Unit 3 Exam

Sickle Cell Disease - Etiology & Pathophysiology

- A group of inherited, autosomal recessive disorders characterized by an abnormal form of hemoglobin in the RBC. - HgB S causes the erythrocyte to stiffen & elongate, taking on a sickle shape in response to low oxygen levels. - Hypoxia can be caused by viral or bacterial infections, high altitude, emotional or physical stress, surgery, & blood loss. - Usually identified in infancy or early childhood. - Incurable disease that is often fatal by middle age because of renal failure, pulmonary infection, & stroke.

Organizations

- A group of people who come together for a purpose or as a collection of people brought together for a predtermined purpose in a defined environment. - A purposefully designed, structured social system developed for the delivery of health care serives by specialized workforces to defined communitites, populations, & markets.

Elder Abuse

- Act that causes physical, verbal, financial, or psychosocial injury or exploitation as well as the physical neglect of an older adult. - Abuse of older adults is under reported. - Majority of the abuse is committed by spouses & children.

Diagnostic Studies - Clotting Studies

- Activated Clotting Time - evaluation of intrisic coagulation status. Used during dialysis, coronary artery bypass procedure, & arteriograms. - Activated Partial Thromboplastin Time - assessment of intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. Longer in patients using heparin. - Antithrombin - naturally occuring protein synthesized by liver that inhibits coagulation through inactivation of thrombin & other factors. Depleted in DIC. - Bleeding Time - measurement of timed, small skin incision bleeds. Reflection of ability of small blood vessels to constrict. - Capillary Fragility Test - reflection of caplillary integrity when positive or negative pressure is applied to various areas of the body. Positive test is indication of thrombocytopenia, toxic vascular reactions. - Clot Retraction - reflection of clot shrinkage or retraction from sides of test tubes after 24 hours. Used to confirm a platelet problem. - D Dimer - assay to measure a fragment of fibrin that is formed as a result if fibrin degradation & clot lysis. Used as an adjunctive measure in diagnosis of hypercoaguable conditions. - Fibrin Split Products - reflection of degree of fibrinolysis & predisposition to bleed. Screening test for DIC. Elevated levels are associated with DIC, advanced malignancy, severe inflammation. - Fibrinogen - reflection of level of fibrinogen. Increase is fibrinogen possible indication of enhancement of fibrin formation, making patient hypercoaguable. Decrease indicates that patient possibly predisposed to bleeding. - International Normalized Ratio - standardized system of reporting PT based on a reference caliberation model & calculated by comparing the patients PT with a control value. - Platelet Count - number of circulating platelets. - Prothrombin Time - assessment of extrinsic coagulation by measurement of factors I, II, V, VII, X. - Thrombin Time - reflection of adequacy of thrombin. Prolonged thrombin time indicates that coagulation is inadequate secondary to decreased thrombin activity.

Anemia - Nursing Plans & Interventions

- Administer blood products as prescribed. - Alternate rest & activities. - Teach about diet - maximize intake of iron (red meats), folic acid (green vegetables), vitamin B12 (glandular meats). - Instruct need for vitamin supplements - take iron on an empty stomach, adminster B12 & folic acid orally. - If parentral iron is used, use z track method. - Provide gentic information if client has sickle cells. - Teach client that iron (oral) may turn stool blake. - Give liquid iron through a straw, with oral care afterwards. - Teach client to report any unusual bleeding.

Pediatric Hemophilia - Nursing Plans & Interventions

- Administer fresh frozen plasma. - Administer pain medications. - Follow blood precautions. - Teach family home care - recognize early signs of bleeding into joints, local treatment for minor bleeds, administration of replacement factor, discuss dental hygiene, provide protective care, have child wear MedicAlert identification. - Refer family to genetic counseling. - Support child & family during periods of growth & development.

Hematologic System - Gerontologic Considerations

- Aging leads to a decrease in bone marrow mass & circularity & an increase in bone marrow fat. - Although the older adult is capable of maintaining adequate blood cell levels, the reserve capacity leaves the older adult more vulnerable to possible problems with clotting, transporting oxygen, & fighting infections. - Hemoglobin levels beginning to decrease after middle age, with low normal levels seen in most older people. Healthy older adults are not able to produce reticulocytes in response to hemorrhage or hypoxemia as well as younger adults. - The RBC plasma membranes are more fragile in the older person, may account for a a slight increase in MCV & a slight decrease in MCHC. - Total WBC & differrential are generally not affected by aging.

Sickle Cell Disease - Nursing & Collaborative Management

- Alleviating the symptoms from the complications of the disease. - Minimizing end organ damage. - Promptly treating serious sequelae, such as Acute Chest Syndrome. - Teach to avoid high altitudes, maintain adequate fluid intake, & treat infections. - SCD requires many hospitalizations. - Oxygen may be administered to treat hypoxia. - Vigilantly assess for any changes in respiratory status (respiratory failure is the most common cause of death). - Fluids & electrolytes are administered to reduce blood viscosity & maintain renal function. - Hydroxyurea (chemotherapy drug) increases production of hemoglobin F, decreases reactive netrophil count, increases RBC volume, & alters adhesion of sickle RBC to the endothelium.

Hemophilia

- An X linked recessive genetic disorder caused by a defective or deficient coagulation factor. - Hemophilia A - recessive sex linked (transmitted by female carries, exclusively in men). - Hemophilia B - recessive sex linked (transmitted by females, displayed exclusively in men). - Von Williebrand Disease - autosomal dominant, seen in both genders, recessive (in severe forms).

Postpartum Infections - Nursing Assessment

- Any clinical infection of the vaginal canal & perineum that occurs within 28 days of delivery. - Predisposed to infection - ROM >24 hours, any lacerations or operative incisions, hemorrhage, hematomas, lapses in aseptic technique before or after delivery, anemia or poor physical health prior to delivery, & intrauterine manipulation. - Predisposed to Puerperal Morbidity - temperature of 100.4 F or higher, morbidity occurs within the 1st 24 hours after delivery, & temperature elevation occurs on 2 successive days or 2 successive 4 hour assessments. - Signs of infection. - Most common organisms are streptococcal & anaerobic organisms.

Thrombocytopenia - Diagnostic Studies

- Any reduction in platelets below 150,000. - Examination of peripheral blood smears may help distinguish acquired disorders from congenital disorders. - Bone marrow tests to rule out production problems.

Minor Attributes - Organizational Environments

- Both internal environment as well as an external environment. - Internal consists of an integrated web of factors such as organizational culture, systems such as information systems or human resources management system, structural elements such as role responsibility, rules, & practices. - External consistent of those external forces, conditions, or events that affect the organization, such as economic trends or new laws & government regulation. - Interplay between the internal & external environments of the HCO, where organizational decisions & operations are affected by perceived forces from the external environment. - Organizations integrated into their environments will also change those environments in some ways, adding to the complexity of the relationship. - HCO policies created to meet environmental challenged might conflict with professional values or with legal guidelines, requiring actions to negotiate & resolve the conflict. - The need to change in response to environmental effects means the HCOs are complex & their work environments are notably ambiguous.

Scope of Health Care Organizations

- Broad & complex with numerous variables to consider when examining different types & categories of HCOs. - Limited to organizations that provide a range of health care services for health promotion, illness, & wellness care (hospitals, ambulatory care centers, home health agencies, clinics, nursing homes, provider offices, & long term care). - Can be classified mission, financial classification, & ownership.

Elder Abuse - Nursing Assessment

- Bruises on upper arms. - Broken bones caused by falls. - Dehydration or malnutrition. - Overmedication. - Poor physical hygiene, improper medical care. - Withdrawn behavior, feelings of hopelessness. - Behaviors that may be demanding, belligerent. - Repeated visits to health care agency for injuries & falls. - Injuries that do not correlate with stated cause. - Misuse of money children or legal guardian.

Leadership

- Bureaucratic structures require authoritative leadership capable of controlling all aspects of the organization. Leadership has changed with this new era of organizational thinking where organizations are viewed as fluid, adaptive, & dependent on an engaged & activated workforce. - A leadership that creates inspiration, is able to sustain motivation to achieve results, & that values the contributions of all members. - These leaders have to read the environment & interpret the trends of changes for others. - Must be able to lead others through turbulent & uncertain environments & most be able to adapt to hange as readily as their followers.

Normal Postpartum Changes - Integumentary System

- Chloasma & hyperpigmentation areas regress, some areas may remain permanently darker. - Palmer erythema declines quickly. - Spider nevi fade, some in legs may remain.

Disseminated Intravascular Coagulation (DIC)

- Coagulation disorder with paradoxical thrombosis & hemorrhage. - DIC is an acute complication of conditions such as hyptoension & septicemia. It is suspected when there is blood oozing from 2 or more unexpected areas. The 1st phase involves abnormal clotting in the microcirculation, which uses up clotting factors & results in the inability to form clots, so hemorrhage occurs. - Prothrombin Time - prolonged. - Partial Thromboplastin Time - prolonged. - Fibrinogen - decreased. - Platelet Count - decreased. - Fibring Degradation Products - increased.

Minor Attributes - Structure

- Collective of formal rules & policies that govern organizational practices & that promote the effective management of materials & resources. - Creates various roles & associated responsibilities that are required for organizational function. - Organizational rules, policies, & authority are necessary for the integration of diverse functions & activities across the organization into a coordinated system capable of supporting purpose of the organization. - A balance needs to be maintained that provides the structure necessary for sustaining the HCO while not producing unnecessary constraints. - Management authority & control is relatively weak in relationship to professional authority because decision making related to practice is not subject to control by those outside the profession. - Result of divided authority is that management control by those outside of the profession is limited to those work activities that lie outside the professional's scope of practice.

Rape & Sexual Assault - Nursing Plans & Interventions

- Communicate nonjudgemental acceptance. - Provide physical care to treat injuries. - Give clear, concise explanations of all procedures to be performed. - Document factual, objective statements of physical assessment, record client's exact words. - Notify police & encourage victim to prosecute. - Collect & label evidence carefully in the presence of a witness. - Notify rape crisis team or counselor. - Allow discussion of feeling about the assault. - Advise of potential of venereal disease, pregnancy, & HIV. - Provide information about medical care available. - Support client, family, & friends.

Consumer Health Informatics (CHI)

- Consumer health informatics is defined by the American Medical Information Association as a form of health information technology geared towards delivering better health care decision making based upon the consumer informatics stands at the crossroads of other disciplines, such as nursing informatics, public health, health promotion, & health education. - Perhaps the most challenging & rapidly expanding field in health informatics. - Paving the way for health care in the Information Age & advancing the medical home concept & the use of personal health records. - Includes technologies focuses on patients as the primary use of health information.

Normal Clotting Mechanisms - Lysis of a Clot

- Counter mechanism of clotting serves to keep blood in its fluid state. - Auto coagulation may be achieved by antithrombin activity, vessel & platelet activity, & fibrinolysis. - Fibrinolysis - process resulting in the dissolution of the fibrin clot. - The fibrinolytic system is initiated when plasmingoen is activated to plasmin. The plasmin attacks either fibrin or fibrinogen by splitting the molecules into smaller elements knows as fibrin split products.

Intimate Partner Violence

- Criminal act of physical, emotional, economic, or sexual abuse between an assailant & victim who most commonly are, or were, in an intimate relationship. - Abuse is usually a tension releasing action as well as a lack of impulse control. - Persons act more violently when drinking or using drugs. - Relationship is usually characterized by extreme jealously & issues of power & control. - Women in a bat erring relationship may lack self confidence & feel trapped. They may be embarrassed about situation, which results in isolation & dependency on the abuser. - Abuse often begins during pregnancy or occurs more frequently during pregnancy.

Complex Adaptive Systems

- Current theory describes the organization as having biological characteristics that allow the organization to react & change when stimulated. - Defines a new way of viewing organizations are organic & lifelike entities that are open to the environment & capable of transforming themselves in light of perceived opportunities & threats. - The organizations can read & interpret the environment & they can adjust & adapt though the coordinated action of the interdependent parts. - The need for change & adaptation requires that all organizational members to be engaged & motivated to meet the organizations goals. - Viewing the organization as a living social system recognizes the creative energy of the people who innovate to produce desirable products & services in uncertain, changing environments.

Anemia - Nursing Assessment

- Deficiency of erythrocytes, reflected as decreased Hct, Hgb, & RBCs. - Pallor, especially of the ears & nail beds, palmer crease, conjunctiva. - Fatigue, exercise intolerance, lethargy, orthostatcic hypotension. - Tachycardia, heart murmurs, heart failure. - Signs of bleeding, such as hematuria, melena, & menorrhagia. - Dyspnea. - Irritability, difficulty concentrating. - Cool skin, col intolerance. - Risk factors - deit lacking iron, folate, & vitamin B12, family history, medication history, & exposure to toxic agents. - Diagnostic test- hgb <10, hct <36, RBC 4 X 10, bone marrow aspiration is positive. - Blood loss either acute or chronic. - Medical history of kidney disorders.

Nursing Informatics

- Defined by the American Nursing Association. - A speciality that integrates nursing science, computer science, & information science to manage & communicate data, information, knowledge, & wisdom in nursing practice. - Supports consumers, patients, nurses, & other providers in their decision making in all roles & settings. - Accomplished through the use of information structures, information processes, & information technology.

Intimate Partner Violence - Nursing Assessment

- Delay between time of injury & time of treatment. - Anxious when answering questions about injury. - Abdominal injuries during pregnancy. - Looks to abuser for answers to questions related to injuries. - Description or suicidal ideation. - Feeling of responsibility for provoking partner. - Low self esteem. - Abrasions, cuts, lacerations, sprains, Blake eyes. - Psychosomatic complaints. - Concurrent use of alcohol or drugs.

Thrombocytopenia - Collaborative Care

- Diagnostic - history & physical, bone marrow aspiration & biopsy, CBC, & specific studies. - Immune Thrombocytopenic Purpura - corticosteriods, immunoglobulins, anti Rh, rituximab, splenectomy, immunosuppressives. - Thrombotic Thrombocytopenic Purpura - identification & treatment of cause, plasmapheresis, prednisone, chemotherapy, immunosuppressives. - Heparin Induced Thrombocytopenia - direct thrombin inhibitor, indirect thrombin inhibitor, warfarin, plasmapheresis. - Decreased Platelet Production - identification & treatment or removal of cause, corticosteriods, platelet transfusions.

Normal Postpartum Changes - Urinary System

- Diuresis occurs, woman excretes up to 3000 mL/day of urine. - Bladder distention & incomplete emptying are common. - Persistent dilation of ureter & renal pelvis increase risk for UTI. - Urine glucose, creatinine, & blood urea nitrogen levels are normal after 7 days.

Postpartum Hemorrhage - Nursing Plans & Interventions

- Early postpartum - review chart, VS, LOC, keep bladder empty. - Late postpartum - anticipate quick hospitalization, keep warm, administer medications. - Hematoma development - apply ice to perineum, monitor VS, administer analgesics & antibiotics.

Intimate Partner Violence - Nursing Plans & INterventions

- Establish trust, use nonjudgemental approach. - Treat physical wounds & injuries. - Document factual, objective statements about the client's physical condition, injuries, & interactions with partner or family. - Determine potential for future violence. - Provide crisis intervention. - Assist with referral to shelter if necessary or desired. - Assist client with contacting authorities. - Interview abused partner when abuser is not present.

Elder Abuse - Nursing Plans & Interventions

- Establish tuts, use nonjudgemental approach. - Meet physical needs, treat wounds & injuries. - Document factual, objective statements about client's physical condition, injuries, & interactions with significant other & family. - Report suspected abuse to the appropriate local or state authorities. - Arrange community resources to provide respite care for the caregiver. - Arrange visiting nurses, nutrition services, or adult day care if possible.

Normal Postpartum Changes - GI System

- Excess analgesia & anesthesia may decrease peristalsis. - No bowel movements are expected for 2 to 3 days.

Postpartum Hemorrhage - Nursing Assessment

- Excessive uterine bleeding during 1st hour following delivery. - Excessive uterine bleeding during postpartum period. - Blood loss of more than 500 mL during vagina delivery. - Signs of hypovolemic shock - decreased BP, weak, rapid pulse, & cool, clammy skin. - Signs of hematomas developing in perineum - intense perineal pain, swelling & blue/black discoloration, urinary retention. - Signs of bleeding from unrealized lacerations - continuous trickle from vagina, bleeding in spurts, & bleeding in presence of contracted Fundus. - Signs of bleeding from uterine atony - soft, boggy uterus, Fundus that does not firm.

Health Care Economics

- Focused on how people deal with a finite resource & scarcity. - People are constantly juggling how to get the most of life & health by choosing how they use resources available to them. - Defined as behavioral spice that begins with two propositions about human behavior. - Human behavior is purposeful or goal directed, implying that persons act to promote their own interests.

Normal Clotting Mechanisms - Plasma Clotting Factors

- Formation of a visible fibrin clot on the platelet plug is the conclusion of a complex series of reactions involving different clotting factors. - Plasma proteins circulate in inactive forms until stimulated to initiate clotting through 1 of 2 pathways, intrinsic or extrinsic. - Intrinsic Pathway - activated by collagen exposure from endothelial injury when blood vessel is damaged. - Extrinsic Pathway - initiated by tissue factor or tissue thromboplastin is released extravascularly from injured tissues. - Coagulation follows the same final pathway of the clotting cascade - thrombin coverts fibrinogen to fibrin.

Sickle Cell Disease - Complications

- Gradual involvement of all body systems, especially spleen, lungs, kidneys, & brain. - Infection is a major cause of morbidity & mortality in patients (pneumonia is most common). - Acute Chest Syndrome is a term that describes acute pulmonary complications such as pneumonia, tissue infarction, & fat embolism. Characterized by fever, chest pain, cough, pulmonary hypertension, MI, HF, & ultimately cor pulmonale.

Normal Postpartum Changes - Hematologic System

- Hct rises. - WBC is elevated (12,000 to 25,000). - It is difficult to use WBC for determination of infection. - Blood clotting factors are elevated, increases risk for thromboembolism.

Hemophilia - Nursing Management

- Health Promotion - genetic counseling before reproduction. - Acute Interventions - stop topical bleeding, administer specific coagulation factors, rest, management of any life threatening complications that may develop as result of hemorrhage. - Ambulatory & Home Care - teach to recognize disease related problems & learn which problems can be resolved at home & which require hospitalization, teach to perform daily oral hygiene without causing trauma.

Managed Care Organizations

- Health care providers & insurance companies assume a part of the financial responsibility for health care. - Patients pay a monthly premium for health care insurance. - Medicaid & Medicare have incorporated managed care into their health plans. - Patients can choose from several different plans under the managed care system, including preferred provider organizations., health care maintenance organizations, & patients may receive health care from a list of providers who participate in the PPO or HMO. - The health care services that these plans cover are determined by the employer & not the insurance company. - Insurance payment varies according to geographic region & depends greatly on the type & plan of coverage. - May often leave the patient with unpaid medical expenses or the need to obtain prior authorization before seeking treatment or medication.

Diagnostic Studies - Complete Blood Count Studies

- Hemoglobin - measurement of gas carrying capacity of RBC. - Hematocrit - measure of packed cell volume of RBCs expressed as a percentage of the total blood volume. - RCB Count - number of ciculating RBCs. - RBC Morphology - examination of ahpe & size of RBCs. - WBC Count - measurement of total number of leukocytes. - WBC Differential - determination of whether each kind of WBC is present in proper proportion. - Platelet Count - number of platelets available to maintain platelet clotting functions.

Pediatric Iron Deficiency Anemia

- Hemoglobin levels below normal range because of the body's inadequate supply, intake, or absorption of iron. - May be caused by inadequate store during fetal development, deficient dietary intake, chronic blood loss, poor utilization of iron by the body.

Normal Clotting Mechanisms - Vascular Response

- Immediate local vasconstrictive response occurs when a blood vessel is injured. - Vasoconstriction reduces leakage of blood from the vessel not only by restricting the vessel size but also by pressing endothelial surfaces together. - The pressing of the endothelial surfaces together enhances vessel wall stickiness & maintains closure of the vessel even after vasoconstriction subsides. - Vascular spasm may last for 20 to 30 minutes, allowing time for platelet response & plasma clotting factors to be activated.

Postpartum Infections - Nursing Plans & Interventions

- Implement general care pertinent to any client with a diagnosed infection. - Perineal Infection - stay warm, assess site, sits bath. - Endometriosis- bed rest, antibiotics. - Parametritis - promote lochia like & uterine drainage. - Peritonitis - transferred to ICU. - Mastitis - breastfed every 2 to 3 hours & make sure breast are emptied. - Thrombophlebitis - anticoagulant. - Cystitis & Pyelonephritis - collect urine for analysis & culture.

Child Abuse - Nursing Assessment

- Includes physical & mental injury, sexual abuse, & neglect. - Most important indicators of abuse - injuries not congruent with the child's developmental age or skills, injuries not correlated with the stated cause, & delay in seeking medical care. - Bruises in unusual places & in various stages of healing. - Bruises, welts caused by belts, cords. - Burns. - Whiplash injuries caused by being shaken. - Bald patches where hair has been pulled. - Fractures in various stages of healing. - Failure to thrive, unattended to physical problems. - Torn, stained bloody under clothes. - Bedwetting. - STDs. - Parent seeing child as different from other children. - Parent using child to meet own needs. - Parent seldom touching or responding to child. - Child appearing frightened & withdrawal in presence of parent or other adult. - Family history of frequent over, unstable employment, martial discord, & family violence. - One parent answering all the questions.

Pediatric Hemophilia

- Inheriated bleeding disorder. - Transmitted by an X linked recessive chromosome. - Has 0% to 25% factor activity in blood. - Usually missing factor VIII or factor IX.

Pediatric Sickle Cell Anemia

- Inherited automsomal disorder of Hgb. - Occurs primarily in persons of African or Mediterranean descent. - Usually appears after 6 months. - Hgb S replaces all or part of the normal Hgb, which causes RBCs to sickle when oxygen is released into the tissues. - Hgb S has less than a normal life span, which leads to chronic anemia.

Learning Organizations

- Intelligent, living systems perceive, respond, & adapt. - Changing & adapting are the result of learning - perceiving stimuli, organizing a change response, & then reviewing the results of the change to determine if a satisfactory outcome was obtained. - Learning organizations are those that are receptive to their environments, are open to change, & have adopted processes that allow their personnel to experiment, make changes, risk mistakes, & take responsibility for their decisions. - A culture of learning is important because professional judgement & decision making are central to the delivery of health care services in destabilized, uncertain environments.

Power

- Is commonly defined as the ability to influence others or to control events & circumstances. - Much of this power was in the form of the decision making that supported control of organizational operations. - Power is now seen as a more diffuse, even infinite, phenomenon in that much power resides in the individual or within teams in the complex adaptive systems. - It is no longer an exclusive tool of management because much decision making & action is the responsibility of those who function outside of the management structure.

Postpartum Hemorrhage

- Leading cause of maternal mortality that demands prompt recognition & intervention. - Can be caused by - uterine Antony, lacerations of the vagina, hematoma development in the cervix, perineum, or labia, retained placental fragments, & full bladder. - Predisposing Factors - high parity, dystoncia (prolonged labor), operative delivery, overdistention of the uterus, abruptio placental, previous history of, infection, & placenta previa.

Pediatric Hemophilia - Nursing Assessment

- Male Child - prolonged bleeding at umbilical cord, injection site, or circumcision. - Prolonged bleeding. - Hemarthrosis. - Spontaneous bleeding. - Loss of motion in joints. - Pain.

Bureaucracy

- Max Weber developed the first theoretical model of bureaucracy in the early 20th century. - Described the principles of organization that created efficiency in work design & were thought to be the most effective way to organize work. - Also described the distribution of authority in bureaucracies, noting that authority grounded in position & divided into hierarchies was preferable to the authority derived from personal characteristics. - Bureaucratic designs was common to the large organization that developed during the Industrial Revolution because the manufacturing & distribution of goods required a rational system of centralized control to effectively acquire resources & efficiently convert them to a finished product. - The drawback to this model is that it takes little account of the organization as a social system within an environment. - Mainly focuses on authority & control to achieve efficient production within a closed system.

Private or Indemnity Health Insurance

- May be purchased on a group basis or purchased by individual consumers. - Most Americans with private health insurance receive it though an employer sponsored program.

DIC - Nursing Plans & Interventions

- Monitor client for bleeding. - Monitor vital signs. - Monitor PT/INR. - Protect client from injury & bleeding - provide gentle oral care & mouth swabs, minimize needle sticks, turn client frequently, & use gentle suction to prevent trauma.

Normal Postpartum - Nursing Plans & Interventions

- Monitor vital signs every 4 hours for 24 hours then every 8 hours. - Check fundal height & firmness. - Assess & document lochia. - Teach client about normal lochia changes. - Assess perineum & episiotomy site. - Examine breast. - Teach breast self examination. - Assist mother & infant with breast feeding. - Assess bladder & urine output. - Catheterize only if necessary. - Teach symptoms of UTI. - Promote retuning of perineal muscles by Kegel exercises. - Assess bowel & anal area. - Prevent thrombophlebitis. - Determine the need for RhoGam. - Determine the need for a rubella vaccine. - Assess maternal psychological adaptation. - Assess mother infant bonding behaviors. - Promote mother & infant bonding. - Teach responses to cues from the baby. - Encourage verbalization of feelings, offer support in nonjudgemental manner. - Instruct client to notify HCP or clinic promptly of heavy vaginal bleeding, temperature of 100.4 or higher lasting 24 hours, a red warm lump in breast, pain on urination, & tenderness in calf. - Teach self care for discharge. - Counsel about sibling rivalry, especially if there is a toddler. - Assist client with choice of contraceptive method.

Major Attributes - Specialized Health Care Workforce

- Notable for the highly specialized workforce needed to deliver health care services. - The work produced is complex, variable, & at times urgent. - The knowledge & skills that these workers bring to the HCO are necessary for the effective delivery of services in an ambiguous, challenging work environment. - The need for this workforce increases the costs for HCOs but it also benefits the organization in terms of maintaining standards & ensuring quality service outcomes. - An interprofessional approach to the treatment of human health problems not only is a distinguishing feature of the HCO but also serves to increase the complexity of the organization.

Thrombocytopenia - Patient & Caregiver Teaching

- Notify HCP of - black, tarry stool, black or bloody vomit, sputum, or urine, bruising, bleeding from mouth, headache, difficulty talking, confusion, & sudden weakness in arm or leg. - Ask HCP regarding restrictions in normal activities. - Do not blow nose forcefully. - Do not bend head below waist. - Do not pluck eyebrows. - Do not puncture your skin (tattoos). - Use soft bristle tooth brush. - Ask HCP provider before any procedure (dental cleaning, pedicure).

Child Abuse - Nursing Plans & Interventions

- Nurses are legally required to report all cases of suspected abuse to the appropriate local or state agency. - Take color photographs of injuries. - Document factual, objective statements about child's physical condition, child family interactions, & interviews with family. - Establish trust & care for the child's physical problems. - Recognize own feelings of disgust & contempt for parents. - Assist child & family to develop self esteem. - Teach basic child development & parenting skills. - Support the need for family therapy.

Normal Postpartum Changes - Musculoskeletal System

- Pelvic muscles regain tone in 3 to 6 weeks. - Abdominal muscles regain tone in 6 weeks unless distress recti occurs.

Normal Postpartum

- Period after pregnacy & delivery (usually 6 weeks) when the body returns to the nonpregnat state. - Care during thise period is focused on wellness & family integrity. - Teaching must be initiated early to cover the physical self care needs & the emotional needs of the mother, infant, & family.

Sickle Cell Disease - Diagnostic Studies

- Peripheral blood smear may reveal sickled cells & abnormal reticulocytes. - Presence of HgB S can be diagnosed by sickling test, which uses RBCs & exposes them to a deoxygentation agent. - The accelerated RBC breakdown causes jaundice, elevated serum bilirubin levels, & abnormal laboratory test results.

DIC - Nursing Assessment

- Petechiae, purpura, hematomas. - Oozing from IV sites, drains, gums, & wounds. - GI & GU bleeding. - Hemoptysis. - Mental status change. - Hypotension, tachycardia. - Pain.

Rape & Sexual Assault - Nursing Assessment

- Physical assessment with careful documentation of injuries. - Emotional status - self blame, anxiety, fear, humiliation. - Coping behaviors. - Identification of support systems. - Details of assault.

Normal Clotting Mechanisms - Platelet Plug Formation

- Platelets are activated when they are exposed to interstitial collagen from an injured blood vessel. - Platelets stick to one another & form clumps. - The interaction causes the platelets to release substances (Platelet Factor 3 & Serotonin), which facilitate coagulation. - At the same time, platelets release adenosine diphosphate, which increases platelet adhesiveness & aggregation, thereby enhancing the formation of a platelet plug.

Medicare

- Provides health care coverage for all people ages 65 & orders, people who are permanently disabled, & individuals 65 & older with end stage renal disease. - Federal health insurance program that individuals or their spouses paid into through employment of self employment taxes. - Includes hospital insurance, supplemental medical insurance, Medicare advantage plans, or outpatient prescription drug coverage.

Sickle Cell Disease - Clinical Manifestations

- Reasonably good health the majority of the time. - May have chronic health problems & pain because of organ tissue hypoxia & damage. - Anemic but asymptomatic except during episode. - Pallor is most easily detected by examining the mucus membranes (most individuals with sickle cell anemia have dark skin). - Primary symptom is pain. - Pain episodes are most commonly associated with fever, swelling, tenderness, tachypnea, hypertension, nausea, & vomiting.

Thrombocytopenia

- Reduction of platelets below 150,000. - Acute, severe, or prolonged decreases from normal range can result in abnormal hemostasis that manifests as prolonged bleeding from minor trauma or spontaneous bleeding without injury.

Clinical Research Informatics

- Relates to informatics whose objective is to advance the biomedical/health sciences through the humane & ethical use of informatics. - Included issues relating to the use of information & knowledge as well as the sound & socially appropriate collection & maintenance of person specific &/or de identified patient data. - Electronic health records will enhance the availability of clinical data for research & quality improvement initiatives.

Patient Protection and Affordable Care Act

- Requires that most US citizens & legal residents have health insurance. - Creation of state based exchanged though which individuals can purchase coverage with subsidies available to low income families. - A major expansion of the Medicaid program of the nation's poorest individuals. - The requirement for employers to cover their employees or pay penalties, with exceptions for small employers. - New regulations on health plans in the private market requiring them to cover all individuals, regardless of health status. - Establishment of national, voluntary insurance program for purchasing community living assistance services. - Increases in payments for primary services. - Greater support for prevention, wellness, & public health activities.

Normal Postpartum - Nursing Assessment

- Review prenatal, antepartum, L&D, & early postpartum records for status, lab data, & possible complications. - Review newborn's record for Apgar scores, sex, possible complications, & relevant psychosocial information. - Assess postpartum status - vital signs, fundal height & firmness, lochia, urination, perineum, bowel sounds, 7 presence of thrombophlebitis. - Assess maternal infant bonding & identify teaching needs of mother & family.

Clinical Health Care Informatics

- Seeks to transform health care & enhance human health through a creative & innovative use of informatics. - Transformation will be accomplished through a well educated & properly trained informatics, workforce, and enhanced performance of health care processes & systems, appropriate public policy, & a relevant research agenda. - Includes the development of direct approaches to patients & their families & even individuals who are not yet patients.

Hemophilia - Clinical Manifestations & Complications

- Slow, persistent, prolonged bleeding. - Delayed bleeding from minor injuries. - Uncontrollable hemorrhage after dental extractions or irritation of the gingiva with a hard bristle tooth brush. - Epistaxis. - GI bleeding from ulcers. - Hematuria & potential renal failure from GU trauma. - Ecchymoses & subcutaneous hematomas. - Neurological signs such as pain, anesthesia, & paralysis. - Hemarthrosis.

Pediatric Iron Deficiency Anemia - Nursing Plans & Interventions

- Support child's need to limit activities. - Provide rest periods. - Administer oral iron. - Teach family nutritional facts - limit milk to less than 32 oz/day. - Teach about dietary sources of iron - meat, green leafy vegetables, fish, liver, whole grains, legumes. - Be aware of family's income & cultural food. - Refer to nutritionist.

Pediatric Sickle Cell Anemia - Nursing Plans & Interventions

- Teach family to prevent hypoxia - keep child from exercising strenuously, keep child away from high altitudes, avoid letting child become infected, use prophylactic penicillin, keep child well hydrated. - For vaso-occulsive Crisis - administer IV fluids, monitor I&O, administer blood products, administer analgesics, use warm compresses, administer antibiotics. - Administer vaccines. - Refer for genetic counseling.

Clinical Informatics

- The application of information & communication technologies to the delivery of health care services. - Essentially the same regardless of the health professional group involved. - Has 2 sub domains - clinical health care informatics & clinical research informatics.

Medicaid & SCHIP

- The nations mayor public health insurance program for low income Americans, financing health & long term care services for more than 52 million people, including children & many of the sickest & poorest in our nation. - Medicaid has improved access to health care for low income individuals, financed innovations in health care delivery, & functioned as the nation's primary source of long term care financing. - SCHIP was enacted to provide coverage to uninsured low income children who did not qualify for Medicaid. - Medicaid & SCHIP are jointly funded by state & federal governments. - Eligibility is determined by income & need. - Medicaid payments are only paid to qualified hospitals, nursing facilities, & home health agencies & cannot exceed a reasonable estimate of the amount Medicare would pay for the same service.

Hematology

- The study of blood & blood forming tissues. - Includes bone marrow, blood, spleen, & lymph system.

Major Attributes - Public Trust

- The work of early HCOs gained the confidence of the public health that their altruistic purpose was to serve others by providing care & comfort, regardless of circumstances. - Currently, the level of public trust in HCO has eroded with the growth of managed care, national corporate chains of for profit HCOs, & allegations of fraud & a use by the HCPs. - People still turn to their physicians & nurses for help & advice & they still seek services offered by HCOs when they need help with health issues (indicates social contract is still intact). - HCOs that provide quality health care services & are good cooperate citizens will be able to maintain their positive image & their part of the social contract, regardless of profit status.

Functions of Blood

- Transportation - O2 from lungs to cells, nutrients from GI tract to cells, hormones from endocrine glands to tissues & cells, metabolic waste products. - Regulation - fluid & electrolyte balance, acid base balance, body temperature, maintaining intravascular oncotic pressure. - Protection - maintaining hemostasis of blood coagulation, combating invasion of pathogens & other foreign substances.

Thrombocytopenia - Clinical Manifestations

- Usually asymptomatic. - Most common symptom is bleeding, usually mucosal or cutaneous. - Muscosal bleeding may manifest as epistaxis & gingival bleeding & large bullous hemorrhages may appear. Bleeding into the skin is manifested as petechiae, purpura, or superficial ecchymoses. - Prolonged bleeding after routine procedures, such as IV or IM injections may indicate thrombocytopenia. - If bleeding is internal, weakness, fainting, dizziness, tachycardia, abdominal pain, & hypotension. - Major complication is hemorrhage.

Systems Theory

- View of organizations as social systems had an early beginning with the human relations school of organizational theorists. - Focused their study on the needs & desires of people who work in the organization. - Organization has social components that interact & that these components are affects by factors from the outside environment. - Social components interact with environment, technology, & organizational structure in an integrated fashion to create an unified, dynamic system.

Pediatric Sickle Cell Anemia - Nursing Assessment

- parents with sickle cell or trait of. - Frequent infections. - Tiredness. - Chronic hemolytic anemia. - Delayed physical growth. Vaso-occulsive Crisis: - Fever. - Severe abdominal pain. - hand foot syndrome. - Arthralgia. - Leg ulcers. - Cerebrovascular accidents.

Postpartum Infections - Assessment Data for Puerperal Infection

-Perineal infection. - Endometritis - infection of lining of uterus. - Parametritis - pelvis cellulitis. - Peritonitis. - Thrombophlebitis. - UTI. - Pyelonephritis. - Mastitis - breast.

Pediatric Iron Deficiency Anemia - Nursing Assessment

0 Pallor, paleness of mucous membranes. - Tiredness, fatigue. - Overweight. - Dietary intake low in iron. - Milk intake greater than 32 oz/day. - Pica habit (eating non food substacnes). - Usually seen in infants 6 to 24 months.

What are the symptoms of hemophilia?SATA 1. Deep bruising 2. Pain in joints 3. Palpitations 4. Frequent nosebleeds

1 2 4

A patient with hemophilia has hemarthrosis of the knee. The nurse will (SATA) 1. Have pt rest affected joint 2. Pack the joint with ice 3. Apply heat to the joint 4. Administer analgesics 5. Administer aspirin

1 2 4 (pain meds should be tylenol codeine, not ibuprofen)

Letting-go-phase

10 days to 6 weeks postpartum; mothering functions established; sees infant as a unique person

During an assessment of a patient in the hospital diagnosed with thrombocytopenia, which of the following data collected by the RN would cause for immediate concern and should be reported to the HCP immediately? A. The patient is difficult to arouse B Platelet count of 86,000 C Large amount of ecchymosis on the back D Purpura on oral mucosa

A Difficulty in arousing a patient could indicate cerebral hemorrhage, which is life threatening and requires immediate action.

The nurse indicates that her patient is exhibiting s/s of hemophilia. Which of the following s/s would she be referring to? SATA A. double visions B. Unexplained nose bleeds C. Fever D. Convulsions/seizures E. Yellowing sclera

A B D

Which is true of ITP?SATA A. It is primarily an autoimmune disorder B. Platelets with this disorder survive 8-10 days C. It is also known as immune thrombocytopenia purpura D. Many patients are asymptomatic E. Initially treated with Corticosteroids

A C D E

A mother questions the etiology of hemophilia and how her son got it. How should the nurse respond? SATA A. Carrier females pass it to the baby B. S/S are apparent immediately at birth C. Both males and females can be affected D. Transmitted by an X-linked recessive chromosome E. Babies receive the disorder from their fathers

A D

Aplastic anemia

A blood disorder in which the body's bone marrow doesn't make enough new blood cells, resulting in a deficiency of all types of blood cells

What is the most common cause of uterine atony in the first 24 hours postpartum?

A full bladder

What dynamics prevent a battered spouse from leaving the battering situation?

A woman in a battering relationship may lack self-confidence and feel trapped. She is often embarrasses to tell friends and family, so she becomes isolated and dependent upon the abuser.

Which of the following conditions of a newly admitted patient to your unit would make you suspicious of aplastic anemia? SATA A.Frequent or long-lasting infections B. Oral manifestations including glossitis and cheilitits C. Insidious onset of headaches D. Red skin tone due to polycythemia E. Pale skin tone due to deformed erythrocytes F. Sudden onset of ecchymosis and epistaxis

A,C,F- Oral symptoms are symptomatic of iron deficiency anemia, not aplastic; polycythemia is a condition with too many RBCs, not too few; Pale skin tone would be expected but not due to deformed erythrocytes; this would be indicative of sickle cell.

What types of abuse are seen in older adults?

Abuse can be physical, verbal, psychosocial, exploitive, or physical neglect.

Identify nursing interventions for dealing with an abused child.

All cases of suspected abuse must be reported to appropriate local and state agencies. Take color photographs of injuries. Document fatal, objective statements of the child's physical condition, child-family interactions, and interviews with the family. Establish trust, and care for the child's physical problems. These are the primary and immediate needs of these children. Recognize own feelings of disgust and contempt of the parents, Teach basic child development and parenting skills to family.

Although a client initially wanted to breastfeed, she now has decided to bottle feed. The nurse concludes that teaching regarding breast care for this client has been effective when the client makes which statement? 1. I'll pump 2-3 times a day until my milk supply decreases 2. I'll rub lotion on my breasts id they are sore 3. I'll soak my breasts in a warm tub twice daily for the first week 4. I'll wear a snug bra continuously until my breasts are soft again

Answer 4 Rationale: Mothers who are bottle feeding should be encouraged to suppress milk productions by wearing a snug bra or breast binder, applying cold compresses, and avoiding breast stimulation until primary engorgement subsides

The nurse us caring for a client who delivered vaginally 2 hours ago. The client's funds is firm at 1 cm below the unbilicus and VS are stable. She received morphine IV 4 hours ago for labor pains. The nurse should question which new order from the physician? 1. Sits bath 20 minutes TID 2. Bathroom privileges 3. Regular diet 4. RhoGAM for an Rh-negative client

Answer: 1 Rationale: Application of heat to the perineum 2 hours after delivery will cause vasodilation, and increase the client's risk of edema and hematoma formation. Ice should be applied for the first 24 hours.

A goal on the nursing care plan is "to facilitate parent-infant bonding" To which nursing interventions should the nurse give priority in attaining the goal? 1. Provide assistance and encouragement with rooming in. 2. Encourage the parents to join a new parent support group. 3 Keep the newborn in the nursery at night to allow the parents to rest.

Answer: 1 Rationale: Bonding occurs best when parents have direct and prolonged contact with their newborn in a supportive environment.

Three hours after a vaginal delivery, the client reports increased perineal pain. What should the nurse do first? 1. Assess the perineum 2. Administer analgesia as ordered 3. Apply ice to the perineum 4. perfume perineal care

Answer: 1 Rationale: The first step of the nursing process is assessment. Increased perineal pain in a client with vaginal delivery could be a normal process as delivery anesthetics administered locally wear off. It could also indicate abnormal processes, such as the development of a hematoma. Assessment of this client is needed prior to intervention.

After delivering a 9 pound, 10 ounce baby, a client who is a gravid 5, para 5 is admitted to the postpartum unit. What would be a priority in delivering nursing care to this client? 1. Palpate the funds because she is at risk for uterine atony 2 Offer fluids, since multiparae generally dehydrate faster during labor 3. Preform passive Rom on extremities because she is at risk for thromboembolism 4. Assess client's diet because she is at risk for anemia

Answer: 1 Rationale: Uterine atony is the most common cause of early postpartum hemorrhage. This clients at greater risk because she had an overdistended uterus with a large baby, and she is grand multipara.

When teaching a new mother how to breast feed, the nurse should include which instructions? 1. Wash the nipples with soap and water twice daily 2. Begin nursing with the right breast at each feeding 3. Slide a finger into the baby mouth to break suction before removing from the breast 4. Supplement the baby with formula every12 hours until the milk supply is established

Answer: 3 Rationale: This will help prevent the nipples from becoming sore and the skin from cracking

The nurse should notify the physician immediately of which assessment finding? 1. Three pea sized clots passed 4 hours after delivery 2. Musty odor to lochia 48 hours postpartum 3. Scant amount of rubra lochia after C-section 4. Firm uterus with steady trickle of blood 2 hours after delivery

Answer: 4 Rationale: A steady trickle of blood in the presence of a firm uterus could indicate the presence of vaginal or cervical laceration. The HCP should be notified immediately so further evaluation can be initiated.

A postpartum client who delivered 3 hours ago states, "I feel all wet underneath' What should be the initial action of the nurse? 1. Determine when she last voided. 2. Ask the client to rate her discomfort on a scale from1-10 3. Preform perineal care 4. Have the client roll over to assess her loch flow

Answer: 4 Rationale: It is possible that a significant amount off loch could pool beneath the client after delivery. The highest priority at this time is risk of hemorrhage, and this should be the initial assessment

A client feels faint on the way to the bathroom. What nursing assessments should be made?

Assess BP sitting and lying; asses Hgb and Hct for anemia

Normal Postpartum Changes - Cardiovascular System

At Delivery: - Maternal vascular bed is reduced by 15%. - Pulse may decrease to 50. - Changes hypothesized to result in client's shivering. - BP & pulse should quickly return to pre pregnant level. First 72 Hours: - 24 to 48 hours postpartum, cardiac output remain elevated. - Plasma loss > RBC loss, reverse hemodilution of pregnancy. - Diaphoresis helps restore normal plasma volume.

What information should be given to a client regarding resumption of sexual intercourse after delivery?

Avoid until postpartum examination. Use water-soluble jelly. Expect slight discomfort due to vaginal changes.

Wha tis the most serious complication of IFP? A. Petechiae B. intracranial hemorrhage C. Blood in urine or stools D. Pulmonary embolism

B

Diagnostic Studies - Miscellaneous Blood Studies

Bilirubin - measurement of degree of RBC hemolysis or liver's inability to excrete normal quantities of bilirubin. - Coomb's Test - differentiation among types of hemolytic anemia. Detection of immune antibodies & Rh factor. - Cobalamin - level of cobalamin available for production of new RBCs. - Erythrocyte - measurement of sedimentation of setting of RBCs in 1 hour. Inflammation causes an alteration in plasma proteins, resulting in aggregation of RBCs & making them heavier. - Ferritin - major iron storage protein. Normally present in blood in concentrations directly related to iron storage. - Folic Acid - amount of folic acid available for RBC production. - Hemoglobin Electrophoresis - proteins involved in development of the Hgb molecule have a definitive pattern of separation on electrophesis. Pattern is altered with abnormal hemoglobin synthesis. - Homocysteine - an amino acid formed from methioine. Rapidly metabolizes through pathways that require cobalamin & folic acid. - Methylmalonic Acid - indirect test for cobalamin. Helps differentiate cobalamin deficiency from folic acid deficiency. - Reticulocyte Count - measurement of immature RBCs, a reflection of bone marrow activity in producing RBCs. - Serum Protein Electrophoresis - separates proteins in the blood on basis of electric charge. Helps detects hyperglobulinemic states. - Transferrin - largest proteins that bind to iron. - Transferrin Saturation - decreased in iron deficiency anemia & increased in hemolytic & megablastic anemia.

Which women experience more afterpains more than others?

Breastfeeding women, multiparae, and women who experienced over distention of the uterus.

The nurse is teaching a patient recently diagnosed with polycythemia handout prevention of complications of the disease. Which of the following statements by the patient indicates a need for further teaching? A "I will eat foods low in iron" B "I will wear support hose when I am up" C "I will drink 500mL of fluid or less each day" D "I will use and electric razor for shaving"

C A patient with polycythemia is at a risk for thrombus formation and stroke. The patient needs to intake at least 3L of fluids every day to help decrease this risk.

Which topic is most important for the nurse to include in teaching a patient wit aplastic anemia? A. The importance of getting a full night's rest and napping during the day. B. A high protein, high iron diet C. Avoiding others with infections D. Stress relief techniques

C While all of theses are important teaching points to someone with aplastic anemia, avoiding potential infections is most important since patients could be neutropenic

List three signs of positive bonding between parents and newborn

Calling infant by name, exploring newborn head to toe, using en face position

What behavior might the nurse observe in a child who is abused?

Child may appear frightened or withdrawn in presence of parent or adult.

Identify nursing interventions for working with a rape victim

Communicate nonjudgemental acceptance. Provide physical care to treat injuries. Give clear, concise explanations of all procedures preformed. Notify police; encourage victim to prosecute. Collect and label evidence carefully in the presence of a witness. Document factual, objective statements about physical condition. Record client's exact words in describing the assault. Notify rape crisis team or counselor if available in the community. Allow discussion of feelings about the assault. Advise of potential for venereal disease, HIV, or pregnancy, and describe medical care available.

A woman's WBC is 17,000; she is afebrile and has no symptoms of infection. What nursing action is indicated?

Continue routine assessments; normal leukocytosis occurs during postpartum period because of placental site healing.

Rape & Sexual Assault

Crime involving lack of consent, force, & sexual penetration. An act of aggression, not passion.

While assessing a post-op patient int eh recovery suite, the nurse notes petechiae on the inner thigh. The patient's IV is oozing blood with a decreased LOC. The patient's last BP 5 minutes ago was 72/55. The nurse knows that these are signs of:

DIC

When does battering of women often begin or escalate?

During pregnancy

State four risk factors or predisposing factors to postpartum hemorrhage.

Dystocia or prolonged labor; over distention of the uterus, abruptio placentae, and infection.

The nurse isi assessing an 82 year old patient being admitted to the hospital. The nurse notes multiple areas of bruising on both legs. The nurse knows bruising occurs more easily in the elderly patients because:

Elderly people have more adhesive levels in their blood composition

The nurse is conducting an admission assessment of a client with vitamin b12 deficiency. Which of the following would the nurse include in the physical assessment?

Examine the tongue (The tongue is smooth and beefy in a client with vitae's b12 deficiency)

Minor Attributes

Forms of purposeful organizations & are features they share in common with other types of organizations.

What immediate nursing actions should be taken when a postpartum hemorrhage is detected?

Fundal massage. Notify health care provider if massage does not firm funds. Count pads to estimate blood loss. Assess and record VS. Increase IV fluids and administer oxytocin infusion as prescribed.

What are the common side effects of antibiotics used to treat puerperal infection?

GI adverse reactions: nausea, vomiting, diarrhea, and cramping. Hypersensitivity reactions: rashes, urticaria, and hives

A patient asks the nurse, "my doctor says I need to increase my intake of folic acid. What types of food contain the highest concentration of folic acid?"

Green vegetables and liver

A breastfeeding mother complains of very tender nipples. What nursing action should be taken?

Have her demonstrate infant position on breast (incorrect positioning often causes tenderness). Leave bra open to air-dry nipples for 15 minutes three times daily. Express colostrum and rub on nipples.

Aplastic anemia lab values

Hgb/Hct: decreased MCV: Normal or slightly elevated Reticulocytes: Decreased Serum Iron: Normal or elevated TIBC: normal or elevated Transferrin: Normal Ferritin: normal Bilirubin: normal Serum B12: normal Tolate: normal

What factor places the postpartum client at risk for thromboembolism?

Increased clotting factor.

Why is elder abuse so underreported?

It is difficult for an older person to admit abuse for fear of being placed in a nursing home or being abandoned.

Treatment of aplastic anemia

May include observation, blood transfusions, medications, bone marrow transplantation, and or hospitilazation (depending on severity)

What are the nursing actions for endometriosis and parametritis?

Measures to promote local drainage; antipyretic measures (acetaminophen, cool cloths); administration of analgesics and antibiotics as prescribed; increase of fluids, with attention to high-protein and high-vitamin C diet.

BUBBLE-HEB

Nine components of postpartum assessment: B-Breasts U-uterus B-bladder B-bowel L-lochia E-episiotomy or perineal lacerations H-Homan's sign E-emotional status B-bonding

May women with a positive HIV antibody try to breastfeed?

No, HIV has been found in breast milk

Must women diagnosed with mastitis stop breastfeeding?

No, women who stop breastfeeding abruptly may make the situation worse by increasing congestion and engorgement and providing further media for bacterial growth. Client may have to discontinue breastfeeding if pus is present or if antibiotics are contraindicated for neonate.

Lochia rubra

Occurence: 1-3 days Appearance: Dark, red, bloody; fleshy, musty, stale odor that is non offensive; may have clots smaller than a nickel Composition: Blood with small amounts of mucus, shreds of decide, epithelial cells, leukocytes; may contain fetal meconium, lanugo, or vernix caseosa

Lochia serose

Occurence: 4-10 days Appearance: Pink or brownish; watery; odorless Composition: Serum, erythrocytes, shreds of degenerating decide, leukocytes, cervical mucus, numerous bacteria

Lochia alba

Occurrence: 11-21 days, up to 6 weeks if lactating Appearance: Yellow to white; might have slightly stale odor Composition: Leukocytes, decimal cells, epithelial cells, fat, cervical mucus, cholesterol, bacteria

State four risk factors for or predisposing factors to postpartum infection.

Operative delivery, intrauterine manipulation, anemia or poor physical health, traumatic delivery, and hemorrhage.

Horman's sign

Pain in calf upon dorsiflexion of foot is recorded as a positive sign and may indicate thrombophlebitis Inspect for pedal edema, redness, or warmth; if abnormal changes are present, assess pedal pulse

What family dynamics are often seen in child abuse cases?

Parent sees child as "different" from other children. Parent uses child to meet his or her own needs. Parent seldom touches or responds to child. Parent may be very critical of child. There is a family history of frequent moves, unstable employment, marital discord, and family violence. One parent answers all of the questions.

A nurse discovers a postpartum client with a boggy uterus that is displaced above and to the right of the umbilicus. What nursing actions indicated?

Preform immediate fundal massage. Ambulate to the bathroom or use bedpan to empty bladder because cardinal signs of bladder distention are present.

Factors that slow involution

Prolonged labor and delivery Anesthesia Grand multiparity Retained placental fragments or membranes Full urinary bladder Infection Overdistention of the uterus

How does the nurse differentiate the symptomalogy of cystitis from that of pyelonephritis?

Pyelonephritis has the same symptoms as cystitis (dysuria, frequency, and urgency) with the addition of flank pain, fever, and pain at the costovertebral angle.

Involution

Reduction in uterine size after delivery to prepregnant size, caused by uterine contractions that constrict and occlude underlying blood vessels at placental site

Three days postpartum, a lactating mother has full, warm, taut, tender breasts. What nursing actions should be taken?

She is engorged; have newborn suckle frequently; take measures to increase milk flow: warm water, breast massage, and supportive bra.

What are the signs of endometriosis?

Subinvolution (boggy, high uterus); loch returning to rubra with possible foul smell; temperature 100.4 F or higher; unusual fundal tenderness.

Thrombocytopenia - Nursing Assessment

Subjective Data: - Recent hemorrhage. - Excessive bleeding. - Viral illness. - HIV infection. - Cancer. - Anemia. Objective Data: - Fever, lethargy. - Petechiae, ecchymoses, purpura. - Splenomegaly, abdominal distention, positive guacic. - Low platelet count, prolonged bleeding time.

Hematologic System Focused Assessment

Subjective Data: - Unusual bleeding or bruising. - Black, tarry stool. - Blood in vomitus. - Swelling in neck, armpits, or groin. - Dark colored urine. - Fatigue. - Heart palpitations. Objective Data: - CBC. - WBC with differential. - Clotting - PY, INR, aPTT, platelets. - Hgb, Hct. Physical Exam: - Inspect skin for lesions or color changes. - Auscultate BP for alterations or orthostaisis. - Palpate pulse for tachycardia, liver & spleen for enlargement, & lymph nodes for lymphadenopathy.

A woman has decided to take birth control pills as her contraceptive method. What should she do if she misses taking the pill for 2 consecutive days?

Take 2 pills for 2 days and use an alternative form of birth control.

Upon admission to the postpartum room, 3 hours after delivery, a client has a temperature of 99.5 F. What nursing actions are indicated?

Temperature is probably elevated due to dehydration and work of labor; force fluids and retake temperature in one hour; notify HCP if temp is above 100.4 F

What should the fundal height be at 3 days postpartum for a woman who has had a vaginal delivery?

Three fingerbreadths/cm below the umbilicus

What is the purpose of giving decussate sodium (Colace) to the postpartum client?

To soften the stool in mothers with third- or fourth-degree episiotomies, hemorrhoids, or C-section delivery

Factors that enhance involution

Uncomplicated labor and delivery Breastfeeding Early ambulation Complete expulsion of placenta and membranes

A woman asks why she is urinating so much in the postpartum period. The nurse bases the response on what information?

Up to 3000 mL a day can be voided because of the reduction 40% plasma volume increase during pregnancy.

Normal Postpartum Changes - Reproductive System

Uterus: - Myometrial contractions occur for 12 to 24 hours post delivery due to high oxytocin levels (prominent in mulitparas, breast feeding women, & women who have experienced over distention of the uterus). - Involution occurs (1 to 2 cm/day) - 1st day at or 1 to 2 cm above umbilicus & 7 to 10 days decreases to 12 week size, slides back under symphysis pubis. - Placenta contracts & heals without scarring. Cervix: - Becomes porous with a transverse slit. - Heals within 6 weeks. Vagina: - Rugae reappear within 3 weeks. - Walls are thin & dry. Breasts: - Nonlactating - nodules are palpable & engorgement may occur 2 to 3 days postpartum. - Lactating - milk sinuses (lumps) are palpable, colostrum (yellowish fluid) is expressed first, then milk (bluish white), & breasts may feel warm, firm, tender for 48 hours.

REEDA

components of episiotomy assessment R-redness E-Edema E-ecchymosis D-discharge A-approximationof skin edges

S/S of aplastic anemia

fatigue, dyspnea, cardiovascular and cerebral responses

Taking-in-phase

first 3 days postpartum; needs to discuss labor and delivery; preoccupied with own needs; passive and dependent; touches and explores infant

Taking-hold-phase

third to tenth day postpartum; obsessed with body functions; rapid mood swings; anticipatory guidance most effective now