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INTENSIVE FINAL COACHING - NP2
 

INTENSIVE FINAL COACHING - NP2

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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