OB/Ped's Exam and Pharm 1

embryonic period week 5

large head, upper limb buds, heart beating

7 month fetus

lean body, less wrinkled and red, nails appear

informed consent

accept or reject treatment options as part of their right to function autonomy

20 lbs child maintenance fluids twice as much. hourly rate

20lbs to kg 20 divided by 2.2 is 9.09kg 9.09kg x 100 is 909 909 x 2 is 1818 1818 divided by 24 hours is 75ml/hr

maintenance fluid requirements in severely dehydrated pt fluid bolus

20ml/kg then maintenance fluids requirements exp- 25kg 20ml x 24kg = 480ml bolus then 1580ml maintenance fluids

surfactant production begins

21-24 weeks 24 weeks

monozygotic

1 ovum 1 sperm, identical genes, same sex, no hereditary influence know, 2 amnions, 1 chorion

suggest three strategies the nurse could use when caring for a child who is deaf

1- assess the child's self-help skills. 2- identify how the family communicates. 3- encourage the parents to stay with the child. 4- develop a communication board. 5- always face the child when speaking. 6- do not exaggerate speech. 7- be aware of your body language and nonverbal communication

suggest three strategies the nurse could use when caring for a child who has a severe visual impairment

1- assess the child's self-help skills. 2- orient the child to landmarks in the room and typical environmental sounds. 3- encourage parents to stay with child. 4- keep objects in the immediate environment in the same place. 5- explain all procedures

list three behaviors that are warning signs of a nurses overinvolvement

1- buying gifts. 2- giving out home a phone number. 3- accepting invitations to family gatherings. 4- visiting the child on days off. 5- lending or borrowing money. 6- sharing personal information. 7- making decisions for the family

to provide appropriate care for the child and family, during the initial interview, the nurse should gather information about the following five areas

1- decision making practices. 2- child rearing practices. 3- extent of family support. 4- communication practices. 5- health and illness practices

list five key component of open communication in a family centered care environment

1- establish a rapport with the family. 2- encourage questions. 3- empower the parents to care for their children through education and support. 4- effectively manage conflict with families. 5- solicit feedback from families

identify seven strategies to manage conflict that may occur between parents and the nurse

1- understand the parents perspective. 2- determine a mutually agreed upon goal. 3- look for win-win solution. 4- actively listen. 5- openly express feelings. 6- avoid blaming. 7- summarize the discussion

what is a family

a social group whose members share common goals and values and whose members are committed to each other, may or may not be biologically related

teh embryo is fully implanted in the uterus on which day after comception

10

maintenance fluid requirements in 24 hour for 10 to 20 Kg child

1000ml + 50ml/kg for each additional kg between 10 to 20 kg exp- 14kg pt (10kg = 1000ml) (1000) + (50ml x 4kg) = 1000 + 200 = 1200ml

dizygotic

2 ova 2 sperm, not identical genes, maybe same sex, maybe different, hereditary and or ethnic tendency often found, 1 amnion, 2 chorions

What was identified in the chapter as a societal issue that affects maternity and pediatric nursing

families are the fastest growing group of homeless people

medication classification for pregnancy

A- best no harm to fetus B- animals say safe (Tylenol) C- benefit for mom D- risk for baby x-do not use

toxic ingestion primary assessment

A-airway B-breathing C-circulation D-disability: neurological assessment E-exposure

fundus is at xiphoid process

36 weeks

heart contains four chambers

8 weeks

maintenance fluid for an 8kg baby

8 x 100ml is 800ml

all abdominal organs are within the abdominal cavity

9-12 weeks 10 weeks

iron deficiency anemia side effects

consitpation, stained teeth, tar stool.

amniotic membranes and fluid

constant body temperature. oral fluid and repository for waste. cushion for fetus from trauma. freedom of movement for musculoskeletal development. facilitates symmetrical growth

violence

constant stressor. abuse of the child may be physical, sexual, emotional, form of neglect

explain the bowel expected adaptation involved in elimination that occur during pregnancy

constipation and hemorrhoids; effect of increase progesterone, which decreases peristalsis and intestinal displacement by enlarging uterus

toxic ingestion secondary assessment

F-full set of vital signs G-give comfort measures H-head to toe assessment I-inspect posterior surfaces

Special supplemental nutrition program for women, infants and children (WIC) provides supplemental food supplies to bottle fed children but no to breastfeeding mothers

False

Throughout history, children have been valued and protected by society

False

adults have a greater body surface area in relation to body mass, resulting in greater potential for fluid loss

False- pediatric dehydration very quick process, children have increased metabolic rate, respiratory distress- insensible fluid loss Neonate apx 40% of body water is ECF

most of potassium is housed extracellularly and Na intracellularly?

False- potassium is housed intracellularly and Sodium is housed extracellularly

antepartum history

GTPAL

gastroesophageal reflux disease (GERD) pharm

H2 antagonists to reduce gastric acid levels. Mucosal protectants proton pump inhibitors to block acid production. prokinetics to stimulate the gastric emptying and improve tone

cleft palate post operative care

I/O's, monitoring packing, ESSR (enlarge nipple, swallowing, sucking, rest), speech therapy, position in a supine position- unless secretions then elevate the HOB, suction at bedside (nothing in mouth). elbow restraints (unless supervised during baths, arm exercises, circulation checks- neurovascular, skin) maintain Logan bow at all times after lip repair, reapplying as necessary, keep mouth free from everything!, adequate hydration- oral fluids (NO straws), rinse mouth with water after each feeding, perform lip care to incision site, monitor s/s infection and pain

IV bolus in a 63lbs child

IV bolus rule: 20ml/kg first change 63lb to kg 63 divided by 2.2 is 28.6kg 28.6kg x 20 ml is 572ml/hr

corrosives tx toxin ingestion

IV fluids, NPO, analgesics, steroids, antibiotics, NG tube

tylenol

Mucomyst binds to Tylenol to decrease toxicity in blood

an infant has undergone repair of the cleft lip. which of the following would not be part of the post op care

NG feedings until sutures are removed

failure to thrive- goals for nutrition

NG tube enteral feedings at night, normalized weight, correct deficiencies in nutrition, catch up growth, establish adequate eating patterns and intake. (concentrate formula, adding formula power to breastmilk, high calorie and protein foods, avoid giving juice, add instant breakfast to milk drinks, add vegetable oil or butter to foods when cooking and high fat foods, give tube feedings)

pyloric stenosis pre op

NPO, IV fluids, Labs- electrolytes WNL, NG tube- reduce pressure (respiratory distress)

elective abortion

Roe vs wade- women rights to abort 1st trimester, state rights 2nd trimester and 3rd unless mothers life might be jeopardized by continuing the pregnancy

cleft palate BAD post op signs

SOB, respiratory distress, more than 10ml post bleeding (mouth, lip, nose)- surgical packing dislodged

advocacy

Speaking or arguing in support of a policy or person's right

lead (plumpish) medication toxin ingestion

Succimer (chemet), hydration, calcium, phosphorus, vit C and D, anticonvulsants, iron

TORCH

T- toxoplasmosis >256 antibodies- recent infection. dont change the litter box O-other (syphilis, hepatitis, HIV) R-Rubella> 20 immune to rubella C-Cytomegalovirus (CMV)- no CMV antibodies H-herpes simplex (HSV)- no HSV antibodies

infants (developmental approaches)

developing a sense of trust vs mistrust

Placenta (auxiliary structures)

Thick, disk shaped

Hospital policies have changed in response to an awareness of children's emotional and psychologic needs

True

The first public health program for mothers and children was initiated by Lillian Wald

True

during the 19th century, the most serious child health problem were directly related to poverty and overcrowding

True

corporal punishment (discipline measures)

a controversial form of discipline usually involving spanking

trimester

a division of pregnancy; one of three equal parts of approx. 13 weeks each

ductus arteriosus

a small amount of blood from the right ventricle is circulated to the lungs to nourish the lung tissue. the rest of the blood from the right ventricle joins oxygenated blood in the aorta through the third shunt- the head and upper body receive the greatest amount of oxygenated blood

gliadin

a protein found in rye, oats, barley, wheat

esophageal atresia with tracheoesophageal fistula (TEF) management

a surgical emergency includes- ligation of fistula (present) / end-side anastomosis of the esophagus requiring a thoracotomy.

behavior modifications (discipline measure)

a technique that rewards positive behavior and ignores negative behavior

primipara

a woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation or more

multipara

a woman who has completed two or more pregnancies to 20 weeks of gestation or more

psychosocial adaption- 2nd trimester week 14 to 26

acceptance- fetus "feels real", excitement- experiences fetal movement, concern if no fetal movement by 20 weeks, fetus is primary focus- prenatal visit every 4 weeks, screening test- diabetes, neural tube defects

biliary atresia s/s

acholic stool (first sign in infancy) and bile stained urine, as it progresses ascites, hypertension, growth and development failure, jaundice, prurtus

Biliary atresia s/s

acholic stools (pale, white, clay color due to the bile not getting down to the intestines), bile stained urine. progression- ascites, hypertension, growth and development failure, jaundice and pruritus (due to the increase level of bile), glowing yellow eyes

empowerment

actions taken to enable another person to fully participate in the decision making

herpesvirus serotypes 1 and 2 tx

acyclovir orally

tuberculosis

aerosolized droplets screened- + xray (protect abd) s/s-general malaise, fatigue, loss of appetite, weight loss, fever infant- amniotic fluid or umbilical vein tx- isoniazid, rifampin, ethambutol

yolk sac

aids in transferring maternal nutrients and oxygen. blood cells and plasma are manufactured in the sac during the second and third week while uteroplacental circulation is extablished

esophageal atresia with tracheoesophageal fistula pre op

airway patency. prevention of pneumonia and gastric or blind pouch decompression

8 weeks fetal development- parent know

all body organs are formed

lead free MD

all children born on or after jan 1 2015 must be tested at 12 and 24 months. all children born before jan 1 2015 should be screened up to 6 years of age

presumptive indications of pregnancy

amenorrhea, nausea and vomiting, urinary frequency and urgency, breast enlargement and tenderness, fatigue, quickening (may be gas), chadwick's sign (change of color in vag), intensified skin pigmentation, missed period

chlamydia tx

antibiotics in infants eyes after birth (erythromycin amonicillin or azithromycin to mother during pregnancy

acetaminophen (Tylenol) toxin ingestion

antidote Mucomyst

salicylate (aspirin) toxin ingestion

antidote vit K, activated charcoal to decrease absorption, sodium bicarbonate, potassium replacement, glucose, hemodialysis for severe cases. Vit K

cytomegalovirus (CMV) tx

antiviral: ganciclovir

gravida

any pregnancy, regardless of duration

stress

any situation, positive or negative, requiring an adjustment on the part of individuals, families, or groups

Bioethics

application of ethics to health care

communal families

are groups of people who have chosen to live together as extended family groups. relationships motivated by social value or financial necessity. spiritually

types of perinatal loss nurse side

are you ok to take care of them because of self issues, be there for the family "get them through the worse day of their life" acknowledge the baby was real, use babies name, allow family time alone with the baby

dizygotic twins (fraternal)

arise from two separate ova fertilized by two separate sperm. two placentas, two chorions, two amnions. may be same sex or different sex. may not have similar physical traits. incidence may be increased by genetic predisposition, maternal age, or gentility drugs.

lead (plumbish) toxin ingestion treatment

around 45mcg/dl- oral chelation therapy, dimercaptosuccinic acid (DMSA) succimer greater than 45mcg/dl- IV injected chelation therapy, ethylenediaminetetraacetic acid (EDTA) recommend screening- lead level of 5mcg/fl considered unsafe

foramen ovale

as infant breathes, resistance to blood flow to lungs falls and the foramen ovale closes, tissue proliferation cause it to fill in the septum between the right and left atria

biliary atresia

bile back up into live- scaring, need for new liver. refers to the obstruction or absence of the extrahepatic bilde duct. at birth, liver normal then the structrual problems lead to significant cellular damage and eventual live failure and death.

adolescent (developmental approaches)

ask questions, use technology, HUGE body image issues, privacy, some what parents with them, some want independence, control is important, striving for identiy, concerned more about the here and now, peers are very important and separation causes anxiety- support groups, provide activities to interact, concerned how things will impact their body appearance, believe they are invincible and things wont happen to them

when esophagus is closed off from trachea and the stomach is connected to the trachea (TEF)

aspiration

herpesvirus serotypes 1 and 2 s/s in infant

asymptomatic during incubation period of 2 to 12 days. local infection of skin, mouth, eyes, encephalitis or disseminated disease c/s prevent fetus from infection / avoid outbreak at birth no outbreak- vag / outbreak- C/S greater then 35 weeks- mom given antiviral for herpes

cytomegalovirus (CMV)

asymptomatic, leading cause of neonatal hearing loss herpes virus most serious effects occur in fetus and immunocompromised people isolated in urine, saliva, blood, cervical mucus, semen, breast milk, feces

RBC volume

blood pressure

Jehovah's witness

blood transfusion not allowed. respect the physician bur trust god more

chadwick's sign

bluish color that often extends to the vagina and labia; cause is hyperemia

fetal period week 9 to 12

body grows faster than the head, face is broad, intestines enter abdomen, gender becomes more differentiated

2 month fetus

body well formed, nose flat eyes far apart, digits well formed, head elevating, tail almost disappeared, eye/ear/nose/mouth recognizable

failure to thrive- nonorganic

bonding issues between mother and baby such as, internal and external stressors (financial/marriage/mental illness). inability to provide adequate calories and lack of knowledge on feeding issues. absence of history contributing to a psychosocial causes

pyloric stenosis post op

bowel sounds, NG tube out, diet- clears to 1/2 formula to full formula

a mother brings her 7 month old infant to the well baby clinic for a check up. she is concerned that the baby is overweight. she feeds the infant formula that has 20 cal/oz whenever the infant is hungry the nurse should instruck the mother too

bring a 3 day record of the infants intake back from further evaluation

Goodell's sign

cervical, uterine and vaginal softening with increased vascularity of the connective tissue

Chadwick sign

cervix has a change in color

goodell sign

cervix has a change in consistency

mucus plug formation

cervix, forms early on in pregnancy to form a barrier from infection

ductus venosus

cessation of umbilical cord blood flow with birth causes it to become nonfunctional; becomes a ligament

same sex parent families

challenges from a community that is unaccustomed to alternative lifestyles. children's adaptive depends on the parents psychological adjustment

Varicella zoster virus

chicken pox, herpes virus family direct contact or respiratory tract, may persist in a latent state in nerve ganglia, reactivation resulting in herps zoster (shingles). 90% of women are immune greatest risk for congenital varicella syndrome is between 13- 20 weeks maternal antibodies protect fetus live vaccine- cant get if pregnate

potential problems in families with substance abuse

child neglect, risk taking behaviors, possible criminal activities

failure to thrive mixed causes

combination of organic and inorganic factors

healthy families

communicate openly, flexible roles, agree on basic principles, adaptable, not overwhelmed, volunteer assistance, spend time together/facilitate autonomy, seek appropriate resources for support, transmit cultural and expectations to children

school age communication

communicate thoughts and appreciate viewpoint of others. understands rules, attention span 30 min

coping strategies of families external

community strategies- maintaining active linkages with the community social support strategies- extended family, friends, neighbors, self help groups, formal social support. spiritual strategies- seek advice or clergy, becoming more involved in religious activities, having faith in god, prayer

intracellular fluid (ICF)

compartment is more difficult to dehydrate

nontraditional

complex households, single parent families, blended families, adoptive families, unmarried couples with children, multigenerational families, homosexual parent families

sonogram

confirmation of pregnancy measure gestational age 8 weeks heart seen

Umbilical cord

contains two arteries and one vein which are surrounded by Wharton's jelly. 2 artery's have deoxygenated blood/ 1 vein has oxygenated blood. Wharton's jelly- specialized connective tissue (protects blood vessels). provides circulatory pathway to embryo

nursing communication with Hispanics

conversational methods- polite with preliminary small talk

toxoplasmosis precautions

cook meat thoroughly, avoid touching mouth or eyes while handling meat, wash surfaces that come contact with uncooked meat, avoid uncooked eggs and unpasteurized milk, wash fruit and veggies prior to eating, wash hands well after working with soil or handing animal, avoid direct or indirect contact with cat feces

what breast changes occur during pregnancy

darkening of the areolae, increased nipple and areolae size, areolae become more erect, montgomery tubercles become more prominent

diarrhea factors to fluid loss

deadly to children if not fixed, roto virus, Norwalk, e coli, salmonella, shigella, antibiotics (need probiotic), gastro bug, emotional/stress, IBS, food poisoning, allergies, increase in the frequency, fluidity, and volume of stool, accompanies acute and chronic disorders, inflammatory or noninflammatory, gastroenteritis, norovirus, rotavirus lead to electrolyte imbalance, hypovolemic shock manifestations- dry hot skin, change in skin texture/turgor, dry mucous membranes, cramps, nausea, vomiting, large volume stools, increased heart rate, increased RR, decreased tearing, fever

early childhood death concept

death as a reversible and temporary separation

adolescence death concept

death as inevitable and irreversible but of a distant event

infancy-toddler death concept

death as loss of the caregiver

hypernatremic

dehydration with a sodium concentration greater than normal. slow fluid infusion not to shift. adding potassium (make sure they have urinated for adequate kidney function) before giving K (PICC line for greater than 30K water loss is greater than the electrolyte loss, resulting in a serum sodium greater than normal

hyponatremic

dehydration with a sodium concentration of less than normal- cystic fibrosis electrolyte loss is greater then the water loss, resulting in a serum sodium less then normal

correct injection technique for infants of mothers who are known carriers of hepatitis b virus is to

delay all injections until the infant has been bathed

failure to thrive

demonstrated failure of growth for a period of time, delay in developmental milestones

gastroesophageal reflux disease (GERD) management

depends on severity- no therapy needed for infant who is thriving and has no respiratory infection. changes in feeding- (upright for 30) small frequent feedings, thickened feedings with rice cereal (if approved by MD). surgical interventions- nissen fundoplication

lactose intolerance s/s

diarrhea, bloating, abdominal pain

types of teratogens

diseases, drugs, alcohol, cigarettes, environmental hazards

redirection (discipline measure)

distract the child with another object

marital conflict and divorce

divorce is loss that needs to be grieved therapeutic play age appropriate, active listening

Single parent families

divorced, widowhood, childbirth, adoption among unmarried women

what are the four elements of negligence/malpractice

duty, breach of duty, damage, proximate cause

fetal monitoring

electronic fetal monitoring external and internal

separation anxiety

emerges around 6 months, can last 30 months (2.5 years)

parvovirus B19

erythema infectiosum, lace like rash, s/s- fever, malaise, joing pain, death to infant- failure of fetal red blood cell production followed by severe fetal anemia, hydrops (edema), heart failure tx- starch bath, pain meds

chlamydia pharm

erythromycin- babys eyes, azithromycin, amoxicillin, clindamycin

communication with children

establish a comfortable setting, introduce yourself, clarify your role and explain your role. use open ended questions when first conducting the assessment, maintain privacy and confidentiality, therapeutic communication techniques (verbal and nonverbal responses)

EDC

estimated date of confinement

nagels rule from EDD

estimated date of deliver subtract 7 days add 3 months subtract 1 year

EDD

estimated date of delivery

a nurse reacts with anger because a woman who did not have prenatal care explains that she does not see pregnancy as an illness requiring medical care. the nurses reaction demonstrates

ethnocentrism

reasoning (discipline measure)

explain why a behavior is not permitted

anemia s/s

fatigue, pale skin, muscles weakness, jaundice, polycythemia, petechia, purpura- polycythemia response to hypoxia caused increased RBC and HCT, jaundice suggests hemolysis, petechiae and purpura suggest bleeding tendency. failure to thrive suggest chronic disease or organ failure

Extracellular Fluid (ECF)

fluid is in intersitial space (surrounding the cells: lymph fluid), intravascularly (within the blood vessels or plasma), and Transcellularly (cerebrospinal fluid, pericardial fluid, pleural fluid, synovial fluid, sweat, digestive secretions). Child more likely to lose ECF than ICF throw illness, trauma, fever

planning for baby

folic acid, preconception care, progesterone

the mother of a child with celiac disease asks, "how long must he stay on this diet?" which response by the nurse is best

for the rest of his life

embryonic period week 4

forth week- embryo shape changes, neural tube close, face and upper respiratory tract begins

human papillomavirus (HPV)

gential warts (condylomas). direct sexual contact or perinatally through birth process. warts can resolve spontaneously. can occur during birth epithelial tumors of larynx in children, cervical dysplasia, cancer has zero effect on baby

ampicillin

group b streb (GBS)

carbon monoxide toxic ingestion s/s

headache, nausea, angina, seizure, coma

carbon monoxide s/s toxin ingestion

headache, nausea, angina, seizures, coma, hypoxia, visual disturbances, altered level of consciousness, cherry red lips and cheeks

Christian science

healing is divinely natural, not miraculous. use physician or midwife, may refuse medical tx, spiritual framework, exemptions from immunization

infant communication

hearing, seeing, smelling, tasting, touch. crying, babbling and cooing, single word production, name simple objects. high need for cuddling and security. happy vs angry voice, family vs stranger voice, separeation anxiety

ultrasound

high frequency sound waves allows observer to detect movement emtional responses- expectant mother, expectant father

adoptive families

high standards, lack of knowledge of the child's health history, when and how do you tell about adoption

placental hormones

human chorionic gonadotropin human placental lactogen estrogen progesterone relaxin

hormones

human chorionic gonadotropin (hCG), estrogen, progesterone, Human placental lactogen (hLG), relaxin

esophageal atresia with tracheoesophageal fistula (TEF) assessment findings

hx of polyhydramnios- mom too much amniotic fluid. may have other congenital defects. excessive salivation and drooling- respiratory distress. 3 C's- coughing, choking, cyanosis. increased respiratory distress after feeding. (has to be fixed or death)

Gastroesophageal reflux disease (GERD) assessment findings

hx of premature birth, BPD, CP, TEF, CF. excessive spitting up or forceful vomiting. irritability, heartburn. hematemesis, blood in stool. dysphagia. recurrent pneumonia. apnea or apparent life threatening event (ALTE)

fever, hyperventilation, burns, trauma, hemorrhage, diabetes factors to fluid loss

hyperpyrexia, WOB (work of breathing)

amniocentesis 2nd trimester

identify chromosomal or biochemical abnormalities done between 15-20 weeks

breasts body changes

increase in size- stretch marks may develop, highly vascular, nipple changes- increase in size, darken colostrum production

Failure to thrive

infant and child who falls below 5th percentile in weight. children whose weight or rate of weight gain is significantly below that of comparably aged children. can result from numerous organic or medical causes: chromosomal abnormalities, defects in the heart or lungs, CNS damage, exposure to toxins. also may result from multifunctional interplay between child temperament, parental expectations, maternal emotional state and sociodemographic factors

Neonatal mortality

infant deaths that occur in the first 28 days of life

sensory information

information obtained form sight, taste, touch, smell, and hearing

gastroesophageal reflux s/s in preschool/older children

intermittent emesis. chronic heartburn. regurgitation. esophagitis.

nursing communication with middle easterners

interpreters- should be from an acceptable region: information is typically shared only with friends and family, paternalism- a male's opinion or permission is often required

lactose intolerance

intolerance to lactose, a sensitivity disorder resulting in the inability to digest lactose from milk products, caused by inadequate production of or defect in the enzyme lactase

chronic illness- nursing

involve sibling or family in education about ill child, condition, treatment, physical changes, disabilities, expected diease progression

braxton hicks contractions

irregular contractions that occur throughout the pregnancy. contractions are infrequent and less noticeable during the first two trimesters. contractions are more frequent and more intense during the third trimester

failure to thrive- postnatal causes (nonorganic)

lack of maternal support, family conflict, poor parenting, difficult child, child abuse, feeding disorders

goals of chronic care family

keep normal, social, remain intact, achieve and maintain normalizaiton, maximize function throughout the course of the illness

a patient is in her third trimester of pregnancy. she tells the nurse that her posture seems to have changed and that she occasionally experiences low back pain

lordosis occurs as a result of the enlargement of the uterus, which decreases abdominal muscle tone and increase mobility of the pelvic joints, tilting the pelvis forward and resulting in lower back pain, a change in her posture, and shifting forward the center of gravity

hagar's sign

lower uterine segment can be flexed against the cervix

corrosive toxic ingestion

lye, bleach, ammonia, household cleaners edema RDS visible burns difficulty swallowing do not induce vomiting

endocrine changes to the body- parathyroid hormone

maintains calcium hemostasis, decreased during 1st trimester- normal during remainder of pregnancy

antepartum assessment and care- subsequent visits

maternal hearts and lungs as indicated, vital signs, weight, urinalysis (always), uterine size/fundal height (baby growing), Leopold's maneuvers- determines fetal position, fetal heart rate and activity, warning signs, ultrasound as indicated, lab testing- glucose screening, isoimmunization, group b strep, pelvic exams as indicated- usually first visit

separation anxiety- protest

may cry, scream, physical, searches for parents with their eyes and clings to parents, child is agitated, resist caregivers, cries, inconsolable

less interventional care

more choices for birth, low risk- no monitors, eating, family centered care, less moving the patient, mother and baby together.

cleft palate assessment findings

more common in females, usually occurs with cleft lip, palpate the newborns palate and ability to suck. opening not always detected in newborns

hypertrophic pyloric stenosis assessment finding

more common in males and twin males, projectile emesis

fetal period week 25 to 28

more likely to survive if born after 24th week, assumes a head down position

multigravida

more than one pregnancy

acetaminophen (Tylenol) toxic ingestion

most common medication poisoning in children

estimated date of delivery (EDD)

nagels rule sonogram

a nurse is assessing a pregnant woman during a prenatal visit. several presumptive indicators of pregnancy are documented.

nausea and vomiting, quickening, amenorrhea

salicylate (aspirin) s/s toxin ingestion

nausea, vomiting, thirst, hyperventilation, tinnitus, confusion, seizures, coma, respiratory failure, circulatory collapse, oliguria, bleeding tendencies, sweating, dehydration, fever, hyponatremia, hypokalemia, dehydration, hypoglycemia

substance abuse in pregnancy

negligence

malpractice

negligence of a professional person

nursing process and perinatal infections outcomes

neonate vital signs remain within normal range, neonate is free from signs and symptoms of infection

embryonic period germ layer- ectoderm

nervous system, skin, hair

dehydration

no tears, sunken fontanels/eyes, irritable, dark urine, increased heart rate, decreased blood pressure, prolonged cap refill

lead (plumpish) Tx toxin ingestion

oral/IV chelation, DMSA (succimer), EDTA

Roman Catholic

organ donation permitted

child with special needs

parent grieving may be long term, financial hardship, strain on marriage or partnership. need coping skills

Reduce the rising cost of health care costs

patient satisfaction, outcomes from falls (with injury), diagnosis related groups for fixed amount of money to cover services for specific Dx. HMO's PPO's Health insureance

competency

patients able to think through a situation and make rational decisions

identify the four requirements of informed consent

patients competence to consent, full disclosure of information, patients understanding of information, patient's voluntary consent

ultrasound 2nd and 3rd trimester- transabdominal

position on back, need full bladder during 2nd trimester, allow to urinate soon after structures located confirmation of fetal viability, evaluation of fetal anatomy, estimation of gestational age, assessment and comparison of fetal growth, determine location of placenta and umbilical, determine of fetal position, guide needle placement for procedures

list the positive indications of pregnancy

positive- fetal heart sounds, fetal movement felt by examiner, visualization of fetus

potential problems with adolescent parents

poverty, inability to seek higher educations, high infant mortality rates

potential problems of single parents

poverty, overwhelming child rearing responsibilities

how does the woman's perception of the baby change during pregnancy- 2nd trimester

preceives fetus as real and needing her protection

failure to thrive- prenatal causes

prematurity with or without complications, exposure to toxins, environmental influences, infection, placental abnormalities, maternal illness- HTN, preeclampsia, heart disease, anemia

gonorrhea tx

prenattally is ceftriaxone and azithromycin with test to cure amoxicillin ceftriaxone also given to infants to prevent ophthalmia neonatorum

a toddler is brought to the emergency room after ingesting an undetermined amount of drain cleaner. the nurse should expect to assist with which of the following first

prepare for intubation

stages of separation anxiety

protest, despair, detachment

Toxoplasmosis

protozoal infections- ingestion of raw or under cooked mean, contact with infected car feces (good hand washing), crosses placental barrier to the fetus. highest transmission in 3rd trimester, more severe effects in 1st trimester

birth centers

provided maternity care outside acute care settings for low risk pregnant women

external fetal monitoring advatages

provides more data than auscultation, provides a permanent reord that is printed or stored electonically, strip provides a graphic record for review, shows fetal response before, during, and after every contraction

nursing care for dying child/family

provind adequate pain control, care, privacy, information of the signs of imminent death and waht to expect in the immediate postmortem period, keep communicating with family, siblings need time and attention, respect privacy, allow the family to remain with the child

preparation

provision of information before procedures, treatments, or events

Maryland children's health programs (MCHP)

public health insurance programs, preventive health with Medicaid, CHIP program

fetal period week 13 to 16

rapid growth in length, head becomes smaller

alpha-fetoprotein screening (AFP)

rare, main protein in fetal plasma, increases with advancing gestational age of fetus but decrease after birth, screen for chromosomal anomalies or neural tube defects, should be done 15-22 week (most accurate 16-18 weeks 2nd trimester), screening only- abnormal results must be followed up with ultrasound and amniocentesis

Morbidity

ration of sick to well persons in a defined population

positive changes

signs that can be attributed only to the presence of the fetus

the primary benefit of a preconception class is to

reduce the risk of having a baby with a birth defect

external fetal monitoring limitations

reduced mobility, frequent maternal changes, may ne uncomfortable for patient, difficult to trace for women with thick abdominal fat pad, may divert attention from keeping herself from being confortable

coping strategies of families internal

relationship strategies- family group reliance, greater sharing together, role flexibility. cognitive strategies- normalizing, controlling the meaning of the problem by reframing ad passive appraisal, joint problem solving, gaining of information and knowledge. communication strategies- being open and honest, use of humor or laughter

ethics

rules or principles that govern conduct

TEF surgical complication

scaring, reflux, long recovery

empathy

seeing a situation from another persons perspective while remaining objective

Group B Streptococcus (GBS) infant complications

sepsis, pneumonia, meningitis (all can be late onset) C/S- wont pass to baby

the developmentally appropriate strategy for the nurse to use when performing preoperative teaching with a 10-year old is to

sequentially organize information

reactions in the family

situation crisis, stages of grief

fetal period week 29 to 32

skin pigmentaed according to race, had more subcutaneous fat, survival is good if born during this time, feel baby kick

Wharton's jelly

specialized connective tissue that protects blood vessels. prevents obstruction cause by pressure

fertilization

sperm enters ovum chemical signal prompts secondary oocyte to complete second meiotic division true moment of fertilization occurs as nuclei unite chromosomes pair up to produce diploid zygote each nucleus has 23 chromosomes = 46 total union of nuclei creates zygote

types of perinatal loss

spontaneous abortion (miscarriage), ectopic pregnancy, intrauterine fetal death (IUFD/stillbirth), fetal condition not compatible with life, neonatal death, maternal death

syphilis s/s

spontaneous abortion, still birth, prematurity, congential syphilis, enlarged liver/spleen, skin lesions, rash, osteitis, pneumonia, hepatitis

High risk families

substance abuse, teen parents, what support system? experiencing martial conflict, divorce, adolescent parents, affected by violence against one or more of the family members, involved with substance abuse, chronically ill child

substance abuse

substance has strong pull over parent, substance interrupts a child's normal growth and development. child at risk for emotional and health problems. child most likely to follow in parents path

rights of fetus vs right of mother

support mother. give all resources available

hydrocarbon tx toxin ingestion

support ventilation, administer O2, IV fluids

cleft palate management

surgical correction, identify alternate feeding devices- special nipple for a bottle, frequent burping, enlarged nipples. monitor for ear infections (more prone) 2 to 3 days after surgery should e able to take fluids. correct lip then palate

biliary atresia management

surgical intervention called the kasai procedure to divert bile flow to jejunum

pyloric stenosis management

surgical relief to the pyloric obstruction

placenta- metabolic

synthesis of glycogen, cholesterol, and fatty acids

which example describes how a nurse can display an open body posture

talking while the hands are freely moving

the purpose of discipline is to

teach a child how to effectively function in a society

cleft lip surgical S/S infection

temp, pain scale- flacc, o reeda, salt

the optimal time to prepare a toddler for a painful procedure is just before the procedure is performed

true

to listen with impartiality, nurses must hold their personal beliefs and values in abeyance

true

unintentional injuries are the leading cause of death in children aged 1-19 years

true

foramen ovale

the blood enters the right atrium. most of the blood passes directly into the left atrium through the second shunt. mixes with the small amount of blood returning from the lungs

what we say is often less important than how we say it

true

what is the difference among the three classifications: presumptive, probable, and positive indications or pregnancy

the difference among the indications is that presumptive indicators are least reliable because they can often be caused by other conditions; probable indicators are stronger evidence but still may have other causes; positive indicators are those caused only by pregnancy

4 weeks fetal development- parent know

the fetal heart begins to beat

parity

the number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation, not the nubmer of fetuses (twins) born. the numeric designation is not affected by whether the fetus is born alive or stillborn (showing no signs of life a birth

which nursing action indicates that the nurse understand the components of effective communications

the nurse asks an adolescent whether she can give her a hug

Christian

the way of Jesus

vernix caseosa

thick cheese substance. protects the body, covers skin to protect baby from constant exposure to amniotic fluid

hypertrophic pyloric stenosis definition

thickening and tightening of pylorus muscle causing an obstruction

basic guidelines for communication with children and families

touch, physical proximity and environment, listening, visual communication, tone of voice, body language, timing.

family structures

traditional, nontraditional, high risk

amniotic membranes and fluid

two fetal membranes, amnion (inner) and chorion (outer). protection growing fetus, derived from two sources. fetal urine and fluid transported from maternal blood (shock absorber) "bag of water" protects the growing fetus and promotes normal prenatal development. providing a stable temperature

fetal membranes and amniotic fluid

two fetal membranes- amnion (inner) and chorion (outer). protects growing fetus. derived from two sources- feta urine, fluid transported from maternal blood. shock absorber

Vomiting factors to fluid loss

viral, food intoleracnce, bacteria, illness, gerd, cold, gi obstruction, concussion, migraine, infections, obstructions, motion sickness, metabolic alterations, psycholgical alterations, association with diarreah, gastroenteritis, allergic reaction, side effects of medications, green emesis- bile, fecal odor indicates lower intestinal obstruction or peritonitis, bright red- blood has not been in contact with gastric juices. DX- CBC, rad, blood cx, abg

aspirin

vit k to stop bleeding

24 weeks fetal development- parent know

weight 1 lb, 10 oz. activity is increasing. fetal respiratory movement begins

BMI equations

weight in lbs x 703 divided by height in inches squared kg divided by meters squared (1 inch = 2.54cm) (cm divided by 100 = meters)

high maternal mortality rates

early recognition of pregnancy

research shows that the verbal content of a message conveys more than nonverbal communication

false

the nurse expresses empathy using similar words to restate what the speaker has just said

false

there is no link between children living in poverty and poorer health outcomes

false

touch communicates more meaning to a younger child than to an older child

false

when talking with toddlers, nurses should use proper technical terms for body parts and processes

false

communicating with families

family centered care emphasizes that the family is intimately involved in the care of the child. nurse respects the fmaily diversity, identify the foundational strengths, establish rapport, availability and openness to questions, family education and empowerment

an example of a family that is classified as high risk

family headed by adolescents

nuclear family

family headed by two parents who are motivated to learn about parenting

iron deficiency anemia s/s

fatigue, pale skin, weakness, jaundice (hemolysis), polycythemia (response to hypoxia causes increased RBC and HCT), petechiae/purpura (bleeding tendeny), failure to thrive (chronic diseases or organ failure)

conception

fertilization of ovum must occur within 24 hours after ovulation (14 days before start of next period) most sperm survive 1 to 2 days

12 weeks fetal development- parent know

fetal heartbeat may be heard by doppler device

fetal period week 17 to 20

fetal movement can be felt, changes in skin and hair- vernix, lanugo, brown fat, can see gender

how does the woman's perception of the baby change during pregnancy- 1st trimester

fetus seems vague and unreal, rather than seeming like a baby to her

potential problems in families with special needs children

financial hardship, marital stress, sibling resentment

assessment of influences on fetal development

genetic factors (DNA), teratogens, interaction of genetic and environmental factors

rubella

german measles airborne droplet or direct contact with nasopharyngeal secretions greatest risk in 1st trimester crosses placenta test for immunity and vaccinate live vaccine

Bad food for celiac disease

gluten: breads, rolls, bagels, bran, broth, cakes, cereal, cookies, hotdogs, pasta, pastries, pizza, enriched flour, white flour, matzo flour/meal, rye, fried chicken

minimum urinary output by age- preschooler and young school age

greater than 1 to 2 ml/kg/hr

minimum urinary output by age- infants and tolddlers

greater than 2 to 3 ml/kg/hr

auxiliary structures

grow simultaneously with fetus- placenta (gas exchange, waste), fetal membranes (sac of fluid), umbilical cord (life line)

fetal period week 21 to 24

growing and gaining weight, little subcutaneous fat, lungs producing surfactant, some gas exchange is possible

obesity

growing epidemic concern in the US. contributing factors- latch key kids (both parents working, kids alone at home), parental fear of increasing rate of abduction and abuse, more fast food restaurants and processed foods then ever. results- increase in diseases and conditions we've never seen before.

embryonic period week 7

growth and refinemet of all systems occur, face human looking, rudimentary skeleton

fetal period week 33 to 38

growth of all body systems continues, lots of subcutaneous fat, testes in scrotum, breast are enlarged, considered full term at 38 weeks gestation

gastrointestinal body changes

gum swelling- increased vascularity displacement of intestines-lateral and posterior (constipation) displacement of stomach- superior and lateral hemorrhoids- venous pressure/ congestion constipation- delayed intestinal motility, increased progesterone levels gallstone formation- delayed gallbladder emptying

a pregnant woman at 10 weeks of gestation exhibits the following signs of pregnancy during a routine prenatal check up. which ones would be categorized as probable signs of pregnancy

hCG in the urine, beast tenderness, hegar's sign

placenta- endocrine

hCG, progesterone (hormones), human chorionic somatomammotropin

embryonic period week 8

had definite human form, external genitalia begin to differentiate

lanugo

hair (fine hair) keeps oil on skin. help vernix caseosa adhere to the skin

a Muslim woman is admitted to the postpartum unit after delivering a baby girl. considering the cultural needs of this patient, what should be included in her plan of care

having only female nurses care for the patient

toddler communication

hearing, seeing, smelling, tasting, touch. two word combinations, turn talking in communication, "NO" security object separation/stranger anxiety high. dependent . short attention span.

cardiovascular system

heart and blood volume

nursing process and perinatal infections intervention

review prenatal and delivery record, provide eye prophylaxis, observe neonate for signs and symptoms of infection, monitor labs

which of the following foods would be appropriate for a 12 month old child with celiac disease

rice cereal

goals of chronic care child

keep normal, social, achieve and maintain normalizaiton, obtain the highest level of health and function possible (physically, emotionally, psychosocially)

gastroesophageal reflux complication of GER

malnourishment- failure to thrive. aspiration. pneumonia- wheezing, crackles. fluid/electrolyte imbalance. Barrett's- diplegia- cancer. FTT, apnea or ALTE (call 911). wheezing/asthma. pneumonias. Barrett's esophagus cancer surgical interventions- gastric fundus wrap around esophagus. avoid-spice, citrus, greasy

psychosocial adaption- 3rd trimester week 27 to 40+ teaching

managing symptoms- backpain, round ligament pain, indigestion, braxton hicks (not real labor), exercise and rest, traveling- after 36 weeks stay home, childbirth classes, hospital tour

when teaching the mother of a toddler diagnosed with lead poisoning, which of the following should the nurse include as the most serious complication if the condition goes untreated

neurologic deficits

Labor, Delivery, Postpartum room (LDRP)

one room for all care, infant and mother always together

gastroesophageal reflux in children

retrograde passage of gastric material into the esophagus. allergies, positioning, stress, coughing, impairment, disease, infection, after meals, GERD is a more severe and chronic from-irritability, back arching, esophagitis, failure to thrive

TEF surgical ER/ Pharm

thoracotomy, pre op- airway patency, prevention of pneumoina and gastric or blind pouch decompression. Post op- NG tube, pt/ot for feedings broad spectrum antibiotics- aspiration pneumonia

choose the appropriate infant care teaching for the woman who gave birth by cesarean because of active herpes

thoroughly wash your hands before handling the infant

a newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. the physician has prescribed IV fluids of dextrose water with sodium and potassium. the baby's admitting potassium level Is 3.4 mEq/l. the nurse should

verify the infant has urinated

5 month fetus

vernix and lanugo appear, legs lengthen, sebaceous glands appear

nursing communication with southeast Asians

voice tone- soft voice, eye contact- no prolonged eye contact

moderate dehydration

5 to 10% of body weight (50-100ml/kg of fluid loss) exp 80lbs (80lbs x 5%) = 4lbs to (80lbs x 10%)= 8lbs

minimum urinary output by age- school age and adolescents

0.5 to 1 ml/kg/hr

third trimester

13 weeks

maintenance fluid requirements in 24 hour for less than 10 kg child.

100ml/kg

change in body systems- reproductive- uterus

10ml to 5000ml growth pattern- weeks gestation roughly equal to uterine height blood flow- increases dramatically 450 to 650 ml/min up too 1200ml/min Braxton hicks contractions- irregular contraction throughout pregnancy

at what point in gestation is it possible to hear fetal heart sounds using a doppler

12 weeks

fetal sex apparent by external genitalia

12 weeks

second trimester

12 weeks

uterus can first be palpated above the symphysis pubis

12 weeks

first trimester

13 weeks

maintenance fluid requirements in 24 hour for greater than 20 kg child

1500ml + 20ml/kg for each additional kg over 20kg exp- 24kg pt (20kg = 1500ml) (1500) + (20ml x 4kg) = 1500 + 80 = 1580ml

fundus can be palpated about halfway between symphysis pubis and umbilicus

16 weeks

acetaminophen (Tylenol) toxin ingestion s/s

1st 24 hours: malaise, nausea, vomiting, sweating, pallor, weakness 2nd 24 hours: rise in liver enzymes/ bilirubin, right upper quadrant pain, prolonged prothrombin time 3 to 7 days: jaundice, liver necrosis, signs of hepatic failure 5 to 7 days: recovery or progression to death, sodium restricted high calorie, high protein diet.

Gastroesophageal reflux pharm

H2 antagonist to reduce gastric acid level- tagament (cimetidine), Pepcid (famotidine), zantac (ranitidine) PPI mucosal protectants proton pump inhibitors to block acid production- protonix (pantoeprazole), Maalox (calcium carbonate) prokinetics to stimulate the gastric emptying and improve tone

use nageles rule to calc the EDD of Feb 4, 2014 last normal menstrual cycle date

2/4/14 + 7 days = 2/11/14 - 3 months = 11/11/13 + 1 year = 11/11/14 Nov. 11, 2014

fundus is at the level of umbilicus

20 weeks

fetal movements felt by mother

20 weeks 16-24 weeks

5 month pregnant fetus development

20 weeks. can see gender. fetal movement can be felt. changes in skin and heir (vernix- thick cheese substance/ lanugo- hair/ brown fat) mother feels movement (quickening). baby develops a regular schedule of sleeping, sucking, kicking. hands can grasp. baby assumes a fav position in utero. vernix protects the body and lanugo keeps oil on skin. head, hair, eyebrows, eyelashes present. size of a banana fetal movement feels like fluttering or butterflies. brown fat is heat producing fat deposited on the back of the neck, behind the sternum, around kidneys- maintain temp

fetal circulatory shunts to close after birth

3 holes keep blood form lungs and liver. divert blood. 1st- ductus venosus. 2nd- foramen ovale. 3rd- ductus arteriosus

umbilical cord- fetal circulatory circuit

3 holes to keep blood from lungs and liver, three shunts divert blood

trimesters

3 total first trimester- 13 weeks second trimester- 12 weeks third trimester- 13 weeks

7 months pregnant fetal development

28 weeks. more likely to survive if born after 24 weeks. assumes a head down position. eyes begin to open and close. baby can breathe at this time. surfactant needed for breathing at birth is formed. baby is two thirds its final size. size of an eggplant. with maturation of the lungs, pulmonary capillaries, central nervous system. plumper/smoother skin. blood formation shifts from the spleen to the bone marrow

closure of the neural tube

4 weeks

consent vs assent

7 to 12 year old research study/aware of what is going to happen to them descent 13-18 years old- not to continue on with care

40lb child urinated 15 ml in 3 hours. is this enough

40lb to kg 40 divided by 2.2 is 18.18kg 15ml divided by 3 hours is 5 ml of urine per hour. average is 1-2 ml/kg 18.18(1) to 18.18(2) for range 18.18 to 36ml per hour. child need fluids. not enough urine output.

Toxic ingestion assessments

5 W (Who, what, when, where, why). A- airway B-Breathing C-circulation D-disability neurological assessment E-exposure F-full set of vitals G-give comfort measures H-head to toe assessment I-inspect posterior surfaces

toxic ingestion assessment

5 W's- who, what, when, where, why symptoms may be difficult to recognize, but can be life threatening primary assessment- ABCDE secondary assessment- FGHI

varicella zoster immune globulin (VZIG)

5 days before birth or 2 days after birth- needs to be given within 72 hours live vaccine- mother cant get while pregnate

anemia: iron deficiency

6 months, 2 years, adolescents, multisystem effects, decreased oxygen carrying capacity of blood- decreased oxygen to cells

iron deficiency anemia in children

6 months- baby starts to eat 2 years- no phase, picky eater adolescents- body image, puberty, standards is the most common cause of anemia during infancy, childhood, adolescense

external ear development begins

6 weeks

toxin ingestion

6 years of age most susceptible, prepare for intubation with most toxins

2 months pregnant fetus development

8 weeks, has definite human form, external genitalia begin to differentiate. all body organs are formed. size of a raspberry embryo has a definite human form, refinements to all systems continues. ears are low set. external genitalia begin to differentiate

use nageles rule to calc the EDD of Aug 2, 2013 last normal menstrual cycle date

9/2/13 + 7 days = 9/9/13 - 3 months = 5/9/13 + 1 year = 5/9/14 May 9 2014

vomiting and diarrhea assessment

ACCT (amount, color, consistency, time/duration), is it think? weight of a diaper. stool and urine counts. teach S/S of diarrhea and dehydration- PEWS (pediatric early warning score) how is the kid doing, q4 hour vitals, q4 hour pews

common chronic conditions of childhood

ADHD, ADD, asthma (reactive airway disease), autism, bleeding disorders (hemophilia), bronchopulmonary dysplasia, cancer, cardiac disorders, cerebral palsy, chronic renal failure, congenital heart disease, cystic fibrosis, developmental delay, DM, Downs, hepatitis, HIV, Aids, hydrocephalus, inborn error of metabolism, juvenile arthritis, lupus, intellectual impairments, muscular dystrophy, neural tube defects, phenylketonuria, seizure disorders, sickle cell disease

best for celiac disease

CORN! whole family participate in diet, high protein, fresh veggies

Mormon (the church of Jesus Christ or latter day saints

Call clergy, abortion opposed unless mom's life is threatened, natural birth control

obesity related disease in children

DM type 1 and 2 (type 2 increasing), dyslipidemia, HTN, cardiovascular disease, obstructive sleep apnea, fatty liver, orthopedic complications, osteoarthritis of the joints

obesity associated comorbidities

DM type 1 and 2 (type 2 increasing), dyslipidemia, HTN, cardiovascular disease, obstructive sleep apnea, fatty liver, orthopedic complications, osteoarthritis of the joints. DM, dyslipidemia, HTN, CV disease, obstructive sleep apnea, pulmonary embolism, hepatic steatosis (fatty liver), orthopedic complications

a pregnant woman with four children reports the following obstetric history: a stillbirth at 32 weeks of gestation, triplets (2 sons and a daughter) born via cesarean section at 30 weeks gestation, a spontaneous abortion at 8 weeks of gestation, a daughter born vaginally at 39 weeks gestation. GTPAL

G-5 T-1 P-2 A-1 L-4

salicylate (aspirin) toxin ingestion

GI, CNS, hematopoietic, metabolic, risk for bleeding to death, antidote vit k

Dehydration from systems

GI- vomiting, diarrhea, pyloric stenosis, malabsorption Endocrine- fever, DM, cystic fibrosis Skin- burns, sweating Lungs- tachypnea Kidney-renal failure Heart- heart failure Mild vs moderate vs severe

confidentiality

HIPAA

esophageal atresia with tracheoesophageal fistula (TEF)

HX of polyhydramnios (mom too much amniotic fluid) excessive salivation and drooling can lead to respiratory distress. increased respiratory distress after feeding. atresia- absence or narrow opening. fistula- abnormal connection between organs. congenital malformation in which the esophagus terminates before it reaches the stomach and or a fistula is present that forms an unnatural connection between the esophagus and the trachea. esophagus ends in a blind pouch and there is a distal tracheoesophageal fistula

hypertrophic pyloric stenosis nursing side

HX- infants feeding schedule with type, amount, frequency of fluid taken compare to vomiting assessment which includes frequency, amount, color, consistency, as well as projection

out of the 3 types of dehydration, which is most common in children

Isonatremic dehydration occurs as a result of equal solute and water losses, thus maintaining a normal sodium concentration of 135-145 electrolytes and water loss happens in the same proportions as they exist in the body. serum sodium stays normal

authoritarian parents permit compromises about rules

false

multigravida

a woman who has had two or more pregnancies

nulligravida

a woman who has never been pregnant

nullipara

a woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks of gestation or more

gravidity

a woman who is or has been pregnant regardless of duration of the pregnancy

primigravida

a woman who is pregnant for the first time

it is better not to tell a child how long a painful or invasive procedure will take

false

probable indications of pregnancy

abdominal enlargement, goodell's sign (soft cervix), uterine changes- ballottement (feel fetus), Braxton hicks contractions, palpable fetal outline, positive pregnancy test, chadwick's sign on cervix

fistula

abnormal connection between organs

fistula (TEF)

abnormal connection between organs

infertility pregnancy loss

abnormalities of fetal chromosomes, abnormalities of the cervix or uterus, congenital, trauma/surgery, lesions, endocrine abnormalities, immunologic factors, environmental agents, infections, STD's, advance age greater than 35, miscarriage, get pregnant cant hold

mens factors contributing to infertility

abnormalities of the sperm, abnormal erections, abnormal ejaculations, abnormal seminal fluid

failure to thrive nonorganic

absence of history contributing to a psychosocial cause

which of the following would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration

absence of tear formation

atresia

absence or narrow opening

atresia (TEF)

absence or narrow opening

potential complication of amniocentesis

amniotic fluid embolism, hemorrhage, infection, abruption placentae, placenta or umbilical cord trauma, premature labor, bladder or intestinal puncture (of baby), RH isoimmunization, intrauterine fetal death, amnionitis, injury from needle puncture, amniotic fluid leakage, bleeding, spontaneous abortion, premature birth

amniocentesis

amniotic fluid obtained by inserting a needle through the abdominal and uterine walls indicated for woman 35 and older and women with family history of chromosomal or neural tube defect or inborn errors of metabolism contraindicated in anterior uterine wall is completely covered by placenta or amniotic fluid level Is insufficient

celiac disease

an inborn error of metabolism characterized by the inability to break down gliadin gliadin is a protein found in rye, oats, barley, wheat

the parents report that their 1 day old is drooling and having choking episodes with excessive amount of mucus and skin color changes during feedings. the nurse should contact the primary care provider to further assess the baby and request an order for which of the following

an x-ray with orogastric catheter placement

cleft lip post op

apply elbow restraints to prevent infant pulling at repair site- neurovascular, skin, rom assessments needed. keep incision clean and dry- NS, peroxide, antibiotics. maintain airway patency- aspirate excessive secretions. pain management (FLACC scale) and prevent crying. s/s of infection- O REEDA, SALT, Temp,

once a procedure is completed, it should not be discussed with the child

false

Home births

at home, familiar setting with family support

active listening

attending to another person to gain an understanding of the actual and implied message

positive indications of pregnancy

auscultation of fetal heart sounds, fetal movement felt by provider- abd assessment, ultrasound- see baby

professional boundaries- signs of under involvement

avoiding child or family, calling in sick to avoid taking care of family or child, trading assignments to avoid taking care of a child or family, spending less time with a particular child (know your limits)

esophageal atresia with tracheoesophageal fistula pharm

broad spectrum antibiotics since aspiration pneumonia is inevitable

38+ weeks fetal development- parent know

baby fills total uterus. baby gets antibodies from mother

increased interventions improving mother infant bonding

baby friendly- encourage breast feeding, skin to skin faster, delayed bathing

32 weeks fetal development- parent know

baby has fingernails and toenails. subcutaneous fat is being laid down. baby appears less red and wrinkled

16 weeks fetal development- parent know

baby's sex can be seen. although thin, the fetus looks like a baby

decreasing infant mortality rates

back to sleep campaign

Group B streptococcus (GBS)

bacterial infection found in lower GI or urogenital tract. swab rectum and vag at first apt. transmitted during delivery. IV antibiotics (ampicillin) recommended before delivery if GBS + or status unknown- protect baby first. (4 hours prior to delivery)

gentamicin

bacterial infections (used in combination with penicillin)

therapeutic relationship

balance between appropriate involvement and professional separation when relating to children and their families

evaluating fetal monitoring strips

baseline fetal heart rate baseline fetal heart rate variability peridic patters- accelerations and decelerations (early, late, variable)

separation anxiety- despair

become inactive, withdraws from others, quiet, uncommunicative, may regress to earlier behavior or apathetic. child feels hopeless and becomes quiet, withdrawn, apathetic.

separation anxiety- detachment

becomes interested in environment, interacts with strangers or familiar caregivers, appears happy, and if parents reappear, the child may ignore them. child becomes interested in the environment, plays and seems to form relationships with caregivers and other children

the parent of an infant with a cleft palate asks when the palate will be repaired. the nurse responds by stating the repair is done at the following times

before speech development

a nurse is caring for a 10 month old weighing 8.0kg, who was admitted for dehydration. the infant has vomited five times in the last three hours and has had no wet diapers in the last 8 hours. which of the following orders received should the nurse question

begin an IV line and administer a fluid bolus with dextrose 10%

fatalism

belief that events are predestined

Four of the most important ethical principles are

beneficence, nonmaleficence, autonomy, justice

syphilis tx

benzathine penicillin G

ethical concepts

best course of action in a certain situation, right and reasonable, ANA

documentation

best evidence that a standard of care had been maintained

para

birth after 20 weeks gestation, regardless if live birth or stillborn, not number of fetuses can be broken into term, preterm, abortion, living

foods bad for celiac disease

breads/rolls, bagels, bran, broth, cakes, cereal, cookies, hotdogs, pasta, pastries, pizza, enriched flour, white flour, matzo flour/meal, rye, fried chicken

professional boundaries- signs of over involvement

buying gifts for individual children or families, providing home or cell numbers, lending or borrowing money, visiting or spending time with the child or family during off duty time, competing with other staff members for the child's or families affection

how can family center care be achieved

by creating partnerships with families and by recognizing that families have the right to fully participate in planning, implementing, and evaluating a child's care

closed off parents (communication)

can just be tired, need a break, need to eat, need someone to listen to them, to vent

ultrasound disadvantages

cannot identify all fetal structural defects cost if no insurance

musculoskeletal changes to the body

calcium storage- increase absorption, high fetal demands, no loss of bone density. separation of rectus abdominus muscles- varies from slight to severe postural changes- increased mobility of pelvic ligaments, pelvic instability (wide stance), lumbosacral curvature, stooped shoulder appearance (weight of breasts pull shoulders forward)

cardiovascular body changes

cardiac hypertrophy and displacement vascular resistance changes increased blood volume blood pressure- supine hypotension (baby weight on vena cava) increased cardiac output- increased heart rate increased fibrinogen levels- hypercoagulable state (great for delivery, bad after- risk for DVT, PE, Clots) heart dose enlarge- 50% more blood volume not normal to have high BP during pregnancy

which statement about family centered care maternity care is correct

care is adapted to meet the physical and psychologic needs of the family

umbilical arteries (2)

carries deoxygenated blood two arteries that carry blood high in carbon dioxide and other waste products away from the fetus to the placenta

umbilical arteries (2)

carries deoxygenated blood and waste products from the fetus to the placenta

umbilical vein

carries oxygenated blood carries freshly oxygenated and nutrient rich blood from the placenta back to the fetus

umbilical vein

carries oxygenated blood and nutrients from the placenta to the fetus

a practice model that uses a systematic approach to identify specific patients and manage patient care is

case management

Family centered maternity care

childbirth is usually a normal, healthy event. childbirth affects the entire family/ family restructuring is required. families involved in making decisions about care, given adequate information and professional support

placenta- fetal component

circulation- fetal heart

esophageal atresia with tracheoesophageal fistula (TEF) assessment finding

classic signs: 3 C's- couching, choking, cyanosis. excessive oral secretions, coughing, choking, and respiratory distress. may have congenital heart disease, GU analomies, possible Vater syndrome (vertebral defects), anorectal, TEF, esophageal atresia and renal analomies

potential problems of same sex parents

conflicts with community values

rubella s/s

congenital heart disease, IUGR, cataracts, mental retardation, hearing impairments

5 leading causes of infant mortality

congenital malformations, deformations, chromosome abnormalities, disorders related to low birthweights, sudden infant death syndrome, unintentional injury

Wharton's jelly

connective tissue that prevents compression of the blood vessels to ensure continued nourishment of the embryo or fetus

the pregnant woman who becomes infected with chickenpox should be taught to report promptly

cough or dyspnea

When esophagus is closed off from trachea and stomach (TEF)

coughing, chocking, cyanosis

Human papillomavirus (HPV)

cream or gel, cryotherapy, electrocautery, vaccine,

adolescents communication

create theories and generate many explanations for situations. communicate like adults. "imaginary audience" need independence.

middle childhood death concept

death as sad and irreversible but not necessarily inevitable

failure to thrive- adverse outcomes

decreased cognitive function, developmental delays, social problems, lower IQ score related to poor nutrition

endocrine changes to the body- pancreas

decreased glucose levels- 10 to 20% lower, hypoglycemia precautions, decreased insulin sensitivity-later half of pregnancy

discipline

designed to teach a child how to effectively function in a society

placental hormones- relaxin

detectable in maternal serum by time of first missed menses, inhibits uterine activity, aids in softening of cervix, relaxes pelvic joints

amniocentesis 3rd trimester

determine fetal lung maturity L/S ration "lacithin/sphingomyelin" test for fetal lung maturation >2:1 surfactant adequate phosphatidylglycerol (PG)- another phospholipid surfactant evaluate fetal hemolytic disease

monozygotic twins (identical)

develop from one single fertilized ovum- zygote divides into two separate cells (embryos) at first cleavage division. same sex hand have same appearance. placenta and sac vary by timing of division. occurs randomly. not affected by reproductive techniques.

Toddlers (developmental approaches)

developing a sense of autonomy, egocentric, control is a major issues- need rituals/routine, obtain childs routine from parents, give choices

placenta- maternal component

development- 3 decidual layers, circulation- exchange of substances between mother and baby in intervillous space

lead (plumbism) toxic ingestion s/s

developmental delays, abdominal pain, neurologic changes, irritability, impair cognitive function

lead (plumpish) s/s toxin ingestion

developmental delays, abdominal pains, neurologic changes, irritability, impaired cognitive functions, lethargy, hyperactivity, cognitive and perceptual motor difficulties, clumsiness, death, anemia, anorexia, N/V, constipation,

potential problems of blended families

differences in parenting styles, values, discipline

embryonic period

differentiation of cells (function), development of specialized structures, teratogens can damage developing structures, prenatal growth and development proceed in patterns

embryonic period germ layer- endoderm

digestive system, lungs, urinary tract, vital organs (pancreas, liver)

urinary body changes

dilated ureters and renal pelvis increased glomerular filtration rate and renal plasma flow- increased glycosuria, medium for bacteria growth urinary frequency- stress incontinence, nocturia prone to UTI

parental reaction depends on how acute/serious the situation is

disbelief- when illness is serious or sudden, anger, guilt, both. demonstrate fear, anxiety, frustration, signs or depression- when acute phase is over

a patient is 14 weeks pregnant. she calls the prenatal clinic to report that she noticed slight, painless spotting this more. she reveals that she did have intercourse with her partner the night before

discuss cervical and vaginal friability and increased vascularity; makes the vagina and cervix softer and more dilcate so spotting after intercourse is expected; caution that any bleeding should be reported so it can be evaluated

a patient is 3 months pregnant. she tells the nurse that she is worried because a friend told her that vaginal and bladder infections are more common during pregnancy. she wants to know if this could be true and if so why

discuss impact of increased vaginal secretions and impact of stasis of urine that contains nutrients and has a high pH; review prevention measures at this time

cleft lip surgical correction

done early in the first few months of life. can be prolonged several months (24 hour recovery) keep incision clean and dry with NS, peroxide, antibiotics. maintain airway patency- aspirate excessive secretions. pain management and prevent crying. NONO elbow restraints- neurovascular, skin, ROM assessments

chorionic villus sampling (CVS)

dx fetal chromosome or metabolic abnormalities, indicated for woman who are at high risk for genetic anomalies dx from fetal cells, preformed transcervical or transabdominal between 10-13 weeks, does not detect neural tube defects, test can detect more than 200 disorders (downs, tay sachs, sickle cell), lithotomy position

embryonic period Germ layers

ectoderm (outer layer) mesoderm (middle layer) endoderm (inner layer)

corrosives s/s toxin ingestion

edema, visible burns, difficulty swallowing, severe chemical burns of mouth, throat, esophagus. splash burns to eyes and skin. whitish burns of mouth and pharynx, edema, difficulty swallowing, drooling, respiratory distress, pain, residual difficulty swallowing, severe burns causing perforation can lead to vascular collapse and shock

teratogens

effects most serious when structure is forming, susceptibility to harm is influenced by genetic makeup of mother and embryo, same defect can be caused by differnet teratogens, one teratogen can cause different defects, embryo can be affected by fathers exposure to teratogen, some effects not apparent until later in life

Coping

efforts directed toward managing or solving various events, problems, or stressors

how do we facilitate family centered care

empower mother, include family in teaching

gonorrhea side effects

endocervicitis and weakness of fetal membrane increase risk for premature rupture, preterm labor

cytomegalovirus (CMV) infant s/s

enlarged spleen and liver, CNS abnormalities, jaundice, chorioretinitis, growth restrictions, hearing loss

endocrine changes to the body- thyroid gland

enlarges, increased basal metabolic rate- up to 25%, increased T4- return to normal in later pregnancy, essential for fetal brain development check thyroid level when dx with pregnancy

an appropriate time to teach a 4-year old about surgery is immediately after the parents have gone home

false

an authoritarian parent discusses the household rules with the child

false

psychosocial adaptation- 1st trimester week 1 to 13 teaching

exercise and rest (ran before can run still), nutrition- manageing nausea and vomiting, managing heartburn, avoid teratogen exposure- smoking, drugs, alcohol, include prescription medicaitons, fetal growth and development, sexual activity- ok unless complications, danger signs- bleeding, cramping, pain, s/s dehydration

hydrocarbons toxin ingestion

exp- gasoline, mineral oil detect: suspected base on odor of breath and clothing

multigenerational families

extended family consists of members from three or more generations living under one roof. boomerang familie

28 weeks fetal development- parent know

eyes begin to open and close. baby can breathe at this time. surfactant needed for breathing at birth is formed. baby is two thirds its final size

embryonic period week 6

eyes continue to develop, heart finishes development

a child with a hearing impairment needs to have an arm cast. what can the nurse do to facilitate communication with the child throughout the cast application process

face the child when speaking

cleft palate

failure of the palate to fuse during embryonic development. the defect may be unilateral or bilateral and varies from a split uvula to a complete opening of the hard and soft palate.

cleft lip

failure of the upper lip to fuse during embryonic development. can be unilateral or bilateral and varies from notching or one side of the lip to a compete opening between the lip and nose. the more extensive the defect the more oral facial and related structures are involved.

Negligence

failure to act in the way a reasonable, prudent person of a similar background would act in a similar circumstance

obstetrical nurse legal ethical issues

failure to follow standards of care, to communicate, follow the chain of command

failure to thrive organic

failure to gain weight secondary to physical factors/ diseases

African American women have lower maternal mortality rates than Caucasian women

false

Nagel's rule from LMP

first day of LMP (last menstrual period) add 7 days subtract 3 months add 1 year

yolk sac

first few weeks of life, nourished by the sac. provides nutrients and blood cells until the placenta fully forms

primigravida

first pregnancy

hypertrophic pyloric stenosis

first thought- reflux but persistent. results when the circular area of muscle surrounding the pylorus hypertrophies and obstructs gastric emptying.

pyloric stenosis assessment finding

forceful vomiting- occurring 30 to 60 minutes after feedings. constant hunger. olive shaped mass palpated when stomach is empty. colicky pain. abdominal distention

Blended families

formed when single, divorced, or widowed parents bring children from a previous union into their new relationship. contemporary family- yours/mine/ours. discipline often causes family conflict

Birth center

freestanding, antepartum, intrapartum, postpartum, newborn care- low risk mothers, midwifes

fertilization is complete when

fusion of the sperm and ovum nuclei occurs

placenta

gas exchage and waste. thick, disk shaped, major function: metabolic synthesis of glycogen, cholesterol, fatty acids Transfer of substances between mother and fetus- gas exchange, nutrient transfer, waste removal (carbon dioxide, urea, uric acid, bilirubin), antibody transfer, transfer of maternal hormones, glucose, fatty acids, electrolytes, vitamins endocrine- HCG, progesterone (hormones)/ if male testosterone, human chorionic somatomammotropin. no blood mixing. maternal component- development: 3 decidual layers. circulation: exchange of substance between mother and baby in intervillous space fetal component- circulation fetal heart

surfactant

gas exchange in lungs. needed for breathing at birth

placenta- transfer of substances between mother and fetus

gas exchange, nutrient transfer, waste removal, antibody transfer, transfer of maternal hormones

hydrocarbons toxic ingestion

gasoline, kerosene, mineral oil detection- suspected base on odor of breath and clothing s/s- will display signs of respiratory distress or may vomit

potential problems of multigenerational families

generational conflicts

consequences (discipline measure)

helps children see the direct result of their misbehavior

hep B + tx

hep B immune globulin given with in 12 hours of birth and hep B vaccine at birth then 1 month then 6 months early bath before injections and procedures

hep B - tx

hep B vacine at birth then 1 month then 6 months

common for cleft lip/palate due to

heredity, decreased folic acid, smoking, ETOH

common to cleft lip and cleft palate

heredity, dietary factors- decreased folic acid, risk factors- exposure to teratogens, maternal intake of Dilantin, alcohol, cocaine, smoking

narcotic overdoses- heroin and opioid epidemic toxic ingestions

heroin and fentanyl- a powerful synthetic opioid

carbon monoxide toxic ingestion source

household fires, improperly vented automobiles, furnaces

psychosocial adaptions- 2nd trimester week 14 to 26 teaching

hygiene, activing and sleep- sleep positions, comfortable positions increasingly difficult, sexual activing- complications, body changes- 14 to 26 weeks

integumentary body changes

hyperactive sweat glands- feel warmer and perspire more hyperactive sebaceous glands- increased acne hair growth- grows more rapidly, less hair loss hyperpigmentation- nipples, areola, cervix, vagina, vulva change color, melasma, linea nigra striae gravidarum- stretch marks- dna

obesity precursor

hyperlipidemia, sleep apnea, cholelithiasis (gallstones), orthopedic problems, hypertension, diabetes, psychosocial difficulties- self esteem, body image

antepartum assessment and care- preconception

idnetifies any problems before pregnancy occurs- appropriate treatment if necessary, exposure to teratogens, teach health behaviors that result in successful pregnancy, obtain complete history and physical-offers baseline, initiate folic acid- 400 to 800 mcg daily in all women of childbearing age, decreases risk of neural tube defects in the fetus

embryonic period week 2

implantation complete

placenta

implantation. endocrine gland produces four hormones to maintain the fetus. metabolic function for respiration, nutrition, excretion, storage

lead (plumbism) toxic ingestion- source

imported objects (toys, meds, candy), foods, paint,

failure to thrive- organic

in addition to an underlying condition it can be due to inadequate caloric intake, inability to retain calories or increased losses (emesis/diarrhea), faiure to gain weight secondary to physical factors/ disease

Erythromycin

in infant eyes to prevent infection of chlamydia and gonorrhea

infertility

inability to conceive after 1 year of regular intercourse without contraception

communicating with families

include all family members- facilitate family centered care and trust. encourage the families to keep a journal or write down questions to ask. remain nonjudegmental- respect diversity. encourage feedback, follow through with actions or requests. define and problem solve together.

full disclosure and understanding

includes the treatment purpose and expected results, risks, side effects, benefits, other treatments

endocrine changes to the body-adrenal glands

increased cortisol level- regulate protein and carbohydrate metabolism, increased secretion of aldosterone- reabsorption of excess sodium

Hep B s/s

increased incidence of prematurity, low birth weight, neonatal death, at risk for acute infection in mother has hep B during preg. or is chronic carrier for hep B surface antigen.

respiratory body changes

increased oxygen consumption- hyperventilation decreased airway resistance increased vascularity- nasal stuffiness, epistaxis, decreased lung capacity- upward displacement of diaphragm increased chest circumference thoracic breathing deeper breathes

psychosocial adaptions- 3rd trimester week 27 to 40+

increased vulnerability, increased dependency (on support), preparation for children (natural vs drugs)- nesting, birth plan, danger signs- preterm labor, UTI, vaginal bleeding, severe n/v, severe edema

placental hormones- human placental lactogen

increases availability of glucose for fetus- reduces maternal metabolism of glucose allowing transport to the fetus

an 8-year-old child hit by a car has been in the intensive care unit (ICU) for a week. she has a lengthy recovery ahead. both parents have been at her side since the injury. they have not been properly eating and look exhausted. an appropriate nursing diagnosis for this family would be

ineffective family health maintenance management related to the situational crisis.

impaired nutrition possible dx

ineffective infant feeding pattern- failure to thrive. imbalance nutrition- decreased electrolytes/ dehydration. acute pain. impaired skin integrity. caregiver role strain- teaching, support groups. knowledge deficit- lots of learning: preop post op

legal concepts

informed consent- age of consent, competence, full disclosure and understanding, appropriate interpretation services

toxic ingestion

ingestion of or exposure to toxic substances, most occur in the child's home or homes of relatives/friends, toxic substance are ingested (most common) or inhaled, children less than 6 years of age most susceptible

gluten- celiac disease

is a general term that refers to the storage proteins found in wheat, barley, rye. requires dietary modifications to prevent chronic maldigestion and malabsorption

torch infections

is a medical acronym for a set of perinatal infections. infections can lead to severe fetal anomalies or even fetal loss. group of viral, bacterial, and protozoan infections that enter the fetal bloodstream trans placentally via the chrionic villi

effective communication

is based on honesty , caring, respect, and a direct approach. can empower children in situations where children are experiencing a loss of control and diminished autonomy

severe dehydration

is greater than 10% body weight loss, tachycardic, bradycardic in most severe cases, thread pulses, rapid and deep RR, markedly decreased BP as a sign of Hypovolemic shock, apathetic, lethargic, unconscious, drinks poorly or unable to drink. parched mucosa, markedly depressed anterior fontanel, markedly sunken eyes with absent tears, prolonged cap refill minimal; extremities cold, mottled or cyanotic, tenting for skin turgor, minimal urine output

minimal to no dehydration

is less than 3% weight loss with no S/S

mild to moderate dehydration

is less than 5 to 10% of weight loss with normal to increased weak pulses, normal to fast RR, fatigued, restless, irritable, thristy and eager to drink, dry mucosa, sunken anterior fontanel, slightly sunken eyes with decreased tears, prolonged cap refill with cold extremities, prolonged skin turgor recoil, decreased/concentrated urine

Chronic illness

is long term, persisting more than 3 months, does not spontaneously resolve, usually without complete cure, frequently has residual characteristics that limit activities of daily living, requires adaptation or special assistance

cleft palate surgical correction

is typically done after the lip repair, during the first year or life. older children who have not had cleft lip or palate repair is early childhood sometimes have both lip and palate repair done simultaneously

the mother tells the nurse that the diagnosis of colic upsets her because she knows her infant will continue to have colicky pain which of the following responses by the nurse would be most appropriate

it can be difficult to listen to your baby cry so long and so long, so try to make sure that you get some free time away

a woman's last menstrual period (LMP) began on September 10, 2013 and it ends on September 15, 2013. use nageles rule, the estimated date of birth would be

june 14, 2014

biliary atresia- surgical interventions

kasai procedure that diverts flow of bile to jejunum. temporary fix until the child grows and develops or when a liver transplant is needed. can use adult liver in children.

perinatal loss nursing considerations

keep pt and family informed, recognize meaning of loss to family, provide support, manage own feelings of loss, prepare the family about the babies look, separate loss family from newborn families, use univeral sign for loss, pictures of the baby for parents, memory box, assisting with the grieving process

BMI 70 kg and 157 cm

kg divided by meters squared first change 157 cm into meters by dividing by 100. 157 divided by 100 is 1.57 70kg divided by 1.57 squared is 28.3 or 28

BMI calculation

kg divided by meters squared (1 in = 2.54cm) (cm divided by 100 = meters)

Labor and Delivery Room (LDR)

labor, birth, recovery in one room. transfer to postpartum when ready, keep mom and baby together

dysfunctional families

lack of financial resources, absence of adequate family support, birth of an infant who needs specialized care, ill children, unhealthy habits, smoking, abuse of other substance, inability to make mature decisions, "sandwich generation"

umbilical cord

life line. contains two arteries and one vein which are surrounded by Wharton's jelly. provides circulatory pathway to embryo. 2 artery's carry deoxygenated blood. vein carried oxygenated blood

ultrasound 1st trimester- transvaginal

lithotomy position, probe with disposable cover inserted into vagina determining the presence and location of pregnancy, detecting multifetal gestations, estimating gestational age, confirming viability, identifying need for follow up testing, identifying characteristics of fetal abnormalities, as an adjunct for trans cervical or transabdominal chorionic villus sampling

potential problems of adoptive families

little time to prepare for the birth, little support after

Acetaminophen (Tylenol) toxin ingestion

liver, most common, antidote Mucomyst

factors that affect sibling reactions

loneliness, fear, worry, anger, resentment, jealousy, guilt (address concers directly/counseling). older then 10- can be emotionally close to hospital child, fear of getting illness, perceiving that their parents are acting differently toward them

what is "supine hypotensive syndrome"? what signs and symptoms might a woman with this syndrome display? what should the nurse do to prevent or relieve it?

lying in the supine position places the heavy uterus over the aorta and inferior vena cava, which temporarily occludes these vessels. signs and symptoms include lightheadedness, dizziness, agitation, and sometimes brief unconsciousness. this position can reduce placental blood flow. preventions/treatment is to position woman on her side or with a pillow under one hip

preschoolers (developmental approaches)

magic thinking, weird body image, striving for initiative- separation anxiety from parents, fear bodily harm/mutilation- don't understand body integrity/ painful things preformed in a treatment room to keep hosptial room safe, thinking is egocentric, magical and view illness or hospitalization as a punishment

psychosocial issues that affect nutrition in infants, children, adolescents- failure to thrive

manifested as inadequate growth resulting from inability to obtain or use calories required for growth. usually described in an infant or child who falls below the 5th percentile for weight. cluster of concurrent symptoms

Traditional hospital setting

many different rooms for each part of delivery, delay of parent to infant contact

infertility treatments

medications- progesterone, surgical procedures- scar tissue, therapeutic insemination, egg donation-age, surrogate parenting, advanced reproduction techniques- IVF, GIFT, ZIFT (sperm donation

Placenta major functions

metabolic, transfer of substances between mother and fetus, endocrine

lactose intolerance management

milk products are restricted, diet is supplemented with commercial lactase preparations (lactaid, dairy ease) to alleviate symptoms

embryonic period week 3

missed menstrual period, central nervous system begins developing

cleft lip surgical pre op

modify feedings and use tools, bottle, or nipple feeds- add strength, frequent burping- more air in with feedings

abortion

mom up until 22 to 24 weeks has the rights over the fetus. after 24 weeks the fetus takes on its own rights

cleft palate post op

monitor I/O. monitor packing- usually removed in 2 to 3 days. avoid objects that can harm the palate repair. avoid pacifiers or tongue depressors. monitor for infection. supine position. elbow restraints speech therapy

impaired nutrition nursing interventions

monitor for complications, pain management, monitor fluid and electrolytes, monitor intake and output, record daily weights- same time same scale same method, observe family coping and support systems, observe family interaction with infant- rejection denial anger or bond with baby- holding, consult with other disciplines as necessary- OT PT nutrition case management

carbon monoxide toxin ingestion

most common and fatal inhalation poisoning source: household fires, improperly vented automobiles, improperly ventilated heaters or vehicles. odorless, colorless gas that binds to hemoglobin more effectively than does oxygen

placental hormones- progesterone

most important to maintain pregnancy- inhibits spontaneous contractility of uterus, prevents tissue rejection of fetus, preparation for lactation- develops lobes and lobules in the breast, facilitates maternal fat deposits to provide energy reserves for pregnancy and lactation

20 weeks fetal development- parent know

mother feels movement (quickening). baby develops a regular schedule of sleeping, sucking, and kicking. hands can grasp. baby assumes a favorite position in utero. vernix (lanolin- like covering) protects the body, and lanugo (fine hair) keeps oil on skin. Head hair, eyebrows, and eyelashes present.

hepatitis b immunoglobulin (HBIG)

mother hep b + 12 hours post birth bath first with hep b vaccine

hepatitis b vaccine

mother hep b + then given with immunoglobulin mother hep b - given at birth then 1 month then 6 months

human immunodeficiency virus (HIV)

mother to infant antiviral therapy- no cure prevention, testing

school aged (developmental approaches)

movers and shakers- ask a lot of questions, know Dx, why questions, ask relevant questions about illness, understand cause and effect, coping stratages- sleeping, talking with others, distractions. friends are important. striving for industry, concerned with body disability and death, more relaxed with physical examination but very uncomfortable with any type of genital examination

salicylate/aspirin toxin ingestion

multi system effects- GI, CNS, hematopoietic and metabolic

embryonic period germ layer- mesoderm

muscles, bones, circulatory system

Carbon monoxide toxic ingestion

one of the most common and fatal inhalation poisonings, dangerous as its colorless and odorless,

lactose intolerance

no lactase enzyme, the inability to tolerate lactose, the sugar found in dairy products, is the result of an absence or deficiency of lactase, an enzyme found in the secretions of the small intestines that is required for the digestion of lactose

antepartum fetal surveillance

non stress test contraction stress test biophysical profile maternal assessment of fetal movement

traditional

nuclear families- two parents who view parenting as the major priority in their lives. single or dual income. motivated to learn

living

number of currently living children

term

number of pregnancies ended 38 weeks and beyond

perterm

number of pregnancies ended between 20 to 38 weeks

abortion

number of pregnancies ended prior to 20 weeks

antepartum assessment and care- initial visit

obstetric hx, menstrual hx, contraceptive hx, medical and surgical hx (reprodutive parts), family hx (both parents)- birth defects, genetic diseases, include partner health and family hx, baseline lab studies (anemia, std), psychosocial hx- smoking, alcohol, drug use, abuse assessment, support system, physical exam, vaginal exam, fundal height, confirmation of pregnancy- fetal heart rate, sonogram

biliary atresia

obstruction or absence of the extrahepatic ducts, if not treated, can lead to liver failure or death

an infant is admitted with dehydration. what is the most accurate intervention to monitor the patients intake and output

obtain daily weights

psychosocial issues that affect nutrition- nursing care

obtain health and nutritional hx. measure baseline wt and ht. monitor activity level. assess developmental milestones. assess interaction patterns of primary caregiver. observe for negative interactions with others. observe for indications of hunger and satiety, assess the child's ability to be soothed. observe feeding and eating patterns

primipara

one birth at more than 20 weeks (first baby full term)

healthy families

open communication. accurate perceptions about the nature and degree of conflict. constructive efforts to resolve the conflict, such as willingness to consider the view of the other, consider alternate solutions and compromise

Cleft palate assessment

opening not always detected in newborns, can occur with cleft lip (correct lip then palate), palpate the newborns palate and ability to suck.

failure to thrive causes

organic, nonorganic, mixed

maintenance fluids for an 24 kg child

over 20 kg is 1500 + 20ml/kg 1500+ 4 x 20ml 1500+ 80 1580ml in a day

gastroesophageal reflux in infants

over feeding, feedings they should have. upright position 30 min after feedings. GERD related to- amount, frequency, formula change, positions.

woman factors contributing to infertility

ovulation disorders, fallopian tubes abnormalities, cervical abnormalities

carbon monoxide toxic ingestions tx

oxygen or hyperbaric chamber

carbon monoxide tx toxin ingestion

oxygen or hyperbaric chamber, 100% oxygen by NRB

ductus venosus

oxygenated blood from the placenta enters the fetal body through the umbilical vein. appx half the oxygenated venous blood goes through the liver during early pregnancy and the rest bypasses the liver and enters the inferior vena cava through the first shunt

Gonorrhea

perinatally during birth process or premature rupture of membrane, sexual abuse, sexual intercourse. ophthalmia neonatorum most common trans during vag birth chlamydia infection common with

self esteem

personal value that individuals place on themselves

Endocrine system

pituitary gland, thyroid gland, pancreas, placental hormones,

Time out (discipline measures)

placing child in a non-stimulating environment for approximately 1 minute per years of age

antepartum assessment and care

preconception care initial visit subsequent assessments

why is progesterone essential in pregnancy

pregnancy cannot be maintained without progesterone

presumptive changes

pregnancy related changes felt by the woman

probable changes

pregnancy related changes that can be observed by an examiner

confirmation of pregnancy

presumptive indication probable indications positive indicaions

confirmation of pregnancy

presumptive indications- subjective symptoms the women feels probable indications- seen by provider (objective) positive indications- it is pregnancy and nothing else (see baby on sono)

list the presumptive indication of pregnancy.

presumptive- some signs are amenorrhea, nausea, vomiting, fatigue, urinary frequency, breast, and skin changes

esophageal atresia with tracheoesophageal fistula (TEF) goal

prevent pneumonia and respiratory distress until surgery can be done

infertility types

primary- never conceived secondary- conceived at least once before

list the probable indications of pregnancy

probable- some signs are abdominal enlargement, cervical softening, ballottement, Braxton hicks contractions, and pregnancy test

placental hormones- estrogen

produced primarily by placenta- about 7 weeks, creates "favorable" environment in uterus, preparation for lactation- assists in development of ductal system in the breast

Ovaries body changes

progesterone secretion- pregnancy maintenance (placenta takes over around 7 weeks), ovulation ceases

chronic illness- impact on family

require many resources, stressful, situational crisis, physical/social/financial support, coping, open communicaiton, flexibility, ongoing education, fear, anxiety, guilt

win-win solution

resolution of conflict that both parties can support

3 components of family centered care

respect, collaboration, support

religious beliefs affecting health care

respect, perception, resources

salicylate (aspirin) manifestation toxin ingestion

respiratory alkalosis to loss of potassium, increased metabolic rate, ketones to metabolic acidosis hypokalemia, dehydration, decreased platelet level

when esophagus is connected to trachea and not stomach (TEF)

respiratory distress

corrosives toxin ingestion

respiratory distress syndrome, DO NOT INDUCE VOMITING. exp- lye, bleach, ammonia

hydrocarbons s/s toxin ingestion

respiratory distress, vomiting, chemical pneumonitis from aspiration, pneumonia and acute hemorrhagic necrotizing disease in 24 hours, burning sensation in mouth and pharynx, characteristic petroleum breathe odor, N/V, anorexia,

celiac disease- physiologic effects on small intestine

result of inflammation to the small intestine due to a permanent sensitivity to gluten. immune system damages the villi in the small intestine. villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. villi become flattened and useless thus contributing to the malnutrition

ductus arteriosus

rising arterial oxygen levels cause constriction; becomes a ligament

nursing process and perinatal infections assessment

risk factors, gestational age, maternal infection, s/s of neonatal infection

Chorionic villus sampling (CVS) risk to baby

risk for damage to placenta, miscarriage, damage to baby stucture

internal family coping strategy's

role flexibility, being open and honest, joint (family) problem solving, using humor

ultrasound advantages

safe, clear visulaiztion non invasice results are immediate

family centered care

safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family including those of the newborn and older children. respects the pivotal role of the family. supportive

increased in ambulatory and community based care setting

same day surgery, urgent care, home care, community care- school based health centers

factors that affect parents reactions

seriousness of threat, previous experience with illness and hospitalization, medical procedures involving diagnosis and treatment, available support system, personal ego strengths, previous coping abilities, additional stresses on the family, cultural and religious beliefs, communication patterns among family members

varicella zoster virus interventions needed

severity of newborn illness increases greatly if maternal infection occurs 5 days before delivery or 2 days after birth- varicella zoster immune globin (VZIG) must be given with in 72 hours after birth separate baby until sore heal

syphilis

sexual transmission. crosses placenta to fetus- infection via amniotic fluid may occur. lab test in first trimester or first antenatal visit.

herpesvirus serotypes 1 and 2

sexullay- HSV 1, non sexually HSV2, transmission after rupture of membranes, fetus expose to the virus through indirect contact with infected genitals or direct contact with those tissues furing delivery

Lillian Wald is recognized for which contribution to nursing

she initiated public health nursing at the Henry Street settlement

rubella infants

shead virus up to one year abortion recommended if exposed 1st trimester

How as cost containment affected maternity and pediatric care

shortened length of stay after delivery. vaginal birth 48 hours, C/S 4 days

umbilical cord- changes in blood circulation after birth

shunts no longer needed- close as respiratory is initiated.

Barbiturates toxin ingestion

similar to those associated with ETOH, often use in conjunction with stimulants, may have a paradoxical effect of hyperactivity in children exp- amytal, butisol, caffeine

endocrine changes to the body- pituitary gland

slightly enlarged, increased prolactin production- preparation for breastmilk production, oxytocin production- stimulates contractions, stimulates milk ejection reflex

explain the renal expected adaptations involved in elimination that occur during pregnancy

slowed passage of more alkaline urine and dilation of the ureters as a result of progesterone increases the risk for UTI's, bladder irritability, nocturia, urinary frequency, and urgency (first and third trimester after lightening)

an adolescent tells the nurse. I don't like this hospital room. an active listening response to this child's statement is

so would you prefer a different room

amniocentesis teaching

sob, bleeding, fever, cramping, s/s complications, need to rest, need to hydrate

external family comping strategy's

social support systems, seeking information from clergy, seeing spiritual meaning in events, joining self help groups

potential problems of dual income families

stress- child care

brown fat

subcutaneous fat layer for warmth outside mother at birth. heat producing fat deposited on the back of the neck, behind the sternum, around the kidneys. helps the neonate maintain temperature stability after birth

hypertrophic pyloric stenosis management

surgical interventions- pre op- NPO, IV fluids, labs (electrolytes), NG tube (pressure on diaphragm- respiratory distress). Post op- bowel sounds. NG out. clear liquid diet then 1/2 formula then full formula

cleft lip management

surgical repair occurs early in infancy- staged. identify alternate feeding devices- special nipple for bottle, frequent burping. breast feeding- strengthens facial muscle in baby

Wharton's jelly

surrounds the arteries and vein. specialized connective tissue, protects blood vessels cord cushioning, soft substance, prevent obstruction caused by pressure

biliary atresia

the obstruction or absence of the extrahepatic ducts. if not treated, can lead to liver failure or death

ethnocentrism

the opinion that the beliefs and customs of one's own ethnic group are superior to those of others

culture

the sum of the values, beliefs, and practices of a group of people that are transmitted from one generation to the next

Hepatitis B

transmitted through saliva, blood, vag secretions, semen. crosses placental barrier

chlamydia

transmitted to infant through birth process if mother infected. common cause of ophthalmia neonatorum. usullay asymptomatic. cause premature rupture of membranes, premature labor, chorioamnionitis

anemia management

treat the underlying condition- nutrition supplements, blood products, medications to restore iron and RBC production. iron administration- take with meal to prevent nausea, vit C will increase absorption

iron deficiency anemia treatment

treat underlying conditions, supplement, blood, medications, eat with iron to prevent nausea (some people take on empty stomach), take with vit C to increase absorption, mile will decrease absorption, eat spinach, dried fruit, red meats

placental hormones- human chorionic gonadotropin

trophoblasts secrete hCG in early pregnancy- stimulates progesterone and estrogen production, causes positive pregnancy test

Premature births have increased in the past two decades

true

active listening requires attentiveness, empathy, an open mind, and clarifying what the speaker says

true

children of authoritarian parents tend to lack self confidence

true

communication involves more than expressing words from one person to another

true

cultural differences are particularly important to consider with regard to touch and personal space

true

evaluation of the family's understanding is an ongoing process

true

explanations should include what the child will experience through the senses

true

infant mortality rates have continued to drop since 1950 as a result of better neonatal care

true

permissive parents tent to inconsistently discipline their children

true

talking to a child with your hands on your hips is an example of a closed body posture

true

the child or family members may feel intimidated when the nurse stands over then while talking

true

the nurse can demonstrate attentiveness by maintaining eye contact

true

1 g of body weight = 1ml of body fluid?

true- exp gain 2.5kg in 24 hours will equal 2500ml

children have a greater proportion of water (ICF and ECF) and water turnover than adults do

true- pediatric dehydration very quick

a 5-year old is schedule for a computed tomography (CT) scan of her head. what is the best time for her mother to initiate a discussion about the procedure

two hours before the procedure

multipara

two or more births at more than 20 weeks

which fetal circulatory structure carries blood with the highest oxygen concentraction

umbilical vein

psychosocial adaptation- 1st trimester week 1 to 13

uncertainty- miscarrage, ambivalence- conflicted feelings if unexpected, primary focus is self, not fetus- fetus remains vague and unreal, emotional lability- teach how to manage moods, reassure about normalcy

The nurse is administering gastrostomy feedings to an infant after surgery to correct a tracheoesophageal fistula to prevent air from entering the stomach once that syringe barrel is attached to the gastrostomy tube the nurses should

unclamp the tube after pouring the complete amount of formula to be administered into the syringe barrel

age of consent

under 18 but pregnant- right to consent for pregnancy related issues, parents right to consent to health issues. under 18 delivered- all rights to baby and self

when obtaining a history from the parents of a child diagnosed with salmonella, the nurse should ask the parents if the child has been exposed to which of the following possible sources of infection

undercooked eggs

Cleft lip assessment findings

unilateral or bilateral, assess infants ability to suck or eat, assess family and infant interactions, challenges- feeding (breast feeding strengthens the muscles of the face- better for baby)

cleft lip assessment findings

unilateral or bilateral. more common in males. assess infants ability to suck or eat. assess family and infant interaction.

adolescent parenting

unlikely to attain a high level of education

preschooler communication

use words they dont fully understand. expansion of word combination- speak in full sentences. strive for independence. clearly set limits and boundaries. attention span 5 to 10min.

chlamydia s/s

usually asymptomatic pneumonia, ophthalmia neonatorum

reproductive system

uterus and cervix

vagina and vulva body changes

vaginal secretions increase- thick and acidic (prevent infection), may increase growth of yeast

pre embryonic period

week 1 to 3 initiation of cell division entry of the zygote into the uterus (3 to 4 days after conception) implantation in the decidua maintaining the decidua location of implantation mechanism of implantation fundus of uterus- blood flow, muscle, placenta

the health care team determines that the family of an infant with failure to thrive who is to be discharged will need follow up care. which of the following would be the most effective method of follow up

weekly visits by a community health nurse

endocrine changes to the body- metabolism

weight gain- adequate weight gain encouraged (not to exceed x amount), water retention- dependent edema, carpal tunnel syndrome, carbohydrate metabolism changes- secondary to increased insulin demands

celiac disease

weight loss, diarrhea- for a few weeks (no absorption, alveoli flat or dead), constipation with abdominal pain, delayed puberty, iron- anemia, anxiety, depression. also known as gluten enteropathy or tropical sprue, results from the inability to digest gluten.

chronic illness- impact on sibling

what are the needs of the sibling? are they being met? fear, anxiety, guilt,

gastroesophageal reflux questions for parents

what are you feeding the child? how often? when did it start? any cough? weight loss? gagging? does baby burp and cry in pain? does baby swallow a lot when not feeding? does baby gag/cough a lot for no reason? does baby seem constantly congested? weight loss? any arching/discomfort when feeding?

how does the woman's perception of the baby change during pregnancy- 3rd trimester

whats to see her baby on the outside and as a separate being

Obesity

when intake of food exceeds expenditure, the excess is stored as fat. is an excessive accumulation of fat in the body and is assessed in children through a body mass index (BMI) that exceeds the 95th percentile for age. as equal to or greater than the 95th %

federal projects for maternal child care

wic

BMI calculation

wt in lbs x 703 divided by ht in inches sqaured

BMI is 60 lbs and 50 inches

wt in lbs x 703 divided by inches squared. 60x703 divided by 50 squared. 42180 divided by 50 squared 16.8 or 17

celiac disease s/s

wt loss, diarrhea for weeks, constipation, abdominal pain, dental enamel, hydroplagia, delayed puberty, iron anemia, anxiety, depression.

a mother tells the nurse that she puts her 3-year-old son in a time out chair in a corner for 3 minutes when he misbehaves. she asked the nurse if this is correct. the nurse responds

you are correctly using the time out

a statement that uses effective reasoning techniques is

you are not being very nice when you throw toys at your friend

a child has just been diagnosed with diabetes. the child's father tells the nurse, my wife will be back in the morning. before she left, she told me that she has a lot of questions about what to do. what is the most appropriate response for the nurse to make at this time

your wire might want to write down her questions so she wont forget anything when she comes back tomorrow