason → increases uterine tone and decreases postpartum bleeding. -Contraindications →Only give PP, not during pregnancy or labor. Carboprost (Hemabate) -Reason → PP hemorrhage last resort, clots the blood (hemostasis) when uterine message + oxytocin are not working. -Contraindications → HTN, uterine scar tissue

CAD → Meds + Education

Meds → MOA / Adverse >Antihyperlipidemics → ↓ cholesterol → give @ night b/c cholesterol forms most @ night. -Statins → rhabdo & kidney failure, check liver function. -Niacin → diarrhea, fatigue, abd pain. -Bile acid sequestrants → abd pain, constipation >Angina pain -Nitroglycerine -O2 -Morphine → reduces → myocardial O2 consumption, BP / HR, anxiety and fear, pain >↓ ♥ workload -Beta blockers → bronchospasms, blood sugar masking, blood pressure lowering, bradycardia. >Vasodialators -ACE inhibitors → Angioedema, cough (dry), elevated K+ -ARB → Angioedema, elevated K+, lithium toxicity. -Opioid (morphine) give IV → RR depression >↓ Myocardial contraction -CCB → ↓ BP & ↓HR >Antiplatelet -Asprin → Bleeding risk, GI upset -Heparin → Bleeding risk, Antidote protamine sulfate >Anticoagulent -Warfarin → Bleeding risk , antidote vitamin K Education - ↓ fat, carb, sugar, salt diet. Encourage ↑ fiber, omega 3. -Replace clients diet with healthy oils. -Omega 3 foods → walnuts, tofu, tuna -Omega-3 fatty acids are helpful in reducing triglyceride levels. -Activity + exercise -Woman may feel fatigue as first S&S, as opposed to a man who might pain or SOB. -Dx, S&S, complications w/out adherance. -Smoking cessation -Medication → take statins @ night b/c cholesterol forms @ night.

Contraception Considering contraception? → What works best for pt? Need to get a full physical + and medical hx. Contraception Assessments: -Medical hx -Personal hx → how many sexual partners? Safe sex? -Ob/Gyn hx GTPAL → Gravida, term, preterm, abortion, living -Physical Exam -Diagnostic testing -Family hx

Natural Family Planning / Behavioral → Higher chance of getting pregnant because everybody is different (unless stick to abstinence). -Abstinence -Withdrawal of peepee -Calender rhythm method -Basal body temp Barrier Methods → Can protect against STI's, one-time usage except for active lesions of skin or muscous membranes like genital herpes. -Male condoms -Female condoms -Spermicide -Cervical cap -Copper IUD→ don't use if you have PID Hormonal → Highly effective if taken consistently, doesn't protect against STI's only against pregnancy. -Birth Control (wont work on abx), don't use if hx blood clots. -Plan B → can't use if already pregnant. -Transdermal contraceptive patch -Progestin IUD → don't use if you have PID Permanent → Doesn't protect against STI's is a surgery, most are nonreversible. -Vasectomy -Tubal ligation -Hysterectomy

Blood Glucose Levels

Normal Glucose levels -70-126 mg/dL Criteria for Dx -Plasma glucose >200 mg/dL -Fasting plasma glucose >126 mg/dL -Two hour post load glucose >200mg/dL during GTT test. -A1C >6.5 % Goal -keep BS under control <126 -Keep A1C <7

Pancreatitis

Pancreas function -Regulates blood sugar (insulin & glucagon) -Secretes pancreatic juice which breaks down all categories of food. -Produces digestive enzymes for fats, carbs, and proteins Pancreas Location → behind the stomach in the upper left abdomen Patho → Acute or Chronic -Inflammation of the pancreas. -Blocked or spillage of pancreatic enzymes → begins to destroy pancreatic cells → causing autodigestion + pain. Acuse Risks -Gallstones → When a gallstone obstructs the common bile duct, it can lead to inflammation of pancreas. -Trauma -Infection → mumps or viral hepatitis -Meds -High triglyceride levels Chronic Risks -Alcohol abuse -Smoking -Genetics -Obstruction → blockages, stones, cancers, tumors. -Autoimmune -Pancreatic Divisum → anatomical variation where the ducts of the pancreas do not join together properly. Diagnostics -Hx + physical exam -↑ Serum amylase + lipase -↑ Blood sugar -Ca+ levels → low -Triglycerides -Ultrasound -CT -Xray -ECRP -H&H -Stool test -BUN / creatine Complications -Pancreatic pseudocyst → fluid filled sac around pancreas -Abscess -Cancer -Hemorrhage -Hypotension - ↑ HR -DM -Kidney disease -Abdominal compartment syndrome -Pleural effusion -Pneumonia S&S -Cullen's sign → superficial edema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. -Severe abdominal pain → place client in semi fowler's (fetal position) -Abdominal distension -↑ Blood suagar levels -N/V -Fat in stool -Weight loss -Leukocytosis -Low grade fever Interventions / Education Assess → Nutrition + alcohol -Improve nutritional status → Ca+ supplements, TPN -Monitor BS levels. -Relieve pain/discomfort -Monitor fluid + electrolyte balance. → IV fluids -Monitor skin integrity. -Monitor for complications. -NPO or NG tube suction -Surgeries → dra

5 P's of Labor

Passenger= baby / fetal head and body size -Flexed arms and legs -Chin to chest -Rounded back Passageway = Birth Canal / maternal pelvis and soft tissues. -Station Power -Contractions to open up cervix. -Duration → beginning to end of one contraction. → how long did it last? -Frequency → beginning of one contraction to the beginning of the next contraction. → how often is it occuring? -Dilation @ 10cm fully open -Effacement 100% thin. Position = of whatever makes mom most comfy. -Squat can be easier, promotes fetal descent. Psychological response -Cultural considerations, personal birth plan -Coping mechanisms, how she deals w/ pain

Sickle Cell Anemia

Patho -Genetics → Inherited disease, mutation in genes. -Lack of O2 → causes cell to sickle. Can occlude/block blood supply = ischemia. Risk Factors / Causes -Mother + Father both carry genes. -African American S&S -Dehydrated, overexertion, elevated temp → Sickle cell crisis. Complications → Sickle Cell Crisis -Vasoocclusive → hypoxia + necrosis -Aplastic → Infection w/ HPV, stops bone marrow-producing RBC's. -Sequestration → Sickled cells are pooled in organs, mostly spleen. -Damage to the spleen increases the risk for infection -Acute chest syndrome → fever, high HR, increased RR, bilateral wheezes. Diagnostics -Sickle cell turbidity test -H&H -Electrophoresis -NB health screening test → heel stick -CBC Nursing Interventions → Monitor -Pain level -Hydration status + I's & O's -S&S of sickle cell crisis. -Labs -Assessments -Med / Tx Adherence -I's + O's -Tx effectiveness Prevent or tx Pain + Dehydration (causes pain) →Treatments -Pharmacological tx -Distraction therapy -Breathing techniques -Coping Mechanisms

PID →Pelvic Inflammatory Disease

Patho -comes from untreated chlamydia + gonorrhea. -bacteria grows in pelvis -risk for infertility -risk for ectopic pregnancies bc scarring potential in fallopian tubes Risk factors -unprotected sex -sex w/ multiple people -history of STI's -Recent pelvic surgery / abortion -Placement of IUD w/ in 3 weeks S&S -fever -pelvic pain -painful intercourse Assessment -hx or current STIs? -Pelvic exam -Blood and urine test -Culture

Complication of CAD → ACS (Acute Coronary Syndrome)

Patho -Atherosclerosis → plaque formation + thrombosis -Coronary artery blockage -MI → myocardial infarction -Myocardial ischemia -Rupture of an atherosclerotic plaque (a buildup of fatty deposits in the arteries) in the coronary arteries, leading to the formation of a blood clot that can partially or completely block blood flow. Types of ACS • Unstable Angina → chest pain that is sudden + often gets worse over short period of time. -Unrelieved pain @ rest -Warning signs for MI -More severe narrowing of coronary arteries, ↓ O2 to ♥. -No permanent damage. -O2 above 94%, Asprin, Nitro, Morphine. -Cardiac biomarkers normal. • NSTEMI → partial occlusion of coronary vessel, small clot! -No ST elevation, but slight MI -Develops myocardial (♥ muscle) damage & ischemia. -Elevated ♥ biomarkers → Troponin, CK, CK-MB -1st nursing intervention → make sure IV line is open for heparin and antiplatelet therapy • STEMI → Occlusion of coronary vessel, ischemic death, severe damage. -ST elevation + myocardial infarction -Radiation of pain → jaw, neck, shoulder, arm -Lightheadedness -Cold sweats -N/V -SOB -Need PCI → Percutaneous coronary intervention→ restores coronary perfusion. -Shit! Labs -ECG/EKG -Cardiac biomarkers -Stress test -Coronary angiography → dynamic x-ray pictures of your heart. Complications -CHF -Arrhythmias -Cardiogenic shock -Death Education Preventative measures → lifestyle modifications, med regiment, regular check ups. -Dx + S&S -When to call 911

DM type 1

Patho = Autoimmune → happens in childhood. -Pancreas metabolizing itself. -Beta cell destruction → damages insulin release→ insulin release impaired → 0 to little insulin secreted. Risk Factors (Causes) -Genetics -Viruses -Toxins -Autoimmune Diagnostics -A1C -Ketones -Fasting BS -Random BS -GTT → Glucose Tolerance Test -Electrolytes → K+ S&S -Thinner in stature -Hyperglycemia -Tingling + numbness in hands & feet -Slow healing -Dry skin -Recurrent infections -Weight loss -Muscle wasting Complications -Hypoglycemia -DKA→ Can be type 2 if pt has illness/stress →Shortage of insulin, resulting in hyperglycemia & and production of ketones. -Microvascular → nephropathy, retinopathy, neuropathy -Macrovascular → CAD, stroke, PAD Interventions -Assessment → Risk factors, S&S, labs, screenings (foot/eye) -Education → Cannot undo dx, proper insulin administration, how/when to take insulin, S&S, long-term complications, importance of nutrition + exercise, how/when to check BS.

DVT pathophysiology + risk factors

Patho → Blood clot that develops in deeper veins. usually in leg/knee/hip area. Virchow's Triad 3 factors (risk) → Venous Stasis = circulation is impaired. -Surgery -Immobilization -Traveling long hours -Varicose veins -Obstruction -Late pregnancy -Obesity -HF -A-fib → Endothelial damage -Trauma / injury -Indwelling devices → stents, valves, IV access -IV drug usage -Medications → Hypercoagulable state → Increased tendency of the blood to clot. -Genetics -Cancers -Hormonal contraceptives -Postpartum -Severe illness → sepsis -HIT → Heparin Induced Thrombocytopenia -All 3 = blood clot!

PE → Pulmonary Embolism

Patho → Blood clot that travels through the bloodstream and lands in lungs, blocking blood flow to lung tissue. Risks -DVT - 3 factors → Venous stasis, Endothilial damage, Hypercoagulable state. Complications -Cardiac arrest -Cardiac arrhythmias -Pleural effusion → fluid buildup in membrane around lungs. -Pulmonary HTN -Pulmonary infarction → Death in lung tissue -Death Diagnostics -D-Dimer -ABG's -PT -PTT -INR -CMP -CBC -Chest X-ray -CT - scan -Ventilation perfusion scan → shows circulation of air & blood in lungs, can detect PR, uses IV contract.

Respiratory Alkalosis

Patho → Carbonic acid deficit. -Hyperventilation "blows out" CO2, ↓ CO2 in lungs, having excess O2 retention. -↓ CO2 = ↑ O2 (lungs) Risk Factors (Causes) → Can reverse if you know the cause. -Hyperventilation -Extreme anxiety/fear → panic disorder -Hypoxemia → low O2 in blood -Salicylate / Asprin intoxication & toxicity -Gram (-) sepsis -Inappropriate ventilator settings → too much mechanical ventilation. Diagnostics -ABG's = PaCO2 is basic+ pH basic -↓ K+ -↓ Ca+ -↓ Phosphate -Toxicology screening S&S -Lightheadedness -Inability to concentrate → Cerebral artery vasoconstriction -↓ Cerebral blood flow -Numbness/tingling -Tinnitus -loss of consciousness -tachycardia / ventricular arrhythmias -Air hunger = ↑ RR -Chvastek / Trosseau's sign Interventions → treat underlying cause! -Educate pt about calming down techniques. -Breathing slowly → let CO2 accumulate -breathe into paper bag -Anti-anxiety agents -Monitor electrolytes → K+, Ca, Phosphate -Emotional support

Cellulitis

Patho → Deep inflammation of subcutaneous tissue, usually due to bacterial skin infection. Staph or strep that got in from a break in skin. -One extremity. Risks -Cracked, dry skin. -Wounds → cuts, ulcers, bites, puncture wounds -Poor hygiene -Tattoos -Chronic skin conditions → eczema, athlete's foot -Chickenpox -Shingles -CVI Diagnostics -CBC → WBC are elevated -Wound culture/ sensitivity → staph or strep -X-ray → swelling and density of skin -CT scan → show skin thickening Complications -Septicemia/sepsis → blood poisoning from bacteria. -Gangreen -Amputation -Infection can go to muscle, bone, or bloodstream. S&S -Tenderness -Pain -Redness -Warmth -Foul odor -Pustules with drainage → purulent -Fever -Chills -Fatigue -ALOC's Interventions -Collect wound cultures & sensitivity. → clean skin only, not pus. -Perform wound care, debridement, assess wound vac. -promote nutrition & hydration. -Apply moist heat for healing. -Elevate extremity -I's + O's Education -Teach how to do their own wound care. -S&S, complications -Nutrition and hydration -Take all antibiotics even if you feel better. -Report drainage to nurse. Meds -Antibiotics -Analgesics

CAD → Coronary Artery Disease

Patho → Develops from plaque accumulation (lipid build up) in arteries that breaks off Risks -Genetics → Fam Hx -Age → Male = >45, Female = >55 -Gender → Males first -Ethnicity → African -Menopause -Hyperlipidemia → ↑ cholesterol, blood has too many lipids. -HTN → Causes inflammation, injury to tissues, ↑ ♥ workload. -Obesity / Sedentary lifestyle -Tobacco / Opioid use → ↑ HR/BP/♥ workload -Depression -High stress Complications > ACS → Acute Coronary Syndrome → Rupture of an atherosclerotic plaque (a buildup of fatty deposits in the arteries) in the coronary arteries, leading to the formation of a blood clot that can partially or completely block blood flow. • Unstable Angina • NSTEMI • STEMI Diagnostics -Lipid Panels (will be elevated) -CRP → helps find inflammation -EKG → measures electrical signals in ♥ -Stress test → Evaluates ♥ function + blood flow. -♥ Catheterization → detects clogged arteries + irregular ♥ beats. S&S -SOB / fatigue / ↑ RR → Impaired perfusion, body wants O2 but plaque is blocking, so O2 demand is ↓ -Angina → less O2 to tissues causes chest pain. -tissue death = MI → ♥ attack. Interventions -Monitor S&S, MI, complications, and labs. -Administer proper medication regimen. -Collab with → Dietician, Pharmacy, Cardiologist

Hepatitis

Patho → Hepatocytes become targets for virus/toxins. -Viral hepatitis -Alcohol hepatitis -Drug induced hepatitis Dx -AST / ALT -Alkaline phosphate -Bilirubin -Coagulation studies -Serum proteins → Albumin -Liver biopsy → do early b/c liver can regenerate. -Ultrasound -Alcohol levels Assessment -Assess Risk Factors → living conditions, risky sexual behavior, IV drug use, meal prep, work, recent travels, meds, or alcohol use. -Assess urine, stool, and bowel habits. S&S Acute -N/V -Anorexia -Flu like symptoms → fatigue -Pruitis → itching -Gray stool → reduction in the amount of bile reaching the intestines. S&S Chronic -Jaundice -Edema -Palmar erythema → redness coloration of hands. -Spider angiomas → blood vessel lesions, look like spider webs. -Confusion -Asterixis → involuntary wrist movements. -Bruising -Bleeding

Right/Left Heart Failure share

Patho → Inability to pump blood adequately to meet O2 demand. -Systolic dysfunction → problem w/ contraction & emptying. (low ejection fraction) -Diastolic dysfunction → problem w/ relaxing & filling. (normal ejection fraction) Risk factors -CAD -African + Hispanic -Drugs/toxins -Smoking -Hyperthyroidism → ↑ metabolic demand -Obesity -MI -DM -HTN Labs -BNP → # 1 diagnostic -Lipid Panel -Echocardiogram -ECG -Chest x-ray -Liver → AST/ALT -Cardiac biomarkers Certain Complications -Arrhythmias -Pulmonary edema -Cardiogenic shock -Thromboembolism Interventions / Education -I's + O's -Daily weights -Low Na+ diet -Fluid restriction -Teach pt about dx -♥ rehab -PCI → stent -CABG -♥ transplant -pacemaker -Avoid giving IV bolus → ♥ can't handle fluid overload b/c fluid in bloodstream can make it harder for ♥ to pump. Meds >Diuretics -Removes extracellular fluid -K+ wasting/sparing -Check w/ digoxin toxicity >Vasodialators -ACE inhibitors → Angioedema, cough (dry), elevated K+ -ARB → Angioedema, elevated K+, lithium toxicity. >↓ ♥ workload -Beta blockers → bronchospasms, blood sugar masking, blood pressure lowering, bradycardia. -Digoxin -↑ Myocardial contraction -Watch for toxicity → halo yellow/green, low K+, N/V, ALOC's -Digoxin effects HR and BP -Antidote digi fab

Pneumonia

Patho → Infection in the lung tissue caused by microbes. -Person inhales, aspirates, or carries microbe by blood. -Acute lung infection of bronchioles, alveoli, or ducts. -Inflammation occurs and brings water into the lungs → pulmonary edema. Types -Community acquired -Hospital acquired -Aspiration → oral contents that are not supposed to be in lungs. (dysphagia or stomach contents from surgery) -Opportunistic -Viral (caused by flu) /fungal/bacterial (strep) -Necrotizing Risks -Immunosuppressants - ↓ LOC -Intubation -Older age -Immobility -IV drug abuse -Smoking Complications -Sepsis -Pleuritis -Pleural effusion → buildup of fluid between lung tissue -Atelectasis → collapsed lung -Pneumothorax → air outside lung -Acute respiratory failure Diagnostics -Sputum culture & sensitivity -CBC -ABG's -Chest X-ray -C reactive protein S&S -Breath sounds → Rhonchi, crackles, ↓ breath sounds, ↑ fremitus (vibration). -Cough -Dyspnea / tachypnea -Fever / chills -Pleuritic chest pain -Sputum -Fatigue -Older adults >65 → Confusion, ↓ LOC's, hypothermia. -More than >2 , ADMIT. CURB65 C → Confusion U → BUN >20 R → Respiration >30 B → Blood pressure → Systolic <90 & Diastolic <60 65 + Interventions -Monitor → Vitals, labs, cultures, S&S. -Assess→ Risk factors/causes for pneumonia, complications, airway patency, secretions. -Promote → Preventative practices, hydration, nutrition, and rest. -Collab → O2 therapy, Pharmacy, Dietician, Respiratory therapy, PT. - Tx in order→ O2, cultures, antibiotics, vaccine

Iron Deficiency Anemia

Patho → Lack of iron is inadequate for the synthesis of hemoglobin. Risk Factors / Causes -Inadequate diet -Pregnancy -Mensus -GI conditions/blood loss -Malabsorption issues → Celiac dx -Hemorrhage -Gastric bypass S&S -Pallor -Weakness -Fatigue -Glossitis → tongue to become inflamed. -Brittle/rigid nails -Angular chelitis → inflammatory skin condition -Microcytic RBC's -Pica -Tachycardia -Dyspnea Diagnostics -H&H ↓ -Fe+ serum ↓ -MCV (cell size) ↓ -TIBC (transferrin) ↑ Nursing Interventions → Monitor -Labs -S&S -Bleeding -Med / Tx Adherence -I's + O's -Tx effectiveness →Treatments -Oral iron supplementation + Vitamin C → helps absorb iron. -IV iron -Admin RBC's → blood loss only -Treat underlying condition causing the Fe+ deficiency. -Promote comfort -Stool softeners, fluids, or enemas for constipation. →Education -Sources of iron → red meats, dark leafy greens, tofu, liver. -Drink oj or vitamin C to help with absorption of Fe+. -Take meds 1 hour before eating. -Iron can stain your teeth → brush good. -Iron can make poop black/tarry/constipated.

Appendicitis Appendix Location → McBurney's point, RLQ, which is between the umbilicus and the anterior superior iliac spine.

Patho → Inflammation of the appendix due to obstruction. Can lead to infection. -Overgrowth of bacteria, edema occurs and possible perforation. (hole or rupture) Risks -Trauma -Blockage from stool (common) -Age 10-30 -Male -Fam hx Diagnostics -Hx + physical exam -CBC w/ differential -CT -X ray Complications -Perforation -Abscess -Gangreen -Peritonitis → inflammation/redness on lining of your belly or abdomen. -Septic shock S&S -Vital sign + lab △'s → ↑ HR, ↑ Temp (low grade fever) , ↑WBC's, ↓ BP. -Abdominal pain or distension → place client in semi fowler's (fetal position) -Rebound tenderness -Mc Burney's point → lower right quadrant pain from palpitating. -Loss of appetite -N/V -Constipation or diarrhea -Children are unable to hop. -Emergent!!! → Call doc → sudden stop of pain, no bowel sounds, can't handle pain. Interventions Preop -Prep pt for surgery. -Monitor → VS, perforation, peritonitis -Keep pt NPO -Relive discomfort/pain -No enemas / laxatives -IV fluids Interventions Postop -Monitor → VS, surgical site, drain, drainage, or NG tube. -Administer pain meds or antibiotics. -Assess → blood sugar, gas, last BM and stool characteristics. -Ambulate early -Use IS 10x hour. -Cough + deep breathe -Advance as tolerated diet -High fiber foods -Encourage hydration + nutrition.

Hyperglycemia

Patho → Insufficient insulin production/secretion. BS is higher than >126 mg/dL Risk Factors (Causes) -Sedentary lifestyle -Obesity -Hx DM -Stress -Illness -Dehydration -Missing dose of insulin/oral meds -Steroids Diagnostics -Ketones -BS >126 mg/dL -A1C >6.5% S&S -Polydipsia -Polyphagia -Poluria -Hot/dry skin -Fruity mouth -Numbness/tingling -vision changes -Dry mouth -Deep/rapid breaths → air hunger -Slow wound healing Complications → damage blood vessels -Microvascular → nephropathy, retinopathy, neuropathy -Macrovascular → CAD, stroke, PAD -DKA → Type 1 Complication -HHS → Type 2 Complication Interventions -Assessment → S&S, labs, risk factors, screenings. -Prevention→ Healthier lifestyle, exercise, diet, substitutes for sugar + stop smoking. -Education → Preventative measures, how/when to take BS, how to give insulin/what scale to use, take meds as prescribed.

Hypoglycemia

Patho → Insufficient nutritional intake. BS falls below <70 mg/dL Risk Factors (Causes) -↑ Exercise -Meds → insulins, beta-blockers (mask symptoms) , oral DM meds. -Skipping meals -Excessive Alcohol use -Children, elderly →population because lack of self-care ability. Diagnostics -A1C -Electrolyte levels → K+ -BS <70 mg/dL S&S -H → Headache -I → Irritability -W→ Weakness -A → Anxiety -S→ Shaky -S → Sweaty -H → Hunger -↑ HR -↓ K+ levels Complications -Diabetic Coma -Seizures -ALOC's Interventions -Assessment → S&S, Risk factors, labs, screenings. -Primary prevention → changing lifestyle for DM, diet + stop smoking. -Secondary Prevention → screenings -Educate →Danger signs, how to prevent, S&S, Avoid caffeine + alcohol, schedule meal times, carry candy, how/when check BS, wear DM ID band, eat before physical activity. -IV → dextrose (D50%) / infusion of glucose -Eat 15 grams of carbohydrates. Wait 15 minutes, then check blood glucose. →repeat if blood glucose still < 80 mg/dL. Follow with meal. (oj, soda, milk, 3 teaspoon granulated sugar)

DM type 2

Patho → Insulin is produced but the body cannot utilize it. Cellular resistance to insulin. Risk Factors (Causes) -Sedentary lifestyle -Obesity -Prediabetes Dx -Fam Hx ->30 age -High cholesterol Diagnostics -A1C -Ketones -Fasting BS -Random BS -GTT → Glucose Tolerance Test -Electrolytes → K+ S&S -Hyperglycemia -Tingling + numbness in hands & feet -Slow healing -Dry skin -Recurrent infections Complications -Hypoglycemia -HHS → BS levels are too high for too long → severe dehydration + confusion, life-threatening. -Microvascular → nephropathy, retinopathy, neuropathy -Macrovascular → CAD, stroke, PAD Interventions -Assessment → Risk factors, S&S, labs, screenings (foot/eye) -Education →Can change #'s to Dx, proper med administration, don't stop taking meds, S&S, long-term complications, importance of nutrition + exercise, how/when to check BS.

GERD

Patho → Issue with sphincter, gets lazy or overworked -Pushes backward on sphincter. -Regurgitation/reflex of stomach acid into the esophagus. -Reflux causes irritation and inflammation of the esophagus. Risks → What causes more pressure on the stomach? -Alcohol -Smoking -Fatty /spicy foods -Eating late at night -Caffeine → tea, coffee, chocolate -Drugs → anticholinergics, asthma, morphine, CCB, Asprin -H. pylori → infects stomach lining -Obesity -Hiatal hernia -Pregnancy -Delayed stomach emptying Diagnostics -Hx + physical exam -Upper GI X-ray -Endoscopy → examines for abnormalities. -Esophageal Manometry → measures pressure + function on esophagus. Complications -Esophageal stricture → becomes narrow, can cause dysphasia. -Barrett's esophagitis → tissue similar to intestine replaces tissue lining is esophagus → ↑ risk cause cancer. -Asthma -Chronic cough -Esophagitis -Ulcerations -Pulmonary complications -Dental erosions S&S -Pyrosis → ♥ burn -Indigestion -Chest pain -Hypersalivation -Lump in throat sensation -Sore throat Interventions / Education -Avoid factors that trigger symptoms. → spicy foods, fatty foods, eating at night, alcohol, smoking. -Elevate HOB >30 degrees -Sit up 2-3 hours after meals. -Small, frequent meals. -Low-fat diet + fiber, alkaline, non citrus, complex carbs, lean proteins. Meds -PPI → Omeprazole, Pantoprazole -H2 Antagonist Receptors → Famotidine, Ranitidine -Antacids → Aluminum hydroxide, Calcium carbonate (Alka-Seltzer, Tums), Magnesium hydroxide (Milk of Magnesia). Surgery -Laparoscopic fundoplication

Vitamin B-12 Deficiency Anemia → Also called Pernicious Anemia.

Patho → Lack of Intrinsic factor. Is needed to protect/ retain vitamin B-12 absorption. Risk Factors / Causes -Absence of intrinsic factor. -Malabsorption issues → Crohn's dx, Celiac dx. -↓ intake of vitamin B-12 -GI conditions → inflammatory bowel disease, pts w/ GI surgery, bariatric surgery, gastrectomy. -Meds → PPI's , metformin, histamine blockers, antacids. -Vegetarians S&S -Nausea -Diarrhea/Constipation -Bloating -Palpitations -Muscle weakness -Dysneapea -Neurological manifestations → ALOC's , paresthesia, trouble balancing, loss of position sense (proprioception). -Glossitis → tongue to become inflamed. Diagnostics -Vitamin B-12 level ↓ -RBC's ↓ -H&H ↓ -MCV ↑ (RBC's are large b/c lack of vitamins are unable to regulate size. They get too big and get destroyed.) -(+) Antibody test -Serum Bilirubin → Liver or B12 problem? -Upper endoscopy → atrophy of stomach lining? Nursing Interventions → Monitor -Labs -Neuro -Med / Tx Adherence -Tx effect

Left Sided HF

Patho → Pulmonary congestion Complications -Pulmonary edema -Pleural effusion → buildup of fluid in cavities (arthrocentesis but watch for pneumothorax.) -Left ventricular thrombus S&S -Low O2 -Cyanotic -Pallor -ALOC's -Cough -Blood tinged sputum -Tachycardia (↑ PR) -S3 sounds present -Orthopnea → SOB relieved by sitting/standing -Paroxysmal nocturnal dyspnea

Respiratory Acidosis

Patho → Retained CO2 / Impaired CO2 secretion -↑ CO2 = ↓ O2 (lungs) Risk Factors (Causes) → Can reverse if you know the cause. -Obesity -Sleep Apnea -Aspiration -Atelectasis (Lung pop) -Pneumothorax (Air outside lung) D = Drugs → Opioids / Sedatives = Respiratory Depression E = Edema (fluid in lungs) P = Pneumonia (excess mucous) R = Respiratory center of brain is damaged E = Emboli (pulmonary) S = Spasms (asthma) → swelling of airways S = Sac elasticity damage (COPD) Diagnostics -ABG's = PaCO2 is acidic + pH acidic -O2 stats -Chest X-ray -BMP S&S -SOB -Shallow RR -Wheezing -Anxiety -ALOC's -HA -Pale/Cyanotic -VS = ↑BP, ↑HR, ↓O2 Complications -Seizures -Respiratory Arrest -Coma -Death Interventions -Monitor S&S → ABC's, LOC's, electrolytes, ABG labs. -Med administration / Education about meds -Reposition → high fowlers -Encourage / Educate → deep breathing excercises -Suction secretions -Incentive spirometer → Help strengthen lungs + ↑ lung capacity. Meds -Bronchodilators (open airways) -Antibiotics (lung infections) -Thrombolytics / Anticoagulants (emboli) -Steroids -O2 -Anticholinergics (blocks spasms)

Right Sided HF

Patho → Systemic congestion Complications -Heptamegoly -Splenomegaly -Renal failure S&S -Dysnepea -Cough -Dependent edema -Weight gain -Peripheral edema/anasarca → swelling of whole body! -GI bloating -Ascites -Anorexia -Nausea -JVD (assess sitting up) -Fatigue/weakness

Metabolic Alkalosis

Patho → Too much bicarb & loss of H+ ions Risk Factors (Causes) -Severe vomiting -Gastric suction -Loss of stomach HCl -Loss of K+ (hypokalemia)→ Diuretic therapy -Diuretic therapy Diagnostics -ABG's → High bicarb + high blood pH -↓ K+ levels -Urine Chloride levels S&S -Tingling of fingers & toes -Dizziness -Cramping muscles → tetany -Lungs compensating → slowing RR Complications -Seizures -Decreased DTR Interventions -Monitor I's + O's -IV NS → restoring fluid volume -Give KCl for hypochloremia & hypokalemia -PPI administration → for HCl production -Carbonic anhydrase inhibitors → for Bicarb excretion

PAD → Peripheral Arterial Disease

Patho → What's going on w/ the arteries? →Problem pushing oxygen rich blood Away from the heart due to plaque build up. -O2 can't get to legs! = bad blood flow -WORSE PROBLEM → Ischemia (low oxygen) & - Necrosis (tissue death). Risks -Drugs # 1 risk factor → smoking -DM -HTN -Genetics -Males -Hyperlipidemia -Obesity Complications -Chronic rest pain -Ulceration → round, smooth, eschar, granulation, NO LEAKS -Gangreen → necrotic tissues -Delayed wound healing/infections -Amputations Diagnostics -Duplex Doppler imaging -Segmental BP's -Ankle-brachial index -Lipid panel -CRP → C reactive protein detects inflammation. -Blood glucose S&S -Intermittent claudication → calf pain caused by ↓ BF. -Paresthesia -Pulses → diminished / absent -Prolonged cap refill -Cool skin → complete arterial obstruction -Hairless or thin and shiny hair -Thick toe nails -Abdominal girth -Mottling of foot + lower leg → blotchy, red-purplish marbling of the skin Interventions -Skin care -Wound care -Pain control -Promote circulation by hanging legs -Assess pedal pulses -Check blood glucose -Stent, angioplasty. bypass grafts Education -Foot care → do every day, no sandals, trim nails. -Wear clean, loose, warm, soft socks. → Nothing tight! -Avoid cold weather / wearing anything tight → vasoconstriction. -Don't cross legs / ankles. -Walk to the point of pain, stop and take breaks, then continue. -S&S -Avoid tobacco use -Change lifestyle Meds -Cilostazol → IC pain, vasodilator, antiplatelt. -Antiplatelts → prevent platelet aggregation (aspirin + heparin) -ACE → vasodilation -Statins → IC pain, take statins @ night b/c cholesterol forms @ night.

CVI → Chronic Venous Insufficiency -Follows under the umbrella term of PVD

Patho → What's going on w/ the veins? → Problem Vacuuming deoxygenated blood back to the heart! Blood begins to pool in the legs. Risks -DVT / hx -Standing/sitting too long. -Obesity -Varicose veins -Pregnancy Complications -DVT -Osteomyelitis -Amputations (rare) -Venous ulcers Diagnostics -Duplex ultrasound -CT venogram -Segmental BP's -Ankle-brachial index -Lipid Panel -CBC -Blood glucose S&S V → Volumptious pulses & varicose veins E → Edema → pain I → Irregular shaped sores N → No sharp pain, is DULL. Y→ Yellow + brown ankles -Leathery skin -Skin conditions → eczema, cellulitis, pruritus, dry, itchy. -Ulcers are irregular shaped, leaking, shiny red, yellow slough, painful. -Normal cap refill/pulse Interventions -Elevate legs above ♥ -Assess skin / wounds for S&S of infection. -Apply moisture to cracked skin -Wound care / moist dressings -If legs are different sizes, get different size TED hose. -Chronic CVI → give antibiotics for cellulitis Education -Legs above ♥ → helps w/ venous blood return. -Don't cross legs / ankles -Skin care → lotions /creams -Avoid staying in one position for too long. -How /when to apply compression stockings. -Keep glucose regulated → bacteria loves sugar. - ↑ protein, zinc, vitamin C → wound healing Meds -Antibiotics for bacterial infections → not topical

Chronic Stable Angina

Patho → ♥ msucle does not recieve enough O2, causing pain. -Microvascular → problems with dilation -Prinzmetal → from substances -Occluded coronary stent. Risks -Physical exertion -Exposure to cold temps → vasoconstricting -Stress -Heavy meals → more BF to GI and not ♥ -Sedentary lifestyle -Tobacco / stimulants Complications -CHF -ACS -Cardiac arrest -MI -Cardiogenic shock Diagnostics -ECG -Echocardiogram -Stress test -Chest X-ray -Cardiac biomarkers -Hx + physical exam -♥ Catherization S&S -Ranges from discomfort to agonizing pain. -May feel "impending doom" -Pain may radiate to shoulder, neck, jaw, upper left arm. -Tightness in chest "feels like choking" -Weakness / numbness in arm and hand/ -SOB -Pallor -Subsides w/ nitro Interventions -Assess → PQRST pain assessment, BP trends (for nitro administration) -Meds → O2, Nitro, Asprin, Morphine -Reduce → anxiety, pain, complications -Monitor → Vitals, labs, S&S -Collab → PT, Dietciaian, Cardiologist, Surgical (PCI or CABG) Education -How/when to take nitro → up to 3x, wait 5 min inbetween. If after 3rd dose and still pain, call 911. -Lifestyle changes → smoking cessation + diet + exercise -Self care techniques → breathing techniques and stress management. -Maintain normal blood glucose + BP -Go to follow-up appointments.

MRSA (methicillin-resistant Staphylococcus aureus)

Patho →Infection caused by a type of staph infection that is resistant to antibiotics. -Direct or indirect contact. -Immunosuppression or altered skin integrity allows bacteria to bypass the body's natural defenses and enter into the tissue. Types -Healthcare → colonize in medical devices. More resistant. -Community → exposure in exposed surfaces that can affect healthy individuals. Risks -Chronic illness → DM, Kidney disease, Cancers -Activities that cause damage to skin → close contact sports. -IV drug use -Crowded or unsanitary conditions → Prisons -HIV -Immunosuppressant meds. Diagnostics -Cultures → blood, urine, sputum, wound scraping. -PCR → highly sensitive and standard -Nasal swab → Not active infection, tests for colonization. Complications → become systemic, effects whole body system. -Sepsis → blood -Endocarditis → ♥ -Osteomyelitis → bone -Necrotizing pneumonia -Septic joints S&S -SSTI → Soft skin & tissue → armpit, groin, back of neck. -Boil with whitehead, looks like spider bite. -Cellulitis -Warmth -Erythmea → redness -Edema -Fluid-filled cavity -Purulent drainage -Fever -Lethargy Interventions / Education -Infection prevention -Complication prevention -Monitor S&S, labs -Administer meds → pain, fever, infection -Wound care & skin care -Give immunizations -Promote hydration & nutrition -Dispose of sharps -Proper hand hygiene -Don't take off gloves until done in room → unless you are switching gloves for other wounds. -Don't sit on pt bed. -Wash hands outside pt room. -Cover wounds -Sanitize surfaces -Use PPE in patients rooms. → Contact UNLESS →Droplet if going into mucous membranes → if MRSA is in lungs or wound irrigation. -Wash and change linen frequently. Meds -Oral antibiotics → Clindimyacin -Vancomycin → IV antibiotic → hard on kidneys

Metabolic Acidosis

Patho→ 2 types -Normal anion gap metabolic acidosis → Direct loss of bicarbonate. -High anion gap metabolic acidosis → excessive accumulation of acids Risk Factors (Causes) → Normal + High Normal -Diarrhea -Lower intestinal fistulas -Diuretics -Early renal insufficiency -Excessive Cl -TPN w/ out bicarbonate (HCO3) High -Lactic acidosis -Salicylate poisoning (acetylsalicylic acid) -Chronic kidney disease -Methanol -Ethylene -DKA -ketoacidosis w/ starvation Diagnostics -ABG's → low bicarb, low blood pH -Elevated H+ -↑ K+ levels in blood = result of the shift of potassium out of the cell. -↓ CO2 levels S&S -↑ RR, ↓BP -Cold, clammy skin -Arrhythmias -HA -Confusion -Drowsiness -N/V -Peripheral vasodilation + decreased cardiac output occur when the pH drops to less than 7. Complications -Shock -Death -Seizures Interventions → Correct metabolic imbalance. -From Cl? → Eliminate Cl -Give sodium bicarbonate → but not during cardiac arrest. -Monitor K+ levels for hyper/hypokalemia. -Give alkalizing agents. → IV more basic -Hemodialysis or peritoneal dialysis -Safety precautions -Cimetidine → Prevents acid base imbalance, antacid, metabolic acidosis correction med.

Pain Management

Pharmacalogical intervention →Epidural, spinal block, opioids and benzos (see page 487, table 14.1) Watch for CNS depression and FHR Non Pharmacological measures → breathing, lavender, distraction, tv, talking, massage. Continuous labor support, hydrotherapy, hypnosis, ambulation and maternal position changes, transcutaneous electrical nerve stimulation (TENS), acupuncture and acupressure, attention focusing and imagery, therapeutic touch and massage, breathing techniques, and effleurage.

Normal Development Tasks r/t Age Play, Communication, Safety Education

Play -Use play to educate children on dx and procedures. -Play helps kids understand better at the developmental age, using simple terms. -Understand a child's physical, cognitive, social, emotional, and language development. -Identify developmental milestones and potential delays. -Can do play therapy, gross motor skills, social skills training to help child develop. Communication -Evaluate expressive and receptive language skills. -Identify speech sound development, vocabulary, grammar, and pragmatic (social) language skills. -Can do speech therapy. -Want to see improved speech, vocab, engaging in conversations. Safety Education -When they start walking, safety measures enhanced - fire, sharp, furniture screwed down. -Evaluate a child's knowledge of safety rules and potential hazards. -Assess understanding of emergency procedures and basic safety practices. -Teach them at the level they understand, include play.

Primary VS Secondary Menorrhea's

Primary = It's always been that way Secondary = △'s, happened acutely. -Menorrhea =mestrual bleeding -Amenorrhea = 0 bleeding -Dysmenorrhea = painful periods -Menorrhagia/Hypermenorrhea = heavy bleeding (r/f anemia, hemorrhage). -Oligomenorrhea/Hypomenorrhea = little bleeding -Metrorrhagia = bleeding between cycle

PP Depression

Risk Factors -Hx of impaired mental state (anxiety/depression) -financial or employment problems -baby with special needs -single parent -under 16, over 35+ -isolation, lack of social support S&S -uncontrollable mood swings -insomnia -not wanting to participate in childcare Tx -working with mental health provider -medication -support -education -referrals. -Take meds every day at same time, don't stop just because you feel better. -report changes in mood -go to hospital if you have thoughts of suicide /infant harm.

Erectile Dysfunction

Risk Factors -Lack of blood flow to penis -Underlying conditions (heart disease, diabetes, obesity, HTN, hormonal imbalances) -Age -Nerve signals do not reach penis -Medications → Beta blockers, antidepressants, antipsychotics, hormone, chemo, opiods. -Cancer Tx -meds w/ -afil to fill weenie up (for ED help)

Baby Blues

Risk Factors -Lack of sleep -relationship problems -stress S&S -depression -anxiety -mood swings Tx -Education on hormones decreases after pregnancy, causing the emotions. -Education on danger signs -on going health assessments -Report any thoughts of suicide or self harm/infant harm -report if lasting longer than 2 week period

PP Psychosis

Risk Factors -PP Depression S&S -hallucinations -delusions -thoughts of self harm/infant harm -homicidal thoughts Interventions -Rapid hospitalization -working with mental health providor -medication Discharge -Take meds every day at same time, don't stop just because you feel better. -report changes in mood -go to hospital if you have thoughts of suicide /infant harm

PPH → Hx + Risk Factors

Risk Factors • Precipitous labor (less than 3 hours) • Uterine atony (boggy and not tightening) • Placenta previa / placental abruption • Labor induction or augmentation • Operative procedures (vacuum extraction, forceps, cesarean birth) • Retained placental fragments • Prolonged third stage of labor (more than 30 minutes) • Multiparity, more than three births closely spaced • Uterine overdistention (large infant, twins, hydramnios)

Amniocentesis

Risk factors - Infection -Rh sensitization -Vaginal bleeding -Amniotic fluid leakage Rationale for test → genetic testing, AMA, hx abnormal screening tests, fam hx of genetic disorders, neural tube defects, possibility polyhydramnios.

Electrolyte Relationships

Sodium/Potassium = Inverse - ↑Na+ = ↓ K+ Calcium/Phosphate = Inverse - ↑Ca = ↓ Phos Calcium/Vitamin D = Vitamin D helps Ca absorb. - ↑Ca = ↑Vitamin D Magnesium/Calcium = Similar -↑Mag = ↑Ca Magnesium/Potassium = Similar -↑Mag = ↑K+ Magnesium/Phosphate = Inverse -↑Mag = ↓ Phos

Pulmonary Embolism → Stable VS Unstable

Stable S&S -Cough -SOB -Tachycardia -Tachypnea -Anxiety -Fever -Pleuritic chest pain → more on inspiration than expiration Interventions -Raise HOB #1 -Close monitoring -ECG & Telemetry for dysrhythmias -Bleeding assessment + risk management -Vitals support → BP + O2 -Pain & Anxiety manangement -Pt + Family Education ----- Unstable S&S -Tachypnea → ↓ O2 and vital △'s → #1 S&S -Chest pain → sudden & onset -Hypotension -palpitations -Diaphoresis -Cough → can contain blood -Anxiety & Impending doom feeling -ALOC's -Syncope -Dysneapea & SOB -Sudden Cardiac arrest Interventions -Call rapid response code -Close monitoring, increased nursing vigilance -ECG & Telemetry for dysrhythmias -BP support → Fluids, pressors, strict I's + O's -Pain & anxiety management -O2 & Respiratory support -Surgical embolectomy → catheter or open Sx on cardiac bypass. -Recurrent PE → ICV filter and thrombolytics

Hep C → # 1 way to get is sharing needles

Transmission → Blood & bodily fluids. Causes -Same as HBV Risk factors -Same as HBV -Highest in African Americans. Incubation → 18-180 days. S&S -Same as HBV -Chronic HCV → increased risk of chronic liver disease, including cirrhosis or liver cancer. Dx -Anti-HCV -HCV RNA Prevention -Same as HBV -No vaccine for Hep C. Medical management -No benefit from diet, supplaments, or rest. -Tx → HCV direct-acting antivirals -No cough syrup -Don't donate blood.

Hep B

Transmission → Blood & bodily fluids. -Semen -Saliva -Vaginal secretions -Mucous membranes -Breaks in skin Causes -Unprotected sex w/ infected individual -Infants born to infected mothers -Contact w/ infected blood -Substance use -Contaminated needle Risk factors -HCW → Frequent exposure to blood or blood products. -IV drug users -Living w/ a person who has HBV -Dialysis -Tattoos -Recipient of blood products Incubation → 45-180 days S&S -GI → N/V, stomach pain, anorexia -Malaise -Dark colored urine -Clay colored stool -Flu like symptoms -Jaundice Dx -HBsAG → active infection -Anti-HBs → antibody to core antigen of HBV. Prevention -HBV vaccine -Needle precautions → sharps containers -Avoiding unprotected bodily fluids -Safe sex practices with barrier contraceptives. -Blood donation screening -Testing pregnant women -Hand washing Medical management -HBV vaccine → 18 + & people with HCV. -Normal healthy pts will gain antibodies + recover w/ in 6 months. -Elder adults may have a harder time recovering → have a serious risk of severe liver cell necrosis or acute hepatic failure, particularly if other illnesses are present. -Prevent transmission → Wash hands, contact precautions, don't eat around blood. -Pt education → avoid contaminated bodily fluids, get screenings, avoid risky behavior.

Hep D → Super Infection with HBV

Transmission → Coinfection w/ Hep B. Causes -HBV Risk factors -Same as HBV Incubation → 2-26 weeks S&S -Same as HBV -Patients are more likely to develop acute hepatic failure and to progress to chronic active hepatitis and cirrhosis. Dx -HDAg / HBAg → Active infection -Anti HDV → Antigen Prevention -Same as HBV. Medical Management -Interferon alfa → high dose, long-duration therapy.

Hep A /E

Transmission →Fecal oral route Causes -Ingestion of contaminated food/water in contact w/ stool. Risk factors -Crowded conditions → schools, prisons, work place, poor countries. -Poor hygiene/ sanitation/ lack of hand washing. -Infected food handler. -Shellfish from sewer contaminated waters. -Sexual activity oral - anal. -Multiple sex partners -Hand to mouth contact. -Uncooked / under cooked meats. Incubation A →15-50 days E→ 15-64 days S&S 1st Phase -HA -Malaise -Fever -Flu like symptoms S&S 2nd Phase -Dark urine -Skin and sclera jaundice -Tender liver -Liver + spleen enlargement Dx Hep A → none for E -HAV antigens → found in stool, 7-10 days before illness, 2-3 weeks after symptoms appear. -Anti HAV IgM → Active infection. -Anti HAV IgG → Previous infection or vaccination. -Hepatitis RNA test Prevention -Hygiene + hand washing -Give immunoglobulins → IV, oral, IM, sub-q -HAV vaccine → 2 doses, 6 months' apart. Medical management -Bed rest during acute stage -Avoid illicit substances → drugs, alcohol, herbs. -Small frequent meals, low protein + caloric intake. → for anorexia, N/V. -Ambulate early + frequently.

Uterine Rupture

Uterine Rupture → tearing of the uterus that may result in fetus being expelled into the peritoneal cavity. Risk Factors -Previous C-section -Forceps delivery -Trauma -Overdistention → twins/triplets -too much oxytocin S/Sx -"tearing or ripping" -hard abdomen -sudden stop of contractions -sudden severe abdominal pain -FHR → bradycardia, tachycardia, late decels, decreased variability -Fetal distress -hypovolemic shock -Hypotension Interventions -C-section -Hysterectomy -IV fluids + IV oxytocin + blood products

VEAL CHOP

V → Variable → Concerning with V dips E → Early → good! Mirrors contractions A → Acceleration → good, temp increase in FHR L → Late → bad, hypoxia C → Cord compression H → Head compression, labor process O → Okay P → Placental insufficiency -What effects it? → Positioning of fetus/mom, contractions, placental function, meds. Interventions -reposition hips higher than head, all fours like a dog. -Call provider -document FHR patterns seen -discontinue oxytocin / pitocin -O2 non rebreather mask -↑ IV fluid rates, improves intravascular volume + hypotension -assess client for any underlying causes -educate/keep client calm on why interventions are given for benefit of FHR -modify pushing in second stage labor for fetal oxygenation -document all interventions -prepare for c-section if not corrected in under 30 min.

Vaginal Exam

Vaginal Exam Ex: 3/80%/-2 Dilation, effacement, station → 3 cm dilated (most important), 80% effaced, -2 station. When to keep / stay home? -Can be sent home because she is not in active labor, she is in EARLY labor at anything 6cm and below. -Will take time to dilate fully to 10 cm. -We admit her over 4cm, true labor, regular contractions 3-5 min apart, lasting 60-90 seconds. UNLESS -membranes ruptured (will say in question) = this can also mean potential for cord prolapse. -it is her third child, then must admit because baby will come out fast. → Precipitous delivery.

ABG Interpretation -evaluates gas exchange in lungs + kidneys -clients O2 status

acid ← pH → base 7.35 - 7.45 base ← PaCO2 (respiratory) → acid 35 - 45 acid ← HCO3 (bicarbonate = metabolic) → base 22 - 26 ROME = Respiratory Opposite Metabolic Equal -Uncompensated → CO2 or HCO3 are in range. -Partially Compensated → CO2 & HCO3 are both out of range. -Fully Compensated → if pH is within range.

Anemia Classifications

↓ Erythrocyte production → not enough RBCs being made. → Hypo-proliferative. -Iron deficiency -Vitamin B-12 deficiency (Pernicious) -Folic Acid deficiency (Megaloblastic) ↑ Erythrocyte destruction →RBC's dying → Hemolytic -Sickle Cell -Hemolytic