NECC Theory Exam 2- 3
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miakimball1 on April 2, 2012
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193 terms
Terms | Definitions |
|---|---|
 Signs of pregnancy | 1. presumptive -subjective: what the patient tells you 2. probable -objective: what you see 3. positive -diagnostic: definitive |
| Presumptive evidence signs | -amenorrhea -breast changes -skin pigmentation changes -abdominal enlargement and striae |
| Presumptive evidence symptoms | patient c/o -nausea and vomiting -urinary frequency -breast tenderness -weight gain -constipation -fatigue -quickening |
| Probable evidence | -uterine/ abdominal enlargement -pigmentation of skin -stretch marks (striae) -changes in pelvic organs 1. hegar's sign 2. goodell's sign 3. chadwick's sign -braxton hicks contractions (false labor) -ballottment -pregnancy tests for HCG |
| Hegar's sign | softening of the lower uterine segment (isthmus) |
| Goodell's sign | softening of tip of the cervix |
| Chadwick's sign | bluish discoloration of cervix and vaginal mucosa |
| Ballottment | pushing of belly to determine fluid shift |
| Positive evidence | -fetal heartbeat heard by examiner from 12 weeks on 120- 160 -fetal outline confirmation by ultrasound -fetal movement detected by examiner |
| Gravity | number of pregnancies |
| Parity | number of births after 20 weeks of gestation |
| TPALM | Term: 37-42 weeks Preterm: before 37 weeks Abortion: TAB/SAB Living: number of children alive Multiples: number of sets of multiples |
| TAB | therapeutic abortion |
| SAB | spontaneous abortion -miscarriage |
| EDB | estimated date of birth |
| Determination of EDB | 1. ultrasound -crown to rump length 2. nagele's rule -determines EDB and properly follows pregnancy -date of last period -subtract 3 months -add 7 days |
| Prenatal care | -regular health supervision is necessary to ensure that subtle and untoward changes will not go undetected -Nurse is responsible for: monitoring unexpected physiological and psychological changes for providing health education for greater understanding of the events of pregnancy |
| 1st prenatal visit | 1. health history 2. physical exam 3. diagnostic tests |
| Prenatal health history | 1. current pregnancy 2. risk assessment 3. OBGYN history -STI's, multiple partners 4. medical history -family history -nutritional history (iron, folic acid, and vit. c.) |
| Prenatal physical exam | 1. pelvic exam -group B Strep testing (IV antibiotics) 2. calculation of EDB |
| Prenatal diagnostic tests | validate pregnancy 1. pregnancy test -HCG in urine by day 26 2. blood -HCG secreted after day 1 -CBC -H & H 3. cervical smears -GBS testing -STI testing |
| Normal pregnancy visits | -periodic -schedule -interval history -blood pressure history and weight -urinalysis (for protein or glucose) -fetal well being fundal height fetal heart tones fetal position -leopold testing (checking for crown, rump and spine) |
| Pregnancy tests | 1. chorionic villi sampling 2. amniocentesis 3. ultrasonography 4. labs tests 5. monitoring fetus well being |
| Chorionic villi sampling | -35+ women -invasive test to detect defects -looking at babys genes -downs -cystic fibrosis -sickle cell |
| Amniocentesis | -large needle to capture fluid -invasive -for genetic disorders |
| Lab tests | 1. glucose screen -test for gestational diabetes -24- 28 weeks -should be under 140 2. triple screen -AFP (alpha fetal protein) -HCG -Estreol 3. GBS (group B streptococcus) -30% normally in vaginal canal -complications come if baby encounters GBS 4. HIV -25 - 30% give HIV to baby -C section is needed -AZT treatment (antiviral) |
| Monitoring fetal well being | -may be done during pregnancy to help check the health, activity level, and growth of the fetus. -it also may be done to help detect any problems and find out if further tests are needed. 1. reactive stress test (RST) -good -baby is reactive -3 accelerations of 10-15 increase in 20 min. 2. nonreactive stress test -bad 3. biophysical profile |
| Common disorders of pregnancy | -reproductive system -cardiovascular system -respiratory system -GI/GU -miscellaneous |
| Prenatal education | -physiological changes during pregnancy -danger signs -health teaching |
| Pregnancy hygiene teaching | -cleanliness (shower everyday) -avoid douching (interrupts normal flora in vagina) -cotton underpants (allows breathing to promote avoidance of baterica) |
| Pregnancy breast care teaching | -supportive bra -preparation of nipple for breastfeeding -braless- occationally -expose nipples to sunlight and air (helps to toughen nipples) -nipple rolling -breast shields (helps draw nipple out if inverted or flat) |
| Cardiovascular system teaching | -postural hypotension: no lying down or supine, causes SVC suppression -adequate iron and vitamins in diet -avoid supine position after 14 weeks gestation, encourage side lying position -assess for s&s venous thrombosis: edema, swelling, pain -excercise, frequent walking, changes in position: prevent DVT -elevate extremities when possible: encourages venous return |
| Respiratory system teaching | -position changes: semi fowlers position -lightening: 3rd trimester, baby drops and mom can breathe easier -cold mist humidifier: epistaxis (nose bleed) is common |
| Urinary system teaching | -never limit fluids -avoid increase in fluids at night -empty bladder every 2 hours -kegel exercises: during pregnancy and after |
| GI system teaching | -morning sickness (crackers before OOB, accupressure) -small frequent meals -avoid greasy foods -dry meals: limit fats and high sugar -drink carbonated beverages: soda= bicarbonate- neutralizes acidity -use of herbs and salts in flavoring -avoid lying down after eating -antacids: limit use but ok to use, low sodium (sodium= HTN and edema) -good mouth hygiene |
| Elisa blood test | test for HIV -confirm with blot |
| Weight management during pregnancy | -monitor pattern of weight gain -caloric increase is only 300 cal/day -overweight women should not diet during pregnancy -teach diet management -breastfeeding= HIGH calorie burner (body burns calories by making milk) |
| Musculoskeletal system teaching | -frequent rest periods -change position frequently -get up slowly from sitting position |
| Pregnancy skin care | -stretch marks -dark line -oatmeal baths, topical ointments, antihistimines -vit. E |
| Medication use during pregnancy | drugs cross the placenta to the fetus -prenatal vitamins -OTC (use cautiously) -prescription |
| Pregnancy danger signs | -vaginal bleeding (1st 12 weeks= normal) -contractions -rupture of membranes -pain |
| Pregnancy teaching | -travel: no flying in 3rd trimester -work -exercise: normal routine, walking, yoga -sex: as long as water hasn't been broken |
| Developmental tasks of pregnancy | 1. pregnancy validation -ambivalence: confusion, unsure 2. fetal embodiment -mom feels baby is part of her 3. fetal distinction -mom feels baby moving, living 4. role transition -mom becomes mom |
| Psychosocial adaptation to pregnancy | Reva Rubin -seeking safe passage for herself and her child through pregnancy, labor and delivery -ensuring the acceptance by significant persons in her family of the child she bears -binding-in to her unknown baby -learning to give of herself |
| Role adaptation of significant other | 1. psychosocial findings -couvade: dad takes on symptoms of pregnancy -reactions to the pregnancy 2. tasks -1st trimester: announcement phase -2nd trimester: moratorium phase -3rd trimester: focusing phase 3. expectant siblings: jealously is increase if age gap is 4+ years -reaction to pregnancy is age dependent: positive or negative 4. expectant grandparents -reaction is situational |
| Single expectant mother | -single by choice -single by accident -single by divorce or separation -single and pregnant by casual acquaintance |
| Antepartum nursing diagnoses | -body image disturbance -anxiety -altered nutrition -knowledge deficit -alteration in role performance -altered sexuality patterns |
| Intrapartum | the time span from the beginning of labor until the birth of the babe and placenta |
| Labor | regular, progressively intense uterine contractions that, overt time, produce cervical effacement and dilation, leading to the development of expulsive forces adequate to move the fetus through the birth canal against the resistance of soft tissue, muscle and the body structure of the pelvis. |
| Labor begins by: | -process not fully understood -combination of maternal and fetal factors biochemical: mom releases oxytocin and prostaglandins hydrostatic: compression due to gravity, fluid around baby must have no net force |
| Premonitory signs of labor | -lightening -pelvic pressure -urinary frequency -irregular contractions -diarrhea, indigestion, weight loss (1-2 lbs) -loss of mucous plug, bloody show, changes in vaginal mucosa -burst of energy |
| Prodomal labor | false labor -irregular contractions that do not increase in frequency, duration or intensity -walking decreases intensity -sedation stops contractions -contractions felt in abdomen -no bloody show -no cervical change |
| True labor | -contractions regular, become longer, more intense -contractions stronger, more effective with walking sedation does not stop -contractions felt in lower back, often like menstrual cramps -bloody show -cervical change |
| Critical factors in labor | -power -passage -passenger -position -psyche |
| Power | forces of labor = power -uterine contractions effect: effacement and dilation phases of contractions frequency, duration, intensity, interval -maternal pushing affected by dycota and pecipidus |
| Effacement | thinning and shortening of cervical neck |
| Dilation | cervix changes from closed to open |
| Dycota | abnormal, long labor |
| Pecipidus | fast labor |
| Contractions | -to dilate and efface cervix -frequency: how often -duration: how long -intensity: how strong |
| Passage | -perineum: stretches against babies head 4 classic shapes of pelvis 1. gynecoid: 50% of women -good -optimal for NSVD -round 2. android: -heart shaped -common to arrest (stop) labor 3. anthropoid: -good -ovoid shape with long posterior/anterior diameter 4. platypelloid: 5% of women -ovoid shape with wide diameter |
| Passenger | 1. presentation -vertex (head down) GOOD -mentum (chin) -breech (bottom/feet) -transverse (across) 2. lie -transverse -longitudinal= GOOD 3. attitude -flexion= GOOD -extension 4. position -left or right -which side presenting part is toward |
| Fetal skull | 1. sutures -sagittal (left and right halves) -lamboidal (parietal and occipital) -coronal 2. fontanels (when baby is born)- soft and flat -anterior (front) -posterior (back) |
| Engagement | presenting part settles into pelvis - bad + good close to delivery |
| NSVD | normal spontaneous vaginal delivery |
| Bilotable | baby is still in fluid |
| Position | L= left R= right O= ossiput M= mentum T= transverse A= anterior P= posterior |
| Fetal assessment in labor | assessment of fetal heart rate (110- 160 unborn) -auscultation: doppler -fetal heart monitoring: ultrasound |
| Deceleration | -late = drop after moms contraction -variable |
| Fetal status | 1. nonreassuring FHR -deceleration: variable or late= drop after moms contraction -fetal bradycardia: under 110 bpm -fetal tachycardia: above 160 bpm 2. reassuring -acceleration: 15- 20 beats above baseline every 20 min -evidence of acceleration -no evidence of decelerations -fetal activity |
| Psyche | factors which influence a womens emotional responses to labor -lack of knowledge -fear of pain -personal or family stress -degree of self confidence -feeling of loss of control -negative attitudes about birth -cultural background -concern for personal safety -a friendly and comfortable environment |
| Stages of labor | Stage 1: dilation -latent phase -active phase -transition Stage 2: pushing to birth of infant Stage 3: delivery of placenta Stage 4: involution of uterus |
| SROM | spontaneous rupture of membrane -before contractions= 15% -gush or leak -fluid should be clear and odorless -presence of meconium= risk for aspiration -meconium (yellow, green fluid, particulate) -odor= possible need for antibiotics |
| AROM | forced breaking of water -performed by provider |
| Latent phase of labor | early phase of labor 1. cervix -dilation: 0-3 cm -effacement: 0-40% (posterior moving to anterior) 2. contractions -irregular -frequency: 5-10 min -duration: 30-45 sec -intensity: feeling slight cramping, period-like 3. fetal station -high 4. psyche -happy, talkative |
| Active phase of labor | VITALS: every hour 1. cervix -dilation: 4-7 cm -effacement: 40- 80% 2. contractions -2 -5 min 3. station - -2 to 0= head at cervix 4. status of membranes -once membrane breaks: -risk for infections increases -within 24 hrs to deliver -dont increase sterile vaginal exams 5. psyche -anxious |
| Transition phase of labor | VITALS: every 15 min 1. cervix -dilation: 7- 10 cm -effacement: 100% 2. contractions -2- 3 min -duration: 60- 90 sec 3. station - -1 to +1 -full bladder and rectum can affect babys decent 4. psyche -"i cant do this anymore!" |
| 2nd stage of labor | 1. contractions -frequency: 2- 3 min -duration: 60- 90 sec 2. cervix -FULLY dilated 3. psyche -urge to push |
| Positioning in labor and birth | -recumbent -semi fowlers -squatting -side laying -sitting -hands and knees |
| Vertex | babys head is down |
| Episiotomy | -before baby crowns, a small slice in the vaginal skin -medial lateral: to side more room to cut muscle takes longer to heal -midline: straight to anus is extra tearing happens= tears to anus |
| Ilius | bowel stops birth |
| VBAC | vaginal birth after cesarian |
| FTP | failure to progress |
| CPD | cefalopelvic disproportion |
| Cesarian section | (C-section) -incidence: on the rise -indications: babys breech, FTP, CPD, VBAC, or ilius -types: low line bikini cut -complications: risk is much higher, bleeding, infection, organ safety, DVT, pneumonia, and dehydration. |
| 3rd stage of labor | placental expulsion -takes up to 30 min to expel -BP decreases and pulse increases -vitals every 5 min -vaginal= up to 500 ml blood loss -c-section= up 1000 ml blood loss -ensure placenta is intact! |
| Newborn | immediate interventions: -assignment of APGAR score -clamping of cord -maintain patent airway -thermoregulation -eye care -vit k (initiates clotting) -infant identification and security (bracelet baby!) |
| 4th stage of labor | 1st hour after birth -bonding and nutrition |
| APGAR score | -increments of 2 -highest= 10 |
| Interventions during labor and birth | -provide nutrition and hydration -promote elimination -promote physical and emotional comfort and support -promote ambulation and positioning (if no epidural) -document progress of labor -provide immediate care of mother and infant after birth -promote parent-infant bonding |
| Causes of pain in labor | -cervical dilation -stretching of vagina and perineum -hypoxia of uterine muscle -pressure on adjacent structures -fear/ tension pain cycle |
| Maternal effects of pain | 1. physical -increased cardiac output, BP, P, T, RR -increased pallor and diaphoresis -increased nausea and vomiting 2. psychological -increased anxiety -maternal change of goal/plan -interference with bonding -social, cultural, and emotional responses |
| Neonatal consequences of pain relief choices | -systemic drug pass through placenta to fetus (IM drugs, not epidural) -immature fetal liver and renal systems prolong metabolism of drugs -increased risk for hypoxic infant -timing and admin -possible effect of FHR changes |
| Nonpharmocologic pain management in labor | -position and movement -localized pressure (touch and massage) -heat/cold -hydrotherapy (jacuzzi tub) -intradermal injection of sterile water= distracts from pain -tens -emotional support: doula- privately paid support partner prepared childbirth exercises music hypnosis |
| Pharmocologic methods of pain management in labor | 1. narcotics -can cause respiratory depression in mom and baby -demerol/ morphine -stadol/ nubain -narcotic agents -CARRY NARCAN! 2. sedatives -seconal/ nebutal -phenothiazines |
| Regional anesthesia | temporary interruption of conduction of nerve impulses 1. epidural 2. spinal 3. intrathecal 4. pudenal 5. local infiltration |
| Epidural | -L4/L5 -heavy feeling -mom lay on back after -4 -6 hours to wear off |
| Spinal | -covers more area -totally numb -24 hours to wear off |
| Intrathecal | -subarachnoid space -covers more area with morphine |
| Pudendal | for episiodomy |
| Local infiltration | for episiodomy repair -peridis= itchiness, treated CAREFULLY with benadryl -nausea and vomiting -urinary retention |
| Factors influencing implantation | -maternal age -fibroids -abnormal endometrial development |
| Identical twins | -split one egg -each have its own placenta -monozygotic |
| Fraternal twins | -two eggs are fertilized -dizygotic |
| Placenta | 1. fetal side= smooth 2. maternal side= rough side |
| Functions of the placenta | -it is the lungs, GI tract and the kidneys of the fetus -no blood exchange between mom and fetus -placenta acts as a filter -1 umbilical vein= TO the fetus -2 umbilical arteries= AWAY from fetus -secretes hormones during pregnancy -HCG, estrogen, progesterone, HCS |
| Umbilical cord | -lifeline between mom and baby -function: 1. bring nutrients 2. carry wastes away from fetus to placenta |
| Membranes | 1. choronic membrane -maternal side 2. amniotic membrane -develops around fetus -contains amniotic fluid |
| Amniotic fluid | -clear -alightly alkaline -constantly reabsorbed, never stagnant -formed from MOTHER'S SERUM and FETAL URINE |
| Functions of amniotic fluid | -shock absorber -temp maintenance -dilating wedge -lubricates birth canal during labor |
| Polyhydramnios | excess amniotic fluid |
| Oligohydramnios | too little amniotic fluid |
| Reproductive changes during pregnancy | -increased size and capacity of uterus -braxtons- hicks contractions -goodell's sign -chadwick's sign -elevated HCG levels -hypertrophy, increased vascularization, hyperplasia of vaginal epithelium -increased acidity of secretions |
| HCG | human chorionic gonadotropin |
| HCS | human chorionic somatomammotropin |
| Uterus | -increases 20 times nonpregnant size -r/t estrogen and progesterone -walls thin -weight and volume increase (full term holds 4-8 L of fluid) -shape changes -contractions -endometrium= decidua after implantation |
| Uterus changes during pregnancy | -walls thin to 1.5 cm or less -weight increases to 50-1000 grams -volume changes from less than 10ml to 4-8 L |
| Cervix changes during pregnancy | -cervical softening -mucous plug form at bottom of cervix |
| Ovary changes during pregnancy | -anovulation= without ovulation -corpus luteum |
| Corpus luteum | -endocrine tissue which produces hormones, estrogen, and progesterone which prepares the uterine lining for receiving an embryo -yellow color |
| Vagina changes during pregnancy | -increased vascularity= bluish discoloration -increased acidity of vaginal secretions -leukorrhea= white vaginal discharge which leads to yeast infections |
| Breast changes during pregnancy | -external changes size breasts become nodular (bumpy) -areola and nipples pigmentation changes -internal changes |
| Cardiovascular system changes during pregnancy | -heart: slightly enlarges ausculatory changes position shift -hemodynamic changes: heart rate= 10- 15 increase cardiac output increase blood volume increase= 45% increase blood volume vasodilation arterial blood pressure increases in 3rd trimester |
| Respiratory changes during pregnancy | -oxygen consumption increases -RR increases and breathing capacity unchanged -abdominal- thoracic breathing= inspiration increases 30-40 -patient c/o SOB |
| Urinary changes during pregnancy | -increased frequency -increased risk of of trauma and infection -urinary stasis (decreased urinary output) -glycosuria and proteinuria -nocturia |
| GI changes during pregnancy | -nausea and vomiting: because of hormones, -decreased GI motility -changes in taste and smell -hypertrophy of gums -increased acidity of gastric contents/ pH= heartburn -esophageal regurgitation -constipation -hemorrhoids |
| Musculoskeletal changes during pregnancy | -lordosis= curvature of back -"waddling" gait -diastasis recti= separation of muscles -fatigue -edema of lower extremities in later pregnancy |
| Metabolic changes during pregnancy | -nutrient metabolism= increase diet by 300 calories -protein and carb demand increases -iron needs change= usually need increases and folic acid -water metabolism -pica= eating non-food items (diet, rocks) -weight gain= 1. normal= 25-35 lbs 2. overweight= 15-20 lbs 3. underweight= 30lbs 1st trimester= 3 lbs 2nd trimester= 10 lbs 3rd trimester= 15 lbs |
| Endocrine changes during pregnancy | -pituitary: FSH and LH hormone suppressed (ovulation hormones) gradual rise in oxytocin and prolactin production as fetus matures -thyroid: basal metabolic rate (bodys resting energy use) increases 25% |
| Involution | uterus shrinking back down to size |
| Immunologic changes during pregnancy | -resistance to infection decreases -WBCs increases but efficacy decreases -cellular immune response is decreased -immunoglobin levels: IgG changes IgA and IgM levels stable |
| Dental needs during pregnancy | -any bacterial problems can be sent into system to baby -bacteria causes preterm birth -bleeding gums |
| Principles of mother-baby care | -promotes family togetherness -couplet care: facilitation of optimal interaction between mother and baby coordination of appropriate nursing assessments and interventions -education on self and newborn care |
| Postpartum assessment | 1. maternal system changes 2. postpartum physical assessment 3. complete shift assessment 4. psychosocial adaptation 5. maternal emotional adjustments 6. teaching needs |
| Maternal system changes | 1. vital signs: -1st hr= every 15 min -then every hr for 4 hrs -c-section= every hr for 24 hrs 2. cardiovascular: -watch H&H -HCT will stabilize in 24 hrs -WBC will increase 3. respiratory: -vaginal= 6 weeks to normalize -C-section= 8 weeks to normalize 4. GI: -increase fiber and fluid 5. urinary: -straight cath if voiding is absent -pain= major indicator of full bladder 6. musculoskeletal: -joints up to 6 weeks to stablize 7. immune and integumentary: -hyperpigmentation resolves -Rh factor -assess moms MMR status |
| MMR in pregnancy | -measles, mumps and rubella -dont be pregnant for 12-3 months before getting vaccine -live vaccine |
| Reproductive changes after pregnancy | -uterus= pear shaped -involution= shinks back to size -lochia= discharge starts as bright red -cervix= closes back up -vagina= canal size decreases -perineum= healing from tearing or episiotomy -breasts= lactating, pigmentation changes |
| Initial postpartum assessment | 1. vitals signs 2. fundal check 3. vaginal bleeding 4. perineal check 5. bladder 6. response to anesthesia 7. pain management |
| Uterine involution | 1. lochia= uterine debris after birth 2. lochia rubia= 3-4 days, dark red, fleshy, musty, stale non-offensive odor, clot size less than a nickel 3. lochia serosa= 4-10 days, pink or brownish 4. lochia alba= 11-21 days, up to 6 weeks, yellow to white, possible stale odor -should NOT: have foul odor have large clots saturated pad in less than 15 minutes |
| Assessment of the perineum | Redness Edema Ecchymosis Discharge Approximation |
| Lacerations | 1st degree: -limited to perineal skin and vaginal mucosa 2nd degree: -involves underlying fascia and muscles 3rd degree: -involves anal sphincter, possibly anterior wall of rectum 4th degree: -extends through rectal mucosa to lumen of rectum |
| Postpartum shift assessment | Breast Uterus Bladder Bowel Lochia Episiotomy/perineum Edema/pain in calf Emotions |
| Cesarean birth assessment/ complications | -risk of lowered self esteem r/t failure to achieve vaginal birth -increased levels of fatigue -activity intolerance -incision pain -risk of re-hospitalization for uterine infection -surgical wound infection -complications from surgical wounds -cardiopulmonary and thromboembolic complications -promote comfort post c-section -use 1 finger to check fundus as mom exhales -uterine massage only if absolutely indicated -rolled towel under belly when side lying -position baby for feeding to avoid pressure on abdomen -will need help lifting baby from crib |
| Postpartum diagnostic testing | -CBC -blood type -rubella immune status |
| Postpartum nursing diagnosis | -pain (acute) -fluid volume excess -breastfeeding -infection, risk for -altered urinary elimination -constipation -altered parenting -knowledge deficit -self-care -hygiene |
| Attachment | social signals designed to increased the proximity of parent and child |
| Maternal emotional adjustments | Rubin's phases 1. taking in: -dependent 2. taking hold: -dependent- independent 3. letting go: -interdependent |
| Postpartum cultural beliefs | 1. african caribbean -avoid chilling (showers) for 2 weeks -BF preferred 2. chinese -eat "hot" food for 1 month -men not present during labor -FF preferred 3. south asians -infant washed before handled -postnatal seclusion for mom and infant -BF preferred, except colostrum (milky breast fluid 1st 3 days) |
| Postpartum physiologic changes | -return of menses/ ovulation -self-care measures -s&s of infection -resumption of sexual intercourse -scheduling of routine postpartum visit with provider -rest/sleep requirements -community resources -family planning -contraception method must be safe for individual and understood |
| Types of contraception | -abstinence -barrier -hormonal -traditional IUD -sterilization |
| Postpartum phase | the period from birth through the first 6 weeks of life |
| Length of gestation | 10 lunar months |
| Quickening | maternal perception of fetal movement and occurs by 20 weeks gestation |
| Proliferative phase | during the menstrual cycle to ovulation -begins when the endometrial glands enlarge in response to increased estrogen -endometrium increases in thickness 6-8 times -reaches its peak just before ovulation |
| Secretory phase | follows ovulation -glands secrete small quantities of endometrial fluid in prep for a fertilized ovum -provides a nourishing bed for implantation |
| Most accurate determination of EDB | measurement of fundus to symphysis pubis |
| Prenatal visit schedule in normal pregnancy | -28- 32 weeks= every 4 weeks -36 weeks= every 2 weeks -term= weekly |
| Zygote | conception to 2 weeks |
| Embryo | 2nd week to 8th week |
| Fetus | 8th week to delivery |
| Neonate | 1st 4 weeks of life |
| Boggy uterus | -bad -increased risk for bleeding |
| MMR in pedi | given at 12 months |
| Hep B in pedi | minimum age vaccine can be given is 24 weeks |
| Kindergarden vaccine requirements | 1. hep B 2. DTAP 3. varicella 4. MMR 5. roto |
| Pedi developmental milestones | 5th- 6th month= sitting up with support or pillow |
| Nutritional development | -1st 6 months= breast milk or fortified formula -4 -6 months= intro of solid foods -2nd 6 months= rice cereal, fruits, veggies (1 every 3-4 days), weaning occurs by 1st year, drink from a cup -toddler= finger foods, frequent small meals, limit sweets -preschooler= child has food preferences, limit juice to 8-12 oz/day -schoolage= balance food pyramid diet -adolescence= need for 2000- 3000 cal/day |
| Levels of behavior | 1. attachment 2. separation anxiety 3. stranger fear 4. temperament |
| Attachment | -progresses during infancy -develops the ability to discriminate the mother from others -achieves object performance -separation from consistent caregiver |
| Separation anxiety | -begins at 6 months -constantly crying and protesting when parents not present -normal and healthy part of mental health |
| Stranger fear | -beings about 6 months -protests or cries when held by another person -normal behavior -shows parental attachment |
| Temperament | -manner of thinking, behaving or reacting -response to dealing with life -behavioral tendencies -potential for optimum development exists when the environmental expectations and demands fit the child's type of behavior 1. easy child= tempered, regular and predictable 2. difficult child= highly active, irritable, irregular habits 3. slow to warm up child= inactive, moody, moderate irregular habits |
| Role of play in development | 1. infancy -solitary play -social interaction enhances play 2. toddler -parallel play, play side by side -may not see interactive play 3. preschool -associative play -interact with other during play -dramatic play 4. schoolage -cooperative play -increase playtime with friends -extremely important method of learning |
| Anemia | a condition of less than normal RBC count and hemoglobin level -often an underlying disorder -results in a diminished amount of oxygen delivery to body tissues |
| Hypoproliferative | a decrease in the production of RBCs |
| Hemolytic | excessive destruction of RBCs |
| Anemia signs and symptoms | integumentary -pallor (pale skin) -cool to touch -intolerance to cool temps -brittle nails cardiovascular -*tachycardia at rest*, increasing with activity and during and immediately after meals -murmurs and gallops with auscultation with severe anemia -orthostatic hypotension respiratory -dyspnea on exertion -decreased oxygenation saturation levels neurologic -increased somnolence and fatigue -headache |
| Microcytic anemia | iron deficiency anemia -more frequent in women, older adults, and people with poor diets -generally preventable in kids -iron fortified cereals and formulas for infants -teens at risk due to rapid growth and poor diet causes: -blood loss -poor intestinal absorption -inadequate diet |
| Iron deficiency anemia symptoms | symptoms: -mild -weakness and pallor to rapid fatigue -tachycardia -palpitations -chest pain -glossitis (inflammation of the tongue) -brittle, fine hair -spoon shaped nails |
| Iron deficient anemia management | -drug therapy -oral iron supplements (ferous sulfate) -IM iron injections -diet teaching= iron increase in diet potatoes, green leafy veggies, wheat and grains |
| Iron deficient anemia interventions | -assess childs drug history for asa and steroids -decrease stimulation -frequent rest periods -small frequent meals to decrease oxygen demands |
| Thalassemia | inherited anemia -thalassemia major= most common -often in mediterranean descent 1. minor -no s&s -mild anemia 2. intermediate -severe anemia 3. major (cooleys anemia) -anemia requiring transfusion |
| Thalassemia complications | treatment: -iron overload from transfusions no treatment: -pathologic fractures -cardiac arrythmias -liver failure -heart failure -death |
| Cooley's anemia assessment | (thalassemia major) -pallor and yellow skin and sclera (3-6 months) -splenomegaly (enlarged spleen) or hepatomegaly (enlarged liver) -small body and large head -failure to thrive -6- 12 months= life threatening |
| Thalassemia management | -no treatment for mild and moderate -transfusion of packed RBCs for major -no iron supplements -diet low in iron rich foods avoid strenuous activity -surgery= splenectomy or bone marrow transplantation |
| Sickle cell anemia | -partial or complete replacement of Hgb with abnormal hgb S -RBCs take on "sickle" shape -cells are rigid and obstruct capillary blood flow -hypoxia occurs and causes sickling -mostly in blacks |
| Sickle cell crisis triggers | -dehydration -deoxygenation -fever -infection |
| Sickle cell crisis | acute exacerbations that vary in severity and frequency 1. vaso-occlusive thrombotic -most common -very painful -stasis of blood with clumping of cells in microcirculation> ischemia> infarction -signs= fever, pain, tissue engorgement 2. splenic sequestration -life threatening, can occur in hours -blood pools in spleen -signs= profound anemia, hypovolemia, and shock 3. aplastic crisis -diminished production and increased destruction of RBCs -triggered by viral infection or depletion of folic acid -signs= profound anemia and pallor |
| Keylation | getting rid of Hgb that iron attaches to |
| Polycythemia vera | disease with sustained increase in blood H&H -massive production of RBCs -excessive leukocyte production -excessive production of platelets -cancer of RBCs |
| Polycythemia vera signs and symptoms | -persistent Hct above 55% -HTN -dark and flushed appearance of hands and face -distension of superficial veins -weight loss -fatigue -intense itching -enlarged hemorrhoids -swollen painful joints -enlarged, firm spleen |
| Polycythemia vera management | -drink at least 3 L of fluids daily -anticoagulant therapy -intense therapies to suppress bone marrow activity -oral chemotherapy drugs |
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