NSG 2421 Trimester 1 Exam

Cycle of Violence

Tenson → Battering → Honeymoon

When do you have a legal obligation to contact the police.

When the victim of abuse is a child.

ABCs of visual pediatric assessment

Appearance breathing circulation (colour)

Friedman’s Structure

Views famliy structure as acomplishing two things, it is affective (it provides affection), and it provides socialization and social placement

Calgary family assessment

Assesses family structure (losses, broad), developmental milestones (walking etc), family function (how well the family works)

Mcgill model

Assesses fmaily, health, collaboration, and learning

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)

Near miss

Potential error no harm

No harm event

Error, no harm

Medication error

Causes harm

Crtitical Incident

Causes serious harm

Dexamethasone

Long acting corticosteroid

Pregnisone

Short acting corticosteroid, can disrupt sleep patterns

Where is fluid kept

65% intercellular, 25% interstitial, 10% plasma

Magnesium

More important in pedes due to MALNUTRITION

HIT YOUR LYTES GOOD

Calculation for pediatric fluid balance.

100ml/Kg for first 10, 50ml/Kg for next 10, 20ml/kg for remaining weight.

Typical pediatric urine output

0\.5-2.0ml/Kg

Dehydration s/s in neonate

Sunken fontanels, delayed cap refil, adult dehydration symptoms

Fluid overload s/s in neonate

Expanded fontanells, crackles, pulmonary/cerebral edema

Normal pCO2

35-45mmHg, Under 2 its 26-41

Normal HCO3

21-28mmol/L, Infant 16-26

Growth vs development

Growth=size, development=personhood

Freud’s Oral stage

B to 1yr - Sucking, biting, just kinda jamming stuff in there

Freud’s Anal Stage

1 to 3yrs - Potty training, bladder control

Freud’s Phallic Stage

3 to 6yrs - Relationship with parents forms, being away from trusted adults in school/daycare

Freud’s Latent stage

6 to 12yrs - Learning about gender roles

Freud’s Genital Stage

12 to Adult - I want to have sex

Piaget’s Sensory-Motor

B to 2yr - Reflexes, basic shit

Piaget’s Preoperational Stage

2 to 7yr - Egocentric, magical thinking, very creative

Piaget’s Concrete opperational stage

7-11yrs - Less self-centered, thinking more coherent, very curious

Piaget’s Formal Operational Stage

11-A - Thoughts more adaptable, flexible, abstraction possible

Eriksons Trust vs Mistrust Stage

B to 1y - Depends on the childs needs being met

Erikson’s Autonomy vs Shame/Guilt Stage

1 to 3y - Increased indepence, testing the limits of their role

Erikson’s Initiative vs Guilt Stage

3 to 6y - Playing, starting to express themselves

Erikson’s Industry vs Inferiority Stage

6 to 12y - Self worth linked to activities and social groups

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

Infant Developmental Milestones

Holds head up without help, Voice recognition, Supports most of it’s own weight when held upward, supported walking

Toddlerhood Developmental Milestones

Throwing, Scribbling, Push and pull toys, Talking, Can undress and kinda dress

Parallel Play

Typicall engaged in by toddlers, playing beside someone else but not engaged with them directly

Preschool Aged Play

Want to emulate parents, whisks, trainers etc, safety scissors as motor skill develops

School Aged Play

Can do stuff that requires concentration like sports

Adolescent Play

Mostly social

Separation Anxiety Cycle

Fear → Despair → Withdrawl/Denial

Dealing with Seperation Anxiety

Look to the parents first, be firm about tasks

Coming methods of childhood coping

Regression, Repression, Rationalization, and Fantasy

Assessing a B to 6m

Usually fine, no stranger anxiety

Assessing 6m to 1y

Stranger danger, keep them with the parent, least invasive → most invasive

Assessing 1 to 3y

Assess quick as you can, usually anxious an hyperactive, still working least to most invasive

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!”

Assessing 6 to 13yr

Usually willing to cooperate, modesty more and more important.

Assessing 13 to 18yr

Can take a more head to toe approach, modesty is very very important.

Thrush

White spots coating the back of the throat, common side effect of corticosteroid therapy

Tylenol Max Pediatric Dose

10-15mg/Kg daily max

APGAR

Apperance, Pulse, Grimace, Activity, Respirations

Egg and sperm viability window

Egg is viable for about 24 hours, sperm is viable for about 48

Due date calculation

The first day of the last menstrual period - 3 months + 7 days

Considered Term

After 37 weeks before 42 weeks

Recommended maternal assessment schedule pre-natal

Every 4 weeks for the first 28 weeks, every 2 weeks 28-36 weeks, once a week 36+

What is assessed at a prenatal visit

Vital signs, weight, uterine size, fetal heartbeat, urinalysis, blood tests, GBS status, psych

G TPAL

Gravita, Term, Preterm, Abortions, Living

Different between stillbirth and abortion

Stillbirth is part 20 weeks

What placental side is maternal and what side is fetal

Maternal = Red/fleshy, fetal = shiny/grey

Subjective signs of pregnancy

Morning sickness, “feeling” pregnant, subjective

Probable signs of pregnancy

A positive pregnancy test, objective tests that do not 100% confirm a pregnancy. Can be cause by other things.

Positive signs of pregnancy

Can only mean you’re pregnant, no other explanation. Ultrasound.

Fetal Development at 4th Week

Fetal Heart Beat Begins to Beat

Fetal Development at 8th Week

All Body Organs Formed

Fetal Development at 8-12th Week

Fetal heart rate can be detected

Fetal development at 16th Week

The sex of the fetus can be detected

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

Fetal development at 24th week

weighs 780g (1lb 10oz), increasingly active, respiratory movements begin, sucking movements

Fetal development at 28th week

Eyes open/close, baby can breathe, surfactant is develpoped, baby is 2/3 final lenght

Fetal Development at 32nd week

Fingernails and toenails form, subcutaenous fat is developing, less red and wrinkled

Fetal Development at 38+ weeks

Baby fills entire utereus, receiving antibodies from mother

Trimester 1 S/S

Extreme fatigues, N/V, Swolen Breasts, Taste changes, Heartburn, Mood Swings, Constipation, Urinary Frequency, Weight Changes

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

Trimester 3 S/S

SOB, Heartburn, Swelling, Hemorrhoids, Tender breasts, colostrum excretion, Umbilical protrusion, Lightening, Braxton-hicks contractions

Safe sex and pregnancy

Sex safe 6 weeks after delivery, sex fine throughout pregnancy if no complications

Caffiene Limit Pregnant

1-2 Cups/Day

Foods to avoid when pregnant

Unpasturized dairy, raw fish/canned tuna, raw eggs, deli meat

Lightening timeframe pregnancy

2 weeks pre-pregnancy, baby moves down into pelvis

Normal fetal orientation

ROA or LOA (Right occipit anteroir or Left occipit anteroir)

4 P’s of labour

Pelvis, Passenger, Power, and Psyche

Different Pelvis’s

Position (4 P’s)

Use of gravity to hasten labour, we want people to ambulate when we can.

Powers (4 P’s)

Refers to how strong a woman’s contractions are

Psychological (4 P’s)

Assessment of mental state, providing reassurance.

Contraction Frequency vs Duration

Frequency= Start to Start, Duration = Start to end

Expected FHR During Labour

110-160

Cardinal Movements

Engagement → Descent → Flexion → Internal Rotation → Extension → External rotation/restitution → Expulsion

Where is the 1st stage of labour typically conducted, and until when

At home, and typically until the active phase

Entering Active Phase

4-7cm dilation, 40-80% effacement

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

Entering the Second Stage

Full dilation to birth, most influence of the 4 p’s

Laceration Degrees

1st - Superficial, 2nd - Through the perineum, 3rd - Through anal sphincter muscle, 4th - Through Rectum

Third Stage of labour

Delivery of placenta

Fourth stage of labour

Return to hemodynamic state, can experience bladder hypotonia

R.E.E.D.A Post Partum assessment

Redness, edema, ecchymosis, discharge, approximation

Lochia progressoin

Rubra → Serosa → Alba