1
Q
nursing role in genetic counseling
A
- taking family history and referring for further genetic counseling
- explain purposes, risks/benefits of all screening and diagnostic tests
- discussing costs, benefits, and risks of using health insurance, and potential risks of discrimination
- Counsel the family that there are resources available- gvt assistance, medicaid, WICK, foodstamps
- Because of HIPAA, we can’t tell anything to anyone about illegal immigrants, etc.
- emotional support
2
Q
appropriate weight gain during pregnancy
A
-Underweight (BMI
3
Q
Interventions for preeclampsia
A
- Clear the airway and administer adequate oxygen
- Position mom on her left side and protecting her from injury
- Suction equipment must be readily available to remove mouth secretions after seizures
- IV fluids given after seizure to replace fluid
- Mag is administered to prevent further seizures
- FHR monitored closely
- Mag level, respiratory rate, reflexes and urine output closely monitored
4
Q
HELLP syndrome
A
- H: hemolysis resulting in anemia and jaundice
- EL: elevated liver enzymes resulting in elevated ALT and AST, epigastric pain, and N/V
- LP: low platelets resulting in thrombocytopenia, abnormal bleeding and clotting times, bleeding gums, petechiae, and possibly DIC
5
Q
management of HELLP
A
- Lower BP with rapid acting antihypertensives,
- prevention of convulsions with mag,
- use of steroids for fetal lung maturity,
- birth of infant
- blood component therapy is transfused to address microangiopathic hemolytic anemia
6
Q
Cardiac disorders in pregnancy
A
- continue to take cardiac medications as prescribed
- Anything they have is going to get worse because of increased oxygen demand and change in blood flow
7
Q
management of labor with nonreassuring heart tones
A
- left lateral position
- 8-10 L oxygen with nonrebreather
- be prepared for delivery
8
Q
management of shoulder dystocia
A
- intervene immediately due to cord compression
- perform McRobert’s maneuver (hyperflexing legs) and application of suprapubic pressure
- assist with squatting position, hands and knees, or lateral recumbent position to free shoulder
- anticipate c-section if no success in dislodging shoulders
- after birth assess newborn for crepitus, deformity, Erb’s palsy, or bruising
9
Q
induction vs augmentation
A
- Induction: stimulating contractions via medical or surgical means
- Augmentation: enhancing ineffective contractions after labor has begun
10
Q
Pitocin doses and side effects
A
- 0.5 mu/min, increase by 1-2 my/min q30-60 mins
- postpartum hemorrhage: 10 units infused at 20-40 mu/min
- side effects: increased uterine motility and painful contractions
11
Q
postpartum expected assessment findings
A
BUBBLEEE:
- Breasts (size, contour, engorgement): Check for cracks, redness, fissures, or bleeding, and note whether they are erect, flat or inverted
- Uterus (height of fundus, firmness): Fundus should be midline and feel firm, boggy or relaxed is a sign of uterine atony; Fundus progresses downward at a rate of one fingerbreadth (1cm) per day after birth and should be nonpalpable by 10 days postpartum
- Bladder (voiding, bladder emptying)
- Bowels (bowel sounds, distention)
- Lochia (amount, color, odor)
- Episiotomy and perineum (lacerations, hematoma): Inspect for irritation, ecchymosis, tenderness, or hematomas
- Extremities: Hypercoagulability
- Emotional status: assess interaction with baby
12
Q
Amounts of lochia
A
- Scant: 1-2 inch stain and 10 mL loss
- Light or small: 4 in stain or 10-25 ml loss
- Moderate: 4-6 in stain and 25-50 ml loss
- Large or heavy: pad is saturated within 1 hour after changing it
13
Q
colors of lochia
A
- Rubra: deep-red mixture to mucus, tissue debris, and blood that occurs for the first 3-4 days after birth… becomes paler and more serous after this
- Serosa: second stage; pinkish brown; expelled 3-10 days postpartum
- Alba: final stage; creamy white or light brown; 10-14 days, but can last 3 to 6 weeks postpartum
14
Q
calories for breastfeeding
A
extra 300
15
Q
patho of postpartum hemorrhage
A
Five T’s:
- Tone: uterine atony, distended bladder
- Tissue: retained placenta and clots
- Trauma: vaginal, cervical, or uterine injury
- Thrombin: coagulopathy (preexisting or acquired)
- Traction: causing uterine inversion
16
Q
Management of postpartum hemorrhage
A
- massage boggy uterus to stimulate contractions and expression of any accumulated blood clots
- administer Pitocin
- fluid administration
- monitor for s/s of shock
- antibiotics for infection
17
Q
management of postpartum affective disorders
A
- baby blues: usually self-limiting and resolves within 2 weeks
- PPD: symptoms last beyond 6 weeks and worsening; Combination of antidepressant medication, antianxiety medication, and psychotherapy in an outpatient and inpatient setting
- postpartum psychosis
18
Q
APGAR
A
- heart rate
- respiratory effort
- muscle tone
- reflex irritability (non; grimace; cough, sneeze, or cry)
- color
19
Q
IUD problems
A
- Increases the risk of PID, uterine perforation, ectopic pregnancy, uterine expulsion, and bacterial vaginosis
- Does not protect against STIs
20
Q
infant nutrition
A
- In the first 24 hours, looking for 1 pee and 1 poop or more
- By 4-6 months their birth weight should be double
- By 12 months their birth weight should be tripled
21
Q
SGA Newborns: Common Problems
A
- Perinatal asphyxia- more at risk for fetal demise
- Difficulty with thermoregulation
- Hypoglycemia
- Polycythemia
- Meconium aspiration
- Hyperbilirubinemia
- Birth trauma- less developed
- More at risk for failure to thrive
22
Q
LGA Newborns: Common Problems
A
- Birth trauma- shoulder dystocia
- Hypoglycemia
- Polycythemia
- Hyperbilirubinemia - jaundice
23
Q
nursing management of neonatal asphyxia
A
immediate resuscitation, continued observation, neutral thermal environment, blood glucose levels, parental support and education
24
Q
management of transient tachypnea of the newborn
A
- Oxygenation
- Supportive care
- IV fluids or gavage feedings
- Supplemental oxygen
- Neutral thermal environment
25
management of RDS
-Supportive care; close monitoring
-Respiratory modalities: ventilation (CPAP, PEEP); exogenous surfactant; oxygen therapy
-Antibiotics for positive cultures; correction of metabolic acidosis
(Strep B is a common infection to lose babes to)
-Fluids and vasopressors; gavage or IV feedings
-Blood glucose level monitoring
-Clustering of care; prone or side-lying position
-Parental support and education
26
management of meconium aspiration
- Suctioning at birth
- Adequate tissue perfusion
- Decrease in oxygen demand and energy expenditure
- Neutral thermal environment
- Parental support and education
27
management of infants with diabetic mothers
- Prevention of hypoglycemia (oral feedings, neutral thermal environment, rest periods)
- Maintenance of fluid and electrolyte balance (calcium level monitoring, fluid therapy, bilirubin level monitoring)
- Parental support and education
28
types of surgery for breast cancer
- modified radical mastectomy: most common; removal of all breast tissue and axillary lymph nodes; pectoralis major muscle remains intact
- local breast conserving surgery (lumpectomy): used to diagnose
- radical mastectomy: removal of all breast tissue, axillary nodes, and pectoral muscles
29
Post-op mastectomy
- assess for drainage
- position in semi-Fowler's and arm positioned so that each joint is higher than the one before it
- no BP or injections on affected side
- initiate arm exercises
30
teaching for post-mastectomy
- Watch for edema of affected arm
- Lymphedema can occur any time after axillary node dissection
- Discuss symptoms of recurrence and importance of making regular visits to the physician to monitor recovery and detect changes
- Provide incision care with emollient as prescribed to soften and prevent wound contracture
- Encourage the client to perform breast self-examination on the remaining breast
- Do not let the affected arm hang dependent
- Do not carry a purse over the affected arm
31
postop for prostate cancer
Continuous Bladder Irrigation (CBI/ Murphy drip):
- triple lumen catheter
- provides continuous irrigation to prevent bleeding and to flush the bladder of tissue and clots after TURP
- titrate CBI so the outflow is light pink without clots
32
opioid you can use during labor
fentanyl
33
nadir
- the lowest ANC after myelosuppressive chemotherapy, targeted therapy, or radiation therapy that suppresses bone marrow function
- 500 is the lowest ANC… 500-1500 is at risk
34
PUSH scores
- ulcers are categorized according to size, exudate, and type of tissue
- 0 is healed
- 17 is not healed
35
Braden scale
- Scores six subscales: sensory perception, moisture, activity-mobility, nutrition, friction, and shear
- 18 is at risk
- 12 or less is high risk of ulcer development
36
excessive GH in children vs adults
- children: gigantism
| - adults: acromegaly
37
hypophysectomy
- removal of pituitary tumor
| - done via transphenoidal surgery
38
hypophysectomy complications
- Stroke or blindness if nearby arteries are damaged
- Temporary onset of diabetes insipidus, which usually resolves itself within 1 to 2 weeks of surgery
- Possible damage to pituitary could cause hypopituitarism
39
hypophysectomy postop care
- Maintain adequate airway
- Perform serial neuro assessments to identify changes in mental status
- Elevate HOB 30-45 degrees to decrease edema and promote CSF flow to the lumbar cistern
- Side lying position if unconscious to facilitate drainage
- Avoid leaning forward, blowing nose or sneezing
- Do not remove nasal packing until surgeon orders it
40
priority tx with addisons crisis
- Hypothermia is priority… fluids first
- Hypotension second… epi, norepinephrine, dopamine
- replace missing hormones
- Put in recumbent position with legs elevated
41
postop adrenalectomy
- Vitals, central venous pressure, and urine output must be monitored frequently
- s/s of hypocorticism must be assessed hourly for the first 24 hrs
- IV glucocorticoids given as prescribed
- Monitor for early indications of shock, infection, and alterations in blood glucose and electrolytes
- Increased steroids to meet metabolic demands are needed if additional stress occurs
- Room must be kept cool and patients clothing and bedding changed often if he or she perspires profusely (side effect of surgery on the adrenal gland)
- Assess abdomen for distension and bowel sounds
- Assess for s/s of adrenal crisis
42
priority tx for myxedema coma
-levothyroxin
43
postop thyroidectomy
- reduction of stress and anxiety to avoid precipitation of thyroid storm
- Attention to compromise of the airway by hemorrhage (could run down neck to behind the head/neck) or recurrent laryngeal nerve injury is emphasized
- Maintained in semi-fowlers, with head and neck well supported
- Hemovac may be in place for first 24-48 hrs
- Check for dysphagia and hoarseness, signs of laryngeal nerve injury, and for bleeding and infection
- Evidence of hypocalcemia resulting from unrecognized removal of the parathyroid glands must also be assessed
- Monitor for resp distress
44
metabolic vs respiratory acidosis/alkalosis
- respiratory: pH is opposite from everything else
| - metabolic: everything (including pH) goes the same direction
45
endocarditis
- infection or inflammation of the heart valves or of the lining of the heart
- most commonly from Streptococcus viridans
46
Natriuretic factors
NATRECOR (Nesiritide BNP): causes smooth muscle dilation and decreases workload of the heart by decreasing preload and afterload, decreasing BP by dilating arteries and veins
47
ABGs
- Measurement of the pH and partial pressures of dissolved gases (oxygen, carbon dioxide) of the arterial blood
- Perform Allen’s test to assess collateral circulation before arterial puncture
- Pressure should be maintained at the puncture site for a minimum of 5 minutes
48
patho of pneumonia
Exposure to foreign matter -> inflammatory response -> capillary walls become ‘leaky’ -> fluid shifts from capillaries to interstitial space and then to alveoli -> alveoli fill with fluid -> lungs lose compliance -> VQ mismatch
49
Treatment of TB
RIPES:
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
- Streptomycin
50
asthma diagnostics
ABGs, IgE*, sputum cultures, PFTs*, chest x-rays
51
PE diagnostics
- Enhanced spiral computed tomography (CT) scan (specific for PE)
- D-dimer test is elevated
- Ventilation-perfusion scan (V/Q) is done for pts who cannot have contrast media
52
pulmonary edema diagnostics
increase in B-type natriuretic peptide (BNP) levels to assess for HF (
53
Cor pulmonale definition and s/s
- right-sided hypertophy of the heart from pulmonary HTN
- s/s: related to dilation and failure of the R ventricle with subsequent increase in intravascular volume and systemic venous congestion: S3, ECG – increased P wave amplitude, distended neck veins (JVD), hepatomegaly, ascites, epigastric distress, peripheral edema, and weight gain, dyspnea, orthopnea
Process 2
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