FINAL 250 Flashcards

Question

car seats

Answer 1

must be used for all children middle back seat, rear facing

Answer 2

add 5ml of sweetener no mixing with formula or primary foods along side of mouth, upright, not when crying, if put syringe in infant mouth they will tend to stop crying and suck on syringe. oral syringe injections - 25 gauge, 5/8 in needle, vastus lateralis check IV site every hour

Answer 3

call poison control dont induce vomiting take EVERYTHING with you (what was ingested, urine, vomit, etc) Go to ER have meds locked and up high.

Answer 4

prednisone - usually high doses albumin protect from injection - room with non infectious child check urine for protein

Answer 5

behavioral changes, feeding problems, elevated temp

Answer 6

mold, pets, carpets, upholstered furniture, smoking in household

Answer 7

tx with ASA high doses and IVIG autoimmune can lead to coronary artery aneurysm s/s- strawberry tongue, red hands and feet, cracked lips

Answer 8

LIP- elbow restraints, position supine or side lying, logans bar to decrease manipulation, cuddle to soothe baby- dont want to cry and put strain on sutures, NO utensils, feed upright - formula and soft foods only, allow breaks - have difficulty adjusting to nose breathing. PALATE- position prone to promote drainage, can have hearing and speech problems

Answer 9

infection, fractures, bone pain, bleeding, anemia

Answer 10

acute renal failure- check bun, cr, I&O, daily weight, VS stroke - give no added salt diet, diuretics, and HTN meds

Answer 11

increase temp, increase WBCs, HA, nuchal rigidity newborn - poor sucking, high pitched cry, lethargy

Answer 12

to function as normally as possible

Answer 13

4 defects: VSD, pulmonic stenosis, overring aorta, hypertrophy of right ventricle may have tet spells risk for emboli, seizures, loss of consciousness or sudden death following anoxic spell

Answer 14

teach parents to watch for tachycardia, tachypnea most teaching abour surgery is done out of hosp

Answer 15

Assess BP - higher in upper extermities, lower in lower exterm EKG, MRI will show - left sided heart enlargement due to bac pressure and also notching of the ribs from the enlarged collateral vessels

Answer 16

DKA - kussmaul resp, ketonuria, polyuria, excessive thirst, dry mucous membranes, acetone breath, are in metabolic acidosis.

Answer 17

suffocation - most common dall down stairs, pick things up and eat them, can burn easily

Answer 18

Poisons, dart into streets, can drown in even 2 in of water, can open doors while driving, will put anything in their mouths.

Answer 19

Motor vehicle accidents, sport injuries, drugs, firearms, walking to school - avoid unsafe areas

Answer 20

motor vehicle, firearm, drugs, alcohol, suicides

Answer 21

older cities - lead based paint used in houses, peels off and children eat it can also be inhaled

Answer 22

birth to 1 year infants need consisten, loving care by a mothering person mistrust results when their is deficient or lacking of trust in the infants life, or their basic needs are not met.

Answer 23

1 to 3 years autonomy- the child is able to control their new physical abilities as well as mental abitilies shame and doubt happens when they are made to feel small, forced to be dependent in ares they capable of being in control

Answer 24

3 to 6 years initative- children are able to have their own mind and control their actions with being aware of threats If they are made to feel their actions are bad, they will start to feel a sense of guilt

Answer 25

6 to 12 yrs industry- feel the need to work, want to carry out activities that they can finish or complete. Start to compete and cooperate with others and learn rules if too much is expected of them or they feel they cant measure up they have feelings of inferiority

Answer 26

12 to 18 yrs start to become very concerned with their apperances and discovering their role in life if they have trouble discovering their rold they end up in role confusion

Answer 27

BP - not taken on a newborn P **120-160**, apical for 1 min, 110-160 for fetal HR R **30 -60**, periods of apnea less then 20 sec is normal T **97.7 - 99.1** (F) 36.5 - 37.2 , anything lower than 97.7 or 36.5, intervene, could be infection

Answer 28

flexed, with some vernix and lanugo, newborn rash (sometimes seen), milia, iris-deep blue, sclera white, ears should recoil, small white dots on palate, breast engorgement is common and will subside, labia majora cover minora and clit - white or blood tinged fluid normal, closer the creases come to heel more mature they are, testes should be descended.

Answer 29

90th precentile, above 8 lbs at risk for hypoglycemia and birth trauma Problems: more likely to go thru a longer labor, suffer injury at birth, or need to be delivered by C-section, shoulder dystocia, fx of clavicle, damage to cervical or brachial plexus, or facial or phrenic nerves, cephalhematoma, subdural hematoma, bruising , congenital heart defects, higher mortality rate

Answer 30

shunts 20-30% of blood f/umbilical vein to inferior vena cava & away f/immature **liver**; closes by 7-14 days after birth

Answer 31

provides opening btwn RA & LA so blood can bypass nonfunctioning lungs & go directly to **LV & aor**ta; opens only in **R-to-L** direction b/c of high RA pressure & low LA pressure; closed by 3rd month

Answer 32

widely dilated to carry blood f/PA to aorta & **avoid** nonfunctioning lungs; functional closure by 10-96 hrs. & permanent closure within 2-3 mos.

Answer 33

Uterus increases in size and the walls thin, vaginal secretions increase and ph decreases, breasts and nipples increase in size - colostrum is produced, hyperpigmentation, hair grows, resp are faster and deeper, N&V due to high hcg levels first 6-12weeks, frequent urination in 1st and 3rd trimester, kindeys enlarge, center of gravity changes.

Answer 34

problems- fetal distress, asphyxia, higher morbidity & mortality rates, low Apgar scores, meconium aspiration, polycythemia, hypoglycemia (b/c of inadequate storage of glycogen by liver), inadequate thermoregulation

Answer 35

Comprehensive Health History Reasons for seeking care History-OB, Menstrual, Contraceptive, Med/Surg Physical Exam- Head to Toe Pelvic Exam-external, internal, shape and measurements Lab Tests

Answer 36

**Initial** Blood type and RH, Antibody screen, CBC-H&H, VDRL or RPR, HIV, Hep B Surf antigen, Tb, Rubella **15-16 weeks** MSAFP or triple or quad screen, Ultrasound **24-28 weeks** Glucose challenge test or glucose tolerance, CBC, Rhogam if indicated **36 weeks** GBS

Answer 37

**Maternal assessment ** Vital signs, weight, urine-glucose, protein, ketones Common discomforts, nutrition Warning signs Appropriate lab tests, u/s etc **Fetal assessment** Fetal heart tones Fetal movement Fundal height measurement Leopold’s

Answer 38

**1ST STAGE**: Onset of Labor → 10cm Latent- 0-3 cm, Active 4-7 cm, Transition 8-10cm **2nd STAGE:** 10cm→Birth 3rd Stage: Birth of Baby →Delivery of Placenta 4th Stage: Delivery of Placenta →1-4hours post-partum

Answer 39

CONTRACTIONS: REGULAR, STRONGER, LONGER, MORE INTENSE, Back to Front CERVIX: PROGRESSIVE CERVICAL DILATATION, MORE ANTERIOR LABOR: MAY BEGIN WITH ROM

Answer 40

Contractions: Inconsistent in frequency, duration & intensity, Don’t change or may decrease w/activity (such as walking) Pain: Felt in abd. & groin May be more annoying than painful Cervix Doesn’t significantly change in effacement or dilation

Answer 41

with contractions- increase BP and P WBC: 14,000-25,000 cells/mm³ Resp rate nd 02 consumption increase increase metabolism increase temp may have N&V, muscle cramps and aches

Answer 42

Baseline variability: we like to see some variability, its reassuring ex. Goes from 115, 120, 122, 130 etc. **Absent**-no variability Minimal-less than, equal to 5bpm \*\*\*\*Moderate-6-25 bpm(we love this!!) Marked-over 25 bpm Long term: Fluctuations of 6-10bpm Short term: One beat to the next. Must have internal monitor. No variability: Fetal sleep pattern or distress

Answer 43

Check labor progress to see if shes completely dilated Continue to monitor mom and baby: FHT's, Vital Signs, Contractions Support for mom and dad Turn radiant warmer on, have O2, ambu bag, (if resp depression) Put bed in delivery position if needed Perineal prep if requested (vag delivery is clean technique) Assist nurse-midwife or MD as needed Call NICU if required – if thick meconium, or a pre-me, or resp. depression,

Answer 44

Crowning Nurse Midwife or Physician will:push baby a lil to Control speed of delivery of head. (face down LOA, ROA) Watch perineum Episiotomy: only if needed Check for nuchal cord Clear mucous from baby's **mouth** then nose Deliver shoulders: light traction down and then up Clamp cord. Usually significant other cuts cord, ONCE THE BABY IS OUT

Answer 45

Bonding taking place: Place warmed blanket over mom's abdomen so baby may be given to mom Assess baby Apgar score at 1 and 5 minutes, color, breathing, even if moms holding baby Weight, length, head circumference of baby in the warmer Footprints Identification bands, HUGS security band , 2 on baby 1 on mom 1 on dad ## Footnote

Answer 46

Nurse-midwife or MD will usually hold slight traction on cord, Too much traction could result in tearing of the cord. Inspect placenta Check for lacerations after delivery Nursing Interventions: Administer Oxytocin after delivery of placenta if ordered Fundus, watch for excessive bleeding, Massage it Vital Signs Assist with laceration/episiotomy repair DIRTY DUNCAN= MATERNAL, Shiny Shultz- fetal (baby)

Answer 47

VS q 15 minutes x 1 hour Fundus: location in relation to umbilicus. One hour after delivery right at umbilicus (back up from the 3 cm down @ delivery) One sonometer down q day!! (3 days post partum= 3; 2 days =2) Bladder - have them void Lochia: Rubra (Red) first bleeding they have Perineum- put ice on everyones perineum that gives birth first 24 hr Pain management-ibuprofen! or Motrin Bonding

Answer 48

Classic signs Missed period\*\*\*\* Vaginal bleeding\*\*\*\* Abdominal pain\*\*\*\* Shock s/s are possible Exam + pregnancy test Adnexal fullness or tenderness or both on ovaries + Champaign sign (cervical motion tenderness)

Answer 49

Labs: B Hcg and Serum Progesterone Transvaginal u/s Surgical removal (Ruptured Ectopic, Tube ruptured) Taking tube out is salpingectomy methotrexate - for a intact ectopic the tube has not yet ruptured, this is a chemp drug it’s a folic acid that makes cells stop growing

Answer 50

Have blood products available Pre-op labs generally include CBC, Type & Rh, Serum quantitative B Hcg Post-op Care: Verify Rh and antibody status Rhogam if indicated Grief counseling Fertility counseling

Answer 51

BP 140/90 proteinuria- +1 or +2 edema- dependent, eyes, face, fingers reflexes- normal +2 urine output- 30ml/hr

Answer 52

bp 160/110 proteinruria - +3 or +4 edema- generalized with pulmonary hyperreflexia - +3 or +4 -clonus urine - \>20ml/hr headache blurred vision irritability

Answer 53

Monitor: Wt & VS’s, Urine dipstick for ketones, Labs as ordered liver function, electrolytes Environment: quiet, dark, no odors Medications: Phenergan, Benedryl, Zantac, Pepcid, Prilosec, Reglan, Zofran, Methyprednisolone Diet progresses slowly Must have no N/V for 48Hrs IV fluids and may need TPN Psychosocial Assessment Emotional support

Answer 54

miscarriage & PTL & PTD (preterm) IUGR risk of congenital heart lesions in NB maternal mortality rate (in some cases 50% or \>)

Answer 55

Check BS q 2hr Insulin requirements substantially decrease after delivery so BS values are tracked closely, lower insulin med given IV of D5W initiated Risks of preeclampsia/eclampsia, PPH (b/c a big baby their uterus cant contract as much), and infection exist Breastfeeding is advised and encouraged it decreases insulin needs significantly

Answer 56

``` Anomalies = gross ascities, lg tumor, open neural tube deficits Excessive Size (diabetics)= cephlo-pelvic disproportion (CPD), usually \>4000 gms Associated with maternal DM, obesity, multiparity, lg wt gain, lg parents Malposition = 25% have persistent occiput posterior (back labor) \*\*\*Reposition her on all fours\*\*\* Malpresentation = breech is most common Frank = thigh flexed, knees extended Complete = thigh and knees flexed Incomplete breech =foot extends below buttocks and knee extends below buttocks Multifetal pregnancy = overdistention of uterus leading to dysfunctional patterns ```

Answer 57

Carefully assess during/after ROM Immediate identification since fetal hypoxia can result & even death can occur w/o tx SVE to lift presenting part Maternal position changes\*\*\*\* Emotional support and information O2 & IV fluids Prepare for emergency delivery

Answer 58

Definition: Normal progress is made initially then changes in the active phase of labor ctx’s become weak & inefficient or stop altogether Common causes-CPD cephalopelvic disproportions & malpresentations Tx- assess fetal size and status if normal-ambulation, hydrotherapy, an enema, stripping membranes, nipple stim, and oxytocin or ptocin-can be used if abnormal -c/section \*\*Hypotonic uterine dysfunction is more common than hypertonic.

Answer 59

Means to predict inducibility of the cx Score includes-Cx dilation, effacement, fetal station, cx consistency, & cx position Each category is scored 0-3 A score \> or = to 8- means a successful induction is likely

Answer 60

Oxytocin - produced in posterior pituitary gland It stimulates uterine ctxs It is given IVPB as a 2nd line on a pump to induce or augment labor Indications- IUGR, PROM, dysfunctional ctxs, postterm pregnancy, chorioamnionitis, maternal medical conditions (DM, pulmonary Dx), PIH, Fetal demise, Hx precipitous delivery

Answer 61

After delivery: \>90% of these women return to normal glucose levels 6 weeks PP/ After BF stop 75 gm 2hr glucose challenge test is done to assure a return to normal ## Footnote \*\*\*The infants of these women are at greater risk of obesity & DM in childhood or adolescence\*\*\*

Answer 62

Bacterial infection after childbirth Temp of 100.4 of ↑ after the 1st 24 hrs. & occurring on at least 2 of the 1st 10 days following childbirth

Answer 63

Goal: confine infectious process to uterus & prevent spread of infection throughout body Abx until afebrile & asymptomatic for 24-48 hrs. Prophylactic dose of Abx IV to any woman having a C/S Comfort measures: warm blankets, cool compresses, cold/warm drinks, heating pad Foods high in Vit. C & protein to aid healing

Answer 64

Temp of 100.4 or higher within 36 hrs. of birth, chills, malaise, anorexia Abd. pain & cramping, uterine tenderness, purulent, foul-smelling lochia Tachycardia, subinvolution Elevation in leukocytes

Answer 65

Cultured & broad-spectrum Abx Analgesics Warm compresses or sitz baths may provide comfort & promote healting by increasing circulation to area Surgical debridement for necrotizing fasciitis

Answer 66

Edema, warmth, redness, tenderness, pain Edges of wound may pull apart, seropurulent drainage Fever & malaise

Answer 67

ABX - Pt. instructed to take med for entire time prescribed & not to stop when symptoms subside 2500-3000mL fluid/day

Answer 68

Begin on 1st or 2nd PP day Dysuria frequency, urgency, suprapubic pain Hematuria, low-grade fever Pyelonephritis: chills, spiking fever, costovertebral angle tenderness, flank pain, N&V

Answer 69

Supportive measures: moist heat or ice packs, breast support, bed rest, analgesics Measures to prevent mastitis: position infant correctly & avoid nipple trauma & milk stasis, breastfeed q2-3h & avoid formula supps, nsg pads changed as soon as wet, avoid continuous pressure on breasts f/tight bras or infant carriers Breast should be completely emptied at each feeding to prevent stasis, which can result in abscess Massage over affected area before & during feeding helps ensure complete emptying

Answer 70

May think she has flu b/c of fatigue & aching MM Temp of 102.2 of higher, chills, malaise, HA Characterized by localized lump or wedge-shaped area of pain, redness, heat, inflammation, & enlarged axillary Lymph node Hard, tender area may be palpated

Answer 71

Readmission to hospital Anticoagulation therapy w/IV heparin & IV abx Warfarin may be given when heparin is d/c

Answer 72

Occurs when infection spreads along venous system & thrombophlebitis develops Clinical S/S Ovarian vein syndrome: pain in groin, abd., or flank Fever, tachycardia, N, V, bloating, decreased or absent bowel sounds

Answer 73

Tobacco-↓O2, LBW vasoconstriction Alcohol-IUGR, CNS, Facial Features marijuana-Tremors, ↑Moro Reflex Cocaine-Abruptio, low birth weight Amphetamines-Vasoconstriction Anti-depressants-unknown long-term

Answer 74

Ascribing lifelike attributes to inanimate objects. Fear a toilet because in a cartoon it ate a child.

Answer 75

Characteristic injuries: intracranial bleeding, retinal hemorrhages, fx of ribs/long bones Severe forms: seizures, posturing, alterations in LOC, apnea, bradycardia, death Long-term outcomes: seizure, blindness, developmental delays, hearing loss, cerebral palsy, mild to profound mental, cognitive, motor impairments

Answer 76

Conflicting stories about “accident” or injury Cause of injury blamed on sibling/other party Injury inconsistent w/hx (concussion & broken arm f/falling off bed) Inappropriate response of caregiver (exaggerated/absent emotional response, refusal to sign for added tests or agree to necessary treatment, excessive delay in seeking treatment, absence of parents for questioning) Inappropriate response of child (little/no response to pain, fear of being touched, excessive/lack of separation anxiety, indiscriminate friendliness to strangers)

Answer 77

pneumococcal conjugate vaccine (PCV); reduce RF (breastfeed for 1st 6 mos., avoid propping bottle, ↓ or D/C pacifier, prevent exposure to tobacco smoke)

FINAL 250 Flashcards

(102 cards)