MC final notes.txt

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MC final notes.txt
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2012-10-08 15:35:50
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MC Final
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MC Final
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  1. What do breasts do?
    Produce milk after birth to provide nourishment and maternal antibodies for the infant
  2. Ductus venosus
    Diverts some blood away from the liver as it returns from the placenta
  3. Foramen ovale
    diverts most blood from the right atrium directly to the left atrium rather than circulating it to the lungs
  4. Ductus arteriosus
    diverts most blood from the pulmonary artery into the aorta
  5. GTPAM
    Gravida (any pregnancy), Term (born after 37 weeks gestation), Preterm (after 20 before 37), Aborted before 20 weeks of gestation), Living (currently living), Multiple 3,1,0,1,1,1
  6. How would you counsel mother about infant regarding hep B?
    if mother has hep B, infant should receive a single dose of hepatitis B immune globin for temporary immunity right after birth
  7. Frank breech
    fetal legs are flexed at the hips and extend towards the shoulders; most common; butt at cervix
  8. Full or complete breech
    reversal of the cephalic presentation with flexion of the head and extremities-both feet and buttocks present at cervix
  9. Footling breech
    one or both feet are present at the cervix
  10. Epidural block
    observe for hypotension and urinary retention; initially record BP every 5 minutes after block is begun and after each reinjection until stable; record fetal heart rates; placenta perfusion
  11. When to stop/start oxytocin?
    Begins at low rate and is adjusted up or down according to how fetus responds to labor and contractions; when contractions are well established, often possible to reduce rate of oxytocin; augmentation of labor usually requires less total oxytocin than induction because uterus is more sensitive to the drug when labor has started; oxytocin is discontinued or reduced if signs of fetal compromise or excessive uterine contractions occur; fetal heart rate>160 or <119/late decelerations, or loss of variability contractions>2 min, duration>90 seconds
  12. Alternating breasts during breastfeeding
    increases milk production-high protein and high fat content
  13. Homan�s sign treatment
    superficial-analgesics, local application or heat and elevation of legs; DVT with subcu or IV anticoagulants such as heparin may be continued up to six weeks after birth; antidote for warfarin OD is vitamin K
  14. 6 weeks post partum oral contraceptives and breast feeding
    OC decreases breast milk production and is contraindication in the breastfeeding mom until lactation is well established; women who breast feed 10 times a day do not ovulate for 10 weeks post partum; BF is NOT a reliable means of contraception; progestin-only OC�s (minipill) many be used until menstruation returns in women who breast feed regularly
  15. Sleeping pattern of infants
    about 15-20 hours a day; 1st reactive phase-1st 30 minutes-best time to initiate bonding; next few hours-sleep phase; second reactive phase; stability phase
  16. Hydrocephalus shunt, ICP, bulging fontanelles---what do you do next?
    Semi fowlers
  17. Which formula would be best for PKU baby?
    Partially breastfed and supplemented with lofenalac
  18. CHF in children-modify feeding techniques select all
    small and frequent; soft nipple with large hole; high caloric; folding and comforting
  19. Radiation therapy for kid with Hodgkins
    sun blocking agent; conserve energy; expressions of anger; appetite stimulation
  20. Types of inhalants
    glue, aerosols, cleaning fluids
  21. Osteopathy SELECT ALL
    pressure points, manipulation, traditional
  22. Children with asthma need what kind of relief
    guided imagery
  23. Play for mentally retarded
    play to their mental age not physical age
  24. Respiratory distress syndrome
    Increase to 60/min or more; tachypnea with grunting, nasal flaring, cyanosis, intercostal and sternal retractions; surfactant given through intubation; giving betamethasone 1-2 days before delivery to mother may reduce chance of RDS; placed in incubator to conserve energy
  25. Post term neonate
    asphyxia caused by chronic hypoxia due to deteriorated placenta; meconium aspiration; poor nutritional status-hypoglycemia; increase in RBC; birth defects; seizures; long and thin; loose skin; little lanugo or vernix; long nails; thick hair; incubator because fat has been used up
  26. Abnormal finding in 6 month old
    head lag present; NORMAL finding is double weight at 5-6 months
  27. What does a 1 yr old like to do?
    Push/pull toys; activity boxes; reading; singing; nursery rhymes; large picture books; shopping; nesting blocks
  28. Reportable situations
    TB, food borne illness, abuse
  29. Safety of 15 month old
    easily distracted; trusting of others; frequent falls; teach stranger safety; do not personalize clothes; no lollipops; no sharp edged objects or furniture
  30. Enuresis
    primary-child has never been dry; secondary-recurrence after 1 yr of dryness; more common in boys; sometimes result of inappropriate toilet training
  31. Adolescent girls vs. boys
    boys grow later but growth spurt lasts longer; testicles and insides grow first; girls grow 2 years faster than boys
  32. Adolescent-Piaget
    oriented to problem solving; stage of formal operations and has the ability to reason logically and abstractly
  33. Adolescent-Erikson
    self-definition and self esteem are main concerns; identity crisis because of physical changes and conflict about future choices and expectations of others; must adapt to new changes and develop new self concept and vocational choices; learns to understand self in relation to others� perceptions and expectations
  34. In admission to the hospital for the toddler,
    stay calm
  35. Hospitalized toddler
    be truthful, separation anxiety; peek-a-boo; transitional object from home; some regression can occur
  36. Response to opiates
    elimination of drug may be longer due to immature liver enzyme system; renal clearance may be greater than in adults; decreased protein binding capacity in blood of small newborns may allow a greater of free unbound drug in body; dosages influenced by wt and differences in expected absorption, metabolism, and clearance
  37. Clean catch urine
    antiseptic; rinse and dry; front to back; midstream caught in sterile container; specimen sent to lab promptly
  38. Tympanic temperature measurement
    tympanic membrane and hypothalamus share the same blood vessel (perfused by same circulation)
  39. When child is hearing impaired,
    be at eye level with child; face to face with child; eye contact; short sentences; avoid exaggerated lip or face movement; persistence of moro reflex after 4 months may indicate deafness
  40. To avoid Reye�s syndrome
    avoid aspirin-salicylates during flu/chicken pox, could be genetic
  41. Meningitis
    airway, breathing and circulation; slowed pulse, irregular resp and increased BP reported immediately
  42. Decorticate and decerebrate
    decorticate-damage to cortex of brain; arms towards self CORE; decerebrate-brainstem injury; side rails raised, head of bed slightly elevated; increasing ICP checks-LOC, pupils, vitals, motor signs
  43. If there is a concussion, what would you find?
    Retrograde amnesia immediately before accident, during and after
  44. Why do we inoculate re: meningitis?
    H. influenza is most common causative agent; H. influenza type B vaccine and PCV have decreased incidence of bacterial meningitis
  45. 3 types of juvenile RA
    systemic-intermittent spiking fever, re: joints; psoriatic has psoriasis; enthesitis involves tendon insertion sites and associated with eye inflammation and irritable bowel disease
  46. Compartment syndrome
    pain unrelieved by medication or swelling, cyanosis or pallor of digits, decreased pulse and skin temp should be immediately reported as they may be signs of comp syndrome
  47. What will relieve morning joint discomfort?
    Moist heat
  48. How to give aerosol and drainage?
    Done before meals
  49. Nursing care for asthmatics
    give room temp water; cold can trigger bronchospasm
  50. Smoke inhalant injury
    pulmonary edema from 6-72 hours (DON�T PICK 72)
  51. Sickle cell crisis
    severe ABD pain; risk for stroke as a complication of vasoocclusive sickle cell crisis
  52. Parent understanding of sickle cell crisis
    not protective gear for playing sports
  53. Treatment for thalassemia
    frequent blood transfusions may cause hemosiderosis-excessive iron stored in tissues
  54. If child has chemotherapy,
    abdomen may be firm, slightly distended, no BM; peripheral neuropathy may be signaled by severe constipation caused by decreased serve sensations to the bowel
  55. Meckel�s diverticulum
    blind pouch may form is vitelline duct fails to disappear completely; occurs near ileocecal valve
  56. Nephrotic syndrome-what do you assess for?
    If prednisone is given, assess for infection as signs of infection can be masked
  57. Topical agent used to treat burn patients-silver sulfadiazine cream 1% (Silvadene)
    effective against gram +&- bacteria and yeast; do not use if allergic to sulfa drugs; does not sting; softens eschar; expensive; remove old before reapplying
  58. Varicella and precaurions with toddler
    airborne
  59. If parents are alcoholic, then child may be
    super coper (savior) feels overly responsible, often has a job to help out, and tries to do everything perfectly
  60. If child with autism is hospitalized,
    child needs structure, slow paced with few distractions, avoid sudden movements and loud noise
  61. Insulin reg and NPH with peaks
    regular first, then NPH; reg peak-2-5 hrs; NPH peak-4-12 hours
  62. Ketoacidosis
    signs and symptoms-BS>150; polyuria; polydipsia; polyphagia; fruity odor; fatigue; abdominal pain; red lips/flushed face; dehydration; disorientation; drowsiness progressing to coma; deep and rapid respirations
  63. Treatment of diabetes insipidus
    hormone replacement of vasopressin in the form of desmopressin; monitor for signs of overdose which include symptoms of water intoxication (edema, lethargy, nausea, CNS signs); med ID should always be worn; may limit children�s access to bathrooms and water fountains
  64. Symptoms of strabismus
    eye squinting or frowning to focus, missing objects that are reached for, covering one eye to see, tilting the head to see, dizziness or headache
  65. If child has hypoglycemia, give
    life saver
  66. Children who fail to thrive (nonorganic) have what appearance?
    Rag roll (hypotonia), appear wary of caregivers, are apathetic
  67. Digoxin with children
    check dose by 2 nurses; single dose larger than 50 mcg should be reconfirmed; if pulse is <100 in child, tell dr; tell dr if pt vomits; tachycardia and irregularities in pulse should be reported
  68. Sexual curiosity of preschooler
    assess knowledge, be honest and accurate about sex; parents are advised to ignore behavior and distract child with another activity
  69. Gastroenteritis
    inflammation of stomach and intestines; problem in diarrhea is fluid and electrolyte imbalance and failure to thrive; noninfectious causes of diarrhea-food intolerance, overfeeding, improper formula prep, ingestion of high amounts of sorbitol
  70. Inadequate secretion of insulin
    ketonemia-ketone bodies that accumulate in blood; impacts physical and psychological growth and development of children; treatment designed to optimize growth and development and minimize complications
  71. If allergic to eggs,
    avoid influenza vaccine

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