D028 advanced health assessment special populations 2023, Exams of Nursing

Download D028 advanced health assessment special populations 2023 and more Exams Nursing in PDF only on Docsity! pregnancy FMH ? - ✔ genetic disease sickle cell cystic fibrosis muscular dystrophy autoimmune pregnancy history - ✔ nutritional intake social support sexual history income pregnancy risk factor questions - ✔ tobacco alcohol illicit drugs toxic exposure physical abuse GPTPAL - ✔g-gravidity (total number of pregnancies) P-Parity (number of pregnancies after 20 weeks) T-Term- number of pregnancies considered term 37- 40 weeks P-premature- pregnancies between 20-37 weeks a-abortions- induced or spontaneous termination before 20 weeks L- live births - number of living children naegele's rule - ✔LMP + 7 days -3 months if the women has a regular 28 days cycle pregnancy regular exams include - ✔fundal height fetal movement presence/absence preterm labor symptoms estrogen in pregnancy - ✔thromboembolic events increases estrogen used to promote endometrial growth contributes to hypercoagulable state D028 advanced health assessment special populations 2023 progesterone pregnancy - ✔GERD- lower esophageal sphincter tone decreases as a result of rising levels of estradiol and prgesterone common complications of pregnancy - ✔anemia gestation diabetes hypertension vaginal bleeding vaginal infection uti pregnancy and vaginal bleeding - ✔all need to be considered serious and life threatening 50% end in miscarriage if early in pregnancy pregnancy and UTI - ✔untreated uti may lead to pyelonephritis, preterm labor, maternal sepsis, or death pregnancy and uncommon complications - ✔preterm labor (prior to 37 weeks) uterus not at expect size for gestation pregnancy- uterus too small for gestation - ✔intrauterine growth restriction inaccurate EDD improper fundal measurement fetus lying transverse pregnancy- uterus too large for gestation - ✔inaccurate EDD improper fundal measurement fetal macrosomia multiple gestation molar pregnancy gestation diabetes pregnancy- common compliants - ✔constipation hemorrhoird backach e edema breast tenderness contractions pregnancy- fundal height measurement - ✔reflects baby growth correlates with weeks of pregnancy from 18-32 pregnancy weight gain - ✔fetus fluid- blood- breast- uterine amniotic fluid maternal fats and protein weight gain is slow in 1st trimester and rapid in 2nd and slows in 3rd pregnancy and normal changes to the face - ✔chloasma/melasma irregular brown patches of skin pregnancy and normal changes to the hair - ✔hirsutism (increase hair in face and abdomen) pregnancy and normal changes to the eyes - ✔pallor or jaundice pregnancy and normal changes to the nose - ✔nasal congestion epistaxis pregnancy and normal changes to the mouth - ✔gingival enlargement with bleeding pregnancy and normal changes to the thyroid gland - ✔symmetric enlargement pregnancy and normal changes to the lungs - ✔rate/pattern change diaphagmatic elevation pregnancy and normal changes to the heart - ✔apical pulse (may be ratated up and left towards 4th intercostal space be enlargement of uterus) venous hum(increase blood flow) mammary souffle pregnancy and normal changes to the breast - ✔peak in 3rd trimester increase vascularity, glandular hyperplasia increase in montogery glands increase in venous pattern secretion of colostrum increased nodularity and tenderness pregnancy and normal changes to the uterus - ✔grow (muscle cell hypertrophy, increase in fibrous and elastic tissue, blood vessels, and lymphatics) 1st tri- inverted pear, confinded in pelvis 1-2 tri- expands into globular shape and extends beyound pelvic brim pregnancy and normal changes to the abdomen - ✔stria gravidarum- stretch marks linea nigra- brown pigment vertical shape diastatis recti- separation of rectus abdominis muscles pregnancy physical exam of abdomen - ✔palpate organs and masses fetal movement (24 weeks) uterine contractility APGAR - ✔evaluates newborn's neurologic recovery from birth and adaptation to extrauterine life scored 1 & 5 minutes scores range 1-10 APGAR scoring - ✔8-10 normal (both at 1 minute and 5 minutes) 5-7 nervous system depression (at 1 minutes, if at 5 minutes then high risk for sebsequent CNS and organ system dysfunction) 0-4 severe depression, requires immediate resuscitation (at 1 minute) preterm - ✔<34 weeks late preterm - ✔34-36 weeks term - ✔37-42 weeks post-term - ✔> 42 weeks extremely low birth weight - ✔<1000 g very low birth weight - ✔<1500 g low birth weight - ✔<2500 g normal birth weight - ✔>= 2500 g new born examination - ✔self console turns to voice quiet in presence of singing track colorful objects responds to touch (if not preformed might have neurologic condition, illness/infection, drug withdrawal) birth weight by first year and height - ✔triples increases by 50% 3 month physical milestone for infant - ✔head at 90 degree angle use arms to prop up visually track through midline 5 month physical milestone for infant - ✔purposeful grasp roll loss of head lag reach for objects transfer objects from hand to hand play with feet rock on stomach 7 month physical milestone for infant - ✔sit in tripod position push head/torso up off the floor support weight on legs rake with hands 9 month physical milestone for infant - ✔get to and from sitting crawling pull to standing finger-thumb opposition eye-hand coordination 12 month physical milestone for infant - ✔walk 15 month physical milestone for infant - ✔more complex motor skills 2 years physical milestone for infant - ✔climbs up and down stairs 4 month cognitive milestone - ✔coo interest in environment 6 month cognitive milestone - ✔babbles imitates sounds 9 month cognitive milestone - ✔discriminates between parents and others trial and error problem solving 12 month cognitive milestone - ✔points to pictures in books in response to verbal cues use of single words 15 month cognitive milestone - ✔learns through imitating complex behaviors knows objects are used for specific purpose 2 year cognitive milestone - ✔2 word phrases uses complex toys (understands sequence of putting toys together) 5 month social mile stone - ✔responsive to social stimuli facial expressions 9 month social milestone - ✔socially interactive plays games umbilical cord fall off - ✔by 2 weeks of age ortolnai - ✔evaluates for posterior dislocation barlow - ✔evaluate for abilit to sublux or dislocate an intact but unstable hip primitive reflexes - palmar grasp - ✔birth-4 months primitive reflexes - plantar grasp - ✔birth- 8 months primitive reflexes - rooting - ✔birth- 4 months primitive reflexes - moro/startle - ✔birth- 4 months primitive reflexes - asymmetric tonic neck - ✔birth-2 months primitive reflexes - trunk incurvation/ galant - ✔birth- 2 months primitive reflexes - landau - ✔birth- 6 months primitive reflexes - parachute - ✔8 months- lifelong primitive reflexes - positive support - ✔birth- 6 months primitive reflexes - placing and stepping - ✔birth- variable early childhood physical development after infancy rate of growth slows by - ✔half early childhood physical development toddlers gain - ✔2-3 kg per year grow 5 cm per year early childhood physical development toddler social development - ✔impulsive poor self-regulation temper tantrums middle childhood development- cognitive - ✔little ability to understand consequence middle childhood social development - ✔independent enjoy accomplishments try to fit into social structures morals are simple (clear sense of right and wrong) BMI underweight - ✔> 5th percentile BMI healthy weight - ✔5-85th percentile BMI overweight - ✔85- 95 percentile BMI obese - ✔> 95th percentile RR in childhood - ✔20-40 in early 15-25 in late childhood adult levels at 15 yo visual acuity for childhood - ✔3 month- eye converge, baby reaches 12 months- 20/200 <4 months- 20/40 > 4 months 20/30 maxillary protrusion - ✔overbite mandibular protrusion - ✔underbite stills murmur in childhood - ✔most common childhood murmur grade 1-2 musical, vibratory, midsystolic LLS border, radiates to carotids, carotid compression will cause it to disappear diminished with change in position form supine to sitting to standing venous hum in childhood - ✔soft, hollow, continuous louder in diastole below right clavicle eliminated by lying supine carotid bruit in childhood - ✔early midsystolic harsh louder on the left side heard in carotid area or above clavicle