NSG 2421 Trimester 1 Exam

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Cycle of Violence

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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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