Monthly Archives: May 2012

Maternal/Child Health (OB): The Basics

There is a lot of newly introduced vocabulary alongside a different conceptual view in the care of both the pregnant woman and the unborn child or newborn.

The content is organized into 3 main phases of peripartum care:
Antepartum (before the pregnancy)
Intrapartum (during pregnancy)
Postpartum (after pregnancy) 

Below is an abbreviated outline of the content typically covered in this course:

  • Fetal conception and development
    – Phases of the menstrual cycle
    – Process of fertilization
    – Fetal and Maternal changes
  • Risk factor and fetal assessment
    – Maternal and paternal psychosocial responses to pregnancy
    – Prenatal care: GTPAL, office visits, labs
    – Fundal height assessment
    – Anticipatory guidance for the first, second and third trimesters,
    – Fetal and maternal assessment methods: ultrasound, chorionic villi sampling (CVS), amniocentesis, electronic fetal monitoring, nonstress test (NST), contraction stress test (CST), biophysical profile (BPP), fetal pH blood sampling
  • Labor and Delivery
    – Leopold maneuvers – helps to determine fetal presentation, fetal position, fetal lie and fetal engagement
    – True vs False labor
    – The four stages of labor
    – The 3 phases of the first stage of labor: latent, active, transition
    – Analgesia and anesthesia – local, regional, peridural, intradural blocks
  • High risk pregnancies
    – Miscarriage/spontenous abortion – emergency!
    – Hydatiform Mole – developmental anomaly, “grape-like” clusters
    – Abruptio placentae – premature complete or partial detachment of the placenta from the uterine wall
    – Placenta previa – abnormal implantation of the placenta
    – Anemia
    – Ectopic pregnancy – abnormal implantation of fertilized egg outside of the uterus
    – Infection – TORCH (Toxoplasmosis, Other [HIV, Varicella, Parvo, Syphillis, Coxsackievirua], Rubella, Cytomegalovirus, Herpes simplex)
    – Preterm labor
    – Dystocia – difficult birthing
    – Preeclampsia, eclampsia
    – Hyperemesis gravidarum
    – Gestational diabetes
  • Postpartum
    – Normal postpartum changes of the uterus, cervix, breasts, CV, hematologic, integumentary, musculoskeletal system
    – Normal postpartum vital signs: high temp, low pulse, normal BP, rare changes in RR
    – Measuring fundal height – height decreases 1 cm per day
    – Assessing lochia (postpartum discharge) – rubra → serosa → alba
    – Assessing perineal area and episiotomies (incision of the posterior vaginal wall)
    – Examine breasts for tenderness, engorgement, breastfeeding techniques
    – Assist with mother-baby bonding
    – Assess urinary, bowel movements
    – Determine needs for RhoGAM, rubella vaccine, medications
  • Newborn care
    – APGAR assessment
    – The 5 symptoms of respiratory distress: retractions, tachypnea ( > 60), dusky color, expiratory grunt, flaring nares
    – Newborn prophylactic eye care with erythromycin ointment
    – Physical assessment: vitals, measurements, head-to-toe, reflexes
    – Primary concerns of: aspiration, infection, hypothermia, hypoglycemia, hemorrhagic disorders, hyperbilirubinemia
    – Assess elimination and feeding patterns
    – Screen for genetic disorders such as phenylketonuria (PKU) after breast milk/formula ingestion
    – Provide teaching about newborn care concerning bathing, diapering, crying and comfort

Under each area of content, familiarize yourself with the associated vocabulary, consider the type of care the mother and/or child should receive at this stage in pregnancy and what the nurse should be aware for in terms of possible complications.

Image source.
Content derived from HESI Comprehensive Review for NCLEX-RN Examination.
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Pediatrics: The Basics

Think of Pediatrics as the baby version of Med/Surg. Much of the content applied in med/surg parallels that of pediatric care. However, it is important to consider the factor of developmental care when studying the content.

The course introduces the basics of development in the lifespan of infant to 18 years of age. Two main revisited concepts include Erikson’s stages of psychosocial development and Piaget’s developmental theory.

Erikson’s Stages of Psychosocial Development
[0-2 years] : Trust vs Mistrust
[2-4 years] : Autonomy vs Shame & Doubt
[4-5 years] : Initiative vs Guilt
[5-12 years] : Industry vs Inferiority
[13-19 years] : Identify vs Role confusion
[20-24 years] : Intimacy vs Isolation
[25-64 years] : Generativity vs Stagnation
[65-death] : Ego Integrity vs Despair

Piaget’s Stages of Cognitive Development
[birth-2 years] : Sensori-motor
[2-7 years] : Preoperational
[7-11 years] : Concrete operational
[11 years +] : Formal operational

In studying for this course, relay back to the information you learned in Med/Surg, Assessment and Foundations, but apply them in a developmental context. For example, when caring for a child with respiratory disease, consider the capacity of their lungs or their cognitive ability to learn how to use an inhaler. Also consider the complexity of giving medications to a young population. Often times, the dosages must be calculated precisely based on their body surface area. In the clinical setting, medications are given in carefully set IV pumps which administer the medications in precise amounts.

Image Source.

Critical Care: Basics of EKGs

Interpretation:

  • 1 small square = 0.04 seconds horizontally and 0.1 mV vertically
  • 1 large square =  0.20 seconds horizontally and 0.5 mV vertically

To calculate heart rate (HR), there are 3 methods:

  • Count the number of R waves in a 6 second strip (30 large squares)
  • Count the number of large squares between two QRS complexes and divide into 300.
  • Count the number of small squares between two QRS complexes and divide into 1500

The process of interpreting a rhythm:

  1. Look for the P wave – is it upright or inverted? is there one for every QRS? are there flutter of fibrillatory waves present?
  2. Measure the PR interval – is it normal or prolonged?
  3. Measure duration of QRS complex – is it normal of prolonged?
  4. Assess the ST segment – is it flat, elevated or depressed?
  5. Note the T wave – is it upright or inverted?

Overall, you want to know: what is the dominant rhythm, what is the clinical significance and what is the appropriate treatment?

Normal EKG durations:

  • P wave = 0.06-0.12 seconds
  • P-R Interval = 0.12-0.20 seconds
  • QRS complex = 0.06-0.10 seconds
  • ST segment = 0.12 seconds
  • T wave = 0.16 seconds
  • QT interval = 0.34-0.43 seconds

Types of dysrhythmias (general names and classifications, more detail covered in your theory classes)

  • Sinus rhythms:
    Normal sinus rhythm
    Sinus tachycardia
    Sinus bradycardia
    Sinus arrhythmia
  • Atrial rhythms:
    Premature atrial contractions (PACs)
    Paroxysmal supraventricular tachycardia (P/SVT)
    Atrial flutter
    Atrial fibrillation
  • Heart blocks (the AV node is sick!):
    1st degree heart block
    2nd degree heart block, Type I (Wenckebach)
    2nd degree heart block, Type II
    3rd degree heart block or complete heart block
  • Ventricular rhythms:
    Premature ventricular contractions (PVCs)
    Ventricular tachycardia
    Ventricular fibrillation
    Asystole
    Pulseless electrical activity (PEA)

In studying for each of the dysrhythmias, you need to not only learn how to identify them, but also what to do next once you have identified the rhythm (treatment? monitor? IV? O2?)

Image Source: #1, #2.