5. BreastfeedingMilk is Produced by the breast alveoliColostrum contains less fats and carbohydrates than

mature milkInitial duration: 1-2 minutesPurpose: promotes bondingRegular duration: 10 minutesThe amount of breastmilk produced is directly related

to the effectiveness of SUCKINGBreast milk can remain frozen up to 6 monthsIncrease galactogoguesIncrease caloric intake by 500 calories/dayNot allowed in a client receiving COUMADIN

• Mastitis is an infection of the parenchyma of the mammary gland

• usually occurring 2 to 3 weeks postpartum• Breast engorgement can cause low-grade

fever in the early• Risk factors: breast-feeding, recent weaning,

and fissures of the areola

• Treatment includes continued breast-feeding or pumping from the affected side

• ice packs, and support

Domains of Learning

• Cognitive - knowledge• Affective - behavior• Psychomotor - skills

13. SIGNS OF PREGNANCY

Presumptive symptoms: SUBJECTIVE SYMPTOMS

Probable signs: OBJECTIVE SIGNS

FHT

• FHT audible via doppler @ 10 – 12 weeks• FHT audible via Fetuscope @ 18 – 20 weeks • FHT audible via stethoscope or w/out

instrument – 20 weeks onwards

PE

• Vital signs/ IO• Uterus and lochia• abdomen • perineum • Bladder function • breasts • lungs• extremities

• 1st – onset of labor to full dilation• 2nd – complete dilatation to delivery• 3rd – delivery of baby to delivery of placenta

First stageDilatations

Frequency Duration

Latent Phase

0-3 cm 5-10 mins 20-40 mins

Encourage walking : shortens 1st stage of laborEncourage to void q 2-3 hrs : full bladder inhibits uterine contractionbreathing (chest breathing technique)

Active 4-8 cm 3-5 mins 30-60 secs

M – edications – have meds readyA – ssessment include: v/s, cervical dilatation & effacement, fetal monitor, etcD – ry lips – oral care (ointment), dry linensBreathing – abdominal breathing

Transition 8-10 cm 2-3 mins 45-90 secs

I – inform of progress (to relieve emotional support)R – restless support her breathing techniqueE – encourage & praise

SECOND STAGE OF LABOR

• Crowning occurs• PRIMI – transfer to DR @ 10 cm dilatation• MULTI – transfer to DR @ 7 – 8 cm dilatation• Position in lithotomy both legs at the same

time• BULGING OF PERENIUM surest sign of

delivery initiation• PANT & BLOW Breathing, fetal pushing

should be done on an open glottis

• Respiratory alkalosis– Due to incorrect breathing– Hyperventilation– S/sx

• RR• Lightheadedness• Tingling sensation• Carpopedal spasm• Circumoral numbness

Preterm Labor

labor after 20 weeks and before 37 weeks

Triad signsPremature contractions every 10-20 minaEffacement of 50 – 80%Dilatation of 2 – 3 cm

–Rhythmic contractions–Lower abdominal cramping–Low back pain–Pelvic pressure–Increase in vaginal discharge–Bloody vaginal discharge (bloody

show)

Risk factors:

– Prior preterm delivery– African American race– Poverty – Lack of prenatal care– Exertion or Stress– ↓BMI– Extremes of maternal

age (younger than 18 or older than 40)

– Tobacco use– Substance abuse

– Prior induced abortion

– Prior cervical surgery– Periodontal disease– Uterine

overdistension – Vaginal bleeding

during pregnancy– Uterine anomaly– Anemia– Reproductive tract

infections

Home Management

– CBR– Avoid Sex– Empty bladder– Drink 3 – 4 Glasses of H2O

• Full bladder inhibit contraction

Cleft lip/ cleft palate

PYLORIC STENOSIS

• Thickening of the pylorus muscle

• SURGERY: Pyloromyotomy/Fredet-Ramstedt procedure

ASSESSMENT: • Olive-shape mass• Vomiting

PROJECTILEBLOOD STREAKEDWITHOUT BILE

Peristaltic wavesFailure to thrivedehydreation

NURSING INTERVENTIONS

PREOPERATIVELY:• Administer replacement fluids and electrolytes• Prevent vomiting:NPO,high Fowlers, minimize

handling• strict I&O • daily weights• urine specific gravity

NURSING INTERVENTIONS

POSTOPERATIVELYAdvance diet as toleratedFeeding- small, frequent feeding within 24 hoursGradual increase the amount- 48 hoursFeed slowly and burp frequentlyPlace on the right sideElevate headObserve incisionHealth teaching

CHD- Congenital Hip Dysplasia

Asymmetrical gluteal folds

Ortolani’s Click

Limited Hip Abduction

Positive Trendelenburg Sign04/18/2023 06:06:12 AM

• Additional skin folds with knees bent• When lying on abdomen, buttocks of affected

side will be flatter because head of femur falls toward bed from gravity

• T _ _ _ _ _ _ _ _ _ _RG test- used when child is old enough to walk– He have to stand on affected leg only– Pelvis will dip on normal side as child

attempts to stay erect

04/18/2023 06:06:12 AM

04/18/2023 06:06:12 AM

CLUBFOOT (TALIPES)• Abnormal rotation of the

ankle• Varus- inward rotation• Valgus- outward rotation• Calcaneous- upward rotation• Equinas- downward rotation

MEDICAL MANAGEMENT• Exercise• Casting• Denise brown shoe• Surgery and casting for

several months

ASSESSMENT:• Foot cannot be manipulated

by PROM into correct position

NURSING INTERVENTIONS:• Provide cast care • Child who is learning to walk

must be prevented from trying to stand

• Assess toes to be sure that cast is not too tight

• Need to monitor special shoes for continued fit throughout treatment

CLUBFOOT CASTING

I s o l a t i o n P r e c a u t i o n s

T i e r s

S t a n d a r d F o r A L L c l i e n t s

T r a n s m i s s i o n – b a s e d F o r S O M E c l i e n t s

T r a n s m i s s i o n – B a s e d

A i r b o r n e

L e s s t h a n 5 m i c r o n s

M o r e t h a n 3 f e e t

A i r b o r n e

R e q u i r e m e n t s N e g a t i v e p r e s s u r e r o o m

F r e q u e n t h a n d w a s h i n g

P a r t i c u l a t e or N – 9 5 M a s k

A i r b o r n e

I n d i c a t i o n s M e a s l e s

T u b e r c u l o s i s

V a r i c e l l a

D r o p l e t

M o r e t h a n 5 m i c r o n s

L e s s t h a n 3 f e e t

D r o p l e t

R e q u i r e m e n t s P r i v a t e r o o m

F r e q u e n t h a n d w a s h i n g

M a s k → w i t h i n 3 f e e t of c l i e n t

D r o p l e t

I n d i c a t i o n s D i p h t h e r i a

G e r m a n M e a s l e s

M u m p s

D r o p l e t

I n d i c a t i o n s P e r t u s s i s

P h a r y n g i t i s

P n e u m o n i a

C o h o r t i n g

P r e s c h o o l e r → S a m e A G E

S c h o o l e r → S a m e S E X

H a n d w a s h i n g

P r e p a r a t i o n F i n g e r n a i l s → l e s s t h a n ¼ i n c h

A s s e s s for s k i n b r e a k s

R e m o v e A L L j e w e l r y

H a n d w a s h i n g

R e q u i r e m e n t s R u n n i n g w a t e r → W A R M

S o a p → L i q u i d : 2 – 4 m l or 1 t s p

T i s s u e p a p e r

H a n d w a s h i n g

K e y p o i n t s 1 0 – 1 5 s e c s

C i r c u l a r m o v e m e n t s

F r i c t i o n

H a n d w a s h i n g

M e d i c a l H a n d s L o w e r T h a n E l b o w s

D r y in r o t a t i n g m o t i o n f r o m E l b o w s to H a n d s

H a n d w a s h i n g

S u r g i c a l H a n d s H i g h e r T h a n E l b o w s

D r y in r o t a t i n g m o t i o n f r o m H a n d s to E l b o w s

D o n n i n g P P E

W a s h h a n d s

G o w n

M a s k

E y e w e a r

G l o v e s

R e m o v i n g P P E

G l o v e s

W a s h h a n d s

M a s k

G o w n

E y e w e a r

SICKLE CELL DISEASE• Autosomal recessive inheritance pattern• Sickled RBCs live for 6-20 days only• Usually no symptoms prior to age 6 months• HgbS- sensitive to changes in oxygen content of RBC• Insufficient oxygen cause it to sickle, become

rigid and clumped together--- capillary blood flow

ASSESSMENT FINDINGS

• First sign in infancy- “COLIC”- due to abdominal pain (Abdominal infarct)

• Spleenomegaly- due to hemolysis and phagocytosis– later part is due to firbrosis from repeated infarct

• Leg ulcers in adolescent– due to blockage of blood supply to skin of legs

• Delayed growth and development

PRECIPITATING FACTORSFEVEREMOTIONAL/ PHYSICAL STRESS INFECTIONDEHYDRATIONHYPOXIAEXTREME FATIGUEEXTREME CHANGES IN ALTITUDE

VASO-OCCLUSIVE CRISIS• Most common• Painful• Obstructs blood vessels• Treatment: hydration, oxygen, electrolyte

replacement, bed rest, avoid tight clothing, keep wounds dry and clean

SPLENIC SEQUESTRATION• Life-threatening- causing decrease blood volume and

shock• Treatment: transfusion and spleenectomy

CYSTIC FIBROSIS

membrane conductance regulator protein (chloride channel in exocrine tissues)

Chloride transport problems

thick, viscous secretions in the lungs, pancreas, liver,

intestine, and reproductive tract

increased salt in sweat gland secretions

• pancreatic insufficiency, recurrent pancreatitis, weight loss)

• recurrent abdominal pain• biliary cirrhosis• vitamin deficiencies, • genitourinary problems (male and female

infertility),• clubbing of the extremities

bronchial plugging/bronchial wall thickening due to inflammation

bronchial infections

Airflow obstruction

•CYSTIC FIBROSIS multisystem disorder transmitted as autosomal recessive trait affecting the EXOCRINE gland.

SX:•    high level of NaCl in the sweat• “salty kissed”• increased viscosity of mucous

glands secretion

DIAGNOSTIC TEST

SWEAT CHLORIDE TEST“PILOCARPINE IONTOPHORESIS”-production of sweat is stimulated-sweat is collected -sweat electrolytes are measuredNORMAL: LESS THAN ____mEq/LABNORMAL:MORE THAN ____mEq/LHIGHLY SUGGESTIVE:_____mEq/L requires a repeat test

TRACTIONS• Pulling force exerted on bones

to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities

• SKIN TRACTION-Buck’s traction-Russell traction-Cervical traction-Pelvic Traction

BUCK’S TRACTION

• Exerts straight pull in the extremity

• Generally used to immobilize the leg in a client with hip fracture

• Shockblocks at the foot of the bed

RUSSELL TRACTION

• Knee is suspended in a sling attached to a rope and pulley on a Balkan frame– creates an upward pull from the knee

• Weights are attached at the foot of the bed– creating a horizontal force exerted on the tibia and fibula

• Generally used to stabilize fractures on the femoral shaft

• Head of bed: Flat

Cervical traction pelvic traction

NURSING CARE FOR PATIENTS WITH TRACTION

• Check traction apparatus• Bed in proper position• Line of traction within the axis of the

bone• Do not rest affected limb against foot

of the bed• Perform neurovascular checks:• Prevent foot drop

Primary dysmenorrhea • no identifiable pelvic pathology• menarche or shortly thereafter• crampy pain before or shortly after the onset of

menstrual flow - 48 to 72 hours• excessive production of prostaglandins• Psychological factors, such as anxiety and tension

Secondary dysmenorrhea• pelvic pathology such as endometriosis,tumor, or pelvic inflammatory disease (PID) exists

mgt

• Relieve anxiety• Aspirin every 4 hrs• NSAIDS• Continuous low-level local heat • mechanism is not clear• increases blood flow and may counteract

constriction and• muscle contraction• continue usual activities