America's Note PDF - Week 1-2

Week 1 Con traception (1) *Explain assessments, interventions, and teaching related to family planning. Abstinence: only one with no risks Calendar Rhythm Method Standard Day method (cycle beads) Basal Body Temperature: body temp rises after ovulation due to increase in progesterone which is respons...

Week 1 Con traception (1) *Explain assessments, interventions, and teaching related to family planning. Abstinence: only one with no risks Calendar Rhythm Method Standard Day method (cycle beads) Basal Body Temperature: body temp rises after ovulation due to increase in progesterone which is responsible for preparing your uterus for pregnancy. Coitus interruptus (withdrawal): pull-out method Cervical mucus ovulation detection method Lactation amenorrhea (not menstruating) method: temporary postpartum contraceptive method. Breastfeeding serves as birth control. Week 2 Routine Prenatal Care (2) *3. Risks determined by prenatal diagnostic testing Lab and what they test for CBC: infections and anemia Pap test: cervical cancer Urinalysis: pregnancy, DM, gestational hypertension, renal disease, infection HIV: STI or STD Venereal Disease research laboratory (VDRL) or Rapid plasma reagent (RPR): syphilis screening mandated by law A1C or 1 hr gtt: hyperglycemia. Done at initial visit for at-risk clients and at 24-28 weeks of gestation for all pregnant clients because placenta becomes lazy and insulin resistant. 3hr gtt: done if at least 2 positive screenings for high glucose levels. Overnight fasting required. Maternal serum alpha-fetal protein: neuro defects, and abnormal can indicate DOwn syndrome if value is down (indicator NOT final diagnostic test for down) Amniocentesis: only offered if the noninvasive tests come back with an issue or also usually done for mothers over 35 that are considered high risk pregnancies. Done around 15-18 weeks; monitor pt for infection, rupture membrance (this can cause aominotic fluid loss and fetal death due to fluid loss) Contraction Stress Test (CST): DOes stress out baby and mom, stimulates contractions with oxytocin, not routine as much, risk for preterm labor. We want a NEGATIVE result for this. Gtt: Glucose Tolerence Test: Done once at 14-18 wks for pts that are high risk. OR 22-32 WEEKS FOR REGULAR/ROUTINE SCREENING. 1 rs normal standard, NO fasting (1 hr wait) then BG check, if higher than 140 then do a 3 hr glucose test, 3 hr MUST FAST, Blood taken out before and then 1-2-3 hr BG check (2 failures/above 140 = gestational diabetes). NST: Non-Stress Test: Monitors bby inside, tocometer measures uterus stress (is it contracting) Fetal HR (dopler), measures that baby is contracting/kicking/presence. Reactive/NonREactive: Want to see reaction of bby, bby HR increase for at least 15 seconds by 15 beats during, 2 times for 20 minutes. This is stress fil for baby. NON REACTIVE: Fetal HR NOT high enough , need more testing routinely (once a week). Labs: Glucose: (to be qualified for gestational diabtees) BG over 140 Fetal HR: 110-160 RH Positive (we want) if not administered RH via IM @28week within 72 hrs. *5. Danger signs during pregnancy including early bleeding Can be caused by: -​ Spontaneous abortion: goals include maintaining fluid balance, preventing infection, managing pain, and providing emotional support. -​ Ectopic pregnancy: egg fertilized in the fallopian tube or abdomen. Stabbing pain on one side of the pelvis. If ectopic ruptures and there is blood in the pelvic cavity there will be extreme pain, tachycardia, pallor, and dizziness. Immediate Tx for non ruptured ectopic pregnancy is through meds such as Methotrexate (absorbs folic acid, do NOT take any vitamin supplements) or by Salpingostomy (piece of fallopian tube taken out). -​ Gestational trophoblastic disease (almost like a cancer): pregnancy has started and something in the genetics has malfunctioned where it just becomes a ball of abnormal trophoblast cells essentially. Since it does reside in the uterus doctors do consider chemotherapy because they do view it as a cancer type. High HCG levels and bleeding occurring. Recommend to not get pregnant for 1 yr or have an IUD (since it triggers an increase in the endometrial lining). -​ Placenta previa: placenta positioned near or over the cervix during pregnancy. The placenta bleeds. NO pain. Mom must have a c-section if this is the case and they are term. If they are less than 37 weeks gestation they go on bed rest. -​ Abruptio placentae: placenta separates from the inner wall of the uterus before birth. Painful bleeding! Mom might have a c-section if they are term. Encourage bed rest -​ Vasa previa: umbilical cord over cervix. Treatment involves close monitoring during pregnancy through non-stress tests and regular ultrasounds, corticosteroids to help the fetus’s lungs mature, and C-section. Usual treatment for early bleeding is bed rest and avoiding sex. Further Complications by Trimester: 1st Trimester: hyperemesis gravidarum (unable to hold down food for more than 24 hrs = ketones in urine, dehydration, jaundice. Tx is IV hydration), infection (UTI), miscarriage, ectopic pregnancy (fertilized egg attaches outside of the uterus, usually in a fallopian tube), fever chills, diarrhea, horrible lower back pain can indicate kidney dysfunction; GOAL is to get pt to 10cm dilation 2nd & 3rd Trimester: uterine contractions (no more than 6 in one hour), leaking of fluid, non fetal movement, vaginal bleeding, signs of gestational diabetes, and gestational hypertension. 4th: Post Partum Depression, Post Partum Hemmorhage. (Goal for 2nd is to deliver baby and 3 for placenta, 4th is DO NOT LET pt bleed 2 death) VEAL CHOP: Variable Decelerations = Cord Compressions Early Decelerations = Head Compression Accelerations = Okay! Late Decelerations = Placental Deficiency. -​ When pt has variable decelerations = KNEE TO CHEST or Trenenburn. -​ When pt has MODERATE variability = healthy fetal nervous system. Week 3 Glucose Regulation (2) *Provide appropriate nursing and collaborative interventions to optimize hormonal regulation. ​ Diabetic management during pregnancy. ○​ Diet and exercise: have them make a food diary, higher intake of proteins and fats, less carbohydrates. Perform kick counts after 24 weeks. *Recognize when an individual has signs of impaired hormonal regulation: clinical manifestations & lab results indicative of ​ Gestational DM: Normal Fasting glucose before meals is 60-99 mg/dL, and less than or equal to 120 mg/dL 2 hrs after meals. Manifestations: thirst, blurred vision, frequent urination, fatigue, polyhydramnios (>20cm), Labs indicative of GDM: -​ 1 hr gtt: fasting not necessary. Positive screening is 130-140 mg/dL or greater. Screened in first prenatal visit and again at 24-28 weeks gestation because of the placenta. -​ 3 hour ogtt: necessary if 2 or more positive screenings for DM. Necessary overnight fasting. Serum glucose levels determined at 1, 2, and 3 hrs following glucose ingestion.  -​ Urine with ketones Week 4 Routine Labor (1) *Recognize when an individual has problems with reproduction -The 4 stages of labor; phases of the first stage 1st stage (0-10cm): onset of regular uterine contractions and lasts through full dilation of the cervix. Divided into latent (early) and active phases. In the latent phase the cervix effaces to allow for dilation, contractions are irregular at this point. In the active phase, the cervix dilates, and the fetal presenting part descends. Pain management: sedatives, opioids, epidural, nitrous. Longest stage; 12.5 hours duration average. Oxytocin is usually administered during this time. 2nd stage (full dilation-birth): complete cervical dilations and contractions every 1-2 min and ends with the birth of the fetus. Composed of a latent phase where the fetus descends passively during contractions, and the active phase where the fetus descends due to maternal pushing. Pain relief measures: epidural, nitrous oxide, local, and pudental block. 3rd stage (delivery of neonate - placenta): fetus is born. Stage lasts through the expulsion of the placenta. 5-30 min duration. Post vaginal assessment begins. Schultz presentation (shiny) or Duncan presentation (inside out placenta, looks darker). We want the entire placenta to come out whole, not in chunks. 4th stage: delivery of the placenta and lasts for 1-4 hrs. VS return to homeostasis. Lochia scant to moderate rubra. Pain management involves IV, oral meds, and topical meds for vaginal trauma. -​ Labor can take 12-18 hours - Priority interventions for Intrapartum emergencies should be done when having: prolapsed umbilical cord, meconium stained amniotic fluid, fetal distress, dystocia of labor, precipitous labor, uterine rupture, anaphylactoid syndrome of pregnancy. Non pharm: shower, bath/tub, pelvic pressure to relieve back pain, massaging, breathing techniques, ambulating. Pharmacological: nitric oxide (laughing gas), epidural (should be well hydrated and VS stable, after epidural it is common for B/P to go down), IV (Fentanyl), and numb nerve of the sacral area with injection. Help pt see the difference between true vs false contractions. (true = dilation, do not go away w/position chance, blood & clear fluid present, consistent/presistent.. Braxton Hicks (false contractions)= Go away w/walking, not consistent, go away with repositioning. High-Risk Labor (1) *Recognize when an individual has problems with reproduction according to risk factors, causes, and clinical manifestations for the following postpartum complications -​ Preterm labor: uterine contractions and cervical changes that occur between 20-36.6 week gestation. Risk factors: advanced maternal age (>35), low pre pregnancy weight, infections (urinary, HIV, herpes), previous preterm birth, multifetal pregnancy, smoking, drugs, lack of prenatal care. Management/Tx: bed rest, no intercourse, hydration, monitor for infection of PROM Nifedipine or Terbutaline given for mom to stop the contractions -​ Recognize cues that indicate problems with perfusion. Past smoking, bright red blood in briefs (previa)/dark red blood (abruptio), HR elevated/lowered, RR/cyanosis present, edema in both extremities. -​ Interpret lab and diagnostic studies related to perfusion. WBS (indicates infection) range is 5,000-10,000 Platelet: 150,000-450,000 (signifies bleeding/loss) Hemogoblin: 12.0-16.0 g/dL (women); 13.5-17.5 g/dL (men) Hematocrit: 41%-53% (men); 36%-46% (women) Week 5 Routine Postpartum Care (2) *Recognize when an individual has problems with reproduction. ​ - Expected physiological changes in the postpartum period. Normal blood loss is 100lbs, +4’9 Low glucose High glucose  Assessment ​ Cold/clammy skin ​ Polydipsia ​ Diaphoresis ​ Polyphagia ​ Tachycardia ​ Polyuria ​ Lightheadedness ​ Rapid respiratory (acidosis) ​ Irritability ​ Intense hunger ​ Range ( Treatment Stage 1: redness that's not blanchable. NO break in skin. -> Transparent film Stage 2: partial epithelial damage. Very shallow. Blister. -> Hydrochloride Stage 3: full epithelial damage. -> Alginate (takes away moisture) or Hydrogel (adds moisture) Stage 4: beyond muscle damage -> Alginate or Foam (if debridement) or Hydrogel How to promote healing? ​ Foods with: ○​ Protein: eggs, etc. ○​ Vitamin C: oranges, lemons, strawberries, kiwi, bell peppers ○​ Zinc: shellfish, oysters, beef ○​ Vitamin E: sunflower seeds, almonds, spinach, avocados ​ Nutritional supplements What is the normal BMI range? ​ Normal: 18.5 -24.9 What do you recommend to maintain a healthy BMI? If high: Exercise, Healthy food habits, Food diary If low: ​ Are they exercising too much? ​ Not eating enough? ​ Muscle wasting? What client teaching would you prefer for diet modification? Education on substitution, asking them to make a meal plan w/you, ask what's their goal in a measurable time. Where do you start for diet modification? 1.​ Start by knowing what they eat. (Assessment) 2.​ Substituting meals for a healthier option or a healthier change in the food. 3.​ What's their goal What are nutritional supplements for anemia? ​ B12 ​ Folic acid ​ Iron How do you diagnose sleep apnea? ​ + Polysomnography/ Sleep study What do you need to qualify for CPAP? ​ Polysomnography/ Sleep study How do you qualify for oxygen? ​ 30 min with no oxygen ○​ SpO2 needs to be less than 88% Recognize Lung Sound and Intervention: Dx Sound Intervention Asthma Wheezing Ipratropium- Albuterol (SABA) Atelectasis Crackles (in inspiration) Incentive spirometer (know steps on how to teach this) C.F. Crackles Chest percussion therapy/Chest physiotherapy Acetylcysteine Week 14 ​ Communication with healthcare ​ Team steps ○​ What's a call out? Addressing and raising concerns about a patient to encourage change. ○​ What is closed loop communication? Sending a message, receiving the message, verifying the message. ○​ What's a proper handoff? Includes medical history, current condition, medications, & tx plans. ○​ Situational monitoring? Actively scanning and assessing pt conditions for early intervention. ​ Healthcare economics ○​ Insurance something? Fluid excess ​ Low sodium ​ Fluid moves into cells ​ Dehydration ​ Hypertension Fluid deficit ​ High Sodium ​ Hypotension ​ Tachycardia ​ Hypovolemia Electrolytes to know: ​ Magnesium (1.8-2.6 mg/dL): ○​ Key treatment for preeclampsia to prevent seizures ○​ Low magnesium s/s: tremors, muscle spasms, muscle cramps, fatigue, abnormal eye movements (nystagmus), loss of appetite. ○​ High magnesium s/s: muscle weakness, hypotension, heart arrhythmias, confusion. ○​ ANTIDOTE: calcium gluconate ○​ Tetany: involuntary muscle cramps or spasm due to low calcium or magnesium levels. ​ Potassium (3.5-5.0): ○​ Hypokalemia: constipation, heart palpitations, fatigue, muscle weakness ○​ Hyperkalemia: chest pain, muscle weakness, irregular heart rhythms, SOB Arthritis ​ Know how to support mobility ​ Medication used: Methotrexate What assessments and purpose of the after fracture? ​ Testing CSM: ○​ Circulatory (pulses +2 and equal, temperature, cap refill of less than 2 seconds) ​ Arterial perfusion system is working ○​ Sensory (ask if they can feel it) ​ Checking for nerve damage ○​ Motor function ​ Move it (distal to area) ​ Nerves are intact What to do after amputation? Lay flat on stomach (prone) to prevent contractures to wear prosthesis.