neck, it should be clamped with two clamps and

➢ http://www.scribd.com/doc/23037509/Mater cut between the clamps.

nal-and-Child-Bullets-Review ➢ An Apgar score of 7 to 10 indicates no immediate
distress, 4 to 6 indicates moderate distress, and 0
➢ Maternal and child bullets review to 3 indicates severe distress.
➢ According to Kübler-Ross, the five stages of death ➢ To elicit Moro’s reflex, the nurse holds the
and dying are denial, anger, bargaining, neonate in both hands and suddenly, but gently,
depression, and acceptance. drops the neonate’s head backward. Normally, the
➢ Flight of ideas is an alteration in thought neonate abducts and extends all extremities
processes that’s characterized by skipping from bilaterally and symmetrically, forms a C shape
one topic to another, unrelated topic. with the thumb and forefinger, and first adducts
➢ La belle indifférence is the lack of concern for a and then flexes the extremities.
profound disability, such as blindness or paralysis ➢ Pregnancy-induced hypertension (preeclampsia)
that may occur in a patient who has a conversion is an increase in blood pressure of 30/15 mm Hg
disorder. over baseline or blood pressure of 140/95 mm Hg
➢ Moderate anxiety decreases a person’s ability to on two occasions at least 6 hours apart
perceive and concentrate. The person is accompanied by edema and albuminuria after 20
selectively inattentive (focuses on immediate weeks’ gestation.
concerns), and the perceptual field narrows. ➢ Positive signs of pregnancy include ultrasound
➢ A patient who has a phobic disorder uses self- evidence, fetal heart tones, and fetal movement
protective avoidance as an ego defense felt by the examiner (not usually present until 4
mechanism. months’ gestation
➢ In a patient who has anorexia nervosa, the ➢ Goodell’s sign is softening of the cervix.
highest treatment priority is correction of ➢ Quickening, a presumptive sign of pregnancy,
nutritional and electrolyte imbalances. occurs between 16 and 19 weeks’ gestation.
➢ A patient who is taking lithium must undergo ➢ Ovulation ceases during pregnancy.
regular (usually once a month) monitoring of the ➢ Any vaginal bleeding during pregnancy should be
blood lithium level because the margin between considered a complication until proven otherwise.
therapeutic and toxic levels is narrow. A normal ➢ To estimate the date of delivery using Nägele’s
laboratory value is 0.5 to 1.5 mEq/L. rule, the nurse counts backward 3 months from
➢ Early signs and symptoms of alcohol withdrawal the first day of the last menstrual period and then
include anxiety, anorexia, tremors, and insomnia. adds 7 days to this date.
They may begin up to 8 hours after the last ➢ At 12 weeks’ gestation, the fundus should be at
alcohol intake. the top of the symphysis pubis.
➢ Al-Anon is a support group for families of ➢ Cow’s milk shouldn’t be given to infants younger
alcoholics. than age 1 because it has a low linoleic acid
➢ The nurse shouldn’t administer chlorpromazine content and its protein is difficult for infants to
(Thorazine) to a patient who has ingested alcohol digest.
because it may cause oversedation and ➢ If jaundice is suspected in a neonate, the nurse
respiratory depression. should examine the infant under natural window
➢ Lithium toxicity can occur when sodium and fluid light. If natural light is unavailable, the nurse
intake are insufficient, causing lithium retention. should examine the infant under a white light.
➢ An alcoholic who achieves sobriety is called a ➢ The three phases of a uterine contraction are
recovering alcoholic because no cure for increment, acme, and decrement.
➢ The intensity of a labor contraction can be
alcoholism exists
assessed by the indentability of the uterine wall at
➢ To help a mother break the suction of her breast- the contraction’s peak. Intensity is graded as mild
feeding infant, the nurse should teach her to (uterine muscle is somewhat tense), moderate
insert a finger at the corner of the infant’s mouth. (uterine muscle is moderately tense), or strong
➢ Administering high levels of oxygen to a (uterine muscle is boardlike).
premature neonate can cause blindness as a ➢ Chloasma, the mask of pregnancy, is
result of retrolental fibroplasia. pigmentation of a circumscribed area of skin
➢ Amniotomy is artificial rupture of the amniotic (usually over the bridge of the nose and cheeks)
membranes. that occurs in some pregnant women.
➢ During pregnancy, weight gain averages 25 to 30 ➢ The gynecoid pelvis is most ideal for delivery.
lb (11 to 13.5 kg). Other types include platypelloid (flat), anthropoid
➢ Rubella has a teratogenic effect on the fetus (apelike), and android (malelike).
during the first trimester. It produces ➢ Pregnant women should be advised that there is
abnormalities in up to 40% of cases without no safe level of alcohol intake.
interrupting the pregnancy. ➢ The frequency of uterine contractions, which is
➢ Immunity to rubella can be measured by a measured in minutes, is the time from the
hemagglutination inhibition test (rubella titer). beginning of one contraction to the beginning of
This test identifies exposure to rubella infection the next.
and determines susceptibility in pregnant women. ➢ Vitamin K is administered to neonates to prevent
In a woman, a titer greater than 1:8 indicates hemorrhagic disorders because a neonate’s
immunity. intestine can’t synthesize vitamin K.
➢ When used to describe the degree of fetal descent ➢ Before internal fetal monitoring can be performed,
during labor, floating means the presenting part a pregnant patient’s cervix must be dilated at
isn’t engaged in the pelvic inlet, but is freely least 2 cm, the amniotic membranes must be
movable (ballotable) above the pelvic inlet. ruptured, and the fetus’s presenting part (scalp or
➢ When used to describe the degree of fetal buttocks) must be at station –1 or lower, so that a
descent, engagement means when the largest small electrode can be attached.
diameter of the presenting part has passed ➢ Fetal alcohol syndrome presents in the first 24
through the pelvic inlet. hours after birth and produces lethargy, seizures,
➢ Fetal station indicates the location of the poor sucking reflex, abdominal distention, and
presenting part in relation to the ischial spine. It’s respiratory difficulty.
described as –1, –2, –3, –4, or –5 to indicate the ➢ Variability is any change in the fetal heart rate
number of centimeters above the level of the (FHR) from its normal rate of 120 to 160
ischial spine; station –5 is at the pelvic inlet. beats/minute. Acceleration is increased FHR;
➢ Fetal station also is described as +1, +2, +3, +4, deceleration is decreased FHR.
or +5 to indicate the number of centimeters it is ➢ In a neonate, the symptoms of heroin withdrawal
below the level of the ischial spine; station 0 is at may begin several hours to 4 days after birth.
the level of the ischial spine. ➢ In a neonate, the symptoms of methadone
➢ During the first stage of labor, the side-lying withdrawal may begin 7 days to several weeks
position usually provides the greatest degree of after birth.
comfort, although the patient may assume any ➢ In a neonate, the cardinal signs of narcotic
comfortable position. withdrawal include coarse, flapping tremors;
➢ During delivery, if the umbilical cord can’t be
loosened and slipped from around the neonate’s
1
 sleepiness; restlessness; prolonged, persistent, ➢ A nonstress test is considered reactive (negative)
high-pitched cry; and irritability. if two or more fetal heart rate accelerations of 15
➢ The nurse should count a neonate’s respirations beats/minute above baseline occur in 20 minutes.
for 1 full minute. ➢ A nonstress test is usually performed to assess
➢ Chlorpromazine (Thorazine) is used to treat fetal well-being in a pregnant patient with a
neonates who are addicted to narcotics. prolonged pregnancy (42 weeks or more),
➢ The nurse should provide a dark, quiet diabetes, a history of poor pregnancy outcomes,
environment for a neonate who is experiencing or pregnancy-induced hypertension.
narcotic withdrawal. ➢ A pregnant woman should drink at least eight 8-oz
➢ In a premature neonate, signs of respiratory glasses (about 2,000 ml) of water daily.
distress include nostril flaring, substernal ➢ When both breasts are used for breast-feeding,
retractions, and inspiratory grunting. the infant usually doesn’t empty the second
➢ Respiratory distress syndrome (hyaline membrane breast. Therefore, the second breast should be
disease) develops in premature infants because used first at the next feeding.
their pulmonary alveoli lack surfactant. ➢ A low-birth-weight neonate weighs 2,500 g (5 lb 8
➢ Whenever an infant is being put down to sleep, oz) or less at birth.
the parent or caregiver should position the infant ➢ A very-low-birth-weight neonate weighs 1,500 g
on the back. (Remember back to sleep.) (3 lb 5 oz) or less at birth.
➢ The male sperm contributes an X or a Y ➢ When teaching parents to provide umbilical cord
chromosome; the female ovum contributes an X care, the nurse should teach them to clean the
chromosome. umbilical area with a cotton ball saturated with
➢ Fertilization produces a total of 46 chromosomes, alcohol after every diaper change to prevent
including an XY combination (male) or an XX infection and promote drying.
combination (female). ➢ Teenage mothers are more likely to have low-
➢ The percentage of water in a neonate’s body is birth-weight neonates because they seek prenatal
about 78% to 80%. care late in pregnancy (as a result of denial) and
➢ To perform nasotracheal suctioning in an infant, are more likely than older mothers to have
the nurse positions the infant with his neck nutritional deficiencies.
slightly hyperextended in a “sniffing” position, ➢ Linea nigra, a dark line that extends from the
with his chin up and his head tilted back slightly. umbilicus to the mons pubis, commonly appears
➢ Organogenesis occurs during the first trimester of during pregnancy and disappears after
pregnancy, specifically, days 14 to 56 of pregnancy.
gestation. ➢ Implantation in the uterus occurs 6 to 10 days
➢ After birth, the neonate’s umbilical cord is tied 1" after ovum fertilization.
(2.5 cm) from the abdominal wall with a cotton ➢ Placenta previa is abnormally low implantation of
cord, plastic clamp, or rubber band. the placenta so that it encroaches on or covers
➢ Gravida is the number of pregnancies a woman the cervical os.
has had, regardless of outcome. ➢ In complete (total) placenta previa, the placenta
➢ Para is the number of pregnancies that reached completely covers the cervical os.
viability, regardless of whether the fetus was ➢ In partial (incomplete or marginal) placenta
delivered alive or stillborn. A fetus is considered previa, the placenta covers only a portion of the
viable at 20 weeks’ gestation. cervical os.
➢ An ectopic pregnancy is one that implants ➢ Abruptio placentae is premature separation of a
abnormally, outside the uterus. normally implanted placenta. It may be partial or
➢ The first stage of labor begins with the onset of complete, and usually causes abdominal pain,
labor and ends with full cervical dilation at 10 cm. vaginal bleeding, and a boardlike abdomen.
➢ The second stage of labor begins with full cervical ➢ Cutis marmorata is mottling or purple
dilation and ends with the neonate’s birth. discoloration of the skin. It’s a transient
➢ The third stage of labor begins after the neonate’s vasomotor response that occurs primarily in the
birth and ends with expulsion of the placenta. arms and legs of infants who are exposed to cold.
➢ In a full-term neonate, skin creases appear over ➢ The classic triad of symptoms of preeclampsia are
two-thirds of the neonate’s feet. Preterm hypertension, edema, and proteinuria. Additional
neonates have heel creases that cover less than symptoms of severe preeclampsia include
two-thirds of the feet. hyperreflexia, cerebral and vision disturbances,
➢ The fourth stage of labor (postpartum and epigastric pain.
stabilization) lasts up to 4 hours after the placenta ➢ Ortolani’s sign (an audible click or palpable jerk
is delivered. This time is needed to stabilize the that occurs with thigh abduction) confirms
mother’s physical and emotional state after the congenital hip dislocation in a neonate.
stress of childbirth. ➢ The first immunization for a neonate is the
➢ At 20 weeks’ gestation, the fundus is at the level hepatitis B vaccine, which is administered in the
of the umbilicus. nursery shortly after birth.
➢ At 36 weeks’ gestation, the fundus is at the lower ➢ If a patient misses a menstrual period while taking
border of the rib cage. an oral contraceptive exactly as prescribed, she
➢ A premature neonate is one born before the end should continue taking the contraceptive.
of the 37th week of gestation. ➢ If a patient misses two consecutive menstrual
➢ Pregnancy-induced hypertension is a leading periods while taking an oral contraceptive, she
cause of maternal death in the United States. should discontinue the contraceptive and take a
➢ A habitual aborter is a woman who has had three pregnancy test.
or more consecutive spontaneous abortions. ➢ If a patient who is taking an oral contraceptive
➢ Threatened abortion occurs when bleeding is misses a dose, she should take the pill as soon as
present without cervical dilation. she remembers or take two at the next scheduled
➢ A complete abortion occurs when all products of interval and continue with the normal schedule.
conception are expelled. ➢ If a patient who is taking an oral contraceptive
➢ Hydramnios (polyhydramnios) is excessive misses two consecutive doses, she should double
amniotic fluid (more than 2,000 ml in the third the dose for 2 days and then resume her normal
trimester). schedule. She also should use an additional birth
➢ Stress, dehydration, and fatigue may reduce a control method for 1 week.
breast-feeding mother’s milk supply. ➢ Eclampsia is the occurrence of seizures that aren’t
➢ During the transition phase of the first stage of caused by a cerebral disorder in a patient who has
labor, the cervix is dilated 8 to 10 cm and pregnancy-induced hypertension.
contractions usually occur 2 to 3 minutes apart ➢ In placenta previa, bleeding is painless and
and last for 60 seconds. seldom fatal on the first occasion, but it becomes
➢ A nonstress test is considered nonreactive heavier with each subsequent episode.
(positive) if fewer than two fetal heart rate ➢ Treatment for abruptio placentae is usually
accelerations of at least 15 beats/minute occur in immediate cesarean delivery.
20 minutes. ➢ Drugs used to treat withdrawal symptoms in
neonates include phenobarbital (Luminal),

2
 camphorated opium tincture (paregoric), and ➢ The length of the uterus increases from 2½" (6.3
diazepam (Valium). cm) before pregnancy to 12½" (32 cm) at term.
➢ Infants with Down syndrome typically have ➢ To estimate the true conjugate (the smallest inlet
marked hypotonia, floppiness, slanted eyes, measurement of the pelvis), deduct 1.5 cm from
excess skin on the back of the neck, flattened the diagonal conjugate (usually 12 cm). A true
bridge of the nose, flat facial features, spadelike conjugate of 10.5 cm enables the fetal head
hands, short and broad feet, small male genitalia, (usually 10 cm) to pass.
absence of Moro’s reflex, and a simian crease on ➢ The smallest outlet measurement of the pelvis is
the hands. the intertuberous diameter, which is the
➢ The failure rate of a contraceptive is determined transverse diameter between the ischial
by the experience of 100 women for 1 year. It’s tuberosities.
expressed as pregnancies per 100 woman-years. ➢ Electronic fetal monitoring is used to assess fetal
➢ The narrowest diameter of the pelvic inlet is the well-being during labor. If compromised fetal
anteroposterior (diagonal conjugate). status is suspected, fetal blood pH may be
➢ The chorion is the outermost extraembryonic evaluated by obtaining a scalp sample.
membrane that gives rise to the placenta. ➢ In an emergency delivery, enough pressure
➢ The corpus luteum secretes large quantities of should be applied to the emerging fetus’s head to
progesterone. guide the descent and prevent a rapid change in
➢ From the 8th week of gestation through delivery, pressure within the molded fetal skull.
the developing cells are known as a fetus. ➢ After delivery, a multiparous woman is more
➢ In an incomplete abortion, the fetus is expelled, susceptible to bleeding than a primiparous woman
but parts of the placenta and membrane remain because her uterine muscles may be
in the uterus. overstretched and may not contract efficiently.
➢ The circumference of a neonate’s head is ➢ Neonates who are delivered by cesarean birth
normally 2 to 3 cm greater than the have a higher incidence of respiratory distress
circumference of the chest. syndrome.
➢ After administering magnesium sulfate to a ➢ The nurse should suggest ambulation to a
pregnant patient for hypertension or preterm postpartum patient who has gas pain and
labor, the nurse should monitor the respiratory flatulence.
rate and deep tendon reflexes. ➢ Massaging the uterus helps to stimulate
➢ During the first hour after birth (the period of contractions after the placenta is delivered.
reactivity), the neonate is alert and awake. ➢ When providing phototherapy to a neonate, the
➢ When a pregnant patient has undiagnosed vaginal nurse should cover the neonate’s eyes and genital
bleeding, vaginal examination should be avoided area.
until ultrasonography rules out placenta previa. ➢ The narcotic antagonist naloxone (Narcan) may
➢ After delivery, the first nursing action is to be given to a neonate to correct respiratory
establish the neonate’s airway. depression caused by narcotic administration to
➢ Nursing interventions for a patient with placenta the mother during labor.
previa include positioning the patient on her left ➢ In a neonate, symptoms of respiratory distress
side for maximum fetal perfusion, monitoring fetal syndrome include expiratory grunting or whining,
heart tones, and administering I.V. fluids and sandpaper breath sounds, and seesaw retractions.
oxygen, as ordered. ➢ Cerebral palsy presents as asymmetrical
➢ The specific gravity of a neonate’s urine is 1.003 movement, irritability, and excessive, feeble
to 1.030. A lower specific gravity suggests crying in a long, thin infant.
overhydration; a higher one suggests ➢ The nurse should assess a breech-birth neonate
dehydration. for hydrocephalus, hematomas, fractures, and
➢ The neonatal period extends from birth to day 28. other anomalies caused by birth trauma.
It’s also called the first 4 weeks or first month of ➢ When a patient is admitted to the unit in active
life. labor, the nurse’s first action is to listen for fetal
➢ A woman who is breast-feeding should rub a mild heart tones.
emollient cream or a few drops of breast milk (or ➢ In a neonate, long, brittle fingernails are a sign of
colostrum) on the nipples after each feeding. She postmaturity.
should let the breasts air-dry to prevent them ➢ Desquamation (skin peeling) is common in
from cracking. postmature neonates.
➢ Breast-feeding mothers should increase their fluid ➢ A mother should allow her infant to breast-feed
intake to 2½ to 3 qt (2,500 to 3,000 ml) daily. until the infant is satisfied. The time may vary
➢ After feeding an infant with a cleft lip or palate, from 5 to 20 minutes.
the nurse should rinse the infant’s mouth with ➢ Nitrazine paper is used to test the pH of vaginal
sterile water. discharge to determine the presence of amniotic
➢ The nurse instills erythromycin in a neonate’s fluid.
eyes primarily to prevent blindness caused by ➢ A pregnant patient normally gains 2 to 5 lb (1 to
gonorrhea or chlamydia. 2.5 kg) during the first trimester and slightly less
➢ Human immunodeficiency virus (HIV) has been than 1 lb (0.5 kg) per week during the last two
cultured in breast milk and can be transmitted by trimesters.
an HIV-positive mother who breast-feeds her ➢ Neonatal jaundice in the first 24 hours after birth
infant. is known as pathological jaundice and is a sign of
➢ A fever in the first 24 hours postpartum is most erythroblastosis fetalis.
likely caused by dehydration rather than infection. ➢ A classic difference between abruptio placentae
➢ Preterm neonates or neonates who can’t maintain and placenta previa is the degree of pain.
a skin temperature of at least 97.6° F (36.4° C) Abruptio placentae causes pain, whereas placenta
should receive care in an incubator (Isolette) or a previa causes painless bleeding.
radiant warmer. In a radiant warmer, a heat- ➢ Because a major role of the placenta is to function
sensitive probe taped to the neonate’s skin as a fetal lung, any condition that interrupts
activates the heater unit automatically to normal blood flow to or from the placenta
maintain the desired temperature. increases fetal partial pressure of arterial carbon
➢ During labor, the resting phase between dioxide and decreases fetal pH.
contractions is at least 30 seconds. ➢ Precipitate labor lasts for approximately 3 hours
➢ Lochia rubra is the vaginal discharge of almost and ends with delivery of the neonate.
pure blood that occurs during the first few days ➢ Methylergonovine (Methergine) is an oxytocic
after childbirth. agent used to prevent and treat postpartum
➢ Lochia serosa is the serous vaginal discharge that hemorrhage caused by uterine atony or
occurs 4 to 7 days after childbirth. subinvolution.
➢ Lochia alba is the vaginal discharge of decreased ➢ As emergency treatment for excessive uterine
blood and increased leukocytes that’s the final bleeding, 0.2 mg of methylergonovine
stage of lochia. It occurs 7 to 10 days after (Methergine) is injected I.V. over 1 minute while
childbirth. the patient’s blood pressure and uterine
➢ Colostrum, the precursor of milk, is the first contractions are monitored.
secretion from the breasts after delivery.

3
➢ Braxton Hicks contractions are usually felt in the ➢ A pregnant patient should take folic acid because
abdomen and don’t cause cervical change. True this nutrient is required for rapid cell division.
labor contractions are felt in the front of the ➢ A woman who is taking clomiphene (Clomid) to
abdomen and back and lead to progressive induce ovulation should be informed of the
cervical dilation and effacement possibility of multiple births with this drug.
➢ The average birth weight of neonates born to ➢ If needed, cervical suturing is usually done
mothers who smoke is 6 oz (170 g) less than that between 14 and 18 weeks’ gestation to reinforce
of neonates born to nonsmoking mothers. an incompetent cervix and maintain pregnancy.
➢ Culdoscopy is visualization of the pelvic organs The suturing is typically removed by 35 weeks’
through the posterior vaginal fornix. gestation.
➢ The nurse should teach a pregnant vegetarian to ➢ During the first trimester, a pregnant woman
obtain protein from alternative sources, such as should avoid all drugs unless doing so would
nuts, soybeans, and legumes. adversely affect her health.
➢ The nurse should instruct a pregnant patient to ➢ Most drugs that a breast-feeding mother takes
take only prescribed prenatal vitamins because appear in breast milk.
over-the-counter high-potency vitamins may harm ➢ The Food and Drug Administration has established
the fetus. the following five categories of drugs based on
➢ High-sodium foods can cause fluid retention, their potential for causing birth defects: A, no
especially in pregnant patients. evidence of risk; B, no risk found in animals, but
➢ A pregnant patient can avoid constipation and no studies have been done in women; C, animal
hemorrhoids by adding fiber to her diet. studies have shown an adverse effect, but the
➢ If a fetus has late decelerations (a sign of fetal drug may be beneficial to women despite the
hypoxia), the nurse should instruct the mother to potential risk; D, evidence of risk, but its benefits
lie on her left side and then administer 8 to 10 L may outweigh its risks; and X, fetal anomalies
of oxygen per minute by mask or cannula. The noted, and the risks clearly outweigh the potential
nurse should notify the physician. The side-lying benefits.
position removes pressure on the inferior vena ➢ A patient with a ruptured ectopic pregnancy
cava. commonly has sharp pain in the lower abdomen,
➢ Oxytocin (Pitocin) promotes lactation and uterine with spotting and cramping. She may have
contractions. abdominal rigidity; rapid, shallow respirations;
➢ Lanugo covers the fetus’s body until about 20 tachycardia; and shock.
weeks’ gestation. Then it begins to disappear ➢ A patient with a ruptured ectopic pregnancy
from the face, trunk, arms, and legs, in that order. commonly has sharp pain in the lower abdomen,
➢ In a neonate, hypoglycemia causes temperature with spotting and cramping. She may have
instability, hypotonia, jitteriness, and seizures. abdominal rigidity; rapid, shallow respirations;
Premature, postmature, small-for-gestational-age, tachycardia; and shock.
and large-for-gestational-age neonates are ➢ The mechanics of delivery are engagement,
susceptible to this disorder. descent and flexion, internal rotation, extension,
➢ Neonates typically need to consume 50 to 55 cal external rotation, restitution, and expulsion.
per pound of body weight daily. ➢ A probable sign of pregnancy, McDonald’s sign is
➢ Because oxytocin (Pitocin) stimulates powerful characterized by an ease in flexing the body of
uterine contractions during labor, it must be the uterus against the cervix.
administered under close observation to help ➢ Amenorrhea is a probable sign of pregnancy.
prevent maternal and fetal distress. ➢ A pregnant woman’s partner should avoid
➢ During fetal heart rate monitoring, variable introducing air into the vagina during oral sex
decelerations indicate compression or prolapse of because of the possibility of air embolism.
the umbilical cord. ➢ The presence of human chorionic gonadotropin in
➢ Cytomegalovirus is the leading cause of the blood or urine is a probable sign of pregnancy.
congenital viral infection. ➢ Radiography isn’t usually used in a pregnant
➢ Tocolytic therapy is indicated in premature labor, woman because it may harm the developing
but contraindicated in fetal death, fetal distress, fetus. If radiography is essential, it should be
or severe hemorrhage. performed only after 36 weeks’ gestation.
➢ Through ultrasonography, the biophysical profile ➢ A pregnant patient who has had rupture of the
assesses fetal well-being by measuring fetal membranes or who is experiencing vaginal
breathing movements, gross body movements, bleeding shouldn’t engage in sexual intercourse.
fetal tone, reactive fetal heart rate (nonstress ➢ Milia may occur as pinpoint spots over a
test), and qualitative amniotic fluid volume. neonate’s nose.
➢ A neonate whose mother has diabetes should be ➢ The duration of a contraction is timed from the
assessed for hyperinsulinism. moment that the uterine muscle begins to tense
➢ In a patient with preeclampsia, epigastric pain is a to the moment that it reaches full relaxation. It’s
late symptom and requires immediate medical measured in seconds.
intervention. ➢ The union of a male and a female gamete
➢ After a stillbirth, the mother should be allowed to produces a zygote, which divides into the
hold the neonate to help her come to terms with fertilized ovum.
the death. ➢ The first menstrual flow is called menarche and
➢ Molding is the process by which the fetal head may be anovulatory (infertile).
changes shape to facilitate movement through ➢ Spermatozoa (or their fragments) remain in the
the birth canal. vagina for 72 hours after sexual intercourse.
➢ If a woman receives a spinal block before delivery, ➢ Prolactin stimulates and sustains milk production.
the nurse should monitor the patient’s blood ➢ Strabismus is a normal finding in a neonate.
pressure closely. 5 ➢ A postpartum patient may resume sexual
➢ If a woman suddenly becomes hypotensive during intercourse after the perineal or uterine wounds
labor, the nurse should increase the infusion rate heal (usually within 4 weeks after delivery).
of I.V. fluids as prescribed. ➢ A pregnant staff member shouldn’t be assigned to
➢ The best technique for assessing jaundice in a work with a patient who has cytomegalovirus
neonate is to blanch the tip of the nose or the infection because the virus can be transmitted to
area just above the umbilicus. the fetus.
➢ During fetal heart monitoring, early deceleration ➢ Fetal demise is death of the fetus after viability.
is caused by compression of the head during ➢ Respiratory distress syndrome develops in
labor. premature neonates because their alveoli lack
➢ After the placenta is delivered, the nurse may add surfactant.
oxytocin (Pitocin) to the patient’s I.V. solution, as ➢ The most common method of inducing labor after
prescribed, to promote postpartum involution of artificial rupture of the membranes is oxytocin
the uterus and stimulate lactation. (Pitocin) infusion.
➢ Pica is a craving to eat nonfood items, such as ➢ After the amniotic membranes rupture, the initial
dirt, crayons, chalk, glue, starch, or hair. It may nursing action is to assess the fetal heart rate.
occur during pregnancy and can endanger the ➢ The most common reasons for cesarean birth are
fetus. malpresentation, fetal distress, cephalopelvic

4
 disproportion, pregnancy-induced hypertension, ➢ Kegel exercises require contraction and relaxation
previous cesarean birth, and inadequate progress of the perineal muscles. These exercises help
in labor. strengthen pelvic muscles and improve urine
➢ Amniocentesis increases the risk of spontaneous control in postpartum patients.
abortion, trauma to the fetus or placenta, ➢ Symptoms of postpartum depression range from
premature labor, infection, and Rh sensitization of mild postpartum blues to intense, suicidal,
the fetus. depressive psychosis.
➢ After amniocentesis, abdominal cramping or ➢ The preterm neonate may require gavage
spontaneous vaginal bleeding may indicate feedings because of a weak sucking reflex,
complications. uncoordinated sucking, or respiratory distress.
➢ To prevent her from developing Rh antibodies, an ➢ Acrocyanosis (blueness and coolness of the arms
Rh-negative primigravida should receive Rho(D) and legs) is normal in neonates because of their
immune globulin (RhoGAM) after delivering an Rh- immature peripheral circulatory system.
positive neonate. ➢ To prevent ophthalmia neonatorum (a severe eye
➢ If a pregnant patient’s test results are negative for infection caused by maternal gonorrhea), the
glucose but positive for acetone, the nurse should nurse may administer one of three drugs, as
assess the patient’s diet for inadequate caloric prescribed, in the neonate’s eyes: tetracycline,
intake. silver nitrate, or erythromycin.
➢ If a pregnant patient’s test results are negative for ➢ Neonatal testing for phenylketonuria is mandatory
glucose but positive for acetone, the nurse should in most states.
assess the patient’s diet for inadequate caloric ➢ The nurse should place the neonate in a 30-
intake. degree Trendelenburg position to facilitate mucus
➢ Rubella infection in a pregnant patient, especially drainage.
during the first trimester, can lead to spontaneous ➢ The nurse may suction the neonate’s nose and
abortion or stillbirth as well as fetal cardiac and mouth as needed with a bulb syringe or suction
other birth defects. trap.
➢ A pregnant patient should take an iron ➢ To prevent heat loss, the nurse should place the
supplement to help prevent anemia. neonate under a radiant warmer during suctioning
➢ Direct antiglobulin (direct Coombs’) test is used to and initial delivery-room care, and then wrap the
detect maternal antibodies attached to red blood neonate in a warmed blanket for transport to the
cells in the neonate. nursery.
➢ Nausea and vomiting during the first trimester of ➢ The umbilical cord normally has two arteries and
pregnancy are caused by rising levels of the one vein.
hormone human chorionic gonadotropin. ➢ When providing care, the nurse should expose
➢ Before discharging a patient who has had an only one part of an infant’s body at a time.
abortion, the nurse should instruct her to report ➢ Lightening is settling of the fetal head into the
bright red clots, bleeding that lasts longer than 7 brim of the pelvis.
days, or signs of infection, such as a temperature ➢ If the neonate is stable, the mother should be
of greater than 100° F (37.8° C), foul-smelling allowed to breast-feed within the neonate’s first
vaginal discharge, severe uterine cramping, hour of life.
nausea, or vomiting. ➢ The nurse should check the neonate’s
➢ When informed that a patient’s amniotic temperature every 1 to 2 hours until it’s
membrane has broken, the nurse should check maintained within normal limits.
fetal heart tones and then maternal vital signs. ➢ At birth, a neonate normally weighs 5 to 9 lb (2 to
➢ The duration of pregnancy averages 280 days, 40 4 kg), measures 18" to 22" (45.5 to 56 cm) in
weeks, 9 calendar months, or 10 lunar months. length, has a head circumference of 13½" to 14"
➢ The initial weight loss for a healthy neonate is 5% (34 to 35.5 cm), and has a chest circumference
to 10% of birth weight. that’s 1" (2.5 cm) less than the head
➢ The normal hemoglobin value in neonates is 17 to circumference.
20 g/dl. ➢ In the neonate, temperature normally ranges from
➢ Crowning is the appearance of the fetus’s head 98° to 99° F (36.7° to 37.2° C), apical pulse rate
when its largest diameter is encircled by the averages 120 to 160 beats/minute, and
vulvovaginal ring. respirations are 40 to 60 breaths/minute.
➢ A multipara is a woman who has had two or more ➢ The diamond-shaped anterior fontanel usually
pregnancies that progressed to viability, closes between ages 12 and 18 months. The
regardless of whether the offspring were alive at triangular posterior fontanel usually closes by age
birth. 2 months.
➢ In a pregnant patient, preeclampsia may progress ➢ In the neonate, a straight spine is normal. A tuft of
to eclampsia, which is characterized by seizures hair over the spine is an abnormal finding.
and may lead to coma. ➢ Prostaglandin gel may be applied to the vagina or
➢ The Apgar score is used to assess the neonate’s cervix to ripen an unfavorable cervix before labor
vital functions. It’s obtained at 1 minute and 5 induction with oxytocin (Pitocin).
minutes after delivery. The score is based on ➢ Supernumerary nipples are occasionally seen on
respiratory effort, heart rate, muscle tone, reflex neonates. They usually appear along a line that
irritability, and color. runs from each axilla, through the normal nipple
➢ Because of the anti-insulin effects of placental area, and to the groin.
hormones, insulin requirements increase during ➢ Meconium is a material that collects in the fetus’s
the third trimester. intestines and forms the neonate’s first feces,
➢ Gestational age can be estimated by ultrasound which are black and tarry.
measurement of maternal abdominal ➢ The presence of meconium in the amniotic fluid
circumference, fetal femur length, and fetal head during labor indicates possible fetal distress and
size. These measurements are most accurate the need to evaluate the neonate for meconium
between 12 and 18 weeks’ gestation. aspiration.
➢ Skeletal system abnormalities and ventricular ➢ To assess a neonate’s rooting reflex, the nurse
septal defects are the most common disorders of touches a finger to the cheek or the corner of the
infants who are born to diabetic women. The mouth. Normally, the neonate turns his head
incidence of congenital malformation is three toward the stimulus, opens his mouth, and
times higher in these infants than in those born to searches for the stimulus.
nondiabetic women. ➢ Harlequin sign is present when a neonate who is
➢ Skeletal system abnormalities and ventricular lying on his side appears red on the dependent
septal defects are the most common disorders of side and pale on the upper side.
infants who are born to diabetic women. The ➢ Mongolian spots can range from brown to blue.
incidence of congenital malformation is three Their color depends on how close melanocytes are
times higher in these infants than in those born to to the surface of the skin. They most commonly
nondiabetic women. appear as patches across the sacrum, buttocks,
➢ The patient with preeclampsia usually has and legs.
puffiness around the eyes or edema in the hands ➢ Mongolian spots are common in non-white infants
(for example, “I can’t put my wedding ring on.”). and usually disappear by age 2 to 3 years.

5
➢ Vernix caseosa is a cheeselike substance that ➢ During pregnancy, the abdominal line from the
covers and protects the fetus’s skin in utero. It symphysis pubis to the umbilicus changes from
may be rubbed into the neonate’s skin or washed linea alba to linea nigra.
away in one or two baths. ➢ In neonates, cold stress affects the circulatory,
➢ Caput succedaneum is edema that develops in regulatory, and respiratory systems.
and under the fetal scalp during labor and ➢ Obstetric data can be described by using the
delivery. It resolves spontaneously and presents F/TPAL system:
no danger to the neonate. The edema doesn’t ➢ F/T: Full-term delivery at 38 weeks or longer
cross the suture line. ➢ P: Preterm delivery between 20 and 37 weeks
➢ Nevus flammeus, or port-wine stain, is a diffuse ➢ A: Abortion or loss of fetus before 20 weeks
pink to dark bluish red lesion on a neonate’s face ➢ L: Number of children living (if a child has died,
or neck. further explanation is needed to clarify the
➢ The Guthrie test (a screening test for discrepancy in numbers).
phenylketonuria) is most reliable if it’s done ➢ Parity doesn’t refer to the number of infants
between the second and sixth days after birth and delivered, only the number of deliveries.
is performed after the neonate has ingested ➢ Women who are carrying more than one fetus
protein. should be encouraged to gain 35 to 45 lb (15.5 to
➢ To assess coordination of sucking and swallowing, 20.5 kg) during pregnancy.
the nurse should observe the neonate’s first ➢ The recommended amount of iron supplement for
breast-feeding or sterile water bottle-feeding. the pregnant patient is 30 to 60 mg daily.
➢ To establish a milk supply pattern, the mother ➢ Drinking six alcoholic beverages a day or a single
should breast-feed her infant at least every 4 episode of binge drinking in the first trimester can
hours. During the first month, she should breast- cause fetal alcohol syndrome.
feed 8 to 12 times daily (demand feeding). ➢ Chorionic villus sampling is performed at 8 to 12
➢ To avoid contact with blood and other body fluids, weeks of pregnancy for early identification of
the nurse should wear gloves when handling the genetic defects.
neonate until after the first bath is given. ➢ In percutaneous umbilical blood sampling, a blood
➢ If a breast-fed infant is content, has good skin sample is obtained from the umbilical cord to
turgor, an adequate number of wet diapers, and detect anemia, genetic defects, and blood
normal weight gain, the mother’s milk supply is incompatibility as well as to assess the need for
assumed to be adequate. blood transfusions.
➢ In the supine position, a pregnant patient’s ➢ The period between contractions is referred to as
enlarged uterus impairs venous return from the the interval, or resting phase. During this phase,
lower half of the body to the heart, resulting in the uterus and placenta fill with blood and allow
supine hypotensive syndrome, or inferior vena for the exchange of oxygen, carbon dioxide, and
cava syndrome. nutrients.
➢ Tocolytic agents used to treat preterm labor ➢ In a patient who has hypertonic contractions, the
include terbutaline (Brethine), ritodrine (Yutopar), uterus doesn’t have an opportunity to relax and
and magnesium sulfate. there is no interval between contractions. As a
➢ A pregnant woman who has hyperemesis result, the fetus may experience hypoxia or rapid
gravidarum may require hospitalization to treat delivery may occur.
dehydration and starvation. ➢ Two qualities of the myometrium are elasticity,
➢ Diaphragmatic hernia is one of the most urgent which allows it to stretch yet maintain its tone,
neonatal surgical emergencies. By compressing and contractility, which allows it to shorten and
and displacing the lungs and heart, this disorder lengthen in a synchronized pattern.
can cause respiratory distress shortly after birth. ➢ During crowning, the presenting part of the fetus
➢ Common complications of early pregnancy (up to remains visible during the interval between
20 weeks’ gestation) include fetal loss and serious contractions.
threats to maternal health. ➢ Uterine atony is failure of the uterus to remain
➢ Fetal embodiment is a maternal developmental firmly contracted.
task that occurs in the second trimester. During ➢ The major cause of uterine atony is a full bladder.
this stage, the mother may complain that she ➢ If the mother wishes to breast-feed, the neonate
never gets to sleep because the fetus always should be nursed as soon as possible after
gives her a thump when she tries. delivery.
➢ Visualization in pregnancy is a process in which ➢ A smacking sound, milk dripping from the side of
the mother imagines what the child she’s carrying the mouth, and sucking noises all indicate
is like and becomes acquainted with it. 7 improper placement of the infant’s mouth over
➢ Hemodilution of pregnancy is the increase in the nipple.
blood volume that occurs during pregnancy. The ➢ Before feeding is initiated, an infant should be
increased volume consists of plasma and causes burped to expel air from the stomach.
an imbalance between the ratio of red blood cells ➢ Most authorities strongly encourage the
to plasma and a resultant decrease in hematocrit. continuation of breast-feeding on both the
➢ Mean arterial pressure of greater than 100 mm Hg affected and the unaffected breast of patients
after 20 weeks of pregnancy is considered with mastitis.
hypertension. ➢ Neonates are nearsighted and focus on items that
➢ The treatment for supine hypotension syndrome are held 10" to 12" (25 to 30.5 cm) away.
(a condition that sometimes occurs in pregnancy) ➢ In a neonate, low-set ears are associated with
is to have the patient lie on her left side. chromosomal abnormalities such as Down
➢ A contributing factor in dependent edema in the syndrome.
pregnant patient is the increase of femoral ➢ Meconium is usually passed in the first 24 hours;
venous pressure from 10 mm Hg (normal) to 18 however, passage may take up to 72 hours.
mm Hg (high). ➢ Boys who are born with hypospadias shouldn’t be
➢ Hyperpigmentation of the pregnant patient’s face, circumcised at birth because the foreskin may be
formerly called chloasma and now referred to as needed for constructive surgery.
melasma, fades after delivery. ➢ In the neonate, the normal blood glucose level is
➢ The hormone relaxin, which is secreted first by 45 to 90 mg/dl.
the corpus luteum and later by the placenta, ➢ Hepatitis B vaccine is usually given within 48
relaxes the connective tissue and cartilage of the hours of birth.
symphysis pubis and the sacroiliac joint to ➢ Hepatitis B immune globulin is usually given
facilitate passage of the fetus during delivery. within 12 hours of birth.
➢ Progesterone maintains the integrity of the ➢ HELLP (hemolysis, elevated liver enzymes, and
pregnancy by inhibiting uterine motility. low platelets) syndrome is an unusual variation of
➢ Ladin’s sign, an early indication of pregnancy, pregnancy-induced hypertension.
causes softening of a spot on the anterior portion ➢ Maternal serum alpha-fetoprotein is detectable at
of the uterus, just above the uterocervical 7 weeks of gestation and peaks in the third
juncture. trimester. High levels detected between the 16th
and 18th weeks are associated with neural tube

6
 defects. Low levels are associated with Down delivery, but the patient should be instructed to
syndrome. avoid becoming pregnant for 3 months.
➢ An arrest of descent occurs when the fetus ➢ A 16-year-old girl who is pregnant is at risk for
doesn’t descend through the pelvic cavity during having a low-birth-weight neonate.
labor. It’s commonly associated with ➢ The mother’s Rh factor should be determined
cephalopelvic disproportion, and cesarean before an amniocentesis is performed.
delivery may be required. ➢ Maternal hypotension is a complication of spinal
➢ A late sign of preeclampsia is epigastric pain as a block.
result of severe liver edema. ➢ After delivery, if the fundus is boggy and deviated
➢ In the patient with preeclampsia, blood pressure to the right side, the patient should empty her
returns to normal during the puerperal period. bladder.
➢ To obtain an estriol level, urine is collected for 24 ➢ Before providing a specimen for a sperm count,
hours. the patient should avoid ejaculation for 48 to 72
➢ An estriol level is used to assess fetal well-being hours.
and maternal renal functioning as well as to ➢ The hormone human chorionic gonadotropin is a
monitor a pregnancy that’s complicated by marker for pregnancy.
diabetes. ➢ Painless vaginal bleeding during the last trimester
➢ A pregnant patient with vaginal bleeding of pregnancy may indicate placenta previa.
shouldn’t have a pelvic examination. ➢ During the transition phase of labor, the woman
➢ In the early stages of pregnancy, the finding of usually is irritable and restless.
glucose in the urine may be related to the ➢ Because women with diabetes have a higher
increased shunting of incidence of birth anomalies than women without
➢ glucose to the developing placenta, without a diabetes, an alpha-fetoprotein level may be
corresponding increase in the reabsorption ordered at 15 to 17 weeks’ gestation.
capability of the kidneys. ➢ To avoid puncturing the placenta, a vaginal
➢ A patient who has premature rupture of the examination shouldn’t be performed on a
membranes is at significant risk for infection if pregnant patient who is bleeding.
labor doesn’t begin within 24 hours. ➢ A patient who has postpartum hemorrhage
➢ Infants of diabetic mothers are susceptible to caused by uterine atony should be given oxytocin
macrosomia as a result of increased insulin as prescribed.
production in the fetus. ➢ Laceration of the vagina, cervix, or perineum
➢ To prevent heat loss in the neonate, the nurse produces bright red bleeding that often comes in
should bathe one part of his body at a time and spurts. The bleeding is continuous, even when the
keep the rest of the body covered. fundus is firm.
➢ A patient who has a cesarean delivery is at ➢ Hot compresses can help to relieve breast
greater risk for infection than the patient who tenderness after breast-feeding.
gives birth vaginally. ➢ The fundus of a postpartum patient is massaged
➢ The occurrence of thrush in the neonate is to stimulate contraction of the uterus and prevent
probably caused by contact with the organism hemorrhage.
during delivery through the birth canal. ➢ A mother who has a positive human
➢ The nurse should keep the sac of immunodeficiency virus test result shouldn’t
meningomyelocele moist with normal saline breast-feed her infant.
solution. ➢ Dinoprostone (Cervidil) is used to ripen the cervix.
➢ If fundal height is at least 2 cm less than ➢ Breast-feeding of a premature neonate born at 32
expected, the cause may be growth retardation, weeks’ gestation can be accomplished if the
missed abortion, transverse lie, or false mother expresses milk and feeds the neonate by
pregnancy. gavage.
➢ Fundal height that exceeds expectations by more ➢ If a pregnant patient’s rubella titer is less than
than 2 cm may be caused by multiple gestation, 1:8, she should be immunized after delivery.
polyhydramnios, uterine myomata, or a large ➢ The administration of oxytocin (Pitocin) is stopped
baby. if the contractions are 90 seconds or longer.
➢ A major developmental task for a woman during ➢ For an extramural delivery (one that takes place
the first trimester of pregnancy is accepting the outside of a normal delivery center), the priorities
pregnancy. for care of the neonate include maintaining a
➢ Unlike formula, breast milk offers the benefit of patent airway, supporting efforts to breathe,
maternal antibodies. monitoring vital signs, and maintaining adequate
➢ Spontaneous rupture of the membranes increases body temperature.
the risk of a prolapsed umbilical cord. ➢ Subinvolution may occur if the bladder is
➢ A clinical manifestation of a prolapsed umbilical distended after delivery.
cord is variable decelerations. ➢ The nurse must place identification bands on both
➢ During labor, to relieve supine hypotension the mother and the neonate before they leave the
manifested by nausea and vomiting and paleness, delivery room.
turn the patient on her left side. ➢ Erythromycin is given at birth to prevent
➢ If the ovum is fertilized by a spermatozoon ophthalmia neonatorum.
carrying a Y chromosome, a male zygote is ➢ Pelvic-tilt exercises can help to prevent or relieve
formed. backache during pregnancy.
➢ Implantation occurs when the cellular walls of the ➢ Before performing a Leopold maneuver, the nurse
blastocyte implants itself in the endometrium, should ask the patient to empty her bladder.
usually 7 to 9 days after fertilization. ➢ Psychiatric nursing bullets review 9
➢ Implantation occurs when the cellular walls of the ➢ According to Kübler-Ross, the five stages of death
blastocyte implants itself in the endometrium, and dying are denial, anger, bargaining,
usually 7 to 9 days after fertilization. depression, and acceptance.
➢ Heart development in the embryo begins at 2 to 4 ➢ Flight of ideas is an alteration in thought
weeks and is complete by the end of the processes that’s characterized by skipping from
embryonic stage. one topic to another, unrelated topic.
➢ Methergine stimulates uterine contractions. ➢ La belle indifférence is the lack of concern for a
➢ The administration of folic acid during the early profound disability, such as blindness or paralysis
stages of gestation may prevent neural tube that may occur in a patient who has a conversion
defects. disorder.
➢ With advanced maternal age, a common genetic ➢ Moderate anxiety decreases a person’s ability to
problem is Down syndrome. perceive and concentrate. The person is
➢ With early maternal age, cephalopelvic selectively inattentive (focuses on immediate
disproportion commonly occurs. concerns), and the perceptual field narrows.
➢ In the early postpartum period, the fundus should ➢ A patient who has a phobic disorder uses self-
be midline at the umbilicus. protective avoidance as an ego defense
➢ A rubella vaccine shouldn’t be given to a pregnant mechanism.
woman. The vaccine can be administered after

7
➢ In a patient who has anorexia nervosa, the ➢ Phobic disorders are treated with desensitization
highest treatment priority is correction of therapy, which gradually exposes a patient to an
nutritional and electrolyte imbalances. anxiety-producing stimulus.
➢ A patient who is taking lithium must undergo ➢ Dysfunctional grieving is absent or prolonged
regular (usually once a month) monitoring of the grief.
blood lithium level because the margin between ➢ During phase I of the nurse-patient relationship
therapeutic and toxic levels is narrow. A normal (beginning, or orientation, phase), the nurse
laboratory value is 0.5 to 1.5 mEq/L. obtains an initial history and the nurse and the
➢ Early signs and symptoms of alcohol withdrawal patient agree to a contract.
include anxiety, anorexia, tremors, and insomnia. ➢ During phase II of the nurse-patient relationship
They may begin up to 8 hours after the last (middle, or working, phase), the patient discusses
alcohol intake. his problems, behavioral changes occur, and self-
➢ Al-Anon is a support group for families of defeating behavior is resolved or reduced.
alcoholics. ➢ During phase III of the nurse-patient relationship
➢ The nurse shouldn’t administer chlorpromazine (termination, or resolution, phase), the nurse
(Thorazine) to a patient who has ingested alcohol terminates the therapeutic relationship and gives
because it may cause oversedation and the patient positive feedback on his
respiratory depression. accomplishments.
➢ Lithium toxicity can occur when sodium and fluid ➢ According to Freud, a person between ages 12
intake are insufficient, causing lithium retention. and 20 is in the genital stage, during which he
➢ An alcoholic who achieves sobriety is called a learns independence, has an increased interest in
recovering alcoholic because no cure for members of the opposite sex, and establishes an
alcoholism exists. identity.
➢ According to Erikson, the school-age child (ages 6 ➢ According to Erikson, the identity-versus-role
to 12) is in the industry-versus-inferiority stage of confusion stage occurs between ages 12 and 20.
psychosocial development. ➢ Tolerance is the need for increasing amounts of a
➢ When caring for a depressed patient, the nurse’s substance to achieve an effect that formerly was
first priority is safety because of the increased risk achieved with lesser amounts.
of suicide. ➢ Suicide is the third leading cause of death among
➢ Echolalia is parrotlike repetition of another white teenagers.
person’s words or phrases. ➢ Most teenagers who kill themselves made a
➢ According to psychoanalytic theory, the ego is the previous suicide attempt and left telltale signs of
part of the psyche that controls internal demands their plans.
and interacts with the outside world at the ➢ In Erikson’s stage of generativity versus despair,
conscious, preconscious, and unconscious levels. generativity (investment of the self in the interest
➢ According to psychoanalytic theory, the superego of the larger community) is expressed through
is the part of the psyche that’s composed of procreation, work, community service, and
morals, values, and ethics. It continually evaluates creative endeavors.
thoughts and actions, rewarding the good and ➢ Alcoholics Anonymous recommends a 12-step
punishing the bad. (Think of the superego as the program to achieve sobriety.
“supercop” of the unconscious.) ➢ Signs and symptoms of anorexia nervosa include
➢ According to psychoanalytic theory, the id is the amenorrhea, excessive weight loss, lanugo (fine
part of the psyche that contains instinctual drives. body hair), abdominal distention, and electrolyte
(Remember i for instinctual and d for drive.) disturbances.
➢ Denial is the defense mechanism used by a ➢ A serum lithium level that exceeds 2.0 mEq/L is
patient who denies the reality of an event. considered toxic.
➢ In a psychiatric setting, seclusion is used to ➢ Public Law 94-247 (Child Abuse and Neglect Act of
reduce overwhelming environmental stimulation, 1973) requires reporting of suspected cases of
protect the patient from self-injury or injury to child abuse to child protection services.
others, and prevent damage to hospital property. ➢ The nurse should suspect sexual abuse in a young
It’s used for patients who don’t respond to less child who has blood in the feces or urine, penile or
restrictive interventions. Seclusion controls vaginal discharge, genital trauma that isn’t readily
external behavior until the patient can assume explained, or a sexually transmitted disease.
self-control and helps the patient to regain self- ➢ An alcoholic uses alcohol to cope with the stresses
control. of life.
➢ Tyramine-rich food, such as aged cheese, chicken ➢ The human personality operates on three levels:
liver, avocados, bananas, meat tenderizer, salami, conscious, preconscious, and unconscious.
bologna, Chianti wine, and beer may cause severe ➢ Asking a patient an open-ended question is one of
hypertension in a patient who takes a monoamine the best ways to elicit or clarify information.
oxidase inhibitor. ➢ The diagnosis of autism is often made when a
➢ A patient who takes a monoamine oxidase child is between ages 2 and 3.
inhibitor should be weighed biweekly and ➢ Defense mechanisms protect the personality by
monitored for suicidal tendencies. reducing stress and anxiety.
➢ If the patient who takes a monoamine oxidase ➢ Suppression is voluntary exclusion of stress-
inhibitor has palpitations, headaches, or severe producing thoughts from the consciousness.
orthostatic hypotension, the nurse should ➢ In psychodrama, life situations are approximated
withhold the drug and notify the physician. in a structured environment, allowing the
➢ Common causes of child abuse are poor impulse participant to recreate and enact scenes to gain
control by the parents and the lack of knowledge insight and to practice new skills.
of growth and development. ➢ Psychodrama is a therapeutic technique that’s
➢ The diagnosis of Alzheimer’s disease is based on used with groups to help participants gain new
clinical findings of two or more cognitive deficits, perception and self-awareness by acting out their
progressive worsening of memory, and the results own or assigned problems.
of a neuropsychological test. ➢ A patient who is taking disulfiram (Antabuse)
➢ Memory disturbance is a classic sign of must avoid ingesting products that contain
Alzheimer’s disease. alcohol, such as cough syrup, fruitcake, and
➢ Thought blocking is loss of the train of thought sauces and soups made with cooking wine.
because of a defect in mental processing. ➢ A patient who is admitted to a psychiatric hospital
➢ A compulsion is an irresistible urge to perform an involuntarily loses the right to sign out against
irrational act, such as walking in a clockwise circle medical advice.
before leaving a room or washing the hands ➢ “People who live in glass houses shouldn’t throw
repeatedly. stones” and “A rolling stone gathers no moss” are
➢ A patient who has a chosen method and a plan to examples of proverbs used during a psychiatric
commit suicide in the next 48 to 72 hours is at interview to determine a patient’s ability to think
high risk for suicide. abstractly. (Schizophrenic patients think in
➢ The therapeutic serum level for lithium is 0.5 to concrete terms and might interpret the glass
1.5 mEq/L. house proverb as “If you throw a stone in a glass
house, the house will break.”)

8
➢ Signs of lithium toxicity include diarrhea, tremors, ➢ Anxiety is nonspecific; fear is specific.
nausea, muscle weakness, ataxia, and confusion. ➢ Extrapyramidal adverse effects are common in
➢ A labile affect is characterized by rapid shifts of patients who take antipsychotic drugs.
emotions and mood. ➢ The nurse should encourage an angry patient to
➢ Amnesia is loss of memory from an organic or follow a physical exercise program as one of the
inorganic cause. ways to ventilate feelings.
➢ A person who has borderline personality disorder ➢ Depression is clinically significant if it’s
is demanding and judgmental in interpersonal characterized by exaggerated feelings of sadness,
relationships and will attempt to split staff by melancholy, dejection, worthlessness, and
pointing to discrepancies in the treatment plan. hopelessness that are inappropriate or out of
➢ Disulfiram (Antabuse) shouldn’t be taken proportion to reality.
concurrently with metronidazole (Flagyl) because ➢ Free-floating anxiety is anxiousness with
they may interact and cause a psychotic reaction. generalized apprehension and pessimism for
➢ In rare cases, electroconvulsive therapy causes unknown reasons.
arrhythmias and death. ➢ In a patient who is experiencing intense anxiety,
➢ A patient who is scheduled for electroconvulsive the fight-or-flight reaction (alarm reflex) may take
therapy should receive nothing by mouth after over.
midnight to prevent aspiration while under ➢ Confabulation is the use of imaginary experiences
anesthesia. or made-up information to fill missing gaps of
➢ Electroconvulsive therapy is normally used for memory.
patients who have severe depression that doesn’t ➢ When starting a therapeutic relationship with a
respond to drug therapy. patient, the nurse should explain that the purpose
➢ For electroconvulsive therapy to be effective, the of the therapy is to produce a positive change.
patient usually receives 6 to 12 treatments at a ➢ A basic assumption of psychoanalytic theory is
rate of 2 to 3 per week. that all behavior has meaning.
➢ During the manic phase of bipolar affective ➢ Catharsis is the expression of deep feelings and
disorder, nursing care is directed at slowing the emotions.
patient down because the patient may die as a ➢ According to the pleasure principle, the psyche
result of self-induced exhaustion or injury. seeks pleasure and avoids unpleasant
➢ For a patient with Alzheimer’s disease, the experiences, regardless of the consequences.
nursing care plan should focus on safety ➢ A patient who has a conversion disorder resolves
measures. a psychological conflict through the loss of a
➢ After sexual assault, the patient’s needs are the specific physical function (for example, paralysis,
primary concern, followed by medicolegal blindness, or inability to swallow). This loss of
considerations. function is involuntary, but diagnostic tests show
➢ Patients who are in a maintenance program for no organic cause.
narcotic abstinence syndrome receive 10 to 40 ➢ Chlordiazepoxide (Librium) is the drug of choice
mg of methadone (Dolophine) in a single daily for treating alcohol withdrawal symptoms.
dose and are monitored to ensure that the drug is ➢ For a patient who is at risk for alcohol withdrawal,
ingested. the nurse should assess the pulse rate and blood
➢ Stress management is a short-range goal of pressure every 2 hours for the first 12 hours,
psychotherapy. every 4 hours for the next 24 hours, and every 6
➢ The mood most often experienced by a patient hours thereafter (unless the patient’s condition
with organic brain syndrome is irritability. becomes unstable).
➢ Creative intuition is controlled by the right side of ➢ Alcohol detoxification is most successful when
the brain. carried out in a structured environment by a
➢ Methohexital (Brevital) is the general anesthetic supportive, nonjudgmental staff.
that’s administered to patients who are scheduled ➢ The nurse should follow these guidelines when
for electroconvulsive therapy. caring for a patient who is experiencing alcohol
➢ The decision to use restraints should be based on withdrawal: Maintain a calm environment, keep
the patient’s safety needs. intrusions to a minimum, speak slowly and calmly,
➢ Diphenhydramine (Benadryl) relieves the adjust lighting to prevent shadows and glare, call
extrapyramidal adverse effects of psychotropic the patient by name, and have a friend or family
drugs. member stay with the patient, if possible.
➢ In a patient who is stabilized on lithium (Eskalith) ➢ The therapeutic regimen for an alcoholic patient
therapy, blood lithium levels should be checked 8 includes folic acid, thiamine, and multivitamin
to 12 hours after the first dose, then two or three supplements as well as adequate food and fluids.
times weekly during the first month. Levels should ➢ A patient who is addicted to opiates (drugs
be checked weekly to monthly during derived from poppy seeds, such as heroin and
maintenance therapy. morphine) typically experiences withdrawal
➢ The primary purpose of psychotropic drugs is to symptoms within 12 hours after the last dose. The
decrease the patient’s symptoms, which improves most severe symptoms occur within 48 hours and
function and increases compliance with therapy. decrease over the next 2 weeks.
➢ Manipulation is a maladaptive method of meeting ➢ Reactive depression is a response to a specific life
one’s needs because it disregards the needs and event.
feelings of others. ➢ Projection is the unconscious assigning of a
➢ If a patient has symptoms of lithium toxicity, the thought, feeling, or action to someone or
nurse should withhold one dose and call the something else.
physician. ➢ Sublimation is the channeling of unacceptable
➢ A patient who is taking lithium (Eskalith) for impulses into socially acceptable behavior.
bipolar affective disorder must maintain a ➢ Repression is an unconscious defense mechanism
balanced diet with adequate salt intake. whereby unacceptable or painful thoughts,
➢ A patient who constantly seeks approval or impulses, memories, or feelings are pushed from
assistance from staff members and other patients the consciousness or forgotten.
is demonstrating dependent behavior. ➢ Hypochondriasis is morbid anxiety about one’s
➢ Alcoholics Anonymous advocates total abstinence health associated with various symptoms that
from alcohol. aren’t caused by organic disease.
➢ Methylphenidate (Ritalin) is the drug of choice for ➢ Denial is a refusal to acknowledge feelings,
treating attention deficit hyperactivity disorder in thoughts, desires, impulses, or external facts that
children. are consciously intolerable.
➢ Setting limits is the most effective way to control ➢ Reaction formation is the avoidance of anxiety
manipulative behavior. through behavior and attitudes that are the
➢ Violent outbursts are common in a patient who opposite of repressed impulses and drives.
has borderline personality disorder. ➢ Displacement is the transfer of unacceptable
➢ When working with a depressed patient, the nurse feelings to a more acceptable object.
should explore meaningful losses. ➢ Regression is a retreat to an earlier
➢ An illusion is a misinterpretation of an actual developmental stage.
environmental stimulus.

9
➢ According to Erikson, an older adult (age 65 or ➢ Confrontation is a communication technique in
older) is in the developmental stage of integrity which the nurse points out discrepancies between
versus despair. the patient’s words and his nonverbal behaviors.
➢ Family therapy focuses on the family as a whole ➢ For a patient with substance-induced delirium, the
rather than the individual. Its major objective is to time of drug ingestion can help to determine
reestablish rational communication between whether the drug can be evacuated from the
family members. body.
➢ When caring for a patient who is hostile or angry, ➢ Treatment for alcohol withdrawal may include
the nurse should attempt to remain calm, listen administration of I.V. glucose for hypoglycemia,
impartially, use short sentences, and speak in a I.V. fluid containing thiamine and other B
firm, quiet voice. vitamins, and antianxiety, antidiarrheal,
➢ Ritualism and negativism are typical toddler anticonvulsant, and antiemetic drugs.
behaviors. They occur during the developmental ➢ The alcoholic patient receives thiamine to help
stage identified by Erikson as autonomy versus prevent peripheral neuropathy and Korsakoff’s
shame and doubt. syndrome.
➢ Circumstantiality is a disturbance in associated ➢ Alcohol withdrawal may precipitate seizure
thought and speech patterns in which a patient activity because alcohol lowers the seizure
gives unnecessary, minute details and digresses threshold in some people.
into inappropriate thoughts that delay ➢ Paraphrasing is an active listening technique in
communication of central ideas and goal which the nurse restates what the patient has just
achievement. said.
➢ Idea of reference is an incorrect belief that the ➢ A patient with Korsakoff’s syndrome may use
statements or actions of others are related to confabulation (made up information) to cover
oneself. memory lapses or periods of amnesia.
➢ Group therapy provides an opportunity for each ➢ People with obsessive-compulsive disorder realize
group member to examine interactions, learn and that their behavior is unreasonable, but are
practice successful interpersonal communication powerless to control it.
skills, and explore emotional conflicts. ➢ When witnessing psychiatric patients who are
➢ Korsakoff’s syndrome is believed to be a chronic engaged in a threatening confrontation, the nurse
form of Wernicke’s encephalopathy. It’s marked should first separate the two individuals.
by hallucinations, confabulation, amnesia, and ➢ Patients with anorexia nervosa or bulimia must be
disturbances of orientation. 12 observed during meals and for some time
➢ A patient with antisocial personality disorder often afterward to ensure that they don’t purge what
engages in confrontations with authority figures, they have eaten.
such as police, parents, and school officials. ➢ Transsexuals believe that they were born the
➢ A patient with paranoid personality disorder wrong gender and may seek hormonal or surgical
exhibits suspicion, hypervigilance, and hostility treatment to change their gender.
toward others. ➢ Fugue is a dissociative state in which a person
➢ Depression is the most common psychiatric leaves his familiar surroundings, assumes a new
disorder. identity, and has amnesia about his previous
➢ Adverse reactions to tricyclic antidepressant identity. (It’s also described as “flight from
drugs include tachycardia, orthostatic himself.”)
hypotension, hypomania, lowered seizure ➢ In a psychiatric setting, the patient should be able
threshold, tremors, weight gain, problems with to predict the nurse’s behavior and expect
erections or orgasms, and anxiety. consistent positive attitudes and approaches.
➢ The Minnesota Multiphasic Personality Inventory ➢ When establishing a schedule for a one-to-one
consists of 550 statements for the subject to interaction with a patient, the nurse should state
interpret. It assesses personality and detects how long the conversation will last and then
disorders, such as depression and schizophrenia, adhere to the time limit.
in adolescents and adults. ➢ Thought broadcasting is a type of delusion in
➢ Organic brain syndrome is the most common form which the person believes that his thoughts are
of mental illness in elderly patients. being broadcast for the world to hear.
➢ A person who has an IQ of less than 20 is ➢ Lithium should be taken with food. A patient who
profoundly retarded and is considered a total-care is taking lithium shouldn’t restrict his sodium
patient. intake.
➢ Reframing is a therapeutic technique that’s used ➢ A patient who is taking lithium should stop taking
to help depressed patients to view a situation in the drug and call his physician if he experiences
alternative ways. vomiting, drowsiness, or muscle weakness.
➢ Fluoxetine (Prozac), sertraline (Zoloft), and ➢ The patient who is taking a monoamine oxidase
paroxetine (Paxil) are serotonin reuptake inhibitor for depression can include cottage
inhibitors used to treat depression. cheese, cream cheese, yogurt, and sour cream in
➢ The early stage of Alzheimer’s disease lasts 2 to 4 his diet.
years. Patients have inappropriate affect, ➢ Sensory overload is a state in which sensory
transient paranoia, disorientation to time, stimulation exceeds the individual’s capacity to
memory loss, careless dressing, and impaired tolerate or process it.
judgment. ➢ Symptoms of sensory overload include a feeling of
➢ The middle stage of Alzheimer’s disease lasts 4 to distress and hyperarousal with impaired thinking
7 years and is marked by profound personality and concentration.
changes, loss of independence, disorientation, ➢ In sensory deprivation, overall sensory input is
confusion, inability to recognize family members, decreased.
and nocturnal restlessness. ➢ A sign of sensory deprivation is a decrease in
➢ The last stage of Alzheimer’s disease occurs stimulation from the environment or from within
during the final year of life and is characterized by oneself, such as daydreaming, inactivity, sleeping
a blank facial expression, seizures, loss of excessively, and reminiscing.
appetite, emaciation, irritability, and total ➢ The three stages of general adaptation syndrome
dependence. are alarm, resistance, and exhaustion.
➢ Threatening a patient with an injection for failing ➢ A maladaptive response to stress is drinking
to take an oral drug is an example of assault. alcohol or smoking excessively. 13
➢ Reexamination of life goals is a major ➢ Hyperalertness and the startle reflex are
developmental task during middle adulthood. characteristics of posttraumatic stress disorder.
➢ Acute alcohol withdrawal causes anorexia, ➢ A treatment for a phobia is desensitization, a
insomnia, headache, and restlessness and process in which the patient is slowly exposed to
escalates to a syndrome that’s characterized by the feared stimuli.
agitation, disorientation, vivid hallucinations, and ➢ Symptoms of major depressive disorder include
tremors of the hands, feet, legs, and tongue. depressed mood, inability to experience pleasure,
➢ In a hospitalized alcoholic, alcohol withdrawal sleep disturbance, appetite changes, decreased
delirium most commonly occurs 3 to 4 days after libido, and feelings of worthlessness.
admission.

10
➢ Clinical signs of lithium toxicity are nausea, ➢ After electroconvulsive therapy, the patient
vomiting, and lethargy. should be monitored for post-shock amnesia.
➢ Asking too many “why” questions yields scant ➢ A mother who continues to perform
information and may overwhelm a psychiatric cardiopulmonary resuscitation after a physician
patient and lead to stress and withdrawal. pronounces a child dead is showing denial.
➢ Remote memory may be impaired in the late ➢ Transvestism is a desire to wear clothes usually
stages of dementia. worn by members of the opposite sex.
➢ According to the DSM-IV, bipolar II disorder is ➢ Tardive dyskinesia causes excessive blinking and
characterized by at least one manic episode that’s unusual movement of the tongue, and involuntary
accompanied by hypomania. sucking and chewing.
➢ The nurse can use silence and active listening to ➢ Trihexyphenidyl (Artane) and benztropine
promote interactions with a depressed patient. (Cogentin) are administered to counteract
➢ A psychiatric patient with a substance abuse extrapyramidal adverse effects.
problem and a major psychiatric disorder has a ➢ To prevent hypertensive crisis, a patient who is
dual diagnosis. taking a monoamine oxidase inhibitor should
➢ When a patient is readmitted to a mental health avoid consuming aged cheese, caffeine, beer,
unit, the nurse should assess compliance with yeast, chocolate, liver, processed foods, and
medication orders. monosodium glutamate.
➢ Alcohol potentiates the effects of tricyclic ➢ Extrapyramidal symptoms include parkinsonism,
antidepressants. dystonia, akathisia (“ants in the pants”), and
➢ Flight of ideas is movement from one topic to tardive dyskinesia.
another without any discernible connection. ➢ One theory that supports the use of
➢ Conduct disorder is manifested by extreme electroconvulsive therapy suggests that it
behavior, such as hurting people and animals. “resets” the brain circuits to allow normal
➢ During the “tension-building” phase of an abusive function.
relationship, the abused individual feels helpless. ➢ A patient who has obsessive-compulsive disorder
➢ In the emergency treatment of an alcohol- usually recognizes the senselessness of his
intoxicated patient, determining the blood-alcohol behavior but is powerless to stop it (ego-
level is paramount in determining the amount of dystonia).
medication that the patient needs. ➢ In helping a patient who has been abused,
➢ Side effects of the antidepressant fluoxetine physical safety is the nurse’s first priority.
(Prozac) include diarrhea, decreased libido, weight ➢ Pemoline (Cylert) is used to treat attention deficit
loss, and dry mouth. hyperactivity disorder (ADHD). 14
➢ Before electroconvulsive therapy, the patient is ➢ Clozapine (Clozaril) is contraindicated in pregnant
given the skeletal muscle relaxant succinylcholine women and in patients who have severe
(Anectine) by I.V. administration. granulocytopenia or severe central nervous
➢ When a psychotic patient is admitted to an system depression.
inpatient facility, the primary concern is safety, ➢ Repression, an unconscious process, is the
followed by the establishment of trust. inability to recall painful or unpleasant thoughts or
➢ An effective way to decrease the risk of suicide is feelings.
to make a suicide contract with the patient for a ➢ Projection is shifting of unwanted characteristics
specified period of time. or shortcomings to others (scapegoat).
➢ A depressed patient should be given sufficient ➢ Hypnosis is used to treat psychogenic amnesia.
portions of his favorite foods, but shouldn’t be ➢ Disulfiram (Antabuse) is administered orally as an
overwhelmed with too much food. aversion therapy to treat alcoholism.
➢ The nurse should assess the depressed patient for ➢ Ingestion of alcohol by a patient who is taking
suicidal ideation. disulfiram (Antabuse) can cause severe reactions,
➢ Delusional thought patterns commonly occur including nausea and vomiting, and may
during the manic phase of bipolar disorder. endanger the patient’s life.
➢ Apathy is typically observed in patients who have ➢ Improved concentration is a sign that lithium is
schizophrenia. taking effect.
➢ Manipulative behavior is characteristic of a ➢ Behavior modification, including time-outs, token
patient who has passive– aggressive personality economy, or a reward system, is a treatment for
disorder. attention deficit hyperactivity disorder.
➢ When a patient who has schizophrenia begins to ➢ For a patient who has anorexia nervosa, the nurse
hallucinate, the nurse should redirect the patient should provide support at mealtime and record
to activities that are focused on the here and now. the amount the patient eats.
➢ When a patient who is receiving an antipsychotic ➢ A significant toxic risk associated with clozapine
drug exhibits muscle rigidity and tremors, the (Clozaril) administration is blood dyscrasia.
nurse should administer an antiparkinsonian drug ➢ Adverse effects of haloperidol (Haldol)
(for example, Cogentin or Artane) as ordered. administration include drowsiness; insomnia;
➢ A patient who is receiving lithium (Eskalith) weakness; headache; and extrapyramidal
therapy should report diarrhea, vomiting, symptoms, such as akathisia, tardive dyskinesia,
drowsiness, muscular weakness, or lack of and dystonia.
coordination to the physician immediately. ➢ Hypervigilance and déjà vu are signs of
➢ The therapeutic serum level of lithium (Eskalith) posttraumatic stress disorder (PTSD).
for maintenance is 0.6 to 1.2 mEq/L. ➢ A child who shows dissociation has probably been
➢ Obsessive-compulsive disorder is an anxiety- abused.
related disorder. ➢ Confabulation is the use of fantasy to fill in gaps
➢ Al-Anon is a self-help group for families of of memo
alcoholics. ➢ COMMUNICABLE DISEASE NURSING
➢ Desensitization is a treatment for phobia, or COMMUNICABLE DISEASE
irrational fear. Infectious Agent or its toxic products - AGENT
➢ After electroconvulsive therapy, the patient is Directly or Indirectly - MODE OF TRANSMISSION
placed in the lateral position, with the head Person, Animal or Intermediate Vector – HOST
turned to one side. Environment - ENVIRONMENT
➢ A delusion is a fixed false belief. ECOLOGIC TRIAD OF DISEASE
➢ Giving away personal possessions is a sign of Agent – element, substance, animate or inanimate
suicidal ideation. Other signs include writing a that may serve as stimulus to initiate a disease
suicide note or talking about suicide. process
➢ Agoraphobia is fear of open spaces. Host – organism that provides nourishment for
➢ A person who has paranoid personality disorder another organism
projects hostilities onto others. Environment – physical (climate), biological
➢ To assess a patient’s judgment, the nurse should (plants & animals)
ask the patient what he would do if he found a CONTAGIOUS VS. INFECTIOUS
stamped, addressed envelope. An appropriate Contagious
response is that he would mail the envelope. Diseases that are easily spread directly
transmitted from person to person (direct contact)

11
through an intermediary host 2. Epidemiological Investigation
Infectious 3. Case finding; early dx and prompt treatment
Diseases that caused by a pathogen not 4. Isolation and Quarantine
transmitted by ordinary contact but require a 5. Disinfection; disinfestation
direct inoculation through a break in the skin or 6. Medical Asepsis
mucous membrane. a. Handwashing
NOTE: ALL CONTAGIOUS DISEASE ARE b. Concurrent disinfection
INFECTIOUS BUT INFECTIOUS DISEASE IS NOT c. Personal protective equipments (PPEs)
ALWAYS CONTAGIOUS d. Barrier Cards/Placarding
What is Infection? Objectives of CCD
INFECTION - "the state or condition in which the Restoration of health, reduce deaths and disability
body or part of the body is invaded by a Interpretation of control measures to IFC for
pathogenic agent ( bacteria, virus, parasites etc.) practice to prevent spread of CD.
which under favorable conditions multiplies and Promotion of health and prevention of spread of
produces effects which are injurious…" CD
Infectious Agent Diseases that require weekly monitoring:
A. RESIDENT ORGANISMS 1. Acute flaccid paralysis (AFP) polio
deeply seated in the epidermis, not easily 2. Measles
removed by simple handwashing, 3. Severe acute diarrhea (SAD)
Ex: Staphylococci 4. Neonatal tetanus
B. TRANSIENT ORGANISM 5. AIDS
represent recent contamination, Diseases that require reporting w/in 24 hrs
survive for a limited period of time, acquired 1. Acute flaccid paralysis (AFP) polio
during contact with the infected colonized patient ➢ 2. Measles
or environment, Diseases targeted for eradication
easily removed by good handwashing 1. Acute flaccid paralysis polio
Ex: ( Klebsiella & Pseudomonas) 2. Neonatal tetanus
Infectious Agent 3. Measles
Bacteria – heama organism, systemic 4. Rabies
Virus – nuero organism, systemic Epidemiology
Fungi – skin organism, local Study of the occurrence and distribution of
Protozoa – GI organism, local diseases in the population
Infectious Agent Patterns of occurrence of disease –frequency of
FACTORS THAT AFFECTS THE AGENT TO disease occurrence
DEVELOP A DISEASE Sporadic
Pathogenicity – ability to cause a disease On and off occurrence of the disease
Infective dose – no of organism to initiate Most of the time it is not found in the community
infection One or two cases that occur are not related
Virulence – ability to enter or move through Endemic
tissues Persistently present in the community all year
Specificity – ability of the organism to develop round
antigens Ex: malaria in Palawan
STAGES OF INFECTIOUS PROCESS Epidemic
Means of Transmission An unexpected increase in the number of cases of
1. CONTACT - most common means of disease
transmitting microorganisms from one person to Pandemic
another. Epidemic of a worldwide proportions
A. Direct Contact (person to person) Time Related Patterns of Occurrence
occurs when one person touches another cyclical variation
best vehicle is the Hands especially those of the a periodic increase in the number of cases of a
Health Care workers disease
Indirect Contact (inanimate object) a seasonal disease, an increase is expected or
- occurs when a person touches an inanimate there is usual increase- dengue fever during rainy
object contaminated by an infected patient seasons are increased but it is not considered an
2. AIRBORNE epidemic because it is expected to rise at this
- droplet, dust, organisms in env. particular time
3. VECTOR - insects or animals hot spot-a rising increase that may lead to an
4. VEHICLE epidemic
- food (salmonella), water (shigellosis), blood
(Hepa B), medication ( contaminated infusion) Time Related Patterns of Occurrence
PREVENTION OF Short time fluctuation
COMMUNICABLE DISEASE A change in the frequency of occurrence of a
Prevention is worth a pound than cure disease over a short period of time
PREVENTION OF Maybe (+) or (-)
COMMUNICABLE DISEASE Secular variation
Health Education – primary role of the nurse A change in the frequency of occurrence of a
Specific Protection- handwashing, use of diseae taking place over a long period of time
protective devices Ex: a.) the change in the pattern of occurrence of
Environmental Sanitation – clean and conducive polio after being eradicated in 2000, then sudden
for health repport of cases in 2001 due to mutant restraints.
Definition of Prevention b.) small pox virus-eradicated in 1979 (last case
“Actions aimed at eradicating, eliminating, or reported) and no another incidence as of today
minimizing the impact of disease and disability. Types of Epidemiology
The concept of prevention is best defined in the Descriptive Epidemiology - concerned with
context of levels, traditionally called primary, disease frequency & distribution
secondary, and tertiary prevention” Analytic Epidemiology
A Dictionary of Epidemiology, Fourth Edition Is a study of the factors affecting occurrence and
by John M. Last distribution of the disease.
Prevention of Needlestick Injuries Ex. Epidemiologic investigation
Dispose Used Needles in Puncture Proof Needle Therapeutic/Clinical
Containers Study of the efficacy of a treatment of a particular
Don’t Recap Needles (Unless using the One- disease
handed Technique) Ex. Clinical trial of a newly proposed therapeutic
Use Gloves When Handling Needles (Won’t regimen
Prevent Injuries but May Lessen Chance of Evaluation Epidemiology
Transmitting Diseases) Study of the over-all effectiveness of a total/
CONTROL OF C0MMUNICABLE DIESEASE comprehensive public health program.
1. Notification Ex. Evaluation of the under five clinic

12
 0.05 ml (dose) – ID, right arm
Note: We make use of the epidemiology in CHN in School entrance BCG
order to come up a community diagnosis and also When the child enters Grade 1 with or without
to determine the effectiveness of a particular scar on the right arm then still go on with the
treatment vaccination except if he is repeating Grade 1
Types of Epidemiologic Data Schedule of immunization
Demographic data DPT
Demography is the study of population groups 3 doses, 4 weeks or 1 month interval
Ex. Population size and distribution Target age: 1 ½ to 11 months but child is eligible
Vital Statistics up to 6 years
Environmental data If 7 years old and above DT only not P
Health services data 0.5 ml, IM, vastus lateralis
Ex. Ratio between nurse and the population being
served
Ex. Degree of utilization of health facility/ service Schedule of immunization
Epidemiologic Investigation OPV
3 doses, 4 weeks/1 month
1st step- Statement of the problem Target population: same as above, eligibility until
2nd step- Appraisal of facts – describing the Grade 6
epidemic in terms of time, place, person. 2-3 drops, oral route
3rd step- formulation of hypothesis *Feb 8-March 8: Oplan Polio Revival Drive
4th step-Testing the hypothesis No side effect, but advise the mother to avoid
5th step- Conclusion and recommendation feeding the child for 30 minutes after the vaccine,
TERMS if vomits within the 30 minute period, repeat the
Disinfection – pathogens but not spores are vaccination
destroyed
Disinfectant – substance use on inanimate objects Schedule of immunization
Concurrent disinfection – ongoing practices in the Hepa B
care of the patient to limit or control the spread of 3 doses, 4 weeks
microorganisms. Can be given at birth
Terminal disinfection – practices to remove Target age 1 ½ to 11 months
pathogens from the patient’s environment after 0.5 ml, IM, vastus lateralis
his illness is no longer communicable Patient may experience local tenderness
FACTORS AFFECTING ISOLATION Schedule of immunization
Mode of Transmission Measles
Source 9 to 11 months
Status of the client’s defense mechanism Most babies have protection because of maternal
Ability of client to implement precautions antibodies thus this vaccine is given at 9 months
ISOLATION because the time where the maternal antibodies
EPI wear off, other virus if it still active it will kill the
Launched by DOH in cooperation with WHO and vaccine
UNICEF last July 1976 0.5 ml, subcutaneous, any arm
Objective – reduce morbidity and mortality among Measles
infants and children caused by the six childhood Fever and measles rash lasting for 1 to 3 days
immunizable diseases within 2 weeks after immunization (modified
PD No. 996 (Sept. 16, 1076) – “ Providing for measles)
compulsary basic immunization for infants and
children below 8 y/o Immunization
PP No. 6 (April 3, 1996) – “ Implementing a United Fully Immunized Child
Nations goal on Universal Child Immunization by when he received all the antigens that should be
1990” given in the first year of life (1 dose BCG, MV; 3
RA 7846 (Dec. 30, 1994) – immunization hepa B doses DPT, OPV, HB)
PD No. 4 (July 29, 1998) – “Declaring the period of Completely Immunized Child
September 16 to October 14, 1998 as Ligtas All vaccines given but went beyond 0ne year of
Tigdas Month and launching the Phil Measles age
Elimination Campaign”
Legislation, Laws affecting EPI
Proclamation No. 46 – “polio eradication project”
Proclamation No. 1064 – AFP surveillance
Proclamation No. 1066 – National Neonatal
Tetanus Elimination Campaign
EPI .
BCG - TB
DPT – Diptheria, Pertussis, Tetanu
OPV - Poliomyletis
Hepatitis B
Measles
Immunization
Contraindications
-conditions that require hospitalization
For DPT 2 and 3 – history of seizures/ convulsions
within 3 days after the first immunization with
DPT
Nursing responsibility: ask how the child reacts to
the first dose
For infant BCG – clinical AIDS
The following conditions are NOT
contraindications:
Fever up to 38.5 ºC
Simple or mild acute respiratory infection
Simple diarrhea without dehydration
Malnutrition (it is indication for immunization)

Schedule of immunization
Infant BCG
0 to 11 months or 0 to 1 year
at birth

13