270 Final
energy production
CO is tied to
It inhibits the activity of osteoclasts .It can also decrease the resorption of calcium in the kidneys again leading to lower blood calcium levels
Calcitonin reduces calcium levels in the blood by what two main mechanisms:
Nevus flammeus
Capillary angioma below the surface of the skin that is purple or red, caries in size and shape, is commonly seen on the face, and does not blanch or disappear
umbilical cord vein
Carries oxygenated blood to embryo
atherosclerosis
Characterized by a focal deposit of cholesterol and lipids within the intimal wall of the artery. Inflammation and endothelial injury play a central role in the development
Unstable Angina
Chest pain that is new in onset, occurs at rest, or has a worsening pattern. It is unpredictable and is an emergency.
CABG (Coronary Artery Bypass Graft)
Creation of a new blood supply to an area of the heart with a clotted/blocked artery.
Hypercalcemic crisis
Definition: calcium >15mg/dL can result in life-threatening neuro, cardio, and renal problems Treatment: saline, diuretics, antiarrhythmic agents, calcitonin, phosphate replacement
Subinvolution
Delayed return of the uterus to its nonpregnant size and consistency. placental site does not heal lochia persists brisk periods of lochia rubra D&C may be necessary
wheezing
Difficult breathing with a high-pitched whistling or sighing sound during expiration
tampon-like; 10mg gradually released over 12 hours; continuous fetal monitoring - softens cervix, cervical ripening - if mom is having too many contractions take it out - give second dose if bishop score doesn't change
Dinoprostone (Cervidil)
beneficence
Doing good or causing good to be done; kindly action
maternal serum alpha- fetoprotein (MSAFP)
Done between 15-22 weeks to test for neural tube defects If positive ultrasound and amniocentesis ordered
avanafil; sildenafil; tadalafil; vardenafil causes smooth muscle relaxation and increased blood flow into the corpus cavernosum side effects - headache - leg/back pain -flushing -blurred vision -priapism contradicted if taking nitrates
Drug therapy for ED
notify HCP of any symptoms of bleeding no contact sports blow nose gently dont bend down with your head lower than your waist prevent constipation electric razor dont use tweezers no aspirin or NSAIDs soft bristle toothbrush count menstraul pads
Educational Facts for Thrombocytopenia
• Hemodilution • Decreased peripheral resistance • Increased cardiac circulation and turbulence - May have murmur - May lead to cardiac failure • Cyanosis • Growth retardation
Effects of Anemia on Circulatory System
Clomiphene
Estrogen partial agonist: synthetic used in infertility to induce ovulation
• X-linked recessive trait • Males are affected • Females may be carriers • Degree of bleeding depends on amount of clotting factor and severity of a given injury
Etiology of Hemophilia A
Decreased: chest wall movement, deep breathing, vital capacity, Pa O2, Sa O2, cough effectiveness, response to hypoxia
Gerontologic Considerations: Effects of Aging on Respiratory System
· 4%-6%
Glycosylated hemoglobin level
Fetal effects - opthalmia neonatorum -sepsis Tx -PCN, erythromycin and ceftriaxone
Gonorrhea fetal effects Tx
fetal effects -possible chronic respiratory papillomatosis Tx - laser ablation or cryotherapy -possible c- section
HPV fetal effects Tx
mild anemia
Hgb 10-12 g/dL
- removal of cause - no aspirin - corticosteroids - IV immunoglobulins - splenectomy - immunosuppressive therapy -plasma exchange HIT - stop heparin, go on argatroban
How is Thrombocytopenia Treated?
gravida
How many times a woman has been pregnant including current pregnancy
• Monitor constantly • risk of nosocomial infection • Conserve energy and stress • O2 sats • O2 - Hood - CPAP - NC - ET - ECMO (NICU only) • Labs • Peripheral or Umbilical line • Prepare for transfer to NICU
Immediate Care High Risk Infant
Cafe au lait spots
In neurofibromatosis, a common clinical feature is the presence of several smooth-edged tan-to-brown pigmentations on the skin called -6 or more is considered pathognomonic for neurofibromatosis
become completely numb used for C- sec highly associated with maternal hypotension client must remain flat for 6 to 8 hrs after delivery
Indications for spinal block
cardiac angiography
Invasive procedure to image the heart and blood vessels using radiopaque medium
- Over 4000 grams (8-13) - Usually DM - Assess for birth injury and hypoglycemia
LGA
most common fetal position
LOA (left occiput anterior)
non-reactive stress test
Less than 2 accelerations of 15 BPM within a 20 minute period. may indicate hypoxemia and acidosis
cardiac ischemia as well as other organs.
Low cardiac output can cause
right
MI with HR of 30 is affecting what coronary artery?
Easy bruising • Epistaxis • Gingival bleeding • Excessive bleeding with lacerations or surgeries • Menorrhagia
Manifestations of Von Willebrand Disease
1st day of last period + 7 days - 3 months
Nagele rule
Diabetic neuropathy
Nerve damage due to metabolic derangements of diabetes - Sensory versus autonomic neuropathy
Brain Natriuretic Peptide (BNP)
Normal: <100 Elevated levels indicate CHF
Fatigue, weakness wt loss, n/v postural hypotension hypoglycemia hyponatremia hyperkalemia hyperpigmentation of mucous membranes and skin loss of body hair hypovolemia
Nursing assessment for Addison's disease
- causes due to ovarian function= hormones replacement therapy ART -IVF -GIFT -ZIFT -ICSI
Nursing care for female infertility
Discover if its a side effect to medication is it reversible androgen replacement therapy emotional support educate on drug therapy
Nursing care r/t ED
VS and FHR supine position with hands across chest maternal blood sample label samples after - wash abdomen - assist to bathroom - monitor FHR 1 hour after procedure - watch for contraction or fluid leaking from vagina
Nursing care r/t amniocentesis
- identify type of abortion - VS, LOC every hour - save all peripads, linens - start IV 18 gauge - Give RhoGAM - grief protocol - Teach client to notify nurse of the following .Temp above 100.4, foul smelling vaginal discharge, bright red bleeding with tissue larger than a dime
Nursing interventions for miscarriage
Hypoglycemia
Occurs when • Too much insulin in proportion to glucose in the blood • Blood glucose level less than 70 mg/dl
preterm labor
Onset of labor between 20 to 37 weeks gestation
32-48
PaCo2
80-100
PaO2
• Coagulation process is abnormally stimulated • Excessive amounts of thrombin are generated • Fibrinolytic mechanisms are activated and cause extensive destruction of clotting factors
Pathophysiology of DIC
Electronic Medical Record (EMR)
Patient medical record from a single medical practice, hospital, or pharmacy that is not shared
Cheyne-Stokes
Periods of difficult breathing (dyspnea) followed by periods of no respirations (apnea)
• Many Blood Cells • Increased blood viscosity • Can crowd out clotting factors • May cause anemia if hemoglobin is not available. • Clubbing of fingers and toes
Polycythemia
Decreased interest in surroundings Unable to feel pleasure or joy for infant Feels unworthy Sleep disturbances
Postpartum Depression
◦ Suicidal or Homicidal tendancies ◦ 2/1000 ◦ 50% chance of recurrence ◦ Can experience bipolar disorder or major depression
Postpartum Psychosis
TORCH infections
Prenatal infex that lead to severe abnormalities = most common HEARING IMPAIRMENT & MR Toxoplasmosis Other = syphillis, varicella, HIV Rubella Cytomegalovirus Herpes Simplex
GnRh antagonists -cetrorelix -ganirelix
Prevents premature LH surges and premature ovulation in women undergoing ovarian stimulation
b,c
Pt teaching is not effective when pt states what about IPT (select all that apply) A. I should use a soft bristle toothbrush B. It is okay to play contact sports as long as all members of each team know my condition C. I can take aspirin if I have a headache D. I need to take caution when using knifes or other sharp materials.
• Usually within 1-2 hrs • Alveoli collapse with expiration; inadequate gas exchange • SIN (substernal retractions, inspiratory grunting, nasal flaring)
RDS
Biot's respirations
Rapid and deep respirations followed by 10 to 30 seconds of apnea
Chronic Stable Angina
Refers to chest pain that occurs intermittently over a long period of time with the same pattern of onset, duration, and intensity of symptoms.
Babinski reflex
Reflex in which a newborn fans out the toes when the sole of the foot is touched lasts until 1 year
Diastole
Relaxation of the heart
Cushing's disease
Results from excessive adrenocortical activity May be related to excessive use of corticosteroid medications or due to hyperplasia of the adrenal cortex Over secretion of corticosteroids can also be caused by pituitary tumor Can be caused by bronchogenic carcinoma or other malignancy
sexual abuse
STDs in infants and kids indicates
above 95%
SaO2
Vacuum erection device (VED)
Second line therapy. Vacuum causes blood to be drawn into corpora. Can be used in combination with constriction bands to prolong effect.
description: fever, abdominal pain and tenderness, foul- smelling vaginal discharge, bleeding Tx: termination of pregnancy, antibiotic therapy, monitoring for septic shock
Septic miscarriage description and Tx
Acne, Blurred vision, Cataracts or glaucoma ,Easy bruising, Muscle weakness, difficulty sleeping, high bp, insomnia, increased body hair, swollen puffy face, sudden mood swings, water retention, swelling
Steroid medication side effects
Cephalohematoma
Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.
gestational trophoblastic disease (Hydatidiform Mole)
Swollen, fluid-filled grape like clusters in the placenta. Associated with choriocarcinoma which is a rapidly metastasizing malignancy. an embryo rarely present
signs of ovulation should be taught - cervical mucus assessment - basal body temp - mittelschmerz
Symptothermal, prothermal, or fertility awareness
DIC
Syndrome of abnormal clotting that is systematic and pathologic. Large amounts of clotting factors are depleted, causing widespread external and internal bleeding. Related to fetal demise, infection and sepsis, pregnancy induced hypertension and abruption placentae
fetal effects - still birth - congenital syphilis -hydrocephaly -congenital cataracts -copper-colored rash - cracks around the mouth - hypothermia Tx - Tx before 16 wks to prevent transmission -PCN -erythromycin
Syphilis fetal effects Tx
sputum studies
Test obtained by coughing deeply and producing mucus from the lung itself. Mucus is then sent to lab for analysis. Used to test for bronchitis, TB, lung abscess, or pneumonia
Fasting plasma glucose level >126 mg/dl - Random or casual plasma glucose measurement ≥200 mg/dl plus symptoms - Two-hour OGTT level ≥200 mg/dl using a glucose load of 75 g
Tests to Diagnose Diabetes Mellitus
stroke volume
The amount of blood ejected from the heart in one contraction.
I statement= insufficient evidence to recommend for or against
The current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined
pituitary gland
The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.
thoracic expansion
The expansion of the chest wall palpated when the person takes a deep breath; should be bilateral and symmetric; never want thumb to move more than an 1 inch
take iodine, and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body which can absorb iodine.
The function of the thyroid gland is to
Preload
The precontraction pressure in the heart as the volume of blood builds up.
ethical delimma
This is the choice between two or more equally justifiable alternatives.
lymph system
This system is part of the circulatory system. It produces lymphocytes to fight infection that may be found in the blood stream. It also collects, filters (lymph nodes), and transports fluids from around the tissues back to the veins of the circulatory system.
fetal effects - still birth - microcephaly -hydrocephalus - blindess -deafness Tx - sulfadrugs
Toxoplasmosis fetal effects Tx
can be applied to lower abdomen, upper outer arm, buttock, or upper torso delivers continuous progesterone and estrogen be applied on the same day once a wk for 3 wks, followed by 1 wk w/out patch
Transdermal contraceptive patch
-fluids -pain management -folic acid daily supplements -blood transfusions (during crisis) -Hydroxyurea (an anti-sickling agent) -bone marrow transplant.
Treatment for Sick Cell Anemia
TB skin test
Tuberculin hypersensitivity test to detect a current or past infection with Mycobacterium tuberculosis. positive with induration of 11 or more
Turbutaline
Used for external cephalic version *Helps relax the uterus* Monitor lung sounds & baby Can cause jittery & rapid heart rate (also used for asthma)
bronchophony, egophony, whispered pectoriloquy
Vocal resonance is tested via these three things:
Fatigue - Shortness of breath - Glossitis - Muscle weakness - Weight loss - Tachycardia - Difficulty breathing
What are symptoms of megaloblastic anemia?
nose bleeds, increased intracranial pressure, leaking of CSF, stroke
What are the complication for trans sphenoidal surgery?-
is a type of vitamin B that helps your body produce and maintain new red blood cells. It is found in ● Dried beans ● Whole Wheat ● Oranges
What is Folic Acid?
whispered pectoriloquy
a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue (123)
Mittelschmerz
abdominal pain that occurs midway between the menstrual periods at ovulation
orthopnea
ability to breathe only in an upright position
10 months
able to crawl at
5-6 months
able to roll from belly to back at
8 months
able to sit unsupported at
cardiac temponade
acute compression of the heart caused by fluid accumulation in the pericardial cavity
headache flushing hypotension
adverse effects of nitrates
thyroid gland
affects metabolism
high platelets low immune function
affects of splenectomy
24 hrs
after ovulation how long do you have for fertilization
boys= 14 girls= 10
age of growth spurt
coma seizure no ketonuria blood glucose above 600
assessment finding r/t HHS
Inspection -prolonged expiration -tripod position - pursed lips Percussion -Hyperresonance Auscultation - Wheezes -decreased breath sounds
assessment of an asthma exacerbation inspection, percussion, auscultation
fatigue and pallor Hgb < 11, Hct < 37% 1st tri Hgb < 10.5, Hct< 35% 2nd tri Hgb < 10, Hct < 32% in 3rd tri noncompliance with prenatals
assessment of anemia throughout pregnancy
Inspection -no change Palpation -decreased movement -decreased fremitus Percussion -dull Auscultation -fine crackles - absent sounds
assessment of atelectasis inspection, palpation, percussion, auscultation
audible air escaping from chest wound cough cyanosis decreased breath sounds on side of injury decreased O2 dyspnea frothy secretion's tracheal deviation Asymmetrical BP in arms Chest pain decreased BP distended neck veins dysthymias muffled heart sounds rapid thready pulse asymmetrical chest movement subcutaneous emphysema
assessment of chest trauma
5000 Ml
average CO
5th grade
average reading level
normal 110- 160 round to 5 BPM between contractions within 10 min of strip big box= 1 min, little box= 10 sec
baseline of fetal heart rate
Contraction frequency
beginning of one contraction to the beginning of the next contraction (measured inminutes)
preformed earlier than amniocentesis (usually 10- 12 wks) look for genetic defects
benefits of chorionic villus sampling
leiomyomas fibroids, myomas, fibromyomas, fibromas
benign tumors arising from the muscle tissue of the uterus
6 months 12 months
birth wt doubles by and triple by
Von Willebrand Disease
bleeding disorder caused by a deficiency of von Willebrand factor, a "sticky" protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation
Peripheral Arterial Disease
blockage of arteries carrying blood to the legs, arms, kidneys and other organs
hemothorax
blood in the pleural cavity
lochia rubra
blood-tinged discharge, includes tissue and decidua; lasts 1 to 3 days postpartum
Acroyanosis
blue hands and feet in a newborn. NORMAL FINDING for first 24 hrs
central cyanosis
bluish discoloration of the skin or mucous membranes due to hemoglobin carrying reduced amounts of oxygen
wear shields, to help infant latch
breastfeeding with inverted and retracted nipples
Infertility
can't conceive for 1 year of unprotected sex
minimize crying to prevent strain on lip suture line maintain logan bow to lip if applied care with restraints cleanse suture site with sterile water after feeding
care of surgical site post op for cleft lip or palate
Erythrocytes
carry O2 and CO2 concaved
child abuse and neglect bullying youth violence Intimate partner violence elder abuse and neglect
categories for IPV
Research Education Practice Community
categories of mission statements
Trauma pulmonary infection/ aspiration prolonged ventilator assistance shock fat emboli spesis
cause of acute respiratory distress syndrome
pneumothorax
cause of asymmetrical chest in newborn
congenital hip dislocation
cause of hip click, unequal limb length, and asymmetrical gluteal folds in newborn
Genetic disposition (young Jewish men); smoking; tobacco allergy; autoimmune response
causes of buergers
can put head to ear can rap arm around chest can barely bend wrist sticky friable transparent skin no lanugo no creases on feet no breast pina of ear stays folded
characteristics of preterm infant
Aplastic Anemia
characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow
angina
chest discomfort or pain that occurs when myocardial O2 demands exceed supply
acreta
chorionic villi attach directly to myometrium
peripheral vascular disease
circulatory problems that can be due to arterial or venous pathology
1: medication , specific diseases, inherited 2: left sided HF 3: lungs and hypoxemia 4: cardiovascular system and thromboembolic occlusion 5: multifactorial orgins with hematologic or metabolic
classes of pulmonary hypertension
hypertension in the upper extremities and decreased or absent pulses in the lower extremities
classic finding of coaraction of the aorta
remain active sit with feet elevated avoid pressure on lower thighs dorsiflex foot to relive leg cramps cool- air vaporizer or saline nasal spray to help with nasal stuffiness
comfort measures for 20 wks
tension, battering incident, honey moon phase
cycle of battery
fetal effects - still birth - congenital CMV -microcephaly -IUGR -cerebral palsy - mental retardation - rash - jaundice Tx - none
cytomegalovirus fetal effects Tx
restrictive respiratory disorders
decreased expansion of lungs attributable to alterations in the lung parenchyma, pleura, chest wall, or neuromuscular function. cant fully expand
breastfeeding jaundice
decreased milk intake r/t fezer calories consumed by infant before mothers milk is well established
hypoparathyroidism
deficient production of parathyroid hormone
preload
degree of stretch of the cardiac muscle fibers at the end of diastole
Partial: placenta lies over part of cervical os complete: placenta lies over entire cervical os marginal: edge of placenta meets the rim of the cervical os Low lying: placenta implants in lower uterine segment with a placental edge lying near the cervical os
degrees of previas
• RBCs appear large • Abnormal shapes • Structure contributes to erythrocyte destruction • Decreased serum cobalamin levels • Normal serum folate levels and decreased cobalamin levels suggest megaloblastic anemia due to cobalamin deficiency
diagnostics for cobalamin deficiency
chest X-ray ECG monitoring ABGs Spiral CT scan D-dimer troponin level
diagnostics for pulmonary embolism
- 12-lead ECG - CXR - Oxygen saturation - Cardiac enzymes - CBC with differential - Metabolic profile - PT/PTT/INR
diagnostics for unstable angina
Chest X- ray sputum pule ox CBC blood cultures
diagnostics r/t pneumonia
avoid dieting add 500 calories to pregnancy intake 8 glassess of water a day
diet during breastfeeding
Gradual onset= physiologic factors sudden onset= psychologic issues
difference between a gradual and rapid on set of ED
Caput succedaneum
diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days
angiopathy
disease of blood vessels
Acromegaly and giantism
diseases caused by too much growth hormone
- Diuretics ( ie: Lasix) - Adrenergic inhibitors-relax muscles keep sm vessels open as with Raynauds (ie: Cardura, Minipress, Flomax) - Direct vasodilators-widen vessels (ie: Nitrobid, Apresoline) - Angiotensin inhibitors-potent vasoconstriction (ie: Capoten, Lisinopril, Catopril) - Calcium channel blockers-decreases ca entering cardia muscle which leads to decreased muscle contraction maintains b/p (Norvasc, Plendil)
drugs used for hypertension
Pulmonary hypertension
elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles.
plantar reflex
elicited touching the soles of the feet. toes curl downward. (birth to 8 months)
temperature pulse above 100 malaise, anorexia excess fundal tenderness uterine subinvolution lochia returning to rubra from serosa foul- smelling lochia
endometritis assessment
BP - 140/90 or increases of 30/15 above baseline Labs - Tr to 1+ proteinuria
explain BP and labs r/t mild preeclampsia
polydactyly
extra fingers or toes
justice
fairness; rightfulness
fluids and corticosteroids
first treatment for thrombocytopenia with platelets at 50,000
- Obesity with increased waist circumference - Elevated triglycerides - Hypertension - Abnormal serum lipids - Elevated fasting blood sugar
five risk factors referred to as metabolic syndrome which is thought to be related to insulin resistance?
manifestations -paradoxical movement of chest wall -respiratory distress interventions -O2 -analgesia -positive pressure ventilation
flail chest manifestations and intervention
amniotic fluid
fluid within the amniotic sac that surrounds and protects the fetus; made of water and urine
limit tampon use avoid douching refrain from intercourse avoid heavy lifting 3L of fluids a day
follow up care after hysterectomy
meat, raisins, spinach, beets, beans, peanut butter, whole grains, iron fortified cereals, eggs
food high in iron
meat dairy aspartame
foods eliminated with PKU
vegetables fruits juices cereals bread starches
foods with low phenylaline levels
mom can't pus baby past a certain spot vacum used more often -Mighty vac -kiwi
forceps of vacum extraction
BP = CO X SVR
formula for BP
12-23 wka
fundus rises above symphysis
• Pallor • Jaundice • Pruritus palpations tachycardia fatigue dyspnea mummers angina MI blurred vision hepatomegaly splenomegaly sensitive to cold glossitis bone pain headache vertigo
general manifestations of anemia
rapid pulse rapid, shallow respirations and dyspnea increased restlessness flaring of nares retractions cyanosis
general signs of hypoxia
no nipple bud vernix over entire body lanugo over entire body full extension of extremities in resting posture testes in the inguinal canal or labia majora widely separated
gestational age assessment around 28 wks
raised nipple with a tissue bud descended testes with large rugae on the scrotum labia majora large and covering the minora vernix only in the creases lanugo only on shoulders hypertonic flexion of extremities in resting posture
gestational age assessment around 40 wks
3 months
head turns to locate sounds by
absolute bed resr wt daily test urine for protein daily high protein diet could be hospitalized and tx with magnesium sulfate
home management for preeclampsia
Adrenocorticotrophic hormone (ACTH) Thyroid-stimulating hormone (TSH) Luteinizing hormone (LH) Follicle-stimulating hormone (FSH) Prolactin (PRL) Growth hormone (GH)
hormones released by the anterior pituitary gland
Oxytocin Antidiuretic hormone (ADH)- (vasopressin)
hormones released by the posterior pituitary gland
over 65, disabled, and end- stage renal disease
how do you get medicare
As treatment, the goal is a) to replace the blood volume to prevent shock and b) to find the source of acute blood loss, and stopping the bleeding. IV fluids are used to prevent hypovolemia and maintain fluid volume. -Packed red blood cells (pRBCs) are the primary treatment used in acute anemia to restore the blood lost. Each unit of RBCs is expected to increase the hematocrit by 3 points
how is acute blood loss treated
heavy, squeezing, pressing, burning substernal, radiating to left arm or jaw
how is angina often described
Necrotizing enterocolitis
hypoxic- ischemic injury to the mucosa of the intestinal tract results in abdominal distention, sepsis, and nutritional impairment
≤6.5%
ideal goal for A1C
secondary prevention
identifying and treating psychological disorders in the early stages, before they become serious screening recommended for a specific group
turn client of left side increase IV fluids 02 Notify HCp assess FHR
if hypotension occurs during admin of epidural what do you do
clots
if you have high platelets you are at risk for
bleeding
if you have low platelets you are at risk for
placenta previa
implantation of the placenta over the cervical opening or in the lower region of the uterus bleeding usually being in 3rd tri A MEDICAL EMERGENCY
pre-term birth
inadequate wt gain late in pregnancy causes
Description: moderate to heavy bleeding with tissue and products of conception present; open cervical os Tx: hospitalization; D&C
incomplete miscarriage description and Tx
used for pain relief during episiotomy and perineal repair
indication for local anesthesia during labor
Mastitis
inflammation of the breast with redness; most commonly occurs in women who are breastfeeding 2-3 weeks postpartum treat with antibiotcs
endocarditis
inflammation of the inner lining of the heart
endometritis
inflammation of the inner lining of the uterus
◦ Chart review ◦ Rh and Rubella status ◦ Head to toe ◦ VS BP - orthostatic hypotension Pulse - bradycardic ok, tachycardic abnormal Resp - breathsounds Temp -- >100.4 F (38C) abnormal fundal ht lochia
initial post partum assessment
Long-acting (basal) once a day - Rapid/short-acting (bolus) before meals
insulin Regimen that closely mimics endogenous insulin production is
apply pressure
intervention after lymph/ bone marrow biopsy
IV glucose]parental hydrocortisone fluids
interventions during Addison's crisis
• Nursing intervention for the victim of abuse or neglect is to provide shelter and promote reassurance of his or her safety. - Tending to physical injuries - Staying with the client to provide security - Assisting the client to recognize options - Promoting trust - Reporting to authorities when there is "reason to suspect" child abuse or neglect
interventions for victim of abuse
- Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent hypoglycemia - Best done after meals - Exercise plans should be started • After medical clearance • Slowly with gradual progression
interventions needed during exercise for diabetic patients
place in incubator or some sort of isolation cultures admin antibiotics
interventions when newborn develops sepsis
cardiac catheterization
introducing a catheter into a vein or artery to measure pressure and flow patterns of blood
Health Care Economics
is a behavioral science that addresses how to allocate limited resources among unlimited demands and how to pay for these resources.
oxygen-hemoglobin dissociation curve
is a curve that plots the proportion of hemoglobin in its saturated (oxygen-laden) form on the vertical axis against the prevailing oxygentension on the horizontal axis.
D-dimer test
is a global marker of coagulation activation and measures fibrin degradation products produced from fibrinolysis (clot breakdown). The test is used for the diagnosis of DVT when the patient has few clinical signs and stratifies patients into a high-risk category for reoccurrence.
Acromegaly
is a hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood
Calcitonin
is a hormone that is produced in humans by the parafollicular cells (commonly known as C-cells) of the thyroid gland it acts to reduce calcium levels in the blood.
Ferrous Sulfate (Iron)
is a iron preparation used to treat anemia. -Increase fiber and iron, take on empty stomach, spread throughout day. -Vitamin C increases absorption. - stools will turn dark green to black
Hypophysectomy
is a procedure to access and remove the pituitary gland. To access it, an incision is made beneath the patient's upper lip to enter the nasal cavity. A speculum is inserted, and special forceps are used to remove the pituitary tumor
DIC
is a serious condition in which your body will create many blood clots, using up all your clotting factors and can lead to a hemorrhage that cannot be controlled.
Thalassemia
is an inherited disease of blood abnormalities characterized by a lower than normal amount of hemoglobin made and fewer than normal red blood cells in the body. It consists of a group of disorders ranging from barely detectable in the blood to severe or fatal anemia.
sickle cell anemia
is an inherited, autosomal recessive disorder. The presence of abnormal hemoglobin (Hgb S) causes the red blood cells to stiffen and elongate into a crescent shape. The decrease in O2 causes the cell to sickle in shape. This genetic disorder is incurable and is often fatal. It is usually found during routine neonatal screening. patients will have exacerbations triggered by things like dehydration and hypoxia
uterine prolapse
is downward displacement of the uterus
O2 saturation
is the extent to which hemoglobin is saturated with oxygen
Technology
is the knowledge and use of tools, machines, materials, and processes to help solve human problems.
Plasma
is the main component of blood and consists of 90% water, and 10% proteins, ions, nutrients, dissolved gases, and wastes. It functions in maintaining blood pH and osmotic balance. makes up 55% of blood volume.
paO2
is the measurement of oxygen in arterial blood
cystocele
is the relaxation of the anterior vaginal wall with prolapse of the bladder
rectocele
is the relaxation of the posterior vaginal wall with prolapse of the rectum
tissue culture chlamydiazyme microTrak
lab dx for chlamydia
wet slide
lab dx for trichomoniasis
viral culture
lab dx for yeast infection
elevated levels of fibrin, PT, and PTT platelet count decreased reduced fibrinogen reduced clotting factors increased D dimers
lab r/t DIC
low RBCs, low Hgb, and low Hct.
lab values r/t anemia
A D-dimer test is done a n d would be elevated for a pt with a blood clot
lab values r/t blood clot
hyperpigmentation hypernatremia hypokalemia decreased WBCs increased plasma cortisol
labs r/t crushing's disease
prolonged bleeding time due to defective platelets deficiency in factor vWF prolonged PTT
labs r/t von Willebrand disease
Pernicious anemia
lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream due to a lack of intrinsic factor in stomach secretions.
epigastric pain or clonus
last symptoms before a seizure in preeclampsia
ASD VSD PDA coarctation of aorta
list acyanotic CHD
retinopathy, nephropathy, neuropathy
list microvascular complications
neutrophil- high infection eosinophil- high= allergies basophil monocyte- high = parasites lymphocyte
list types of leukocytes and what abnormalities indicate
Threatened Incomplete Complete Septic Missed Recurrent. habitual
list types of miscarriages
spina bifida occulta meningocele myelomeningocele
list types of spine bifida
teach catechization program admin propantheline or bethanachol to improve continence dev bowl program assess skin frequently assess ROM and ambulation
long term care for spina bifida
mental retardation hyperactivity dev delays attention deficits poor coordination facial abnormalities cardiac and joint problems
long term complications of FAS
NST (non-stress test)
looks at FHR in response to fetal movements and/or uterine contractions doesn't stimulate contractions reactive vs non reactive
miscarriage (spontaneous abortion)
loss of pregnancy by 20th week (fertilization age) usually r/t chromosomal defects
blood clots
main concern with polycythemia
cleft lip: place client on side or upright in infant seat cleft palate: place client on side or abdomen remove oral secretions carefully with bulb syringe or Yankauer suction set
maintaining patent airway and proper positioning post op for cleft lip/ palate
• Purpose: - To help others, regardless of the profit status of the ownership arrangements. - Is determined by the organization's mission, vision, and values. Specialized healthcare workforce public trust
major attributes of health care organizations
2 arteries, 1 vein, Wharton's jelly= protects AVA, keeps them from being compressed
make up of the umbilical cord
spina bifida
malformation of the vertebrae and spinal cord resulting in varying degrees of disability and deformity depending on the location of the malformation (neural tube defect)
O2 monitoring ABGs beta 2 adrenergic agonisits anticholinergics steriods IV fluids IV mag intubation
management for asthma attack
• Improve cardiac function: Medications, digoxin, ace inhibitors • Remove accumulated Fluid and sodium: diuretics, fluid restrictions, low salt diets • Decrease cardiac demands: limiting activity, preserving body temperature, treating infections, reduce effort of breathing, • Improve tissue oxygenation
management for congenital heart defects
- Minimizing risk factors -Sodium restriction, weight reduction, moderation of alcohol intake, exercise, smoking cessation, drug therapy.
management for hypertension
Fetal - Body fairly well proportioned; skin red and wrinkled; sweat glands forming - Blood formation increases in bone marrow and decreases in liver - Alveolar ducts and sac present - Lecithin begins to appear in amniotic fluid - Can hear - Testes in descent to scrotum - Wt 600 g/ 1.3 lb Maternal - Uterus rises to the level of the umbilicus - Diastolic bp gradually increases
maternal and fetal changes 24 wks
Ejection fraction
measurement of the volume percentage of left ventricular contents ejected with each contraction
ejection fraction
measurement of the volume percentage of left ventricular contents ejected with each contraction
Silverman-Andersen
measures how bad reparatory distress is in infants want zeros
Radioactive iodine uptake test
measures rate of iodine uptake Patients with hyperthyroidism exhibit a high uptake, hypothyroidism will have low uptake
thrombolytic agents IABP CABG PCI with stenting
medical interventions for MI
isoniazid, rifampin, pyrazinamide, ethambutol
medication used to treat TB
Rho (D) immune globulin rubella vaccine
medication/ vaccines that may be needed postpartum
NST CST BPP AFI VAS Kich counts
methods of fetal surveillance
congestive heart failure
more often associated with acyanotic defects condition in which the heart is unable to pump effectively
more saturation
more pressure to oxygen =
adolescents and young adults
most cases of STDs occur in
lung cancer
most common cause of SIADH
Hashimoto's thyroiditis
most common cause of hypothyroidism
Down Syndrome (Trisomy 21)
most common chromosomal abnormality occurs when cell division is abnormal, there is extra genic material from chromosome 21
preeclampsia
most common hypertensive disorder, develops during pregnancy and is characterized by elevated BP and proteinuria
NO BRUSHING TEETH for 10 days silk floss suction toothets swish warm water
mouth care after hypophysectomy
ventilation
movement of air into and out of the lungs; CO2
Arterial -stop smoking -topical antibiotics -saline dressing -bed rest -fibrinolytic agents Venous -systemic antibiotics -compression dressing -limb elevation -fibrinolytic agents and anticoagulants
noninvasive treatment for PVD
pacifiers, holding, rocking
nonphamrgolic pain management for infants
distraction
nonpharm pain management for toddlers
supportive bra or binder ice packs avoid breast stimulation
nonpharmacologic measures of milk suppression
20-40 sec on heparin= 45-70
normal aPTT
Euthroid
normal functioning thyroid
awake flexed extremities strong lusty cry obvious presence of subcutaneous fat
normal general appearance after birth
13-17 g/dL (men) 12-15 g/dL (women)
normal hgb
nasal mucosa pink, moist with no edema, exudate, blood, or polyps nasal septum straight; nares patent bilaterally light pink, moist, with no exudate or ulcerations smooth, moist, and pink trachea midline AP diameter 1:2 breath sounds clear without crackles, rhonchi, or wheezes excursion equal bilaterally with no increase in tactile fremitus
normal physical assessment of the respiratory system
150-400 x 10^9/L
normal platelet count
150, 000 to 300, 000
normal platelet levels
1.010- 1.030
normal specific gravity
T3 = 0.9-1.95 T4 = 4.4-12.5 TSH= 0.4 to 4.0
normal thyroid levels
below 150
normal triglycerides
postpartum blues
normal, 5-7 days after delivery unexplained tearfulness, feeling down, and having decreased appetite
Pack history
number of packs a day times the number of years
Para
number of pregnancies of 20 wks
check FHR for cord prolapse/ cord compression check color to see if its meconium stained do vaginal exam to check for cord
nurses responsibility after any time membranes are ruptured
assess BP and pulse every 5 to 15 minutes determine FHR with every contraction observe perineal area for the following -increase in bloody show -bulging perineum and anus -visibility of the presenting part palpate bladder for distention assess amitotic fluid for color and consistency
nursing assessment during second stage of labor
bleeding: concealed or dark read uterine tenderness persistent abdominal pain rigid, boardlike abdomen FHR abnormalities
nursing assessment for abruptio placentae
menorrhagia dysmenorrhea uterine enlargement low back pain and pelvic pain
nursing assessment for benign tumors of the uterus
possible absence of early symptoms of pregnancy missed period; full feeling in lower abdomen, lower quadrant tenderness positive pregnancy test
nursing assessment for ectopic pregnancy
keep bulb syringe or suction immediately available: suction mouth then nose turn neonate on side or stomach and pa firmly on the back, holding head 10 to 15 degrees lower than feet
nursing care of newborn for aspiration
rest take VS record ECG nitroglycerin
nursing during anginal attack
check BP dont use with mag = hypotension rise slowly
nursing implications for nifedipine
monitor apical HR assess for hypoxia auscultate lungs for crackles admin O2 elevate head of bed daily wt I and O limit sodium elevate lower extremities check apical pulse before giving digoxin admin diuretics in the morning
nursing interventions for heart failure
apply ice pack to perineum to decrease swelling and pain monitor VS if severe hemorrhage and hypovolemic shock occur: -increase IV infusion wide open -give O2 -VS -lower head of bed; supine -insert foley
nursing interventions for hematoma development
phototherapy - mask over eyes -monitor skin temp - small diaper - no other clothes -turn every 2 hrs - turn off the lights for 5-15 minutes every 8 hours to assess for conjunctivitis - monitor for signs of dehydration maintain hydration: nipple, gavage, and IV fluids
nursing interventions for hyperbilirubunemia
swaddle and minimize handling decrease stimuli pacifier place prone keep bulb syringe close at hand
nursing interventions for infants of mothers that used narcotics
ventilations done over mouth and nose using a size 1 or 0 40 to 60 per minute if heart rate is under 60 compressions are done with thumbs side by side 3: 1 start IV fluids admin sodium bicarbonate or epinephrine admin glucose
nursing interventions for newborn resuscitation
bed rest admin antibiotics inform dentist
nursing interventions for rheumatic fever
constant bubbling = leak don't lift off floor use occlusive dressing if tubing falls out put tube in sterile water if it gets disconnected
nursing priorities for chest tubes
Avoidance of vigorous coughing, sneezing, and straining at stool to prevent CSF fluid leakage at entry site. HOB elevated 30 degrees at all times Frequent neurological assessment Mild analgesics for headache No tooth brushing for 10 days
nursing r/t hypophysectomy
obtain in the morning use tongue blade to start gag reflex
nursing r/t sputum test
monitor VS, LOC, ECG, O2, urine output assess for fluid overload monitor glucose and potassium give potassium for hypokalemia add dextrose to IV fluid for blood glucose below 250
ongoing monitoring for DKA
Merperidine (Demerol)
opioid - don't exceed 48 hours to avoid toxic metabolite normeperidine. do not inhibit uterine contractions
Syndrome of Inappropriate Antidiuretic Hormone
overproduction of the antidiuretic hormone ADH, leading to bloating, water retention, and electrolyte imbalance
FACES
pain scale for preschool aged kids
Aplastic Anemia
patient will have pancytopenia, decrease of all blood cell types and is mostly caused by autoimmune activity
acreta, increta, percreta, vase previa typically results in hysterotomy
placenta abnormalities
increta
placenta invades myometrium
previous uterine scars, surgery, and fibroid tumors
placenta previa is associated with
audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of fetus
positive signs of pregnancy
prone position assess incision for drainage and infection assess neuro function
post op nursing care for spina bifida
Keep head up, brushing teeth with soft bristle toothbrush, keep incision clean and dry. ( must keep calcium gluconate at bedside) thyroid replacement such as Levythroxine or Synthroid, possible Ca replacement 1200mg- Calcium a day and Vit D 400iu-800iu per day.
post op teaching for thyroidectomy
right coronary artery = SA node
posterior coronary artery blood supply
monitor respiratory status remove excess secretions elevate 30 degrees provide oxygen as prescribed maintain NPO admin IV fluids
pre op care for TEF
informed consent empty bladder (full if before 20 wks) supine with wedge under hip VS Surgical asepsis
preparing mom for invasive fetal Dx test
assess for allergies to contrast dye VS NPO flushed feeling when dye is injected
preprocedural nursing for cardiac catherization
up to 90 days postexposure chancre highly infectious
primary syphilis
always admin O2 at the lowest concertation possible when correcting hypoxia
principle of oxygen therapy for newborn
- At the first sign • Check blood glucose - If less than 60 mg/dl, investigate further for cause of signs/symptoms - If monitoring equipment not available, treatment should be initiated
protocol with suspected hypoglycemia
Precipitous labor
quick labor without a dr present
vs, discharge, labial or vulvar redness, and pruritus for possible infection complaints of hot flashes , mood swings, and night swears dysparunia
reproductive assessment for older women
meds, people, equipment, time
resources in a healthcare organization
Thrombotic Thrombocytopenic Purpura (TTP)
results from impaired funciton of ADAMTS13, a von-willebrand factor cleaving protease. Thus, large vWF multimers build and cause a prothrombotic state resulting in microvascular thrombosis. Thrombocytopenia and hemoltic anemia with shcistocyte formation occur as erythrocytes are sheared by platelet rich thrombi.
turtle sign
retraction of the fetal head against the mother's perineum after it emerges
less oxygen in blood causing HYPOXEMIA Causes: fever, hypoventilation, decrease in pH , increase CO2 oxygen goes to tissues causing respiratory acidosis
right shift on oxygen- hemoglobin dissociation curve
no hot tubs, saunas, and steam rooms through out pregnancy
safety concerns during first 8 wks of pregnancy
chorionic villus sampling
sampling of placental tissue for microscopic and chemical examination to detect fetal abnormalities
pineal gland
secretes melatonin
Cor pulmonale
serious cardiac disease associated with chronic lung disorders, such as emphysema enlargement of the right ventricle caused by a primary disorder of the respiratory system. most common cause is COPD
corneal light reflex
shine a light toward a child's eye. the light should be reflected in the same spot in the two corneas. Used to assess brain swelling.
persistent neonatal reflexes after 6 months delayed dev milestones apparent early reference for one hand poor suck, tongue thrust spasticity scissoring of legs involuntary movements seizures
signs of cerebral palsy
Unexplained injuries • Child is frightened of adults • Child reports injury by parent or caregiver • Conflicting or unconvincing explanation for injuries • Extremes of behavior • Delayed physical or emotional development • Lack of attachment to parent
signs of child abuse
Is frequently absent from school • Begs or steals food or money • Lacks needed medical or dental care, immunizations, or glasses • Is consistently dirty and has severe body odor • Lacks sufficient clothing for the weather • Abuses alcohol or other drugs • States that there is no one at home to provide care
signs of child neglect
bright- red, flank vaginal bleeding temp over 100.4 F foul smelling vaginal dischage
signs of complications to D&C to report
intense perineal pain swelling and blue-black discoloration on perineum pallor, tachycardia, and hypotension; feeling of pressure in vagina, urethra, and bladder urinary retention, uterine displacement
signs of hematomas developing in perineum
chest pain tachycardia hypotension SOB
signs of hemothorax
Increased -co2 -acidity -dpg -exercise -temperature
signs of right shift
• Has difficulty walking or sitting • Suddenly refuses to change for gym or to participate in physical activities • Reports nightmares or bedwetting • Experiences a sudden change in appetite • Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior • Becomes pregnant or contracts an STD
signs of sexual abuse in children
occult: dimple with or without hair tuft at base of spine presence of a sac flaccid paralysis and limited or no feeling below the defect head circumference abnormal
signs of spina bifida
parathyroid glands
small pea-like organs that regulate calcium and phosphate balance in blood, bones, and other tissues
milia
small raised white spots on nose, chin, and forehead
2 months
social smile by
1: from the beginning of regular contractions or ROM to 10 cm dilation and 100% effacement 2: 10 cm to delivery of the fetus 3: Delivery of the fetus to delivery of the placenta 4: Arbitrarily lasts about 2 hrs after delivery of the placenta
stages of labor
•Nose •Pharynx, • Adenoids, •Tonsils, •Larynx, • Trachea •Epiglottis
structures in the upper respiratory tract
GnRH agonists -leuprolide -nafarelin
suppresses release of LH and FSH with continuous use. May be used in the treatment of endometriosis
microcephaly growth retardation short palpebral fissures maxillary hypoplasia strabismus abnormal palmar creases, irregular hair poor suck, cleft lip, cleft palate, small teeth
symptoms for FAS
multiple strains some of which are implicated in cervical cancer alarming rate increase in adolescent pop lesions may be small, warlike or clustered may be flat or raised
symptoms for HPV
Dilation of the cervix
the expansion or stretching of the cervix during labor 0-10 cm
atrial septal defect (ASD)
there is a hole between the atria oxygenated blood from the left atrium is shunted to the right atrium and lungs
ventricular septal defect (VSD)
there is a hole between the ventricles oxygenated blood from left ventricle is shunted to the ventricle and recirculated t the lungs
surgery and lifelong hormone replacement
treatment for hypopituitarism
ACE inhibitors
way to decrease proteinuria in patients with nephropathy
elevate legs one or two times per day for around an hour
ways to decrease edema during pregnancy
syndactyly
webbed fingers or toes
Presumptive, probable, and positive signs of pregnancy
what's required for a confirmation of pregnancy
normal maternal blood flow and vol to placenta Normal O2 in maternal blood adequate exchange of O2 and CO2 in placenta open circulatory path between placenta and fetus through vessels and umbilical cord normal fetal circulatory and O2 carrying function
what's required to maintain fetal oxygenation
Thalassemia Major
•Life-threatening form of thalassemia •Physical & mental growth restriction •Pale & jaundiced, splenomegaly, hepatomegaly, cardiomegaly •Symptoms develop in childhood
positive contraction stress test
(Abnormal) A positive result is represented by late decelerations of FHR, with 50% or more of the contractions in the absence of hyperstimulation of the uterus.
negative contraction stress test
(Normal) A negative result is represented by no late decelerations of fetal heart rate (FHR).
tertiary prevention
*Minimize the effects of the disease through treatment modalities* -manage gestational diabetes, nutrition counseling for someone with HTN
Yellow zone peak flow
- 50-79% of personal best/baseline - indicates caution - something is triggering asthma - quick relief meds
cardiac output
- Amount of blood ejected by the left ventricle in one minute. - Normal is 4-8 Liters/minute - Can increase up to 2.5 Liters per minute during strenuous activity
Hemodynamic measurements
- Heart - pump - Blood - volume for the pump to move - Vascular tone - resistance against the pump
ABO incompatibility Type O mother with Type A, B, or AB fetus
- Maternal antibodies cross placenta and attack fetal RBCs - Causes hemolysis and fetal anemia - Less severe than
Cardiomyopathy
- Myocardium around left ventricle is altered, altering cardiac function, resulting in decreased cardiac output - Increased heart rate and increased heart muscle mass compensates in early stages. In later stages, heart failure develops
Alpha-fetoprotein screening
-fetal serum protein used to predict neural tube defects -performed between 16-18 weeks -high incidence of false positives
Red zone peak flow
-severe airway narrowing, take action Peak flow below 50%
hgb to increase by 1 hct to increase by 3%
1 unit of blood causes
Iron Metabolism
1) Very tightly controlled metabolic pathways 2) active absorption by small intestine a) 2-35% of it eaten b) stored in liver, marrow, special proteins
zygote
12-14 days after fertilization from the time the ovum is fertilized until it is implanted into the uterus
Patient Protection and Affordable Care Act
2010 legislation aimed at reducing the number of uninsured individuals and decreasing health care costs
heart pump blood vol vascular tissue
3 elements needed for heart function
determine fetal health and compromise decrease perinatal morbidity and mortality guide interventions of OB team
3 goals of fetal surveillance
JVD, hepatomegaly, peripheral edema
3 main signs of right sided HF
1. VSD 2. Aorta placed over and above the VSD 3. Pulmonary stenosis 4. Right ventricular hypertrophy
4 defects of tetraolgy of fallot
fetal breathing fetal body movement fetal muscle tone reactivity of FHR amniotic fluid index 0 or 2= 10
5 factors of BPP
partners practices number of pregnancies' protection past STDs
5 p's of a sexual hx
1. powers -passive: contractions -Active: pushing 2. passage -soft tissue: cervix, bladder -Bony pelvis: shape 3. Passenger (baby) -head molding -baby too big - hyydrocephils - gastroschisis 4. Psyche - mom is too tired - she gives up 5. Position of mom - need to keep mom moving
5 ps of the birthing process (contributing factors to whether mom can deliver )
fetus
9 weeks after fertilization to term fewer anomalies caused by teratogens
DIC(disseminated intravascular coagulation)
A STATE OF DIFFUSE CLOTTING IN WHICH FACTORS ARE CONSUMED WHICH LEAD TO WIDE SPREAD BLEEDING
Egophony
A change in vocal resonance in the presence of a lung consolidation condition in which the transmission of the "eee" sound becomes a nasal "ay" sound.
Diabetes
A chronic multisystem disease related to - Abnormal insulin production - Impaired insulin utilization - Or both
Acquired Hemolytic Anemia
A condition caused by the destruction, or hemolysis, of red blood cells faster than they can be produced.
Placenta
A structure that allows an embryo to be nourished with the mother's blood supply attaches inside the uterus has a maternal and fetal side
metabolic syndrome
A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.
Brazelton Neonatal Behavioral Assessment Scale
A test often administered to newborns that measures responsiveness and records 46 behaviors, including 20 reflexes.
low pH and PaO2 High PaCO2 and HCO-3
ABGs in COPD
(saturated solution of potassium chloride)- suppresses release of hormones and decreases vascularity of thyroid. Puts patient in euthyroid state before surgery.
Administer sodium iodide-suppresses release of thyroid hormone SSKI
Maintenance inhaler
Advair Diskus (fluticasone/salmeterol) Advair HFA (fluticasone/salmeterol) AirDuo RespiClick (fluticasone/salmeterol) Breo Ellipta (fluticasone/vilanterol) Dulera (mometasone/formoterol) Symbicort (budesonide/formoterol)
CNS depression depressed DTRs decreased urinary output decreased respirations
Adverse reactions of magnesium
rescue inhaler
Albuterol
Idiopathic Thrombocytopenia Purpura
An acquired hemorrhagic disorder characterized by excessive destruction of platelets and a discoloration caused by petechiae beneath the skin with normal bone marrow. usually an acute condition in kids and chronic in adults
palmar grasp
An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object. lessens by 3-4 months
Pancreas
An organs in the abdominal cavity that works to secrete insulin and glucagon into the bloodstream to help regulate blood glucose levels.
- ↑ Serum ferritin - ↑ Iron stores - Normal folate and cobalamin levels
Anemia of chronic disease findings
• Gradual development • Symptoms caused by suppression of any or all bone marrow elements • General manifestations of anemia - Fatigue, dyspnea
Aplastic Anemia Clinical Manifestations
• Preventing complications from infection and hemorrhage • Untreated prognosis is poor - 75% fatal • Treatment options - Bone marrow transplantation - Immunosuppressive therapy
Aplastic Anemia Nursing Management
augmentation of labor
Artificial stimulation of uterine contractions that have become ineffective.
Fluid deprivation test—withhold fluids for 8-12 hours. Weigh patient frequently. Inability to slow down the urinary output and fail to concentrate urine are diagnostic. Stop test if patient is tachycardic or hypotensive Trial of desmopressin and IV hypertonic saline Monitor serum and urine osmolality and ADH levels
Assessment and Diagnostic Findings of DI:
G and P Gestational age FHR Maternal VS Contraction frequency, intensity, and duration vaginal exam -fetal position and presentation -cervical dilation, effacement, position, and consistently -fetal station statues of membranes urine glucose and albumin data
Assessment with suspected start of labor
Diabetic nephropathy
Associated with damage to small blood vessels that supply the glomeruli of the kidney Leading cause of end stage renal disease Critical factors for prevention/delay • Tight glucose control • Blood pressure management
erthema toxicum
BENIGN RASH OF UNKOWN CAUSE IN NEWBORNS BLOTCHY RED AREAS MAY HAVE WHITE OR YELLOW PAPULES OR VESICLES IN CENTER comes and goes
Regurgitation
Backflow of blood through a valve that cannot close properly due to damage or disease (valvular incompetence or insufficiency)
Fetal effects - neonatal sepsis and death Tx -treated with clindamycin or ampicillin or metrondazole(not 1st tri)
Bacterial vaginosis fetal effects Tx
Mongolian spots
Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates
Accelerations
Brief, temporary increases in FHR of at least 15 beats more than baseline and lasting at least 15 second- (same parameters as Nonstress Test)
Adverse reactions -woman with a preexisting narcotic dependency will experience withdrawal symptoms immediately Nursing Implications -Give IV or IM -Obtain drug Hx before admin -monitor resp, pulse
Butorphanol and Nalbuphine adverse reactions nursing implications
• If pituitary damaged, ADH, cortisol and thyroid replacement may be needed. • Drug Therapy —Somatostatin analogs, GH receptor antagonists, and dopamine agonists
complications of hypophysectomy
air leak airway obstruction aspiration bleeding fistuala impaired cough infection subcutaneous emphysema tracheal necrosis tube displacement
complications of tracheostomy
infection fetal injury rupture water
complications r/t amniocentesis
fetal distress active herpes placenta previa high risk after c- section/ V-back ?
contraindications for induction
known CPD fetal stress placenta previa prior classical incision on uterus active herpes unripe cervix
contraindications to use Pitocin
sab cord with alcohol at each diaper change, or keep clean with mild soap and water
cord care
assess FHR for variables vaginal exam - keep hand inside until C-sec putting pressure on baby's head knee to chest position don't move cord= blood cords
interventions for prolapsed cord
head of bed down mcroberts superbaric pressure
interventions for shoulder dystocia
surgical -hysterectomy -anterior and posterior vaginal repair nonsurgical -kegal exercises - knee- chest position - pessary use
interventions for uterine prolapse, cystocele, and rectocele
Rh incompatibility ABO incompatibility Prematurity Sepsis Perinatal asphyxia Maternal diabetes mellitus or intrauterine infections cephalohematoma
predisposing risk factors for hyperbilirubunemia
heals better
why do drs typically let you tear
. Excess GH stimulates gluconeogenesis and lipolysis, causing hyperglycemia and elevated free fatty acid levels
why dose acromegaly cause diabetes mellitus
prevent proteinuria
why give ace inhibitors to diabetics
lipodystrophy
with subq injections you rotate sites to prevent what
Rhonchi
Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.
Adverse reactions - fetal narcosis, distress -hypotension -Itching -urinary retention -Respiratory depression Nursing Indications -Record use accurately -Don't admin if resp below 12 -Have narcan -monitor resp, pulse, and BP
Fentanyl and hydromorphone adverse reactions nursing implications
ectopic pregnancy
Fertilized ovum implanted outside the uterine cavity commonly a result of tubular obstruction medical emergency
tanner stages
Five stages of sexual development in adolescence evaluating pubic hair, genitals and breast development
Nevus simplex
Flat, pink area on the nape of the neck, on the mid-forehead, or over the eyelids resulting from dilation of the capillaries; also called stork bites, salmon patches, or telangiectatic nevi.
gravida, term births( past 38 wks), preterm births (20 wks to 37), abortions, living children
GTPAL stand for
Identification of issues through assessment Patient and family teaching Referrals for appropriate resources, such as ◦ Mental health ◦ Social work ◦ Nutritional support ◦ Caregiver support
General interventions for family dynamics
everyone will have health insurance expansion of Medicaid requirement for employers to cover their employees or pay penalties, with exceptions for employers with few employees cover all individuals regardless of health status increase in payments for primary care services greater support for prevention, wellness, and public health activities
Goals of the patient protection and affordable care act
Hypopituitarism
Growth hormone deficiency — Occurs in children — Presenting complaint is short stature Most involve GH and gonadotropins due to tumor
expectorants
Guaifenesin
22-26
HCO3-
Variable decelerations
HR up or down, cord compression = VERY BAD Prolapsed cord= push head up, change mom position
stidor
Harsh or high-pitched respiratory sound, caused by an obstruction of the air passages
Early decelerations
Head pressed on. This is ok.
- Diuretics • Daily weight, I & O, decreased dependent edema, decrease in SOB, crackles, decrease in JVD - ACE inhibitors/angiotensin-receptor blockers • Prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Results in systemic vasodilation, reducing preload and afterload. - Digoxin - Beta blockers (Coreg) - Nesiritide citrate (Natrecor)
Heart Failure Treatment
Intraventricular hemorrhage
Hypoxia causes vessel damage in the tiny periventricular capillaries, resulting in symptoms of ICP
not hormonal interuterine device still ovulate creates hostile environment high association with dysmenorrhea and infection
IUD
A, D, E. Garlic should not be encouraged as it promotes bleeding, and wrestling is a contact sport that should be avoided. All of the other responses are correct.
In order to reduce the risks associated with hemophilia, a patient should engage in which of these following measures. Select all that apply A. Use a soft-bristle toothbrush B. Incorporate liver and garlic in their diet C. Select wrestling as their sport of choice D. Wear a Medic-Alert tag E. Practice good hand hygiene
injections of salt, fluids, and glucocorticoid hormones immediately
In patients suspected of having an addisonian crisis, the doctor must begin treatment with
Stenosis
Inability of the leaflets to open and close properly (constriction or narrowing)
Moro reflex
Infant reflex where a baby will startle in response to a loud sound or sudden movement. last till 3-4 months
Primary polycythemia (polycythemia vera) is diagnosed due to high levels of Hgb, RBC, WBC, platelets, leukocyte alkaline phosphatase, uric acid, cobalamin levels and histamine levels. Primary polycythemia has low to normal EPO level. Secondary polycythemia has a high EPO level.
Lab r/t polycythemia
direct combs test
Laboratory blood test to detect auto anti-bodies against red blood cells, which can cause cellular damage. These anti-bodies result in hemolytic anemia. normal findings: negative, no agglutination.
Labs - 2+ to 4+ proteinuria -increased HCT, BUN, Uriic acid, AST& ALT, creatine - decreased RBCs - hemolysis - increased liver enzymes - thrombocytopenia Considerations -significant risk for hemorrhage, abruption, renal failure, pulmonary edema, hepatic rupture, and death - DO NOT PALPTE THE LIVER
Labs and considerations r/t HELLP syndrome
chronic idiopathic thrombocytopenic purpura
Lasts 6 months or longer and mainly occurs in adults. The body produces autoantibodies and specialized white blood cells that target their own platelets which leads to thrombocytopenia from damage to megakaryocytes.
blood more saturated ( not in tissues) HYPOXIA Causes: cold, decreased co2 in blood , hyperventilation causing a decrease in CO2 and rise in pH which is known as RESPIRATORY ALKALOSIS
Left Shift on oxygen- hemoglobin dissociation curve
Angiopathy
Macrovascular-Diseases of large and medium sized blood vessels Occur with greater frequency and with an earlier onset in diabetics Development promoted by altered lipid metabolism common to diabetes
Cataracts glaucoma Hypertension heart failure Truncal obesity moon face buffalo hump sodium retention hypokalemia, hyperglycemia negative nitrogen balance altered calcium metabolism Decreased inflammatory responses, impaired wound healing increased susceptibility to infections Osteoporosis compression fractures Peptic ulcers pancreatitis Thinning of skin striae
Manifestations of Cushing's syndrome
• Bleeding tendencies range from mild to severe • Symptoms may not occur until 6 mos of age - Mobility leads to injuries from falls and accidents • Hemarthrosis - Bleeding into joint spaces of knee, ankle, elbow leading to impaired mobility • Ecchymosis • Epistaxis • Bleeding after procedures - Minor trauma, tooth extraction, minor surgeries - Large subcutaneous and intramuscular hemorrhages may occur - Bleeding into neck, chest, mouth may compromise airway
Manifestations of Hemophilia
Fetal - Brown fat deposits develop beneath skin - Fetus is 15 - 17 inch - Fetus begins storing iron, calcium, and phosphorus - Wt 1800 to 2200 g/ 4.9 lb Maternal - Fundus reaches xiphoid process - Breast and full and tender - Urinary frequency - Swollen ankles - Dyspnea
Maternal and Fetal changes 32 wks
Fetal - Fetus occupies entire uterus - Maternal antibodies are transferred to fetus - L/S ratio is 2:1 and phosphatidylglycerol (PG) is present - Wt 3200 g + / 7.1 lb Maternal - Lightening - Burst of energy - Backaches increase - Urinary frequency - Braxton Hicks intensify
Maternal and Fetal changes 36- 40 wks
Biophysical Profile (BPP)
Method for evaluating fetal status during the antepartum period based on five variables originating with the fetus most accurate predictors of fetal- well being
Contraction Stress Test (CST)
Method for evaluating fetal status during the antepartum period by observing response of the fetal heart to the stress of uterine contractions that may induce recurrent episodes of fetal hypoxia. contractions induced with oxytocin or nipple stimulation
Prostaglandin insert into vagina softens cervix
Misoprostol (Cytotec)
description: fetus dead, placenta atrophied but passage of the products of conception has not occurred, cervix closed Tx: watchful waiting, check clotting factors and possible terminate pregnancy to lessen the chances of developing DIC
Missed miscarriage description and Tx
What it tests: needed for induction; control induction How to do it: intensity calculated with IUCP total of all contraction intensities in 10 min acme-resting tone Goal= 200-300 Warning: over 400 is excessive uterine activity and increases the risk for uterine rupture
Montevideo units (MVUs) What it test How to do it Goal warning
MONA for MI
Morphine Oxygen Nitroglycerin Aspirin
D because blood is much thicker than normal.
Polycythemia can result in which of the following adverse outcomes in a patient? A. Excessive bleeding B. Urticaria C. Nausea/Vomiting D. Blood clots
Hypoglycemia Allergic reactions Lipodystrophy Somogyi effect Dawn phenomenon
Problems with insulin therapy
Percutaneous Umbilical Blood Sampling (PUBS)
Procedure for obtaining fetal blood through ultrasound-guided puncture of an umbilical cord vessel to detect fetal problems such as inherited blood disorders, acidosis, or infection; also called cordocentesis. Can be used to give a blood transfusion
• Typical patient is asymptomatic except during sickling episodes • Symptoms can be - Pain and swelling - Pallor of mucous membranes - Fatigue
Sickle Cell Disease Clinical Manifestations
- Avoid high altitudes, maintain fluid intake, treat infections, pain control • O2 for hypoxia and to control sickling • Pain management • Acute chest syndrome - Antibiotics - O2 therapy - Fluid therapy • Folic acid daily supplements • Blood transfusions in crisis • Hydroxyurea: Antisickling agent - Erythropoietin in patients unresponsive to hydroxyurea • Bone marrow transplant
Sickle Cell Disease Nursing Management
● Hypertension * one of the first signs ● Headache ● Vertigo ● Dizziness ● Tinnitus ● Visual changes ● pruritus (itching) ● Paresthesias (abnormal tingling in hands and feet) ● Erythromelalgia (redness on hands and feet and is often made worse in hot water) ● Angina ● heart failure ● intermittent claudication (pain in legs) ● thrombophlebitis
Signs and Symptoms of Polycythemia
a, b, d, f
The nurse is teaching a client diagnosed with primary polycythemia about possible complications from the disease. What complications would the nurse present in a teaching plan? Select all that apply. a. Visual disturbance b. Orthopnea c. Hearing loss d. Gout e. Weight loss f. Headache
Grade A= strongly recommends
There is high certainty that the net benefit is substantial
Grade D= Recommends Against
There is moderate or high certainty that the intervention has not net benefit or that the harms outweigh the benefits
Grade C= No recommendations for or against
There may be considerations that support providing the intervention for an individual patient but not for the general population. There is at least moderate certainty that the net benefit is small
lochia alba
Thicker, whitish yellowish discharge with leukocytes and degenerated cells; lasts up to 6 weeks
Hypercyanosis Spell
Transient period when there is an increase in right to left shunting of blood - Hypoxia, pallor, and tachypnea - Precipitated by crying, defecation and feeding - Older children will assume a squatting position to decrease blood return from the lower extremities
• Infusion of Von Willebrand's protein concentrate • DDAVP infusion prior to surgery or to treat bleeding episode • Aminocaproic acid to treat bleeding in mucous membranes (in some cases) • Avoid aspirin or NSAIDs (increased bleeding time and inhibit platelet function) • Manage bleeding episodes with prompt infusion therapy
Treatment and interventions of Von Willebrand Disease
DDAVP—intranasal bid Can also use Diabenese and thiazide diuretics in mild disease as they potentiate the action of ADH If renal in origin—thiazide diuretics, NSAIDs (prostaglandin inhibition) and salt depletion may help Educate patient about actions of medications, how to administer meds, wear medic alert bracelet
Treatment for DI
• It varies depending on the cause of the anemia. • Treatment involves supportive care until causative agent can be resolved. -hydration -electrolyte replacement -blood products -folate replacement -glucocorticoids -plasma exchange
Treatments for Acquired Hemolytic Anemia
Monitor HR, BP, RR (respiratory failure...may need mechanical ventilation), EKG, Temperature Keep environment quiet and patient cool (cooling blankets and sedatives as prescribed) No foods containing iodine (seafood...seaweed, dairy, eggs) Decrease fever Antithyroid medications (block synthesis) : Methimazole PTU "Propylthiouracil" Steroids Betablockers
Tx for thyroid storm
Opioids -Fentanyl -Hydromorphone Opiod agonist/ antagonist - Butorphanol -Nalbuphine Regional Block -Local -Pudendal block -paracervical -Epidural -Spinal
Type of pain management during labor
class 1: unrestricted physical activity class 2: ordinary activity causes fatigue, palpations, angina class 3: with less- than- ordinary activity, cardiac decompensation symptoms ensue class 4: cardiac insufficiency even with rest
Types and extend of cardiac disease
- Sickle cell anemia • Most severe • Homozygous for hemoglobin S (HbSS) - Sickle cell thalassemia - Sickle cell HbC disease - Sickle cell trait (HbAS)
Types of SCD
USPSTF
U.S Preventative Services Task Force, has five levels of of evidence with a recommended grade A-D and I
b
When providing education to a patient on how to take their iron supplement, which statement made by the patient requires you to give them more information? A) "I will take this iron supplement on an empty stomach." B) "I will not take this iron supplement with orange juice." C) "I will wait 2 hours after taking my iron supplement before I take my calcium supplements." D) "Since the iron supplement causes constipation, I will drink plenty of fluids and take a stool softener as needed."
pursed lip breathing
a technique of exhaling against pursed lips to prolong exhalation, preventing bronchiolar collapse and air trapping; done to increase expiratory airway pressure, improve oxygenation of the blood, and help prevent early airway closure. help to decrease anxiety
tension pneumothorax
a type of pneumothorax in which air that enters the chest cavity is prevented from escaping
Cobalamin Deficiency
also known as Vitamin B12 deficiency, is a condition resulting from insufficient dietary intake or poor gastrointestinal absorption of vitamin B12. This causes lower than normal amounts of vitamin B12 to be absorbed by the bloodstream and tissues. Inadequate absorption can result in anemia or nervous system damage
healthcare organization
are a purposefully designed, structured social system developed for the delivery of health care services by specialized workforces to defined communities, populations, or markets.
normal= 31-33 cm tape measure is stretched around scapula and over nipple line
assessing chest circumference after birth
normal= 6-9 lb weigh at birth and daily normally lose 5-15% of birth wt in first wk of life
assessing wt after birth
lethargy temperature instability difficulty feeding subtle color changes respiratory distress hyperbilirubinemia
assessment for newborn with sepsis
UTI pneumonia sepsis acute illness newly diagnosed type 2 diabetes
causes of HHS
evolution of antibodies against multiple platelet antigens , leading to reduced platelet survival and impaired production
causes of Idiopathic Thrombocytopenia Purpura
blood incompatibilities sepsis drug reactions
causes of Jaunice w/in first 24 hrs
thrombus or clotting shock or hemorrage
causes of MI
- End-stage renal disease • Primary factor: ↓ Erythropoietin - Chronic liver disease - Chronic inflammation - Malignant tumors - Chronic endocrine diseases
causes of anemia due to Chronic Disease
atherosclerotic heart disease HTN coronary artery spasm cardiopathy physical exertion, cold temperatures
causes of angina
➢ Chemical agents and toxins ➢ Drugs (alkylating agents, antiseizure, antimicrobials, gold, nsaids, antithyroid) ➢ Immune suppression of stem cells by autoreactive t-lymphocytes ➢ Radiation ➢ Toxic injury to bone marrow stem cells ➢ Viral and bacterial infections
causes of aplastic anemia
down syndrome
causes of brushfield spots in iris, epucanthal folds, and low set ears
Anoxic Injury before, during, or after birth maternal infections kernicterus low birth wt
causes of cerebral palsy
- Pernicious anemia • Insidious onset - Nutritional deficiencies - Hereditary enzymatic defects
causes of cobalamin deficiency
rubella rheumatic fever smoking FAS diabetic mom down syndrome CMV toxoplasmosis IDM
causes of congenital heart defects
trauma DIC uterine atony retained placenta
causes of early post partum hemorrhage
- problems with ovulation, fallopian tubes, or conditions that affect the uterus or cervix - chronic diseases -genital infection
causes of female infertility
- Poor nutrition - Malabsorption syndromes - Drugs - Alcohol abuse and anorexia - Lost during hemodialysis
causes of folic acid deficiency
TB trauma Pulmonary embolism with infarction. Torn pleural adhesions in association with spontaneous pneumothorax. Bullous emphysema. Necrotizing infections.
causes of hemothorax
CNS damage Hypoglycemia Drug withdrawal
causes of high pitched cry in an infant
Hashimoto's thyroiditis Common in those previously treated for hyperthyroidism Atrophy of gland with aging Medications like lithium, iodine compounds, antithyroid meds can cause Radiation treatments to head and neck Infiltrative diseases like amyloidosis, scleroderma Iodine deficiency and excess Hypothalamic or pituitary abnormality
causes of hypothyroidism
PCOS endometrioses stress Hx of mumps low sperm count STDs low testosterone PID medication
causes of infertility
• Inadequate dietary intake - 5% to 10% of ingested iron is absorbed • Malabsorption • Blood loss • Hemolysis
causes of iron deficiency anemia
Subinvolution - 4-6 wks postpartum -lochia rubra over 2 wks retained placental fragments
causes of late post partum hemorrhage
infection cold exposure stroke meds
causes of myxedema
chronic hypoxia sleep apnea kidney tumors releasing erythropoietin performance-enhancing drug EPO
causes of polycythemia
ARDS aspiration, inhaled toxins, pneumonia, sever hypoxia anaphylactic reaction hypoalbuminemia left ventricular heart failure overhydration with IV fluids O2 toxicity
causes of pulmonary edema
Autoimmune disorders; genetic tendency woman); unknown etiology
causes of raynauds
- Renovascular disease - Pheochromocytoma - Primary hyperaldosteronism - Cushing's syndrome - Diabetes - Dysfunction of the thyroid, pituitary or parathyroid gland - Coarctation of the aorta - Pregnancy - Neurologic disorders
causes of secondary hypertension
- Injury to vessel wall - Venous stasis -Hypercoagulability
causes of thrombophlebitis
Childbirth, CHF, DKA, infection, PE, stress, trauma, surgery
causes of thyroid storm
hydrocephalus
causes of widely separated sutures in newborns
used with spermicide contraindicated if cervical anomalies exist associated with cervical changes
cervical cap
cervix can be directly anterior and palpated easily or can be posterior and difficult to palpate
cervical position
fetal effects - still birth or neonatal death - preterm birth = pneumonia -opthalmia neonatorum Tx - erythromycin
chlamydai fetal effects Tx
change in LOC irritability vomiting headache on awakening motor dysfunction unequal pupil response seizures change in personality
classic signs of intracranial pressure in toddlers and older children
Classic - Polyuria, Polydipsia, Polyphagia, Weight loss • Weakness • Fatigue • Nonspecific symptoms - May have classic symptoms of type 1 • Fatigue • Recurrent infections • Recurrent vaginal yeast or monilia infections • Prolonged wound healing • Visual changes
classic symptoms of type 2 DM and nonspecific symptoms
• History of recent, sudden weight loss • Classic symptoms - Polydipsia - Polyuria - Polyphagia
classic symptoms r/t recent onset of type 1 DM
• Parenteral administration of cobalamin • Increase in dietary co
collaborative care for cobalamin deficiency
• No specific drug or diet is effective in treating thalassemia • Thalassemia minor - Body adapts to decreased Hb • Thalassemia major - Blood transfusions with IV deferoxamine
collaborative care for thalassemia
atelectasis
collapsed lung; incomplete expansion of alveoli
wear well- fitting supportive bra maintain proper posture use semi- flower position at night for dyspnea
comfort measures for women 32 wks pregnant
cardiac defects respiratory infections feeding difficulties delayed development skills mental retardation skeletal defects altered immune function endocrine dysfunction
common associated problems with down syndrome
small head flat, wide nasal bridge upward, outward slant of eyes white spots on iris low set ears small mouth and protruding tongue short neck single crease in palms short in stature hypotonic flexibility atlantoaxial instability
common physical characteristics r/t down syndrome
CO= amount of blood ejected by the left ventricle in 1 min SV/ Ejection fraction= amount of blood ejected each beat
compare CO and SV/ ejection fraction
description: all products of conception passed; cervix closed Tx: none
complete miscarriage description and Tx
polycythemia vera
condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels
congenital hypothyroidism
condition present at birth that results in lack of thyroid hormones; results in poor physical and mental development; formerly called cretinism
live, motile, normal sperm present in cervical mucus fallopian tubes patent adequate progesterone and secretory endometrium semen is supportive to pregnancy
conditions required for fertilization to occur
only way to prevent STDs used with spermicide penis must be withdrawn while erect water- soluble jelly used only
condom
Esophageal Atresia and Tracheoesophageal Fistula
congenital anomaly in which the esophagus does not fully develop is an emergency
foramen ovale
connects the two atria in the fetal heart
ductus venosus
connects the umbilical vein to the inferior vena cava, bypassing the liver; get cut
Troponin
contractile proteins released after MI. draw 3 sets 3-5 hrs apart
inspiration
contracting inspiratory muscles to move air into lungs
asthma
contradiction for carboprost
hypertention
contradictions for methylergonovine
STD (herpes)
contraindications for CVS
Hx of coagulation problems thromboembolism liver disease reproductive cancer CAD
contraindications for birth control
bleeding disorder antepartum hemorrhage causing acute hypovolemia infection or tumor at injection site allergy to -caine drugs CNS disorders
contraindications for epidural and spinal blocks
Sexual, health and psychosocial Hx IIEF Physical exam focusing on secondary sex characteristics DRE for prostate size, consistency and presence of nodules Assessment of BP and peripheral pulses and femoral arteries Rule out diabetes Hormonal levels for endocrine related problems PSA and CBC Nocturnal penile tumescence and rigidity testing vascular studies
diagnostics used for ED
Promotes hypertriglyceridemia - Detrimental effects on liver - Can cause severe hypoglycemia because of inhibitory effect on glucose production by the liver
effects of alcohol on pts with diabetes
calcium effects the contractions of the heart to make each beat more effective. Calcium is needed with each heart contraction. Remember calcium channel blockers......calcium causes constriction. With hypertension sometimes calcium channel blockers are administered to dilate vessels.
effects of calcium on the heart
small IUGR
effects of cigarette smoking on infants
decrease -pain meds -beta-blockers -antidepressants cause cough -ace inhibitors
effects of different medications on the respiratory system
hepatic dysfunction - cirrhosis= jaundice spleen enlarged cataracts cerebral damage V/D all with in first month of life
effects of galactosemia
magnesium= depressed respirations, hypocalcemia, and hypotonia narcosis= decreased respirations and hypotonia
effects of medicine used during labor on infant
irritability, hyperactivity high pitched cry coarse flapping tremors poor feeding, frantic sucking, vomiting, and diarrhea nasal stuffiness
effects of narcotic use on infants
asthma
episodes of breathing difficulty due to narrowed or obstructed airways causes trapped air leading to wheezing
• Hemolysis also occurs • Problem with globulin protein - Abnormal Hb synthesis • One thalassemic gene - Thalassemia minor • Two thalassemic genes - Thalassemia major
etiology for Thalassemia
• Absence of IF • Acid environment required for IF secretion • GI surgery • Long-term users of H2 -histamine receptor blockers
etiology of cobalamin deficiency
ask patient for return demonstration use open ended questions (what will you do if...) involve caregiver
evaluating patient learning
Assault with blunt object crush injury explosion fall sports injury
examples of blunt chest trauma
Arrow Gunshot knife stick
examples of penetrating trauma
hyperbilirubunemia
excessive accumulation of bilirubin in the blood due to RBC hemolysis
BP - above 160/ 110 Labs - 2+ to 4+ proteinuria -increased HCT, BUN, Uriic acid, AST& ALT, creatine - decreased RBCs
explain BP and labs r/t severe preeclampsia
• Pain: Intermittent claudication • Pulse: Diminished or absent • Ulcer: Deep, pale, located on toes, feet or other areas of skin • Skin: Dependent rubor, pallor upon elevation; dry, shiny skin; cool or cold temp; • Complications: Gangrene
explain arterial Insufficiency pain pulse ulcer skin complications
wake up with hyperglycemia check at 2-3 am and its high caused by high hormones at night, body makes to much
explain dawn effect
wake up with hyperglycemia check at 2-3 am and its low caused by taking too much insulin or not having a night time snack man made error
explain somogi effect
radiation: baby near something cold evaporation: moisture on babies body convection: cool airflow conduction: body touching cool objects
explain the different types of heat loss after baby is born
begins immediately after ovulation and ends with menstruation postovulatory phase requires 13-25 days corpus luteum reaches its peal of function activity 8 days after ovulation, secreting estrogen and progesterone the fertilized ovum is implanted in the endometrium
explain the luteal phase
days 1-5 of cycle shedding of the endometrium occurs in the form of uterine bleeding
explain the menstrual phase
periodic vasoconstriction in upper layers of endometrium initiates shedding of functional 2/3 of the endometrium
explain the menstrual phase of the endometrial cycle
about 3 days prior to ovulation, there is marked rise in LH and FSH, slight decrease in production of follicular estrogen, and a rise in progesterone finale maturation of a single follicle and release of its mature ovum ovulation marked be day 14 a mature mature follicle ruptures and the ovum is released from the ovary the ovum is picked up by the fimbriated end the the fallopian tube and transported to the uterus
explain the ovulatory phase
increment= going up acme= peak decrement= going down resting tone= time in-between
explain the parts of a contraction
day 5 to ovulation begins the first day of menstruation and ends 14 days later in the preovulatroy phase FSH is secreted by the antertior pituitary preovulatory surge of LH converts follicle to a corpus luteum, which produces progesterone
explain the proliferation (follicular) phase
depends on estrogen
explain the proliferative phase of the endometrial cycle
Pain: Aching, cramping, relieved by elevation • Pulse: Present • Ulcer: Superficial, pink; over inner or outer ankle • Skin: Thick and tough; brawny pigment, normal temp; may have edema • Complications: Poor healing
explain venous insufficiency
Myxedema coma
extreme hypothyroidism(abrupt med cessation), rare with a high mortality rate = decreased cardiac output leads to decreased tissue perfusion which leads to brain and organ depletion leading to multi-organ failure
artificial tears sunglasses when in bright light annual eye examinations
eye care for exophthalmos
- Resolution of enclosed hemorrhage (cephalhematoma, large amt of bruising) - Infection - Dehydration - Sepsis
factors that increase risk for physiologic jaundice
abuse
family dynamic that is always negative
feed in upright position feed slowly, with frequent burping use soft, large nipples; prosthetic palate; or rubber tipped asepto syringe ESSR method: -Enlarged nipple opening - stimulate child to Suck -Swallow normally - Rest
feeding with cleft lip and palate
ovarian function decreases breast tissue involutes ovaries and the uterus atrophy, nether may be palpable atrophy of vulva vaginal mucous membrane becomes fry dyspareunia
female reproductive changes r/t age
Fetal - Embryo becomes a fetus - Heart found through ultrasound - Lower body develops - Determine sex - Kidneys produce urine - Wt 14 g/ 0.03 lb Maternal - Uterus rises above pelvic brim - Braxton Hicks - Risk for UTI ^ - Fully functioning placenta - Wt gain 2- 4 lb during 1 st trimester
fetal and maternal changes 12 wks
Fetal - Major divisions of brain - Heart begins to pump blood - Limb buds - Ears Dev - Wt 1-2 g Maternal - Nausea - Uterus becomes globular shape - Hegar sign - Goodell sign - Cervical flexes - Chad wick sign - Leukorrhea - No noticeable wt. changes
fetal and maternal changes 8 wks
The part of the fetus that presents to the inlet Vertex= head/ cephalic shoulder= acromion Breech= buttocks
fetal presentation
Location of presenting part in relation to midpelvis or ischial spines expressed as cm above or below the spines station 0 is engaged station -2 is 2 cm above ischial spines
fetal station
liver
filters toxins and dead red blood cells from the blood where clotting factors are made
10-12 months
fine pincer grasp appears at
lanugo
fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.
fluids
first intervention for DIC
wt loss
first sign of type 1 diabetes
petechia, tachycardia
first signs and symptoms of DIC
restlessness anxiety tachycardia
first signs of hypoxia
extreme thirst
first signs of type 2 diabets
Green leafy vegetables such as lettuce, cabbage, spinach, peas, asparagus, meat, milk, and soybean oil
foods high in vitamin K
- Cardiac ouput = stroke volume X heart rate - CO = SV X HR
formula for CO
flail chest
fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment
ethical committees
groups of persons who provide structure and guidelines for potential healthcare problems, serve as an open forum for discussion, and function as patient advocates; provide education, policy and guideline recommendations, and case review
giantism
growth hormone (GH) excess that occurs before fusion of the epiphyseal growth plates. Therefore, by definition the condition is only seen in growing children.
Torticollis
head tilt due to shortening or spasm of one sternomastoid muscle
optimization of health evidence (uspstf) Patient/ community centered enculturation
health promotion is characterized as
systolic heart failure
heart can't contract and eject
have lower hgb during infections WBC wont increase very much
hematologic differences in older adults
manifestations -dyspnea -decreased or absent breath sounds -dullness to percussion -decreased Hgb -shock Interventions -chest tube insertion -iv fluids -packed red blood cells
hemothorax manifestation and interventions
Cytomegalovirus
herpes-type virus that usually causes disease when the immune system is compromised
secondary hypertension
high blood pressure caused by the effects of another disease
Epinephrine: rapidly responds to stress by increasing your heart rate and rushing blood to the muscles and brain. It also spikes your blood sugar level by helping convert glycogen to glucose in the liver. Norepinephrine: works with epinephrine in responding to stress. can cause vasoconstriction (the narrowing of blood vessels). This results in high blood pressure.
hormones released by the adrenal medulla and what they do
monitor LOC, BP, VS every 4 hrs external fetal monitor assess for vaginal bleeding and abdominal pain bed rest in left lying position 16-18 guage IV indwelling urinary catheter I&O decrease stimuli admin MgSO4 assess DTRs and assess for clonus
hospital management for preeclampsia
bed rest is side lying external fetal monitoring meds: mag, betamethasone monitor FHR
hospital management of preterm labor
identifying the source of bleeding and stopping it. Supplemental iron If blood loss is extreme, blood transfusion may be necessary. -Foods such as lean red meat, poultry, fish, leafy green vegetables, brown rice, lentils and beans can all boost your haemoglobin. Vitamin C helps with iron
how is chronic blood loss treated
- The initial evaluation includes a CBC and a review of peripheral blood smear. - Serum cobalamin and serum folate levels are reviewed. If cobalamin levels are low, megaloblastic anemia may be caused by cobalamin deficiency.
how is megaloblastic anemias diagnosed
Negative feedback glands respond by increasing or decreasing the secretion of a hormone based on feedback from various factors (glucose/insulin) Positive feedback- feedback increases the target organ action beyond normal (ie: breastfeeding)
how is the endocrine system regulated
1-3 times
how many times can you suction at a time
with insertion of little finger into the baby's mouth
how to break baby's suctioning to breast
1st letter= moms R or L 2nd letter= Baby Occipital or Sacrum 3rd letter= moms Anterior, Posterior, or Transverse Heart tones - O= below umbilics -S= above umbilicus -L or R-= which quadrant
how to describe position of baby and where heart rate is
place a thin line along entire lower lid in conjunctival sac use only one tuber per baby and discard after 1 min wipe away excess
how to give erythromycin ointments
admin via endotracheal tube as an adjunct to O2 and ventilation therapy to prevent and treat RDS
how to give surfactant to newborns
● Beef, liver, and chicken ● Fish and shellfish such as trout, salmon, tuna fish, and clams ● Fortified breakfast cereal ● Low-fat milk, yogurt, and cheese ● Eggs
how to increase vitamin B12 in your diet
vaginal = support uterus c-section= support insision
how to massage uterus with vaginal and c-sec delivery
Take BP between contractions, in side-lying position
how to take BP during labor
change pad as needed and with every voiding and defecation instruct t wipe front to back good handwashing use ice packs, sitz baths, using a squeeze bottle for perineal lavage, and topical application of anesthetic spray and pads
hygiene and comfort measures for perineum and episiotomy
duration of contractions lasting longer than 90 sec= tetanic frequency of contraction lasting over 2 min= tachysystole increased uterine resting rate
hyperactive uterine activity
Emphysema
hyperinflation of air sacs with destruction of alveolar walls r/t lost alveoli recoil, and increased CO2 retention
Essential part of diabetes management - ↑ Insulin receptor sites - Lowers blood glucose levels - Contributes to weight loss
importance of exercise with pts that have diabetes
An adult's previous experiences can be used as a resource for learning. An adult is more oriented to learning when the material is useful immediately, not sometime in the future. Learning is reinforced by application and prompt feedback.
important things to know about andragogy
Effective pedagogy have various teaching and learning tools that can be drawn upon or used in the classroom. use props and a lot explanation
important things to know about pedagogy
insufficient subcutaneous fat larger ratio of body surface area to body wt extended, open body position immature hypothalamus
in preterm infants temperature instability r/t
poorly developed suck small stomach immature digestion process hypoglycemia anemia hyperbilirubinemia
in preterm infants there are nutrition problems r/t
lung immaturity lack of surfactant lining alveoli PDA, r/t hypoxia results in RDS
in preterm infants there is respiratory distress due to
heart failure
inability of the heart to pump enough blood to meet the tissues O2 demands
secondary infertility
inability to conceive after a previous pregnancy
small baby
inadequate early wt gain during pregnancy causes
obstructive respiratory disorders
increase the resistance within air passages hard to exhale (asthma, COPD, emphysema)
watch VS (bp for hypotension) Watch FHR sitting, leaning forward, feet dangling perhydrate with IV fluids to prevent hypotension with test dose check for side effects (weird taste in mouth ringing in ears)
indications for epidural block
COPD CF IPAH
indications for lung transplant
drop in temp preovulatory and postovulatory mucus is thick at ovulation cervical mucus is abundant, watery, thin, and clear cervical os dilates slightly, softens, and rises in the vagina
indications of ovulation
Human Chorionic Gonadatropin (hCG) - Novarel -Pregnyl -Profasi
induces ovulation by stimulating release of eggs from follicles
Myocarditis
inflammation of the myocardium
pericarditis
inflammation of the pericardium
Antihistamines
inhibit allergic reactions of inflammation, redness, and itching caused by the release of histamine
establish IV access give NS continuous regular insulin identify hx of diabetes, time of last food, time and amount of last insulin injection
initial interventions for DKA
Remove the cap from the MDI and shake well. Breathe out all the way. Place the mouthpiece of the inhaler between your teeth and seal your lips tightly around it. As you start to breathe in slowly, press down on the canister one time. Keep breathing in as slowly and deeply as you can. (It should take about 5 seconds for you to completely breathe in.) Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung. Repeat the above steps for each puff ordered by your doctor. Wait about 1 minute between puffs. Replace the cap on the MDI when finished. If you are using a corticosteroid MDI, you should use a valved holding chamber as described above.
instructions when using MDI
analgesics for pain bed rest in semi flower position for comfort and promote drainage antibiotics to reduce inflammation and pain
interventions for PID
assess circulation airway and breathing establish IV access remove clothing cover sucking chest wound with nonporous dressing tapped on 3 sides stabilize impaled objects with bulky dressing, do not remove prepare for emergency needle decompression if tension pneumothorax or cardiac tamponade present
interventions for chest trauma
7-10 good 4-6 needs moderate resuscitative effort 0-3 severe need for resuscitation
interventions for different Apgar scores
Bed rest with bathroom privileges palpate fundus and abdomen to assess pain and involution admin antibiotics
interventions for endometritis
stay warm assess site daily for decrease in redness, pain, and discharge assist with sitz bath and perineal lamp antibiotics and analgesics
interventions for perineal infection
• assess uterus and bladder • IVF • O2 • notify healthcare provider • labs • bedrest • close monitoring • medications • (oxytocin, methylergonovine, carboprost, misoprostol) • support • ? prepare for surgery
interventions for postpartum hemorrhage
give ice water orange juice
interventions to stimulate fetus for NST
spina bifida occulta
is a defect of vertebrae only. no sac is presented and it is usually a benign condition, although bowel and bladder problems may occur
Health informatics
is a discipline in which health data are stored, analyzed, and disseminated through the application of information and communication technology
Empowerment
is an approach to clinical practice that emphasizes helping people discover and use their innate abilities to gain mastery over their own condition. They have the tools such as knowledge control and resources and experience to implement and evaluate their self management.
Informatics
is the science that encompasses information science and computer science to study the process, management, and retrieval of information.
Chronic blood loss
is typically caused by slow bleeding related to an underlying cause (Bleeding ulcers, hemorrhoids, menstrual bleeding, etc).
blood supply to the function endometrium is blocked and necrosis occurs functional layer separates from basal layer and mensuration begins day 1 of next cycle
ischemic phase of endometrial cycle
• Clinical manifestations are similar to those of cobalamin deficiency • Insidious onset • Absence of neurologic problems • Treated by replacement therapy • Encourage patient to eat foods with large amounts of folic acid
key points of folic acid deficiency
Acute idiopathic Thrombocytopenic purpura (ITP)
kids 2-6; IgG antibodies against GpIIb-IIIa (Type II HSR) abrupt onset 1-3 wks viral infection Epistaxis, easy bruising, petechiae Rx: corticosteroids, IVIg
smears, cultures nucleic acid amplification testing (NAAT)
lab dx for gonorrhea
labwork of patients suffering from acute blood loss may not reflect low hemoglobin of hematocrit levels for 36-48 hours.
lab work for acute blood loss
VDRL and FTA-ABS
laboratory dx for syphilis
hgb increase by 1 and hct increase by 3%
labs after 1 unit of blood
➢ Decreased hgb, wbc, platelets, and reticulocytes ➢ Increased MCV, serum iron and tibc ➢ Bone marrow biopsy, aspiration, and pathologic examination may be done
labs r/t aplastic anemia
normal bleeding time reduction in factor VIII (A) reduction in factor IX (B) prolonged PTT
labs r/t hemophilia A and B
hypoglycemia hyponatremia hypoxia prolonged QT pericardial effusion
labs r/t myxedema
fasting BG= 100-125 HbA1C= 5.7-6.4
labs r/t prediabetes
restlessness, rapid/ shallow breathing, bradycardia
late signs of hypoxia
lethargy combativeness coma dyspnea at rest use of accessory muscles retraction of intercoastal spaces on inspiration pause for breath between sentences, words dysrhythmias hypotension cyanosis cool, clammy skin diaphoresis decreased urine output unexplained fatigue
late signs of inadequate oxygenation
glucagon, epinephrine, growth hormone, cortisol
list Counterregulatory hormones - Oppose effects of insulin - Increase blood glucose levels
1. Trust v Mistrust: Infancy 2.Autonomy v Shame and Doubt: Early Childhood 3. Initiative v Guilt: Play Age 4. Industry v Inferiority: School Age 5. Identity v Role Confusion: Adolescence 6. Intimacy v Isolation: Young Adult 7. Generativity v Stagnation: Adulthood 8. Integrity v Despair: Mature Age
list Erikson stages of dev
Cognitive- used to increase knowledge via lectures, discussion, or written material. Psychomotor- kinesthetic learning whereas the student is touching and manipulating equipment to learn a skill. Affective- Changing attitudes dealing with feelings
list and explain the three domain of education
nitrates, beta blockers, calcium channel blockers, Ranolazine
list antianginals
Sociocultural- language, value system, educational background, support system. Psychological- emotions such as anxiety, fear, anger and depression, decreased coping. Physiological- pain, fatigue, oxygen deprivation
list barrier to education
SVC (unoxygenated) --> Rt atria --> Tricuspid --> Rt ventricle --> Pulmonic valve --> Lungs (Oxygenated) --> Lt atria --> Mitral valve --> Lt ventricle --> aortic valve --> aorta --> Body
list blood flow through the heart
deficient in iron, cobalamin, folic acid decreased erythropoietin decreased iron availability chronic ulcers, colon cancer, liver disease acute trauma, aneurysm, gi bleed sickle cell disease, medications, incompatible blood, trauma
list causes of anemia
Drug induced - alcohol -antiandrogens -antihypertensive -TCA -antianxiety - drugs Endocrine -diabetes -hypogonadism -obesity Genitourinary -Radical prostatectomy -renal failure Neurologic -CVD -parkisons Psychologic Vascular -hypertension -peripheral vascular disease Agining
list common risk factors r/t erectile dysfunction
Tetralogy TGA TA
list cyanotic CHD
Autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, accountability, confidentiality
list ethical principles
Age and developmental stage, motivation, readiness, active involvement, relevance, feedback, nonjudgmental support, simple to complex learning, repetition, timing, environment, emotions, physiological events, cultural aspects, psychomotor ability (muscle strength, motor coordination, energy, sensory activity)
list factors effecting education
- Promotes glucose transport from bloodstream across cell membrane to cytoplasm of cell • Decreases glucose in the bloodstream - ↑ Insulin after a meal Stimulates storage of glucose as glycogen in liver and muscle • Inhibits gluconeogenesis • Enhances fat deposition • ↑ Protein synthesis
list functions of glucose
Oral contraceptives transdermal patch hormone injections hormone implants vaginal ring
list hormonal birth control methods
Internal • Organizational culture—values, beliefs, and practices • Role responsibility, rules, and practices External • Economic trends • New laws • Government regulations
list internal and external minor attributes
caerebrovascular, cardiovascular, and peripheral vascular disease
list macrovascular complications of DM
Glands- organs of the endocrine (produce hormones to secrete in blood to affect target cells.) Target cells are cell specific that affect their specific organ. Hormones- chemical substances produced by the endocrine glands (lipid vs water soluble) Lipid soluble dissolve in lipids and emerge inside the cell. (ie: estrogen, steroids, thyroid) Water soluble hormones dissolve in water and and binds to surface of cell. (ie: FSH, Insulin) Target tissue - body tissue or organ that the hormone has its effect on.
list part of the endocrine system
menstrual phase proliferation (follicular phase) ovulatory phase luteal phase
list phases of menstrual cycle
Surfactant Blood supply Bronchi Bronchioles Alveolar
list structures in the lower respiratory tract
menstrual, proliferative,secretory, ishemic
list the phases of the endometrial cycle
bronchial= over trachea bronchovesicular= over main bronchi vesicular= over lesser bronchi, bronchioles, lobes
list the three different lung sounds and their locations
acquired immune thrombocytopenia thrombotic thrombocytopenia purpura HIT
list the types of thrombocytopenia
condoms, diaphragm, and cervical cap
list types of barrier methods
Follicle- stimulating hormone agonists -follitropin - urofollitropin GnRH agonists -leuprolide -nafarelin GnRh antagonists -cetrorelix -ganirelix Human Chorionic Gonadatropin (hCG) - Novarel -Pregnyl -Profasi Menotropins - Humegon -Peragonal -Repronex Selective Estragon receptor Modulator - clomiphene
list types of drug therapy for female infertility
Rapid acting: Lispro (Humalog), aspart (Novolog), and glulisine (Apidra) Short-acting: Regular - Intermediate-acting: NPH Longacting: Glargine (Lantus), detemir (Levemir)
list types of insulin
testes atrophy, lose wt, and soften erection changes prostate enlargemt
male reproductive changes r/t age
stopping cigarette smoking drug therapies airway clearance techniques breathing exercises increased fluids immunizations long term O2 exercise plan nutritional supplemtation
management of COPD
murmur cyanosis, clubbing poor feeding frequent regurgitation frequent respiratory infections activity intolerance
manifestation of congenital heart disease
Muscle weakness Anorexia Dark pigmentation Hypotension Hypoglycemia Low sodium levels High potassium levels Can result in Addisonian crisis
manifestations of addison disease
• General manifestations of anemia • Pallor is the most common finding • Glossitis is the second most common - Inflammation of the tongue
manifestations of iron deficiency anemia
sore, cracked nipples flulike symptoms: malaise, chills, and fever red, warm lump in breast
mastitis assessment
Fetal - Head is still dominant, face looks human and arm/ leg ratio is proportionate - Scalp hair appears - Meconium in bowel and anus open - Most bones and joint cavities seen on ultrasound and muscular movement - Heart muscle well dev and blood formation active in spleen - Respiratory bronchioles appear - Kidneys in position - Cerebral lobes in position and cerebellum assumes some prominence - General sense organs differentiated - Testes in position for descent or vagina open - Wt 100g / 0.22 lb Maternal - Quickening - Colostrum - Serum cholesterol increases - Placenta is clearly defined - Insulin resistance - Wt gain of 1 lb per week until birth
maternal and fetal changes 16 wks
Fetal - Vernix protects the body - Lanugo - Eyebrows, eyelashes, and head hair - Fetus sleeps, sucks, and kicks - Wt 200- 400g/ 0.44- 0.88 lb Maternal - Fundus reaches level of umbilicus - Breasts secret colostrum; areolae darken - Amniotic sac= 400 mL fluid - Postural hypotension - Quickening= pregnancy becomes REAL - Nasal stuffiness - Leg cramps - Varicose veins - Constipation
maternal and fetal changes 20 wks
elevated= open neural tube defects and multiple gestations low= down syndrome
maternal serum alpha- fetoprotein (MSAFP) results
eat high calorie food fist limit liquids at meal time rest before meals more frequent meals and snacks
maximizing food intake in COPD
elevated Hct= polycythemia thick blood makes it harder for heart to pump give IV fluids to thin blood can end up causing jaundice
meaning when baby has is a red color
erythrocyte sedimentation rate
measures time it takes for erythrocytes to settle to the bottom of a test tube used to assess inflammation
encourage to eat raw fruits, veg, cereals with bran drink 3 L of fluid per day exercise frequently
measures to avoid constipation during pregnancy
eat small frequent meals, avoid spicy/greasy foods, don't lie down after avoid sodium bicarbonate
measures to avoid heartburn
PTCA arthrotomy CABG coronary laser therapy coronary artery stent
medical interventions for angina
Vasopressin(ADH replacement) Levothyroxine(thyroid replacement) somatrotropin (growth hormone) glucocorticoids?(glucose)
medications given after the removal of the pituitary and why
Cephalosporins (a class of antibiotics), most common cause Dapsone Levodopa Levofloxacin Methyldopa Nitrofurantoin Nonsteroidal anti-inflammatory drugs (NSAIDs) Penicillin and its derivatives Phenazopyridine (pyridium) Quinidine
medications that cause anemia
amnion= inner chorion= outer
membranes of the placenta
cerebral palsy
nonprogressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia
above 60
normal HDL
40%-52% (men) 36%-47%
normal Hct
40-80 mg/dL
normal High-density lipoprotein (HDL)
1-3
normal INR
below 100
normal LDL
85-125 mg/dL
normal Low-density lipoprotein (LDL)
11-14 sec
normal PT time
4.7-6.1 million
normal RBCs level
· 3-5.5 mmol/L
normal Total cholesterol
50-150
normal Triglycerides
Respiration= 30-60 HR= 110-160 Temp= 36.5-37.5 C BP= 80/50
normal VS for newborn
5,000-10,000
normal WBC count
700- 800 mL
normal amount of amniotic fluid by end of term
7.35- 7.45
normal blood pH
7.35-7.45
normal blood pH
9.5-10
normal calcium level
below 200
normal cholesterol
round or slightly molded caput succedaneum open, flat anterior and posterior fontanels, sutures slightly separated or overlapping due to molding
normal condition of an infants head after birth
elastic turgor and subcu fat milia, vernix increases lanugo, mottling harlequin sign erythema toxicum monogolian spots telangiectatic nevi
normal condition of skin after birth
symmetrically placed pseudostrabismus chemical conjunctivitis subconjunctival hemorrhage from pressure absence of tears dolls eye movement
normal condition of the eyes after birth
intact lip and palate epstain pearls sucking pads in cheeks presence of rooting, sucking, swallowing, and gagging reflexes
normal condition of the mouth and chin after birth
below 100
normal d dimer
50-75%
normal ejection fraction
Females: 60-160 Males: 80-180
normal iron level
2.5-4.5
normal phosphorus level
Temp= elevated due to dehydration (100.4) Pulse= drop to 50 blood pressure= should be normal respirations= normal
normal postpartum vital signs
moon face truncal obesity buffalo hump abdominal striae muscle atrophy thinning of the skin hirsutism in females hyperpigmentation amenorrhea edema, poor wound healing bruises easily HTN susceptible to infections osteoporosis peptic ulcer formation
nursing assessment for Cushing's disease
Vaginal bleeding, usually in 1st tri size and date discrepancy abnormal fundal hight anemia excessive N/V abdominal cramping early symptoms of preeclampsia
nursing assessment for Hydatidiform Mole
(3 C's) Chocking Coughing Cyanosis Excess salivation Respiratory Distress Aspiration Pneumonia
nursing assessment for TEF
Jaundice total bilirubin level increasing more than 5 mg/day positive direct combs test increased reticulocyte count anemia urine and stools may be dark
nursing assessment for hyperbilirubunemia
painless, bright- red vaginal bleeding in 3rd tri soft uterus possible signs of shock placenta in lower uterine segment FHR is usually normal
nursing assessment for placenta previa
signs of placental separation -lengthening of the umbilical cord outside vagina -gush of blood Uterus changes from oval to globular mother describes a full feeling in vagina firm uterine contractions continue
nursing assessment for placental separation and third stage of labor
fatigue thin, dry hair, dry skin thick, brittle nails constipation bradycardia, hypotension goiter periorbital edema, facial puffiness cold intolerance wt gain T3 below 70 T4 below 5 husky voice slow speech
nursing assessment r/t hypothyroidism
gestational age of 20 wks or less fetal viability absent uterine cramping, backache, and pelvic pressure bright- red vaginal bleeding - note number a perineal pads per hour - note symptoms of shock - assess need for emotional support look for IPV
nursing assessment r/t miscarriage
Poor staffing Lack of time and resources Lack of confidence Frequent Interruptions Lack of privacy
nursing barriers to education
monitor for bleeding monitor VS monitor PT and INR gentle oral care minimize needle sticks turn client frequently decrease taking BP pressure to any oozing site Heparin during first phase
nursing care for DIC
stop bleeding as quickly as possible -pressure -ice give coagulation factor joint bleeding -RICE -rest - no ice - copmpression -elevate no contact sports use protective equipment soft toothbrush avoid subq and IM injections no asprin
nursing care for hemophilia
evaluate for Rh isoimmunization and for ABO incompatibility promote stooling by early feedings of milk assess at birth and daily for presence of jaundice monitor bilirubin levels assist with phototherapy if needed
nursing care for hyperbilirubinemia
perform a heelstick glucose assessment on all SGA or LGA babies or infants of diabetic mothers, jittery babies and babies with high-pitched cries report any blood glucose levels under 40 feed baby early prevent cold stress which leads to hypoglycemia
nursing care for hypoglycemia in newborns
monitor O2 therapy monitor thermoregulation monitor fluid and electrolytes report wt loss over 12% weigh diapers daily maintain nutrition
nursing care for preterm infant
instruct the woman to drink 3- 4 glasses of water before coming for exam and not to urinate late in the 3rd tri place wedge under the right hip to displace uterus to the left
nursing care r/t ultrasounds
keep newborn dry and warm place cap on head take temp every 4 hours if temp falls below 36.4 place in radiant warmer or put skin to skin
nursing care to prevent hypothermia for newborns
nurse controls whether to increase, decrease, or stop observe fetal and maternal response every 15 min if there are non reassuring FHR= turn Pitocin off piggyback at lowest port infuse slowly and increase in 20-30 increments always controlled by pump
nursing considerations for oxytocin
NPO after midnight post op -watch for gag reflex -have patient sitting up
nursing for bronchoscopy
before: obtain signed consent. have pt be NPO 6-12 hrs before the test After: Keep patient NPO until gag reflex returns. If biopsy was done watch for hemorrhage and pneumothorax
nursing for bronchoscopy
have client rest monitor VS protect from light dont give with ED drugs watch for tingling under tongue
nursing for nitrates
Before: avoid scheduling immediately after mealtime. avoid admin of inhaled bronchodilator 6 hrs before During: assess for respiratory distress After: Assess for respiratory distress. provide rest
nursing for pulmonary function test
Before: get signed consent During: position pt upright with elbows on an overbed table and feet supported. Don't talk or cough during procedure After: watch for signs of hypoxia and pneumothorax, and verify breath sounds in all fields. Encourage deep breaths
nursing for thoracentesis
• Dietary and lifestyle changes • Blood or blood product transfusions • Drug therapy • Oxygen therapy • Patient teaching - Nutrition intake - Compliance with drug therapy
nursing implications for anemia
give in the mornings before meals check serum hormones levels routinely check BP and pulse regularly wt daily avoid foods high in iodine
nursing implications for thyroid replacement drugs
institute bed rest with no vaginal or rectal manipulation and notify health care provider immediately monitor BP and pulse every 15 min; apply electric BP monitor if available apply external uterine and fetal monitor place client in side-lying position to increase uterine perfusion closely monitor contractions and FHR begin IV with 16- 18 gauge review CBC, clotting studies, Rh factor, and type and type/ cross match watch for signs of DIC prepare for immediate emergency C- section monitor for blood loss; save pads and linens
nursing intervention for abruptio placentae
teach prevention UTIs -void frequently -void before and after sex - wipe front to back stress regular exercise
nursing interventions during 12 wks of pregnancy
Explain the screening test and obtain blood sample for maternal serum alpha- fetoprotein (MSAFP) between 15-22 wks explain the multiple- marker, or triple, screen blood test, and obtain a specimen fro screening around 16- 18 wks to measure the MAAFP, hCG, and unconjugated estriol
nursing interventions during 16 wks of pregancy
explain and obtain a blood sample for a glucose challenge (24-28 wks) between 24- 32 wks two or three ultrasound measurement may be taken 2 wks apart to compare against standard fetal growth curve
nursing interventions for 24 wks
safety measures - wear low healed shoes or flats - avoid heavy lifting - sleep on side to relieve bladder pressure preparation for delivery -do pelvic tilt exercises - pack a suitcase -discuss postpartum circumstances
nursing interventions for 36- 40 wks
pre op and post op D&C care assess vs, vaginal discharge, uterine cramping discharge instructions - prevent pregnancy for 1 year - obtain monthly serum hCG levelss for 6 mo, then every 2 mo for 6 mo
nursing interventions for Hydatidiform Mole
medications -morphine -nitrates -ACE inhibitors -Beta blockers -Calcium channel blockers -aspirin VS, ECG admin O2 obtain cardiac enzymes IV keep in semi flowers bed rest for 12 hrs
nursing interventions for MI
admin enema and douche as prescribed pre op note amount and character of vaginal discharge. post op there should be less than one saturated pad in 4 hours check for blood clots encourage ambulation as soon as possible I and O assess voiding patterns observe incision for bleeding gradually increase diet provide stool softeners for first bowel movement
nursing interventions for a hysterectomy
dry infant under warmer or skin to skin with mom suction mouth then nose with bulb syringe keep head slightly lower than body assess airway status obtain APGAR score at 1 and 5 minutes keep head covered gestational age assessment assess cord for 3 vessels collect cord blood (Rh, blood type, Hct, cord blood gas) doc passage of meconium and urine check for gross anormlities
nursing interventions for baby immediately after birth
Multidisciplinary (OT, speech, neurologist, RT, ect) feed in a way that prevents aspiration - sit upright -support lower jaw admin anticonvulsants and diazepam
nursing interventions for cerebral palsy
elevate HOB admin O2 admin digoxin and diuretics daily wt I and O low sodium diet
nursing interventions for congestive heart failure (kids)
monitor VS, fundus, lochia every 15 min monitor LOC keep bladder empty anticiapte increasing oxytocin and admin of ergot preparation IM count pads saturated monitor I&O
nursing interventions for early postpartum hemorrhage
VS check for vaginal bleeding start IV notify HCP abdominal ultrasound possible laparotomy type and cross match
nursing interventions for ectopic pregnancy
Nurse more frequently and manually express milk before feeding wear supportive bra take warm or hot showers watch for symptoms of mastitis to reduce possibility of breasts engorgement, start breastfeeding as soon as possible after birth to prevent use breast pump alleviate pain by wearing supportive bra, taking analgesics, applying warm compresses it ice packs or washed cabbage leaves
nursing interventions for engorgement of breasts
teach home glucose monitoring teach signs of hypo and hyperglycemia dietochian teach signs and symptoms of ketocaidosis possible induction 38 - 40 wks
nursing interventions for gestational diabetes
• Close supervision and safe environment • Dental procedures in controlled situation • Shave only with electric razor • Superficial bleeding—apply pressure for at least 15 minutes + ice to vasoconstrict • If significant bleeding occurs, transfuse for factor replacement
nursing interventions for hemophilia
monitor for signs of ICP maintain seizure precautions elevate head of bed pre pare for surgery to drain the excess fluid off brain (ventricular shunt placement)
nursing interventions for hydrocephalus
culture and sensitivity of breast milk breastfeed every 2-3 hrs and to make sure breasts are emptied with each feed do not let mom cease breastfeeding abruptly may have to discontinue breastfeeding if there is pus in breast milk or if antibiotic is contraindicated for breastfeeding if the baby starts having diarrhea contact HCP bed rest 48 hrs
nursing interventions for mastitis
do not perform Leopold maneuvers, vaginal examination, rectal manipulation, or internal monitoring use bed rest to extend the period of gestation until fetal lung maturity is achieved monitor BP and pulse every 15 min start IV obtain blood specimen for CBC, clotting studies, Rh factor, and type/ cross match monitor contractions and FHR, place external monitor on client place in side- lying position monitor blood loss and save pads
nursing interventions for placenta previa
monitor growth and dev teach use of bulb syringe for suctioning naras teach signs of respiratory infections assist with feeding problems feed to back and side of mouth monitor for signs of cardiac difficulty or respiratory infection
nursing interventions r/t down syndrome
increased cal by 300 increase protein by 30g/day increase intake of iron and folic acid increase intake of vit A,C, and calcium drink 8-10 glasses of fluid per day
nutritional interventions during pregnancy
RBCs hematocrit hemoglobin
o2 carrying capacity expressed by
Aortic Stenosis
obstructive narrowing immediately before, at, or after the aortic valve oxygenated blood flow from the left ventricle into the systemic circulation is diminished symptoms caused by low cardiac output
estrogen in pills prevents secretion of FSH, preventing ovulation woman still menstruates lowest failure rate of methods
oral contraceptives
lochia serosa
pale pinkish to brownish discharge lasting up to 10 days postpartum
1. monitors calcium blood levels 2. make more or less PTH in response to calcium blood levels
parathyroid function
F= facial expression L= leg movements A= Activity C= Cry C= Consolabiluty
parts of FLACC pain scale
*A*ppearance: pink all over = 2 *P*ulse: > 100 bpm = 2, < 60 = 0 *G*rimace: sneeze, cough, loud cry = 2 *A*ctivity: active movement = 2 *R*espiration: strength, not rate
parts of an apgar score
Enlarged thyroid gland acceleration of body process -wt loss -increased appetite -Diarrhea -Heat intolerance -Tachycardia, Palpations, Increased BP Exopthalos T3 above 220 T3 above 12 Low TSH Radioactive iodine uptake increased
parts of an assessment for hyperthyroidism
sole creases breast tissue bud skin, vessels, and peeling genitalia resting posture
parts of gestational age assessment after delivery
Progressive destruction of pancreatic cells by body's own T cells - Autoantibodies cause a reduction of 80% to 90% of normal cell function before manifestations occur - Genetic predisposition Long preclinical period Antibodies present for months to years before symptoms occur Manifestations develop when pancreas can no longer produce insulin Rapid onset of symptoms Present at ER with ketoacidosis
pathophysiology of Type 1 diabetes
• Pancreas continues to produce some endogenous insulin •Insulin produced is either insufficient or poorly utilized by tissue
pathophysiology of type 2 DM
To prevent oxygen loss, avoid: - Demanding physical activity - Emotional stress - Environments with low oxygen (high altitudes, nonpressurized airplane flights) - Smoking - Known sources of infection To make sure you're getting enough fluids: - Avoid too much exposure to the sun - Have fluids on hand, both at home and away - Recognize signs of dehydration To avoid infection: - You or your child should be vaccinated - Seek emergency medical attention for temperature of 101.5 0 F or higher - Practice good hand hygiene
patient and family education for sickle cell anemia
Rest as much as possible ➢ Avoid people who are sick ➢ Try to avoid large groups of people ➢ Wash hands often ➢ Clean your mouth and gums every day ➢ Avoid doing thinks that could cause you to bump or cut yourself
patient education for aplastic anemia
inhale slowly and deeply through nose exhale slowly through pursed lip, as if whistling breath out 3 times longer than breathing in do 8-10 repetitions 304 times a day
patient teaching on pursed lip breathing
- Premenopausal women - Pregnant women - Persons from low socioeconomic backgrounds - Older adults - Individuals experiencing blood loss
people at risk for iron deficiency anemia
Amniotomy (AROM)
performed by a physician or midwife during a vaginal exam, amnihook makes small hole in membrane, observe fluid for color and amount (important bc meconium)
temp above 100.4 red, swollen, very tender perineum purulent drainage, induration
perineal infection assessment
Variable -> Chord compression Early decelerations ->Head compression Accelerations -> O2 good (happy baby) Late decelerations -> Pelvic insufficiency
periodic episodic changes in FHR and what they mean
right sided heart failure
peripheral edema Results in peripheral congestion due to the inability of the right ventricle to pump blood out to the lungs; often results from left sided failure or pulmonary disease
hypertension
persistent BP greater than 140/90
manifestations -dyspnea -decreased movement of involved chest wall -decreased or absent breath sounds on the affected side -hyperresonace to percussion Interventions -chest tube insertion
pneumothorax manifestations and interventions
• Establishment of national policies and standards have been developed to outline how technology is applied and used. Must demonstrate: • Meaningful use criteria (evolving) • Certification standards • Practices to reduce barriers for information exchange
policies for T&I
crackles (rales)
popping sounds heard on auscultation of the lung when air enters diseased airways and alveoli; occurs in disorders such as bronchiectasis or atelectasis
assess for signs of shunt malfunction - buldging of fontanels - change is size of head - change in LOC - headache assess for signs of infection - fever -shun tract appears reddened, tender, and swollen - decreased feeding/ vomiting -stiff neck and headache monitor I and O
post op care for hydrocephalus
maintain NPO admin IV fluids monitor I and O provide gastrotomy tube care and feedings as prescribed monitor doe post op stricture of the esophagus
post op for TEF
VS LOC compression device over arterial site observe insertions site for hematoma maintain bedrest
post op for cardiac catherization
8 wks
posterior fontanel closes by
uterine atony lacerations of the vagina hematoma development in the cervix, perineum, or labia retained placental fragments full bladder
postpartum hemorrhage can be caused by
keep sac and stool and urine cover sac with moist sterile dressing elevate foot of bed and position child on his or her abdomen, with legs abducted measure head circumference at least every 8 hrs and check fontanels assess neurological function empty bladder
pre op nursing interventions for spina bifida
Addisonian crisis
precipitated by physical or emotional stress, sudden withdrawal of steriods.
multiparity pelvic tearing during childbirth vaginal muscle weakness with aging and obesity
predisposing conditions r/t uterine prolapse, cystocele, and rectocele
Arterial -Atherosclerosis -advanced age Venous -hx of DVT -valvular incompetence
predisposing factors for PVS
family hx Hx of more than two spontaneous abortions hydramnios previous baby weighing over 8 lb 13.5 oz high parity obesity recurrent monilia vaginitis glycosuria
predisposing factors for diabetes during pregnancy
high parity dystocia, prolonged labor operative delivery overdistention of the uterus abruptio placentae infection placenta previa
predisposing factors for postpartum hemorrhage
BP of above 140/90 on two occasions at least 4 hrs apart after 20 wks gestation - proteinuria - it occurs predominantly in primigravida and in multigravida who previously had preeclampsia
preeclampsia is characterized by
abruptio placentae
premature separation of the placenta from the uterine wall usually in 3rd tri A MEDICAL EMERGENCY
changes that might make a woman think she is pregnant. such as amenorrhea, fatigue, nausea, vomiting, polyuria, breast changes(darkened areolae, enlarged Montgomery glands), quickening(slight fluttering movements of the fetus felt by the women, usually between 16-20 wks of gestation).
presumptive signs of pregnancy
early ambulation foot paddling and ankle rolling after general anesthesia examine legs daily for pain, warmth, and tenderness or a swollen vein
preventing thrombophlebitis postpartum
postpartum perineal exercises spaced pregnancies wt control
prevention of uterine prolapse, cystocele, and rectocele
Ischemic heart attack MI Cardiomyopathy valvular heart disease HTN
primary causes of heart failure
examiner suspects a women is pregnant. such as abdominal enlargement hegar's sign(softening and compressibility of the lower uterus) chadwick's sign (deepened violet-bluish color of the cervix and vaginal mucosa) goodell's sign(softening of the cervical tip) ballottement braxton hicks positive pregnancy test
probable signs of pregnancy
respiratory acidosis organ damage - NEC -PDA -IVH monitor hematocrit levels
problems r/t neonatal hypoxia
based on opinion of patients limits dr. choices do what patient wants and not what they need
problems with pay for performance programs
lightening braxtonhicks cervical softening and slight effacement Bloody show or expulsion of mucus plug burst of energy
prodromal signs of labor
B cells
produce antibodies
bone marrow
produces RBCs contains immature RBCs
Menotropins - Humegon -Peragonal -Repronex
product made of FSH and LH to promote the development and maturation of follicles in ovaries
subdermal, progestin- only contraceptive subq in upper arm effective 24 hrs after insertion; good for 3 yrs suppress ovulation and thickens cervical mucus
progestin implant
Truncus arteriosus
pulmonary artery and aorta do not separate; one artery, rather than two arteries, arises from both ventricles one main vessel receives blood from the left and right ventricle together. blood mixes in the right right and left ventricles through large VSD= cyansus
left sided heart failure
pulmonary edema, results in pulmonary congestion due to the inability of the left ventricle to pump blood to the periphery
confirm pregnancy number a fetuses growth placement heartbeat
reason for ultrasound during 1st tri
position gender size heartbeat abnormalities placenta placement amniotic fluid vol
reason for ultrasound during 2nd and 3rd tri
done at 14- 20 wks for genetic defects 3rd tri for lung maturity and rH factor collected in brown tubes
reasons for amniocentesis
Galactosemia
recessive genetic disorder; characterized by body's inability to tolerate galactose. as galactose accumulates in the blood, several organs are affected.
25- 35 lb in total 1st tri= 1-4 lb 2nd and 3rd tri= 1 lb each wk
recommendations for wt gain during pregnancy
technology and media reliable websites education materials that are brief and easy to read
recommended teaching for Gen X (1965-1980)
lecture patient education TV channels printed materials
recommended teaching for baby boomers
technology and media apps and websites group teaching active learning approaches
recommended teaching strategies for millennials
lecture pictures and printed materials
recommended teaching strategies for veterans
Reactive non-stress test
recording of a minimum of 2 FHR accelerations (15bpm for at least 15 sec per episode) w/ fetal movement w/in a 20 min period
D&C
refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping.
low potassium
regular insulin can lead to what electrolyte imbalance
Station of baby
related to position in relationship to the ischial spines= 0
lung biopsy
removal of lung tissue followed by microscopic examination
complaints of urinary problems, prostate enlargement testosterone levels
reproductive assessment for older men
autonomy
right to make own decisions
Elevated serum lipids, hypertension, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states and homocysteine level.
risk factors for CAD
heredity male African Americans age hyperlipidemia HTN smoking obesity inactivity metabolic syndrome stress substance abuse
risk factors for angina
family hx men increased age African Americans use of alcohol, tobacco, caffeine obesity high salt and fat diet use of oral contraceptives stress
risk factors for hypertension
obesity smoking hypertension high fat intake sedentary lifestyle
risk factors for macrovascular complications of DM
hypertension genetic predisposition smoking chronic hyperglycemia
risk factors for nephropathy
abdominal or chest surgery air pollution altered consciousness prolonged bed rest chronic lung disease HV aspiration NG tube IV drug use malnutrition resident of long term care facility smoking trach
risk factors for pneumonia
poor protein intake previous hypertension diabetes multiple gestations hydatidiform mole prior pregnancy w/ preeclampsia family Hx
risk factors for preeclampsia
Obesity (abdominal/visceral) sedentary lifestyle urbanization certain ethnicities
risk factors for type 2 DM
gonorrheal conjunctivitis neonatal herpes congenital syphilis oral candidiasis
risks to newborns r/t STDs
taking in- mom focused on themselves, observing taking hold- good time for teaching letting go feels confident as the role of mom, looses fears and fantasies
rubins psychologic adaptions
women often have a syncopal spell on first ambulation nurse should check Hgb and Hct for anemia and BP sitting and lying down to look for orthostatic hypotension
safety concern after delivery
6 weeks to 6 months postexposure influenza- type symptoms generalized rash that affects palms of hands and soles of feet lesions contagious
secondary syphilis
includes the day of ovulation to 3 days prior to next menstrual period
secretory phase of endometrial cycle
Dry and peeling of skin
seen in postterm infants, dry crackly skin, white cracks
CK/CKMB, TROPONIN
serum cardiac markers after MI
clubbing; above 160 normal is 160
sign of long term hypoxia
• Signs and Symptoms: redwhite-blue syndrome of digits; pallor or cyanosis that is bilateral or unilateral; normal pulse; sensory changes in extremities; pain. Triggers long-term exposure to cold, stress, lesions can progress to gangrene
signs and symptoms / triggers of raynauds
bleeding tendencies range from mild to severe and symptoms may not occur until around 6 months of age when mobility leads to injuries from falls and accidents. Manifestations of Christmas disease include hemarthrosis, ecchymosis (bruising), epistaxis (nosebleeds), and bleeding after procedures such as minor trauma, tooth extraction, minor surgeries.
signs and symptoms of Christmas disease (Hemophilia B) and type A
Excessive thirst large volumes of dilute urine low ADH hypernatremia dehydration lose too much fluid
signs and symptoms of DI
sudden onset of pain in the lower sternal region pain not relieved by rest or nitroglycerin n/v anxiety pain persists for hours r days rapid, irregular, and thready pulse decreased LOC dysrhythmias narrowed pulse pressure bowel sounds absent or high pitched ECG changes cool, pale, diaphoretic skin dizziness, fatigue, syncope
signs and symptoms of MI
low urine output High levels of ADH hyponatremia over hydrated retain too much fluid excessive thirst
signs and symptoms of SIADH
SOB Tachycardia Hypoxia Hemoptysis
signs and symptoms of a pulmonary embolism
lethargy or difficulty waking temp above 37.8 C vomiting green, liquid stools refusal of two feedings in a row presence of fever
signs and symptoms of a sick newborn who needs medical attention
Enlargement of hands and feet thickening and enlargement of face and head bony and soft tissues sleep apnea signs of DM cardiomegaly hypertension
signs and symptoms of acromegaly
tachycardia poor circulation wt gain tachypnea SOB cyanosis pulmonary congestion hepatomegaly edema
signs and symptoms of congestive heart failure (kids)
intolerance of heat fine straight hair budging eyes facial flushing enlarged thyroid tachycardia high BP wt loss muscle wasting clubbing diarrhea tremors
signs and symptoms of hyperthyroidism
Irritability of neuromuscular system Tetany hypertonic muscle contractions numbness, tingling cramps in extremities laryngeal spasm bronchospasm carpopedal spasm ( flexion of the elbows and wrists, dorsiflexion of the feet) seizures
signs and symptoms of hypoparathyroidism
fatigue hair loss dry skin brittle nails numbness and tingling of the fingers, amenorrhea weight gain decreased heart rate and temperature lassitude cognitive changes, elevated cholesterol levels constipation hypotension
signs and symptoms of hypothyroidism
pallor unexplained fever poor feeding enlarged liver or spleen headache anorexia decreased growth facial deformities bronzed colored skin splenomegaly hepatomegaly
signs and symptoms of thalassemia
easy bruising, epistaxis (nosebleeds), bleeding from the gums, excessive bleeding with lacerations or surgeries, and menorrhagia (heavy menstrual bleeding), hemarthrosis
signs and symptoms of von Willebrand disease
Signs and Symptoms: pain at rest, intermittent claudication; decreased or absent pulses; rubor and cyanosis of extremities; signs of decreased circulation Triggered by smoking, cold, and emotional stress. Affects hands and feet. Has periods of exacerbations and remissions; gangrene is a complication.
signs and symptoms/ triggers of buergers
bleeding gums or nose reduced lab values of platelets, fibrogen, and prothrombin bleeding from injection sites, IV sites ecchymosis
signs of DIC
progressive fatigue malasia wt loss chronic cough night sweats hemoptysis low grade fever chest pain
signs of TB
bad cough that last longer than 3 wks pain in the chest cough up blood or sputum weakness or fatigue wt loss chills fever sweating at night
signs of active TB
tachypnea dyspnea retractions hypoxia tachycardia
signs of acute respiratory distress syndrome
vaginal bleeding adnexal or abdominal mass sharp, unilateral or bilateral pelvic pain, abdominal pain referred shoulder pain syncope; shock
signs of acute rupture r/t ectopic pregnancy
missed period full feeling in lower abdomen lower quadrant tenderness positive pregnancy test vaginal bleeding sharp, unilateral or bilateral pelvic pain referred shoulder pain shock
signs of an ectopic pregnancy
black, tarry BM bruising or small purple spots on skin confusion and weakness headache and change in vision
signs of bleeding
continuous trickle from vagina bleeding in spurts bleeding in presence on contracted fundus
signs of bleeding from unrepaired laceration
soft, boggy uterus usually above umbilicus fundus that does not firm up with massage
signs of bleeding from uterine atony
swollen, firm, and painful breasts then more swollen, hard, shiny, and slightly lumpy when palpated, nipple may retract into the areola
signs of breast engorgement
cyanotic increased sputum leads to right sided heart failure hypoxia hypercapnia polycythemia tachypnea dyspnea clubbing tripod position accessory muscles cardiac enlargement
signs of chronic brochities
increased CO2 retention minimal cyanosis pursed lip breathing dyspnea very thin hyperpresence orthopneic barrel chest dyspnea prolonged expiratory time jerky sentences anxious thin accessory muscles
signs of emphysema
discomfort localized in abdomen no lower back pain cervix does not progressively change contractions decrease in intensity or frequency with ambulation
signs of false labor
hypoglycemia: jitteriness, tremors, lethargy, hypotonia, apnea, weak or high pitched cry, seizures hypocalcemia: jitteriness, apnea, increased muscle tone, edema, abdominal distention, feeding intolerance, and chvostek sign EFV: edema, tachycardia, buldging fontanels, and rales in lungs DFV: sunken fontanels, poor skin turgor, and dry mucous membranes
signs of fluid and electrolyte imbalances in preterm infants
• Diastolic pressure 140 or greater • Retinal hemorrhages, exudates or papilledema • Restless, confusion, stupor, and/or coma • Blurred vision • Headache • Nausea/vomiting
signs of hypertensive crisis
• Confusion • Irritability • Diaphoresis • Tremors • Hunger Acute Complications • Hypoglycemia • Weakness • Visual disturbances • Can mimic alcohol intoxication Untreated can progress to loss of consciousness, seizures, coma, and death
signs of hypoglycemia
Tachycardia (early) BP Tachypnea Vasoconstriction pale & cool cold & clammy CNS changes—anxious, confused, lethargic when blood loss reaches 30-40% (late) urine output
signs of hypovolemic shock
decreased BP weak, rapid pulse cool, clammy skin, colored ashen or gray
signs of hypovolemic shock
irritability, lethargy increased head circumference bulging fontanels widening suture lines "sunset" eyes high pitched cry feeding difficulties decreased muscle tone and strength
signs of increased ICP in infants
decreased -co2 -acidity -dpg -exercise -temperature
signs of left shift
hypoventilation hypotension hypothermia hyponatremia hypoglycemia lactic acidosis respiratory failure
signs of myxedema coma
umbilical cord lengthens blood changed shape of uterus to globular shape
signs of placental separation
JVD, hepatosplenomegaly, pitting edema
signs of right sided heart failure
poor feeding dysphagia drooling regurgitating undigested food
signs of stricture of the esophagus
pain in the lower back that radiates to abdomen pain accompanied by regular rhythmic contractions contractions that intensify with ambulation Progressive cervical dilation and effacement
signs of true labor
irtitabilty seizures tremors high pitched cry poor feeding fever nasal stuffiness tachypnea temp instability
signs of withdrawal in neonates
Goodell's sign
softening of the cervix
Hegar's sign
softening of the lower uterine segment
fetal circulation
special vessels and circulation present in fetus; includes de-O2 blood in umbilical arteries coursing to placenta, and O2 nutrient-rich blood via umbilical veins
1st degree= epidermis 2nd degree= dermis, muscle, fascia 3rd degree= anal sphincter 4th degree= rectal mucosa
stages of tears
4 months
steady head control by
amniocentesis
sterile procedure; needle puncture of the amniotic sac to withdraw amniotic fluid for analysis
Follicle- stimulating hormone agonists -follitropin - urofollitropin
stimulates follicle growth and maturation by mimicking the body's natural FSH
Selective Estragon receptor Modulator - clomiphene
stimulates hypothalamus to increases production of GnRH, with increases release of LH and FSH. End results in stimulation of ovulation
primary prevention
strategies aimed at preventing health problems immunizations, exercise, safe living
Suction when secretions cannot be cleared with coughing or possibly before performing trach care Will insert the suction catheter about 4-5 inches or until resistance is felt. Pull back a little before applying suction DO NOT SUCTION LONGER THAN 10 SECONDS Pre-oxygenate before, during and after
suctioning a trach
• Impaired myocardial function - Tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine output • Pulmonary congestion - Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis •Systemic venous congestion - Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
symptoms of CHF in kids
Dyspnea Orthopnea Crackles Cough Fatigue Tachycardia Anxiety restlessness Confusion Paroxysmal nocturnal dyspnea
symptoms of Left sided HF
fever, tachycardia, agination, anxiety, and HTN
symptoms of Thyroid storm
General manifestations of anemia, neutropenia, and thrombocytopenia. ○ fatigue ○ Pale skin ○ Bleeding of the nose or gums ○ Rash of small purplish or red spots ○ Rapid heart rate ○ Shortness of breath ○ Chest pain ○ Bruising of unidentified origin ○ Among more
symptoms of aplastic anemia
- Chest pain - Cough - Crackles - Enlarged heart - Dependent edema - Dyspnea - Enlarged liver - Fatigue - JVD - syncope
symptoms of cardiomyopathy
• Acute: valves become red, swollen and inflamed with lesions developing on leaflets • Chronic: scar tissue develops, leaflets become rigid and deformed, stenosis or regurgitation develops
symptoms of chronic and acute rheumatic fever
● Glossitis ● Fatigue ● Numbness ● Poor balance ● Reduced sensation of touch ● Memory loss ● Shortness of breath
symptoms of cobalamin deficiency
- Arthralgias - Myalgias - Back pain - Abdominal discomfort - Weight loss - Headache - Clubbing of fingers - Splinter hemorrhages in nail beds - Petechiae - Osler's nodes on fingers or toes-painful tender, red or purple pea-sized lesions - Janeway's lesions on palms or soles-flat, painless, small, red spots - Roth's spots
symptoms of endocarditis
• Jaundice - Destroyed RBCs cause increased bilirubin • Enlarged spleen and liver - Hyperactive with macrophage phagocytosis of the defective RBCs • Accumulation of hemoglobin molecules can obstruct renal tubules - Tubular necrosis
symptoms of hemolytic anemia
peripheral edema wt gain distended neck veins nausea nocturia weakness hepatomegaly ascites
symptoms of right sided HF
gradual onset no fever mild fatigue stuffy nose sneezing sore throat cough
symptoms of the common cold (Viral Rhinitis)
abrupt onset high fever headache aches and pain fatigue symptoms of cold
symptoms of the flu
1. Sudden onset of intense abd. pain - momentarily pain w/ diffuse pain thereafter 2. vaginal bleed: spotting-severe hemorrhage 3. Hyperventilation 4. Restlessness 5. Agitation 6. Tachycardia 7. no contractions
symptoms of uterine rupture
Easy bruising Bleeding Purpura (small red dots under the skin as a result of small bleeds) Nosebleeds Bleeding in the mouth or around the gums Heavy menstrual periods Blood in vomit, urine, or stool Bleeding in the head
symptoms r/t ITP
- Asymptomatic frequently - Moderate anemia • Splenomegaly • Mild jaundice
symptoms r/t Thalassemia minor
F= many asymptomatic, dysuria, urgency, vaginal discharge, uterine tenderness M= leading cause of nongonococcal urethritis
symptoms r/t chlamydia
• General symptoms of anemia • Sore tongue • Anorexia • Nausea • Vomiting • Abdominal pain • Neuromuscular manifestations - Weakness - Paresthesias of the feet and hands - ↓ Vibratory and position senses - Ataxia - Muscle weakness - Impaired thought process
symptoms r/t cobalamin deficiency
incontinence or stress incontinence urinary retention bladder infections
symptoms r/t cystocele
F= majority are asymptomatic M= dysuria, yellowish-green discharge, urinary frequency
symptoms r/t gonorrhea
vesicles in clusters that rupture and leave painful erosions that cause painful urination remission and excaberations may be contagious when asymptomatic
symptoms r/t herpes
constipation hemorrhoids sense of pressure or need to defecate
symptoms r/t rectocele
retractions tachypnea (above 60) circumoral cyanosis expiratory grunting flaring nares
symptoms r/t respiratory distress in an infant after delivery
- Life-threatening - Physical and mental growth often retarded - Pale - Symptoms develop in childhood - Splenomegaly - Hepatomegaly - Jaundice - Chronic bone marrow hyperplasia • Expansion of bone marrow space
symptoms r/t thalassemia major
F= green, yellow, or white frothy foul- smelling discharge with itching M= asymptomatic
symptoms r/t trichomoniasis
dysmenorrhea pulling and dragging sensations in pelvis and back dyspareunia pressure, protrusions fatigue low backache
symptoms r/t uterine prolapse
F= odorless, white or yellow, cheesy discharge with itching M= asymptomatic
symptoms r/t yeast infections
1. Prepubertal 2. Enlargement of Scrotum/Testes, Reddening/Texture change of scrotum 3. Enlargement of Penis (length) 4. Enlargement of Penile diameter 5. Adult Size
tanner stages for boys
1. prepuberty 2. breast budding 3. full enlargement of breast 4. menarche occurs, pubic hair darkens
tanner stages for girls
feet should be checked daily for changes wash daily with mild soap (dont soak) dry well don't go barefoot professional should remove calluses nails cut straight across
teaching about foot care with diabetes
after treatment pts will need daily hormone replacement signs of overdose are same as hyperthyroidism
teaching for hyperthyroidism
sit eye to eye with patient use assistive listening devices speak slowly and clearly quiet environment
teaching patients with hearing loss
use simple wording present 1 instruction at a time ask yes or no questions avoid open ended questions reinforce instructions often minimize distractions
teaching patients with mild cognitive impairment
use read to text electronic tablets large print good lighting provide verbal instructions
teaching patients with vision loss
signs and symptoms of STDs Mode of transmission of STDs sexual contact should be avoided with anyone while infected
teaching r/t STDs
heavy vaginal bleeding with clots temperature of 100.4 or higher lasting more than 24 hrs a red, warm lump in breast pain on urination tenderness in calf
tell mom to call HCP if ______ happens post partum
IABP (intra-aortic balloon pump)
temporary Catheter balloon threaded up through descending aorta, synchronized with person's heart rhythm Improves coronary perfusion and perfusion of organs
manifestations -cyanosis -air hunger -extreme agitation - subcutaneous emphysema -neck vein distension - hyperresonance to percussion - tracheal deviation away from the affected side intervention - needle decompression - chest tube insertion
tension pneumothorax manifestations and interventions
10-30 years postexposure cardiac and neurological destruction
tertiary syphilis
tactile fermitus
test feeling vibrations from saying 99 to see if there is consolidation or liquid in lungs
Fluid Deprivation test no fluid for 8-12hrs frequent wts if urine is still not concentrated and pts has polyuria= DI STOP test if pt has tachycardia and hypotension
tests for DI and nursing interventions
CK-MB
tests for myocardial injury. increase 3-6hrs after MI
Blood transfusions Iron Chelation therapy—for iron overload Splenectomy may be required Moderate cases survive into their 30s
thalassemia treatment
afterload
the amount of resistance to ejection of blood from the ventricle
purpura
the appearance of multiple purple discolorations on the skin caused by bleeding underneath the skin
mean arterial pressure
the average pressure in a patient's arteries during one cardiac cycle
primary infertility
the couple has never achieved pregnancy
myocardial infarction
the disruption in or deficiency of coronary artery blood supply, resulting in necrosis of myocardial tissue
impaired fecundity
the experience of difficulty conceiving or carrying a pregnancy to term
Levine's sign
the global position of heart attack; a fist clenched over the chest
cardiomyopathy
the term used to describe all diseases of the heart muscle
Down Syndrome (Trisomy 21), older moms
things associated with low MSAFP
It is up to the nurse that knows the patient and determines the appropriateness of education Nurse plans the teaching to meet learning outcome Learning outcomes are goal oriented Outcome is to change behavior or attitude Patient has to be motivated to learn
things that need to be planned r/t patient education
visual disturbances swelling of face, fingers, or sacrum severe, continuous headache persistent vomiting epigastric pain infection (chills, temp, dysuria, pain in abdomen) fluid discharge or bleeding from vagina change in fetal movement
things to report immediately during pregnancy
effacement
thinning of the cervix during labor 0--100%
Description: spotting w/out cervical changes Tx: bed rest for 24 hrs - 48 hrs; no sex for 2 wks
threatened miscarriage description and Tx.
Oligohydramnios
too little amniotic fluid; less than 400 mL
Polyhydramnios
too much amniotic fluid; above 2000 mL often seen in diabetic women
O2 therapy Low sodium diet bronchodilators diuretics vasodilators calcium channel blockers inotropic agents
treatment for Cor pulmonale
diagnosis quickly stabilize patient treat cause control thrombi's and bleeding blood transfusions/ FFP cryopreceitate - given for low fibrogen heparin for thrombi
treatment for DIC
IV admin of insulin NS fluid replacement add dextrose to IV wen glucose goes below 250 electrolyte replacement recording I and O ECG monitoring assess LOC assess blood glucose
treatment for HHS
corticosteroids IV immunoglobulins Ritimab splenectomy immunosuppressive platelet transfusion anti- D antibody
treatment for ITP
eliminate cause, give diuretics (Lasix), fluid restriction, I&O, daily wt., lab chemistries
treatment for SIADH
D&C endometrial ablation
treatment for abnormal uterine bleeding
focuses on returning GH levels to normal by surgical, radiation or drug therapy
treatment for acromegaly
Restore circulatory status—fluids, steroids May need lifelong steroid therapy and mineralocorticoid therapy additional salt intake Check orthostatics Daily weights Aware that stressors can precipitate crises Medic alert bracelet or similar identification of history
treatment for addisons disease
➔ Bone Marrow transfusion/transplant ➔ Immunosuppressive Therapy ➔ High dose cyclophosphamide ➔ Long term cvc If left Untreated there is a 75% chance of Fatality
treatment for aplastic anemia
blood thinners Ace diuretics' - Surgery - Heart transplant (dilated)
treatment for cardiomyopathy
doxycycline or azithromycin cefoxitin gentamycin
treatment for chlamydia
- Nitrates-dilate peripheral blood vessels, coronary arteries, and collateral vessels. - Beta blockers-decrease myocardial contractility, HR, SVR, and BP - Calcium channel blockers-systemic vasodilation with decreased SVR, decreased myocardial contractility and coronary vasodilation
treatment for chronic stable angina
Include foods like liver, fortified breakfast cereals, fish, yogurt, and milk in your diet to bring vitamin B12 levels up. Treatment may also include oral supplements or B12 injections.
treatment for cobalamin deficiency
rest hydration decongestants acetaminophen
treatment for common cold (Viral Rhinitis)
lifelong thyroid replacement
treatment for congenital hypothyroidism
If pituitary source transphenoidal hypophysectomy Radiation of pituitary also appropriate Adrenalectomy may be needed in case of adrenal hypertrophy Temporary replacement therapy with hydrocortisone or Florinef Adrenal enzyme reducers may be indicated if source if ectopic and inoperable. If cause is r/t excessive steroid therapy, tapering slowly to a minimum dosage
treatment for crushing's disease
1. diuretics 2. digoxin 3. ACE inhibitors
treatment for end stage heart failure (refectory)
eliminating milk and lactose containing formula
treatment for galactosemia
ceftriaxone plus doxycycline or azithromycin
treatment for gonorrhea
prevent and treat bleeding replacement therapy for clotting factors (a and VW) desmopressin acetate- stimulate an increase in factor VIII and vWF antifibrinolytic therapy- inhibits fibrolysis
treatment for hemophilia
• DDAVP (Desomopressin Acetate) - IV - Causes 2-4 X increase in factor VIII activity - Used for mild hemophilia • Replace missing clotting factors • Transfusions - At home with prompt intervention to reduce complications - Following major or minor hemorrhages
treatment for hemophilia
Acyclovir, famciclovir, valacyclovir
treatment for herpes
Radioactive iodine- permanent and cure for hyperthyroidism. Destroys all or part of thyroid- usually one dose cure their hyperthyroidism - have to be careful not to put in hypothyroid state. Antithyroid Medications- PTU (propylthiouracil) and Methimazole or Tapazole Beta blockers
treatment for hyperthyroidism
Thyroid ablation medication Radioactive iodine therapy Thyroidectomy
treatment for hyperthyroidism
Administer 1 mg of glucagon IM or subcutaneously » Side effect: Rebound hypoglycemia - Have patient ingest a complex carbohydrate after recovery - In acute care settings » 20 to 50 ml of 50% dextrose IV push
treatment for hypoglycemia if not alert enough to swallow
15 to 20 g of a simple carbohydrate » 4 to 6 oz fruit juice » Regular soft drink - Avoid foods with fat » Decrease absorption of sugar • Recheck BS in 15 minutes - If above 70 give a snack or meal
treatment for hypoglycemia when the pt is alert enough to swallow
Steroids' levothyroxine
treatment for myxedema
transfusion
treatment for platelets below 50,000
● therapeutic phlebotomy to reduce the patient's hematocrit levels to a normal level ● antiplatelet agents to reduce the risk of blood clotting due to their thick blood viscosity ○ Ex. hydroxyurea can slow down the growth of cells in the body, especially RBCs and platelets.
treatment for polycythemia
O2 intubation assess for bleeding monitor PTT and INR inferior vena cava filter fibrinolytic agent heparin enoxaparin warfarin analgesia
treatment for pulmonary embolism
Penicillin G IM 2.4 million units if allergic= tetracycline, doxycycline, cefriaxone
treatment for syphilis
1. knee to chest position 2. give O2 3. give morphine 4. act calm
treatment for tet spells
antiviral drugs if given within 24-48 hrs of onset rest hydration acetaminophen
treatment for the flu
Metronidazole
treatment for trich
• M - Morphine • O - Oxygen • N - Nitroglycerin • A - Aspirin: Why would you give non-enteric coated?
treatment for unstable angina
myomectomy ( removal of fibroids without removal of the uterus) hysterectomy hormonal regimens uterine artery embolization of the blood vessels supplying the fibroid tumor cryosurgery
treatment for uterine fibroids with menorrhagia
miconazole and clotrimazole nystatin fluconazole PO single dose
treatment for yeast infections
- Meal plan based on individual's usual food intake and is balanced with insulin and exercise patterns - Insulin regimen managed day to day •
treatment regimen based on what for type 1
Emphasis based on achieving glucose, lipid, and blood pressure goals - Calorie reduction
treatment regimen based on what for type 2
aerosol sprays smoke animals mold aspirin NSAIDS occupation URI
triggers for asthma attacks
Any event that can lead to acidosis, such as infection or extreme dehydration. Also , fatigue, exposure to cold, strenuous exercise, high altitudes, and psychosocial stress.
triggers for sickle cell anemia
eclampsia
true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma
uterine inversion
turning of the uterus inside out after birth of the fetus
tonic neck reflex
turning the head to one side, extending the arm and leg on that side, and flexing the limbs on the opposite side lasts until 3-4 months
Acyanotic (L to R shunt) -increased pulmonary blood flow or obstruction Cyanotic (R to L shunt) -decreased blood flow or mixed-blood flow
two categories of congenital heart defects
I would ask the patient of her LMP and I would also ask the patient when did she have sexual intercourse.
two most important questions to determine possible pregnancy
taychardia and hypotension
two signs of blood loss/ shock
Emphysema/Chronic Bronchitis
two types of COPD
ultrasound transducer= fetal HR toco= fundus
types of external fetal monitors
ultrasound transducer (fetal HR) Tocotrasducer (toco) (fundus)
types of external fetal monitors and were they are places
For profit Not for profit
types of financial categories
• Hemophilia A - "Classic hemophilia" - Deficiency of factor VIII - Accounts for 80% of cases of hemophilia • Hemophilia B - Also known as Christmas disease - Caused by deficiency of factor IX - Accounts for 15% of cases of hemophilia
types of hemophilia
after water breaks; sterile fetal or internal scalp electrode (FSE) - drilled into babies head or butt -measures beat to beat -more accurate Intrauterine pressure catheter (IUCP) -measures how strong contractions are -intensity of contractions - can be used to NS for meconium stained fluids or oligohydramnios
types of internal fetal monitors and considerations
Kinesthetic- Visual Auditory
types of learners
- Cobalamin (vitamin B12) deficiency - Folic acid deficiency - Drug-induced suppression of DNA synthesis - Inborn errors - Erythroleukemia
types of megaloblastic anemias
private and public
types of ownership
- Immune thrombocytopenic purpura - Thrombotic thrombocytopenic purpura - Heparin-induced thrombocytopenia and thrombosis syndrome - Acquired thrombocytopenia from decreased platelet production
types of thrombocytopenia
low transverse (best) low vertical classical = doesnt heal as well, no V-back
types of uterine incisions during c-section - which is best
absent= undetectable minimal= under 5 BPM moderate= 6- 25 bpm marked= above 25 bpm
types of variability
Usually occurs in people over 35 years of age • 80% to 90% of patients are overweight Greater in some ethnic populations - Increased rate in African Americans, Asian Americans, Hispanic Americans, and Native Americans - Native Americans and Alaskan Natives: Highest rate of diabetes in the world
typical populations with type 2 DM
Acute blood loss
typically occurs because of sudden hemorrhage as a result of trauma, complications of surgery, or conditions/diseases that disrupt vascular integrity
echocardiogram
ultrasound of the heart
NT-proBNP
used for diagnosis of impaired left ventricular ejection fraction.
pulmonary function tests
used to evaluate lung function. Involves use of spirometer to assess air movement as patient performs prescribed respiratory maneuvers
Thoracentis
used to obtain specimen of pleural fluid for diagnosis, used to remove pleural fluid, or instill medication.
CRIES
used with infants 32- 60 wks for assessment of pain
Mechanical dilation
uses Catheter with 2 balloons to stretch out cervix usually falls out around 5cm
pre op - do not drink alcohol, smoke, take aspirin or anticoagulant meds 24 hrs before during procedure - expect cramping post op - pelvic pain -fever -malaise - n/v - PCA pump - check for bleeding, VS, pain level, neurovascular assessment
uterine artery embolization
- Manually place back; anesthesia for pain control; IVFs & oxytocin
uterine inversion Tx
Late decelerations
uteroplacental insufficiency
contractions occur 12 to 24 hrs post-delivery involution occurs (1 to 2 cm/day) - 1st day: at if 1 to 2 cm above umbilicus - 7 to 10 days: under symphysis pubis
uterus changes after birth
Concerned with efficiency and distribution. Linked to access. Greatest among individuals with multimorbid chronic conditions.
utilization of resources depends on
diastolic heart failure
ventricles can't relax and fill
S3
ventricular gallop- 'kentucky' • occurs during rapid ventricular phase of diastole • commonly associated with left ventricular failure and is caused by blood from the left atrium slamming into an already overfilled ventricle during early diastolic filling.
BP should rise no more than 30 points sytolic and 15 points diastolic - average is 90- 140 S and 60- 90 D pulse= 60-90 resp= 16- 24
vital signs during pregnancy
people with low socioeconomic status and members of ethic and racial minorities
vulnerable populations
Uterine contractions every 10 minutes or more often menstrualike cramps; low, dull backache; and pelvic pressure increase or change in vaginal discharge ROM (rupture of membranes)
warning signs of preterm labor
controlling hypertension loosing wt not smoking low fat diet exercise
ways to decrease risk for macrovascular complications of DM
MSAFP (maternal serum) and AFAFP ( amniotic fluid)
ways to gain alpha- fetoprotein screenig
eating dry crackers before getting out of bed small frequent meals no fatty food no skipping meals
ways to prevent nausea during first 8 wks of pregnancy
1. planning is involved 2. the outcomes are goal oriented 3. the patient is motivated to learn
what are the three main attributes of patient education
congestive heart failure
what can VSD lead to
uterine rupture or abruption
what can hyperactive uterine activity cause
hyper inflated lungs
what causes hyperresonace with percussion of chest
caused by high levels of circulating ACTH that bind to the melanocortin 1 receptor on the surface of dermal melanocytes
what causes the hyperpigmentation in addisons disease
full bladder
what could cause the uterus to be higher than the umbilics after delivery
stridor low pitched snoring during inhalation
what do you hear with partial airway breathing
T= Thienopyridines (clopiogrel) H= Heparin R= Renin angiotensin inhibitors - ACE O= Oxygen M= morphine B= Bete blockers I= interventions (stent) N= Ntroglycerin S= Statin S= salcyate Aspin
what does THROMBINS 2
- number of sexual partners -religious beliefs allergies -previous methods -cost -side effects - adherence
what factors influence the choice of the most appropriate method of birth control
- with each contraction blood flow from mom to baby ceases as the uterine myometrial veins are compressed -mother and baby physiologically separated -pushes baby into the cervix= thinning of cervix
what happens during a contraction
fertilization takes place in ampulla (outer third) section of the fallopian tube the zygote takes 3-4 days to enter uterus it takes 7-10 days to complete the process
what happens during implantation
it may cause in a retained placenta, which predisoposes the client to hemorrhage and infection
what happens if you give oxytocin before the placenta is delivered
the corpus luteum regresses, estrogen and progesterone levels decrease and the endometrium is shed via menstruation
what happens in the absence of implantation
Hct rises WBC count is elevated ( hard to dictate infection) blood- clotting factors are elevated; increases risk for DVT
what happens to hematologic system postpartum
nonlactating -nodules are palpable - engorgement may occur 2-3 day post partum lactating - milk sinuses palpable - colostrum expressed then milk
what happens to the breast after delivery nonlactating and lactating
diuresis occurs bladder distention and incomplete emptying are common increased risk for UTIs
what happens to uterine system postpartum
b
what is a possible cause of aplastic anemia? a: blood loss b: viral/bacterial infections c: jaundice d: vitamin B12 deficiency
assessment of the patients ability and readiness to learn identification of teaching methods development of learning goals with the patient implementation of the teaching evaluation of the patient learning
what is part of a teaching plan
Hct is low, anemia can be caused by blood loss= abruptio placenta, placenta previa, rupture
what it means when baby is pale
PO
what route for medication is not used during labor
vitamin K
what to admin to prevent hemorrhagic disorders in newborns
vital signs fundal ht and firmness lochia urination perineum bowel sounds presence of thrombophlebitis bonding
what to assess postpartum
palpate for spongy, full feeling over symphysis check urge to void when bladder is palpated assist client to ambulate for first void (OH) should void w/in 4 hrs of delivery watch for urine retention catharize only if necessary Kegel exercises
what to assess r/t bladder and urine output postpartum
smoking, drugs, alcohol, and caffeine , stress
what to avoid while breastfeeding
check apical pulse (must be above 60) check dig level (normal 0.8-2)
what to do before giving digitoxin
wear boxers chart basal temp track ovulation take prenatals good diet decrease stress
what to do when having a hard time concieving
Nitrazine paper turns black or dark blue assess FHR vaginal exam for prolapsed cord color and amount of amniotic fluid should be noted check pts temperature every hour
what to do when membranes rupture
reposition stop pictocin increase IV fluids O2 vaginal exam tocolysis- stop contractions put on FSE and IUPC amniofusion
what to do when there are nonreassuring patterns on a fetal monitor
Anticoagalant
what to give for a fib
more common in black women and women who have never bean pregnant most common symptom is abnormal uterine bleeding tend to disappear after menopause
what to know about benign tumors of the uterus
how baby tolerated labor mom on any drugs meconium stained amniotic fluid prenatal care mom have active herpes gestational age mom blood type any abnormalities
what to know about newborn before they are born
reduce the number of sexual contacts avoid sex with those who have multiple partners examine genital area and avoid sexual contact if anything is abnormal wash hands and genital area before and after sexual contact use condom as a barrier use water based lubricants rather than oil-based lubricants use a vaginal spermicidal gel avoid douching
what to teach about safe sex
pneumothorax
what to watch for after lung biopsy
patients needing care
what's in unlimited demand in health care organizations
sexual orientation sexual practices type of protection contraceptive practices previous STDs
what's included in a sexual history
Mineralocorticoid—aldosterone which effects blood pressure and sodium absorption, loss of potassium by kidney Glucocorticoids—cortisol. Affects metabolism, regulates blood sugar levels, affects growth, antiinflammatory action, decreases effects of stress Adrenal androgens—sex hormones
what's released by the adrenal cortex and what are they responsible for? (Salt, Sugar, Sex)
Open neural tube defects
whats associated with high MSAFP
- past 39 wks or - medical reasons GD, preeclampsia, baby getting too big
when a mom would be induced
Before analgesia and anesthesia to determine the progress of labor to determine whether second stage pushing can begin
when are vaginal exams preformed
they are taken at night, most cholesterol is synthesised when dietary intake is at its lowest
when do you give satins and why
2 year
when does a child speak 2-3 word sentences
18 months
when does a child throw ball overhand
5 years
when does a child tie their own shoes
4 years
when does a child use scissors
4 years
when does birth length double
2 years
when does child achieve 50% of adult ht
8 months
when does the child sit unsupported
after 16 wks
when is PUBS done
secondary polycythemia
when less O2 is available (high altitude) or when EPO production increases
Paraxysmal nocturnal dyspnea
when lying for a long time, the heart cant compensate for increased volume. pulmonary congestion results dangle legs to relieve
around 28 wks
when should women start childbirth classes
During contraction since mom and baby are separated
when to give pain meds during labor
first hour of life
when to give vitamin K injection
after 24hrs of breast milk or formula ingestion
when to screen for PKU
umbilics
where fundus is 1st 24 hrs after delivery
a, b, d, e
which of the following are clinical manifestations of aplastic anemia? (select all that apply) a: pale skin b: rash of small purplish or red spots c: bleeding of the nose or gums d: brittle nails e: fatigue
It was first discovered in populations around the Mediterranean Sea but also affects populations in the Middle East, Africa, and Asia.
who is affects by thalassemia
self pay Medicare Medicaid private insurance
who pays for healthcare services
Doctors Nurses Managers Boards/directors head= chapplen
whos part of an ethical comittee
can lead to lactic acidosis
why do you discontinue metformin when giving contrast
stroke, fractured hip, fractured knee
why would a patient be a blood thinners
Vitamin D must be given to absorb calcium phosphate binding drugs such as Renagel or or Sevelamar . They help prevent hypocalcemia. phosphate binders reduce absorption of phosphates as they can't rid phosphates . People with renal failure take phosphate binding drugs such as Renagel or Sevelamer. These medications prevent hypocalcemia caused by the elevated phosphorous. Normal phosphorous level-is 3.0-5.5.
with hypoparathyroidism why would a pt take vit D and phosphate binding drugs
HIV CMV Gonorrhea syphilis
with what STDs can moms not nurse
ROM > 24 hrs any laceration or operative incision Hemorrhage Hematomas Anemia or poor physical health before delivery intauterine manipulation, manual removal of placentae, retained placental fragments
women predisposed to postpartum infection
Fetal effects - oral thrush or perineal rash Tx -treated with miconazole nitrate cream or nystatin cream in pregnancy
yeast infection fetal effects Tx
Idiopathic Thrombocytopenic Purpura (ITP)
• An acquired hemorrhagic disorder characterized by - Thrombocytopenia: excessive destruction of platelets - Purpura: discoloration caused by petechiae beneath the skin
Thalassemia
• An autosomal recessive genetic disorder of inadequate production of normal hemoglobin - Common in ethnic groups near the Mediterranean Sea and equatorial regions of Asia and Africa
S2
• Associated with aortic and pulmonic valve closure • (dub)
S1
• Associated with tricuspid and mitral valve closure • (lub)
Physiologic Jaundice
• Begins after 24 hours • Immature liver has impaired ability to conjugate bilirubin
Pathologic Jaundice
• Begins within 1st 24 hours • Rh incompatiblity - Rh- mom antibodies attack RBCs of Rh +fetus - Hydrops fetalis
Hemolytic Anemia
• Destruction or hemolysis of RBCs at a rate that exceeds production • Third major cause of anemia
Type 1 Diabetes Mellitus
• Formerly known as "juvenile onset" or "insulin-dependent" diabetes • Most often occurs in people under 30 years of age • Peak onset between 11 and 13 years of age
Sickle Cell Disease (SCD)
• Group of inherited, autosomal recessive disorders • Presence of an abnormal form of hemoglobin in the erythrocyte • Hemoglobin S (HbS), abnormal
- Under 2500 grams (5-8) - Placental insufficiencies, smoking, infections, HTN, malnutrition - Maintain temp and BS
• SGA and IUGR
diabetes insipidus
antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect
protamine sulfate
antidote for heparin
vitamin K
antidote for warfarin
increase fluid intake O2 therapy physiotherapy antibiotics if not viral NSAIDS antipyretics
treatment for pneumonia
becomes parous with a transverse slit heals within 6 wks
what happens to the cervix after delivery
heart, thymus, digestive tract, kidneys, gonads
list organs with secondary endocrine functions
baby will have swelling, decreased O2, increased bilirubin, anemia
what happens when mom has negative blood and baby is positive and mom has antibodies
Betamethasone and dexamethasone
* Corticosteroids that increase the production of surfactant to accelerate fetal lung maturity & reduce the incidence or severity of RDS. * Used for a client in preterm labor between 28-32 weeks' gestation whose labor can be inhibited for 48 hrs without jeopardizing the mother or fetus.
Anemia
- Number of erythrocytes (red blood cells [RBCs]) - Quantity of hemoglobin - Volume of packed RBCs (hematocrit)
- Insulin from an outside source
- Required for type 1 diabetes - Prescribed for patient with type 2 diabetes who cannot control blood glucose by other means
Hemoglobin A1C test
- Useful in determining glycemic levels over time - Not diagnostic, but monitors success of treatment - Shows the amount of glucose attached to hemoglobin molecules over RBC life span • 90 to 120 day
S4
- atrial gallop 'tennessee' • Linked to resistance to ventricular filling It's most frequently associated with left ventricular hypertrophy that is the result of long standing hypertension
Green zone peak flow
-good control Peak flow 80-100%
rheumatic fever
A bacterial infection that can be carried in the blood to the joints. injures the heart, blood vessels, joints, and subq tissue
first day postpartum fundus is 1 cm below umbilicus and midline and firm massage the fundus if it is soft or boggy
assessing fundal ht and firmness post partum
normal= 33-35 cm (2 cm larger than chest) tape measured placed above eyebrows and stretched around fullest part of occiput, at posterior fontanel
assessing head circumference after birth
Fetal - Fetus can breathe, swallow, and regulate temperature - Surfactant forms in lungs - Fetus's eyelids open - Wt 1005 g/ 2.2 lb Maternal - Fundus is halfway between umbilicus and xiphoid process - Thoracic breathing replaces abdominal breathing - Fetal outline is palpable - Heartburn - Hemorrhoids
Maternal and fetal changes 28 wks
normal= 46-52.2 cm measured from crown to rump and rump to heel, or from crown to heel
assessing length after birth
•Hydrocortisone: cortisol, it regulates how the body converts fats, proteins, and carbohydrates to energy. It also helps regulate blood pressure and cardiovascular function. •Corticosterone: This hormone works with hydrocortisone to regulate immune response and suppress inflammatory reactions
2 specific glucocorticoids released by the adrenal cortex include:
Peak Expiratory Flow Rate (PEFR)
Maximal flow rate, measured in liters, that can be generated during a forced expiratory maneuver. used to check control of asthma.
BP risk factors proteinuria wt gain edema headache irritability IUGR increased DTRs and clonus oliguria blurred vision
nursing assessment for preeclampsia
chest pain SOB tachycardia joint pain chorea rash subq nodulea fever
nursing assessment for rheumatic fever
embryo
3-8 wks after fertilization embryo most vulnerable to teratogens= congenital anomalies
chronic bronchitis
a condition in which the bronchi in the lungs are constantly swollen and clogged with mucus r/t increased sputum production and inflammation in the lining of the bronchials
Thrombocytopenia
a condition in which there is an abnormally small number of platelets circulating in the blood
multiple kids polyhydramnios older patient
predisposing factors for postpartum hemorrhage
diabetes cardiac disease preeclampsia placenta previa infection ( UTI) stress smoking
predisposing factors r/t preterm labor
12.87
the mean age of menarche
Tetralogy of fallot
a congenital malformation of the heart involving four distinct defects child experiences tet spells r hypoxic episodes that are relieved by a squatting position
Fecundability
the monthly probability of conception
foreign body pulmonary embolism pneumonia pump failure pneumothorax pulmonary bronchial constrictions
6 reasons for dyspnea
Echymosis
a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.
Phenylketonuria (PKU)
a disorder related to a defective recessive gene on chromosome 12 that prevents metabolism of phenylalanine
hypoxic drive
A "backup system" to control respiration; senses drops in the oxygen level in the blood.
port-wine stain
a flat vascular birthmark made up of dilated blood capillaries, creating a large, reddish-purple discoloration on the face or neck doesn't fade, can effect organs it covers
vernix
a greasy substance that protects the fetus in utero and can still be present at birth
C
A couple has just found out their baby has hemophilia. The nurse is explaining how to safely take care of the child at home. Which of the following statements shows effective family teaching? a. "We will keep the baby inside at all times." b. "We will go to the ER every time the baby has a superficial cut" c. "We will buy a medical alert bracelet in case something happens later in life and we are not around". d. "We will give our baby some aspirin after her vaccinations if she is fussy."
puerperal morbidity
A maternal temperature of 38 degrees C (100.4 degrees F) or higher on any 2 of the first 10 postpartal days, excluding the first 24 hours. The temperature is to be taken by mouth at least four times per day.
Dawn phenomenon
A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in the client with diabetes mellitus. Treatment includes administering an evening dose of intermediate acting insulin at 10 pm.
Vibroacoustic stimulation (VAS)
A noninvasive method of evoking a reactive NST in fetuses found to be in a low activity state via a device that emits vibration and sound
3
A patient comes into the ED with pain, swelling, redness in leg and warm to touch. They have a sudden onset of shortness of breath, chest pains, and cough. What are these signs and symptoms most common in? 1) Anemia 2) Hemophilia 3) Blood clot 4) Blood Cancer
b, c, d
A patient newly diagnosed with Cobalamin Deficiency needs guidance on selecting foods high in Vitamin B12. You are helping the patient choose foods high in this vitamin. What foods will you guide the patient to choose? (SATA) a. Spinach b. Yogurt c. Liver d. Fish
the day before ovulation and the day of ovulation
the most fertile days of pregnancy
Megaloblastic Anemias
a group of disorders caused by impaired DNA synthesis and characterized by the presence of large red blood cells. • Majority result from deficiency in - Cobalamin (vitamin B12) - Folic acid
stepping reflex
a neonatal reflex in which an infant lifts first one leg and then the other in a coordinated pattern like walking lasts until 3-4 months
P50
the partial pressure of oxygen when hemoglobin is 50% saturated
Systolic blood pressure
the pressure created in the arteries when the left ventricle contracts and forces blood out into circulation
Hypothalamus
a neural structure lying below the thalamus; directs eating, drinking, body temperature; helps govern the endocrine system via the pituitary gland, and is linked to emotion
Diastolic blood pressure
the pressure in the arteries when the left ventricle is refilling
adrenal glands
a pair of endocrine glands that sit just above the kidneys and secrete hormones (epinephrine and norepinephrine) that help arouse the body in times of stress.
it reduces the amount of urine produced in the body at night by the kidneys. The bladder then fills will less urine. Also has vasoconstriction qualities.
Describe the action and administration of DDAVP (Vasopressin)
Toxoplasmosis
a parasite which is most commonly transmitted from animals to humans by contact with contaminated feces
small baby injury card compression amniotic banding respiratory destress
the problem with too little amniotic fluid
vacuum erection device intraurethral devices and intracavernosal injections penile implants
Devices and implants used for erectile dysfunction
cough suppressants
Dextromethorphan Codeine Benzonatate Diphenhydramine
an analysis of the nasal fluid for a protein called beta-2 transferrin CT and MRI scans may also be require to determine the location and severity
Diagnosing a CSF leak r/t hypophysectomy includes
cord prolapse pre term labor respiratory destress
the problem with too much amniotic fluid
• Decreased Von Willebrand factor levels • Von Willebrand antigen levels • Decreased platelet agglutination • Prolonged bleeding time • PTT may be normal or prolonged
Diagnosis Laboratory Findings for von willebrand disease
health history - age -occupation -past injury - surgery -infections -sexual practices -stress -medication Hx serum analysis - sperm concetration - motility -morphology Hormone studies -tesosterone -LH -FSH
Diagnostics for male infertility
used with spermicide must be fitted left in 6 hrs after intercourse refitted with wt changes and pregnancy
Diaphragm
DASH eating plan
Dietary Approach to Stop Hypertension; good diet for reducing sodium intake
CHF atrial dysthymias
ASD can lead to
Mucolytics
Acetylcysteine (Mucomyst)
• Replacing blood volume to prevent shock • Identifying the source of the hemorrhage • Stopping blood loss • Correcting RBC loss
Acute Blood Loss Collaborative Care
bilirubin encephalopathy
Acute manifestation of bilirubin toxicity occurring in the first weeks after birth.
Pedagogy
the profession or principles of teaching, or instructing kids
Growth hormone (GH) or somatotropin
a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in human development.
percutaneous transluminal coronary angioplasty
a procedure in which a small balloon on the end of a catheter is used to open a partially blocked coronary artery by flattening the plaque deposit and stretching the lumen (AKA angioplasty)
Members of the family Relationships among family members Other individuals that influence the family Use of a genogram or ecomap helps to illustrate family members and social relationships Considers concurrent development of individuals within the family (life cycle) Assessment of family member interactions and behaviors toward one another
Family Assessment
The forces at work within a family that produce particular behaviors or symptoms
Family dynamics is defined as
coronary angiogram
a recording of an x-ray of the heart's circulation detects coronary artery spasms
thyroid storm
a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism
vitamin K
Helps blood clot, not to be ingested in high amount when on warfarin
Heparin induced thrombocytopenia
Heparin causes a decrease in platelet count because of the formation of a complex with platelet factor 4, IgG antibodies against platelet-heparin complex that the spleen proceeds to destroy
meningocele
a sac is present at some point on the spine contains only meninges and spinal fluid and has less neurologic involvement than a myelomeningocele
myelomeningocele
a sac is present at some point on the spine is more sever than meningocele because the sac contains spinal fluid, meninges, and nerves
opthalmia neonatorum
a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia
mission statement
a statement of the organization's purpose - what it wants to accomplish in the larger environment
Chadwick's sign
Bluish-purple coloration of the vaginal mucosa and cervix
determine whether cervix will respond to induction score above 5 shows success factors -dilation -effacement -station -cervical consitency -cervical position
Bishop score
● Easy or excessive bruising (purpura) ● Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs ● Prolonged bleeding from cuts ● Bleeding from your gums or nose ● Blood in urine or stools ● Unusually heavy menstrual flows ● Fatigue ● Enlarged spleen
Signs and Symptoms of Thrombocytopenia
pay for performance
a strategy using financial incentives to reward providers for achieving a range of payer objectives, including delivery efficiencies, submission of data and measures to the payer, and improved quality and patient safety
uterine rupture
a tear in the wall of the uterus
abdominal pain fruity breath dry mouth sunken eyes fever flushed, dry skin ketonuria, glucosuria restlessness kussmaul respirations n/v rapid, weak pulse glucose above 250 urinary frequency
assessment findings of DKA
Magnesium Sulfate
CNS depressant administered to a preeclamptic client to prevent seizures, may be used as a tocolytic to stop preterm labor contractions
umbilical cord arteries
Carry deoxygenated blood from embryo
● Alcoholism ● Vegetarian diets ● Long term use of antacids ● Crohn's Disease ● Celiac Disease ● Atrophic gastritis
Causes of cobalamin deficiency
T cells
Cells created in the thymus that produce substances that attack infected cells in the body.
Raynaud's
Condition of small arteries and arterioles of the fingers and skin; constriction in response to cold or emotional upsets
systole
Contraction of the heart
abnormal glucose screen ( 1 hour ar 24- 26 wks) polyphagia polydipsia polyuria
assessment for diabetes during pregnancy
Thrombophlebitis
Inflammation of vein with a clot formation made up of various elements in blood supply trapped in a fibrin mesh.
stress echocardiogram
a test that combines an exercise stress test with an echocardiogram to assess left ventricular wall motion both before and immediately after exercise
Im injection every 3 mo admin during 1st 5 days of cycle wt gain, irregular or unpredictable periods no periods for some increases risk for osteoporosis
Depo-provera
using endoscope with surgical instrument inserted into part of the brain by going through the nose and the sphenoid bone into the sphenoidal sinus cavity.
Explain trans sphenoidal pituitary surgery
Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP)
a variant of severe preeclampsia
second stage of labor
Heralded by the involuntary need to push, 10 cm of cervical dilation, rapid fetal descent, and birth averages 1 hr for a primigravida, 15 min for a multipara
moderate anemia
Hgb 6-10
severe anemia
Hgb <6
Indomethacin
NSAID for premature babies with certain heart disorders-given to PDA because it causes to constrict and close the vessel.
continuous slow absorption of estrogen/ progestin placed deep in vagina once every 3 wks and is removed on day 21, after 7 days free a new one is inserted additional contraction for first 7 days
NuvaRing
spleen
Organ near the stomach that produces, stores, and eliminates blood cells
metformin day of surgery and 48 hours
Patients undergoing surgery or radiologic procedures requiring contrast medium should hold their
anti- D antibody
Plasma derived immunoglobulin Causes transient anemia by clearing the antibody coated RBC -Since this causes transient anemia you don't want to give it to a child who is already anemic
◦ Mild depression, early onset, no longer than 2 weeks ◦ Fatigue, weeping, mood swings, anxiety ◦ Continues infant care ◦ Cause unknown - hormone related possibly ◦ Usually Self-limiting
Postpartum blues
Peripheral Vascular Disease
Results in interference to blood flow - Arterial: Compromises oxygen supply and alters demand - Venous: Blockage within venous system
involution
Return of the uterus to a nonpregnant state after birth
a, c, d
Risk Factors for disseminated intravascular coagulation include: A) Septic abortion B) Pregnancy C) HELLP syndrome D) Infection E) Congestive heart failure
Nevus vasculosus
Rough, red collection of capillaries with a raised surface that disappears with time; also called strawberry hemangioma.
Fetal effects - congenital heart defects -IUGR -Congenital cataracts - hearing or vision problems may arise in later childhood Tx - no Tx
Rubella fetal effects Tx
Anaphylactoid syndrome of pregnancy (amniotic fluid embolism)
Rupture of amniotic sac causing infiltration of amniotic fluid into the maternal circulation. Amniotic fluid travels to and obstructs pulmonary vessels
• Gradual involvement of all body systems • Usually fatal by middle age from renal and pulmonary failure • Prone to infection - Pneumonia, most common infection
Sickle Cell Disease Complications
Frequent infections - Chronic pain - Fatigue - Swelling of hands and feet - Delayed physical growth - Vision problems - Leg ulcers - dilute urine -hematuria -gallstones -splenomegaly -hepatomegaly - Shortness of breath - Jaundice or pallor - Vasoocclusive crisis
Symptoms of Sickle cell Anemia
electronic health record
Systematic collection of a patient's health care and treatment in a digital format that can be shared
b
Thalassemia is a/an A. acquired virus B. inherited disorder C. fungal infection D. none of the above
Endometrial cycle
The 28 days of the menstrual cycle as they apply to the events in the uterus. also known as the uterine cycle, and has the three subphases: menstruation, the proliferative phase, and the secretory phase.
Type 1 - sudden -anytime under the age of 21 Type 2 - gradual -mostly in adulthood
compare and contrast onset of type 1 and 2
Assessment and Diagnostic Findings Trousseau's sign—can check with a BP cuff Chvostek's sign—tapping over facial nerve causes spasm of the mouth, nose and eye Lab studies may reveal calcium levels of 5-6 mg/dL or lower Serum phosphate levels will be decreased
assessing tetany with hypoparathyroidism
exhalation
The passive part of the breathing process in which the diaphragm and the intercostal muscles relax, forcing air out of the lungs.
aldosterone, which maintains the right balance of salt and water while helping control blood pressure
The principle mineralcorticoid is
contraction duration
The time of the contraction Measured from the beginning to the end of one contraction measured in seconds
patent ductus arteriosus (PDA)
There is a return to fetal circulation in an attempt to provide O2 to brain large organs; it results in worsening respiratory distress and pulmonary edema due to increased blood flow to lungs
patent ductus arteriosus (PDA)
There is an abnormal opening between the aorta and the pulmonary artery usually closes 72 hours after birth oxygenated blood from the aorta return to the pulmonary artery causes pulmonary hypertension causes a characteristic machine like murmur
coarctation of the aorta
There is an obstructive narrowing of the aorta
Grade B= Recommends
There is high certainty that the benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
Non pregnant - 5-10,000 Pregnant - 12-15,000 Labor and PP - can go to 25-30,000 common Usually back to normal 4-7 days
WBCs throughout pregnancy
HYPERTHYROIDISM
WHEN TSH IS DECREASED THEN T3 AND T4 ARE INCREASED
HYPOTHYROIDISM
WHEN TSH IS ELEVATED AND T3 AND T4 ARE DECREASED =
Exercise Testing
Want to reach it in short amount of time (20-30 min) Need to choose protocol that fits patient (enough discrimination to determine VO2peak) Looking for when HR can no longer level off after 3 minutes.
cancers drugs (chemo) ITP infections alcoholism radiation hemodlysis HIT DIC
What Causes Thrombocytopenia
D; antifibrinolytic medications are used to slow down the process of fibrinolysis, which is the breakdown of blood clots
What are antifibrinolytic medications used for? A. To speed up the process of fibrinolysis B. To supplement clotting factors C. To be used so hemophiliacs may play sports D. To slow down the process of fibrinolysis
a, c,e
What are physical findings of ITP (Select all that apply) A. Petechia B. Diarrhea C. Bleeding from GI & urinary tract D. Blurry vision E. Gingival bleeding
b,c,d
What are some causes of Vitamin B12 Deficiency? (SATA) a. Paleo diet b. Alcoholism c. Atrophic Gastritis d. Long-term antacid use e. Long-term use of NSAIDs
- Patients may not have symptoms of acute blood loss until after 500 mL is lost, except for vasovagal syncope. - Vital signs may reflect tachycardia and then hypotension. - Patients may experience shortness of breath, generalized weakness, dizziness or lightheadedness.
What physical assessments might you expect with you patient with blood loss?
Thyroid Stimulating Hormone (TSH)
When the level of thyroid hormones (T3 & T4) drops too low, the pituitary gland produces
1,2,5
Which lab values could be a possible sign of anemia? 1) Low rbc count 2) Low Hgb 3) Elevated Hct 4) Elevated A1c 5) Low Hct
B
Which of the following is not a clinical manifestation of hemophilia? a. Excessive bruising b. aPTT of 35 c. Hemarthrosis d. Spontaneous hematuria
c
Which of the following is not an example of acute blood loss? A. cutting a finger while cooking B. gunshot wound C. gastrointestinal bleed D. hematoma from surgery complications
Mastitis, abscess
You continue to breast feed with_____ but stop is there is a _____
Angina
______can occur when thyroid replacement is initiated as it enhances effects of cardiovascular catecholamine
rooting reflex
a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple lasts until 3-4 months
Megaloblastic Anemia
a blood disorder characterized by anemia in which the red blood cells are larger than normal
ductus arteriosus
a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta
circumoral cyanosis
a bluish discoloration around the mouth; normal first 24 hrs
friction rub
a coarse, grating, adventitious lung sound heard when the pleurae are inflamed
Prediabetes
a condition in which the blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes
Pudendal block
an anesthetic administered to block sensation around the lower vagina and perineum
Graves disease
an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos
Buerger's
an inflammatory occlusive vascular disease involving the medium-sized arteries and veins
10- 12 months
able to walk with help at
Disseminated Intravascular Coagulation (DIC)
abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues
hypertensive disorders high gravidity abdominal trauma short umbilical cord cocaine use
abruptio placentae is r/t
hydrocephalus
accumulation of cerebrospinal fluid within the ventricles of the brain that does not drain properly from the cranium
Myxedema
accumulation of mucopolysaccharides in sc and interstitial tissues. Is the extreme form of hypothyroidism. Can progress to shock
retained placental fragments
after the first postpartum day, the most common cause of uterine atony is
pneumothorax
air in the pleural cavity
Cobalamin Deficiency
aka vitamin B12 Megaloblastic anemia • Intrinsic factor (IF) - Protein secreted by the parietal cells of the gastric mucosa • IF is required for cobalamin absorption in the small intestine
3
all teeth dev by
Addison's disease
also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesn't produce enough of certain hormones. you produce too little cortisol and, aldosterone and sex hormones.
left coronary artery= AV node
anterior coronary artery blood supply
18 months
anterior fontanel closed by
excessive uterine bleeding during the first hour after delivery - more than 1 saturated pad every 15 min excessive bleeding during the postpartum period - more than one saturated pad per hour hypovolemic shock hematomas developing in perineum bleeding from unrepaired laceration bleeding from uterine atony
assessment for postpartum hemorrhage
Inspection -barrel chest -cyanosis -tripod position -use of accessory muscles Percussion -Hyperresonant or dull if consolidation Auscultation -crackles -wheezes distant breath sounds
assessment of COPD inspection, percussion, auscultation
failure of fusion of the lip, palate, or both difficulty sucking and swallowing
assessment of cleft lip or palate
Inspection -tachypnea -use of accessory muscles Palpation -increased fremitus above effusion -absent fremitus over effusion Percussion -Dull Auscultation -decreased or absent over effusion -egophony above effusion
assessment of pleural effusion inspection, palpation, percussion, auscultation
Inspection -tachypnea -use of accessory muscles -duskiness or cyanosis Palpation -increased fremitus over affected area Percussion -dull over affected area Auscultation -early: bronchial sounds -Later: fine or coarse crackles, egophony, whispered pectoriloquy
assessment of pneumonia inspection, palpation, percussion, auscultation
Inspect gland Observe for goiter-enlargement of thyroid due generally to lack of iodine. (not common in US as we are BIG salt lovers) Check TSH, serum T3 and T4 Estrogens, Dilantin, Tagamet, Heparin, amiodarone, PTU,steroids and Lithium can cloud the accuracy T3 more accurate indicator of hyperthyroidism according to text
assessment of the thyroid
pain dyspnea n/v fatigue Diaphoresis, pallor, weakness syncope dysrhythmias
assessment with angina
renal failure COPD cardiac problems dyslipidemia diabetes steroids use estrogen use
associated physical problems with HTN
hydrocephalus neurogenic bladder, poor anal sphincter tone congenital dislocated hips club feet skin problems scoliosis
associated problems with spina bifida
Thalassemia minor
asymptomatic silent carrier of thalassemia
Coronary Artery Disease
atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle
• Price and Cost • Supply and Demand • Basis for price determination • Cost effectiveness • Efficient and equitable decisions are made about the allocation of resources. • Efficiency • Is determined by how resources are used. • Value
attributes of economics
nocturnal penile tumescence
avg male has 5 erections a night --> NPT is preserved if impotence is due to a psychogenic cause
peliv inflammatory disease
complication of untreated STDs, involves one or more of the pelvic structures can cause adhesions and eventually sterility
Type 1 DM
beta-cell destruction leading to absolute insulin deficiency
Bronchophony
the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue 99
Disorders of the CNS like head injury brain surgery tumors infections or medications like vincristine phenothiazines TCAs or thiazide diuretics
causes of SIADH
Andragogy
the study of teaching adults
-The body producing antibodies that target RBC -drugs -infections -trauma -idiopathic -DIC -HELLP syndrome -prosthetic heart values -cancer
causes of acquired hemolytic anemia
Nifedipine
calcium channel blocker; relaxes smooth muscles of uterus by blocking calcium
contraction intensity
can only be measure with an internal monitor after ROM acme- resting tone
40 -50 % increase in blood vol = have physiologic anemia do to blood dilution increase RBCs and WBCs Hgb decreases to 10 -14 superior venacava and arteries can get compressed when lying on bac = decreased BP ( supine hypotension)
cardiovascular changes that happen during birth
a petrolatum gauze dressing or a generous amount of petroleum may be applied with each diaper change for 1 to 2 days to prevent the diaper from adhering to the site
care after circumcision
• Prophylactic treatment for patients having - Removal or drainage of infected tissue - Renal dialysis - Ventriculoatrial shunts • Antibiotic administration - Monitor antibiotic serum levels - Subsequent blood cultures - Renal function monitored
care for endocarditis
newborn should remain on first breast 10 min, then switch to second breast and suckle until satisfied use warm water, no drying soap on nipples let nipples air dry for 15 mins 2-3 times daily
care of breasts and nipples r/t breastfeeding
gynecoid pelvis
categorized as a typical female pelvis (although only about half of all women have this type of pelvis); the rounded shape of the gynecoid inlet allows the fetus room to negotiate the dimensions of the bony passageway
imperforate anus Gi obstruction
cause of no stool first 24hrs after birth
patent ductus arteriosus (PDA)
cause of persistent mummer after birth
OP
causes back labor
problems of the hypothalamic pituitary system tresticular disorders= 50 % of the time problems of the ejaculatory system infection ( mumps, STIs, bacterial infections) congenital anomales drugs radiation substance use
causes for male infertility
withdrawal of steroids stressful event
causes of Addison's crisis
Can occur secondary to brain tumors, head trauma, infections of the CNS, and surgical ablation or radiation Nephrogenic DI—relates to failure of the renal tubules to respond to ADH. Can be related to hypokalemia, hypercalcemia and to medications (lithium demeocycline
causes of DI
SEPSIS cancers transfusion of mismatched blood abruptio placentae amniotic fluid embolism HELLP syndrome septic abortion extensive burns heatstroke
causes of DIC
undiagnosed diabetes inadequate tx of existing diabetes insulin not taken as prescribed malfunction of insulin pump infection
causes of DKA
bronchoscopy
the visual examination of the bronchi using a bronchoscope
Autonomic neuropathy
damage to nerves supplying the internal body structures that regulate functions such as blood pressure, heart rate, bowel and bladder emptying, and digestion
vaginal bleeding facial edema extreme wt gain or loss pounding headache abdominal/ epigastric pain chills and fever painful urination change of frequency or strength of fetal movement
danger signs of pregnancy
primary hypertension
denotes high blood pressure from an unidentified cause; also called essential hypertension
magnet organization
designates organizations worldwide where nursing leaders successfully align their nursing strategic goals to improve the organization's patient outcomes. provides a roadmap to nursing excellence, which benefits the whole of an organization. means education and development through every career stage, which leads to greater autonomy at the bedside.
- *Labs: Low levels of factor VIII or IX, prolonged PTT - *Normal: platelet count, PT, and fibrinogen
diagnosis for hemophilia
Assessment and Diagnostic Findings Overnight dexamethasone suppression test
diagnosis of Cushing disease
ABGs O2 electrolytes ECG Chest x-ray echocardiography CT scan MRI cardiac catherization
diagnostic for cor pulmonale
- Hx and physical exam of both partners - review of menstrual and gynecologic Hx -STDs -Hormone levels . FSH, LH, prolactin . urinary LH - Pap test and HPV test - ovulatory study -tubal patency study - pelvic ultrasound
diagnostic studies for female infertility
TB skin test Chest X-ray sputum smear and culture
diagnostics for TB
ECG Exercise stress test stress echocardiogram coronary angiogram cardiac catheterization
diagnostics for angina
race and ethnicity socioeconomic geographical regions
disparities that lead to inability for healthcare services
antibiotics. antidepressants. anti-seizure drugs. blood thinners. heart rhythm drugs. nonsteroidal anti-inflammatory drugs (NSAIDs) sedatives.
drugs that cause petechia
Nonmaleficence
duty to do no harm
restlessness lethargy tachypnea dyspnea on exertion tachycardia mild hypertension dysrhythmias diaphoresis decreased urine output unexplained fatigue
early signs of inadequate oxygenation
Somogyi effect
early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes
● avoid iron supplements ● encourage hydration therapy ● side effects of myelosuppressive drugs ● healthy and proper diet ● exercise especially leg exercises to prevent DVT
education for polycythemia
fidelity
faithfulness; loyalty
LMP
first day of last menstrual period
physiological, safety, love/belonging, esteem, self-actualization
list parts of Maslow's hierarchy of needs
perineal infection endometritis DVT UTI pyelonephritis mastitis
list puerperal infections
structure organizational environment • Is the formal rules and policies that govern organizational practices. • Is necessary for the integration of diverse functions and activities across the organization
minor attributes of healthcare organizations
petchia
minute, pinpoint hemorrhage under the skin
upper esophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea
most common TEF
variability
most important indicator of fetal well - being means baby has automatic neuro system and adequate oxygenation with good variability (moderate 10 -15 bpm- jagged appearance)
kids, elderly, disabled
must report what types of abuse
folic acid
need to prevent tubule defects; take before pregnant
BNP (brain natriuretic peptide)
peptide that causes natriuresis. High in HF.
infection, dislodged placenta, hemorrhage
risks with PUBS
wet lungs
signs of left sided heart failure
veracity
truthfulness
key to open cells to allow nutrients in
what is the biggest thing insulin does
