NURS 335 Study Guide - Cervical Dilation, Uterine Contraction, Trilobite

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aishadresser

14 May 2023

School

VCU

Department

Nursing

Course

NURS 335

Professor

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Document Summary

Four p"s: interrelated components that make up the process of labor and birth. Powers forces that cause the cervix to open and that propel the fetus downward through the birth canal. 2 powers = uterine contractions + mother"s pushing efforts. Uterine contractions primary powers of labor during the first stage (from onset until full dilation of the cervix) involuntary smooth muscle contractions woman cannot consciously cause them to start or stop. Intensity and effectiveness are influenced by many factors. Walking, drugs, maternal anxiety, and vaginal exams. Cause the cervix to efface (thin) and dilate (open) to allow the fetus to descend in the birth canal. Before labor cervix is tubular structure about 2-3. 8 cm long. The cervix thins and shortens d/t contractions simultaneously pushing the fetus downward as they pull the cervix upward (think like pushing a ball out of the cuff of a sock)

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CASE STUDY:

Jolinda Hobble had a history of her left knee slipping out of joint since 1998. She went to see Dr. Ralph J. Verygood, an orthopedic surgeon who recommended corrective surgery after Jolinda had a major dislocation of the left kneecap in July of 2000. As a result of this surgery, Jolinda suffers from palsy of her left foot, a condition evidenced by numbness in her big toe and three adjoining toes, the numbness extending about half way up her foot on both the top and the bottom. Jolinda was advised that she might still experience postsurgical knee problems, including inability to walk altogether. She also says that she was not specifically warned about possible postsurgical numbness to either her left leg or foot. Dr.Verygood says that he did indeed warn Jolinda about this possibility.

The surgery was performed July 31, 2000. Jolinda was placed under general anesthetic and remained unconscious throughout the operation. Dr. Verygood performed a surgical procedure which has the effect of realigning the entire mechanism controlling the kneecap in order to correct the knee dislocation. During the operation a pneumatic tourniquet was applied to Jolinda's leg to help the operation procedure by cutting off the blood supply to the leg to create a dry (bloodless) surgical field. Following surgery Jolinda's leg was wrapped by Nurse Vicky with a padded dressing consisting of expandable bandage extending from the toes to the top of her leg. Nurse Vicky is an employee of the hospital.

Dr. Verygood was scheduled to take a few days vacation after the operation, but he nevertheless checked on Jolinda in the recovery room within one hour of the surgery. He also wrote detailed orders to be followed during his absence.

Jolinda says that she first awakened around dinner time on the day surgery was performed, but that she did not regain full consciousness until the following morning. At that time she became aware of a throbbing pain in her left leg which was concentrated on the knee and foot. Jolinda first complained about the pain to the hospital nurse, Nicky the morning after surgery. Nothing was done about the pain, however, until she was checked by Dr. Greatman, Dr. Verygood's partner, on the second postoperative day. Following Dr. Greatman's visit, Jolinda's bandages were cut off in the foot area giving her some relief and after which she experienced a tingling sensation throughout the whole foot.

Jolinda received follow up care from Dr. Verygood after surgery for about one year and during this time period Jolinda's complaints of pain and numbness in her left foot continued.

Here is some more information to consider: You end up hiring for your expert, Dr. Richard Cutgood, a board certified orthopedic surgeon, who had performed literally thousands of knee surgeries in his medical career. Dr. Cutgood is of the opinion that the risk of the type of injuries Jolida has following this type of surgery was statistically nonexistent.

Dr. Cutgood concluded that the most probable cause of plaintiff's injury was external pressure either from the tourniquet used during surgery or from the application of tight bandages after the operation. He considered the probability of nerve damage during the actual surgical procedure to be small because the surgical knife "isn't long enough to reach over and cut that nerve." Regarding the tourniquet, from his experience tourniquet pressure ordinarily does not result damage to the nerves unless "it is incorrectly applied or it is applied over a bony prominence or the tourniquet itself is defective."

Dr. Cutgood stated that while nothing in the record indicated that defendant did anything wrong during the surgery, he was of the opinion defendant was "below the usual and customary standard of care" as such result "does not generally occur without some untoward action of the surgeon."

Does the doctrine of Res Ipsa Loquitor apply to this case? What does this legal term mean? What are the conditions that need to be present for this doctrine to apply?

ibarra091521

1. The nurse working in a long-term care facility incorporates a focused assessment of
the immune system for all newly admitted patients over the age of 65. Older adults

are more likely to develop problems related to immune function than are middle-
aged people. The focused immune assessment includes a systemic approach based

on age-related changes in immunologic function. (Learning Objective 4)
a. What changes in the immune system in the older adult increase the incidence of
infection and cancer in this population?
b. Explain why older adults may have decreased inflammatory responses.
c. Why are older adults at increased risk of gastroenteritis and diarrhea secondary
to proliferation of intestinal organisms?

2. The nurse educator for an oncology unit is preparing an in-service presentation for
new nurses about the care of patients with immunodeficiencies. Patients with cancer
who are receiving chemotherapy, as well as those with bone marrow transplants, are
immunocompromised and require special attention to assess for signs of infection.
The nurse educator focuses on special care needs of this patient population.
a. What is the rationale for assessing the pulse and respiratory rates for 1 full
minute in a patient with immunodeficiency?
b. What special precautions about dietary restrictions and food preparation should
be included in the teaching for a patient with immunodeficiency?
c. What nursing actions should be implemented to decrease the risk of infection in
the patient with immunodeficiency?
3. Molly Baker, a 22-year-old patient, presents to the clinic with the diagnosis of
allergic rhinitis. She states that she develops paroxysmal sneezing, clear nasal
drainage and congestion, watery, red eyes, and nasal itching from the late spring
until the first frost in the fall. She states that she has a dry cough and voice
hoarseness. She complains of feeling extremely tired, unable to sleep at night, and
having difficulty concentrating on her collegiate course work.
a. What further assessment should the nurse provide?

Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of
fibromyalgia syndrome. The nurse at the clinic obtains a history and physical
assessment of the patient. (Learning Objective 2)
a. On what areas should the nurse concentrate when interviewing the patient
during the history process?
b. On what areas should the nurse concentrate when assessing the patient?
c. What diagnostic tests are used with fibromyalgia syndrome?

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NURS 335 Study Guide - Cervical Dilation, Uterine Contraction, Trilobite

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