Final Summer 2024 Student.pdf

Topic Maternal 1. Maternal Mortality/Death Key Concepts: o Leading Causes: Hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labor. o Prevention: Early detection of high-risk...

Topic Maternal 1. Maternal Mortality/Death Key Concepts: o Leading Causes: Hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labor. o Prevention: Early detection of high-risk pregnancies, access to skilled birth attendants, and timely interventions. o Interventions: Use of prenatal vitamins, adequate prenatal care, managing pre-existing conditions (e.g., hypertension, diabetes). 2. Social Determinants of Health/Barriers to Care Key Concepts: o Factors: Income, education, access to healthcare, cultural beliefs, and language barriers. o Impact on Care: Poor social determinants can lead to delayed care, inadequate treatment, and increased complications. o Overcoming Barriers: Implementing culturally competent care, expanding access to healthcare, and education programs for underserved populations. 3. Contraception: Pros/Cons of Methods/Patient Education Key Concepts: o Hormonal Methods: Birth control pills, patches, injections, and implants. Pros: Highly effective, can regulate periods. Cons: Side effects like weight gain, mood changes. o Barrier Methods: Condoms, diaphragms. Pros: No hormones, protection against STIs. Cons: Less effective than hormonal methods, must be used correctly every time. o IUDs (Intrauterine Devices): Copper and hormonal. Pros: Long-term, highly effective. Cons: Can cause cramping, irregular periods initially.  o Patient Education: Discuss proper use, potential side effects, and what to do if a dose is missed (for hormonal methods). 4. Contraception: Natural Family Planning Key Concepts: o Methods: Rhythm method, cervical mucus monitoring, basal body temperature. o Effectiveness: Varies, less effective than hormonal or barrier methods. Requires careful tracking of menstrual cycle. o Patient Education: Teach patients how to accurately track fertility signs, importance of consistency, and the limitations of this method. 5. Vasectomy Key Concepts: o Procedure: Outpatient surgical procedure for male sterilization; cuts and seals the vas deferens. o Effectiveness: Permanent, nearly 100% effective after sperm clearance. o Post-Operative Care: Rest, scrotal support, ice packs, and pain management. Importance of follow-up sperm analysis to confirm sterility. 6. STIs: Assessment (HPV) Key Concepts: o Clinical Presentation: Often asymptomatic; can cause genital warts, abnormal Pap smear results. o Screening: Pap smear for women, HPV DNA test for high-risk strains. o Prevention: HPV vaccination (Gardasil), safe sex practices. o Patient Education: Importance of regular screenings, potential for HPV to resolve on its own, and the link to cervical cancer. 7. STI Treatment & Medication (Herpes) Key Concepts: o Medications: Acyclovir, Valacyclovir, Famciclovir. o Management: Suppressive therapy to reduce frequency and severity of outbreaks, especially important in pregnancy to reduce neonatal transmission. o Patient Education: Avoiding triggers, recognizing early signs of outbreaks, and safe sex practices to prevent transmission. 8. Mastectomy Care Key Concepts: o Post-Operative Care: Monitoring for signs of infection, managing drains, pain management, and preventing lymphedema. o Complications: Lymphedema, seroma, wound infection. o Psychosocial Support: Addressing body image issues, providing resources for counseling, and support groups. o Long-Term Care: Regular follow-ups, exercises to prevent lymphedema, and screening for recurrence. 9. Fibrocystic Breast Changes Key Concepts: o Presentation: Lumpy, tender breasts, often related to menstrual cycle. o Management: Supportive bras, pain relief (NSAIDs), and reducing caffeine intake. o Patient Education: Reassure that it’s a benign condition, importance of regular breast exams, and when to report changes (e.g., new lumps, discharge). 10. GYN Cancers  Key Concepts: o Types: Cervical, ovarian, endometrial, and vulvar cancers. o Risk Factors: HPV infection (cervical cancer), family history, age, obesity (endometrial cancer). o Screening: Pap smears, HPV testing, CA-125 for ovarian cancer (not a screening test but used in diagnosis and follow-up). o Treatment: Surgery, chemotherapy, radiation, depending on the type and stage of cancer. o Patient Education: Importance of regular screenings, recognizing symptoms (e.g., abnormal bleeding, pelvic pain), and following up with healthcare providers. 11. Intimate Partner Violence (IPV) Key Concepts: o Recognition: Physical injuries, inconsistent explanations, fearfulness, and isolation. o Screening: Routine screening during prenatal visits using validated tools. o Prevention Measures: Education on healthy relationships, community resources, and safety planning. o Therapeutic Communication: Create a safe environment, use empathetic and non-judgmental language, and provide information about resources. 12. Skin Adaptations in Pregnancy Key Concepts: o Common Changes: Hyperpigmentation (e.g., melasma, linea nigra), striae gravidarum (stretch marks), and increased oiliness or acne. o Management: Use of sunscreen to prevent worsening of hyperpigmentation, moisturizing to manage stretch marks, and appropriate acne treatments safe for pregnancy. o Patient Education: Reassure that most skin changes resolve postpartum, importance of skincare during pregnancy. 13. Hormones in Pregnancy Key Concepts: o Estrogen: Increases uterine blood flow, prepares the breasts for lactation. o Progesterone: Maintains the uterine lining, prevents contractions early in pregnancy. o hCG (Human Chorionic Gonadotropin): Maintains corpus luteum early in pregnancy, used as the basis for pregnancy tests. o Relaxin: Relaxes ligaments in the pelvis, helps prepare for childbirth. o Patient Education: Explain the roles of these hormones in maintaining pregnancy and preparing for labor. 14. Nutrition/Weight Gain in Pregnancy Key Concepts: o Caloric Needs: Increase by about 300-500 calories per day in the second and third trimesters. o Weight Gain: Recommended weight gain varies by pre-pregnancy BMI (e.g., 25-35 lbs for normal BMI, 15-25 lbs for overweight). o Nutritional Needs: Increased intake of folic acid, iron, calcium, and protein. o Patient Education: Importance of a balanced diet, avoiding certain foods (e.g., raw fish, unpasteurized dairy), and the risks of excessive or insufficient weight gain. 15. Calculating TPAL Key Concepts: o TPAL: Term births, Preterm births, Abortions, and Living children. o Calculation Example: A woman who has had 2 full-term births, 1 preterm birth, 1 abortion, and has 3 living children would be G4P2113. o Patient Education: Explain the TPAL system to patients to clarify their obstetric history. 16. Nagele's Rule Key Concepts: o Calculation: Subtract 3 months from the first day of the last menstrual period (LMP), then add 7 days and one year to determine the estimated due date (EDD). o Example: LMP of July 10th, 2023 → EDD of April 17th, 2024. o Patient Education: Help patients understand how due dates are calculated and the variability of actual delivery dates. 17. Stages of Labor: Nursing Interventions Key Concepts: o First Stage: Onset of contractions to full cervical dilation (10 cm). Monitor maternal and fetal status, encourage mobility, and manage pain. o Second Stage: Full dilation to delivery of the baby. Support pushing efforts, monitor fetal descent, and prepare for delivery. o Third Stage: Delivery of the baby to the delivery of the placenta. Monitor for signs of placental separation, manage bleeding, and assess the mother’s condition. o Fourth Stage: First 1-2 hours postpartum. Monitor vital signs, bleeding, and bonding with the baby. o Patient Education: Educate about what to expect during each stage and the importance of following healthcare provider instructions. 18. Labor Assessment: Physical Key Concepts: o Components: Cervical dilation, effacement, station, and fetal position. o Tools: Use of a Bishop score to evaluate the readiness of the cervix for labor.  o Patient Education: Explain the significance of cervical exams and the information they provide about labor progress. 19. Labor Stages Key Concepts: o Latent Phase: Mild contractions, early cervical dilation (0-3 cm). o Active Phase: Stronger contractions 19. Labor Stages (continued) Active Phase (continued): o Cervical dilation progresses from 4-7 cm. o Contractions become more intense and frequent. o Nursing Interventions: Encourage breathing techniques, provide pain relief options, and monitor maternal and fetal status. Transition Phase: o Cervical dilation from 8-10 cm. o Contractions are very strong and close together. o Nursing Interventions: Provide continuous support, prepare for the second stage of labor, and help manage pain and anxiety. 20. Pain Management in Labor (Systemic) Key Concepts: o Systemic Analgesia: Includes opioids like fentanyl, and nalbuphine administered via IV or IM. o Advantages: Provides pain relief without significant impact on labor progress. o Disadvantages: Can cause maternal sedation, respiratory depression, and neonatal respiratory depression if administered close to delivery. o Nursing Considerations: Monitor maternal vital signs and fetal heart rate, and educate patients about possible side effects. 21. Fetal Position Interventions Key Concepts: o Occiput Anterior (OA): Optimal fetal position for delivery. o Occiput Posterior (OP): Can cause prolonged labor and back pain. o Interventions for OP: Position changes (e.g., hands-and-knees, side-lying), manual rotation by the provider, and encouragement of mobility. o Patient Education: Explain the importance of fetal positioning and how maternal movements can influence it. 22. Fetal Monitoring: Strip Assessment/Causes Key Concepts: o Baseline Fetal Heart Rate (FHR): Normal range is 110-160 bpm. o Variability: Indicates fetal well-being; classified as absent, minimal, moderate, or marked. o Accelerations: Temporary increases in FHR; a sign of fetal well-being. o Decelerations: Classified as early, variable, or late, each with different causes (e.g., head compression, cord compression, uteroplacental insufficiency). o Patient Education: Educate about the purpose of fetal monitoring and what the tracings indicate. 23. Fetal Monitoring: Strip Interpretation Key Concepts: o Early Decelerations: Mirror contractions; benign, caused by head compression. o Variable Decelerations: Abrupt decreases in FHR; caused by cord compression. o Late Decelerations: Occur after the peak of the contraction; associated with uteroplacental insufficiency. o Nursing Interventions: For late decelerations, reposition the mother, administer oxygen, increase IV fluids, and notify the provider. 24. Non-Pharmacologic Pain Management in Labor Key Concepts: o Techniques: Breathing exercises, massage, hydrotherapy, position changes, and use of birthing balls. o Advantages: No risk of drug-related side effects, promotes maternal control and comfort. o Patient Education: Encourage the use of these techniques alongside or instead of pharmacologic methods to manage labor pain. 25. Fetal Monitoring: Decelerations (VEAL/CHOP) Key Concepts: o VEAL CHOP Mnemonic: § Variable = Cord compression § Early = Head compression § Acceleration = Okay (well-being) § Late = Placental insufficiency o Nursing Interventions: Tailor interventions based on the type of deceleration observed. For example, for variable decelerations, consider changing maternal position or amnioinfusion. 26. Postpartum GU Adaptation Key Concepts: o Physiological Changes: Increased diuresis (excretion of fluids), potential for urinary retention due to swelling or perineal trauma. o Nursing Interventions: Monitor urinary output, encourage voiding within 6-8 hours postpartum, and assess for signs of bladder distension. 27. Postpartum Assessment Key Concepts: o BUBBLE-HE: A common mnemonic for postpartum assessment.  § Breasts: Assess for engorgement, pain, and breastfeeding difficulties. § Uterus: Check fundal height, firmness, and position (midline and at or below the umbilicus). § Bladder: Monitor for urinary retention and adequate voiding. § Bowels: Assess for bowel sounds, constipation, and hemorrhoids. § Lochia: Monitor the amount, color, and odor of vaginal discharge. § Episiotomy/Perineum: Check for signs of infection, healing, and pain. § Homan’s Sign: Assess for deep vein thrombosis (DVT). § Emotional Status: Evaluate maternal bonding, mood, and signs of postpartum depression. 28. Parental/Newborn Bonding Key Concepts: o Bonding Behaviors: Skin-to-skin contact, eye contact, breastfeeding, and early initiation of care by parents. o Nursing Interventions: Encourage rooming-in, support breastfeeding, and educate parents on the importance of bonding for newborn development. 29. Postpartum Assessment: Extremities Key Concepts: o DVT Risk: Increased risk postpartum due to hypercoagulability. o Assessment: Check for leg pain, swelling, warmth, and positive Homan's sign (though controversial). o Nursing Interventions: Early ambulation, use of compression stockings if needed, and patient education on signs of DVT. 30. Jaundice Interventions  Key Concepts: o Physiologic Jaundice: Common in newborns after 24 hours, due to immature liver function. o Interventions: Phototherapy, ensuring adequate hydration and feeding to promote bilirubin excretion. o Patient Education: Teach parents to monitor for yellowing of the skin or eyes, and when to seek medical care. 31. Newborn Nutrition: Breastfeeding Education Key Concepts: o Benefits: Provides optimal nutrition, antibodies, bonding, and reduces risk of infections. o Latching: Proper latch technique to prevent nipple pain and ensure effective feeding. o Frequency: Newborns typically feed every 2-3 hours, 8-12 times in 24 hours. o Patient Education: Support for breastfeeding, addressing common challenges, and recognizing signs of adequate intake (e.g., wet diapers, weight gain). 32. Newborn Discharge Instructions Key Concepts: o Safety: Proper car seat use, sleep on back (to reduce SIDS risk), and avoiding exposure to sick individuals. o Feeding: Instructions on breastfeeding or formula feeding, signs of hunger, and feeding frequency. o Warning Signs: Educate parents on signs of infection, jaundice, dehydration, and when to seek medical help. o Follow-Up: Importance of pediatrician visits and vaccinations. 33. APGAR Scores Key Concepts:  o Components: Appearance (skin color), Pulse (heart rate), Grimace (reflexes), Activity (muscle tone), and Respiration (breathing). o Scoring: Each category is scored 0-2, with a total possible score of 10. Scores of 7-10 are generally normal; 4-6 may require some resuscitative measures; 0-3 indicates severe distress. o Nursing Interventions: Immediate care based on the score, including stimulation, oxygen, and potential resuscitation. 34. Gestational Diabetes: Newborn Complications Key Concepts: o Complications: Hypoglycemia, respiratory distress syndrome, macrosomia (large birth weight), and increased risk of obesity/diabetes later in life. o Nursing Interventions: Monitor newborn blood glucose levels, early and frequent feedings, and watch for signs of respiratory distress. 35. Newborn Vital Signs Key Concepts: o Normal Ranges: Temperature: 36.5-37.5°C (97.7- 99.5°F), Heart Rate: 120-160 bpm, Respiratory Rate: 30-60 breaths/min. o Assessment: Monitor for temperature stability, regular heart rate, and normal breathing patterns without retractions or grunting. o Nursing Interventions: Maintain thermoregulation, assess respiratory status, and monitor heart rate regularly. 36. Newborn Assessment: Medications Key Concepts: o Vitamin K: Prevents bleeding due to vitamin K deficiency, given IM at birth. o Erythromycin Eye Ointment: Prevents neonatal conjunctivitis caused by gonorrhea or chlamydia.  o Hepatitis B Vaccine: First dose given before discharge from the hospital. o Patient Education: Inform parents about the purpose of these medications and ensure consent is obtained where necessary. 37. Hypertensive Disorders in Pregnancy (continued) Key Concepts: o Types: Chronic hypertension, gestational hypertension, preeclampsia, and eclampsia. o Preeclampsia: Characterized by hypertension, proteinuria, and edema after 20 weeks of gestation. o Complications: Can lead to eclampsia (seizures), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), and organ damage. o Nursing Interventions: Monitor blood pressure, administer antihypertensive medications, assess for signs of worsening condition (e.g., severe headaches, visual disturbances), and educate on the importance of regular prenatal visits. 38. Hypertensive Disorders in Pregnancy (continued) Key Concepts: o Preeclampsia: Hypertension with proteinuria after 20 weeks of gestation. o Eclampsia: Preeclampsia with the onset of seizures. o Gestational Hypertension: Elevated blood pressure without proteinuria after 20 weeks of pregnancy. o Chronic Hypertension: Pre-existing hypertension or hypertension diagnosed before 20 weeks. o Nursing Interventions: Monitor blood pressure, educate on signs of worsening condition (e.g., headaches, visual changes), and manage medications as prescribed (e.g., labetalol, nifedipine). 39. Preeclampsia/Fetal Complications  Key Concepts: o Fetal Risks: Intrauterine growth restriction (IUGR), preterm birth, and placental abruption. o Management: Close fetal monitoring (ultrasound, non-stress tests), corticosteroids for fetal lung maturity if early delivery is anticipated, and timing of delivery based on maternal and fetal well-being. o Nursing Interventions: Monitor fetal heart rate, educate the mother on the importance of fetal kick counts, and assess for signs of fetal compromise. 40. Preeclampsia/Preterm Medications Key Concepts: o Magnesium Sulfate: Used to prevent seizures in severe preeclampsia and to provide neuroprotection for preterm infants. o Corticosteroids (e.g., Betamethasone): Administered to enhance fetal lung maturity in cases of preterm labor or when early delivery is anticipated. o Nursing Interventions: Monitor for signs of magnesium toxicity (e.g., diminished reflexes, respiratory depression), monitor fetal heart rate, and educate the mother on the importance of medication adherence. 41. HELLP Syndrome Assessment/Diagnosis Key Concepts: o Definition: A severe form of preeclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets. o Symptoms: Right upper quadrant pain, nausea, vomiting, headache, and visual disturbances. o Diagnosis: Based on laboratory findings (elevated liver enzymes, low platelets, hemolysis). o Nursing Interventions: Stabilize the mother, prepare for possible delivery, manage pain, and monitor for signs of worsening condition or DIC (disseminated intravascular coagulation). 42. Gestational Diabetes/Newborn Concerns Key Concepts: o Newborn Complications: Hypoglycemia, respiratory distress syndrome, jaundice, and macrosomia. o Management: Close monitoring of maternal glucose levels during pregnancy, early feeding of the newborn to prevent hypoglycemia, and monitoring for signs of respiratory distress. o Nursing Interventions: Educate the mother on the importance of glucose control, monitor the newborn’s blood glucose, and support early breastfeeding or formula feeding. 43. Intrapartum Complication: Shoulder Dystocia Nursing Interventions Key Concepts: o Definition: Difficulty delivering the shoulders after the head has emerged, often due to the baby’s size. o Complications: Brachial plexus injury, clavicle fracture, and hypoxia. o Nursing Interventions: Use the McRoberts maneuver (hyperflexing the mother’s legs), apply suprapubic pressure, avoid fundal pressure, and prepare for potential neonatal resuscitation. 44. Meds-Induction (Based on Bishop’s Score) Key Concepts: o Bishop Score: Assesses cervical readiness for labor (dilation, effacement, station, consistency, and position). o Induction Medications: Prostaglandins (e.g., misoprostol) to ripen the cervix, and oxytocin (Pitocin) to stimulate contractions. o Nursing Interventions: Monitor fetal heart rate and contractions, assess cervical changes, and educate the mother on the induction process. 45. Pitocin Interventions Key Concepts: o Uses: Induction or augmentation of labor, management of postpartum hemorrhage. o Complications: Uterine hyperstimulation, fetal distress, uterine rupture. o Nursing Interventions: Continuous fetal monitoring, titrate Pitocin carefully based on uterine response, and monitor for signs of hyperstimulation (e.g., contractions closer than 2 minutes apart, fetal distress). 46. Meds for Preterm Labor Key Concepts: o Tocolytics: Medications used to suppress premature labor (e.g., magnesium sulfate, nifedipine, indomethacin). o Corticosteroids: Administered to enhance fetal lung maturity. o Nursing Interventions: Monitor for side effects of tocolytics (e.g., hypotension, pulmonary edema), educate the mother on the importance of bed rest and hydration, and prepare for possible transfer to a higher level of care if needed. 47. Perinatal Mood Disorders Key Concepts: o Types: Postpartum blues, postpartum depression, postpartum psychosis. o Risk Factors: History of depression, lack of social support, stressful life events. o Nursing Interventions: Screen for mood disorders during and after pregnancy using tools like the Edinburgh Postnatal Depression Scale (EPDS), provide support and resources, and refer to mental health services when necessary. 48. Meds for Postpartum Hemorrhage  Key Concepts: o Medications: Oxytocin (Pitocin), methylergonovine (Methergine), carboprost (Hemabate), misoprostol (Cytotec). o Indications: Used to control or prevent postpartum hemorrhage by promoting uterine contractions. o Nursing Interventions: Administer medications as prescribed, monitor uterine tone and bleeding, assess for side effects (e.g., hypertension with Methergine), and educate the mother on the importance of follow-up care. 49. Postpartum Hemorrhage Risk Factors Key Concepts: o Risk Factors: Uterine atony, retained placental fragments, lacerations, prolonged labor, and use of oxytocin. o Nursing Interventions: Early recognition and treatment of postpartum hemorrhage, continuous assessment of uterine tone, prompt administration of uterotonic medications, and preparation for surgical intervention if needed. 50. Postpartum Hemorrhage: Priorities Key Concepts: o Priorities: Ensure adequate uterine contractions to control bleeding, replace lost fluids (IV fluids, blood products), monitor vital signs, and assess for signs of shock. o Nursing Interventions: Fundal massage, administration of uterotonic medications, and immediate notification of the healthcare provider if bleeding does not subside. 51. Perinatal Palliative Care Key Concepts:  o Definition: Care focused on providing comfort and support for families facing life-limiting conditions in the fetus or newborn. o Nursing Interventions: Offer emotional support, provide clear communication about prognosis and care options, and respect the family's wishes and cultural practices. 52. Therapeutic Communication: Loss Key Concepts: o Communication Strategies: Use empathetic, non- judgmental language, allow parents to express their emotions, and provide resources for grief counseling. o Nursing Interventions: Create a supportive environment, offer memory-making options (e.g., footprints, photographs), and respect cultural practices related to loss. 53. Perinatal Loss Key Concepts: o Types: Miscarriage, stillbirth, neonatal death. o Emotional Impact: Profound grief, potential for postpartum depression, impact on the couple's relationship. o Nursing Interventions: Provide compassionate care, support the family through the grieving process, and refer to support groups or counseling services. 54. Contraception: Barrier Methods/Patient Education Key Concepts: o Barrier Methods: Male and female condoms, diaphragms, cervical caps, spermicides. o Advantages: Protection against STIs (condoms), no hormones. o Disadvantages: Must be used correctly every time, less effective than hormonal methods.  o Patient Education: Demonstrate proper use, discuss the importance of using barrier methods consistently, and address any concerns or misconceptions. 55. Diagnosis, Procedure, and Treatment of Female Infertility (continued) Key Concepts: o Diagnostic Procedures: Hormonal assessments (FSH, LH, prolactin, thyroid function), hysterosalpingography (HSG) to evaluate fallopian tube patency, laparoscopy for endometriosis or pelvic adhesions, and semen analysis for male factor infertility. o Treatment Options: § Ovulation Induction: Clomiphene citrate, letrozole, gonadotropins. § Assisted Reproductive Technologies (ART): In vitro fertilization (IVF), intrauterine insemination (IUI). § Surgical Interventions: Tubal surgery for blockages, laparoscopic treatment for endometriosis. o Nursing Considerations: Provide emotional support, educate patients on the treatment process and potential outcomes, and refer to fertility specialists as needed. 56. Emergency Contraception Key Concepts: o Types: Levonorgestrel (Plan B), ulipristal acetate (Ella), and copper IUD (Paragard) as emergency contraception. o Mechanism of Action: Prevents or delays ovulation; the copper IUD creates an inhospitable environment for sperm and eggs. o Timing: Most effective when taken within 72 hours of unprotected intercourse; the copper IUD can be used up to 5 days after. o Patient Education: Explain the correct use, potential side effects (e.g., nausea, changes in the menstrual cycle), and follow-up care if menstruation is delayed. 57. Primary vs. Secondary Infertility Key Concepts: o Primary Infertility: Difficulty conceiving after 12 months of unprotected intercourse without any prior pregnancies. o Secondary Infertility: Difficulty conceiving after a previous successful pregnancy. o Causes: Similar causes for both types, including ovulatory disorders, tubal damage, uterine conditions, and male factors. o Nursing Considerations: Assess for contributing factors, provide education on fertility treatments, and offer emotional support. 58. Math- Dosage Calculations Key Concepts: o Dosage Formula: Dose required = (Desired Dose / Stock Dose) x Volume of Stock. o Example: If a patient needs 250 mg of a drug and you have a stock solution of 500 mg/2 mL, the calculation would be: (250 mg / 500 mg) x 2 mL = 1 mL. o Practice: Regularly practice dosage calculations for oral, IV, and IM medications. 59. Math- Calculating IV Med Rates Key Concepts: o Formula: IV flow rate (mL/hr) = Total Volume (mL) / Time (hours). o Example: To administer 1,000 mL of fluid over 8 hours, the flow rate would be 1,000 mL / 8 hours = 125 mL/hr. o Nursing Considerations: Ensure accuracy in calculations to prevent over- or under-infusion, and monitor the IV site and patient response. 60. Math- I&O (Intake and Output) Calculations  Key Concepts: o Intake: Includes all fluids a patient consumes or receives, such as: § Oral fluids (water, juice, milk, etc.) § IV fluids (normal saline, medications in fluid form) § Enteral feedings (tube feeding) § Medications administered in liquid form. o Output: Includes all fluids that leave the patient's body, such as: § Urine § Feces (especially if liquid or diarrheal) § Vomit § Drainage from surgical drains § Insensible losses (from breathing and sweating, typically estimated) Conversions: o 1 ounce (oz) = 30 milliliters (mL) o 1 cup = 8 oz = 240 mL o 1 pint (pt) = 16 oz = 480 mL o 1 quart (qt) = 32 oz = 960 mL Calculation Example with Conversions: o Intake: § The patient drank 1 cup (8 oz) of water: Conversion: 8 oz × 30 mL/oz = 240 mL § Received 1,000 mL of IV fluids. § Took 2 oz of liquid medication: Conversion: 2 oz × 30 mL/oz = 60 mL § The patient also received 250 mL of enteral feeding. § Total Intake: 240 mL (water) + 1,000 mL (IV fluids) + 60 mL (medication) + 250 mL (enteral feeding) = 1,550 mL o Output: § The patient urinated 600 mL. § Vomited 0.5 pints: Conversion: 0.5 pt × 480 mL/pt = 240 mL § Output from a surgical drain was 100 mL. § Total Output: 600 mL (urine) + 240 mL (vomit) + 100 mL (drain) = 940 mL o Net Fluid Balance: § Intake (1,550 mL) - Output (940 mL) = +610 mL  § Interpretation: The patient has a positive fluid balance, indicating fluid retention. This may require monitoring, especially if the patient is at risk for conditions like heart failure or kidney issues. Nursing Considerations: o Accuracy: Ensure all intake and output are accurately measured and recorded. o Fluid Balance Assessment: Monitor for signs of dehydration (e.g., dry mucous membranes, decreased skin turgor) or fluid overload (e.g., edema, shortness of breath). o Patient Education: Teach patients the importance of fluid balance, particularly if they have conditions that affect fluid regulation (e.g., kidney disease, heart failure). 61. Care of the LGBTQ Patient Key Concepts: o Inclusive Care: Use of gender-neutral language, asking about preferred pronouns, and respecting patient identity. o Health Disparities: Increased risk for certain conditions (e.g., STIs, mental health issues) due to discrimination and barriers to care. o Nursing Considerations: Provide culturally competent care, offer resources specific to LGBTQ health needs, and create a welcoming and safe environment. 62. Culturally Competent Care/LGBTQ Key Concepts: o Cultural Awareness: Understanding and respecting cultural beliefs, values, and practices in healthcare. o LGBTQ-Specific Concerns: Access to care, discrimination, and mental health challenges. o Nursing Interventions: Ensure confidentiality, address biases, and advocate for the patient’s needs. 63. Case Study: Complications Key Concepts: o Scenario-Based Learning: Application of knowledge to real-world situations involving pregnancy and childbirth complications. o Common Complications: Preterm labor, preeclampsia, shoulder dystocia, postpartum hemorrhage, and fetal distress. o Nursing Considerations: Prioritize interventions based on the situation, collaborate with the healthcare team, and provide patient-centered care. 64. Case Study: Complications (Continued) Key Concepts: o Critical Thinking: Analyzing patient data, anticipating potential complications, and implementing evidence-based interventions. o Documentation: Accurate and timely documentation of assessments, interventions, and patient responses. o Patient Education: Provide clear explanations of the complication, treatment options, and what to expect during and after the intervention.