WGU D447 OA

Epiglottitis

a severe and potentially fatal swelling of the epiglottis, the flap of tissue that prevents food from entering the windpipe during swallowing

epiglottitis s/s

anxious, restlessness, stridor, high fever, sore throat, hoarse, muffled voice, drooling, pt in tripod, dysphagia, respiratory distress

Epiglottitis treatment

secure airway with intuvation or anticipate it, antibiotics, corticosteroids

postpartum hemmorhage

blood loss of >50] in vaginal delivery, >1000 in C-section

postpartum hemorrhage risk factors

uterine atony (boggy), magnesium administration, birth canal trauma, precipitous delivery (quick labor), retained placental fragments, uterus inversion or subinvolution, coagulopathies, multiparity, fetal macrosomia (baby over 8lbs 13oz), long labor

PPH s/s

saturating pad every 15 min, soft/boggy uterus, large blood clots, constant blood flow from vagina, s/s hypovolemic shock (tachycardia, hypotension, cool/clammy skin)

postpartum hemorrhage

low hemoglobin and hematocrit

PPH tx

uterine stimulants-oxytocin, methylergonovine (except in pt with hypertension) misoprostol (safe for high bp), carboprost. bimanual compression, uterine packing, surgical intervention (ie. artery ligation, hematoma evacuation,, hysterectomy.) empty bladder

pph nursing considerations

firmly massage fundus every 15 min for 1-2 hours, administer o2, IV fluids, blood products as ordered. elevate patients legs

gestational diabetes goal

use diet and exercise to keep glucose levels within normal range

gestational diabetes leads to

macrosomia, hypoglycemia in newborn preterm labor, PROM, elevated hematocrit in newborn, respiratory distress syndrome (underdeveloped lungs in newborn). impaired glucose tolerance during pregnancy.

gestational diabetes RF

obesity, HTN, Familial Hypercholesterolemia, GDM in previous pregnancies, DM1 or 2

Gestational diabetes s/s

usually asymptomatic, polyurua, polydypsia

gestational diabetes labs/dx

1hr/3hr glucose tolerance tests

Gestational diabetes treatment

diet modification, exercise, blood glucose monitoring, insulin (most oral diabetic meds are contraindicated during pregnancy)

gestational diabetes complications

fetal macrosomia, neonatal hypoglycemia, increased risk of preeclampsia, birth trauma, c-section and diabetes following pregnancy

Gestational diabetes education

Take blood glucose readings first thing in the AM (fasting) and 2 hours after each meal.

Recognize s/s and treatment for hyperglycemia and hypoglycemia.

Teach the patient/guardian how to administer insulin.

epidural

given only after 4cm dilated. takes 20-30min to take full effect. make sure pain levels are going down, not up. can cause maternal hypotension, fetal bradycardia, low platelet count for mom

epidural nursing considerations

priority-check bp, administer IV fluids and position mom on her side to prevent hypotension. monitor FHR, and maternal vital signs continuously

mastitus

an inflammatory condition of the breast that is possibly accompanied by infection and usually associated with lactation

mastitis risk factors

incomplete breast emptying, clogged duct, cracked nipples, irregular feedings, poor attachment, maternal stress/fatigue, poor hygiene

mastitis s/s

lump that doesn't get smaller after nursing, pus draining from nipple, fever, chills, achy, fatigue, red, swollen, warm and tender, can cause abscess.

mastitis education

wash hands, apply heat before feeding, apply cold compress after feeding, allow nipples to air dry, pump if breastfeeding is too painful, feed more than 8 times, finish antibiotics even if symptoms improve, they different feeding positions

endometritis

an infection of the uterine lining or endometrium

endometritis risk factors

c-section, retained placental fragments, prolonged rupture of membranes, episiotomies, laceration, prolonged labor

endometritis s/s

chronic pain in the pelvis, dyspareunia, dysmenorrhea, chills, achy, fatigue, uterine tenderness, foull smelling lochia rubra, fever

endometritis nursing considerations

clindamycin, antibiotics for bacterial infection, teach client to take ALL of medicine

biliary atresia

rare, serious disease of the newborn, not genetically inherited. congenital process with malformed or missing bile ducts, or progressive inflammatory process, causing bile duct Fibrosis.

biliary atresia s/s

jaundice, pruritis, may develop large, hardened liver with swollen abdomen, Grey or tan stool, dark urine, weight loss, irritability

Biliary atresia dx

measure circumference of abdomen, xray of abdomen, enlarged liver/spleen, abd. ultrasound-small or no gallbladder bladder, radioactive scan of liver (HIDA)- bile flow (done first usually) liver biopsy

biliary atresia tx

Kashi surgery or liver transplant

rheumatic fever

inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated, can lead to long term cardiac damage (rheumatic heart disease)

rheumatic fever s/s

fever, joints pain, swelling, chest pain, fatigue, small, painless bumps beneath the skin

rheumatic fever labs

positive throat culture, increased antistreptolysin-O titer, increased crp/esr, hemolytic strep

otitis media

commonly known as middle ear infection, is an inflammation of the middle ear

otitis media risk factors

allergies, 2nd hand smoke, pacifier use, physical defects

otitis media s/s

diarrhea, vomiting, irritability, pain in ear, fever

otitis media rx

full Coarse of antibiotics

otitis media prevention

schedule visit for pneumonococcal vaccine

pain scale

Riley infant pain scale

FLACC postop pain scale

heart rate and bp can also determine pain

FLACC pain scale

face: 0= relaxed, 1= grimacing, 2= cries or shows other signs of distress

legs: 0=relaxed, 1= restless or kicks, 2= draws legs up or pulls away

activity: 0= relaxed, 1= squirming or shifting, 2= guarded or stiff

cry: 0= none, 1= moans or whimpers, 2= cries steadily or screams

consolability: 0= easily comforted, 1= difficult to comfort, 2= inconsolable

umbilical cord prolapse

occurs when the umbilical cord descends into the vagina or cervix before the baby's head

umbilical cord prolapse RF

premature ROM, breech presentation, polyhydramnios, small baby, low-lying placenta

umbilical cord prolapse tx

manual elevation, cesarean delivery, oxygen therapy, place the client in trendelenburg or knees to chest

miliaria

commonly known as heat rash or prickly heat, is a skin condition caused by blocked sweat glands, leading ti trapped sweat under the skin (thunk heat and moisture)

miliaria education

wear loose, lightweight clothing, avoid occlusion of skin, move closer to a cooler environment, wash with warm water, monitor temperature

miliaria rx

water-washabke skin emollient, lotions, colloidal oatmeal products

preeclampsia

an increase in bp >140/90, past 20 weeks gestation accompanied by proteinuria

preeclampsia risk factors

family history, genetic/epigenetic predisposition, nulliparoty multiple gestation, maternal age >35, BMI >30

preeclampsia s/s

proteinuria, thrombocytopenia, severe headache, changes in vision, sudden weight gain or a sudden appearance of edema

preeclampsia rx

anti-hypertensive meds, magnesium sulfate for seizure prophylaxis

preeclampsia nursing considerations

monitor BP, med administer, patient education, monitor for magnesium toxicity, collect urine sample for proteinuria

magnesium toxicity

flushing, nausea, vomiting and weakness, decreased urine output, which progresses to loss of DTR decreased breathing, muscle paralysis, and then severe cardiovascular effects like hypotension, bradycardia and eventually cardiac arrest and coma

HIV s/s

flu-like symptoms, lymphadenopathy, thrush, weakness, night sweats, weight loss and rashes

HIV labs

decreased WBC, decreased CD4+

HIV DX

ELISA and Western Blot, if untreated and CD4+ drops below 200, it is indicative of AIDS

HIV RX

ART antiretroviral therapy, giving zidovudine 6-12 hours after birth to newborn is crucial as it helps prevent mother to baby transmission

HIV education

practice safe sex, encourage PREP, prevent infection, breastfeeding is contraindicated

herpes management in pregnancy

antiretroviral treatment: to suppress outbreaks and reduce the risk of needing a cesarean section.

a cesarean section is recommended for those who have active lesions in the third trimester to avoid transmission to baby.

avoid sexual activity and oral sex with partners who have active lesions, especially in late pregnancy.

breastfeeding can continue if there are no lesions on the breast, however if lesions present, breastfeeding should ne stopped. valacyclovir and acyclovir are generally considered safe in breastfeeding women.

educate wash hands before handling baby and after contact with any herpetic lesions

carefully cover lesions on the body, avoid kissing the baby

monitor baby for symptoms of rash and fever for three weeks after birth

clubfoot

genetic disorder causing deformity of rhe foot

clubfoot s/s

affected foot turned sharply upward and smaller calf muscle om affected leg

clubfoot dx

visual inspection prenatal US or newborn screening

clubfoot treatment

serial casting new cast every week for 5-8 weeks and bracing, surgical repair

cast care

highest priority-circulations - pain, paresthesia, parlor, pulselessness, paralysis

interventioms: assess fingers and toes, pulses, mobe.ebt, grips, sensation, capillary refill and color

extreme pain and pain meds dont help-compartment syndrome.

always keep dry don't stick anything in to itch, handle plaster casts with pals until dry.

newborn assessment

highest priority to ensure newborn survival is to establish and maintain am open airways and effective breathing after birth. other immediate priorities include preventing heat loss by keeping the newborn warm and closely monitoring vitals and performing initial assessment of the infants overall condition (APGAR)

Neonatal Resuscitation

initial step: place newborn on warner, sniffing position, suction airways, dry and stimulate for 30 sec

ventilation: if needed for apnea, gasping or HR <100: apply positive pressure ventilation, monitor chest rise, continue PPV

chest compressions: if HR <60 dwpsite effective ventilation- initiate compressions, combine with PPV, re-evaluate

medication and fluids: administer epinephrine, consider volume expansion

meds given after birth: vitamin K for clotting, erythromycin for prevention of eye infection, hep B to prevent a serious, potentially life-long liver infection

RSV

commonly viral lung infection in children <2

RSV patho

spread via droplets, causing bronchiole inflammation Md increased mucus production

RSV RF

premature infants, heart or lung disorders age <2

RSV s/s

cough, sneezing, fever, wheezing, deep or rapid breathing, prolonged expiration.

RSV labs/dx

clinical presentation, nasopharyngeal swab

RSV TX

supportive care mechanical ventilation, and antiviral for severe cases. palavizumab

RSV Nc

nasal suctioning for excessive secretions, keep patient hydrated and calm. administer 02.

respiratory distress restlessness, agitation, dyspnea, nasal flaring, retraction, tachypnea, grunting, adventitious breath sounds, use of accessory muscles, tachycardia, parlor, diaphoresis, cyanosis. priority: assess airways and patency