NURS 509A Exam3

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NURS 509A Exam3
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  1. Benefits of Breastfeeding
    prevent infections, earaches, respiratory distress, diarrhea, obesity, cancer, diabetes, save money

    for mom: decreased postpartum hemorrhage, caner ovarian, heart disease, return to norm weight faster, increase effectiveness of immies.
  2. Breastfeeding Reccommnedation AAP
    at least 1 yr

    WHO: exclusively for 6 months, then up to 2 yrs.
  3. Contraindications of breastfeeding
    • infant: gut issues
    • Mom: HIV, herpes (active), drugs, meds consult med book
  4. Feeding Breastfeeding
    8-12 times a day

    by day 4: 6-8 wet diapers

    if lose >7% of weight-concern
  5. Signs of infant hunger
    • open mouth, rooting, such on hand, lip smacking
    • cry: late sign of hunger
    • goal: eat every 2-3 hours.
  6. Colustrum
    yellow, first 2-3 days of milk: immunity, laxative for meconium

    transitional milk: both colustrm and reg milk

    Reg milk: Beginning of feeding more water, end of feeding more fat.
  7. Prolactin
    • primary hormone responsible for lactation
    • Note: estrogen and progesteron suppress lactation
    • suckling increase prolactin levels=increase milk vol.

    malnutrition: decrease fat content in milk .
  8. Rooting Reflex
    chin to breast=child open wide
  9. Breastfeeding Nutritional Needs
    need extra 500 calores
  10. Breast milk storage
    • at room temp for 6-8 hrs
    • refrigerator up to 5 days
    • freezer 3-6 months
  11. Breast feeding issues
    Sore nipples: Pain, due to poor latch, poor position. Tx: use ointment

    Mastitis: flu like symptoms, inflammation/infection due to bacteria through cracks

    engorgement: plugged milk; firm, pain, tender TX: cold packs
  12. Mastitis
    • flu like symptoms, fever,  malasie, unilateral breast pain
    • inflammation/infection due to bacteria (S. aureus) through cracks
    • wash hands before feeding
    • Tx: antibiotic, compresses.
    • Proper latch techniques and frequent emptying of the breasts will help prevent engorgement.
  13. Signs of poor/good latch
    • Poor Latch:
    • unable to stay on
    • pain by mom (some pain is normal)
    • dimpling of babys cheek
    • nipples flat, cracked, or blanched
    • no milk content in babys mouth

    • good latch:
    • tongue cupped beneath breast,
    • lips are out and relaxed
    • cheeks are full
    • regular rhythmic sucking
    • position: nipple to  nose then top of upper lip, mouth wide open, tongue down

    suck:swallow: 1:1 or 2:1
  14. Ballard
    assess physical and neuromuscular maturity of neonate. 

    determine gestational age.
  15. Umbilical cord antiseptics for preventing sepsis and deathamong newborns
    The cord stump  dries and falls off within five to 15 days. Infection of the umbilical cord stump (omphalitis), caused by skin bacteria, is a significant cause of illness and death in newborn babies in developing countries.

    There is significant evidence to suggest that topical application of chlorhexidine to umbilical cord reduces neonatal mortality and omphalitis in community and primary care settings in developing countries.

    It may increase cord separation time however, there is no evidence that it increases risk of subsequent morbidity or infection.

    There is insufficient evidence to support the application of an antiseptic to umbilical cord in hospital settings compared with dry cordcare in developed countries.
  16. Transition to extrauterine life: Respiratory
    • amniotic fluid removed from lungs
    • cease placental blood flow-decrease oxygen-decreased pH (acidosis)-stimulate medulla for respiratory-stimulate respiration
    • surfactant produced by lungs keep alveolar sacs partially open

    30-60 per min is normal, 10 second pause is normal

    bulb syringe: mouth first then nose, in mouth on sides
  17. Transition to extrauterine life: Cardio
    During fetal: ductus arteriosos, foramen ovale, ducturs venousus shunt most blood away from lungs and liver

    at birth these shunts close=pulmonary vessels dilate.

    HR 120-160

    apical 100-180, listen for 1 min due to irregularities
  18. Transition to extrauterine life: Thermoregulation
    • Heat loss: heat loss 4 times faster than adults. Brown fat (nonshivering thermogenesis)
    • via convection (loss of body heat), radiation (transfer with objects), conduction ( transfer direct skin contact), evaporation

    • Cold Stress:
    • increase need for oxygen
    • respiratory distress
    • decrease surfactant production
    • hypoglycemia
    • metabolic acidosis
    • jaundice
  19. Brown fat (Nonshivering Thermogenesis)
    • oxidation of brown fat to produce heat
    • located in neck, thorax, axillary
  20. Neutral Thermal Environment (NTE)
    environment maintain body temperature with minimal metabolic changes and/or oxygen consumption.

    86.6-92.3 F (32-33.5 C)

    axillary: 36.5-37.5
  21. Kangaroo Care
    • best source of heat: mothers chest
    • reduce low body temp, illness, infections, breastfeeding difficulties, decrease hospital stay, etc.
  22. Transition to extrauterine life: Hematological
    Vitamin K: produced in intestine but need food and normal flora first, so give shot-prevent hemorrhagic disease

    • Hematocrit: normal 48-69%
    • >65% polychthemia

    Metabolic: hypoglycemia is common during transition period. (40-60 is normal)
  23. Polycythemia
    • >65% of hct
    • increase risk for juandice, and damage to brain as results of blood stasis
  24. Bilirubin
    indirect bilirubin:  (nonwater soluable) produced from breakdown of red blood cells, converted to direct bilirubin (conjugated) (water soluble) by liver enzyme which can be excreted in urine and stool. 

    hyperbilirubinemia: (high levels of unconjugated bilirubin in blood due to immature liver, high red blood cells.

    risk factors: hemolysis of excessive RBC, short RBC life, liver immature, lack intestinal flora
  25. Adaptations to Extrauterine Life: GI
    • Stomach: gastric capacity expands, gastrocolic reflex, cardiac sphincter-easy regurgitation
    • stools: meconium, transitional, breast milk, formula
  26. Types of Stools
    • Meconium: green, black, thick, tar-like
    • Transitional stool: green-brown, looser
    • Breast milk stool: mustar color and consistency, seedy, sweet-sour smell
    • Formula stool: pale-yellow to light-brown, firmer, feces smell
  27. Meconium Aspiration Syndrome
    • - fetus may pass meconium stool into the amniotic fluid due to relaxation of fetal anal sphincter. 
    • -due to stressful event: asphyxia, cord compression, intolerance to labor
    • -Respiratory distress (obstruction, decreased surfactant, hemorrhagic pulmonary edema) , tachypnea, cyanosis, retractions, nasal flaring, grunting, rales, rhonchi, barrel-shaped chest. 
    • -stained amniotic fluid, skin discoloration

    • Post term
    • TX: artificial surfactant, initric oxide (helps absorb meconium),if still distress ECMO (oxygenates blood for them)
  28. Blood Glucose
    • 40-60 mb/dl is normal
    • risk factors: prematurity, intrauterine growth restriction, small for gestational age, postmaturity, large for gestation age, maternal diabetes, infection, asphyxia, cold stress.

    S&S: jittery, cyanosis, sweat, tachypnea, poor suck, apnea, low temp, dyspnea, irritable, lethargic

    heel stick: on lateral pads
  29. Jaundice
    • visible when serum bilirubin levels =5-7mg/dl
    • excessive RBC destruction
    • within 24 hours- liver
    • after 24 hours- unconjugated bilirubin

    TX: phototherapy, protect eyes, turn every 2 hrs. Prevent kernicterus
  30. Adaptations of Extrauterine life: urinary
    • void with 12-24 hours
    • 1-2 during first 2 days
    • at least 6 voids by day 4

    weight loss 5-10% of birth weight is normal
  31. Period of reactivity
    first period of reactivity: 15-30 min, alert and active, respirations irregular, vigorously respond to external stimuli, rapid HR, brief apnea. 

    Period of Sleep: 30min-2hrs, sleep, respiratory and HR decease, no response to stimuli

    Second Period of Reactivity: 2-8hrs, vary alert and sleep, respiration and HR depends on activity and stimuli. may pass mecomium, increased bowel.
  32. APGAR
    • at 1 and 5 minutes
    • adaptation; 10 is best score (uncommon)
    • respirations, crying
    • reflex, irritability
    • pulse, HR
    • skin color, extremities
    • muscle tone
  33. Nursing Actions during 4th stage of labor
    • keep warm, dry, put hat
    • APGAR at 1, 5 minutes
    • vital signs (if stable within 30 min, then 1 hr; unstable every 5-15 minutes)
    • inspect cord for bleeding
    • weight/height
    • assessment within 2 hours
    • gestational age assessment
    • blood glucose
    • Erythromyxin ophthalmic ointment
    • Phytonadione IM
    • Bath
  34. Erythromyxin ophthalmic ointment
    for gonococcal or chlamydial eye infections
  35. Acrocyanosis
    • cyanosis on feet and hands
    • normal
  36. Vernix
    • white cheesy substance on auxiliary and genital 
    • estimate gestational age
  37. Lanugo
    • fine, downy hair, decreases with age
    • premies
  38. Magolian spots
    • bluish discolored area on back, buttocks
    • mistaken for bruises
    • document size and location
  39. Erythema Toxicum
    • red rash macules an papules. 
    • normal
  40. Milia
    • white papules on face
    • normal
  41. Ecchymosis
    under eyes, face
  42. Mottling
    • transient pattern of pink and white blotches on skin
    • response to cold environment
  43. Harlequin Sign
    • one side of body pink, other white
    • vasomotor instability
  44. Molding
    • elongation of fetal head as it adapts to birth canal
    • resolved in 1 wk
  45. Cephalhematoma
    • hematoma between periosteum and skull, unilateral swelling
    • trauma
  46. Caput
    • localized soft tissue edema of scalp
    • spongy
    • pressure during labor
  47. Doll's Eyes
    symmetrical deviation of the eyes when the head is moved in different positions, always returning to center
  48. Epstein s Pearls
    • white, pearl-like epithelial cysts on gum margins and palate
    • benign
  49. Natal Teeth
    • usually benign but can be congenital defects
    • often loose, remove due to aspiration
  50. Hypospadias
    urethral opening is on the ventral surface of penis.
  51. Epispadias
    urethral opening is on the dorsal side of penis
  52. Barlow-Ortolani Maneuver
    • hip displacia
  53. Newborn Reflexes: Moro
    • hold baby, let head drop back
    • response: c shape with thumb and index finger
    • symmetrical abduction and extension of arms and legs and legs flex up against trunk.

    also startle reflex
  54. Newborn Reflexes: tonic Neck
    • turn head to side so chin is over shoulder
    • response: fencing

  55. Newborn Reflexes: Rooting
    • brush cheek near mouth
    • response: turns toward direction of stimulus

    may not response if recently fed
  56. Newborn Reflexes: sucking
    • place finger/nipple in mouth
    • response: sucking motion

    may not response if recently fed.
  57. Newborn Reflexes: palmer grasp
    • place finger in hand
    • response: grasps finger
  58. Newborn Reflexes: Plantar Grasp
    • place thumb against ball of feet
    • response: toes flex tightly down in grasping motiong
  59. Newborn Reflexes: Babinski
    • stroke lateral surface of sole upward
    • response: hyperextension and fanning of toes
  60. Newborn Reflexes: stepping
    • hold neonate upright with feet touch surface
    • response: steps with one foot up.
  61. Eye prophylaxis
    • early care
    • erythromycin, tetracycline, silver nitrate
    • prevent gonorrhea, chlamydia infections
    • into conjunctival sacs
  62. Vitamin K
    • early care
    • aquamephyton, phytonadione
    • prevent bleeding problems
    • IM vastus lateralis
  63. Cord Care
    • keep clean and dry, wash with soap and water
    • don't cover with diaper
    • remove clamp at 24 hrs
    • sponge bath until cord falls of (10-14 days)
  64. SIDS
    • back to sleep
    • remove soft bedding and stuffed animals
    • avoid overheating
    • avoid bed sharing
  65. Feedings
    • breast milk and formula are 20kcal/oz
    • don't need water

    • formula feed every 3-4 hrs
    • burp every 12 oz
  66. Newborn screenings
    • hearing
    • PKU
    • hypothyroidism
  67. Infant of Diabetic Mother
    • Macrosomia (birth weight of 4000 grams or more)
    • round face
    • skin is red (plethoric)
    • poor muscle tone
    • irritable/tremors

    monitor blood glucose, respiratory distress, cold stress
  68. Neonatal Abstinence Syndrome (NAS)
    • meconium may be drug test
    • signs of withdrawal start day 3
    • Signs: irritable, jitter, rigid muscle tone, high pitch cry, minimal sleep, fever, sweat, yawn, sneeze, fever, tachypnea
    • Interventions: feeding (frantic rooting and sucking, rest (dark room, swaddle, pacifier), bond
  69. Health Disparities LGBT
    • poor health:
    • unequal access to health coverage
    • stigma
    • lack of culturally competent health services
    • discrimination
    • scarcity of staff trained
  70. Sex
    • biological anatomy
    • male-intersex-female
  71. Gender Identity
    • how you feel about your sex
    • man-transgender-woman
  72. Gender Expression
    • how you present feelings to the world
    • masculine-androgynous-feminine
  73. Sexual Orientation
    • who you are attracted to
    • toward men-bisexual/pansexual-towards women
  74. Physical Behavior
    • physical action
    • with men-with more than one gender-with women
  75. LGBTQQI
    • lesbian
    • gay
    • bisexual
    • transgender
    • queer
    • questioning
    • intersex
  76. Administering Subcutaneous Medication
    • meds less than 1ml, sue TB syringe
    • 90 or 45 degrees
    • 5/8 inch needle, 23-25 gauge
    • pinch subcutaneous tissue
    • separate multiple by 1 inch
    • location: tricep, in children anterolateral thigh
    • what to administer: MMR, zoster, polio,
  77. Administer IM
    • Sites: deltoid, ventrogluteal site, vastus lateralis, baby on anterolateral thigh
    • 90 degrees
    • aspirate (unless vaccine)
    • 1 inch apart if multiple
    • What: DTaP, Hib, Hep A, Hep B, HPV, PCV, IPV
    • needle 5/8 inch to 1 and 1 1/2 for adults
    • 22-25 gague

    Note: smaller number: bigger needle
  78. Mixing medication
    • check compatibility
    • insulin: air into cloudy first, then clear-draw up clear then cloudy
  79. Administering Intradermal medication
    • PPD
    • ventral surface of forearm
    • 5-15 degrees into epidermis
    • insert until bevel is covered (1/8 inch)
    • wheal 1/4 inch
    • mark circle
  80. Psychosocial and psychological interventions to prevent postpartum depression
    • Overall, psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression.
    • Promising interventions include the provision of intensive, professionally-based postpartum home visits, telephone-based peer support, and interpersonal psychotherapy
  81. Postpartum Hemorrhage Prevention: uterine massage
    • Uterine massage given every 10 minutes for 60 minutes after birth effectively reduced blood loss.
    • downside: staff time and pain for woman
  82. Teen Birth Rates Drop
    • From 2007–2011, teen birth rates decreased 20% for non-Hispanic whites, 24% for blacks, 27% for American Indian/Alaska Natives (AI/AN), and 34% for Hispanics.
    • However, in 2007, non-Hispanic black and Hispanic teen birth rates were more than two times higher than the rate for non-Hispanic white teens, and remained so in 2011.
  83. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women
    Pelvic floor muscle training is commonly recommended both during pregnancy and after the birth to prevent and treat incontinence.
  84. Involution of uterus
    • uterus returns to pre-pregnant size, shape an location, placental site heals.
    • uterine contraction and atrophy of the uterine muscle
  85. Afterpains
    • first five postpartum days
    • cramps
    • related to the uterus working harder to remain contracted (prevent hemorrhage) and increase oxytocin
  86. Tone of fundus
    • firm (contracted) or soft (boggy)
    • boggy- not contracted, at risk for blood loss= massage, give oxytocin per orders

    position of uterus: if displaced can be because of distended bladder-risk for hemorrhage, have pt void
  87. Lochia
    bloody discharge from uterus contains sloughed off necrotic tissue-healing of uterus

    lochia rubba, lochia serosa, lochia alba

    scant, light, moderate, heavy (pad soaked in one hour)

    small clots normal, large report. both document size

    Concerns: clot size large, clumps, foul smell, return to bright red (need progression)
  88. Lochia Rubba
    • day 1-3
    • bloody with small clots, bright red
    • moderate to scant
  89. Lochia Serosa
    • day 4-10
    • yellow, pinkish
    • scant
  90. Lochia Alba
    • day 10
    • white color
  91. Primary Engorgement
    • increase in the vascular and lymphatic system of the breast, precedes initiation of milk production
    • breast become large, firm, warm, tender
    • resolves on own 24-48 hrs.

    TX: heat, express milk or feed infant, bra.  (if breast feeding, ice if not breast feeding)

    sequent breast engorgement
  92. Endocrine System Postpartal
    • estrogen, progesterone, prolactin levels decrease.
    • non-lactating: prolactin decrease
    • lactating: prolactin increase.

    Note: lactating-menses suppressed, ovulation suppressed

    contraceptives no estrogen
  93. Cardiovascular Postpartal
    • blood loss 500 mL  (c section 800-1000)
    • early ambulation: DVT
    • at risk for thrombosis due to clotting factors
    • risk orthostatic hypertension
  94. Homan's Sign
    • cardio postpartal
    • assess for DVT
    • A positive sign is present when there is pain in the calf on dorsiflexion of the patient's foot at the ankle while the knee is fully extended.[3]
  95. Postpartum Chills
    • chills, shaking for first few hours after deliver
    • due to vascular instability
    • normal
  96. GI Postpartal
    • at risk for constipation (decreased GI mobility, physical activity, fluid loss, perineal pain and trauma)
    • hemorrhoids
    • appetite
    • weight loss
  97. Urinary Postpartal
    • chart if urinated during labor
    • observe for bladder distention
    • check for UTI
    • if don't urinate within 12 hrs-catheter
    • measure first 24 hrs.
  98. Musculoskeletal Postpartal
    • muscle soreness is normal- ice pack then heat
    • diastatis recti abdominis
  99. Diastasis Recti Abdominis
    • separation of rectus muscle
    • normal finding
    • will diminish
  100. Immune Postpartal
    • Rh -Rhogam
    • Rubella (cant get pregnant)
    • temperature greater than 100.4 after first 24 hrs may be infection
  101. Postpartum Blues
    • common, first few weeks
    • due to hormone level change, fatigue, stress
    • S&S: anger, anxiety, mood swings, sad, cant eat or sleep.
    • can lead PPD
  102. BUBBLE
    • Breasts: engorgement, mastitis, nipples, latching
    • Uterus: fundus
    • Bowel Function: return to normal
    • Bladder Function: void 6-8 hrs at least 150 mL
    • Lochia: pooling, not complete pad in 1 hr
    • Episiotomy/perineum: REEDA: redness, edema, ecchymosis, discharge, approximation
    • Lower Extremeties: DVT, cap refills, pulses, need abulation
    • Emotions: fatigue
  103. REEDA: Perineum
    • redness
    • edema
    • ecchymosis
    • discharge
    • approximation
  104. Discharge Instructions Pospartal
    • concern-call
    • excessive lochia: smell, large clots, saturate pad in 1 hr
    • fever higher 100.4
    • frequent urination
    • breast tender, warm, red
    • chest pain, urination, signs of depression
  105. Postpartum Depression
    • lasts 6-12 months
    • risk: hx of depression, lack of support, poor relationship, stress
    • S&S: lack sleep, uncontrolled cry, fear, anxiety, guild, inability to care for baby, decreased affection, thoughts of harming child, suicidal thoughts.
  106. Cesarean Section check up
    • 2 wks-suture removal then 8 weeks
    • vaginal in 6 weeks.
  107. Postpartum Hemorrhage
    • blood loss greater than 500 mL within first 24 and 1000ml for C-section
    • causes: caused by uterine atony or a failure of the uterus to contract appropriately after delivery, lacerations, hematomas, retained placenta.
    • intervention: for boggy uterus: massage.
  108. Endometritis
    • most common postpartum infection
    • infection of endometrium, starts at placental site and spread to endometrium

    Risk: prolonged rupture of membranes, prolonged labor, C section, PPH, group beta strep

    S&S: fever, tachycardia, uterine tenderness, subinvolution, malaise, lochia heavy/foul, abd pain

    CBC, cultures, urinalysis-antibiotic.
  109. Sleep
    • cyclical states/altered consciousness
    • decreased motor activity

    promotes: increased metal performance (learn, memory), restore energy, improve ability cope, helps immune system
  110. Rest
    • milk to no activity
    • relax, stress free
    • feel refreshed
  111. Factors affect sleep
    • age
    • lifestyle
    • physical activity
    • food/alcohol
    • meds
    • caffeine
    • sleep habits
    • illness
    • environment (temp, noise, light, odor, bed)

    Nursing interventions: offer foods promote sleep, safety, sleep hygiene, educate meds, clustered care, environment, promote comfort/relaxation, support bedtime routines.
  112. Insomnia
    sleeplessness, is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired.
  113. Circadian disorders
    Circadian rhythm sleep disorders are a family of sleep disorders affecting, among other things, the timing of sleep
  114. Restless leg syndrome
    Restless leg syndrome is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations.
  115. Hypersomia
    • Hypersomnia, or excessive sleepiness, is a condition in which a person has trouble staying awake during the day.
    • People who have hypersomnia can fall asleep at any time.
  116. Sleep apnea
    sleep disorder characterized by pauses in breathing or instances of very low breathing during sleep
  117. Narcolepsy
    sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks.
  118. Bruxism
    grind teeth at night
  119. Stages of Labor
    • 1st: onset of contraction (latent: <3cm, active 4-7cm 6-24 hrs, transition 8cm to complete 3-6 hrs)
    • 2nd: dilation of cervix to birth of fetus (latent rest, labor down; active is pushing)
    • 3rd: birth of fetus to delivery of placenta
    • 4th: last about 2 hrs, bonding of baby.
  120. Leopold's Maneuvers
    • determine fetus location in the fundus
    • determine location of fetal back
    • presenting part
    • location of cephalic prominence.
  121. Nursing Support during labor
    • emotional support
    • information, coping techniques
    • comfort (massage, warm baths, etc.)
    • advocacy

    position: during firs stage: upright , second stage upright (helps align fetus)
  122. FHR monitoring: variability
    • decreased when fetus is asleep
    • decrease if hypoxia, acidosis

    parasympathetic and sympathetic nervous system
  123. Pelvic Sizes: Gynecoid
    • Best, 50%
    • inlet: round*
    • mid: round*
    • outlet: wide transverse AP diameter*
  124. Pelvic Size: android
    • 20%
    • inlet: heart shape*
    • mid: short AP diameter
    • outlet:short AP diameter
  125. Pelvic Size: Anthropoid
    • 25%
    • inlet: long AP diam*
    • mid: round*
    • outlet: narrow transverse
  126. Pelvic Size: Platapoid
    • 5%
    • inlet: wide transverse*
    • mid: round, wide*
    • outlet: wide transverse but short AP
  127. Nursing Practice Framework
    focus: health ecology/biomedical framework and person behaviors/environment 

    tx: person/environment: healing (hospital) to optimal self-reliance (shape health behaviors), coaching/guiding
  128. Nursing Framework
  129. Clinical Practice Knowing/Critical Thinking
    • knowledge/skills: education, CE, observe
    • Practice

    • Vulnerable (or resilient) person/systems
    • Environment/context (exposure or risks/resources)
    • clinical status: outcomes/result

    • Review, meta-analysis, practice guidelines
    •  
  130. Teaching Skills and Nursing Practice
    • client/family need information to make decision
    • shorter hospital stays, need more teaching for home care
    • compliance and shortens hospital stay
    • empower client/family

    • who:teach client, family, peers, groups, students, new employees
    • what: disease information, meds, procedures, prevention/promotion, clinical process.
    • what: change in behavior/knowledge/skill/attitude; change due to stimuli; active process not just give information.
  131. Teaching & Learning
    • Teaching: interactive, planning and implementing
    • effective communication- convey information, assess verbal and nonverbal feedback, accommodate learning styles.

    Learning:  change in behavior, knowledge, skills, attitudes

    • Rights:
    • time (free of pain, trust, enough time)
    • context (environment)
    • goal (engage, committed, include family, realistic)
    • content (appropriate, reinforcement, learning level)
    • method (learning style, ability to learn, strategies vary)
  132. Three Domains of Learning
    • Cognitive: thinking, storage/recall information
    • Psychomotor: do, hands-on, think and do
    • Affective: emotions, change feelings, beliefs, attitudes, values (influence how much is learned)

    assess learning: needs, health beliefs, readiness, ability to learn, literacy level, ability to see, hear, etc., learning style, time, resources.
  133. Learning Barriers
    • motivation
    • readiness (physical and emotions)
    • timing (open to learn)
    • active involvement
    • type of feedback given
    • repetition
    • learning environment
    • scheduling session
    • amount/complexity of content
    • communication
    • special population
    • developmental age
    • culture
    • literac
  134. SMART
    • specific
    • measurable
    • atteniable
    • relalistic
    • time
  135. Teaching Strategies
    • group discussion
    • demonstration
    • demonstration/return
    • one on one
    • audiovisual
    • printed materials
    • programmed instruction
    • simulation
    • role play
    • self instruction
    • distance learning
    • concept map
  136. Evaluate Learning
    • tests/written exercises
    • oral questions
    • interviews
    • questionnaires
    • simulation
    • checklist
    • direct observation of performance
    • client report
    • client records
  137. Components of a teaching Plan
    • teaching strategies: method
    • content: information to reach goal
    • Schedule: organization
    • Instructional Material: tools

    • documentation: learning needs, objectives, topics, measurable outcomes, need for more teaching, referrals, resources provided.
    • Rights: time (free of pain, trust, enough time)
    • context (environment)
    • goal (engage, committed, include family, realistic)
    • content (appropriate, reinforcement, learning level)
    • method (learning style, ability to learn, strategies vary)
  138. Cultural Diversity, nurses need to know:
    • how cultural groups understand life processes;    
    • how cultural groups define health and illness;    
    • what cultural groups do to maintain wellness;    
    • what cultural groups believe to be the causes of illness;    
    • how healers cure and care for members of cultural groups; and    
    • how the cultural background of the nurse influences the way in which care is delivered.
  139. Culture
    • what have in common
    • behavior patterns, arts, beliefs, customs, lifestyles
  140. Socialization
    process of learning to become a members of a society or a group
  141. Acculturation
    • immigrant assumes characterizes of that culture
    • accept both new and old culture
  142. Bicultural
    identify with two cultural groups
  143. Multicultural
    multiple cultures influencing a person, community, society
  144. Ethnocentrism
    belief own group is superior
  145. Culturally Competent Care: Purnell and Paulanka
    culture is learned, the totality of beliefs and practices that guide world view and decision making.

    cultural competence
  146. Culturally Competent Care: Leninger
    understanding cultural commonalities and cultural diversities in order to provide competent care.
  147. Culturally Competent Care: Campinha-Bacote
    cultural competency as process, not an end point, evolve over time.

    awareness, skills, knowledge, encounters, desire
  148. BALI
    • Be aware of your own culture
    • Appreciate patients culture
    • Learn more about patient culture
    • Incorporate beliefs into care plan.
  149. Elder Terminology
    • young old: 60-74
    • middle old: 75-84
    • old-old/elite old: 75-100
    • centenarians: over 100
  150. Geriatrics/Gerontology
    • Geriatrics: study and health care of elderly
    • Gerontology: branch of science aging and aging problems
  151. Ageism
    stereotyping and discrimination against old
  152. Senescence:
    late adulthood, after 65
  153. Senility
    characteristics of old age
  154. Life Span vs Life Expectancy
    • life span: max (110-120)
    • Life expectancy: men 72, women 79
  155. Fact: 48% of all hospitalized patients are above 65 yrs.
    • dependence on social security
    • other: subsidized housing, food stamps, stocks, saving, life/house insurance, health insurance
  156. Caring for Elderly
    • disease accumulate and interact
    • drugs accumulate and interact
    • atypical response to disease/tx
    • diminished physio reserve
    • Focus on improved function not cure disease
    • multiple losses impact physical/mental health
    • decisions
    • multidisciplinary approach

    decreased homeostasis, chronic illness
  157. Definition: chronic illness
    • permanent
    • leaves residual disability
    • nonreversible pathological alterations
    • requires special training for rehab
    • requires long period of supervision, observation or care

    arthritis, deformities, hypertension, hearing impairment, heart disease, cataracts

    • difficulties:
    • don't understand reason for tx
    • difficult procedures
    • time, finances, side effects
    • embarrassment
    • lack of support
    • depression
  158. Frail Elderly
    older adult with one or more chronic illness who are functionally impaired most of the time
  159. Geri Health Assessment
    physical, mental, functional, social/economic, environment

    • nutrition: deficiencies, diets high in fat, sugar: weight loss, albumin, anemia, muscle wasting, edema, poor wound healing
    • Physiological
    • sensory
    • cognition: safety
    • GI: elimination
    • Gallbladder
    • Pancreas
    • Liver
    • Immune: less efficient thermoregulation
  160. Newborn at risk: maternal factors
    • age >16 or >35
    • environment/drugs
    • disease
    • late/poor prenatal care
    • multiple gestations
    • low socioecon
    • gravida, para
    • pregnancy complications
  161. Newborn risk: intrapartum factors
    Intrapartum factors: HR abnormal, presentation, blood loss, rupture of membrane, fever, prolonged labor
  162. Newborn risk: neonatal factors
    • congenital anomalies
    • gestational age
    • SGA vs LGA
  163. SGA (small for gestational age)
    • asphyxia
    • hypoglycemia
    • polycythemia
    • hypothermia
    • hyperbilirubinemia
  164. LGA (large for gestational age)
    • birth trauma
    • hypoglycemia
    • polycythemia
    • poor motor
    • difficulty feeding
    • hyperbilirubiemia
  165. IDM (infant of diabetic mother)
    Characteristics: macrosomia (>4000grams), round face (tomato), skin red (plethoric), poor muscle tone, irritable

    problems: birth trauma, hypoglycemia, hypocalcaemia, hyperbilirubinemia, polycythemia, respiratory distress.

    TX: monitor blood glucose, trauma, signs for respiratory distress, signs of cold stress
  166. Post Term infant
    Characteristics: dry, crack skin; no vernix or lanugo; longer fingernails; abundant hair; long thing; skin loose; meconium stain

    induce at 40 wks

    problems: trauma, hypothermia, hypoglycemia, polycythemia, MAS, PPHN, pneumonia, pneumothorax
  167. Prematurity
    • <37 weeks
    • viable >24 weeks

    complications: respiratory distress, thermoregulation, nutrition, cardio, metabolic, nuero, developmental

    Beta mexidone to help lungs mature, steroid prior to delivery try to stop so lungs develop
  168. Respiratory Distress Syndrome
    • increases work 4-6 hrs
    • grunt, flare, retracting (suprasternal, intercostal, sub sternal, subcostal)
    • tachypnea
    • cyanosis
    • x-ray
    • worsen in 48-72 hrs

    complications: air leaks (leads to pneumothorax) infection, apnea, chronic lung disease

    • TX: oxygen, CPAP if PaO2<40 or PaCO2>60,
    • surfactant replacement,
  169. Artificial surfactant
    • decreases surface tension
    • decreases work for breathing
    • decreases leaks (protein and water=edema)
    • decreases atelectasis
    • increases alveolar stability on expiration
  170. Patent Ductus Arterious
    ductus arterious remains open after birth

    complications: CHF, chronic lung disease, renal failure, intraventicular hemorrhage

    Assessment: heart murmur, apnea/bradycardia, bounding pulse

    DX: echocardiogram
  171. Intraventicular Hemorrhage
    • preemies at high risk, RDS
    • within 72 hrs
    • grade 1-4, head ultrasound

    • S&S: full or bulging fontanel, decreased BP, need oxygen
    • interventions: keep warm and head midline

    • Grade I: germinal matrix
    • Grade II: inside ventricle
    • Grade III: ventricle and enlarged by the blood
    • Grade IV: into brain tissue
  172. Neonatal Abstinence Syndrome (NAS)
    • infant urine and meconium can be drug tested
    • opiates withdrawal symptoms
    • severe go to NICU

    S&S: irritable, jittery, poor muscle tone, overactive moro, high pitched cry, fever, diaphoretic
  173. Group B Streptococcal Disease
    • cause meningitis and sepsis
    • all women tested 37 weeks

    Risk factors: hx, UTI, deliver before 37 wks, fever during labor, ROM prolonged, ROM before 37 wks

    • early onset: vertical transmission
    • late onset: horizontal (external to infant
  174. Nursing Documentation
    must be legible, identify patient, support for dx, justify tx, document results, advice

    needs to accurately reflect: nursing assessment, care, tx, and other services

    • date/time, legible, grammatically correct, spelling
    • objective, include quotes, abbreviation standards
    • correct errors according to institutional policy
    • conversation with family
    • second hand information provide who
    • translator
    • don't alter record later, write addendum or late entry note
    • don't point fingers
    • disclosure
    • follow up tx and responses to tx
  175. Spontaneous abortion
    Occur without medical or mechanical means, miscarriage.
  176. Threatened abortion
    Continue pregnancy, have bleeding. Intervention: bed rest.
  177. Incomplete abortion
    Fragments retained, can cause infection. With medication cause cramps=release products of conception
  178. Missed abortion:
     fetus expires during first 20 wks, retained in uterus, do D&C
  179. Ectopic pregnancy
    • Implant somewhere other than uterus, i.e. fallopian tubes.
    • Salpingostomy (remove from tubes)
    • Risk: pelvic inflammatory disease, anything scarring tubes
    • S&S: vaginal bleeding, doubled over to one side.
  180. Molar Pregnancy
    • Villi fills with fluid, incomplete pregnancy (not viable). Genetic abnormalities.
    • Hcg continues to rise, due ultra sound
    • D & C, Rhogam.
  181. DIC (disseminated intravascular coagulation)
    • Syndrome body breaking down blood clots faster than it forms clots.
    • Hemorrhage, can lead to maternal death. Delivery baby.
    • Decrease uterine activity, induce labor, fluid balance, pain, FHR
  182. Placenta Previa
    Placenta attaches near cervical os (partial), or on. Causes bleeding

    Risk factors: advanced maternal age, prior c section, smoke/drugs, pervious hx, uterine scaring, endometriosis, hx of induced abortion.

    Cardinal Sign: bright red painless bleeding late in pregnancy. Bed rest.
  183. Placental Abruption
    Separation of placenta from its sight af implantation after 20 wks and before delivery.  (Partial or complete)

    Bleeding can be concealed or apparent.

    S&S dark red bleeding, uterus is tender, abd stiff, dull ache that radiates, balling up in uterus.

    Risk: drug, alcohol, smoke, hypertension, diabetes, advanced maternal age, abd trauma, abuse, mult pregnancy.

    Hypoxia for fetus, cerebral palsy, death.

    DIC for mom
  184. PIH (pregnancy induced hypertension)
    • At least two separate occasions of higher than 140/90 readings after 20 wks.
    • 4-6 hrs apart.
    • Resolves at least 12 wks postpartum.
    • Monitor protein output in urine.
  185. Preeclampsia:
    gestation hypertension (140/90) + proteinuria

    Proteinuria: 24 hr urine: 300mg of protein or urine dipstick +1 or +2. HELLP
  186. Eclampsia:
    • Seizure activity with preeclampsia.
    • Intervention: bed rest, deliver. S&S headache, epigastric pain, N & V
    • Risk: first pregnancy, African, diabetic, advanced maternal age, multiple gestations.
    • @ Risk for:  stroke, DIC, placental abruption
  187. HELLP(hemolysis, elevated liver enzymes and low platelets)
    • Complications of severe preeclampsia
    • Hemolysis: red blood cells destruct as travel through vessels 
    • Elevated liver enzymes:  from decreased blood flow and damage to liver
    • Low platelets: platelets aggregating at the site of damaged vascular endothelium
  188. Gestational diabetes Mellitus: 
    • Test at 24 and 28 wks gestation.
    • Oral glucose test.
    • Positive 130 or 140
    • Risk:  maternal obesity, advanced maternal age, African, previous hx, macrosomic baby, family history.
    • Baby @ risk for:  hypocalcemia, hyperbilirubin, respiratory distress. (monitor fetal nonstress test, Biophysical Profile)
  189.  Premature Rupture of Membranes (PROM)
    Rupture of membrane one hour before onset of labor
  190. Preterm premature rupture of membranes (PPROM)
    • before 37 weeks.
    • give med that softens cervix (sevadil)=labor
    • risks for: infection, preterm labor/birth,
  191. Preterm Labor
    • labor after 20 weeks, but before 37 weeks
    • Risk: infection, dehydration, PPROM, substance abuse, uterine bleeding, diabetes, preeclampsia.
    • Dx: 4 contractions in 20 minutes or 8 contractions in 60 minutes. with progressive change in cervix (increase of more than 1 cm and efface 80%)
  192. Cesarean Birth (C Section)
    • deliver through abdominal wall via incision.
    • increased hospital stay, longer recover, increased pain, negative emotions response.
    • Complications after: hemorrhage, DVT, PE, paralytic ileus, hematuria, infections
    • assess or involution, fundus, lochia, incision care.
  193. Thrombophlebitis
    • an inflammation of a blood vessel wall with subsequent blood clot formation, especially in the lower extremities and the pelvis.
    • risk factors are of greater concern: patients with existing varicose veins; clotting disorders; C-section delivery; DM II; advanced maternal age; smoking; obesity; prolonged sitting or standing.
    • Interventions:  signs of blood clot (presence of an area that is hot, red, painful, edematous). Elevation of affected limb is an appropriate intervention.
  194. Bereavement
    • the state of being without, or the absence of someone or something to which the person is attached or value
    • loss person, thing, relationship, situation.
  195. Mourning
    • ourward, social expression of loss.
    • influenced by culture
  196. Grief: Normal
    physical, emotion, cognitive, and behavioral reactions

    tight chest, palpitations, GI disturbance, lack energy, weight gain/loss, shakes

    numbness, sad, fear, anger, anxiety, despair, empty, shame, etc.

    disbelief, confusion, inability to concentrate

    carry reminders, over-reactivity, changed relationships, impaired work, crying.
  197. Grief: Anticipatory
    • grief before a loss or fear of potential loss.
    • help prepare

    • living will, etc.
    • can be misinterpreted.
  198. Grief: Disengranchised
    encountered when a loss cannot be openly acknowledged, socially sanctioned
  199. Complicated Grief
    • normal grief, but reactions intensify and prolonged
    • interfere with physical, social, pysch function.
  200. Chronic Grief
    reactions don't subside but instead continue over long period of time.
  201. Delayed Grief
    reactions are suppressed/postponed
  202. Exaggerated Grief
    survivor resorts to self-destructive behaviors i.e. suicide.
  203. Masked Grief
    survivor is unaware that behaviors that are interfering with normal functioning are a result of a loss.

    careless behavior
  204. Children Grief
    depends on developmental age.

    signs: nervousness, rages, sick, accident, antisocial, rebel, nightmares, depression,
  205. Nursing Interventions for grief
    • presence
    • listen, touch,
    • let them tell you, encourage reflection
    • identify feelings
    • normalize grief
    • identify support systems
    • provide spiritual support
  206. Theories of Aging
    • Biological (change in body: genetic, free radicals, immunity, neuroendocrine, organs) helps nurse understand how body change, plan care to decrease vulnerability to stress/disease (health promotion/prevention)
    • Sociological: disengagement, activity, continuity; gain insight how pt responds to illness, plan activities and teaching
    • Psychological: human needs. understand pt, where they are coming from.
  207. Aging: changes
    • Physio: Brain: neurotransmitters decrease, bran cells loses, neurons reduce size.
    • Intelligence: crystal maintained (acquired knowledge-wisdom), fluid-gradual decrease (emotions, created, spatial, nonintellectual information), pychomotor decline
    • learning: slower at processing information
    • attention span: decreased
  208. Nursing action in aging population
    • time for response: 19 seconds
    • memory: lists, post it notes
    • promote/support health
    • decrease anxiety, depression
  209. Delirium
    • acute confusion (temporary, reversible)
    • risk: >80 years old, infection, dehydration, fracture, electrolyte imbalance.
    • alters LOC
  210. Pseudo-Dementia
    • depression
    • appears as dementia
    • medication induced, psychotic conditions
  211. Dementia
    • progressive impairment in cognitive function (memory, orientation, judgment, reasoning, attention, language and problem solving)
    • decline in 2 or more acquired intellectual functions
    • stable LOC.
    • chronic, permanent

    most common: Alzheimer's disease
  212. Alzheimer's Disease
    • most common form of dementia
    • irreversible decline in: memory, performance of routine tasks, time/space orientation, communication, abstract thinking, ability to learn

    • atrophy of brain with neurotic plaques
    • disturbances in neurotransmitters Actylcholine, serotonin (sleep pattern)

    death due to patient noncompliance in meds, malnutrition, etc.

    • down syndrome
    • genetic link?
    • dx: autopsy or biopsy, clock test
  213. Dementia Nursing Management
    • safety: child proof, but respect patient
    • no restriction, but safety
    • decrease stimuli
    • don't argue
    • watch for discomfort
    • protect individuality, independence
  214. Elder Abuse
    • Physical: physical pain/injury, restraint
    • Sexual: non-consensual sexual contact
    • Psychological/Emotion: mental pain, distress through verbal and nonverbal acts
    • Material/Financial Abuse: improper use of funds
  215. Neglect
    • failure or refusal to fulfill any part of a person's obligations or duties to an elderly person
    • active: intentional failure to care
    • passive: unintentional
    • self neglect: own behavior threatens then
  216. Abandonment
    desertion of elderly by an individual who has physical custody of the elder or who has assumed responsibility for their care.

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