NCM-234-FINAL-EXAM-COVERAGE.pdf

NCM 234 FINAL EXAM COVERAGE Post-Partum Complications (Thrombophlebitis, Pulmonary Embolism, Postpartum Affective Disorders) Problems Related to Maturity (Preterm Neonate, Post term Neonate) Potential Complications Related to Prematurity (Respiratory Distress Syndrome,...

NCM 234 FINAL EXAM COVERAGE Post-Partum Complications (Thrombophlebitis, Pulmonary Embolism, Postpartum Affective Disorders) Problems Related to Maturity (Preterm Neonate, Post term Neonate) Potential Complications Related to Prematurity (Respiratory Distress Syndrome, Retinopathy of Prematurity, Periventricular/Intraventricular Hemorrhage (IVH), Necrotizing Enterocolitis (NEC), Anemia of Prematurity The Newborn at Risk Because of Problems Related to Gestational Age or Birth Weight (Small for Gestational Age (SGA), Large for Gestational Age (LGA) Acute Conditions of Neonates (Meconium Aspiration Syndrome, Neonatal Jaundice or Neonatal Hyperbilirubinemia, Neonatal Sepsis) RLE 204 FINAL EXAM COVERAGE AOG and EDC Computation Leopold’s Maneuver Fundic Height Measurement Labor and Delivery Concepts and Skills Partograph Essential Newborn Care (Unang Yakap) Immediate Newborn Care Apgar Scoring Ballard’s Scoring Postpartum Assessment (BUBBLES-HE) THROMBOPLEBITIS DISEASE Thrombus -Blood clot that forms in a vessel and remains steady Embolism -a clot that travels from the site where it formed to another location in the body Phlebitis -Inflammation of the lining of blond vessels Thrombophlebitis -inflammation with the formation of blood clots. Etiology Venous stasis = statis- slow/stagnant Increase Fibrinogen (blood thinner - anticoagulant) Hypercoagulability of blood Dilatation of lower extremity veins due to pressure of the Fetal presenting part during pregnancy PREDISPOSING FACTORY FOR THROMBOSIS Inactivity/prolonged bed rest Obesity Cesarean birth Smoking - cause vasoconstriction. History of previous thrombosis Varicose veins Diabetes mellitus Prolonged time in stirrups in second stage of labor Age >35 years Parity greater than 3 Dehydration Classification 1. Superficial Vein Disease (SVD) 2. Deep vein thrombosis (DVT) Superficial venous Thrombosis Blood clots that affects the superficial veins (located just under the skin) CLNICAL MANISFESTATION Swelling Tenderness redness, warmth Pain on walking Palpable enlarged, hardened vein Deep Vein Thrombosis (DVT) ▪ blood clot that develops within a deep rein in the body. Femoral Thrombophlebitis ▪ Femoral, saphenous, or popliteal vein are Involved ▪ Venous inflammation accompanied with arterial spasm giving the leg a white or appearance Clinical manifestations: Fever, chills Tender, stiffness, pain on ambulation Tachycardia leg swelling (>2cm than the unaffected leg) Erythema/redness and treat or pallor and coolness of affected leg skiny and white skin dive to streching From secondary to swelling Positive Homan’s sign ❖ pain in the calf of the leg on dorsiflexion of the Foot) ❖ sign of deep vein thrombosis (DVT) THERAPEUTIC MANAGEMENT ❖ bed rest with the affected les elevated ❖ application of mist heat bed cradle keeps pressure bed cradle keeps pressure of the bedclothes off the affected leg  Check for bed wrinkles to prevent secondary pressure problem of a pressure ulcer while on bed rest. Therapeutic Management ❖ Never massage the skin over the clot ❖ Analgesic ❖ Antibiotic ❖ Avoid prolonged standing ❖ Heparin (NORSC) – Anticoagulant (prevent clotting) ❖ woman can continue to breastfeed while receiving heparin. Antidote: Protamine sulfate in care of heparin overdose Antidote: Vitamin k for warfarin overdose woman has to discontinue breastfeeding coumadin because its derivatives can be parted in breast milk. ❖ Monitor the activated partial thromboplastin time (APTT)-40 to 60 seconds or prothrombin time (PT) NURSING INTERVENTIONS ❖ prevent thrombus formation ❖ promote frequent ambulation. ❖ Elevate lower extremities ❖ Prevent prolonged time in obstetric stirrups to avoid pressure agains popliteal area ❖ Stirrups should be wall ❖ Range of motion exercises passive exercise: if another cannot ambulate ❖ Avoid using pillows or knee patch to prevent pressure on the popliteal space and cosequent pooling of blood ❖ wear anti embolism or elastic support stockings for the first 2 weeks after birth ▪ put stockings on before she rites to the morning INTERVENTIONS WHILE ON ANTICOAGULANT THERAPY 1. Instruct to report bleeding, bruises, petechial, epistaxis, blood in urine or fons, bleeding gums, increased vaginal bleeding ecchymosis spots on the skin, or oozing from an episiotomy suture Ime Hematuria - blood in the urine Hematochezia - blond in the stool 2. Appropriate medication schedule 3.Avoid over the counter medication 4. Use over the counter medication Gingivitis – inflammation of the gums 5. Report unusual bleeding, unexplained fever, unusual fatigue 6. Avoid excessive intake of vitamin k foods (broccoli, cabbage, lettuce when taking warfarin 7. With proper treatment, the acute symptoms of femoral thrombophlebitis last only a few days, but the full cause of the disease the 4 to 6 weeks before it is resolved. PULMONARY EMBOLISM ❖ Rare but life – threatening complication of DVT ❖ Obstruction of the pulmonary artery CLINICAL MANIFESTATION ❖ Sudden, sharp chest pain ❖ Tachypnea, tachycardia ❖ orthopnea (inability to breathe except in an upright position) or orthopneic position ❖ cyanosis ❖ Management NOTE: Pulmonary embolism is an emergency and serious problem oxygen administer immediately due to risk for cardiopulmonary arrest ICU monitoring NURSING CARE OF THE HIGH-RISK IN NEWBORN Body temp Regulation 1. Initiate respiration Initiation and Maintenance of Respiration 2. Establishment of extra uterine circulation 3. Control of body temperature 4. Adequate Nourishment 5. Establishment of waste Elimination 6. Prevention of infection 7. Establishment of infant and parent relationship or bonding 8. Developmental care 9. Preterm Neonate neonate born before and of 37th week of gestation Weight