**MC FINAL

Active movements are present Fetal skin is transparent Lanugo hair begins to develop Skeletal ossification occurs

Week 16

Embyro is 1.5 to 2 mm Lung buds appear Blood circulation begins Heart is tubular and begins to beat Neural plate becomes brain and spinal cord

Week 2-3

Lanugo covers entire body Fetus has nails Muscles are developed Enamel and dentin are depositing Heartbeat is detected by regular fetoscope

Week 20

Hair on head is well formed Skin is reddish and wrinkled Reflex hand grasp functions Vernix covers entire body Fetus has the ability to hear

Week 24

Limbs are well flexed Brain is developing rapidly Eyelids open and close Lungs are developed sufficiently to probide gas exchange (lecithin forming) If born, neonate has the ability to breathe at this time

Week 28

Bones are fully developed Subcutaneous fat has collected Lecithin-to-sphingomyelin ration 1.2:1

Week 32

Skin is pink and body is rounded Skin is less wrinkled Lanugo is disappearing L/S ratio > 2:1

Week 36

Skin is pinkish and smooth Lanugo is present on upper arms/shoulders Vernix decreases Fingernails extend beyond fingertips Sole creases run down to the heel Testes are in the scrotum Labia majora are well developed

Week 40

Embryo is 0.4 to 0.5 cm Embyro is 0.4 g Double heart chambers are visible Heart is beating Limb buds appear

Week 5

Eyelids begin to fuse Circulatory system through umbilicus is well established Every organ is present

Week 8

placenta importance

is important for gas exchange -doesn't provide nutrition, and is not an oxygen organ or a nutritional organ *** it just provides the means for it to be done.

epigastric pain in the third trimester

is indicative of hepatic involvement and therefore should not be left untreated

Rupture of membranes

is when the amniotic membranes rupture and allow the amniotic fluid to escape.

Oligohydramnios

is when you have too little amniotic fluid. -If a patient has <300 ml of fluid, low final height. Suspect poor kidney function of baby, do a fetal renal U/S.

signs of hypoglycemia in a new born

jitteriness, lethargy, DIFFICULTY FEEDING, and irregular breathing

Check back (Newborn Assessment)

look for dimpling on back of spine can indicate spina bfida + hydrocephalus

Reflexes of baby (Newborn Assessment)

look for symmetry

Wilms Tumor

malignant neoplasm of the kidney occurring in young children, usually before age 5 years. the most frequent early signs are hypertension, pain, and hematuria.

Nutrition is:

the single most important factor in the growth and development of children.

Quickening

the stage of pregnancy at which the mother first feels movements of the fetus

Fetal monitoring

the use of an electronic device to continuously record the fetal heart rate and maternal uterine contractions to assess fetal status and the progress of labor

Erikson - What if stage is not completed?

then may get stuck in that stage, recognize that chronological age has some impact in progressing through stages

Anemia during pregnancy

there is low oxygen mother can be fatigue, tired if there is low oxygen baby will not grow. To combat anemia make sure her foods have IRON in diet, do an nutritional assessment.

Meconium

thick dark green mucoid material that is the first feces of a newborn child

*Amnion*

thick membrane that forms the amniotic sac that surrounds the embryo and fetus)

Colostrum

thin, milky fluid secreted by the breast during pregnancy and during the first days after birth before lactation begins

when fundus is away from midline

think bladder full

with premature rupture of membranes

think infection and tachy maybe another indication of infection

overstretched or overstressed

think uterine atony

concept of time

time entity, put with event for young children

Non stress test (NST) on pts with diabetes;

to ensure placenta is still healthy because diabetes is an vascular disease. -Baby can develop fetal abnormalities from type 1 diabetes -If sugars are controlled with diet and not insulin NST is not needed.

Serum tests; QUAD /MSAFP 15-21 weeks (no sooner no later)

to identify open neural tube defects, trisomy 18 and 21, this is a diagnostic test, and amniocentesis is done if QUAD is positive. -Also due are blood type and RH, CBC, STI, rubella, HIV, hepatitis, syphilis

Nurse's role in exam is:

to make sure all samples are labeled correctly, assist doctor, make sure patient is comfortable.

Why do you not give tub bath until cord falls off

to prevent infections

Kawasaki disease

tx of ____ includes IV gamma gobulin or ASA.

Procardia

action: Calcium Channel blocker; relaxes smooth muscles, including the uterus by blocking calcium entry dosage and route: Loading 30 mg PO Maintenance dosage 10 to 20 mg PO q4-6h adverse reaction: Maternal reactions include transient tachycardia, palpitations, hypotension, dizziness, headache, nervousness, peripheral edemia, fatigue, nausea, and facial flushing. Fetal and newborn reactions are rare and are related to maternal hypotension, which would affect uteroplacental perfusion. Nursing and considerations: Do not use sublingual route. Avoid use or use caurtiously with magnesium sulfate because severe hypotension can result. Assess woman and fetus according to agency protocol, being alert for adverse reactions.

Cytotec/Misoprostol

action: Prostaglandin E1(PGE1) ripens the cervix, making it softer and causing it to begin to dilate and efface; it stimulates uterine contractions indications: PGE1 is used for preinduction cervical ripening (ripens cervix before oxytocin induction of labor when the Bishop score is 4 or less) and to induce labor or abortion (abortifacient agent) Dosage: Insert 25 to 50mcg (1/4 to 1/2 of a 100mcg tablet) intravaginally into the posterior fornix using the tips of index and middle fingers without use of lubricant. Repeat every 3 to 6 hours as needed to a maximum of 300 to 400 mcg in a 24 hour period or until an effective contraction pattern is established (three or more uterine contractions in 10 minutes), cervix ripens(Bishop score of 8 or higher), or significant adverse reactions occur. administer 50 to 100 mcg PO q4-6 (gastrointestional effects are increased; there are insufficient data to support effectiveness; therefore oral administration is generally not recommended.) Adverse Reactions: Higher dosages are more likely to result in adverse reactions such as nausea and vomiting, diarrhea, fever, tachysystole (12 or more uterine contractions in 20 minutes without alteration of fetal heart rate or pattern), hyperstimulation of the uterus (tachysystole with nonreasurring fetal heart rate patterns), or featal passage of meconium. Risk for adverse reactions reduceded with lower dosages (ie. 25mcg) and longer intervals between doses(ie, q6h) Nursing considerations: Explain the proceedure to the woman and her family. Ensure that an informed consent has been obtained per agency policy. Assess maternal-fetal unit before each insertion and during treatment, following agency protocol for frequency. Assess maternal vital signs and health status, fetal heart rate, pattern and status of pregnancy, including indications for cervical ripening or induction of labor, signs of labor or impending labor, and the Bishop score. Recognize that a nonreassuring fetal heart rate or pattern; maternal fever, infection, vaginal bleeding, or hypersensitivity; and regular, progressive uterine contractions and history of cesarean birth or uterine scar contracte the use of misoprotol. Use caution if the woman has a history of asthma; glaucoma; or renal, hepatic, or cardiovascular disorders. Have woman void before procedure. Assist woman to maintain a supine position with lateral tilt or side-lying position for 30 to 40 minutes after insertion. Prepare to swab vagina to remove unabsorbed medication using saline-soaked gauze wrapped around fingers and to administer terbutaline 0.25mg subcutaneously or intravenously if significant adverse reactions occur. Initiate oxytocin for induction of labor at least 4 hours after last dose of misoprostol was administered, following agency protocal, if ripening has occured and labor has not begun. Document all assessment findings and administered procedures. A nonscored 100mcg tablet must be cut in the pharmacy to ensure dosage acccuracy.

At what point would you consider applying oxygen?

add oxygen if < 90%.

Necrotizing Enterocolitis

an acute inflammatory disease occurring in the intestines of premature infants, acute inflammatory disease of the GI tract occurring in newborn 4-10 days post birth ascites, absent bowel sounds, bowel loop distension, bile emesis, occult blood tx stop oral feed, og tube and decompress, abx, iv fluids

Communication:Visual deficit

announce yourself, let them know that you are there. Keep routine in the room the same. Make sure they have their glasses on. Bright lights.

erythromycin

antibiotic drops/ointment put into newborns eyes to prevent chlamydia and gonorrhea. Prevents blindness from infection

Reglan

antiemetic

phenergan

antiemetic

Zofran

antiemtic/CNS 5-HT receptor antagonist. Treat nausea/vomitting post operation; chemo/radiation

premature rupture of membranes

assess temperature because client is at risk for infection

Prenatal testing

at risk-women over 35, diabetes, hypertension, history, finances, overweight, heart disease, genetic disease.

6 months old

at what age can infants start to eat solid foods?

Term birth

between 38 weeks and 42 weeks

Treatment for Jaundice: Increased feeding

bilirubin excreted in urine and feces

The taking-in phase begins immediately following:

birth and lasts a few hours to a couple of days. The woman is excited and talkative during this phase and repeatedly reviews the labor and birth experience. It is important for the nurse to allow her the time to express her feelings.

Risks to the newborn

birth injury due to Macrosomia, hypoglycemia, respiratory issues due to meconium, or prematurity, or DM,

mongolian spots

bluish purple spots of pigmentation

cleansing breath

breathing technique used during labor; helps focus on the contraction

high pitched cry in hyperalbulminemia

can be a manifestation of actue bilirubin and encepalopathy

plant steroles and salicylates

can be applied to breast to suppress lactation

congenital hip dysplasia

can be seen in client with limited hip abduction

swaddling newborn bebore heelstick

can reduce pain

what is necessary prior to 3hr glucose test

carbohydrate load prior to 3hr glucose test

CNM

certified nurse midwife;clinical nurse manager

incompetent cervix

cervix is unable to hold the fetus in, usually occurs after week 20+ . -Cerclage ring put on or cervix can be stitched shut

age 12

children's brains stop growing at _____.

Overall fluid status is measured by

daily weights

embryonic period [the critical period]

day 15 to day 60

DM Type 2

diet controlled before pregnancy

Amniocentesis requires the bladder to be:

empty

corpus luteum

endocrine tissue which produces hormones, estrogen, and progesterone which prepares the uterine lining for receiving an embryo

Before administering pitocin, where should the fetus be?

engaged in the birth canal at a minimum of 0 station.

Teach the clent to avoid sexual intercourse until:

episiotomy/laceration is healed & vaginal discharge has turned white

tet spells

episodes of bluish skin from crying or feeding called

Omega 3

essential for normal brain growth and development, prevention of heart disease because clotting, blood pressure, and triglyceride.

EDC

est. date of confinement, est date of delivery normally 280 days or 40 wks

*FERN TEST*

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

Newborns who are formula fed should be burped:

every 15-30 mLs

Complications of pregnancy!!!!!!!!

example Mongolian spots Tuft Oculta Polydactly

mag sulfate

excreted through kidneys

Normal weight loss for newborn

expect a newborn weight loss of 5-10% in first weeks.

EDD

expected (estimated)date of delivery

preterm neonate

feeding challenges, hypoglycemia, fragility, neurosensitivity, RDS, hyperbilirubin, anemia, retinopathy, seizures

Epidural effect on Baby

fetal bradycardia; prolonged decelerations -monitor baby

Accelerations

happens with movement above the baseline. - Good Thing!

stridor

high-pitched sound heard on inspiration; upper-airway sound indicating partial obstruction of the trachea or larynx

Risk factors of Pre-Term Birth

history of preterm birth, uterine or cervical anomalies, multiple gestation, hypertension, diabetes, obesity, clotting disorders, infection, fetal anomalies, premature rupture of membranes, vaginal bleeding, late or no prenatal care, drug use, smoking, alcohol, violence, stress. -early predictive factors of preterm labor and birth include *fetal fibronectin*, there presence in a women with intact membranes suggest an increased risk for preterm labor. And salivary estriol, this increases before the spontaneous onset of term and preterm labor.

hCG

hormone produced early in pregnancy by the placenta, human chorionic gonadotropin

every hour

how often should you check an IV site on an infant?

Betamethasone

improves baby's lung maturity given in utero.

Moderate

in _______ asthma, episodes occur once a week, increased resp. effort, wheezing Severe -occurs frequently, severe RD, retractions

exerting upward pressure is priority

in client with prolapsed cord

depoprovera is contraindicated

in clients with hisotry of osteoporosis

Jaundice

inability of the newborn's immature liver to handle bilirubin (by product of the RBC breakdown).

Anemia; maternal and fetal risks

increased need for oxygen requires the pregnant woman to increase her iron intake

methergine

increases bp- but is used to stop bleeding

unilateral breast pain

indicative of mastitis

mastitis

infection in breast, baby's saliva is contaminated. Most important to tell mom is to keep breastfeeding

Bleeding in second trimester

infection, preterm labor, trauma, not much done until after 20 weeks.

Clavicles (Newborn Assessment)

intact

uterine fibroid

interferes with uterines ability to contract

First stage pain:

internal visceral may be felt as back/leg pain

leakage of fluid

is a complication after amniocentesis

caput

is a localized, easily identifiable, soft area of the scalp, generally resulting from a long and difficult labor or vacuum extraction. Extra fluid should be reabsorbed within 12 hours after birth. Crosses suture lines.

Maternal Serum Alpha Fetal Protein

is a prenatal test to detect spina bifida

applying pressure to the presenting part

is a priority becuase it can relieve cord compression

What is the amnion?

is a thin but tough sac of membrane that covers an embryo. -Main purpose is to protect the embryo during the months of pregnancy. It helps reduce the risk of injuries to the unborn embryo and its development in the womb.

Erythema toxicum

is a transient maculopapular rash seen in newborns.

Indomethacin

is an NSAID that suppresses preterm labor & uterine contraction.

Treatment of Jaundice

is based on baby's age; check levels and determine if need active treatment or it's going to come and go -phototherapy, transfusion, breasting may help.

Management of burns

is focused on pain control and infection prevention. -*In the immediate aftermath, the burn should be cooled with saline soaked cool cloths. -No oil/butter should be rubbed on the burn as it will continue to burn the skin. -Ice should never be used on a burn.

20 weeks uterus height

is just below [two fingers] umbilicus (plus or minus 2 cm)

a manifestation of uteroplacental insufficiency

is late decelerations

Hand hygiene

is paramount to prevent the spread of disease. -This is particularly important in an immunosuppressed child who is a surgical patient.

Convection

is the flow of heat from the body surface area to cooler air.

Conduction

is the loss of heat from the body surface area to cooler surfaces that the newborn may be in contact with.

Radiation

is the loss of heat to a cooler surface that is not in direct contact with the newborn.

What is the chorion?

is the outer membrane that surrounds the amnion, the embryo and other membranes and entities in the womb. -Formed by two layers; trophoblast as the outer layer and mesoderm as the inner layer.

Polyhydramnios

is too much amniotic fluid. Identified by fundal height more than 2 liters of fluid. -Suspect gestational diabetes, abnormalities.

cyanosis

lack of O2 in the tissues. Central cyanosisis your core body and is concerning- Peripheral is extremities

LMP

last menstrual period

Low birth weight

less than 2500 grams

caput succadaneum

localized swelling of the soft tissues of the scalp caused by pressure on the head during labor.........normal finding......crosses suture line

Plantar reflexes (Newborn Assessment)

look for clubbed feet

Genitals (Newborn Assessment)

look for descended testes, labia covers clitoris

Patent anus (Newborn Assessment)

meconium stool in the first 24 hours

Safe environment parameter for newborns

medical record - ID # - Sex - Date of Birth

What causes pain because it has prostaglandin in it?

menstrual blood has prostaglandins. NSAIDs are anti-prostaglandin

Rectal, axillary, oral, temporal & tympanic

methods of taking a temperature in an infant is ____.

condoms

most effective in protecting from STIs

NST

most widely used technique for antepartum evaluation of fetal well being performed during the third trimester.

Three markers for fetal well being

movement, heart tones, is baby growing?

2nd period of reactivity

newborn usually ready to eat after waking. May need to be suctioned, stimulated, get to cry to loosen liquids before feeding

APGAR of 7-10 indicates

no distres

cold cabbage leaves

nonpharmacological treatment for engorgment

hypoglycemic babies

normal blood sugars for newborn: 70-100 lowest clinically accepted BS is 60

birth control pills

not preferred for over 35

physiologic jaundice

occurs 24 hours after birth due to bilirubin's levels rise because the newborn's liver can not keep up with the breakdown of RBC. -If levels get too high and over 20 the baby will get kernicterus - mental problems

nuchal cord

occurs when the cord is wrapped around the fetal neck

*BREECH* Presentation

occurs when the fetal buttocks enter the maternal pelvis first. Breech presentations occur in approximately 3% of births and are classified according to the attitude of the fetal hips and knees. Breech presentations are more likely to occur in preterm births or in the presence of a fetal abnormality such as hydrocephaly (head enlargement due to fluid) that prevents the head from entering the pelvis.

physiologic jaundice

occurs48-72 hours after birth due to bilirubin levels rise because the newborn's liver can not keep up with the breakdown of RBC. If levels get too high and over 20 the baby will get kernicterus - mental problems

protein in urine helps identify the severity

of preclampsia

Morphine sulfate

opioid delivered with spinal block

Inversion of uterus s&s

pain in lower abd vag bleeding dizziness low BP pallor

dysmenorrhea

painful period- could be from endometriosis, or fibroid. Heating pads, exercise, stretching, good nutrition, avoid alcohol and drugs, decrease caffeine. NSAIDS is most commonly prescribed.

Abruption

painful risk factors-hypertension, trauma, drug use, past C-section

DM Type 1

patient on insulin coming into pregnancy,

AMNIOTIC FLUID AMOUNT

peaks around 34 weeks at 800-1000mL and then decreases to 500-600mL at term

erythema toxicum

pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks.

Post dates (past 42 weeks) -risks:

placenta breakdown, baby gets bigger, meconium, stillbirth.

Methods of induction

prostaglandins applied cervically admin of IV oxytocin amniotomy stripping of membranes nipple stimulation

*STATION*

refers to the level of the presenting part in relation to the maternal ischial spines. In the normal female pelvis, the ischial spines represent the narrowest diameter through which the fetus must pass. The ischial spines, blunted prominences located in the midpelvis, have been designated as a landmark to identify station zero.

left side lying position

relieves pressure being exerted on inferior vena cava; provides better blood supply and oxyenation

non pharmacological

repositioning, music, drawing, toys, or distractions are examples of ___________.

Magnesium Sulfate Risk to Baby

respiratory depression

Natural family planning

rhythm method, hormone free, identifying fertile period

Prolong deceleration

right now cut off O2 to mom; seizure, PE, CVA really compressed cord.

tubal ligation/vasectomy

risk of ectopic pregnancy goes up.

Montgomery Tubercles

sebaceous glands that secrete protective lubricating oily substance in pregnancy, nursing

Morning sickness is due to:

secretion of hCG by placenta, subsides end of 1st trimester, management includes eating crackers upon awakening and eating small frequent meals.

Bulb syringe

self-contained, soft rubber and manual pump designed to create pressure to deliver fluid as it passes through one-way valves located within the bulb. It is used only to deliver fluids; it cannot be used for aspiration.

Basic fears of children are:

separation, abandonment and fear of pain/unknown. [Infants from 6 mos. through toddler hood - fear of separation.]

APGAR of 0-3 indicates

severe distress

Hyperemesis Gravidarum

severe nausea and vomiting in pregnancy--can cause severe dehydration in mother and fetus

epiglottitis

severe, life threatening infection of the epiglottis and supraglottic stuructures that occurs most commonly in children between 2 and 12 years of age. (croup)

anytime the mothers rubella is negative

she needs to be given a rubella titer right after delivery and avoid pregnanc at least for 1 month

Effacement

shortening of the uterine cervix and thinning of its walls as it is dilated during labor, Thinning of the cervix in preparation for childbirth

Communication: Hearing deficit

sign language, pictures, computerized electronics, eye contact, touch, turn light on. Gain their attention before speaking, face child when speaking, speak slowly and loudly.

epigastric pain is

sign of hepatic problems and should be something reported during the 3rd trimester

Grunting and nasal flaring are:

signs of respiratory distress

Third stage pain:

similar to first stage pain

First degree laceration extends through:

skin of perineum

Second degree laceration extends through:

skin of perineum muscles of perineum

Nagele's Rule

start w/ 1st day of last menstrual period and count back 3 months, then add 7 days, One method for calculating the estimated date of birth, or "due date."

Moro Reflex

startle reflex; activiated when support for the neck and head is suddenly removed; arms out as grasping onto something

A client who is at 8 weeks of gestation tells the RN that she isn't sure she is happy about being pregnant. The RN should respond to the client by

stating, "It is normal to have feelings during the first few months of pregnancy." Ambivalence during the first trimester is a normal response. The client usually overcomes ambivalence before the second trimester.

Terbutaline

sub-Q side effects are maternal tachycardia -used for preterm labor, can only give three injections, if terbutaline doesn't stop contractions then Magnesium sulfate is given (4 gram bolus, 2 gram maintenance).

Naegele's rule

subtract (-) 3 months, add (+) 7 days, and (+) 1 year to the start of the last period. *ex/ LMP 8/3/14 Month: 8-3 = 5 Day: 3 + 7 = 10 Year: 14+1= 15 EDD = 5/10/15

C/Section

surgical birth of the fetus an incision in the abdominal wall and uterus

Hip dysplasia (Newborn Assessment)

symmetry gluteal folds

Crackles and wheezing are

symptoms of fluid or infection in the lungs.

retrovir

taken daily can reduce chance of transfer from mother to infant

Apgars

test given to newborns one minute after birth and again four minutes later. It is a scaled rating of the infant's physical condition based on 5 measures

afterpains are increased with

the amount of pregnancies

A RN is teaching a group of clients who are pregnant about behaviors to avoid during pregnancy. The client needs further instruction when

the client states "I can have a drink of wine with dinner." No alcohol should be consumed during pregnancy.

Lanugo

the fine downy hair covering a human fetus

Menarche

the first occurrence of menstruation in a woman

Cystic Fibrosis

the following are all S/S of ______ Newborns may see meconium ileus. Bulky greasy, foul-smelling stools containing large amounts of fat. Infants eat well but don't gain weight. Salty taste to skin (sweat chloride test over 60 mEq/L). Poor absorption of Vit D.

from weeks 18-32

the fundal height should be similar to GA +/- 2

Postpartum the mother should not lift anything that is heavier than:

the infant

object permanence

the infant knows that an object still exists even if covered up or removed from sight (9-10 month)

conception

the interruption of the ability to conceive.

acrocyanosis

the nuse should swaddle infant due to it's poor circulatory system

Caput

the occiput of the fetal head which appears at the vaginal introitus prior to delivery of the head

*Intervillous Space*

the part of the placenta that surrounds the chorionic villi and contains maternal blood

Lightening

the process or time during late pregnancy when the fetal head begins to descend into the mother's pelvis, resulting in a lessening of pressure on the diaphragm

Amniotic fluid

the serous fluid in which the embryo is suspended inside the amnion

Postpartum disorders are:

unexpected events or occurrences that may happen during the PP period

Spontaneous abortion or can choose to legally terminate

up to 20 weeks

Changes in fetal circulation

upon first breath the ducts begin to close. Assess CV system for color, pulse, cap refill and blood pressure

When is the newborns first urine and stool?

urine within 24 hours, 1st stool in 12 hours. -The first stool is meconium and is black and tarry

When is the newborns first urine and stool

urine withing 24 hours, 1st stool in 12 hours. The first stool is meconium and is black and tarry

Emergency contraception

use with antiemetic, doesn't have any effect on implanted fetus, done within 72 hours.

Azithromycin

used for urethral, cervical, and rectal chlamydial infection 1g orally in single dose

intrauterine pressure cath

used to assess uterine contraction activity

tocolytics

used to stop labor contractions; associated with pulmonary edema

Determine Presentation of baby:

vaginal exam and Leopold's, head down or vertex,

Erythema toxicum

very common rash in infants. It appears in up to half of newborns carried to term, usually between day 2-5 after birth. small pustular lesions, each on a separate reddened base.

2nd Stage of Labor Begins

w/ 10 cm dilation and ends w/ birth of fetus -Urge to push, concentration w/ pushing efforts -Delivery of Baby; 2nd stage delivery of baby (2-3 hrs), baby crowning and close to delivery, 3rd stage delivery is of placenta - biggest risk is hemorrhage, 4th stage is recovery is complete 2 hrs.

liver

we have to be careful when administrating acetaminophen to children as it can damage the ___.

Anatomical problems in males affecting the renal system

• *Crypytorchidism* -One or both testes fail to descend through the inguinal canal into the scrotal sac (no concern until 1 year )monitor for spontaneous descent in first 12 months of life, surgical correction between 1-2 yrs, monitor for bleeding • *Epispadias*- Urethral orifice located on the dorsal surface of the penis (above the usual opening) • *Hypospadias* .-Urethral opening located below the glans penis along the ventral surface Nursing management- sometimes antispasmodics such as Ditropan is prescribed post-op to treat painful bladder spasms. No tub baths, monitor pain level and output.

*TUBERCULOSIS* Pediatric Variations in Mantoux skin test

• *Induration of 15 mm* or greater in child 4 years or older considered positive for TB • *Induration 10 mm* or greater is positive in child younger than 4 years • *Induration of 5 mm* or greater is positive in children from high-risk group, such as with *Immunocompromised condition*

*BLOOD VOLUME*

• An increase in maternal blood volume begins during the first trimester and peaks at term. • The increase approaches 40% to 45% and is due primarily to an increase in plasma and erythrocyte volume. • Additional erythrocytes, needed because of the extra oxygen requirements of the maternal and placental tissue, ensure an adequate supply of oxygen to the fetus. • The elevation in erythrocyte volume remains constant during pregnancy.

*LEUKORRHEA*

• An increased whitish vaginal discharge, results from hyperplasia of the vaginal mucosa and increased mucus production from the endocervical glands. • The discharge is often profuse and may be worrisome. As the due date approaches, cervical effacement and dilation cause a breakdown of the mucus plug, resulting in an increased vaginal discharge. The nurse should reassure the patient about the normalcy of leukorrhea during pregnancy • CALL PHYSICIAN : If the discharge appears thicker; becomes bloody or yellowish/green; is accompanied by a foul odor; or if it causes itching, irritation, or pain in the vulvar or vaginal area.

Risks with inadequate nutrition:

• Cardiac and organic failure, electrolytic imbalance, cardiac dysrhythmia, tooth enamel erosion, esophageal damage. Kids are obsessive picky eaters. • Older kids become obsessive and restrictive. • Over-eaters think about meals before all else. • In little kids they can become constipated, unhealthy. • Anemia can be an issue. Food fads are not uncommon and if the child has a daily food intake that is overall balanced, the parent should be comforted and instructed to continue to track the intake.

*CARDIAC OUTPUT*

• Cardiac output increases, and peaks around the 20th to 24th week of gestation at about 30% to 50% above pre-pregnancy levels. • It remains increased for the duration of the pregnancy. With the increased vascular volume and cardiac output, vasodilation (related to progesterone induced relaxation of the vascular smooth muscle) prevents an elevation in blood pressure. • The woman's pulse rate frequently increases up to 10 to 15 beats per minute to facilitate effective circulation of the increased blood volume

*IRON DEFICIENCY ANEMIA*

• Caused by inadequate supply of dietary iron • Most common ages 6 months - 2 yrs. & in adolescences • Generally preventable o Iron-fortified cereals and formulas for infants o At risk if excessive cow's milk intake in toddlers- poor iron source o Adolescents at risk because of rapid growth and poor eating habits

Pregnancy *PRESUMTIVE*

• Chadwick's sign • Goodell's sign • Ballottment • Positive Pregnancy Test

*ASTHMA*

• Chronic inflammatory disorder of airways • Bronchial hyperresponsiveness • Episodic • Limited airflow or obstruction that reverses spontaneously or with treatment Assessment • Asthmatic episode begins with irritability, restlessness, malaise, chest tightness; progresses to hacking, irritable, nonproductive cough, with development of retractions, hyperresonance, crackles, rhonchi, wheezing, dyspnea • Ventilatory failure, asphyxia may occur • Young children may assume tripod position; older children sit upright with shoulders in hunched-over position

*INFECTIOUS MONONUCLEOSIS* Presentation and concerns

• Common in adolescents • Diagnostic tests • Therapeutic management • Prognosis • Nursing care management • 30-50 day incubations • *Throat can be significant pain* • *Spleen can get enlarged red flag constant abdominal pain and referred pain to the shoulder*

*TWO CATERGORIES of CARDIAC DEFECTS*

• Congenital-Anatomic: abnormal function-result in heart failure and hypoxemia- "Within" • Acquired (i.e., Rheumatic Heart Disease)- "Without" Disease process : • Infection • Autoimmune response • Environmental factors • Familial tendencies

*TRUE LABOR*

• Contractions are at regular intervals. • Contractions increase in frequency, duration, and intensity. • Pains usually begin in lower back, radiating to the abdomen. • Dilation and effacement of the cervix are progressive. • Activity such as walking usually increases labor pains.

*FALSE LABOR*

• Contractions are irregular. • Usually there is no increase in frequency, duration, or intensity of contractions. • Pains usually occur in the abdominal region. • There is no change in the cervix. • Walking may lessen the pain.

*SICKLE CELL ANEMIA* Diagnosis

• Cord blood in newborns • Newborn screening done in 43 states • Genetic testing to identify carriers and children who have disease • Sickle turbidity test

*APLASTIC ANEMIA* Patho and presentation

• Deficiency of circulating erythrocytes and all other formed elements of blood , resulting from the arrested development of cells within the bone marrow • Hypoplastic anemia: profound depression of RBCs but normal white blood cells WBCs and platelets • Treatment- restore function to the bone marrow & involves immunosuppressive therapy & bone marrow transplant.

*SEIZURE TYPES* Absence Seizures

• Formerly called petit mal or lapses • Brief loss of consciousness • Minimal or no change in muscle tone • Almost *always appear in childhood (4 to 12 years old)* PT LOOKS AS IF THEY ARE DAYDREAMING

*CHLOASMA* or *MELASMA GRAVIDARUM*

• Forms the "mask of pregnancy". This dark, blotchy brownish pigmentation change occurs around the hairline, brow, nose and cheeks and often gives the appearance of "raccoon eyes." • The heightened pigmentation fades after pregnancy but can recur after exposure to the sun. • During pregnancy the skin becomes photosensitive and sunburn may occur in a shorter exposure time than usual for the individual.

*IRON*

• Iron is necessary for the formation of hemoglobin, the oxygen-carrying component of the erythrocyte. • The increased need for oxygen requires the pregnant woman to increase her iron intake. • The fetal need for iron is greatest during the last 4 weeks of pregnancy, when the fetal iron stores are amassed.

*ICP* Personality and Behavioral Signs of Increasing Pressure

• Irritability, restlessness • Drowsiness, indifference, decrease in physical activity and motor skills • Diminished physical activity • Inability to follow commands, memory loss • Lethargy and drowsiness

*ICP* *INFANTS* sign and symptoms

• Irritability/ poor feeding • *High pitched cry/ difficult to soothe* • Fontanels: Tense & Bulging • Cranial Sutures Separated • Eyes: Sun Setting Eyes signs • Scalp Veins Distended

*CHORIONIC VILLUS SAMPLING (CVS)*

• Is an invasive procedure that can be used to obtain a fetal karyotype. • Because the villi arise from trophoblast cells, their chromosome structure is identical to that of the fetus. • CVS is performed between 10 and 12 weeks' gestation and results are available quickly due to the rapid proliferation of the chorionic villi cells. • Using ultrasound guidance to locate the chorion cells, a thin catheter is inserted vaginally into the intrauterine cavity.

*SEIZURE TYPES* Therapeutic Management

• Ketogenic Diet ( High Fat, Adequate Protein, Low Carbs) • Vagus Nerve Stimulation • Epilepsy Surgery

*SPINA BIFIDA* Types

• Occulta • Meningocele • Myelomeningocele

*ICP* Pain Management in Comatose Child

• Opioids • Fentanyl, Midazolam, Vecuronium • Acetaminophen Codeine • Quiet, Dim lit environment *PAIN INCREASES ICP*

*ICP* Medications

• Osmotic Diuretics • Sedatives / Antiepileptic's • Paralytic agents • Anti-Pyretics • Barbiturates (last resort)

*PHARYNGITIS* Clinical Manifestations

• Varies in severity from no symptom to severe • Pharyngitis - Headache, fever, abd pain. • Tonsils and pharynx inflamed, exudate, petichiea on palate • Scarlatene rash

*THE FETAL PERIOD* *Weeks 13 to 16*

• Very Rapid Growth • Coordinated Movements • Ossification of Skeleton • External Genitalia Recognized • Ovaries Differentiated • Ovarian Follicles Present

*ANEMIA* Three Types or Causes

↓ RBC Production ↑ RBC Loss ↑ RBC Destruction

A client who is 2 weeks postpartum and breastfeeding reports breast engorgement. Which recommendation should the nurse make?

"Apply cold compresses between feedings"

tetralogy of fallot

"Boot-shaped heart" Pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertropophy

A parent has been given info about care of a newborn following circumcision. Which statement by the parent indicates a need for further teaching?

"I will give him a tub bath within a couple of days." *A tub bath should not be given until the circumcision is completely healed.

Which of the following statements made by the parent of a newborn indicates a good understanding of how to use a bulb syringe to suction excess mucus from the newborn's airway?

"My baby's mouth should be suctioned before her nose." to prevent aspiration during the gasp response.

A nurse is preparing to administer a vitamin K (Aquamephyton) injection to a newborn. Which of the following is an appropriate response by the nurse to the newborn's mother regarding why this medication is given?

"Vitamin K assists with blood clotting."

Anacephaly

"no brain" baby dies at birth usually-failure of the brain to form

*ANGIOMAS*

"vascular spiders" - tiny, bluish- end-arterioles - occur ABOVE THE WAIST ONLY; may be star shaped, slightly raised, do not blanch with pressure; caused by increased estrogen levels

GI disorder presentations and treatment *HIRSCHSPRUNGS*

(*congenital aganglionic megacolon*) Acute or chronic - Congenital anomaly with mechanical obstruction results because of inadequate motility in an intestinal segment. *Ribbon-like and foul-smelling stools.* Treatment- Surgical removal of the section (may have a temporary colostomy)

Parity

(obstetrics) the number of live-born children a woman has delivered

Amniocentesis

(pregnancy) extraction by centesis of amniotic fluid from a pregnant woman (after the 15th week of pregnancy) to aid in the diagnosis of fetal abnormalities

*PISKACEK SIGN*

(uterine asymmetry with a soft prominence on the implantation side) may also be associated with uterine tumors.

Neurological - seizures and LOC - using Glasgow coma

* Score of 1-15 * Score of 9-15 (unaltered state of consciousness) Score of 8-4 (state of coma) Score of 3 or below (deep coma) Glasgow Coma Scale assesses: Eye opening- pupil dilation Verbal Response- answer questions Motor Response- move when asked -Neuro exams include hand strength, limb strength, and ability to follow commands, ability to move eyes in equal and uniform fashion, deep pain stimulus response, symmetrical and coordinated movement, clear, speech.

Important stuff about respiratory

**ABC'S trump all!! Maintain the Airway first. -Children have Shorter airway, larger tonsils, Epiglottis & trachea is longer and flaccid, floppy which is a greater risk to child's airway. -Upper Resp- Sinuses, airway, trachea, upper bronchioles. -Lower Resp- involves lower bronchus and lungs.

When a child is brought in by EMS for evaluation following an accident the nurse understands that the child is evaluated on the A-B-C-D scale

**Airway, Breathing, Circulation and Deformity (& Exposure; signs of trauma bleeding, rash). -This is the standard trauma algorithm for emergency care: • Airway- Is the airway patent? • Breathing- Is the breathing sufficient? RR, cyanosis, lung auscultation • Circulation- Is the circulation sufficient? Cap refill, pulse, color changes • Disability- What is the level of consciousness? Alert, responds voice, responds to pain, unresponsive AKA Glasgow Coma Score.

When to Take APGARs?

**At 1 and 5 minutes -possibly at 10 minutes if score is not where you want it to be

Adapting to deficits

**Child will learn to adapt to deficits quickly, better to recognize problem early on before they adapt, then harder to find the problems. May adapt to disabilities so that you may not notice them

Hallmarks of Cystic Fibrosis

**Complex; exocrine disease; thick mucus that blocks exocrine glands that affect several body systems; Respiratory, GI, and reproductive. -thick mucus secretions block the exocrine glands and other body systems as well as contribute to bacterial growth. -CF is a multisystem disease (failure of two or more organs) mucous overproduction; initially presents itself in the GI system, causing obstruction, bulky stools, that are frothy and foul smelling, [Malnutrition, anemia, growth failure persists] - In lungs; impedes lungs [crackles, wheezes, diminished breath sounds with dry non-productive cough; pneumonia, bronchitis]. -salty skin [sweat not reabsorbed] -don't typically live through teenage years w/o transplant -Both parents have to have autosomal recessive gene (trait) to pass on. Children are typically sterile.

APGAR 0-3

**Immediate resuscitation!! -Establish airway -Provide O2 -Stimulate newborn

What drug is most frequently used for severe or postoperative pain in children?

**Most common medication used post-op pain is *morphine* - Biggest risk - Respiratory depression. • Titrate meds very carefully; until 110 lbs. or 50 kg use adult dose, cannot continue to use age and weight=overdose • When child is 50 kg they can go up to the adult dosing • Aware of Respiratory depression, liver and kidneys functional, hydrated well, addiction possibility

Reyes Syndrome - complicated how?

**No aspirin to any child under the age of 18, with a viral illness. -Reye's syndrome thought to be driven by the use of aspirin in a child who has, or has recently had a febrile illness. **Aspirin used only when benefit outweighs risk [some rheumatologist's and cardiologist's will use aspirin in children if their condition warrants it].

Immunocompromised or suppressed children - what are the risks? How do we prevent risks?

**No aspirin to any child under the age of 18, with a viral illness. -Reye's syndrome thought to be driven by the use of aspirin in a child who has, or has recently had a febrile illness. -**Aspirin used only when benefit outweighs risk (some rheumatologist's and cardiologist's will use aspirin in children if their condition warrants it). -Best possible infection control for all patients is excellent hand hygiene by patient, family and nursing personnel. **Handwashing super important!!

Constipation may also occur due to increase/decrease in activity, anxiety, or disease - so we must get some historical information - what would you be asking?

**The nurse should ask the caregiver: to describe the color, consistency, frequency, and characteristics of stool. -Pain of constipation is typically left sided abdominal pain. -Some rectal pressure may be evident. -Focus on fluids, exercise and fibrous fruits are recommended. -Children with a sense of lack of control may hold their stools and develop mega-colon. -Education for the caregiver: dietary needs, toileting practices, and bowel cleansing.

Kawasaki disease

**requires long term antibiotic therapy, ASA therapy -onset of high fever [up to 104f] and enlarged lymph nodes on the neck. -Bright red rash [more obvious on groin area]. -Conjuctivitis -dry cracked lips -"strawberry tongue" -swollen hands and feet after fever subsides -skin peels off hands and feet -treat with high dose aspirin and gamma globulin. -Most cases occur in children under the age of 5 years.

Milestones of infancy

*-0-6 months, 14 lbs at 6 months and 21 lbs at 1 year. -Babble 4-6 mo. -Tummy to back 5 mo. -Back to tummy at 6 mo. -Sit up 8 mo Stand 11 -Walk 12 months

During fetal development a nurse can recognize well- being of the fetus through 3 things?

*3 Methods baby is growing/active: - fetal movement -fetal heart rate -fundal height

Respiratory distress in older children

*6 years old-wheezing, crackles, tripod position, drooling, adventitious breath sounds, nasal flaring, tachycardia, tachypnea, labored breathing

Why are children more prone to UTI?

*Children have unique challenges avoiding UTI's due to their frequent interest in handling their genitals with unclean hands (hand hygiene), as well as having short urinary tracts in girls.

More with cares for sprains & fractures

*Crutches or braces may be used as adjunctive therapy. If no weight bearing is ordered, patient should be fit for crutches. -Casts; don't stick anything down into cast, or make indents in casts. Complications; compartment syndrome, cast syndrome (compressing) -Nursing Considerations; skin, perfusion, sensation and movement, emotional affect of child, respiratory management, & pain management

Other therapies for sprains and broken bones

*Crutches or braces may be used as adjunctive therapy. If no weight bearing is ordered, patient should be fit for crutches. -Casts; don't stick anything down into cast, or make indents in casts. Complications; compartment syndrome, cast syndrome (compressing) -Nursing Considerations; skin, perfusion, sensation and movement, emotional affect of child, respiratory management, & pain management.

*APLASTIC ANEMIA* Diagnosis

*Definitive diagnosis confirmed by bone marrow aspiration (shows conversion of red bone marrow to fatty bone marrow)*

Discipline and limit setting - what is appropriate. Know families - and how they cope with stress - how do children cope with stress?

*Discipline is for- Safety and education with positive reinforcement; to make good choices, aggressiveness with toddlers because they don't remember: Withholding, time out, rationalizing, distractions -Harmful disciplines - Corporal punishment (okay to hit, slap or harm), Isolation (in some cases), (demoralizing) screaming/verbal abuse, neglect - passive aggression. -Authoritarian- dictator -Authoritative/democratic-is most effective **Beneficial - Time out (without isolation) redirection, distraction, positive reinforcement, modeling preferred /desired behavior, removal of privileges, natural consequences of actions.

Decelerations [Early, late, variable]

*Early- head compression *Variable- cord compression *Late- placental insufficiency!

Assess from the Top down [Newborn Assessment]

*Gestational markers; Breast buds, creases on feet, ear rebound or recoil, descended testes, labia covers clitoris & bottom of the feet has crease.

Describe the terms used to evaluate contractions

*INCREMENT*- building of the contraction *ACME*- peak of the contraction *DECREMENT*- decrease in the contraction

*DEHYDRATION* presentation and management 3 types of dehydration oral rehydration opposed to IV

*Isotonic* - Water and salt are lost in equal amounts. Primary form of dehydration in children-replace fluid rapidly *Hypotonic* -Electrolyte loss exceeds water loss leaving the serum hypotonic. Replace rapidly. *Hypertonic* -Water loss exceeds electrolyte loss. Serum sodium concentration is greater than 150 mEq/L puts them at risk for neurological changes. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes if IV fluid replacement necessary- REPLACE SLOWLY infuse over24-48 hrs to prevent cerebral edema. Where do we lose fluid? Skin, resp, bladder, bowel, • In hypertonic, shock not a big threat, neuro problems more evident, damages may be permanent • Elevated Labs with Dehydration- Hct, Hgb, BUN, creatinine, and Urine specific gravity • IV fluid replacement is typically saline solution with 5% dextrose

Pain is a frequent assessment done on all patients - what about pain assessments in children?

*Manage as you would an adult. -Pain scales- Faces and FLACC are preferred. *For children 10-12 years old can use the numerical pain scale. -Believe the child's report.

Vaginal exams are means to measure progress, what are you examining and what it means? Example - 3cm, 90%, -2 ( what does this mean)

*Measuring: Effacement, dilation, presentation, (descent) station, position* * 3 cm dilated, 90% effaced and 2 cm above ischial spine [active phase of labor—admit pt.] -Ex/ what is 1, 50 and minus 1? Answer: 1 cm dilated, 50% effaced, 1 cm above ischial spine -Ex/ Complete, complete (or fully, fully) and +2? Answer: 10 dilate, 100%, below ischial spines. *Note: +4 on the floor, - is away from* -Presentation of baby: vaginal exam and Leopold's head down or vertex

*CYSTIC FIBROSIS* First Sign

*Meconium ileus* Lack of first bowel movement

Autism

*Multi-spectrum process- from savants to non-functional; Early intervention- realistic goals; productive individual -Unable to engage in social communication (poor eye contact) -Communication impairment (no language use or major errors in speech) -Restrictive and repetitive behaviors (playing w/ toys in unusual way, preoccupied w/ parts of toy instead of just playing w/ it, following strict routine)

Ways to interact friendly interchange with parents/address child:

*No medical jargon -Get to their eye level, engage child and address child -Talk slowly & clearly (concrete words) assess child's cognitive ability -Utilize play, transitional objects, drawings, colors, pictures -Use a child life specialist to assist with communication & interactions -Allow child to make noise and be upset, give child something to do. [Make nice with parents]

Communication with children and families. What are the general rules to communicate with everyone, and specifically children.

*No medical jargon, Get to their eye level, engage child and address child, Talk slowly & clearly (concrete words), assess child's cognitive ability, utilize play, transitional objects, drawings, colors, pictures, use a child life specialist to assist with communication & interactions, allow child to make noise and be upset, give child something to do.

Pre and post-operative care of the child with any surgery and then specific signs to watch for in respiratory issues, throat surgery, abdominal surgery, extremities, head.

*Pre-OP - NPO if necessary, explain what is going to happen *Post-surgical-*Pain management*, checking incision, check for bleeding (excessive swallowing for tonsillectomy), and monitor vitals, proper diet is in place, proper activity level. [[(From Lecture): *Do a Head to toe; airway, dressings, distal pulses, ROM, if bed ridden check for circulation issues (SCDs), Check I&O, activity, check IV site to make sure patent; not infiltrated. *Tonsillectomy-lie to one side or semi-fowlers 30°, evaluate drainage. No red stuff to eat/drink. *Appendectomy-look for abd distention, check for pain, I&O, bowel sounds. **Know what the pts. orders are**]].

Why do children have more Respiratory infections?

*Shorter softer airway, short Eustachian tubes, soft epiglottis & trachea, larger tonsils; exposed to more bugs (germs), doesn't have a very good immune system, puts everything in mouth. *Children are oral, poor at hygiene, and not fully developed tissues to manage the illness. Intercostal muscles weak, abdominal breathers when little. Infants are obligate nose breathers. **ABC'S trump all!! Maintain the Airway first.........epiglottis is longer and flaccid and greater risk to child's airway.

Why more infections in children?

*Shorter softer airway, short Eustachian tubes, soft epiglottis & trachea, larger tonsils; exposed to more bugs (germs), doesn't have a very good immune system, puts everything in mouth. *Children are oral, poor at hygiene, and not fully developed tissues to manage the illness. Intercostal muscles weak, abdominal breathers when little. Infants are obligate nose breathers.

Respiratory - croup syndromes, risks, how do we manage? [Use only cool mist vaporizers due to risk of burns. Rest is promoted] some medications? Know these. Surgical interventions and sign to observe for?

*Stridor*; trachea get edematous because it's dry. Sounds like a seal (seal bark), moist steam (humidifier); evening or at night time take kid outside. **Viral, some is transient. Larynx can become inflamed and swollen. Narrow airway diameter so children more susceptible. Poor tissue perfusion.

Gestational Diabetes Mellitus (GDM)

*Surveillance- Cannot metabolize carbohydrates (manifests during latter half of pregnancy because of altered "hormone milieu"); age >25; obese, history of large babies, family history of DM, ethnicity risk factor, treated with diet or insulin (depends on blood sugar) *Risks to baby: risks for impaired insulin tolerance and DM later in life, macrosomia (big baby)

Diabetes Mellitus Type 2

*Surveillance- Insulin resistance or inadequate production of insulin; age >30; slow onset, can be treated with insulin or diet *Risks to baby: effect growth and development of fetus (risk of major congenital defects due to hyperglycemia during organ development phase), increased risk of perinatal death, adverse effects throughout life for child.

AFE (amniotic fluid embolus) - risk:

*everyone at risk*, -mother's do not survive if AFE is released into cardiac or resp. systems, -Causes by change in intrauterine pressure [rupture membranes, IUPC, manipulation within uterus] - S/Sx of AFE: dyspnea, chest pain

Latent phase [of stage 1]

*not many risk factors; baby is not in any stress, contractions are far enough apart not very strong, uterus not too tired yet, really affecting baby.

Remember where baby is ischial spine:

+4 on the floor "below", and - (minus) is away from "above"

*FUNGAL STI*

- CANDIDA - YEAST

Dehydration

- Children that become dehydrated may suffer long term organ damage; encourage fluids - PO or IV. -Watch the titration however, it may cause problems if we run fluids too rapidly. -We do not restrict fluids, keep track of what they are drinking - milk may thicken secretions - fruit juice may induce diarrhea, soda/pop -May also induce diarrhea or cramping.

VIRAL STI - THE 4 H's

- HERPES = HSV-1 = Cold Sores & HSV-2 = Genitals - HPV = Human Pampillovirus-> Lead to Cervical CA - HBV = Hepaptitis B - HIV/AIDS

Management of Croup

- Nebulization, oxygen tent, corticosteroids, if necessary use antibiotics, monitoring, artificial airway in emergency. -Use cool night air, cool air from the refrigerator or freezer, or a steamy bathroom (from running a hot shower) to assist in rearing the child's breathing. -With any respiratory compromise, elevate HOB to ease breathing.

Restraints

- are used for procedures to keep children safe. *MUST BE ORDERED!* *2 common types of restraints- mummy and elbow restraints. • Elbow prevents elbow flex - can't reach things to pull/touch. • Mummy is swaddling and whole body stabilization. Used for procedures and medication administration.

Uterine Atony

- caused by full bladder, no tone to uterus, multiple babies, infections, distended uterus circumstances, rapid/slow fatigued labor, infection in the uterus, retained placenta. -Don't want it bogy.

Convection heat loss

- cold with swooping by, drafts, etc

Evaporation heat loss

- cold with the wetness - must dry off baby

Conduction heat loss

- contact with a cold surface

What is the benefit of play?

- learn to socialize -learning society rules -communication; express thoughts -learning fine & gross motor skills -creativity & conceptualize -master skills -get stronger (muscles) -Enables child to explore, express, solve problems -Cognitive and Physical development, helps form independence over time. -provides psychosocial needs of child

Graves' (hyperthyroidism)

- overstimulation of thyroid w/ excess production of thyroid hormone (autoimmune) -S/Sx: enlarged thyroid gland, raised, thickened skin, palpitations, tachycardia, shakiness, increased perspirations, tremor, weight loss; low TSH, high T3 and T4 (Tx w/ methimazole)

Diarrhea

- rehydrate (severely - IV therapy, PO if possible), avoid soda, caffeine, sweet juices and milk; pedialyte or anything w/ electrolytes, monitor I & O, do not stop diarrhea in order to get rid of the cause (if not long term) -Do not use anti-diarrheal, do not restrict dieting.

Diabetes

- thorough education of disease, manage insulin and glucose, diet and activity, let child self-medicate. **Manage insulin, diet, & activities (is the focus DM1) *Hyperglycemia* - polyuria, polyphagia, polydipsia, slurred speech, fatigue, blurred vision, ketones in blood and urine, fruity breath. *Hypoglycemia* - shakiness, pale, sweaty, hunger, palpitations, loss of consciousness. [[Note: DM- Airway, shock, infection, fluids, pain, drugs (versed, morphine)- Key for DM is let child self-medicated and learn.]]

Hypothyroidism

- thyroid gland underactive, not enough thyroid hormone secreted, can lead to goiter if untreated, thyroid hormone controls metabolism rate -S/Sx: bradycardia, tiredness, cold intolerance, low T3 and T4, high TSH (Tx w/ levothyroxine)

Rhogam

-(Immungoglobulin) Prevent the formation of Rho(D) antibody in rH- pt. for prophylaxis threatened abortion in (rH-neg mom & future rH+ baby). -S/E: Joint muscle pain, h/a, dizzy, weakness, N/V/D, stomach pain, rash, itching -Give to mom @ 28-32 weeks and @ birth if baby is positive then another dose is given within 72 hours.

Misoprostol (cytotec)

-(Not approved by the FDA for ob use...what?); used for cervical ripening to induce labor & contractions/decrease loss of blood after labor. -S/E: torn uterus, death to fetus, h/a, abdominal pain, N/V.

Terbutaline (Bricanyl)

-(SubQ) Makes the smooth muscles of the uterus relax when under stress. -Reduce number & frequency of contractions. -S/E: "fight or flight" response, racing HR, flushing, tremors. **Don't give to women with heart disease, hyperthyroidism, poorly controlled DM.

Kids More prone to UTI

-*Children have unique challenges avoiding UTI's due to their frequent interest in handling their genitals with unclean hands (hand hygiene), as well as having short urinary tracts in girls. *Signs/Symptoms of UTI in children: Neonate -are failure to thrive, jaundice, fever or hypothermia, poor feeding, or vomiting. Infant -usually is a poor feeder, has fever, strong-smelling urine, vomiting, and diarrhea. Preschooler -often presents with anorexia and sleepiness along with vomiting, diarrhea, abdominal pain, fever, strong-smelling urine, enuresis, dysuria, urgency, or frequency. School-age child- has new enuresis, strong-smelling urine, urgency, or flank pain and some changes of personality. Adolescents-often experience fatigue and flank pain. Visual inspection of external genitalia for irritation, pinworms, sexual abuse, trauma, or vaginitis is important.

Example of late decels

-140 min. variable, NOT decelerate after contractions -Pt at risk for late deceleration- cocaine, high BP, postdates, smoking

Stage 4 [Recovery]

-2 hours -contractions continue / prevent excessive blood loss

Retinopathy of prematurity

-A disorder involving abnormal blood vessel development in the retina of the eye in a premature infant, linked to excessive prevision of O2, increasing in rate due to the greater number of VLBW infants that survive.

Apgar scores

-Activity [muscle tension] -Pulse [HR 110-160] -Grimace -Appearance; Color = Pink, acrocyanosis [hand and feet blue] -Respiratory Rate [30-60]

A CRNA is explaining an epidural procedure to a client. What is the role of the nurse before, during, and after administration of an epidural?

-Administer a bolus of IV fluids prior to epidural insertion. -Have oxygen and suction ready in the event of respiratory depression. -Palpate the client's bladder for distention and insert indwelling Foley catheter if necessary.

Epidural anesthesia: what needs to be completed before an epidural can be placed? What are the risks to mother and then to baby with epidural?

-Administered during 1st and 2nd stage of labor, -*Preload patient w/ rapid infusion of IV fluids prior to administration to help prevent hypotension*. *Risks - maternal hypotension, if administered improperly can cause CNS effects, decreased placental perfusion -Consent before epidural, 1L bolus of fluids, CBC w/ platelets, sit in C-position -Check vitals q5min until ok from anesthesia then q30min

Mechanical initiation of induction

-Aminotomy- artificial rupture of membranes (AROM) to augment or induce labor; Relaxation and breathing techniques -Non-Invasive; Nipple stimulation, Ambulation, hydration, hydrotherapy -Accupuncture -Ingestion of laxative (castor oil)

Prematurity

-Birth of a baby before the start of the 37th week -Largest single contributor to infant mortality

Treatment of Uterine Rupture

-C-section, get baby out and control rapid bleeding, possible hysterectomy (never labor again)

Apgars 0-3

-Call code, CPR, Ambu bag, O2, resuscitate baby

Chemical initiation of induction

-Cervical Ripening agents; Dinoprostone (Cervidil) -Induce labor contractions; Misoprostol (Cytotec) -Stimulate uterine contractions; oxytocin

Maternal Uterine Activity expectations

-Contractions= uterine activity -Frequency= read from the start of one to the start of the next -Strength= only with internal monitoring (ruptured; IEFM) -Duration= how long the contractions last

Harmful disciplines

-Corporal punishment [okay to hit, slap or harm] -Isolation (in some cases) -Demoralizing; screaming/verbal abuse -Neglect - passive aggression. Types: Authoritarian- dictator & Authoritative/democratic (is most effective) *Parent can go in and out of different style modes sometimes

DM: Effect on growth & development of fetus

-DM 1 & 2- Major congenital defects in CNS, cardiac, skeletal anomalies (due to hyperglycemia), Increase risk of perinatal death, adverse effects throughout child's life *GDM- risk for impaired insulin tolerance & DM later in life, macrosomia (big baby)

Anti-seizure medications

-Dilantin; can cause significant overgrowth of oral gingiva. -Strict management of the gums should be discussed with the patient and family.

Variable Decelerations

-Due to cord compression -as noted "V" shape on monitor; cord compression; change mothers position, stop infusion, apply oxygen, and increase IV fluids

HTN (fetal results):

-Growth restriction, neonatal morbidity, decreased placental perfusion; decreased fetal heart rate, fetal death.

Pitocin (Oxytocin)

-Stimulate uterine smooth muscle; induce labor, control post-partum bleeding. -S/E: seizure, hypotension, increased uterine motility, painful contractions, decreased uterine blood flow, hyponatremia. ↑BP -Titrate 1 to 2 mU in 3 ml of fluids uterine rupture, severe hypoxia, Tachysystolie raise every 20-30 goal contraction 2-3 min.

Croup signs

-Stridor; trachea get edematous because it's dry. -Sounds like a seal (seal bark) -stares into space [because of working hard on breathing], stridor, and seal barking cough

Manage newborn pain:

-Sugar water -Skin to skin -Swaddling/burrito wrap -Movement Rocking -Sucking -Distractions -Decrease stimuli

Medications of labor and when to administer them.

-Sytemic Meds- IV push- Nubian, Stadol, Demerol -Best time to give is during contraction -Peak of contraction = less med to baby

Biophysical profile (BPP) is a noninvasive "fetal physical examination"

-The fetus responds to central hypoxia by alterations in movement, muscle tone, breathing, and heart rate patterns. 5 *Components*: NST (HR), fetal breathing, fetal movement, fetal tone, amniotic fluid volume. [2 points ea, 8 to 10 good, 6 is meh... and repeated in 24 h]. *Done for high-risk pregnancies; mother has DM, GDM, HTN, baby small, baby less active, PAST DUE DATE.

Hemabate

-[Abortion drug] termination of pregnancy (13-20 weeks) & control post-partum hemorrhage -S/E: Dizzy, paresthesia, dystonia, HTN, pulmonary edema, respiratory distress, abd pain, uterine rupture, fever, pain.

Transition Phase of Labor (3rd phase of stage 1)

-[parameters] 8-10 cm pushy, 2-3 min lasting 60 secs. -For 2 hours or less. Very painful. Pt may want pain meds but now all meds go straight to baby.

Teach the child (seizures)

-about seizure triggers and safety should be implemented as soon as the child is able to understand the information, as evidenced by repeat demonstration or conversation.

Macrosomia

-check glucose -large-bodied baby commonly seen in diabetic pregnancies -weighs more than 4000 g (8.8 pounds)

What is oligohydramnios?

-decreased amniotic fluid (<300 ml) Resulting in: Intrauterine fetal restraint or compression [clubbing of feet], renal abnormalities, poor placental perfusion, premature rupture of membranes, can lead to cord compression during labor and decreased fetal blood flow.

A child with nausea, vomiting and diarrhea should be given:

-electrolytic replacement fluids -bland foods such as banana, rice, applesauce, dry toast and CLEAR liquids. -Sugars, fats and fiber should be avoided until all symptoms have subsided and stools return to normal.

Alleviate stress and fears:

-explain procedure -distraction -ask parent to stay and participate in care -explain what's going on

Ultrasound (U/S)

-first trimester- dating -second trimester -dating and anatomy -third trimester- abnormalities and placement

CHF (kid)

-fluid restriction is not used w/ peds except in severe cases, poor feeding and growth, SOB, excessive sweating, bulging fontanelles -May be prescribed diuretics (Lasix), digoxin, vasodilators (captopril); All three may be used depending on the case -Vigilant surveillance of vital sign and bleeding. If bleeding is severe the patient must be attended with pressure held to the site while another nurse contacts the physician and calls for immediate assistance.

3rd degree burns:

-full thickness -white -waxy or leathery -no blanching or bleeding -may be black in color (eschar) -less painful from nerve damage -referred to burn center -skin grafting necessary -risk for infection and fluid loss **take several weeks to heal

Sickle cell anemia

-genetics, crescent shaped RBCs, sickling in joints. -Causes: Poor O2, severe pain, weakness -Risks: Infections and dehydration -Tx: O2, fluids (IV), Abx, pain meds.

Neuro exams include:

-hand strength, limb strength -ability to follow commands -ability to move eyes in equal and uniform fashion -deep pain stimulus response -symmetrical and coordinated movement -clear, speech.

Mastitis

-hot red streaks, unilateral, warm to touch, flu-like symptoms, engorged lymph nodes under arms -Treatment: Keflex (Abx), keep breast empty (milk duct infected)

Make a visual inspection of placenta

-maternal side; cotyledons (Dirty Duncan; bloody, messy) -cord embed in center for baby side (dirty Duncan or shiny Schultz). -Inspect cord; How many vessels (AVA) two arteries and one vein -If not AVA = renal disease or cardiac problems of baby, look for any missing pieces. -Risk to mom is hemorrhage

Oral meds

-measure correctly, don't use spoon or cup, no ASA for children except for Kawasaki's. -Uncooperative use syringe. -Do not mix in formula. Mix in food. - Make sure getting correct dose.

Non-Stress Test

-measures heart rate acceleration; 15 beat increase in 15 seconds need three in 20 minutes. -non-reactive NST doesn't meet the 15 beat criteria.

Drugs (fetal results):

-meth; tremors, poor muscle tone, -heroin;withdrawl, -cocaine; teratogenic malformations, structural or organ anomalies, later in fetal life or during early infancy may cause mental retardation, blindness, hearing loss, deafness, stillbirth, or malignancy

GERD

-more common in *premature infants*, S/S: vomiting (may include undigested food or formula), fussy or irritated mood, refusal to feed because of discomfort, choking, wheezing, apnea, weight loss, frequent respiratory infections • May need to change volume of feeding, small amounts more often and burping frequently • Cereal added to bottle, position more upright (45 degree angle) • Meds: PPI (omeprazole), H2 inhibitors (cimetidine) • Surgical: Nissen fundoplication, feeding jejunostomy

Psychosis

-most severe form. -Disengaged with life and reality -Hears voice -Needs to be hospitalized to keep baby safe.

3rd Degree laceration of perineum

-mucosa, down to rectal sphincter -Ice, analgesics, sitz bath, + Stool softener

Non-Pharm methods to allievate pain

-music and distraction -relaxation -holding hand -cuddling -reassurance -For baby use non-nutritive suckling, cuddling, sugar water -Play, toys, draw pictures

Postpartum blues

-normal phenomenon, hormone changes, scared that baby will take up energy. -Starts 3 to 10 days after delivery -Last 2 to 3 weeks

Physiological Anemia of Pregnancy (pseudoanemia)

-occurs in wks 32-34 and shows low Hct and increase in total plasma volume -Educate to drink 6-8 glasses of water to stay hydrated and diet high in protein and iron [May need to supplement iron] fetal need for iron is greatest in last 4 weeks of gestation

1st Degree laceration of perineum

-only vaginal mucosa involved -Ice and analgesics

Graves' (hyperthyroidism)

-overstimulation of thyroid w/ excess production of thyroid hormone [autoimmune] **S/Sx: enlarged thyroid gland, raised, thickened skin, palpitations, tachycardia, shakiness, increased perspirations, tremor, weight loss; low TSH, high T3 and T4 -Treatment w/ methimazole

concept of sharing

-preschooler looks to his peers for new ideas and information and begins to develop an understanding of what it means to be kind. -The preschooler is more social and is often more willing to share toys with others than when he was a toddler. (Ages 3-6 years)

Pyloric stenosis (GI problems)

-recognized by projectile vomiting -pea sized nodule at sternum -no weight gain -irritable -Failure to thrive

Thyroid medications

-should be given on an empty stomach, at the same time every day. -Thyroiditis, Hashimoto's or thyroid storm can cause critical thyroid values and extreme hyperthyroid symptoms. -Endocrine issues require extensive testing for the family and the patient. -The stronger the education, the better the health of the patient, typically.

Head (Newborn Assessment)

-size, circumference, caput, fontanelles, suture lines -eyes (clear red reflex) -ears aligned and coiling, hearing -natal teeth, flexibility of tongue, cleft palate, moisture, -ability to suck and swallow (premature babies do not have synchronized sucking/swallowing)

Minimal variability

-stays within < 5 BPM, non reassuring if continues for longer than 20 minutes - can result from fetal hypoxia, CNS depressant meds, preexisting neurological injury, congenital abnormalities

Apgars 3-7

-stimulate baby, dry, suction baby to rid of fluids, O2 blow by

1st degree burn:

-superficial -erythematous and painful -involve intact epidermis w/o blistering -no fluid loss -only outer epidermis layer -heals w/o scarring in 4-5 days [<10% according to 9s]

2nd degree burn:

-superficial partial thickness or deep partial thickness, -partial destruction of dermis -red painful w/ blister -weeping/moist appearance -heal w/ minimal scarring 7-10 days [10-20% according to 9s] • **2nd degree that involve >50% of dermis, destroy nerve fibers so less painful, white pale appearance 2-3 wks to heal, hard to distinguish between this and 3rd degree, at risk for fluid volume loss, skin grafting necessary [>20% according to 9s]

Pre Cath Procedure

-teach child and family about the disease, its cause, and treatment. -NPO. -Answer questions child or family has, explain the risk of bleeding, infection, thrombus, arrhythmias, perforation, stroke, and even death.

Intussusception (GI problems)

-telescoping of bowels [bowels slides into adjacent part of intestines]; causing obstructions, bowel perforation, infection, & death

Gomco clamp

-this method of circumcision uses a clamp that is placed around the cone and foreskin and is tightened to provide enough pressure to crush the blood vessels. -remove foreskin after 3-5 minutes

Diabetes

-thorough education of disease -manage insulin and glucose -manage diet and activity -let the child self-medicate if able **Manage insulin, diet, & activities is the focus for DM1 -*Hyperglycemia* - polyuria, polyphagia, polydipsia, slurred speech, fatigue, blurred vision, ketones in blood and urine, fruity breath -*Hypoglycemia* - shakiness, pale, sweaty, hunger, palpitations, loss of consciousness

4th Degree laceration of perineum

-through rectal sphincter -Ice, analgesics, sitz, Stool softener and + antibiotics (prevent infection [e.coli])

Hypothyroidism

-thyroid gland underactive -not enough thyroid hormone secreted -can lead to goiter if untreated -thyroid hormone controls *metabolism rate*. **S/Sx: bradycardia, tiredness, cold intolerance, low T3 and T4, high TSH -Treatment w/ levothyroxine

DO NOT GIVE an immunization

-to an ill child due to concerns about manipulating the immune system with a child who is ill or has a fever. -Fever above 100.4 or 101°F. -The nurse should also be prepared to intervene with epinephrine and diphenhydramine in the event of an anaphylactic reaction.

What does the nurse look for in a child with hydrocephalus?

-track the size of the infant head size at every visit allows the nurse to recognize changes in head diameter due to fluid building. Signs/symptoms (based on age): • Increased ICP • tapping on the skull (resonant sound) "Macewen's sign" or "cracked pot" due to cranial suture separation • child has difficulty holding head upright • face and cranial vault disproportionate • prominent forehead, dramatic head enlargement • optic chiasm, and compression of optic nerve if untreated. -A clogged shunt can cause headache, neurological changes, confusion, and vomiting.

Benefits of Bottle feeding

-unwanted chemicals from mom -anyone can feed the baby -publicly acceptable -know how much baby is getting with feeding

Otic Meds (Ear drops)

-up and back at age 3 -otherwise down and back < 3 years

2nd Degree laceration of perineum

-vaginal mucosa and initial perineal muscle -Ice, analgesics, + sitz bath

Pregnancy appropriate activities

-walking, swimming, keep heart rate below 140. -Don't do any new activities, stay with same routines. (don't start exercising if you didn't pre pregnancy). -Activity is important it prepare women for labor.

Breast engorgement

-warm showers, cabbage leaves, empty breast, manual expressing, snug bra to support tissues of breast

Separation comfort care

-with favorite items or activity, distraction, parents room in or go with child to procedures. -Child will protest separation due to anxiety, [prep with tours and explanation, use transitional objects] reinforce when they will see parent again. -Despair follows due to grief of separation, detachment due to ongoing anger/coping skills.

What is jaundice?

-yellowing of the skin; RBC changing from fetal to adult -common in breast fed babies, traumatic injury at birth. -Jaundice is the condition in which blood contains excessive amounts of bilirubin. -The deposition of conjugated and unconjugated bilirubin in the skin gives the yellow color seen in jaundice. -Jaundice is not a disease, but the symptom of a disease; 20% of newborn infants have jaundice.

Cervical Dilatation

...

Estimated Fetal Weight (EFW)

...

Fetal Fibronection

...

Leukorrhia

...

New Ballard Scale

...

Oomphalacele

...

Ptylism

...

Riley's Pain Scale

...

Risk Appraisal

...

Station

...

vertex

...

What are the danger zones?

0 to 3 = resuscitation, 4 to 6 = newborn is in danger.

Latent phase of labor:

0-3 cm mild to moderate contractions irregular q 5-30 min lasts 30-40 sec

Amnioinfusion

0.9% sodium chloride or lactated Ringer's solution, is instilled into the amniotic cavity through a catheter into the uterus to supplement the amount of amniotic fluid. Helps prevent variable decelerations caused by cord compression

deep tendon reflexes

0: absent reflex 1+: trace, or seen only with reinforcement 2+: normal 3+: brisk 4+: nonsustained clonus (i.e., repetitive vibratory movements) 5+: sustained clonus Deep tendon reflexes are normal if they are 1+, 2+, or 3+ unless they are asymmetric or there is a dramatic difference between the arms and the legs. Reflexes rated as 0, 4+, or 5+ are usually considered abnormal.

APGAR Color scoring

0= Blue, pale 1= pink body, cyanotic hands and feet (acrocyanosis) 2= Completely pink

APGAR Muscle tone scoring

0= Flaccid 1= some flexion 2= well-flexed

APGAR Heart rate scoring

0= absent 1= <100 2= >100

APGAR RR scoring

0= absent 1= slow, weak cry 2= good cry

APGAR Reflex irritability

0= none 2= grimace 3= cry

*TONSILS GRADES*

1 - Near Airway Opening 2 - Midline between Uvula 3 - Almost Touching Uvula 4 - Touching Tonsils

Explain what is 1/50/ -1?

1 cm dilated, 50% effaced, 1 cm above ischial spine

*PROM*

1 hour before onset of labor at any gestational age Premature rupture of membranes

First stage of labor:

1-1.5 cm (onset of labor)

Normal RR for a child?

1-5 yrs - Normal RR is 25 to 30 bpm, anything > 60 bpm in infants is dangerous.

Identify two methods used to assess the intensity of contractions

1. *FREQUENCY*- of a contraction is measured from the beginning of one contraction to the beginning of the next contraction. *DURATION*- of a contraction is measured from the start of one contraction to the end of the same contraction. 2. *INTENSITY*- of a contraction is most frequently measured by uterine palpation and is described in terms of mild, moderate, and strong

*TETRALOGY OF FALLOT* Four Defects

1. *V*entricular *S*eptal *D*efect 2. Overriding Aorta 3. Hypertrophic Right Ventricle 4. Pulmonary stenosis (valve stiffen and thicken) or atresia (Pulmonary valve restrictive hole).

*UMBILICAL HERNIAS*

1. A hernia is a protrusion of the bowel through an abnormal opening in the abdominal wall. 2. In children, hernias most commonly occur at the umbilicus and through the inguinal canal. 3. A hydrocele is the presence of abdominal fluid in the scrotal sac.

*INFECTIOUS MONONUCLEOSIS* Assessment

1. Fever, malaise, headache, fatigue, nausea, abdominal pain, sore throat, enlarged red tonsils 2. Lymphadenopathy and hepatosplenomegaly 3. Discrete macular rash most prominent over the trunk may occur.

*KAWASAKI DISEASE*

1. Kawasaki disease is also known as mucocutaneous lymph node syndrome and is an acute systemic inflammatory illness. 2. The cause is unknown, but may be associated with an infection from an organism or toxin. 3. Cardiac involvement is the most serious complication; *aneurysms can develop.*

*INFECTIOUS MONONUCLEOSIS* Interventions

1. Provide supportive care. 2. Monitor for signs of splenic rupturer

Explain Complete/complete (or fully/fully)/ +2

10 cm dilated, 100%, 2 cm below ischial spines.

CVS can be done at

10-12 weeks

FHR can be heard by Doppler at:

10-12 weeks GA

When does the umbilical cord fall off

10-14 days

normal fetal heart tone

110-160

Baseline (Always know parameters)

110-160 HR of fetus.

Baseline [Always know parameters]

110-160 fetal heart rate

Labor typically begins within ___ hours after ROM.

12

Meconium 1st passed

12 -24 hours after birth. If no poop take rectal temp to see if anus is open.

If all factors are stable, postpartum assessments of vital signs as well as uterine firmness location, and position should be done every:

15 min x 4 for the first hour, every 30 min x 2 for the second hour, hourly x 2 for at least 2 hr, and then every 4 to 8 hr for the remainder of the client's hospitalization.

FHM *ACCELERATION*

15 x 15 Okay No Action needed

How long should the newborn nurse?

15-20 minutes (but don't educate the mother on the timing)

Quad screen can be done when?

15-20 weeks GA

MSAFP screening done when?

15-22 weeks

MSAFP screening is done:

15-22 weeks of gestation

AFP can be measured from the amniotic fluid between:

16 and 18 weeks

MSAFP can be done when?

16-18 weeks of gestation

What is the FHR in the first trimester and at term

160-170 BPM (first trimester) 120-160 BPM (term) **typically twice the maternal HR

PENICILLIN INVENTED

1941

What is the typical I/O rate in a child? (Typical drip rate and typical volume out)

1ml/per kg of body weight/per hr. Check skin turgor, mucous membranes (moist, wet & slippery), weigh diaper grams=mils, urine color & output.

When drugs are most dangerous for the fetus

1st Trimester (fetus being formed) and 3rd trimester (would destabalize mom supporting baby)

Meconium

1st stool passed, greenish-black, tarry appearance. Formed as a fetus, consists of shed skin cells & lanugo hair that was swallowed.

Umbilical Cord contents

2 arteries and 1 vein. If all not present may be sign of congenital abnormality. -Vein carries oxygenated blood to fetus. Arteries carry waste and deoxygenated blood away

Umbilical Cord contents

2 arteries and 1 vein. If all not present may be sign of congenital abnormality. Vein carries oxygenated blood to fetus. Arteries carry waste and deoxygenated blood away

Pregnant mothers should consume how much water each day?

2 to 3 Liters of water from food and beverage sources.

Know lb/kg conversion.

2.2 lb = 1 kg

PP the mom should consume ______ to_______ ml of water each day.

2000-3000

Labor usually occurs ___ hrs after ROM.

24

When is the umbilical cord clamp removed?

24 hours

What is Physiological Jaundice

24 hours to the 7th day [appears later; it resolves itself sometime]

The recommended weight gain during pregnancy is usually:

25-35lbs 3-4 lb in first trimester 1 lb per week in the last two trimesters

HYPERglycemia in Kids

250

Normal newborn weight range:

2500-4000 grams

Glucose testing

26-28 week

lanugo

28-30 weeks

What is the child most afraid of - 3 things?

3 big stressors: -losing control or independence -their punishment/pain -change in body images. **[separation from parent and family, fear of unfamiliar, fear of pain and loss of control]

Fontaneles dissapear when

3 months for posterior and 12-18 months for anterior

Umbilical Cord

3 vessels in cord of the baby. -Two arteries and one vein. -Fetal circulation is opposite of mothers. They are protected by wharton's jelly, to keep the vessels from compressing against each other.

What would you expect to see in a normal umbilical cord?

3 vessels; 2 arteries and 1 vein.

Nuva ring

3 weeks in 1 week out.

normal newborn RR

30-60

Respiratory rate 2 hours after birth

30-60 breaths per minute

DKA in Children

300

GBS can be tested when?

35-37 week GA

Beta strep testing

35-37 weeks

Take temp; Normal newborn (Newborn Assessment)

36.5-37.2 C [or 99 F] and vitals

Rocephin

3rd generation parenteral -pretty long half life-kidney doesnt clear as quickly and biliary elimination and reabsorption -penetrates CNS -N. gonorrhea is exquisitely susceptible to rocephin

NPH long acting insulin if given @ 8 am peaks?

4 - 12 hours

Explain Contractions for 12 hours, what is 4/90/ -2?

4 cm dilated, 90% effaced and 2 cm above ischial spine [active phase of labor—admit patient]

Active phase of labor:

4-7 cm moderate to strong contractions regular q 3-5 min lasts 40-70 sec

Blood pressure drops in the second trimester because of increased volume of blood, heart rate goes up, red blood cells go down(anemia). Normal hemoglobin non pregnant 14, hematocrit 36

40. While pregnant hemoglobin 11 and hematocrit 30.

Encourage women who are lactating to add an additional ___ calories/day to their prepregnancy diet.

500

It is recommended that clients who are lactating consume ____ mcg of folic acid.

500

Moderate variability:

6-25/min

Newborns should have how many diapers a day?

6-8 wet diapers 3-4 stools per day

Newborn BP should be

60-80 systolic and 40-50 diastolic

It is recommended that _____ mcg of folic acid be taken during pregnancy.

600

HYPOglycemia in Kids

70

BPP: normal score is

8-10

Transition phase of labor

8-10 cm strong to very strong contractions q 2-3 min lasts 45-90 sec

When do screen for iron deficiency anemia, what age?

9 - 24 mos.

Newborn temp should be

97.7-98.9

BPP abnormal score is

<4

Previa

= no pain

Fever..........what constitutes "fever" in a child?

> 100.4 or 101 degrees May say 101 degrees or above.

Amniocentesis: when and for what reason?

> 35 years old [Chromosomal testing: Down Syndrome], genetics testing -Typically done after 15 weeks -Need informed consent and know risks of procedure -MSAFP (Maternal Serum Alpha-Fetoprotein)- Quad screen (screen for genetic issues) -Identify kidney and lung functions

Taking the temp of a child. Route options by age.

> 6yrs oral & tympanic temp., < 6yrs tympanic, axillary, or rectal for those who are disoriented, unconscious or in respiratory distress. Infants axillary is best.

Minimal variability:

> undetectable but <5/min

Marked variability:

>25/min

Hydrotherapy

A back rub, and massage may be helpful, but counterpressure is most effective in relieving back discomfort.

A nurse is palpating the client's bladder and is encouraging her to void every 1 to 2 hr during labor predominantly because a

A distended bladder reduces pelvic space, impedes the fetal descent necessary for delivery, and places the bladder at risk for trauma during the labor process.

*BLASTOCYST*

A fluid-filled sphere formed about 5 days after fertilization of an ovum that is made up of an outer ring of cells and inner cell mass. This is the structure that implants in the endometrium of the uterus.

Pathologic Jaundice

A hemolytic disorder, diagnosed by a heel stick blood test to test the degree of hyperbilirubnemia. Born with the disease.

Chloasma

A masking across face of dark haired women.

*Yolk Sac*

A membranous sac attached to an embryo, providing early nourishment and functioning as the circulatory system of the embryo before internal circulation begins

What is Preeclampsia?

A multisystem, vasopressive disease process that targets the cardiovascular, hematologic, hepatic, renal, and central nervous system. If you are pregnant and your systolic pressure is 140+ or the diastolic pressure is 90+ on several readings, it is too high.

What is Stridor?

A narrowing of the upper airway, that causes a shrill sound on inhalation.

The mother asks the nurse, "How can I tell if my baby is receiving enough to eat?" What should the nurse tell the mother?

A newborn is receiving adequate nutrition if he is content between feedings, gains weight, and has 6 to 8 wet diapers/day.

How often should the newborn be burped during breastfeeding?

A newborn should be burped when alternating breasts.

During ambulation to the bathroom, a postpartum client experiences a gush of dark red blood that soon stops. On assessment, a RN finds the clients uterus to be firm and midline & at the level of the umbilicus. The nurse interprets this finding as

A normal postural discharge of lochia.

Gravida

A pregnant woman.

Pudendal block

A pudendal block is a transvaginal injection of a local anesthetic into the area in front of the pudendal nerve that anesthetizes the perineum, vulva, and rectal areas for episiotomy, expulsion of the fetus, and episiotomy repair.

Choanal atresia

A rare congenital anomaly, blocked posterior nostrils on one or both sides. Feedings by mouth are either difficult or impossible. Surgery opens the airways.

Erythema Toxicum

A red, raised rash on a neonate. Is not harmful and goes away on it's own.

Regarding BISHOP scoring, when is a woman ready for labor?

A score of 9 for nulliparas 5 or more for multiparas

The urge to have a bowel movement is

A sign of complete dilation and fetal descent. If there is fecal material present at the rectum, the nurse should cleanse the perineum rather than escorting the client to the bathroom. The nurse should not remove a fecal impaction.

A toddler walks with....

A wide, unsteady gait

Striae gravidarum

AKA stretch marks common, fade but never disappear.

APGAR score

APGAR Activity - Pulse - Grimace - Appearance Respirations Activity 0-absent 1-flexed 2-active Pulse 0-absent, 1-<100, 2->100 Grimace 0-no response, 1-grimace, 2-sneeze Appearance 0-blue/gray, 1-acrocyonosis, 2-pink Respirations 0-absent, 1-slow, 2-normal

Common Apgars

APGARs are 0-10 score; most common Apgar scores are 7-9, very rarely 10.

*CARDIAC CATHETERIZATION* POST Procedure

ASSESS • Pulses below Cath site • Temp & Color or affected extremity • Pressure dressing MONITOR • Cardiac & O2 monitoring every 4 hours • Vital signs 15mins (1hr) 30min (1hr) 1 Hours (4Hr) Total of 6 hours • Bed sheets for Blood. (if blood apply pressure at site *REPORT IMMEDIATELY*) *Immobilize the affected extremity to a flat position for:* • 4-6 hours for Venous Entry • 6-8 hours for Arterial Entry Hydrate the child Administer Tylenol or Motrin

*CARDIAC CATHETERIZATION* PRE Procedure

ASSESS • Accurate Height and Weight • Symptoms of Infection • Bilateral Pulses • Baseline O2 Sat Obtain a history of allergy to iodine Familiarize pt. with the procedure

Hydatidiform mole - (gestational trophoblastic disease) a uterine size that increases abnormally fast. The trophoblastic tissue causes

Abnormally high levels of hCG that result in excessive nausea and emesis. No fetus present on the ultrasound. Scant or profuse dark brown or red vaginal bleeding that 1st occurs in the 2nd trimester, usually around the 16th week of gestation.

Thrombophlebitis: position arm:

Above the lever of the heart

Found in preterm newborns

Abundant lanugo, flat areolas without breast buds, and heels that are movable fully to the ears are

Methatrexate

Action: Decreases action of dihydrofolic acid reductase enzyme, which stops growth of actively proliferating tissue such as a tumor or fetus immunosuppressant indication: Ectopic pregnancy, rheumatic conditions, psoriasis, chemotherapy Dose: 50 mg/m2 intramuscularly x1: may repeat in 1 week if B-hCG is increased adverse reaction: Thrombocytopenia and other blood related disorders, neurotoxicity, nausea and vomiting, fever, dizziness, diarrhea, pruritus Nursing Considerations: Provide grief support for loss of pregnancy. Counsel woman to report increased abdominal pain, which could indicate tubal rupture. Follow-up care us needed until B hCG levels are nondetectable. If methotrexate treatment fails, surgical intervention may be necessary.

Prostin, prepidil, Cervidil

Action:Prostaglandian E2 (PGE2) ripens the cervix, making it softer and causing it to begin to dilate and efface; it stimulates uterine contractions. Indications: PGE2 is used for preinduction cervical ripening (to ripen cervix before oxytocin induction of labor when the Bishop score is 4 or less) and to induce labor or abortion (abortification agent). Dosage and Route: Place Cervidil insert (10mg dinoprostone gradually released over 12 hours) intravanginally into the posterior fornix. Remove after 12 hours or the onset of labor. Keep insert frozen until ready to use ( no rewarming is needed). Uterine contractions usually begin in 5 to 7 hours. Induction may be initiated if needed, 30 to 60 minutes after placement of the insert. Use Prepidil gel (2.5ml syringe containing 0.5mg of dinoprostone) into cervical canal just below internal cervical os or into posterior fornix; a shield can be used to prevent insertion past internal os. Repeat gel insertion in 6 hours as needed to a maximum of 1.5mg in a 24 hour period. Bring gel to room temperature before administration. Do not force the warming process by using a warm water bath or other source of external heat such as a microwave. Contiune treatment until maximum dosage is administered or until an effective contraction pattern is established(Bishop score of 8 or more), or significant adverse reactions occur. Initiate oxytocin for induction of labor, if needed, within 6 to 12 hours after the last instillation of the gel. adverse Reactions: Potential adverse reactions include headache, nausea, and vomiting, diarrhea, fever, hypotension, tachysystole (12 or more uterine contractions in 20 minutes without alteration of fetal heart rate or pattern), Hyperstimulation of the uterus (tachysystole with nonreassuring fetal heart rate or patterns), or fetal passage of meconium. Adverse reactions are more common with intercervical administration. Nursing considerations: Explain procedure to woman and her family. Ensure that an informed consent has been obtained per agency policy. Assess maternal vital signs and health status, fetal heart rate and pattern, and status of pregnancy, including indications for cervical ripening or induction of labor, signs of labor or impending labor, and the Bishop score. Recognize that a nonreassuring fetal heart rate or pattern; maternal fever, infection, vaginal bleeding, or hypersensitivity; and regular, progressive uterine contractions and hystory of cesarean birth or uterine scar contraindicate the use of dinoprostone. Use caution if the woman has a history of asthma; glaucoma; or renal, hepatic, or cardiovascular disorders. Have woman void before insertion. Assist woman to maintain a supine position with lateral tilt or side-lying position for 30 to 60 minutes after insertion of gel or for 2 hours after placement of insert. Allow woman to ambulate after recommended period of bed rest and observation. Prepare to swab vagina to remove remaining gel using a saline-soaked gauze wrapped around fingers or pull string to remove insert and administer terbutaline, 0.25 mg subcutaneously or intravenously, if significant adverse reactions occur. Initiate oxytocin for induction of labor within 6 to 12 hours after last instillation of gel or at least 30 to 60 minutes after removal of the insert. Follow agency protocal for induction if ripening has occured and labor has not begun. Document all assessment findings and administration procedures. Dinoprostone is the only FDA- approved medication for cervical ripening or labor induction.

Most common childhood leukemia?

Acute lymphocyte

Naegele's Rule

Add 7 days and subtract 3 months from date of LMP

*BROWN FAT*

Adipose tissue around shoulder blades, neck and upper body that keeps infants warm since they cannot shiver

How would you assist to loosen secretions in a child when the virus abates?

Administer oxygen by nasal catheter or face mask, sometimes difficult may need to just place mask by face. Mist tent that provides oxygen, humidity or medications. A hood controls amount of oxygen that mixes with room air & enters the hood. Intermittent Positive Pressure Breathing (IPPB) combination oxygen & medications, used most often with Cystic Fibrosis pts.

What is the nursing intervention for Hyperemesis?

Advise to take multivitamins regularly, Promote Rest Teach to avoid foods and stimulus that evoke vomiting; avoid spicy foods, eat crackers early in the morning Eat small frequent meals; bland food, high protein Ginger capsule beneficial for vomiting (In hospital) - NPO and antiemetics administers IV Therapy- fluids with dextrose and vitamins are given.

*ICP* Management

Airway management is primary concern Cerebral hypoxia *LASTING >4 MINUTES MAY CAUSE IRREVERSIBLE BRAIN DAMAGE- RECOGNIZE EARLY!!* CO2 causes vasodilation, increased cerebral blood flow, and increased ICP May have minimal gag and cough reflexes Risk of aspiration of secretions

Which pathway do you ALWAYS follow in examining a child with a trauma injury who is presenting to your ED? Know the "ABCD" of trauma evaluation.

Airway, Breathing, Circulation and Deformity (ABCD).

Burns care:

Airway, shock, infection & fluid intake, Pain.

Burns care:

Airway, shock, infection & fluid intake, Pain. -1st degree burn: superficial, erythematous and painful, involve intact epidermis w/o blistering, no fluid loss, only outer epidermis layer, heals w/o scarring in 4-5 days (<10% according to 9s) -2nd degree burn: superficial partial thickness or deep partial thickness, partial destruction of dermis, red painful w/ blister, weeping/moist appearance, heal w/ min. scarring 7-10 days (10-20% according to 9s) 2nd degree that involve >50% of dermis, destroy nerve fibers so less painful, white pale appearance 2-3 wks to heal, hard to distinguish between this and 3rd degree, at risk for fluid volume loss, skin grafting necessary (>20% according to 9s) -3rd degree burns: full thickness, white, waxy or leathery, no blanching or bleeding, may be black in color (eschar), less painful from nerve damage, referred to burn center, skin grafting necessary, risk for infection and fluid loss, take several weeks to heal.

Stage 1 of Labor [Includes 3 Phases]

All of Labor (3-24 hr) 0-10 dilation Variable (longest stage) [plan for issues]

Chronic HTN treated with:

Alpha-methyldopa (Aldomet), Labetalol (Trandate), nifedipine (Procardia), furosemide (Lasix), HCTZ (HydroDiuril)

*NEOPLASMS WILMS TUMOR (ORGAN)*

Also called Nephroblastoma intra abdomen and kidney tumor. Peaks at 3 years of age *Avoid abdomen palpation* Treatment • Surgery & Chemo (with or without Radiation)

Be familiar with Wilm's tumor and nursing considerations.

Also called nephrobalstoma is a malignant adenosarcoma of the kidney. Most common in children age 3 to 4 years. Treated with chemo. Prepare child for hair loss. Also when handling child never palpate unnecessarily could tumor could rupture and disseminate.

A nurse is teaching a group of new parents about proper techniques for bottle feeding. Which instructions should the nurse provide?

Always keep the nipple full of formula to prevent the newborn from sucking in air during the feeding. The newborn should be burped after each ½ oz, and he should be cradled in a semi-upright position. Any unused formula should be discarded.

What is the AAP "Back to Sleep" Program?

American Academy of Pediatrics, program is placing baby on back to go to sleep, to prevent SIDS.

*AMNIOCENTESIS*

Amniocentesis is an invasive procedure that involves the removal of amniotic fluid. Under ultrasound guidance, a needle is inserted through the maternal abdomen and into the amniotic sac. Amniocentesis may be performed beginning at 12 weeks' gestation. Components of the amniotic fluid, including fetal cells, may be analyzed for chromosomal abnormalities, fetal lung maturity, infection, and the presence of bilirubin in Rh-sensitized pregnancies.

The ________ forms a fluid-filled sac that surrounds the embryo and later the fetus, located in the inner membrane, and formed around week 2.

Amnion

800-1200 mL by the end of pregnancy Surrounds, cushions, and protects fetus; allows movement Maintains body temp for fetus Contains urine and is measure of kidney function

Amniotic fluid

Which of the following is a test for fetal lung maturity?

An L/S ratio of 2:1 indicates fetal lung maturity (2.5:1 or 3:1 for a client who has diabetes mellitus).

cephalhematoma

An accumulation of blood between the bones of the skull and periosteum

Caput succedaneum

An accumulation of fluid within the newborns scalp.

denver 2

An assessment that is used to assess development in children ages 1 month -6 years for gross motor, language, & social skills.

Doppler

An electronic stethoscope

A nurse on the obstetrical unit admitted a client who is in labor. The client is HIV status. The nurse is aware that...

An episiotomy is contraindicated for clients who are HIV+ due to the risk of maternal blood exposure. Also, the use of internal fetal monitors, vacuum extraction, and forceps during labor should be avoided because of the risk of fetal bleeding

Placenta previa

An implantation of the placenta in the lower uterine segment, near or over the internal cervical os. It accounts for 20% of all antepartal hemorrhages.

Ptyalism

An increase in salivation during pregnancy

Male pelvis, heart-shaped, not favorable for labor and birth, narrow pelvic planes that can cause slow descent and midpelvic arrest

Android pelvis

Cystic Fibrosis

Autosomal recessive hereditary disease caused by error in metabolism congenital disease affecting lungs air passages are clogged with mucus and pancreas. pancreatic production 2nd to mucus plugging ducts. Respiratory & Gastrointestinal systems are mostly affected

A client who is undergoing a nonstress test asks a RN to explain why use an acoustic vibration device. The RN states that the device is used to:

Awaken the sleeping fetus. *If there is no fetal movement (fetus sleeping), vibroacoustic stimulation (sound source, usually a laryngeal stimulator) is activated for 3 seconds on the maternal abdomen over the fetal head to awaken a sleeping fetus

Fetal lie

Axis of the maternal spine in relation to the axis of the fetal spine.

A nurse is evaluating a client's biophysical profile (BPP). Which of the following are variables should be included in this test?

BPP assesses the fetal well-being by measuring, fetal breathing, tone, reactive FHR, amniotic fluid volume, and gross body movements with a score of 2 for each normal finding, and 0 for each abnormal finding for each variable.

*BRONCHIOLITIS* Presentation

BRONCHIOLITIS AND RSV *INFANTS AT GREATEST RISK* DESCRIPTION - Highly communicable; usually transmitted by direct contact with respiratory secretions - *ALL RESPIRATORY CAN BE SUMMED UP WITH INFLAMMATION AND SECRETIONS.* ASSESSMENT - Rhinorrhea - Low-grade fever - Lethargy - Poor feeding - Tachypnea, dyspnea - Nasal flaring - Retractions - Expiratory wheezes - Grunting - Diminished breath sounds

Stimulating the outer lateral portion of the newborn's soles will elicit a

Babinski's reflex.

Milia

Baby acne

Which conditions can occur in a neonate secondary to maternal hormone exposure?

Baby may have enlarged breasts, pseudomenstruation (vaginal bleeding), and puffy labia in girls.

___________ cannot pass through the placenta, but nutrients, drugs, antibodies, and viruses can pass through

Bacteria

Administering prophylactic antibiotics to kids with a heart defect for dental or oral procedures.

Bacterial endocarditis

What UTI indicator?

Bacterial growth on urine specimen

BBT

Basal body temp

5 Parts to fetal monitoring

Baseline ; Variability; Accelerations; Decelerations; maternal activity Late; Variable; Early; Prolonged.

How do we communicate with children and respond to their fears - separation/ pain

Basic fears are: separation, abandonment and fear of pain/unknown. -Separation comfort care with favorite items or activity, distraction, parents room in or go with child to procedures. -Child will protest separation due to anxiety, (prep with tours and explanation, use transitional objects) reinforce when they will see parent again. -Despair follows due to grief of separation, detachment due to ongoing anger/coping skills. -Alleviate stress and fears: explain procedure, distraction, ask parent to stay and participate in care and explain what's going on.

Communication: Cognitive issues

Be gentle and kind, very short directives. Praise. Hold boundaries.

At what age is the MMR recommended/given? (15 mos) - Preferred site?

Between 12-15mos and given in the vastus lateralis.

Labs essential to have for pt. prior to delivery

Blood type, CBC (hgb, hematocrit), rH, HIV , hepatitis, Gbs [unsure of status, give abx for unknown prevention infection to baby]

The only reliable sign of approaching labor

Bloody show/mucous plug releases

Acrocyanosis

Blue coloring of neonate extremities due to poor peripheral circulation while blood is shunted to internal organs. Swaddle and hold infant.

What constitutes pre-term?

Born < 37 weeks gestation.

What constitutes post-term?

Born > 42 weeks gestation.

*ICP*

Brain is enclosed in the solid bony cranium and is well protected but highly vulnerable to pressure that may accumulate within the enclosure *The volume 80% brain, 10% CSF, blood 10% * must remain approximately the same at all times. A change in one leads to compensation from another but the capacity for spatial compensation is limited, once compensation is exhausted, increase in volume will result in a rapid rise in ICP.

BUBBLEHE (Postpartum Assessment)

Breast Uterus Bladder Bowels Lochia Episiotomy Homan's (*Do not assess this anymore) Extremities/Emotions

Nipples (Newborn Assessment)

Breast buds, not flat

Presumptive signs - changes experienced by the woman that make her think that she may be pregnant: Amenorrhea, fatigue, N/V, Uterine enlargement

Breast changes - Darkened areola, enlarged Montgomery's tubules, Quickening - slight fluttering movements of the fetus felt by a woman, usually between 16 to 20 weeks of gestation. Linea Nigra, Chloasma (mask of pregnancy),Striae gravidarum

What is mastitis? How is it treated? What do we teach mom?

Breast infection. Treatment includes massage, moist heat, antibiotic therapy, rest and frequent nursing. Continue to nurse, drink plenty of fluids, use analgesic for pain relief and well-fitting support bra.

*SURFACTANT*

By 24 weeks, the fetus has fingernails and the lungs have begun to secrete surfactant, a substance that decreases surface tension in the alveoli and is necessary for survival following birth. *BETAMETHASONE* To increase in prema

What is Pre-Term labor?

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

How do we communicate with children?

Children in general - Get to their level physically. Simple words. Eye contact. Play to demonstrate. Approachable.

Pulmonary Embolus S&S

Chills Apprehension Pleruitic Chest pain Dyspnea tachypnea hemoptysis heart murmurs peripheral edema distended neck veins elevated temp hypotension hypoxia

Which STD is the leading cause of infertility? Why is it so dangerous?

Chlamydia, because it is known as the "silent STI", at least 50% of affected individuals are asymptomatic.

The ________ forms the fetal part of the placenta, located in the outer membrane

Chorion

What happens when cord is clamped

Circulatory pathway abruptly changes.

Which physical symptoms would you expect in the child in respiratory distress?

Circumoral Cyanosis (darkening of skin around eyes, nose and mouth), nasal flaring, wheezing, tachycardia, tachypnea & stridor.

Cord care for the infant and the rationale for providing it .

Clamps or ties must be secure until safe to remove(prevents hemorrhage), triple dye to prevent infection (test purpose only), clean w/ rubbing alcohol & do not bathe until it falls off to assist in drying out and call Dr if cord show's signs of infection.

Microcephaly

Condition in which the head is unusually small as a result of defective brain development and premature ossification of the skull

4 ways babies lose heat

Conduction (contact w/cold surface), Convection (air movement), Evaporation (heat rises into the air) and Radiation (body puts out heat secondary to metabolism).

*CONGENITAL HEART DEFECTS* Patho of and Presentation

Congenital Defects- Older classification • *Acyanotic* -May become cyanotic • *Cyanotic*- May be pink and May develop CHF Newer classification of CHD- Hemodynamic characteristics • Increased pulmonary blood flow- mimic R - sided HF • Decreased pulmonary blood flow- • Obstruction of blood flow out of the heart- upper extremities differ from lower • Mixed blood flow

*TWO CATERGORIES of CARDIAC DEFECTS*

Congential / Anatomic - W

*Foramen Ovale*

Connects the left and right atria, allowing blood to flow directly from the right to the left side of the heart

The second stage of labor

Consists of the expulsion of the fetus.

Signs of infiltration

Cool to touch, redness/blanching, paleness, edema (swelling), painful

There is a high risk of _________ surrounding external cephalic version.

Cord prolapse

A client who is at 32 weeks gestation, is diagnosed with placenta previa & is actively bleeding. The RN anticipates what medication to be ordered

Corticosteroids (Betamethasone) will be prescribed for fetal lung maturation if delivery of the fetus is anticipated (cesarean birth).

Third stage of labor:

Delivery of placenta

A nurse is caring for a client who is 1-day postpartum. The nurse is assessing for maternal adaptation and mother-infant bonding. Which of the following behaviors by the mother indicates a need for the nurse to intervene?

Demonstrates apathy when the infant cries, Views the infant's behavior as uncooperative during diaper changing

Menopausal pt with uterine fibroids should avoid what herb?

Don Quai because of phytoestrogen

How to give ear drops to a 9 mo old child.

Down and back

Lanugo

Down like hair on the neonate.

What is the 4th leading cause of death in children 19 years and younger?

Drowning

What can effect perfusion in placenta?

Drugs, not enough fluid, smoking, malnutrition, diabetes, hypertension affect perfusion in placenta.

Signs and symptoms of impending labor: *BLOODY SHOW*

During pregnancy the cervix is plugged with mucus. The mucus plug acts as a protective barrier for the uterus and its contents throughout the pregnancy. As the cervix begins to soften, stretch, and thin through effacement, there may be rupture of the small cervical capillaries. The added pressure created by engagement of the presenting part may lead to the expulsion of a blood-tinged mucus plug, called bloody show. Its presence often indicates that labor will begin within 24 to 48 hours. Late in pregnancy, vaginal examination that involves cervical manipulation may also produce a bloody discharge that can be confused with bloody show.

*Neural Tube*

During the third and fourth weeks, development of the nervous system is well underway. A thickened portion of the ectoderm develops into the neural plate. The top portion will differentiate into the neural tube, which forms the central nervous system (brain and spinal cord)

Kawasaki disease

Dx: by symptoms: Abrupt onset and sustaining temp 1040 F Inflamed mouth, strawberry tongue, Enlarged non-tender lymph nodes, Peeling of finger and toe tips, Conjunctivitis.

What is reading disability?

Dyslexia

*ATOPIC DERMATITIS*

ECZEMA Description Superficial inflammatory process involving primarily the epidermis Major goals of management: • Relieve pruritus • Lubricate Skin • Reduce Inflammation • Prevent • Control Secondary Infections

*PERCOCIOUS PUBERTY*

Early Puberty • For Girls age 8 (normal- age 10) • For Boys age 9 (normal - age 12) We can slow but not reverse !!! Treatment: • Luteinizing hormone given • Dress childlike their age (Psychosocial)

Decelerations

Early, late, variable, prolonged

A client who is at 7 weeks of gestation is experiencing N/V in the morning. The nurse in the prenatal clinic provides teaching that should include:

Eat crackers or plain toast before getting out of bed. Nausea and vomiting may occur during the first trimester. The client should eat crackers or dry toast ½ to 1 hr before rising in the morning to relieve discomfort.

Know the reasons and the findings of each vaginal exam.

Effacement, dilation, presentation, (descent) station, position

Hyperbilirubinemia

Elevated bilirubin level that causes physiologic jaundice. Baby's inability of its immature liver to handle bilirubin.

What is moulding?

Elongation of head from vaginal delivery.

Molding

Elongation of the baby's head during childbirth.

Day 15-week 8 after conception

Embryonic period

Treatment of infantile eczema.

Emollient bath

How would you intervene on their behalf??

Emotional support, tripod position, elevate the HOB, use humidifier or moist water bottle by head.

When caring for the Cystic Fibrosis patient, which considerations would be in place when doing discharge teaching?

Encourage physical activity, keep them calm, chest physical therapy (CPT) a combination of postural drainage and percussion (clapping and vibrating of the affected areas) this loosen secretions, make sure visitors are not sick and follow strict handwashing procedures.

Some nursing interventions to facilitate sibling acceptance of the infant include:

Encouraging the parents to have a gift from the infant to give the sibling, arranging for one parent to spend time with the sibling while the other parent is caring for the infant, and giving preschool and school-age kids a doll as their "baby."

Ovarian hormones cause changes in the...

Endometrium

Direct visualization through lighted scope is?

Endoscopy

A newborn was not dried completely after delivery. The nurse understands that which of the following mechanisms causes the newborn to lose heat?

Evaporation is the loss of heat that occurs when a liquid is converted to a vapor. In a newborn, heat loss by evaporation occurs as a result of vaporization of the moisture from the skin.

Vital sign frequency

Every 1-2 hours for first couple hours and then every 4 hours for the first 24 hours.

Maximum contraction frequency and length

Every 2 minutes lasting longer than 90 seconds - if any longer call the doctor. Reduces fetal O2.

How often are newborns fed?

Every 2-4 hours.

Maternal Uterine Activity - what are the expectations?

Example: Primigravida 160 fetal heartrate, contractions every 7 min. baby sleeping, dehydrated mom, baby depressed, Braxton hicks; give IV fluids [fetal movement; increased variability], monitor, postdate (give O2 then see increase in variability; more efficient contractions), fetal monitoring.

Smegma

Excess secretions and dead skin cells that collect beneath the foreskin of the penis.

Cystic Fibrosis is a defect in what?

Exocrine system

How would you address the tasks at a pediatric level?

Explain procedures in terms child & family can understand, do not make promises you cannot keep, give analgesic b4 painful procedure if possible. Crying is normal. Avoid performing painful or scary procedures in child's room or play room.

Stage 2 of labor

Expulsion (delivery) - provide encouragement and neonatal care.

*BURNS* Management

Extent of burn injury • Modified rule of nines may be used for pediatric population Fluid replacement therapy • *Parameters such as vital signs, urine output, adequacy of capillary filling, sensorium status determine adequacy of fluid resuscitation* Pain management • Administer pain medications, including opioid analgesics, as prescribed, including prior to any whirlpool, débridement procedure or any other procedure, activity involving high risk for pain Inhalation burns - can close up the airways

*BLADDER EXOTROPHY*

Extrusion of the urinary bladder to the outside of the body thru a defect in the lower abdominal wall

Medications administered to baby at the time of birth

Eye prophylaxis (Erythromycin ointment) , Vitamin K promotes normal blood clotting & a Hep B vaccination (per AAP guidelines & parents).

A primigravida client at 39 weeks gestation comes to the birthing unit with her partner because she's been having regular contractions. She states that her "water broke." What is the nurse's priority assessment?

FHR Monitoring

Reactive NST

FHR is a normal baseline rate with moderate variablity Two accelerations to 15 bpm for at least 15 secs in 20 min period

In women who are high risk

FHR should be assessed every 5 min in the second stage of labor.

Treatment for Fungal STI

FLAGYL - Don't Drink Alcohol

*CLEFT LIP* Management

Facial malformations that occur during embryonic development that may appear separately or together. Big issues with feeding. Closure of lip defect precedes correction of the palate. Closure of the palate is typically 12 to 18 months of age. Big effect on speech development.

*INCOMPETENT CERVIX*

Failure of the cervix to remain closed until the fetus is mature enough to survivie outside the uterus

*GLUCOSE TOLERANCE TEST*

Fasting = 60-110 mm/dL, 1 hour = 190 mm/dL, 2 hours = 140 mm/dL, 3 hours = 125 mm/dL

A postpartum client who delivered her third infant 2 days ago. The nurse recognizes that which symptoms are suggestive of postpartum depression?

Fatigue, insomnia, flat affect, and bouts of crying are symptoms that are commonly seen in postpartum clients who are experiencing depression.

Breast Feeding Techniques

Feed every 2 to 4 hours, LATCH = Latch, Audible Swallowing, Type of Nipple, Comfort, Hold. 6 to 8 wet diapers & at least 2 stools per day (stool is yellow & seedy).

What is ascites?

Fluid in the peritoneal cavity

A nurse is caring for a client who is experiencing postpartum hemorrhage. What should the nurse use to replace fluid volume in this client?

Fluid volume replacement should be with IV isotonic solutions such as lactated Ringer's solution or 0.9% sodium chloride, colloid volume expanders, such as albumin and blood products (packed RBCs and fresh frozen plasma).

How should a nurse address a 12 yr old child with IQ of 67?

Focus on and praise strengths

A prenatal nurse recommends folic acid supplements to a client who is 18. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency?

Folic acid supplements are recommended to prevent neural tube defects in the fetus. It is recommended that all women of childbearing age take this supplement. Fresh green, leafy vegetables, liver, peanuts, cereals, and wholegrain breads.

Ovarian hormones: 1) 2)

Follicle-stimulating hormone (FSH) Luteinizing hormone (LH)

The clients bladder needs to be _____ before an ultrasound.

Full

*GLOMERULONEPHRITIS* Patho

Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus, most of which are caused by an immunological reaction. 2. The disorder results in proliferative and inflammatory changes within the glomerular structure. 3. Destruction, inflammation, and sclerosis of the glomeruli of the kidneys occur. 4. Inflammation of the glomeruli results from an antigen-antibody reaction produced by an infection elsewhere in the body. 5. Loss of kidney function develops.

Betamethoasone

Glucocorticoid given to enhance fetal lung maturity and surfactant production.

What test for blood glycemic levels over several months.

Glyocylated hemoglobin

Normal female pelvis, transversely rounded, and most favorable for labor and birth

Gynecoid pelvis

Skin to skin contact

Helps stabilize baby temp, establishes breast milk, bonding

A nurse is assessing the reflexes of a newborn. In checking for the Moro reflex, the nurse should perform which of the following?

Hold the newborn in a semi-sitting position, then allow the newborn's head and trunk to fall backward.

*NASOPHARYNGITIS* Treatment

Home Management Self-limiting persists for 7-10 days

Distention of the renal pelvic area.

Hydronephrosis

What is the treatment for those identified?

Hypoglycemia given glucose by IV line and PKU controlled with a special limited phenylalaline diet, foods containing protein.

Hyperemesis gravidarum [excessive vomiting]

IV fluids, antiemetics.

What do we use it for?

If scores are too low, newborn maybe considered premature.

What does it indicate/predict?

If you do not see 3 vessels notify Dr. there is a strong possibility of congenital defects or cord anomaly.

A nurse is aware that which of the following is a contraindication for circumcising a male newborn?

In hypospadias & epispadias, the urethra is located somewhere other than the tip of the urethra, and the foreskin is needed for plastic surgery to repair the defect. Family Hx of hemophilia, hypospadias, and epispadias are all contraindications.

Which presenting symptoms would be found in a patient with gonorrhea?

In men, burning sensation during urination, yellowish-white discharge from penis and painful or swollen testicles. Women usually asymptomatic. But may have dysuria & vaginal/anal discharge.

The first stage, latent phase

In stage 1, latent phase, the cervix dilates from 0 to 3 cm and contraction duration ranges from 30 to 45 seconds.

When providing teaching about car seat safety to the parents of a newborn, the RN should instruct the parents to restrain the newborn in a car seat

In the back seat in a semi-reclined, rear-facing position. **Infants who weigh up to 9.1 kg (20 lb) should be restrained in a car seat in a semi-reclined, rear-facing position in the back seat of the car.

A nurse is caring for a postpartum client. The nurse understands that which of the following findings are the earliest indication of hypovolemia caused by hemorrhage?

Increasing pulse and decreasing blood pressure

Three phases of uterine contractions

Increment (building), acme (peak), decrement (decline)

Ballard scale

Indicates maturity

*OSTEOMYELITIS*

Infection in the bone Secondary to a bacterial infection from an outside source. Antibiotic treatments imperative, 3-4 weeks as minimum Nursing care- Complete bed rest and immobility of limb • Pain management concerns • Long-term intravenous access (for antibiotic administration • Nutritional considerations • Long-term hospitalization/therapy • Psychosocial needs

Chorioamnionitis

Infection of the amniotic membranes

Lymphadenopathy is enlargement of lymph nodes that is indicative of?

Infection or disease

Thalassemia

Inherited defect in the ability to produce hemoglobin, usually seen in persons of Mediterranean background.

*CARDIAC CATHETERIZATION*

Invasive procedure (determines defects) Provides information about O2 saturations in great vessels & heart chambers Risks Include: • Hemorrhage From Entry Site • Clot Formations • Blockage Distally • Arrhythmias General Anesthesia unnecessary for this procedure.

Vitamin B6/pyridoxine

Involved in protien metabolism. 2mg day reduces nausea and vomiting.

What can happen to a babies head during labor?

Irregular head shape.

Braxton Hicks

Irregular, ineffective contractions of the uterus that occur throughout pregnancy

Uterine inversion

Is a condition in which the uterus turns inside out and can be caused by the placenta being removed too vigorously prior to its natural detachment process.

Dehydration

Kids lose fluid quicker than adults. They have faster respiration and more body surface area to lose water. When sick kids tend to not to want to take sips of water. Tests to assess: Specific Gravity urine test Normal test is 1.010 to 1.030 Postitive dehydration is when it is concentrated and urine specific gravity test results is > 1.030 Negative or Dilute if it is < 1.010 Sign of dehydration - pick the number higher that 1030- which means a higher concentration of urine = higher results

*PEDICULOSIS CAPITIS*

LICE Administer Permethrin (Nix)

Station

Level of descent of the presenting part into birth canal (-5 to +5, 0 is ischeal spines, +5 crowning)

Post parenting

Life without kids at home, after they grow up (stage of family cycle)

Nuchal cord

Loops in the cord that can wrap around neck of fetus.

Smoking tobacco during pregnancy is associated with :

Low Birth Weight

*Alpha-Fetoprotein* *Low Levels*

Low levels of serum AFP are associated with Down syndrome. The incidence of Down syndrome increases with maternal age to approximately 1 in 100 at age 40 or older. *Done at 12-14 Weeks*

What is "Thrombocytopenia"?

Low platelet count (easy bruising & bleeding), nursing considerations bleeding, soft bristle tooth brush and no jumping or sharp toys.

Fundus Massage

Never massage one that is contracted. It may invert causing the need for surgery and possible hysterectomy. Monitor q15 minutes x1 hour, then q30 minutes x3 hours.

New Ballard Scale

Newborn maturity rating scale, assesses neuro and physical maturity, 6 developmental areas for 1-5 values. Totals are added to give maturity rating in weeks of gestation (35 indicates 38 weeks of gestation)

erythema toxicum

Newborn red rash - NORMAL- develop due to the baby's ultra sensitive skin

Time of day Somogyi phenomenon occurs?

Night time

Do infants have normal Hgb and Hct?

No, its higher Hgb 15-18 g/dl & Hct 45 to 60%

What are the non-pharmacological measures used to enhance medication or change the pain perception?

Non-pharm: guided imagery, distraction, play, music, massage, aromatherapy, pet therapy, hand holding, deep breathing, parental presence, play, non-nutritive sucking, playing with toys.

Absent or undetectable variability is considered:

Non-reasurring

subglottic croup

Nonspecific term applied to respiratory conditions that have a brassy cough with inspiratory stridor

Caput Succedaneum is:

Normal Should resolve within 24 hrs

Apgars 7-10

Normal Apgar's **at 7 watching baby

Acrocyanosis

Normal. Bluish color of the baby's hands and feet - extremities and lasts approximately 24 hours after birth

What is infection aquired in hospital setting?

Nosocomial infection

RR first Why?

Not accurate if child starts to cry.

Placenta Previa

Not painful, bleeding -Implantation of the placenta over the cervical opening or in the lower region of the uterus,

Prolapse of Umbilical Cord

Note pressure of presenting part on umbilical cord, which endangers fetal circulation

pathologic jaundice

Occurs immediately afterbirth. a blood disorder, diagnosed by a heel stick blood test to test the degree bilirubin. Can be caused by rH factor or ABO- Hyperbilirubenemia. The baby is born with this disease

Fetoscope

One: A fiberoptic scope for looking directly at the fetus within the uterus. Two: A stethoscope designed for listening to the fetal heart beat.

*NEOPLASMS HODGKINS (Lymphoma)* Definition

Originates in single lymph node or single change of node Metastasizes to spleen, liver, Bone marrow, Lungs & other tissues Classifications: A- Asymptomatic - No symptoms B- Symptomatic - Fever > 3 days, night sweats, Weight loss 10% or > 6 months *REED-STERNBERG CELLS PRESENT* Treatments: • Radiation • Chemo

What is an "ectopic pregnancy"?

Outside; a tubal pregnancy, rare cases abdominal or ovarian pregnancy.

The vein carries...

Oxygenated blood and nutrients to the fetus

Ductus Venosus

Oxygenated blood travels to the inferior vena cava through this

Meds given to tx PP hemorrhage

Oxytocin Methergine Cytotec Hemabate

*LET DOWN REFLEX*

Oxytocin stimulates milk ejection from the breasts.

FHM *LATE DECELERATION*

Perfusion problem Execute an action

*VP SHUNT CARE* Signs and Symptoms of Shunt Infection

Period of greatest risk is 1 to 2 months after placement Infections include: • Septicemia • Bacterial endocarditis • Wound infection • Shunt nephritis • Meningitis • Massive dose antibiotics or shunt removal

Positive CST is indicated when:

Persistent and consistent late decels on more than half of the contractions.

To assess motor function in 8 yr old fractured radius.

Pinky to thumb

Postpartum hemorrhage is the most serious and most common complication. -What are some of the causes and what are our INITIAL intervention and other nursing interventions.

Pitocin [no need to titrate once baby is out], fundal massage, methergen (contraindicated in HTN), cytotec, hemobate

PROM

Premature Rupture of Membranes

What discharge teaching/instruction would you give a new mother who will breast-feed?

Proper position (stomach-to-stomach), tickle corner of mouth to open babies mouth, areola in mouth not just nipple, place finger between baby's mouth & areola to break suction, offer both breast during feeding, tingling feeling when nursing is the let-down reflex, drink more fluids and keep baby on breast (supply & demand)

Client is diagnosed w/ mitral valve prolapse. The ECG reveals tachyarrhythmias. Which medication should the RN anticipate the PCP will prescribe?

Propranolol (Inderal) is prescribed to treat arrhythmias.

Vernix Caseosa

Protective coating on skin in utero. Aborbs naturally after birth.

Why is it there?

Protects the skin from the drying effects of amniotic fluid, should be left on and it will absorb.

Kwashiorkor disease is deficiency in what?

Protein

Hormones in the placenta

Provides estrogen and progesterone. Placenta provides HCG, HCG will go away later in pregnancy.

Craving for chemical substance.

Psychological dependence

*PTYALISM*

Ptyalism, excessive saliva production often with a bitter taste, may occur and can be unpleasant or embarrassing. Its cause is uncertain, although stimulation of the salivary glands from eating starch or decreased unconscious swallowing when nauseated may be contributing factors

*PARASITIC STI*

Pubic Lice/Crabs Trichomoniasis Treated with Flagyl - so do not breast feed Examples: Pubic Lice/Crabs

*THE FETAL PERIOD* *Weeks 30 to 34*

Pupillary light reflex is present

*PYROSIS*

Pyrosis results from irritation to the esophageal lining by gastric secretions and acids. Eating small meals, avoiding lying down after meals for at least 1 hour, and limited use of antacids can alleviate some of these symptoms.

Breastfeeding

Q2 to 4hours

Bottle feeding

Q2-4 hours

Rest, Ice, Compression and Elevation are standards of care for sprains.

R: Rest, allows to heal I: Ice for first 48 hours at 15 min. intervals to decrease swelling C: Compress, ace wraps E: Elevation, early motion; helps keep full ROM

If contractions are of too long a duration or do not have complete relaxation or uterine tone in between contractions, the adverse effect will be

Reduced fetal oxygen supply.

Folic Acid

Reduces neural tube defects by 50% - spinabifida & anencephaly, 400 micrograms daily - 1 month prior to pregnancy. Oranges

What considerations are key in obtaining cooperation from a child when you are working with them?

Reducing anxiety and calming children for procedures.

Fetal position

Refers to the direction of a reference point in the fetal presenting part to the maternal pelvis.

*FETAL LIE*

Refers to the relationship of the long axis of the woman to the long axis of the fetus.

Position

Relationship between the presenting part of the fetus to a designated point on one of four quadrants of pelvis

A nurse is reviewing the fetal monitor tracing of a client who is in active labor. The nurse knows that a fetus receives more oxygen during?

Relaxation between uterine contractions

Recommended strategy in classroom for a child with ADHD.

Remind child to refocus attention

Renal - concern failure

Renal disease causes chronic electrolyte imbalance, fluid retention, profound fatigue, foamy urine, low GFR, high creatinine. -In late stage, fluid sodium retention, poor color, poor decision making, brain fog.

Which vitals are reliable in a child/relied upon?

Respirations, radial >2yrs old and apical for <2yrs old, temperature, blood pressure, weight and height. Most important blood pressure & temp.

Presence of PG on a fetal lung test is associated with:

Respiratory distress

Inversion of the uterus

Retained placenta Uterine atony Excessive fundal pressure Abnormally adherent placental tissue Multiparity Fundal implantation of the placenta Extremem traction applied to the umbilical cord Leiomyomas

Why not to use ASA (Aspirin)?

Reye's Syndrome, which results from a virus (ex. flu, chickenpox) and the use of aspirin at the same time.

If giving baby aspirin, they are at risk for what?

Reye's syndrome

Which of the following medications should the nurse anticipate will be necessary to administer preceding an external version for a client who has Rh-negative blood and did not receive adequate prenatal care?

RhO(D) immune globulin (RhoGAM)

What is autoimmune, beta hemolytic, streptococcus, affects the heart, joints, CNS, skin and subcutaneous is called?

Rheumatic fever

Strep Complications?

Rheumatic fever (scarlet fever)

A client at 14 weeks of gestation who is diagnosed with hyperemesis gravidarum. Which of the following are risk factors for this client?

Risk factors for hyperemesis gravidarum include obesity, multifetal gestation, vitamin B deficiencies, and maternal age less than 20.

The nurse should be aware that which of the following are risk factors for dysfunctional labor?

Risk factors such as short stature, cephalopelvic disproportion, fetal malpresentation, and maternal fatigue are risk factors for dysfunctional labor.

Magnesium Sulfate risks to babies

Risk to babies born with magnesium sulfate on board are at risk for respiratory depression.

What is the appropriate anxiety reducing technique for a 6 yr old?

Running around the playground.

What is the sensation the patient will feel when completion of dilation and fetal descent?

She will feel like she needs to take a big ole poooo!

Body temperature maintenance

Shivering, muscle movement, brown fat

How do they maintain heat?

Shivering, muscle movements and production of heat using stored fat (known as brown fat). Keep head covered.

A client experiences a large gush of fluid from her vagina while walking. The first RN action after establishing that the fluid is amniotic fluid

Should be to monitor FHR for distress.

Be familiar with the signs, symptoms and treatments of sickle cell anemia.

Sickle cell anemia occurs in children where both parents carry the recessive gene. Sickling (abnormal or sickle shaped RBC's) is key to disorder. These RBC's are ineffective oxygen carriers and cause anemia. S & S anemia, lethargy, weakness, fever, thrombosis and painful clumping of blood vessels. Treated with analgesics, RBC transfusion, oxygen therapy and hydration.

A RN is administering magnesium sulfate IV to a client with severe preeclampsia for seizure prophylaxis. Which indicate magnesium sulfate toxicity?

Signs of magnesium sulfate toxicity include the absence of patellar deep-tendon reflexes, urine output less than 30 mL/hr, respirations less than 12/min, and a decreased level of consciousness.

Adverse responses from the sibling to a new infant can include:

Signs of sibling rivalry and jealousy, regression in toileting and sleep habits, aggression toward the infant, increased attention-seeking behaviors, and whining.

*PSEUDO ANEMIA*

Since the plasma volume is greater than the increase in erythrocytes (30%), the hematocrit (a measurement of the red blood cell concentration in the plasma decreases by about 7%. This alteration is termed "physiological anemia of pregnancy" or "pseudoanemia."

Quickening

Slight fluttering movements of fetus felt by a woman

46.What is Acrocyanosis? Why are we concerned with it?

Slowed peripheral circulation due to immaturity (arms & legs appear cyanotic). Common in 1st 24 hours of life not a serious condition.

ventricular septal defect (VSD)

Small defects in lower or muscular portion of septum (no treatment). loud systolic murmur - nl life expectancy Large defects in upper or membranous portion of septum loud systolic murmur, enlarged heart engorgement of pulmonary circuit, thrill Tx. Pulmonary artery band or surgical closure with intractable heart failure,

Which lab test gives you reliable information in the child evaluated for dehydration?

Specific gravity normal 1.010 - 1.025

*ASTHMA* Severity classification

Step I- symptoms less than twice a week Step II- Symptoms occur more than twice a week, but not daily Step III- Daily symptoms occur in conjunction with exacerbations twice a week Step IV- Symptoms occur continually, along with frequent exacerbations that limit the child's physical activity and quality of life.

SVE

Sterile Vaginal Examination

*OXYTOCIN*

Stimulates uterine contractions Used to induce labor or to augment a labor progressing slowly because of inadequate uterine contractions

Augmentation of labor

Stimulation of uterine contractions after labor has started but progress is unsatisfactory

A nurse is caring for an infant who has a high bilirubin level & is receiving phototherapy. Which findings in the newborn is the highest priority?

Sunken Fontanels... *Infants receiving phototherapy are at greatest risk for dehydration related to loss of water from frequent loose stools due to increased bilirubin excretion.

A nurse should consider the possibility of neonatal withdrawal syndrome if a newborn

Symptoms of withdrawal from maternal substance abuse include CNS disturbances such as an excessive or continuous high-pitched cry and a markedly hyperactive Moro reflex.

T O R C H

T toxoplasmosis - stay away from kitty litter O other- hepatitis, herpes zoster, syphillis R Rubella C Cytomegalovirus H Herpes

What considerations would you have in place to maintain pulmonary function in the pediatric post-operative patient?

TCDB, elevate HOB & use pillows if age appropriate (not w/infants), use humidifier or vaporizer, avoid pollutants (such as smoke or airborne chemicals), saline nasal spray or decongestant for relief of nasal symptoms. Blow bubbles or cotton balls.

*ICP* management Coma Assessment Pediatric Glasgow Coma Scale

THREE PART ASSESSMENT Includes: • Eyes • Verbal response • Motor response *Score of 15*: unaltered LOC *Score of 8*: Generally accepted as definition of a coma *Score of 3*: extremely decreased LOC (worst possible score on the scale)

PP hemorrhage VS findings:

Tachycardia Hypotension

A pregnant client is diagnosed with iron deficiency anemia and has been prescribed iron supplements. The rn should advise the client to

Take the iron supplements with orange juice because Orange juice contains vitamin C, which aids in the absorption of iron.

If adolescent threatens suicide, what nursing action is appropiate?

Take threat seriously

Describe the "5 Ps" and how each influences labor and birth *Psychosocial influences (previous experiences, emotional status)*

The last "P" (psychosocial influences) acknowledges the many other critical factors that have an effect on parents such as their readiness for labor and birth, level of educational preparedness, previous experience with labor and birth, emotional readiness, cultural influences, and ethnicity. Transition into the maternal role, and most likely, into the paternal role as well, is facilitated by a positive childbirth experience.

formal operations

The middle adolescent reaches ___________ stage according to Piaget.

Hindmilk

The milk the baby gets later. Has more fat and calories.

First 8 weeks of pregnancy

The most critical period of human development

Newborns who are bottle feeding do best when they are held close and at a 45˚ angle. All other techniques are correct for bottle feeding the newborn.

The newborn should not be placed in the supine position because of the danger of aspiration.

Cervical *DILATION*

The opening and enlargement of the cervix that progressively occurs throughout the first stage of labor. Cervical dilation is expressed in centimeters and full dilation is approximately 10 cm. With continued uterine contractions, the cervix eventually opens large enough to allow the fetal head to come through. At this point, the cervix is considered fully dilated or completely dilated and measures 10 cm

Cervical OS

The opening of the cervix

Hypospadias

The opening to the penis is at the bottom.

Epispadias

The opening to the penis is at the top.

Phimosas

The opening to the uncircumcised penis is very small.

Chorion

The outermost cell layer that surrounds the embryo and fluid cavity.

*SUPINE HYPOTENSION SYNDROME*or *VENA CAVAL SYNDROME*

The pregnant woman may experience supine hypoten- sion syndrome, or vena caval syndrome (faintness related to bradycardia) if she lies on her back. The pressure from the enlarged uterus exerted on the vena cava decreases the amount of venous return from the lower extremities and causes a marked decrease in blood pressure, with accompanying dizziness, diaphoresis, and pallor

Cervical *EFFACEMENT*

The process of shortening and thinning of the cervix. As contractions occur, the cervix becomes progressively shorter until the cervical canal eventually disappears. The amount of cervical effacement is usually expressed as a percentage related to the length of the cervical canal, as compared to a non-effaced cervix. For example, if a cervix has thinned to half the normal length of a cervix it is considered to be 50% effaced.

*INVOLUTION*

The reduction in uterine size after birth

Fetal attitude

The relationship of the fetal extremities and chin to the fetal torso.

*SHOULDER* Presentation

The shoulder presentation is a transverse lie. This presentation is rare and occurs in less than 1% of births. The maternal abdomen appears large from side to side, rather than up and down. In addition, the woman may demonstrate a lower than expected (for the gestational age) fundal height measurement. Although the shoulder is usually the presenting part, the fetal arm back, abdomen, or side may present in a transverse lie.

*VERNIX CASEOSA*

The skin is now covered with a thick, cheese-like material that protects the fetal skin from exposure to the amniotic fluid.

*TRANSITION PHASE*

The transition phase is the most intense phase of labor. Transition is characterized by frequent, strong contractions that occur every 2 to 3 minutes and last 60 to 90 seconds on average. Fortunately, this phase often does not take long because dilation usually progresses at a pace equal to or faster than active labor (1 cm/hr for a nullipara and 1.5 cm/hr for a multipara). The laboring woman may feel that she can no longer continue or she may question her ability to cope with much more. Other sensations that a woman may feel during transition include rectal pressure, an increased urge to bear down, an increase in bloody show, and spontaneous rupture of the membranes (if they have not already ruptured).

Transverse

The transverse abdominis is the muscle that runs horizontally though the stomach region

Subinvolution is when:

The uterus remains enlarged with continued lochial discharge and may result in PP hemorrhage

*FIRST STAGE OF LABOR*

The first stage of labor is often referred to as the stage of dilation. This stage begins with the onset of regular uterine contractions and ends with complete dilation of the cervix. The first stage of labor is most often the longest stage and its duration can vary considerably among women. The first stage of labor is divided into three distinct phases: latent, active, and transition.

*DDH DEVELOPMENTAL DYSPLASIA of the HIP* Treatment

Therapeutic Management-Importance of early intervention- once a week! *Newborn to 6 months*: PAVLIK HARNESS for abduction of hip*- worn continuously. Needs frequent follow-up in office. 3-5 months until confirmed stable by x-ray. *Watch skin integrity.* *Ages 6 to 18 months*: Dislocation unrecognized until child begins to stand and walk; use traction and cast immobilization (spica cast), Frequent neurovascular checks! *Older child*: Operative reduction- reconstruction needed- difficult after 4 years!!!

Types of Burn:

Thermal (hot liquid/grease 80% of burns hospitalized), Chemical, Radiation (sun), and Electrical. -Management is focused on pain control and infection prevention.

FHM *EARLY DECELERATION*

They are caused by head compression. Identify Baby position

Conducting an admit Hx for a client at 39 weeks gestation, she tells the RN that she's been leaking from her vagina for 2 days. The RN knows that

This client is at risk for infection. *Rupture of membranes exceeding 24 hr before delivery increases the risk that infectious organisms will enter the vagina and then eventually into the uterus.

Hand hygiene is paramount to prevent the spread of disease

This is SUPER important in an immunosuppressed child who is a surgical patient.

RhoGAM

This prevents isoimmunization for an Rh negative mother

Phases in Stage 1 Labor

Three Phases: Latent, Active, Transition

Convection heat loss

Thru cold are swooping by, drafts, etc

Conduction heat loss

Thru contact with a cold surface

Radiation

Thru the transfer of the cold object onto another object

Evaporation heat loss

Thru the wetness - must dry off baby

Postpartum

Time after delivery until 6th week after birth

Intrapartum

Time during labor and delivery

Beneficial discipline

Time out [without isolation], redirection, distraction, positive reinforcement, modeling preferred /desired behavior, removal of privileges, natural consequences of actions.

Rupture of membrane note:

Time, color (normal is clear) of amniotic fluids

Why do we dry a baby at birth?

To balance heat loss, heat production and create neutral thermal environment and protect the brain.

What is the rationale for performing an ultrasound prior to doing an amniocentesis.

To determine the location of the placenta and the fetal parts. To minimize the risk for placenta or fetal damage, premature labor, or abortion.

Why is Erythromycin ointment put in the eyes of the newborn?

To prevent gonorrheal or chlamydial ophthalmia neonatorum (a conjunctivitis infection in babies eyes after birth).

What is Polyhydramnios (hydramnios)?

Too much amniotic fluid (>2L) -Usually occurs in multiple gestations, fetal anomalies, and complications of maternal diabetes -Too much fluid can obscure fetal heart tracings -Incorrect (malpostioning) of fetus -Risk for prolapsed cord since baby is pushed high up into cavity -Preterm rupture of the membranes [Increased risk of infections].

*FUNDUS* of Uterus

Top of the Uterus

hemobate

Treatment for uterine atony caused by postpartum hemorrhage. -given when bleeding won't stop with pitocin

True contractions

True contractions do not go away with hydration or walking. Instead, they are regular in frequency, duration, and intensity, and become stronger with walking.

A nurse is assessing a postpartum client for fundal height, location, and consistency. The fundus is found to be displaced laterally to the right and there is uterine atony. Which of the following is the cause of the uterine atony?

Urinary retention - can result in a distention of the bladder. A distended bladder can cause uterine atony and lateral displacement from the midline, usually to the right.

Parameters for the use of ASA (aspirin) in a child - When would you use it?

Use of ASA (Acetylsalicylic Acid) or aspirin is prohibited until the child is 19 yrs old. Some children -- such as those suffering from juvenile rheumatoid arthritis or Kawasaki's disease (inflammation of blood vessels)-- need to take aspirin as part of their treatment. (In such cases the benefits of aspirin outweigh the small chance of developing Reye's syndrome.) Question Dr. if it is prescribed before giving to child.

Ballard Scale

Used to determine gestational age POSTNATALLY(after birth)

fetoscope

Used to listen to baby's heartbeat

Terbutaline (Brethine)

Uses to relax uterine smooth muscle to inhibit uterine activity

Sickle Cell Crisis - What is it? How do we treat it?

Vaso-occlusive sickle cell crisis is caused atypical sickle-shaped morphology of the red blood cell in Sickle cell patients. • Symptoms of acute pain occur when the sickle cell shaped blood cells blocks the capillaries and vasculature becomes static. *Extreme pain in abdomen & joints* • Lack of circulation and perfusion cause anoxia to tissues, great pain, and anxiety. • Hydration and pain control are the focus of nursing intervention. **May need blood transfusion if severe

VLBW

Very Low Birth Weight 1.0 to 3.5 lbs

Positive signs of pregnancy

Visualization of fetus (ultrasound), fetal heartbeat (doppler or fetoscope)

Preclampsia interventions

Vitals Q1H, cardiac monitor, urine output Q1H, fetal monitor, check for protein in urine, put patient on left side. -Only cure is delivery of baby and placenta, keep patient on mag sulfate 24 hours after delivery. Magnesium sulfate is used 4 gram bolus and 2 gram maintenance given.

Monitoring Mom during Epidural

Vitals every 5 mins. On mom initially until stable Q30min [on Pitocin]

What vitamin aids in the absorption of Iron?

Vitamin C

Candida Albicans S&S

Vulvar itching Thick, creamy white vag discharge Vulvar redness White patches on vag walls Gray white patches on tongue and gums

Chlamydia s&s

Vulvar itching Vag spotting White, watery vaginal discharge

*SYNDACTLY*

Webbing of the skin between the digits and toes

Blastocyst is free-floating

Week 1

2nd & 3rd trimester risk assessments

Weight, bp, urine, uterus, fetal heart tones, edema, maternal serum alpha fetoprotein (MSAFP), triple marker screen

*SPINAL MUSCULAR ATROPHY*

Werdnig-Hoffmann Disease Type 1 • Manifests within 1st 2 months of life • *Lies in Frog Position*, Weak, Cry, Cough, Generalized Weakness • Active* Movement limited to fingers and toes* • Normal sensation & Intellect • *Death By 2 yrs of Age*

A nurse sees a 5 yr old fall and bump head. What question should nurse ask?

What is your name?

Plastibell

What procedure is this called, when a string is tied over a fitted plastic ring beneath the foreskin. Are heals and plastic ring falls off in 7-10 days.

When wouldn't you use ASA (aspirin)?

When a child has a fever or an illness.

Ballottment

When the fetus bounces and rebounds from tapping belly

When can bathing by immersion be done?

When the newborn's umbilical cord has fallen off and the circumcision has healed on males

AFE [amniotic fluid embolus]

Who is at risk for AFE- all moms -RARE case though (spontaneous), recognized dyspnea, chest pain. -amniotic fluid is drawn into the maternal circulation and carried to mom's lungs

Uterine rupture

Who is at risk- prior C-sections, large babies, contractions too close to each other, multiple babies, rapid labor, prior abortion/uterine manipulation with window or scarring in uterus.

*CLEFT LIP* Post op Nursing Considerations

With palate surgery- change infant's position frequently to facilitate breathing. Placed on abdomen during immediate post-op period. Avoid placing objects in the mouth after cleft palate repair. Avoid foods that could damage the palate repair.

Meconium staining of the amniotic fluid

With thick fresh meconium places the fetus at risk for meconium aspiration syndrome.

1st Urine passed

Within 24 hours of birth, document how many times urinates daily.

Is hemorrhage possible after the cord has been clamped and cut?

Yes, because baby needs vitamin K.

Nutritional assessments

[In toddlers] **Too much calcium= Anemia because "calcium impedes iron absorption" -Adolescents (puberty)- surge of growth. Muscle mass. -Anorexia - Not eating; Control issues, body dysmorphia. -Bulimia - Binge and purge; Body dysmorphia.

Haemophilus influenzae

___________ is the most common cause of epiglottitis.

Breech

a baby that is turned upside down in the birth canal, since the head is the largest part it may become trapped

APGAR scoring is:

a brief physical exam done immediately following birth to rule out abnormalities.

nevus flammues (port wine stains)

a capillary angioma below the surface of the skin that is purple or red, varies in size and shape, is commonly seen on face and does not blanch or disappear.

spina bifida

a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it

Gastroschisis

a congenital fissure of the abdominal wall not at the umbilicus. Enterocele, protrusion of the intestine, is usually present

Linea Nigra

a dark line appearing on the abdomen and extending from the pubis toward the umbilicus

Vistaril

a drug (trade names Atarax and Vistaril) used as a tranquilizer to treat anxiety and motion sickness, Acts as a CNS depressant at the subcortical level of the CNS., Hydroxyzine 50-100mg (QID) (PO, IM)-AVoid eldery,renal C/I: early prego; warn: Glaucoma, BPH, Resp ADR: urinary retent, dizz, drowsiness, dry mouth, blurry vision Histamine H1 antagonist- 1st gen

Vitamin K

a fat-soluble vitamin that helps in the clotting of blood, newborns ability to produce is poor usually will get a vit. k shot IM

Trimester

a period of three months

Acute Glomerulonephritis

a person with ____ will have smoky brown urine because of the RBC's.

Apical pulse

a(an) _______ is the best option for an infant pulse reading.

Abnormal Pregnacy discomforts:

abdominal pain, discharge, headache, poor vision, slurred speech, upper trunk edema

Positive CST is normal or abnormal

abnormal

hydrocephalus

abnormal accumulation of cerebrospinal fluid in the ventricles of the brain as a result of developmental anomalies, infection, injury, or tumor

Patent ductus ateriosus

abnormal opening between the pulmonary artery and the aorta caused by failure of fetal ductus arteriosus to close after birth

DIC risk factors

abruptio placenta AFE missed abortion fetal death in utero Severe preeclampsia or eclampsia (GHTN) Septicemia cardiopulmonary arrest hemorrhage hydatiform mole

Amenorrhea

absence or suppression of normal menstrual flow

Test for NAS

Sample: Urine, meconium

A nurse is caring for a client who is breastfeeding and has mastitis. Which of the following should the nurse teach the client?

"Completely empty each breast at each feeding or with a pump."

A nurse determines that a client who is pregnant needs further instructions about an amniocentesis when the client states,

"I need to have a full bladder for the procedure to be done." *An amniocentesis requires an empty bladder to prevent an inadvertent puncture from occurring.

A postpartum client who is being d/c'd 2 days after delivery has been diagnosed with a UTI. The nurse reviews discharge instructions with the client. Which of the following statements by the client indicates a need for further teaching?

"I will perform peri care and apply a perineal pad in a back/front direction." & "I won't nurse my baby until I have finished taking the antibiotic."

Physiological jaundice

** Occurs after 24 hours to the 7th day [it resolves itself sometimes] -caused by immune hepatic function (baby liver not working yet); occurs after >24 hrs, peaks at 72, lasts 5-7 days

Postpartum pouring out blood. What do you do?

***Intervention #1 --Massage her Fundus***

Newborn care - initial assessments:

**1st Respiratory (breathing) Initiation and continuing breathing [maintenance] -Apgar scores -Assess Pulse rate; palpate cord for baby heart rate

Chorioamnionitis

Inflammation of the amniotic sac (fetal membranes); usually caused by bacterial or viral infection. Also called amnionitis.

How can we minimize the stress of hospitalization?

**Alleviate stress and fears: ask parents stay participate, explain procedure, and provide distractions **Ways to min. stress - rooming in w/ patient [parent should be primary source for coping & comfort], bring an object from home, draw pic to hang in room, offer choices of watching movie or picking a game, therapeutic play, child life specialist, guided imagery, role modeling (decrease fear and anxiety and coping skills), move to procedure room [not in their own room]

Post Cath Procedure

**Lie flat. -Monitor vitals (HR, RR, BP); distal pulse -restrain -maintain IV therapy (dehydration) -Monitor bleeding of the site, and apply pressure above site if bleeding. *Note: place dressing on top to reinforce, do not remove dressing MD applied. -Monitor pain and administer pain meds as prescribed. -May need to add sedation if too rambunctious. -Vigilant surveillance of vital sign and bleeding. If bleeding is severe the patient must be attended with pressure held to the site while another nurse contacts the physician and calls for immediate assistance.

Know the risks of Croup syndromes

**Viral, some is transient. -Larynx can become inflamed and swollen. -Narrow airway diameter so children more susceptible. -Poor tissue perfusion.

Pathological jaundice

**before the 24th hour and after the 7th day -Occurs <24hours or lasts longer than 7days. -Usually result of blood incompatibilities, infections, preterm, RBC disorders, birth trauma, assisted delivery

HOW they play in each of these stages? Note: primary school they tend to play in single sex groups.....and in high school they group by interest groups.

*5 types of play • Solitary (0-2 Years) - infant/ toddlers. Adolescent. Child should be socialized. Can be at any stage, but do not want this type of play only • Parallel (2.5-3 Years) - toddlers. Two toddlers doing the same task, hasn't learned to play with each other. Egocentric. (two children playing together but oblivious to the fact, don't understand the concept of someone outside of themselves) • Associative (3-4 Years) - preschool, early child. Get together to something accomplished, but no rules. • Organized/cooperative (4-6 Years) - school aged/adolescents. Organized sports, rules. Concept of rules upholding. Need moderators. Sports w/Rules • Onlooker/Spectator (2-2.5 Years) - toddlers, young preschool. RED flag if it continues with this type of play; autism, cognitive development problems (can see in toddler or preschooler, but should want to participate)

Play is important - know the different play methods seen by each group of children.

*5 types of play "Play is the work of the child" -Solitary (0-2 Years) - infant/ toddlers. Adolescent. Child should be socialized. Can be at any stage, but do not want this type of play only. Video games. -Parallel (2.5-3 Years) - toddlers. Two toddlers doing the same task, hasn't learned to play with each other. Egocentric. (two children playing together but oblivious to the fact, don't understand the concept of someone outside of themselves) -Associative (3-4 Years) - preschool, early child. Get together to something accomplished, but no rules. -Organized/cooperative (4-6 Years) - school aged/adolescents. Organized sports, rules. Concept of rules upholding. Need moderators. Sports w/Rules -Onlooker/Spectator (2-2.5 Years) - toddlers, young preschool. RED flag if it continues with this type of play; autism, cognitive development problems (can see in toddler or preschooler, but should want to participate)

Placental separation (3rd stage of labor)

*5-30min to get it out, gush of blood shows placenta is detached, cord gets longer, uterus gets very firm (cramping and pressure), -visual inspection of placenta (dirty Duncan or shiney schultz), - cord is centered in placenta, - 3 (AVA) 2 arteries and 1 vein, (if not; renal disease of baby) -Biggest risk to mom is hemorrhage

*KAWASAKI DISEASE* Signs and Symptoms

*ACUTE STAGE* • Fever • Conjunctival hyperemia (Blood shot eyes) • Red Throat • Swollen Hands, Rash, Enlarged Cervical Lymph Nodes) *SUBACUTE STAGE* • Cracking Lips and Fissures • Desquamation of skin on tips of fingers and toes • Joint Pain • Cardiac manifestations *CONVALESCENT STAGE* • Child appears normal but signs of inflammation may be present

Acquired defects are usually associated with an infectious process- what bacteria is the issue?

*Acquired defects are related disease process [infection, autoimmune response, environmental factors, familial tendencies] (Acquired) ** Streptococcus* causes Rheumatic fever (scarlet fever) - also deposits scars on heart valves. -Valves may need to be replaced. RF is a complication of strep illnesses. Strep identification and full treatment instruction imperative.

*CARDIAC MEDS-EDUCATION AND CONCERNS* *Captopril (Capoten) or Enalapril (Vasotec)*

*Angiotensin-converting enzyme (ACE) inhibitors* reduce afterload by causing vasodilation, resulting in decreased pulmonary and systemic vascular resistance. • Nursing Consideration- Monitor B/P before and after the medication is administered. • Monitor for signs of *HYPER*kalemia. • Client Education • Parents should be instructed to monitor B/P frequently.

How to promote perfusion to the placenta, and what can interfere?

*Any disease or substance that interferes with vascular perfusion: HTN, DM, smoking, drugs, poor nutrition, etc. -"work horse" -AVA (2 Arteries, 1 vein) -It is the mechanism for gas exchange. -Educate to promote bedrest, adequate hydration, good nutrition, lateral side lying position -Part of the endocrine; secretes HCG, HCS, progesterone -Pre-eclampsia, smoking, drugs, poor nutrition can all affect perfusion -Placenta starts to breakdown on post dates.

When labor is not progressing what are some of the non - pharmacological and pharmacological means to make a difference.

*Induction- chemical or mechanical modalities to initiate uterine contractions

Milestones of infants to toddlers - Be aware of these so if a child has not reached a milestone, what questions should you be asking and when do we alert the MD?

*Infancy- greatest rate for growth at 6 mo. (7 lb.) Double birth weight @ 6 months (14), and triple weight by 1 year old (21lbs). *Children; grow from head to tail, middle to distal, simple to complex, grow at the same steps but not the same rates. * Anterior fontanelles close 12-18 months, 6-8 weeks posterior fontanelles close

Which of the following nursing interventions will promote comfort for a client who has a small hematoma of the perineal area?

-Apply ice to the perineal area for the first 24 to 48 hr. -Encourage sitz baths at least twice a day. -Use a topical antiseptic cream or spray on the perineal area.

Carditis

Inflammation of the heart - manifestation of rheumatic fever that can be fatal

Injury prevention in each stage of childhood

*Infants-[MVA, aspiration, suffocation, SIDs, choking], falls, baby-proof the house, drown in 1" of water, set the thermostat on the water heater low. Now a code for new homes. *Toddlers- MVA, drowning, suffocation, aspiration (choking), stranger danger, also diving, ATV or motorized bikes, tools and equipment, fire hazards, gates for confinement, stove top, outlet covers, doorknobs, lock up dangerous household items and medications. As they get older the risk taking behaviors need to be managed. *Adolescents - alcohol, drugs, MVA, guns.

Asthma - complex respiratory illness - how do we recognize?

*Inspiratory and expiratory wheezing, use meds that are prescribed. -Give steroids, IV access, infusers *Reactive airway symptoms; - non-productive cough, retractions, nasal flaring, tachypnea, wheezes, can get air in, but have trouble pushing it out, symptoms of respiratory distress.

Signs/Symptoms of UTI in children:

*Neonate* -are failure to thrive, jaundice, fever or hypothermia, poor feeding, or vomiting. *Infant* -usually is a poor feeder, has fever, strong-smelling urine, vomiting, and diarrhea. *Preschooler* -often presents with anorexia and sleepiness along with vomiting, diarrhea, abdominal pain, fever, strong-smelling urine, enuresis, dysuria, urgency, or frequency. *School-age child*- has new enuresis, strong-smelling urine, urgency, or flank pain and some changes of personality. *Adolescents*-often experience fatigue and flank pain. Visual inspection of external genitalia for irritation, pinworms, sexual abuse, trauma, or vaginitis is important.

Normal Fetal heart rate, when movement occurs, and when you can palpate fundal height and begin measuring with a tape measure.

*Normal fetal HR 110-160 BPM -Fundal Height at 10-12 weeks; symphysis pubis -Usually initiated at 22 wks -Fundal Height at 20 weeks- umbilicus -Measure: 1cm per week after 20 weeks [22-34 wks fundal measurement correlates w/ wks gestation]

Medication administration to children

*Oral meds- measure correctly, don't use spoon or cup, no ASA for children except for Kawasaki's. Uncooperative use syringe. Do not mix in formula. Mix in food. Make sure getting correct dose. *IM/SubQ- know equipment and sites. Best site vastus lateralis for babies and toddlers. Vaccines in deltoids (preschool/school aged). Ventral gluteal- choice, no major vessels, easy landmarks, less pain. PCN (oil based) *IV meds- 24g IV (shorter catheter), 22g when older, 5/8 needle-1 in. Check for infiltration frequently because of movement. Use plastic domes (cups) over the site, tape, wrap in gauze, immobilizers, use tegaderm to view sites, use restraints if necessary and lots of tape Otic Meds (Ear drops)- up and back at age 3, otherwise down and back < 3 years *Trach for child- less than 5 seconds on suction. One pass. Ensure Tubing is half the size of trach (prevent edema or trauma).

*SPINA BIFIDA* Treatment

*PREVENTION* • Start Folic Acid at Preconception • Folic Acid Supplementation of *0.4 mgs daily*

Forms of child abuse -and your Legal responses of a child maltreatment.

*Physical, Sexual, Verbal, Neglect* -Difficult to pin point -The nurse looks for repeated admissions or office visits for unexplained physical injury. -*Spiral fractures* is a main sign indicating child abuse suspicious bruising, welts, or burns, new or healing lacerations -fear of going home -retinal hemorrhage (SIDS; babies) -hunger, clothing unsuited for weather (neglect) [*The nurse observes the child for signs of fear of the adult care-giver, inability to answer questions without looking to the adult for approval, a child with little reaction to pain, poor eye contact, or injury inconsistent with the story given for reason of injury.] -*To report child abuse the nurse can call local law enforcement agency and/or follow institution policy. NURSE MUST REPORT ANY SUSPICIOUS MALTREATMENT OF CHILDREN*.

Diabetes Mellitus Type 1 concerns, management and fetal surveillance

*Surveillance- Insulin dependent DM; symptoms (polyuria, polydipsia, weight loss); age <30, 10% of those diagnosed with DM. *Risks to baby: effect growth and development of fetus [risk of major congenital defects due to hyperglycemia during organ development phase], increased risk of perinatal death, adverse effects throughout life for child.

Transition phase [of 1st stage]

- 8-10 cm dilated, start to feel pushy, contractions 2-3 min apart, fastest most difficult try not to stay in this phase for more than 2 hours, getting more meds to baby at this time.

Managing blood administration

-* Consent*, type and cross, -needle 20 gauge (smallest), -Vitals before and after transfusion, -double check blood with another nurse, -reaction to blood (Benadryl), -Administer unit within 4 hours (no longer than 30 min on the unit). -Run with NaCl and special filter closest to the hub of the IV -Document clearly -Stay w/ the for first 15 min of blood starts running, if reaction is going to happen will likely happen during this time.

Normal ranges for pediatric temperature

-2 months: 99.4 (37.5) -4 month: 99.5 (37.5) -1 year: 99.7 (37.7) -2 years: 99.0 (37.2) -4 years: 98.6 (37.0) -6 years: 98.3 (36.8) -8 years: 98.1 (36.7) -10 years: 98.0 (36.7) -12 years: 97.8 (36.6)

Stage 2 of Labor [Delivery of the Baby]

-2-3 hours -baby crowning within 2 hours

I.V. meds

-24g IV (shorter catheter), 22g when older, 5/8 needle-1 in. -Check for infiltration frequently because of movement. -Use plastic domes (cups) over the site, tape, wrap in gauze, immobilizers, use tegaderm to view sites, use restraints if necessary and lots of tape

Magnesium sulfate

-4 g bolus, 2 g maintenance. Inhibit uterine contraction (delay birth) -S/E: include flushing, feeling uncomfortably warm, headache, dry mouth, nausea, and blurred vision. -Women often say they feel wiped out, as though they have the flu. These side effects can be uncomfortable, but they are not dangerous. -Too much Mag sulfate you get Knee-Jerk reflex (DTR); -reversal is calcium gluconate.

Post dates: Pregnancy lasted longer than EDB

-42 weeks, do not go beyond 41. -Watch for placental breakdown -stressed baby; meconium passage aspiration, baby's get large, stillbirth Pregnancy lasted longer than EDB

Stage 3 [Delivery of Placenta]

-5-30 min -risk for postpartum bleeding [hemorrhage]

Placental separation (3rd Stage of Labor)

-5-30 min to get out, gush of blood big scab pulled off...cord lengthen at perineum, increased contractions. -Uterus will get very firm [cramping, pressure] with movement of placenta.

Shoulder dystocia

-At risk Diabetic mother with out of control w/ diabetes; -large babies, shoulder is stuck in pubic bone, labor is not progressing, nurse push above symphysis [not fundus] to help pop shoulder out from under symphysis; -brachial plexus (severe), fractured clavicle (no mvmt of arm).

Shoulder dystocia

-At risk with out of control diabetic moms -Macrosomia babies, could get stuck in the pubic bone. Labor not progressing, pushing...not coming out. Head out then retract.

Full-Term Baby

-Average weight 3500 g [7.5 lbs] -Average length 20"

Fetal results for poor nutrition:

-B12 deficiency; megaloblastic anemia, neurodevelopmental delays. *Inadequate nutrition - low birth weight, inadequate development, preterm birth, neurological defects

hypoglycemia in a newborn

-BS is normal at 70 to 100. -hypoglycemia occurs when the BS is < 60. -Signs include jittery, startled look, tremors, shakiness - Cold stress leads to hypoglycemia.

5 Parts to fetal monitoring:

-Baseline -Variability -Accelerations -Decelerations [early, late, prolonged] -Maternal activity

Erikson's theories of Development - why?

-Because if you do not recognize lags in developmental stages we as nurses cannot assist the family in helping this child become a social and productive person. -Object permanence is crucial, separation anxiety, concept of time, death, sharing. -Developmental level drives the way we design and deliver their care.

Treatment for Pre-Eclampsia

-Bed rest, vitals Q1hr, listen to lungs, I&O, DTR -Administer magnesium sulfate [Antidote- calcium gluconate]

3rd Stage of Labor

-Begins w/ birth of infant and ends w/ delivery of placenta 5-10 minutes, uterus becomes contracted

Define Macrosomia - and what are the risks?

-Big baby 90th Percentile- shoulder dystocia, -Increased fundal height is common -Monitor Blood sugar and Respiratory (meconium)

Phototherapy

-Bili light; blue spectrum light. -light is absorbed by bilirubin and changes the structure, allowing it to be excreted from the body more easily -

Chemo therapy has risks and side effects

-Chemo Therapy- N/V, loss of hair, loss of appetite, weakness, lethargy -Nursing management: Infection control issues; isolation from others who are sick, handwashing.

How do children with cardiac disease present to your ED, and how do you manage?

-Child will present with SOB, irritability, edema, poor activity tolerance, puffy fontanels, delayed activity, poor nutrition, and altered vital signs.

GI issues - dehydration is huge.

-Children that become dehydrated may suffer long term organ damage - so we must encourage fluids - PO or IV. -Watch the titration, it may cause problems if we run fluids too rapidly. -We do not restrict fluids, but should be mindful of what types of things they are drinking - milk may thicken secretions - fruit juice may induce diarrhea, soda/pop - may also induce diarrhea or cramping.

Tx/Risks associated with bili treatment:

-Concerned about eye damage (covered), -feed a lot more frequently (poop and pee out faster), -thermoregulation, -Bili lights and Bili blanket.

Late Decelerations

-Due to placental insufficiency -non-reassuring drops in FHR after the end of the contraction

How do we keep babies safe in the hospital setting?

-Electronic tracking of infants -Identification bands placed on mother and infant shortly after birth (matching) -Follow hospital protocol when transferring baby from nursery to mother's room (bassinets, no carrying child in halls) -When two or more babies have similar last names, "NAME ALERT" name followed by another letter. -Hospital personnel visible ID at all times, visitors all need name badges.

Congenital disorders

-Exist at birth -Genetic: inherited -Teratogenic: acquired during gestation

Fever Management - How and why?

-Fever is the primary reason for pediatric ED admission. -Fever management is imperative to prevent pediatric febrile seizure. -Temperature greater than 100.4 is considered fever and requires treatment. -If the fever does not respond to treatment, or lasts longer than 72 hours, the child should be evaluated to determine the cause of fever. -Any child under the age of 6 months requires evaluation.

Newborn assessment - what is the first assessment?

-First assessment is ALWAYS Respiratory! -APGAR next - Activity, Pulse (HR >110), Grimace, Appearance (color; pink, acrocyanosis), Respiratory Rate [>30] *Done at 1 min and 5 min. of life* APGAR: Can score 0-10, most common score, "Normal" score of 7-9 APGAR score of 3 - [O2 by ambu bag, call code] APGAR of 3-7 - [stimulate baby, give blow by O2, suction, dry them; Prevent cold stress in baby. -Temp should be 36.5-37.2C taken axillary [rectal can be done in nursery to check anal patentcy] *Take HR through pulse in cord* -Gestational markers -Apical pulse -Listen to bowels sounds, soft belly -Head to toe on baby [Head - OFC, fontanelles, suture lines, eyes, ears (alignment and coiling), mouth, flexibility of tongue, cleft, suck and swallow, check clavicles] -Blood sugar -Plantar reflex, club foot, genitals, descended testes, scrotum enlarged, dimple at base of spine.

Delivery Room Cares

-Frequent vitals q2-4hours -Weight/length, foot print -Vitamin k -erythromycin ointment

Ballard scale (Newborn Assessment)

-Full gestational mark (10 different steps with grade) use in NICU premature -step gives us a grade and will give you how many weeks gestation the baby is.

Accelerations

-Happens with movement above the baseline. Good! -Brief, temporary increases in FHR of at least +15 beats more than baseline and lasting at least 15 second- (same parameters as Non-stress Test)

Immunizations - What/when?

-Hep B- [Hepatitis B] First @ 1-2 months, Next @ 6-18 months -DTap- [Diptheria, Tenus, Pertussis] @ 15-18 months -Hib- [Haemophilus influenza type b] @ 12-15 months -PCV- [Pneumoccoccal] @ 12-15 months -IPV- [Inactivated Polio Virus] @ 6-18 months -Influenza- yearly after 6 months -MMR- [Measles, Mumps, Rubella] @ 12-15 months -Varicella- @ 12-15 months -HepA- 2 doses @ 12-23 months

Palliative Care; Cancer

-Hospice; comfort care, pain management, help with ADL's, parental support & education for the family. -Management- Infection control issue, hand wash, contact precautions.

A nurse is caring for a client who is in labor. Which of the following should the nurse assess for following placement of an epidural?

-Hypotension in the mother because it is an adverse effect of epidural analgesia. -Epidural analgesia also causes fetal bradycardia

Medications during Active Phase of labor

-IV push- Nubian, Stadol, Demerol -best time to give is during contraction [peak of contraction] = less med to baby

About consents

-If a child is of age, they don't need their parent's signature. -If emancipated they can sign as well. If not the parent must sign. -In emergencies physician can approve if parents are not available. -Religious beliefs can be overturned by courts in some cases. *Need signature consent for invasive procedures; from parent, guardian or emancipated; pregnant, military, court order *Consents are Voluntary, understanding of procedure (cognitive/language barriers; interpreter if needed), attempt to contacts [document] telephone attempt; life or limb.

Consents - for invasive procedures [*Need signature consent for invasive procedures; from parent, guardian or emancipated; pregnant, military, court order]

-If a child is of age, they don't need their parent's signature. -If emancipated they can sign as well. If not the parent must sign. -In emergencies physician can approve if parents are not available. -Religious beliefs can be overturned by courts in some cases. *Consents are Voluntary, understanding of procedure [cognitive/language barriers; interpreter if needed], attempt to contacts [document] telephone attempt; life or limb.

Risks of rupturing membranes, nursing interventions

-If patient not in labor DO NOT rupture membranes -Rupture of membrane at 1 cm risk for infection -Time stamp 24 hours -Risk for Ascending infection

Nutritional needs

-Infant- breast feed up to 1 year, no milk prior -Solid foods - around 6 mo., slowly new food every 3-4 days -Toddlers - picky eaters, physiological anorexia, grazers; no food fads are detrimental unless purposely not eating. -Growth problems if not receiving proper amount of proteins: Ask what they like (if don't like milk find another option for calcium) **Too much milk can cause anemia [Ca impedes iron absorption]

Normal ranges for pediatric respirations

-Infant: 25 to 55 -Toddler: 20 to 30 -Preschooler: 20 to 25 -School-aged: 14 to 22 -Adolescent: 12 to 18

Normal ranges for pediatric blood pressure

-Infant: 65/45 to 100/65 -Toddler: 90/55 to 105/70 -Preschooler: 95/60 to 110/75 -School-aged: 100/60 to 120/75 -Adolescent: 110/65 to 125/85

Normal ranges for pediatric Heart rate

-Infant: 80 to 150 -Toddler: 70 to 110 -Preschooler: 65 to 110 -School-aged: 60 to 95 -Adolescent: 55 to 85

What is the role of the child life specialist?

-Is an expert in child development and therapeutic play -She can assist in diversion activities during procedures, arrange for therapeutic play, or simply let the child take time to play.

prolapsed cord

-Lack of O2 and blood flow to the fetus. -When noting FHT will be noted by a variable deceleration - Turn mom on LEFT side. -Non engaged baby is at higher risk if ruptured membrane because the cord can fall down and get in the way

Chest and Belly (Newborn Assessment)

-Listen Heart (apical 1 min) -lungs -belly and bowels palpate gentle (round and soft) -chest is round, ap same as lateral diameter -cord is clamped and drying, and clean, with three vessels

Manage pre-eclampsia Meds:

-Magnesium sulfate- (MGSO4) seizure prophylactic; drug of choice because of CNS depressing. -Antihypertensives (when diastolic pressure reaches 110 mm/hg) [NOT First line intervention!]

Before discharge

-Make sure the baby able to void

Skin (Newborn Assessment)

-Mongolia spots, newborn rash, milia (across nose), hematoma on body, stork bites, nevi, lacerations (treat and cover)

**Restraints 411:

-Must be removed every 2 hours. -Parent teaching and return demonstrations must be validated. -Chemical restraints are sedation. Can be used to reduce anxiety. **Airway MUST BE MANAGED at all times. Child must be under direct surveillance at all times.

Treatment for placental abruption/Previa

-NEVER check cervix with active profuse bleeding (ultrasound, line start IV) -treatment is IV therapy, monitor, cross-matched for blood, set up for a section...see on monitor- decreased variability, and decelerations.

maternal gestational diabetes

-NO oral agents...must give insulin. -A large baby is associated with a mother who has maternal diabetes. -A baby born to mom will be hypoglycemic since the fetus was used to having to supply all that insulin in utero

Postpartum Issues

-NSAIDs; Motrin for pain management, Ice, sitz bath, stool softner (tears) -Breast engorgement- warm showers, cabbage leaves, empty breast, manual expressing, snug bra to support tissues of breast -Non lactating- cold compress, very snug bra, ice -Mastitis- hot red streaks, unilateral, warm to touch, flu-like symptoms, engorged lymph nodes under arms Tx; Keflex, keep breast empty (milk duct infected) -Blues- normal phenomenon, hormone changes, scared that baby will take up energy. Last 2 to 3 weeks -Depression- more severe. Meet basic needs but, no longer care for yourself, not taking a shower, not engaged Require meds and outpatient therapy. At higher risk for post-partum depression if needed meds prior, -Psychosis- most severe form. Disengaged with life and reality. Hears voice. Needs to be hospitalized to keep baby safe.

How do you determine EDD?

-Naegele's rule - add 7 days and subtract 3 months from 1st day of LMP -Fundal height - correlates to weeks of gestation from approx. 22-34 weeks gestation; -12 wks gestation fundus should be at level of symphysis pubis; -20 weeks at umbilicus; initiated at around 22 weeks -Fetal heart sounds heard w/ Doppler 10-12wks or by 17-19wks w/ fetal stethoscope

Nubain [nalbuphine]

-Narcotic. Kicks in within 2-3 minutes. Lasts 10 or so hours. -Pain relief and relaxation during labor; labor pain; postoperative pain after C-section; can precipitate withdrawal symptoms if pt has opioid dependency

hormone feedback system and the responses of the body under the influences of hormones.

-Negative Feedback brings conditions within the body back to balance [homeostasis] (most systems) -Positive Feedback keeps enhancing the original stimlus (oxytocin stimulates contractions, more oxytocin, more frequent contractions)

Are food fads that different children encounter harmful?

-No, and are usually self- limiting. -Adolescents have many different needs for greater caloric intake and more concentrated iron, folic acid, and protein.

Toddlers: Food fads a problem?

-No, food fads are not really a problem. -picky eaters, physiological anorexia "grazers". Introduce healthy snack foods. -They may incur physiological anorexia and physiological anemia due to the milk ingestion.

Pain management for children - both pharm and non- pharm management

-Non-Pharm methods- music and distraction, relaxation, holding hand, cuddling, reassurance, baby's (non-nutritive suckling, cuddling, sugar water), play, toys, draw pictures *Manage as you would an adult. Pain scales- Faces and FLACC are preferred. Believe the child's report. *For children 10-12 years old can use the numerical pain scale *ALWAYS treat pain to validated level of response. Chart pain, intervention and response. -Pharm- Morphine is the primary pain med for peds.

How would the nurse rule it out hydrocephalus?

-Normal growth patterns and circumference in the head rules out concern for hydrocephalus. **If an increase in cranial size is noted on exam, hydrocephalus as well as brain tumor should be ruled out.

Normal oxygenation levels in children on pulse oximetry. When would you intervene?

-Normal oxygenation levels is: 91-100% -Oxygen therapy should be implemented when a child's oxygen falls below 90% on room air.

separation anxiety

-Normally occurs between 7 to 12 months and peaks between 9 to 18 months, but decreases for most children by age 2 ½. -If the anxiety is severe and excessively disruptive, & persists for longer than 4 weeks, the child should be evaluated by a mental health professional

When is Vaginal Exam done?

-On admission for baseline, when mom needs to bear down, asks for pain meds, or when water breaks -Every time put finger there increase risk of infection

Pitocin

-Oxytocin (posterior pituitary) -induces labor and stops hemorrhaging after delivery of placenta

What scale is used for newborn baby pain?

-PIPP (Premature Infant Pain Profile 27 wks- term) -NIPS (Neonatal Infant Pain Scale 28-38 wks) -NPASS (Neonatal Pain, Agitation and Sedation Scale) **CRIES score (32-60 wks)

Signs & Symptoms of Uterine Rupture

-Pain, stopped contraction, rigid abdomen (blood pouring in abd), late decelerations, decreased variability...and prolonged decelerations

Dysmenorrhea - a common complaint with women - what are the non-pharmacological and pharmacological treatments.

-Painful period- could be from endometriosis, or fibroid. -Heating pads, exercise, stretching, good nutrition, avoid alcohol and drugs, decrease caffeine. Heat, NSAIDS is most common prescribed.

infant colic

-Parent may be completely overwhelmed and exhausted. -Child has "fussy period" every day. -Car rides and walking the floor in cradled arms may help settle the baby. -This syndrome tends to resolve between 12 and 16 weeks spontaneously. -Sometimes a formula may aggravate the condition [dairy intolerance] and mom's diet may be implicated, but typically, it spontaneously resolves.

Types of seizures

-Partial; focal localized in one area -Partial Complex; LOC with change in behavior. Confusion. Origin is temporal lobe. -Partial Simple; Last for 5 min, child only remembers aura. Sx only on one side of body. No LOC. -Generalized; starts in all parts of the brain. -Tonic/Clonic; muscle spasms, LOC, contraction of limbs. Confusion. Bladder incontinence. -Atonic; Sudden drop to the floor, no LOC, No convulsions, "stare". Several times per day "petit mal" -Tonic/myoclonic/clonic; "grand mal". Stiffness.

4th Stage of Labor

-Physiological adaption following placenta delivery (1-2 hrs) Lochia rubra, bright red blood flow, bonding w/ infant, breastfeeding.

If there is a non reassuring Fetal Heart rate - what are the nursing interventions?

-Position change -O2 (by mask 8-10 L- getting it down to the placental bed), IV floods, Stop the Pitocin [all at the same time] -Call the provider -Document very carefully the time exactly/

If the fetal monitoring is non-reassuring what is the nursing interventions to provide intra uterine resuscitation.

-Position change -O2 [by mask 8-10 L- getting it down to the placental bed], IV floods, Stop the Pitocin [all at the same time] -Call the provider -Document time very carefully

Cord Prolapse - At risk:

-Premature rupture of membrane, -multiple fetuses, -transverse position, -head too high, breech position; -Vagina exam, -Take pressure off cord of the presenting part, -Head to get c-section, -Place in reverse trandelenberg position, -fetal monitor; decelerations

Uterine Rupture - risk:

-Prior c-section, multiple babies, prior abortion, large baby, contractions too close together, rapid labor; -S/Sx:late and prolonged decels, rigid abdomen, contractions stop! -C-section to resolve the issue

Which of the following should occur first for an internal scalp electrode to be applied?

-Prior to the insertion of an internal fetal monitor and an intrauterine pressure catheter, the membranes must first have ruptured. -Cervical dilation, effacement, & engagement of the fetus are also needed.

Separation anxiety

-Refers to severe distress that occurs when a child is separated from his or her primary caretaker-Begins 6 months of age and peaks in intensity at 14-18 months and then gradually declines;start to accept fact that parents will come back.

Cognitively impaired children

-Require more vigilance, more discussions, more education and we must help parents realize their true potential realistically, but the children need to socialize. -*Children need opportunity to play, grow and develop, and need to NOT be compared to able-bodied and non-delayed peers. -Guide parents to enable the kids to grow/learn/manage themselves.

What are signs of Respiratory distress in babies?

-Retractions; use of accessory muscles -grasping, tachypnea (80-100 breaths per minute) -elevated respiratory rate -shallow labored breathing -head bobbing -Cyanosis -flaring nostrils -audible expiratory grunting -in infants color change, and as condition worsens flaccidity and apnea occurs.

Prolonged deceleration

-Right now! cut off from O2 in mom; Supine Hypotentsion, seizure, PE, CVA really compressed cord.

NAS - neonatal abstinence syndrome - that which a baby endures during withdrawal - what are the signs of NAS? What is the management of the NAS?

-S/Sx- Tremors, irritable, crying, vomiting, constant eating still not enough, weight loss, hyperreflexia, arching of back, baby in pain seizure. -Sample- Urine, meconium (stool) -Treat with medications; *methadone* or *morphine* to ween, time, swaddle (swing), watch baby closely. -Score every 3 hours.

Discipline is for:

-Safety and education with positive reinforcement; to make good choices, aggressiveness with toddlers because they don't remember: -Withholding, time out, rationalizing, distractions

Reasons for Restraints

-Safety; keep patient safe, procedures **Restraints: used for procedures to keep safe and postoperatively (prevent pulling of IV or sutures)

Difference between sprains/ fractures

-Sprains are soft tissue injuries (ligaments and tendon; occur after puberty after growth plates of epiphysis is closed) -Fractures occur when the bone undergoes more stress than it can absorb (Open or closed). Most common causes; falls, MVA, & bicycle accidents.

Sprains versus Fractures

-Sprains are soft tissue injuries [ligaments and tendon; occur after puberty after growth plates of epiphysis is closed]. -Fractures occur when the bone undergoes more stress than it can absorb [Open or closed]. Most common causes; falls, MVA, & bicycle accidents.

ICP in children - specifically infants. Know possible causes, nursing interventions, priority care.

-The intracranial pressure (ICP) is the pressure of the CSF in the subarachnoid space between the skull and the brain. -Causes: contusions (bruises), brain tumor, subdural or epidural hematoma, abscess, ischemic anoxic-states, hypertensive encephalopathy, acute liver failure, hypercapnia, Reye's Syndrome, venous sinus obstruction, CSF obstructed; hydrocephalus, meningeal disease choroid plexus tumor, subarachnoid hemorrhage. -Priority nursing interventions: maintenance of a patent airway; inadequate oxygenation or excess carbon dioxide causes cerebral blood vessels to dilate, resulting in an increase in ICP. Monitor vitals closely (intracranial bleeding = increase in body temp.), HOB elevated, loosen clothing around neck, protect child from injury (seizures). -S/Sx: Irritability, bulging fontanelles

Types of Burn:

-Thermal [hot liquid/grease 80% of burns hospitalized] -Chemical -Radiation (sun) -Electrical

Pitocin

-Titrate 1 to 2 mU in 3 ml of fluids uterine rupture, severe hypoxia, Tachysystole raise every 20-30 -goal contraction 2-3 min

Curative Care; Cancer

-Treat the cancer with drugs/radiation or surgery -Surgery- Remove tumors, surgical complications.

*Erikson's theories show how children interact, when milestone is not met there is stagnation in steps moving:

-Trust vs. mistrust (birth-1year) -Autonomy vs shame and doubt (1-3 years)- toddlers learning to be different, moving quickly away from parent, doing things themselves [balance independence and self-sufficiency] -Initiative vs guilt (3-6 years) exploring everything, mimic things you do. [wanting to be independent and needing to stay attached to parents] -Industry vs. inferiority (6-12 years)- mastery; star baseball player; frustrated [sense of confidence through mastery of tasks] -Identity vs. role confusion (12-18 years) - teenagers are struggling to find who you are, family is important if they are given positive reinforcement, if they don't get reaffirmation they look for it elsewhere. [struggling to find out who they are, biggest impact coming from parents or peers]

Erikson's theory

-Trust vs. mistrust (birth-1year) -Autonomy vs shame and doubt (1-3 years)- toddlers learning to be different, moving quickly away from parent, doing things themselves [balance independence and self-sufficiency] -Initiative vs guilt (3-6 years) exploring everything, mimic things you do. [wanting to be independent and needing to stay attached to parents] -Industry vs. inferiority (6-12 years)- mastery; star baseball player; frustrated [sense of confidence through mastery of tasks] -Identity vs. role confusion (12-18 years) - teenagers are struggling to find who you are, family is important if they are given positive reinforcement, if they don't get reaffirmation they look for it elsewhere. [struggling to find out who they are, biggest impact coming from parents or peers]

Demerol [Meperidine]

-Used for pain management -Opioid analgesic. Used for chronic pain or intense short term pain episodes.

Methergine

-Uterine stimulant; increase contraction force & frequency-stim smooth muscle. Control post-partum hemorrhage in 2nd Stage of labor. -S/E: HTN, atrial spasm, h/a, seizure, N/V.

Cord prolapse with Decelerations:

-Vaginal exam first [only when you see bad things happening] -Take the pressure off the cord [by repositioning or pushing off presenting part pushing down] -Extreme reverse t-bird, butt in air position.

Variability

-Want moderate -beat to beat change, how well baby is managing his environment [fetal health/well being] -Marked, moderate, minimal, & absent

NAS Treatment

-With medications; methadone or morphine to ween -time

Jaundice

-Yellowing of skin & eyes -RBC is changing from baby to adult type. -RBC is breaking down, bilirubin is byproduct of breakdown [bilirubin accumulate in blood stream] -because of traumatic birth or injury

Preferred site for injections by age

-[vastus lateralis for infants, deltoid if arms are large enough to inject]. *BEST SITE is- vastus lateralis for babies and toddlers. *Deltoid site for Vaccines in for preschool/school aged children. *Ventral gluteal- choice place for IM, no major vessels, easy landmarks, less pain (safely give after the child is walking and build some muscle mass on glute).

Episodic accelerations of the FHR from baseline should be interpreted by the nurse as indicative of

Intact CNS response to fetal movement.

Non-stress test (NST)

-a test that monitors fetal heart rate. A positive test would be in which the heart rate accelerates by at least 15 beats per minute for at least 15 seconds, with at least two acceleration episodes, in a 20 minute period. For "high risk maternal or fetal factors"

Cord prolapse

-at risk for premature rupture membranes -head not engaged, too high up -multiple fetus -breech/transverse position (unstable lie).

Education for asthma

-avoid triggers [dust, fear, anxiety] -use meds that are prescribed [steroids, bronchodilators] and always have them with you

Variability

-beat to beat change, how well baby is managing his environment [fetal health/wellbeing] -Marked, moderate, minimal, & absent.

Hemophilia

-bleeding disorder caused by congenital X-linked deficiency of either clotting factor VIII or IX (pt. cannot clot; bleed out) -S/Sx: Hemiarthrosis (blood in joint), discovered at circumcision or tooth extraction (bleeding), long term; mobility limitations, bony changes, and crippling deformities -Tx: Identify deficient factors and administer the proper replacement factors, prompt tx for bleeding episodes.

Nutritional needs for baby's/infants

-breast milk or formula for 1 full year. -Solids; at around 6 mo. when Surge of growth is the greatest.

Non pharmacological pain management for the laboring patient

-breathing, effleurage, exercise ball, change position, aromatherapy, hydrotherapy (tub/shower), counter pressure (occipital posterior presentation)

Dinoprostone (Cervidil)

-cervical ripening; produces contractions, dilation & effacement of cervix, initiate labor or expulsion of fetus. -S/E: abnormal contractions, warmth in vagina, back pain, amniotic fluid embolism, fever

Augment Labor during the Active Phase

-change position, walking, artificial rupture in membrane, sitting on a ball -Pitocin [aka vitamin P] ↑BP

Other signs the nurse observes for abuse

-child signals fear of the adult care-giver -inability to answer questions without looking to the adult for approval -a child with little reaction to pain -poor eye contact -injury inconsistent with the story given for reason of injury. *To report child abuse the nurse can call local law enforcement agency and/or follow institution policy.

Crohn's Disease

-chronic inflammatory disease characterized by periods of exacerbations and remissions in small bowels; terminal ileum; potential nutritional deficiencies (but can affect any portion) • Age of onset is between 10-20 years; condition occurs throughout life • S/Sx: Acute or insidious onset; abdominal pain, diarrhea, anorexia, & weight loss • Goal for treatment: controlling the disease, including remission & preventing relapse while maintaining adequate nutrition. Nurse can offer emotional support • Meds: Corticosteroids (reduction of inflammation) for acute exacerbations; Metronidazole (Flagyl) and ciprofloxacin (Cipro) treatment of perianal complications. Antibiotics; ampicillin (Marcillin), gentamicin (Garamycin), clindamycin (Cleocin), and metronidazole (Flagyl) are effective during acute exacerbations; Immunosuppressive medications are useful with corticosteroid-resistant disease

Radiation

-cold through the transfer of the cold object onto another object

Hirchsprungs- (GI problems)

-congenital aganglionic megacolon, is caused by a congenital absence of Meissner's and Auerbach's autonomic plexus in the bowel wall. -This absence of ganglion cells results in lack of motility in the affected portion of the bowel

Active Phase (2nd phase of stage 1)

-contractions 2-3 min apart. -Baby undergoing hypoxia during these contraction. 1-1 ½ cm, dilation and effacement

Purpose of amniotic fluid:

-cushion the fetus/cord -helps baby maintain normal body temperature -allows for symmetrical growth -prevents fetus from sticking to amnion -allows freedom of movement for baby

Constipation

-idiopathic or functional constipation -Symptoms associated with constipation are poor appetite, straining w/ stools, hard, sometimes bloody stools, tenderness (colon/small bowels), and rectal fissures. -Diagnosis: based on symptoms, abdominal radiography & barium enema -Manage by focusing on dietary intake (regular diet w/all nutrients), add fresh fruits and fibers, adequate fluids, limit dairy and keeping bowel sort of empty, stool softener at HS. Or, suppositories, enemas, GoLTYELY for chronic constipation.

IM/SubQ

-know equipment and sites. -Best site vastus lateralis for babies and toddlers. -Vaccines in deltoids (preschool/school aged). -Ventral gluteal- choice, no major vessels, easy landmarks, less pain. PCN (oil based)

Episiotomy

-large baby, ease delivery, mom too tired, tissue is too taught. -Avoid ripping -Midline and medial lateral type.

Trach for child

-less than 5 seconds on suction. -One pass. -Ensure Tubing is half the size of trach [prevent edema or trauma].

Latent Phase (1st phase of Stage 1)

-longest variable -not a lot of risk factors because no regular cervical change -contractions far enough apart, not a lot of stress with the baby. -Uterus is warming up.

Treatment for burns:

-manage pain -cover to prevent infection -replace fluid loss -adequate nutrition.

Depression

-more severe than blues. -Meet basic needs but, no longer care for yourself, not taking a shower, not engaged -Requires meds and outpatient therapy. -At higher risk for post-partum depression if needed meds prior pregancy

Pain Management with Epidurals -- biggest risk to mom is hypotension - which causes fetal decelerations, how to prevent?

-obtain consent, fluids (bolus), CBC with platelets, sit in right position [C-position] -Prevent maternal hypotension- I.V. fluids, get her off her back [wedge on right hip; no supine]

Iron Deficiency anemia

-occurs in adolescents & toddlers -Adolescents- muscle growth, menses, poor diet (fast foods) -Toddlers- Milk, Ca+ impedes iron absorption -Tx: Diet, vitamin C, iron foods, iron supplement (NO iron supplement with milk; constipation, and stains teeth).

develop breast tissue

during puberty girls begin to ______________, girls also enter puberty before boys.

Hirschprungs

-peristalsis is impeded by obstruction and can become a perforation, no stools, need surgery to fix; Failure to pass meconium within the first 48 hours of life, failure to thrive, poor feeding, chronic constipation, & Down syndrome. • S/Sx: vomiting, abdominal obstruction, failure to pass stools, diarrhea, flatus, or explosive bowel movements (ribbon, pellet shaped, foul smelling) • Surgical correction- resect affected bowel w/ or w/o colostomy, excise agaglionic segment of bowel • Post-Op: Nurse to monitor patent NG, abdominal distention, assess for return of bowel sounds, I&O (including NG/colostomy output) • Nurse to teach caregivers to care for colostomy, skin care, referral to community resources. Emotional support

Diarrhea (GI problems)

-rehydrate; if severely dehydrated - IV therapy, PO if possible -avoid soda, caffeine, sweet juices and milk -pedialyte or anything w/ electrolytes okay -Monitor I & O -do not stop diarrhea in order to get rid of the cause (if not long term) Do not use anti-diarrheal, do not restrict dieting.

Transient tachypnea of the newborn (TTN)

-retractions, expiratory grunting, or cyanosis and is relieved by low-dose oxygen therapy. -Mild or moderate respiratory distress typically is present at birth or within 6 hours of birth. -self-limited disorder without significant morbidity. -Transient tachypnea of the newborn resolves over a 24-hour to 72-hour period.

Digoxin (Cardiac Drugs)

-strengthens the heart; better pump; control and slow certain irregular or fast heartbeats. -S/E: drowsiness, upset stomach, Digoxin toxicity; slow HR, dizzy, pale color, weakness, clammy, loss of appetite, blurred vision, or halos around objects -Monitor for signs of dig toxicity.

cytotec (Misoprostol)

-used as a cervical ripening agent, and also used to control post partum bleeding -Medication that may be used for medical management of a missed miscarriage

Stadol [Butorphanol]

-used for Pain management -narcan DOES NOT reverse Stadol effects -Can be used throughout labor [should not be given within 1 hour before delivery]

Lasix (Cardiac Drugs)

-used to reduce edema in both acute and chronic cardiovascular, pulmonary, and kidney diseases; fluid overload, high BP. -S/E: dry mouth, increase thirst, h/a, skin sensitive to the sun, N/V -Increased risk for blood clots, hypotension, dehydration, hypokalemia monitor electrolytes, monitor and replace K in diet.

Three disadvantages of a *BREECH* presentation

1. An increased risk for umbilical cord prolapse because the presenting part may not be covering the cervix (i.e., footling breech) 2. The presenting part (buttocks, feet) is not as smooth and hard as the fetal head and is less effective in dilating the cervix 3. Once the fetal body (abdomen) is delivered, the umbilical cord can become compressed. The fetus must then be delivered expeditiously to prevent hypoxia. Rapid delivery may be difficult since the fetal head is usually the largest body part and in this situation, there is no time to allow for molding.

*KAWASAKI DISEASE* management and treatment

1. Monitor temperature frequently. 2. Assess heart sounds and heart rate and rhythm. 3. Assess extremities for edema, redness, and desquamation. 4. Examine eyes for conjunctivitis. 5. Monitor mucous membranes for inflammation. 6. Monitor strict I&O. 7. Administer soft foods and liquids that are *neither too hot nor too cold.* 8. Weigh child daily. 9. Provide Passive ROM exercises to facilitate joint movement. 10.* Administer acetylsalicylic acid (ASPIRIN) as prescribed for its antipyretic and antiplatelet effects (additional anticoagulation may be necessary if aneurysms are present).* 11. Administer Immunoglobulin IV as prescribed to reduce the duration of the fever and the incidence of coronary artery lesions and aneurysms; intravenous immunoglobulin is a blood product, so blood precautions when administering it are warranted.

*GLOMERULONEPHRITIS* Management

1. Monitor vital signs, weight, intake and output, and characteristics of urine. 2. Limit activity; provide safety measures. 3. Provide high-quality nutrient foods. a. Restrictions depend on the stage and severity of the disease, especially the extent of the edema. b. In uncomplicated cases, a regular diet is permitted, but sodium is restricted to a "no added salt to foods" diet. c. Moderate sodium and fluid restriction is prescribed for a child with hypertension or edema. d. Foods high in potassium are restricted during periods of oliguria. e. Protein is restricted if the child has severe azotemia resulting from prolonged oliguria. 4. Monitor for complications (e.g., renal failure, hypertensive encephalopathy, seizures, pulmonary edema, heart failure) 5. Administer diuretics (if significant edema and fluid overload are present), antihypertensives (for hypertension), and antibiotics (to a child with evidence of persistent streptococcal infections) as prescribed. 6. Initiate seizure precautions and administer anticonvulsants as prescribed for seizures associated with hypertensive encephalopathy. 7. Instruct parents to report signs of bloody urine, headache, or edema. 8. Instruct parents that the child needs to obtain appropriate adequate treatment for infections, specifically for sore throats, upper respiratory infections, and skin infections.

*NEPHROTIC SYNDROME* Patho presentation and management

1. Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia (hypoproteinemia), and edema (Fig. 42-1). 2. Physical Assessment Findings - Weight gain over a period of days or weeks - Facial and periorbital edema decreased throughout the day - Ascites (Abdominal Fluid) - Edema in the ankles - Anorexia - Diarrhea - Irritability - Lethargy - Decreased frothy urine - Blood pressure within expected reference range or slightly below 3. The primary objectives of therapeutic management are to reduce the excretion of urinary protein, maintain protein-free urine, reduce edema, prevent infection, and minimize complications.

*GLOMERULONEPHRITIS* Presentation

1. Periorbital and facial edema that is more prominent in the morning 2. Anorexia 3. Decreased urinary output 4.* Cloudy, smoky, brown-colored urine (hematuria)* 5. Pallor, irritability, lethargy 6. In an older child: Headaches, abdominal or flank pain, dysuria 7. Hypertension 8. Proteinuria that produces a persistent and excessive foam in the urine 9. Azotemia 10. Increased blood

A nurse is providing care to multiple clients on the postpartum unit. Which of the following clients is at greatest risk for developing a puerperal infection?

A client who does not wash her hands between perineal care and breastfeeding

What is an "incompetent cervix"? - What is the treatment for this condition?

Cervix that dilates prematurely. Cervical cerclage or cervical ring that holds the cervix together for the remainder of the pregnancy. Removed once labor begins or after 37 weeks.

*APLASTIC ANEMIA* Treatment

1. Prepare the child for bone marrow transplantation if planned. 2. Administer immunosuppressive medications as prescribed; antilymphocyte globulin or antithymocyte globulin may be prescribed to suppress the autoimmune response. 3. Colony-stimulating factors may be prescribed to enhance bone marrow production. 4. Corticosteroids and cyclosporine (sandimmune) may be prescribed. 5. Administer blood transfusions if prescribed and monitor for transfusion reactions. 6. Monitor for signs related to the disease and to complications of the treatments and medications administered.

Which of the following clients should the nurse be concerned about regarding weight gain? A client who has gained

A client who has gained 3.6 kg (8 lb) in her first trimester has gained too much weight. Recommended weight gain during pregnancy is usually 11.2 to 15.9 kg (25 to 35 lb).

The arteries of the umbilical cord carry...

Deoxygenated blood and waste from the fetus

*HEMOPHILIA* TREATMENT

1.* DDAVP-IV (Desmopressin Acetate Injection) or nasal spray* • Causes two to four times' increase in factor VIII activity • *Used for mild hemophilia* 2. Replace missing clotting factors, Factor VIII 3. Transfusions-At home with prompt intervention to reduce complications, Following major or minor hemorrhages

Retained placenta

2 types; adhered and non-adhered -Management non-adhered- Manual removal -Management adhered placenta- accreta, increta, & percreta; only known at time of birth. Cannot control bleeding therefore leads to hysterectomy.

*Active phase [of stage 1]

2-3 min apart contractions, baby is undergoing hypoxia during contractions, contractions getting stronger, dilation and effacing happening 1-2 cm/hr, should not take more than 4-6 hours if lasts longer -Risk factor is decreased perfusion to baby and fatiguing uterus, augment labor nonpharmacologically: position change, artificial rupture of membranes -Pharmacological: Pitocin risks raises BP, titrate very carefully begins 1-2 mU in 3 ml of fluid, can cause uterine rupture, uterine hyperstimulation (tachysystole of uterus), can only raise every 20-30 min, behavior of mom in this phase is in pain and focused, give meds during this phase: nubain, stadol and give during peak of contraction gives less med to baby (vessels are constricted).

Transition phase of labor

A client, in active labor & becomes nauseous and vomits. The client is also very irritable & needs to have a bowel movement. She states, "I've had enough. I can't do this anymore. I want to go home right now." What labor phase is the client in?

*FETAL ATTITUDE*

Describes the relationship of the fetus' body parts to one another. The fetus normally assumes an attitude of flexion.

*Ductus Arteriosus*

A blood vessel in a fetus that connects the pulmonary artery to the aorta

Surfactant

A chemical that stabilizes the walls of the alveoli

Decrease or loss of variability means:

Meds that depress the CNS Fetal hypoxemia w/resulting acidosis Fetal sleep cycle congenital abnormalities

cephalohematoma

A collection of blood under the scalp (specifically between the periosteum and the cranium, therefore a cephalohematoma does not cross suture lines) of a newborn usually located over the parietal bone. Risk factors include large neonatal birth weight, forceps delivery and mother's first pregnancy.

Mononucleosis or Epstein-Barr virus (EBV)

A herpes virus (kissing disease). Infects the salivary glands is transmitted by saliva, coughs, sneezes and direct contact mouth-to-mouth.

*SICKLE CELL DISEASE*

A human genetic disease caused by a recessive allele that results in the substitution of a single amino acid in the hemoglobin protein; characterized by deformed red blood cells that can lead to numerous symptoms.

*MORULA*

A solid ball of cells that makes up an embryo; in humans, this stage occurs within four days of fertilization.

A nurse is providing discharge instructions for a client. At 4 weeks postpartum, the client should contact her PCP for which client findings?

A sore nipple that has cracks and fissures is an indication of mastitis.

What would you look for in a child suspected to have endured child abuse?

A sudden change in behavior, anger, history and injury in relationship to story.

G6PD

A test for glucose 6 phosphodehydrogenase deficiency prevalant in African, Asian and Mediterranean babies

*FOURTH STAGE OF LABOR*

A time of physiological adaptation that begins following delivery of the placenta and lasts 1-2 hours. The uterus should be firmly contracted. Uterus remains firmly contracted. Lochia rubra, bright red blood flow with occasional small clots. Vital signs return to prelabor values. Some experience perineal discomfort usually related to trauma from the episiotomy or tearing, or hemorrhoids. Excited, tired. Bonding and attachment with infant. Initiation of breastfeeding. Culturally influenced.

What is vernix caseosa?

A white thick cheesy material that protects the skin, made of epithelial cells and the secretions of glands.

Primigravida

A woman during her first pregnancy

Narcan

Action: Opioid antagonist that blocks both mu and kappa opioid receptors from the effects of opioid agents Indications: Reverses opioid-induced respiratory depression in woman or newborn; may be used to reverse pruritus from epidural opioids. Dosage and Route:adult: opioid overdose 0.4 to 2 mg intravenously,may repeat IV at 2 to 3 minute intervals up to 10 mg; If IV route not available, IM or SC administration may be used. adult: postoperative opioid depression-initial dose 0.1 to 0.2mg IV at 2 to 3 minute intervals up to three doses to desired degree of reversal obtained; may be repeat dose in 1 to 2 hours if needed. newborn: opioid-induced depression- initial dose us 0.1mg/kg intravenously, intramusculary, or subcutaneously; may be repeated at 2 to 3 minute intervals up to three doses until desired degree of reversal is obtained. adverse effects Maternal hypotension and hypertension tachycardia, hyperventilation, nausea and vomiting, sweating, and tremulousness Nursing and considerations: Woman should delay breastfeeding until medication is out of system; do not give to mother or newborn if woman is opioid dependent-may cause abrupt withdrawal in woman and newborn if given to woman for reversal if respiratory depression caused by opioid analgesic; pain will return suddenly.

Vit K (acquamephytin)

Action: This intervention provides vitamin K because the newborn does not have the intestinal flora to produce this vitamin in the first week after birth. Vitamin K promotes formation of clotting factors (II, VII, IX, and X) in the liver. Indication: Vitamin K is used for prevention and treatment of hemorrhage disease in the newborn. Neonatal Dosage: Administer a 0.5 to 1mg. (0.25 to 0.5ml) dose intramusculary within 2 hours of birth; the dose may be repeated if newborn shows bleeding tendencies. Adverse Reactions: Edema, erythea, and pain at injection site may occur rarely; hemolysis, jaundice, and hyperbilirubinemia have been reported, particulary in preterm infants Nursing Considerations: Wear gloves. Administer in the middle third of the vastus lateralis muscle using a 25 gauge, 5/8-inch (22-mm) needle. Inject into skin that has been cleaned, or allow alcohol to dry on puncture site for 1 minute to remove organisms and prevent infection. Stablize leg firmly and grasp muscle between the thumb and fingers. Insert the needle at a 90 degree angle; aspirate and inject medication slowly if there is no blood return. After removing needle, rub gently on the injection site with a dry gauze square to decrease the pain. Observe for signs of bleeding from the site.

Hemabate

Action: contraction of uterus Side effects: Headache, nausea and vomiting, fever, tachycardia, hypertension, diarrhea contraindications: asthma, hypersensitivity Dosage and Route: 0.25 mg IM or intramyometrially every 15 to 90 minutes up to eight doses Nursing and consideration: continue to monitor vaginal bleeding and uterine tone.

Pitocin

Action: contraction of uterus; decreases bleeding side effects: infrequent: water intoxication; nausea and vomiting Contraindications: None for postpartum hemorrhage Dosage and Route 10 to 40 units/L diluted in lactated Ringers' solution or normal saline at 125 to 200 mU/min IV or 10 to 20 units IM Nursing Considerations continue to monitor vaginal bleeding and uterine tone.

A client who is prescribed magnesium sulfate. The nurse recognizes that which of the following is a contraindication for use of this medication

Acute fetal distress, cervical dilation > 6 cm, vaginal bleeding, and severe pregnancy-induced hypertension are complications that are contraindicated by the use of magnesium sulfate to stop labor. *They require immediate delivery of the fetus.

When should you start measuring a woman's fundal height?

After 12 weeks GA

An amniocentesis may be performed when?

After 14 weeks gestation

Embryo

After blastocyte is fully implanted.

Pediatric Dosing - How? Why?

Age & weight in kilograms. Medication doses in children are based on body weight in kilograms. 2.2 lb = 1 kg

A RN is caring for a client who is diagnosed with gonorrhea. Which medications should the nurse anticipate the provider will prescribe?

Ceftriaxone (Rocephin) ordoxycycline (Vibramycin) orally for 7 days is prescribed for the treatment of gonorrhea.

*PPROM*

Membranes rupture before 37 weeks of gestation

At age 2? 4? 6?

Age 2 - talk & play with b4 procedure, allow thumb or pacifier sucking, sing or whistle, rub arms or back and hold in your arms if possible. Age 4 - let child play with & explore equipment b4 procedure, explain using simple words, encourage family to support & comfort child when possible, allow security object (doll or blanket) during procedure, praise child and allow child to hold or help with equipment whenever possible. Age 6 - Use simple words to explain, use dolls or puppets to explain procedure, ensure privacy, encourage child to talk about procedure and ask questions and give praise and rewards to child.

Preparing child for procedure/surgery.....how to do reduce anxiety?

Age 2 - talk & play with b4 procedure, allow thumb or pacifier sucking, sing or whistle, rub arms or back and hold in your arms if possible. Age 4 - let child play with & explore equipment b4 procedure, explain using simple words, encourage family to support & comfort child when possible, allow security object (doll or blanket) during procedure, praise child and allow child to hold or help with equipment whenever possible. Age 6 - Use simple words to explain, use dolls or puppets to explain procedure, ensure privacy, encourage child to talk about procedure and ask questions and give praise and rewards to child.

vaginal exams should start at:

Age 21

Which conditions are screened at birth with the newborn blood test?

Anemia, blood glucose level (hypoglycemia), phenylketonuria (PKU), hypothyrodism, sickle-cell trait, maple syrup urine disease and G6PD.

Decidua

Another term for endometrium.

antepartum

Another term for pregnancy

Anatomical landmarks of the fetal skull: *SINCIPUT*

Anterior area known as the "brow"

FSH and LH are released by which gland

Anterior pituitary

Oval shaped pelvis

Anthropoid pelvis

Teratongenic factors

Anything that can cause risk to the baby

A nurse is caring for a newborn following a spontaneous vaginal delivery. Five minutes after birth, the newborn's heart rate is 90/min. Which of the following Apgar heart rate scores should the newborn receive?

Apgar heart rate score of: 1

A newborn has just been circumcised using a Gomco procedure. Which nursing intervention is part of the initial care for this newborn?

Apply petroleum gauze to the site for 24 hr to prevent the skin edges from sticking to the diaper.

A nurse is caring for a newborn who was born at 38 weeks of gestation, weighs 3,200 g, and is in the 60th percentile for weight. Based on the weight and gestational age of this newborn, the nurse should classify this neonate as

Appropriate for gestational age (between the 10th and 90th percentile.)

Spinal blocks

Are administered late in the second stage, but most commonly preceding a cesarean birth.

Mongolian spots

Are dark areas observed in dark-skinned newborns

A rising pulse rate and decreasing blood pressure

Are often the first signs of inadequate blood volume.

AROM

Artificial Rupture of Membranes (amniotomy, use an amniohook)

Signs and symptoms of impending labor: *BRAXTON-HICKS CONTRACTIONS*

As the pregnancy approaches term, most women become more aware of irregular contractions called Braxton-Hicks contractions. As the contractions increase in frequency (they may occur as often as every 10 to 20 minutes), they may be associated with increased discomfort. Braxton-Hicks contractions are usually felt in the abdomen or groin region and patients may mistake them for true labor.

What is an APGAR score?

Assess newborn's condition at birth. A = appearance, P = pulse, G= grimace, A = activity and R = Respiratory effect. Strength & viability

*CLEFT LIP* Pre op Nursing Considerations

Assess the newborns ability to suck. Support mom's desire to continue breastfeeding. May have to pump and use in special feeding devices. Stimulate the infant to suck, swallow and breathe. To prevent choking and coughing, steady gentle pressure is held at the bottom of the bottle. Teach them to feed in the upright position. Burp frequently, more air is swallowed and this will help with aspiration and ab distention

A client presents to L&D with stabbing abdominal pain, rigid abdomen and heavy, bright red bleeding. The nurse is aware that these findings are

Associated with Abruptio placenta. *Abruptio placenta is the sudden onset of intense localized uterine pain with bright red vaginal bleeding. An abdomen that is both rigid and tender is also a common assessment finding.

Condition characterized by bronchospasms, mucosal plugging, edema, impaired gas exchange.

Asthma

Signs and symptoms of impending labor: *LIGHTENING*

At about 38 weeks in the primigravid pregnancy, the presenting part (usually the fetal head) settles downward into the pelvic cavity, causing the uterus to move downward as well. This process, called lightening, marks the beginning of engagement. Signs and symptoms include • Leg cramps or pains • Increased pelvic pressure • Increased urinary frequency • Increased venous stasis, causing edema in the lower extremities • Increased vaginal secretions, due to congestion in the vaginal mucosa

Vacuum-assisted birth

Attachment of vacuum cup to fetal head, using negative pressure to assist birth of head Prerequisites Vertex presentation Ruptured membranes Absence of CPD (ceohalic disproportion)

Signs and symptoms of impending labor: *WEIGHT LOSS*

Before the onset of labor, changes in the levels of estrogen and progesterone can lead to electrolyte shifts and may result in a reduction in fluid retention. The increased fluid loss can lead to a weight loss of up to 3 pounds (0.5 to 1.5 kg).

Presentation

Cephalic (Vertex is normal/best for delivery, face or brow), Breech (footling or frank), shoulder

CNM

Certified Nurse Midwife

In addition to oxytocin (Pitocin) administration, what other methods of augmenting or inducing labor should a nurse anticipate?

Cervical ripening

*SECOND STAGE OF LABOR*

Begins with full dilation of the cervix (10 cm) and ends with the expulsion (birth) of the fetus. Contractions continue at a similar rate as during the transition phase; 2-3 minutes apart lasting 60 seconds and strong by palpation. Fully dilated. May have an urge to push that increases as the fetal head descends. Many women prefer to push so that they can use the contractions and work with them. When head is crowning may feel intense pain, burning. Often during this stage many women get a "second wind" as they see that they are making progress and are embarking on a new (labor) phase. Intense concentration with pushing efforts.

*THIRD STAGE OF LABOR*

Begins with the birth of the infant and ends with the delivery of the placenta. Usually takes 5-10 minutes, and may take up to 30 minutes. The uterus should be firmly contracted. Uterus becomes globelike. Uterus rises upward. Umbilical cord descends further. Gush of blood as placenta detaches. Some discomfort or cramping as the placenta is expelled. Focus on infant well-being. Crying common. Expressions of relief. Culturally influenced.

How to protect immunocompromised children?

Best possible infection control for all patients is excellent hand hygiene by patient, family and nursing personnel. **Handwashing super important!!

A client at 32 weeks gestation, is diagnosed with preterm labor. Which medication should the PCP prescribe to hasten fetal lung maturity?

Betamethasone (Celestone) a glucocorticoid that is given to clients in preterm labor to hasten surfactant production.

What chemical assists the neonatal lungs to function properly?

Betamethasone/Dexamethasone admin to mom prior to delivery to accelerate lung maturity in fetus. Lung surfactant admin to neonates w/ RDS (respiratory distress syndrome) allows lungs to slide over each other & not get sticky.

Benefits of Breastfeeding

Better nutrition, lower risk of allergies, reduce risk of infections, enhanced mother-infant bonding, correct temperature of milk

Benefits of breastfeeding

Better nutrition, lower risk of allergies, reduced infections, enhanced bonding, involution of uterus, delayed ovulation, correct temp of milk, free, convenient

Delivery of the baby and delivery of the placenta - what are the risks?

Biggest risk to mom is hemorrhage

Important about birth control

Birth control needs to fit with patients lifestyle

Opthalmia neonatorum

Blindness in newborn. To prevent infection of the eyes, the baby is given erythromycin ointment to eyes immediately after birth. -Caused by mothers chlamydia or gonorrhea

Opthalmia neonatorum

Blindness in newborn. To prevent infection of the eyes, the baby is given erythromycin ointment to eyes immediately after birth. Caused by mothers chlamydia or gonorrhea

Retinopathy of prematurity

Blindness that develops from hypo-oxygenation. Keep O2 levels as low as possible

Ductus Arteriosis

Blood from the pulmonary artery is shunted though this to the aorta which allows shunting of the blood around the fetal lungs

Foreamen ovale

Blood is shunted from the right atrium to the left atrium through this.

*Fetal Circulation*

Blood travels through the umbilical vein from the placenta to the fetus . There are three shunts unique to fetal circulation: 1. Ductus Venosus 2. Foramen Ovale 3. Ductus Arteriosus

Chadwick's Sign

Bluish discoloration of vagina due to vascular congestion

*CHADWICKS SIGN*

Bluish purple hue that appears on the cervix, vagina, and vulva; increased blood flow and engorement

Rule of 9's for burn evaluation.

Body surface is divided in area representing areas of 9% determined by Total Body Surface Area. - the face counts as 18%, chest 18%, back 18%, genitals 1%, each leg 13.5%, each arm is 9%

Rule of 9's for burn evaluation.

Body surface is divided in area representing areas of 9% determined by Total Body Surface Area.- the face counts as 18%, chest 18%, back 18%, genitals 1%, each leg 13.5%, each arm is 9 -Tx: manage pain, cover to prevent infection, replace fluid loss, adequate nutrition, -*In the immediate aftermath, the burn should be cooled with saline soaked cool cloths. -No oil/butter should be rubbed on the burn as it will continue to burn the skin -Ice should never be used on a burn.

Cold stress

Brown fat loss -Kangaroo care for thermal stabilization -skin to skin

How do baby's generate heat?

Brown fat, vasoconstriction - this shunts blood to interior, move around to increase their metabolism

A 24 lb 17 mo old toddler fractured femur, what type of traction?

Bryant's traction

hypoglycemia in a newborn

CBS is normal of 40-60. This condition occurs when the BS is < 40. Signs include jittery, startled look, tremors, shakiness- Cold stress leads to hypoglycemia.

*SPINA BIFIDA*

CNS defect occurs as a result of neural tube failure to close during embryonic development.

A postpartum RN is caring for a client who has (DVT). Which of the following clinical findings should the nurse anticipate the client will exhibit?

Calf tenderness, swelling, warm extremity and elevated temperature are clinical findings in clients who have DVT.

Understand dehydration risks

Can lead to electrolyte imbalance that must be replaced or could lead to death.

Distinguish between Caput succedaneum & Cephalohematoma.

Caput is fluid in the newborn's scalp (causes puffy scalp & edematous) disappears in a few days. Cephalohematoma is blood (capillary rupture) between skull bones & periosteum (membrane that covers the skull) Swelling stops midline and it will eventually absorb.

If only a carrier for the Sickle Cell trait, what characteristics do you present?

Carrier is free from disease

Categories of drugs that harm fetus

Category D (may pose risk) and Category X (known to pose a risk)

What symptoms would you look for if you were concerned about hypoxia in your patient?

Change in color, expiratory grunt (severe respiratory arrest), chest retractions, grasping and shallow, labored breathing and head bobbing.

*CROUP* Presentation

Characterized by hoarseness, "barking" cough, inspiratory stridor, and varying degrees of respiratory distress

*ACTIVE PHASE*

Characterized by more active contractions. Contractions become more frequent (every 3 to 5 minutes), last longer (60 seconds), and are of a moderate to strong intensity. The woman becomes more focused on each contraction and tends to draw inward in an attempt to cope with the increasing demands of the labor. Cervical dilation advances more quickly as the contractions are often more efficient. While the length of the active phase is variable, nulliparous women generally progress at an average speed of 1 cm of dilation per hour and multiparas at 1.5 cm of cervical dilation per hour.

What are the symptoms of respiratory distress in an infant?

Chest movements = a lag on inspiration or seesaw movement, Intercostal retractions = Spaces between ribs no indent, Xiphoid retraction = xiphoind process should not indent, Nares dilating (flaring) = nares do not flare out and Expiratory grunt = should not hear a grunting sound.

Signs of respiratory distress

Chest movements, lag on inspiration, seesaw movement, intercostal retractions, xiphoid retraction, nares flaring, expiratory grunt

Other Skin Issues:

Chicken pox would be deferred unless emergent with diagnosis being done preliminarily over the phone to prevent spread. -**Hallmark chicken pox- spots are the size of a pencil eraser (roughly) and pink, become vesicular, and crust over with scabs as they heal. -Measles are characterized by Koplik's spots in the oral cavity (hallmark signs)

Faces Pain Scale

Child as young as 3 can use. Six cartoon faces range smile- cry child chooses face that best describes how they feel .

An analgesic give to 22mo old for broken ribs, how do you know it is effective?

Child is fell asleep

Why is it important that the newborn breastfeed and receive colostrum?

Colostrum is secreted during days 1 to 3 and contains the IgA immunoglobulin that provides passive immunity to the newborn.

*NASOPHARYNGITIS*

Common Cold Caused by numerous viruses: • RSV • Rhinovirus • Adenovirus • Influenza • Parainfluenza Viruses

Strep considerations and treatments?

Common in children >2yrs old. Hard to swallow, lump in throat, fever that will not go away and white patches on the tonsils. Treated with large doses of antibiotics (penicllin) right after diagnosis.

There are three different types of placenta previa:

Complete (total)-covers entire cervical os. Partial-partially occludes the cervical os. Marginal-encroachment of the placenta to the margin of the cervical os Risk factors: conditions that cause scarring of the uterus (c-section, multiparity, increased maternal age), large placental mass, smoking, cocaine use, prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity.

When/why do we foot-print an infant?

Completed before mother or baby leave delivery room, another form of identification.

Early decels mean:

Compression of the fetal head resulting from uterine contraction Vaginal exam Fundal pressure

*Ductus Venosus*

Connects the umbilical vein to the inferior vena cava, closes by day 3 of life and becomes a ligament

*COLOSTRUM*

Creamy whitish-yellow liquid that precedes milk production; contains antibodies, essential proteins, fat "liquid gold"

How do we recognize signs and symptoms of pain in newborns?

Crying (moaning, screaming), facial expression (wry mouth, grimacing) Posture of trunk (rear upwards) and legs (kicking, tightened), restlessness.

*TETRALOGY OF FALLOT* Signs and symptoms

Cyanotic Heart Defect Characterized By: • Ventricular Septal Defect • Distinguished By Respiratory Difficulties • Cyanosis • Tachycardia • Tachypnea • Diaphoresis

Undescended testicles is called?

Cyrptochordism

RN working in a prenatal clinic is providing education to a client who is pregnant. The client states that she hates milk. A good source of calcium

Dark green, leafy vegetables *Calcium is very important to a developing fetus. It is involved in bone and teeth formation. Good sources of calcium include calcium-fortified orange juice, nuts, legumes, and low oxalate, dark green, leafy vegetables.

Linea nigra

Dark line of pigmentation from the umbilicus to the pubic area.

*LINEA NIGRA*

Dark line that extends from the umbilicus to the mons pubis

Braxton Hicks contractions

Decrease with hydration and walking.

*ICP* Late Signs of Increasing Pressure

Decreased LOC Decreased motor response to command Decreased sensory response to painful stimuli Alterations in pupil size and reactivity Papilledema-(optic disc pressure) Decerebrate or decorticate posturing Cheyne-Stokes respirations

Which findings from a client who is pregnant should indicate to a nurse that the client should undergo a contraction stress test (CST)?

Decreased fetal movement, Intrauterine growth restriction (IUGR), Postmaturity, Advanced maternal age, are all findings that require interventions. Assessing fetal well-being by performing a CST would be indicated.

Fetal cord compression

Decreases fetal oxygenation

Chadwick's sign

Deepened violet-bluish color of vaginal mucosa secondary to increased vascularity of the area.

What nursing diagnosis be for patient with pyloric stenosis with persistant vomiting?

Deficient fluid volume r/t excessive vomiting.

A 12-year-old wide receiver has muscle cramps.

Dehydration and electrolyte imbalance

*DDH DEVELOPMENTAL DYSPLASIA of the HIP* Description

Description- Abnormal development of hip; femoral head situated improperly in acetabulum • Therapeutic Management-Importance of early intervention- once a week! • *Newborn to 6 months: PAVLIK HARNESS for abduction of hip*- worn continuously. Needs frequent follow-up in office. 3-5 months until confirmed stable by x-ray. *Watch skin integrity.* • *Ages 6 to 18 months*: dislocation unrecognized until child begins to stand and walk; use traction and cast immobilization (Spica cast), Frequent neurovascular checks! • Older child: operative reduction- reconstruction needed- difficult after 4 years!!!

*BISHOPS SCORE*

Determines readiness for labor

Leopold's Manuever

Determining the fetal presentation and position by palpating the maternal abdomen.

*DYSTOCIA*

Defined as a long, difficult or abnormal labor, is a term used to identify poor labor progression. Dystocia may arise from any of the three major components of the labor process

What is dysuria?

Difficulty urination

Stage 1 of labor

Dilation - Monitor mom's vitals, gather data, emotional support, relieve pain, assess fetal well being

A nurse is caring for a client who has (DIC). Which antepartum complication should the nurse understand is a risk factor for this client?

Disseminated intravascular coagulation (DIC) may occur secondary in a client who has preeclampsia.

Under which circumstances would you NOT immunize a child?

Do not give a child with fever.

*LATENT PHASE*

During the first stage of labor, the phase from the onset of contractions until the cervix is dilated 4 cm (so 0-3 cm). Contractions can occur every 10-15 minutes and gradually increase to 5 minutes apart. Each contraction lasts 30-40 seconds & is mild to moderate in intensity.

Epidural Block

Epidural blocks are administered during labor and allow the client to participate in the labor process while remaining comfortable.

*EPIDURAL HEMATOMA*

Epidural hemorrhage-blood formed between dura and the skull Cerebral edema- some degree expected 24-72 hrs after trauma

Trache kit at the beside is for?

Epiglottitis

THREE GERM LAYER *ENDODERM*

Epithelium of the Pharynx, Thyroid, Thymus, Parathyroid, Respiratory Passages, Gastrointestinal Tract, Liver and Pancreas

During newborn assessment, a RN observes small white nodules on the roof of the newborn's mouth. This is a characteristic of which conditions?

Epstein's pearls

A nurse is preparing to administer prophylactic eye ointment into the eyes of a newborn to treat ophthalmia neonatorum. Which of the following medications should the nurse anticipate administering?

Erythromycin (Romycin)

EDD

Estimated Due Date

Ovaries secrete: 1) 2)

Estrogen and progesterone

Estrogen in the placenta

Estrogen is a growth hormone, helps baby and mom grow.

Discontinue oxytocin (Pitocin) if uterine hyperstimulation occurs with contraction frequency more than

Every 2min; contraction duration longer than 90sec; contraction intensity results with pressures > 90 mmHg as shown by IUPC; and a uterine resting tone 20 mmHg between contractions showing no relaxation of uterus between contractions.

Assessments are done in the active phase for women who are low risk and in the latent phase for women who are high risk.

Every 30 min

FHR assessments are done during the latent phase for women who are low risk.

Every 60 min

pregnancy affects:

Every part of the body is affected by pregnancy. The younger a woman is the better her body can tolerate the pregnancy. [ex. fluid shift]

Leopold's maneuver

Feeling for location of the baby - important in determining risk during delivery

FHR

Fetal Heart Rate (110-160)

Anatomical landmarks of the fetal skull: *MENTUM*

Fetal chin

Engagement

Fetal head has moved into birth canal and can no longer be moved out of pelvis

Moderate variability

Fetal heart rate fluctuations or changes are 6 to 25 beats/min from the baseline

Positive Signs -signs that can only be explained by pregnancy.

Fetal heart sounds, Visualization of fetus by ultrasound, Fetal movement palpated by an experienced examiner

Absent variability

Fetal monitoring- no detectable variation around baseline caused by utero-placental insufficiency -0-1 beats variation

Regarding kick counts, what are signs that a woman needs further evaluation?

Fetal movements of less than 3 in one hour No fetal movement for 12 hours

Week 9-birth

Fetal period

BPP assess for

Fetal well being

Primary reason parents seek help for their child??

Fever

Considerations for care?

Find out what the pt. wants and give them choices.

1st period of reactivity

First 30 min to 2 hours - good time for bonding, then the baby will sleep for 2-4 hours and good time to do baby checks, administer medicines, shots, weight.

Nagele's Rule

First day of last period plus 7 days, minus 3 months, plus one year.

FPAL

Florida (full-term) Power (pre-term) And (abortions) Light (living)

What is caput succedaneum? Is it temporary or permanent?

Fluid in newborn's scalp that disappears in a few days.

What is the "Tetrology of Fallot"?

Four major heart defects occur simultaneously: pulmonary stenosis, ventricular septal defect, overriding aorta and hypertrophy of the right ventricle.

Fetal descent and cervical dilation are caused by

Frequency, duration, and strength of contractions

A nurse is preparing to bathe a newborn and notices a bluish marking across the newborn's lower back. The nurse should understand that this mark is

Frequently seen in newborns who have dark skin. Mongolian spots are commonly found over the lumbosacral area of newborns who have dark skin and are of African-American, Asian, or Native-American origin.

Normal bleeding

Friability or easy bleeding of cervix when scraped (after sex or vaginal exams) is normal.

Second stage of labor:

Full dilation Intense contractions BIRTH!!

What are thee 2 types of scoliosis?

Functional and structural

GTPAL

G - Gravida T - Term P - preterm A - Abortion L - Living Children

GTPAL

G = #pregnancies, T = # term at 37 weeks or more, P = # preterm born between 20-37 weeks, A = Abortions, L = Living

GTPAL

G=gestation (how many pregnancies), T=how many term (37-40 weeks) pregnancies, P=pre term births (before 37 weeks), A=abortions (spontaneous or induced), L=living children

What is the Ballard Scale?

Gestational age maturity guide or measurement.

Patient complains of being shaky and sweaty and is diabetic. What is the first thing nurse should do?

Give him OJ

Rh sensitization

Give mom Rhogam at minimal 28 week mark and anytime there is an exposure risk to fetal blood. -Also give after deliver if baby is + blood If mom's body has already started attacking the body the baby may develop jaundice

Rh sensitization

Give mom Rhogam at minimal 28 week mark and anytime there is an exposure risk to fetal blood. Also give after deliver if baby is + blood If mom's body has already started attaching the body the baby may develop jaundice

methergen

Give to contract uterus to remove clots

Which of the following conditions has medications that can be prescribed as prophylactic treatment during labor or immediately following delivery?

Gonorrhea, Chlamydia, HIV, Streptococcus ß-hemolytic, Group B

Are all probable signs of pregnancy - changes that make the examiner suspect a woman is pregnant (related to physical changes of the uterus).

Goodell's sign, ballottement, Chadwick's sign, Hegar's sign, Abdominal enlargement related to changes in uterine size, shape, & position, fetal outline felt by examiner, Braxton Hicks contractions, Positive pregnancy test

Most common cause of status epilepticus.

Gran mal seizures, abrupt stopping of meds, or generalized infection

Stimulating the pads of the newborn's hands will elicit the

Grasp Reflex

Vernix (Newborn Assessment)

Greasy white substances which protects the skin in the uterus and after birth. It does not need to be washed off and is absorbed if left.

Rate of growth

Greatest growth in infants, and then again in adolescents which puts them at risk for anemia due to menstruation and muscle mass increase.

What routinely occurs at a pediatric well child visit?

Growth charts, head & chest measurements until 3 yrs old, immunizations due, education and VS.

Benadryl/Diphenhydramine

H1 antagonists, 1st generation; Used in allergic conditions such as seasonal rhinitis, etc. motion sickness/ nausea; itiching from spinal

Normal VS of newborn

HR 110-160, BP 60-80 / 40-50, Temp 97.6 to 98.6, 36.5 to 37.2 C. Respirations 30-60 with periods of 15 second apnea. Abnormal if grunting, nasal flaring, crackles and wheezing

Normal VS of newborn

HR 120-160, BP 60-80 / 40-50, , Temp 97.6 to 98.6Respirations 30-60 with periods of 15 second apnea. Abnormal if grunting, nasal flaring, crackles and wheezing

What is measured? When is it measured?

HR, Respiratory effort, muscle tone, reflexes/irritability and color. Measured at 1 min and 5 min , if < 7 at 5min measure again at 10mins.

*NEONATES NORMAL VITALS*

HR: 110-160 RR: 30-60 BP: 70/50

What is the single most important nursing measure that should be done to prevent newborn infection?

Hand hygiene is the most important nursing intervention to prevent infection. The nurse must engage in a 3-5min scrub from elbow to finger tips before entering the nursery and thereafter. Hands should be washed before & after contact w/ the newborn.

A client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which maternal position should the nurse suggest to the client to help facilitate normal labor progress?

Hands and Knees

A client who is at the greatest risk for postpartum infection is the client who

Has premature rupture of membranes and prolonged labor.

Viable

Having change at life outside the womb (20 weeks)

A basic human need

Healthcare is...

Accelerations mean:

Healthy fetal/placental exchange

*FETAL HEART RATE*

Heard Between 10-12 wks. Gestation 110-160 BPM

Thrombosis tx drugs:

Heparin Warfarin (coumadin)

What types of things do you monitor when a child has an IV running?

Infiltration, infection, thrombophelibitis, CWMS (circulation, warmth, motion & sensation, average output rate 1ml/per kilo/per hr.

A nurse is caring for a newborn who was born to a mother who is infected with hepatitis B. What treatment should this newborn receive?

Hepatitis B and the hepatitis B immunoglobulin (HBIG) vaccines. Both should be administered within 12 hrs of birth. The hepatitis B vaccine induces protective antibodies in newborns who receive the recommended three doses.

Galactosemia

Hereditary disease where the newborn can't digest galactose.

*ALPHA-FETOPROTEIN* *High Levels*

High levels may be indicative of an open neural tube defect, but may also result from incorrect dates, multiple pregnancy or fetal demise. *Done at 12-14 Weeks*

If a newborn is unable to pass meconium in the first 24 hours is called?

Hirschsprungs disease

A malignant lymph disease characterized by Reed Sternberg cells is called?

Hodgkins disease

Who do you notify immediately if biological agent used as weapon?

Hopital's infection control and CDC

2 arteries and 1 vein

How many blood vessels does the placenta have?

HCG

Human Chorionic Gonadotropin (can be found 7-10th day of pregnancy but also if there is a loss of pregnancy)

HPL

Human Placental Lactogen (hormone produced close to beginning of Trimester 2 until week 34 and then decreases.

*BRONCHIOLITIS* Management

INTERVENTIONS • Maintain patent airway • Position at 30- to 40-degree angle, neck slightly extended CHILD WITH RSV • *Isolate in private room or with another child with RSV (Droplet)* • Administer ribavirin (Virazole) as prescribed (anti-viral agent) • *No pregnant nurses should care for child receiving ribavirin* • Administer respiratory syncytial virus immune globulin (RSV-IGIV, RespiGam) as prescribed

IUGR, causes, risks, how do you recognize this in the antepartum period?

IUGR-Poor growth of baby in womb; not enough oxygen & nutrients from placenta. -Causes: High altitudes, multiple pregnancy, placenta problems, Preeclampsia, Eclampsia, infections during pregnancy (cytomegalovirus, rubella, syphilis, toxoplasmosis), -Risk factors: ETOH, smoking, drug addiction, clotting disorders, HTN, heart disease, kidney disease, poor nutrition -Baby is *Flaccid*, risk for cold stress (no brown fat), immature lungs

*CEPHALIC PRESENTATION* or HEAD FIRST

Identifies that the fetal head will be first to come into contact with the maternal cervix. Cephalic presentations constitute the most desirable position for birth and occur in approximately 95% of pregnancies. There are *FOUR* types of cephalic presentations.

pathologic jaundice treatment

If jaundice is mild can be treated with phototherapy - note to ALWAYS cover newborns' eyes. -If severe then blood transfusions can be in done in utero or after birth by day 2

pathologic jaundice treatment

If jaundice is mild can be treated with phototherapy - note to ALWAYS cover newborns' eyes. If severe then blood transfusions can be in done in utero or after birth by day 2

*TRANSVERSE (HORIZONTAL) LIE*

If the head to tailbone axis of the fetus is at a 90-degree angle to the woman, A transverse lie occurs in fewer than 1% of pregnancies.

Galactosemia

In a newborn or young infant with failure to thrive, bilateral cataracts, jaundice

*BROW* Presentation

In the brow position, the fetal head is partly extended. This is an unstable presentation that converts to a vertex if the head flexes, or to a face presentation if the head extends. The occipitomental diameter (the largest anteroposterior diameter) presents to the maternal pelvis and the sinciput (fore and upper part of the cranium) is the presenting part.

*FACE* Presentation

In the face presentation, the fetal head is fully extended and the occiput is near the fetal spine. The submentobregmatic diameter presents to the maternal pelvis and the face is the presenting part.

Types of breech presentations *FOOTLING*

In the footling breech position, one or both of the fetal leg(s) are extended with one foot ("single footling") or both feet ("double footling") presenting first into the maternal pelvis.

Signs and symptoms of impending labor: *RUPTURE OF THE MEMBRANES*

In the majority of pregnancies, the amniotic membranes rupture once labor is well established, either spontaneously or by *Amniotomy*, the artificial rupture of the membranes by the primary care provider. Rupture of the membranes is a critical event in pregnancy.

*MILITARY* Presentation

In the military position, the fetal head presents in a neutral position, which is neither flexed nor extended. The occipitofrontal diameter presents to the maternal pelvis and the top of the head is the presenting part.

Signs and symptoms of impending labor: *CERVICAL CHANGES*

In the non-pregnant woman, the cervix is normally rigid. In preparation for passage of the fetus, the cervix undergoes many physiological changes. The cervix softens ("*cervical ripening*"), stretches, and thins, and eventually is taken up into the lower segment of the uterus. This softening and thinning is called cervical effacement.

PKU

Inability to breakdown protein- easily controlled with diet. -Test all baby's when born

PKU

Inability to breakdown protein- easily controlled with diet. Test all baby's when born

Reason to lie on left side

Increase blood flow and oxygenation to fetus

Pain S&S:

Increased BP Tachycardia Hyperventilation

Nutritional needs

Increased calories, increased calcium, protein & vitamins, maintain iron and folic acid intake, avoid laxatives and enemas, use iodized salt, eat fiber, increase fluid intake

*UPPER AIRWAY INFECTION MANAGEMENT*

Infections are described according to the anatomic area of involvement: UPPER RESPIRATORY TRACT • Nose, pharynx LOWER RESPIRATORY TRACT • Bronchi and bronchioles CROUP SYNDROMES • Infections of epiglottis,larynx

Postpartum risks - how do we intervene if a patient has a postpartum hemorrhage - the initial response?

Intervention #1- *Massage her FUNDUS* [If +2 deviated to right- full bladder] -Pitocin [no need to titrate once baby is out], fundal massage (first), administer methergen (But contraindicated in HTN), cytotec, hemobate.

*CELIAC DISEASE*

Intolerance to gluten Accumulate glutamine (toxic) Vitamin deficiency > Need Supplements CELIAC CRISIS • Caused by infection • Fasting • Ingestion of Gluten

Linea nigra

Is a dark colored line extending from symphysis pubis to top of fundus, common.

Abdominal effleurage

Is a gentle stroking of the abdomen in rhythm with breathing during contractions.

*TOCODYNAMOMETER*

Is a pressure-sensitive device that is applied against the uterine *FUNDUS*. When the uterus contracts, the pressure that is exerted against the "toco" is measured and recorded on graph paper.

*WHARTON JELLY*

Is a specialized connective tissue that surrounds the two arteries and one vein in the umbilical cord. This tissue, in addition to the high volume and pressure in the blood vessels, is important because it *helps to protect the umbilical cord from compression*.

Pregnancy-induced hypertension (PIH); preeclampsia

Is a type of hypertension (high blood pressure) that happens only during pregnancy. It can be mild or become very serious. (1) high blood pressure, which is the first sign, followed by (2) Protein in your urine. This may happen early in your pregnancy or not until the end. Most often, it occurs after the 20th week or so of your pregnancy and lasts until a week after childbirth.

Leukorrhea

Is a white or gray discharge with a musty odor, normal during pregnancy, do not douche or wear tampons, peri-pads are ok. Since vaginal pH increases from 4-6.5 mother at risk for yeast infections.

Oligohydramnios

Is an inadequate amount of amniotic fluid, less than 300mL, which contributes to intrauterine growth restriction of the fetus, restrict fetal movement, and cause fetal distress during labor.

*OBLIQUE LIE*

Is one that is at some angle between the longitudinal and the transverse lie.

*ENGAGEMENT*

Is said to have occurred when the widest diameter of the fetal presenting part has passed through the pelvic inlet. In a cephalic presentation, the largest diameter is the biparietal; in breech presentations, it is the intertrochanteric diameter. Engagement can be determined by external palpation or by vaginal examination. In primigravidas, engagement usually occurs approximately 2 weeks before the due date.

Sacral counterpressure

Is the application of steady pressure to the lower back to counteract the pressure exerted on the spinal nerves by the fetus, which especially occurs with an occiput posterior presentation.

Fetal descent

Is the downward movement of the fetus in the birth canal.

Transition phase of labor.

Is the phase where the client becomes irritable, feels rectal pressure that can feel similar to the need to have a bowel movement, and can become nauseous with emesis.

The fourth stage

Is the recovery period

1st stage of labor

Is variable [last up to 12 hrs], be aware of what's happening with your patient

Dehydration signs, symptoms, in the neonate

It can happen quickly, because baby has little reserves of fluid. S/S = vomiting, diarrhea, oral hydration (mouth), color urine (pale yellow/white)and # of wet diapers.

Anatomical landmarks of the fetal skull: *ANTERIOR FONTANEL*

It is diamond shaped and is positioned where the sagittal, frontal, and coronal sutures intersect. The anterior fontanel remains open until approximately 18 months of age to allow normal brain growth to occur

Why is Hgb and Hct higher?

It is usually higher because their bodies are growing fast.

Coin rubbing can be mistaken for child abuse because?

It leaves marks on the skin

If a BPP comes back as 6.....

It should be retested

Between 18 and 30 weeks the fundal height should measure what?

It should equal the week of gestation

Wharton's jelly

Jelly substance that protects the cord.

PRIMARY reason to place infant skin-to-skin on mother after birth.

Keep warm, establish breast milk and facilitate bonding.

When teaching parents about how to care for their newborn's umbilical cord, a nurse should include which of the following nursing interventions?

Keeping the newborn's cord dry and clean helps reduce infection and hastens drying.

A nurse is providing discharge instructions to a postpartum client following a cesarean birth. The client reports leaking urine every time she sneezes or coughs. The nurse suggests the client perform what to help alleviate this problem?

Kegel exercises

Erythropoetin produces is controlled after birth by the?

Kidneys

What is the organ affected by Wilm's tumor?

Kidneys

Dehydration

Kids lose fluid quicker than adults; faster respiration and more body surface area to lose water. -sick kids tend to not to want to take sips of water. Tests to assess: Specific Gravity urine test Normal test is 1.010 to 1.030 Postitive dehydration is when it is concentrated and urine specific gravity test results is > 1.030 Negative or Dilute if it is < 1.010 Sign of dehydration - pick the number higher that 1.030- which means a higher concentration of urine = higher results

What is the "hallmark" sign of Measles?

Koplik spot's, by day 2 or 3, diagnostic bluish-white pinpoint spots with red rim in person's mouth.

Naegele's Test

Menstrual period date minus 3 months, plus 7 days and 1 year

Grieving families - stages of grieve and how do we respond to family needs?

Kubler-Ross: -Denial and isolation- feelings of numbness, disbelief and shock *Remind the family to slow down "take it easy", pay attention to safety measures, & retain healthy habits -Anger- developed awareness to impending death, upset, and guilt. *Give spiritual care; Chaplain, family's personal clergy. Prayer, meditation, spiritual text, making self available to family. Physical exercise, journaling, drawing, therapeutic play. Bargaining- "what did I do to make this happen?" Bargain with self or God. Reinforce child's illness is no one's fault -Depression- profound sadness, excessive worry, insomnia *Get extra help from hospital social worker, physician, social worker or professional counselor -Acceptance- emotional adjustment to child's death *Continue to offer support and encouragement. Offer community resources for continued grief.

Acute HTN treated with:

Labetalol hydrochloride, Hydralazine, Nifedipine, Sodium nirtroprusside (Nitropress) *Note: #delivery is the only cure for preeclampsia otherwise -laying on left lateral side, seizure prophylaxis with magnesium sulfate, antihypertensives

prolapsed cord

Lack of O2 and blood flow to the fetus. When noting FHT will be noted by a variable deceleration - Turn mom on LEFT side. Non engaged baby is at higher risk if ruptured membrane because the cord can fall down and get in the way

A client who has meconium stained fluid. Which solutions does the nurse anticipate the provider to prescribe for an amnioinfusion?

Lactated Ringer's solution and 0.9% sodium chloride

Which assessment findings in a newborn who was born at 32 weeks of gestation should indicate that a complication may be developing?

Large head in comparison to the body, lanugo over the body, a weak grasp reflex, and skin that is thin, smooth, shiny, and possibly translucent.

Anatomical landmarks of the fetal skull: *BREGMA*

Large, diamond-shaped anterior fontanel

Which condition is it associated with? How is it treated?

Laryngotracheobronchitis (LTB) or Croup Syndrome, viral infection of upper airways. Treated with cool, humdified air and keeping child calm.

LMP

Last Menstrual Period

Foods high in folic acid are:

Leafy vegetables Dried peas Dried beans Seeds Orange juice

A nurse is examining an infant who was just delivered at 41 weeks of gestation. Which characteristics indicates that this infant is postterm?

Leathery, cracked, and wrinkled skin is seen in a newborn who is post term due to placental insufficiency.

Acyanotic Heart Disease

Left to Right Shunting through an abnormal opening Obstructive lesions, Majority surgically correctable Respiratory Failure &/or CHF, Ideally early diagnosis and surgical repair

Deep Vein Thrombosis S&S

Leg pain Chills Unilateral swelling, warmth, redness Warm extremity Calf tenderness Elevated temp Cough Tachycardia

Magnesium sulfate

Magnesium sulfate is an anticonvulsant that would be prescribed for a client who is exhibiting signs and symptoms of severe preeclampsia as evidenced by this client's elevated blood pressure and 3+ proteinuria.

Physiologic Jaundice

Manifests about 48 to 72 hours after birth, common with difficult or traumatic deliveries, that could lead to RBC damage. Usually Benign.

Chloasma

Mask of pregnancy (pigmentation increases on the face)

Which of the following actions should a nurse take when bringing a newborn to a mother for breastfeeding for security purposes?

Match the mother's identification band with the newborn's.

MSAFP

Maternal Serum Alpha Fetoprotein (detects multiples, birth defects, neural tube defects)

*QUICKENING*

Maternal awareness of fetal movements.

Risk Factors for Abrutio Placenta

Maternal hypertension, blunt abdominal trauma, cocaine abuse, and cigarette smoking are risk factors for abruption placenta.

Fetal tachycardia means:

Maternal infection Fetal anemia Fetal heart failure Fetal cardiac dysrythmias Maternal use of cocaine or meth Maternal dehydration

Fourth stage:

Maternal stabilization of vital signs

A client who is prescribed terbutaline (Brethine) 0.25 mg subcutaneously. Which of the following is an adverse effect of this medication?

Maternal tachycardia is a normal adverse effect that will decrease over time.

Child has tenderness in the lower right abdomen area. What is this called?

McBurney's point

Which measures would you perform on a child under 1 yoa, at each office visit? Why? What would you consider/be concerned about with an increased OFC?

Measure head and chest circumference until age 3 yrs. If an increase check for hydrocephalus or tumors.

Fundal height

Measurement of the size of the uterus (should coincide with age of fetus)

A client with a DVT is being cared for by a postpartum RN. Which nursing intervention should the nurse include in the client's plan of care?

Measuring leg circumferences, applying warm moist compresses to the affected extremity, and instructing the client to remain on bed rest with the affected extremity elevated.

A nurse is caring for a client who is at 42 weeks of gestation and in active labor. The nurse should understand that the fetus is at risk for which of the following?

Meconium aspiration

*BETAMETHASONE*

Medication stimulates lung development in premies?

*ASTHMA* Medications

Medications • Quick relief (rescue): Short-acting β2 agonists, systemic corticosteroids • Long term (preventer): Corticosteroids, antiallergy agents, NSAIDS, long-acting β2 agonists, leukotriene modifiers (Singulair), long-acting bronchodilators, nebulizers Theophylline: monitor serum levels-ER settings Leukotriene modifiers-(Singulair) block inflammation & bronchospasm effects Chest physiotherapy • Breathing exercises; physical training

*Chorionic villi*

Microscopic, finger-like projections that emerge from the outer sac which surrounds the developing baby. Chorionic villi are of fetal origin and eventually form the placenta.

Client in active labor. Dilated 5cm, membranes intact, FHR 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds, and have beat-to-beat variability of 20/min. client is exhibiting signs of which of:

Moderate variability, FHR accelerations, No FHR decelerations, Normal baseline FHR

Distinguish between Molding & Subdural hematoma.

Molding is elongation of head from overlap of skull bones during birth. Subdural hematoma blood collects in the space between the dura mater and the arachnoid mater, usually from head trauma "shaken-baby syndrome".

Hyperbilirubinemia precautions

Monitor amt of exposure to light , provide extra fluids at least 25% more to prevent dehydration, monitor bilirubin levels to insure they are decreasing, baby's temp and protect eyes from phototherapy treatment.

What to do with Cord prolapse?

Monitor for decelerations, vaginal exam feel (cord pulsation...keep cord from being compressed, presenting part), alert some for C-section

You are evaluating a post-operative pediatric patient wearing a pulse oximeter. What are the parameters you would expect to find in this patient?

Monitor oxygen carefully too little will not be effective and too much can be toxic. Monitor child & equipment often.

*NEOPLASMS OSTEOGENIC SARCOMA (ORGAN)*

Most Common Bone Cancer in Kids • Affects long bones...(Femur) Symptoms: • Pain from the bone *DON'T IGNORE* Treatment: • Surgical Resection • Chemotherapy

*ANEMIA*

Most Common Hematologic Disorder • Decrease in # of RBCs and HgB Concentration • *Decrease in O2 Carrying Capacity of Blood*

Pulmonary Ductus Arteriousous (PDA)

Most common Cardiac Lesion. Continuous murmur upper left sternal border-machinery-like sound. X-ray-cardiomegaly. Bounding pulses/low diastolic pressure. Tx: Medical-fluid restriction, diuretics, indomethacin. Surgical ligation (increased Pulmonary Bld Flow)

Asthma

Most common chronic illness in childhood is ____.

Lochia rubra

Mostly red and bloodly, for 2 days after birth, smells like blood

What to do if recognize AFE?

Mother does not survive...cannot breakdown clot. Happens because of change in intrauterine pressure (putting tools in the uterus). -If recognize, save the baby (C-Section)

Normal respiratory status

Movements of diaphragm and abdominal muscles are synchronized

Pain management of the postpartum patient, which patient will report more uterine pain?

Multipara pt. and if they are breast feeding it makes the uterus contract a lot. PAIN!

Communal Family

Multiple families in one house

What is different, and what are the myths and fallacies regarding "pain management in children"?

Myth: children don't feel pain, neonates don't feel pain due to immature nervous system. They become accustomed to pain, pain doesn't last as long, and children should learn to tolerate pain for later in life. -Pain in children=*ALWAYS treat pain to validated level of response. Chart pain, intervention and response.

Hyperemesis Gravidarum

N/V that lasts beyond month 4 and weight loss of 8 pounds or more.

*DDH DEVELOPMENTAL DYSPLASIA of the HIP* Assessment

NEONATE AND INFANT: • *Positive Ortolani's Click* • Asymmetrical Gluteal Folds • *Positive Barlow's Sign* OLDER INFANT AND CHILD: • *Positive Trendelenburg's* sign • Uneven gait • *Hip ultrasound to confirm*

maternal gestational diabetes

NO oral agents...must give insulin. A large baby is associated with a mother who has maternal diabetes. A baby born to mom will be hypoglycemic since the fetus was used to having to supply all that insulin in utero

Medications used for postpartum care.

NSAIDS; Motrin for pain management

Client in active labor received meperidine (Demerol) 50mg IV for pain 30min prior to delivery. Which med should the rn be prepared to give?

Naloxone (Narcan) to the neonate (an opioid antagonist) should be administered to the neonate for respiratory depression.

It is used to correct neonatal depression caused by maternal opioids.

Naloxone (Narcan).

RSV

Name the most common cause of hospitalization in children younger than 1 year of age

signs of respiratory distress in newborn

Nasal flaring, cyanosis, retractions (ribs)- supra sternal, substernal and intercostal, see saw breathing or abnormal movement of chest/abdomen

A newborn who was born at 32wks gestation. His birth weight is 1,100g. His Apgar scores are 3 at 1min and 7 at 5 min. He's experiencing nasal flaring, grunting, & intercostal retractions. What characteristics does the nurse may see at this birth?

Nasal flaring, grunting, and substernal and intercostal retractions indicate that the infant is experiencing respiratory distress

Define "neonate" or "neonatal period" ?

Newborn's during the 1st 28 days of life.

Amenorrhea

No menstrual period

GI disorder presentations and treatment *INTUSSCUSCEPTION*

Normal comfort interrupted by periods of sudden acute pain, *palpable sausage-shaped mass, red currant jelly stools (mixture of blood and mucus)*. Telescoping of one portion of the bowel into another. Air-enema to treat it.

5 - 10% loss from birthweight

Normal neonate weight parameters at discharge. >10% would not discharge, need to monitor and make a feeding plan.

Provides exchange for nutrients and waste products Structure is complete by week 12 Produces progesterone to maintain pregnancy by week 12 Provides passive immunity for the first few months of birth Genetic testing can be done by week 10-12

Placenta

What signs pertaining to respirations indicate that a newborn is having no difficulty adapting to extrauterine life?

Normal respiration rate for a newborn increases from 30-60/min w/ short periods of apnea (< 15 seconds) occurring most frequently during the (REM) sleep cycle. -Periods of apnea lasting < 15 seconds are normal. Newborns are obligatory nose breathers.

When talking to a teen about chemical use and sexual activity how would you go about it/what considerations would you have in place?

Not talking in front of parent's if teen is uncomfortable. Offering them brochures or printed material to read at their convenience.

FHM *VARIABLE DECELERATION*

Noted as V-shaped on the monitoring strip. Variable decels can occur anytime during monitoring of the fetus. They are caused by *cord compression*. The intervention is to change the mother's position; if pitocin is infusing, stop infusion, alert physician

Medication administration and specific nursing treatments

Nurse has to understand the child's medications -*ALWAYS double check dosing and meds prepared to ensure accurate administration. -Small amounts, FlavorRX, gain the children's trust and involvement as soon as able.

Helping with Shoulder dystocia

Nurse push above the symphysis [hard] helps pop the shoulder out. -Can cause nerve damage, flaccid arm, non-flexed arm in baby

*RHEUMATIC FEVER* Nursing Treatment

Nursing Mgt- Treat infection & complete antibiotic course! • Eradication of hemolytic streptococcus • Prevention of permanent cardiac damage • Palliation of other symptoms • Prevention of recurrence of RF

A client is in the transition phase of labor and feels that she needs to have a BM with the peak of contractions. An appropriate

Nursing intervention is to Prepare for an impending delivery.

24hrs post-delivery, a newborn is getting circumcised. Hasn't been fed for several hrs & is restrained on the circumcision board. RN will provide care after circumcision and prior to D/C. Identify priority RN Intervention after circumcision care.

Observe the newborn for bleeding by conducting checks every 15 min for 1 hr and then every hour for at least 12 hr.

Non stress test

Observing for acceleration of fetal heart rate with movement. Shows intact central and autonomic nervous systems., method for evaluating fetal status during antepartum period by obvserving for accelerations of fetal heart rate Third trimester used to check fetal well being, External FHR monitor to observe accelerations in response to movement. Reactive is defined by: 2 or more accelerations in 20 min at least 10 bpm above baseline and lasting at least 15 sec. nonreactive: this does not happen in 40 min

Late decelerations

Occur after contractions and means placental insufficiency and fetal distress. BAD.

Variable decelarations

Occur during or after contractions and means cord compression. Can be altered by changing mom's position or giving her O2.

Acute Glomerulonephritis

Occurs 1 to 3 weeks after strep infection

pathologic jaundice

Occurs immediately afterbirth. a blood disorder, diagnosed by a heel stick blood test to test the degree bilirubin. -Can be caused by rH factor or ABO- Hyperbilirubenemia. The baby is born with this disease

Fundal Height

Once it's above the level of symphysis pubis, it is between 12-14 weeks; at the Umbilicus it is about 20 weeks; Rises 1cm per week until 36th week

What is the test for Factor 8 (VIII) in hemphilia?

PTT

Placenta abruption

Pain!! [severe abdominal pain and bleeding] -Premature separation of the placenta from the uterine wall is

Braxton Hicks

Painless, irregular contractions that are usually relieved with walking

Para

Parting of mother and baby (aka birth)

The four P's of approaching labor

Passage, Passenger, Powers, Psyche

*BALLOTTEMENT*

Passive movement of the unengaged fetus may be due to uterine tumors or cervical polyps instead of the presence of a fetus.

Client 40wks gestation, contracting Q3-5 mins, & becoming stronger. 3cm dilated, 80% effaced, and -1 station. Client wants pain meds now. RN suggests

Patterned breathing techniques, Butorphanol (Stadol) 2 mg IV as prescribed, Application of heat or cold, Distraction or a focal point. -Nonpharmacological comfort measures can be safely used while the client is in the latent phase of labor

Desquamate

Peeling of the neonate skin

Risk factors for subinvolution of uterus:

Pelvic infection and endometritis Retained placental fragments not completely expelled from the uterus

40.What is the preferred treatment for syphilis?

Pencillin G

A RN is teaching a group of women who are pregnant about measures to relieve backache during pregnancy. The nurse should teach the women...

Perform the pelvic rock exercise every day. Use good body mechanics.

How is Hyperbilirubinemia treated?

Phototherapy, infant is placed in isolette with special flourescent overhead lights. Goal to prevent kernicterus (bilirubin encephalopathy, brain damage).

formal operations

Piaget's last stage of cognitive development in which the adolescent becomes capable of abstract thinking covering 12-16 yrs old.

preoperational

Piaget's second stage of cognitive development (lasting from about age 2 to age 6 or 7), during which the child begins to represent the world symbolically

concrete operations

Piaget's stage in which children learn such concepts as conservation and mathematical transformations; about 7 - 11 years of age

sensorimotor

Piaget's stage in which the child explores the world through interaction of his mouth and hands with the environment this is stage I and covers birth-2 yrs.

What are the signs of placental separation - risks and nursing interventions?

Placenta abruption - severe *pain* and bleeding [DO NOT CHECK CERVIX] -Lack of gas exchange to fetus, mom could hemorrhage -May require delivery if serious -If noncatastrophic just require hospitalization, labs, monitoring

Retained placenta:

Placenta or fragments of the placenta remain in the uterus preventing the uterus from contracting which leads to uterine atony or subinvolution Med given: oxytocin....if unsuccessful then tocolytic for d&c

Over Due Baby 40+ weeks

Placenta starts to age after 40 weeks. Biophysical profile is done after 40 weeks.

Stage 3 of labor

Placental (delivery) - monitor for hemorrhage, document placenta condition and side presented, fundal massage.

Flat with an oval inlet, labor and birth are difficult due to short anteroposterior diameter

Platypelloid pelvis

What are the 3 "P's" of Type I diabetes?

Polyuria, polydypsia, polyphagia

Reason for plugged breast ducts

Poor rotation during breast feeding

Lie

Position of the fetal spinal cord in relation to the mothers

Coping with Stress

Positive - Child begins to expand their world when parents are absent. =Healthcare providers can see the child adapt. -If parents are gone too long........abandonment can set in. **Stress helps them learn how to cope. -Long term stress (not good), however display itself in physical manifestation.

Hospitalization causes many issues - Stress is the Big one. This can be positive and negative, please explain.

Positive - Child begins to expand their world when parents are absent. Healthcare providers can see the child adapt. If parents are gone too long........abandonment can set in. **Stress helps them learn how to cope. -Negative - Long term stress (not good), however display itself in physical manifestation.

What are the nursing interventions that should be managed in most post-operative cases? [Repair of lacerations, tonsillectomy, and appendectomy]

Post-surgical-**Pain management, checking incision, check for bleeding [excessive swallowing for tonsillectomy], and monitor vitals.

*VP SHUNT CARE*

Postoperative interventions: • Position on nonoperative side to prevent pressure on shunt valve • Keep flat as prescribed • Observe for increased ICP; if present, elevate head of bed 15 to 30 degrees

What do we evaluate?

Posture, test flexibility, reflexes and identifies physical characeristics to determine physical maturity.

Hyperkalemia is excess of what?

Potassium

In the child suffering from gastroenteritis, which lab value would be of highest importance??

Potassium (normal levels 3.5-5.0)

Cardiac Cath stuff to know:

Pre Procedure- teach child and family about the disease, its cause, and treatment. NPO. -Answer questions child or family has, explain the risk of bleeding, infection, thrombus, arrhythmias, perforation, stroke, and even death. Post Procedure- **Lie flat. Monitor vitals (HR, RR, BP), distal pulse, restrain, maintain IV therapy (dehydration), and Monitor bleeding of the site and apply pressure above site if bleeding. -Note: place dressing on top to reinforce, do not remove dressing MD applied. Monitor pain and administer pain meds as prescribed. May need to add sedation if too rambunctious.

PTL

Pre Term Labor

First two weeks after conception

Pre-embryonic period

Which of the following are risk factors for postpartum hemorrhage?

Precipitous delivery, lacerations, inversion of the uterus, and retained placental fragments are all risk factors associated with postpartum hemorrhage.

PIH

Pregnancy Induced Hypertension

PIH

Pregnancy Induced Hypertension - -3 big factors are elevated proteins: protein spilling into the urine, Edema and High BP -Mild preeclampsia protein 1-2+ BP is 140/90 -Moderate preeclampsia protein 3-4+ BP is 160/110 -Eclampsia = hardly any urine and copious amounts of protein BP 170-200/110 -Lack of urination and build of up protein can cause kidney malfuncion, edema and raised BP

PIH

Pregnancy Induced Hypertension - 3 big factors are elevated proteins- protein spilling into the urine. / Edema and High BP Mild preeclampsia protein 1-2+ BP is 140/90 Moderate preeclampsia 3-4+ BP is 160/110 Eclampsia = hardly any urine and copious amounts of protein BP 170-200/110 Lack of urination and build of up protein can cause kidney malfuncion, edema and raised BP

Pre-Eclampsia

Pregnancy Induced Hypertension. Sudden weight gain, headache, edema. Left lateral positioning. Any pregnant woman with high BP

What is "PIH"? What do we monitor and why, in the PIH patient?

Pregnancy-induced hypertension (PIH); Leads to mild or severe preeclampsia; Monitor protein in urine , increase in BP and edema; or HELLP syndrome - H = Hemolysis (destruction of RBCs), EL = Elevated Liver enzymes and LP = Low Platelet count.

Uterine contractions and cervical changes that occur between 20 and 37 weeks of gestation

Preterm labor

Reasons for c-sections:

Prior C-sections, failure to descend, failure to dilate, infections, fetal distress intolerance, unstable lie, Previa or abruption or placenta, rupture uterus, cord prolapse, prior vertical C-sections

Progesterone in the placenta

Progesterone helps maintain, slows things down, makes environment comfy, thickened endometrial lining. Progesterone is very important in pregnancy. Progesterone=prolife. 500 ml per minute of blood goes through placenta.

Lactating does not prevent pregnancy, even if menses has not yet resumed.

Progesterone only oral contraceptives (mini pills) are a good form of birth control once lactating. -Have diaphragm refitted by her PCP, which should be done after a pregnancy and birth or a 7kg (15lb) weight change.

Pudendal

Saddle block. Done internally/vaginally by OBGYN. Blocks just pelvic area.

A nurse is caring for a client admitted to the labor and delivery unit. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe?

Prolapsed umbilical cord

Is a potential complication for a fetus in a breech presentation. Breech presentation would most likely cause dystocia (prolonged, difficult labor).

Prolapsed umbilical cord

*CYSTIC FIBROSIS* Systems Effected

RESPIRATORY SYSTEM: Stagnation of mucus in airways, destroying lung tissue GASTROINTESTINAL SYSTEM: Intestinal and pancreatic obstruction secondary to excessive mucus production INTEGUMENTARY SYSTEM: Abnormally high concentrations of sodium and chloride in sweat REPRODUCTIVE SYSTEM: Sterility of males caused by vas deferens obstruction by mucus; fertility may be inhibited in females because of cervical mucus plug

rH important

RH negative means mom has no antibodies (RH Negative is BAD). -Rhogam is given at 28 weeks and after birth if baby is RH positive. -Rhogam also given with abortion, amniocentesis, and trauma that punctures abdomen

*BLADDER EXOTROPHY* Risk Factors / Clinical Manifestations / Diagnostic Findings Labs / Medical Treatment / Nursing Interventions / Patient Education /

RISK FACTORS - Congenital defect - Cause unknown CLINICAL MANIFESTATIONS -Exposed bladder mucosa -Widened symphysis pubis -External genitalia defects DIAGNOSTIC FINIDINGS LABS - Structural defect - UA to indicate infection MEDICAL TREATMENT - Antibiotics - Closure of abdominal defect within first few days of life - Staged Surgical management for bladder and genitalia reconstruction

*TEST FOR SYPHILLIS*

RPR = Rapid Plasma Reagin is like VDRL= Venereal Disease Research Laboratory

When taking RR and pulses what considerations will you have?

RR take before other vitals because it will not be accurate if child starts to cry. radial pulse in children > 2yrs old and apical for < 2yrs old listen for 1 full min.

Anencephaly

Rare congenital condition in which some or all of the cranium and cerebrum are missing in a newborn

Ballottement

Rebound of unengaged fetus

Stage 4 of labor

Recovery - Monitor mom's vitals, fundal height, lochia, first void, r/o hemorrhage, encourage fluids, breastfeed baby, client teaching

Which is less typical?

Rectal Temperature

What is "erythema toxicum"? Is it dangerous?

Red raised rash that goes away on its own, not dangerous.

*PALMAR ERYTHEMA*

Redness present on palms; caused by increased estrogen levels

To help assist a child with lumbar puncture you apply EMLA prior to do what?

Reduce discomfort

An amnioinfusion can be used to:

Reduce severity of variable decelerations (cord compression) Dilute meconium-stained amniotic fluid

Renal issues

Renal disease causes: -chronic electrolyte imbalance -fluid retention -profound fatigue -foamy urine -low GFR -high creatinine. **In late stage: fluid sodium retention, poor color, poor decision making, brain fog.

Which of the following is the initial nursing action the nurse should take when late decelerations appear on the fetal monitor?

Reposition the client in to left-lateral position to increase uteroplacental perfusion. The greatest risk to the fetus during late decelerations is uteroplacental insufficiency.

Involution

Reproductive organs return to prepregnancy state (takes 6 weeks). Uterus s/b at midline and firm - deviation to side means full bladder, boggy means bleeding. Lochia continues for 3-4 weeks, earthy smell and small clots ok but big clots and large clots not. Constipation for 1-2 weeks is normal.

Normal findings 2 hours after birth

Respirations wet and rapid. If continues after 2 hr then it becomes abnormal

Normal findings 2 hours after birth

Respirations wet and rapid. If continues after 2 hr then it becomes abnormal -RR >60 after 2 hours is Not Good. Need to observe!

What is the neonate suddenly responsible for handling on its own for the first time, following delivery?

Respirations, circulation, body temp and source of nourishment.

atrial septal defect (ASD)

S/S - no cyanosis, pulses normal. 2nd heart sound wide 3rd heart sound left lower sternal border has right ventricular flow murmur. X-ray - pulmonary artery is prominent, heart enlarged. Repair is by direct closure before 5 yrs. ,

Appendicitis (GI problems)

S/Sx: RLQ pain or abdominal pain referred, vomiting, fever, difficult to identify **If perforated, the pain disappears [very dangerous]

*DIASTASIS RECTI*

SEPARATION OF THE LONGITUDINAL MUSCLES OF THE ABDOMEN (RECTUS ABDOMINIS) DURING PREGNANCY

*ANEMIA* DECREASED RBC Production

SIGNS & SYMPTOMS • Pallor • Tachycardia • Fatigue • SOB • Muscle Weakness • Heart Murmur • PICA EXAMPLES: Nutritional Deficiency: IRON Bone Marrow Failure: *APLASTIC ANEMIA*

*ANEMIA* INCREASED RBC Destruction

SIGNS & SYMPTOMS • Tachycardia • Dark Urine • Fatigue EXAMPLES: INTRACORPUSCULAR (In the cell) - *SICKLE CELL ANEMIA* EXTRACORPUSCLAR (Out of the cell) - Immunologic

*ANEMIA* INCREASED RBC Loss

SIGNS & SYMPTOMS: • Pallor • Fatigue/ Headache • Muscle Weakness • Cool Skin • Tachycardia EXAMPLES: ACUTE BLOOD LOSS: • Epistaxis • *HEMOPHILIA* • DIC • Hypersplenism

What are symptoms of hypoxia?

SOB or dyspnea, restlessness, fatigue, anxious, impaired coordination, paniac and facial expressions. Breathing muscles, gasping, wheezing, mental changes, changes in skin color, mucous membranes and cyanosis.

*BACTERIAL STI*

STI caused from bacteria usually treatable w/antibacterial ANTIBIOTICS CHLAMYDIA GONORRHEA (Can Cause Blindness in newborns) SYPHILLIS (stages) 1. Red oval sores 2. Red hands and rash 3. Brain lesions

apgar

Score of 0 Score of 1 Score of 2 Component of Acronym Appearance/Complexion blue or pale all over blue at extremities body pink (acrocyanosis) no cyanosis body and extremities pink Appearance Pulse rate Absent <100 ≥100 Pulse Reflex irritability no response to stimulation grimace/feeble cry when stimulated cry or pull away when stimulated Grimace Activity none some flexion flexed arms and legs that resist extension Activity Respiratory Effort absent weak, irregular, gasping strong, lusty cry Respiration

What is the often overlooked and most common risk factor for recurrent otitis media?

Second hand smoke, recurrent URI's and bottle propping.

Neuro - seizures - how do you manage seizures in children? ** Seizures- Airway, safety, documentation

Seizure management- (lecture says airway first then safety). -Maintain the airway, roll the child to their side, and stay with them during the seizure. -Anti-seizure medications should be given on a strict schedule. -Some children should wear helmets. -No child with seizure should be in or around water without continual observation.

Child launching

Sending kids into the world (stage of family cycle)

5 Major stressors

Separation anxiety, Bodily injury/pain, Loss of control, Unknown & Unfamiliar events and environment, Unclear limits regarding expectation are all examples of the ______.

Placenta abruption risks

Severe pain and bleeding -DO NOT CHECK CERVIX!!

STI'S

Sexually-transmitted infections

Ectopic pregnancy

Signs and symptoms of an ectopic pregnancy include unilateral lower-quadrant abdominal pain with or without bleeding.

What can cross the placenta?

Small molecules cross the placenta except for very large molecules. Heparin and insulin doesn't cross. Food sources, smoking, drugs, viruses, caffeine cross.

*MAGNESIUM SULFATE*

Smooth Muscle Relaxant Level between 6-8 Used for Eclampsia and Preterm labor Overdose signs - Loss of Deep Tendon Reflexes, Respiratory Depression, Decreased urine output Antidote- Calcium Gluconate

What is their purpose?

Soft spots in the newborns skull that do not fuse to allow the head to mold to fit throught the birth canal.

What are the posterior fontanels?

Soft spots, located on the crown of the head (near the back or occiput), smaller and triangular shaped. Closes by the 3rd mo.

What are the anterior fontanels?

Soft spots; found just above the forehead, they are diamond shaped. Close between 12-18 mos.

*HEGARS SIGN*

Softening and compressibility of lower uterus

Hegar's sign

Softening and compressibility of the lower uterus

Goodell's sign

Softening of cervical tip

Goodell's Sign

Softening of the cervix in the 8th week of gestation.

*GOODELLS SIGN*

Softening of the tip of the cervix may also be caused by infection, hormonal imbalance or pelvic congestion.

Hegar's sign

Softening of the uterus at about 6 weeks

Signs and symptoms of impending labor: *GASTROINTESTINAL DISTURBANCES *

Some women experience gastrointestinal disturbances (diarrhea, nausea, vomiting or indigestion) as a sign of impending labor. The etiology of the gastrointestinal disturbances is generally unknown.

Parenteral fluid is given by?

Somewhere other than GI tract

Signs/symptoms of good vs. bad technique

Sore & cracked nipples = poor latch/placement, engorgement = not feeding often enough, plugged ducts = poor rotation during feedings and mastitis = bacteria from baby's mouth, infects breast duct (continue to breast feed).

Common problems with breastfeeding

Sore & cracked nipples, engorgement, plugged ducts and mastitis.

What is the largest organ in the lymphatic system?

Spleen

SROM

Spontaneous Rupture of Membranes

Premature rupture of membranes

Spontaneous rupture of the amniotic membranes, 1 hr or more prior to the onset of true labor

Four Stages of Labor

Stage 1 (Dilation), Stage 2 (Expulsion), Stage 3 (Placental), Stage 4 (Recovery)

Normal fluid intake and output in children. [Parenteral fluid volumes are based on this knowledge].

Standard is 1ml to 2ml/kg/hr. This is normal urinary output.

A nurse is caring for a client who has mastitis. Which of the following is the typical causative agent of mastitis?

Staphylococcus aureus

Clapping hands will elicit the

Startle reflex.

Lochia serosa

Starts after bleeding diminishes, color is pinkish brown and lasts for about 7 days, smell is slightly earthy

*PHARYNGITIS*

Strep Throat Risk of Rheumatic Fever

*STRIAE GRAVIDARUM*

Stretch marks

Striae gravidarum

Stretch marks most often found on the abdomen and thighs

*THE FETAL PERIOD* *Weeks 35 to 40*

Strong hand grasp reflex orientation to light 3000-3800 gm. (6.5-7.5 lbs.) 17.3-19.2 inches ( 45-50 cm)

*SUBDURAL HEMATOMA*

Subdural hemorrhage-bleeding between the dura and the cerebrum Cerebral edema- some degree expected 24-72 hrs after trauma

How do you apply Naegle's Rule?

Subtract 3 mos from 1st day of LMP and +7 days

Tetralogy of Fallot

VSD, Pulmonary stenosis, overriding aorta,and right ventricular hypertrophy. S/S include X-ray. Surgical repair done after age 3 if possible. (decreased Pulmonary Blood Flow)

S/Sx of Pre-Eclampsia:

Sudden weight gain or gaining more than a pound a week especially in the last trimester. -Swollen face, hands and feet which worsens in the morning -Headaches, Blurred vision, Seeing spots -Persistent painful heartburn -Decreased production of urine (oliguria) -Hyperreflexia -Nausea or vomiting, Epigastric pain (pain between your sternum and navel)

In diabetic pregnancy

Sugar crosses placenta but insulin doesn't so there is a risk of macrosomia (big baby) -babies are at risk for getting stuck during birth, lung immature, birth injury -monitor baby for hypoglycemia, assess lungs.

A nurse is caring for an infant who is preterm and has respiratory distress syndrome (RDS). Which of the following assessment findings will assist the nurse in evaluating the efficacy of synthetic surfactant?

Surfactant therapy stabilizes the alveoli and prevents collapse, thereby increasing lung compliance and maintaining or improving oxygen saturation

A nurse in an antepartum clinic is providing care for a client. Which of the following clinical findings are suggestive of TORCH?

Symptoms of TORCH are flu-like in presentation. They may include reports of joint pain, malaise, rash, and tender lymph nodes.

This can help with breast engorgement.

Taking a warm shower prior to feedings, not immediately after, can assist with the letdown reflex and milk flow.

How would you counsel a parent/family considering whether or not to immunize?

Teach that the purpose to immunize is to eradicate the disease, Give them info about the importance of keeping up-to-date on immunizations, Clinical studies have shown they are safe, even for newborns and maybe administered as recommended.

Skin disorder characterized by patches of alopecia?

Tenitus capitus

What is the congenital heart with 4 defects?

Tetralogy of Fallot

TOF

Tetrology of Fallot - 4 things- be able to recognize these 4 things... 1- pulmonary stenosis 2- Ventricular septal defect 3- Overriding aorta 4- Hypertrophy of the R ventricle

With women who are low risk

The FHR should be assessed every 15 min in the second stage of labor.

Prior to the performance of an amniotomy

The amniotic membranes should have ruptured. *It is also imperative that the fetus is engaged at a level 0 station and at the level of the maternal ischial spines to prevent prolapse of the umbilical cord.

Anatomical landmarks of the fetal skull: *VERTEX*

The area between the anterior and the posterior fontanels

Anatomical landmarks of the fetal skull: *OCCIPUT*

The area of the fetal skull that is occupied by the occipital bone, beneath the posterior fontanel.

Stage 1, active phase

The cervix dilates from 4 to 7 cm, and contraction duration ranges from 40 to 70 seconds.

Stage 1, transition phase

The cervix dilates from 8 to 10 cm, and contraction duration ranges from 45 to 90 seconds.

Chadwick's sign

The cervix is blue or purple and can occur as early as 6 weeks.

Which of the following classifications of heart disease is the client symptomatic with marked limitations on physical activity?

The classification system will guide the provider in the management of cardiovascular disease. Clients exhibiting symptoms with marked limitations on physical activity are in Class III.

A nurse is performing a fundal assessment for a client in her 2nd postpartum day and observes the client's perineal pad for lochia. She notes the pad to be saturated about 12 cm with lochia that is bright red in color and contains small clots.

The client has moderate lochia rubra containing small clots with a fleshy odor, which is a normal finding for the second day postpartum

Which of the following positions should a nurse place a client in prior to a cesarean birth?

The client will need to be positioned supine, for the cesarean birth. Placing a wedge under the right hip, will tilt the client so she will not experience the pressure of her gravid uterus that is compressing on the inferior vena cava.

Types of breech presentations *COMPLETE (FULL) *

The complete, or full, breech position is the same as the flexed position with the fetal buttocks presenting first. The legs are typically flexed. Essentially, this position is a reversal of the common cephalic presentation.

Respiratory distress syndrome

The condition resulting from inadequate production of surfactant and the resultant collapse of alveoli

Why a footling breech is bad

The cord can prolapse due to too much empty space in the uterus. O2 and blood supply would be cut off.

Amniotic Fluid index

The depths of the four quadrants surrounding the baby are measured in centimeters, normal 5cm-19cm

Describe the role of a *Doula*

The doula is a woman who has received professional training and is experienced in childbirth. The doula's role is to provide continuous information and physical and emotional support to the woman and her partner before, during, and immediately after the birth. She does not function in a clinical role but instead specializes in providing comfort measures to decrease the woman's anxiety.

*EMBRYONIC PERIOD*

The embryonic period is the time period beginning with the third week after fertilization and continuing until the end of the eighth week. This period is known as the organogenetic period that denotes the formation and differentiation of organs and organ systems

*VERTEX* Presentation

The fetal head presents fully flexed. This is the most frequent and optimal presentation as it allows the smallest suboccipitalbregmatic diameter to present. It is called a "vertex presentation."

A non reactive NST would indicate what about the fetus?

The fetal heart rate does not accelerate adequately with fetal movement. -A BPP or CST will need to be done now

DANGER SIGNS TO REPORT *FIRST TRIMESTER*

Vaginal Bleeding Abdominal Cramping Severe or Prolonged vomitting

*LONGITUDINAL LIE*

The fetus is in a longitudal lie if the head to tailbone axis of the fetus is the same as the woman's. In more than 99% of pregnancies, the lie is longitudinal. In the longitudinal lie, either the fetal head or the fetal buttocks enter the pelvis first.

Foremilk

The first milk the baby gets. Has less fat and calories.

When should the nurse provide the client and coaching partner education during the labor process?

The first stage, latent phase. Because client is not in any pain and is ready to learn.

Prepuce

The foreskin of the penis.

Types of breech presentations *FRANK*

The frank breech is the most common of all breech presentations. In the frank breech position, the fetal legs are completely extended up toward the fetal shoulders. The hips are flexed, the knees are extended, and the fetal buttocks present first in the maternal pelvis.

When performing nursing care for a newborn after birth, which of the following nursing interventions is the highest priority?

The greatest risk to the newborn is cold stress. The highest priority intervention is to prevent heat loss. Covering a newborn's head with a cap prevents cold stress due to excessive evaporative heat loss.

*TET SPELLS* Signs and Symptoms

The infant becomes: • Acutely cyanotic (Hypercyanotic) • Abnormally deep and rapid breathing • Oxygen requirements exceed the blood supply, • Occurs during stressful situations... feedings or crying. *PT SQUATS TO SHUNT BLOOD* • *Rarely seen before 2 months of life and usually occur in the first year and can occur with stressful situations.* • The spells cause cerebral hypoxia and require prompt assessment and treatment to prevent brain damage or possibly death.

Discuss why a preterm infant is at risk for ineffective thermoregulation? The infant's low birth weight and gestational age means that

The infant has little glycogen stored in his liver and little brown fat available for producing heat. He lacks subcutaneous fat to insulate his body and his flaccid muscle tone does not allow him to take a flexed position to prevent heat loss.

Newborn 40 weeks gestation. A forceps-assisted birth was necessary. The newborn weighs 9lb, 8oz. The newborn has marked caput succedaneum and marked bruising about the face, head, and shoulders. How should the nurse characterize this infant?

The infant is at term (40 weeks) and LGA (greater than the 90th percentile in weight).

Anatomical landmarks of the fetal skull: *POSTERIOR FONTANEL*

The intersection between the posterior cranial sutures closes 6-8 wks

A RN is giving instructions to a mother about how to breastfeed her newborn. Which action by the mother indicates the need for additional teaching?

The mother places a breast shield over her nipple before placing the nipple in the newborn's mouth. *A breast shield isn't routinely used for breastfeeding. A breast shield is worn when the nipples are flat/inverted, or when they are sore/cracked.

4 hrs after admission to the nursery a newborn is taken to his mother for his 1st feeding. The mother wants to bottle feed. The RN educates on bottle feeding. Which observations by the nurse indicates that the mother needs additional teaching?

The mother places the newborn in a supine position during feeding.

What percentage of a newborn's birth weight is expected to be lost during the first 24 hr?

The normal weight loss after birth is 5 to 10%. All newborns should lose some weight after birth due to fluid loss.

What does the nurse look for when evaluating a child for possible child abuse?

The nurse looks for repeated admissions or office visits for unexplained physical injury. • Spiral fractures is a main sign indicating child abuse • suspicious bruising, welts, or burns, new or healing lacerations • fear of going home • retinal hemorrhage (SIDS; babies) • hunger, clothing unsuited for weather (neglect)

A client in active labor who's vaginal exam 1 hr ago showed that she was 3 cm dilated, 50 percent effaced, and had a - 3 station. Her membranes ruptured spontaneously. The nurse should assess her for which sign?

The nurse should always assess for signs of a prolapsed cord when membranes rupture.

A nurse is caring for a client in labor. The client experiences hypotension and fetal bradycardia. Which of the following nursing actions should the nurse implement?

The nurse should be prepared to administer ephedrine via an IV bolus -position the client laterally -increase IV fluids -initiate oxygen.

Describe the "5 Ps" and how each influences labor and birth *Passageway + Passenger and their relationship (engagement, attitude, position*

The passageway and the passenger have been identified as two of the factors that affect labor. The next "P" is the relationship between the passageway (maternal pelvis) and the passenger (fetus and membranes). The nurse assesses the relationship between the two when determining the engagement, station, and fetal position.

*PASSAGEWAY*

The passageway consists of the maternal pelvis and the soft tissues. The bony pelvis through which the fetus must pass is divided into three sections: the inlet, midpelvis (pelvic cavity), and outlet. Each of these pelvic components has a unique shape and dimension through which the fetus must maneuver to be born vaginally. In human females, the four classic types of pelvis are the gynecoid, android, platypelloid, and anthropoid.

Describe the "5 Ps" and how each influences labor and birth *Passageway (maternal pelvis)*

The passageway consists of the maternal pelvis and the soft tissues. The bony pelvis through which the fetus must pass is divided into three sections: the inlet, midpelvis (pelvic cavity), and outlet. Each of these pelvic components has a unique shape and dimension through which the fetus must maneuver to be born vaginally. In human females, the four classic types of pelvis are the gynecoid, android, platypelloid, and anthropoid.

A client who is pregnant should promptly report which of the following symptoms to the primary care provider?

Vaginal bleeding *Vaginal bleeding during pregnancy is always a dangerous sign and the client should notify her primary care provider.

Face is well formed Limbs are long and slender Kidneys begin to form urine Spontaneous movement occurs Heartbeat is detected by Doppler transducer Sex is visually recognizable

Week 12

Describe the "5 Ps" and how each influences labor and birth *Passenger (fetus and placenta)*

The passenger is referred to as the fetus and the fetal membranes. In the majority (96%) of pregnancies, the fetus presents in a head-first position. The fetal skull, usually the largest body structure, is also the least flexible part of the fetus. However, because of the sutures and fontanels, there is some flexibility in the fetal skull. These structures allow the cranial bones the capability of movement and they overlap in response to the powers of labor. The overlapping or overriding of the cranial bones is called molding.

*POSITIVE SIGNS OF PREGNANCY*

The positive indicators of pregnancy are attributable only to the presence of a fetus: • Fetal heartbeat • Visualization of the fetus • Fetal movements palpated by the examiner

Describe the "5 Ps" and how each influences labor and birth *Powers (physiological forces)*

The powers are the physiological forces of labor and birth that include the uterine contractions and the maternal pushing efforts. The uterine muscular contractions, primarily responsible for causing cervical effacement and dilation, also move the fetus down toward the birth canal during the first stage of labor.

*PRE-EMBRYONIC PERIOD*

The pre-embryonic period refers to the first 2 weeks of human development after conception. Rapid cellular multiplication, cell differentiation, and establishment of the embryonic membranes and primary germ layers occur during this time.

Erikson's Theory

Theory that proposes eight stages of human development. Each stage consists of a unique developmental task that confronts individuals with a crisis that must be resolved.

A mother asks why it is important to keep the nipple full of formula when bottle feeding. The RN explains

To prevent the newborn from swallowing air.

Manage preterm labor: Goal is to decrease the strength and frequency of the contractions, and to make sure of optimal fetal status.

Tocolysis - use of meds to inhibit uterine contractions: Beta-adrenergic agonist (aka beta mimetics)- ritodrine (Yutopar), turbutaline sulfate (Brethine), Magnesium sulfate- (MGSO4) *Calcium gluconate is antidote* -Prostaglandin synthetase inhibitors- indomethacin (Indocin) -Calcium Channel Blockers (CCB)- nifedipine (Procardia)

Signs and symptoms of impending labor: *ENERGY SPURT*

Toward the end of the pregnancy, some women experience a sudden increase in energy coupled with a desire to complete household preparations for the new baby. Some refer to this energy spurt as "*nesting*." The energy spurt may be related to an increase in the hormone adrenaline, which is needed to support the woman during the work of labor. Women should be cautioned not to overexert themselves doing household chores and instead to "store up" their energy for the childbirth process.

Be familiar with Diptheria, transmission and treatment

Transmitted through droplets, begins with a sore throat, fever and generalized pain and malaise (weak or discomfort). Treated with antibiotics.

syphyllis in newborn

Treatment with Penicillin G

*HERPES TREATMENT

Treatments of the same family. - Acyclovir - Valtrex - Flamavir

Signs and Symptoms of NAS

Tremors, irritable, crying, vomiting, constant eating still not enough, weight lose, hyperreflexia, arching of back, baby in pain.

Downs syndrome

Trisomy 21, congenital that is caused by a chromosomal disorder/abnormality

Nuclear Dyad

Two people who live together without children.

Late decels mean:

UPI causing inadequate fetal oxygenation Maternal hypotension placental abruption Uterine hyperstimulation w/pitocin

Variable decels mean:

Umbilical cord compression Short cord Prolapsed cord Nuchal cord Oligohydraminos

Cryptorchidism

Undescended testes

Gonorrhea S&S

Urethral discharge Painful urination Frequency Yellowish-green vag discharge Reddended vulava & vag walls

One way to prevent infection with a new burn patient.

Use sterile technique

Isolette

Used as an incubator for premature infants; provides controlled temperature and humidity and an oxygen supply.

*NON STRESS TEST*

Used to determine fetal well being in high risk pregnancy and especially useful in postmaturity (notes response of fetus to own movements); a health fetus will usually response to its own movement by means of an FHR acceleration of 15 beats, lasting for at least 15 seconds after the movement, twice in a 20 minute period; the fetus that response with the 15/15 acceleration is considered reactive and healthy

Contraction Stress Test

Used to evaluate placental/fetal reserve. Observation of fetal heart rate to stress of uterine contractions., an evaluation of the respiratory function of the placenta; able to identify the risk for intrauterin asphyxia by observing the response of FHR to uterine contractions. blood flow to the intervillous space of the placenta is reducted momentarily, thereby decreasing oxygen transport to the fetus.

*NITRAZENE TEST*

Used to test the amniotic fluid pH. Blue indicates a ruptured membrane. Yellow/Orange indicates an intact membrane.

*FETAL ULTRASOUND*

Used with TOCO to listen to fetal heart sounds Babies turn head down (Vertex) between 32-34 wks

After delivery, the uterus contracts and gradually returns to its prepregnant state. This is referred to as:

Uterine involution is the return of the uterus to the prepregnant state, and postpartum contractions aid in this occurring.

Fetal bradycardia means (less than 60)

Uteroplacental insufficiency Umbilical cord prolapse Maternal hypotension Prolonged umbilical cord compression Fetal congenital heart block Anesthetic meds

VEAL CHOP

V- Variable Deceleration = C- Cord Compression E- Early Deceleration = H- Head Compression A- Acceleration = O- Okay! L- Late Deceleration = P- Placental Insufficiency (Heart Rate Pattern) & (Cause)

What is done to ensure an accurate weight?

Weigh same time each day before feeding, balance scale before weighing, weigh without clothes or diaper, note of any additional equipment being weighed (IV, brace, cast).

abstinence

[No lovin'] best way to protect from STIs and pregnancy.

Distractions

____ are great to help children who are experiencing pain.

Mild

_____ asthma does not interfere with ADL, slight increase in resp. effort, slight wheezing

school age

______ children are more engrossed in fact than fantasy.

Pre conceptual counseling/care (this care is for education; identifying risks and nutrition)

a lot of times not covered by insurance -for high risk patients, cancer patients, over 35, patients with genetic issues - educate them on poor lifestyles, [drinking, smoking], vaccines

Hyperemesis Gravidarum

a problem of extreme nausea and vomiting causing electrolyte imbalance, dehydration and severe weight loss

cerclage ring

a ring or loop put on the incompetent cervix

PAP Smear

a sample of secretions and superficial cells of the uterine cervix and uterus

RRheumatic fever

a severe disease chiefly of children and characterized by painful inflammation of the joints and frequently damage to the heart valves

Striae

a streak or a linear scar that often results from rapidly developing tension in the skin, such as seen on the abdomen after pregnancy.

Terbutaline

action: B2 adrenergic agonist; relaxes smooth muscles, inhibiting uterine activity and causing bronchodilation Dosage and Route: Subcutaneous injection: 0.25 mg q20-30 min for up to 3 hours (hold for heart rate greater than 120 beats/min) Adverse reactions: Maternal reactions include shortness of breath, coughing, nasal stuffiness, tachypnea, pulmonary edema, tachycardia, palpitations, skipped beats, myocardial ischemia, chest pain, hypotension, fluid retention and decreased urine production, tremors, dizziness, nervousness, muscle cramps and weakness, headache, hyperinsulinemia, hyperglycemia, hypokalemia, hypocalcemia, metabolic acidosis, nausea and vomiting, fever, and altered thyroid function. Fetal reactions include hyperinsulinemia, hyperglycemia, and tachycardia. Neonatal reactions include hypoglycemia, hypocalcemia, hyperbilirubinemia, hypotension, and ileus. Nursing Considerations: Teach woman and family assessment measures (pulse, BP, respiratory effort, insertion site for infection, signs of PTL, and adverse reactions of terbutaline), whom to call if problems or concerns arise, site care and pump maintenance, activity restrictions, and how to arrange for follow-up care.

Magnesium Sulfate

action: Central nervous system depressant; relaxes smooth muscles, including uterus Dosage and Route: Mix 40 g in 1,000 ml intravenous solution, piggyback to primary infusion, and administer using controller pump: Loading dose of 4 to 6 g over 20 minutes. Maintenance dosage: gradually increases from 2 g/hr to 4 g/hr as needed to suppress contractions; contractions; continue until contractions stop (or one contraction or less in 10 to 15 minutes) or intolerable abverse reactions develop Adverse Reaction: Maternal adverse reactions include hot flashes, sweating, nausea and vomiting, drowsiness, blurred vision, diplopia, headache, ileus, generalized muscle weakness, dizziness, hypocalcemia, Shortness of Breath, and transient hypotension. Some may subside when loading dose is completed. Fetal and newborn reactions are uncommon and include decreased breathing movement, reduced Fetal Heart rate variability, nonreactive NST, Hypocalcemia, lethargy, hypotonia, and respiratory depression. Intolerable adverse reactions include respiratiory rate less than 12, pulmonary edema, absent DTRs, chest pain, severe hypotension, altered level of consciousness, exterme muscle weakness, urine output less than 25 to 30 ml/hr or less than 100 ml/4 hr, and serum magnesium level of 10 mEq/L (9mg/dl) or greater. Nursing considerations: Assess woman and fetus to obtain baseline before beginning therapy and then before and after each increment; following frequency of agency protocol. Monitor serum magnesium levels with higher doses; therapeutic range is between 4 and 7.5 mEq/L or 5 and 8 mg/dl. Discontinue infusion and notify physician if intolerable adverse reactions occur. Ensure that calcium gluconate (1 g=10ml of 10% solution) is available for emergency administration to reverse magnesium sulfate toxicity.

Erythromycin ophthalmic solution for newborn

action: Erythromycin and tetracycline antibiotic ointments are both bacteriostatic and bactericidal. They provide peophylaxis against Neisseria gonorrhoease. Topical treatment of neonatal conjuctiv itis caused by Chlamydia trachomatis is not indicated; instead the infant should be treated with a 14 day course of either oral erythromycin or ethylsuccinate (American Academy of Pediatrics, Committee on Infectious Diseases, 2006) Indication: These medications are used for the prevention of ophtalmia neonatorum newborns of mothers who are infected with gonorrhea. Neonatal Dosage: Apply a 1 to 2 cm ribbon of ointment to the lower conjunctival sac of each eye; medicines may also be used in drop form. Adverse Reaction: They may cause chemical conjunctivitis that lasts 24 to 48 hours; vision may be blurred temporarily Nursing considerations Administer within 1 to 2 hours of birth. Wear gloves. Cleanse eyes if necessary before adminstration. Open eyes by putting a thumb and finger at the corner of each lid and gently pressing on the periorbital ridges. Squeeze the tube and spread the ointment from the inner canthus of the eye to the outer canthus. Do not touch the tube to the eye. After 1 minute, excess may be wiped off. Observe eyes for irritation. Explain treatment to parents. Eye prophylaxis for ophthalmia neonatorum is required by law in all states of the united states.

Kawasaki disease

an acute disease of young children characterized by a rash and swollen lymph nodes and fever. Leading cause of cardiovascular disease in America, because it weakens BV walls, which can lead to aneurysms.

Apgar score

appearance, pulse, grimace, activity, respiratory effort. Scored at 1 & 5 minutes after birth. Give 0-2 for each category. 0-3 requires resuscitation.

For breast engorgement:

apply cool compresses b/t feedings apply warm compresses take warm shower b4 breast feeding

infants who are large for gestational age

are at increased risk for hypoglycemia

Embryo

the developing human organism from about 2 weeks after fertilization through the second month

Demerol

action: Opiod agonist analgesics stimulate mu and kappa opiod receptors to decrease transmisson of pain impluses Indication: moderate-to-severe labor pain; postoperative pain after cesarean birth dosage and route Meperidine hydrochloride-25 mg intravenously; 50 to 100 mg intramusculary or subcutaneously; may repeat in 1 to 3 hours Hydromorphone hydrochloride- 1mg IV every 3 hours as needed; 1 to 2 mg IM, may repeat in 3 to 6 hours if needed, or 3 to 4 mg, may repeat in 4 to 6 hours if needed. adverse effects: Nausea and vomiting, sedation, confusion, drowisness, tachycardia or bradycardia, hypotension, dry mouth, pruritus, urinary, retention, respiratory, depression ( woman and newborn), decreased fetal heart Rate (FHR) variability, decreased uterine activity if given in early labor. Nursing Considerations: Assess maternal vital signs, degree of pain, FHR and pattern, and uterine activity before and after administion: observe for respiratory depression, notifiy primary health care provider is maternal respirations are 12 breaths/min or less; encourage voiding every 2 hours and palpate for bladder distention; administer with a phenothiazine or benzodiazepine, if ordered, to potentiate the analgesic effect, enhance sedation, and decrease nausea and vomiting; if birth occurs within 1 to 4 hours of dose, observe newborn for respiratory depression; have naloxone available as antidote; implement safety measures as appropriate, including use of side rails and assistance with ambulation; continue use of nonpharmacologic pain relief measures.

Aldomet

action: Postganglionic nerve endings: interfers with chemical neurotransmission to reduce peripheral vascular resistance, causes CNS sedation adverse effects: maternal sleepiness, postural hypotension constipation; rare; drug-induced fever in 1% of women and positive Coombs' Test result in 20% Fetal: after 4 month maternal therapy, positive Coombs' test result in infant. nursing and consideraditions: Assess for effects of medicarions, alert woman and family to expected effects of medications, assess blood pressure frequently because precipitae decrease can lead to shock and perhaps abruptio placentae; assess urinary output; maintain bed rest in a lateral position with side rails up; use with caution in presence of maternal tachycardia.

Indiocin (Indomethacin)

action: Prostaglandin synthetase inhibitor; relaxes uterine smooth muscle Dosage and route: loading 50 mg rectally or 50 to 100 mg orally; then 25 to 50 mg orally q6hr for 48 hours adverse reactions: maternal reactions include nausea and vomiting, dyspepsia, pyrosis, dizziness, oligohydramnios, and reduce platelet aggregation increasing risk for hemorrhage. Fetal reactions involve constriction of ductus arteriosus progressing to premature closure. Neonatal reactions include bronochopulmonary dysplasia, respiratory distress syndrome, intracrainal hemorrhage, necrotizing enterocolitis, and hyperbilirubinemia. nursing considerations: Used if gestional age is less than 32 weeks. Administer for 48 hours or less. Do not use for women with bleeding potential (coagulopathy), peptic ulcer disease, or oligohydramnios. Assess woman and fetus according to agency policy, being alert for adverse reactions. Determine amniotic fluid volume and function of ductus arteriosus before initiating therapy and within 48 hours of discontinuing therapy; assessment is critial if therapy continues for more than 48 hours. Administer with food or use rectal route to decrease GI distress. Monitor for signs of postpartum hemorrhage.

Rhogam

action: Suppression of immune response in nonsensitized women with Rh-negative blood who received Rh-positive blood cells because of fetomaternal hemorrhage, transfusion, or accident. Indications: Routine antepartum prevent at 26 to 28 weeks of gestation in women with Rh-negative blood; suppression of antibody formation after birth, miscarrage/pregnancy termination, abdominal trauma, ectopic pregnancy, amniocentesis, version, or chorionic villi sampling. Dosage/Route: Standard dose: 1 vial (300 mcg)IM in deltoid or gluteal muscle; microdose: 1 vial (50 mcg)IM in deltoid muscle; Rho(D) immune globulin (Rhophylac) can be given IM or IV (available in prefilled syringes) adverse effects: Myalgia, lethargy, localized tenderness and stiffness at injection site, mild and transient fever, malaise, headache, rarely nausea, vomiting, hypotension, tachycardia, and allergic response Nursing considerations: Give standard dose to mother at 28 weeks of gestation as prophylaxis or after an incident or exposure risk that occurs after 28 weeks of gestation (e.g. amniocentesis, second-trimester miscarriage or abortion, afterversion) and within 72 hours after birth if baby is Rh positive. Give microdose for first-trimester miscarrage or abortion, ectopic pregnancy, chronic villi sampling. Verify that the woman is Rh negative and has not been sensitized, and if postpartum, that Coombs' test is negative, and the baby is Rh positive. Provide explanation to the woman about the procedure, including the purpose, possible side effects, and effect on future pregnancies. Have the woman sign a consent form if required by agency. Verify correct dosage and confirm lot number and woman's identity before giving injection (verify with another registered nurse or by other procedure per agency policy); document administration per agency policy. Observe patient for at least 20 minutes after administration for allergic response, The medication is made from human plasma ( a consideration if woman is a Jehovah's Witness). The risk of transmitting infectious agents, including viruses, cannot be completely eliminated.

Methergine

action: contraction of uterus side effects: Hypertension, nausea, vomiting, headache contraindication: hypertension, cardiac disease Dosage and Route: 0.2 mg IM every 2 to 4 hours up to five doses; 0.2 mg IV only for emergency Nursing Considerations: Check blood pressure before giving and do not give if more than 140/90 mm Hg; continue monitoring vaginal bleeding and uterine tone.

Nubain

action: mixed agonist-antagonist analgesic; stimulates kappa and opioid receptor and blocks mu opioid receptor Indication labor pain, postoperative pain after cesarean birth dosage and Route 10mg intravenously; 10 to 20 mg intramusculary q3-6hr

Stadol

action: mixed agonist-antagonist analgesic; stimulates kappa opiod receptor and blocks mu opiod receptor Indication: labor pain; postoperative pain after cesarean birth Dosage and route: 1 mg intravenously q3-4hr; 2 mg intramusculary q3-4hr adverse effects: confusion sedation, sweating; transient sinusoidal-like fetal heart rhythm; less respiratory depression, nausea and vomiting Nursing consideration: see mepridine;may precipitate withdrawal symptoms in opioid-dependent women and their newborns

Preterm labor

after 20 weeks before 37 weeks, regular uterine contractions that cause cervical change. -Most common cause is dehydration. -Uterus requires food, fluids, and rest.

Amniotic fluid is in amniotic sac

allows free movement for baby, protects baby, protects umbilical cord, temperature control, supports lung and GI systems. -fluid is clear and sterile.

Doppler

amplifies sound too difficult to hear with acoustic stethoscopeuses ultrasonic waves to detect difficult to hear vascular sounds such as fetal hearbeat or vascular tones; apply gel first!

hypospadias

an abnormal condition in males in which the urethra opens on the under surface of the penis

phimosis

an abnormal tightness of the foreskin preventing retraction over the glans of penis

Breast changes in pregnancy

are due to estrogen-progesterone production. -The breasts may have a feeling of fullness, tingling or tenderness. - The breast size increases and the areola of the nipple darkens and the vascularity increases. -The secretions from the sebaceous glands (Montgomery tubercles) help keep the nipple supple and prevent cracking. -By the 16th week of pregnancy colostrum can be expelled from the nipples.

Grunting and nasal flaring

are signs of respiratory distress.

Milia

are small white bumps that occur on the nose due to clogged sebaceous glands.

Reflexes (Newborn Assessment)

arms, recoil

The umbilical cord contains two ______ and one _______.

arteries; vein

Coarctation of the Aorta

backing up into the L side of the heart. narrowing of the descending portion of the aorta resulting in a limited flow of blood to the lower part of the body

Mechanical methods to ripen cervix:

balloon caths hydroscopic dilators and sponges laminara tents synthetic dilators and sponges

What is Pathological Jaundice

before the 24th hour and after the 7th day [Born with this]

quickening

begins between weeks 16-22

late decel

begins late in contraction w/ onset at or after the peak of uterine contraction

Clindamycin

broad spectrum antibacterial that blocks protein synthesis; its most serious side effect involves pseudomembranous colitis due to C. difficile overgrowth, resulting in severe diarrhea (once this happens, take pt off this med and put on oral vanco or metronidazole), cleocin

Mother's blood and babies blood never comes in contact:

but it does sometimes in delivery, procedure, or trauma -there is a one layer membrane that protects from blood crossing over.

urinary frequency lessens

by the end of the first trimester

incompetent cervix

cervix is unable to hold the fetus in, usually occurs after week 20+ . Cerclage ring put on or cervix can be stitched shut

Magnesium sulfate works by relaxing smooth muscles (diaphragm and uterus)

check urine output every hour, deep tendon reflexes every hour, can have respiratory depression, watch respiratory rate and heart rate. -Mag sulfate reversal is calcium gluconate.

Skin issues

children get many bites, rashes, acne, and many can be treated with over the counter medications and avoid the irritant.

screening test must be repeated if

client left beofre 24 hr old

Talipes

clubfoot, normally in boys. Must be surgically corrected

Pt at risk for late deceleration

cocaine, high BP, postdates, smoking

Non lactating

cold compress, very snug bra, ice

cephalhematoma

collection of blood between periosteum and skull bone that it covers does not cross suture line results from trauma during birth

what are the 4 ways that a baby can lose heat?

conduction convection evaporation radiation

Body temperature loss

conduction (goes from baby to colder surface), convection (air movement causes heat to move away from baby), evaporation (heat rises into air from baby), radiation (body puts out heat secondary to metabolism, normal for all people).

epispadias

congenital defect in which the urinary meatus is located on the upper surface of the penis

Discontinue oxytocin if:

contraction frequency more often than every 2 mins contraction duration longer than 90 seconds no relaxation of uterus between contractions uterine resting tone greater than 20 mmHg between ctx

Insulin

control gestional prevent high birth weight, blindness

increased swelling antepartum

could be sign of preeclampsia

IUD

cramping with insertion

Acrocyanosis

cyanosis of the hands and feet in the first week of life is caused by combination of high hgb level and vasomotor instability, it's normal for infants to have this

Oligohydramnios

dec volume of amniotic fluid; related to renal dysfunction

What is indicated when the fontanele is sunken in?

dehydration

What is indicated when the fontanele is sunken?

dehydration

creases over soles and feet

develop at 39 weeks

dehyrdation

diarrhea and vomiting is the #1 reason for _______.

oxcytocin

discontinued if contractions last longer that 90 secs

priority step for amniocentesis

do ultrasound first to verify placement of placenta and fetus

effluerage

doesn't require any teaching for the client. just indicates soothing massage technique by the nurse

Perfusion to placenta

don't smoke, drink alcohol, drugs, no dieting, lying supine (lay on left side to increase blood perfusion) called supine hypertension.

depo shot

done every 12 weeks, increases calcium - causes lining to get thinner and thinner until no lining left to implant.

NAS -Neonatal Abstinence Syndrome

drug withdrawal that occurs in newborn infants whose mothers were frequent drug users during pregnancy

Sperm

during puberty boys begin to produce ____, because of hormonal changes.

protest

during the ____ stage of separation anxiety (unless seriously ill) the children feel abandoned and cry out , it is pitiful & continues until they fall asleep or their mom returns

Denial

during the ____ stage of separation anxiety the children act disinterested in parents visits, act like they've settled in but only an act to prevent further emotional pain

Dispair

during the ____ stage of separation anxiety the children look sad, don't look at you, lonely, refuse to eat & clutch to their favorite toy or blanket, don't move around much

nasal pharyngeal wash

dx of RSV is normally done by ___.

massaging fundus helps

early postpartum hemorrhage is caused by uterine atony

Pica

eating earth or clay or chalk, compulsive eating of nonnutritive substances such as clay or ice

amniocentesis

extraction by centesis of amniotic fluid from a pregnant woman to aid in the diagnosis of fetal abnormalities

20 pounds and 1 year old is approriate for

facing the car seat facing forward

For placenta previa/abruptio assess:

fetal heart tones, CBC, give IV and have blood standing by, give oxygen, apply fetal monitor, contact doctor.

when the mother is up; soothing to fetus

fetus falls asleep

12 weeks uterus height

final height of uterus should be right above pubic symphysis

telangectiatic nevi

flat pink or red marks that easily blanch and are found on the newborns back of the neck, nose, upper eye lids, and middle of the forehead

Marked variability

fluctuation range greater than 25 beats/minute, starting to get into trouble here

crackles and wheezing are signs of

fluid or infection in the lungs

Behavior of mom during Active Phase of labor

focused, in pain, introspective, staying together

*Hematopoiesis*

formation and development of red blood cells

continuous bleeding and firm fundus

found in client with cervical laceration

cloudy urine

frequent cloudy urine may indicate uti

Postpartum: if uterus is +2 umbilicus & deviated to right

full bladder

Third stage: Signs of placental separation from the uterus are indicated by:

fundus firmly contracting swift gush from introitus of dark blood umbilical cord appears to lengthen as placenta descends vaginal fullness of exam

celiac disease

genetic disorder characterized by an inability to absorb a component of gluten that causes an immune reaction that damages the lining of the small intestine

polyhrdramnios =

gi and neuro anomalies

fetuses respond to higher blood glucose levels

give cracker and juice to mother during NST

If breast lump is detected:

go to doctor.

Early Decelerations

head compression *safe* , Begin prior to peak of the contraction and end by the end of it. Caused by head compression. no need for intervention if variability is within normal range (6-10) and the FHR is within normal range.

Motrin

headache relief from spinal block

Preclampsia S/S

headache, dizziness, epigastric pain, visual changes, edema, rise in BP, protein in urine, increase in weight.

1st Trimester risk assessments

health history, physical assessment, lab tests, HIV test, urine test for albumin, glucose and bacteria, mantoux, genetic counseling, determine EDD, initial risk assessment

Steroids

help control inflammation and swelling in the body; pain and discomfort -S/E: adrenal suppression, elevated pressure in eyes, increased BP, mood swings, weight gain, fat deposits in abdomen and face. Long term-cataracts, high blood sugar, and increased risk for infections, thinning bones, and thin skin, bruise easily. Inhaled-oral thrush, hoarseness.

massaging the fundus

helps prevent risks of hypotonicity; also decreases blood loss

Magnesium Sulfate Risk to Mom

hemorrhage [makes the muscles relaxed]

Meningocele, Myelomeningocele

hernial protrusion of the meninges through abone defect in the cranium or vertebral column; may be repaired surgically

Valtrax/Zovirax/Acyclovair

herpatic drug to control out breaks

tingling in fingers indicates the client is

hyperventilating

postterm neonate

hypoglycemia, birth injury, meconium aspiration, TTN, dehydration

abdominal distention in a newborn

hypokalemia

Two complications that can occur following PP hemorrhage include:

hypovolemic shock anemia

polyhydrominos

increased level of amniotic fluid. -Very uncomfortable mom, lots of stretch marks, uterus may not be able to contract after birth. -2 Fetal conditions associated with this: kidney and GI trach (Kidney not filtering and baby inability to swallow

polyhydrominos

increased level of amniotic fluid. Very uncomfortable mom, lots of stretch marks, uterus may not be able to contract after birth. 2 Fetal conditions associated with this is kidney and GI trach (Kidney not filtering and baby inability to swallow

Subinvolution s&s

increased vag bleeding uterus enlarged and higher than normal in the abd relative to umbilicus boggy uterus prolonged lochia d/c with irregular or excessive bleeding

Identify contributing factors of postpartum depression.

maternal fatigue from the labor & birth, socioeconomic factors, maternal anxiety about assuming a new role, the rapid decline in maternal estrogen and progesterone levels w/ the expulsion of the placenta, & postpartum physical discomfort/pain.

Cold cabbage leaves

may also be applied to breasts to decrease swelling and relive discomfort

positive ferning test

may indicate PROM

prolonged decelerations

may result in fetal death; report immediately

Bleeding in pregnancy

miscarriage, placental abruption, placental Previa, infection, trauma, preterm labor, labor, intercourse.

APGAR or 4-6 indicates

moderate distress

Biophysical Profile

modified adds amniotic fluid index (want > 5), this assessment evaluates: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, qualitative amniotic fluid volume. each component is scored as 2 or 0. a "good" score is a 10, and am 8 is ok as long as amniotic fluid scores a 2.

Cord infection s&s:

moist and red foul odor purulent drainage

Post partum hemorrhage is considered to occur if the client loses how much blood?

more than 500 mL after vaginal birth more than 1000 mL after c/s

Normal Pregnancy discomforts

morning sickness, bleeding gums, swelling, fatigue, heartburn, constipation, back pain, discharge, headache, poor vision, nausea and vomiting, pedal edema, numbness and tingling

Management of Croup

nebulization, oxygen tent, corticosteroids, if necessary use antibiotics, monitoring, artificial airway in emergency. -Use cool night air, cool air from the refrigerator or freezer, or a steamy bathroom (from running a hot shower) to assist in rearing the child's breathing. With any respiratory compromise, *elevate HOB to ease breathing*.

Erythromycin Ophthalmic

ophthalmic antibiotic

Preterm premature rupture of membranes

pontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation

lateral recumbent

position to put mother after delivering baby

oxcytocin stimulated contraction test

positive and negative are two results; postive indicates and adverse reaction

A nurse is assessing a postpartum client who is exhibiting signs of tearfulness, insomnia, lack of appetite, and a feeling of letdown. The nurse knows these signs and symptoms are characteristics of

postpartum depression.

Gestational diabetes

pregnancy related, when not pregnant gestational reverses itself.

amniocentesis

preterm labor andmiscarriage are possible complications; feelings of tightness may indicate onset of uterine contractions

amenorrhea

primary [pregnancy, menopause], secondary [absence of period > 6 months; anorexia]

cerclage

procedure to reinforce weakened cervix

Progestrone

produced by the copus luteum, this hormoe is often called " the hormone of pregnancy" it is responsible for: maintenance of pregnancy, final maturation of the mammary gland, reduced excitability of smooth muscle fibers, negative feedback to the hypothalamus, shutdown FSH, placenta later takes on production

Dystocia

prolonged, difficult labor

clients with gonorrhea are at increased risk for

prom

Pre-Eclampsia Objective:

protein in urine 1+ or >, BP (look at baseline first), ↑30 mm/hg sys & 15mm/hg diastolic [kidneys shutting down, watch for urine output]

Pre-Eclampsia Subjective:

puffy edema, blurry vision, headache, bloody show, epigastric pain

*POSITION*

refers to the location of a fixed reference point on the fetal presenting part in relation to a specific quadrant of the maternal pelvis. The presenting part can be right anterior, left anterior, right posterior, and left posterior. These four quadrants designate whether the presenting part is directed toward the front, back, right, or left of the passageway.

Neonatal abstinence syndrome

remember low stimulation, low light, calm atmosphere

Circumcision

removal of the foreskin (prepuce), exposing the glans penis

36 weeks uterus height

should be 36cm (plus or minus 2) after 36 weeks baby starts to move down because head starts to engage

massaging fundus during hypotonicity

should be done in order to prevent further post partum hemorrhage

Third degree laceration extends through:

skin of perineum muscles of perineum anal sphincter

Fourth degree laceration extends through:

skin of perineum muscles of perineum anal sphincter anterior rectal wall

Milia

small raised white spots on nose, chin, and forehead

Lanugo (Newborn Assessment)

soft downy hair on the newborn's body, which is absent in preterm newborns, appears with maturity, and then disappears again with postmaturity

Second stage pain:

somatic occurs with fetal descent and expulsion

Probably signs of pregnancy

temp raised, positive urine (hcg present), cervical changes (goodell's and chadwicks signs), vulvar & vaginal changes, uterine changes, ballottement, enlargement of abdomen

First 24 hours for neonate needs

temp regulation, circulation, respiration, sources of nourishment, void and stool

Fetus

the developing human organism from 9 weeks after conception to birth

Ritodrine

used for cessation of uterine contractions serious side effects no longer marketed, side effects: severe preeclampsia or eclampsia active viginal bleeding, Intrauterine infection (chorioamnionitis), cardiac disease, Medical or obstetric condition that contraindicates continiation of pregnancy. Dilation greater than 6 cm Fetal: Estimated gestational age greater than 34 weeks fetal death, lethal fetal anomaly, acute fetal distress, Chronic intrauterine growth restriction. nursing considerations: Explain the purpose and side and effects of tocolytic therapy to woman and her family. Position woman on her side to enhance placental perfusion and reduce cervical pressure. Monitor maternal vital signs, including lung sounds and respiratory effort, fetal heart rate and pattern, and labor status according to hospital protocol and professional standard. Assess mother and fetus for signs of adverse reactions related to tocolytic being administered. Determine maternal fluid balance by measuring daily weight and intake and output. Limit fluid intake to 1500 to 2500 ml/day, especially if a B adrenergic agonist or magnesium sulfate is being administered. Provide psychosocial support and opportunities for women and family to express feelings and concers. Offer comfort measures as required. Encourage diversonal activities and relaxation techniques.

Pancreatic enzymes

what enzyme is lacking in a pt with Cystic Fibrosis ?

Aceadote, given via IV

what is the anecdote for an accidental od of Tylenol? And how is it administered.

PUC

what is the best method to collect a urine sample from an infant?

steam (from hot shower or bath)

what is the best tx for Croup

face scale

what is the most common pain scale used with children.

hand washing

what is the most important teaching for the parents of a pt with RSV is ____.

FLACC

what is the scale used to assess pain which incorporates the use of face, legs, activity, cry, consolability

Erikson

what theorist believes schoolage children are in industry vs inferiority.

Piaget

what theorist believes schoolage children are in the concrete operations stage?

epiglottitis

when a pt has ____ NEVER examine the pharynx.

Wilms Tumor

when a pt has __________ you must never palpate the abdomen.

IV pump

when running an IV on an infant, they should always be ran on an ____.

Nursing interventions to assist the father in bonding with the infant include providing education about infant care

when the father is present

Placenta previa

when the placenta partially or totally covers the cervix. Signs occure when the woman experiences painless bleeding in the 1st stage of labor. Do not do a SVE and call the doctor

Placenta previa

when the placenta partially or totally covers the cervix. Signs occurs when the woman experiences painless bleeding in the 1st stage of labor. Do not do a VE and call the doctor

internal electrode is contraindicated

with jet hydrotherapy

Breast care

women should do self exam monthly, 7-10 after cycle. Purpose to look for unusual lumps, doing frequently a women will recognize if something is different.

Hyperbilirubinemia

would be present as jaundice.

Monostat/Terazol

yeast infection control

Lochia alba

yellow white, starts on about day 10 and has earthy smell.

What is jaundice in newborns?

yellowing of skin, RBC changing from fetal to adult RBC, see it when breast feeding, traumatic injury at birth with breakdown of RBC

* HEMOPHILIA* Hemophilia A

• "Classic hemophilia" • Deficiency of factor VIII (8) • Accounts for 80% of cases of hemophilia • Occurrence: 1 in 5000 males • Bleeding tendencies range from mild to severe • Symptoms may not occur until 6 months of age • Mobility leads to injuries from falls and accidents • Hemarthrosis - evidenced by joint pain, stiffness, warmth, swelling, redness, deformities • Bleeding into joint spaces of knee, ankle, elbow leading to impaired mobility • Ecchymosis

*DROWNINGS* Near drowning's

• *Drowning is second leading cause of accidental death in children* • Death occurs from asphyxia while submerged • Can occur with even small quantity of water (even as small as a pail of water) • Near drowning: survived at least 24 hours after submersion • Admit of observation-complications 24 hours after such as respiratory or cerebral edema

*CROUP* Forms

• *Laryngitis*- MILD ..hoarse voice mild airway obstruction. • *(Spasmodic Laryngitis)* no symptom LTB • * Laryngotracheobronchitis (LTB)*- MODERATE - kids wake up middle of night with barking cough, cold type symptoms, breath steam, then go out to cool air (Steam is treatment NOT COOL MIST VAPORIZERS) • *Epiglottitis*- SEVERE - medical emergency- inflammation of epiglottis obstructed, DROOLING, WEAK, TRIPOD POSITION, APPEARS TOXIC. Bacterial in nature treatment with antibiotics

*TWINS*

• *Monozygotic (identical)*: develop from ONE fertilized oocyte that divides into equal halves during an early cleavage phase of development • *Dizygotic (fraternal)*: develop from TWO fertilized oocytes and may be the same or different genders.

*NEOPLASMS NEUROBLASTOMA (ORGAN)*

• *The Silent Tumor* Originates From Embryonic Neural Crest Cells • Prognosis poor because diagnosis is usually not made until tumor has metastasized. • Mass in Abdomen is common Treatment: • Surgery • Chemo • Radiation

*SICKLE CELL ANEMIA*

• A hereditary hemoglobinopathy • Ethnicity- Occurs primarily in African-Americans, Occurrence 1 in 375 infants born in United States, 1 in 12 have sickle cell trait

*SEIZURE TYPES*

• Absence seizure (previously referred to petit mal) • Tonic-clonic seizure (previously referred to as grand mal) • Myoclonic seizure (Variety of seizure episodes, Symmetric or asymmetric involvement) • Atonic or akinetic seizure (Muscle tone is lost for a few) seconds.

*NEOPLASMS LEUKEMIA (Blood)* Two Types

• Acute lymphoid leukemia (ALL) : lymphoblasts in the bone marrow • Acute myelogenous (AML) : myeloblasts in bone marrow

*SICKLE CELL ANEMIA* Medical Management

• Aggressive treatment of infection • Possible prophylactic antibiotics from 2 months to 5 years • Monitor reticulocyte count regularly to evaluate bone marrow function • Blood transfusion, if given early in crisis, may reduce ischemia • Frequent transfusion decreases hemosiderosis (iron in tissues) • Treat with iron chelation such as feroxamine + vitamin C to promote iron excretion • Rx—hydroxyurea (cytotoxic) decreases production of abnormal blood cells and decreases pain

*CROUP* Management

• Airway management • Maintain hydration, orally or intravenously • High humidity with cool mist • Nebulizer treatments - Epinephrine- Racemic Epi - Steroids

*TYPES OF HEMOPHILIA* Hemophilia B

• Also known as Christmas disease- named after Stephen Christmas the 1st patient described with this disease • Caused by deficiency of factor IX (9) • Accounts for 15% of cases of hemophilia

*PHARYNGITIS* Therapeutic management

• Antibiotics ( oral PCN) prevent ARF (acute rheumatic fever) • Should see response in 24 hours

*CYSTIC FIBROSIS* Description

• Autosomal recessive disorder; causes chronic multisystem disorder of exocrine gland dysfunction • Most common symptoms include pancreatic enzyme deficiency, progressive chronic lung disease, sweat gland dysfunction Inherits defective gene from both parents with an overall incidence of 1:4

*HEMOPHILIA* Nursing Considerations

• Avoid rectal temp and unnecessary skin punctures • Control localized bleeding-factor replacement, pressure • Monitor for occult blood in urine, stool and nasogastric fluid • *Factor replacement side effects- Headache, flushing, low Na+, changes in HR and BP*

Investigate if not child is not meeting milestones

• Babbling at 4 months • Roll front to back 5 months • Back to tummy at 6 months • Pick things up like food (handful) 4-6 months • Sitting by 8 months • Pick things up with Pincher 8-9 months • Object permanence by 9-10 months • Walk at 12 months

*NEOPLASMS LEUKEMIA (Blood)* Diagnosis

• Based on history and physical manifestations • Blood smear • Frequent low blood counts • Lumbar puncture • Bone marrow aspiration

*NEOPLASMS* Three types

• Blood • Lymph • Organ

Pregnancy *PROBABLE*

• Breast tenderness • N/V • Amenorrhea • Areola darkening • Fatigue • Urinary frequency • Quickening

*HEMOPHILIA* DIAGNOSIS

• Can be *diagnosed through amniocentesis* • Genetic testing of family members to identify carriers • Diagnosis on basis of hx, laboratory tests (labs), and examination • Labs: low levels of factor VIII or IX, prolonged PTT • Normal: platelet count, prothrombin time (PT), and fibrinogen

*THE FETAL PERIOD* *Weeks 26 to 29*

• Capable of surviving if born at this time • Lungs capable of breathing air • CNS can regulate Temp and Breathing • Eyelids are open • Toenails are evident • Brown fat present • Erythropoiesis (red blood cell creation in spleen but ends at 28 wks when Bone Marrow takes over the job

Other Skin Issues:

• Chicken pox would be deferred unless emergent with diagnosis being done preliminarily over the phone to prevent spread. - **Hallmark chicken pox- spots are the size of a pencil eraser (roughly) and pink, become vesicular, and crust over with scabs as they heal. • Measles are characterized by Koplik's spots in the oral cavity (hallmark signs)

*SPINA BIFIDA* Assessment

• Depends on degree of spinal cord involvement • Flaccid Paralysis of Legs • Altered Bladder Function • Altered Bowel Function • Hip Joint Deficit

*Types of Sickle cell Crisis* Aplastic crises

• Diminished production and increased destruction of RBCs • Triggered by viral infection or depletion of folic acid • Signs include profound anemia, pallor

*DROWNINGS* Therapeutic Management

• Emergency resuscitative efforts at the scene • Management is based on degree of cerebral insult • Aspiration is frequent complication • Prognosis • Care depends on condition of the child • Helping parents cope with feelings of guilt • Parental anxiety related to prognosis • Prevention of drowning

THREE GERM LAYERS *ECTODERM*

• Epidermis, epithelium of mouth, oral glands, teeth, and organs of special sense • Central Nervous System • Peripheral Nervous System • Hypophysis (pituitary) • Supranenal Medulla

Physiological changes in pregnancy *HORMONES*

• Estrogen - ovary and then placenta • Progesterone - ovary and then placenta • Follicle stimulating hormone (FSH) - pituitary • Luteinizing (LH) - anterior pituitary • Prostaglandin - helps ripen cervix to prepare for birth • Prolactin - anterior pituitary, makes milk • Pitocin - posterior pituitary, moves milk

*OTITIS MEDIA* management

• Etiology and pathophysiology • Common in 1st 2yrs of life 7 when enter school. Less common after 7 yrs. of age • OM, AOM • Diagnostics • Therapeutic management • Pharmacologic • Surgical • Nursing care management • Prevention of recurrence • PE tubes are tiny holes cut into the ear drum to help it drain. • REVIEW PT/PARENT EDUCATION ON PREVENTION OF OTITIS MEDIA AND PE TUBES.

*CAST CARE*

• Examine cast for pressure areas • Monitor extremity for circulatory impairment; if present, contact physician • Instruct family, child not to stick objects down into cast

Pregnancy *POSITIVE*

• FHT's • Fetal movement by provider • Visualization of fetus

*GROWTH HORMONE DEFICIENCY*

• Fall off growth curve around 1yr • Look proportional • X-ray of hand or wrist (Bone Age) • Growth Hormone injections at night / bedtime (when we grow) Epiphyseal growth plate closes. No need for treatment after 18

*MEDICATIONS AND DRUGS THAT ARE BAD FOR PREGNANCY*

• Fat-Soluble Vitamins (too high/low) • Alcohol • Tobacco • Caffeine • Cocaine & Crack • Opiates • Sedatives • Amphetamines • Marijuana • Radiation • Lead

*THE FETAL PERIOD* *Weeks 21 to 25*

• Fetus gains weight • Skin appears pink or red • REM begins at 21 wks • Fingernails • Lungs secrete *surfactant* decrease surface tension in alveoli

*ICP* Nursing Care in Child

• Frequent repositioning • Avoid Activities that Increase ICP • Eliminate / limit environmental noise • Suctioning -*Contraindicated causes Hypoxia + Cough = ↑ICP*

*IRON DEFICIENCY ANEMIA* Iron supplements

• Give between meals for max. absorption • *GIVE with a multivitamin or fruit juice* because Vit C increase absorption • DON'T give with milk or antacids because these decrease absorption • Side effects of iron supplements- black stools, constipation and foul aftertaste, liquid iron stains the teeth- give through a straw, brush after administration

*NEOPLASMS LEUKEMIA (Blood)* Definition

• Group of malignancies that affect bone marrow and lymph system • Overproduction of WBC (cellular destruction of RBC) • Bone marrow dysfunction leads to anemia and neutropenia • Increased production of immature WBC • Affects: spleen, liver, lymph glands

*THE FETAL PERIOD* *Weeks 9 to 12*

• Head rounded with human characteristics. Unable to determine sex. Intestines still present in umbilical cord. Ovaries and testes distinguishable. • Resembles human being, with disproportionately large head. Eyes fused. Skin pink and delicate. Upper limbs almost reached final length. Intestines in the stomach. Sex distinguishable externally.

*ICP* *CHILDREN* signs and symptoms

• Headache • Vomiting (usually projectile) • Seizures • Diplopia (Dbl vision), blurred vision

*IMPETIGO* Description

• Highly contagious bacterial infection of skin • Caused by beta-hemolytic streptococci, staphylococci, or both

*DROWNINGS* Pathophysiology

• Hypoxia • Aspiration • Hypothermia- may make resumption of cardiac function possible if body temp is less than 86 degrees

*ICP* Nutrition

• IV admin of fluids- parenteral nutrition • Caution w/over hydration • Later: gastric feedings w/NG Tube or GI Tube • Pt may have risk of Aspiration

*HEMOPHILIA* Definition

• Impaired ability to control bleeding, bleeding time is extended due to lack of clotting factors • Bleeding can be internal or external & can have different levels of severity depending on the % of clotting factor a child's body contains

Manage symptoms of CF

• Important that parents know how to manage the disease at home; teach about disease, proper techniques of portable suctioning at home, respiratory therapy prior to meals, teach family how to administer meds. • Needs well-balanced, high protein, high caloric food diet, don't strain with BM • Pancreatic enzymes with meals must be taken, daily vitamin supplements (optimizing nutrition), • Chest physiotherapy (percussion and vibrations) loosen and drain • Manage airway use nebulizers and inhalers.

*CARDIAC MEDS-EDUCATION AND CONCERNS* *Digoxin (Lanoxin)*

• Improves myocardial contractility Infants do not receive more than 1 ml of Digoxin Nursing Actions: • Monitor the pulse and withhold the medication if: • *INFANTS* pulse is less than *90/min* • *CHILDREN* less than *70/min*. • Give with H2O to prevent tooth decay • Infants *do not* receive *more than 1 ml* of Digoxin Monitor for toxicity as evidenced by bradycardia, dysrhythmias, nausea, vomiting, or anorexia.

concept of death

• Infant; undefined due to level of cognition. • Toddlers; unable to distinguish fact from fantasy inhibits true perception of death (death may mean separation from parents; respond with fear and sadness). • Preschoolers: can understand that something is wrong. Fear of death as early as 3 years. Magical thinkers; don't say death is like going to sleep (fear of sleeping). • School-age child: realistic understanding of death but is not precise until they understand the concept of time (ages 8-9). • Adolescents: can understand death, but difficulty in accepting it as reality. Thinks death can be defied. Emotional ability to face death is absent.

*RHEUMATIC FEVER*

• Inflammatory autoimmune disease occurs after *Group A β-hemolytic streptococcal pharyngitis* *(Strep Throat)* • Infrequently seen in United States; big problem in Third World • Affects joints, skin, brain, serous surfaces, and heart • Manifests 2-6 weeks after untreated or partially treated strep • Rheumatic Heart Disease is a result from Rheumatic fever affecting *MITRAL VALVE*

*LECITHIN-to-SPHINGOMYELIN* (L/S ratio)

• Lecithin and sphingomyelin are the protein components of surfactant, the lung enzyme that is formed by the alveoli beginning around the 22nd week of gestation. • After amniocentesis, the lecithin/sphingomyelin ratio • (L/S ratio) may be quickly determined by a "shake test" or sent to the laboratory for a quantified analysis. • An L/S ratio of *2:1*, which typically occurs by 35 weeks gestation, is traditionally accepted as lung maturity • (a ratio of 3:1 in the infant of a diabetic mother).

*Types of Sickle cell Crisis* Splenic Sequestration

• Life threatening—death can occur within hours • Blood pools in the spleen • Signs • Profound anemia, hypovolemia , and shock

*THE FETAL PERIOD* *Weeks 17 to 20*

• Maternal awareness of fetal movements (*Quickening*) • *Vernix Caseosa*(cheese like covering) • Hair appears on eyebrows and head • *Lanugo*(fine hair) covers body • *Brown fat*(subcutaneous deposits) • Fetal Uterus formed or Testes begin to descend in abdominal wall • Weighs about 300 gm or .66 lbs

*PRURITUS GRAVIDARUM*

• Stasis of bile in the liver (intrahepatic cholestasis) occasionally occurs late in pregnancy and can cause severe itching (pruritus gravidarum). • This condition disappears soon after birth. Patients should be advised that avoiding high-fat meals can reduce the presence or frequency of these symptoms.

*IDIOPATHIC SCOLIOSIS*

• Mild scoliosis- 10-20 degree curvature- bracing and exercise (bracing slows the progression of the curvature to allow skeletal growth and maturity. They are not curative- wear brace 16-23 hours a day. No lotions or powders • Curvature greater than 40 degrees needs surgery. Internal fixation system to straighten and realign the spine along with a bony fusion to stabilize the correction. Elicits proper alignment

*SICKLE CELL ANEMIA* Nursing Management

• Monitor child's growth—watch for failure to thrive • Careful multisystem assessment • Assess pain • Observe for presence of inflammation or possible infection • Carefully monitor for signs of shock • Usually need to increase fluid

*Types of Sickle cell Crisis* Vaso-occlusive [VOC] thrombotic

• Most common type of crisis—very painful • Stasis of blood with clumping of cells in microcirculation → ischemia → infarction • Signs: fever, pain, tissue engorgement

*SICKLE CELL ANEMIA* Prognosis

• No cure (except possibly bone marrow transplants) • Supportive care/prevent sickling episodes • Frequent bacterial infections may occur because of immunocompromised • Bacterial infection is leading cause of death in young children with sickle cell disease • Strokes in 5% to 10% of children with disease

*BIO PHYSICAL PROFILE (BPP)*

• Nonstress test • Fetal breathing movements (one or more episodes of rhythmic fetal breathing movements for 30 seconds) • Fetal movement (three or more discrete body or limb movements) • Fetal tone (one or more episodes of extension of a fetal extremity with return to flexion, or opening or closing of a hand) • Determination of the amniotic fluid volume (a single vertical pocket of amniotic fluid exceeding 0.8 inch (2 cm) is considered evidence of adequate amniotic fluid)

*SEIZURE TYPES* Infantile Spasms

• Onset in first 6 to 8 months of life • *Usually associated with some degree of cognitive impairment* • Cause: possibly caused by disturbance of central neurotransmitter regulator at specific phase of brain development

*SICKLE CELL ANEMIA* Pathology

• Partial or complete replacement of normal Hgb with abnormal Hgb S • Hgb in the RBCs takes on an elongated "sickle" shape • Increased RBC destruction *** • Sickled cells are rigid and obstruct capillary blood flow • Microscopic obstructions lead to engorgement and tissue ischemia • Hypoxia occurs and causes sickling • Differences between effects of normal (A) and sickled (B) red blood cells on circulation with related complications

*TET SPELLS* Treatment

• Place infant in a* knee chest position (assists breathing and increases oxygen to body tissues (shunts the blood flow back up)* • Administer 100% oxygen and fluids - for volume expansion and keeps Hct & blood viscosity in acceptable limits. • Administer morphine (helps reduce the infundibular spasm- the spasm that occurs in Tetralogy of Fallot where pulmonary blood flow is decreased and right-left shunting increases.)

Theories concerning the onset of labor: *FETAL FACTORS*

• Placental aging- and deterioration triggers the initiation of contractions. • Fetal cortisol concentration - increases. This results in a decrease in the production of placental progesterone and an increase in the release of prostaglandins. • Fetal membranes - produce prostaglandins, which aid in the stimulation of uterine contractions.

*PEDIATRIC INDICATORS of CARDIAC DYSFUNCTION*

• Poor Feeding • Tachypnea/Tachycardia • Failure to Thrive / Poor Wt. Gain / Activity Intolerance • Developmental Delays • Prenatal History: Alcohol, Diabetes Mellitus, Substance Abuse • Family History

*SICKLE CELL ANEMIA* Crisis

• Precipitating factors o Anything that increases body's need for oxygen or alters transport of oxygen o Trauma o Infection, fever o Physical and emotional stress o Increased blood viscosity caused by dehydration o Hypoxia

*PROLACTIN*

• Prolactin, also produced by the *ANTERIOR* pituitary gland, is responsible for initial lactation. • Although this hormone increases 10-fold during pregnancy, the elevated levels of estrogen and progesterone inhibit lactation by interfering with prolactin-binding to the breast tissue. • Prolactin may also play a role in fluid and electrolyte shifts across the fetal membranes

*PROSTAGLANDINS*

• Prostaglandins are lipid substances found in high concentrations in the female reproductive tract and in the uterine decidua during pregnancy. • A decrease in prostaglandin levels may contribute to hypertension and preeclampsia. • At term, an increased release of prostaglandins from the cervix as it softens and dilates may contribute to the onset of labor.

*SPINA BIFIDA* Interventions

• Protect the sac (cover w/ sterile moist non adherent dressing; change every 2-4 hrs) • Prone (on stomach) Position • Aseptic technique

*ASTHMA* Diagnostics

• Pulmonary function tests-most accurate • Skin testing for allergens

*ATOPIC DERMATITIS Assessment

• Redness • Pruritus • Minute Papules • Vesicles • Weeping • Oozing • Crusting Of Lesions

*CARDIAC CATHETERIZATION* Discharge

• Remove the dressing day after procedure and cover with Band-Aid for 2-3 days • Keep the site clean and dry ( avoid tub baths for 2-3 days) • Observe for Redness, Edema, Drainage, Bleeding, Fever • Avoid Strenuous Activity • Child may return to school if appropriate • Administer Motrin or Tylenol for discomfort • Keep Follow up Appt.

*ASPIRATION PNEUMONIA*

• Risk for child with feeding difficulties • Prevention of aspiration • Feeding techniques, positioning Avoid aspiration risks • Hydrocarbons, lipids • Solvents • Talcum powder

The Glasgow coma scale allows the practitioners to use a numerical system to evaluate in a standardized way, the brain/neurological function. *Score of 1-15*

• Score of 9-15 (unaltered state of consciousness) • Score of 8-4 (state of coma) • Score of 3 or below (deep coma) Glasgow Coma Scale assesses: 1. Eye opening- pupil dilation 2. Verbal Response- answer questions 3. Motor Response- move when asked

THREE GERM LAYERS *MESODERM*

• Smooth muscle coats, connective tissues, and vessels associated with tissues and organs • Blood • Bone marrow • Muscular Tissues • Skeletal Tissues • Suprarenal Cortex

*SEIZURE TYPES* Atonic Seizures

• Sudden momentary loss of muscle tone • Onset usually ages 2 to 5 • May or may not have loss of consciousness • Sudden fall to ground, often on face • *Less severe: head droops forward several times* • Helmet worn if frequent occurrence

*TET SPELLS* Definition

• Tet or blue spells occur in some heart defects- Tetralogy of Fallot and other defects where there is obstruction to pulmonary blood flow and communication between the ventricles.

Congenital defects

• Tetralogy of fallot [become cyanotic when crying (right to left sided) because of overworking the heart], tricuspid atresia, CHF, & other mixed defects -Signs/symptoms: cyanotic (knees to chest); difficulty, turn blue when active: crying, eating or acyanotic (left to right; stress on lungs- pulmonary HTN edema, and other respiratory illnesses) children learn to adapt to limitations **Order of cares for cardiac defects: Airway, Fluid intake, Rest

*THE FETAL PERIOD*

• The beginning of the *NINTH* week marks the beginning of the fetal period when the embryo has now developed into a recognizable human being. • The fetal period is characterized by rapid body growth and differentiation of tissues, organs, and systems.

*PICA*

• The consumption of non-nutritive substances or food. Substances that are most often ingested include clay, dirt, cornstarch, and ice. .

*SEIZURE TYPES* Febrile Seizures

• Transient disorder of childhood • Affect approximately 3% to 8% of children • *Usually occur between ages 6 months and 3 years* • Rare after age 5 • Twice as frequent in males

Chromosome anomalies and risks?

• Trisomy • Deletion • Translocation

*ATOPIC DERMATITIS* Treatment

• Use EMOLIENT CREAM • Not LOTION • After shower and bath

Management of Asthma

• Use nebulized medication, corticosteroids, antibiotics where needed, bronchodilators. • Daily air flow meters to track airway function. -Implement green-yellow-red system and teach interventions at each level. • Increasing humidity in the environment will ease a compromised airway for the child with a reactive airway, whether viral, allergen, or bacterial trigger. **Signs of hypoxia include confusion, tripod position, and stridor.

Theories concerning the onset of labor: *MATERNAL FACTORS*

• Uterine muscle stretching- which causes a release of prostaglandins. • Pressure on the cervix- which stimulates the release of oxytocin by the maternal posterior pituitary gland. • Oxytocin stimulation - increases significantly during labor and works together with prostaglandins to activate uterine contractions. • Increase in the ratio of estrogen to progesterone: As term approaches, biochemical changes cause a decreased availability of progesterone (relaxes smooth muscle) to the uterine myometrial cells. With rising estrogen levels, the uterus becomes more excited and contractions begin.

DANGER SIGNS TO REPORT *SECOND TRIMESTER*

• Vaginal Bleeding • Burning or Painful Urination • Fever, Increased Pulse Rat • Decreased or Absent Fetal Movements • Unrelenting Nausea or Vomiting • Abdominal Pain or Cramping • Swelling Of Face or Fingers, Headaches, Visual Disturbances or Epigastric Pain.

*BURNS* Patho

• Very young child who has been burned severely has higher mortality rate than older child or adult with comparable burns • Lower burn temperatures and shorter exposure to heat can cause more severe burn in child versus adult • *Severely burned child at increased risk for fluid and heat loss, dehydration, metabolic acidosis versus adult* • Burns involving more than 10% of total body surface area require some form of fluid resuscitation • Scarring more severe in children

DANGER SIGNS TO REPORT *THIRD TRIMESTER*

• Visual Disturbances • Headache • Hand And Facial Edema • Fever • Vaginal Bleeding • Abdominal Pain; Uterine Contractions • Premature Rupture of Membranes

*DUCHENNE MUSCULAR DYSTROPHY*

• Waddling Gait, • Frequent Falls, • *GOWER SIGN*- Pushing Self to An Upright Positing By "Walking" Hands Up The Legs. • Lordosis (High Archy Back), • Enlarged Muscles, Especially Thighs and Upper Arms. • Profound Muscular Atrophy In Later Stages And Mental Deficiency Common

*TYPES OF HEMOPHILIA* Etiology of Hemophilia A

• 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 • Up to one third of cases have no known family history

*CARDIAC MEDS-EDUCATION AND CONCERNS* *Furosemide (Lasix) or chlorothiazide (Diuril)*

•*Potassium-wasting diuretics* rid the body of excess fluid and sodium. Nursing Considerations: • Monitor I&O • Monitor for signs of *HYPO*kalemia. • Monitor weight daily.