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Parallel play is characteristic of what age

Toddlers typically exhibit parallel play, during which they participate in various activities alongside one another but remain primarily independent. Parallel play is without group organization or common goals.


Cooperative play

is organized, requires the ability to follow rules, and involves a leader-follower approach to activities. One or two children direct the activity and assign roles. Cooperative play, which develops during the PRESCHOOL years, is goal-oriented and may involve a formal game or task


Onlooker behavior

is when an interested child sits and observes others at play but does not engage in an activity.



- is a disease due to Toxoplasma gondii, a parasite that infects humans via cat feces or ingestion of undercooked meat.
- In a normal healthy adult, the infection goes unnoticed (no symptoms or only flulike symptoms are present) and causes no long-term damage.
- However, in a pregnant client, the parasite can be passed from mother to baby in utero and can cause significant damage to the growing fetus. If toxoplasmosis is acquired during pregnancy, it can cause stillbirth or serious fetal malformations.
- Pregnant clients should be advised to stay away from a litter box or cat feces to reduce toxoplasmosis risk.



- is a thin, milky white vaginal discharge that is normal during pregnancy.
- It is caused by increased levels of estrogen and is harmless.
- However, leukorrhea may become a problem if it changes color or develops a discernible odor, or if itching or burning occurs


Cervical lacerations

- should be suspected if the uterine fundus is firm and midline on palpation despite continued vaginal bleeding. - The bleeding can be minimal to frank hemorrhage.
- Severe pain or a feeling of fullness is not associated with cervical lacerations.


Complete inversion of the uterus presents

with a large, red mass protruding from the introitus.


A vaginal hematoma

- formed when trauma to the tissues of the perineum occurs during delivery.
- more likely to occur following a forceps- or vacuum-assisted birth or an episiotomy.
- pt reports persistent, severe vaginal pain or a feeling of fullness. If the client had epidural anesthesia, pain may not be felt until the effects have worn off.
- Vaginal bleeding is unchanged.
- The uterus is firm and at the midline on palpation.
- If the hematoma is large, the hemoglobin level and vital signs can change significantly. In a client with epidural analgesia, a change in vital signs may be an important indicator of hematoma.


Uterine atony presents

with a boggy uterus on palpation and an increase in vaginal bleeding


Syndrome of inappropriate antidiuretic hormone (SIADH) secretion results in

- water retention and dilutional hyponatremia
- Clients with SIADH often require hypertonic saline for sodium repletion to increase serum sodium levels with a minimal infused volume of water.


Treatment of Sickle Cell Crisis

Sickle cell disease (SCD) is a hereditary hemoglobinopathy in which normal hemoglobin is replaced with abnormal hemoglobin S in red blood cells. The cells change to a sickle shape with triggers (eg, dehydration, infection, high altitude, extremes in temperature). This causes occlusion of small blood vessels with ischemia and damage to organs.

Sickle cell crisis occurs when inadequate oxygenation or hydration exacerbates sickling and causes red blood cells (RBCs) to clump together in the capillaries (vasoocclusion). Vasoocclusion causes severe ischemic pain, hypoxia, and possible organ dysfunction if left untreated.

Adequate oxygenation and hydration may reverse the acute sickling response. In the sickled state, RBCs cannot carry enough oxygen from the lungs to the tissues, even with supplemental oxygen. The priority intervention is the administration of IV fluids to reduce blood viscosity and restore perfusion to the areas previously affected by vasoocclusion (Option 1). Only after IV rehydration reverses vasoocclusion can nonsickled RBCs effectively carry supplemental oxygen to the tissues

Management of sickle cell crisis focuses on the following:
1. Pain control with narcotics - analgesics are provided around the clock or with patient-controlled analgesia, rather than as needed, to prevent breakthrough pain.
2. Hydration - aggressive intravenous and oral hydration is recommended (to reduce the viscosity of the blood)
3. Oxygenation - to prevent pulmonary complications and provide comfort
4. Infection prevention – age-appropriate vaccination plus pneumococcal, influenza, and meningococcal vaccination
5. Diet - the client is encouraged to have a high-protein, high-calorie diet with folic acid and a multivitamin without iron
6. Folic acid - given to help in the creation of the new red blood cells needed due to the hemolysis

- Don't increase Iron in theses pts - The anemia in SCD is related to the destruction of red blood cells from sickling, not a deficiency in iron. Increased iron intake is not needed. Clients often require blood transfusions and run the risk of iron overload from multiple transfusions.

- Cold promotes sickling and should be avoided. Ice packs are used on joints with bleeding in hemophilia to promote vasoconstriction.


Priority interventions for active or suspected air embolism from a central line:

1. Clamp the catheter to prevent more air from embolizing into the venous circulation.
2. Place the client in Trendelenburg position on the left side, causing any existing air to rise and become trapped in the right atrium.
3. Administer oxygen if necessary to relieve dyspnea.
4. Notify the HCP or call an RRT to provide further resuscitation measures.
5. Stay with the client to provide reassurance and monitoring as the air trapped in the right atrium is slowly absorbed into the bloodstream over the course of a few hours.


latex allergy

The greatest risk factor for latex allergy is long-term multiple exposures to latex products. Powdered latex gloves were banned in the 1990s, and the incidence of latex allergy is decreasing. It is estimated that 73% of clients with spina bifida have a sensitivity to latex. This can be a result of frequent exposure to latex during their lifelong care.

A classic screening question is whether the lips swell when blowing up balloons (which have latex in them). Another is if your hands itch and/or burn after wearing rubber gloves

Some proteins in rubber are similar to plant-derived food proteins. Therefore, certain foods may cause a latex-food syndrome in clients with an allergy to latex. Common foods include bananas, avocados, tomatoes, chestnuts, kiwis, potatoes, peaches, grapes, and apricots

bananas, kiwis, avocados, tomatoes, peaches, and grapes because some proteins in rubber are similar to food proteins


Steps for chest tube removal include:

A chest tube is removed when drainage is minimal (<200 mL/24 hr) or absent, an air leak (if present) is resolved, and the lung has reexpanded.

The general steps for chest tube removal include:
1. Premedicate the client with analgesic (eg, IV opioid, nonsteroidal anti-inflammatory drug [ketorolac]) 30-60 minutes before the procedure to promote comfort as evidence indicates that most clients report significant pain during removal
2. Provide the health care provider (HCP) with sterile suture removal equipment
3. Instruct the client to breathe in, hold it, and bear down (Valsalva maneuver) while the tube is removed to decrease the risk for a pneumothorax. Most HCPs use this technique to increase intrathoracic pressure and prevent air from entering the pleural space (Option 2).
4. Apply a sterile airtight occlusive dressing to the chest tube site immediately; this will prevent air from entering the pleural space
5. Perform a chest x-ray within 2-24 hours after chest tube removal as a post-procedure pneumothorax or fluid accumulation usually develops within this time frame.

- The client should be placed in semi-Fowler's position or on the unaffected side to promote comfort and facilitate access for tube removal.


Testing for CSF

Cerebrospinal fluid (CSF) rhinorrhea (or CSF otorrhea) can confirm that a skull fracture has occurred and transversed the dura.
- If the drainage is clear, dextrose testing can determine if it is CSF. However, the presence of blood would make this test unreliable as blood also contains glucose.
- In this case, the halo/ring test should be performed by adding a few drops of the blood-tinged fluid to gauze and assessing for the characteristic pattern of coagulated blood surrounded by CSF.

- Identification of this pattern is very important as CSF leakage places the client at risk for infection. The client's nose should not be packed. No nasogastric or oral gastric tube should be inserted blindly when a basilar skull fracture is suspected as there is a risk of penetrating the skull through the fracture site and having the tube ascend into the brain. These tubes are placed under fluoroscopic guidance in clients with such fractures.


Polycythemia is expected with COPD because

- The client with severe COPD will have a chronically low oxygen level, hypoxemia.
- To compensate, the body produces more red blood cells (RBCs) to carry needed oxygen to the cells.
- A high RBC count is called polycythemia.


Characteristics of schizophrenia with catatonia

A diagnosis of schizophrenia with catatonia can be made if the clinical features meet the criteria for a diagnosis of schizophrenia and include at least 2 of the following additional features:

- Immobility—the client remains in a fixed stupor or position for long periods
Refuses to move about or engage in activities of daily living
- May have brief spurts of excitement or hyperactivity
- Remaining mute
- Bizarre postures—the client holds the body rigidly in one position
- Extreme negativism—the client resists instructions or attempts to be moved
- Waxy flexibility—the client's limbs stay in the same position in which they are placed by another person
- Staring
- Stereotyped movements, prominent mannerisms, or grimacing


Infants with cyanotic cardiac defects can develop polycythemia

Infants with cyanotic cardiac defects can develop polycythemia (elevated hemoglobin levels) as a compensatory mechanism due to prolonged tissue hypoxia.
- Polycythemia will increase blood viscosity, placing an infant at risk for stroke or thromboembolism
- An infant with polycythemia must stay hydrated.


Decerebrate posturing is a sign

of severe brain damage.

- During assessment, the nurse would observe arms and legs straight out, toes pointed down, and the head/neck arched back


carotid endarterectomy

- surgical procedure that removes atherosclerotic plaque from the carotid artery.
- Clients with carotid artery disease are at increased risk for transient ischemic attack and stroke. Post-surgical risks include cerebral ischemia and infarction as well as bleeding.

- Blood pressure is closely monitored during the first 24 hours post surgery. Hypertension may strain the surgical site and trigger hematoma formation, which can cause hemorrhage or airway obstruction. Systolic blood pressure is maintained at 100-150 mm Hg to ensure adequate cerebral perfusion and avoidance of hemorrhage or strain.


Rationalization - defense mechanism

using excuses to explain away threatening circumstances


Displacement - defense mechanism

transferring thoughts and feelings toward one person or object onto another person or object


Regression - defense mechanism

returning to a previous level of development


Introjection - defense mechanism

taking on the qualities or attitudes of others without thought or examination


Reaction formation - defense mechanism

behaving in a manner or expressing a feeling opposite of one's true feelings


Repression - defense mechanism

keeping unacceptable thoughts or traumatic events buried in the unconscious


sublimation - defense mechanism

transforming unacceptable thought or needs into acceptable actions


When should kids go to the dentist?

children have their first dental visit within 6 months of first tooth eruption or by their first birthday


After delivery of the placenta, how should the fundus be?

- After delivery of the placenta, the uterus begins the process of involution.
- The fundus should be firm, midline, and halfway between the umbilicus and symphysis pubis


A "boggy uterus"

indicates that the uterus is not in a contracted state and there is a risk of excessive blood loss. The contracted uterus muscle compresses the open vessels at the placental site and decreases the amount of blood loss.

- The immediate nursing action when a "midline, boggy uterus" is assessed is to massage the fundus with the palm of the hand in a circular motion.
- Fundal massage stimulates contraction of the uterus.
- If the uterus responds, the nurse should then recheck the uterine tone and position in 30 minutes.

- The first action is to use massage. If the uterus does not respond to massage, the next actions are to administer oxytocin (Pitocin)
- Oxytocin promotes contraction by stimulating the smooth muscle of the uterus.
- The HCP should be notified if there is no response to the massage as this lack of response can indicate complications such as retained placental tissue