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INTENSIVE FINAL COACHING - NP2 INTENSIVE FINAL COACHING - NP2 Presentation Transcript

  • INTENSIVE FINAL COACHING NURSING PRACTICE 2
  • NURSING PRACTICE 2
    • Obstetrics Nursing
    • Pediatric Nursing
    • Community Health Nursing
  • BEMOC
    • 6 functions of BEMOC:
    • 1 st  PARENTAL ADMINISTRATION of OXYTOCIN in the 3 rd stage of labor
    • 2 nd  PARENTERAL ADMIN of LOADING DOSE of ANTI-CONVULSANTS
    • 3 rd  PARENTERAL ADMIN of INITIAL DOSE of Abx
    • 4 th  Performance of assisted deliveries
  • BEMOC
    • 5 th removal of retained products of conception
    • 6 th manual removal of retained palcenta
  • CEMOC
    • 6 functions + assisting in CS and providing BT
  • ESSENTIAL PROCEDURES in OB
    • ALPHA-FETO PROTEIN
    • Purpose:
    • To assess the presence of neural tube defects and Down syndrome
    • Indication:
    • Increase AFP  NEURAL TUBE DEFECT
    • Decrease AFP  DOWN’s SYNDROME
  • IMPORTANT NOTES on AFP:
    • AFP  is a GLUCOPROTEIN produced by fetal yolk sac, GI tract and liver
    • test is done between 16 and 18 weeks of gestation
  • AMNIOCENTESIS
    • Purpose:
    • To assess the fetal growth and maturity, and to determine the genetic disorders and sex of the fetus.
    • NOTES:
    • test done between 14-16 weeks  to assess the chromosomal aberrations
    • test done after 35 weeks  to assess the fetal lung maturity
  • Important notes of amniocentesis
    • VOID first
    • Position  SUPINE
    • L/S ratio  2:1 indicates fetal lung maturity
    • Advise the client to report:
      • fetal hyperactivity
    • COMPLICATIONS: placental, cord and bladder puncture
  • BIOPHYSICAL PROFILE
    • To assess:
      • FETAL BREATHING MOVEMENTS – (0-2)
      • BODY MOVEMENTS – (0-2)
      • MUSCLE TONE – (0-2)
      • REACTIVE HEART RATE – (0-2)
      • AMNIOTIC FLUID – (0-2)
    • To identify  ASPHYXIA
  • CHORIONIC VILLI SAMPLING
    • PURPOSE:
    • To determine the chromosomal or genetic disorders in the fetus. It is the earliest test possible on fetal cells.
    • Sample obtained by SLENDER CATHETER passed through the cervix.
  • CONTRACTION STRESS TEST
    • PURPOSE:
    • to determine that a HEALTHY FETUS can withstand DECREASED O2 during contraction but a COMPROMISED FETUS CANNOT.
  • Important notes In cst:
    • 2 types:
    • Nipple-stimulated CST:
    • - Massage or rolling of nipples
    • - check the FHR
    • OCT (Oxytocin challenge test)
    • - “piggy-back”
    • - controlled by infusion pump
    • - increase every 15-20 minutes until 3 good contractions in 10 minutes
  • FETAL MOVEMENT COUNT
    • Notes:
    • - 5-6 movements per counting time.
    • - teach the mother to count 2-3 times daily
    • - 30-60 minutes each time
  • FETAL HEART MONITORING
    • Early deceleration
    • Indication: FETAL HEAD COMPRESSION
    • What to do: NONE
    • Late deceleration
    • Indication: PLACENTAL INSUFFICIENCY
    • What to do: Administer o2
    • Variable deceleration
    • Indication: CORD COMPRESSION
    • What to do:
    • - lateral recumbent pos and give o2
  • GUTHREI CAPILLARY BLOOD TEST
    • PURPOSE:
    • To screen PKU
    • NV: 2mg/dL
    • What to do:
      • Give high protein diet 24-24 hours BEFORE the test
  • HYSTEROSALPHINGOGRAPHY
    • PURPOSE:
      • Check PATENCY
    • NOTES:
      • done in PRE-OVULATORY PHASE
      • contraindicated in pregnancy (bcoz of dye)
  • LEOPOLD’s MANEUVER
    • POSITION:
      • DORSAL RECUMBENT  to relax the abdomen
    • NOTES:
      • Warms hands
      • Use pal not fingers
      • 1 st maneuver: FETAL PRESENTATION
      • 2 nd maneuver: FETAL BACK and FHR
      • 3 rd maneuver: ENGAGEMENT
      • 4 th maneuver: FETAL ATTITUDE
  • NOTES on LM:
    • 1 st ,2 nd ,3 rd maneuver  facing the HEAD PART
    • 4 th maneuver  facing the FOOT PART
  • Lecithin/sphingomyelin
    • NOTES:
      • To assess FETAL LUNG MATURITY
      • 35-36 weeks lungs is at mature level
      • If not mature, what to do?  give BETAMETHASONE (as ordered)
  • Non-stress test
    • PURPOSE:
      • To assess the fetal activity and well being
    • NOTES:
      • REACTIVE TEST: NORMAL FHR + >15 bpm = 15 mins or more
      • NON-REACTIVE TEST: NORMAL FHR + <15 bpm = 15 minutes  INDICATION: FETAL JEOPARDY
      • ACCELERATONS of HR means NORMAL
      • Monitor FHR in 30 minutes
  • PUBS
    • PERCUTANEOUS UMBILICAL BLOOD SAMPLING
    • PURPOSE:
      • to locate umbilical cord and detect chromosomal abnormalities
    • NOTES:
      • Do not void before the procedure
      • Use during 2 nd and 3 rd trimister
  • SWEAT CHLORIDE TEST
    • PURPOSE:
      • To detect CYSTIC FIBROSIS
    • NOTES:
      • Normal CHLORIDE level: 90-110 mg/dL(serum)
      • Normal SWEAT level: 10-35 mEq/L
      • >60 mEq/L of SWEAT means CYSTIC FIBROSIS
  • LOCHIA
    • RIYADH-SAUDI-ARABIA
    • RUBRA-SEROSA-ALBA
    • RUBRA (reddish)  1-3 days
    • SEROSA (brownish/pinkish)  4-10 days
    • ALBA (whitish)  10-14 days  up to 3 weeks – 60 days
  • OB PHARMA
    • Dimercaprol  ANTIDOTE in LEAD POISONING  Give IM
    • BETAMETHASONE  for fetal lung maturity  give 48 hrs before delivery
    • MAGNESIUM SULFATE  ANTICONVULSANTS
      • Monitor 3 signs  DTR, U/O, RR
    • PITOCIN (Oxy)  Oxytocic  induce labor
  • OB PHARMA
    • RhoGAM  prevents ERYTHROBLASTOSIS FETALIS
    • VITAMIN K  prevent fetal bleeding
    • YUTOPAR (Ritrodrine)  TOCOLYTIC
      • Relax UTERUS
  • 4 stages of human sexual response
    • 1 st EXCITEMENT
      • ARTERIAL DILATION and VENOUS CONSTRICTION
    • 2 nd PLATEAU
      • CBQ  REACHED FIRST BEFORE ORGASM
      • Women: Formation of ORGASMIC PLATFORM and NIPPLE ENGORGEMENT
      • Men: FULL DISTENSION OF PENIS
    • 3 rd ORGASM
      • Discharge
      • CBQ  SHORTEST STAGE
    • RESOLUTION
      • External and Internal organs return to unaroused state
      • Generallt takes 30 MINUTES
  • MENSTRUAL CYCLE
    • MENSTRUAL
    • PROLIFERATIVE
    • SECRETORY
    • ISCHEMIC
  • PHASES of menstrual cycle
    • MENSTRUAL
      • 1-5 days
      • LOW ESTROGEN
    • PROLIFERATIVE
      • 6-14 days
      • HIGH ESTROGEN
      • THICK ENDOMETRIUM
      • CLEAR MUCUS
    • SECRETORY
      • 15-24 days
      • HIGH PROGESTERONE
      • INCREASE BLOOD FLOW TO THE UTERUS
    • ISCHEMIC
      • 25-28 days
      • DECREASED ESTRO and PROGESTERONE
      • MENSTRUATION BEGINS
  • IMPORTANT NOTES
    • 2-5 days  average menstruation days
    • 30-40 mL avergae blood loss
    • 40-45 years old  start MENOPAUSAL
    • 55 years old  start of TESTOSTERONE declines
  • FUNCTIONS OF HORMONES Estrogen Progesterone 1. inhibits FSH release 1. inhibits LH release 2. cause proliferation of endometrial lining 2. increases vascularity in the uterus 3.  cervical mucous production (+ spinnbarkeit) 3. maintains the course of pregnancy 4. causes water retention
  • FETAL GROWTh
    • OVUM  from ovulation - fertilization
    • ZYGOTE  from fertilization - implantatn
    • EMBRYO  from implantation-5-8 weeks
    • FETUS  5-8 weeks to term
    • CONCEPTUS
  • SIGNS and symptoms of pregnancy
    • PRESUMPTIVE SIGNS
      • Amenorrhea
      • Breast changes
      • QUICKENING
      • N&V
      • Urinary Frequency
  • SIGNS and symptoms of pregnancy
    • PROBABLE SIGNS
      • Abdominal changes
      • Hegar’s sign
      • Goodell’s sign
      • Uterine growth
      • Ballotement
      • Braxton’ Hicks Contraction
      • Chadwicks sign
  • SIGNS and symptoms of pregnancy
    • POSITIVE SIGNS
      • Fetal parts
      • UTZ
      • FHR
  • MASTERY DRILL
    • Abdominal striae
    • Amenorrhea
    • Balotement
    • Braxton’s Hicks contraction
    • Breast tenderness
    • FHR
    • Goodell’s sign
    • Hegar’s sign
  • MASTERY DRILL
    • Nausea and vomiting
    • (+) pregnanct test
    • QUICKENING
    • UTZ
    • Urinary frequency
  • DISCOMFORT DURING PREGNANCY
    • Ankle edema
    • What to do: ELEVATE
    • Back ache
    • What to do: PELVIC ROCK EXERCISE
    • Breast tenderness
    • What to do: SUPPORTIVE BRA
  • DISCOMFORT DURING PREGNANCY
    • Constipation
    • What to do: Increase FLUID & FIBER
    • Dyspnea
    • What to do: HOB elevated
    • Fatiue
    • What to do: Frequent rest periods in between activities
  • DISCOMFORT DURING PREGNANCY
    • Constipation
    • What to do: WALKING
    • Ptyalism
    • What to do: CHEW sugarless gum
    • Leg cramps
    • What to do: DORSIFLEX the toes
    • Nasal stuffiness
    • What to do: Apply cool moist air
  • NOTES
    • Backache  relieved by using PELVIC ROCK EXERCISE
  • EXPECTED WT GAIN DURING PREGNANCY
    • TOTAL WEIGHT GAIN: 20-25 lbs
    • 1 st trimester:
    • - 1 lb /month  3-4 lbs total
    • 2 nd trimester:
    • - 0.90 lb / week  10-12 lbs total
    • 3 rd trimester:
    • - 0.50 lb / week  8-11 lbs total
  • NOTES
    • The pregnant women needs additional 300 calories per day
    • Lactating mother needs 500 calories per day
    • The pregnant FILIPINO client needs approximately 2140 calories/day
    • 3-4 servings/day of vegetables of pregnant
    • The pattern of weight gain is more important than the amount of weight gain
  • NOTES
    • IRON intake of 2 tablets/day  start at 5 th month to 2 months postpartum
    • CHLOROQUINE 2 tablets  for malarial infested areas in whole duration of pregnancy
    • 3-4 glasses of MILK/day  pregnant
    • HBMR  pink in color (pregnancy care package)
  • EXERCISES in PREGNANCY
    • PELVIC TILT
      • Backache
      • strengthen abdominal muscles
  • EXERCISES in PREGNANCY
    • TAILOR-SITTING
      • STRETCHES muscles of inner thigh
  • EXERCISES in PREGNANCY
    • SQUATTING position
      • Straighten the birth canal
  • EXERCISES in PREGNANCY
    • KEGEL’S EXERCISE
      • strengthens the PUBOCOCCYGEAL MUSCLES and PELVIC FLOOR MUSCLES
  • PRENATAL VISITS
    • 1  1-3 months
    • 1  4-6 months
    • 2  7 th month
    • 4  8-9 th months
  • FORMULAS
    • NAGELE’S RULE  determine EDC
      • -3 months
      • + 7 days
      • + 1 year
    • McDonald’s RULE  determines AOG
      • Start from 22 weeks to term
      • FH(cm) x 8/7 = AOG in weeks
      • FH(cm) x 2/7 = AOG in LUNAR MONTHS
  • EXAMPLE
    • LMP October 20, 2008, fundic height, 28 cm
      • EDC __________________
      • Ans: July 27,2009
      • AOG: ________________
      • Ans: 28 x 8/7
  • OB HISTORY
    • _______________ number of pregnancies regardless of outcome
    • _____________ number of pregnancy that reach the age of viability
  • OB HISTORY
    • G
    • P
    • T – erm ( 38-42 weeks)
    • P – re-term ( 20-37 weeks)
    • A – bortion ( before viablity)
    • L
    • M
  • EXAMPLE
    • This is my first pregnancy. I am on my 27 th week. I have not been pregnant before.
    • Ans: _____________________
    • 1-0-1-0-0
  • FALSE LABOR TRUE LABOR
    • F  IRREGULAR
    • P  confined to hospt’l
    • W – Releived by walking
    • BS - ABSENT
    • F – REGULAR
    • P – radiates from lumbo-sacral to abdomen
    • W- Intensified
    • BS  PRESENT
  • METHODS OF DELIVERY
    • READ METHOD
      • Classes in RELAXATION and ABDOMINAL BREATHING TECHNIQUES
    • LAMAZE METHOD
      • BREATHING, EFFLEURAGE, RELAXATION
    • LAMAZE METHOD
      • Husband-coached child birth
  • MECHanism OF LABOR
    • D
    • E
    • F
    • IR
    • E
    • ER
    • E
  • STAGES OF LABOR
    • FIRST STAGE OF LABOR
      • Onset of TRUE LABOR to FULL cervical diatation
      • LATENT  0-3cm
      • ACTIVE  4-7cm
      • TRANSITIONAL  8-10 cm
  • STAGES OF LABOR
    • LATENT
      • excited and happy
      • inform the progress of labor
    • ACTIVE
      • give narcotic analgesics
      • praise and encourage the client
    • TRANSITION
      • irritable, circumoral pallor
      • monitor the progress of labor
  • NOTES
    • If narcotic analgesic is given on transition stage it will cause RESPIRATORY DEPRESSION
    • Primiparas are normally not taken in the delivery room until the perineum is bulging
    • THE PRIMARY REASON OF EPISIOTOMY  help prevent prolonged pressure on fetal head
    • the NITRAZINE TEST -> to differentiate URINE and AMNIOTIC FLUID
  • NOTES
    • CROWNING occurs at the SECOND STAGE OF LABOR
    • in 2 nd stage of labor  encourage to PUSH DOWN
    • SIM’s position or KNEE CHEST pos  to lessen the pregnant client discomfort
    • to prevent RESPI ALKALOSIS  use PAPER BAG
  • NOTES
    • The UMBILICAL CORD is CLAMP  after no pulsation
    • clear the mucus in the MOUTH first then NOSE of the newborn
    • BONDING begins during the first hour of pregnancy
    • Eye drops  for PROPHYLAXIS  apply at LOWER CONJUNCTIVA
  • NOTES
    • FREQUENCY  beginning of contraction to the end of contraction
    • DURATION  beginning of first contraction to the beginning of second contraction
    • INTENSITY  mild, moderate and strong.  PEAK
  • NOTES
    • FHR normal 120-160. During contraction FHR DECREASES normally
    • FHR ausculation is done during NO UTERINE COTRACTION.
    • FHR ausculation is done also DURING UTERINE CONTRACTION but for 30 seconds only to identify the changes
  • ABORTION
    • Types of abortion:
      • Threatened
      • Inevitable
      • Complete
      • Incomplete
      • Missed
      • Septic
      • Recurrent/Habitual
  • INEVITABLE
    • Abdominal Pain
    • Ans: Moderate
    • Vaginal Bleeding
    • Ans: Moderate
    • Cervix
    • A ns: OPEN CERVIX
  • INCOMPLETE
    • Abdominal pain
    • Ans: SEVERE
    • Vaginal bleeding
    • Ans: SEVERE
    • Cervix
    • Ans: OPEN CERVIX
  • INEVITABLE / INCOMPLETE
    • Abdominal Pain
    • Ans: Moderate
    • Vaginal Bleeding
    • Ans: Moderate
    • Cervix
    • Ans: OPEN CERVIX
    • Abdominal pain
    • Ans: SEVERE
    • Vaginal bleeding
    • Ans: SEVERE
    • Cervix
    • Ans: OPEN CERVIX
  • HABITUAL/RECURRENT
    • 3 or more episodes of abortion
  • Threatened / INEVITABLE
    • Abdominal Pain
    • Ans: MILD
    • Vaginal Bleeding
    • Ans: MILD
    • Cervix
    • Ans: CLOSED CERVIX
    • Abdominal Pain
    • Ans: Moderate
    • Vaginal Bleeding
    • Ans: Moderate
    • Cervix
    • Ans: OPEN CERVIX
  • MASTERY DRILL
    • Moderate bleeding and open cervix
      • Ans: INEVITABLE
    • Mild bleeding and closed cervix
      • Ans: THREATENED
    • Severe bleeding and open cervix
      • Ans: INCOMPLETE
    • No fetal movement
      • Ans: MISSED
  • P.P A.P
    • Painless
    • BRIGHT RED BLEEDING
    • SOFT, BOGGY UTERUS
    • Types:
      • marginal
      • partial
      • total
    • Painful
    • DARK RED VAGINAL BLEEDING
    • BOARD-LIKE UTERUS
    • Types:
      • partial
      • marginal
      • total
      • central
  • GESTATIONAL HPN
    • Occur AFTER 20 th week
    • signs  EDEMA of hands  “RING FINGER”
    • 2 types:
    • PRE-ECLAMPSIA
      • proteinuria
      • BP increased
      • EDEMA/wt gain
    • ECLAMPSIA  3 s/sx + CONVULSION
  • WHAT TO DO:
    • CBR
    • DARKENED ROOM
    • INCREASED PROTEIN
    • Left lateral position
    • Increase UTERINE and RENAL blood flow
    • Administer MgSO4 as prescribed
      • DTR INCREASED
      • RR DECREASED
      • U/O DECREASED
  • NOTES
    • PIH  common cause of death among pregnant mothers
    • HOME CARE  is effective in managing mild pre-eclampsia
    • SEVERE pre-eclampsia  is managed in the HOSPITAL (MgSO4)
    • ECLAMPSIA  Priority is SAFETY of mother and fetus
  • CARDIAC DISEASES
    • CLASS I  no signs of discomfort
    • CLASS II  ordinary physical activity may result in discomfort
    • CLASS III  little activity cause discomfort
    • CLASS IV  discomfort experience at rest
  • RUBIN’s POST PARTUM PHASE
    • TAKING-IN PHASE
      • 1-3 days
      • mother is “SELF-CENTERED”
    • TAKING HOLD
      • 3 days – 2 weeks
      • mother is “INDEPENDENT”
    • LETTING GO
      • 10 days/2 weeks to 6 weeks
      • mother integrates her new role
  • NOTES
    • CRYING and INSOMIA  are common manifestations of post-partum blues
    • 4 th -5 th day  onset of post partum blues
    • perineal pad is saturated within an hour  HEAVY LOCHIAL DISCHARGE
    • PAIN in the perinea  most common symptom of perineal hematoma
    • SITZ BATH  most common method for relieving discomfort from episiotomy
  • NOTES
    • The correct method of cleaning the perineum is from FRONT to BACK
    • BREAST ENGORGEMENT  usually occurs on the 3 rd post partum day.
  • notes
    • Fever  >38 degrees on day 2 to 10 is the important sign of post partum infection
    • Blood loss of 500 mL or more during and after delivery (first 24 hours)
    • DIC  occur at 24 hours and within 7-14 days post partum
  • NOTES
    • Elevation of mother’s temperature 24 hours after delivery  NORMAL
    • BRADYCARDIA after delivery is normal
    • the FUNDIC HEIGHT decrease 1 fingerbreadth or 1 cm per day
  • CCOMPOSITION OF MILK
    • 1 st week of lactation
      • Colustrum  High IgA
    • 7-10 days after lactation
      • TRANSITIONAL MILK  Low IgA
    • After 2 weeks of lactation
      • MATURE MILK  has 20 kcal/oz nutrients for infants needs
  • FAMILY PLANNING METHOD
    • Cervical mucus  bawal magjerjer from first day to 4 th day of slippery dischrages
    • BBT
      • avoid sex from 1 st day – 3 rd day of menstrual bleeding
    • SYMPTOTHERMAL
      • BBT + CERVICAL SECRETIONS
  • FAMILY PLANNING METHOD
    • LAM
      • 6 months only
      • BREASTFEEDING  8-10 times a day
    • ORAL CONTRACEPTIVES
      • s/e IRREGULAR BLEEDING, MISSED PERIODS and REDUCE MILK PRODUCTION
    • DEPO
      • 3 months effective
      • contain PROGESTIN
      • Changes in vaginal bleeding is normal
  • FAMILY PLANNING METHOD
    • NORPLANT
      • place in UPPER ARM 8-10 cms above elbow crease
      • 5 years effective
      • effective 24 hours after insertion
      • s/e  HIRSUTISM, wt loss
  • FAMILY PLANNING METHOD
    • BTL
      • permanent
      • reversal surgery is possible but DIFFICULT
      • before surgery  NPO
      • after surgery  REST, avoid sex for at least 1 week
      • REPORT if  high fever in 4 weeks
  • FAMILY PLANNING METHOD
    • Vasectomy
      • permanent
      • STERILITY is NOT IMMEDIATE
      • fully effective only 20-25 ejaculations or 1-3 months
  • FAMILY PLANNING METHOD
    • IUD
      • check the IUD on the first month of insertion
      • How to check  SQUATTING position  insert 1-2 fingers into vagina  feel the strings
  • FAMILY PLANNING METHOD
    • Vaginal methods
      • spermicide, diaphragm, cervical cap
      • spermicides  1 hour before sex
      • diaphragm or cervical cap  ahead of time before sex
      • AVOID DOUCHING 6 hours AFTER
      • use of CERVICAL CAP may affects the result of Pap’s smear
  • notes
    • SMOKING  is contraindicated if taking ORAL CONTRACEPTIVES
    • cervical cap  requires refitting by a physician every 2 years. After delivery or after weight gain or weight loss 15-20 lbs
  • MY OBSTRETICS NOTES:
    • MCHN = is involved NURSING PROCESS, EVIDENCE-BASED PRACTICE and NURSING THEORY
    • Abuse is more common than before = nursing care is preserving the evidence
    • CBR = number of birth over the total population multiply by 1000. It is an indicator in the increased of population
    • CDR = total number of DEATH over the total number of population multiply by 1000. It is an indicator of decreased in population.
    • 15 – 44 yo = is the child bearing age
    • FDR = fetal death in utero weighing 500 grams in uterus
    • Death of fetus is usually cause by = MATERNAL DISEASE
    • PREMATURITY – is the number 1 cause of fetal mortality
    • HYPERTENSION = is the common cause of maternal mortality
    • IMR = index in fetal death
    • NURSE – MIDWIFE  attend uncomplicated birth
    • Law suit – usually occur in PERINATAL COMPLICATIONS
    • Family types:
    • Dyad family = no child, unmarried, living together
    • NUCLEAR family = with children, married
    • COHABITATION family = not married , living together
    • Extended family
    • Blended Family
    • Communal family = “kulto”
    • Foster family
    • Gay / lesbian family
    • Adoptive family
    • Extended (multigenerational ) family
    • INTRAUTERINE LIFE – is the starts childbearing
    • Hypothalamus –is the thermoregulation system of the bod.  realease GnRH  triggers APG  released FSH and LH  Androgen ( sex hormone )
    • APG ( releases 7 hormones) and PPG ( 2) = ADH and Oxytocin
    • MENARCHE  first menstruation; THELARCHE  breast development and ADRENARCHE  pubic hair growth
    • Androgen is release by adrenal cortex, testis (male ) and ovary ( female)
    • Nitric oxide – is the cause of vasodilation in male penis erectile
    • ISCHICAVERNOSUM – is the muscle that is responsible for contarcion and blocking the blood supply to the penis .
    • LEYDIG CELLs- release
    • Fourchette – is the site of episiotomy
    • Perineal body – is the site of KEGELS EXERCISE to strengthen muscle
    • Sac / follicle: 5-7 M in utero ; 2M at birth ; 500,000 age 7 yo and 300 at age 2
    • MENOPAUSE = the point at which no fxn oocytes remain in the uterus
    • INFERTILITY  not able to conceive after 1 year of sex (atleast)
    • STERILITY  inability to conceive bcoz of known condition
    • ISTHMUS  is the site of BTL and the site of Ectopic pregnancy
    • Ampulla  site of fertilization of fecundation
    • Interstitial  2 cm
    • Fallopian tube  is an oviducts
    • Doderleins bacilli  make the vagina acidic , rich in glycogen
    • DO NOT DOUCH daily  alter the acidity of the vagina causing bacterial invasion
    • ROUND LIGAMENST  causing the the uterus to be steady ‘
    • The OVARIES (lateral fornix) anterior of it is BLADDER and posterior of it is RECTUM .
    • Ischium = is the bone that seat
    • SACRUM  is the landmark in pelvic measurement
    • False Pelvis  superior half ; True Pelvis  inferior half
    • Gynecoid is the ideal pelvis for female and Androis for male
    • Placenta – 15-20 cotyledons
    • Menarche ; 9-17 yo with an average of 12.5 yo; cycle = 25-35 days ; duration 2-7 days (A. 4-6 days); flow 10 -75 ml (A: 30 ml ) . Menopause ( 45 – 55 yo)
    • Estrogen = release in ovaries and progesterone = release in placenta and corpus luteum
    • ESTROGEN = hormone of women and PROGESTERONE = hormone of pregnancy
    • FOLLICULAR phase  1-14 days and LUTEAL phase  15-22 yo
    • Sexual orientation and sexual expression is totally different. SO  refers to homo, hetero, bisexual, transsexuals. SE  fetish, transvestism, sadomasochism
    • CALENDAR METHOD  monitor your menses in 6 to 12 periods and subtract lowest days to 18 as constant and the highest number of days 11 . The difference is the fertile period.
    • Basal Body temperature  3 days before PEAK of estrogen and 3 days after fertilization means FERTILE. The temperature should be taken only at least 3 hours of sleep.
    • CERVICAL MUCUS METHOD  cloudy and thick = can’t swim / infertile ; thin and watery = fertile
    • WITHDARWAL = means CERVICAL INTERRUPTUS.
    • Cervical cap and diaphragm  6 hours stay and remove before 24 hours
    • CERVICAP CAP  is not usually recommended because it result to TSS ; fit snugly
    • ORAL CONTRACEPTIVES  combine estrogen and progesterone while MINIPILLS  has progestin only
    • BTL  resume sex after 2-3 days
    • SQ injections (Depo-povera)  injected every 3 months and is effective in 5 years
    • diaphragm  stop using once you gain weight ( 15-20 lbs)
    • INVOLUTION  return of the uterus to its pre-pregnant state normally 6-8 weeks after pregnancy
    • Non- Breastfeeding mother will resume menstruation in 4 – 6 weeks after pregnancy
    • Life-span of OVUM  24-48 hours and SPERM  24-72 hours
    • PRE-EMBRYONIC STAGE:
    • Encompasses first 14 days after conception
    • ECTODERM
    • Tooth enamel, CNS , PNS, sebaceous, skin, hair, nails and mammary glands
    • MESODERM
    • Dentin of teeth , heart, circulatory system , blood cells , lymph vessels , Upper Respiratory system and suppository structures (connective tissue)
    • ENDlODERM
    • Iining of pericardial, pleura and peritoneal cavities
    • Lining of GIT, RT, parathyroid and thyroid, tonsils , Lower urinary system
    • DECIDUA  “ falling off” means endometrium
    • DECIDUA Basalis  forms the maternal side of the placental
    • DECIDUA capsularis  overlies the embryo
    • DECIDUA vera  doesn’t come in contact with the fetus
    • DECIDUA  “ falling off” means endometrium
    • DECIDUA Basalis  forms the maternal side of the placental
    • DECIDUA capsularis  overlies the embryo
    • DECIDUA vera  doesn’t come in contact with the fetus
    • hCG  seen in pregnancy test , first hormone release In placenta
    • Hormone in placenta  hCG, hPL, estrogen and progesterone
    • Normal Amniotic fluid  800-1200 ml . It is said in OLIGOHYDRAMNIOS phase  <300 ml and POLYHYDRAMNIOS  > 2000 ml . It si called as fetal drink . 98 % - 99 & water and 1-2% electrolytes
    • ESPHAGEAL ATRESIA and HIRCHSPRUNG  fetal congestion d/o associated with polyhydramnios
    • KIDNEYS  fetal organ affected in clients with oligohydramnios
    • CHORION is outside and AMNION is inside
    • PLACENTA  formed in 8 weeks, it function as circu, endo, respi and GIT; formed by union of chorionic and deciduas basalis
    •  
    •  
  • PEDIATRIC NURSING
    • APGAR  1 st minute and 5 minutes after birth
      • A-P-G-A-R
      • 1 st minute  adaptation to extrauterine life
      • 5 th minutes  overall status
    • ESTABLISHING A PATENT AIRWAY
      • suction MOUTH first before NOSE
      • Manifestation of respi distress
        • persistent cyanosis, retractions, flaring nostrils
  • NOTES
    • Suction MOUTH first before NOSE
      • to prevent aspirations of secretions
      • start M then N
    • Vigorous suctioning  bradycardia
  • COLD STRESS
    • Hypothermia
    • Hypoglycemia
    • EVAPORATION  is the major cause of heat loss after delivery because the baby is bathed in amniotic fluid. It is best to completely dry the baby.
  • HEAT LOSS
    • When newborn is placed on cool surfaces
      • Ans: CONDUCTION
    • Heat loss by the air current in the nursery
      • Ans: CONVECTION
    • cool objects that are not direct contact with the baby
      • Ans: RADIATION
    • loss of heat because of moisture due to the amniotic fluid at birth
      • Ans: EVAPORATION
  • NOTES
    • ___________ prophylaxis to prevent against OPTHALMIA NEONATORUM
    • ___________ antibiotic used in eye prophylaxis
    • ___________ 1% eye drops that is used as eye prophylaxis
    • ___________ Vitamin K route and site
  • BREASTfeeding
    • 8-10 times/day
    • 15-20 minutes per breast
    • sufficient in 6 months
    • CHIN touching the breast
    • MOUTH wide open
    • LOWERLIP OUTWARD
    • More areola above than below
  • RA 9288
    • Done after 24 hours – 48 hours – 72 hours
    • 5 diseases:
      • CAD
      • CH
      • GALACTOSEMIA
      • PKU
      • G6PD
  • RA 9288
    • CH  ____________________
      • MENTAL RETARDATION
    • CAD  ___________________
    • GALACTOSEMIA  _________________
    • PKU  _____________________________
    • G6PD  ___________________________
  • DEVELOPMENTAL MILESTONE INFANCY
  • 2 months SOCIAL SMILE
  • 6 months
    • FIRST TEETH
    • DOUBLES WEIGHT
  • 7 months
    • CRAWLS
  • 8 months
    • PALMAR GRASPS
  • 9 months
    • CREEPS
  • 10 months
    • FIRST WORD
  • 12 months
    • STANDS
    • TODDLERS
  • 12 months
    • TRIPLES the BIRTH WEIGHT
  • 15 months
    • goes up the stairs
    • Walks ALONE
  • 2 years old
    • Handles a spoon well
  • 3 years old
    • RIDES a TRICYCLE
    • PRE-SCHOOLERS
  • 4 years old
    • Doubles the weight
  • 5-6 years old
    • RIDES A BICYCLE
  • MASTERY DRILL
    • SOCIAL SMILE ____________
    • FIRST TEETH _____________
    • DOUBLES WEIGHT ________
    • CRAWLS ____________
    • PALMAR GRASPS ___________
    • CREEPS ________________
  • MASTERY DRILL
    • FIRST WORD
    • STANDS
    • TRIPLES the BIRTH WEIGHT
    • goes up the stairs
    • Walks ALONE
    • Handles a spoon well
    • RIDES a TRICYCLE
  • NOTES
    • Introduction of foods in the infant should be done between 4-6 months
    • introduce food every 3-5 days  to identify allergy
    • PEANUT  1 yo
    • EGG  2 yo
    • FISH  3 yo
  • NOTES
    • Egg white  introduced 2 yo
    • Egg yolk  introduce 4-5 months
    • 3 yo  300 – 800 words
    • 4 yo  1500 words
    • 5 yo  2000 words
    • The use of toothbrush and toothpaste  2-3 yo
  • GROWTH and DEVELOPMENT
    • TODDLERS (1-3 years)
      • Always says “No”
      • Autonomy vs Shame and Doubt
      • Oedipal stage
      • Ritualism
      • Sibling rivalry
      • Solitary play
      • temper tantrums
      • throws ball overhead
  • GROWTH AND DEVELOPMENT
    • TODDLERS (1-3 yo)
      • toilet training (bowel)
      • 2-3 word sentences
  • GROWTH and DEVELOPMENT
    • PRE-SCHOOLERS (3-5 yo)
      • Always ask “WHY”
      • Associative play
      • 4-5 sentences
      • TRICYLCLE RIDING
      • Handedness
  • GROWTH and DEVELOPMENT
    • SCHOOL AGE (6-12 yo)
      • Capable of telling time
      • peer socialization
      • Sense of Industry
      • Mature gross and fine motor
      • Moral development
  • GROWTH and DEVELOPMENT
    • ADOLESCENCE (12-19 years)
      • Growth spurt
      • Sense of identity
      • Secondary sex characteristics
  • MAsTERY DRILL
    • Mature gross and fine motor
    • Growth spurt
      • Secondary sex characteristics
    • Mature gross and fine motor
      • Always ask “WHY”
    • Mature gross and fine motor
    • TRICYLCLE RIDING
  • KAWASAKI DISEASE
    • Multi-system vasculitis
    • DOC: ASPIRING
    • PS: STRAWBERRY TOUNGUE
    • s/sx: SPIKING 5 days
    • Dx tst: ESR
  • ACUTE LYMPHOCYTIC LEUKEMIa
    • Proliferation of IMMATURE WBC
    • Lab: WBC 150, 000 /mm3
    • NsgDx: Risk for infection
    • Instruct the client to avoid CROWD PLACES
    • ALLOPURINOL  is given to a child undergoing chemotherapy to DECREASE URIC ACID PRODUCTION
  • ACUTE LYMPHOCYTIC LEUKEMIa
    • Bone-marrow aspiration  definitive dx for leukemia
    • JAW PAIN  taking VINCRISTINE SULFATE should be reported to the physical immediately
    • ANTI-EMETICS  are best given 1 hour before beginning chemotherapy and every 2-6 hours for the next 24 hours
  • CROUP (laryngotracheobronchitis
    • CROUP (laryngotracheobronchitis)
    • S/sx: BARKING COUGH or BRASSY COUGH
    • Mgt:
      • increase humidity in room  cool mist
      • turn on warm / hot shower
      • Keep tracheostomy at bedside
  • PYLORIC STENOSIS
    • Narrowing for pylorus (barrium swallow)
    • Ss/x  PROJECTILE VOMITING
    • Mgt:
      • RIGHT SIDE LYING position
      • SURGERY  FREDET-RAMSTEDT
  • HIRSCHSPRUNG’s DISEASE
    • Absence of aganglionic cells
    • S/sx  RIBBIN LIKE STOOL or PELLET-LIKE STOOL
    • Mgt:
      • LOW RESIDUE diet
      • stool softener
      • colostomy
  • INTUSSUScEPTION
    • TELESCOPING of a portion of the bowel
    • s/sx:
      • COLICKY PAIN
      • SAUSAGE-SHAPED MASS
      • CURRANT-JELLY LIKE STOOL (blood and mucoid)
  • MENINGOCELE
    • Failure of posterior laminae to fuse with herniation of sac-like cyst of meninges, CSF and spinal nerves
    • S/sx:
      • presence of sac in the lumbar area
    • Mgt:
      • PRONE POSITION
      • WET STERILE DRESSING
      • TAPE MEASURE at the bedside
      • CREDE’s MANEUVER
  • HYDROCEPHALUS
    • CSF imbalance
    • Dx test: CT SCAN
    • s/sx: sunset eyes
    • Mgt:
      • AV SHUNT insertion (shunt failure is dilated scalp veins)
      • measure HEAD CIRCUMFERENCE
  • CLEFT lip CLEFT PALATE
    • Failure of maxillary process to fuse with nasal process
    • Teach ELBOW RESTRAINTS
    • Apply LOGAN BAR
    • Use LARGE, SOFT NIPPLES, BRECK FEEDER
    • Position: Supine or side lying
    • Failure of the palatine processes
    • Use CUP when feeding
    • Refer to speech therapist
    • Position: PRONE
  • CYSTIC FIBROSIS
    • Blockage of exocrine glands
    • Autosomal recessive
    • Dx test: SWEAT CHLORIDE TES
    • Mgt: Postural drainge (before meals at bedtime)
    • HIGH CALORIE, HIGH SODIUM
  • PKU
    • Deficiency of ________________________
    • Dx test:
      • GUTHRIE TEST REVEALS
    • Mgt:
      • GENETIC COUNSELLING
      • RESTRICT FOODS HIGH IN PROTEIN
      • PROVIDE PHENYLALANINE DIET until adolescence
  • CELIAC’s DISEASE
    • Intolerance to GLUTEN in small intestines
    • s/sx: FAILURE TO THRIVE
    • Nsg Mgt:
      • Avoid B-R-O-W
      • Give foods  CORNS, CEREALS, SOYBEANS, RICE
      • CBQ  if the child is going party allow the mother to make a cake made of free gluten
  • CONGENITAL HIP LOCATION
    • Malformation of the hip (FEMUR HEAD is completely dislocated from the ACETABULUM)
    • s/sx:
      • SHORTER leg on the one side
      • UNEVEN GLUTEAL FOLD
      • Decreased leg mobility
      • WADDLING duck-like gait
      • ORTOLANI’s or BARLOW’s test
  • CONGENITAL HIP LOCATION
    • Nsg Mgt:
      • Maintain ABDUCTION
      • use DOUBLE or TRIPLE DIAPER
      • PAVLIK HARNESS Is used to keep the legs in abduction
  • SCOLIOSIS
    • Lateral curvature of the spine
    • s/sx:
      • uneven shoulder
      • length pants is longer on the other side
      • one hip or shoulder appears to be higher
    • Nsg Mgt:
      • MILWAUKEE or BOSTON BRACE for 23 hours a day
      • exercise  CHEERDANCE, DANCING, SWIMMING
    • COMMUNITY HEALTH NURSING
  • CBQ notes
    • Aggregate focused
    • Community is a primary client of the community health nurse
    • Goal of CHN is to raise the level of health of the citizenry
  • MASTERY DRILLS
    • ___________ primary client in community health nursing
    • _________unit of service
    • _________ultimate goal of CHN
    • _________primary focus of CHN
    • _________main activity of CHN
    • _________ main activity of PHDS
  • HD or HT or FC
    • Husband has been caring for his wife with Alzheimer’s disease for 3 years
    • Unimmunized 1 year old child
    • Bulimia
    • Presence of mass on breast
    • A 14 year old with pimples
    • Jim is training to become a professional boxer
  • 5 Pillars of PHC
    • Use of appropriate technology
    • Essential health services
    • Active community participation
    • Accessibility
    • Inter and Intra sectoral linkages
  • Mastery drill
    • Inter-agency task force on influenza
    • Education about prevailing health problems including methods of prevention and control
    • Fund-raising led by PTA for the installation of sanitary toilets in the elementary school
  • Mastery drills
    • National Health Insurance Program (PhilHealth)
    • Promotion of adequate food supply and proper nutrition
    • RA 8423 (creating the Philippine Institute of Traditional and Alternative Medicine)
  • Mastery drill
    • Immunization against the major infectious diseases
    • Provision of safe water and basic sanitation
    • Maternal and Child Health Nursing Including Sanitation
    • Prevention and control of locally endemic diseases
  • Mastery drills
    • Oral Rehydration Solution
    • “ Tapat ko, Linis Ko”
    • Appropriate treatment of common diseases and injuries
    • Provision of essential drugs
    • RA 9502 (Universally Accessible, Cheaper and Quality Meds
  • Mastery drills
    • _________ A higher computed value of this indicator means a longer life expectancy
    • Epidemiology
    • Dependency Ratio
    • Sensitivity
    • Swaroop’s index
  • Mastery drills
    • _________ Host, agent and environment
    • Epidemiology
    • Dependency ratio
    • Sensitivity
    • Crowding index
  • Mastery drills
    • _________ Two of the four who contracted leptospirosis died.
    • Crude Birth rate
    • Specificity
    • Case Fatality Rate
    • Survey
  • Mastery drills
    • _______ Sputum microscopy can identify those who have pulmonary tuberculosis
    • A. Sensitivity
    • B. Specificity
    • C. Dependency ratio
    • D. Social indicator
  • Mastery drills
    • _______________ % of community dwellings with level III water supply
    • Social indicator
    • Environmental indicator
    • Specificity
    • Sensitivity
  • Mastery drills
    • This refers to the number of births among women in their reproductive years.
    • Dependency ratio
    • Crude Birth Rate
  • Mastery drill
    • Use of questionnaires and / or personal interviews
    • General fertility rate
    • Survey
    • Case study
    • Interview
  • Mastery drill
    • The transmission of infectious and communicable diseases is facilitated by a high computed value of this indicator.
    • Crowding index
    • Social indicator
    • Environmental indicator
  • Mastery drill
    • Housing conditions, communication network and transportation system.
    • Case fatality rate
    • Crude birth rate
    • Social Indicator
    • Environmental indicator
  • Mastery drill
    • In Municipality Y, 100 people who are working support about 78 young and old member of the community.
    • Specificity
    • Dependency ratio
    • Case fatality rate
    • Crowding index
  • formula
    • CBR = TB / TP x 1000
    • CDR = TD / TP x 1000
    • IR = # of NEW CASES / TP risk for disease
    • PR = # of NEW&OLD cases / TP examined
    • SMR = TD in specified group / TP of specified group
  • formula
    • FDR = TFD at conception/ TLB x 1000
    • NDR = TD under 28days / TLB x 1000
    • IMR = TD under 1 year/ TLB x 1000
    • Population Density:
    • PD = TP/ Total # of square meters x 1000
    • DR = # of po. 0-14 and 65+ / Population 15-64 years old
  • formula
    • Sex Ratio = # of M / # of F x 100
    • Literacy rate = # of pop. 8 yo > who can read and write / # of pop. 8 yo >
    • TARGET SETTING:
    • EP (children) = TP x 27% (old is 3%)
    • EP (mother) = TP x 3.5%
  • formula
    • Crowding index = number of person in a household / number of rooms used for sleeping
    • - describe the ease by which a CD can be transmitted
    • The framework for the implementation of the HSRA is the __________________.
    • The elements of FOURmula ONE for Health are:
    • The 4 pillars of PHC:
    • 1.
    • 2.
    • 3.
    • 4.
    • The DOH 3 roles and functions:
    • 1.
    • 2.
    • 3.
    • ______________________  is a gap between actual and achievable health status
    • ______________  is a condition that promotes injury or prevents people from realizing their full health potential
    • ___________________________  are periods of unusual demand that require adjustment
  • MASTERY DRILL
    • _________  is the family’s perception of the condition/problem _________  must have a purpose, based on priorities and flexible to the needs of the client. The _________________  contains essential and indispensible equipment of the nurse.
    • The _________________  is a TOOL utilized by the nurse to perform nursing procedures with ease. The 4C’s must be considered in the use of the bag: complete contents, clean very often, contact with patient’s articles avoided, and convenient arrangement.
    • The EPIDEMIOLOGIC TRIAD  is affected by 3 factors:
      • AGENT,
      • HOST and
      • ENVIRONMENT.
    • ________  is INTERMITTENT ________  continuous occurrence of a disease throughout a period of time. ________  is unusually LARGE number of cases in a relatively short period.
    • _____________  is the simultaneous occurrence of disease in several countries  UNIVERSAL
    • Pregnant women are given _______ “IU” of vitamin A  _________ starting on the 4 month of pregnancy. It must not be given in the first trimester.
    • The 1 st dose of TT  is given anytime during pregnancy The 2 nd dose of TT is given _____ after the 1 st dose, giving 80% protection for ____ years. The 3 rd dose of TT is given 6 months after the 2 nd dose, 95% protection for _____ years. The 4 th dose of TT is given 1 year after the 3 rd dose, giving ____protection for ______ years
    • To be qualified for a home delivery, must be: Full term Less than 5 pregnancies Cephalic No existing disease No history of risk And adequate pelvis
    • The first POST-PARTUM visit  is recommended on the ________ OF LIFE
    • The second POST-PARTUM visit  is recommended after ______ of life
    • Ideal pregnancy is between ______ years old, but not if economically stable with spacing of ____ years and with ____ children.
    • Newborn screening: RA _______ Congenital hypothyroidism Congenital adrenal hyperplasia Galactosemia Phenylketunuria G6PD deficiency
    • ______  vaccine is given at birth, 0.05 mL intradermally. It is stored at the body of the refrigerator. _______  is first given at birth, again after 6 weeks and a third time after 8 weeks, o.5 mL IM (vastus lateralis).  stored in the body of the refrigerator. ________  is first given at 6 weeks with an interval of 4 weeks, 0.5 mL IM (vastus lateralis) OPV  is given 6 weeks with an interval of 4 weeks, 2 drops PO. It is stored in freezer. ________  is given at 9 months, 0.5 mL SQ  freeze  85% effective
    • RA 9288  is the Newborn Screening Act mandating all newborns to undergo testing (ideally between the _______ hours of life.
    • Environmental sanitation: ________  sources of water (POINT SOURCE) are protected wells or developed springs catering _____-households.
    • ________  water sources (COMMUNAL FAUCETS/STAND-POSTS) have a reservoir, a piped distribution network and communal faucets serving around 100 households.
    • _______  water sources (WATERWORKS SYSTEM) have a source, a reservoir, a piped distribution network and households taps.
    • The 4 rights in food safety: Right ______ Right ______ Right ______ Right storage
    • Toilet facilities: ______ – toilet facilities little or no water to wash waste into the receiving space ______ – toilet facilities are connected to a sewerage system to a treatment plant _____ – toilet facilities are the water carriage type of such as water-sealed flush toilet types with septic tanks.
    • ______ Code of sanitation of the Philippines _____ Civil Service Eligibility _____ Devolution or LGC 1991 _____ Garbage Disposal Act
    • _____ Solid Waste Ecological Management ____ Clean Air Act _____ Reporting of Communicable Disease _____ Birth Registration Law
    • ________________ is a social system that shares the same interest , norms and belief in the same environment within a geographical boundary.
  • FORMULA CBR = TB / TP x 1000 CDR = TD / TP x 1000 IR = # of NEW CASES / TP risk for disease PR = # of NEW&OLD cases / TP examined SMR = TD in specified group / TP of specified group
    • FDR = TFD at conception/ TLB x 1000
    • NDR = TD under 28days / TLB x 1000
    • IMR = TD under 1 year/ TLB x 1000
    • Population Density:
    • PD = TP/ Total # of square meters x 1000
    • DR = # of po. 0-14 and 65+ / Population 15-64 years old
    • Sex Ratio = # of M / # of F x 100
    • Literacy rate = # of pop. 8 yo > who can read and write / # of pop. 8 yo >
    • TARGET SETTING:
    • EP (children) = TP x 27% (old is 3%)
    • EP (mother) = TP x 3.5%
    • Crowding index = number of person in a household / number of rooms used for sleeping
    • - describe the ease by which a CD can be transmitted
  • cbq
    • PROXIMITY  most common risk factor of PTB in the Philippines