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3738 Exam 1
n/a
153
Nursing
Undergraduate 3
09/03/2014

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Cards

Term
Describe palliation
Definition
alleviate symptoms without a cure
Term
What are the two categories of pain?
Definition
nociceptive and neuropathic
Term
Describe nociceptive pain
Definition
caused by damage to somatic or visceral tissues
Term
Describe somatic pain
Definition
superficial (arising from skin, mucous membranes), sharp, burning, prickly or deep (bone or CT)
Term
Describe visceral pain
Definition
responds to inflammation, stretching and ischemia; intense cramping pain
Term
Describe neuropathic pain
Definition
burning, shooting, stabbing, sharp or electric shock like pain
Term
Acute pain control eventually leads to what?
Definition
elimination
Term
Describe chronic pain
Definition
greater than 3 months; waxes and wanes; pain is controlled but does not go away
Term
What are the 7 elements of a pain assessment?
Definition
patter, location, intensity, quality, associated symptoms, management strategies, patient's beliefs
Term
Describe a multimodal approach to pain
Definition
use of two or more different meds to control pain
Term
What is the most common side effect of a narcotic analgesic?
Definition
constipation
Term
Describe nonopioids
Definition
have analgesic ceiling; no physical dependence; available OTC (asprin, tylenol, motrin, aleve)
Term
What are 4 types of opioids?
Definition
morphine, codeine, demerol, dilaudid
Term
Describe the side effects of opioids
Definition
constipation, n/v, sedation, respiratory depression and pruritis
Term
What substance rapidly reverses the effects of opioids?
Definition
narcan
Term
Corticosteroids should not be given with what?
Definition
NSAIDs
Term
What do corticosteroids treat?
Definition
edema and inflammation
Term
antidepressants may be good for what kind of pain?
Definition
neuropathic
Term
Describe scheduling in med administration
Definition
focus in on prevention and control of pain once pain has become severe
Term
Describe the titration of medication
Definition
does adjustment based on adequacy of analgesic effect vs side effects produced; goals is to use smallest dose to give effective pain control with fewest side effects
Term
What are the 5 Ps of labor and birth?
Definition
Passenger, passageway, powers (uterine contractions), position of mother, psychological response of mother
Term
Define fontanels
Definition
where sutures intersect
Term
Describe the anterior fontanel
Definition
largest, diamond shaped, closes by 18 months
Term
Describe the posterior fontanel
Definition
triangular shaped, closes 6-8 weeks after birth
Term
Describe fetal presentation
Definition
part of the fetus that enters the pelvic inlet first and leads through the birth canal
Term
Describe fetal lie
Definition
relationship of long axis of fetus to the long axis of mother
Term
ID fetal lie position:
fetal spine is parallel to maternal spine
Definition
longitudinal
Term
ID fetal lie position:
fetal spine is at right angle to maternal spine
Definition
transverse
Term
ID fetal lie position:
fetal spine is at an angle to maternal spine
Definition
oblique; likely to convert to longitudinal or transverse during labor
Term
Describe fetal attitude
Definition
relationship of feta body parts to each other; normal is flexion
Term
Describe fetal position
Definition
relationship of presenting part to one of the 4 quadrants of the maternal pelvis
Term
Describe the nomenclature of fetal position
Definition
Location of presenting part R or L of maternal pelvis; presenting part of fetus (occiput, sacrum, mentum, scapula); presenting part in relation to Anterior, posterior or transverse maternal pelvis; LOA most common
Term
Describe placenta previa
Definition
misplacement of the placenta; requires c-section
Term
Define station in childbirth
Definition
relationship of presenting part to imaginary line between ischial spines of maternal pelvis
Term
Define engagement
Definition
when the largest diameter of the presenting part reaches the maternal pelvic brim
Term
ID aspect of maternal pelvis:
formed by upper margins of pubic bone, sacrum and sacral promontory
Definition
pelvic inlet/brim
Term
ID aspect of maternal pelvis:
formed by symphysis pubis, ischium and portion of ileum, sacrum and coccyx
Definition
pelvic cavity/mid-pelvis
Term
ID aspect of maternal pelvis:
formed by pubic arch, ischial tuberosities and tip of coccyx
Definition
pelvic outlet
Term
Define effacement
Definition
thinning and shortening of cervical canal from 0-100
Term
Describe true labor
Definition
progressive cervical change; cervix must be effacing AND dilating
Term
In primagravidas, effacement occurs ____
Definition
prior to dilation
Term
In multigravidas effacement ____
Definition
and dilation progress together
Term
Describe primary powers
Definition
responsible for effacement and dilation of cervix and descent of fetus; involuntary contractions at points in upper uterine segment; followed by short rest periods
Term
Describe secondary powers
Definition
bearing down efforts that aid in expulsion of fetus; pushing occurs when woman feels the urge
Term
Define "laboring her down"
Definition
moving the woman so gravity can assist with birth
Term
Pushing before the mom is ready can lead to what?
Definition
maternal fatigue
Term
The mother pushing on the side can change the baby between what two positions?
Definition
LOP to LOA
Term
Describe lightening in labor
Definition
feeling like the baby has dropped; easier for mom to breath but puts more pressure on bladder
Term
When will the mucus plug be expelled?
Definition
two weeks before labor
Term
What is ROM in labor?
Definition
rupture of membranes
Term
What are 3 signs associated with labor?
Definition
1-3 pound weight loss; diarrhea, and nausea
Term
What are the 3 phases of labor stage 1?
Definition
early (0-3cm), active (4-7cm), transition (8-10)
Term
Women ask for pain meds at what point in labor?
Definition
stage 1 active
Term
What are the behavioral characteristics of stage 1 transition phase?
Definition
yelling, irritability, n/v
Term
In what stage of labor does pushing happen?
Definition
stage 2
Term
What are the complications of an episiotomy?
Definition
increases risk of tearing to rectum and leg
Term
What are 3 signs of placental separation?
Definition
lengthening of umbilical cord, gush of blood, globular appearance of abdomen
Term
What is a cleansing breath?
Definition
deep breath in through nose and out to mouth
Term
What is the most common cause of labor?
Definition
uterine stretch (distention)
Term
What are 2 reasons engagement in labor may not occur?
Definition
baby is too big; baby is transverse or breech
Term
What is the normal FHR range?
Definition
110-160
Term
FHR normally accelerates with what?
Definition
fetal movement, vaginal exam, and abdominal palpation
Term
FHR deccerlates with what?
Definition
fetal head compression, compression of umbilical cord, and uteroplacental insufficiency
Term
What are the CDV changes of the mother in labor?
Definition
increased CO, increased BP, increased WBC 14-16k
Term
Describe maternal GI changes in labor
Definition
slowed GI motility, increased possibility of n/v and diarrhea
Term
Describe the neurological changes a mother goes through in labor
Definition
changes as stages progress: euphoria, seriousness, amnesia,elation
Term
Describe gate control theory in regards to labor pain
Definition
massaging thighs and abdomen to simulate normal somatosensory reactions and distract from the pain
Term
When in labor is analgesia given and why?
Definition
during a contraction; perfusion to baby is less
Term
What area does a pudendal effect?
Definition
numbs perineum (nerve of ischial spine)
Term
Describe the function of an intrathecal
Definition
regional anesthesia, lasts 12 hrs, morphine derivative
Term
Define EFM
Definition
electronic fetal monitoring
Term
What are the two categories of FHM patterns?
Definition
reassuring and non-reassuring
Term
Describe IA in fetal monitoring
Definition
intermittent auscultation
Term
What are two types of external fetal monitoring and their placement sites?
Definition
FHR (ultrasound transducer) lower fetal back, Uterine contractions (tocotransducer) placed on fundus
Term
What is the form of invasive internal monitoring?
Definition
spiral electrode
Term
What two things are required for internal fetal monitoring?
Definition
ROM, cervical dilation
Term
Define IUPC
Definition
intrauterine pressure catheter
Term
What is the normal range for Montevideo units?
Definition
mVus; 150-250 for 10 mins
Term
What can cause reduced fetal oxygen supply?
Definition
maternal hypertension or hypotension (hemorrhage or analgesia), hypovolemia from hemrrhage
Term
Describe the 4 levels of FHR variability
Definition
absent; minimal (< or = 5bpm); moderate (6-25); marked (>25)
Term
What are the two categories of changes in baseline FHR?
Definition
periodic (with contractions) and episodic (without contractions)
Term
What is the criteria for FHR accelerations?
Definition
must be 15 or> over baseline and last 15 secs or more
Term
Describe early decelerations
Definition
gradual decrease and increase return to baseline and occurring with uterine contractions
Term
Describe variable decelerations
Definition
visual abrupt decrease in FHR below baseline; U V or W shape; caused by umbilical cord compression
Term
What 4 things can the nurse do to rectify variable decelerations?
Definition
change mom's position, assess for cord prolapse, alter pushing technique, discontinue oxycotin
Term
Describe late decelerations
Definition
gradual decrease after contraction has started and continues once it is over; uteroplacental insufficiency
Term
What is the cause of poop stained amniotic fluid?
Definition
baby defecated out of stress
Term
What are 3 types of ROM?
Definition
spontaneous, artificial, premature
Term
What 4 things do you need to assess about the patient's contractions?
Definition
onset, frequency, duration, and intensity
Term
What is the function of a med that is a labor augmentor?
Definition
boosts labor
Term
What is a FAD?
Definition
forcep assisted delivery
Term
What is a VAD?
Definition
vacuum assisted delivery
Term
How long is the post partum period?
Definition
6 wks
Term
What are the 3 stages of Rubin's Stages of Maternal Attachment?
Definition
taking in, taking hold, and letting go
Term
What is the nurse's action when patient has boggy uterus with heavy lochia?
Definition
massage the uterus
Term
What is the nurse's action when you find the uterus firm and lochia flow?
Definition
notify health care provider immediately; possible lacerations hematoma or retained placental fragments
Term
Describe proper care of episiotomy site post op
Definition
use cold water, then warm for healing; shower, not bath; sitz baths
Term
Describe the two types of mastitis
Definition
congestive: improper emptying of breasts while feeding causing obstruction of ducts
Infectious: result of damage to breast from improper latch
Term
How long after delivery should women void?
Definition
4-6 hrs
Term
What is the #1 reason for a boggy uterus?
Definition
full bladder
Term
What are the signs of maternal attachment?
Definition
eye contact, feeding, being attentive to baby, calling baby by its name
Term
Describe the feeding and elimination patterns of newborns
Definition
formula: 3-4 hrs
Breastfeed: 2-3 hrs
6-8 wet diapers; 2-3 poops per day
Term
What 3 time periods are common for discontinuation of breastfeeding and why?
Definition
6 hrs (baby is asleep), 6 wks (mom goes back to work), 6 months (baby get teeth)
Term
What are the 5 S's of comforting a crying baby?
Definition
Swaddle, sway/swing, shush (resembles mom's heart in utero), side lying, sucking
Term
How often should you bathe newborns?
Definition
2-3 days
Term
How long is the neonatal period?
Definition
28 days
Term
Describe the first period of reactivity for a newborn
Definition
first 30 mins of life, HR 160-180, alert, best time to breastfeed
Term
Describe the second period of reactivity
Definition
4-8 hrs after birth, periods of tachycardia and tachypnea, increased muscle tone, meconium passed
Term
What is the most critical and immediate adjustment for newborns to life?
Definition
establishment of respirations
Term
What is the normal infant RR?
Definition
30-60
Term
What is the normal HR for a newborn?
Definition
110-160; decrease below 100 if sleeping, increase above 180 if crying
Term
Non shivering thermogenesis is accomplished by _____
Definition
brown fat; secondarily by increased metabolic activity
Term
Describe brown fat
Definition
unique response organ for cold adaptation in new borns; reserves rapidly depleted with cold stress
Term
ID aspect of heat loss:
loss of heat due to cooler air currents
Definition
convection; prevented by placing baby away from air ducts or doors
Term
ID aspect of heat loss:
transfer of heat not in direct contact with the baby
Definition
radiation; walls are cold
Term
ID aspect of heat loss:
loss of heat when water is vaporized
Definition
evaporation; dry baby when born
Term
ID method of heat loss:
transfer of heat to cooler surfaces by direct skin contact
Definition
conduction
Term
How many kcal per day does a newborn require for growth?
Definition
120; initial weight loss of 5-10% is normal
Term
What is given to the newborn for their coag difficulties?
Definition
Given Vit K IM to stimulate synthesis of prothrombin
Term
When does physiologic jaundice occur in newborns?
Definition
After first 24 hrs of life
Term
____ high in ____ provides some passive immunity for breastfed infants
Definition
colostrum; IgA
Term
When is a baby considered pre-term?
Definition
<38 wks
Term
What should the Gl level of a newborn be?
Definition
>40
Term
T/F: BPH predispose men to cancer of prostate gland
Definition
false
Term
Describe causes of BPH
Definition
result of decrease testosterone in proportion to estrogen leading to gland growth
Term
Describe the clinical symptoms of BPH
Definition
obstructive:difficulty initiating voiding, decrease in flow force; irritative: urinary frequency, urgency, dysuria
Term
What are the 3 goals of collaborative care for BPH?
Definition
restore bladder draining, relieve patient' symptoms, prevent/treat complications
Term
Describe the conservative treatment for BPH
Definition
decrease caffeine, alcohol, spicy food, evening fluid intake; set up timed voiding schedule
Term
Describe TURP
Definition
Transurethral Resection of Prostate; removal of prostatic tissue through cytoscope under anethesia; most effective treatment for BPH
Term
What is the most common cancer among men and what racial group is effected the most?
Definition
Prostate cancer; Blacks
Term
What is the primary area of metastasis in prostate cancer?
Definition
bones
Term
Growth of prostate cancer is highly dependent on what?
Definition
present of androgens
Term
Describe varicocele
Definition
dilation of veins that drain testes; may be associated with infertility from increased heat(corrected by ligation)
Term
Describe testicular cancer
Definition
rare; mostly occurs in whites 15-34; non tender firm scrotal mass and scrotal swelling
Term
PMS is related to the ___ phase of the menstrual cycle
Definition
luteal
Term
ID:
long intervals between menses; >35 days
Definition
oligomenorrhea
Term
DI:
excessive/prolonged menstrual bleeding
Definition
menorrhagia
Term
ID:
irregular bleeding or bleeding between periods
Definition
metorrhagia
Term
Menopause is diagnosed by a decrease in ___ and an increase in____
Definition
estrogen; FSH
Term
Describe HRT for menopausal women
Definition
estrogen if no uterus; estrogen and progesterone for women with uterus, if estrogen only, promotes endometrial cancer
Term
What is the primary cause of female infertility?
Definition
PID
Term
Describe endometriosis
Definition
presence of abnormal endometrial tissue in sites outside endometrial cavity
Term
What are 4 benign ovarian cysts?
Definition
dermoid, follicular, corpus luteum, polycystic ovary syndrome
Term
ID cyst type:
originate from germ cells that contain fat, hair and teeth
Definition
dermoid cysts
Term
ID cyst:
asymptomatic, shrink over menstrual cycles, mature grafian follicle issue in young women
Definition
follicular cysts
Term
ID cyst:
occur after ovulation; pain, tenderness over ovary, delayed menses, disappear without treatment
Definition
corpus luteum cysts; prevented by birth control
Term
Describe polycystic ovary syndrome
Definition
occurs most often in <30; cause of infertility; commonly seen with obesity and hirutism; can lead to CDV and type 2 diabetes
Term
What are the clinical manifestations of ovarian cysts?
Definition
often asymptomatic unless large; constipation, menstrual irregularities, urinary frequency, full feeling in abs/pelvis
Term
When is surgery for cysts required?
Definition
>8cm that don't shrink or are solid
Term
Describe leiomyomas
Definition
uterine fibroids (smooth muscle tumors); nodular, enlarged uterus, increased pelvic pressure
Term
Describe polyps
Definition
benign lesion of cervix/endometrium in reproductive years; most common>40; bleeding with sex, removed surgically
Term
ID female cancer:
rare; more common >60; highly associated with HPV; possible itching burning pain
Definition
vulvar cancer
Term
What is the most common site of vulvar cancer?
Definition
labia majora
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