Final Flashcards
(75 cards)
1
Q
Birth - 2 hr assessment
A
Stabilization Relieving airway obstruction -Bulb syringe -Neosucker -Respirations: 30-60 bpm, avg is 40 Maintaining O2 supply Maintaining body temp Baseline of physical growth – weight, head circumference, length, chest, abdomen LGA, AGA, SGA Classification Variations: -LBW, VLBW, IUGR, preterm, full term, late term, postterm
2
Q
When is the APGAR test performed
A
Done at 1 and 5 minutes – and again at 10 if needed
- 1 min score determines how well newborn tolerated birthing process
- 5 min scare determines how well newborn is doing outside mother’s womb
3
Q
What are the 5 parts of the APGAR score
A
Activity Pulse Grimace Appearance (color) Respirations
4
Q
What do the combined scores mean
A
0-3 is severely depressed
4-6 is moderately depressed
7-10 is excellent condition
5
Q
Rooting Reflex
A
stroke infant’s cheek – head turns in direction of touch
6
Q
Gripping Reflex
A
place something in infant’s hand – infant grasps
7
Q
Toe Curling Reflex
A
stroke sole of foot – infant curls toes if inner stroke / infant spreads toes if outer stroke
8
Q
Moro Reflex
A
sudden noise of movement – infant throws head and arms back and cries
9
Q
Galant Reflex
A
stroke infant’s lower back – infant curves toward side that is stroked
10
Q
Mechanisms of heat loss - thermoregulation
A
Convection
Conduction
Radiation
Evaporation
11
Q
Cold Stress
A
O2 consumption increases and vasoconstriction occurs
- This decreases oxygen uptake by lungs and oxygen delivery to tissues
- Anaerobic glycolysis increases
- There’s a decrease in PO2 and pH which leads to metabolic acidosis
12
Q
Glucose Maintenance
A
BG levels should stabilize at 50-60 mg/dL within first few hours
- At 40: initiate feeding and recheck at one hr
- Below 40: consider feeding or initiate 10% dextrose bolus
13
Q
Signs of hypoglycemia
A
Irritability, jitteriness, lethargy, apnea, feeding problems, mottled skin, temp instability
14
Q
Nursery Admission
A
Eye prophylaxis, Vit K, umbilical cord care, BG screening, temp reg
15
Q
Physiologic Jaundice
A
- Occurs in about half of the healthy term newborns
- 80% preterm infants
- Typically arises more than 24 hr after birth
- Manifested by progressive increase in unconjugated bilirubin level in cord blood
16
Q
Pathologic Jaundice
A
Level of serum bilirubin that, when untreated, can result in kernicterus
17
Q
Respiratory Adaptations
initiation of breathing
A
- Chemical factors: chemoreceptors stimulate medulla to trigger respirations
- Mechanical factors: compression of fetal chest during vaginal delivery
- Thermal factors: skin sensory receptors
- Sensory factors: tactile stimulation
18
Q
Respiratory Distress
A
Nasal flaring
Intercostal/subcostal retractions
Grunting
19
Q
CV Adaptations
A
Includes closure of three shunts -Ductus venosus -Foramen ovale -Ductus arteriosus Physiological changes associated with lung inflation and neonatal respiration Hematopoietic system changes -Term hemoglobin 14-24 g/dl -Term hematocrit 44-64%
20
Q
CV Distress
A
Tachycardia
Bradycardia
Color
21
Q
Renal Adaptations
A
- Fluid and electrolyte balance
- Signs of risk for renal system problems
- An infant should void within first 24 hours – 98% void within 30
22
Q
Renal Impairment
A
Consider if infant hasn’t voided within 48 hours
23
Q
GI Transition
A
Adequate suck-swallow coordination Energy requirements -Breastfeeding/ formula feeding Digest and metabolize food -Meconium
24
Q
Physical Injury
A
- Soft tissue
- Trauma secondary to dystocia
- Accidental lacerations
25
Parent teaching
| Sleep wake states
```
Quiet sleep
Active sleep
Drowsy
Alert inactivity
Fussy
Crying
```
26
Parent teaching other factors
Gestational age
Time
Stimuli
Meds
27
Nursing assessment
| Skeletal
```
Molding
Caput succedaneum
Cephalhematoma
Hip dysplasia
Fractured clavicle
```
28
Nursing
| Lab and Diagnostic Tests
Genetic screening
Hearing screening
Collection of specimens (heelstick, venipuncture, obtaining urine specimen, restraining infant)
29
Nursing
| Therapeutic and Surgical Procedures
IM injection
Phototherapy for hyperbilirubinemia
Circ (gomco clamp, mogen clamp, plastibell)
30
Human Trafficking Statistics
3rd largest criminal enterprise in the world; 2nd most profitable in U.S.
20-30 million victims trapped in modern day slavery
-68% labor, 22% sexual, 10% state imposed labor
-50% HT victims are children, 80% are women and girls
-70% female victims are trafficked into commercial sex trade
31
HT Risk Factors
addicted to drugs or alcohol, have criminal records, have mental health issues, love their traffickers, are open to recruitment again
32
HT Nursing Red Flags
- Seem anxious or fearful; avoids eye contact
- Unexplained bruises/cuts
- Potential relationship with someone who is dominating
- Never alone
- Not in control of finances
- Inconsistent details in story
- No ID
- Inability to leave job/residence – can’t schedule appointments
- Afraid of law enforcement
- Doesn’t speak english
33
Osteoporosis Def.
- Skeletal disorder characterized by decreased bone strength predisposing to an increased risk of fracture
- More bone mass is absorbed than new body mass is laid down
- Bone strength: bone density and bone quality
34
Bone Remodeling
```
Bone is removed from skeleton
-Clears worn out pieces
to promote new dev.
-New tissue is formed
-Responds to mechanical loading
-Releases calcium and other ions
Osteoblasts: bone formation
Osteoclasts: bone resorption
```
35
Osteoporosis NonMod Risk Factors
- Being over 50
- Female
- Race/ethnicity
- Menopause
- Fam history
- Low body weight
- Poor health – fragile
36
Osteoporosis Mod Risk Factors
- Not getting enough calcium or vit D
- Diet and inactive lifestyle
- Smoking and excessive alcohol
- Meds
37
Osteoporosis Dx
common sites
tests
- Wrist, Compressed vertebrae in spine, Hip
- Dual-energy X-ray Absorptiometry Scan (DXA)
- Measures bone density in hip, spine, and forearm
- T-score is determined by comparing the woman’s bone density to that of the average peak density of the same sex and race
- 2.5 or below: osteoporosis
- 1 – 2.5: osteopenia – bone density between normal and osteoporosis
38
Osteoporosis Risk Reduction
Diet high in calcium and vit D
-Older than 50: 1200 mg calcium and 800-1000 IU Vit D
-Dairy, green leafy veggies, salmon, sardines, yogurt, oj
Weight bearing exercise
39
Osteoporosis Meds
- -Calcium supplements
- -Bisphosphates
- Inhibits resorption of bone (Fosamax, Boniva, Actonel, Reclast)
- AE: GI irritation and esophageal ulceration
- Must stay upright for at least 30 min after taking med; NPO 30-60 min
- -Estrogen receptor modulators
- Binds with estrogen receptors, producing estrogen like effects on bone and reduces resorption (Raloxifine and Evista)
- AE: hot flashes, increased risk of venous thromboembolism
- -Denosumab (Prolia and Xgeva)
- Treats human monoclonal antibody
- Prevents dev of osteoclasts
- SubQ injection q 6 mo
- Should also receive 1000 mg calcium and at least 400 IU Vit D
- AE: increased risk of infection, hypocalcemia, osteonecrosis of jaw, atypical femur
40
Menopause Def
| avg age
- Complete cessation of menses for one year – 6000 US women reach daily
- Avg Age: 51 (45-55)
41
Perimenopause
- Begins with 1st changes in menstrual cycle – ends with cessation of menses
- Changes can include shorter or longer cycles, less frequent cycles, lighter or heavier cycles
42
Induced/Surgical Menopause
- After surgical intervention
| - Side effects of chemo or radiation therapy
43
Post-Menopause
-Time in a woman's life after menopause
44
Physiological Changes
Peri
Post
```
Peri:
-Irregular cycles
-Mood changes
-Occasional vasomotor symptoms
-Vaginal dryness
Post:
-Atrophy of genitourinary tissue
-Cessation of menses
-Vasomotor instability (hot flashes)
-Mood disorders
```
45
Associated Health Risks w Menopause
| Estrogen def - CV
Accelerated increase in LDL and total cholesterol during the year immediately after the final menstrual period
46
Associated Health Risks w Menopause
| Estrogen def - GU
Genital changes
- Atrophy
- Vaginal pH increases -> lactobacilli growth reduced -> vaginitis
- Dyspareunia
- Urinary frequency
47
Associated Health Risks w Menopause
| Estrogen def - Vasomotor Instability
- Hot flashes
- Night sweats
- Changes in norepi and serotonin affects the thermoregulatory zone
48
Associated Health Risks w Menopause
| Estrogen def - MS
- Osteoporosis
| - Redistribution of fat
49
Associated Health Risks w Menopause
| Estrogen def - Psych
Mood and behavior responses
- Insomnia: common
- Stress and insomnia closely linked
- Fatigue
- Depression, anxiety, emotional labile, nervousness
- Difficulty concentrating
50
Hormonal Therapy
| Risks and SE
- Increased risk for breast and endometrial cancer; blood clots
- Associated with estrogen use: headaches, nausea, vomiting, and bloating
- Can be reduced by switching type or routine
51
Hormonal Therapy
| Treatment and routes
```
Treatment guidelines: oral, topical creams, transdermal prep, vaginal rings
Routes:
-Oral (systemic)
-Vaginal
-Transdermal – avoids first pass
--Lower doses
--More stable dosing (continuous)
--Decreased thrombotic events (estrogen)
--Progestins – synthetic – progesterone like activity
```
52
Hormonal Therapy
| Low Dose Vag Estrogen
- Restores bacterial flora and pH
- Improves thickness and elasticity of tissue
- No need for progesterone with local estrogen
53
Hormonal Therapy
| Bioidentical Hormones
Synthesized in a lab and are chemically identical to the hormones produced in our body
-17B-estradiol
-Estriol
-Estrone
-Progesterone
Regular sexual activity preserves vaginal function by increasing blood flow to genital region and helping maintain size of vagina
-Without sex and estrogen, the vagina can become smaller
54
Nonhormonal Therapy
Antidepressants – primary treatment for menopause-associated depression
Other drugs for vasomotor symptoms
-Clonidine: antiHTN drug
-Gabapentin: antiseizure drug
Selective estrogen receptor modulators (SERMS)
55
Menopause Sx Relief
| Non-Pharm Methods
- Relaxation and stress reduction techniques
- Exercise and eating healthy (most effective)
- -Caloric content, Adequate intake of calcium and vit D, Reduction of symptoms
- Weight management
- Moderate alcohol use
- Yoga (for hot flashes)
- Stop smoking
- Acupuncture: stimulates specific anatomic points
- -Shows reduction in hot flashes
- -Needles: 40 gauge to 30 gauge
- -Injection size: 22 - 25 gauge
- Phytoestrogens: plant based foods that may have effect on estrogen receptors
- -Isoflavones: most studied – have estrogen agonist/antagonist properties (soy and red clover)
- -Studies show relief in symptoms (hot flashes) but no benefit on bone loss
- Herbs
- -Black cohosh – inconsistent findings, should not be used with liver disorder
- -Ginkgo biloba – benefit inconsistent and unreliable
56
Menopause Nursing
Risk of infection
- Change to alkaline secretions in vagina
- -Decreased estrogen level thinning of vaginal mucosa
- -Atrophy of vaginal mucosa
- Sexual dysfunction
- Disturbed sleep pattern
57
Cancer Screening Recommendations
```
Mammogram:
-40-44 offer
-45-54 annual
-Greater than 55 every 2 years
Clinical breast exam:
-Clinical breast exams are not recommended for breast cancer screening among average risk women of any age
Breast self awareness:
-Be familiar with breasts
Enhanced screening:
-Mammogram yearly and MRI
```
58
Fibrocystic Changes
| Etiology and Clinical Manifestations
Most common benign breast change
Etiology:
-More common in 20s and 30s
-Normal hormone variation during monthly cycle contributes to this
-Estrogen and progesterone causes cells to proliferate
Clinical Manifestations:
-Breast lumpiness, with or without tenderness
-Sx usually develop week before menstruation begins and subsides week after
59
Fibrocystic Changes
| Dx and Managment
```
Dx:
-Palpate excessive nodularity
-Change can form in cysts -> US -> fine needle biopsy
Management:
-Conservative
-Dietary, vitamin supplements
-Reducing smoking and alcohol
-NSAIDs
-Vit E and B6
```
60
Fibroadenoma
| Etiology and Clinical Manifestations
Common benign solid mass of the breast
Etiology:
-Made of glandular and fibrous breast tissue
-Exact cause is unknown
-Influenced by estrogen
Clinical manifestations:
-Discrete, solitary lumps less than 3 cm, firm, round, smooth
-Woman may experience tenderness during menstrual cycle
61
Fibroadenoma
| Dx and Treatment
```
Dx:
-Review client history
-Physical exam
-Diagnostic tests
--Mammogram
--US
--Biopsy (fine needle aspiration, core)
--MRI
Treatment:
-Cryoablation
-Surgical excision
--Lump suspicious
--Sx. Severe
-Don’t respond to dietary changes or hormonal therapy
```
62
Malignant Breast Cancer
| Patho
1 in 8 women will be diagnosed
Pathophysiology:
-Presents within breast
-Genetic alterations (inherited or spontaneous
-Rate of growth
--Effects of progesterone and estrogen
--Other factors: human epidermal growth factor receptor 2 (HER2) / neuro
63
Malignant Breast Cancer
| 2 main types
Ductal carcinoma: originates in the lactiferous ducts and invades surrounding breast structure
-Usually unilateral, not well delineated, solid, nonmobile, and nontender
Lobular carcinoma: originates in the lobules of the breast
-Nonpalpable, appear smaller in imaging studies than its actual size
64
Malignant Breast Cancer
| Invasive vs Noninvasive
- Invasive is infiltrating
- Noninvasive is ‘in situ’ – nonspreading
- Most common type is invasive ductal carcinoma
65
Malignant Breast Cancer
| Risk Factors
- Nonmodifiable: gender, age, fam hx, genes, menstrual cycle
- Modifiable: alcohol, poor diet, lack of exercise, childbirth timing, DES, hormone replacement therapy , radiation, toxins
66
Malignant Breast Cancer
| Clinical Manifestations
- Breast lump
- Change in size, shape, or feel of breast
- Fluid coming from nipple
- Bone or breast pain
- Skin ulcers
- Swelling of arm
- Weight loss
67
Malignant Breast Cancer
| Dx and Surgery
Dx and Monitor:
-Physical exam, mammogram, MRI, US, breast biopsy, CT, PET, lymph node biopsy
Surgery: goal
-Remove as much of the cancer as possible (breast conserving or mastectomy)
-Breast conserving: lumpectomy, quadranectomy, partial mastectomy, or segmental mastectomy
-See if cancer spread to lymph nodes under arm (sentinel lymph node biopsy or axillary lymph node dissection)
-Restore breast’s shape after cancer is removed (breast reconstruction)
--May be immediate or delayed
-Relieve sx of advanced cancer
68
Malignant Breast Cancer
| Management and Prognosis
Management:
-Chemo, radiation, hormonal therapy, targeted-biologic therapy
Prognosis:
-Location, size and shape, metastasis, hormone receptor, tumor markers, gene expression
69
Malignant Breast Cancer
| Nursing Assessment
- Hard lump, dimpling of ski, retraction of nipple, alteration in contour of breast, change in skin color, change in texture, discharge, pain and ulceration
- Post-Op: monitor bleeding, position arm on operative side – on pillow, slightly elevated, avoid BP measurements in affected arm, teach post mastectomy exercise, discuss potential complications, emotional support
70
Malignant Breast Cancer
| Pot Nursing Dx
Disturbed body image
Anticipatory grieving
Acute/chronic pain, self-care deficit
71
Ovarian Cancer
| Sx
- Bloating, pelvic/abdominal pain, difficulty eating or feeling full quickly, urinary frequency or urgency
- Post menopausal women: abnormal uterine bleeding, dx of endometrial hyperplasia, breast tenderness, vaginal secretions, virializing sx due to increased testosterone
72
Ovarian Cancer
| Detection
Early: no universal screenings – PAP smear doesn’t cover
High risk: fam hx, genetic predisposition (BRCA mutation)
-Potential tests:
--Blood tests (CA-125, OVA-1, Inhibin B and A)
--Transvaginal US
--Pelvic exam
--CT scan
--Biopsy
--Surgery
73
Ovarian Cancer
| Treatment
- Surgery
- Chemo – systemic or intraperitoneal
- Radiation or Radiotherapeutic procedures
- Complimentary therapies
74
Cervical Cancer
| Vaccine
Linked to HPV, 95% are squamous cells
Gardasil-9 helps protect against
-Contains types 6, 11, 16, 18, 31, 33, 45, 52, 58
-Completing all doses provides best protection
-Vaccine works for at least 10 years
-AE: pain, swelling, dizziness, fainting, nausea, headache
75
Cervical Cancer
| Assessment
- All women should be screened at 21
- Between 21 and 29 should have Pap smear every 3 years – not tested for HPV unless abnormal Pap
- Between 30 and 65 should have Pap and HPV every 5 years
- Women over 65 shouldn’t be screened unless dx’d with cervical pre-cancer
