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➢ Maternal and child bullets review ➢ When used to describe the degree of fetal

➢ According to Kübler-Ross, the five stages of descent during labor, floating means the
death and dying are denial, anger, bargaining, presenting part isn’t engaged in the pelvic
depression, and acceptance. inlet, but is freely movable (ballotable) above
➢ Flight of ideas is an alteration in thought the pelvic inlet.
processes that’s characterized by skipping ➢ When used to describe the degree of fetal
from one topic to another, unrelated topic. descent, engagement means when the largest
➢ La belle indifférence is the lack of concern for diameter of the presenting part has passed
a profound disability, such as blindness or through the pelvic inlet.
paralysis that may occur in a patient who has ➢ Fetal station indicates the location of the
a conversion disorder. presenting part in relation to the ischial spine.
➢ Moderate anxiety decreases a person’s ability It’s described as –1, –2, –3, –4, or –5 to indicate
to perceive and concentrate. The person is the number of centimeters above the level of
selectively inattentive (focuses on immediate the ischial spine; station –5 is at the pelvic
concerns), and the perceptual field narrows. inlet.
➢ A patient who has a phobic disorder uses self- ➢ Fetal station also is described as +1, +2, +3,
protective avoidance as an ego defense +4, or +5 to indicate the number of
mechanism. centimeters it is below the level of the ischial
➢ In a patient who has anorexia nervosa, the spine; station 0 is at the level of the ischial
highest treatment priority is correction of spine.
nutritional and electrolyte imbalances. ➢ During the first stage of labor, the side-lying
➢ A patient who is taking lithium must undergo position usually provides the greatest degree
regular (usually once a month) monitoring of of comfort, although the patient may assume
the blood lithium level because the margin any comfortable position.
between therapeutic and toxic levels is ➢ During delivery, if the umbilical cord can’t be
narrow. A normal laboratory value is 0.5 to 1.5 loosened and slipped from around the
mEq/L. neonate’s neck, it should be clamped with two
➢ Early signs and symptoms of alcohol clamps and cut between the clamps.
withdrawal include anxiety, anorexia, tremors, ➢ An Apgar score of 7 to 10 indicates no
and insomnia. They may begin up to 8 hours immediate distress, 4 to 6 indicates moderate
after the last alcohol intake. distress, and 0 to 3 indicates severe distress.
➢ Al-Anon is a support group for families of ➢ To elicit Moro’s reflex, the nurse holds the
alcoholics. neonate in both hands and suddenly, but
➢ The nurse shouldn’t administer chlorpromazine gently, drops the neonate’s head backward.
(Thorazine) to a patient who has ingested Normally, the neonate abducts and extends all
alcohol because it may cause oversedation extremities bilaterally and symmetrically,
and respiratory depression. forms a C shape with the thumb and
➢ Lithium toxicity can occur when sodium and forefinger, and first adducts and then flexes
fluid intake are insufficient, causing lithium the extremities.
retention. ➢ Pregnancy-induced hypertension
➢ An alcoholic who achieves sobriety is called a (preeclampsia) is an increase in blood pressure
recovering alcoholic because no cure for of 30/15 mm Hg over baseline or blood
alcoholism exists pressure of 140/95 mm Hg on two occasions at
least 6 hours apart accompanied by edema
➢ To help a mother break the suction of her
and albuminuria after 20 weeks’ gestation.
breast-feeding infant, the nurse should teach
➢ Positive signs of pregnancy include ultrasound
her to insert a finger at the corner of the
evidence, fetal heart tones, and fetal
infant’s mouth.
movement felt by the examiner (not usually
➢ Administering high levels of oxygen to a
present until 4 months’ gestation
premature neonate can cause blindness as a
➢ Goodell’s sign is softening of the cervix.
result of retrolental fibroplasia.
➢ Quickening, a presumptive sign of pregnancy,
➢ Amniotomy is artificial rupture of the amniotic
occurs between 16 and 19 weeks’ gestation.
membranes.
➢ Ovulation ceases during pregnancy.
➢ During pregnancy, weight gain averages 25 to
➢ Any vaginal bleeding during pregnancy should
30 lb (11 to 13.5 kg).
be considered a complication until proven
➢ Rubella has a teratogenic effect on the fetus
otherwise.
during the first trimester. It produces
➢ To estimate the date of delivery using
abnormalities in up to 40% of cases without
Nägele’s rule, the nurse counts backward 3
interrupting the pregnancy.
months from the first day of the last menstrual
➢ Immunity to rubella can be measured by a
period and then adds 7 days to this date.
hemagglutination inhibition test (rubella titer).
➢ At 12 weeks’ gestation, the fundus should be
This test identifies exposure to rubella
at the top of the symphysis pubis.
infection and determines susceptibility in
➢ Cow’s milk shouldn’t be given to infants
pregnant women. In a woman, a titer greater
younger than age 1 because it has a low
than 1:8 indicates immunity.
linoleic acid content and its protein is difficult ➢ In a premature neonate, signs of respiratory
for infants to digest. distress include nostril flaring, substernal
➢ If jaundice is suspected in a neonate, the nurse retractions, and inspiratory grunting.
should examine the infant under natural ➢ Respiratory distress syndrome (hyaline
window light. If natural light is unavailable, the membrane disease) develops in premature
nurse should examine the infant under a white infants because their pulmonary alveoli lack
light. surfactant.
➢ The three phases of a uterine contraction are ➢ Whenever an infant is being put down to sleep,
increment, acme, and decrement. the parent or caregiver should position the
➢ The intensity of a labor contraction can be infant on the back. (Remember back to sleep.)
assessed by the indentability of the uterine ➢ The male sperm contributes an X or a Y
wall at the contraction’s peak. Intensity is chromosome; the female ovum contributes an
graded as mild (uterine muscle is somewhat X chromosome.
tense), moderate (uterine muscle is ➢ Fertilization produces a total of 46
moderately tense), or strong (uterine muscle is chromosomes, including an XY combination
boardlike). (male) or an XX combination (female).
➢ Chloasma, the mask of pregnancy, is ➢ The percentage of water in a neonate’s body is
pigmentation of a circumscribed area of skin about 78% to 80%.
(usually over the bridge of the nose and ➢ To perform nasotracheal suctioning in an
cheeks) that occurs in some pregnant women. infant, the nurse positions the infant with his
➢ The gynecoid pelvis is most ideal for delivery. neck slightly hyperextended in a “sniffing”
Other types include platypelloid (flat), position, with his chin up and his head tilted
anthropoid (apelike), and android (malelike). back slightly.
➢ Pregnant women should be advised that there ➢ Organogenesis occurs during the first
is no safe level of alcohol intake. trimester of pregnancy, specifically, days 14 to
➢ The frequency of uterine contractions, which is 56 of gestation.
measured in minutes, is the time from the ➢ After birth, the neonate’s umbilical cord is tied
beginning of one contraction to the beginning 1" (2.5 cm) from the abdominal wall with a
of the next. cotton cord, plastic clamp, or rubber band.
➢ Vitamin K is administered to neonates to ➢ Gravida is the number of pregnancies a
prevent hemorrhagic disorders because a woman has had, regardless of outcome.
neonate’s intestine can’t synthesize vitamin K. ➢ Para is the number of pregnancies that
➢ Before internal fetal monitoring can be reached viability, regardless of whether the
performed, a pregnant patient’s cervix must fetus was delivered alive or stillborn. A fetus is
be dilated at least 2 cm, the amniotic considered viable at 20 weeks’ gestation.
membranes must be ruptured, and the fetus’s ➢ An ectopic pregnancy is one that implants
presenting part (scalp or buttocks) must be at abnormally, outside the uterus.
station –1 or lower, so that a small electrode ➢ The first stage of labor begins with the onset
can be attached. of labor and ends with full cervical dilation at
➢ Fetal alcohol syndrome presents in the first 24 10 cm.
hours after birth and produces lethargy, ➢ The second stage of labor begins with full
seizures, poor sucking reflex, abdominal cervical dilation and ends with the neonate’s
distention, and respiratory difficulty. birth.
➢ Variability is any change in the fetal heart rate ➢ The third stage of labor begins after the
(FHR) from its normal rate of 120 to 160 neonate’s birth and ends with expulsion of the
beats/minute. Acceleration is increased FHR; placenta.
deceleration is decreased FHR. ➢ In a full-term neonate, skin creases appear
➢ In a neonate, the symptoms of heroin over two-thirds of the neonate’s feet. Preterm
withdrawal may begin several hours to 4 days neonates have heel creases that cover less
after birth. than two-thirds of the feet.
➢ In a neonate, the symptoms of methadone ➢ The fourth stage of labor (postpartum
withdrawal may begin 7 days to several weeks stabilization) lasts up to 4 hours after the
after birth. placenta is delivered. This time is needed to
➢ In a neonate, the cardinal signs of narcotic stabilize the mother’s physical and emotional
withdrawal include coarse, flapping tremors; state after the stress of childbirth.
sleepiness; restlessness; prolonged, persistent, ➢ At 20 weeks’ gestation, the fundus is at the
high-pitched cry; and irritability. level of the umbilicus.
➢ The nurse should count a neonate’s ➢ At 36 weeks’ gestation, the fundus is at the
respirations for 1 full minute. lower border of the rib cage.
➢ Chlorpromazine (Thorazine) is used to treat ➢ A premature neonate is one born before the
neonates who are addicted to narcotics. end of the 37th week of gestation.
➢ The nurse should provide a dark, quiet ➢ Pregnancy-induced hypertension is a leading
environment for a neonate who is experiencing cause of maternal death in the United States.
narcotic withdrawal.
➢ A habitual aborter is a woman who has had ➢ Abruptio placentae is premature separation of
three or more consecutive spontaneous a normally implanted placenta. It may be
abortions. partial or complete, and usually causes
➢ Threatened abortion occurs when bleeding is abdominal pain, vaginal bleeding, and a
present without cervical dilation. boardlike abdomen.
➢ A complete abortion occurs when all products ➢ Cutis marmorata is mottling or purple
of conception are expelled. discoloration of the skin. It’s a transient
➢ Hydramnios (polyhydramnios) is excessive vasomotor response that occurs primarily in
amniotic fluid (more than 2,000 ml in the third the arms and legs of infants who are exposed
trimester). to cold.
➢ Stress, dehydration, and fatigue may reduce a ➢ The classic triad of symptoms of preeclampsia
breast-feeding mother’s milk supply. are hypertension, edema, and proteinuria.
➢ During the transition phase of the first stage of Additional symptoms of severe preeclampsia
labor, the cervix is dilated 8 to 10 cm and include hyperreflexia, cerebral and vision
contractions usually occur 2 to 3 minutes apart disturbances, and epigastric pain.
and last for 60 seconds. ➢ Ortolani’s sign (an audible click or palpable
➢ A nonstress test is considered nonreactive jerk that occurs with thigh abduction) confirms
(positive) if fewer than two fetal heart rate congenital hip dislocation in a neonate.
accelerations of at least 15 beats/minute occur ➢ The first immunization for a neonate is the
in 20 minutes. hepatitis B vaccine, which is administered in
➢ A nonstress test is considered reactive the nursery shortly after birth.
(negative) if two or more fetal heart rate ➢ If a patient misses a menstrual period while
accelerations of 15 beats/minute above taking an oral contraceptive exactly as
baseline occur in 20 minutes. prescribed, she should continue taking the
➢ A nonstress test is usually performed to assess contraceptive.
fetal well-being in a pregnant patient with a ➢ If a patient misses two consecutive menstrual
prolonged pregnancy (42 weeks or more), periods while taking an oral contraceptive, she
diabetes, a history of poor pregnancy should discontinue the contraceptive and take
outcomes, or pregnancy-induced hypertension. a pregnancy test.
➢ A pregnant woman should drink at least eight ➢ If a patient who is taking an oral contraceptive
8-oz glasses (about 2,000 ml) of water daily. misses a dose, she should take the pill as soon
➢ When both breasts are used for breast- as she remembers or take two at the next
feeding, the infant usually doesn’t empty the scheduled interval and continue with the
second breast. Therefore, the second breast normal schedule.
should be used first at the next feeding. ➢ If a patient who is taking an oral contraceptive
➢ A low-birth-weight neonate weighs 2,500 g (5 misses two consecutive doses, she should
lb 8 oz) or less at birth. double the dose for 2 days and then resume
➢ A very-low-birth-weight neonate weighs 1,500 her normal schedule. She also should use an
g (3 lb 5 oz) or less at birth. additional birth control method for 1 week.
➢ When teaching parents to provide umbilical ➢ Eclampsia is the occurrence of seizures that
cord care, the nurse should teach them to aren’t caused by a cerebral disorder in a
clean the umbilical area with a cotton ball patient who has pregnancy-induced
saturated with alcohol after every diaper hypertension.
change to prevent infection and promote ➢ In placenta previa, bleeding is painless and
drying. seldom fatal on the first occasion, but it
➢ Teenage mothers are more likely to have low- becomes heavier with each subsequent
birth-weight neonates because they seek episode.
prenatal care late in pregnancy (as a result of ➢ Treatment for abruptio placentae is usually
denial) and are more likely than older mothers immediate cesarean delivery.
to have nutritional deficiencies. ➢ Drugs used to treat withdrawal symptoms in
➢ Linea nigra, a dark line that extends from the neonates include phenobarbital (Luminal),
umbilicus to the mons pubis, commonly camphorated opium tincture (paregoric), and
appears during pregnancy and disappears diazepam (Valium).
after pregnancy. ➢ Infants with Down syndrome typically have
➢ Implantation in the uterus occurs 6 to 10 days marked hypotonia, floppiness, slanted eyes,
after ovum fertilization. excess skin on the back of the neck, flattened
➢ Placenta previa is abnormally low bridge of the nose, flat facial features,
implantation of the placenta so that it spadelike hands, short and broad feet, small
encroaches on or covers the cervical os. male genitalia, absence of Moro’s reflex, and a
➢ In complete (total) placenta previa, the simian crease on the hands.
placenta completely covers the cervical os. ➢ The failure rate of a contraceptive is
➢ In partial (incomplete or marginal) placenta determined by the experience of 100 women
previa, the placenta covers only a portion of for 1 year. It’s expressed as pregnancies per
the cervical os. 100 woman-years.
➢ The narrowest diameter of the pelvic inlet is warmer, a heat-sensitive probe taped to the
the anteroposterior (diagonal conjugate). neonate’s skin activates the heater unit
➢ The chorion is the outermost extraembryonic automatically to maintain the desired
membrane that gives rise to the placenta. temperature.
➢ The corpus luteum secretes large quantities of ➢ During labor, the resting phase between
progesterone. contractions is at least 30 seconds.
➢ From the 8th week of gestation through ➢ Lochia rubra is the vaginal discharge of almost
delivery, the developing cells are known as a pure blood that occurs during the first few
fetus. days after childbirth.
➢ In an incomplete abortion, the fetus is ➢ Lochia serosa is the serous vaginal discharge
expelled, but parts of the placenta and that occurs 4 to 7 days after childbirth.
membrane remain in the uterus. ➢ Lochia alba is the vaginal discharge of
➢ The circumference of a neonate’s head is decreased blood and increased leukocytes
normally 2 to 3 cm greater than the that’s the final stage of lochia. It occurs 7 to 10
circumference of the chest. days after childbirth.
➢ After administering magnesium sulfate to a ➢ Colostrum, the precursor of milk, is the first
pregnant patient for hypertension or preterm secretion from the breasts after delivery.
labor, the nurse should monitor the respiratory ➢ The length of the uterus increases from 2½"
rate and deep tendon reflexes. (6.3 cm) before pregnancy to 12½" (32 cm) at
➢ During the first hour after birth (the period of term.
reactivity), the neonate is alert and awake. ➢ To estimate the true conjugate (the smallest
➢ When a pregnant patient has undiagnosed inlet measurement of the pelvis), deduct 1.5
vaginal bleeding, vaginal examination should cm from the diagonal conjugate (usually 12
be avoided until ultrasonography rules out cm). A true conjugate of 10.5 cm enables the
placenta previa. fetal head (usually 10 cm) to pass.
➢ After delivery, the first nursing action is to ➢ The smallest outlet measurement of the pelvis
establish the neonate’s airway. is the intertuberous diameter, which is the
➢ Nursing interventions for a patient with transverse diameter between the ischial
placenta previa include positioning the patient tuberosities.
on her left side for maximum fetal perfusion, ➢ Electronic fetal monitoring is used to assess
monitoring fetal heart tones, and fetal well-being during labor. If compromised
administering I.V. fluids and oxygen, as fetal status is suspected, fetal blood pH may
ordered. be evaluated by obtaining a scalp sample.
➢ The specific gravity of a neonate’s urine is ➢ In an emergency delivery, enough pressure
1.003 to 1.030. A lower specific gravity should be applied to the emerging fetus’s
suggests overhydration; a higher one suggests head to guide the descent and prevent a rapid
dehydration. change in pressure within the molded fetal
➢ The neonatal period extends from birth to day skull.
28. It’s also called the first 4 weeks or first ➢ After delivery, a multiparous woman is more
month of life. susceptible to bleeding than a primiparous
➢ A woman who is breast-feeding should rub a woman because her uterine muscles may be
mild emollient cream or a few drops of breast overstretched and may not contract efficiently.
milk (or colostrum) on the nipples after each ➢ Neonates who are delivered by cesarean birth
feeding. She should let the breasts air-dry to have a higher incidence of respiratory distress
prevent them from cracking. syndrome.
➢ Breast-feeding mothers should increase their ➢ The nurse should suggest ambulation to a
fluid intake to 2½ to 3 qt (2,500 to 3,000 ml) postpartum patient who has gas pain and
daily. flatulence.
➢ After feeding an infant with a cleft lip or ➢ Massaging the uterus helps to stimulate
palate, the nurse should rinse the infant’s contractions after the placenta is delivered.
mouth with sterile water. ➢ When providing phototherapy to a neonate,
➢ The nurse instills erythromycin in a neonate’s the nurse should cover the neonate’s eyes and
eyes primarily to prevent blindness caused by genital area.
gonorrhea or chlamydia. ➢ The narcotic antagonist naloxone (Narcan)
➢ Human immunodeficiency virus (HIV) has been may be given to a neonate to correct
cultured in breast milk and can be transmitted respiratory depression caused by narcotic
by an HIV-positive mother who breast-feeds administration to the mother during labor.
her infant. ➢ In a neonate, symptoms of respiratory distress
➢ A fever in the first 24 hours postpartum is syndrome include expiratory grunting or
most likely caused by dehydration rather than whining, sandpaper breath sounds, and
infection. seesaw retractions.
➢ Preterm neonates or neonates who can’t ➢ Cerebral palsy presents as asymmetrical
maintain a skin temperature of at least 97.6° F movement, irritability, and excessive, feeble
(36.4° C) should receive care in an incubator crying in a long, thin infant.
(Isolette) or a radiant warmer. In a radiant
➢ The nurse should assess a breech-birth ➢ If a fetus has late decelerations (a sign of fetal
neonate for hydrocephalus, hematomas, hypoxia), the nurse should instruct the mother
fractures, and other anomalies caused by birth to lie on her left side and then administer 8 to
trauma. 10 L of oxygen per minute by mask or cannula.
➢ When a patient is admitted to the unit in The nurse should notify the physician. The
active labor, the nurse’s first action is to listen side-lying position removes pressure on the
for fetal heart tones. inferior vena cava.
➢ In a neonate, long, brittle fingernails are a sign ➢ Oxytocin (Pitocin) promotes lactation and
of postmaturity. uterine contractions.
➢ Desquamation (skin peeling) is common in ➢ Lanugo covers the fetus’s body until about 20
postmature neonates. weeks’ gestation. Then it begins to disappear
➢ A mother should allow her infant to breast- from the face, trunk, arms, and legs, in that
feed until the infant is satisfied. The time may order.
vary from 5 to 20 minutes. ➢ In a neonate, hypoglycemia causes
➢ Nitrazine paper is used to test the pH of temperature instability, hypotonia, jitteriness,
vaginal discharge to determine the presence and seizures. Premature, postmature, small-
of amniotic fluid. for-gestational-age, and large-for-gestational-
➢ A pregnant patient normally gains 2 to 5 lb (1 age neonates are susceptible to this disorder.
to 2.5 kg) during the first trimester and slightly ➢ Neonates typically need to consume 50 to 55
less than 1 lb (0.5 kg) per week during the last cal per pound of body weight daily.
two trimesters. ➢ Because oxytocin (Pitocin) stimulates powerful
➢ Neonatal jaundice in the first 24 hours after uterine contractions during labor, it must be
birth is known as pathological jaundice and is a administered under close observation to help
sign of erythroblastosis fetalis. prevent maternal and fetal distress.
➢ A classic difference between abruptio ➢ During fetal heart rate monitoring, variable
placentae and placenta previa is the degree of decelerations indicate compression or prolapse
pain. Abruptio placentae causes pain, whereas of the umbilical cord.
placenta previa causes painless bleeding. ➢ Cytomegalovirus is the leading cause of
➢ Because a major role of the placenta is to congenital viral infection.
function as a fetal lung, any condition that ➢ Tocolytic therapy is indicated in premature
interrupts normal blood flow to or from the labor, but contraindicated in fetal death, fetal
placenta increases fetal partial pressure of distress, or severe hemorrhage.
arterial carbon dioxide and decreases fetal pH. ➢ Through ultrasonography, the biophysical
➢ Precipitate labor lasts for approximately 3 profile assesses fetal well-being by measuring
hours and ends with delivery of the neonate. fetal breathing movements, gross body
➢ Methylergonovine (Methergine) is an oxytocic movements, fetal tone, reactive fetal heart
agent used to prevent and treat postpartum rate (nonstress test), and qualitative amniotic
hemorrhage caused by uterine atony or fluid volume.
subinvolution. ➢ A neonate whose mother has diabetes should
➢ As emergency treatment for excessive uterine be assessed for hyperinsulinism.
bleeding, 0.2 mg of methylergonovine ➢ In a patient with preeclampsia, epigastric pain
(Methergine) is injected I.V. over 1 minute is a late symptom and requires immediate
while the patient’s blood pressure and uterine medical intervention.
contractions are monitored. ➢ After a stillbirth, the mother should be allowed
➢ Braxton Hicks contractions are usually felt in to hold the neonate to help her come to terms
the abdomen and don’t cause cervical change. with the death.
True labor contractions are felt in the front of ➢ Molding is the process by which the fetal head
the abdomen and back and lead to progressive changes shape to facilitate movement through
cervical dilation and effacement the birth canal.
➢ The average birth weight of neonates born to ➢ If a woman receives a spinal block before
mothers who smoke is 6 oz (170 g) less than delivery, the nurse should monitor the
that of neonates born to nonsmoking mothers. patient’s blood pressure closely. 5
➢ Culdoscopy is visualization of the pelvic organs ➢ If a woman suddenly becomes hypotensive
through the posterior vaginal fornix. during labor, the nurse should increase the
➢ The nurse should teach a pregnant vegetarian infusion rate of I.V. fluids as prescribed.
to obtain protein from alternative sources, ➢ The best technique for assessing jaundice in a
such as nuts, soybeans, and legumes. neonate is to blanch the tip of the nose or the
➢ The nurse should instruct a pregnant patient area just above the umbilicus.
to take only prescribed prenatal vitamins ➢ During fetal heart monitoring, early
because over-the-counter high-potency deceleration is caused by compression of the
vitamins may harm the fetus. head during labor.
➢ High-sodium foods can cause fluid retention, ➢ After the placenta is delivered, the nurse may
especially in pregnant patients. add oxytocin (Pitocin) to the patient’s I.V.
➢ A pregnant patient can avoid constipation and solution, as prescribed, to promote postpartum
hemorrhoids by adding fiber to her diet.
involution of the uterus and stimulate ➢ Milia may occur as pinpoint spots over a
lactation. neonate’s nose.
➢ Pica is a craving to eat nonfood items, such as ➢ The duration of a contraction is timed from the
dirt, crayons, chalk, glue, starch, or hair. It moment that the uterine muscle begins to
may occur during pregnancy and can tense to the moment that it reaches full
endanger the fetus. relaxation. It’s measured in seconds.
➢ A pregnant patient should take folic acid ➢ The union of a male and a female gamete
because this nutrient is required for rapid cell produces a zygote, which divides into the
division. fertilized ovum.
➢ A woman who is taking clomiphene (Clomid) to ➢ The first menstrual flow is called menarche
induce ovulation should be informed of the and may be anovulatory (infertile).
possibility of multiple births with this drug. ➢ Spermatozoa (or their fragments) remain in
➢ If needed, cervical suturing is usually done the vagina for 72 hours after sexual
between 14 and 18 weeks’ gestation to intercourse.
reinforce an incompetent cervix and maintain ➢ Prolactin stimulates and sustains milk
pregnancy. The suturing is typically removed production.
by 35 weeks’ gestation. ➢ Strabismus is a normal finding in a neonate.
➢ During the first trimester, a pregnant woman ➢ A postpartum patient may resume sexual
should avoid all drugs unless doing so would intercourse after the perineal or uterine
adversely affect her health. wounds heal (usually within 4 weeks after
➢ Most drugs that a breast-feeding mother takes delivery).
appear in breast milk. ➢ A pregnant staff member shouldn’t be
➢ The Food and Drug Administration has assigned to work with a patient who has
established the following five categories of cytomegalovirus infection because the virus
drugs based on their potential for causing birth can be transmitted to the fetus.
defects: A, no evidence of risk; B, no risk found ➢ Fetal demise is death of the fetus after
in animals, but no studies have been done in viability.
women; C, animal studies have shown an ➢ Respiratory distress syndrome develops in
adverse effect, but the drug may be beneficial premature neonates because their alveoli lack
to women despite the potential risk; D, surfactant.
evidence of risk, but its benefits may outweigh ➢ The most common method of inducing labor
its risks; and X, fetal anomalies noted, and the after artificial rupture of the membranes is
risks clearly outweigh the potential benefits. oxytocin (Pitocin) infusion.
➢ A patient with a ruptured ectopic pregnancy ➢ After the amniotic membranes rupture, the
commonly has sharp pain in the lower initial nursing action is to assess the fetal
abdomen, with spotting and cramping. She heart rate.
may have abdominal rigidity; rapid, shallow ➢ The most common reasons for cesarean birth
respirations; tachycardia; and shock. are malpresentation, fetal distress,
➢ A patient with a ruptured ectopic pregnancy cephalopelvic disproportion, pregnancy-
commonly has sharp pain in the lower induced hypertension, previous cesarean birth,
abdomen, with spotting and cramping. She and inadequate progress in labor.
may have abdominal rigidity; rapid, shallow ➢ Amniocentesis increases the risk of
respirations; tachycardia; and shock. spontaneous abortion, trauma to the fetus or
➢ The mechanics of delivery are engagement, placenta, premature labor, infection, and Rh
descent and flexion, internal rotation, sensitization of the fetus.
extension, external rotation, restitution, and ➢ After amniocentesis, abdominal cramping or
expulsion. spontaneous vaginal bleeding may indicate
➢ A probable sign of pregnancy, McDonald’s sign complications.
is characterized by an ease in flexing the body ➢ To prevent her from developing Rh antibodies,
of the uterus against the cervix. an Rh-negative primigravida should receive
➢ Amenorrhea is a probable sign of pregnancy. Rho(D) immune globulin (RhoGAM) after
➢ A pregnant woman’s partner should avoid delivering an Rh-positive neonate.
introducing air into the vagina during oral sex ➢ If a pregnant patient’s test results are negative
because of the possibility of air embolism. for glucose but positive for acetone, the nurse
➢ The presence of human chorionic gonadotropin should assess the patient’s diet for inadequate
in the blood or urine is a probable sign of caloric intake.
pregnancy. ➢ If a pregnant patient’s test results are negative
➢ Radiography isn’t usually used in a pregnant for glucose but positive for acetone, the nurse
woman because it may harm the developing should assess the patient’s diet for inadequate
fetus. If radiography is essential, it should be caloric intake.
performed only after 36 weeks’ gestation. ➢ Rubella infection in a pregnant patient,
➢ A pregnant patient who has had rupture of the especially during the first trimester, can lead
membranes or who is experiencing vaginal to spontaneous abortion or stillbirth as well as
bleeding shouldn’t engage in sexual fetal cardiac and other birth defects.
intercourse.
➢ A pregnant patient should take an iron ➢ Kegel exercises require contraction and
supplement to help prevent anemia. relaxation of the perineal muscles. These
➢ Direct antiglobulin (direct Coombs’) test is exercises help strengthen pelvic muscles and
used to detect maternal antibodies attached to improve urine control in postpartum patients.
red blood cells in the neonate. ➢ Symptoms of postpartum depression range
➢ Nausea and vomiting during the first trimester from mild postpartum blues to intense,
of pregnancy are caused by rising levels of the suicidal, depressive psychosis.
hormone human chorionic gonadotropin. ➢ The preterm neonate may require gavage
➢ Before discharging a patient who has had an feedings because of a weak sucking reflex,
abortion, the nurse should instruct her to uncoordinated sucking, or respiratory distress.
report bright red clots, bleeding that lasts ➢ Acrocyanosis (blueness and coolness of the
longer than 7 days, or signs of infection, such arms and legs) is normal in neonates because
as a temperature of greater than 100° F (37.8° of their immature peripheral circulatory
C), foul-smelling vaginal discharge, severe system.
uterine cramping, nausea, or vomiting. ➢ To prevent ophthalmia neonatorum (a severe
➢ When informed that a patient’s amniotic eye infection caused by maternal gonorrhea),
membrane has broken, the nurse should check the nurse may administer one of three drugs,
fetal heart tones and then maternal vital signs. as prescribed, in the neonate’s eyes:
➢ The duration of pregnancy averages 280 days, tetracycline, silver nitrate, or erythromycin.
40 weeks, 9 calendar months, or 10 lunar ➢ Neonatal testing for phenylketonuria is
months. mandatory in most states.
➢ The initial weight loss for a healthy neonate is ➢ The nurse should place the neonate in a 30-
5% to 10% of birth weight. degree Trendelenburg position to facilitate
➢ The normal hemoglobin value in neonates is mucus drainage.
17 to 20 g/dl. ➢ The nurse may suction the neonate’s nose and
➢ Crowning is the appearance of the fetus’s mouth as needed with a bulb syringe or
head when its largest diameter is encircled by suction trap.
the vulvovaginal ring. ➢ To prevent heat loss, the nurse should place
➢ A multipara is a woman who has had two or the neonate under a radiant warmer during
more pregnancies that progressed to viability, suctioning and initial delivery-room care, and
regardless of whether the offspring were alive then wrap the neonate in a warmed blanket for
at birth. transport to the nursery.
➢ In a pregnant patient, preeclampsia may ➢ The umbilical cord normally has two arteries
progress to eclampsia, which is characterized and one vein.
by seizures and may lead to coma. ➢ When providing care, the nurse should expose
➢ The Apgar score is used to assess the only one part of an infant’s body at a time.
neonate’s vital functions. It’s obtained at 1 ➢ Lightening is settling of the fetal head into the
minute and 5 minutes after delivery. The score brim of the pelvis.
is based on respiratory effort, heart rate, ➢ If the neonate is stable, the mother should be
muscle tone, reflex irritability, and color. allowed to breast-feed within the neonate’s
➢ Because of the anti-insulin effects of placental first hour of life.
hormones, insulin requirements increase ➢ The nurse should check the neonate’s
during the third trimester. temperature every 1 to 2 hours until it’s
➢ Gestational age can be estimated by maintained within normal limits.
ultrasound measurement of maternal ➢ At birth, a neonate normally weighs 5 to 9 lb (2
abdominal circumference, fetal femur length, to 4 kg), measures 18" to 22" (45.5 to 56 cm)
and fetal head size. These measurements are in length, has a head circumference of 13½" to
most accurate between 12 and 18 weeks’ 14" (34 to 35.5 cm), and has a chest
gestation. circumference that’s 1" (2.5 cm) less than the
➢ Skeletal system abnormalities and ventricular head circumference.
septal defects are the most common disorders ➢ In the neonate, temperature normally ranges
of infants who are born to diabetic women. The from 98° to 99° F (36.7° to 37.2° C), apical
incidence of congenital malformation is three pulse rate averages 120 to 160 beats/minute,
times higher in these infants than in those and respirations are 40 to 60 breaths/minute.
born to nondiabetic women. ➢ The diamond-shaped anterior fontanel usually
➢ Skeletal system abnormalities and ventricular closes between ages 12 and 18 months. The
septal defects are the most common disorders triangular posterior fontanel usually closes by
of infants who are born to diabetic women. The age 2 months.
incidence of congenital malformation is three ➢ In the neonate, a straight spine is normal. A
times higher in these infants than in those tuft of hair over the spine is an abnormal
born to nondiabetic women. finding.
➢ The patient with preeclampsia usually has ➢ Prostaglandin gel may be applied to the vagina
puffiness around the eyes or edema in the or cervix to ripen an unfavorable cervix before
hands (for example, “I can’t put my wedding labor induction with oxytocin (Pitocin).
ring on.”).
➢ Supernumerary nipples are occasionally seen resulting in supine hypotensive syndrome, or
on neonates. They usually appear along a line inferior vena cava syndrome.
that runs from each axilla, through the normal ➢ Tocolytic agents used to treat preterm labor
nipple area, and to the groin. include terbutaline (Brethine), ritodrine
➢ Meconium is a material that collects in the (Yutopar), and magnesium sulfate.
fetus’s intestines and forms the neonate’s first ➢ A pregnant woman who has hyperemesis
feces, which are black and tarry. gravidarum may require hospitalization to
➢ The presence of meconium in the amniotic treat dehydration and starvation.
fluid during labor indicates possible fetal ➢ Diaphragmatic hernia is one of the most
distress and the need to evaluate the neonate urgent neonatal surgical emergencies. By
for meconium aspiration. compressing and displacing the lungs and
➢ To assess a neonate’s rooting reflex, the nurse heart, this disorder can cause respiratory
touches a finger to the cheek or the corner of distress shortly after birth.
the mouth. Normally, the neonate turns his ➢ Common complications of early pregnancy (up
head toward the stimulus, opens his mouth, to 20 weeks’ gestation) include fetal loss and
and searches for the stimulus. serious threats to maternal health.
➢ Harlequin sign is present when a neonate who ➢ Fetal embodiment is a maternal
is lying on his side appears red on the developmental task that occurs in the second
dependent side and pale on the upper side. trimester. During this stage, the mother may
➢ Mongolian spots can range from brown to blue. complain that she never gets to sleep because
Their color depends on how close melanocytes the fetus always gives her a thump when she
are to the surface of the skin. They most tries.
commonly appear as patches across the ➢ Visualization in pregnancy is a process in
sacrum, buttocks, and legs. which the mother imagines what the child
➢ Mongolian spots are common in non-white she’s carrying is like and becomes acquainted
infants and usually disappear by age 2 to 3 with it. 7
years. ➢ Hemodilution of pregnancy is the increase in
➢ Vernix caseosa is a cheeselike substance that blood volume that occurs during pregnancy.
covers and protects the fetus’s skin in utero. It The increased volume consists of plasma and
may be rubbed into the neonate’s skin or causes an imbalance between the ratio of red
washed away in one or two baths. blood cells to plasma and a resultant decrease
➢ Caput succedaneum is edema that develops in in hematocrit.
and under the fetal scalp during labor and ➢ Mean arterial pressure of greater than 100 mm
delivery. It resolves spontaneously and Hg after 20 weeks of pregnancy is considered
presents no danger to the neonate. The edema hypertension.
doesn’t cross the suture line. ➢ The treatment for supine hypotension
➢ Nevus flammeus, or port-wine stain, is a syndrome (a condition that sometimes occurs
diffuse pink to dark bluish red lesion on a in pregnancy) is to have the patient lie on her
neonate’s face or neck. left side.
➢ The Guthrie test (a screening test for ➢ A contributing factor in dependent edema in
phenylketonuria) is most reliable if it’s done the pregnant patient is the increase of femoral
between the second and sixth days after birth venous pressure from 10 mm Hg (normal) to
and is performed after the neonate has 18 mm Hg (high).
ingested protein. ➢ Hyperpigmentation of the pregnant patient’s
➢ To assess coordination of sucking and face, formerly called chloasma and now
swallowing, the nurse should observe the referred to as melasma, fades after delivery.
neonate’s first breast-feeding or sterile water ➢ The hormone relaxin, which is secreted first by
bottle-feeding. the corpus luteum and later by the placenta,
➢ To establish a milk supply pattern, the mother relaxes the connective tissue and cartilage of
should breast-feed her infant at least every 4 the symphysis pubis and the sacroiliac joint to
hours. During the first month, she should facilitate passage of the fetus during delivery.
breast-feed 8 to 12 times daily (demand ➢ Progesterone maintains the integrity of the
feeding). pregnancy by inhibiting uterine motility.
➢ To avoid contact with blood and other body ➢ Ladin’s sign, an early indication of pregnancy,
fluids, the nurse should wear gloves when causes softening of a spot on the anterior
handling the neonate until after the first bath portion of the uterus, just above the
is given. uterocervical juncture.
➢ If a breast-fed infant is content, has good skin ➢ During pregnancy, the abdominal line from the
turgor, an adequate number of wet diapers, symphysis pubis to the umbilicus changes
and normal weight gain, the mother’s milk from linea alba to linea nigra.
supply is assumed to be adequate. ➢ In neonates, cold stress affects the circulatory,
➢ In the supine position, a pregnant patient’s regulatory, and respiratory systems.
enlarged uterus impairs venous return from ➢ Obstetric data can be described by using the
the lower half of the body to the heart, F/TPAL system:
➢ F/T: Full-term delivery at 38 weeks or longer
➢ P: Preterm delivery between 20 and 37 weeks ➢ Meconium is usually passed in the first 24
➢ A: Abortion or loss of fetus before 20 weeks hours; however, passage may take up to 72
➢ L: Number of children living (if a child has died, hours.
further explanation is needed to clarify the ➢ Boys who are born with hypospadias shouldn’t
discrepancy in numbers). be circumcised at birth because the foreskin
➢ Parity doesn’t refer to the number of infants may be needed for constructive surgery.
delivered, only the number of deliveries. ➢ In the neonate, the normal blood glucose level
➢ Women who are carrying more than one fetus is 45 to 90 mg/dl.
should be encouraged to gain 35 to 45 lb (15.5 ➢ Hepatitis B vaccine is usually given within 48
to 20.5 kg) during pregnancy. hours of birth.
➢ The recommended amount of iron supplement ➢ Hepatitis B immune globulin is usually given
for the pregnant patient is 30 to 60 mg daily. within 12 hours of birth.
➢ Drinking six alcoholic beverages a day or a ➢ HELLP (hemolysis, elevated liver enzymes, and
single episode of binge drinking in the first low platelets) syndrome is an unusual variation
trimester can cause fetal alcohol syndrome. of pregnancy-induced hypertension.
➢ Chorionic villus sampling is performed at 8 to ➢ Maternal serum alpha-fetoprotein is detectable
12 weeks of pregnancy for early identification at 7 weeks of gestation and peaks in the third
of genetic defects. trimester. High levels detected between the
➢ In percutaneous umbilical blood sampling, a 16th and 18th weeks are associated with
blood sample is obtained from the umbilical neural tube defects. Low levels are associated
cord to detect anemia, genetic defects, and with Down syndrome.
blood incompatibility as well as to assess the ➢ An arrest of descent occurs when the fetus
need for blood transfusions. doesn’t descend through the pelvic cavity
➢ The period between contractions is referred to during labor. It’s commonly associated with
as the interval, or resting phase. During this cephalopelvic disproportion, and cesarean
phase, the uterus and placenta fill with blood delivery may be required.
and allow for the exchange of oxygen, carbon ➢ A late sign of preeclampsia is epigastric pain
dioxide, and nutrients. as a result of severe liver edema.
➢ In a patient who has hypertonic contractions, ➢ In the patient with preeclampsia, blood
the uterus doesn’t have an opportunity to pressure returns to normal during the
relax and there is no interval between puerperal period.
contractions. As a result, the fetus may ➢ To obtain an estriol level, urine is collected for
experience hypoxia or rapid delivery may 24 hours.
occur. ➢ An estriol level is used to assess fetal well-
➢ Two qualities of the myometrium are elasticity, being and maternal renal functioning as well
which allows it to stretch yet maintain its tone, as to monitor a pregnancy that’s complicated
and contractility, which allows it to shorten by diabetes.
and lengthen in a synchronized pattern. ➢ A pregnant patient with vaginal bleeding
➢ During crowning, the presenting part of the shouldn’t have a pelvic examination.
fetus remains visible during the interval ➢ In the early stages of pregnancy, the finding of
between contractions. glucose in the urine may be related to the
➢ Uterine atony is failure of the uterus to remain increased shunting of
firmly contracted. ➢ glucose to the developing placenta, without a
➢ The major cause of uterine atony is a full corresponding increase in the reabsorption
bladder. capability of the kidneys.
➢ If the mother wishes to breast-feed, the ➢ A patient who has premature rupture of the
neonate should be nursed as soon as possible membranes is at significant risk for infection if
after delivery. labor doesn’t begin within 24 hours.
➢ A smacking sound, milk dripping from the side ➢ Infants of diabetic mothers are susceptible to
of the mouth, and sucking noises all indicate macrosomia as a result of increased insulin
improper placement of the infant’s mouth over production in the fetus.
the nipple. ➢ To prevent heat loss in the neonate, the nurse
➢ Before feeding is initiated, an infant should be should bathe one part of his body at a time
burped to expel air from the stomach. and keep the rest of the body covered.
➢ Most authorities strongly encourage the ➢ A patient who has a cesarean delivery is at
continuation of breast-feeding on both the greater risk for infection than the patient who
affected and the unaffected breast of patients gives birth vaginally.
with mastitis. ➢ The occurrence of thrush in the neonate is
➢ Neonates are nearsighted and focus on items probably caused by contact with the organism
that are held 10" to 12" (25 to 30.5 cm) away. during delivery through the birth canal.
➢ In a neonate, low-set ears are associated with ➢ The nurse should keep the sac of
chromosomal abnormalities such as Down meningomyelocele moist with normal saline
syndrome. solution.
➢ If fundal height is at least 2 cm less than
expected, the cause may be growth
retardation, missed abortion, transverse lie, or ➢ During the transition phase of labor, the
false pregnancy. woman usually is irritable and restless.
➢ Fundal height that exceeds expectations by ➢ Because women with diabetes have a higher
more than 2 cm may be caused by multiple incidence of birth anomalies than women
gestation, polyhydramnios, uterine myomata, without diabetes, an alpha-fetoprotein level
or a large baby. may be ordered at 15 to 17 weeks’ gestation.
➢ A major developmental task for a woman ➢ To avoid puncturing the placenta, a vaginal
during the first trimester of pregnancy is examination shouldn’t be performed on a
accepting the pregnancy. pregnant patient who is bleeding.
➢ Unlike formula, breast milk offers the benefit ➢ A patient who has postpartum hemorrhage
of maternal antibodies. caused by uterine atony should be given
➢ Spontaneous rupture of the membranes oxytocin as prescribed.
increases the risk of a prolapsed umbilical ➢ Laceration of the vagina, cervix, or perineum
cord. produces bright red bleeding that often comes
➢ A clinical manifestation of a prolapsed in spurts. The bleeding is continuous, even
umbilical cord is variable decelerations. when the fundus is firm.
➢ During labor, to relieve supine hypotension ➢ Hot compresses can help to relieve breast
manifested by nausea and vomiting and tenderness after breast-feeding.
paleness, turn the patient on her left side. ➢ The fundus of a postpartum patient is
➢ If the ovum is fertilized by a spermatozoon massaged to stimulate contraction of the
carrying a Y chromosome, a male zygote is uterus and prevent hemorrhage.
formed. ➢ A mother who has a positive human
➢ Implantation occurs when the cellular walls of immunodeficiency virus test result shouldn’t
the blastocyte implants itself in the breast-feed her infant.
endometrium, usually 7 to 9 days after ➢ Dinoprostone (Cervidil) is used to ripen the
fertilization. cervix.
➢ Implantation occurs when the cellular walls of ➢ Breast-feeding of a premature neonate born at
the blastocyte implants itself in the 32 weeks’ gestation can be accomplished if
endometrium, usually 7 to 9 days after the mother expresses milk and feeds the
fertilization. neonate by gavage.
➢ Heart development in the embryo begins at 2 ➢ If a pregnant patient’s rubella titer is less than
to 4 weeks and is complete by the end of the 1:8, she should be immunized after delivery.
embryonic stage. ➢ The administration of oxytocin (Pitocin) is
➢ Methergine stimulates uterine contractions. stopped if the contractions are 90 seconds or
➢ The administration of folic acid during the longer.
early stages of gestation may prevent neural ➢ For an extramural delivery (one that takes
tube defects. place outside of a normal delivery center), the
➢ With advanced maternal age, a common priorities for care of the neonate include
genetic problem is Down syndrome. maintaining a patent airway, supporting efforts
➢ With early maternal age, cephalopelvic to breathe, monitoring vital signs, and
disproportion commonly occurs. maintaining adequate body temperature.
➢ In the early postpartum period, the fundus ➢ Subinvolution may occur if the bladder is
should be midline at the umbilicus. distended after delivery.
➢ A rubella vaccine shouldn’t be given to a ➢ The nurse must place identification bands on
pregnant woman. The vaccine can be both the mother and the neonate before they
administered after delivery, but the patient leave the delivery room.
should be instructed to avoid becoming ➢ Erythromycin is given at birth to prevent
pregnant for 3 months. ophthalmia neonatorum.
➢ A 16-year-old girl who is pregnant is at risk for ➢ Pelvic-tilt exercises can help to prevent or
having a low-birth-weight neonate. relieve backache during pregnancy.
➢ The mother’s Rh factor should be determined ➢ Before performing a Leopold maneuver, the
before an amniocentesis is performed. nurse should ask the patient to empty her
➢ Maternal hypotension is a complication of bladder.
spinal block. ➢ Psychiatric nursing bullets review 9
➢ After delivery, if the fundus is boggy and ➢ According to Kübler-Ross, the five stages of
deviated to the right side, the patient should death and dying are denial, anger, bargaining,
empty her bladder. depression, and acceptance.
➢ Before providing a specimen for a sperm ➢ Flight of ideas is an alteration in thought
count, the patient should avoid ejaculation for processes that’s characterized by skipping
48 to 72 hours. from one topic to another, unrelated topic.
➢ The hormone human chorionic gonadotropin is ➢ La belle indifférence is the lack of concern for
a marker for pregnancy. a profound disability, such as blindness or
➢ Painless vaginal bleeding during the last paralysis that may occur in a patient who has
trimester of pregnancy may indicate placenta a conversion disorder.
previa.
➢ Moderate anxiety decreases a person’s ability patient can assume self-control and helps the
to perceive and concentrate. The person is patient to regain self-control.
selectively inattentive (focuses on immediate ➢ Tyramine-rich food, such as aged cheese,
concerns), and the perceptual field narrows. chicken liver, avocados, bananas, meat
➢ A patient who has a phobic disorder uses self- tenderizer, salami, bologna, Chianti wine, and
protective avoidance as an ego defense beer may cause severe hypertension in a
mechanism. patient who takes a monoamine oxidase
➢ In a patient who has anorexia nervosa, the inhibitor.
highest treatment priority is correction of ➢ A patient who takes a monoamine oxidase
nutritional and electrolyte imbalances. inhibitor should be weighed biweekly and
➢ A patient who is taking lithium must undergo monitored for suicidal tendencies.
regular (usually once a month) monitoring of ➢ If the patient who takes a monoamine oxidase
the blood lithium level because the margin inhibitor has palpitations, headaches, or
between therapeutic and toxic levels is severe orthostatic hypotension, the nurse
narrow. A normal laboratory value is 0.5 to 1.5 should withhold the drug and notify the
mEq/L. physician.
➢ Early signs and symptoms of alcohol ➢ Common causes of child abuse are poor
withdrawal include anxiety, anorexia, tremors, impulse control by the parents and the lack of
and insomnia. They may begin up to 8 hours knowledge of growth and development.
after the last alcohol intake. ➢ The diagnosis of Alzheimer’s disease is based
➢ Al-Anon is a support group for families of on clinical findings of two or more cognitive
alcoholics. deficits, progressive worsening of memory,
➢ The nurse shouldn’t administer chlorpromazine and the results of a neuropsychological test.
(Thorazine) to a patient who has ingested ➢ Memory disturbance is a classic sign of
alcohol because it may cause oversedation Alzheimer’s disease.
and respiratory depression. ➢ Thought blocking is loss of the train of thought
➢ Lithium toxicity can occur when sodium and because of a defect in mental processing.
fluid intake are insufficient, causing lithium ➢ A compulsion is an irresistible urge to perform
retention. an irrational act, such as walking in a
➢ An alcoholic who achieves sobriety is called a clockwise circle before leaving a room or
recovering alcoholic because no cure for washing the hands repeatedly.
alcoholism exists. ➢ A patient who has a chosen method and a plan
➢ According to Erikson, the school-age child to commit suicide in the next 48 to 72 hours is
(ages 6 to 12) is in the industry-versus- at high risk for suicide.
inferiority stage of psychosocial development. ➢ The therapeutic serum level for lithium is 0.5
➢ When caring for a depressed patient, the to 1.5 mEq/L.
nurse’s first priority is safety because of the ➢ Phobic disorders are treated with
increased risk of suicide. desensitization therapy, which gradually
➢ Echolalia is parrotlike repetition of another exposes a patient to an anxiety-producing
person’s words or phrases. stimulus.
➢ According to psychoanalytic theory, the ego is ➢ Dysfunctional grieving is absent or prolonged
the part of the psyche that controls internal grief.
demands and interacts with the outside world ➢ During phase I of the nurse-patient
at the conscious, preconscious, and relationship (beginning, or orientation, phase),
unconscious levels. the nurse obtains an initial history and the
➢ According to psychoanalytic theory, the nurse and the patient agree to a contract.
superego is the part of the psyche that’s ➢ During phase II of the nurse-patient
composed of morals, values, and ethics. It relationship (middle, or working, phase), the
continually evaluates thoughts and actions, patient discusses his problems, behavioral
rewarding the good and punishing the bad. changes occur, and self-defeating behavior is
(Think of the superego as the “supercop” of resolved or reduced.
the unconscious.) ➢ During phase III of the nurse-patient
➢ According to psychoanalytic theory, the id is relationship (termination, or resolution,
the part of the psyche that contains instinctual phase), the nurse terminates the therapeutic
drives. (Remember i for instinctual and d for relationship and gives the patient positive
drive.) feedback on his accomplishments.
➢ Denial is the defense mechanism used by a ➢ According to Freud, a person between ages 12
patient who denies the reality of an event. and 20 is in the genital stage, during which he
➢ In a psychiatric setting, seclusion is used to learns independence, has an increased
reduce overwhelming environmental interest in members of the opposite sex, and
stimulation, protect the patient from self-injury establishes an identity.
or injury to others, and prevent damage to ➢ According to Erikson, the identity-versus-role
hospital property. It’s used for patients who confusion stage occurs between ages 12 and
don’t respond to less restrictive interventions. 20.
Seclusion controls external behavior until the
➢ Tolerance is the need for increasing amounts patients think in concrete terms and might
of a substance to achieve an effect that interpret the glass house proverb as “If you
formerly was achieved with lesser amounts. throw a stone in a glass house, the house will
➢ Suicide is the third leading cause of death break.”)
among white teenagers. ➢ Signs of lithium toxicity include diarrhea,
➢ Most teenagers who kill themselves made a tremors, nausea, muscle weakness, ataxia,
previous suicide attempt and left telltale signs and confusion.
of their plans. ➢ A labile affect is characterized by rapid shifts
➢ In Erikson’s stage of generativity versus of emotions and mood.
despair, generativity (investment of the self in ➢ Amnesia is loss of memory from an organic or
the interest of the larger community) is inorganic cause.
expressed through procreation, work, ➢ A person who has borderline personality
community service, and creative endeavors. disorder is demanding and judgmental in
➢ Alcoholics Anonymous recommends a 12-step interpersonal relationships and will attempt to
program to achieve sobriety. split staff by pointing to discrepancies in the
➢ Signs and symptoms of anorexia nervosa treatment plan.
include amenorrhea, excessive weight loss, ➢ Disulfiram (Antabuse) shouldn’t be taken
lanugo (fine body hair), abdominal distention, concurrently with metronidazole (Flagyl)
and electrolyte disturbances. because they may interact and cause a
➢ A serum lithium level that exceeds 2.0 mEq/L psychotic reaction.
is considered toxic. ➢ In rare cases, electroconvulsive therapy
➢ Public Law 94-247 (Child Abuse and Neglect causes arrhythmias and death.
Act of 1973) requires reporting of suspected ➢ A patient who is scheduled for
cases of child abuse to child protection electroconvulsive therapy should receive
services. nothing by mouth after midnight to prevent
➢ The nurse should suspect sexual abuse in a aspiration while under anesthesia.
young child who has blood in the feces or ➢ Electroconvulsive therapy is normally used for
urine, penile or vaginal discharge, genital patients who have severe depression that
trauma that isn’t readily explained, or a doesn’t respond to drug therapy.
sexually transmitted disease. ➢ For electroconvulsive therapy to be effective,
➢ An alcoholic uses alcohol to cope with the the patient usually receives 6 to 12 treatments
stresses of life. at a rate of 2 to 3 per week.
➢ The human personality operates on three ➢ During the manic phase of bipolar affective
levels: conscious, preconscious, and disorder, nursing care is directed at slowing
unconscious. the patient down because the patient may die
➢ Asking a patient an open-ended question is as a result of self-induced exhaustion or injury.
one of the best ways to elicit or clarify ➢ For a patient with Alzheimer’s disease, the
information. nursing care plan should focus on safety
➢ The diagnosis of autism is often made when a measures.
child is between ages 2 and 3. ➢ After sexual assault, the patient’s needs are
➢ Defense mechanisms protect the personality the primary concern, followed by medicolegal
by reducing stress and anxiety. considerations.
➢ Suppression is voluntary exclusion of stress- ➢ Patients who are in a maintenance program for
producing thoughts from the consciousness. narcotic abstinence syndrome receive 10 to 40
➢ In psychodrama, life situations are mg of methadone (Dolophine) in a single daily
approximated in a structured environment, dose and are monitored to ensure that the
allowing the participant to recreate and enact drug is ingested.
scenes to gain insight and to practice new ➢ Stress management is a short-range goal of
skills. psychotherapy.
➢ Psychodrama is a therapeutic technique that’s ➢ The mood most often experienced by a patient
used with groups to help participants gain new with organic brain syndrome is irritability.
perception and self-awareness by acting out ➢ Creative intuition is controlled by the right side
their own or assigned problems. of the brain.
➢ A patient who is taking disulfiram (Antabuse) ➢ Methohexital (Brevital) is the general
must avoid ingesting products that contain anesthetic that’s administered to patients who
alcohol, such as cough syrup, fruitcake, and are scheduled for electroconvulsive therapy.
sauces and soups made with cooking wine. ➢ The decision to use restraints should be based
➢ A patient who is admitted to a psychiatric on the patient’s safety needs.
hospital involuntarily loses the right to sign out ➢ Diphenhydramine (Benadryl) relieves the
against medical advice. extrapyramidal adverse effects of psychotropic
➢ “People who live in glass houses shouldn’t drugs.
throw stones” and “A rolling stone gathers no ➢ In a patient who is stabilized on lithium
moss” are examples of proverbs used during a (Eskalith) therapy, blood lithium levels should
psychiatric interview to determine a patient’s be checked 8 to 12 hours after the first dose,
ability to think abstractly. (Schizophrenic then two or three times weekly during the first
month. Levels should be checked weekly to example, paralysis, blindness, or inability to
monthly during maintenance therapy. swallow). This loss of function is involuntary,
➢ The primary purpose of psychotropic drugs is but diagnostic tests show no organic cause.
to decrease the patient’s symptoms, which ➢ Chlordiazepoxide (Librium) is the drug of
improves function and increases compliance choice for treating alcohol withdrawal
with therapy. symptoms.
➢ Manipulation is a maladaptive method of ➢ For a patient who is at risk for alcohol
meeting one’s needs because it disregards the withdrawal, the nurse should assess the pulse
needs and feelings of others. rate and blood pressure every 2 hours for the
➢ If a patient has symptoms of lithium toxicity, first 12 hours, every 4 hours for the next 24
the nurse should withhold one dose and call hours, and every 6 hours thereafter (unless
the physician. the patient’s condition becomes unstable).
➢ A patient who is taking lithium (Eskalith) for ➢ Alcohol detoxification is most successful when
bipolar affective disorder must maintain a carried out in a structured environment by a
balanced diet with adequate salt intake. supportive, nonjudgmental staff.
➢ A patient who constantly seeks approval or ➢ The nurse should follow these guidelines when
assistance from staff members and other caring for a patient who is experiencing
patients is demonstrating dependent behavior. alcohol withdrawal: Maintain a calm
➢ Alcoholics Anonymous advocates total environment, keep intrusions to a minimum,
abstinence from alcohol. speak slowly and calmly, adjust lighting to
➢ Methylphenidate (Ritalin) is the drug of choice prevent shadows and glare, call the patient by
for treating attention deficit hyperactivity name, and have a friend or family member
disorder in children. stay with the patient, if possible.
➢ Setting limits is the most effective way to ➢ The therapeutic regimen for an alcoholic
control manipulative behavior. patient includes folic acid, thiamine, and
➢ Violent outbursts are common in a patient who multivitamin supplements as well as adequate
has borderline personality disorder. food and fluids.
➢ When working with a depressed patient, the ➢ A patient who is addicted to opiates (drugs
nurse should explore meaningful losses. derived from poppy seeds, such as heroin and
➢ An illusion is a misinterpretation of an actual morphine) typically experiences withdrawal
environmental stimulus. symptoms within 12 hours after the last dose.
➢ Anxiety is nonspecific; fear is specific. The most severe symptoms occur within 48
➢ Extrapyramidal adverse effects are common in hours and decrease over the next 2 weeks.
patients who take antipsychotic drugs. ➢ Reactive depression is a response to a specific
➢ The nurse should encourage an angry patient life event.
to follow a physical exercise program as one of ➢ Projection is the unconscious assigning of a
the ways to ventilate feelings. thought, feeling, or action to someone or
➢ Depression is clinically significant if it’s something else.
characterized by exaggerated feelings of ➢ Sublimation is the channeling of unacceptable
sadness, melancholy, dejection, impulses into socially acceptable behavior.
worthlessness, and hopelessness that are ➢ Repression is an unconscious defense
inappropriate or out of proportion to reality. mechanism whereby unacceptable or painful
➢ Free-floating anxiety is anxiousness with thoughts, impulses, memories, or feelings are
generalized apprehension and pessimism for pushed from the consciousness or forgotten.
unknown reasons. ➢ Hypochondriasis is morbid anxiety about one’s
➢ In a patient who is experiencing intense health associated with various symptoms that
anxiety, the fight-or-flight reaction (alarm aren’t caused by organic disease.
reflex) may take over. ➢ Denial is a refusal to acknowledge feelings,
➢ Confabulation is the use of imaginary thoughts, desires, impulses, or external facts
experiences or made-up information to fill that are consciously intolerable.
missing gaps of memory. ➢ Reaction formation is the avoidance of anxiety
➢ When starting a therapeutic relationship with a through behavior and attitudes that are the
patient, the nurse should explain that the opposite of repressed impulses and drives.
purpose of the therapy is to produce a positive ➢ Displacement is the transfer of unacceptable
change. feelings to a more acceptable object.
➢ A basic assumption of psychoanalytic theory is ➢ Regression is a retreat to an earlier
that all behavior has meaning. developmental stage.
➢ Catharsis is the expression of deep feelings ➢ According to Erikson, an older adult (age 65 or
and emotions. older) is in the developmental stage of
➢ According to the pleasure principle, the psyche integrity versus despair.
seeks pleasure and avoids unpleasant ➢ Family therapy focuses on the family as a
experiences, regardless of the consequences. whole rather than the individual. Its major
➢ A patient who has a conversion disorder objective is to reestablish rational
resolves a psychological conflict through the communication between family members.
loss of a specific physical function (for
➢ When caring for a patient who is hostile or disorientation, confusion, inability to recognize
angry, the nurse should attempt to remain family members, and nocturnal restlessness.
calm, listen impartially, use short sentences, ➢ The last stage of Alzheimer’s disease occurs
and speak in a firm, quiet voice. during the final year of life and is
➢ Ritualism and negativism are typical toddler characterized by a blank facial expression,
behaviors. They occur during the seizures, loss of appetite, emaciation,
developmental stage identified by Erikson as irritability, and total dependence.
autonomy versus shame and doubt. ➢ Threatening a patient with an injection for
➢ Circumstantiality is a disturbance in associated failing to take an oral drug is an example of
thought and speech patterns in which a assault.
patient gives unnecessary, minute details and ➢ Reexamination of life goals is a major
digresses into inappropriate thoughts that developmental task during middle adulthood.
delay communication of central ideas and goal ➢ Acute alcohol withdrawal causes anorexia,
achievement. insomnia, headache, and restlessness and
➢ Idea of reference is an incorrect belief that the escalates to a syndrome that’s characterized
statements or actions of others are related to by agitation, disorientation, vivid
oneself. hallucinations, and tremors of the hands, feet,
➢ Group therapy provides an opportunity for legs, and tongue.
each group member to examine interactions, ➢ In a hospitalized alcoholic, alcohol withdrawal
learn and practice successful interpersonal delirium most commonly occurs 3 to 4 days
communication skills, and explore emotional after admission.
conflicts. ➢ Confrontation is a communication technique in
➢ Korsakoff’s syndrome is believed to be a which the nurse points out discrepancies
chronic form of Wernicke’s encephalopathy. between the patient’s words and his nonverbal
It’s marked by hallucinations, confabulation, behaviors.
amnesia, and disturbances of orientation. 12 ➢ For a patient with substance-induced delirium,
➢ A patient with antisocial personality disorder the time of drug ingestion can help to
often engages in confrontations with authority determine whether the drug can be evacuated
figures, such as police, parents, and school from the body.
officials. ➢ Treatment for alcohol withdrawal may include
➢ A patient with paranoid personality disorder administration of I.V. glucose for
exhibits suspicion, hypervigilance, and hostility hypoglycemia, I.V. fluid containing thiamine
toward others. and other B vitamins, and antianxiety,
➢ Depression is the most common psychiatric antidiarrheal, anticonvulsant, and antiemetic
disorder. drugs.
➢ Adverse reactions to tricyclic antidepressant ➢ The alcoholic patient receives thiamine to help
drugs include tachycardia, orthostatic prevent peripheral neuropathy and Korsakoff’s
hypotension, hypomania, lowered seizure syndrome.
threshold, tremors, weight gain, problems with ➢ Alcohol withdrawal may precipitate seizure
erections or orgasms, and anxiety. activity because alcohol lowers the seizure
➢ The Minnesota Multiphasic Personality threshold in some people.
Inventory consists of 550 statements for the ➢ Paraphrasing is an active listening technique in
subject to interpret. It assesses personality which the nurse restates what the patient has
and detects disorders, such as depression and just said.
schizophrenia, in adolescents and adults. ➢ A patient with Korsakoff’s syndrome may use
➢ Organic brain syndrome is the most common confabulation (made up information) to cover
form of mental illness in elderly patients. memory lapses or periods of amnesia.
➢ A person who has an IQ of less than 20 is ➢ People with obsessive-compulsive disorder
profoundly retarded and is considered a total- realize that their behavior is unreasonable, but
care patient. are powerless to control it.
➢ Reframing is a therapeutic technique that’s ➢ When witnessing psychiatric patients who are
used to help depressed patients to view a engaged in a threatening confrontation, the
situation in alternative ways. nurse should first separate the two individuals.
➢ Fluoxetine (Prozac), sertraline (Zoloft), and ➢ Patients with anorexia nervosa or bulimia must
paroxetine (Paxil) are serotonin reuptake be observed during meals and for some time
inhibitors used to treat depression. afterward to ensure that they don’t purge what
➢ The early stage of Alzheimer’s disease lasts 2 they have eaten.
to 4 years. Patients have inappropriate affect, ➢ Transsexuals believe that they were born the
transient paranoia, disorientation to time, wrong gender and may seek hormonal or
memory loss, careless dressing, and impaired surgical treatment to change their gender.
judgment. ➢ Fugue is a dissociative state in which a person
➢ The middle stage of Alzheimer’s disease lasts leaves his familiar surroundings, assumes a
4 to 7 years and is marked by profound new identity, and has amnesia about his
personality changes, loss of independence, previous identity. (It’s also described as “flight
from himself.”)
➢ In a psychiatric setting, the patient should be ➢ A psychiatric patient with a substance abuse
able to predict the nurse’s behavior and problem and a major psychiatric disorder has a
expect consistent positive attitudes and dual diagnosis.
approaches. ➢ When a patient is readmitted to a mental
➢ When establishing a schedule for a one-to-one health unit, the nurse should assess
interaction with a patient, the nurse should compliance with medication orders.
state how long the conversation will last and ➢ Alcohol potentiates the effects of tricyclic
then adhere to the time limit. antidepressants.
➢ Thought broadcasting is a type of delusion in ➢ Flight of ideas is movement from one topic to
which the person believes that his thoughts another without any discernible connection.
are being broadcast for the world to hear. ➢ Conduct disorder is manifested by extreme
➢ Lithium should be taken with food. A patient behavior, such as hurting people and animals.
who is taking lithium shouldn’t restrict his ➢ During the “tension-building” phase of an
sodium intake. abusive relationship, the abused individual
➢ A patient who is taking lithium should stop feels helpless.
taking the drug and call his physician if he ➢ In the emergency treatment of an alcohol-
experiences vomiting, drowsiness, or muscle intoxicated patient, determining the blood-
weakness. alcohol level is paramount in determining the
➢ The patient who is taking a monoamine amount of medication that the patient needs.
oxidase inhibitor for depression can include ➢ Side effects of the antidepressant fluoxetine
cottage cheese, cream cheese, yogurt, and (Prozac) include diarrhea, decreased libido,
sour cream in his diet. weight loss, and dry mouth.
➢ Sensory overload is a state in which sensory ➢ Before electroconvulsive therapy, the patient
stimulation exceeds the individual’s capacity is given the skeletal muscle relaxant
to tolerate or process it. succinylcholine (Anectine) by I.V.
➢ Symptoms of sensory overload include a administration.
feeling of distress and hyperarousal with ➢ When a psychotic patient is admitted to an
impaired thinking and concentration. inpatient facility, the primary concern is
➢ In sensory deprivation, overall sensory input is safety, followed by the establishment of trust.
decreased. ➢ An effective way to decrease the risk of suicide
➢ A sign of sensory deprivation is a decrease in is to make a suicide contract with the patient
stimulation from the environment or from for a specified period of time.
within oneself, such as daydreaming, ➢ A depressed patient should be given sufficient
inactivity, sleeping excessively, and portions of his favorite foods, but shouldn’t be
reminiscing. overwhelmed with too much food.
➢ The three stages of general adaptation ➢ The nurse should assess the depressed patient
syndrome are alarm, resistance, and for suicidal ideation.
exhaustion. ➢ Delusional thought patterns commonly occur
➢ A maladaptive response to stress is drinking during the manic phase of bipolar disorder.
alcohol or smoking excessively. 13 ➢ Apathy is typically observed in patients who
➢ Hyperalertness and the startle reflex are have schizophrenia.
characteristics of posttraumatic stress ➢ Manipulative behavior is characteristic of a
disorder. patient who has passive– aggressive
➢ A treatment for a phobia is desensitization, a personality disorder.
process in which the patient is slowly exposed ➢ When a patient who has schizophrenia begins
to the feared stimuli. to hallucinate, the nurse should redirect the
➢ Symptoms of major depressive disorder patient to activities that are focused on the
include depressed mood, inability to here and now.
experience pleasure, sleep disturbance, ➢ When a patient who is receiving an
appetite changes, decreased libido, and antipsychotic drug exhibits muscle rigidity and
feelings of worthlessness. tremors, the nurse should administer an
➢ Clinical signs of lithium toxicity are nausea, antiparkinsonian drug (for example, Cogentin
vomiting, and lethargy. or Artane) as ordered.
➢ Asking too many “why” questions yields scant ➢ A patient who is receiving lithium (Eskalith)
information and may overwhelm a psychiatric therapy should report diarrhea, vomiting,
patient and lead to stress and withdrawal. drowsiness, muscular weakness, or lack of
➢ Remote memory may be impaired in the late coordination to the physician immediately.
stages of dementia. ➢ The therapeutic serum level of lithium
➢ According to the DSM-IV, bipolar II disorder is (Eskalith) for maintenance is 0.6 to 1.2 mEq/L.
characterized by at least one manic episode ➢ Obsessive-compulsive disorder is an anxiety-
that’s accompanied by hypomania. related disorder.
➢ The nurse can use silence and active listening ➢ Al-Anon is a self-help group for families of
to promote interactions with a depressed alcoholics.
patient. ➢ Desensitization is a treatment for phobia, or
irrational fear.
➢ After electroconvulsive therapy, the patient is reactions, including nausea and vomiting, and
placed in the lateral position, with the head may endanger the patient’s life.
turned to one side. ➢ Improved concentration is a sign that lithium is
➢ A delusion is a fixed false belief. taking effect.
➢ Giving away personal possessions is a sign of ➢ Behavior modification, including time-outs,
suicidal ideation. Other signs include writing a token economy, or a reward system, is a
suicide note or talking about suicide. treatment for attention deficit hyperactivity
➢ Agoraphobia is fear of open spaces. disorder.
➢ A person who has paranoid personality ➢ For a patient who has anorexia nervosa, the
disorder projects hostilities onto others. nurse should provide support at mealtime and
➢ To assess a patient’s judgment, the nurse record the amount the patient eats.
should ask the patient what he would do if he ➢ A significant toxic risk associated with
found a stamped, addressed envelope. An clozapine (Clozaril) administration is blood
appropriate response is that he would mail the dyscrasia.
envelope. ➢ Adverse effects of haloperidol (Haldol)
➢ After electroconvulsive therapy, the patient administration include drowsiness; insomnia;
should be monitored for post-shock amnesia. weakness; headache; and extrapyramidal
➢ A mother who continues to perform symptoms, such as akathisia, tardive
cardiopulmonary resuscitation after a dyskinesia, and dystonia.
physician pronounces a child dead is showing ➢ Hypervigilance and déjà vu are signs of
denial. posttraumatic stress disorder (PTSD).
➢ Transvestism is a desire to wear clothes ➢ A child who shows dissociation has probably
usually worn by members of the opposite sex. been abused.
➢ Tardive dyskinesia causes excessive blinking ➢ Confabulation is the use of fantasy to fill in
and unusual movement of the tongue, and gaps of memo
involuntary sucking and chewing. ➢ COMMUNICABLE DISEASE NURSING
➢ Trihexyphenidyl (Artane) and benztropine COMMUNICABLE DISEASE
(Cogentin) are administered to counteract Infectious Agent or its toxic products - AGENT
extrapyramidal adverse effects. Directly or Indirectly - MODE OF
➢ To prevent hypertensive crisis, a patient who TRANSMISSION
is taking a monoamine oxidase inhibitor should Person, Animal or Intermediate Vector – HOST
avoid consuming aged cheese, caffeine, beer, Environment - ENVIRONMENT
yeast, chocolate, liver, processed foods, and ECOLOGIC TRIAD OF DISEASE
monosodium glutamate. Agent – element, substance, animate or
➢ Extrapyramidal symptoms include inanimate that may serve as stimulus to
parkinsonism, dystonia, akathisia (“ants in the initiate a disease process
pants”), and tardive dyskinesia. Host – organism that provides nourishment for
➢ One theory that supports the use of another organism
electroconvulsive therapy suggests that it Environment – physical (climate), biological
“resets” the brain circuits to allow normal (plants & animals)
function. CONTAGIOUS VS. INFECTIOUS
➢ A patient who has obsessive-compulsive Contagious
disorder usually recognizes the senselessness Diseases that are easily spread directly
of his behavior but is powerless to stop it (ego- transmitted from person to person (direct
dystonia). contact) through an intermediary host
➢ In helping a patient who has been abused, Infectious
physical safety is the nurse’s first priority. Diseases that caused by a pathogen not
➢ Pemoline (Cylert) is used to treat attention transmitted by ordinary contact but require a
deficit hyperactivity disorder (ADHD). 14 direct inoculation through a break in the skin
➢ Clozapine (Clozaril) is contraindicated in or mucous membrane.
pregnant women and in patients who have NOTE: ALL CONTAGIOUS DISEASE ARE
severe granulocytopenia or severe central INFECTIOUS BUT INFECTIOUS DISEASE IS NOT
nervous system depression. ALWAYS CONTAGIOUS
➢ Repression, an unconscious process, is the What is Infection?
inability to recall painful or unpleasant INFECTION - "the state or condition in which
thoughts or feelings. the body or part of the body is invaded by a
➢ Projection is shifting of unwanted pathogenic agent ( bacteria, virus, parasites
characteristics or shortcomings to others etc.) which under favorable conditions
(scapegoat). multiplies and produces effects which are
➢ Hypnosis is used to treat psychogenic injurious…"
amnesia. Infectious Agent
➢ Disulfiram (Antabuse) is administered orally as A. RESIDENT ORGANISMS
an aversion therapy to treat alcoholism. deeply seated in the epidermis, not easily
➢ Ingestion of alcohol by a patient who is taking removed by simple handwashing,
disulfiram (Antabuse) can cause severe Ex: Staphylococci
B. TRANSIENT ORGANISM Prevent Injuries but May Lessen Chance of
represent recent contamination, Transmitting Diseases)
survive for a limited period of time, acquired CONTROL OF C0MMUNICABLE DIESEASE
during contact with the infected colonized 1. Notification
patient or environment, 2. Epidemiological Investigation
easily removed by good handwashing 3. Case finding; early dx and prompt treatment
Ex: ( Klebsiella & Pseudomonas) 4. Isolation and Quarantine
Infectious Agent 5. Disinfection; disinfestation
Bacteria – heama organism, systemic 6. Medical Asepsis
Virus – nuero organism, systemic a. Handwashing
Fungi – skin organism, local b. Concurrent disinfection
Protozoa – GI organism, local c. Personal protective equipments (PPEs)
Infectious Agent d. Barrier Cards/Placarding
FACTORS THAT AFFECTS THE AGENT TO Objectives of CCD
DEVELOP A DISEASE Restoration of health, reduce deaths and
Pathogenicity – ability to cause a disease disability
Infective dose – no of organism to initiate Interpretation of control measures to IFC for
infection practice to prevent spread of CD.
Virulence – ability to enter or move through Promotion of health and prevention of spread
tissues of CD
Specificity – ability of the organism to develop Diseases that require weekly monitoring:
antigens 1. Acute flaccid paralysis (AFP) polio
STAGES OF INFECTIOUS PROCESS 2. Measles
Means of Transmission 3. Severe acute diarrhea (SAD)
1. CONTACT - most common means of 4. Neonatal tetanus
transmitting microorganisms from one person 5. AIDS
to another. Diseases that require reporting w/in 24 hrs
A. Direct Contact (person to person) 1. Acute flaccid paralysis (AFP) polio
occurs when one person touches another ➢ 2. Measles
best vehicle is the Hands especially those of Diseases targeted for eradication
the Health Care workers 1. Acute flaccid paralysis polio
Indirect Contact (inanimate object) 2. Neonatal tetanus
- occurs when a person touches an inanimate 3. Measles
object contaminated by an infected patient 4. Rabies
2. AIRBORNE Epidemiology
- droplet, dust, organisms in env. Study of the occurrence and distribution of
3. VECTOR - insects or animals diseases in the population
4. VEHICLE Patterns of occurrence of disease –frequency
- food (salmonella), water (shigellosis), blood of disease occurrence
(Hepa B), medication ( contaminated infusion) Sporadic
PREVENTION OF On and off occurrence of the disease
COMMUNICABLE DISEASE Most of the time it is not found in the
Prevention is worth a pound than cure community
PREVENTION OF One or two cases that occur are not related
COMMUNICABLE DISEASE Endemic
Health Education – primary role of the nurse Persistently present in the community all year
Specific Protection- handwashing, use of round
protective devices Ex: malaria in Palawan
Environmental Sanitation – clean and Epidemic
conducive for health An unexpected increase in the number of
Definition of Prevention cases of disease
“Actions aimed at eradicating, eliminating, or Pandemic
minimizing the impact of disease and Epidemic of a worldwide proportions
disability. The concept of prevention is best Time Related Patterns of Occurrence
defined in the context of levels, traditionally cyclical variation
called primary, secondary, and tertiary a periodic increase in the number of cases of a
prevention” disease
A Dictionary of Epidemiology, Fourth Edition a seasonal disease, an increase is expected or
by John M. Last there is usual increase- dengue fever during
Prevention of Needlestick Injuries rainy seasons are increased but it is not
Dispose Used Needles in Puncture Proof considered an epidemic because it is expected
Needle Containers to rise at this particular time
Don’t Recap Needles (Unless using the One- hot spot-a rising increase that may lead to an
handed Technique) epidemic
Use Gloves When Handling Needles (Won’t
Time Related Patterns of Occurrence after his illness is no longer communicable
Short time fluctuation FACTORS AFFECTING ISOLATION
A change in the frequency of occurrence of a Mode of Transmission
disease over a short period of time Source
Maybe (+) or (-) Status of the client’s defense mechanism
Secular variation Ability of client to implement precautions
A change in the frequency of occurrence of a ISOLATION
diseae taking place over a long period of time EPI
Ex: a.) the change in the pattern of occurrence Launched by DOH in cooperation with WHO
of polio after being eradicated in 2000, then and UNICEF last July 1976
sudden repport of cases in 2001 due to mutant Objective – reduce morbidity and mortality
restraints. among infants and children caused by the six
b.) small pox virus-eradicated in 1979 (last childhood immunizable diseases
case reported) and no another incidence as of PD No. 996 (Sept. 16, 1076) – “ Providing for
today compulsary basic immunization for infants and
Types of Epidemiology children below 8 y/o
Descriptive Epidemiology - concerned with PP No. 6 (April 3, 1996) – “ Implementing a
disease frequency & distribution United Nations goal on Universal Child
Analytic Epidemiology Immunization by 1990”
Is a study of the factors affecting occurrence RA 7846 (Dec. 30, 1994) – immunization hepa
and distribution of the disease. B
Ex. Epidemiologic investigation PD No. 4 (July 29, 1998) – “Declaring the
Therapeutic/Clinical period of September 16 to October 14, 1998
Study of the efficacy of a treatment of a as Ligtas Tigdas Month and launching the Phil
particular disease Measles Elimination Campaign”
Ex. Clinical trial of a newly proposed Legislation, Laws affecting EPI
therapeutic regimen Proclamation No. 46 – “polio eradication
Evaluation Epidemiology project”
Study of the over-all effectiveness of a total/ Proclamation No. 1064 – AFP surveillance
comprehensive public health program. Proclamation No. 1066 – National Neonatal
Ex. Evaluation of the under five clinic Tetanus Elimination Campaign
EPI
Note: We make use of the epidemiology in BCG - TB
CHN in order to come up a community DPT – Diptheria, Pertussis, Tetanu
diagnosis and also to determine the OPV - Poliomyletis
effectiveness of a particular treatment Hepatitis B
Types of Epidemiologic Data Measles
Demographic data Immunization
Demography is the study of population groups Contraindications
Ex. Population size and distribution -conditions that require hospitalization
Vital Statistics For DPT 2 and 3 – history of seizures/
Environmental data convulsions within 3 days after the first
Health services data immunization with DPT
Ex. Ratio between nurse and the population Nursing responsibility: ask how the child reacts
being served to the first dose
Ex. Degree of utilization of health facility/ For infant BCG – clinical AIDS
service The following conditions are NOT
Epidemiologic Investigation contraindications:
Fever up to 38.5 ºC
1st step- Statement of the problem Simple or mild acute respiratory infection
2nd step- Appraisal of facts – describing the Simple diarrhea without dehydration
epidemic in terms of time, place, person. Malnutrition (it is indication for immunization)
3rd step- formulation of hypothesis
4th step-Testing the hypothesis
5th step- Conclusion and recommendation Schedule of immunization
TERMS Infant BCG
Disinfection – pathogens but not spores are 0 to 11 months or 0 to 1 year
destroyed at birth
Disinfectant – substance use on inanimate 0.05 ml (dose) – ID, right arm
objects School entrance BCG
Concurrent disinfection – ongoing practices in When the child enters Grade 1 with or without
the care of the patient to limit or control the scar on the right arm then still go on with the
spread of microorganisms. vaccination except if he is repeating Grade 1
Terminal disinfection – practices to remove Schedule of immunization
pathogens from the patient’s environment DPT
3 doses, 4 weeks or 1 month interval
Target age: 1 ½ to 11 months but child is
eligible up to 6 years
If 7 years old and above DT only not P
0.5 ml, IM, vastus lateralis

Schedule of immunization
OPV
3 doses, 4 weeks/1 month
Target population: same as above, eligibility
until Grade 6
2-3 drops, oral route
*Feb 8-March 8: Oplan Polio Revival Drive
No side effect, but advise the mother to avoid
feeding the child for 30 minutes after the
vaccine, if vomits within the 30 minute period,
repeat the vaccination

Schedule of immunization
Hepa B
3 doses, 4 weeks
Can be given at birth
Target age 1 ½ to 11 months
0.5 ml, IM, vastus lateralis
Patient may experience local tenderness
Schedule of immunization
Measles
9 to 11 months
Most babies have protection because of
maternal antibodies thus this vaccine is given
at 9 months because the time where the
maternal antibodies wear off, other virus if it
still active it will kill the vaccine
0.5 ml, subcutaneous, any arm
Measles
Fever and measles rash lasting for 1 to 3 days
within 2 weeks after immunization (modified
measles)

Immunization
Fully Immunized Child
when he received all the antigens that should
be given in the first year of life (1 dose BCG,
MV; 3 doses DPT, OPV, HB)
Completely Immunized Child
All vaccines given but went beyond 0ne year
of age