234 FINAL EXAM

What has the greatest impact on our health?

Healthy behaviors (50%), environment (20%), genetics (20%), access to care (10%)

What is upstream thinking?

Looking upstream where the real problem is happening Googled definition: taking wise collective action to ensure better outcomes rather than simply responding to, and being overwhelmed by, crises we could have foreseen

Know examples of upstream thinking.

- Postpartum nurses teaching new mothers about safe sleep habits for baby to decrease infant mortality - American heart association offering cooking classes to teach about the importance of heart healthy meals (mainly with diabetics) - Nurses teaching teachers suicide prevention courses since teachers are on the frontline to see the signs most of the time - Super shots immunizing as many kids as possibly to lower child disease rates

What are health disparities?

- systemic, potentially avoidable health differences that adversely affect socially disadvantaged groups - Disparities in health care delivery: bias and stereotyping, unequal treatment with racial/ethnic groups

What groups of individuals tend to experience health disparities? Know which groups of individuals are considered to be vulnerable populations.

Poverty stricken people, racial/ethnic groups, uninsured people, children and elderly, lack of education

What is Healthy People 2030?

A plan based on the past 5 previous healthy people initiatives (1979-2020)

What are social determinants of health?

Social determinants of health are shaped by the distribution of money, power, and resources throughout the local communities, nations, and the world (Income, education, housing, job security, food security, transportation, geography, and social support --> Where people are born, grow up, live, work, and age, as well as systems put in place to deal with illness)

What is the Health Belief Model and what does it describe?

Analyzes the probability of making changes to improve health→ used to describe why some people take actions to prevent a disease and others don't

What patient perceptions are important before one will be willing to take action or make a change?

Perceived susceptibility, and severity of disease, risk factors, perceived benefits of health action, and perceived barriers

What is self-efficacy and why is it important?

- When A patient believes in one's ability to complete a task or meet a challenge (“won't try if you don't think you can do it!”) - You want the patient to be empowered with these decisions so they will go through the stages of this model

What is health coaching?

- Working together to form a plan to have the patient work to reach full potential health → partnering with clients in a thought provoking and creative process that inspires them to maximize their personal and professional potential - We want to keep track of patients health to see if there's changes through the models

What is a risk factor?

Something that increases the chances of developing a disease

Know which risk factors are modifiable and which are non-modifiable for heart disease.

Modifiable factors: to help fix hypertension→ exercise, diet, or medication Non-modifiable: age or gender or ethnicity cannot be modified to fix hypertension

What is a SMART goal?

An acronym that stands for: specific, measurable, achievable, realistic, and timely -->

How many minutes each week should an adult exercise if exercising moderately?

150 minutes a week

How many minutes each week should an adult exercise if exercising vigorously?

75 minutes a week

What are the key attributes of Care Coordination (CC)?

- Interprofessional team - proactive plan of care - evidence based care - targeted set of purposeful activities - proactive follow up - efficiency - communication

What population groups/diagnoses benefit from care coordination?

all of them??

What is SBAR

SBAR: situation, background, assessment, request/recommendation - Situation: what’s the situation right now? - Background: what the clinical background - Assessment: what the problem - Recommendation: what do i recommend/request be done

what is ISBARR

ISBARR: identify, situation, background, assessment, recommendation, repeat - Identify: introduction yourself - Situation: state the purpose - Background: tell the story - Assessment: state what you think is going on, your interpretation, a focused assessment: relevant data - Recommendation: what you'd like to see done - Repeat: read back and verify

Define advocacy and Know examples of advocacy.

Act of speaking for others to assist them to meet needs and its an expectation for all who assume the role of the professional nurse

What is health literacy?

Capacity to read, comprehend, and follow through on health information

At what reading level should patient education material be?

5th-6th grade level

What are the negative impacts of low literacy skills?

- People are at increased risk for poor health - lower income - limited education - more chronic health conditions

What are some possible indicators of low health literacy?

- Excuses: “i forgot my glasses” - Lots of papers folded up in purse/pocket - Lack of follow through - Seldom ask questions - Questions asked are basic in nature (indicates poor teaching from last facility) - Difficulty explaining medical concerns, plan of car, medications

What is the teach-back method and when should it be used?

a way of checking understanding by asking patients to state in their own words what they need to know or do about their health

Know examples of macronutrients.

protein, carbs, and fats

How many calories are in each gram of carbohydrates within the daily value

Carbohydrate (45% to 65% daily calories) → found in starchy foods

How many calories are in each gram of proteins within the daily value

Proteins (10% to 35% of daily calories)

How many calories are in each gram of fats within the daily value

Fats (20% to 35% of daily calories)

what're the calories within a carbohydrates

4 calories per gram

what're the calories within a protein

4 calories per gram

what're the calories within a fat

9 calories per gram

What is the Basal Metabolic Rate (BMR)?

The energy needed to maintain life- sustaining activities for a specific period of time at rest

How is BMI calculated in an adult

- When calories in = calories out , weight will stay the same - If someone wants to lose weight calories out should be more than calories in or vice versa for gaining weight - EQUATION: BMI = (Weight in pounds divided by Height^2 ) x 703 --> HEIGHT IS IN INCHES

What are the percentiles/numbers on the BMI chart for underweight, healthy weight, overweight and obese

- underweight: less then 18.5 - healthy weight: 18.5 to 24.9 - overweight: 25.0 to 29.9 - obese: anything 30.0 or greater

what is SNAP

SNAP: monthly allotment to help low-income families buy nutritious foods

what is WIC

WIC: supplemental foods and nutrition education to low income pregnant/postpartum women and at risk children > 5 years old , nutrition assessments, and food voucher, formula assistance

what is meals on wheels

Meals on wheels: provides nutritious meals, a quick safety check and much-needed human connection to homebound seniors or older adults

What four major causes of deaths in the US can be attributed to poor diets

Cardiovascular disease, diabetes, some cancers, obesity

What is a realistic and healthy goal for weight loss (how many pounds per week)

loosing 1-2 pounds a week

What is food insecurity

Insecurity: the state of being without reliable access to a sufficient quantity of affordable, nutritious food

What is a food desert

Desert: an urban area in which it is difficult to buy affordable or good-quality fresh food

Besides smoking, what are other ways to get nicotine into one’s system?

Chew, dip, mouth sprays, snuff

What health risks are seen in women over 35 who smoke 15 or more cigarettes a day

Develop heart attacks, strokes, and blood clots

What is primary prevention? Know examples

Health promotion and specific prevention (before the disease process starts) - Goal: maintain/improve general health of the individual/family/community - examples: Immunization, education, change in diet

What is secondary prevention? Know examples

Having a diagnosis but trying to stop it - Goal: identify individuals in early, detectable stage of disease - Screenings or any kind (BP, Diabetes, cholesterol, or colorectal)

What is tertiary prevention? Know examples

Helps to restore and rehabilitate (helps to manage/minimize the disease) - Goal: focus on rehabilitation to help people attain and retain an optimal level of functions - PT after a surgery or taking medications

At what age should women start getting Pap smears

21

What age group finds the best benefits from colonoscopies

45 years old

What does a ‘D” rating from the US Preventative Taskforce (USPSTF) tell you about the benefit of a particular health screening

D rating means that it is not a recommended screening to get done

what is a live/attenuated vaccine and examples of them

use a weakened form of the virus which grows and replicates but doesnt cause illness - Intranasal flu, mmr, rotavirus, varicella,

what is an inactivated vaccine and what are some examples of them

contain viruses whose genetic material; has been destroyed by heat, chemicals, or radiation so they cannot infect cells and replicate, but still can trigger an immune response (a dead microorganism) - Hep A, injectable flu, and rabies

Who should not get a live vaccine?

Severely immunocompromised people as well as pregnant women → any slight disease could hurt an immunocompromised person and the live disease could hurt the fetus

What is herd immunity and why is it so important and what percent of immunization is needed for herd immunity

- when majority of population is vaccinated it works or has developed immunity - It makes it possible to protect the population from a disease including unvaccinated people

what is active immunity and examples of it

Immunity which results from the production of antibodies by the immune system in response to the presence of an antigen (produced by a person's own immune system) - Vaccine immunization or surviving an infection

what is passive immunity and some examples of it

short term immunity which results from the introduction of antibodies from another person or animal (immunity given by another person) - When a baby receives a mothers antibodies through the placenta or breast milk

Who should get the flu shot?

EVERYONE 6 MONTHS OF AGE AND OLDER SHOULD GET A FLU VAX EVERY SEASON

What is the recommended age(s) to receive the HPV vaccine?

- Girls and boys get 2 doses at age of 11-12 (recommened) - If girl or boy is over 15 they get 3 doses

what is the HEP B vax

prevents viral infection transmitted through blood or body fluids (3 injections and IM)

whats the ROTAVIRUS (RV) vax

prevents disease that causes diarrhea, vomiting, fever, abdominal pain, and dehydration ( 2 dose given orally) → live vax

whats the DTAP vax

a 5 dose series given IM → TDAP booster given) - Diphtheria: breathing problems and paralysis - Tetanus: lockjaw (muscles tightness in jaw) - Pertussis: whooping cough and pneumonia

whats the HAEMOPHILUS INFLUENZAE TYPE B CONJUGATE (HIB) vax

prevents the haemophilus influenzae bacterium that can cause meningitis, pneumonia, epiglottis, and death (3 or 4 dose round given IM) → DOES NOT CAUSE THE FLU

whats the PNEUMOCOCCAL VACCINE (PCV)

prevents against pneumococcal bacterial infection that can cause pneumonia, meningitis, endocarditis, and death (4 dose round given IM)

whats the MEASLES, MUMPS, RUBELLA, (MMR) vax

2 dose rounds given subcutaneously (SQ) → airborne!!1 - Measles: rash, fever, ear infection, pneumonia, seizures - Mumps: fever, headache, deafness, meningitis, and death - Rubella: rash, fever, arthritis, miscarriage, birth defects

whats the INACTIVATED POLIO (IPV) vax

prevents polio which causes fever, nausea, vomiting, fatigue, paralysis, death (attacks central nervous system) (4 does rounds given IM or subcutaneous)

whats the VARICELLA vax

prevents chickenpox which is airborne (2 dose, live vax, given subcutaneously)

whats the HUMAN PAPILLOMAVIRUS (HPV) vax

prevents asymptomatic virus that spreads through skin to skin via sexual contact (2 round given IM at 11-12 y/o or 3 doses after 15th bday)

whats the FLU vax

prevents getting the flu by using an inactivated vaccine given every flu season (airborne, given IM)

whats the MENINGOCOCCAL CONJUGATE (MCV4) vax

prevents strains A,C,W,Y which cause meningitis (vax given IM)

whats the MENINGOCOCCAL B vax

Separate from Men. Conjugate vax (men ACWY) → only prevents against serogroup B meningococcal disease

whats the HEP A vax

prevents Hep. A which causes jaundice, diarrhea, fever, and weakness (2 dose given IM)

whats the COVID 19 vax

SARS virus prevention and is a one dose with a lot of boosters due to other strains

age range for infants

birth to 12 months

age range for toddlers

1-3 years old

age range for preschoolers

3-5 years old

age range for school age

5-12 years old

age range for adolescents

12-18 years old

age range for young adults

18 - 35 years old

age range for middle adults

35-65 years old

age range for older adults

65 years or older

What types of things are assessed when looking at growth

(per summersett via email) --> an increase in size; we measure this through measuring length, weight, head circumference, etc

NOT A QUESTION BUT A REMINDER FOR ANYONE USING: for what to expect in terms of physical, developmental, cognitive, and psychosocial development for the various developmental stages

this is the infant through older adult information from exam 2 that we all made flashcards or note pages from the 70 slide presentation

What percentage of birth weight may be lost the first few days of life and When should it be regained by?

10% is lost and is regained within 2 weeks

what is the birth weight calculations

1. convert the birth weight pounds into OUNCES (multiply by 16) 2. add left over ounces to the pounds just converted 3. convert the weight lost into ounces if needed 4. divide the ounces LOST over the BIRTH WEIGHT 5. multiply #4 answer by 100 6. if its over 10% it is too much lost

An infant's birth weight be what by 6 months and what by 12 months?

At 6 months it should double and at 12 months it should triple

what the 6 and 12 month weight calculations

1. KEEP POUNDS AND OUNCES SEPARATE 2. multiply given weight by 2 (6 lb 5ox: 6x2=12 and 5x2=10) 3. #2 answer is the 6 month weight (12 lb 10oz) 4. multiply given weight by 3 (6lb 5oz: 6x3=18 and 5x3=15) 5. #4 answer is the 12 month weight (18 lb 15oz)

What is anticipatory guidance?

the advice pediatricians provide to avoid problems that could occur in the future (preventive couseling)

What foods should be avoided to prevent choking in infants younger than 12 months?

Nuts, cereals, hard veggies or fruits (blueberries or peas)

Why should cow’s milk be avoided in infants younger than 12 months?

Does Not obtain good iron amounts (use breastmilk or formula for iron needs)

Why should honey be avoided in those younger than 12 months?

Risk of botulism poisoning (and foods with honey in them)

Why should bedtime bottles be avoided?

- It can promote erosion of tooth enamel - Contributes to extra weight gain - If bottles been given IN BED the liquid can enter into their lungs and choke them

What are some causes of SIDS

Sleeping on stomach or side, overheating, and toys or pillows in the bed

what're risk reducers for SIDS

- flat on back - no toys in crib - appropriate heat and clothing - proper education before discharge

Why are toddlers at risk for choking?

Because they like to put things in their mouth alot

What is parallel play?

Doing the same things next to one another

What are warning signs of child abuse?

- Any injuries that are unusual - Depression,anxiety, unusual fears - Changes in behavior: aggression, anger, hostility, hyperactivity - Neglecting things like food, clothing, shelter, affection

What are warning signs of suicide risk in adolescents?

- Changes in eating and sleeping patterns - loss of interest - withdrawal from friends - alcohol and drug use - unnecessary risk taking - obsession with death - acting out behaviors or running away

what is delirium

- ACUTE condition with a cause (UTI) and limiting condition - Results in confusion and other disruptions in thinking and behavior (changes in perception, attention, mood, and activity level) - More abrupt confusion, emerging over days or weeks - Fluctuating menta; status is important to identify because it ofte signals a need for additional treatment - NEED TO KNOW THE BASELINE MENTAL STATE

what is dementia

- Not specific disease (wide range of sym[potms) → associate with a decline in memory or other thinking skills severe enough to reduce person's ability to to ADLS - Caused by damage to brain cells and the damage interferes with the ability of brain cells to communicate with each other - Must have at least 2 of the following core functions significantly impaired to be considered with dementia: memory, communication and language, inability to focus and pay attention, reasoning and judgment, visual perception, disorientation - Alzhiemers is most common illness then there's multi-infarct dementia - Most used assessment tool: mini mental state exam - NO CURE

Know the physical changes associated with aging that a nurse should be aware of.

- Wrinkles - gray hair - loss of body mass in extremities - increase body mass in the trunk - Skin, vision, hearing, taste, smell - musculoskeletal - GI (decreased gastric motility and constipation) - GU (urinary system) - impaired heat/cold perception - Functional status is impacted (ADL”s→ eating, toileting, etc. affect cognitive physical, psychosocial, and social domains) → these changes can be due to chronic illness or disease or degree of chronicity

Know the health concerns specific to the older adult

- Falls→ leading cause of mortality - Osteoporosis→ small thin frame, white, family history, inactivity, low calcium - Preventing injury → driving considerations (are they safe to drive) - Influenza→ major cause of mortality/morbidity (get vaccine) - Pneumococcal infections → vaccines advised - Tuberculosis → risk factors are poverty, homelessness, substance abuse, aids - Delirium and dementia

How is culture defined?

"A pattern of shared attitudes, beliefs, self-definitions, norms, roles and values that can occur among those who speak a particular language or live in a defined geographical region" (Giddens, 2021, p. 29)

What is culturally competent care?

Conveying acceptance of the patients health beliefs while sharing information, encouraging self-efficacy, and strengthening patients coping resources (book definition)

Cultural competency is a major element in eliminating what

health disparities and providing safe and quality health care

Which STI’s are bacterial and treated with antibiotics

Gonorrhea Syphilis Chlamydia Trichomoniasis Bacterial vaginosis (bv) Vulvovagicnal candidiasis

Which STI’s are viral that may be treated with antivirals

HIV/AIDS Hep. B Genital herpes HPV/genital warts Cytomegalovirus

When does seroconversion occur with HIV infections?

3-12 weeks for most people

What is PrEP and who should take it?

PREP = pre-exposure prophylaxis - Who: people at risk for contracting HIV, has HIV positive partner, has multiple partners and doesn't use condoms, injects drugs and shares needles

How often do patients on PrEP need to see their healthcare provider

Every 3 months to get repeat testing and get med Refills

What is PEP, who should take it, and when does it need to be started

PEP = post-exposure prophylaxis - Who: anyone after a potential exposure to HIV to prevent it - When: if condom broke during sex, if sexually assaulted, healthcare worker exposed at work (within 72 hours) → ONLY TAKEN IN EMERGENCIES

Who does the CDC recommend receiving the HPV vaccination and at what ages

Girls and boys receive Gardasil at age 11-12 (2 dose series 6-12 months apart) OR 3 dose after age of 15

What is PID and which two STI’s are more likely to cause PID

- PID: infection of upper gential tract for females (symptoms are: pelvic pain, fever, irregular vaginal bleeding, could be asymptomatic) - 2 STI’s: untreated gonorrhea and chlamydia

Define family dynamics

Interrelationships between and among individual family members or the forces at work within a family that produce particular behaviors or symptoms

What is a family genogram and what information may it provide about a patient’s family

Its a visual/graphic representation of a family and its members tree which shows the relationship and medical history for everyone

Which kind of condoms protect against STIs and which do not protect against STIs?

- DO: Condoms made of latex, polyurethane, or animal skin - DONT: Lambskin natural ones

What type of lubricants should be used with condoms and what type of lubricants should not

- SHOULD: Only water soluble should be used - SHOULDNT: Oil based shouldn't be used because it breaks down condoms

Which birth control methods are considered barrier methods

condoms and diaphragms

Which methods of birth control are considered hormonal

- oral contraceptives - vaginal contraceptive ring - transdermal contraceptive patch - progestin-only injection - implanted progestin (Nexplanon) - some IUDs

Which methods of birth control are considered permanent

Tubal ligation

Which methods of birth control are considered long-acting reversible contraceptives (LARCs)

Implantable progestin (nexaplanon) progestin only injection IUDS Vasectomy

Which women should avoid using a diaphragm as a method of birth control

women who are more prone to UTI's, toxic shock, or have a latex allergy

What would you teach a woman about how to use the vaginal contraceptive ring (how often it is changed, how long it stays in, etc.)

- It is placed in the vagina and secretes estrogen and progestin bypassess liver for metabolism - Leave in for 3 weeks and out for 1

What would you teach a woman about how to use the transdermal contraceptive patch (how often it is changed, how long it stays on, where it goes, etc.)

- Patch is placed on skin of an arm for 1 week removed and new patch applied - It's done for 3 weeks (rotating sides) then a patch free week for 1 week - Women with a BMI > or equal to 30 don't use this

What hormones are contained in COC’s

Estrogen-progestin

What hormone is contained in Depo-Provera injections

Progestin

What are contraindications for COC’s

- Smokers > 35 years old - History of CV or CAD - History of breast cancer - Pregnancy - Estrogen dependent or liver tumors - Lactation less than 6 weeks - Headaches with neurologic symptoms - History of diabetes > 20 years - Thromboembolic disorders

How often is Depo-Provera (progestin-only injection) administered? How long can it take for fertility to return once Depo is stopped

- Every 3 months - (google answer) → should return within 3-6 months after last injection

What hormone is in Nexplanon (implantable) and how is this method of birth control administered

Progestin - An implant in the non dominant upper arm (minor surgical procedure)

less effective kinds of birth control

male condom, fertility awareness based methods, diaphragm, sponge

middle effective kinds of birth control

injectable, pill, patch, vaginal ring

most effective kinds of birth control

tubal ligation, male vasectomy, implant, IUD

What are the recommendations for preconception care and counseling

- Be up tp date with vaccinations (rubella and hepatitis B - Chronic disease management (diabetes, hypothyroidism, HIV/AIDS, making sure meds are safe during pregnancy) - Screenings for STI’s - Treatment for depression - Lifestyle modification (smoking, drinking, obesity) Folic acid to prevent neural tube defects

Know GTPAL and how to use it to show a woman’s obstetrical history

G: gravida: any pregnancy even any losses or if currently pregnant T: term (38-42 weeks) P: preterm (20-37 weeks) A: abortions (spontaneous: unintended loss or miscarry or elective) L: living children

what're the time frames for: term, preterm, post-term, 1st trimester, 2nd trimester, 3rd trimester, viability

- Term: 38-42 weeks - Preterm: at least 20-37 weeks - First: 1-13 weeks - Second: 14-26 weeks - Third: 27-40 weeks - Viability: (capacity to live outside uterus) → around 23-25 weeks

how do you calculate Naegele’s Rule

1. Determine LMP (FIRST day of last normal menstrual period) 2. Subtract 3 months 3. Add 7 days 4. May need to change the year - EXAMPLE: LMP: 3-21-21 March (3) → december, 21 + 7 = 28, 2021) Answer: 12/28/21

What hormone is tested for in pregnancy tests

hCG→ human chorionic gonadotropin

What are the specific recommendations for a pregnant woman’s diet

- Well balanced diet - 64-96 ounces of water daily - 70 grams of protein - Increased fiber - Increased vitamins and minerals (iron 30 mg, folic acid 400 mg) - Prenatal vitamin

What is the recommended weight gain for a woman within a normal BMI

25-35 pounds

Why have spina bifida rates gone down

women have been taking folic acid more

What is the TORCH screen

Detects 5 infections - Toxoplasmosis (from cats) - Other (hepatitis b, HIV, Varicella) - Rubella - Cytomegalovirus (CMV) - Herpes simplex (HSV)

What is quickening and when is it felt

Kicking counts felt at 16-22 weeks

When is HIV testing recommended in pregnancy

test for it at the first OB visit (if women is high risk test again in 3rd trimester)

How does treatment of an HIV positive pregnant mom help the baby in terms of HIV transmission to the infant

When using ART prenatally it decreases viral transmission to 1% or less

Which babies are at risk for Rh incompatibility and why

When the mom and dad are Rh negative and fetus is Rh positive --> this is because the mom will develop antibodies against the Rh antigens in her first pregnancy so when mom becomes pregnant again the baby will have problems if its Rh positive

Who should receive RhoGam and when is it given

- All pregnant women with Rh negative blood type - 72 hours within possible exposure to Rh positive blood

When are FHT’s normally heard

Starting at 10-12 weeks w doppler (110-160 bpm)

What are the testing and treatment guidelines for Group B (Beta) streptococcus infection also know as GBS infection and why is it important to treat

- Screening by recto-vaginal culture between 35-37 weeks on all pregnant woman → treat in labor with penicillin G - it can cause sepsis in the baby later on after contracting infection

When considering cervical dilation, how many centimeters do the following compare to: a penny? Oreo? Bagel?

Penny: 2cm Oreo: 4cm Soda can: 6cm Donut: 8cm Bagel: 10cm

Know VEAL CHOP

V: variable decelerations --> C: cord compression E: early decelerations --> H: head compression A: accelerations --> O: okay L: late decelerations --> P: placental insufficiency

What is the difference between effacement and dilation of the cervix

- effacement: expressed in percentages 0-100 - Dilation: in centimeters (0-10 cm)

What do the following terms mean in relationship to contractions: frequency, duration, and interval

- Frequency: how frequent they happen (from one contraction to the next) - Duration: the length of actual contraction - Interval: relaxation time (period between end of one contraction and the beginning of the next

What are the four P’s affecting labor

- powers: uterine contraction (strength and frequency) - Passage: maternal pelvis and birth canal - Passenger: baby - Psyche: response and mindset of mom

What do Leopold’s maneuvers determine

determine fetal position presentation and placement of electronic fetal monitoring (used in labor)

How do the early, active, and transitional phases of labor compare as far as the number of centimeters dilation

- Early: 0-3cm - Active: 4-7cm - Transition: 8-10cm

What should you document when a mother’s water breaks

T: time A: amount: scant, small, moderate, large C: color: clear, bloody, meconium (first stool of baby) O: odor: foul smell could indicate infection

How are the stations (not stages) of fetal position determined and what is the significance of a minus or positive station

--> -3 to a +3 (Position of fetal head in relation to the fetal spine) - Negative means baby is above ischial spine - zero is baby is aligned with the spine - positive means its below the spine

How are the findings of a Sterile Vaginal Exam documented

- Dilation, effacement, station Example: 5/100%/+2

What do SROM, PROM, and PPROM mean

- SROM: spontaneous rupture of membranes - PROM: premature rupture of membranes - PPROM: prolonged premature rupture of membranes

What is the third stage of labor

- Birth of baby to delivery of placenta - Placental separation: Contracting fundus, gush of dark blood from introitus, feeling vaginal fullness as placenta comes out, lengthening of umbilical cord - Mom doesn't notice placenta coming as much due to the euphoria of having a baby - 5-30 minutes - After placental delivery: profound physiologic changes, BP stabilizes, significant blood loss, repair lacerations after birth, assess fundal height and vaginal bleeding, assess and encourage bonding/breastfeeding/skin to skin

What is the fourth stage of labor

- Immediate postpartum recovery period (up to 4 hours) - Check vitals and fundal every 15 minutes Lochia: (discharge) is moderate rubra → this is after mom has baby

What is a fundal massage and why is it important

Encourages contraction and lessen any postpartum bleeding and pain while uterus contracts to shrink

why is it important to do fungal checks and vitals every 15 minutes post birth

- It's important to watch for hemorrhaging so we can catch it early - Check if fundus is soft or firm - Look for signs or symptoms of shock (low BP and increased HR of mom)

what is the second stage of labor

- 10 centimeters to birth of baby → epidurals can prolonged this stage - Pushing stage - Use a upright position, a ball, squatting, hands and knees - Encourage rest between pushes, room quiet, and use short directions - Have patient bear down and push like they are pooping

what is the first stage of labor and whats it divided into

- 0-10 centimeters and is the LONGEST stage - Divided into 3 stages (early, active, and transition) - Early: irregular mild contractions that increase frequency and duration (go on for days) → 0-3 cm (mom feels excited, in control, and centered on self) - Active: moderate to strong more regular contractions → 4-7cm (mom i smore serious, fatigued, loss of control) - Transition: 8-10cm, frequent and strong contractions with lots of blood (mom is: frustrated, cant walk, N/V, loss of control, irritability) → rectal pressure and wanting to push due to +2 to +3 station

What does APGAR scoring tell you and What are considered acceptable scores, moderate, and severe distress in the newborn

Systematic method for assessing infants condition and transition to extrauterine life at birth - Acceptable: 7-10 - Moderate difficulty: 4-6 - Severe distress: 0-3

What do the letters of APGAR stand for and what is needed for the full 2 points on each

A: appearance→ pink P: pulse→ greater than 100 bpm G: grimace→ cries and pulls away A: activity→ active movement R: respiration→ strong cry

What are three signs of respiratory distress in an infant and describe what each looks like or sounds like

Nasal flaring Grunting Retractions

What are the normal ranges for the following vital signs in newborns: Temp, pulse, respirations

- Temp.: 97.7 to 99.5 degrees - Pulse: 120-160 bpm - Respiration: 30-60 per minute

What is the most common method (site) to take temperatures on neonates and why are some sites not used

The most common site is axillary - Rectal temperatures may be used at times when a core temperature is crucial, but there is a risk of injury so we use axillary first - Oral is contraindicated in neonates and other methods may be less accurate

What causes PHYSIOLOGICAL jaundice and when does it appear

- Immature liver and immature enzyme system - 3-4 days after birth

What causes PATHOLOGICAL jaundice and when does it appear

- Hemolytic disease, Rh incompatibility, prematurity - Within 24 hours of birth

How is jaundice treated

Phototherapy is used

What is meconium and what does it look like

Black, tarry, and sticky and its the first poop of a newborn

Describe the newborn startle (or Moro) reflex

“Startle reflex” → when a baby is startled by a noise and throws back head and extends the arms and legs, cries, and then pulls extremities back in

Describe the newborn Babinski/plantar grasp reflex

When sole of foot is firmly stroked and the big toe bends back towards top of the foot and other toes fan outward

describe the palmar grasp reflex

an involuntary movement where babies can grip things very hard with their hands (the "death grip")

Why do babies need a Vitamin K injection

Prevents hemorrhaging disease

What immunization is given to babies in the hospital and what muscle is it injected into

Vitamin K → IM given in the vastus lateralis

Why is Erythromycin Eye Ointment administered to all newborns and when should it be given

- to prevent ophthalmia neonatorum due to gonorrhea/chlamydia - Within 1-2 hours of birth

Explain how to use a bulb syringe on a newborn

Compress syringe and place inside of mouth on one side of choking/congestion

Explain cord care for a newborn

- Clean with warm water if soiled - Let cord sir dry - Keep on outside of diaper (fold diaper down) - Clamp is removed once the stump is dry and baby is ready for discharge - rest falls off within 10-14 days

Explain circumcision care for a newborn

- Assess for bleeding (circ check) - Avoid wipes (water and washcloth only) - Apply vaseline with every diaper change

What are Mongolian spots, where are they likely seen, and what can they be mistaken for

- Bluish-gray spots seen on base of the spine or buttocks or shoulders - Benign spots not associated with any conditions (african american or asian babies are more likely to have these posts) - Mistaken for child abuse

What is molding

Abnormal head shape on the babies head due to pressure from child birth

Define lanugo and vernix

- Lanugo: small soft thin hairs that cover the babies extremities -Vernix: thick cheese like substance that covers the baby especially in the creases

When is the hearing screen done in newborns and why is it important

- Before an infant is discharged (1 month typically) - To see if infants can hear or not

How should a newborn be dressed and how can parents check to see if the infant is warm enough

Dress similar to adult and add one additional light layer of clothing

What are factors that influence a mother's decision to breast or bottle-feed?

financial reasons, marital status, education, culture, father’s attitude, etc

What are signs of neonatal hypoglycemia (low blood sugar)

- Shakiness - Blue tint to skin and lips (cyanosis) - Stopping breathing (apnea) - Low body temperature (hypothermia) - Floppy muscles (poor muscle tone) - Not interested in feeding. - Lack of movement and energy (lethargy) - Seizures

What are the four methods of heat loss and give an example of how each method could contribute to heat loss in an infant.

- evaporation of water from your skin if it is wet (sweating) - Radiation (similar to heat leaving a wood stove) - Conduction (such as heat loss from sleeping on the cold ground) - Convection (similar to sitting in front of a fan or having the wind blow on you)

How is bilirubin excreted from the body and what are the potential harmful effects to an infant who has excessive bilirubin levels

Pooping and peeing - Jaundice can happen in infants with high bilirubin levels (hyperbillirubiin)

Why is “skin to skin” so important for a baby

Newborn benefits: - Stabilizes respirations and oxygenations - Increases glucose levels - Maintains temperature - Supports optimal brain development

When is APGAR scoring done

Just after birth of the baby