Exam 3 Mother Baby

risk factors for breast cancer

- female - age: 1 in 8 invasive breast cancers in women younger than 45; invasive breast cancers found in 2/3 women aged 55 and older - race: white women are more likely to develop breast cancer, but black women are more likely to die because they tend to have a more aggressive form. asian, hispanic, and native american women have a lower risk of developing and dying from breast cancer - early menarche (less than 12) - late menopause (over 55) - nulliparity or first pregnancy after 30 years - personal history of breast cancer - genetics: family hisotry in first degree, family history of other cancers, mutations in the BRCA1 genes - previous irradiation of the chest area as a child or young woman as treatment for another cancer - previous abnormal breast biopsy results - long term hormone replacement therapy with estrogen and progesterone - excessive alcohol consumption - overweight or obese - physical inactivity

postpartum infections - objective findings

- fever, chills - pain or redness of wounds - purulent wound drainage or wound edges not approximated - tachycardia - uterine subinvolution - abnormal duration of lochia, foul odor - elevated white blood cell count - frequency or urgency of urination, dysuria, or hematuria - suprapubic pain - localized area of warmth, redness, or tenderness in the breasts - body aches, general malaise

chronic illness: physical manifestations (S/S) at the end of life

- heart rate increases- decrease in strength of pulses - low blood pressure - force of respiratory effort declines - increased work of breathing, apnea - cheyne stokes respirations - expiratory sign and noisy respirations - death rattle

hypertonic uterine contractions

- latent phase of labor - uncoordinated, erratic contractions are powerful but ineffective - uterine blood flow is reduced by high muscle tone between contractions

visual impairment

- myopia: nearsightedness - hyperopia: farsightedness - astigmatism: unequal curvature of the cornea or the lens causing light rays to bend in different directions - color deficiency (achromatopsia): only see things as black and white or in shades of gray. common in males - amblyopia: lazy eye and poor vision that happens in one eye usually strabismus: eyes are not aligned because of lack of coordination of the extra-ocular muscles. cross eyed - glaucoma: IOP increase leads to atrophy of the optic disk and blindness - cataract: opacity, or loss of transparency of the lens - retinopathy of prematurity: eye disease that can happen in babies who are premature - blocked lacrimal duct: excessive tearing and crusting of eyelids - infections: conjunctivitis or pink eye, orbital cellulitis, etc

hypotonic uterine contractions

- secondary arrest - occurs during the active phase of labor - contractions are coordinated but too weak - fundus can be easily indented with fingertip pressure

postpartum hemorrhage

>500ml (vag birth) >1000ml (C/S) - If boggy uterus, massage fundus - elevate legs 20-30 degrees to promote venous return - give oxytocin, uterine stimulants : methylergonovine (Methergine -not for HTN pt), Misoprostol (Cytotec), carboprost (Hemabate) leading cause of maternal death worldwide early PPH is the first 24 hours. late PPH is 24 hours to 6 weeks PP PPH: trauma - soft tissue trauma: predisposing factors, lacerations, hematomas - management: involves repairing the trauma before excessive blood loss occurs. visualization of lacerations may be difficult PPH: uterine atony - manifestations: fundus is difficult to locate. boggy or soft feel tp the fundus - management: measures to contract the uterus. provide fluid replacement - over distention of the uterus, multi-parity, precipitate labor or delivery, prolonged labor, use of forceps or vacuum extractor, cesarean birth, manual removal of placenta, uterine inversion, placenta previa, accreta, low implantation, induction/augmentation, general anesthesia, chorioamnionitis, clotting disorders, previous postpartum hemorrhage or uterine surgery, disseminated intravascular clotting, uterine leiomyomas

osteoporosis

A condition in which the body's bones become weak and break easily. - increased spaces in the bone after menopause - decrease of estrogen accelerates bone loss - reduced bone density - susceptible to fractures calcium and vitamin d and sunlight exposure necessary

cerebral palsy

A loss or deficiency of motor control with involuntary spasms caused by permanent brain damage present at birth - chronic disorder of posture and movement - difficulty controlling muscles and issues with gait - comorbidities: cognitive, hearing, speech, visual impairment. seizures and behavorial issues

autism

ASD is a group of developmental disabilities characterized by persistant deficits in social communication and interaction that can cause significant challenges. diagnosed with DSM-5 etiology - maternal rubella - untreated phenyllketonuria - tuberous sclerosis - anoxia during birth - encephalitis - seizures - fragile x syndrome!! clinical manifestations: noticeable by 3 - infant: lack of social ability, verbalization, and smiling. not seeking comfort or cuddling - social: lack of awareness of feelings, abnormal play, impairment in relationships - language: impaired verbal communication, abnormal nonverbal communication, absence of imaginative play - behavioral: spinning around and rocking, repetitive use of items like a toy, excessive order, distress over change in environment, routine insistence, self injurious behaviors

fetal alcohol syndrome disorder

classic defects of persistent symmetric growth retardation, malformations of the face and skull, skeletal and cardiac malformation, and CNS deficits, including intellectual and developmental disabilities resulting from maternal alcohol consumption manifestations - prenatal and postnatal growth deficiency - microcephaly - joint anomalies during childhood and periods of growth - mild to moderate intellectual disability present in early childhood - tremulousness/seizures in the neonatal period - irritability - hyperactivity -abnormal facial features: short palpebral fissures, smooth philtrum, thin upper lip

hypothyroidism

condition in which the thyroid gland does not completely develop, causing insufficient thyroid hormone to meet the body's metabolic needs. etiology: caused by an absent, underdeveloped, or ectopic thyroid gland manifestations: skin mottling, large anterior fontanel, large tongue, hypotonia, slow reflexes, distended abdomen, prolonged jaundice, lethargy, constipation, feeding problems, coldness to touch, umbilical hernia, hoarse cry, excessive sleeping diagnosis: elevated TSH (low T4) management: lifelong thyroid hormone replacement (levothyroxine)

clubfeet

congenital dysplasia of all tissue (bone, muscle, ligaments, nerves, and blood vessels) below the knee. can be diagnosed prenatally by ultrasounds. radiographic imaging is rarely used or necessary for assessment of a clubfoot. ponseti casting method: weekly, gentle stretching and manipulation of the misaligned bones followed by application of a well-molded long-leg plaster cast - tendoachillis lengthening to correct the equinis contracture - correction in 6-8 weeks french physiotherapy method: daily sequential stretching, strengthening, and mobilization of the foot followed by taping and splinting to allow for gradual correction of deformity

abnormal bleeding

abnormal uterine bleeding is that which occurs with abnormal frequency, lasts an abnormal length of time, occurs irregularly, or is excessive in amount. most occur in cycles without ovulation, often near puberty and perimenopause. common causes - pregnancy complications, such as spontaneous abortion - anatomic lesions, either benign or malignant, of the vagina, cervix, or uterus - drug induced bleeding, such as breakthrough bleeding that occurs in some women who are taking hormonal contraceptives - systemic disorders such as DM, uterine myomas, hypothyroidism, or blood coagulation disorders - failure to ovulate

head injury

any mechanical force to the scalp, skull, meninges, or brain types - closed head injuryL non-penetrating injury to the head in which no break occurs in the integrity of the barrier between the outside environment and the intracranial cavity - open head injury: penetrating injury to the head in which there is a break in the integrity of the barrier. infection is a concern!! - coup injury: cerebral injury sustained directly below the site of impact skull fractures: linear, depressed, basilar (battle sign, raccoon eyes, rhinorrhea, otorrhea, and hemotympanum), and comminuted (fragmented bone pieces) contusion: petechial hemorrhage along the superficial aspect of the brain concussion: transient and reversible neuronal dysfunction, with instantaneous loss of awareness and responsiveness intracranial hemorrhage: epidural (rapid because arterial damage), or subdural (acute or chronic injury tot he vein)

natural family planning methods

any of several methods of conception control that do not rely on medication or a physical device for effectiveness - calendar or rhythm method: track menstrual history to predict when you ovulate - standard days method: avoid unprotected sex on days 8-19 of menstrual cycle - cervical mucus and two day method: presence or absence of cervical secretions to identify fertile days - symptothermal method: uses body temperature to predict ovulation. high body temp probably gonna get pregnant - abstinence least reliable - breastfeeding because you can still get pregnant - coitus interruptus: pulling out

Acute Lymphocytic Leukemia (ALL)

Immature lymphocytes (lymphoblasts) predominate. This form is seen most often in children and adolescents; onset is sudden cause is abnormal proliferation of immature WBCs which compete with normal cells for space and nutrients. bone marrow production of other cells is suppressed, so low numbers of RBCs and platelets is seen

menstrual disorders

PMS PMDD abnormal bleeding dysmenorrhea

augmentation to labor

artificial methods to stimulate uterine contractions. oxytocin is considered when labor had begun spontaneously but progress has slowed or stopped because of poor contractions surgical: amniotomy medical: prostoglandins or oxytocin mechanical: intracervical inserts to gradually stretch and soften the cervix

intrauterine drug exposures

behavioral signs - irritability - yawning - jitteriness, tremors, seizures - muscular rigidity, increased muscle tone - restless, excessive acitvity - exaggerated moro relfex - prolonged cry and difficult to console - poor sleeping patterns signs related to feeding - excessive sucking - uncoordinated sucking and swallowing - frequent regurgitation or vomiting - diarrhea - weight loss

benign versus malignant breast tumors

benign disorder of the breast - fibrocystic breast changes in reproductive years - fibroadenoma in teenage years and 20s - ductal ectasia while approaching menopause - intraductal papilloma just before or during menopause malignant tumors - 1 in 8 women will develop breast cancer - invasive tumors increase with age - early menarche increases risk - late menarche does not increase risk

Myelomeningocele (spina bifida)

a congenital defect of the spine that allows the spinal contents to protrude. incomplete closure of the vertebrae (NTD) classifications - occulta: L5 and S1 with failure of vertebrae to completely fuse. manifestations may be a dimple, TUFT OF HAIR, hemangioma, or lipoma in the lower lumbar or sacral area - meningocele: saclike protrusion filled with spinal fluid and meninges - myelomeningocele: most severe and the sac is filled with spinal fluid, meninges, nerve roots, and spinal cord

ADHD

a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity

fractures

break or disruption in a bones continuity. generally occur when excessive or traumatic force exceeds the strength of the bone. they are common and can vary in severity from minor to life-threatening. may result from accidental trauma (falls), non-accidental trauma (child abuse), or pathologic conditions that result in fragile bones (osteogenesis imperfecta, tumors, cysts) transverse: break or fracture line occurs at right angles to the long axis of the bone oblique: diagonal or slanting break that occurs between the horizontal and perpendicular planes of the bone greenstick: break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side. seen most in the forearm spiral: twisted or circular break that affects the length rather than the width. seen in child abuse simples vs compound: simple fracture the skin is intact. compound the skin or muscle has been disrupted

explain recommended healthcare visit and screening timing for women

breast self exam: once a month right after your period when breasts are less tender clinical breast exam: 20-39 every 3 years. 40 and up every year mammography: same as above vulvar self examination pelvic examination pap test fecal occult blood testing

fetal influence on dysfunctional labor

breech presentation fetal anomalies multiple gestation fetal size: macrocosmic infant weighs more than 8 pounds 13 oz at birth. head or shoulder may not be able to adapt to the pelvis, known as cephalopelvic disproportion. shoulder dystocia: shoulders become impacted above the maternal symphysis pubis. umbilical cord is compressed and respiration is prevented rotation abnormalities: occiput posterior or occiput transverse delay fetal descent and other mechanisms of labor. deflexion abnormalities: poorly flexed fetal head presents a larger diameter to the pelvis than if the head were flexed with the chin on chest

respiratory distress

caused by insufficient surfactant in the lungs. occurs more frequently in preterm infants and increases as gestational age decreases. also occurs when there has been asphyxia, csection, multiple births, male infants, cold stress,a nd maternal diabetes. patho: surfactant decreases surface tension, allowing the alveoli to remain open when air is exhaled. with too little, the alveoli collapse each time the infant exhales. the risk for atelectasis, hypoxia, and hypercapnia increases manifestations: tachypnea, nasal flaring, retractions, and cyanosis. grunting on expiration is characteristic and signifies physiologic efforts to maintain lung expansion management: surfactant replacement therapy, oxygen, nasal CPAP, inhaled nitric oxide therapy, correction of acidosis, iv fluids

cancer: treatment (chemo, radiation, BMT)

chemo - drugs to kill cancer cells. also affect cells of the hematopoietic system, GI tract, integumentary system - side effects: pain, nausea, fatigue, bone marrow suppression, alopecia, bruising, vomiting, mucositis - risk for anorexia, neutropenia, thrombocytopenia, and OIs radiation - can be administered to cure or eradicate disease or administered in low doses as palliative therapy to prevent further growth - CT and xrays are done to identify the site when the radiation will go - side effects: fatigue, skin damage, hair loss, NV, low blood counts - slows the growth of tumors and kills rapidly dividing cells non-selectively Bone marrow transplant/ hematopoietic stem cell transplantation - allows extremely high doses of chemo without regard for bone marrow recovery because hematopoiesis will be restored through transplant - stem cells are harvested from bone marrow, peripheral blood, and umbilical cord blood - bone marrow is used to reconstitute the immune function of the child after high-dose chemo - healthy bone marrow cells are infused into the bloodstream and migrate to the marrow space to replenish the child's immune function

seizures

consists of brief paroxysmal behavior caused by excessive discharge of neurons epilepsy: recurrent seizures that do not occur with acute illness. diagnosis after 2 or more seizures or convincing EEG readings classification - generalized or diffuse (includes febrile): onset is at any age. includes both hemispheres or all parts of brain. consciousness is impaired - focal: at any age. limited functional area in one hemisphere - unknown: cannot be characterized as aware or awareness is impaired - unclassified: unusual characteristics and classification is indeterminate

traction

continous traction exerts a constant pull and is used for fractures and dislocations intermittent traction provides a periodic pull or force and is used for contractures, low back pain, or muscle spasm sin traction: noninvasive. foam rubber straps, adhesive mokeskin, elastic bandages, or cloth belts applies to the skin and then attached to the weights and pulleys skeletal traction: exerts greater force and tolerated for longer periods. helps maintain correct alignment of the bony fragments and assists in proper healing. maintained by a metal device inserted into th e bone (skull, ulna, femur, tibia, heel)

menopausal changes

decline in sex steroids and estradiol have numerous physical and psychological effects on the woman. vasomotor instability, breast tissue reduction, sleep difficulty, depression, atrophy or urogenital epithelium, vaginal tissue, and dermis, osteoporosis, coronary heart disease, lethargy, headaches, concentration difficulty, hot flashes common symptoms: hot flashes, night sweats, depression, anxiety, irritability, decreased libido, fatigue, aches, pains, insomnia

precipitate labor

delivery occurs within 3 hours of labor onset may be affected by - efficient and strong uterine contractions - extremely compliant birth canal - history of rapid labor - maternal cocaine use (abruptio placentae)

hydrocephalus

develops as a result of an imbalance between the production and absorption of CSF. as excess CSF accumulates in the ventricular system, the ventricles become dilated and the brain is compressed against the skull. this results in enlargement of the skull if the the sutures are open and signs and symptoms of increased ICP if the sutures are fused arnold chiari malformations can cause it treatment: ventriculoperitoneal shunt. drain into where fluid is and goes into the abdomen so its absorbed there

hodgkin's lymphoma

distinguished from other lymphomas by the presence of large, cancerous lymphocytes known as Reed-Sternberg cells

jaundice in newborn

during first 24 hours: jaundice is pathological (r/t liver problems) - may lead to bilirubin encephalopathy - if severe kernicterus - emergency after 24 hours: physiological jaundice r/t inc amount of unconjugated bilirubin in system - hemolytic disease of the newborn resulting from incompatibility between blood of mother and fetus - excessive hemolysis results in erythroblastosis fetalis - infants severely affected may develop hydrops fetalis treatment - phototherapy (blue light) - want baby to poop out bilirubin so feed the baby

maternal soft tissue obstruction

during labor, a full bladder is a common soft tissue obstruction. bladder distention reduces available space in the pelvis and intensifies maternal discomfort. patient should be assessed for bladder distention regularly and encouraged to void every 1-2 hours. catheterization may be needed if she cannot urinate or receives regional block

education regarding DVT

how to prevent thrombosis - regular schedule of activity, preferably walking - avoid prolonged standing or sitting in one position - when sitting, elevate your legs and avoid crossing them - maintain a daily fluid intake of 12 or more 8 oz glasses to prevent dehydration and poor circulation - stop smoking educate - teach the woman how to prevent excessive anticoagulation - explain the treatment regimen, including the schedule of medication - teach how to inject heparin - NSAID and aspirin may increase risk of hemorrhage - instruct woman taking warfarin that eating lots of vitamin K can interfere - use a soft toothbrush to prevent bleeding

dysfunctional labor

dysfunctional labor is characterized by lack of progression of cervical effacement, dilation, or fetal descent

precocious puberty

early onset of puberty, traditionally considered as the onset of puberty before 8 years of age in girls and before 9 years of age in boys. premature appearance of secondary sexual characteristics , accelerated growth rate, and advanced bone maturation. etiology: can be idiopathic or caused by CNS tumors, head trauma, infection, septo-optic dysplasia, genetic mutations, or cranial radiation manifestations - girls: breast developments, enlargement of vagina, pubic hair, axillary hair, acne, growth spurt, adult body odor, menstrual period, moodiness - boys: testicular enlargement, penis enlargement, pubic hair, facial hair, acne, deepening of voice, adult body odor, moodiness diagnosis: gold standard in the gonadotropin releasing hormone stimulation test (GNRH)

Methergine

ergot alkaloid, uterine stimulant stimulated sustained contraction of the uterus and causes arterial vasoconstriction to prevent hemorrhage used for the prevention and treatment of postpartum or post abortion hemorrhage caused by uterine atony or subinvolution

Subinvolution

failure of the uterus to return to a non-pregnant state caused by retained placental fragments and infection

fibrocystic changes in breast

fibrosis or thickening of the normal breast tissue may occur in early stages, cysts may form in the later stages and are felt as multiple, smooth, well-delineated nodules that have a tender, movable character. lumpy, rubbery, or rope-like nodules often vary in size. these are not cancerous, although atypical hyperplasia of the terminal breast ducts or lobules is associated with a greated risk for breast cnacer.

ineffective maternal pushing

ineffective maternal pushing - incorrect pushing techniques or inefficient position - fear of injury because of pain and tearing sensations felt by mother when she pushed - minimal or absent urge to push - maternal exhaustion - regional block analgesia may suppress urge - psychological unreadiness to let go of fetus

chronic illness: understanding of death

infancy and toddlerhood (sensorimotor): death as loss of the caregiver early childhood (2-7)(preoperational): death as a reversible and temporary separation middle childhood (7-12) (concrete operations): death as sad and irreversible but not necessarily inevitable adolescence (12+) (formal operations): death as inevitable and irreversible but often a distant event

psychological problems

labor is an emotionally intense and stressful event that prompts fight or flight - increases glucose consumption which reduces the energy available to contract the uterus - releases catecholamines, which interfere with uterine contractility and reduce the placenta blood supply - reduce the effectiveness of labor contractions and maternal pushing efforts - increase pain perception and reduce tolerance

scoliosis

lateral deviation of the spine greater than 10 degrees, as measured using a Cobb angle measurement, a techniques for measuring the extent of a lateral curvature rotation of the vertebral bodies in the spine, therefore considered a three-dimensional deformity congenital - present at birth - increases in severity over time - most common - infantile, juvenile, adolescent neuromuscular: cerebral palsy syndromic: marfan syndrome spinal tumors neural axis abnormalities early onset scoliosis - infant and children less than 8 years - risk for thoracic insufficiency syndrome: progressive rotation of the ribs impairs growth of one or both lungs - need frequent respiratory assessments - brace (curve greater than 25 but skeletally immature) or surgical correction (curvature 40-50) options

premature rupture risk factors (maternal and fetal)

maternal - infections of the vagina or cervix (gonorrhea, chlamydia, trichomonas, group B strep, or bacterial vaginosis) - amniotic sac with a weak structure - chorioamnionitis (intraamniotic infection) - previous preterm birth - incompetent cervix or short cervical length (less than 25 mm) - over distention of uterus - maternal hormonal changes - recent vaginal intercourse - maternal stress or low socioeconomic status - maternal nutritional deficiencies fetal - fetal abnormalities or malpresentation - newborn is at risk for sepsis after birth - risk for umbilical cord compression, reduced lung volume, and deformities

diabetic ketoacidosis

metabolic consequence of a severe insulin deficit leading to hyperglycemia and the presence of ketone bodies in the blood, followed by metabolic acidosis. etiology: results from an absolute or relative insulin deficit. most common cause is insulin resistance, as in a stress response initiated by an infection. in the adolescent the most common cause is one or more missed insulin injections. manifestations: abdominal and chest pain, NV, fruity breath, decreased LOC, kussmaul respirations, and symptoms of dehydration diagnosis: blood glucose above 200, venous pH below 7.3, ketonuria, ketonemia, serum potassium elevated abnormal, serum phosphorus low, carbon dioxide low management: hourly glucose monitoring, hourly vitals, neurologic checks, strict intake and output, assessment of fluid and electrolyte status, iv fluid replacement, potassium replacement, continuous insulin

medications

methergine oxytocin hemabate pitocin cytotec betamethasone

mood/anxiety disorders

mood disorders: disturbances in function, affect, or thought processes that can affect the family after childbirth as severely as physiologic problems peripartum depression: onset of depressive disorder during pregnancy or postpartum. involves at least a 2 week period of depressed mood or loss of interest in almost all activities accompanied by at least four of the following: changes in appetite or weight, sleep and psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death postpartum depression: feelings of sadness and crying, loss of pleasure in usual activities, anxiety, agitation, irritability, feelings of guilt, fatigue and sleep disturbance, difficulty concentrating, depression, suicidal thoughts postpartum anxiety disorders: most common include panic disorder, postpartum OCD, and post-traumatic stress disorder. panic disorder manifests as tachycardia, palpitations, SOB, chest pain, and fear of dying. OCD involves consuming thoughts that she might harm the baby and fears being alone with the baby. PTSD women perceive childbirth as traumatic event. nightmares and flashbacks about the event, anxiety, and avoidance of reminders of the event

Bacterial Meningitis

most common infectious process affecting the CNS early diagnosis and prompt antibiotic therapy reduces mortality causes - neonatal: group B strep, E coli - 2 months to 12 years: N meningitidis, strep pneumo, H. flu B - older children: N meningitis

brain tumors

most common solid tumor and second most common childhood malignancy afte leukemia. management: initial intervention is surgery. the goal is to remove as much as possible without disturbing the brain tissue

neuroblastoma cancer

most commonly diagnosed malignancy in infants and found in infants and children. embryonal cancer of the sympathetic nervous system presents in a range fro, very aggressive tumors that are unresponsive to treatment to tumors that spontaneously regress patho: arises from neural crest cells, which normally develop in the sympathetic nervous system and the adrenal medulla. cells proliferate and begin to form a solid mass or tumor manifestations: in most cases an abdominal mass and protuberant and firm abdomen are present. impaired ROM, pain and limping, cough, decreased chest expansion

rhabdomyosarcoma

muscle or striated tissue malignancy that most often occurs perioribitally, in the head and neck in younger children, or in the trunk and extremities in older children

developmental dysplasia of the hip (DDH)

neonates: isntability of the hip; the femoral head can be displaced partially or fully from the acetabulum by the examiner - diagnosis: barlow and ortalani maneuvers infants: asymmetry of the gluteal skinfolds when lying with the legs extended against the examining table older children: abnormalities in child's gait. may exhibit limping, toe-walking, or waddling gait. bilateral dysplasia is always more difficult to identify than unilateral dysplasia because no normal hip can be used for comparison at risk: females, those born breech, those with torticollis treatment - pavlik harness: maintain proper alignment of the hip in the joint - spica cast: completely immoblixe the hip joints

Pitocin (oxytocin)

oxytocic synthetic compound identical to the natural hormone from the posteriori pituitary that stimulated uterine smooth muscle, resulting in increased strength, duration, and frequency of uterine contractions. uterine sensitivity to oxy increases gradually during gestation. it has vasoactive and antidiuretic properties. indications: induction or augmentation of labor at or near term. maintenance of firm uterine contraction after birth to control postpartum bleeding. management of inevitable or incomplete abortion

chronic illness: care of the family and siblings

parents - increase parent confidence - acknowledge each parent as a person ease the worries by providing info and easy access to the HCP when questions arise acknowledge the child as valuable and unique siblings - often have feelings of guilt regarding their role - educate the sibling about the condition, treatment, changes, disabilities, and disease progression - sometimes they regress in developmental stage and activities - include sibling as much as possible

Intrapartum Emergencies

placental abnormalities - placenta previa or previous cesarean birth is associated with an abnormally adherent placenta (placenta accreta) - placenta accreta can cause immediate or delayed hemorrhage after birth - placenta increta is when the placenta penetrates the uterine muscle itself - placenta percreta is when the placenta penetrated all the way through the uterus - methotrexate used prolapsed umbilical cord: slips down after the membranes rupture, subjecting it to compression between the fetus and pelvis. interferes with fetal oxygenation and potentially fatal - common for breech presentation, transverse lie, hydramnios - prompt treatment and delivery - position the womans hips higher than her head to shift the fetal presenting part towards diaphragm (knee to chest, trendelenburg, hips elevated with pillows) - vaginal elevation using sterile hand - cesarean delivery usually uterine rupture - complee: direst communication between the uterine and peritoneal cavities - incomplete: into the peritoneum covering the uterus or into the broad ligament but not into the peritoneal cavity - dehiscnence: partial separation of an old uterine scar. - common after a previous cesarean birth uterine inversion: uterus completelyt or partly turns inside out, usually during the third stage of labor - physician will try to replace uterus through the vagina into a normal position - laparotomy with replacement may be done anaphylactoid syndrome: amniotic fluid is drawn into the maternal circulation and carried to the woman's lungs. fetal particulate matter in the fluid obstructs pulmonary vessels. can lead to hypoxemia

postpartum complications

postpartum hemorrhage - major cause of maternal death - cumulative blood loss of more than 1000 for cesarean and 500 for vaginal - early PPH: first 24 hours of birth. usually caused by uterine atony (relaxed muscles allow rapid bleeding from the endometrial arteries at the placental site. lack of muscle tone that results in failure of the uterine muscle fibers to contract firmly around blood vessels when the placenta separates). can also be caused by trauma to the birth canal, hematomas, retention of placental fragments, and abnormalities of coagulation - manifestations: uterine fundus is difficult to locate, soft or boggy fundus, uterus that becomes firm when massaged but loses tone when stopped, excessive lochia, excessive clots expelled - administer oxytocin as prophylaxis or uterine massage - Late PP: 24 hours to 12 weeks after birth. most common cause is subinvolution or retained fragments subinvolution: delayed return of the uterus to its non-pregnant size and consistency - by 14 days the uterus should no longer be palpable above the symphysis pubis - most common cause are retained placental fragments and pelvic infection - signs include prolonged discharge of lochia, irregular or excessive uterine bleeding, sometimes profuse hemorrhage, pelvis pain or feelings or pelvis heaviness, backache, fatigue, and persistant malaise

mood disorders continued

postpartum psychosis: mental state in which a person's ability to recognize reality, communicate, and relate to others is impaired. manifestations include agitation, irritability, rapidly shifting moods, disorientation, disorganized behavior. some mothers have delusions about the baby and experience hallucinations. need immediate medical attention and hospitalization to prevent suicide or infanticide bipolar II disorder: suffer from periods of irritability, hyperactivity, euphoria, and grandiosity. exhibit little need for sleep and are seldom aware they have a problem. the depressions are characterized by tearfulness, preoccupation with guilt, feelings of worthlessness, sleep and appetite disturbance, and inordinate concern with the baby's health.

PMDD

premenstrual dysphoric disorder - a condition associated with severe emotional and physical problems that are closely linked to the menstrual cycle. Symptoms occur regularly in the second half of the cycle and end when menstruation begins or shortly thereafter.

PMS

premenstrual syndrome, a group of symptoms that occur in women, typically between ovulation and a period ways to reduce symptoms - diet: reduce consumption of caffeine, salty foods and simple sugars. eat smaller meals, drink 2000 ml of water daily and avoid alcohol - exercise/stress management: physical exercise to relieve tension and guided imagery. warm bath to relieve stress - sleep and rest: maintain consistent sleep routine in the evening

hemabate

prostaglandin, oxytoxic stimualtes contraction of the uterus used for the treatment of postpartum hemorrhage caused by uterine atony or abortion

discuss the nurse's role for families needing care related to fertility and infertility

psychosocial therapy: stress of infertility can have a detrimental effect on a couples relationship. and anxiety about getting pregnant is one factor that can affect fertility in a woman. lifestyle modifications: loose clothing, reduce lubricants, no cellphones at belt or hip, change nutrition, lose weight, counseling for optimal timing of intercourse medical therapy: clomiphene citrate. menotropins, follitropins, human chorionic gonadoptropin, exogenous progesterone, gonadoptropin-releasing hormone antagonists, metformin, letrozole assisted reproductive technology (ART): intrauterine insemination (women is given ovarys stimulating meds followed by timed intercourse) invitro fertilization (IVF ovarian stimulation is followed by needle aspiration of mature ovarian follicles. sperm sample is introduced to the mature folicles outside the body for fertilization) surrgoacy and adoption

preterm infant complications

respiratory distress syndrome bronchopulmanry dysplasia (chronic lung disease) intraventricular hemorrhage: bleeding around and into the ventricles of the brain. it results from the rupture of the fragile blood vessels in the germinal matrix, located around the ventricles of the brain. retinopathy of prematurity: can result in visual impairment or blindness in preterm infants. injury tot he retinal blood vessels. fluid leakage and hemorrhage can cause scarring, traction on the retina, and retinal detachment necrotizing enterocolitis: serious inflammatory condition of the intestinal tract that can lead to necrosis of the intestinal mucosa. the ileum and proximal colon are most affected. - manifestations: feeding intolerance, increased abdominal girth caused by distention, increased gastric residuals, decreased bowel sounds, visible loops of bowel, vomiting, abdominal tenderness, erythema of the intestinal wall, blood int he stool, and infection signs

prolonged labor

result of problem with one or more stages in the progression of labor there is increased likelihood when - nullipara - cervix that is not dilated - weaker than usual uterine muscles - AMA - sedatives or analgesics used

growth hormone deficiency

results from inadequate production or secretion of GH by the pituitary gland, causing poor growth and short stature. hypoglycemia is sometimes the manifestation of GH deficiency etiology: can be isolated or associated with an underlying cause. such causes include hypopituitarism, congenital malformations of the gland, brain tumors, head trauma, cranial irradiation. may be associated with turner syndrome, prader-willi syndrome, and chronic illnesses such as renal disease and IBD manifestations: height below the fifth percentile for age and sex, diminished growth rate, immature or cherubic facies, delayed puberty, hypoglycemia, diminished muscle mass with relatively increased body fat, and micropenis diagnosis: measurements of growth over 6-12 months, thryoid fucntion tests, electrolytes, BUN, creatinine, CBC, insulin growth factor management: replacement therapy

type 1 diabetes

results when the pancreas is unable to produce and secrete an adequate amount of insulin. this is most common childhood endocrine disorder etiolofy: inflammatory process in the insulin-secreting islet cells of the pancreas resulting from an autoimmune process that causes their eventual destruction. viral and bacterial infections may trigger this disease manifestationsL hyperglycemic signs, the 3 ps, weight loss, fatigue, blurred vision daignosis: GbA1C greater than or equal to 6.5 or fasting blood glucose exceeding 126 or 2 hours oral glucose tolerance test greater than 200 management: insulin therapy to reverse metabolic imbalances

ewing sarcoma

second most common bone tumor seen in children. challenging diagnosis because this disease mimics infection and is difficult to differentiate found most often in the flat bones of the axial skeleton such as the vertebrae, ribs, scapula, and pelvic bones manifestations: pain, soft tissue swelling, fever

dysmenorrhea

severe and frequent menstrual cramps and pain during your period. may be primary, existing from the beginning or periods, or secondary, due to underlying condition

problems of the pelvis

small or abnormally shaped pelvis can slow labor and obstruct fetal passage. the patient may experience poor contractions, slow dilation, slow fetal descent, and a long labor. greater risk for uterine rupture with thinning of the lower uterine segment, especially if contractions remain strong

contraceptives

sterilization - tubal sterilization (ligation) - vasectomy hormonal contraceptives - hormone implant - hormone injections - oral contraceptives - emergency contraceptives - transdermal contraceptive patch - contraceptive vaginal ring intrauterine devices barrier methods - chemical barriers: creams and gels - mechanical barriers: male condom, female condom, sponge, diaphragm, cervical cap/leas shield

SIADH

syndrome of inappropriate antidiuretic hormone: inability to excrete free water resulting from excessive production or release of ADH or vasopressin etiology: most frequent cause is excessive use of vasopressin in the treatment of central DI. other causes include CNS infections, head trauma, brain tumors, and generalized seizures. usually resolves when underlying condition is treated manifestations: hyponatremia, decreased urine output, increased urine specific gravity (more than 1.03), fluid retention with slightly elevated plasma volume, weight gain, increased urine osmolality management: correction of underlying cause, fluid restriction of 1L/day, IV infusion of NaCl nursing considerations: assess for signs of fluid overload (edema, weight gain, urine specific gravity). they are at risk for seizures due to hyponatremia

betamethasone

this can help speed up lung development in preterm babies. it causes the release of surfactant

small gestational age newborn

those who are below the 10th percentile in size on growth charts. they have failed to grow in the uterus as expected, which is called intrauterine growth restriction. can be preterm, full term, or postterm. risk factors include congenital malformations, chromosomal anomalies, genetic factors, and fetal infections, poor placental function, small size, separation, or malformation can interfere. preeclampsia or severe diabetes, smoking, drug or alcohol abuse, and severe maternal malnutrition SGA usually have low apgar scores, meconium aspiration, polycythemia, hypoglycemia, and inadequate thermoregulation - symmetricL the infants weight, length, and head circumference are all less than the 10th percentile, but the body is proportionate and appears normally developed for size. total number of cells decreased - asymmetric: caused by conditions in the third trimester. the head is normal in size but seems large for the rest of the body. the length is normal, but the weight is less than the 10th percentile. the liver, spleen, thymus, adrenals, and placenta are smaller than normal.

complications continued

thromboembolic disorders: caused by venous stasis, hyper-coagulation, blood vessel injury, varicose veins, obesity, history, smoking - superficial venous thrombosis: most associated with varicose veins and limited tot he calf area. signs and symptoms include swelling of the involved extremity as well as redness, tenderness, and warmth. treatment includes analgesics, rest, and elastic support - DVT - PE: fragments of a blood clot dislodge and are carried to the lungs. can result in dyspnea, chest pain, tachycardia, tachypnea, hemoptysis. heparin is given puerperal infection: term used to describe bacterial infections after childbirth. most common are endometritis, wound infections, UTI, mastitis, and septic pelvic thrombophlebitis. these are infections that effect the genital tract any time from rupture of membranes up to 42 days postpartum hypovolemic shock: during and after birth, the woman can tolerate blood loss that approaches the volume of blood added during pregnancy - early signs: mild tachycardia or hypotension. respiratory rate increases. vasoconstriction causes the skin to become pale and cool to touch. mother becomes anxious, confused, and lethargic

TOLAC/VBAC contraindications

trial of labor after cesarean: planned or attempted vaginal birth after cesarean Vaginal birth after cesarean: successful trial of labor

cytotec

used for cervical ripening (softening and opening the cervix), constipation, treatment of miscarriages that do not pass on their own, and treatment of serious postpartum hemorrhage