nu8SlnC 8uLLL1S _____________

___________________________________________________________
lnformaLlon Lo flll mlsslng gaps of memory

When sLarLlng a LherapeuLlcrelaLlonshlp wlLh a paLlenL Lhe nurseshould explaln LhaL Lhe purpose of
LheLherapy ls Lo produce a poslLlve change

A baslc assumpLlon of psychoanalyLlc Lheory ls LhaL all behavlor has meanlng

CaLharsls ls Lhe expresslon of deep feellngs and emoLlons

Accordlng Lo Lhe pleasureprlnclple Lhe psyche seeks pleasure andavolds unpleasanL
experlencesregardless of Lhe consequences

A paLlenL who has a converslondlsorder resolves a psychologlcal confllcLLhrough Lhe loss of a speclflc
physlcalfuncLlon (for example paralyslsbllndness or lnablllLy Lo swallow) 1hlsloss of funcLlon ls
lnvolunLary buLdlagnosLlc LesLs show no organlc cause

Chlordlazepoxlde (Llbrlum) ls Lhedrug of cholce for LreaLlng alcoholwlLhdrawal sympLoms

lor a paLlenL who ls aL rlsk for alcohol wlLhdrawal Lhe nurse shouldassess Lhe pulse raLe and blood
pressureevery 2 hours for Lhe flrsL 12 hours every4 hours for Lhe nexL 24 hours and every 6hours
LhereafLer (unless Lhe paLlenL'scondlLlon becomes unsLable)

Alcohol deLoxlflcaLlon ls mosLsuccessful when carrled ouL ln asLrucLured envlronmenL by a
supporLlvenon[udgmenLal sLaff

1he nurse should follow Lheseguldellnes when carlng for a paLlenL whols experlenclng alcohol
wlLhdrawalMalnLaln a calm envlronmenL keeplnLruslons Lo a mlnlmum speak slowlyand calmly ad[usL
llghLlng Lo preve

nLshadows and glare call Lhe paLlenL byname and have a frlend or famllymember sLay wlLh Lhe paLlenL
lf posslble

1he LherapeuLlc reglmen for analcohollc paLlenL lncludes follc acldLhlamlne and mulLlvlLamln
supplemenLsas well as adequaLe food and flulds

A paLlenL who ls addlcLed LooplaLes (drugs derlved from poppy seedssuch as heroln and morphlne)
Lyplcallyexperlences wlLhdrawal sympLoms wlLhln12 hours afLer Lhe lasL dose 1he mosLsevere
sympLoms occur wlLhln 48 hoursand decrease over Lhe nexL 2 weeks

8eacLlve depresslon ls a responseLo a speclflc llfe evenL

ro[ecLlon ls Lhe unconsclousasslgnlng of a LhoughL feellng or acLlonLo someone or someLhlng else

SubllmaLlon ls Lhe channellng of unaccepLable lmpulses lnLo soclallyaccepLable behavlor

8epresslon ls an unconsclousdefense mechanlsm wherebyunaccepLable or palnful LhoughLslmpulses
memorles or feellngs arepushed from Lhe consclousness or forgoLLen

Pypochondrlasls ls morbld anxleLyabouL one's healLh assoclaLed wlLhvarlous sympLoms LhaL aren'L
caused byorganlc dlsease

uenlal ls a refusal Lo acknowledgefeellngs LhoughLs deslres lmpulses or exLernal facLs LhaL are
consclouslylnLolerable

8eacLlon formaLlon ls Lheavoldance of anxleLy Lhrough behavlor and aLLlLudes LhaL are Lhe opposlLe of
repressed lmpulses and drlves

ulsplacemenL ls Lhe Lransfer of unaccepLable feellngs Lo a moreaccepLable ob[ecL

8egresslon ls a reLreaL Lo anearller developmenLal sLage

Accordlng Lo Lrlkson an older adulL (age 63 or older) ls ln LhedevelopmenLal sLage of lnLegrlLy
versusdespalr

lamlly Lherapy focuses on Lhefamlly as a whole raLher Lhan Lhelndlvldual lLs ma[or ob[ecLlve ls
LoreesLabllsh raLlonal communlcaLlonbeLween famlly members

When carlng for a paLlenL who lshosLlle or angry Lhe nurse should aLLempLLo remaln calm llsLen
lmparLlally useshorL senLences and speak ln a flrmquleL volce

8lLuallsm and negaLlvlsm areLyplcal Loddler behavlors 1hey occur durlng Lhe developmenLal sLage
ldenLlfledby Lrlkson as auLonomy versus shameand doubL

ClrcumsLanLlallLy ls a dlsLurbanceln assoclaLed LhoughL and speechpaLLerns ln whlch a paLlenL
glvesunnecessary mlnuLe deLalls anddlgresses lnLo lnapproprlaLe LhoughLs LhaLdelay communlcaLlon of
cenLral ldeas andgoal achlevemenL

ldea of reference ls an lncorrecLbellef LhaL Lhe sLaLemenLs or acLlons of oLhers are relaLed Lo oneself

Croup Lherapy provldes anopporLunlLy for each group member Loexamlne lnLeracLlons learn and
pracLlcesuccessful lnLerpersonal communlcaLlonskllls and explore emoLlonal confllcLs

korsakoff's syndrome ls bellevedLo be a chronlc form of Wernlcke'sencephalopaLhy lL's marked
byhalluclnaLlons confabulaLlon amneslaand dlsLurbances of orlenLaLlon

A paLlenL wlLh anLlsoclalpersonallLy dlsorder ofLen engages lnconfronLaLlons wlLh auLhorlLy flgures
suchas pollce parenLs and school offlclals

A paLlenL wlLh paranold personallLydlsorder exhlblLs susplclonhypervlgllance and hosLlllLy
LowardoLhers

uepresslon ls Lhe mosL commonpsychlaLrlc dlsorder

Adverse reacLlons Lo LrlcycllcanLldepressanL drugs lnclude LachycardlaorLhosLaLlc hypoLenslon
hypomanlalowered selzure Lhreshold LremorswelghL galn problems wlLh erecLlons or orgasms and
anxleLy

1he MlnnesoLa MulLlphaslcersonallLy lnvenLory conslsLs of 330sLaLemenLs for Lhe sub[ecL Lo lnLerpreL
lLassesses personallLy and deLecLsdlsorders such as depresslon andschlzophrenla ln adolescenLs and
adulLs

Crganlc braln syndrome ls LhemosL common form of menLal lllness lnelderly paLlenLs

A person who has an lC of lessLhan 20 ls profoundly reLarded and lsconsldered a LoLalcare paLlenL

8eframlng ls a LherapeuLlcLechnlque LhaL's used Lo help depressedpaLlenLs Lo vlew a slLuaLlon ln
alLernaLlveways

lluoxeLlne (rozac) serLrallne(ZolofL) and paroxeLlne (axll) areseroLonln reupLake lnhlblLors used Lo
LreaLdepresslon

1he early sLage of Alzhelmer'sdlsease lasLs 2 Lo 4 years aLlenLs havelnapproprlaLe affecL LranslenL
paranoladlsorlenLaLlon Lo Llme memory losscareless dresslng and lmpalred[udgmenL

1he mlddle sLage of Alzhelmer'sdlsease lasLs 4 Lo 7 years and ls markedby profound personallLy changes
loss of lndependence dlsorlenLaLlon confuslonlnablllLy Lo recognlze famlly members andnocLurnal
resLlessness

1he lasL sLage of Alzhelmer'sdlsease occurs durlng Lhe flnal year of llfeand ls characLerlzed by a blank
faclalexpresslon selzures loss of appeLlLeemaclaLlon lrrlLablllLy and LoLaldependence

1hreaLenlng a paLlenL wlLh anln[ecLlon for falllng Lo Lake an oral drug lsan example of assaulL

8eexamlnaLlon of llfe goals ls ama[or developmenLal Lask durlng mlddleadulLhood

AcuLe alcohol wlLhdrawal causesanorexla lnsomnla headache andresLlessness and escalaLes Lo a
syndromeLhaL's characLerlzed by aglLaLlondlsorlenLaLlon vlvld halluclnaLlons andLremors of Lhe hands
feeL legs andLongue
_____________________________________________________________________________________
______
31


nu8SlnC 8uLLL1S _____________
___________________________________________________________

ln a hosplLallzed alcohollc alcoholwlLhdrawal dellrlum mosL commonlyoccurs 3 Lo 4 days afLer
admlsslon

ConfronLaLlon ls a communlcaLlonLechnlque ln whlch Lhe nurse polnLs ouLdlscrepancles beLween Lhe
paLlenL'swords and hls nonverbal behavlors

lor a paLlenL wlLh subsLancelnduced dellrlum Lhe Llme of druglngesLlon can help Lo deLermlne wheLher
Lhe drug can be evacuaLed from Lhe body

1reaLmenL for alcohol wlLhdrawalmay lnclude admlnlsLraLlon of lv glucosefor hypoglycemla lv fluld
conLalnlngLhlamlne and oLher 8 vlLamlns andanLlanxleLy anLldlarrheal anLlconvulsanLand anLlemeLlc
drugs

1he alcohollc paLlenL recelvesLhlamlne Lo help prevenL perlpheralneuropaLhy and korsakoff's syndrome

Alcohol wlLhdrawal may preclplLaLeselzure acLlvlLy because alcohol lowersLhe selzure Lhreshold ln some
people

araphraslng ls an acLlve llsLenlngLechnlque ln whlch Lhe nurse resLaLeswhaL Lhe paLlenL has [usL sald

A paLlenL wlLh korsakoff'ssyndrome may use confabulaLlon (madeup lnformaLlon) Lo cover memory
lapsesor perlods of amnesla

eople wlLh obsesslvecompulslvedlsorder reallze LhaL Lhelr behavlor lsunreasonable buL are powerless
LoconLrol lL

When wlLnesslng psychlaLrlcpaLlenLs who are engaged ln aLhreaLenlng confronLaLlon Lhe nurseshould
flrsL separaLe Lhe Lwo lndlvlduals

aLlenLs wlLh anorexla nervosa or bullmla musL be observed durlng m

ealsand for some Llme afLerward Lo ensureLhaL Lhey don'L purge whaL Lhey haveeaLen

1ranssexuals belleve LhaL Lheywere born Lhe wrong gender and mayseek hormonal or surglcal LreaLmenL
Lochange Lhelr gender

lugue ls a dlssoclaLlve sLaLe lnwhlch a person leaves hls famlllar surroundlngs assumes a new
ldenLlLyand has amnesla abouL hls prevlousldenLlLy (lL's also descrlbed as fllghL fromhlmself")

ln a psychlaLrlc seLLlng Lhe paLlenLshould be able Lo predlcL Lhe nurse'sbehavlor and expecL conslsLenL
poslLlveaLLlLudes and approaches

When esLabllshlng a schedule for a oneLoone lnLeracLlon wlLh a paLlenLLhe nurse should sLaLe how
long LheconversaLlon wlll lasL and Lhen adhere LoLhe Llme llmlL

1houghL broadcasLlng ls a Lype of deluslon ln whlch Lhe person belleves LhaLhls LhoughLs are belng
broadcasL for Lheworld Lo hear

LlLhlum should be Laken wlLh foodA paLlenL who ls Laklng llLhlum shouldn'LresLrlcL hls sodlum lnLake

A paLlenL who ls Laklng llLhlumshould sLop Laklng Lhe drug and call hlsphyslclan lf he experlences
vomlLlngdrowslness or muscle weakness

1he paLlenL who ls Laklng amonoamlne oxldase lnhlblLor for depresslon can lnclude coLLage
cheesecream cheese yogurL and sour cream lnhls dleL

Sensory overload ls a sLaLe lnwhlch sensory sLlmulaLlon exceeds Lhelndlvldual's capaclLy Lo LoleraLe or
processlL

SympLoms of sensory overloadlnclude a feellng of dlsLress andhyperarousal wlLh lmpalred Lhlnklng
andconcenLraLlon

ln sensory deprlvaLlon overallsensory lnpuL ls decreased

A slgn of sensory deprlvaLlon ls adecrease ln sLlmulaLlon from LheenvlronmenL or from wlLhln oneself
suchas daydreamlng lnacLlvlLy sleeplngexcesslvely and remlnlsclng

1he Lhree sLages of generaladapLaLlon syndrome are alarmreslsLance and exhausLlon

A maladapLlve response Lo sLressls drlnklng alcohol or smoklngexcesslvely

PyperalerLness and Lhe sLarLlereflex are characLerlsLlcs of posLLraumaLlcsLress dlsorder

A LreaLmenL for a phobla lsdesenslLlzaLlon a process ln whlch LhepaLlenL ls slowly exposed Lo Lhe
fearedsLlmull

SympLoms of ma[or depresslvedlsorder lnclude depressed moodlnablllLy Lo experlence pleasure
sleepdlsLurbance appeLlLe changes decreasedllbldo and feellngs of worLhlessness

Cllnlcal slgns of llLhlum LoxlclLy arenausea vomlLlng and leLhargy

Asklng Loo many why" quesLlonsylelds scanL lnformaLlon and mayoverwhelm a psychlaLrlc paLlenL and
leadLo sLress and wlLhdrawal

8emoLe memory may be lmpalredln Lhe laLe sLages of demenLla

Accordlng Lo Lhe uSMlv blpolar lldlsorder ls characLerlzed by aL leasL onemanlc eplsode LhaL's
accompanled byhypomanla

1he nurse can use sllence andacLlve llsLenlng Lo promoLe lnLeracLlonswlLh a depressed paLlenL

A psychlaLrlc paLlenL wlLh asubsLance abuse problem and a ma[or psychlaLrlc dlsorder has a dual
dlagnosls

When a paLlenL ls readmlLLed Lo amenLal healLh unlL Lhe nurse shouldassess compllance wlLh
medlcaLlonorders

Alcohol poLenLlaLes Lhe effecLs of Lrlcycllc anLldepressanLs

lllghL of ldeas ls movemenL fromone Loplc Lo anoLher wlLhouL anydlscernlble connecLlon

ConducL dlsorder ls manlfesLed byexLreme behavlor such as hurLlng peopleand anlmals

uurlng Lhe Lenslonbulldlng"phase of an abuslve relaLlonshlp Lheabused lndlvldual feels helpless

ln Lhe emergency LreaLmenL of analcohollnLoxlcaLed paLlenL deLermlnlngLhe bloodalcohol level ls
paramounL lndeLermlnlng Lhe amounL of medlcaLlonLhaL Lhe paLlenL needs

Slde effecLs of Lhe anLldepressanLfluoxeLlne (rozac) lnclude dlarrheadecreased llbldo welghL loss and
drymouLh

8efore elecLroconvulslve LherapyLhe paLlenL ls glven Lhe skeleLal musclerelaxanL succlnylchollne
(AnecLlne) by lvadmlnlsLraLlon

When a psychoLlc paLlenL lsadmlLLed Lo an lnpaLlenL faclllLy Lheprlmary concern ls safeLy followed by
LheesLabllshmenL of LrusL

An effecLlve way Lo decrease Lherlsk of sulclde ls Lo make a sulcldeconLracL wlLh Lhe paLlenL for a
speclfledperlod of Llme

A depressed paLlenL should beglven sufflclenL porLlons of hls favorlLefoods buL shouldn'L be
overwhelmed wlLhLoo much food

1he nurse should assess Lhedepressed paLlenL for sulcldal ldeaLlon

ueluslonal LhoughL paLLernscommonly occur durlng Lhe manlc phaseof blpolar dlsorder

ApaLhy ls Lyplcally observed lnpaLlenLs who have schlzophrenla

ManlpulaLlve behavlor lscharacLerlsLlc of a paLlenL who haspasslve aggresslve personallLy dlsorder

When a paLlenL who hasschlzophrenla beglns Lo halluclnaLe Lhenurse should redlrecL Lhe paLlenL
LoacLlvlLles LhaL are focused on Lhe here andnow
_____________________________________________________________________________________
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32


nu8SlnC 8uLLL1S _____________
___________________________________________________________

When a paLlenL who ls recelvlngan anLlpsychoLlc drug exhlblLs musclerlgldlLy and Lremors Lhe nurse
shouldadmlnlsLer an anLlparklnsonlan drug (for example CogenLln or ArLane) as ordered

A paLlenL who ls recelvlng llLhlum(LskallLh) Lherapy should reporL dlarrheavomlLlng drowslness
muscular weakness or lack of coordlnaLlon Lo Lhephyslclan lmmedlaLely

1he LherapeuLlc serum level of llLhlum (LskallLh) for malnLenance ls 06 Lo12 mLq/L

Cbsesslvecompulslve dlsorder lsan anxleLyrelaLed dlsorder

AlAnon ls a selfhelp group for famllles of alcohollcs

uesenslLlzaLlon ls a LreaLmenL for phobla or lrraLlonal fear

AfLer elecLroconvulslve LherapyLhe paLlenL ls placed ln Lhe laLeral poslLlonwlLh Lhe head Lurned Lo one
slde

A deluslon ls a flxed false bellef

Clvlng away personal possesslonsls a slgn of sulcldal ldeaLlon CLher slgnslnclude wrlLlng a sulclde noLe
or LalklngabouL sulclde

Agoraphobla ls fear of openspaces

A person who has paranoldpersonallLy dlsorder pro[ecLs hosLlllLlesonLo oLhers

1o assess a paLlenL's [udgmenLLhe nurse should ask Lhe paLlenL whaL hewould do lf he found a
sLampedaddressed envelope An approprlaLeresponse ls LhaL he would mall Lheenvelope

AfLer elecLroconvulslve

LherapyLhe paLlenL should be monlLored for posLshock amnesla

A moLher who conLlnues Loperform cardlopulmonary resusclLaLlonafLer a physlclan pronounces a chlld
deadls showlng denlal

1ransvesLlsm ls a deslre Lo wear cloLhes usually worn by members of LheopposlLe sex

1ardlve dysklnesla causesexcesslve bllnklng and unusualmovemenL of Lhe Longue and
lnvolunLarysucklng and chewlng

1rlhexyphenldyl (ArLane) andbenzLroplne (CogenLln) are admlnlsLeredLo counLeracL exLrapyramldal
adverseeffecLs

1o prevenL hyperLenslve crlsls apaLlenL who ls Laklng a monoamlneoxldase lnhlblLor should avold
consumlngaged cheese caffelne beer yeasLchocolaLe llver processed foods andmonosodlum
gluLamaLe

LxLrapyramldal sympLoms lncludeparklnsonlsm dysLonla akaLhlsla (anLs lnLhe panLs") and Lardlve
dysklnesla

Cne Lheory LhaL supporLs Lhe useof elecLroconvulslve Lherapy suggesLs LhaLlL reseLs" Lhe braln clrculLs
Lo allownormal funcLlon

A paLlenL who has obsesslvecompulslve dlsorder usually recognlzesLhe senselessness of hls behavlor
buL lspowerless Lo sLop lL (egodysLonla)

ln helplng a paLlenL who has beenabused physlcal safeLy ls Lhe nurse's flrsLprlorlLy

emollne (CylerL) ls used Lo LreaLaLLenLlon deflclL hyperacLlvlLy dlsorder (AuPu)

Clozaplne (Clozarll) lsconLralndlcaLed ln pregnanL women and lnpaLlenLs who have
severegranulocyLopenla or severe cenLralnervous sysLem depresslon

8epresslon an unconsclousprocess ls Lhe lnablllLy Lo recall palnful or unpleasanL LhoughLs or feellngs

ro[ecLlon ls shlfLlng of unwanLedcharacLerlsLlcs or shorLcomlngs Lo oLhers(scapegoaL)

Pypnosls ls used Lo LreaLpsychogenlc amnesla

ulsulflram (AnLabuse) lsadmlnlsLered orally as an averslonLherapy Lo LreaL alcohollsm

lngesLlon of alcohol by a paLlenLwho ls Laklng dlsulflram (AnLabuse) cancause severe reacLlons lncludlng
nauseaand vomlLlng and may endanger LhepaLlenL's llfe

lmproved concenLraLlon ls a slgnLhaL llLhlum ls Laklng effecL

8ehavlor modlflcaLlon lncludlngLlmeouLs Loken economy or a rewardsysLem ls a LreaLmenL for
aLLenLlon deflclLhyperacLlvlLy dlsorder

lor a paLlenL who has anorexlanervosa Lhe nurse should provldesupporL aL mealLlme and record
LheamounL Lhe paLlenL eaLs

A slgnlflcanL Loxlc rlsk assoclaLedwlLh clozaplne (Clozarll) admlnlsLraLlon lsblood dyscrasla

Adverse effecLs of haloperldol(Paldol) admlnlsLraLlon lncludedrowslness lnsomnla weaknessheadache
and exLrapyramldal sympLomssuch as akaLhlsla Lardlve dysklnesla anddysLonla

Pypervlgllance and de[ vu areslgns of posLLraumaLlc sLress dlsorder (1Su)

A chlld who shows dlssoclaLlonhas probably been abused

ConfabulaLlon ls Lhe use of fanLasyLo flll ln gaps of memory
_____________________________________________________________________________________
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33


varlcose avold crosslng legs knees and ankle genLle massage on affecLed area elasLlc bandage
conLacL physlclan lf soreness
redness or warmLh develops ln
Lhe velns (llfe LhreaLenlng can
cause embollsm)
Skln lLches use of loLlon on areas of dryness Ldema on laLe pregnancy
pressure of an enlarged uLerus
on pelvlc velns
Lower dally lnLake of salL 3g/day Also elevaLe legs and feeL for shorL perlods durlng Lhe day uyspnea ls
ofLen normal durlng Lhlrd LrlmesLer urlnary frequency durlng laLe ln
pregnancy enlarglng uLerus ls
causlng pressure on Lhe
bladder 2nd monLh less frequency
because uLerus rlses lnLo Lhe
abdomlnal cavlLy
8ackache /pelvlc rock wear low heeled shoes
nausea / PeaL3burn sff
Calclum Labs for leg cramps
leLal alcohol syndrome [olnL and
llmb abnormallLles mlcrocephaly abn cns newborns of moLhers addlcLed Lo narcoLlc such as heroln
suffer wlLhdrawal sx Smoklng newborn ls smaller CS Apply gel before feLal Lransducer Lo lmprove
conducLlon of sound CaLheLer keep bladder empLy durlng Lhe procedure CS dellvery care ls mosL
llkely of LhaL who undergone abdomlnal surgery Shock hypo LachyLachy lnC lC hyper bradybrady
aLlenL conLrolled analgesla
devlce glves a larger Lhan
normal dose of Lhe drug Lo
provlde lnsLanL paln rellef
osLop abdomlnal dlsLenLlon ambulaLlon MulLlgravlda pasL bables came
fasLwhen shouLs 1PA 8A8? lS
CCMlnC! provlde lmmedlaLely
a clean fleld for dellvery lL head conLlnues Lo crown allow
head Lo emerge slowly and
dellver lL beLween conLracLlon
nLvL8 push back flrmly on Lhe
head nLvL8 place pressure on
Lhe vaglnal meaLus nLvL8 leL
Lhe legs close nLvL8 sllde
flnger lnLo Lhe vaglna and
dellvers Lhe head durlng
conLracLlons MosL common feLal compllcaLlon ln elecLlve cs premaLurlLy Ma[or lndlcaLlon
dlsproporLlonaLe ls Lhe feLal
head Lo blrLhlng canal
Care for Lhe young famlly Crede's prophylaxls prevenL opLhalmla neonaLorum sllver nlLraLe 1 sol'n
penlclllln eryLhromycln (occurs ln conLacL wlLh gonoccocus) lnapproprlaLe agenL mycosLaLln (fungus)
uon'L rlnse eyes afLer lnsLlllaLlon
AdmlnlsLer wlLhln 2 hrs afLer blrLh
vlLamln k anLlhemorrhaglc
anLerlor/laLeral Lhlgh lM belng
admlnlsLered because of
lacklng bacLerlal flora ln colon
8ecLal Lemp check for paLency (Lhese days noL belng pracLlced) l 32 / 18
C x 18 + 32
8egurglLaLlon of small amounL of
mucus sucLlons and conslders lL normal Pexacholorophene soap can
cause neurologlc damage
Peallng of cord sLump 7Lh day
lnlLlal ax lncludes px
appearance neurologlc
reflexes gesLaLlonal age
8ablnskl sLroklng fooL from heal Lo Loe Moro provldlng sudden change ln equlllbrlum lanLar
lnfanL's feeL Lo Louch surface 1onlc neck reflex flexlon of lefL arm and leg and exLenslon
of Lhe rlghL arm and leg when
Lhe head ls Lurned Loward Lhe
rlghL Moro reflex absenL and dlmlnlshed wlLhln flrsL 24 hrs normal due Lo Lemporary varlaLlon ln CnS
condlLlons SLerlle waLer for flrsL feedlng lf
lL was asplraLed due Lo Cl
anomaly sLerlle waLer ls less
lrrlLaLlng Lo Lhe lungs
lnLercosLal reLracLlons abnormal ComforLable poslLlon ln
breasLfeedlng Lhe baby lylng
on your slde
Sore nlpples expose nlpples Lo alr afLer feedlng 1o break sucLlon of Lhe baby place flnger ln Lhe
corner of Lhe mouLh 1o alerL baby Lo grab and hold brush Lhe nlpple agalnsL Lhe mouLh 1o make nlpple
more promlnenL hold lL b/w 2 flngers hyslologlc welghL loss 310 of lLs welghL regnanL moLher
addlLlonal 300 kcal LacLaLlng moLher addlLlonal 300 kcal MaLuraLlonal crlsls dlsequlllbrlum relaLed Lo
anLlclpaLed developmenLal Lask 8e dlrecLlve and offer cllenL speclflc guldellnes for reduclng sLress Mllk
producLlon prolacLln A1
LeL down of mllk oxyLocln
ln 3rd Lrlm where maLernal
anLlbodles are Lransferred Lo Lhe feLus lgC mosL abundanL 80 crosses placenLa
lgA 13
lgM largesL macrophage obese
member lgA colosLrums 8lack and sLlcky sLool meconlum sLool normal 8rlck dusL normal plnklsh
brlck colored powder sLaln sLool CpponenL of clrcumclslon penlle
ulceraLlon and meaLal sLenosls
roponenL of lL physlcal hyglene
Cord care wlpe wlLh alcohol on
and around lL a couple Llmes a
day when lL falls off l can puL
Lhe baby down ln baLh waLer
ku for lnherlLed cause of menLal reLardaLlon early dx 8aby 3 day old (+) [aundlce physlologlc
lnablllLy Lo con[ugaLe lndlrecL blllrubln normal ln 2nd Lo 3rd day dlsappears ln 4Lh or 3Lh day
aLhologlc 1sL 24 hrs
reLerm born before 38Lh week
reLerm posLerm sga and lga
all prone Lo hypoglycemla SCA 13 lnches head (133) 11
lnches chesL (13) 21 and half
lnches lengLh 6 and half lbs
(7) skln dry desquamaLlon
loose folds abdomen appears
sunken reLerm and sga hlghesL rlsk for morLallLy reLerm 30 weeks Lhlck layer of
vernlx no palpable breasL
Llssue sofL plnna folded
smooLh soles wlLhouL creases
lanugo enLlrely promlnenL
cllLorls wldely separaLed labla
no arm recoll
PypoLhermla (lmmaLure cns
regulaLory mechanlsm LlghLly
flexed poslLlon decreased
sLores of brown faL and
glycogen) Cold sLress compromlsed heaL producLlon ablllLy due Lo decreased brown faL sLorage
Pumldlfled C2 ls warmed Lo prevenL cold sLress CLher problem LhaL may occur wlLh cold sLress
lncreased meLabollc raLe 8rown faL abundanL vascular and nerve supply 8espl dlsLress head sllghLly
elevaLed and neck sllghLy
hyperexLended Lo open alrway
due Lo decreased surfacLanL Alveolar collapse leads Lo respl acldosls and meLabs alkalosls 8eLrolenLal
flbrolpasla
admlnlsLer C2 aL 40
concenLraLlon or less
uexLroslx deLecLs presence of hypoglycemla 8aLlonale an luM (lnfanL of
dlabeLlc moLher) has
hyperlnsullnemla and
decreased gluconeogenesls
rone also Lo polycyLhemla lncreased 88C Safe rule of Lhumb offer 2 Lo 4 cc Lhe flrsL 24 hrs Lhen
lncrease 1 cc every oLher feedlng Lo a max of 10 cc 1ube meas'L ear Lo Lhe nose/mouLh Lo Lhe xyphold
process LubrlcaLe wlLh sLerlle waLer nC1 waLer based lubrlcanL nor peLrolaLum 13 cc ls ordered 3 cc ls
asplraLed
13 3 10 cc ls Lo be Laken
Common cause of sepsls group
8 beLa sLrepLococcus and gram
negaLlve organlsm Asphyxla lnc CC2 ph under 733 and dec o2 level Coombs LesL
88C dlrecL
lasma lndlrecL
MoLher 8h () and Lype A
8aby 8h (+) and Lype C
baby has [aundlce due Lo 8h
lncompaLlblllLy MoLher 8h negaLlve
8aby 8h poslLlve
rhogam ls ordered 72 hrs afLer
dellvery Lo prevenL maLernal anLlbody formaLlon Sepsls Larly slgn fever LaLe slgns hyperacLlvlLy poor
feedlng Lachypnea (+) hcg ln Lhe urlne 10 days afLer Lhe mlssed perlod CounLlng back s monLhs from Lhe
flrsL day of lasL normal
mensLrual perlod and aadlng 7
days vu8L and 8ubella LlLer deLecLs syphllls and german measles Albumln and glucose LesL
deLecLs kldney lnfecLlon
preeclampsla and dlabeLes
Sudden vaglnal dlscharge and faclal swelllng SPCuLu be reporLed Mood changes (amblvalence
moodswlngs self focused) nuLrlLlon 46 servlngs of meaL 3 6 of frulLs and vegeLables 4 of cereals 4 of
mllk nC lA1S Anu SlMLL CPC lncreased vlL c broccoll baked poLaLo canLaloupe green peppers 3Lh
monLh fundal helghL aL Lhe umblllcus lP1 feLal mov'L lrrlLaLlng vaglnal dlscharge Lrlchomonas or
candlda alblcans PearLburn / yrosls burnlng
sensaLlon ln esophageal area
LhaL radlaLes upward freq
burplng of small amounL of
sour LasLlng llquld avold
greasy foods and reachlng for
lLems by bendlng aL Lhe knees
Lo relleve use of nonsodlum
anLaclds (mllk of Magnesla)
and slps of mllk or hoL Lea
revenLlng leg cramps aL nlghL decreaslng mllk lnLake and lncreaslng calclum lacLaLe lerLlllzaLlon
falloplan Lube Slngle ferLlle e[aculaLlon 3 Lo 4 mllllon 33 cc 1 Lsp MlLosls cell dlvlslon same number
and paLLern of chromosomes ZygoLe unlon of male and
female gameLe 2 weeks
Cellular change (morula Lo
blasLocysL Lo LrophoblasL)
Lmbryo 2 weeks 2 monLhs organ developmenL leLus 2 monLhs dellvery CompleLlon of
ferLlllzaLlon 7 Lo 9 days Lmbedded ovum ls surrounded by declduas basalls and capsularls lacenLa's
prlmary purpose
meLabollc exchange b/w
maLernal and feLal
8ody flexed feLal hearL beaL
neural Lube closed llver
consplcuous 4 weeks
ulglLs well formed osslflcaLlon some movemenL 8 weeks Scalp halr nalls kldney secreLes urlne sex
deLermlnaLlon meconlum 16 weeks (4mos) vernlx lanugo LeeLh enamel and
denLln feLal movemenL felL by
moLher (qulckenlng) 20
weeks (3 mos)
SurfacLanL puplls reacLlng Lo llghL eyebrows and eyelashes 28 weeks (7 mos) leLal clrculaLlon hlgh
vascular reslsLance uucLus arLerlosus shunLs blood
from pulmonary arLery Lo Lhe
descendlng aorLa
becomes llgamenLum arLerlosum umblllcal veln carrles arLerlal blood from Lhe placenLa Lo Lhe feLus
1wlns gravlda 1 MosL llkely Lo have Lwlns eldesL among opLlons and mulLlgravlda MosL llkely Lo have
down syndrome CeneLlc dx and counsellng 3 monLhs or 12Lh week 8heumaLlc hearL dlsease
Class 1 no llmlLaLlon
Class 2 sllghL
Class 3 moderaLe
Class 4 unable Lo carry on
acLlvlLy Ma[or compllcaLlon lncreased
blood volume and poLenLlal
congesLlve hearL fallure feLal
hypoxla and/or deaLh
lf dellvered normally should be
carefully monlLored because
hlgh rlsk for posLparLal
hemorrhage Cardlac decompensaLlon cough dyspnea edema arrhyLhmla Class l cardlac dlsease on
penlclllln and Coumadln
prophylaxls conLlnue
pregnancy and penlclllln
change coumadln Lo heparln
Mlnlmal mornlng slckness ln dlabeLlc pregnanL keLoacldosls may occur puLLlng Lhe feLus aL rlsk
ulabeLlc conLrol self monlLorlng of dexLrosLlx
values spllL lnsulln doses use
of mlxed lnsullns lncreased
lnsulln doses as requlred
AmnlocenLesls evaluaLe leclLhln/sphlngomyelln (L/S)
raLlo lndlcaLlve of lung
maLurlLy ls 21
Serlal urlnary esLrlol lndlcaLor of near lmpendlng deaLh ls 4 mg ln 24 hrs 8hyLhm meLhod changes ln
basal body Lemp lncrease ln
progesLerone secreLlon
lalls 02' for 13 days and rlses 03 08' for 3rd day LffecLlveness of Lhls ls Lo Lake noLe of oral and
cervlcal mucus changes Condom mechanlcal blockage of sperm Spermaclde kllllng of sperm
decreaslng sperm moLlllLy chemlcal blockage Lo sperm Cral conLracepLlve suppresslon
of ovulaLlon alLeraLlon ln
endomeLrlal maLuraLlon
alLeraLlon ln cervlcal mucosa
CompllcaLlon LhromboembollLlc dlsease robable cause of lnferLlllLy lf
Lhere ls a hx of lu sLrlcLure
of falloplan Lubes
8ubln's lnferLlllLy LesL conLrolled amL of CC2 ls lnLroduced under pressure lnLo Lhe lnLrauLerlne cavlLy
Cravlda 2 ara 2 pregnanL for
Lhe 4Lh Llme and had 2 prevlous
pregnancles carrled Lo Lhe
perlod of varlablllLy 4321 0+1+2+3+4 uon'L eaL durlng labor asplraLlon SS enema cleanse Lhe large
bowel and allow more room ln
Lhe blrLh canal
lull bladder lmpedes descenL of Lhe feLus nlLrazlne Lape LesL urlne (red) Alluld (blue) oslLlve bloody
show happens wlLh lncreased ln cervlcal dllaLaLlon ushes down before one's cervlx ls fully dllaLed may
develop cervlcal edema 8reech feLal sacrum presenLaLlon lrank breech wlLh legs
exLendlng over Lhe anLerlor
surface of Lhe body
CompleLe breech slLLlng When glvlng 8n medlcaLlons for paln lL ls lmporLanL Lo assess fhL and
maLernal v/s PypervenLllaLe alkalosls Llngllng of face flngers and feeL lf moLher ls alkalosls feLus wlll
experlence acldosls and vlse versa
1o correcL alkalosls /
hypervenLllaLlon breaLhe lnLo
a paper bag
Cynecold pelvls rounded lnleL
nonpromlnenL lschlal splnes
wlde and deep sacral curve
mosL favorable Lype for
chlldbearlng Androld male promlnenL lschlal splne AnLhropold A dlameLer ls longer Lhan Lransverse
dlameLer laLypellold shallow pelvls Con[ugaLes 1rue CbsLeLrlc mosL lmporLanL ulagonal 13 cm
used Lo asses
lnleL dlsLance b/w sacral
promonLory and Lhe lower
margln of Lhe symphysls publs
8llschlal dlameLer Lransverse dlameLer of Lhe pelvlc ouLleL ALLlLude refers Lo Lhe relaLlon of
Lhe feLal parLs Lo one anoLher
or Lo Lhe posLure of Lhe feLus ln
uLero SuLure and fonLanels are greaL
dlagnosLlc value
LlghLenlng engagemenL of Lhe
presenLlng parL pressure on dlaphragm ls relleved LefL occlpuL anLerlor mosL common poslLlon 8lghL
occlpuL anLerlor verLex
presenLaLlon Loward Lhe rlghL
fronL quadranL of Lhe maLernal
pelvls resenLaLlon parL of Lhe feLus
whlch enLers pelvlc
passageway flrsL
1ransverse lle scapula
presenLlng parL due Lo
placenLa prevla small pelvls
or relaxed abdomlnal walls
Ma[or cause of perlnaLal deaLh breech presenLaLlon Lrauma susLalned dellvery lP1 b/w symphlsls and
navel cephallc lP1 above navel breech SLeps uescenL flexlon lnLernal
roLaLlon exLenslon exLernal
roLaLlon expulslon
CompleLe flexlon advanLageous
because feLus ls presenLlng Lhe
smallesL anLeroposLerlor
dlameLer of Lhe skull
1rue labor vs false labor
cervlcal dllaLaLlon and
effacemenL 2ndly regular
conLracLlons CnseL of Lrue labor regular and predlcLable conLracLlons lncreased esLrogen oxyLocln
and feLal corLlcosLerolds nC1 progesLerone Cervlcal dllaLaLlon and effacemenL are accompllshed by
uLerlne conLracLlons only 3 conLracLlons/10 mln perlod adequaLe uLerlne conLracLlllLy SLop oxyLocln lf
havlng Loo sLrong conLracLlon LaLe deceleraLlon Lurns on lefL slde Lhen calls Lhe physlclan lace Lhe
uoppler over Lhe area where Lhe lP1 are heard besL 8eLaLobeaL varlablllLy lnLerval b/w lP1 8asellne
lP8 range of lP8
obLalned b/w conLracLlons or
when Lhe pL ls noL ln labor
MaLernal fever common cause of feLal Lachycardla Saddle block anesLhesla may
use forcep dellvery because of
loss of Lhe moLher's urge Lo
bear down feLal bradycardla
and maLernal hypoLenslon
LaceraLlon 1sL perlneal skln and vaglnal mucosa 2nd + muscles and fascla
3rd +anal sphlncLer
4Lh +exposure of recLal lumen
When ln acLlve labor check perlneum flrsL When head crowns asks px Lo panL When dellverlng
placenLa asks px Lo bear down When Lhere ls no slgn of placenLal
separaLlon do noL
manlpulaLe walL furLher
When 8CM check for cord prolapse flrsL prlorlLy check Lhe lP1 When cord prolapsed prlmary ob[
ls Lo relleve pressure on Lhe umblllcal cord When pre eclamplc probable selzure 8eadlly avallable C2
and sucLlon machlne Classlc slgns of pre eclampsla
(proLelnurla welghL galn
excesslvely hyperLenslon)
redlsposlng facLors uM
MulLlple pregnancy Pmole
nC1 placenLa prevla or
abrupLlon placenLa
urug Mg SC4 sedaLlve anLlconvulsanL vasodllaLor uon'L admlnlsLer when () knee [erk reflex
llrsL slgn of recovery ls dluresls
lf complalns headache check 8
lmmedlaLely PyperacLlve u18 and paLLelar reflex pL may convulse AborLlon LermlnaLlon of pregnancy
aL any Llme before varlablllLy MosL frequenL cause of early sponL aborLlon defecL of Lhe embryo
Shlrodkar procedure for lncompeLenL cervlx CompllcaLlon of abrupLlon placenLa hypoflbrlnogenemla
Pmole dev'L normally of
placenLa rapln enlargemenL of
uLerus wlLh bleedlng
degeneraLlng vlll dlsLended
wlLh fluld ln grapellke clusLers
CelesLone lncrease feLal lung maLurlLy lf uLerus ls boggy massage unLll flrms roper Lechnlque ln
massaglng supporLlng lower porLlon whlle massaglng Lhe upper porLlon PelghL of fundus decreases
normally Z Lo lnch dally uLerus should reLurn Lo nonpregnanL sLaLe on Lhe 6Lh wk 1 and Z monLh
1emporary glycosurla and proLelnura ls normal normal esLrogen levels 310 weeks posLparLum
LxLernal cervlcal os ls oval
shaped always ldenLlfy her as
havlng borne a chlld
(+) breasL mllk decreased prolacLln lncreased fsh Mllk leL down can be achleved by
sucklng hearlng an lnfanL's cry
and seelng Lhe lnfanL
ColosLrums (+) anLlbodles and lgA 8reasLfeedlng helps moLher Lo a more rapld lnvoluLlon osLparLal
hemorrhage can lead
Lhe moLher Lo be anxlous and
resLless hypoLenslon deflned
as esLlmaLed bld loss of more
Lhan 300 cc from dellvery
Lhrough he 28Lh day
posLparLum 8eLalned placenLal fragmenLs
heavy vaglnal dlscharge (+)
cloLs boggy uLerus massage
expels more cloLs
uLerlne aLony compllcaLlon LhaL
can lead Lo moderaLe brlghL
red bleedlng fundus flrm on
palpaLlon uLerlne rupLure severe
agonlzlng paln conLracLlon
ceases shocky mlnlmal
vaglnal bleedlng no lP1
uLerlne sublnvoluLlon dragglng backache LndomeLrlLls red dlscharge
small amounL foul odor
uLerlne cramplng
arameLrlLls lnfecLlon exLendlng
Lo pelvlc connecLlve Llssue
around Lhe uLerus
elvlc LhrombophleblLls onseL ls
on 2nd week posLparLum
lnvolvlng uLerlne or ovarlan
velns wlLh chllls and hlgh fever
Sheehan's syndrome / anLerlor plLulLary necrosls posLparLal hemorrhage severe
hypovolemlc shock lncreased
breasL slze loss of publc and
axlllary halr genlLal aLrophy
amenorrhea LxLrauLerlne llfe closure of foramen ovale and ducLuc arLerlosus kldney funcLlon of baby
glomerular funcLlon ls low Moldlng feLal skull bones shlfL poslLlon Lo ease passage of Lhe baby CappuL
succedaneum swelllng of scalp Llssue 1rendelenburg Lo faclllLaLe dralnage of mucus


Cause of preeclampsla 1)ldlopaLhlc or unknown common ln prlml due Lo 1sL exposure Lo chorlonlc vllll
2)common ln mulLlple pre (Lwlns) lncrease exposure Lo chorlonlc vllll 3)common Lo mom wlLh low
socloeconomlc sLaLus due Lo decrease lnLake of CPCn nurslng care romoLe bed resL Lo decrease C2
demand faclllLaLe sodlum excreLlon waLer lmmerslon wlll cause Lo urlnaLe prevenL convulslons by
nurslng measures or selzure precauLlon
1) dlmly llL room quleL calm envlronmenL
2) mlnlmal handllng plannlng procedure
3) avold [arrlng bed
prepare Lhe followlng aL bedslde
Longue depressor
Lurnlng Lo slde done Al1L8 selzure! Cbserve only! for safely
L ensure hlgh proLeln lnLake ( 1g/kg/day) na ln moderaLlon A anLlhyperLenslve drug Pydralazlne (
Apresollne)
C convulslon prevenL Mg So4 CnS depressanL
L valuaLe physlcal parameLers for Magneslum sulfaLe
Magneslum SC4 1oxlclLy 1 8 decrease 2urlne ouLpuL decrease 38esp 12 4aLella reflex absenL
1sL slgh Mg SC4 LoxlclLyanLldoLe Ca gluconaLe 3ulabeLes MelllLus absence of lnsufflclenL lnsulln (lsleL
of Langerhans of pancreas) luncLlon of lnsulln faclllLaLes LransporL of glucose Lo cell
ux 1 hr 30grglucose Lolerance LesLC11
normal glucose 80 120 mg/dl
80 hypoclycemlc ( euglycemla) 120 hyperglycemla 3 degrees C11 of 130 mg/dL maLernal effecL
uM 1) Pypo or hyperglycemla 1sL LrlmesLer hypo 2nd 3rd Lrlm hyperglycemlc 2) lrequenL
lnfecLlon monlllasls 3) olyhydramnlos 4) uysLocladlfflculL blrLh due Lo abnormallLles ln feLus or mom
3) lnsulln requlremenL decrease ln lnsulln by 33 ln 1sL Lrl 30 lncrease lnsulln aL 2nd 3rd LrlmesLer
osL parLum decrease 23 due placenLa ouL leLal effecL
1)hyper hypoglycemla
2)macrosomla large gesLaLlonal age baby dellvered 400g or 4kg
3)preLerm blrLh Lo prevenL sLlllblrLh newborn LffecL uM 1) hyperlnsullnlsm 2) hypoglycemla normal
glucose ln newborn 43 33 mg/dL
hypoglycemlc 40 mg/dL
Peel sLlck LesL geL blood aL heel
Sx Pypoglycemla hlgh plLch shrlll cry Lremors admlnlsLer dexLrose
3)hypocalcemla 7mg
Sx
Calcemla LeLany 1rousseau slgn 33

Clve calclum gluconaLe lf decrease calclum 8ecommendaLlon
1herapeuLlc aborLlon
lfpush Lhrough wlLh pregnancy
1)anLlbloLlc Lherapy Lo prevenL sub acuLe bacLerlal endocardlLls
2)anLlcoagulanL heparln doesn'L cross placenLa
Class l ll good progress for vaglnal dellvery
Classlll lv poor prognosls for vaglnal dellvery noL CS!
nC1 llLhoLomy! Plgh semlfowlers durlng dellvery no valsalva maneuver
8eglonal anesLhesla!
Low forcep dellvery due Lo lnablllLy Lo push lL wlll shorLen 2nd sLage of labor
PearL dlsease Moms wlLh 8Pu aL chlldhood
Class l no llmlL Lo physlcal acLlvlLy
Class ll sllghL llmlLaLlon of acLlvlLy Crdlnary acLlvlLy causes faLlgue dlscomforL
8ecommendaLlon of class l ll 1) sleep 10 hrs a day 2) resL 30 mlnuLes afLer meal Class lll moderaLe
llmlLaLlon of physlcal acLlvlLy Crdlnary acLlvlLy causes dlscomforL
8ecommendaLlon
1) early hosplLallzaLlon by 7 monLhs
Class lv marked llmlLaLlon of physlcal acLlvlLy Lven aL resL Lhere ls faLlgue dlscomforL
8ecommendaLlon 1herapeuLlc aborLlon xll lnLraparLal compllcaLlons 1Cesarean uellverylndlcaLlons a
MulLlple gesLaLlon b ulabeLes c AcLlve herpes ll d Severe Loxemla e lacenLa prevla f AbrupLlo
placenLa g rolapse of Lhe cord h Cu prlmary lndlcaLlon l 8reech presenLaLlon [ 1ransverse lle
rocedure
aclasslcal verLlcal lnserLlon Cnce classlcal always classlcal
bLow segmenL blklnl llne Lype aesLheLlc use
v8AC vaglnal blrLh afLer CS lnlL81lLl1? lnablllLy Lo achleve pregnancy WlLhln a year of aLLempLlng lL
Manageable
S1L8lLl1? lrreverslble
lmpoLency lnablllLy Lo have an erecLlon
2 Lypes of lnferLlllLy 1) prlmary no pregnancy aL all
2) Secondary 1sL pregnancy no more nexL preg
LesL male 1sL
more pracLlcal less compllcaLed need sperm only sLerlle boLLle conLalner ( noL plasLlc has chem)
36
Slms Puhner LesL or posL colLal LesL rocedure sex 2 hours before LesL mom remalns suplne 13 mln
afLer e[aculaLlon
normal cervlcal mucus musL be sLreLchable 8 10 cm wlLh 13 20 sperm lf 13 low sperm counL
8esL crlLerla sperm moLlllLy for lmpoLency
lacLors low sperm counL
1)occupaLlon Lruck drlver 2) chaln smoker admlnlsLer clomld ( chomephlne clLraLe) Lo lnduce
spermaLogenesls MgL Cll1 CameLe lnLra lalloplan 1ransferfor low sperm counL lmplanL sperm ln
ampula 1) Moman ovu l aLl on no ovulaLlon uue Lo lncrease prolacLln hyperprolacLlnemla
AdmlnlsLer parlodel ( 8romocrypLlce MesylaLe)
AcLlon anLlhyper prolacLlneurla
Clve mom clomld acLlon Lo lnduce oogenesls or ovulaLlon
S/L mulLlple pregnancy
2) 1ubal Cccluslon Lubal blockage Px of lu LhaL has scarred Lubes use of luu appendlclLls (bursL)
scarrlng
dx hysLerosalphlngography used Lo deLermlne Lubal paLency wlLh use of radlopaque maLerlal
MgL lvl lnvlLroferLlllzaLlon (LesL Lube baby)
Lngland 1sL LesL Lube baby