N2 ModA Blueprint Study Guide.docx

**Pathophysiology II NURS 3321** Module A Blueprint/Study Guide 60 questions **Pathophysiology in general approx. 2- 5 questions** What is Pathophysiology? (in general) **Pathophysiology is the study of how normal physiological processes are altered by disease. The "why" behind the changes we o...

**Pathophysiology II NURS 3321** Module A Blueprint/Study Guide 60 questions **Pathophysiology in general approx. 2- 5 questions** What is Pathophysiology? (in general) **Pathophysiology is the study of how normal physiological processes are altered by disease. The "why" behind the changes we observe.** What is Mechamism of Disease **How diseases disrupt normal bodily functions** What is Disease Processes **How diseases evolve and affect the body over time.** What are Clinical Manifestations **The signs and symptoms** What are Complications **Potential secondary problems that may arise due to the disease or its treatment.** **Pedi G&D approx. 15-20 questions** Overview of Human Growth & Development -- what is it? Why is it important? **The biological, physiological, and environmental changes from conception through adulthood. Crucial for identifying and managing deviations** What factors play a part? What are the stages? And age ranges **Prenatal:** **Conception-Birth, rapid growth** **Infancy: 0-2 years, rapid growth** **Early Childhood: 2-6 years, steady growth** **Middle Childhood: 6-12 years, steady growth** **Adolescence: 12-18 years, rapid growth** **Adulthood: 18+, slow growth** How is the growth during each stage? Slow, steady, rapid? What are some key features of each stage? Cognitive development, Language development, Emotional development, Social development. It will be good to understand Erikson & Piaget for both patho and HCD **Erikson:** **0-1 : Trust vs Mistrust** **1-3 : Autonomy vs Shame/Doubt** **3-6 : Intiative vs Guilt** **6-12: Industry vs Inferiority** **12-20 : Identity vs Confusion** **20-35 : Intimacy vs Isolation** **35-65 : Generativity vs Stagnation** **65+ : Integrity vs Despair** **Piaget:** **Sensorimotor (0-2): Gaining knowledge through senses and motor movement** **Preoperational (2-7): See the world symbolicly** **Concrete Operational (7-11): Develops of rationale thought/problem solving and less egocentric** **Formal Operational (11+): Logical thinking/concern with future** Motor Development Gross v Fine **Gross involvle large muscle movements such as walking or crawling** **Fine involves smaller muscle movements like grasping or writing or claping** Tanner Staging for puberty **Objective classification system to track development and sequence of secondary sex characteristics during puberty** **HCD in general approx. 2-5 questions** What is healthcare delivery? Why is nursing important? What are some basic nursing care interventions for a hospitalized patient? Morning routine, evening routine, water, linen change, bathing, dressing, toothbrushing, ambulation. Tidy up the room, etc. **Pedi G&D approx. 15-20 questions** Are kids just little adults? **No** **Newborns** APGAR **Appearance** **Pulse** **Grimace** **Activity** **Respiration** Quiet alert state, bonding, skin to skin, breastfeeding **First 30-60 min after birth (golden hour) newborns display a quiet alert state good for bonding and breastfeeding** Meconium, stool changes from there **Black and tarry initially and then transitions to a yellow color..**. Average weight, length, head circumference and chest circumference of term newborn. **Weight:7 lbs** **Length: 20 in** **Head Circumfrence: 14 in** **Chest Circumfrence: 2 in less than head circumfrence** Newborn and infant assessment head to toe. **Fontanels: Check for sunken fontanels\...anterior closes by 18 months and posterior closes around 2-3 months** Reflexes: **Rooting, grasp, moro, babinski** Common Defense Mechanisms What is Regression? **Return to an earlier behavior** What is Repression? **Involuntary forgetting of traumatic situation** What is Rationalization? **Attempt to make unacceptable feelings acceptable** What is Fantasy? **A creation of the mind to help deal with unacceptable behavior** Communicating with children- how do we give choices? **Give A or B as opposed to yes or no, be honest, use terms they will understand, encourage play** Family Centered Communication- what is it? Why it is useful? **Best care is achieved when nurse and family work together** Is play important? How does it have a role? **Yes, it plays a role in education, emotional management, and social cooperation** **Pain** What are some behavioral signs of pain in the pedi population? **Crying, grimacing, changes in sleep and eating patterns, limb withdrawal\...** What are some physiological signs of pain? **Decreased O2, Increased HR and BP, increased muscle tone, dilated pupils, dilated pupils\...** What are some non-pharmacologic methods to manage pain? **Distraction, massage, warm/cold therapy, breathing, guided imagery** **Reproduction approx. 35-40 questions** Understanding of the basic pathophysiology, etiology, risk factors, clinical manifestations, pharmacological treatment\* (if applicable), diagnostics (lab values) and therapeutic procedures, effect on fetus/newborn (if applicable), the impact on labor, delivery, and type of delivery (if applicable), priority interview questions, assessment, nursing care/interventions, and the patient education for the following: - Basic principles of Hypovolemic Shock (as discussed in class + basic interventions) **Hypotension, tachycardia, pallor, and anxiety in mom. Marked to absent variability and late decels or bradycardia in baby.** **Causes:** **1^st^ trimester: spontaneous abortion, ectopic pregnancy** **2^nd^ trimester: molar pregnancy** **3^rd^ trimester: placenta previa, abruptio placentae, vasa previa** **IV fluids, blood products, vasopressors\...** - Incompetent Cervix **Painless cervical effacement and dilation not associated with contractions and usually occurs in 2^nd^ trimester resulting in spontaneous abportion or premature birth** **Cerclage Band** - Ectopic Pregnancy **Egg attaches somewhere outside of the uterus usually fallopian tube** **Causes: blockage from trauma, scare tissue, inflammation, infection, misshaped** **Pregnancy will be terminated** **Early Signs: light vaginal bleeding, and pelvic pain (could be referred shoulder pain or urge to have bowel movement)** **If egg continues to grow tube could rupture (life threatening): lightheadedness, fainting, shock** - Abortion (Think types related to medical complications and patient communication) **Spontaneous Abortion (miscarriage) unattended pregnancy loss before 20 weeks gestation.** **Threatened: Possible mild cramps, slight spotting, no tissue, and cervix closed** **Inevitable: Mild-moderate cramps, moderate bleeding, no tissue, and cervix dilated** **Incomplete: Severe cramps, heavy bleeding, tissue, dilated with tissue in canal** **Complete: Mild cramps, minimal bleeding, tissue, cervix closed after passing tissue** **Missed: No cramps, none/spotting, no tissue, cervix closed** **Septic: Cramps vary, bleeding varies malodorous, tissue vary, cervix dilated** **Recurrent: Cramps vary, bleeding varies, tissue, cervix dilated** - Hydatidiform mole/molar pregnancy (Gestational Trophoblastic Disease) **Tissue that would normally become fetus becomes an abnormal growth in uterus and still triggers symptoms of pregnancy. Thought to be caused by problem with genetic information** **Complete: Egg with no genetic information is fertilized it does not develop fetus but grows lump of tissues that look similar to cluster of grapes** **Partial: Egg fertilized by two sperm, placenta becomes the molar growth and fetus tissue can form with severe defects.** **Risk Factors: Age\>35, history of molars or miscarriages, and diet low in folic acid** **Manifestations: dark brown to bright red bleeding during first trimester, severe N/V, vaginal passage of clusters, pelvic pressure or pain** - Placenta Previa **Part or all placenta is covering cervical opening (usually found on ultrasound)** **Manifestations: painless vaginal bleeding and possible signs of hypovolemic shock** **No vaginal exams, sex, or heavy activity** - Placental abruption **Premature separation of the placenta (partial or complete)** **Manifestations: Sudden, intense, and localized abdominal pain, firm fundus with little relaxation, vaginal bleeding but could be concealed, alteration to FHR** **(absent variability, bradycardia)** **Nursing Care: Monitor bleeding and vitals of mother and baby, report, do not attempt vaginal exam, IVs, prepare for c-section** - Vasa Previa **Blood vessels coming off the placenta intertwine with bag of water. If membrane reuptures and causes a tear baby and mom both bleeds out.** **No sex, no vaginal exams, no heavy activity** - Uterine Rupture **Risk Factors: previous c-section or uterine trauma/anomaly** **Manifestations: FHT lost, pain, contractions cease** **Prevention is best!** **Interventions: get help, IV fluids, blood products, O2, prep for c-section** - Amniotic Fluid Embolism **Bolus of amniotic fluid or fetal cells enter maternal circulation and into lungs, cause is unknown.** **60-80% mortality** **Prepare for code and c-section** - Pre-Eclampsia/Eclampsia/HELLP Syndrome **Patho: Spiral arteries of the placenta remain narrow which causes decreased perfusion to the placenta which causes uteroplacental insufficiency** **Risk Factors: Nullipara, age extremes, diabetes, obesity, multiple gestations, previous HTN** **Manifestations: HTN, proteinuria (300g or more in 24 hours and or 1+ greater on dipstick), oliguria, edema, N/V, flulike symptoms** **Hypoxia in fetus (marked or absent variability)** **Delivery done ASAP and considered cure for condition** **Assess: bp, proteinuria, mag toxicity, bed rest regimen** - Cord Prolapse **Cord exits uterus before the baby which leads to cord compression and fetal hypoxia** **Manifestations: visible cord, palpable cord, signs of fetal hypoxia** **Diagnostic: pelvic exam** **C-section will be preformed** **Nursing Goal: get pressure off the cord "knee-chest"** - Shoulder Dystocia **Shoulder of fetus does not fit through birth canal "stuck"** **Sudden stop after head exits the birth canal** **Effects on fetus: prolonged time in canal, structural damage to shoulder** **McRoberts maneuver** - Amniotomy **Rupture of amniotic sac to induce labor** **Nursing Care: monitor FHR, state of mother, assess amniotic fluid** - Vacuum & Forceps (use and impact on newborn) **Used to shorten second stage of labor is mother or baby are not tolerating well (exhaustion)** **Facial trauma from forceps or Subgaleae Hemorrhage vacuum** - Gestational Diabetes & Fetal/Newborn Concerns - Rh Isoimmunization: - when is RhoGAM needed: typical and atypical situations - patient education - Infections - Group Beta Strep (the list above + considerations for mom and fetus/baby, impact on delivery) **Naturally occurring in some women (35%) in the lower GI and genital tract. Bacteria can pass from mother-baby during labor and cause infection** **Risks: preterm labor, prolonged rupture membrane, previous infection, positive for GBS** **Manifestations: fever, drowsiness, trouble breathing during first week** **IV antibiotics until cultures are negative** - Mastitis **Manifestations: sudden (after 10 days), unilateral, localized, red, hot, temp\>101.1, flulike symptoms** **Client Education: proper hand washing, regular complete emptying, proper posture and latch, full course of antibiotics** - Endometritis - Wound infections (C/S or episiotomy or tear) - Labor - Basic hormone involvement 1. **Progesterone (secreted by the placenta): Decreases during late pregnancy allows uterine contractions strengthen\...Braxton-Hicks** 2. **Estrogen (secreted by the placenta): Increases\...makes uterus more sensitive to stimuli** 3. **Oxytocin (secreted by maternal posterior pituitary): Increases and stimulates uterine contractions** 4. **Prostaglandins (secreted by fetal membranes): increases strength of uterine contractions and further enhances oxytocin** - Causes of pain in labor 1. **First Stage: internal pain fetal at back (dilation & stretching of cervix and contractions)** 2. **Second Stage: somatic (fetal descent\...pressure described as burning or tearing)** 3. **Third Stage: pain w/ expulsion of placenta similar to stage one** 4. **Fourth Stage: caused by the stretching of the vagina that incurred during second stage** - Basic Stages of Labor (how are you feeling in the stages & basics of what is happening) **First Stage** - **Latent: 0-3 cm, contractions irregular and mild, talkative and eager** - **Active: 4-7 cm, contractions more regular, feeling of helplessness and anxiety** - **Transition: 8-10 cm, contractions strong, tired "cannot continue", urge to push** **Second Stage: Pushing results in birth** **Third Stage: Delivery of neonate and placenta** **Fourth Stage: Maternal vitals stabilize** - 5 P's & what they represent in detail 1. **Passenger: Fetus and Placenta\...consists of the size of the fetal head, fetal presentation(part of fetus leading through birth canal first), fetal lie(longitudinal or transverse), fetal attitude, station, and position (relationship of specific presenting part to 4 quads of maternal pelvic)** 2. **Passageway: Birth Canal\...composed of the pelvis, cervix, and vagina** 3. **Powers: Contractions\...uterine contractions** 4. **Position: Maternal Position\...position should be changes (gravity helps)** 5. **Psychological: Maternal State** - Cephalopelvic Disproportion (CPD) **Fetus head is too large and the mother's pelvis is to narrow for fetus to pass** - True vs False Labor 1. **True labor leads to cervical dilation and effacement\...contractions longer and stronger and can be felt in lower back radiating to abdomen, walking can increase intensity** 2. **False labor contractions can be painless and irregular, walking eases, no significant dilation or effacement** - Dilation and Effacement **Widening of cervix opening and thinning of tissue** - Rupture of membranes (types, concerns, and assessment) - Leopold Maneuvers **External palpations through abdomen to determine number of fetuses, presenting part, lie, degree of descent, and location of fetus back to assess heart tones** - Pushing - Induction of labor/augmentation (indications, complications, nursing actions, meds, stripping membranes) - Medication in labor -- effect on baby and mom (meds to start and stop contractions) - Pain during labor (causes, patient education, why we choose meds based on the stage of labor, effect on baby and nursing car for baby related to pain meds, narcotic antidote) - Fetal Assessment/Fetal Monitoring - Nursing Responsibilities with fetal heart monitoring - Signs of fetal well being - Nonstress Test Mother presses button every time she feels movement\... - Monitor Placement -- how that is done, where is the heart - Internal vs External advantages/disadvantages - Contraction: Qualities (duration, frequency, intensity) **Duration: how long each individual contraction lasts** **Frequency: how often does a contraction happen** **Intensity: how "intense" individual contraction is (mmHg)** - Category 1, 2 3 **Category 1: Everything is normal and WDL** **Category 2: somewhere in the middle and requires heightened surveillance** **Category 3: Abnormal and requires prompt evaluation and action** - Variability - Overall meaning, patho, and the causes of the different types **"The interplay between the sympathetic and parasympathetic produces variability\..." and is the indication of CNS development and PRIMARY indicator of fetal oxygenation"** **Absent: no variation- fetal acidemia** **Minimal: less than or equal to 5 bpm- fetus sleeping or maternal meds** **Moderate: 6-25 bpm- optimal level** **Marked- greater than or equal to 25 bpm- stress or mild hypoxia** - Accelerations **Short term rises in the heart rate of at least 15 bpm lasting 15 seconds. Normal and healthy!** - Decelerations - Identification, likely cause (patho), interventions to resolve 1. **Early Decelerations: fetal head compression causes vagus nerve stimulation with drop-in heart rate. No intervention required** 2. **Late Deceleration: Uteroplacental insufficiency. Pt in side lying position, IV fluid bolus, discontinue oxytocin, consider tocolytic, oxygen, notify provider** 3. **Variable Decelerations: Umbilical core compression. Knee-chest, discontinue oxytocin, oxygen, get compression off (amnioinfusion, hand)** - Preterm Labor - Causes (including insufficient cervix), S/S, Labs, Nursing Care, patient restrictions, Meds **Uterine contractions and cervical changes that occur between 20-36 weeks and 6 days** **Risk Factors: infections, previous pre terms, multiples, too much or little fluid, age\>35, smoking, preeclampsia, any complications really.** **Labs: fetal fibronectin, cervical cultures, CBC, urinalysis, Fern test** **Manifestations: contractions, pressure in pelvis, low backpain, urinary frequency, rupture of membrane, change in vaginal discharge, change in dilation** - Postpartum - Lochia: types, amount, smell, concerns, why is it important to monitor this? **Rubra: bright red 1-3 days after birth , concerns if stops then starts again** **Serosa: pink 3-10 days after birth\...combo of blood, mucus, and leukocytes** **Alba: yellowish/brown 10-14 days after birth and can last up to 6 weeks** **IMPORTANT to monitor for PPH** - Involution of the Uterus (normal vs causes of subinvolution) **The uterus should contract up on itself and stop postpartum bleeding. Natural release of oxytocin aids in this\....** - Postpartum Assessment (BUBBLE) **Breasts: temp, color, nipple, pain\...** **Uterus: firm or boggy, location which should decrease 1 cm below umbilicus each day, inspect incisions** **Bladder: void 6-8 hours after delivery\...ability to empty bladder** **Bowel: flatus, distention, auscultate** **Lochia: appropriate color for time** **Episiotomy: red, edema, ecchymosis, drainage, approximation** - Basic hormone changes - Postpartum Hemorrhage (all info **+** meds) **The myometrium of the uterus should compress the dilated blood vessels of the uterus to stop bleeding** **Causes: Uterine Atony, Gential Tract Trauma, Retain POC, Coagulopathy** - Postpartum Depression (3 types) 1. **Postpartum Blues: feelings of sadness, sleep pattern disturbances, feelings of inadequacies, and crying easily** 2. **Postpartum Psychosis: pronounced sadness, disorientation, confusion, paranoia, thoughts of self- harm or to baby** 3. **Postpartum Depression: feelings of guilt and inadequacies, anxiety, prolonged fatigue, mood swings, rejection of infant** - Rubin's Phases (basics) 1. **Taking In: 1-2 days pp, preoccupied with own needs, touches and explores infant, discuss birth from her perspective** 2. **Taking Hold: 2-3 days pp, obsessed with bodily functions, mood swings, pt teaching most effective** 3. **Letting Go: after 6 weeks pp, begins to see infant as unique person** - Principles of Breastfeeding, benefits, latch, output, types of milk - Contraception: basic advantages and disadvantages of the different types - GTPAL **Gravidity: number of pregnancies including current** **Term: number of pregnancies carried to term** **Preterm: number of pregnancies carried between 20-36.6 weeks** **Abortion: number of losses before 20 weeks (elective/spontaneous)** **Living: number of living children** - Newborn Vital Signs + I&0 in fist 24 hours - Gestational Diabetes - Erectile Dysfunction (what is, risk factors, prevention, medications (nursing considerations) **Inability to attain or maintain an erection sufficient to permit satisfactory sexual intercourse** **Risk factors: heart disease, HTN, stroke, MS, parkinsons, spinal cord injury, direct injury to penis, diabetes, COPD, medications, lifestyle choices** **Prevention: mitigation of risks, regular exercise and healthy diet** **Medications: Viagra & Coalis increase blood flow to penis (Nitroglycerine is contraindicated)** - Hypospadias **Birth defect where opening of the urethra is not located at the tip of the penis (no circs)** - Epispadias **Urethra does not develop into a full tube and urine exits from an abnormal location, cause is** **unknown** - Menopause (Health problems associated with declining estrogen levels, clinical manifestations, basic hormone therapy -with/without uterus) - Fertility (elements essential for normal fertility) **Female: cervical mucus favorable, patent fallopian tubes, ovaries produce and release normal, no obstructions, endometrium healthy, adequate hormones** **Male: testes produce sperm, genital tract unobstructed, normal secretions, ejaculate in vagina** - Endometritis vs Endometrioses - Infections - Group Beta Strep (the list above + considerations for mom and fetus/baby, impact on delivery) - Mastitis - Endometritis - Wound infections (C/S or episiotomy or tear) - Be familiar with terms such as: - Antepartum, Intrapartum, Postpartum, Vertex/Cephalic - primigravida, multipara/multiparous, precipitous **Maternal Newborn Medication List** - Make sure you research the newborn related indication. - Make sure you know the route for a newborn. 1. Phytonadione *(Vitamin K)* \[prevent hemorrhage\] 2. Erythromycin Ophthalmic Ointment \[antibacterial\] 3. Hepatitis B Vaccine\* \[immunization\] - Maternal Medications - Make sure you research the maternal related indication. - Required Medications for the Assignment 1. Oxytocin *(Pitocin)* \[uterine stimulant/uterotonic\] 2. Misoprostol *(Cytotec)* \[uterine stimulant/uterotonic\] 3. Methylergonovine *(Methergine)* \[uterine stimulant/uterotonic\] 4. Carboprost Tromethamine *(Hemabate)* \[uterine stimulant/uterotonic\] 5. Tranexamic acid *(TXA)* \[antifibrinolytic\] 6. Betamethasone **\[↑ Fetal Lung Maturity\]** 7. Terbutaline *(Brethine)* **\[uterine relaxant/tocolytic\]** 8. Nifedipine **\[uterine relaxant/tocolytic, calcium channel blocker\].** 9. Indomethacin \[uterine relaxant/tocolytic\] 10. Magnesium Sulfate *(MgSo~4~)* 11. Ephedrine \[treats hypotension\] 12. Hydralazine \[antihypertensive, calcium channel blocker\] 13. Labetalol \[antihypertensive, beta blocker\] 14. MMR Vaccine\* \[immunization\] 15. TDaP Vaccine\* \[immunization\] 16. Influenza Vaccine\*\[immunization\] - \*Immunizations - The immunizations will not fit the template perfectly. - Information on the vaccine can be found on the CDC website. - Research and write a brief description of the disease(s) and the effects on the body. - Example: What does a patient with measles look like? Mumps? Rubella? - Suggested Maternal Medications - These medications that are commonly given on a maternal newborn floor. These are NOT required for your assignment. 1. Acetaminophen *(Tylenol)* \[pain & fever\] 2. Naproxen *(Aleve)* \[pain\] 3. Fentanyl \[pain\] 4. Ketorolac *(Toradol)* \[pain\] 5. Hydromorphone Hydrochloride *(Dilaudid)* \[pain\] 6. Naloxone *(Narcan)* \[opioid antagonist\] 7. Polyethylene glycol *(Miralax)* \[constipation\] 8. Docusate Calcium \[constipation\] 9. Senna \[constipation\] 10. Ferrous Sulfate \[anemia\]