OB Remediation for Kaplan PDF

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Redmidation notes from Kaplan that can be used...

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1. Newborn Care at Birth  You always suction the mouth first  An APGAR score is taken at 1 & 5 mins  Prevent the newborn from getting cold  Infant & mother should have matching numbers on bands  Newborns are given Vitamin K injection 2. Nutrition: Life Cycle  There is nutrition for all areas of life: Pregnancy, Infant, Toddler, Childhood, Adolescent, and Elderly  Each stage has things that are most important for that time in the life cycle but each one has specific Vitamins & Calories an individual should have at each age  Pregnant women need to increase calories by 300 per day  During pregnancy the women will need to supplement iron, folic acid, and calcium 3. Labor & Birth: Cesarean  Epidurals are use in most c sections  Make sure you as the nurse provide emotional support  Indwelling catheter is inserted before c section  After the woman has the c section the nurse must check the fundus 4. Newborn  Listen to the apical pulse for a full minute when baby isn’t crying  first stool of baby is meconium & its black/ tarry; it’s passed between 12-24hrs  Make sure to assess the size of the fontanelles back of head & top of head & have parents look for deviations 5. Abuse: Child  There can be physical or sexual child abuse  Make sure you watch for signs such as history of incidents, bruises, burns, fractures, abdominal injury & disturbed parent child interaction  For sexual watch for bleeding, STD, frequent UTI, sudden behavior changes 6. Otitis Media  Infection of the middle ear that can be acute or chronic  Can come from an upper respiratory infection  This is common in children  There are many indications & it can be fixed with tubes 7. Labor & Birth  Labor Process stages: fetal engagement, contractions, dilation & effacement, and rupture of membranes  There are 4 stages of labor:

i. First stage: Latent- 0-3 cm dilated, Active- 4-7 cm dilated, transition- 8-10cm dilated ii. Second stage: full dilation to baby being delivered iii. Third stage: birth of baby to the placenta coming out iv. Fourth stage: the first 2 hrs after birth 8. Phenylketonuria (PKU)  Cause by deficiency in liver enzyme phenylalanine hydroxylase  The body cant metabolize phenylalanine so it accumulates in the body  If not treated it can lead to mental retardation  Treat by restricting protein foods containing the amino acid such as: Meat, milk, eggs, beans , artificial sweeteners & bread  Blood levels should be monitored 9. Pregnancy: Prenatal Care  Go to all appointments  Take folic acid to reduce risk for neural tube defects  Increase recommended daily intake  Instruct patient to quit smoking, limit caffeine, avoid alcohol, avoid meds not approved by the HCP  Have good nutrition 10. Pregnancy: Prenatal Care  Go to all appointments  Take folic acid to reduce risk for neural tube defects  Increase recommended daily intake  Instruct patient to quit smoking, limit caffeine, avoid alcohol, avoid meds not approved by the HCP  Have good nutrition 11. Cleft Lip & Palate  Cleft lip is usually repaired between 6-12 months i. Make sure these infants have adequate nutrition ii. After surgery make sure they stay on side lying position & they burp often during feedings  Cleft Palate repaired at approximately 18 months i. After surgery make sure the infant lies on abdomen ii. Avoid suction, straws or anything related to the mouth 12. Down Syndrome  This is a chromosomal abnormality where they have an extra chromosome  The child’s physical features will more than likely consist of low nasal bridge, flat forehead, protruding tongue, low set ears, epicanthal fold

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These individuals have a lifetime of complications and normally do not live to be very old Make sure you inform the parents as much as you can about down syndrome

13. Nutrition: Life Cycle  There is nutrition for all areas of life: Pregnancy, Infant, Toddler, Childhood, Adolescent, and Elderly  Each stage has things that are most important for that time in the life cycle but each one has specific Vitamins & Calories an individual should have at each age  Pregnant women need to increase calories by 300 per day  During pregnancy the women will need to supplement iron, folic acid, and calcium 14. Therapeutic Communication  Listen to & understand client  Establish a good nurse-client relationship i. Trust is the most important in these relationships  The nurse must know their own strengths & weaknesses 15. Labor & Birth  Labor Process stages: fetal engagement, contractions, dilation & effacement, and rupture of membranes  There are 4 stages of labor: i. First stage: Latent- 0-3 cm dilated, Active- 4-7 cm dilated, transition- 8-10cm dilated ii. Second stage: full dilation to baby being delivered iii. Third stage: birth of baby to the placenta coming out iv. Fourth stage: the first 2 hrs after birth 16. Postpartum  Assess patient every 15 mins for first hour, every 30 mins the next hour and every hour for the next 2 hours  Lochia is very important after birth i. Check for color of blood, how much blood and are there any clots  The fundus being firm is also important. If it is boggy then It must be massaged until it us firm  By 10or more days the lochia will be white & if it turns back pink/ red there is a problem 17. Growth & Development: School-Aged Child  This is ages 6-12  These children have problems that are expected at this age & problems that indicate serious psychiatric disturbances  Problems that school age children have are: stealing, bullying, substance abuse 18. Postpartum

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Assess patient every 15 mins for first hour, every 30 mins the next hour and every hour for the next 2 hours Lochia is very important after birth i. Check for color of blood, how much blood and are there any clots 1. Day 1-3: Rubra- bloody w/ fleshy odor, may have clots 2. Day 4-9: Serosa- pink/brown w/ fleshy odor 3. Day 10+ : Alba- yellow-white The fundus being firm is also important. If it is boggy then It must be massaged until it us firm

19. Pregnancy Complications: Preexisting & Gestational;  Cardiac disease & Diabetes Mellitus can be diagnosed before pregnancy, and they have them forever  Gestational diabetes and gestational hypertension are only while you are pregnant and then they go away i. These things need to be monitored closely during pregnancy to make sure the baby is okay 20. Croup Syndrome  This is given different names depending on the main anatomic area that it affects  Acute laryngotracheobronchitis (LTB) is the most common  When they have this you need to check the respiratory rate, breathing quality, lung sounds, presence of cough, and pulse oximetry  Have the individual in high fowlers and cool humidity through a mask 21. Labor & Birth: Cesarean  Epidurals are use in most c sections  Make sure you as the nurse provide emotional support  Indwelling catheter is inserted before c section  After the woman has the c section the nurse must check the fundus to see if it is firm or boggy (normal is firm)  Keep in mind if this is a first-time mother  Provide emotional support for the mother...