1. Dysmenorrhea – a common complaint with women – what are the non-pharmacological and pharmacological treatments.
• Dysmenorrhea- painful
... [Show More] menses
• Non pharmacological-heat, exercise, increase calcium
• Pharmacological- NSAIDs
2. Obstetrical issues – pregnancy risks - Know Naegle’s Rule – to establish gestational age
• Naegle’s Rule is first day of last missed period subtract 3 months add 7 days and add one year
• Fundal height(14 weeks just above the symphysis), 12 weeks embryonic stage organ development, 10-12 weeks heart tones, movement starts at 16 weeks multigravida, 18 weeks primigravida
3. Poor nutrition, drugs, HTN, DM are all issues of perfusion – what will the fetal result be.
• IUGR are large head skinny not much brown fat had poor perfusion
• Small for gestational are proportional have brown fat
• Macrosomic- body as big as head, worried about birth injuries they usually come from uncontrolled diabetic, Poor lung maturity, hypoglycemic(jittery, lethargy)
• Meconium staining- post dates because of stress
4. Anemia becomes a problem in pregnancy – can you discuss the maternal and fetal risks
• Most pregnant women have anemia, normal phenomenon, plasma volume goes up not RBC volume so women become anemic, iron supplements
• Constipation- they are already constipated and then the iron supplements make them even more, exercise water calcium orange juice no laxatives fiber stool softener
5. Hypertension – preeclampsia has specific symptoms – please know these as well as treatment modalities and nursing interventions – keep In mind Magnesium Sulfate, nursing interventions
• HTN, edema, proteinuria. Subjective signs are headache, gastric pain, swelling, blurred vision. Organs effected are brain, hear, liver and kidneys.
• Nursing interventions- DTRs, vitals every hour, respiratory rate, lung sounds, urine output, put Foley in, bedrest
• Magnesium sulfate is used to relax muscles, vessels. The blood vessels are tight and the blood pressure goes up. If we don’t treat this seizures will happen. Hypoxia, IUGR, small baby.
6. Pre- term labor – define it; signs and symptoms, treatment modalities and nursing interventions.
• Labor that begins before 37 weeks, regular contractions that cause cervical change
• Nursing interventions- bedrest, hydration(500ml LR bolus), fetal monitor, left side, UA(UTI can cause uterine irritability)
• 2cm 80% effaced what should the doctor order? Terbutaline, a tocolytic that stops contractions and delays the labor process, side effects- maternal tachycardia, baby’s HR goes up too. If this is not working, we then use Magnesium sulfate. Mag is given to relax the uterus, smooth muscle relaxant, give her 4g bolus over a 15-20 min timeframe, then 2g maintenance dose.
• If we send her home-pelvic rest nothing in the vagina, this can stimulate contractions. Semen is prostaglandin, which can start labor.
• Betamethasone is for lung maturity, we need 24 hours for it to work.
7. Diabetes Mellitus – Type 1, Type 2 and Gestational DM all have issues that are common to all and specific to each. Note the concerns specific to each, management and fetal surveillance
• Type 1- no insulin production, fetal anomalies, risk to baby developing, insulin levels go down in the first trimester, the need rapidly increases
• Type 2- usually diet controlled, if not she needs insulin, macrosomic baby because sugar crosses the placenta insulin does not
• GDM- diabetes only in pregnancy
8. Define Macrosomia – and what are the risks
• Risks of Macrosomia are birth injury, lung immaturity, hyperglycemia.
9. During fetal development a nurse can recognize well- being of the fetus through 3 things?
• Fetal heart tones, fetal movement, fundal height
• Fundal height at 32 weeks should be 28-34cm, 1 cm per gestational week give or take 2 weeks
10. How do you determine EDD?
• Naegele’s Rule is first day of last missed period subtract 3 months add 7 days and add one year
11. What is an NST, and a BPP for whom would you recommend these tests?
• NST- Non-stress test, to look for fetal activity
• BPP- Bio physical profile, ultrasound that looks at 4 different markers. Scored 0-2, 8 being the best. A 6 they are probably keeping mom to watch her and baby, 4 and under delivering baby.
1. Full body fetal movement
2. Fetal tone
3. Amniotic fluid amount- need to see 500ml fluid or its oligohydramnios
4. Breathing movement- intercostals moving, chest expansions
12. Amniocentesis: when and for what reason?
• We do amniocentesis to check for chromosomal anomalies including Down Syndrome and Trisomy 18. Only other time is at end of pregnancy when we are checking lung maturity(L/S ratio).
13. Amniotic fluid surrounds the baby and has 5 functions – oligohydramnios means? Polyhydramnios- what are you thinking?
• Functions
1. Fetal movement
2. Protect the cord
3. Cushioning the baby
4. Temperature control
5. Making sure the GI and renal systems are working
• Oligohydramnios- Not enough amniotic fluid
• Polyhydramnios- Too much amniotic fluid
14. It is all about the placenta and perfusion – how do promote perfusion to the placenta, and what can interfere? (any disease or substance that interferes with vascular perfusion: HTN, DM, smoking, drugs, poor nutrition, etc.)
• HTN, DM, smoking, drugs, malnutrition all affect perfusion, will use intrauterine resuscitation to regain perfusion to the placenta.
15. Know fetal heart rate monitoring – 5 parts and what does each tell you.(ie: accelerations are always positive, healthy babies)
a. Baseline (110-160bpm) normal fetal heart rate during a 10 minute segment rounded to the nearest 5bpm,
b. Variability;most important, at least a moderate variability we know baby has enough oxygen supply and neurological response and will be able to manage whatever is thrown at it, why would a baby have minimal variability? Mom on drugs, baby is sleeping, mom is dehydrated, hasn’t eaten, we gave mom drugs to help with labor
Absent or undetectable-considered non-reassuring
Minimal- less than 5/min
Moderate- 6 to 25/min
Marked- greater than 25/min
c. Accelerations; an abruptincreased fetal heart rate above baseline with onset to peak of the acceleration less than 30 seconds and less than 2 minutes in duration, caused by vaginal exam and fundal pressure
d. Decelerations; decrease or loss of fetal heart rate
Early; mirrors moms contraction, compression of the fetal head from a contraction, vaginal exam, fundal pressure(benign deceleration, NORMAL), no intervention
Late; decrease in FHR after mom’s contraction looks like a U, uterine placenta insufficiency causing inadequate fetal oxygenation, maternal hypotension, abruption placenta, uterine hyper stimulation with oxytocin(BAD, need intrauterine resuscitation)
Variable; decrease in FHR looks like a V, cord compression, short or prolapsed cord, nuchal (cord around the neck), oligohydramnios, need intrauterine resuscitation
Prolonged; greater then 2 minutes but less than 10 minutes
a. Maternal Uterine Activity – what are the expectations.
16. Know Normal Fetal heart rate, when movement occurs, and when you can palpate fundal height and begin measuring with a tape measure.
• Fetal well-being is fetal movement, fetal heart tones and fundal height. All moms can feel the baby movement first between 16-20 weeks, primigravida feel it first at 18-20 weeks, it is a butterfly feeling low in the abdomen. Multigravida is 16-18 weeks.
• When can we hear fetal heart tones with a Doppler? By 10-12 weeks because the uterus is coming outside of the pelvis at this time. 110-160bpm
• Fundal height starts at 14 weeks, it grows with the weeks gestation, we don’t use cm till after 20 weeks, if a mommy is 16 weeks where would we see fundal height? Halfway between the symphysis pubis and the umbilicus, 20 weeks is the umbilicus and 12-14 weeks is the symphysis pubis. We start at the symphysis pubis and measure cm to the top of the uterus. Give or take 2 cm. So if its 28 weeks it could be 26 or 30. If the measure is wrong by more than 2cm the date could be wrong or twins or something else is growing in the uterus. If it is less than 2 cm the date could be wrong, the baby isn’t growing.
17. If there is a non reassuring Fetal Heart rate – what are the nursing interventions?
• Intrauterine resuscitation
1. Turn on left side
2. LR 500 ml bolus
3. Oxygen via mask 8-10 liters
4. Stop Pitocin
5. Call Dr.
18. Epidural anesthesia is common place, what needs to be completed before an epidural can be placed? What are the risks to mother and then to baby with epidural.
• Bolus a liter of fluids, consent, order, vital signs, CBC to look at platelets.
• Risks of regional anesthesia is hypotension, we prevent this by fluids and put a wedge under her right side so she is not flat on her back. What will we see on the fetal monitor if mom is having hypotension? A prolonged deceleration or bradycardic events and hypoxia
19. Labor is a progression – we recognize change with behavioral and physiological changes. Vaginal exams are means to measure progress – do you understand what you are examining and what it means? Example – 3cm, 90%, -2 ( what does this mean)
• 3cm dilated, 90% effaced, 2cm above the ischial spines
20. Know the Stages and phases of labor – recognize some of the characteristics and what we would know with a vaginal exam. What nursing interventions should occur?
There are four stages which are 1. Labor 2. Birth of baby, 3. Placenta delivery and 4. Recovery. In the labor stage there are three phases.
• Latent phase, which is variable, also the longest, mom will be between 0 and 4cm dilated. Mom will be chatty, interactive. We want to help the uterus get food fluid and rest during this period for next phases. Labor is active regular contractions that cause cervical change. First thing we would do if a mom comes in is to hydrate her, IV Lactated Ringers. She will be contracting between 10-15 minutes, possibly going down to 5 minutes.
• Active phase, she will have more pain and more anxious, contractions will be 2-3 minutes apart, focused and can’t talk between her contractions, 4-7cm dilated, 1cm per hour. There is a time stamp with the active phase of labor, 4-6 hours. If the active phases goes longer than 6 hours there can be hypoxia to the baby and exhaustion to the mother.
• Transition phase,lasts 30 min to 2 hours, pain pressure scared restless. 8-10cm dilated, feeling to push, There is a 2 hour timestamp on pushing except with an epidural we give them 3 hours.
Stage 2 Birth of baby; When she becomes 10cm we know we are moving into the second stage of labor. There are two ways to expel the baby vaginally, actively(Valsalva maneuver) or nonvoluntarily(Ferguson’s response or reflex). Non pharmacological ways to birth the baby are walking, changing positions
Stage 3 Placenta delivery should be 5-30 min after birth of baby, DO NOT PULL PLACENTA OUT, make sure you inspect to make sure no infection and is intact
Stage 4 Recovery stage is 2 hours post delivery, assess lochia, fundus should be firm and at or near umbilicus
21. When labor is not progressing what are some of the non – pharmacological and pharmacological means to make a difference.
• Pharmacological- Pitocin
• Non-pharmacological- walking, labor ball, rupture of membranes(by the doctor)
22. Delivery of the baby and delivery of the placenta – what are the risks?
• Hemorrhage
• Placenta abruption and previa.
• Shoulder dystocia, diabetics are at risk because they can have macrosomic babies and they can have injury coming through the birth canal. We can tell this is happening when the mother is in the second stage of labor and she is not progressing. When the doctor tells us to we need to push on the symphysis, to free the shoulder.
• Amniotic fluid embolism, both mom and baby are at risk, present with dyspnea and chest pain, are plan is to c- section, mom does not usually survive this.
• Prolapse cord, small babies and babies in transverse position or unstable lie or babies that are too high. Can see decelerations, we need to push whatever is on the cord off. Use Trendelenburg or shoulders on bed butt up in air. Then go to c- section.
• Ruptured uterus, risk if had prior section, vback, smokers, big babies, traumatic events. Bleeding and you can feel fetal parts right under the skin, go to C-section.
23. IUGR, causes, risks, how do you recognize this in the antepartum period?
• IUGR- intrauterine growth restriction, baby doesn’t grow to normal weight during pregnancy.
• Causes- preeclampsia, placenta problems, multiple pregnancies, chronic HTN, advanced diabetes, smoking/drinking/drugs, anticonvulsants, malnutrition
• Risks- low blood sugar, thermoregulation issues, low resistance to infection
• A lag in fundal height of 4cm or more, ultrasound to check biophysical profile
24. What are the signs of placental separation - risks and nursing interventions?
• Signs of placenta separation- gush of blood, cord lengthening, contraction uterus gets tight, mom complain of lots of pressure
25. Postpartum risks – how do we intervene if a patient has a postpartum hemorrhage – the initial response?
• Primary hemorrhage is within the first 24 hours and secondary is within 6 weeks postpartum.
• Fundal height should be at the umbilicus, we want it hard, if boggy MASSAGE THE FUNDUS. Make sure the bladder is empty. 500ml blood loss for vaginal delivery, 800ml for C-section.
• If you massage the fundus and it is still soft, open up the Pitocin, that doesn’t work use Methergine(not given with HTN), Cytotec, Hemabate. If she is still bleeding she will go to OR and have her uterus removed.
26. Newborn assessment – what is the first assessment? Then? Know APGAR…. And thermoregulation and the prevention of cold stress.
• Assess airway first
• Appearance
• Pulse
• Grimace
• Activity
• Respiratory
An Apgar score is assigned based on a quick review of systems that is completed at 1 and 5 min of life. this allows the nurse to rapidly assess extrauterine adaptation and intervene with appropriate nursing actions. ● 0 to 3 indicates severe distress ● 4 to 6 indicates moderate difficulty ● 7 to 10 indicates minimal or no difficulty with adjusting to extrauterine life
• 3 or 4 we will need respiratory help, we bag the baby, baby will die if we don’t intervene with respiratory support
• Thermoregulation- Wipe baby down, wrap in 2 new blankets, cap on head return to mom
27. How do we keep babies safe in the hospital setting?
• Check ID bands, baby in crib unless mom is holding, keep baby away from door, wear ID badges
28. Physiological jaundice is common – how do you recognize this, the most common cause, and how do we handle Hyperbilirubinemia? What are the treatment modalities and risks of the treatment?
• Pathological jaundice happens in the first 24 hours, Physiological jaundice- happens with breast feeding babies at 24 hours
• Nursing interventions- feed then often, phototherapy may be needed, cover the genitals/eyes, no lotions, increase fluids and check bilirubin
• Kernicterus can cause brain damage
29. NAS – neonatal abstinence syndrome – that which a baby endures during withdrawal – what are the signs of NAS? What is the management of the NAS?
• Baby is jittery, hungry all the time, skin breakdown, screaming, hard to sooth its having withdrawal.
30. Milestones of infancy –
• Posterior fontanel closes at 6-8 weeks, Anterior Fontanel closes at 12-18 months
• Front to back 5 months, Back to front roll 6 months, 8 months sits unsupported, 12 month walks
• No cows milk till 1 year old, no solid foods till at least 6 months, one food at a time
31. ICP in children – specifically infants. Know possible causes, nursing interventions, priority care.
• Headaches, increase pulse and BP, rigid, possible posturing, bulging fontanel
• Causes- brain tumor, traumatic hematoma, chronic infection, head injury, hemorrhage
• Nursing Interventions- I&Os, daily weights, weigh diapers, Neuro checks, HOB 30 degrees, keep from coughing
32. Know informed consents
• Parents or legal caregiver 18 years of age with cognitive ability sign consent, show attempt for consent if emergency, physicians job to get consent
• Informed consent is a legal document signed telling the family what will happen during the procedure, risks.
33. Communication with children and families. What are the general rules to communicate with everyone, and specifically children.
• Simple words, get on eye level, use pictures, involve them, use play, talk to them to make them comfortable. Be honest so you won’t lose their trust.
34. Play is important – know the different play methods seen by each group of children
• Play is social interaction, exercising, learning self-confidence, communication, play does NOT change temperament its genetic,
• Solitary play- independent, plays alone, could be a developmental issue, environmental issue where they were told they are not good enough, abuse, infant to toddler
• Parallel play- children play next to one another but not doing the same thing, toddler to preschool
• Associative play- group of children play in similar or identical activities without formal organization, group direction or goal, preschool to school age
• Cooperative(Organized) play- working together to solve a problem or achieve a goal, everyone wins, school age to adolescence
• We need to watch out for the spectator or onlooker if that is the only play they participate in.Could be autism or another delay
35. How do we communicate with children and respond to their fears – separation/ pain
• Having a parent around will ease the stress, respiratory complains, pain, anxiety and they rest better. Bring the child’s favorite article from home. Explaining the procedure in age appropriate manner.
36. Pain management for children – both pharm and non- pharm management
• Pharmacological is Morphine, the drug most used in children, because it can be carefully titrated and has a shorter half-life, it gets out of the system faster.
• Non pharmacological pain management techniques we use are music, distraction, cuddling, swaddling, guided imagery, pictures, relaxation, nonnutritive sucking, kangaroo care, sucrose.
37. Know Erikson’s theory and some of the characteristics of each group. Provide education regarding the unique characteristics that you find at each age. Keep in mind the challenges of hospitalization on the pediatric patient.
• Trust vs Mistrust(infant, birth to 18months) Developing attachments to all the important people in their life, object permanence in 9 months, separation anxiety begins around 4-8 months, stranger fear happens 6-8 months, their basic needs have been met, mistrust and anxiety can occur if basic needs aren’t met
• Autonomy vs Shame(toddler, 18months-3yr) independence, want to do things by themselves, let them do it on their own, separation anxiety
• Initiative vs Guilt(preschool, 3-6yr) show off things they have accomplished
• Industry vs Inferiority(school age, 6-12yr) mastering a task
• Identity vs Role confusion(Adolescence, 12-18yr) self identify, discover identity
38. Discipline and limit setting – what is appropriate. Know families – and how they cope with stress – how do children cope with stress?
• Have the care provider/parent stay to relieve some of the anxiety. Parents can help a lot since they know the child and what the child needs. Separation anxiety in the toddler, aggression can happen in any age.
39. Medication administration to children – lets discuss oral meds, IM, IV, Subq. Otic, ophthalmic,
• Oral meds for an infant by syringe into the buccal cavity. A little at a time just in case they spit some out. We must not put medication into formula, they will not take the formula anymore. Medications are based on weight and metabolic disorders like kidney or liver.
• IM injections 5/8 in vastus laterals for infants and toddlers
• IV medication administration, 24 gauge usually because they have small veins. Shorter catheter with higher risk of infiltration, use a lot of tape. Children have less tolerance to fluid shifts, so the younger the less amount of fluid you give them. Check for infiltration all the time, kids are always moving more chance the catheter will move.
• Otic- pull down and back
40. What is the role of the child life specialist?
• Provides support for normal development and coping strategies, in any setting, for parents or the child
41. Neurological – seizures and LOC – using Glascow coma scare – remember airway is always first. Care of the child during and after seizure.
• Seizures- Airway first, provide oxygen if necessary, remove objects make sure they are in a safe place, side lying position, document the time/date of the seizure. Absence seizure, parents think the kid is daydreaming or just not paying attention. Tonic-clonic seizure, is more serious.
• Glascow coma scale(GCS) is to look for neurological changes usually after a head injury. By using 3 categories, eye opening, motor response, and verbal response. Document the LOC for the neuro checks.
42. Autism
• s/s- usual attachment to objects, delayed language development, withdrawn, spending time alone rath3er than with others, avoids eye contact, withdrawal from physical contact, minimal pretend play, intense temper tantrum/aggression, repetitive movements, grunting/humming
• Nursing interventions- early recognition, PT/OT, speech therapy, set clear rules, realistic goals, decrease environmental stimuli, assist with nutritional needs
43. Respiratory – croup syndromes, risks, how do we manage? Use only cool mist vaporizers due to risk of burns. Rest is promoted, some medications? Know these. Surgical interventions and sign to observe for?
• Croup is a group of illnesses affecting the larynx trachea and bronchi. Barking cough. Epiglottitis is the most serious risk, medical emergency. Thumb sign, steeple sign. Routine immunization of Hib, NO tongue blade or throat cultures
• S/S dysphonia high fever, sore throat, dyspnea, and rapidly progressing resp obstruction.
• Nursing care- Maintain airway, provide rest and humidification, encourage fluids, nebulizer epinephrine, corticosteroids, antibiotic therapy. Be on standby for intubation. Cool mist vaporizers.
44. Why do children have more Respiratory infections?
• Toddlers get more infections because they are around other kids, everything goes in their mouth, they share utensils/cups, they don’t wash their hands. Toddlers have shorter tracheas, larger tonsils, can’t blow their noses.
45. Cardiac – nursing interventions? Rest? And circulation – know the care of cardiac Catheter. Children admitted with Congestive heart failure – nursing interventions, management.
• Diagnostic Cath is done to see the severity and measure the pressure. The younger the child the more necessary it is to use a femoral artery.
• Pre procedure- check for allergies to iodine or shellfish, NPO 4-6 hours before, baseline vital signs, pre sedation
• Post procedure- cardiac monitoring, vital signs, lie flat for 4-8 hours, possible restraint, check for bleeding, assess access site, pressure dressing, monitor for pain, monitor I&O, encourage fluid intake to excrete dye, check pedal pulse if we don’t feel we have a clot, if bleeding occurs hold pressure above the site.
• If bleeding lie flat, pressure above site, don’t remove the bandage. How would we know if there was a clot? Absence pulses distal, check pedal pulses
• Congestive Heart Failure- keep the child comfortable, give oxygen
Management- monitor vital signs, recognize signs and symptoms, uses and side effects of medications(digoxin, Lasix, -prils).
46. Know Drugs usually seen in cardiac care – digoxin, Lasix, also steroids, as well as all obstetrical drugs for antepartum care, postpartum issues.
• Betamethasone is a steroid that is given to help fetal lung maturity, given 24-34 weeks for preterm labor
• Terbutaline is a tocolytic in treatment of preterm labor to stop uterine contractions before 37 weeks. 3 times an hour, can cause cardiac issues
• Pitocin(Oxytocin)- uterine contraction stimulant, induces labor, strengthen contractions, causes a hypoxic environment for the baby, give Pitocin on a pump with a fetal monitor. We titrate it in labor, we let it free flow after birth to let the uterus contract. If this doesn’t work we try methergine, but its contraindicated in hypertension or preeclamptic patient.
• Magnesium Sulfate- give 24hrs after baby is born, is a muscle relaxant for preterm labor and preeclampsia. 4g bolus and 2g maintenance.
• Cervical ripeners- Cervidil, help dilate the cervix
• Cytotec(Misoprostol)- stop post-partum hemorrhage
• Methylergonovine(Methergine)- prevention and control of post-partum hemorrhage
• Hemabate(Carboprost)- reduces post-partum bleeding, has nasty side effects
47. Endocrine system – diabetes what is some of the symptoms? How is it managed?
• S/S of hypoglycemia- hunger, lightheadedness, shakiness, headache, irritability, pale cool skin, diaphoresis
• S/S of hyperglycemia- thirst, polyuria, N/V, abdominal pain, skin is warm dry and poor turgor, dry mucus membranes, confusion, weakness
• Education for diabetes- Nutrition, exercise and insulin.
48. GI system – diarrhea, dehydration, constipation – recognize symptoms of each and management
• Dehydration s/s- Dry mucus membranes, poor skin turgor, sunken in fontanel.
• Dehydration is huge in children because they don’t tolerate a shift in fluids well. Encourage fluids. Best way to find out output is daily weights. IV therapy is the easiest way to replace fluids, PO pedialyte.
• We don’t want to stop diarrhea, because we want whatever is in the body to pass. If they are vomiting, we give them something to stop. NO NPO or clear liquid diet, we don’t restrict foods in children, we let them eat or drink what they want. Avoid fruit juice, avoid milk.
• Constipation- Children get busy playing and don’t want to stop to go to the bathroom. Have parents have a bowel program, making sure their kid goes poop at least once a day.
49. Renal – concern failure – what type of dialysis? Common urinary issues, presentations, causes, treatment.
• Little girls get UTIs the most because of their smaller urethras. Children are more prone to UTIs because of urinary retention.
• Limit bubble baths, sex after intercourse for adolescence, no douches or powder. Encourage fluids, frequent and complete voiding, antibiotics as needed, suggest cotton underwear, wipe from front to back.
• S/S- poor appetite, vomiting, increased thirst, enuresis, pallor, fatigue, blood in urine
• Document each UTI. The more UTIs the child gets it can lead to retrograde in the kidneys, which can lead to renal strictures and renal damage.
50. MS system: recognize care of a sprain vs fracture – then think through all the needs of the immobilized child. And why, and what are the nursing interventions? Difference between sprains/ fractures and education for both.
• Sprain- stretching or tearing of ligaments
• Fracture- Assess pain, neuromuscular checks, stabilize the injured extremity
• RICE- Rest Ice Compression Elevate, every system is compromised by immobilization
51. Immunocompromised or suppressed children – what are the risks? How do we prevent risks?
• ALWAYS Wash hands
• S/S of infection in a child- fever, redness, streak in the skin, pulse may go up, increased pain, fatigue, LOC changes
52. Blood issues – sickle cell anemia, iron deficiency anemia, hemophilia – know symptoms and priority needs and management.
• Sickle cell anemia- genetic disorder both parents have the trait, symptoms include fatigue, pain in joints, SOB, pallor. Nursing management- increase fluids, pain management, possible oxygen, monitor for infection, no high impact sports, genetic testing, temperature exacerbates
• Iron deficiency anemia- need iron supplement after 6 months especially breast feed child, toddlers that drink too much milk, calcium messes with iron absorption. Nursing care- black tarry stools, drink with straw will stain teeth, constipation, tale iron supplement with vitamin c, diet lean red meat, cereals, raisins
• Hemophilia- genetic passed through the maternal side, disorder in which the ability of the blood to clot is severely reduced, usually caused by defective factor VIII(a clotting protein), more common in men, Von Willebrand disease is seen in some women, to identify this you have to do a blood count. Nursing management- don’t take iron with milk or on a full stomach, take iron prior to eating or at least two hours after, watch for bleeding, be careful with razors, sports, dental work, being safe in important find activities for child to do that is safe
53. Know how to manage blood administration –
• You need a consent, doctors order, type and cross, two nurses check, baseline vitals then q15min, can’t pull it more than one hour before administration, no more than 4 hours to run the bag of blood, only with normal saline with filtered tubing
54. Cancer care – we move from curative to palliative care – what are some of the goals of palliative care? These children may be immunocompromised – or immunosuppressed – how do we manage?
• Neutropenic care- no to low white blood cells, patient wears a mask, sometimes isolated, don’t allow them around other sick people,
• Palliative care- taking care of a dying child, hospice support groups, comfort and pain management
55. Chemo therapy has risks and side effects – name them and note nursing management of each
• Chemo makes children lose their hair, oral lesions, weight loss, pain, bone cancer they could have a traumatic amputation, radiation destroys tissue
• How do we manage the side effects of chemo therapy? Antiemetics, nystatins to manage yeast infections
56. Grieving families – stages of grieve and how do we respond to family needs?
• Stages of grief(denial, anger, bargaining, depression, acceptance)
• Grief counselors, include the other children, pastors, support groups, no timestamp on grieving but if it interferes with life situations then it becomes pathological and intervention is needed
57. Pre and post-operative care of the child with any surgery and then specific signs to watch for in respiratory issues, throat surgery, abdominal surgery, extremities, head. There are some similarities and specific needs of each.
• Preoperative care- education decreases the fear, role play, what they will look like after, IV insertion, explain the pain scale, safety
• Postoperative care- assessment, check IV, respirations, LOC, have all equipment in the room before they come back from surgery,
• Abdominal surgery- wound care, pain management, check bandage circle and time to watch bleeding
• Tonsillectomy- watch for frequent swallowing, avoid red drinks
58. Forms of child abuse –and your Legal responses of a child maltreatment.
• Forms of child abuse- Physical, sexual, emotional, financial neglect, verbal, Munchausen by proxy syndrome involves fabrication of illnesses or symptoms by the parent
• Watch out for green stick fractures, multiple admissions, multiple bruising, burns, failure to thrive, poor hygiene, no eye contact, not wanting to go home.
59. Skin – each age has unique skin challenges – know them, how to treat and the risks. Burns are specifically difficult for children - think holistic approach.
• Infants- diaper rash, milia
• Toddler-impetigo, bites
• Preschool- measles, chicken pox, rubella, fifth disease
• School age- abrasions, lacerations, lice
• Adolescence- acne
• Burns- first hypovolemic shock replace fluids watch I&O, next infection antibiotics, pain management, nutrition increase protein, scarring post healing
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