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CONCORDIA NUR 418 PEDS/OB EXAM 1
Family Centered Care concepts (FCC Care Video ) - CORRECT ANSWER-Focus shifted from the biomedical aspect of a child's condition to view the child in the context of their family Use of interdisciplinary team specific per fam Employees dignity, respect, collaboration, participation, information sharing •Family is involved in the care planning. Increases adherance, improves outcomes Maintain routines, foods, languages Assigning Parity - CORRECT ANSWER--number of times a woman has given birth to a fetus with a gestational age of 20 weeks or more (alive or stillborn) G= total number of times pregnant T= number of term infants born (Between 38-42wks) P= number of preterm infants born (Between 20-37 wks) A= number of abortions before 20 weeks L= number of children currently living Parity - CORRECT ANSWER--multipara: 2 or more births at more or 20 weeks - nulipara: no births at more than 20 weeks gestation - primapara: 1 birth at more than 20 weeks gestation Fundal height - CORRECT ANSWER--fundal height in cm should equal weeks of gestation + or - 2 - 12 weeks= above symphysis pubis - 16 weeks= halfway between symphasis pubis and umbilicus - 20 weeks= on the umbilicus *Top of uterus, cervix is base Focus of Community Based Maternal Child Health Programs (Maternal child Discussion board) - CORRECT ANSWER-Specific objectives of MCH Care focuses on the reduction of maternal, perinatal, infant and childhood mortality and morbidity and the promotion of reproductive health and the physical and psychosocial development of the child and adolescent within the family. Community Based Delegation - CORRECT ANSWER-Community based nurse: serves communities with greater risks and barriers to achieving positive maternal and child health outcomes obstetric/neonatal nurse: work with pregnant women to ensure healthy pregnancies before, during, and after childbirth, works directly with newborn infants What can be delegated? - CORRECT ANSWER-•Delegate to role below nurse. Cannot delegate assessment. Stable condition. Predictable. YES to bathing NO to assessing a wound
False Labor - CORRECT ANSWER--Braxton hicks: uterus contractibility increases in response to increased estrogen levels - can begin in second trimester but some women dont feel them until 3rd - contractions are irregular with no particular pattern - as uterus enlarges they are more noticeable - ensure adequate fluid intake and recommend maternity girdle for uterus support False Labor Changes - CORRECT ANSWER-*False labor: if no change in cervix within 2 hours, irregular contractions (hydrate patient) True labor: If cervix changes (effacement & dilation) Fetal Monitoring (OB ch 9 pg 272 Box 9-1) - CORRECT ANSWER-Overall Goals: - support maternal coping and labor progress - Maximize uterine blood flow - Maximize umbilical blood flow - Maximize oxygenation - Maintain appropriate uterine activity Fetal Monitoring (OB ch 9 pg 272 Box 9-1) - Nurse Interventions - CORRECT ANSWER-Nursing actions: - Review plan/expectations with woman and her family - Maintain calm environment - Stay at the bedside as much as possible - Monitor only at the level needed for this patient - Frequent position changes/upright positioning - Judicious use of technology- 0 Safe Ranges and Therapeutic Levels - CORRECT ANSWER--if a med is dosed below minimum safe range= child isnt getting therapeutic dose - if a med is dosed above safe range= may be toxic, severe medical consequences Nonpharm: Bradley method - CORRECT ANSWER-It's a medication-free method that emphasizes relaxation as a form of pain reduction during labor. But it's also a comprehensive plan that focuses on healthy living throughout your pregnancy. Pediatric Physiological Differences to medication - CORRECT ANSWER--immature blood brain barrier - increased permeability of skin and conjunctiva - immature cardiovascular system - higher metabolic rate - differences in protein binding - altered absorption patterns - delayed gastric emptying, relative lack of gastric acid - immature renal function - high total water volume - low body fat - rapidly growing tissues - large body surface area Higher water volume Lower body fat Increased skin permeability Immature blood brain barrier Postpartum Assessment (OB Chp 12) - CORRECT ANSWER-supine position - pain level - last urine and BM - LOC - VS - cap refil - edema - breast for redness - check fundus (fundal height, boggy, firm) - check peri pad and note the amount of blood - episiostomy, c-section, tear assess for redness, edema, drainage, approximation - check for edema in extremeties - assess emtional status - assess comfort level
circulation Least invasive/intrusive Assess at baseline Visual, Auscultation, Palpation Talk to parent Order of Assessment w/Pain Assessment (Peds chp 8Text pg 149*) - CORRECT ANSWER-Assess VS and cause of the pain (injection, injury, surgical procedural, of disease process) VS= increased HR, BP and R.Rate. Observe and monitor for reaction to pain- facial expression, movement, vocalized ( furrowed brows, restlessness, withdraw from stimulation, wariness, no vocalization, use appropriate pain scale. Go from least invasive to most intrusive, saving painful areas for last. Developmental Characteristics of Pain Presentation - CORRECT ANSWER--infants: rapid changes in behavioral state, distinctive motor movements associated with pain - toddlers: generalized restlessness, guarding of painful site, excessive crying - pre- school: cry and struggle, may deny pain - school age: stiff body posture, withdrawn - adolescents: can describe quantity and location of pain •FACES vs Number •If screaming: no obstruction, no change in LoC FLACC (Newborns-age 7): Faces, Legs, Activity, Crying, Consolability Developmentally Appropriate Interaction /Establishing Rapport w/ Small Children (Module Presentation) Pg. 145 - CORRECT ANSWER-Child Participation and Comfort During Assessment Use these best practices when assessing a toddler or preschool- age child. 1. Allow the child to select which digit to put the pulse oximeter on. 2. May demonstrate use on the caregiver's finger to show that it is a painless procedure. 3. Allow child to select which arm to use for BP check when appropriate. 4. Talk to the child and tell of the tight "hug" feeling to expect on the arm with BP check. 5. Allow child to stay with caregiver so that respiratory rate and BP will not be falsely increased because of anxiety. 6. Assess toddlers in their comfort zone, usually in a parent's lap. 7. Remember to protect a preschooler's modesty. 8. Approach children and get down to their eye level. 9. Give praise whenever it is appropriate. Identifying Assessment Priorities to Influence Family Communication (Peds text pg 131, pg 144, pg 161, pg 46; Peds Module presentation) Especially pg 46!! - CORRECT ANSWER-Family APGAR questionnaire: A—Adaptation: the ability to use resources for problem solving in a crisis P—Partnership: the ability to share responsibilities and nurturing roles in a crisis G—Growth: the ability to achieve physical or emotional growth A—Affection: the ability to demonstrate love and attention to family members R— Resolve: the ability to devote time to other family members in the nurturing process Functional Family Assessment (Peds text pg 131, pg 144, pg 161, pg 46; Peds Module presentation) - CORRECT ANSWER-The nurse conducts a Functional Family Assessment through interviews with family members. This type of assessment also allows the nurse to develop cultural sensitivity in recognizing cultural factors that shape family perceptions, as well as cultural competence as a nursing assessment tool. Carrier Testing, Predictive Testing, Pre-Implantation Testing, Amniocentesis, Diagnostic Testing ( Peds Presentation Genomics & Gentics) - CORRECT ANSWER--diagnostic
testing: family member has symptoms of disease that may be causeed by mutated genes the testing will reveal if the suspected disorder is present (huntingtons, CF) - presymptomatic and predictive testing: family history of genetic condition testing can show risks for identifiying i.e colorectal cancer - carrier testing: family history of genetic disorder (sickle cell or CF) or high risk group testing can be done before having children to see if they have the genes - preimplantation testing- IVF, embryos are screened for genetic abnormalities - amniocentesis: prenatal genetic test where doctor inserts a thin, hollow needle through abdominal wall and into the uterus to collect a small amount of amniotic fluid for testing Endometrial Preparation and Infertility (OB Presentation: Womens Health and FCC Presentation/ Slide on Essesntial Components of Fertility and Cause of Infertility- Female) - CORRECT ANSWER--endo, PCOS, TSS, STIs, HPV, PID, ovarian masses or cancer, cystitis 1. favorable cervical mucus: cervicitis, cervical stenosis 2. clear passage between cervix and tubes: myomas, endo, polyps, cervical stenosis 3. patent tubes with normal motility: PID, endo, IUC 4. ovulation and relase of ova: PCOS. hypothyroidism, endo 5. no obstruction between ovary and tubes: adhesions, endo, PID
- endometrial preperation: anovulation, luteral phase defect Different types of Infertility - CORRECT ANSWER-Understanding different types of infertility: *endometrial prep for conception (ovulation, luteal phase need to be right) *adhesions, endometriosis (egg can't get through tube) *Maternal weight gain (about 25 lb) - Overweight (none) - underweight (more than 25lb) *organs formed by 8 weeks. *Hydration, nutrition" Calculating EDD (Module Presentation, Text) - CORRECT ANSWER-Naegel's Rule 1. first day of last menstrual period 2. count back 3 calendar months 3. add 1 year and 7 days to that date Presumptive Signs of Pregnancy (OB Text Chp 3 & 4, pg 60 & 74) - CORRECT ANSWER--absence of menstruation - n/v - breast changes (Enlargement, tenderness, increased vascularity) - fatigue - urination frequency - quickening (first awareness of fetal movement) Subjective signs Fatigue, N/V, breast tenderness, etc Due Date - CORRECT ANSWER-LMP= SEPTEMBER 7th, 2021 - 3 months JUNE 7th, 2021 +7 days JUNE 14th, 2021 + 1 year EDD= JUNE 14th, 2022 Cardiovascular Changes in Pregnancy (OB Text Chp 3 & 4, pg 60 & 74) TABLE 4- 1 - CORRECT ANSWER--decrease in PVR (blood pressure) - increase in blood volume, cardiac output, and peripheral dilation - increase in RBC, WBC, and plasma - increase in demand for iron - Hypercoagulability - increased venous pressure and decreased blood flow to extremeties= edema, varicosities, hemorrhoids - supine hypotensive syndrome (When supine--> Enlarged uterus compresses the inferior vena ceva-->reduced blood flow to the right atrium-->redueced CO)
infection - to reduce the incidence and burden of disease - reduces risk of long term disability and death - to promote herd immunity KNOW: MMR, dTAP NO varicella before age 1 - Generate long lasting immunity - Herd immunity - Mimics natural way of fighting infection - Give education Vaccine Contraindications (Module Presentation, Vaccine links, Text ) - CORRECT ANSWER--Permanent contraindications: anaphylaxis; encephalopathy not due to another identifiable cause and occurring within 7 days of pertussis vaccination - live vaccines contraindications: pregnancy, immunosuppression S/S of Preclampsia and Eclampsia (OB text Chp 7 pg 156 & 165) - CORRECT ANSWER--new onset hypertension after 20 weeks gestation with two blood pressure readings at least 140/90 taken at least 4 hours apart - impaired liver function - elevated creatinine level - new onset cerebral/visual symptoms (headache) - pulmonary edema/ SOB - low platelet count - HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) Preclampsia Interventions/Symptoms from collab - CORRECT ANSWER-*Always put mom on left side *Severe headache *HTN *Blurred vision *Swelling *Seizure Hyperemesis Gravidarum (OB Text pg 172 & 224: figures) - CORRECT ANSWER-- vomiting so severe it leads to dehydration, electrolyte imbalance, weight loss - early treatment of N/V to prevent hyperemesis Give: •Antiemetics, IV hydration, vitamin B Birth Presentation Positions - Baby - (OB Text pg 172 & 224: figures) - CORRECT ANSWER-1. cephalic (head first) 2. breech (pelvis first) 3. shoulder (shoulder first) Abruption Placentae ( OB Text Chp 7 pg 184; OB Module 5 Presentation) - CORRECT ANSWER--risk factors: hypertensive disorders, previous abruption, maternal age, preterm pregnancies, uterine fibroids, cigarette smoking, meth use, abdominal trauma - risk for woman: hemorrhage, maternal death - risk for fetus: low birthweight, preterm delivery, stillbirth - assesment: vaginal bleeding (severe), fetal assessment: tachy, brady, late decelerations S/S Abruption Placentae ( OB Text Chp 7 pg 184; OB Module 5 Presentation) - CORRECT ANSWER-•s/s: bright red vaginal bleeding, severe abdominal pain, decreased fetal movement Abruptio Placentae ( OB Text Chp 7 pg 184; OB Module 5 Presentation) - CORRECT ANSWER-risk factors: endometrial scarring, c-section, short pregnancy intervals, advanced maternal age, diabetes, hypertension, cigarette smoking, uterine abnomalities risks for woman: hemorrhage, hypovolemic shock risk for fetus: anemia, hypoxia, death assessment: painless vaginal bleeding in third trimester, may be accompanied with
abdominal pain, contractions; fetal HR changes contraindications: vaginal exam Interventions: c-section is necessary usually •Placenta covering cervix. NO internal exam Chronic Constipation (Peds Text Chp 15, pg 345) - CORRECT ANSWER--may have trace blood or pain - hirschsprung disease: causes blockage of the intestine bc of lack of nerves in the bottom segment of the colon - results in constipation from birth - eat whole wheat foods •Change diet, routine, activity •Miralax Moderate Dehydration (ATI, Peds Text Chp 15 pg 325-346; Module Presentation) - CORRECT ANSWER--causes: poor oral hydration, increased aerobic activity, recent illness - causes in body system: diabetes, CF, fever, burns, tachypnea, HR, renal failure
- prevent fluid and electrolyte imbalance - more prone to imbalances because a greater percentage of body water in infants is extracellular - limited ability to dilute and concentrate urine Oral rehydration NOT water (pedialyte) Check fontanelle for depression Severe Dehydration (ATI, Peds Text Chp 15 pg 325-346; Module Presentation) - CORRECT ANSWER--weight loss is most significant indicator of dehydration - rapid respiration can cause dehydration because they can cause evaporation of fluid on mucus membranes - can lead to shock IV fluids, no oral hydration Fluid Volume and Metabolic Differences in Peds pt's (ATI, Peds Text Chp 15 pg 325- 346; Module Presentation) - CORRECT ANSWER--GI tract has larger proportion of surface area than adults - infants have greater body surface area than adults - metabolic rate is higher - more likely to lose ECP than ICP *fluid output 1ml/kg/hr Reason for Feeding Tube Placement (Module Presentation; Peds Text pg 328) - CORRECT ANSWER--when foods cannot safely be taken by mouth - when nutrition is insufficient - when eating or swallowing is impaired - to conserve energy for other vital activities •Dietary need, supplemental feeding, energy conservation •Eating disorders •Coma Appendicitis (Module Presentation; Peds Text pg 328) - CORRECT ANSWER-- blockage in the lining that results in infection •Present similarly as adult. RLQ pain, rebound pain, n/v •Change is not always good (new lack of pain may mean perferation) •Pain mgmt
