Ati exam- summary

Comprehensive OB–Pediatric–Women’s Health Study Guide

Musculoskeletal — Scoliosis

  • Definition: Scoliosis is a lateral curvature of the thoracic spine that forms an S- or C-shape. This condition results in asymmetry in the alignment of the ribs, shoulders, hips, or pelvis.

  • Assessment Findings:

    • Unilateral rib hump visible during forward bending.
    • Uneven shoulders or hips.
    • Clothing that fits unevenly.

  • Causes:

    • Neuromuscular disorders (e.g., cerebral palsy).
    • Connective tissue disorders.
    • Congenital malformations.

  • Nursing Interventions:

    • Screen for scoliosis during adolescence.
    • For moderate curvature, encourage brace use for a minimum of 23 hours per day.
    • Teach skin care, emotional support, and body-image acceptance.
    • In severe cases, prepare the patient for spinal fusion surgery, and provide log-roll post-operative care.

Preeclampsia & Severe Features

  • Definition: A pregnancy-specific hypertensive disorder that occurs after 20 weeks of gestation.

  • Key Findings:

    • Blood Pressure (BP) ≥ 140/90 mmHg; classified as severe if BP ≥ 160/110 mmHg.
    • Proteinuria (≥1+).
    • Presence of facial or hand edema.
    • Severe headache or blurred vision.
    • Right upper quadrant (RUQ) or epigastric pain with elevated liver enzymes.
    • Pulmonary edema indicates severe disease progression.

  • Nursing Interventions:

    • Administer magnesium sulfate (anticonvulsant).
    • Monitor deep tendon reflexes (DTRs), respiratory rate (>12/min), and urine output (>30 mL/hr).
    • Keep calcium gluconate readily available as an antidote.
    • Administer antihypertensives (e.g., labetalol, hydralazine).
    • Maintain a quiet environment, lateral positioning for the patient, and continuous fetal heart rate (FHR) monitoring.
    • Delivery is the definitive treatment for severe preeclampsia.

HELLP Syndrome

  • Definition: A life-threatening complication of severe preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets (H.E.L.L.P).
  • Assessment Findings:
    • Severe RUQ pain or epigastric pain.
    • Jaundice and/or petechiae.
    • Elevated AST/ALT levels, decreased platelet count, with signs of disseminated intravascular coagulation (DIC).
  • Interventions:
    • Administer magnesium sulfate for seizure prevention.

Neurologic & Pediatric Emergencies

Increased Intracranial Pressure (ICP)

  • Causes: Head injury, meningitis, hydrocephalus, tumors.

  • Early Signs:

    • Infants: Bulging fontanel, high-pitched cry, poor feeding, and sunset eyes (downward gaze).
    • Children: Headache, vomiting (without nausea), and blurred vision.

  • Late Signs: Cushing triad (increased BP, decreased heart rate, and decreased respiratory rate), fixed pupils, and posturing.

  • Nursing Care:

    • Elevate the head of the bed (HOB) to 30 degrees and keep the head midline.
    • Avoid suctioning, coughing, or activities that increase intracranial pressure (e.g., Valsalva maneuver).
    • Maintain a quiet environment; implement seizure precautions.

Seizure Care

  • During Seizure:
    • Turn the patient to the side, remove hazards from the environment, and note the onset and duration of the seizure.
    • Never insert objects into the patient’s mouth.
  • After Seizure (Postictal Phase):
    • Maintain the airway, observe for confusion, and check for Todd’s paralysis (temporary weakness of one side of the body).
  • Medications:
    • Phenytoin (toxicity occurs when > 20 µg/mL leading to symptoms such as ataxia and nystagmus).
    • Valproate (monitored for liver toxicity).
    • Levetiracetam (fewer drug interactions).

Head Injury & Hydrocephalus

  • Reporting Symptoms: Persistent vomiting, unequal pupils, drowsiness, and severe headache.
  • Patient Education: Avoid sedatives and contact sports; wake the child every 2 hours for the first 24 hours.
  • Hydrocephalus Findings: Cerebrospinal fluid (CSF) buildup leads to a larger head, sunset eyes, nausea, and vomiting.

Meningitis

  • Findings: Fever, nuchal rigidity, positive Kernig’s and Brudzinski’s sign, photophobia.
  • CSF Analysis: Cloudy appearance, increased protein, decreased glucose, and increased white blood cells (WBC) in bacterial meningitis.
  • Precautions: Implement droplet isolation for 24 hours after antibiotics.
  • Interventions: Administer IV antibiotics, maintain a quiet room, monitor ICP, and implement seizure precautions.

Reye’s Syndrome

  • Cause: Viral infection combined with aspirin (ASA) use.
  • Signs: Vomiting → lethargy → coma, with increased ammonia levels in the blood.
  • Care: Administer Mannitol to reduce ICP and vitamin K; avoid aspirin in children.

Cardiac Disorders in Children

Example and Effect

  • Increased Pulmonary Blood Flow:

    • Conditions like Patent Ductus Arteriosus (PDA), Atrial Septal Defect (ASD), and Ventricular Septal Defect (VSD).
    • Results in left-to-right shunting and increased risk for congestive heart failure (CHF).
    • Treatment includes administering diuretics, providing increased caloric feeds, and giving indomethacin.

  • Decreased Pulmonary Blood Flow:

    • Conditions like Tetralogy of Fallot (TOF) and tricuspid atresia.
    • Symptoms include cyanosis, often relieved by squatting.
    • Treatment includes knee-chest positioning, oxygen administration, and surgical interventions.

  • Obstructive Disorders:

    • Conditions such as Coarctation of the Aorta, Aortic Stenosis (AS), and Pulmonary Stenosis (PS).
    • Findings include increased blood pressure in the arms and decreased blood pressure in the legs.
    • Requires comparing pulses and treating hypertension.

  • Mixed Disorders:

    • Conditions such as Transposition of the Great Arteries (TGA) and Hypoplastic Left Heart Syndrome (HLHS).
    • Results in cyanosis leads to heart failure.
    • Prostaglandin E is administered to keep the ductus arteriosus open.

  • Digoxin Considerations:

    • Hold if heart rate < 90 bpm for infants or < 70 bpm for children.
    • Symptoms of toxicity include vomiting, bradycardia, and anorexia.
    • Administer 1 hour before or 2 hours after meals.

  • Congestive Heart Failure Signs:

    • Symptoms include tachypnea, retractions, poor feeding, hepatomegaly, and weight gain.
    • Treatment includes oxygen therapy, furosemide, ACE inhibitors, maintaining semi-Fowler's position, and offering small, frequent feedings.

Breast Engorgement

  • Definition: Breast fullness, tenderness, and swelling resulting from milk accumulation after childbirth.
  • Findings:
    • Breasts may appear firm, warm, shiny, and painful.
    • Patients may experience a low-grade fever.
  • Nursing Care:
    • Apply cold compresses between feedings.
    • Encourage frequent breastfeeding or expression of milk to relieve pressure.
    • Recommend wearing a supportive bra and avoiding tight clothing or nipple stimulation between feedings.
    • Provide mild analgesics for comfort.

Newborn — Cold Stress

  • Definition: Excessive heat loss leading to hypothermia, hypoglycemia, and metabolic acidosis in the newborn.
  • Signs:
    • Body temperature below 36.5 °C.
    • Mottled, cool skin.
    • Lethargy, poor feeding, and apnea.
  • Interventions:
    • Warm the newborn gradually with a radiant warmer or through skin-to-skin contact.
    • Ensure immediate drying after birth to prevent further heat loss.

Kawasaki Disease

  • Key Signs: At least 5 days of fever, rash, red tongue, and edema.
  • Treatment: Administer intravascular immunoglobulin (IVIG) and aspirin.
  • Important Note: Avoid live vaccines for 11 months post-IVIG administration.

Rheumatic Fever

  • Cause: Follows streptococcus infection.
  • Major signs: Carditis, polyarthritis, and chorea.
  • Treatment: Penicillin for 10 days and aspirin, along with long-term prophylaxis.

Hematologic

  • Iron-Deficiency Anemia: Signs include fatigue, pallor, and spoon nails. Treat with iron supplementation and orange juice; black stools are normal.
  • Sickle Cell Disease: Characterized by vaso-occlusion leading to pain, swelling, and priapism. Treatment includes hydration, oxygen supplementation, opioids, and hydroxyurea.
  • Hemophilia A/B: Presents with joint bleeding; treated with Factor VIII or IX. Patients should avoid aspirin.
  • Leukemia: Results in bone-marrow failure leading to anemia, increased susceptibility to infection, and bruising; utilizes neutropenic precautions.
  • Aplastic Anemia: Presents with pancytopenia requiring bone-marrow transplant.

Musculoskeletal & Skin Disorders

  • Developmental Dysplasia of the Hip (DDH): Presents with asymmetric skin folds and positive Ortolani or Barlow test. Treatment includes the Pavlik harness for infants younger than 6 months.
  • Juvenile Arthritis: Characterized by morning stiffness. Treatment includes NSAIDs, methotrexate, and range of motion (ROM) exercises.
  • Burns: Parkland formula is used for calculation: 4 ext{ mL} imes ext{weight (kg)} imes ext{% of total body surface area (TBSA)}; administer half within 8 hours and the other half over the next 16 hours. Utilize sterile dressings and a high-protein diet.
  • Impetigo: Appearance of honey-crusted lesions. Management includes mupirocin and daily cleansing.
  • Eczema: Presents as dry, itchy patches and is treated with emollients, topical steroids, and cotton clothing.
  • Ringworm: Treated with antifungals like griseofulvin for 6–8 weeks; wash linens, and do not share combs.

Gastrointestinal & Renal Considerations

  • Monitoring: Regular temperature and blood glucose monitoring for newborns; using hats and blankets to prevent drafts.

Third-Trimester Bleeding

  • Causes:
    • Placenta Previa: Presents as painless bright-red bleeding.
    • Placental Abruption: Characterized by painful, rigid abdomen with dark bleeding.
  • Nursing Actions:
    • Avoid vaginal examinations.
    • Use large-bore IV lines for administering fluids and blood products.
    • Continuously monitor fetal heart rate (FHR) and maternal vitals.
    • Weigh pads to estimate blood loss and prepare for C-section if indicated.

Common vs. Reportable Late-Pregnancy Findings

  • Finding: Shortness of breath on exertion.
    • Meaning: Normal as the uterus pushes against the diaphragm.
  • Finding: Swollen feet/ankles.
    • Meaning: Normal due to venous congestion.
  • Finding: Headache unrelieved by medication.
    • 🚨 Report: Indicates possible preeclampsia.
  • Finding: Braxton Hicks contractions.
    • Meaning: Normal, as the uterus practices for labor.

Fetal Monitoring Preparation

  • Action: Assess dilation and effacement to determine the need for internal monitor placement.
  • Speculum Exam: Conducted by the provider only.
  • Nitrazine Test: Checks pH to assess if rupture of membranes (ROM) is suspected.

Magnesium Sulfate Nursing Care

  • Nursing Action: Keep calcium gluconate available as an antidote for magnesium toxicity.
  • Assessment: Check DTRs hourly to detect early toxicity.
  • Fluid Limitation: Limit IV fluids to ≤125 mL/hr to prevent pulmonary edema.
  • Monitoring: Conduct hourly intake and output (I&O) to ensure renal clearance.

Labor Complications

  • Late Decelerations: Indicates potential uteroplacental insufficiency. Actions include stopping oxytocin, repositioning the mother, and administering oxygen.
  • Prolonged Active Phase: This may result in potential dystocia; consider oxytocin induction if necessary.
  • Moderate Variability: Considered reassuring fetal status.

Phototherapy Care

  • Care Guidelines:
    • Undress the infant except for a diaper.
    • Avoid lotions or creams on the skin.
    • Reposition the infant every 2 hours.
    • Maintain hydration and monitor temperature.
    • Loose green stools or mild rashes are expected side effects.

Pelvic Inflammatory Disease (PID)

  • Definition: A result of untreated chlamydia or gonorrhea.
  • Findings: Fever, pelvic pain, foul discharge, and increased C-reactive protein.
  • Treatment: Administer ceftriaxone via intramuscular injection and doxycycline orally for 14 days.
  • Teaching: Complete the medication course, abstain from sexual intercourse until cured, practice safe sex with condoms, and report recurrence of symptoms.

Contraceptive & Women’s Health Medications

Types & Key Points

  • Levonorgestrel (Plan B): Take within 120 hours post-intercourse (best if taken within 72 hours).
  • Combined Oral Pills: Take at the same time daily; avoid use if hypertensive or experiencing migraines.
  • Depo-Provera: Administered intramuscularly every 3 months; may cause weight gain and decreased bone density.
  • IUD: Check strings monthly and report any pain or fever.
  • Emergency Contraception: Nausea is common; test for pregnancy if no menses occurs after 7 days.

Preeclampsia vs. Eclampsia

  • Preeclampsia: Hypertension paired with proteinuria following 20 weeks of gestation.
    • Management: Administer magnesium sulfate, ensure rest, monitor closely.
  • Eclampsia: Preeclampsia plus seizures.
    • Management: Maintain airway, provide oxygen, and stabilize prior to delivery.

Postpartum Hemorrhage

  • Definition: Blood loss exceeding 500 mL during vaginal delivery or exceeding 1000 mL during cesarean delivery.
  • Causes: Uterine atony, retained placenta, or lacerations.
  • Interventions:
    • Massage the fundus until firmness is restored.
    • Administer oxytocin; if ineffective, consider methergine (not to be used in patients with hypertension) or misoprostol.
    • Monitor vital signs, urine output, and amount of bleeding.

Hypoglycemia and Newborn Care

  • Hypoglycemia Presentation: Jittery, poor feeding.
    • Management: Early feeding, intravenous D10W if blood glucose is less than 40 mg/dL.
  • Jaundice: Characterized by yellowing of the skin; managed with phototherapy and hydration.
  • Sepsis: Present with temperature instability and lethargy; treated with antibiotics (ampicillin and gentamicin) and isolation.
  • Neonatal Abstinence Syndrome (NAS): High-pitched cry, tremors, poor feeding; treated with quiet environment and morphine/methadone taper while monitoring for seizures and weight.

Respiratory Distress Syndrome (RDS)

  • Signs: Grunting and cyanosis.
  • Management: Surfactant therapy, oxygen support, and thermoregulation.

Pediatric Nursing — Mobility & Development

  • Scoliosis: Characterized by uneven shoulders and hips. Treatment includes bracing for 23 hours daily or surgery as needed, along with frequent skin checks.
  • Developmental Dysplasia of the Hip (DDH): Identified through Barlow and Ortolani tests—treated with a Pavlik harness for up to 23 hours a day.
  • Cerebral Palsy: A non-progressive motor disorder treated with physical therapy, occupational therapy, and medications such as baclofen or Botox.
  • Muscular Dystrophy: An X-linked disorder characterized by a Gower sign, increased risk of falls, and respiratory failure—managed with physical therapy and steroids.
  • Spina Bifida: Presenting with an open sac requires moist sterile dressing care, prone positioning, and monitoring for hydrocephalus and latex allergies.

Safety Across Ages

  • Infants: Require rear-facing car seats and safe sleep practices.
  • Toddlers: Emphasis on childproofing and drowning prevention.
  • School-age: Helmet use and seatbelt enforcement are critical.
  • Adolescents: Driving safety and education on substance abuse are essential.

Community & End-of-Life Care

Abuse Recognition & Prevention

  • Signs of Abuse: Inconsistent stories, injuries at varied healing stages, or fear of caregivers.
  • Types of Abuse: Include physical, emotional, sexual, neglect, and elder abuse.
  • Nurse's Role: Mandatory reporting, thorough documentation, and providing therapeutic support to victims.

Therapeutic Communication at End-of-Life

  • Principle: Listen actively, validate feelings, but avoid giving false reassurance about prognoses.
  • Physiologic Signs of Dying: Reduced appetite, cool extremities, and irregular breathing patterns must be addressed.

Pharmacology & Math Essentials

Hospice / Palliative Medications

  • Benzodiazepines: Example includes Lorazepam and Midazolam used for anxiety and restlessness.
  • Opiates: Morphine and Fentanyl used for pain management and relief of dyspnea.
  • Corticosteroids: Dexamethasone is used to reduce inflammation.

Newborn Medications

  • Vitamin K: Administered to prevent bleeding, given as 0.5–1 mg IM before circumcision.
  • **Erythromycin Eye Ointment