Exam 1 Study Guide.pdf

Exam 1 Study Guide  PEDS Most multiple choice, each 2 points & select all that apply, 3 points (50-60 questions) 1 or 2 matching or ordering When fine motor skills occur or merge—> Piagets sensimotor stage birth-2months How old might they be if the...

Exam 1 Study Guide  PEDS Most multiple choice, each 2 points & select all that apply, 3 points (50-60 questions) 1 or 2 matching or ordering When fine motor skills occur or merge—> Piagets sensimotor stage birth-2months How old might they be if they can speak in full sentences—> Mostly @2 yrs, but range of 2-3 yrs Reflexes are present What type of foods baby’s first try & when solid foods are introduced—> Solid foods introduce @6months, 1st try breast milk or formula NO immunizations  Vitals Try to get VS when child is sleeping/resting Start w least invasive 1st—RR & then most invasive—BP/Temp Heart Rate: Sources Apical= Best for infants < 23 mo o May also use femoral & brachial arteries Radial Pulse= only in children >24 mo Rhythms Irregularities can be present o Count for 1 full minute— (Heart rate in children are often irregular, count the full minute!!!) Sinus arrhythmia o Variation in HR with breathing (HR going up & down) o Totally normal! Respiratory Rate: The younger the child, the more abdominal breathing you'll see Diaphragmatic respirations Rate is often irregular in infants & young children Need to count for 1 full minute In hospital, we'll often obtain SpO2 as well Be wary of pulse ox sensor burns! (can burn infants feet--assess skin and make sure intact--note when the last time it has been changed) Change probe site q 4-8 hours Most accurate way to measure respiratory rates in a newborn? Hand on stomach to feel diaphragmatic respirations Blood Pressure: Most important factor in obtaining an accurate BP reading in pediatrics is proper cuff size Too small of cuff —falsely high BP Too large of cuff—falsely low BP BP Sources In infants & small children— calves & arms Once preschooler sized, usually best to get BP on arms Temperature should be close to 36.8C/98.6F Too high or too low can cause issues in pediatric patients Children < 4 yo= axillary (#1), tympanic, temporal, rectal Older children= use any of previous sources as well as oral if they are developmentally able Rectal rearely done—Should NEVER be done on heme/onc patients! (Can break skin and then it will be a source of infection!!!) (most accurate source for temp) Lubricate probe & insert a max of 1 inch (kids) or 0.6 inches (infants) Stress, pain fear-- Can cause HR & RR to Increase Important to notice early changes in VS bc--> Children compensate well, but fall fast & hard  Weight Expectations Newborns may lose up to 10% of their birth weight initially Height Expectations Birth weight should 4 y.o.= birth length should double o Double by 6 mo Gain ab 2 inches per year after o Triple by 1 yo o Quadruple by 2.5 yo By age 13 yo= birth length should triple Annual weight gain after this is ab 5lbs per yr Pubertal weight gain averages: Females: 18 kg or 40 lbs & Males: 24 kg or 52 lbs Infants= measure laying down, completely nude Height is obtained when standing up Children & teens= Standing scale (if able), light clothing, no shoes o >36 months old & when able Length Expectations 0 – 6 mo= gains 1 inch/month 6 – 12 mo= gain 0.5 inch/month By end of 1st yr of life, birth length expected to increase by 50% Length is obtained when laying down o 0-36 months old Head Circumfrance: Should be measured at every visit up to 24mo Directly related to brain growth & development of intracranial volume Slightly above the brow line & should loop back around the occipital prominence 1st sign of increased intracranial pressure in an infant? Head circumfrance will increase Growth is cephalocaudal (Head to toe) Development occurs via proximo-distal direction (midline of the body, out) A child cannot learn tasks until the nervous system is ready Neonatal reflexes must be lost before development can progress  Infant Reflexes: Stepping Reflex Sucking Reflex When held upright w 1 foot touching flat surface, appear to Reflexive sucking when nipple/ finger is placed in infant's "walk" mouth Disappears at 2 mo Disappears at 2-5 mo Develops @36 weeks in utero, why premies have hard time feeding Rooting Reflex Palmar Grasp Newborn will turn head towards the side when you touch Elicited when place finger in infant's palm, firm hold their cheek & will open lips to suck Disappears at 4-6 mo Disappears at 3 mo Babinski Reflex Tonic Neck "Fencer Position" Along the lateral aspect of the sole and across the plantar When newborn is supine & head turned to 1 side, those surface results in fanning & hyperextension of toes extremities will straighten & the opposite side flexes Disappears at 12 mo Disappears at 4 mo Moro Reflex "Startle Reflex" When startled by loud noise or "dropped", the infant's arms move out & up, fingers spread -- Infant reflexes play a key role in saftey The slowly brings arms toward middle Disappears at 4 mo At what ages do I use this pain scale? Face Legs Activity consolabi a 1. NIPS Pain Scale ↳ 1yr 2. FLACC Pain Scale 2m-Ty Used for neonates & infants under 1 year of age 2 months- 7 years old Look at 6 areas & score from 0-2 based on behavior Assess behaviors of the child Scale runs from 0 - 10 3. Numeric Pain Scale & Non-Communicating Children's Pain 4. Wong-Baker FACES Pain Scale 3 Checklist Used for kids age 3 & older Should all be familiar with the numeric pain scale Have kids rate their pain based on the pictures of faces Explain each face to the child & then have them tell you Non-Communicating Children's Pain Checklist which face they are For children who are unable to communicate for any reason Behaviors are observed for 10 minutes Six subcategories are each scored on a scale of 0 – 3 o 0 = Not at all, 1 = Just a little, 2 = Fairly often, 3 = Very often Subcategories (Base which scale you use on both age & developmental level) o Vocal, facial, body & limbs, social, activity, physiological Cutoff Scores Use both ur personal assessment & parent's assessment! o 11 or higher indicates moderate to severe pain Verbal & non-verbal cues o 6 – 10 indicates mild pain Denver Developmental Screening Tool (DDST) Types of Play Onlooker Zyr- Standard measure of attainment of developmental milestones from birth to 6 years Solitary Infant - Parallel Toddler Only measures milestones, not intelligence/IQ - Associative Preschool - Types of play Team Play School-age - Infants= mobiles, music, noise-making objects, soft toys, teething toys, social interaction Solitary Play (Planing alone Pain Managment Tips Toddlers= cloth books, large crayons & paper, push & pull toys, child- EMLA (lidocaine) cream before any needle sticks in kids appropriate shows & videos Parallel Play (Next to but not interacting) Sweet-Eze pacifier dips for infants before needle sticks , Preschoolers= Imitative & imaginative play, drawing/painting, Distraction, Medical Play running & jumping, child-appropriate shows & videos Associative (Interacting but Take pt to treatment room working not School-Age= Games that can be played alone or together with others, team sports, musical instruments, arts & crafts, collections cooperative (working together) Med Calculation 1kg= 2.2lbs 1 Fluid question 1 med dose (Med comes in ___ how many ML?) # X = Long 1lb= 16oz Fluid requirements are based on weight or body surface area 1kg= 2.2lb ▪ Weight is most common & easiest to quickly calculate (BSA is most accurate) 1kg= 1000g 1g= 1000mg Calculation method: DAILY FLUID REQUIREMENTS 1mg= 1000mcg 100ml/kg for the 1st 10kg of body weight 1L= 1000mL 50ml/kg for the 2nd 10kg or body weight 20ml/kg for the remaining body weight This will give you the 24hr fluid requirement Divide by 24 to get their hourly fluid rate Ex. Calculate maintenance fluids for a child who weighs 88lbs Ex. Calculate maintenance fluids for a child who weighs 98lbs 8 5 kg. 100m2X8 850mulday HR = 850/24ur = 35 4 muhr. 5kg =. 14 kg - 100mc X 10 = 1000 m t HR = 1200m2/24hr 50m/hr = 50 mL X 4 = 200 m 14ng 1200m - 32n9 100mcX 10 = 1000m + 30miX 10 = JoOm /[Yur Smulhu + HR = 1750mz = 72. 10miX=om Med dose: Weight: 26lbs (11.8kg) Orders Acetaminophen (Tylenol) 12mg/kg Ibuprofen (Motrin) 110mg 1. What dose of Tylenol would you give? 2. How many mL would you give her if the suspension was labeled (160mg/5mL) 3. How many mL would you give her of (100mg/5mL) suspension?. 2 MX5m. A XSm = 4 tlmg Weight: 14 lbs (6.6 kg) Maggie recently got an ear infection. Her doctor prescribed BID amoxicillin for the next 10 days. Orders Amoxicillin 50 mg/kg/dose What dose would you give Maggie? How many mL is her dose? How many mL per day does she need to drink to stay hydrated? Her mom is worried since she isn’t eating well. Weight: 40 lbs, 101 cm Cooper loves to fish and be outside! Unfortunately, he is in the hospital today for some treatment and you are his nurse. Calculate Cooper’s BSA His methotrexate is ordered for , 15mg/m²once per week. What is his dose? While in the hospital, what rate should his maintenance IVF be running?  Family Centered Care, Hospitalization, Child Abuse/Neglect Don’t use family as an interpreter, use a medical interpreter! Preparing for Surgical Procedures Preoperative Care Psychological and physical preparation just like before any other procedure Food & fluid restrictions Encourage caregiver presence Separation anxiety is huge in children Parents may not want to be involved; others may want to be overly involved! Preoperative sedation Used frequently in young children Reduces anxiety Promotes amnesia Sedation Saftey: 1. Identification bands 2. Environmental Factors Windows/blinds Electrical equipment Collecting & disposing of small objects (green caps, saline caps, etc) Furniture Crib rails! (NEVER walk away unless crib rail is UP!!) 3. Activity Supervision Toys Incubator/Isolette –Neonates- Newborns Preventing falls Infant crib –Newborn- 2 mo Safe Sleep Junior crib – 2 mo- 6 mo (if they can sit up unassisted, CANT use this crib) Cage crib – 6 mo- toddlers Posey net bed – >3 yrs **This is a restraint!** (Need order w/ XX amount of hrs) Transporting: Within same unit, pts can walk or be carried if able Transporting off the unit--> Transport depends on age, condition of pt & destination Wheelchair, stretcher, crib, wagon, bed, isolette Critically ill child ▪ At least 2 staff mem ▪ Continuous monitoring ▪ Always have airway/emergency supplies on hand!!!! Restraints: Therapeutic holds vs restraints--> Therapuetic hold= 5 yrs is considered a restraint Nursing staff CANT maintain any type of restraint for a significant amount of time without an order & proper assessment by a qualified provider Mummy wrap or swaddle restraint ▪ May see Papoose board for certain procedures Elbow immobilizers/welcome sleeves Mittens Med Administration: Oral meds with syringes – Infant considerations--> Tongue thrust, spit med out--very important bc infants get low doses & loosing any meds can be critical (Admin on side of cheeck) IM--> Protect joints  Infants Trust vs Mistrust Toddler Autonomy vs Doubt Developmental tasks: Learning to walk, use fine muscle, toilet, communicate Preschool Initiative vs Guilt Dev’t Tasks: Independence of self care, Learning sexual role identity, Forming reality concepts, Internalizing right and wrong, ID with family members and others School-age Industry vs Inferiority Development: Acquiring game skills, Relate positively to peers, Build wholesome self-concept, Refine communication skills Adolecents Identity vs Confusion Development: Forming peer relationships, Responding to an appropriate sexual role, Attaining emotional independence, Sense of economic independence Breast milk or formula only for first 4-6 mos. Solid foods (cereal, fruit, vegetables) by 6 mos. (earliest 5mo and at least 13kg; juice starts at 6mos) HEEADSSS Assessment (Youth = 14-18 yr olds) (Adolecents) Assessment tool to review sensitive topics w/ teens Should be asked at ALL well child visits & hospital admissions Always talk to the teen w/o parent/guardian in the room --> Home, education, activities, drugs, sex, suicide Confidentiality = Any info shared in confidence within the healthcare setting Abuse/Neglect: Munchausen Syndrome by Proxy Caregiver exaggerates or fabricates S/S of illness in a child (the proxy) to gain attention or gratification Child may undergo needless & painful procedures/ treatments Maltreatment may be physical, emotional & psychological Cultural Awarness: Certain cultural practices or appearances can be mistaken for child maltreatment Coining – Vietnam, Cambodia, Loas Cupping – Middle East, Asia, Latin America, Eastern Europe Moxibustion – Traditional medicine practice in East Asian cultures - Often confused for cigarette burns Mongolian Spots – a completely normal birth mark that often appears on infants of African & Asian decent - May look like a large bruise over the lower back & buttocks  Cardiovascular Dysfunction in the Pediatric Patient Increased Pulmonary Blood Flow 1. Atrial Septal Defect Hole between 2 atria Loud, harsh *murmur* w/ split S2 Can be asymptomatic Closes naturally or w/ therapeutic catheterization 2. Ventricular Septal Defect (Most common defect) Hole between two ventricles *murmur* Upper Body Close naturally or w/ surgery Deox OX 3. Patent Ductus Arteriosus (Body) ↓ Does not close within 1st weeks of life (Not closing like it should) lungs Blood flows from aorta → pulmonary artery (2 main BV leaving the heart) -(Therefore letting oxygen rich blood mix w/ oxygen poor) Med tx: Indomethicin -body Characteristics of IPBF Abnormal connection between the 2 sides of the heart ↓ Left lower body = Higher Either between septum or great vessels Pressure Increased blood volume on the right side of the heart Increased pulmonary blood flow & Decreased systemic blood flow Decreased pulmonary blood flow “Right to left shunt” 1. Tetralogy of Fallot Cause oxygen-poor blood to flow out of the heart & into the rest of the body 4 anomalies: (PROV). 3 1. VSD 2. Pulmonary stenosis 3. Overriding aorta 4. RV hypertrophy → Mixed blood flow “Tet Spells” Episodes of acute hypoxia or cyanosis Cyanotic – blue lips, nails, skin - > due to reduced Oxygen-rich blood SOB, incr. RR, Fainting Cyanotic Defects Children – instinctive squat 4 T’s Infants – usually occurs during crying or after feeding 1.Tricuspid Atresia Children – w/ activity 2.Tetralogy of Fallot 2. Tricuspid Aresia (Tricuspid valve doesn’t form) Incompatible w/ life unless: 3.Transposition of the Great Vessels Patent foramen ovale PDA, ASD, VSD may be present - > To allow blood flow to lungs bie ! 4.Truncus Arteriosus & code Cyanosis in newborn period, Tachycardia, Dyspnea Older children will have clubbing sign of chronic Of levels * * A Treatment: Prostaglandin needed to keep the PDA open until surgical correction Conditions that cause cyanosis can lead to Higher risk of endocarditis & arrhythmias Dizziness, fainting, seizures d/t low O2 levels Delayed G & D Obstructive Blood Flow Defects Pressure before defect is increased, results in decr. cardiac output 1. Coarctation of the Aorta Pressure differences in extremities Constrictive band around aorta Upper: Elevated BP & Bounding pulses Dizziness, HA, fainting, epistaxis Lower: Lower BP, Weak/absent femoral pulses & Cool skin 2. Aortic Stenosis Narrowing of aortic valve Infant Sx: Faint pulses, Hypot/Tachy, Exercise Intolerance Child Sx: Dizziness, chest pain, possible murmur, Exercise intolerance 3. Pulmonic Stenosis Narrowing of pulm valve or artery May be asymptomatic * Varied cyanosis Cardiomegaly & HF R.Ventriesaa Mixed Blood Flow Defects 1. Transposition of the Great Arteries Cyanotic, mixed blood flow > -swapped Incompatible w/ life EMERGENCY septostomy performed to create a connection between the right & left sides 2. Hypoplastic Left Heart Syndrome Cyanotic, mixed blood flow LV nonfunctional, UNDERdeveloped Severe cyanosis & decreased cardiac output Requires several complex surgeries or transplant to survive Pharmacologic Management Cardiac Catheterization Prostaglandin (Tet of Fallot, Hypoplastic Left Heart Syn, TGA) Used to evaluate, diagnose & repair defects Keeps Patent Ductus Arteriosis (PDA) open Catheter peripherally inserted & threaded into Indomethacin heart using fluoroscopy Closes PDA Contrast injected (Iodine-based) —How to keep structures open that typically close after birth Diuretics & RiSk HYPOKt = & Furosemide or cholorothiazide PRE-procedural care N/V, Dizziness— Eat K+ high foods, Daily I&O, Daily weights Prepare child & family Digoxin Developmentally approp. materials to explain procedure Improves contractility Assess & mark pulses Admin Q12 hr (On the dot!) Antidote → immune fag Baseline VS & O2 sats Check HR before admin NPO 4-6 hrs prior on Weight NOT cause: gram negative bacillus Gardnerella thin white or gray discharge w/ fishy odor, increases after sex. PH >4.5. + clue cells. + “whiff test” Treatment: Metronidazole (Flagyl) BV during pregnancy= PPROM, Preterm labor, PID, PP endometritis, Chorioamnionitis (inflamm of placenta) Untreated BV= increase PID Infections characteried by Cervititis Cervicitis: inflammation or infection of cervix Caused by: Chlamydia & Gonorrhea Both reportable Chlamydia Curable STI—Reportable to state Bacterial infection—Cause: Chlamydia trachomatis Vaginal Discharge, Dysuria, urinary frequency Spotting &/or postcoital bleeding Treatment: Azithromycin or Doxycycline--Both partners Pregnant individuals: ALL are screened at initial visit, if + rescreened in 3-4 weeks after completing therapy, & in 3rd trimester Difficult to diagnose if asymptomatic--> leads to PID, then infertility. Potential infection during birth, Neonatal conjunctivitis, Pneumonia, Preterm birth, Stillbirth, Low birth weight Gonorrhea Curable STI—Reportable to state lab Bacterial infection—Cause: Neisseria gonorrhoeae Dysuria, Dysmenorrhea, Vaginal bleeding btwn periods, PID, Bartholin's abscess Yellowish –green discharge Treatment: Azithromycin 1g PO & Ceftriaxone (Rocephin) IM Pregnant individual screened at initial visit Highly contagious! Spread genital/anal/oral- to – genital as well as to newborn @ birth Potential infection during birth, Rhinitis, Vaginitis, Chorioammionitis, Preterm birth, Intrauterine growth restriction Infections characterized by Genital Ulcers Herpes Simplex (HSV) Two types---Outbreaks can occur of both types in either location HSV-1: Oral herpes, known as “cold sores” or “fever blisters” HSV-2: Genital herpes Syphilis Genital herpes simplex virus (HSV-2) Fluid filled blisters=diagnosis NO CURE. Lifelong recurrent viral infection. 1st outbreak is always most severe Dry blisters=no accurate diagnosis Transmitted by contact- unaware of infection Incubation period: 3-7 days, may last 1-3 wks. Blister-like lesions on vulva, vagina & perineal areas Dysuria, fever, HA, muscle aches Virologic & serologic tests Treatment: Acyclovir---suppress symptoms Congenital infection, Blindness, Seizure, Premature birth, Low birth weight Syphilis Reportable disease to state lab Curable--Cause: Treponema pallidum (spirochete bacteria) Blood tests: + Venereal Disease Research Laboratory (VDRL) & Rapid Plasma Reagin (RPR) Primary: chancre on area bacteria entered body Secondary: rash, sore throat, swollen lymph nodes, flu-like symptoms Latent: No symptoms, No longer contagious Tertiary: damage to internal organs. Treatment: Penicillin G IM injection--Sexual partners Congenital infection, Preterm labor, Miscarrage, Preterm birth/Stillbirth Genital Warts (HPV) NO CURE--warts can be removed. Extensive vulvar condyloma acuminate--> Cause: Human Papillomavirus (HPV) Prevention: HPV vaccine wart-like lesions, clusters, raised/ flat on vulva, cervix, vagina & anus Treatment: Aimed at removing lesions by freezing, burning, laser or excision--Trichloroacetic acid (TCA) or bichloracetic acid (BCA) Pap smear and visual inspection Pregnancy: May develop warts in throat  Hepatitis B vaccine is given to all infants after birth Hepatitis A -- Spread via GI tract; polluted water, uncooked shellfish from contaminated waters, food handlers that are carriers of hepatitis with poor hand washing, or/and oral/anal sex. Feces of an infected person. Hepatitis B Most threatening to fetus & neonate --Transmitted through saliva, blood serum, semen, menstrual blood & vaginal secretions Disease of liver; often a silent infection Prevention Vaccination Screen all pregnant women routinely for hepatitis B surface antigen (HBsAg) during early prenatal visit Treatment Supportive with HBsAg + mom - infant treated with HBIG & begin vaccinations Hepatitis C Most common blood-borne infection in U.S.—injecting IV drugs All pregnant women at high risk should be tested for Hep C antibodies @1st PNV Interferon alfa-2b Preterm labor, Preterm birth, Placenta abruption, Gestational hypertension, Fetal growth restriction Zika Virus Transmission via bite of infected Aedes mosquito Pregnant women can pass virus to fetus--> Microcephaly, a serious birth defect of brain Also transmission has been reported through blood transfusions, sexual contact Fever, rash, headaches, bone pain, joint tenderness & conjunctivitis CDC recommendations Abstaining w/ anyone who has traveled to areas with documented active infections (6 months) Prevention measures: avoid travel to areas of virus Blood test available, but no vaccine to prevent zika Group B Streptococcus Normal Flora, colonized to fetus during vaginal birth Life threatening to newborns—> sepsis, meningitis, pneumonia Mother: chorioamnionitis, endometritis, PP wound infection S/D Rectovaginal culture at 35-37 weeks Penicillin G IV, initial bolus, then Q4 hrs; at least 4 hrs before birth Torch Infections Joint pain, flu-like symptoms, rash, lymph node enlargement Toxoplasmosis (Other)Hepatitis A/B, syphilis, mumps, parvovirus B19 and varicella-zoster Rubella (German measles) Cytomegalovirus Herpes simplex virus (HSV) HIV/AIDS Retrovirus attacks & destroys T – lymphocytes. HIGH RISK pregnancy High viral load & low CD4 cell counts= greater chance to pass HIV to baby Transmitted intimate sexual contact, sharing needles, mother to fetus during pregnancy through placenta & breast milk Avoid amniocentesis, forceps/vacuum extraction, internal fetal monitoring &/or episiotomy due to risk of maternal blood exposure Planned cesarean section at 38 weeks. No breastfeeding; risk of transmission of HIV. Newborn is treated w/ antiretroviral syrup w/in 12 hrs after birth to reduce transmission Risk factors IV drug use, multiple partners, h/o multiple STI, men having sex with men Blood transfusions – rare occurrence Medications: Retrovir, antiretroviral agent-->Begin at 14 weeks of gestation & in labor; infant given this at birth & for 6weeks. Human Immunodeficiency Virus (HIV) Transmission Heterosexual transmission most common in women Risk factors AIDS= severe depression of cellular immune system associated w/ HIV infection Fever, HA, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat & rash Screening & diagnosis Serious health disorder can be diagnosed before symptoms Universal, routine testing of all pregnant women ASAP Re-test in 3rd trimester for high-risk pregnancy Counseling for HIV testing Serious complications to women & during pregnancy, to fetus & newborn Every pregnant individual should be checked for STIs during 1st prenatal visit W/o treatment, STIs can lead to serious health problems for mother & fetus/newborn Key points: Safer sex practices are key to STI prevention STIs cause substantial mortality & morbidity, suffering & economic burden Reportable STIs vary by state: Syphilis, gonorrhea, chlamydia, chanroid, PID, HIV & AIDS are reportable in every state. Pregnancy confers no immunity from infection Use universal precautions consistently Prevention: Vaccinations Safe sex practices--> Condom use Limit # of sexual partners Avoid sharing needles Regular STI testing  Care in the Antepartum Period HCG: (Pregnancy test) Ectopic pregnancy or miscarriage: low # (Blood test to see) Molar pregnancy or multiple-gestational pregnancy or genetic abnormality: high # ***HCG: Doubles every 2-3 days exp. Early on in pregnancy Naegeles Rule:*** Physical Signs of Pregnancy Determining Estimated Date of Delivery Presumptive- findings reported by mother that suggest the presence of pregnancy Date of LMP Subtract 3 months Probable- findings noted by the healthcare provider that suggest a pregnancy is present Add 7 days Add a year Positive- finding that confirms pregnancy *** Pregnancy test urine does not mean you are 100% positive—-Pregnancy test by itself doesn’t confirm you are pregnant (some tumors & medications can produce HCG) Presumptive Signs (subjective) Probable (objective) signs Amenorrhea Positive pregnancy test (HcG)*** Breast tenderness/enlarged Abdominal enlargement Montgomery glands and darkened areolae Ballottement Fatigue Braxton Hicks contractions Nausea and vomiting Cervical changes on exam: (Bluish in color, soft, lower Quickening (~16-20wks) — **Mom can feel bby part of uterus can be softer)*** moving (normal) Goodell’s sign (Softening of cervix) Skin changes Chadwick’s sign (Vasuclarization/cervix blue/purple) Urinary frequency Hegar’s sign (Softening of lower cervix) Positive signs (Only things that can actully confirm pregnancy) Ultrasound visualization of embryo or fetus Fetal movement felt by examiner (Leopolds) Auscultation of fetal heart tones via Doppler 1st Trimester (1-13 weeks) (Most important/critical G&D of baby) Fetal G&D, maternal changes, lifestyle, adjustment, testing, potential complications, dietary F/U Pee alot Intravaginal ultrasound 1st! Check viability of baby Important to know: Current medications prescribed, OTC, Substance use & Mental Health Cell-free fetal DNA--> Blood test on mom Nuchal Translucency testing--> Ultrasound on neck, indicator of down syndrome Chorionic Villus Sampling (CVS)--> Invasive, go into placenta & get samples Labs 1st Prenatal Visit: 1. CBC , Blood type & Rh factor, UA 2. TORCH Toxoplasmosis (Cats litterbox, from cats eating rodants--Can be fatal to fetus, while mom barely sick) Other infections Rubella Cytomegalovirus Herpes 3. STI's 2nd Trimester (14-26 weeks) Fetal G&D, maternal changes, fetal movement, potential complications, feeding, & birth plan, CBE prep, dietary F/U 20 Week Anatmy Scan Quad Screen--> Blood tests Alpha-Fetoprotein (AFP)--> Check for neural tube defects (esp. if mom is not taking prenatal vitamins such as folic acid which decreases neural tube defects). Amniocentesis--> Invasive, aspirate amniotic fluid Prenatal Visit: 20 Week Anatomy Scan Gestational Diabetets Screening (24-28w) --1hr glucose tolerance test (if over 140, move on to 3hr test) if fail again=gestational diabetes 3rd trimester (27-40 weeks) fetal G&D, maternal changes, fetal movement, fetal evaluation, potential complications, prep. for feeding, birth prep. s/sx of labor, pain management, parenting & postpartum prep. Pee alot (baby pushing on bladder) NO specific tests for 3rd tri NEWBORN SCREENING—> Required by law Prenatal care: Laboratory Testing-GBS screening--> 36w rectal & vaginal swab. Bacterial, actually normal flora but can cause sepsis in baby. If +, antibiotics during labor Rhogam given at 28-30w--> (-) Blood Type Tdap given around 30w--> Anyone around newborn should be up to date too Gravida/Para (GTPAL): 2 Didget System: G (Gravidity): Total # of pregnancies a woman has had P (Parity): # of pregnancies =/or >20 weeks regardless of outcome (live or not). 5-Digit System, ”GTPAL” The FIVE-digit system uses the following abbreviations: Gravida (G): Total times pt has been pregnant. Birth w/multiples= 1 pregnancy. Term (T): Total # of previous births born at =/or > 37 weeks. Preterm (P): Total # of previous births born at between 20 & 36 + 6 completed weeks. Abortus (A): Total # spontaneous/terminated 15 bpm lasting for at least 15 seconds in a 20-min time span. Reactive FHR normal baseline with moderate variability Two FHR accelerations at least 15/min (10/min prior to 32 weeks) for at least 15 seconds (10 seconds prior to 32 weeks) w/in 20-minute time frame. Nonreactive NO accelerations w/in 20-minute time frame If this happens, further assessment is needed Biophysical profile (BPP) BPP 1) NST 2) Fetal Breathing Movements (U/S) 3) Fetal Activity(U/S) 4) Fetal Muscle Tone(U/S) 5) Amniotic Fluid Volume(U/S) 0 or 2 points for each Maximum score = 10– 8-10 normal, 4-6 abnormal,