NSG 2421 Trimester 1 Exam

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107 Terms

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Cycle of Violence
Tenson → Battering → Honeymoon
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When do you have a legal obligation to contact the police.
When the victim of abuse is a child.
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ABCs of visual pediatric assessment
Appearance breathing circulation (colour)
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Friedman’s Structure
Views famliy structure as acomplishing two things, it is affective (it provides affection), and it provides socialization and social placement
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Calgary family assessment
Assesses family structure (losses, broad), developmental milestones (walking etc), family function (how well the family works)
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Mcgill model
Assesses fmaily, health, collaboration, and learning
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Medication reconciliation
The process of a patient informing the healthcare team of all their previous medication use prior to arriving in the hospital setting (prevents med errors)
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Near miss
Potential error no harm
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No harm event
Error, no harm
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Medication error
Causes harm
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Crtitical Incident
Causes serious harm
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Dexamethasone
Long acting corticosteroid
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Pregnisone
Short acting corticosteroid, can disrupt sleep patterns
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Where is fluid kept
65% intercellular, 25% interstitial, 10% plasma
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Magnesium
More important in pedes due to MALNUTRITION
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HIT YOUR LYTES GOOD
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Calculation for pediatric fluid balance.
100ml/Kg for first 10, 50ml/Kg for next 10, 20ml/kg for remaining weight.
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Typical pediatric urine output
0\.5-2.0ml/Kg
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Dehydration s/s in neonate
Sunken fontanels, delayed cap refil, adult dehydration symptoms
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Fluid overload s/s in neonate
Expanded fontanells, crackles, pulmonary/cerebral edema
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Normal pCO2
35-45mmHg, Under 2 its 26-41
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Normal HCO3
21-28mmol/L, Infant 16-26
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Growth vs development
Growth=size, development=personhood
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Freud’s Oral stage
B to 1yr - Sucking, biting, just kinda jamming stuff in there
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Freud’s Anal Stage
1 to 3yrs - Potty training, bladder control
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Freud’s Phallic Stage
3 to 6yrs - Relationship with parents forms, being away from trusted adults in school/daycare
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Freud’s Latent stage
6 to 12yrs - Learning about gender roles
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Freud’s Genital Stage
12 to Adult - I want to have sex
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Piaget’s Sensory-Motor
B to 2yr - Reflexes, basic shit
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Piaget’s Preoperational Stage
2 to 7yr - Egocentric, magical thinking, very creative
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Piaget’s Concrete opperational stage
7-11yrs - Less self-centered, thinking more coherent, very curious
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Piaget’s Formal Operational Stage
11-A - Thoughts more adaptable, flexible, abstraction possible
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Eriksons Trust vs Mistrust Stage
B to 1y - Depends on the childs needs being met
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Erikson’s Autonomy vs Shame/Guilt Stage
1 to 3y - Increased indepence, testing the limits of their role
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Erikson’s Initiative vs Guilt Stage
3 to 6y - Playing, starting to express themselves
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Erikson’s Industry vs Inferiority Stage
6 to 12y - Self worth linked to activities and social groups
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Erikson’s Indentity vs Role Confusion Stage
13 to 17y - Problems assessing with the parents in the room due to increased independence, modesty, forming of a new identity
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Infant Developmental Milestones
Holds head up without help, Voice recognition, Supports most of it’s own weight when held upward, supported walking
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Toddlerhood Developmental Milestones
Throwing, Scribbling, Push and pull toys, Talking, Can undress and kinda dress
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Parallel Play
Typicall engaged in by toddlers, playing beside someone else but not engaged with them directly
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Preschool Aged Play
Want to emulate parents, whisks, trainers etc, safety scissors as motor skill develops
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School Aged Play
Can do stuff that requires concentration like sports
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Adolescent Play
Mostly social
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Separation Anxiety Cycle
Fear → Despair → Withdrawl/Denial
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Dealing with Seperation Anxiety
Look to the parents first, be firm about tasks
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Coming methods of childhood coping
Regression, Repression, Rationalization, and Fantasy
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Assessing a B to 6m
Usually fine, no stranger anxiety
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Assessing 6m to 1y
Stranger danger, keep them with the parent, least invasive → most invasive
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Assessing 1 to 3y
Assess quick as you can, usually anxious an hyperactive, still working least to most invasive
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Assessing 3 to 6yr
Usually fine unless traumatized, more private, can start to integrate play into assessment. Involve positive feedback. “Thank you for staying still!”
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Assessing 6 to 13yr
Usually willing to cooperate, modesty more and more important.
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Assessing 13 to 18yr
Can take a more head to toe approach, modesty is very very important.
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Thrush
White spots coating the back of the throat, common side effect of corticosteroid therapy
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Tylenol Max Pediatric Dose
10-15mg/Kg daily max
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APGAR
Apperance, Pulse, Grimace, Activity, Respirations
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Egg and sperm viability window
Egg is viable for about 24 hours, sperm is viable for about 48
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Due date calculation
The first day of the last menstrual period - 3 months + 7 days
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Considered Term
After 37 weeks before 42 weeks
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Recommended maternal assessment schedule pre-natal
Every 4 weeks for the first 28 weeks, every 2 weeks 28-36 weeks, once a week 36+
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What is assessed at a prenatal visit
Vital signs, weight, uterine size, fetal heartbeat, urinalysis, blood tests, GBS status, psych
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G TPAL
Gravita, Term, Preterm, Abortions, Living
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Different between stillbirth and abortion
Stillbirth is part 20 weeks
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What placental side is maternal and what side is fetal
Maternal = Red/fleshy, fetal = shiny/grey
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Subjective signs of pregnancy
Morning sickness, “feeling” pregnant, subjective
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Probable signs of pregnancy
A positive pregnancy test, objective tests that do not 100% confirm a pregnancy. Can be cause by other things.
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Positive signs of pregnancy
Can only mean you’re pregnant, no other explanation. Ultrasound.
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Fetal Development at 4th Week
Fetal Heart Beat Begins to Beat
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Fetal Development at 8th Week
All Body Organs Formed
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Fetal Development at 8-12th Week
Fetal heart rate can be detected
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Fetal development at 16th Week
The sex of the fetus can be detected
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Fetal development at 20th week
Heart beat can be detected, mother experiences quickening, baby develops a regular sleep/wake schedule, vernix and lanugo present, head hair, eyebrows, eyelashes present
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Fetal development at 24th week
weighs 780g (1lb 10oz), increasingly active, respiratory movements begin, sucking movements
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Fetal development at 28th week
Eyes open/close, baby can breathe, surfactant is develpoped, baby is 2/3 final lenght
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Fetal Development at 32nd week
Fingernails and toenails form, subcutaenous fat is developing, less red and wrinkled
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Fetal Development at 38+ weeks
Baby fills entire utereus, receiving antibodies from mother
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Trimester 1 S/S
Extreme fatigues, N/V, Swolen Breasts, Taste changes, Heartburn, Mood Swings, Constipation, Urinary Frequency, Weight Changes
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Trimester 2 S/S
Body aches, stretch marks, linea nigra, skin darkening around nipples, darker patches on face, carpal tunnel, ankel edema, insomnia, vivid dreams
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Trimester 3 S/S
SOB, Heartburn, Swelling, Hemorrhoids, Tender breasts, colostrum excretion, Umbilical protrusion, Lightening, Braxton-hicks contractions
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Safe sex and pregnancy
Sex safe 6 weeks after delivery, sex fine throughout pregnancy if no complications
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Caffiene Limit Pregnant
1-2 Cups/Day
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Foods to avoid when pregnant
Unpasturized dairy, raw fish/canned tuna, raw eggs, deli meat
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Lightening timeframe pregnancy
2 weeks pre-pregnancy, baby moves down into pelvis
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Normal fetal orientation
ROA or LOA (Right occipit anteroir or Left occipit anteroir)
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4 P’s of labour
Pelvis, Passenger, Power, and Psyche
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Different Pelvis’s
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Position (4 P’s)
Use of gravity to hasten labour, we want people to ambulate when we can.
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Powers (4 P’s)
Refers to how strong a woman’s contractions are
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Psychological (4 P’s)
Assessment of mental state, providing reassurance.
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Contraction Frequency vs Duration
Frequency= Start to Start, Duration = Start to end
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Expected FHR During Labour
110-160
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Cardinal Movements
Engagement → Descent → Flexion → Internal Rotation → Extension → External rotation/restitution → Expulsion
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Where is the 1st stage of labour typically conducted, and until when
At home, and typically until the active phase
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Entering Active Phase
4-7cm dilation, 40-80% effacement
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Entering Transition Phase
8-10cm dilation, 80-100% effacement, More frequent strong contractoins, q1-2mins, 60-90s each, can experience lack of control, n/v
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Entering the Second Stage
Full dilation to birth, most influence of the 4 p’s
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Laceration Degrees
1st - Superficial, 2nd - Through the perineum, 3rd - Through anal sphincter muscle, 4th - Through Rectum
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Third Stage of labour
Delivery of placenta
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Fourth stage of labour
Return to hemodynamic state, can experience bladder hypotonia
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R.E.E.D.A Post Partum assessment
Redness, edema, ecchymosis, discharge, approximation
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Lochia progressoin
Rubra → Serosa → Alba