Maternal Nursing PDF

**MATERNAL NURSING** ==================== *Sir Marc Adlawan* **OB Nursing** - Client-centered - Priority: Safe labor & delivery High Risk: - H -- - Hypertension ---\> encephalopathy - Gestational: ✔️HPN (up to 140/90 mmHg); ❌proteinuria, edema; - PIH: protei...

**MATERNAL NURSING** ==================== *Sir Marc Adlawan* **OB Nursing** - Client-centered - Priority: Safe labor & delivery High Risk: - H -- - Hypertension ---\> encephalopathy - Gestational: ✔️HPN (up to 140/90 mmHg); ❌proteinuria, edema; - PIH: proteinuria, edema, HPN (up to 160/100 mmHg) - Mild preeclampsia: focus on weight - Severe preeclampsia: aura - Eclampsia: seizure, coma - H.mole ---\> choriocarcinoma (uterine Ca) - Hx of preterm delivery: \< 37 weeks - Mgt: stop contraction! - I -- - Age: - \35 y/o ---\> Down Syndrome/Trisomy 21 - Immunity problem - SLE - MS - G -- glucose: DM \ safe during pregnancy; ⬆️dose during 1^st^ tri - DMT2: macrosomic, hypoglycemic - Best mgt: weight reduction (diet + exercise) - GDM: Best mgt: - D -- diet: 6 meals/day - E -- exercise: walking, swimming - I -- insulin - Routes: IV, SUBQ - M -- mgt: No to OHA - H -- - HIV: continue antiretroviral - Active infection: ❌breastfeeding - hOverweight - R -- Rh incompatibility: affects next baby - Mother: (-) Rh - Baby: (+) Rh - Rhogam: given 28^th^ week AOG; 24-48 hrs after delivery/abortion - I -- IUGR, maternal Infection (UTI) - Pyelonephritis: preterm L&D - S -- Sedentary lifestyle ---\> obesity - Addiction: smoking, alcohol, drugs (cocaine ---\> abruptio placentae) - K -- Kidney dse ---\> ⬆️Na ---\> HPN - S -- STDs (herpes Type II, syphilis) - Hutchinson's teeth: teeth of child w/ maternal syphilis **AGE OF GESTATION** - Detect possible risks/complication - Assessed: Utz - confirmatory - Detects fetal age & size **Preterm** **Term** **Post-term** ------------- ----------- ------------------ \< 37 wks 38-42 wks \>42 wks & above Long but thin **PREGNANCY** - P -- pregnancy: - 9 months - 280 days - 3 trimesters - 40 weeks - R -- RBC & plasma volume ⬆️ ---\> hemodilution ---\> physiologic anemia (pseudoanemia) - RBC: 35%⬆️ - Plasma vol: 50%⬆️ - Mgt: improve diet - E -- emotions ---\> Rubin's Task of Pregnancy: - 1^st^ tri: acceptance of pregnancy - (-) acceptance: Ambivalence ---\> presence of 2 conflicting emotions - 2^nd^ tri: acceptance of baby - Bonding with baby - 3^rd^ tri: preparation for parenthood - Role transition - G -- give nutritious diet - ⬆️iron: ⬇️IDA - Liver (well-cooked) - Lean and red meat - Leafy vegetables - Legumes & nuts - ⬆️Folic acid/B9: ⬇️NTD; increase 3 months before pregnancy - Green leafy vegetables - Ovo: eggs - Vege: vegetables - Vegan diet ---\> ❌B12 ---\> pernicious anemia ---\> red beefy tongue - Lacto: Dairy products - N -- note for bleeding - 1^st^ sign: tachycardia - Causes: - 1^st^ tri: - Ectopic pregnancy: ruptures @ 12 weeks - Ebortion - Green papaya ---\> ⬆️oxytocin ---\> contraction ---\> abortion - 2^nd^ tri: - H.mole - Suction curettage - DOC: Methotrexate ---\> ⬇️folic - Premature cervical dilatation & contraction/Incompetent Cervix - Shirodkar: permanent surgery - McDonald's: temporary cerclage - 3^rd^ tri: - PIH - Placental problems - Placenta previa - Abruptio placenta - A -- Amniocentesis ---\> empty bladder - Detects lung maturity, problems with NTD ---\> Alpha fetoprotein ⬆️ - ⬆️: tube defects - ⬇️: down syndrome - Leopold's maneuver: empty bladder - Detect fetal position - Best position: modified recumbent position + pillows on the (R) side - Best position during pregnancy: left sidelying to prevent compression of major blood vessels ---\> supine hypotension syndrome - Utz: detect fetal age, size & wt - Vaginal: empty bladder - Transabdominal: full bladder - N -- note for complication ---\> Danger Signs: - S -- swelling - UE: mild PIH - LE: (N)/expected - C -- chills & fever ---\> sepsis - Sepsis: - Adult: ⬆️temp - Newborn: ⬇️temp ---\> hypothermia - A -- abdominal pain: epigastric pain ---\> aura (severe preeclampsia) ---\> seizure (Eclampsia) - B -- boardlike abdomen ---\> abruptio placenta - B -- BP - ⬆️: PIH - ⬇️: shock - B -- blurred vision - S -- sudden leakage of amniotic fluid/foul-smelling vaginal discharge - C -- CS candidates - A -- Abruptio placentae - B -- breech position - C -- CPD - D -- distressed fetus - Check FHR ---\> (N): 110-160 bpm - Emergency CS: - \180: severe tachycardia - M -- multiple pregnancy - P -- PIH - S -- STD: Herpes Type 2 - T -- Transverse presentation - Y -- yes to SAFETY - Yes to Breastfeeding ---\> advantages: - A -- antibody IgA ---\> protects immature GIT - B -- brain development - C -- cost-free, cost-effective - D -- digestible \ placenta of the 1^st^ tri - Abnormally high: - H.mole - Twin pregnancy - Abnormally low: - Abortion - Ectopic pregnancy - HPL (Human Placental Lactogen): ⬇️1^st^ tri; ⬆️ on 2^nd^ & 3^rd^ tri - ⬆️: GDM - ⬇️: abortion - Benefits: Prepares breast for lactation - Risks: - Diabetogenic hormone - Insulin resistant hormone - Relaxin: relaxation of bones & joints - Abn ⬆️: DDH (Developmental Dysplacia of the Hip) ---\> common in girls - Estrogen: hormone of women - Prepares the genatalia for pregnancy - ⬆️E: ⬇️FSH - Progesterone: hormone of pregnancy - Keeps uterus relaxed ---\> maintains pregnancy - relaxes smooth muscles ---\> constipation **CHANGES DURING PREGNANCY** - ⬆️Estrogen = ⬇️FSH - ⬆️Progesterone = ⬇️LH - ⬇️FSH, LH ---\> no ovulation - Surge of LH = ovulation **SIGNS OF OVULATION** - L -- lady appears moody - I -- increased temp in the body; 1 day before ⬇️1F - B -- breast tenderness - O -- ovaries releases egg cell - G -- great desire for sex - A -- at the 14^th^ day before the end of menses - N -- note for cervical discharge - Midcycle pain: Mittelschmerz **REPRODUCTIVE SYSTEM CHANGES** - Vagina: discoloration; purplish/bluish ---\> Chadwick's sign - Cervix: softening ---\> Goodel's sign; via IE - Uterus: softening (lower uterine segment) ---\> Hegar's sign; via IE - Ovaries: - ⬆️Estrogen = ⬇️FSH - ⬆️Progesterone = ⬇️LH V C 4^th^ week AOG --- --- ---------------- C G 2^nd^ month U H 6^th^ week AOG **Fundus** - palpable portion of the uterus - @ the tip of the uterus - Uterus is palpable until 9^th^ day only - 10^th^ day: no longer palpable ---\> settles into pelvic cavity - Descent: 1 fingerbreadth/day or 1 cm/day Palpated: - 1^st^: during pregnancy ---\> determine AOG - 2^nd^: during L&D ---\> determine degree of contraction (hypo/hypertonic) - Hypertonic: \> 90 secs; common in primigravida - Hypo: common in multigravida (5 or more pregnancies) 3^rd^: during postpartum ---\> determine uterine involution (return of reproductive system in a prepregnancy state) **CARDIOVASCULAR SYSTEM CHANGES** - BP: slightly ⬇️ - Best position: LSL, pillows on the right - Heart size: ⬆️ - HR: ⬆️about 10-15 bpm - Hemodilution ---\> anemia (pseudoanemia): - RBC: ⬆️about 35% - Plasma volume: ⬆️about 50% - WBC: ⬆️ to fight infection - Plasminogen: ⬆️=⬆️clotting ---\> high risk for DVT (+) Homan sign ---\> pain upon dorsiflexion - ⬆️Iron = ⬇️anemia - Empty stomach - Acidic env't - With food - (+) Vit C for faster & better absorption - Liquid form: use straw \ worn before standing LMP: due date Urine PT: measures HCG in the urine Serum PT: measures HCG in the blood Ultrasound: most accurate way to determine gestational age \*\*When Beta-HCG is \> 2000 mg/dL **Initial Routine Screening** - Blood type & Rh factor - CBC - Infections: Rubella, HIV, RPR/DRL, Hepa B - Pap smear & cultures for gonorrhea & chlamydia - Hemoglobin--- & inherited diseases **RESPIRATORY SYSTEM CHANGES** RR: ⬆️about 2-3 cpm PaCO2: ⬇️bcos of hyperventilation ---\> mgt: - Assess further - If caused by anxiety: - NC - Anxiolytic/minor tranq - Respiratory Alkalosis: NO to brown bag ---\> ⬆️risk for asphyxiation **Epistaxis** --- nose bleeding Mgt: - Lean forward - Apply ice on the bridge of the nose **INTEGUMENTARY SYSTEM CHANGES** Melasma - Mask of pregnancy - Chloasma d/t ⬆️MSH (temporary) ---\> avoid sunlight exposure Linea Nigra - d/t ⬆️MSH (temporary) - From symphysis to umbilicus Striae Gravidarum - Stretch marks (permanent) - Use virgin coconut oil or cocoa buttermilk **GASTROINTESTINAL SYSTEM CHANGES** Mouth - ⬇️pH (acidic) - Mgt: frequent oral care Morning Sickness - Normal/expected in 1^st^ tri only ---\> d/t ⬆️HCG & ⬇️glucose Pica - Eating inedible, non-nutritious food - Complication: malnutrition = anemia Hemorrhoids - D/t ⬆️venous pressure - Mgt: - Avoid constipation ---\> ⬆️OFI - Frequent position changes ---\> promotes peristalsis - Hot Sitz Bath Constipation --- d/t progesterone Pyrosis/Heartburn - Priority: airway - Mgt: - F -- fatty & spicy must be avoided - U -- upright position: best POC - L -- lying down after meal: bad position - S -- sff & sips of milk Hyperemesis Gravidarum - Cause: abnormal ⬆️HCG (H.mole) - Occurs when: entire pregnancy (1^st^-2^nd^ tri) - Complication: - Dehydration - Metabolic alkalosis ---\> hypokalemia - Uterine cancer (Choriocarcinoma) - Mgt: - active vomiting: NPO but ⬆️IVF - No vomiting: - DAT - ⬆️OFI **SAFE!!** ---\> won't cross placental barrier - H -- Heparin - I -- Insulin - B -- Bacteria ex. Syphilis - M -- Marijuana (affects cognition of mother) **RENAL SYSTEM CHANGES** Polyuria: normal ---\> d/t rapid diuresis Urinary frequency: - 1^st^ tri: ⬆️ - 2^nd^ tri: ⬇️-\> d/t baby is floating = no pressure on the bladder - 3^rd^ tri: ⬆️very frequent bc uterus is so enlarged Kegel's exercise: strengthen the pubococcygeal muscle **MUSCULOSKELETAL SYSTEM CHANGES** Backache: - d/t Lordosis ---\> pride of pregnancy - Mgt: exercise ---\> pelvic rocking/tilting ROA: ideal L&D LOP: back labor Leg cramps - Caused by ⬆️activity, ⬇️Calcium - Mgt: - Rest period - Dorsiflexion - Adequate Ca in the diet - Adequate phosphorus **SIGNS OF PREGNANCY** Earliest sign: amenorrhea 1^st^ mens: menarche Confirmation: Utz **PreSumptive** --- **S**ubjective signs; weaker sign; as verbalized by pt - B -- breast tenderness - U -- urinary frequency - F -- fatigue - A -- amenorrhea - L -- linea nigra - I -- increased pigmentation - Q -- quickening - S -- striae gravidarum - M -- morning sickness **PrObable** --- **O**bjective signs; stronger sign; as assessed by the nurse - B -- ballotement - E -- enlarged abdomen - B -- braxton hick's contraction - C -- chadwick's sign - G -- goodelle's sign - H -- hegar's sign - P -- positive PT **Positive** --- absolute; MD/OB-GYN - Ultrasound - 1^st^ tri: Doppler (8-12 wks) - 2^nd^ tri: Fetoscope (20 wks) +-----------------------------------+-----------------------------------+ | **2^nd^ TRIMESTER** | | +===================================+===================================+ | 16^th^ | Quickening (multi) | +-----------------------------------+-----------------------------------+ | 20^th^ | Quickening (primi) | +-----------------------------------+-----------------------------------+ | 24^th^ | Hearing is established | | | | | | Gender (5^th^ month) | +-----------------------------------+-----------------------------------+ | **3^rd^ TRIMESTER** | | +-----------------------------------+-----------------------------------+ | 28^th^ | Lung surfactant | +-----------------------------------+-----------------------------------+ | 32^nd^ | Subcutaneous tissue is formed | | | | | | Brown Fats: once metabolized, | | | there will be production of heat | +-----------------------------------+-----------------------------------+ | 36^th^ | Testes descends | +-----------------------------------+-----------------------------------+ Cryptorchidism --- failure of the testes to descent - Surgery: Orchiopexy (1yr after birth) - Delay surgery: first 6 months **LABOR & DELIVERY** ==================== **STAGES OF L&D** **STAGES** **FOCUS** ------------ ------------------- ----------- ------------------------------------------------------------- I Longest stage Cervix Onset of true labor until full dilatation II Expulsion stage Baby Full dilatation to expulsion of baby III Placental stage Placenta Expulsion of baby to delivery of placenta IV Post-partal stage Mother Delivery of placenta to postpartum (4-6 hrs after delivery) **Hemorrhage** - NSD: \> 500 mL - CS: \> 1000 mL **STAGE 1** **Cervical dilatation (cm)** **Phases** **Duration** **Frequency** ------------------------------ ------------------ -------------- --------------- 1-3 **Latent** 15-30 secs 15-30 min 4-7 **Active** 40-60 secs 3-5 min 8-10 **Transitional** 60-90 secs 2-3 min - \> 90 secs: hypertonic contractions - Common to primigravida - Mgt: oxy drip STOP! - Hypotonic contraction - Common to multigravida - DOC: oxytocin - Always check BP prior - S/e: hypertension - Boggy uterus - Mgt: fundal massage **Latent** **Active** ----------- ------------ ------------ **Primi** 6-11 hrs 1.2 cm/hr **Multi** 4-8 hrs 1.5 cm/hr [Latent Phase] - Diet: - DOH: DAT (NSD) - Pilitteri: NPO - Enema, Emotion - DOH: No - Pilitteri: Yes - Support - Voiding - Q 2 hrs - Hastens delivery - Ambulation - c/i: cord prolapse - Hospital admission Oxytocin: hastens delivery Tocolytics: halts delivery MgSO4 [Active Phase] - A -- apdate the progression of labor ---\> 1 cm/hr - A -- anesthesia - s/e: hypotension - Mgt: - Reposition - Elevate the legs [Transitional Phase] - Transfer to DR table: fully dilated - Primi: 10 cm - Multi: 8-10 cm - ✔️Bulging perineum **STAGE 2** - Focus: baby - Maneuver: Ritgen's Maneuver ---\> to prevent further laceration - Episiotomy - Site: fourchette - When: 2-3 consecutive contractions - DOC: Oxytocin **STAGE 3** - Focus: placenta - \# of cotyledons: 20-30 - Retained placental fragments ---\> causes hemorrhage (24 hrs after) Placental presentations: - Schultz - Shiny, Senter - Fetal's side - Duncan - Dirty - Mother's side - Edge (more bleeding) Signs of Placental Separation - Calkin sign: 1^st^ sign - Fundus is globular - Rises @ the umbilicus - Firm - Sudden gush of blood - Lengthening of the cord **STAGE 4** - Focus: mother BUBBLE HER - B -- bowel: constipation d/r pressure/pain - Mgt: OFA - U -- uterus: firm, contracting - Abnormal: boggy ---\> uterine atony - B -- bladder: rapid diuresis - ⬆️temp: - \< 24 hrs: normal d/t mild DHN - Mgt: ⬆️OFI - \> 24 hrs: abnormal; infection - Mgt: check CBC ---\> ⬆️WBC - DOC: antibiotic, antiviral - B -- breast engorgement (fullness) - Encourage breastfeeding - Water intake ⬆️ - Wear supportive bra - Warm compress - L -- lochia - Present: normal - Absent: abnormal ---\> internal bleeding ---\> hemorrhage - Normal: RSA - Abnormal: RAS ---\> postpartal infection **Rubra** Red; w/ small, minimal clots (decidua) 1-2 days ------------ ---------------------------------------- ------------ **Serosa** Pink/brown 4-10 days **Alba** White/milky 10-14 days - E -- emotions - Postpartum blues ---\> depression ---\> psychosis - Taking iN --- Narcissistic: mother focuses on self - Taking Hold --- starts to initiate newborn care - Letting Go --- mother assumes primary caregiver role - H -- Homan's sign - Mgt: early ambulation - NSD: 4-6 hrs - CS: \< 24 hrs - E -- episiorraphy - R -- related complications - Hemorrhage - \< 24 hrs: uterine atony - \> 24 hrs: retained placental fragments **ABNORMALITIES** ================= **H.MOLE/GESTATIONAL TROPHOBLASTIC DISEASE** Cause: unknown Hormone: abnormal ⬆️HCG level Confirmatory Test: Utz ---\> snowstorm pattern/grape-like vesicles - dark brown chocolate vaginal discharge (sign of bleeding) ---\> tachycardia (first sign of bleeding) - Transvaginal: empty bladder - Transabdominal: full bladder R/f: - M -- marrying type O husband - O -- origins: Taiwanese, Filipinos - L -- low folic, iron, carotene, protein - E -- age: \>35 y/o S/sx: - Outstanding/Pathognomonic sign: rapid ⬆️fundic height - H -- HCG abnormally high - H -- has (+) PT - H -- has (-) FHR/FHT, fetus - H -- hyperemesis gravidarum ---\> ⬇️Na, ⬇️K ---\> Metabolic Alkalosis - H -- hanep sa pattern: snowstorm pattern in Utz - H -- hanep sa discharge: dark brown chocolate vaginal discharge Mgt: - Suction curettage - DOC: Methotrexate (chemo drug) - s/e: ⬇️folic acid ---\> NTD - HCG monitoring: H.mole can reoccur - As early as 6 months to 1 yr - **NOTE:** no pregnancy for 1 year ---\> safe sex only (use condoms w/ spermicidal) **PIH (PREGNANCY-INDUCED HYPERTENSION)/TOXEMIA OF PREGNANCY** - Latest: Preeclampsia - Can lead to encephalopathy ---\> seizure ---\> coma - **Gestational HPN:** ⬆️BP only; ❌proteinuria, edema - Rest: left side lying - Diet: ⬇️salt, fat Cause: unknown R/f: - P -- parity (multiple) - I -- age: \40 y/o - H -- Hx of HPN ---\> vasoconstriction Types: - [Mild PIH] - Most outstanding sign: rapid weight gain - Sign of rapid wt gain: tightening of ring finger **(BEQ!)** - P -- proteinuria 1+ to 2+ (1-2g CHON in urine) - I -- edema: mild/localized/angioedema - H -- hypertension 140/90 mmHg - Diet: - low fat, salt - Adequate protein - Rest: Left side lying - [Severe PIH] - Aura: epigastric pain (1^st^ sign) - HELLP Syndrome - Hemolysis: RBC breakdown/destruction - Elevated Liver enzymes (⬆️AST, ALT) ---\> liver damage - Low Platelet count: sign of bleeding - Monitor for bleeding - Headache: ⬇️BS to brain - Visual disturbances: blurred vision - P -- proteinuria 3+ to 4+ (3-4g CHON) - I -- edema - H -- HPN: 160/100 mmHg - Rest: Left SL - Diet: - Low salt, fat - Adequate CHON - Drugs: - Anti HPN: Apresoline ---\> CCB - [Eclampsia] - Combination of mild + severe + seizure + coma Mgt: - Rest: Left SL - Diet: - low salt, fat - Adequate CHON - Drugs: - Anti HPN: Apresoline - Anti seizure: Valium (Diazepam) (ans if ❌MgSO4 sa choices) - DOC: Magnesium SO4 IV ---\> CNS downer + Anti-seizure - Toxicity: BURP - B -- BP⬇️ - U -- UOP \< 30 cc/hr - R -- RR \< 12 cpm - P -- patellar/DTR weak/absent - Antidote: Calcium Gluconate IV **PRETERM L&D** - \< 37 weeks - (+) contraction - (+) dilation Focus: STOP Cause: unknown RF: - D -- DHN - U -- UTI: Pyelonephritis ---\> inflammed renal pelvis - C -- chorioamnionitis (infexn) (Ruptured bag of water \> 24 hrs) -- -- Effects: - P -- preterm baby - A -- amnionitis - S -- sepsis - E -- endometritis S/sx: - Maternal: - Most outstanding sign: sudden gush/leakage of bloody amniotic fluid - Preterm baby: - P -- hyPothermia - P -- hyPoglycemia - R -- RDS ---\> (-) lung surfactant - E -- anemia of prematurity - T -- inTraventricular hemorrhages (w/in the ventricles) - E -- apnea of prematurity - R -- retinopathy of prematurity (retrolental fibroplasia) - r/f: ⬆️O2 lvl - Complication: blindness - M -- mmhmmh Cryptorchidism (undescended testes) - Waiting period: 6 months - Surgery: Orchiopexy (1yr of age) Mgt: - Rest period: LSL - Mgt DHN: ⬆️OFI, ⬆️IVF - Monitor for signs of infection - DOC: - [T]ocolytics: to stop contractions - s/e: [T]achycardia ---\> check HR - Ri[t]odrine (Yutopar) - [T]erbutaline (Bricanyl) - If cannot stop contraction: Corticosteroid (Betamethasone) - Effect to baby: ⬆️lung surfactant (produced @ 28^th^ week) ---\> ⬆️lung compliance - Effect to mother: ⬇️immune system ---\> immunosuppressant - Monitor for signs of infection: - Check Temp - CBC: ⬆️WBC (Leukocytosis) **GESTATIONAL DIABETES MELLITUS (GDM)** \(N) BS: 70-110 mg/dL If untreated: leads to T2DM Cause: unknown Hormone: ⬆️HPL ---\> increases during 2^nd^-3^rd^ tri R/f: - O -- obesity - H -- Hx of large baby (macrosomia) - A -- age: \> 25 y/o Effects: - T1DM: birth defects ---\> cystic fibrosis - T2DM: macrosomia, hypoglycemic baby - GDM: macrosomia, hypoglycemic baby (hyperinsulinemia) Mgt: - D -- diet: 6x/day - E -- exercise: walking, swimming - I -- insulin (IV/SUBQ) - 1^st^ tri: ⬇️dose - 2^nd^ tri: ⬆️ - 3^rd^ tri: ⬆️ - M -- mgt: no to OHA (teratogenic) **PLACENTA PREVIA** - Low-lying placenta Types: 1. Totalis - Totally covered cervix - CS 2. Partialis - 50% covered cervix - CS 3. Low-lying/Marginal - 25% covered cervix - W/ bleeding: CS - W/o bleeding: NSD Mgt: - P -- - parity (multiple) - painless, bright red bleeding - shock: mother - SGA: baby - R -- replaced blood loss: - O2 therapy - BT - E -- encourage rest: LSL - V -- VS monitoring: BP, HR ---\> shock "hypo-tachy-tachy" - I -- inspect FHR/FHT - A -- avoid IE, enema, sex - If ❌bleeding: allowed IE - S -- secure consent ---\> double set-up (NSD ---\> emergency CS) **ABRUPTIO PLACENTA** - Painful separation of the placenta S/sx: - Painful, dark red bleeding - No bleeding: concealed (Couvelaire Uterus: noncontracting uterus) - Uterine regidity: board-like abdomen Mgt: - A -- R/f: - Addiction: smoking, alcohol, cocaine ---\> vasoconstrictor - A parity (multiple) - B -- Begin CS - R -- replace blood loss: - O2 - BT - U -- - Use modified recumbent position - Uterine rigidity - P -- painful, dark red bleeding - T -- 3^rd^ tri \>20 wks - I -- inspect FHR/FHT - O -- observe complication: - DIC (Disseminated Intravascular Coagulation) **PEDIATRIC NURSING** Focus: family-centered **Basic Division of Life** ---------------------------- ----------------------------- Newborn 1^st^ 28 days/1^st^ 4 weeks Infant 1 month-1yr Toddler 1-3 y/o Preschooler 3-5 y/o (300-400 why?/day) School-age 6-12 y/o Adolescent 13-21 y/o Basic foundation of all Psychosocial task: trust ---\> consistency **INFANCY (1 mo-1 yr)** Important concept: trust ---\> consistency Play: Solitary - Solo - Safe toys - Colorful Fear: Stranger anxiety ---\> peaks @ 8 months Accidents: - F -- falls ---\> lower the bed - A -- aspiration - S -- suffocation ---\> POC: semi upright (bottle feeding position) - ❌prone ---\> if spina bifida ✔️ SAFETY - S -- solitary play, stranger anxiety - A -- alert for SIDS (Cot Death/Crib Death) ---\> common in premature boys - ❌prone position - F -- feed baby immediately ---\> learned response - Signs of hunger: - Playing of tongue - Crying (last sign) +-----------------------+-----------------------+-----------------------+ | 6 months | Cereal | ⬆️thiamine (vit B1) | | | (iron-fortified) + | | | | breast milk | | +=======================+=======================+=======================+ | 7 months | Vegetables (sweet; | ⬆️Vit A | | | yellow/orange) | | +-----------------------+-----------------------+-----------------------+ | 8 months | Fruits (sweet) | ⬆️Vit C | +-----------------------+-----------------------+-----------------------+ | 9 months | White Meat (chicken, | ⬆️CHON | | | fish) | | +-----------------------+-----------------------+-----------------------+ | 10 months | Egg yolk | | +-----------------------+-----------------------+-----------------------+ | 12 months | Adult food | | | | preparation; egg | | | | whites | | | | | | | | ✔️Healthy, nutritious | | +-----------------------+-----------------------+-----------------------+ - E -- - encourage rest & sleep - Encourage play: universal language of children - T -- the \#1 approach: touch/hold ---\> trust - Y -- you encourage breast feeding Fine Motor Development 0 month Strong grasping reflex ----------- ----------------------------------------- 3 months Grasping reflex fades away 6 months Palmar grasp w/ control 7 months Transfers object from 1 hand to another 9 months Pincer grasp (finger-thumb opposition) 10 months Clapping of hands 12 months Throwing of objects Gross Motor Development 1 month Headlag; (-) head control ----------- ----------------------------------------- 2 months Social smile 3 months Slight headlag, slight head control 4 months Head control ---\> (-) headlag 5 months Rolling over ---\> ⬆️falls 6 months Sits with support ---\> high chair 7 months Sits leaning forward w/ minimal support 8 months Sits w/o support 9 months Crawling/creeping 10 months Standing w/ support 11 months Cruising 12 months Standing w/o support; walks w/ support 15 months Walks w/o support 18 months Run & jump in place 24 months Opening doors by turning doorknobs 30 months Jumps from a chair **TODDLER (1-3 y/o)** Important concept: autonomy (independence) Play: Parallel play - Side by side - Same toy - No communication Fear: Separation anxiety ---\> peak @ 18 months - Stages: - Protest: inconsolable cry - Despair: withdrawn, lack of appetite - Denial/Detachment: ignores primary caregiver Accidents: - P -- poisoning - B -- burns (scalded) ---\> hot water burn - D -- drowning (washing machine) TIRNS - T -- temper tantrums - normal & expected ---\> d/t lack of vocabulary/expressive skills - Abnormal: ---\> seek medical advice - 5 y/o & above - 5x/day or more - Mgt: - T -- time out: 1 min/yr of age - Face the wall - Chair - I -- independence (autonomy) - R -- routines/rituals/favorites - Give what they want & need; if not ---\> temper tantrums - N -- negativism "NO, Me do" \ how to do things Play: Associative play - w/o real organization ---\> ❌rules - W/o leader/follower Fear: Castration/Body mutilation/Bodily harm Accidents: MVA MAGIC - M -- magical thinking (imaginative) - Make believe play: dolls - Mutilation/castration ---\> offer colorful bandages - A -- associative play - G -- guilt: start of morality principle (superego) - I -- imaginative; imaginary playmate ---\> acknowledge but do not explore - C -- curious (300-400 why questions/day) **SCHOOL-AGE (6-12 y/o)** S = same sex normal ---\> Boys w/ boys; girls w/ girls Important concept: industry Play: competitive (indoor) Fear: School phobia Accidents: MVA DIMPLES - D -- death: form of punishment; boogeyman - I -- industrious: how to do things well - M -- modest - P -- peer relationship starts here; "chum period" - L -- loss of control: during hospitalization - E -- explanation of procedure: use simple terms - S -- school phobia - B -- bullying - U -- unfamiliar structures - O -- overly demanding teachers **ADOLESCENT (13-21 y/o)** A = attachment to opposite sex Important concept: identity Play: competitive (outdoor) Fear: Separation from peers Accidents: - Suicide - Homicide CHARICES - C -- competitive play - H -- hates to be alone (peer) - A -- attachment to opposite sex - R -- role confusion/role diffusion ---\> overcome - I -- identity (who am i?) ---\> achieve - C -- concerns about their peers - E -- altered body image (pimples, burn on face) ---\> ⬇️self-esteem ---\> suicide - S -- separation from peers; suicide - Attempt: females - Successful suicide: males