carrier testing: used to identify one copy of a gene mutation that when two copies present will cause a genetic disorder. also if there is a family history of a disorder.
preimplantation testing: PGD: early detection of genetic disorders such as trisomy 21 hemophilia and tay sachs disease
newborn screening: detect genetic disorders that can be treated early in life.
risks for a child with a genetic disorder:
maternal age over 35, history of previous pregnancy with mutation, man or woman with genetic disorder, family history of disorder.
parents have options to: continue or terminate the pregnancy, prepare for a child with genetic disorder, use gene therapy when available.
Nursing action for termination: stages of grief, communication, support group therapy.
nursing action for continuing pregnancy: inform, refer to support groups, grief over loss of their dream child, encourage.
degree of malformation vary based on length of exposure, amount of exposure, and when it occurs during human development.
Drugs and Chemicals:
*Alcohol: low birth weight, microcephaly, mental retardation, unusual facial features due to midfacial hypoplasia, cardiac defects.
*ACE inhibitors: renal tubular dysplasia that can lead to renal failure and fetal or neonatal death, intrauterine growth restrict.
*Anticonvulsants(carbamazepine): neural tube defects, craniofacial defects, including cleft lip and palate, IUGR
*Cocaine: hear, limbs, face, GI, and genitourinary tract defects, cerebral infarctions, placental abnormalities.
*Coumadin: spontaneous abortion, fetal demise, fetal or newborn hemorrhage, central nervous system abnormalities.
*Cytomegalovirus: hydrocephaly, microcephaly, cerebral calcification, mental retardation, hearing loss.
*Chicken Pox: hypoplasia of hands and feet, blindness/cataracts, mental retardation.
Rubella: heart defects, deafness and or blindness, mental retardation, fetal demise.
Syphilis: skin, bone, teeth defects, fetal demise.
Toxoplasmosis: fetal demise, blindness, mental retardation(found in cat feces and uncooked or rare beef or lamb. avoid cats and changing litter box)
primary germ layers begin to develop around day 14:
Ectoderm: outer germ layer: epidermis, hair and nail follicles, sweat glands, nervous system, pituitary gland, adrenal medulla, lens cornea, internal ear, mucosa of oral and nasal cavities.
Mesoderm: middle germ layer: dermis, bond cartilage, skeletal muscles, cardiac muscles, kidneys, adrenal cortex, bone marrow and blood, lymphatic tissue, lining of blood vessels.
Endoderm: mucosa of esophagus, stomach, and intestines. epithelium of respiratory tract, including lungs, liver and mucosa of gallbladder, thyroid gland, pancreas.
by the end of 8 weeks the primary germ layers form a clearly defined human that is 3cm in length with all organ systems formed.
causes: 1/3male, 1/3female, 1/3both.
male: endocrine: low levels of LH, FSH. spermatogenesis: problems with the process and are called gonadotoxins and they are drugs like calcium channel, alcohol, nicotine, infections, illness, heat exposure, pesticides, radiation. sperm antibodies: mainly in men with a vasectomy reversal or testicular trauma. Disorders of intercourse like retrograde ejaculation.
female: ovulatory dysfunction: inconsistent, or anovulation. tubal and pelvic problems: uterine fibroids, damage from PID. Cervical mucus factors: surgeries or infection that interfere with the sperm surviving in the uterus.
women: autoimmune disorders, diabetes, eating disorders, excessive alcohol drinking, excessive exercising, obesity, older age, STD.
men: pollutants, alcohol, marijuana or cocaine, impotence, older age, STD, smoking.
lab tests: TSH, FSH, LH and testosterone and screening for STD's
semen analysis: abstains for 2-3 days prior, and includes volue, sperm concentrations, motility, morphology, white blood cell count, immunobead, and mixed agglutination reaction test. several tests may be needed because sperm production fluctuates.
ovulatory: BBT every morning and a rise by 0.4 signals ovulation for 3 consecutive days. ovarian reserve testing, on the 3rd day of cycle serum FSH and estradiol test is performed needs more evaluation if FSH is greater than 10. and detecting LH surge which happens 36 hours before ovulation and is the ideal time for intercourse if pregnancy is desired.
Male: hormonal therapy for endocrine dysfunction. lifestyle changes. corticosteroids to decrease sperm antibodies. treat infections, surgery to repair anything that is blocked or can inhibit transport of sperm.
female: lifestyle changes and drugs such as clomiphene citrate, surgery to open tubes, myomectomy for fibroids, antibiotics for infections.
supine hypotension: instruct to avoid supine position from mid pregnancy onward, advise to lay on side and rise slowly to decrease the risk of a hypotensive event.
orthostatic hypotension: keep feet moving when standing and avoid standing for a long time. rise slowly from lying position to a sitting or standing to decrease a hypotensive event
anemia: encourage the woman to include iron rich foods in daily dietary intake and take iron supplementation: red meat, pork, seafood, beans, dark green leafy veggies like spinach, apricots.
dependent edema lower extremities and or vulva: wear loose clothing, maternity girdle for support to enhance circulation avoid standing or sitting for a long time dorsiflex feet periodically when standing or sitting, elevate legs while sitting, position on side when lying down
varicosities: wear support hose put on before rising in morning before legs have been in a dependent position, lie on her back with legs propped against a wall in a 45 degree angle to spine periodically throughout the day instruct the woman to avoid crossing legs when sitting
NVP: avoid strong odors and causative factors, eat small frequent meals, eat slow, eat crackers or dry toast before rising or whenever nauseous, drink cold clear carbonated beverages like ginger ale or lemonade, avoid fluid with meals, peppermint candies, brushing teeth after eating, take vitamins at bedtime with a snack not in the morning, B6 25mg by mouth TID. oral drugs to manage symptoms
salivation: gum or hard candy to use astringent mouthwash
bleeding gums: brush gently with soft toothbrush, daily flossing, nutrition
flatulence: maintain regular bowel habits, regular exercise, avoid gassy foods, chew slowly, knee chest position during periods of discomfort
heartburn: small frequent meals, good posture, adequate fluid intake but not with meals, avoid fatty or fried foods, upright for 30-45 minutes after eating, refrain from eating 3 hrs. before bedtime.
constipation: adequate fluid intake, regular exercise, increase fiber, regular bowel habits, good posture and body mechanics.
hemorrhoids: avoid bearing down, ice packs, warm baths and sitz baths, witch hazel compresses, elevate hips and lower extremities during rest periods throughout the day.
low back pain/joint discomfort/difficulty walking: proper body mechanics, good posture, pelvic rock/pelvic tilt exercises, supportive shoes with low heels, warmth or ice to painful area, maternity girdle, use massage, relaxation techniques, firm mattress with pillows for support.
diastasis recti: abdominal strengthening exercises like crunches no sit ups, proper sitting up from lying down(roll to side, lift torso up using arms until in sitting position)
round ligament pain: lie on side and flex knees up to abdomen, bend toward pain, do pelvic tilt/rock exercises, warm baths or compresses, side lying in exaggerated sims position with pillows for additional support of abdomen and in between legs, maternity belt.
leg cramps: dorsiflex foot to stretch calf muscle, warm baths or compresses to the affected area, change positions slowly, massage area, regular exercises and conditioning.
multiparity: should not assume they need less help just cause they have been there. need time to process strategies to handle multiple children. challenges of giving attention to all kids equally.
maternal age: maternal identity is very difficult to achieve for the adolescent who is in the throes of evolving her own identity as an adult independent from her family. she will function at a lower level of competence. the younger the more difficult to accept body changes, seek health care, and plan for changes and higher rate of abuse.
*early adolescence: ages 11-15 are self centered and oriented towards the present and pregnancy is usually the result of abuse or coercion.
*middle adolescence: 14-16 years more capable of abstract thinking and understanding of behaviors and their consequences
*by age 17-20 late adolescence and are likely to be capable and active participant in health care decisions.
*older mothers over 35: chronic diseases, fetal chromosomal abnorms, low birth weight, premature births, multiple births, but better equipped psychosocially but difficulty in changing her life from a career woman to a mother.
lesbian mothers: lack social support. nurse needs to strive to use language and to avoid making assumptions about gender orientation. include birth partners as much as possible
single parent: may live below poverty level, higher stress, need to make a decision whether to proceed with the pregnancy.
multigestation: if carrying more than 3 they may need counseling to pick which to keep so they can let the remaining fetuses grow to term but this poses a ethical dilemma.
socioeconomic: financial barriers, immigrant women face significant economic barriers.
Abused: IPV(intimate partner violence), screen all pregnant women.
military: for veterans pregnancy can make mental health conditions worse. get support from on base clinics.
nursing actions: use ALPHA a screening tool. establish a trusting relationship.
prescriptive beliefs: expected: remain active during pregnancy, remain happy to bring the baby joy and good fortune, drink chamomile tea to ensure labor, soup with ginseng root is good strength tonic, cravings need to be satisfied or the baby will be born with a birthmark, sleep flat on your back to protect fetus from harm, safety pin to an undergarment to protect fetus from cleft lip or palate.
restrictive beliefs: do not have your picture taken it might cause stillbirth, avoid sex in 3rd causes resp distress in newborn, coldness in any form cause arthritis or other illness, avoid seeing an eclipse moon cause it will result in a cleft lip or palate, do not reach over your head or the cord will wrap around the baby's neck
taboos: avoid funerals, widows, or women who have lost a child, they will bring bad fortune to the baby. avoid hot and spicy foods they can overexcite the woman, early baby showers will invite the evil eye. avoid praising the newborn it will call attention to the gods to the vulnerable infant.
intro: changes, development, nutrition, breathing and relaxation techniques,
Labor: signs, stages, role of support person, practice.
Plans: options, interventions(epidural), hospital tour.
Variations: back labor, cesarean delivery, episiotomy, assisted delivery, EFM, Pitocin, epidurals.
Newborn: care, breastfeeding
Postpartum: transition to parenthood
visualization of complex facial movements and features, connection of umbilical vessels, chorionic plate of the placenta, age, size, fluid volume, vaginal bleeding, ventriculomegaly, hydrocephaly, congenital brain defects, malformations, pelvic abnormals, hypoxic brain injury, inflammatory brain disorders.
timing: ordered as needed commonly done by patient to see baby
advantages: organs, blood flow, structures, brain evaluations
timing: first or second tri usually 10-13 weeks
procedure: women supine or lithotomy, catheter is inserted either transvaginally or abdominally using a needle and ultrasound to guide, biopsy of tissue is removed, villi are harvested and cultured for chromosomal analysis
results: within 1 week, provides specific info on specific chromosomal abnormality detected.
can be performed before amniocentesis
some bleeding after procedure is normal.
nursing: assess fetal heart twice in 30 minutes, report abd pain, cramping, leaking, bleeding, fever, chills. administer RhoGAM to Rh N women post procedure to prevent antibody formation.
for genetic testing, assessment of fetal lung maturity, hemolytic disease, infections.
risk for disorders with advanced maternal age >35.
timing: 14-20 weeks
results: sample is sent to lab for cell growth and results available in 2 weeks. elevated bilirubin indicate fetal hemolytic disease, positive culture indicates infection,
purpose: test fetal lung maturity, L/S ratio, phosphatidylglycerol(PG), lamellar body count(LBC) and results are:
L:S ratio > 2:1 indicates fetal lung maturity
L:S ratio < 2:1 fetal lung immaturity and risk for RDS
positive PG indicates fetal lung maturity
negative PG immature fetal lungs
a LBC of >50,000 is mature lungs
LBC may be hindered by the presence of meconium, vaginal bleeding, vaginal mucous, or hydramnios.
risks: trauma to fetus or placenta, bleeding, PTL, maternal infections, Rh sensitization from fetal blood into mom.
nursing: prep abd. with antiseptic like betadine, label specimens, assess FHR, no heavy lifting for 2 days, RhoGAM post procedure as ordered.
assessing it in the maternal blood for NTD, developmental defects, ventral abdominal wall defects.
timing: 15-20 weeks
results: increased are associated with NTD, anencephaly, omphalocele, gastroschisis.
decreased are associated with trisomy 21
risks: high false positive rate meaning the test results indicate an abnormality in a normal fetus. and occur with low birth weight, oligohydramnios, multifetal gestation, decreased maternal weight, underestimated fetal age.
if a false low level can occur as a result of fetal death, increased maternal weight, overestimated fetal gestational age.
prostaglandin can be produced stimulating the uterus to contract when overdistended form multiple gestation or polyhydramnios, or uterine abnormalities.
decidual activation: from hemorrhage, upper UTI.
inflammation and infection In the decidua, fetal membranes, and amniotic fluid. the cytokines or bacterial endotoxins can stimulate prostaglandin release resulting in cervical ripening, contractions, and weakening and rupture of membranes.
Risks: prior preterm birth, history of 2nd tri lost, history of incompetent cervix, IVF pregnancy, cerclage, multiple gestation, DES exposure, hydramnios or oligohydramnios, infection, PROM, short pregnancy interval less than 9mo, pregnancy problems like hypertension, diabetes, vaginal bleeding, clotting disorders, low BMI, low pre pregnancy weight, poor weight gain, age younger than 17 or older than 35 years, late or no prenatal care, obesity, high BMI, working long hours, long periods of standing, African American ethnicity, IPV, lack of support, smoking, alcohol, drugs, low education, poverty.
Detection: fetal fibronectin, proteomics to identify inflammatory activity, genomics, cervical length, bacterial vaginosis, fetal fibronectin in cervicovaginal fluid, cervical length of <20mm.
*fFN is better at predicting who will not deliver preterm than who will.
gestational age of >20week and <37weeks
regular UCs >6hr and at least one of the following
cervical changes: cervix >1cm dilated or 80%effaced.
tocolytic drugs to suppress uterine contractions in preterm labor: may prolong for up to 2-7days along with steroids to improve lung maturity, delaying delivery for several days to give corticosteroids time to work and to treat group b strep infections. IV hydration, Progesterone, corticosteroid therapy like betamethasone,
when to not treat PTL:
hemorrhage, maternal disease, fetal compromise, chorioamnionitis, fetal death, PPROM
*bedrest leads to muscle atrophy, cardiovascular deconditioning, maternal weight loss, stress for the woman and her family.
nursing actions: obtain fFN as ordered before sterile vag exam, don't if ROM, bleeding, sexual intercourse or prior collection in last 24 hours. assess urinary infection, ROM, bleeding discharge, dehydration, report fetal tachy, IV hydration, tocolytic agents, glucocorticoids, on side to increase uteroplacental perfusion and decrease pressure on maternal inferior vena cava, report BP greater than 140/90 or less than 90/50 a temp greater than 100, or HR greater than 120. auscultate lungs for pulmonary edema, assess cervical changes, emotional support, what for se of tocolytic drugs such as chest tightness or discomfort, cough, shortness of breath, o2sat of less than 95 and increased resp and HR, changes in behavior such as apprehension, anxiety, or restlessness. WBC are elevated in women who have received corticosteroids and indicate infection,
administered continuous IV infusion via a pump initial dose of 4-6g in 20 minutes, then 2g/hr. therapeutic level at 5-8mg in maternal serum levels.
effects: flushing lethargy headache, muscle weakness, diplopia, dry mouth, respiratory distress
fetal effects: lethargy, hypotonia, respiratory depression, may reduce risk of cerebral palsy if given before preterm birth.
nursing: monitor FHR and UCs, serum mag,
*signs of toxicity: absent DTR, respiratory rate<14, severe hypotension and muscle relaxtion, decreased consciousness, lungs for signs of pulmonary edema, I&O for fluid overload or output <30mL/hr.
*the antidote for mag toxicity is calcium gluconate or calcium chloride 5-10mEq given IV slowly over 5-10 minutes.
action: depresses synthesis of prostaglandin, delay delivery 48+hrs. fetal side effects so only in short term,
Dosage: 50mg orally then 25-50mg orally q6hr. contraindications: renal or hepatic impairment, active peptic ulcer disease, coagulation disorders or thrombocytopenia, NSAID sensitive asthma.
Maternal effects: nausea, heartburn, GI upset, serous side effects are common.
Fetal effects: constriction, reversible decrease in renal function with oligohydramnios.
Nursing: monitor FHR and UC's, treat nausea and heartburn.
inhibits smooth muscle contractions of uterus by blocking calcium availability for muscle contraction, delaying delivery 48-72 hours.
Dosage: 10-20mg PO every 4-6 hours.
Maternal effects: flushing headache, dizziness, nausea, transient hypotension, cardiovascular collapse, tachycardia, do not use with terbutaline.
Nursing: monitor FHR and UC's, monitor maternal BP, and HR, hold dose for blood pressure <90/50 or HR >120.
can delay delivery for 3 days, given IV or SQ,
Dosage: terbutaline IV/SQ, IV maximum dose 0.08mg/min, Ritodrine IV max dose is .350mg/min
maternal effects: cardiac or cardiopulmonary arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia, high rates of serious maternal side effects including tachycardia, hyperglycemia, hypokalemia, Ritodrine: hallucinations, don't use if poorly controlled diabetes and thyroid disease.
fetal: cardiovascular problems IVH
Nursing: monitor FHR, UC, I&O, lungs, maternal HR and hold dose if HR >120.
risks for preterm PROM: previous preterm prom, bleeding during pregnancy, hydramnios(poly) too much amniotic fluid, multiople gestation, STDs, cigarette smoking,
risks for women: maternal infection chorioamnionitis, preterm labor and birth, cesarean birth.
risks for fetus and newborn: sepsis, delivery preterm, hypoxia, or asphyxka due to umbilical cord compression from decreased fluid, fetal deformities if before 26weeks.
medical mgmt.: induction of labor, ampicillin and erythromycin, corticosteroids to reduce RDS, avoid digital exams, monitor, monitor L/S ratio, antibiotics, counseling.
nursing: assess for infection by fetal and maternal tachycardia and maternal fever of 100, uterine tenderness, malodorous fluid or discharge, NST, BPP
findings: increased n/v, size greater than dates and palpation of excessive number of fetal parts, blood volume expansion greater than 50-60% an additional 500cc, increased cardiac output, uterine growth greater up to 10L of contents, and more than 20lbs,
mgmt.: bed rest DOES NOT prolong pregnancy, monitor monitor monitor, type and crossmatch blood, EFM, type of birth, triplets+ are cesarean.
nursing: facilitate nutritional contents cause she needs more iron calcium and mag to grow multiples, support, monitor
h. pylori may be cause.
findings: vomiting, weight loss, acetonuria, ketosis, dry mucous, poor skin turgor, malaise, low BP
mgmt.: b6, IV hydration, dextrose and vitamins especially thiamine, antihistamines H1 receptor blockers, for nausea, labs of kidney and liver functions,
nursing: assess triggers, ginger given, antiemetics, support, IV hydration, vitamins, monitor I&O and specific gravity, lyte values, NPO until vomiting is controlled, no intake of fluids with meals
risks for the woman: hypo/hyperglycemia, DKA, preeclampsia, nausea, spontaneous abortion, preterm labor, exacerbation of diabetes related conditions, infection.
risks for newborn and fetus: defects like cardiac, GI, all related to maternal hyperglycemia during organogenesis, growth disturbance, hypoglycemia, hypomagnesemia, IUGR, asphayxia(suffocation), RDS, prematurity, stillbirth
assessment: SMBG 4-8times a day. urine ketone monitoring, record keeping, exercise.
mgmt.: Medical nutrition therapy, A1c <7%, insulin needs for type 1 increases by the end of pregnancy insulin requirements may be two to three times that of prepregnancy levels and may require three or four injections per day of Humulin insulin.
nursing: ingest 10-15g of carb for blood glucose of 60 to raise blood gluoce by 30-40 in 30min.
insulin resistance during pregnancy. 2 main factors are increased maternal adiposity and insulin desensitizing hormones produced by the placenta.
as the placenta increases in size so does the hormones that create the insulin resistance leading to a progressive insulin resistance.
test at 24-28 weeks 1 hour glucose tolerance test and a result of 130-140 is positive and then a 3hr test is done.
fetus risks: macrosomia, hypoglycemia, hyperbilirubinemia, shoulder dystocia, RDS,
treat: diet and exercise, insulin, oral hypoglycemic agents, cesarean birth if baby is over 4500 grams, monitored frequently.
nursing: self administration of insulin, monitoring, check four times a day one fasting and 3 postpradinal. and fasting you want less than 95 and postpradinal you want between 120-135. diet, exercise like walking 10-15min after meal. and exercise 3 or more times a week for 30 minutes.
Patho: normally in pregnancy the womans blood pressure falls due to general relaxation of muscles.
*microvascular fat deposition within the liver causing epigastric pain, liver damage may progress to HELLP syndrome which is Hemolysis, Elevated Liver enzymes and Low Platelets. right upper quad pain and signals worsening preeclampsia.
*protein is excreted in the urine, uric acid creatinine and calcium clearance are decreased and oliguria develops. Oliguria is a sign of severe PE.
*platelet count below 100,000 is an indication of severe preeclampsia
*hyperreflexia and severe headaches and can progress to eclampsia
*blurring or double vision, photophobia, scotoma
*decreased serum albumin and results in tissue edema.
*pulmonary edema from volume overload related to left ventricular failure as the result of extremely high vascular resistance.
risks: nulliparity, younger than 19 or older than 35, obesity, multiple gestation, family hx, preexisting hypertension, previous PE, DM.
risks for the woman: cerebral edema, hemorrhage, stroke, DIC, pulmonary edema, CHF, Hepatic failure, renal failure, abruptio placenta.
risks for fetus: premature delivery, IUGR, LBW, fetal intolerance to labor because of decreased placental perfusion, stillbirth
assess: BP, proteinuria, Lab values of liver function enzyme increase, diminished kidney function and altered coagulopathies.
mgmt.: antihypertensive drugs(hydralazine IV vasodialator, Aldomet, Labetalol a beta blocker, calcium channel blocker Procardia) are used but the only cure is delivery. Mag sulfate: CNS depressant. and Delivery.
nursing: assess, administer medication, assess for CNS changes, assess for epigastric or RUQ pain, weight daily, urine for protein, Lab values: normal creatinine is 72 and youll see elevations, hematocrit >35, Low platelet count under 100,000, elevated serum AST >41, ALT>30, I&O, maintain bed rest in lateral recumbent position.
triggered by: cerebral vasospasm/hemorrhage/ischemia/edema,
warning signs: severe persistent headache, epigastric pain, N/V, hyperreflexia with clonus, restlessness.
care during seizure: remain with client, call for help, lower the head of bed and turn womans head to one side, lay on left side, anticipate need for suction or aspiration, padded side rails, record, notify.
after seizure: assess both mom and baby, airway, give oxygen 10L, IV access, administer Mag Sulfate.
hemolysis is the result of red blood cell destruction as the cells travel through constricted vessels,
elevated liver enzymes from decreased blood flow and damage to liver.
Low platelets from platelets aggregating at the site of damage causing platelet consumption and thrombocytopenia.
* may appear at any time
*only cure is delivery
Risk for woman: abruptio placenta, renal failure, liver hematoma and rupture, death.
risk for fetus: preterm birth, death.
woman presents with complains of malaise nausea and RUQ pain. unexplained bruising, petechiae, bleeding from injection and IV sites,
mgmt.: replace platelets and immediate delivery
nursing: assessment, lab tests, notify, administer platelets, support.
found during ultrasound and four classes are:
Total: completely covers the cervical os
Partial: partially covers the cervical os
marginal: edge of the placenta is at the margin of the cervical os
Low-lying: implanted in lower uterin segment clos proximity to cervical os
risks: endometrial scarring: previous placenta previa, prior cesarean delivery, abortion, multiparity. Impeded endometrial vascularization: maternal age >35, diabetes, smoking, uterine anomalies/fibroids/endometritis. increased placental mass: large placenta, multiple gestation.
woman is at risk for: hemorrhagic and hypovolemic shock due to blood loss, maternal exsanguinations in 10min, anemia.
fetus is at risk for: disruption of blood flow, blood loss, hypoxia, anoxia, and death, anemia, morbidity and mortality.
findings: painless hemorrhage and fetal malposition, bleeding usually near the end of second tri or in the third tri and may be slight, ultrasound confirms, NO VAG EXAMS,
mgmt.: cesarean delivery, blood transfusion as needed.
nursing: assessment of bleeding, placenta location, fetal lung maturity, vital signs, bed rest with bathroom privileges, corticos to promote fetal lung health, labs, anticipate cesarean birth.
signs are : severe sudden onset of intense abdominal pain, uterine contractions, uterine tenderness, dark vaginal non clotting bleeding, blood trapped between placenta and decidua, concealing hemorrhage resulting in tenderness and abdominal pain, hypovolemia, abnormal FHR,
risk factors: previous abruption, hypertension, cocaine, meth, and cigarettes, PPROM, thrombophilia, fibroids.
risks for the woman: hemorrhagic shock, DIC of the relase of thromboplastin into the maternal venous system triggering DIC, hypoxia damage to organs such as kidneys and liver, postpartum hemorrhage.
risks for baby: preterm birth, hypoxia, anoxia, neuro injury, death, IUGR, death.
findings: hypovolemic shock(oliguria, thread pulse, shallow irregular respirations, pallor, cold, clammy skin, and anxiety. vaginal bleeding, severe abdominal pain, oliguria, *during pregnancy signs of shock don't show up till maternal blood loss of 25-30%, fetal: tachycardia, bradycardia, category 2,3 FHR loss or variability of FHR, late decel, decreasing baseline.
emergency magmt: monitoring volume status, restoring blood loss, monitoring fetal status, monitoring coagulation status and correcting defects, expect delivery. corticosteroids for fetal lung health.
nursing:monitor, assess, palpate, manage, administer oxygen 8-10L by mask, emotional support, labs, ultrasound, anticipate cesarean birth, RhoGAM.
risk factors: prior tubal damage: tubal corrective surgery/sterilization or previous ectopic pregnancy. Assisted reproduction. PID. smoking. abdominal adhesions.
woman is at risk for: hemorrhage related to fallopian rupture. decreased fertility related to removal of tube.
you'll find before rupture: pelvic or abdominal pain, abnormal bleeding, normal vital signs, no tenderness or uterine changes. BUT after: severe lower abdominal pain, pelvic sharp stabbing tearing pain, syncope, unstable vital signs, pain in neck or shoulder with peritoneal hemorrhage due to diaphragmatic irritation.
mgmt.: diagnosis usuing serum progesterone, hCG, ultrasound, and then surgical or medical mgmt. use non surgical mgmt. drug methotrexate a folic acid antagonist that will dissolution the mass.
nursing: ensure stabilization of cardiovascular status, diet high in iron, se of methotrexate are N/V, stomatitis, so DO NOT USE Alcohol and NSAID's. cramping for 2-3 days starting treatment of drug.
fetal and maternal effects and mgmt. of STD's: chlamydia, gonorrhea, GBS, Hep B(HBV), HCV, HPV, Syphilis, trichomonus, candidiasis, bacterial vaginosis, HIV/AIDS: *chlamydia: silent disease: fetus contact at delivery causes conjunctivitis and premature birth, treat with amoxicillin, can lead to PID treat all partners.
*Gonorrhea: no symptoms or burning and yellow green discharge, can lead to PID, treat with cephalosporin. contact of fetus at birth leads to opthalmia neonatorum may cause blindness treat with antibiotic ointment into eyes of all newborns.
*GBS: asymptomatic carriers, UTI's, chorioamnionitis, transmission is low but can result in fetal permanent neurological sequelae, penicillin or ampicillin IV during labor.
*HBV: low grade fever anorexia, N/V, fatigue, rashes, leads to cirrhosis of liver and liver cancer, can cause fetal liver caner and cirrhosis, no specific treatment. but immunoprophylaxis of all newborns born to positive women, HBIG to neonate at delivery and Hep B series initiated.
*HCV: no symptoms, liver cancer and cirrhosis, treat with ribavirin and interferon can still breastfeed.
*HPV: asymptomatic, genital warts are flat, popular or pedunculated growth on the genitals, can cause respiratory papilomatosis in newborn, treat with wart removal during pregnancy, don't necessarily have to have a cesarean birth.
*Syphilis: ulcer or chancer then a rash advancing to CNS damage, congenital syphilis causes preterm birth, physical deformity, neurological complications, stillbirth and death, treat with penicillin
*trichomonas: malodorous yellow green discharge and vulvar irritation, can lead to PROM and PTL, can lead to fetal resp and genital infection, treat with metronidazole.
*candidiasis: disturbance in vaginal flora, pruritus, soreness, dyspareunia, abnormal discharge with yeasty odor, treat with topical azole therapies.
bacterial vaginosis: fishy odor, preterm labor, PROM, treat with metronidazole
*HIV/AIDS: weakens immune system, fever fatigue sore throat and lymphadenopathy, fetus in early treatment of antiretroviral is affective in reducing transmission, maternal IgG antibodies to HIV are present up to 18months. treat with antiviral, No breastfeeding, cesarean birth.
Toxoplasmosis: fatigue, muscle pain, can cause spontaneous abortion, LBW, anemia, neurological disease, avoid eating raw meat and contact with cat feces, treat with sulfadiazine after first trimester.
other infections: like hepatitis B
Rubella: nasopharyngeal secretions: maculopapular rash, lymph node enlargement, slight fever, headache, malaise. if infected in first 4 weeks of gestation risks are deafness, eye defects, CNS anomalies, and severe cardiac malformations, get rubella immunization, don't give until postpartum, and not to become prego for 3 months after shot.
CMV: transmitted by droplet contact, may have mono like symptoms, LBW, IUGR, hearing impairment, CNS abnormalities, no treatment available
Herpes simplex: chronic lifelong viral infection: painful genital lesions, may cause sepsis and neuro complications if fetus comes in contact with active lesion. no cure but treat outbreak with acyclovir to suppress, do cesarean delivery.
normal cardiac changes: increase blood volume, plasma volume expansion, increase in RBC, increased cardiac output, increased HR, heart slightly enlarges and goes to the left, compression of vena cava, increased estrogen leads to vasodilatation which lowers peripheral resistance and increases cardiac output.
leading to : pulmonary hypertension, pulmonary edema, congestive heart failure, maternal or fetal death.
risks for fetus: decreased oxygenation, fetal hypoxia leading to permanent CNS damage, death, IUGR.
findings: dyspnea, orthopnea, nocturnal dyspnea, syncope during or after exertion, palpitations, chest pain, fatigue, cyanosis, fluid retention.
nursing: cardiovascular assessment: auscultation of heart, lungs, and breath sounds, LOC, RR, body weight and weight gain, color temp and turgor, edema, o2 sats EKG, electrocardiogram, urinary output, EFM,
labs related to renal function and perfusion are lytes, BUN, creatinine, proteins and uric acid.
risks: history of eating disorder, close spacing of pregnancies, multiple gestation, excessive bleeding, adolescence
woman is at risk for: fatigue, reduced tolerance to activity
findings: pallor, fatigue, weakness, malaise, anorexia or pica, edema, hemoglobin below 10-11, hematocrit below 33%
treat: iron supplement with 325mg TID ferrous sulfate
nursing: take iron at bedtime and on an empty stomach to increase absorption and decrease GI upset, constipation strategies, assess fatigue.
increased progesterone results in hyperventilation and increased tidal volume.
thorax changes decrease residual capacity and volume while oxygen consumption increases
increased estrogen results in mucosal edema, hypersecretion, and capillary congestion
respiratory physiology in normal pregnancy tends toward respiratory alkalosis
Asthma is a preexisting disorder: varying levels of airway obstruction, bronchial edema, hyperresponsive to allergens, viruses, pollutants, exercise and cold.
if symptoms worsen they do so in 17-24weeks gestation, can cause hypoxia to the fetus.
signs: cough, wheezing, tightness, shortness of breath, respiratory rate >20, and hypoxia signs: cyanosis, lethargy, agitation, respiratory rate >30.
treat: bronchodilators, inhaled steroids, oral corticosteroids, allergy injections, and antihistamines,
nursing: administer oxygen to maintain pao2 greater than 95%, ongoing maternal pulse oximeter, baseline arterial blood gases pulmonary function tests, beta agonist inhalation therapy as ordered.
risks for Venous thrombosis during pregnancy include:
bed rest, obesity, severe varicose vein, dehydration, trauma, history of thrombosis, diabetes, heart disease, renal disease or serous infections.
mgmt.: Doppler and MRI chest xray and ECK to diagnose PE, treatment and goals include prevention of further clot, treat with anticoagulation therapy for DVT such as Heparin. treat PE is to stabilize a woman with a life threatening PE and transfer to ICU thromboembolitic therapy and catheter or surgical embolectomy may be done.
nursing: manage pain, heparin SQ to her abdomen, side effects are bleeding gums, nosebleeds, easy bruising, excessive trauma at injection sites.
cocaine: changes in the brain as well as changes in psychosocial and environmental factors, cocaine blocks the reuptake of catecholamines which results in an increase in circulating catecholamines in blood and leads to vasoconstriction. hypertension, tachycardia, uterine contractions, MI, dysrhythmias, seizures, and death. and acute use in 3rd tri can cause preterm labor PROM, abruptio placenta, meconium staining, and LBW.
Heroine: fetus becomes dependent, primary effects of heroin are analgesia, sedation, feeling of well being, euphoria, and the newborn with have withdrawal symptoms, increased incidence of meconium aspiration at birth, sepsis, IUGR< and neurodevelopmental behavioral problems
marijuana: causes tachycardia and low blood pressure, orthostatic hypotension. neonates born have an altered response to visual stimuli, increased tremilousness, high pitched cry which is indicative of neurological problems.
ask the 4P's:
Have you ever used alcohol or drugs during this pregnancy?
have you ever had a problem with drugs or alcohol in the past?
does your partner have a drug or alcohol problem?
do you consider one of your parents to have a problem with drugs or alcohol?
any yes to those needs further evaluation of habits.
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year old child that was delivered at 37 weeks and tells the nurse that she doesn't have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as:
1.G = 3, T = 2, P = 0, A = 0, L =1
2.G = 2, T = 0, P = 1, A = 0, L =1
3.G = 1, T = 1. P = 1, A = 0, L = 1
4.G = 2, T = 0, P = 0, A = 0, L = 1
1, 4, 5, and 6. The probable signs of pregnancy include uterine enlargement, Hegar's sign (softening and thinning of the uterine segment that occurs at week 6), Goodell's sign (softening of the cervix that occurs at the beginning of the 2nd month), Chadwick's sign (bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at week 6), ballottement (rebounding of the fetus against the examiners fingers of palpation), Braxton Hicks contractions and a positive pregnancy test measuring for hCG. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler) at 10-12 weeks and by nonelectronic device (fetoscope) at 20 weeks gestation, active fetal movements palpable by the examiner, and an outline of the fetus via radiography or ultrasound. frequency 1-2min, duration 50-90 sec, less painful
progress to +4,
pressure, urge to push, stretching, burning, desire to sleep, slow reactions,
assess FHR UC q5-15min,
use squatting bars or birthing balls
rest between contractions
assist with breathing and pushing.
Morphine: 5-10mg IM/2-5mg IV, side effects are CNS depression, neonatal respiratory depression, avoid use when close to delivery time about 1hr.
Stadol: 2-4mg IM/2mg IV, se are no respiratory depression in woman or neonate, check for history of drug abuse, and no not give due to possible sudden withdrawal response in woman and baby.
Fentanyl: 50-100mg IM in conjunct with regional anesthesia, short action and crosses the placenta rapidly, se are FHR changes, hypotension, maternal/fetal CNS depression, resp. distress, monitor for side effects such as sedation, nausea, vomiting, itching, and resp. rate and effort.
Local: injected into perineum at episiotomy site: second stage of labor immediately before labor, episiotomy repair, risk for hematoma, infection. monitor for return of sensation to area and swelling of injection site.
Regional: block: anesthetic injected in the pudendal nerve(close to the ischial spines) via needle guide called trumpet. second stage of labor, prior to time of delivery. anesthetizes vulva, lower vagina and part of perineum for episiotomy and use of low forceps. Risk of local anesthetic toxicity risk for hematoma, infection. Monitor for return of sensation for the area, swelling, infection urinary retention.
Epidural block: injected in to the epidural space, located outside the dura between the dura and spinal canal via an epidural catheter, first or second stage of labor, both vag and cesarean births, 100% blockage of pain, can be used with opioids to allow walking during first stage of labor. most common complication is hypotension, n/v, pruritis, respiratory depression, alterations in FHR, metallic taste in mouth, dizziness, tinnitus, hypertension, watch for obtained consent, lab values for bleeding and clotting abnormalities and platelet count, IV fluid bolus with NS or LR, do time out, urinary retention and cathertization needed and when DC note intact cath tip.
Spinal block: injected in subarachnoid space, rapid acting with 100% blockage and motor sensation can last up to 3 hours, observe for spinal leakage or headache.
fluctuations in the baseline FHR that are irregular in amplitude and frequency. The fluctuations are visually quantified as the amplitude of the peak to trough In bpm, in 10min windows, excluding accelerations and decelerations, reflects the interaction between the fetal sympathetic and parasympathetic nervous system:
Absent: amplitude range is undetectable
Minimal: amplitude range is visually undetectable <5bmp
Moderate: amplitude from peak to trough 6bpm to 25bpm
Marked: amplitude range >25bpm
minimal or absent causes by: supine hypotension, cord compression, uterine tachysystole, drugs like alcohol, or fetal sleep, prematurity. consider AROM, and consider more invasive monitoring such as FSE, consider delivery, change mothers position, assess fetal scalp stimulation or VAS, assess hydration and give IV to reduce uterine activity and promote perfusion, DC oxytocin, oxygen at 10L.
Early: nadir lowest point, mirror the contractions: causes are UC, fetal head is subjected to pressure that stimulates vagal nerve, fetal head compression and decreased transient blood flow with corresponding Po2 decrease. no mgmt. required.
Variable: SUDDEN ABURPT decelerations of >15bpm lasting 15sec-2min: most common seen in labor, an acceleration that follows a deceleration is a shoulder a compensated response to hypoxemia and an increase in the FHR of 20bpm for <20seconds. periodic or episodic, U/W/Y shaped, causes are umbilical cord occlusion/compression, prolonged cord compression with rebound tachycardia, head compression, mgmt. is to consider anmioinfusion, tocolytics and delivery, 10L oxygen, FSE, SVE, modify pushing.
Late: nadir of decelerations occurs after the peak of contraction, and recovery of decel occurs after the UC: fetal intolerance to labor, uteroplacental insufficiency, maternal hypertension, or placental changes or abnormalities. mgmt. is to consider tocolytics and delivery, changes in maternal position, DC oxytocin, assess hydration, VAS, Oxygen at 10L, FSE.
Prolonged: apparent abrupt decrease by 15bpm below base for longer than 2min but shorter than 10min: causes are interruption of uteroplacental perfusion by tachysystole, maternal hypotension, abruptio placenta, cord compression, cord prolapse, profound head compression, rapid fetal descent, treat is amnioinfusion, tocolytics, delivery, change position, oxygen at 10L, IV hydration, SVE, FSE
sinusoidal: visually apparent smooth sine wave undulating pattern with a frequency of 3-5min that persists for >20min
2: indeterminate not adequate to classify them as category 1 or 3 and require evaluation and surveillance: include ANY of the following: bradycardia with variability, tachycardia, minimal marked or absent baseline variability w/o decels, absence or induced accelerations, recurrent variable decelerations with minimal or moderate variability, prolonged decelerations, recurrent or late decelerations with moderate variability.
3: abnormal and predictive of abnormal fetal acid base status and require prompt evaluation, depending on situation, intrauterine resuscitation should be initiated: absent variability with any of the following, recurrent late decelerations, recurrent variable decelerations, bradycardia, sinusoidal pattern.
complications in labor: induction, c/s, failed vaginal birth
risks for delivery:
abnormal progress of labor,
higher rates or c/s
extremely problematic epidural or spinal outcomes
higher rates of VBAC but also infection
wound infection, delayed wound healing, excessive blood loss, DT, and endometritis.
findings: delayed fetal descent, abnormal labor.
mgmt.: anticipate complications, assure proper beds and exam tables and chairs for obese patient, positioning for administering epidural to obese woman...on her left side.
most common induction agent. relased by pituitary gland to stimulate UC's, uterine response occurs in 3-5 minutes with a half life of 10, continued use over a long time can lead to desensitization and ineffective UC's.
fetal stress or compromise, IUGR, oligohydramnios, or isoimmunization
previous vertical uterine scare or prior transfundal uterine scar
placental abnormalities such as previa or vasoprevia
abnormal fetal position
umbilical cord prolapse
active genital herpes
risks associated with inductions:
tachysystole leading to cat 2 and 3 FHR patterns
* always infused by pump
*10units in 1000mL=3mL/hr.
*20units in 1000mL=6mL/hr.
*if UC are too frequent then DC or when FHR is abnormal.
*increase if UC are inadequate and discontinue once active labor is achieved.
*auscultate FHR and UC at least every 30min in active labor and q 15min in the second stage.
*if cat 2 or 3 happen then change maternal position, IV bolus of 500mL LR, consider terbutaline, o2 at 10L, discontinue oxy, notify provider, monitor labor with SVE, 1cm hr is good progress.
vacuum: on head, its easy, less anesthesia, less maternal damage, fewer fetal injuries, 3 attempts for a period of 15 minutes the 3 pull rule. pops off the cavuum is a warning sign that too much pressure, then proceed to c/s. can cause scalp lacerations or bruising, obtain consent, pump not to exceed 500-600mm Hg,
Forceps: low is used when skull is at +2 or lower, outlet are used when head is visible on perineum. can cause skull fracture, lacerations, bruising, only when fetus is over 36 weeks.
turtle sign: head retracts after already coming out.
risk factors: fetal macrosmia, maternal DM, history, prolonged second stage, excessive weight gain.
risks associated: delay in delivery, clavical fracture, lacerations, infections, bladder injury, postpartum hemorrhage,
mgmt.: downward tractions to head with suprapubic pressure, episiotomy midline, McRoberts: sharply flexing the thigh onto the maternal abdomen to straighten the sacrum, Woods corkscrew, c/s.
complete: hormones prematurely activated, familial puberty, tumors, idiopathic.
incomplete: caused by ovarian or adrenal secretion, boys: tumors, androgen secretion from testis or leydig cell adenoma, familial sex linked disorder, girsl: ovarian cyst, estrogen tumor,
Precocious from other: CNS cause: encephalitis, brain abscess, hydrocephalus, head trauma, arachnoid cyst.
signs: tanner stage 2: presence of breast development in girls <8 or testicular development in boys less than age 9.
tanner stage 2: pubic hair
acne on face,
advance bone age
increased height velocity
GnRH stimulation test with LH response >10
monitor and document assessment data carefully
administer a GnRHa to stop the progression of pubertal development and suppress the release of GnRH hormones. IM injection. usually is called Lupron Depot Pediatric and is treatment for central precocious puberty and is weight based. beginning dose starts at 3.75mg and are increased based on weight can be given IM or SQ.
Congenital Hypothyroidism: most in asymptomatic infants: signs are goiter, abdominal distention, hoarse cry, umbilical hernia, lethargy, hypotonia, open posterior fontanel, open cranial structures, prolonged jaundice, pallor, enlarged tongue, constipation, dry skin, resp difficulties, poor weight gain, generalized edema. acquired hypothyroidism: onset in childhood or teen years, autoimmune condition like hashimotos thyroiditis or lithium. changes in hair or hair loss, dry cool skin , depressed tendon reflexes, bradycardia, constipation, extreme fatigue, cold sensitive, abnormal menstruation, weight increase, delayed bone age, delayed dentition, muscle weakness, delayed or precocious puberty, decline in school performance. hyperthyroidism: graves disease: occurs mostly in 12-14 years, tends to be familial, elevated T3/4 and undetectable TSH. exopthalmus, restlessness, fatigue, tachycardia, high blood pressure, increased perspiration, weight loss, difficulty sleeping, signs/tests: hypokalemia, hypercalcemia, alkalosis, urinary calcium, moon face, fat pad in shoulder, buffalo hump, mood changes, growth delay, depression, irregular or absent menstruation, excessive cortisol levels, hyperglycemia, arteriosclerosis, referral to a pediatric endocrinologist, 24 urine, labs, bone scan, mri of pit gland, ct for adrenal gland,
treat: surgery, or radiation therapy, fluids, pain mgmt., electrolytes, lifelong cortisol replacement, stress dosing of hydrocortisone injections in times of ill, fever vomiting, trauma,
Addisons disease: hypoglycemia, mild unless child gets sick, weakness, fatigue, dizziness, rapid pulse, dark skin that appears as if the child is very tanned, black freckles, weight loss, bluish color on nipples and genitals, salt cravings, <blood sugar and sodium and blood pressure, >potassium
*addisonian crisis: sudden, penetrating pain in lower back or legs, severe vomiting and diarrhea, dehydrations, low blood pressure, and loss of consciousness
one or more positive autoantibodies: ICA, IAA, GAD, IA-2B.
physical assessment, administer insulin. only regular insulin IV for DKA,
Diet: diabetic diet and count carb exchanges and adjust insulin based on diet.
Physical exercise: extra complex carb and protein 30min to 1 hour prior
causes of hypoglycemia: too much insulin for amount of food eaten: give 15grams carbs, injected insulin into muscle: recheck in 15 min, too much activity for inulin dose: if <70 give another 15grams of carbs, too much time between meals: recheck in 15min. too few carbs eaten or illness or stress: if unconscious give IM glucagon.
causes for hyper: too little insulin: give additional at usual injection time. Illness or stress: use sliding scale, Too many carbs eaten: increase fluids, meals too close, too many snacks, inulin under skin not SQ, too little activity: give extra insulin if ketones
teach: hygiene with front to back wiping, moist wipes, air flow, warm bath in clear water gentle soap pat dry.
Pinworm itching usually present fecal oral spread and lay eggs in warm areas at night, tape test to lift bean shaped white eggs from area.
teach: hand hygiene after bathroom, meds, avoid scratching.
vulvar ulcers: 10-15yrs, purulent bases and raised red edges, nonsexually transmitted, CMV maybe, HSV maybe also, may require a foley, topical antibiotic, usually heals in 1-3 weeks,
imperforate hymen: malformation, seen at birth, amenorrhea, chronic pain in abdomen or back, surgical repair pain mgmt.,
cryptorchidism: undescended: congential, urology or surgery by age 2 if undescended. encourage loose clothing.
Hydrocele: painless collection of fluid resolves around a year, monitoring if under a year.
Varicocele: painless collection of dilated tortuous veins, feels worms like, dull ache or fullness, monitor and may need surgery.
Torsion twisting of testicle: painful, abrupt, peak at 12-18years, shapr pain and swelling and then rapid resolution. provide pain mgmt., possible surgery.
Epidiymitis: diffuse swelling, frequency and dysuria, or discharge sometimes a fever, chalmydia is most common cause, prepare of possible surgery.
Orchitis: painful inflammation infection of testis, present with scrotal swelling, pain, tenderness, redness and shininess, associated with other infections, viral or bacterial treatment. treat with bed rest, ice packs, NSAIDs, support of testis, antibiotics.
PID: infection of upper genital tract structures in women: genital gonorrhea and douching, lower abdominal, ovarian or fallopian and cervical motion tenderness should reveive empiric treatment, antibiotics. condoms. abstinence.
Trichomoniasis: in females: purulent thin discharge, itching, painful urination, pain with intercourse, postcoital bleeding, worse during menstruation. Men: less sever, asymptomatic spontaneous resolution. clear or mucoid discharge and or pain. only reliable test for male is called a PCR test of the urine.
treat: avoid alcohol, antibiotic treatment, no sex until treatment is complete and symptoms are gone. and followup.
Gonorrhea: spread to blood or the joints causing painful arthritis with red, swollen joints. spread by contact with infected sites, most through sexual contact in adolescents, mother to infants during delivery, severe eye infection in infants can lead to blindness. give ilioticin in infant eyes at birth to all. symptoms: pain, yellow white sometimes green discharge in men, anal itching, soreness, bleeding, painful bowel movement, rectal infection. start antibiotics, condoms, abstinence
chlamydia: most common STD, asymptomatic, conjunctivitis and pneumonia in infants born to mothers through birth canal. antibiotic therapy, condoms and abstinence. test all females in pregnancy.
syphilis: singl sore then chancre, then rash of red rough spots on hands and feet, muscle aches and fatigue, sore throat, headaches, final stage: difficult coordinating muscles and paralysis. in congenital in babies: nasal congestion, enlarged liver and spleen, rash on palsm and soles, turns dark or even coppery, seizures, developmental delay and missing milestones. treat with antibiotics and penicillin,
risks: maternal age over 35, alteration in oocyte prior to reproduction, each cell has 3 copies of chromosome 21, or 47 chormosomes.
s/s: small head, flattened broad head, flattened middle face, almond shaped up slanting eyes, small downturned mouth, low set ears, heart murmurs short hands that have a single crease, feeding problems.
treat: diagnosis early, strict attention to feeding may result in immediate emesis, annular pancreas to cause obstruction, severe constipation, smaller shorter and increased obesity in teen years so monitor development, hypothyroidism is very common, risk for pneumonia, ear infections, joint laxity,
Trisomy 18(Edwards): maternal nondisjunction during meiosis: hand gestures with overriding finder, nail hypoplasia, severe heart defects.
trisomy 13(patau): survival less than 3 days.
treat for both: end of life care as necessary.
entire x loss (45, X)
only known disorder where the fetus can survive while missing an entire chromosome.
affects only girls girls receive no x chorm from father and just inherit from the mother.
s/s: prematurity, feeding difficulties, pitting and latching, reflux an failure to thrive, webbed thick short neck or nuchal folds, short stature, shield like chest, nonfunctional ovaries, thyroid dyfunction, heart defects, visual impairments,
treat: feeding difficulties to anticipate, lack of sexual charcteristics need to be noted. give estrogen, but still remain infertile.
long arm of chromosome 7
broad forehead, low nasal root, bulbous nasal tip, strabismus, full lips, wide mouth, full cheeks, small jaw, prominent earlobe, long neck. IQ score show severely delayed. overall sociable cocktail personality. hoarse deep voice, hernias, joint laxity, ADHA, overly friendly, elastin problems, puberty early, poor math skills, strong memory for auditory information such as instruction and read out loud. difficulty handwriting, drawing, and buttoning.
chart and plot spots carefully, BP yearly, scholiosis seen and short stature, growth curves, hearing and seeing disabilities, average to low average learning, ADHD, speech problems,
type 2: hearing loss, unbalanced, ringing in the ears,
dwarfism: short stature,
gene alteration on chromosome 4.
converts cartilage to bone and this gene since mutated cannot
s/s: frontal bossing, flattening, water on the brain and x ray shows the bones reveal this disease, rarely reach 5 feet, foot drop, narrowing of spinal colum, bowed legs, clubbed feet,
males inherit a single x chromosome from mother and therofre show signs more than girls.
s/s: long narrow face, prominent jaw and forehead, large ears, flat feet, enlarged testicles, issues with communicaitons, IQ is disabled, hyperactivity, hand flapping, lack of eye contact, aggression and anxiety, autism,
flat midface, thin upper lip, small chin, short upturned nose, short fissures, growth deficiencies, communication and language affected, organ damage, difficulty in suck/swallow/breath coordination, NO alcohol during pregnancy, entire lower extremitity from knee down
calf looks smaller and has less ability to develop muscle strength
fixed in plantar-flexed and pronated position that connot be dorsiflexed or manually stretched to natural position.
Achilles is extremely tight or shortened.
start the ponseti technique of serial casting within the first week of life. casts changed weekly for up to 12 weeks.
always use plaster because of its ability to be molded.
symptoms to teach about: feet appear to turn inward, walking on the lateral border of foot, tip-toe walking, rocker-bottom foot,
can also stretch heel cords, serial splinting at age 12 weeks, splints, taping, orthoses
surgical: soft tissue release, tendon transfers, bony procedures.
in toeing and bowling ball could be placed between legs
causes: vitamin D resistant rickets, skeletal dysplasia, dwarfism, tumor, infection or trauma, obesity
differences between normal bowing and deformity:
usually symmetrical, no worsening with growth, no lateral knee thrust, occurrence before 2 yrs, outgrown by about 2yrs,
bracing, slows down deformity but doesn't correct it, surgical correction of blounts disease is tibial derotational osteotomies one side at a time for 4-6 weeks,
risks: first born, female, left side affected, breech , limited hip motion, laxity, petite sized mother, neuromuscular disorders, geographical traditions, seasonal patterns,
tests: barlow test: measures hip stability along with ortolani test: dislocated, Galeazzi sign: uneven knee heights in bent knee position.
treat: pavlik harness, bryants traction, spica cast, surgery
lack of blood supply to the femoral head
s/s: pain sudden, referred to groin, thigh, knee, increases with movement, decreases with rest, limp.
*AVN stages: prenecrosis: causing loss of blood supply, Necrosis: readiographs show normal, but no blood and intact head, Revascularization: now bone, dead bone, fractures. Bone Healing: bone returns to normal strength.
treat: eliminate hip irritation, restore ROM, contain femoral head in the rim of the acetabulum, traction either bryants or bucks, bracing casting 6-12 weeks, or surgery.
s/s: irritable, refuses to eat, hip flexion contracture, abduction and externally rotated position of comfort, pain with hip ROM, erythema, edema, fever, looks septic, normal cbc, limp, history of trauma, surgery or infection, hip abnormality, febrile, toxic, positive leukocytosis.
treat: incision and drainage, and repeat in 3 days, antibiotics through picc for 3-12 weeks,
curvature of the spine, congenital or infantile, idiopathic or adolescent, neuromuscular.
congenital or infantile scoliosis: before age 6 months: intrauterine or external uterine forces applied to infants during growth and development, left sided more common in infants, girls with a right sided have worse prognosis.
treat: bracing TLSO, risser cast, growing rods changed every 6 months, definitive spinal fusion.
more common in females, right sided but not painful. forward bend test: characteristic rib hump, asymmetrical shoulder heights, asymmetrical peliv obliquity, decreased ROM of upper trunk, >10 degree curve ucually S or C shaped
treat: observation for minor curves 15-25 degrees, bracing for moderate curves of 25 or more TLSO, risser cast every 6-12 weeks followed by bracing
adolescent idiopathic scoliosis AIS:
9-adulthood, S or C shaped laterally to either side, most common type, usually undetected, more commonly in girls than boys,
< in environmental temp, neonatal body temp, depletion of gluccose and < surfactant
> in respiratory rate, HR, and oxygen consumption.
s/s: axillary temp below 97.7, cool skin, lethargy, pallor, tachypnea, grunting, hypoglycemia, hypotonia, jitteriness, weak suck.
nursing: dry neonate remove wet blankets, place cap on heat, skin to skin contact, pre warmed blankets, swaddle, radiant warmers, delay bath, place probe over BAT areas,
pink with acrocyanosis of hands and feet, milia on bridge of nose and chin, lanugo on back shoulders and forehead, peeling orcracking of skin on infants >40, Mongolian spots, hemangiomas such as salmon colored patch or port wine stain, stork bites on neck and eye lid between eyes or on the upper lip and deepen in color when crying,
abnormals: jaundice within first 24 hours called pathological, pallor, grennish yellow color from meconium stained, abundant lanugo, thin translucent skin, pilonidal dimple in the buttocks.
State: deep sleep
Behavior: minimal body twitches and eye movement cycles between deep and light sleep
Actions: do not try to wake up or feed infant
State: light sleep
Behaviors: more active body movement, may smile
Actions: more easily aroused and stimulated
Behavior: awakens easily; can be rocked back to sleep or made more awake
Actions: may enjoy being held and cuddled, responds to gentle stimuli, may self comfort by sucking
State: quiet alert
Behavior: eyes open; quiet and attentive
Actions: best time for interacting
State: active alert
Behaviors: more sensitive to stimuli; active body movement, may be tired or hungry or need changing
Actions: decrease stimuli, provide a quiet environment, provide comfort measures, the infant may attempt to self comfort
Behaviors: grimaces, cries, or whimpers
Actions: the infant may self-comfort, meet infant needs
Immediate postoperative: assess for LOC, O2 sats, fundus, lochia, urinary output, VS. Newborn: every 30min for 2 hours.
First 24 hours: Vitals, respirations and sedation level as per post intrathecal morphine administration, pain and bleeding, I&O, complete post-anesthesia asses for reaction to morphine such as decreased respirations, itching, and vomiting and intervene.
24-discharge: incisional site for drainage and signs of infections, or urinary disturbances.
Acryocyanosis: hands and feet are blue, cold environment and immature circulation.
Circumoral cyanosis: cyanosis of mouth, if persists may be cardio myopathy
mottling: pink and white clothes on the skin, cold environment
Harlequin sign: one side is pink and other side is white, related to vasomotor instability
Mongolian spots: flat bluish color on butt and back, African American, mistaken for bruising need to document size, resolves on own
Erythema toxicum: rash with red macules and papules, appear within 24hrs.-2weeks after, benign and disappears on own
Milia: white papules on face more seen on bridge of nose and chin, leave them alone and let them resolve on own
Lanugo: find downy hair often on back, shoulders, forehead, gradually falls off, can assist in guessing gestational age.
Vernix caseosa: protective covering looks whitish, cheesy, can assist in guessing age, full term usually have no vernix.
jaundice: yellowing of skin, pathologic in first 24hrs. after 24 is physiological.
Epstein pearls: white pearl cysts on gums and palate, benign and disappear.
Natal teeth: immature and usually associated with defects, loose and need to be removed to decreases risk of swallowing and aspiration.
moro: birth-6months: head drop back baby makes c shape with thumb and index finger, slow respone might occur in sleep or preterm. asymmetrical to injury of clavical.
startle: birth-4months: make loud sound near baby, baby makes fencing position with arms and legs extended in direction in which head is turned. possible deafness, neurological deficit.
tonic neck: birth to 4-6months: fencing position body to where head is facing, after 6 months may indicate cerebral palsy.
Rooting: disappears between 3-6 months: brush side of cheek, neonate turns head toward it and opens mouth. if not neurological defects
Sucking: disappears at 10-12 months: place gloved finger in mouth and sucking occurs, if not neurological defects.
Palmar grasp: disappears at 3-4 months: neonate grasps finger tightly if not nerve or muscle injury.
Plantar grasp: disappears at 3-4 months: toes flex tightly down in a grasping motion, weak or absent may indicate spinal cord injury
Babinksi: disappears at 1 year: stroke surface of foot in upward motion, hyperextension and fanning of toes, if absent neurological defect.
Stepping or dancing: disappears at 3-4 weeks: dancing in place, if not may indicate hypotonia.
large water contecnt fat content account for 52%, carbs lactose 37%, protein: whey 60-80, and casein 20-40%, antibodies, lipase amylase and epidermal growth factor, nerve growth factor, interleukins, immunoglobulins A and G. laxative effects.
colostrum is produced in first 2-3 days before milk comes in
milk has approx. 23 calories per ounce and has foremilk which has lower fat content and hind milk which is more fatty.
produced by hormone prolactin
oxytocin produces let down reflex which forces milk into the lacteriferous ducts of the breast.
early clues to feed: rooting, head bobbing, stirring, burying.
late: crying, and can inhibit latching on. agitation.
movement: walks, run, stands on tiptoes, climbs on furniture, builds towers of blocks, kicks balls, climbs stairs while holding support, pulls or carries toys while walking.
language: points to objects when named by others recognizes names of people and things, learns own name, repeats words, say 10 words to 250 words, in 2-4 word sentences.
Cognitive skills: finds objects that are hidden, identify and sort colors and shapes, play make believe, scribble and show hand preference, asks why.
social: imitates others, gains awareness of self, spending time with other children, parallel play, affection openly, display defiance, separation anxiety.
movements: hops and stands on one foot, throws overhand, catches a bounced ball, uses scissors, dresses self and undress, goes up and down stairs without assistance, draws squares and circles, triangles, stick figures, brushes own teeth and toileting, skip ride bike and swim, uses utensils when eating.
language: speaks clearly, up to 900 words, sentences, tells stories, uses future tense, comprehends rhyming, full name and address.
cognitive: recalls parts of story, counts to ten, colors, time, same and different, imagination and creativity.
Social/emotional: independent, new things, themselves, obey rules, role play, friends, negotiate problem solving, reality and fantasy, gender differences, demanding or eager to help. aftraid of dark, left alone and ghosts and monsters.
head: lice, hair status, lesions
eyes: glasses, vision, broken blood vessels, jaundice, dryness,
teeth: loosing their primary teeth, 6 year molars, good dental hygiene, braces, brush after all meals, fluoride in water supply is low use treatment, tooth fairy may not visit every home so don't say anything.
nose: boggy or blue indicates allergies, nosebleeds, airflow,
cardio: auscultation, may have benign murmur that will resolve during this stage.
resp: asthma, should be clear, check for CRDS such as barrel chest and clubbed fingers., pallor, cyanosis related to respiratory or cardiac issues.
GI: enuresis, encopresis: deliberate withholding of stool,
Repro: menarche date, precocious puberty is before age 7 for girls and 9 for boys, boys see upper body mass, thick hair all over, nocturnal emission or release of semen during sleep.
cog: 6-9 is preoperational thought, 10-11 concrete operations 12-15 operations. can see decenter(see perspectives other than their own), freuds: 6-12 latency stage, eriksons industry versus inferiority, kohlbergs pre conventional level, forms blubs, best friends, same gender friends, playing games, video games, understands rules.
piagets: 11-15 is formal operations develops analytic thinking, abstract thinking social issues, politics, long term and et goals, self to peers, the prefrontal cortex of adolescent is still developing and is are of brain associated with critical thinking and decision making. responsible for the risk taking behaviors.
freuds: genital stage. eriksons: identity vs role confusion and intimacy vs isolation. self conscious, body to others bodies, dressing different, personal values, wants to be an adult, has mood swings, on stage around others, sense in invincibility, impulsive, unrealistic career goals, tests limits and rules, knows right from wrong,
HR 85bpm, R 11-22, BP 118-120/?
fluid requirement: 1500mL + 20mL/kg/hr.
skin: oily back axillae breast and anus, acne, daily washing is important, birthmarks, check for bruising and burns, tattoos and peircings,
Head: headaches, brittle or dry hair from color dying.
Eye: acuity testing at ages 12, 15, 18, contacts or glasses, eye makeup,
Ears: hearing aids, trauma, peircings, gauges,
MTT: mouth and toungue lip peircings, tobacco use, red gums for periodontal disease, dental erosion tooth lose and cavities, third molars(wisdom teeth) erupt 17-21.bruxism: teeth grinding from stress, malocclusion: misaligned teeth.
Repo: Pap and breast exam, testicular exam, hernia checks for boys, abuse, Puberty: genetics for onset of timeing, stages: girls: 8-13 and is completed in about 4 years. Boys: 9-14 and completed in 3.5. sex hormones: androgens, estrogen and progesterone, growth spurts: girls: 10-12, boys: 12-14. lean mass will <in girls and >boys, adipose will >girls and < in boys. one breast may develop faster.
male and female voice deepen
boys develop adams apple
pubic hair >
scrotum increases n size.
tanner staging of male sex:
1. preadolescent: no pubic hair, same size as childhood
2. spares growth, hair, slight enlargement, testes larger, somewhat reddened and altered in texture.
3. darker coarser hair, larger in length, further enlarged testes and scrotum.
4. coarse and curly hair in adult, more area covered with hair, further length and development of glands, further enlarged testes and darkening of scrotal skin.
5. hair onto thighs, adult size and shape
1. preadolescent: no hair
2. sparse growth of long slightly pigmented hair along labia
3. hair darkens and curlier and spreads over pubis,
4. pubic hair is coarse and curly and spreading
5. adult pubic hair spread over thighs.
bacteria but can be caused by virus.
most common cause is RSV, peaks between 6-12 months of age.
pulling at ears, bulging red or opaque eardrum,
yellow or green or purulent foul smelling drainage
visualation confirmed with tympanometry
antibiotics, corticosteroids for OE(swimmers ear),
feed infant upright
avoit exposure to tobacco, avoid propping bottle, discontinue pacifier after 6 months, complete anticiotic therapy as prescribed, myringotomy is incision in eardrum to relieve pressure, drain fluid, tympanostomy is tubes placed in ear to relieve pressure and usually fall out within a year.
caused by bacteria or virus
peaks at 4-7 years old.
grading scale: +1-+2= normal size, +3 is enlarged tonsils seen with infection, +4 is seen with significant almost touching or "kissing" tonsils.
assessment: sore throat, red or covered with exudates, difficulty swallowing, mouth breathing with halitosis, enlarged adenoids may affect speech, snoring or sleep apnea, dehydration and airway obstruction.
Diagnosis: analysis reveals leukocytosis, throat culture identify bacterial cause.
Treat: antibiotics, tonsillectomy, after surgery place child in side lying or prone position to drain secretions until he or he is awake, gentle oral care, avoid coughing, using straw, or blowing nose, give popsicles and ice chips, no acidic food, bright red blood Is not normal. if continually swallowing the child is bleeding so assess for restlessness, frank red blood in the mouth and nose and increased pulse. give adequate pain relief IV. no hard or sharp foods like chips, take pain meds before eating.
mucus may be produce wheezing, and crackle sounds.
apnea, nasal congestion, fever, variant cough, tachypnea, can progress to severe resp distress.
diagnosis: CXR seen as hyperinflation and patchy atelectasis
ELISA identify the viral cause, ABG,
Treat: monitoring, humidified oxygen or heliox, contact percautions, PEEP(mech ventilation), drug therapy(beta antagonists, steroids, bronchodilators) hydration, palivizumab a vaccine.
assessment: recurrent resp infections, pneumonia, bronchitis, parents report salty taste of childs skin. digital clubbing indication of hypoxia, barrel chest, protruding abdomen or pot belly with thin extremities, bulky stools or steatorrhea, vaginal itching, headaches.
diagnosis: prenatal DNA testing of amniotic fluid for deletion of delta F508 chromosome
sweat chloride test: positive test shows 2-5times normal sodium and chloride level repeat to confirm. 50 or greater is suspicious over 60 on two occasions is positive. stool specimen is absent of trypsin.
treat: maintain airway, provide pulmonary hygiene, chest physiotherapy postural drainage, chest percussion vibration and coughing and deep breathing, cupped hands to clap on chest. vibration for those too frail to handle percussion with hands. vest broad wrap that encircles the chest, medications(bronchos, antibiotics, mucolytic agents) dronase alfa for pulmonary enzyme via nebulizer which thins mucus and improves lung function.
*antihistamines are not allowed in CF because they dry making expectoration of mucus more difficult.
triggers: smoke, cold air, viral infections, stress, pet dander, exercise.
immediate response: resolving in 1-2 hours. delayed response, bronchosonstriction can recur and last for several hours, airway hyper responsiveness can last for weeks or months, decreased Po2 and hypoxia.
assessment: non productive cough, frothy, shortness of breath, wheezing, chest pain, food allergies and triggers, head bob in infants, absence of breath souns, hyperresonance, pulse ox low, hyperinflation, hypoxemia, hypercarbia, use spirometry to confirm diagnosis or peak flow meter.
treat: avoid triggers, use of spacers/aerochambers, valved holders of metered dose inhalers MDI better than through the mouth.
*avoid overuse of SABAs which are like albuterol in the nebulizers.
usually in infants bron at less than 28 weeks. resolves around 36 weeks of postconceptrual age. peaks at 2-6 years old. obesity and craniofacial abnormalities are factors.
signs: cessation of breathing, starting and then awakening from sleep, snoring, mouth breathing, daytime sleepiness, hypoventilation, nail bed cyanosis, nasal or oral obstruction, obesity.
treat: administer methylaxanthines and doxapram with prematurity. CPAP vent. tonsillectomy, weight reduction, tracheostomy, caffeine, theophylline as ordered.
congenital: child is born with it: single or multiple abnormalities, cyanosis when blood flow is insufficient to lungs, seen as PDA, ASD, VSD, TOF, TA, COA, AS, PS, PA,
acquired can occur in the normal heart or in the heart with congenital defect due to infections, autoimmune factors, genetic factors, teratogens any inhaled ingested or absorbed agent that has the possibility of altering genetic structure of function. ACE, smoking, lithium, Coumadin, Dilantin, CMV, rubella, varicella, HIV, herpes, infant of diabetic mother.
Treat: cardiac cath for visualization, support, regular diet, watch about physical sports and s/e of birth control in females.
left to right mixing or shunting of blood. increased for stroke.
signs: heart murmur, emboli, recurrent resp infections, few symptoms in children, shortness of breath, tires easily with playing, poor feeding, poor growth if CHF develops, liver enlargement.
treat: digoxin, diruetics, closure with cardiac catheterization transeptal closure across the defect, offer small frequent feedings, blood thinners for several months following cath. antibiotics for dental work.
assessment: right to left shunting, tet spells sudden marked incrase in cyanosis, syncope, pink tet spells due to left to right shunting, increased irritability due to lack of oxygen, clubbing of fingers. poor growth, Tet spells: children may squat during a spell to improve blood flow from legs back to brain and organs. boot shaped heart,
treat:oxygentation improvement prevention of crying, maintain fluid balance, vasopressors, prostaglandin E drip to keep PDA open, do not give Prost E if having RDS. hold child on shoulder with knees drawn up to chest.
primary: ventricles primarily affected and become enlarged thickened and stiff
child is born with normal anatomy, but heart muscle loses the ability to pump effectively heart failure and cardia arrhythmias occur, leading cause of heart transplant in children.
assessment: sweating with feedings, dizziness, weight loss, murmur, hepatomegaly, fatigue, frequent colds,
treatment: during acute phase: maintain intravenous fluid, endotracheal intubation, ventilator, diuretics, anticoagulation therapy, maintain ACE inhibitors that have positive inotropic,
chronic phase: anticipate major complications that can include arrhythmias and CHF, maintain diuretics,
prevent overstimulation of the heart. this is a life threatening condition allow for grieving of the parents
signs: edema in face, cardiac enlargement, gallop rhythm, tachypnea, shortness of breath, fatigue, poor appetite, poor growth, sweting with minimal activity.
treat: elevate HOB, decrease oxygen consumption, monitor intake and output, monitor breath sounds, provide supplemental oxygen, give aldactone, diuril, Lasix, all help treat CHF, surgery, avoid high salt content in food,
abdominal bloating, diarrhea, vomiting, weight loss, flatulence, delayed growth, dental defects, skin rash on elbows, butt and knees, severe form: anemia, b12 deficiency, osteopenia due to calcium malabsorption.
tests: blood, CBC, IgA, anti tissue antibodies, confirm with endoscopy, test for other problems if symptomatic.
treat with gluten free diet which may decrease need for insulin, if addisons disease tests are lytes cortisol and acth levels
autoimmune liver disease check liver function tests
arthritis test with joint exam RF, ANA, SSA, SSB
if autoimmune thyroid test TSH, T3/4
treat: with IV therapy for hydration for vomiting, diarrhea. do not start gluten free diet before endoscopy exam.
lump in the groin area commonly on the right side. intermittent pain, feeling of weakness or pressure in the groin, burning or gurgling feeling a t the bulge. with incarceration increase in pain, fever, tachycardia, bilious vomiting and no stool, with strangulation erythema and edema over a tender groin mass.
treat: start IV fluids, prepare for surgery, frequent diaper change,
once repaired patient should not have additional problems with that side, opposite side will need periodic exams,
*umbilical hernias spontaneously close after 1 year.
cramping, bloating, diarrhea, constipation, change in stool, urgency to go,
tests: CBC, WBC, stool culture, endoscopy if bleeding to rule out IBD,
treat: eat small meals and avoid trigger foods, dietary changes such as removing fatty foods, dairy, carbonated beverages, and caffeine, increase in high fiber foods, eating several small meals, fiber supplements, laxative such as miralax, Imodium to relieve diarrhea. probiotics
eating is unplesent and burns
recurrent vomiting, silent with just into the esophagus, arching during or after meals, irritable, crying, chronic cough, choking, slow weight gain, pneumonia is common, sleep interruption,
treat: positioning is important in infants may need to breastfeed in upright position, thicken feedings if needed, place upright after feedings.
tense, distended abdomen, large residual greater than 2mL, occult blood in stool, period of apnea, decreased BP, poor temp stability.
emergency care: stop feedings, maintain IV fluid
acute care: IV therapy, TPN, antibiotics, sometimes surgery is required.
chronic care: after symptoms subside restart feeding, if short bowel syndrome may require long term PTN, goal of short bowel is to advance to Enteral feedings.
*avoid kool aid, juice, soda.
water diarrhea, abdominal cramping, vomiting, dehydration, headache, fever and chills temp above 102.5.
give Iv of electrolytes, antibiotics may be administered if stool culture is positive. withhold fluids 2-3 hours, start with 1tbs of fluid every 15 minutes for 1 hour then 1 ounce of fluid, every 1/2 hour pedialyte water popsicles and ginger ale. after several hours may have clear broth and several saltines, if pt starts to vomit then stop fluids and start over. moisture lips with Vaseline, BRAT diet
infrequent stools, hard and small and pebble like or large in size two or less times a week, holding stools in, impaction.
may need IV fluids, enemas or oral electrolytes solutions may be used for disimpaction. treated at home with high dose of polyethylene glycol. can also give treatment at home like mineral oil, lactulose, ducolax, enemas may be short term but helpful, do regular times for stooling usually after meals for 5-10 minutes, daily record of stools and medication, reward chart for success. increase in exercise, increase in fluid intake, fiber,
children 2-6yrs normally
e. coli caused
fever, vomiting, abdominal pain, flank pain, back pain, dysuria, frequency, urgency, hematuria, jaundice, poor intake, failure to thrive. increases for children with spina bifida from a neurogenic bladder.
obtain a urine specimen
treat: antibiotics immediately before results are back, amoxicillin every 8-12 hours, monitor vitals, temp and BP, take antibiotics for whole time 7-14 days. cranberry juice. avoid use of bubble baths or essential oils in baths. avoid tight clothing and diapers, ample water intake and high fiber diet.
most common congenital anomaly affecting the urinary tract in children.
frequency, pain, incontinence, fam history, enlarged bladder,
treat with ceftriaxone twice daily, cefotaxime every 6-8 hours or amoxicillin orally. surgical correction can be performed. stages of vesicoureteral reflux: 1 is ureter only, 2: ureter pelvis, 3: mild or moderate dilation and tortusity of urter, 4: moderat dilation and or tortuosity of the renal pelvis, 5: gross dilatation and tortuosity of ureter.
edema, weight gain, decreased urine output, anorexia, easily fatigued hypertension.
treat: oxygen delivery, CT, drainage of pleural effusion, cortisone therapy, diuretic therapy furosemide, intravenous albumin infusion 25% albumin, watch for shortness of breath.