Milestones in Infant Development: 0-12 Months, Study Guides, Projects, Research of Nursing

Download Milestones in Infant Development: 0-12 Months and more Study Guides, Projects, Research Nursing in PDF only on Docsity! Focus Points Exam 3 Page 1 Family Focused Nursing Exam 3 – Focus Points Below you will find questions and suggestions to help you focus your reading and studying for Exam 3, which covers modules 15- 20. This is ONLY a guide. Module 15: Complications of Postpartum • What are the signs of cervical laceration, perineal hematoma and uterine atony? o Uterine Atony: absence or lack of usual muscle tone in the uterus. Most common cause of early postpartum hemorrhage. First complication assessed for with vaginal bleeding. ▪ Unable to locate fundus with palpation ▪ Uterus is soft or boggy ▪ Fundus high in abdomen ▪ Prolonged, excessive bright red lochia ▪ Irregular or excessive bleeding ▪ Excessive clots expelled with fundal massage ▪ Tachycardia and Hypotension ▪ Skin is pale, cool, and clammy w/loss of turgor and pale mucous membranes ▪ Risk factors: more pregnancies, big baby, twins, anything that stretches the uterus out, prolonged labor o Cervical Laceration: difficult to detect, if not repaired significant blood loss can occur. ▪ Sensation of oozing or trickle of blood from vagina, laceration, or episiotomy ▪ Excessive rubra lochia (with or w/out clots) ▪ Risk factors: big baby, operative birth( vacuum), speed of labor(fast), previous injury or scar of cervix, pushing before cervix is fully dilated ▪ Vaginal bleeding even though uterus is firm and contracted o Perineal Hematoma: can be detected visually, if a vaginal hematoma not as easy to detect ▪ Severe pain and pressure ▪ Signs and symptoms of shock ▪ Pressure sensation in rectum (urge to defecate) or vagina ▪ Difficulty voiding ▪ Bulging, blueish mass or area of red-purple discoloration on vulva, perineum, or rectum ▪ Risk factors: fast labor, operative labor( forceps or vacuum), episiotomy, first pregnancy ▪ Often has to have surgery to repair Focus Points Exam 3 Page 2 • Discuss common causes of postpartum hemorrhage. Focus Points Exam 3 Page 5 feeding to prevent milk stasis no medium for bacteria • Antibiotics Focus Points Exam 3 Page 6 • Continuing breastfeeding (q2-4hrs), especially on affected side • Beginning to breastfeed from unaffected breast first to initiate letdown reflex • Pt to report any redness or fever ▪ Encourage • Air drying nipples • warm packs on affected breasts • Rest, analgesics, and fluid intake of at least 3,000 mL per day • Well-fitting bra for support ▪ Teach proper infant positioning and latching techniques. Mom should release infant’s grasp on nipple before removing her from breast ▪ Administer antibiotics ▪ Increasing fluid intake will be vital in discouraging stasis during breastfeeding. • What are the signs and symptoms of thrombophlebitis? Describe assessment and nursing interventions. Describe what postpartum patients are at particular risk of developing DVT. o S&S ▪ Leg pain and tenderness ▪ Unilateral area of swelling, warmth, and redness ▪ Calf tenderness ▪ Positive Homans sign ▪ Increased diameter of affected extremity ▪ Low-grade fever and chills o Assessment & Interventions ▪ Encourage rest ▪ Facilitate bed rest and elevation of the pt’s extremity above the level of her heart as prescribed (avoid using a knee gatch or pillow under knees) ▪ Administer intermittent or continuous warm moist compresses as prescribed ▪ Do NOT massage the area ▪ Measure leg circumference ▪ Provide thigh high antiembolism stockings who is @ high risk for venous insufficiency ▪ Administer analgesics ▪ Administer anticoagulants o Risk factors: ▪ Hypercoagulabitltiy of the blood and venous stasis during pregnancy and early puerperium ▪ Obese pt’s ▪ Hx of smoking ▪ C- section ▪ Multiparity ▪ >35 years ▪ Hx of previous thromboembolism ▪ Diabetes Melitus Focus Points Exam 3 Page 7 • Recall the signs and symptoms of postpartum infections. o Generic ▪ Flulike symptoms- body aches, chills, fever (38˚C/100.4˚F)- after first 24 hours, fever of 100.4 or higher for 2 consecutive days during the first 10 days of postpartum ▪ malaise/fatigue ▪ Anorexia and nausea ▪ Tachycardia o Uterine infection- endometritis o Wound infections- c section incisions, epistotomies, lacerations o Mastitis • Describe the action, side effects and nursing implications of drugs used to control postpartum bleeding. - 807 o Oxytocin (Pitocin) ▪ Uterine Stimulant, promotes uterine contractions ▪ SE • CNS: maternal: COMA, SEIZURES fetal: INTRACRANIAL HEMORRHAGE • Resp: fetal: ASPHYXIA, hypoxia • CV: maternal: hypotensionfetal: arrhythmias • F and E: maternal: hypochloremia, hyponatremia, water intoxication • Misc: maternal: ↑ uterine motility, painful contractions, abruptio placentae, ↓ uterine blood flow, hypersensitivity ▪ Implications • Assess uterine tone and vaginal bleeding • Monitor for adverse reaction: H2O intoxication- lightheadedness, N&V, headache, and malaise.  Cerebral edema w/seizures, coma, and death. • Limit physical activity to conserve strength; increase iron and protein. o Methylergonovine (Methergine) ▪ Uterine Stimulant, controls PP hemorrhage • Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution ▪ SE • STROKE, dizziness, headache • Tinnitus • dyspnea • HYPERTENSION, arrhythmias, AV block, chest pain, palpitations • nausea, vomiting • cramps • diaphoresis • paresthesia • allergic reactions Focus Points Exam 3 Page 10 ▪ Decreased social support ▪ Anxiety about assuming role of being a mom ▪ Unplanned/unwanted pregnancy ▪ Hx of previous depressive episode ▪ Low self esteem ▪ Hx of domestic violence o S&S ▪ Lack of appetite/ weight loss ▪ Sleep pattern disturbances ▪ Feeling of inadequacies and/ or guilt ▪ Intense mood swings ▪ Anxiety/ panic attack ▪ Fatigue persisting beyond a reasonable time frame ▪ Feeling of loss ▪ Persistent sadness/flat affect ▪ These feelings of anxiety or sadness may be accompanied by tearfulness and insomnia. ▪ Irritability ▪ Rejection of infant ➢ PP Psychosis- Pronounced sadness, disorientation, confusion, paranoia, and delusional thoughts/hallucinations of self-harm/ harm to infant Module 16: Promoting Health during the First Year of Life • Describe the common developmental milestones during the first year of life (know when to expect specific milestones). Focus on major things like sitting, walking, senses, talking, etc. Birth to 1 month • Physical development: 5-7 oz weight gain weekly for 1st 6 months, ~1 in height gain per month 1st 6 months, FOC grows 2.5 cm (1 in)/month for 1st 6 months • Gross motor development: turn head from side to side, head lag, lack of head control • Fine motor development: hands closed, grasp reflex still strong • Sensory development: can see objects 8-10 inches from face, vision near 20/100, follows light to their midline, quiets when hears voices (especially parents) • Vocal development: cries with displeasure/stress, makes comfort sounds when feeding • Social development: watches parents’ face intently when talking 2 Months • Physical development: posterior fontanel closes, crawling reflex gone • Gross motor development: less flexed in prone position, less head lag, lifts head 45 degrees, holds head in sitting position but bends forward, asymmetric tonic neck flex position • Fine motor development: hands open, grasp reflex fades Focus Points Exam 3 Page 11 • Sensory development: binocular fixation with convergence to near objects; follows toy from side to midline; looks for the source of sounds, turns head to side of sound, likes contrasting colors • Vocal development: distinct vocalizations, differentiated crying, coos, vocalizes to familiar voice • Social development: social smile 3 Months • Physical development: primitive reflexes fading • Gross motor development: holds head erect but bobs forward when sitting, slight head lag; symmetric body positioning; forearms weight bearing; notices own hand • Fine motor development: holds toy, hands loosely open, clutches own hands, pulls at blankets & clothing • Sensory development: follows toys to periphery (full 180 degrees), locates sound, can coordinate stimuli from sense organs • Vocal development: squeals with pleasure, coos/babbles, vocalizes while smiling, babbles when talked to, less crying when awake • Social development: interested in environment, stops crying when they see parent, recognize faces & objects, aware of “strange” situations 4 Months • Physical development: drooling begins; moro, tonic neck & rooting reflexes gone • Gross motor development: little to no head lag; balances head well, back less rounded, able to sit erect if propped up; rolls from back to side • Fine motor development: inspects & plays with hands; pulls blankets over face to play- “peek-a-boo!”; tries to reach objects, but overshoots them; plays with toys placed in hand; carries objects in mouth • Sensory development: accommodate to near objects; beginning hand eye coordination • Vocal development: LAUGHS; consonants- n, k, g, p, b; sounds change with mood • Social development: demands attention by fussing; bored if left alone; anticipates feeding when seeing mother or care-giver; shows interest in strange stimuli; begins to show memory 5 Months • Physical development: teething begins • Gross motor development: no head lag; holds head steady; back straight; turns from tummy to back; feet in mouth • Fine motor development: grasps objects voluntarily; uses palmar grasp; plays with toes; puts objects into mouth; holds 1 cube while looking at another • Sensory development: tracks dropped toy; sustained visual inspection; localizes sounds made below the ear Focus Points Exam 3 Page 12 • Vocal development: squeals; coos with vowel sounds • Social development: smiles at own image; pats bottle/breast with both hands; playful, but with rapid mood swings; knows family vs. strangers; vocalizes displeasure when toys taken away; discovers parts of their body 6 Months Focus Points Exam 3 Page 15 • Physical development: raises head from prone or supine position • Gross motor development: moves from prone to sitting; stands while holding on, sits from standing by falling; recovers balance while sitting; lifts foot to take step • Fine motor development: crude release of object • Sensory development: continues to improve • Vocal development: meaning to “dada” & “mama”; may say one word- “hi”, “bye” or “no” • Social development: OBJECT PERMENENCE; pulls on clothing of care takers to get attention; waves bye-bye; actually stops behavior when told “no” & cries if scolded; plays interactive games- pat-a-cake, gives “five” 11 Months • Physical development: eruption of lower lateral incisor starts • Gross motor development: walks holding furniture or both hands held; from sitting position, pivots to reach objects • Fine motor development: neat pincher grasp; drops toy deliberately for someone to pick up; puts object after another in container; manipulates objects to remove them • Sensory development: continues to improve • Vocal development: imitates sounds • Social development: displays joy & satisfaction with task mastery; frustrated reactions to restrictions; rolls ball to another when asked; anticipates body gestures with familiar stories or songs; plays games- up & down, peek-a-boo; shakes head for “no” 12 Months • Physical development: birth weight tripled, length increased by 50%; 6- 8 teeth; lumbar curve develops • Gross motor development: walks well with 1 hand; may attempt to stand alone • Fine motor development: builds 2 block tower without success; turns book pages • Sensory development: follows rapidly moving object; listens for reoccurring sounds • Vocal development: says 3-5 words other than “mama” & “dada” • Social development: searches for hidden objects where it was last seen; shows emotions such as jealousy, anger & fear; shows affection; enjoys familiar surroundings & explores away from parent; may need security blanket or object; clings to parent • Recall appropriate play activities based on development. – object permanence o Play is dependent; pleasure is demonstrated by a quieting attitude (1 month), a smile (2 months), and a squeal (3 months). From 3 to 6 months infants show more discriminate interest in stimuli and begin to play alone with a rattle or soft stuffed toy or with someone else. They interact much more during play. By 4 months of age they Focus Points Exam 3 Page 16 laugh aloud, show preference for certain toys, and become excited when food or a favorite object is Focus Points Exam 3 Page 17 brought to them. They recognize an image in a mirror, smile at it, and vocalize to it. o By 6 months to 1 year, play involves sensorimotor skills. Infants play actual games such as peek-a-boo and pat-a- cake. They demonstrate verbal repetition and imitation of simple gestures. Play is much more selective, not only in terms of specific toys but also in terms of “playmates.” Although play is solitary or one sided, infants choose with whom they will interact. At 6 to 8 months they usually refuse to play with strangers. Parents are definite favorites, and infants know how to attract their attention. At 6 months they extend the arms to be picked up, at 7 months cough to make their presence known, at 10 months pull the parent's clothing, and at 12 months call them by name. This represents a tremendous advance from the newborn who signaled biologic needs by crying to express displeasure. • Describe patient education related to introduction of solid foods. o Solids foods should not be introduced prior to 4-6 months o Early introduction of solids is a common cause of infant GI problems o Start with Fe fortified cereals o Introduce new foods slowly, every 5-7 days o Infants need breastmilk until at least 1 year Modules 17: Complications of the Newborn Associated with Gestational Age and Maturity • What are the neonatal complications that may occur due to maternal diabetes? o Hypoglycemia, LGA, increased risk for death and stillborn, cardiac abnormalities, skeletal defects, small left colon syndrome, risk of shoulder dystocia during childbirth due to macrosomia o Respiratory distress o Higher risk of birth traumas, clavicle fractures, brachioplexus injuries o IUGR- intrauterine growth restriction • Identify characteristics of a preterm infant. o Flaccid, lethargic, vernix, lanugo, bigger head, more apnea spells, not as many creases on feet, skin is translucent, ear cartilage sticks • Define infants who are categorized as late preterm. What complications are they at higher risk for developing? Focus Points Exam 3 Page 20 a supplemental nursing system may be necessary if the infant's weight loss is greater than 3% per day. o Late preterm infants are at risk for hypoglycemia. Therefore blood glucose level measurements should be performed according to hospital protocol. • What are the signs of neonatal sepsis? What are the causes of neonatal sepsis? How is it diagnosed and treated? o Sepsis Neonatorum ▪ A systemic infection from bacteria in the bloodstream. Newborns are particularly susceptible to sepsis because their immune systems are immature and they react more slowly to invasion by organisms. Newborns and especially preterm infants have fewer antibodies and are unable to localize infection as well as older children. This inability allows the infection to spread easily from one organ to another. o Signs – apnea, changes in color and activity, lethargy, can’t maintain temperature (lower than 36.5), vomiting ▪ Signs are not usually very specific – no fever, chills. o Causes: Common causative agents of neonatal sepsis include bacteria such as group B streptococci, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Staphylococcus coagulase negative, Haemophilus influenzae, and Listeria monocytogenes; Enterobacteriaceae such as Escherichia coli, Pseudomonas, and Bacteroides fragilis; and fungi such as Candida albicans. ▪ Many sources of infection - Infection can come from the mother, long labor, cross-contamination, etc... o Diagnostic Testing: A complete blood count with differential may show decreased total neutrophils, increased bands (a form of immature neutrophils), an increased ratio of immatureneutrophils to total neutrophils, and decreased platelets. Elevated levels of leukocytes are normal in newborns. A sudden rise or fall in leukocyte levels compared to previous results is abnormal. o If patient is symptomatic, dr going to order cultures. Cultures are gold standard for diagnosing infection. o The C-reactive protein (CRP) level, a sign of an inflammatory process, begins to rise 4 to 6 hours after infection begins and is abnormal within 24 hours. It falls rapidly when inflammation subsides. Focus Points Exam 3 Page 21 o Treatment: Broad-spectrum antibiotics are given intravenously until culture and sensitivity results are available. ▪ Only 85% of blood cultures will grow anything. Patient symptomatic but culture is negative so keep them on antibiotic. Treat for 10 days from the time the first negative culture happens. Infection in spinal fluid is 21 days from first negative culture o Breast-feeding has a protective benefit. Focus Points Exam 3 Page 22 o Preterm babies more at risk o The more invasive procedures done increases the risk • Compare and contrast pathologic and physiologic jaundice of the newborn. What are the complications of hyperbilirubinemia? o Pathologic (abnormal) – jaundice occurring as result of underlying pathologic condition such as blood incompatibility, within first 24 hours of life o Physiologic (normal) – small amount of milk breastfed babies get isn’t enough to flush out bilirubin, most babies get this o HYPERBILIRUBINEMIA (PATHOLOGIC JAUNDICE) ▪ When the total serum bilirubin (TSB) level reaches 5 to 7 mg/dL, jaundice is visible in the face. Jaundice is considered abnormal or nonphysiologic when the TSB level rises more rapidly and to a higher level than is expected or stays elevated for longer than normal. ▪ Nonphysiologic jaundice may be seen in the first 24 hours of life. It is a concern because it may lead to acute bilirubin encephalopathy, the acute manifestation of bilirubin toxicity. This may lead to kernicterus, the chronic and permanent result of bilirubin toxicity. Kernicterus typically occurs when bilirubin gets above 25. In this condition, bilirubin deposits cause yellowish staining of the brain. It is more likely to occur in infants who have suffered sepsis, hypoxia, or respiratory acidosis. ▪ Those who survive may suffer from cerebral palsy, intellectual disability, hearing loss, or more subtle long-term neurologic and developmental problems. ▪ Causes: The most common cause of pathologic jaundice is hemolytic disease of the newborn caused by incompatibility between the blood of the mother and that of the fetus. Excessive hemolysis causes erythroblastosis fetalis. • Infants with erythroblastosis fetalis are anemic from destruction of red blood cells. RhoGAM is used. o *Infants of diabetic mothers are more likely to develop nonphysiologic jaundice, especially if they have macrosomia. • Describe the treatment and care of the infant receiving phototherapy.- use ATI o Phototherapy: It is the most common treatment of jaundice and involves placing the infant under special fluorescent lights. Focus Points Exam 3 Page 25 o Feeding- may lack ability to absorb & digest feedings, may have inability or decr ability to suck/swallow/breathe ▪ May need trophic feeding (small volume enteral feedings) at first, or IV TPN if swallow ability is absent • What is cold stress? Who is at risk for it and why? What is the most important reason to protect preterm infant from cold stress? Focus Points Exam 3 Page 26 o Cold stress is a term that describes excessive heat loss that leads to hypothermia and results in the utilization of compensatory mechanisms to maintain the neonate’s body temperature. ▪ Occurs when there is: decr in environmental temp, decr in neonate’s temp, incr in resp rate & heart rate, incr oxygen consumed, depletion of glucose, and decrease surfactant- which leads to resp distress o Who is at risk for it and why? ▪ *Preterm babies & SGA= because they have no extra fat to hold in heat ▪ *Infants w/ hypoglycemia, sepsis, neurological problems, endocrine problems, or cardiorespiratory problems= because they already have altered compensatory mechanisms o *What is the most important reason to protect preterm infant from cold stress ▪ Prevent respiratory distress the cold stress will exacerbate the respiratory distress • Describe techniques to decrease environmental stimuli for infants in the NICU. -Memic intra-uterine environment (quiet, dark, boundaries) • How would you increase bonding between parents and infants in the NICU? Module 18: Congenital and Acquired Problems of the High Risk Newborn • Describe common congenital anomalies and their management, including nursing care: gastroschisis, cleft lip/palate, omphalocele, tracheoesophageal fistula, hydrocephalus, necrotizing enterocolitis (NEC), diaphragmatic hernia, meningocele, and myelomeningocele. o Cleft lip/palate ▪ Congenital midline fissure, or opening, in the lip or palate, resulting from primary palate to fuse ▪ Feeding is difficult for infants • Cleft lip- unable to form seal around nipple • Cleft palate- unable to form vacuum to maintain suction ▪ Increase risk of aspiration ▪ Surgery cleft Palate: Usually wait until child is older 12-18 months to take advantage of changes in Focus Points Exam 3 Page 27 palate that happen as child grows. Problems with speech formation, nasal regurgitation and nasal speech. Focus Points Exam 3 Page 30 ▪ Monitor abdominal girth daily ▪ Monitor vital signs: signs of shock and anemia ▪ Rest intestine: stop oral feeding initiate parenteral and enteral feeding ▪ Monitor labs • Low hematocrit, plts • Elongated prothrombin time and thromboplastin time • Decreased fibrinogen o Diaphragmatic hernia o Birth defect that occurs in mother’s uterus o Diaphragm doesn’t develop properly- some or all of the abdominal organs move into chest o This can affect how the lungs develop and grow o Nursing care: ▪ Watch for: difficulty breathing, tachypnea, tachycardia, cyanosis, abnormal chest development ▪ Treatment: ventilation, suction, ECMO, surgery ▪ Monitor pulse ox, ABG’s o Trachoesophageal fistula o An abnormal opening between the trachea and esophagus o Results in respiratory distress, difficulty in feeding o Copious mucus and choking are signs o Infants need to be suctioned o Diagnostics can be done prenatally o Nursing care: ▪ Infants should be kept in supine position with head of bed kept at 30 degrees Focus Points Exam 3 Page 31 • Facilitates respiratory efforts and prevents aspiration and reflux ▪ Close observation to keep patient airway, ENSURE THAT AIRWAY IS KEPT CLEAR ▪ Thermoregulation ▪ Maintaining fluid balance via IV (because cannot eat until it is fixed surgically) ▪ Monitor and maintain acid-base balance o Gastroschisis o Baby’s intestines found outside of the baby’s body, exiting through a hole beside the belly button o Intestine herniate through defect in abdominal wall to right of the umbilicus (peritoneal sac not present) o No membranes cover the organs o Organs are red, inflamed and swollen o Nursing care: ▪ Infection control ▪ Rupture prevention- careful handling of positioning ▪ Heat and fluid loss prevention • Fluid replacement is vital • Careful thermoregulation is necessary ▪ Postoperative care and close monitoring o Parenteral feeding o Require mechanical ventilation • Omphalocele o Protrusion of the intestines into the base of the umbilical cord (intact peritoneal sac present) Focus Points Exam 3 Page 32 o Organs are not swollen or inflamed o The organs are inside the umbilical cord. This is actually beneficial because the umbilical cord protects those organs from amniotic fluid ▪ Amniotic fluid is caustic to organs o Nursing care: o •Cover exposed area with saline-soaked pads and plastic drape to prevent excessive fluid loss, drying, and temperature instability o •NPO for 30 days to allow bowel to heal and ensure adequate blood perfusion. o •IV fluids and parenteral nutrition o •May need OG tube with intermittent suction o •Antibiotics o •Because the infant’s skin did not grow with the organs internally, surgery is stretched over 7-10 days until all of the abdominal contents are able to be placed within the abdominal cavity. o •Omphalocele is a midline defect – need to assess and monitor other midline systems – brain, spinal cord, genitalia, bladder. So can have lots of other issues. • Hydrocephalus o Excessive cerebral spinal fluid o Nursing care: ▪ Assess head circumference, fontelles, cranial sutures, and LOC ▪ Obtain neurologic and vital signs ▪ Monitor increase in intracranial pressure ▪ Administer prescribed medications which may include antibodies to prevent infection and analgesics for pain ▪ Give small frequent feedings to decrease the risk of vomiting and provide skin care for the head to prevent breakdown • Discuss the treatment of preterm infants with respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), periventricular-intraventricular hemorrhages, and retinopathy of prematurity (ROP). Focus Points Exam 3 Page 35 • Recall the grieving process of the family after the death of an infant. o 1 – 3 months: validation of pregnancy, changing body ▪ Thoughts turn inward as the pregnancy is validated. A woman’s focus is on her changing body. ▪ Loss – seen as something wrong with her body, which was unable to support the pregnancy. o 4 – 6 months: fetal embodiment ▪ A sense that something is really growing inside her. She reviews conflict with her own mother. ▪ Loss – She may question her ability as a mother. o 6 – 9 months: fetal distinction ▪ Views the baby as an individual distinct from herself. Increasing sense of responsibility for the child’s health. ▪ Loss – pain of severed emotional ties b/c the developed fetus is seen as a person • Bereavement Models – o Kubler Ross ▪ Denial-numbness: numbed shock, you think there must be some mistake. A dream you expect to wake up from. ▪ Anger-protest: “why me?” ▪ Bargaining-despair: God, if you will just heal me, I will be such a good Person for the rest of my life. If this doesn’t work then comes despair. ▪ Depression-detachment ▪ Acceptance-recovery o Lindemann ▪ Accepting the painful emotions ▪ Actively reviewing the experiences and events ▪ Testing new patterns of a and role relationships • Duration of a grief reaction depends on the success w/ which a person does the grief work. o Davidson ▪ Shock and Numbness • From time of notification to about 3 weeks. May seem to be doing well. Responding to basic needs • also prenatal diag of a fatal disease or anomaly • Feeling of “being in a daze.” She may seem to be doing well at the funeral. However, she is numb and is only responding to basic needs. It is usually 3 weeks when she feels the full impact (after family and friends have left). ▪ Searching and Yearning • 3 weeks to 4 months. Details, diagnosis, Focus Points Exam 3 Page 36 reasons, “what if”, anger, saving mementos • characterized by restlessness, anger, guilt, and ambiguity. Searching is the need to identify what has happened and who and what was lost. Yearning for what could have been. Searching and Focus Points Exam 3 Page 37 yearning reappear with intensity at the anniversary of the death. ▪ Disorientation and Disorganization • 5 - 7 months. Guilt, emptiness, depression, low self- esteem. • Sense of disorientation. Peaks just before the first anniversary. Now fully aware of the reality of the death. Emptiness that the loss has brought . No longer testing what is true. Weight loss, insomnia, physical illness. ▪ Reorganization • 18-24 months. Sense of “new normal”, renewed energy, sensible eating and sleeping habits, reconciliation. Stabilization of old relationships. • Sense of release. Stable eating and sleeping. They are by no means • Grief resolution is a misnomer – leads to false assumption that parents get over the loss of an infant. Parents will talk about an infant many years after their death as though it happened yesterday • Reproductive Loss o Miscarriage o Preterm birth o Birth of a child with an anomaly o Death of one of more of multiple gestation o Intrauterine fetal death o Neonatal death o Relinquishment o SIDS • Symptomatology of normal grief o Acute grief occurring in waves. 20-60 min o Tightness in throat o Choking, SOB o Sighing o Lack of muscular power o Tension o Frequent crying o Sense of unreality o Guilt o Irritability and anger o Restlessness o Lack of energy o Preoccupation with the image of the deceased • Behaviors of pathological grief o Overactivity w/out a sense of loss o Symptoms belonging to those of the deceased o Psychosomatic conditions o Social isolation. Loss of social interaction patterns. Focus Points Exam 3 Page 40 • Mother/father have different feelings • Couple needs to communicate and support ea other Focus Points Exam 3 Page 41 • Children’s grief expression and understanding varies w/ age o Families do not expect a loss to happen to them. The sudden and unexpected nature of their loss leads them to unprepared, both in life experiences and knowledge about grief responses and the mourning process. They are unaware of what they might need for positive memories of this tragic time in their lives. o WHAT NOT TO SAY!! ▪ “You’re young, you can have others.” ▪ “At least you have other children.” ▪ “You have an angel in heaven.” ▪ “This happened for the best.” ▪ “Better for this to happen now, before you knew the baby.” ▪ “There was something wrong with the baby anyway.” ▪ Do not call the baby a “fetus” or “it”. o What TO say – ▪ “I’m sad for you.” ▪ “How are you doing with all of this?” ▪ “This must be hard for you.” ▪ “What can I do for you?” ▪ “I’m sorry.” ▪ “I’m here, and I want to listen.” o Ask whether the parents want to view the child. It if is born alive, allow them to hold him/her. If there are abnormalities, offer explanation if possible. Point out particular features of the child. Do not limit the time that parents spend with the child. Do not hurry them out to the postpartum area. o Create memories – blessing, baptism, prayers, readings. Certificate w/ footprints, weight, sex. Blanket, cap. Memento gift from the hospital. Photographs. Save all the memories even if the parents refuse them at first • Differentiate between the various treatments for infertility. o Semen analysis – FIRST in infertility workup. Cheapest and least invasive. o Pelvic examination – assess for uterine or vaginal anomalies o Hormone analysis – eval hypothalamic-pituitary-ovarian axis to include serum prolactin, FSH, LH, estradiol, progesterone, and thyroid hormones. o Endometrial biopsy – evals endometrial response, secretory, and luteal phase of cycle. o Postcoital test – evals coital technique and mucus secretions o Ultrasonography – transvaginal or abdominal ultrasound procedure performed to visualize female reproductive organs. o Hysterosalpingography – outpatient radiological procedure in which dye is used to assess the patency Focus Points Exam 3 Page 42 of the fallopian tubes. Assess for hx of allergies to iodine & seafood Focus Points Exam 3 Page 45 • Procedures to aid in fertilization o In vitro (fertilization outside of body) o IUI – sperm injected into mom Module 20: Promoting the Health of Women Across the Lifespan • Discuss the leading causes of death for women. o Heart disease o Stroke o Cancer • Identify recommended screening tests for reproductive health maintenance. Pap smear, mammogram o Cervical – hpv infection (pap smear to test for it) o Breast (most common) – catch early – age (1:8 under 45, 2:3 over age 55) family hx, genetics, race, estrogen exposure, DES exposure, breast changes, smoking, gender, breast feeding and pregnancy lowers risk b/c you’re not exposed to estrogen as much. o BRCA 1 and 2- a genetic defect. the most common cause of hereditary breast cancer which can result in a 80% risk of developing breast cancer. o Ages 11-24 ▪ Pap smear starting at age 21 ▪ Chlamydia and gonorrhea o Ages 25-64 ▪ Clinical breast exam (over age 40) ▪ Mammogram (biennial for women 50-74) ▪ Pap smear every 3 years ▪ Chlamydia and gonorrhea ▪ Bone density o Ages 65-ancient ;) ▪ Clinical breast exam ▪ mammogram • What are the effects of estrogen and progesterone upon the breasts? o Swollen, lumpier, fibrocystic changes in breast during cycle when hormones are high. Proliferative and non- proliferative. o Mastodynia and mastalgia- breasts undergo cyclic changes in respose to hormones • What is fibrocystic breast disease? o Fibrocystic changes can involve breast glandular and/or stromal tissues o Two types proliferative and non-proliferative. Proliferative more likely to get breast cancer Focus Points Exam 3 Page 46 o FBD is the most frequent benign disorder of the breast o Seen in premenopausal women between the ages of 20-50 o Typical symptoms include breast pain and tender lumps. Symptoms may change with different stages of the menstrual cycle o Diagnosis by palpation or mammography o Treatment is needle aspiration of biopsy of mass • What are modifiable and non-modifiable risks factors for breast cancer? – prob a select all that apply a. Non-modifiable i. Gender ii. Age (1:8 under age 45, 2:3 over age 55) iii. Genetics- BRCA1 and BRCA 2 genes more likely to get breast cancer iv. Family history- one first degree relative doubles risk to get breast cancer v. Estrogen exposure- don’t choose when we start period or stop. More cycles we have more likely to have breast cancer. Pregnancy has protective bc estrogen is low during it b. Modifiable i. Parity- number of pregnancies ii. Lactation- don’t have cycles iii. Oral contraceptives iv. Hormone replacement therapy- greater than 10 years greater increase bc estrogen stays at a constant level v. Alcohol use vi. Weight- overweight and obesity because estrogen hangs out in fat cells vii. Physical activity • Review signs and symptoms of ovarian cancer. a. Abnormal bleeding. Irritable, bloated, tenderness (nonstop), painful intercourse, sensation of fullness b. Silent cancer, symptoms mimic pms symptoms c. Symptoms mimic period symptoms. So if it isn’t going away, they need to get it checked. • What interventions are appropriate to treat a woman with PMS? a. Luteal phase after ovulation b. Important to track symptoms c. Decrease refined sugars, salty foods, caffeine, and alcohol d. Healthy diet of whole grains, fruits, and vegetables e. Supplements may be helpful f. Regular exercise Focus Points Exam 3 Page 47 g. Stress reduction techniques h. Oral contraceptives i. NSAIDS j. Selective Serotonin reuptake inhibitors (SSRIs) k. Diuretics What is primary and secondary ammenorhea? ● Primary- never menstruated by age 13 without secondary sexual development or by age 15 years with secondary sexual development ● Secondary- menstruating woman who has no menses for 6 months • What is primary and secondary dysmenorrhea? a. Primary i. Cramps without underlying disease ii. Cyclic due to excessive amounts of prostaglandins in uterus. iii. Pain lasts about 2 days and rarely persists beyond 3 days. iv. No underlying pelvic disease present. v. Prostaglandins cause smooth muscle contraction b. Secondary i. Underlying pathology of the reproductive tract that requires further research ii. Ex. IUD, endometriosis, PID, anatomic anomalies like cervical stenosis or imperforate hymen, uterine displacement or ovarian cysts. • What are common causes of abnormal uterine bleeding? a. Drug induced b. Medical reasons c. Anovulation d. Pelvic lesions e. Pregnancy complications f. Types i. Menorrhagia-prolonged bleeding or excessive bleeding at regular intervals ii. Polymenorrhea-bleeding at intervals <21 days iii. Menometrorrhagia- prolonged bleeding at irregular intervals iv. Intermenstrual bleeding- bleeding between periods v. Dysmenorrhea- painful menstrual cycles 1. Primary- Absent pelvic pathology 2. Secondary- present pelvic pathology • Describe common problems affecting older women ---