Anemia
a reduction in the number of red blood cells, the amount of hemoglobin, or hematocrit
apheresis
Withdrawal and separation of blood elements.
blast phase cells
Immature white cells that are dividing rapidly.
engraftment
The successful "take" of the transplanted cells in the patient's bone marrow (recipient)
Erythrocytes
red blood cells
glossitis
smooth, beefy red tongue
hemoglobin A (HbA)
normal adult hemoglobin whose globin unit consists of two alpha and two beta chains
hemoglobin F (HbF)
The main type of hemoglobin in the fetus, having two normal A chains and two normal gamma chains that bind oxygen more tightly than does hemoglobin A or S.
hemoglobin S (HbS)
the hemoglobin of sickle cell disease in which 2 are normal A chains and 2 abnormal beta chains that fold poorly, causing the red blood cells to assume a sickle shape under low oxygen conditions
hemolytic
destruction of red blood cells
hypercellularity
Cellular excess in the peripheral blood.
indolent
slow growing
intrinsic factor
a substance normall secreted by the gastric mucosa that is needed for intestinal absorption of vitamin B12
leukemia
blood cancer that results from a loss of normal cellular regulation, leading to uncontrolled production of immature WBCs in the bone marrow
leukocytes
WBCs fight infection
leukopenia
reduction in the circulating number of WBC
Lymphomas
cancers of the lymphoid cells and tissues with loss of cellular regulation and abnormal overgrowth of lymphocytes
cellular regulation
process to control cellular growth, replication, and differentiation to maintain homeostasis
malignant
cancerous
multiple myeloma (MM)
A white blood cell cancer of mature B-lymphocytes called plasma cells that secrete antibodies.
nadir
the period after chemotherapy in which bone marrow suppression is the most severe.
pancytopenia
low circulating numbers of all blood cell types
perfusion
adequate arterial blood flow through the tissues (peripheral perfusion) and blood that is pumped by the heart (central perfusion) to oxygenate body tissues
peripheral blood stem cells (PBSC)
stem cells that have been released from the bone marrow and circulate within the peripheral blood
pernicious anemia
anemia resulting from failure to absorb vitamin B12, caused by a deficiency of intrinsic factor (a substance normal secreted by the gastric mucosa), which is needed for intestinal absorption of vitamin B12
philadelphia chromosome
abnormal chromosome associated with chronic myelogenous leukemia caused by a translocation of the ABL gene from chromosome 9 onto the BCR gene of chromosome 22
polycythemia vera (PV)
general increase in red blood cells (erythremia) that have decreased function
SCD crisis
episodes of extensive cellular sickling that obstruct perfusion causing tissue hypoxia and severe pain
sickle cell disease
A genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape. mutation of beta genes that causes chronic anemia, pain, disability, organ damage, increased risk for infection, and early death because of poor blood perfusion
stomatitis
mouth sores
teratogen
any factor that can cause a birth defect
Thrombocytopenia
A reduction in the number of platelets circulating in the blood from reduced platelet production
Thrombocytopenic purpura
The destructive reduction of circulating platelets after normal platelet production.
Febrile reaction to blood transfusion
Caused by antibodies. S/S include fever, chills, HA, flushing, tachycardia, increased anxiety stop and notify physician, change IV tubing, treat sypmtoms if present: o2, fluids, epinephrine as ordered, recheck crossmatch record with unit
allergic reaction to blood transfusion
mild: hives, pruritis, facial flushing severe: SOB, bronchospasm, anxiety stop and notify physician, change IV tubing, treat sypmtoms if present: o2, fluids, epinephrine as ordered, recheck crossmatch record with unit
Hemolytic transfusion reaction
Low back pain, hypotension, tachycardia, fever and chills, chest pain, tachypnea, hemoglobinuria, may have immediate onsetstop and notify physician, change IV tubing, treat sypmtoms if present: o2, fluids, epinephrine as ordered, recheck crossmatch record with unit obtain 2 blood samples distal to infusion site, obtain first UA-test for hemoglobinuria, monitor fluid/electrolyte balance, evaluate serum calcium levels
universal donor
O-
universal recipient blood type
Type AB+
blood component: RBCs leukoreduced
collected by apheresis technology increases oxygen carrying capacity and treats symptomatic anemia
blood component: RBC reduced by whole blood donation
increases oxygen carrying capacity, treats symptomatic anemia
blood component: RBC washed
increases oxygen carrying capacity, used for severe repeated allergic transfusion reactions and or IgA deficient patients
BUBBLE HE assessment
Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Homan's Sign, Emotional Status
Order of blood draw
1. Sterile tubes (yellow or blood culture)2. citrate/ coagulation tube (light blue)3. serum tube (red, royal, orange) serum separator (gold or red/black speckled)4. heparin tube/ plasma separator (light green or green/black speckled)5. EDTA (lavender, pink, royal, tan, or white)6. glycolytic inhibitor / Sodium fluoride (grey)
SallyBringsReallyGood Grease and Leaves the Gravy
sterileblueredgoldgreen lavendergray
Which action would the nurse perform to best ensure effective insertion of a venous access device into a patient's arm?A. Anchor the vein by placing a thumb 1 to 2 inches below the site.B. Insert the device tip at a 45-degree angle distal to the proposed site.C. Place the patient's left arm in a dependent position for 5 minutes before assessment.D. Apply a tourniquet to the left antecubital fossa 8 to 12 inches above the proposed site.
a. Anchoring the vein by placing a thumb 1 to 2 inches below the site stabilizes the vein, increasing the possibility of a successful insertion. The angle of insertion should be 10 to 30 degrees. Placing the patient's arm in a dependent position is directed toward improving visualization of the vein. Applying a tourniquet to the left antecubital fossa is directed toward improving visualization of the vein and should be applied 4 to 6 inches above the site.
How might the nurse prepare a patient to anticipate some discomfort when inserting a venous access device?A. Instruct the patient to expect a sharp, quick stick.B. Insert the access device as quickly as possible.C. Apply a topical anesthetic to the area before inserting the device.D. Promise that the procedure will not hurt once the device has been inserted.
a. Rationale: Educating the patient to have reasonable expectations about the possible discomfort will best prepare him or her for it. Inserting the access device as quickly as possible will not prepare the patient regarding what to expect. Applying a topical anesthetic will reduce the likelihood of pain; however, this is not routinely done when inserting a venous access device. It is inappropriate to make such a promise.
Which of the following technique(s) is/are best for minimizing a patient's risk for injury when inserting a venous access device?A. Inserting the needle with the bevel upB. Using a vein on the dorsal surface of the armC. Holding the skin taut directly below the siteD. All of the above
d. All of these actions will minimize injury to the patient. Inserting the needle bevel-up minimizes vein trauma by the needle itself. Use of adequate veins reduces the chance for rupture. Holding the skin taut directly below the site will decrease drag on insertion.
The nurse is inserting an over-the-needle catheter into a newly admitted patient. What will the nurse do after confirming blood return?A. Loosen or remove the tourniquet.B. Advance the catheter 1 inch into the vein.C. Lower the catheter until it is flush with the skin.D. Thread the catheter into the vein up to the hub.
c. Lowering the catheter until it is flush with the skin minimizes the risk of passing the needle through the opposite vessel wall. The tourniquet is loosened or removed later in the procedure. This is done later in the procedure. Threading the catheter into the vein up to the hub is done later in the procedure.
Which instruction might the nurse give to nursing assistive personnel (NAP) regarding the care of a patient with an intravenous access device?A. "Assess the IV site frequently for signs of inflammation."B. "Be sure not to obscure the insertion site with the dressing."C. "Let me know when you notice that the IV bag contains less than 100 milliliters."D. "Explain the symptoms of infection to the patient.
c.
social cognitive theory
individuals expectations influence their behaviors
cognitive-behavioral theory
thought affect behavior. helping people to change they way they thing about health and illness
prenatal care
Consuming a healthy diet. Taking a prenatal vitamin with minimum dailic folic acid requirements, getting regular exercise, avoid alcohol and drugs, managing preexisting conditions.Monitor mothers weight, BP, urine
Family Systems Theory
a theory that views the family as a system of interacting parts whose interactions exhibit consistent patterns and unstated rules
structural-functional family
family is a social system with specific roles
Family Stress Theory
Family response to & coping with stressful events
family life cycle theory
families pass through stages and relationships transition.
structural family assessment
who is in your family? who else lives with you? has anyone moved out recently?
genital congestion
a reflexive autonomic response facilitated by the parasympathetic and inhibited by the sympathetic nervous responses. getting an erection
Fundus
top of uterus
Braxton Hicks contractions
false labor
hyperemia
congestion with blood of the cervix resulting in bluish-purple color that extends to the vagina and labia
ovaries
secretes progesterone for the first 6-7 weeks of pregnancy. once the placenta is developed, it produces progesterone throughout pregnancy
Progesterone in pregnancy
Progesterone levels increase greatly during pregnancyPrepare breasts for lactation and reduce contractions of uterus (reduces spontaneous abortion)high levels affect brain (progesterone converted to allopregnanolone)- facilitates GABA receptors, increases inhibition, anxiolytic properties (reduces stress)Behavioral prophylactic for reducing spontaneous abortion
how much can blood volume increase in pregnancy
45%
why does plasma volume increase from week 6-32 weeks in pregnancy
it transports nutrients and oxygen to placenta, meets demands of maternal tissue in uterus and breasts, protects mom during blood loss in childbirth
RBC normal count and pregnant count
4.2-5.4 million3.8-4.4 million
hemoglobin normal count and pregnant count
12-16 g/dL11
hematocrit normal count and pregnant count
37-47%33%
WBC normal count and pregnant count
5,000-10,0005,000-15,000
pytalism
excessive salivation
pyrosis
heartburn
Melasma
Brownish pigmentation of the face during pregnancy; also called chloasma and "mask of pregnancy
chloasma
pigmentary skin discoloration usually occurring in yellowish brown patches or spots
how many weeks can the uterus be palpated at the umbilicus and then at the xiphoid process
20, 36
how is the fetus protected from bacteria ascending from the vagina
thick mucus fills the cervical canal
physiologic (pseudo) anemia
the plasma volume expands faster and to a greater extend than RBC volume which creates a dilution of hemoglobin concentration
Hypotensive syndrome
reduced blood pressure that can occur in women who lie down on their back which causes the uterus to compress the vena cava
what does slight hyperventilation and decreased airway resistance allow?
increased oxygen needs to be met
GFR (glomerular filtration rate)
90-120 mL/minRenal function
increased renal plasma flow results in an increased GFR which often causes
spilling of glucose and other nutrients into the urine
hCG (human chorionic gonadotropin)
This stimulates the corpus luteum to produce estrogen & progesterone
what may cause nausea in early pregnancy
Increased human chorionic gonadotropin (hCG) and estrogen levels
what does increased progesterone cause
relaxation of smooth muscles which results in stasis of urine and the risk of UTIs and constipation
what maintains the uterine lining, prevents uterine contractions, and helps prepare the breast for lactation
progesterone
what happens in the initial antepartum visit
complete histore, physical examination to determine potential risks and to obtain baseline data
Is it safe to have sex while pregnant?
yes
what does making the transition to the role of a mother involve
mimicking the behavior of other mothers, fantasizing about the baby, developing a sense of self as mother, and grieving the loss of previous roles
paternal responses depend on the ability to
perceive the fetus as real, gain recognition as the role of a parent, and to create a role as an involved father
human chorionic gonadotropin (hCG)
hormone produced by the placenta to sustain pregnancy by stimulating the ovaries to produce estrogen and progesterone until the fetus is developed enough to assume the function at 10-12 weeks
estrogen functions to
Stimulates uterine growthIncreases the blood flow to uterine vesselsStimulates development of the breast ducts to prepare for lactation
Progesterone during pregnancy
-Maintains endometrium -Prevents uterine contractions-prevents tisuue rejection of the fetus -prepares breasts for lactation-Secreted by:*Corpus luteum - first 12 weeks of pregnancy*Placenta - 12 weeks until the end of pregnancy
amenorrhea
absence of menstruation
Goodell's sign
softening of the cervix
Chadwick's sign
Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.
when does fetal movement start
second trimester
Hegar's sign
softening of the lower uterine segment
Ballottement
a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus
gestational age 5-8 weeks
mom misses period, nausea, fatigue, tingling of breasts, uterus is a size of a lemon
gestational age 9-12 weeks
nausea, uterus is a size of an orange
gestational age 13-16 weeks
~Fetal movement around 16 weeks felt~Uterus has risen into the abdomen~Fundus midway between symphysis pubis and umbilicus~Colostrum present~Blood volume increases
gestational age 17-20 weeks
~Fetal movements felt~Heartbeat can be heard with a fetoscope~Skin pigmentation increases~Areolae darken~Melasma and linea nigra may be obvious~Braxton Hicks contractions palpable ~Fundus at the level of the umbilicus at 20 weeks
gestational age 21-24 weeks
~Relaxation of smooth muscles of veins and bladder increases the chance of varicose veins and UTIs~More aware of fetal movements
gestational age 25-28 weeks
~Greatest weight gain~Lowest hemoglobin levels~ Lordosis may be cause of back pain
gestational age 29-32 weeks
~Heartburn is common as uterus presses against diaphragm and displaces stomach~ Braxton Hicks contractions more noticeable ~ Lordosis increases~Waddling gait develops due to increased mobility of pelvic joints
gestational age 33-36 weeks
~Shortness of breath ~Hard to find comfortable position to sleep~Umbilicus protrudes~Varicosities are pronounced~Pedal or ankle edema present~Urinary frequency noted following lightening when presenting part settles into pelvic cavity
gestational age 37-40 weeks
~Woman is uncomfortable~Ready to deliver~Cervix softens, begins to efface; mucus plug is often lost
uterine souffle
soft, blowing sound made by the blood in the arteries of the pregnant uterus and synchronous with the maternal pulse
Agglutination inhibition test
Presence of agglutination is considered a negative result
When can fetal heart tones be heard with a stethoscope?
16-20 weeks
gravida
has been pregnant reguardless of how long
primigravida
first pregnancy
multigravida
woman who has been pregnant more than once
para
number of pregnancies that have ended at 20 or more weeks whether or not the baby was alive
nullipara
no births after 20 weeks
primipara
a woman who has borne one child after 20 weeks
multipara
woman who has given birth to two or more children
what is the gravida and para of a women who gives birth to twins
1, 1
average duration of pregnancy from the first day of the last normal menstrual period is
40 weeks or 280 day
Nageles rule for calculating a due date is?
1st day of the last menstrual periodAdd 7 daysSubtract 3 months
average RR of pregnant women is
16-24
preeclampsia
a complication of pregnancy characterized by hypertension, edema, and proteinuria
what is the recommended weight gain for a pregnant woman
25-35 lbs, the amount is more for underweight woman and less for obese woman
what is tested in each visit during a urine test
protein, glucose, and ketones
fetal HR should be
110-160
ambivalence
mixed feelings or emotions
couvade
symptoms of pregnancy and birth experienced by fathers
Doula
A caregiver who provides continuous physical, emotional, and educational support for the mother before, during, and after childbirth.
Protein intake during pregnancy
71 g/day, normal is 46g
what can excessive weight gain in pregnant woman cause
macrosomnia and other complications
macrosomia
baby with a large body
how much weight should a pregnant woman gain each week
1.1-4.4 lb during the first trimester and 0.8-1lb for the rest
what are the fat soluble vitamins and where are they stored
ADEK in the liver. over consumption can have toxic effects
why is it necessary for the daily intake of water soluble vitamins to be higher
excesses are excreted
what minerals are pregnant women most likely to not take enough of
iron and calcium. they are often added as a supplement
how much water should a pregnant woman drink in a day
8-10 cups
how much grains, vegetables, fruits, milk products, and protein should a pregnant woman eat every day
grain: 7-9 oz vegetables 3-3.5 cups fruit: 2 cups milk: 3 cups protein 6-8 oz
what should you do for a low-income pregnant woman who does not have the money or knowledge for proper nutrition
refer her for financial assistance and nutritional counseling
lactose intolerant women should increase _ intake from _
calcium, calcium-rich vegetables
nutritional risk factors that warrant adaptations of diet during pregnancy
abnormal preg weight, anemia, eating disorders, pica, multiparity, substance abuse, closely spaced pregnancies, multifetal pregnancies
a lactating mother should increase her caloric intake to
330 more calories in the first 6 months then 400 more the second 6 months
How much iron is needed during pregnancy?
1000 mg of absorbed iron because it increases in maternal RBC and for fetal iron storage
heme iron
Iron—found in red meat, fish, and poultry—that the body absorbs efficiently.
nonheme iron
the iron in foods that is not bound to proteins; found in both plant-derived and animal-derived foods
why do pregnant women need more sodium
to provide for the expanded blood volume and the needs of the fetus
why is calcium important in pregnancy
it is transfered to the fetus especially in the last trimester and is important for mineralization of fetal bones and teeth
importance of vitamin A in pregnancy
fetal growth and cell diffusionacutane should not be taken during pregnancy
importance of vitamin D in pregnancy
metabolism of calcium
importance of vitamin E in pregnancy
antioxidant, important for tissue growth and integrity of cells
importance of vitamin K in pregnancy
necessary for blood clotting
importance of vitamin B6 in pregnancy
amino acid metabolism and in blood, hormone, and immune function
importance of vitamin B12 in pregnancy
cell division, protein synthesis, and formation of RBC
importance of folic acid in pregnancy
cell replication and amino acid and hemoglobin synthesis
importance of iron in pregnancy
formation of hemoglobin and enzymes for metabolism, storage for the fetus in the liver for use after birth, expanded maternal volume, formation of fetal RBC
importance of calcium in pregnancy
fetal bone and teeth formation, cell membrane permeability, coagulation, and neuromuscular function
importance of zinc in pregnancy
fetal and maternal tissue growth, cell differentiation and reproduction, DNA and RNA synthesis, metabolism, acid-base balance
importance of magnesium in pregnancy
cell growth and neuromuscular function, activates enzymes for metabolism of protein and energy
gynecologic age
The number of years since menarche (first menstrual period).
complete proteins contain
all essential amino acids
essential amino acids
Amino acids that are needed, but cannot be made by the body; they must be eaten in foods
incomplete proteins
Proteins that are missing one or more of the essential amino acids; found in plant sources such as nuts and legumes
Pica
an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month
ultrasound
real time scanning which a rapid sequence of fixed images is displayed on the screen, showing movement in tissues can detect heartbeat of fetus and breathing and movement
alpha-fetoprotein
protein that binds with estradiol in the bloodstream of immature mammalstrue gestational age must be known
multiple marker screening
Analysis of maternal serum for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriols that may predict chromosomal abnormalities of the fetus; often called triple-screen. Addition of tests such as inhibin A has improved accuracy of the results, leading to alternate names for this package of tests.
Non-stress test
Looks at FHR with activity - Favorable results- 2 or more FHR accelerations of 15 beats lasting 15 seconds in a 20 minute period
FHR
fetal heart rate
Biophysical profile
A test that assess five variables; fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction
Maternal Assessment of Fetal Movement
-Movements by the fetus are assessed by themother.-They are often called "kick counts."-Several methods for the mother to count-At least 10 fetal movements within 12 hours-Count two or three times per day to identify whether the fetus has at least three movements in 60 minutes
involution
Return of the uterus to a nonpregnant state after birth
how does the site of placetal attachment heal
exfoliation which leaves the endometrium smooth and without scars
how many days after childbirth should the fundus be no longer palpable abdominally
14
how should lochia be assessed
amount, type, odor foul odor suggests endometrial infection
endometrium
inner lining of the uterus
Lochia rubra, serosa, and alba
Rubra-for the first two hours, decreases, total about 3-4daysSerosa-lasts about 22-27days, in most, after 10 days it changes to AlbaAlba-lasts about 10-14days, but may last longer-in total bleeding lasts about 4-8weeks
when does the vagina regain its nonpregnant size
6-10 weeks
thrombi
blood clotsprevented by frequent ambulation
what can reduce musculoskeletal discomfort
exercises to strengthen abdominal muscles, good posture, and body mechanics
dyspareunia
painful intercoursebreastfeeding mothers are more likely to experience this due to vaginal dryness from inadequate estrogen
postpartum blues
a mild, transient emotional letdown experienced by a majority of women after giving birthtemporary and should not last more than 2 weeks
Peurperium period
first 6 weeks after birth
Catabolism
Metabolic pathways that break down molecules, releasing energy.
decidua
the thick layer of modified mucous membrane that lines the uterus during pregnancy and is shed with the afterbirth.
Exfoliation
The removal of excess dead cells from the skin surface.
Subinvolution of the uterus
Uterus remains enlarged with continued lochial discharge which may result in postpartum hemorrhage
milk ejection reflex
release of breast milk in response to oxytocin, also called the let-down reflex
episiotomy
surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth
uterine atony
inability of the uterus to contract effectivelyprimary cause of excessive bleeding
diastasis recti
midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles
Prolactin
stimulates milk productionwill return to nonpregnant levels in 14 days if not breast feeding
REEDA
redness, edema, ecchymosis, drainage, approximationfor the assessment of the episiotomy or laceration
what kind of sitz baths should be recomended after birth
cool for the first 24 hours then hot after
fourth trimester
First 12 weeks after birth, a time of transition for parents and siblings.
Kegel exercises
repetitious contraction and relaxation of the pubococcygeal muscle to improve vaginal tone and urinary continence
abdominal breathing
slows RR rate and encourages deeper breathscan be started on 1st day postpartum
Head lift
few days after childbirth
knee and leg rolls
begins firming the waist
Attachment and bonding
process by which a parent comes to love and accept a child and a child comes to love and accept a parent
TAKING IN PHASE (POST PARTUM)
- immediatly after birth (hours- couple days)- Passive dependent behavior- relies on others for comfort, rest , and care. concerned for her own needs and overall health of newborn, talkative and excited reviewing birth experience.
Letting go phase
interdependent phase after birth in which the mother and family move forward as a system with interacting members
Taking hold phase
focuses on maternal role and care of the newborn; eager to learn; may develop blues
Promethazine
Antiemetic, normal antepartum drug
antiemetic
drug that prevents or stops vomiting
Ondansetron
Zofran for nausea and vomiting, normal antepartum drug
decussate sodium
stool softenernormal postpartum drug
Simethicone (Mylicon)
Antiflatulentnormal postpartum drug
antiflatulent
relieves gas and bloating in GI tract
oxycodone/acetaminophen
Percocetnormal postpartum drug
benzocaine pregnancy category
local anesthetic