Sterilization femal use transcervical flexible agent no anesthesia that cause scaring and close

tubial still get birth cotrol till fully close risk pregnancy occur and profusion of tube fobial.
Second tubilacation done with anesthesia is burn flobial tube risk of anesthesia and pregnancy.
Male vasectomy less invasive and do 20 enjeculation to opty out before surgery and follow
sperm testing 6 month so must use birth and is reversable .
Infertility cant conceive for at least 12 months always test guys first due semen analysis.then d
o femal histrosogmotrofy use contract dye make sure no selfish or iodine allergy this all for
contract dye. Laparoscopy blow co2 gas in abdomen frmale after encourage patient walk and
fiber intake and fluid .
Signs of pregnancy :-presumptive sign can be explan by other than preg like menohea no period
this when body like athlete which fat is low , vomiting may be pregnant but can be stomach
virus urinary frequency may be drinking to much , breast changes maybe PMS , quickening gas,
urine enlargemet can be cancer
-positive sign no other explant definitely pregnant like provide feel move fetal or visual of baby
or come from vigina, h beat baby.
- probable signs hagger sign chadwicks sign godosign, Braxton hicks contcation , allotment,
positive pregnancy test

Calculating due date Miguel rile : take date give you as first day of woman ‘s last period and add
9 months and add another week April 1 2019 last period January 1 2020 then jan 8 2020

Fundal height measured from sandifetus tubus up top of fundus of uterus between 18 and 32
weeks gestation of fundal height will equal gestational age so if fundal height 20 cm then
estimate about 20 weeks pregnant

GTPAL , g total women time she pregnant, t number birth occur 38 weeks and about, p preterm
birth occurred between 20-37 weeks , abortion miscargiare count , living childen .
Expect changes during pregnancy cardiovascular changes increase co 30-50 percent, blood
voulune increase 30-45 % and hr incres, o2 incres, lung compacity decarse due uterus ,repisra
incres, cervical cervix softer and blue purple color breast changes larger with darker areolas
skin change maybe chloasma linea nigra line runs from navel to punic bone striae stretch
mark . supine vena cava syndrome when mom gets hypoten bp low due weight of uterus on
vena cava when she is supine position lay on back uterus push vena cava so teach to lay on her
left side or semi fowler’s position or place wedge under one hip to prevent venba cava from
being compressed from uterus

Ultrasound for comform pregn and ass baby form growth and drink full glass wter to fill
bladder to get sound except amniocentesis .Bpp ultrasound for fetal well being score 8-10
normoal less 8 is fetal asphyxia due insufficient o2 , 5 areas reactive fetal heart rate, fetal
breathing, movment gross body movemt, fetal tone, amniotic fluid volume , each of those scor
2 or 0

NST no invasire measure fetal hr response to fetal ovemnt during trimester and acoustic
vibration device may be used to help awaknen the sleeping fetus orange juice as well help ,
mom will be given like button to push when she feels movement and provider asses fetal heart
r when she pushes . this test done when mom report decrese fetal. Ovemt , diabetes
gestational mom ,hypertens or post maturity . interpretation result nst is reactive is normal
finding like hr normal and moderate variability and accelerates at least two times in 20 min
time period, if result non reactive is abno mean fetal hr no accelerate sufficiently with fetal.
Ovemnt so further assess like do CST .
CST invasive test to mesure fetal hr response to contractions so either nipple stimulation or
oxytocin is used to induce reaction , if negative result mean normal findin no late deceleration
of fetal hr with 3 contractions within 10 min if positive result is abno findin is late deceleleration
present for 50% or more contractions this indicte uteroplacental insufficiency .complication of
test due we inducing contarctions so is preterm labor .

Bleeing durging pregn : - gestestional trophoblastic disese or molar pregnancy is abno growth of
trophoblastic villi in placenta are blight clusters they prevent embryo from develop properly
can result choriocarcinoma . sign symptoms dark brown bleeding resemble prune juice nausea
vomiting abnorm high HCG , dign ultrasound . treat evacuation of the mole via curettage or
chemotherapy for choriocarcinoma .
Placenta previa when placenta implants on or near cervical ahs is bottom of uterus versus
attaching fundus is top ueterus so it result bleeding during third trimester : 3 types – complete
or total placenta previa placenta covers the entire cervical off – incomplete or partial covers
part cervical ahs – marginal or low line is when attach lower uterus but not cover cervical oz at
all . sign symptom painless bright red bleeing in seconf trimester deacrse Himatocrit and
hemoglobin key word is painless .diagn with ultra ound . nursing care no perform vaginal exams
or insert anthing vaginally admin iv fluid and blood products as prescribed educate on need for
bed rest , if feels delivery anticipated the baby then admin corticosteroids as ordred to help
promote fetal lung growth help lung mature very quickly
Abruptio placenta premature separation of placenta from uterus in third trimester I is risk of
maternal and fetal morbidity as well as mortality risk fact moms with hyperten , mom trauma
like motor vehicile accident , cocaine use , smoking . sign sympt intense uterine pain with dark
red bleeding is painful bleeding , deacr hematorict and hemoglobin , hypovolemic shock maybe
symptom to that tarchy hypoten and pallor . fetus may exhibit signs of fetal distress . nurse
care ADMIN IV FLUID AND BLOOD PRODUCTS AS ORDERD , O2 , ADMIN CORTICOSTEROID TO
HELP PROMOTE FETAL LUNG

Incompetent cervix premature dilate cervix leads to expulsion of fetus .signs symto pelvic
pressure bleeding or pink vaginal discharge and a gush of fluid which indicates membranes have
been ruptured .therapeutic procedu cervical cerclage its basically cervix sewn closed is done
around 12-14 weeks gestation the cerclage or stitch is removed around 37 weeks gestation or
when spontaneous labor occurs.teaching adhere to activity restriction or bed hydration
because dehydration lead to uterine contractions and no intercourse .
Hyperemesis gravidarum excess nausea and vomiting last 12 weeks of gestation , withing
pregnancy its fairly typicaly to haver nausea and vomiting in first 3 months but usally kind of
dies off gets better with hyperemesis goes past those 3 months maybe 9 months and while
delivering I related to elevated HCG levels. Sign symp nausea vomiting dehydration electrolyte
imbalance weight loss ketones or acetones , elevated urine specific gravity your basically
dehydrated and usually electroly your are off . nursing care monitor eyes and nose along
weight , admin iv fluid . med pyridoxine is vitamin b6 , antiemetic med , antinausea meds like
metoclopradine and odensentron oyu can go I on steroids if none of these work be on
prednisone..

Anemia due inadequate iron rish foods or inadequate iron stores .sign symptom fatigue pallor
shortness of breath low H&H hemoglobin below 11 and hematocrit below 33 % , may exhibit
pica is food cravings or eating of weird things like paper clay this indicate iron defenicy. Nurse
care eat iron food include meat green leaf veg fruit and beens. Med ferrous sulfate is iron supp
idealy taken on an emty stoma vitamin c as well for absorbtion incree , increase fluid and fiber
due iron supp has side effect of constipation .

Gestational diabetes is impaired glucose tolerance during pregn risk associate miscarriage ,
infect, prom or premature rupture of membrane , preterm labor, macrosomia , ketoacidosis ,
hyperglycemia, hypoglycemia , increase risk develop later on diabtes after pregna type 2 .sign
symtoms hypoglycemia (symptom headach weakness shakiness blurred vision diaphoresis ),
hyperglycemia( 3 P’s polyuria polydipsia polyphagia ) , nausea vom iting fruity breath odor with
hyperglycemia , gi upset is common excess weight gain during pregn often occur with
gestational diabete . diagn glucose tolerance test ( all pregnant do this )around 24-28 weeks
gestation no fasting is required if over 140 then recommend a 3 hour oral glucose tolerance test
with 3 h test overnight fasting is required n o caffeine or smoking for 12 h prior test fasting
glucose obtained and glucose levels measured at one two and three h after ingestion of a
hundress gram of glucose . treat insulin because most oral diabetic med are contraindicated
wuring pregnancy they are few may be okay if provider said okay .

Physiological changes inducate that labor and delivery is imminent for mom like backache ,
minimal weight loss like between one and 3 pounds , feeling lightening ( baby drop lower in
pelvis and can breath little more easily when that happens, experience contractions , bloody
show is where you have brown or bloody mucus discharge may have a burst of energy like
going around house and nesting and cleaning up and getting redy for baby, gi upset , if she ha
rupture of her membranes (premature repture) she may have clear watery fluid discharge
when test this fluid using nitrazine paper if it is amniotic fluid then this paper will turn blue if it
remain yello paper then chances it was just urine .
When mom pregnant she get often braxtom hicks contarctions are pretty much falsly they r
intermittent contractions and often goes away if mom walk or changes position sometimes if
she is dehydrated drink water or emty her bladder that will help these contacrion go away ,
when she experience them the cervix is not dilated and fetus is not engaged in pelvis however
real contraction is like regular in duration and between contractions and overtime will be
stonger and foes not goes away if she walk and drink or emty bladder and see cervical chenges
at the same time and baby may be engaged in pelvis these deffe between true and false labor.
Stages of labor 4 :- first stage begins with onset of labor and ends with complete dilation of
cervix to 10 cm – second stage begins with full dilation and ends swith birth of baby – thirst
stage begin with delivery of baby and end with delivery of placenta – fouth begings delivery of
placenta and ends when mom vital sign have been stabilized . first stage has 3 phases :- latent
phase the cervix dilate between 0-3 cm mom may expr mild to moderate contraction and
during this time she may be talkative she may be eager like she is ready to use her breathing
techniques and she is excited about birth of her baby – next active phase cervix dilation
between 4-7 cm mom having strong contraction she is no longer talkative and eager feeling
anxious because is really ge]tting real now and strating to hurt feel may restless and may fel
helplessness – transition phase cervix dilate between 8-10 cm mom having very stong
contractions at this point she will feel like cant go on this is out of control also this time
because birth of baby is imminent there is all this pressure that is being applied to. Moms pelvis
she may have strong urge to push or to have bowel movmen ( poo mean is in transitional phase
and first stage labor)

5ps childbirth : First p fo passenger is baby then placenta , second p passageway is basically
birth canal so if passenger the baby is too big for passageway the birth canal then we run into
prbl . Third p power is these are uterine contractions hekp promote effacement and dilation of
cervix , fourth p is position if mom is like squatting or kneeling this help promote fetal descent
an d help labor and delivery to progress more effectively versus if m om flat on her back like
stirrups it does help promote fetal descent and will slow down labor and delivery – fifth p mom
psychological response if she stresses or anxious this can impede labor .

Fisrt p: -first presentation what part is presenting at the botton at mom like what point toward
mom vagina this can be baby head , baby chin their shoulder of they r breech or their sacrum
or their feet, the we have lie will be either transverse or longitudinal or parallel , then we have
attitude so is baby flexed or extended like stretched out , postion baby describe with 3 letters
first be either R or L for right or left and refer to if the back baby head is facing towards the
moms right side then that’s an R if back head is facing toward mom’s left side that’s L . second
letter will be either O for occiput and S for sacrum and M for mentrum or an SC for scapula , if
head is coming through then that’s occiput , if baby head hyperextended and chin is presenting
part that mentum , if shoulder coming out that’s scapula if booty coming out sacrum , third
letter is either anterior posterioir or transverse so if back of head is facing toward moms
anterior side which is your front side that would be A if back head facing toward mom backside
the posterior that’s P if baby facing one side or other directly then will be transverse T . use
googlr ROA LOA to see picture position. In nclex show pict baby tell what 3 letter descbre baby
postion. Or give 3 letter you pick pic.-lastly have station describe how far the bay is into pelvis
so at level of ischial spines this station zero , if baby is farther down like toward vigina is a
position station verus farther up that negative , so if she will spines is zero as the baby coming
out then we r gonna have like plus one station plus two plus 3 station if farther up not close to
being delivred is negative station

Pain. Management during labor: - effleurage where you use fingertips to lightly stoke the moms
abdomen during contractions – sacral counter pressure use heel of hand or fist to push against
the mom sacrum if she is having back labor pain – breathing techniques and advise her to take
a cleasing breath before going into -imagery – hydrotherapy like relief by taking shower or bath
during labor relief or at least reduce it – music or hot or cold therapy . pharmacological
interventions med: sedatives such as barbiturates this can lead to neonatal respiratory
depression so use it very early phase of labor – opiod analgestics so one is meperidine can lead
to sedation tachycardia hypotension and decrse fetal hr variability and neonatal respiratory
depression , naloxone is antidote for opiod analgestics and you would only want to use opiod
analgestics once the cervix is dilated at least 4 cm becsue if you admin it too soon it can really
slow down labor and delivery right prolong process quite a bit – epidurals eliminate sensation
from umbilicus that’s belly button to thighs you admin it when mom is at least 4 cm dilated
side effects is maternal hypotension fetal bradycardia -spinal block eliminate sensation from
nipples all the way to feet we would often use this with cesarean birth side effect maternal
hypotension , fetal bardycadia , headache if we have leakage of cerebral spinal fluid , maternal
bladder and uterine atony .nursing care who is receiving epidural or spinal block admin iv fluid
to help counteract side effect of maternal hypotension , position mom on her side to prevent
supine hypotension syndrome ( if she is flat on her back the weight fetus and her belly pushes
against vena cava cause hypoten ) so put little pillow under hipper another or position on her
site then that prevent that from happening , monitor vital contininually , monitor fetal heart
rate patterns rate

Fetal HR patterns:-
- Leopold maneuvers palpate moms uterus through her abdomen to determine fetal life
and fetal attitude and the point of maximal impulse or PMI is where baby heart beat can
be heard the loudest and that’s is where we r going to place the external transducer to
monitor the fetal hr we would expect fetal hr between 110 -160 beat per min and
expect moderate variability accelerations may be present or absent early decelerations
may be present or absent but no see late decelerations or any variable deceleration in
fetal hr .
- Fetal hr patterns:- accelerations is temporary increase in fetal hr above the baseline it is
reassuring and no interventions is needed for acceleration however if we have fetal
bradycardia this where fetal hr drops below 110 for at least 10 min it can be due to
uteroplacental insufficiency , umbilical cord prolapse , maternal hypotension and
possibly due to anesthetic meds .if we have bradycardia present we want to
discontinue oxytocin if mom is receiving that we want to place the patient in a side lying
position admin oxygen and notify provider , if we have fetal tachycardia presnt fetal h
river 160 beats per min for 10 min this due maternal infection , cocaine use or possibly
dehydration if this occur may admin antipyretics as ordred by provider admin oxygen
and possibly iv fluid bolus.- early deceleration is slowing of baby HR during contraction
due to compression of baby head when mom is having that contraction no intervention
is expect finding so early deceleration is okay however late deceleration not okay is
slowing baby hr after contraction has started and it has a prolonged amount of time
before it return to baseline it happens after the contractions has started and take while
before that HR returns to norm al range so when it happens this is due to to utero
placental insufficiency , nurse interven placing patient sideline position admin iv fluid
dc oxytocin admin oxygen palpating the uterus for tachysystole which is like more
frequent and more intense contractions and notify provider .- variable deceleration is
not okay is where we have transient variable slowing of fetal hr if we have this is
 indicate umbilical cord compression so place patient in knee chest position or
reposition patient from side to side discontinues oxytocin admin oxygen
Procedure to assist with labor and delivery:
- Internal fetal monitoring place electrode on fetuses scalp to closely monitor the fetal
hr .
- EYE UPC IS INTRA UTERINE PRESSURE CATHETER TO MONITOR THE STRENGTH OF
MOMS CONTRACTIONS IF WE DO THIS WILL EXPECT CONTRACTION STRENGTH
BETWEEN 50-85 MMHG IF OVER 90 THAT CAUSE FOR CONCERN . IN ORDER TO PLACE
INTERNAL FETAL MONITOR MOM’S MEMBRANES MUST BE RUPTURED AND DILATED AT
LEAST 2 CM AND PRESENTING PART MUST BE DESCENDED . RISK WITH INTERNAL FETAL.
MONITORING INFECTOPN FOR BOTH BABY AND MOM use this only for high pregnancy
not for all mom .
- - external cephalic version ECF is where we manipulate the moms abdominal wall under
ultrasound guidance top move baby from either a transverse or breech position into a
vertex position where head is down presenting part is head and facing down , it is
performed after 37 weeks gestation , risk it has an increased risk for umbilical cord
compression as well as for placental abruption . nursing care if mom is RH negative
make sure she recived rhogam at 28 weeks gestation and then following the ECF
procedure we would perform a test that’s called kleihauer-betke test it checks for
presence of fetal blood in maternal circulation so if blood found we admin aditional
rhogam to mom , also during this procedure give iv fluid and tocolytics meds to relax
uterus and make it easier to manipulate the fetus , monitor hr and maternal vital signs
during this procedure .
Ways induce labor:- through cervical ripening this is where we would allow for cervical
sofetening effacement and dilation and we can do this through a number different ways we can
use ballon catheters , membrane stripping, dillators , chemical agnets (misoprostol ) either
oraly or vaginally help soften dilate and efface the cervix and prepare for delivery , can use
oxytocin is uterine stimulant used to increase the strength the frequency and the length of
uterine contractions , while mom in oxytocin want closly monitor her contractions as well as
fetal hr if there certain circumstances present discontent it , circumstances ar to dc oxytocin
are: contractions are happening more frequently than every two min is okay if happen only 1
min apart that’s prb need dc oxytocin , if contraction last for more than 90 se this is problem ,if
contraction intensity is ober 90 mmhg when we r using an IUPC then that would be also be
cause concern and indicate that we need dc oxytocin , if mom ‘s resting tone is greater than 20
mmhg we need dc oxytocin . just make sure contractions not happening frequently and too
strong and no lasting too long should be resting time between contraction . we can admin
terbutaline to help decrese uterine activity

-Amniotic is we rupture the moms amniotic membrane using shrap instrument by provider
performed to induce our augment labor or in preparation fo an amnio infusion . amniotic
carries risk of cord prolapse so ensure presenting part of fetus is engaged prior to performing
an amniotic , also there is increase infect so ideally want delivery to occur within 24 h of
performing an amniotic .
-Amnio infusion is using either lactated ringers or normal saline into amniotic cavity so use this
if mom has insuffi amniotic fluid in that cavity or if fetal cord compression is present .

-vacuum we are applying traction to fetal head using a cup like device the baby must be in a
vertex position so head down and we would use this if mom is exhausted or not pushing
effectively so it does carry an increase risk of maternal lacerations as well as infant subdural
hematoma or possibly kaput succedaneum
- forceps( look like salad tong) they are like spoon like blades that are used to assist in delivery
when there ‘s like abnor fetal presentation or fetal distress , risk are increased risk maternal
lacerations as well as bladder injury for mom on baby facial bruising as well as nerve palsy

Complication during labor and delivery :

- Prolapsed umbilical cord is where protrudes through the mom cervix ahead of baby and
casues cord compression and this compromises fetal circulation so there cord compress
and not enough blood getting through there to provide oxygen and nutrient to baby ,
nursing care call for assistance then insert two fingers into vagina one on either side of
cord an lift the presenting part of fetus off the cord so cord no longer compressed then
place mom in a knee chest postion or in trendlenburg position is mom head is lowe and
fett are higher to try to lift baby off that cord then you r apply a warm saline moistened
gauze or towel over cord .
- Meconium stained amniotic fluid this occur more often when a baby is in breech
position and then thing we worry about is that is often indicate fetal hypoxia so if we
have meconium strained amniotic fluid in addition to either late or variable fetal hr
decelerations this is an ominous sign so need arrange for wquipment and resource for
possible neonatal resuscitation after birth .
- Dystocia is basically difficult or abno labor due to uterine abnormalities or if birth canal
is like too small for size of baby or if there’s fetal malpresentation sign symotoms of
dystocia include insufficient progress in dilation of basement and descent of baby .if
dystocia is occurring as nurse can help with progression of labor by encouraging the
mom to change positions frequently and to ambulate , assist with an amniotamy if that
is indicated , admin oxytocin as prescribed by provider . for shoulder dystocia apply
suprapubic pressure to help assit with delivery of baby and then advise mom to be on
her hands and knees to help rotate baby from posterior to anterior , then prepare for
forceps assisted or vacuum assisted birth if needed then possible cesarean section if
that baby just not going to able to be delivred vaginally .
- -precipitous labor where labor lasts less than 3 h from the onset of contractions to the
time when baby is delivered , risk hypertonic uterine contraction oxytocin and
multiparous mom meaning a mom who has had previous births or several births , so this
labor happening a little bit more quickly , complications can occur for both the mom
amd the baby for mom lacerations tissue trauma possible uterine rupture amiotic fluid
embolism possible postpartum hemorrahe ( precipitous labor mean mom rsik
postpartum hemorrhage) in terms of baby compliactions include fetal hypoxia due to
hypertonic contraction possible for intraccarnial hemorrhage due to head trauma when
the baby is born with a precipitous labor .
 - Uterine rupture risk factor trauma like if mom in a motor vehicle accident when she is
pregnant this can result uterine rupture also over distension of uterus is risk factor so
if mom is carrying twins triplets or more this can over distend the uterus and place her
at higher risk for rupture , hyperstimulation of uterus with oxytocin is risk factor . sign
and symptom if mom is complaining of severe abdomal pain that she describe as ripping
or tearing then that should really raise a red flag immediately think about uterine
rupture , if fetal hr patterns are non reassuring meaning that you see either bardycar
variable or late decelerations or decresed variability those are potential signs and sympt
that you would see with uterine rupture , if mom exhibiting sign and symptom of
hypovolemic shock sucj as tachycadia hypotension and pallor you may suspect uterine
rupture . nuring care admin iv fluid and blood products as prescribed , prepare patient
for immediate emergency c section and possible hysterectomy .
- Smniotic fluid embolism infiltration of amniotic fluid into maternal circulation and it will
travel to an obstruct pulmonary vasculature leads respiratory distress and circulatory
claps in mom , sign and symptom if mom complaining of sudden chest pain if she is
exhibiting dyspnea cyanosis tachcardia hypotension and bleeding are all sign and
symtoms that she may have an amniotic fluid embolism . nursing care admin iv fluid and
blood products as prescribed assist with intubation and mechanical ventilation if
indicated

Postpartum assess and care:

Fundus: after birth the fundus should be firm it should be midline and it should be at level of
umbilicus which is the bellybutton, at 12 hours the fundus will be one cm above the umbilicus
and then after that it will descend one to two cm every 24h so at day 6 fundus should be
halfway between the umbilicus and the symphysis pubis and then by two weeks the uterus
should no longer be palpable because it is descended below the symphysis pubis . nursing care
assess the fundus every 8 hours , assess the fundal height the uterine placement is it midline or
is it displaced laterally , assess consistency of uterus it should be firm not boggy and check for
that every 8 h so if we find that fundus has been displaced laterally it is not midline then the
priority nursing intervention is to have your patient void empty their bladder and that will likely
take care of that prb , advise patient to void every two to 3 hours to prevent future
displacement of uterus , if fundus is boggy instead firm then our priority nursing intervention is
to massage the fundus in circular motion also admin oxytocin as prescribed to increase uterine
contractions and to prevent hemorrahaging , encourage patient breastfeed because this also
stimulates the release of naturally occurring oxytocin which help uterus contract and also
prevent bleeding .
Locjia: discharge that patient will have after give birth 3 stages :- lochia rubra which is bright
red color it is expected that the pateints’s discharge will be bright red for 1 to 3 days after
delivery of baby thyen we will move into lochia serosa : is pinkish brown color this will last for
about 4 to 10 days after delivery finally we have lochia alba which is a yellow white in color and
it will last for eleven days to 8 weeks after delivery .
Abnormal lochia if you see spurting of blood form the patient vagina that is not expected and
you would want to notify the provider right away , if patient saturates her perineal pad in under
15 min that excessive bleeing and also cause for concern its indicative of hemorrhaging if her
lochia is malordorous then that could be indicative of an infect told provider is she has lochia
rubra past day 3 that would not be normal , so check under patient for pooled lochia because
sometimes that may not be initially obvious but if you kind of lift her up and you see all this
blood then can be indicative of hemorrahagin address that.

Postpartum care for the perineum : provide stool softeners to prevent constipation and to
avoid having her strain when she is having a bowel movement , educate about perineum
cleaning after she voids should use a squeeze bottle that’s comprised of water plus an anti
septic solution , she needs make sure she is wiping front to back and blot dry versus like wipe
because its going to be very tender and painful down there for a little while , give her ice packs
to apply to her pereunium help pain as well swelling , she can use scent baths twice a day or
more to help pain , may give her pain med NSAIDs or opiod analegescis if she had c section ,
provide topical anesthertics as well as with hazel wipes if she has hemorrhoids .

Breast : breastfeeding colostrum is secreted during pregnancy and for two to 3 days
immediately following delivery is rich in antibodies and protein and fat soluble vitamins , milk is
not produced for approximately 3 to 5 days after delivery . teaching immediately after delivery
make sure baby is latched on to breast correctly so we don’t want baby just taking in the tip of
the nipple in their mouth we want to make sure they have the whole areola or part of aerial at
least in their mouth not just nipple , need to educate mom that breasfeeding produces
oxytocin which hekp the uterus to contract and prevent hemorrhaging and want her to be
alert for sign and symptom of mastitis include cracked nipples as well as flu like symtoms .

Postpartum cardiovascular changes that you would expect : in terms of blood loss if patient has
had a vaginal delivery then we would expect about 500 ml of blood loss if they have c section
this will be double approximately about 1000 ml , also after delivery expect patient coagulation
factors to be increases for two to 3 weeks which places then at higher risk for a blood clot ,
elevated wbc counts for girst week between 20000-25000 ,then you would be worries about
infec but this is to be expected after birthn due she is at high risk for a blood clot we r gonna
really want to take some steps to prevent DVT so we gonna want to assess her legs for signs of
DVT this include unilateral swelling erythema and warmth in one leg , encourage her to get up
and ambulate as mush as possible to help prevent DVT

Postpartum care in term immune system so rubella vaccine will be given to patient with a titer
that its less than one to 8 and we want to advice the patient after she receives vaccine not to
get pregnant for at least one month from seed from the time that she received that vaccine . im
term rhogan admin it within 72h of birth to RH negative moms who have given birth to Rh
positive babies in order to prevent formation of antibodies in mom which help protect baby
should she get pregnant again . hep b vaccine and immune globulin to babies born to infected
moms within 12 h of birth other vaccine given include varicella tdap those given to patients
who do not have immunity to those things

Maternal role attainment 3 phases :- dependent or taking in phase so this occurs during first 24
to 48 h after birth this is where mom relies on others for assistance she is eager to share her
birth exper with others .- dependent independent phase is taking hold phase this starts around
2 nor 3 and can last for several weeks is where mom is focused on learning how to care for her
baby like how read baby hunger cues .. – phase independent phase letting go phase is where
mom has developed her skills pretty well now she can pay attention to her rest family and to
herself she resumes her role as an intimate partner and an individ in addition to be ing a mom
at this point . signs indicate we have impaired bonding between mom and baby , if mom
ignores her baby if she is disgusted with her baby diapers or spit up if she expresses
disappointment in infant or apathy when baby cries like baby crying nad mom not doing
anything or even paying attention or doesnot even talk about infant then these are all signs
impaired bonding . nurse intervention to promote bonding between mom and her baby
promote skin on skin contact between mom and baby , encourage early breastfeeding ,
educate mom on hunger cues from infant so this poses nthe biggest risk if we think theres
impaired bonding between the two, if mom doesn’t recognize those hunger cues then baby is
not going to be getting enough food and nutrients , provide lots support and praise to mom
like when she is doing something right or you know recognizes a cute definitely pile the praise ,
encourage cuddling , diapering feeding and bathing , provide info about community resources
as well as support organizations in the community .
Paternal infant bonding sign dad is forming a good bond with baby is when holds the infant and
maintains eye contact if he kind recognize and verbalize features that are similar to his own in
baby that’s good sign , if dad is talking to singing and reading to infant good., encourage always
dad to take hands on approach to help facilitate bonding.
Interm sibling adaptation sometimes doesn’t go so well if you have got like atoddles or
preschooler and you r bringing an infant home can expect some possible regression in terms of
toileting or sleeping like say they were already potty trained and sleeping through the night
without wetting their bed then all of sudden you brin home baby and now they are wetting
their bed their pants this is kind of some regression , if sibling showing aggression towards
infant or suddenly have these behavior issues they r trying to like get attention this can indicate
kind of adverse sibling adaption to infant so educat for parent on how to promote positive
sibling at obtaintion includes making sure sibling is one the first people to se the baby so bring
sibling to hospital to see baby provide a gift from the infant to sibling so have that gift ready to
go when sibling comes to meet baby for first time if you have preschooler you can give
preschooler a doll to care for if older child you have them help provide care for baby as
appropriate

Postpartum teaching : teachy mom about breast care encourage mom to wash her hands prior
to breasfeeding she should wear supportive bra and drink lots of fluids and apply breast milk to
sore nipples amd allow that air dry , report5 sign and symptoms of mastitis to her provider
includes things like cracked and sore nipples and flu like symtoms . in terms of breast
engorgement encourage her to empty her breast with each feeding so till like breast softens all
the way she can apply cool compresses after feeding and apply warm compresses or take
warm shower prior to breastfeeding and then fresh and cold cabbage leaves can be applied for
breast engorgement if mom not going to breadfeed then we provide some education regarding
the suppression of lactation so she should werar a supportive bra for first 72 h and avoid any
kind of breast stimulation avoid having like warm water hit her breast she can use mild
analgesics as needed and shes can also apply kind of cold fresh cabbage leaves on her breast to
deal with engorgement .
Postpartum regard sexual intercourse avoid sex intercourse till vaginal discharge has turned
white that lochia alba if she had episiotomy we need make sure that is completely healed
before engaging in sexual intercourse nhappen around 2 to 4 weeks . physical reaction to sexual
stimulation may be diminished for about 3 months after delivery then use of an counter
lubricant may be needed to prevent discomfort , need warn mom that ovulation may occur as
early as one month after delivery so pregnancy can occur while mom is breasfeeding nso
definitely need discuss the use of contraception unless she wants to have babies ten months
apart.

Complications in postpartum period coagulation fractors increased for 2 to 3 weeks after

delivery so she is in high risk for DVT sign symtoms of that include unilateral leg pain swelling
warmth and redness in order to prevent dvt advise to ambulate early and frequently avoid
prolonged immobility elevate legs when sitting avoid crossing the legs kinda you cutting off the
blood flow that place you high risk for dvt , drink plenty of fluid like 2 to 3 l fluid a day no
smoking and wear anti embolic stockings like compression stockings. if she does that was dvt
nursing care interventions encourage bed rest and elevate of affected leg above level of heart ,
never have pillow or knee catch under that knee that’s affected , apply warm moist compresses
over area do not massage her leg that is contraindicated and then you could administer
analgesics and anticoagulants such as wafrin or heparin as prescribed , implement bleeding
precaution if she is on anticoagulant . – pulmonary embolism is complication of dvt blood clot
move into pulmonary vasculator occluding the vessel and obstructing blood flow to lungsb sign
symtoms include dipnia chest pain tachypnea hypotension hypoxia peripheral edema bloody
sputum . tret PE place patient in a semi fowler’s , admin oxygen as prescribed admin
thrombolytic med as prescribed includes like med like alteplase or streptokinase they all end
ase , implement bleeding precautions when they are on those thrombolytic med know that
those coagulation factors aren increased snd she will have incr4ease risk dvt and possible PE.
Postpartum hemmorrahging due to certain conditions such as ITP( idiopathic
thrombocyropenic purpura) or DiC(disseminated intravascular coagulation ) other risk of
factors for hemorrhaging include uterus should be firm not boggy (boggy is risk
hemorrhaging) , precipitous delivery delivery within 3 h baby come, fast retained placental
fragments ,lashes lacerations are hematomas that mom may have sustained during the delivery
process ,use of magnesium sulfate during labor , inversion of uterus . sign symptoms if mom
saturates her pad her perenium pad under 15 min indicate definitely hemorrhaging , blod clots
that are bigger than a quarter , tachycard, hypotension, cool clammy skin , if mom has constant
boozing of blood from the vagina that definitely a key sign amd symto need to let provider
know , if her HNH is decrses so if her hemoglobin and hematocrit decrse this indicate of
hemorrhaging . nuring care if mom has uterine atony if that uterus is boggy want firmly massge
the uterus and make sure it firms up , admin oxygen iv fluid blood products as prscribed ,
elevate mom’s legs to promote venous return of blood n, admin oxytocin and misoprostol to
help stimulate uterus and get it for firm up and to stop that bleeding
Postpartum infection: -endometritis n risk factor associate with getting endometritis include c
section , having retained placental fragments , having prolonged rupture of membrane if mom
membrane rupture then we want delivery to happen within a 24 h period of time if it goes
longer than that then that places mom higher risl for endometritis also if we wear using
internal fetal monitoring or internal uterine monitoring then this also risk for endometritis .
sign and symtoms include pelvic pain flu like symtoms such as fever body aches malaise also if
she has excessive or mount odorous lochia this can be indicative of animtritis and if we run lab
work her wbc count may also br elevated . nursing care collect vaginal and blood cultures as
ordred , admin antibiotic and analgesics as prescribed , reinforce the importance of good hand
hygiene with mom.- mastitis infection breast risk factors include having blocked duct using
poor brestfeeding technique , so if mom letting baby just like suck nipple baby not getting at
least part of aerao is this mouth then this place mom at higher risk for mastitis if mom is using
inadequate hand hygiene prior to brasfeeding . sign symotom painful reddened area that is
hard on one breast ,mom also may have flu like symtoms include fever body aches malaise ,
then if we run lab wbc count elevate . nursing c are antibiotic as ordred , educate mom so she
needs to make sure she wahse her hands prior to bresfeeding , breastfeed frequently and to
emty her breasts with each feeding so if it is too painful to have her baby feed and to empty
entire breast she can use pump after the baby done feeding to help empty that breast so those
are some keys teaching points .- urinary tract infection uti rsik associate with it include urinary
catheterization frequent pelvic examination and having c section .sign symtoms include urinary
urgency frequency and pain also may she have symtoms such as like fevr chills malaise and her
urine may be cloudy and or mal odorous if we run urinalysis her urine will be positive for
presence of bacteria wbc and possible rbc as well . nursing care obtain urine sample fo
urinalysis admin antibiotic as prescribed educate mom wipe front to back increase fluid intake
3 l a day cranberry juice to prevent future utis .
Postpartum mental health :- postpartum blues last no more than 10 days after delivery of baby
symptom include crying insomnia decrase appetite and a feeling letdown with postpartum
blues this resolve without interventions.- postpartum depression sign symtoms persistent
feelings of sadness intense mood swings lack of appetite possible like apathy towards the
infant anxiety and panic attacks typically require intervention so provide education to mom if
she is just having some of these thing of blue , if those feelings kind of persist and are more
intense then chances are she may need intervention definitely notify provider .- postpartum
psychosis occir within first couple weeks after delivery risk factor key with someone getting
postpartum psychosis is a history of bipolar disorder symtoms include confusion delusions
halluciantions paranoia the maintnig we worry about is patient and/or baby may be at risk for
harm so definitely get mom who exhibiting these symtoms some immediate help to provide for
safety for everyone
Pediatric

Parenting Styles, Piaget, Erikson and Best

Practices for Examining Children
Authoritative poarentive style best authoritarian no good

all right this video will start the first part of our pediatric nursing video series if you are
following along with cards I'm in the blue section starting on card one so we're going to
be talking about nursing care and assessment of children from birth allthe way to 20 years of age
so let's go over some key basic concepts that you need to know so first of all I would be
familiar with the different parenting styles so there are four that I'm going to go over here
the first is an authoritarian parenting style which is the same as a dictatorial parenting style so
this is where the parent controls their child's behavior through unquestioned rules and
expectations so it's like my way or the highway it's overly strict then the second parenting style I
would know is permissive this is where the parent has. little control over the child's behavior
and they actually consult the child when making decisions and then the third
style is authoritative or democratic. parenting style this is where the parent
sets some rules but they will explain the reasons behind the rules and they
also enforce the rules so there will be consequences if the child does not follow the rules but it's
less strict and less like this is what you need to do and I'm not going to explain why which is
more of a Thor eteri in' type of style and then the last parenting style is a passive parenting style
this is where the parent is pretty much uninvolved and indifferent to the
child's behavior so they're doing their own thing and they're like do whatever you want so in
terms of what isconsidered like the best parenting style it is the authoritative parenting style
or democratic parenting style soauthoritative sounds a lot like authoritarian so how do you not
mix those two things up well the way I remember it is that authoritarian starts with or doesn't
start but ends with the letter n so I think that is not a very good parenting style and authoritative
ends with V like ve so I think it's a very good parenting style so that's how I remember that
authoritative is very good and authoritarian is not very good okay so
let's talk about some theories that are important to note so we have Piaget theory of cognitive
development there are a lot of details that you can memorize with this theory basically I
would be familiar with what the four stages are what the age ranges are for
each stage and what the goal is at each stage so the first stage is the sensorimotor stage this goes
from birth to about two years of age the goal during this stage is to achieve the
object permanence so this usually happens around nine months of age the second stage is the pre-
operational stage this goes from two years to about seven years old and the goal during this
phase is symbolic thought and then the third stage is concrete operational this goes from seven
years to about eleven years old and the goal during this time
is operational thought the child will begin to see the perspective of others up until then they're
kind of more self centered you know and just see the things in a very egocentric way but starting
in this phase they will start seeing the perspective of others and be able to empathize with others
and then the last stage is the formal operational stage this goes from eleven years
through adulthood so during this time the goal is to grasp abstract concepts so that's Piaget
Erikson so we have Erikson theory of psychosocial development with this theory again I
would be familiar with the different stages roughly what the age ranges are and what the like
what the goal is during that time or what the crisis is
in this case so with infancy this is considered between like birth and like eighteen months for this
theory the crisis at this age is trust versus mistrust so if you take
care of your infant feed them when they're hungry hold them when they're crying like basically
build trust with your infant then that that goal is met during that time the second phase is early
childhood which extends from around 18 months to about three years of age during this time the
crisis is autonomy versus shame and doubt so the way I remember this is this is like
right around the terrible - who's like 2 to 3 years old and I remember my
daughter always saying I do self so you try to help her or have her do something and she you
know like I do self so she was really exerting her autonomy during
this time so that's how I remember that this during this time autonomy versus
shame and doubt is the crisis at this time then preschool is the next stage so this goes from about
3 years of age to about 6 years of age the crisis at this
stage is initiative versus guilt and then we have school-aged children which is about 6 years of
age through 12 years of age and the crisis during this time
is industry versus inferiority and then adolescence goes from 12 to 20 years of
age and during this time the crisis is identity versus role confusion which
kind of makes sense like when you are a teenager you're really trying to get
that identity you're trying to figure out how you fit in what's unique to you
you've really developing that identity and then you have young adulthood which goes from about
20 to 40 years of age and this is where you have the crisis of intimacy versus isolation and then
middle adulthood goes from about 40 to 65 years of age and during this time the
crisis is generativity versus stagnation and then lastly we have maturity which is from 65 years of
age and older where the crisis is ego integrity versus
despair so again there could be many details you would memorize that you could memorize with
each of these stages but again I would be familiar with the crisis at each stage the age range at
each stage and that's pretty much it I think you can get away with that okay let's talk about when
we're doing a physical examination of children what are some best practices so some best
practices include keeping the medical equipment out of sight until you really
need to use it you don't want to have like syringes for their vaccinations
prominently displayed to like freak them out until you're actually ready to use
those so kind of keep medical equipment out of sight you want to use
age-appropriate language instead of you know medical jargon so you don't want to
confuse the child you want to just use age-appropriate language very simple easy to understand
words you want to possibly demonstrate assessment on a doll or a puppet so if you've got like a
little teddy bear doll you can show what you're about to do so that the child
sees that it's not really that big of a deal and that their little teddy bear
got this done so they can easily get it done you can allow the child to handle the equipment if it's
safe you know
depending on the equipment or you can have like little play equipment like a
play stethoscope or things like that to try to get the child more comfortable
you can also allow the child to roleplay using the play equipment so you could be like oh listen
to your teddy bears heartbeat and this is how you do it and that will get the child more
comfortable with the whole assessment process and then you always want to
allow the child to sit on the parents lap if they want and you never like kick
the parent out of the room or anything you really it's all about making the
child more comfortable and trusting the provider trusting you as a nurse to just
you know be able to relax and get through the assessment so when you're doing your assessment
of child a lot of the same things apply as when you're doing a head-to-toe
assessment on an adult so when you forexample are listening to their lungs you shouldn't hear
crackles you shouldn't see like substernal retractions or
grunting same type of thing with adults right when you're listening to the
child's heart you shouldn't hear extra heart sounds or murmurs or things like
that or any like you know pericardial friction rubs again that's gonna be the
same as it is for adults the cranial nerves the cranial nerves will be the
same on a child as they are for an adult so as long as you know your cranial
nerves you would assess them in the same way as you do with adults roughly on children so that
being said there are some key differences in your assessment
and we will really be focusing on those in the coming videos like what is different with children
what is expected what is not expected what do you do
about itthat type of thing so I am going to stop here when I pick it up we will first
talk about vital signs with children and the key differences that you find with children versus
with adults so thanks for watching and stay tuned
English (auto-generated)

ital Signs, Physical Assessment and Infant

Reflexes

okay in this video we're gonna start off by talking about vital signs for children so I wouldn't get
hung up on very specific numbers at each age range like birth the 1 1 to 2 2 to 3 like what
the differences are I would however be familiar with trends so let's talk about some of those
trends that you need to know so for temperature the baby or child's temperature will be higher
when they're younger so at 1 years old the average temperature that you can expect is 99.9
degrees Fahrenheit which as an adult that would be a little high that'd be like a low-grade fever
but as a one-year-old it's expected and normal to have that higher temperature so when
they get to about 5 years old then the average temperature is 98.6 which is definitely more in line
with the expected temperature as an adult for pulse the child's pulse will definitely be faster when
they're younger as a baby it can be between like 80 and 180 beats per minute which is really fast
if you had an adult with a pulse of 180 you're probably calling a rapid response that's
way out of range but for a newborn that's completely expected at 2 to 10 years age the pulse may
be between 60 and 100 and 10 bees per minute which is pretty consistent with what you would
see in an adult in terms of respirations these will also be faster when the child is younger so as a
newborn you would see respiration rate between 30 and 35 breaths per minute it's not until the
child is between like 6 and 12 years old that you see a range between like 19 and 21 breaths per
minute which is more similar to what you would expect with adults blood pressure blood
pressure on the other hand will be lower in children than it is as an adult so with infants
you may get a systolic blood pressure between like 65 and 78 and a diastolic blood pressure
between 41 and 50 – that is super lowyou had an adult patient with a blood
pressure of 70 over 45 you're also going to be calling a rapid response because they likely have
sepsis or they're hemorrhaging or something because that's way too low as an adult so just know
that as an infant that is an okay range like that blood pressure I just mentioned that would be
totally expected and normal for an infant so as the child gets older so around 10 years of age
you're gonna see a little higher blood pressure so it may vary between 97 and 134 systolic and
vary between 58 and 94 diastolic so more in line with what you would see as an adult but in
general what pressure is very low as a child and then gradually increases as the child
gets older okay so those are the trends I want you to know four vital signs let's start getting into
physical assessment of the infant so as I described in my last video in general we're looking for a
lot of the same things as we are when we're doing a head-to-toe on adult an adult but there
are some key differences and I'm going to talk about that here so let's first talk about fontanel's so
fontanel's are not something you find on adults so you're gonna need to be able to do a
specific assessment for those on children so fontanel's should not be bulging and
they should not be sunken they should be flat and soft okay the posterior fontanelle closes at six
to eight weeks and that's a very important number to remember the anterior fontanelle closes
between 12 and 18 months so you definitely have to know the difference and when they're
expected to close between the posterior and anterior so definitely remember that in terms of
height and weight of an infant the birth weight will double approximately at six
months and it will triple at one year and that's also a really important thing to know infants will
grow about one inch per month for the first six months so that's about two point five centimeters
and their length will increase by 50% at one year as compared to when it was how long they
were at birth in terms of dentition so we're talking teeth the first tooth will usually erupt between
six and ten months of age starting with the lower central incisor teeth children will have about
six to eight teeth when hey are one years old signs of teething if you're a parent you probably
know what this looks like but it's like pulling on ears drooling fussiness and sleeping issues in
terms of how to care for your infant's teeth you really want to clean the teeth with a cool wet
washcloth all right so now let's talk about infant reflexes so there are seven to be familiar
familiar with I would know how to elicit those reflexes and the age ranges that they're expected
to be present if these reflexes are present past the expected age range that is not an expected
finding and that would be cause for concern so let's talk about the seven reflexes and the age
ranges and how to elicit those reflexes sofirst of all we have the sucking or rooting reflex so this
is where you if you rub the baby's cheek they will turn towards that side and start to suck so
the expected age range for having this reflex is birth to about four months of age then you have
the Palmer grasp so this is where you would place an object in the baby's palm they would grasp
the object you would see this present between birth and about three months of age then you have
the plantar plantar grasp this is where you would touch the sole of the foot on the baby and they
would curl their toes you would expect to see this between birth and about eight months of age
and then you have the Moro reflex which is basically the infant's response to lack of support or
falling so if you kind of let them kind of fall back a little bit their arms and legs will extend and
their fingers will form this like C shape so you would expect to see the moral reflux present
between birth and four months of age then you have the tonic neck reflex so when the infant's
head is turned to one side the arm and the leg on that side will extend and the arm and the leg on
the other side will flex so you would expect to see this between birth and a you know two about
three or four months of age and then you have the bin ski's reflex this is an important one to
remember you would elicit this by stroking the outer edge of the baby's like the sole of their foot
and that toes should fan up and out okay you would expect to see this for the first year of age
if the Babinski reflex extends beyond that like when they're like four or five then that would be
an unexpected finding and then you have these stepping reflex so this is the way you would elicit
this is touching the infant's feet to a flat surface and they will respond by like making stepping
movements so you would expect this for basically the first month of age from birth to about four
weeks old so I am going to stop here when we come back we're going to talk about gross and
fine motor skills and what we can expect kind of at each month during the first year

Infants: Gross and Fine Motor Skills,

Language and Age-appropriate Activities
okay in this video we're gonna continue to talk about infant assessment and care so we're gonna
start by talking about gross motor skills and fine motor skills there's a lot of growth and
development in those areas during the first year so you do need to know that at each month
what new skill or what milestone the infant achieves so let's first talk about gross motor skills at
1 month of age the infant will still be demonstrating head lag so head lag is basically like poor
head neck control so they're just not able to kind of keep their head like upright and in line with
their shoulders at 2 months of age they will raise their head when they're prone so if you place
your baby on their tummy they will raise their head up and then naround 3 months of age only
slight head lag will remain they should not really have any head Lac present around 4
months of age so they shouldn't have that like bubbly head where they can't hold it up at 4
months of age as well they should be able to roll from their back to their side at 5 months they
should be able to roll from their front to their back and then at 6 months they should be able to
roll from their back to their front so that's the hardest one for them to do at 7 months they should
be able to sit up by leaning forward and kind of supporting themselves with both of their hands
and then at 8 months they can sit up unsupported so they don't have to lean forward on hands
they can actually just sit up normally that's an important milestone to know and then at
9 months they should be able to pull up to a standing position and also creep on their hands and
knees 10 months they should be able to go from prone a prone position to sitting and then at 11
months they should be able to walk along while holding on to something and then at 12 months
they should be able to sit down from a standing position so those are some important gross motor
skill milestones that I'd be familiar with if you have the cards they're on card nine so it's good
good for memorization that way okay let's talk about fine motor skills so at one month
the infant will have their grasp reflex present so we talked about the reflexes in my previous
video so they'll have that reflex still present at three months they should no longer have that
grasp reflex present at six months they should be able to hold a bottle themselves at seven
months they should be able to move objects from hand to hand at nine months they will have a
crude pincer grasp so a pincer grasp is where you use kinda like the forefinger
and thumb to hold something so it'll be kind of a crude pincer grasp and then at ten months they
should be able to grab a rattle by the handle and kind of shake that around and then an eleven
months they should develop a neater pincer grasp and be able to put objects in a
container using that neater pincer grasp and then at twelve months this is an important one to
know if you're in nursing school they should be able to try and build a two block tower
unsuccessfully so they will not be able to do it successfully it will be an unsuccessful attempt at a
two block tower so I definitely know that okay let's talk a little bit about some language
milestones that you can expect with infants so we would expect an infant to have like at least one
word by about ten months of age and then approximately three to five words by one
year of age in terms of separation anxiety this is definitely expected and normal that a baby
would exhibit separation anxiety so this is where a baby would protest once separated from
their parent you would see this begin around four to eight months of age and then stranger fear is
another thing that is common and expected so this is where a baby is less likely to accept a
stranger someone they don't know this is evident between six and eight months of age so in terms
of age-appropriate activities the baby will the infant will be engaging in solitary play so this is
they're not interacting with other children at this page at this phase you don't expect them to like
have this collaborative type play with other children they'll be playing by themselves solitary
play is expected at this age so appropriate toys can include rattles blocks balls teething toys
nesting toys and like playing patty-cake okay so those are expected kind of activities and toys
that you would expect an infant to play with and I am going to stop here when we pick it up in

 Infants, Immunizations, Nutrition and

Safety

okay in this video we're gonna start by talking about immunisations that the
baby needs to get within their first year of life there are a lot but I have a couple tricks that may
help you so at birth the baby will only get one vaccine and that is for Hep B so that's
fairly easy to remember but at two months they're gonna get a whole bunch of vaccines so the
mnemonic that I like to use use is be doctor hip so the B stands for Hep B so that'll be the
second Hep B vaccination they get there at two months the D for doctor stands for DTaP the R
and dr. stands for RV or roto virus vaccine the H in hip will stand for the hip vaccine HIV the I
will stand for IPV and the P will stand for PCV okay so be doctor hip at four months
we're gonna drop the B part of that and just have dr. hip so they will get all those vaccines I just
talked about at two months but not the Hep B again yet and then at six months we're gonna
remember these vaccines by the mnemonic be doctor hip again so at two months and
at six months they're getting the same vaccines but again at four months word rocket dropping
the Hep B all right and then we also need to remember in addition to those vaccines that starting
at six months of age we would expect the baby to get their annual flu vaccine so that starts at six
months so those that's kind of an easy way to remember or easier way to remember the
immunizations during the first year and we'll go over more immunizations when we talk about
toddlers okay let's talk about some infant nutrition now so we would expect the baby during the
first year of their life to be either breastfed or use iron fortified formula you would not give the
baby cow's milk during the first year of life whole milk can be given start at one year of age you
also want to begin giving the baby vitamin D supplements within the first few days of
life because again vitamin D is necessary for the absorption of calcium alternate sources of fluid
beyond like the breast milk or the formula is not needed so you're not going to need to give the
baby water you're not gonna need to give the baby juice or anything else the only fluid they need
is that breast milk or that formula so that's an important thing to know you're going to
introduce solids to the baby around four to six months of age when the baby has voluntary
control of their head and neck so again when they have that head lag we're definitely not gonna
try to feed them we want them be able to sit upright and have control of that head and neck the
first food that we introduce is iron fortified cereal and then we introduce foods one at a time over
a five to seven period five to seven day period to identify any possible allergies so we
start with the iron fortified cereal and then we'll add one food at a time for five to seven days
make sure they don't have any reactions to that and then add a second food after that and let's
keep going with that in terms of choking hazards we definitely want to avoid certain foods that
pose choking hazards for infants as well as toddlers these foods are really important for you to
know for your exam so this includes popcorn raisins peanuts grapes raw carrots so like really soft
cooked carrots are okay but not raw carrots hotdogs are a no-no celery peanut butter
candy and tough knee these are all foods that pose a choking hazard and should be avoided in
infants you also want to take measures to prevent burns in infants and toddlers so you want to
turn handles of pots and pans towards the back of the stove not have them like hanging out
where they can grab them you want to cover the electrical outlets you want to turn your water
heater temperature down to below 120 degrees Fahrenheit that's a super important one
to know you want to apply a waterproof sunscreen on the infant and you want to use an SPF at
least 15 or higher likely much higher and you want to reapply that sunscreen every two to three
hours and avoid but however avoid liberal application of sunscreen on infants who are under six
months of age you can also you also want to dress your children in tight weave cotton fabric
which allows for sun protection other safety things you want to prevent drowning in the
infant so you never want to leave the baby unattended around water sources so
this includes bathtubs toilets cleaning buckets and pools you want to close the
bathroom doors and lock the toilet seats so that the baby doesn't accidentally drowned
in terms of crib safety you're gonna want to always place your infant on their back to sleep super
important so placing on their back is the safest way for them to sleep it will help to
prevent SIDS which is sudden infant death syndrome you do not want to place anything in the
crib with the baby so no stuffed animals pillows that type of thing you want to use a firm
mattress and a snug fitting crib mattress and you want to remove crib Mobile's by four to five
months old because they can start grabbing that and possibly you know hurt themselves and then
most importantly you want to make sure that the crib slats are less than two and three eighths
inches apart so it's like a random little number but it's a really important number to know so two
and three eighths inch is as wide as you want to see those crib slats so if those crib slats are two-
and-a-half inches apart that is too wide and that is not safe for the baby and then finally when
it comes to car seats you want the baby in a rear facing car seat until two years old they
should be in the backseat ideally in the middle and then you want to use lower anchors and
tethers to secure the seat if those are available in the car you want to position the car seat at a 45
degree angle and position the harness at or just below the infant's shoulders so that some
important car seat safety information to remember so that's it with infants so we will pick it up
and talk about toddlers .

Toddlers

okay in this video we're going to talk about toddlers so let's first talk about expected weight and
height so at two-and-a-half years old so this is thirty months old we would expect a toddler's
weight to be approximately four times their birth weight in terms of height we would expect
toddlers to gain about three inches per year which is approximately seven point five centimeters
their head circumference should roughly be equal to their chest circumference between one and
two years old in terms of language when a toddler is one year old we would expect expect
them to use what's called hollow phrases which are one-word sentences at two
years of age we would expect them to use sentences that contain two to three words each in
terms of age-appropriate activities some things we would expect the toddler to play with include
blocks push pool toys large piece puzzles and puppets so if you remember when we are
talking about infants it is expected that they engage in solitary play with toddlers we would
expect them to Gaede engage in parallel play so they will be playing next to their friend there are
another toddler but they're not playing with them in terms of like doing anything that requires
like cooperation so they're both playing and just playing next to each other so that's called
parallel play toilet-training so toilet training usually begins between like two and three years of
age it really should begin when the toddler has a sensation of needing to either defecate or
urinate until they have that like recognition that they need to do that and then it's
probably premature to begin toilet training in terms of gross and fine motor skills let's talk about
what we can expect during the toddler years so at fifteen months we would expect our toddler to
walk without help and to successfully be able to build a two-block Tower at 18 months the
toddler should be able to throw a ball overhand and jump in place using both feet they should be
able to use a spoon without rotation and they should be able to build a three to four block tower
at two years the toddler can go up and down stairs by placing both feet on both on the steps so
they're not going like one foot at a time like we would they would be doing this and then
back down like that at two years they are also able to build a six to seven block tower and then at
two and a half years of age we would expect the toddler to be able to stand on one foot at least
momentarily and then draw a circle in terms of fighting fine motor skills and then let's talk
about immunizations so we had our tips when it came to the first year of life the tip I want to
offer here is the phrase I'm HPV so I apostrophe M H P V so that stands for the letters of the
immunizations that they will need during this time so the AI is for IPV now they're getting three
doses of the IPV if they got the third dose at six months then we don't need another one here so
you may be able to drop the eye so that third dose of IPV happens between six and eighteen
months so a lot of toddlers get it at six months but it may be a year and it could be as late as
eighteen months so that's the eye the M stands for MMR so that is the MMR vaccine that
H stands for hip HIV the P stands for PCV and the V stands for varicella so there's a couple new
immunisations in here which are the MMR and the varicella vaccines that you don't see during
the first year of life at 12 to 23 months so somewhere in that range the toddler is also going to get
their hep a vaccination so they get the Hep A in two doses at least six months apart and then
between 15 and 18 months of age they would get DTaP okay and then of just like when we were
talking about flu vaccines for infants starting at six months when when the baby grows older and
they're a toddler they should get their annual flu vaccine really from here on out in terms of
nutrition we want to switch the toddler from whole milk to low-fat milk around two years of age
we also want to limit juice consumption so this is a really important one to four to six ounces per
day and we want to avoid choking hazards which we went over in my last video we want to
supervise the child during meals just in case they do choke and we also want to cut food into
bite-sized pieces to prevent choking so that is it for toddlers when we come back we will start
going over preschool age children

Preschoolers and School Age Children

okay in this video we're going to talk about preschoolers and school-aged children so let's first
talk about preschoolers and what kind of growth we can expect so in terms of weight we would
expect a preschooler to gain between four and a half and six and a half pounds a year in terms of
height we would expect them to grow between two and a half and three and a half inches
per year in terms of gross and fine motor skill type milestones that we find during the preschool
years at three years old we would expect our preschooler to be able to ride a tricycle so that one's
pretty easy to remember because a tricycle has three wheels so at three years old they should
be able to ride a tricycle also at this age they should be able to jump off the bottom step of some
stairs at four years old they should be able to skip and hop on one foot they should be able to
throw a ball overhead and use scissors to cut out a shape at five years old they should build a
jump rope and draw a stick figure with seven body parts and then at six years old they should be
able to identify their right versus their left hand and use a utensil to like spread peanut butter or
butter in terms of some key beliefs that happened during the preschool years there's several that
are very important to know so one is the concept of magical thinking so this is where a
preschooler will believe that their thoughts can cause events to occur so if something bad
happens to a sibling or to their mom and dad they may think it's because they
were naughty like they did something bad and they caused this event to happen they also have
the belief in animism so this is where inanimate objects are alive like their little stuffed dog or
their doll they're like a real person and they're talking and doing things like a like I'm someone
who's alive and then time so if you tell a preschooler that mom will be home at 4:30 p.m.
they're not going to really understand that there no that's not going to make sense to them but if
you tell them mommy will be home after your nap this afternoon then that makes more sense in
terms of be able to kind of identify time they're not gonna be able to tell time on a
clock or understand like 4:30 p.m. but they can understand events taking place relative to some
of their daily activities in terms of age-appropriate activities for preschoolers you can find
them playing ball playing with puzzles tricycles dress-up pretend and role-playing painting and
reading books so those are all age-appropriate activities for preschoolers in terms of the type of
play with other children we would expect preschoolers to engage in associative play so this is
where children are playing together there's some interaction but it's not very organized okay so
before with toddlers we had the parallel play right now we have associative play again there's
more interaction but no organization really all right let's talk about immunisations so between
four and six years old I remember the immunizations using the word dim di M so the D stands
for D tap the I stands for IPV and the M stands for MMR also during this time we want
the preschooler to get their annual flu vaccines in terms of nutrition preschoolers need roughly
half the calories of adults we want to make sure we're providing at least five servings
of fruits and veggies a day for our preschooler and then in terms of activity we want to limit their
screen time officially to under two hours a day but honestly it probably should be a lot
less than that and then we want to allow for at least an hour of physical activity per day for
preschoolers in terms of sleep preschoolers need a lot of sleep so we are expecting them to sleep
about 12 hours each night we want a consistent bedtime routine for preschoolers and that's very
important and want to avoid allowing preschoolers to sleep with their parents and we can
provide a nightlight if needed for our preschooler okay school-aged children so this is children 6
to 12 years of age in terms of weight we're going to expect the same kind of growth as we did
with preschoolers so that's about four and a half to six and F six and a half pounds
a year in terms of height we would expect a growth of two inches per year and then in terms of
age-appropriate activities during this time period we would expect interactions with the peer
group so that's gonna be really really important so we're gonna expect competitive play and
cooperative play they may play board or video games jump rope bicycles organized sports and a
variety of crafts and hobbies so again now we're playing together it's organized it's cooperative or
competitive in terms of sleep needed at age 11 we would expect an
eleven-year-old to need approximately not 9 hours of sleep per night in terms of immunisations
at 11 to 12 years of age the child should get Tdap there HPV
vaccine and a meningitis vaccine and then of course they're getting their annual flu vaccine and
then let's talk a little bit about injury prevention for both preschoolers as well as school-aged
children so we always want to encourage the use of protective equipment when
they're out bicycling or skateboarding or skating so that means like a helmet
and pads we want to lock away firearms and make sure that the ammunition like the bullets are
stored separately than the guns and we want to lock away all
cleaners and chemicals we want to set the water heater temperature less than 120 degrees which I
know I've mentioned that on a previous video but it's really important for you to know you do
not want to leave children unattended by any body of water including pools and you
want to have your child use aforward-facing car seat or booster seat
and they are four foot nine inches tall and the backseat is safest bicycle safety you want to make
sure you're educating your child make sure that bikes the right size first of all and then you
want to educate them to ride in a single-file line versus side by side and
in the direction of traffic they should wear light-colored clothing with fluorescent material so that
they are highly visible to cars so that is it
Adolescents and Safe Medication
Administration
okay in this video we're going to start off by talking about adolescence and
then we're going to get into safe medication administration for the pediatric population
so with adolescents we would expect girls to stop growing between two and two and a
half years after the onset of menarche menarche is a fancy way of saying when they get
their period boys will stop growing at approximately 18 to 20 years of age I
would definitely know the order of sexual maturation in girls versus boys
so with girls you're going to have development of breasts first then pubic
hair then axillary hair and then menstruation with boys we're going to
have testicular growth pubic hair development penile enlargement axillary hair facial
hair and then voice changes so definitely know those if you're following with cards I'm
on 24 and those are listed there age-appropriate
activities for teens include video games music sports reading and possibly taking
care of a pet in terms of immunisations between 16 and 18 years of age we want
to give the teen an MCB 4 booster so this is for meningitis particularly if the teen is
going to be going off to college in a dormitory type of setting that's a very crowded
environment and the risk for meningitis goes up in that kind of environment so we
definitely want to protect them against meningitis and of course we want to give them an
annual flu vaccine as well in terms of injury prevention automobile safety is
going to be really important during this time so you definitely want to teach
your teen to wear their seatbelt not use their cell phone while driving they should never
drive impaired or ride with anybody else who's impaired and then
also during this time you really want to monitor your teen for mental health
issues including the presence of self-harm and then you want to discuss the risks of
substance abuse with your teen and monitor for signs of substance abuse as well okay
so that's it in terms of going through birth through adolescence through 20 years of age
we're going to go over some safe medication administration principles when providing
medication to children so when we're talking about oral medication
administration we want to use the smallest measuring device possible when
administering this type of medication so we want to use a syringe for small amounts and
use a medicine cup for large amounts we never want to use like a teaspoon or a
tablespoon from our kitchen to administer this medication we want to avoid mixing
medication with formula because if the baby or toddler
is not gonna drink the rest of the formula if they don't drink it all they're not getting their
medication we can add flavoring to medication to make it more tolerable and we can
also use a nipple to allow an infant to like suck the medication we want to place a small
amount of the medication in the side of the child's mouth and we can Stroke under the
child's chin and kind of hold their cheeks together to promote
swallowing so those are some best practices when it moves during oral medication to
children in terms of optic medications so this is like eye drops you want to use one hand
to pull the lower eyelid downward while instilling
the medication into the conjunctival sack for I ain't miss you want to apply from the inner
to the outer canthus of the eye and you want to apply it before nap or bedtime because
those appointments can temporarily cause
blurred vision in the child if you're applying both eye drops and I aunt meant
for the child you want to apply the eye drops first wait about three minutes and
then apply the ointment in terms of otic medications so for the ear you want to
pull the pinna down and back for children under three and you want to pull the pinna up
and back for children over three and then for intradermal injections you want
to use a 26 to 30 gauge needle with the
bevel up at a 15 degree angle so almost kind of flat and then for subcutaneous
injections you want to insert into fat tissue so common sites can include the abdomen
and the anterior thigh as well as the lateral upper arm you want to use a 26 to 30 gauge
needle inject less than a half a milliliter and insert it at a 90 degree angle you can insert
it at a 45 degree angle for very thin children for intramuscular injections we want to use
a 22 to 25 gauge needle it should be 0.5 to 1 inch in length and we want to
inject do the injection in the vastus lateralis the ventral gluteal or the
deltoid muscle so for infants and small
children the vastus lateralis is preferred and that's a super important thing to know okay
and then for IV medication administration we want to use a 22 24 gauge catheter we
want to apply em la creme 60 minutes before the procedure so we're gonna put the
cream on we're gonna top it with an occlusive dressing and then prior to you're gonna
wait your 60 minutes and then prior to the procedure you're gonna remove the
dressing and cleanse the skin and then do the injection you want to use a
treatment room for painful procedures versus the child's bed or playroom so
you want to keep those kind of safe places like the playroom you don't want
to be that to be a place where you do painful things so taking the child to a
treatment room is sometimes a better option you want to keep keep IV equipment out of
sight until the procedure begins and you can always
allow the patient the parents to stay if desired so often the child will want the
parents to stay and that's totally good you want to offer choices for the child
and use play therapy whenever possible and then you want to swaddle infants and offer
sucrose or other non-nutritive sucking before during and after the
procedure so that non-nutritive sucking is really calming for the baby and is definitely
something you're going to want to have happen while you're doing these painful
procedures as a pain relief mechanism so that is it for. medication administration

Nursing - Pain Assessment, Hospitalization

and Death/Dying
okay in this video we are going to
finish up part 1 of my pediatric video
series so we are first going to talk about pain assessment for children if
you are following along with cards I'm
on card 30 there's a lot of details to remember here so I would know the different pain scales I
would know what age range you would use each scale for
and then I would know the components of each scale so first up is the cries scale so that CRI
es you would use this scale for infants under six months of age components include crying
requires o2 increased vital signs expression and sleepless the flat scale could be used from ages
to months to seven years components of the flacc scale include face legs activity
cry and console ability then we have the faces scale which can be used from ages
three and up so in this scale it uses a diagram of six faces to help rate the child's pain on a scale
from zero to five and then you have that outer scale which can be used from ages 3 to 13 years of
age it uses six photographs to rate pain on a
scale from zero to five and then you have the numeric scale which is what we
use for adults primarily you can use that for children ages five and older so
not below that so this is where you would have the child rate their pain on
a scale from zero to ten zero being no pain ten being the worst pain they've
ever had and then you have a non communicating child's pain checklist so this can be used for
children three and up and you basically basically you're going to observe the child's behaviors
for ten minutes in order to really gauge
their level of pain when they cannot communicate all right so that's pain assessment let's talk
about hospitalization and. this is how each age range kind of deals with hospitalization and
illness so as an infant they have no ability to verbalize their discomfort which is very
frustrating as a parent when you have an infant you know something's wrong but
you don't know exactly what's wrong because they can't verbalize it so important thing to do
when you're dealing with an infant who is sick is that you want to provide consistency in
caregivers when you have a toddler they also have a limited ability to verbalize
discomfort and follow directions so they may be a little verbalize a little bit
but not a lot so they may exhibit separation anxiety during this time and
they may exhibit regression so you may have like a toddler who was
potty-trained but when they're sick or dealing with a hospitalization they may regress back to
wetting their pants again you should encourage parents to provide routine care for the toddler
while they're in the hospital as much as possible for preschoolers I think you
probably remember when I talked about magical thinking so magical thinking may leave the
preschooler to believe that illness is a punishment for something
they did or they thought okay they may also exhibit separation anxiety and you
want to really avoid the use of medical jargon with this really with any children and offer choices
whenever possible for school-aged children they can actually describe their pain and
understand the concept of cause and effect so you always want to provide
factual information to a school-aged child and then for adolescents the most
important thing for you to know here isthat they may experience body image
issues and feelings of isolation from their peers so body image and peer interactions are like key
concerns for adolescents so you want to provide
sexual information to this age group as well and encourage contact with their peers maybe they
can come visit them at the hospital if they're hospitalized or something like that
okay in terms of death and dying infants and toddlers really have no concept of
death however you may find them
mirroring their parents emotions and they may also exhibit regression like if
they've been paying they may no longer be pi trained or if they're pretty well
behaved they may start acting acting out when dealing with death and dying
preschoolers view death as temporary so that's super important for you to know
or your exam they also engage inmagical thinking so they may this may lead the child to feel
guilt or shame because maybe they think their thoughts or actions cause you know someone's
death or dying and they may believe that separation from parents is punishment
for bad behavior for the school-aged child they begin to have a more adult-like concept of death
and dying fear of the unknown and fear of death may lead to uncooperative behavior in
school-aged children and then for adolescents they are likely to have an
adult-like understanding of death and dying they are influenced by their peers more so than their
parents and they are stressed out by changes in their physical appearance so again they have
those body image issues and then let's talk briefly about signs of impending
death so when someone is dying they may have the sensation of heat but their
skin will feel cool you may exhibit decrease movements and sensations in the
patient they will likely exhibit a decreased level of consciousness they may have swallowing
issues as well as incontinence bradycardia is usually indicative that death is nearing as well
as hypotension and then they may exhibit abnormal respirations such as chained
Stokes respirations which is basically periods of apnea alternating with
periods of hyperventilation so in terms of nursing care when when someone a patient dies when a
child dies you want to remove the tubes and equipment from the body you want to allow the
family to stay with the child's body as long as they like and you want to allow the family to rock
the infant and toddler if that's what they want to do and you want to offer to have the family
assist in preparation of the body so if you get like a question that says you know a child has
passed away and one of the options is you're asking the parents to like leave the room while
preparing the body when they want to stay that's not the right answer you
really should allow the parents to engage in care and preparation as much
as they want to and stay with that body as much as they want to in terms of grief obviously
parents of a deceased child are going to be experiencing a lot
of grief when does it become complicated grief well if it extends for over a year
after loss and affects the parents ability to perform their ADL's or
activities of daily living then that would be indicative of complicated grief
also if it causes such intense thoughts and emotions that they like can't leave
the house can't work those type of things and that is also indicative of complicated grief so that is
it for our first first part of the pediatric video series when I come back we're going to
start talking about pediatric disorders by body system it's a big unit so we'll be in there for a
while but hang in there and we will get through this information together take care

Meningitis
okay in this video we are starting part two of my pediatric nursing video series
if you are following along with cards I'm on card 34 which is like the starts
like the pink stack so we'll be talking about pediatric disorders by body system
so first up let's talk about meningitis so meningitis is inflammation of the
meninges and the cerebral spinal fluid so the meninges are the connective tissue that covers the
brain and the spinal cord so with meningitis viral meningitis is more common and will often
resolve without treatment bacterial meningitis on the other hand is much more serious with a
higher mortality rate and definitely requires treatment so in terms of prevention of meningitis
the hip and the PCV vaccines can help prevent bacterial meningitis signs and symptoms of
meningitis are super important for you to know so this can include photophobia so kind of pain
with light like difficulty having light headache nausea and vomiting is very
common irritability a high-pitched cry like an infant as well as poor feeding fever is another
symptom and as well as nuchal rigidity so that's like stiffness
in the neck and then bulging fontanel's in infants that would be a late sign of meningitis so if you
remember when we were talking about fontanel's those should be soft and flat they should not
be bulging or sunken seizures can also happen with meningitis and then you also
get a positive bruise in skis and positive kernig sign so let's talk about those two signs because
those are really important to know so with bruise in ski
sign you're gonna have the patient kind of lay flat and you're gonna pull up on their head that's
gonna cause pain and then they're gonna flex up their knees so the way I remember this is
bruising
skis if you pull up on their neck they're like bro that hurts so bro in skis that's kind of how I
remember kernig sign you're also gonna have the patient lie supine you're gonna have
them bend their knees and try to straighten that leg and straightening that leg at the knee will hurt
a lot in a patient who has meningitis so that would be a positive kernig sign and the
way I remember that one is that the word knee starts with K and kernig starts
with K so those kind of go together so definitely remember those two signs
we're gonna have lots of signs that we're going to talk about that are named after random people
so I'll always try to have a trick to help you remember those and then lastly petechiae which
are like kind of like red dots on the skin that can happen with meningitis as
well okay in terms of a lab test that you would do when you suspect meningitis
we're going to need to do a CSF analysis
or cerebral spinal fluid analysis and the way we get that is through a lumbar puncture so once we
get that specimen
there are different attributes that you find with bacterial meningitis versus
viral meningitis so with bacterial meningitis the CSF will be cloudy and you will have an
elevated white blood cell count and
elevated protein levels glucose levels will be decreased and it will result in
a positive Gram stain with viral meningitis the CSF will be clear you will have possibly a
slightly elevated white blood cell count and you will have normal levels of protein and glucose
and a negative Gram stain so really important
to know the differences between those two in terms of when you're performing
the lumbar puncture to get the cerebral spinal fluid you want to make sure the child empties his
or her bladder prior to the procedure you want to apply that m-lok cream on the injection site
about one hour before the procedure remember we're putting the in la creme we're placing an
occlusive dressing we're waiting an hour taking the dressing off cleaning the area thoroughly you
want to place the child in a side-lying cannonball position so they're going to be kind of rounding
their back and tucking their head like they're doing a cannonball into a pool and then
afterwards you want to ensure that the
child remains flat for up to 12 hours after the procedure to prevent theleakage of CSF or cerebral
spinal fluid
if they have leakage then that can result in a very severe headache
okay so nursing care of patients with
meningitis you want to implement droplet precautions right away if meningitis is suspected and
you want to maintain droplet precautions for at least 24 hours following the initiation of
antibiotics for like a bacterial meningitis you want to provide keep the patient NPO so nothing by
nothing by mouth no food or drinks if he or she has a decreased level of consciousness
because if their level of consciousness is decreased then their swallowing may
also be impaired and they're at risk for aspiration you want to provide a dark
quiet environment because of that photophobia really we want to decrease
stimulation and you want to administer
medications as ordered so this can include IV antibiotics and corticosteroids for bacterial
meningitis in terms of you definitely when a
patient has meningitis you need to be observing them for signs of increased inter-cranial pressure
or ICP so it's
very important for you to know what those signs are so those include bulging
fontanelles a high-pitched cry an increase in head circumference in the child irritability
bradycardia a headache seizures and respiratory changes so I'm going to stop
here when we pick it up in my next video we will go over race syndrome and some more neuro
type disorders okay
thanks for watching
English (auto-generated)

Reye's Syndrome and Seizures

] okay we're gonna continue on with some
other neurological disorders that we
find in the pediatric population so the
next one I want to talk about is Ray's
syndrome so Ray's syndrome is a
life-threatening disorder that causes
encephalopathy and fatty changes in the
liver the big important thing you need
to know about Ray's syndrome is the risk
factor so children who have had a recent
viral infection and are given aspirin to
treat a fever are at higher risk for ray
syndrome so you never want to give
aspirin to a child who has a fever or
some kind of viral infection because of
this risk so signs and symptoms of Ray's
syndrome include irritability confusion
excessive vomiting seizures and loss of
consciousness in terms of labs because
we have these fatty changes in the liver
the liver enzymes both ast and alt will
be increased also you may find an
elevated serum ammonia level so
diagnosis requires a liver biopsy and a
CSF analysis to rule out meningitis
because there's a lot of signs and
symptoms that kind of overlap between
those two conditions in terms of nursing
care you're going to want to take
measures to decrease intracranial
pressure or ICP so you're going to want
to maintain the head in like a neutral
position so you don't want to hyper flex
or hyper extend the neck you want to
keep the head of the bed at least 30
degrees up okay so not flat because that
will also you know increase
inter-cranial pressure so you want that
to be up and then you may administer
mannitol which is a diuretic that will
bring down that inter-cranial pressure
just administer that as ordered and then
in order to prevent hemorrhaging you're
going to want to monitor the patient
closely for bleeding and administer
vitamin K if needed to produce the
clotting factors to prevent that
hemorrhaging
so that is Ray's syndrome let's now talk
about seizure
and epilepsy so seizures are
uncontrolled electrical discharge of
neurons in the brain risk factors
associated with seizures include fever
cerebral edema infection exposure to
toxins a brain tumor
hypoxia lead poisoning electrolyte
imbalances and hypoglycemia so those are
all risk factors that can lead to
seizures and children epilepsy is
basically chronic recurring seizures so
risk factors associated epilepsy include
trauma infection and hemorrhaging so
let's talk about the few less a few five
key types of seizures so the first one I
want to go over here is tonic clonic so
a tonic clonic seizure can be preceded
by an aura or not so an aura is some
kind of visual or some other disturbance
that happens before the seizure so I
actually get an aura before I get a
migraine I haven't had a migraine in
many years knock on wood
but before I got the migraine I would
get this weird flashing light like in
one eye and and then I would get the
headache so it's the same type of thing
with seizures or maybe some kind of
weird light thing or feeling that you
have prior to the onset of a seizure or
there may be no aura so the three phases
of a tonic-clonic seizure the first
phase is the tonic episode this is where
you have stiffening of the muscles and
loss of consciousness the second phase
is the chronic episode this is where you
have rhythmic jerking of the extremities
and then the last phase is the post
ekdal phase and this is where the
patient is confused and very sleepy so
another type of seizure that happens
particularly in children are absence
seizures so this is where the patient
would have loss of consciousness for
about five to ten seconds key features
of the seizure include blank staring eye
fluttering
lip-smacking picking it close and
dropping objects so absence seizures can
really resemble daydreaming so often
children will be at school and they'll
just be kind of staring out in the space
and the teacher thinks they're not
paying attention and they're daydreaming
but they may be having a seizure
that actually happened with a friend of
mine her daughter had it had a number of
absence seizures unbeknownst to anybody
and teacher just thought she was just
not paying attention you can also have a
myoclonic seizure which is a brief
stiffening of the extremities or an
atomic seizure which is loss of muscle
tone that results in falling so if you
look at that word a tonic it looks like
a like no tone so if you have no tone no
muscle tone you're just gonna drop and
fall and then status epilepticus is a
prolonged seizure activity that lasts
over thirty minutes or a single seizure
that does not ever enter that post ictal
phase so remember we're going through
the three phases we got the tonic and
then the clonic and then the post ictal
if we never get to post it doll and
we're like appear in tonic and clonic
for a prolonged amount of time then that
would be status epilepticus
okay so diagnosis of a seizure we're
gonna want to do an EEG to identify the
origin of the seizure so if you remember
from med-surg this is the same with kids
as it is with adults you want to have
the patient abstain from caffeine prior
to the procedure they do not need to be
NPO so NPO is not necessary they can eat
and drink they can have their breakfast
before the test however we want them to
wash their hair prior to the procedure
super important I know so for an EEG you
want them to wash the hair because
they're going to apply all those little
electrodes on their scalp so if your
patient is having a seizure let's talk
about nursing care kind of before during
after the seizure super important to
know for your test so if a patient is at
risk for seizures you
to implement seizure precautions so this
means padding the side rails of the bed
and having suction and oxygen equipment
readily available there at the bedside
during the seizure the first thing you
want to do is turn the patient to their
side if they're like standing up in the
room you want to gently lay them down on
the floor on their side you want to
clear the area of hazardous objects you
want to loosen the patient's restrictive
clothing and you do not ever want to
insert an airway or a tongue blade or
anything else into the patient's mouth
when they're having a seizure you may
need to administer oxygen and you
definitely want to note the onset and
duration of the seizure so you can
report that to the provider post
procedure you want to keep the patient
in a lateral position check their vital
signs you want to reorient the patient
and you want to keep them NPO until they
are fully awake and their swallow reflex
has returned so they can safely swallow
medications that can be used to treat
seizures include antiepileptic
medications such as phenytoin and
carbamazepine as well as valproic acid
so with phenytoin in particular you're
going to want to closely monitor the
plasma or blood levels of phenytoin in
the patient's blood because there is a
narrow therapeutic range it would be
very easy to go above that range and end
or enter into this toxic range so you
need to closely monitor their blood
levels they're going to need to get
regular blood draws to ensure that are
in that therapeutic range so that's some
education that you'll need to provide
the patient's family if they're on
phenytoin surgical there are some
surgical interventions if we're dealing
with recurrent serious seizures so this
can include removal of whatever tumor or
lesion is causing the seizure you can
have a hemispherectomy or a corpus
callosotomy you can also insert a vagal
nerve stimulator this is where a
stimulator is implanted
in the left chest wall and connected to
an electrode at the vagus nerve so again
more you know those are more extreme
interventions but sometimes necessary if
a patient has epilepsy okay so I'm going
to stop here we will pick it up with
more disorders in my next video Thanks
English (auto-generated)

 Head Injury

Stabilize cervical spine first thing. Observe early sign of cranial pressure. For infant
earler sign irritability, high pitch cry, poor feeding, sating sun sign (eye point down),
boldding folt nails, separation cranial suture. Early sign child nausea vomitinh head ach
seizure difficulty school , blurt vision, inability follow coomond, , lethargy, late sign child
abdno pubil response no round to light, brdayca, hyperte, decarse motor response and
sensory, abno resperation( change stock breading0 s and posture (decoracate and
decerebate)

Intervent keep head angle 30 degrre no flat and over extended keep head neutral
midline position. Educat avoid cough blow nose, admin stool softner for straiing, insert
urinary catether, minimize sucksing, and decrse stimulation( limit noise , visitor)
implement seizure caution. Med menatole (esthmatic diathic for incres cerebral edema)
antipelatic help prevent seizye and antibiot for penetrating injury. Complication : epidural
hommerrahe (bleeding between dora and scale) symptom short period caution follow
peiod alertness and then coma, subdora hemorrhage (bleed between dora and rectnod
membrame symptom irritability vomiting seizure ), and brain herrenation downward
shift brain tissue symp lock brain stem reflextion like issue blinking pupul no react to
light , decrse level conscious hypert bradyca respiratory arrest

 - Sensory Disorders

all right in this video we're going to

talk about a few sensory disorders in
children so first let's talk about
vision if we are doing a vision
screening on a child we can use a
Snellen chart or alternatively we can
use a tumbling e or pitcher chart we
would position the child ten feet away
from the Snellen chart and after the
test they would be given a fraction such
as 20 over 30 this means that the child
needs to be 20 feet away from a letter
in order to read it where most people
can be 30 feet away from that letter and
read it so that means the child is a
little bit nearsighted if we are testing
for color vision we would use the
Ishihara test and then there's a couple
of different vision kind of disorders
that you should be familiar with
so myopia means nearsightedness that
means you can see things that are closer
in but have a harder time when they're
farther away and then hyperopia means
farsightedness that means you can see
objects that are farther away but have a
harder time seeing things that are
closer in and then lastly strabismus is
an important one for you to know this is
a deviation of the eye either
outward or inward or down or up and this
is due to poor muscle control in that
eye so some things you can do to test
for strabismus one is the corneal light
reflex test this is where you would
shine a light and have the patient focus
in on that light and you see where the
light reflects in their pupils if it's
in exactly the same place on either you
know either pupil then that is normal if
it's in one spot on one eye and a little
deviated on the other eye then that
would be abnormal and could be
indicative of strabismus another test
you can do is a cover test so let's say
that I have strabismus on this eye and
it's like deviates outward and this eye
is fine
I cover this I then this you will see
this pupil this I move right it will
move to start tracking and look straight
ahead so normally it would deviate but
when I cover this it will move and if
you see that movement then that is
indicative that strabismus may be
present other signs and symptoms of
strabismus include likes having
misaligned eyes if you can visually see
that they're not quite aligned or if the
patient is complaining of dizziness
headaches and diplopia which is double
vision these are all other signs and
symptoms so in terms of treatment for
strabismus we would use occlusion
therapy this is where we patch the
stronger eye to make this I actually
work a little harder and to strengthen
the muscles that support that eye so
that they are better aligned so those
are the key things I think you should
know about vision let's talk about
hearing loss so there are two types of
hearing loss to be familiar with one is
conductive hearing loss and the other is
sensory neural hearing loss with
conductive hearing loss there is an
issue in the middle ear that blocks
sound waves from reaching the inner ear
it could be due to excess cerumen
which is like ear wax or it could be due
to repeated ear infections when we're
talking about sensory neural hearing
loss this is an issue in the inner ear
or an issue with the auditory nerve and
the auditory nerve may be damaged due to
a birth defect by it may be damaged due
to an infection or it could be damaged
due to an auto toxic medication for
example vancomycin is known to be auto
toxic so that can cause issues with
hearing so signs and symptoms will vary
a little bit whether we're talking about
infants or talking about children in
infants if they lack a startle reflex if
you like clap right next to a baby they
should kind of like jump right and be
startled if they're not do
that then that would be a warning sign
that they may have hearing loss also if
that baby is not making any babbling
sounds by seven months old then that
would also be a warning sign for hearing
loss in children some of the signs and
symptoms that they have hearing problems
may include delayed speech so if you
can't really understand anything they're
saying they don't have intelligible
speech by two years old then that would
be a warning sign also if they are
yelling constantly using a monotone you
know if their voice is very monotone or
if they have shy behavior like they are
avoiding interactions with others then
these would also be possible things you
know items of concern that you would
need to bring up with the pediatrician
and could be indicative of hearing
issues so in terms of nursing care it
really depends on the severity of the
hearing loss but we can assist the child
with either sign language hearing aids
and then of course we need to provide
for safety for the child so if they are
not hearing well we need to provide like
visual cues as opposed to auditory cues
if there's a safety issue that they need
to act on so I'm gonna stop here and we
will pick it up with more information in
my next video thanks for watching
English (auto-generated)

 Respiratory Therapies Inhalers, CPT,

Oxygen and Suctioning
alright in this video we are going to
talk about some respiratory therapies
that can be used in children so let's
first talk about inhalation therapy it's
important to know the teaching that you
need to provide a child and/or their
parents regarding the use of an MDI
which is a metered dose inhaler and then
you also need to be familiar with the
differences between an MDI and a DPI
which is a dry powder inhaler so with an
MDI you're going to shake the inhaler 5
to 6 times and then attach the spacer
we're going to advise the child to take
a deep breath and exhale they should
place the inhaler between their lips and
press the inhaler and take a slow deep
breath for 3 to 5 seconds
and then hold their breath for 5 to 10
seconds before removing the inhaler and
slowly exhaling okay so after they use
the MDI they need to clean it as well as
the spacer so they're going to do this
after each use of the MDI they also need
to rinse their mouth and expectorate so
expecto 8 is a fancy word for spit and
we do this because we want to prevent
having a fungal infection in the mouth
okay the key difference is with a dpi a
dpi we're not going to shake the device
and we are not going to use a spacer but
pretty much everything else is the same
we're gonna be taking a slow deep breath
holding our breath for 5 to 10 seconds
and we're going to be rinsing and
spitting after using that inhaler okay
so that is inhalation therapy let's now
talk about chest physiotherapy or CPT so
chest physiotherapy uses percussion
vibration postural drainage and
breathing exercises to loosen secretions
so they can be coughed up or suctioned
out so an example of a condition that
would definitely benefit from CPT is
cystic fibrosis
cystic fibrosis we have thick tenacious
tenacious mucus that we want to try to
get out so these patients definitely
benefit from chest physiotherapy so some
of the nursing care important points I
want you to know is that we want to
schedule the chest physiotherapy before
meals or at least one hour after meals
to prevent vomiting okay
and then we also want to administer a
bronchodilator about 30 minutes to 1
hour before treatment to help open up
the airways to make loosening the
secretions more effective during the
chest physiotherapy okay and then in
terms of oxygenation so just like with
adults with children we are expecting an
spo2 between 95 and a hundred percent
it's important to know the signs and
symptoms of hypoxemia which is
insufficient oxygen levels in the blood
so there are early signs and there are
late signs and it's going to be really
important for you to differentiate
between the two
okay so early signs include restlessness
irritability
- Kip Nia tachycardia pallor and
abnormal breathing so when I say
abnormal breathing I mean that they may
be using their accessory muscles they
may exhibit nasal flaring and they may
have adventitious lung sounds okay if
we're talking about late signs of
hypoxemia these signs will include
decreased level of consciousness so if
the child is in a stupor then that would
be indicative of that would be like a
late sign of hypoxemia bradycardia Brady
opinio and cyanosis so these are signs
and symptoms that are late so late signs
of hypoxemia and then I would also be
familiar with the signs of oxygen
toxicity so too much oxygen to months
too much oxygen can cause
hypoventilation as well as increased
paco2
then eventually unconsciousness if we
are not careful okay all right so there
are many different devices that we can
use to administer oxygen to the child so
one is an oxygen hood that fits over the
infant's head and we would use a minimum
flow rate of between 4 and 5 liters per
minute when using an oxygen hood we can
also use a nasal cannula which you guys
are probably familiar with so this
provides between 1 and 6 liters per
minute of oxygen if we are giving a
child 4 liters per minute or more we
want to make sure we humidify the oxygen
in order to prevent drying of the nasal
mucosa which in turn can cause injury so
we really want to humidify that oxygen
to prevent mucosal injury a face mask
can also be used so this is used for
high oxygen flow rates and for mouth
breathers so you would use a flow rate
between 5 and 10 liters per minute
approximately so in terms of nursing
care we always want to use the lowest
flow rate we can to correct the
hypoxemia so we don't end up with oxygen
toxicity which we just talked about the
signs and symptoms of that also we want
to warm oxygen to prevent hypothermia
and we want to prevent combustion we
want to place a no smoking sign when
we're using oxygen we want to make sure
the child is wearing a cotton gown so
they should not be wearing wool or any
kind of synthetic fabric because that is
you know that can be combustible and
then we want to ensure electrical
equipment is grounded and there are no
flammable materials near the oxygen
source okay and then the last thing I'm
going to talk about in this video is
endotracheal and tracheal suctioning and
some best practices to keep in mind okay
so we only want to suction as needed to
maintain patency of the tube so we are
not suctioning the tube routinely okay
that's important to know we want when
we're doing the suctioning
we want to place our patient in a high
fowler's or Fowler's position we want to
select a catheter that is half the
diameter of the tracheostomy tube and
then we're going to hyper oxygenate the
patient prior to suctioning and we
always want to obtain kind of baseline
breath sounds and vital signs prior to
suctioning and monitor their oxygen
levels throughout the procedure we want
to set the vacuum pressure between 60
and 100 mmHg
for infants and we want to limit the
suction time for infants to under five
seconds and then under ten seconds for
children and then we want to allow
between 30 and 60 seconds between
suctioning attempts if we need to do
more than one pass so those are some key
respiratory therapies I think you need
to be familiar with and we will pick it
up with more good information in my next
video Thanks
English (auto-generated)

Acute Respiratory Conditions: Tonsillitis,

Nasopharyngitis & Streptococcal
Tonsillitis due viral and bacte inf sign and sympt sore throt defeculty swolling and fever
and ear infec, if asses tontils is red and swollen . lab after aspect tonsiltis due culture for
strepthroat( group a beta hemli steptococ GABHS) , frequent infect led kidney infec and
rematic fever, so diagnos it as queqly as possible . Med antiperiodic( asemifon anset),
antibio , gaggle warm salt water for pain. Surger tonsilaectomy . intervention nursing
care after surgery position patent on abdominal or on side and always asses sign
symptom for hemorrahgene ( tachy hypot and pallor mean bleed out internaly), alos if
they swolloing very frequently and clear throat a lot is sign bleeding from surgery site
alert provider. After patient gag reflex return after surgery provider clear liquid and and
slow soft food(no shrap hard) , no red color liquid no give citus juicee and milk based
food. Blood tange muscous is expected profuse bleding no expecting, no blow or clear
nose and no coughing , limit activity up 10 day to prevrnt risk bleeding , full recovery
happen next 2 weeks

Nasophargitis is fancy common cold is self limit due virus , better feel 10 days.
Symptom sign fever nasal inflame and irritation. Nursing care antipatotical med for fever
, colness vapressder , child over 6 give decongestion and cough suppression .

Streptoccocal phaphigitis is srep throat, symp inflame tonsil and phyrinx inflm , if do ass
see accesade , headch fever abdominal pain, lsuspect it so ab strep culture to check
GEBHS to treat GEBHS to not end up compilcation kidney infec and ramatic fever .med
antibio, antipariotic for fever also help with pain and inflam

Acute Respiratory Condition: Bronchiolitis,

Pneumonia, Epiglottitis & Influenza
all right in this video I'm gonna
continue talking about some important
acute respiratory conditions so the next
one I want to touch on is bronchiolitis
which is infection of the bronchi and
bronchioles caused by RSV
which is respiratory syncytial virus so
signs and symptoms can include fever
cough wheezing and rhinorrhea
so rhinorrhea is like a fancy name for
like a runny nose so in terms of nursing
care we can provide humidified oxygen we
can suction the nasopharynx for the
child as needed and then we should
encourage increased fluid intake the
next condition I want to touch on is
bacterial pneumonia so this is a lung
infection often caused by streptococcus
or mycoplasma bacteria so signs and
symptoms of pneumonia can include a high
fever chest pain
- Kip Nia as well as respiratory
distress so if a patient is exhibiting
nasal flaring retractions or
adventitious breath sounds these are all
signs and symptoms of respiratory
distress other signs and symptoms of
pneumonia can include pallor and
lethargy so in terms of nursing care
we're going to want to collect a sputum
sample so we can send that off for
culture and sensitivity and we're going
to provide antibiotics antipyretics
oxygen and IV fluids as ordered by the
provider all right the next condition is
a super important one to know so it is
bacterial epiglottitis this is a
life-threatening respiratory illness
caused by Haemophilus influenzae so
signs and symptoms will include drooling
difficulty speaking and difficulty
swallowing other signs and symptoms can
include high fever and inspiratory
stridor so in terms of nursing care when
we talked previously about like strep
throat and tonsillitis we talked about
getting a throat culture in this case if
a patient presents with signs and sent
of epiglottitis so again drooling having
difficulty swallowing and speaking we do
not want to collect a throat culture we
don't want to put a tongue blade in
their mouth we don't really want to put
anything in their mouth because that is
very risky and could cause their airway
to close up
so again if they present with the signs
and symptoms that I just described we do
not put a tongue blade or get a throat
culture of any kind for these patients
we will also be administering IV fluids
oxygen and antibiotics as ordered and
then we need to prepare for possible
intubation for a patient who has
bacterial epiglottitis because it is
very dangerous and their airway may
close up okay next let's talk about
influenza influenza is a contagious
viral respiratory infection
signs and symptoms can include fever
chills malaise body aches and a dry
cough some of you may have had the flu
in the past so you may be familiar with
these symptoms so in terms of nursing
care we want to encourage the patient to
get lots of rest and to increase their
fluid intake also we can give an
antiviral medication if we catch it and
provide that medication within 48 hours
of the onset of symptoms okay if we
catch it within those first 48 hours we
can give them a medication such as
cinema beer which again as an antiviral
medication that can limit the severity
and the length of the patient's illness
if we give it after 48 hours the
effectiveness of this antiviral
medication is somewhat limited all right
and then lastly in this video let's talk
about some respiratory complications
that can occur when we have a patient
who has had like pneumonia or some of
these other respiratory conditions that
we've talked about so one respiratory
complication is a pneumothorax which is
when there is air in the pleural space
that surrounds the lungs or they can
have a pleural effusion which is where
there is fluid in that pleural space
that's a
the lungs the signs and symptoms will be
pretty similar between these two
conditions so signs and symptoms can
include dis Nia which is difficulty
breathing chest pain decreased spo2
and tachycardia so if we have a patient
who has a pneumothorax or a pleural
effusion
we need to get that air or that fluid
out of that pleural space so we're going
to do a needle aspiration and remove
that fluid or air and we're going to
likely place a chest tube so that is it
as far as the key acute respiratory
conditions I think you should know and
when I pick it up in my next video we
will talk about some chronic respiratory
conditions that are also important to
note so thanks so much for watching
Chronic Respiratory Conditions: Asthma &
Cystic Fibrosis
Asthma chronic inflm of airway and and irematent and ireversabale, triger cold air
tabaco smock exercise , allergen. Sign symptom wheezing cough anxiety dyspnea
chest tightnes, use exsocaroty muscle . diagn pulmonary function test.med
bronchodilator short acting (albrutola for prio exercise and acute asthma attack)
sulmatoral is long acting brochdia no use for acute, anticholonigerc( atrippin ),
colocosteroid like pretnosole decrse airway inflm. Teach to understand effect use peak
flometer (device alert patient to tighting of airway befor symptom occur) use it same
time everyday and sure marker is 0 and stand and blow as hard and quickly as can and
perform test 3 time and pick the highest value. Family keep child indoor with long care is
been day long mowning done , keep insude when pollon count is high . complic
asthma statis asthmestic is airtway obstraction that unresponse to treat also may he
has respiratory failor so both we need intubate patient

Systic fibros genetic cause thick musous to obstract variety productif organ of body
lung liver pancear SI and reproductive organ. Key factor both parent has gene is
arosomale reccesive disor. Sign symto amiconium ileus at birth, for respor sign wheeze
cough barrel chest synus , GastroIntes symto loose fatty stool , delay growth wight loss
fat solibale vitamin difiency, integamity sympt high sodium chloride in sweat salivia and
tear. Test swaet chloride tes, dna test , pulmonary function test and stool analysius.
Treat chest physiotherapy to loose secretion like cought out or suck it down,
brachodilator albutoral antichologic , ab antibiotic if have pulmonary inflm , dorness
alpha for decrse mucous vascaty help tin mucous, oxygen . high protein amd calorie
diet, fat solibalve vitain, fat intake increase , adm pancteatic enzyme withing 30 min of
etating provide this with meal

Congenital Heart Disease: Signs &

Symptoms, VSD, ASD, PDA, Tetralogy of
Fallot..
all right in this video we're going to
start talking about cardiovascular
disorders in the pediatric population if
you are following along with cards I'm
on card 63 in that death so we're going
to spend some time talking about
congenital heart disease or CH D so with
congenital heart disease we have some
kind of anatomical abnormality in the
heart that causes the key symptoms of
heart failure as well as hypoxia
so with heart failure our heart is not
beating effectively and this can result
in things such as tachycardia
hypotension weak pulses fatigue as well
as something called cardiomegaly which
is enlargement of the heart we can also
end up with signs and symptoms of
pulmonary congestion so backup of blood
and fluid into the lungs which can cause
to Kipp Nia dis Nia which is difficulty
breathing as well as signs and symptoms
of respiratory distress which can
include nasal flaring retractions and
wheezing we can also end up with signs
and symptoms of a systemic congestion
with heart failures this is where the
blood and fluid is backing up to the
rest of the body so these symptoms can
include peripheral edema ascites so
that's like enlarged abdomen
hepatomegaly which is an enlarged liver
as well as neck vein distension so these
are all signs and symptoms of heart
failure and the other key sign and
symptom with congenital heart disease
that I mentioned is hypoxia so
insufficient oxygen in the body with
hypoxia the child may have cyanosis
where they have like a blue color they
may have to Kipp Nia dyspnea so
difficulty breathing clubbing which is
like the spoon-shaped fingernails as
well as something called polycythemia
which is an increase in the red blood
cells in the body so when there's not
enough oxygen in your body your body is
like oh crap I better make more red
blood cells to get more oxygen
out there so we end up with increased
levels of red blood cells
that's called a polycythemia okay all
right we're gonna talk about there's a
lot of different types of defects I'm
not gonna go into all the details about
each one but I will tell you some of the
key features like key signs and symptoms
and treatment for each of them so let's
first talk about the congenital heart
defects that caused an increase in
pulmonary blood flow one is called a
ventricular septal defect or VSD this is
where there is a hole in the septum that
separates the left and right ventricle
so okay that membrane that separation
that septum there's a hole in there and
this causes a loud harsh murmur at the
left sternal border okay so this is a
key symptom with this condition in terms
of treatment we can close this hole
during a cardiac cath or via open-heart
surgery then we have an atrial septal
defect or ASD this is where we have a
hole in the septum that separates the
left and right atria okay and this
results in a loud harsh murmur with a
fixed split second heart sound okay
that's the key symptom with ASD again in
terms of treatment we can close it
during a cardiac cath or through
open-heart surgery and then the last
condition I'm going to go over that
causes an increase in pulmonary blood
flow is something called a patent ductus
arteriosus or PDA for short
so the ductus arteriosus is a fetal
artery that connects the aorta to the
pulmonary artery and it should close
after birth but if it is still open
that is a patent ductus arteriosus so
key symptoms of PDA include a machine
hum murmur bounding pulses and a wide
pulse pressure so what I mean by a why
pulse pressure is we have our systolic
blood pressure over our diastolic blood
pressure and there's usually you know a
small difference between those two
numbers with a wide pulse pressure
there's a big difference between those
two numbers so the way I remember the
symptoms of PDA is somewhat
inappropriate or disturbing but I think
of a guy named a bud who really hates
PDA public displays of affection right
like people kissing or you know being
affectionate in public and it makes him
want to take his machine gun out which
he doesn't do because he doesn't have
one okay but it makes his pulse is bound
to right like he gets really upset about
it so he has bounding pulses he thinks
about getting a machine gun out and then
he also has this wide pulse pressure and
that's how I remember PDA in terms of
treatment we can actually give the
patient who has PDA something called
indomethacin which is an NSAID which can
help close the patent ductus arteriosus
also we could include the PDA with coils
during a cardiac catheterization as well
so that's another option so in
indomethacin is a is a key treatment for
this condition but we can also use the
coils during cardiac cath okay now let's
talk about cardiac heart defects that
cause a decrease in pulmonary blood flow
there are two that I'd be familiar with
the first is called tetralogy of the
fallow and hopefully I'm saying that
right follow I think that's right it
includes four different defects the
defects that it includes our pulmonary
stenosis ventricular septal defect
overriding aorta and right ventricular
hypertrophy okay the way I remember
about what's included in this particular
defect is I think of the word prove PR o
ve so the P would stand for pulmonary
stenosis the AR withstand for right
ventricular hype
trophy the Oh with Stanford overriding
aorta and the V would stand for
ventricular septal defect and the e
doesn't stand for any of those defects
but it could stand for excellent because
you remember the P ROV right so proof
key symptoms of tetralogy the fallow
include cyanosis and hypoxia and then
treatment includes a surgical repair of
these defects within the first year of
life for the child okay
the second congenital heart defect that
I would know that decreases pulmonary
blood flow is something called tricuspid
atresia
so with tricuspid atresia there is
complete closure of the tricuspid valve
this requires a ASD or a VSD defect to
be present in order for blood to be
oxygenated at all in the body key
symptoms of tricuspid atresia include
cyanosis dyspnea tachycardia hypoxemia
which is insufficient oxygen in the
blood and clubbing in terms of treatment
where that child would require surgery
and surgery is usually done in three
stages during the first stage we would
do a shunt placement during the second
stage we would do what's called a Glenn
procedure and then the third stage we
would do a modified Fontan procedure
okay so I'm going to stop here when I
pick up with my next video we will go
over congenital heart defects that
obstruct blood flow thanks so much for
watching
English (auto-generated)

Congenital Heart Defects: Coarctation of

the Aorta, Pulmonary Stenosis...
all right in this video we're going to
continue talking about congenital heart
disease we're now going to focus our
attention on congenital heart defects
that obstruct blood flow in the body so
one such defect that's super important
for you to know is something called
coarctation of the aorta this is where
we have narrowing of the aorta at the
location of the ductus arteriosus and
this results in obstructed blood flow
from the ventricle so keep in mind that
this narrowing of the aorta occurs after
blood has already been supplied to the
upper extremities okay so it really
impacts blood flow to the lower
extremities so key signs and symptoms of
this condition include high blood
pressure and bounding pulses in the arms
however in the lower extremities we're
going to have low blood pressure and
weak pulses in addition we may have skin
that's cool to the touch because we have
this impaired blood flow so those are
really important signs and symptoms to
remember in terms of treatment for this
condition we can do a balloon
angioplasty or we can put in stents to
help open up that narrowing okay the
next condition that causes obstruction
of blood flow is something called
pulmonary stenosis so this is where we
have narrowing of the pulmonary valve
and the key symptom to remember with
this condition with this condition is a
systolic ejection murmur in terms of
treatment we can do a balloon
angioplasty we can also do what's called
a valve vada mean to correct the
situation the next one I'm going to talk
about is an aortic stenosis so this is
where we have narrowing of the aortic
valve as opposed to the pulmonary valve
and key symptoms of this include
hypotension decreased pulses tachycardia
and possible exercise intolerance in
terms of treatment we can do a balloon
dilation we can also perform a valve
oddity all right so now let's turn our
tension to cardiac defects that can
cause mixed blood flow in the body so
one such condition is something called
transposition of the great arteries or
TGA so this is where the aorta is
connected to the right ventricle instead
of the left ventricle like it's supposed
to be and the pulmonary artery is
connected to the left ventricle instead
of the right ventricle like it's
supposed to be so if a patient has TGA
they must also have a septal defect or a
PDA present in order for blood to be
oxygenated at all so key symptoms of the
of this condition of TGA include
cyanosis or kind of blue skin as well as
cardiomegaly or enlargement of the heart
in terms of treatment we are going to be
doing surgery with typically within the
first two weeks of life where we switch
these arteries arteries around to be in
the right place okay the next condition
that causes mixed blood flow is
something called truncus arteriosus so
this is where there is no septum between
the left and right ventricle so key
symptoms of this condition include heart
failure lethargy and possibly a murmur
and then treatment includes surgical
repair within the first month of life
typically and then the last condition
that causes mixed blood flow is
something called hypoplastic left heart
syndrome so this is where the left side
of the heart is underdeveloped when a
patient has this condition they will
either have ASD present which is an
atrial septal defect or a patent foramen
ovale
so a patent foramen ovale means that the
septum between the left and right atrium
is not fully developed so you have this
little hole so again one of these two
conditions must be present in order for
the blood to be oxygenated in the
patient so key symptoms associated with
this condition include heart failure
lethargy
enosis and cold hands and feet so in
terms of treatment we're going to
perform surgery and we're gonna do the
surgery in three different stages so
stage one includes something called a
Norwood procedure stage two includes
applying something called a Glenn shunt
and then the third stage includes
something called a Fontan procedure I
would not get hung up in the details of
these procedures but just be aware that
the surgery is done in three different
stages okay so I'm going to stop here
when we come back we will talk about
diagnosis of congenital heart disease
and we're going to talk about nursing
care as well as medications so stay
tuned
English (auto-generated)

Congenital Heart Defects: Diagnosis,

Cardiac Catheterization, Nursing Care,
Meds
Diag chd by EKG monitor, chest xray echocardio gram, cardiac catherization, can
repain VSD and PSD . asses for shelfich and idon before do cartas dye for cardiac
catheri. Patimnt NPO for 4 -6 h priod pressure, and locate and mark pedal puluse on
feet, after make sure pulse present on extretmity check pulses make sure blood flow
doen in extremity.check insertion side for beeling, maintain affect extremity in straight
position for 4-8 h , increase fluid intake to help extrete dye, no bath tube for at least 3
day , li mit activity for 24h.nurcare due sign synm hypexia , hf so miniminaze energy so
provide frequent rest perios, small frequent meal , colastere care,use nipple with large
opening, high density formula if he receive it, and minimize cry because take lot energy
which require more ox is prb for has cogentital hd, semi folew position, knee chest
position and calm if he has hyrximia or sinusus . med dejaxone improbe myocardia
contrcativity, ace sanhibitoy like kapitril decrase afterload , beta blocker metaboli help
idesce hr and pb , diriutic like phynosomal limit excess sodium in body.
For admin dijaxone in childe Take pulse prior to adminand hold med no give if infant 90
beat/min or child less 70 beat/min because dijaxone slor hr down so no give with these
parameters.use cathebirate devise to prevent overdose no spoon to measure dijaxone.
Monitor for sign symptom dijoxine toxicity (brady card gi upset vomiting disrythmia0 no
second dose if he vomint or drop out first dose because we don’t know how much he
took or swolloe he got. Monitory regular blood level to check toxicity therapeutic range
0.8-2 over high risk. After dijaxone give water and brush teeth to prevent decay, if miss
dose no double it or make it up.in general we don’t double med dose expect birth
control.
Bacterial Endocarditis, Rheumatic Fever
and Kawasaki Disease
Endocarditis infec underlining heart affect hear6t valve sue streptocc , risk factor
congenital heart defect, sihgn symto fever decarse appetite, muscle joint pain heart
murur, malaise weight lose,flue type symto. Treat av antibiotic over prolong long t
amo0ut time through peak line . family teach take profelactive antibio prior surgery and
or dental work .
rheumatic fever inflma of heart and bv and joint due GEBHS same bacteri cause
strepthroat that risk factor If untreated strep . sign sympt maffle heart sound , pericardial
fractur rub chest pain, no tender sucbcutamous nasous over bony pronanence , rash
develop on trac and innersehface of child extremity, large joint swolling and
chorea( involuntary muscle mov). Lab strep culture check GERHD , blood test check Iso
title level if high is rheumatic fever is gold standar. Elevate crp and psl level.diag joint
crateria ( two major or one major and two manior present : major : cardiatis
subcutamneus nasor, pary arthritis, erythema manjenitem is rash in trac and extremit
and chore, minor fever altragia (large joint swolo). Nurse care antibio , encourage bed
rest to prevent cardiac diamage, educate need of polofatec prior dental work or surgery
going forward.
Kawsaki dise systemic vasculitis (inflm bv) cause unknow , sign symnto during acute
phase: high fever that unreponsibe to antipariotic med, red eye and dry eye red chap
and crack lip, red tongue, swolow oral muscous, red palm and sole and swolor hand
feet, large lymph node, cardiac symtoms dysrhythmia and mayocarditis.during subacute
phase when no fever which dissolve , have peeling skin around nail palm and sole,
conbalos phase no clinical manifestation but do abno lab value abno cbs crp arbunin ,
csr. Med , gama glubolin ABGG giving passive artificial antibatic, high dose asprin give
( no give asprin to child who has virus or flu like but her we do). Nursing care montor
cardia function, dialy weight, eyes nose, educate no receive life immunusation for at
least 11 months

Epistaxis, Iron Deficiency Anemia, Sickle

Cell Anemia and Hemophilia
alright in this video we are gonna talk
about some bleeding disorders in
children so let's first talk about
epistaxis which is a fancy name for a
nosebleed
so risk factors associated with
epistaxis include having some kind of
trauma to the nose also if it is like
low humidity like very dry then that is
a risk factor and makes a vigil more
likely to have a nosebleed also
sometimes children have an underlying
condition which predisposes them to
nosebleeds including hemophilia or
leukemia and then certain medications
also can increase the risk of epistaxis
so in terms of nursing care we want the
child to sit upright and to bend their
head forward we don't want their head
back because that increases the risk
that they're gonna aspirate the blood so
we want them to bend their head forward
and then we can apply pressure to the
lower part of their nose with the thumb
and finger we can also encourage the
child to breathe through their mouth
until the bleeding stops and we can pack
the affected nostril with like tissue or
cotton and then we can also apply ice
across the bridge of the nose to help
decrease the bleeding
so that is epistaxis let's talk about
iron deficiency anemia so more times
than not iron deficiency anemia occurs
because these kids are like chugging way
too much milk so they're drinking all
this melt cow's milk and cow's milk is
super low in iron it's not an iron rich
beverage so they're drinking all this
milk and it's filling them up and
they're not eating or drinking other
things which are richer and iron so they
end up with iron deficiency anemia also
if a child has a malabsorption disorder
this can also result in iron deficiency
anemia so signs and symptoms of anemia
include fatigue shortness of breath
pallor which is like paleness they may
also have like spoon shaped fingernails
as well as tachycardia so when we run
labs we will notice that
their red blood cell count as well as
their hematocrit and hemoglobin levels
will all be decreased in terms of
nursing care of course we're going to
want to encourage the parents to limit
the child's intake of cow's milk and
encourage increased intake of iron rich
foods so these foods can include raisins
beans green leafy vegetables meat
poultry and peanut butter we may need to
administer an iron supplement so if
we're doing this keep in mind that
vitamin C increases the absorption of
iron so it's going to be really
important that the child gets sufficient
vitamin C to allow for absorption of the
iron we also want to when possible use a
straw for giving it like an oral form
that helps to prevent like
teeth-staining we also want to encourage
the child to kind of brush their teeth
afterwards to help prevent staining as
well if we are giving it through an iamb
injection we want to use AZ tract method
and we never want to massage the area
afterwards also we should give the
family and the child a heads up that the
iron supplement will cause their stool
to tart to turn 8re green color which
can be very alarming to them if they
don't know ahead of time that that is
normal and expected when it comes to
iron supplements alright so that is iron
deficiency anemia let's talk about
sickle cell anemia so sickle cell anemia
is an autosomal recessive genetic
disorder that causes normal hemoglobin
to be replaced with abnormal sickle
hemoglobin this in turn results in the
red blood cells in the body sickling and
the sickling causes increased blood
viscosity as well as obstruction of
blood flow and this obstruction in turn
can lead to tissue hypoxia
so risk factors include a family history
of sickle cell anemia because it's an
autosomal recessive
genetic disorder also certain cultures
are at higher risk for sickle cell
anemia so this includes
african-americans and people of
Mediterranean Indian and Middle Eastern
descent so signs and symptoms of sickle
cell anemia include pain so severe pain
usually 10 out of 10 also the patient
may have shortness of breath fatigue
pallor as well as jaundice and we'll
talk a little bit more about that that
jaundice occurs due to the destruction
of the red blood cells in the body so
diagnosis of sickle cell anemia is done
through a sickle turbidity test or we
can do what's called a hemoglobin
electrophoresis which is really the gold
standard and offers a definitive
diagnosis for sickle cell anemia alright
now let's talk about the different
sickle cell phases the first phase is
the vaso occlusive crisis so during this
time the patient will have severe severe
pain also swollen joints abdominal pain
as well as vision issues may be present
and then after that we have the
sequestration stage which is where the
spleen and the liver may be enlarged as
well as the patient may have hypovolemia
and may be at risk for hypovolemic shock
during this phase and then the third
phase is the aplastic phase which is
where the patient has severe anemia and
then finally we have the hyper hemolytic
phase which is where we have red blood
cell destruction which results in
jaundice and then we also have anemia so
in terms of labs someone with sickle
cell anemia will have decreased
hemoglobin they will also have elevated
white blood cell counts as well as
elevated bilirubin due to the
destruction of the red blood cells in
terms of nursing care we're going to
administer IV fluids oxygen and blood
products as prescribed we're also going
to give opioid analgesics
around-the-clock so again they're having
very severe pain so opioid analgesic
are completely appropriate and we want
to get ahead of the pains we're gonna
give them on a schedule around the clock
we would treat infections with
antibiotics as ordered and then we
really want to educate the patient on
the importance of adequate fluid intake
okay because they're really at risk for
hypovolemia and hypovolemic shock so we
definitely want them to increase their
fluid intake and we want them to engage
in really good hand hygiene to prevent
infection and then lastly we want to
encourage as much rest as possible all
right let's move on now to hemophilia so
hemophilia is a rare inherited bleeding
disorder that impairs clotting in the
body and this in turn increases the risk
of bleeding in patients so there are two
main types that I'd be familiar with one
is hemophilia a and the other is
hemophilia B so with hemophilia A there
is a deficiency in factor 8 so when I
see human of hemophilia A a and 8 kind
of sounds similar so that helps me
remember what goes with what and then
with hemophilia B this is where we have
a deficiency in factor 9 so signs and
symptoms of hemophilia include excessive
bleeding as well as joint pain and
stiffness and impaired mobility as well
as bruising so labs labs are going to be
really important to understand for
hemophilia so with hemophilia aPTT
levels will be prolonged okay however PT
levels as well as platelet levels will
not be affected so their platelet levels
and their PT levels which PT is
prothrombin time will not be affected
but the apt apt t levels will be
prolonged in terms of meds we can
replace whatever factor they're missing
so we can administer a factor
replacement we can also give them
vasopressin which helps to increase
levels of factor 8 and then we can give
them corticosteroids to decrease
inflammation
in terms of nursing care we're really
gonna want to prevent bleeding in the
patient so we're definitely never going
to give them aspirin because that
increases the risk of bleeding we would
avoid skin punctures whenever possible
we should encourage the patient to use a
soft bristled toothbrush and not engage
in any contact sports so swimming would
be a good choice as opposed to like
football and then we want to encourage
rice which again rice stands for rest
ice compression and elevation and this
would help control the bleeding in the
patient so hopefully this video has been
helpful and I will see you soon in
another video
English (auto-generated)

 Infectious Gastrointestinal Disorders and

Dehydration
alright in this video we are going to
talk about gastrointestinal disorders as
well as dehydration so there are any
number of viruses or bacteria that can
cause a gastrointestinal disorder I'm
gonna focus on just a handful that I
feel like are most important to know so
let's first talk about rotavirus so
rotavirus is a viral infection as
opposed to a bacterial infection and it
is the most common cause of diarrhea in
young children so if you might recall
there is a roto virus vaccine that is
recommended for children and it can help
prevent this infection or make it much
less severe if the child gets a
rotavirus vaccine so in terms of
transmission this is transmitted through
the fecal-oral route symptoms include
fever vomiting loose watery stools and
then those stools may also be mallow
Duras another cause of a
gastrointestinal disorder is ecoli so E
coli is a bacterial transmission routes
do vary in terms of symptoms usually
with this type of infection you will
have watery diarrhea then like abdominal
cramping and then a lot of weight a lot
of times it's segues into bloody
diarrhea then we have Salmonella which
is also a bacterial infection it is
transmitted through undercooked meat and
poultry so that's gonna be an important
preventative thing that you're going to
want to educate your patients and their
family on is that we need to fully cook
all of our meats to help prevent
salmonella poisoning and then it can
also be transmitted from person to
person or pet to person and then signs
and symptoms of a salmonella infection
can include nausea vomiting abdominal
cramping bloody diarrhea and fever and
then the last the last gastrointestinal
disorder I wanted to talk about is
something called e4 McGillis which is
the bacteria that causes pinworm which
you may have heard of so some
he signs and symptoms of pinworm include
perianal itching so that's why the most
important one to know also restlessness
and difficulty sleeping are common this
is again is transmitted through the
fecal-oral route as a parent if you
suspect that your child has a pin worm
infection you're gonna want to place
some tape over the child's anus at night
before they go to bed and remove it
first thing in the morning before they
get up and start walking around and you
want to send that sample to the
laboratory to see if it is positive for
pin worms if they are experiencing
symptoms such as perianal itching
restlessness and difficulty sleeping
okay let's talk about some of the risk
factors that would make it more likely
that someone would come down with a
gastrointestinal disorder some of these
risk factors include poor hygiene
crowded living conditions poor
sanitation and lack of clean water in
terms of nursing care the number one
thing we can do to help rehydrate a
child who is having all of this diarrhea
due to a gastrointestinal disorder is to
provide an oral rehydration solution
such as Pedialyte so it's going to be
the most important intervention to help
them stay hydrated and to help with
electrolyte balances so we would not
want to give them fruit juice soda any
kind of chicken or beef broth anything
caffeinated is also not recommended and
then there's something called the BRAT
diet which includes bananas rice
applesauce and toast which may sound
like a good idea but again it is not the
recommended intervention for providing
rehydration so we want to give an oral
rehydration solution so I know I
repeated that a couple times but it's
really important for you to know other
things we're going to want to recommend
to our families with this type of
gastrointestinal disorder going on is
that they should clean the child's toys
change the bed linens it's important
that the child and the rest of the
family perform really good hand hygiene
we also don't want family members
sharing dishes or utensils and then
again we don't want the family consuming
undercooked foods which can lead to a
salmonella infection okay
let's talk a little bit more about
dehydration which is a big symptom that
can occur with any of these
gastrointestinal disorders so it's
important for you to be able to be able
to differentiate between mild moderate
and severe dehydration so with mild
dehydration the child may have weight
loss up to five percent their capillary
refill may be slightly longer like
slightly over two seconds and they may
experience slight thirst if their
dehydration moves on to moderate
dehydration then we'll see more weight
loss like up to nine percent weight loss
they may have slight to Kipp Nia
they'll have dry mucous membranes they
may have a slight increased pulse and
they may have like a decreased amount of
tears that they you know when they cry
they might not have a lot of those tears
if we move on to severe dehydration then
we're going to get a fairly significant
amount of weight loss so over 10 percent
capillary refill will be over four
seconds here and then we'll have
tachypneic as well as tachycardia and
then we also may have orthostatic
hypotension present which means that
their blood pressure will drop when they
stand up and then they will have extreme
thirst they will have no tears they may
also have sunken eyeballs as well as
sunken fontanel's
and then they may pee very little so
we'll have a lagaa urea or an urea so
they either peeing very little or
they're peeing not at all so their urine
output is definitely affected by the
dehydration so one of the most important
things to know about dehydration and
monitoring the hydration status of your
child for infants and for young
children the best indicator of hydration
status is counting the number of wet
diapers that they that they have per day
so if that is significantly decreased
then we know we're probably looking at
severe dehydration so definitely count
those diapers if they are the normal
like 6 to 8 diapers a day then we're
know we're doing we know we're doing
okay in terms of hydration so hopefully
this video has been helpful and I will
pick it up with more gastrointestinal
disorders in children in my next video
thanks for watching
English (auto-generated)

Cleft Lip and Cleft Palate

alright in this video we are going to
talk about cleft lip and cleft palate so
with cleft lip this is where we have
incomplete fusion of the oral cavity
that results in an opening through the
upper lip that extends towards the nose
the way we treat this is through surgery
the surgery is called Kyllo plasti and
it is typically done around 2 to 3
months of age in terms of nursing care
prior to the procedure we want to
encourage the use of a wide base nipple
and we can also encourage the caregiver
or parent to squeeze the baby's cheeks
during feeding after the surgery we
really don't want the baby sucking on a
nipple or pacifier because that causes
tension on the suture line which can
disrupt the operative site so the baby
is likely going to need to use a special
feeder we may also need to apply an
elbow restraint or like an arm splint to
prevent the baby from taking their hand
and messing with their operative site as
well in terms of incision care we will
likely get orders to swab that area with
either normal saline dilute hydrogen
peroxide or sterile water we may also
get an order to apply antibiotic
ointment or petroleum petroleum jelly to
the site in terms of complications
complications that are common with cleft
lip include ear infections possible
hearing loss as well as dental issues
okay moving on to cleft palate now so
with cleft palate we have incomplete
fusion of the Palantine plates so this
results in an opening that connects the
mouth to the nasal cavity and in terms
of surgical repair we would do this a
little later than we would do with a
cleft lip repair so a cleft palate
surgery would surgical repair would be
done around 6 to 12 months of age in
terms of nursing care before the surgery
we
make sure that the caregiver is feeding
the baby in an upright position that
they are burping the baby often and they
are using a bottle with a one-way valve
which will ensure that there is always
milk in the nipple for the baby during
the feeding after the surgery again
we're going to want to avoid having the
baby suck on a nipple or pacifier
because again that creates tension on
the suture site and then in the
immediate post-op period we may place
the baby laterally or possibly on their
stomach to help prevent aspiration and
to facilitate drainage and then we also
may need to apply elbow restraints or an
arm splint to prevent the baby from
disrupting disrupting the operative site
with their hands complications a lot of
the complications associated with cleft
palate are the same as we saw with cleft
lips so this includes ear infections
possible hearing loss as well as dental
issues also with cleft palate we may
have speech or language problems in the
baby so that is it for cleft lip and
cleft palate we'll pick it up with more
GI topics in my next video thanks
English (auto-generated)

GERD and Hypertrophic Pyloric Stenosis

alright in this video we are gonna talk
about a couple of gastrointestinal
disorders so we're going to talk about
GERD as well as hypertrophic pyloric
stenosis so let's first talk about GERD
which is gastrointestinal reflux disease
this is where the gastric contents of
the stomach reflux back into the
esophagus causing mucosal injury due to
the gastric acid it is very very common
in babies and usually self resolves
before 1 year of age so both of my
kiddos had reflux and it did in fact
self resolve around ten months of age so
signs and symptoms depend on whether
we're talking about an infant as opposed
to a child so with infants spitting up
is a key symptom and definitely
something that my kids did all the time
during that first year so I basically
stopped changing my clothes because at
any time I had dried spit up or even wet
spit up if I change my clothes they're
just gonna spit up on that too so I just
walked around for that first year after
they were born with spit up on my
clothes so in addition to spitting
spitting up the infant will have
irritability they'll likely cry a lot
and they may have stiffening and arching
of their back and a little older
children we may have signs and symptoms
such as heartburn chronic coughing chest
pain as well as difficulty swallowing in
terms of diagnosis we can diagnose GERD
using an upper GI endoscopy as well as
an intro esophageal pH study where we
check the pH of the esophagus in terms
of nursing care there's a lot of
teaching we need to do for the family of
a child who has GERD first of all we
want to encourage small frequent meals
so that's gonna be really important to
know in addition we can tell the parent
that they can thicken the infant's
formula with rice cereal so by
thickening the formula it
stay down better and it'll be harder to
reflux back up into the esophagus also
it's gonna be really important that the
child keep their head elevated at least
thirty degrees after meals for at least
an hour so we don't want the kid eating
and then laying down flat because we're
definitely going to get reflux then so
they really need to have their head
elevated for at least an hour after
meals also we want to avoid certain
types of food which place the child at
higher risk for reflux so these foods
include caffeine containing products
citrus peppermint spicy foods and fried
foods in terms of medications there's a
couple different medications that can
help including proton pump inhibitors
such as a Matt Brazil or h2 receptor
antagonists such as Renata Dean there is
a surgical option as well for severe
GERD this is called Nissen
fundoplication this is where we take the
fundus of the stomach and we wrap it
around the distal esophagus so again we
would only use this procedure for very
severe GERD that is not responsive to
medications and some of the teaching
that we just talked about all right now
let's talk about hypertrophic pol oryx
to nosis so this is where we have
thickening of the pyloric sphincter
which is the smooth muscle between the
stomach and the small intestine so
because we have thickening a thickening
of that sphincter it basically causes an
obstruction between the stomach and the
small intestine so we end up with signs
and symptoms such as projectile vomiting
so with GERD remember we had a lot of
spitting up but we didn't have
projectile vomiting with this condition
we will have projectile vomiting there
may be blood in the vomit in addition we
may palpate an olive shaped mass in the
right upper quadrant and we may see the
peristalsis waves on the patients AB
and then because the patient is like
vomiting all the time and not really
getting enough nutrients then we may see
failure to thrive we may have
dehydration and the child may actually
lose weight in terms of diagnosis we
would do this with an ultrasound so this
ultrasound will reveal a sausage-shaped
mass at the place where the pyloric
sphincter is because again it's
thickened in that area and it will
appear as a sausage shaped mass so
that's important to know in terms of
surgery the surgery that we can use to
correct this is something called a pie
Laura myotomy which is a surgery to
enlarge the opening at the Pelorus which
essentially removes the obstruction
between the stomach and the small
intestine okay so that's it for this
video we will pick it up with more GI
disorders in my next video thanks so
much for watching
English (auto-generated)