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Duvall's Stages of Family Life
Looks at family over time and addresses their universal tasks: married couples, w/ kids up to mos., w/ preschoolers ^6 yrs, w/ schoolage kids ^13, w/ adolescents ^19, launching young adults, middle age parents (empty nest), retired and old age (to death of spouse)
Birth rate definition
Number of births per 1000 women of childbearing age
Maternal mortality def.
Number of maternal deaths per 100 000 live births from complications of l and d and postpartum
Neonatal mortality
Infant deaths per 1,000 live births of 20 wks. gest. to 28 days
Infant mortality
Infant deaths from 1 mo. to 1 yr. per 1,000
pregnancy w/o regard to outcome
fetus reaches viability (20-24 wks gest.)
never been pregnant
pregnant for the first time
woman has experienced two or more pregnancies
one pregnancy w/ fetus reaching viability
completed two or more pregnancies which have reached viability
fundic souffle
Fetal heart rate of 115-160
mov't of unengaged head 16-18 wks ^, probable sign of pregnancy (could be a tumor)
first recognition of fetal mov't, 18 wks w/ primipara, 14-16 w/ multipara, sooner w/ twins
Pregnancy tests measure
HCG (human chorionic gonadotroipin hormone)
Estimated date of delivery/ end date of confinement. Nagele's rule: last period plus seven days minus three months, plus one year
Vaginal delivery after having a c-section
What to include in a pregnant woman's hx
Current and past pregn. char., gyn. hx, current medical hx, family hx, cultural/religious background, personal data
Uterine changes during pregn.
Enlargement (due to incr. in estrogen and progesterone), increase in vascularity and dilation of b.v., incr. in tissue
Grows and elevates out of the pelvic area, can be palpated above symphysis by 12-14 wks, pushes on bladder, can hold 5-10 L
Chadwick's sign
5-8 wks, purple blue vagina and cervix
Braxton-Hicks contractions
Not in everyone, occur after 4 mos. Painless and normal
Uterine souffle
Bruit, sound of blood going to placenta, synchronous w/ maternal pulse
McDonald sign
Easy flexion of the fundus over the cervix
Hegar sign
Softening of the lower uterine segment
Goddell sign
Softening of the cervix
Cardiovascular changes w/ pregnancy
Cardiac hypertrophy, diaphragm displaces up and left, pulse inc. by 10-15 bpm by 20 wks, BP decr. 1 and 2 trimester, 3 normal (should NEVER increase). Blood volume incr. by 1500 cc, CO incr. by 30-50 % by 32 wk
White mucous discharge, musty odor, normal variation, fills cervical canal forming mucus plug, barrier against bacterial invasion in pregnancy
Hormonal changes w/ placental detachment
Estrogen decr, stimulates prolactin and oxytocin (uterus contracts to prevent hemorrhage)
Neuro changes w/ pregnancy
Numbness and tingling in hands, compression of pelvic nerves-leg pain, lightheadedness (hypoglycemia b/c of infant), leg cramps or tetany-hypocalcemia
Lab exams associated w/ pregn.
Clean catch urine, PPD, pap, cervical, and vaginal smears, VDRL (syphillis), herpes, chlamydia, and gonorrhea, CBC, blood type, aby screening, HIV and hep. CAN'T have vaginal delivery w/ herpes outbreak
Prenatal exam
Nutritional info, health maint. q4wks to 28 wks, q2wks 29-36 wks, qwk >36
Danger signs during pregnancy
HA, visual disturbance, muscular irritability, epigastric pain, vomiting, discharge...htn? decr. fetal movt for at least 24 hours
S/S of preterm labor
Uterine contractions q10min or less, esp. if getting harder or more freq, menstral like cramps, low dull backache, pelvic pressure, incr. vaginal discharge
massage over abdomen w/ fingers to reduce pain
Theories for what causes labor
Don't know: uterine distension, incr. uterine pressure, age of placenta, incr. sensit. to oxytocin, changes in barometric pressure or hormone conc. (estrogen and prostaglandins increase, progesterone decreases)
During the process of birth, includes 1-4 hours after birth, when mother/baby leave delivery area
Preliminary signs of labor
Lightening (baby drops-first baby: 1 wk before labor), increase in vaginal mucus/secretions, persistent low back pain, incr. in Braxton-Hicks contract., ripening, ROM (may be spontaneous), nesting syndrome, diarrhea
True labor
Contractions have a regular pattern, shortening interval, inr. intensity and duration, start from back to front, intensified by walking
Internal exam reveals this for true labor:
Progressive effacement and dilation, position and presentation of fetus, pelvic station and descent, status of membranes.
Cervix changes (3)
Ripening: softening
Effacement: thins out
Dilatation: opens, must be 10 cm. for ALL vaginal deliveries (incl. premies)
Fetus descends to level of ischial spine (Station 0), Above is - below is + (closer to delivery a good thing). Negative station: baby floating
Bloody show
Impending labor: cervical secretions mixed w/ blood from ruptured capillaries, mucus plug expelled
Window of safety after ROM
24 hours, after that, increased risk of infection for mother and baby
Nsg interventions after ROM
Check fetal monitor for change in FHR and pattern, check for possible cord prolapse, note and record: exact time, color, odor, clarity, and amt.
Test for presence of amniotic fluid
Blue: positive
Yellow: negative
Shape of fontanelles
Ant. is diamond, remains open 18 mos.
Post. triangle, smaller, closes 12 wks
Fetal lie
Relation of fetus to mother, only longitudinal a vaginal birth candidate
Stages of Labor
Stage I: Early phase-7-8 hrs, 0-3 cm, 30-45 sec, 5-20 min. interval. Active Phase-3-5 hrs, 3-7 cm, 60 sec, 2-4 min. intervals. Transition Phase: 7-10 cm, .5-1.5 hrs, 70-90 sec., .5-1 min. intervals (VERY HARD phase)
Stage II: Expulsion, pushing stage, complete/complete
Stage III: Placental (5min-1hr), after delivery of infant, ends w/ deivery of placenta
Stage IV: Recovery 1-4 hrs after birth, physiological readjustment, fudnal firmness, v.s., bonding, hemorrhage, food and fluids, output, baby to breast
Number of b.v. in umbilicus
3: AVA
Signs of placental delivery
Uterus contracts firmly, separation of placenta from uterine wall. Globular shaped uterus, rise of fundus in abdomen (should be firm) sudden gush or trickles of blood, increase descent of cord
Retained placenta
more than 30 minutes after delivery, placenta does not detach
Nursing intervention for intrapartum
VS, fetal monitoring, change position (off back, on left side), keep bed and pt. clean and dry, breathing, back rub, adequate oxygenation, monitor fluids (up to 500 cc blood loss reasonable), urinalysis to monitor for infection.
Fever causes fetal...
tachycardia, give IV antibiotics stat
V-vac can be performed when this type of incision used
Low transverse
Nursing considerations w/ epidural
Monitor for hypotn, IV wide open w/ pressure
Degree of lacerations w/ delivery
1st degree: vaginal mucosa and perineal skin
2nd degree: above plus underlying fascia and muscle
3rd: all of above and anal sphincter
4th: All w/ tear extending up into rectal wall
Indications for labor induction
After 40 wks, deteriorating placenta, fetal death, prolonged ROM, facilitate labor
C/I for induced labor
Reasons to perform a C-section: fetal distress, placenta previa, abruptio placenta, CPD(cephalopelvic disproportion), predisposition to uterine rupture, grand-multiparity, past hx of traumatic delivery
major stressor to infants in the hospital
Interrupted routine, parental separation, lack of stimulation, and delayed response to crying/needs
Behaviors exhibited by stressed infants in the hospital
Poor feeding, irritability, crying, altered sleep patterns
Interventions for stressed infants and children in the hospital
Encourage parent participation, consistent nursing care, promote home routine, provide stimulation, respond promptly to cry, arrange for volunteers to hold, rock, play
Major stressors for toddlers in hospital setting
Interrupted routine and rituals, separation from parents, loss of control, fear of being hurt
Behaviors exhibited by toddlers in hospital
Protest, Despair, Detachment, Developmental regression, refusing to eat/sleep disturbance
Preschool age stressors in hospital
Pain/bodily injury, separation from parents, loss of control
Behavior exhibited by preschoolers in hospital
Passive withdrawal, poor appetite, sleep disturbances, magical thinking, fantasy, enuresis, aggression
School age child stressors
Guilt, fear of pain, loss of control, body image changes, missing school and friends, falling behind in school
Question child
Use pain rating scale
Evaluate behavior and physiologic state
Secure patient's involvement
Take cause of pain into account
Take action
Body surface area, method of prescribing medication to peds...more common in oncology and critical care
Body weight method
convert lbs. to kg, round to .01
Calculating daily fluid requirements
100 mL/kg/day first 10 kg
50 mL/kg/day next 10 kg
20 mL/kg/day for each kg above 20
Complications w/ viral nasopharyngitis
Pain in ear, increased respirations (>50-60), fever, cough (persistent 2+ days), wheezing, poor sleeping, listlessness, increased irritability
Complications w/ strep
18 days after->rheumatic fever
10 days after->glomerular nephritis
Complications w/ mono
hepatic and spleen involvement->jaundice
Caused by RSV, major cause of hospitalization in infants. Affects lowre respiratory tract. Tx w/ croup tent, clear liquids, clear nasal secretions,
Hallmark of epiglottitis
Dyspnea, dysphagia, drooling and dysphonia. Have trach set ready, NO TONGUE BLADES, decreased incidence since H. influenzae vaccine
LTB: caused by virus but can have secondary bacterial infection, inspiratory stridor, gradual onset, lowgrade fever,
Etiology of CF
Commonly manifests as pancreatic deficiency and pulmonary disease

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