FLASHCARDS IN UWORLD <FUNDAMENTAL<PHARMACOLOGY<<LAB VALUES Chamberlain

FLASHCARDS IN UWORLD &lt;FUNDAMENTAL&lt;PHARMACOLOGY&lt;&lt;LAB VALUES Chamberlain/FLASHCARDS IN UWORLD QUESTIONS DECK (542) 1 Parallel play is characteristic of what age Toddlers typically exhibit parallel play, during which they participate in various activities alongside one another but remain primarily independent. Parallel play is without group organization or common goals. 2 Cooperative play is organized, requires the ability to follow rules, and involves a leader-follower approach to activities. One or two children direct the activity and assign roles. Cooperative play, which develops during the PRESCHOOL years, is goal-oriented and may involve a formal game or task 3 Onlooker behavior is when an interested child sits and observes others at play but does not engage in an activity. 4 Toxoplasmosis - is a disease due to Toxoplasma gondii, a parasite that infects humans via cat feces or ingestion of undercooked meat. - In a normal healthy adult, the infection goes unnoticed (no symptoms or only flulike symptoms are present) and causes no long-term damage. - However, in a pregnant client, the parasite can be passed from mother to baby in utero and can cause significant damage to the growing fetus. If toxoplasmosis is acquired during pregnancy, it can cause stillbirth or serious fetal malformations. - Pregnant clients should be advised to stay away from a litter box or cat feces to reduce toxoplasmosis risk. 5 Leukorrhea - is a thin, milky white vaginal discharge that is normal during pregnancy. - It is caused by increased levels of estrogen and is harmless. - However, leukorrhea may become a problem if it changes color or develops a discernible odor, or if itching or burning occurs 6 Cervical lacerations - should be suspected if the uterine fundus is firm and midline on palpation despite continued vaginal bleeding. - The bleeding can be minimal to frank hemorrhage. - Severe pain or a feeling of fullness is not associated with cervical lacerations. 7 Complete inversion of the uterus presents with a large, red mass protruding from the introitus. 8 A vaginal hematoma - formed when trauma to the tissues of the perineum occurs during delivery. - more likely to occur following a forceps- or vacuum-assisted birth or an episiotomy. - pt reports persistent, severe vaginal pain or a feeling of fullness. If the client had epidural anesthesia, pain may not be felt until the effects have worn off. - Vaginal bleeding is unchanged. - The uterus is firm and at the midline on palpation. - If the hematoma is large, the hemoglobin level and vital signs can change significantly. In a client with epidural analgesia, a change in vital signs may be an important indicator of hematoma. 9 Uterine atony presents with a boggy uterus on palpation and an increase in vaginal bleeding 10 Syndrome of inappropriate antidiuretic hormone (SIADH) secretion results in - water retention and dilutional hyponatremia - Clients with SIADH often require hypertonic saline for sodium repletion to increase serum sodium levels with a minimal infused volume of water. 11 Treatment of Sickle Cell Crisis Sickle cell disease (SCD) is a hereditary hemoglobinopathy in which normal hemoglobin is replaced with abnormal hemoglobin S in red blood cells. The cells change to a sickle shape with triggers (eg, dehydration, infection, high altitude, extremes in temperature). This causes occlusion of small blood vessels with ischemia and damage to organs. Sickle cell crisis occurs when inadequate oxygenation or hydration exacerbates sickling and causes red blood cells (RBCs) to clump together in the capillaries (vasoocclusion). Vasoocclusion causes severe ischemic pain, hypoxia, and possible organ dysfunction if left untreated. Adequate oxygenation and hydration may reverse the acute sickling response. In the sickled state, RBCs cannot carry enough oxygen from the lungs to the tissues, even with supplemental oxygen. The priority intervention is the administration of IV fluids to reduce blood viscosity and restore perfusion to the areas previously affected by vasoocclusion (Option 1). Only after IV rehydration reverses vasoocclusion can nonsickled RBCs effectively carry supplemental oxygen to the tissues Management of sickle cell crisis focuses on the following: 1. Pain control with narcotics - analgesics are provided around the clock or with patient-controlled analgesia, rather than as needed, to prevent breakthrough pain. 2. Hydration - aggressive intravenous and oral hydration is recommended (to reduce the viscosity of the blood) 3. Oxygenation - to prevent pulmonary complications and provide comfort 4. Infection prevention – age-appropriate vaccination plus pneumococcal, influenza, and meningococcal vaccination 5. Diet - the client is encouraged to have a high-protein, high-calorie diet with folic acid and a multivitamin without iron 6. Folic acid - given to help in the creation of the new red blood cells needed due to the hemolysis - Don't increase Iron in theses pts - The anemia in SCD is related to the destruction of red blood cells from sickling, not a deficiency in iron. Increased iron intake is not needed. Clients often require blood transfusions and run the risk of iron overload from multiple transfusions. - Cold promotes sickling and should be avoided. Ice packs are used on joints with bleeding in hemophilia to promote vasoconstriction. 12