PCH FINAL EXAM Questions And 100% Verified Correct Answers.

Amniocentesis - correct answer Aspiration of amniotic fluid from the amniotic sac. Done during the 2nd and 3rd trimester. Amniocentesis Purpose at 2nd Trimester - correct answer Advanced maternal age Chromosomal abnormality search Previous infant with chromosomal defect Elevated MSAFP Pregnancy after 3 or more abortions Amniocentesis at 3rd Trimester - correct answer Determines lung maturity L/S ratio Diagnosis fetal hemolytic diseases Amniocentesis Procedure - correct answer Needs signed consent. Done in supine position. Monitor MBP and FHR. Used to locate fetus and placenta. Skin prep—local anesthetic. Use 2-4 inch 20-21g needle. Discard first 2 mL of amniotic fluid. Remove 20 mL of amniotic fluid. Show mom FHR. Fetal monitoring done for 30-60 minutes. Report any vaginal bleeding, contractions, and leaking of AF. Rh IG may be needed post-procedure. Amniocentesis Advantages and DIsadvantages - correct answer Advantages--relatively safe, painless, fetal loss rate is low Disadvantages--timing--takes 2 weeks for results! Ultrasound - correct answer High frequency sound waves. Real-time picture on monitor. Save, non-invasive, accurate, painless. Transvaginal and in lithotomy position. Only takes 10-15 minutes and you can get pictures. Ultrasound 1st trimester use - correct answer Determine gestational age Measure crown to buttocks Observe fetal heartbeat Observe maternal pelvis and uterus Ultrasound 2nd and 3rd trimester use - correct answer Check fetal viability, anatomy and growth Locate placenta/cord Check fetal presentation Check amniotic fluid volume Guides placement for other procedures Ultrasound Advantages and Disadvantages - correct answer Advantages--non-invasive, safe, relatively comfortable, and immediate results. Disadvantages--can't see every single defect, costly if uninsured, abnormal findings can lead to maternal anxiety Non-Stress Test Purpose - correct answer Assess fetal well-being. External monitor attached to abdomen Non-Stress Test Interpretation - correct answer Reactive=2 accelerations of FHR that remains elevated=GOOD. Non-reactive--FHR may vary a bit but if there are no movements=BAD Non-Stress Test Advantages and Disadvantages - correct answer Advantages--can be done in-office, non-invasive/painless, completed in 20-40 minutes, quick results if it's good, no limited times you can do it. Disadvantages--high rate of false positive results, vibroacoustic stimulation. Uterine Contractions - correct answer Involuntary contractions of the uterus--rhythmic and intermittent, with a period of relaxation between contractions, which allows the woman and the uterine muscles to rest and restores blood flow to the uterus and placenta, which is temporarily reduced during each uterine contraction. Uterine contractions are responsible for THINNING AND DILATING THE CERVIX, THEN THRUSTING THE PRESENTING PART TOWARD THE LOWER UTERINE SEGMENT Uterine Contractions Assessment - correct answer A. Cervical canal 2 cm in length would be described as 0% effaced. B. Cervical canal 1 cm in length would be described as 50% effaced. C. Cervical canal 0 cm would be described as 100% effaced. Dilation is dependent on the pressure of the presenting part and the contraction and retraction of the uterus. The diameter of the cervical os increases from less than 1 cm to approximately 10 cm to allow for birth. When the cervix is fully dilated, it is no longer palpable on vaginal examination. Assess frequency, intensity, duration, and resting tone during uterine contraction. Fetal Station - correct answer Refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. It is measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines. (0) station is designated when the presenting part is at the level of the maternal ischial spines. When the presenting part is above the ischial spines, the distance is recorded as minus stations. When the presenting part is below the ischial spines, the distance is recorded as positive stations. Stages of Labor: First Stage - correct answer Lasts for 12.5 hours. Dilation--0 to 10 cm. The first stage is the longest stage and begins with the first TRUE contraction and ends with the full dilation of the cervix. It is divided into three phases, each corresponding to the progressive dilation of the cervix. Stages of Labor: Second Stage - correct answer The cervix is at full dilation and the mother has intense contractions every 1-2 minutes--Birth occurs--pushing results in the birth of the fetus. It is called the expulsive stage and BEGINS WHEN THE CERVIX IS COMPLETELY DILATED AND ENDS WITH THE BIRTH OF THE NEWBORN. This stage of labor primarily involves moving the fetus through the birth canal and out of the body. The maternal urge to push is generally felt when there is direct contact of the fetus to the pelvic floor. Stages of Labor: Second Stage Phases - correct answer Latent--usually calm with passive descent of the baby through the birth canal--the fetal head is negotiating the pelvis, rotating, and advancing in descent. Descent--active pushing and urges to bear down. The fetal head is lower in the pelvis and is distending the perineum, causing the strong urge to push. Stages of Labor: Third Stage - correct answer This stage STARTS AFTER THE NEWBORN IS BORN AND ENDS WITH THE SEPARATION AND BIRTH OF THE PLACENTA. Continued uterine contractions typically cause the placenta to be expelled within 5 to 30 minutes. If the newborn is stable. bonding of the infant and mother takes place during this stage. Shultz presentation--shiny fetal surface of placenta emerges first. Duncan presentation--dull maternal surface of placenta emerges first Stages of Labor: Fourth Stage - correct answer Restorative phase or immediate postpartum period. This period is when the MOTHER'S BODY BEGINS TO STABILIZE AFTER THE HARD WORK OF LABOR AND THE LOSS OF THE PRODUCTS OF CONCEPTION--critical period for maternal physiologic transition as well as new family attachment--close monitoring of both the newborn and the mother are done during this stage. Keep an eye on vitals, the amount and consistency of the lochia and the uterine fundus every 15 minutes for at least 1 hour Varicella Zoster - correct answer Ø highly infectious, spread by direct contact + droplets, lesions are initially intensely pruritic erythematous macules that evolve to papules and then to clear fluid-filled vesicles. Acyclovir is given. Supportive care is the way to go. Communicability—1 day before lesions appear and until all lesions have formed crusts. o 1-2 days before rash—fever, fatigue, loss of appetite, headache appear o After rash—macules start in the center of the trunk and spread to the face and proximal extremities. o Macules progress to papules and then to vesicles before crusting over. Scabs appear in about a week. Roseola - correct answer Ø called 6th disease. Common between 6-18 months. Appears with a sudden high fever that then quickly drops. After the fever occurs, a pink rash will form. Febrile seizures can occur with the high temperature. These kids usually develop Scarlet Fever. Helminthic Infections--Lyme Disease - correct answer o caused by a tick bite. Presents with a ring-like rash at the site of the bite. Take a good history and see if they were ever walking in tall grass/hiking/playing outside frequently. Rash occurs 7-14 days after the tick bite. May present with malaise, fever, mild neck stiffness, headache, myalgia, and arthralgia. Take AB-Doxycycline if patient is above age 8 and Amoxicillin if the patient is below age 8. Helminthic Infections: Head Lice - correct answer o Nits are non-communicable but are produced by the lice and readily visible 1/4th inch away from the scalp—looks like dandruff but doesn't detach easily from the hair shaft. Lice spread through direct contact. S/S: pruritus at the nape of the neck/occipital area/behind the ears, low grade temp and cervical lymphadenopathy may occur. Secondary infection can occur due to scratching. Use lice shampoo and nit comb. Helminthic Infections: Scabies - correct answer o caused by female mites that burrow into the epidermis in areas where the skin is thin and moist, like between the fingers, toes, interdigital spaces, palms, axilla, and groin. It forms a burrow which looks like a grayish-white line composed of dermis and feces. S/S: severe itching (usually at night) and vesicular and papular lesions. Apply GBH or Permethrin cream then scabicide lotion from the neck to the feet. Helminthic Infections: Pinworms - correct answer o most common helminthic infection in the U.S. Child scratches the perianal area and eggs are redeposited from the hands to the GI tract through hand-mouth route. Pinworm Tape Test—wrap scotch tape around a tongue depressant, apply to perianal area as soon as the child awakens and before the child bathes or has a bowel movement—put the tongue depressor in a glass jar and send to the lab, where technicians can view the worms on a slide under a microscope. Anti-helminthic treatments are used. Week 6 of Fetal Growth - correct answer Formation of the lungs, fetal circulation, further brain development, primitive skeleton forms, CNS forms, brain waves detectable. Body is in a C-shape. Week 7 of Fetal Growth - correct answer Straightening of the trunk, nipples/hair follicles form. Elbows/toes are visible. Arms/legs move. Diaphragm is formed. Heartbeat is heard. Mouth with early tooth-buds and lips form. Week 8 of Fetal Growth - correct answer Facial features continue to develop. Heart development is complete. Lungs form more. Hands and feet have digits, webbing may continue to form. Lymphatic system development. External genitals form. Function of: Placenta - correct answer Metabolic: provides glycogen, cholesterol, and fatty acids. Transfer of substances: respiratory gas exchange, nutrient transfer, waste removal, antibody and hormone transfer. Endocrine: HCG (supports endometrial lining to maintain pregnancy), HCS (high enough glucose level in mother's blood to circulate to fetus), estrogen and progesterone (stop contractions before the fetus reaches full term). Function of: Amniotic fluid - correct answer Cushions against any impact Provides constant temperature Muscular development of the limbs Keeps membranes off of body parts Room for fetal movement 500-1000 mL at birth Function of: Umbilical Cord - correct answer Connects fetus to placenta Carries oxygen and nutrients from the placenta to the fetal bloodstream Passes antibodies from mother to fetus (late) 3 vessels--2 arteries=deoxygenated blood. 1 vein=oxygenated blood Nuchal cord=around neck Function of: Fetal Circulation - correct answer Goes from right to left Right ventricle is larger and works harder 3 shunts divert most circulating blood away from the lungs and liver--Ductus venosus (connects umbilical vein to inferior vena cava), Foramen Ovale (anatomic opening between the right and left atrium), Ductus arteriosus (connects the main pulmonary artery to the aorta)=all 3 close ater birth Differentiate between the four classes of Congenital Heart Defect - correct answer 1. Decreased pulmonary blood flow (ToF, Tricuspid Atresia) 2. Increased Pulmonary Blood Flow (Atrial Septal Defect, Ventricular Septal Defect, Patent Ductus Arteriosus) 3. Obstructive Disorders (Coarctation of the Aorta, Aortic Stenosis, Pulmonary Stenosis) 4. Mixed Disorders (Transposition of the Great Vessels, Total Anomalous Pulmonary Venous Return, Truncus Arteriosus, Hypoplastic Left Heart Syndrome) Tricuspid Atresia - correct answer The valve between the right atrium and right ventricle fails to develop. As a result, there is no opening to allow blood flow from the RA to RV, thus no blood flows through the pulmonary artery to the lungs. Tricuspid Atresia S/S - correct answer Tachypnea Dyspnea Cyanosis Fatigue during feeding Slow growth Sweating Tricuspid Atresia Treatment/Management - correct answer Treatment--3 surgeries 1. Shunt insertion--first few days of life. Keeps blood flowing to the lungs. 2. Glenn Shunt or Hemi-Fontan Procedure--3-6 months, connects Superior Vena Cava to Right Pulmonary Artery Fontan Procedure--18 months to 5 years--path is created for oxygen-depleted blood returning to the heart to flow into the arteries that will take it directly into the lungs. Tricuspid Atresia Dx Tools - correct answer Ultrasound of the heart Electrocardiogram Echocardiogram Chest X-ray Cardiac catheterization MRI of the heart Patent Ductus Arteriosus - correct answer Failure of the fetal circulatory Ductus Arteriosus to close--connection between the aorta and pulmonary artery. 2nd most common. Patent Ductus Arteriosus S/S - correct answer Can have no symptoms at all or: Tachypnea Shortness of breath Poor feeding Tachycardia Patent Ductus Arteriosus Treatment/Management - correct answer Wait and watch if it will close on its own. Otherwise. they may give NSAIDS (Indocin blocks hormone-like chemicals that keep the PDA open) or surgical intervention if needed. Pulmonary Stenosis - correct answer Obstruction of blood flow between the right ventricle and the pulmonary arteries due to improper development of the pulmonary valve during the last 8 weeks of fetal growth. The right ventricle has to work harder. Pulmonary Stenosis S/S - correct answer Tachypnea Labored Breathing Tachycardia Fatigue Peripheral and Facial Edema Pulmonary Stenosis Treatment/Management - correct answer If it's mild, not a lot of treatments for it. If moderate to severe/life-treatening, they will do a balloon dilation valvuloplasty--a balloon is put through the femoral or umbilical artery to open the narrowed area for proper blood flow. Complications of Cardiac Surgery - correct answer § Bacterial endocarditis—because you're opening the chest so bacteria can get in. § Cardiac arrhythmias § Heart failure § Hemorrhage § Pneumonia—if not moving post-surgery § Pleural effusion—if they don't have chest tubes, they might for this. § Pneumothorax § Seizures § Infection § Atelectasis § Cardiac tamponade § Cerebrovascular accident § Pulmonary Edema Acute Rheumatic Fever - correct answer Occurs most often in school-aged children aged 5-15 years old. Group A streptococcal pharyngeal infection. Develops 2-4 weeks after the initial streptococcal infection. Lasts 6-12 weeks and may occur with subsequent strep infection Acute Rheumatic Fever S/S - correct answer § Fever § Painful and tender joints, most often in the knees, ankles, elbows, and wrists § Pain in one joint that migrates to another joint § Red, hot, or swollen joints § Small, painless bumps beneath the skin § Chest pain § Heart murmur § Fatigue § Flat or slightly raised, painless rash with a ragged edge § Jerky, uncontrollable body movements (Sydenham Chorea) § Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham Chorea. Rheumatic Fever Treatment/Management - correct answer § Manage inflammation § Fever reduction § Eradication of the bacteria § Prevent permanent heart damage § Prevent recurrences § 10-day course of antibiotics § Maintenance course of antibiotics until adulthood § Anti-inflammatory treatment § Anti-convulsant medications Pneumonia Viral v. Bacterial - correct answer o treat the bacterium with antibiotics if it is bacterial pneumonia but use comfort measures for a viral pneumonia, as it is self-limiting. Foreign Body Aspiration - correct answer Ø Infants and young children are notorious for putting things up their nose. What happens is they will deeply inhale something, and it will go into their lungs. Foreign Body Aspiration Treatment - correct answer § Bronchoscopy is done to remove the object. Either general anesthesia or semi-conscious sedation is used. Relax the child to put the tube down the lungs. Foreign Body Aspiration S/S - correct answer § If Upper Airway is affected,