Megan’s review

Amniocentesis

• Used for genetic diagnostics and to detect neural tube defects
• Involves withdrawing a small sample of amniotic fluid
• Takes 45-60 minutes
• Risks include miscarriage, amniotic fluid leakage, infection, and injury to the body.
• Results take 3-4 weeks

Chorionic Villus Sampling

• Cell is taken from the placenta
• Used for testing (CVS)
• Associated with a low risk of miscarriage

Urine Tests

• Detect sugar (glucose), which indicates gestation
• Detect protein (albumen), which indicates hypertension

Toxoplasmosis

• Contracted during pregnancy
• Occurs through handling cat stool in soil or cat litter

Late Deceleration

• Caused by uterine insufficiency
• Reposition the mother to her left side
• Administer oxygen

Placenta Previa

• Characterized by painless bleeding in the third trimester of pregnancy
• Avoid digital cervical exams

Ideal Weight Gain During Pregnancy Based on BMI

• BMI 18.5-24.9: Gain 25-35 lbs
• BMI less than 18.5: Gain 28-40 lbs
• BMI 25-29.9: Gain 15-25 lbs
• BMI over 30: Gain 11-20 lbs

Intrauterine Resuscitation: VEAL CHOP

• Late deceleration indicates placental insufficiency
• Implement lateral positioning to the left side
• Perfusion and give oxygen

Lochia

• Rubia (red): 1-3 days, mainly blood, tissue debris, decidua, possibly vernix caseosa, lanugo, meconium
• Fusca (brownish): 3-7 days, increasing hemolysis, less blood, serous secretion (lymph, leukocytes)
• Serosa (pink): 1-10 days
• Alba (white): 10-14 days and may last for up to 6 weeks

Uterine Involution

• The fundus should be firm, not boggy

Cleft Lip

• Common orofacial cleft
• More prevalent in males
• Highest incidence among people of Asian descent
• Caused by multiple genes, potentially aided by factors during weeks 5-8 of gestation
• These factors include viral infections, seizure medications, smoking, drinking, hyperthermia, stress, maternal obesity, and folic acid deficiency

Cleft Palate

• The palatal process does not close normally around 9-12 weeks of gestation
• Repaired shortly after birth, between 2 to 12 weeks of age

Hyperopia (Farsightedness)

• Difficulty seeing close objects, clearer vision for far objects
• Diminishes by age 5
• Symptoms include headaches, dizziness, and eye strain after schoolwork
• Treatment includes convex lenses
• Refractive surgery can be performed to prevent amblyopia

Myopia (Nearsightedness)

• Light rays do not reach the retina causing blurred vision
• Signs and symptoms include squinting and inability to see distant objects
• Able to read books or computer screens at close range

Strabismus

• Non-parallelism in different fields of gaze
• Causes visual lines to cross even when focused on the same object
• Diagnosed with corneal light reflex test and cover test
• Treatment involves ocular patching of the stronger eye

Nystagmus

• Rapid, irregular, involuntary eye movement
• Caused by a disorder of the central nervous system

Glaucoma

• Increased IOP due to obstruction or impaired outflow of aqueous humor
• S&S: Buphthalmos (enlarged eye globe), epiphora (excessive tearing), and photophobia (sensitivity to light)
• Prevent IOP increase by maintaining a quiet, calm environment with dim lighting
• Give antiglaucoma medications temporarily and analgesia for pain

Retinoblastoma

• Malignant tumor of the retina, usually seen in children before age five
• "Cat's eye" appearance
• Late signs: visual acuity disturbances, pain, inflammation, and hyphemia
• Diagnosed by the absence or abnormality of red reflex during the fundus exam
• MRI confirms the diagnosis and staging of the tumor

Club Foot

• Plantar flexed foot with an inverted heel and adducted forefoot
• Identified during newborn nursing assessment
• Treated with serial casting
• Severe cases require surgery at 9-12 months old

Pyloric Stenosis

• Hypertrophy of the circular muscles of the pylorus
• Narrows the pyloric canal between the stomach and duodenum
• Often causes projectile vomiting

Pyloric Stenosis Treatment

• Surgery (pyloromyotomy via laparoscopy)
• Vomiting may occur 36 hours postoperatively
• Report persistent vomiting after 48 hours to the healthcare provider
• Small feedings are usually started around 4-6 hours postoperatively

Crohn’s Disease

• Results from extended exposure to increased levels of cortisone
• Caused by an adrenal tumor or prolonged steroid therapy
• Symptoms include a round "moon" face, facial flushing, and pink or purple stretch marks (striae) on the skin
• Steroid therapies may need to be reduced to the lowest possible level

Seizure

• Maintain airway patency
• Do not place anything in the child’s mouth during a seizure
• Monitor oxygenation saturation, and color should remain pink
• Pulse oximeter should read 95% or greater

Otitis Media (Tympanostomy Tubes)

• With chronic infections, myringotomy tubes are placed in the typmpanic membrane
• Aids effusion drainage and pressure equalization
• Can be remedied by stapedectomy (excision of the stapes to improve hearing) or tympanoplasty (restores function to the sound-transmitting mechanism of the middle ear)

Iron Deficiency

• Sickle cells are a genetic disorder and is found within the RBC

Sickle Cell Anemia

• Caused by vaso-occlusion of blood cells
• Treatment includes hydration and pain control medications (morphine)
• Symptoms include weakness, pallor, fatigue, tissue hypoxia, and jaundice
• Monitor for internal bleeding by checking urine and stool for occult blood

Disseminated Intravascular Coagulation (DIC)

• Disorder of coagulation that occurs as hypoxia, acidosis, shock, and endothelial damage
• Coagulation process stimulated abnormally
• Excessive amounts of thrombin are generated, and fibrinolytic mechanisms are activated
• Monitor for hemorrhage, bleeding, shortness of breath, lethargy, pallor, increased heart rate, decreased blood pressure, headache, dizziness, and muscle weakness

Osteomyelitis

• Infection of bone or around the bone
• Symptoms may include pain in the affected bone, fever, irritability, and/or guarding of the affected limb.

Glomerulonephritis

• Inflammation and damage to the filtering part of the kidneys (glomerulus)
• Caused by strep throat
• Symptoms: hematuria (tea-colored or red urine), edema, hypertension, headache; severe disease causes ascites
• Monitor for hypertension, urinary output, and renal status
• Dietary restrictions of sodium, potassium, and fluid intake are needed

Nephrotic Syndrome

• Disorder of the renal system with excessive protein excretion into the urine
• Symptoms include edema, decreased urine production, ascites, respiratory compromise, hypertension, anorexia, diarrhea, & vomiting
• Cause is unknown
• Peak onset is 2-7 years of age
• Treat with diuretics & albumin replacement early

Genital Herpes

• Caused by herpesvirus hominis type 2
• No known cure
• Diagnosed by culture of the lesion secretion or isolation of HSV antibodies in blood serum
• Incubation period is 3-14 days
• Treatment includes acyclovir and valacyclovir
• Can be transmitted to the newborn during pregnancy
• Cesarean delivery is a must if there is an active lesion

PKU

• Capillary heel stick is done 24 hours following birth for genetic screening in all states.
• Newborns should have eaten for at least 24 hours for accuracy
• All states require testing for phenylketonuria (PKU)
• Defect in protein metabolism with accumulation of amino acid phenylalanine, which can result in mental retardation
• Treatment in the first 2 months of life can prevent this

PKU Symptoms

• Hypoglycemia
• Poor feeding
• Jitteriness/tremors
• Weak cry/apnea/irregular respirations
• Hypothermia
• Lethargy
• Flaccid muscle tone
• Cyanosis
• Seizures/coma

Type 1 Diabetes Symptoms

• Polyuria
• Polydipsia
• Weight loss
• Muscle wasting
• Polyphagia
• Nocturia
• Tachycardia
• Blurred vision
• Fatigue
• Vaginal moniliasis (yeast infection)

Ketoacid Accumulation

• Abdominal pain, nausea, vomiting
• Fruity-smelling breath
• Weakness
• Mental confusion
• Coma
• Slow, labored breathing
• Flushed cheeks & face

Hemorrhage

• Risk factors for postpartum: previous history of PPH, prolonged or difficult labor, overdistended uterus, use of magnesium sulfate, preeclampsia, induction/augmentation of labor, forceps/vacuum delivery, cesarean section, high parity.

Appendicitis

• Inflammation and edema develop leading to cellular malnutrition
• Necrosis and pain result
• If not diagnosed early, rupture and fecal material cause peritonitis

Hirschsprung’s Disease

• A congenital anomaly with mechanical obstruction
• Results from inadequate motility in an intestinal segment
• Ganglion cells result in a lack of motility in the affected portion of the bowel and foul smelling

Crohn's Disease

• Lesions are "skip lesions"
• A noncontiguous segment of the bowel
• Ulcerative colitis has a continuous segment of the bowel
• Causes the GI tract to have inflammation

Post Surgery

• A patient should be ambulatory
• Continuous devices and compression socks prevent any surgery

Ice Pack

• Apply an ice pack to prevent viganal swelling

Newborn Hygiene

• Normal newborn stool looks yellow and seedy
• First stool is meconium- thick, black, and tarry
• Tell parents not to do anything to a newborns umbilical cord because it will dry and fall off by itself
• Know what newborns are assessed
• Measurements such as Chest, head, height, and weight

Newborn Scalp Veins

• Used because peripheral veins are too small and hard to find

Nose Bleeds

• Tilt or lean forward
• Apply ice

Asthma Control Tests

• PEAK FLOW is used for asthma
• Keep levels in green

Digoxin

• Heart medications will help strengthen it, but monitor toxicity

Allergies

• An allergy to food occurs
• An elimination diet can be used
• Stop the medication, give O2, and give Epinephrine if an allergic reaction occurs

Assess Breathing

• Use of accessory muscles, retractions and wheezing, sternal and intercostal retraction muscles, cyanosis
• The transplant questions focus on rejection, infection, medication, isolation precautions, and anti suppressing medications

Incontinence

• Oxybutynin is an overactive bladder Newborn Rectal Temperatures
• A nurse can measure temperature axillary
• A UAP (Unlicensed Assistive Personnel) are unable to take the temperature

Sprain Management

• Reducing swelling (RICE)
• Rest, ice, compression, and elevation

Nasal Gastric Tubes

• For a neonate NG TUBE, there is a nasal gastric tube through the nares

Cystic Fibrosis

• Cardiac catheterization, lay flat, do not bleed, keep legs stabilized, do your five P’s neurovascular checks, and check for blood clots
• Atopic dermatitis is a dermatology condition

Tick Prevention

• Prevent tick exposure by wearing pant legs in your socks

Pinworms

• Treated by body worm temperatures
• Scotch tape and press it over the rectum to treat everyone

Celiac Disease

• A gluten free diet can determine which foods are gluten free Phenobarbital
  • Does not stop abruptly or miss a dose