Objective 43 - sdfadsf PDF

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Objective 3.43.1

1. Assessment (data collection) including: a. Daily weights In the past a woman’s weight gain was restricted during pregnancy. It was thought that minimal weight gain would keep the fetus small and therefore easier to deliver. Evidence shows that low maternal weight gain is associated with complications such as preterm labor, and recommendations for weight gain during pregnancy have gradually increased. b. Vital signs The woman’s blood pressure should be taken in the same arm and in the same position each time for accurate comparison with her baseline value. Monitor maternal vital signs every 2 hours or depending on the doctor’s order. c. Signs and symptoms associated with specific complication  Bleeding Bleeding means different things throughout your pregnancy. “If you are bleeding heavily and have severe abdominal pain and menstruallike cramps or feel like you are going to faint during first trimester, it could be a sign of an ectopic pregnancy,”  Contractions Early in the Third Trimester Contractions could be a sign of preterm labor.  A persistent severe headache, abdominal pain, visual disturbances, and swelling during your third trimester These symptoms could be a sign of preeclampsia. That’s a serious condition that develops during pregnancy and is potentially fatal. The disorder is marked by high blood pressure and excess protein in your urine that typically occurs. d. Pain / comfort level The nurse helps the woman to cope with labor by comforting, positioning, teaching, and intrapartum nursing in care of the woman’s partner. The nurse should provide continuous labor support in a hands-on, in-person manner rather than rely on monitors viewed from outside the labor room. e. Client’s coping ability Coping is a dynamin process in which emotions and stress affect and influence each other, coping changes the relationship between the individual and the environment. Adjustment is the outcome of coping at a specific point in time. Educate patient on different relaxation techniques. As early as latent phase encourage patient to begin alternative therapy of pain relief. At the transition phase, assist patient with pant-blow breathing. f. Identify client’s needs according to Maslow o Physiological - Survival of the mother and baby, basic needs for air, food, water, sleep, and shelter o Safety & Security - Free of fear, secure and comfortable in body, birthplace, resources, use of medical interventions.

o Love & Belongingness - Connected to, supported, encourage & respected by doctors, nurses, and family o Self-Esteem - Sense of accomplishment, confidence, and empowerment o Self-Actualization - Fulfillment of full potential, hope, and creation. o Self-Transcendence Needs - oneness, wholeness, and beyond self. 2. Nursing interventions including: a. Monitor client’s diet accordingly A well-balanced diet and moderate exercise promote healing and recovery from birth. Because constipation may be a problem, the mother is taught about high-fiber foods (e.g. whole-grain breads, and fruits and vegetables with the skins). Breastfeeding mother should not try to lose weight while nursing. b. Monitor IV therapy as needed When intravenous infusion is started and need to be monitored to allow for the administration of fluids and drugs. The woman may have a constant fluid infusion, or venous access may be maintained with a saline lock to permit greater patient mobility in early labor. c. Provide a restful environment The nurse should minimize environmental irritants as much as possible. Provide a supportive environment for the client  Encourage the woman to bathe, shower or wash her genitals at the onset of labor and as often as she feels she wants to.  Encourage her to move around and get into the position she feels most comfortable in.

Objective 3.43.2 1. Assessment (data collection) including: a. Bladder assessment The bladder is assessed for distention, which may occur soon after birth. The women often do not feel the urge to urinate because of the effects of the anesthetic, perineal trauma, and loss of fetal pressure against the bladder. If her bladder is full, the uterus will be higher than expected and often displaced to one side. A full bladder inhibits uterine contraction and can lead to hemorrhage. Catheterization will be needed if the woman cannot urinate. b. Intake and output A well-balanced diet and moderate exercise promote healing and recovery from birth. Because constipation may be a problem, the mother is taught about high-fiber foods (e.g. whole-grain breads, and fruits and vegetables with the skins). c. Temperature Temperature is to be taken hourly if normal. d. Lochia assessment Vaginal discharge after delivery, called lochia, is composed of endometrial tissue, blood, and lymph. Lochia gradually changes characteristic during the early postpartum period:  Lochia rubra is red, because it is composed mostly of blood; it lasts for about 3 days after birth.  Lochia serosa is pinkish because of its blood and mucus content. It lasts from about the third through the tenth day after birth.  Lochia alba is mostly mucus and its clear or colorless or white. It lasts from the tenth through the twenty-first day after birth. e. Fundal assessment The uterine fundus (the upper portion of the body of the uterus) descends at a predictable rate as the muscle cells contract to control bleeding at the placental insertion site an as the size of each muscle cell decreases. Immediately after the placenta is expelled, the uterine fundus can be felt midline, at or below the level of the umbilicus, as a firm mass. After 24 hours, the fundus begins to descend about 1 cm (one finger’s width) each day. By 10 days postpartum, it should no longer be palpable. f. Wound assessment The perineum should be assessed for normal healing and signs of complication. The REEDA acronym helps the nurse remember the five signs to assess.  R – redness (pain with redness indicate infection)  E – edema (severe edema interferes with healing)  E – ecchymosis (large bruises interfere with normal healing  D – discharge (no discharge should be present)  A – approximation (suture should be intact)

g. Identify client’s needs according to Maslow According to Abraham Maslow, people’s needs span from deficiency to being needs, which start at basic biological necessities and build toward self-actualization. These stages flow upward from survival, safety, belongingness and love, esteem, and finally, self-actualization and transcendence. By applying Maslow’s Hierarchy to the experience of childbirth, it becomes clear that a woman and baby’s needs in pregnancy and birth also span from deficiency to being. 2. Nursing interventions including: a. Increase fluid intake After giving birth, the mother can be hydrated right away if it not contraindicated. b. Encourage client to void frequently; Catheterize if necessary Encourage client to void frequently because if her bladder is full, the uterus will be higher than expected and often displaced to one side. A full bladder inhibits uterine contraction and can lead to hemorrhage. Catheterization will be needed if the woman cannot urinate. c. Medications as ordered Medication should be given with care. Many medications taken by the mother are secreted in breast milk but in varying concentrations depending on the drug. In general, timing the drug dose so that it passes its peak of action before the infant’s nursing sessions begin can reduce the amount delivered to the infant. d. Teach good hygiene practices The woman is taught to do perineal care after each voiding or bowel movement to cleanse the area without trauma.

Objective 3.43.3 1. Perform thorough assessment of newborn infant Two commonly used methods to assess jaundice are the following: a. Icterometer: the icterometer is a plastic strip with increasingly deeper yellow stripes representing level of jaundice. The strip is placed against the infant’s nose until the skin blanches. The underlying skin tone is matched to the corresponding shade of yellow. b. Transcutaneous bilirubin measurement (TcB): Transcutaneous measurement of jaundice is noninvasive. The FDA has approved the Colormate III bilirubinometer as a screening device to determine whether a more accurate blood test or follow-up is indicated. 2. Identify signs of jaundice present in infant Jaundice causes the skin and the white of the eyes to assume a yellow orange cast. There is more evidence of jaundice in infants who are breastfed. Breast milk jaundice begins to be seen about the fourth day, when the mother’s milk supply develops. 3. Report findings to instructor and / or appropriate staff member Jaundice that appears in the first day of life is not normal because it is always pathological and necessitates prompt intervention and should be recorded and reported. Jaundice is a condition wherein the liver of the newborn is immatures. 4. Assist with care of infant with jaundice a. Phototherapy is used to reduced serum bilirubin levels. The newborn is places in an incubator under a bank of fluorescent lights. The eyes are protected from the lights; the infant is turned frequently, and the hydration is monitored closely as the infant often develops loose stools. b. Exchange transfusion is when a plastic catheter is inserted into the umbilical vein of the newborn, small amount of blood (10 to 20mL) is withdrawn, and equal amount of Rhnegative blood are injected. 5. Document nursing care given Nursing documentation is necessary for clinical communication. Appropriate documentation provides a precise reflection of nursing assessments, changes in clinical state, and the care provided to the patient. Documentation provides evidence of care and it is essentially a professional skill and medical legal requirement of nursing practice. 6. Monitor infant status and follow up care The nurse responsible for the following:  observe the newborn’s color and reporting any evidence of jaundice during the first and second days  helping to interpret the treatment to parents  observing and assisting the physician with the phototherapy and exchange transfusion

Objective 3.43.4

1. Height and weight  One of the best methods to evaluate the progress of a child is to measure his or her growth. The weight, height (or length), and head circumference (up to age 3 years) of a child should be measured during each office visit and plotted on a growth chart.  A child’s weight is often used to determine nutritional needs and the proper dosage of a medication to administer to the child. The medical assistant should exercise care in measuring weight. Infants are weighed in a recumbent position. Older children are weighed in a standing position. 2. Head circumference  In obtaining the infant head circumference, the infant needs to be lying down on his back (supine) or in semi-fowlers positing.  Wrap a flexible measuring tape around his head just above his eyebrows and ears, and around the back where his head slopes up prominently from his neck. The goal is to measure his head at the spot where it has the largest circumference. 2. Monitor energy level by observing: 1. Age-appropriate play  Play activities in the preschool child increase in complexity.  At 2 to 3 years of age, the child imitates the activities of daily living of the parents (hammering, shaving, feeding the doll).  By 4 years of age, the child may develop broader themes such as a trip to the zoo.  By 5 years of age, a trip to the moon demonstrates the child’s imaginary abilities. Play enables the child to experience, the victim, the superpower, or the acquisition of toys or friends they desire. Appealing to the child’s magical thinking is the best approach.  School-age children use skills and knowledge they obtain to attempt to master the activities they enjoy, including music, sports, and art. 2. Sleep and rest periods  The development and reinforcement of optimal bedtime habits are important in the preschool years. Parents should be guided to engage the child in quiet activities before bedtime, to maintain specific rituals that signal bedtime readiness. Age Newborns (0-3 months) Infants (4-11 months) Toddlers (1-2 years of age)

Recommended amount of sleep 14 to 17 hours 12 to 15 hours 11 to 14 hours

Preschoolers (3-5 years of age) School-aged children (6-13 years of age) Teenagers (14-17 years of age)

10 to 13 hours 9 to 11 hours 8 to 10 hours

3. Promote adequate fluid intake to promote normal stool elimination pattern Age

Total Fluid Intake/Day 4-8 years of age 1,000-1,400 mL 9-13 years of age 1,200-2,300 mL 14-18 years of age 1,400-3,200 mL 4. Promote adequate intake through food preparation Use of the MyPlate and The Portion Plate is an educational and healthful guide for eating for all ages. Age 2-3 4-8 9-13 1418

Daily calories needed based on age and gender and level of activity (min to max) 1,000 kcal 1,400-2,000 kcal 1,600-2,600 kcal 2,000-2,800 kcal

5. Monitor Integumentary system Assessment of the integumentary system involves gathering data about the skin, hair, and nails. In gathering information about the integumentary system, a good inspection and a detailed description from the patient is required.

Objective 3.43.5

1. Promote privacy during assessment by pulling the curtains while in examination room and when they are changing or if the nurse or doctor is carrying out a treatment or examination. 2. The bladder capacity of a child can be approximated by the following formula: Age in years + 2 = Ounces of bladder volume or capacity. Normally the color of urine ranges from a straw color to an amber. Urine normally has an odor. The urine has a stronger odor when it is more concentrated. Urine that has been sitting for long periods of time can have an ammonia smell. Bright and dark red urine can mean blood in the urine that originates anywhere from the kidneys to the urethra. 3. Pain during urination and a burning sensation a patient feels is due to the white blood cells that are fighting the infection along the urethra. 4. a. Cleanse perineum with each diaper change b. Wipe perineum from the front to back c. Avoid bubble baths d. Have child urinate immediately after a bath e. Use white, cotton underwear f. Use loose-fitting pants g. Increase fluid intake to cleanse the system efficiently h. Drink concentrated cranberry juice 5. UTI’s are common in children. They are more common in girls than boys (except during the neonatal period) and occur predominantly in children 7 to 11 years of age.

3.43.6 Monitor for factors that add to poor self-esteem  Perhaps counterintuitively, praise can be a significant factor in low self-esteem. Findings suggest that “overly positive, inflated praise” sets unattainable standards for children and can ultimately reduce self-esteem while increasing narcissistic tendencies. The answer appears to be in praising effort rather than ability.  Peer Victimization  High body mass index  Academic Stress  Negative feedback Identify personal ways in which the child succeeds  Praising your child’s choices will help them stay focused on the things they can control in life—such as their efforts and their attitude. Acknowledge and reinforce positive behaviors  Positive attention is the best reward.  Praise the process rather than the result.  Look for rewards that reinforce good behavior.  Vary the frequency of incentives over time. The goal is self-motivation.  Divide ambitious goals into smaller tasks. Dividing large goals into smaller tasks and rewarding the achievement of smaller tasks is an effective method to encourage good behaviors. Parenting Skills-While not an exhaustive list, the following tips can help you improve your parenting skills: 1. practice active listening with your child 2. show love and affection daily 3. offer choices when possible 4. teach them how to express their feelings 5. make time for your child 6. avoid yelling, shaming, and labeling 7. assign age-appropriate chores 8. let your child fail (this teaches them how to be resilient) A child must be able to express what he or she wants and how he or she feels with freedom and safety. Include the patient and family. Work toward a professional, respectful relationship with your patients, incorporating their preferences and values in care goals and plans. Support groups provide safe places for people living with a disability or illness and their family members to meet, share information and develop friendships. Good personal hygiene habits are directly related to less illnesses, better health and enhance personal appearance. Poor hygiene habits can also affect your self-esteem....