MCN CONCEPTS

Pregnancy can be complicated by situations unique to childbearing (e.g., placental bleeding), or by long-standing conditions predating pregnancy and continuing into the childbearing process (e.g., age socioeconomic status, cardiac problems); for common discomforts of pregnancy, see Table 6.5.

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TABLE 6.5 Common Discomforts During Pregnancy

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Discomfort	Trimester	Intervention
Morning sickness	First	Eat dry carbohydrate in am; avoid fried, odorous, and greasy foods; small meals rather than large.
Fatigue	First	Rest frequently, as needed.
Urinary frequency	First, end of third	Kegel exercises, perineal pad for leakage.
Heartburn	Second, third	Small meals, bland foods, antacids if ordered.
Constipation	Second, third	Sufficient fluids, foods high in roughage, regular bowel habits. No laxatives unless ordered, including mineral oil.
Hemorrhoids	Third	Avoid constipation; promote regular bowel habits.
Varicosities	Third	Avoid crossing legs and long periods of sitting or standing; rest with feet and hips elevated; avoid elastic garters and other constrictive clothing.
Backache	Third	Use good posture and body mechanics; low-heeled shoes; exercises to strengthen back muscles.
Insomnia	Third	Conscious relaxation; supportive pillows as needed; warm shower before retiring.
Leg cramps	Third	Flex toes toward knees for relief; ensure adequate calcium in diet.
Supine hypotensive syndrome	Third	Left side-lying position.
Vaginal discharge	Second	Correct personal hygiene, refer to physician. Do not douche.
Skin changes, dryness, itching	All	Interventions are symptomatic; cool baths, lotions, oils as indicated.

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General Nursing Responsibilities

1. Teach danger signals of pregnancy early in prenatal period so that client is aware of what needs to be reported to health care provider on an immediate basis (see Table 6.6).
2. Be aware that early teaching allows the client to participate in the identification and reporting of symptoms that can indicate a problem in her pregnancy.
3. Early recognition and reporting of danger signals usually results in diminishing the risk and controlling the severity of maternal/fetal complications.
4. Interventions are specific for the individual risks.
5. Evaluation centers around whether or not the risk was controlled or eliminated, and how the maternal/fetal reaction was controlled.

1. Anne T. is hospitalized for the treatment of severe preeclampsia. Which of the following represents an unusual finding for this condition?

1. Proteinuria 3+. 2. Blood pressure 160/100. 3. Convulsions. 4. Generalized edema.

Answer Rationale:3 Convulsions are associated with an eclamptic condition. The other findings are usual for severe preeclampsia.

2.

A woman is admitted with severe preeclampsia. What type of room should the nurse select for this woman?

1. The room farthest from the nursing station. 2. The quietest room on the floor. 3. The labor suite. 4. A room next to the elevator.

Answer Rationale:2 A quiet room, in which stimuli are minimized and controlled, is essential to the nursing care of the severely preeclamptic client. Because she will need continuous monitoring, the room farthest from the nursing station is inappropriate. Additionally, this client may not need to be in the labor suite; the first goal of care is to prevent the condition from worsening.

3.

The action of hormones during pregnancy affects the body by

1. blocking the release of insulin from the pancreas. 2. preventing the liver from metabolizing glycogen. 3. raising resistance to insulin. 4. enhancing the conversion of food to glucose.

Answer Rationale:3 Hormonal influences during pregnancy cause a resistance to insulin utilization at the cellular level. It allows sufficient glucose for placental transport to the fetus, and also prevents the blood sugar in the nondiabetic client from falling to dangerous levels. In the diabetic client, it requires increases in her insulin doses. It does not affect the release of insulin. Gluconeogenesis is not altered. The conversion of food to glucose is not the problem in pregnancy; the problem is, rather, the utilization of the glucose.

Pediatric Oncology

Pediatric Oncology
STAGES OF CANCER TREATMENT

Induction Goal: to remove bulk of tumor Methods: surgery, radiation/chemotherapy, bone marrow transplant Effects: often the most intensive phase; side effects of treatment are potentially life threatening Consolidation Goal: to eliminate any remaining malignant cells Methods: often chemotherapy/radiation therapy Effects: side effects will still be evident Maintenance Goal: to keep child disease free Method: chemotherapy (this phase may last for several years) Observation Goal: to monitor the child at intervals for evidence of recurrent disease and complications of treatment Method: treatment is complete; child may continue in this stage indefinitely Late effects of treatment Impaired growth and development, usually related to radiation of growth centers CNS damage resulting in intellectual, psychologic, or neurologic sequelae Impaired pubertal development including hormonal or reproductive problems Development of secondary malignancy Psychologic problems (poor self-esteem, depression, anxiety) related to living with a life-threatening disease and complex treatment regimen Side Effects From combined effects of treatment: nausea, vomiting, diarrhea, alopecia, anemia (low RBCs), increased susceptibility to infection (low WBCs), bleeding (low platelets), stomatitis, mucositis, pain, learning problems From radiation (findings differ according to site radiated): sleepiness, reddened skin From chemotherapy: drug toxicity specific to agents used Developmental: behavior problems, avoidance of school and friends, low self-esteem or self-image Nursing Interventions Help child cope with intrusive procedures. Provide information geared to developmental level and emotional readiness. Explain what is going to happen, why it is necessary, and how it will feel. Allow child to handle and manipulate equipment. Use needle play as indicated. Allow child some control in situations (e.g., positioning, selecting injection site). Support child and parents. Maintain frequent clinical conferences to keep all informed. Always tell the truth. Acknowledge feelings and encourage child/family to express them, assure them that feelings are normal. Provide contact with another parent or an organized support group such as Candlelighters. Try to keep daily life as normal as possible. Minimize side effects of treatment. Skin breakdown Keep clean and dry; wash with warm water, no soaps or creams. Do not wash off radiation markings. Avoid exposure to sunlight. Avoid all topical agents with alcohol (perfumes and powders). Do not use electric heating pads or hot water bottles. Bone marrow suppression Decreased RBCs allow child to determine activities. provide frequent rest periods. Decreased WBCs avoid crowds, isolate from children with known communicable disease. evaluate any potential site of infection. monitor temperature elevations. Decreased platelets make environment safe. select activities that are physically safe. avoid use of salicylates. Administer transfusions as ordered. Interpret peripheral blood counts to guide specific interventions and precautions. Nausea and vomiting Administer antiemetic at least half an hour before chemotherapy; repeat as necessary. Encourage relaxation techniques. Eat light meal prior to administration of therapy. Ensure adequate oral intake or administer IV fluids as necessary. Alopecia Reduce trauma of hair loss (especially in children over age 5 years). Buy wig before hair falls out. Discuss various head coverings with boys and girls. Avoid exposing head to sunlight. Discuss feelings. Stomatitis, mucositis (see Pediatric Oncology - Bone Marrow Transplant in Unit 5). Nutrition deficits Establish baseline prior to start of treatment. Measure height and weight regularly. Provide small, frequent meals. Consult dietitian as needed. Provide high-calorie, high-protein supplements. Developmental delays Discuss limit setting, discipline. Some behavior problems might be side effects of drug therapy. Facilitate return to school as soon as able. Realize changing needs of child.

NCLEX PEDIA 3

Nephrosis (Nephrotic Syndrome)
General information

Autoimmune process leading to structural alteration of glomerular membrane that results in increased permeability to plasma proteins, particularly albumin
Course of the disease consists of exacerbations and remissions over a period of months to years
Commonly affects preschoolers, boys more often than girls

Pathophysiology
Plasma proteins enter the renal tubule and are excreted in the urine, causing proteinuria.
Protein shift causes altered oncotic pressure and lowered plasma volume.
Hypovolemia triggers release of renin and angiotensin, which stimulates increased secretion of aldosterone; aldosterone increases reabsorption of water and sodium in distal tubule.
Lowered blood pressure also stimulates release of ADH, further increasing reabsorption of water; together with a general shift of plasma into interstitial spaces, results in edema.
Prognosis is good unless edema does not respond to steroids.

Medical management

Drug therapy
Corticosteroids to resolve edema
Antibiotics for bacterial infections
Thiazide diuretics in edematous stage
Bed rest
Diet modification: high protein, low sodium

Assessment findings
Proteinuria, hypoproteinemia, hyperlipidemia
Dependent body edema
Puffiness around eyes in morning- due to circulatory congestion
Ascites
Scrotal edema
Ankle edema
Anorexia, vomiting, and diarrhea, malnutrition
Pallor, lethargy
Hepatomegaly

Nursing interventions
Provide bed rest.
Conserve energy.
Find activities for quiet play.
Provide high-protein, low-sodium diet during edema phase only.
Maintain skin integrity. Do not use Band-Aids.
Avoid IM injections (medication is not absorbed into edematous tissue).
Turn frequently.
Obtain morning urine for protein studies.
Provide scrotal support.
Monitor I&O, vital signs and weigh daily.
Administer steroids to suppress autoimmune response as ordered.
Protect from known sources of infection.

1. 2 Y.O OLD WITH NRPHROTIC SYNDROME ON REMISSION, WHAT IS THE PRESCRIBED DIET:
A.LOW SALT, LOW FAT
B.REG DIET WITH NO ADDED SALT

ANSWER: B. LOW SALT DIET IS INDICATED DURING EXACERBATIONS.