Only $2.99/month

Terms in this set (333)

✯ ________ Complications GI/GU
▪︎ Poor sucking
⇢ May tucker easily if we are trying to orally feed them by breast or bottle.
▪︎ Poor swallowing
⇢ Might not be able to suck and swallow all of the feeding that they need.
▪︎ Poor gag reflex
⇢ Poor gag reflex puts them at risk for aspiration.
▪︎ Small stomach capacity
⇢ High calorie and protein need, but a small stomach capacity and poor ability to suck and swallow.
▪︎ Difficulty absorbing fat
▪︎ Calcium and Phosphorus deficiency (deposited in third trimester)
⇢ If the baby is born prior to the third trimester or doesn't make it all the way through the third trimester they may have low calcium and phosphorous.
▪︎ Increased BMR and oxygen needs
▪︎ At risk for Necrotizing Enterocolitis (NEC)
⇢ If they have decreased peristalsis and potentially decreased blood flow to the intestine, they are at risk for infection so they may get NEC. With this they can lose large portions of their intestine. It can actually be life threatening.
▪︎ Immature kidneys
⇢ Can be a problem with formula. Much of formula and protein is filtered through the kidneys.
▪︎ Glomerular Filtration Rate (GFR) decreased
⇢ Can impede their ability to process excess fluids.
▪︎ Limited ability to concentrate urine
▪︎ What are the implications for feeding _____ newborns?
⇢ Often use TPN initially. If they are able to/when they are able to to use it, they will start Gavage/NG feedings. Slowly as the baby is tolerate it we will introduce oral feedings. Through bottle and breasts. Once the baby is able to do all of the feedings orally we are very encouraged by that. In healthy situations we may see them starting to ween the baby to a crib so that it can maintain temperature on its own as long as it is gaining weight and able to do all of its feedings by mouth. You may also see them fortifying breast milk or using special formulas for these babies.
✯ Newborn of the _______ _______ _______ Care
▪︎ Promote PNC (prenatal care)
⇢ Getting her the help she needs during the pregnancy.
▪︎ Newborn drug screen
⇢ Collect urine from a baby in a u-bag. Want to do this as soon as possible after delivery, so if the baby does have the drug in its system it is not cleared prior to use getting the specimen.
⇢ Positive drug screen on the baby is considered child abuse. Otherwise, it is child endangerment. Social services decides if the baby should stay with the mother in these cases.
▪︎ Social service consultation
⇢ See if the mother is going through tx. What are plans for this baby? Is she caring for her other kids appropriately? Can she care for this baby appropriately? Where should the baby go if she can't care for it appropriately?
⇢ Social services can help answer all of these questions. They can help find a safe environment for the child that's best for the mother and baby.
▪︎ Medication administration
⇢ If mother is addicted to morphine, we would get an order for a small amount of morphine and wean the baby off of it.
⇢ Baby is weaned off in a couple of ways.
・The baby gaining weight and growing will help it wean itself. In addition to that we will do abstinence scoring. This will indicate how well the baby doing. We'll adjust the dosing based off of that.
▪︎ Reduce withdrawal symptoms
⇢ Obsessive sucking and then projectile vomititng, diarrhea, skin excoriation, sweating, inability to sleep for a period of time, difficulty calming down, high pitched cry
・Consider all of these things in abstinence scoring
▪︎ Abstinence scoring
⇢ Scoring tool to look at how addicted the baby is
⇢ Used as a decision factor when they're looking at the medication and the decision to wean down or if the baby needs more and is not tolerating a wean.
▪︎ Small, frequent feedings
⇢ Often helpful. If the baby is obsessively sucking and then projectile vomititng this can help alleviate this.
▪︎ Monitor GI status
⇢ Are they having diarrhea or vomititng?
▪︎ Swaddle, pacifier, calm infant
⇢ Provide them with comfort. Can have a difficult time consoling themselves. Gently rock or talk to the baby.
▪︎ Skin protection
⇢ Especially since the baby is at risk for skin excoriation.
⇢ Ex: Desitin to the bottom
▪︎ Decrease stimulation
⇢ Quiet, dark room, etc...
⇢ Helps them sleep and not stay agitated.
▪︎ These babies are in the hospital for a prolonged period of time. It is important that we keep them on task developmentally.
⇢ Talk to them and show them bright colors or use a baby mobile. May also see occupational therapy working with these babies so they can be social and meet all of their developmental milestones.
✯ __________ __________ __________ Considers;
▪︎ Consider fertility and being aware of the most fertile time. Women looks at changes that take place during the menstrual cycle
▪︎ Lifespan of the egg
⇢ 1-3 days
▪︎ Life span of the sperm
⇢ 2-7 days
⇢ Conception does not take place at that magic moment. It can happen hours or days after intercourse has taken place. The sperm has to make its way up through the fallopian tubes to meet the egg. Sperm has longevity so it can happen days after the event.
▪︎ Maximum fertility during the 5 days preceding ovulation
⇢ If trying to get pregnant these are the days they should be engaging in sexual intercourse
⇢ If she does not want to get pregnant she should be abstaining during these days.
▪︎ Pros;
⇢ Free
⇢ Safe
・No chemicals or drugs like we might with the pill
⇢ Accepted in religions and cultures that do not accept other methods
⇢ Increased awareness of menstrual cycle
・and how their body works
⇢ Involves nothing artificial during intercourse
▪︎ Concerns;
⇢ Must have regular cycles to predict
・May be very difficult to predict when the 5 days preceding ovulation are taking place. Typically this is based on a history of cycle lengths and when ovulation takes place.
⇢ May interfere with spontaneity
・If she's ovulating and its your anniversary? May have some decisions to make.
⇢ Must keep records
・And be organized to know when she is at her most fertile days
⇢ Comfortable with their body
・Are they comfortable with checking their cervical mucous
⇢ Not as reliable as other methods
・If effectiveness is a major concern this may not be a good option.
✯ Assessment of the Fertility: Female - ______ ______;
▪︎ Cause 25% of infertility
▪︎ Track Basal Body Temperature
⇢ Will see an increase. Indicates a good time to have intercourse. Tells us about her ovulation status.
⇢ Ask women to record her basal body temp
▪︎ May Test:
▪︎ Gonadotropin levels
▪︎ FSH (day 3)
⇢ Should be measures at cycle day 3.
⇢ Most valuable test in assessing ovarian reserve or the # of oocytes of the follicle in the ovary
▪︎ LH (mid cycle)
⇢ LH surge on the day of ovulation. This indicates a fertile day. Tells us if she is ovulating.
⇢ We would expect daily sampling of LH at mid cycle to see if she's having an LH surge.
⇢ Home LH indicators are available for women to seen when they are having their LH surge/ovulating. This urine test would give a positive indication = a fertile day and should engage in intercourse.
▪︎ Progesterone (day 21)
⇢ Progesterone gives us an idea about the evidence of ovulation taking place.
⇢ Expect to draw this at day 21 or 7 days after we believe ovulation has occurred.
⇢ This generally indicates an adequate luteal phase telling us that she is ovulated.
▪︎ Prolactin
⇢ A hormone that if present can frequently cause ovulatory dysfunction if it's too high.
⇢ Also plays a role in breastfeeding
⇢ Looking for high levels of prolactin that could be causing ovulatory dysfunction.
▪︎ Thyroid Stimulating Hormone
⇢ Stimulates prolactin secretion the by pituitary gland
⇢ Hypothyroidism (low thyroid levels) can have a dramatic effect on ovulatory function. Can cause irregular cycles and bleeding irregularity.
▪︎ Androgen levels
⇢ Often associated with testosterone
⇢ This can cause ovulatory dysfunction. Sometimes these women report oligomenorrhea or anovulation d/t amenorrhea (no period at all).
✯ STIs; __________
▪︎ Lifelong viral infection.
▪︎ Signs/ Symptoms: Often asymptomatic, presence of genital warts, cervical dysplasia
⇢ Usually not until she goes for an annual exam and gets tested for HPV that she finds out she is infected.
▪︎ Link between HPV and cervical Cancer
▪︎ Cause: 60 genotypes r/t hpv
⇢ Some of these are linked to the presence of genital warts.
⇢ Some of them are also related to cervical dysplasia or changes in the cellular structure of the cervical cells up to and including cervical cancer.
▪︎ Transmission: sexual contact
⇢ Genital Contact. Not even using a barrier method like a female or male condom can completely eliminate the risk of getting HPV because there is still some genital contact.
▪︎ Treatment:
⇢ Podophyllin (teratogenic)
・Should not be given to pregnant women because it can be linked to congenital anomalies.
⇢ Surgical removal or cryotherapy
・If she has warts they can be surgically removed or removed with cryotherapy.
▪︎ Vaccines:
⇢ Gardasil- (strands 6, 11, 16, and 18) Given to 9 -26 year olds
・Now in the regimen for young people. There is also talk about its approval for the use in boys. Since men can also be affected by HPV and transmit it to women.
・Not effective against all strands of HPV.
⇢ Cervarix
・Newer vaccine that can be effective against other strands of HPV.
⇢ While the Vaccines are great and can deeply diminish the occurrence of HPV and can help decrease incidences of cervical cancer because of that, they are not effective against ALL strands of HPV.
▪︎ The major concerns of HPV are its potential link to cervical cancer and some women (depending on the strand) may have genital warts associated with HPV.
✯ Myths Surrounding Partner ______ and ______
▪︎ Battering is infrequent
⇢ About 1/3 of all women will experience some kind of abuse in their lifetime. 10% of all women will report this abuse.
▪︎ Abused women often provoke the abuse
⇢ 'She pushed him over the edge'. Gives permission to the abuser to act that way. We should all understand that we are all responsible for our own behavior. Even if somebody is being somewhat inappropriate, it does not allow someone to act abusively towards that person. Abused women are not provoking the abuse. It is up to the other person who is doing the abuse to act in a way that promotes diplomacy and self-control.
▪︎ Drugs and ETOH cause abuse
⇢ There are higher rates of abuse in situations with drugs and ETOH. However, this is not an excuse to abuse another person. We're all in control and responsible of our own behavior.
▪︎ Abused women can easily leave the situation
⇢ Easy for many people not in the relationship to tell them to leave. Woman may stay in an abusive situation due to finances (especially if they are dependent on the male), kids are involved (concerned about how it will effect them), love hate relationship with the abuser, and if she does leave what are the long term implications, She may feel that her safety is in jeopardy if she leaves now. Need to have a plan in place.
▪︎ Violence is a low income issue
⇢ Low income can lead to stress in a relationship. However, violence is something that can take place in any SES. Any age, culture, or race. Not just a low income issue. Low income patients may report it to hospital mores. Those with higher incomes can report it privately and take care of matters that way.
▪︎ Abused women are safe during pregnancy
⇢ Physical abuse is often aimed at the breast/torso area. Often times the abuser finds the pregnancy a threat. Not all of the attention is on him. This can be a time where abuse can be initiated or actually perpetrated (become worse).
✯ _______ __________: Nursing Assessment
▪︎ Respect, trust, and advocacy
⇢ Build a relationship with the patient. Going to respect her as a human being, ask her questions, and take her word for it. Don't want to push her too hard on this.
⇢ Build a relationship that has trust at the base of it, so that she feels that she can tell you the truth.
⇢ Going to advocate for her, her desires, and rights.
▪︎ Listen to her
⇢ Maker her feel heard and we'll believe what she says.
▪︎ Stress myths
⇢ Stress that she didn't do anything to make this happen. It is unacceptable behavior.
▪︎ Let her talk at her own speed
⇢ Not going to push her. Ask open ended questions. Be concerned and document things in her own words.
▪︎ May have conflicting feelings toward abuser
⇢ May be in the honeymoon period.
▪︎ Should she leave?
⇢ Want to make sure that she can leave safely and has a plan together.
▪︎ Signs of abuse:
⇢ Neuro signs
・Headaches, tension headaches, migraines, hearing loss, detached retinas
⇢ Gyn signs
・Reports of painful intercourses, frequent STIs, pelvic pain
⇢ OB signs
・Late prenatal care, recurrent therapeutic abortions, recurrent spontaneous abortions
⇢ GI signs
・IBS, feeling of a lump in the throat
⇢ Musculoskeletal signs
・Fibromyalgia, painful joints
⇢ Psychiatric Signs
・Panic, anxiety, mood disorders, substance abuse, eating disorders
⇢ Constitutional Signs
・Abrasions, sleep disturbances, appetite problems, decreased concentration, frequent use of tranquilizers
⇢ Trauma
・Injury to her female organs, accident histories (more than usual), having sexual trauma, history of frequent old fractures
⇢ Other Signs
・History of frequently missed appointments, neglected appearance, and the way she relates to HCP like lack of eye contact. See if she is not acting appropriately given the situation. Defensive injuries. Delayed reports of symptoms or seeking care for injuries way after the incident occurred.
✯ Sexual Violence Nursing Management: _______
▪︎ Many emergency departments have this type of specially trained nurse available to work with patients who have gone through sexual violence.
▪︎ Rape is a trauma and crime
⇢ We treat this physiologically, psychosocially, and legally it is a crime.
▪︎ Obtain history
▪︎ Prevention of STIs
⇢ Therapy will take place for this. Will often order prophylactic antibiotics to help prevent some STIs under these circumstances. Since gonorrhea, chlamydia, and some other STIs can be treated with antibiotics.
▪︎ Prevention of pregnancy
⇢ Emergency contraception may be ordered. It can be used pretty effectively 72-96 hours, depending on which form it is, after the incident.
▪︎ Collect evidence:
⇢ Clothes
・We'll label it. Presence of fluid or semen may be present. However, this does not indicate any sexual assault occurred. This is not up to nurses to decide. It's up to legal authority.
⇢ Swabs of fluid
・Or any secretions. Can be in the vaginal area or mouth as well. Often times there is sexual dysfunction on the part of the perpetrator. Sometimes they may use a condom and we may not find anything.
⇢ Hair and fingernail scrapings
・Looking for loose pubic hairs or potentially hairs that may have transferred. The woman's hair & any loose hairs will be collected for testing.
・If she was fighting the rape she may have tissue or cellular debris under her nail that belongs to the perpetrator. This can be helpful in identification.
⇢ Blood samples
・To see if there are any infections.
⇢ Urine samples
・If she was drugged what did they drug her with.
⇢ Photographs
・If there was any additional trauma. Need consent to do so.
✯ _______ _______
▪︎ Understanding the type of family structure by completing a family assessment enables the nurse to provide appropriate care
▪︎ Traditional nuclear family- husband is the provider, the wife stays home with children
⇢ Is becoming less common than the other types of families discussed.
▪︎ Dual-career/earner family- Both parents are working
⇢ Most families today have dual earners that both share various household and child-rearing responsibilities.
▪︎ Childless family or childfree family
⇢ Infertility accounts for childless families and some couples choose to be childfree.
▪︎ Extended family- Couple and relative(s) share household responsibilities and raising children
⇢ May have a grandparent that helps with the household or may require care and assistance.
▪︎ Extended kin family- 2 nuclear families share household responsibilities and support networks
⇢ Live very near and pool resources. This may be seen in Latino communities.
▪︎ Single-parent family- one parent handles most household responsibilities and the majority of raising children
⇢ A growing group. There are about 13 million one- parent families in the U.S.
⇢ Traditionally this is result of divorce, abandonment, separation, or death of a partner. However, the non-traditional single parent group, the mother was never married.
▪︎ Stepparent family- biological children of one parent and other parent is not biological parent
⇢ Consists of one of the parents not being the biological parent.
▪︎ Binuclear family- biological children of parents now in two separate nuclear families.
⇢ The biological child is part of two traditional nuclear families in which each biological parent is remarried. Often these children spend somewhat equal time in two families.
▪︎ Nonmarital heterosexual cohabiting family- couple that chooses not to legally marry
▪︎ Gay and lesbian families- same-sex cohabiting couple with or without children