JCCC RN NURS150 Unit 3

ovarian cancer; screeing & diagnosis

*75% of ovarian cancers are not diagnosed until the cancer has advanced to stage III or IV*—primarily because there is no adequate screening test. •Most useful tool is transvaginal ultrasound •The BRCA1 and BRCA 2 are linked with hereditary breast and ovarian cancers. •Ovarian symptom index includes pelvic and abdominal pain, urinary frequency and urgency, increase abdominal size (bloating) and difficulty eating (feeling full).

pregnancy complication

*Bleeding* during pregnancy Hyperemesis gravidarum Blood incompatibility Anemia Amniotic fluid imbalances Multiple gestation Premature rupture of membranes

Syphylis

*Chancre=Syphylis* •Causative Organism: Bacterium Treponema pallidum Clinical Manifestations •Passed from person to person through direct contact with a syphilis chancre (lesion) •*Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications and transmission, if not treated* •A negative ("nonreactive") VDRL test is compatible with a person not having syphilis. However, a person may have a negative VDRL and still have syphilis since, in the early stages of the disease, *the VDRL often gives negative results (false negative VDRL)*. •BUT, the test is reliable during the second stage. Complications •*Easier to acquire HIV, due to open lesions. ALL patients who have syphilis should be treated for HIV infection* •Penicillin is the preferred medication for treatment of all stages

Cancer causes & risk factors

*Genetic link* Hereditary predisposition is responsible for approximately 50 types of cancer that is linked in families *Chromosomal abnormalities* CML - Philadelphia chromosome-Chronic Myologic Leukeumia TP 53 mutation-tumor suppressor gene may not work *Immunodeficiencies* Unknown Environmental Obesity-known & proven link-due to increased androgens, which then causes excess estrogen Viruses-enter cells and change the DNA-especially Leukemia Hep B, Herpes 8, Epstein Barr Hormones-reproductive cancers *Ionizing radiation-radiation to treat cancer can predisposed to developing cancer later in life. Same with Chemo*. Parental & prenatal exposure to paints, solvents, chemicals Prenatal exposure to smoke/alcohol Chemicals Smoke, asbestos, fungicides, smoked meats, anti cancer agents, alcohol, arsenic,

PROM/PPROM Nursing Management

*Infection prevention* Risk is greater Watch VS, increase in pulse & temp Watch for tachycardiac fetal HR Identification of uterine contractions Education and support Discharge home (PPROM) if no labor within 48 hours Mostly all infection prevention Keep area clean and dry No tub baths Watch for signs of true labor

vaginal birth after cesarean (VBAC)

*LOW TRANSVERSE ABDOMINAL INCISIONS ONLY* Controversy related to risk of uterine rupture and hemorrhage Contraindications Midline incision Uterine scarring/adhesions Staffing issues

placental abruption

*Obstetric emergency* involving premature separation Risk factors Management dependent on gestational age, extent of hemorrhage, and maternal-fetal oxygenation perfusion Maintenance of maternal cardiovascular status Prompt delivery of fetus Cesarean birth if fetus still alive; vaginal birth if fetal demise

managing chemo side effects; infection

*Priority intervention* Increased risk for sepsis, monitor for possible sites of infection, treatment with antibiotics in suspected infection, monitor FEVER Most concerning infections: viruses such as flu & pneumocystis carinii, candida, staph and group A strep Prophylaxis for pneumocystis carinii - Bactrim Good hand washing ANC = Absolute neutrophil count Neulasta, Neupogen Subq injections to stimulate bone marrow to produce WBC's lower fever tolerance

Selective Estrogen Receptor Modulators (SERMs)

*Tamoxifen* (Nolvadex) estrogen antagonistic (estrogen blocking) and agonistic (estrogen like) effects on certain tissues. They bind to the estrogen receptor sites •Associated with an increased incidence of endometrial cancer, pulmonary embolus, deep vein thrombosis, hot flashes, vaginal discharge and bleeding. •women with ER+ breast cancer are to take a SERM for up to 5 years after initial treatment.

abnormal findings during a breast exam

*begin with inspection* Inspect for color venous pattern thickening edema Retraction Increased Venous Prominence Peau d'Orange - orange peel appearance Nipple Inversion Paget's Disease - involves the nipple, areola and surrounding skin

laser therapy

*destroys diseased cervical tissue by using a focused beam of high-energy light to vaporize it (burn it off) *after the procedure, the woman experience a watery brown discharge for a few week *very effective in destroying precancers and preventing them from developing into cancers

1st trimester spontaneous abortion

*fetal genetic abnormalities is most common* Most due to natural causes Before 20 wks 80% of all occur during this time increases with maternal age

oral contraceptives

*work by adding hormones to system that mimic pregnancy and suppress ovulation*. Contraindications Family history of stroke, diabetes, breast or endometrial cancer History of liver or renal disease, thromboembolic disease, sickle cell disease, *hypertension, smoking* of 15 cigarettes or more per day, *depression, headaches*, migraines, convulsions and asthma. Possible Side Effects: Thromboembolic disorders and other vascular problems, including CVA and MI Nausea, breast discomfort, weight gain Risk of side effects is highest in older women (>35), in those with long duration of use and in cigarette smokers Please Note: Many antibiotics interfere with effectiveness of OCs. An alternative method of contraception should be used for duration of antibiotic therapy and a week afterwards

cervical cancer; risk factors

*•Early age for first intercourse •Promiscuous male partners •Unprotected sexual intercourse •Multiple sex partner •Infections with genital herpes or chronic chlamydia* Primary prevention includes: •Identify high risk behaviors •Take steps to prevent STI's •Avoid early sexual activity •Receive HPV vaccine •Instruct women on the importance of screening

DDH clinical manifestations

+ Ortolani and/or Barlow test - "click or clunk" Shortening of the leg Asymmetric thigh or gluteal folds Trendelenburg sign Limp or waddle gait Unilateral or bilateral

Accute lymphoblastic leukemia (ALL)

- "Unrestricted proliferation of immature WBCs in the blood-forming tissues of the body" - Immature WBCs take nutrients for metabolism from the normal cells (in bone marrow & solid organs) *Low leukocyte count* - Bone marrow suppression then leads to anemia (RBCs), infection (WBCs) and bleeding (Platelets) - Leukemic cells invade: *spleen, liver*, lymph, CNS,, kidneys, testes, ovaries, GI, lungs

Non Hodgkins Lymphoma; Burkitts

- B-cell abnormalities - Jaw, abdomen or orbit involvement is common - Rare in the US - 50% of childhood cancer in Africa - Usually an issue in 3rd world countries - Large Deforming facial tumors (may start with Epstein Barr Virus) - Chromosomal Abrnormalities

osteogenesis imperfecta type 2

- lethal - disorder of production, secretion, or function of collagen - fractures in utero, "thick" bones due to callus formation, micromelia Management Supportive, Exercise, Splinting, Surgery May use braces/splints Biophosphanate meds IV Pamidronate-usually monthly No contact sports Nursing Care Careful handling! Education of schools and family Letter re: diagnosis GOALS Prevent deformities, limit fractures, Prevent contractures Muscle weakness osteoporosis

Decerebrate posturing

-"extensor posturing"; -abduction of arms, elbow and wrist extension damage to: midbrain

Non Hodgkins Lymphoma; treatment & prognosis

-Chemotherapy -Aggressive radiation -Surgery - for large tumors & impingement ->80% of children with significant disease are cured -Almost all children with limited disease are cured

hodgkins lymphoma; diagnostic testing

-Lymph node biopsy -CXR, CT, MRI -CBC, ESR, Hepatic function -*Reed-Sternberg* cells present (owls eyes) -Staging: I-IV -Advanced disease may need bone marrow aspirate

Non-Hodgkin's Lymphoma

-Malignant tumor of lymphoid tissues origin - *Can be spread throughout the body* -*Affects nodes located deeply* within the body -3 types: -Lymphoblastic lymphoma (30-40%) -Burkitt lymphoma/small cell (40-50%) -Large cell lymphoma (<15%) Poorly differentiated cells, but the disseminate early on. Common finding is a mediastinal tumor. Invasion of the meninges is common Caused from B &T lympcytes 90% will have a disease free long term survival

Hodgkins lymphoma; clinical manifestations

-Sentinel node - first node suspected to be involved (primary site) -*Fever* -*Drenching night sweats* -Unexplained weight loss (10% or more) -High metabolic needs of cancer cells -Nausea -Leukocyte count may be normal, elevated or decreased -ESR (sed. rate) elevated; (cells are dropping to bottom of test tube faster) -mild anemia -*Infection* is often the first sign-

Non Hodgkins Lymphoma; clinical manifestations

-Similar to leukemia -Fever -Unexplained weight loss -Enlarged lymph nodes/glands (cervical, axillary, inguinal or femoral) -May not have enlarged glands/nodes -Tumor in chest (mediastinum) - lung/heart problems from impingement -Disease progresses rapidly

Decorticate posturing

-adduction of arms (arms fold to chest); flexion of elbows and wrists arms to the core (corpse) damage to: cerebral cortex

types of acute leukemia

-divided into ALL and AML based on phenotype of blasts -accumulation of Myeloblasts = AML -accumulation of lymphoblasts = ALL (85%)

incidence rate of high risk pregnancy

1 in 4

how long can you leave on an IV tourniquet

1 minute to minimize effects of stasis and hemoconcentration

Seizures; Diagnostic Tests

1. glucose, elctrolytes & calcium-rule out metabolic causes 2. Lumbar puncture-r/o meningitis or encephalitis 3. skull xray examination- r/o fractures or trauma 4. CT & MRI- r/o tumors & identify abnormalities 5. EEG-evaluate seizure type and med selection 6. Video EEG-see behavior w/EEG changes

how many attempts should you make to insert an IV

2 by any single nurse

Spastic CP

70-80% of cases Hypertonicity of muscles Tight muscles Spastic movements Poor motion/balance control

recommended caffeine intake during pregnancy

<300mg/day 1 cup of coffee is 240mg

Hydraminos

> 2,000 mL of amniotic fluid at term

rheumatoid arthritis during pregnancy

A chronic systemic disease characterized by inflammation of the joints, stiffness, pain, and swelling that results in crippling deformities Symptoms may improve & even go into remission May have flareups after baby comes

status epilepticus

A condition in which seizures recur every few minutes or last more than 30 minutes. *STAT* ABC's give lorazapam or diazepam ore fosphenytoin common neurological emergency in children febrile seizures are most common type age, cause and duration influences prognosis evaluate blood glucose & electrolytes

Osteogenesis Imperfecta (OI)

A hereditary disease resulting in the formation of brittle bones that fracture easily. There is faulty synthesis of collagen, the main structural protein in connective tissue. Heterogeneous, autosomal dominant genetic bone disorder 8 types - Type 1 most common (50% of all OI cases) Clinical manifestations Bone breaks easily Bone deformities Impaired growth of teeth, condition of teeth Blue sclera Hearing loss Can't pick them up by their heels to change their diapers. Don't' pick them up under their arms. May present as a child abuse situation if it is unknown at birth. May have traumatic birth like shoulder dysplasia

Cytomegalovirus (CMV) while pregnant

A herpesvirus that can produce the symptoms of prolonged high fever, chills, headache, malaise, extreme fatigue, and an enlarged spleen. >50% of population-asymptomatic-probably not an issue. Problem if she gets it for the FIRST time in the 1st semester. Changing diapers, kissing little kids, mindful it is very contagious. Can lead to IUGR, microcephaly, jaundice hearing loss & intellectual disability

Rubella (German Measles) in pregnancy

A highly contagious viral disease, especially affecting children, that causes swelling of the lymph glands and a reddish pink rash; may be harmful to the unborn baby of a pregnant woman who contracts it depends on timing of infection. Symptoms include congenital cataracts, glaucoma, cardiac defects, microcephaly, hearing & intellectual disabilities. Cardiac defects usually if contracted in the first trimester

HER2 cancer cell test

A pathology report from a biopsy may determine if cancer cells contain the HER2 gene. If the result is positive, this gene may be responsible for the rapidly cancerous growing cells. This is an aggressive type of cancer this grows faster and is more likely to spread and return.

protracted disorders

A series of events that causes a slower rate of cervical dilation and/or descent of babies head

basal body temp method

A woman's basal body temperature is lowest upon awakening in AM *Temperatures typically rise within a day or 2 after ovulation occurs and remain elevated for about 2 weeks until menstruation begins* Abstain from end of period to 3-4 days after increase in temperature

Oral contraceptives danger signs

ACHES A--abdominal pain, hepatic pain C--chest pain, cardia pain H--headaches E--Eye problems, hypertension S--Severe leg pain, VTE

Air Embolism

Air in the circulatory system. Air in circulation gets into right ventricle, lodges against the pulmonary valve & blocks flow of blood from ventricle into pulmonary arteries. Symptoms: Respiratory distress, coughing, wheezing, cyanosis. Increased heart rate (weak & rapid), decreased blood pressure. Altered level of consciousness. Possible chest, low back, & shoulder pain. Interventions: 1. Pinch off catheter or secure system to prevent entry of air. 2. Place patient on left side in Trendelenburg position. 3. Call for immediate assistance. 4. Monitor vital signs and breath sounds (including pulse oximetry). 5. Administer oxygen.

complete abortion

All the products of conception are expelled. Therapeutic Management: No medical or surgical intervention necessary Follow-up appointment to discuss family planning

missed abortion

An abortion in which the products of conception are no longer viable but are retained in the uterus for at least 6 weeks. Therapeutic Management: Evacuation of uterus (if inevitable abortion does not occur): suction curettage during first trimester, dilation and evacuation during second trimester Induction of labor with intravaginal PGE2 suppository to empty uterus without surgical intervention

rotationplasty

An operation where a portion of the limb is removed while the remaining limb below is rotated and reattached. -Often performed as a treatment for distal femoral osteosarcoma

ectopic pregnancy: Nursing management

Analgesics for pain Medications for medical treatment Methotrexate Prostaglandins Teaching about signs and symptoms of rupture Severe sharp stabbing pain on one side (unilateral) Dizziness or may faint Hypotension, increased pulse (like shock) *THIS IS A MEDICAL EMERGENCY* Hypovolemic shock Surgery Emotional support Education about prevention is KEY Avoiding STI's Avoiding IUD's Smoking Prenatal care early to confirm pregnancy implantation site

Gabapentin (Neurontin)

Anticonvulsant anti arthralgia creatine kinase ^ angioedema

Topiramate (Topamax)

Anticonvulsant bleeding

Lamotrigine (Lamictal)

Anticonvulsant meningitis Liver failure Steven Johnson Syndrome (rash)

Carbamazepine (Tegretol)

Anticonvulsant suicidal thoughts Hepatic Steven Johnson Syndrome (rash) agranulocytosis (CBC)

Valproic Acid (Depakote)

Anticonvulsant suicidal thoughts Hepatic & pancreatic

Oxcarbazepine (Trileptal)

Anticonvulsant suicidal thoughts Steven Johnson Syndrome (Rash)

Levetriacetam (Keppra)

Anticonvulsant suicidal thoughts Steven Johnson Syndrome (rash) agranulocytosis (CBC)

Phenytoin (Dilantin)

Anticonvulsant suidical thoughts hepatic failure steven johnson syndrome (rash) agranulocytosis (CBC)

managing chemo side effects; nausea/vomiting

Antiemetics, like Zofran (ondansetron), 30 minutes before chemo/radiation treatment and q6 hrs for the next 24 hours (or more) after chemo Like to give via oral route when possible as the ondansetron can work on the site where it is needed & is more effective Small, frequent meals Sips of liquids Avoid greasy, spicy foods Choose crackers, toast, rice, jello

forceps or vacuum assisted birth

Application of traction to fetal head Risk of tissue trauma to mother and newborn Prevention is key Change mom's position Encourage walking Empty bladder regularly Stay well hydrated Assess mom and fetal status throughout

ALL -acute lymphoblastic leukemia; prognosis

BETTER when: Leukocyte count is <50,000 Age - 1 to 9 years old at diagnosis Female gender Prognosis becomes poorer with relapse. Depends on Age, gender, stage at dx

cervical insufficiency: therapeutic management

Bed rest, pelvic rest, avoidance of heavy lifting Cervical cerclage Suture the cervix closed

Diazepam (Valium)

Benzodiazepine Respiratory Distress drowsy dizzy lethargy *used for status epileptics*

Clonazepam (Klonopin)

Benzodiazepine suidical thoughts sedation

Types of Factors for high risk pregnancy

Biophysical -genetic, diabetes, infection, nutritional status, eating disorders, diseases Psychosocial -emotional distress, depression, smoking, alcohol domestic abuse, caffeine, hx of violence, unsafe cultural practices Socioeconomic - age, poverty, lack of prenatal care, parity, marital status, ethnicity, healthcare accessibility Environmental - radiation, pesticides, pollutants, drugs, stress

managing chemo side effects; mouth ulcers

Bland, moist, soft diet Good oral hygiene/mouth care Mouth rinse of salt, baking soda, water Magic mouthwash, nystatin and Chlorhexadine Analgesics Avoid hot, crunchy, spicy or salty foods

ALL -acute lymphoblastic leukemia; Treatment

Bone marrow transplant - siblings are best match Not done in ALL until *2nd remission* Long term survival with BMT 25-50%

AML Acute Myelogenous Leukemia; treatment

Bone marrow transplant-siblings are best match done in AML with *first remission* due to poorer prognosis

managing chemo side effects; hemmorhagic cystitis

Burning with urination Oral/IV fluid intake 1 ½ times normal (150%) *void at least every two hours* to prevent hemorrhagic cystitis.

abruptio placentae; lab & diagnostics

CBC, INR, fibrinogen levels, PT/PTT, type and cross-match, non-stress test, biophysical profile

Hodgkin Lymphoma (HL)

Cancer of the lymph system *Lymph nodes close to the surface of the body* 40-45% of lymphomas are Hodgkin Peak occurrence in adolescent boys (15-19); and after 55 years of age (Vietnam Vets) Often metastasizes to spleen, liver, bone marrow, lungs, and other tissues May be genetic link, occurs in families; infectious (HSV, CMV, EBV) or environmental hazard Will feel masses Fairly responsive to treatment

Lymphomas

Cancerous growth of lymphoid tissue, usually derived from B lymphocytes (the plasma cell) WBC's *solid Tumors*

uterine rupture

Catastrophic rupture at a scarred area *Obstetric emergency; onset marked by sudden fetal bradycardia* 10-30 minutes is all it takes

labor induction: therapeutic management

Cervical ripening (Bishop's score, see Table 21.2) Herbal agents Red raspberry Evening primrose Castor oil, hot baths, enemas Sexual intercourse with breast stimulation Mechanical methods Surgical methods Stripping of membranes Amniotomy (break water) Pharmacologic agents Prostaglandins Oxytocin

Post term labor: maternal risks

Cesarean birth, dystocia, birth trauma, postpartum hemorrhage infection.

preterm labor subtle signs*

Change in vaginal discharge with mucus/water/blood Feels pelvic pressure, bearing down sensation Low dull back ache Nausea/vomiting/diarrhea Aching in thighs

Congenital clubfoot (talipes equinovarus)

Characterized by plantar flexion at ankle; heel titled inward and forefoot adducted Can be unilateral or bilateral 2 classifications Positional Syndromic-more severe and resistant to treatment Management *Serial casting* Nursing Care Skin Care Cast Care watch for swelling, redness, perfusion, check toes

Ceasaran birth : Assessment & Management

Classic or low transverse incision VBAC need a low transverse incision Major surgical procedure with accompanying risks Nursing Assessment: H&P exam for maternal and fetal indications Nursing Management Preoperative care Offering questions Skin prep Postoperative care Careful monitoring of vital signs s/s bleeding, cloting, pain

Spinnbarkeit

Clear, slippery, stretchy quality of cervical mucus during ovulation. avoid intercourse until 4th day after

myelomeningocele; orthopedic issues

Clubfeet Scoliosis/Kyphosis *Prevention of skin breakdown* Mobility/positioning-pressure pads & turning Functional ability loss of sensation & muscle tone Walking becomes more difficult as they age.

STI Patient Interview

Collect: Symptoms Risk of Exposure Prior STI exposure or treatments

hyperemesis gravidarum; nursing management

Comfort and nutrition (NPO, IV fluids, hygiene, oral care, stict I&O) Support and education: reassurance; home care follow-up Avoid noxious stimuli - Avoid tight waistbands Eat small, frequent meals Separate fluids from solids by consuming fluids in between meals. Avoid lying down or reclining for at least 2 hours after eating. Use high-protein supplement drinks. Avoid foods high in fat. Increase your intake of carbonated beverages. Increase your exposure to fresh air Eat when you are hungry, Drink herbal teas containing peppermint or ginger. Avoid fatigue manage stress in life. Schedule daily rest periods Eat foods that settle the stomach, such as dry crackers, toast, or soda

essential characteristics of culture & ownership

Commitment To values, vision & mission Engagement Being fully present, physically and emotionally Passion Loving your work and letting it show Initiative Seeing what needs to be done and taking action to get it done Stewardship Effectively shepherding limited resources Belonging Being included, feeling included, and including others Fellowship Being a friend and having friends at work Pride In your profession, your hospital, your work, and yourself

iron deficiency anemia; nursing management

Compliance with drug therapy: prenatal vitamin iron supplement, 30mg/day Dietary instruction and counseling Tough on the GI system things that interfere with iron absorption. Chocolate Coffee caffeine *Take iron supplements between meals* May be uncomfortable on an empty stomach though.

hyperemesis gravidarum; therapeutic management

Conservative (diet and lifestyle changes) Hospitalization with parenteral therapy

The patch

Contains estrogen and progesterone as the birth control pill does. (Xulane ) Patch is a thin beige patch that is to be replaced once a week for 3 weeks; 4th week is patch free, menses occur Should be placed on the skin on time for greatest effectiveness Side effects are the same as with "the pill"

depoprovera

Contains progesterone only Given IM or SQ (low dose form) every 90 days Suppresses ovulation and endometrial growth, and thickens cervical mucus. *Reestablishment of regular ovulation may take more than a year after stopping* *May adversely affect lipids* *Bone loss-non reversible* May be used by women over 35 who smoke, women with sickle cell, congenital heart Decreased risk of endometrial cancer, less PID, fewer uterine fibroids

cervical insufficiency: nursing management

Continuing surveillance; close monitoring for preterm labor Emotional support Education of s/s of preterm labor. Inform of changes ASAP More frequent visits

Ataxic CP

Coordination issues Wide based gait Jerky speech

culture self awareness

Cultural Self-Awareness of one's own beliefs and attitudes is essential ◦ Take inventory of feelings ◦ Examine biases and prejudices ◦ Attempt to genuinely "see" patients *The first step to developing cultural competence involves self-awareness* Your behavior may reflect to others thoughts hidden to you

breast cancer; hormonal therapy

Current recommendations for most women with ER+ breast cancer are to take an anti-estrogenic agent daily for up to 5 years after initial treatment. (SERM or aromatase inhibitors) The objective is to *block or counter the effect of estrogen*. Think- estrogen deprivation. estrogen is the hormone of cell growth and can contribute to the growth and division of cancer cells. ER+/PR+ have better prognosis than if they are negative

psychological effects of immobility

Decreased sensory input Language Varying abilities Feelings of isolation, decreased independence, exploration/expression May regress Behavioral changes Siblings may feel like they do not get enough attention Financial burdens Parental guilt Help the kids/family cope with resources ready.

ALL -acute lymphoblastic leukemia; diagnostics

Determine which blast cells are involved, the number of each and which treatment is appropriate •Based on history & symptoms •Family hx? •Initially WBC count will be low, because of immature WBCs (leukopenia) •Peripheral blood smear shows high # of blasts (immature leukocytes) •Definite diagnosis made by *bone marrow aspiration or biopsy* •Lumbar puncture •To determine if it has crossed to the CNS

PROM/PPROM Key Assessments

Determining the date, time, and duration of membrane rupture by client interview Ascertaining gestational age of the fetus based on date of mother's last menstrual period, fundal height, and ultrasound dating Questioning the woman about possible history of or recent UTI or vaginal infection that might have contributed to PROM Assessing for any associated labor symptoms, such as back pain or pelvic pressure Assisting with or performing diagnostic tests to validate leakage of fluid, such as Nitrazine test, "ferning" on slide, and ultrasound. Contamination of Nitrazine tape with lubricant or insufficient fluid will render the assessment unreliable. Continually assessing for signs of infection including: Elevation of maternal temperature and pulse rate Abdominal/uterine tenderness Fetal tachycardia more than 160 bpm Elevated white blood cell count and C-reactive protein Cloudy, foul-smelling amniotic fluid

DDH management & care

Diagnostics Physical exam X-ray - after 4 months of age Management Pavlik harness, Hip spica cast Traction, Closed reduction w/ casting, open reduction w/casting Open reduction, osteotomies, tenotomies Nursing Care Cast/harness care - skin care Development Feeding Transport The goal is to realign the bones and promote normal hip development Realignment can occur within the first 12 months most often.

risk factors for dystocia

Epidural analgesia/excessive analgesia Multiple gestation Hydramnios Maternal exhaustion Ineffective maternal pushing technique Occiput posterior position Longer first stage of labor Nulliparity, short maternal stature

Nitrazine test

Evaluation of body fluids using a test swab to determine the fluid's pH; urine exhibiting an acidic result-yellow amniotic fluid exhibiting an alkaline result-blue

incomplete abortion

Expulsion of the fetus with retained placenta before 20 weeks' gestation. cervical os open Therapeutic Management: Client stabilization Evacuation of uterus via D&C or prostaglandin analog

Cancer; diagnosis

Family history-sometimes there is a link Physical exam, history of present illness o May have pain with joint movement, lumps or bumps on bones or muscles, may have visible signs like leukokoria in retinoblastoma o Fever, anemia, enlarged lymph nodes, enlarged liver or spleen, infection, bleeding CBC o WBC usually low on lab analysis, acutely (especially in leukemias) o WBC can also be high-but the majority of the cells are immature and undifferentiated o Low Hgb and/or low platelets-may be having lysiss of RBC's Chemistry o Catecholamines o Tumor Markers Urinalysis o Catecholamines, blood Peripheral blood smear o Leukemias-usually immature WBC R adiographs- Xray MRI/ CT scan MRI helpful with brain tumors because biopsies are hard Bone Scan Biopsy Definitive diagnosis in solid tumors Lumbar Puncture • Assesses involvement of CNS (blood or brain) Bone marrow aspiration • Definitive diagnoses of leukemias

FASD

Fetal Alcohol Spectrum Disorder 1st trimester affects organ development 2nd trimester affects brain development 3rd trimester causes retardation of growth & development NO amount of alcohol is safe during pregnancy low

ALL-Acute lymphoblastic leukemia; clinical manifestations

Fever Pallor Fatigue Anorexia Vomiting (with CNS involvement) *Petechiae or unusual bleeding/bruising Bigger, darker than usual and in unusual places* Bone/joint pain (after bone marrow expansion) Bones are weakened due to the overcrowding Abdominal pain Headache (with CNS involvement)

Positional plagiocephaly (positional molding)

Flattening of dependent cranial bone (occiput). increase in incidence due to "back to sleep" Teach parents to change positions, tummy time and avoid excessive use of carseat. If marked, then requires custom-shaped helmet to afford room for brain growth in flattened area while moderating growth in other areas. Used before sutures fuse.

Genital herpes; implications in pregnancy

Genital HSV can lead to potentially fatal infections in babies If a woman has active genital herpes at delivery, a c-section is usually done

Dental/dry mouth care during chemo

Good oral hygiene, soft toothbrush Educate on late development of adult teeth Radiation to head area can cause cavities, gum disease Limit chewy foods Mouth swabs, lip balm

ectopic pregnancy: nursing assessment

Hallmark sign *abdominal pain with spotting within 6 to 8 weeks after missed menses-50% of the time* Contributing factors Review hx for PID-red flag due to scarring Previous ectopic pregnancy Hx of STI's Use of fertility meds Over 35 endometriosis Laboratory and diagnostic testing: transvaginal ultrasound, *serum beta hCG (will be LOW)*; additional testing to rule out other conditions Signs of pregnancy will be present Risk for *massive hemorrhage* Pain may mimic a ruptured ovarian cyst, spontaneous abortion, appendicitis or salpingitis

precipitous labor

Hard & fast labor lasting less than 3 hours risking postpartum hemorrhage

shoulder dystocia

Head is delivered but shoulders become impacted above mother's symphysis pubis. McRoberts Maneuver Apply suprapubic pressure Forceps

Early signs of ICP

Headache Vomiting Blurred vision Dizziness Decreased pulse and respirations Increased blood pressure or pulse pressure Pupil reaction time decreased and unequal Sunset eyes Changes in LOC Seizures In an infant: bulging, tense fontanel, wide sutures and increased head circumference, dilated scalp veins and high-pitched cry

early signs of ICP

Headache Vomiting Blurred vision Dizziness Decreased pulse and respirations Increased blood pressure or pulse pressure Pupil reaction time decreased and unequal Sunset eyes Changes in LOC Seizures In an infant: bulging, tense fontanel, wide sutures and increased head circumference, dilated scalp veins and high-pitched cry

Types of CP

Hemiplegia o Right/left or upper/lower Diplegia o 2 arms or 2 legs Quadriplegia o All 4 extremities are affected Monoplegia/ Triplegia o Most rare o Just 1 or 3 limbs affected

ALL -acute lymphoblastic leukemia; symptoms from organ involvement

Hepatosplenomegaly Meningeal infiltration - ICP Cranial nerves (facial nerve)-LATE diagnosis Spinal nerves (lumbosacral plexus, hypothalamus, cerebellum) Other - r/t organ involvement

managing chemo side effects; nutrition

High protein, high calorie foods (ensure or pediasure may help) Encourage them to eat whatever sounds good unless contraindicated (Vitamin C, for example) Monitor intake & output, height, weight Tube feeds or TPN if necessary for calories Assess any other underlying factors No vitamin C with methotrexate No favorite foods, they won't like them later

ketogenic diet

High-fat, low-carbohydrate meal plan in which ketones are made from metabolic pathways used in converting fat as a source of energy.

developmental dysplasia of the hip (DDH)

Hip dislocation, subluxation, shallow acetabulum Causes: physiologic, mechanical and genetic factors Large degree of affectedness. Physiologic factors-hormone factors, breech babies, multi fetuses, large babies. Can run in families Can be corrected. Affects walking and ability to move. Early correction is best.

dystocia assessment

History of risk factors Maternal frame of mind Vital signs Uterine contractions Fetal heart rate, fetal position

Causes of Dystocia: Problems with the Powers

Hypertonic uterine dysfunction Hypotonic uterine dysfunction Protracted disorders Arrest disorders Precipitate labor

Rh incompatibility

If mother is Rh- and baby is Rh+, mother may develop antibodies against the infant's blood Risks increase with subsequent pregnancies Treatment is *RhoGAM for mom at 28weeks* & *again within 72 hours of birth* to prevent sensitization to fetal blood.

placenta previa; risk factors

Increased w/ the increase in c-sections in the US Being over 35 Previous c-sections or uterine injury Smoking, hypertention, diabetes

ALL -acute lymphoblastic leukemia; treatment phases

Induction phase - complete remission or disappearance of leukemic cells - 95% have remission in the first 7 days in the hospital, then discharged, - Criteria for remission is 5% blast cells or less CNS prophylaxis - intrathecal (reduces risk of CNS infiltration) - either prevents or treats CNS infiltration Consolidation/Intensification phase - Continues to reduce total tumor burden, target resistant cells - Multiple chemo drugs (combo) - Maintain remission- out patient chemos or oral medications Maintenance phase - continuation of remission phase, further reduce leukemia cells - Lasts 2 ½ - 3 years - Frequent monitoring of CBC Re-induction - relapse of leukemic cells in bone marrow - Multiple chemo drugs used - Most relapses occur in the first year off chemo, then start over Uses a portacath PICC line NO PIV

hypotonic uterine dysfunction

Ineffective contractions to push baby along

Moro reflex

Infant reflex where a baby will startle in response to a loud sound or sudden movement.

Phlebitis

Inflammation of the wall of a vein. Could be chemical (irritating meds or solution, rapid infusion rates, med incompatibilities), mechanical (long periods of cannulation, poorly secured catheters, catheters bigger than the vein, catheters in areas of flexion), or bacterial (lack of hand hygiene, lack of aseptic technique). Symptoms: Reddened, warm area around the insertion site or along the path of the vein (possibly streak formation, or palpable venous cord). Interventions 1. Stop infusion. 2. Discontinue IV. 3. Restart IV in another site. 4. 4. Apply warm, moist compress to site.

Types of brain tumors

Infratentorial: Medulloblastoma Brainstem glioma Supratentorial: Astrocytoma

How to develop culturally competent care

Integration of your nursing knowledge with the cultural needs of the patient. Understanding that meeting cultural needs assists in improving health and health-related outcomes. Appreciation of another person's cultural needs. Communication based on cultural understanding. Sensitivity to another's cultural needs. Dignity is a crucial aspect of holistic care. Knowledge about culture comes only with effort. Acceptance of the beliefs and characteristics of another person.

contraindications to tocolytic drugs

Intrauterine infection Active hemorrhaging Fetal distress Fetal abnormalities incompatible with life Severe IUGR Severe pre-eclampsia Prolonged PROM (infection risk) Fetal demise, intrauterine

Neurological disorder; inspection & observation

LOC Vitals head, face & neck cranial nerve function motor function reflexes sensory function ICP

procedures during chemo

LP and bone marrow aspiration most common Educate and explain to patient beforehand Younger children - sedated Lidocaine used to numb site CT/MRI Contrast - allergies Parent presence and support whenever possible

hematoma

Leakage of blood into tissues surrounding IV site. Due to nicking of vein during venipuncture, the needle slipping out of the vein, using a cannula too large for the vein, or insufficient pressure applied to the site after removal of the needle or cannula. Symptoms: Immediate swelling at the site, leakage of blood at insertion site, and ecchymosis. Intervention: 1. Remove the needle or cannula. 2. Apply light pressure with a sterile, dry dressing. Hold pressure over the site. 3. Elevate extremity (to maximize venous return) 4. Apply ice for 24 hours to prevent extension of hematoma. 5. Restart IV in other extremity.

infiltration

Leaking of intravenous solution or medication into the surrounding tissue. Can occur if IV cannula dislodges or perforates the wall of the vein. Symptoms: Edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness in the area of the infiltration, and a significant decrease in the flow rate. Interventions: 1. Stop infusion. 2. Discontinue IV catheter, 3. Apply sterile dressing, elevate extremity. 4. Some institutions encourage a warm compress to be applied to site. 5. Restart infusion at a different site.

Obtunded

Less than full alertness (altered level of consciousness), typically as a result of a medical condition or trauma.

late signs of ICP

Lowered LOC Decreased motor and sensory responses Bradycardia Irregular respirations Cheyne-Stokes respirations Decerbrate or decorticate posturing Fixed and dilated pupils Lowered LOC Decreased motor and sensory responses Bradycardia Irregular respirations

neurological disorders; diagnostics

Lumbar Puncture testing

managing chemo side effects; steroid side effects

May make them hungrier Increased facial puffiness Temporary weight gain Increased irritation

managing chemo side effects; neurological

Mental depression May have a change in affect Constipation from decreased bowel innervation Foot drop/weakness & numbness of extremities Jaw pain Post-radiation somnolence from cranial radiation Can be a permanent change

Infection of IV site

Microbial contamination of IV catheter or IV solutions. Large range of symptoms: abrupt temperature elevation after infusion started, increased pulse & respiratory rate, headache, nausea, diarrhea, vomiting, chills, shaking, backache. Can also have redness, edema & drainage at site. Can lead to sepsis. Interventions: 1. Stop IV solution (if one is infusing). 2. Notify primary provider. 3. Possible culture of insertion site and catheter tip. 4. Discontinue IV catheter. *most care is preventive*:

abruptio placentae; Risk Factors

Mom over 35 Poor nutrtion Multiple gestation Alcohol, smoking Poor controlled hypertension Severe abdominal trauma

placenta previa; Nursing Management

Monitoring of maternal-fetal status Vaginal bleeding; pad count *Avoidance of vaginal exams* FHR Support and education: fetal movement counts, effects of prolonged bed rest (if necessary); signs and symptoms to report Preparation for c-section i Blood type & cross to prepare for blood transfusion Preparation for possible cesarean birth Tocolytics Rhogam (if needed)

brain tumors

Most common solid tumors in children 20% of all childhood cancers (3/100,000/yr) 2nd most common kind of childhood cancer Cause unknown; can be malignant or benign Avoid this terminology though-they associate with curative Cells have spread or not spread Most occur in the midbrain, cerebellum & brainstem Always treat tumors in the brain. Not a lot of room for extra growth and increased pressure is problematic Any tumor can be fatal depending on size, location and effects on adjacent organs.

breast cancer; clinical manifestations

Most often in *upper, outer quadrant* (has most glandular tissue) If palpable, cancer is hard, irregularly shaped, poorly delineated, non mobile, non tender Nipple discharge may be present, unilateral Peau d'orange Advanced signs may included skin dimpling, nipple retraction, skin ulceration or enlarged lymph nodes

magnetic resonance mammography (MRM)

Most useful in patients with proven breast cancer when assessing for multifocal or multicentric disease, chest wall involvement, tumor recurrence, or response to chemotherapy. It can detect tumor angiogenesis (vessel growth) that accompanies a majority of breast cancers—even early ones. Currently MRM is used as a complement to mammograms.

immunizations during chemo

NO live virus vaccines in immunocompromised child Delay vaccination with MMR virus until 3 months after chemo complete Avoid exposure to varicella

Drinking during pregnancy

No amount is safe intake increases the risks of defects damage can occur at any stage cognitive & behavior issues are lifelong these defects are completely preventable

arrest disorders

No progress for more than 2 hours

Are most seizures from epilepsy?

No. Mostly from high fever, infection or head trauma, hypoxia, toxins or cardia arrhythmias

intrauterine fetal demise

Numerous causes Devastating effects on family and staff Nursing Assessment Inability to obtain fetal heart sounds Ultrasound to confirm absence of fetal activity Labor induction Nursing Management Assistance with grieving process Referral for mental health care

...

Nursing Assessment Prevention; risk factors Continuous assessment of client and fetus Nursing Management Prompt recognition is the key Measures to relieve compression Knee chest position Assist to changing position & placing a sterile gloved hand up off of the cord until the baby is delivered

labor induction & augmentation: Assessment & Management

Nursing Assessment Relative indications; gestational age determination Fetal status; maternal status; Bishop's score (8 & up, good chance of vaginal delivery) Nursing Management Explanations Oxytocin administration Pain relief and support

....

Nursing Assessment Risk factors C-section uterine scarring Multiparity Too much stimulation of the uterus, excessive Onset of sudden fetal distress; other signs Continuous acute abdominal pain Vaginal bleeding Hematuria Loss of station of presenting part hypovolemic shock Nursing Management Preparation for urgent cesarean birth Continuous maternal and fetal monitoring *MASSIVE blood loss can occur*

Causes of dystocia: Problems with the Passenger

Occiput posterior position-sunny side up Breech presentation Multifetal pregnancy Macrosomia Cephalopelvic disporportion (CPD) Structural abnormalities

hyperemesis gravidarum; nursing assessment

Onset, duration, course of N/V; diet history; risk factors, weight, associated symptoms, perception of situation ^Liver enzymes, ^CBC, BUN, down electrolytes, ^urine specific gravity, ultrasound to look for molar pregnancy or check for multiples

Ectopic pregnancy

Ovum implantation outside the uterus Obstruction to or slowing passage of ovum through tube to uterus Often due to tubal scarring from PID Twice as likely with Chlamydia Therapeutic Management Medical: drug therapy (methotrexate, prostaglandins, misoprostol, and actinomycin) Surgery if rupture Rh immunoglobin if woman Rh negative *risk for massive hemorrhage* Rupture can be very painful. May have a rigid abdomen Common site is fallopian tube. Potential for ruputure increases as time passes.

managing chemo side effects; anemia

PRBC transfusion Limit activity - as tolerated Procrit RBC stimulator

seizure precautions (KNOW THESE)

Padding of side rails and other hard objects Side rails raised on bed at all times when child is in bed Oxygen and suction at bedside Supervision, especially during bathing, ambulation, or other potentially hazardous activities Use of a protective helmet during activity may be appropriate. Child should wear a medical alert bracelet.

abruptio placentae; classifications

Partial abruption with concealed hemorrhage. Partial abruption with apparent hemorrhage. Complete abruption with concealed hemorrhage.

Causes of Dystocia: Problems with the Passageway

Pelvic contraction Making the passageway to small Obstructions in maternal birth canal Caused by swelling that interferes with descent

self reflection

Perform self-reflection of one's own values/beliefs. Acknowledge one's own feelings and behaviours toward working with clients, families and colleagues who have different cultural backgrounds, health behaviours, belief systems, and work practices. Explore one's strategies for resolving conflicts that arise between self and colleagues and/or clients from diverse groups. Recognize and address inequitable, discriminatory, and/or racist behaviours or institutional practices when they occur

Cultural Influences on Health Care

Physiologic variations Reactions to pain Mental health Gender roles Language and communication Orientation to space and time Food and nutrition Family support Socioeconomic factors

cervical insufficiency

Premature dilatation of cervix Usually occurs in 4th or 5th month before viability Cause unknown; possibly due to cervical damage Cervical cancer survivors. Part of certix is removed and weakens cervix.

Causes of CP

Prenatal, Stroke Infection Brain bleed asphysia Perinatal, Prolonged labor Premature birth LBW, esp. <36wks Postnatal Sepsis Meningitis Non-accidental trauma, (Shaken Baby Syndrome)

ELLA

Prevents pregnancy when taken orally with 5 days after contraceptive failure or unprotected intercourse Not intended for routine contraception Progesterone agonist/antagonist: main effect is to delay or inhibit ovulation

3 stages of syphylis

Primary Stage: •Heralded by a single or multiple chancres (lesion) • The chancre is usually firm, round, small and painless. It appears at the spot where syphilis entered the body. Chancre lasts 3 - 6 weeks, and heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage. Secondary Stage: •Skin rash and mucous membrane lesions •Rash appears as rough, red or reddish brown spots both on the palms of hands and the bottom of feet •Fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue •*Signs and symptoms (but not infection) will resolve with or without treatment* Latent Stage: •Begins when primary and secondary symptoms disappear •No signs or symptoms; infection remains in the body •Develops in about 15% of untreated persons •Can appear 10 - 20 years after infection was first acquired •Damage to internal organs: brain, nerves, eyes, heart, blood vessels, liver, bones, and joints Signs and symptoms include: difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia *may cause death*

ANA (American Nurses Association)

Professional organization for all RNs. Concerned with licensure, collective bargaining and education political interests state constiuents

indications for forceps/vacuum assisted birth

Prolonged second stage of labor, non-reassuring FHR pattern, failure of presenting part to rotate & descend, limited sensation or inability to push effectively, presumed fetal jeopardy or fetal distress, maternal heart disease, acute pulmonary edema, intrapartum infection, maternal fatigue, infection

Dystocia management

Promoting labor progress Providing physical and emotional comfort Promoting empowerment

Umbilical Cord Prolapse

Protrusion of the umbilical cord before the baby Obstetric emergency Pathophysiology: partial or total occlusion of cord with rapid fetal deterioration

causes of dystocia: problmes with the Psyche

Psychological distress Young moms Hormone imbalances may impede Decreased release of stress hormones may cause hypoxia

McRoberts maneuver

Pull knees to head to open up pelvis. The purpose is to straighten the pelvic curve and allow baby's shoulder to pass through

breast cancer; adjunctive therapies

Recommended after surgery. •These therapies include local therapy such as radiation therapy systemic therapies using chemotherapy, hormonal therapy immunotherapy.

Contraception methods

Reversible: Behavioral - abstinence, fertility awareness-based methods, withdrawal Barrier -diaphragm, cervical cap, sponge *MUST REMAIN IN PLACE 6 HOURS AFTER INTERCOURSE.* *Latex condom is most effective, less likely to break* Hormonal - oral, injectable or transdermal patch contraceptive, vaginal ring, implantable contraceptive, emergency contraceptive Rely on estrogen or progestin or combo Permanent: Tubal ligation Vasectomy

Preterm labor: Nursing Assessment

Risk factors Subtle signs* Change in vaginal discharge with mucus/water/blood Feels pelvic pressure, bearing down sensation Low dull back ache Nausea/vomiting/diarrhea Aching in thighs Contraction pattern (4 contractions every 20 minutes or 8 contractions in 1 hour) Cervical effacement > 80% and dilation >1cm Laboratory and diagnostic testing: CBC, urinalysis, amniotic fluid analysis, fetal fibronectin, cervical length via transvaginal ultrasound, salivary estriol, home uterine activity monitoring, nitrazine, fern test

cervical insufficiency: Nursing Assessment

Risk factors, Hx of fetal loss in 2nd trimester Previous incidence Preterm labor hx Pink-tinged vaginal discharge or pelvic pressure Cervical shortening via transvaginal ultrasound <25mm at wk 16-24 is abnormal length

Preterm labor: therapeutic managment

Risk prediction Tocolytic drugs: there are no clear first-line drugs to manage preterm labor; may prolong pregnancy for 2 to 7 days while steroids can be given for fetal lung maturity Antibiotic prophylaxis for women with group B streptococcus (25% of women) More likely if PROM Internal monitoring used Mom has a fever Previous pregnancy with group b Hispanic or African American Antibiotics are given prophylactically (cephalosporins)

febrile seizures

Seizures that result from sudden high fevers, particularly in children. *Greater than 39/102.2* not the result of an intracranial infection, metabolic imbalance and are usually related to a viral illness. usually benign

breast cancer; prognosis

Several factors *Tumor size* - the smaller the better the prognosis. *spread to the lymph nodes* under the arm (axilla) *Breast cancer metastasizes widely and to almost all organs of the body, but primarily to the bone, lungs, lymph nodes, liver and brain*. The first sites of metastasis are usually local or regional...chest wall. .

hyperemesis gravidarum

Severe & relentless form of nausea and vomiting Symptoms usually resolve by week 20 Weight loss >5% of pre-pregnancy body weight Dehydration, ketosis, metabolic alkalosis, and hypokalemia Frist time moms under age 35

Cushing's triad

Signs of increased intracranial pressure: 1. hypertension 2. bradycardia 3. irregular respirations

extravasation

Similar to infiltration but a vesicant or irritating medication or solution infiltrates into the surrounding tissue. Examples of vesicant drugs: vasopressors, calcium, potassium, chemotherapy. Symptoms: Pain, burning, and redness at the site may progress to blistering, inflammation, and necrosis of tissue. Could cause skin sloughing, tissue necrosis, functional or sensory loss in affected area, disfigurement or loss of limb. Interventions 1. Immediately stop infusion. 2. Notify primary provider. 3. Do not discontinue IV until it is known that the protocol does not include running an antidote specific to the vesicant drug through the same line. 4. Discontinue IV catheter. 5. Apply warm or cold compresses, depending on type of solution that extravasated.

intrauterine contraceptives

Small plastic T-shaped device placed uterus inside by Dr. or NP to provide contraception (see Fig. 4.16-p. 151) 3 Types: (Copper) ParaGard & (Hormonal) Mirena & Skyla ParaGard (non-hormonal): May be used for up to 10 years. (3-5 years is usual) Release of copper ions prevents pregnancy by making the endometrium of the uterus hostile to implantation of a fertilized egg by causing a nonspecific inflammatory reaction and inhibiting the meeting of sperm and egg. Mirena & Skyla(low dose progestin): Effective for 5-7 years. Causes thinning endometrium of uterus and thickening of mucus that is hostile to sperm. Possible adverse reactions: Dysmenorrhea (painful periods) Heavy bleeding Uterine perforation Ectopic pregnancy

PROM/PPROM Risk Factors

Smokers No/reduced prenatal care Low BMI Placenta previo or abruption UTI Multiples cervical Cerclage amniocentisis

Athetoid (dyskinetic) CP

Smoother, fluid, wormlike movements, but still loss of control Involuntary jerky; but more writhing

conditions associated with early bleeding during pregnancy

Spontaneous abortion Ectopic pregnancy Gestational trophoblastic disease Cervical insufficiency

Fosphenytoin (Cerebyx)

Steven Johnson Syndrome (rash)

Implantable Hormonal Contraception

Subdermal time-release that delivers synthetic progestin which inhibits ovulation. Minor surgical procedure to implant and later remove. Delivers 3 years of continuous, effective contraception. Mechanism of action and side effects identical to other progesterone only hormonal contraceptives. Women should be counseled prior to insertion that they might experience initial irregular bleeding and/or amenorrhea (no menstrual bleeding) as time progresses.

atonic seizure

Sudden decrease in muscle tone -> loss of postural control -> patient may fall ("drop attack") injury may result from fall seen in kids with Lennox-Gastaut syndrome

infantile spasms

Sudden, rapid flexion of neck and truck, adduction of shoulders and outstretched arms, variable flexion of lower extremities mode unknown usually between 3-12months peak at 3-7months rarely seen after 18 months Treatment is ACTH via IM injection.

occiput POSTERIOR position

Sunny side up

Acculturation

The adoption of cultural traits, such as language, by one group under the influence of another.

Bishop Scoring System

The duration of labor is inversely cor-related with the Bishop score: a score over 8 indicates a successful vaginal birth. Bishop scores of less than 6 usu-ally indicate that a cervical ripening method should be used prior to induction Based on Dilation (cm), Effacement (%), Station Cervical Consistency, Position of Cervix

breast cancer; surgical management

The main goal of surgery is to gain local control of the disease. Breast-Conserving surgery - lumpectomy with radiation therapy Simple Mastectomy- removal of all breast tissue and the axillary nodes and pectoral muscles are spared. Modified Radical Mastectomy - removal of breast tissue and a few positive axillary nodes. Priority of care for post-surgical clients includes: *Assessment of respiratory status*. Other nursing interventions include, monitoring of urinary output, assessment of incisional care and of course education regarding lymphedema.

values clarification

The process that allows individuals to become fully conscious of their values so they can be more self-directed and effective in achieving optimal wellbeing.

metastasis

The spread of cancer cells beyond their original site throught the lymphatic system & blood circulation

vaginal ring

Thin, flexible ring that releases progestin and estrogen. Ring is placed by squeezing it between thumb and index finger while inserting it into vagina Ring is worn for 3 weeks, removed for one week. (It is taken out the week of the period.) After the period a new ring is inserted. Side effects are the same as "the pill" .

types of spontaneous abortions

Threatened Spotting early. No loss of fetal tissue. Inevitable Bleeding, Ruptured membranes & dilation Incomplete Heavy bleeding with some fetal tissue DC needed Complete Passage of all products of conception Missed Non viable embryo retained for 6 weeks Habitual Hx of 3 or more consecutive, spontaneous abortions

abruptio placentae; nursing management

Tissue perfusion: *left lateral position*, strict bed rest, oxygen therapy, vital signs, *fundal height*, continuous fetal monitoring, Support and education: empathy, understanding, explanations, possible loss of fetus, reduction of recurrence Big IV needed May need blood transfusion Catheter to monitor kidney function Monitor vaginal bleeding every 15 minutes C-section will be needed to stop the bleeding and try to save mom and baby

RN's rold for culturally sensetive care

To be an advocate for the patient, in finding a solution for their problems by making referrals to appropriate ancillary staff and agencies. To be open minded and non-judgmental regarding culturally sensitive patient issues. Be more accepting and understanding about the diversity of culture in the surrounding community. Provide education for the culturally diverse community. Treat each client as a unique individual, keeping in mind that culture is just part of the person's wholeness.

Preterm Labor: Nursing Management

Tocolytic administration *Magnesium sulfate torbuteline* Client education Recognition of s/s of preterm labor Appropriate prenatal care Identifying and reducing risks Simple as preventing dehydration Psychological support Assess stress level Domestic violence? Makign referrals as necessary Looking for the underlying cause

fluid overload

Too large a volume of fluid infuses into the circulatory system. Rapid infusion of an IV solution could also be a cause. Symptoms: Increased blood pressure, dyspnea, moist crackles, cough, restlessness, distended neck veins, rapid & shallow respirations. Interventions: 1. Slow IV rate. 2. Notify primary provider immediately 3. Place patient in high Fowler position. 4. Monitor vital signs and breath sounds frequently.

spontaneous abortion: nursing Management

Treat the underlying cause Continued monitoring: vaginal bleeding, pad count, passage of products of conception, pain level, preparation for procedures, medications Support: physical and emotional; stress that woman is not the cause of the loss; verbalization of feelings, grief support, referral to community support group. VERY important *1 pad/hr is significant*

Dystonic CP

Twisting movements, Malrotation of legs

malignant cells are

Undifferentiated Variable, depending on the level of differentiation, the more undifferentiated, the faster the growth Invades Metastasize into blood, lymph, other areas of the body

fertility awareness-based methods

Use physical signs & symptoms that fluctuate throughout menstrual cycle to predict fertility. Pregnancy is avoided by abstinence or barrier methods during times of fertility. *Most effective if menstrual cycles are regular*. Rely on the following assumptions: Ovum is released 14 days prior to menstruation and it lives approximately 24 hours Sperm can live 5 days after intercourse. Fertile or unsafe period is 3 days before and 3 days after ovulation. Exact time of ovulation cannot be precisely determined, so an addition 2-3 days should be added to the beginning and end of fertile period.

threatened abortion

Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed. Therapeutic Management: Conservative supportive treatment Possible reduction in activity in conjunction with nutritious diet and adequate hydration

inevitable abortion

Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open. Therapeutic Management: Vacuum curettage to reduce risk of excessive bleeding and infection Prostaglandin analogs such as misoprostol to empty uterus of retained tissue (only used if fragments are not completely passed)

vetriculoperitoneal shunt

VP Shunt main treatment of hydrocephalus to drain excess CSF. Complications include; infection obstruction revision as the child grows *rapid drainage* will decrease ICP and cause extreme headache, collapse of the ventricles, formation of subderal hematomas and neurological deterioration

Spontaneous abortion: Nursing Assessment

Vaginal bleeding-amount, color- 1pad/hr is significant. Cramping or contractions-frequency & duration Vital signs, pain level Client's understanding - does she know what is happening?

Pregnancy Adolescents; nursing assessment

Vision of self in future Realistic role models; emotional support Level of child development education Financial and resource management; work and educational experience Anger and conflict resolution skills Knowledge of health and nutrition for self and child Challenges of parenting role Community resources USUALLY Occurs within 6 months of becoming sexually active. 1 in 4 will have another baby within 2 years.

Benign cells are

Well Differentiated-performing their job. Maybe hyperplastic. Progressive and slow Growth is by expansion, without invasion of the surrounding tissues Does not metastasize

Doll's eyes

When the head is turned to one side, the eyes should move conjugately to the opposite direction if the brainstem is intact evaluated cranial nerve 3, 4 & 5 useful for infants, uncooperative or comatose child *absence of eye movements may indicate ICP*

cephalopelvic disproportion

a baby's head or body is too large to fit through the mother's pelvis

Neonatal Abstinence Syndrome (NAS)

a condition in which a child, at birth, goes through withdrawal as a consequence of maternal drug use Charcteristics include CNS hypersensitivity automonic dysfunction (dizzy, hypotensive) respiratory distress temperature instability hypoglycemia termors seizures abnormal cry patterns feeding difficulties GI disturbances

spina bifida

a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it Neural tube should close at the end of the 4th week of pregnancy. *400mg of Folic Acid* daily is recommended to prevent and reduce risks by 50% May be found in AFP testing or an amnio. IF so, c-section is scheduled Diagnosis made based on presentation and H&P and clinical manifestations Neurosurg is the one who evaluates and does the surgery. Usually within the first 24-48 hours of life. Issues may appear in adolescence as the child has grown. location of the lesion plays a role in the loss of function

essure

a method of tubal sterilization that blocks the oviducts by use of metal coils to create scar tissue

Toxoplasmosis in pregnancy

a parasite which is most commonly transmitted from animals to humans by contact with contaminated feces Host is a warm blooded animal, usually cat. Pregnant women should not change litter boxes. Moms remain asymptomatic, but fetus has low birth weight, enlarged liver and spleen, jaundice, IUGR, hydrocephalus or microencephaly, neurological damage and fetal anemia. The earlier mom is infected, more serious the effects.

Cheyne-Stokes respiration

a pattern of alternating periods of hypopnea or apnea, followed by hyperpnea

mini pill

a progestin-only contraceptive pill Doesn't interfere with breastfeeding Antibiotics don't affect effectiveness Contraindications: Uterine bleeding of unknown etiology Liver nodules or tumors History of bariatric surgery (absorption is skewed) Ovarian cyst or ovarian cancer History of ectopic pregnancy

Professional Identity

a sense of oneself that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse. 7 core values

withdrawal reflex

a spinal reflex that pulls a body part away from a source of pain

confusion

a state in which disorientation exists. alert, but responds inappropriately to questions

postictal state

a state of decreased/altered level of consciousness following an epileptic seizure

stupor

a state of near-unconsciousness or insensibility response only to vigorous stimulai

cold knife cone biopsy

a surgical scalpel or laser is used to remove cervical tissue.

hydrocephalus

abnormal accumulation of fluid (CSF) in the brain causing enlargement and ICP must be identified early treatment needs to be initiated to prevent brain damage from ICP a VP shunt is usually placed

dystocia

abnormal or difficult labor

Leukokoria

abnormal white retinal reflex in a newborn (the expected red reflex is absent); further evaluation is needed to determine the cause

lack of response to painful stimuli is

abnormal! may indicate a life threatening condition Report this finding immediately to the HCP

NLN (National League for Nursing)

advanced excellence in education professional development teaching resources

scoliosis

an abnormal lateral curvature of the spine Multiple causes Idiopathic Congenital/chromosomal Neuromuscular disorders Involves lateral curve, rotation and thoracic hypokyphosis Manifestations One leg may appear shorter than the other Clothes may not fit right, or hang right. Therapeutic Management Surgery >40 degree Straighten spine & increase functional ability Braces, spinal fusion, rods Post surgery Frequent turning, neurovascular assessments, sensation, strength, cap refill, swelling

cheyne stokes respirations

an abnormal pattern of breathing characterized by periods of apnea followed by deep rapid breathing

leukoblasts

an immature leukocyte, or white blood cell

iron deficiency anemia

anemia resulting when there is not enough iron to build hemoglobin for red blood cells Usually due to inadequate dietary intake of iron Therapeutic Management: eliminate symptoms, correct deficiency, replenish iron stores Nursing Assessment Fatigue, weakness, malaise, anorexia, susceptibility to infection (frequent colds), pale mucous membranes, tachycardia, pallor, bluish tinge to lips Abnormal lab results Low hemoglobin, low hematocrit, low serum iron, microcytic and hypochromic cells (pale, tiny cells), and low serum ferritin

breast cancer; chemotherapy

anticancer agents in addition to other treatments to delay or prevent a recurrence of breast cancer. It is systemic common side effect include nausea, vomiting, bone marrow suppression, taste changes, alopecia fatigue.

abruptio placentae; therapeutic management

assessment, control, and restoration of blood loss; positive outcome; prevention of DIC - DIC-little blood clots form all throughout the body in small vessels

One pupil dilated and reactive

associated with intracranial mass

full consciousness

awake and alert, oriented to time, place, and person, behavior appropriate for age

obtunded

awakens with difficulty, responds appropriately when aroused

tonic neck reflex

baby head turned to a side, the extremities on that side extend ( birth to 4 months)

veins of choice for venipuncture

basilic cephalic median metacarpal

priority nursing assessment for a change in LOC

call the HCP

micro calcifications

can be an early sign of breast cancer detectable by mammography NOT ultrasound Ultrasound can detect cysts

characteristics of cancer in adults

cancerous cells generally arise from epithelial cells (in organs, resulting in carcinomas), rather than the embryonal (neuroectodermal) cells Organs, skin Environmental agents Usually found on screening May develop over 20 years Not as responsive

preterm labor

cervical changes and regular uterine contractions occurring between 20 and 37 weeks of pregnancy

neurolgical disorders; motor function

changes in gait, muscle tone or strength may indicate: ICP head injury cerebral infection

venipuncture

check order wash hands prime lock IWIN explain procedure Select site mark site release tourniquet cleanse site don clean gloves Reapply tourniquet rotate hub stabilize vein bevel up, 10-30 degree angle, quick thrust flashback advance catheter off needle release tourniquet karate hold snap safety attache primed saline lock tape flush dress discard gloves label reposition client document

systemic lupus erythematosus (SLE) during pregnancy

chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs pregnancy is a trigger-STRONG correlation to stress Nursing Assessment: Profound fatigue, General malaise, Fever, Poly arthritis, Skin rashes, Multi organ involvement, Abnormal kidney and clotting labs, Signs of infection Nursing Management: Be on a low dose of prednisone (that may lead to gestational diabetes) Discussion of future contraception

Characteristics of cancer in pediatrics

clinical manifestations of cancers are most often related to changes in the blood cells. Can be compression, infiltration, or obstruction, or in solid tumors, Embryonic cells Short latent period Detection is usually accidental Responsive to treatment Leukemia is the most common form Changes in the CBC

cervical cancer; therapeutic management

colposcopy; management depends on severity and woman's health history •choices all involve destroying as many affected cells as possible.

Paro Virus B19 in pregnancy

common & self limiting if mom gets it. Causes fifth disease. Fetal anemia, spontaneous abortion.

Epilepsy

condition in which seizures are triggered recurrently from within the brain. commonly discovered in childhood mostly unknown etiology good prognosis many kids outgrow it *management focuses on controlling seizures or reducing their frequency*

Cerebral Palsy (CP)

condition of motor dysfunction caused by damage to the cerebrum during development or injury at birth; characterized by partial paralysis and lack of muscle coordination *Non-progressive* Secondary Conditions Seizures Behavioral issues Musculoskeltal issues Mild and severe MOST common physical disability in childhood

strabismus

crossed eyes

cervical cancer; treatment options

cryotherapy cone biopsy on ionization LEEP ore LLETZ Cold knife cone biopsy Laser therapy (cramping and bleeding may occur after the above) Hysterectomy Radiation Therapy Chemoradiation (cisplatin)

Vital sign changes during ICP

decreased pulse & respirations Increased blood pressure and pulse pressure increased ICP decreases the cerebral blood flow significantly. A response is triggered that increases arterial pressure in order to overcome the increased ICP.

Multiple Sclerosis (MS) during pregnancy

degenerative disease characterized by sclerotic patches along the brain and spinal cord Depends on severity Greater risk for falls Inadequate muscle strength for labor Not usually a big issue

placent previa; therapeutic management

dependent on bleeding, amount of placenta over os, fetal development and position, maternal parity, labor signs and symptoms Contractions may or may not occur

Spina Bifida Clinical Manifestations

depends on type and level of defect tethered spinal cord brain abnormalities External lesion Tuft of hair---closed----true spina bifida. External dimpling-do diagnostics-may not have any deficits. Often develop scoliosis Muscle atrophy in lower extremities (depends on location of deformity) Poor bladder control Contractures Club foot Hydrocephalus Chiari malformation-incomplete drainage of CSF

cryotherapy

destruction of cervical tissue by freezing with liquid nitrogen

graduate competencies for nursing identity

developed by the NLN (National League of Nursing)

breast cancer during pregnancy

diagnosed and treated the same EXCEPT no radiotherapy, no chemo in first trimester. No termination necessary defined as diagnoisis during gestation or within 1 year of birth

pulse pressure

difference between systolic and diastolic pressure 40-60 is normal

neurological disorders; sensory function

distinguish between light touch, pain vibration heat cold alterations can result from brain or spinal cord lesions

Tocolytics

drugs used to stop preterm labor Magnesium

labor augmentation

enhances ineffective uterine contractions after labor has begun

post term assessment

estimated date of birth; daily fetal movement counts, non-stress tests twice weekly, amniotic fluid analysis, weekly cervical examinations, client understanding, anxiety, and coping ability

Fern test

estrogens in amniotic fluid cause crystallization of the salts ; crystals appear as a blade of fern

Important Vital signs for patient with ICP

expect: Increased blood pressure and pulse pressure drop in Pulse & Respirations

post term management

fetal surveillance; decision for labor induction; support; education, intrapartal care

seizures; nursing management

focus on preventing injury administer appropriate medications provide education & support to family

Acute Myelogenous Leukemia (AML)

form of leukemia that arises from immature bone marrow cells

5 levels of consciousness

full consciousness confusion obtunded stupor coma

BRCA1 and BRCA2 gene

genetic test for women who have two first degree relatives who were diagnosed with breast cancer before the age of 50 or women who have family history of both breast and ovarian cancer. Test results are either positive or negative for the presence of the gene.

Muscular Dystrophy

group of x linked inherited diseases characterized by progressive weakness and degeneration of muscle fibers without involvement of the nervous system Missing protein called dystrophin. largest group of muscle diseases in kids Duchenne, Becker, limb girdle

invasion

growth of the primary tumor into surrounding tissues

loop electrosurgical excision procedure (LEEP) or large-loop excision of the transformation zone (LLETZ)

gynecologic procedure that uses a thin, low-voltage electrified wire loop to cut out abnormal tissue in the cervix

neurological disorders; head, face & neck

head circumference may indicate microcephaly or hydrocephaly

most dangerous complication of pregnancy

hemorrhage bleeding at any time during pregnancy is potentially life threatening

vagus nerve stimulation

implantable device that deliver electrical impulses to left vagus nerve; set to send a stimulus from the vagus nerve to the brain to interrupt seizure activity.

placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus *Painless Placenta Previa Bright Red Blood in 2nd/3rd Trimester*

neurological disorders; reflexes

infant cannot perform tasks on demand. reflexes needed to assess neuro health. Moro tonic-neck withdrawal reflex

chorioamionitis

inflammation of the chorion and amnion

lumbar puncture (LP)

inserting a needle into the lumbar region of the spine in order to collect spinal fluid, commonly called a "spinal tap" Newborn positioned upright, head flexed forward child positioned on the side, head flexed forward, knees to abdomen use distraction maintain asepsis encourage fluids after apply EMLA cream to site 30-60 min prior.

Post term labor

labor that occurs after 42 weeks gestation unknow etiology

macrosomia

large-bodied baby commonly seen in diabetic pregnancies

varicella voster in pregnancy

lays dormant in the system. Chicken pox & shingles. Congenital syndrome can occur if infected during first trimester. Low birth weight, skin lesions in a linear pattern, spontaneous abortion, cataracts, growth restriction, intellectual disabilities, early death

Nursing Education

learning a body of knowledge (foundation) understand core values and beliefs of the profession context of professional practice emphasize: elxellence caring integrity diversity holism patient-centeredness ethical practice valued & applied *guided reflection is critical*

2nd trimester spontaneous abortion

likely related to maternal conditions such as: Diabetes Hypertension Herpes UTI

leukopenia

low WBC count

placenta previa; classifications

low lying marginal partial complete

FASD phenotype

low nasal bridge epicanthal folds short palpebral fissures flat mid face short nose thin upper lip indistinct philtrum micrognathia

post term labor: fetal risks

macrosomnia-big baby shoulder dystocia, brachial plexus injuries, Pressure during birth from all the pushing May cause permanent nerve injury low Apgar scores, postmaturity syndrome, cephalopelvic disproportion

neuroblastoma

malignant abdominal tumor •Occurs in about 1/7,000 live births •95% occur in children under 10 years of age, but the most common diagnosis is at age 23 months •Slightly higher incidence in boys •Primary site is the abdomen (adrenal gland or retroperitoneum) , can also occur in the head, neck, chest or pelvis •Originate from embryonic neural crest cells that form the adrenal medulla and sympathetic nervous system (considered a silent tumor)

astrocytoma

malignant tumor of astrocytes (glial brain cells)

neurological disorder; health history

may be significant for prematurity difficult birth infection during pregnancy nausea vomiting headaches changes in gait falls visual disturbances recent trauma delays in growth & development

neurological disorder; vital signs

may provide underlying cause ICP, cerebral infections brain stem injury head injury May cause increase BP & Pulse Pressure, decrease pulse & respirations

colposcopy

microscopic examination of the lower genital tract using a magnifying instrument called a colposcope.

isoimmunization

mixture of fetal and maternal blood causing anti-D antibodies to be produced

Substance Abuse effects on fetus

most common poor feeding irritability

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges

CA-125 (cancer antigen-125 tumor marker)

non-specific blood test used as a generalized tumor marker in the detection of ovarian cancer. It is also used to monitor treatment and to determine the extent of the disease High degree of sensetivity by not specificity

pinpoint pupils

often observed in poisonings, brain stem dysfunction and opiate use

breast self exam

once considered essential, now optional instead stress breast awareness self exam is one way for women to be familar with their breast tissue

Acute leukemia

onset of symptoms is quick, sometimes within a few weeks. Mostly affects kids Leukocyte development is stopped at the blast phase and then those leukocytes are undifferentiated. (baby WBC's with no function) Can progress quickly and can lead to death within weeks to months without treatment. 95% with ALL have initial remission -Will have remission during induction phase <5% -Those first 7ish days 80% live 5 years or longer -Some will relapse

abruptio placentae; clinical manifestations

painful, dark-red vaginal bleeding (port-wine color) "knife-like" abdominal pain; uterine tenderness; contractions; decreased fetal movement. Fetal distress Rapid assessment is essential to ensure prompt, effective interventions to prevent maternal and fetal morbidity and mortality

who is usually the first to notice changes in LOC

parents Listen & respond

fine needle aspiration

placement of a very thin needle inside the tumor mass and extracting cells for microscopic evaluation less expensive, results available quickly

Craniostynostosis

premature closure of cranial sutures. Can inhibit brain growth distorted skull appearance prominent ridge, palpable surgery may be needed. usually occurs later in child hood.

abruptio placentae

premature separation of the normally located placenta from the uterine wall *Medical Emergency* After 20weeks Leads to massive hemorrhage Degree of distress depends on how much abruption has accured. Etiology unknown Vital signs can be within normal range, even with significant blood loss, because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shock

Preterm Premature Rupture of Membranes (PPROM)

premature spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation. *no unsterile digital cervical exams until woman is in active labor* expectant management if fetal lungs immature betamethasone Nursing Assessment: risk factors, signs and symptoms of labor, electronic FHR monitoring, amniotic fluid characteristics Nitrazine test, fern test, ultrasound

Epilepsy; treatment

primary mode is anticonvulsants Goal is to use the fewest drugs with the fewest side effects that control the seizures may take time May use: vagal nerve stimulator Ketogenic diet

indications for labor induction or augmentation

prolonged gestation, prolonged premature rupture of the membranes, gestational hypertension, cardiac disease, renal disease, chorioamnionitis, dystocia, intrauterine fetal demise, isoimmunization, diabetes

NAS baby; nursing management

promote comfort (low environmental stimuli) swaddle to decrease irritability gentle rocking & pacifier meet nutritional needs prevent complications May need morphine or phenobarbital. promote parent/child interactions! At risk for sking breakdown, dehydration & irritability

NCSBN (National Council of State Boards of Nursing)

protect public health & welfare set standards licensure KSBN (KS)

spina bifida myelomeningocele

protrusion WITH SPINAL CORD, sensory & motor deficits, LE paralysis, incontinence If it breaks the priority is to call the doctor. Keep it moist, warm & intact.

ACEN (Accreditation Commission for Education in Nursing)

provide specialized accredidation for all types of nursing programs

myoclonic seizure

quick, repetitive jerks

mammography

radiographic imaging of the breast can detect tumors smaller than 1cm (palpable at 2.5cm) *gold standard screening method for breast cancer* >40=annual screening

sentinel lymph node biopsy

removal and examination of the sentinel nodes which are the first lymph nodes to which cancer cells are likely to spread from a primary tumor *the status of the lymph nodes is the most important prognostic factor in breast cancer*

Fixed and dilated pupils

represents at neurological emergency associcated with brain stem herniation due to ICP

Increased Cranial Pressure (ICP)

rise in the pressure inside the sull that can result from or cause brain injury

most important way to reduce addiction in pregnancy

routine screeing and education

sunset eyes

sclera above iris late sign of ICP priority assess

substance abuse in pregnancy; assessment

screen all pregnant women use screening questionnaires use accepting terminology use urine toxicology screenings *being non-judgement is the key to success* a positive drug screen in a newborn warrants an investigation by CPS.

Dilated but reactive pupils

seen after seizures

absence seizure

seizure involving a brief loss of consciousness without motor involvement; previously termed petit mal (little bad) seizure uncommon before age 5 no postictal state may have small jerks, twitching multiple occur daily

habitual abortion

spontaneous abortion occurring in 3 or more consecutive pregnancies Therapeutic Management: Identification and treatment of underlying cause (possible causes such as genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases, or immunologic problems) Cervical cerclage in second trimester if incompetent cervix is the cause

Premature Rupture of Membranes (PROM)

spontaneous rupture of the amniotic sac prior to the onset of true labor after the 37th week of gestation *no unsterile digital cervical exams until woman is in active labor* Nursing Assessment: risk factors, signs and symptoms of labor, electronic FHR monitoring, amniotic fluid characteristics Nitrazine test, fern test, ultrasound

coma

state of profound unconsciousness from which person cannot be aroused even with painful stimulai

tonic-clonic seizure

stiffening-jerking, then relaxation; repeat a major motor seizure involving all muscle groups; previously termed grand mal (big bad) seizure associated with an aura Loss of consiousness occurs cyanosis may occur loss of bladder control is common no memory of seizure postictal state after and will sleep deeply 30min-2hrs *safety is primary concern* no restraints protect head roll to their side time seizure suction AFER seizure

labor induction

stimulating contractions via medical or surgical means

Pregabalin (Lyrica)

suicidal thoughts

Cone biopsy (conization)

surgical removal of a cone-shaped segment of the cervix for diagnosis or treatment useful for precancers and early cancers

Chronic Leukemia

symptoms develop over months to years, most of the leukocytes produced are mature. Affects mostly adults Progression is slower than in acute, disease process can extend for years.

Trastuzumab (Herceptin)

targets, binds to and inactivates the HER-2/neu protein, thus slowing tumor growth. Side effects include cardiac toxicity, thrombosis, fever chills, N/V pain.

Group B Streptococcus in pregnancy

test for bacterium that, if transmitted from the mother, can cause life-threatening infections in newborns

culture

the enduring behaviors, ideas, attitudes, and traditions shared by a large group of people and transmitted from one generation to the next

Duchenne Muscular Dystrophy (DMD)

the most common and severe. Number 1 lethal cause of genetic disorders for children. Affects exclusively little boys. normal development until age 3-5 when they may notice an increase in falls and coordination issues, issue with stairs and fatigue quickly. Pseudohypertrophy of large muscle groups. Upper arms and upper legs may feel unusually firm. May have tightness in those muscles May tippy toe walk. Later they develop profound muscle atrophy. Gowers sign. Characteristic way of going from sitting to standing . Potential complications Falls Respiratory compromise Cardiomyopathy No cure Use corticosteroids, but it is supportive not curative Diagnosed with a muscle biopsy. Many have cognitive learning disabilities Can develop contractures over time. Life expectancy is late adolescence, early 20's Develop scoliosis; affects heart and lungs Need wheelchairs usually by elementary age. LOTS of therapy, pT, ot etc.

functional ability

the physical, psychological, cognitive, and social abilities to carry out the normal activities of life

Enculturation

the process by which culture is learned and transmitted across the generations

pregnancy in women with HIV

threats to self, fetus, and newborn - Early identification can allow early treatment & prevent transmission Therapeutic Management: - oral antiretroviral drugs twice daily from 14 weeks until birth - IV administration during labor - oral syrup for newborn in 1st 6 weeks of life - decision for birthing method-*strong rec for c-section, not required* •Nursing Assessment: - history and physical examination; •Multiple partners - HIV antibody testing - testing for STIs Herpes Syphllis HPV

Zika Virus Symptoms in pregnancy

transmitted by adenes mosquitoes it cause fever, rash, joint pain, conjunctivitis, muscle pain, headache causes microcephaly, profound intellectual disabilities. Getting bit while pregnant is the issue. Unknown whether or not it can lay dormant.

retinoblastoma

tumor arising from a developing retinal cell (a congenital, malignant tumor) •Most common intraocular malignancy in children. Can be hereditary •Average age at diagnosis 17 months, mostly occurs under 5 years old •Majority are nonhereditary unilateral •Caused by somatic mutation (normal cells), germinal mutation (more primitive cells) or chromosomal abnormality •Mutated gene is unable to produce the body's natural signals to stop the growth of the retinal cells and the child can die.

hypertonic uterine dysfunction

uncoordinated uterine activity. Contractions are frequent and painful but ineffective in promoting dilation and effacement. Uterus doesn't relax between contractions Stresses baby, decreases O2 when squeezed.

emergency contraception

use of high-dose contraceptives to prevent pregnancy after unprotected sex *Contrary to popular misconception, emergency contraception is NOT a form of abortion, and may provide a woman's last chance to avoid pregnancy*. Plan B must be used within 72 hours of unprotected intercourse (i.e. date rape) or failed contraception (torn condom). Ideally first dose within 12 hours The sooner used the better. Reduces chance of pregnancy by 80%.

stereotactic needle guided biopsy

used on non-palpable lesions detected by mammography. Allows avoidance of surgical biopsy

breast cancer; radiation therapy

used to decrease the chance of a local recurrence in the breast by eradicating residual microscopic cancers cells. Acute side effects consist of mild to moderate erythema, breast edema, fatigue. skin breakdown.

spina bifida meningocele

vertebrae don't completely enclose spinal cord, cerebrospinal fluid exits through opening, but no nerves enter the "bulge"

Hepatitis B virus in pregnancy

virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood Preterm birth, fetal distress during labor, meconium peritonitis, low birth weight & neonatal death. Infected newborns will be lifelong carriers.

breast self-examination technique

visual inspection, then tactile palpation Note: changes in size, color, contour or symmetry sores, scaly skin or discharge palpate: in a spiral, wedge or vertical strip use a circular rubbing motion with the pads of 3 fingers without lifting the fingers use light, medium and firm pressure

Will mental health facilities give preference to a pregnant women?

yes

reproductive cancer; diagnositics

• Clinical breast exam • Mammography • Pap smear • Transvaginal Ultrasound • CA - 125

GI effects of immobility

• Decreased eating/nutrient intake • Constipation and/or diarrhea • Weak abdominal muscles

Benign mass characteristics

• Frequently painful • Firm, rubbery mass • Bilateral masses • Induced nipple discharge • Regular margins (clearly delineated) • No skin dimpling • No nipple retraction • Mobile, not affixed to the chest wall • No bloody discharge

Obese pregnancy risk factors

• Gestational diabetes • Hypertension • Thromboembolism • Stillbirth • Macrosomia-Bigger baby • Higher rate of C-sections • Infection • Postpartum hemorrhage • Maternal mortality • Precipitous Labor-hard and fast

malignant mass characteristics

• Hard to palpation • Painless • Irregularly shaped (poorly delineated) • Immobile, fixed to the chest wall • Skin dimpling • Nipple retraction • Unilateral mass • Nipple discharge • Spontaneous nipple discharge

risk factors for breast cancer

• High genetic rate • Female sex • Age over 40 • Early menarche • Late menopause • First pregnancy after age 30 • Early or prolonged use of oral contraceptives • High fat diet (possible) • Low fiber diet (possible) • Excessive alcohol intake • Cigarette smoking • Exposure to low level radiation • Hormone replacement therapy • Obesity • History of endometrial or ovarian cancer *More than 80% of all cases of breast cancer are sporadic disease.*

hydrocephalus; assessment

• Irritability • Lethargy • Poor feeding • Vomiting • Complaints of headache in older children • Changes in LOC • seizures • vomiting • In an infant, wide-open bulging fontanels. They will fee full tense and very full. • Upon percussion, a "cracked pot" sound is heard during percussion and can indicate separation of the sutures.

brain tumors; diagnostics

• MRI (most common) • Angiography (MRI or CT) • CT • LP • EEG • Bone scan • Bone marrow aspiration definitive is biopsy

hydropcephalus; nursing management

• Maintaining cerebral perfusion • Minimizing neurologic complications • Maintaining adequate nutrition • Promoting growth and development • Support and educate

managing pain during chemo

• Monitor pain appropriately • Multidisciplinary pain team • Morphine, Fentanyl, Hydromorphone • Non-Pharm and Pharm pain interventions • Avoid IM injections

breast cancer; modifiable risk factors

• Not having children at all or not having children until after age 30—this increases the risk of breast cancer by not reducing the number of menstrual cycles • Postmenopausal use of estrogens and progestins—the Women's Health Initiative study (2002) reported increased risks with long-term (>5 years) use of HRT • Failing to breast-feed for up to a year after pregnancy—increases the risk of breast cancer because it does not reduce the total number of lifetime menstrual cycles • Alcohol consumption—boosts the level of estrogen in the bloodstream • Smoking—exposure to carcinogenic agents found in cigarettes • Obesity and consumption of high-fat diet—fat cells produce and store estrogen, so more fat cells create higher estrogen levels • Sedentary lifestyle and lack of physical exercise—increases body fat, which houses estrogen

preventive & follow up measures for endometrial cancer

• Schedule regular pelvic examinations after the age of 21. • Visit health care practitioner for early evaluation of any abnormal bleeding after menopause. • Maintain a low-fat diet throughout life. • Exercise daily. • Manage weight to discourage hyperestrogenic states, which predispose to endometrial hyperplasia. • Pregnancy serves as a protective factor by reducing estrogen. • Ask your doctor about the use of combination estrogen and progestin pills. • When combination oral contraceptives are taken to facilitate the regular shedding of the uterine lining, take risk reduction measures. • Be aware of risk factors for endometrial cancer and make modifications as needed. • Report any of the following symptoms immediately: o Bleeding or spotting after sexual intercourse o Bleeding that lasts longer than a week o Reappearance of bleeding after 6 months or more of no menses • After cancer therapy, schedule follow-up appointments for the next few years. • After cancer therapy, frequently communicate with your health care provider concerning your status. • After surgery, maintain a healthy weight.

Classifications of CP

• Spastic • Athetoid (dyskinetic) • Ataxic • Dystonic • Mixed

HIV

• Universal testing of pregnant women for HIV - refusal must be documented • Transmission of HIV to newborn can occur across the placenta , through exposure to contaminated blood at birth or through breast milk

Renal effects of immobility

• Urinary stasis in renal pelvis • Voiding in horizontal position • Kidney stones • Impaired peristalisis

Leukemia classifications

• myeloid: uncontrolled granulocyte production • lymphoid: uncontrolled lymphocyte production • acute: short term • chronic: long term

Wilms Tumor

•"Nephroblastoma" •Most common intraabdominal and kidney tumor in children •Peak age is 3 years old; more common in boys •Majority diagnosed under 5 years of age or younger •Typically only one kidney is affected •1-2.5% with familial origin; genetic link? •Most likely comes from malignant, undifferentiated metanephrogenic blastoma (primordial cells) •Rarely metastasis - tumor is encapsulated •Occurrence more in left kidney •Still requires Chemo •Good prognosis

syphylis; implications in pregnancy

•*High risk of stillbirth or early infant death - infants must be treated or death may result* •Can be passed transplacentally to fetus. Left untreated, one of the following can occur: second trimester abortion, stillborn infant at term, congenitally infected infant, uninfected live infant.

retinoblastoma; clinical manifestations

•*Leukokoria*-white eye reflex (white spot on retina) •*Strabismus*- cross eyed appearance •Blindness (late sign) •Orbital cellulitis •Unilateral mydriasis-one eye dilated more •Change in color of iris, white spots •Hyphema-blood in the anterior chamber of the eye •Nystagmus-involuntary eye movements •Weight loss, poor appetite, fatigue •Red painful eyes •glaucomoa

Aromatase Inhibitors

•*anastrazole (Arimidex)* •letrozole (Femara) •exemestane (Aromasin) works by inhibiting the conversion of androgens to estrogens. •Side effects: hot flashes, bone pain, fatigue, nausea, cough, dyspnea and headache. •Usually given to women with advanced breast cancer. •In recent clinical trials, in postmenopausal women with breast cancer, the aromatase inhibitors were shown to be superior to tamoxifen for the treatment of metastatic disease.

risk factor associated with preterm labor & birth

•African-American race (double the risk) •Maternal age extremes (<16 years & >40 years old) •Low socioeconomic status •Alcohol or other drug use, especially cocaine •Poor maternal nutrition •Maternal periodontal disease •Cigarette smoking •Low level of education •History of prior preterm birth (triples the risk) •Uterine abnormalities, such as fibroids •Low pregnancy weight for height •Pre-existing diabetes or hypertension •Premature rupture of membranes •Late or no prenatal care •Short cervical length •STI's: gonorrhea, Chlamydia, trichomoniasis •Bacterial vaginosis (50% increased risk) •Chorioamnionitis •Hydramnios •Gestational hypertension •Cervical insufficiency •Short pregnancy interval (<1 year between births) •Placenta previa •Abruption placenta •Maternal anemia •Urinary tract infection •Domestic violence •Stress, acute and chronic

Risk Factors for preterm labor & birth

•African-American race (double the risk) •Maternal age extremes (<16 years and >40 years old) •Low socioeconomic status •Alcohol or other drug use, especially cocaine •Poor maternal nutrition •Maternal periodontal disease •Cigarette smoking •Low level of education •History of prior preterm birth (triples the risk) •Uterine abnormalities, such as fibroids •Low pregnancy weight for height •Pre-existing diabetes or hypertension •Multiple pregnancy •Premature rupture of membranes •Late or no prenatal care •Short cervical length •Sexually transmitted infections: gonorrhea, Chlamydia, trichomoniasis •Bacterial vaginosis (50% increased risk) •Chorioamnionitis •Hydramnios •Gestational hypertension •Cervical insufficiency •Short interpregnancy interval (<1 year between births) •Placental problems, such as placenta previa and abruption placenta •Maternal anemia •Urinary tract infection •Domestic violence •Stress, acute and chronic

rhabdomyosarcoma; treatment

•Aggressive multimodal therapy due to potential for metastasis •Chemo & radiation to prevent metastasis •Surgery to remove tumor if possible •May not be possible due to location •High dose radiation Chemo for 1-2 years depending on Stage and tumors reaction to chemotherapeutic agents and/or radiation

ewings sarcoma

•Also called Primitive Neuroectodermal tumor •Malignant bone tumor •Arises in the shaft of the long/ trunk bones *from the marrow spaces NOT from osseous tissue* •Most often affects the long bones, femur, tibia, fibula, humerus, ulna, vertebra, scapula, ribs, pelvis & skull •Occurs in individuals younger than 30 years old Usually adolescent, early 20's •More common in Caucasians *no lump on the bone*

endometrial cancer

•Also known as *uterine cancer* •A malignant neoplastic growth of the lining of the uterus. •Uncommon before the age of 40 and risk increases with age.

brain tumor; nursing care

•Assessment • VS, Neurological status • Manifestations • Gait, verbal communication • May have Turban dressing •Positioning • *Lying flat and facing away from light* clue you in • *On non-operative side*, head & neck midline to alleviate pressure. • HOB can be elevated •Pain • Non-pharm and pharm (side effects) •Fluids • Monitor swallow, gag reflex • IVF, Mannitol (used to decrease ICP in acute situations) • Foley-exact measurements

hodgkins lymphoma; treatment

•Based on stage when diagnosed •Chemotherapy - Used in combo with radiation - Main treatment for stage IV •Radiation - Involved field - Extended field Good prognosis Based on age, stage & gender

wilms tumor; treatment

•Based on staging (combination of these) Surgery Chemotherapy Radiation-to shrink tumor •Surgery - removal of tumor, kidney, adrenal and other tissues affected. With both kidneys, partial nephrectomy on other side, transplant from twin, sibling or parent •Chemo for 6-15 months

skeletal effects of immobility

•Bone demineralization •Loss of joint mobility → fibrotic changes • →→ contractures •Hypercalcemia and hyperphosphatemia •Osteoporosis (calcium moves from bones to blood) •Increased fractures •Kidney stones (renal calculi) •Electrolyte imbalances •Bone growth stops, but reabsorption continues

breast cancer statistics

•Breast cancer is a major health problem in the US. •At present there is no cure. •190,000 women and 1900 men develop this disease and more than 40,000 die of it annually. •A new case is discovered every 2 minutes. It is estimated that 1 in 7 women will develop the disease at some time in her life.

Non Hodgkins Lymphoma; diagnostics

•CBC, LFTs, electrolytes, uric acid, LDH •*Bone marrow aspiration/biopsy* of tumor (used for staging) •LP - meningeal involvement •CXR, bone scan, gallium scan, CT, MRI

Genital Herpes

•Cause: Herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2 Clinical Manifestations: •No or minimal signs or symptoms from HSV-1 or HSV-2 infection •When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum •The blisters break, leaving tender ulcers (sores) that make take 2-4 weeks to heal the first time they occur •*Another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak* •*Condoms should be used even when the client is asymptomatic. Herpes infection is chronic and recurrent.* Complications •Recurrent painful genital sores •There is no cure •Can be severe in people with suppressed immune systems Herpes may play a role in the spread of HIV. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious •The treatment regimen for primary genital herpes infections includes acyclovir 400 mg tid for 7-10 days. Client should be taught to abstain from intercourse until the lesions are gone.

Lymphogranuloma Venerum

•Caused by specific strains of chlamydia trachomatis •Associated with homosexual men, but women may also contract •*Begins as painless genital lesions and spreads via lymphatic pathways, if untreated will infect lymphatic and central nervous systems* Stages: •Primary - ulcer that may not be noticed •Secondary - infection has spread to lymph nodes and through lymph pathways; swollen lymph nodes, abscesses are common *Early antibiotic treatment is key to prevent complications*: Tetracycline, Doxycycline, Erythromycin

HPV & Cervical cancer

•Cervical cancer is linked to HPV, which is acquired through sexual activity. •HPV is the most common type of STI with at least 50% of sexually active men and women becoming infected at some point in their lifetime. •Most people who have HPV are asymptomatic and do not realize they have the virus.

cervical cancer; screening & diagnosis

•Cervical cancer is linked to HPV, which is acquired through sexual activity. •HPV is the most common type of STI with at least 50% of sexually active men and women becoming infected at some point in their lifetime. •Most people who have HPV are asymptomatic and do not realize they have the virus.

neuroblastoma; treatment & prognosis

•Chemotherapy is mainstay treatment •*Silent tumor*- 70% of cases diagnosis is made after metastasis has already occurred •Prognosis depends on stage & age •Survival under 1 year of age 75% •over 1 year of age less than 50% •Can have spontaneous regression •Poor prognosis for many •90% survival for low risk stage •30% survival at higher risk stage prognosis is better for under age 1 and low risk stage

cervical cancer; clinical manifestations

•Clinically, the first sign of trouble is *abnormal vaginal bleeding*, usually after sexual intercourse. •vaginal discomfort, malodorous discharge dysuria.

retinoblastoma; prognosis

•Cure rates for survival are better than for retention of useful vision •Survival rate is 95% in unilateral & bilateral tumors •May spontaneously regress •Children w/ hereditary form (bilateral) are more likely to have secondary tumors- osteosarcoma •Usually have vision loss •Radiation can increase risk for secondary tumor

metabolic effects of immobility

•Decreased BMR •Catabolism •High serum calcium •Protein breakdown - negative nitrogen balance •Hypercalcemia •Decreased production of stress hormones •Electrolyte imbalances

integumentary effects of immobility

•Decreased circulation •Edema •Skin breakdown du to Friction/mechanical irritation from bony prominences •Impaired hygiene •Nerve deficits Hot & cold

neuroblastoma; clinical manifestations

•Depend on location and severity of disease (stage) •Symptoms from tumors pressing on organs and other structures •Children with advanced tumor often look very sick •Metastasis: pallor, weakness, pain, irritability, anorexia and weight loss •Lymphadenopathy •Bone pain, limp •Orbits - ecchymosis, edema •Kidneys - urinary frequency, retention

chlamydia; implications in pregnancy

•Doxycycline, ofloxacin and levofloxacin are all contraindicated during pregnancy. Pregnant women are treated with azithromycin or amoxicillin followed by repeat culture in 3 weeks (CDC, 2006). •*Infant may be born with newborn conjunctivitis treated with erythromycin ointment NOT silver nitrate, may develop pneumonia.* Can cause preterm labor and fetal death.

HIV; Pregnancy & Neonates

•ELISA and Western blot tests cannot be used for infants <18 months old, no distinction at that age between infant and maternal antibodies. •NAAT (nucleic acid amplification test) should be performed in the first 12 hrs after birth. Repeat at 1-2 months, 4-6 months and 12-18 months. •For term infants AZT will be given prophylactically 2mg/kg/dose PO every 6 hours beginning at 8-12 hours after birth and continuing for 6 weeks •Newborns are often preterm and/or SGA and show failure to thrive. •Early signs of disease: enlarged spleen and liver, swollen glans, recurrent respiratory infections, rhinorrhea, interstitial pneumonia, GI problems (diarrhea and weight loss), GU infections, persistent oral and genital candidiasis infections and loss of developmental milestones.

retinoblastoma; nursing care

•Education about diagnostic test and pupil dilation •Enucleation of the eye - fear of disfigurement. Discuss post op swelling, bruising. Eye socket shape is kept with surgically implanted "sphere" so there is not a sunken area. •Fitted for prosthesis within 3 weeks •Post op care/dressing changes •Eye protection of "good" eye •Genetic counseling •Infection prevention

genital warts; HPV

•Extremely common Cause: •Human papilloma virus (more than 100 HPV types - at least 14 are cancer causing) •Infects the skin and mucous membranes, especially in genital areas including the skin of the penis, vulva, anus, and the linings of the vagina, cervix, and rectum •*Highly contagious* Clinical Manifestations: •Most people who become infected are unaware of it •Genital warts usually appear as small bumps or groups of bumps in or around vulva or anus, on cervix, penis, scrotum, groin or thigh. •Warts may appear weeks to months after sexual contact with an infected person or may not appear at all. If left untreated, genital warts may go away, remain unchanged or increase in size or number. Complications •Cervical cancer •HPV is linked with cervical cancer. HPV types are often referred to as "low-risk" (wart-causing) or "high-risk" (cancer-causing). In 90% of cases, the body's immune system clears the HPV infection naturally within 2 years. This is true of both high-risk and low-risk types Treatment •Prevention of cervical cancer by routine exams (PAP smears) •Podofilox or imiquimod cream, podophylin resin, trichloroacetic acid or bichloroacetic acid, cryotherapy or surgical removal. Treatment may not be effective Nursing interventions •Counsel client that condoms might reduce the risk for HPV-associated diseases, but HPV infection can occur in areas that are not covered or protected by a condom (e.g. scrotum, vulva, or perianus).

cervical cancer; vaccines

•Gardasil and Cervarix are vaccines approved by the U.S. Food and Drug Administration to protect girls and women from HPV and thus prevent cervical cancer. •The vaccine is not a substitute for routine cervical cancer screening. •an IM injection and scheduled as a three dose series with the second and third dose administered 2 and 6 months after the first dose. *The recommendation age for vaccination of females is 9 to 26 years of age. Protections last for 6-8 years.*

breast cancer; non-modifiable risk factors

•Gender (female) •Aging (>50 years old) •Genetic mutations (BRCA1 and BRCA2 genes) •Personal history of ovarian or colon cancer •Increased breast density increases the risk three-to-fivefold •Family history of breast cancer •Personal history of breast cancer (three- to fourfold increase in risk for recurrence) •Race/ethnicity (higher in White women, but African-American women are more likely to die of it) •Previous abnormal breast biopsy (atypical hyperplasia) •Exposure to chest radiation (radiation damages DNA) •Previous breast radiation (12 times normal risk) •Early menarche (<12 years old) or late onset of menopause (>55 years old), which represents increased estrogen exposure over the lifetime

Teaching to prevent pregnancy in adolescence

•High-risk behaviors that lead to pregnancy •Involvement in programs such as Free Teens, Teen Advisors, or Postponing Sexual Involvement •Planning and goal setting to visualize their futures in terms of career, college, travel, and education •Choice of abstinence or taking a step back to become a "second-time virgin" •Discussions about sexuality with a wiser adult—someone they respect can help put things in perspective •Protection against STIs and pregnancy if they choose to remain sexually active •Critical observation and review of peers and friends to make sure they are creating the right atmosphere for friendship •Empowerment to make choices that will shape their life for years to come, including getting control of their own lives now •Appropriate use of recreational time, such as sports, drama, volunteer work, music, jobs, church activities, and school clubs

wilms tumor; diagnostic testing

•History and physical (H&P) Symptoms Family history Congenital anomalies •Abdominal CT, MRI, ultrasound •UA •Hematologic tests •Inferior venocavogram For large tumors to see if its wrapped around or pushing on the vena cava

gonnorhea; implications in pregnancy

•Implications for Pregnancy: Infection at time of birth may cause opthalmia neonatorum in the newborn. •May lead to corneal scarring, alceration or rupture of the eyeball within 24 hrs!! Speedy treatment is essential!!

radiation therapy

•Interferes with synthesis and causes breaking of DNA & RNA strands •Radiation attacks healthy cells too •Treatments over several weeks •Desquamation-peeling & cracking of skin •Do not remove markings •Good skin care no lotions, powders over markings Use anti-microbial soap & cool washcloth •Protect from sun and wind •Most common side effect is fatigue •Now they are immunocompromised •Risk of infertility •do not cover skin with dressing

reproductive health history & physical exam

•Interview the woman carefully to determine any current or past factors that might increase her risk of cancer, such as early menarche, late menopause, sexually transmitted infections use of hormonal agents. infertility. •symptoms—such as abnormal vaginal bleeding or discharge or vaginal discomfort. •Often symptoms are vague and nonspecific and the woman may attribute them to another problem, such as aging, stress or improper diet. *physical exam & pelvic exam*

ewings sarcoma; nursing care

•Limb preservation is usually possible •high dose radiation may damage bone •Prepare patient and family for biopsy, bone marrow aspiration •Skin care to radiation site Radiation can cause dryness, peeling, cracking Child should be taught skin care techniques; no heat or ice packs, stay out of the sun, loose fitting garments (increased sensitivity) •Body image if loss of limb •Physical therapy

neuroblastoma; diagnostics

•Looking for tumor & metastasis locations •CT scans, skeletal survey, x-rays, bone scan, bilateral bone marrow aspirate and biopsies •*Catecholamines in urine* hormone released by adrenals at times of stress

Muscular effects of immobility

•Loss of Strength •Loss of mass (atrophy) •Loss of endurance •decreased venous return → Decreased cardiac output •Loss of mobility •Weak back & ab muscles

wilms tumor; clinical manifestations

•Mass in the abdomen •Usually palpable....but *DON'T palpate*, it may rupture •Firm, non tender, deep in flank •Other symptoms from tumor compression: hematuria, urinary frequency/urgency, anemia, pallor, anorexia, lethargy, hypertension, weight loss, fever, difficulty breathing more common in beckwith weidemen

managing chemo side effects; bleeding

•Monitor platelet count •Platelet transfusion for active bleeding (monitor for bleeding cessation) •No contact or risky sports •Avoid needle sticks •Careful mouth care •No suppositories/rectal temps. void every two hours

PPROM discharge teaching

•Monitor your baby's activity by performing fetal kick counts daily. •Check your temperature daily and report any temperature increases to your health care provider. •Watch for signs related to the beginning of labor. Report any tightening of the abdomen or contractions. •Avoid any touching or manipulating of your breasts, which could stimulate labor. •Do not insert anything into your vagina or vaginal area—no tampons, avoid vaginal intercourse •Do not swim in pools or in the ocean or sit in a hot tub or Jacuzzi. •Take showers for daily hygiene needs; avoid sitting in a tub bath. •Maintain any specific activity restrictions as recommended. •Wash your hands thoroughly after using the bathroom and make sure to wipe from front to back each time. •Keep your perineal area clean and dry. •Take your antibiotics as directed if your health care provider has prescribed them. •Call your health care provider with changes in your condition, including fever, uterine tenderness, feeling like your heart is racing, and foul-smelling vaginal discharge.

PPROM teaching

•Monitor your baby's activity by performing fetal kick counts daily. •Check your temperature daily and report any temperature increases to your health care provider. •Watch for signs related to the beginning of labor. Report any tightening of the abdomen or contractions. •Avoid any touching or manipulating of your breasts, which could stimulate labor. •Do not insert anything into your vagina or vaginal area—no tampons, avoid vaginal intercourse •Do not swim in pools or in the ocean or sit in a hot tub or Jacuzzi. •Take showers for daily hygiene needs; avoid sitting in a tub bath. •Maintain any specific activity restrictions as recommended. •Wash your hands thoroughly after using the bathroom and make sure to wipe from front to back each time. •Keep your perineal area clean and dry. •Take your antibiotics as directed if your health care provider has prescribed them. •Call your health care provider with changes in your condition, including fever, uterine tenderness, feeling like your heart is racing, and foul-smelling vaginal discharge.

osteosarcoma

•Most common bone cancer in children •Peak age is 10-25 years, more common in boys •Most common sites are the metaphysis (adjacent to the growth plate) of the long bones, mostly in the legs •Leading to malignant osteoid tissues •More than half in the femur, can also occur in humerus, tibia, pelvis, jaw and phalanges •On the next slide, take note of the "sunburst" appearance of the tumor indicated by the arrows most common metastis is to the lungs....

Leukemia (pediatric)

•Most common pediatric cancer, 1/3 of all child cancers, 80% are ALL •More common in boys, Caucasians •Peak age is 2-5 years of age •Cancer of bone marrow, lymphatics May find swollen lymph nodes •Increase in survival rates If they have relapse it is usually harder to treat Most are curable •Leukemia & Lymphoma Society •May be a secondary cancer •Leukemias do not form tumors, but rather are spread throughout the bloodstream. They interfere with normal functioning of the circulatory or lymphatic systems. -Hematopoiesis: formation and maturation of blood cells This process occurs rapidly, and when the cycle is disrupted the cells proliferate excessively, causing immature cells in circulation.

chlamydia

•Most frequently reported STI •Causative Organism: Bacterium Chlamydia trachomatis Clinical Manifestations •Symptoms usually mild or absent •Can occur "silently" before a woman recognizes a problem •Can cause discharge from penis of an infected man Complications •*Can cause irreversible damage including infertility in women* •Women are frequently re-infected if their sex partners are not treated •All sex partners should be evaluated, tested and treated. abstain from sexual intercourse until they and their sex partners have completed treatment, otherwise re-infection is possible, even if using condoms

ewings sarcoma; treatment

•Multimodal - intensive radiation of bone with chemo •Surgery for amputation ONLY if radiation causes significant bone defect. Limb is usually salvageable. •3 year survival rate 78% with multiple chemo agents (if localized disease) •Chemo •Most often diagnosed in young adult athletes

administering chemo

•Multiple agents, combination therapy To hit the cells at different stages of cell cycle •Do not selectively kill cancer cells •Follow all policies/procedures •Double glove or wear "chemo gloves" •Gown if possibility of splash •Always given through central line •Monitor for anaphylaxis during chemo treatment & 1 hour after treatment is done •Have emergency equipment available •Discard drug containers in special designated bin •Monitor hydration status Super important for the chemo to get in.... And then get out Side effect of chemo: *Destruction of normal cells* change diaper hourly

ovarian cancer

•Ninth most common cancer among women and the fifth most common case of cancer deaths for women. •Mainly develops in older women. >60 •The most important variable influencing the prognosis is the extent of the disease. •Prognosis is poor. Dx is usually at stage ¾ •Recurrence is common even after surgery, radiation & chemo. •considered the worst of all the gynecologic malignancies, primarily because they develop slowly and remain silent an without symptoms until the cancer is far advanced. •It has been described as the "overlooked disease" or *silent killer*

Women over 35 in pregnancy

•Nursing Assessment - Preconception counseling; lifestyle changes; beginning pregnancy in optimal state of health •Smoking, drugs, alcohol, obesity - Laboratory and diagnostic testing for baseline; amniocentesis; quadruple blood test screen •Quad-drawn at 15-20 wks. - AFP, hCG, UE, Placental hormone •Nursing Management - Promotion of healthy pregnancy; education; early and regular prenatal care; dietary teaching; continued surveillance

Cardiovascular effects of immobility

•Orthostatic intolerance •Thrombus formation risk •Increased workload on the heart •Venous pooling •Horizontal position •Edema •Decreased efficiency of neurovascular reflexes •Increase if venous return, due to redistribution of the blood. •Increased blood pressure & heart rate. Will decrease over time.

osteosarcoma; clinical manifestations

•Pain •Swelling •Increased WBCs, Sed. Rate, CRP (inflammation marker) •Pulmonary metastasis in 20%

rhabdomyosarcoma; diagnostics

•Physical exam •CXR, MRI, CT scan to help define primary tumor location •Bone scans, bone marrow aspirate and biopsies •To determine metastasis •Lumbar puncture - to evaluate CNS involvement •Biopsy from excision to determine histology

osteosarcoma; diagnostics

•Physical exam •X-rays, bone scan, CT scan, MRI •Surgical biopsy is needed for definite diagnosis at cellular level

HIV Positive Pregnancy; nursing management

•Pretest - Risk assessment survey - Informed consent posttest counseling • Inform of test results • Safe sex guidelines • Be sure to document •Education - Different stages of infection - Safe sex precautions - Avoidance of breast feeding - Preventative therapies, including prophylactic therapies •Support - Preparation for labor, birth, and afterward - Elective cesarean birth - Compliance with antiretroviral therapy - Family planning methods

retinoblastoma; treatment

•Radiation - for unilateral occurrence; to destroy tumor •Photocoagulation - laser blood vessels that supply tumor •Cryotherapy - freeze tumor •With advanced disease/optic nerve involvement- enucleation or removal of the eye is recommended •Fitted with a prosthesis •Chemo

astrocytoma; clinical manifestations

•Related to size and location, potentially child's age •Symptoms appear rapidly *or* over time •Seizures (contralateral), Hemiparesis, Vision disturbances, Memory loss, Personality & behavior changes, Increased ICP leading to Headache, nausea, vomiting, lethargy •Brain stem tumors •Cranial neuropathies, Difficulty urinating, hypertonicity, weakness, changes in respiratory patterns, •Cerebellar tumors •Ataxia, dysmetria, Uncoordinated muscle movement, Nystagmis (poor vision) •Note that in young infants and small children, effects of ICP may not manifest as quickly due to the ability of sutures to separate •Instead you may see irritability, fussiness, failure to thrive or a regression or failure to complete developmental milestones

rhabdomyosarcoma; clinical manifestations

•Related to tumor size and pressure on surrounding organs •Primary tumor site may never be known •Vague symptoms •Quicker diagnosis in places such as orbit due to smaller area and more obvious - eye swelling, ptosis, vision changes •Persistent complaints of headache

seizure teaching

•Remain calm. •If child is standing or sitting, ease child to the ground, if possible. •Time seizure episode. •Tight clothing and jewelry around the neck should be loosened, if possible. •Place child on one side and open airway, if possible. •Do not restrain the child. •Remove hazards in the area. •Do not forcibly open jaw with a tongue blade or fingers. •Document length of seizure and movements noted, also cyanosis or loss of bladder or bowel control and any other characteristics. •Remain with child until fully conscious. •Call EMS if: • The child stops breathing • Any injury has occurred • Seizure lasts for more than 5 minutes • This is the child's first seizure • Child is unresponsive to painful stimuli after seizure

respiratory effects of immobility

•Resp. shallow, slower •Decreased chest expansion •Decreased respiratory muscle use •Secretions •Cough •Diminished vital capacity •decreased Core abdominal muscle tone •Decreases oxygen saturation and impairs gas exchange •Decreased chest expansion

endometrial cancer; screening & diagnosis

•Screening is not routinely done because it is not practical or cost effective. •ACS recommends that women be informed of the risks and symptoms of endometrial cancer at the onset of menopause and strongly encouraged to report any *unexpected bleeding or spotting*. •Ultrasound is used for the evaluation of postmenopausal bleeding. •Endometrial biopsy will aide in the diagnosis. •Pelvic exam is often normal in the early stages •Changes in size, shape or consistency of the uterus may exist in advanced stages

Trichomonas vaginalis

•Signs & Symptoms: *Frothy, greenish gray vaginal discharge, pruritus*, burning with urination. *Strawberry patches on cervix or vaginal walls*. Wet mount of vaginal secretions shows flagellated trichomonads. • Tx: Single 2 g dose of metronizadole PO •Implications for Pregnancy: >Risk for PROM, preterm birth and low birth •High risk of stillbirth or early infant death - infants must be treated or death may result

Vulvovaginal candidiasis

•Signs & Symptoms: Thick, white, curdy discharge, severe itching, dysuria, dyspareunia. Diagnosis based on presence of hyphae and spores in a wet mount preparation of vaginal secretions. •Tx: Intravaginal insertion of miconazole or other azole preparation at bedtime for 1 week. Cream may be prescribed for topical application to vulva if needed. •Implications for Pregnancy: If infection is present at birth, and infant is born vaginally, the infant may contract *thrush*.

bacterial vaginosis

•Signs & Symptoms: Thin, watery, yellow gray discharge with *fishy odor*. Wet mount prep shows "clue cells" which look like fried eggs. • Implications for Pregnancy: Associated with PROM, preterm labor, intra-amniotic infection, and endometriosis postpartally (CDC, 2006)

ewings sarcoma; clinical manifestations & diagnostics

•Similar to Osteosarcoma: Pain, swelling @site, ↑ WBCs, ↑ sed. rate, ↑ CRP Fever, resp. distress & spinal cord compression •Diagnosis: X-rays, bone scan/biopsy, CT scan, MRI

breast cancer staging

•Staging involves classifying the cancer by the extent of the disease based on: Tumor size Extent of lymph node involvement Evidence of metastasis Purpose is to determine the probability that the tumor has metastasized, appropriate course of therapy, and assess the client's prognosis.

long term effects of cancer treatment

•Stunted linear growth- may need GH •Risk of Secondary malignancies •Cognitive, psychological, emotional affects •Hormonal/ Fertility problems Chemo increases the risk of infertility. May harvest eggs or sperm for later. •Osteoporosis •Hearing problems •Dental problems •Enteritis-Virus to decreased immune system •Hepatic fibrosis •Neuropathy •Cardiac

osteosarcoma; nursing care

•Support - dealing with diagnosis, amputation Consider child life & a counselor •Body image •Chemo side effects •Phantom limb pain •PT - prosthesis - 6-8 weeks after surgery •Grief

brain tumor; treatment

•Surgery •Remove, debulk •Biopsy-will define type of tumor •Alleviate intracranial pressure-usually need extra monitoring •Radiation •Not under 3 y/o*-book says kids under 2 due to extensive brain development •To shrink tumor before surgical removal •Chemo •Blood brain barrier-awareness to choose correct chemo

osteosarcoma; treatment

•Surgery - biopsy then limb salvage or amputation •Chemo pre-op chemo in limb salvage to shrink tumor pre and/or post op in most instances •If amputation - Neurontin neuropathic pain •Amitriptyline/gabapentin for phantom pain (after amputation)

wilms tumor; nursing care

•Surgery 24-48 hours after diagnosis •Due to lack of time prior to surgery, keep explanations to child simple and as exact as possible •"Do not palpate abdomen" •Educating on effects of chemo, radiation •Post op care for abdominal surgery- monitor bowels, BP, infection, pulmonary status, kidney function, antiemetics to prevent vomiting •Education - prevention of UTIs, protection of remaining kidney (NO contact sports) •Monitor for hypertension

ovarian cancer; therapeutic management

•Surgical intervention remains the mainstay of management of ovarian cancer. •radiation may be warranted. Chemotherapy is recommended for all stages of ovarian cancer.

Wilms tumor; prognosis

•Survival is one of the highest of the childhood cancers •Staging determines treatment •Stages I & II- 90% chance of cure with multimodal treatment

iron deficiency anemia teaching

•Take your prenatal vitamin daily; if you miss a dose, take it as soon as you remember. •take iron supplements between meals. •Awareness of the side effects of iron supplementation •Avoid taking iron supplements with coffee, tea, chocolate, and high-fiber foods. •Eat foods rich in iron, such as: Meats, green leafy vegetables, legumes, dried fruits, whole grains, Peanut butter, bean dip, whole-wheat fortified breads and cereals •consume the food along with a food high in vitamin C. •Increase your exercise, fluids, and high-fiber foods to reduce constipation. •Plan frequent rest periods during the day.

cervical cancer

•The 5 year survival rate for all stages of cervical cancer is 72%. •Cervical cancer is five to eight times more common in women affected with HIV or AIDS than those who do not have this virus. •Tends to occur in midlife. •Barriers to screening and prevention of cervical cancer include procrastination, fear of finding out that they have cancer, and embarrassment of having a Pap test. •Cervical cancer is one of the most treatable cancers when detected at an early stage. Linked to HPV

endometrial cancer; therapeutic care

•The stage of the disease will direct the treatment. •It usually involves surgery with adjunct therapy based on pathologic findings. •Surgery most often involves removal of the uterus, fallopian tubes and ovaries. •More advanced stages will require radiation and chemotherapy.

STI Prevention

•The surest way is to avoid transmission •Abstain from sexual intercourse or be in a long-term mutually monogamous relationship with a partner who has been tested and known to be uninfected •More risk with multiple partners •*Latex condoms used consistently and correctly can reduce but NOT prevent transmission •Female clients using oral contraceptives may be at risk and should be assessed further for risk. If risky behavior is identified, counsel to use condoms as well. Oral birth control does NOT prevent STIs*

STI's

•Transmitted by sexual contact •*Most STIs occur in clients ages 15 to 24* •Complications for *females* are worse, e.g. infertility especially with chlamydia and gonorrhea •Not unusual for an individual to have 2 or more STIs simultaneously •If client has an open lesion from an STI, transmission of organism is easier •STIs may be transmitted even if partner wears a condom (e.g. genital warts) •Client and all of his/her sex partners must avoid sex until completion of treatment

rhabdomyosarcoma

•Tumors occur in many sites (mainly the head, neck, orbit) •Most common soft tissue cancer in children •Occurs in all age groups, but most common in children less than 5 years old, Caucasians •Comes from undifferentiated (embryonic) mesenchymal cells in muscles, tendons, bursae, fascia, fibrous, connective, lymphatic or vascular tissues •Originates from striated skeletal muscle

Gonorrhea

•Very common STI •Causative Organism: Bacterium Neisseria g. •Grows and multiplies easily in warm, moist areas of reproductive tract including: cervix, uterus, and fallopian tubes in women, and in the urethra in women and men Clinical Manifestations: •Infested persons may be asymptomatic, women more so than men •Discharge from vagina or penis: yellow, bloody, white or green •*Dysuria & urethritis* in men •*Vaginal bleeding* with intercourse Complications in women: •May have NO symptoms, however the disease process is damaging internal organs possibly leading to sterility, i.e. pelvic inflammatory disease (PID), PID can damage the fallopian tubes •infertility •increase risk of ectopic pregnancy • •*Left untreated, gonorrhea can spread to the blood and/or joints - Life threatening condition* •High incidence of co-infection with chlamydia, patients are usually treated for both •*Full recovery is expected* if treated and must be finished before sex is resumed.

vulnerable populations

•Women who are positive for (HIV) •Adolescents •Pregnant women over age 35 •Obese women

labor induction teaching prep

•Your health care provider may recommend that you have your labor induced. This may be necessary for a variety of reasons, such as elevated blood pressure, a medical condition, prolonged pregnancy over 41 weeks, or problems with fetal heart rate patterns or fetal growth. •Your health care provider may use one or more methods to induce labor, such as stripping the membranes, breaking the amniotic sac to release the fluid, administering medication close to or in the cervix to soften it, or administering a medication called oxytocin (Pitocin) to stimulate contractions. •Labor induction is associated with some risks and disadvantages, such as overactivity of the uterus; nausea, vomiting, or diarrhea; and changes in fetal heart rate. •Prior to inducing your labor, your health care provider may perform a procedure to ripen your cervix to help ensure a successful induction. •Medication may be placed around your cervix the day before you are scheduled to be induced. •During the induction, your contractions may feel stronger than normal. However, the length of your labor may be reduced with induction. •Medications for pain relief and comfort measures will be readily available. •Health care staff will be present throughout labor.

breast cancer; immunotherapy

•an attempt to stimulate the body's natural defenses to recognize and attack cancer cells. •*trastuzumab (Herceptin)* targets, binds to and inactivates the HER-2/neu protein, thus slowing tumor growth. •This protein regulates cell growth, is present in small amounts on the surface of normal breast cells and in most breast cancers •Unlike chemotherapy, Herceptin spares the normal cells. •We all have HER2, it's just a matter of whether it has abnormal growth. •Used in conjunction WITH chemo