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Psychosocial tasks for each trimester of pregnancy:
- 1st trimester: accepting the pregnancy
- 2nd trimester: accepting the baby
- 3rd trimester: preparing for the baby and end of pregnancy
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Couvade syndrome
when men experience the physical symptoms of pregnancy when their partner is pregnant
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Primigravida
a woman in her first pregnancy
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Multipara
a woman who has had one or more children
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Lightening
- about 2 weeks before term, the fetal head settles into the pelvis to prepare for birth
- the uterus returns to the height it was at 36 weeks
- a woman's breathing will be easier, seems to lighten the load
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Hegar's sign
- extreme softening of the lower uterine segment upon bimanual examination
- a probably sign of pregnancy
- occurs in the 6th week of pregnancy
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Ballottement
- upon bimanual examination, tap the lower uterine segment and you can feel the fetus bounce or rise in the amniotic fluid against the top hand
- a probably sign of pregnancy
- occurs during the 16th-20th week of pregnancy
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Braxton Hicks contraction
- begin by the 8-12th week of pregnancy
- "practice" contractions
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Operculum
- mucous plug in cervical canal that protects the fetus from bacteria
- discharged as a preparation for birth
- "bloody show"
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Goodell's sign
- softening of the cervix in pregnancy
- extreme softness just before birth - "ripe"
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Chadwick's sign
vaginal walls change from light pink to deep violet during pregnancy
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Montgomery's tubercles
- sebaceous glads of the areola
- enlarge and become protuberant during pregnancy
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Striae gravidarum
stretch marks
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Diastasis
- when the abdominal wall can't stretch enough during pregnancy, the recctus muscles separate
- the site appears as a bluish groove
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Linea nigra
narrow brown line appears along happy trail during pregnancy
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Melasma (Chloasma)
- darker pigmentation on cheeks and across nose during pregnancy
- "mask of pregnancy"
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Changes in respiratory system during pregnancy
- chronic respiratory alkalosis fully compensated by a chronic metabolic acidosis
- chronis shortness of breath
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Para
- number of pregnancies that have reached viability
- regardless of whether the infants were born alive
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Gravida
- Woman who is or has been pregnant
- Number of pregnancies
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Primipara
woman who has given birth to one child past the age of viability
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Multipara
woman who has carried two or more pregnancies to viability
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Nulligravida
woman who has never been pregnant and is not currently pregnant
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Colostrum
- a thin, watery, yellow fluid that precedes breast milk
- composed of protein, sugar, fat, water, minerals, vitamins, and maternal antibodies
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Leukorrhea
- a whitish, viscous vaginal discharge
- a response to high estrogen levels during pregnancy
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TORCH infections
- teratogenic maternal infections
- Toxoplasmosis - cat litter
- Other - HBV, HIV
- Rubella
- Cytomegalovirus
- Herpes simplex virus
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Hyperplasia
- growth occuring from increasing the number of cells formed
- occurs early in pregnancy
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Hypertrophy
- growth occuring from enlargement of existing cells
- occurs late in pregnancy
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Recommended weight gain during pregnancy
- 25-35 lbs
- or adjusted per a woman's needs
- per trimester: 3-12-12
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Why is folic acid so important during pregnancy?
Necessary for red blood cell formation. Since a woman's blood volume doubles, she needs lots of folic acid.
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Why are respiratory disorders more serious in children than adults?
- lumens are smaller, more likely to be obstructed
- too little or excessive mucus production
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Hypoxia vs. cyanosis
- hypoxia: decreased oxygen in body cells
- cyanosis: a blue tinge to the skin
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Epiglottitis s/s
- - dysphagia
- - inspiratory stridor
- - cough
- - high fever
- - hoarseness
- - very sore throat
do not attempt to visualize spiglottis unless there is an artificial airway readily available!
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Ventricular septal defect
- an opening is present in the septum between the two ventricles
- blood shunts from left to right across the septum
- increased pulmonic blood flow
- acyanotic disorder
- results in R ventricular hypertrophy and increased pressure in the pulmonary artery
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Patent ductus arteriosus
- duct from the pulmonary artery to the aorta doesn't close at birth
- blood shunts from the aorta to the pulmonary artery
- causes increased pressure in the pulmonary circulation and R ventricle hypertrophy
- given indomethacin/Indocin or ibuprofen (prostaglandin inhibitors) to promote closure
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Pharmacologic interventions to obstruction of blood flow in children
- beta-blockers or calcium channel blockers: reduce cardic hypertrophy before the defect is corrected
- digoxin and diuretics: reduce the severity of CHF from HTN (age appropriate HR for dig!!!)
- beta-blocker (propranolol/Inderal): to aid pulmonary artery dilation in a hypoxic episode of Tetralogy of Fallot
- prostaglandin (PGE): to keep ducts patent
- prostaglandin inhibitor (indomethacin/Indocin): to close ducts
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Transposition of the Great Arteries
- the aorta arises from the R ventricle instead of the L
- the pulmonary artery arises from the L ventricle instead of the R
- creates two systems of blood flow - deoxygenated blood flowing to the body and oxygenated blood flowing to the lungs
- only survivable is there are septal defects as well
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Tetralogy of Fallot
- four anomolies: pulmonary stenosis, VSD, dextroposition (overriding) of the aorta, and hypertrophy of the R ventricled/t pulmonary stenosis, blood shunts from the R side to the L ventricle and the aorta, the added effort causes the hypertrophy
- common with Down Syndrome
- during hypoxic episode, place in knee-chest position, give O2, give morphine sulfate or propranolol
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indomethacin/Indocin
- NSAID
- inhibits prostaglandin synthesis
- encourage duct closure in the heart in PDA
- assess for glomerular filtration, impaired platelet aggregation, and diminished gastrointestinal and cerebral blood flow
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Pain scales for children
- CRIES: assesses infants (crying, O2, vitals, facial expression, and sleeplessness)
- FLACC: uses five types of behavior in children/infants (facial expression, leg movement, activity, cry, consolability)
- FACES: uses 6 cartoon faces, can be used as young as 3yrs
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Learning at each stage of childhood:
- infant: explores environment with their senses
- toddler: needs rituals, likes imitation
- preschooler: centered, role-playing
- school-age: immediate reward, the "right" way to do things
- adolescent: wants immediately benefit from information
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Fear at each stage of childhood:
- infant: separation
- toddler/preschooler: separation, the dark, the unknown, intrustive procedures, mutilation
- school-age/adolescent: loss of body parts, loss of life, loss of friends
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Play for children on bedrest
- infant: stimulation, hands, soft toys
- toddlers: put-in, take-out games
- preschool: creative materials
- school-age: books, crayons, music, projects
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Signs of pregnancy
- presumptive: amenorrhea, sore breasts, n/v
- probable: + preggo test, HCG test
- positive: fetal heart sound, visualization of the fetus, movement of the fetus
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