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Nur 1025C Ultimate Exam 3 Review Notes
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This is a comprehensive and detailed review note on Exam 3 for Nur 1025c. *Essential for exam prep!! *All for you!!
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NUR 1025C EXAM 3Module 5 exemplars: Caregiver Skills Development, Alternative Therapies, Clinical Ethics and Bioethics/Abortion, Minor
Consent and Severely Impaired Newborns, Interpersonal Violence, and Child Maltreatment, Family Response to Health
Promotion
Module 6 exemplars: Changes to Family Dynamics, Negative/Dysfunctional Family Dynamics, Child Rearing Practices,
Cerebral Palsy, Trauma and Injury, Intellectual Disability, Failure to Thrive, Malnutrition, Vitamin Deficiency, Obesity/Type 2
Diabetes, Otitis Media, Conjunctivitis, and Antibiotics
Abortion: purposeful interruption of pregnancy before 20 wks of gestation.
Therapeutic – an abortion performed for reasons of maternal or fetal health or disease
(usually after 20 wks)
Elective—performed at the women’s request.
First trimester: early elective abortion (performed @ <9 wks)
o Induced abortion is the safest and less complex method.
o Surgical: aspiration
o Medical: methotrexate and misoprostol; mifepristone
Second trimester
o Dilation and evacuation: can be done up to 20 wks but usually done around 13-16.
o Cervical prep w prostaglandins
o Emotional considerations
Post-op emergency signs & symptoms: fever greater than 100.4, chills, foul smelling
vaginal discharge, heavy bleeding that causes 2 pads to fill w blood in 2 hrs., abdominal pain
w pressure.
Methotrexate: Can be given IM or PO (usually w OJ), or inserted vaginally (occurs 3-7 days
later)
o Women should follow up to make sure baby is terminated.
Mifepristone: can be taken up to 7 wks after missed period.
Misoprostol: prostaglandin that acts directly on the cervix to soften and dilate and cause
the uterus to contract and blocks the progesterone.
Infertility: affects ¼ woman; increases risk w increasing age.
Woman under 35: Diagnosis for couples who have not achieved pregnancy after 1 yr of
regular unprotected intercourse.
Woman older than 35: 6 months of trying.
Factors affecting fertility:
Ovarian Factors
• Developmental anomalies
• Anovulation—primary
• Pituitary or hypothalamic hormone disorders
• Adrenal gland disorders (rare)
• Congenital adrenal hyperplasia (rare)
• Anovulation—secondary
• Disruption of hypothalamic-pituitary-ovarian axis
• Anorexia
• Insufficient body fat in athletic women
• Increased prolactin levels
• Thyroid disorders
• Premature ovarian failure
• Polycystic ovary syndrome
• Medications
• Oral contraceptives
• Progestins
• Antidepressant and antipsychotic drugs
, • Corticosteroids
• Chemotherapy
Tubal/Peritoneal Factors
• Developmental anomalies of the tubes
• Reduced tubal motility
• Inflammation within the tube
• Tubal adhesions
• Disruption caused by tubal pregnancy
• Endometriosis
Uterine Factors
• Developmental anomalies of the uterus
• Endometrial and myometrial fibroid tumors
• Asherman's syndrome (uterine adhesions or scar tissue)
Vaginal-Cervical Factors
• Vaginal-cervical infections
• Cervical mucus inadequate
• Isoimmunization (development of sperm antibodies)
Other Factors
• Nutritional deficiencies
• Obesity
• Thyroid dysfunction (hyperthyroidism and hypothyroidism)
• Idiopathic conditions
Immunizations:
Immunization with live or attenuated live viruses is contraindicated during
pregnancy because of potential teratogenicity; recommended vaccination with these
agents should be part of postpartum care. Live-virus vaccines include those for measles
(rubeola and rubella), varicella (chickenpox), and mumps, as well as the Sabin (oral)
poliomyelitis vaccine (no longer used in the United States). Vaccines that can be
administered during pregnancy include combined tetanus-diphtheria-acellular
pertussis (Tdap), recombinant hepatitis B, and influenza (inactivated) vaccines.
Hep B: IM injections are used to administer immunizations such as the hepatitis B (HepB)
vaccine. HepB vaccination is recommended for all infants before discharge. (informed
consent must be signed).
Vitamin K: IM inj. Is administered to all newborns shortly after they are born.
Preferred site for infants: vastus lateralis, using a 25 gauge, 5/8” needle
T-dap: administer between 27 & 36 wks. Should be given EVERY pregnancy, if not
administered during give immediately postpartum.
Rubella vaccine: should be given if titer is over 1.8
Rh Immune globulin: Testing for blood type is done at 1st prenatal visit.
o If mom is Rh neg, she will have an antibody screening in the 1st & 3rd trimester.
o Women with Rh-negative (D-negative) blood type who are carrying an Rh-positive (D-
positive) fetus can develop antibodies against the D antigen on the fetal red blood
cell, causing lysis of the fetal red blood cells. This can lead to life-threatening
hemolytic disease of the fetus and newborn.
o A dose of 300 micrograms of Rh immune globulin is routinely administered at 26 to
30 weeks to all Rh-negative women without evidence of anti-D alloimmunization
o Other indications for administration of Rh immune globulin to Rh-negative women
during pregnancy include chorionic villus sampling, amniocentesis, spontaneous or
, therapeutic abortion, ectopic pregnancy, external cephalic version, and abdominal
trauma
Family centered care
• Recognizes family as constant in child’s life
• Systems must support, respect, encourage, and enhance strength and competence
of family
• Needs of all family members must be addressed
• Concepts of enabling and empowering
Biorhythmicity: The fetus is in tune with the mother’s natural rhythms such as her heart
beat; a recording of a mother’s heartbeat can sooth a crying infant.
Postpartum blues: usually subsides in about 10 days after birth.
Coping w PP blues: 1) remember that “blues” are normal & that both the mom & dad may
experience them. 2) get plenty of rest- nap when the baby does. 3) Use relaxation
techniques. 4) Do something for yourself. 5) Plan a day outside of the house. 6) Talk to your
partner about the way you feel. 7) If you are breastfeeding, give yourself & the baby some
time to learn. 8) Seek out and use community resources such as La Leche League or
community mental health centers.
Adolescent Mothers: becoming a parent is biologically possible for the adolescent female,
her egocentricity and concrete thinking can interfere with her ability to parent effectively. Mortality
rates are higher among infants of adolescent mothers. This can be related to inherent problems
associated with preterm birth or other conditions, but it is also influenced by the mother's
inexperience, lack of knowledge, and immaturity.
They provide warm and attentive physical care; however, they use less verbal interaction
than do older parents, and adolescents tend to be less responsive and to interact less
positively with their infants than do older mothers.
Extended time bonding is recommended for youg mothers.
Pain: “Pain is whatever the person says it is, and whatever the person says it does.”
Includes verbal & non-verbal cues.
Can be assessed by observing the child’s vital signs, physiological observation & self-report.
Common fears among children can persist into adulthood results in avoidance of needed
care as an adult
Assessing pain in peds--behavioral, if old enough / reliable then subjective/verbalized,
physiologic (change in BP or HR)
Pain rating scales:
o should be age/developmentally appropriate.
o Consistent use of same scale by all staff; if possible, same person should check
pain in babies, people w communitive/ cognitive impairment/ chronic/
complex pain
QUESTT:
Question the child
Use a pain rating scale
Evaluate behavioral and physiologic changes
Secure parent’s involvement
Take the cause of pain into account
Take action and evaluate results
FACES
FLACC- facial, expression, leg movement, activity, cry & consolability
Nonpharmacologic management (reduces infants pain perception)
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