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In the absence of sonographic signs of ectopic pregnancy medications routes cheap epitol 100 mg mastercard, the fluid collection is highly likely to represent an intrauterine gestational sac symptoms hiatal hernia purchase genuine epitol line. Caution should be used in making the presumptive diagnosis of a gestational sac in the absence of a definite yolk sac or embryo treatment yeast infection male purchase epitol now. If the embryo is not identified, the mean sac diameter may be useful for determining timing of ultrasound follow up. However, the crown-rump length is a more accurate indicator of gestational age than the mean gestational sac diameter. Presence or absence of cardiac activity should be documented with a 2-D video clip or M-mode [7]. With transvaginal scans, cardiac motion is usually observed when the embryo is 2 mm or greater in length; if an embryo less than 7 mm in length is seen without cardiac activity, a subsequent scan in one week is recommended to ensure that the pregnancy is nonviable [18-22]. Amnionicity and chorionicity should be documented for all multiple gestations [26-28]. Appropriate fetal anatomy for the first trimester should be assessed and include the calvarium, fetal abdominal cord insertion, and presence of limbs when fetus is of sufficient size [31-35]. The nuchal region should be imaged, and abnormalities such as cystic hygroma should be documented. A quality assessment program is recommended to ensure that false-positive and false-negative results are kept to a minimum [11,12]. The image must be magnified so that it is filled by the fetal head, neck, and upper thorax. The fetal neck must be in a neutral position, with the head in line with the spine, not flexed and not hyperextended. Electronic calipers must be placed on the inner borders of the nuchal line with none of the horizontal crossbar itself protruding into the space. The uterus, including the cervix, adnexal structures, and cul-de-sac, should be evaluated. The presence, location, appearance, and size of adnexal masses should be documented. The measurements of the largest or any potentially clinically significant leiomyomata should be documented. Includes suspected placenta previa, vasa previa, and abnormally adherent placenta r. Suspected uterine anomalies In certain clinical circumstances, a more detailed examination of fetal anatomy may be indicated [4]. Fetal cardiac activity (by video clip or M-mode), fetal number, and presentation should be documented. Abnormal heart rate and/or rhythm should be documented Multiple gestations require the documentation of additional information: chorionicity, amnionicity, comparison of fetal sizes, evaluation of amniotic fluid volume in each gestational sac, and fetal genitalia (when visualized. A qualitative or semiquantitative estimate of amniotic fluid volume should be documented. The placental location, appearance, and relationship to the internal cervical os should be documented. The umbilical cord should be imaged, and the number of vessels in the cord documented. The placental cord insertion site should be documented when technically possible [70,71]. It is recognized that apparent placental position early in pregnancy may not correlate well with its location at the time of delivery. Transvaginal or transperineal ultrasound should be performed if the relationship between the cervix and the placenta cannot be assessed. Color and pulsed Doppler ultrasound should be performed to assess vasa previa or abnormal placenta cord insertion [75]. Gestational age assessment First-trimester crown-rump measurement is the most accurate means for sonographic dating of pregnancy. Beyond this period, a variety of sonographic parameters such as biparietal diameter, abdominal circumference, and femoral diaphysis length can be used to estimate gestational age. It should be noted that abdominal circumference is the least reliable of these measurements for estimating gestational age [76,77]. The variability of gestational age estimation, however, increases with advancing pregnancy.
See also Complete blood count Hepatitis C virus medicine for pink eye order generic epitol canada, 392�393 anemia screening and medicine vs engineering buy epitol cheap online, 224 breastfeeding and medicine hat alberta canada buy genuine epitol on line, 290�291 third trimester measurement of, 116 health care worker vaccination, 442�443 Hemoglobin electrophoresis, 214 internal fetal monitoring and, 179 Hemoglobin H disease, 215 milk donor testing for, 293 Hemoglobinopathies, 213�215. See also Dehydration Hormonal contraceptives, 205 preterm labor and, 258 Hospice care, 376 Hydrocephalus (hydrocephaly) Hospital discharge. See Discharge posthemorrhagic, 323 Hospitalists, 22 toxoplasmosis and, 434 Hospitalization. See also Intensive care unit; Hydrocortisone, postnatal, bronchopulmonary Neonatal functional units; Obstetric dysplasia and, 351�352 functional units Hydrops, 238, 406 antepartum, 243�244 Hydroxyzine, neonatal withdrawal and, 336�337t intrapartum, 170�175 Hyperbilirubinemia. See Diabetes mellitus breastfeeding and, 290 Hypertension discharge readiness and, 153 admission policies on, 171 infants exposed to, 342 adult-onset, small for gestational age infants medical risks with, 337 and, 235 milk donor testing for, 293 bariatric surgery and, 218 recommended consultation for, 477, 479 chronic, 230, 232 women with syphilis and, 428 antepartum management, 233�234 Illumination, 55�56 diagnosis, 233 Imiquimod, 404 intrapartum management, 234 Immunizations. See also Vaccines, live fetal well-being tests and, 144 antepartum, 117�119, 413�414 gestational, 230 Bacille Calmette�Guerin, 427 intensive care admission of obstetric patients for health care workers, 442 and, 244�245 hepatitis A virus, 99, 118, 386 intrauterine drug exposure and, 338 human papillomavirus, 99, 404 postpartum follow-up on, 208 influenza viruses, 98, 118, 198, 295, 442 preconception care for, 101 measles, 99 preeclampsia and eclampsia and, 231 measles�mumps�rubella, 99, 118�119, 413�414 in pregnancy meningococcus, 99, 118 chronic hypertension, 232�234 of neonate exercise and, 138 after discharge, 313 fetal well-being tests and, 144 counseling on, 202 incidence and definitions, 230 for hepatitis B. See Hepatitis B virus, new preeclampsia and eclampsia, 231�232 born immunization routine testing and, 146 for human immunodeficiency virus coinfec recommended consultation for, 477 tions, 402�403 stillbirth and, 261 hospitalized, 366�367 venous thromboembolism in pregnancy and, pneumococcus, 99, 118 225 postpartum maternal, 198 Hyperthyroidism postpartum monitoring, 208 preconception control of, 100�101 preconception, 98�99 pregnancy and, 222�223 rotavirus, 366 Hypervolemia, 269f tetanus�diphtheria acellular pertussis, 98�99, Hypocapnia, 324 198, 422�423 Hypoglycemia varicella zoster virus, 99, 413�414 gestational diabetes mellitus and, 227 web sites on, 406 late preterm infants and, 280 Immunoglobulin A, 435 in newborns, 299�300, 333�335, 334f Immunoglobulin G, 393, 434 uncontrolled pregestational diabetes mellitus Immunoglobulin M, 434, 435 and, 220 Inactivity period, obstetric privileges after, Hypotension, multifetal pregnancy reduction 486�488 and, 242 Incarcerated women, antepartum care for, Hypothermia, 270 151�153 mild, hypoxic�ischemic encephalopathy and, Incontinence, pertussis and, 422 324�325 Incubator cleaning, 458�459 Hypothyroidism Indomethacin, 324 neonatal, 142 Induced termination of pregnancy preconception control of, 100�101 definition, 500�501 pregnancy and, 222, 223 measures of, 507 Hypotonicity, neonatal, 284b reporting requirements and recommendations, Hypoxemia, as reversible, 347�348 509�510 Hypoxic cardiorespiratory failure, 347�349 Induction of labor Hypoxic�ischemic encephalopathy, 324�325 abnormal fetal well-being tests and, 146 Hysterectomy cervical ripening and, 180�181 gravid, cesarean delivery on maternal request isoimmunization and, 238 and, 193 pregestational diabetes mellitus and, 221 postpartum hemorrhage and, 254, 255 for premature rupture of membranes, 179, 260 Hysteroscopic sterilization devices, 203�204 stillbirth and, 261 index 563 Infant abduction prevention, 305 Infections (continued) Infant death. See also Neonatal death postpartum hemorrhage and, 254 definition, 499 postpartum visits and, 305 reporting requirements and recommendations, rubella, 409�411 509 sexually transmitted. See also Occupational exposure infections to bloodborne pathogens spirochetal, 427�433 antibiotics, 450 toxoplasmosis, 433�435 cohort programs, 451�452 transmissible, admissions policies on, 172 dress codes, 444�445 tuberculosis, 424�427 environmental, 454�460 varicella zoster virus, 411�414 noncritical surfaces, 456�458 viral, 383�414 nursery linen, 460 West Nile virus, 414 patient care equipment, 458�459 workplace, Occupational Safety and Health sterilization and disinfection, 455�456 Administration guidelines on, 441�442 hand hygiene, 444 Infertility health care-associated infections and, 439 abnormal body mass index and, 102 labor and delivery admissions policy, 440 sexually transmitted infections and, 99, 415, 416 neonatal considerations, 446�454 treatments nursery admission policy, 440�441 assisted reproductive technology for, 105 obstetric considerations, 445�446 prenatal care visit frequency and, 107 personnel health standards, 442�444 Influenza viruses, 98, 118, 198, 295, 404�406, postpartum infections and, 450�451 442 prevention and, 440�454 Informed consent standard precautions, 441�442 for drug or metabolite testing, 129 transmission-based precautions, 453t for interhospital transfer, 80�81 Infections. See also Critical neonates with, 452�454, 453t care; Neonatal intensive care units parasitic, 433�435 Intercostal drain placement and removal, 364 pertussis, 422�424 Intercourse pneumocystis jiroveci pneumonia, 403 genital herpes simplex virus infection and, 394 postpartum, 450�451 postpartum, 201 postpartum counseling on, 208 preterm labor and, 258 564 index Interferon, pegylated, 393 Intrapartum care, labor (continued) Interferon-gamma release assay, 114b, 424, 425 fetal heart rate monitoring, 177�180, Interhospital transfer 179�180b for critical care, 89 induction of, 180�181 delivery of extremely preterm neonates and, 250 management of, 176�177 enforcement and penalties for violating federal onset of, 175 patient screening and transfer require premature rupture of membranes, 175�176 ments, 517 multiple gestations, 243 equipment, 84�86 planned home birth, 170 federal general requirements, 517�518 preeclampsia, 232 federal requirements for patient screening and, of pregestational diabetes mellitus, 221�222 513 safety considerations, 169 goals for high-risk patients, 77 underwater births, 170 of incarcerated women, 152�153 Intrauterine devices, 204 maternal, 78 Intrauterine growth assessment, 280 medical�legal responsibilities, 80�81 Intrauterine growth restriction. See also Hyperbilirubinemia assessment of, 280�281 assessment of, 330�331 definition of, 265 breastfeeding and, 329�330 follow-up after discharge, 374 cytomegalovirus and, 383 with hemolytic disease, hyperbilirubinemia follow-up assessment, 331�332 and, 326 follow-up plans for, 307 hypoglycemia and, 299�300, 333�335, 334f hepatitis B and, 387 safe transportation of, 312 in newborns, 301, 303b, 306 Laundering, 54, 444�445, 457, 460, 523 parent education on, 310 Lay midwives, 494 in preterm infants, 326 Leadership, quality improvement and, 62�63 vacuum extraction and, 190 Lead exposure, prenatal, 141 Jehovah�s Witnesses, 322 Learning disability, infants on extracorporeal Jitteriness, neonatal, 284b membrane oxygenation and, 349 Joint Commission, 67, 70, 169, 186 Legal issues Joint Committee on Infant Hearing, 298 drug use testing during pregnancy, 338 family and medical leave, 157 K interhospital transfer, 77, 80�81 Kell antibodies, alloimmunization and, 238 pregnant adolescents, 151 Kernicterus, 325, 326 Lethargy, neonatal, 284b Ketoacidosis, diabetes and, 219 Leukomalacia, periventricular, 323, 324 Kick counts, 145, 146�147 Level I care facilities. See also Subspecialty care precipitous, intrauterine drug exposure and, facilities 338 advanced practice registered nurses for, 32�33 premature, exercise during pregnancy and, 138 hypoxic�ischemic encephalopathy care at, 324 premature rupture of membranes, 175�176 medical providers for, 25�26 preregistration for, 173 personnel and equipment for, 15�16 preterm, 158 Level of consciousness, neonatal, 280 preterm admission policies, 171 Levels of care, classification system, 30�33. See safety considerations, 169 also Interhospital transfer trial of labor after cesarean delivery, 159�160 Levonorgestrel intrauterine device, 204, 205 Labor and delivery health care providers Levothyroxine, 223 birth plan and, 174 Licensed direct-entry midwives, 491, 492�493, labor management by, 176�177 494 mother�s arrival in labor area and, 173 Licensed midwives, 491, 492�493, 494 Labor dystocia, 189b, 256 Lidocaine, 286, 364�365 Laborists, 22 Lighting, 55�56, 366 Lactation. See also Bronchopulmonary dysplasia Maternal�fetal medicine specialist chronic, retinopathy of prematurity and, 353 antepartum hospitalization and, 243 restrictive twin�twin transfusion syndrome and, 242 exercise during pregnancy and, 138 Maternal fever, uncomplicated, breastfeeding intrauterine growth restriction and, 236b and, 291 Lupus anticoagulant, antiphospholipid syndrome Maternal hemorrhage, 254�255 and, 211 Maternal morbidity and mortality. See also Lupus erythematosus, systemic, 144 Maternal death Lyme disease, 432 asthma and, 212 Lymphadenopathy, generalized, 434 sickle cell disease and, 215 Maternal risks, postterm pregnancy and, 255�256 M Maternal serum alpha-fetoprotein Macrocytic anemia, 224 aneuploidy and, 123, 124 Macrosomia neural tube defects and, 125, 126 bariatric surgery and, 218 recommended consultation for, 479 gestational diabetes mellitus and, 227 Maternal transport, 78. See Midwives & Mothers in aspiration, postterm pregnancy and, 255 Action management of, 279 Managed care, return transport and, 89�90 nasopharyngeal suctioning, 271 index 567 Medicaid programs, 517 Mediterranean ethnicity Medical complications before pregnancy, 211�223 anemia and, 113t antiphospholipid syndrome, 211�212 genetic screening for, 121t asthma, 212�213, 214b hemoglobinopathies and, 214 hemoglobinopathies, 213�215 Medroxyprogesterone acetate injections, 205 inherited thrombophilias, 215�216 Membrane examination, fetal death and, 261 obesity and bariatric surgery, 216�218 Membrane rupture. See Rupture of membranes pregestational diabetes mellitus, 219�222 Membrane stripping, labor induction and, 181 thyroid disease, 222�223 Mendelian inheritance disorders, 120, 121t Medical errors Meningitis, 417 communication and, 69 Meningococcus vaccine, 99, 118 disclosure of, 70 Menstrual dates, for estimated date of delivery literacy and language barriers and, 5 calculation, 109 patient safety and, 67�68 Mental illness of parent, discharge readiness and, Medical insurance 307 hospital medical screening and, 517 Meprobamate, neonatal withdrawal and, public, at late preterm infant delivery, 281 336�337t Medical record(s. See also Informed consent Metabolite screening of abuse, 132 informed consent for, 129 of antepartum hospitalization, 244 in newborns, 297 electronic, 38, 173 Methadone, 337, 343 of evaluation for labor, 172, 173 Methamphetamine, nursing infants and, 337 interhospital transfer and, 517 Methemoglobinemia, 364 of intrauterine growth, 280 Methicillin-resistant Staphylococcus aureus, 454 of management of labor, 177, 178 Methyldopa, 234 of neonatal information, 279 Microcephaly, 383, 434 on operative vaginal delivery, 191 Microcytic anemia, 113t, 121t, 224 of physician to care for newborn, 175 Midpelvis operative vaginal delivery, 191 on postpartum orders, 196 Midwifery Education Accreditation Council, prenatal, 173�174 492�493, 495 of routine laboratory tests, 112 Midwives, 23 of trial of labor after cesarean delivery and elec Midwives, glossary of organizations and terms, tive repeat cesarean delivery, 190 491�496 transfer to neonatal care of, 265 Midwives & Mothers in Action, 494 of vaccines, 118 Midwives Alliance of North America, 492�493, vaginal birth after cesarean delivery and trial of 494�495 labor after cesarean delivery consider Midwives Model of Care, 493, 495 ations and, 159, 160 Mild chronic hypertension, 233 of venous thromboembolic events, 225 Milk Medical screening examination requirements, for banked human, 293 transfer, 513�514 collection and storage, 291�293, 292t Medications. See also specific medications human, for preterm infants, 359 admission evaluation of, 172 preparation area, 51 antenatal corticosteroid therapy and, 248�249 Minerals assessment in high-risk infants, 378 neonatal supplementation, 294 contraindications for breastfeeding and, 291 preconception supplementation, 104t, 105 critical care in pregnancy and, 245 for pregnant and lactating adolescents and delivery of extremely preterm neonates and, women, 135�136t 250 toxicity during pregnancy, 139�141 for genital human papillomavirus during preg Miscarriage. See Fetal death nancy, 404 Misoprostol, 261 maternal, medical record of, 279 Model State Vital Statistics Act and Regulations milk donor testing for, 293 (1992), 2011 revisions to, 508 misuse and abuse during pregnancy, 100, 152 Modified biophysical profile, 145, 149�150, 236 neonatal resuscitation, 273�274 Monochorionic diamniotic multiple gestation, preconception history taking of, 101 145 psychotropic, teratogenic effects of, 246 Monochorionic placentation, 241. See also safe practices for, 69 Multiple gestations teratogenic potential of, 141�142 Mood disorders, postpartum, 202�205. See also therapeutic drug level, bariatric surgery and, Emotional responses, postpartum; 219 Psychosis, postpartum 568 index Mood swings, severe, intrauterine drug exposure National Organization for Competency Assurance, and, 338 495 Mother�infant relationship, 205�206, 313, 314 National Patient Safety Goals, 67 Motor vehicle crashes, trauma during pregnancy National Practitioner Data Bank, 21�22 and, 246 National Pregnancy Mortality Surveillance Multidrug-resistant M tuberculosis, 427 System, 500 Multidrug-resistant organisms, 454 National Quality Measures Clearinghouse, 64 Multifetal pregnancy reduction, 242 Nausea, in pregnancy, 139, 219 Multiple gestations Nebulizer cleaning, 459 antepartum management Necrotizing enterocolitis, 338, 346 fetal surveillance, 240 Needle aspiration, of tension pneumothorax, 267 nutritional considerations, 239 Needle safety, 442, 522 prenatal diagnosis, 239�240 Needlestick Safety and Prevention Act (2000), complications 519 death of one fetus, 241�242 Neisseria gonorrhea. See Gonorrhea discordant growth, 145, 241 Neonatal Abstinence Scoring System, 338, growth restriction, 241 340�341f multifetal pregnancy reduction, 242 Neonatal care. See also Neonatal functional units preterm labor and delivery, 240�241 for adopted infants, 314�315 twin�twin transfusion syndrome, 242 Ballard Score and, 282�283f delivery considerations, 194 breastfeeding, 287�293, 289t, 292t incidence of, 239 catheter-related bloodstream infections, infant identification in, 278 446�448 intrapartum management, 243 for chlamydia, 415�416 intrauterine growth restriction and, 236b circumcision, 286�287 neonatal resuscitation readiness and, 267 classification system for, 13�16 preeclampsia and eclampsia and, 231 clothing, 287 prenatal care visit frequency and, 107 communication of information, 278�279 recommended consultation for, 479 congenital syphilis, 428�429, 430�431f, retinopathy of prematurity and, 353 431�432 Multisystem organ dysfunction, surfactant therapy conjunctival care, 284 and, 347 in delivery room Mumps, 99, 442. See also Measles�mumps� assessment, 268, 269f, 270, 274, 275f, 276 rubella vaccine body temperature maintenance, 270 Muscle tone, neonatal, 268, 280 clearing the airway, 270�271 Mycobacterium bovis, 427 positioning, 271 Mycobacterium tuberculosis, 424. See also resuscitation management plan, 266�268 Tuberculosis stimulation, 271 Myocardial infarction, intrauterine drug exposure supplemental oxygen administration, and, 338 271�272 Myxedema, 223 ventilation, 272�273 facilities for, 43�45 N family-centered environment for, 265 Naloxone, 274 follow-up, 313�314 Narcotics. See Opioids for gonorrhea, 417 Nasopharyngeal suctioning, 270�271 health care-associated pneumonia, 448�450 National Academy of Sciences, 133 hospital discharge National Association of Certified Professional of healthy newborns, 306�308 Midwives, 495 of late preterm infants, 309 National Center for Health Statistics, 64, 508, infant identification, 265, 278 510 infant security, 305 National Commission for Certifying Agencies, nurse�patient ratios, 30 495 in nursery National Diabetes Data Group, 228, 228t assessment, 280�283 National Fetal and Infant Mortality Review, 66 maturity assessments, 282�283f National Heart, Lung, and Blood Institute, 350 potential illness signs, 284b National Institute of Child Health and Human parent education and psychosocial factors, Development, 178, 249, 325 309�312 National Institutes of Health, 216, 240�241 physician-directed follow-up, 308, 309 National Newborn Screening and Genetic postdischarge, 16 Resource Center, 296 postpartum counseling on, 201 index 569 Neonatal care (continued) Neonatal functional units preventive acoustics, 57 immunizations, 295 admission and observation, 47�48 scope of, 265�266 clerical areas, 54 quality improvement indicators in, 65b components, 45 radiation exposure, 365�366 disaster preparedness and evacuation plan, 54 screening education areas, 54 blood spot, 296�298 electrical outlets and electrical equipment, 57 cyanotic congenital heart disease, 304 illumination, 55�56 developmental dysplasia of the hip, neonatal intensive care unit, 50�51 302�303 newborn nursery, 48�49 glucose, 299�300 nursing areas, 53�54 hearing, 298�299 oxygen and compressed-air outlets, 56�57 hyperbilirubinemia, 301, 302f, 303b resuscitation, 45�47 mandated, 295�296 safety and environmental control, 54�55 skin care, 285 scrub areas, 53 toxoplasmosis, 435 special care nursery, 49�50 transitional, 265, 284�287 supporting service areas, 51�52 for tuberculosis, 425�427 wall surfaces, 56 umbilical cord care, 285�286 windows, 56 varicella zoster virus, 413 Neonatal gonococcal infection, 416 visiting policies, 304�305 Neonatal heart rate. See also Neonatal care radiation risk, 365�366 Neonatal narcotic abstinence syndrome, 335, 339b. See Neonatal death respiratory distress syndrome, 345�347 definition, 499 retinopathy of prematurity, 353�356, 355t drug withdrawal in. See Neonatal drug with Neonatal death drawal anticipated, 375�376 with infections, 452�454, 453t bereavement follow-up, 370 influenza viruses and, 405�406 definition, 499 interhospital transfer of, 78�79 determining cause of, 369�370 pain prevention and management, 362�365 home births and, 170 parvovirus B19 and, 406�407 in-hospital support and counseling, 367�369 pertussis in, 424 pertussis and, 422, 424 rubella in, 409, 410, 411 pregnant adolescents and, 151 well-being assessment, information on, 202 prior, recommended consultation for, 478 Nephropathy, 219, 231 Neonatal drug withdrawal Neural tube defects, 124, 125, 217 discharge and follow-up care, 342 Neurobehavioral abnormalities, intrauterine drug management of acquired opioid and benzodiaz exposure and, 338 epine dependency, 342�343 Neurologic diseases, maternal, anesthesia risks maternal nonnarcotic drugs causing, 336�337t and, 186�187 screening, 338 Neuromuscular maturity, signs of, 282f signs of, 335, 337�338, 339b Newborn blood spot screening, 296�298 treatment, 338�339, 340�341f, 342 Newborn care. See Neonatal care 570 index Newborn care providers O choosing, 157 Obesity and obese patients identified, on maternal medical record, 175 anesthesia risks and, 186�187 Newborn nursery, 48�49. See Neonatal intensive care units and, 128 Niemann�Pick disease type A, 121t morbid, cesarean delivery and, 192 Nifedipine, 234 obstetric functional units for, 39 Nitric oxide, inhaled, 348, 352 preconception care for, 101 Non-English speaking parents, discharge readiness preconception weight loss and, 102 and, 153 preeclampsia and eclampsia and, 231 Nonobstetric hospital services, pregnant patients pregestational diabetes mellitus and, 219 in, 244 before pregnancy, 216�218 Nonobstetric surgery in pregnancy, 245�246 residual postpartum weight retention and, 200 Nonreactive nonstress test, 147 stillbirth and, 261 Non�Rh-D alloimmunization, 237 trial of labor after cesarean delivery and, 189b Nonsteroidal antiinflammatory drugs, 258 venous thromboembolism in pregnancy and, Nonstress test, 145, 146, 147�148 225 biophysical profile and, 149 weight gain during pregnancy and, 136�137, intrauterine growth restriction and, 236 137t, 239 modified biophysical profile and, 149�150 Observation�admission�transition nursery, 276 multiple gestations and, 240 Obstetric and medical complications postterm pregnancy and, 256 anemia, 223�225 Normocytic anemia, 224 antepartum hospitalization, 243�244 North American Registry of Midwives, 492�493, critical care in pregnancy, 244�245 495�496 labor and delivery Portfolio Evaluation Process, 496 antenatal corticosteroid therapy, 248�249 Nosocomial infections, surfactant therapy and, births at threshold of viability, 249�250 346 chorioamnionitis, 250�251 Nuchal translucency, aneuploidy and, 121, 123, endocarditis, 251, 252b 124 endometritis, 252�254 Nuclear imaging, teratogenic potential of, 142 fetal pulmonary maturation, 248 Nulliparity, stillbirth and, 261 maternal hemorrhage, 254�255 Nurse�midwives, 23 postterm pregnancy, 255�256 Nurse�patient ratios, 30 premature rupture of membranes, 259�260 Nurse practitioners, 27�33 preterm birth, 256�259 Nursery stillbirth, 260�262 admission policies, 440�441 late preterm infants and, 281 neonatal assessment, 280�283, 282�283f, medical complications before pregnancy, 284b 211�223 newborn, 48�49, 458 neonatal resuscitation and, 267 special care, 49�50, 276 nonobstetric surgery, 245�246 Nursery linen cleaning and disinfecting, 460 pregnancy-related complications, 223�243 Nursing areas, 53�54 psychiatric disease, 246 Nutrition trauma during pregnancy, 246�248 anemia of prematurity and, 321�322 Obstetric death, 500 antepartum, after bariatric surgery, 218�219 Obstetric functional units first-trimester patient education on, 132�133, bed need analysis, 43�45 134�136t, 136 combined units, 39�43 homelessness and, 153 components, 37�39 during labor, 158, 177 delivery, 41�43 multiple gestations and, 239 labor, 40�41 neonatal, 265 postpartum and newborn care, 43 postpartum, 200, 201, 208 Obstetrician�gynecologists preconception counseling, 102�103, 103�104t, antepartum hospitalization and, 243 105 granting privileges for, 481�482 of preterm infants safety education by, 247 after discharge, 361�362 Obstetric nurse, vaginal delivery and, 187 enteral, 359, 360�361t, 361 Obstetric Privileges parenteral, 356, 357�358t, 358 after inactivity period, 486�488 for technology-dependent infants, 374�375 Basic Level, 482 index 571 Obstetric Privileges (continued) Oxygen desaturation, late preterm infants and, for family physicians, 484�485 309, 312 new equipment or technology and, 485�486 Oxygen saturation monitoring, neonatal Specialty Level, 483 pain response and, 362 Subspecialty Level, 483 resuscitation and, 268, 269f, 270, 271�272 Occupational exposure to bloodborne pathogens for special care infants, 375 approved state plans, 520 Oxygen therapy communication of hazards, 527�529 administration of, 268, 269f, 270, 271�272 engineering and work practice controls, bronchopulmonary dysplasia and, 350 521�523 equipment cleaning, 459 exposure control plan, 520�521 home, 375 hepatitis B vaccination, 525�526 retinopathy of prematurity and, 343�345, housekeeping, 524�525 353�354 mandatory universal precautions, 521 Oxytocic agents Occupational Safety and Health Administration in labor induction, 180, 181 guidelines on, 519 postpartum hemorrhage and, 254 personal protective equipment, 523�524 Oxytocin challenge test, 146, 148�149 postexposure evaluation and follow-up, 526�527 P record-keeping requirements, 529�530 Pacific Island descent, late preterm infants and, Occupational Safety and Health Administration, 281 441�442 Pacifiers, safe sleeping and, 311 Ofloxacin, 415 Pain management.
The splints are worn for 3 to 6 weeks as appropriate with treatment progressing according to the patient�s progress medications knowledge order epitol 100 mg overnight delivery. Early active mobilization protocols apply a controlled amount of stress to the repaired tendons symptoms 2015 flu buy generic epitol line, encouraging increased tendon glide with fewer adhesions medications zoloft side effects generic 100mg epitol with amex. Various subprotocols use varying techniques for applying the controlled stress, including, but not limited to, active contraction while using rubber band traction and active contraction in a tenodesis splint. Describe the difference between the congenital anomalies camptodactyly and clinodactyly. This flexion deformity is caused by tightening of the skin, ligaments, and tendons; abnormal musculature; and irregularly shaped bones. It commonly occurs bilaterally at the middle phalanx of the small nger into radial deviation. The deformity is caused by shortening of the phalanx on most often the radial side of the digit. Describe the benets of pressure therapy in the therapeutic management of a burned hand. Pressure therapy is an essential key to preventing or controlling hypertrophic scarring after a burn. Pressure garments applying approximately 25 mm Hg pressure will help control scarring by decreasing circulation to the maturing scar tissue, thereby preventing excessive growth of the scar tissue. Pressure garments are typically elastic customized garments worn over the affected area 24 hours a day. What scar contractures can potentially occur after a burn to the dorsum of the hand Burns to the palmar surface of the hand can potentially result in the loss of thumb and nger extension and abduction. Transfer of a muscle-tendon unit will result in what change in muscle grade using a 0 to 5 muscle grading scale Other variables can affect and decrease the muscle grade of a transfer; however, loss is not automatic. Subsequent deformities, including joint instabilities and subluxations, occur because of the lost integrity of ligaments and tendons. What are common wrist and hand deformities developed by patients with a diagnosis of systemic lupus erythematosus Dene Raynaud�s phenomenon and discuss its etiology, clinical presentation, and treatment. It is often experienced by individuals with vascular disorders, including systemic lupus erythematosus and atherosclerosis, as well as with rheumatoid arthritis. It is also commonly seen in response to repeated digital trauma, vibration, and prolonged cold exposure. The presenting symptoms of Raynaud�s phenomenon often include a �triple response� of vascular changes, although not all individuals experience three color changes and the order of the color changes varies. Typically the digit(s) will assume a blanched appearance (lack of blood flow because of vasospasm), followed by cyanosis (venous pooling), and then followed by reddening of the digit(s) as arterial blood flow returns to the digit(s. Treatment for this disorder consists of surgical removal of the proximal obstruction; patient education on the effects of smoking and caffeine, avoidance of cold and vibration, and avoidance of vasoconstrictive medications; biofeedback; and use of oral vasodilatory medications. Rehabilitation of the hand and upper extremity, ed 5, St Louis, 2002, Vol 46, p 779, Mosby. Cannon N et al: Diagnosis and treatment manual for physicians and therapists, ed 4, Indianapolis, 2001, Hand Rehabilitation Center of Indiana. Rehabilitation of the hand and upper extremity, ed 5, St Louis, 2002, Vol 118, p 1902, Mosby. Rehabilitation of the hand and upper extremity, ed 5, St Louis, 2002, Vol 90, p 1494, Mosby. Rehabilitation of the hand and upper extremity, ed 5, St Louis, 2002, Vol 102, pp 1667-1674, Mosby. Rehabilitation of the hand and upper extremity, ed 5, St Louis, 2002, Vol 27, pp 439-452, Mosby.
A delay in surgery may result in the bowel becoming trapped with resultant gangrene medicine vile generic 100 mg epitol. You should redo the test afer you�ve worked through the unit medications rapid atrial fibrillation purchase epitol australia, to evaluate what you have learned medicine bow order epitol 100 mg overnight delivery. Objectives � When you have completed this unit you should be able to: � Communicate beter with parents. Communication with parents 15-1 Why is it important that you are able to communicate well with the parents of a newborn infant For many months they have been imagining what their infant will look like and how the infant will behave. The frst few days afer delivery are a very special time for parents, therefore, and it is a pleasure for the nurses and doctors to share this experience with them. However, if the infant is not normal and healthy, then the parents are anxious, afraid and confused. Poor communication makes this unhappy experience all the more difcult and unpleasant. Bonding is the special emotional relationship that parents develop with their infant. Bonding starts during early pregnancy, especially afer the mother frst feels her fetus move. Every efort must be made to ensure that bonding takes place, especially in teenage mothers and mothers who do not want the pregnancy. Bonding is ofen poor with preterm infants when the parents are separated from their newborn infant. Anxiety about a sick infant or an infant with a birth defect can also interfere with the normal bonding process. During pregnancy you should encourage the parents to speak about their unborn fetus. When available, an antenatal ultrasound photograph of the fetus strengthens bonding. Allow the mother to hold her infant and put the infant to the breast as soon as possible afer birth. Practising skin-to-skin care (kangaroo mother care) is a very powerful way of promoting and strengthening bonding with both parents. Take a photograph of the infant for the parents if the mother and the infant cannot be together. If the infant is small or ill and has to be cared for in the nursery, the parents must be allowed to visit their infant whenever they want. They can also help with simple nursing procedures such as changing nappies and giving nasogastric feeding. This helps them realise that it is their infant and that the infant �does not belong to the hospital�. Grandparents should be encouraged to visit the newborn infant, especially if the grandmother is going to help care for the infant. However, visiting children must not be allowed to become a nuisance in the nursery. Explain the implications of the abnormalities and stress what can be done to correct them. Managing the family of a sick or dying infant 15-7 How should bad news be told to parents If a fetus or newborn infant has died or is very sick, it is important that the parents be told as soon as possible. A member of staf who knows the parents, or the most experienced member of staf, should give the bad news. Give the parents a momento such as a name band, piece of hair or a Polaroid photograph.
No new adverse events judged as being possibly or probably related to treatment were reported after the 6-month follow-up period treatment that works buy epitol 100mg free shipping. No additional study data is available for this patient after the 6-month follow-up period medications containing sulfa purchase epitol line. Summary of Safety and Effectiveness Page 16 P010039 At the time of the 12-week follow-up visit medications with weight loss side effect epitol 100 mg cheap, all device related adverse events had resolved, except for one patient who had moderate elbow stiffness and mild swelling that was still ongoing at the time of the 6-month follow-up visit. This patient, who had an x-ray with normal findings at baseline and 12 weeks, was unresponsive to treatment and terminated study participation soon after the 6-month follow-up visit for surgery. There were no new device related adverse effects reported during the long -term (3-12month) follow-up period. The results show a good safety profile for the system and show that the system can be used to relieve pain and improve functional activity. Chronic proximal plantar fasciitis is defined as traction degeneration of the plantar fascial band at the origin on the medial calcaneal tuberosity that has persisted for six months or more. The shock wave is generated by discharging a high voltage capacitor located in the Control Unit into a cylindrically shaped coil system in the Hand piece which is surrounded by a cylindrical metallic membrane. The transient magnetic field produced by the coil induces eddy currents in the metal membrane, causing it to repel from the coil, producing a pressure wave. The membrane is immersed in water and the pressure wave produced by the membrane propagates through the water to a concentric parabolic reflector, where it is reflected to a focal point outside of the Hand piece in front of the reflector. Instructions for cleaning and low level disinfection are provided in the Operating Instructions. The hand piece and applicator can be cleaned using a soft cloth and a general purpose surface disinfectant. Because the device is for use in intact skin only, neither high level disinfection nor sterilization are necessary. A patient should fully discuss these alternatives with his/her physician to select the method that best meets expectations and lifestyle. Most patients with chronic proximal plantar fasciitis do not require surgery to relieve the symptoms. The use of shoe inserts (cups and pads), orthotics, oral non-steroidal anti-inflammatory agents, and local steroid injections provide pain relief in most patients. However, symptoms may persist in some patients over an extended period of time despite all forms of conservative management. However, even surgical intervention does not always result in success and could be associated with surgical complications. For the specific adverse events that occurred in the clinical studies, please see Section X below. The testing showed that typical value for the different parameters met the acceptance/performance criteria. In addition, peak positive and negative acoustic 2 pressures were also determined for the minimum flux density setting of 0. Table 1: Summary of Shock Wave Characterization Tests 2 Energy Flux Density Setting: mJ/mm 0. The study was conducted at six (6) clinical sites, all in the United States, with two (2) of the six (6) geographic sites for a single investigator. For the purpose of this study, painful heel syndrome was defined as chronic proximal plantar fasciitis that had persisted for at least 6 months before study enrollment. The patient and the clinician performing the efficacy assessments were blinded; the clinician administering the treatment (active and placebo) was not blinded. All study procedures for both groups were identical except that of the stand-off used. Active or sham procedures were administered at three (3) treatment visits approximately 1 week apart, with subsequent follow-up visits at 6 weeks, 3 months, 6 months, and 12 months after the last treatment session. The primary endpoint of comparison between the Duolith Group and Placebo Group is 3 months after the last treatment session (approximately 14 weeks after randomization.
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