DOH NURSING Study Guide 2026

Hyperemesis gravidarum requiring hospitalization is defined by persistent vomiting, dehydration (ketonuria), significant weight loss (>5% pre-pregnancy weight), and inability to tolerate any oral intake. IV fluid and antiemetic therapy are needed to prevent Wernicke's encephalopathy from thiamine deficiency.

Uterine atony (failure of the uterus to contract after delivery) accounts for ~80% of postpartum hemorrhage. Risk factors include prolonged labor, multiparity, overdistended uterus (twins, polyhydramnios), oxytocin augmentation, and magnesium sulfate use. The '4 T's': Tone, Tissue, Trauma, Thrombin.

DOH supports ERAS protocols incorporating preoperative optimization, reduced fasting with carbohydrate drinks, multimodal opioid-sparing analgesia, early mobilization, early oral nutrition, and goal-directed fluid therapy.

DOH mandates use of standardized early warning scoring systems (NEWS/PEWS) with defined trigger thresholds for escalation, including specific criteria for rapid response team activation by any clinical staff member.

Loop diuretics inhibit the Na-K-2Cl cotransporter in the loop of Henle, causing loss of sodium, potassium, magnesium, and chloride. Hypokalemia and hypomagnesemia are common adverse effects requiring supplementation monitoring, especially significant in patients on digoxin.

Accidental decannulation is life-threatening because the child cannot breathe without the tracheostomy tube (or cannot breathe adequately). A replacement tube of the same size and a size smaller must always be at the bedside. This is the highest-priority safety concern.