Nur 221 Final Exam Review

NUR 221 Final Review

Obstetrics:
• Physiological changes of pregnancy of each body system including fundal height and vs
• Postpartum changes (progressive,- return of menstruation and lactation retrogressive,- involution of the uterus, 6 weeks involution,- return of the uterus to it’s pre-pregnant stage, contraction, lochia- rubra-1-3 days, mod-heavy, red w/ clots, serosa-4-10 days, mod-scant, pink, alba-11-21 days, scant, whitish/tan)
• Postpartum checks ( B-breasts U-uterus/fundus B-bleeding B-blues/bowels L-lochia E-episiotomy H-headache E-emotions R, REEDA)
• Types of episiotomies (advantages, disadvantages)
• Hormone levels
• Breastfeeding (hormones, care, nutrition during)
• Taking in,- first 24 hours, dependent, needy, discuss delivery cont. taking hold,- days 2-6, teachable, independent, self-care letting go- day 6+, ok separation and relinquishing care to others
• Postpartum blues- 1st 10 days vs. depression
• Maternal attachment/bonding- enface (and sensitive period- first hour after birth, best time to breast feed, baby alert, bonding occurs)
• G & P (TPAL) # pregnancies, # pregnancies to term, (Term, Preterm, Abortion, Living)
• Contraception (types, who should get what kind, teaching) – oral pills-not over 35, no smokers, no hx of thrombo, diaphragm-refit +/- 10lbs, in 30 min bf/ 6 hrs aft, aft pregnancy
• Menstruation (menopause,- cease PMS,- breast tenderness, edema, depression, avoid caffeine, dysmenorrhea,- painful
• Impotence, infertility, diagnostic tests – lack of conception after one year of unprotected intercourse, basal body temp, ovulation tests, semen analysis, post-coital tests,
• 4 P's of labor (attitude, lie presentation, position, engagement, station)
• Mechanism of labor (DFIEEE)
• Signs of labor, true vs. false
• Stages of labor (contraction patterns, interventions, danger signs)
• Early vs. late vs. variable decels (cause and action needed)
• Nagele's rule- +7 days/-3 months
• Analgesia vs. anesthesia (effects on mom and baby)
• Labor induction (AROM, prostaglandins, pitocin)
• C/S (pre-op, post-op, indications) VBAC, TOLAC
• Stages of fetal development- 4th wk-heart beat, 8th wk-heart 4 chambers, 12th wk-secretes urine, nails, 16th wk-lanugo, liver/pancreas dev, 20th wk-vernix, head hair, 1st quickening, fundus @ umbilicus, 24th wk-surfactant, 32nd wk-brown fat, 38th wk-lanugo goes away, lose vernix, 40th wk-considered term
• Positive,- objective, by MD/NP, x-ray, fetal heart tones, ultra sound, probable,- objective, abd enlargement, Hegar’s sign, Goodell’s sign, Braxton-Hicks contractions, ballottement, positive pregnancy test presumptive signs of pregnancy- subjective, menstrual supp, n/v, vaginal changes (Chadwick’s), quickening, breast/skin changes, fatigue
• Adolescent pregnancy differences
• Nutrition & vitamins needed
• Diagnostic tests (NST, CST, ultrasound, amniocentesis , AFP, PUBS, FFN, CVS)
• Anemia (iron def, sickle cell, megaloblastic)- effect on mom and baby
• Gestational diabetes, heart disease, hypertension, rubella, candidiasis, HSV, STDs, glomerulonephritis, AIDS, PVD, Rh incompatibility, TORCH (effect on mom/baby)
• PIH - s/s, mild/severe/eclampsia (interventions, nursing dx)
• Causes of bleeding (SAB, ectopic pregnancy, incompetent cervix, placenta previa, abruptio placenta (causes, s/s, interventions)
• Hydatiform mole (interventions, tx)
• Types of abortion
• DIC (s/s, interventions)
• Preterm labor (causes, tx)
• Hypertonic/hypotonic contractions, prolonged/precipitous labor, ruptured uterus (causes, risks, tx, interventions)
• Causes of fetal distress - malpresentation, abnormalities, characteristics, interventions
• Prolapsed cord, hydramnios, oligohydramnios - causes, interventions
• Hemorrhage - causes, interventions, early vs. late, s/s
• Postpartum infection - mastitis, endometritis, episiotomy
• Thrombophlebitis (3 kinds)
• Pulmonary embolism/amniotic fluid embolism (s/s, tx, interventions)
• Meds - oxytocin, methergine, cytotec, hemabate, rhogam, mag sulfate, calcium gluconate, betamethasone, terbutaline, nifedipine

Newborn:
• Transition to extrauterine life (all body systems)
• Surfactant, - peaks at 35 wks L/S ratio – 2:1
• V/S – hr 120-160, resp 30-60
• Types of heat loss, - convection(air cond. rooms), radiation(heat transf. to object in room), evaporation(dry off), conduction(hat) cold stress – major concern, no shivering, uses brown fat and needs glucose
• Physiologic (after 1st 24 hrs from polycytemia/immature liver) vs pathologic jaundice (in 1st 24 hrs requires medical attention) (levels, - bilirubin 5-7mg =jaundice, 20-24 mg =kernicterus,- staining of brain cells tx – 1st breastfeeding, phototherapy, hydrate)
• Erythroblastosis fetalis
• Periods of reactivity
• IgG,- crosses placenta(passive acquired) IgA,- from breast milk IgM- fetus makes by 20th wk
• Reflexes - Babinski, grasp, Moro, rooting, stepping, tonic neck
• APGAR – Appearance(color), Pulse(hr), Grimace(reflexes), Attitude(muscle tone), Respirations
• Normal newborn physical findings - fontanelles, - anterior closes @ 12-18 months, posterior closes @ 2-4 months umbilical cord, - 2 arteries, 1 vein, falls of 2-3 weeks skin findings
• Umbilical cord care – clean and dry, no baths until falls off
• Circumcised- decreased chance for infection vs. uncircumcised care- clean especially well, increased chances of UTI, retract foreskin to clean
• Abnormal newborn findings - hip dysplasia- clicking
• Hypoglycemia - risk factors, effects, glucose levels
• Nutrition, caloric requirements, weight gain/ loss
• General care, immunizations
• SGA/LGA, preterm, posterm (characteristics)
• RDS - s/s, tx, risk factors, ABGs
• Gavage feeding
• Risks of baby born to diabetic mom
• Drug addicted babies (characteristics, signs of withdrawal)
• Neonatal infection - syphilis, GBS, HIV

Pediatrics:
• Growth and development (milestones, toys/play, Erickson's stages)
• Denver Developmental screening test (what it assesses)
• Assessment techniques according to age
• Puberty (sequence of development, girls vs. boys, sexuality)
• Age related V/S
• Dehydration in the child (assessment findings, interventions)
• Maintenance/replacement fluid requirements (formula)
• Hospitalization (fears/concerns, interventions)
• Medication administration
• Depression in the teenager
• Genetic disorders (autosomal dominant/recessive, sex-linked)
• Downs syndrome, Turners, Klinefelter's (assessment findings, complications)
• Finding on EENT exam
• Failure to thrive (organic vs. non-organic, s/s, interventions, dx)
• Accidents - burns, poison, injury, drowning, choking
• Restraints - mummy, clove hitch, elbow, net-top crib)
• Aspirin/acetaminophen toxicity, caustic poison (assessment findings, interventions)
• Vaccines - schedule, s/e, contraindicated
• Communicable disease - diphtheria, pertussis, scarlet fever, Hib, rubella, rubeola, mumps, polio, varicella, mono, fifth disease, head lice
• Child abuse - characteristics of abuse/abusers, common findings
• Suicide - 3rd leading cause of death among teens
• Congenital heart defects - ASD, VSD, PDA, coarctation, tetralogy of Fallot, transposition of vessels
• Cardiac cath - what is assessed, interventions
• Heart failure - right/left sided, s/s, interventions, LARC
• Rheumatic fever - cause, s/s, complications, tx, interventions
• Kawasaki disease - s/s
• Nasopharyngitis - allergies vs. common cold, interventions
• Croup - assessment, interventions, tx
• Epiglottitis - cause, 4 D's, interventions, prevention
• Asthma - triggers, interventions, Meds, s/s, diagnostics, PFT, exercise
• Bronchiolitis – cause, tx, interventions, medications
• Pneumonia
• Cystic Fibrosis – cause, patho, assessment, interventions
• SIDS
• TB – tx, assessment, interventions
• CNS – LOC, s/s of increased ICP, Cushing’s triad, pupil response
• Decorticate vs. decerebrate posturing
• Diagnostic tests (labs, LP, EEG, CT, MRI) that assess CNS
• Glasgow coma scale
• Seizure disorders – classification, causes, s/s, postictal, interventions, meds, risks, precautions
• Meningitis – s/s, Brudzinsk/Kernig signs, complications
• Encephalitis, Reye’s syndrome, Guillain-Barre syndrome (s/s, etiology, tx)
• Hydrocephalus – communicating vs. non-communicating, shunt placement, complications
• Spina Bifida – pre/post op assessment and interventions
• Cerebral Palsy – cause, diagnosis, definition
• Degrees of mental retardation
• Head injuries – epidural vs. subdural, s/s
• Fractures – orthopedic interventions (cast, traction, consequences of immobility)
• Scoliosis – braces, screening, physiologic changes, pre-op/post-op teaching
• Legg-Calve-Perthes disease, osteogenesis imperfecta, juvenile rheumatoid arthritis, muscular dystrophy, amputations (assessment, interventions)
• Cleft lip/palate – cause, assessment, pre-op/post-op interventions
• Tracheoesophageal fistula, pyloric stenosis - define, assessment, intervention
• Omphalocele, gastroschisis, intussusception, Hirschsprung's, hernia
• Appendicitis - s/s, pre/post op, positioning, discharge teaching
• Lactose intolerance, Crohn's vs. ulcerative colitis, celiac disease, gastroenteritis, parasitic worms, biliary atresia, hepatitis
• UTI's - assessment, interventions, Meds, enuresis
• Hypopsadias, epispadias, chordee, cryptorchidism, exostrophy of the bladder
• Cancer - types of cancer cells, assessment, interventions, tx, nursing diagnoses, chemotherapy
• Hodgkins, neuroblastoma, nephroblastoma (Wilm's tumor)
• Osteogenic sarcoma, Ewing's sarcoma
• Support for the family with cancer, threats to body image, interventions, children's views
• Sickle cell anemia vs. sickle cell trait, sickle cell crisis
• Hemophilia - assessment, interventions before/during bleeding, hemarthrosis
• Meds - cytoxam, methotrexate, vincristin, digoxin, lasix, morphine, indomethacin, prostaglandin E, albuterol,
Vanceril (corticosteroid), Cromlyn, rocephin, *Dilantin, phenobarbital, tegretol, depakene (monitor serum levels)

Psych:
• Dementia, Alzheimer's, delirium
• Stages of grieving
• Coping mechanisms, defense mechanisms
• DSM-IV-TR (axis 1-5)
• Admission and discharges - voluntary, informal, involuntary, commitment, emergency involuntary
• Levels of psychotherapy – supportive, reeducation, reconstruction
• Behavioral therapy – self-control, desensitization, aversion, modeling, operant conditioning
• Cognitive therapy
• Milieu therapy
• Group therapy – initial, working, termination stage
• Anxiety – levels, interventions, benzodiazepines
• Phobias
• OCD – characteristics, interventions
• Somatoform disorders – somatization, hypochondriasis, conversion disorder – implementation
• PTSD – stressors, assessment, implementation
• Eating disorders (anorexia, bulimia) – assessment findings, onset/clinical course, risk factors, complications, tx, interventions
• Depression – levels, assessment findings, meds, nursing diagnoses, teaching
• Suicidal behavior – plan, signs, interventions
• Domestic violence – abusive behaviors, assessment, cycle of abuse, types of violence, interventions
• Rape – assessment, interventions, rape trauma syndrome
• Autism – characteristics, interventions, predisposing factors
• ADHD - characteristics, interventions, predisposing factors, nursing priorities
• Conduct disorder – types, assessment, interventions vs. ODD – assessment, interventions
• Tourette’s – predisposing factors, s/s, meds, interventions
• Dissociative disorders – dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder – assessment and interventions
• Bipolar disorder – interventions, s/s for mania and depressive phases
• ECT – uses, pre/post/during procedure
• Schizophrenia – assessment, characteristics, thought process, motor activity, affect, perceptions, types, interventions, meds
• Delusions vs. hallucinations vs. illusions
• Paranoid disorders – types, interventions
• Personality disorders – schizoid, schizotypal, paranoid, histrionic, narcissistic, avoidant, dependent, OCD, antisocial, borderline, passive-aggressive
• Meds – benzos, buspirone, tricyclic antidepressants, SSRI’s, haloperidol, pimozide, clonidine (tourette’s)