Health Authority Abu Dhabi Maternal and Child Health Nursing IMPORTANT TERMS Ballotement Rebounding of the fetus

s against the examiner's finger on palpation Chad i!"#s sign Bluish coloration of the mucus membranes of the cervix, vagina and vulva that occurs at about 6 weeks of pregnancy and is a probable sign of pregnancy Embryo Fetal development from day 1 until ! weeks after conception or until the mebryo measures " cm from crown to rump $ertili%ation #niting of sperm and ovum, which occurs within 1$ hours of ovulaton and within $ to " days of insemination, the average duration of viability for the ovum and sperm &oodell#s sign %oftening of the cervix that occurs at the beginning of the second month of gestation and is probable sign of pregnancy Hegar#s sign &ompressibility and softening of the lower uterine segment that occurs at about week 6 of gestation Im'lantation 'ttachment of the (ygote to the uterine wall 6 to 1) days after conception (e!ithin )(* + to + s'hingomyelin )S* ration *he ratio of the two components of the amniotic fluid, used for predicting fetal lung maturity+ the normal ,-% ratio in amniotic fluid is $.1 or higher when the fetal lung is mature/ ,iability *he capability of the fetus to survive outside the uterus+ about $$ to $0 weeks after the last menstrual period, or fetal weight more than )) g/ MENSTR-A( C.C(E O/arian Hormones 1ncludes the follicle stimulating hormone 2F%34 and lueteining hormone 2,34 Released by the anterior pituitary glands 'verage length of menstruation $! days O,ARIAN CHAN&ES 5reovulatory phase ,uteal phase -TERINE CHAN&ES 6enstrual phase 5roliferative phase %ecretory phase $EMA(E PE(,IS MEAS-REMENTS True 'el/is ,ies below the pelvic brim &onsist of the pelvic inlet, midpelvis and pelvic outlet $alse 'el/is 1s the shallow portion above the pelvic brim

 %upports the abdominal viscera T.PES O$ PE(,IS &yne!oid o 7ormal female pelvis o *ransversely rounded or blunt o 6ost favorable for successful labor and birth Anthro'oid o 8val shape o 'de9uate outlet, with a normal or moderately narrow pubic arch T.PES O$ PE(,IS Android o :edged; shaped or angulated o %een in males o 7ot favorable for labor o 7arrow pelvic planes can cause slow descent Platy'elloid o Flat with oval inlet o :ide transverse diameter but short anteroposterior diameter, making the outlet inade9uate $ERTI(I0ATION AND IMP(ANTATION $ERTI(I0ATION 1$ hours of ovulation and within $ to " days of insemination <ach reproductive cell carries $" chromosomes %perm carry an = or > chromosome ? => male+ == female/ IMP(ANTATION @ygote propelled toward the uterus @ygote implants 6 to ! days after ovulation Blastocysts secretes chorionic gonadotropin to ensure tat the corpus luteum remains viable and secretes estrogen and progesterone for first $ to " months of gestation $ETA( DE,E(OPMENT 5remebryonic period. first $ weeks after conception <mbryonic period. beginning of the the third though the eight week after conception Fetal period. beginning of the ninth week after conception and ending with birth SA(IENTS POINTS O$ $ETA( DE,E(OPMENT 1EE2 34 )35 + 34* 3eart is detected by Aoppler trasnducer 1EE" 46 Bernix caseosa covers entire body 1EE2 47 ,ecithin forming 1EE2 89 0$ ? 0! cm in length $ )) gm 1ee" 65 0! ? $ cm in length

 "))) ? "6)) gm ,anugo is present in upper arms and shoulders Bernix caseosa decreases $ETA( EN,IRONMENT Amnion <ncloses the amniotic fluid cavity 1nner membranes that forms about the second week of embryonic development Forms a fluid ? filled like sac that surrounds the embryo and later the fetus Chorion 8uter membrane Becomes vasculari(ed and forms the fetal part of the placenta Amnioti! :luid &onsist of !)) ? 1$)) m, by the ned of pregnancy %urrounds, cushion, and protects the fetus and allows fetal movement 6aintains the body temperature of the fetus &onsist mainly of urine and is therefore a measure of fetal kidney function Pla!enta <xchange of nutrients and waste products between the fetus and the mother Aevelops by the third month By week !, genetic testing can be done $ETA( CIRC-(ATION -mbili!al !ord $etal heart rate $etal !ir!ulation by'ass o Auctus arteriosus o Auctus venosus o Foramen ovale OBSTETRICA( ASSESSMENT &ESTATION Time :rom :ertili%ation o: the o/um until the estimated date o: !on:inement or estimated date o: deli/ery About 475 days Nagele#s rule :or estimating the date o: !on:inement &RA,IDIT. AND PARIT. &ra/idity o Cravida o Cravidity o 7ulligravida o 5rimigravida o 6ultigravida PARIT. o 1s the number of births 2not the number of fetuses ? e/g/ twins4 carried past $) weeks gestation, whether or not the fetus was born alive o 7ullipara o 5rimipara o 6ultipara

&TPA( &ra/ida Term Preterm Abortion (i/ing !hildren SI&NS O$ PRE&NANC. PRES-MPTI,E SI&NS 'menorrhea 7ausea and vomiting 1ncraesed si(e and increased feeling of fullness in breasts 5ronounced nipples #rinary fre9uency Duickening Fatigue Aiscoloration of the vaginal mucosa Probable signs -terine enlargement Hegar#s sign %oftening and thinning of the lower uterine segment that occurs at about week 6 &oodell#s sign %oftening of the cervix that occurs at the beginning of the second month Chad i!"#s sign Bluish discoloration of the mucous membranes of the cervix, vagina and vulva that occurs about at 6 week Ballotement Rebounding of the fetus against the examinerEs fingers on palpation Bra;ton Hi!"#s !ontra!tions Positi/e 'regnan!y test POSITI,E SI&N $etal heart rate dete!ted by ele!troni! de/i!e )Do''ler* at 35 + 34 ee"s and by non ele!troni! de/i!e ):etos!o'e* at 45 ee"s o: gestation A!ti/e :etal mo/ements 'al'able by e;aminer Outline o: :etus /ia radiogra'hy or ultrasonogra'hy $-NDA( HEI&HT Is measured to e/aluate gestational age o: the :etus During the se!ond and third trimester :undal height in !entimeters a''ro;imately e<uals :etal age in ee"s = 4!m 39 ee"s + hal: ay bet een the sym'hysis 'ubis and the umbili!us At 45 to 44 ee"s> the :undus is a''ro;imately at the lo!ation o: the umbili!us At 89 ee"s> the :undus is at the ;i'hoid 'ro!ess MATERNA( RIS2 $ACTORS &erman Measles Maternal in:e!tion the :irst 7 ee"s o: gestation !arries the highest rate o: :etal in:e!tion Se;ually Transmitted Disease

 Sy'hilis 6ay cross the placenta 1nfection usually leads to spontaneous abortions &enital Her'es 8rganisms may cross the placenta Fetus is contaminated after membranes rupture or with vaginal delivery &onorrhea &ontaminated at the time of delivery Risk for opthalmia neonatorum, sepsis and pneumonia H-MAN IMM-NODE$ICIENC. ,IR-S )HI,* Transmitted through body :luids Re'eated e;'osure to /irus during 'regnan!y through unsa:e se;ual 'ra!ti!es or intra/enous drug use !an in!rease the ris" o: transmission to the :etus Treated ith 0ido/udine S-BSTANCE AB-SE Physi!al signs o: drug abuse in!ludes? dilated or !ontra!ted 'u'ils> :atigue> tra!" mar"s> s"in abs!esses> in:lamed nasal mu!osa> and ina''ro'riate beha/ior by the mother $etal al!ohol Syndrome Fitteriness, physical abnormalities, congenital anomalies, and growth deficits Smo"ing ,ow birth weight, a higher incidence of birth defects CARDIO,ASC-(AR S.STEM 8RD month @ blood /olume in!rease 85 + A5B E'ista;is + o!!urs due to hy'eremia o: the nasal membrane Slight heart in!reases 35 to 3A beatsC Minute in the latter hal: o: 'regnan!y Dro' in se!ond trimester Physiologi! anemia Aue to hemodilution Normal /alues? 3ct. "$ ? 0"G 3gb. 1)/ ? 10 g-d, Cardio/as!ular system Pathologi! anemia @ most !ommon hematologi! disorder Edema o: lo er e;tremities + normalD edema o: u''er e;tremities + 're + e!lam'sia <levate extremities above the hip level ,ari!osities &an be prevented thru wearing panty hose or support stockings B#,B'R B'R1&8%1*1<% ? relieved thru positioning. side lying with pillow under the hips and modified knee chest Cardio/as!ular system Thrombo'hlebitis or Dee' ,ein thrombosis 3omanEs sign 6ilk leg or H5hlagmasia 'lba dolens ENDOCRINE S.STEM

 <levated h&C; peak third month and drops <strogen and progesterone continue to be secreted until 6 months <striol increases ? sign of fetal well being RESPIRATOR. S.STEM %hortness of breath because of enlarging uterus 3yperventilation 7asal congestion ? response to increased estrogen levels Castrointestinal 6orning sickness 3yperemesis gravidarum <mesis gravidarum 3eartburn Aecrease emptying of bladder Food cravings 5tyalism Flatulence &onstipation 3emorrhoids RENA( S.STEM 1st trimester ? fre9uent urination $nd trimester ? normal as bladder has already adFusted "rd trimester ? increase in fre9uency of urination due to pressure of the gravid uterus on urinary bladder Clycosuria 7octuria 5roteinuria M-SC-(OS2E(ETA( S.STEM ,ordosis ? pride of pregnancy %oftening of all ligaments and Foints :addling gait ,eg cramps INTE&-MENTAR. S.STEM %triae gravidarum 5rotruding umbilicus ,inea nigra &hloasma ? mask of pregnancy REPROD-CTI,E CHAN&ES Amenorrhea Chad i!"#s sign &oodell#s sign 8perculum ? mucus plug+ progesterone Hegar#s sign Tingling> soreness and dar"ening o: the areola (ABORATOR. TEST Blood type and Rh Factor

'B8 typing is performed to determine the womanEs blood type in the 'B8 antigen system 1f the client has Rh negative and has a negative antibody screen, she will need repeat antibody screens and should receive Rh immune globulin at $! weekEs gestation Rubella titer 1f titer is less than 1.! the patient should receive appropriate immuni(ation %hould be counselled not to become pregnant for 1 to " months and avoid contact with immunocompromised Rubella vaccine administerd at the same time as Rh immune globulin, it may not be effective Tuber!ulin s"in Test May 're:er to 'er:orm a:ter deli/ery Positi/e s"in test indi!ates the need :or !hest radiogra'h )using an abdominal lead shield* to rule out a!ti/e disease 1n pregnant. will be performed until after $) weeks of gestation 2after the fetal organs are formed4 -RINA(.SIS AND -RINE C-(T-RE #sed to check for sugar and protein in the urine Clycosuria is a common result of decreased renal threshold that occurs during pregnancy :hite Blood cells in the urine may indicate infection Ietonuria may result from insufficient food intake or vomiting ,evels of $J to 0J protein in the urine may indicate infection of preeclampsia DIA&NOSTIC TEST -(TRASONO&RAPH. 'ssist in conforming gestational age and estimated date of delivery Aone abdominally or transvaginally Al'ha + :eto'rotein s!reening &an detect spina bifida and down syndrome 1f the level is elevated and the gestation is less than 1! weeks, a second sample is drawn 'n ultrasound is performed for elevated levels to rule out fetal abnormalities or multiple gestation Chorioni! ,illus Sam'ling *o detect genetic abnormalities Arink water to fill bladder to aid in the visuali(ation of the uterus for catheter insertion 1nstruct the client to report bleeding, infection, or leakage of fluid at insertion site after the procedure 1ncreases the risk of Rh sensiti(ation 'mniocentesis 1" to 10 weeks Aetermine genetic disorders, metabolic defects, and fetal lung maturity RIS2 6aternal hemorrhage 1nfection Rh isoimmuni(ation 'bruptio placenta

 'mniotic fluid emboli 5remature rupture of the membranes Inter/entions 8btained informed consent <mpty bladder before the procedure 5repare the client for ultrasonography, which is performed to locate the placenta 5osition the client supine $ERN TEST 1s a microscopic slide test to determine the presence of amniotic fluid leakage #sing sterile techni9ue, a specimen is obtained from the external os of the cervix and vaginal pool and is examined on a slide under a microscope 5osition. dorsal lithotomy 1nstruct the client to cough, which will cause the fluid to leak from the uterus if the membranes are ruptured Nitra%ine Test 1s used to detect the presence of amniotic fluid in vaginal secretions p3 of 0/ to / and do not affect the nitra(ine strip or swab 'mniotic fluid has a p3 of K/) to K/ and turns the nitra(ine strip or swab blue 5osition. Aorsal lithotomy Blue ? green, blue gray, deep blue ? indicates that membranes are probably ruptured N-TRITION 'verage weight gain $ to " lbs for women with a normal prepregnancy weight/ 'n increase of about ")) cal-day is needed during pregnancy+ greater in the last two trimester 'n increase of about )) cal- day is needed during lactation T.PES O$ ,E&ETARIAN DIET ,acto ? ovo vegetarian ,acto vegetarian Began 5esco Begetarian ABORTION Ty'es o: abortion %pontaneous 1nduced *hreatened 1nevitable 1ncomplete &omplete 6issed 3abitual Inter/ention? Bed rest 6onitor vital signs &ount perineal pads 6onitor for shock

CARDIAC DISEASE NE1 .OR2 HEART ASSOCIATION $-NCTIONA( C(ASSI$ICATION O$ HEART DISEASE Class I #ncompromised/ 7o symptoms and no limitation in ordinary physical activity, e/g/ shortness of breath when walking, climbing stairs etc/ Class II %lightly compromised/ 6ild symptoms 2mild shortness of breath and-or angina4 and slight limitation during ordinary activity/ NE1 .OR2 HEART ASSOCIATION $-NCTIONA( C(ASSI$ICATION O$ HEART DISEASE Class III 6arkedly compromised/ 6arked limitation in activity due to symptoms, even during less; than;ordinary activity, e/g/ walking short distances 2$)?1)) m4/ &omfortable only at rest Class I, <xperiences symptoms even while at rest/ 6ostly bedbound patients/ Assessment? %igns and symptoms of cardiac decompensation &ough Ayspnea 5alpitations and tachycardia 5eripheral edema &hest pain %igns of respiratory infection %igns of congestive heart failure and pulmonary edema Inter/entions During labor 're'are to do the :ollo ing 6onitor vital signs fre9uently 5lace the client on a cardiac monitor and on an external fetal monitor DIABETES ME((IT-S First trimesteer insulin needs decrease Auring the second and third trimesters, increases in placental hormones cause an insulin resistant state, re9uiring an increase in the clientEs insulin dose/ *he fetus produces its own insulin and pulls glucose from the mother, which predisposes the mother to hypoglycemic reactions &ESTATIONA( DIABETES ME((IT-S 8ccurs in pregnancy 2during the second trimester or third trimester4 in clients not previously diagnosed as diabetic and occurs when the pancreas cannot respond to the demand for more insulin %creened. $0 to $! weeks " hour oral glucose tolerance test will be performed to confirm gestational diabetes mellitus Predis'osing !onditions :or gestation diabetes? 8lder than " years old 8besity

6ultiple gestation Family history of diabetes mellitus

DISSEMINATED INTRA,ASC-(AR COA&-(ATION )DIC* Clotting !as!ade is a!ti/ated> resulting in !lots in the mi!ro!ir!ulation The ra'id and e;tensi/e :ormation o: !lots !auses the 'latelets and !lotting :a!tors to be de'letedD this results in bleeding and the 'otential /as!ular o!!lusion o: organs :rom thromembolus :ormationC Predis'osing !onditions? 'bruptio placentae 'mniotic fluid embolism Cestational hypertension 1ntrauterine fetal death ,iver disease %epsis ASSESSMENT #ncontrolled bleeding Bruising, purpura, petechiae, and echhymosis 5resence of occult blood in excretion such as stool 3ematuria, hematemesis, or vaginal bleeding %igns of shock INTER,ENTIONS monitor vitals signs+ assess for bleeding and signs of shock ECTOPIC PRE&NANC. Missed menstrual 'eriod Abdominal 'ain ,aginal s'otting to bleeding that is dar" red or bro n Ru'tured? in!reased 'ain> re:erred shoulder 'ain> signs o: sho!"C Inter/entions 8btain assessment data and vital signs 6onitor bleeding and initiate measures to prevent rupture and shock 6ethothrexate 2folic acid antagonist4 may be prescribed to inhibit cell division in development embryo ENDOMETRITIS Assessment &hills and fever 1ncreased pulse Aecreased appetite 3eadache Backache 5rolonged, severe afterpain *ender, large uterus Foul odor lochia or reddish brown lochia Inter/entions?

5osition the client in FowlerEs position to facilitate drainage or lochia 'dminister comfort measure such as back rubs and position changes and pain medications as prescribed ee"s

$ETA( DEATH IN -TERO Client !an de/elo' DIC i: the dead :etus is retained in the uterus :or 8 to 6 or longer

H.DRATIDI$ORM MO(E $orm o: gestational tro'hoblasti! disease that o!!urs hen the thro'hoblasts> hi!h are the 'eri'heral !ells that atta!h the :ertili%ed o/um to the uterine all> de/elo' abnormallyC The mole 'resents as an edematous gra'e + li"e !luster that may be nonmalignant or may de/elo' into !horio!ar!inoma ASSESSMENT Fetal heart rate not detectable Baginal bleeding, which may occur as early as the fourth week or as late as the second trimester+ may be bright red or dark brown in color and may be slight profuse or intermittent %ymptoms of gestationa hypertension b y $)th week Fundal height greater than expected for gestational date <levated h&C #ltrasound showing a characteristic of snowstorm pattern INTER,ENTIONS <vacuation of the mole is done by vacuum aspiration+ oxytocin is administered after evacuation to contract the uterus *issue is sent to the laboratory for evaluation, and follow ? up is important to detect changes suggestive of malignancy &ESTATIONA( H.PERTENSION Can be mild or se/ere leading to e!lam'sia or 're e!lam'sia Predis'osing !onditions 5rimigravida :omen younger than 1L years old or older than 0) years &hronic renal disease &hronic hypertension Aiabetes mellitus Rh incompatibility COMP(ICATIONS 'bruptio placenta A1& *hrombocytopenia 5lacental insufficiency 1ntrauterine growth restriction 1ntrauterine fetal death Inter/entions

6onitor for 3<,,5 2hemolysis, elevated liver en(yme, and low platelet count4

INCOMPETENT CER,IE Premature dilation o: !er/i; hi!h o!!urs during the 6th or Ath month o: 'regnan!yC ASSESSMENT? F<*', 6<6BR'7<% B1%1B,< *3R8#C3 *3< &<RB1= B'C17', B,<<A17C STA&ES O$ (ABOR $IRST STA&E SECOND STA&E THIRD STA&E $O-RTH STA&E 6gt. orient the client and the family/ *he longest phase 6gt. 'ssist in pushing 'verage duration. ? ")/ 'ssess B%, fundal height and lochia SI&NS O$ P(ACENTA( DE(I,ER. )&-R(* Cushing of blood #terus firm and round Red bloody show ,engthening of the umbilical cord EAR(. DECE(ERATIONS Fetal head compression *x. none (ATE DECE(ERATIONS #tero ; 5lacental insufficiency *x. 8xygen ,ARIAB(E DECE(ERATIONS &ord compression 5lace the client to left lateral position and administer oxygen IN CASE $HR PATTERN INDICATES $ETA( DISTRESS )DEAR* D is!ontinue intra/enous o;yto!in E le/ate head o: bed to 85 degrees A administer o;ygen by :a!emas" at 7 + 35 (Fmin R e'osition !lient to side lying POINTS TO REMEMBER The $HR is best heard dire!tly o/er the :etal ba!" Ha/e the oman em'ty her bladder be:ore beginning Position? DORSA( REC-MBENT I: you are right + handed> stand on the omen#s right> :a!ing her

Aus!ultate :etal heart tones

hen :inished

R-PT-RES O$ MEMBRANE )ROM* NORMA( CHARACTERISTICS O$ AMNIOTIC $(-ID? 'ale> stra + !olored> thin> atery and ithout strong odourD usually A55 + 3455 m( R86 may occur with a small drop or a stream of fluid from the vagina 7itra(ine paper is used to check the p3 of the fluid/ Blue alkaline 78*<. 5rolonged R86, more than 1$ ? $0 hours before birth, predisposes the client and fetus to infection CHARACTERISTIC O$ $(-ID AND 1HAT IT SI&NI$IES? *hick, cloudy and foul smelling ? infection Creenish ? brown or yellow stained ? fetal distress MECONI-M STAINED AMNIOTIC $(-ID 5osition infant in %#517< &3<&I . fetal scalp blood sampling for '&1A8%1% %uction to prevent meconium aspiration 'dminister oxygen if necessary *his might be a se9uela to umbilical cord compression 5repare for stressed infant, with possible transfer to intensive care unit ,ITA( SI&NS AND MEAS-REMENT Tem'erature? 89CA + 8GD sur:a!e tem'erature is 're:erred Pulse rate? 335 + 395 bFmD 375 i: !rying and 355 i: slee'ing Res'iratory rate? 85 + 95D abdominal breather Blood 'ressure? 75F6A :irst 89 hours )not routinely ta"en* (ength? 6A + AA !m Head !ir!um:eren!e? 83 + 87 Chest !ir!um:eren!e? 83 + 89 1eight ? 9 + H lbsC 35B 1eight loss :or the :irst :e days NOTE? 1eight doubles at 9 monthsD tri'les at 3 year and <uadru'les at 4 I years RE$(EEES Seen hen !hee" is stro"ed and ne born res'onds ith a turn o: the head to ard the tou!h 1ell de/elo'ed at birth Pressure on the 'alms o: the hands or soles o: the :eet !auses :le;ion o: :inger and toes Immediate> bilateral symmetri! res'onse to sudden Jarring or abru't !hange in e<uilibriumC Diminished by 9 months o Rooting o Su!"ing o &ras' o Moro 1hen 'lantar lateral sur:a!e is stro"ed the toes :lareC Disa''ears at one year

$en!ing re:le;D hen the ne born lies on the ba!" ith head turned to one side> the arm and leg on the same side are e;tended> and the o''osite arm is :le;edC Disa''ears 8 @6 months o: age o Babins"i o Toni! ne!" BIOPH.SICA( PRO$I(E It assess :i/e :etal bio'hysi!al /ariables? Breathing movement *one Cross body movement 'mniotic fluid volume Fetal reactivity 27%*4 )The :irst :our /ariables are assessed by ultrasoundD normal :indings K 4D abnormal :inding K 5D ma;imum s!ore 35* IMP(ICATION? 7ormal fetal biophysical activities indicates that &7% is normal and the fetus is not hypoxemic/ 'bnormal findings with oligohydramnios indicate fetal danger 2'cidosis and impeding death4 %ee findings. 7ormal ! ? 1) 2if amniotic fluid volume is ade9uate4 <9uivocal. 6 'bnormal. M0 RIS2? NONIN,ASI,E PROCED-RE PEDIATRIC N-RSIN& STA&ES O$ &RO1TH AND DE,E(OPMENT PERIODS O$ ACCE(ERATED AND DECE(ERATED &RO1TH RATE RAPID Fetal, infancy and adolescence Slo %chool age Alternating *oddler and preschooler IN$ANC. PERIOD DE,E(OPMENTA( THEORIES $RE-D + 8ral 6outh is the center of gratification 5'R<7*% '**1*#A< ? should be able to wean the child from using bottle before 1! months of age otherwise it might dampen personality development 7ormal 7arcissism or self ? love Eri!"son *rust Bs/ 6istrust 6other is the most important person at this age Piaget

%ensorimotor 2OH(BER& + Amoral COMMON $EAR %tranger anxiety P(A. %8,1*'R> TO.S 6obile toys, rattle and red big balloon 2red, white and black are colors for stimulation4 Common Problems Falls 'spiration

TODD(ER No is their :a/orite ord Ritualisti! Al ays !onsider their se!urity blan"ets li"e their :a/orite stu::ed toy DE,E(OPMENTA( THEORIES $RE-D Anal )E&O* Anus and re!tum are the !enter o: grati:i!ation TOI(ET TRAININ& SI&NS 'ble to verbali(e toilet needs 'ble to sit, stand and walk PARENTS ATTIT-DE? 7either too rigid nor lenient 2might affect the personality development of the child4 ERIC2SON Autonomy /sC Shame and doubt Parents are the most im'ortant 'erson To hold on and let go PIA&ET + Pre!on!e'tual Phase )Stage I? Preo'erational* &oncepts or ideas without logic &haracteri(e by simple classification :ith ego centric thinking 2cannot put self in place of another4 2OH(BER& )MORA(* 5reconventional 5unishment and obedience COMMON $EARS %eparation anxiety P(A. 5arallel ? a solitary play in the presence of another without sharing association TO.S 5ush ? pull toys, pounding peg and ,ego COMMON PROB(EMS Fall 5oisoning

Burns of all types IMPORTANT CONCERNS 7utrition 2Ical; 1))kcal-day4 Aentition &omplete $) teeth by $ years Begins dentist visit at $ N years Begins brush teeth at $ years &onsider the si(e of the toothopaste 2pea;si(ed4

PRESCHOO(ER ,ery imaginati/e ) ith imaginary :riends* Begins to masturbate )e;'loration* DE,E(OPMENTA( THEORIES $RE-D + Phalli! or Oedi'al )Su'erego* ERIC2SON 1nitiative vs/ Cuilt Family is the most important person &onscience begins to develop at this stage %ibling Rivalry PIA&ET + Stage II o: Pre + o'erational thought 'eriod Inows what is right but not HwhyO %ays many words but without meaning #nable to understand other point of view PRESCHOO(ER 2OH(BER& &onventional &hildEs moral standards are those of others COMMON $EAR 6utilation and castration P(A. 'ssociative and cooperative *8>%. Aolls and Iitchen %et COMMON PROB(EM Behicular accident 5oisoning SCHOO(ER G + 33 years old Chara!teri%ed by ha/ing the most slo 'eriod o: gro th and de/elo'ment Normal Homose;uality DE,E(OPMENTA( THEORIES $RE-D (aten!y Ho'es ans ers on <uestions about se;

Peer o: the same se; must be !onsidered PIA&ET Con!rete O'erations De/elo'ment o: mental !lassi:ying and ordering a!ti/ities 1ith !on!e't o: re/ersibility -nderstands other 'oint o: /ie 2OH(BER& Con/entional Desires to 'lease others COMMMON $EARS $ear o: death $ear o: re'la!ement or dis'la!ement :rom s!hool P(A. Com'etiti/e TO.S Dominoes> !hess> s!rabble In:ormati/e materials )boo"s> bro!hures> atlas> almana! and en!y!lo'edias COMMON PROB(EM ,ehi!ular a!!ident &unshot ounds

ADO(ESCENT 34 + 37 years old Chara!teri%ed by gro th s'urt hi!h begins early in girls about 3 to 4 years Seba!ious glands are a!ti/e )EMPHASI0E IMPORTANCE O$ &OOD H.&IENE* De/elo'mental theory $RE-D &enital and se;ual relationshi' ith others Masturbation and se;ual relationshi' ith others Body image de/elo'ment and a!!e'tan!e by o''osite se; are im'ortant ERIC2SON )IDENTIT. ,S RO(E CON$-SION* 5eer of opposite sex is the most important person H:ho am 1PO PIA&ET 'bility of abstract thinking 2OH(BER& 1nternal control of conduct Aecides between socially accepted standards COMMON $EAR $ear o: 'eer reJe!tion COMMON PROB(EMS ,ehi!ular a!!ident &unshot ounds BREAST$EEDIN& AD,ANTA&E

Readily available Reduced incidence of allergies Reduced incidence of maternal breast cancer <conomical 5romotes facial muscle, Faw and teeth 6other infant bonding *ransfer of maternal antibodies DISAD,ANTA&E 5revents other from feeding the infant ,imits paternal role in feeding &ompels the mother to monitor her diet carefully 6aybe difficult to a working mother Aigest 9uickly so more feeding is recommended BOTT(E $EEDIN& AD,ANTA&E Permits the :ather to :eed Mother might trans:er medi!ations $e er :eedings $eeding in 'ubli! is embarrassing DISAD,ANTA&E &ost Creater preparation and effort Re9uires refrigeration and storage 7o transfer of maternal antibodies AoesnEt benefit mother physiologically

-NIL-E CHARACTERISTICS O$ BREAST $EEDIN& B + est :or babies R + edu!e allergi! rea!tion E + !onomi!al A + l ays a/ailable S + a:eFmaintenan!e the stool so:t T +em'erature al ays right $ + resh E + motional bonding E + asily establish D + igestible I + mmunity N + utritious & + IT disorders lo ered NOTE? TO ENS-RE ADEL-ATE $EEDIN&> the !hild must? 1et 9 to 7 dia'ers a days &ain eight

PH.SIO(O&IC CHAN&ES RESPIRATOR. S.STEM Initial Breath is triggered by !hemi!al and thermal stimulus Sur:a!tant Chemi!al K (o O4 and High CO4 K lo blood 'H Thermal K abru't !hange in tem'erature CARDIO,ASC-(AR S.STEM Note? $rom $etal !ir!ulation to systemi! !ir!ulation Du!tus /enosus Du!tus arteriosus $oramen O/ale RENA( S.STEM All stru!tural organs in the renal system are 'resent but still doesn#t :ully mature until the :irst year o: li:e Neonate has lo ability to remo/e drugs and 'rone to e;!essi/e ater loss ,oiding should o!!ur ithin 46 hours Bladder /oluntarily em'ties hen stret!hed by a 3A ml /olume o: urine resulting to a /oiding o: 45 times a day &ASTROINTESTINA( S.STEM Ade<uate s allo ing and su!"ing re:le; Bo el sound !an be heard 3 hour a:ter birth Ra'id 'eristalti! a/e and simultaneous non 'eristalti! a/s along the entire eso'hagus )migrating motor !om'le; that 'ro'el nutrients :or ard MECONI-M CONTENTS? Amnioti! :luid intestinal se!retions Shed o: mu!osal !ells 'ossibly blood EECRETED? 46 to 67 hours CHARACTERISTICS? Sterile> greenish bla!" and /is!ous HEMATOPOETIC AND HEPATIC S.STEM Blood /olume o: :ull term neonate is 75 to 335 mlF"g or a/eraging to 855 ml (i/er K redu!ed glu!orenyltrans:erase )!on/ert indire!t bilirubin to dire!t bilirubin* Physiologi! Maundi!e + a:ter 46 hours to G days Pathologi! Jaundi!e + ithin 46 hours @ 'hotothera'y NE-RO(O&IC S.STEM Pla!ing the :inger at the neonate !hee" and :ollo ing its dire!tion K 6 months Pla!ing solid :ood in the mouth and it ill be s'itted )anterior*F s allo ed )'osterior* Rooting re:le; E;trusion re:le; Change in e<uilibrium K 6 months

E;'osure to loud sound K 6 months Turning the head at the side> e;tremities o: the same side :ollo the dire!tion K 6 months Moro re:le; Startle re:le; Toni! + ne!" re:le; ):en!ing or bo;er re:ele;* A ee"s K baby a''ears to ta"e ste's or dan!e hen held u'right ith hisFher :eet tou!hing a solid sur:a!eC M + stro"ing the sole o: the :oot and there ill be :anning K 7 + 34 months Dan!e ste' Babins"i Re:le;

AP&AR SCORIN& AP&AR AP&AR SCORE + DrC ,irginia A'gar S'e!ial Considerations? 3st 3 min + determine general !ondition o: baby Ne;t A min@ determine baby#s !a'abilities to adJust e;tra uterinely Ne;t 3A min + de'endent on the A min a''earan!e@ !olor + slightly !yanoti! a:ter 3st !ry baby be!omes 'in"C P@ 'ulse rate + a'i!al 'ulse + le:t lo er ni''le &@ grima!e + re:le; irritability@ tangential :oot sla'> !atheter insertion A + a!ti/ity + degree o: :le;ion or mus!le tone R + res'iration Baby !ry + ithin 85 se!s $ailure to !ry a:ter 85 se!s + as'hy;ia near the neonatorum Res'C de'ression + due mom gi/en DemerolC Administer Nalo;one AP&AR S!oring Chart? 5 3 4 HR @ absent N355 O355 Res' e::ort @absent ? slo > irreg> ea" ? good strong !ry Mus!le tone @ :la!!id e;tremities @ some :le;ion @ ell :le;ed Re:le; irritability Catheter @ no res'onse @ grima!e @ !ough> snee%e Tangential $ootsla' @ NR @ grima!e @ !ry Color @ blueF'ale @ a!ro!yanosis )body@ 'in" e;tremities@blue* @ 'in"ish AP&AR result 5 + 8 K se/erely de'ressed> need CPR> admission NIC6 + 9 K moderately de'ressed> needs add#l su!tioning P O4 G @ 35 KgoodF healthy N-RSIN& CARE O$ CHI(DREN ith PH.SIO(O&ICA( PROB(EMS T1O T.PES O$ CARDIAC DISORDERS Congenital Heart De:e!ts 'cyanotic &yanotic

A!<uired !ardia! disorders ASSESSMENT Cyanosis Clubbing S<uatting Murmurs $re<uent nose bleeds BP dis!re'an!ies INTER,ENTIONS Administer !ardia! medi!ations Allo :re<uent rest 'eriod Pro/ide high !alories nutritious diet A/oid !onta!t ith in:e!tious 'erson Allo 'arents to /entilate :ears and !on!erns Tea!h 'arents CPR Position !hild to in!rease o;ygenation AC.ANOTIC HEART DE$ECTS Atrial Se'tal De:e!t De:e!t in all se'arating le:t and right atium Signs and Sym'toms De!reased CO + ta!hy!ardia R /entri!ular hy'ertro'hy In!reased 'ulmonary /as!ular resistan!e A, node in/ol/ement K arrhythmias TREATMENT Close by sutureF'at!h ,ENTRIC-(AR SEPTA( DE$ECT De:e!t in all se'arating le:t and right /entri!le Signs and Sym'toms? De!reased CO K ta!hy!ardia R /entri!ular hy'ertro'hy In!reased 'ulmonary /as!ular resistan!e (oud Harsh murmur Treatment? Closure by sutureF 'at!h PATENT D-CT-S ARTERIOS-S Retention o: :etal /essel Joining 'ulmonary artery to aorta SI&NS AND S.MPTOMS In!reased 'ulmonary :lo De!reased CO K ta!hy!ardia TREATMENT? Indometha!in

Rash"ind umbrella

COARCTATION O$ THE AORTA Narro ing o: des!ending aorta> usually a:ter the ar!h SI&NS AND S.MPTOMS? Heada!he> e'ista;is> ICP HTN o: u''er e;tremities TREATMENT Enlargement o: a::e!ted 'ortion Surgi!al e;tension ith to end anastomosis C.ANOTIC DE$ECTS TETRA(O&. O$ $A((OT Consist o: De:e!ts? ,SD Pulmoni! stenosis O/erriding aorta R /entri!ular Hy'ertro'hy SI&NS AND S.PTOMS? Cyanosis Tet S'ell $ailure to thri/e S<uatting TREATMENT Blalo!" Tausig Pro!edure Re'air o: 'ulmoni! /al/e ,SD !losure Re'air o: o/erriding aorta RHE-MATIC $E,ER A systemati! in:lammatory disease that e::e!ts !onne!ti/e tissueC Caused by an a!<uired immunity to grou' A beta + hemolyti! stre'to!o!!al in:e!tionC Causes !ardia! damage in A5B o: all !asesC ASSESSMENT? MAMOR MANI$ESTATION? Carditis Erythema marginatum Sub!utaneous nodule Chorea )Sydenham#s Chorea* Polyarthritis MINOR MANI$ESTATIONS $e/er o: 87C4+87CH QC )353+354 Q$* Arthralgia Raised erythro!yte sedimentation rate or C rea!ti/e 'rotein (eu"o!ytosis

EC& sho ing :eatures o: heart blo!"> su!h as a 'rolonged PR inter/al )Cannot be in!luded i: !arditis is 'resent as a maJor sym'tom* $irst Degree A,@Blo!" Pre/ious e'isode o: rheumati! :e/er or ina!ti/e heart disease N-RSIN& DIA&NOSIS? Altered Cardia! $un!tion Altered Health maintenan!e Inter/entions Bed Rest Administer Meds $luid restri!tion Tea!h long term !are

&ASTROINTESTINA( D.S$-NCTION $AI(-RE TO THRI,E May be organi! or non organi!C Child !annot obtain or utili%e ade<uate !alori! inta"e ne!essary :or gro thC Non + organi! $IT is !aused by a disturban!e in the 'arent !hild bonding ASSESSMENT? 1eight NAth 'er!entile De/elo'mental delays Inade<aute :ood inta"e INTER,ENTIONS? daily eights Pro/ide emotional su''ort during :eeding In!rease !alorie :ormula Pro/ide de/elo'mental stimulation Tea!h 'arents ade<uate nutrition and :ood 're' C(E$T (IP AND PA(ATE ASSESSMENT? Ob/ious !le:t in u''er li' Cle:t in so:t andF or hard 'alate Di::i!ult su!" and s allo &OA(? Promote bonding INTER,ENTIONS $eed ith s'e!ial ni''les and bottles Hold semi + u'right :or :eeding Role model :or :amily (i' re'air done at a''ro;imately 4 months POST OP? Side lying 'osition 2ee' suture line !lean Elbo restraints

Palate re'air done at a''ro;imately 4 years POST OP? Elbo restraint O::er :luids ith !u' only DentalF s'ee!hF hearing re:erral

P.(ORIC STENOSIS Hy'ertro'hy and Hy'er'lasia i: Pylori! S'hin!ter ASSESSMENT Progressi/e /omiting Mil" emesis 1eight loss Irritable> hungry ,isible 'eristalsis Assess suture line INTER,ENTIONS? Stri!t I P O NPO Maintain I, in:usions Ad/an!e diet a:ter surgery Assess suture line ESOPHA&EA( ATRESIA AND TRACHEOSOPHA&EA( $IST-(A Eso'hagus ends in blind 'ou!hC Communi!ation bet een eso'hagus and tra!heaC May o!!ur se'arately or together ASSESSMENT? Di::i!ulty s allo ing Drooling Coughing Di::i!ulty breathing INTER,ENTIONS HOB ele/ated Su!tion I, hydration &T :eeding INT-SS-SCEPTION In/agination or teles!o'ing o: one 'ro'ortion o: the bo el into an adJa!ent 'ortion> !ausing obstru!tion ASSESSMENT? Barium enema Surgi!al redu!tion Ad/an!e diet INTER,ENTIONS Paro;ysmal abdominal 'ain ,omiting

Sausage sha'ed mass Tea!h 'arents

HIRSCHSPR-N&#S DISEASE ASSESSMENT? Me!onium ileus Consti'ation Abdominal distention $oul smelling> ribbon li"e stool Em'ty re!tal /ault INTER,ENTIONS (o residue Administer enemas Assess abdominal girth PHEN.(2ETON-RIA Missing 'henylalanine hydro;ylase and !annot !on/ert 'henylalanine into tyrosine ASSESSMENT Musty odor s"in $air s"in> e!%ema SCREENIN& TEST &uthrie test To maintain (o 'henylalanine le/el &i/e (o:enala! C.STIC $IBROSIS Autosomal re!essi/e inherited disorder hi!h a::e!ts the e;o!rine gland :un!tionC ASSESSMENT? $re<uent res'iratory in:e!tions 1hee%ing> rales Clubbing Altered !hest diameter $atty> $rothy> :oul smelling stools Me!onium ileus Salty tasting s"in INTER,ENTIONS? Administer aerosoli%ed treatments Chest 'hysiothera'y and 'ostural drainage Administer? 'ro'hyla!ti! antibioti!sC Pan!reati! en%ymes> ater soluble /itamins A>D>E In!reased Na= inta"e &eneti! !ounselling DIET? High !arbohydrates> moderate :ats and 'roteins

(E-2EMIA Most !ommon !hildhood disorder The malignant !ell in/ol/e is the? ASSESSMENT? $re<uent in:e!tions $atigue> 'allor> ta!hy!ardia Anemia 1eigh loss Bone 'ain INTER,ENTIONS? Assist ith diagnosti! 'ro!edures? Bone marro as'iration (umbar 'un!ture Administer Chemothera'y Indu!tion thera'y? to indu!e remission ,in!ristine (@ As'araginase Daunorubi!in Prednisone Allo'urinol TA2E NOTE? RE,ERSE ISO(ATION DIET? So:t bland diet> small :re<uent :eedings NEPHROTIC S.NDROME A /iral !ondition that a::e!ts glomerular :iltration and !auses loss o: 'rotein NEPHROSIS )Toddler> 'res!hooler 4 + 9* REMEMBER? In!rease 'rotein> de!rease :ats> de!rease NA= 1I(M#S T-MOR A tumor that arises in renal tissue during embryoni! de/elo'mentC -sually en!a'sulatedC MaJor Nursing Consideration? DO NOT PA(PATE ABDOMEN NE-RA( T-BE DE$ECTS S'ina Bi:ida? de:e!t in the !losure o: /ertebral !olumn Meningo!ele? A !yst li"e a sa! !ontaining meninges and CS$ 'rotrude outside /ertebral !olumnC Myelomeningo!ele? de:e!t in/ol/ing meninges> s'inal !ord and ner/e roots that 'rotrude outside the /ertebral !olumn and is by a thin membranous sa! ASSESSMENT? Membranous sa! in lumbar sa!ra area Head !ir!um:eren!e $la!!idity o: lo er e;tremities Congenital hi' dislo!ation Bo el and bladder :un!tion INTER,ENTIONS?

Prote!t sa! :rom inJury A/oid !ontamination o: sa! Pla!e in 'rone Trendelenburg 'osition Pre/ent s"in brea"do n

BACTERIA( MENIN&ITIS O!!urs belo 46 months and o!!urs during inter or !old season SI&NS AND S.MPTOMS? May be slo or sudden Se/ere heada!he Delirium Restlessness Irritability $e/er ,omiting Sti:: ne!" and s'ine Sei%ure Coma Pete!hiae In/oluntary ar!hing o: the ba!" in se/ere !ases DIA&NOSTIC TESTS AND (ABS CS$ )(umbar Pun!ture*? !loudy> in!rease 'rotein> de!rease glu!ose Ele!trolytes and serum and urine osmolarities to dete!t SIADH THERAPE-TIC MANA&EMENT Administer antibioti! Pro/ide isolation until 46 hours a:ter antibioti! Ta"e :re<uent /ital signs and neurologi!al !he!"s Com:ort measures Restri!t :luids COMP(ICATIONS? E'ile'sy Sensory loss hydro!e'halus

SCO(IOSIS (ateral !ur/ature o: the s'inal !olumnC -sually a::e!ts the thora!i! area May !ause body image disturban!e res'iratory !om'romise or !ardia! im'airment REMEMBER? Se/ere s!oliosis may lead to inter:eren!e in the normal res'iration due to distortion and de:ormity in the rib !ageC C-RRENT MANA&EMENT? Straightening and realignment o: the /ertebrae E;ternal )Bra!ing* Mil au"ee )Cur/e higher than T7*

Internal )surgi!al* :i;ation te!hni<ues END O$ MCN