PART I; Discussion; pharmacological vs non-pharmacological intervention

discuss pharmacological versus non-pharmacological nursing interventionsused for pain management during labor and birth. list two differentclassifications of drugs used for pain relief during labor and birth, andinclude potential side effects of the drugs on the fetus. also, describe twonursing interventions by the nurse to provide comfort during labor and birththat could be considered as non-pharmacological and the expected outcomes.

PART 2; CASE STUDY; assessment of a pregnant client

Scenario

You are a registered nurse (RN) working in a Women’s OB/GYN Clinic. Elizabeth Jones, 37 years old, presents to the prenatal clinic after missing her last 2 menstrual cycles. Her home pregnancy test was positive. An ultrasound at the clinic confirms pregnancy. Gestational age is calculated to be 10 weeks. An initial assessment of Ms. Jones’s medical and obstetrical history is as follows.

Obstetric/Gynecologic (OB/GYN) history: Uncomplicated spontaneous vaginal delivery at 39.2 weeks (3 years ago); Cesarean section x 1 at 37.5 weeks for non-reassuring fetal heart tones (1.5 years ago); abnormal Papanicolau (PAP) smear x2, + human papilloma virus (HPV), colposcopy within normal limits

Medical history: Chronic hypertension (HTN) x 5 years;

Allergies: Penicillin

Social history:

• (+) tobacco, “occasional” per client (pt), <5 per/day currently, has smoked “off and on” for 15 years
• (+) cocaine use, states she has not used any cocaine/drugs for > 1 year; (-) alcohol use
• Abusive partner with first pregnancy, states she has a new partner x 4 years
• Depression, currently not taking meds for treatment (tx)

Medications: Prenatal vitamins; Labetalol 200mg BID;

Family history: Insulin-dependent diabetes mellitus (mother); HTN and heart disease (father); breast cancer (maternal grandmother, deceased)

Instructions

Write a two to three-page analysis of this scenario that answers the following questions:

1. What should the nurse consider related to caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases and depression?
2. Document the considerations of yourself as the professional nurse in regards to self-awareness; be aware of attitudes, values and beliefs that you hold related to clients from different social backgrounds so that care is not affected negatively.
3. What conditions are in Mrs. Jones history that would cause concern during pregnancy, labor, and birth?
4. What concerns should be discussed with Ms. Jones before she leaves her appointment?

Each answer to your question should include the following:

• A correct answer with thorough development of the topic
• Gives clinical examples
• Include evidence from scholarly sources
• Appropriate use of medical terminology

PART 3; assignment – newborn nutrition teaching presentation[ use a brochure or pamphlet

Instructions

Create a teaching tool to promote breastfeeding. The material created to educate new mothers on breastfeeding will influence the mother’s decision to breastfeed, including duration, based on the quality and content of the teaching.

Assignment Requirements

Your teaching tool will be a trifold and must include this relevant content for a mother considering the risks and benefits of breastfeeding a newborn.

• Explain how breast milk is formed in the mammary glands and the physiology of breast milk
• Include two 2020 National Health Goals related to newborn nutrition to support breast feeding as the best choice. See the link below:
  • https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health
• Discuss the advantages of breastfeeding related to immunities transferred to the newborn
• Describe three additional benefits of breast feeding with supporting rationales
• Include at least two supporting resources
• Document must be written

here is the link to 2020 National Health Goal ; https://www.healthypeople.gov/2020/topics-objectiv…

PART 4; ASSIGNMENT- CHILD OBSERVATION WORKSHEET

Explain the topics in the worksheet by age. Identify one milestone and one expected norm for each category by age group.

After you fill out the milestones and expected norms for each category by age group, observe a child of any age for 30 minutes to an hour, and apply the knowledge that you learned to the child you are observing and record this information in the purple Observation Data column.

PART5; Assignment – Pediatric Assessment Concept Map PDA with RSV

Scenario

You are working in a large urban pediatric clinic after-hours.

A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

• The child is in less than 10^th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
• Born at 36 weeks gestation.
• Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
• T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
  A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.

After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.

The client is discharged with these orders:

• methylprednisolone 0.4 mg/kg oral BID for 3
• Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
• Call if needed prior to the Q4 dose.
• Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
• Return for re-evaluation in 3 days

Instructions

In a two to three-page APA formatted paper, provide reponses for these questions and requests for information:

Criteria:

1. Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
2. Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
3. What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
4. What are the characteristic signs/symptoms of bronchiolitis?
5. Vivi Mitchell been prescribed the following medications; acetaminophen, albuterol nebulizer, corticosteroids. Provide the rationale for why each medication has been included as part of her medical management and explain any potential contraindications related to these medications.
6. You are designing Vivi Mitchell’s plan of care. Identify two priority nursing diagnoses to include in your plan. For each nursing diagnosis, identify two SMART goals, and two interventions for each goal.
7. What short and long-term possible complications should the nurse anticipate?
8. What client education is appropriate for Vivi Mitchell as she is discharged from the after-care clinic?

* Include a minimum of 2 scholarly sources

PART 6; ASSIGNMENT- PEDIATRIC DATA, ASSESSMENT, AND PRIORITIZATION OF INTERVENTIONS

Scenario

A 5-year-old Gabriel is a multiracial male weighing 48 lbs with an allergy to penicillin arrives in the emergency room, no cultural considerations identified. You are handed the following notes on the patient that read:

He arrived in ER with his mother after falling out of bed after jerking movement activity as witnessed by his older brother while sleeping. Right-upper extremity appears with deformity. Mother and child speak English. Child has no significant medical history. Mother reports incontinent of urine during episode.

Your Assessment

Vital Signs: T 102.9, P 135, R 24, BP 118/60, O2 sat 100% RA

General Appearance: appears drowsy; face flushed, quiet

Neuro: oriented X3
Cardiovascular: unremarkable
Respiratory: lungs clear

Integumentary: very warm, dry
GI/GU: abdomen normal

Physician Orders

• Complete Blood Count (CBC)
• Complete Metabolic Panel (CMP)
• Urinalysis with culture and sensitivity (U/A C&S)
• Blood Cultures x 2
• X-rays kidneys,
• Influenza screening
• Acetaminophen 15 mg/kg PO now
• Ibuprofen 10 mg/kg PO now
• Pad side rails
• Suction at bedside with seizure precautions
• Radiographs of right arm
• Cast to right arm
• Start PO fluids and increase as tolerated

The physician discharges Gabriel from ER to home with a diagnosis of; Right ear infection, Acute Febrile Seizure and fracture of the right ulna.

Discharge orders include:

• Follow up with pediatrician in 7 days
• Follow up with pediatric orthopedics in 7-10 days
• Cefuroxime 30mg/kg PO BID for 10 days not to exceed 100mg daily. What is the recommended dosage if cefuroxime is supplied as an oral suspension 125mg/5ml or 250/5ml?
• Acetaminophen 15 mg/kg PO Q4 hours PRN fever or pain and ibuprofen 10 mg/kg PO Q6 hours PRN fever and pain for up to 3 days.
• Acetaminophen is available as 160 mg/5 mL.
  Ibuprofen is available as 100 mg/ 5 mL.
• What is the amount of acetaminophen in mg and ml per dose? What is the amount of ibuprofen in mg and ml per dose?

Instructions

Develop a discharge plan with three goals listed in order of priority, prior to discharge from current orders. Provide rationale for why you listed the goals in a particular order. Also, list three nursing interventions to meet each of the goals (you should have nine interventions in total). Last, give the mother the exact dosage she will need to give the child for acetaminophen, ibuprofen, and the cefuroxime when she gets home and explain why the exact dosage is important.

PART 7; DISCUSSION of PEDIATRIC SAFETY

instructions

This discussion will focus on the importance of teaching a chosen safety concern in the pediatric population. You will present your response in the discussion addressing the following questions: (discussion should be 300 words).

Initial Post:

1. Determine the age and developmental stage and how that impacts the child related to the safety concern.
2. Describe why you believe the safety education you chose will benefit the pediatric population. Who do you believe is the target age range for this specific educational teaching?
3. Describe at least three nursing diagnoses related to the incident you are providing teaching to prevent. Support your choices with rationales citing 1-2 scholarly sources.