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• There seems to be a mix of different words and phrases in different languages, possibly for a language learning exam
• General signs of pneumonia include:

  • Fever: Usually high
  • Cough: Unproductive to productive with whitish sputum
  • Tachypnea
  • Crackles and decreased breath sounds
  • Chest pain
  • Retractions
  • Nasal flaring
  • Pallor to cyanosis (severity-dependent)
  • Chest radiography shows diffuse or patchy infiltration with peribronchial distribution
  • Behavioral signs: irritability, restlessness, malaise, lethargy
  • Gastrointestinal symptoms: anorexia, vomiting, diarrhea, abdominal pain
• Assessment for pneumonia:

  • Children may appear acutely ill with high fever, tachycardia, chest or abdominal pain, chills, and signs of respiratory distress
  • Breath sounds are often diminished, and crackles (rales) may be present
  • Dullness on percussion indicates total consolidation
  • Chest radiography often reveals consolidation
  • Laboratory studies show leukocytosis
• Therapeutic management of pneumonia includes:

  1. Heptavalent pneumococcal conjugate vaccine

  2. IV fluid therapy

  3. Antibiotics

  4. Antipyretics

  5. Frequent assessment of oxygen saturation levels

  6. Humidified oxygen to help labored breathing and prevent hypoxemia

  7. Chest physiotherapy (CPT) to encourage mucus movement and prevent obstruction

  8. Repositioning the child to prevent pooling of secretions
• Viral pneumonia management:

  • Oxygen with cool humidified air
  • Fluid intake
  • Antipyretics for fever
  • Chest physiotherapy
  • Postural drainage
• Aspiration pneumonia management:

  • Proper feeding techniques
  • Children at risk for swallowing difficulties are kept NPO (nothing by mouth)
  • Enteral feeding tube
  • Positioning the child in a side-lying position if at risk for vomiting and airway obstruction
• Bacterial pneumonia assessment:

  • Symptoms in infants: irritability, lethargy, poor feeding, abrupt fever, seizures, respiratory distress
  • Symptoms in older children: headache, chills, abdominal pain, chest pain, meningism, hacking non-productive cough, scattered crackles, diminished breath sounds
• Bacterial pneumonia interventions:

  • Hospitalization when pleural effusion or empyema accompanies the disease
  • Blood and sputum culture
  • IV antibiotics for hospitalized patients initially, then shift to oral
  • Oxygen for respiratory distress
  • Cool mist tent to moisten airway
  • Suction to maintain a patent airway
  • Chest physiotherapy/postural drainage every 4 hours
  • Promotion of bed rest
• Isolation precautions for pneumococcal and staphylococcal infections:

  • Cough suppressants administered with caution
  • Chest tube drainage for staphylococcus
  • Thoracentesis for direct antibiotic administration
• Nursing care management for children with respiratory disorders:

  • Monitor for weight loss and signs of dehydration in any viral disease
  • Signs of dehydration include decreased urinary output, dry mucous membranes, decreased tear production, poor skin turgor, and sunken fontanelles
  • Conduct respiratory assessments
  • Administer supplemental oxygen as required
  • Provide fluids and antibiotics
• Differences between regurgitation and vomiting:

  • Timing
  • Forcefulness
  • Description
  • Distress
  • Duration
  • Amount

  
• Nursing care management for pneumonia:

  • Respiratory assessment
  • Administration of supplemental oxygen
  • Fluids
  • Antibiotics
  • Monitoring the child's respiratory rate, rhythm, and depth, oxygenation, general disposition, and level of activity
  • Intravenous fluids may be needed to prevent dehydration during the acute phase
  • Lying on the affected side if pneumonia is unilateral ("good lung up") splints the chest on that side and reduces pleural rubbing
  • Fever control by cooling the environment and administering antipyretic drugs
• Urinary Tract Infection (UTI) classification:

  • Bacteriuria
  • Pyuria
  • Asymptomatic bacteriuria
  • Symptomatic bacteriuria
  • Recurrent UTI
  • Persistent UTI
  • Febrile UTI
  • Cystitis
  • Urethritis
  • Pyelonephritis
  • Urosepsis
• Signs and symptoms of straight catheterization:

  • Scanty urination
  • Burning urination
  • Incomplete emptying of the bladder
  • Cloudy and dark foul-smelling urine
  • Presence of blood in the urine
  • WBC greater than 11,000
  • Frequent urges to void
  • Urine is foul-smelling and cloudy
  • Low-grade fever
  • Lethargy
• • Causative agent: staphylococcal enterotoxin produced by some strains of Staphylococcus aureus
  • Incubation period: 1 to 7 hours
  • Mode of transmission: ingestion of contaminated food such as poultry, creamed foods, and inadequately cooked foods
• Bacterial Infectious Diseases That Cause Diarrhea and Vomiting:

  • Salmonellosis:
  • Causative agent: Salmonella bacteria
  • Incubation period: 6 to 72 hours for intraluminal type; 7 to 14 days for extraluminal type
  • Mode of transmission: ingestion of contaminated food, especially chicken and raw egg
  • Listeriosis:
  • Causative agent: Listeria monocytogenes
  • Incubation period: variable, ranging from 1 day to more than 3 weeks
  • Mode of transmission: ingestion of unpasteurized milk or cheeses or vegetables grown in contaminated soil; important to avoid during pregnancy due to potential complications
  • Shigellosis (Dysentery):
  • Causative agent: organisms of the genus Shigella
  • Incubation period: 1 to 7 days
  • Mode of transmission: contaminated food, water, or milk products
  • Staphylococcal Food Poisoning:
• Common Disorders of the Stomach and Duodenum:

  1. Gastroesophageal Reflux:

  • Regurgitation of stomach secretions into the esophagus through the lower esophageal sphincter; common in infants due to lower esophageal sphincter immaturity

  2. Pyloric Stenosis:

  • Condition where hypertrophy or hyperplasia of the muscle surrounding the sphincter makes it difficult for the stomach to empty

  3. Peptic Ulcer Disease:

  • Shallow excavation in the mucosal wall of the stomach, pylorus, or duodenum; rare in children, more common in males; can be primary (H. pylori infection) or secondary (due to severe stress or medication use)
• Warning signs to see a doctor for gastrointestinal issues:

  • Inability to keep liquids stable for 24 hours
  • Vomiting of blood
  • Diarrhea lasting more than 2 days
  • Fever above 40 degrees
  • Low urine output
• Implementation

  1. Ensure the woman and her support person feel confidence in the healthcare personnel

  2. Establish a helping relationship early on with both the woman and her support person

  3. Coordinate healthcare team members such as anesthesiologist, surgeon, pediatrician or neonatologist, and recovery room or high-risk nursery personnel

  4. Focus on teaching and support interventions to help the woman understand what is happening

  5. Provide adequate "talk time" post-surgery to allow the woman to review and integrate her experience
• Nursing Diagnosis

  1. Fear related to impending surgery

  2. Pain related to a surgical incision

  3. Deficient fluid volume related to blood loss from surgery

  4. Powerlessness related to medical need for episiotomy or cesarean birth

  5. Risk for anxiety related to unanticipated circumstances surrounding birth

  6. Risk for infection related to a surgical incision

  7. Risk for hemorrhage related to surgical procedure

  8. Risk for impaired parent–infant attachment related to unplanned method of birth
• Outcome Identification and Planning

  1. Primary Outcome: Healthy mother and healthy baby

  2. Decisions for the method of birth are often made suddenly, allowing only a few minutes for planning

  3. Limited time to organize presurgical steps such as gastrointestinal or anesthesia preparation

  4. Ensure plans include discharge or home care instructions, as the woman typically remains in the healthcare facility for only 2 to 4 days
• Outcome Evaluation

  1. Patient states she understands the reason for her cesarean birth

  2. Patient states she felt well prepared for cesarean birth even in light of an emergency

  3. Couple states they feel able to cope with newborn care even with mother recovering from surgery

  4. Patient remains free of signs and symptoms of infection after an episiotomy

  5. Patient states her incisional pain is controlled and tolerable

  6. Patient states birth was a fulfilling experience even in light of the unplanned cesarean birth
• Episiotomy


  Episiotom
• Monitoring Fetal Well-Being

  Essential to assess fetal heart rate (FHR) immediately post-amniotomy to ensure no cord prolapse has occurred
• Episiotomy


  A surgical incision of the perineum aimed at preventing tearing during childbirth, relieving pressure on the fetal head, and potentially shortening the second stage of labor
• Amniotomy


  Should only be performed when the fetal head is firmly applied to the cervix to minimize the risk
• Women with epidural anesthesia may not require additional medication for episiotomy repair
• Episiotomies are sutured after birth to promote proper healing
• Despite initial pressure anesthesia, most women require local anesthetic during episiotomy repair due to the return of sensation
• Pressure from the fetal head during pushing may temporarily numb the perineal nerves, allowing episiotomy without anesthesia
• Defibulation is the surgical opening of the labia
• Episiotomy may be necessary for those who have had female genital cutting
• Internal Electronic Monitoring

  The most precise method for assessing FHR and uterine contractions
• Fetal Oxygen Saturation Level

  Allows for direct measurement of fetal oxygen saturation, providing valuable information on fetal oxygenation status during labor
• Vibroacoustic Stimulation


  Used during labor to assess fetal responsiveness, similar to nonstress tests during pregnancy
• Scalp Stimulation


  Assess fetal well-being during labor, particularly when FHR variability appears depressed
• Fetal Blood Sampling

  1. Obtained from the fetal scalp following cervical dilatation during labor reveals signs of fetal hypoxia during labor

  2. Risk: Involves a small risk of laceration on the newborn scalp

  3. While not commonly used nowadays, this monitoring method remains valuable for detecting fetal distress during labor
• Oxygenation status during labor

  Oxygen saturation sensor inserted into the uterus; Beside the fetus's cheek after rupture of membranes
• Considerations for oxygenation status monitoring

  • Risk of Infection: Procedure carries a small risk of uterine infection
  • Preference: Typically reserved for women with existing internal contraction or fetal monitors
• Factors contributing to the rise in Cesarean Birth

  • Improved safety of cesarean birth
  • Increased use of fetal monitors for early detection of fetal problems
  • Higher incidence of obesity among women
  • Scheduled or elective cesarean births; elective cesarean births chosen for convenience, history of sexual trauma or to prevent future urinary or anal incontinence
  • Healthcare providers' concerns about malpractice suits related to allowing vaginal births in cases of fetal distress