L &D Flashcards
(83 cards)
1
Q
__________ STIMULATION -RELEASED BY PITUITARY AT TERM
A
OXYTOCIN STIMULATION -RELEASED BY PITUITARY AT TERM
2
Q
__________ DECREASED and _____________ INCREASE- INCREASES
ABILITY OF UTERUS TO CONTRACT (______________ MAINTAINS
PREGNANCY, SO LOWER LEVELS STIMULATE LABOR.)
A
PROGESTERONE and ESTROGEN
ROGESTERONE
3
Q
PROSTAGLANDIN RELEASE - PRODUCED BY ____________, ____________
, AND __________STIMULATES LABOR
A
PROSTAGLANDIN RELEASE - PRODUCED BY DECIDUAS, UMBILICAL
CORD, AND AMNION STIMULATES LABOR
4
Q
- AGING PLACENTA-LIMITS ITSELF -MADE TO FUNCTION OPTIMALLY
FOR _______
A
- AGING PLACENTA-LIMITS ITSELF -MADE TO FUNCTION OPTIMALLY
FOR 41 WEEKS
5
Q
MATERNAL FACTORS for triggering labor
A
- UTERINE MUSCLES STRETCHED TO
THRESHOLD POINT =>RELEASE OF
PROSTAGLANDINS AND OXYTOCIN THAT
STIMULATE CONTRACTIONS - INCREASED PRESSURE ON THE CERVIX
STIMULATES NERVE PLEXUS => RELEASE OF
OXYTOCIN BY THE MATERNAL PITUITARY
GLAND - INCREASE IN ESTROGEN WHICH ENHANCES
MYOMETRIUM TO PRODUCE CONTRACTIONS - PROGESTERONE (“PRO-PREGNANCY
HORMONE”) IS FUNCTIONALLY WITHDRAWN
ALLOWS ESTROGEN TO CONTRACT THE
UTERUS - OXYTOCIN & PROSTAGLANDINS SOFTEN
CERVIX AND STIMULATE MYOMETRIAL
CONTRACTIONS
6
Q
FETAL FACTORS triggering labor
A
- PROSTAGLANDIN SYNTHESIS BY THE
FETAL MEMBRANES AND THE
DECIDUA STIMULATE
CONTRACTIONS - FETAL CORTISOL INCREASES- ACTS
ON PLACENTA, INCREASE
PROSTAGLANDINS, REDUCES
PROGESTERONE ALL STIMULATE
UTERUS TO CONTACT.
7
Q
COMPONENTS OF LABOR
5 “P”S
A
- PASSENGER- FETUS
- PASSAGEWAY MOTHER’S PHYSICAL CAPACITY TO DELIVER
INFANT - POWERS-2 TYPES INVOLUNTARY AND VOLUNTARY
- POSITION OF MOTHER-MAKES A DIFFERENCE PHYSIOLOGICALLY
IN THE FETUS’S ABILITY TO DESCEND IN THE PELVIS - PSYCHOLOGICAL- A WOMAN’S PSYCHE CAN INFLUENCE THE
PROGRESS OF LABOR
8
Q
POWERS OF LABOR-
A
voluntary = secondary powers “ bearing down” “ ferguson reflex”
and involuntary = dilation and effacement
9
Q
_________OF UTERUS RESPONSIBLE FOR DILATION
(OPENING) AND EFFACEMENT (THINNING) OF THE CERVIX
A
Lower 3rd
10
Q
INTENSITy ( description)
- MILD –
- MODERATE –
- STRONG
A
Mild: UTERINE WALL IS EASILY INDENTED DURING CONTRACTION (NOSE)
- MODERATE – RESISTANCE TO INDENTATION DURING CONTRACTION (CHIN)
- STRONG – UTERINE WALL CANNOT BE INDENTED DURING A CONTRACTION
(FOREHEAD
11
Q
DILATION AND EFFACEMENT – OCCUR IN________
DILATION –
EFFACEMENT –
A
OCCUR IN THE FIRST STAGE OF LABOR –
UC’S PUSH THE PRESENTING PART OF FETUS TOWARDS CERVIX – OPENS
AND THINS
ENLARGEMENT OR OPENING OF CERVIX (FROM CLOSED TO
10CM)- 10CM CERVIX CAN NO LONGER BE PALPATED
THE SHORTENING AND THINNING OF CERVIX (0% - 100%)
12
Q
Typically, first time moms will______ and then __________
multipara ______
A
Typically, first time moms will efface and then dilate
do it at the same time
13
Q
Contractions:
FREQUENCY
- DURATION
- RELAXATION
A
FREQUENCY
* FROM BEGINNING OF ONE CONTRACTION TO THE BEGINNING OF
ANOTHER
- DURATION
- BEGINNING OF CONTRACTION TO THE END OF
SAME CONTRACTION - RELAXATION
- PERIOD BETWEEN CONTRACTIONS
- ALLOWS BLOOD FLOW TO THE UTERUS AND
PLACENTA THAT WAS REDUCED DURING
CONTRACTION
14
Q
(2ND POWERS: VOLUNTARY EFFORTS)
A
- OCCUR ONCE THE CERVIX IS FULLY DILATED
- WOMEN FEELS URGE TO PUSH
(2ND POWERS: VOLUNTARY EFFORTS)
BEARING DOWN POWERS
15
Q
PELVIS
A
- GYNECOID (NL FEMALE)
- ANTRHROPOID (APE LIKE)
- ANDROID (NL MALE)
- PLATYPELLOID (FLAT)
16
Q
ISCHIAL SPINES & STATION
A
*REFERS TO THE DESCENT OF THE PRESENTING
PART OF THE FETUS (HEAD, BOTTOM, ETC.) IN
RELATION TO THE ISCHIAL SPINE
17
Q
-5 CENTIMETERS IS ________ THE ISCHIAL
SPINES
A
above
18
Q
- TYPES:
- COMPLETE FLEXION-VERTEX
- MODERATE FLEXION-SINCIPUT
- PARTIAL EXTENSION-BROW
A
19
Q
- FETAL POSITION
- ROA- RIGHT OCCIPUT ANTERIOR
- ROP- RIGHT OCCIPUT POSTERIOR
- LOA- LEFT OCCIPUT ANTERIOR
- LOP-LEFT OCCIPUT POSTERIOR
- LSA-LEFT SACRUM ANTERIOR
A
20
Q
LIGHTNING
* URINARY CHANGES
* BACK PAIN
* INCREASED PRESSURE ON HIPS
* HORMONE RELAXIN
* VAGINAL CHANGES
* BLOODY SHOW
* WEIGHT LOSS-PROGESTERONE & ESTROGEN CHANGES CAUSE ELECTROLYTE SHIFT & WATER
LOSS (0.5-5KG)
* ENERGY SURGE-MATERNAL NESTING INSTINCT FROM INCREASED EPINEPHRINE & DECREASED
PROGESTERONE
* RUPTURE OF MEMBRANES MAY OCCUR
* BRAXTON-HICKS CONTRACTIONS BECOME STRONGER & MORE FREQUENT
A
21
Q
USE OF NITRAZINE PAPER:
A
YELLOW OR GREEN INDICATES MEMBRANES INTACT; BLUE
INDICATES RUPTURE
22
Q
AMNIOTIC FLUID FERN TEST
A
23
Q
STRAW COLORED W/NATURAL ODOR:
- GREENISH- BROWN-
- YELLOW- FETAL HEMOLYTIC DISEASE-
- PORT-WINE COLOR-
A
STRAW COLORED W/NATURAL ODOR: NORMAL
* GREENISH- BROWN- MECONIUM- POSSIBLE ANOXIA OR HYPOXIA ASSESS BABY FOR
DEVELOPMENTAL DELAYS HRF CHEMICAL PNEUMONIA
* YELLOW- FETAL HEMOLYTIC DISEASE- CHECK COOMB’S ASSESS BABY FOR JAUNDICE
* PORT-WINE COLOR- BLEEDING (ABRUPTION PLACENTAE) EMERGENCY C-SECTION/EMERGENCY BIRTH
24
Q
Amniotic fluid
NORMAL
*OLIGOHYDRAMNIOS
*HYDRAMNIOS (POLYHYDRAMNIOS)
A
NORMAL 400-1000 ML (DEPENDS ON
GESTATION)
*OLIGOHYDRAMNIOS- <500 ML 32-36 WKS.-
FAILURE OF KIDNEY DEVELOPMENT
*HYDRAMNIOS (POLYHYDRAMNIOS) 2000 ML 32-
36 GESTATION- FETAL GI OBSTRUCTION/ATRESIA
25
NORMAL FHR
* TACHYCARDIA HR >
* BRADYCARDIA HR <
NORMAL FHR 110-160
* TACHYCARDIA HR > 160 FOR 10 MINUTES OR LONGER
* BRADYCARDIA HR < 110 FOR 10 MINUTES OR LONGER
26
ABSENCE OF VARIABILITY: ( think about no activity possiblities) doesn't always have to be bad
FETUS SLEEPING, SEDATION (OPIATE,
MAGNESIUM SULFATE) CORD COMPRESSION, FETAL HYPOXIA
27
LOCATING FHR:
LEOPOLD’S MANEUVERS
start at the top to locate what part of the fetus is located in the fundus
The second= location of the fetal back
third : presenting part
fourth= baby cephalic prominence
28
* FACTORS THAT HELP MAINTAIN FETAL O2 & + RESPONSE TO UTERINE CONTRACTIONS:
* PLACENTAL PROFUSION
* HIGH CONCENTRATION OF FETAL RBC’S
* INCREASED ABILITY OF FETAL HGB TO
CARRY O2
* HIGH FETAL CARDIAC OUTPUTSTRESSFUL TIME FOR FETUS
29
* EXTERNAL 2 TRANSDUCERS-
ULTRASOUND
FOR FHR & TOCOTRANSDUCER UTERINE
ACTIVITY
30
* INTERMITTENT OR CONTINUOUS
* AUSCULTATION W/FETOSCOPE OR DOPPLER
INTERMITTENT, DETERMINES FHR ONLY
* ELECTRONIC FETAL MONITOR-DETECTS
FETAL HYPOXIA &/OR ACIDOSIS DURING
LABOR-INTERPRETING FHR PATTERNS
MONITORS FHR & UTERINE ACTIVITY
* GUIDELINES Q 30 MINS STAGE 1& Q 15
MINS STAGE 2
31
INTERNAL-
DIRECT METHOD
OF MEASURING FHR &
UTERINE ACTION W/ SPIRAL
ELECTRODE ON FETAL
SCALP & INTRAUTERINE
CATHETER MEASURES
INTENSITY OF
CONTRACTIONS
32
Baseline ___________
bpm. This is the
vertical center of the
strip.
Horizontal numbers-
increments of _____________
Small boxes=________
Baseline 110-160
bpm. This is the
vertical center of the
strip.
Horizontal numbers-
increments of 30 BPM
Small boxes=10 secs
33
Normal FHR
______BPM above
baseline
Moderate FHR
over ________ bpm
above baseline
Loss-
Normal FHR 6-
25 BPM above
baseline
Moderate FHR
over 25 bpm
above baseline
Loss-flat line-do
not see any
variability in
FHR from
baseline
34
Reassuring Fetal Heart Rate (FHR) -
110-160
bpm, increased heart rate from baseline with
no decreases (Normal), also Indeterminate
FHR- cont. to monitor
35
Non-reassuring FHR-
(abnormal evaluate &
Treat)- examples-tachycardia, Bradycardia,
Several decreases from baseline, irregular
rhythm, decreases in FHR within 30 seconds
after contraction
36
Non reassuring:
Tachycardia FHR
Causes:
Nursing-
Bradycardia FHR
Causes:
Nursing
>160 for > or = to 10 mins
Fever, infection, chorioamnionitis, dehydration,
anxiety, anemia, certain drugs
Take VS, call MD treat the underlying cause ( antibiotics, antipyretics)
<110 bpm for > or = 10 mins
supine position, problems with placenta or
anything that causes hypoxia (low O2 in tissues) or
hypoxemia (low O2 in blood) to fetus.
37
marked variability
38
Accelerations-increase in FHR of at
least _______PM above baseline FHR &
lasting at least _____seconds
Causes
Medical/nursing interventions
Accelerations-increase in FHR of at
least 15 BPM above baseline FHR &
lasting at least 15 seconds- 15 by 15
Causes-fetal movement during
vaginal exam, nurse touches babies'
head-baby is startled; transient
umbilical vein compression
Medical/nursing interventions-none
Good
39
Decelerations-three types:
Early-
Cause:
Variable-
Causes:
Nursing interventions:
Early-Decrease in FHR begins and ends with contraction. Bottom of FHR
(Nadir) should match with Acme (peak) of CTX
Heart rate should go back up during resting phase of CTX; Expected
Cause: fetal head compressed during second stage of labor(mom
pushes)
Variable- an abrupt decrease of FHR (<100bmp) during various phases of
CTX< 30 secs.
Causes: cord compression; nuchal, short, prolapsed, knot, caught
between pelvis and fetus
Irregular form “V” Unpredictable but quickly returns to baseline
Nursing interventions:
Turn mom L side, knee to chest
Give 02
give fluids
call MD prepare for amnioinfusion-relieves pressure on cord
40
Late Decelerations-
Causes:
Nursing interventions-
bad!(if uncorrectable & associated
with Tachycardia & Loss of Varitbilty)
“U” shaped-Starts after Peak of CTX and ends after
contraction during rest period of contraction (returns
to baseline after CTX ends)
Causes: uteroplancental insufficiency such as HTN,
preeclampsia, post-due mom (old placenta), excessive
oxytocin, supine hypotension, uterine tachysystole
(frequent uterine contractions-5 in 10 mins, CTX that
last 2 mins)
Nursing interventions-turn mom left side, elevate
legs, 10 L 02 via mask, turn off Pitocin, Increase IV
fluids, assess for uterine tachysystole, possible fetal
electrode and intrauterine-pressure catheters (IUPC),
call MD-emergency
41
uterine tachysystole
42
Asessing Strips
Assess:
What is FHR?
Any
Accelerations?
Any
Decelerations
?
Is there
Variability?
Which
category
(I, II or III)?
43
Strip A
44
TRUE VS. FALSE
* TRUE-
* FALSE-
* TRUE- CTX THAT CHANGES MADE TO THE CERVIX
* FALSE- CTX ARE IRREGULAR LITTLE TO NO CERVICAL
CHANGE
45
STAGE ONE-
BEGINS WITH THE ONSET OF LABOR ENDS W/ COMPLETE CERVICAL DILATION
46
LATENT PHASE: 😁😁😁😁😁
CERVIX BEGINS TO THIN AND OPEN, CTX INCREASE IN
FREQUENCY, INTENSITY, & DURATION
CERVICAL DILATION: 0-5 CM
mother is laughing and chilling.... doing
can eat and drink ( 7-9 hrs for primi)
4-5 for multi
47
ACTIVE PHASE:
MODERATE, REGULAR FREQUENCY EVERY 2-3 MINS/CERVICAL DILATION:6-10 CM (COMPLETELY EFFACED)
ACTIVE
* 4-7 CM DILATION
* 80-100% EFFACED
* -1 TO 0 STATION
* MODERATE TO STRONG CTX; UTERUS FIRM
* 3-5 MINUTES APART 40-70 SECONDS
48
49
TRANSITION PHASE: URGE TO START PUSHING
cervix dilated beyond 7 cm
80-90% top of head may be below ischial spine
CERVICAL DILATION: 10 CM. If sac isnt broken physician may break it
TRANSITION
UTERUS FIRM
* 8-10 CM DILATION
* 100% EFFACED
* +1TO +4 STATION
* CTX 2-3 MINUTES APART 45-90 SECONDS LONG
50
STAGE TWO
BEGINS WAS COMPLETE DILATION OF CERVIX, ENDS W/ DELIVERY OF BABY
51
STAGE THREE
BEGINS AFTER THE DELIVERY OF THE BABY AND ENDS WITH DELIVERY
OF PLACENTIA
52
Closed glottis technique vs open glottis
In childbirth, the closed glottis technique is often referred to as "bearing down" or "valsalva maneuver."
During the pushing stage of labor, the woman holds her breath and bears down, using abdominal muscles to push the baby through the birth canal.
The individual holds their breath and contracts their abdominal muscles to create intra-abdominal pressure, which can help stabilize the spine and support the body during lifting or exertion.
53
STAGE FOUR
BEGINS AFTER DELIVERY OF PLACENTA AND IS COMPLETED AFTER THE
STABILIZATION OF THE BIRTH PARENT AND INFANT; IT IS THE IMMEDIATE POSTPARTUM
54
MECHANISM OF LABOR:
ENGAGEMENT
* DESCENT
* FLEXION
* INTERNAL ROTATION-
* EXTENSION-
* RESTITUTION & EXTERNAL ROTATION
* EXPULSION-
55
ENGAGEMENT-
GREATEST DIAMETER OF FETAL HEAD PASSES THROUGH PELVIC INLET;
CAN OCCUR LATE PREGNANCY OR EARLY LABOR
56
DESCENT- ( relation to…)
MEASURED BY STATION-DEGREE OF DESCENT OF FETUS IN RELATION TO
ISCHIAL SPINES -5-0-+5
57
FLEXION-
HEAD FLEXES SO THAT SMALLEST DIAMETER PASSES THROUGH PELVIC
ARCH
58
INTERNAL ROTATION-
HEAD ROTATES TO OCCIPITOANTERIOR POSITION TO PASS
THROUGH ISCHIAL SPINES
59
EXTENSION-
HEAD AT PERINEUM DEFLECTED ANTERIORLY
60
RESTITUTION & EXTERNAL ROTATION=PEEK- A- BOO
HEAD REVERTS BACK TO LATERAL AND
SHOULDERS DESCEND. Parts of the head is out
61
EXPULSION-
ANTERIOR SHOULDER USUALLY COMES FIRST FOLLOWED BY REMAINDER
OF BODY
62
Medications used
nalbuhine - not for opiate addicted women
morphine - decrease paina nd pee
sedatives (seconal)
63
HYDROTHERAPY-
STIMULATION OF NERVES IN SKIN AND VASODILATION; REDUCES
* CATECHOLAMINE RELEASE
64
ALL ___________________ MEDS AFFECT
FETUS
ORAL, IM, & IV
65
THE DECISION TO USE PAIN MEDS IN LABOR SHOULD
BE MADE BY _______________________
* ASSESSMENTS ______________
THE DECISION TO USE PAIN MEDS IN LABOR SHOULD
BE MADE BY THE WOMAN IN COLLABORATION WITH
HER PHYSICIAN OR MIDWIFE
* ASSESSMENTS NEEDED BEFORE AND DURING
ADMINISTRATION
66
NALBUPHINE (NUBAIN)-
* MORPHINE-
* SEDATIVES-
* FENTANYL-
AGONIST/ANTAGONIST DO NOT USE IN OPIATE
* ADDICTED WOMAN (PRECIPITATE WITHDRAWAL SYNDROME)
ONSET 30 SECS, PEAK 20 MINS, DURATION 2 HOURS INDUCES
* SLEEP
RELIEVE ANXIETY & INDUCE SLEEP. SECONAL, HYDROXYZINE
OPIOID, USED PRIMARILY IN EPIDURAL AS AN ADJUNCT TO
ANESTHETIC AGENTS
67
Medication assessments : maternal
* RESPIRATORY
DEPRESSION
* HYPOTENSION
* URINARY RETENTION
* DECREASED
CONTRACTIONS
68
Assessments : Infant
FETAL/NEWBORN
* BRADYCARDIA
* RESPIRATORY DEPRESSION
* APNEA
* CYANOSIS
* *****NARCAN (NALOXONE) – OPIOID
ANTAGONIST
* NEONATE – 0.01MG/KG IV, IM, SC
* MATERNAL - 0.4-2MG IV Q2-3 MIN PRN
CNS/RESP DEPRESSION
69
EPIDURAL ANESTHESIA ( disadvantages)* THINK ABOUT WHERE ITS PLACED*
DISADVANTAGES:
* MAY NOT BE ABLE TO PUSH
* LONGER LABOR THAN THOSE WITHOUT EPIDURAL
* CONTRAINDICATIONS:
* HEMORRHAGE, SPINAL INFECTION, ALLERGY, HYPOTENTION, FETAL DISTRESS,
ITCHING
* ANTICOAGULATION THERAPY, TUMORS NEAR SITE, HX OF SPINAL INJURY/SURGERY
70
FENTANYL (SUBLIMAZE) - ADVERSE
* RESPIRATORY DEPRESSION (MATERNAL AND FETAL)
* HYPOTENSION (MATERNAL)
* CNS DEPRESSION (MATERNAL AND FETAL)
* FHR CHANGES
71
IF HYPOTENSIVE – ( FENTANYL)
IF HYPOTENSIVE – ADMINISTER 02, PLACE WOMAN IN LATERAL POSITION, INCREASE IV FLUIDS
72
REGIONAL ANESTHESIA: SPINAL BLOCK
*
LIDOCAINE-SUBARACHNOID SPACE-MIXES W/CSF
* ADVANTAGES: DEEPER LEVEL OF ANESTHESIA; MOTHER HAS
NO FEELING IN LOWER EXTREMITIES
* ADVERSE EFFECTS: HYPOTENSION (MONITOR BLOOD
PRESSURE)SPINAL HA, FETAL BRADYCARDIA.
* NURSING INTERVENTIONS: VS, MOM FLAT, INCREASE FLUIDS,
BLOOD PATCH
73
* INCREMENT
* ACME
* DECREMENT
buildup of contraction begins at the fundus and spreads throughout uterus
peak of intensity
the relaxation of the muscle
74
Woman should (pushing)
push for 6-8 seconds followe by a slight exhale repeating effort three to four times per contraction
75
convex and concave
flexed and extended
76
_____________is an ascending infection, originating in the lower genitourinary tract and migrating to the amniotic cavity
Chorioamnionitis
77
LOCAL BLOCK:
PUDENTAL BLOCK
GIVEN IN THE 2ND STAGE OF
LABOR JUST BEFORE
DELIVERY BLOCKS
SENSATION AROUND VAGINA
* EPISIOTOMY REPAIR
* DOESN’T DEPRESS NEONATE
* ADVERSE: ALLERGIES,
PROBLEMS PUSHING
* INTERVENTIONS: ASSESS
FOR LOCAL PAIN WHEN
BLOCK WEARS OFF
78
WHEN TO NOTIFY PHYSICIAN OR ANESTHESIOLOGIST/NURSE
ANESTHETIST
* CONTRACTIONS
* IF CONTRACTIONS STOP OR DECREASE
* DECREASED BP
* NON-REASSURING FHR
* HYPOTENSION
* SYSTOLIC BP <100 MMHG
* 20% DECREASE IN BP FROM PRE-ANESTHESIA
LEVELS
79
GENERAL ANESTHESIA: IV PENTOTHAL.SUCCINYLCHODHOLINE THEN
NITROUS OXIDE + 02
* MAINLY USED IN EMERGENCY CSECTION
* RISKS FOR FETAL DEPRESSION, UTERINE RELAXATION, MATERNAL
VOMITING & ASPIRATION
* ENSURE WOMAN IS NPO
* IV WITH LARGE BORE NEEDLE
* PLACE FOLEY
* ADMINISTER MEDS TO DECREASE GASTRIC ACIDITY (PANTOPRAZOLE)
* WEDGE HIP PREVENT VENA CAVA SYNDROME
* ASSIST WITH SUPPORTIVE CARE OF NEWBORN
80
CERVIX RIPENED –
( bishop)
sOFT AND READY TO DILATE* BISHOP SCORE OF 8 OR MORE (BASED ON STATION,
DILATION, EFFACEMENT, POSITION AND CONSISTENCY
* PROSTAGLANDIN GEL
* CERVIDIL INSERT (SE: N/V, FEVER, HYPOTENSION,
UTERINE HYPER STIMULATION
81
METHODS OF INDUCTION
* AMNIOTOMY – ARTIFICIAL RUPTURE OF MEMBRANESASSESS FHR AFTER
* OXYTOCIN (PITOCIN) IV – HORMONE THAT STIMULATES UC’S
* NURSING INTERVENTIONS: TITRATE DRUG TO MATERNAL
AND FETAL RESPONSE, VITAL SIGNS
* D/C OXYTOCIN IF CONTRACTIONS TOO FREQUENT,
CONTRACTIONS TOO LONG (>90 SECONDS), FHR NONREASSURING
82
BETAMETHASONE
* CLASS:
* ACTION:
* DOSE:
* SIDE EFFECTS:
* NURSING RESPONSIBILITIES:
* TEACH PT:
BETAMETHASONE
* CLASS: SYNTHETIC STEROID HORMONE
* ACTION: STIMULATES FETAL LUNG MATURITY
* DOSE: 0.6 MG PO
* SIDE EFFECTS: HIGH GLUCOSE LEVELS, FATIGUE, FEVER,
HUNGER DIZZINESS, FAINTING, ADRENAL CRISIS, CUSHINGOID
FEATURES, DECREASED WOUND HEALING
* NURSING RESPONSIBILITIES: MONITOR FLUID BALANCE,
INFECTIONS
* TEACH PT: TAPER GRADUALLY, INCREASE ACTIVITY, HIGH
PROTEIN DIET, GOOD ASEPSIS, ABOUT SIDE EFFECTS
83
