NUR2513: Maternal Child Nursing Exam 3
Exam 3 Terms and Talking Points
● Echocardiogram
o A noninvasive ultrasound used to visualize the heart. It provides details on the
structure including dimensions, movement, and pressure gradients. It can also be
used to estimate blood flow.
▪ There is a high r/o bleeding, so one must lie on that side for quite a while.
● Cardiac catheterization
o An invasive procedure involving inserting a catheter through a large vein and
artery to get to the heart. It allows for direct measurements of pressure,
visualization of structures using a contrast medium, and some corrective
procedures.
● CT imaging
o Creates many views of an organ (as if in slices). Dense structures appear white
while less dense structures appear gray/black.
▪ PET/SPECT: a CT with the use of an iodine-based radio isotopic contrast
medium
▪ The machine resembles a large tube.
o The child must lie still to avoid creating artifacts (may require sedation)
● Epiglottitis
o Patho: Inflammation of the epiglottis (flap that covers the larynx). This is an
emergency because the epiglottis cannot open to allow in air. It occurs often from
the age of 2 to 8 years old. It can be bacterial or viral (H. influenzae B is a
common cause that has been reduced by hib vaccine).
o Assessment: It resembles a mild upper respiratory tract infection, but spreads to
the epiglottis in 1 to 2 days. The child then experiences a high fever, sore throat,
inspiratory stridor, hoarseness, tongue protrudes, and excessive saliva.
▪ Stimulating the gag reflex can cause a complete obstruction, so never
attempt to stimulate it, visualize it, or get a direct culture.
o Management: Oxygen is used for respiratory distress, IV fluids, antibiotics, and
an endotracheal airway may be required to manage.
● Pyelonephritis
o An infection of the pelvis of the kidney. It is usually d/t E. coli from a UTI.
o The client will have CVA tenderness, fever, flank pain, and symptoms of a UTI
o It is treated with antibiotics
● Hydrocele
o A collection of fluid within the processus vaginalis of the scrotum. This can be
seen in utero with an ultrasound, and it causes the scrotum of the newborn to be
enlarged. An uncomplicated hydrocele will go away on its own (fluid is
reabsorbed).
o They can also occur d/t an inguinal hernia, and they go away when the hernia is
repaired.
o A drug injection can be used to decrease fluid production in older adults
,● Epispadias
o A defect in the dorsal wall of the urethra resulting in the meatus being located on
the top side of the penis. This can result in UTIs because some urine becomes
trapped (incomplete incontinence). It can also interfere with fertility in the future.
o A meatotomy can be done to extend the urethra to its normal position. Surgical
repair may be delayed util age 3 to 4 if extensive and a testosterone cream may be
needed to encourage growth.
o A urinary catheter will be in place for 3 to 7 days and causes painful bladder
spasm (acetaminophen and oxybutynin for pain relief)
● Cord Prolapse
o Can occur anytime the membranes rupture if the fetus is not firmly fitted into the
cervix. The risk is increase with presentation other than cephalic, placenta previa,
intrauterine tumors, small fetus, polyhydramnios, multiple gestation
▪ The pressure of the baby’s head can completely occlude blood flow
o Assessment: cord is felt or visualized as presenting and the FHR has variable or
late decelerations.
o Manage: put pressure on the presenting part of the fetus to relieve pressure on the
cord. This requires an emergency c-section
▪ Also, one can use the knee chest position, Trendelenburg position, oxygen,
tocolytics, and amnioinfusion
● Decreased fetal movement
o Do kick counts (at least 10 moves per hour). If baby is not moving, they may be
asleep, so eat sugar, change pos, or walk (measure again in 1 hour). If 10 kicks are
not felt in the second attempt, get to the hospital. May or may not be serious
(placental insufficiency or poor maternal nutrition). Recommended not start
before 24 to 28th weeks
● 1st trimester, 2nd trimester, and 3rd trimester labs
o 1st Tri: hcg, CBC, STD check, Rh factor, rubella status
o 2nd Tri: glucose screen (at 24 to 28 weeks)
o 3rd Tri: GBS swab (at 36 weeks), amniocentesis (lung maturity)
● NST
o Nonstress test: Measures FHR in response to movement. Uses an FHR monitor
and uterine contraction monitor. The woman pushes a button when she feels a
movement. The FHR should increase 15+ bpm for 15 seconds and return to
baseline (no change may = poor oxygenation/placental perfusion). The test lasts
20 minutes, at least 2 movements are expected, no movement could mean the
fetus is sleeping (give OJ or walk around)
o Goals: establish baseline, check for variability, check for variable accelerations,
and decelerations
▪ Decelerations: early, variable, late
o Nonreactive
, ▪ No fetal movements occur or there is low short term FHR variability (< 6
bpm) throughout testing
▪ A nonreactive requires further testing (biophysical profile test)
▪ Baby could be sleeping, has hypoglycemia, or decreased perfusion
● Bronchiolitis
o Inflammation of the small bronchioles and is usually d/t to a virus (RSV most
commonly). It occurs most commonly in children younger than 2.
o Assessment: Initial congestion, rhinorrhea, and fever. Progresses to a dry hacking
cough, hoarseness, rhonchi, rales, wheezing, and retractions. Diagnosis based on
symptoms or ELISA
o Management: Antipyretics, hydration, nasal suctioning, nasal saline, avoiding
tobacco, and hospitalization in severe cases. Hand washing prevents spread.
Palivizumab antibody can be used as a prophylactic during RSV season.
Symptomatic treatment
▪ A hot shower (steam can also help)
● Kawasaki Disease
o Patho: A febrile syndrome that involves generalized vasculitis leading to coronary
aneurysms, thrombus formation, and myocardial infarction. It has an unknown
etiology, but it appears to occur after infections. It is a disease by exclusion.
o Assessment: It is divided into an acute phase (week 1) and subacute phase (week
2 and 3). The criteria include a fever (>100.4F) for 5+ days and four or more of
the following:
▪ Hand/feet changes (edema, erythema, peeling)
▪ Polymorphus exanthema (diffuse maculopapular rash of trunk/extremities)
▪ Bilateral conjunctivitis without exudate
▪ Changes in lips/mouth (strawberry tongue, cracked lips, erythema)
▪ Cervical lymphadenopathy
o Assessment Cont.: Lab data includes thrombocytosis, leukocytosis, +ESR, +CRP,
+liver enzymes, and mild anemia. The acute phase involves, irritability, fever, and
joint pain. The subacute phase involves desquamates, platelet count increase,
aneurysms, thrombi formation, and MI
o Management: The use of antipyretics, IV fluids, and IVIG (passive immunity) +
aspirin for coronary aneurysms.
● Administration of blood products
o The blood product must be carefully matched to the child’s blood type.
o It must be infused with an isotonic solution (normal saline) to prevent hemolysis
▪ Hypotonic solutions cause RBCs to rupture and hypertonic causes them to
shrink
o Packed RBCs is the most common transfusion because it helps minimize overload
▪ Typically given 15 ml/kg at 10 ml/kg/hr
▪ Proportions of 10 ml/kg will raise Hct by 5 points and plates by 10,000
mm3
Exam 3 Terms and Talking Points
● Echocardiogram
o A noninvasive ultrasound used to visualize the heart. It provides details on the
structure including dimensions, movement, and pressure gradients. It can also be
used to estimate blood flow.
▪ There is a high r/o bleeding, so one must lie on that side for quite a while.
● Cardiac catheterization
o An invasive procedure involving inserting a catheter through a large vein and
artery to get to the heart. It allows for direct measurements of pressure,
visualization of structures using a contrast medium, and some corrective
procedures.
● CT imaging
o Creates many views of an organ (as if in slices). Dense structures appear white
while less dense structures appear gray/black.
▪ PET/SPECT: a CT with the use of an iodine-based radio isotopic contrast
medium
▪ The machine resembles a large tube.
o The child must lie still to avoid creating artifacts (may require sedation)
● Epiglottitis
o Patho: Inflammation of the epiglottis (flap that covers the larynx). This is an
emergency because the epiglottis cannot open to allow in air. It occurs often from
the age of 2 to 8 years old. It can be bacterial or viral (H. influenzae B is a
common cause that has been reduced by hib vaccine).
o Assessment: It resembles a mild upper respiratory tract infection, but spreads to
the epiglottis in 1 to 2 days. The child then experiences a high fever, sore throat,
inspiratory stridor, hoarseness, tongue protrudes, and excessive saliva.
▪ Stimulating the gag reflex can cause a complete obstruction, so never
attempt to stimulate it, visualize it, or get a direct culture.
o Management: Oxygen is used for respiratory distress, IV fluids, antibiotics, and
an endotracheal airway may be required to manage.
● Pyelonephritis
o An infection of the pelvis of the kidney. It is usually d/t E. coli from a UTI.
o The client will have CVA tenderness, fever, flank pain, and symptoms of a UTI
o It is treated with antibiotics
● Hydrocele
o A collection of fluid within the processus vaginalis of the scrotum. This can be
seen in utero with an ultrasound, and it causes the scrotum of the newborn to be
enlarged. An uncomplicated hydrocele will go away on its own (fluid is
reabsorbed).
o They can also occur d/t an inguinal hernia, and they go away when the hernia is
repaired.
o A drug injection can be used to decrease fluid production in older adults
,● Epispadias
o A defect in the dorsal wall of the urethra resulting in the meatus being located on
the top side of the penis. This can result in UTIs because some urine becomes
trapped (incomplete incontinence). It can also interfere with fertility in the future.
o A meatotomy can be done to extend the urethra to its normal position. Surgical
repair may be delayed util age 3 to 4 if extensive and a testosterone cream may be
needed to encourage growth.
o A urinary catheter will be in place for 3 to 7 days and causes painful bladder
spasm (acetaminophen and oxybutynin for pain relief)
● Cord Prolapse
o Can occur anytime the membranes rupture if the fetus is not firmly fitted into the
cervix. The risk is increase with presentation other than cephalic, placenta previa,
intrauterine tumors, small fetus, polyhydramnios, multiple gestation
▪ The pressure of the baby’s head can completely occlude blood flow
o Assessment: cord is felt or visualized as presenting and the FHR has variable or
late decelerations.
o Manage: put pressure on the presenting part of the fetus to relieve pressure on the
cord. This requires an emergency c-section
▪ Also, one can use the knee chest position, Trendelenburg position, oxygen,
tocolytics, and amnioinfusion
● Decreased fetal movement
o Do kick counts (at least 10 moves per hour). If baby is not moving, they may be
asleep, so eat sugar, change pos, or walk (measure again in 1 hour). If 10 kicks are
not felt in the second attempt, get to the hospital. May or may not be serious
(placental insufficiency or poor maternal nutrition). Recommended not start
before 24 to 28th weeks
● 1st trimester, 2nd trimester, and 3rd trimester labs
o 1st Tri: hcg, CBC, STD check, Rh factor, rubella status
o 2nd Tri: glucose screen (at 24 to 28 weeks)
o 3rd Tri: GBS swab (at 36 weeks), amniocentesis (lung maturity)
● NST
o Nonstress test: Measures FHR in response to movement. Uses an FHR monitor
and uterine contraction monitor. The woman pushes a button when she feels a
movement. The FHR should increase 15+ bpm for 15 seconds and return to
baseline (no change may = poor oxygenation/placental perfusion). The test lasts
20 minutes, at least 2 movements are expected, no movement could mean the
fetus is sleeping (give OJ or walk around)
o Goals: establish baseline, check for variability, check for variable accelerations,
and decelerations
▪ Decelerations: early, variable, late
o Nonreactive
, ▪ No fetal movements occur or there is low short term FHR variability (< 6
bpm) throughout testing
▪ A nonreactive requires further testing (biophysical profile test)
▪ Baby could be sleeping, has hypoglycemia, or decreased perfusion
● Bronchiolitis
o Inflammation of the small bronchioles and is usually d/t to a virus (RSV most
commonly). It occurs most commonly in children younger than 2.
o Assessment: Initial congestion, rhinorrhea, and fever. Progresses to a dry hacking
cough, hoarseness, rhonchi, rales, wheezing, and retractions. Diagnosis based on
symptoms or ELISA
o Management: Antipyretics, hydration, nasal suctioning, nasal saline, avoiding
tobacco, and hospitalization in severe cases. Hand washing prevents spread.
Palivizumab antibody can be used as a prophylactic during RSV season.
Symptomatic treatment
▪ A hot shower (steam can also help)
● Kawasaki Disease
o Patho: A febrile syndrome that involves generalized vasculitis leading to coronary
aneurysms, thrombus formation, and myocardial infarction. It has an unknown
etiology, but it appears to occur after infections. It is a disease by exclusion.
o Assessment: It is divided into an acute phase (week 1) and subacute phase (week
2 and 3). The criteria include a fever (>100.4F) for 5+ days and four or more of
the following:
▪ Hand/feet changes (edema, erythema, peeling)
▪ Polymorphus exanthema (diffuse maculopapular rash of trunk/extremities)
▪ Bilateral conjunctivitis without exudate
▪ Changes in lips/mouth (strawberry tongue, cracked lips, erythema)
▪ Cervical lymphadenopathy
o Assessment Cont.: Lab data includes thrombocytosis, leukocytosis, +ESR, +CRP,
+liver enzymes, and mild anemia. The acute phase involves, irritability, fever, and
joint pain. The subacute phase involves desquamates, platelet count increase,
aneurysms, thrombi formation, and MI
o Management: The use of antipyretics, IV fluids, and IVIG (passive immunity) +
aspirin for coronary aneurysms.
● Administration of blood products
o The blood product must be carefully matched to the child’s blood type.
o It must be infused with an isotonic solution (normal saline) to prevent hemolysis
▪ Hypotonic solutions cause RBCs to rupture and hypertonic causes them to
shrink
o Packed RBCs is the most common transfusion because it helps minimize overload
▪ Typically given 15 ml/kg at 10 ml/kg/hr
▪ Proportions of 10 ml/kg will raise Hct by 5 points and plates by 10,000
mm3
