Flashcards.

WHAT IS IT?

This card lists the warning signs of cancer and the stages of cancer. The warning signs use the word CAUTION as a memory aid.

WARNING SIGNS OF CANCER (CAUTION)

• •Change in bowel pattern
• •A sore that does not heal
• •Unusual bleeding
• •Thickening of the breast, testicle, or skin
• •Indigestion
• •Obvious change in a mole
• •Nagging cough

CANCER STAGING

• •Stage 0: carcinoma in situ
• •Stage I: local tumor growth
• •Stage II: limited spreading
• •Stage III: regional spreading
• •Stage IV: metastasis to other organs

WHAT IS IT?

Burn staging classifies how deep a burn goes into the skin and tissue.

TABLE

• •First degree -> Reddened, painful, intact skin
• •Second degree -> Partial thickness, broken skin, pain, pink/red, blisters
• •Third degree -> Full thickness, often painless, white/black eschar (dead tissue)
• •Fourth degree -> Muscle and/or bone exposed; common in electrical burns

WHAT IS IT?

This is a decision tree to sort congenital heart defects (heart defects present at birth). It splits defects first by whether cyanosis (bluish skin from low oxygen) is present, then by vascularity (lung blood flow) and signs of cardiac enlargement.

DECISION TREE

No cyanosis, with cardiac enlargement and normal/altered vascularity:

• •Patent ductus arteriosus (PDA)
• •Aortic stenosis
• •Pulmonic stenosis
• •Coarctation of the aorta

Cyanosis present:

• •Transposition of the great arteries (TGA)
• •Truncus arteriosus
• •TAPVC (total anomalous pulmonary venous connection)
• •Tricuspid atresia
• •Single ventricle
• •Ebstein's anomaly
• •Pulmonic atresia
• •Tetralogy of Fallot
• •Atrial septal defect
• •Ventricular septal defect
• •[source decision-tree branches partly garbled, verify branch assignments at source]

WHAT IS IT?

Gestational diabetes is high blood sugar during pregnancy. Increased weight and pregnancy hormones cause insulin resistance, which raises blood sugar. If the mother has high blood sugar, glucose crosses the placenta to the baby. The baby's body then makes more insulin, causing excessive growth.

Quick Concept: Maternal insulin does not cross the placenta, only glucose does, so the fetus responds to the mother's high sugar by making its own extra insulin.

ASSESSMENT

Maternal changes:

• •1st trimester: insulin needs are reduced
• •2nd and 3rd trimester: insulin resistance occurs as hormones increase, so insulin needs increase
• •Right after the placenta delivers: hormones and insulin requirements decrease; gestational diabetics should no longer need insulin or diet management after delivery

Newborn changes:

• •The baby grows faster and larger, but its function still reflects age, not size
• •Macrosomic (large baby) = 4000 g

Assessments:

• •Screen for glucose and protein in urine at regular prenatal visits (glucosuria and ketonuria)
• •Check blood sugar between 24 and 28 weeks with glucola testing
• •High-risk patients may be screened at the beginning of pregnancy

MANAGEMENT

• •Ideal to control with diet and exercise
• •Monitor for typical diabetes mellitus (DM) complications (signs of infection, high blood pressure, edema, proteinuria)

WHAT IS IT?

Preeclampsia is a hypertensive (high blood pressure) disorder with a BP of 140/90, plus proteinuria (protein in the urine), occurring after 20 weeks of gestation (pregnancy). A woman may or may not have symptoms but will have elevated blood pressures and proteinuria.

Diagnostic criteria:

• •Proteinuria: over 300 mg in a 24-hour urine specimen, and a protein:creatinine ratio over 0.3
• •Blood pressure: 140/90 or more on two occasions 4 hours apart, OR a systolic of 160 mmHg or more, OR a diastolic of 90 mmHg or more. Both 140/90 and 160/90 are classified as preeclamptic hypertension.

ASSESSMENT

• •Sudden increase in edema (swelling) in the hands and face
• •Sudden weight gain from excess fluid retention
• •Complaints of headache, epigastric (upper-middle abdomen), or RUQ (right upper quadrant) pain
• •Vision changes: a serious symptom, from swelling and irritation of the brain and CNS (central nervous system)
• •Proteinuria: MUST be present to be preeclampsia

Fetal assessment:

• •Intrauterine growth restriction (IUGR): placental blood flow is not at its best

MANAGEMENT

• •Delivery of the baby is the only treatment
• •Magnesium sulfate is given prophylactically (preventively) for seizure prevention
• •Some antihypertensive (BP-lowering) drugs might be given to manage BP

WHAT IS IT?

Some infections during pregnancy are concerning because they can pass to the fetus (through the placenta or during delivery) and harm the newborn. The TORCH group is a helpful memory aid for these infections.

TORCH

• •T: Toxoplasmosis
• •O: Other (such as Group B strep, HIV, syphilis)
• •R: Rubella
• •C: Cytomegalovirus
• •H: Herpes simplex

DETAILS

Toxoplasmosis:

• •A parasitic disease passed to the mother while handling cat litter, undercooked or raw meat, or gardening; passed to the fetus through the placenta
• •The mother is usually asymptomatic but may have a rash or flu-like symptoms for a few weeks to months
• •Can cause fetal death, spontaneous abortion, and neurologic complications
• •Educate the mother to never change cat litter

Other (Group B strep):

• •All women are screened during the prenatal period by a vaginal swab at 35 to 37 weeks
• •All women have the bacteria; results depend on the amount colonized
• •Prophylactic antibiotics (penicillin or ampicillin) are given during labor to women who screen positive
• •The main cause of bacterial infections in newborns, which causes sepsis

Other (HIV):

• •Delivery by c-section to limit transmission
• •Infants are given antiretrovirals

Other (Syphilis):

• •Woman is given penicillin, and the fetus receives penicillin after delivery

Rubella:

• •Passed through the placenta
• •Most dangerous if the mother gets it in the first trimester
• •Can cause brain damage, hearing loss, miscarriage, stillbirth, and various congenital defects
• •Assess the mother's immunity by drawing a titer. If non-immune, vaccinate immediately after delivery because it is a live vaccine. The vaccine protects future pregnancies.

Cytomegalovirus (CMV):

• •A very common, asymptomatic virus passed through bodily fluids
• •Passed through the placenta or during delivery; can cause intrauterine growth restriction, seizures, blindness, hepatomegaly, splenomegaly, jaundice, hearing loss, microcephaly, and/or death

Herpes Simplex:

• •Passed during birth if active lesions are present; a c-section should be done with an active lesion to prevent transmission
• •Acyclovir may be given around 36 weeks to prevent an outbreak during labor and delivery
• •Can cause serious neonatal complications (death, neurologic issues, etc.)

WHAT IS IT?

The newborn physical exam is the first physical assessment after birth. It establishes a baseline. Assess for temperature stability and note all abnormalities.

Keep the baby warm:

• •Nursing interventions must maintain temperature stability

The intrauterine to extrauterine transition period has 3 phases:

• •Reactivity: most alert and the best feeding time, in the first hour
• •Decreased responsiveness: sleepy, in the second hour
• •Reactivity: a second reactivity phase, hours 2 to 6, alert

ASSESSMENT

General observations:

• •Newborns should have a flexed posture and coordinated movements
• •Count extremities, fingers, toes
• •Check for an anus; if not patent (open), do NOT feed; if no anus is found, this is an emergent surgery
• •In males, check that the urinary meatus (opening) is on the penis; hypospadias is when the meatus is on the under portion, and NO circumcision can be performed on these clients
• •Check for hip dysplasia using the Ortolani maneuver: rotate the thighs outward and feel for clicks at the hips; no clicking or crepitus is normal; any clicking or crepitus indicates hip dysplasia; also check by placing the infant prone and looking for symmetrical buttock creases, where symmetry indicates no dysplasia

Vital signs:

• •Some newborns may have slight, subtle tremors that can be normal or due to drug withdrawal, hypocalcemia, or hypoglycemia
• •Listen to the apical pulse for 1 full minute: 120 to 160 BPM resting is normal
• •Listen to respirations for 1 full minute: 30 to 60 RR is normal
• •Axillary (armpit) temperature: 97.8 to 99 F is normal

Head:

• •Measure head, weight, length
• •Fontanels (soft spots): anterior and posterior

Eyes:

• •Weak eye muscle
• •Newborns may have strabismus or disconjugate gaze (eyes not aligned)

Ears:

• •No pits or skin tags

Mouth:

• •Assess for an intact palate, no teeth

Chest:

• •Assess for clavicular (collarbone) fractures from birth
• •Breast tissue swelling might be observed
• •May note secretions from the nipple

Umbilical cord:

• •Assess for 2 arteries and 1 vein
• •Assess for meconium staining on the cord

• •[source fragment unclear, verify at source: source lists fontanel locations as anterior "back of the head" and posterior "top of the head," which appears reversed]

WHAT IS IT?

This card covers the newborn assessment, including normal measurements, the APGAR score, medications and labs, and possible complications during delivery.

NORMAL MEASUREMENTS

• •Weight: 6 to 10 lbs
• •Length: 18 to 22 in
• •Head circumference: 33 to 35 cm
• •Chest circumference: 30 to 33 cm

MEDS AND LABS

• •Vitamin K: prevents hemorrhage
• •Optic antibiotic: prevents newborn blindness
• •PKU (phenylketonuria) level: within 24 hours after feeding begins
• •Coombs' test: if mother is Rh-negative
• •Immunizations: Hep-B (hepatitis B) can be given

PHYSICAL ASSESSMENT

• •Fontanelles (soft spots): anterior (diamond-shaped), posterior (triangular)
• •Mouth: assess for cleft lip or palate
• •Heart: assess for murmur
• •Respirations: assess breathing
• •Umbilical cord: 1 vein, 2 arteries, clamped
• •Genitalia: male, testes palpable; female, discharge of blood or mucus is normal
• •Extremities: equal length

APGAR SCORE (scored at 1 minute and 5 minutes; 8 to 10 normal, 4 to 6 moderate depression, 0 to 3 needs aggressive resuscitation)

Appearance:

• •2: pink torso and extremities
• •1: pink torso, blue extremities
• •0: blue all over

Pulse:

• •2: greater than 100
• •1: less than 100
• •0: absent

Grimace:

• •2: vigorous cry
• •1: limited cry
• •0: no response to stimulus

Activity:

• •2: actively moving
• •1: limited movement
• •0: flaccid

Respiratory effort:

• •2: strong loud cry
• •1: hypoventilation, irregular
• •0: absent

POSSIBLE COMPLICATIONS DURING DELIVERY

• •Meconium aspiration
• •Cord presentation
• •Breech presentation
• •Limb presentation
• •Postpartum hemorrhage

WHAT IS IT?

This card lists types of traction (a pulling force used to align or immobilize bones) and the matching body part or patient group.

TABLE

• •Buck's traction: knee immobility
• •Russell traction: femur or lower leg
• •Dunlap traction: skeletal or skin
• •Bryant's traction: children under 3 years, under 35 lbs, with a femur fracture

• •[source fragment unclear, verify at source: the original card also begins listing "Infant's Development" milestones and "Erikson's Stages of Psychosocial Development," which appear to belong to separate cards]

WHAT IS IT?

This card lists food sources for the water-soluble vitamins.

TABLE

• •Folic acid: green leafy vegetables, liver, beef and fish, legumes, grapefruit and oranges
• •Niacin: meats, poultry, fish, beans, peanuts, grains
• •Vitamin B1 (thiamine): pork, nuts, whole-grain cereals, legumes
• •Vitamin B2 (riboflavin): milk, lean meats, fish, grains
• •Vitamin B6 (pyridoxine): yeast, corn, meat, poultry, fish
• •Vitamin B12 (cobalamin): meat, liver
• •Vitamin C (ascorbic acid): citrus fruits, tomatoes, broccoli, cabbage

WHAT IS IT?

This card lists food sources for the fat-soluble vitamins: A, D, E, and K.

FOOD SOURCES

• •Vitamin A: liver, egg yolk, whole milk, green or orange vegetables, fruits
• •Vitamin D: fortified milk, fish oils, cereals
• •Vitamin E: vegetable oils, green leafy vegetables, cereals, apricots, apples, peaches
• •Vitamin K: green leafy vegetables, cauliflower, cabbage

WHAT IS IT?

This card lists common food sources for each dietary mineral.

FOOD SOURCES

• •Calcium: broccoli, carrots, cheese, collard greens, green beans, milk, rhubarb, spinach, tofu, yogurt
• •Chloride: salt
• •Iron: bread and cereals, dark green vegetables, dried fruits, egg yolk, legumes, liver, meats
• •Magnesium: avocado, canned white tuna, cauliflower, cooked rolled oats, green leafy vegetables, milk, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt
• •Phosphorus: fish, nuts, organ meats, pork, beef, chicken, whole-grain bread and cereals
• •Potassium: avocado, banana, cantaloupe, carrots, fish, mushrooms, oranges, pork, beef, veal, potatoes, raisins, spinach, strawberries, tomatoes
• •Sodium: American cheese, bacon, butter, canned food, cottage cheese, cured pork, hot dogs, ketchup, milk, mustard, processed food, soy sauce, table salt, white and whole-wheat bread
• •Zinc: eggs, leafy vegetables, meats, protein-rich foods

WHAT IS IT?

This card explains how to estimate the expected date of delivery (EDD) and how to describe a pregnancy outcome.

NAEGELE'S RULE

• •Start with the 1st day of the last menstrual period
• •Add 7 days, then subtract 3 months
• •Example: Sep 13th, then Sep 20th, then Jun 20th

PREGNANCY OUTCOME (GTPAL)

• •G: gravidity (number of pregnancies)
• •T: term births
• •P: preterm births
• •A: abortions or miscarriages
• •L: current living children

WHAT IS IT?

TORCH is a group of infections that can harm a fetus during pregnancy. This card lists them and adds related medication and prevention notes.

TORCH (mnemonic)

• •Toxoplasmosis
• •Other (Hepatitis, Syphilis, HIV)
• •Rubella
• •Cytomegalovirus
• •Herpes simplex

NURSING CONSIDERATIONS

Rho immune globulin:

• •Given by the IM (intramuscular) route at 28 weeks of gestation and again within 72 hours after delivery.
• •Also given within 72 hours after potential or actual exposure to Rh+ blood, and must be given with each subsequent exposure to Rh+ blood.

Other teaching:

• •Folic acid should be started 3 months before pregnancy; it decreases the incidence of neural tube defects.
• •Warfarin is teratogenic (causes birth defects), especially in the 1st trimester. Heparin is not. They cause the worst damage during the 1st trimester.

WHAT IS IT?

This card describes the four stages of labor.

TABLE

• •1st stage (Cervical dilation): begins with the onset of regular contractions and ends with complete dilation. Phases: Latent (0 to 3 cm), Active (4 to 7 cm), Transitional (8 to 10 cm)
• •2nd stage (Expulsion): begins with complete dilation and ends with delivery of the fetus
• •3rd stage (Placental): begins immediately after the fetus is born and ends when the placenta is delivered
• •4th stage (Maternal homeostatic stabilization): begins after delivery of the placenta and continues for 1 to 4 hours after delivery

WHAT IS IT?

Placenta previa is when the placenta covers or lies near the cervical opening. This card compares its signs with abruptio placentae (when the placenta separates from the uterine wall early).

PLACENTA PREVIA

• •Painless bright red vaginal bleeding
• •Soft uterus
• •Vaginal exams are contraindicated

ABRUPTIO PLACENTAE

• •Dark red vaginal bleeding
• •Uterine pain and/or tenderness
• •Uterine rigidity

WHAT IS IT?

This card matches fetal heart rate changes on the monitor to their likely cause.

MAPPINGS

• •Variable decelerations: cord compression
• •Early decelerations: head compression
• •Accelerations: okay (a reassuring sign)
• •Late decelerations: placental insufficiency
• •[source fragment unclear: source lists "late accelerations" but pairs it with placental insufficiency, which describes late decelerations; verify at source]

WHAT IS IT?

This card lists normal postpartum vital sign ranges and the findings that should be reported.

NORMAL RANGES

• •Temperature: may rise to 100.4 F during the first 24 hours postpartum because of the dehydrating effects of labor. Any higher elevation may be caused by infection and must be reported.
• •Heart rate: may decrease to 50 bpm (normal puerperal bradycardia); over 100 bpm may indicate excessive blood loss or infection.
• •Blood pressure: should be normal; suspect hypovolemia if it decreases.
• •Respiratory rate: rarely changes; if it increases significantly, suspect pulmonary embolism, uterine atony, or hemorrhage.

WHAT IS IT?

This card lists antibiotics to avoid during pregnancy and the harm each can cause. A memory phrase is "MCATO." It also notes the use of magnesium sulfate.

TABLE (MCATO)

• •Metronidazole: hepatic (liver) failure (relatively contraindicated)
• •Chloramphenicol: gray baby syndrome
• •Aminoglycosides: ototoxicity (ear/hearing damage)
• •Tetracyclines: teeth discoloration and liver failure
• •Others: nitrofurantoin, quinolones, and sulfonamides

MAGNESIUM SULFATE

• •Used to stop preterm labor and to prevent and control seizures in pre-eclamptic and eclamptic patients
• •Decreases urine output, deep tendon reflexes, respiratory rate, and blood pressure

WHAT IS IT?

Fontanels are the soft spots on a baby's skull where the bones have not yet joined. This card gives when each one closes.

NORMAL RANGES

• •Anterior fontanel: closes between 12-18 months of age
• •Posterior fontanel: closes between birth and 2-3 months of age

WHAT IS IT?

This card lists the childhood and adult immunization schedule by age, with memory aids in parentheses.

TABLE

• •Birth: HepB, plus Vitamin K
• •2, 4, 6 months (DIHHPR / diaper): DTaP, IPV (6 to 18 months), HepB (2 and 4 months), Hib, PCV, Rotavirus; influenza yearly starting at 6 months
• •12 to 15 months (Harry V. Potter, MD): Hib, Varicella, PCV, MMR, DTaP (15 to 18 months); HepA (12 to 23 months, 2 doses at least 4 weeks apart)
• •4 to 6 years (I did my vaccines): IPV, DTaP, MMR, Varicella
• •11 to 12 years (Don't have money here): DTaP, HPV, Meningococcal; HPV (1st at 11 to 12 years, 2 months after the 1st, 6 months after the 1st, up to age 26)
• •Adult (Don't HIT the adult): Influenza yearly, TDaP every 10 years
• •Elderly (Don't break your HIP): Herpes Zoster (60 years), Influenza yearly, Pneumovax-23

WHAT IS IT?

This card lists safety rules for choosing toys for children to prevent injury and infection.

SAFETY PRINCIPLES

• •No small toys for children under age 4
• •No metal (diecast) toys if O2 (oxygen) is in use, because of sparks
• •Beware of fomites (objects that harbor bacteria); a stuffed animal is a fomite
• •For a child of 9 months, do not pick any answer with the words: build, make, construct, sort, stack

WHAT IS IT?

This card lists common herbal supplements, their uses, and key teaching points.

TABLE (herb -> use and cautions)

• •St. John's Wort: treats depression/anxiety. Interacts with SSRIs. Causes sun sensitivity.
• •Garlic: lowers blood pressure and cholesterol. Interacts with aspirin and warfarin.
• •Ginkgo Biloba: improves memory. Thins the blood (do not take with aspirin or warfarin). Do not take with a history of seizures.
• •Echinacea: immune-boosting function. Can cause liver toxicity in renal (kidney) patients. Not effective with HIV.
• •Ginger: relieves nausea and vomiting. Do not take with a history of deep venous thrombosis. Interacts with blood thinners.
• •Black Cohosh: treats menopausal symptoms. Contraindicated in pregnancy (causes premature labor).
• •Kava Kava: treats insomnia and muscle pain. Associated with liver illnesses.
• •Saw Palmetto: used for prostate health. No specific patient teaching.

KEY POINT

• •If it starts with G, it thins the blood. Do not give with warfarin, aspirin, and heparin.

WHAT IS IT?

Methylphenidate (Ritalin) is a medication used to treat ADHD (attention-deficit hyperactivity disorder).

NURSING CONSIDERATIONS

• •Assess for heart-related side effects and report them immediately
• •The child may need a drug holiday because the drug stunts growth

WHAT IS IT?

Erik Erikson described eight stages of social and emotional growth across the lifespan. Each stage has a central conflict the person must resolve. Success builds a healthy personality.

• •Trust vs. Mistrust (birth to 1 year): infant learns to trust caregivers who meet needs.
• •Autonomy vs. Shame and Doubt (1 to 3 years): toddler gains independence, wants to do things alone.
• •Initiative vs. Guilt (3 to 6 years): preschooler explores, plans, and takes initiative through play.
• •Industry vs. Inferiority (6 to 12 years): school age child masters skills and feels competent.
• •Identity vs. Role Confusion (12 to 18 years): adolescent forms a sense of self.
• •Intimacy vs. Isolation (young adult): forms close, committed relationships.
• •Generativity vs. Stagnation (middle adult): contributes to others and the next generation.
• •Integrity vs. Despair (older adult): reflects on life with a sense of acceptance.

WHAT IS IT?

Jean Piaget described four stages of how thinking develops in children. Each stage shows new ways of understanding the world.

• •Sensorimotor (birth to 2 years): learns through senses and movement. Develops object permanence (knows an object exists even when hidden).
• •Preoperational (2 to 7 years): uses symbols and language. Thinking is egocentric (sees the world only from own view). Magical thinking is common.
• •Concrete Operational (7 to 11 years): logical thinking about real, concrete things. Understands conservation (amount stays the same even if shape changes).
• •Formal Operational (11 years and up): abstract and hypothetical thinking. Can reason about ideas and possibilities.

Quick Concept: Sensory, Symbols, Sensible (concrete), Speculation (abstract).

WHAT IS IT?

The infant period is birth to 12 months. Motor and social skills appear in a predictable order. These are average ages and may vary.

KEY POINTS

• •2 months: social smile.
• •4 months: holds head steady, rolls front to back.
• •6 months: sits with support, rolls both ways.
• •7 to 8 months: sits without support.
• •9 months: crawls, develops stranger anxiety.
• •10 months: pulls to stand.
• •12 months: birth weight triples, stands alone, may take first steps, says 1 to 2 words.

WHAT IS IT?

The toddler period is 1 to 3 years. The child gains mobility, language, and independence. Negativism and saying "no" are normal.

KEY POINTS

• •15 months: walks alone well, uses a few words.
• •18 months: runs clumsily, builds a tower of blocks, begins toilet training readiness signs.
• •2 years: walks up and down stairs, uses 2 to 3 word phrases, follows simple commands.
• •3 years: rides a tricycle, speaks in short sentences, can say first name.
• •Parallel play is typical (plays beside other children, not with them).
• •Strong fear of separation from parents.

WHAT IS IT?

The preschool period is 3 to 6 years. Fine motor skills, language, and imagination grow quickly. Children begin to play with others.

KEY POINTS

• •4 years: hops on one foot, throws a ball overhand, uses scissors.
• •5 years: skips, ties shoelaces, draws a person with body parts.
• •Speech is fully understandable by others around age 4 to 5.
• •Associative play is typical (plays together with shared goals but loose rules).
• •Magical thinking and fear of bodily harm are common. Use simple, honest words during care.

WHAT IS IT?

School age is 6 to 12 years. Adolescence is 12 to 18 years. The focus shifts from family to peers and then to identity.

KEY POINTS

• •School age: enjoys rules, games, and collecting. Wants to feel competent and accepted by peers.
• •School age play is cooperative (organized, with rules and roles).
• •Adolescence: rapid physical growth and puberty. Peer group is very important.
• •Adolescents think abstractly and question rules. They seek independence and privacy.
• •Body image and fitting in are major concerns. Risk-taking behavior may increase.

WHAT IS IT?

Pregnancy lasts about 40 weeks from the last menstrual period. It is divided into three trimesters of about 13 weeks each.

• •First trimester (weeks 1 to 13): organs form. Highest risk for the effects of teratogens (substances that harm the fetus). Nausea is common.
• •Second trimester (weeks 14 to 27): often the most comfortable time. Mother feels fetal movement (quickening) around 16 to 20 weeks.
• •Third trimester (weeks 28 to 40): rapid fetal growth and weight gain. Mother may have back pain, shortness of breath, and trouble sleeping.

Quick Concept: Term birth is 37 weeks or later.

WHAT IS IT?

Many discomforts in pregnancy are normal and not dangerous. The nurse teaches safe ways to ease them.

KEY POINTS

• •Nausea and vomiting: common in the first trimester. Eat small, frequent meals and dry crackers before rising.
• •Heartburn: eat small meals, avoid spicy and fatty foods, stay upright after eating.
• •Constipation: increase fiber, fluids, and activity.
• •Backache: use good posture, wear low-heeled shoes, do pelvic tilt exercises.
• •Leg cramps: stretch the calf with toes pointed up. Check calcium intake.
• •Urinary frequency: normal in first and third trimesters. Do not cut fluids.
• •Edema of feet and ankles: elevate legs and rest. Report sudden or facial swelling (may signal a problem).

WHAT IS IT?

Some symptoms signal a serious problem. The mother must report these to her provider right away.

ASSESSMENT

• •Vaginal bleeding.
• •Sudden gush or leaking of fluid from the vagina.
• •Severe or constant headache.
• •Blurred vision or spots before the eyes.
• •Swelling of the face, hands, or fingers.
• •Severe abdominal pain.
• •Fever or chills.
• •Painful or burning urination.
• •Persistent vomiting.
• •A large decrease in or absence of fetal movement.

WHAT IS IT?

Standard tests are done during pregnancy to protect the mother and fetus. Timing matters for some of them.

KEY POINTS

• •Blood type, Rh factor, and antibody screen: at the first visit. An Rh-negative mother may need Rho(D) immune globulin (RhoGAM).
• •Complete blood count: checks for anemia.
• •Rubella titer and hepatitis B surface antigen: check immunity and infection.
• •Urinalysis: checks for protein, glucose, and infection at visits.
• •HIV (human immunodeficiency virus) screening: offered to all.
• •Pap test and tests for sexually transmitted infections as indicated.
• •1-hour glucose challenge test for gestational diabetes: around 24 to 28 weeks.
• •Group B Streptococcus (GBS) vaginal and rectal swab: around 36 to 37 weeks.

WHAT IS IT?

The Five P's are the main factors that affect the progress of labor. The nurse uses them to assess how labor is going.

• •Passenger: the fetus and placenta. Includes fetal size, lie, presentation, and position.
• •Passageway: the birth canal, including the bony pelvis and soft tissues.
• •Powers: the uterine contractions and, in the second stage, maternal pushing.
• •Position: the mother's posture and position changes during labor.
• •Psyche: the mother's emotional state, support, and coping.

WHAT IS IT?

Fetal heart rate (FHR) monitoring checks how the fetus tolerates labor. The nurse reads the baseline rate and variability.

KEY POINTS

• •Normal baseline FHR is 110 to 160 beats per minute.
• •Moderate variability (small fluctuations in the baseline) is a reassuring sign of good oxygenation.
• •Tachycardia is a baseline above 160 for 10 minutes or more. Causes include maternal fever and infection.
• •Bradycardia is a baseline below 110 for 10 minutes or more.
• •External monitoring uses belts on the abdomen. Internal monitoring needs ruptured membranes and dilation.

Quick Concept: Baseline plus moderate variability equals a reassuring pattern.

WHAT IS IT?

These are drug-free ways to ease labor pain. They are safe, lower stress, and can be used alone or with medication.

KEY POINTS

• •Breathing techniques and relaxation (such as patterned breathing).
• •Position changes, walking, and rocking.
• •Hydrotherapy: warm shower or tub.
• •Massage and effleurage (light abdominal stroking).
• •Counterpressure on the lower back for back labor.
• •Heat or cold packs.
• •Continuous labor support from a partner or doula.
• •A calm environment with dim lights and quiet.

WHAT IS IT?

An epidural is a pharmacologic pain option. Medication is placed in the epidural space of the lower spine to numb the lower body during labor.

KEY POINTS

• •The main side effect is maternal hypotension (low blood pressure), which can lower fetal heart rate.
• •Give a bolus of intravenous fluid before placement to help prevent hypotension.
• •After placement, monitor blood pressure often and watch the fetal heart rate.
• •If hypotension occurs, turn the mother to her side, increase fluids, and notify the provider.
• •The mother stays in bed and needs help moving. Monitor the bladder for retention.
• •Other options include intravenous opioids, which can cause newborn respiratory depression if given close to birth.

WHAT IS IT?

BUBBLE-HE is a memory tool for the head-to-toe postpartum assessment. The nurse checks each item to find problems early.

ASSESSMENT

• •B - Breasts: soft, filling, or engorged. Check nipples.
• •U - Uterus: fundus should be firm, midline, and at or below the umbilicus.
• •B - Bladder: should void within 6 to 8 hours. A full bladder pushes the uterus up and right.
• •B - Bowels: check return of bowel sounds and passage of gas or stool.
• •L - Lochia: vaginal discharge. Note amount, color, and odor.
• •E - Episiotomy or perineum: assess with the REEDA tool (Redness, Edema, Ecchymosis, Discharge, Approximation).
• •H - Homans sign and lower extremities: check for signs of a clot.
• •E - Emotions: assess bonding and mood.

WHAT IS IT?

Lochia is the vaginal discharge after birth. It changes color in a normal pattern as the uterus heals.

• •Lochia rubra: dark red, days 1 to 3.
• •Lochia serosa: pinkish brown, about days 4 to 10.
• •Lochia alba: yellowish white, about days 10 to 14 and may last several weeks.

KEY POINTS

• •Lochia should never go backward in color (for example, return to bright red after turning pink).
• •A foul odor suggests infection.
• •Saturating a pad in 1 hour or large clots may signal hemorrhage. Report this.
• •A firm fundus with heavy bleeding may mean a laceration.

WHAT IS IT?

Breastfeeding gives the newborn ideal nutrition and antibodies. The nurse teaches good latch and feeding habits.

KEY POINTS

• •The first milk is colostrum, which is rich in antibodies and protein.
• •A good latch covers most of the areola, not just the nipple. This prevents sore nipples.
• •Feed on demand, about 8 to 12 times in 24 hours in the first weeks.
• •Signs of enough intake: 6 or more wet diapers per day and steady weight gain.
• •Break suction with a clean finger before removing the baby from the breast.
• •Empty one breast before switching to help the baby get the richer hindmilk.
• •Exclusive breastfeeding is recommended for about the first 6 months.

WHAT IS IT?

Some symptoms after birth signal a serious problem such as hemorrhage, infection, or a blood clot. The mother must report these right away.

ASSESSMENT

• •Heavy bleeding: saturating one pad in an hour or large clots.
• •Foul-smelling lochia or fever above 100.4 degrees Fahrenheit (38 degrees Celsius).
• •A boggy (soft) uterus that does not firm up with massage.
• •Calf pain, redness, warmth, or swelling (possible clot).
• •Chest pain or shortness of breath.
• •Severe headache or visual changes (possible late preeclampsia).
• •Painful, red, hot area on the breast with fever (possible mastitis).
• •Thoughts of harming self or the baby, or being unable to care for the baby.

WHAT IS IT?

APGAR is a quick newborn assessment done at 1 and 5 minutes after birth. Five signs are each scored 0, 1, or 2 for a total of 0 to 10.

• •A - Appearance (color): 0 blue or pale all over, 1 body pink with blue limbs, 2 pink all over.
• •P - Pulse (heart rate): 0 absent, 1 below 100, 2 at or above 100.
• •G - Grimace (reflex irritability): 0 no response, 1 grimace, 2 cry or active withdrawal.
• •A - Activity (muscle tone): 0 limp, 1 some flexion, 2 active motion.
• •R - Respirations: 0 absent, 1 slow or weak cry, 2 good strong cry.

KEY POINTS

• •7 to 10 is normal. 4 to 6 is moderately depressed. 0 to 3 is severely depressed.
• •A low score means the newborn needs support, not that long-term outcome is set.

WHAT IS IT?

Newborns have normal reflexes that show an intact nervous system. Most disappear by a set age. Their absence or staying too long may signal a problem.

KEY POINTS

• •Moro (startle): when startled, arms and legs extend, then curl in. Fades by 3 to 6 months.
• •Rooting: stroke the cheek and the baby turns toward it to feed. Fades by about 3 to 4 months.
• •Sucking: object in the mouth triggers sucking. Helps feeding.
• •Palmar grasp: object in the palm and the baby grips. Fades by about 3 to 4 months.
• •Plantar grasp: pressure on the sole and the toes curl down. Fades by about 8 months.
• •Babinski: stroke the sole and the toes fan out. Normal in infants. Disappears by about 1 year.
• •Tonic neck (fencing): turn the head and the arm on that side extends.
• •Stepping: held upright with feet on a surface, the baby makes stepping motions.

WHAT IS IT?

Newborn screening finds serious conditions early so treatment can start before harm occurs. It is done before discharge.

KEY POINTS

• •A heel-stick blood sample screens for metabolic and genetic disorders, such as phenylketonuria (PKU), hypothyroidism, and sickle cell disease.
• •The exact panel of conditions is set by each state. Verify at source.
• •Hearing screening is done before discharge to find hearing loss early.
• •Critical congenital heart disease screening uses pulse oximetry to check oxygen levels.
• •Some tests, such as PKU, need the newborn to have fed first for an accurate result.
• •Teach parents that a positive screen needs follow-up testing to confirm.

WHAT IS IT?

Routine care protects the newborn right after birth. The nurse follows standard steps for safety and infection control.

KEY POINTS

• •Keep the newborn warm. Dry right away and use skin-to-skin contact or a warmer to prevent cold stress.
• •Erythromycin eye ointment prevents eye infection from bacteria in the birth canal.
• •Vitamin K injection prevents bleeding because the newborn gut cannot make vitamin K yet.
• •Hepatitis B vaccine is given, often before discharge.
• •Check identification bands match the mother before every handoff.
• •Teach parents to place the baby on the back to sleep to lower the risk of sudden infant death syndrome (SIDS).

WHAT IS IT?

Vaccines protect children from serious diseases on a set schedule. These are common high-yield points. Always verify the current schedule at source.

KEY POINTS

• •Birth: first hepatitis B (HepB) vaccine.
• •2 months: starts a series that includes DTaP (diphtheria, tetanus, pertussis), IPV (polio), Hib (Haemophilus influenzae type b), PCV (pneumococcal), and rotavirus.
• •12 to 15 months: first MMR (measles, mumps, rubella) and first varicella (chickenpox). These are live vaccines.
• •12 to 23 months: hepatitis A series.
• •4 to 6 years (school age): booster doses of DTaP, IPV, MMR, and varicella.
• •Live vaccines such as MMR and varicella are usually avoided in pregnancy and severe immunosuppression.

WHAT IS IT?

Some people should not get certain vaccines, or should wait. The nurse screens for these before giving any vaccine.

KEY POINTS

• •A severe allergic reaction (anaphylaxis) to a prior dose or vaccine component is a contraindication.
• •Live vaccines (such as MMR and varicella) are avoided in pregnancy and in people who are severely immunocompromised.
• •A moderate or severe acute illness is a reason to wait. A mild illness, such as a cold, is not.
• •A low-grade fever or mild soreness after a prior dose is not a contraindication.
• •Document the vaccine, lot number, site, and education given.
• •Have emergency equipment ready in case of an allergic reaction.

WHAT IS IT?

Screening finds cancer early in people without symptoms. These are general adult guidelines. Exact ages vary by source and risk, so verify at source.

KEY POINTS

• •Mammogram (breast): screening is generally offered starting around age 40 to 50, then on a regular schedule.
• •Pap test (cervical): generally starts at age 21. After that it is done every few years, sometimes combined with HPV (human papillomavirus) testing.
• •Colonoscopy (colorectal): screening generally starts at age 45 and repeats about every 10 years if normal.
• •PSA (prostate-specific antigen) test (prostate): discussed with the provider, generally around age 50, earlier if higher risk.
• •Higher-risk people may start screening earlier or more often.

WHAT IS IT?

Iron is needed to make hemoglobin, which carries oxygen in the blood. Low iron causes anemia. Pregnant clients and growing children need more iron.

KEY POINTS

• •Heme iron (from animals) is absorbed best: red meat, liver, poultry, and fish.
• •Non-heme iron (from plants): beans, lentils, tofu, spinach, and iron-fortified cereals.
• •Vitamin C foods (such as citrus) boost iron absorption. Pair them with iron-rich meals.
• •Tea, coffee, and calcium can lower iron absorption. Separate them from iron meals.
• •Teach clients taking oral iron to expect dark stools and to prevent constipation.

WHAT IS IT?

Calcium builds and keeps bones and teeth strong. It also helps muscles and nerves work. Needs are high in children, pregnant clients, and older adults at risk for osteoporosis.

KEY POINTS

• •Dairy: milk, yogurt, and cheese are top sources.
• •Leafy greens: kale, broccoli, and collard greens.
• •Canned fish with soft bones: sardines and salmon.
• •Calcium-fortified foods: tofu, orange juice, and cereals.
• •Vitamin D helps the body absorb calcium. Get it from sunlight, fortified milk, and fatty fish.
• •Teach older adults that weight-bearing exercise plus calcium and vitamin D supports bone health.

WHAT IS IT?

Good nutrition in pregnancy supports fetal growth and maternal health. Needs rise for several key nutrients.

KEY POINTS

• •Folic acid lowers the risk of neural tube defects. Start before conception if possible. Sources include leafy greens, beans, and fortified grains.
• •Iron needs rise to support the larger blood volume and the fetus.
• •Calcium and protein needs increase.
• •Recommended weight gain for a normal-weight client is about 25 to 35 pounds total. Verify at source for other body weights.
• •Extra calories are needed in the second and third trimesters, not a full "eating for two."
• •Avoid alcohol, raw or undercooked foods, high-mercury fish, and unpasteurized products.

WHAT IS IT?

A low-sodium diet limits salt to lower fluid retention and blood pressure. It is used for heart failure, hypertension, and some kidney and liver disease.

KEY POINTS

• •Avoid added table salt and salty snacks.
• •Limit canned soups, cured and processed meats (bacon, ham, lunch meat), and pickled foods.
• •Read labels and choose "low sodium" or "no salt added" products.
• •Watch for hidden sodium in cheese, sauces, and restaurant or fast food.
• •Use herbs, spices, and lemon to add flavor instead of salt.
• •Teach clients that many salt substitutes contain potassium. Check first if they take certain blood pressure or kidney medications.

WHAT IS IT?

A renal diet supports clients with chronic kidney disease. It limits nutrients the kidneys cannot clear well. The exact limits depend on lab values and dialysis status.

KEY POINTS

• •Limit potassium: avoid bananas, oranges, potatoes, tomatoes, and salt substitutes.
• •Limit phosphorus: avoid dairy, nuts, and dark colas. Phosphate binders are taken with meals.
• •Limit sodium to control blood pressure and fluid.
• •Control protein based on the stage and on dialysis. Dialysis clients often need more protein.
• •Limit fluids if the client is on dialysis or makes little urine.
• •Teach clients to track weight daily, since rapid gain signals fluid retention.