NURS 2111 OB and Peds Final Exam Study Guide 2023,100% CORRECT

NURS 2111 OB and Peds Final Exam Study Guide 2023 Maternal Study Guide 1. Condoms health promotion patient teaching • Male condom – Unroll before putting on penis. Penis has to be erect before placing on. Pinch top of condom to make sure there is a space between the head of the penis and the condom for the semen. Make sure it is not too tight or too loose. Protects against STIs. 2. Chlamydia • Bacterial infection caused by CHLAMYDIA TRACHOMATIS and it is the MOST reported STI. • Majority of women are ASYMPOTMATIC, but if S/S are present, it includes: mucopurulent GRAY-WHITE discharge, vulvar itching, dysuria, urinary frequency, endometritis, and Male S/S – penile discharge, dysuria, and testicular pain or edema (swelling). • If left untreated, it can lead to pelvic inflammatory disease (PID), which can cause infertility and ectopic pregnancy. • If not treated during pregnancy, it can cause PROM, preterm labor, and postpartum endometritis. • If transmitted to the neonate, it can cause conjunctivitis and pneumonia after delivery. • MEDS – Doxycycline [Vibramycin] (used as a tx for 7 days, but contraindicated during pregnancy). Azithromycin [Zithromax in a single dose] or Amoxicillin (prescribed during pregnancy). Erythromycin (ophthalmic eye drops/ointment given to neonate following delivery) within 2 hours. • At a higher risk for gonorrhea and HIV. 3. Gonorrhea • Bacterial infection caused by NEISSERIA GONORRHOEAE and is the SECOND most commonly reported STI. • Similar to Chlamydia, most women are ASYMPTOMATIC. If S/S are present, it includes: YELLOWISH-GREEN vaginal discharge, dysuria, dysmenorrhea, vaginal bleeding between periods. Male S/S – dysuria, testicular pain or edema (swelling), and penile discharge (white, green, yellow, or clear), sometimes profuse. • In pregnancy, gonorrhea is associated with chorioamnionitis, premature labor, spontaneous abortion, PROM, and postpartum endometritis. • If transmitted to the neonate, ophthalmia neonatorum occurs which can lead to blindness; hence, the importance of ERYTHROMYCIN. • Meds - 4. Syphilis • Caused by a spirochete bacterium TREPONEMA PALLIDUM. • Primarily affects Blacks, Hispanics, and racial/ethnic minority groups. • Has 5 stages: Primary, Secondary, Early Latency, Late Latency, and Tertiary (LATE). - Primary A chancre (painless ulcer) at the site of bacterial entry that will disappear within 3 to 6 weeks without intervention. This period is highly contagious especially whenever chancres are present. - Secondary Appears 2 to 6 months after initial exposure and is manifested by flu-like symptoms and a maculopapular rash of the trunk, palms, and soles. Alopecia and adenopathy are both common during this stage. Lasts about 2 years. - Early/Late Latency (Hidden Stages) Characterized by the absence of any clinical manifestations of disease, though the serology is positive. This stage can last as long as 20 years. - Tertiary (Late) Damage to internal organs occurs. • Meds – Penicillin G in a single dose. Doxycycline or tetracycline orally, if allergic to penicillin. Do not administer if pregnant. • If left untreated or undiagnosed, can be transmitted to the neonate and cause stillborn birth or congenital abnormalities. 5. Trichomoniasis • Caused by a protozoan parasite called TRICHOMONAS VAGINALIS. • Can be sexually transmitted OR can be transmitted from wet surfaces like a hot tub. • S/S in women: FROTHY, GREENISH-YELLOW, FOUL SMELLING DISCHARGE and vulvar itching, edema, and redness. Men are asymptomatic. • Although this infection is localized, there is increasing evidence of preterm birth, premature rupture of membranes, low-birth-weight infants, postpartum endometritis, and infertility in women with this type of vaginitis. • Meds - A single 2-g dose of oral metronidazole (Flagyl) or tinidazole (Tindamax) for both partners is a common treatment for this infection. Metronidazole is not given during the first trimester of pregnancy due to the teratogenic effects on the fetus. 6. IUD • Active T-shaped device inserted through the cervix and placed in the uterus. Most effective contraceptive methods. • Must be monitored monthly by clients after menstruation to ensure the presence of the small string that hangs from the device into the upper part of the vagina to rule out migration or expulsion of the device. • Advantage: IUD can maintain effectiveness for 3 to 10 years (hormonal IUD 3 to 5 years; copper IUD 10 years) • Disadvantage: This method can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy and can be expelled. • Warnings for Potential Complications for Intrauterine System Users: P = Period late, pregnancy, abnormal spotting or bleeding A = Abdominal pain, pain with intercourse I = Infection exposure, abnormal vaginal discharge N = Not feeling well, fever, chills S = String length shorter or longer or missing • Contraindications: Active pelvic infection, abnormal uterine bleeding, and severe uterine distortion • Complications – bacterial vaginosis which can lead to PID. • No douching when IUD because it pushes the bacteria up and it’ll get trapped in the IUD. 7. Pelvic inflammatory disease • An infectious condition of the pelvic cavity that may involve the fallopian tubes, ovaries, and peritoneum. • Major cause of female infertility • Higher in young adolescent girls and young adults • S/S – lower abdominal pain, spotting after intercourse, fever and chills, irregular bleeding • Complications – fibrosis, scarring, loss of tubal function, ectopic pregnancy, pelvic abscess, infertility, recurrent or chronic episodes, chronic abd pain, pelvic adhesions, and depression 8. Infertility • Primary: Defined as an inability to conceive despite engaging in unprotected sexual intercourse for at least 12 months. • Secondary: You have a child and now unable to get pregnant after that child. • RF: overweight or under weight and PID • Common factors associated with infertility can include decreased sperm production, endometriosis, ovulation disorders, and tubal occlusions. • Nonmedical, lifestyle changes, and alternative measures – nutritional and dietary changes, exercise and stress mgmt, herbal meds if prescribed, acupuncture, and avoid high scrotal temperatures • Medical therapy – Ovarian stimulation: Clomiphene citrate and Letrozole • Assisted Reproductive Technologies - Intrauterine insemination - In vitro fertilization-embryo transfer - Gamete intrafallopian transfer - Donor oocyte - Donor embryo - Gestational carrier - Surrogate mother - Therapeutic donor insemination 9. Teratogens • Substance, organism, physical agent, or deficiency state present during gestation that can cause abnormal postnatal structure or function of fetal development • 4 types: physical agents, metabolic conditions, infection, and drugs or chemical agents • Ionizing radiation—leads to abnormal brain development, mental impairment, and leukemia. • Organic mercury—leads to damage of the neural system, mental impairment, behavioral and cognitive problems, and blindness. • Lead exposure—can cause spontaneous abortions, delayed fetal development, increased risk of fetal death, or abnormal mental or physical development. • Toxoplasma—leads to spontaneous abortion or stillbirth, underdeveloped fetal brain, blindness, and seizures. • Syphilis bacteria—can cause fetal death, spontaneous abortion, liver and spleen enlargement, and congenital syphilis. • Rubella virus—leads to abnormal brain development. • Cytomegalovirus—leads to underdevelopment of the fetal brain, blindness, deafness, jaundice, and liver and spleen dysfunction. • Varicella zoster—leads to underdeveloped limbs, and brain or eye malformations. • Herpes virus—causes fetal death, microcephaly, herpetic pneumonia, and meningoencephalitis. • Maternal conditions—obesity, diabetes, hypothyroidism, hyperthyroidism, and phenylketonuria (PKU). • Drugs—include thalidomide (limb malformations); alcohol (fetal alcohol spectrum disorder); angiotensin-converting enzyme (ACE) inhibitors (antihypertensive agents) (prematurity, intrauterine growth restriction [IUGR]); cocaine (placental abruption, prematurity, microcephaly); and tetracycline (yellow-brown teeth discoloration) 10. Endometriosis • A complex syndrome characterized by an estrogen-dominant chronic inflammatory process that affects primarily pelvic tissues, including the ovaries. • Commonly found attached to the ovaries, fallopian tubes, the outer surface of the uterus, the bowels, the area between the vagina and rectum, and the pelvic side wall. • RF – the aging process, family hx of endometriosis, lean body size, infertility • Mgmt – Pain relief, hormonal suppression, and surgery • Tx – Removal of lesions or hysterectomy • NC – Educate!!! 11. PMS • Recurrent physical, emotional, and behavioral symptoms that occur during the luteal phase or last half of the menstrual cycle and resolve with the onset of menstruation. • Can lead to serious depression • Peak time for PMS is 4 to 7 days PRIOR to menses • Women spend up to 10 years of their life in a compromised physical functioning and psychological well-being. 12. Nägele’s Rule • Subtract 3 months from LMP and add 7 days 13. Non-stress test • Non-invasive test done in the third trimester to measure FHR response to fetal movement. • Give mom orange juice prior to test to energize baby. • Mom pushes a button when she feels fetal movement. • If fetus is sleeping, a vibroacoustic device may be used to awaken them. • Results reactive or non-reactive. Reactive is normal: 2 fetal heart accelerations from the baseline of the heart rate higher than at least 15 bpm lasting at least 15 seconds within a 20 mins recording period! Non-reactive is abnormal!! Further testing is recommended (biophysical profile or contraction stress test). 14. Signs of pregnancy • Presumptive: Can be defined by things/reasons other than pregnancy - Amenorrhea - Fatigue - Nausea/Vomiting - Urinary Frequency - Quickening/Fluttering in stomach • Probable (Objective): Changes that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus). - Abdominal enlargement: Related to changes in uterine size, shape, and position - Hegar’s Sign: Softening and compressibility of the lower uterus - Chadwick’s Sign: Deepend violet bluish color of cervix and vaginal mucosa - Goodell’s Sign: Softening of cervical tip - Ballottement: Rebound of unengaged uterus - Braxton Hicks Contractions: False contractions that are painless, irregular, and usually relieved by walking Positive Pregnancy Test: Woman’s hormonal level may not be normal • Positive: Very distinct things. - Fetal Heart Sounds - Fetal Heartbeat can be heard - Can see the baby with ultrasound - Can feel movement in the uterus 15. Group B Streptococcus • Culture is obtained from screening at 35 to 37 weeks by swabbing vaginal and rectal area. If positive, an IV prophylactic antibiotic is given during labor. • Maternal effects (sepsis, chorioamnionitis, and endometritis after delivery) and fetal effects (meningitis, pneumonia, and sepsis). • Natural occurring bacteria found in 50% of healthy adults in the gastrointestinal and urinary tract. 16. Fetal circulation • Umbilical cord contains 2 arteries and 1 vein (AVA). • Three shunts also are present during fetal life and will close once baby takes first breath: - Ductus venosus—connects the umbilical vein to the inferior vena cava. - Ductus arteriosus—connects the main pulmonary artery to the aorta. - Foramen ovale—anatomic opening between the right and left atria. 17. Betamethasone • A glucocorticoid administered deep IM (ventral gluteal or vastus lateralis muscle) in two injections 24hr apart to enhance fetal lung maturity and surfactant production for fetuses between 24 to 34 weeks. Requires 24hr to be effective. 18. Gravida • GTPAL (G = # of pregnancies including current pregnancy even if baby did not make it, T = Term births [over 37 weeks], P = Pre-term [20 to 36.6 weeks], A = Abortions, L = Living) • Nulligravida – Never been pregnant • Primigravida – First pregnancy. • Multigravida – Multiple pregnancies. 19. Pregnancy induced hypertension (PIH) – GESTATIONAL HYPERTENSION • Begins after 20th week of pregnancy • 2 blood pressures greater than 140/90 at 2 different times, at least 4 to 6 hours apart. • Blood pressure returns to baseline by 12 weeks postpartum. No proteinuria. • Anti-hypertensive meds – Methyldopa, nifedipine, hydralazine, and labetalol 20. Preeclampsia • Hypertension and +1 protein will be present in urine. • Low dose aspirin therapy will be initiated. • Edema can be present. • Severe Preeclampsia – BP > 160/100, proteinuria > 3+, headache, blurred vision, edema, hepatic dysfunction • Possible complication is seizures. 21. Magnesium sulfate • Given as prophylactic treatment to prevent seizures in patients with eclampsia and severe preeclampsia. • KEEP CALCIUM GLUCONATE BEDSIDE. • Monitor for signs of magnesium toxicity (vomiting, respirations less than 12/min, urinary output less than 30/min, absence of patellar deep tendon reflexes. • PATIENTS SHOULD BE ON FLUID RESTRICTION OF 25 ML TO 125 ML/HR. 22. Abruptio placenta • Premature separation of placenta from uterus, which can be a partial or complete detachment. Separation occurs after 20 weeks of gestation. • S/S – Sudden onset of intense localized abdominal pain with dark red vaginal bleeding, fetal distress, findings of hypovolemic shock, uterine tenderness, and contractions with hypertonicity • NC - Place mom on strict bed rest and in a left lateral position to prevent pressure on vena cava. - Administer oxygen to ensure adequate tissue perfusion. - Obtain maternal vs q 15 mins as indicated. - Observe for signs of hypovolemic shock. - Insert an indwelling urinary (Foley) catheter to assess hourly urine output. - Initiate an IV infusion for fluid replacement using a large-bore catheter. - Assess fundal height for changes. - Monitor amount and characteristics of bleeding q 15 to 30 mins. - Institute continuous electronic fetal monitoring. - Assess contractions and report any increased uterine tenseness or rigidity. - Also observe the tracing for tetanic uterine contractions or changes in fetal heart rate patterns suggesting that the fetus has been compromised. - Be alert for signs and symptoms of DIC, such as bleeding gums, tachycardia, oozing from the IV insertion site, and petechiae, and administer blood products as ordered if DIC occurs. 23. Ectopic pregnancy • Ovum implants in the Fallopian tubes or abdominal cavity due to the presence of endometrial tissue. S/S – Unilateral stabbing pain in abdomen, and signs/symptoms of hemorrhage (tachycardia, hypotension, pallor) • Can lead to fallopian rupture and extensive bleeding, which leads to surgical removal of damaged tube if pregnancy is not dissolved. • Methotrexate will be administered to dissolve pregnancy if identified prior to rupture. • Salpingostomy is done to remove ectopic pregnancy and salvage the fallopian tube, if not ruptured. Salpingectomy is the removal of the fallopian tube. 24. Placenta previa • Placenta is implanted in the lower uterine segment near or over the internal cervical os. May be total or partial. Low-lying placenta refers to the placenta implanted in the lower uterine segment but does not reach the os. • S/S – Painless bright red bleeding during the second half of pregnancy. • Complications associated with placenta previa include PROM, preterm labor and birth, surgery-related trauma to the structures adjacent to the uterus, anesthesia complications, blood transfusion reactions, over-infusion of fluids, abnormal placental attachments, postpartum hemorrhage, anemia, thrombophlebitis and infection. • Mgmt - Depends on gestation. Usually observation and bed rest. If woman is bleeding, may be placed in LDR and monitored. Usually prefer to wait until >34 weeks for delivery. Delivery is usually by cesarean. Active management for a woman who is term (37 weeks or more) having minimal bleeding, vaginal birth may be attempted. If the woman is <36 weeks, not in labor, and the bleeding is mild or stopped, expectant management (observation )is best. Antepartum steroids (betamethasone) may be ordered to promote fetal lung maturity. No vaginal exams and pelvic rest. A cevical length <3mm increases the risk for postpartum hemorrhage. 25. HELLP syndrome • H = Hemolysis (resulting in anemia and jaundice). • EL = Elevated Liver enzymes • LP = Low platelets (less than 100,000/mm) • Stabilize BP (rapid acting antihypertensive meds will be used) and assessment of fetal well-being. Magnesium sulfate will be given behind antihypertensive meds to prevent seizures. Betamethasone will be given if necessary if baby is between 24 to 34 weeks. • High risk of bleeding out and maternal death. 26. Stages of labor • 1st stage of labor - 0 to 10 cm - Cervical effacement and dilation occurs - Early Phase (latent) – 0 to 3 cm: Mother is talkative and eager - Active Phase – 4 to 7 cm: Mother is restless, anxious, and may feel helpless - Transition Phase – 8 to 10 cm: Mother is experiencing a lot of pain, has the urge to push, and may feel like she is having a bowel movement due to increased rectal pressure • 2nd stage of labor - 10 cm to birth - Contractions intensify in duration - Pushing efforts begin with contractions - ROM may occur if haven’t already (note color, amount, and if it has meconium or not) • 3rd stage of labor - Birth to delivery of placenta - Can last from a few mins to 30 mins - Signs of placental separation: Gush of blood Lengthening of umbilical cord - Shiny Schultz (fetal side) vs Dirty Duncan (maternal side) • 4th stage of labor - Recovery phase - Lasts about 2 hours - NC: Monitor VS q 15mins, encourage breastfeeding, massage fundus q 15mins, skin to skin for at least 1 hour, monitor for bleeding, perform perineal care, monitor urinary output, oxytocin given fast after delivery to help uterus contract 27. Umbilical cord prolapsed • The umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix. This results in cord compression and compromised fetal circulation. • NC – 1st, IMMEDIATELY CALL FOR HELP/NOTIFY PROVIDER. Next, use a sterile-gloved hand and insert two fingers into the vagina, applying finger pressure on either side of the cord to the fetal presenting part to elevate it off of the cord. Reposition in a knee- chest position, Trendelenburg, or a side-lying position. Administer oxygen at 8 to 10 mL via a face mask to improve fetal oxygenation. Provide continuous fetal monitoring. 28. True/False labor • True Labor – cervical change and fetal descent, increase in bloody show, regular and strong contractions that are intensified by walking, and felt in lower back and goes all the way around to the lower abdomen • False Labor – Braxton Hicks (uterine contractions irregular), no cervical change or bloody show, felt in back or abdomen, contractions stop/go away with walking or position change 29. Care of the laboring client • Includes the fetus, mother, and support person. • Fetus – Perform LEOPOLD MANEUVERS to aid in probable location where FHT can be best auscultated on mom’s abdomen. Once found, tocotransducer will be applied to mom’s abdomen over the fundus to measure contractions and external fetal monitoring will be placed on abdomen where fetus is located to assess FHR patterns. • Mother – Assess contractions (frequency, intensity, duration, and resting tone of UC), perform vaginal exams to assess for cervical change, descent/station, fetal position, presenting part and lie, and check membrane status. If IUPC is needed, make sure membranes are ruptures and cervix is fully dilated. Also, provide quiet, dim lights; minimal distractions; speak in low tones; ice chips; dry, clean gown and bed sheets; medications, if necessary; pillows; cool wash cloths. Always inform of labor progress, procedures, etc. • The support person – give frequent and appropriate feedback. Give specific tasks. Encourage to eat and drink fluids. 30. Oxytocin • Given to induce labor or for post-partum hemorrhage • Promotes uterine contractions • Administered fast after delivery to help uterus contract • Assess uterine tone and vaginal bleeding • NC – Monitor FHR and contractions. Administer terbutaline to decrease uterine activity if needed. *Discontinue oxytocin if contractions occur MORE THAN EVERY 2 MINS, LAST LONGER THAN 90 SECS, INTENSITY > 90mmHg W/ IUPC, or RESTING TONE > 20mmHg BETWEEN CONTRACTIONS 31. Shoulder dystocia • Difficulty delivering the shoulders after the head is delivered. • Maternal risk include vaginal or perineal trauma. • Fetal risks include asphyxia, brachial nerve injury from over stretching the neck, clavicle fractures, and cervical nerve damage. • Tx is to anticipate, perform Mc Robert’s maneuver (explain everything to patient), suprapubic pressure, DO NOT APPLY fundal pressure, and sometimes fracturing clavicle is necessary. 32. Uterine rupture • Complete rupture involves the uterine wall, peritoneal cavity, and/or broad ligament. Internal bleeding is present. • Incomplete rupture occurs with dehiscence at the site of a prior scar. Internal bleeding might not be present. • RF – Overdistention of the uterus from a fetus who is LGA, a multifetal gestation, or polyhydramnios and forceps-assisted birth. • Expected Findings – Clients report sensation of “ripping,” “tearing,” or sharp pain, abd pain, or uterine tenderness. • NC – Administer IV fluids. Administer oxygen. Administer blood products if prescribed. Prepare client for immediate c-section, which can involve laparotomy and/or hysterectomy, and inform the client and their partner about the treatment. 33. Fetal position (Longitudinal, transverse, oblique) • Longitudinal lie – Position that we want baby in (head first); however, if butt is presenting, this baby will require a c-section. • Transverse lie – Shoulder is presenting part. Patient will require a c-section. • Oblique lie – Baby’s head is in mother’s hips. If baby does not rotate itself before the laboring process, c-section may be necessary. 34. Amniotic fluid • Assessment completed after ROM. • Should be watery, clear, and have a slightly yellow tinge. • Odor should not be foul. • Volume is between 700 to 1000 mL • Use nitrazine paper to confirm that amniotic fluid is present. 35. Five essential factors of labor (passenger, etc...) • Passageway - Size and shape must be adequate to allow fetus to pass. Cervix must dilate and efface in response to contractions and fetal descent. • Passenger - Consists of the fetus and the placenta. The size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position affect the ability of the fetus to navigate the birth canal. The placenta falls under this category because it also must pass through the canal. • Powers - Uterine contractions cause effacement. Involuntary urge to push and voluntary bearing down helps in the expulsion of the fetus. • Position - GRAVITY!!! Frequent changes increases comfort, relieves fatigue, and promotes circulation. • Psyche - Very important that there is no tension, anxiety, or stress. KEEP PATIENT AS CALM AS POSSIBLE!!! 36. Neutral thermal environment in newborn • Thermoregulation - NBs keep warm by metabolizing brown fat. Very unique to babies. Brown fat is going to activate by stimulation of the sympathetic nervous system. Baby converts it into energy. Once a baby is using it to keep warm, it can’t get it back. You do not want baby to use up brown fat reserve. • 4 types of Heat Loss: - Conduction: caused by putting a baby directly on a cold surface - Convection: flow of heat from body surface to a colder surface (placed in bassinet close to ac or fan) - Evaporation: Loss of heat as surface liquid (having cold blankets stay on them, sweating - Radiation- loss of heat from body surface to a colder surface (keep away from cold window) 37. Care of the postpartum client • Monitor physiologic and psychologic adaptations • Restore maternal physiologic function • Support neonate’s physical adaptation • Promote rest and comfort • Promote family/newborn bonding • Provide education on self and newborn care which encourages assumption of parental, caretaking role • Monitor emotional state of woman and her sleep 38. Fetal surveillance • Internal or external fetal monitoring. If internal, mom’s cervix must be fully dilated and membranes must already be ruptured. Internal monitoring increases the risk of infection and injury to mother/fetus. *REMEMBER: VEAL CHOP and its primary interventions* 39. Postpartum blues, depression, and psychosis • Postpartum blues – Usually happens in the first 10 days after delivery. Peaks on day 5 and subsides on day 10. • S/S: Emotional, mood swings, tearful, irritability, sleep and appetite disturbed • TX – Usually resolves on its own • Postpartum depression – Onset can be as early as 24 hours or as late as several months following birth. These patients normally have a history of severe PMS, alcohol/substance abuse, or eating disorders. They may also have a thyroid dysfunction. • S/S: Low self-esteem, loss of pleasure in activities, mood changes, persistent sadness, irritability, an inability to adjust to motherhood role, panic attacks, obsessive thinking, and suicidal thinking. • TX - Early diagnosis and treatment shortens length of depression, counseling, anti- depressant therapy - SSRI’s, tricyclic antidepressants (6 months or more), anti-anxiety medications may be needed, and household help and support groups • Postpartum psychosis – Usually presents within 3 weeks of delivery. Patient may have bipolar symptoms, delusion, confused and hallucination. Beyond the scope of maternity nurses. Need hospitalization with medical care (psychiatric emergency). If treated with lithium before pregnancy may resume following birth, if the woman is not breastfeeding. These mothers may harm the baby. 40. Skin to skin • Regulates baby’s temperature and promotes bonding between mom and baby. Also, normalizes mom and baby’s vital signs! 41. Ballard score • Completed at 2-24 hours of life • Combined score gives an estimated gestational age • SEVERAL assessments • Each scored 1-4/5 • NB maturity rating: Two parts - Neuromuscular (score from -1 to 5) - Physical maturity (score based on how eyes look, lanugo, etc) 42. Lochia • Lochia Rubra – 1 to 3 days after delivery and is usually dark red with small clots • Lochia Serosa – 4 to 9 days after delivery and is usually pinkish brown. If foul-smelling, check for infection • Lochia Alba – 10 to 14 days after delivery (up to a few months) and is usually creamy white. *NO LOCHIA IS A PROBLEM. TOO MUCH LOCHIA MAY INDICATE A PROBLEM* • Scant - < 5cm (2 inch) stain • Light - < 10cm (4 inch) stain • Moderate - <15cm (6 inch) stain • Large/Heavy - >15cm (6 inch) stain or one pad saturated within two hours • Excessive – SATURATION OF PERINEAL PAD WITHIN 15 MINS *BE SURE TO CHECK FOR POOLING OF BLOOD UNDER THE BUTTOCKS* 43. Rubin’s Postpartum Phase of Regeneration • Taking-in phase (Dependent): Occurs during first 3 days after delivery. She relies on others for assistance. She is eager to talk about her birth experience. • Taking-hold phase (Dependent-independent): Occurs on day 3 and usually lasts 10 days to several weeks. Mom wants to learn and practice caring for baby. When teaching, avoid taking over because mother may interpret herself as unable to compete. Be sure to let mom take care of infant and only step in to assist. • Letting-go phase (Interdependent): Mom adjusts to physical separation of baby and realize that the baby no longer is a part of her body. Sometimes feelings of letdown and depression may begin. 44. Respiratory distress syndrome (RDS) AKA Wimpy White Boy Syndrome • Surfactant deficiency poor gas exchange ventilator failure • Birth weight alone/gestational age is NOT an indicator of fetal lung maturity • Risk factors: Preterm infants, meconium, perinatal asphyxia, maternal complications • Assessment: - Respiratory distress - Tachypnea - Nasal flaring - Grunting - Retractions - Labored breathing - Fine crackles - APNEA (longer than 15 seconds) • Diagnostics/Labs: o CXR o Blood glucose o ABGs (in order to correct acidosis) o R/o infection o Cultures: blood • Treatment: o Respiratory support (ventilator) to correct respiratory acidosis o Sodium bicarbonate to correct metabolic acidosis o Decrease stimuli (cluster care) o Lung Surfactant through ET tube 45. Fundal massage • Place one hand on top of fundus and one hand at bottom of uterus to support it. Massage in circular motion. Pay attention to blood amount, color, and odor. 46. Apgar scoring (Quick Newborn Assessment: Immediately following birth) A – APPEARANCE (Skin color), P – PULSE (heart rate 90 to 160), G – GRIMACE (Reflex irritability), A – ACTIVITY (Muscle tone), and R – RESPIRATIONS (30 to 60) • 1 & 5 minutes of life • Assess adaptation - 0-3: Severe distress - 4-6: Moderate distress - 7-10: None/ minimal distress 47 Pathologic and physiologic jaundice (Hyperbilirubemia) • Pathologic - PROBLEM; due to an underlying disease - Liver problem, RBC disorder, ABO incompatibility or infection - Jaundice < 24 hours • Physiologic - Benign to a degree - Due to breakdown of fetal RBCs - Jaundice appears > 24 hours • S/S: - Press in cheek or abdomen and release - Yellow tint Sclera, skin and mucous membranes • Treatment: Phototherapy - Overhead, bili bed (levels should decrease every 4 to 6 hours) - Eye mask at all times (to protect cornea and retina) - Undressed; for males cover penis (keep diaper on) with surgical mask - NO lotions or ointments - Turn off lights to drawn labs - Remove lights and mask q3-4 hours (allows for bonding with family) - FEED! Feed! FEED! (removes bilirubin from body through stool) 48. Post-partum hemorrhage • Blood loss of > 1000 mL after vaginal or cesarean birth • S/S: Saturating pad < 15min, soft/boggy uterus, large blood clots, S/S of hypovolemic shock (tachycardia, hypotension, cool/clammy skin) • Tx: Uterine stimulants (oxytocin [monitor for adverse reactions of water intoxication: lightheadedness, N/V, headache, malaise], methylergonovine [methergine – IV : DO NOT GIVE IF ANY BP ISSUES. Monitor for adverse reactions: hypertension, N/V, and headache], misoprostol [Cytotec 800-1000 mcg. Assess uterine tone and vaginal bleeding], carboprost [Hemabate – IV : Causes massive diarrhea. Monitor for adverse reactions: hypertension, chills, headache, N/V]) 49. Bonding and attachment • Signs of Bonding: holding the infant, talking or singing to the infant, gazing and smiling at the infant, recognition of the infant’s distinct features • Signs of Impaired Bonding: Ignoring infant, apathy when infant cries, disgust with diapers or spit-up, expressing disappointment in infant. Parental Teaching - Encourage hands-on approach (cuddling, diapering, bathing) and skin-to-skin contact. - Provide education on infant hunger cues, and encourage early breastfeeding. 50. Prenatal testing • Laboratory tests include a Pap smear, vaginal cultures, urine specimen (protein is not normally present). Assess for edema, check for preeclampsia and kidney disease. Recommended to test for diabetes if not already a diabetic. Ketones indicate burning fat, need to assess diet, blood could indicate UTI or kidney disease). Blood studies (sickle cell, Hgb & Hct, Rh) EDD) also determined. Determine blood group and Rh. Many HCPs do HIV testing, GC, and VDRL or RPR. CDC suggests chlamydia screening for all pregnant women (retest during third trimester). Peds Study Guide 51. Increased Intracranial Pressure • Could lead to neurologic dysfunction. • Early S/S in newborns and infants – bulging or tense fontanels, increased head circumference, high-pitched cry, poor feeding, distended scalp veins, irritability • Early S/S in children – increased irritability, headache, N/V, diplopia, seizures, and lethargy. • Late S/S in all – Bradycardia, abnormal respirations, decreased LOC, coma • NC – Provide interventions to reduce ICP (positioning; avoidance of coughing, straining, and bright lights; and, minimizing environmental stimuli) 52. Glasgow Coma Scale • Objective measure of child’s LOC by assigning numerical values to the presence of developmentally appropriate clues: Eye-opening, verbal response, motor response • The total scores range from 15 to 3 - The lower the score, the less responsive the child 53. Spina bifida • Congenital neural defect from incomplete closure of vertebrae • Tend to have clubfeet, scoliosis, and contracture and dislocation of the hips • Dx – checking alpha protein levels in blood • Mgmt – Prenantal supplementation of folic acid of 0.4 mg. • Closure - Prenatal-microscopic closure around 19-25 weeks’ gestation - Postnatal closure immediately to decrease risk of infection, morbidity, and mortality - May require orthopedic devices to help with closure • These kids tend to have latex allergy and have other congenital defects such as clubfoot and hydrocephalus • NC - Protect exposed cyst prior to surgery. Cover sac with sterile, saline-moistened, non-adherent dressing. Place infant in prone position with hips flexed. Avoid pressure on sac. 54. Seizures • DX – EEG to identify origin of seizure. • TX – antiepileptics, vagal nerve stimulator, craniotomy to remove brain tissue causing swelling • NC – Seizure precautions (pad side rails, suction/oxygen equipment at bedside). Monitor serum levels of antiepileptics. - During seizure: Lower patient to bed or floor if standing/sitting. TURN PATIENT TO THE SIDE. Loosen restrictive clothing. DO NOT PUT ANYTHING IN THE PATIENT’S MOUTH. DO NOT RESTRAIN PATIENT. Note onset and duration of seizure. - Post-seizure: Check vital signs, neurological signs. Reorient patient, determine possible trigger, NPO until fully awake. 55. ADHD (most common neuro disorder in childhood) • Characterized by inattention, impulsivity, distractibility, and hyperactivity • Cause unknown but may be alteration in dopamine and norepinephrine neurotransmitter system • S/S – failure to pay attention, doesn’t listen, doesn’t understand instructions, talks excessively, easily distracted • Mgmt – Medication management of ADHD includes the use of psychostimulants, nonstimulant norepinephrine reuptake inhibitors, and/or α-agonist antihypertensive agents. • Methylphenidate, dextroamphetamine- psychostimulant. Gradually inc dose to reach therapeutic results. Child will have decreased appetite—give the medication with or after the meal. Give last dose of the day prior to 1800 to prevent insomnia. Adverse effects—insomnia, anorexia, nervousness, hyper/hypotension, tachycardia, and anemia • Avoid caffeine • TCA is used as adjunct therapy for insomnia • This is not a cure. Behavior therapy and classroom restructuring may also be helpful. • NC - Provide emotional support and education. Work closely with the school (teach hardest academic subject is in the morning). Teach families and school personnel to use behavioral techniques such as time-out, positive reinforcement, reward or privilege withdrawal, or a token system. Educate families on stimulant medications (take in morning) to decrease insomnia. 56. Down syndrome (Trisomy 21 – no cure) • A genetic disorder caused by the presence of all or part of an extra 21st chromosome • Most common chromosomal abnormality associated with intellectual disability • Kids with down syndrome tend to GI issues, cardiac issues, tend to be obese, and have apnea; therefore, different ologists are needed on their team. • Seen more in kids where the maternal age is older than 35 years • LABS/DX – prenatally, afterbirth during chromosome analysis, or looking at the child - Echocardiogram- to detect cardiac defects - Vision and hearing screening- to detect vision and hearing impairments - Thyroid hormone level- to detect thyroid disease - Cervical radiographs- to assess for atlantoaxial instability - Ultrasound- to assess for gastrointestinal malformations • S/S – low set ears, depressed nasal bridge and small nose, hypotonia, short stature • NC – providing supportive measures such as promoting growth and development, preventing complications, promoting nutrition (Use of a bulb syringe, humidification, and changing the infant’s position can lessen the problem. Breastfeeding a baby with Down syndrome is usually possible, and the antibodies in breast milk can help the infant fight infections. High fiber intake is important for children with Down syndrome because their lack of muscle tone may decrease gastric motility, leading to constipation), and providing support and education to the family • *If neck pain, unusual posturing of the head and neck (torticollis), change in gait, loss of upper body strength, abnormal reflexes, or change in bowel or bladder functioning is noted in the child with Down syndrome, immediate attention is required* 57. Autism • Onset in infancy or early childhood; ranges from mild (Asperger syndrome) to severe • Many children with autism are intellectually disabled, requiring lifelong supervision, though the majority of children with ASD display normal to high intelligence levels • Autistic behaviors may be first noticed in infancy as developmental delays or between the age of 12 and 36 months when the child regresses or loses previously acquired skills • S/S are usually noticeable between 12 and 36 months. Indicators include lack of social ability, lack of verbalization, little interest in verbal interaction/response, inability to use toys, lack of smiling, excessive preoccupation with creating order • Early identification is essential • TX - Stimulants to control hyperactivity and Antipsychotics for repetitive and aggressive behaviors. • Many families are drawn to the use of complementary and alternative medical therapies in attempts to treat their autistic child. They may use vitamins and nutritional supplements, herbs or restrictive diets, music therapy, art therapy, and sensory integration techniques. To date, these therapies have not been scientifically proven to improve autism. • NC – Work closely with the family to determine the child’s routine, habits, and preference. Refer to other disciplines as needed. Stress importance of a rigid, unchanging routine. Teach family to decrease stimuli. Assess the parents’ need for respite care and make referrals accordingly. Provide positive feedback to parents for their perseverance in working with their child. • IMPORTANT TO NEVER DISRUPT AN AUTISTIC CHILD’S USUAL SCHEDULE. 58. Meningitis • Bacterial Meningitis - Infection of the meninges. Can lead to brain damage, nerve damage, deafness, stroke, and even death. Requires rapid assessment and tx. - Causes inflammation, swelling, purulent exudates, and tissue damage to the brain. It can occur as a secondary infection to upper respiratory infections, sinus infections, or ear infections, and can also be the result of direct introduction through LP; skull fracture or severe head injury; neurosurgical intervention; congenital structural abnormalities, such as spina bifida; or the presence of foreign bodies, such as a ventricular shunt or cochlear implants. - Medical Emergency and requires prompt hospitalization and tx. - S/S – sudden onset of symptoms, preceding respiratory illness or strep throat, photophobia, rash, muscle rigidity, stiff neck - Symptoms in infants can be more subtle and atypical, BUT hx may reveal poor sucking and feeding, very weak cry, lethargy, and vomiting as well. *Presence of positive Kernig and Brudzinski signs can indicate irritation of the meninges • NC – IV antibiotics immediately after the LP and blood cultures (length of antibiotics depends on results of culture), corticosteroids to decrease inflammation, supportive measures (proper ventilation), reduce ICP, tx fluid volume deficit, give antipyretics (acetaminophen and ibuprofen) for fever management, make sure they have their vaccines (Hib), and initiate appropriate isolation precautions—in addition to standard precaution, infants and children diagnosed with bacterial meningitis will be placed on droplet isolation until 24 hours of antibiotics to prevent transmission to others • Aseptic Meningitis (most common type of meningitis and is seen in those younger than 5) - Usually viral (Enteroviruses, such as echovirus and coxsackievirus) and can be managed at home. - S/S – Positive Kernig and Brudzinski signs, photophobia, fever - Tx – aggressively as if the child has bacterial meningitis until the diagnosis is confirmed. After confirmed, tx is mainly supportive because illness is self- limiting, 3 to 10 days • NC- comfort measures, reduce pain, and fever. Aseptic meningitis can be managed successfully at home if the child’s neurologic status is stable and he or she is tolerating oral intake 59. Conjunctivitis • Inflammation of the bulbar or palpebral conjunctiva. • Can be viral or bacterial. Most common bacterial cause is staph aureus. Most common cause in newborns is chylamydia or gonorrhea. • Can be infectious, allergic, or chemical in nature • S/S – REDNESS, edema, tearing, discharge, eye pain, CRUSTING OF EYELIDS, itching of the eyes (usually with allergic conjunctivitis) • TX – Bacterial: ophthalmic antibiotic ointment or drops • Viral: self-limiting and does not require topical medication • Eye drops with antihistamine or mast cell stabilization may be helpful for allergic conjunctivitis • LABS/ DX – Culture to determine exact causative organism for appropriate antibiotic • Nursing Care - Alleviate symptoms with warm compresses - Teach parents how to apply eye drops or ointments - Teach families to minimize seasonal allergens - Tell parents to wash hands diligently before and after caring for the child to prevent spread - Discourage from sharing towels and washcloths - Teach to clean eyes from inner to outer. 60. Reyes Syndrome • Primarily affects children younger than 15 years of age who are recovering from a viral illness • Triggered by the use of salicylates or salicylate-containing products (Aspirin, Alka-Seltzer and Pepto-Bismol) to treat a viral infection. This reaction causes brain swelling, liver failure, and death in hours, if treatment in not initiated. • S/S – Severe and continual vomiting, changes in mental status, lethargy, irritability, confusion, and hyperreflexia • LABS/DX – elevated liver function test, elevated serum ammonium level • Ask about any recent viral issue such as chicken pox or flu or have they taken any aspirin • NC – Maintain cerebral perfusion, manage and prevent increased ICP, provide safety measures due to change in LOC and risk for seizures, monitor fluid status to prevent dehydration and overhydration, educate the family 61. Cleft lip/palate • 62. Tracheoesophageal Fistula/Esophageal atresia • 63. Celiac disease • Autoimmune disorder that causes gluten intolerance. • S/S – Steatorrhea, lethargy, failure to thrive, abdominal pain and distention, anemia, weight loss. • Think BROWN – Barley, Rye, Oats, Wheat - Nope! • FT – Substitute grains with corn, rice, or millet. 64. Tonsillectomy • Provide patient with ice collar post-operatively. Assess for frequent swallowing or throat clearing, as this may be a sign of bleeding! Avoid red foods/liquids, spicy foods, straws, coughing, and blowing nose forcefully. 65. Epiglottitis • Caused by Haemophilus influenzae type b • Life-threating inflammation of the epiglottis and surrounding structures occurring in ages 1-8. Huge risk factor is refusal of vaccinations, especially HIB. • S/S – Hoarse or muffled voice, drooling, dysphagia, dysphonia, distressed respiratory efforts, tripod position, high fever • TX – Secure airway with intubation. Do not obtain throat cultures, use a tongue depressor, have the child open their mouth, or insert anything into the mouth. IV Antibiotics. • FT – Encourage compliance with vaccine schedule. *DO NOT LEAVE THIS CHILD UNATTENDED IF YOU SUSPECT EPIGLOTTIS. DO NOT EVEN LEAVE WITH PARENTS. DO NOT LAY THIS CHILD FLAT (supine)* 66. Croup • Most often seen in those that are 3 months – 3 years of age • Parainfluenza is responsible for most cases • Symptoms occur most often at night, presenting suddenly as a barking cough similar to a seal, with resolution of symptoms in the morning. Croup is usually self-limited, lasting only about 3 to 5 days. • Complications of croup are rare but may include worsening respiratory distress, hypoxia, or bacterial superinfection (as in the case of bacterial tracheitis). • Will hear audible, respiratory stridor in severe case • FT – Take kids into humid night air, use a cool mist humidifier in their rooms, or take them into a steamy bathroom. Keep child calm because crying aggravates it. Use of corticosteroids (dexamethasone) if prescribed will help decrease inflammation. *IF CHILD BECOMES OR CYANTOIC OR STRUGGLING TO BREATHE, CALL 911 IMMEDIATELY* 67. RSV • Typically causes bronchiolitis. • RSV is spread via droplets; therefore, droplet precautions are necessary with this patient. RSV is very, very contagious. • The younger the child, the more severe RSV is. • S/S of bronchiolitis – poor feeding, deep or rapid breathing, cough, sneezing, prolonged expiration • Tx – Supportive care. Mechanical ventilation and antivirals for severe cases. Mild cases can be treated at home with antipyretics, adequate hydration, and close observation. • NC – Mainly supportive. For severe cases, position the child with the HOB elevated to maintain a patent airway. Hand hygiene is extremely important. Assess and monitor respiratory effort. Keep patient hydrated and calm. Frequent suctioning may be needed. IV fluid if patient cannot eat. Administer oxygen if needed. Be sure to clean all equipment that is being used on this child. *IF AT HIGH RISK, THERE IS A VACCINE THAT CAN BE ADMINISTERED; HOWEVER, THE VACCINE IS VERY COSTLY; THEREFORE, THERE’S A CRITERIA (LESS THAN 2, BORN PREMATURE, CHRONIC LUNG DISEASE, AND ETC): SYNAGIS (PALIVIZUMAB) 68. Cystic fibrosis • Inherited multisystem disorder that severely impairs the lung function and causes dysfunction in other organs/tissues that makes thick and sticky mucus or sweat. • Both parents must be carriers of the mutated gene in order for the child to inherit it. • DX – Sweat chloride test!!! • TX – Meds: Pancreatic enzymes (pancrelipase) given with meals and snacks and fat soluble vitamins (A,D,E,K). Procedures – Chest physiotherapy (uses percussion, vibration, postural drainage, and breathing exercises to loosen respiratory secretions). Schedule treatments before meals or several hours after. • NC – Administer oxygen. Encourage increased intake of fluids, high fat/high-calorie diet. Facilitate referral to pulmonologist. 69. Otitis externa • Infection and inflammation of the ear canal and external structures, also known as, “swimmer’s ear” because their ear canals are always wet • Pseudomonas aeruginosa and Staphylococcus aureus are typical causative agents, though fungi such as Aspergillus and other bacteria also may be implicated • Moisture in the ear canal usually contributes to whatever pathogen is there • NC – Administer otic combination drops (antibiotics and steroids) or antifungal eardrops as prescribed depending on causative agent. Administer analgesics for pain relief. Teach family the proper administration of drops (lie with affected side up, instill drops warmed to body temperature, and remain side-lying for 3-5 mins). Also teach parents about prevention of reinfection (avoid use of cotton swabs, frequently sanitize earbuds, use 1:1 solution of isopropyl alcohol and white vinegar after swimming or showering) 70. Genitourinary system • 71. Sickle cell disease • Autosomal recessive disorder primarily seen in AFRICAN-AMERICANS caused by abnormal shape of RBCs (lifespan is short – about 20 days). Leads to tissue hypoxia, occlusion of small blood vessels, and organ damage. • S/S – Pain, fatigue, jaundice, swollen hands/feet. • *INFANTS WITH SCA ARE USUALLY ASYMPTOMATIC UNTIL 3-4 MONTHS BECAUSE Hgb F PROTECTS AGAINST SICKLING* • TX/POSSIBLE COMPLICATIONS - Vaso-occlusive crisis (most common): S/S – severe pain, swollen joint, abd pain. This leads to local tissue damage and ischemia and impedes circulation - Acute chest syndrome (impedes gas exchange) - Multiple organ dysfunction • Nursing Care - Prevent vaso-occlusive crisis (Keep pain under control with opioid analgesics) - Maintain hydration status - Prevent infections (hand hygiene and immunizations) - Support family (refer to different resources) - Educate the family (teach about genetics and encourage family members to be tested. Teach family how to administer prophylactic penicillin for infection prevention and hydroxyurea and L-Glutamine for acute pain episodes. Also teach family to avoid crowds, dress appropriately for weather, and stress mgmt/triggers to prevent sickle-cell crisis (SICKLE): SIGNIFICANT BLOOD LOSS (Surgery, trauma, etc) ILLNESS (will be on prophylactic penicillin) CLIMBING OR FLYING TO HIGH ALTITUDES KEEPING CONTINUED STRESS (MENTAL OR PHYSICAL) LOW FLUID INTAKE (DEHYDRATION) ELEVATED TEMPERATURE (Fever or Strenuous exercise) or COLD *DO NOT TAKE MEPERIDINE FOR PAIN MGMT DURING SSC BECAUSE MULTIPLE DOSING HAS BEEN ASSOCIATED WITH AN INCREASED RISK OF SEIZURES* 72. Wilms’ tumor • Most common renal tumor/ 2nd most common abdominal solid tumor in children. Thought to be related to immature kidney cells. Occurs commonly between ages 2-5. No family hx, one kidney is affected. If hx, both kidneys are affected. • S/S – typically asymptomatic. may have mobile abdominal mass discovered by parent when bathing child or by a PCP during exam, complaining of abd pain, hematuria, hypertension, fatigue, anemia, and fever • Tx – Surgical removal of tumor and affected kidney (nephrectomy) is tx of choice, chemo and radiation done before or after surgery. • NC – Assess remaining kidney function (CRITICAL), POSTOP care similar to abd surgery, monitor for chemo or radiation adverse effects • *NEVER PALPATE THE ABDOMEN OF A CHILD WITH WILMS TUMOR BECAUSE IT MAY RESULT IN TUMOR SEEDING AND METASTASIS. 73. Congestive heart failure • Inability of the heart to adequately supply blood to meet the body’s needs. • S/S – Poor feeding, activity intolerance, weak pulses, fatigue, cardiomegaly - Pulmonary Congestion (Left-sided HF): Lef t affects the Lungs!!! - Systemic Congestion (Right-sided HF): Right affects the Rest of the body. • TX – Digoxin (Monitor for signs of digoxin toxicity – N/V, bradycardia, dysrhythmias) Diuretics to reduce congestion, ACE inhibitors, and beta blockers. Closely monitor I&Os and electrolyte levels. • NC - Take apical pulse before administering digoxin. Hold for pulse < 90 bmp for infants and < 60 bpm for older children. Therapeutic level 0.8-2 ng/mL. Elevate head when feeding, use nipple with enlarged opening to decrease energy required, use high-calorie formulas. Weigh patient daily!!!! 74. Hemophilia A • X linked recessive disorder inherited from mothers to sons. Factor VIII deficiency. • S/S - Excessive bleeding/bruising, intracranial hemorrhages and cephalohematomas in newborns, hemathrosis (bleeding in joints and muscles), and decreased ROM • Labs/Dx: Decreased Hgb and Hct if bleeding is severe or prolonged, increased aPTT, decreased Factor VIII • Nursing Care - Prevent bleeding episodes by teaching the family to avoid intense contact sports, protect toddlers w/ soft helmets, and avoiding trampolines and riding ATVs. Manage bleeding episodes by administering Factor VIII replacement as prescribed by SLOW IV PUSH. In mild cases, DESMOPRESSIN can be used. If external bleeding, apply pressure until bleeding stops. If inside a joint, apply ice or cold compresses and elevate the injured extremities except when contraindicated. Educate family on medical alert bracelet, notification of diagnosis to school and staff, how to administer IV infusion of Factor VIII, and involve children as developmentally appropriate. *DO NOT GIVE ASA (ASPIRIN) OR NSAIDS (IBUPROFEN) BECAUSE THEY MAKE BLEEDING WORSE. ACETAMINOPHEN ONLY!!* *HEMATOLOGIST WILL NEED TO BE PRESENT DURING SURGICAL OR DENTAL PROCEDURES* 75. Testicular Torsion • Twisting of the testicle and spermatic cord. • Usually occurs in boys aged 12 to 18 years, but can occur at any time. • EMERGENCY SURGICAL INTERVENTION NEEDED!!!! • S/S – Abrupt onset of severe unilateral testicular pain, swelling, inguinal pain, nausea. • NC – Keep patient and family calm, administer analgesics before and after surgery, and provide routine POSTOP care. 76. Prostaglandin (Alprostadil) • Direct vasodilation of the ductus arteriosus smooth muscle • Indicated for temporary maintenance of ductus arteriosus patency in infants with ductal- dependent congenital heart defects • Nursing Implications - Monitor arterial BP, respiratory rate, heart rate, ECG, temperature, and pO2; watch for abdominal distention. Fresh IV solution required every 24 hours. Reposition catheter if facial or arm flushing occurs. Use with caution in neonate with bleeding tendency. • Contraindicated in respiratory distress syndrome or persistent fetal circulation 77. Congenital heart defects • 78. Growth and Development including average measurements of infants at birth - 12 months • Remember: When 6 months, weight will double. By 12 months, weight will have tripled - Tend to lose 5-10% of weight in first week - Regain weight within 10 to 14 days - By 1 year of age, length has increased by 50% Age Weight Length Head Circumference Birth 7.5 lbs (3.4 kg) 19-21 in (48-53 cm) 13-14 in (33-35 cm) 6 months 16 lbs (7.3 kg) 25-27 in (63.5-68.5 cm) 16.5-17.5 in (42-44.5 cm) 12 months 23 lbs (10.5 kg) 28-30 in (71-76 cm) 17.7-18.7 in (45-47.5 cm) • Developmental 79. Atraumatic care • Care to eliminate or minimize psych & physical distress of child & fam w/in the health system • Ex. Teddy bear in room- sit them down & explain procedure, foster parent-child • relationship, prepare child for unfamiliar procedure, dec pain, allow play time/ expressing fear, privacy, respect culture, provide choices • Psych stress= anxiety, fear, stress, anger, disappointment, sadness • Physical= sleepiness, pain, temp immobile • 3 principles= prevent or minimize child separation from fam, promote a sense of • control, prevent body harm • Setting: anywhere, personnel: anyone 80. Physical assessment approaches/strategies • 81. Tanner Sexual Maturity Rating • 82. Discipline Strategies • 83. Medication Administration & Routes (all) including the use of IV pumps • 84. Effective Communication • 85. Mandatory newborn screening • 86. Whooping cough (Pertussis) • Highly contagious bacterial respiratory infection characterized by whooping cough and copious secretions. • Prevention: DTaP vaccine!!!! • Biggest risk to getting this infection is LACK OF VACCINATION!!!! • S/S – rapid coughing followed by high pitched inhalation with characteristic “whoop” sound, cyanosis, and vomiting • NC – Maintain droplet precautions, encourage fluids, position patient in High Fowler’s during periods of coughing, provide a high-humidity environment, and frequent suctioning to mobilize secretions. 87. Scabies • Contagious skin infection caused by mites. • S/S – Intensely itchy, especially at night, rash (white lines) especially in between fingers, toes, or skin folds, thin, pencil-like marks on the skin • TX – Oral ivermectin in severe cases. Mild cases use topical cream. • NC – Apply 5% permethrin topical cream over entire body to remain on skin for 8 to 14hrs; repeat in 1 to 2 weeks - Treat entire family and persons that have been in contact with the infected person during and 60 days after infection • FT - Wash underwear, towels, clothing, and sleepwear in HOT water. - Vacuum carpets and furniture. - Apply calamine lotion or cool compresses until itching subsides following treatment. 88. Hypothyroidism vs Hyperthyroidism • Hypothyroidism - can be congenital or acquired - Certain populations at risk (Downs, maternal hypothyroidism). - Decreased thyroid hormones. - Decreased T3, T4, T3 resin uptake. - TSH usually elevated. - Lifelong thyroid supplementation. • Hyperthyroidism - rare in children - Mostly seen as Graves disease - Excessive T3, T4, T3 resin uptake - TSH usually low - Treated by destruction of thyroid gland Hypothyroidism Hyperthyroidism Tiredness/Fatigue Nervousness/Anxiety Constipation Diarrhea Cold Intolerance Heat Intolerance Weight gain Weight loss Dry, thick skin; edema of face, eyes, and hands Smooth, velvety skin Decreased growth 89. Diabetes mellitus Type I & II • Type 1: caused by a deficiency of insulin secretion(pancreatic β-cell damage). - S/S – Polyuria, Polydipsia, Polyphagia, Increased frequency of infections, and insulin dependent • Type 2: consequence of insulin resistance (β-cell impairment). - the body can produce insulin but not enough to meet the body’s needs - S/S – sedentary lifestyle, average age 50, hx of increase BP, fatigue • PT – Drink plenty of fluids. Do NOT skip insulin when sick. Self measurement of blood glucose and administration of insulin if needed. Teach about urine ketone testing. Teach signs and symptoms of hypoglycemia and hyperglycemia and how to treat it. Teach patient about diet and exercise as part of DM management. 90. Diabetic Ketoacidosis • Life threatening condition with high blood glucose levels and ketones in the blood and urine. Rapid onset. More common with DMI. • RF – Illness/infection, untreated or undiagnosed type 1 DM, missed insulin dose • S/S – 3 Ps, weight loss, fruity breath odor, kussmaul respirations (increased rate and depth), GI upset, and dehydration. • Labs/Dx: Blood glucose > 250 mg/dL, ketones in blood and urine, metabolic acidosis, and hyperkalemia. • Tx – Treat underlying cause (e.g. infection), IV fluids and insulin, and bicarbonate for SEVERE acidosis only. • NC – Monitor blood glucose hourly. Closely monitor VS, electrolytes (especially potassium!), and I&Os. Monitor for S/S of cerebral edema. *REMEMBER, The K in DKA reminds you to monitor K!!!* 91. Lyme disease • Tick-transmitted infection from a bite from an infected deer. • Tick must be attached for 36 to 48 hours for infection to occur. Prompt removal of tick to prevent infection. • S/S – Stage I (localized): Erythema migrans (ring-shaped, bullseye lesion), flu-like symptoms (malaise, fever, body aches) - Stage II (disseminated): Multiple smaller erythema migrans lesions, fever, dizziness, headache, carditis, facial palsy. - Stage III (late): Arthritis, cognitive impairment. • Tick Removal Guideline: Use fine-tipped tweezers, protect your fingers, grab tick as close to the skin as possible, do not twist or jerk tick, once removed, clean site with soap and water and wash your hands, and save the tick for identification in case the child becomes sick by putting it in a plastic bag, write date of the bite on the bag, and place in freezer. • Tx – Antibiotics (Doxycycline) and analgesics (NSAIDs). In children younger than 8, use amoxicillin because it can cause permanent discoloration of teeth. 92. Infectious mononucleosis • Self-limited illness caused by the Epstein-Barr virus. • Commonly called the “kissing disease” since it is transmitted via oropharyngeal secretions. • Most often seen in adolescents and young adults. • S/S – Sore throat, lymphadenopathy, fever, extreme fatigue, splenomegaly, and rash • NC – Treat the symptoms. • FT – Provide the child with salt-water gargles. If child has splenomegaly, encourage the avoidance of contact sports due to the risk of splenic rupture. 93. Normal ranges for heart rate and respiratory Newborn/Infant HR 110 to 160 bpm Newborn/Infant RR 40 to 60 bpm Toddler HR 70 to 120 bpm Toddler RR 20 to 30 bpm Preschooler HR 65 to 110 bpm Preschooler RR 20 to 25 bpm School-age HR 60 to 100 bpm School-age RR 14 to 26 bpm Adolescent HR 55 to 96 bpm Adolescent RR 12 to 20 bpm