Download Sphincter control for toileting: 18-24 months, girls are earlier Gravita

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Sphincter control for toileting: 18-24 months, girls are earlier
Gravita: pregnant. Para: number of pregnancies that a woman has regardless of whether the
newborn is born alive or dead
o Primipara: given birth once after a pregnancy of at least 20 months
o Multipara: more than one births
o Nulli: no viable offspring
G (gravida) T (term births) P (preterm births) A (abortions) L (living children)
Erikson’s developmental level
o Newborn: trust vs. mistrust
o Toddler (1-3): autonomy vs. shame & doubt
o Pres-school (3-6): initiative vs. guilt
o School-age (6-12): industry vs. inferiority
o Adolescent: identity vs. role confusion
o Young Adult: Intimacy vs. Isolation
o Middle adulthood (40-55): generativity vs. stagnation: create or nurture things, have
success to feel useful
o 55+: egointegrity vs. despair: reflect on life
Risks for diabetic mothers: polyhydramnios, HTN, ketoacidosis, preterm labor, hypoglycemia,
UTI, chronic monomial vaginitis, difficult labor, c-sec, post-partum hemorrhage, renal, cardiac,
skeletal, and CNS systems malformateion. Newborn risks: cord prolapse, congenital anomaly,
macrosomia, birth trauma from increased size, preterm birth, fetal asphyxia, intrauterine
growth restriction, perinatal death, respiratory distress syndrome, polycythemia,
hyperbilirubinemia, hypoglycemia (low temp, lethargy, low blood sugar), childhood obesity
Treatment for diabetic mothers: tight glucose control and watch baby, determine insulin
requirements from HbAIC (less than 7% indicates good control), fasting: less than 95 or 105 if
diabetic, during labor: less than 110 with IV saline and blood glucose levels monitored q 2 hrs.
Breastfeeding helps normalize blood glucose levels, focus on lifestyle education, if c-sec: give
short-acting insulin or glucose based on levels and monitor hourly with ½ dextrose ready for
baby.
When does anterior fontanel close: 18 months, posterior: 8-12 weeks
o Bulging: ICP
o depressed: dehydration
Ovulation occurs: 14 days before next menstruation
Fertilization occurs 24 hours after ovulation
Premature rupture of the membranes: water brakes before true labor. risk for infection,
prolapsed cord, abruption placentae, and preterm birth. Management: no digital cervical exam,
continuous electronic fetal heart rate, look for distress or hypoxia or meconium in amniotic fluid
(fetal distress related to hypoxia), foul odor: infection
Prolapsed cord: protrusion of cord alongside or ahead of the presenting part of the fetus. 50%
perinatal mortality rate, fetal perfusion declines rapidly, prevention is key, more common in
mal-presentation, growth restriction, premature, ruptured membranes with high station fetus,
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hydramnios, grandmultiparity, and multifetal gestation. Tx: sterile gloved hand into vagina and
hold presenting part off cord, put women in trendelenburg or knee-chest position, monitor FHR,
maintain bed rest and give oxygen, if not fully dilated do c-sec a.s.a.p.
Post-partum blues (3-7 days) depression (beyond 6 weeks-mood and behavior changes)
psychosis (3 weeks after: sleep distrubances, fatigue, depression, and hypomania, delirium and
hallucination, anger, bizarre behavior, thoughts of violence, suicide is greatest hazard)
o Caused by: prenatal anxiety, difficult labor or pregnancy, high-risk pregnancy or specialneeds infant, hormonal changes with decreased estrogen and progesterone
Newborn VS
o HR: 120-160 (180 when crying and 100 when sleeping)
o RR: 30-60
o Temp: 36.5-67.5
Newborn reflexes: sucking, Moro (startled), stepping, tonic neck, rooting, Babinski (until 1 yr:
toes fan out), palmar grasp, gag, cough
Cervical cancer risk factors: HPV, early sex, lower socioeconomic status, promiscuous,
unprotected sex, STDs, smoking, HIV, Oral contraceptive, PID
Signs of adolescent depression: giving away things, writing letters, using drugs
Jaundice: yellowish skin, mucous membranes, and sclera within first 3 days of life, blanced are a
will appear yellow before cap refill, first 24 hours of life it is checked (12-15), lasts 5-7 days when
using UV lights or phototherapy
Secondary sex characteristics develop at age of 11-14
Fetal positions: L or R, presenting part: O, S, M, A, D(back), then location of presenting part: A, P,
T. LOA is most common and most favorable, ROA 2nd.
Pregnancy signs and symptoms
o Presumptive: absence of menstruation, nausea, fatigue, breast tenderness.
o Probable: Braxton hicks contractions, positive HCG test, abdominal enlargement,
goodells (cervix), Hegar’s (uterine), Chadwick’s (blue-purple cervix)
o Positive: FHR, palpate for movements, ultrasound
o 1st trimester: urinary frequency, fatigue, N/V, breast tenderness, constipation, nasal
stuffiness, bleeding gums, epistaxis, cravings, leucorrhea
o 2nd trimester: backache, leg cramps, varicosities, hemorrhoids, flatulence with bloating
o 3rd trimester: fatigue, urinary frequency, leucorrhea, constipation, dependent edema,
SOB, dyspnea, heartburn and indigestion, contractions
Fetal movement: 16-20 weeks, gross indicator of fetal well-being
Breastfeeding: upright position, every 2-3 hours for 10-20 minutes, gives baby colostrum,
transitional milk and then mature milk, decreases constipation for newborn, increases weight
loss for mother, decreases infection, baby needs good suck and swallow reflexes, 4 positions:
football, cradle, across-the-lap, side-lying. LATCH: Latch, Audible swallowing, type of nipple,
comfort of nipple, hold or position (scored 0-2 pts each, score 8-10 best)
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Continuous internal fetal monitoring: spiral electrode into presenting part to assess FHR and
pressure or contractions. Must have: ruptured membranes, cervical dilation of at least 2 cm, low
presenting part, skilled person
Fetal accelerations: increase in HR. Deceleration: decrease in HR from PNS stimulation. Early:
lowest point at peak of contraction. Late: decline after contraction. Variable (most common).
Repetitive late decelerations and late decelerations with decreasing baseline variability are
nonreassuring signs. Caused by hypoxia. Tx: turn mom to left side, administer oxygen, increase
IV fluids, tell doc, reduce oxytocin. Emergency c-sec possible
Cesarean birth: classic or low transverse incision. Causes: shoulder dystocia, fetal distress, active
gonorrhea, herpes 2, placenta previa, Hep B, fetal macrosomia, prolapsed cord, previous classic
incision, HTN, diabetes, hydrocephalus, neural tube defects. Risks: infection, hemorrhage,
aspiration, pulmonary embolism, urinary tract trauma, thrombophlebitis, paralytic ileus,
atelectasis, newborn: fetal injury and transient tachypnea
Perimenopause: around menopause: low estrogen
Psychological pregnancy: 1st: denial, ambivalence. 2nd: excitement. 3rd: worry, bills, compassion
Stages of labor
o 1st: latent phase (0-3 cm) active (4-7 cm: increase contraction) transition (8-10:
contraction 1-2 minutes, irritable and out of control, urge to bare down, most difficult
but shortest, 1 hr in first birth and 30 minutes multi)
o 2nd: complete dilation and effacement, fetus moves through birth canal: pelvic and
perineal phase, increase in bloody show, crowning
o 3rd: birth and ends with separation of placenta: uterus rises up, umbilical cord lengthens,
sudden trickle of blood, uterus changes to globular, placental expulsion
Therapeutic communication: listen and understand
Ectopic pregnancy: not in uterus, pain, bleeding 4-6 weeks, solution: surgery
Oral contraceptives: inhibits the release of follicular stimulating hormone. Side effects: nausea,
vomiting, increased risk for infection and DVT
Ultrasound: full bladder, earliest done at five weeks
Contraction stress test: done at 28 weeks, give oxytocin and watch for fetal movements
including late decelerations
Newborn care at delivery: suction (aspiration of airway: mouth first), APGAR 1 and 5 minutes, ID
band, warm, promote bonding
Skin loses elasticity as part of aging
Post-term: over 42 weeks, might see dry skin, bigger but less fat, hypoglycemia, long fingernails
SGA: less than 10%. risks: heat loss, hypoglycemia. Keep warm, check temp. look for s/s: IUGR,
head larger than body, poor muscle tone, hypoxia
Lightening: fetal presenting part begins to descend into maternal pelvis. Impending sign of labor
Chronological age is not predictor of physiological change
Preconception counseling: smoking and alcohol cessation, prenatal vitamins, folic acid, exercise
Preeclampsia: hypertension and proteinuria and edema during 20-40 week. Give Magnesium to
prevent seizures and Procardia for BP. May have to deliver baby immediately. Prevent by diet
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Nagle’s rule: estimated date of delivery: -3 months + 7 days
Fetal development: 4 weeks heartbeat, 8 weeks organ form, 12-18 weeks heartbeat with
Doppler, 16 weeks sex, 20 weeks heart beat with stethoscope, 28 weeks eyes open and close, 32
weeks toe nails and other details
Ovulation resides 12 weeks after delivery. Breastfeeding will delay
Spontaneous abortion: before fetus is viable, bleeding and cramping. Look for clots and fetal
tissue, encourage rest and no sex for 2 weeks.
APGAR: Appearance (color), pulse (heart rate: 100>), grimace (reflexes: sneeze, cough, or cry),
activity (muscles: tight flexion, good resistance), respiratory (regular, 30-60). 7-10 correct
Bonding for premature: skin-skin but avoid over stimulation because you don’t want to burn
precious calories
Non stress test: done at 28 weeks. Test fetal movements after eating. FHR 15 increase for 15
seconds for 20 minute intervals. Done with Doppler.
Vaginal infections during pregnancy (yeast infections): don’t douche, wear cotton underwear,
increase air and keep it dry
Chlamydia: most common STD, thick discharge, men have dysuria, must tell contact and report.
Tx: azithromycin
Contractions: from beginning of one to the beginning of the other in seconds
Epidural anesthesia: monitor fetus BP and HR for hypo, give fluids and oxygen and turn to left
side and call doctor
Rhogam: given when RH + baby has RH – mom
Pica: eat disgusting stuff, most often in rural areas and family history
Labor: contractions that do not decrease with rest
Postpartum infection symptoms: increase temperature (104), chills, tachycardia, foul odor
Iron supplements: increase Hg for iron deficiency anemia, may cause constipation & dark stool
Surfactant: increase opening of alveoli. Used for pre-mature or less than 2 LS ratio
Postpartum care: check fundus, check discharge for hemorrhage and infection, VS, BUBBLE-EE
(breasts, uterus, bladder, bowels, lochia, episiotomy/perineum, extremities, emotional), uterus:
should be midline and firm at level of umbilicus. Lochia: rubra (deep-red, few clots, 3-4 days),
Serosa (pinkish brown, 3-10 days, WBC and RBC), Alba (creamy white or light brown 10-14 days
or up to 6 weeks). If Rubra after serosa: call doctor: may be subinvolution
Oxytocin: increases contractions. Stop if decrease HR or sustained contractions that don’t relax
Lamaze: labor and delivery method of relaxation and breathing, slow-paced, rhythmic
Alpha-fetoprotein screening: done at 16-18 weeks, tests neural tube defects if elevated, may be
used with biomarker screening for Down.
Newborn with drug mom: high pitched cry, agitated, inconsolable, not coordinated. Give
morphine
Kohlberg:
4-10: preconventional: punishment vs obedience
7-10: Conventional: interpersonal beliefs (good-child, bad child)
10-12: rules to follow social order
13+: post conventional: question status quo
Age
Words
Action
newborn
12-36 months
200, two word
Blocks, imitates adult, walking
(toddler)
sentences
36 months-5 years 1500, complete
Run, jump, climb, brush teeth,
(pre-school)
sentences
play with balls, skip
6 + (school-age)
Interested in peers and
family, role modeling
Toy
Mobile with contrast
Household toys, tricycle,
chalk, bucket, crayons
Make figures,