PEDS MATERNITY EXIT HESI
A middle-aged couple comes to the family planning center to discuss methods of contraception and asks about sterilization. As a means of determining whether this method of sterilization is appropriate, which question should the nurse ask the couple?
"Do you plan to have any other children?" Sterilization is a method of contraception for couples who have completed their families. It should always be considered a permanent end to fertility, because reversal surgery is difficult and expensive and may not be covered by insurance. Additionally, reversal surgery is not always successful, and it increases the risk of ectopic pregnancy. Therefore the nurse would ask the couple about plans for having children in the future to help determine the correct method of contraception. The assessment questions noted in the other options may be appropriate to ask a client who may be undergoing surgery, but they are not specifically related to sterilization. TEST-TAKING STRATEGY: Note the strategic word "sterilization" in the question to direct you to the correct option. Review: the effects of sterilization.
Marilyn Formosa, 27 years old, schedules an appointment at the family planning clinic. Marilyn tells the nurse that she will be getting married in 1 month, that she is seeking a convenient form of contraception, and that she would like to take the pill. She tells the nurse that her relationship with her fiancé has been mutually monogamous since she started seeing him, 8 years ago. Marilyn says that she and her fiancé plan to have children at some point. The nurse obtains information about Marilyn's health history. What is the most important question for the nurse to ask Marilyn to elicit data related to the contraindications to oral contraceptives?
"Have you ever had thrombophlebitis?" Oral contraceptives are contraindicated in women with or with a history of thrombophlebitis, thromboembolitic disorders, stroke, or coronary artery disease and in women with other risk factors for thrombosis. They are also contraindicated during pregnancy and in women with known or suspected breast carcinoma, known or suspected estrogen-dependent neoplasm, benign or malignant liver tumor, or undiagnosed genital bleeding. Dieting and a family history of kidney disease are not contraindications to the use of oral contraceptives. Oral contraceptives may improve acne. TEST-TAKING STRATEGY: Knowledge regarding the contraindications associated with the use of oral contraceptives is needed to answer this question. Use the ABCs (airway, breathing, and circulation). Thrombophlebitis involves the circulation. Remember that thrombophlebitis and thromboembolitic disorders are contraindications to the use of oral contraceptives. Review: the contraindications to oral contraceptives.
Which statements by Joanna reflect a need for further information?
"He's too young to get cavities." "I will apply sunscreen if we are outside for more than an hour." Cavities can occur in teeth of a person of any age, and parents of toddlers should be taught how to care for a toddler's teeth, and be provided with information about foods that are highly likely to cause cavities. Toddlers are at a very high risk for poisoning, and a major cause is improper storage of harmful items. Therefore, locking cleaning supplies and other toxic items is essential, along with constant vigilance in supervising the toddler. Toddlers can chew, but may have problems with large pieces of food. Food should be cut into small pieces; round pieces may be easily aspirated and are choking hazards. It takes practice for a toddler to learn how to chew gum, but not to swallow it. Sunscreen should be applied before any exposure to sunlight. Parents should always use a care safety seat, even if the trip is short. TEST-TAKING STRATEGY: Note the strategic words "further need for information." Focus on the subject, safety guidelines for toddlers. Choose those options that do not reflect safety for this age group. Review: safety guidelines for toddlers.
A nurse provides information to a female client about the use of a diaphragm. Which statement by the client indicates a need for further information?
"I have to insert the diaphragm immediately before intercourse." RATIONALE: When in place over the cervical os, the diaphragm blocks access of sperm to the cervix. Because the device does not fit tightly enough to completely block penetration of sperm, however, it must be filled with spermicidal jelly or cream before insertion. (Spermicide must be reapplied with repeated intercourse.) It may be inserted as long as 6 hours before intercourse. The diaphragm must remain in place for at least 6 hours after intercourse, but, because of the risk of toxic shock syndrome, it should not be left in place for more than 24 hours. TEST-TAKING STRATEGY: Note the strategic words "need for further information" in the query of the question. These words indicate a negative event query and the need to select the incorrect client statement. Recall that one advantage of the diaphragm is that it may be inserted as long as 6 hours before use. This will direct you to the correct option. Review: client teaching regarding the use of a diaphragm.
A nurse provides instructions to a breastfeeding mother about measures that will provide relief from breast engorgement. Which statement by the mother indicates an understanding of the instructions?
"I should switch to formula to feed my baby for 1 week." "I need to stop breastfeeding until the engorgement resolves." CORRECT: "I should apply warm packs to my breasts before each feeding." "I need to apply ice packs to my breasts 20 minutes before a feeding." RATIONALE: When breast engorgement occurs, the breasts become edematous, hard, and tender, making feeding and even movement painful. The nurse should encourage the woman to begin breastfeeding early after delivery and to feed frequently as a means of preventing engorgement. The nurse would also teach the woman about the application of cold and heat, massage, and breastfeeding techniques. Cold is used after feeding to reduce edema and pain. Heat is applied just before feedings to increase vasodilation and milk flow. Massage of the breasts causes release of oxytocin and increases the speed of milk release. This decreases the length of time that the infant nurses on painful breasts. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike indicating changes in the breastfeeding schedule or cessation of breastfeeding. To select from the remaining options, recall the effects of heat and cold, which will direct you to the correct option.
During the 30-week follow-up visit, the nurse assesses Janice and asks, "How are you feeling these days?" Which of these statements from Janice would indicate that further assessment is needed? Select all that apply.
"I spend so much time going to the bathroom!" "I haven't been sleeping well for several days." "I've noticed that I get out of breath after I vacuum the floors." CORRECT: "Since yesterday I've noticed that the baby isn't moving as much. CORRECT: "I've noticed that my fingers and face have been swollen when I wake up in the morning." "RATIONALE: During the second and third trimesters of pregnancy, certain signs and symptoms may indicate complications. Any change in the pattern or frequency of fetal movements should be investigated immediately to detect or rule out fetal jeopardy. Swelling of the face or fingers may indicate a hypertensive condition or preeclampsia. Discomforts that are expected during this trimester of pregnancy include insomnia, frequent urination (caused by impingement of the enlarging uterus on the bladder, resulting in reduced bladder capacity), and shortness of breath (resulting from limitation of diaphragm movement by the enlarging uterus). TEST-TAKING STRATEGY: Note the strategic words "further assessment is needed" in the question. While reviewing Janice's statements, look for those that indicate endangerment of either the mother or the fetus. It is also important to recall the expected discomforts of pregnancy.
The lactation consultant nurse visits Annie to discuss breastfeeding and to observe as Annie breastfeeds her baby. The nurse discusses mastitis, its signs and symptoms, how to prevent it, and what to do if it occurs. Which statements by Annie reflect understanding of the information that is being presented? Select all that apply.
"It won't hurt to miss a few feedings if I'm too tired." CORRECT: "I'll wash my nipples carefully before and after feedings." "I should expect to have sore, cracked nipples when starting to breastfeed." "If I get mastitis, I'll have to stop breastfeeding from that side until it is healed." CORRECT: "If my nipples are sore, I should apply warm water compresses before breastfeeding." CORRECT: "If I get mastitis, I can continue to breastfeed and will make sure to empty the breast every 2 to 4 hours." RATIONALE: Mastitis, a breast infection, may affect one or both breasts. It may be prevented with the use of proper technique and positioning for breastfeeding, preventing the development of cracked nipples, and emptying the breasts at regular intervals by means of breastfeeding, manual expression, or breast pumping. Cleanliness is also important. If mastitis occurs, breastfeeding is still recommended, because it is important to empty the breasts. Missed feedings can contribute to mastitis. The nipples may be sore (but not cracked) at the beginning of breastfeeding, and warm water compresses may be comforting before breastfeeding. TEST-TAKING STRATEGY: Focus on the subject, prevention and treatment of mastitis. Recalling the importance of cleanliness and the importance of continuing breastfeeding even if mastitis is present will direct you to the correct options.
THE PROCESS OF LABOR Assessment
"Lightening" or "dropping": Fetus descends into the pelvis about 2 weeks before delivery in a primipara; the fetus may engage into the pelvis after labor commences in a multipara. Braxton Hicks contractions increase in intensity. Vaginal mucosa becomes congested, and secretion of vaginal mucus increases. Brownish or blood-tinged cervical mucus (a.k.a. "show") is passed. The cervix ripens, becoming soft and partly effaced, and may begin to dilate. The client may experience a sudden burst of energy. Water loss of 1 to 3 lb (0.5 to 1.4 kg) results from fluid shifts produced by the changes in progesterone and estrogen levels. Spontaneous rupture of membranes occurs.
The primary health care provider performs a physical examination and gives Marilyn a prescription for an oral contraceptive. The nurse then provides information to Marilyn about how to take the medication. Which statement by Marilyn indicates a need for further information?
"Once I start taking the pill, I don't need to worry about getting pregnant." RATIONALE: Because maintaining a constant hormone level is important for effectiveness, the woman using oral contraceptive must take a pill at the same time each day. Unless a woman begins the pills during the first 7 days of the menstrual cycle, she should use another contraceptive method during the first week of the first cycle until blood hormone levels are established. If the woman misses a pill, she should take it as soon she remembers. If the woman misses a period and thinks that she might be pregnant, she should stop taking the pill and have a pregnancy test immediately. TEST-TAKING STRATEGY: Note the strategic words "need for further information" in the question. These words indicate a negative event query and the need to select the incorrect client statement. Recalling that blood hormone levels must be established for an oral contraceptive to be effect will direct you to the correct option. Review: client instructions regarding the administration of oral contraceptives.
The nurse is assessing Mrs. Valenti's nutritional status. Which statements by Mrs. Valenti indicate a risk for malnutrition? Select all that apply.
"Sometimes I have to make myself eat." "Food just doesn't taste the same as it used to." "Sometimes I have trouble swallowing my food." Several factors including dysphagia, decreased enjoyment of food because of a diminished sense of taste, and a lower motivation to eat may increase the risk of malnutrition in an older adult. Many older adults require dentures to eat, but this is only a problem if they are ill fitting. A stable weight and consumption of several servings of fruits and vegetables every day are signs/symptoms of good nutrition. TEST-TAKING STRATEGY: Focus on the subject, risk factors for malnutrition, and choose the options that might indicate interference with a person's intake of food. Difficulty swallowing food, diminished sense of taste, and decreased motivation to eat would all affect one's nutritional status. Review: risk factors for malnutrition in the older adult.
why does an older adult have Seborrheic dermatitis and keratosis formation?
"because the immune system, which prevents fungal growth from overpopulating the scalp, is in decline that sebum and Malassezia trigger an immune reaction and inflammation, causing the scalp to shed white flakes
how can you remember Lawrence Kohlberg stage of development?
"give me moral kohlberg please"
what is Kyphosis?
(hunchback) An excessive curvature in the thoracic portion of the vertebral column.
why does an older adult have Decreased perspiration?
*Decrease in size, number and function of both eccrine and apocrine glands*This decrease results in the older adult's ability to regulate body temperature through perspiration and evaporation from the skin*As the ability to sweat decreases, the older adult may be unable to control body temperature by the normal sweating mechanism, and therefore is at high risk for heat exhaustion*Sebaceous glands increase in size with age, but the amount of sebum produced is decreased*Men experience a minimal decrease in sebum production, typically after 80 years of age, while women begin to produce less sebum following menopause
why does an older adult have Thinning of the epidermis and easy bruising and tearing of the skin?
*The capillaries become thinner and more easily damaged, leading to bruised and discolored areas known as senile purpura *There is a gradual decline in both touch and pressure sensations, causing the older adult to be at risk for injury such as burns and pressure sores Subcutaneous tissue becomes thinner in the: face, neck, hands, and lower legs, resulting in more visible veins in the exposed areas, and skin that is more prone to damage
when does the weight double in an infant?
5 to 6 months
normal apical rate for an adolescent?
55 to 90 beats per minute
what is the average height and weight at age 12?
59 inches (30.5 cm to 150 cm) and 88 lb (40 kg)
Lower central incisors erupt after how many months?
6 to 8 months
school aged child apical rate?
60 to 100 beats per minute
normal apical rate for preschoolers?
70 to 110 beats per minute
what is the normal blood pressure in an infant?
73/55
what is the normal apical pulse rate of a toddler?
80 to 120 beats per minute
what is the normal apical rate in a 1-year-old?
90 to 130 beats per minute
averages 90/56 mm Hg
96.8° F to 99° F (36° C to 37.2° C)
normal axillary temperature for preschoolers?
97.5° F to 98.6° F; 36.4° C to 37° C
normal oral temperature for preschoolers?
97.5° F to 98.6° F; 36.4° C to 37° C
normal temperature for an adolescent?
97.5° F to 98.6° F; 36.4° C to 37° C
school aged child oral temperature?
97.5° F to 98.6° F; 36.4° C to 37° C
what is the normal axillary temperature of a toddler?
97.5° F to 98.6° F; 36.4° C to 37° C
what is a normal axillary temperature in newborns?
97.7° F to 99.5° F (36.5° C to 37.5° C)
DIAGNOSTIC TESTS Nitrazine Test Description
A Nitrazine test strip is used to detect the presence of amniotic fluid in vaginal secretions, which have a pH of 4.5 to 5.5 and do not affect the yellow Nitrazine strip or swab. Amniotic fluid has a pH of 7.0 to 7.5 and turns the yellow Nitrazine strip blue.
what helps prepare the toddler for sleep?
A consistent bedtime ritual helps prepare the toddler for sleep.
PHYSIOLOGICAL MATERNAL CHANGES Integumentary System
A dark streak, or linea nigra, may appear down the midline of the abdomen. Chloasma (the "mask of pregnancy"), a blotchy brownish hyperpigmentation, may appear over the forehead, cheeks, and nose. Reddish-purple stretch marks (striae) may appear on the abdomen, breasts, thighs, and upper arms. Vascular spider nevi may appear on the neck, chest, face, arms, and legs. The rate of hair growth may slow
Stage 1 Interventions Throughout Stage 1
A labor curve, often called a Friedman curve, may be used to identify whether a woman's cervical dilation is progressing at the expected rate. Keep mother and partner informed of progress. Provide privacy. Offer fluids and ice chips, plus ointment for dry lips. Encourage voiding every 1 to 2 hours. Monitor maternal vital signs. Monitor FHR with the use of a Doppler ultrasound transducer, fetoscope, or electronic fetal monitor. Assess FHR before, during, and after a contraction, keeping in mind that the normal FHR is 110 to 160 beats/min. Assess uterine contractions by means of palpation or monitor, determining frequency, duration, and intensity. Assess status of cervical dilation and effacement. Assess fetal station presentation and position, using the Leopold maneuvers. Assist with pelvic examination and prepare for a Nitrazine test and a fern test (characteristic "fernlike" pattern of cervical mucus when a specimen of cervical mucus is allowed to dry on a glass slide and is viewed under a low-power microscope; it provides evidence of the presence of amniotic fluid and detects rupture of membranes and onset of labor) as prescribed. Assess the color of the amniotic fluid if the membranes have ruptured (check the FHR immediately after rupture); meconium-stained fluid may indicate fetal distress.
A sexually active single female client is discussing methods of contraception with the family planning nurse. The client tells the nurse that her primary concern is avoiding contracting sexually transmitted infections (STIs). In responding to the client, which method of protection does the nurse say provides the best protection against many STIs?
A latex condom Latex condoms provide the best protection available (other than abstinence) against many STIs. A diaphragm and a cervical cap provide a mechanical barrier to prevent the passage of sperm into the uterus but do not provide protection against STIs. An IUD, which is inserted into the uterus, provides no protection against STIs. Focus on the subject, protection against STIs. Eliminate the diaphragm and cervical cap first because they are comparable or alike. To select from the remaining options, visualize each, then eliminate the intrauterine device because it is inserted into the uterus and therefore would not protect against an STI. Review: methods of preventing STIs.
ovum
A mature egg cell
why does backaches occurs in the second and third trimesters of pregnancy?
A result of an exaggerated lumbosacral curve caused by the enlarged uterus, backache generally occurs in the second and third trimesters.
what can help a preschooler get to sleep?
A security object and a night light will help the preschooler get to sleep.
Leopold's Maneuvers
A series of four maneuvers designed to provide a systematic approach whereby the examiner may determine fetal presentation and position.
what causes the toddler to change toys often.?
A short attention span causes the toddler to change toys often.
Long-Acting Contraceptives Depot Medroxyprogesterone Acetate (depot shot)
A single intramuscular injection provides safe, effective contraception for 3 months or longer. When injections are discontinued, an average of 12 months is required for fertility to return. Menstrual disturbances are common during use; cycles become irregular at first, and after 6 to 12 months, menstruation may cease entirely.
A nurse has just assisted in the delivery of a newborn infant and is preparing to help deliver the placenta. For which sign/symptom of placental separation does the nurse monitor the woman?
A soft, boggy fundus Shortening of the umbilical cord CORRECT: Vaginal fullness on examination Assumption of a discoid shape by the uterus RATIONALE: Signs/symptoms of placental separation include a firmly contracting fundus; a change in the uterus from a discoid to a globular shape, which occurs as the placenta moves into the lower uterine segment; a sudden gush of dark blood from the introitus; apparent lengthening of the umbilical cord as the placenta descends to the introitus; the presence of vaginal fullness (placenta) on vaginal or rectal examination; and the presence of fetal membranes at the introitus. TEST-TAKING STRATEGY: Focus on the subject, the signs/symptoms of placental separation. Thinking about the physiologic process of placental separation will direct you to the correct option.
Why should A toddler never be allowed to fall asleep with a bottle containing milk, juice, soda pop, or sweetened water because
A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, or sweetened water because of the risk of bottle-mouth caries
Dilation:
A transformation that changes the size of an object, but not the shape.
Urinalysis and Urine Culture
A urine specimen for glucose and protein determinations should be obtained at every prenatal visit. Glycosuria is a common result of the decreased renal threshold that occurs during pregnancy. Persistent glycosuria may indicate diabetes. White blood cells in the urine may indicate infection. Ketonuria may result from insufficient food intake or vomiting. Levels of 2+ to 4+ protein in the urine may indicate infection or preeclampsia.
what are the interventions for hemorrhoid's during pregnancy?
A warm sitz bath may relieve discomfort. The client should sit on a soft pillow. Advise client to eat high-fiber foods and avoid constipation. The client should drink sufficient fluids. Exercise, such as walking, should be increased. Ointments, suppositories, or compresses may be prescribed by the primary health care provider or nurse-midwife.
why is ABO typing performed on a pregnant woman?
ABO typing is performed to determine the woman's blood type.
Nonstress Test: Nonreactive Result
Abnormal No accelerations or accelerations of less than 15 beats per minute or lasting less than 15 seconds during a 40-minute observation
Factors Contributing to Infertility in Men
Abnormalities of the sperm Abnormal erections Abnormal ejaculation Abnormalities of seminal fluid
A nurse has provided information to a 16-year-old girl about adequate nutritional intake. Which statement by the girl indicates a need for additional information?
According to the MyPlate food plan, three servings per day should be consumed from the dairy group. Protein foods are not acceptable substitutes for this food group. The other statements are accurate. TEST-TAKING STRATEGY: Note the strategic words "need for additional information." These words indicate a negative event query and the need to select the incorrect statement by the 16-year-old girl. Recalling the components of the MyPlate food plan and remembering that protein is not a substitute for the dairy group will direct you to the correct option. Review: the MyPlate food plan.
LATER ADULTHOOD Psychosocial Concerns
Adjustment to deterioration in physical and mental health and well-being Threat to independent function and fear of becoming a burden to loved ones Adjustment to retirement and loss of income Loss of skills and competencies developed early in life Coping with changes in role function and social life Diminished quantity and quality of relationships and coping with loss Dependence on governmental and social systems Access to social-support systems Costs of health care and medications
POSTPARTUM DISCOMFORTS Episiotomy
Administer perineal care after each voiding. Encourage the use of an analgesic spray as prescribed. Administer analgesics as prescribed if non-pharmacological comfort measures are unsuccessful.
Pudendal Block
Administered just before birth of baby Injection site at pudendal nerve by way of a transvaginal route Blocks perineal area for episiotomy Effect lasts about 30 minutes No effect on contractions or fetus
Mrs. Frances Valenti, 85 years old, lives in a residential home for older adults. She visits the clinic and tells the nurse that she is having persistent diarrhea. During the physical assessment, the nurse notes that Mrs. Valenti appears weak when walking, that she is intermittently confused, and that her skin is dry. Her temperature is 101° F; 38.3° C, her apical pulse is 92 beats/min and irregular, her respiratory rate is 28 breaths/min, and her blood pressure is 108/70 mm Hg. Mrs. Valenti tells the nurse that she has been able to eat and drink small amounts but that the diarrhea will not stop. The nurse suspects that Mrs. Valenti is dehydrated. Which action should the nurse implement first to treat the dehydration?
Administering oral Pedialyte Oral hydration is the first approach to the treatment of dehydration if the client is able to ingest fluids. Sport drinks, though high in sugar, are often recommended over tap water because they are easily absorbed by the stomach, are generally palatable to clients, and will more quickly correct the dehydration. Pedialyte and other commercial fluid and electrolyte solutions are also available. The administration of IV fluids is a last-resort approach. There is no reason to maintain Mrs. Valenti on NPO status; in fact, this could worsen the dehydration. TEST-TAKING STRATEGY: Note the strategic word "first." NPO status is inappropriate because Mrs. Valenti has been able to tolerate food and fluid intake and because this intervention may worsen the dehydration. Oral rehydration (noninvasive) would be implemented before the administration of IV fluids (invasive). From the remaining options, focus on the rehydrating oral solution mentioned in each. It would be best to administer a fluid-and-electrolyte solution to Mrs. Valenti. Review: interventions for the treatment of dehydration in the older client.
THE ADOLESCENT Safety
Adolescents are risk-takers. Instruct adolescents in the dangers of cigarette smoking, caffeine ingestion, drugs, and alcohol. Help adolescents recognize that they have choices when difficult or potentially dangerous situations arise. Advocate the use of seat belts; discuss the causes of motor vehicle accidents, including the use of cell phones and other electronic devices while driving. Discuss water safety. Warn adolescents about the dangers of guns, violence, and gangs. Instruct adolescents in the complications associated with body piercing, tattooing, and tanning. Discuss such issues as bullying, date rape, sexual relationships, and sexually transmitted infections, and the dangers of the Internet in regard to communicating and setting up meetings (dates) with unknown persons.
how many hour a night is recommended for an adolescent?
Adolescents tend to stay up late and, in an attempt to catch up on missed sleep, sleep late whenever possible; an average of 8 hours per night is recommended.
Adverse affects of Long-Acting Contraceptives Depot Medroxyprogesterone Acetate (depot shot)
Adverse effects include abdominal bloating, headache, depression, decreased libido, and osteoporosis.
what are the interventions for constipation during pregnancy?
Advise client to eat high-fiber foods. The client should drink sufficient fluids. Advise client to exercise regularly. Laxatives or enemas should not be used until client has consulted with the primary health care provider or nurse-midwife.
why do blood pressure decrease with age?
Age-related changes associated with the cardiovascular system include increased blood pressure and decreased cardiac output.
why do respirations/apical pulse decrease with age?
Age-related changes associated with the respiratory system include decreased gas exchange and diffusing capacity.
LATER ADULTHOOD: PRIORITY POINTS TO REMEMBER!
Aging is a natural process that is common to all individuals. The young adult tends to ignore physical signs/symptoms and postpone seeking health care. The task of middle adulthood is to achieve generativity. Age-related changes can increase the older client's risk for injury. Excess bathing may result in dryness, itching, and skin disruption. Regular exercise helps maintain muscle tone and strength and improves circulation. The reduced respiratory function associated with aging places the client, particularly the immobile client, at risk for pneumonia. Age-related decline in immune system function increases the older client's risk of infection. Age-related changes can alter the mechanism of medication absorption, putting the client at risk for adverse medication reactions. One common sign/symptom of an adverse reaction to a medication in the older client is an acute change in mental status. Any suicide threat by an older client should be taken seriously.
PRECAUTIONS TO PREVENT INFANT ABDUCTION
All personnel must wear identification that is easily visible at all times. No one without appropriate identification should handle or transport infants. Enlist parents' help in preventing kidnapping. Teach them to allow only hospital staff with proper identification to take their infants from them. Teach parents and staff to transport infants only in their cribs, never by carrying them. Question anyone carrying an infant outside the mother's room. Question anyone with a newborn near an exit or in an unusual part of the facility. Be suspicious of anyone who does not seem to be visiting a specific mother, asks detailed questions about nursery or discharge routines, asks to hold infants, or behaves in an unusual manner. Be suspicious of unknown people carrying large bags or packages that could contain an infant. Respond immediately when an alarm signals that a remote exit has been opened or an infant has been taken into an unauthorized area. Never leave infants unattended. Teach parents that infants must be watched at all times. Infants may be taken into the bathroom with the mother, if necessary. Suggest that mothers have the nursing staff take care of the infant if the mother wants to nap or feels unwell and no family members are present. If infants need to be moved to another area, take one infant at a time. Never leave an infant in the hall while the nurse is in a room with another mother. Never leave an infant unsupervised. When an infant is in the mother's room, position the crib away from the doorway, preferably on the side of the mother's bed opposite the door. Protect codes or card keys that allow entrance to the maternity units or nurseries so that unauthorized people cannot use them. When a parent or family member comes to a nursery to take an infant, always match the infant and adult identification bracelet numbers. Never give an infant to anyone who does not have the correct identification bracelet or other proper identification. Alert hospital security immediately if any suspicious activity occurs. Suggest that parents not place announcements in the newspaper or signs in the yard that might alert an abductor that a new baby is in the home.
MATERNAL PSYCHOLOGICAL CHANGES Ambivalence
Ambivalence may occur early in pregnancy, even when the pregnancy is planned. Mother may experience dependence-independence conflict and ambivalence related to role changes and increased financial responsibilities. Partner may experience ambivalence related to assuming the new role, increased financial responsibilities, and anticipation of having to share the partner's attention with the child. Factors that may be related to acceptance of a pregnancy are the woman's readiness for the experience and identification with the motherhood role.
PRESUMPTIVE SIGNS/SYMPTOMS OF PREGNANCY
Amenorrhea Nausea and vomiting Increased size and feeling of fullness in breasts Pronounced nipples Urinary frequency Quickening Fatigue Discoloration and thickening of the vaginal mucosa
DIAGNOSTIC TESTS Amniocentesis Description
Amniotic fluid is aspirated between 15 and 20 weeks of pregnancy to enable detection of genetic disorders and metabolic defects and to aid assessment of fetal lung maturity.
ADAPTATION TO NEW FAMILY MEMBERS Adaptation of an Adolescent
An adolescent may be embarrassed because the pregnancy confirms the continued sexuality of the parents or repelled by the obvious physical changes in his or her mother. Some adolescents are immersed in their own developmental tasks and are indifferent to the pregnancy unless it directly affects them or their activities. Some adolescents become very involved and want to help with preparations for the new baby.
Oral contraceptive therapy has been prescribed for a client with a history of seizures who is taking phenytoin. Which information should the nurse provide to the client after reviewing the new prescription?
An increased dosage of the oral contraceptive must be prescribed because phenytoin reduces the effectiveness of oral contraceptives. RATIONALE: Phenytoin is an anticonvulsant that reduces the effectiveness of oral contraceptives. When a client is taking a medication that diminishes the effectiveness of oral contraceptives, an increased dosage of the oral contraceptive may be required. An increased dosage of the phenytoin would not be necessary; additionally, this could be harmful to the client and lead to phenytoin toxicity. The effect of the phenytoin is not magnified while the client is taking the oral contraceptive. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike and call for an increased dosage of phenytoin. In choosing from the remaining options, remember that phenytoin diminishes the effectiveness of oral contraceptives. Review: the medications that affect oral contraceptives.
Freud (psychosexual)-Toddler: 1 to 3 years
Anal stage: gains a sense of control over instinctive drives
anterior fontanel
Anterior side of the skull Where the sagittal suture and coronal suture meet
POSTPARTUM DISCOMFORTS PERINEAL DISCOMFORT
Apply ice packs to the perineum during the 24 hours after delivery to reduce swelling. After the first 24 hours, apply warmth through the use of sitz baths.
PARENT TEACHING Circumcision Care of the newborn
Apply petroleum jelly gauze to the penis, except when a Plastibell (plastic device slipped between the penis and the foreskin for circumcision) is used. Remove petroleum jelly gauze, if applied, after first voiding following circumcision. Monitor site for swelling, infection, and bleeding. Cleanse the penis after each voiding by squeezing warm water over the penis. A milky covering over the glans penis is normal and should not be disrupted. A yellow crust may form over the circumcision site; this is a normal part of the healing process. Monitor newborn for urine retention.
OBSTETRICAL PROCEDURES Amniotomy
Artificial rupture of membranes (AROM) is performed by the primary health care provider or nurse-midwife to stimulate labor if the fetus is at zero or + station. The procedure increases the risk of cord prolapse and infection . Monitor FHR before and after AROM. Record time of AROM, FHR, and characteristics of fluid. Meconium-stained amniotic fluid may be associated with fetal distress. Bloody amniotic fluid may indicate abruptio placentae or fetal trauma. An unpleasant odor to amniotic fluid is associated with infection. Polyhydramnios is associated with maternal diabetes and certain congenital disorders. Oligohydramnios is associated with intrauterine growth retardation and congenital disorders. Expect more variable decelerations after rupture of the membranes as a result of cord compression during contractions. Limit client activity if prescribed.
PERFORMING THE LEOPOLD MANEUVERS Preparation
Ask the mother to empty her bladder. After warming hands, apply them to the mother's abdomen with firm, gentle pressure.
PHYSICAL EXAMINATION Gastrointestinal and Endocrine System IN THE NEWBORN
Assess cord for meconium staining. Monitor bowel sounds, which should be audible within 1 to 2 hours after birth. Ensure that the anal opening is patent. Breastfeeding can usually begin immediately after birth; based on the primary health care provider's preference and agency protocols, bottle-fed newborns may be initially offered no more than 30 mL of formula. Be alert for regurgitation or vomiting. Position newborn on right side after feeding but remember that the side-lying position is not recommended for sleep because it is easy for the newborn to roll into the prone position, which is contraindicated because it increases the risk of sudden infant death syndrome (SIDS). Look for normal stool and the passage of meconium stool. Meconium stool, which is greenish-black with a thick, sticky, tarlike consistency, is usually passed during the first 12 hours of life. Transitional stool, the second type of stool excreted by the newborn, is greenish brown and of looser consistency than meconium stool. Perform a newborn screening test (including the test for phenylketonuria) as prescribed before discharge after sufficient protein intake; the newborn should be receiving formula or breast milk for 24 hours before screening. Monitor newborn for signs/symptoms of blood glucose alterations: the blood glucose concentration should remain above 40 mg/dL.
PARENT TEACHING clothing of the newborn
Assess diaper and clothing needs for the newborn with the mother. Explain to the mother that the newborn's head should be covered in cold weather to prevent heat loss. Instruct the mother to layer the newborn's clothing in cooler weather.
STAGES OF LABOR: ASSESSMENT AND INTERVENTIONS Stage 3 interventions
Assess maternal vital signs. Assess uterine status. Provide parents with an explanation regarding delivery of the placenta. Examine placenta for cotyledons (one or more fetal villous trees, containing a fetal artery and a vein and suspended into the maternal cotyledon) and membranes to verify that it is intact
PARENT TEACHING breastfeeding OF THE NEWBORN
Assess the newborn's ability to latch on to the mother's breast and suck. Teach the mother about engorgement. Teach the mother how to pump her breasts and how to store breast milk properly. Explain to the mother that breast milk is a sufficient and superior diet for the first 4 to 6 months. Give the mother the phone numbers of local organizations that offer support to breastfeeding mothers.
Annie Yeats, 25 years old, gave birth to a healthy full-term girl an hour ago. Annie's husband, Jamie, was with her during the labor and vaginal delivery. The family was allowed some time for bonding, and after delivery of the placenta Annie was moved to the postpartum unit. Annie has no history of medical problems, and this was her first pregnancy. Her temperature is 98.4° F (36.9° C), her apical pulse is 82 beats/min, her respiratory rate is 18 breaths/min, and her blood pressure is 122/80 mm Hg. She plans to breastfeed her daughter. One hour after delivery, the nurse checks Annie for postpartum bleeding. Which procedure is best for this purpose?
Assessing Annie's blood pressure Visually assessing bleeding by checking Annie's perineal pad Asking Annie how much bleeding she has had since the last check CORRECT: Visually assessing bleeding by checking the linens under Annie's buttocks and the perineal pad RATIONAL: Estimating blood loss after delivery is important and can be done by visually examining the perineal pad. However, when the mother is supine, blood may flow between the buttocks and onto the linens beneath the mother, not onto the perineal pad. Therefore, it is also important to check the linens under the mother's buttocks for bleeding. The blood pressure may not change unless a significant amount of bleeding occurs. Asking Annie about the amount of bleeding is not a reliable means of assessment. Checking the bed linens and perineal pad provides a complete assessment of blood loss. TEST-TAKING STRATEGY: Focus on the subject, assessment for postpartum bleeding, and note the strategic word "best." Eliminate the option that relies on Annie's interpretation first. Next, note that the correct option provides the most complete data. Remember that vaginal bleeding may miss the perineal pad and flow onto the linens under the woman's buttocks.
After 2 days Mrs. Valenti is feeling better, and the discharge planner begins arranging for her to be sent back to the residential home. The nurse gives report to the nurse at the home, and Mrs. Valenti arrives there late in the afternoon. Which measures should the nurse at the residential home implement to prevent recurrence of dehydration? Select all that apply.
Assessing urine output Monitoring her pulse and respiratory rates, and blood pressure Find out what fluids she prefers besides water and offer those Measures to help prevent dehydration in older adults include monitoring pulse rate and respiration for increases and the blood pressure for a decrease, all of which may indicate dehydration. In addition, urine output should be monitored, because decreased urine output may indicate dehydration. Fluids should be offered every hour, including with the evening snack, and the nurse should find out what fluids are preferred and offer those, with the exception of drinks containing caffeine (e.g., coffee and iced tea), which acts as a diuretic. TEST-TAKING STRATEGY: Focus on the subject of the question; measures to prevent dehydration and select the measures that best meet the criteria. Eliminate the option that contains the closed-ended word "only" and the options that involve offering caffeine-containing fluids. Review: measures to prevent dehydration in older adults.
FETAL MONITORING Periodic Patterns in the FHR Hypertonic Uterine Activity
Assessment of uterine activity includes frequency, duration, intensity of the contractions, and uterine resting tone. The uterus should relax between contractions for 60 seconds or longer. The average resting tone is 5 to 15 mm Hg. In hypertonic uterine activity, the uterine resting tone between contractions is high, reducing uterine blood flow and decreasing the fetal oxygen supply.
at the beginning of the preschool period what is complete?
At the beginning of the preschool period, the eruption of the deciduous (primary) teeth is complete.
process of labor (Attitude)
Attitude is the relationship of the fetal body parts to one another. The normal intrauterine attitude is flexion, in which the fetal back is rounded, the head is forward on the chest, and the arms and legs are folded against the body.
Erikson (psychosocial)-Toddler: 1 to 3 years
Autonomy vs shame and doubt
physical characteristics of the school age child?
Average height and weight at age 12 are 59 inches (30.5 cm to 150 cm) and 88 lb (40 kg) The first permanent (secondary) teeth erupt around age 6, and deciduous teeth are gradually lost Regular dentist visits are necessary, and the school-age child must be supervised while brushing and flossing teeth; fluoride supplements may be necessary Sleep requirements range from 10 to 12 hours a night
what is the average height and weight for a preschooler?
Average height and weight at age 5 are 43 inches (102 cm); 32 lb (14.5 kg), respectively.
what should you avoid microwaving for infants?
Avoid microwaving baby bottles and baby food
why should you avoid placing large toys in a crib?
Avoid placing large toys in the crib because an older infant may use them as steps to climb.
normal 1-year old vitals
Axillary temperature: 96.8° F to 99° F (36° C to 37.2° C) Apical rate: 90 to 130 beats per minute Respirations: 20 to 40 breaths per minute Blood pressure: averages 90/56 mm Hg temp 36° C to 37.2° C
normal newborn vitals
Axillary temperatures usually taken because if a thermometer is inserted incorrectly into the rectum, it can cause perforation of the mucosa Axillary temperature: 97.7° F to 99.5° F (36.5° C to 37.5° C) Apical rate: 120 to 160 beats per minute (100 sleeping, 180 crying) Respirations: 30 to 60 (average 40) breaths per minute Blood pressure: averages 73/55 mm Hg temp 36.5° C to 37.5° C
Monitoring of Basal Body Temperature during natural family planning methods
Basal body temperature may decrease slightly before ovulation and then increase slightly with ovulation.
PARENT TEACHING Bathing of the newborn
Bathe the newborn in a warm room before feeding. Have all equipment for bathing available. Use a mild soap (not on the face). Proceed from the cleanest area to the dirtiest. Clean eyes from the inner canthus outward. Special care should be taken to clean under the folds of the neck, as well as the underarms, groin, and genitals. Make bath time enjoyable for both the newborn and the mother.
should you make sure toys have no small pieces?
Be sure that toys have no small pieces.
Laboratory tests are performed on a woman in the first trimester of pregnancy, and the results indicate that she is negative for Rh factor. Which explanation of this finding should the nurse provide to the woman?
Because the Rh factor is not present, the client will need to receive Rh immune globulin at about 28 weeks' gestation. RATIONALE: If the client is Rh negative and the result of an antibody screen is negative, she will need repeat antibody screens and should receive Rh immune globulin around 28 weeks' gestation to prevent the formation of anti-Rh antibodies. An Rh-negative woman should also receive Rh immune globulin within 72 hours of delivery if her newborn is Rh-positive. On the basis of the data provided in the question, the other options are incorrect. TEST-TAKING STRATEGY: Note the subject of the question, Rh factor, and focus on the data in the question. Recalling the significance of an Rh-negative test result and noting that the client of the question is the woman will assist you in answering correctly.
PHYSIOLOGICAL MATERNAL CHANGES Reproductive System Cervix
Becomes shorter, more elastic, and larger in diameter Endocervical glands secrete a thick mucus plug, which is expelled from the canal when dilation begins Increased vascularization causes softening and the violet discoloration known as the Chadwick sign, which occurs at approximately 4 weeks of gestational age
PHYSICAL EXAMINATION Reflexes Babinski (Plantar) Reflex
Beginning at the heel of the foot, the examiner gently strokes upward along the lateral aspect of the sole, then moves the finger along the ball of the foot. The newborn's toes hyperextend and the big toe dorsiflexes. The plantar reflex disappears after 1 year. Absence of this reflex indicates the need for a neurological examination.
Process of Labor: expulsion
Birth of the entire body
A nurse in a daycare center is planning play activities for a group of toddlers. Which choices are the most appropriate play materials for these children?
Blocks, rocking horse, finger paints, wooden puzzles, thick crayons, paper The toddler engages in parallel play. Appropriate toys promote increased locomotive skills, meet the need for tactile play, and are safe. Blocks, a rocking horse, finger paints, wooden puzzles, thick crayons, and paper are all appropriate toys for a toddler. Videos, a compact disc player, board games, sewing kits, and paint-by-number kits are more appropriate for a school-age child. Rattles, stuffed animals, squeaky dolls, and soft mobiles are more appropriate for an infant. TEST-TAKING STRATEGY: Note the subject of the question, car seat safety for a 4-year-old child. Recalling that air bags, when released, can be harmful or lethal to a small child will help you eliminate the option that addresses this action. Next, focus on the age of the child in the question and eliminate the options regarding the use of a booster seat and the options addressing a forward-facing position. Review: car safety principles for children.
Chadwick's sign
Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.
Mongolian Spots
Bluish-black pigmentation On lumbar dorsal area and buttocks Gradually fade during first and second years of life Common in Asian and dark-skinned races
body mass of an adolescent increases to what size?
Body mass increases to adult size.
when does bowel training develop for a toddler?
Bowel control develops before bladder control.
FETAL MONITORING Periodic Patterns in the FHR Fetal Bradycardia and Tachycardia
Bradycardia is FHR slower than 110 beats/min for 10 minutes or longer. Tachycardia is FHR faster than 160 beats/min for 10 minutes or longer. If either of these patterns is encountered, the nurse should change the position of the mother, administer oxygen, and notify the primary health care provider or nurse-midwife.
postpartum changes to the breast
Breasts continue to secrete colostrum. A decrease in estrogen and progesterone levels after delivery stimulates the secretion of prolactin, which promotes production of breast milk. Breasts become distended with milk on the third day after delivery. Engorgement occurs in 48 to 72 hours in non-breastfeeding mothers. Breastfeeding relieves engorgement.
when does Shortness of Breath and Dyspnea occur during the 2nd and 3rd trimester of pregnancy?
Breathing difficulties may occur in the second and third trimesters as a result of pressure on the diaphragm.
FETAL MONITORING Periodic Patterns in the FHR Accelerations
Brief, temporary increases in the FHR of at least 15 beats more than the baseline, lasting at least 15 seconds Usually a reassuring sign, reflecting a responsive, nonacidotic fetus Usually occur with fetal movement May be nonperiodic (having no relation to contractions) or periodic May occur with uterine contractions, during vaginal examinations, with mild cord compression, or when the fetus is in a breech presentation
Tailor sitting
Buttocks on the floor with legs flexed and crossed ("pretzel sitting")
at what age is head circumference and chest circumference in a newborn equal?
By 1 to 2 years of age
Oral Contraceptives Cautions and Contraindications: Possible Effects
By inducing endometrial regression, oral contraceptives may decrease or eliminate menstrual flow during the initial months of use, but breakthrough bleeding and spotting may occur. If bleeding irregularities persist during use, the possibility of malignancy should be investigated. If two consecutive periods are missed, the client should be evaluated for pregnancy. Estrogens and progestins can cause birth defects; if pregnancy should occur, oral contraceptives should be discontinued. After the discontinuation of oral contraceptive use, a period of 1 to 3 months may be required before normal menstruation resumes; in extreme cases, cyclic menses may not return for as long as 1 year. Estrogen excess causes nausea, breast tenderness, and edema; progestin excess can increase appetite and cause fatigue and depression. Oral contraceptives enter breast milk and reduce milk production; therefore they should not be taken by women who are breastfeeding. The incidence of twin births has been shown to be increased in women who become pregnant shortly after discontinuing oral contraceptives.
A pregnant client who is taking a prescribed iron supplement calls the nurse in the obstetrician's office and reports that she has been constipated. What is the best response the nurse should give to the client?
COORECT: To increase her daily intake of high-fiber foods That this is a normal occurrence during pregnancy To take the iron supplement every other day instead of every day To start taking an oral laxative daily until the constipation resolves The best response is for the client to increase her daily intake of high-fiber foods. Constipation is common during pregnancy. It may be caused by decreased intestinal motility or pressure from the uterus or may be a result of iron supplementation. The client should not discontinue or change the frequency of administration of an iron supplement that has been prescribed. If constipation persists, the client would be instructed to consult with the primary health care provider or nurse-midwife regarding a prescription for a laxative; taking a laxative on a daily basis could be harmful. Although constipation is a normal occurrence during pregnancy, the nurse should teach the client measures, such as including additional fiber in the diet, to alleviate and prevent its occurrence. TEST-TAKING STRATEGY: The nurse would not instruct a client to adjust the dosage of a prescribed medication. A laxative needs to be prescribed by the primary health care provider or nurse-midwife. Note the strategic word best. This indicates the response that would be the most appropriate in this situation. To select from the remaining options, focus on the subject of constipation. This will direct you to the correct option.
Maureen and Robert decide to have James Nicholas circumcised before he is discharged from the hospital. The nurse conducts teaching for home care of the circumcised newborn. Which statement by Maureen indicates a need for further instruction?
CORECT: "I'll clean the penis with a baby wipe during each diaper change." "I'll check the circumcision site for bleeding during each diaper change." "I'll apply petroleum jelly to the penis during each diaper change until it heals." "If his penis turns red, swells, or has a discharge, I'll call the pediatrician right away." RATIONALE: Many newborn infants are discharged soon after circumcision, and thorough client teaching is important. Parents should be taught to check carefully for bleeding, to cleanse the site with warm water until the circumcision is healed (5 to 6 days), and to apply petroleum jelly during each diaper change until the site is healed. Redness, swelling, or discharge indicates infection, and the primary health care provider should be notified immediately if any of these findings are noted. Commercial baby wipes should not be used because they contain alcohol, which may delay healing and cause discomfort for the newborn. TEST-TAKING STRATEGY: Note the strategic words "need for further instruction." This phrase indicates a negative event query and the need to select the incorrect client statement. Read each option carefully and note the word "baby wipe" in the correct option.
After a year, Marilyn calls the nurse to report that she may be pregnant. She says, "I missed 2 days of pills, so we've been using the rhythm method. Do I still take today's pill?" Which responses by the nurse are appropriate? Select all that apply.
CORRECT "Can you stop by the office this afternoon for a pregnancy test?" "Keep taking the birth control until your pregnancy is confirmed." "The rhythm method is quite accurate. You probably are not pregnant." "Wait a week, and if you still think you're pregnant stop the birth control pill." CORRECT "Do not take the birth control until you are tested in the office for pregnancy." Pregnancy, or possible pregnancy, is a contraindication to the use of oral contraceptives. The client should be told to stop taking the contraceptive until pregnancy is confirmed or ruled out. The rhythm method, though commonly used, is not always effective, because ovulation is often irregular. The nurse cannot determine whether the client is pregnant with just a telephone conversation. A pregnancy test should be performed as soon as possible. TEST-TAKING STRATEGY: The subject of the question is whether or not oral contraceptives should be used if pregnancy is a possibility. Recall that pregnancy is a contraindication to oral contraceptives and eliminate the options that are comparable or alike in that Marilyn is advised to continue taking the oral contraceptive. Review: contraindications to oral contraceptives.
The next day, the newborn's blood type comes back as A-positive. Annie is type B-negative. The obstetrician prescribes an intramuscular dose of Rho(D) immunoglobulin (RhoGAM) for Annie. The nurse explains the purpose of the RhoGAM, and prepares the injection. Which statement by Annie reflects a need for further education?
CORRECT: "My baby will need a dose of this medication, too." "My husband doesn't need to have a dose of this medication." "This shot will prevent a reaction in my body from the blood of my baby." "This shot will make it safer for my future babies if they have a positive blood type." RATIONALE: Rho(D) immunoglobulin (RhoGAM) is given within 72 hours of delivery to prevent antibody sensitization in a Rh-negative woman who has given birth to a Rh-positive infant, in whom fetomaternal transfusion may have occurred. The immune globulin promotes the destruction of any fetal Rh-positive cells that may have entered the mother's bloodstream before her body has had a chance to form antibodies against them. As a result, future pregnancies with Rh-positive infants will not be at risk for hemolysis. Only the mother receives the injection. TEST-TAKING STRATEGY: Note the strategic words "need for further education," which indicate a negative event query and the need to select the incorrect statement. Thinking about the purpose of Rho(D) immunoglobulin and the recipient of the medication will direct you to the correct answer. Remember, the mother is the recipient of the medication.
A nurse notes documentation in the medical record that a woman in labor is at +1 station. Based on this finding, what does the nurse determine is the presenting part of the fetus?
CORRECT: 1 cm below the ischial spines 1 cm above the ischial spines At the level of the ischial spines Above the level of the ischial spines Station is the relationship of the presenting part of the fetus to an imaginary line drawn between the maternal ischial spines. It is a measure of the degree of descent of the presenting part of the fetus through the birth canal. Station is expressed in centimeters above or below the spines. When the presenting part is 1 cm below the ischial spines, the station is noted as +1. When the presenting part is 1 cm above the ischial spines, the station is noted as -1. When the presenting part is at the level of the ischial spines, the station is noted as zero. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike in that they indicate that the level of the presenting part is at or above the ischial spines. To select from the remaining options, focus on the words "+1 station" in the question, which will direct you to the correct option.
Which priority action would the nurse take after attaching an external electronic fetal monitor to a pregnant client?
CORRECT: Checking the fetal heart rate Discussing the labor process with the client Assessing the frequency of the contractions Documenting the time that the monitor was attached RATIONAL: Assessing the fetal heart rate is the priority action after an electronic fetal monitor is attached to a pregnant client. Although assessment of the frequency of contractions is important, it is not the priority. Likewise, documenting and discussing the labor process with the client are components of the plan of care but are not the priority. TEST-TAKING STRATEGY: Note the strategic word "priority" in the query of the question. Use the ABCs; airway, breathing, and circulation; and remember that fetal heart rate reflects the ABCs.
A nurse is preparing to apply erythromycin ophthalmic ointment to a newborn's eyes. Which action should the nurse plan to take?
CORRECT: Cleansing the infant's eyes before applying the ointment Applying the ointment to the upper conjunctival sac of each eye Rinsing the excess ointment from the eye using normal saline solution Applying the ointment from the outer canthus to the inner canthus of the eye RATIONALE: The infant's eyes are cleansed before the administration of eye ointment. The ointment is placed in the lower conjunctival sac of each eye and deposited from the inner canthus to the outer canthus. The ointment is not rinsed from the eye, although it may be wiped from the outer eye area after 1 minute. TEST-TAKING STRATEGY: Focus on the subject of the question, the basic principles. These principles and careful reading of each option will direct you to the correct option.
A nurse performing an initial assessment of a newborn who is awake and alert counts the infant's apical heart rate and obtains a rate of 130 beats/min. Based on this finding, which action should the nurse take?
CORRECT: Documenting the finding Contacting the pediatrician Reassessing the heart rate in 5 minutes Stimulating the infant and reassessing the heart rate RATIONALE: The normal heart rate of a newborn is 100 to 160 beats/min. Therefore the nurse would document the finding. The other options are incorrect and unnecessary. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike and indicate that a heart rate of 130 beats/min is abnormal. Review: normal newborn vital signs.
Penny's labor continues, and she is now at 9 cm of dilation. During contractions, the fetal heart monitor shows the patterns depicted on the graph. What does the nurse determine?
CORRECT: No action is required The oxytocin infusion must be stopped Penny should be moved into a side-lying position Oxygen, at a rate of 8 to 10 L/min by way of a face mask, needs to be administered RATIONAL Early deceleration of the fetal heart rate (FHR) is an obvious gradual decrease and then return to baseline that is associated with uterine contractions. Early decelerations are considered benign, and nursing interventions are not required. Moving the mother into a side-lying position, administering oxygen, and stopping the oxytocin infusion are interventions that would be needed for late or variable decelerations of the FHR, which may indicate fetal distress. TEST-TAKING STRATEGY: Focus on the subject, interpretation of FHR and patterns during labor. In recognizing that the pattern of deceleration corresponds with the uterine contractions, you should also recognize early decelerations. Remember that early deceleration of the FHR is associated with contractions of the uterus, are considered benign, and nursing interventions are not required.
A nurse assessing a newborn's reflexes tests the Babinski (plantar) reflex. The nurse notes that when the reflex is elicited, the infant's toes hyperextend and the big toe dorsiflexes. How should the nurse document this finding?
CORRECT: Positive Negative Unresponsive Depressed RATIONAL: To elicit the Babinski reflex, the nurse begins at the heel of the foot and strokes upward along the lateral aspect of the sole of the foot, then moves the finger across the ball of the foot. In the characteristic response, all toes hyperextend and the big toe dorsiflexes. This is recorded as a positive sign. Although the response depends on general muscle tone and condition of the infant, an absence of response requires neurological evaluation. Therefore the other options are incorrect. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike and identify a negative neurological response.
A nurse monitoring lochial flow in a woman who delivered 2 hours earlier notes that the client's perineal pad shows drainage measuring less than 1 inch in a 1-hour period. How should the nurse report the lochial flow?
CORRECT: Scant Light Heavy Excessive RATIONAL: Lochia is the discharge from the uterus in the postpartum period, consists of blood from the vessels of the placental site and debris from the decidua (thick layer of modified mucous membrane that lines the uterus during pregnancy and is shed with afterbirth). The following guide may be used to determine the amount of flow: scant, less than 2.5 cm (1 inch) on menstrual pad in 1 hour; light, less than 10 cm (4 inches) on pad in 1 hour; moderate, less than 15 cm (6 inches) on pad in 1 hour; heavy, saturation of pad in 1 hour; and excessive, saturation of pad in 15 minutes. TEST-TAKING STRATEGY: Focus on the subject of the question, a woman who delivered 2 hours earlier with drainage of less than an inch in 1 hour. This information and the use of guidelines to determine the amount of lochial flow will direct you to the correct option. Review: postpartum assessment of the amount of lochial flow.
INITIAL CARE Apgar Scoring System of the newborn
Calculate and record the Apgar score 1 and 5 minutes after delivery. Assess each of the five vital indicators to be scored and assign a value ranging from 0 (very poor) to 2 (excellent) for each item. Add the points to determine the total score. Deliver the appropriate interventions.
10-11 months of age infant skills
Can move from prone to sitting position Walks while holding on to furniture Stands securely Entertains self for periods
LATER ADULTHOOD: PAIN Pain
Can occur from numerous causes and most often occurs from degenerative changes in the musculoskeletal system. Failure to alleviate pain can lead to functional limitations affecting his or her ability to function independently.
Nevus Flammeus (Port-Wine Stain)
Capillary angioma directly below epidermis Nonelevated, sharply demarcated, red to purple, dense areas of capillaries Commonly appears on face Does not fade with time Can be removed with laser surgery
why is car safety seats for an infant not placed in the cars front seat.
Car safety seats are not placed in the front seats of cars; the infant could be seriously injured if the passenger air bag is released
Variable Decelerations
Caused by conditions that restrict flow through the umbilical cord Do not have the uniform appearance of early and late decelerations The shape, duration, and degree of fall below baseline heart rate are variable; these fall and rise abruptly with the onset and relief of cord compression. Variable decelerations also may be nonperiodic, occurring at times unrelated to contractions. Variable decelerations are significant when the FHR repeatedly decreases to less than 70 beats/min and persists at that level for at least 60 seconds before returning to baseline.
Postpartum Blues
Caused by physiological and emotional stress, may also be due to hormonal changes in the mother. The mother may feel upset and depressed at times. Verbalization of concerns and fears should be encouraged.
PHYSIOLOGICAL MATERNAL CHANGES Skeletal System
Center of gravity changes. Postural changes occur as the increased weight of the uterus exerts a forward pull on the bony pelvis.
STAGES OF LABOR: ASSESSMENT AND INTERVENTIONS Stage 2 Assessment
Cervical dilation is complete when stage 2 begins. Progress of labor is measured by descent of fetal head through the birth canal (change in fetal station). Uterine contractions occur every 2 to 3 minutes and last 60 to 75 seconds; the intensity is strong. Increase in bloody show occurs. Mother feels urge to bear down; assist mother in pushing efforts.
Stage 1: Assessment Latent Phase
Cervical dilation of 1 to 4 cm Uterine contractions every 15 to 30 minutes, 15 to 30 seconds in duration and of mild intensity Mother talkative and eager to be in labor
Stage 1: Assessment Active Phase
Cervical dilation of 4 to 7 cm Uterine contractions every 3 to 5 minutes, 30 to 60 seconds in duration and of moderate intensity Possible feelings of helplessness on the part of the mother Restlessness and anxiety as contractions become stronger
Stage 1: Assessment transition Phase
Cervical dilation of 8 to 10 cm Uterine contractions every 2 to 3 minutes, 45 to 90 seconds in duration and of strong intensity Mother becomes tired, is restless and irritable, and feels out of control
Cervix postpartum changes
Cervical involution occurs. After 1 week, the muscle begins to regenerate.
MIDDLE ADULTHOOD psychosocial Changes
Changes may include expected events such as children moving away from home (post parental family stage) or unexpected events such as the death of a close friend. Time and financial demands decrease as children move away from home, and couples face redefinition of their relationships. People in this group may become grandparents and are achieving generativity.
what interventions can prevent supine hypotension in a pregnant woman?
Changing the position to the lateral recumbent (right or left side) to relieve the pressure of the uterus on the inferior vena cava may help prevent supine hypotension.
After Episiotomy INTERVENTIONS
Check episiotomy site. Institute measures to relieve pain. Provide ice pack for 24 hours after procedure. Instruct the client in the use of sitz baths (immersion of the perineal or episiotomy area in a warm water solution). Apply analgesic spray or ointment as prescribed. Provide perineal care, using clean technique; apply a peripad without touching the inside surface of the pad. Instruct the client in proper care of incision. Instruct the client to dry perineal area from front to back and to blot area instead of wiping it. Instruct the client to shower rather than bathe in a tub to decrease the risk of infection at the episiotomy site. Report any bleeding or discharge to the primary health care provider.
A nurse preparing a woman in the third trimester of pregnancy for a physical examination assists the woman into the supine position on the examining table. While waiting for the obstetrician to arrive, the woman suddenly complains of feeling lightheaded and dizzy. Which immediate action should the nurse take?
Checking the woman's blood pressure Calling the obstetrician to the examining room Placing a cool cloth on the woman's forehead CORRECT: Assisting the client in a lateral recumbent position RATIONAL: When a pregnant woman is in the supine position, particularly during the second and third trimesters, the weight of the gravid uterus partially occludes the vena cava and descending aorta. The occlusion impedes return of blood from the lower extremities and consequently reduces cardiac return, cardiac output, and blood pressure. This is known as supine hypotensive syndrome. Signs/symptoms include faintness, lightheadedness, dizziness, and agitation. A lateral recumbent position alleviates the pressure on the blood vessels and quickly corrects supine hypotension. Although the nurse may take the woman's blood pressure, this is not the action to take immediately. It is not necessary to call the obstetrician to the examining room. Placing a cool cloth on the woman's forehead will not alleviate the problem. TEST-TAKING STRATEGY: Note the strategic word "immediate." Focusing on the data in the question reveals that a nursing action needs to be taken to alleviate the problem. Thinking about the pathophysiology and the cause of supine hypotension will also direct you to the correct option.
PHYSIOLOGICAL MATERNAL CHANGES Cardiovascular System
Circulating blood and plasma volumes increase. Physiological anemia occurs as the plasma increase exceeds the increase in red blood cell production. Iron requirements are increased. The heart is elevated and moved to the left because of displacement of the diaphragm as the uterus enlarges. Pulse may increase by about 10 beats per minute. Blood pressure may decline in the second trimester. Retention of sodium and water may occur.
what helps prevent vena cava compression?
Client is allowed to assume a comfortable position to help prevent vena cava compression.
Lactose intolerance:
Clients need to incorporate sources of calcium other than dairy products into their dairy patterns regularly.
Piget (cognitive development)-age: 6 to 12 years
Concrete operational (7 to 11 years)
Barrier Devices Condoms for Men
Condoms are available without a prescription. Most condoms are made of latex, which is impermeable to bacteria and viruses; therefore, in addition to protecting against pregnancy, latex condoms protect against STIs. (Polyurethane condoms also protect against STIs, but condoms made from lamb intestines are permeable to viruses and do not protect against STIs.) Allergy to latex may develop in men or women, especially with repeated exposure.
LATER ADULTHOOD: INFECTION Infection
Confusion is a common sign/symptom of infection in the older adult, especially infection of the urinary tract. There are also nonspecific signs/symptoms that indicate illness or infection. Carefully monitor the client with infection because of the diminished and altered immune response.
when does constipation occur during pregnancy?
Constipation occurs in the second and third trimesters,
Penny's labor is progressing slowly because her contractions are inadequate, so the obstetrician prescribes intravenous oxytocin to augment labor. While the oxytocin is being administered, the nurse monitoring Penny closely, notes that her contractions are occurring every 3 minutes and are lasting 60 seconds. Which action should the nurse take?
Contact the obstetrician Stop the oxytocin infusion Transport Penny to the delivery room CORRECT: Maintain the current dosage of oxytocin RATIONALE: Oxytocin, a hormone naturally produced by the posterior pituitary gland, stimulates uterine contractions and may be used to induce labor or to augment a labor that is progressing slowly because of inadequate uterine contractions. The nurse monitors the client closely and maintains the dosage if the intensity of contractions results in intrauterine pressure of 40 to 90 mm Hg (as shown by an internal monitor), if the duration of contractions is 40 to 90 seconds, if the contractions come at 2- to 3-minute intervals, or if cervical dilation of 1 cm/hr occurs in the active stage. Oxytocin is stopped if uterine hyperstimulation or a non-reassuring pattern of fetal heart rate occurs. There is no need to contact the obstetrician at this time or to transport Penny to the delivery room, because she is still progressing through the first stage of labor. TEST-TAKING STRATEGY: Focus on the subject of the question, the action of oxytocin. Recalling the purpose of oxytocin and noting that the client's contractions are occurring every 3 minutes and lasting 60 seconds will direct you to the correct option.
A nurse monitoring the fetal heart rate (FHR) pattern of a woman in the first stage of labor whose cervix is dilated 6 cm notes the presence of early decelerations. Based on this finding, what action should the nurse take?
Contacting the nurse-midwife CORRECT: Continuing to monitor the FHR pattern Administering oxygen at 10 L by face mask Preparing the woman for immediate delivery RATIONALE: Early deceleration of FHR is a visually apparent gradual decrease and return to baseline FHR that occurs in response to fetal head compression during a contraction. It is a normal and benign finding, and therefore no intervention is necessary. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike, in this case those indicating that the FHR pattern is an unexpected and abnormal finding.
True Labor
Contractions increase in duration and intensity. Cervical dilation and effacement are progressive.
STAGES OF LABOR: ASSESSMENT AND INTERVENTIONS Stage 3 labor Assessment
Contractions occur until the placenta is expelled. Monitor client for signs/symptoms of placental separation. Delivery of placenta occurs 5 to 30 minutes after birth of baby. Schultze's mechanism: Center portion of placenta separates first and its shiny fetal surface emerges from the vagina. Duncan's mechanism: Margin of placenta separates and the dull, red, rough maternal surface emerges from the vagina first.
Kohlberg (moral)-age: 6 to 12 years
Conventional: conforms to rules to please others
play for the preschooler
Cooperative Imaginary playmates Likes to build and create things Simple, imaginative play Understands sharing and is able to interact with peers Enjoys a large space for running and jumping Likes dress-up clothes, paints, paper, and crayons for creative expression Activities such as swimming and sports for growth development Activities such as puzzles and toys for fine motor development
umbilical cord
Cord contains two arteries and one vein. Arteries carry deoxygenated blood and waste products from the fetus. Vein carries oxygenated blood and provides oxygen and nutrients to the fetus.
Therapies for Infertility Surgical Procedures
Correction of a varicocele Endoscopic procedures Laparotomy, laser surgery techniques, and microsurgical techniques to reduce adhesions or correct obstructions Transcervical balloon tuboplasty to open the fallopian tubes
what should be covered to protect from shock for infants?
Cover electrical outlets.
6-7 months of age infant skills
Creeps Sits with support Imitates Exhibits fear of strangers Holds arms out Frequent mood swings Waves bye-bye
Sexually Transmitted Infections Herpes
Culture is indicated for clients with a history of the disease and in those with active lesions and is performed to determine the route of delivery. Weekly cultures may be performed beginning at the 35th or 36th week of pregnancy and continued until delivery.
Sexually Transmitted Infections Chlamydia
Culture is indicated if the client is in a high-risk group: adolescents, those who have had multiple sex partners, and those with a history of sexually transmitted infections. Culture is indicated if an infant or infants from previous pregnancies have exhibited neonatal conjunctivitis or pneumonia.
Sexually Transmitted Infections Gonorrhea
Culture is performed during the initial prenatal examination and may be repeated during the third trimester in high-risk clients.
Nevus Vasculosus (Strawberry Mark)
Cutaneous capillary hemangioma Raised, clearly delineated, dark red, with a rough surface Common in head region, but can occur elsewhere on the body Disappears by early school years
FETAL MONITORING Early Decelerations
Decrease in fetal heart rate (FHR) to below baseline; the rate at the lowest point of the deceleration usually remains above 100 beats per minute Occur during contractions as the fetal head is pressed against the woman's pelvis or soft tissues, such as the cervix, after which FHR returns to baseline by the end of the contraction Tracing shows a uniform shape and mirror image of uterine contractions Not associated with fetal compromise; require no intervention
LATER ADULTHOOD Physiological Changes Reproductive System
Decrease in testosterone production and size of testes Changes in the prostate gland, sometimes leading to urinary problems Decreased secretion of hormones with the cessation of menses Vaginal changes, including decreased muscle tone and lubrication Impotence or sexual dysfunction in both sexes; variation in sexual function with general physical condition, mental health status, and medications
Adulthood LATER ADULTHOOD Physiological Changes Renal System
Decreased kidney size, function, and ability to concentrate urine Decreased glomerular filtration rate Decreased bladder capacity Increased residual urine and increased incidence of urinary tract infections Impaired excretion of medication
LATER ADULTHOOD Physiological Changes Gastrointestinal System
Decreased need for calories Diminished appetite and thirst and reduced oral intake Reduced lean body weight Digestive disturbances Shortened stomach-emptying time Reduced absorption of carbohydrates, proteins, fats, and vitamins Increased tendency to constipation Increased susceptibility to dehydration Tooth loss Difficulty chewing and swallowing food
Adulthood LATER ADULTHOOD Physiological Changes endocrine System
Decreased secretion of hormones, with specific physiological changes related to each hormone's function Decreased metabolic rate Decreased glucose tolerance, with resistance to insulin in peripheral tissues
why does an older adult have Decreased skin turgor, elasticity, and subcutaneous fat?
Decreased subcutaneous fat, muscle laxity, degeneration of elastic fibers, and collagen stiffening may lead to wrinkling and decreased turgor *With increasing age, there is a gradual atrophy of subcutaneous tissue in some areas of the body, and a gradual increase in others
What does decreased elastin and collagen mean for our patients?
Decreased turgor of skin, causes wrinkles, sagging skin, impaired wound healing
LATER ADULTHOOD Physiological Changes The Senses
Decreased visual acuity Decreased accommodation in eyes, requiring increased time for adjustment to changes in light Decreased peripheral vision and increased sensitivity to glare Presbyopia and cataract formation Narrowed and straightened optic blood vessels, opaque gray arteries, and gray or yellow spots of hyaline degeneration, called drusen, near the macula Possible loss of hearing Inability to discern taste of food Diminished smell acuity
POSTPARTUM INTERVENTIONS Client Teaching
Demonstrate newborn-care skills as necessary. Provide the opportunity for the mother to bathe the newborn. Instruct the mother in feeding technique. Instruct the mother to avoid heavy lifting for at least 3 weeks. Instruct the mother to plan at least one rest period per day. Instruct the mother in postpartum exercises. Instruct the mother that contraception should begin after delivery or with the initiation of sexual intercourse. (Intercourse should be postponed at least until lochia ceases and the episiotomy has healed.) Instruct the mother to report any chills, fever, increased lochia, or feelings of depression to the primary health care provider immediately. Instruct the mother in the importance of follow-up.
As Penny's labor progresses, the obstetrician performs another examination and concludes that Penny is in the second stage of labor. Which of these assessment findings should the nurse expect to note at this stage of labor? Select all that apply.
Descent of 1 to 2 cm Pink to bloody mucus CORRECT: Increase in bloody show CORRECT: Increased urge to bear down CORRECT: Cervical dilation of 10 cm with 100% effacement CORRECT: Contractions 2 minutes apart, 90 seconds in duration RATIONALE: The second stage of labor is the stage during which the infant is born. The stage begins with cervical dilation of 10 cm and complete (100%) cervical effacement. The increase in bloody show, increased urge to bear down, and increased duration and frequency of contractions are part of the descent, or active pushing, phase of the second stage of labor. Mucus that is pink to bloody and descent of 1 to 2 cm are findings that are characteristic of the first stage of labor. TEST-TAKING STRATEGY: Focus on the subject, assessment findings of the second stage of labor, and eliminate the options that are not consistent with this subject. Recalling that the infant will be born at the end of the second stage of labor will help you answer correctly.
A nurse is developing a plan of care for an older client that addresses interventions to prevent cold discomfort and the development of accidental hypothermia. Which outcomes are desired and should be selected by the nurse for the plan of care? Select all that apply.
Desired outcomes for nursing interventions to prevent cold discomfort and the development of accidental hypothermia include warm hands and feet; relaxed, uncurled body; body temperature higher than 97° F; absence of shivering; and no complaints of feeling cold. TEST-TAKING STRATEGY: First eliminate the option that contains the closed-ended word "only." Next focus on the subject, desired outcomes for interventions to prevent cold discomfort and the development of accidental hypothermia. This will direct you to the option that indicates that the client is not shivering and the option that indicates that the client's body temperature is 98° F. Review: interventions and desired outcomes for preventing hypothermia.
PHYSICAL EXAMINATION Skin Harlequin sign
Development of deep-pink or red coloration over one side of the newborn's body while other side remains pale or of normal color May indicate shunting of blood resulting from a cardiac problem or may signal sepsis
LATER ADULTHOOD pysiological Changes Cardiovascular system
Diminished energy and endurance, resulting in decreased tolerance for exercise Decreased compliance of the heart muscle Thickening, and increased rigidity of heart valves Decreased cardiac output, resulting in decreased efficiency of blood return to the heart Decreased resting heart rate Weak peripheral pulses Increased blood pressure but susceptibility to postural hypotension
LATER ADULTHOOD Physiological Changes Musculoskeletal System
Diminished muscle mass strength, and muscle atrophy Decreased mobility, range of motion, flexibility, coordination, and stability Change of gait to a shortened step and wider base Changes in posture and stature resulting in a decrease in height Increased brittleness of the bones Deterioration of joint capsule components Kyphosis of the dorsal spine
Which findings are normal age-related physiological changes? Select all that apply.
Diminished visual acuity Increased susceptibility to urinary tract infections Increased incidence of awakening after onset of sleep Anatomic changes in the eye affect the older individual's visual ability acuity, sometimes leading to problems in carrying out activities of daily living. Light adaptation is diminished and visual fields reduced. The heart rate slows and the heart valves thicken. Age-related changes that affect the urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory is usually maintained. Sleep pattern changes are common with increasing age. Older persons generally experience an increased incidence of awakening after sleep onset. TEST-TAKING STRATEGY: Focus on the subject, physiological changes that occur with aging. Read each characteristic carefully and think about the physiological changes that occur with aging to select the correct options. Review: the normal age-related changes.
Factors Contributing to Infertility in Women
Disorders of ovulation Abnormalities of the fallopian tubes Abnormalities of the cervix
FETAL MONITORING
Displays fetal heart rate (FHR) Used to monitor uterine activity Used to assess frequency, duration, and intensity of contractions Used to assess FHR in relation to maternal contractions Baseline FHR measured between contractions; normal FHR at term is 110 to 160 beats/min
vagina postpartum changes
Distention decreases, although muscle tone never recovers completely to the pregravid state.
A nurse checking the vital signs of an older client notes that the client's resting heart rate is 60 beats per minute. Which action should the nurse take on the basis of this finding?
Document the finding. RATIONALE: In an adult client, a heart rate slower than 60 beats per minute indicates bradycardia and a heart rate faster than 100 beats per minute indicates tachycardia. The heart rate decreases with age, so a rate of 60 beats per minute is within the normal parameters. Therefore, because the rate presented in the question constitutes a normal finding, the nurse would document the heart rate. On the basis of the data in the question, the other options are unnecessary. TEST-TAKING STRATEGY: Focus on the data in the question. Recalling the normal respiratory rate in an older client and recalling that the heart rate decreases as a client ages will direct you to the correct option. Review: age-related changes of the cardiac and respiratory system.
A nurse taking the vital signs of a client who delivered a healthy newborn infant 4 hours ago notes that the client's oral temperature is 101.2° F (38.4° C). Which action would be appropriate?
Documenting the findings CORRECT: Notifying the primary health care provider Retaking the temperature rectally Telling the client that the temperature at this level is expected at this time RATIONALE: Temperatures up to 100.4° F (38.0° C) in the 24 hours after birth are often related to the dehydrating effects of labor. The appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading. However, a temperature higher than 100.4° F indicates an infection, and the primary health care provider should be notified. Although the nurse also would document the findings, the appropriate action would be to contact the primary health care provider. There is no useful reason for taking the temperature rectally. Telling the client that her increased temperature is expected at this time is incorrect. TEST-TAKING STRATEGY: Use the process of elimination and data in the question regarding the physiological findings in the immediate postpartum period to assist in answering this question. Noting that the temperature is 101.2° F (38.4° C) will direct you to the correct option.
how can you remember Erik Erikson stage of development?
ERIK is social with ERIKson
Cleansing Breath
Each contraction begins and ends with a deep inspiration and expiration.
what are interventions to decrease nausea and vomiting in pregnancy?
Eating dry crackers before arising Eating small, frequent, low-fat meals during the day Drinking liquids between meals rather than at meals Avoiding fried foods and spicy foods Acupressure (some types may require a prescription) Herbal remedies, only if approved by the primary health care provider or nurse-midwife (select to learn more about complementary therapies for nausea)
Janice comes to the clinic for her 39-week visit. (Refer to Janice's record by referring "Chart" below.) Based on the data recorded (refer to medical record), the nurse concludes that one condition may be a problem. What is it? Vital Signs Blood pressure 162/110 mm Hg Temperature: 98.4° F Pulse 92 beats/min Respirations 14 breaths/min Subjective Data "I've had a headache for the last few days." "My vision seems blurry lately." "I've had to take off my rings because my fingers are swollen." Objective Data Urine dipstick: proteinuria +2; glucose negative Bilateral ankle edema, +2Edema of face and fingers Fundal height 38.5 cm Fetal heart tones (FHTs): 140 beats/min Deep tendon reflexes: 2+
Eclampsia Mild preeclampsia CORRECT: Severe preeclampsia Chronic hypertension A client experiencing severe preeclampsia will have a blood pressure of 160/110 mm Hg or higher on two separate occasions and will have 2+ to 3+ proteinuria on dipstick testing. Headaches, blurred vision, and facial and finger edema may also be present. Chronic hypertension would have been detected before pregnancy or before 20 weeks of gestation. Mild preeclampsia presents with a blood pressure of 140/90 mm Hg, minimal or no headache, no vision problems, and proteinuria of less than 2+ on dipstick testing. Eclampsia is an emergency that is characterized by seizure activity and sometimes coma. TEST-TAKING STRATEGY: Note the subject, "which condition could be a problem" and correlate. This will direct you to the correct option.
when does ankle edema occur during pregnancy?
Edema usually occurs in the second and third trimesters
why does ankle edema usually occur during the 2nd and 3rd trimesters of pregnancy?
Edema usually occurs in the second and third trimesters as a result of vasodilation, venous stasis, and increased venous pressure below the uterus.
Process of Labor: extension
Enables the head to emerge when the fetus is in a cephalic position Begins after the head crowns Is complete when the head passes under the symphysis pubis and occiput and the anterior fontanel, brow, face, and chin pass over the sacrum and coccyx and are over the perineum
POSTPARTUM DISCOMFORTS Breast Discomfort from Engorgement
Encourage client to wear a supportive bra at all times, even while sleeping. Encourage the use of ice packs if the client is not breastfeeding. Encourage the use of warm soaks before feeding for the breastfeeding mother. Administer analgesics as prescribed if non-pharmacological comfort measures are unsuccessful.
what are the interventions of breast tenderness in all three trimesters of pregnancy?
Encourage the client to wear a supportive bra. The use of soap on the nipples and areolar areas should be avoided to help prevent drying.
PHYSIOLOGICAL MATERNAL CHANGES Reproductive System Uterus
Enlarges from a weight of 60 g to 1000 g Irregular contractions occur
CERVIX
Entrance to the uterus
how do you prevent heat loss in a newborn?
Evaporation: Keep newborn dry and well wrapped with a blanket. Radiation: Keep newborn away from cold objects and outside walls. Convection: Shield newborn from drafts. Conduction: Perform all treatments on a warm, padded surface. Keep temperature in room warm.
DIAGNOSTIC TESTS α-Fetoprotein (AFP) Screening implementation
Explain that the AFP level is determined with the use of a single maternal blood sample drawn at 16 to 18 weeks' gestation. If the level is increased and the gestation is of less than 18 weeks, a second sample is drawn. In the presence of an increased AFP level, ultrasound is performed to rule out fetal abnormalities or multiple gestation.
Stage 2 of labor
Expulsion of the fetus
Contraction Stress Test implementation
External fetal monitor is applied to the mother, and a 20- to 30-minute baseline strip is recorded Uterus is stimulated to contract, either by the administration of a dilute dose of oxytocin or by having the mother use nipple stimulation until three palpable contractions with a duration of 40 seconds or more in a 10-minute period have been achieved Frequent maternal blood-pressure readings are performed, and the mother is monitored closely while increasing doses of oxytocin are given
OBSTETRICAL PROCEDURES External Version
External manipulation moves the fetus from an abnormal position into a normal presentation. External version is indicated for an abnormal presentation after the 34th week. Monitor vital signs. If the mother is negative for Rh factor, check to refer that RhoGAM was given at 28 weeks' gestation. Prepare client for non-stress test to evaluate fetal well-being. IV fluids and tocolytic therapy may be administered to relax the uterus and ease manipulation of fetus. Ultrasound is used during the procedure to evaluate fetal position and placental placement and guide direction to the fetus. Abdominal wall is manipulated to direct fetus into a cephalic presentation if possible. Monitor blood pressure to identify vena cava compression. Monitor client for unusual pain.
Process of Labor: external rotation
External rotation of the head accompanies internal rotation of the shoulders
DIAGNOSTIC TESTS Non Stress Test (NST) implementation
External ultrasound transducer and the tocodynamometer (a.k.a. the "toco") are applied to the mother, and a tracing of at least 20 minutes duration is obtained so that the FHR and the uterine activity may be observed. Obtain baseline blood pressure and recheck pressure frequently. Position mother in the lateral position to avoid vena cava compression. The mother may be asked to press a button every time she feels fetal movement; the monitor records each point of fetal movement, and the record is used as a reference against which to assess FHR response.
Maternity Client: Antepartum Care PRIORITY POINTS TO REMEMBER!
Fertilization occurs in the upper region of the fallopian tubes. Most substances in maternal blood can be transferred to the fetus. The umbilical cord contains two arteries and one vein. Positive signs of pregnancy include auscultation of the fetal heart rate, active fetal movements palpable by the examiner, and the outline of the fetus on ultrasound. The gravid uterus partially occludes the vena cava and descending aorta when the mother lies in a supine position, sometimes resulting in supine hypotensive syndrome; this may be prevented or corrected by positioning the mother in a lateral position. During the second and third trimesters (weeks 18-30), fundal height in centimeters approximately equals the fetus's age in weeks, plus or minus 2 cm. An increase of about 300 calories per day is needed during pregnancy. An increase of about 500 calories per day is needed during lactation. A diet high in folic acid and folic acid supplementation are important. The pregnant woman should drink at least eight to ten 8-oz (235ml) glasses of fluid each day, of which four to six glasses should be water. The non-stress test reveals whether the fetal heart rate accelerates when the fetus moves. The contraction stress test is used to evaluate the response of the fetal heart to recurrent short interruptions in placental blood flow and oxygen supply that occur with uterine contractions.
positive signs of pregnancy
Fetal heart rate, detectable with an electronic device (Doppler transducer) at 10 to 12 weeks and with a nonelectronic device (fetoscope) at 20 weeks of gestation Active fetal movements palpable by examiner Outline of fetus on ultrasound
Transverse or horizontal (lie of labor)
Fetal spine is at a right angle, or perpendicular, to the mother's spine. Presenting part is the shoulder. Delivery is made by cesarean section.
Oblique (lie of labor)
Fetal spine is at a slight angle from a true transverse (horizontal) lie . Delivery is made by cesarean section if position is uncorrectable.
A non-stress test is performed on a pregnant woman, and the woman is told by the obstetrician that the results are nonreactive. Based on this test result, what determination does the nurse make?
Fetal well-being has been established. CORECT: A contraction stress test will be scheduled. Placental function and oxygenation are adequate. The results are inadequate and the non-stress test must be repeated. RATIONALE: A nonreactive stress test indicates a nonreassuring or abnormal finding. A contraction stress test may be performed if non stress test findings are nonreactive. The contraction stress test records the response of the fetal heart rate to stress induced by uterine contractions, identifying the fetus whose oxygen reserves are insufficient to tolerate the recurrent mild hypoxia of uterine contractions. On the basis of the data in the question, the other options are incorrect. TEST-TAKING STRATEGY: Focus on the subject of the question, a nonreactive non stress test. Adequate placental function and oxygenation and established fetal well-being are comparable or alike, so eliminate these options. To select from the remaining options, focus on the strategic word "nonreactive," which will direct you to the correct option.
week 16 fetal period
Fetus is 11.5 to 13.5 cm long. Fetus weighs 100 g. Active movements are present. Skin is transparent. Lanugo hair begins to develop. Skeletal ossification takes place.
week 20 fetal period
Fetus is 16 to 18.5 cm long. Fetus weighs 300 g. Lanugo covers the entire body. Fetus has fingernails and toenails. Muscles are developed. Enamel and dentin are being deposited. Heartbeat is detectable with a regular (nonelectronic) fetoscope.
week 24 fetal period
Fetus is 23 cm long. Fetus weighs 600 g. Hair on head is well formed. Skin is reddish and wrinkled. Reflex hand grasp is functioning. Vernix caseosa covers the entire body. Fetus can hear.
week 28 fetal period
Fetus is 27 cm long. Fetus weighs 1100 g. Limbs are well flexed. Brain is developing rapidly. Eyelids open and close. Lungs are developed sufficiently to provide gas exchange (lecithin forming). If born at this time, neonate can breathe.
week 32 fetal period
Fetus is 31 cm long. Fetus weighs 1800 to 2100 g. Bones are fully developed. Subcutaneous fat has accumulated. Lecithin-to-sphingomyelin (L/S) ratio is 1.2:1.
week 36 fetal period
Fetus is 35 cm long. Fetus weighs 2200 to 2900 g. Skin is pink and the body rounded. Skin is less wrinkled. Lanugo is disappearing. L/S ratio is higher than 2:1.
week 40 fetal period
Fetus is 40 cm long. Fetus weighs 3200 g or more. Skin is pinkish and smooth. Lanugo remains on the upper arms and shoulders. Vernix caseosa coverage decreases. Fingernails extend beyond fingertips. Sole (plantar) creases run down to the heels. Testes are in the scrotum. Labia majora are well developed.
week 12 fetal period
Fetus is 6 to 9 cm long. Fetus weighs 19 g. Face is well formed. Limbs are long and slender. Kidneys begin to form urine. Spontaneous movements occur. Heartbeat is detectable with a Doppler transducer between 10 and 12 weeks. Sex is visually recognizable.
THE PROCESS OF LABOR Shoulder Presentation
Fetus is in a transverse lie, or the arm, back, abdomen, or side may present. If the fetus does not spontaneously rotate or it is not possible to turn the fetus manually, a cesarean section is almost always necessary.
platypelloid pelvis
Flat, with an oval inlet Wide transverse diameter but short anteroposterior diameter, making outlet inadequate for labor and birth
Why is fluoride important for infants?
Fluoride supplement drops help strengthen your baby's enamel on their teeth as they form. Additionally: Fluoride drops strengthen enamel by helping to battle tooth decay and cavities during primary and permanent teeth development
Fluoride supplementation may be needed starting around how many months of age?
Fluoride supplementation may be needed starting around 6 months of age. 6 months of age
Piget (cognitive development)- Adolescent: 12 to 20 years
Formal operations (11 years to adulthood)
week 1 embryonic stage
Free-floating blastocyst
PHYSIOLOGICAL MATERNAL CHANGES Renal System
Frequency of urination increases in the first and third trimesters as a result of pressure of the enlarging uterus on the bladder. This reduces bladder capacity. Diminished bladder tone is caused by hormonal changes. The renal threshold for glucose may be reduced.
Example: A woman is pregnant for the fifth time. She has undergone two elective abortions, both in the first trimester; gave birth to a daughter at 40 weeks' gestation; and gave birth to a son at 35 weeks' gestation. Therefore she is gravida (G) 5 and para 2; term (T) 1 (the daughter born at 40 weeks); preterm (P), 1 (the son born at 35 weeks); abortion (A), 2 (the abortions are counted in the gravidity but not included in the parity because they were performed before 20 weeks' gestation); and living children (L), 2.
GTPAL = 5, 1, 1, 2, 2
THE ADOLESCENT Play
Games and athletics are the most common forms of play. Competition and strict rules are important. Adolescents enjoy such activities as sports, videos, movies, reading, parties, dancing, hobbies, computer and other electronic games or activities, music, and experimenting with makeup and hairstyles. Friends are important, and adolescents like to gather in small groups.
why does fatigue occur during the first and third trimesters?
Generally a result of hormonal changes, fatigue usually occurs in the first and third trimesters.
Freud (psychosexual)- Adolescent: 12 to 20 years
Genital stage: develops relationships with members of the opposite sex, plans life goals, and gains strong sense of personal identity
Gestation
Gestation lasts approximately 280 days. Use Nagele's rule to calculate the estimated date of delivery (EDD) or estimated date of confinement (EDC). (For Nagele's rule to be accurate, the woman must have a regular 28-day menstrual cycle.)
4-5 months of age infant skills
Grasps objects Switches objects from hand to hand Rolls over for first time Enjoys social interaction Begins to show memory Aware of unfamiliar surroundings
Janice Casey, 27 years old, is pregnant for the third time. She is in her first trimester. Janice's husband has accompanied her to the maternity clinic, and he tells the nurse that he is going to be with Janice throughout labor and delivery. The nurse, obtaining an obstetric history from Janice, notes that her menstrual periods are regular and that her last period was on August 25, 2016. Janice tells the nurse that she has one son, born at 40 weeks' gestation, and one daughter, born at 36 weeks' gestation. She says that these pregnancies progressed normally, without complications. Janice has no history of medical or surgical problems. Her temperature is 98° F (36.7° C), her apical pulse is 80 beats/min, respirations are 18 breaths/min, and blood pressure is 120/78 mm Hg. The nurse completes Janice's obstetric history. How does the nurse record Janice's history of gravidity and parity?
Gravida 2, para 2 CORRECT: Gravida 3, para 2 Gravida 3, para 3 Gravida 2, para 3 Gravida refers to the number of pregnancies, including the current one. Parity is the number of births (not the number of fetuses, e.g., twins) carried past 20 weeks at delivery, whether or not the fetus was born alive. Because this is the client's third pregnancy, her gravidity is 3. Because Janice is in her first trimester of this pregnancy and also has one son who was born at 40 weeks' gestation and one daughter who was born at 36 weeks' gestation, her parity is 2. TEST-TAKING STRATEGY: Focus on the subject of the question, the obstetric history of Janice. Recalling the definitions of gravidity and parity and reading the data in the case study description carefully will direct you to the correct option.
A nurse is obtaining an obstetric history from a client who is pregnant. The client tells the nurse that she gave birth to twins at 36 weeks' gestation and had a stillbirth at 24 weeks. The client also reports that she experienced a spontaneous abortion at 12 weeks' gestation. How should the nurse document the woman's pregnancies?
Gravida 2, para 4 Gravida 3, para 5 CORRECT: Gravida 4, para 2 Gravida 5, para 3 Gravida refers to the number of pregnancies, of any length, that the woman has had. Para (parity) refers to the number of pregnancies that have progressed past 20 weeks at delivery. Because the client is pregnant and was pregnant with twins, pregnant before the stillbirth at 24 weeks, and pregnant before experiencing a spontaneous abortion at 12 weeks' gestation, she is referred to as gravida 4. Because only two of the pregnancies progressed past 20 weeks, she is para 2. Therefore the client is gravida 4, para 2. TEST-TAKING STRATEGY: Focus on the data in the question. Recalling the definitions of gravida and para and reading the data carefully will direct you to the correct option. Review: the definitions of gravida and para.
Gravida
Gravida is used to refer to the number of pregnancies or to the pregnant woman herself. Gravidity is the state of being pregnant. A nulligravida is a woman who has never been pregnant. A primigravida is a woman who is pregnant for the first time. A multigravida is a woman in at least her second pregnancy.
THE ADOLESCENT Skills
Gross and fine motor skills are well developed. Strength and endurance increase.
what should you do for the infant on bed or changing table?
Guard infant on bed or changing table.
PHYSICAL EXAMINATION Mouth of the newborn
Gums are moist and pink. Soft and hard palates are intact. Epstein's pearls (small white cysts) may be present on the hard palate. Uvula is in midline. Tongue moves freely, is symmetric, and has a short frenulum. Sucking and crying movements are symmetric. Newborn is able to swallow. Gag reflex is present.
PHYSICAL EXAMINATION Vital Signs of the newborn
Heart rate: 100 to 160 beats/min (should be assessed for 1 full minute because of irregularities after birth) Respirations: 30 to 60 (average 40) breaths/min (should also be assessed for 1 full minute) Axillary temperature: 97.7° F to 99.5° F (36.5° C to 37.5° C) Blood pressure: 73/55 mm Hg
when does heartburn occur in pregnancy?
Heartburn, which occurs in the second and third trimesters
how does height and weight increase in a toddler?
Height and weight increase in step like fashion, reflecting growth spurts and lags. (Weight gain is slower during this phase than in infancy.)
physical characteristics of the toddler
Height and weight increase in step like fashion, reflecting growth spurts and lags. (Weight gain is slower during this phase than in infancy.) The toddler should refer a dentist soon after the first teeth erupt, usually around 1 year of age; a fluoride supplement may be necessary. A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, or sweetened water because of the risk of bottle-mouth caries. The toddler typically sleeps through the night and takes one daytime nap; nap is discontinued around age 3. A consistent bedtime ritual helps prepare the toddler for sleep. Security objects may also help the toddler get to sleep.
A nurse assists an obstetrician in performing an amniotomy on a woman admitted to the labor unit. Which action should the nurse take immediately after the procedure?
Helping the woman walk CORRECT: Checking the fetal heart rate Assisting the woman in bathing Checking the woman's temperature RATIONALE: Amniotomy is the artificial rupture of membranes that is performed by the primary health care provider to stimulate labor. The primary risk associated with amniotomy is that the umbilical cord will slip down in the gush of fluid and become compressed between the fetal presenting part and the woman's pelvis, obstructing blood flow to and from the placenta and reducing gas exchange. Therefore the nurse's action immediately after the procedure would be to check the fetal heart rate. Although the nurse would monitor the woman's temperature and help the woman bathe, these are not immediately necessary actions. The woman would not be allowed to walk unless this has specifically been prescribed. TEST-TAKING STRATEGY: Use the ABCs; airway, breathing, and circulation; which will direct you to the correct option, checking the fetal heart rate.
LATER ADULTHOOD Physiological Changes Hematological System
Hemoglobin and hematocrit levels at the low end of the normal range Tendency to increased blood clotting
LABORATORY TESTS Hemoglobin and Hematocrit
Hemoglobin and hematocrit levels drop during gestation as a result of increased plasma volume. An increase in the hematocrit level may indicate the development of gestational hypertension. A decrease in the hemoglobin level to less than 10 g/dL (Hgb 100 mmol/L) or in the hematocrit level to less than 35% for females indicates anemia.
PHYSICAL EXAMINATION Reflexes Moro reflex
Hold the newborn in a semi-sitting position and then allow the head and trunk to fall backward to at least a 30-degree angle. The newborn assumes sharp extension and abduction of the arms with the thumbs and forefingers in a C position; this is followed by flexion and adduction to an "embrace" position (legs follow a similar pattern). The Moro reflex is present at birth and disappears by 6 months of age if neurological maturation is not delayed beyond 6 months of age. A body jerk motion may be the response between 8 and 18 weeks. A persistent response lasting more than 6 months may indicate a neurological abnormality.
PHYSICAL EXAMINATION Reflexes Stepping ("Walking")
Hold the newborn in a vertical position, allowing one foot to touch a table surface. The newborn simulates walking, alternately flexing and extending the feet. The walking reflex is usually present for 3 to 4 months.
what is the best food for infants younger than 6 months?
Human milk is the best food for infants younger than 6 months.
PRIORITY POINTS TO REMEMBER!
Human milk is the best food for infants younger than 6 months. Skim and low-fat milk should not be used for infants because the essential fatty acids are inadequate and the solute concentration of protein and electrolytes is too high. Fluoride supplementation may be needed starting around 6 months of age, depending on the infant's intake of fluoridated tap water. Introduce solid foods one at a time, usually at intervals of 4 to 7 days, to identify food allergens. Avoid giving solid foods that place the child at risk for choking, such as nuts, foods with seeds, raisins, popcorn, grapes, pieces of hot dog, and peanut butter. Baby-proof the home; hazardous items must be stored out of reach. Toddlers are eager to explore the world around them. Preschoolers are active and inquisitive; because of their magical thinking, they may believe that the daring feats seen in cartoons are possible and may attempt them. Children should always wear a helmet when riding a bike, using inline skates or skateboards, or participating in other activities that may result in falls. Teach children to avoid speaking to strangers and to never accept a ride, toys, or gifts from a stranger. Teach children how to dial 911 in an emergency situation. Teach parents to keep the poison-control hotline number available. Adolescents are risk-takers. Discuss such issues as bullying, date rape, sexual relationships, and sexually transmitted infections and the dangers of the Internet with regard to communicating and setting up meetings (dates) with unknown persons.
PHYSIOLOGICAL MATERNAL CHANGES Reproductive System vagina
Hypertrophy and thickening of the muscle occurs. Vaginal secretions increase; usually these are thick, white, and acidic.
how can you remember the apical rate of infant sleeping?
I'm going to keep it 100, I want to sleep
FETAL MONITORING Interventions for Non-reassuring Patterns
Identify the cause (check for cord prolapse). Discontinue oxytocin. Change the mother's position (avoid the supine position for patterns associated with cord compression). Administer oxygen by face mask at 8 to 10 L/min. Increase intravenous fluids as prescribed. Notify the primary health care provider or nurse-midwife as soon as possible. Prepare to initiate continuous electronic fetal monitoring with internal devices, if these are not contraindicated. Prepare for cesarean delivery if necessary.
Erikson (psychosocial)- Adolescent: 12 to 20 years
Identity vs role confusion
Erikson- Adolescent: 12 to 20 years
Identity vs role confusion
if one dose is missed when should the missed dose be taken?
If a dose is missed, that dose should be taken together with the next scheduled dose
what happens If the client has a negative titer, indicating susceptibility to the rubella virus?
If the client has a negative titer, indicating susceptibility to the rubella virus, she should receive the appropriate immunization after delivery.
what If the client is Rh negative and has a negative result on antibody screening?
If the client is Rh negative and has a negative result on antibody screening, she will need repeat antibody screens and should receive Rh immune globulin at 28 weeks' gestation.
if three doses are missed when should the missed doses be taken?
If three doses are missed, a new cycle should be initiated, starting 7 days after the last pill was taken; an additional form of birth control should be used during the first two weeks of the new cycle.
if two doses are missed when should the missed doses be taken?
If two doses are missed, two doses should be taken each day on the next 2 days.
fundus assessment after delivery
Immediately after delivery, the fundus can be palpated midway between the symphysis pubis and umbilicus, after which it rises to a level just above the umbilicus; next it sinks to the level of the umbilicus and remains at this level for about 24 hours. After 24 hours, the fundus begins to descend by approximately 1 cm, or one fingerbreadth, each day. By the 10th to 14th day after delivery, the fundus is in the pelvic cavity and cannot be palpated abdominally. Note that a flaccid fundus indicates uterine atony and should be massaged until firm; a tender fundus indicates infection.
With impaired vascularity what can we expect from our patients?
Impaired thermoregulation, pale color, lower skin temperature, impaired wound healing- the mediating factors can not travel through the vascular system to assist with wound healing
Joanna asks the nurse about toilet-training Joel. She is not sure whether he is ready and anticipates that he will throw temper tantrums if she begins to toilet-train him. The nurse tells Joanna to watch for certain signs of readiness to toilet-train. What are they? Select all that apply.
Impatience with a wet or soiled diaper. A dry diaper when the child wakes from a nap RATIONALE: Signs of readiness for toilet training include the ability to stay dry for 2 hours; waking dry from a nap; the ability to sit, squat, and walk; the ability to remove clothing; the ability to recognize the urge to defecate or urinate; the ability to sit on the toilet for 5 to 10 minutes without fussing or getting off; impatience with a wet or soiled diaper; and willingness to please the parent. TEST-TAKING STRATEGY: Focus on the subject, readiness to toilet-train. Note the strategic words "refusal" and "increased number of wet diapers" in the incorrect options. Review: the signs of readiness for toilet-training.
THE PROCESS OF LABOR Breech Presentation
In a frank breech, the fetus' legs are extended across the abdomen toward the shoulders. In a full (complete) breech, the head, knees, and hips are flexed but the buttocks are presenting. In a footling breech, one or both feet are presenting. Delivery by cesarean section may be required in the case of a breech presentation, although it is often possible to deliver vaginally.
THE PROCESS OF LABOR Cephalic Presentation
In the most common presentation, the fetal head appears first.
PHYSICAL EXAMINATION neck of the newborn
In the newborn, the neck is short and thick. Head is held in midline. Trachea is in midline. Range of motion is good, and newborn is able to flex and extend the neck.
Internal Fetal Monitoring
In this invasive intervention, the membranes are ruptured and an electrode is attached to the presenting part of the fetus. The mother's cervix must be dilated 2 to 3 cm for internal monitoring to be conducted.
METHODS OF CONTRACEPTION Natural Family Planning Methods Coitus Interruptus
In this method, also called "withdrawal coitus," the penis is removed from the vagina before ejaculation. Fluid that escapes from the penis before ejaculation is not felt by the man or woman and may contain sperm; sperm spilled on the vulva may enter the vagina and cause pregnancy.
OBSTETRICAL PROCEDURES Episiotomy
In this procedure, an incision is made in the perineum to enlarge the vaginal outlet and facilitate delivery.
OBSTETRICAL PROCEDURES Cesarean Delivery
In this procedure, the fetus is delivered through the uterine wall, usually by way of a low-segment transabdominal incision of the uterus
Therapies for Infertility Advanced Techniques
In vitro fertilization Gamete intrafallopian transfer Tubal embryo transfer Microsurgically assisted fertilization Preimplantation genetic testing
A home-care nurse is providing information to an older client about measures to prevent constipation. Which action should the nurse tell the client to take?
Include bran in the daily diet. Diet is a common cause of constipation in older adults. Usually a lack of certain foods, rather than the consumption of certain foods, leads to the problem. Fresh fruits and vegetables contain natural laxatives and should be included in the daily diet. Another dietary cause of constipation is the lack of fiber or bulk and reduced fluid intake. Therefore the client should include fiber, such as bran, in the diet and should drink 2000 mL of fluid daily unless it is contraindicated because of a medical condition. Constipation may be caused by overuse or improper use of laxatives stemming from the client's excessive concern about the frequency of bowel movements. The client would not be instructed to take a laxative on a daily basis. TEST-TAKING STRATEGY: Recalling that the nurse would not instruct a client to take a laxative on a daily basis will assist you in eliminating this option. To select from the remaining options, focus on the subject, preventing constipation. The nurse would not instruct the client to reduce the amount of fresh fruit eaten each day or to keep fluid intake to 1000 mL daily. Both of these measures would worsen constipation. Review: the measures for preventing constipation.
Stage 1 of labor
Includes latent, active, and transition stages Effacement and dilation of the cervix occurs
why does Increased vaginal discharge occur in all three trimesters of pregnancy?
Increased discharge, which may occur in all three trimesters, results from hyperplasia of vaginal mucosa and increased mucus production.
school aged child nutrition
Increased growth needs Feed a balanced diet chosen from foods in the MyPlate food plan.
What does a decrease in epidermal thickness and turnover rate, and decreased dermal thickness mean for our patients?
Increased risk of skin tears, impaired wound healing, decreased barrier function, rough appearance
Nonstress Test: Reactive Result
Indicates a healthy fetus Two or more FHR accelerations of at least 15 beats per minute, lasting at least 15 seconds from the beginning of the acceleration to the end, in association with fetal movement, during a 20-minute period
OBSTETRICAL PROCEDURES Induction
Induction is the deliberate initiation of uterine contractions that stimulates labor. Elective induction may be accomplished with an infusion of oxytocin. Obtain baseline tracing of uterine contractions and FHR. Increase IV dosage of oxytocin as prescribed only after assessing contractions, FHR, and maternal blood pressure and pulse. Do not increase rate of oxytocin infusion once the desired contraction pattern (contraction frequency of 2 to 3 minutes and lasting 60 seconds) is obtained. Discontinue oxytocin if contraction frequency is less than 2 minutes, duration is more than 90 seconds, or fetal distress is noted.
Erikson (psychosocial)-age: 6 to 12 years
Industry vs inferiority
Erikson-School-age: 6 to 12 years
Industry vs inferiority
Kohlberg (moral)- Infancy: birth to 1 year
Infant has no awareness of right or wrong
PARENT TEACHING Uncircumcised care of the Newborn
Inform the mother that the foreskin and glans are two similar layers of cells that separate from each other and that the separation process is normally complete between 3 and 5 years of age. Instruct the mother not to pull back the foreskin and to allow the natural separation to occur. Inform the mother that as the process of separation occurs, sterile sloughed cells build up between the layers of the foreskin and the glans. After retraction occurs, daily gentle washing of the glans with soap and water will be sufficient to maintain adequate cleanliness.
Erikson (psychosocial)- Preschool: 3 to 6 years
Initiative vs guilt
ANESTHESIA Lumbar Epidural Block
Injection site in epidural space at L3-L4 Administered after labor is established or just before a scheduled cesarean birth Relieves pain of contractions and numbs vagina and perineum May cause hypotension Does not cause headache because the dura mater is not penetrated Assess maternal blood pressure Mother maintained in side-lying position or with a rolled blanket beneath the right hip to displace the uterus from the vena cava Administration of intravenous fluids as prescribed Increased fluids as prescribed if hypotension occurs Monitor for adverse effects of opioid epidurals (e.g., nausea and vomiting, pruritus, respiratory depression)
ANESTHESIA Subarachnoid (Spinal) Block
Injection site in spinal subarachnoid space at L3-L5 Administered just before birth Relieves uterine and perineal pain and numbs vagina, perineum, and lower extremities May cause maternal hypotension May cause bladder distension and postpartum headache Requires mother to lie flat for 8 to 12 hours after spinal injection Administration of IV fluids as prescribed
Amnion
Inner membrane that encloses the amniotic cavity Appears around the second week of embryonic development Forms a fluid-filled sac that surrounds the embryo and, later, the fetus
breastfeeding postpartum
Instruct mother in breastfeeding procedure. Put the baby to breast as soon as the mother's and baby's conditions are stable (on delivery table, if possible). Stay with the mother each time she nurses until she feels secure or confident with the baby and her feelings. Uterine cramping may occur the first day after delivery while the mother is nursing, when oxytocin stimulation causes the uterus to contract. Use general hygiene and wash the breasts once daily. If engorgement occurs, the mother should breastfeed frequently, apply warm packs before feeding, apply ice packs after feedings, and massage the breasts. The mother should not use soap on the breasts, because it tends to remove natural oils, increasing the likelihood of cracked nipples. If cracked nipples develop, they should be exposed to air for 10 to 20 minutes after feeding, the baby's position should be rotated for each feeding, and the mother should ensure that the baby is latched onto the areola, not just the nipple. The client's bra should be well fitted and supportive. The breasts may leak between feedings or during coitus; place a breast pad in bra. Medications should be avoided unless prescribed. Gas-producing foods and caffeine should be avoided. Hormonal contraceptives may cause a decrease in the milk supply and are best avoided during the 6 weeks after birth. Oral contraceptives containing estrogen are not recommended for breastfeeding mothers; progestin-only birth control pills are less likely to interfere with the milk supply. The baby will develop his or her own feeding schedule.
what should the school age child avoid doing with animals?
Instruct the school-age child to avoid teasing or playing roughly with animals.
Newborn James Nicholas is taken to the nursery for assessment and placed in the infant warmer while he is cleansed. His vital signs are stable, and he settles easily. Before taking the infant back to his mother, the nurse administers an injection of vitamin K. Which injection route and site are appropriate?
Intravenous Subcutaneous, upper arm Intramuscular, dorsogluteal muscle CORRECT: Intramuscular, vastus lateralis muscle RATIONALE: Vitamin K, when administered for the prevention of hemorrhagic disease in the newborn, is given intramuscularly in the vastus lateralis. It is never given as a subcutaneous injection, and intravenous vitamin K is only used in special situations, such as for a preterm infant who does not have any muscle mass to support injections. The dorsogluteal muscle is very small and poorly developed in newborns, and the sciatic nerve is much more prominent at this age. Additionally, the deltoid muscle of a newborn does not have enough mass for an injection. TEST-TAKING STRATEGY: Focus on the subject, the appropriate injection route and site. Note the strategic word appropriate. This indicates the best site for the injection in this situation. Recall the routes of administration for prophylactic vitamin K dosing. Thinking about the physiology of a newborn will also help you answer correctly.
A nurse is providing information to the parents of a 5-month-old infant about introducing solid foods to the infant. Which of the following instructions should the nurse give to the parents?
Introduce one new food at a time at intervals of 4 to 7 days.
Ovulation Induction
Involves the use of medication to induce ovulation Increases the risk of multiple births May cause ovarian hyperstimulation syndrome (OHSS). This is a medical condition that can occur in some women who take fertility medication to stimulate egg growth and in other women in very rare cases. Most cases are mild, but rarely, the condition can be severe and lead to serious illness or death.
LATER ADULTHOOD Mental Health Concerns
Isolation: Client is alone and desires contact with others but is unable to make that contact. Grief: The client perceives loss, including physical, psychological, social, and spiritual aspects. Depression: The increased dependency that older adults may experience can lead to feelings of hopelessness and helplessness, a diminished sense of self-control, and reduced self-esteem and self-worth; these changes may interfere with daily function and lead to depression. Suicide: Any suicide threat by an older client should be taken seriously.
The mother of a newborn is upset because her newborn has a birthmark on the left side of the forehead. The mother, on being told that it is a nevus vasculosus (strawberry mark), asks the nurse whether the mark is permanent. What should the nurse tell the mother?
It is a permanent mark It will need to be removed with surgery It will disappear on its own by the early school years CORRECT: It is nothing to be concerned about because it is so small RATIONALE: Nevus vasculosus (strawberry mark) consists of enlarged capillaries in the outer layers of the skin. It is dark red and raised, with a rough surface, giving it a strawberry appearance. Usually located on the head, a nevus vasculosus may grow larger for 5 to 6 months but usually disappears by the early school years. No treatment is necessary. TEST-TAKING STRATEGY: Eliminate the option that tells the mother that it is nothing to be concerned about, because this is a non-therapeutic statement. For you to select from the remaining options, it is necessary to know that this type of birthmark will disappear.
A client discussing family planning methods with the nurse tells the nurse that she uses the calendar method because her menstrual periods are regular. Which information about the reliability of this method should the nurse provide to the client?
It is unreliable. The calendar method is based on the fact that ovulation occurs approximately 14 days before the onset of menses. It is unreliable because many factors, such as illness or stress, can affect the time of ovulation. In the basal body temperature method, the woman charts her temperature each morning before getting out of bed. The basal body temperature may decrease slightly before ovulation and then increase slightly with ovulation. This method, which is not reliable because errors are frequent, is often used along with other methods. Therefore the other options are incorrect. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike and indicate that the calendar method is a reliable method. Review: the calendar method of contraception.
PHYSICAL EXAMINATION General Guidelines
Keep newborn warm during the examination. Begin with general observations, then perform assessments that are least disturbing to the newborn. Initiate nursing interventions for abnormal findings. Document normal and abnormal findings.
what number should you keep available for infant?
Keep the poison-control hotline number available.
A nurse who has just assisted in the delivery of a newborn infant is providing initial care to the infant. Which action should the nurse take to prevent heat loss by way of conduction in the infant?
Keeping the infant away from drafty areas Keeping the infant away from cold windows CORRECT: Warming the hands before touching the infant Drying the infant as soon as possible after birth RATIONALE: Conduction of heat away from the body occurs when a newborn comes in direct contact with an object that is cooler than his or her skin. Placing an infant on a cold surface or touching the newborn with cold hands or a cold stethoscope causes this type of heat loss. Convective heat loss occurs when heat is transferred to air surrounding the infant. Keeping the infant out of drafts and maintaining warm environmental temperatures help prevent this type of heat loss. Radiation is the transfer of heat to cooler objects that are not in direct contact with the infant. An infant placed near a cold window loses heat by way of radiation. Heat loss by way of evaporation occurs when a wet surface is exposed to air. Drying the infant as soon as possible after birth and after bathing prevents this type of heat loss. TEST-TAKING STRATEGY: Focusing on the strategic words "heat loss by way of conduction" in the question and recalling the definition of conduction will direct you to the correct option.
Freud (psychosexual)-age: 6 to 12 years
Latency stage: focuses on developing peer relationships
What does a decrease in the number and size of sweat glands mean for our patient?
Leads to skin that is dry and flaky- increased risk of wounds
PHYSICAL EXAMINATION Body Measurements of the newborn
Length: 45 to 55 cm (18 to 22 inches) Weight: 2500 to 4300 g (5.5 to 9.5 lb) Head circumference: 33 to 35.5 cm (13 to 14 inches) Chest circumference: 30 to 33 cm (12 to 13 inches); should be equal to or 2 to 3 cm less than the head circumference
A nurse prepares to teach a pregnant woman to perform tailor-sitting exercises. Which instruction should the nurse provide to the client?
Lie flat on the back and place both feet against a wall. Position self on the hands and knees and arch the back five times in a 30-second period. Sit with the legs straight, press the knees toward the floor, and hold the position for 10 seconds. CORRECT: Bend the knees, place the soles together, use the thigh muscles to press the knees to the floor, and hold the position for 5 to 15 minutes. RATIONALE: Tailor-sitting exercises are useful in alleviating heartburn and shortness of breath or dyspnea. The woman sits on the floor, bends her knees, places the soles together, uses her thigh muscles to press the knees to the floor, and holds the position for 5 to 15 minutes. The other options are incorrect descriptions of this exercise. TEST-TAKING STRATEGY: Note the subject of the question, tailor-sitting exercises, and visualize each option. Recalling the purpose of these exercises and noting the strategic words "tailor-sitting exercises" in the question will assist you in answering correctly.
process of labor (Lie)
Lie is the relationship of the spine of the fetus to the spine of the mother.
PHYSICAL EXAMINATION Extremities OF THE NEWBORN
Limbs are flexed, with full range of motion; movements are symmetric. Fists are clenched. Legs are bowed. Major gluteal folds are even. Soles are creased. Assess for fractures (especially clavicle) and dislocations (hip dysplasia). Slight tremors are common but may also signal hypoglycemia or drug withdrawal.
what are the physiological changes associated with the Integumentary System in later adulthood?
Loss of pigment in hair and skin Wrinkling of the skin Thinning of the epidermis and easy bruising and tearing of the skin Decreased skin turgor, elasticity, and subcutaneous fat Increased nail thickness and slowed nail growth Decreased perspiration Dry, itchy, scaly skin Seborrheic dermatitis and keratosis formation
LATER ADULTHOOD Physiological Changes Immnune System
Lymphocyte counts tend to be low. Resistance to infection and disease is decreased. Confusion is a common sign of infection in the older adult, especially infection of the urinary tract.
MIDDLE ADULTHOOD sexuality Changes
Many couples renew their relationships and find increased marital and sexual satisfaction. The onset of menopause and climacteric may affect sexual health. Stress, health, and medications can affect sexuality.
Three weeks after the birth of her baby, Sara, Annie calls her obstetrician's office and speaks to the nurse. She tells the nurse that she has been feeling "hot" and very fatigued, even though she has been resting and has had her husband at home to help with the baby. The nurse asks Annie to come to the office for a checkup, and notes the assessment findings in Annie's record. Based on these assessment findings (refer "Chart" below), what problem does the nurse suspect? Vital Signs Temperature: 100.9° F (oral)Pulse: 110 beats/min Respiratory rate: 14 breaths/min Blood pressure: 118/64 mm Hg Subjective Information "I've been breastfeeding Sara every 4 to 6 hours with no problems, and she seems to be fine." "I've been so tired for the past few days, even though I'm getting sleep, but I haven't been hungry." "My lower belly is very sore. I also noticed that my vaginal discharge has increased and changed back to a brownish color. It's smellier now, too. "I've had no problem passing urine. Objective Information Small amount of lochia, brownish with a strong foul odor, on pad Complains of pain on palpation of lower abdomen No bladder distention noted Uterine fundus nonpalpable Lung sounds clear Urine clear Urinalysis findings normal White blood cell count: 12,000 cells/mm3
Mastitis Influenza CORRECT: Edometritis Bladder infection Endometritis (infection of the uterine lining) is common during the postpartum period. Signs/symptoms include fever, quickened pulse, nausea and anorexia, increased fatigue, lower abdominal pain, uterine tenderness, and increased lochial flow with a strong foul odor. Leukocytosis is also present. Mastitis is a breast infection; there is no information in Annie's record to indicate that mastitis is present. There are no specific data indicating that influenza (flu) is present. If a bladder infection were present, the urine would be cloudy and the urinalysis results would be abnormal. TEST-TAKING STRATEGY: Focus on the subject of the question, feeling "hot" and very fatigued. Thinking about the pathophysiology and signs and symptoms associated with each condition listed in the options will direct you to the correct one.
PHYSIOLOGICAL MATERNAL CHANGES Reproductive System Ovaries
Maturation of new follicles is blocked. Ovum production ceases.
Janice Casey, 27 years old, is pregnant for the third time. She is in her first trimester. Janice's husband has accompanied her to the maternity clinic, and he tells the nurse that he is going to be with Janice throughout labor and delivery. The nurse, obtaining an obstetric history from Janice, notes that her menstrual periods are regular and that her last period was on August 25, 2016. Janice tells the nurse that she has one son, born at 40 weeks' gestation, and one daughter, born at 36 weeks' gestation. She says that these pregnancies progressed normally, without complications. Janice has no history of medical or surgical problems. Her temperature is 98° F (36.7° C), her apical pulse is 80 beats/min, respirations are 18 breaths/min, and blood pressure is 120/78 mm Hg. Janice asks the nurse about her expected date of delivery. Using Nagele's rule, what does the nurse calculate the estimated date of delivery (EDD)?
May 25, 2017 May 31, 2017 CORRECT: June 1, 2017 July 1, 2017 For Nagele's rule to be accurate, the woman must have a regular 28-day menstrual cycle. The nurse subtracts 3 months from the first day of the last menstrual period, adds 7 days, and then adjusts the year as necessary. Subtracting 3 months from August 25, 2016, yields May 25, 2016. Adding 7 days yields June 1, 2016. Adding 1 year to June 1, 2016 brings the EDD to June 1, 2017. TEST-TAKING STRATEGY: Recalling the use of this rule will help you answer the question. Recalling that there are 31 days in the month of May will also help you answer correctly.
Therapies for Infertility Medications
May be prescribed for the man or the woman May be prescribed to improve semen quality, improve erections, induce ovulation, prepare the uterine endometrium, or support the pregnancy once it is established
General Anesthesia
May be used for some surgical interventions Mother not awake Presents the risk of respiratory depression and vomiting
Therapies for Infertility therapeutic insemination
May involve use of the partner's semen or that of a donor to overcome a low sperm count In intrauterine insemination, direct placement of sperm in the uterus is done
THE PROCESS OF LABOR station
Measurement of the progress of descent, in centimeters, above or below the midplane from the presenting part to the ischial spine Station 0: at ischial spine Minus station: above ischial spine Plus station: below ischial spine
Process of Labor: Engagement
Mechanism by which the fetus nestles into the pelvis Also termed lightening or dropping
when does Menstrual periods begin after puberty?
Menstrual periods begin about 2½ years after the onset of puberty.
PHYSIOLOGICAL MATERNAL CHANGES Metabolic and Endocrine Activity
Metabolic function and basal metabolic rate increase. Body weight increases. Thyroid gland enlarges slightly and thyroid activity increases. Parathyroid increases in size. Water retention is increased, contributing to weight gain.
METHODS OF CONTRACEPTION Sterilization
Methods include tubal ligation and vasectomy; sterilization is used by couples who have completed their families. Sterilization should always be considered a permanent end to fertility, because reversal surgery is not always successful. Reversal surgery for tubal ligation increases the risk of ectopic pregnancy. Complications of sterilization include those of any surgery: hemorrhage, infection, and complications of anesthesia. The couple must be informed that complete sterilization by means of vasectomy does not occur immediately and that it may take a month or longer after surgery. The man who has undergone a vasectomy will submit semen specimens for analysis until two successive specimens show that no sperm are present.
Modified-Paced Breathing
Modified-paced breathing is used when slow-paced breathing is no longer effective. Breathing is shallow and fast.
LATER ADULTHOOD: PAIN interventions of Pain
Monitor for signs/symptoms of pain and identify precipitating factor(s) and the pattern of pain. Monitor the impact of the pain on activities of daily living. Provide pain relief through measures such as distraction, relaxation, massage, and biofeedback. Administer pain medication as prescribed, and instruct the client in its use. Evaluate the effects of pain-reducing measures.
POSTPARTUM INTERVENTIONS Nursing Care
Monitor vital signs. Assess height, consistency, and location of fundus. Monitor color, amount, and odor of lochia. Assess breasts for engorgement. Monitor perineum for swelling or discoloration. Monitor episiotomy site for healing. Assess incisions or dressings of client who has given birth by cesarean. Monitor bowel status. Monitor intake and output. Encourage frequent voiding. Encourage ambulation. Administer Rho(D) immune globulin (RhoGAM) as prescribed within 72 hours of delivery to the Rh factor-negative client who has given birth to an Rh-positive newborn. Assess mother's bonding with the newborn. Assess emotional status of the new mother.
what is the developmental stage of Lawrence Kohlberg?
Moral development
Process of Labor: internal rotation
Most commonly from the occiput transverse position, assumed at engagement into the pelvis, to the occiput anterior position while continuously descending
second Maneuver
Move hands downward over each side of the abdomen, applying firm, even pressure. The fetus' back, which is a smooth, hard surface, should be felt on one side of the abdomen. Irregular knobs and lumps, which may be the hands, feet, elbows, and knees, will be felt on the opposite side of the abdomen.
which food plan provides dietary guidelines for children as young as 2 years of age.?
Myplate for kids
PHYSIOLOGICAL MATERNAL CHANGES Gastrointestinal System
Nausea and vomiting may occur as a result of the secretion of human chorionic gonadotropin (hCG). hCG is a hormone produced by the placenta after implantation and is detected in some pregnancy tests. The presence of hCG generally subsides by the third month. Constipation is caused by decreased gastrointestinal (GI) motility or pressure of the uterus or results from iron supplementation. Flatulence and heartburn occur because of decreased GI motility and slowed emptying of the stomach. Hemorrhoids result from increased venous pressure. Gum tissue may become swollen and bleed easily. Ptyalism (excessive secretion of saliva) may occur.
what should you avoid mixing with formula infants?
Never mix food or medications with formula.
can you vigorously shake an infant?
Never vigorously shake an infant.
when are new foods introduced to an infant??
New foods are introduced one at a time, usually at intervals of 4 to 7 days
why are New foods introduced to an infant one at a time, usually at intervals of 4 to 7 days?
New foods are introduced one at a time, usually at intervals of 4 to 7 days, as a means of identifying food allergies.
PHYSICAL EXAMINATION Head and Neurological System of the newborn
Newborn head size is proportionally larger than that of adults because of cephalocaudal development (the head is one fourth of the body length and allows the infant to gain control over the neck muscles so that the head can be held steady). Myelinization of nerve fibers is incomplete, so primitive reflexes are present. Fontanels are open to permit brain growth. Molding, including asymmetry of the head resulting from pressure in the birth canal, may be present; disappears in about 72 hours. Bruises may be present as a result of birth trauma. Caput succedaneum, edema of the soft tissue over bone (crosses over suture line), subsides within a few days. Cephalhematoma, swelling caused by bleeding into an area between the bone and its periosteum, does not cross over suture line; usually absorbed within 6 weeks with no treatment. Head lag is common when newborn is pulled to a sitting position. When prone, newborn should be able to lift the head slightly and turn it from side to side. Assess newborn for abnormal head size and bulging or depressed anterior fontanel. Measure and graph head circumference in relation to chest circumference and length. Assess newborn's movements, noting symmetry, posture, and abnormal movements. Test newborn's reflexes. Observe newborn for jitteriness, marked tremors, and seizures. Assess newborn for lethargy. Assess pitch of cry.
FETAL MONITORING Late decelerations
Non-reassuring pattern that reflects impaired placental exchange or uteroplacental insufficiency Resemble early decelerations but begin well after the contraction begins; fetal heart rate returns to baseline after the contraction ends The degree of decrease in the rate from baseline is not related to the degree of uteroplacental insufficiency. Interventions include improving placental blood flow and fetal oxygenation.
Which intervention does the nurse immediately implement for James Nicholas on the basis of his 1-minute Apgar score?
None Preparing for neonatal resuscitation Supporting spontaneous respiratory efforts CORRECT: Gently stimulating the infant by rubbing his back and administering oxygen RATIONALE: The Apgar scoring method is used for quick evaluation of the newborn infant's cardiorespiratory adaptation after birth. A 1-minute score of 4 to 7 means that the nurse should take measures to stimulate the infant, such as gently rubbing the infant's back, while administering oxygen. Resuscitation is necessary for scores of 0 to 3. For Apgar scores of 8 to 10, no action is needed except for continued observation and support of the infant's own spontaneous efforts. TEST-TAKING STRATEGY: Focus on the strategic word "immediately" and consider the appropriate interventions for a newborn with an Apgar score of 6. Recalling that the Apgar score ranges from 0 to 10, with 10 being the best possible score, will help you answer correctly.
Doppler Blood Flow Analysis
Noninvasive Doppler ultrasonography is used to study the blood flow in the fetus and placenta.
why does an older adult in later adulthood have Thickening, and increased rigidity of heart valves?
Normal changes in the heart include deposits of the "aging pigment," lipofuscin. The heart muscle cells degenerate slightly. The valves inside the heart, which control the direction of blood flow, thicken and become stiffer. A heart murmur caused by valve stiffness is fairly common in older people.
Types of Pelvis Gynecoid
Normal female pelvis Transversely rounded or blunt Most favorable for successful labor and birth
Lesson 5: Maternity Client: Intrapartum Care PRIORITY POINTS TO REMEMBER!
Normal labor is characterized by a consistent progression of contractions, cervical dilation and effacement, and fetal descent. In true labor, contractions increase in duration and intensity. In false labor, contractions are irregular and do not produce dilation, effacement, or descent. If fetal bradycardia or tachycardia occurs, change the position of the mother and administer oxygen, then assess the mother's vital signs; the primary health care provider is notified immediately. Decreased variability may result from fetal hypoxemia, acidosis, or the use of certain medications. Interventions for late decelerations include improving placental blood flow and fetal oxygenation. Assess the color of the amniotic fluid if the membranes have ruptured, because meconium-stained fluid may indicate fetal distress. If the membranes rupture, the priority nursing action is to assess the fetal heart rate. Monitor lochia discharge. Lochia may be red and moderate in amount in stage 4. General anesthesia presents a danger of respiratory depression, vomiting, and aspiration. An oxytocin infusion is discontinued if uterine contraction frequency is less than 2 minutes or duration is longer than 90 seconds, or if fetal distress is noted.
PHYSICAL EXAMINATION Hepatic System of the newborn
Normal or physiological jaundice appears after the first 24 hours in the full-term newborn and after the first 48 hours in the premature newborn; jaundice occurring before this time (pathological jaundice) may indicate early red blood cell hemolysis and must be reported to the primary health care provider. Feed newborn early to stimulate intestinal activity and to keep the bilirubin level low. Assess newborn for jaundice: apply pressure with a finger on the nose, forehead, or sternum for several seconds to empty all capillaries; if jaundice is present, the blanched area will appear yellow before capillaries fill. Prevent chilling; hypothermia can cause acidosis, which interferes with bilirubin conjugation and excretion. The liver stores iron passed from the mother for 5 to 6 months. The newborn is at risk for hemorrhagic disorders; coagulation factors synthesized in the liver are dependent on vitamin K, which is not synthesized until intestinal bacteria are present. Handle the newborn carefully and monitor him or her for any bruising or bleeding episodes. Administer an intramuscular dose of vitamin K (usually 0.5 to 1 mg) in the lateral aspect of the middle third of the vastus lateralis muscle to the newborn as prescribed to help prevent hemorrhagic disorders.
PHYSICAL EXAMINATION skin of the newborn
Normal skin ranges from pinkish red (light-skinned newborn) to pinkish brown or pinkish yellow (dark-skinned newborn); a dark-red color is common in premature newborns. Vernix caseosa, lanugo, and milia may all be present. Dry, peeling skin may be seen as well. Cyanosis is common with hypothermia, infection, and hypoglycemia and with cardiac, respiratory, and neurological abnormalities. Acrocyanosis (peripheral cyanosis), which results from poor perfusion of blood to the periphery of the body, is normal in the first few hours after birth or if the infant becomes cold. Assess newborn for ecchymosis and petechiae resulting from the trauma of birth; if applicable, look for forceps marks. Assess skin turgor over the abdomen to determine hydration status.
PHYSICAL EXAMINATION Chest, Respiratory System, Cardiovascular System of the newborn
Note that the chest appears circular because the anteroposterior and lateral diameters are roughly equal. Make sure that the nipples are prominent; they may appear edematous. Also, note if there is any white discharge, which is common. Note that breast tissue is present. Palpate the clavicles for fractures. Count respirations, which appear diaphragmatic, for 1 full minute. Bronchial sounds are usually heard on auscultation. Position the newborn on side. Suction, as necessary. Observe the neonate for signs/symptoms of respiratory distress and hypoxemia; administer oxygen, using a hood, if necessary and as prescribed. Assess the apical heart rate for 1 full minute. Listen for murmurs. Palpate pulses. Assess for cyanosis; blanch skin on trunk and extremities to assess circulation.
A nurse calculates an infant's Apgar score 1 minute after birth and obtains a score of 8. Based on this finding, which action should the nurse take?
Notifying the infant's pediatrician Administering oxygen to the infant CORRECT: Recalculating the infant's Apgar score 5 minutes after birth Attempting to stimulate the infant by rubbing the infant's back RATIONALE: The nurse calculates the infant's Apgar score at 1 and 5 minutes after birth for rapid evaluation of early cardiopulmonary adaptation. If the score is between 8 and 10, no intervention is needed except for support of the infant's spontaneous efforts. If the score is between 4 and 7, the nurse gently stimulates the infant by rubbing his or her back and administers oxygen to the infant. A score between 0 and 3 indicates the need for resuscitation. TEST-TAKING STRATEGY: Eliminate options that are comparable or alike and indicate the need for intervention.Review: the Apgar score and appropriate interventions on the basis of the score.
A nurse in a prenatal clinic, performing an initial assessment of a pregnant client, is using Nagele's Rule to determine the client's estimated date of delivery (EDD). The client tells the nurse that her last menstrual period (LMP) began on February 10, 2016. What EDD does the nurse calculate with this information?
November 17, 2016 RATIONALE: for Nagele's Rule to be accurate, the woman must have a regular 28-day menstrual cycle. The nurse would subtract 3 months and then add 7 days to the first day of the LMP, then add 1 year to that date. Subtracting 3 months from February 10, 2016 is November 10, 2015. Adding 7 days to November 10, 2015 is November 17, 2015. Adding 1 year to November 17, 2015 yields the correct answer, November 17, 2016. TEST-TAKING STRATEGY: Use of Nagele's Rule to calculate the EDD will direct you to the correct option.
NUTRITIONAL COUNSELING
Nutritional needs depend on the mother's pre-pregnancy weight, the ideal weight for her height, and whether she is breastfeeding. If the mother is breastfeeding, calorie needs are increased by approximately 200 to 500 calories per day as prescribed by the primary health care provider, and the mother may require increased fluids and the continuation of prenatal vitamins and minerals.
The mother of a 4-year-old child calls the clinic nurse and expresses concern because the child has been masturbating. In considering the child's developmental stage, the nurse should determine that this is an expected finding. Using Freud's psychosexual stages of development, use the list of options to choose the behaviors to the associated stage that can be taught to the mother to alleviate her concerns.
ORAL- focus is on oral gratification and mouth-sucking and swallowing. ANAL- gains a sense of control over instinctive drives and withholding or expelling feces. PHALLIC- becomes aware of self as a sexual being and masturbation is common. LATENT- developing peer relationships with little to no sexual motivation present. GENITAL- develops relationships with people of the opposite sex. RATIONALE: According to Freud's psychosexual stages of development, the oral phase is associated with oral gratification and mouth-sucking and swallowing. In the anal stage, the child gains a sense of control over instinctive drives characterized by withholding or expelling feces. In the phallic stage, the child becomes aware of self as a sexual being and devotes much energy to examining genitalia, masturbating, and expressing interest in sexual concerns. The latent focuses on developing peer relationships with little to no sexual motivation, and in the genital stage the individual focuses with developing relationships with people of the opposite sex. The nurse should alleviate the mother's concern by telling the mother that this behavior, masturbation, is normal. TEST-TAKING STRATEGY: Focus on the subject, Freud's psychosexual stages of development. Make connections between the name of each stage and the action or behavior noted within that stage; this will assist in answering correctly.
INITIAL CARE Assessment of the newborn
Observe or assist with initiation of respirations. Calculate Apgar score. Note characteristics of cry. Monitor newborn for nasal flaring, grunting, retractions, and abnormal respirations. Obtain vital signs. Observe newborn for signs of hypothermia or hyperthermia. Assess newborn for gross anomalies.
DIAGNOSTIC TESTS Amniocentesis implementation
Obtain informed consent. If the client is less than 20 weeks pregnant, she should have a full bladder to support the uterus; if amniocentesis is being performed after 20 weeks' gestation, the client should have an empty bladder to minimize the chance of puncture. Prepare the client for ultrasonography, which is performed to locate the placenta and avoid puncture. Obtain baseline vital signs and fetal heart rate (FHR); monitor every 15 minutes. Position the client supine during the exam and on the left side after the procedure. Instruct the client to notify the primary health care provider or nurse-midwife if chills or fever develops, fluid leaks from the needle-insertion site, fetal movement decreases, or uterine contractions occur. Rh-negative women may be given RhoGAM to counter risks related to the procedure.
DIAGNOSTIC TESTS Chorionic Villus Sampling (CVS) implementation
Obtain informed consent. Instruct the client to drink water to fill her bladder before the procedure to aid in positioning the uterus for catheter insertion. Instruct the client to report bleeding, infection, or leakage of fluid at the insertion site after the procedure. Because CVS increases the risk of Rh sensitization, Rh-negative women may be given Rho(D) immune globulin (RhoGAM).
Fertilization
Occurs in the upper region of the fallopian tubes within 12 hours of ovulation and 2 to 3 days of insemination, which are the average durations of viability for the ovum and sperm, respectively. Once the ovum is fertilized, its membrane undergoes changes that prevent the entry of other sperm. Sperm carry an X and a Y chromosome: XY is male, XX female.
what should toddlers avoid in regards to food?
Offer a limited number of foods at any one time; avoid concentrated sweets and empty calories.
how do you prevent bottle-mouth caries?
Offer fruit juice from a cup. rather than a bottle, to prevent bottle-mouth caries
why does an older adult have Dry, itchy, scaly skin?
Older adults may have decreased extracellular water, surface lipids, and sebaceous gland activity, leading to dry skin
ADAPTATION TO NEW FAMILY MEMBERS Adaptation of Older Children
Older children are more aware of changes in the mother's body that show that a baby is to be born. Older children look forward to the baby's arrival and expect the infant to be a playmate. Older children (school age) generally enjoy taking responsibility for the care of a younger sibling. Children should be encouraged to feel the fetus move and may benefit from sibling classes, which provide an opportunity for children to discuss the changes the new baby will mean for the family.
A pregnant woman expresses concern to the nurse about how her 10-year-old daughter will adapt to a newborn's introduction into the home. Which response should the nurse make to the woman?
Older school-age children often enjoy taking responsibility for the care of a younger sibling. Older school-age children often enjoy taking responsibility for the care of a younger sibling. The nurse would appropriately teach the pregnant woman measures to deal with adaptation to a new infant. The information in the other options is inaccurate. TEST-TAKING STRATEGY: Eliminate the options, using the closed-ended words "always" and "must." Focusing on the age of the daughter will assist you in choosing correctly from the remaining options. Review: content related to sibling adaptation to a new family member.
Oral Contraceptives Medication Interactions
Oral contraceptives should be avoided by women using hepatotoxic medications. The pill interferes with the activity of bromocriptine mesylate and anticoagulants and increases the toxicity of tricyclic antidepressants. Antibiotics may decrease the absorption and effectiveness of oral contraceptives.
Freud (psychosexual)- Infancy: birth to 1 year
Oral gratification
which factors bear on selection of a contraceptive method?
Other factors that bear on selection of a contraceptive method include family planning goals, age, frequency of intercourse, the individual's ability to comply with the therapy, and cultural and religious preferences
Chorion
Outer membrane Becomes vascularized and forms the fetal part of the placenta
Anthropoid pelvis
Oval Adequate outlet and normal or moderately narrow pubic arch
postpartum changes to Ovarian Function and Menstruation
Ovarian function depends on the rapidity with which pituitary function is restored. Menstrual flow resumes within 8 weeks in non-breastfeeding mothers. Menstrual flow usually resumes within 3 to 4 months in breastfeeding mothers. Breastfeeding mothers may experience amenorrhea during the entire period of lactation. Women may ovulate without menstruating, so breastfeeding should not be considered a form of birth control.
Diagnostic Tests in Infertility women
Ovulation prediction Ultrasonography Postcoital test Endocrine function tests Hysterosalpingography Endometrial biopsy Hysteroscopic laparoscopy
PHYSIOLOGICAL MATERNAL CHANGES Respiratory System
Oxygen consumption increases by 15% to 20%. Diaphragm is elevated because of the enlarged uterus. Respiratory rate remains unchanged, but shortness of breath may be experienced by the pregnant woman.
Telangiectatic nevii (stork bites)
Pale pink or red, flat, dilated capillaries On eyelids, nose, lower occipital bone, and nape of neck Blanch easily More noticeable during crying periods Disappear by age 2 years
Parity
Parity is the number of births (not the number of fetuses—e.g., twins) carried past 20 weeks' gestation, whether or not the fetuses were born alive. A nullipara is a woman who has not had a birth at more than 20 weeks of gestation. A primipara is a woman who has had one birth that occurred after the 20th week of gestation. A multipara is a woman who has had two or more pregnancies resulting in viable offspring.
PHYSICAL EXAMINATION Immune System OF THE NEWBORN
Passive immunity (IgG) is received by way of the placenta. Passive immunity (IgA) is received in colostrum. An increase in IgM indicates infection in utero. Use aseptic technique when caring for the newborn. Observe standard precautions when handling the newborn. Perform meticulous handwashing and wear a gown when caring for the newborn. Ensure that infection-free staff cares for the newborn. Monitor the newborn's temperature. Observe the newborn for any cracks or openings in the skin. Administer eye medication within 1 hour of birth to prevent ophthalmia neonatorum.
Pattern-Paced Breathing
Pattern-paced breathing sometimes is referred to as pant-blow. After a certain number of breaths (modified-paced breathing), the woman exhales with a slight blow and then begins modified-paced breathing again.
EARLY ADULTHOOD Cognitive Changes
People in this group generally demonstrate rational thinking habits. Conceptual, problem-solving, and motor skills have improved. Preferred occupational areas are being identified.
MIDDLE ADULTHOOD Cognitive Changes
People in this group may become interested in learning new skills, possibly through educational or vocational programs for people entering the job market or changing careers.
STAGES OF LABOR: ASSESSMENT AND INTERVENTIONS Stage 2 Interventions Throughout Stage 2
Perform assessments every 5 minutes. Monitor maternal vital signs. Monitor FHR with the use of Doppler ultrasound, a fetoscope, or an electronic fetal monitor. Assess FHR before, during, and after a contraction, keeping in mind that normal FHR is 110 to 160 beats/min. Assess uterine contractions by means of palpation or with the use of a monitor, determining frequency, duration, and intensity. Provide mother with encouragement and praise and provide for rest between contractions. Keep mother and partner informed of progress. Maintain privacy. Provide ice chips and ointment for dry lips. Assist mother into a position that promotes comfort and assists pushing efforts, such as the lithotomy position, semisitting, kneeling, side-lying, or squatting, Monitor mother for signs/symptoms of approaching birth, such as perineal bulging or appearance of the fetal head. Prepare for birth. After the birth, provide initial newborn care. Assess mother for shivering and provide warmth as needed . Promote parental-neonatal attachment.
Cesarean delivery Ater surgery interventions
Perform general postoperative assessments and interventions. Burning and pain on urination may indicate a bladder infection. A tender uterus and foul-smelling lochia may indicate endometritis. A productive cough or chills may indicate pneumonia. Pain, redness, or edema of an extremity may indicate thrombophlebitis.
Cesarean delivery before surgery interventions
Perform general preoperative assessments and interventions. If surgery was planned, prepare the mother and partner. If the surgery will be performed on an emergency basis, quickly explain the procedure and why it is needed to the mother and partner. Make sure that preoperative diagnostic tests, including the Rh factor, are performed.
After the procedure:
Perform non-stress test to evaluate fetal well-being. Monitor client for uterine activity, bleeding, ruptured membranes, and decreased fetal activity. In Rh-negative clients, perform Kleihauer-Betke test as prescribed to detect the presence and amount of fetal blood in the maternal circulation and to identify clients who need additional RhoGAM.
A nurse teaches a pregnant woman how to perform Kegel exercises to help maintain bladder control. Which instruction should the nurse provide? Select all that apply.
Perform the exercise while urinating. Perform the exercise once only after urinating. CORRECT: Repeat the contraction-relaxation cycle 30 times a day. CONTRACT: Contract the muscles around the vagina and hold for 10 seconds, then relax the muscles for 10 seconds. Continuously contract and relax the muscles around the vagina at least 30 times and perform the exercise three times a day. RATIONALE: Kegel exercises improve tone of the muscles of the pelvic floor and help maintain bladder control. They are not performed during urination, because urine retention increases the risk of urinary tract infection. The woman is taught to contract the muscles around the vagina and hold for 10 seconds, then relax the muscles for 10 seconds. The contraction-relaxation cycle is repeated 30 times a day. TEST-TAKING STRATEGY: Eliminate the option that contains the closed-ended word "only." To select from the remaining options, visualize each and think about the purpose of Kegel exercises. This will direct you to the correct options.
DIAGNOSTIC TESTS Non Stress Test (NST) Description
Performed to assess placental function and oxygenation Used to determines fetal well-being Enables evaluation of FHR in response to fetal movement
That evening, during an assessment, the nurse finds that Annie's uterine fundus is above the umbilicus and to the left of the midline of the abdomen. What action by the nurse is a priority?
Performing fundal massage Performing a sterile urinary catheterization Assessing the lochia on Annie's perineal pad CORRECT: Assisting Annie to the bathroom to help her void RATIONAL: A full bladder causes the uterus to be displaced above the level of the umbilicus and off to one side of the midline of the abdomen. It may also lead to uterine atony, because it prevents the uterus from contracting normally. The priority nursing intervention is to assist the woman in emptying her bladder as soon as possible, either by taking her to the bathroom or offering a bedpan if she is not ambulatory. Fundal massage should be performed, if the fundus is boggy, once the bladder has been emptied. Catheterization is done only if the woman is unable to void after measures have been taken to encourage urination. Assessing the lochia does not address the problem. TEST-TAKING STRATEGY: Note the strategic word "priority" in the question. Knowledge regarding the correct position of the uterine fundus after delivery, as well as what might cause the fundus to be located to the side, is needed to answer this question. Remember that a full bladder causes the uterus to be located above the level of the umbilicus and to one side of the midline of the abdomen.
LATER ADULTHOOD period
Period between 65 years and death; also referred to as older adulthood
age range of early adulthood
Period between the late teens and the middle to late thirties
MIDDLE ADULTHOOD period
Period between the middle to late thirties and the middle sixties
Freud (psychosexual)- Preschool: 3 to 6 years
Phallic stage: becomes aware of self as sexual being
why does an older adult have Slowed reflexes?
Physical changes in nerve fibers slow the speed of conduction. And the parts of the brain involved in motor control lose cells over time.
physical changes of early adulthood
Physical growth is usually complete by age 20. People in this group are generally quite active. Severe illnesses are less common than in older groups, but people in early adulthood tend to ignore physical signs/symptoms and postpone seeking health care. Lifestyle habits such as smoking, stress, lack of exercise, poor personal hygiene, and family history of disease increase the risk of future illness.
Stage 4 of labor
Physical recovery; 1 to 4 hours after delivery
Cholasma
Pigmented area of the face (mask of pregnancy)
when should the oral contraceptive be taken each day?
Pills should be taken at the same hour each day.
PHYSICAL EXAMINATION Reflexes Palmar-Plantar Grasp
Place a finger in the palm of the newborn's hand, then place a finger at the base of the toes; the newborn's fingers curl around the examiner's fingers and the toes curl downward. Palmar response lessens by 3 to 4 months. Plantar response lessens by 8 months.
Third Maneuver
Place hand above the symphysis pubis. Bring thumb and fingers together and grasp the part of the fetus between them (may be either the head or the buttocks).
Fourth Maneuver
Place hands on the sides of the lower abdomen, close to the midline. Slide hands downward and press inward. If it has been determined that the buttocks are in the fundus, feel for the head. If the head cannot be felt, it has probably descended.
First Maneuver
Place palms on each side of the upper abdomen and palpate around the fundus. If the head is in the fundus, a hard, round, movable object is palpable . The buttocks will feel soft, with an irregular shape, and are more difficult to move.
PHYSICAL EXAMINATION Reflexes crawling
Place the newborn on his or her abdomen. The newborn begins making crawling movements with the arms and legs. The crawling reflex usually disappears around 6 weeks of age.
Which precautions should the nurse take to prevent newborn abduction? Select all that apply.
Placing the newborn's crib close to the mother's door Instructing the mother to carry the newborn to the nursery after feeding Closing the hospital room door if the infant needs to be left unattended CORRECT: Questioning unknown person(s) who are carrying large bags or packages CORRECT: Ensuring that all health care personnel wear proper name (identification) badges RATIONALE: Precautions to prevent infant abduction include placing a newborn's crib away from the door, transporting a newborn only in the crib and never carrying the newborn, expecting health care personnel to wear identification that is easily visible at all times, and asking a nurse to attend to the newborn if no one is available to watch the newborn (the newborn is never left unattended). The nurse should monitor the environment closely and question any suspicious or unknown person, especially one carrying a large bag or package that could contain an infant. TEST-TAKING STRATEGY: Focus on the subject, precautions for preventing infant abduction. Read each option carefully and select the options that provide protection to the infant. This will direct you to the correct options.
school age child play
Play is more competitive. Rules and rituals are important aspects of play and games. The school-age child enjoys drawing, collecting items, dolls, pets, guessing games, board games, listening to the radio, TV, reading, and videos and computer games. Many children of this age participate in team sports. School-age children also enjoy secret clubs, gang activities, and scouting organizations.
Nonstress Test: Unsatisfactory Result
Poor quality of the FHR tracing prevents interpretation
DIAGNOSTIC TESTSS Fern Test implementation
Position the client in the dorsal lithotomy position. Instruct the client to cough, which will cause fluid to leak from the uterus if the membranes have ruptured. Under sterile technique, a specimen is obtained from the external portion of the cervix and vaginal pool, then examined on a slide under a microscope. A fernlike pattern, caused by the salts in the amniotic fluid, indicates the presence of amniotic fluid.
Dorsal Lithotomy Position
Position used for examination of pelvic organs. For example, delivery of baby, ob/gyn exam.
dorsal lithotomy position.
Position used for examination of pelvic organs. For example, delivery of baby, ob/gyn exam.
Kohlberg (moral)- Adolescent: 12 to 20 years
Post conventional: focuses on individual rights and principles of conscience
Kohlberg (moral)- Preschool: 3 to 6 years
Preconventional: conforms to rules to avoid punishment
Piget (cognitive development)- Preschool: 3 to 6 years
Preoperational (2 to 7 years)
Piget (cognitive development)-Toddler: 1 to 3 years
Preoperational (2 to 7 years)
safety for preschoolers
Preschoolers are active and inquisitive (magical thinking). Children of this age can learn simple safety practices because they can follow simple and verbal directions and their attention span is longer. Refer to the American Academy of Pediatrics for information on car safety. Teach the preschooler basic safety rules to ensure safety when playing in a playground near swings and ladders. Never allow the preschooler to play with matches or lighters. The preschooler should be taught what to do in the event of a fire or if clothes catch fire; fire drills should be conducted. Guns should be stored unloaded and secured under lock and key; the preschooler should be taught to leave an area immediately if a gun is seen and to tell an adult. The preschooler should be taught never to point a toy gun at another person. Teach the preschooler that if another person touches his or her body in an inappropriate way, he or she should tell an adult. Teach the preschooler to avoid speaking to strangers and to never accept a ride, toys, or gifts from a stranger. Teach the preschooler his or her full name, address, parents' names, and telephone number. Teach the preschooler how to dial 911 in an emergency situation. Keep the poison-control hotline number available.
What is the preoperational stage?
Preschoolers use their capacity for symbolic thought to develop language, engage in pretend play, and solve problems. But their thinking is not yet logical They are egocentric (unable to take others' perspectives) and are easily fooled by perceptions, failing conservation problems because they cannot rely on logical operations.
Fetal Circulation Bypass
Present because of the fetus' nonfunctioning lungs, bypasses must close after birth to allow blood to flow through the lungs and the liver. The ductus arteriosus connects the pulmonary artery to the aorta, bypassing the lungs. The ductus venosus connects the umbilical vein and inferior vena cava, bypassing the liver. The foramen ovale is the opening between right and left atria of heart, bypassing the lungs.
Process of Labor: flexion
Process of the fetal head's nodding forward, toward the fetal chest
what are the interventions for vaginal discharge in all three trimesters of pregnancy?
Proper cleansing and hygiene are important. The client should wear cotton underwear. Douching should be avoided. The client should be advised to consult the primary health care provider or nurse-midwife if infection is suspected.
THE PROCESS OF LABOR Breathing Techniques
Provide a focus during contractions, interfering with transmission of pain sensation. Begin with simple breathing patterns and progress to more complex ones as needed. Promote relaxation and oxygenation.
Joanna Burns has brought her 2-year-old son, Joel, to the well-baby clinic for a scheduled visit. She expresses concern to the nurse about her son's behavior, telling the nurse that she has a great deal of difficulty getting Joel to bed at night. Joel throws temper tantrums to postpone the event, she reports. Joanna also tells the nurse that because of this behavior she is worried about being able to toilet-train Joel. Joanna asks the nurse about strategies to deal with Joel's behavior. What should the nurse tell Joanna?
Provide a quiet activity for 30 minutes before bedtime Toddlers often resist going to bed by stalling or even throwing temper tantrums to postpone the event. Firm, consistent limits are needed when toddlers try stalling tactics. Warning the child a few minutes before it is time for bed may reduce bedtime protests. Winding down with a quiet activity for 30 minutes before bedtime also helps the toddler prepare for sleep. Bedtime rituals are important and should be followed consistently. Daytime naps do not need to be avoided; a balance of activity, rest, and sleep is important. Avoiding high-carbohydrate snacks and excitement before bedtime promotes relaxation. TEST-TAKING STRATEGY: Eliminate the option containing the closed-ended word "any." Next, recall that carbohydrates provide energy and eliminate this option. To choose from the remaining options, remember that allowing the child to use stalling tactics will promote resistance at bedtime rather than prevent it. Review: bedtime rituals for the toddler and strategies to promote sleep.
middle adulthood stage Erik Erikson
Psychosocial crisis: generativity versus stagnation Task: fulfilling life goals that involve family, career, and society Successful resolution: ability to give and care for others and guide others Unsuccessful resolution: self-absorption; inability to grow as a person
later adulthood stage Erik Erikson
Psychosocial crisis: integrity versus despair Task: looking back over one's life and accepting its meaning Successful resolution: sense of integrity and fulfillment Unsuccessful resolution: dissatisfaction with life
early adulthood stage Erik Erikson
Psychosocial crisis: intimacy versus isolation Task: establishing intimate bonds of love and friendship Successful resolution: ability to love deeply and commit oneself to a relationship Unsuccessful resolution: emotional isolation, egocentricity
what is puberity?
Puberty is the maturational, hormonal, and growth process that occurs when the reproductive organs begin to function and secondary sex characteristics develop.
PHYSICAL EXAMINATION Reflexes Pull-to-Sit Reflex
Pull the newborn up from the wrist while the newborn is in the supine position with the head in midline. The head will lag until the newborn is in an upright position, after which the head will be level with the chest and shoulders momentarily before falling forward. The newborn will then attempt to lift the head for a few minutes. The response depends on the newborn's general muscle tone and condition, as well as maturity level.
Kohlberg (moral)-Toddler: 1 to 3 years
Punishment and obedience orientation
Penny Martin, age 29, has been admitted to the birthing center with contractions, which, she reports, have been 3 minutes apart and regular for 2 hours. This is the first pregnancy for Penny and her husband, Gilbert, and they tell the nurse that they have eagerly looked forward to the baby's arrival after 4 years of trying to conceive. Examination reveals that Penny is 100% effaced and dilated to 4 cm. The membranes are bulging but intact. Penny exclaims, "I can't wait to get this over with! We've looked forward to this for so long!" Her vital signs: blood pressure 122/78 mm Hg; pulse 78 beats/min, respirations (between contractions) 16 breaths/min, temperature 98.2° F (36.8° C). Penny is admitted to the labor room in the first stage of labor. Which breathing pattern should the labor room nurse teach Gilbert so that he may coach Penny?
Pushing in short bursts when the urge is very strong Exhaling small amounts of air through an open glottis during pushing CORRECT: A deep inspiration and expiration at the beginning and end of each contraction Taking a cleansing breath at the beginning of a contraction, holding her breath, then pushing as hard as she can for as long as possible RATIONAL Breathing exercises provide a focus during contractions, interfering with the transmission of pain sensation. During the first stage of labor, the client uses cleansing breaths (a deep inspiration and expiration at the beginning and end of each contraction), slow-paced breathing, modified-paced breathing, pattern-paced breathing, and breathing to prevent pushing. If the woman pushes strenuously before the cervix is completely dilated, she risks injury to the cervix and fetal head. TEST-TAKING STRATEGY: Note the subject, the first stage of labor. Note that the breathing patterns identified in the incorrect options are comparable or alike in that they are all breathing exercises that involve pushing.
The nurse immediately assesses the newborn infant to determine the Apgar score and records the findings. Nursing Assessment Notes, Heart rate: 130 beats/min, Respiratory effort: weak cry, Muscle tone: minimal flexion of extremities, Reflex irritability: Grimacing in response to nasal/oral bulb suction, Skin color: Normal body skin but blue extremities. The nurse, using the Apgar scoring chart, calculates James Nicholas' 1-minute Apgar score. What is it? Type the score in fill in the blank.
RATIONAL: 6 The Apgar score is a method used to express the findings of a rapid assessment of the newborn as he or she enters extrauterine life. The five categories are heart rate (counted apically with the use of a stethoscope or by means of palpation of the umbilical cord), respiratory effort (by means of observation of respiration and crying effort), muscle tone (based on the degree of movement and flexion of the extremities), reflex irritability (based on the newborn's response to bulb/catheter suction of the nasopharynx), and general skin color. Apgar evaluations are made at 1 and 5 minutes after birth. TEST-TAKING STRATEGY: Focus on the subject, the Apgar score. Use the Apgar scoring chart to match the assessment findings to the score for each category, then calculate the total score.
Process of Labor: restitution
Realignment of the fetal head with the body after the head emerges
Ballotment
Rebounding of the fetus against the examiner's finger on palpation. When the examiner taps the cervix, the fetus floats upward in the amniotic fluid.
what are the interventions for fatigue during the first and third trimesters?
Recommend that the client arrange for frequent rest periods throughout the day. The client should get regular exercise. Teach client to perform muscle-relaxation and strengthening exercises for the legs and hip joints. The client should avoid eating and drinking foods containing stimulants throughout pregnancy.
LATER ADULTHOOD Physiological Changes Respiratory System
Reduced stretch and compliance of the chest wall Reduced strength and function of respiratory muscles Decreased size and number of alveoli Decreased depth of respirations and oxygen intake Diminished ability to cough and expectorate sputum
Pica
Refers to eating nonfood substances; cultural values such as beliefs regarding the effect of a material on the mother or fetus may make pica a common practice; iron deficiency may occur.
school aged child skills
Refinement of fine motor skills Continued development of gross motor skills Increased strength and endurance
how is regular dental care essential for preschoolers?
Regular dental care is essential, and the preschooler requires assistance with brushing and flossing of teeth; a fluoride supplement may be necessary.
how can you prevent dental caries in a school- aged child?
Regular dentist visits are necessary, and the school-age child must be supervised while brushing and flossing teeth; fluoride supplements may be necessary
THE PROCESS OF LABOR Position
Relationship of assigned area of the presenting part or landmark to the maternal pelvis
what should you remove from the patients reach?
Remove chemicals, medications, poisons, and plants from the infant's reach.
POSTPARTUM PERIOD
Reproductive tract returns to normal, non-pregnant state Starts immediately after delivery and is usually complete by week 6 after delivery
LATER ADULTHOOD: PAIN assessment of Pain
Restlessness Verbal reporting of pain Agitation Moaning Crying
why does nausea and vomiting occur in the first trimester of pregnancy?
Results from increased hCG levels and changes in carbohydrate metabolism
Why is Rh factor type is important to determine?
Rh factor type is important to determine because if the mother is Rh-negative and delivers an Rh-positive fetus, an antigen-antibody reaction can occur that causes the destruction of fetal red blood cells.
why is RH factor performed on a pregnant woman?
Rh factor typing is conducted to determine the presence or absence of Rh antigen (Rh-positive or Rh-negative).
lochia assessment postpartum
Rubra is a bright-red discharge that appears from delivery day to day 3. Serosa is a brownish-pink discharge that appears on days 4 to 10 after delivery. Alba is a white discharge that appears on days 10 to 14 after delivery. Normally the discharge has a fleshy odor. Discharge diminishes daily but may increase with ambulation. Weigh perineal pad before and after use and identify the amount of time between pad changes to most accurately determine the amount of lochial flow.
Joanna Burns has brought her 2-year-old son, Joel, to the well-baby clinic for a scheduled visit. She expresses concern to the nurse about her son's behavior, telling the nurse that she has a great deal of difficulty getting Joel to bed at night. Joel throws temper tantrums to postpone the event, she reports. Joanna also tells the nurse that because of this behavior she is worried about being able to toilet-train Joel. Joanna asks the nurse about strategies to deal with Joel's behavior. Joanna asks the nurse how to deal with Joel's bedtime temper tantrums. Which strategy should the nurse recommend to Joanna?
Safely isolating Joel and ignoring the temper tantrum Temper tantrums, a common toddler response to anger and frustration, are often a result of thwarted attempts at exerting mastery and autonomy. Generally the most effective method of handling a tantrum is to safely isolate and ignore the child. The child should learn that nothing, not even attention, is gained from a tantrum. Giving in to the child's demands or scolding and punishing the child will only worsen the behavior. Toddlers stop using tantrums when they do not achieve their goals and as their verbal skills increase. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike in that they involve punishment for Joel's behavior. From the remaining options, recall that giving in to a child's demands is not helpful in extinguishing a tantrum. Also, note the strategic word "safely" in the correct option. Review: measures for dealing with temper tantrums.
LABORATORY TESTS Hepatitis B Surface Antigen
Screening for hepatitis B infection is recommended for all women because of the prevalence of the disease in the general population.
Sexually Transmitted Infections syphillis
Screening is performed during the initial prenatal examination and may be repeated during the third trimester in high-risk clients.
where should you seat the child during meals?
Seat the toddler in a high chair at the family table for meals.
what objects help the toddler prepare for sleep?
Security objects may also help the toddler get to sleep.
Diagnostic Tests in Infertility Men
Semen analysis Endocrine function tests Ultrasonography Testicular biopsy Sperm-penetration assay Hemizona assay
Piget (cognitive development)- Infancy: birth to 1 year
Sensorimotor (birth to 2 years)
Stage 3 of labor
Separation and expulsion of the placenta
A pregnant woman at 20 weeks' gestation calls the nurse at the maternity clinic and reports that she has noticed a white fluid draining from her nipples. What should the nurse tell the client?
She must come to the clinic to be checked. CORRECT: This is an expected occurrence during pregnancy This is frequently the first sign of a breast infection. She should notify the nurse-midwife of this finding. RATIONAL: Colostrum, the creamy white-to-yellowish-to-orange premilk fluid, may be expressed from the nipples as early as 16 weeks' gestation. This is an expected occurrence during pregnancy. It is not necessary for the client to notify the nurse-midwife or to report to the clinic to be checked. It is not a sign/symptom of infection. TEST-TAKING STRATEGY: Eliminate options that are comparable or alike and indicate that a problem exists. This will direct you to the correct option.
A woman in the first trimester of pregnancy calls the nurse at her obstetrician's office and reports that brown patches have developed on her face. What should the nurse tell the client?
She should cover the discoloration with makeup. She should come to the clinic immediately to be checked. CORRECT: This is a normal skin change, the result of the hormonal fluctuations that occur during pregnancy. She should monitor the discoloration and make an appointment with the obstetrician if the patches worsen. RATIONAL: Increased skin pigmentation, a normal occurrence during pregnancy, may begin as early as the second month of pregnancy, when estrogen and progesterone cause the level of melanocyte-stimulating hormone to increase. Women with dark hair or skin exhibit more hyperpigmentation than do women with very light skin. Areas of pigmentation include brownish patches, called chloasma, that usually involve the forehead, cheeks, and bridge of the nose. This sign/symptom is commonly called the "mask of pregnancy." Covering the discoloration with makeup may diminish the appearance of the brown patches, but it is not the most appropriate option. It is not necessary for the client to come to the clinic immediately, nor is it necessary for the client to make an appointment if the patches worsen. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike and indicate that the woman should be seen by the obstetrician. To select from the remaining options, recall that increased skin pigmentation is a normal occurrence during pregnancy.
The nurse provides information to Marilyn about follow-up care while taking the oral contraceptives. Which instruction should the nurse provide to Marilyn?
She will need to have a yearly pelvic and breast examination, Papanicolaou (Pap) smear, and blood pressure measurement. RATIONALE: A woman who takes oral contraceptives should have a yearly pelvic and breast examination, Pap smear, and blood pressure measurement. Cardiovascular tests and liver function studies are not necessary. TEST-TAKING STRATEGY: Recalling the use and adverse effects of oral contraceptives will help you select the correct option. Also note that the correct options that involves yearly examination of reproductive organs and structures.
how can you remember Sigmund Freud stage of development?
Sigmund is sexual
8-9 months of age infant skills
Sits steadily when unsupported Crawls May stand while holding on to support Begins to stand without help
what interventions can prevent syncope in a pregnant woman?
Sitting with the feet elevated and changing positions slowly helps prevent syncope.
PHYSIOLOGICAL MATERNAL CHANGES Reproductive System Breasts
Size increases. Nipples become more pronounced. Areolas become darker. Superficial veins become prominent. Hypertrophy of the Montgomery follicles occurs. Colostrum may leak from the breast.
what 2 milks should not be given to an infant?
Skim and low-fat milk should not be given to a infant
why should skim milk or low-fat milk not be given to an infant?
Skim and low-fat milk should not be given, because the essential fatty acids are inadequate and the solute concentration of protein and electrolytes is too high.
how many hours of sleep can a school aged infant have?
Sleep requirements range from 10 to 12 hours a night
Slow-Paced Breathing
Slow-paced breathing promotes relaxation. Slow-paced breathing is used for as long as possible during labor.
LATER ADULTHOOD Physiological Changes Neurological System
Slowed reflexes Slight tremors and difficulty with fine motor movement Loss of balance Increased incidence of awakening after onset of sleep Increased susceptibility to hypothermia and hyperthermia Short-term memory may decline (although long-term memory is usually maintained)
vascular spider nevi
Small, bright red elevations of the skin radiating from a central body
2-3 months of age infant skills
Smiles Turns head from side to side Cries Follows objects Holds head in midline
when are solid foods introduced to an infant?
Solid foods are introduced at 5 to 6 months of age.
why should you Introduce one new food at a time at intervals of 4 to 7 days? for toddlers?
Solids may be added to feedings when the infant is 5 to 6 months old. Rice cereal is introduced first because of its low allergenic potential. The recommended sequence after the introduction of rice is weekly introduction of fruits, followed by vegetables and then meat. Cheese may be used as a substitute for meat or as a finger food. Parents are instructed to introduce one food at a time, usually at intervals of 4 to 7 days, as a means of identifying food allergies. Foods are never mixed with formula in the bottle. TEST-TAKING STRATEGY: Note the subject of the question, food allergies. Recalling that food allergies are a concern when solid food is introduced will help direct you to the correct option. Review: the principles involved in introducing solid foods to an infant.
what does infants play with?
Solitary Enjoys soft stuffed animals, crib mobiles with contrasting colors, squeeze toys, rattles, musical toys, water toys in the bath, large picture books and, after beginning to walk, push toys
which religion do not sanction the use of contraceptives other than natural planning methods?
Some religions, such as Roman Catholicism, do not sanction the use of contraceptives other than natural planning methods.
METHODS OF CONTRACEPTION Spermicides
Spermicides, which are dispensed as foams, gels, creams, and suppositories, may be purchased without a prescription. Used alone, spermicides are only moderately effective; combined use with a diaphragm or condom increases efficacy. A spermicide must be applied before coitus but no more than 1 hour in advance (when used alone). Containers for foam preparation must be shaken thoroughly before each use to ensure dispersal of the spermicide. Suppositories or tablets should be inserted at least 10 to 15 minutes before intercourse to allow time for dissolution. A spermicide should be reapplied each time intercourse is anticipated. Douching should be postponed for at least 6 hours after coitus.
After checking Penny again, the obstetrician decides to perform rupture of the membranes (ROM). Penny is told that she will need to empty her bladder first and then remain in bed after the procedure. Which of these assessment findings after ROM indicate that the amniotic fluid is normal? Select all that apply.
Strong odor Thick and cloudy CORRECT: Watery consistency Greenish-brown color CORRECT: Pale and straw-colored RATIONALE: Normal amniotic fluid is pale or straw-colored and of a watery consistency, without a strong odor. Thick, cloudy amniotic fluid or a strong odor might indicate an intrauterine infection. Greenish-brown fluid reflects the presence of meconium and may indicate that the fetus has had a hypoxic episode. TEST-TAKING STRATEGY: Focus on the subject, normal amniotic fluid, and eliminate the options that are not normal findings. Note the terms "strong odor," "cloudy," and "greenish-brown" in the incorrect options.
INITIAL CARE Interventions of the newborn
Suction mouth, then nares, using a bulb syringe. Dry newborn and stimulate crying by rubbing. Maintain temperature stability; wrap newborn in warm blankets and place a stockinette cap on head. Keep infant with mother to facilitate bonding. Place newborn at mother's breast if breastfeeding is planned or place neonate on mother's abdomen. Place newborn in warmer. Position newborn on side or abdomen or in modified Trendelenburg position to facilitate drainage of mucus. Ensure newborn's proper identification; always follow agency procedures. Footprint newborn and fingerprint mother on identification sheet per agency policies and procedures. Place matching identification bracelets on mother and newborn.
amniotic fluid
Surrounds, cushions, and protects the fetus and permits fetal movement Maintains the body temperature of the fetus Consists largely of fetal urine and is therefore a measure of fetal kidney function Drunk, swallowed, and urinated into by the fetus and breathed into the fetus' lungs
what trimester of pregnancy does syncope appear in?
Syncope usually occurs in the first trimester of pregnancy.
how often should you take axillary temperatures on A newborn?
Take newborn's axillary temperature every hour for the first 4 hours of life, every 4 hours for the remainder of the first 24 hours, and then every shift.
PARENT TEACHING Formula Feeding OF THE NEWBORN
Teach sterilization techniques if the water supply is located in an area where purification of the water is questionable. Remind the mother not to heat bottles of formula in a microwave oven. Explain to the mother that formula is a sufficient diet for the first 4 to 6 months. Assess the mother's ability to burp the newborn.
THE ADOLESCENT Nutrition
Teaching about the MyPlate food plan is important. Calcium, zinc, iron, folic acid, and protein are especially important nutritional needs. Body image is very important to children in this age group. Eating disorders are a concern in this age group.
A subarachnoid (spinal) block is administered to a woman before a cesarean section. During the immediate postpartum period, which vital sign does the nurse check most closely as part of monitoring for adverse effects of the block?
Temperature Apical pulse Respirations CORRECT: Blood pressure RATIONALE: The injection site for a subarachnoid block is in the spinal subarachnoid space at L3-L5. This type of anesthesia, administered just before birth, relieves uterine and perineal pain and numbs the vagina, perineum, and lower extremities. The adverse effects of a subarachnoid block are maternal hypotension, bladder distention, and postural puncture headache. Although the nurse would monitor the woman's temperature, pulse, and respirations, the blood pressure must be monitored most closely. TEST-TAKING STRATEGY: Focus on the subject, an adverse effect of the block, and note the strategic words "most closely." Recalling that maternal hypotension is an adverse effect will direct you to the correct option.
postpartum vital signs changes
Temperature may be increased up to 100.4° F (38° C) during the 24 hours after delivery because of dehydration, and fluids should be encouraged; if the temperature rises higher than 100.4° F (38° C), notify the primary health care provider, because this could indicate infection. Bradycardia is common during the first week, with a range of 50 to 70 beats/min; a pulse rate greater than 100 beats/min could indicate blood loss or infection. Blood pressure usually remains unchanged; if the blood pressure drops, bleeding or hypovolemia should be suspected. Respirations rarely change; if they increase significantly, suspect pulmonary embolism, uterine atony, or bleeding.
what can cause breast tenderness in all three trimesters of pregnancy?
Tenderness, which may occur in all three trimesters, is caused by increased levels of estrogen and progesterone.
Long-Acting Contraceptives Intrauterine Devices (IUDs)
The IUD is inserted into the uterus to provide continuous pregnancy protection by preventing fertilization of the egg by sperm, inhibiting tubular transport, and preventing implantation into the endometrium. The primary concern is pelvic inflammatory disease resulting from STI. Women who are at risk for sexually transmitted infections (STIs) (e.g., women who are not in mutually monogamous relationships) should not use IUDs. The woman who is to use an IUD must be taught about the device's side effects; the major side effects are cramps and increased menstrual bleeding. If pregnancy occurs while an IUD is in place, the risk of ectopic pregnancy is increased. The woman must be taught to check for the presence of the plastic strings, or "tail," extending from the IUD into the vagina, once a week during the first 4 weeks, then monthly after menses and if she detects signs/symptoms of expulsion (cramping or unexpected bleeding); if the strings become longer or shorter, the client should contact her primary health care provider.
Nutrition in pregnant women
The average weight gain during pregnancy is 25 to 35 lb (11 to 16 kg) for women of normal prepregnancy weight. An increase of about 300 calories per day is needed during pregnancy. Caloric needs are greater in the last two trimesters than in the first An increase of about 500 calories per day is needed during lactation. The client should be encouraged to consume a diet high in folic acid and to take a folic acid supplement; a diet rich in folic acid is necessary for all women of childbearing age to prevent neural-tube defect in the fetus during the first trimester of pregnancy. The client should drink at least eight to ten 8-oz (235ml) glasses of fluid each day, four to six of them water. Sodium is not restricted unless specifically prescribed by the primary health care provider or nurse-midwife. Cultural considerations in nutrition must be taken into account.
The nurse notes documentation in the record of a client in labor that the client is completely effaced. Based on this information, what conclusion should the nurse make?
The cervical os is completely dilated. The client will require induction with the use of oxytocin. Enlargement of the cervical canal that occurs during the first stage of labor is complete. CORRECT: The shortening and thinning of the cervix that occurs during the first stage of labor is complete. RATIONALE: Effacement is the shortening and thinning of the cervix that occurs during the first stage of labor. Dilation is the enlargement of the cervical os and cervical canal during the first stage. When the cervical os is completely dilated, the client is prepared for the birth of the baby. Induction is the deliberate initiation of uterine contractions that stimulates labor. In this situation, induction is not necessary. TEST-TAKING STRATEGY: Eliminate options that are comparable or alike. Complete enlargement of the cervical canal is comparable to a completely dilated cervical os. To select from the remaining options, think about the definition of effacement. This will direct you to the correct option.
MIDDLE ADULTHOOD physical changes
The changes of aging become evident between 40 and 65 years. The individual becomes aware that changes in reproductive and physical abilities signify the beginning of another stage in life. Physiological changes often have an impact on self-concept and body image. Physiological concerns include stress, level of wellness, and the formation of positive health habits.
A nurse reviewing the record of a client seen in the clinic notes that the nurse-midwife documented the presence of the Goodell sign during examination of the client. What conclusion does the nurse make on the basis of this finding?
The client is definitely pregnant. CORRECT: The nurse-midwife noted softening of the cervix. The client exhibits a presumptive sign of pregnancy. The nurse-midwife noted a violet coloration of the cervix. RATIONALE: In the early weeks of pregnancy, the cervix softens as a result of pelvic congestion (Goodell sign). Cervical softening is noted on physical examination. The presence of the Goodell sign is a probable indication of pregnancy. Another probable indication of pregnancy is the Chadwick sign, in which the cervix changes from pink to a violet color. Presumptive indications of pregnancy are also termed subjective changes because they are experienced and reported by the woman. Positive indications of pregnancy include auscultation of fetal heart sounds, fetal movement felt by the examiner, and visualization of the fetus on ultrasonography. TEST-TAKING STRATEGY: Focus on the subject, the finding of a Goodell sign. Recall the description of the Goodell sign and that presumptive signs/symptoms are subjective will help direct you to the correct option.
During a conversation with a nurse, an older client states, "I'm so dissatisfied with my life; it's just been one disappointment after another." Using Erik Erikson's theory of psychosocial development, which interpretation of the client's statement does the nurse make?
The client is demonstrating unsuccessful resolution of the crisis associated with this developmental stage. According to Erikson, all individuals pass through eight psychosocial stages over the course of a lifetime. Each stage represents a crisis in which the goal is to integrate physical, maturation, and psychosocial demands. In later adulthood, the psychosocial crisis is integrity versus despair. The task during this stage is to look back over one's life and accept its meaning. A sense of integrity and fulfillment indicates successful resolution of the crisis. Dissatisfaction with life indicates unsuccessful resolution of the crisis. TEST-TAKING STRATEGY: Note the subject of the question: the older client is dissatisfied with life, which indicates unsuccessful resolution of the crisis. The other options are comparable or alike and indicate successful resolution of the crisis. Review: Erikson's description of psychosocial development in later adulthood.
what intervention should be done if the client has a negative titer, indicating susceptibility to the rubella virus?
The client must be using effective birth control at the time of the immunization and must be counseled not to become pregnant for 3 months (or as recommended by the primary health care provider) after immunization.
A nurse is conducting a psychosocial assessment of a 40-year-old client. Which findings would the nurse recognize as a sign/symptom of emotional health in a person in middle adulthood?
The client provides guidance during interactions with his children. Middle adulthood is the period between the middle to late thirties and the middle sixties. According to Erikson's developmental theory, the psychosocial crisis of middle adulthood is generativity versus stagnation. The developmental task is to fulfill life's goals involving family, career, and society; successful resolution is demonstrated by the willingness to give to and care for others and to guide others. Middle adults can achieve generativity with their own children or the children of close friends or through other social interactions with the next generation. Making decisions about career, marriage, and parenthood; verbalizing readiness to assume parental responsibilities; and establishing intimate bonds of love and friendship are signs of emotional health in the early adult years. TEST-TAKING STRATEGY: Note the subject, psychosocial development of the adult. Focusing on the age of the client will direct you to the correct option. Review: the psychosocial development of middle adulthood.
what are the interventions for backaches during pregnancy?
The client should be encouraged to rest. Good body mechanics and improved posture will help alleviate pain. Low-heeled shoes should be worn. The client should be taught pelvic rocking and abdominal breathing exercises. Sleeping on a firm mattress may help relieve pain.
interventions for Urinary Urgency and Frequency in pregnancy
The client should drink 2 quarts (2 liters) of fluid during the day. Encourage the client to void at regular intervals. Sleeping on the side may relieve pressure on the bladder. Perineal pads may be worn, if necessary. Kegel exercises will help strengthen bladder control.
what are interventions to decrease heartburn in pregnancy?
The client should eat small, frequent meals. Advise client to sit upright for 30 minutes after a meal. Milk should be drunk between meals. Fatty and spicy foods should be avoided. Teach client to perform tailor-sitting exercises. Client should take antacids only if they are recommended by the primary health care provider or nurse-midwife.
what are the interventions for ankle edema during pregnancy?
The client should elevate her legs at least twice a day. Advise the client to sleep in the lateral position. Supportive stockings should be worn. The client should avoid sitting or standing in one position for long periods.
what are the interventions for leg cramps during pregnancy?
The client should get regular exercise, especially walking. Dorsiflexing the foot of the affected leg relieves pain Increasing calcium intake may help prevent cramps.
what are the interventions for Shortness of Breath and Dyspnea during pregnancy?
The client should plan frequent rest periods. Sleeping with the head elevated or sleeping on the side may bring relief. The client should avoid overexertion. Teach client to perform tailor-sitting exercises
MONITORING FETAL MOVEMENT Kick Count
The client sits quietly or lies on the left side and counts fetal kicks for a set period as instructed. Instruct the client to notify the primary health care provider or nurse-midwife if she counts fewer than 10 kicks in a 12-hour period or as instructed by the primary health care provider or nurse-midwife.
Which instruction should the nurse provide to the mother about car seat safety?
The convertible restraint is used for toddlers and preschoolers. It is best that the child ride in a rear-facing position for as long as possible, to the highest height and weight allowed by the manufacturer of their convertible seat. Once a child has outgrown the rear-facing seat, a forward-facing seat with a full harness should be used for as long as the child fits. Booster seats are for older children who have outgrown their forward-facing car safety seats. Air bags can be harmful or even lethal to small children.
PHYSICAL EXAMINATION Abdomen Umbilical Cord in the newborn
The cord contains three vessels, two arteries, and one vein; if fewer than three vessels are noted, notify the primary health care provider. Small, thin cords may be associated with poor fetal growth. Assess the cord for intactness and ensure that the clamp is secured. The cord should be clamped for at least 24 hours after birth; the clamp may be removed when the cord is dried and occluded. Note any bleeding or drainage from the cord. Hospital protocol and primary health care provider preference determines the technique and skin preparation used for cord care; protocols may involve the use of antibiotic ointment, triple dye, alcohol, soap and water, sterile water, povidone-iodine, or another treatment. If signs/symptoms of infection (e.g., moistness, oozing, discharge, reddened base) occur, antibiotic treatment is prescribed.
PHYSICAL EXAMINATION Ears of the newborn
The ears should be symmetric. Cartilage should be firm and demonstrate recoil. Pinna should be on or above line drawn from canthus of eye. Low-set ears are associated with Down syndrome.
week 5 embryonic stage
The embryo is 0.4 to 0.5 cm long. The embryo weighs 0.4 g. Double heart chambers are visible. The heart beats. Limb buds begin to form.
week 2 and 3 embryonic stage
The embryo is 1.5 to 2 mm long. Lung buds appear. Blood circulation begins. The heart is tubular. The neural plate becomes the brain and spinal cord.
week 8 embryonic stage
The embryo is 3 cm long. The embryo weighs 2 g. The eyelids begin to fuse. The circulatory system through the umbilical cord is well established. Every organ system is present.
EARLY ADULTHOOD sexuality Changes
The emotional maturity needed to engage in mature sexual relationships has developed. Young adults are at risk for sexually transmitted infections.
Family Systems and Family Dynamics PRIORITY POINTS TO REMEMBER!
The family strongly influences the health behaviors of its members, and the health status of each individual influences how the family unit functions and its ability to achieve goals. The nurse should identify the family structure and roles of the family members and assess family dynamics to formulate a plan of care. The nurse must recognize the cultural and religious influences that affect family function. Until the young toddler feels secure in the affection of his or her parents, expecting the toddler to welcome a newborn infant into the family is not realistic. Older children often enjoy taking responsibility for the care of a younger sibling. Adolescents are more likely to take risks with sexual activity because they believe that the chance of becoming pregnant is small. Several factors, including the need or desire for contraception, personal preference, cultural and religious beliefs and practices, effectiveness, and safety, should be considered in the choice of a method of birth control. The nurse must identify the expected outcomes for family planning and discuss the contraindications for the chosen method of contraception. Oral contraceptives are contraindicated in women with a history of thrombophlebitis, thromboembolitic disorders, stroke, or coronary artery disease; other risk factors for thrombosis; known or suspected breast carcinoma; benign or malignant liver tumors; undiagnosed abnormal genital bleeding. Oral contraceptives are also contraindicated in pregnant women. Oral contraceptives should be used with caution by women with diabetes mellitus, women who are smokers, woman who have risk factors for cardiovascular disease (e.g., hypertension, obesity, hypercholesterolemia), and women anticipating elective surgery in which postoperative thrombosis might be expected. Most condoms are made of latex, which is impermeable to bacteria and viruses; therefore, in addition to protecting against pregnancy, latex condoms protect against STIs. (Polyurethane condoms also protect against STIs, but condoms made from lamb intestines are permeable to viruses and do not protect against STIs.) Because of the risk of toxic shock syndrome, a diaphragm should not remain in place for more than 24 hours. Natural family planning methods involve the use of physiological cues to predict ovulation; coitus is avoided when conditions are favorable for fertilization. Natural family planning methods are acceptable to most religious groups because they do not involve the use of medications, chemicals, or devices.
Barrier Devices Condoms for Women
The female condom is a prelubricated polyurethane pouch that is inserted into the vagina. Available without a prescription, the female condom help provides protection against STIs in addition to pregnancy. It cannot be combined with a male condom. The female condom should be used just once and then discarded.
Fetal Heart Rate (FHR)
The fetal heart rate (FHR) depends on gestational age: 160 to 170 beats/min in the first trimester but slowing with fetal growth to 120 to 160 beats/min near or at term. The FHR is approximately twice the maternal heart rate.
OBSTETRICAL PROCEDURES Forceps Delivery
The forceps are two spoon-like articulated blades that are used to assist in the delivery of the fetal head. Reassure the mother and explain need for forceps. Monitor mother and fetus during delivery. Check neonate and mother after delivery for injury. Assist in repair of any lacerations.
THE PROCESS OF LABOR Powers
The forces acting to expel the fetus
FUNDAL HEIGHT
The fundal height is measured to help gauge the fetus' gestational age. During the second and third trimesters (weeks 18-30), fundal height in centimeters approximately equals the fetus' age in weeks, plus or minus 2 cm. At 16 weeks, the fundus can be found halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, the fundus is at the umbilicus. At 36 weeks, the fundus is at the xiphoid process.
safety for the infant?
The home should be baby-proofed. Car safety seats are not placed in the front seats of cars; the infant could be seriously injured if the passenger air bag is released, because safety seats extend closer to the dashboard. For more information refer Guard infant on bed or changing table. Use gates to protect infant from stairs. Never vigorously shake an infant. Be sure that bathwater is not hot; do not leave child unattended in bath. Do not hold infant while drinking or working near hot liquids. Cool vaporizers should be used instead of steam to help prevent burn injuries. To help prevent choking, avoid offering food that is round and similar in diameter to the airway. Be sure that toys have no small pieces. To help prevent strangulation, hang mobiles and other toys over the crib well out of reach of the infant. Avoid placing large toys in the crib; an older infant may use them as steps to climb. Cribs should be positioned away from curtains and blind cords. Cover electrical outlets. Remove hazardous objects from low, reachable places. Remove chemicals, medications, poisons, and plants from the infant's reach. Keep the poison-control hotline number available.
PHYSICAL EXAMINATION Renal System of the newborn
The immature kidneys are unable to concentrate urine. A weight loss of 5% to 15% during the first week of life occurs as a result of voiding and limited intake. Weigh the newborn daily. Monitor intake and output; weigh diapers, if necessary. Measure specific gravity of urine, if necessary. Assess newborn for signs of dehydration.
what 2 choices does the mother have to feed an infant?
The infant may breastfeed or bottle-feed, depending on the mother's choice.
nutrition in an infant
The infant may breastfeed or bottle-feed, depending on the mother's choice. Human milk is the best food for infants younger than 6 months. Whole milk should not be introduced to an infant until after 1 year of age. Skim and low-fat milk should not be given, because the essential fatty acids are inadequate and the solute concentration of protein and electrolytes is too high. Fluoride supplementation may be needed starting around 6 months of age. Solid foods are introduced at 5 to 6 months of age. New foods are introduced one at a time, usually at intervals of 4 to 7 days, as a means of identifying food allergies. Sequence of introduction of solid foods: rice cereal; fruits and vegetables, first yellow and then green; meats; egg yolks, avoiding egg whites (introduce egg white toward the end of the first year); cheese may be used as a substitute for meat and as a finger food. Avoid solid foods, such as nuts, foods with seeds, raisins, popcorn, grapes, pieces of hot dog, and peanut butter that put the infant at risk for choking. Avoid microwaving baby bottles and baby food. Never mix food or medications with formula. To help prevent botulism, never add honey or corn syrup to formula, water, or other fluid. Offer fruit juice from a cup. rather than a bottle, to prevent bottle-mouth caries.
PHYSICAL EXAMINATION newborn Genitals Female
The labia are edematous and the clitoris enlarged. Smegma (white mucoid discharge) is present. Pseudomenstruation (blood-tinged mucus) may be seen. A hymen tag may be visible. First voiding should occur within 24 hours.
what is the major socializing mechanism in toddlers?
The major socializing mechanism is parallel play; therapeutic play may be started at this age.
play for the toddler
The major socializing mechanism is parallel play; therapeutic play may be started at this age. A short attention span causes the toddler to change toys often. The toddler explores body parts of self and others. Typical toys include push/pull toys, blocks, sand, finger paints, bubbles, large balls, crayons, trucks, dolls, containers, Play-Doh, toy telephones, cloth books, and wooden puzzles.
A nurse teaches the husband of a woman who is in the active phase of stage 1 labor how to perform effleurage on his wife. Which observation by the nurse indicates that the spouse is performing the procedure correctly?
The man lightly pushes on his wife's sacral area with his fist. The man exerts steady pressure on his wife's abdomen during a contraction. CORRECT: The man lightly strokes his wife's abdomen in rhythm with her breathing during a contraction. The man exerts light pressure with the heel of the hand over the area of the uterine fundus. RATIONALE: Effleurage (light massage) and counter pressure are two methods that provide pain relief to a woman in the first stage of labor. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during a contraction. It is used to distract the woman from contraction pain. Counter pressure is steady pressure, applied to the sacral area with the fist or heel of the hand, that may help the woman cope with the sensations of internal pressure and pain in the lower back. Therefore the other options are incorrect. TEST TAKING STRATEGY: Use the process of elimination. Eliminate the options that are comparable or alike in that they describe pushing or exerting pressure on the abdominal area. Also, recalling the description of effleurage will help direct you to the correct option.
PHYSICAL EXAMINATION Thermoregulatory System of the newborn
The newborn does not shiver to produce heat. Newborns have brown fat deposits, which produce heat.
PHYSICAL EXAMINATION Eyes of the newborn
The newborn's eyes are slate gray (light skin) or brownish gray (dark skin). Normal eyes are symmetrical and clear. Pupils are equal and round and react to light by accommodation. Blink reflex is present. Eyes cross because of weak extraocular muscles. Red reflex is present. Eyelids are often edematous as a result of pressure during the birth process and the effects of eye medication.
PHYSICAL EXAMINATION nose of the newborn
The nose, flat and broad, should be located in the center of the face. In the newborn, nose-breathing is obligatory. Occasionally the newborn sneezes to clear obstructions.
LATER ADULTHOOD Medications
The nurse should routinely assess the number of prescription and nonprescription medications used by the older client and determine whether any may be eliminated or combined. The nurse should closely monitor the older client for adverse effects and response to medication therapy because of the increased risk for medication toxicity. One common sign/symptom of an adverse reaction to a medication in the older client is an acute change in mental status.
LATER ADULTHOOD Physiological Changes touch sensation
The older client experiences pain, but sensation of pain may be diminished as compared to a younger client. Pain results from numerous causes, most often degenerative changes in the musculoskeletal system; failure to recognize signs/symptoms of pain and alleviate pain may lead to functional limitations affecting the older adult's ability to function independently.
A mother changing her newborn daughter's diaper notes the presence of a small amount of blood on the infant's labia. The mother is concerned and tells the nurse that the infant is bleeding from the vaginal area. After assessing the infant, what response does the nurse provide to the mother?
The pediatrician will need to check the infant. CORRECT: A small amount of vaginal bleeding is normal. The bleeding is nothing to be concerned about. The bleeding is probably a result of trauma from the birth process. RATIONALE: In the full-term female infant, edema of the labia and a white mucous vaginal discharge are normal. A small amount of vaginal bleeding, known as pseudomenstruation, may occur as a result of the sudden withdrawal of the mother's hormones at birth. It is not a result of trauma. Because the finding is normal, the pediatrician will not need to check the infant. Telling the mother that the finding is nothing to be concerned about is not the most appropriate option, because it is nontherapeutic. TEST-TAKING STRATEGY: Recalling that this finding is normal will assist you in eliminating options that indicate that a problem exists. Telling the mother that the finding is nothing to be concerned about is non-therapeutic.
METHODS OF CONTRACEPTION Oral Contraceptives Cautions and Contraindications: Women at Risk
The pill is contraindicated during pregnancy and for women with known or suspected breast carcinoma, known or suspected estrogen-dependent cancers, benign or malignant liver tumors, and undiagnosed abnormal genital bleeding. Oral contraceptives should be used with caution by women with diabetes mellitus, smokers, woman who have risk factors for cardiovascular disease (e.g., hypertension, obesity, hypercholesterolemia), and women anticipating elective surgery in which postoperative thrombosis might be expected.
PHYSICAL EXAMINATION newborn Genitals male
The prepuce (foreskin) covers glans penis. The scrotum is edematous. Look for meatus at tip of penis. The testes have descended but may retract with cold. Assess genitalia for hernia or hydrocele. First voiding should occur within 24 hours.
nutrition in the preschooler
The preschooler exhibits food fads and has strong food and taste preferences. By 5 years, the preschooler tends to focus on social aspects of eating, table conversation, manners, and willingness to try new foods.
the preschooler skills
The preschooler has good posture. Fine motor coordination and athletic abilities begin to develop. Increasing skill is demonstrated in activities that require balance. The preschooler usually talks in three- or four-word sentences by age 3, five- or six-word sentences by age 4, and longer sentences that contain all parts of speech by age 5. Speech is easily understood by others, and the preschooler can clearly understand what others are saying.
the preschooler requires how many hours of sleep a day?
The preschooler requires about 12 hours of sleep each day.
Lesson 6: Maternity Client: Postpartum Care PRIORITY POINTS TO REMEMBER!
The priority nursing care of the mother after birth is to promote firm uterine contraction, promote comfort, and promote parent-infant attachment. To most accurately determine the amount of lochial flow, weigh the perineal pad before and after use and keep track of the time between pad changes. Encourage fluids in the postpartum period because of the dehydrating effects of the labor and delivery process. If the client's temperature rises higher than 100.4° F (38° C), the primary health care provider is notified, because this could indicate infection. In the postpartum period, a pulse rate greater than 100 beats/min could indicate blood loss or infection. If the blood pressure drops, bleeding or hypovolemia should be suspected. Women may ovulate without menstruating, so breastfeeding should not be considered a form of birth control. All women should be assessed for depression during pregnancy and in the postpartum period.
Lesson 7: Care of the Newborn PRIORITY POINTS TO REMEMBER!
The priority nursing care of the newborn after birth is to promote normal respiration, maintain normal body temperature, place identification bracelets on the newborn infant and mother, and promote attachment. The newborn's Apgar score is assessed and recorded at 1 and 5 minutes after birth. An intramuscular dose of vitamin K is prescribed to prevent hemorrhagic disorders; administer in the lateral aspect of the middle third of the vastus lateralis muscle. Eye medication is prescribed to prevent ophthalmia neonatorum (a form of conjunctivitis contracted by newborns during passage through the birth canal from a mother infected with either Neisseria gonorrhoeae or Chlamydia trachomatis); medication must be administered within 1 hour of birth. When performing the physical examination, keep the newborn warm; begin with general observations and then perform assessments that are least disturbing to the newborn first. Cold stress causes oxygen consumption and energy to be diverted from maintaining normal brain cell function and cardiac function, resulting in serious metabolic and physiological conditions. Acrocyanosis (peripheral cyanosis) is normal in the first few hours after birth and then may be noted intermittently for next 7 to 10 days. Slight tremors may be a common finding but may also signal hypoglycemia or drug withdrawal. Normal, or physiological, jaundice appears after the first 24 hours in full-term newborns and after the first 48 hours in premature newborns; jaundice occurring before this time (pathological jaundice) may indicate early hemolysis of red blood cells and must be reported to the primary health care provider. First voiding should occur within 24 hours of birth. Meconium stool, which is greenish black, with a tarlike consistency, is usually passed during the first 24 hours of life. The mother must be taught to check the identification of any person who comes to remove the baby from her room as one of the precautions against newborn abduction (e.g., nurses must be wearing photo identification or some other security badge).
A pregnant client has been scheduled for amniocentesis, and the nurse is providing information to her about the procedure. What should the nurse tell the woman?
The procedure will take about 2 hours. The obstetrician will locate the fetus with the use of the Leopold's maneuvers. CORRECT: The client may feel pressure as the needle is inserted and mild cramping as the needle enters the uterine muscle. Several serious risks are associated with the procedure, and several informed consent forms will have to be signed. RATIONALE: Amniocentesis is a relatively simple and safe procedure that permits the diagnosis of many fetal anomalies and confirms fetal maturity. It is a relatively painless procedure that takes only a short amount of time. Ultrasonography is used to locate the fetus and placenta and identify the largest pockets of amniotic fluid that can safely be sampled. A small amount of local anesthetic may be injected into the skin. The woman may feel pressure as the needle is inserted and mild cramping as the needle enters the myometrium. Leopold's maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus. Informed consent will need to be provided by the client before the procedure. Although risks are associated with the procedure, the need for several informed consents to be signed is not warranted. TEST-TAKING STRATEGY: Focus on the subject of the question, amniocentesis. Knowing that the signing of several informed consent forms is unnecessary will help you eliminate that option. Review the remaining options. Recalling that an ultrasound is performed before the procedure and that amniocentesis takes only a short time to perform will assist you in the process of elimination and direct you to the correct option.
THE PROCESS OF LABOR Descent
The process that the fetal head undergoes as it begins its journey through the pelvis A continuous process that occurs from the time of engagement until birth Assessed on the basis of the measurement of station
what is apical rate?
The rate measure of the heart itself (APex/Pical)
During the office visit, the nurse assesses Joel's developmental level, documents the findings, and reviews the data (refer "Chart" below). Which statement correctly describes the nurse's assessment of these findings? Physical Development Chest circumference exceeding head circumference Lateral diameter of chest exceeding anteroposterior diameter Has 16 primary teeth Language Development Uses pronouns "I," "me," and "you" Refers to self by name Talks incessantly Understands directional commands. Socialization Development Does not tolerate separation from parent Fears strangers Brief attention span Willing to share toys
The socialization findings are not appropriate for a 2-year-old child. By the age of 2 years, children should have a sustained attention span, exhibit increased independence from their parents, be less likely to fear strangers, and have an awareness of ownership, as expressed by phrases such as "my toy." The findings listed under the "Physical Development" and "Language Development" tabs are appropriate for Joel's age. TEST-TAKING STRATEGY: Focus on the subject, developmental milestones for a 2-year-old. Keep in mind the appropriate milestones for a child of this age and decide which data in the question reflect achievement of these milestones and which do not. Review: growth and development milestones
PHYSICAL EXAMINATION Spine OF THE NEWBORN
The spine should be straight, the posture flexed. The spine should be momentarily supportive of the head when the infant is prone. The arms and legs should be flexed. The chin should be flexed on upper chest. The newborn should demonstrate well-coordinated, sporadic movements. A degree of hypotonicity or hypertonicity may be indicative of central nervous system damage. Assess the newborn for hair tufts and dimples around the spinal column, which may be indicative of an opening.
Barrier Devices contraceptive sponge
The sponge, which is designed to fit over the cervix, is inserted into the vagina after being moistened with water. The device provides protection for as long as 24 hours and for repeated instances of sexual intercourse.
skills for the toddler
The toddler begins to walk with one hand held by age 12 to 13 months, runs by 2 years, and walks backward and hops on one foot by 3 years. Children of this age usually cannot alternate feet when climbing stairs. Toddlers are beginning to master fine motor skills for building, undressing, and drawing lines. The young toddler often uses "no," even when he or she means "yes," to assert independence. The toddler is beginning to use short sentences and has a vocabulary of about 300 words by age 2; tends to ask many "why" questions.
which body parts does the toddler explore?
The toddler explores body parts of self and others.
what does the toddler do best eating?
The toddler generally does best eating several small, nutritious meals each day rather than three large meals.
bowel and bladder training in an toddler?
The toddler is beginning to exhibit signs of readiness for toilet training. Bowel control develops before bladder control. By age 3, the toddler has generally achieved fairly good bowel and bladder control.
when should a toddler refer a dentist?
The toddler should refer a dentist soon after the first teeth erupt, usually around 1 year of age; a fluoride supplement may be necessary.
how is the usual sleep pattern of a toddler?
The toddler typically sleeps through the night and takes one daytime nap; nap is discontinued around age 3.
DORSIFLEX
The turning of the foot or the toes upward.
PARENT TEACHING Cord Care of the newborn
The umbilical clamp may be removed after 24 hours. Keep the cord clean and dry. Keep diapers from covering the cord; fold diaper below cord. Assess cord for odor, swelling, and discharge. Sponge-bathe the newborn until the cord falls off (within 2 weeks).
A nurse is providing information about the fetal circulation to a client who is pregnant for the first time. What should the nurse tell the client?
The umbilical cord holds two veins and one artery. Fetal blood circulation takes place strictly in the placenta. CORRECT: The umbilical vein carries freshly oxygenated, nutrient-laden blood from the placenta to the fetus. The one umbilical artery carries freshly oxygenated, nutrient-laden blood from the placenta to the fetus. The course of fetal blood circulation runs from the fetal heart to the placenta for exchange of oxygen, nutrients, and waste products and then back to the fetus for delivery to fetal tissues. The fetal umbilical cord has two arteries and one vein. The arteries carry deoxygenated blood and waste products away from the fetus to the placenta, where these substances are transferred to the mother's circulation. The umbilical vein carries freshly oxygenated and nutrient-laden blood from the placenta back to the fetus. TEST-TAKING STRATEGY: Note the subject of the question, fetal circulation. Eliminate the option that contains the closed-ended word "strictly." Recalling that the umbilical cord has one vein and two arteries will direct you to the correct option from those remaining.
METHODS OF CONTRACEPTION Oral Contraceptives Cautions and Contraindications: Cardiovascular Risks
The use of combination oral contraceptives has been associated with venous and arterial thromboembolism, pulmonary embolism, myocardial infarction, and thrombotic stroke. The risk of thromboembolism is increased in the presence of other risk factors, especially heavy smoking and a history of thromboembolism, hypertension, cerebrovascular disease, coronary artery disease, myocardial infarction, or surgery in which postoperative thrombosis might be expected. The pill is contraindicated for women with a history of thrombophlebitis, thromboembolitic disorders, stroke, coronary artery disease, and other risk factors for thrombosis. Oral contraceptives may be discontinued as long as 4 weeks before surgery in which postoperative thrombosis might be expected. Women taking oral contraceptives should be informed about the symptoms of thrombosis and thromboembolism (e.g., leg tenderness or pain, sudden chest pain, shortness of breath, severe headache, sudden visual disturbance) and instructed to stop taking the medication and notify the primary health care provider if these symptoms occur.
OBSTETRICAL PROCEDURES Vacuum Extraction
The vacuum is a cap-like device applied to the fetal head to facilitate extraction by means of suction. Traction is applied during uterine contractions until descent of the fetal head is achieved. Assess FHR every 5 minutes if external fetal monitoring is not used. Assess newborn at birth and throughout postpartum period for signs/symptoms of cerebral trauma. Monitor neonate for developing cephalohematoma. Caput succedaneum (edema of the soft tissue over bone) is normal and will resolve in 24 hours.
Lochia
The vaginal discharge that occurs after childbirth.
A nurse is performing a physical assessment of a woman who delivered a child 24 hours earlier. In what anatomic area should the nurse, assessing involution, expect to locate the fundus of the uterus? Refer to figure.
1 RATIONAL: Involution refers to changes in the uterus as it returns to the non-pregnant size and condition after delivery. Immediately after delivery, the fundus can be palpated midway between the symphysis pubis and umbilicus. Within a few hours postpartum, the fundus rises to just above the level of the umbilicus and then sinks to the level of the umbilicus, where it remains for about 24 hours. After 24 hours the fundus begins to descend by approximately 1 cm, or one fingerbreadth, per day. By the 10th to 14th day after delivery, the fundus is in the pelvic cavity and cannot be palpated abdominally. Therefore, 24 hours after delivery, the fundus would be palpated at the level of the umbilicus. ' TEST-TAKING STRATEGY: Focus on the subject, a woman who delivered 24 hours earlier. Recalling the process of involution and noting the words "delivered a child 24 hours earlier" in the question will assist you in answering the question.
Three months later, Marilyn visits the primary health care provider's office because of ear pain. The primary health care provider's assessment and prescription are shown in Marilyn's health record (refer "Chart" below). Based on these prescriptions, what should the nurse teach Marilyn at this time? Vital Signs and Focused Physical AssessmentTemperature: 100.9° F (oral)Pulse: 88 beats/minRespiratory rate: 10 breaths/minBlood pressure: 110/72 mm HgClient complains of left ear pain and severe sinus congestion of 2 days's duration. Came to the office today Current MedicationsDaily women's vitaminOrtho-Cyclen, oral contraception New PrescriptionsPseudoephredine (Sudafed) 30 mg every 4 hours as needed for nasal congestionAmpicillin (Omnipen) 500 mg orally every 6 hours for 7 daysNormal saline nasal rinse as needed
The vitamins should not be taken while taking the antibiotic. The oral contraceptive should be stopped until the antibiotic prescription is finished. The oral contraception should be stopped while taking the pseudoephedrine for nasal congestion. CORRECT: An alternate form of birth control will be needed while taking the ampicillin and for at least 1 month afterward. RATIONALE: Several medications, including penicillin antibiotics, can reduce the effectiveness of oral contraceptives, which may in turn result in unintended pregnancy. Marilyn should use an alternate form of birth control while taking the ampicillin and for at least 1 month afterward, but the oral contraceptive should not be stopped. Vitamins and pseudoephedrine do not interact with oral contraceptives. TEST-TAKING STRATEGY: Eliminate the options that are comparable or alike in that they indicate that the oral contraceptive should be stopped. To select from the remaining options, recall that vitamins do not interact with oral contraceptives. Therefore the nurse should teach the client to use an alternate form of birth control while on the antibiotic and for at least 1 month afterward. Review: the medication interactions with the use of oral contraceptives.
cardiac output
The volume of blood ejected from the left side of the heart in one minute.
POSTPARTUM PERIOD Assessment
The weight of the uterus decreases from 2 lb to 2 oz (0.9 kg to 57 g) in 6 weeks.
Ultrasonography IMPLEMENTATION
The woman may need to drink water to fill her bladder before the procedure to help obtain a better image of the fetus. Inform the client that the test presents no known risks to her or to the fetus.
what does the toddler do to assert independence?
The young toddler often uses "no," even when he or she means "yes," to assert independence.
implantation
The zygote propels itself down the fallopian tube, toward the uterus. Implantation in the uterine wall occurs 6 to 10 days after ovulation.
POSTPARTUM DISCOMFORTS Afterbirth Pains
These pains, which result from contraction of the uterus, are more common in multiparas, breastfeeding mothers, clients treated with oxytocin, and clients who had an over distended uterus during pregnancy, such as those who carried twins.
what can syncope and supine hypotension be caused by?
These problems may be hormonally triggered or caused by increased blood volume, anemia, fatigue, sudden position changes, or lying supine (the weight of the enlarged uterus places pressure on the inferior vena cava).
A nurse is planning to determine the presentation and position of the fetus, using the Leopold maneuvers. Prioritize and number the nursing actions in the order in which they would be performed. (The number 1 would indicate the first action and the number 6 represents the last action.) From smallest to largest, what are the different classes of structures that make up the human body?
1- Explain the procedure to the woman. 2- Ask the woman to empty her bladder. 3- Wash hands and don gloves. 4- Palpate the uterine fundus to determine the fetal part felt. 5- Palpate the sides of the uterus to determine the location of the fetal back. 6- Palpate the suprapubic area to determine whether the presenting part is engaged.
Toddler age range
1-3 years old
THE PROCESS OF LABOR Presentation
This aspect is named for the portion of the fetus that enters the pelvis, or presents, first.
DIAGNOSTIC TESTS α-Fetoprotein (AFP) Screening
This assay is used to assess the quantity of fetal serum proteins; an increased level is associated with an open neural tube (e.g., spina bifida) and abdominal wall defects; it is also used to detect Down syndrome.
OBSTETRICAL PROCEDURES Bishop Score
This assessment, used to determine maternal readiness for labor because it aids evaluation of cervical status and fetal position, is indicated before the induction of labor. Five factors are each assigned a score of 0 to 3, after which the total score is calculated. A score of 6 or more indicates a readiness for labor induction.
Maureen, age 28, has just given birth to a baby boy. A cesarean section was performed when, after 12 hours of labor, it was discovered that the fetus was in a breech position and labor was not progressing. Maureen's husband, Robert, was at the bedside during the delivery. This is their second baby; their first child, Sadie, is 4 years old. They were expecting to have a boy, on the basis of prenatal ultrasounds, and decided to name the baby James Nicholas. Maureen will be breastfeeding her son. After the cesarean delivery, the obstetrician hands the newborn to the delivery room nurse. Prioritize the nurse's actions in caring for the newborn in the order in which they would be performed. From smallest to largest, what are the different classes of structures that make up the human body?
1-Calculating the newborn's Apgar score 2-Checking the newborn's temperature 3-Wrapping the newborn in a warm blanket 4-Placing the newborn at the mother's breast RATIONALE: The first assessment of the newborn, the Apgar score, is performed after birth (1 and 5 minutes after delivery) to ascertain the newborn's status and determine the need for resuscitation. This is the first priority. The nurse next takes the newborn's temperature, wraps the newborn in a warm blanket, and places him at the mother's breast. Other priority actions include suctioning the newborn's nares and drying the newborn. The nurse also places identification bracelets on the newborn and mother. In some settings, the father or partner also wears an identification bracelet. TEST-TAKING STRATEGY: Use the ABCs airway, breathing, and circulation; to assist you in determining that checking the Apgar score is the first priority. Next, visualize the nursing actions from the items presented. Checking the temperature addresses a physiological need and would need to be done before wrapping the newborn in a blanket. After body warmth is ensured, the newborn is given to the mother.
A pediatric nurse is developing nursing care plans on the basis of Erik Erikson's stages of psychosocial development. Using Erikson's stages of psychosocial development, number the psychosocial crises in order of occurrence on the basis of developmental stage, from birth (1) to 20 years of age (5). From smallest to largest, what are the different classes of structures that make up the human body?
1-Trust versus mistrust 2-Autonomy versus shame and doubt 3-Initiative versus guilt 4-Industry versus inferiority 5-Identity versus role confusion
Barrier Devices Cervical Cap
This device fits snugly over the cervix and is held in place by suction. A cervical cap must be fitted by a primary health care provider, and the user must be taught how to insert it. The cap, which is filled with spermicidal cream or jelly before use, may be inserted as long as 6 hours before intercourse (there is no need to apply additional spermicide with repeated intercourse); it should remain in place for at least 8 hours after intercourse but no longer than 24 hours.
Ultrasonography
This imaging modality is used to outline and identify fetal and maternal structures; it also helps confirm gestational age and estimated date of delivery.
Natural Family Planning Methods Method
This method combines the calendar method, monitoring of basal body temperature, and cervical mucus monitoring. The woman makes note of other signs/symptoms that occur around the time of ovulation, such as weight gain, abdominal bloating, Mittelschmerz (pain on ovulation), and increased libido.
Natural Family Planning Methods cervical mucus method
This method involves the monitoring of changes in the cervical mucus caused by increasing estrogen levels during the follicular phase of the menstrual cycle. The woman assesses her cervical mucus by wiping it from the vaginal orifice with a tissue each day and checking for changes in consistency. The couple avoids intercourse when the mucus indicates that ovulation is imminent — the mucus becomes clear and slippery and stretches without breaking.
Natural Family Planning Methods Calendar Method
This method is based on the fact that ovulation occurs approximately 14 days before the onset of menses.
DIAGNOSTIC TESTS Biophysical Profile
This noninvasive assessment of the fetus includes fetal breathing movements, fetal movements, fetal tone, amniotic fluid index, and fetal heart rate patterns, all assessed through the use of a non-stress test. Normal fetal biophysical activities indicate that the central nervous system is functional and that the fetus is not hypoxemic.
FETAL MONITORING External Fetal Monitoring
This noninvasive mode of monitoring is conducted with the use of a tocotransducer and Doppler ultrasonic transducer.
Placenta
This organ develops by the third month of gestation to permit exchange of nutrients and waste products between fetus and mother; also produces hormones to maintain pregnancy. Placenta depends on maternal circulation. Large particles such as bacteria cannot pass through the placenta, but nutrients, drugs, antibodies, and viruses can. In the third trimester, transfer of maternal immunoglobulin to the fetus provides passive immunity to certain diseases for the first few months after birth. By week 8, genetic testing may be performed.
FETAL MONITORING Periodic Patterns in the FHR Variability
This pattern is denoted by fluctuations in the baseline FHR. Absent variability or undetected variability is considered nonreasoning. Minimal variability is greater than undetected but not more than 5 beats/min. In moderate variability, the FHR fluctuates from 6 to 25 beats/min. Marked variability involves fluctuation in the FHR greater than 25 beats/min. A temporary decrease in variability may occur when the fetus is in a sleep state. (Sleep states do not usually last longer than 30 minutes.) Decreased variability may result from fetal hypoxemia, acidosis, or certain medications.
PHYSICAL EXAMINATION Reflexes Startle Reflex
This reflex is best elicited when the newborn is at least 24 hours old. Examiner makes a loud noise or claps hands to elicit the response. Similar to Moro reflex, but the hands remain clenched. The startle reflex should disappear by 4 months.
PHYSICAL EXAMINATION Reflexes swallowing
This reflex occurs spontaneously after infant sucks and obtains fluids. Newborn swallows in coordination with sucking without gagging, coughing, or vomiting.
DIAGNOSTIC TESTSS Fern Test Description
This simple test is used to determine whether amniotic fluid is leaking.
False Labor
This state does not produce dilation, effacement, or descent. Contractions are irregular and without progression. Walking has no effect on contractions but often relieves false labor.
Involution
This term is used to describe changes in the uterus as it returns to its non-pregnant size and condition. Clients who breastfeed may experience more rapid involution
Papanicolaou Smear
This test may be better known by some as the Pap smear. The Pap smear is performed during the initial prenatal examination to screen for cervical neoplasia.
DIAGNOSTIC TESTS Chorionic Villus Sampling (CVS) Description
This test, which involves the aspiration of a small sample of chorionic villus tissue at 10 to 13 weeks' gestation, is performed for the purpose of detecting genetic abnormalities.
what can you do to help prevent choking in infants?
To help prevent choking, avoid offering food that is round and similar in diameter to the airway.
what should you do to prevent strangulation from an infant?
To help prevent strangulation, hang mobiles and other toys over the crib well out of reach of the infant.
A nurse, assigned to care for a hospitalized child who is 8 years old, plans care, taking into account Erik Erikson's theory of psychosocial development. According to this theory, which choice represents the primary developmental task of the child?
To master useful skills and tools According to Erikson's theory of psychosocial development, the school-age child's task is to master useful skills and tools of the culture (industry versus inferiority). Gaining independence from parents is the psychosocial task of the adolescent. Development of a sense of trust in the world is the psychosocial task of an infant. The development of a sense of control over self and body functions is the psychosocial task of the toddler. TEST-TAKING STRATEGY: Focus on the subject, the developmental level of an 8-year-old child. Use knowledge of Erikson's theory of psychosocial development to answer this question. Review: Erikson's theory of development.
Toddlers are at risk for aspiration from which kind of foods?
Toddlers are at risk for aspiration from small foods that are not easily chewed (e.g., nuts, foods with seeds, raisins, popcorn, grapes, pieces of hot dog).
Toddlers are beginning to master fine motor skills for doing what?
Toddlers are beginning to master fine motor skills for building, undressing, and drawing lines.
safety for the toddler
Toddlers are eager to explore the world around them. The toddler should be supervised at play. Refer to the American Academy of Pediatrics for information on car safety. Lock all car doors. Use back burners on the stove to prepare meals; turn handles inward and toward the middle of the stove to keep pots from being pulled off the stove. Keep dangling cords from small appliances away from the toddler. Place inaccessible locks on windows and doors, and keep furniture away from windows. Secure screens on all windows. Place gates at stairways. Do not allow the toddler to sleep or play in an upper bunk. Never leave a toddler alone near a bathtub, pail, swimming pool, or any other body of water. Keep toilet lids closed. Store all medicines, poisons, and other toxic products high and locked out of reach; keep household plants out of reach as well.
PHYSICAL EXAMINATION Reflexes Sucking and Rooting
Touch the newborn's lip or cheek or the corner of the mouth with a nipple. Newborn turns head toward the nipple, opens the mouth, takes hold of the nipple, and sucks. Reflex usually disappears after 3 to 4 months but may persist for as long as 1 year.
The nurse developing a plan of care for Mrs. Valenti will prioritize the following concerns from the highest priority (1) to the lowest (4). From smallest to largest, what are the different classes of structures that make up the human body?
1. Loss of fluid volume 2. Confusion 3. Possible injury 4. Potentially damaged skin RATIONALE: The most appropriate (highest priority) concern for the client who is dehydrated is loss of fluid volume. Possible injury and confusion compete for second priority. Because confusion is an actual client problem and could place the client at risk for an injury, confusion is the second priority and possible injury is the third priority. The possibility of damaged skin is the fourth priority. TEST-TAKING STRATEGY: Note the subject, loss of fluid volume, which is the highest priority. Next, focus on the data in the case study to identify confusion as the second priority. Also, note that possible injury and potentially damaged skin are risk problems and not actual problems, which makes them lesser priorities. To select from these remaining two concerns, remember that confusion can result in injury to the client. Review: priorities for the client with dehydration.
Erikson (psychosocial)- Infancy: birth to 1 year
Trust vs mistrust
what typical toys does the toddler play with?
Typical toys include push/pull toys, blocks, sand, finger paints, bubbles, large balls, crayons, trucks, dolls, containers, Play-Doh, toy telephones, cloth books, and wooden puzzles.
A client attending prenatal birthing class asks the nurse how long it takes for an egg to implant in the uterus once it has been fertilized. Which response should the nurse give?
10 days Fertilization occurs when one spermatozoon enters the ovum and the two nuclei containing the parents' chromosomes merge. Once the ovum is fertilized, implantation gradually occurs from the sixth through the 10th day. Implantation is complete on the 10th day. TEST-TAKING STRATEGY: Note the subject of the question, implantation after egg fertilization. Knowledge regarding the process of fertilization and implantation is needed to answer this question. Remember that implantation is the embedding of the fertilized ovum in the uterine mucosa 6 to 10 days after conception. Review: the process of fertilization and implantation
what is the normal apical rate in an infant when sleeping?
100 beats per minute
Anterior fontanel (soft and flat in a normal infant) closes between what age?
12 and 18 months
when does the weight triple in an infant?
12 months
normal respirations for an adolescent?
12 to 20 breaths per minute
The toddler begins to walk with one hand held by what age?
12-13 months
what is the normal apical rate in an infant?
120 to 160 beats per minute
school aged child respirations?
16 to 20 breaths per minute
normal blood pressure for preschoolers?
16 to 22 breaths per minuite
normal respirations for preschoolers?
16 to 22 breaths per minute
what is the normal apical rate in an infant when crying?
180 crying
how can you remember the apical rate of infant crying?
180 degrees of crying
Once the nurse has implemented treatment for Mrs. Valenti's dehydration, which occurrence indicates the best expected outcome the client could have?
Urine output greater than 30 mL/hr The expected outcome for the client with deficient fluid volume is that adequate fluid volume and electrolyte balance will return, as evidenced by a urine output greater than 30 mL/hr. Other expected outcomes would also include normal blood pressure, decreasing heart rate, consistent weight, and normal skin turgor. Thirst, dry mucous membranes, and a decrease in blood pressure are defining characteristics of deficient fluid volume. TEST-TAKING STRATEGY: Focus on the subject, an expected outcome. Also note that the incorrect options are comparable or alike in that they are signs/symptoms of a fluid volume deficit. Review: fluid and electrolyte balance.
postpartum urinary tract changes
Urine retention may result from loss of elasticity and tone; loss of sensation in the bladder caused by trauma, medications, anesthesia; or lack of privacy. Diuresis usually begins within 12 hours of delivery.
how can you protect the infant from the stairs?
Use gates to protect infant from stairs.
Posterior fontanel (soft and flat in a normal infant) closes after
2 to 3 months
The toddler begins to run by what age?
2 years of age
Contraction Stress Test Description
Used to assess placental oxygenation and function Helps determine fetus' ability to tolerate labor and reveals fetal well-being Fetus is exposed to the stressor of contractions to assess the adequacy of placental perfusion under simulated labor conditions Performed if non stress test findings are abnormal (nonreactive)
Local Anesthesia
Used to block pain during episiotomy Administered just before birth of baby No effect on fetus
THE PROCESS OF LABOR Leopold Maneuvers
Used to determine position, presentation, and engagement First maneuver is used to determine which part of the fetus is in the fundus Second maneuver reveals which side of the uterus the back is located on and on which side the fetal arms and legs are located Third maneuver confirms fetal position Fourth maneuver is used only in the late stage of pregnancy, in cephalic presentations, to determine how far the fetus has descended into the pelvic inlet
Janice Casey, 27 years old, is pregnant for the third time. She is in her first trimester. Janice's husband has accompanied her to the maternity clinic, and he tells the nurse that he is going to be with Janice throughout labor and delivery. The nurse, obtaining an obstetric history from Janice, notes that her menstrual periods are regular and that her last period was on August 25, 2016. Janice tells the nurse that she has one son, born at 40 weeks' gestation, and one daughter, born at 36 weeks' gestation. She says that these pregnancies progressed normally, without complications. Janice has no history of medical or surgical problems. Her temperature is 98° F (36.7° C), her apical pulse is 80 beats/min, respirations are 18 breaths/min, and blood pressure is 120/78 mm Hg. At 30 weeks' gestation, Janice is seen in the maternity clinic for a follow-up visit. The nurse checks the fundal height. Which measurement does the nurse expect to see?
20 cm 26 cm CORRECT: 30 cm 34 cm RATIONALE: From 22 weeks to term, the fundal height, which is measured in centimeters, is roughly equal (plus or minus 2 cm) to the gestational age of the fetus in weeks. Therefore, because this client is at 30 weeks' gestation, her fundal height would be 30 (plus or minus 2 cm). If fundal height exceeds the number of weeks of gestation, additional assessment is necessary to investigate the cause of the unexpectedly large uterine size. If fundal height is less than expected on the basis of gestational age, the estimated date of delivery must be confirmed. If the dates are accurate, further assessment may be necessary to determine whether the fetus' growth is inadequate. TEST-TAKING STRATEGY: Focus on the subject of the question, the fundal height at 30 weeks'. Noting the strategic words "30 weeks gestation" in the question and recalling that from 22 weeks to term the fundal height is roughly equal (plus or minus 2 cm) to the gestational age of the fetus in weeks will direct you to the correct option.
what are the normal respirations of a 1-year-old?
20 to 40 breaths per minute
what is the normal respirations rate of a toddler?
20-30 beats per minute.
when does Shortness of Breath and Dyspnea occur during pregnancy?
2nd and 3rd trimesters of pregnancy
The toddler begins to walk backwards and hops on one foot by what age?
3 years old
by what age does the toddler has generally achieved fairly good bowel and bladder control.?
3 years old
what are the normal respirations of an infant?
30 to 60 (average 40) breaths per minute
how many words for vocabulary is said by a toddler by age 2?
300 words
what is the normal temperature in Celsius for an infant?
36 to 37.2 C
PROBABLE SIGNS/SYMPTOMS OF PREGNANCY
Uterine enlargement Hegar sign (refer image) Goodell sign Chadwick sign Ballottement (refer image) Positive result on pregnancy test for human chorionic gonadotropin (hCG)
ADAPTATION TO NEW FAMILY MEMBERS Adaptation of a Toddler
Very young children (2 years and younger) are unaware of maternal changes occurring during pregnancy and are unable to comprehend that a new brother or sister is going to be born. Because toddlers have little perception of time, many parents delay telling them that a baby is expected until shortly before the birth. Any household changes that must be made, such as changes in sleeping arrangements, should be made several weeks before the birth so that the toddler does not feel displaced by the new baby. Until the toddler feels secure in the affection of his or her parents, expecting him or her to welcome a newborn into the family is not realistic; frequent reassurances of parental love and affection are crucial. A gift "given" to the toddler by the new baby when the infant arrives home from the hospital may help the toddler accept the new family member. The parents can be taught to accept strong feelings that the toddler expresses, such as anger, jealousy, and frustration, without judgment and to continue reinforcing the toddler's feeling of being loved.
14-15 months of age infant skills
Walks alone Can crawl up stairs Shows emotions such as anger and affection Explores away from parent in familiar surroundings
12-13 months of age infant skills
Walks with one hand held Can take a few steps without falling
Anthroid pelvis
Wedge-shaped or angulated Seen in males Not favorable for labor Narrow pelvic planes conducive to slow descent and mid pelvis arrest
what are the physical characteristics of the infant?
Weight has doubled at 5 to 6 months and tripled by 12 months. By 1 to 2 years of age, head circumference and chest circumference are equal. Anterior fontanel (soft and flat in a normal infant) closes between 12 and 18 months. Posterior fontanel (soft and flat in a normal infant) closes after 2 to 3 months. Lower central incisors erupt after 6 to 8 months. The infant sleeps most of the time.
Percutaneous Umbilical Blood Sampling
When fetal blood sampling is necessary, a needle is inserted directly into the fetal umbilical vessel under ultrasound guidance. Fetal heart rate monitoring is necessary for 1 hour after the procedure; a follow-up ultrasound to check for bleeding or hematoma formation is performed 1 hour after the procedure.
Barrier Devices Diaphragm
When in place over the cervical os, the diaphragm blocks access to the cervix. Because the device does not fit tightly enough to completely block penetration of sperm, it must be filled with spermicidal jelly or cream before insertion. (Spermicide must be reapplied with repeated intercourse.) The diaphragm may be inserted as long as 6 hours before intercourse but must remain in place for at least 6 hours after intercourse; because of the risk of toxic shock syndrome, however, it should not be left in place for longer than 24 hours.
PHYSICAL EXAMINATION Reflexes Tonic Neck ("Fencing")
While the newborn is falling asleep or sleeping, gently and quickly turn the head to one side. As the newborn faces the left side, the left arm and leg extend outward while the right arm and leg flex. When the head is turned to the right side, the right arm and leg extend outward while the left arm and leg flex. This reflex usually disappears within 3 to 4 months.
Whole milk should not be introduced to an infant until after what age?
Whole milk should not be introduced to an infant until after 1 year of age.
why does an older adult have Increased nail thickness and slowed nail growth?
With age, there is a rapid decrease in the growth rate for both toenails and fingernails As a result, both kinds of nail thicken, because of the piling up of nail cells, called onychocytes.
postpartum Gastrointestinal Tract changes
Women are usually very hungry after delivery. Constipation may occur. Hemorrhoids are common.
METHODS OF CONTRACEPTION Natural Family Planning Methods breastfeeding
Women who breastfeed exclusively (at least 10 times in 24 hours with no supplementary feedings) may avoid ovulation and the resumption of menstrual cycles; however, this method alone is not a reliable means of contraception.
A nurse is performing an ophthalmoscopic examination of an older client. Which age-related change would the nurse expect to note while viewing the retina?
Yellow spots near the macula RATIONALE: Age-related changes of the retina include narrowed and straightened blood vessels, opaque gray arteries, and gray or yellow spots of hyaline degeneration, called drusen, near the macula. Red blood vessels, a clear fundus, and a yellow-orange optic disc are all normal findings, not age-related changes. TEST-TAKING STRATEGY: Focus on the subject, an age-related finding. Eliminate the option containing the word "clear." Next, recalling that blood vessels are normally red will assist you in eliminating this option. Recalling the normal color of the optic disc will direct you to the correct option from the remaining choices. Review: age-related findings in the eye.
EARLY ADULTHOOD psycosocial Changes
Young adults are separating from their families of origin. Much attention is paid to occupational and social pursuits to improve socioeconomic status. Decisions regarding career, marriage, and parenthood are being made. Young adults must adapt to new situations.
linea nigra
a dark line appearing on the abdomen and extending from the pubis toward the umbilicus
what is fluoride?
a naturally occurring element present in many minerals, water supplies, and foods.
Seborrheic keratosis
a skin condition characterized by waxy, raised, wart-like lesions
security object
a special attachment to a toy or object such as a blanket that the baby carries and uses it for comfort when crying
colostrum
a specialized form of milk that delivers essential nutrients and antibodies in a form that the newborn can digest
Naegele's Rule
add 9 months and 7 days to Last Menstrual Period OR add 7 days to LMP, subtract 3 months, add 1 year
apgar score
an evaluation of a newborn infant's physical status
Seborrheic dermatitis
an inflammation that causes scaling and itching of the upper layers of the skin or scalp
The first permanent (secondary) teeth erupt and deciduous teeth are gradually lost around what age?
around 6 years of age
striae
atrophic pink, purple, or white linear streaks on the breasts, associated with pregnancy, excessive weight gain, or rapid growth during adolescence
school aged child blood pressure?
averages 107/64 mm Hg
normal blood pressure for an adolescent?
averages 121/70 mm Hg
what is the normal blood pressure in a 1-year-old?
averages 90/56 mm Hg
what is the normal blood pressures rate of a toddler?
averages 92/55 mm Hg
What temperature do you take on a newborn?
axillary
posterior fontanel
back soft spot-on fetal skull between parietal and occipital bone
when does backaches occur during pregnancy?
backache generally occurs in the second and third trimesters.
why should you avoid foods such as nuts, foods with seeds, raisins, popcorn, grapes, pieces of hot dog, and peanut butter
because nuts, foods with seeds, raisins, popcorn, grapes, pieces of hot dog, and peanut butter that put the infant at risk for choking.
drusen
benign deposits on the ocular fundus that show as round yellow dots and occur commonly with aging
what are the major causes of injuries in school aged children?
bicycles, skateboards, and team sports as the child's motor abilities and independence increase.
infant age range
birth to 12 months
when can breast tenderness occur during pregnancy?
breast tenderness can occur in a all three trimesters
Why do Urinary Urgency and Frequency occur in the first and third trimesters of pregnancy?
caused by the pressure of the uterus on the bladder, usually occur in the first and third trimesters.
what should a school aged child always wear when riding a bike or using inline skates, skateboards, or other items that could result in falls?
children should always wear a helmet when riding a bike or using inline skates, skateboards, or other items that could result in falls.
Children of this toddler age usually cannot alternate feet when doing what?
climbing the stairs
what is the developmental stage of Jean Piaget?
cognitive development
how can you remember Jean Piaget stage of development?
cognitive jeans
nuclear family structure
consists of two partners, heterosexual or homosexual, and perhaps one or more children mother, father, children
to prevent burn injuries what can be used instead of steam for infants?
cool vaporizers
cribs should be positioned away from what for infants?
curtains and blind cords
do respirations decrease or increase with age?
decrease
does apical rate decrease or increase with age?
decrease
what is atrophy?
decrease in muscle size
why does Constipation occurs in the second and third trimesters of pregnancy?
decreased intestinal motility or the displacement of the intestines or as a result of iron supplementation.
the third through eighth weeks after conception are called the
embryonic stages
What is the sensorimotor stage?
experiencing the world through senses and actions
presbyopia
farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age.
when can fatigue occur during pregnancy?
fatigue usually occurs in the first and third trimesters.
in vitro fertlization
fertilization of an egg in a nutrient medium and subsequent transfer back to the mother's body
lower central incisors
first deciduous teeth to erupt
single family structure
formed when one of the parents leaves the nuclear family through death or desertion or when a single person decides to give birth to or adopt a child
blended family structure
formed when parents bring unrelated children from prior or foster-parenting relationships to a new joint-living situation
Grandparent household
grandparent or grandparents caring for grandchildren
G: T: P: A: L:
gravidity term births preterm births abortions or miscarriages current living children
when does hemorrhoids occur during pregnancy?
hemorrhoid's Usually occur in the second and third trimesters of pregnancy
why does hemorrhoid's occurs in the second and third trimesters of pregnancy?
hemorrhoids are the result of increased venous pressure or constipation.
extended family structure
includes relatives such as aunts, uncles, grandparents, and cousins in addition to the nuclear family
hypertrophy
increase in muscle size
why does an older adult in later adulthood have Increased blood pressure but susceptibility to postural hypotension ?
increased stiffness of the large arteries, called arteriosclerosis or hardening of the arteries. This causes high blood pressure, or hypertension, which becomes more common as we age.
does blood pressure decrease or increase with age?
increases
when does leg cramps occur during pregnancy?
leg cramps Usually occur in the second and third trimesters of pregnancy
why does leg cramps occur in the second and third trimesters of pregnancy?
leg cramps result from altered calcium-phosphorus balance, pressure of the uterus on nerves, or fatigue.
Acidic pH
less than 7
ischial spine
located superior to the ischial tuberosity and projects medially into the pelvic cavity
Longitudinal or vertical (lie of labor)
longitunal lie: Fetal spine is parallel to the mother's spine. Vertical lie: Fetus is either cephalic or breech presentation.
diffusing capacity
measurement of carbon monoxide (CO2), oxygen, or nitric oxide transfer from inspired gas to pulmonary capillary blood; is reflective of the volume of a gas that diffuses through the alveolar-capillary membrane each minute
A toddler should never be allowed to fall asleep with a bottle containing which fluids?
milk, juice, soda pop, or sweetened water
Multi-adult household
more than one adult living in a household
when do nausea and vomiting occur in pregnancy?
nausea and vomiting occurs in the first trimester
how do you prevent botulism in a infant?
never add honey or corn syrup to formula, water, or other fluid.
A woman who has just delivered a baby asks the nurse when she may resume sexual intercourse. Which response should the nurse give to the client?
ntercourse may be resumed at any time after delivery. Intercourse may not be resumed until menstruation returns. Intercourse may not be resumed until after the 6-week checkup with the obstetrician. CORRECT: Intercourse may be resumed 2 to 4 weeks after delivery, once bleeding has stopped and the episiotomy has healed. RATIONALE: The woman who has just given birth should be told that she may safely resume sexual intercourse by the second to fourth week after delivery, when bleeding has stopped and the episiotomy has healed. The other options are incorrect. TEST-TAKING STRATEGY: Eliminate the option that uses the words "any time." Next eliminate the option that indicates that intercourse may not be resumed until menstruation returns; the return of menstruation varies, depending on whether the woman is breastfeeding. To select from the remaining options, note the word "healed" in the correct option.
A nurse has completed a family assessment and is documenting the information obtained during the interview. The household comprises a father, a mother, one son, and two daughters. What family type should the nurse document?
nuclear A nuclear family consists of two partners, heterosexual or homosexual, and perhaps one or more children. A blended family is formed when parents bring unrelated children from prior or foster-parenting relationships into a new joint-living situation. An extended family includes relatives such as aunts, uncles, grandparents, and cousins in addition to the nuclear family. A multi-adult family is one in which more than one adult is living in a household. TEST-TAKING STRATEGY: Focusing on the data in the question (the father, mother, one son, and two daughters), will help direct you to the correct option. Review: family structures and types.
Single-adult household
one adult living alone in a household
Where is the tocotransducer placed?
over the fundus of the uterus where contractions feel the strongest, and also fastened with a belt.
if a thermometer is inserted incorrectly into the rectum what can that cause?
perforation of the mucosa
Vegetarianism:
potential deficiencies include energy; protein, vitamin B12, zinc, iron, calcium, omega-3 fatty acids, and vitamin D (if limited exposure to sunlight).
what is the developmental stage of Sigmund Freud?
psychosexual development
what is the developmental stage of Erik Erikson?
psychosocial development
why does heartburn occur in the 2nd and 3rd trimesters of pregnancy?
results from an increased progesterone level, decreased gastrointestinal motility and esophageal reflux, and displacement of the stomach by the enlarging uterus.
what is the Sequence of introduction of solid foods?
rice cereal; fruits and vegetables, first yellow and then green; meats; egg yolks, avoiding egg whites (introduce egg white toward the end of the first year); cheese may be used as a substitute for meat and as a finger food
Effacement:
shortening and thinning of the cervix during the first stage of labor
Goodell's sign
softening of the cervix
Haegar's sign
softening of the lower uterine segment
what solid foods should you avoid in an infant?
such as nuts, foods with seeds, raisins, popcorn, grapes, pieces of hot dog, and peanut butter
what trimester of pregnancy does supine hypotension appear in?
supine hypotension occurs particularly in the second and third trimesters.
EPISIOTOMY
surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth
hemorrhoids
swollen, twisted, varicose veins in the rectal region
what is the normal apical rate in a 1-year-old in celsius?
temp 36° C to 37.2° C
toddlers tends to ask what kind of questions?
tends to ask many "why" questions.
starts 9 weeks after conception and lasts through the end of gestation.
the fetal period
QUICKENING
the first movement of the fetus in the uterus that can be felt by the mother
antepartum (prenatal) period
the interval between fertilization and the beginning of labor.
venous stasis
the temporary cessation or slowing of the venous blood flow
what age group begins to exhibit signs of readiness for toilet training.?
the toddler
After the Leopold maneuvers are used to determine the side on which the fetal back is located what happens?
the ultrasound transducer is placed over this area, then fastened with a belt.
Montgomery follicles
tiny sebaceous glands that may appear on the areola
HYPEREXTEND
to extend body part beyond normal limits
Cohabitating partners
unmarried individuals, heterosexual or homosexual, living together
when does Urinary Urgency and Frequency occur in pregnancy?
urinary urgency and frequency occur in the first and third trimesters of pregnancy
Communal groups
various types of families living together
what rules should you teach the school aged child?
water safety rules traffic safety rules
A client, pregnant for the first time, is being seen in the clinic for her first prenatal visit. The client asks the nurse when the baby's heart will begin to beat. During which gestational week does the nurse tell the client that the fetal heart begins to beat?
week 5 RATIONALE: By gestational week 5 the heart has partitioned into four chambers and has begun to beat. Therefore, the other options are incorrect. TEST-TAKING STRATEGY: Focus on the subject of the question, when the fetal heart will begin to beat. Recalling the prenatal development of fetal cardiac structures will assist you in answering this question.
why and how does pregnant women get cholasma?
when estrogen and progesterone cause the level of melanocyte - stimulating hormone to increase. Areas of pigmentation include brownish patches, called chloasma, that usually involve the forehead, cheeks, and bridge of the nose
