CHAPTER 1: PERSPECTIVES ON MATERNAL AND CHILD HEALTH CARE

WRITTEN ASSIGNMENT
1. Create a timeline that depicts the development of maternal, newborn, and womens
health nursing
Development of Maternal Health Nursing (Ricci, 2013)
During the 17th and 18th centuries, women giving birth often died as a result of
exhaustion, dehydration, infection, hemorrhage, or seizures
Approximately 50% of all children died before age , compared with the
0.06% infant mortality rate of today
Women who labored and gave birth at home were traditionally attended to
by relatives and midwives
Centuries ago, granny midwives handled the normal birthing process for
most women. They learned their skills through an apprenticeship with a
more experienced midwife. Physicians usually were called only in
extremely difficult cases, and all births took place at home.
During the early 1900s, physicians attended about half the births in the United
States. Midwives often cared for women who could not afford a doctor
Many women were attracted to hospitals because this showed affluence and
they provided pain management, which was not available in home births.
In the 1950s, natural childbirth practices advocating birth without medication
and focusing on relaxation techniques were introduced. These techniques opened
the door to childbirth education classes and helped bring the father back into the
picture.
Both partners could participate by taking an active role in pregnancy,
childbirth, and parenting
As the end of the 19th century neared, doctors and scientists gained a better
understanding of the root causes of illness. This knowledge helped fuel public
health efforts such as the campaign for safe milk supply, which lead to
pasteurizing milk and to dispensing free milk in some cities
Compulsory vaccination programs began during this time.
 In the late 19th and early 20th centuries, cities became healthier places to live
due to urban public health improvements such as sanitation services and treated
municipal water
Today, childbirth choices are often based on what works best for the mother,
child, and family.

2. Write a report on how the definition of health has changed through the years,
incorporating information about Healthy People 2020
As stated by Ricci (2013), the most straightforward meaning of health is just the
nonattendance of ailment and that is quite a while back. It is being measured by factors -
the mortality and morbidity of the populace. Be that as it may, these ideas of health changes
after some time. At the present time, wellbeing is centered around three key regions which
is the illness avoidance, wellbeing advancement, and health. Also, the simple meaning of
health from the beginning has been changed to a more longer and finish frame. Health, as
characterized by the World Health Organization (2012) is characterized as a "state of state
of complete physical, mental, and social well-being, and not merely the absence of disease
or infirmity" and up unit now, that significance is the premise of different establishment in
characterizing health.

The agenda Healthy People 2020, is a motivation utilized by the United States as a
guide for giving extensive human health services framework for its resident. It is meant to
recognize and battle the most preventable wellbeing illnesses. The extensive objectives
incorporates: "eliminate preventable disease, disability, injury, and premature death;
achieve health equity, eliminate disparities, and improve the health of all groups; create
physical and social environments that promote good health; and promote healthy
development and behaviors across every stage of life" (Ricci, 2013)

Also, the motivation fills in as a technique for measuring the advance of changes in
wellbeing and health topics which incorporates ladies and youngsters' wellbeing themes.
Moreover, the plan is slanted to advancing wellbeing, anticipating illnesses and inability,
taking out variations, and enhancing personal satisfaction (Ricci, 2013)
 Ultimately, it is not a basic approach to characterize or even screen what health is.
Individuals may see themselves as healthy regardless of the possibility that they realize
that they have maladies, and still view them as health because they can control it This
behavior will risk them to developing more intricacies. The health care provider should
manage the different points of view of health

3. Write a brief (1 page) essay on the legal and ethical issues related to providing care to
women, children and their families

As a professional, they are bound by different lawful states and state laws which
guides them to give the gauges of care. What's more, different foundation likewise have own
particular systematized laws which the employees in their organization should take after.
As indicated by Ricci (2013), there are loads of moral issues confronted by the medical
attendant in their training. Some of it are premature birth, substance manhandle, fetal
treatment, maternalfetal struggle, stem cell research, umbilical cord blood banking,
educated assent, patients rights, and privacy/confidentiality

The first issue that considered as a volatile legal, social, and political issue is
abortion. It divides the people to pro-choice and pro-life. The pro-choice says that the mother
have the right to make the decision because that is her body. The pro-life, on the other hand,
says that abortion is a form of murder because you take away the life of the baby. In dealing
with abortion, the health care team, the nurse should stay at the middle. That is, nurse should
be supportive to what the client wants to do with abortion. The nurse should also not her
own belief to the belief of the client (Ricci, 2013)

Substance Abuse in pregnant women can cause severe fetal injury or malformation,
causing again the entrance of ethical and legal principles. Legal and ethical issues involve
child safety and lead to charges of negligence and child endangerment. Privacy is
additionally an issue in the restorative field. This is an issue since it is an intrusion of security.
It is a decide that each customer has the privilege not to be uncovered all data relating to
him/her without his/her assent. It is predominant to the medicinal field and can be a reason
 for legitimate suits when privacy is said to be avoided. Moreover, Procedures such as major
and minor surgery; invasive procedures like amniocentesis internal fetal monitoring, lumbar
puncture, or bone marrow aspiration; treatments placing the person at higher risk; application
of restraints, radiation, chemotherapy; treatments involving research, require informed
consent. Informed consent can be legally given only by people over the age of majority.
Informed consent from minors can be obtained from their parents or guardians.
That is just a part of the legal and ethical issues, and nevertheless, professionals are
bounded by various laws to carry out their practice

4. Explain the difference between discipline and punishment. Discuss 3 strategies for
effective discipline.

Discipline and punishment are words that an individual frequently befuddled. All
things considered, punishment is a type of discipline. Discipline is a way that the guardians
uses to change the undesirable conduct of their kid to an a great more alluring conduct.
Then again, punishment is fairly type of discipline, however it includes the youngsters to
encounter an upsetting outcome. Be that as it may, it is fundamental for the parent to
utilized punishment, however for it to be powerful, there should be a positive reward for
good conduct.

To viably discipline the youngster, there are methodologies for the guardians to
take after. In the first place, every family is novel so accordingly its individuals. The kid
can't be contrasted with your neighbor's youngster. What may appear to be a compelling
approach to discipline another kid won't generally be the powerful when utilized to your
very own child. That is, discipline changes from child to child. Second, discipline dhould
to be planned to build up the person, to impart the correct learning, to do great, and to be a
better individual for the general public. This shouldn't include the child getting embarrassed
about themselves when they did a wrong demonstration. This shouldn't include bringing
down the kid and its pride. Discipline should be founded on what the kids did and includes
deliberately picking the correct decisions in light of the kid's terrible doings. Discipline
should be based from age offering significant esteems and lessons. Third, Discipline is a
 nonstop issue. It doesn't stop when the youngster remedied its terrible demonstration (Ricci,
2013)

GROUP ASSIGNMENT

1. Work with a partner to identify the factors that can affect maternal and child health.
Discuss ways that the nurses can educate client to improve maternal and child health.

According to Ricci (2013), the factors affecting maternal and child health are the
family, genetics, society, culture, health status and lifestyle, access to health care,
improvements in diagnosis and treatments, and empowerment of health care consumer.
Family is the basic unit of the society. They are the ones who are molding the future
through their children. They are the first-hand sources of all things, values, and experiences
a child could get. They provide the childs health beliefs and health values.
The family structure is also important. It comes from divorced family, blended
family, mixed family, adopted family, foster care family, and single-parent family. Another
thing is the parenting styles the parent is using. Whatever types of family and the parenting
styles, it will greatly affect the child and appropriate careful and continuous guidance is
necessary.
In promoting maternal and child health, I would stress the importance of family. I
believed that whatever the child will become, its values and characteristics is being molded
by the family. Yes, there are still lots of factors that affects the child, but no one beats the
family. A health family is a wealth of its members. I would suggest the parents to treat the
child as a unique individual. That is, it is different from other children. In that way, they
can provide an appropriate parenting style to their child.
Moreover, the family should also promote healthy lifestyle and as much as possible,
prevent the child from having vices such as smoking and alcohol drinking as these are the
leading cause of various diseases such as cardiovascular conditions. I would also promote
wellness by providing a well-balanced meal in which the family can incorporate to their
menus. Also, I will suggest daily exercising and to wind up from too much stress.
2. As part of small group, select a barrier that impacts health care for women, children,
and their families. Discuss ways that nurses can reduce the effect of this barrier when
caring for group

One of the health care barriers is financial barrier, an important factor that can limit
care and wellness. Labor and delivery is the most common reason for hospitalization
because almost every minute, babies are born. Not every woman is privileged to have the
financial support or even health insurance. Maternity care involves finances to pay
prenatal, labor and delivery, and postpartum dues. This barrier could be a hindrance for
proper health progress of the pregnant women, growing fetus, and growing child thereafter.
Nurses must be an advocate for the client and their family. They must assess beforehand
regarding their financial status without any discrimination involved. It has been said that
nursing is an art and with a heart, so nurses must provide ideas and available resources to
help the families overcome these barriers (Ricci, 2013).

3. Divide into small groups. Each group may take a specific family structure (single parent,
divorcing parents, blended families, foster care family). Develop an oral presentation
about the specific family structure including possible issues that might occur with this
type of family.

As adopted from Karch (2011):

Adoption can occur domestically (through an agency or intermediary such
as an attorney in the familys own area or country), or the family may choose to adopt
a child from another country. The child may be of a different culture, race, or ethnicity
(Fig. 1.5). Most children in need of adoption in the United States and overseas are not
infants. In recent years there has been an increasing number of children adopted from
the U.S. child welfare systems and internationally (Singer & Krebs, 2008; Simms &
Wilson, 20011). The amount of contact between the child and the birth mother can
vary greatly. In a closed adoption there is no contact between the adoptive parents, the
adopted child, and the birth mother. In an open adoption there is as much contact
among the individuals as desired. Regardless of the method used to adopt a child,
adoptive families may be faced with unique issues. Some adopted children have
complex medical, developmental, behavioral, educational, and psychological issues
(Faver & Alanis, 2012). They may have been exposed to poverty, neglect, infectious
diseases, and lack of adequate food, clothing, shelter, and nurturing, placing them at
risk for medical problems, physical growth and development delays or abnormalities,
and behavioral, cognitive, and emotional problems. The adoptive parents may know
about these problems, but in other situations little if any history may be available.
Differences in culture, ethnicity, or race can further influence the adopted childs sense
of identity (Faver & Alanis, 2012). Children may be subjected to racism or bigotry.
Extended family members may not accept the child as part of the family. Parents need
to emphasize that the adopted child is their child and is as much a part of the family as
any other member. Adopted adolescents and adults may feel a need to identify their
biologic parents. Children adopted from other countries may travel to the country of
their birth, and children adopted domestically may search for biologic relatives.
Although this search is an indicator of healthy emotional growth, it can upset the
adoptive parents, who may feel rejected. As the adopted child grows older, he or she
may feel the loss of a birth family or may question what he or she did that led to the
birth parents decision to proceed with adoption. Attachment to the adoptive family is
important. In order to attach in future relationships children must appropriately grieve
past losses. This can be particularly complex and difficult for older children and
children previously living in foster care or orphanages.
Clear, open, honest communication and discussion are essential to promote
a healthy, strong relationship. Support, guidance, and open communication are key for
all parties involved. Open acknowledgment of the adoptive relationship helps to
nurture a childs self-esteem as he or she learns to understand what it means to be part
of a family through adoption (Femmie, van IJzendoorn, & Palacios, 2011). The
pediatric nurse needs to be sensitive, understanding, and supportive when interacting
with adopted children and their families. Positive adoption language should be used.
This includes saying birth parent when referring to biologic parents instead of
natural or real parent and just parents when talking about adoptive parents (Singer
& Krebs, 2008). Also, do not refer to the child as their adopted child or other children
as natural child (Singer & Krebs, 2008). When discussing adoption using terms such
 as make an adoption plan instead of give away or give up for adoption are
preferred (Femmie et al., 2011). The nurse also needs to provide reassurance and
understanding regarding missing health information and provide appropriate resources
and referrals to resources that are knowledgeable about adoption and sensitive to the
issues that may arise. Sources of information and support available are the Center for
Adoption Support and Education and the North American Council on Adoptable
Children

REFERENCE

Ricci, S. S. et al (2013) Chapter 1, Perspectives on Maternal and Child Health Care. Maternity and
Pediatric Nursing (2nd ed.) (pp.35-51). Philadelphia: Wolters Kluwer Health/Lippincott Williams
& Wilkins.

ASSIGNMENTS, CHAPTER 2: CORE CONCEPTS OF MATERNAL AND CHILD

HEALTH CARE AND COMMUNITY-BASED CARE

WRITTEN ASSIGNMENT

1. Write a list of that need to be addressed to improve a clients learning.

As adopted from Karch (2011):
Slow down and repeat information often. Since most of the education in a health
care setting is done verbally, repeat important information at least four or five times.
Speak in conversational style using plain, nonmedical language. When writing
directions, write only several words, bullet points, or phrases. Use common,
living-room-type language containing one or two syllables whenever possible.
Chunk information and teach it in small bites using logical steps.This is
especially important when there are large amounts of complex information for the
family to learn. Teach for 10 to 15 minutes, give the learner a break, and return later
to chunk again.
Prioritize information and teach survival skills first. Due to time constraints and
multiple demands on the part of staff, coupled with the rapid turnaround times of
 health care encounters for clients, there never seems to be enough time to teach.
Nurses must provide the client and family with the necessary information to meet
their immediate needs. This may include information about:
The childs medical condition
Treatment information
Why the information is important
Possible problems, adverse effects, or concerns
What to do if problems arise
Who to contact for further help, information, or supplies
Use visuals, such as pictures, videos, and models. Use visual resources to enhance
and reinforce learning when available. Drawing simple pictures and charts or using
alternative methods such as color-coding often allows learning to occur for families
who are having difficulty grasping information or concepts.
Teach using an interactive, hands-on approach. When the learner uses hands-on
practice or participates in care, learning occurs more quickly and easily. Learning
first on a doll or model can ease anxiety and bolster self-confidence before doing
care or procedures on the child.

2. Select a cultural group and identify the major health beliefs of that group related to
maternal and child health using Chapter 1 as a reference. Create a chart that lists the
beliefs and propose appropriate nursing interventions for each belief that would
demonstrate cultural competence
ARAB AMERICANS
BELIEF NURSING INTERVENTION
Women subordinate to men; young I will not touch this belief since their
people subordinate to older people health is not put in risk. However, if
there is an excessive control by the
superior family member, such as
violence and abuse, I will act
accordingly.
Family loyalty is primary Nothing wrong. I will enforce it as
best as I can
Good health associated with eating Nothing wrong. I will enforce it as
properly, consuming nutritious foods, best as I can. Fasting should be
and fasting to cure disease observed providing nutritious meals
before fasting.
Illness is due to inadequate diet, shifts in Respect the belief but add a simple
hot and cold, exposure of stomach while pathophysiology to give the cause of
sleeping, emotional or spiritual distress, the disorder. Do not disregard their
and evil eye belief rather supplement it with
scientific explanation
Little emphasis on preventive care Provide preventive measures for
diseases
View of pain as unpleasant, requiring Nothing wrong. I will enforce it as
immediate control or relief best as I can
Birthmarks on newborn due to Birthmarks are congenital and we
unsatisfied maternal cravings must respect their belief because it is
not doing any harm to their health. I
will just explain the real cause of
birthmark
Pain of labor demonstrated via facial To decrease pain, the pregnant should
expressions, verbalizations, and body practice deep breathing and
movements; reluctant to use breathing relaxation techniques. As a nurse, I
and relaxation techniques during labor will demonstrate it and supplement
information regarding it.
Wrapping of newborns stomach at birth Nothing wrong. I will enforce it as
to prevent cold or wind from entering best as I can. However, the rationale
babys body is a bit wrong. I will supplement it
that it also helps in maintain warmth
to the baby
 Breastfeeding often delayed for 2 to 3 We must respect this belief but I will
days after birth encourage them to breastfeed their
baby soon after birth. I will provide
information about breastfeeding after
birth.
Cleanliness important for prayer Nothing wrong. I will enforce it as
best as I can

3. Develop a checklist that a pregnant woman can use to decide about the setting for her
labor and birth experience.
Checklist copied from: http://www.whattoexpect.com/pregnancy/labor-and-delivery/birth-
plan/

Request before birth

Who you'd like to have with you (besides your partner) during labor and/or at
delivery including a doula, your other children, friends, family
Eating or drinking during active labor
Being out of bed (walking around or sitting up) during labor
Being in a tub for labor and/or birth
Personalizing the atmosphere with music, lighting, items from home
Taking photos or videos
What equipment exercise ball, in-room shower, birthing tub you may want
available to you (permitting your chosen facility can accommodate your request)
for use in active labor
Specific birthing positions you'd like your practitioner to support you in
Request during labor and delivery

The type of birth you're planning vaginal or c section

The use of an epidural or other pain medication or wishes about alternatives to
pain meds
Artificial rupture of the membranes and/or leaving membranes intact
 External and internal fetal monitoring
The use of an IV or catheter
The use of oxytocin to induce or augment contractions
Your practitioner's position on episiotomies vs. natural tearing
The use of interventions like forceps or vacuum extraction to assist in the birth of
your child
Request for Newborn Care

Special requests around suctioning baby, such as suctioning by the father

Holding the baby immediately after birth, allowing baby time to creep from belly
to breast
Plans for breastfeeding immediately, having a lactation consultant there to help
When to cut the cord, and cord blood banking
Having your partner catch the baby and/or cut the cord
Postponing weighing the baby and/or administering eye drops until after you and
your baby greet each other
Special requests around the placenta

GROUP ASSIGNEMNT

1. Working with a partner, create a list of factors that have influenced an increase in
community-based care. Prepare an oral presentation for the class, describing the
influence of each factor
Here is the list of factors, according to Ricci (2013)
Cost-effective method of providing care. This means that every finances involved
results to productive health care. This will attract more businesses to be in the health
care industry because health is always needed and creating a community based
structure can both be an advantage for the investor and the community people. Any
weather, any time, any age can have illness, so if health care is near their home,
they will surely want proper treatment making it as the return of investment for the
business owners.
 Increase in disposable income and increased longevity of people with chronic and
debilitating health conditions. This makes health care reachable for the community
especially if the hospital is distant from their home. This will make the lives of the
patient easy. This ensures proper patient monitoring condition, treatment, and
quality of life.
Advancement in technology, thus making client monitoring and procedures to be
successfully done in the community.
Better rehabilitation of illness because the environment is familiar and comfortable
for the patient. The environment they used to be in their everyday will help them
cope and regenerate to their condition, especially that they also have full familial,
and peer support.

2. As part of a four-member group, brainstorm the requirements for assessment, physical

care, education, and resource management needed for discharge planning and case
management for a child with complex medical needs in need of home care. Share your
ideas with the rest of the class.

According to Ricci (2013), Discharge planning is rundown of what to do

proceeding with care from the hospital setting to the home care setting. Case administration
is an approach to discover the balance between the services and the cost of those services.
For the assessment of the services, I feel that they ought to contract a home wellbeing
medical attendant if the client is bed ridden or requires to be in bed most of the time or if
he/she cannot stand up on its own or if he/she have an order that is against vigorous
activities. The family should realize what are the focuses to evaluate and report it to the
medical group promptly. Moreover, the family should also realize what to do as far as
minding the client physically. Give a non-invigorating environment to give rest and
comfort. Give day by day shower to keep up cleanliness and avoid contamination. For
instruction, the family should know and have comprehension regarding the cleint's
condition including the signs and side effects and to pay attention to mediations should
have been taken. Also, advice the family to go, ought to counsel and coordinate with
different organization, group officers to help them to finding the financial aid and strategy
to help under the circumstances.
 3. Role play with another student the following scenario:
A nurse interacting with the parents of a child; the child is to undergo a procedure and
the parents do not speak English. Analyze the interaction for the use of effective
communication techniques. Propose suggestions for improving communication in this
situation.

REFERENCE

Ricci, S. S. (2013). Chapter 2 Core Concepts of Maternal and Child Health Care and Community-
Based Care. Maternity and Pediatric Nursing (2nd ed.) (pp. 51 83). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 3: ANATOMY AND PHYSIOLOGY OF THE

REPRODUCTIVE SYSTEM
WRITTEN ASSIGNMENT

1. Create a flow chart depicting the roles that hormones play during the reproductive cycle
 The pituitary gland releases The hormone will initiate the The release of egg will
Follicle Stimulating Hormone release of egg from the ovary stimulate estrogen production

The thickening of the The hormone will thicken the

endometrium and the
presence of estrogen will
stimulate the production of
Leutinizing hormone (LH)
endometrium to receive
fertilized egg, if there is. Estrogen is being produced in
the ovaries
It also inhibits FSH production

Responsible for ovulation

release of egg exactly at 14
The pituitary gland produces days. Levels of progesterone will be
the LH increased
It also inhibits estrogen
production

The ovaries produce the

If there is no implantation, the progesterone. Keeps the
The endometrium will also myometrium thick until
progesterone level will be
fall, resulting to menses implantation occurs
decreased
It also inhibits LH production

2. Select five of the key terms listed at the beginning of the chapter and write an essay using
them

The ovarian cycle is the series of events associated with a developing oocyte (ovum or
egg) within the ovaries. Whereas men manufacture sperm daily, often into advanced age,
women are born with a single lifetime supply of ova that are released from the ovaries gradually
throughout the childbearing years. In the female ovary, 2 million oocytes are present at birth,
and about 400,000 follicles are still present at puberty. (Ricci et al., 2013) the ovarian cycle
comprises of 3 phases namely the follicular phase, ovulation and the luteal phase. During the
 follicular phase, the follicles grow and mature. The hypothalamus initiates this phase because
of the increased of estrogen levels, the anterior pituitary gland will be triggered to release
follicle stimulating hormone that is responsible in the maturation of the follicles and when it is
fully matured, the Luteinizing hormone tends to be released that is responsible for the rupture
of the follicle. The second phase, which is the ovulation, it is the time when the Graafian
follicle, the mature follicle, ruptures and releasing the mature oocyte. During ovulation, the
cervix produces thin, clear, stretchy, slippery mucus that is designed to help the sperm travel
up through the cervix to meet the ovum for fertilization. (Ricci et al., 2013). The last phase is
the luteal phase. This phase begins at ovulation and ends during the menstrual phase of the
next cycle. Right after the rupture of the follicle and releases the egg it will be later on develops
and form the corpus lutuem which secretes and increase the amount of progesterone as
preparation of for implantation.

GROUP ASSIGNMENT
1. As part of a small group, discuss the two cycles involved in the female reproductive
process and the functions of each cycle. Elect a member of your group to prepare a chart
that depicts the cycles and their effects on the female body. Share the results of your
discussion with the class.
Ricci (2013) discussed that the two cycles in the female reproductive process is the
ovarian cycle and the endometrial cycle. Ovarian cycle is the series of phases or events that
happen in the maturation of the egg cell (ovum). It is composed of three phases known as
the follicular phase, ovulation and the luteal phase. Follicular phase is the phase where
follicles start to grow and form a mature egg. Follicle stimulating hormone will be
produced by the hypothalamus to stimulate coating of immature oocytes. Estrogen is
involved in this cycle, which boosts the maturation of the follicular cells. Estrogen affects
the body by proliferating or thickening the inner uterine walls, which is the endometrium
and the myometrium. Upon ovulation, surge of luteinizing hormone (LH) will rupture the
mature follicle (graafian follicle) to release the mature oocyte (egg cell). During ovulation,
cervix becomes active in secreting an enzyme that will facilitate help for the sperm to go
to the fallopian tube. It can also cause symptoms like vaginal spotting, feeling of wetness
in the vaginal area, increased libido, increase in body temperature, and cramping on the
 lower abdomen. In the luteal phase, ruptured follicular cells transform into corpus luteum
which is responsible for secretion of progesterone, the hormone of pregnancy. Progesterone
will also cause thickening of the inner uterine walls in preparation for implantation, and
increases basal body temperature. However, endometrial cycle involves series of phases or
events that happen in the endometrium. It is composed for 4 phases which is the
proliferative phase, secretory phase, ischemic phase, and menstrual phase. Proliferative
phase is the enlargement of endometrial glands due to the release of estrogen, therefore
causing thickness of the endometrium. Secretory phase involves that phase where corpus
luteum produces the hormone progesterone for pregnancy. This hormone will also interact
with the endometrium to be thickened and secrete necessary enzymes. If conception occurs,
ischemic phase and menstrual phase will not occurs and will proceed to the stages of
pregnancy. But if doesnt, corpus luteum will turn to corpus albicans and lead to the
ischemic phase. Ischemic phase is caused by the sudden drop in levels of estrogen and
progesterone due to failure of fertilization. This will cause the ischemia of the endometrium
causing the shedding that happens during menstruation period. Lastly, menstrual phase as
the actual monthly period (Ricci, 2013).

2. Work with a partner to develop a chart that compares and contrasts the function of
the ovaries in the female and the testes in the male.
OVARIES TESTES
Two structure, oval with appearance like Oval with size like olives. Can be
almonds and shaded pearl. normally observed that the left is lower
than the right
The egg cell develops at the follicle and The sperm is created in the seminiferous
discharge in the distal end of the fallopian tubules which is managed by the anterior
tube. It is additionally being managed by pituitary organ hormones FSH and LH
the anterior pituitary organ hormones
FSH and LH
Includes in the advancement and arrival Includes underway of sperm and making
of egg cell and discharge of progesterone of testosterone
and estrogen.
The ovaries additionally discharge the sex The FSH and LH additionally starts the
hormones estrogen and progesterone testicles to make testosterone essential
male sex hormones. The testosterone is
 included in spermatogenesis creation of
sperm.

REFERENCE
Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 3 Anatomy and Physiology of The
Reproductive System. In Maternity and Pediatric Nursing (2nd ed.) (pp. 91 104). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins

CHAPTER 4: COMMON REPRODUCTIVE ISSUES

WRITTEN ASSIGNMENT
1. From the list of key terms at the beginning of the chapter, select three terms. Write a
one-page summary describing what the terms have in common

For most women, they gone through their monthly menstrual cycle with no or a
little concern. However, according to Ricci et al, some women may experience physical
and emotional symptoms that causes them to visit and consult a doctor specialized with
their case.

Amenorrhea, a type of menstrual disorder, is the absence of menses during the years
of productivity of a woman however, it is normal to those of prepubertal age, pregnant and
postpartum and postmenopausal women. Because given that in the productive age of a
women, her ovaries, pituitary gland and the hypothalamus should be functioning properly.
In addition, amenorrhea has two categories which are (1) the absence of menses at the age
of 14 without the development of the secondary sex characteristics or (2) the absence of
menses at the age of 16 with development of secondary sex characteristics.

Dysmenorrhea which is another type of menstrual disorder is the painful menses.

This is caused by the contractions of the uterus, some women experience cramping in
different frequencies and intensities. Moreover, the cause is the increase of the production
of prostaglandins by the endometrium during an ovulation cycle which causes uterine
contractions. Treating dysmenorrhea can vary from taking OTC pain relievers to hormonal
control. Dysmenorrhea can be classified as primary or spasmodic and secondary or
congestive.
 Dysfunctional uterine bleeding or DUB is another type of menstrual disorders that
is described as the abnormal uterine bleeding that usually occurs at the beginning and end
of a womans reproductive age. It is the irregular, abnormal bleeding that has unknown
anatomic pathology which usually affects 50 percent of women. Additionally, according
to Behera 2011, the pathophysiology of DUB is said to be related hormonal disturbances
which in the absences of ovulation, there will be no formation of the corpus luteum hence,
progesterone will not be produced thus leading to the hyperproliferative state of the
endometrium that will result in to the irregular sloughing off of the endometrium and
excessive bleeding can be observed. The treatment for DUB is usually traced to the
treatment of underlying cause, normalizing the bleeding, treating anemia and preventing
or early diagnosis of cancer.

These three terms found in the beginning of chapter 4 has their similarities as they
are all disorders of the menstrual cycle and all can be treated to through hormonal
replacement and addressing the underlying cause that it causes it aiming to restore quality
of life.

2. Write a report about the types of abortion.

Abortion is the termination of pregnancy before the embryo or fetus became viable
(20 weeks old). It has two types namely medical and surgical abortion. Surgical abortion
is the type which is more commonly done in the United States and maybe worldwide. Both
types of abortion are legal in the United States, in fact it has been said that its the
constitutional right of women to have this decision. Surgical abortion has 3 types: vacuum
aspiration, dilation, and evacuation and induction. These types depend on the gestational
age of the woman. This procedure is usually done under local anesthesia and only takes
few minutes. Pre-operative phase involves dilation of cervix so that on the intraoperative
phase the products of conception are removed by suction evacuation. However, common
problems with this procedure are when the products of conception are not fully removed
causing infection, hemorrhage or even cervical tear. While medical abortion is method used
through administration of medication either orally or vaginal route. It is usually given upon
schedule of check up with the doctor. There are series of drugs given in this type of
abortion: First, methotrexate is given and is known for cancer therapy making it toxic for
 the growing embryo; Second (the most widely used method), giving of mifepristone, an
antagonist of progesterone making pregnancy unlikely; Third, is misprostol, which causes
contraction of the uterus to expel products of conception. Misoprostol is usually combined
either to methotrexate or mifepristone to provide more successful termination (Ricci,
2013).

3. Create a client teaching pamphlet about endometriosis

ENDOMETRIOSIS
Endometriosis is a common female The main cause of endometriosis is
reproductive disorder where the currently unknown. There is no definite
endometrial tissue is not only found in cause why endometrial tissue is
the cavity of the uterus but is also found implanted to other sites in the
scattered in other parts of the female reproductive system. However, the
reproductive system. It can be at the following are the several factors that
ovaries, vagina, ovary, fallopian tube, predisposes women to develop
and even the rectum (Ricci, 2013) endometriosis:
Elderly
Family history of endometriosis
Less than 28 day menstrual cycle
Long menstrual phase
High fat diet
Early onset of menarche
Nullipara.

Assessment includes infertility, Evaluation incorporates fruitlessness,

pain before and during menstrual torment before and amid menstrual
periods and sexual intercourse, painful periods and sex, excruciating pee,
urination, depression, fatigue, painful discouragement, weariness, difficult solid
bowel movements, chronic pelvic pain, discharges, endless pelvic agony,
hypermenorrhea, pelvic adhesions, hypermenorrhea, pelvic grips, sporadic
irregular and more frequent menses, and
 premenstrual vaginal spotting (Ricci, and more successive menses, and
2013) premenstrual vaginal spotting

The most common management is

through medication such as Depo
Provera. Depo Provera is an oral
contraceptive that controls birth. It is
helpful in endometriosis because it
inhibits gonadotropin secretion. The
result will prevent maturation of the
follicle and release of a matured egg and
eventually thinning of the endometrium
(Ricci, 2013)

GROUP ASSIGNMENT

1. With a partner, research premenstrual syndrome and premenstrual body dysphoric

disorder. Develop an oral presentation comparing and contrasting these two
conditions.
As stated byRicci (2013), premenstrual disorder (PMS) is an occasion amid
the menstrual cycle especially in the luteal stage where the ladies encounter extreme
irrelevant indications. Then again, Premenstrual dysphoric disorder (PDD) is a
variation of PMS that is viewed as more extreme than PMS. Less ladies encounter it
contrasted with PMS. In addition, PDD influences 3% to 6% of premenopausal ladies
while PMS up to 75% of bleeding ladies. The correct reason for these are still unknown
yet its indicating out the hormonal changes that produce results amid the month to
month cycle of the female body. Besides, the administration of both PMS and PDD
are fairly the same in approach. It is multidimensional since the signs are well on the
way to be huge and wide, and a solitary approach won't settle it. To lessen the effect
 of these infection in the ladies' lives, instruction, and direction is being given to the
ladies to have them the inclination that they are not overwhelmed by the disorder.
Medicines incorporate lifestyle changes, decreasing anxiety, taking essential
supplements, and solutions if the sign is sufficiently serious. Conference to a medicinal
services facility is additionally an unquestionable requirement (Ricci, 2013)

2. Working as part of a small group select a method of contraception and develop a

teaching plan, including visual aids, that could be used to educate a client about it.
MALE CONDOMS (Ricci, 2013)

More commonly available in the market and can easily be bought over-the-
counter
Male condoms, are made from latex, polyurethane or natural membrane and
may be coated with spermicide that kills sperm.
Male condoms cannot guarantee contraception because there are cases that
it can rupture or slip, causing sperm to be present on vaginal canal.
Do not reuse the condom and immediately dispose ensuring that it is tied.
An emergency post coital pill must be taken to prevent pregnancy.
Non latex Condoms have higher risk of contracting STIs and cause
pregnancy than those that are made with latex
Male condoms are available in varying colors, textures, shapes, sizes, and
thickness.
Proper insertion is putting it on an erect penis with an extra space at the tip
of the penis, so that the seminal fluid and sperm can be contained. It should be
worn throughout the sexual intercourse to prevent pregnancy or contracting
STIs.

FEMALE CONDOMS (Ricci, 2013)

Just like male condoms, they are widely available and inexpensive.
Female condoms are made with polyurethane pouch that are inserted into the vagina.
 It has an inner ring, which is inserted into the vagina, and an outer ring, which sits
outside the vaginal canal and held in place by the pubic bone.
Proper insertion of female condom (AlbatrozStudio, 2016):
Positioning can either be on standing with 1 foot on the chair, sitting on the edge of
a chair, lying down, or squatting position.
Squeeze together the sides of the inner ring.
Other hand will spread out the labia so that the condom can be easier to insert.
Insert the lower ring then the upper ring until it reaches the cervix. Move the finger
side to side to ensure that it is in place and cannot easily slip.
Hold the outer ring of the condom before insertion of penis to prevent the outer ring
to slip inside the vagina. When the condom had unintentionally slipped inside, you
can pull it out and place correctly. Lubricants can also be added when necessary.
After the orgasmic phase, rotate the condom several times before removing then tie it
up and dispose.
In cases that the female condom has ruptured, take an emergency postcoital pill to
ensure no pregnancy.
Do not reuse condoms.

3. As part of a group, create a three-column chart that lists (1) the body part or system
affected by menopausal changes, (2) the changes that occur in it, and (3) appropriate
nursing interventions to prevent or manage the changes. Share your information
with other groups.

System or body part Changes Nursing Interventions

1. Brain Hot flashes Lower room temperatures, use

electric fan or air-condition unit,
wear light clothing, limit alcohol
and caffeine intake, drink water
8-10 glasses per day, stop
smoking or lessen consumption,
avoid warm or hot beverages.
 2. Cardiovascular
3. Skeletal
4. Genitourinary
Levels of HDL lowers,
increased risk in cardiovascular
disease
Rapid loss of bone density,
osteoporosis
Vaginal dryness, stress
incontinence, cystitis
Exercise daily to prevent CVD,
stop smoking to prevent lung
and heart disorders, reduce
caffeine and alcohol intake,
monitor blood pressure, lipid
levels and diabetes.
Engage in regular weight
bearing exercises, walking that
increases osteoblast activity,
increase in calcium and vitamin
D intake, avoid smoking and
excessive alcohol intake.
Use of vaginal tablets, estrogen
releasing vaginal ring,
testosterone patches, OVT
lubricants

REFERENCE
Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 4 Common Reproductive Issues. In
Maternity and Pediatric Nursing (2nd ed.) (pp. 107 156). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins

ASSIGNMENTS, CHAPTER 5: Sexually Transmitted Infections

Written Assignment

1. Develop a teaching handout for a woman with bacterial vaginosis who is receiving
metronidazole.

Bacterial vaginosis is considered as the third most common infection. The main culprit
of the infection is the gram negative bacteria Gardnerella vaginalis.
 The disease is the most common cause of bad vaginal odor, and secretions from the
vaigina because of the alteration of the normal vaginal flora
The cause of the invasion is still not that clear but it can be broight about by multiple
sexual ppartners, douching, and there is no vaginal flora present.
This infection increases the risk for the development of sexually transmitted infections
uncluding herpres, HIV-AIDS, chlamiydia and gonorrhea.
Other factors that are currently looking up that predisposes the women to developing
vaginosis are preterm labor, early ruptures of the membranes, chorioamnionitis,
postpartum endometritis, and PID.
Treatment includes metronidazole, or clindamycin. Treating male partner is not yet
established because as of now, the connection of sexual intercourse in response to the
transmission of the infections is not yet proven.
For metronidazole:
o Assess if there is an infection. Other conditions can mask the manifestation of
vaginosis
o Contraindicated for client who have allergy to any contents of the medication
o The medication can cause darkening of the urine, tell the client about it
o Have bitter metallic taste which is normal
o Guide the client in finishing the therapy.
o May cause dizziness/lightheadedness

2. Create an outline for a class presentation to a local group of adolescents about

preventing STIs.
PREVENTION OF STI (Ricci, 2011)
Adolescents are the real hazard figure for harboring Sexually transmitted
contaminations. There are the ages 15 to 25 years in which half of the instances of
STI originated from. Also, African America, American Indian. The Frozen North
local, people living in destitution and constrained instruction assets are additionally
at high hazard.
STIs incorporate Chlamydia, Gonorrhea, Herpes Type II, Syphilis, Trichomoniasis,
and Venereal warts
 Chlamydia treatable STI caused by Chlamydia trachomatis. Transmission is
through vaginal, butt-centric, oral, and by conveyance of children. Described by
bodily fluid/discharge genital release.
Gonorrhea - treatable STI caused by Neisseria gonorrhoeae. Transmission is
through vaginal, butt-centric, oral, and by conveyance of children. Described by
yellow and foul vaginal release on females and discharge penile release on guys.
Can prompt more genuine complexity including pelvic infection
Herpes Type 2 long lasting intermittent viral sickness and no cure ailment caused
by Herpes simplex infection II. Transmission is through sexual contact and can
likewise harbor through close skin to skin contact. Portrayed by blisterlike genital
sores
Syphilis caused by Treponema pallidum. Transmission is through sexual contact
with a man having the illness.
Trichomaniasis caused by Trichomonas vaginalis through vaginal intercourse.
May be harbor from direct contact of articles that the genital has contact to.
Venereal Warts caused by Human papillomavirus. Transmitted through sexual
contact with an accomplice who have the contamination. Portrayed by wart like
sores.
In avoiding STI, the medical caretaker has an big responsibility. He/she ought to
give compelling direction and advance sound sexual relationship particularly to
young people who are sexually dynamic. They should promote mono sexual
relationship.
Stress out the significance of contraception especially boundary strategies if they
have sex
The medical caretaker ought to be not judgmental in giving the instructing focuses
to people.

3. Give significance that on the off chance that they encounter any anomaly in appearance
or have release they ought to counsel a human services supplier. Select two conditions
from the list of key terms at the beginning of the chapter. Write a report comparing and
contrasting them
 Chlamydia as stated by Ricci et al (2013), is the most common bacterial sexually
transmitted infection in the US. It has the highest rates since mostly 15-19 years old have
unplanned sexual intercourse or sometimes result of pressure or force that they have no
protection for themselves. The infection is asymptomatic to both men and women. The
causative bacterium is Chlamydia trachomatis.
Gonorrhea on the other hand is more serious and potentially severe case of bacterial
STI, it is highly contagious and a reportable condition to the health authorities according
to CDC (2012). It is caused by an aerobic gram negative bacteria, Neisseria gonorrhoeae.
Both Chlamydia and Gonorrhea are transmitted through sexual intercourse.
Uncured infection may lead to premature labor, premature rupture of membranes,
postpartum endometriosis and even infertility. Treatment management includes the
administration of antibacterial that may last to 7- 14 days. In addition, the partner should
also be treated for possible infection. A parent who is infected by neither of these two can
cause the transmission to the baby at birth and may result to Ophthalmia neonatrum that is
highly contagious and may lead to the blindness to the newborn.

GROUP ASSIGNMENT

1. Working with a partner, role-play the following scenario: a young woman is diagnosed
with genital herpes simplex but is embarrassed and hesitant to talk about it with the
nurse. One of you should play the client; the other should play the nurse. Then switch
your roles. Examine how you felt when playing each role

2. As part of a small group, brainstorm ways to enhance the use of condoms to prevent STI.
Present your ideas to the class

Provide information regarding how STIs are transmitted

Enlighten them regarding many types STIs that they can get when having unsafe
sex
Provide information regarding debilitating complications that they can get if they
do not take precautions and early diagnosis of symptoms.
Stress the importance of having protected sex
 Promote the use of barrier methods especially condom, which is the second most
advisable method and the fact that it is not that expensive.
We can also invite an actual patient with STI, which will impart their experience
and what regrets they have.

REFERENCE

Ricci, S. S. (2013). Chapter 5 Sexually Transmitted Infections. Maternity and Pediatric Nursing
(2nd ed.) (pp. 194). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 6: DISORDERS OF THE BREASTS

WRITTEN ASSIGNMENT

1. Select at least five key terms listed at the beginning of the chapter and write an essay
using them.

Breast tumor has a place with the harmful breast issue. It is a neoplastic disease
described by anomalous cells that are quickly growing. It is the most well-known
malignancy of ladies and leads as the reason for death second just behind to lung tumor in
ladies. It is not surely knew what is the reason for breast cancer however a few perspectives
are hereditary qualities, hormonal variables and ecological components (Ricci, 2013)
Breast tumor starts from breast knobs or pimple that became bigger and bigger and ended
up noticeably metastatic. It can be anticipated by utilizing a no expensive technique breast
self examination, that they can do all alone at their home. Breast self examination is a
compelling evaluation where it is more affordable and that each ladies can do all alone.
Technological progressions made help in the analysis of breast growth. One of it is
the mammography which is a method that the breast is imaged and it is an obliged strategy
to analyze malignancy. Notwithstanding, one of the least difficult, yet successful and free
at all method is simply the breast examination. It is a well ordered system where the ladies
screens its breast for any variations from the norm, for example, knocks, release, and
injuries. It is generally done amid or after a hot shower to relax the skin for palpation.
 The most widely recognized treatment for disease obviously, is chemotherapy. It is
a method proposed to prevent the anomalous cells from separating. It utilizes at least one
mix of medications. It doesn't have a particular cell affectation and in this manner, can
influence abnormal cells as well as normal cells. Surgical methodology should likewise be
possible to evacuate the piece of the breast and diminish and keep the spread of disease.
This procedure is called mastectomy, which implies expulsion of the breast tissue. It can
be either part or the entire bosom contingent upon the level of spread of the disease (Ricci,
2013)

2. Create a client education poster depicting key prevention measures for breast cancer

Observance of discharge
Breast self Observance of abnormality in color,
shape, size, etc.
examination Tumor

Clinical breast Mammogram

examination
Exercise
Wellness Health diet

Carcinogenic foods
Avoidance Obesity
Stress
GROUP ASSIGNMENT
1. Work with a partner and select a benign breast condition discussed in the chapter.
Develop an outline that can be used for review and study that describes the condition,
including risk factors, therapeutic management, nursing assessment, and nursing
management

Fibroadenomas (Ricci, 2013)

Fibroadenomas are common benign solid breast tumors that occur in about 25% of all
women and account for up to half of all breast biopsies. They are the most common mass
in women aged 15 to 35 years
They are considered hyperplastic lesions associated with an aberration of normal
development and involution rather than a neoplasm.
Fibroadenomas can be stimulated by external estrogen, progesterone, lactation, and
pregnancy
They are composed of both fibrous and glandular tissue that feels round or oval, firm,
rubbery and smooth, and is mobile and may be tender. They are usually unilateral, but may
present in both breasts
Giant fibroadenomas account for approximately 10% of cases. These masses are frequently
larger than 5 cm and occur most often in pregnant or lactating women. These large lesions
may regress in size once hormonal stimulation subsides
Fibroadenomas are rarely associated with cancer.
Treatment may include a period of watchful waiting because many fibroadenomas stop
growing or shrink on their own without any treatment. Other growths may need to be
surgically removed if they do not regress or if they remain unchanged. Cryoablation, an
alternative to surgery, can also be used to remove a tumor. In this procedure, extremely
cold gas is piped into the tumor using ultrasound guidance. The tumor freezes and dies.
The current trend is toward a more conservative approach to treatment after careful
evaluation and continued monitoring.
 Nursing assessment:
Ask the woman about clinical manifestations of fibroadenomas. These lumps are felt
as firm, rubbery, wellcircumscribed, freely mobile nodules that might or might not
be tender when palpated
Breast fibroadenomas are usually detected incidentally during clinical or self-
examinations and are usually located in the upper outer quadrant of the breast; more
than one may be present. Several other breast lesions have similar characteristics, so
every woman with a breast mass should be evaluated to exclude cancer.
A clinical breast examination by a health care professional is critical. In addition,
diagnostic studies include imaging studies (mammography, ultrasound, or both) and
some form of biopsy, most often a fine-needle aspiration, core needle biopsy, or
stereotactic needle biopsy. The core needle biopsy removes a small cylinder of tissue
from the breast mass, more than the fine-needle aspiration biopsy. If additional tissue
needs to be evaluated, the advanced breast biopsy instrument (ABBI) is used.
This instrument removes a larger cylinder of tissue for examination by using a
rotating circular knife. The ABBI procedure removes more tissue than any of the
other methods except a surgical biopsy (ACS, 2011f)

2. As part of a small group, discuss various methods that could be used to teach a group

of adolescents and young adult women about breast self-examination.

Return demonstration is a good method of educating regarding breast self

examination. Nurses can use a dummy or breast dummy to show the group of adolescents
and young adults on how to position theirselves and 3 strokes to use in checking the breast.
After discussion, we can have them demonstrated one by one on the dummy and can also
provide them privacy spaces in which they can do it to theirselves. We can also use detailed
step by step pictures of activities to be done on breast self examination. We can also use
video presentation, which can be appealing for all of them not get bored listening than the
other methods.
REFERENCE

Ricci, S. S. (2013). Chapter 6 Disorders of the Breasts. Maternity and Pediatric Nursing (2nd
ed.) (pp. 198 204). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 7: BENIGN DISORDERS OF THE FEMALE

REPRODUCTIVE TRACT

WRITTEN ASSIGNMENT

1. Create a chart that compares and contrasts endometrial polyps and fibroids.

POLPYS AND FIBROIDS

COMPARE CONTRAST

They are types of benign growths in Polyps only grow on the inner layer
the female reproductive tract.
(endometrium) of the uterus and in the
Growth of both is not well
understood. But are believed to be cervix while fibroids can grow in
caused by infection, increased level different layers and parts of the uterus.
of estrogen, or local congestion of
cervical vasculature Polyps are smaller than fibroids.
Incidence of growth are increasing Fibroids can also cause painful periods
as they increase age and gradually
declines upon menopausal period. (dysmenorrhea), pressure on the bladder
Single or multiple growths can or the rectum resulting to difficulty
happen
They both have the same symptoms defecating or urination.
in which: they experience bleeding
in between menstrual periods
(metrorrhagia), heavy menstrual
period, bleeding after menopause,
and infertility.
Risk factors for growth of both
include: postmenopausal stage,
hypertension, obesity, and
nulliparity.
 2. Select five key terms from the list at the beginning of the chapter and use them in an
essay describing the common benign conditions of the female reproductive tract.
There are lots of conditions affecting the female reproductive tract and one of these
is the pelvic organ prolapse. It belongs to a general term called pelvic support disorders.
Others that belongs to the class are urinary and fecal incontinence. Pelvic organ prolapse,
from its name, is a prolapse of the organ. It is a herniation of the organs of the pelvic from
their initial placed where they are attached in the pelvis. It is characterized by any part of
the pelvis that protrude outside of the vaginal cavity (Ricci, 2013)
Moreover, Ricci (2013) stated that an estimated of the cases of vaginal delivery
manifest pelvic organ prolapse and each year an approximated quarter of a million women
undergo surgery to resolve the prolapse. The cases are still increasing as aging occurs.
Furthermore, there are four common types of Pelvic organ prolapse and these are the
cystocele, rectocele, enterocele, and uterine prolapse. Cystocele is described as parts of the
posterior bladder wall protrudes downward to the anterior vaginal wall Rectocele is
described as parts of the rectum sags and protrudes into the posterior vaginal wall.
Enterocele is describe as parts of the small intestine protrudes to the posterior vaginal wall.
Uterine prolapse is described as when parts of the uterus descend to the pelvic floor and
pass the vaginal canal (Ricci, 2013)

ASSIGNMENTS, CHAPTER 7: BENIGN DISORDERS OF THE FEMALE

REPRODUCTIVE TRACT

GROUP ASSIGNMENT

1. Working with a partner, compare and contrast stress incontinence and urge
incontinence.
Both stress and urge incontinence has a place with urinary incontinence which is
depicted as an automatic loss of pee because of different components (Ricci, 2013). Urge
incontinence is portrayed as an automatic loss of pee, trailed by a solid urinating inclination
with expanded bladder weight and bladder muscles constriction. Then again, stress
incontinence is an unplanned ejection of pee from upsetting circumstances, for example,
sniffling, hacking, chuckling, and physical effort.
 Additionally, Ricci (2013) likewise expressed that the reason for urge incontinence
can be no cause by any means, neurologic or because of disease. In the interim, stress
incontinence can be realized by debilitated muscles and tendons in the pelvic pit. It is most
common in 50s of age. Moreover, urge incontinence is showed by recurrence and
criticalness to urinate, nocturia and a bigger measure of pee volume than stress
incontinence. Stress incontinence then again is loss of little measures of pee because of
increment in intra-stomach pressure t from physical exertion (Ricci, 2013)

2. As part of a small group, develop a teaching plan for a woman who is to receive a pessary
as part of the treatment for pelvic organ prolapse

Nurses need to be aware of the personal isolation and embarrassment and social
and cultural implications that urinary incontinence may cause as well as the subjective
experiences of using a pessary. With appropriate support, vaginal pessaries can provide
women with the freedom to lead active, engaged social lives. Pessaries are fitted by trial
and error; the woman often needs to try several sizes or styles. The largest pessary that the
woman can wear comfortably is generally the most effective. The woman should be
instructed to report any discomfort or difficulty with urination or defecation while wearing
the pessary. (Ricci, 2013)

REFERENCE

Ricci, S. S. et al (2013) Chapter 7: Benign Disorders of the Female Reproductive Tract.

Maternity and Pediatric Nursing (2nd ed.) (pp.226-238). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.

CHAPTER 8: CANCERS OF THE FEMALE REPRODUCTIVE TRACT.

WRITTEN ASSIGNMENT

1. Develop a written handout that describes ways a woman can reduce her risk for
cancers of the reproductive tract
 REDUCE CANCER RISK (Ricci, 2011)
Dont smoke.
Drink alcohol only in moderation (no more than one drink daily).
Be physically active daily.
Eat a healthy diet.
Stay current with immunizations.
Use a condom with every sexual encounter
Reach and maintain a healthy weight.
Take preventive medicines if needed.
Get recommended screening tests:
Body mass index (BMI) to identify obesity
Mammogram every 1 to 2 years starting at age 40
Pap smear every 1 to 3 years if sexually active, between
the ages of 21 and 65
Cholesterol checked annually starting at age 45
Blood pressure checked at least every 2 years
Diabetes test if hypertensive or hypercholesterolemia
Check for STIs if sexually active

2. Create a matching exercise that lists each of the key terms in Column 1 and their
definitions in Column 2. Give the exercise to a classmate to complete and then score
the responses
Definition according to Ricci (2011)
1. Cervical cytology screening to A. cervical cancer
diagnose cervical cancers. B. cervical dysplasia
2. malignant neoplastic growth of the C. colposcopy
ovary D. cone biopsy
3. cancer of the uterine cervix E. cryotherapy
4. malignant tissue growth arising in the F. endometrial cancer
vagina. G. human papillomavirus
5. malignant neoplastic growth of the H. ovarian cancer
uterine lining I. Papanicolaou (Pap) test
 6. abnormal neoplastic growth on the J. vaginal cancer
external female genitalia K. vulvar cancer
7. usually causes cervical cancer and is
acquired through sexual activity
8. disordered growth of abnormal cells in
the cervix removes a coneshaped
section of cervical tissue. can be used
to completely remove any precancers
and very early cancers
9. is a microscopic examination of the
lower genital tract using a magnifying
instrument called a colposcope.
10. destroys abnormal cervical tissue by
freezing with liquid nitrogen.

GROUP ASSIGNMENTS

1. As part of a small group, choose a reproductive tract cancer. Describe the etiology, risk
factors, symptoms, diagnosis and treatment, and nursing management. Prepare an oral
presentation for class discussion.

VULVAR CANCER (Ricci, 2013)

Vulvar cancer is an abnormal neoplastic growth on the external female genitalia. Vulvar
cancer accounts for approximately 5% of all female genital malignancies. It occurs in about
1.5 per 100,000 women-years in developed countries. It is the fourth most common
gynecologic cancer, after endometrial, ovarian, and cervical cancers.
EIOLOGY
Unknown etiology. Approximately 90% of vulvar tumors are squamous cell carcinomas.
This type of cancer forms slowly over several years and is usually preceded by
precancerous changes. These precancerous changes are termed vulvar intraepithelial
neoplasia
RISK FACTORS
Exposure to HPV type 16
Age over 50 years
 HIV infection
VIN
Lichen sclerosus
Melanoma or atypical moles
Exposure to HSV type 2
Multiple sex partners
Smoking
Herpes simplex
History of breast cancer
Immune suppression
Hypertension
Diabetes mellitus
Obesity (ACS, 2011h)
MANIFESTATIONS
In most cases, the woman reports persistent vulvar itching, burning, and edema that
do not improve with the use of creams or ointments. A history of condyloma, gonorrhea, and
herpes simplex are some of the factors for greater risk for VIN. Diagnosis of vulvar
carcinoma is often delayed. Women neglect to seek treatment for an average of 6 months
from the onset of symptoms. In addition, a delay in diagnosis often occurs after the client
presents to her physician. In many cases, a biopsy of the lesion is not performed until the
problem fails to respond to numerous topical therapies. During the physical examination,
observe for any masses or thickening of the vulvar area. A vulvar lump or mass most often
is noted. The vulvar lesion is usually raised and may be fleshy, ulcerated, leukoplakic, or
warty. The cancer can appear anywhere on the vulva, although about three fourths arise
primarily on the labia (Creasman, 2011b). Less commonly, the woman may present with
vulvar bleeding, discharge, dysuria, and pain
DIAGNOSIS
Annual vulvar examination is the most effective way to prevent vulvar cancer.
Careful inspection of the vulva during routine annual gynecologic examinations remains the
most productive diagnostic technique. Liberal use of biopsies of any suspicious vulvar lesion
is usually necessary to make the diagnosis and to guide treatment. However, many women
 do not seek health care evaluation for months or years after noticing an abnormal lump or
lesion. The diagnosis of vulvar cancer is made by a biopsy of the suspicious lesion, which is
usually found on the labia majora.
TREATMENT
Treatment varies depending on the extent of the disease. Laser surgery,
cryosurgery, or electrosurgical incision may be used. Larger lesions may need more
extensive surgery and skin grafting. The traditional treatment for vulvar cancer has been
radical vulvectomy, but more conservative techniques are being used to improve
psychosexual outcomes
NURSING MANAGEMENT
Women with vulvar cancer must clearly understand their disease, treatment options, and
prognosis. To accomplish this, provide information and establish effective communication
with the client and her family. Act as an educator and advocate. Teach the woman about
healthy lifestyle behaviors, such as smoking cessation and measures to reduce risk factors.
For example, instruct the woman how to examine her genital area, urging her to do so
monthly between menstrual periods. Tell her to look for any changes in appearance (e.g.,
whitened or reddened patches of skin); changes in feel (e.g., areas of the vulva becoming
itchy or painful); or the development of lumps, moles (e.g., changes in size, shape, or color),
freckles, cuts, or sores on the vulva. Urge the woman to report these changes to the health
care provider (ACS, 2011h). Teach the woman about preventive measures such as not
wearing tight undergarments and not using perfumes and dyes in the vulvar region. Also
educate her about the use of barrier methods of birth control (e.g., condoms) to reduce the
risk of contracting HIV, HSV, and HPV. For the woman diagnosed with vulvar cancer,
provide information and support. Discuss potential changes in sexuality if radical surgery is
performed. Encourage her to communicate openly with her partner. Refer her to appropriate
community resources and support groups.

2. Working with a partner, develop ways to promote awareness of the need for compliance
with screening methods.
 Raising the awareness of a group is one of the responsibilities of the nurse
especially if it talks about compliance in the treatment course. Maybe, as a way to develop
their awareness, I will hold a seminar which tackles about cancer and the screening
methods available. I will stress out that although it is a bit pricey, the benefit you can get
with screening will outweigh the price of the service. The seminar will aid them to answer
the most common matter regarding the disease. Also, I will various foundations that can
fund the seminar and aid the people in having the service. Moreover, I will also make
posters regarding the importance of screening. I will use the saying: prevention is the best
cure.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 8 Cancers of The Female Reproductive
Tract . In Maternity and Pediatric Nursing (2nd ed.) (pp. 250 275). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins

ASSIGNMENTS, CHAPTER 9: VIOLENCE AND ABUSE

WRITTEN ASSIGNMENT

1. Select three or four key terms listed at the beginning of the chapter and write an essay
about violence and women that incorporates them

Rape is a serious criminal act. It involves violence and aggressiveness towards a

persons body, and is not a sexual act. According to Ricci (2013), rape is a legal rather
than a medical term. Rape involves force that can be combined with an accessory weapon
or threat to life (gun, knife, publication of scandal, threat to family). Rape denotes
unconsented penile penetration of the vagina, mouth, or rectum. In the United States, 9 in
10 rape cases are female victims. Rape can destruct the social, relational capability and
even the whole life of the victim, which can lead them to have isolation and end up thinking
about suicide. Rape can be hard to prevent because it can be an unexpected act by an
aggressive and sexually starving person. Education about safety must be given to women
and strong law enforcement to provide order (Ricci, 2013). Statutory rape is a classification
of rape in which an adult person is having a sexual activity to a person under legal age even
if the underage person consented. This will involve serious legal and civil issues that could
ruin the life of both persons. However, traumatic experience has low possibility of
occurrence because the sexual activity is planned and agreed upon. Acquintance rape is a
class of rape in which the victim and rapist know each other or even closely related.
Examples of this is rape initiated by a coworker, husbands friend, neighbor, classmate,
sorority/fraternity members, boss or even a teacher. Date rape is a form of acquaintance
rape in which aggression or assault is done to the person the rapist is dating or is married
without consent. This is the case why there is such case like marital rape. This type of rape
can leave the victim with traumatic experience and disorder that could affect their whole
life. Extreme protection physically and emotionally must be given to them because trust
will be hard to gain. Help them toward their life situation in their battle for justice. As a
health care provider, we must keep in mind that rape victims should not be exploited
directly when admitted because legal institutions are the first one to have examinations, as
basis for legal evidence of rape in court proceedings. Sexual activity should always be done
with peace, non coercive participation, and pure love, not with forcing someone to have
sex with them (Ricci, 2013)
 2. Create a poster that depicts the cycle of violence and the characteristics of each phase.

Phase 1Tension building:

Phase 2Acute battering:
Verbal or minor battery
Characterized by
occurs. Almost any subject,
uncontrollable discharge of
such as housekeeping or
tension. Violence is rarely
money, may trigger the
triggered by the victims
buildup of tension. The
behavior: she is battered no
victim attempts to calm the
matter what her response.
abuser.

Phase 3Reconciliation
(honeymoon)/calm phase: The batterer
becomes loving, kind, and apologetic and
expresses guilt. Then the abuser works on
making the victim feel responsible.

GROUP ASSIGNMENT

1. Working with a partner, take turns role-playing a health care practitioner screening a
client suspected of being sexually abused by her husband.
2. As part of a small group, create a list of interview questions that could be used to assess
a potential victim of human trafficking. Discuss what interventions would be appropriate
if it was determined that the client was indeed a victim of this practice.
INTERVIEW QUESTIONS FOR IDENTIFYING POTENTIAL VICTIMES OF
HUMAN TRAFFICKING (Ricci, 2013)
Look beneath the surface and ask yourself: Is this person.
A female or a child in poor health?
 Foreign-born and doesnt speak English?
Lacking immigration documents?
Giving an inconsistent explanation of injury?
Reluctant to give any information about self, injury, home, or work?
Fearful of authority figure or sponsor if present? (Sponsor might not leave victim alone
with health care provider.)
Living with the employer?
Sample questions to ask the potential victim of human trafficking:
Can you leave your job or situation if you wish?
Can you come and go as you please?
Have you been threatened if you try to leave?
Has anyone threatened your family with harm if you leave?
What are your working and living conditions?
Do you have to ask permission to go to the bathroom, eat, or sleep?
Is there a lock on your door so you cannot get out?
What brought you to the United States? Are your plans the same now?
Are you free to leave your current work or home situation?
Who has your immigration papers? Why dont you have them?
Are you paid for the work you do?
Are there times you feel afraid?
How can your situation be changed?

REFERENCE
Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 9 Violence and Abuse. In Maternity and
Pediatric Nursing (2nd ed.) (pp. 278 303). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins
ASSIGNMENTS, CHAPTER 10: Fetal Development and Genetics
WRITTEN ASSIGNMENT

1. Create a flowchart that depicts the flow of blood through the fetus.
FETAL CIRCULATION (Ricci, 2013)

The umbilical vein The rest of the

carries oxygen-rich blood travels down
blood from the to the right
placenta to the liver ventricle and
and through the through the
ductus venosus pulmonary artery.

From there it is
A small portion of
carried to the
the blood travels to
inferior vena cava to
the nonfunctioning
the right atrium of
lungs
the heart

Some of the blood

is shunted through he remaining blood
the foramen ovale is shunted through
to the left side of the ductus
the heart, where it arteriosus into the
is routed to the aorta to supply the
brain and upper rest of the body
extremities
 2. Write a report that describes the process of fertilization through implantation.

Fetal development during pregnancy is measured in number of weeks after fertilization.

The duration of pregnancy is about 40 weeks from the time of fertilization. This equates to 9
calendar months or approximately 266 to 280 calendar days. (Ricci,2013) there are 3 stages of
fetal development namely; preembryonic stage, embryonic stage and the fetal stage.

The preembryonic stage begins with fertilization, also called conception. Fertilization
is the union of ovum and sperm, which is the starting point of pregnancy. Fertilization typically
occurs around 2 weeks after the last normal menstrual period in a 28-day cycle. Fertilization
requires a timely interaction between the release of the mature ovum at ovulation and the
ejaculation of enough healthy, mobile sperm to survive the hostile vaginal environment
through which they must travel to meet the ovum. Fertilization takes place in the outer third of
the ampulla of the fallopian tube. When the ovum is fertilized by the sperm (now called a
zygote), a great deal of activity immediately takes place. Mitosis, or cleavage, occurs as the
zygote is slowly transported into the uterine cavity by tubal muscular movements. At this time,
the developing blastocyst needs more food and oxygen to keep growing. The trophoblast
attaches itself to the surface of the endometrium for further nourishment. Normally,
implantation occurs in the upper uterus (fundus), where a rich blood supply is available. (Ricci,
2013)

GROUP ASSIGNMENT

1. Working with a partner, develop a client education handout that describes the structure
and function of the placenta, umbilical cord, and amniotic fluid.

AMNIOTIC FLUID:

Surrounds the embryo

Serves as cushion to the fetus
Made up of transported maternal blood and urine excreted by the fetus.
The volume is depended as the fetus swallows and excrete urine.
Helps in maintaining body temperature
Provides symmetric growth and development
 UMBILICAL CORD

22 inches long, 1 inch wide

Formed from the amnion
Lifeline from the mother to the growing fetus
Whartons jelly, specialized connective tissue that surrounds the three
blood vessels of the cord
PLACENTA

Protects the fetus from immune attack by the mother

Removes waste from the fetus
Induces the mother to bring nutrients to the growing fetus
serves as the interface between the mother and the developing fetus.

2. As part of a small group, select a genetic disorder to research. Describe the disorder, the
type of inheritance pattern associated with the disorder, and the characteristics of that
type of pattern. Develop an oral presentation about the selected disorder.

Cleft lip and cleft palate are facial and oral malformations that occur very early
in pregnancy, while the baby is developing inside the mother. Clefting results when there is not
enough tissue in the mouth or lip area, and the tissue that is available does not join together properly
(WebMD, 2017). The genetic inheritance pattern of cleft lip and cleft palate is caused by
Multifactorial Inheritance Conditions which are thought to be caused by multiple gene and
environmental factors. That is, a combination of genes from both parents, along with unknown
environmental factors, produces the trait or condition. An individual may inherit a
predisposition to a particular anomaly or disease. The anomalies or diseases vary in severity,
and often a sex bias is present. Multifactorial conditions tend to run in families, but the pattern
of inheritance is not as predictable as with single-gene disorders. The chance of recurrence is
also less than in single-gene disorders, but the degree of risk is related to the number of genes
in common with the affected individual. The closer the degree of relationship, the more genes
an individual has in common with the affected family member, resulting in a higher chance the
individuals offspring will have a similar defect. In multifactorial inheritance the likelihood
 that both identical twins will be affected is not 100%, indicating that there are nongenetic
factors involved. (Ricci, 2013)

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 10 Fetal Development and Genetics . In
Maternity and Pediatric Nursing (2nd ed.) (pp. 307 330). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins

Cleft Lip and Cleft Palate (2017). Retrieved from http://www.webmd.com/oral-health/cleft-lip-cleft-

palate#1

ASSIGNMENTS, CHAPTER 11: MATERNAL ADAPTATION DURING PREGNANCY

WRITTEN ASSIGNMENT
1. Write an essay that describes the physiologic changes that occur in the reproductive
system with pregnancy. Correlate the signs and symptoms of pregnancy with these
changes.
There is part of changes event in the female regenerative framework. These are just
brief adjustment and method for dealing with stress of the body to suit the developing baby.
The Uterus picks up a huge development to account for the development of the infant.
Sometime recently, in a non-pregnant express, the uterus just measures 70gm in weight
and 8cm long. At term amid pregnancy, the uterus inflatables to 1,100 to 1,200 gm and
measures up to 32 cm. The profundity likewise changes from 2.5 to 22cm preceding and
amid pregnancy. Besides, the uterine divider changes from 1 to 0.5 cam however its width
is 4 to 24 cm. This is a typical adjustment on the grounds that the uterus prepares for the
results of conception. The limit increments from 10ml to at least 5l a t term. Braxton Hicks
constrictions can likewise be felt because of upgrading uterine divider compression which
for the most part at the principal trimester. Moreover, the uterus mellows and a positive
Hegar's sign can be seen (Ricci, 2013)

The cervix likewise starts to relax because of clog of blood in the zone. This sign
is called Goodell's sign. What's more, because of the expanding vascularization, the cervix
 will transforms it shading to violet and this is called Chadwick's sign (Ricci, 2013)
Moreover, Ricci (2013), likewise expressed the vagina additionally expands its vascularity
coming about broadening of the organ in arrangement for conceivable vaginal conveyance.
Discharges are additionally more unmistakable, the mucosal generation increments.
Changes in the bosom can likewise be watched. The bosom wind up noticeably delicate,
expansive, and more full because of the level of estrogen and progesterone. There is
additionally stamped obscuring of the areola and the areolas and greased up in arrangement
for locking. Colostrum can likewise be seen releasing by the third trimester.

2. For each of the key terms listed at the beginning of the chapter, create a vocabulary card
that gives the term on one side and the definition on the other side
All definitions are based from Ricci (2013)

BALLOTTEMENT A rebound reflex from the floating fetus if an examiner

pushes against the cervix during pelvic examination.

BRAXTON HICKS Are painless, spontaneous, irregular contractions that

CONTRACTION can be felt throughout pregnancy.

CHADWICKS SIGN It is the bluish discoloration of the cervix.

DIERTARY REFERENCE Are guidelines for nutritional and supplemental needs

INTAKES (DRIs) of the pregnant woman throughout pregnancy

GOODELLS SIGN It is the softening of the cervix.

HEGARS SIGN It is the softening of the isthmus, or the lower segment

of the uterus.

LINEA NIGRA Is a pigmented line seen vertically in the abdomen

which extends from the fundus down to the pubic area.

PHYSIOLOGIC ANEMIA It is a state of hemodilution in which thereis decreased

OF PREGNANCY level of hemoglobin and hematocrit due to increased
levels of plasma than the levels of RBC.

PICA Is a compulsive eating of nonfood things like ice, soil,

dust, or other things that are present in the environment.
 QUICKENING Fetal movements felt by the mother
TRIMESTER A period of 3 months

GROUP ASSIGNMENT

1. Working with a partner, create a chart that lists the nutrients recommended by the DRIs
and then provide suggestions for foods that would supply these nutrients. Analyze the
chart for foods that supply more than one nutrient
Nutrient Pregnant Women Foods
Calories 2,500 cal Rice, cereal, bread
Protein 80 g Lean meat, poultry, fish
Water/fluids 8 glasses daily Drinking water
Vitamin A 770 mcg Banana and squash
Vitamin C 85 mg Citrus foods
Vitamin D 5 mcg Sunlight, fish, egg yolk
Vitamin E 15 mcg Onions, corns, bitter guard
B1 (thiamine) 1.5 mg Salmon, lean pork
B2 (riboflavin) 1.4 mg Cheese, almonds
B3 (niacin) 18 mg Fish, chicken
B6 (pyridoxine) 1.9 mg Sunflower seeds, pistachio
nuts
B12 (cobalamin) 2.6 mcg Shellfish, liver
Folate 600 mcg Green leafy vegetables
Calcium 1,000 mg Milk, cheese
Phosphorus 700 mg Pumpkin and squash seeds
Iodine 220 mcg Oysters, fish
Iron 27 mg liver
Magnesium 350 mg Spinach, chard
Zinc 11 mg Seafood, beef, lamb
 The foods that supply more than 1 nutrient are the green leafy vegetables, squash,
lean port, egg yolk, fish, nuts, seeds and lean meat among others.

2. As part of a small group, choose one of the body systems, excluding the reproductive
system, discussed in the chapter that undergoes changes during pregnancy. Develop a
list of all the changes that occur, including the underlying physiology for each change.
Share your information with the class

Changes in the Respiratory System (Ricci, 2013)

The growing uterus and the increased production of the hormone progesterone cause the
lungs to function differently during pregnancy.
During pregnancy, the amount of space available to house the lungs decreases as the uterus
puts pressure on the diaphragm and causes it to shift upward by 4 cm above its usual
position.
The growing uterus does change the size and shape of the thoracic cavity, but
diaphragmatic excursion increases, chest circumference increases by 2 to 3 inches, and the
transverse diameter increases by an inch, allowing a larger tidal volume, as evidenced by
deeper breathing (Blackburn, 2012).
Tidal volume, or the volume of air inhaled, increases by 40% (from 500 to 700 mL) as the
pregnancy progresses. This increase results in maternal hyperventilation and hypocapnia.
As a result of these changes, the womans breathing becomes more diaphragmatic than
abdominal.
Concomitant with the increase in tidal volume is a 20% to 40% increase in maternal oxygen
consumption due to the increased oxygen requirements of the developing fetus, placenta,
and maternal organs.
Anatomic and physiologic changes of pregnancy predispose the mother to increased
morbidity and mortality and increase the risks of a less than optimal outcome for the fetus.
The frequency and significance of acute and chronic respiratory conditions in pregnant
women have increased in recent years. Because of these various changes, pregnant women
with asthma, pneumonia, or other respiratory pathology are more susceptible to early
decompensation (Frye, Clark, Piacenza, & Shay-Zapien, 2011).
 A pregnant woman breathes faster and more deeply because she and the fetus need more
oxygen. Oxygen consumption increases during pregnancy even as airway resistance and
lung compliance remain unchanged.
Changes in the structures of the respiratory system take place to prepare the body for the
enlarging uterus and increased lung volume (Blackburn, 2012). As muscles and cartilage
in the thoracic region relax, the chest broadens, with a conversion from abdominal
breathing to thoracic breathing. This leads to a 50% increase in air volume per minute. All
of these structural alterations are temporary and revert back to their prepregnant state at the
end of the pregnancy.
Increased vascularity of the respiratory tract is influenced by increased estrogen levels,
leading to congestion.
Rising levels of sex hormones and heightened sensitivity to allergens may influence the
nasal mucosa, precipitating epistaxis (nosebleed) and rhinitis. This congestion gives rise to
nasal and sinus stuffiness and changes in the tone and quality of the womans voice
(Kumar, Hayhurst, & Robson, 2011).

REFERENCE

Ricci, S. S. (2013). Chapter 11 Maternal Adaptation During Pregnancy. Maternity and Pediatric
Nursing (2nd ed.) (pp. 334 356). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

ASSIGNMENTS, CHAPTER 12: NURSING MANAGEMENT DURING PREGNANCY

WRITTEN ASSIGNMENT

1. Develop a client teaching handout for a client who is to have an amniocentesis.

AMNIOCENTESIS (Ricci, 2013)

involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic
fluid for analysis.
performed after an ultrasound examination identifies an adequate pocket of amniotic fluid
free of fetal parts, the umbilical cord, or the placenta.
 detect chromosomal abnormalities and several hereditary metabolic defects in the fetus
before birth
used to confirm a fetal abnormality when other screening tests detect a possible problem
performed in the second trimester, usually between 15 and 18 weeks gestation.
performed after an ultrasound examination identifies an adequate pocket of amniotic fluid
free of fetal parts, the umbilical cord, or the placenta
health care provider inserts a long pudendal or spinal needle, a 22-gauge, 5-inch needle,
into the amniotic cavity and aspirates amniotic fluid
Test results may take up to 3 weeks.
Empty your bladder prior to the procedure.
Pre-procedural fetal monitoring is done that takes 20 minutes to make sure that the fetus is
well and is used as baseline data for comparison before and after procedure.
After procedure, you may position to the most comfortable for you.
Take a rest once returned to home and prevent physical exertion.
Watch out for signs and symptoms like fever, vaginal discharge of amniotic fluid, bleeding,
frequent uterine contractions or any changes in fetal activity. Immediately consult health
care provider for immediate treatment.
If fetal abnormality has been detected, genetic counseling is recommended.

2. Write an essay about essential aspects of prenatal care, incorporating at least three of
the key terms listed at the beginning of the chapter.

Once a pregnancy is suspected and, in some cases, tentatively confirmed by a home

pregnancy test, the woman should seek prenatal care to promote a healthy outcome. The
assessment process begins at this initial prenatal visit and continues throughout the
pregnancy. The initial visit is an ideal time to screen for factors that might place the woman
and her fetus at risk for problems such as preterm delivery. The initial visit also is an
optimal time to begin educating the client about changes that will affect her life (Ricci et
al.,2013).
 In connection, still, according to Ricci et al (2013), Counseling and education of
the pregnant woman and her partner are critical to ensure healthy outcomes for mother and
her infant. Pregnant women and their partners frequently have questions, misinformation,
or misconceptions about what to eat, weight gain, physical discomforts, drug and alcohol
use, sexuality, and the birthing process. The nurse needs to allow time to answer questions
and provide anticipatory guidance during the pregnancy and to make appropriate
community referrals to meet the needs of these clients. To address these issues and foster
the overall well being of pregnant women and their fetuses, specific national health goals
have been established. comprehensive health history is obtained, including age, menstrual
history, prior obstetric history, past medical and surgical history, family history, genetic
screening, lifestyle and health practices, medication or drug use, and history of exposure
to STIs (Jarvis, 2012). It is important that at the initial visit, a comprehensive health history
will be done that includes the OB history of the mother, gravida which is the number of
pregnancy, para or parity which is the number of deliveries at 20 weeks AOG, medication,
drug use and STIs if there is any. Prenatal care identifies high risk pregnancies leading to
early management that will promote the health of the mother and the growing baby.

GROUP ASSIGNMENT

1. Working with a partner, role-play a situation in which a 32-year-old woman comes to

the prenatal clinic for an initial visit because she thinks she is pregnant. Take turns
playing the client and nurse. Develop an assessment checklist for the history and
physical examination and share it with the class.
 PRECONCEPTION 3 CREENING
AND COUN 3 ELING CHECKLI3 T
NAME BIRTHPLACE AGE

DATE: / / ARE YOU PLANNING TO GET PREGNANT IN THE NEXT SIX MONTHS? __ Y
__N
IF YOUR ANSWER TO A QUESTION IS YES, PUT A CHECK MARK ON THE LINE IN FRONT OF THE QUESTION. FILL IN OTHER INFORMATION THAT APPLIES TO YOU

DIET & EZERCI 3 E LIFE3 TYLE

What do you consider a healthy weight for you? __________
___Do you eat three meals a day?
___Do you follow a special diet (vegetarian, diabetic, other)?
___Which do you drink (__coffee __tea __cola __milk __water __other soda/pop
other ________________________________)?
___Do you eat raw or undercooked food (meat, other)?
___Do you take folic acid?
___Do you take other vitamins daily (__multivitamin __vitamin A __other)?
___Do you take dietary supplements (__black cohosh __ pennyroyal __other)?
___Do you have current/past problems with eating disorders?
___Do you exercise? Type/frequency:__________________
Notes:
___Do you smoke cigarettes or use other tobacco products?
How many cigarettes/packs a day? ______________
___Are you exposed to second-hand smoke?
___Do you drink alcohol?
What kind?__________ How often? __________ How much?_________
___Do you use recreational drugs (cocaine, heroin, ecstasy, meth/ice, other?
List:_____________________________________________________
___Do you see a dentist regularly?
What kind of work do you do?________________________________
___Do you work or live near possible hazards (chemicals, x-ray or other radiation,
lead)? List:_____________________________________
___Do you use saunas or hot tubs?
NOTES:

MEDICAL/ FAMILY HI3TORY

MEDICATION/DRUG3
Do you have or have you ever had:
___ Are you taking prescribed drugs (Accutane, valproic acid, blood thinners)? List ___Epilepsy?
them______________________________________________ ___Diabetes?
___ Are you taking non-prescribed drugs? ___Asthma?
List them:_________________________________________________ ___High blood pressure?
___Are you using birth control pills? ___Heart disease?
___Do you get injectable contraceptives or shots for birth control? ___Anemia?
___Do you use any herbal remedies or alternative medicine? ___Kidney or bladder disorders?
List:______________________________________________________ ___Thyroid disease?
NOTES: ___Chickenpox?
___Hepatitis C?
___Digestive problems?
___Depression or other mental health problem?
___Surgeries?
___Lupus?
___Scleroderma?
WOM EN'3 H EALT H ___Other conditions?
Have you ever been vaccinated for:
___Do you have any problems with your menstrual cycle? ___Measles, mumps, rubella?
___ How many times have you been pregnant? ___Hepatitis B?
What was/were the outcomes(s)? _________________________________ ___Chickenpox?
___Did you have difficulty getting pregnant last time? NOTES:
___Have you been treated for infertility?
___Have you had surgery on your uterus, cervix, ovaries or tubes?
___Did you mother take the hormone DES during pregnancy?
___Have you ever had HPV, genital warts or chlamydia?
___Have you ever been treated for a sexually transmitted infection (genital herpes,
gonorrhea, syphilis, HIV/AIDS, other)? List:____________________
GENETIC 3
NOTES: Does your family have a history of or your partner's family
___Hemophilia? ____
___Other bleeding disorders? ____
___Tay-Sachs disease? ____
___Blood diseases (sickle cell, thalassemia, other)? ____
___Muscular dystrophy? ____
HOME ENuIRONMENT ___Down syndrome/Mental retardation? ____
___Do you feel emotionally supported at home? ___Cystic fibrosis? ____
___Do you have help from relatives or friends if needed? ___Birth defects (spine/heart/kidney)? ____
___Do you feel you have serious money/financial worries? Your ethnic background is: ________________________________________
___ Are you in a stable relationship? Your partner's ethnic background is:________________________________
___Do you feel safe at home? NOTES:
___Does anyone threaten or physically hurt you?
___Do you have pets (cats, rodents, exotic animals)? List:_______________
___Do you have any contact with soil, cat litter or sandboxes?
OTHER
Baby preparation (if planning pregnancy):
___Do you have a place for a baby to sleep? IS THERE ANYTHING ELSE YOU'D LIKE ME TO KNOW?
___Do you need any baby items?
NOTES:
ARE THERE ANY QUESTIONS YOU'D LIKE TO ASK ME?

From March of Dimes. Source:

http://publichealth.lacounty.gov/mch/ReproductiveHealth/PreconceptionHealth/PCH_PreconceptionHe
althResources.htm
2. As part of a small group, select an area of self-care important for pregnant women.
Develop a list of ideas that could be useful in promoting self-care in this area. Create a
poster that depicts your suggestion

SLEEP AND REST (Ricci, 2013)

Getting enough sleep helps a person feel better and promotes optimal performance
levels during the day. The body releases its greatest concentration of growth
hormone during sleep, helping the body to repair damaged tissue and grow. Also,
with the increased metabolic demands during pregnancy, fatigue is a constant
challenge to many pregnant women, especially during the first and third trimesters.
The following tips can help promote adequate sleep:

Stay on a regular schedule by going to bed and waking up at the same times.
Eat regular meals at regular times to keep external body cues consistent.
Take time to unwind and relax before bedtime.
Establish a bedtime routine or pattern and follow it.
Create a proper sleep environment by reducing the light and lowering the
room temperature.
Go to bed when you feel tired; if sleep does not occur, read a book until you
are sleepy.
Reduce caffeine intake later in the day.
Limit fluid intake after dinner to minimize trips to the bathroom
Exercise daily to improve circulation and well-being.
Use a modified Sims position to improve circulation in the lower extremities.
Avoid lying on your back after the fourth month, which may compromise
circulation to the uterus.
Avoid sharply bending your knees, which promotes venous stasis below the
knees.
Keep anxieties and worries out of the bedroom. Set aside a specific area in
the home or time of day for them.
REFERENCE

Ricci, S. S. (2013). Chapter 12 Nursing Management During Pregnancy. Maternity and Pediatric
Nursing (2nd ed.) (pp. 398 399). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

ASSIGNMENTS, CHAPTER 13: LABOR AND BIRTH PROCESS

WRITTEN ASSIGNMENT
1. Create a chart that lists the stages (and phases of each stage) of labor. Identify the key
physiologic and psychological changes that occur in each.
STAGES AND PHASES OF LABOR (Ricci, 2013)

First Stage Second Stage Third Stage Fourth Stage

DESCRIPTION From 010 cm From complete Separation and 1-4 hr after the
dilation; consists dilation (10 cm) to delivery of the birth of the
of three phase birth of the placenta; usually newborn; time of
newborn; may takes 510 min, maternal
last up to 3 hr but may take up physiologic
to 30 min adjustment
PHASES Latent phase (0 Pelvic phase Placental
3 cm dilation) (period of fetal separation:
Cervical dilation descent) detaching from
from 0 to 3 cm Perineal phase uterine wall
Cervical (period of active Placental
effacement from pushing) expulsion: coming
0% to 40% Nullipara, lasts outside the
Nullipara, lasts up to 1 hr; vaginal opening
up to 9 hr; multipara, lasts
multipara, lasts up to 30 min
up to 56 hr Contraction
Contraction frequency every
frequency every 23 min or less
510 min Contraction
Contraction duration 60
duration 30 90 sec
45 sec Contraction
Contraction intensity strong
intensity mild to by palpation
palpation Active Strong urge to
phase (47 cm push during the
dilation) later perineal
Cervical dilation phase
from 4 to 7 cm
 Cervical
effacement from
40% to 80%
Nullipara, lasts
up to 6 hr;
multipara, lasts
up to 4 hr
Contraction
frequency every
25 min
Contraction
duration 45
60 sec
Contraction
intensity
moderate to
palpation
Transition phase
(810 cm dilation)
Cervical dilation
from 8 to 10 cm
Cervical
effacement from
80% to 100%
Nullipara lasts
up to 1 hr;
multipara, lasts
up to 30 min
Contraction
frequency every
12 min
Contraction
duration 60
90 sec
Contraction
intensity strong
by palpation

2. Develop a written checklist that can be used by pregnant women to help them determine
if they are in labor.
Experience of Increased cramping and pelvic pressure
Experience of low back pain that radiates toward the abdomen
Pink-tinged secretion blood and mucus
Strong regular contractions that last 45-60 seconds and happens every 5 minutes.
 Sudden gush of blood and fluid
Contractions continue no matter what positional change is made.

GROUP ASSIGNMENT:

1. With a partner, role-play a situation in which a pregnant woman comes to the health
care facility because she thinks she is in labor. Discuss how you would determine if the
woman was experiencing true or false labor.
False labor is a condition occurring during the latter weeks of some pregnancies in
which irregular uterine contractions are felt, but the cervix is not affected. In contrast, true
labor is characterized by contractions occurring at regular intervals that increase in
frequency, duration, and intensity. True labor contractions bring about progressive cervical
dilation and effacement. False labor, prodromal labor, and Braxton Hicks contractions are
all names for contractions that do not contribute in a measurable way toward the goal of
birth. (Ricci, 2013) True labor is characterized by a Regular, becoming closer together,
usually 46 min apart, lasting 3060 sec; Become stronger with time, vaginal pressure is
usually felt; it Starts in the back and radiates around toward the front of the abdomen;
Contractions continue no matter what positional change is made. On the other hand, false
labor is characterized by irregular, not occurring close together; Frequently weak, not
getting stronger with time or alternating (a strong one followed by weaker ones); Usually
felt in the front of the abdomen and the contractions may stop or slow down with walking
or making a position change. It is important to be knowledgeable regarding the difference
between true and false labor so that patients will know what they will do and when they
will proceed to the hospital.
2. As part of a small group, select one of the critical factors that can affect labor and
birth. Develop an oral presentation for the class, including visual aids

The primary and natural source of power in delivery and labor is the uterine
contractions. It signifies the labor and contractions from true labor starts the labor process.
In the first stage of labor, the contractions duration, frequency, and intensity is continuously
increasing. Due to these contraction, the cervix fully dilates to accommodate the passage
of the newborn. The secondary power in labor is the urge that causes increase in intra-
 abdominal pressure exerted by the mother seen in the second stage of labor. Uterine
contractions are involuntary and will happen anytime without the knowledge of the women.
They are rhythmic, with pattern, and intermittent. It have pauses in between to allow the
pregnant women to rest and allows the blood to go to the uterus and placenta. Uterine
contractions are assessed by the frequency how often the contractions occur starting from
the beginning of the contraction to the beginning of the next contraction. It is also assessed
by Duration how long the contractions are measure from the beginning of the contraction
to the end of it; Intensity - refers to the strength contraction, can be mild, moderate, and
strong (Ricci, 2013)

3. With a partner, describe the cardinal movements of labor, demonstrating each movement
with a model or doll.
There are 7 cardinal signs of labor. These are Engagement, Descent, Flexion,
Internal rotation, extension, restitution and external rotation, and expulsion Engagement
happens when the presenting part of the fetus is its widest diameter reaches station 0 level
of ischial spin in the pelvis. Descent is the downward movement of the fetal head until the
pelvic inlet. Flexion is wen the fetal head levels the pelvic floor. The head flex to the chest.
Internal rotation occurs when the fetus goes through the pelvic inlet, and the fetal head
rotates anteriorly. Extension happens when the fetal head extends opposing the fetal chest
as further descent occurs. Restitution and external rotation happens when the shoulders
rotate with further descent. This allows the fetal head return to its normal position. Lastly,
expulsion occurs when the shoulder passes through the pubic symphysis (The Brookside
Associates)

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 10 Fetal Development and Genetics . In
Maternity and Pediatric Nursing (2nd ed.) (pp. 307 330). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins

The Brookside Associates. (n.d.). Retrieved July 11, 2017, from

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/mechan
ism_of_normal_labor.htm
ASSIGNMENTS, CHAPTER 14: NURSING MANAGEMENT DURING LABOR AND
BIRTH

WRITTEN ASSIGNMENT

1. Create an outline that traces the progression of labor from the time a pregnant woman
is admitted to the perinatal unit until birth. Include appropriate nursing assessments
and interventions.
Nursing management for the woman during labor and birth includes comfort
measures, emotional support, information and instruction, advocacy, and support
for the partner (Ricci, 2013)
Nursing care during the first stage of labor includes taking an admission history
(reviewing the prenatal record), checking the results of routine laboratory work
and special tests done during pregnancy, asking the woman about her childbirth
preparation (birth plan, classes taken, coping skills), and completing a physical
assessment of the woman to establish baseline values for future comparison
(Ricci, 2013)
Nursing care during the second stage of labor focuses on supporting the woman
and her partner in making decisions about her care and labor management,
implementing strategies to prolong the early passive phase of fetal descent,
supporting involuntary bearing-down efforts, providing support and assistance,
and encouraging the use of maternal positions that can enhance descent and
reduce the pain (Ricci, 2013)
Nursing care during the third stage of labor primarily focuses on immediate
newborn care and assessment and being available to assist with the delivery of the
placenta and inspecting it for intactness (Ricci, 2013)
The focus of nursing management during the fourth stage of labor involves
frequently observing the mother for hemorrhage, providing comfort measures,
and promoting family attachment (Ricci, 2013)
2. Review the list of key terms at the beginning of the chapter. Select at least three terms
and write a paragraph relating these terms to the nursing management of a woman
during labor.
Leopolds maneuver is an interventions of the nurse to assess the fetal lie, position,
and presentation. It have four steps to perform. The first one is what we call the fundal
group to determine the fetal presentation. It can be either head presentation or breech
presentation. Next maneuver is what we call the umbilical group. It is used to determine
the position of the fetus. The fetal back is described to be smooth and hard, while the
elbows and knees are described with a number of angular protrusions. The third maneuver
is the pawliks grip. This maneuver is used to determine the level of engagement of the
presenting part. If the presenting part is movable, then it is not yet engaged, but if it is
nonmovable, then it is engaged. The last maneuver is the Pelvic group. It is used to
determine the degree the head is flex (Ricci, 2013) Aside from the leopolds maneuver,
nurses should consider some medical interventions during delivery and lavor. The nurse
should monitor the fetal crowning. It is the presentation of the presenting part of the fetus
usually the fetal head when in normal position, to the vaginal opening. It is the start of
the physical act of delivery aided by the natural contractions of the female reproductive
body and can be aided by medical interventions. One of it episiotomy. It is a medical
intervention where the posterior vaginal wall is incise and generally done by the midwife
or obstetrician. It is not a standard procedure and it is only done when the situation calls
(Ricci, 2013)

3. Create drug cards for the following pharmacologic agents, addressing the drugs effect
on maternal and fetal status:

MORPHINE MEPERIDINE

May be given IV or epidurally May be given IV,

Rapidly crosses the placenta,
causes a decrease in FHR
variability
Can cause maternal and
neonatal CNS depression
Decreases uterine contractions
intrathecally, or epidurally
with maximal fetal uptake 23
hr
after administration
Can cause CNS depression
Decreases fetal variability
FENTANYL
Is given IV or epidurally
Can cause maternal hypotension,
maternal and fetal respiratory
depression
Rapidly crosses placenta
DIAZEPAM
Is given to enhance pain relief of
opioid and cause sedation
May be used to stop eclamptic
seizures
Decreases nausea and vomiting
Can cause newborn depression;
therefore, lowest possible dose
should be used

GROUP ASSIGNMENT

1. Working with a partner, develop a list of advantages and disadvantages of external and
internal fetal monitoring. From this list, prepare to debate the use of either type of
monitoring.

EXTERNAL FETAL MONITORING

Advantages
External monitoring can be utilized whether the membranes are intact or ruptured,
and whether the cervix is dilated or still dilating
Noninvasive procedure
Aside from fetal wellbeing, it also measures the characteristics of contractions
duration and frequency
Provides permanent record of fetal heart rate
Disadvantages
The belt where the scanner is placed can limit the mothers movements
Cannot detect short variability
The signals can be disrupted and reading may be false die to obesity, fetal
movement, and malpresentation of the fetus
Transmission from CB radios may also be picked up by the monitor and affects
the reading
Gaps in the monitor strip can occur periodically without explanation.
INTERNAL FETAL MONITORING
Advantages
Usually indicated for high risk pregnancy.
 More accurate in detecting short term changes in the fetal condition
Can accurately the fetal variability as well as fetal heart rate dysrhythmias.
Maternal position and changes in movement doesnt affect in the result of the
monitoring.
Disadvantages
Invasive
Conditions must be met to proceed with the procedure
- Ruptured membranes
- Dilated cervix at least 2cm
- The presenting part of the fetus must be in lower portion for the device to
place
- Requires skilled medical practitioner to place the device
-
2. As part of a small group, list ideas for ways to promote increased use of ambulation and
position changes during labor and birth. Prepare an oral presentation about your ideas.

POSITION DURING THE FIRST STAGE OF LABOR (Ricci, 2013)

Walking with support from the partner (adds the force of gravity to contractions to
promote fetal descent)
Slow-dancing position with the partner holding you (adds the force of gravity to
contractions and promotes support from and active participation of your partner)
Side-lying with pillows between the knees for comfort (offers a restful position and
improves oxygen flow to the uterus)
Semi-sitting in bed or on a couch leaning against the partner (reduces back pain because
fetus falls forward, away from the sacrum)
Sitting in a chair with one foot on the floor and one on the chair (changes pelvic shape)
Leaning forward by straddling a chair, a table, or a bed or kneeling over a birth ball
(reduces back pain, adds the force of gravity to promote descent; possible pain relief if
partner can apply sacral pressure)
 Sitting in a rocking chair or on a birth ball and shifting weight back and forth (provides
comfort because rocking motion is soothing; uses the force of gravity to help fetal
descent)
Lunge by rocking weight back and forth with foot up on chair during contraction (uses
force of gravity by being upright; enhances rotation of fetus through rocking)
Open kneechest position (helps to relieve back discomfort) (Mattson, & Smith, 2011;
Tharpe et al., 2013)

REFERENCE

Ricci, S. S. (2013). Chapter 14 Nursing Management During Labor and Birth. Maternity and
Pediatric Nursing (2nd ed.) (pp. 449 459). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.

ASSIGNMENTS, CHAPTER 15: POSTPARTUM ADAPTATIONS

WRITTEN ASSIGNMENT
1. Choose a body system that undergoes changes after childbirth. Develop a chart that
compares the changes that occur in the system during pregnancy and then after birth.

RESPIRATORY SYSTEM (Ricci, 2013)

CHANGES DURING PREGNANCY CHANGES AFTER BIRTH

Respirations usually remain within the normal Respirations usually remain within the normal
adult range of 16 to 24 breaths per minute adult range of 16 to 24 breaths per minute

During pregnancy, the amount of space
available to house the lungs decreases as the
uterus puts pressure on the diaphragm and
causes it to shift upward by 4 cm above its
usual position
As the abdominal organs resume their
nonpregnant position, the diaphragm returns
to its usual position

The growing uterus does change the size and Anatomic changes in the thoracic cavity and
shape of the thoracic cavity, but rib cage caused by increasing uterine growth
 diaphragmatic excursion increases, chest
circumference increases by 2 to 3 inches, and
the transverse diameter increases by an inch,
allowing a larger tidal volume, as evidenced
by deeper breathing
resolve quickly. As a result, discomforts such
as shortness of breath and rib aches are
relieved

Tidal volume, or the volume of air inhaled, Tidal volume, minute volume, vital capacity,
increases by 40% (from 500 to 700 mL) as the and functional residual capacity return to
pregnancy progresses. This increase results in prepregnant values, typically within 1 to
maternal hyperventilation and hypocapnia. As 3 weeks of birth
a result of these changes, the womans
breathing becomes more diaphragmatic than
abdominal. Concomitant with the increase in
tidal volume is a 20% to 40% increase in
maternal oxygen consumption due to the
increased oxygen requirements of the
developing fetus, placenta, and maternal
organs.

2. Review the list of key terms at the beginning of the chapter. Select one of these terms and
write an essay integrating this term with the topic of the chapter.

Physiological changes are not the only adaptations on the postpartum period. It also
involves a major adjustment to roles, lifestyle, activities, and responsibilities for the mother
and her family because of the entrance of a new member of their family and lives.
Postpartum period maybe is the sweetest and happiest period for the lives of couples
because they can now able to touch and care the baby that they have planned and waited
for 9 months. Attachment is the formation of bond and relationship between the parents
and the newborn. This process involves physical and emotional bond that continually
progresses as time goes by. Attachment has occurred as early as pregnancy was accepted.
It can be seen through having music therapy with the baby or talking to the baby while still
inside the womb. It intensifies when the baby is actually outside of the mothers womb
 where they can give the actual physical care and love that they cant do when the it was still
inside the womb. Nurses play an important role in initiating attachment for clients like
early skin to skin contact as soon as the baby is delivered, through promotion of
breastfeeding, and through promotion of motherly activities. Attachment can further be
successful by limiting interruptions within the bonding periods of the mother and child.

ASSIGNMENTS, CHAPTER 15: POSTPARTUM ADAPTATIONS

GROUP ASSIGNMENT

1. Working with a partner, take turns assuming the role of the client and nurse. Role-play
teaching a postpartum woman about changes that she can expect in her body during the
postpartum period.

REFERENCE

Ricci, S. S. (2013). Chapter 15 Postpartum Adaptations. Maternity and Pediatric Nursing (2nd
ed.) (pp. 491 502). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 16: NURSING MANAGEMENT DURING THE

POSTPARTUM PERIOD

WRITTEN ASSIGNMENT

1. Prepare review cards for the key terms listed at the beginning of the chapter. On the
cards, define each key term and use it in a sentence.
All definitions are copied from Ricci (2013)

ATTACHMENT

Attachment is the development of strong affection between an infant and a significant

other (mother, father, sibling, and caretaker)

I observed strong attachment between the mother and the infant

BONDING

Bonding is the close emotional attraction to a newborn by the parents that develops
during the first 30 to 60 minutes after birth.

The mother and the newborn was given plenty of time for bonding

EN FACE POSITION

Interaction of the mother with their infants through eye-to-eye contact

Positive behavior includes demonstrating en face position

KEGEL EXERCISE

strengthen the pelvic floor muscles to support the inner organs

The nurse encourage the pregnant women to do Kegel exercises regularly

PERIBOTTLE

a plastic squeeze bottle filled with warm tap water that is sprayed over the perineal area
after each voiding and before applying a new perineal pad

The use of peribottle can help to promote comfort and hygiene who had vaginal birth

POSTPARTUM BLUES

are transient emotional disturbances beginning in the first week after childbirth and are
characterized by anxiety, irritability, insomnia, crying, loss of appetite, and sadness

Lots of women in the maternity ward are experiencing postpartum blues

SITZ BATH

ay be prescribed and substituted for the ice pack to reduce local swelling and promote
comfort for an episiotomy, perineal trauma, or inflamed hemorrhoids

Most health care agencies use plastic disposable sitz baths that women can take home
 2. Create a poster using drawings, illustrations, and photos to depict positive bonding and
attachment behaviors.

Left image copied from: https://www.studyblue.com/notes/note/n/ch-21-post-partum-

adaptions/deck/3542089
Right image copied from: http://parentingsquad.com/what-is-attachment-parenting

ASSIGNMENTS, CHAPTER 16: Nursing Management During the Postpartum Period

Group Assignment:

1. Working with a partner, role-play a scenario involving a postpartum woman who is

having difficulty breast-feeding her newborn. Take turns playing the woman and the
nurse.
2. Using the acronym BUBBLE-EE, devise a teaching checklist for a postpartum woman
BUBBLE-EE stands for breast, uterus, bladder, bowels, lochia, episiotomy/ perineum/
epidural site, extremities, and emotional status.

Breast
Assess for characteristic such as size and symmetry
Assess for nipple cracks and discharge
Provide proper breastfeeding

Uterus

Determine the state of uterus by assessing the fundus

Normal uterus is firm. Boggy uterus is sign of infection or atony
 Bladder

Assess for diuresis. Normal is <3000 ml

Uterine atony can cause urinary tract infection

Bowels

Should establish normal pattern after a week postpartum

Abdomen is soft and nontender. Present bowel sounds

Lochia

Assess the progress of lochia from rubra, serora, to alba

Note the smell, appearance, and color as it may indicate problems such as infection

Episiotomy

Assess for irritation, tenderness, warmth, hematoma

Assess for foul smelling purulent discharge, swelling, and redness as it may indicate
infection

Extremities

Assess for motor and function return

Promote ambulation as the mother may be at risk for thromboembolic disorders
Wear antiembolism if there is a risk of developing embolism

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 16 Nursing Management During the
Postpartum Period. In Maternity and Pediatric Nursing (2nd ed.) (pp. 508 540). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins
ASSIGNMENTS, CHAPTER 16: NURSING MANAGEMENT DURING THE
POSTPARTUM PERIOD

WRITTEN ASSIGNMENT

1. Using the terms at the beginning of the chapter, write a report that describes the events
associated with newborn adaptation.

There are lots of events happening to the newborn as a way to adapt in the outside
environment. According to Ricci (2013), most of these events are observed in the first 28
days of life known as the neonatal period The newborn displays variety of reflex that aids in
its survival and a way of adaptation. There are the moro reflex, sucking reflex, Babinski
reflex, gag reflex, and galant reflex. These reflexes are a way to assess the neurological
maturation of the newborn (Ricci, 2013) Many neonatal reflex disappears as the newborn
ages but some reflex including that gag and blinking reflex is permanent throughout life.
This is because these reflexes are essential for survival of the individual. Moreover, the
newborn needs to adapt to the transition of temperature from inside womb to outside
environment. In order to survive, the newborn must maintain the balance between the
produced heat and the lost heat through the process known as thermoregulation. There are
lot of ways where can the health care provided helps the newborn in maintaining the
temperature of the newborn. In order to help the newborn, the health care team must know
the ways the heat is transferred: Conduction, convection, evaporation, radiation. Conduction
involves transfer of heat from an object to other object through a direct contact. Convection
is heat losing from the body surface going to the surrounding air that is cooler than the body
surface. Evaporation happens when a fluid is transformed into a vapor leading to heat loss.
Lastly, radiation involves non direct contact loss of heat from the body to a cooler object.
All of these mechanisms of heat transfer must be taken into consideration to help the baby
adapt to the surroundings. If the baby fails to maintain body heat, he will suffer from cold
stress. It is an event brought about by excessive loss of heat in which the baby will require
the baby to use compensatory mechanisms just to maintain the core body heat. The effects
of this in the newborn is quiet series so the nurse should be able to prevent it from happening.
(Ricci, 2013) Additionally, in terms of bowel elimination, Ricci (2013) stated that the first
 pass of contents in the anal canal of the newborn is the meconium. It is described as greenish
black and tarry consistency and is sterile. In terms on respirations, surfactant in the lungs is
developed after a normal term baby is born. The surfactant is essential in keeping the lungs
from collapsing. Careful monitoring should be considered if the newborn displays periodic
breathing, which is the stopping of breathing that have a duration of 5 to 10 seconds. This is
because the respiratory system of the newborn is still adapting to the outside environment.
Furthermore, neurobehavioral response is also observed in the newborn. These are specific
set of responses to different stimuli.
2. Create a flowchart or diagram that outlines the changes occurring with the transition
from fetal to newborn circulation.
TRANSITION FROM FETAL TO NEWBORN CIRCULATION (Childrens
Hospital of Philadelphia

An increase in the baby's

With the first breaths of life,
At birth, the umbilical cord is blood pressure and a
the lungs begin to expand. As
clamped and the baby no significant reduction in the
the lungs expand, the alveoli
longer receives oxygen and pulmonary pressures reduces
in the lungs are cleared of
nutrients from the mother the need for the ductus
fluid
arteriosus to shunt blood.

These changes increase the

The shift in pressure
stimulates the foramen ovale
to close.
pressure in the left atrium of
These changes promote the
the heart, which decrease
closure of the shunt
the pressure in the right
atrium.

The closure of the ductus

arteriosus and foramen ovale
completes the transition of
fetal circulation to newborn
circulation.
GROUP ASSIGNMENT

1. As part of small group, develop a list of nursing interventions that would be appropriate
to foster newborn behaviors.
Nursing Interventions to foster newborn behaviors (Ricci, 2013)
Advice mother to breastfeed her baby if the baby shows behavior of increased activity,
rooting reflexes, sucking motions, irritability, crying, and fine tremors of the upper and
lower extremities.
Teach mother on proper positioning of the baby during breastfeeding and how to know if
the baby has effective latching.
Teach about proper changing of diaper, hygiene, and bathing techniques for the baby.
Advice to interact with the baby most of the time to have cuddle moments, create bonding,
and develop attachment.
Promote comforting environment and less interruption if the baby is sleeping This can also
be a chance for the mother to regain energy after an exhausting labor.
Encourage mother to have en face position (face-to-face) with the baby to enhance
bonding.
Assess for good motor movements like bringing hands up and feet like pseudowalking
which confirms ability of the child to adapt and respond to stimuli.
Assisting parents on consoling behaviors that they can use when the newborn cannot
consulate on their own. These consoling behaviors include rocking the baby, singing while
patting gently, and comforting embrace.
Assist parents on comforting behaviors they can do to their baby to enhance cuddling of
the baby.
Support and praise the parents all throughout the process
2. Working with a partner, select one body system of the newborn and prepare an oral
presentation detailing the major changes and challenges that occur in this system
RESPIRATORY SYSTEM CHANGES (Ricci, 2013)
The first breath of life is a gasp that generates an increase in transpulmonary
pressure and results in diaphragmatic descent. Hypercapnia, hypoxia, and acidosis
resulting from normal labor become stimuli for initiating respirations. Inspiration of air and
expansion of the lungs allow for an increase in tidal volume (amount of air brought into
 the lungs). Surfactant is a surface tension-reducing lipoprotein found in the newborns
lungs that prevents alveolar collapse at the end of expiration and loss of lung volume. It
lines the alveoli to enhance aeration of gas-free lungs, thus reducing surface tension and
lowering the pressure required to open the alveoli. Normal lung function depends on
surfactant, which permits a decrease in surface tension at end expiration (to prevent
atelectasis) and an increase in surface tension during lung expansion (to facilitate elastic
recoil on inspiration). Surfactant provides the lung stability needed for gas exchange. The
newborns first breath, in conjunction with surfactant, overcomes the surface forces to
permit aeration of the lungs. The chest wall of the newborn is floppy because of the high
cartilage content and poorly developed musculature. Thus, accessory muscles to help in
breathing are ineffective.
One of the most crucial adaptations that the newborn makes at birth is adjusting
from a fluid-filled intrauterine environment to a gaseous extrauterine environment. During
fetal life, the lungs are expanded with an ultrafiltrate of the amniotic fluid. During and after
birth, this fluid must be removed and replaced with air. Passage through the birth canal
allows intermittent compression of the thorax, which helps eliminate the fluid in the lungs.
Pulmonary capillaries and the lymphatics remove the remaining fluid.
If fluid is removed too slowly or incompletely (e.g., with decreased thoracic
squeezing during birth or diminished respiratory effort), transient tachypnea (respiratory
rate above 60 bpm) of the newborn occurs. Examples of situations involving decreased
thoracic compression and diminished respiratory effort include cesarean birth and sedation
in newborns. Research findings support the need for thoracic compression because the
absence of the neonates exposure to labor contractions, which may occur with cesarean
births or heavy sedation during the labor process, is associated with an increased risk of
transient tachypnea at term, with oxygen supplementation being needed for a longer
duration (Donn, & Sinha, 2012).

REFERENCE

Ricci, S. S. (2013). Chapter 17 Nursing Newborn Transitioning. Maternity and Pediatric Nursing
(2nd ed.) (pp. 549 564). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
ASSIGNMENTS, CHAPTER 18: NURSING MANAGEMENT OF THE NEWBORN
WRITTEN ASSIGNMENT
1. Select five or six key terms listed at the beginning of this chapter and use them in an
essay that addresses the key aspects of nursing care of the newborn.

The newborn requires ongoing assessment after leaving the birthing area to ensure
that his or her transition to extrauterine life is progressing without problems. The nurse
uses the data gathered during the initial assessment as a baseline for comparison. (Ricci et
al., 2013). Assessment includes the skin for overall appearance it is important to identify
newborn skin variations.
Common skin variations include the appearance of the vernix caseosa which is a
thick white substance that serves as the protection of the skin. These are formed by the
secretion of the newborns oil glands during the first 2-3 days and it not necessary to be
removed because it can be absorbed by the skin and also serves as a thermoregulation to
the baby as it covers the skin. Another skin variation to be observed are the stoke bites or
also called as the salmon patches in the skin which are caused by immature blood vessels
that are most visible when the baby is crying and considered as normal because they will
completely disappear after the first year. Milia can also be found as these are unopened
sebaceous glands that are frequently located on the nose, chin and forehead which will
disappear within 2-4 weeks. Milia can also appear on the newborns mouth and will be
referred to as the Epstein pearls. Blue or purple splotches can also be found at the llower
back or buttocks of the newborn and these spots are called Mongolian spots. They tend to
occur mostly to African American, Asians, and Indian babies. These spots are caused by
the concentration of pigmentations that will disappear after 4 years of life.

2. Write a step-by-step procedure for administering eye prophylaxis in a newborn.

Application of Eye Prophylaxis (Mayo Clinic, 2017)

1. Do hand washing prior to any intervention

2. Done either sterile or clean gloves
3. Remove the medication cap
 4. Medicine is held by the either hand, while the other hand will hold/spread gently
the eyes of the newborn.
5. Aim for the lower lid of the eyes and do not touch the tip of the medicine tube on
the eye.
6. Squeeze the medicine tube and administer starting from the inner canthus to outer
canthus of the eye. One continuous strip of medication on the whole length of the
lid is enough.
7. Let go of the eyelid and gently press the eyes to ensure absorption of medication.
8. Wipe the tip of the medication tube with clean tissue or cotton ball and place the
cap.
9. Put the medication on the medication cabinet and do handwashing.
10. Document intervention

GROUP ASSIGNMENT

1. Working with a partner, discuss the information that parents need when their newborn
is being discharged from the facility. Create a parent teaching handout that includes this
information.

Image and information below is copied from New England Pediatrics,

http://www.nepeds.com/pdf/Discharge-Guidelines-Newborn-Infants.pdf
 2. As part of a small group, select a common concern, such as transient tachypnea,
physiologic jaundice, or hypoglycemia that may develop as the newborn makes the
transition to extrauterine life. Develop a plan of care to address this problem.
PLAN OF CARE FOR HYPOGLYCEMIA (RICCI, 2013)
Treatment of hypoglycemia in the newborn includes administration of a rapid
acting source of glucose such as a sugar/water mixture or early formula-feeding.
In acute, severe cases, IV administration of glucose may be required. Continuous
monitoring of glucose levels is not only prudent but mandatory in high risk
newborns.
Although there is no specific means of preventing hypoglycemia in newborns, it is
wise and cautious to monitor for symptoms and intervene as soon as symptoms are
noted. Subsequently, early diagnosis and appropriate intervention are essential for
all newborns.
Nursing care of the hypoglycemic newborn includes monitoring for signs of
hypoglycemia or identifying high-risk newborns prone to this disorder based on
their perinatal history, physical examination, body measurements, and gestational
age.
Glucose screening should be performed only on at-risk infants and those with
clinical symptoms compatible with hypoglycemia (National Guideline
Clearinghouse, 2010).
Prevent hypoglycemia in newborns at risk by initiating early feedings with breast
milk or formula.
If hypoglycemia persists despite feeding, notify the primary health care provider
for orders such as intravenous therapy with dextrose solutions.
Anticipate hypoglycemia in certain high-risk newborns and begin assessments
immediately on nursery admission

REFERENCES

Mayo Clinic (2017). Erythromycin (Opthamic Route): Proper Use. Retrieved July 12, 2017, from
http://www.mayoclinic.org/drugs-supplements/erythromycin-ophthalmic-route/proper-use/drg-
20068673
Ricci, S. S. (2013). Chapter 18 Nursing Management of the Newborn. Maternity and Pediatric
Nursing (2nd ed.) (pp. 567 581). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

ASSIGNMENTS, CHAPTER 19: NURSING MANAGEMENT OF PREGNANCY AT

RISK: PREGNANCY-RELATED COMPLICATIONS

WRITTEN ASSIGNMENT

1. Create a chart that compares and contrasts polyhydramnios and oligohydramnios.

POLYHYDRAMNIOS (HYDRAMNIOS) OLIGOHYDRAMIOS

Condition where there is decrease in

Condition where there is too much
amniotic fluid
More than 2000 ml that surrounds the
fetus 32-36 weeks
18% of pregnant with diabetes develops
this condition
Occurs 3% of pregnancies
Idiopathic in nature
Cesarean birth is necessary
Polyhydramnios can cause preterm
births, fetal malpresentation, and cord
prolapsed
Therapeutic management: amniocentesis
or artificial rupture of membranes to
decrease pressure
Close monitoring should be done if the
hydramnios is mild to moderate
Administration of indomethacin which
decrease amniotic volume by decreasing
fetal urinary output however, may cause
premature closure of the fetal ductus
arteriosus.
amniotic fluid
Less than 500 ml
The condition where there is prevention
in the urinary output of the fetus in going
to the amniotic sac
Occurs 5% to 8% of pregnancies
Usually during the last trimester of
pregnancy
Increased risk of perinatal morbidity and
mortality
oligohydramnios can cause cord
compression, fetal isolatation and
hypoxia.
Close monitoring should be done and can
be managed on an outpatient basis with
continuous fetal monitoring
Therapeutic management: amnioinfusion
that is thought to improve fetal heart rate
pattern, decrease cesarean births and
decrease the risk for possible meconium
aspiration syndrome
2. Write an essay that describes a high-risk pregnancy.

High hazard pregnancy is a condition in which the wellbeing of the mother, baby,
or both is in threat. Etiology of this condition may either originate from previous state of
the mother before pregnancy or difficulty that created amid pregnancy. High hazard
pregnancies have increased hazard for morbidity or/and mortality than ladies with ordinary
pregnancy. Wellbeing status of mother and baby is dynamic all through pregnancy, that is
the reason close observing should be actualized to guarantee and screen conceivable
difficulties that could risk the wellness of the mother and baby. This condition increments
in seriousness making it exceptionally disturbing particularly when pregnancy is close to
the end. Impacts of being high hazard can appear amid labor, birth or even postpartum. To
anticipate or deal with this high hazard pregnancy, it must be all around arranged by the
couple and should have undergone prenatal checkup. This will decrease the chance of
problems during pregnancy. This care will enable the couple to decide their wellbeing
status, issues that they can experience, and have early management preceding conception
to guarantee that they will have a sound pregnancy. Early detection of issue will give an
throughout plan of activity all through pregnancy in this way causing a more positive and
effective result.

3. Develop an assessment checklist that could be used to assess a woman with premature
rupture of membranes.
KEY ASSESSMENTS WITH PREMATURE RUPTURE OF MEMBRANES (Ricci,
2013)
For the woman with PROM, the following assessments are essential:
Determining the date, time, and duration of membrane rupture by client interview
Ascertaining gestational age of the fetus based on date of mothers last menstrual
period, fundal height, and ultrasound dating
Questioning the woman about possible history of or recent UTI or vaginal infection
that might have contributed to PROM
Assessing for any associated labor symptoms, such as back pain or pelvic pressure
 Assisting with or performing diagnostic tests to validate leakage of fluid, such as
Nitrazine test, ferning on slide, and ultrasound. Contamination of Nitrazine tape
with lubricant or insufficient fluid will render the assessment unreliable
Continually assessing for signs of infection including:
Elevation of maternal temperature and pulse rate
Abdominal/uterine tenderness
Fetal tachycardia more than 160 bpm
Elevated white blood cell count and C-reactive protein
Cloudy, foul-smelling amniotic fluid

GROUP ASSIGNMENT

1. Working with a partner, practice performing assessment of DTRs and assessment for
ankle clonus. Share with your classmates any difficulties you may have encountered with
the assessments

I followed the procedure on how to properly assess the patellar reflex, deep tendon
reflex, and determine the ankle clonus. I did it well and had no difficulties in the process.

2. As part of a small group, come up with ideas for teaching that would be relevant to a
woman with a high-risk pregnancy. From your ideas, create a teaching checklist to share
with the rest of the class.
TEACHING PLAN (Ricci, 2013)
Avoid noxious stimulisuch as strong flavors, perfumes, or strong odors such as frying
baconthat might trigger nausea and vomiting.
Avoid tight waistbands to minimize pressure on abdomen.
Eat small, frequent meals throughout the daysix small meals.
Separate fluids from solids by consuming fluids in between meals.
Avoid lying down or reclining for at least 2 hours after eating.
Use high-protein supplement drinks.
Avoid foods high in fat.
Increase your intake of carbonated beverages.
Increase your exposure to fresh air to improve symptoms.
 Eat when you are hungry, regardless of normal mealtimes.
Drink herbal teas containing peppermint or ginger.
Avoid fatigue and learn how to manage stress in life.
Schedule daily rest periods to avoid becoming overtired.
Eat foods that settle the stomach, such as dry crackers, toast, or soda
Rest in a quiet environment to prevent cerebral disturbances.
Drink 8 to 10 glasses of water daily.
Consume a balanced, high-protein diet including high-fiber foods.
Obtain intermittent bed rest to improve circulation to the heart and uterus.
Limit your physical activity to promote urination and subsequent decrease in blood
pressure.
Enlist the aid of your family so that you can obtain appropriate rest time.
Perform self-monitoring as instructed, including:
o Taking your own blood pressure twice daily
o Checking and recording weight daily
o Performing urine dipstick twice daily
o Recording the number of fetal kicks daily
Contact the home health nurse if any of the following occurs:
o Increase in blood pressure
o Protein present in urine
o Gain of more than 1 pound in 1 week
o Burning or frequency when urinating
o Decrease in fetal activity or movement
o Headache (forehead or posterior neck region)
o Dizziness or visual disturbances
o Increase in swelling in hands, feet, legs, and face
o Stomach pain, excessive heartburn, or epigastric pain
o Decreased or infrequent urination
o Contractions or low back pain
o Easy or excessive bruising
o Sudden onset of abdominal pain
o Nausea and vomiting
Monitor your babys activity by performing fetal kick counts daily.
Check your temperature daily and report any temperature increases to your health care
provider.
Watch for signs related to the beginning of labor. Report any tightening of the abdomen
or contractions.
Avoid any touching or manipulating of your breasts, which could stimulate labor.
 Do not insert anything into your vagina or vaginal areano tampons, avoid vaginal
intercourse
Do not swim in pools or in the ocean or sit in a hot tub or Jacuzzi.
Take showers for daily hygiene needs; avoid sitting in a tub bath.
Maintain any specific activity restrictions as recommended.
Wash your hands thoroughly after using the bathroom and make sure to wipe from front
to back each time.
Keep your perineal area clean and dry.
Take your antibiotics as directed if your health care provider has prescribed them.
Call your health care provider with changes in your condition, including fever, uterine
tenderness, feeling like your heart is racing, and foul-smelling vaginal discharge.

REFERENCE

Ricci, S. S. (2013). Chapter 19 Nursing Management of Pregnancy at Risk: Pregnancy-Related

Complications. Maternity and Pediatric Nursing (2nd ed.) (pp. 625 666). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 20: NURSING MANAGEMENT OF THE PREGNANCY

AT RISK: SELECTED HEALTH CONDITIONS AND VULNERABLE POPULATIONS

WRITTEN ASSIGNMENT

1. Create a written handout for pregnant women that address the effects of substance use
and abuse during pregnancy.
As stated by Ricci (2013),
Substance use can be viewed along a continuum between social recreational
drug use and addiction. Substance abuse is very prevalent remains and continues to
remain undetected and underdiagnosed in many pregnant women. The positive
overall impact of adequate prenatal care on birth outcomes is well documented. For
pregnant substance users, the receipt of adequate prenatal care is especially critical.
Several studies have reported that increasing the adequacy of prenatal care
utilization in pregnant substance users reduces risks for prematurity, low birth
weight, and perinatal mortality. However, many pregnant women who are
substance users do not seek prenatal care for fear of being reported to Child
Protective Services (Roberts & Pies, 2011). The use of drugs, legal or not, increases
the risk of medical complications in the mother and poor birth outcomes in the
newborn. The placenta acts as an active transport mechanism, not as a barrier, and
substances pass from a mother to her fetus through the placenta. Thus, along with
the mother, the fetus experiences substance use, abuse, and addiction. Additionally,
fetal vulnerability to drugs is much greater because the fetus has not developed the
enzymatic system needed to metabolize drugs (Gilbert, 2011).

Substance Effect on Pregnancy (Ricci, 2013)

Alcohol - Spontaneous abortion, inadequate weight gain, IUGR, fetal
alcohol spectrum disorder, the leading cause of intellectual disability
Caffeine - Vasoconstriction and mild diuresis in mother; fetal stimulation,
but teratogenic effects not documented via research
Nicotine - Vasoconstriction, reduced uteroplacental blood flow, decreased
birth weight, abortion, prematurity, abruptio placentae, fetal demise
Cocaine - Vasoconstriction, gestational hypertension, abruptio placentae,
abortion, snow baby syndrome, CNS defects, IUGR
Marijuana - Anemia, inadequate weight gain, amotivational syndrome,
hyperactive startle reflex, newborn tremors, prematurity, IUGR
Opiates and Narcotics - Maternal and fetal withdrawal, abruptio placentae,
preterm labor, premature rupture of membranes, perinatal asphyxia,
newborn sepsis and death, intellectual impairment, malnutrition
Sedatives - CNS depression, newborn withdrawal, maternal seizures in
labor, newborn abstinence syndrome, delayed lung maturity
2. Develop a poster that illustrates the effects of diabetes on the mother and her fetus and
neonate

Cord prolapse
Fetal death
Hyperglycemia
Polycythemia
Macrosomia
Hypoglycemia
Preterm
Hyperbilirubinemia
IUGR
Congenital abnormalities
RDS

DIABETES
Stillbirth Cesarean birth
UTI Hydramnios
Ketoacidosis Chronic monilial vaginitis
Difficulty in labor Delayed healing of wound which can
Hypertension increases risk for sepsis

3. Write a report on how the cardiovascular changes that occur during pregnancy can
affect a pregnant woman with heart disease and her fetus

Cardiovascular changes during pregnancy includes the increase of cardiac output

by 30-50% from pregnant levels, maternal heart rate increases by 20-30 beats per minute.
The increase is due to both the expansion in blood volume and the augmentation of stroke
volume and heart rate. Other hemodynamic changes associated with pregnancy include a
decrease in both the systemic vascular resistance and pulmonary vascular resistance,
thereby lowering the systolic and diastolic blood pressure. In addition, the
hypercoagulability associated with pregnancy might increase the risk of arteria thrombosis
and embolization. These normal physiologic changes are important for a successful
adaptation to pregnancy but create unique physiologic challenges for the woman with
cardiac disease. (Ricci et al., 2013). Because of these changes that occurs, high risk
pregnant with cardiovascular disease or disorder might have various effect to the mother
including palpitations, shortness of breath, occasional chest pain while some are at risk
with more serious effect like heart failure, arrhythmias and stroke. Their baby might as
 well be affected by low birth weight, respiratory distress, intraventricular hemorrhage,
premature birth and even death.

GROUP ASSIGNMENT

1. As part of a small group, devise a list of teaching topics for a pregnant woman with HIV.
TEACHING TOPICS FOR HIV (Ricci, 2013)
Identify the clients individual needs for teaching, emotional support, and physical care.
Nurses need to approach education and counseling of HIV-positive pregnant women in a
caring, sensitive manner. Address the following information:
Infection control issues at home
Safer sex precautions
Stages of the HIV disease process and treatment for each stage
Symptoms of opportunistic infections
Preventive drug therapies for her unborn infant
Avoidance of breast-feeding
Referrals to community support, counseling, and financial aid
Clients support system and potential caretaker
Importance of continual prenatal care
Need for a well-balanced diet
Measures to reduce exposure to infections

2. Working with a partner, develop a plan of care for a pregnant woman who has sickle
cell anemia.
As adopted from Ricci (2013),
Clients require emotional support, education, and followup care to deal with
this chronic condition, which can have a great impact on the woman and her family.
Monitor vital signs, fetal heart rate, weight gain, and fetal growth. Assess hydration
status at each visit and urge the client to drink 8 to 10 glasses of fluid daily to
prevent dehydration. Teach the client about the need to avoid infections (including
meticulous handwashing), cigarette smoking, alcohol consumption, and
temperature extremes. Assist the woman in scheduling frequent fetal wellbeing
 assessments, such as biophysical profiles, nonstress tests, and contraction stress
tests, and monitor laboratory test results for changes. Throughout the antepartal
period, be alert for early signs and symptoms of crisis. During labor, encourage rest
and provide pain management. Oxygen supplementation is typically used
throughout labor, along with intravenous fluids to maintain hydration. The fetal
heart rate is monitored closely. After giving birth, the woman is fitted with
antiembolism stockings to prevent blood clot formation. Before discharge from the
facility after birth of the newborn, discuss family planning options.

The ability to predict the clinical course of sickle cell anemia during
pregnancy is difficult. Outcomes have improved for pregnant women with the
disease, and nowadays the majority can achieve a successful live birth. However,
pregnancy is associated with an increased incidence of morbidity and mortality.
Optimal management during pregnancy should be directed at preventing pain
crises, chronic organ damage, and early mortality using a multidisciplinary team
approach and prompt, effective, and safe relief of acute pain episodes. Although
these measures do not remove the risk of maternal and fetal complications, they are
thought to minimize them, promoting a successful pregnancy outcome. As part of
the OB health care team, the nurse provides nursing interventions for the labor and
postpartum client aimed at pain management, maternal/fetal safety, and client
education. The overall objective is a healthy outcome for the childbearing family.
The nurse has a vital role in making this happen.

3. With two other students, compare and contrast the nursing care of a woman with asthma
to that of a pregnant woman with asthma.
Asthma is an aggravation of the respiratory tract because of a hypersensitive
reaction. The aggravation will cause limited entry of air. It is dealt with forcefully in a
pregnant lady than in non-pregnant ladies since deficiency of oxygen won't simply the
needs of the mother and will eventually damage her and the baby. The advantages of
resolving asthma is in no question as its benefit exceed the dangers of utilizing
pharmaceuticals. Obviously, the objective of the medical team is to avert hypoxic scenes
 (Ricci, 2013) As indicated by Ricci (2013), pregnant ladies are emphatically and entirely
urged to cease smoking. Since forceful treatment is started, the client might be treated to
resolve the issue regarding the allergens. The pregnant woman is desensitize by
administering little measures of the allergen. This will help the body to pick up resistance
towards it. Additionally, utilization of drugs is of in any event sum as could be allowed,
enough measurements, that can help in counteracting the problem. Moreover, it is critical
to administer drug only when necessary and should be in the minimum dosage as possible.
Remember that there are lots of medications that can cause harm for both the mother and
the baby. In a non-pregnant lady, the utilization of pharmaceuticals is generously
recommended by the doctor in light of the fact that there is no infant to be hurt, however
in pregnant ladies, certain medicines can be teratogenic to the baby. Additionally, Oral
corticosteroids are choice for a non-pregnant lady as it significantly helps for the treatment
of asthma be that as it may, this it is not prescribed for a pregnant women and only utilized
if the asthma condition is severe and requires the medication (Ricci, 2013)

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 20 Nursing Management of the Pregnancy
at Risk: Selected Health Conditions and Vulnerable Populations (2nd ed.) (pp. 670 720).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins

CHAPTER 21: NURSING MANAGEMENT OF LABOR AND BIRTH AT RISK

WRITTEN ASSIGNMENT
1. Develop a chart that summarizes the four obstetric emergency situations.

OBSTETRIC EMERGENCY SITUATIONS (Ricci, 2013)

UMBILICAL CORD protrusion of the umbilical cord alongside (occult) or
PROLAPSE ahead of the presenting part of the fetus
his condition occurs in 1 out of every 300 births and
requires prompt recognition and intervention for a
positive outcome
 Prolapse usually leads to total or partial occlusion of the
cord. Since this is the fetuss only lifeline, fetal
perfusion deteriorates rapidly. Complete occlusion
renders the fetus helpless and oxygen deprived. The
fetus will die if the cord compression is not relieved
Prevention is the key to managing cord prolapse by
identifying clients at risk for this condition.
Be aware that cord prolapse is more common in
pregnancies involving malpresentation, growth
restriction, prematurity, ruptured membranes with a
fetus at a high station, hydramnios, grandmultiparity,
and multifetal gestation
PLACENTA PREVIA Placenta previa is placental implantation in the lower
uterine segment over or near the internal os of the
cervix, typically during the second or third trimester of
pregnancy
With uterine segment formation and cervical dilation,
placental implantation over or near the cervical os,
instead of along the uterine wall, inevitably results in
spontaneous placental separationand subsequent
hemorrhage.
This position can create a barrier for the fetus from the
uterus during the birthing process
It is the most common cause of bleeding in the second
half of pregnancy and should be suspected in any
woman beyond 24 weeks gestation presenting with
vaginal bleeding; ultrasonography (e.g., transvaginal) is
used to diagnose it
During labor and birth, bleeding can be severe, which
can place the mother and fetus at risk. Reported
incidence is approximately 1 in 200 births
he overall maternal prognosis is good if hemorrhage is
controlled and sepsis or other complications are
prevented. Fetal prognosis is directly related to the
amount of blood loss
ABRUPTIO PLACENTA premature separation of a normally implanted placenta
from the maternal myometrium.
Abruptio placentae occurs in about 1% of all
pregnancies throughout the world
 Risk factors include preeclampsia, gestational
hypertension, seizure activity, uterine rupture, trauma,
smoking, cocaine use, coagulation defects, previous
history of abruption, domestic violence, and placental
pathology. These conditions may force blood into the
underlayer of the placenta and cause it to detach
Management of placental abruption depends on the
gestational age, the extent of the hemorrhage, and
maternalfetal oxygenation perfusion/reserve status
AMNIOTIC FLUID Amniotic fluid embolism remains an enigmatic, but
EMBOLISM devastating obstetric condition associated with
significant maternal and newborn morbidity and
mortality.
It is a rare and often fatal event characterized by the
sudden onset of hypotension, hypoxia, and
coagulopathy. Amniotic fluid containing particles of
debris enters the maternal circulation and obstructs the
pulmonary vessels, causing respiratory distress and
circulatory collapse
Prediction and diagnosis of the event are nearly
impossible. However, timely recognition and response
is critical in saving a womans life

2. Write an essay that describes dystocia and the underlying events that can lead to it.

Dystocia is the term used to describe difficulty of birth that can be caused by
different problems like problems in power of expulsion, passenger, passageway, and
psyche. These problems can affect greatly on the fetal descent through the maternal pelvis
causing increased risk of injury to the fetus and mother. An example of dystocia is shoulder
dystocia which is defined as the interruption of full delivery caused by the fetal shoulder
being caught up from the pelvic floor after delivery of fetal head. Other factors that can
also increased risk for dystocia are: use of excessive analgesia and injection through
epidural route; multiple pregnancy; polyhydramnios; ineffective pushing technique of the
mother causing maternal exhaustion; posterior occiput position of the fetus; long duration
of first stage of labor; nulliparity (no prior experience of pregnancy/labor); macrosomia or
 higher than average birth weight; shoulder dystocia; fetal malpresentation; fetal anomalies
like hydrocephalus; maternal age older than 35 years; increased intake of caffeine; maternal
obesity; overdue pregnancy; ineffective uterine contractions; and high fetal station at full
cervical dilation. These many factors can be alarming. However, success of pregnancy will
always depend on the adherence to prenatal check-ups and to the plan of care. So to prevent
any complication during pregnancy and labor, parents should attend check-ups and
participate in their plan of care to ensure positive outcome.

3. Create drug cards for the following tocolytic agents:

Terbutaline
Tocolytic agent
Prevents symptoms caused by contraction or spasms
Will delay birth
Subcutaneous injection
May be repeated if the heart rate of the mother is <130 bpm
Side effects include hypotension, nervousness, anxiety, restlessness, tachycardia,
and nausea
Fetus may experience tachycardia, hypoglycemia, and hypotension.
Nifedipine
Calcium channel blocker, blocks calcium entry to muscle cells, inhibits uterine
activity to arrest preterm labor
Increase risk of hypotension when given with MgSO4
Monitor BP if given with MGSO4, report hear rate of 110 bpm above
Can decrease uteroplacental blood flow which leads to fetal bradycardia and
eventually hypoxia
Adverse effects: headache, flushing, transient tachycardia, hypertension, edema,
transient fetal tachycardia
Indomethacin
Inhibits uterine activity by inhibiting prostaglandin to act in the muscle cells which
causes contractions
Should be taken with food when administering in oral form to prevent GRI
disturbances
Contraindicated with peptic ulcer disease, history of asthma, and above 32 weeks
gestation
Monitor for hemorrhage
Adverse effects (mother): nausea and vomiting, rash, prolonged bleeding time,
hypertension, less amount of amniotic fluid, and heartburn.
 Adverse effects (neonate): ductus arteriosus constriction, closure of ductus
prematurely, less amniotic fluid and hypertension
Magnesium Sulfate
Uterine muscle relaxant to arrest contraction
IV administration. Loading dose of 4-6 over 15-30 mins initially
Infuse at 1-4 g/hr
Monitor LOC
Maternal side effects: nausea and vomiting, dry mouth, lethargy, change in LOC
May cause pulmonary edema
Assess fetal condition continuously
Watch out for magnesium toxicity
Antidote is calcium gluconate
GROUP ASSIGNMENT

1. With a partner, develop a list of assessment questions for a client who is having twins
and is experiencing dystocia. Take turns role-playing an interview with the client.

ASSESSMENT QUESTIONS
1. Asses if the client is in labor
2. Assess the maternal history of the client, such as having twins, previous difficulty
of giving birth, as well as the gravida and parity
3. Assess clients medical conditions such as diabetes and hypertension. This can
contribute to the dystocia and will direct the course of treatment
4. Assess for the 4 critical factors in labor: Power, Passenger, Pathway, and Psyche.
Any problems in those factors can bring difficulty of breathing
5. Ask medications taken in the past as well as the current medications
6. Ask preparedness for cesarean birth
7. Ask if the client have support that can aid her in his recovery and condition
8. Assess the characteristic of contraction such as the intensity, duration and
frequency
9. Ask about her birth plan
2. As part of a small group, discuss the problems that may occur during pregnancy related
to powers of expulsion, passenger, passageway, and psyche. List potential problems and
interventions to facilitate a positive outcome. Share your results with the class in a group
discussion
PROBLEMS WITH POWER
1. Hypertonic uterine dysfunction
Institute bed rest and sedation to promote relaxation and reduce pain.
Assist with measures to rule out fetopelvic disproportion and fetal malpresentation.
Evaluate fetal tolerance to labor pattern, such as monitoring of FHR patterns.
Assess for signs of maternal infection.
Promote adequate hydration through IV therapy.
Provide pain management via epidural or IV analgesics.
Assist with amniotomy to augment labor.
Explain to woman and family about dysfunctional pattern.
Plan for operative birth if normal labor pattern
2. Hypotonic uterine dysfunction
Administer oxytocin as ordered once fetopelvic disproportion is ruled out.
Assist with amniotomy if membranes are intact.
Provide continuous electronic fetal monitoring.
Monitor vital signs, contractions, and cervix continually.
Assess for signs of maternal and fetal infection.
Explain to woman and family about dysfunctional pattern.
Plan for surgical birth if normal labor pattern is not achieved or fetal distress occurs
3. Precipitate Labor
Closely monitor woman with previous history.
Anticipate use of scheduled induction to control labor rate.
Administer pharmacologic agents, such as tocolytics, to slow labor.
Stay in constant attendance to monitor progress
 PROBLEMS WITH PASSENGER

1. Persistent occiput posterior position

Assess for complaints of intense back pain in first stage of labor.
Anticipate possible use of forceps to rotate to anterior position at birth or manual rotation
to anterior position at end of second stage.
Assess for prolonged second stage of labor with arrest of descent (common with this
malposition).
Encourage maternal position changes to promote fetal head rotation: hands and knees
and rocking pelvis back and forth; side-lying position; side lunges during contractions;
sitting, kneeling, or standing while leaning forward; squatting position to give birth and
enlarge pelvic outlet.
Prepare for possible cesarean birth if rotation is not achieved. Administer agents as
ordered for pain relief (effective pain relief crucial to help the woman to tolerate the
back discomfort).
Apply low back counter pressure during contractions to ease the discomfort.
Use other helpful measures to attempt to rotate the fetal head, including lateral
abdominal stroking in the direction that the fetal head should rotate; assisting the client
into a hands-and-knees position (all fours); and squatting, pelvic rocking, stair climbing,
assuming a side-lying position toward the side that the fetus should rotate, and side
lunges.
Provide measures to reduce anxiety.
Continuously reinforce the womans progress.
Teach woman about measures to facilitate fetal head rotation
2. Face and brow presentation
Assist with evaluating for fetopelvic disproportion.
Anticipate cesarean birth if vertex position is not achieved.
Explain fetal malposition to the woman and her partner.
Provide close observation for any signs of fetal hypoxia, as evidenced by late
decelerations on the fetal monitor
3. Breech presentation
Assess for associated conditions such as placenta previa, hydramnios, fetal
anomalies, and multifetal pregnancy.
Arrange for ultrasound to confirm fetal presentation.
Assist with external cephalic version possible after 36 weeks and administer
tocolytics to assist with external cephalic version.
Anticipate trial labor for 4 to 6 hr to evaluate progress if version is unsuccessful.
Plan for cesarean birth if no progress is seen or fetal distress occurs.
After external cephalic version, administer RhoGAM to the Rh-negative woman to
prevent a sensitization reaction if trauma has occurred and the potential for mixing
of blood exists.
4. Shoulder dystocia
Intervene immediately due to cord compression.
Perform McRoberts maneuver and application of suprapubic pressure.
Assist with positioning the woman in squatting position, hands-and-knees position,
or lateral recumbent position for birth to free shoulder.
Anticipate cesarean birth if no success in dislodging shoulders.
5. Multifetal pregnancy
Assess for hypotonic labor pattern due to overdistention.
Evaluate for fetal presentation, maternal pelvic size, and gestational age to
determine mode of delivery.
Ensure presence of neonatal team for birth of multiples.
Anticipate need for cesarean birth, which is common in multifetal pregnancy.
6. Excessive fetal size and abnormalities
Assess for inability of fetus to descend.
Anticipate need for vacuum and forceps-assisted births (common).
Plan for cesarean birth if maternal parameters are inadequate to give birth to large
fetus.
PROBLEMS WITH THE PASSAGEWAY
Assess for poor contractions, slow dilation, prolonged labor.
Evaluate bowel and bladder status to reduce soft tissue obstruction and allow increased
pelvic space.
Anticipate trial of labor; if no labor progression after an adequate trial, plan for cesarean
birth.

PROBLEMS WITH PSYCHE

Provide comfortable environmentdim lighting, music.
Encourage partner to participate.
Provide pain management to reduce anxiety and stress.
Ensure continuous presence of staff to allay anxiety.
Provide frequent updates concerning fetal status and progress.
Provide ongoing encouragement to minimize the womans stress and help her to cope with
labor and to promote a positive, timely outcome.
Assist in relaxation and comfort measures to help her body work more effectively with the
forces of labor.
Engage the woman in conversation about her emotional well-being; offer anticipatory
guidance and reassurance to increase her self-esteem and ability to cope, decrease
frustration, and encourage cooperation.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 21 Nursing Management of Labor and Birth
at Risk (2nd ed.) (pp. 728 760). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins
CHAPTER 22: NURSING MANAGEMENT OF THE POSTPARTUM WOMAN AT
RISK

WRITTEN ASSIGNMENT

1. Develop a written set of guidelines for use by a postpartum woman who has
developed a wound infection
TEACHING A WOMAN FOR POSTPARTUM INFECTION
Continue your antibiotic therapy as prescribed.
Take the medication exactly as ordered and continue with the
medication until it is finished.
Do not stop taking the medication even when you are feeling better.
Check your temperature every day and call your health care provider if it is
above 100.4 F (38 C).
Watch for other signs and symptoms of infection, such as chills, increased
abdominal pain, change in the color or odor of your lochia, or increased
redness, warmth, swelling, or drainage from a wound site such as your
cesarean incision or episiotomy. Report any of these to your health care
provider immediately.
Practice good infection prevention:
Always wash your hands thoroughly before and after eating, using the
bathroom, touching your perineal area, or providing care for your
newborn.
Wipe from front to back after using the bathroom.
Remove your perineal pad using a front-to-back motion. Fold the pad in
half so that the inner ides of the pad that were touching your body are
against each other. Wrap in toilet tissue or place in a plastic bag and
discard.
Wash your hands before applying a new pad.
Apply a new perineal pad using a front-to-back motion. Handle the pad by
the edges (top and bottom or sides) and avoid touching the inner aspect of
the pad that will be against your body.
 When performing perineal care with a peribottle, angle the spray of water
to that it flows from front to back.
Drink plenty of fluids each day and eat a variety of foods that are high in
vitamins, iron, and protein.
Be sure to get adequate rest at night and periodically throughout the day.

2. Create a chart that compares and contrasts postpartum hemorrhage due to uterine
atony and due to retained placental fragments.
UTERINE ATONY AND RETAINED PLACENTAL FRAGMENTS (Ricci,
2013)
COMPARISON CONTRAST
Severe hemorrhage with high morbidity Hemorrhage due to uterine is more
Can lead to hypovolemic shock. common than retained placental
Management includes maintaining fragments. Uterine atony is caused by
hydration the failure of the uterus to contract and
return to its initial state. Retained
placental fragments are tissues that are
parts of product of conceptions that
failed to be removed through the body.
Uterine atony is given with oxytocin to
induce contraction. D&C is the
common management for retained
placental fragments
 3. Prepare drug cards on the following:

HEPARIN WARFARIN

CLASS: Anticoagulant CLASS: Anticoagulant

Pregnancy Category: C
Do not dissolve previously formed clots, but
they do forestall their enlargement and
prevent new clots from forming
Diagnosis and treatment of DIC
Prevention and prophylaxis treatment of
venous thrombosis
Prevention in clotting in artery and heart
surgeries, blood transfusions, dialysis, blood
samples
ONSET: IV immediate; Deep SC 20-60min
Protamine Sulfate - antidote for overdose
Pregnancy Category: X
Interferes with synthesis of Vitamin K
dependent clotting factors resulting in
depletion of clotting factors II, VII, IX, and X
Prevention and prophylaxis treatment of
venous thrombosis, thromboembolic
complications associated with atrial
fibrillation, cardiac valve replacement
ONSET: Oral usually 24 hours. Peak maybe
delayed up to 3-4 days
Vitamin K- antidote for overdose

GROUP ASSIGNMENT
1. Working with a partner, select a postpartum complication. Develop a plan of care for
the woman with this condition.
TEACHING PLAN FOR HEMORRHAGE AND ANTICOAGULAN THERAPY
(Ricci, 2013)
Watch for possible signs of bleeding and notify your health care provider if any
occur:
Nosebleeds
Bleeding from the gums or mouth
Black tarry stools
Brown coffee grounds vomitus
Red to brown speckled mucus from a cough
Oozing at incision, episiotomy site, cut, or scrape
Pink, red, or brown-tinged urine
Bruises, black and blue marks
Increased lochia discharge (from present level)
 Practice measures to reduce your risk of bleeding:
Brush your teeth gently using a soft toothbrush.
Use an electric razor for shaving.
Avoid activities that could lead to injury, scrapes, bruising, or cuts.
Do not use any over-the-counter products containing aspirin or aspirin-like
derivatives.
Avoid consuming alcohol.
Inform other health care providers about the use of anticoagulants,
especially dentists.
Be sure to comply with follow-up laboratory testing as scheduled.
If you accidentally cut or scrape yourself, apply firm direct pressure to the site for
5 to 10 minutes. Do the same after receiving any injections or having blood
specimens drawn.
Wear an identification bracelet or band that indicates that you are taking an
anticoagulant.
Prevention of thrombotic conditions is an essential aspect of nursing management
and can be achieved with the routine use of simple measures:
Developing public awareness about risk factors, symptoms, and preventive
measures
Preventing venous stasis by encouraging activity that causes leg muscles to
contract and promotes venous return (leg exercises and walking)
Using intermittent sequential compression devices to produce passive leg
muscle contractions until the woman is ambulatory
Elevating the womans legs above her heart level to promote venous return
Stopping smoking to reduce or prevent vascular vasoconstriction
Applying compression stockings and removing them daily for inspection of
legs
Performing passive range-of-motion exercises while in bed
Using postoperative deep-breathing exercises to improve venous return by
relieving the negative thoracic pressure on leg veins
Reducing hypercoagulability with the use of warfarin, aspirin, and heparin
 Preventing venous pooling by avoiding pillows under knees, not crossing
legs for long periods, and not leaving legs up in stirrups for long periods
Padding stirrups to reduce pressure against the popliteal angle
Avoiding sitting or standing in one position for prolonged periods
Using a bed cradle to keep linens and blankets off extremities
Avoiding trauma to legs to prevent injury to the vein wall
Increasing fluid intake to prevent dehydration
Avoiding the use of oral contraceptives

Moreover, in women at risk, early ambulation is the easiest and most cost-effective
method. Use of compression stockings decreases distal calf vein thrombosis by decreasing
venous stasis and augmenting venous return (Cavazza, Rainaldi, Adduci, & Palareti, 2012).
Women who are at a high risk for thromboembolic disease based on risk factors or a previous
history of DVT or PE may be placed on prophylactic heparin therapy during pregnancy.
Standard heparin or a low-molecular-weight heparin such as enoxaparin (Lovenox) can be
given, because neither drug crosses the placenta. It is typically discontinued during labor and
birth and then restarted during the postpartum period

2. As part of a small group, identify various factors that place a woman at risk for
thromboembolic complications. Create a set of instructions that address prevention and
risk reduction for childbearing women.
Factors that predisposes the women for infection thromboembolic complications
are lithotomy position, oral contraceptives, smoking, prolonged standing history of
thrombosis, thrombophlebitis, varicosities, prolonged bed rest, diabetes, obesity, cesarean
birth, advanced maternal age, severe anemia, and mutiparity (Ricci, 2013) The main
prevention for thromboembolic complications is of course pointed out on addressing
venous stasis, injury to blood vessels, and hypercoagulation. Ricci (2013) provided a list
of preventive measure to prevent thrombotic conditions. These are encouraging movement
and activity that allows the leg muscles to move that prevents stasis of blood and promotes
venous return. Devices such as sequential compression device and compression stockings
are also recommended. Elevation of womans legs to promote return of venous blood are
 also being practiced. Moreover, any stimuli that contracts the blood vessels are also
avoided, these are: smoking and some medications. Also, avoid any trauma that will injure
the blood vessels. According to Ricci (2013), ambulation is the easiest and cost effective
method in preventing thromboembolism. There are also medications that can help the
women combat thromboembolism. These are heparin and warfarin. It is a prescribed
therapy and should be look upon by a health care team. Frequent blood test is necessary
for these interventions (Ricci, 2013)

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 22 Nursing Management of the Postpartum
Woman at Risk (2nd ed.) (pp. 768 790). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins

ASSIGNMENTS, CHAPTER 23: NURSING CARE OF THE NEWBORN WITH

SPECIAL NEEDS

WRITTEN ASSIGNMENT

1. Select one of the common problems that can affect a newborn with special needs.
Prepare a report that outlines the condition.

A preterm newborn is one who is born before the completion of 37 weeks of

gestation. Although the national birth rate has been declining since the 1990s, the preterm
birth rate has been climbing rapidly. Approximately one in eight babies, or 12.3%, are born
before the 37th week of gestation (March of Dimes, 2010a). Prematurity is now the leading
cause of death within the first month of life and the second leading cause of all infant deaths.
The etiology of half of all preterm births is unknown (Cunningham et al., 2010b). Preterm
births take an enormous financial toll, estimated to be in the billions of dollars. They also
take an emotional toll on those involved. Changes in perinatal care practices, including
regional care, have reduced newborn mortality rates. Transporting high-risk pregnant
women to a tertiary center for birth rather than transferring the neonate after birth is
associated with a reduction in neonatal mortality and morbidity (Furdon & Clark, 2012).
 Despite increasing survival rates, preterm infants continue to be at high risk for
neurodevelopmental disorders such as cerebral palsy or mental retardation, intraventricular
hemorrhage, congenital anomalies, neurosensory impairment, behavioral problems, and
chronic lung disease (Mwaniki, Atieno, Lawn, & Newton, 2012). Making sure that all
pregnant women receive quality prenatal care throughout pregnancy is a major method for
preventing preterm births. Preterm newborns face a myriad of possible complications as a
result of their fragile health status or the procedures and treatments used. Some of the more
common complications in preterm newborns include respiratory distress syndrome,
periventricular-intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of
prematurity, hyperbilirubinemia, anemia, necrotizing enterocolitis, hypoglycemia, infection
or septicemia, delayed growth and development, and mental or motor delays (Leone, Ersfeld,
Adams, Meyer Schiffer, et al., 2012).

2. Write an essay that addresses one of the factors that could place a newborn at risk,
explaining how nurses can intervene to reduce this risk.
Smoking is a common factor that puts everyone in jeopardy. Both the user and the
one who is inhaling the smoke coming out of the cigarette is in great danger. This is not
just risk factor for newborn but also to all people. It brings lots of diseases and affects all
body systems. As I study nursing and getting the knowledge regarding lots of disease,
theres a similar risk factor that present in all diseases, it is smoking. Smoking is very
prominent, whether in public or even in private places such as homes. The government
already places smoking ban and put places as smoking zone. With that, the nurse can
reinforce those places where the smoker can smoke. By that, it can lessen passive smokers.
Also, the most help the nurse can offer is by providing health teaching. The nurses can
conduct health teaching that is open to population of all ages. In the health teaching, they
must stress out the disadvantages of smoking, and what it brings in the body. Moreover,
they can invite smoking organizations who have people who smoke but is able to stop,
which can give wisdom to the population. Moreover, the effects of smoking on the baby
should be stress out. Smoking is teratogenic baby and it brings various conditions that the
baby might develop. It can cause fetal death. Furthermore, nurses can make posters that
 depicts the effects of smoking. Also, independent approach such as partnership or seeking
cooperation of barangay officials to help disseminate the information and of course, control
smoking.

GROUP ASSIGNMENT

1. Working with a partner, develop a chart that compares and contrasts a preterm
newborn and a late preterm newborn. Present your chart to the rest of your class for
discussion.

NEWBORN COMPARISON CONTRAST

PRETERM Preterm and late preterm
newborn are the same because
they fall under 37 weeks
gestation
Both can have complications
on different body systems but
more importantly is on
respiratory system. They most
commonly have respiratory
distress at birth
Other systems:
CNS impaired
thermoregulation control,
hypogltxemia,
developmental delays
GI- Malnutrition,
hypoglycemia,
hyperbilirubinemia,
jaundice, ineffective
sucking and swallowing
reflexes
However, late preterm is
within the concept of
preterm. Late preterm is
the term used for
newborns that are born
between gestational age
of 34 weeks and a day
before 37th week.
Late preterms has more
chance of survival than
early preterms (less than
34 weeks)
Early preterms have more
immature body systems
than late preterms.
 Immune increased risk
for infection
Renal fluid and
electrolyte imbalances
Cardiovascular impaired
blood pressure control

2. As part of a small group, discuss how prematurity affects each body system. Create an
outline study guide to summarize this information.

EFFECTS OF PREMATURITY ON BODY SYSTEMS (Ricci, 2013)

Respiratory System
Among the body system, it is the last to mature and fully developed
The main problem in the system is the deficient level of surfactant
Surfactant is needed to prevent lung collapse and ensure adequate lung
compliance
Risk for apnea, and respiratory distress syndrome
Weak chest wall
Smaller air passage putting the client at risk for obstruction
Does not have the power to remove the fluids in the respiratory tract by
him/herself
Cardiovascular System
Have the most changes when adapting to the extrauterine life
The foramen ovale as well as the ductus are not yet close leading to
abnormal fetal circulation
Impaired circulation resulting to hypoxemic episodes
Risk for hemorrhage related to fragile blood vessels
Gastrointestinal System
Immature musculosekeletal as well as neurological will poise a problem in
sucking and swallowing
 Small stomach capacity and compromised metabolic process will render
unable to efficiently absorb nutrients
Risk for malnutrition and developmental delays.
Urinary System
Cannot adequately filter waste products resulting to less concentrated urine
Slow GRF predispose the child to edema and fluid retention
Risk for drug toxicity because of impaired renal function
Impaired buffer system posing at risk for acid imbalances
Immune System
Immune system is not fully functional
Low level of immunity
Cannot combat high levels of infection/invasion
Cannot adequately manufacture antibodies
Central Nervous System
Lack of coordination in movement
Flexion and muscle tone may be weak
Low level of activity
Difficult to maintain temperature
Inadequate fat to help generate calories/heat
Glucose control is not fully developed leading to hypoglycemia.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 23 Nursing Care of the Newborn With
Special Needs (2nd ed.) (pp. 801 826). Philadelphia: Wolters Kluwer Health/Lippincott Williams
& Wilkins
CHAPTER 24: NURSING MANAGEMENT OF THE NEWBORN AT RISK:
ACQUIRED AND CONGENITAL NEWBORN CONDITIONS

WRITTEN ASSIGNMENT
1. Create a checklist that highlights the key nursing interventions to be used when
providing care to a newborn of a substance-abusing mother

Following are the possible effects to the newborn of a substance abusing mother and its
nursing interventions:

Fetal Alcohol Syndrome

Recognize signs and characteristic of FAS

Plan care: aim in avoiding heat loss,
provide adequate nutrition
reducing environmental stimuli
educate the family

Transient tachypnea of the newborn

provide adequate oxygenation

administer IV fluids
or gavage feeding until respiratory rate is normal
maintain neutral thermal environment to minimize oxygen demand

Respiratory distress syndrome

supportive care
o mechanical ventilation
o Oxygen administration
Continuous monitoring of vital signs, cardiovascular status and oxygen saturation
Administer sodium bicarbonate as ordered to prevent metabolic acidosis
Place newborn in prone position to optimize respiratory status and reduce stress
Gentle suctioning to promote patent airway
Assess LOC to identify intraventricular hemorrhage
2. Research Erbs palsy as a type of brachial plexus injury that can occur in a newborn
with birth trauma. Develop an outline that describes this condition.
ERBS PALSY (adopted from: http://www.cerebralpalsysymptoms.com/erbs-palsy/)

Erbs palsy is an adverse form of obstetric brachial plexus disorder and is usually
triggered by an injury that takes place during the birthing process.
For whatever reason, nerves in the babys upper arm become damaged resulting in
a lifelong condition.
Usually, one to two babies out of every 1,000 will be affected by Erbs palsy.
It gets its name from Erbs point, an area on the babys anatomy located near the
neck where the injury occurs. This point is where the brachial plexus forms by the
connection of the fifth and sixth cranial nerves.
The brachial plexus is central in the operation of a persons arms, hands and fingers.
This system of nerves makes movement and feeling possible.
During a difficult birth, shoulder dystocia usually causes Erbs palsy.
While the infant may still be able to wiggle their fingers, the condition prohibits
their ability to move their shoulder or upper arm.
In some cases, Erbs palsy affects the entire trunk. Unfortunately, this means it also
impacts the spinal cord, impeding its ability to send messages to the arm, hand,
wrist and fingers through the typical system of nerve impulses. This is why babies
with Erbs palsy sometimes appear as though their affected arm is paralyzed.
Note that Erbs palsy only refers to damage done to the brachial plexus upper
nerves.
Sometimes, damage can occur on both ends of this nerve pattern, which can result
in a much more severe disorder known as global or total brachial plexus palsy

3. Write an essay that addresses one of the factors that could place a newborn at risk,
explaining how nurses can intervene to reduce this risk.
ASSESSMENT GUIDE FOR NEWBORN AT RISK FOR INFECTION (Ricci,
2013)
Assess for level of consciousness. Newborns may demonstrate irritability and
decreasing LOC and activity when an infection is present
Assess for Vital signs. Changes in respiration may be observed
 Assess for temperature one of the common characteristic of infection is fever
Assess for skin integrity that may break and serves an entry of microorganisms
Assess for distended abdomen
Danger signs include dehydration and hypoglycemia. Prompt treatment is
necessary
Assess for the cleanliness of the surroundings that may put the client at further
risk for infection

4. Develop a flowchart that illustrates the underlying pathophysiologic mechanisms that

impact the fetus when a woman has diabetes

In the presence of insulin

The body then The glucose present in the
resistance, this uptake of
compensates by producing blood crosses the placenta
blood glucose is prevented
more insulin to overcome via the GLUT1 carrier to
and the blood sugar level
the resistance reach the fetus
remains high.

the fetus is exposed to an As insulin stimulates

excess of glucose, which growth, this means the Once the baby is born, the
leads to an increase in the baby then develops a exposure to excess glucose
amount of insulin larger body than is normal is removed.
produced by the fetus for their gestational age

However, the newborn still

has increased insulin
production, meaning they
are susceptible to low
blood glucose levels.

Information based from: http://www.news-medical.net/health/Gestational-Diabetes-

Pathophysiology.aspx
 GROUP ASSIGNMENT
1. As part of a small group, select one of the acquired conditions that affect newborns.
Collaborate to develop an outline study guide about the disorder.
PERINATAL ASPHYXIA (Ricci, 2013)
A newborn who fails to establish adequate, sustained respiration after birth is said to
have asphyxia.
Physiologically, asphyxia can be defined as impairment in gas exchange resulting in
a decrease in blood oxygen levels (hypoxemia) and an excess of carbon dioxide or
hypercapnia that leads to acidosis.
Asphyxia is the most common clinical insult in the perinatal period. As many as 10%
of U.S. newborns require some degree of active resuscitation to stimulate breathing
with 1.5% requiring extensive resuscitation (Cunningham et al., 2010b).
More than a million newborns who survive asphyxia at birth develop longterm
problems such as cerebral palsy, mental retardation, speech disorders, hearing and/or
visual impairment, and learning disabilities (Zanelli & Stanley, 2012).
Asphyxia occurs when oxygen delivery is insufficient to meet metabolic demands,
resulting in hypoxia, hypercarbia, and metabolic acidosis. Any condition that reduces
oxygen delivery to the fetus can result in asphyxia.
These conditions may include maternal hypoxia, such as from cardiac or respiratory
disease, anemia, or postural hypotension; maternal vascular disease that leads to
placental insufficiency, such as diabetes or hypertension; cord problems such as
compression or prolapse; and postterm pregnancies, which may trigger meconium
release into the amniotic fluid.
Initially, the newborn uses compensatory mechanisms including tachycardia and
vasoconstriction to help bring oxygen to the vital organs for a time. However, without
intervention, these mechanisms fail, leading to hypotension, bradycardia, and
eventually cardiopulmonary arrest. With failure to breathe well after birth, the
newborn will develop hypoxia (too little oxygen in the cells of the body). As a result,
the heart rate falls, cyanosis develops, and the newborn becomes hypotonic and
unresponsive.
2. Working with a partner, create a chart that compares and contrasts omphalocele and
gastroschisis.

COMPARE AND CONTRAST (Ricci, 2013)

Omphalocele
Congenital anomalies of the anterior
abdominal wall near the umbilicus
Defect of the umbilical ring resulting to
protrusion of abdominal content which
may include entire GI tract and liver
The protrusion is enclosed by an external
peritoneal sac
Protected by peritoneal sac
70% of the total cases of anomalies
Risk factors include smoking, infection,
drug use, genetic abnormalities, and
maternal illness
Gastroschisis.
Congenital anomalies of the anterior
abdominal wall near the umbilicus
Defect of the abdominal wall that results
in herniation of abdominal content
The protrusion isnt covered by peritoneal
sac
No protection thus commonly thickened,
edematous, and inflamed
Significant newborn mortality and
morbidity rates
Risk factors are the same as Omphalocele

3. While working with a group of three or four students, review the list of factors that
predispose a newborn to develop NEC. For each factor, brainstorm ways to minimize
or eliminate these factors
NECROTIZING ENTEROCOLITIS (Ricci, 2013)
Prenatal factors
Preterm Labor
Inquire history of pregnancy as well as difficulties and treatment
taken
Advise for maternal nutrition diet and regular prenatal checkup
Oncolytic medication can be used to delay labor
 Careful assessment and guidance for the baby after delivery to
adjust to extrauterine life
Prolonged rupture of membranes
Monitor progress of labor
Induct labor through assisted rupture of amniotic bag
Pre-eclampsia
Control of hypertension
Maintain normal blood pressure
Medication if prescribed
Lifestyle modification
Maternal sepsis
Practice good handwashing
Maintain visitors at minimum
Practice strict aseptic technique
Provide prophylaxis if prescribed
Amnionitis
Prevention of infection through good hygiene and hand washing
Practice strict aseptic technique
Provide prophylaxis if prescribed
Monitor maternal and fetal well being
Uterine hypoxia
Assessment of impaired cardiovascular supply
Promopt administration of supplemental oxygen
Prepare for CS birth

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 24 Nursing Management of the Newborn
at Risk: Acquired and Congenital Newborn Conditions (2nd ed.) (pp. 833 870). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins
ASSIGNMENTS, CHAPTER 25: GROWTH AND DEVELOPMENT OF THE
NEWBORN AND INFANT
WRITTEN ASSIGNMENT
1. Explain language development in the first year of life.

Crying is the only means of communication of an infant which indicated that there
are unmet needs. As time goes by, the means of communication of a newborn develops.
During the first 3 months, the baby coos and makes vocalization different from crying. At
age 4-5 months, the infant will start to make simple vowel sounds, laugh and will be
responsive to voices and recognize his name. between 4-7 months, the infant can now
distinguish emotions via tone of voice. At 6 months, infant starts to yell and squeal to
express joy or displeasure. 7-10 months of age, babbling begins as mamama or dadada. At
the age of 9-12 months, the infant can now recognize simple object by its name and uses
two to three recognizable words.

GROUP ASSIGNMENT
1. Break into groups of 4 and interview a pediatric advanced practice nurse. Take notes on
common issues related to growth and development in infancy.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 25 Growth and Development of the Newborn
and Infant (2nd ed.) (pp. 885 910). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins

CHAPTER 26: GROWTH AND DEVELOPMENT OF THE TODDLER

WRITTEN ASSIGNMENT

1. According to Piaget, what significant cognitive development allows toddlers to engage

in imitative play?

Piagets theory of cognitive development has 4 stages: sensorimotor,

preoperational, concrete operational and formal operational. Sensorimotor stage is from ages
 0-2 years old while preoperational stage is from 2-6 years old. Concrete operational is from
ages 7-12 years old and lastly, formal operational from 12 years old onwards. Toddlers are
ages from 1-3 years old and falls under sensorimotor mostly and preoperational stage. In the
sensorimotor stage, toddlers would want to explore the world through direct sensory and
motor contact with things. They tend to have complex thinking and curiosity to things, thus
making them to experiment on things to see what will happen causing them increase risk for
injuries. In this stage, toddlers, age 2 years old, will engage in imitative play either my
symbolism or idealism from people they see. Examples of which is cutting fruits or cooking
using toys, pouring water on a bottle, feeding a toy, etc during their play periods (Ricci,
2013).
2. Describe the gross motor progression of walking in a toddler.
There are lot of progressions and improvement not just in the cognitive ability of
the children, but also the progression of fine and gross motor. According to Ricci (2013)
the child keeps on growing new motor abilities, and the old ones are keep on refining. as
little child keep growing new engine abilities, they likewise refining the old engine
aptitudes. When refining, reiteration of that motor aptitude makes muscles to remember
and mature and keeps on developing. To begin with obviously, as a little child, they have
a step known as "baby stride". They tend to stand up and walk not easily and may tumble
every now and then. They planted their legs generally separated, making the base
sufficiently wide to bolster them. Their toes are pointed forward, and as opposed to
strolling forward straight, they tend to lean on the left and slowly but finely advance (Ricci,
2013) In addition, after walking, they appear to pick up speed, appearing to ready to keep
running at any minute. They may fall yet have the parachute reflex where their arms are
totally open against the ground to catch themselves. At around 6 months, they can show
more significant and stable step and the feet are nearer together. By 3 years old, the little
child expect a stride and walks like a grown-up in a heel to toe mold (Ricci, 2013)

3. Write a telegraphic phrase you might hear from a 3-year-old who wants cookies and
milk.
Cookies, milk.want
4. Explain what about a toddlers sensory development puts him or her at risk for
accidental ingestion. Name 3 of the most dangerous potential poisons a toddler may
ingest.

Toddlers are naturally curious as they are exploring and learning the outside world.
They examine new thing by sensory perceptions through looking at them, touching them,
gelling them, smelling, and tasting them by placing the object in their mouths. They dont
know yet what things can harm then when they explore it. They cannon discern whether the
thing can be placed in the mouth or not. And because of that, they are at risk for accidental
ingestion. The 3 most dangerous potential poisons they can ingest are Cleaning products,
alcohol, and pesticides (Ricci, 2013)

5. Write suggestions for parents of a difficult 2-year-old about how they might avoid
tantrums in their toddler.
It is important to parents their need to learn the toddlers behavioral cues in order
them to limit activates that are frustrating and may lead to temper tantrums. According to
Ricci et al., (2013), when the parent observes the beginning of frustration, they need to
warn the toddler in a friendly, calm manner. In addition, the use distraction, refocusing or
removal from the activity if necessary prevents the occurrence of temper tantrums.

6. Discuss an action that parents might take when a temper tantrum occurs.
Spoiling your kid everytime can be harmful because they would always want to
satisfy their ego and to pleasure their id. They can become powerful, bossy, and would
control everything because they know that you will give them what they want. And parents
might not want that to happen. Children should always be controlled and known what is right
and wrong. One good way to manage temper tantrums is staying calm and ignoring the
behavior by letting the child do temper tantrums until they become exhausted from it.
Another way to manage is distracting you child to things that they will attract their attention
like toys. If you cant stay calm and are at home, leave the room for a minute and take a deep
breath. This will also act as a cease fire between you and your child. In cases that your child
 becomes violent, hold him/her until they calm down and then initiate serious talk (Mayo
Clinic, 2015).

7. Explain why allowing children to graze on carbohydrate-rich foods throughout the

day may contribute to poor dental health.
Poor dental health can be a result of cavities and plaque that remains in the teeth for
a long time. Children are at risk for developing it because they tend to eat the foods that
contains high value of carbohydrates which mainly are sweets. The sugar from the food
will then attached to the oral mucosa and if not cleaned enough, it will stick there for a long
time attracting bacteria and forming cavities.

GROUP ASSIGNMENT
1. Divide into three groups. Each group will choose a room of a typical house (kitchen,
bathroom, playroom, nursery, garage). List hazards that may be present in the chosen
rooms and ways to make the room safer for a toddler.

HAZARDS IN THE BATHROOM (Ricci, 2013)

Hazards in the bathroom includes, medicines, body lotions, liquid soaps, shampoos,
perfumes and also bathroom cleaning bleach. To ensure the toddlers safety, it is important
for to observe the following:
Store all substances in original containers only.
Never store any liquid other than soda in a soda pop bottle.
Do not allow toddlers access to baby powder, lotion, cream, or other toddler hygiene
products.
Ensure all medications have child-safety caps.
Do not leave within the toddlers reach medications such as lozenges or samples
that are not packaged in safety bottles.
Be very careful with medications that are provided in transdermal patch form.
Do not refer to medicines as candy, as the toddler may mistake pills for candy and
ingest them.
 2. Divide into small groups of two to four people. Group members should imagine that they
will be keeping a toddler for 2 hours in their home. Present a plan for providing toys and
play ideas for the toddler. Discuss why the toys and play plans contribute to normal
toddler growth and development.
Before going ahead in the arrangement of care, first I will guarantee the security of
the environment where the child will stay and play. I will keep the things that can hurt the
child, for example, pointed toys, little toys that the child can swallow. I will likewise clean
the environment and give satisfactory ventilation. Since the client is 2 years of age, I will
give toys that is recognizable things, for example, utensils, dish, phone, plush toys, dolls,
and wicker bin. Moreover, I will have a role pay with the child to help him how to use the
utensils properly as well as on how to throw garbage at the bin. This will enforce the
behavior of the child. I will likewise give toys that looks can produce sounds for music
therapy. Children are attracted to music and will get their attention. Cymbals, drums, and
piano are one of the toys that can encourage their advancement, particularly practice the
hearing perspective. I will likewise give them a chance to watch films that is suitable for
their age and explain them what is happening in the movie for proper guidance.
Additionally, some toys that can reinforce their motor and gross activities such as button
fastening, drawing, climbing are really good activities that can enhance their muscular
skills as well as cognitive and comprehension. It can challenge them to solve for the
problem. Toys are a piece of being fir a kids. It is a thing that youngsters ordinarily
cherishes. It helps in their development and improvement. Play give as a recreational
movement, for the youngster to trouble and simply appreciate and be content with the
action. It is likewise to some degree type of activity, and obviously it gives the tyke to
investigate new things. Toys likewise challenges the mental and perception of the kids.
Play additionally add to building up the motor and social part of the kid (Ricci, 2013)

REFERENCE:

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 26 Growth and Development of the
Toddler (2nd ed.) (pp. 920 945). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins
CHAPTER 27: GROWTH AND DEVELOPMENT OF THE PRESCHOOLER
WRITTEN ASSIGNMENT
1. Explain why a nurse might engage in prayer rituals with a hospitalized child

During the preoperational phase of cognitive development, the preschoolers

concept of faith is intuitive and projective in nature (Ford, 2007). IN addition, according
to Ricci et al., (2013), the familys religious beliefs affect the childs diet, behavior and the
mode of discipline which their parents use and how they view their children. It is important
for the nurse to engage and know the familys rituals in order for him to help in continuing
the ritual when the child is ill and at the hospital.
2. Explain, from a language and comprehension perspective, why a divorcing couple
should not discuss their relationship in front of their 3-year-old.
Divorce is a life changing event. It affects all members of the family regardless of
the age. Separation of guardians can significantly affect the lives of their kids. Kids admire
their folks and their entire family fills in as their enthusiastic security. It is a too hard of an
event for the children to understand. It is a traumatic one when they heard it or discussed
it with their parents. The foundations of the family will befall and it will shape on how the
ability, characteristic, attitude, behavior, disposition of the child, in which divorce mostly
will have a negative impact on the child. The added impact of divorce will just further
increase the severity of the situation when the child fails to fully understand the whole
situation. Parents should not even make promises or discussed it with their child as their
child is yet to developed full comprehension that will able him/her to comprehend why a
divorce will happen, what it will bring, at what will happen after. And although the parents
explained it clearly, there still a great chance that the child will perceived it differently
causing problems later in his/her life.
3. Discuss normal psychosocial changes occurring in the preschool-age child.

Psychosocial development in preschool-age children are well explained on Erik

Eriksons Stages of psychosocial development. During this period, preschool-age children
have a psychosocial task of establishing initiative versus guilt. At this stage, children are
at utmost curiosity and vey eager to learn new things. Initiative can be developed by simple
task for them like allowing the child to participate making their sandwich or getting milk
 for him. This will boost their independency, self confidence, and initiative for further task.
Preschoolers will feel a sense of accomplishment and pride when they finish activities
tasked for them. However, they may feel a sense of guilt if their capabilities can
inadequately finish a task. They might become frustrated and would not engage to that
activity because they dont want to feel guilt. So, it is important to have activities that are
appropriate for them and their capabilities to have a more positive outcome and be able to
proceed to the next stage of psychosocial development. During preschool period, children
had fully developed their superego or conscience on things making it as basis for moral
development or understanding what is right and wrong (Ricci, 2013).

4. Explain the difference between nightmares and night terrors. What can a parent of a
child with night terrors do to help stop the situation from recurring?
Nightmares and night terrors are both events that hinder the child from getting a
good rest and sleep. The difference lies in the awareness of the child after the event. When
the child experience nightmares, they can recall what their dream is about. It is sometimes
brought about by a confusion from what is real and what is not. With night terrors, the child
cannot recall the stimuli and what happened in the dream (Ricci, 2013). Moreover, when
nightmare occurs in the presence of the parents, the child will seek the parents attention
to address the fear but when night terror occurs, the child is unaware that the mother is
present. In addition, after the episode, nightmare could render the child difficult to continue
sleeping, while the child experienced night terror rapidly returns to sleep. Furthermore, a
night terror occurs shortly after sleep when the child is easily wake able. Nightmare on the
other hand, can occur deep in the sleep cycle. To address night terrors, the parent could
wake the child 30 to 45 minutes after sleep. In this way, the time where the night terror
occur is disrupted. If the practice could continue for 1 week, then the incidence of night
terror might be broken (Ricci, 2013)
5. Explain the disciplinary practice of time-out. How does it work?
Time-out or time away from the situation can be very effective in this age group.
The punishment should be used only for intentional misbehavior (knowing something is
forbidden but doing it anyway). It is particularly helpful with dangerous or destructive
behavior. (Ricci et al., 2013). Enforcing a time out will help to impart to the child that what
he or she did is not good. When a preschool starts to behave inappropriately, he or she is
 given a warning that a time-out will be given if the behavior will not stop. If time-out is
necessary to be implemented, the child will be placed on a boring corner, without
distractions to let the child thin and understand that what he or she did is not desirable. The
period a child is in time out depends on the childs age, it requires 1 minute of time-out per
age.

ASSIGNMENTS, CHAPTER 27: GROWTH AND DEVELOPMENT OF THE

PRESCHOOLER

GROUP ASSIGNMENT

1. Divide into small groups. Each group will prepare a 3-day menu for a 4-year-old child.
Have each group take a child with different nutritional needs (slow growth, normal
growth, and overweight).
3 DAY MEAL PLAN FOR CHILD WITH NORMAL GROWTH
Day 1
Breakfast: cup cereal with glass of milk
Snack: grapes with glass water
Lunch: cup rice with ham. 1 glass water
Snack: Buscuits/cookies with glass water
Dinner: serving spaghetti with to 1 glass water
Day 2
Breakfast: cup rice with 1 egg with glass of milk
Snack: banana (sliced) with glass water
Lunch: rice with 1 baked chicken leg
Snack: Sandwich with mayonnaise
Dinner: Beef burger
Day 3
Breakfast: 1 serving of champorado with 1 glass milk
Snack: strawberry with glass water
Lunch: rice with fried pork strips
Snack: Cookies with glass water
Dinner: rice with mixed vegetables
REFERENCE
Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 27 Growth and Development of the
Preschooler (2nd ed.) (pp. 950 971). Philadelphia: Wolters Kluwer Health/Lippincott Williams
& Wilkins

CHAPTER 28: GROWTH AND DEVELOPMENT OF THE SCHOOL-AGE CHILD

WRITTEN ASSIGNMENT

1. Identify the developmental milestones of the school-age child.

DEVELOPMENTAL MILESTONE OF SCHOOL AGE CHILD (Goldfarb
et. al., 2011)
5 to 6 years old
o Vocabulary up to 2000 words
o Sentences are now five or more words
o Determines left and right
o Starting to use why and because to argue
o Can now categorized
o Understands date such as today, tomorrow, and yesterday
o Can count 10 objects one time
o Can copy complex items
o Able to sit at chair, follow instructions, and do simple assignments.
7 to 8 years old
o Observable longer span of attention
o Can initiate to take in responsibilities
o Have knowledge and tell time
o Understand the concept of money
o Orderly naming of months
o Can read a book with themselves
 2. State the scope of the problem of obesity in school-age children. List the teaching
guidelines for dealing with this problem

Obesity in school-age children have growing number of incidence as time goes by.
Obesity develops when there is excessive number of calories taken and calorie loss is
lesser. Obesity is common and can be influenced by many factors like: incidence of obesity
in the family; having unstructured meal plans; being more interested with foods that are
sweet and consist of more carbs; large amount of meal preference; lack of exercise due to
certain situations like parents forbidding their child to go outside the house; and other
possible factors. Obesity in children must be managed accordingly due to increased risk of
cardiovascular disease development (like hypertension), diabetes, respiratory obstructive
complication, orthopedic complications (imbalance of body weight and muscle and bone
strength), and such other possible complications that might develop (Ricci, 2013).

TEACHING GUIDELINES:

Educate parents regarding proper meal plans with considerations on balance on

nutrients needed. They should plan for low fat, moderate sodium, high in calcium, and
low sugar diet.
Advice parents to not reward their child with food.
Encourage parents to praise their child when having good food choices.
Advice parents to role model proper food choices and exercise. Suggest having daily
family bonding activity like doing sports, walking the dog, doing chores, etc.
If their child is a picky eater, they should be educated about food alternative and
creative ways on how to make food healthier. Examples of food alternative is having a
vegetable patty into a whole wheat bun instead of a greasy and fatty burger.

GROUP ASSIGNMENT:
1. Form groups of three people. Each person will choose one age group from the following:
6 to 7, 8 to 9, or 10 to 12 years. Each person should describe the physiologic, cognitive,
and moral changes occurring in the age group. Note significant differences.
As indicated by Ricci (2013), school age year have huge number of changes than
their earlier year, and these progressions begin from the age of 6-7 years of age. On their
development and advancement, they grow a normal of 2.5 inches every year in tallness and
a normal of 7 pounds for each year in weight. Young men and Girls likewise in this age
have comparative stature and weight. Organ development is genuinely consistent until
towards the preadolescent years. On the neurologic framework, skull development are
advancing gradually. Improvements in the respiratory framework include: continuation of
lung and alveoli development; vanishing of stomach breathing; diminish in respiratory rate;
completely created frontal sinuses; and decline in tonsil measure. Be that as it may, tonsils
may seem expansive regardless of the possibility that there is no disease. Critical changes
in the cardiovascular framework are circulatory strain height and lessening in the beat rate.
Advancements in the gastrointestinal framework include: increment conveying limit of the
stomach; lower risk of GI upset, lower caloric needs than earlier years; and most of, many
of the primary teeth have tumbled off. In the genitourinary framework, they have expanded
bladder-pee limit which permits longer periods in the middle of voiding. Improvements in
the musculoskeletal framework include: more prominent tactile motor coordination and
quality; adolescences msucles are maturing and developing; and bone hardening keeps on
advancing. Improvements in the immune framework include: building up and creating
antibodies, for example, IgA and IgG; and having lower hazard for contamination, than
earlier years, because of a more matured immune system. Cognitive advancement in 6-7
years of age include: capacity to facilitate and fuse information about their idea from
various measurement; a more created natural capacity that are suitable when taking care of
complex contemplations and thoughts; creating ability to see things from other individual's
perspective; and developing ability to characterize, separation, think about, and balance
when managing complex things or thoughts. A more exact improvement of these
progressions are seen on the preceding years. In conclusion, moral changes include: having
created feeling of profound quality (or capacity to realize what is good and bad); and having
an expectation to be a decent individual "great kid/great young lady' to individuals they
cooperate with regular and for themselves. They more often than not do great practices and
take after guidelines given to them with a specific end goal to accomplish expectation
(Ricci, 2013).
REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 28 Growth and Development of the
School-Age Child (2nd ed.) (pp. 976 995). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins
Goldfarb, C., Jones, L., Levy, A., & Tocek, K. (2011, December 14). Cognitive Development in
School-Age Children. Retrieved July 12, 2017, from
http://www.aboutkidshealth.ca/En/HealthAZ/DevelopmentalStages/SchoolAgeChildren/Pages/C
ognitive-Development.aspx

ASSIGNMENTS, CHAPTER 29: GROWTH AND DEVELOPMENT OF THE

ADOLESCENT

WRITTEN ASSIGNMENT

1. Briefly discuss each of the five developmental concerns of adolescence covered in this
chapter.

As stated by Ricci (2013),

1. Violence the health and wellbeing of any individual is affected by violence. It can
be form of physical, verbal, emotional, as well as written. It is a harm without the
consent of the other. It is prominent in this age as this is the time where the individual
form groups and other groups might not share the ideas of the other which will result
to violence.
2. Suicide third leading cause of death in adolescents. It can be a result of violence,
substance abuse, mental health instability, depression and other mental illness, and a
lot more factors. This only means that the individual have a very high level of stress
that causes mental issues that he thinks the only way to escape that stress is to take
away his life
3. Homicide second leading cause of death in children ages 10 and 24. Again, this can
be brought by violence. 17.5% of youth is reported carrying a weapon gun, knife, or
 club. The ongoing misunderstanding between groups of adolescents can lead to a gang
war and eventually killings
4. Substance Abuse commonly abused by youths are alcohol, and medications that
either gives them a high feeling or sedation. This have serious long term effects and
consequences on the user. It can lead to addiction, and problems with relationship
especially the family. Furthermore, it can lead to cardiovascular problems leading to
death.
5. Smoking smoking is very rampant in the youth. It is sold in convenience store which
contributes to the user to start and continue to smoke. Just like substance abuse, it can
lead to various problems especially the respiratory problems. Furthermore, it can lead
to cancer and death

2. Describe how the nurse can help children cope with each of those five developmental
concerns of adolescence.
It is important for the nurse to interact and provide support to an adolescent with
the development of their emotional and social aspect because as what Ricci (2013) said,
during this time, the adolescent is starting to experience conflict maybe with their parents
or peers as they identify and develop their self-concept. Trusting and building rapport is
essential for the adolescent to open up his or her personal concerns. The nurse should
observe ways how to communicate with an adolescent that will enhance the relationship
between the nurse and the client. Parents knowledge on how to improve communication
with the teens is important and this includes the following: Set aside appropriate amount
of time to discuss subject matter without interruptions, talk face to face, be aware of body
language, ask questions to see why he or she feels that way, ask him or her to be patient as
you tell your thoughts, choose words carefully so he or she understands you, tell him or
her exactly what you mean, give praise and approval to your teenager often, speak to your
teenage as an equaldont talk down to him or her, be aware of your tone of voice and
body language, dont pretend you know all the answers, admit that you do make mistakes,
and set rules and limits fairly.
ASSIGNMENTS, CHAPTER 29: Growth and Development of the Adolescent
GROUP ASSIGNMENT

1. In groups of three, each person will choose one of the following: psychosocial, cognitive,
or moral development. Prepare a quiz for the other group members. Quizzes will be made
up of five true/false and five fill-in-the-blank questions, using Table 7-2.
2. In groups of three, each person will choose one of the following: early, middle, or late
adolescence. Make a presentation to the rest of the group describing the physical
changes occurring during that part of adolescence.
It is considered that most developmental changes can be seen in early adolescence,
because this is when the onset of puberty happens. In early pre-adulthood, stature of guys
reaches from 52 inches to 69 inches. Weight is in the middle of 77 pounds to 211
pounds. Furthermore, there will be 10 to 30 cm pick up in stature and 7 to 30 kg in weight
for normal guys. In females, the tallness is around 57 inches to 68 inches and weigh is
between 60 pounds to 181 pounds. A gin of 5 to 20cm in stature and 7 to 25 kg in weigh
can be seen in ladies. (Ricci, 2013) As said a while ago early adolescence is the place
pubescence begins. Advancement of sex qualities is more prominent, for example,
development of hair in the armpit and pubic area, improvement of bosom in female ,
changes in the state of hips in females, and improvement of gonads and penis and body
built in guys. The body likewise sweats progressively and there is a profundity in voice in
guys. These changes will need to be adapted by the child as these are normal and all parts
of maturity.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 29 Growth and Development of the
Adolescent (2nd ed.) (pp. 1003 1033). Philadelphia: Wolters Kluwer Health/Lippincott Williams
& Wilkins
CHAPTER 30: ATRAUMATIC CARE OF CHILDREN AND FAMILIES
WRITTEN ASSIGNMENT
1. Discuss the major principles and concepts of atraumatic care
Atraumatic care is defined as therapeutic care that minimizes or eliminates the
psychological and physical distress experienced by children and their families in the health
care system (Hockenberry & Wilson, 2009; Wong, n.d.). the principles of atraumatic care
is based on the premise of to do no harm. According to Ricci et al. (2013), the major
principles of atraumatic care is preventing or minimizing physical stressors to the client
which includes pain, discomfort, immobility, sleep deprivation, inability to eat and changes
in elimination, it also includes the minimization or prevention of child separation from his
or her parents. Moreover, atraumatic care is avoiding or reducing intrusive or any painful
procedures such as injections, multiple puncture or urethral catheterization; avoiding or
reducing any environmental stress such as noise, smell, restrains and controlling
environmental temperature.

2. How do the childs age, developmental level, family situation, community, and state of
health affect the way the nurse conducts a health history?
When conducting history, the nurse should be aware of all the things and
happenings in the past that can post a risk in the client. Of course, the assessment should
be different when it comes to various age groups. In childs age, the nurse should assess
the developmental skills of the child and if it is right on track. Also, the childs maturity
when it comes to physical appearance and genitals should be taken into consideration.
Remember that it is a private matter for the child when talking about sexual relationship
and the nurse should be attentive to the words of the child, including the tone and manner
of speaking. In addition, explore the childs history of violence and including its fears and
if there are any bad events happened in the past. The family situations is a sensitive issue
in the part of the members of the family. It greatly affects the interview and assessment
aspect of the nurse as it is very hard matter to touch and it requires the nurse to establish a
great rapport and professional relationship. The child may not be open at all in this
situation, or burst out of tears when talking about the matter.
 The community serves as a place where the client grows, matures, and develops.
However, it can also be a source of violence for the family. In addition, it contains the
culture that may be sensitive and should be respected by the nurse. The state of health is
also an issue that somewhat can affect the assessment of health history of the client. If the
client have a chronic disease such as HIV, asking the state of health might be difficult for
the nurse especially if it involves severity of the disease and its outcomes.

3. Explain the steps of child and family communication.

The ways on how the child and their family communicate depends on the age or
maturity of the child. Infants communicate to their parents through crying, laughing, touch,
hearing, and through their cute eyes. While parents or family members can communicate
to the infant by cuddling them, holding them, hugging, pinching cheeks, rocking while
singing/humming, doing pick-a-boos and stuffs. Play is most advisable way to have a
communication with the infant. Toddlers and preschoolers can already communicate to
people with the use of telegraphic speech when interacting to needs and wants. They can
take a longer period of time to complete what they want to say, so parents or family
members must bare with the child and let them finish every sentence. Family members can
effectively communicate with toddlers and preschoolers by simply responding and
answering queries and needs of the child. They can also participate in the play of the child
by imitating voices like them and acting like them, which opens the door for
communication and social development (Ricci, 2013). School age children can be very
responsive and eager to communicate when interacted. Parents and family members must
continuously communicate, with honest and straightforward responses, to the child. It is
also important to understand how the child views a situation before explaining or
discussing it with him or her. Having frequent conversations also allow the child to express
and communicate their concerns and feelings, that are beneficial during their adolescence
period where they encounter problems and stressors that should be discussed within the
family. Adolescents might develop shyness and awkwardness when communicating to
their feeling about their experiences and problems. This is why frequent communications
must be stabilized during their previous year so that there is no problem with reaching out
 to each other. Parents must communicate to their child with a non-judgemental and non-
argumentative way so that adolescents will more likely trust and speak up. Parents should
listen attentively to their concerns, not force them to talk, not responding with hurtful
words, and should always keep communication lines open between them (Ricci, 2013).

ASSIGNMENTS, CHAPTER 30: ATRAUMATIC CARE OF CHILDREN AND FAMILIES

GROUP ASSIGNMENT
1. In groups of three, create a poster on ways to incorporate atraumatic care to prevent and
minimize physical stress for children and their families.

AVOID intrusive and painful AVOID irritating noise, smell,

procedures sleep deprivation, restraints,
(injections, punctures, and nausea and vomiting, and
catheterization) skin trauma

ATRAUMATIC
CARE

USE non-pharmacologic and

Therapeutic touch/hug to
pharmacologic measures to
communicate comfort
control and relieve pain.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 30 Atraumatic Care of Children and
Families (2nd ed.) (pp. 1037 1045). Philadelphia: Wolters Kluwer Health/Lippincott Williams
& Wilkins
CHAPTER 31: HEALTH SUPERVISIONS

WRITTEN ASSIGNMENT

1. Discuss the principles of immunization and common barriers to pediatric

immunization
As indicated by Ricci (2013), our immune system is exceptionally dynamic in
guarding the body. In instances of attack of microbes or infections, the immune system can
proficiently recognize ordinary cells and microorganisms/viral cells (Antigen), which
makes them discharge antibodies which are particular to end an antigen. Resistance is the
capacity of the body to guard the body against remote substances. There are types of
immunity which is passive or active, natural or artificial. Active immunity is procured
when the immune framework creates resistant reaction to the outside substance. Also, when
they will experience the antigen once more, they can kill it because they already produced
antibodies against it. This type of immunity develops throughout life as the body is
harboring different antigens. The other type of immunity is the passive immunity. It is not
made by the own body itself but just instilled in the body through vaccinations. They can
either pass the immunoglobulin or the antibodies. This will form either lifelong immunity
through boosters and will for specific time like antitoxin. Currently, there are lots of high
morbid diseases that are vaccinated against. These diseases had killed large numbers of
population when the vaccine is not yet developed. Advancement in science and technology,
as well as in medicine, is currently parting for the continued development of vaccines.
However, not all people have the capacity to afford getting vaccinated. Most vaccines are
costly and this is a big burden to the family especially in the poor sector. Also, their beliefs
regarding vaccination is a problem to come by. This will put them at risk for developing
morbid diseases, and due to not having to capacity to attend to medical needs, it will just
have severe complications. Another barrier is language, it is hard to impart knowledge if
the client is not within the same language as the educator. The willingness in the part of
the client should also established. The time constraints is also a problem since there are
times that they will not be able to attend and vaccinate the child as scheduled (Ricci, 2013)
2. Discuss the principles of health supervision and its three components
According to Ricci (2013), health supervision is health watching and guiding of
families to achieve an optimized level of functioning especially for their children. It
involves providing of services proactively and involves teaching of families regarding
prevention and treatment of the diseases for the child to have health as best as possible.
Moreover, the three components of health supervision are developmental surveillance and
screening, injury and disease prevention, and health promotion. Health supervision starts
from birth up to the child became adolescent, visiting the child through the developmental
years. In developmental screening and surveillance, this includes brief assessment made
over time. It involves monitoring the developmental milestones of the child. This will give
warning to the parent and the health care team about a possible developmental delay.
Furthermore, in injury and disease prevention, the goal is to identify the disease if
there is any and protect the child to lessen the consequences. This is determined by the
nurse assessment. Prevention is achieved through health teaching and anticipatory
guidelines. Lastly, health promotion focuses on maintaining the achieved health and
wellness of the individual. It also addresses what are the ways they can enhance the childs
health status (Ricci, 2013)

3. Describe how a health surveillance visit would be conducted differently with an infant,
toddler, a child in grade school, and an adolescent.
Health surveillance visit in infants are frequently done on their first year of life
because follow ups on immunization status must be checked, if they go around proper
schedule, and visits can also provide update on the result of newborn screenings and will
require more surveillance when infant have been positive for development of congenital
diseases. Health surveillance on toddlers, school age, and adolescent are done infrequently
because it only aims to determine status of growth and development and if development is
appropriate for their age. However, visits can be more frequent in cases that these age
groups have chronic diseases. Visits to adolescents can also be done to inform parents
regarding having booster immunizations, to have data regarding psychosocial development
of the child, and explain to parents about the importance of consistent guidance to their
adolescent children because this age group are at increased risk for troubles, accidents,
 problems, insecurities, peer involvement, and possible use of substances. Aside from age
factor, health surveillance visits can also be done frequently especially to client that are far
from reaching health clinics due to their geographic location (Ricci, 2013).

4. Discuss the key components of health promotion, including key strategies for health
promotion; means of disseminating information; and ways to solve health promotion
problems.

Health promotion focuses on maintaining or enhancing the physical and mental

health of children. The principal components of health promotion are: identifying risk
factors for a disease, facilitating lifestyle changes to eliminate or reduce those risk factors,
and empowering children at the individual and community level to develop resources to
optimize their health.

The nurse implements health promotion through education and anticipatory

guidance Partnership development is the key strategy for success when implementing a
health promotion activity. Identifying key stakeholders from the community allows
problems to be solved and provides additional venues for disseminating information. Health
promotion can be cascaded at schools, day care centers, community agencies, and churches.
(Ricci, 2013)

Anticipatory guidance is primary prevention. The nurse together with the parents
create a plan to optimal health for the child. Provided in the Healthy People 2020, provides
a Health Supervision of Infants, Children, and Adolescents (Hagan, 2008) is another
valuable resource. The skeleton of the guidance provided involves common childhood
health problems. The nurse elaborate that information using the results of risk assessments
and screening tests, health concerns unique to the child, and the interests and concerns of the
parents. Anticipatory guidance for health promotion includes:

Oral healthy practices are important to the overall health of children and
adolescents to prevent dental caries which are the most common chronic illness seen in
children.(Ricci, 2013)
 Causes of this increase in obesity are unhealthy eating habits, decreased physical
activity and sedentary lifestyle. Nurses should emphasize the benefits of health through an
active lifestyle and nutritious eating which also leads a child to maintain his or her self-
esteem. Healthy eating pattern are likely to become a habit and these habit can be passed to
to their children.(Ricci, 2013)

Handwashing is the first personal hygiene topic to be taught to children.

Handwashing prevents disease by limiting a childs exposure to pathogens. The nurse can
introduce the topic to preschool children using cartoons and games. (Ricci et al., 2013)

Skin cancer is a significant health problem in the United States. Blistering sunburns
in children substantially increase the risk of melanoma and other skin cancers (National
Cancer Institute, 2011). People with fair skin are at highest risk for skin cancers, but anyone
can become sunburned and develop skin cancer. When teaching children about safe sun
exposure, remind them that harmful ultraviolet (UV) rays can reflect off water, snow, sand,
and concrete, so being in the shade or under an awning does not guarantee protection. (Ricci,
2013)

ASSIGNMENTS, CHAPTER 31: HEALTH SUPERVISION

GROUP ASSIGNMENT

1. In groups of three, each person will make a presentation to the rest of the group on two
screening tests. Subjects will be drawn at random.
Screening tests are procedures or laboratory analyses used to identify children with
a certain condition. These tests are done to ensure that no child with the disorder is missed.
They have a high sensitivity (a high falsepositive rate) and a low specificity (a low false-
negative rate). If a screening test is positive, follow-up tests with higher specificity are
performed. A risk assessment is performed by the physician in conjunction with the child
and includes objective as well as subjective data to determine the likelihood that the child
will develop a condition.(Ricci, 2013)
 Universal screening- an entire population is screened regardless of the childs individual
risk. This type of screening is performed when a reliable risk assessment procedure is not
available. (Ricci, 2013)
Selective screening -is done when a risk assessment indicates the child has one or more
risk factors for the disorder (Ricci, 2013)
Vision screening- Newborns with ocular structural abnormalities are at high risk for vision
impairment. Vision screening is performed at every scheduled health supervision visit. The
screening procedures for children younger than 3 years of age or for nonverbal children
involve evaluating the childs ability to fixate on and follow objects. The neonate should
be able to fixate on 10 to 12 inches from the face. After fixation, the infant should be able
to follow the object to the midline. By 2 months of age, the infant should be able to follow
the object 180 degrees. The technique of photoscreening can help identify problems such
as ocular malalignment, refractive error, and lens and retinal problems (Ricci, 2013)

Bayley Scales of Infant Development II - the test allows a mental and motor scale for
assessment of cognitive, language, personal social, and fine and gross motor development.
A behavior rating scale is obtained during the testing. It requires direct elicitation. It
requires the nurse to undergo special training (Ricci, 2013)

REFERENCE

Ricci, S. S. (2013). Chapter 31 Health Supervision. Maternity and Pediatric Nursing (2nd ed.)
(pp. 1063 1065). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 32: HEALTH ASSESSMENT OF CHILDREN

WRITTEN ASSIGNMENT
1. List the items that should be included in the functional history and provide an example
where appropriate.
 FUNCTIONAL HISTORY (Ricci, 2013)
Inquire about:
Safety measures (e.g., car seats and their placement, use of seat belts, smoke
detectors, bike helmets)
Routine health care and dental care (including dates of dental care and what was
done)
Nutrition, including a 24-hour dietary recall or weeklong food diary, use of
supplements and vitamins, feeding pattern and satisfaction with diet, amount of
junk food consumed, food likes and dislikes, and the parents perception of the
childs nutrition
Physical activity, recreation, play, and organized sports
Television and computer habits
Sleep behavior and bedtime
Elimination patterns and any concerns
Hearing or vision problems (dates of last screenings and results)
Relationships with other family members and friends, coping and temperament,
discipline strategies, attention or school behavior problems
Religious involvement and other spiritual practices
Use of adaptive and assistive devices such as eyeglasses or contact lenses, hearing
aids, walker, braces, wheelchair
Sexual practices (Burns et al., 2009; Hagan et al., 2008)

2. What are the key considerations for addressing sensitive health issues (sexuality,
substance use, depression, suicide) with an adolescent while taking the health history?
According to Ricci (2013), inquiries in regards to sexuality, substance use, sorrow,
and suicide may be awkward to discuss for young people. Nurse must build up the
relationship with trust with the young people so that they are more open up in answering
those questions. First of all is that d o not go directly to questions pertaining to sensitive
matters. Assess first about the beliefs, predisposition, favorite foods. Set the mood first.
Also, since the questions can be considered as invasion to privacy in the part of the child,
she/he may choose if she/he wants or doesnt want her parents to be with him/her in
 answering those questions. If the child doesnt want, then the nurse can communicate with
the guardian regarding the result and only discussed matters and answers that have an
impact on health. When asking those questions, maintain a non-judgmental approach.
Reassure that the information he/she disclosed to the nurse will always be confidential and
will only be used for the betterment of his/her health status.

3. It is important for the nurse to observe the parentchild interactions during the focused
conversations of the health interview and throughout the physical examination. Provide
some examples of nonverbal, behavioral cues exhibited by infants, toddlers, school-age
children, and adolescents and their parents.
Infants usually use nonverbal cues throughout their infancy because they dont have
verbal skills yet. Examples of nonverbal-behavioral cues used by infant involve grimacing
and kicking their feet as their way to tell that they are irritable or in pain; and turning away
from sounds that they dont like or irritating. Examples of nonverbal-behavioral cues used
by toddlers is having a facial expression of jealousy even when they say they are okay (note
also tone in their voice if grumpy or not); and also projection of crying or tantrums to
communicate their emotions like frustration and anger. Examples of nonverbal-behavioral
cues used by school-age children include not looking in the eyes of their parents when
questioned about troubles in school; another is feeling tensed and stuttering words they are
saying which means that they are making up a story or lying. Lastly, examples of
nonverbal-behavioral cues used by adolescents include getting emotional or starts crying
when asked about her day, this tells their parents nonverbally that they are stressed and
unhappy; another is seeing them head bent down as they enter the house after coming from
class, this tells their parents that their day was not fine.

4. Describe the developmental considerations for examination of a preschooler.

Ricci (2013) listed developmental considerations for examination of a preschooler.

First of all, the examination should be appropriate for the developmental age of the
preschooler. In choosing a place to perform examination, some preschool may be placed in
the examination table especially when they demonstrate willingness. The nurse should be
 standing close by to avoid the preschool feeling along. Reassure the child by holding his
leg with one hand. In directing the examination, the nurse can have the child choose what
to do first, second, and up to last. The nurse should also explain each instrument in a more
simple way, and let the child touch and try the instruments (Ricci, 2013)

GROUP ASSIGNMENT

1. Divide into groups. Each group will be assigned one of the following: vital signs, body
measurements and pain assessment, examination of the head, neck, eyes, ears, nose,
mouth and throat, skin, thorax and lungs, breasts, heart and peripheral perfusion,
abdomen, genitalia and rectum, musculoskeletal system, or neurological system. Each
group should differentiate the normal variations in the physical examination from
differences that may indicate serious alterations in health status and present them to the
class.
SKIN INSPECTION
NORMAL VARIATION
Blueness of the hands and feet, known as acrocyanosis, is normal in babies up to
several days of age and results from an immature circulatory system completing the
switch from fetal to extrauterine life.
Cooling or warming the newborn and young infant may produce a vasomotor
response that causes a mottling of the skin over the trunk and extremities.
Babies of darkly pigmented Native American, African, and Asian parents will be
paler than their parents for many months until the melanocytes in the epidermis
begin production.
Dark-skinned infants commonly have hyperpigmented areolas, genitals, and linea
nigra.
ABNORMAL VARIATIONS
Pallor (defined as decreased pinkness in light skinned patients, ashy-gray in dark-
skinned) is caused by anemia, shock, fever, or syncope.
 Peripheral cyanosis (blue discoloration) occurs in nails, soles, and palms and may
be caused by anxiety or cold; also associated with central cyanosis.
Central cyanosis (blueness of the lips, tongue, oral mucosa, trunk) is caused by
hypoxia or circulatory collapse.
Overall yellow color (jaundice) may be physiologic in the newborn or related to
liver or hematopoietic disease in any age child
Yellowing of nose, palms, and soles may result from excess intake of yellow
vegetables.
Redness of the skin results from blushing, exposure to cold, hyperthermia,
inflammation (localized), or alcohol ingestion.
Lack of color in skin, hair, and eyes is related to albinism.

REFERENCE
Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 32 Health Assessment of Children (2nd
ed.) (pp. 1085 1120). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins

ASSIGNMENTS, CHAPTER 33: CARING FOR CHILDREN IN DIVERSE SETTINGS

WRITTEN ASSIGNMENT
1. List and explain the three phases of separation anxiety.

THREE PHASES OF SEPARATION ANXIETY (Ricci, 2013)

1) PROTEST The child exhibits aggressiveness and great distress, by showing either
intense crying, not wanting to be withdrawn from parents, expression of agitation,
anger, inconsolable grief, and rejection of comfort from other persons, when separated
from parents.
2) DESPAIR When they failed to please their parents and their parents continued to
leave, they will exhibit feeling of sadness, hopelessness, likely become quiet and
withdrawing from other, lack of emotion, and lack of interest in school activities (like
play) and food.
3) DETACHMENT At this phase, the child eventually shows interest again to play,
food, environment, and might even form superficial relationship with teachers, nurses,
or other children. However, when their parents come back for them after, they will
 ignore them because they have developed a coping mechanism to protect themselves
from emotional pain.

2. Explain how the developmental level of preschoolers affects their reaction and response
to hospitalization.
Preschoolers as of now have enhanced verbal abilities. They can comprehend the
circumstance better. They have the ability to reason that they have disease thats why they
are in the hospital. Be that as it may, despite everything they can't conclude why they have
the infection. They are egocentric, and surmise that their wrong doings are caused by their
disease which produces disgrace and uncertainty. Preschoolers, as depicted by Ricci
(2013), fears procedures that will cause physical harm and damage their physical integrity
such as invasive procedures. They decipher words in its own meaning and cannot
comprehend to words that denotes hidden meaning. Example of it is blood. They dont
know the concept of blood and they only know that when they are injured, it will spill out.
Also, preschool who are hospitalized are for the most part kept inside the room. This lose
their inborn nature in to discover their environment. Due to being confined in a room, they
may conclude beliefs that are false which they will have a hard time to spill out for
correction as they do not eventually trust the medical team. (Ricci, 2013)

3. List the factors that affect a childs response to illness and hospitalization
FACTORS AFFECTING CHILDS RESPONSE (Ricci, 2013)
Duration of separation from parents
Age
Developmental and cognitive level
History of illness and hospitalization
Recent life stresses and problems
Preparation time
Temperament
Natural and acquired coping mechanism
Degree of severity of illness
Available support system
 Cultural background
Parents reaction to illness and hospitalization

4. Outline the key nursing components of the admission process.

KEY NURSING COMPONENTS OF ADMISSION PROCESS (Ricci, 2013)

Establishing a trusting, caring relationship with the child and family.

Smile, introduce yourself, and give your title.

Let the child and family know what will happen and what is expected of them.

Ask the family and child what names they prefer to be called by.

Maintain eye contact at the appropriate level.

With a younger child, start with the family first so the child can see that the family
trusts you.

Communicate with children at ageappropriate levels.

The next step, as the childs medical condition allows, involves an orientation to
the hospital unit. Briefly explain policies and routines and the personnel who will
be involved in the care of the child.

During the nursing interview that follows, obtain information about the childs
history, routines, and reason for admission.

Obtain baseline vital signs, height and weight, and perform a physical assessment.

Each health care setting has its own policies and procedures for this.

Recognize the needs of the family and child during this process. If some of this
information already exists, do not ask for it again, except to confirm vital
information such as allergies, medications taken at home, and history of the illness.
 5. Describe the information that should be included in discharge instructions.
According to Ricci (2013), the plan for discharge should be an ongoing process
starting from the admission. In addition, Ricci (2013) listed discharge instruction. First is
that, the nurse should discuss the follow up appointments schedules for the client. The
nurse should stress out that it is a timely manner and any delay can cause problems for the
child. The nurse should also include contact number of the hospital or the nurse
practitionaer in which the family can contact in case of emergencies related to the child.
The recommended diet should also be included as well as suggestions for a day meal. The
instruction should also include if the client is strictly on bed rest, or is it allowed to go out
and play level of activity. More importantly, the nurse should stress out the medication
aspect. Here, the nurse should ensure that the client understands the medication, its dose,
times per day, route, including the adverse effects and special instructions if there are any.
The nurse should also include home interventions that the family can do while the client is
at home.

ASSIGNMENTS, CHAPTER 33: Caring for Children in Diverse Settings

GROUP ASSIGNMENT
1. Divide into five equal groups. Each group will research one of the five types of restraints
or specially designed chairs/carts. The groups will present their findings to the class,
outlining the type of restraint and its purpose and safety issues, and will demonstrate its
use. As part of the presentation, the group should role-play and provide an explanation
for the reason for the restraint to the parent and child.
Mummy restraint is a restraint involving a sheet of linen bring wrap either around
the whole body or every extremity except for one. Thus, means that the body is fully
controlled or kept to minimum. Safety concerns include: making sure all extremities are
secured properly within the sheet, monitor the patient periodically, and making sure that
restraint properly fits without causing choking or resistance against breathing. Proper way
to do it is: 1st, fold the linen into a square where the patients size fits;2nd, put the child at
the center; 3rd, tuck the linen on the right of the baby to the babys left side (make sure that
right arm and legs are covered. Do not include left arm of the baby in the tuck); 4th, the
 remaining linen should be put across the baby making sure it is the right tightness and
fitting (left arm should be within the linen); lastly, monitor patient status (Ricci, 2013).

2. Divide into groups of five to six students and interview a home health nurse. Write a
summary of your understanding of the home health role, including the advantages and
disadvantages of home health nursing.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 33 Caring for Children in Diverse Settings
(2nd ed.) (pp. 1126 1158). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins

CHAPTER 34: CARING FOR THE SPECIAL NEEDS CHILD

WRITTEN ASSIGNMENT

1. Define and discuss vulnerable child syndrome.

Vulnerable child syndrome is a clinical state where parental responses leads to a

chronic/long term mental impact in the part of the child. We can say that the parents are
overly reacting to the condition of the child affecting how the childs response to the
condition. Guardians perceive their child as weak because of the condition and much more
developmental delays will arise. This is just an assumption of the guardian but have a
negative impact on their child. It is normal for them to worry but the excessive emotional
disturbance of the client will be bad for the child because when they sense that their parents
are anxious and afraid and worry, the child will tend to think that it is because of him/her
that makes his/her parents feel that way, causing them to develop the manifestations of
vulnerable child syndrome. Some of the common problems that five rise to vulcerable
child syndrome are prematurity, congenital anomalt, high morbid disease, malnutrition,
feeding problems, long term condition, disabilities, etc.
2. Write three possible nursing interventions for a child who is hospitalized for failure to
thrive
Provide feedings as prescribed (usually 120 kcal/kg/ day is needed to demonstrate
proper weight gain).
Educate parents about proper feeding techniques and recommended volume
strict monitoring and documentation of weight changes, intake and output per
shift/day.

3. Identify four situations/instances when the family of a child with special needs will likely
require additional support.

1) Change of diagnosis. Additional support may be needed for family when the childs
diagnosis will be changed. This can be from a much simpler diseases to a more
complex to life threatening diseases. The nurse should provide holistic care not just
with the patient but also the family
2) Moving into a new setting. The family needs the nurse in supporting information as
well as emotional needs when the child transfers to a new setting. For example, the
child will be transferred from a regular ward to the intensive care unit. This will
provide a great deal of stress to the love ones of the client
3) Periods of developmental changes. The family needs support when the child
demonstrate new developmental skills. Such as in the case of developmental delay or
mental retardation, the family needs the nurse to at least enlighten them what is
happening
4) Parents absence. The absence of parents will add to the stress to the child. Also,
the remaining parent will need to shoulder and decide all in case of emergencies, thus
needing additional support.
4. What is an individualized education plan (IEP)? What role might a pediatric nurse play
in preparing one?

As per Ricci (2013), an individualized education plan (IEP) is a program that

enables the kids to prevail in school. There is a law that manages the program. As per the
law, the arrangement is intended to meet that preschool, primary, secondary level children
 that have specialized needs. The plan may not be possible to developed without the
presence of the care provider such as the nurses. This is because there are the one who is
with the child most of the time, and most commonly, they are the one whom the child
builds trust. The nurse can share his/her insights regarding the needs of the child and will
collaborate to the health team as well as the parents to from the plan.

GROUP ASSIGNMENT

1. In groups of four, develop and present to the class one of the following:

A poster showing a plan for transitioning a special needs child from an inpatient
facility to home.

A poster showing a plan for transitioning a special needs child from pediatric to
adult medical care.

TRANSITION OF SPECIAL NEEDS CHILD FROM INPATENT TO HOME CARE (Ricci,

2013)

It is important for the nurse to establish a trusting relationship with both the
child and family. A trusting therapeutic relationship will make all aspects of
care more effective
The focus is on meeting the childs physical and psychological needs while
involving the family
Assessment in the home is similar to that in the acute care setting but
involves obtaining firsthand data about the family and the way it functions.
The nurse needs to assess the childs growth and development and
thoroughly assess the home environment
The nurse needs to ensure that the home offers a safe and nurturing
environment for the child.
The nurse also needs to assess availability of resources. This includes
necessary equipment such as a hospital bed and oxygen, suitable physical
and emotional surroundings, ability to contact emergency services, power
backup if needed, and ease of evacuation of the child in case of a fire
The nurse needs to assess whether electricity, sanitary conditions, heat, air
conditioning, and telephone access are present
The home care nurse must also assess the familys teaching and learning
needs
The home care nurse must also assess the familys teaching and learning
needs.
REFERENCE

Ricci, S. S. (2013). Chapter 34 Caring for the Special Needs Child. Maternity and Pediatric
Nursing (2nd ed.) (pp. 1167 1174). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

ASSIGNMENTS, CHAPTER 35: Key Pediatric Nursing Interventions

WRITTEN ASSIGNMENT

1. Describe and explain the Eight Rights of pediatric medication administration

The eight rights on pediatric medication administration are right medication, right
patient, right time, right route of administration, right dose, rice documentation, right to be
educated, right refuse. Right medicine involves making sure the that it is the medicine
ordered by the physician, that it is not expired, and that nurses known the action of the
medication and side effects it can cause. Right patient involves making sure that medicine
recipient is the recipient by asking the identity of the patient and confirming with their ID
bracelet and family members; and that identity must be confirmed every administration of
medicine. Right time involves making sure that the medicine is administered at exact or
within 20-30 minutes from the prescribed time, and that PRN medications must be
administered when needed but will depend on the gap from the last administration. Right
route of administration involves ensuring that the route is the route prescribed, that the
route is the safest and most effective in children, and to consult the physician when changes
in route should be done due to the reaction of the child when administered at this route.
Right dose involves ensuring that recommended dose was calculated properly using the
childs weight (double check to make sure it is accurate), that it should be counter-checked
with pharmacist if it is under recommended dose rage, and that unusual large or small
dosage should be verified with the prescriber. Right documentation involves making sure
that all medicines given and refused are charted or encoded in patients chart, including the
time it was administered. Right to be educated involves the right of the patient/family to
be educated regarding the action of medications given to them. Lastly, Right to refuse
involves making sure that before patient/family refuses administration, concerns and
misconceptions must be explained and clarified; that medications use must be emphasized;
and if they still refuse, respect the decision and have them sign refusal paper (Ricci, 2013)
 2. Explain how the absorption of orally administered medications in infants and young
children is different compared to those given to older children and adults.
Although a drugs mechanism of action is the same in any individual, the
physiologic immaturity of some body systems in a child can affect a drugs
pharmacodynamics (behavior of the medication at the cellular level). As a result, the body
may not respond to the drug as intended. The intended effect may be enhanced or diminished,
necessitating a change in the dosage to ensure optimal effectiveness without increasing the
childs risk for toxicity. The childs age, weight, body surface area, and body composition
also can affect the drugs pharmacokinetics (movement of drugs throughout the body via
absorption, distribution, metabolism, and excretion). Drugs are administered to children via
many of the same routes that are used for adults. However, this similarity ends once the drug
is administered. During the absorption process, drugs move from the administration site into
the bloodstream. (Ricci et al., 2013)

In infants and young children, the absorption of orally administered medications is

affected by slower gastric emptying, increased intestinal motility, a proportionately larger
small intestine surface area, higher gastric pH, and decreased lipase and amylase secretion
compared with adults.(Ricci et al., 2013) This is because of the physiologic immaturity of
some body systems in a child. Metabolism of medications in children is altered because of
differences in hepatic enzyme production and the childs increased metabolic rate. Bio
transformation (the alteration of chemical structures from their original form, which allows
for the eventual excretion of the substance) is affected by the same variations affecting
distribution in children. In addition, the immaturity of the kidneys until the age of 1 to 2
years affects renal blood flow, glomerular filtration, and active tubular secretion. This results
in a longer half-life and increases the potential for toxicity of drugs primarily excreted by
the kidneys.

3. Outline the guidelines for determining the correct medication dose by body weight.

MEDICATION ADMINISTRATION (Ricci, 2013)

1. Weigh the child.

2. If the childs weight is in pounds, convert it to kilograms (divide the childs weight in
pounds by 2.2).
 3. Check a drug reference for the safe dose range (for example, 10 to 20 mg/kg of body
weight).
4. Calculate the low safe dose
5. Calculate the high safe dose
6. Determine if the dose ordered is within this range.

GROUP ASSIGNMENT
1. Divide into groups. Each group will be assigned to demonstrate the proper technique for
administering medication to children via the oral, rectal, ophthalmic, otic, intravenous,
intramuscular, and subcutaneous routes. Each group should demonstrate how to
prepare the child for administration and how to provide atraumatic care during
administration and care and comfort after administration.
SUBCUTANEOUS ADMINISTRATION
Adopted from:
http://www.aboutkidshealth.ca/En/HealthAZ/TestsAndTreatments/GivingMedication/Page
s/Subcutaneous-Injections-Injecting-At-Home.aspx
Birth to 12 months - For newborns and infants, inject medicine into the middle of
the thigh where there is a lot of fatty tissue .This is called the anterolateral thigh
muscle. Use the front, outer top of the thigh. Do not use the inner thigh or back of
the thigh.
12 months and older 1) Middle of the thigh. Inject medicine into the middle of the
thigh where there is a lot of fatty tissue.This is called the anterolateral thigh muscle.
Use the front, outer top of the thigh. Do not use the inner thigh or back of the thigh
2) Back of the arm. This is the fatty tissue over the back part of the upper arm
Points to keep in mind - Change sites with each injection. Separate each injection
by at least one inch. Avoid areas that are bruised, scarred from injuries, swollen or
tender.
PROCEDURE
1. Choose the injection spot. Clean the skin with soap and water (do not need to
use an alcohol swab) and pat dry. Try to change injection sites with each
 injection you give. For example, inject into the left thigh in the morning and
right thigh at night.
2. Pinch up on the fatty (subcutaneous) tissue to prevent injection into muscle.
3. Insert needle at a 45 angle to the skin. You do not need to pull back on the
syringe plunger after inserting the needle (aspirate)
4. Give the drug rapidly to reduce pain. Firmly push the plunger down as far as it
will go.
5. Pull the needle out gently at the same angle you put it in. As you take out the
needle, let go of the skin roll.
6. Apply firm pressure with a cotton ball to the injection site for 30 seconds
following each injection to reduce the chance of bruising. Do not rub the area as
it may irritate the skin
7. Put the needle and syringe in a thick, plastic bottle or sharps container with a
lid. Do not try to put the cap back on the needle. This is for safety. When the
container is full, bring it to your local pharmacy. They can safely dispose of it
for you. Do not put it in your regular garbage.

REFERENCE

Ricci, S. S. (2013). Chapter 35 Key Pediatric Nursing Interventions. Maternity and Pediatric
Nursing (2nd ed.) (pp. 1186 1195). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

ASSIGNMENTS, CHAPTER 36: Pain Management in Children

WRITTEN ASSIGNMENT

1. Describe the FACES Pain Rating Scale and how it works.

FACES pain rating scale is an assessment tool where children, as young as 3 years
old, can report the pain they are experiencing by using the Wong-Baker FACES Rating
Scale chart as their reference. Under the faces in the chart, there are number scales that can
be 0-5 and 0-10 in which 5 or 10 being the worst pain and 0 as no pain. This scale must be
 explained first so that the child will have knowledge on how it works. Explaining that, Face
0 is very happy because there is no pain at all. Face 1 indicating the pain hurts just a little
bit. Face 2 indicating that pain hurts a little more. Face 3 indicating the pain hurts even
more. Face 4 indicating that pain hurts a whole lot. Face 5 indicating that the pain hurts
worst as much as you can imagine. The nurse will ask the child to point the face which
corresponds mostly to what they are feeling (Ricci, 2013).

2. Define neuromodulators and describe how they work.

Neuromodulators are substances identifies that modifies the sensation of pain. These
substances have been found to change a persons perception of pain. Examples of these
neuromodulators include serotonin, endorphins, enkephalins, and dynorphins. They work as the
pain perception can be modified peripherally or centrally. In the peripheral nerve fibers, chemical
substances are released that either stimulate the nerve fibers or sensitize them. Peripheral
sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be
needed to cause pain. (Ricci, 2013) This the results to cause more pain perceived by a person.

3. Explain how a childs culture and family influence the pain response.
Social and family impacts extraordinarily influence how the individual responds,
communicates, and deals with the perception of his pain. There are societies that are typical
in which they permit outward articulation of their pain, nonetheless, different societies
would view outward feeling of pain will not make you a man, and it is not acceptable in
their society. Some male makes it as a measure of being a man. Familial impact in pain
reaction depends for the most part on parental response to the capability of the child to
cope up with the pain. Remember the vulnerable child syndrome? It can happen when there
is an overreaction of the family to the pain/disease the child is experiencing. The child
should be supported by the family so that she/he will have an easy time recovering and
adapting to the pain (Ricci, 2013)
GROUP ASSIGNMENT

1. Divide into groups. Each group will pick an age group and develop a nursing care plan
for a child in that age range related to management of pain, including pharmacologic
and nonpharmacological techniques and strategies.
As stated by Ricci (2013),

Infants, including preterm infants, experience pain. Behavioral and physiologic

indicators are used to assess pain. Toddlers commonly react with intense emotional upset and
physical resistance or aggression. Preschoolers may feel that pain is a punishment for
misbehaving or having bad thoughts. School-age children can communicate the type, location,
and severity of pain but may deny having pain to appear brave or avoid further pain.
Adolescents, with their focus on body image and fear of loss of control, often ask numerous
questions and may attempt to remain stoic to avoid being viewed as childish.

Assessment of pain in children includes both subjective and objective data. Nurses
need to tailor the assessment to the childs developmental level and ask appropriate questions
geared to the childs cognitive level. Parental questioning during the health history also is
important. Self-report pain rating scales are valuable assessment tools that allow the childs
level of pain to be quantified. Examples include the FACES pain rating scale, the Oucher pain
rating scale, the poker chip tool, the word-graphic rating scale, visual analog and numeric
scales, and the Adolescent Pediatric Pain Tool.

Nonpharmacologic pain management strategies aim to assist children in coping

with pain and to give them a sense of mastery or control over the situation. These strategies
may be categorized as behavioral-cognitive, in which the child focuses on a specific area or
aspect rather than the pain (e.g., relaxation, distraction, imagery, biofeedback, thought
stopping, and positive self-talk), or biophysical, in which the focus is on interfering with the
transmission of pain impulses reaching the brain (e.g., heat and cold applications, massage and
pressure)

Pharmacologic interventions involve the administration of drugs for pain relief,

most commonly nonopioids and opioid analgesics. The selection of the method is determined
by the drug being administered; the childs status; the type, intensity, and location of the pain;
 and any factors that may be influencing the childs pain. The preferred methods for
administering analgesics include the oral, rectal, intravenous, or local nerve block routes;
epidural administration; and moderate sedation

REFERENCE

Ricci, S. S. (2013). Chapter 36 Pain Management in Children. Maternity and Pediatric Nursing
(2nd ed.) (pp. 1221 1231). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 37: NURSING CARE OF THE CHILD WITH AN

INFECTIOUS OR COMMUNICABLE DISORDER

WRITTEN ASSIGNMENT

1. Describe how a child differs from an adult in immunologic integrity. When looking at
the pediatric patient, break this down by age from infancy through adolescence.

The immune system involves complex responses including phagocytosis, humoral

immunity, cellular immunity, and activation of the complement system. Blood and lymph
are responsible for transporting the agents of the immune system. Due to the immature
responses of the immune system, infants and young children are more susceptible to
infection. (Ricci, 2013)

Newborns, has a decrease inflammatory response to invading organisms that results

with the increase risk for infection. Cellular immunity is generally functional at birth, and
humoral immunity occurs when the body encounters and then develops immunity to new
diseases. Infants, has limited exposure to disease and they start to lose positive immunity
that they acquire from the maternal body especially when breastfeeding stops hence, they
are at higher risk for infection. The young children continue to have an increased risk for
infection and communicable disease because at this age, children are more playful and
active in the community parks. However, risk can be reduced if proper immunization will
be given. While the adolescents have developed and more matured immune system but are
at high risk of acquiring STDs because of unsafe sexual activities. In addition, according
to the CDC (2010), adolescents have the highest rate of infected STDs.
GROUP ASSIGNMENT

1. Divide into groups of two. Refer to Drug Guide 15-1 in the text. Working together,
develop drug cards to distribute and share with classmates so that by the end of the
assignment everyone will have a full set to carry with them. Divide content of Drug Guide
15-1 evenly among groups; each drug card should have the following sections:
Medication, Action/Indication, Nursing Implications, and Common Side Effects. All
information should be age appropriate and not indicative of adults if for an infant.

2. Divide into groups of two. Refer to Table 15-4 in the text. Working together, develop
cards to distribute and share with classmates so that by the end of the assignment
everyone will have a full set to carry with them. Divide content of Table 15-4 evenly
among the groups; each card should have the following sections: Disease,
Pathophysiology, Clinical Manifestations, Complications, and Nursing Implications. All
information should be age appropriate and not indicative of adults if for an infant.
3. In groups of four, choose an infectious disease. Each person will draft a different
nursing diagnosis related to the disease and present it to the group for discussion. Final
drafts are to be combined into a comprehensive nursing plan of care.

SCARLET FEVER NURSING DIAGNOSIS

1. Risk for imbalanced body temperature: fever related to infectious disease process
2. Impaired comfort related to infectious and/or inflammatory process as evidenced by
rash, body aches, nausea, and vomiting

REFERENCE

Ricci, S. S. (2013). Chapter 37 Nursing Care of the Child with an Infectious or Communicable
Disorder. Maternity and Pediatric Nursing (2nd ed.) (pp. 1286). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
ASSIGNMENTS, CHAPTER 38: NURSING CARE OF THE CHILD WITH A
NEUROLOGIC DISORDER

WRITTEN ASSIGNMENT

1. Describe the anatomy and physiology of the pediatric neurologic system and discuss how
it is different from that of adults.

The neurologic system of a pediatric client, according to Ricci (2013), is different

from adults due to a main reason which is underdeveloped and immaturity. The Central
nervous system makes up the brain and spinal cord and this is form in the first 3 to 4 weeks
of gestation. Now, it can be damaged while developing due to teratogens. Moreover, at
birth, the cranial bones, which is the one composing the skill and enclosing the brain, is not
well developed and are not yet fused. This will increase the risk of fracture to the skull and
putting the baby risk for brain trauma. In addition, Ricci (2013) stated that the brain is very
vascular compared to adults and thats why a little trauma will be enough for it to bleed
resulting to hemorrhage. Consequently, premature infants are not so well developed putting
them at higher risk for brain trauma compared to term babies.
As said in the previous paragraph, the skull is not yet firm as the fontanels are not
yet closed. This will allow the brain to grow but of course, putting the baby at risk for
injury. Late closure of the fontanels can depict problems in brain growth. Furthermore, the
spin of the baby is not yet firm and strong compared to adults. It cannot protect well the
spinal cord posing the baby in lots of problems related to injury. The nerves in the nervous
system is also underdeveloped. They dont yet undergo myelination which covers the
nerves and speeds up transmission of impulses. This is why children are progressively
developing their fine and gross motor skills. Of course, preterm infants may have a delay
in developmental skills due to this factor (Ricci, 2013)

2. Name common risk factors for neurologic disorders.

NEUROLOGIC DISORDERS RISK FACTORS (Ricci, 2013)

Family history of neurologic disorder

Brain injury/trauma
 Neonatal infection (meningitis and encephalitis)
Use of drugs other than prescribed supplemental medications and alcohol during
Congenital (environmental and genetic influence)
Neoplasms
Malformations
pregnancy
Use of salicylates in treating viral infection

3. Describe nursing interventions commonly used for a child with a neurologic disorder.

It is essential for the nurse to assess the patients condition to establish a base line
data for future references in determining the patients condition. Monitoring the ICP and
urologic status may prevent further complications by detecting early and providing
appropriate interventions. Measuring the head circumference is also important because
increase in circumference may indicate increase in ICP. Proper positioning of the head
depending on the case is also important for example to a patient with increase ICP, 15-30
degrees elevation is necessary to prevent increase in head pressure. Observing proper
hygiene and reinforcing handwashing is also important to prevent any secondary infection
to the patient that may lead to complications. And also, raise the hand rails to prevent the
patient from falling.

ASSIGNMENTS, CHAPTER 38: Nursing Care of the Child With a Neurologic Disorder

GROUP ASSIGNMENT

1. In groups of 4, each person chooses a disorder from one of the following categories:
seizure disorders, structural defects, infectious disorders, and trauma. Prepare a
presentation of the signs and symptoms for the rest of the group
SEIZURE (Ricci, 2013)
1. Infantile spasms - Presents as a sudden jerk followed by stiffening May see:
Head flexed, arms extended, and legs drawn up
Arms flung out, knees are pulled up, and the body bends forward (referred
to as jackknife seizures)
Cry may precede or
2. Absence (formerly petit mal) - Sudden cessation of motor activity or speech with
a blank facial expression or rhythmic twitching of the mouth or blinking of the
eyelids Complex absence seizure consists of myoclonic movements of the face,
fingers, or extremities and possible loss of body tone. Lasts less than 30 seconds
Child may experience countless seizures in a day. Not associated with a postictal
(after seizure) state May go unrecognized or mistaken for inattentiveness because
of subtle change in childs behavior
3. Tonic-clonic (formerly grand mal ) - Associated with an aura Loss of
consciousness occurs and may be preceded by a piercing cry. Presents with entire
body experiencing tonic contractions followed by rhythmic clonic contractions
alternating with relaxation of all muscle groups Cyanosis may be noted due to
apnea. Saliva may collect in the mouth due to inability to swallow. Child may bite
tongue. Loss of sphincter control, especially the bladder, is common. Postictal
phase: child will be semicomatose or in a deep sleep for approximately 30 minutes
to 2 hours; usually responds only to painful stimuli Child will have no memory of
the seizure; may complain of headache and feeling fatigue Safety of the child is a
primary concern.
4. Myoclonic - Sudden, brief, massive muscle jerks that may involve the whole body
or one body part Child may or may not lose consciousness.
5. Atonic - Sudden loss of muscle tone. In children, may only be a sudden drop of
the head. Child will regain consciousness within a few seconds to a minute. Can
result in injury related to violent fall
6. Simple partial - The symptoms seen will depend on which area of the brain is
affected. Motor activity characterized by clonic or tonic movements involving the
face, neck, and extremities Can include sensory signs such as numbness, tingling,
 paresthesia, or pain Usually persists for 1020 seconds Child remains conscious
and may verbalize during the seizure. No postictal state
7. Complex partial - common type of partial seizure May begin with a simple partial
seizure then progress May or may not have a preceding aura Consciousness will
be impaired. Automatisms and complex purposeful movements are common
features in infants and children. Infants will present with behaviors such as lip
smacking, chewing, swallowing, and excessive salivation; can be difficult to
distinguish from normal infant behavior In older children, will see picking or
pulling at bed sheets or clothing, rubbing objects, or running or walking in a
nondirective and repetitive fashion These seizures can be difficult to control.
8. Status epilepticus Common neurologic emergency in children. Can occur with any
seizure activity. Febrile seizures are the most common type. In children with
epilepsy, it commonly occurs early in the course of epilepsy. Can be life
threatening Prolonged or clustered seizures where consciousness does not return
between seizures The age of the child, cause of the seizures, and duration of status
epilepticus influence prognosis. Prompt medical intervention is essential to reduce
morbidity and mortality.

2. Form groups of 3. Place the name of each drug listed in Drug Guide 16-1 on a piece of
paper and place it in a container. Each person reaches in to take a slip of paper. Each
student must describe the action, indication, and nursing implications (including patient
teaching) of the drug named on the paper.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 38 Nursing Care of the Child With a
Neurologic Disorder (2nd ed.) (pp. 1302 1349). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins
ASSIGNMENTS, CHAPTER 39: Nursing Care of the Child With a Disorder of the Eyes or
Ears

Written Assignment

1. Describe how an infants vision differs from that of an adult and the developmental
benchmarks for vision.
Infants eye color is usually determined between 6-12 months as iris becomes
pigmented. At birth their sclera might seem slightly bluish in color but whitens through the
coming weeks. The infants and young childrens eyeballs occupy a larger space within the
orbit than in adults, making them more susceptible to ocular injury. Newborns spherical
shaped lenses do not allow them to accommodate and focus on distant things, unlike in
adults that can see and focus things that are far. But not all adults have perfect lens, there
are cases where adults lens degenerate due to aging or they develop cataract (hardening of
lens). These cases result to decrease in eye accommodation and vision through time. On
the other hand, newborns usually see and focus to things or faces that are 8-10 inches from
their face. But as they get older, their lens will develop until it reaches adults lens.
Newborns optic nerve is not completely myelinated but will be developed fully on their
first few years of life. This incomplete myelination leads them to have color discrimination
problems. Adults may have full myelination of optic nerves but it does not mean that they
dont have color discrimination problem. Color discrimination can be a result of genetics,
hereditary, eye disorders, or due to aging. This means that children can also have this
problem (Ricci, 2013). Regarding developmental benchmarks for vision, visual acuity
usually is not complete at birth and continues to develop over the first few years of life.
According to Ricci (2013), visual acuity ranges from 20/100 to 20/400 at birth. But this
acuity slowly decreases from 20/100 into 20/90 to 20/80 and so on until it turns to 20/20,
which is the maximum best acuity of the eye, and is usually achieved by 6-7 years old.
Binocular vision may be achieved by 4 months of age because rectus muscles are not yet
fully coordinated at birth.
2. Discuss the risks associated with persistent otitis media with effusion.
Otitis media with effusion is characterized by swelling of the middle air due to
presence of fluid. It can be an event after an acute otitis media or a standalone event. Either
 of the two, there is no infection usually involved. It is said that the Eustachian tube is the
one giving way to the fluid to accumulate in the middle air (Ricci, 2013) There are lots of
risk associated in otitis media. It is one of the severe childhood disease as prompt treatment
can prevent permanent hearing loss. When we talk about hearing loss, the language
department is also affected so as the social communication. This will eventually lead to
developmental delays. Moreover, the disease can also complications such as infection,
development of cyst, eardrum damage among others (Ricci, 2013)

3. What are the factors that increase the risk of developing visual impairment?
Factors that increases the risk of developing visual impairment are prematurity,
Developmental delay, Genetic syndrome, Family history of eye disease, African American
heritage, Previous eye injury, Diabetes, HIV and chronic corticosteroid use, and Trauma

4. What are the laboratory and diagnostic tests used to diagnose disorders of the eye and
ear?
Most cases of eye disorders are diagnosed based on assessment which includes
testing visual acuity using the Snellen chart, history taking and laboratory tests. In cases
of bacterial or viral conjunctivitis, sample will be obtained via eye drain and it will be sent
to the laboratory for culture. While to diagnose hearing disorders or impairment, Weber
and Rinne test are conducted to detect bone or air conduction hearing loss. In addition, if
further evaluation is needed, the nurse may be responsible for administering an acoustic
emissions test or auditory brain stem evoked response test, either in the hospital or
outpatient office. (Ricci et al., 2013) For otitis media with effusion, which is an
inflammation of the ear with discharge, culture from a sample may be conduct to determine
the causative agent and the antibiotic needed for treatment.

GROUP ASSIGNMENT
1. In groups of 4, choose either a blind or deaf child and agree on nursing diagnoses for
the child. Divide the diagnoses among group members, who will work individually to
develop interventions.
 Adopted from Ricci (2013):

NURSING DIAGNOSIS: Sensory perception, disturbed (auditory) related to hearing

loss as evidenced by lack of reaction to verbal stimuli, delayed attainment of language
milestones

Intervention: Improving Hearing

Assess hearing ability frequently because early detection of hearing loss allows for
earlier intervention and correction.
Assess language development at each visit to allow for early detection of hearing loss
(earlier intervention and correction).
Encourage hearing aid use for amplification of sound.
Teach about hearing aid battery safety to avoid aspiration of battery.
Assist child with focusing on sounds in the environment to encourage listening skills.
Refer for and encourage attendance at communication habilitation program to
maximize communication potential.

REFERENCE

Ricci, S. S. (2013). Chapter 39 Nursing Care of the Child With a Disorder of the Eyes or Ears.
Maternity and Pediatric Nursing (2nd ed.) (pp. 1360 1363). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 40: Nursing Care of the Child With a Respiratory Disorder
Written Assignment
1. Discuss how the childs respiratory system can increase the severity of respiratory
disorders as compared to adults. Include differences of the nose, throat, trachea, and
chest.

There are lots of ways the respiratory system itself can cause severity of respiratory
disorders. In fact, the severity of respiratory dysfunction id greater in children than adults.
 It is because of the immaturity and the underdeveloped structures of the childs respiratory
system (Ricci, 2013). According to Ricci (2013), newborns are required to breathe through
their nurse. IN adults, they can use their mouth for breathing especially when their nose is
obstructed. However, in children, they cannot use their mouth as it will not automatically
open for breathing if the nose is obstructed. With that, all outside enters through their nose.
IN the nose, there are cilia that traps debris present in the air, and mucus that picks up
harmful substances. Yet, due to the immaturity of the respiratory system of the child, they
produced little mucous which can just increase their chances of getting infection or making
it more severe.
In the throat, the tongue of the infant is positioned in a way that it can easily obstruct
the oropharynx when displaced. It will cause severe airway obstruction. In addition,
children tend to have larger tonsils even in the absence of illness contributing again to
airway obstruction (Ricci, 2013). Furthermore, per Ricci (2013), the lumen of the trachea
where air passes by is much smaller compared to adults. Swelling and accumulation of
mucus will greatly reduce its diameter and the air that will enter it will be having a hard
time getting through it. It will increase the child work of breathing. In addition, the cricoid
cartilage in children is underdeveloped and this may cause laryngeal narrowing. Also, the
muscles that aids the breathing of the child, especially when labored, is less functional than
those of adults.
Lastly, in the chest, the bronchioles and bronchi have narrower lumen compared to
adults placing them at risk for airway obstruction. In addition, since the children tend to
pick up small objects and put it in the mouth, there is a great chance of aspiration, and the
narrow lumen of the respiratory tract will be blocked. Moreover, the amount of alveoli
present in children is continuously increasing and adults have more of it compared to
children. Preterm infants have smaller numbers of alveoli predisposing them to develop
hypoxemia (Ricci, 2013)

2. List the acute noninfectious respiratory disorders in children and the factors associated
with them.
ACUTE INFECTIOUS RESPIRATORY DISORDER
1. Epistaxis
Nosebleed
Epistaxis may be recurrent and idiopathic
history for initiating factors such as local inflammation, mucosal drying, or
local trauma (usually nose picking). Inspect the nasal cavity for blood.
2. Acute Respiratory Distress Syndrome
occurs following a primary insult such as sepsis, viral pneumonia, smoke
inhalation, or near drowning. Respiratory distress and hypoxemia occur acutely
within 72 hours of the insult in infants and children with previously healthy
lungs
The alveolarcapillary membrane becomes more permeable and pulmonary
edema develops. Hyaline membrane formation over the alveolar surfaces and
decreased surfactant production cause lung stiffness. Mucosal swelling and
cellular debris lead to atelectasis. Gas diffusion is impaired significantly.
3. Foreign Body Aspiration
occurs when any solid or liquid substance is inhaled into the respiratory tract.
It is common in infants and young children and can present in a life-threatening
manner
The object may lodge in the upper or lower airway, causing varying degrees of
respiratory difficulty
4. Pneumothorax
A collection of air in the pleural space
Trapped air consumes space within the pleural cavity, and the affected lung
suffers at least partial collapse.
Some small pneumothoraces resolve independently, without intervention.
3. Develop a teaching plan for the parents of a child with a tracheostomy.

Based from:
http://www.academyofneonatalnursing.org/WritingCenter/TracheostomyinInfants.pdf
4. Describe the nursing interventions used for a child with a common cold.
Nursing interventions used to a child with common colds include promoting
comfort, preventing spread of cold, and providing family education. Promoting comfort
involves relieving the congestion of fluid in the nose by using normal saline nose wash and
followed by suctioning via bulb syringe in infants and toddler; use of normal saline nose
spray in older children; use of cool mist humidifier; promotion to intake plenty of fluids.
Providing family education involves cautioning to not take OTC drugs unless prescribed;
avoidance of use of aspirin which is associated with Reye syndrome; consult their
physician for proper management of illness; educating proper use of normal saline nose
 drops/spray and bulb syringe suction in removing secretions in the nose; educate regarding
complication they should watch out and be reported immediately. This complications
include prolonged fever, enlarged painful lymph node upon palpation, throat pain or pain
upon swallowing, worsening and prolonged cough lasting longer than 10 days, having
breathing difficulty and chest pain, earache, headache, tooth or sinus pain, lethargy or
unusual irritability, and skin rash. Preventing of common cold spread involves educating
about proper handwashing technique, importance of frequent hand hygiene, avoidance of
sneezing in front of others, avoidance of areas where smoke is inhaled, avoidance of
exposure to crowded places especially during winter, avoidance of close contract to
persons with cold, stress importance of drinking plenty of water, and having a nutritious
and balanced nutrition everyday (Ricci, 2013).

5. What are the risks associated with pharyngitis caused by a group A streptococcal
infection?
The complications that can be developed associated with group A streptococcal
infection (commonly known as pharyngitis) includes peritonsillar abscess or
retropharyngeal abscess. The peritonsillar abscess is a from of an inflamed tissue that can
be found in the tonsils which will cause obstruction. Moreover, retropharyngeal abscess
will have pus like discharge in the oropharynx which also can cause obstruction. In
children, GASI can lead to an inflmmatroy disease called rheumatic heart fever. It can
affect the heart, and because of the pathophysiology, it can also affects the kidney (Ricci,
2013)

GROUP ASSIGNMENT

1. In groups of five, divide the respiratory disorders discussed in this chapter, and look up
the signs and symptoms of each. Prepare a chart showing which symptoms are common
and which are specific to various disorders.
NASAL CONGESTION (Ricci, 2013)

SIGNS & ALLERGIC COMMON COLD SINUSITIS

SYMPTOMS RHINITIS
Length of illness Varies; may have year- 10 days or less Longer than 10 to 14
round symptoms days
Nasal discharge Thin, watery, clear Thick, white, yellow, Thick, yellow or green
or green; can be thin
Nasal congestion Varies Present Present
Sneezing Varies Present Absent
Cough Varies Present Varies
Headache Varies Varies Varies
Fever Absent Varies Varies
Bad breath Absent Absent Varies

2. In groups of three, each person chooses a respiratory disorder discussed in the chapter
and prepares a nursing plan for a child with that disorder. Plans are presented to the
group for discussion.
ASTHMA (Ricci, 2013)
NURSING DIAGNOSIS: Ineffective airway clearance related to inflammation,
increased secretions, mechanical obstruction, or pain as evidenced by presence of
secretions, productive cough, tachypnea, and increased work of breathing
Outcome Identification and Evaluation Child will maintain patent airway, free from
secretions or obstruction, easy work of breathing, respiratory rate within parameters
for age.
Interventions: Maintaining a Patent Airway
Position with airway open (sniffing position if supine) to allow adequate
ventilation.
Humidify oxygen or room air and ensure adequate fluid intake (intravenous or
oral) to liquefy secretions for ease in clearance
Suction with bulb syringe or via nasopharyngeal catheter as needed, particularly
prior to bottle-feeding, to promote clearance of secretions.
If tachypneic, maintain nothing by mouth (NPO) status to avoid aspiration.
In older child, encourage expectoration of sputum with coughing to promote
airway clearance.
Perform chest physiotherapy if ordered to mobilize secretions.
Ensure emergency equipment is readily available to avoid delay should airway
become unmaintainable
REFERENCE
Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 40 Nursing Care of the Child With a
Respiratory Disorder (2nd ed.) (pp. 1388 1440). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins

ASSIGNMENTS, CHAPTER 41: NURSING CARE OF THE CHILD WITH A

CARDIOVASCULAR DISORDER

WRITTEN ASSIGNMENT

1. What are the primary nursing implications for an arteriogram?

NURSING IMPLICATIOSN FOR ARTERIOTGRAM (Ricci, 2013)
Make sure the parent signs a consent form.
Administer premedication as ordered.
Obtain childs weight to determine amount of dye needed.
Keep the child NPO before the procedure according to institutional protocol.
After the procedure, maintain the child on bed rest.
Observe the puncture site for bleeding.
Monitor vital signs frequently and check the pulse distal to the site.

2. What are the physiologic changes that occur in the cardiopulmonary system that enable
the newborn to make the transition from fetal circulation to normal circulation?
According to Ricci (2013), the cardiovascular system undergoes various changes
in the transition from the womb to the outside environment. In the womb, the placenta and
the umbilical cord supply the baby with oxygen and blood but in the outside environment,
the placental connection is cut off and that will need the infant to rely on its body systems
to adapt and survive. With the newborns first breath, it signals several changes both the
cardiovascular and respiratory system. The lungs will inflate upon the first breath, reducing
the vascular resistance to blood flow. In the right atrium, the pressure became lower and
the left atrium increases its pressure upon the flow of blood to the left side of the heart.
This changes in pressure closes the foramen ovale. Moreover, the pressure in the
pulmonary artery suddenly drops and this will lead to closure of ductus arteriosus.
Furthermore, the lack of blood flow in the left umbilical vein promotes the closure of ductus
 venosus. The closure of both ductus venosus and arteriosus will became a ligament, and
with lack of blood flow, they will atrophy (Ricci, 2013)

3. What is AV canal defect? What is complete AV canal defect?

Atrioventricular canal defect occurs due to the failure of the endocardial cushions
to fuse. The cushions are needed in order to separate the central parts of the heart which is
near the mitral and tricuspid valve. The complete AV canal defect involves atrial and
ventricular septal defects as well as a common AV orifice and a common AV valve. Partial
and transitional forms of AV canal defect also occur, involving variations of the complete
form. (Ricci et al., 2013) During complete AV canal defect, it permits the flow of blood to
cross over the left atrial and ventricular septum. Therefore, this specific type of cardiac
defect causes a large left-to-right shunt; an increased workload of the left ventricle; and
high pulmonary arterial pressure, resulting in an increased amount of blood in the lungs
and causing pulmonary edema (Fulton & Brown, 2011; Miyamoto et al., 2011).

4. What are the priority nursing assessments and interventions for the child with acute
rheumatic fever?
Priority nursing assessment for a child with acute rheumatic fever includes
assessment of present illness, chief complain, vital signs (especially temperature), and joint
pain; assessment of past/recent medical history of factors like streptoccocal infection, sore
throat, or tonsillitis that are recurrent throughout the year or having this factors present
within the past 2-3 weeks; any past history of acute rheumatic fever; note for unusual
movement of the face and upper extremities (sydenham chorea); inspect for signs on the
skin like erythema marginatum, classic rash, or maculopapular red rash with a cleared
center and elevated edges; ausculate for heart murmurs; and observe for prolonged PR
interval on the ECG. Priority nursing interventions include management of inflammation
and fever; ensuring accurate administration of prescribed antibiotics and prophylaxis after
initial recovery of symptoms; providing comfort by allowing the child to express
frustrations regarding his/her condition and symptoms; offer support when patient is
dealing with abnormal movements; educate the child and parents regarding the condition,
its causes, symptoms, and about when the chorea will subside to decrease their anxiety;
 ensure administration of NSAIDs or corticosteroids, as prescribed, to provide relief of joint
pain and swelling (Ricci, 2013).

GROUP ASSIGNMENT
1. In groups of four, each person chooses a common nursing diagnosis associated with
cardiovascular disorders. Each person should then question the other members of the
group about the key considerations for developing an individualized nursing care plan
for the child with the selected diagnosis.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 41 Nursing Care of the Child With a
Cardiovascular Disorder (2nd ed.) (pp. 1447 1493). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins

CHAPTER 42: NURSING CARE OF THE CHILD WITH A GASTROINTESTINAL

DISORDER

WRITTEN ASSIGNMENT

1. List the typical risk factors in a patients current and past medical history that
commonly are associated with gastroesophageal reflux.
FACTORS ASSOCIATED WITH GERD (Ricci, 2013)
Prematurity, noting prolonged ventilator use or chronic lung disease
Dietary habits (e.g., chocolate, coffee, spicy or fatty foods, caffeine, formula-fed
or breastfed, overeating or overfeeding)
Current medications
Smoking/alcohol use (older children)
Food allergies
Other GI disorders (gastric outlet dysfunction/hiatal hernia) or congenital
abnormalities
Feeding positions and patterns (especially important in infants)
 Sleeping positions/patterns
Other medical history, such as asthma or recurrent infections/pneumonia

2. List the differences between the digestive tract of the pediatric patient and that of the
older child or adult. Provide an example of these differences in the esophagus, stomach,
intestines, and biliary system.
According to Ricci (2013), the differences of the gastrointestinal tract in infant and
children comparing to older children and adult can be reasoned to the immaturity and
underdevelopment of their gastrointestinal tract. Moreover, Ricci (2013) stated the
common differences which can be listed below:
The habit of the children to put things in their mouth puts them in greater risk to
harbor infection
The muscle tone of the lower esophageal tract is not yet fully developed until age 1
month compared to adults that have fully matured LES. This makes infants below
1 moth old risk for frequent regurgitation
The amount of hydrochloric acid secretion is still low in infants while in adults have
enough secretion of HCL acid. This puts the infant to have a hard time digesting
foods. Moreover, the capacity of the newborns stomach is only 10 to 20ml, and
200 ml in 2 months. In adults, they have a capacity of 2000 to 3000 ml.
The small intestine prior to birth is not yet able to function normally. On the other
hand, the adult have a fully functional small intestine. This puts the infant problems
with absorption leading to diarrhea.
In the biliary system, the liver of infant is much larger compared to adults making
it palpable. Moreover, the secretion of pancreatic enzymes is still low postnatally,
and will juts reach adult levels by age 2. With that, younger children have more
difficulty in breaking down foods.

3. What are the key nursing implications for a cleansing enema for fecal impaction or
severe constipation?
Nursing implications, according to Ricci (2013) includes explaining the procedure.
You cannot carry out the nursing process without explaining the procedure, why it is done
 and what to expect. Moreover, there should be a standing order and a consent before the
procedure The nurse should give privacy to the client to avoid shaming and feeling of
shyness. It also fosters cooperation. The client should be relaxing as possible to facilitate
insertion of the enema and to avoid irritation. The position should be I dorsal recumbent as
this arcs the pathway of enema in the GI tract. Monitor for electrolyte imbalances. Enema
administration can be uncomfortable, but calming measures, such as distraction and praise,
provide a comforting environment. After the impaction is removed, promote regular bowel
habits to keep the impaction from recurring.
4. What are the most common causes of viral and parasitic acute infectious diarrhea in the
United States?
Common cause of viral acute infectious diarrhea are Rotavirus, Adenovirus, Norwalk
virus, Caliciviruses, Astrovirus, and Cytomegalovirus.
Common cause of parasitic acute infectious diarrhea are Giardia lamblia, Entamoeba
histolytica, and Cryptosporidium
5. Is ulcerative colitis considered an acute or chronic disorder? Explain.
Ulcerative colitis is a chronic disorder with acute onset of manifestations. This is
because ulcerative colitis is an inflammation involving the colon and the rectum and it
involves the continuous segments. It is a continuous lesions. It is ongoing and lifelong and
exhibits by remissions and relapses. Moreover, its main cause is unknown and thus,
medications are only used to relieve the manifestations.

6. What are the 3 key points of nursing management for the child with diarrhea

According to Ricci (2013), the 3 key points of nursing management for a child with
diarrhea are restoration of fluid and electrolyte balance, maintenance of adequate nutrition,
and providing family education on preventing development of diarrhea.

GROUP ASSIGNMENT
1. Working in pairs, refer to Common Diagnostic and Laboratory Tests 20-1 in the text.
Review and memorize the contents of the table to understand the explanation, indication,
and nursing implications for each test.
 2. Working in pairs, refer to Drug Guide 20-1 in the text. Review and memorize the contents
of the Drug Guide to understand the action, indication, and nursing implications for
each classification.

ASSIGNMENTS, CHAPTER 43: NURSING CARE OF THE CHILD WITH A

GENITOURINARY DISORDER

WRITTEN ASSIGNMENT

1. Explain why the infant or toddler is at increased risk for dehydration during times of
fluid loss or decreased fluid intake.
According to Ricci (2013), since the pediatric patients kidneys are not mature
enough and the blood flow through the kidneys is slower than with the adults, they are
less able to concentrate urine that placed them in a higher risk for dehydration when there
is fluid loss or decrease fluid intake.

2. The nurse is caring for a teenage girl who has had three urinary tract infections over an
18-month period. List the appropriate teaching recommendations for an adolescent girl
to help prevent repeated urinary tract infections.
PREVENTING URINARY TRACT INFECTION IN FEMAILES (Ricci, 2013)
Drink enough fluid (to keep urine flushed through bladder).
Drink cranberry juice to acidify the urine. Avoid colas and caffeine, which irritate
the bladder.
Urinate frequently and do not hold urine (to discourage urinary stasis).
Avoid bubble baths (they contribute to vulvar and perineal irritation).
Wipe from front to back after voiding (to avoid contaminating the urethra with
rectal material).
Wear cotton underwear (to decrease the incidence of perineal irritation).
Avoid wearing tight jeans or pants.
Wash the perineal area daily with soap and water.
While menstruating, change sanitary pads frequently to discourage bacterial
growth.
 Void immediately after sexual intercourse.

3. What are the key nursing implications with the use of corticosteroids for nephrotic
syndrome?
KEY NURSING IMPLICATEIONS WITH THE USE OF CORTICOSTEROIDS
FOR NEPHROTIC SYNDROME (Ricci, 2013)
Administer with food to decrease GI upset.
May mask signs of infection.
Do not stop treatment abruptly, or acute adrenal insufficiency may occur.
Monitor for Cushing syndrome.
4. What are four risk factors for VUR?
FOUR RISK FACTORS FOR VUR
familial history of the VUR
onset of infection in the urinary tract
obstruction in the bladder
dysfunctional/neurogenic bladder

GROUP ASSIGNMENT

1. Working in pairs, refer to Common Laboratory and Diagnostic Tests 21-1 in the text.
Review and memorize the contents of the table to understand the explanation, indication,
and nursing implications for each test

REFERENCE:

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 43 Nursing Care of the Child With a
Genitourinary Disorder (2nd ed.) (pp. 1549 1585). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins
CHAPTER 44: NURSING CARE OF THE CHILD WITH A NEUROMUSCULAR
DISORDER

WRITTEN ASSIGNMENT

1. Explain the use, indications, and nursing implications for orthotics and braces

Orthotics and braces re devices that aid the movement of the child, or it is used for
recovery. It is uniquely fitted in the child by the therapist. According to Ricci (2013), these
devices are used to achieve alignment of the body as a whole or any part of the body, most
commonly the extremities. There are lots to watch out for the use of these devices. The
notes should have a keen eye in assessing the skin around the devices for breakdown. Any
breakdown will cause an entry of bacteria thereby causing complications. Also, the nurse
should also assess for compression syndrome which the devices is too fitted impending the
circulation. The therapist should also provide a schedule of periods of time when the client
should be wearing the device or when the client can rest and not wear the device (Ricci,
2013)
2. List the differences between the neurologic and musculoskeletal systems of an infant or
toddler versus those of the older child or adult. Explain the potential impact of these
differences
DIFFERENCES BETWEEN THE NEUROLOGIC AND MUSCULOSKELETAL
SYSTEMS OF AN INFANT OR TODDLER VERSUS OLDER CHILD OR ADULT
(Ricci, 2013)
1. Infant have immature muscular system compared to adult
2. Infants have immature spine leading to increased spinal cord injury compared to adults
3. The nerves are not yet completely myelinated in children than in adults. This is the
reason for ongoing developmental milestones for children
4. Infants muscles are not developed, and are generally weaker than in adults
5. Although infants have ligaments, tendons, and cartilage present at birth, it is not strong
compared to adults.
 3. What are the key nursing implications for MRI?
KEY NURSING IMPLICATIONS FOR MRI (Ricci, 2013)
Remove all metal objects from the child.
Child must remain motionless for entire scan; parent can stay in room with child.
Younger children will require sedation in order to be still.
A loud thumping sound occurs inside the machine during the procedure, which can
be frightening to children.

4. List four common causes associated with postnatal development of cerebral palsy
CAUSES OF CEREBRAL PALSY (Ricci, 2013)
1. Seizures
2. Viral or bacterial infection of the central nervous system (e.g., meningitis)
3. Toxins
4. Kernicterus (a type of brain damage that may result from neonatal hyperbilirubinemia)

GROUP ASSIGNMENT

1. Divide into two groups. One group will research the muscular dystrophy resources
available in the local community (can be found at www.mda.org). Contact the local
health services coordinator. Report back on the availability of support groups, clinics,
summer camps, equipment loans, and other programs available to families with a child
who has muscular dystrophy. The other group will obtain the same information from the
local affiliate of United Cerebral Palsy (can be found at www.ucp.org).

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 44 Nursing Care of the Child with a
Neuromuscular Disorder (2nd ed.) (pp. 1589 1620). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins
CHAPTER 45: NURSING CARE OF THE CHILD WITH A MUSCULOSKELETAL
DISORDER

WRITTEN ASSIGNMENT

1. What are the signs of neurovascular compromise in a casted extremity?

SIGNS OF NEUROVASCULAR COMPROMISE IN A CASTED EXTREMITY
(Ricci, 2013)
Increased pain
Increased edema
Pale or blue color
Skin coolness
Numbness or tingling
Prolonged capillary refill
Decreased pulse strength (or absence of pulse)

2. What should be included in the teaching guidelines for home cast care?
TEACHING GUIDELINES FOR HOME CAST CARE (Ricci, 2013)
For the first 48 hours, elevate the extremity above the level of the heart and
apply cold therapy for 20 to 30 minutes, then off 1 hour, and repeat.
Assess for swelling, and have the child wiggle the fingers or toes hourly
For itching inside the cast:
o Never insert anything into the cast for the purposes of scratching.
o Blow cool air in from a hair dryer set on the lowest setting or tap lightly
on the cast.
o Do not use lotions or powders.
Protect the cast from wetness.
o Apply a plastic bag around cast and tape securely for bathing or
showering. Continue to avoid placing the cast directly in water (unless
it is Gore-Tex lined).
o Cover it when your child eats or drinks.
 o If a cast become soiled it can be wiped clean with a slightly damp clean
cloth.
o If the cast gets wet, dry it with a blow dryer on the cold setting (if warm
setting is used the child could get burned).
If the child has a large cast, change position every 2 hours during the day and
while sleeping change position as often as possible.
Check the skin for irritation.
o Press the skin back around edges of the cast.
o Use a flashlight to look for reddened or irritated areas.
o Feel for blisters or sores.
Call the physician or nurse practitioner if:
o The casted extremity is cool to the touch, pale, blue, or very swollen.
o The child cannot move the fingers or toes.
o Severe pain occurs when the child attempts to move the fingers or toes.
o Persistent numbness or tingling occurs.
o Drainage or a foul smell comes from under the cast.
o Severe itching occurs inside the cast.
o The child runs a fever greater than 101.5F for longer than 24 hours.
o Skin edges are red and swollen or exhibit breakdown.
o Child complains of rubbing or burning under cast.
o The cast gets wet or is cracked, split, or softened

3. What are the key nursing implications for arthrography?

KEY NURSING IMPLICATIONS FOR ARTHROGRAPHY (Ricci, 2013)
1. Should not be performed if joint infection is present.
2. The joint should be rested for 12 hours.
3. Apply cold therapy afterward and assess for swelling and pain.
4. Crepitus may be present in the joint for 1 to 2 days after procedure.
 4. What are the differences between children and adults in relation to bone healing? What
are the implications of these differences?

The bone of the child have a thick, and periosteum that is strong with networks of
blood vessels. Well, these blood vessels supplies the bone with nourishment in the form of
oxygen and nutrients. And this is the main reason why bone healing is much faster in children
than adults. In fact, the process of bone healing in infant compared to adults are the same,
but the rate is faster in child because of those blood vessels. Moreover, the callus formation
in child is faster compared to adults. And as bone healing and remodeling process continues,
a new bone growth will form at the site of fracture. Overall, the younger the child, the faster
bone healing process. In addition, the growth plate in child is not yet closed because this
determines the growth of the child. The epiphysis is an area where the nutrients are being
supplied so a fracture that is near the epiphysis will heal faster. On the other hand, in adults,
they have closed epiphyseal plate. As a conclusion, the straightening and correcting of
misalignment of bones is easier in children because of the said factors above than in adults
(Ricci, 2013)

GROUP ASSIGNMENT

1. In groups of four, each person chooses a common nursing diagnosis associated with
musculoskeletal disorders. Each person should then question the other members of the
group about the key considerations for developing an individualized nursing care plan
for the child with the selected diagnosis.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 45 Nursing Care of the Child With a
Musculoskeletal Disorder (2nd ed.) (pp. 1625 1665). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins
CHAPTER 46: NURSING CARE OF THE CHILD WITH AN INTEGUMENTARY
DISORDER

WRITTEN ASSIGNMENT

1. What are the primary nursing implications for a child who requires patch or skin
testing? What is an erythrocyte sedimentation rate, and what are nursing implications
related to this lab test?
NURSING IMPLICATIONS FOR SKIN TESTING (Ricci, 2013)
Have emergency equipment available in the event of anaphylaxis (rare).
NURSING IMPLICATIONS FOR ESR (Ricci, 2013)
Send sample to laboratory immediately; if allowed to stand for longer than 3
hours, may result in falsely low result.

2. What are the anatomic and physiologic differences of the sebaceous and sweat glands in
infants and children versus adults?
These glands are already present at birth but not are yet matured enough to carry
out its function. In adults, they have lots of sebaceous glands that lubricates the skin. It
keeps the skin and hair moisturize to prevent dryness. However, due to excessive
productions of this in adolescent, it can cause development of pimples and acne. In terms
of sweat glands, the adult have numerous that produces sweat in response to activity,
temperature, stress, and exercise. This will cause body odor when added to poor hygiene.
In infants, they are not capable of producing sweat and the only way for their sweat glands
to produce sweat is when there is emotional stimuli and heat. With that, they cannot
maintain their temperature well enough leading to loss of temperature. These glands get
matured as the child is growing up (Ricci, 2013)

3. Compare and contrast the skin findings for tinea corporis, tinea capitis, and tinea
versicolor.
1. Tinea corporis - Annular lesion with raised peripheral scaling and central clearing
(looks like a ring)
 2. Tinea capitis - Patches of scaling in the scalp with central hair loss . Risk of kerion
development (inflamed, boggy mass that is filled with pustules)
3. Tinea versicolor - Superficial tan or hypopigmented oval scaly lesions, especially on
upper back and chest and proximal arms More noticeable in the summer with
tanning of unaffected areas

4. Emergency evaluation of the burned child includes a primary survey followed by a

secondary survey. What is included in the primary survey and secondary survey?
According to Ricci (2013), the primary survey includes evaluating the
airway of the child, breathing, and circulation. In the secondary survey, it includes
evaluation of the degree of burns and other injuries. Specifically, primary survey
focuses on assessing the childs airway and identifying if it is patent, block, or
maintainable. It also involves checking for airway injuries or smoke inhalation and
noting if burns are present surrounding the mouth, nose, or eyes. Observe for black
sputum, hoarseness or stridor as this denotes respiratory problems. Also, check for
pulse strength, perfusion status, and heart rate as well as degree of edema

In secondary survey, it specifically includes determining the depth of the burn

and estimating the body percentage affected by burn. Additionally, it also involves
inspecting the child for other bodily injuries (Ricci, 2013)

GROUP ASSIGNMENT
1. In groups of four, each person chooses a common nursing diagnosis associated with
integumentary disorders. Each person should then question the other members of the
group about the key considerations for developing an individualized nursing care plan
for the child with the selected diagnosis.

REFERENCE

Ricci, S. S. (2013). Chapter 46 Nursing Care of the Child With an Integumentary Disorder.
Maternity and Pediatric Nursing (2nd ed.) (pp. 1670 1693). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
ASSIGNMENTS, CHAPTER 47: Nursing Care of the Child With a Hematologic Disorder
WRITTEN ASSIGNMENT
1. What are the common laboratory and diagnostic studies ordered for the assessment of
sickle cell anemia? What are the findings in relation to normal?
COMMON LABORATORY AND DIAGNOSTIC STUDIES FOR THE
ASSESSMENT OF SICKLE CELL ANEMIA (Ricci, 2013)
Newborn Screening HbSS that is out of range. Does not distinguish between
sickle cell disease and sickle cell trait
Screening by Sickledex or sickle cell prep - Does not distinguish between sickle
cell disease and sickle cell trait
Hgb electrophoresis - the only accurate test for sickle cell disease. Hgb
electrophoresis will demonstrate the presence of Hgb S and Hgb F only in the young
infant; in the older infant or child, the result will be Hgb SS.
Hemoglobin: baseline is usually 7 to 10 mg/dL; will be significantly lower with
splenic sequestration, acute chest syndrome, or aplastic crisis
Reticulocyte count: greatly elevated
Peripheral blood smear: presence of sickle-shaped cells and target cells
Platelet count: increased
Erythrocyte sedimentation rate: elevated
Abnormal liver function tests with elevated bilirubin

2. What should be included in the guidelines for teaching parents about preventing
bleeding in the child with hemophilia?
TEACHING GUIDELINES FOR PARENTS ABOUT PREVENTING BLEEDING
IN CHILD WITH HEMOPHILIA (Ricci, 2013)
Protect toddlers with soft helmets, padding on the knees, carpets in the home, and
softened or covered corners.
Children should stay active: swimming, baseball, basketball, and bicycling
(wearing a helmet) are good physical activities.
Avoid intense contact sports such as football, wrestling, soccer, and high diving.
 Avoid trampoline use and riding all-terrain vehicles (ATVs).
Arrange premedication with Amicar if oral surgery is indicated.

3. The priority in sickling crisis is to control pain quickly. What are the ABCs for managing
sickle cell pain?
ABCs OF MANAGING SICKLE CELL PAIN (Ricci, 2013)
A: Assess the pain (use a pain assessment tool).
B: Believe the childs report of pain.
C: Complications or cause of pain (look for complications)
D: Drugs and distraction: pain medication (opiates and NSAIDs, if no contraindications);
use fixed dosing; give on a timed schedule; no PRN dosing for pain medications;
distraction with music, TV, and relaxation techniques
E: Environment (rest in quiet area with privacy)
F: Fluids (hypotonicD5W or D5 with 0.25% normal saline solution)

4. What are the priority nursing assessments for a child with suspected aplastic anemia?
What are the expected laboratory and diagnostic test results?
ASSESSMENT FOR CHILD SUSPECTED WITH APLASTIC ANEMIA (Ricci,
2013)
Determine history of exposure to myelosuppressive medications or radiation
therapy.
Obtain a detailed family, environmental, and infectious disease history.
Note history of epistaxis, gingival oozing, or increased bleeding with menstruation.
Anemia may lead to headache and fatigue.
On physical examination, note ecchymoses, petechiae or purpura, oral ulcerations,
tachycardia, or tachypnea
EXPECTED LABORATORY AND DIAGNOSTIC RESULTS (Ricci, 2013)
Blood in urine
Absence or very low number of hematopoietic cell upon aspiration of bone marrow
Guaiac positive stool
GROUP ASSIGNMENT

1. In groups of four, each person chooses a common nursing diagnosis associated with
hematologic disorders. Each person should then question the other members of the
group about the key considerations for developing an individualized nursing care plan
for the child with the selected diagnosis.

REFERENCE

Ricci, S. S., Kyle, T., & Carman, S. (2013). Chapter 47 Nursing Care of the Child With a
Hematologic Disorder (2nd ed.) (pp. 1625 1665). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins

CHAPTER 48: NURSING CARE OF THE CHILD WITH AN IMMUNOLOGIC

DISORDER

WRITTEN ASSIGNMENT

1. Why do infants experience a physiologic hypogammaglobulinemia between 2 and 6

months of age? Explain why the breastfed infant is better protected during this time.

Hypogammaglobulinemia is a condition where there is a decreased number of

immunoglobulins presence in blood. This immunoglobulin are the ones fighting
infections/infection. It is just normal to appear between 2 and 6 months of age because the
babys immune system cannot produce immunoglobulin yet until 1 year of age. Before the
infant can make its own immunoglobulin, the supply of IGG comes from the mother. And
that supply of IGG starts to decline as the baby because the baby cannot produce its own.
Thats why its between 2 and 6 months that we can see physiologic
hypogammaglobulinemia. Breastmilk is the food of the baby. It contains all necessary
requirements as a food to help the baby develop and grow. It contains maternal Igg that the
baby will acquire. Thats why they are more protected than non-breastfed baby. This is a
form of passive immunity.
2. What should be included in the teaching guidelines about hidden allergens for the child
with a milk allergy?

Teaching guidelines about hidden allergens for the child with a milk allergy involve
avoidance of foods like artificial butter flavor, lactalbumin, nougat, casein, whey, pudding,
yoghurt, and ghee. Unexpected locations of this ingredients to avoid are in some hotdogs,
some deli meats, coffee whiteners, and nondairy products. Parents must practice reading
food labels to be extremely careful and not cause life threatening allergic reactions. They
must also know the symptoms of allergic reactions and immediate consultation must be
done to manage the situation (Ricci, 2013).

3. What are the nursing care implications for lymphocyte immunophenotyping T-cell
quantification?
LYMPHOCYTE IMMUNOPHENOTYPING T-CELL QUANTIFICATION
NURSING IMPLICATIONS (Ricci, 2013)
1. Do not refrigerate specimen.
2. Steroids may elevate lymphocyte levels
3. Immunosuppressive drugs may depress lymphocyte levels.

4. What are the three types of juvenile idiopathic arthritis?

THREE TYPES OF JUVENILE IDIOPATHIC ARTHRITIS (Ricci, 2013)
1. Pauciarticular involvement of four or fewer joints
2. Polyarticular involvement of five or more joints
3. Systemic Joint involvement with fever and rash

5. What should be included in the nursing care plan for promoting comfort and decreasing
pain in a child with juvenile idiopathic arthritis?

Administer medications as prescribed to control inflammation and prevent disease

progression - NSAIDs, corticosteroids, and disease-modifying antirheumatic drugs.
Maintain joint range of motion and muscle strength via exercise (physical or
occupational therapy). Swimming is a particularly useful exercise to maintain joint
 mobility without placing pressure on the joints. Teach families appropriate use of
splints prescribed to prevent joint contractures. Monitor for pressure areas or skin
breakdown with splint or orthotic use. Cluster care to decrease disturbances and allow
for longer uninterrupted rest periods. Pace activities and encourage regular rest periods
to conserve energy. Administer early morning warm bath to ease a.m. stiffness.
Schedule activities for the time of day the child usually has the most energy to
encourage successful participation (Ricci, 2013)

GROUP ASSIGNMENT
1. In groups of two, refer to www.epipen.com/howtouse.aspx. Each group will practice the
appropriate use of the EpiPen by demonstrating the device.

ASSIGNMENTS, CHAPTER 49: NURSING CARE OF THE CHILD WITH AN

ENDOCRINE DISORDER

WRITTEN ASSIGNMENT

1. Name the glands and hormones affected by the posterior pituitary gland and describe
the major effects they have on the body.

The posterior pituitary gland is responsible for the release of the hormone oxytocin
which is the responsible for the increase of uterine contractions and the antidiuretic
hormone which role is the absorption of water in the kidney tubules. If there is
underproduction of the antidiuretic hormone, it may lead to diabetes insipidus which is the
inability to concentrate urine and the excess in urinary output that may potentially result to
dehydration.
2. What are areas of imbalance that may occur in an infant or young child that would not
occur in adults?
This can be denoted by the fact that the endocrine system of the child is not yet
mature and cannot carry out functions just as like adults. With these fluid and electrolyte
imbalances is a common problem in children than in adults. Children may have diarrhea
and dehydration, imbalances in electrolyte and fluid as well as sodium, glucose and other
 substances. This would not occur in normal adults because their endocrine system is
capable of doing its full function (Ricci, 2013)

3. What are the nursing interventions for an adolescent girl with hyperthyroidism
NURSING INTERVENTIONS FOR AN ADOLESCENT GIRL WITH
HYPOERTHYROIDISM (Ricci, 2013)
1. Administer IV fluids and diuretics as prescribed to increase urinary excretion of
calcium in children not in renal failure.
2. Administer prescribed medication to treat hypercalcemia, such as oral phosphate
(antihypercalcemic agent), pamidronate, calcitonin, or etidronate disodium (by
inhibiting bone resorption of calcium).
3. Increase the childs fluid intake to minimize renal calculi formation. Provide fruit
juices to maintain low urinary pH, acidity of body fluids, and calcium absorption.
Strain the urine for renal casts.
4. Dietary calcium is restricted.
5. Monitor for safety by assessing the childs level of muscular weakness, preventing
falls or injury, and checking for fractures.
6. If the child develops renal rickets (osteodystrophy), longterm braces may be required,
so provide family education and encourage compliance.
7. Surgery may be performed to remove abnormal parathyroid tumor.
8. Keep the diet low in phosphorus and watch for hypocalcemia and onset of tetany
after surgery.

4. What are the nursing diagnoses for a child with precocious puberty?
NURSING DIAGNOSES FOR CHILD WITH PRECOCIOUS PUBERTY
1. Disturbed body image related to precocious puberty
2. Chronic low self esteem related to body image
3. Ineffective coping related to the disease process
4. Impaired adjustment related to the disease process
5. Risk for social isolation related to body image
GROUP ASSIGNMENT

1. In groups of three, each person chooses three drugs from Drug Guide 27-1. Look up the
indications, contraindications, warnings, precautions, adverse reactions, dosage, and
administration of each drug. Discuss findings among the group.

ASSIGNMENTS, CHAPTER 50: NURSING CARE OF THE CHILD WITH A

NEOPLASTIC DISORDER

WRITTEN ASSIGNMENT

1. What are the origins and types of cancers typical in children and in adults?

Pediatric cancers originate from primitive mesodermal (embronal) and

neuroectodermal tissues while adult cancers originate from epithelial tissues. Common
pediatric cancers, caused by these cells, in ranking order are leukemia, CNS tumors,
lymphoma, neuroblastoma, rhabdomyosarcoma, Wilms tumor, bone tumors, and
retinoblastoma (Ricci, 2013). According to the National Cancer Institute (2017), top five
common adult cancers in order are breast cancer, lung cancer, prostate cancer, colorectal
cancer, and melanoma.

2. What is the difference between acute lymphoblastic leukemia and acute myelogenous
leukemia?
The difference lies in the origin. Acute lymphoblastic leukemia is a type of
leukemia that originates and affects the lymphoid cells (B cells/T cells) while in acute
myeloid leukemia originates and affects myeloid cells (Ricci, 2013). Although both cancer
have no definite cause, it is said to be a defect in gene or chromosomal abnormalities leads
to mutation of cells and overproduction of the abnormal cells invading the marrow.
Moreover, the age of incidence is also different. In ALL, it is the most common type of
pediatric cancer and it can be seen on ages 2 to 10 years old. On the other hand, AML can
be mostly seen on ages 10 onwards, usually on the adolescent years. The severity is also
different as it is considered that although both are deadly, AML is considered more severe
than ALL. AML is hard to treat which cause drug toxicity in the part of the client.
 Furthermore, their manifestations are much the same and thats why it is hard to determine
whether it is AML or ALL. However, it is said that the manifestations of AML are more
of anemic symptoms and bleeding episode. In ALL, it is more of CNS affectations.

GROUP ASSIGNMENT

1. In groups of three, each person chooses one of the following age groups: preschool,
school age, or adolescent. Then, each chooses a childhood cancer and prepares an
individualized nursing care plan for that child. Plans are presented to the group for
discussion.
NURSING CARE PLAN FOR PRESCHOOL
Nursing Assessment
Explore the childs current and past medical history for risk factors such as
Male gender
Age 2 to 5 years
Caucasian race
Down syndrome, Shwachman syndrome, or ataxia-telangiectasia
X-ray exposure in utero
Previous radiation-treated cancer (Zupanec & Tomlinson, 2010)
Determine the childs history of varicella zoster immunization or disease.
Chickenpox infection in the leukemic child may lead to disseminated,
overwhelming infection
Common signs and symptoms reported during the health history might
include
Fever (may be persistent or recurrent, with unknown cause)
Recurrent infection
Fatigue, malaise, or listlessness
Pallor
Unusual bleeding or bruising
Abdominal pain
Nausea or vomiting
 Bone pain
Headache (Zupanec & Tomlinson, 2010)

NURSING MANAGEMENT
Nursing care of children with ALL focuses on managing disease
complications such as infection, pain, anemia, bleeding, and hyperuricemia and the
many adverse effects related to treatment. Many children require blood product
transfusion for the treatment of severe anemia or low platelet levels with active
bleeding. It is also important to manage the adverse effects of chemotherapy
Children and teens with leukemia suffer pain related to the disease as well
as the treatment. Chemotherapy drugs commonly used in leukemia may cause
peripheral neuropathy and headache. Lumbar puncture and bone marrow
aspiration, which are periodically performed throughout the course of treatment,
also cause pain. The most common areas of pain are the head and neck, legs, and
abdomen (probably from protracted vomiting with chemotherapy). Use distraction
techniques, such as listening to music, watching TV, or playing games, to help take
the childs mind off the pain. Administer mild analgesics such as acetaminophen
for acute episodes of pain. Using EMLA cream prior to venipuncture, port access,
lumbar puncture, and bone marrow aspiration may decrease procedure-related pain
events. In addition, applying heat or cold to the painful area is usually acceptable.
Administer narcotic analgesics, as prescribed, for episodes of acute severe pain or
for palliation of chronic pain (Simon, 2010).

2. In groups of three, each person chooses surgery, chemotherapy, or radiation therapy

and identifies the nursing assessments and interventions related to the treatment.
NURSING ASSESSMENT FOR RADIATION THERAPY (adopted from:
wps.prenhall.com/wps/media/objects/.../radiation_therapy.pdf)
1. Carefully assess and manage any complications, usually in collaboration with the
radiation oncologist.
 2. Assist in documenting the results of the therapy; for example, clients receiving
radiation for metastases to the spine will show improved neurologic functioning as
tumor size diminishes.
3. Provide emotional support, relief of physical and psychologic discomfort,and
opportunities to talk about fears and concerns. For some clients, radiation therapy is a
last chance for cure or even just for relief of physical discomfort
NURSING INTERVENTIONS FOR RADIATION THERAPY (adopted from:
wps.prenhall.com/wps/media/objects/.../radiation_therapy.pdf)
1. Monitor for adverse effects: skin changes, such as blanching, erythema,
desquamation, sloughing, or hemorrhage; ulcerations of mucous
membranes;nausea and vomiting,diarrhea,or gastrointestinal bleeding (for External
Radiation)
2. Assess lungs for rales, which may indicate interstitial exudate. Observe for any
dyspnea or changes in respiratory pattern (for External Radiation)
3. Identify and record any medications that the client will be taking during the
radiation treatment (for External Radiation)
4. Monitor white blood cell counts and platelet counts for significant decreases (for
External Radiation)
5. Place the client in a private room (for Internal Radiation)
6. Limit visits to 10 to 30 minutes, and have visitors sit at least 6 feet from the client
(for Internal Radiation)
7. Monitor for side effects such as burning sensations, excessive perspiration, chills
and fever, nausea and vomiting, or diarrhea (for Internal Radiation)
8. Assess for fistulas or necrosis of adjacent tissues (for Internal Radiation)

REFERENCE

Ricci, S. S. (2013). Chapter 50 Nursing Care of the Child With a Neoplastic Disorder. Maternity
and Pediatric Nursing (2nd ed.) (pp. 1813 1841). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
ASSIGNMENTS, CHAPTER 51: NURSING CARE OF THE CHILD WITH A GENETIC
DISORDER

WRITTEN ASSIGNMENT

1. Discuss the two types of monogenic inheritance as well as the subsets of each type.

The two types of monogenic inheritance are autosomal and x-linked inheritance.
Both inheritances have 2 subsets which is dominant and recessive trait. Autosomal
inheritance conditions are carried by autosomes which means the both male and female are
affected. While X-linked inheritance conditions are carried by a defective X chromosome
of the mother causing females become carriers of the defective gene and males who will
develop the disease. Autosomal dominant inheritance causes an affected parent to have a
50% chance of passing the disorder and 50% chance that normal gene will be passed to
their offspring. It means that if they planned for 4 children: 2 of them have the disorder and
the other 2 is normal, or if they planned 2 offspring, 1 of them have the disorder and the
other does not. Both sexes are equally affected; in addition to that, an affected father will
most likely pass the disorder to his son. Examples of autosomal dominant disorders are
Huntingtons disease, neurofibromatosis, achondroplasia, and polycystic kidney disease.
Autosomal recessive inheritance causes both carrier parents of the disorder to have a 25%
chance of their child to develop the disorder, 50% chance that their child will be carriers
of the defective gene, and 25 % chance of having a normal child. This means that if they
planned for 4 children: 2 of them will be carriers of the gene, 1 of them will have the
symptoms of the disease, and 1 of them will be normal. Both sexes are equally affected; in
addition to that, an affected father will also most likely pass the disorder to his son.
Examples of autosomal recessive inheritance disorders are phenylketonuria, cystic fibrosis,
Tay-Sachs disease, and sickle cell anemia (Ricci, 2013). X-linked dominant inheritance
can be in two cases: in which the father has the defective X chromosome or the mother has
the defective X chromosome. An affected father will have all his daughters possess the
disorder and none with his sons while an affected will have a 50% chance of inheriting the
disorder to both her sons and daughters. However, males are more severely affected with
the disorder than females because they only have 1 X gene unlike females that have 2 X
 gene, which is why severity is low. Examples of X-linked dominant inheritance are
hypophosphatemic rickets, and fragile X syndrome. X-linked recessive inheritance is the
most common x-linked pattern of inheritance. Males are more affected in this disorder than
females, due to single X gene. This makes males develop the disease while females can
also develop the disease if they get 2 defective X chromosome but if they only get 1, they
will become carriers of the disease. If the father is affected with the disease, he will have
all his daughters a carrier and none of his sons will have the disease.If the mother is a
carrier, she will have 25 % chance of having an affected son, 25% chance of having
unaffected son, 25% chance of having a carrier daughter, and 25 chance non-carrier
daughter. Examples of X-linked recessive inheritance are hemophilia, color blindness, and
duchenne muscular dystrophy (Ricci, 2013).

2. What is the purpose of genetic counseling, and what is the nurses role in it?
Genetic disorders usually result in a lifelong complex medical condition. Nurses
must provide ongoing education and support for the child and family about the disorder,
treatment, and management as well as available resources.(Ricci, 2013)
Genetic tests do not yield easy-to-understand results. Genetic counseling helps you
understand and use the results of the genetic testing to make informed decisions. Genetic
counseling is the process of helping people understand and adapt to the medical,
psychological and familial implications of genetic contributions to disease. Interpretation
of family medical histories to assess the chance of disease occurrence or recurrence.
Education about inheritance, testing, management,prevention, resources and research.
Counseling to promote informed choices and adaptation to the risk or condition.

GROUP ASSIGNMENT

1. In groups of three, each person chooses two disorders from Common Chromosomal
Abnormalities and Neurocutaneous Disorders. Group members take turns presenting
synopses of the disorders, including pathophysiology, therapeutic management, nursing
assessment, and nursing management for discussion.
NEUROFIBROMATOSIS (Ricci, 2013)
are neurocutaneous genetic disorders of the nervous system that primarily affect the
development and growth of neural cell tissues. There are distinct types:
neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis
Neurofibromatosis 1 is the more common type and is discussed here
This disorder causes tumors to grow on nerves and produce other abnormalities
such as skin changes and bone deformities. Although many affected persons inherit
the disorder, nearly half of the cases are due to a new mutation
The inheritance pattern is autosomal dominant; therefore, offspring of affected
individuals have a 50% chance of inheriting the altered gene and presenting with
symptoms
Neurofibromatoses are due to a mutation of the neurofibromin gene on
chromosome 17.
The estimated prevalence is 1 in 2,500 to 3,000 live births
There is no cure for neurofibromatosis. Therapeutic management is aimed at
controlling symptoms and managing complications. Surgical intervention can help
reduce some of the bone malformations and remove painful or disfiguring tumors.
These children should have a yearly physical, including blood pressure and
cardiovascular examination, scoliosis screening, ophthalmology examination,
developmental screening, and a neurologic examination.
Nursing Assessment: On assessment the nurse may find caf-au-lait spots (light-
brown macules), which are the hallmark of neurofibromatosis. These are usually
present at birth but can appear during the first year of life and usually increase in
size, number, and pigmentation. They are present all over the body, particularly the
trunk and extremities, while usually sparing the face. Pigmented nevi, axillary
freckling, and slow-growing cutaneous, subcutaneous, or dermal neurofibromas,
which are benign tumors, are other signs of neurofibromatosis. Many children with
neurofibromatosis have larger than normal head circumference and are shorter than
average. Enough features are usually present by 10 years of age to make a diagnosis
(National Institute of Neurological Disorders and Stroke, 2010). The severity of
 symptoms varies greatly, but the diagnosis is made if two or more of the clinical
signs are present
Nursing management will be mainly supportive. Early detection of treatable
conditions and complications is a priority. Provide support and education to the
child and family. Discuss genetic counseling with the family. Referral to
appropriate resources is essential

FRAGILE X SYNDROME (Ricci, 2013)

the most common inherited cause of intellectual disability
It is the outcome of a mutation of a gene (FMR1 [fragile X mental retardation]) on
the X chromosome. This mutation essentially turns off the gene, triggering fragile
X syndrome.
The inheritance of fragile X is complex and is less straightforward than single-gene
or mendelian inheritance. Some carrier females are affected, and not all males with
the gene abnormality show symptoms. Males and females are both fertile and can
transmit the disorder to their offspring, so genetic counseling is appropriate. The
prognosis for individuals with fragile X is good, and they tend to live a normal life
span.
There is no cure for fragile X syndrome. Therapeutic management will be
multidisciplinary and aimed at interventions to improve cognitive, emotional, and
behavioral impairments.
Nursing Assessment: During childhood, clinical manifestations are subtle, with
minor dysmorphic features and developmental delay. Problems with sensation,
emotion, and behavior often are the first signs. A delay in attaining developmental
milestones will most likely be the first clue found on assessment. Intellectual
impairment can range from subtle learning disabilities to severe intellectual
disability and autistic-like behaviors. In adolescence, boys tend to present with
characteristic features such as an elongated face; prominent jaw; large, protruding
ears; large size; macroorchidism (large testes); and a range of behavioral
abnormalities and cognitive deficits (Fig. 51.7). There is a characteristic pattern to
the cognitive deficits, with problems in abstract reasoning, sequential processing,
 and mathematics. Typical behavior problems include attention deficits, hand
flapping and biting, hyperactivity, shyness, social isolation, low self-esteem, and
gaze aversion. In females the clinical manifestations are similar but are more varied
and often present in a milder form.
Nursing Management: will be mainly supportive. Early diagnosis and intervention
with developmental therapies and an individualized education plan are ideal. Care
of these children will be the same as care of other children with intellectual
disability. Provide education and support to the family. The National Fragile X
Foundation provides education and emotional support and works to increase
awareness and advance research for fragile X.

2. In groups of three, each person chooses a different disorder from the chapter and
formulates a nursing plan of care to discuss with the group.
NURSING CARE PLAN FOR DOWN SYNDROME (Ricci, 2013)
Nursing Diagnosis: Risk for delayed growth and development related to physical
disability, cognitive deficits, activity restrictions secondary to genetic disorder
Outcome Identification and Evaluation: Child will demonstrate developmental
milestones within age parameters and limits of disease.
Nursing Interventions: Promoting growth and development
Screen for developmental capabilities to determine childs current level of
functioning
Offer age-appropriate toys, play, and activities (including gross motor) to
encourage further development.
Perform exercises or interventions as prescribed by physical or occupational
therapist: these activities promote function and developmental skills.
Provide support to families: due to immobility and extremity deficits, the
childs progress toward developmental milestones may be slow.
Use therapeutic play and adaptive toys to facilitate developmental
functioning.
Provide stimulating environment when possible to maximize potential for
growth and development.
 Praise accomplishments and emphasize childs abilities to improve self-
esteem and encourage feeling of confidence and competence.
Monitor height and weight and plot on growth chart to identify growth
patterns and deviations in these patterns.

ASSIGNMENTS, CHAPTER 52: NURSING CARE OF THE CHILD WITH A

COGNITIVE OR MENTAL HEALTH DISORDER

WRITTEN ASSIGNMENT

1. What are the primary nursing implications for psychostimulant medications (e.g.,
methylphenidate, dextroamphetamine) prescribed for attention-deficit/hyperactivity
disorder?
PRIMARY NURSING IMPLICATIONS FOR PSYCHOSTIMULANTS (Ricci,
2013)
Methylphenidate has a short half-life; give TID (a.m., midday at school, at home
after school).
Long-acting preparations are given once daily in the a.m.
Adverse effects: decreased appetite, headache, abdominal pain, difficulty sleeping,
irritability, social withdrawal, motor tics.
If dose is too high, child may have flat affect.
Vyvanseif chest pain and fainting occur notify physician at once.
Pemoline is only rarely used because of hepatotoxicity.

2. Define sensory integration dysfunction.

According Ricci (2013), sensory integration dysfunction is a neurologic disorder
where a child has a difficulty or totally cannot organize sensory inputs that are used in daily
living activities. Hypersensitivity or hyposensitivity to the sensory input can result the child
to have a decreased ability to participate in the world as a result of overreaction to different
textures in the environment that is hard for them to process and integrate. Infants that are
born prematurely or small for gestational age has increased risk of acquiring this condition
compared to normal infants. However, childs ability to function can be increased through
occupational and other therapies.
 3. How do untreated mental health alterations in the early years manifest during the
adolescent years?
Mental health alterations are now on the rise due to increasing cases of mental
health disorders. It affects all ages and everyone can be at risk. In a developing child, there
are lots of sources of stress due to the changes and adaptation the child undergoes through
adulthood. There are family and school issues as well as sexual relationship. Due to this
stress, they may develop mental dysfunction. If left untreated, they can regress to earlier
patterns of behavior when they feel safe and secured. It is a form of defense mechanism
and is called regression. This regressive behaviors will continue if the mental health issue
is not addresses. As the child grows to its adolescent years, the regressive behavior will
decrease the child to function and is less capable in achieving skills and abilities in the later
life (Ricci, 2013)

GROUP ASSIGNMENT

1. In groups of four, each person chooses a common nursing diagnosis associated with
mental health disorders. Each person should then question the other members of the
group about the key considerations for developing an individualized nursing care plan
for the child with the selected diagnosis.

REFERENCE

Ricci, S. S. (2013). Chapter 52 Nursing Care of the Child With a Cognitive or Mental Health
Disorde. Maternity and Pediatric Nursing (2nd ed.) (pp. 1889 1898). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.

ASSIGNMENTS, CHAPTER 53: NURSING CARE DURING A PEDIATRIC

EMERGENCY

WRITTEN ASSIGNMENT

1. Create a checklist that identifies the steps for assisting with tracheal intubation.
ASSISTING WITH TRACHEAL INTUBATION (Ricci, 2013)
 1. Prepare equipment and supplies.
2. Draw up medications (for rapid sequence intubation)
3. Turn up the volume on the cardiac monitor so that members of the team can easily hear
the audible QRS indication of the childs heart rate and note any bradycardia with the
procedure.
4. Turn on the suction. Make sure that suction is working by placing your hand over the
tubing before you attach the suction catheter.
5. Continue to ventilate the child with the bagvalve-mask (BVM) and 100% oxygen as the
team prepares to intubate the child.
6. When there is no suspected cervical spine injury, in the child older than age 2 years,
place a small pillow under the childs head to facilitate opening of the airway; this step
is unnecessary in children younger than age 2 due to the prominence of their occiput.
7. When assisting with the intubation, stand beside the childs head and prepare to assist
with suctioning of oral secretions, providing BVM ventilation as needed, and assisting
with securing the tube with tape.
8. Before the initial intubation attempt and after each subsequent attempt to intubate,
provide several inhalations of 100% oxygen via the BVM ventilation method (optimally
for a few minutes).
9. Administer premedication and medications for sedation.
10. Administer paralyzing medication.
11. Observe as the health care professional who is intubating the child follows the
recommended procedure for intubation using the laryngoscope to visualize the vocal
cords.

2. Describe the proper single-rescuer procedure for ventilating a child with a bag-valve-
mask (BVM).

As stated by Ricci (2013),

The proper procedure involves appropriate opening of the airway followed by
providing breaths with the BVM. Ventilation with the BVM may be performed with either
one or two rescuers. First, choose an appropriate sized bag and a corresponding face mask
that fits the infant or child. Self-inflating bags are usually available in neonatal, infant,
 child, and adult sizes. Corresponding masks are available. Choose a face mask that
properly fits the childs face and that provides a seal over the nose and mouth and excludes
the eyes, thus preventing any pressure on the eyes. Connect the BVM via the tubing to
the oxygen source and turn on the oxygen. When resuscitating infants and children, set
the flow rate at approximately 10 L/minute. For an adolescent who is adult sized, set the
flow rate at 15 L/minute or higher to compensate for the larger-volume bag. Check to
make sure that the oxygen is flowing through the tubing to the bag. Self-inflating bags do
not provide free-flow oxygen out of the face mask; manual pumping of the bag is
necessary. However, the bags have a corrugated plastic tail that allows oxygen to freely
flow. Therefore, check over the tail for oxygen flow through the bag.After opening the
airway appropriately place the mask over the childs face. When one rescuer is providing
ventilation (commonly referred to as bagging), the person must provide a seal with the
mask over the childs face with one hand and use the other hand to manipulate the
resuscitator bag. The hand used to provide the mask seal will simultaneously maintain the
airway in an open position. Generally, use the left thumb and index finger to hold the
mask on the childs face. While maintaining a good seal with the mask, use upward
pressure on the jaw angle while pressing downward on the mask below the childs mouth
to keep the mouth open . Take care not to put pressure on the neck with the fourth and
fifth fingers. If adequate personnel are available, a more desirable situation involves one
person standing behind the childs head to maintain an open airway and to provide a seal
of the mask over the face with a hand on each side (usually the thumbs and second
fingers). A second rescuer stands on one side of the child and compresses the bag to
ventilate the child using both hands. If the child is more difficult to ventilate, the two-
rescuer method allows the ventilating nurse to provide better ventilation than with the
one-rescuer method. In addition, the two-rescuer method ensures the best possible mask
seal, as the rescuer holding the mask can use both hands to maintain the seal. (Ricci, 2013)

3. Write an essay that explains the 3 steps for rapid cardiopulmonary assessment.

The ABC are the 3 steps for rapid cardiopulmonary assessment. It stands for
Airway, breathing, and circulation. (Ricci, 2013) In an emergency setting, such as cardiac
arrest, it is required to follow this steps in order. This will improve the chances of the
survival of the client
Airway. Air is important, it is an absolute must to maintain life. However, no matter
how abundant the air is, if the client is unable to breathe it in, it will be useless. Therefore,
it is the first step of the ABC. Assess the patency of the airway and have it positioned in
the midline to align it with the body. Do not touch or even move the client if there is a
suspected spine injury. If there is no injury, reposition the client to facilitate airflow and
entry of air. It is useless when the air cannot enter the childs body. Assess for rising of
chest. If there are secretions obstructing the airway, the nurse can suction for removal. Use
a pulse oximeter to check the pulse as well as the O2 saturation level. Breathing. The nurse
should assess the respiration of the client. Ensure that the air is flowing into the respiratory
system by observing the rising of the chest. Placing your ear in the childs nose and mouth
and listen and feel if the child is breathing. If there is presence of breathing, the nurse
should check the quality of the respiration. Note if it is labored as evidenced by usage of
accessory muscles. Give the client 100% supplemental oxygen if the child is experiencing
respiratory distress. Intubation may be done if interventions failed. Circulation. Evaluate
the circulatory framework of the child. Assess for the pulse, hear rate, strength of pulse,
capillary perfusion, color, and LOC. Note signs of cyanosis such as slow capillary refill
and cold temperature. Check for difference between the central and peripheral pulse. Check
for blood pressure and utilize a cardiac monitor if available. CNS depression can also be
noted and this means that there is low cerebral perfusion rate which is detrimental to the
client. If the circulation is not established, the nurse can perform high quality chest
compression. Also, isotonic fluid resuscitation may be given. Usually a bolus of 20ml/kg
of weight of LR as a bolus. 10ml/kg is utilized for 1 month old infants. Moreover, if the
line fails to establish, intraosseous needle insertion is an option. Central access venous line
can also be established but is considered more risky and complex to do in response to the
time needed.
GROUP ASSIGNMENT

1. In groups of 3, each person chooses a pediatric emergency from those discussed in the
text and presents a summary of the nursing assessment and management, including
laboratory and diagnostic testing and medications that may be required. Then each
group presents the information to other groups in the class.

POISONING (Ricci, 2013)

Emergency care of the pediatric poisoning victim consists of rapid nursing assessment
and prompt management.
Nursing assessment of the poisoning victim focuses on a thorough health history,
followed by physical examination and laboratory and diagnostic testing.
Obtain the health history from the parents or caregiver or, in the case of an older
child or teenager, from the child.
Inquire about the approximate time of poisoning and the nature of the toxin
Was the toxin ingested, inhaled, or applied to the skin? In the case of pill ingestion,
does the caregiver have the medication bottle?
Did the child experience nausea, vomiting, anorexia, abdominal pain, or
neurologic changes such as disorientation, slurred speech, or altered gait?
Determine the progression of the symptoms.
Did the parent or caregiver call the National Poison Control Center Hotline?
Has any treatment been given?
In the case of older children and teens, inquire about any history of depression or
threatened suicide.
Ingestion of medications or chemicals may result in a wide variety of clinical
manifestations. Perform a thorough physical examination, noting alterations that
may occur with particular ingestions, such as:
o Hyper- or hypotension
o Hyper- or hypothermia
o Respiratory depression or hyperventilation
o Miosis (pupillary contraction) or mydriasis (pupillary dilatation)
 Pay particular attention to the childs mental status, skin moisture and color, and
bowel sounds
Nursing Management
When poisoning occurs, give priority to the childs ABCs
Monitor vital signs frequently and provide supportive care
Few specific antidotes are available for medications or other toxins. Ipecac is
rarely used in the health care setting to induce vomiting and is no longer
recommended for use in the home setting
Gastric lavage, administration of activated charcoal (binds with the chemical
substance in the bowel), or whole bowel irrigation with polyethylene glycol
electrolyte solutions may be used.
Occasionally, dialysis is required to lower the level of toxin in the bloodstream
The intervention is based on the source of the ingestion. For example, activated
charcoal is an effective method for preventing the absorption of many medications
but is not effective in the case of an iron overdose. Treatment of seizures and
alterations in thermoregulation may also be needed
Specific treatment of the poisoning will be determined when the toxin is identified
and poison control is queried.
Maintain ongoing assessment of the poisoned child because many toxins exhibit
very late effects

REFERENCE
Ricci, S. S. (2013). Chapter 53 Nursing Care During a Pediatric Emergency. Maternity and
Pediatric Nursing (2nd ed.) (pp. 1948 1949). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins