HOSA NOTES FOR CLINICAL NURSING

HOSA Notes

Proper Body Mechanics:

The safest and most efficient way to transport is “Body Mechanics”

• Applying the mechanical principles of movement to the body

3 Major Factors:

• Center of Gravity

• Base of Support

• Line of Gravity

Center of Gravity:

• Person’s center of gravity is in the pelvis (hip area)

• Approx. half of body weight is distributed below this area.

• EX. Lifting the object but bending on the knees and hips, keeping back straight.

Line of Gravity (Gravitational Plane) :

• Imaginary vertical line, from head, to center of gravity (pelvis), to base (feet)

• For max. Efficiency, the line should be straight from top of head to base, equal weight on each side.

• When a person's body follows this line, all muscles work together for safe and efficient movement without strain.

Positioning the Client:

• Encourage Clients to take walks, and move.

• Immobility leads to many disorders: Pressure Ulcers, Blood Clots, Constipation, Muscle Weakness/Atrophy.

• Assisting Clients with mobility is crucial to improve lifestyle, and prevent disc.

Moving and Positioning Client:

It is IMPORTANT to explain to the client why she/he is being moved (Explain how they can help)

Client Positions:

• Supine: lying on the back

• Prone: Lying on stomach/abdomen

• Sims: Lying on the side (usually left with knee raised

• Fowlers: Lying on back with head elevated

• Dorsal Lithotomy: Lying on back with feet raised in stirrups(Handles)

• Lateral: Lying on side

Positioning Client (Comfort): 

• Maintain Line of Gravity

• Reassure client for comfort

• Handle clients body against injury/pain

• If heavy/immobile, get help

• Only move/position client if a specific order is given

• DO NOT use special devices unless ordered to

• Make sure the nurse signal cord is available to the client.

ROM:

-Every joint has specific/limited range of motion (ROM)

-Regular exercise prevents joint deformities which are caused by long muscle contractions

ROM IS SPLIT INTO 2 TYPES

PROM (Passive ROM) :

-If the client is unable to move, passive ROM is used.

-PROM is when the nurse slowly moves the client's joints with consent.

-Do not force joint movement if pain occurs, stop and contact supervisor.

AROM (Active ROM):

-Active ROM is when a client is performing physical activity individually, supervision may be advised to ensure efficient ROM

-Isometric exercises are those when the client tightens and releases muscle groups.

EVALUATING RISK OF FALLS

-Clients who have difficulty walking or who had a recent fall are vulnerable to falling.

-All clients in healthcare buildings have to be checked for fall risk.

Use of the Transfer Belt: 

-Nurses use a transfer belt/gaited belt to transfer patients

-It is essential to use a transfer belt when transporting weak,unsteady, or paralyzed. 

If Client Falls:

-If a client feels faint, assist them into a sitting position, if no chair/seat available, assist slowly on the ground.

-Do not allow the client to grasp your neck, even amidst falling.

Dangling:

-Dangling refers to sitting on the edge of the bed with your feet hanging in the air, which prepares clients to stand/walk.

-It is important for a nurse to know the clients limitations

HOW TO HELP CLIENT WALK:

-Have client wear non-slip footwear with wide base

-Use a transfer Belt

-Stand slightly behind the client and beside

If client needs support walking:

-Hold the clients lower arms and hands

Mobility Devices:

-Wheel Chair: Often used to move clients who are unable to walk, LOCK WHEELS OF WHEELCHAIR

-Cane: Hand-held curved stick/device used to assist in walking,when there is pain in the hip or knee The three basic canes are Tripod Cane, Standard Straight legged cane,Quad Cane

Personal Hygiene:

Mouth Care:

• Many disease-causing organisms live in the mouth

• Food particles stuck in between teeth can cause inflammation, decay, and loss of teeth.

• Mouth breathing also causes dryness and irritation.

Client Mouth Care:

• Offer client opportunity to brush his or her teeth before/after meals

• Observe the condition of gums, tongue, mucous membrane, and teeth.

• If brushing teeth is impossible, encourage water/mouthwash rinse after meals

• Floss is important (removes debris)

• Both dentures and natural teeth have same care

Dependant Clients:

• Oral Cleaning helps prevent choking (debris removement)

• Unresponsive clients require hourly oral hygiene to combat dryness

Routine Eye Care:

• Remove secretions and liquids with cotton gauze on eyelashes and eyelids moistened with sterile water or saline.

•  Some clients need supplement moisture; Eye Drops

Routine Ear Care:

• Client’s ears washed routinely during bed-bath

• If excessive ear wax, special procedure to remove, to prevent hearing loss.

Hearing Aid Ear Care:

• Hearing aid: Battery operated, sound amplifier

• The size of hearing aid depends on hearing loss level

1. Cleaning ear-piece regularly with saline/prescribed solution

2. Check/replace batteries when needed

3. Avoid exposing aid to heat/moisture

4. Turn volume down before inserting aid into ear

Care for Hands and Feet:

Caring for fingernails:

• Physiological strain can cause fingernail biting

• Torn cuticles are common to cause infection

• Torn/Jagged fingernails need to be clipped to smoothen

Foot Soaks can help with edema, tenderness, or foot infections.

Hair Care:

• Hair care is daily, no matter the location

• Helps make clients feel better, and encourage the clients to do it

• Helps clients be distracted, and adds to clients self esteem.

Skin Care:

• Skin is the body's largest defence and organ, and must stay intact and unbroken to work.

• Skin helps regulate body heat

Basic Vital Signs; HOSA

Vital Signs: Measurements of the body's functions: 

• Body Temperature (Average 37°C Oral)

• BP (Blood Pressure

• Pulse

• Respiration (Breathing)

Most common monitor program is Graphic Method:

• Shows large amounts of information quickly

• Record vital signs to help diagnose quickly

• Records all important vital signs

If Client=Serious Condition, then check vitals every 5, 10, 15 minutes

• Vitals and Medication given are then recorded into a Vitals Sign Sheet

BODY TEMPERATURE

Body Temp. is the heat inside a person's body ( Avg. 37°C Oral/ 98.6°F)

• Celcius and Fahrenheit, important to know conversions 

Signs of an elevated temp (>37):

-Flushed Face/Hot Skin

-Restlessness and Chills

-Thirst

Most Common Areas to check temp:

• Oral (Mouth) O

• Rectum (Anus) R

• Axillary (Armpit) Ax

• Tympanic (Ear Canal) ™

• Temporal (Forehead Vein) TA

Normal body temp is often lowest in the morning and highest in the evening

• Newborns have a higher normal temp than adults

Fever Terms:

Intermittent Fever: Body Temp alternates from average to elevated or subnormal

Remittent Fever: Elevates body temp and comes back to average/near average temp

Constant Fever: Stays elevated, relatively the same

Crisis: A sudden drop from fever to normal body temp

Lysis: Elevated temp slowly returns to normal temp

Relapsing Fever: Returns to normal for at least a day, and elevates again

Hyperthermia:

-Significantly dropped body temp

-May come before death, possible from natural elements

Hyperthermia appears in 2 ways:

Clinical Hyperthermia: Controlled drop of body temp to slow metabolism and need for oxygen.

Accidental Hyperthermia: Appears during sudden drop of body temp, and is life threatening

Use of Thermometer:

• Cover the sensor/bulb with tissue expect for TA ( Temporal Vein)

• Cover Probe(Tube) with thin paper for sanitary reasons

ORAL MEASUREMENT:

• Measure using sublingual arteries under the tongue

• Wait before measuring if hot/cold items consumed

• If patient is unconscious/uncooperative, do not measure oral

• If patient can not breathe through mouth, do not measure oral

RECTAL MEASUREMENT:

• Very accurate method of use

• Uncomfortable and used for unconscious patients

• Cannot use after rectum surgery or in conditions of diarrhea, cancer of rectum, or swelling of the colon (colitis)

AXILLARY MEASUREMENT:

• Least accurate due to not fully inclosed probe

• Used commonly on newborns

• Only use method if any other method is unavailable 

TYMPANIC MEASUREMENT:

• Measures the thermal radiation of the ear canal

• Ideal spot for measuring core temp.

• Fast recording of temp, 1-2 seconds

TEMPORAL MEASUREMENT: 

• Newer method used a Temporal temp. scanner

• The scanner moves across the forehead and calculates peak body temp. Using the artery’s heat

• Quickest and most private method

• More accurate than tympanic method

GLASS THERMOMETERS ARE BANNED AND NOT RECOMMENDED 

PULSE:

Pulse: Heartbeats produce a wave-like pattern of higher blood pressure in the arteries, which can be measured as a heartbeat.

The pulse can be observed in different places:

Radial Pulse; Wrist 

Temporal Pulse; Side of the forehead

Carotid Pulse: Side of the Neck

Brachial Pulse: In Between forearm and bicep

Pulse Rate= Heart Rate (HR)

RATES:

Normal Adult: 60-80 BPM

Newborns: 120-140 BPM; rapid circulation for growth

Pulse Rate changes during meals, exercise, sleep, extreme emotion, or disease…

RATE TERMS:

Pulse Rate changes due to fevers or status of the thyroid glands (10 beats/ 1 degree in fahrenheit elevated)

Tachycardia: Consistently above 100 BPM; Signifies heart disease, heart failure, serious bleeding.

Bradycardia: Below 55 BPM; Pro- Athletes may have natural Bradycardia, or abnormal conditions

Urinary Elimination

• Urine Characteristics:

  • Normal: Color: Light yellow/amber.

    • Clarity: Clear.

    • Odor: Aromatic, as in the smell of urine.

    • Volume: 250-400 mL per void, 500-2,400 mL/24 hrs.

    • Specific Gravity: 1.010-1.025.

    • Acidity: Slightly acidic.

  • Abnormal:

    • Cloudy: Bacteria, mucus, pus.

    • Dark amber: Dehydration.

    • Abnormal components: Microorganisms, blood.

• Urinary Retention:

  • Catheters:

    • Straight: Temporary insertion for immediate drainage.

    • Retention/Indwelling: Continuous drainage post-surgery or for those unable to avoid naturally.

• Urinary Tract Issues:

  • UTIs: Common, caused by microorganisms in the urethra.

  • More frequent in women (shorter urethra).

  • Conditions:

    • Urethritis: Urethra inflammation.

    • Cystitis: Bladder inflammation.

    • Nephritis/Pyelonephritis: Kidney inflammation.

  • Urinary calculi: Stones causing renal colic (severe back pain).

Bowel Elimination

• Feces Characteristics:

  • Normal:

    • Color: Yellowish-brown (bile presence).

    • Consistency: Soft, formed.

    • Shape: Cylindrical, bowel-shaped.

    • Density: Sinks in water.

    • Odor: Characteristic.

  • Abnormal:

    • Hard, dry stools: Constipation.

    • Loose, watery stools: Diarrhea.

    • Pus/mucus: Infection or inflammation.

• Patterns:  

  • Unique to individuals; symptom-free less frequent movements not a concern.

  • Peristalsis moves feces; affected by illness, immobility, diet, or activity changes.

• Flatus:

  • Normal part of digestion; excess can cause discomfort.

  • Relief:

    • Walking, left-side lying, avoiding ice/straws, warm compress.

• Fecal Impaction:

  • Stool too hard/dry to expel.

  • Symptoms: Abdominal discomfort, hard abdomen, pressure.

  • Manual removal: Stop if pain, nausea, or bleeding occurs.

Enemas

• Types:

  • Cleansing: Softens stool, lubricates for evacuation.

  • Disposable (Fleet): Hypertonic saline; draws water into the colon.

  • Carminative: Expels gas and stool.

  • Retention: Small oil amount retained to soothe mucosa.

  • Medicated: Drug delivery via rectum.

  • Harris Flush: Relieves gas/distension.

Nausea and Vomiting

• Causes: Weakness, frequent swallowing, pallor, dizziness, or shakiness.

• Symptoms:

  • Drop in pulse/BP during vomiting.

  • Weakness, discomfort, profuse sweating.

Nursing Care for Elimination

• Monitor regularity and patterns.

• Assist clients with physical limitations (toileting, bedpans).

• Document bowel movements.

• Encourage fluid intake (6-8 glasses/day) and exercise.

• Provide dietary recommendations (high fiber, fruits, vegetables).

• Bowel retraining for incontinence:

  • Regular elimination timing.

  • Physical activity.

  • Fluid/diet adjustments.

Collecting Specimens and Samples:

Labeling:

• Always label the specimen container, including the lid, before collection. Make sure to include the client's name and other necessary data (e.g., date, time).

Hygiene and Precautions:

• Hand hygiene: Wash hands before and after specimen collection to prevent cross-contamination.

• Standard precautions: Always follow standard precautions, such as wearing gloves. In some cases, like sputum collection, you may also need to wear masks and eye protection to minimize exposure to airborne particles.

Sample Collection:

• Clean the area where the specimen is being taken (e.g., urinary tract, wound) to prevent contamination.

• Use sterile technique whenever possible, even if the specimen itself is not sterile. This ensures the sample is as uncontaminated as possible.

• After collection, place specimens in biohazard bags to protect staff and others from contamination.

Transporting the Specimen:

• Immediate transport: Send specimens to the lab immediately to ensure they’re processed while still fresh and accurate.

• Documentation: Ensure that the appropriate lab request forms accompany the specimen. If using electronic records, make sure the computer order is correctly entered.

• Recording: Record the time of collection and forwarding in the client’s health record, so it's clear when the specimen was sent and if any follow-up is needed.

Results Follow-up:

• Review the client’s health record to check if the specimen results should be flagged for immediate attention by the healthcare provider.

Measuring Fluid Intake:

What Counts as Fluid Intake?

• GI system fluids: This includes any fluids taken by mouth, such as water, juice, soup, or tube feeding.

• IV and TPN fluids: Any fluids administered intravenously or as total parenteral nutrition (for those unable to consume food/drink normally) should also be recorded.

Recording the Intake:

• Be sure to record all fluids consumed by the patient during a given period.

• Ice: If the patient consumes ice, count it as 50% water. For example, 100 mL of ice equals 50 mL of fluid intake.

Pain

• Subjective: Only described by the client.

• Self-report: Best indicator of pain.

• Goal of Nursing Care: Relieve pain, no matter the cause.

• Types of Pain:

  • Acute

  • Referred

  • Cancer

  • Chronic

Chronic Pain

• Long-lasting discomfort, often with unknown causes.

• Can interfere with normal functioning.

• Emotional Impact: Frustration, anger, isolation.

• Intractable Pain: Chronic pain that resists treatment.

• Neuropathic Pain: Hard to treat, requires more aggressive measures.

Nociception (Pain Transmission)

• Describes pain transmission and interpretation.

• 4 Phases:

  • Transduction

  • Transmission

  • Perception

  • Modulation

• IASP Categories:

  • Acute Pain

  • Referred Pain

  • Cancer Pain

  • Chronic Pain

Pain Rating Scales

• Pain = 5th Vital Sign, must be assessed regularly.

• Joint Commission Standards: Requires use of pain scales.

• Common Scales:

  • Pain Intensity Scale

  • McGill-Melzack Pain Questionnaire

  • Wong-Baker Faces Pain Scale

  • FLACC

  • NIPS

• Wong-Baker Faces: For children (3-7 years) and non-verbal adults.

Description of Pain

• Pain Characteristics:

  • Character

  • Duration

  • Severity

  • Associated Factors

• COLDSPA: Helps gather symptoms.

• Types of Pain Descriptions:

  • Aching

  • Burning

  • Sharp

• Duration:

  • Occasional

  • Intermittent

  • Spasmodic

  • Constant

• Intensity:

  • Mild

  • Moderate

  • Severe

  • Excruciating

• Consequences of unrelieved pain:

  • Visual disturbances

  • Nausea & vomiting

  • Depression

  • Muscle spasms

  • Withdrawal

Pharmacologic Therapy

• Primary Goal: Pain management.

• Analgesics: Best when given regularly or at onset of pain.

• 3 Major Classes:

  1. Non-opioid NSAIDs

  2. Opioids/Narcotics

  3. Adjuvant Drugs (for other uses, also aid pain).

• Ointments & Liniments: Local anesthetics for relief.

Nursing Interventions

• Empathetic Care: Diversion, music, repositioning, back rubs.

• Comfort Measures: Clean bed, rest, music, warm/soft light.

• Severe Pain: Especially challenging for terminal illness.

• Nursing interventions are complementary to pharmacologic treatments.

Surgical Interventions

• For chronic pain due to tumors or pinched nerves.

• Surgical Options:

  • Removal of pain source (e.g., herniated disks).

  • Ablation Surgery: Cutting nerves transmitting pain (rarely used).

Physical Measures

Massage & Pressure: Helps relieve pain and promote circulation.

TENS: Electrical stimulation to block pain and produce endorphins.

Heat: Vasodilation for pain relief.

Cold: Vasoconstriction to control localized pain.

Exercise: Increases joint flexibility and muscle strength (only to tolerance).

Cognitive-Behavioral Techniques

• Distraction

• Relaxation

• Guided Imagery

• Support Groups

• Stress Management
  (Complementary to pain management).

Alternative & Complementary Techniques

• Nontraditional methods:

  • Chiropractic care

  • Acupuncture

  • Acupressure

  • Hypnosis

  • Biofeedback

• Benefits: Allows clients to take ownership of pain management.

Data Gathering

• Assess pain's character, location, duration, severity, onset, pattern, and coping strategies.

• Physiological and emotional responses to pain, including cultural aspects.

Nursing Diagnoses

• Possible diagnoses:

  • Acute Pain

  • Chronic Pain

  • Ineffective Coping

  • Powerlessness

  • Compromised Family Coping

Care Planning

• Plan with healthcare providers, clients, and family.

• Goals:

  • Gradual pain reduction

  • Successful pain-management program

  • Improve quality of life for chronic pain clients.

Bandages and Binders

Types of Bandages:

• Elastic Roller Bandage (ACE Bandage): Used to wrap around a limb for support, circulation improvement, or to secure dressings.

• Kerlix: Stretchy gauze in a long roll used for various wound coverings.

• Stretch-Net Bandage (Tube Gauze): Stretchy, net-type material to hold dressings in place comfortably.

Antiembolism Stockings/Thromboembolic Disease (TED) Stockings:

• TED Stockings: Cover the foot and legs up to the knee/mid-thigh to ensure venous circulation, helping prevent blood clots.

Pneumatic Compression Device (PDC)/Sequential Compression Device (SCD)/Intermittent Sequential Compression Device (ISCD):

• PDC/SCD/ISCD: Devices that provide alternative pressure to the legs, aiding in circulation to prevent blood clots.

Binders:

• T-Binder: A binder used to secure rectal or perineal dressings.

• Abdominal Binder: Secures around the trunk to support the abdomen or dressings over abdominal areas.

• Montgomery Straps: Used for frequent dressing changes, reducing irritation by not requiring removal of tape each time.

Purpose of Bandages:

• Support: Aids in supporting a limb, joint, or wound/incision.

• Compression: Promotes venous return, prevents edema, or prevents contractures.

• Positioning: Helps immobilize a joint or maintain a specific position for recovery.

• Shape Stump: Used to shape a stump before fitting a prosthesis.

Applying Roller Bandages:

1. Prepare for application:

   • Wear gloves.

   • Check agency policies.

   • Use the correct bandage size (typically <3 in. for arms or legs).

   • Explain to the patient.

2. Procedure:

   • Elevate the extremity above the body/heart.

   • Ensure the patient lies down for at least 15 minutes before applying.

   • Roll the bandage and begin wrapping at the toes/fingers and move upward (toward the hip/shoulder).

   • Apply firm pressure but avoid wrapping too tightly.

   • Overlap each layer about half the width of the previous strip.

   • Anchor the bandage with hypoallergenic tape or Velcro.

3. Post-application:

   • Check circulation to ensure it's not too tight.

   • Dispose of used dressings and gloves.

   • Sanitize hands.

   • Perform a Peripheral Neurovascular Assessment (PNA) every 2 hours.

   • Document the procedure.

Applying Stretch-Net Dressings to Fingers:

1. Prepare and apply:

   • Cut the netting 2.5-3 times the length of the finger.

   • Place the netting on the applicator tube.

   • Gently pull the netting over the finger, twisting at the base to secure.

   • If a thicker dressing is needed, repeat the process.

2. Post-application:

   • Dispose of gloves and document the procedure.

Applying a Binder:

1. Preparation:

   • Wash hands and use gloves.

   • Choose the correct-sized binder.

2. Application:

   • Apply the binder firmly but not too tightly.

   • Fasten the binder starting from the bottom upwards.

   • Ensure the binder doesn't slip upwards or downwards.

3. Post-application:

   • Rewrap every 2-4 hours and check the dressing.

Critical Thinking Exercises:

1. Circulation Check Elements:

   • Pulse: Ensure adequate blood flow to the extremity.

   • Capillary Refill: Check how quickly blood returns to the capillaries (should be under 2 seconds).

   • Color: Look for any signs of pallor or cyanosis indicating poor circulation.

   • Temperature: Check if the extremity is too cold (possible sign of poor circulation).

   • Edema: Observe if there is any swelling due to restricted circulation.

2. TED Stockings Complications:

   • Complaint of Tightness: If the client complains that TED stockings are too tight, you should:

     • Check for signs of impaired circulation.

     • Ensure the stockings are applied properly without causing excessive constriction.

     • Consider adjusting the size of the stockings or replacing them if necessary.

   • Potential Complications:

     • Reduced circulation leading to discomfort, skin irritation, or even ulcers.

     • Blood clots if circulation is impaired.

Heat and Cold Applications

Normothermia Maintenance:

• Crucial to maintaining normal body temperature in healthcare, especially post-surgery, to prevent complications.

• Special precautions for patients vulnerable to hypothermia, such as providing warmed blankets and fluids.

Heat Application:

• Vasodilation: Expands blood vessels, increasing oxygen and nutrient delivery.

• Uses:

  • Relieves pain, stiffness, and inflammation.

  • Promotes wound healing and drainage.

  • Aids in maintaining normothermia.

• Precautions: Avoid burns with prolonged use; ensure controlled temperature for safety.

Cold Application:

• Vasoconstriction: Reduces blood flow and slows metabolism.

• Uses:

  • Stops bleeding and reduces swelling.

  • Relieves pain and controls muscle spasms.

  • Effective for soft tissue injuries within 48 hours of injury.

• Precautions: Prevent frostbite and prolonged exposure that could damage tissue.

Moist vs. Dry Applications:

• Moist heat: More penetrating, faster, but can cause skin maceration if too long.

• Dry heat: Slower, but safer with proper application (e.g., heating pads).

• Cold therapy: Compresses and ice bags are effective for swelling and injury care.

Temperature Ranges:

• Hot: 37.7°C–40.5°C (100°F–105°F)

• Warm: 35°C–37.7°C (95°F–100°F)

• Cold: 10°C–18.3°C (50°F–65°F)

Therapy Types:

• Dry: Includes electric heating pads, infrared lamps, and ultrasound.

• Moist: Compresses, soaks, and packs that help stimulate circulation and manage pain.

• Cold: Ice packs, ice collars, and humidity devices used to treat pain and inflammation.

Key Safety Considerations:

• Regular monitoring of temperature and skin condition during treatment.

• Ensure proper application to avoid complications like burns or frostbite.

• Correct temperature management prevents adverse reactions like chilling or fever.

Pregnancy Overview

• Stages of Pregnancy:

  • First Trimester (Week 1-12): Formation of the embryo, development of organs and structures. The body experiences rising levels of HCG, morning sickness, and fatigue. Heartbeat detectable by end of the trimester.

  • Second Trimester (Week 13-26): Fetus grows rapidly, the mother’s symptoms (like morning sickness) may decrease, and energy returns. It’s the ideal time for an anatomy scan. Fetal movement may be felt.

  • Third Trimester (Week 27-40): Fetus continues rapid growth. The mother may experience back pain, shortness of breath, leg cramps, and frequent urination. The body prepares for labor, and the baby reaches full term.

• Early Signs of Pregnancy:

  • Missed period, nausea, changes in the breasts (tenderness or enlargement), fatigue, food cravings, frequent urination, morning sickness, changes in skin.

• Prenatal Care:

  • Regular Check-Ups: Blood pressure, weight monitoring, fetal heart rate, and urine tests.

  • Nutrition: Emphasis on folic acid, iron, calcium, and vitamin D.

  • Exercise: Walking, swimming, yoga (avoid high-risk exercises like contact sports or activities with risk of falling).

• Labor and Delivery:

  • Stage 1: Early labor (cervical dilation), active labor (intense contractions, more dilation), and transition phase (full dilation).

  • Stage 2: Birth of the baby, including pushing and crowning.

  • Stage 3: Delivery of the placenta.

  • Delivery Methods: Vaginal delivery, cesarean section (often if complications arise or if the baby is breech).

• Complications:

  • Gestational Diabetes: High blood sugar that develops during pregnancy. Managed with diet, exercise, and possibly insulin.

  • Pre-eclampsia: High blood pressure and protein in urine, can lead to organ damage if untreated.

  • Ectopic Pregnancy: Occurs when the fertilized egg implants outside the uterus, often in the fallopian tube. Requires emergency treatment.

  • Miscarriage: Loss of pregnancy before 20 weeks, common causes include chromosomal abnormalities.

  • Preterm Labor: Labor that begins before 37 weeks of pregnancy, which may require special care for the baby.

• Postpartum Care:

  • The uterus shrinks back to pre-pregnancy size.

  • Hormones (estrogen, progesterone) stabilize.

  • Breastfeeding helps with uterine contractions and milk production.

  • Psychological care is important as many women experience mood changes or postpartum depression.

Sexually Transmitted Infections (STIs)

• HIV/AIDS:

  • Transmission: Sexual contact, from mother to child during pregnancy, labor, and breastfeeding.

  • Symptoms: May mimic other illnesses. Lab tests are required for diagnosis.

  • Treatment: Antiretroviral medications to reduce viral load and prevent transmission to the baby.

• Chlamydia:

  • Cause: Chlamydia trachomatis (bacteria).

  • Symptoms: Often asymptomatic, but may cause dysuria, abnormal discharge, and pelvic pain.

  • Treatment: Antibiotics (Azithromycin or Doxycycline).

  • Complications: Can lead to infertility, ectopic pregnancy, and chronic pelvic pain. Co-infection with gonorrhea is common.

• Gonorrhea:

  • Cause: Neisseria gonorrhoeae (bacteria).

  • Symptoms: Painful urination, abnormal discharge, and pelvic pain.

  • Treatment: Antibiotics (Ceftriaxone and Azithromycin).

  • Complications: Can spread to other parts of the body, including the joints and heart. Co-infection with chlamydia is common.

• Syphilis:

  • Cause: Treponema pallidum (bacteria).

  • Stages:

    • Primary: Painless sore (chancre) at the site of infection.

    • Secondary: Skin rash, mucous patches, flu-like symptoms.

    • Tertiary: Organ damage, neurological issues, and potential death.

  • Treatment: Penicillin or other antibiotics, depending on the stage.

  • Complications: Can cause severe organ damage if untreated, including dementia, heart issues, and death.

• Herpes Simplex Virus (HSV):

  • Types: HSV-1 (oral) and HSV-2 (genital).

  • Symptoms: Painful blisters, itching, burning during urination.

  • Transmission: HSV-2 is commonly spread through sexual contact, HSV-1 is spread orally and through oral-genital contact.

  • Treatment: Antiviral medications (Acyclovir, Valacyclovir) to reduce symptoms and outbreaks.

  • Complications: Increases susceptibility to HIV. No cure, but outbreaks may decrease over time.

• Cytomegalovirus (CMV):

  • Cause: Herpes family virus.

  • Symptoms: Often asymptomatic in adults. In pregnant women, CMV can lead to congenital defects in the baby.

  • Treatment: No cure, but antiviral medications may help control symptoms.

• Human Papillomavirus (HPV):

  • Cause: A group of viruses, some of which cause genital warts.

  • Symptoms: Warts on the genital, anus, or mouth. Can lead to cervical or anal cancer if untreated.

  • Treatment: Cryotherapy, topical treatments, and sometimes surgery for precancerous lesions.

  • Prevention: Vaccination (Gardasil) to prevent certain strains of HPV.

• Chancroid:

  • Cause: Haemophilus ducreyi (bacteria).

  • Symptoms: Painful genital ulcer that can bleed easily.

  • Treatment: Antibiotics (Azithromycin or Ceftriaxone).

• Vaginitis:

  • Candidiasis: Caused by Candida albicans (fungal/yeast infection). Symptoms include itching, burning, and thick discharge. Treatment involves antifungal creams (e.g., clotrimazole, miconazole).

  • Bacterial Vaginosis (BV): Caused by an overgrowth of Gardnerella vaginalis. Symptoms include fishy odor and unusual discharge. Treated with antibiotics like metronidazole.

  • Trichomoniasis: Caused by Trichomonas vaginalis (protozoa). Symptoms include vaginal discharge, itching, and odor. Treated with antibiotics (metronidazole).

• Pubic Lice:

  • Cause: Pediculus pubis (parasite).

  • Symptoms: Itching, visible lice or eggs in pubic hair.

  • Treatment: Topical medications (e.g., permethrin or pyrethrins). Clean clothing and bedding thoroughly to prevent reinfection.

Pregnancy Testing

• Home Pregnancy Tests: Measure the presence of HCG in urine. Accurate when used after a missed period.

• Blood Tests: Detect HCG early, even before a missed period. Can confirm pregnancy with greater sensitivity.

Contraception Methods

• Abstinence: 100% effective at preventing pregnancy and STIs.

• Fertility Awareness: Based on tracking ovulation cycle; 75%-99% effective when done correctly.

• Hormonal Methods:

  • Oral Contraceptives: Pills containing estrogen and/or progesterone.

  • Patches: Hormonal patches applied to the skin.

  • Emergency Contraception: Pills taken after unprotected sex to prevent pregnancy.

• Intrauterine Devices (IUDs): T-shaped device placed in the uterus to prevent implantation of the fertilized egg.

• Barrier Methods:

  • Condoms (Male/Female): Prevents sperm from entering the uterus. Also protects against STIs.

  • Spermicides: Chemical agents used with barriers to kill sperm.

• Surgical Methods:

  • Sterilization: Permanent methods include vasectomy for men and tubal ligation for women.

  • Induced Abortion: Termination of pregnancy. Health professionals discourage it as a primary method of contraception.

Assisted Reproductive Technologies (ART)

• In Vitro Fertilization (IVF): Eggs are fertilized outside the body in a lab, then implanted in the uterus. Suitable for women with blocked fallopian tubes, male infertility, or unexplained infertility.

• Artificial Insemination: Sperm is introduced into the reproductive tract without using eggs.

• Fertility Drugs: Enhance ovulation by stimulating egg production, often used in conjunction with ART.

Diseases & Conditions Related to Pregnancy

• Fetal Alcohol Syndrome (FAS): Caused by alcohol use during pregnancy. Can result in growth deficiencies, facial abnormalities, cardiac issues, and mental retardation.

• Drug Use: Cocaine, heroin, and crack can cause withdrawal symptoms in newborns, preterm labor, and birth defects. Marijuana may lead to preterm labor.

TORCH Infections

• Toxoplasmosis: Caused by parasites, can lead to birth defects.

• Other Infections (Syphilis, Hepatitis, Herpes Zoster): May cause pregnancy complications and birth defects.

• Rubella: Can cause congenital defects if contracted during pregnancy.

• Cytomegalovirus (CMV): Can cause hearing loss, developmental delays, and birth defects.

• Herpes Simplex Virus (HSV): Can cause miscarriage, preterm labor, or birth defects if contracted during pregnancy.

Disorders of Ears, Nose, Throat, and Mouth

• Otitis Media: Acute infection of the middle ear, often bacterial. Higher incidence in children exposed to passive smoke inhalation. Treated with antihistamines, decongestants, or warm, moist packs.

• Epistaxis (Nosebleed): Originates from the anterior portion of the nares.

• Tonsillitis: Inflammation of the tonsils due to viral or bacterial infection. Symptoms: difficulty swallowing, elevated WBC count, high temperature. Treatment: tonsillectomy and adenoidectomy (T&A).

• Cleft Lip and Cleft Palate: Congenital deformities often occurring together. Surgical repair (cheiloplasty) allows normal feeding.

• Baby Bottle Syndrome: Continued bottle feeding after teeth eruption, leading to dental caries.

Cardiovascular Disorders - Acyanotic Effects

• Ventricular Septal Defect (VSD): Acyanotic defect; left-to-right shunt of oxygenated blood due to higher left ventricular pressure.

• Atrial Septal Defect (ASD): Abnormal opening between atria via foramen ovale, resulting in an acyanotic defect.

• Patent Ductus Arteriosus (PDA): Persistent opening between aorta and pulmonary artery, leading to pulmonary hypertension and reduced oxygenation.

• Coarctation of the Aorta (COA): Narrowing of the aorta, obstructing blood flow.

Cardiovascular Disorders - Cyanotic Effects

• Transposition of Great Vessels (TGV): Aorta and pulmonary artery reversed; results in circulation of deoxygenated blood, fatal without surgery.

• Tetralogy of Fallot (TOF): Combination of four defects:

  • Pulmonary stenosis (narrowed pulmonary artery)

  • VSD (hole in ventricular septum)

  • Overriding aorta (aorta shifts right, receiving mixed blood)

  • Right ventricular hypertrophy (enlarged ventricle due to strain)

• Tricuspid Atresia: Absence of an opening between the right atrium and ventricle, causing decreased pulmonary blood flow, fatal without intervention.

Blood and Lymph Disorders

• Kawasaki Disease: Inflammation of blood vessels, leading to platelet entrapment and reduced blood flow. Symptoms: strawberry tongue, extremity edema, fever.

• Anemia: Low RBC and hemoglobin levels.

• Iron-Deficiency Anemia: Common in infants, especially if not breastfed. Iron-fortified cereal is recommended.

• Sickle Cell Disease: Genetic disorder common in individuals of African descent. Causes sickle-shaped RBCs, leading to vessel occlusion, ischemia, and infarction.

• Idiopathic Thrombocytopenic Purpura (ITP): Acquired bleeding disorder in children, characterized by bruising, petechiae, epistaxis, and GI bleeding.

• Hemophilia: Hereditary bleeding disorder (X-linked), due to Factor VIII or IX deficiency, affecting clotting ability.

• Leukemia: Bone marrow malignancies classified into:

  • Acute Lymphoid Leukemia (ALL): Most common in children, best prognosis.

  • Acute Myeloid Leukemia (AML): Most common in adults.

  • Chronic Lymphoid Leukemia (CLL): Slow progression, affects mature cells, common in adults.

  • Chronic Myeloid Leukemia (CML): More common in adults.

Gastrointestinal Disorders

• Hernia: Organ protrusion through an abnormal opening.

  • Diaphragmatic Hernia: Rare, intestine protrudes through diaphragm.

  • Umbilical Hernia: Intestine protrudes through weak umbilical ring.

  • Indirect Inguinal Hernia: More common in boys; intestine protrudes into scrotal sac or uterus.

  • Direct Inguinal Hernia: Protrusion through the weakest part of the abdominal wall.

• Lactose Intolerance: Inability to digest lactose, more common in African Americans and Asian Americans. Can lead to stunted growth.

• Intussusception: Telescoping of the bowel in infants, causing hyperactive peristalsis and hypoactivity. Symptoms: currant-jelly stool (clear mucus with blood).

• Colic: Severe abdominal pain in infants under 3 months, causing excessive crying.

• Megacolon (Hirschsprung’s Disease): Absence of parasympathetic nerve supply to colon, preventing peristalsis and causing obstruction.

Respiratory Tract Disorders

• Laryngotracheobronchitis (Croup): Viral infection of upper airways; symptoms include a barky cough and inspiratory stridor.

• Asthma: Chronic airway inflammation, often presenting by age 4. Treated with corticosteroids and bronchodilators.

• Cystic Fibrosis: Genetic disorder affecting exocrine glands, leading to thick mucus secretions and cardiopulmonary complications. Managed with chest percussion therapy.

Urinary/Reproductive System Disorders

• Enuresis: Involuntary urination in children over 5, more common in boys.

• Hemolytic Uremic Syndrome (HUS): Acute kidney failure in children (1-10 years) associated with E. coli. Triad of symptoms: renal failure, hemolytic anemia, thrombocytopenia.

• Glomerulonephritis: Common nephritis in children (5-10 years), causing smoky urine, puffy eyes, and high blood pressure.

• Nephrotic Syndrome: Glomerular basement membrane dysfunction, leading to protein loss in urine.

• Wilms Tumor: Malignant kidney tumor, often asymptomatic until advanced, sometimes with microscopic hematuria.

• Hypospadias & Epispadias:

  • Hypospadias: Urethral opening on the underside of the penis.

  • Epispadias: Urethral opening on the top of the penis.

• Cryptorchidism: Undescended testicle.

Pregnancy and Prenatal Care

• Prenatal Development Stages:

  • Zygote: Fertilized egg, first 2 weeks.

  • Embryo: 2-8 weeks, major organ development.

  • Fetus: 8 weeks to birth.

• Trimesters:

  • First Trimester (Weeks 1-12): Organogenesis, nausea, fatigue.

  • Second Trimester (Weeks 13-26): Fetal movement felt, organs mature.

  • Third Trimester (Weeks 27-40): Rapid growth, maternal discomfort.

• Signs of Pregnancy:

  • Presumptive: Nausea, fatigue, missed period.

  • Probable: Enlarged uterus, positive pregnancy test.

  • Positive: Fetal heartbeat, ultrasound confirmation.

• Pregnancy Complications:

  • Preeclampsia: High BP, proteinuria, edema.

  • Gestational Diabetes: Temporary glucose intolerance.

  • Placenta Previa: Placenta covers cervix, requiring C-section.

• Labor Stages:

  • Stage 1: Dilation (latent, active, transition phases).

  • Stage 2: Birth of baby.

  • Stage 3: Delivery of placenta.

  • Stage 4: Postpartum recovery.

• Postpartum Care:

  • Monitor bleeding, uterine contraction, mood changes.

  • Support breastfeeding and newborn care.