* PROMO FINAL *

Final Exam Overview

  •  - Diet: 16 questions focused on infant and child diet, nutritional labels, and how medical conditions affect diet.

Infant Diet

First 6 Months

  • Primary dietary source: Breastfeeding or iron-fortified formula.

  • Mothers are encouraged to consider vitamin D supplementation for breastfed infants.

4-6 Months

  • Introduction of solids begins, one food at a time to evaluate potential allergies and tolerances.

  • Recommended first solid food: Iron-fortified rice cereal.

After 6 Months

  • Gradual introduction of yellow-orange vegetables and fruits.

  • Around 9 months of age, infants develop the pincer grasp and are capable of self-feeding.

Potential Allergenic Foods

  • Common allergens include:   - Milk   - Eggs   - Peanuts   - Honey   - Citrus fruits

Child Diet

Nutritional Labels

  • Understanding and interpreting nutritional labels is crucial for healthy eating.

Diet for Specific Medical Conditions

  • Hypertension (HTN): DASH diet (Dietary Approaches to Stop Hypertension).

  • Congestive Heart Failure: Sodium-restricted diet.

  • Overweight: Calorie-restricted diet.

  • Elevated Cholesterol/Triglycerides: Fat-restricted diet.

  • Diabetes: Recommendations from the American Diabetes Association (ADA) include non-starchy vegetables, lean proteins, and fiber-rich carbohydrates.

  • Renal Insufficiency: Manage electrolytes and fluids carefully.

  • Liver or Kidney Disease: Protein-controlled diet.

  • Celiac Disease: Gluten-free diet.

  • Chronic Obstructive Pulmonary Disease (COPD): High protein, increased fluid intake, and reduced salt intake.

  • Lactose Intolerance: Avoid dairy products (milk, eggs, creamer).

  • Osteoporosis: Sufficient intake of calcium and vitamin D is encouraged.

  • Anemia: Diet should be high in iron.

  • Cerebrovascular Accident (CVA): Recommended diet includes leafy greens, low sodium, and high potassium foods.

Teaching/Learning and Family Dynamics

  • Total of 5 questions focusing on obstacles to teaching, preventive health measures, and family health dynamics.

Barriers to Teaching

  • Health literacy

  • Language and communication barriers

  • Cultural differences

  • Experiencing discomfort

  • Cognitive/sensory impairments

  • Lack of social support

  • Use of medical jargon

  • Resistance to learning

  • Perceived irrelevance of the information

  • Low motivation

Preventive Health Measures

Primary Prevention

  • Activities meant to prevent or slow the onset of diseases.   - Examples include:     - Eating healthy foods.     - Exercising.     - Wearing sunscreen.     - Receiving immunizations.     - Using seatbelts, helmets, and car seats.     - Practicing safe sex (wearing condoms).

Secondary Prevention

  • Activities that screen and educate to detect illnesses early.   - Examples include:     - Breast self-examination.     - Testicular examinations.     - Blood pressure screenings.     - Diabetes screenings.     - Tuberculosis (TB) skin tests.     - Colon cancer screenings (colonoscopy).

Tertiary Prevention

  • Focuses on halting disease progression and facilitating recovery back to pre-illness state.   - Examples include:     - Rehabilitation programs.     - Teaching about assistive devices.     - Encouraging coping strategies for individuals.

Social Determinants of Health

  • Conditions of birth, growth, work, and aging that affect health outcomes.

Genogram

  • Visual family tree that maps out family relationships.

Parenting Styles

  • Authoritarian (Dictatorial): High control with strict rules; often communicates with phrases like “Because I said so.”

  • Permissive (Laissez-faire): Few rules and avoids saying no; attempts to be friends with the child, e.g., “I mean.. You shouldn’t do that, but it’s okay.”

  • Authoritative (Democratic): Encourages collaboration while maintaining control; facilitates discussion, e.g., “You broke a rule, now let’s talk about why it matters.”

  • Passive: Lacks engagement; ignores behaviors and consequences.

Family Structure

  • Binuclear Family: Couple is no longer married but maintains parental roles.

  • Married-blended Family: Includes stepparents and step-siblings.

  • Single Parent Family: One parent raising children alone.

  • Other forms include extended family, LGBTQIA families, foster families, teen parents, and adoptive parents.

Family Developmental Stages

  • Emphasizing the stages of family evolution and adaptation.

Maladaptive Mental Health

  • Total of 4 questions focused on managing stress and diseases like bipolar disorder and depression.

Stress Management

  • Any stressor can invoke a biological response within the body, whether perceived positively or negatively.

  • Key to managing stress includes recognizing signs and symptoms which allow for effective coping strategies.

  • Coping can be classified as:   - Maladaptive: Ineffective responses such as avoidance and withdrawal.   - Adaptive: Effective responses such as counseling and meditation.

Depression

  • A common mood disorder that ranks high among causes of disability worldwide.

  • Symptoms include:   - Depressed mood   - Sleep disturbances (too little or too much)   - Indecisiveness   - Cognitive difficulties   - Anhedonia (lack of pleasure in activities)

  • Risk factors involve:   - Family or personal history   - Postpartum experiences   - Poor social support network   - Being over 65 years of age.

Reproduction/Prenatal Care

  • Total of 5 questions focused on placental issues, prenatal assessments, and related pathophysiology.

Placenta

  • Begins at implantation and is fully formed by 12 weeks of gestation.

  • Functions include hormonal production (e.g., hCG) and metabolic exchange.

  • Maternal side of placenta: Duncan (dirty side) and fetal side: Shultz (shiny).

  • Placenta Previa: Implantation occurs in the lower uterine segment causing painless vaginal bleeding; vaginal exams contraindicated.

  • Placenta Abruptio: Premature separation of a normally implanted placenta.

Prenatal Assessments

  • Kick Counts: Monitoring fetal movements, recommended 10-12 kicks every 2 hours, ideally after meals.

  • Non-Stress Test (NST): Evaluates fetal well-being based on heart rate response.   - Reactive NST: At least two heart rate accelerations in 20 minutes.   - Non-reactive NST: Less than two qualifying accelerations in two minutes.   - Follow-up tests may include a contraction stress test (CST) or biophysical profile (BPP).

Contraction Stress Test (CST)

  • Induces contractions via nipple stimulation or oxytocin (Pitocin).

  • Monitoring targets achieving three contractions in a 10-minute span.   - Negative CST: reassuring result.   - Positive CST: non-reassuring, indicating possible uteroplacental insufficiency.

Prenatal Periods

  • First trimester: Weeks 1-13.

  • Second trimester: Weeks 14-26.

  • Third trimester: Weeks 27-40.

  • Perinatal period: Extends from the 20th week of gestation to the end of the 28th day after delivery.

Labor and Delivery (L/D)

  • Total of 5 questions focusing on VEAL CHOP MINE, Rhogam, epidurals, and labor interventions.

VEAL CHOP MINE

  • System for understanding fetal heart patterns during labor:   - Variable: Caused by cord compression, managed by moving the client.   - Early: Caused by head compression, managed by identifying labor progression.   - Acceleration: Indicates the fetus is well; no action needed.   - Late: Suggests placental insufficiency; immediate action required.

Rhogam Administration

  • Rh-negative mothers may be exposed to the baby’s blood in late pregnancy and delivery.

  • To prevent Rh incompatibility:   - Administer 1 dose of Rhogam at 28 weeks and another within 72 hours post-delivery.

Epidurals

  • Definition: Anesthetic procedure that numbs sensations in the uterus, abdomen, and lower back.

  • Administered by anesthesiologists or nurse anesthetists.

  • Patients may experience pressure sensations during contractions and remaining sensations in pelvic regions.

  • Foley Catheter: Used during the epidural procedure.

  • It's standard to administer a bolus of 1000 mL IV fluids prior to the epidural to prevent hypotension.

Labor Interventions

  • Pitocin: Used to induce contractions.

  • Pain Relief: Administered via epidurals.

  • Continuous Fetal Monitoring (CFM): Ongoing evaluation of fetal heart patterns.

  • Bishop Score: Score above 8 indicates maternal readiness for labor.

Assisted Delivery Techniques

  • Forceps: May cause bruising of the head.

  • Episiotomy: Surgical enlargement of the vaginal outlet with midline or mediolateral cuts; Kegel exercises may aid in healing.

  • Vacuum Assisted Delivery: Associated risks include maternal exhaustion, fetal distress, cephalohematoma, jaundice due to bruising, and increased risk of vaginal tearing.

Cesarean Birth Considerations

  • Shoulder Dystocia: Call for assistance, time the delivery, apply suprapubic pressure, and position the mother on all fours; avoid fundal pressure.

Postpartum/Newborn

  • Total of 9 questions focusing on phases of maternal recovery and lochia.

Phases of Maternal Recovery

1. Taking In (Dependent Phase)

  • New mother focuses on nurturing the infant while neglecting her own needs for 1-2 days post-delivery.

  • Common behavior includes talking about pregnancy and birth experiences; may require repeated information due to cognitive demands.

2. Taking Hold (Dependent-Independent Phase)

  • If adequately nurtured, the mother seeks to regain control, eager to learn about and care for her baby.

  • Early contact, rooming-in, and anticipatory guidance can enhance this phase.

3. Letting Go (Interdependent Phase)

  • Reintegration into family roles and reassessment of relationships; acknowledges emotional changes and freedom.

Lochia

  • Vaginal discharge following delivery, typically lasts 2-6 weeks.   - Rubra: Red discharge (1-3 days; consists of blood, tissue, and mucus).   - Serosa: Pink/brown discharge (days 2-10; contains leukocytes and serous fluid).   - Alba: White/yellowish discharge (day 10 to 3-6 weeks; final stage).

  • Infection risk is indicated if any stage has an offensive odor.

Amount of Lochia

  • Scant: Less than 1 inch on a pad per hour.

  • Light: Less than 4 inches on a pad per hour.

  • Moderate: Less than 6 inches on a pad per hour.

  • Heavy: Saturated peri-pad within one hour.

  • Excessive: Saturated peri-pad in less than one hour.

Child Health: Well and Ill Child

  • Total of 6 questions focusing on Erickson's psychosocial development, interventions for well children, choking hazards, and disease processes such as ear infections.

Erickson's Stages of Development

Trust vs Mistrust (Birth - 12 Months)

  • Definition: Infant learns whether caregivers meet their needs.

Autonomy vs Shame & Doubt (1-3 Years Old)

  • Definition: Child seeks independence; encouraged autonomy fosters a sense of self-confidence.

Initiative vs Guilt (3-6 Years Old)

  • Definition: Child initiates activities and may develop a sense of guilt if discouraged.

Industry vs Inferiority (6-12 Years Old)

  • Definition: Focus on skill learning and academic success; industry leads to self-confidence.

Identity vs Role Confusion (12-18 Years Old)

  • Definition: Adolescents explore personal values, beliefs, and goals; identity formation is essential.

Interventions for Well Children

  • Promote respect for family diversity.

  • Assess parent-child interactions and support family adaptation to children's health needs.

  • Utilize community resources and engage children through play during assessments.

  • Employ age-appropriate communication during examinations.

Choking Hazards

  • Prevent choking by:   - Cutting food into small pieces.   - Cooking or softening hard foods.   - Ensuring the child sits while eating and supervising meals.

  • Common non-food choking hazards:   - Coins.   - Small toy parts.   - Balloons.   - Button batteries.   - Pen caps and marbles.

Ear Infections (Acute Otitis Media)

  • Most prevalent childhood condition; especially common in children under 5 years.

  • Symptoms include:   - Ear pain.   - Fever.   - Loss of appetite.   - History of upper respiratory infections.

  • Risk factors include:   - Age (6 months to 2 years).   - Eustachian tubes being shorter and straighter.   - Formula-fed children have a higher incidence than breastfed.   - Recent upper respiratory infections.

Treatment and Comfort Measures

  • Apply ice compresses to soothe pain.

  • Administer Tylenol or ibuprofen for discomfort.

  • If bacterial, Amoxicillin prescribed for 10-14 days.

  • Sympathomimetics recommended for children older than 2 years.

  • Emphasis on completing the prescribed medication course.

  • Encourage feeding upright and avoiding secondhand smoke exposure.

  • In cases of recurrent chronic otitis media, myringotomy may be indicated.