Notes
Intra-uterine
Oxygen
- To meet the fetal demands for oxygen, the pregnant mother gradually increases her normal blood flow by about one-third, peaking at about 8 months.
- Respiratory rate and cardiac output increase significantly during this period.
- Feta circulation travels from the placenta through umbilical arteries, which caries deoxygenated blood away from the fetus.
Nutrition and Fluids
- The fetus obtains nourishment from the placental circulation and by swallowing amniotic fluid.
- Nutritional needs are met when the mother eats a well-balanced diet containing sufficient calories and nutrients to meet both her needs and those of the fetus.
- Adequate folic acid, one of the B vitamins, is important in order to prevent neural tube defects
- Folic rich foods are green leafy vegetables, oranges, dried beans and suggest she take a vitamin supplement that contain folic acid.
Rest and Activity
- The fetus sleeps most of the time and develops a pattern of sleep and wakefulness that usually persist after birth.
- Fetal activity can be felt by the mother at about the fifth lunar month of pregnancy
Elimination
- Fetal feces are formed in the intestines from swallowed amniotic fluid throughout the pregnancy, but are normally not excreted until after birth.
- Urine normally is excreted into the amniotic fluid when the kidneys mature (16 to 20 weeks).
Temperature Maintenance
- Amniotic fluid usually provides a safe and comfortable temperature for the fetus.
- Significant changes in the maternal temperature can alter the temperature of the amniotic fluid and the fetus.
- Significant alter in temperature increases due to illness, hot whirlpool baths, or saunas may result in birth defects.
- In the last weeks of gestation, the fetus develops subcutaneous fatty tissue stores that will help maintain body temperature at birth.
Safety
- The body systems form during the embryonic period. As a result, the embryo is particularly vulnerable to damage from teratogen, which is anything that adversely affects normal cellular development in the embryo or fetus.
- It is important for the nurse to inquire about possible pregnancy when giving medications that are known teratogens and also ask when the woman is scheduled for tests that involve radiography (x-ray).
- Smoking, alcohol, and drugs can affect the environment for the fetus. Smoking has been associated with preterm labor, spontaneous abortion, low-birth weight infants, and sudden infant death syndrome and learning disorders.
- Fetal alcohol syndrome (FAS), a result of impaired mitochondrial development, leads to microcephaly, mental retardation, learning disorders, and other central nervous system defects.
Infants
Health Examinations
- Screening of newborns for hearing loss; follow-up at 3 months and early intervention by 6 months if appropriate
- At 2 weeks and at 2,4,6, and 12 months
Protective Measures
- Immunizations: diptheria,tetanus, acellular pertussis (DTaP), inactivated poliovirus vaccine (IVP), pneumococcal, measles-mumps-rubella (MMR), Haemophilus influenzae type B (HIB), hepatitis B (HepB), varicella and influenza vaccines as recommended
- Fluoride supplements if there is adequate water fluoridation (less than 0.7 part per million)
- Screening for tuberculosis
- Screening for phenylketonuria (PKU) and other metabolic conditions
- Prompt attention for illnesses
- Appropriate skin hygiene and clothing
Infant Safety
- Importance of supervision
- Car seat, crib, playpen, bath, and home environment safety ,measures
- Feeding measures (e.g., avoid propping bottle)
- Provide toys with no small parts or sharp edges
- Eliminate toxins in the environment (e.g., chemicals, radon, lead, mercury)
- Use smoke and carbon monoxide (CO) detectors in home
Nutrition
- Breast-feeding to age 12 months
- Breast-feeding and bottle feeding techniques
- Formula preparation
- Feeding schedule
- Introduction of solid foods
- Need for iron supplements at 4 to 6 months
Elimination
- Characteristics and frequency of stool and urine elimination
- Diarrhea and its effects
Rest/ Sleep
- Establish routine for sleep and rest patterns
Sensory Stimulation
- Touch: holding, cuddling, rocking
- Vision: colorful, moving toys
- Hearing: soothing voice tones, music, singing
- Play: toys appropriate for development
Toddlers
Health Examinations
- At 15 and 18 months and then as recommended by the primary care provider
- Dental visit starting at age of 3 or earlier
Protective Measures
- Immunizations: continuing DTaP, IPV series, pneumococcal, MMR, Haemophilus influenzae type B, hepatitis, hepatitis A, and influenza vaccines as recommended
- Screenings for tuberculosis and lead poisoning
- Fluoride supplements if there is inadequate water fluoridation (less than 0.7 part per million)
Toddler Safety
- Importance of constant supervision and teaching child to obey commands
- Home environment safety measures (e.g., lock medicine cabinet)
- Outdoor safety measures (e.g., close supervision near water)
- Appropriate toys
- Eliminate toxins in environment (e.g., pesticides, herbicides, mercury, lead, arsenic in playground materials)
- Use smoke and carbon monoxide (CO) detectors in home
Nutrition
- Importance of nutritious meals and snacks
- Teaching simple mealtime manners
- Dental care
Elimination
- Toilet training techniques
Rest/Sleep
- Dealing with sleep disturbances
Play
- Providing adequate space and variety of activities
- Toys that allow “acting on” behaviors and provide motor and sensory stimulation
Preschoolers
Health Examinations
- Every 1 to 2 years
Protective Measures
- Immunizations: continuing DTaP, IPV series, MMR, hepatitis, pneumococcal, influenza, and other immunizations as recommended
- Screenings for tuberculosis
- Vision and hearing screening
- Regular dental screenings and fluoride treatment
Preschooler Safety
- Educating child about simple safety rules (e.g., crossing the street)
- Teaching child to play safely (e.g., bicycle and playground safety)
- Educating to prevent poisoning; exposure to toxic materials
Nutrition
- Importance of nutritious meals and snacks
Elimination
- Teaching proper hygiene (e.g., washing hands after using bathroom)
Rest/ Sleep
- Dealing with sleep disturbances (e.g., night terrors, sleepwalking)
Play
- Providing times for group play activities
- Teaching child simple games that require cooperation and interaction
- Providing toys and dress-ups for role-playing
School-Age Children
Health Examinations
- Annual physical examination or as recommended
Protective Measures
- Immunizations as recommended (e.g., MMR, meningococcal, tetanus-diphtheria, adult preparation [Td])
- Screening for tuberculosis
- Periodic vision, speech, and hearing screenings
- Regular dental screenings and fluoride treatment
- Providing accurate information about sexual issues (e.g., reproduction, AIDS)
School-Age Child Safety
- Using proper equipment when participating in sports and other physical activities (e.g., helmets, pads)
- Encouraging child to take responsibility for own safety (e.g., participating in bicycle and water safety courses)
Nutrition
- Importance of child not skipping meals and eating balance diet
- Experiences with food that may lead to obesity
Elimination
- Utilizing positive approaches for elimination problems (e.g., enuresis)
Play and Social Interactions
- Providing opportunities for a variety of organized group activities
- Accepting realistic expectations of child’s abilities
- Acting as role models in acceptance of other persons who may be different
- Providing a home environment that limits TV viewing and video games and encourages completion of homework and healthy exercise
Adolescents
Health Examinations
- As recommended by the primary care provider
Protective Measures
- Immunizations as recommended, such as adult tetanus –diphtheria vaccine, MMR, pneumococcal, and hepatitis B vaccine
- Screening for tuberculosis
- Periodic vision and hearing screenings
- Regular dental assessments
- Obtaining and providing accurate information about sexual issues
Adolescent Safety
- Adolescent’s taking responsibility for using motor vehicles safely (e.g., completing a driver’s education course, wearing seat belt and helmet)
- Making certain that proper precautions are taken during all athletic activities (e.g., medical supervision, proper equipment)
- Parent’s keeping lines of communication open and being alert to signs of substance abuse and emotional disturbances in the adolescent
Nutrition and Exercise
- Importance of healthy snacks and appropriate patterns of food intake and exercise
- Factors that may lead to nutritional problems (e.g., obesity , anorexia nervosa, bulimia)
- Balancing sedentary activities with regular exercise
Social Interactions
- Encouraging and facilitating adolescent success in school
- Encouraging adolescent to establish relationships that promote discussion of feelings, concerns, and fears.
- Parents’ encouraging adolescent peer group activities that promote appropriate moral and spiritual values
- Parents’ acting as role models for appropriate social interactions
- Parents’ providing a comfortable home environment for appropriate adolescent peer group activities
- Parents’ expecting adolescents to participate in and contribute to family activities
Young Adults
Health Test and Screenings
- Routine physical examination (every 1 to 3 years for females; every 5 years for males)
- Immunizations as recommended, such as tetanus-diphtheria boosters every 0 years, meningococcal vaccine if not given in early adolescence, and hepatitis B vaccine
- Regular dental assessments (every 6 months)
- Periodic vision and hearing screenings
- Professional breast examination every 1 to 3 years
- Papanicolaou smear annually within 3 years of onset of sexual activity
- Testicular examination every year
- Screening for cardiovascular disease (e.g., cholesterol test every 5 years if results are normal; blood pressure to detect hypertension; baseline electrocardiogram at age 35)
- Tuberculosis skin test every 2 years
- Smoking: history and counseling if needed
Safety
- Motor vehicle safety reinforcement (e.g., using designated drivers when drinking, maintaining brakes and tires) and making sure the vehicle is insured from a company such as Money Expert.
- Sun protection measures
- Workplace safety measures
- Water safety reinforcement (e.g., no diving in shallow water)
Nutrition and Exercise
- Importance of adequate iron intake in diet
- Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol, and fat intake, lack of vigorous exercise)
Social Interactions
- Encouraging personal relationship that promote discussion of feelings, concerns, and fears
- Setting short-and long- term goals for work and career choices
Middle-Aged Adults
Health Test and Screening
- Physical examination (every 3 to 5 years until age 40, then annually)
- Immunizations as recommended, such as a tetanus booster every 10 years, and current recommendations for influenza vaccine.
- Regular dental assessments (e.g., every 6 months)
- Tonometry for signs of glaucoma and other eye diseases every 2 to 3 years or annually if indicated
- Breast examination annually by primary care provider
- Testicular examination annually by primary care provider
- Screenings for cardiovascular disease (e.g., blood pressure measurement; electrocardiogram and cholesterol test as directed by the primary care provider)
- Screenings for colorectal, breast, cervical, uterine, and prostate cancer
- Screening for tuberculosis every 2 years
- Smoking: history and counseling, if needed
Safety
- Motor vehicle safety reinforcement, especially when driving at night
- Workplace safety measures
- Home safety measures: keeping hallways and stairways lighted and uncluttered, using smoke detector, using nonskid mats and handrails in the bathrooms
Nutrition and Exercise
- Importance of adequate protein, calcium, and vitamin D in diet
- Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol and fat intake, lack of vigorous exercise)
- An exercise program that emphasizes skill and coordination
Social Interactions
- The possibility of a middle crisis: encourage discussion of feelings, concerns, and fears
- Providing time to expand and review previous interests
- Retirement planning (financial and possible diversional activities), with partner if appropriate
Elders
Health Test and Screening
- Total cholesterol and high density lipid protein measurement every 3 to 5 years until age 75
- Aspirin, 81 mg daily, if in high- risk group
- Diabetes mellitus screen every 3 years, if in high-risk group
- Smoking cessation
- Screening mammogram every 1 to 2 years (women)
- Clinical breast exam annually (women)
- Pap smear annually if there is a history of abnormal smears or previous hysterectomy of malignancy (United States Preventive Services Task Force, 2003)
- Older women who have regular, normal Pap smear or hysterectomy for nonmalignant causes do NOT need Pap smear beyond the age of 65
- Annual digital rectal exam
- Annual prostate-specific antigen (PSA)
- Annual fecal occult blood test (FOBT)
- Sigmoidoscopy every 5 years; colonoscopy every 10 years
- Visual acuity screen annually
- Hearing screen annually
- Depression screen periodically
- Family violence screen periodically
- Height and weight measurements annually
- Sexually transmitted disease testing, if high- risk group
- Annual flu vaccine if over 65 or in high-risk group
- Pneumococcal vaccine at 65 and every 10 years thereafter
- Td vaccine every 10 years
Safety
- Home safety measures to prevent falls, fire, burns, scalds, and electrocution
- Working smoke detectors and carbon monoxide detectors in the home
- Motor vehicle safety reinforcement, especially when driving at night
- Elder driver skills evaluation (some states require for license renewal)
- Precautions to prevent pedestrian accidents
Nutrition and Exercise
- Importance of a well-balanced diet with fewer calories to accommodate lower metabolic rate and decreased physical activity
- Importance of sufficient amounts of vitamin D and calcium to prevent osteoporosis
- Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol and fat intake, lack of exercise)
- Importance of 30 minutes of moderate physical activity daily; 20 minutes of vigorous physical activity 3 times per week
Elimination
- Importance of adequate roughage in the diet, adequate exercise, and at least six 8-once glasses of fluid daily to prevent constipation
Social Interaction
- Encouraging intellectual and recreational pursuits
- Encouraging personal relationships that promote discussion of feelings, concerns, and fears
- Assessment of risk factors for maltreatment
- Availability of social community centers and programs for seniors
Exam
[mtouchquiz 139]