OB/PEDI FINAL

BP >160/110 x2, 6hrs apart; preteinuria >2+ on dipstick, >2gm in 24 hrs urine; severe H/A; hyperreflexia >3+ and possible clonus (count, chart); visual or cerebral disturbance c/o spots, specks, floaties; ↑serum creatinine; N/V; oliguria; ↓placental perfusion; sml placenta c infarcts

Pregnancy-specific syndrome tht usually occurs >20 wks of gestation and is determined by gestational HTN plus proteinuria

One of the important goals of care for the mom w preeclampsia is prevention or control of convulsions. This drug is the drug of choice in the prevention and tx of convulsions caused by preeclampsia or eclampsia.

Loss of patellar reflexes, resp and mus depression, oliguria, and ↓LOC are signs toxicity from this.

NI: discontinue immediately and adm calcium gluconate per HCP (10 ml of a 10% solution, or 1 g) given slowly IV push (usually by the HCP) over at least 3 min to avoid undesirable reactions such as dysrhythmias, bradycardia, v-fib

This drug is a tocolytic. It's use can ↑duration of labor. The labor of a mom c preeclampsia receiving this may need augmentation c oxytocin/pitocin. The amt of oxytocin needed to stimulate labor > for mom who is not receiving this drug.

Nursing Diagnosis: Risk for FVE r/t ↑Na retention secondary to adm of MgSO4; Risk for impaired gas exchange r/t pulmonary edema secondary to ↑vascular resistance; Risk for ↓CO r/t use of antiHTN drugs; Risk for injury to fetus r/t uteroplacental insufficiency secondary to use of antiHTN meds...

Risk for injury to mom and fetus r/t CNS irritability; Ineffective tissue perfusion r/t preeclampsia secondary to arteriolar vasospasm...

Triggers: allergens (dust mold), irritants (smoke, sprays), exercise, cold air, weather changes, animals, certain meds, strong emotions, food additives, certain foods (nuts, dairy), endocrine factors.

In infants, there is a strong relationship to viral infection and this

S/S of asthma—labored breathing, bilateral wheezing (high-pitched musical sounds), prolonged expiration, irritative tight cough (caused by reduction of airways)

What’s the nurse going to do? The main goals are continuous care approach with reg visits to the HCP, prevention of exacerbations including avoiding triggers, allergens, and using meds as needed, therapeutic efforts to decrease inflammation and relieve/prevent airway narrowing, patient education (environmental control, pharm management, and the use of objective measures to monitor the severity of disease and guide the course of therapy)

Bronchodilators (serevent) - long term symptom prevention; B-adrenergic agonists (short acting) - Albuterol, Xopenex, terbutaline - used to tx acute exacerbations, for prevention of exercise induced bronchospasm. Can cause ↑HR, GI disturbance, irritability, tremor, nervousness, insomnia.

Meds and SE: Methylxanthines (Theophylline and Aminophylline)-smooth muscle relaxant, bronchodilator, frequent blood levels, don’t mix with other meds and calculate doses carefully. Monitor P, BP, RR b/f, during, & after tx. S/E-n/v, tachycardia, hypotension, restlessness, hyperactivity

Inhalers (a lot of them have steroids or Nsaids); NSAID inhalers (Cromolyn sodium);
Epi commonly used for acute attacks-rapid effect, short acting, vasodilation, and decreases mucous production. Dosage 0.01 mL/Kg-may repeat 4xs. S/E-tachycardia, pallor, weakness, nausea, tremors

Supsphrine-type of epi c fast effect, but is slower acting, lasts longer. S/e-tachycardia, pallor, weakness, nausea, tremors; Isuprel-same effects as epi; Nursing alert-avoid ASA administration b/c 2-6% of children with asthma are sensitive to ASA.

Most common serious pulm/gastric disease of children. Primarily affects exocrine glands (mucous production).

Autosomal recessive trait. Both parents have to pass on the gene. Have 1 in 4 chance of getting disease if both parents have genes.

Early Sx-meconium ileus in the NB (tenacious meconium is blocking illeus). Normally, baby should have BM within first 24 hrs of life.

Patho- ↑viscosity of mucous gland secretions, ↑of sweat electrolytes (Na and Cl), ↑enzymatic elements of saliva (parents may say infant tastes salty when they kiss them), abnormalities of autonomic NS, ↑sweat electrolytes (Na and Cl)

Diet-maintenance of nutrition to promote normal growth, dev; Well balanced diet (↑protein, calorie diet); Vit replacement (esp A, D, E, K); ↑protein; Fe supplement (are often anemic); Don’t recommend restriction on fats; May need to drink ensure, pedisure; May require ↑Na in diet (loose a lot thru sweat and saliva); Watch them if they’re sick or it’s hot, may loose more Na; Pancreatic enzyme replacement (give c meals, snacks)

Meds-nebulized epi (vasoconstrict, ↓ edema), steroids, expectorants, bronchodilators, antihistamines, for bacterial infection-amphocyllin 150 mg/kg/day

Meds-nebulized epi (vasoconstrict and decrease edema),steroids, expectorants, bronchodilators, antihistamines, for bacterial infection-amphocyllin 150 mg/kg/day

Timing of diagnostic tests

Metabolic effects: CNS damage, mental retardation, and ↓melanin

Formulas prescribed for infants: Lorenalac and Phenex-1

Syndrome in males that is characterized by small testes, long legs, enlarged breasts, reduced sperm production, mental retardation; a genetic defect in which an extra X chromosome (XXY) is present in the male

CNS depressant; relaxes smooth mus, including the uterus; used to halt preterm labor contractions; used for preeclamptic pts to prevent seizures

↓RR, DTRs, urine output; hypotension; extreme mus weakness; flushing; pulmonary edema serum levels > 9 mg/dl

Use controller pump for adm; follow agency protocol for adm; discontinue infusion and notify HCP if adverse reactions occur; monitor RR < 12/min, urine output < 100 ml/4 hr (25-30 ml/hr, DTRs, levels outside 4-8 mg/dl; keep calcium gluconate at bedside

Newborn risks: hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, large birth rate, congenital anomalies

Bradycardia; tachycardia; late, prolonged decels; hypertonic uterine activity; ↓, absent variability; variable decels falling to < 70 beats/min > 60 sec

Fluctuations in FHR may include irregular fluctuations of two or more cycles/min; ↓can result from fetal hypoxemia, acidosis, or certain meds; a temporary↓ can occur when the fetus in in a sleep state, not usually lasting longer then 30 min

Brief, temporary↑ in FHR of ≥ 15 beats more than the baseline and lasting ≥15 sec; Usually reassuring sign, reflecting a responsive, nonacidotic fetus; usually occur c fetal movement; May hv no relation to contractions or be periodic; May occur c uterine contractions, vaginal examinations, or mild cord compression, or when fetus is in a breech presentation

↓FHR below baseline; rate at lowest point usually remains > 100 beats/min; Occur during contractions as fetal head is pressed against mom's pelvis, soft tissues eg, cervix; return to baseline FHR by end of contractions; not associated c fetal compromise, require no intervention

Nonreassuring patterns reflect impaired placental exchange or uteroplacental insufficiency; begins well after contraction begins and return to baseline after the contraction ends; degree of fall in FHR from baseline is not r/t amt of uteroplacental insufficiency; NI include improving placental blood flow, fetal oxygenation

Caused by conditions that restrict flow through umbilical cord; do not hv uniform appearance; shape, duration, degree of fall below baseline FHR are variable; fall/rise abruptly c onset, relief of cord compression; may be nonperiodic, occurring at x's not r/t contractions; baseline rate/variability are considered when evaluating this; significant when FHR repeatedly↓ to <70 beats/min and persists at that level ≥60 sec a returning to baseline

Effacement, dilation of cervix; 3 stages - latent, active, transition; mom is sociable, excited in latent phase, becoming more inwardly focused as labor intensifies

Expulsion of fetus; pushing stage; mom has intense concentration on pushing c contractions; may doze between contractions

Separation of placenta; expulsion of placenta; mom is excited, releaved after baby's birth; usually very tired

Physical recovery; 1-4 hr after expulsion of placenta; tired, but may find it difficult to rest bc of excitement; eager to become acquainted c newborn

Longest for both nulliparous, multiparous moms/ cervical dilation is 1-4 cm; uterine contractions occur q15-30 min, are 15-30 sec in duration, and are of mild intensity; encourage mom/partner to participate in care; assist c comfort measures, changes of position, ambulation; keep mom/partner informed of progress; offer fluids/ice chips; encourage voiding q 1-2 hrs

Cervical dilation 4-7 cm; uterine contractions occur q305 min, are 30-60 sec in duration, are of moderate intensity; mom may experience feelings of helplessness; mom bc restless/anxious as contractions bc stronger

NI: Encourage maintenance of effective breathing patterns; provide a quiet environment; keep mom/partner informed of progress; promote comfort c back rubs, sacral pressure, pillow support, position changes; instruct partener in effleurage (light stroking of abd); offer fluids/ice chips, ointment for dry lips; encourage voiding q1-2 hrs

Cervical dilation is 8-10 cm; uterine contractions occur q2-3 min, are 45-90 sec in duration, are of strong intensity; mom bc tired, is restless, irritable, feels out of control

Encourage rest between contractions; wake mom at beginning of contractions so she can begin breathing pattern; keep mom/partner informed of progress; provide privacy; offer fluids/ice chips, ointment for dry lips; encourage voiding q1-2 hrs

NI: Monitor moms VS, FHR via US doppler, fetoscope, or EFM, uterine contractions by palpation or monitor, determining frequency, duration, intensity; assess FHR a, during, p any contractions, noting normal FHR is 120-160 beats/min; asses status of cervical dilation cm, effacement %; fetal station eg, -4, position by leopold's maneuver; assist c pelvic exam, prepare for fern test; assess color of amniotic fluid if membranes hv ruptured, bc meconium stained fluid can indicate fetal distress

S/s: Breast changes; amenorrhea; N/V; urinary frequency; fatigue; quickening

S/s: Goodell, Chadwick, Hegar signs; Positive serum/urine pregnancy tests; braxton hicks contractions; ballottement

S/s: Visualization of fetus, FHR tones, by real-time US exam; visualization of fetus by radiographic study; FHR tones detected by Doppler, stethoscope; fetal movements palpated, visible

Changes: ↑blood volume, plasma, P (10 beats/min), and total RBCs (by 40-50%); ↓BP slightly in 2nd trimester

This count may ↑ to 15,000/µl (or even higher during labour and following delivery). The total mass ↑ to fill increased blood volume. The reason for the increase is unknown but is probably a hormonal response. If you have no fever, sore throat, urinary problem or other sx suggestive of an infection, these counts are normal

A numerical formula for estimating the date labor will begin; by subtracting 3 months from the first day of the LMP and adding 7 days to that date, a provisional date of delivery is identified