Maternal Child Final Exam Study Guide- Fall 2024

Hip Dysplasia: - Abnormal development of the pelvic joint causing the head of the femur and the acetabulum not to be aligned properly. Assessment Findings: -Asymmetry & unequal # of skin folds on the posterior thigh. -Limited hip abduction -Shortening of the femur -Widened Perineum -Positive Ortolani test -Positive Barlow test -One leg shorter -Walking on the toes on one foot -Walk with a limp Warning Signs of Preeclampsia: - - Hypertension (140/90+) - protein in urine (1+) - Right upper quad abdominal pain - Severe and constant headaches - Swelling (especially of the face) - Dizziness - Blurred vision - Sudden weight gain (1 lb/day) Methergine (Methylergonovine) - Indication: PPH due to uterine atony or subinvolution. Stimulates contraction of the uterine smooth muscle. ***Contraindication: hypertension!!!!! Pelvic inflammatory disease (PID) - inflammation of organs in the pelvic cavity; usually includes the fallopian tubes, ovaries, and endometrium; most often caused by bacteria. Discharge Teaching: -IUDs increase the risk for PID. -Can cause infertility, ectopic pregnancy, PE, septicemia, ovarian abcess. -Encourage safe sex, and avoid multiple sex partners. Syphilis: Assessment (Primary Stage) - Chancre at site of inoculation begins as papule then ulcerates with a hard edge and clean, yellow base; indurated and PAINLESS; usually located on genitalia; may be solitary or multiple; persists for 1-5 weeks and heals spontaneously Chancre may go unnoticed in females Regional lymphadenopathy Gardasil - Human papillomavirus vaccine; Given to females age 9-26. Need 3 doses of vaccine. Ovarian cancer symptoms: - Early Stages: Abdominal pain Abdominal bloating Urinary urgency/frequency Difficulty eating Feeling full quickly while eating. Late Stages: Increased abdominal girth Unexplained weight loss/gain Menstral changes Education: Preparing for mammogram: - Yearly mammogram starting at age 40. Do not wear deodorant or lotions. Cervical/Uterine Cancer: - Painless, Vaginal bleeding. Genital Herpes Treatment - Cannot be cured; Treat the symptoms with antiviral meds. Ex: Famciclovir, acyclovir, and valacyclovir Normal Vital Signs for Infants - HR= 110-160 RR=30-60 T= 97.0-100.3 Blood sugar= ABOVE 40. Diaphragm Education - Must be refitted every 2 years. Must be refitted if 7kg (15lb) weight change. Must be refitted after pregnancy or second term abortion. Must remain in place 6 hours after intercourse. Apply spermicidal jelly or cream HELLP syndrome - hemolysis, elevated liver enzymes, low platelet count. S/S: Malasie, Influenza-like symptoms, epigastric or right upper quad abdominal pain. Symptoms tend to worsen at night and improve during the day. ***Elevated ALT and AST are indicative of HELLP Hypotension during epidural: Treatment: - Turn to lateral position, place a wedge under one hip. Maintain IV infusion rate or increase according to protocol. Administer 02 by nonrebreather mask at 10-12L/min Elevate legs Administer IV Vasopressor Remain with patient and monitor vitals & FHR Q5 mins. Reassuring fetal heart rate: - Stable fetal heart rate, moderate varability, accelerations, unterine contractions greater than every 2 minutes; duration less than 90 seconds, relaxation interval of at least 60 seconds. Post Date Newborns Apperance: - Dry wrinkled skin Eyes wide open Very little vernix Abundant hair on scalp Long finger nails Folic Acid - Decreases the incidence of neural tube defects. Signs of Hypoglycemia in newborns: - Jitteriness Tremors Irritability Lethargy Hypothermia Hypotonia Poor Feeding Poor Sucking Weak/high-pitched cry Exaggerated Moro reflex Seizures Coma Cyanosis Irregular respirations Apnea Betamethasone (Celestone) - Antenatal steroids. Stimulate production of surfactant in fetus between 24 and 34 weeks gestation. Promotes fetal lung maturity in preterm labor when delivery is likely. Side effects: fluid retention and elevated BP. Administer 2 doses 12mg (usually IM) 24 hours apart (repeat doses not recommended). Provide emotional support to family. Rotavirus - The most important global cause of infantile gastroenteritis. Major cause of acute diarrhea in the USA during winter, especially in daycare centers, kindergartens. Induces fever and vomiting for 2 days and watery diarrhea for 5-7 days. Transmission is fecal-oral. Reye's syndrome (RS) - a potentially fatal condition that has been linked to giving aspirin (salicytate) products to children suffering from viral infections (examples: influenza, gastroenteritis, varicella). Affects the liver and the brain causing liver dysfunction and cerebral edema. Acute rapidly progressing encephalopathy S/S: Lethargy Irritability Combativeness Confusion Delirium Profuse Vomiting Seizures Loss of consciousness Hypoglycemia ***LABS: -Elevated ALT and AST -Decreased PT ***Monitor Neuro Status!!! Mannitol may be given to reduce cerebral edema. Kawasaki disease - Acute systemic vasculitis, resolves in less than 8 weeks. Acute phase: onset of high fever lasting 5 days to 2 weeks, unrelieved by antipyretics. S/S: Enlarged lymph nodes Strawberry tongue Non-blistering rash of hands and feet Bright red, chapped lips Treatment: gamma globulin meds Aspirin!!! Late decelerations - ***BAD! Indicative of TRUE FETAL DISTRESS!!! Fall in fetal heart rate, beginning at or after peak of contraction and returning to baseline after contraction has ended. Cause: uteroplacental insufficiency Intervention: change mom's position, stop pitocin, give O2 and increase fluids Early decelerations - *safe* Begin prior to peak of the contraction and end by the end of it. they are caused by head compression. no need for intervention if variability is within normal range (6-10) and the FHR is within normal range. Variable decelerations - Abrupt decrease in FHR. Cord compression! -as noted "V" shape on monitor; cord compression; change mothers position, stop pitocin if running, apply oxygen, and increase IV fluids Legg-Calve-Perthes Disease - avascular necrosis of the femoral head. Be unilateral or bilateral. Stages include: synovitis, necrotic, fragmentation, reconstruction. Causes by temporary reduction of blood flow to the femoral head. S/S: painless limp, hip stiffness, limited ROM, knee/hip/thigh pain, shortening of affected leg, muscle wasting. Treatment: Limited weight bearing treatment (braces/casts), Rest, NSAIDS for pain, Physical Therapy, Traction, or osteotomy of the hip or femur. Elemite (Nix) - Permethrin- used to treat scabies and head lice (pedi capitis) S/S of brain tumor in children - Headache (worse in the morning) Vomiting/Nausea Buldging fontanels Drowsiness High-pitched cry Decline in school Seizures Diminished physical activity Appendicitis S/S - RLQ pain Low grade fever Nausea Rebound tenderness at McBurney's point Rigid abdomen Decreased/Absent bowel sounds Treatment: Appendectomy (removal of appendix) Rutured Appendix S/S: Sudden relief of pain, followed by increased pain Appendectomy - Pre-op= IV Fluid IV Antibiotic Post-op= Respiratory status and maintain airway Provide 02 as prescribed Obtain vitals Administer analgesics for pain Assess surgical site for bleeding Assess bowel sounds and bowel function Fifth's Disease (Erythema Infectiosum) S/S: - Headache Fever Rashes on cheeks Malaise Abdominal pain Sore Thoat ***Droplet precaution*** Corticosteroid therapy: - Long term effects=growth delays! Lead poisoning symptoms - Irritability Lethargy Anorexia Vomiting Diarrhea Anemia ***Monitor Neuro Status*** Permetherin Cream Education: - Treat all people who have been in close contact over 30-60 days with affected child. (Scabies) Retreat head in 7-10 days after first treatment (lice). Scoliosis - "S like curvature" in the spine. S/S: asymmetry of shoulder height, scapular or flank shape, hip height, or asymmetry of ribs, improperly fitting clothing, one leg shorter than the other. Treatment: Moderate curves (25-45 degrees)= bracing -wear brace for 23 hours per day only remove for personal hygiene (showering). Curves greater than 45 degrees= surgery required -spinal fusion with rod placement Juvenile Rheumatoid Arthritis (JRA) - a chronic arthritic condition affecting the joints that occurs before 16 years of age. S/S: swelling and loss of motion of affected joint, inactivity may increase stiffness or pain, morning stiffness, obvious limp, delayed growth, fever, rash. Nursing considerations: -Assist client with exercise program -Encourage a support group -Encourage physical therapy -Encourage activity as tolerated -Encourage Full ROM exercises -Evaluated pain and response to analgesics -Goal: control pain, minimize damage from inflammation, preserve joint function, and promote normal growth and development. -Apply heat or warm moist packs to affected joints before exercise. -Appropriate exercises (swimming) -Warm baths (paraffin or whirlpools) -Allow adequate time for completion of self-care. -Well balanced diet with adequate fluid intake -Participation in school and contact with peers. -Collaborate with school nurse and teachers to arrange for care during the school day. Treatment: No cure! Treat Symptoms! -NSAIDS(ibuprofen, naproxen, diclofenac, indomethacin, tolmetin) -DMARDs (methotrexate, etanercept) -Corticosteroids (prednisone) -Physical Therapy -Occupational therapy -Ophthalmologist -Dentist -Dietitian -Social Worker -School Nurse -Counselors -Psychologists Education: -Practice relaxation techniques and nonpharmacologic pain management -Exacerbation worsens with illnesses -Schedule follow-up with provider -Regular eye exams Osgood-Schlatter disease - inflammation or irritation of the tibia at its point of attachment with the patellar tendon S/S: . . . . . . . Treatment: . . . . . . . Education: . . . . . . . Terbutaline (Brethine) - Uses to relax uterine smooth muscle to inhibit uterine activity and also used for long term control in asthma. Ephedrine - Used to treat low bp during spinal anesthesia. Also used in asthma treatments. Tonsillectomy - surgical removal of the tonsils Pre-Op= Same as any surgical procedure (npo status) Post-Op= -Placed on abdomen or side until fully awake, then elevate head of bed once awake. -Assess for evidence of bleeding (frequent swallowing, clearing throat, restlessness, bight red emesis, tachycardia, pallor). -Assess the airway and vitals. -Discourage patient from coughing, clearing throat, blowing nose. -Give cool water, crushed ice, ice pops, or diluted fruit juices. NO RED OR BROWN IN COLOR! -Do not give milk products or citrus. -Administer liquid analgesics or tetracaine lollipops. -Provide an ice collar ***Worsening Condition= Continuous swallowing! UTI prevention teaching for girls: - Wipe front to back Void as soon as urge is felt Wear cotton underwear Avoid bubble baths Maintain adequate hydration with caffeine-free drinks. Empty bladder completely Avoid constipation Void after sex Chronic renal failure (CRF) - Progressive and irreversible inadequate kidney function caused by the permanent loss of nephrons. S/S: -Loss of energy -Pallor -Increased Fatigue on exertion -Occasional elevated BP -Delayed growth -Anorexia -Nausea/vomiting -Decreased interest in activities -Decreased or increased urinary output -Compensatory increase to fluid intake -Uremic odor to breath -Headaches -Muscle cramps -Weight loss -Puffiness of face -Malaise -Bone or joint pain -Itchy, bruised skin -Amenorrhea in adolescent girls -Circulatory overload manifested by hypertension, congestive heart failure, and pulmonary edema. -Neurologic involvement (tremors, muscle twitching, confusion, seizures, coma) Urosepsis UTI - Febrile UTI; bacterial illness; urinary pathogens in blood. Treatment: Antibiotics (penicillin, sulfonamide, cephalosporins, and nitrofurantoin). Glascow Coma Scale (GCS) - Neurologic assessment of a patient's best verbal response, eye opening, and motor function. . . . . . . . . . . . . Worsening Head Injury S/S: - Altered mental status Mounting agitation Development of focal lateral neruo signs Marked Changed in vitals S/S of increased ICP Focal seizure - localized seizure often affecting one limb simple= no LOC Complex= change or LOC, strange behavior, dreamlike Partial seizure - a seizure that affects only one part or one side of the brain . . . . . Generalized seizures - seizures that involve the entire brain . . . . . . . Acquired seizures - birth trauma, excessive high fevers as a child, head trauma, electrolyte imbalances, glucose imbalances, etc. . . . . . . Nursing care of child with seizures: - Initiate seizure precaution for any child at risk: -Pad side rails of bed, crib, and wheel chair. -Keep bed free of objects that could cause injury. -Have suction and oxygen equipment available. During A Seizure: -Protect from injury. -If child is on the floor, place blanket under head. -Maintain position for patent airway. -Be prepared for to suction oral secretions. - Turn child to side-lying position (decreases risk of aspiration). -Loosen restrictive clothing. -Do not attempt to restrain child. -Do not attempt to open the jaw or insert an airway during seizure activity. Do not place anything in mouth. -Remove child's glasses. -Prepare to administer oxygen. -Remain with the child. -Note onset, time, and characteristics of seizure. -Remain calm and reassure caregivers. Postseizure: -Maintain side-lying position -Check breathing, vitals, and position of head and tongue. -Assess the head and body for injuries, including the mouth (tongue, teeth). -Perform neuro checks. -Allow for rest if necessary. -Reorient and calm the client. -Maintain seizure precautions, including placing the bed in the lowest position and padding the side rails. -Note the time of the postictal period. -Remain with the client. -Do not offer food or liquids until completely awake and swallowing reflex has returned. -Encourage the client to decribe the period before, during, and after the seizure activity. -Determine if the client experienced and aura, which can indicate the origin for seizure in the brain. -Try to determine the possible trigger (fatigue or stress). -Document the onset and duration of seizure and client findings/observations prior to, during, and following the seizure (level of consciousness, apnea, cyanosis, motor activity, incontinence.)