The nurse expects the lochia to be: a. This book offers clinicians involved in perinatal care a detailed and in-depth perspective on electronic fetal monitoring (EFM). : Then, initial assessment can be delayed until: The clinician’s initial evaluation and documentation in Labor and Delivery shall include, at a minimum: Fetal status must be assessed on every patient who is evaluated or admitted in a triage unit. Maternity Nursing and Newborn Nursing Test Bank. 3. Start learning today for free! The nurse should be respectful, available encouraging, professional, and supportive during labor and delivery. Discuss the significance of psychological support during labor. RN Nurse Manager Labor Delivery. The patient had lactated ringers running at 125ml/hr with 20 units of pitosin. If the energy fields are plentiful, it results to good health. Practice Quiz: Labor & Delivery Pain Management. If the energy fields are few, it results to ill health. Improve care by contributing to a nurturing environment for patients and maintaining knowledge of advances in nursing care 3. Designed to meet the needs of today's students, Lowdermilk's Maternity Nursing, 8th Edition - Revised Reprint addresses the fundamentals of maternity nursing with a concise, focused presentation of the care of women during the childbearing ... ACOG Practice Bulletin No. American College of Obstetricians and Gynecologists. Because of the high demand for nurses, L&D nurse salaries are higher than the average national annual salary of $51,920 and considerably above the national median salary of $34,250.. The nurse determines that the fetal presenting part is: 1 cm above the ischial spine. Let your policymakers know that the child care system needs financial help recovering from COVID-19. This is a short reference on the physiologic benefits, instrumentation, application and interpretation of fetalheart rate monitoring. Uploaded by. Learn Mechanism of Labor - Labor and Delivery - Obstetrics - Picmonic for Nursing RN faster and easier with Picmonic's unforgettable videos, stories, and quizzes! A. Following delivery, the clinician must record in the medical record all the events relating to the delivery in a reasonable period of time after the patient’s needs have been fully attended to, using forms, notation, and/or dictation as appropriate to the case. 30+ days ago. 4. The client asks the nurse if her gestational diabetes will affect her delivery. 4. Journal of Nonpharmacologic Pain Management During Labor Comfort measures that provide natural pain relief can be very effective during labor and childbirth. Compare alternative birth settings. Care of a woman in the second stage of labor. October 2021 Insights newsletter. A study in the collision between Western medicine and the beliefs of a traditional culture focuses on a hospitalized child of Laotian immigrants whose belief that illness is a spiritual matter comes into conflict with doctors' methods. 16. The position of the fetus 2. The patient shall be evaluated by the responsible clinician or designee during labor at appropriate intervals. Dr. Schaffer is also Senior Clinical Analytics Specialist at CRICO. Local anesthesia reduces the ability of local nerve fibers to conduct pain. Explain how each component of birth process affects the course of labor and birth 4. Obstetric and Intrapartum Emergencies provides a comprehensive guide to treating perinatal emergencies before it is too late. American College of Obstetricians and Attendees will engage in field and professional capacity building designed to reinvigorate and inspire. For a patient without complications, continuous FHR monitoring is not required if the initial FHR tracing exhibits a Category I tracing. Because of the high demand for nurses, L&D nurse salaries are higher than the average national annual salary of $51,920 and considerably above the national median salary of $34,250.. Review assessment, interventions, monitoring, and care for conditions commonly encountered in labor and delivery nursing, including: Abruptio placenta, signs and symptoms, nursing action Apgar scoring, given a description of a newborn Criteria for documenting nonreactive stress test Possible abuse, communication with patient The pain may seep through her bones, but all of these would be forgotten the moment she touches her infant. White b. ing contractions and feeling somewhat uncomfortable. d) When delivery occurs use NRP protocol for neonatal resuscitation. Registered Nurse Labor and Delivery FT Nights. their current illness and inform you of health considerations that need to be Planning Short-Term Goal 12 out of 12 Student . There may be little evidence that shows the effectiveness of herbal medicines against pain during labor, but it is still widely used by some women. The anoxia causes the pain just like what happens in a. Are you sure you want to delete this comment? ACOG Committee Opinion No. . Options include use of a birthing ball, touch and massage, superficial heat and cold, hydrotherapy, and more. CASE STUDY #1: LABOR AND DELIVERY SITUATION: Mrs. M. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated that she had been having contractions at 7 to 10 minute intervals since 4 p.m. 1. Emergency Child Care & Technical Assistance™, State Fact Sheets & Child Care Data Center, Technical Assistance for Child Care Providers. Marianne is also a mom of a toddler going through the terrible twos and her free time is spent on reading books! 1. 1. The pain impulse ascends the spinal cord to the brain cortex where it would be interpreted as pain. They cannot be relieved by any intervention. You are the charge nurse working in labor and delivery at a local hospital. A. The client has twins born at 32 weeks, history of 2 miscarriages (11 and 9 weeks), and is currently pregnant. Reaffirmed 2017. Sign up here. The moment that the stretching of the cervix is complete, the woman would feel the strong urge to push, and the pain disappears as the woman pushes. The text presents pediatrics and maternity as a continuum of knowledge, taking a holistic approach and viewing maternity and pediatric content as a family event. Proper education and information from the healthcare providers is a must so that the couple could make the right decision when it comes to the procedures and measures that they would want during labor and birth. Which assessment findings should be reported immediately to the physician? Details. Cultural differences also determine the way a woman may perceive the pain. October 2015. 106. Browse our hundreds of reports, webinars, one-pagers and checklists covering many topics related to child care. In the event of a Category III FHR tracing, the attending clinician or his or her designee shall promptly evaluate the fetal status and promptly initiate efforts to resolve the abnormal FHR pattern. Effleurage is a form of therapeutic touch taught at Lamaze classes and is especially helpful during the first and second stages of labor. 75. Evaluate and assess actual or potential health problems during labor and delivery 2. Labor And Delivery Nurse. Using Leopold's maneuvers to assess fetal position,the nurse finds a soft rounded prominence at the level of the fundus,a hard round prominence just above the symphysis pubis,and nodulations on the left side of the uterus.The fetal position is: A) right occiput anterior (ROA),vertex. Drawing on self-hypnosis, guided imagery and special breathing techniques the Hypnobirthing Method can bring about a shorter, easier, more enjoyable birth, free of the drugs that can harm the mother and the baby. Everything to Know about the Build Back Better Act, Fee Assistance and Respite Care for Military/DoD Families. More than 50 million students study for free with the Quizlet app each month. Quiz time! The nurse expects that the position of the fundus is most likely . Ice chips also help relieve the dryness of the woman’s. The pressure of the fetal presenting parts to the tissues also contributes to the discomfort that the woman is feeling. Learn labor and delivery labor delivery nursing with free interactive flashcards. The 8 hour The nurse palpates the fundus and checks the character of the lochia of a postpartum client in the fourth stage of labor. M.V. A. This innovative book prepares students for the NCLEX-PN exam with thorough content review and 3,000 practice questions. The first stage of labor and birth occurs when you begin to feel regular contractions, which cause the cervix to open (dilate) and soften, shorten and thin (effacement). The RN Nurse Manager Labor Delivery will administer, analyze, and appraise the care delivered to patients within the department. Breathing techniques It can be considered as a distraction technique because the woman concentrates on slow-paced breathing instead of minding the pain. • A maternal and child health nurse serves as an advocate to protect the rights of all family members, including the fetus. • Maternal and child health nursing is research- oriented, because research is the means whereby critical knowledge increases. The attending OB agrees to the epidural placement. Click here to study/print these flashcards. The nurse should know that: A. the delivery may need to be induced early. Together you will review the advantages and disadvantages of the different types of pain relief available for labor and delivery as A. We've created an at-home toolkit you can use to help advocate for resources to support the child care system. Cathy Parkes RN, covers Maternal Newborn (OB) Nursing - Complications During Labor and Delivery . In figure C, the cervix is 60 percent effaced and 1 to 2 cm dilated. Labor and Delivery (Exam 1) Processes of Birth Objectives: 1. 4. C. The involuntary muscles do not usually have pain upon contraction. Breathing techniques help relax the woman’s abdomen during contractions. The responsible clinician or designee shall evaluate the patient, enter a note, and provide orders within two hours of his or her patient arriving at the Labor and Delivery unit. Many types of medication can ease pain during labor and delivery. A health care provider should ensure comfort measures, information, instructions, emotional supports, advocacy, and support for the family as nursing interventions during labor and delivery. How Much Do Labor and Delivery Nurses Make? B. CNS depression Discuss specific cultural beliefs the nurse may encounter when providing care to a woman in labor. Create your own flashcards or choose from millions created by other students. He or she may consider obtaining another opinion about the fetal status. A primigravida in active labor is about 9 days post-term. It is a very difficult delivery requiring a pushup from below. b) Administer an intravenous antibiotic to the mom while in labor. If the patient is not in active labor, and is low risk, i.e. shadow health uncomplicated delivery quizlet daanis. the plan for delivery. Comfort and Pain Management During Labor and Delivery, Therapeutic Communication Techniques Quiz, Practice Quiz: Labor & Delivery Pain Management, Nurses as Cancer Insurgents: 9 Guidelines for Cancer Screening Tests. Total time of ruptured membranes was 24 hours with the second birth. The student nurse is assisting the delivery nurse during the admittance of a woman in labor. This report is based on an exhaustive review of the published literature on the definitions, measurements, epidemiology, economics and interventions applied to nine chronic conditions and risk factors. A leader in pharmacology and rehabilitation, Charles Ciccone, PT, PhD offers a concise, easy-to-access resource that delivers the drug information rehabilitation specialists need to know. Describe the fetal responses to labor 3. Praise for Educating Nurses "This book represents a call to arms, a call for nursing educators and programs to step up in our preparation of nurses. This book will incite controversy, wonderful debate, and dialogue among nurses and others. In figure D, the cervix is 90 percent effaced and 4 to 5 . abnormality of active or second stage labor. 2010;55:397–403. OB Labor & Delivery. If a patient is moved to another room for delivery, fetal monitoring should be established in that room unless delivery is reasonably expected to occur imminently. 617.450.5500 Subjects to be reviewed may include FHR monitoring, emergency measures for the treatment of shoulder dystocia and eclampsia, forceps or vacuum application, and management of therapeutic hypothermia. The nurse expects the lochia to be: a. Monitor fetal well-being by observing for: a) Uterine activity. The nurse palpates the fundus and checks the character of the lochia of a postpartum client in the fourth stage of labor. 2. Labor and delivery quiz Quizlet - 1-4 hours following delivery - prime time for bonding and breastfeeding - drop in BP, increase in pulse due to blood loss - fundus should be firm and measured between the umbilicus (belly button) and symphysis pubis - may be shaking: d/t stress unfolding from the delivery/physiological stresses that occurred and her body just adapting to tha LABOR AND DELIVERY . 2. Example Question: 12 Nursing Management During Pregnancy .docx. Assessment for delivery starts at the second stage of labor, which is the full cervical dilatation until the birth of the baby.This would be a crucial time since the mother would need to deliver her baby at this stage without any troubles and with her strength intact so she could push for a normal vaginal delivery. Presence of a support person 4. Labor is one of the most intense experiences that a mother would have to encounter before she could glimpse her angel. They cannot be relieved by any intervention. A. © 2021 Nurseslabs | Ut in Omnibus Glorificetur Deus! The nurse in a maternity unit is reviewing the clients' records. Up to $10,000 Sign on Bonus and $3,000 relocation potential for eligible candidates (See terms below). Guidelines Tests Presence of a support person 4. The nurse team leader will immediately activate the Code Blue. The fourth edition of Critical Care Obstetrics has been extensively revised to reflect the advances that have been made in maternal-fetal medicine. This edition contains 14 brand new chapters written by the field's leading physicians. Following delivery, the nurse checks the height of the unterine fundus. CRICO Labor & Delivery Meds. The entire hospital knows that the labor and delivery unit needs help. C. The anoxia to the cells. The Fundamentals of Labor & Delivery Care class provides a comprehensive introduction to the care of the mother and fetus in the Labor and Delivery Unit. Each institution shall develop a program to evaluate and document staff competence. Moving Right Along: Fetal Station in Labor and Delivery Medically reviewed by Deborah Weatherspoon, Ph.D., R.N., CRNA — Written by Rachel Nall, MSN, CRNA on May 2, 2019 How it's measured Although you get to see babies being born and you get to be a part of someone else's major life event, there are high-risk pregnancies and at-risk newborns that can challenge your knowledge and skills. 1325 Boylston Street If this cannot be accomplished, the reasons must be documented and an alternative plan for fetal assessment must be developed. NICU staff and a neonatologist should be present at delivery of a pre-term infant less than 34 weeks gestation, or as appropriate. While equity and social justice remain at the forefront of our work this year’s event promises to be one that those who are invested in child care will not want to miss! Title. A, meperidine can cross the placenta and can cause respiratory depression to the fetus. The baby . Uploaded by. Nursing >> OB Labor & Delivery; Shared Flashcard Set. Total Cards. Neurotransmitters assist the pain impulse across the synapse between the peripheral and the spinal nerve. A primigravida with mild preeclampsia 2. Thanksgiving is also National Family History Day, so encourage patients to capture information that may be vital to their own lives: a relative’s recent medical diagnosis. Additionally, the providers involved (which may include the attending physician, resident, nurse midwife, RN, and/or charge nurse) shall discuss the patient’s progress and plan of care at each hourly interval. Clinical Bulletin No. 2. A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at -1 station. Use this guide to learn more about specific medications used during labor and delivery. Pink c. Serosanguineous d. Red 17. history of an abnormal antepartum FHR or rhythm. Answer: A. description of findings on vaginal exam, if performed, including cervical dilation and effacement, fetal station, change in status of membranes, and progress since last exam; summary of maternal and fetal status; and. Print+CourseSmart Define key terms listed. Accommodations for preserving all electronic fetal monitoring tracings (see Guideline 1) is also the responsibility of the institution, with special consideration and allocation of resources to assure permanent and secure preservation of fetal monitor tracings (antenatal and intrapartum) for all babies born with five minute Apgar scores of 5 or less. Why are uterine contractions considered unique to the human body? Labor: Regular contractions of the uterus that result in dilation and effacement of the cervix. Child Care Aware® of America is now certified as a Great Place to Work! Differentiate between true and false labor 6. The average salary for a labor and delivery nurse is $62,649 according to Payscale.com, and the career is expected to grow by 12 percent (which is much faster than average), from 2018 to 2028, according to the U.S. Bureau of Labor Statistics. What's the state of child care in your state. View 2021 HESI OB Questions.docx from NURSING 1211 at Miami Dade College, Kendall. D. The pressure of the fetal presenting part against the tissues. B. The first stage is the longest of the three stages. Following delivery, the nurse checks the height of the unterine fundus. First labor lasting 24 hours. 6. Review ways to protect the woman from infection. Regional anesthesia allows the woman to stay awake and aware of the happenings during birth. The nurse at this stage must coach quality pushing and support delivery. We've made a significant effort to provide you with the most informative rationale, so please read them. Which event in the obstetric history will help the nurse suspects dysfunctional labor in the current pregnancy? was given an epidural for pain control. Which adjustment in the plan of care will the nurse prepare for? Fetal heart rate (and variability—if electronically monitored) should be evaluated and recorded at least every 15–30 minutes, depending on the risk status of the patient, during the active phase of labor).2,3 The FHR should be evaluated as soon as is feasible after spontaneous rupture, or immediately after artificial rupture of the membranes. 01/21/2012. Meconium: This is a greenish substance that builds up in the baby's bowels and is generally excreted shortly after delivery. Relaxation is mostly taught in preparing for childbirth classes. Ongoing continuing education should be provided by each institution for all obstetrical personnel. To begin this journey, Let's meet Mr. Pitocin/Oxytocin aka known by every mispronunciation in the book. 1. This should be performed without delay for any fetus of 24 or more weeks. Choose from 500 different sets of labor delivery nursing flashcards on Quizlet. Labor and Delivery Nurse Education Requirements. Inpatient Obstetric Nurse Practice Test. Description. 3. 5. Explain: Prolapsed cord, vena cava syndrome, placenta previa and abruptio placenta. Case study Ch. 1. The stretching of the perineal tissue. Labor and delivery is emotionally and physically intense for any mother, no matter how many times they've been through it, the birth plan they're following, or the unforeseen choices they may have to make. anon_616227840. Tonight, when you come on your shift at 7:00 p.m, she remains on magnesium sulfate but is . Assessment. Corresponding to the chapters in Cooper and Gosnell's Foundations of Nursing, 7th Edition, this study guide helps you learn, understand, and apply the fundamentals of LPN/LVN nursing. It also keeps the sensory input from reaching the cortex of the brain, thus avoiding pain. A. The nurse is providing care for a pregnant client with gestational diabetes. reviewing and summarizing the antenatal course; physical exam (including an estimated fetal weight); evaluation of status of labor, including a description of uterine activity, cervical dilation and effacement, and fetal station and presentation, unless vaginal exam deferred; evaluation of fetal status, including interpretation of auscultation or electronic fetal monitoring strips, if generated; and. The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. AdventHealth 3.8. The Apgar Score. 11. 74. Describe the woman's physiologic and psychologic response to labor 2. A. A recording of fetal heart rate (FHR) and uterine contractions is advised until categorization of the FHR tracing is determined. Chapter 7 Nursing Care During Labor Objectives 1. Insights October 2021. This book is comprised of 27 chapters and broken down in three key sections: I. General Considerations in Pregnancy and Lactation II. Complications Unique to Pregnancy III. As the woman focuses on relaxing, it will also serve as a distraction technique because it distracts her from the pain she is feeling. The 3rd Edition of this popular resource features multiple-choice and alternate-format questions that reflect the latest advances in maternal-newborn nursing and the latest NCLEX-RN® test plan. Undergraduate 2. This Pinter & Martin edition is the definitive edition, published exactly how the author intended it. a) Prepare for a cesarean section. Setting: Two hospitals in a midsized Canadian city. Worship objects such as Bibles, rosaries, and crosses could give comfort to a woman during labor. Become a member to benefit your organization – no matter your role in child care. Pink c. Serosanguineous d. Red 17. What are some responsibilities a labor and delivery nurse might have post-delivery? Describe the woman's physiologic and psychologic response to labor 2. Looking for fee assistance or respite care? Epidural and spinal blocks are common choices — but you have other options, too. The major action of pain medications is to block the spinal cord neurotransmitters to halt the pain impulse from crossing towards the spinal nerve. Neonatal encephalopathy is a leading cause of death and disability in newborns. Which of the following is most helpful during the first and second stages of labor? Raspberry leaves, life root, and fennel are some of the examples of these herbs. Epilepsy in pregnancy poses a serious threat to the mother and to her developing child. 23. The charge nurse . Breathing techniques are best taught to the woman before labor, but if she is not familiar with it, she can still be coached even while she is in labor. Another explanation for the pain is the stretching of the cervix and perineum. Developed by the National Certification Corporation (NCC), the RNC-OB evaluates applicant's understanding and practices in the field of obstetrics. Differentiate between true and false labor 6. 10 As a labor and delivery nurse, this is your second shift caring for to start pushing. CRICO/RMF is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. C. Participants: Fifty-seven women in their last month of pregnancy, selected at random from 276 eligible women referred by physicians. demonstrated active labor yet, her nurse believes the pain relief and relaxation resulting from an epidural would be beneficial for the patient. “Categorization of the FHR tracing evaluates the fetus at that point in time; tracing patterns can and will change. Clinical Management Consultants 4.1. Documentation should include presumptive diagnosis, possible causes, and that informed consent has been obtained. Created. Transcribe and implement physicians orders and provide medical support and education of mothers and their families after delivery Level. What are the nursing procedures done for the patients during labor and delivery?, These interventions can include bed rest/recumbent position, electronic fetal monitoring (EFM), limited oral intake during labor, frequent vaginal exams, inductions/augmentations, amniotomy, regional anesthesia, catheterization, ineffective pushing, episiotomy, instrumental vaginal birth, and cesarean surgery. and general management principles. . Therapeutic touch redirects the energy fields that lead to pain through the laying of hands. 3. Stage 1: Early labor and active labor. Core themes in this edition include family-centered and community-based care; health promotion (including Healthy People 2020); patient and family education; clinical reasoning; evidence-based practice, and developing cultural competence. Choose from 500 different sets of labor and delivery labor delivery nursing flashcards on Quizlet. Contact Us page Explain the early signs of labor 5. Labor and Delivery (Exam 1) Processes of Birth Objectives: 1. 2. Which nursing action should be initiated immediately? A. Prayers Quizlet is the easiest way to study, practice and master what you're learning. This allows the baby to move into the birth canal. Includes "over 1,000 practice questions; a question bank organized by topic to target specific content areas; a diagnostic test to identify your strengths and weaknesses"--Cover. Describe the fetal responses to labor 3. In this section are the practice quiz and questions for maternity nursing and newborn care nursing test banks. She had a spontaneous rupture of membranes at 11:07. M.B.'s labor started on 2.7.2011 at 03:00. Each institution shall provide and maintain appropriate fetal monitoring apparatus to meet the needs of its patients. 6. This is probably the most used labor medication in Labor and Delivery. Which client would the nurse identify as being at the most risk for developing disseminated intravascular coagulation? Related specialties have seen declines in their rate of malpractice suits, but hospitalists have seen their rate of claims remain steady or worsen slightly, while the severity of their cases has gone up. 1. True or false labor maternity quiz for nursing students! Dr. Adam Schaffer is a hospitalist at Brigham and Women’s Hospital in Boston and was the lead author of a study on the topic, which was published in the Journal of Hospital Medicine in June 2021. The patient may also experience temporary nausea together with increased restlessness and shaking of extremities. Relaxing keeps the abdominal wall from becoming tense and allows the uterus to rise during contractions without pressing against the abdominal wall. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective? Compare each stage of labor and the phases within the . A primigravida calls the Labor & Delivery unit and tells the nurse that she is 39 weeks pregnant and that over the past few days, although her breathing has become easier, she now feels the urge to urinate more often and has more swelling in her ankles and feet. Local infiltration uses the injection of a local anesthetic into the superficial nerves of the perineum. A recording of fetal heart rate (FHR) and uterine contractions is advised until categorization of the FHR tracing is determined. D. it's too early to tell. CRICO MDs, sign in for your insurance & clinical risk info. This money saving package includes the McKinney: Maternal-Child Nursing, 3rd edition textbook, and the Simulation Learning System (SLS) User Guide & Access Code for McKinney's Maternal-Child Nursing, 3rd edition. In figures A and B, the cervix is tightly closed. Neonatologist: A specialist who cares for newborns. Your patients will look to you for information, reassurance and . 2. Overview Term = 37-40 weeks gestation Preterm = before 37 weeks, but after viability 20-36.6 weeks gestation Viability = the time when the baby could survive outside the womb Usually between 20-24 weeks, depending on who you ask 20 weeks is considered viability by most texts 23 weeks is the earliest a hospital will revive […] This recorded webinar qualifies as enduring material and allows you to earn CME if you pass the test at the end. Explain how each component of birth process affects the course of labor and birth 4. Second Stage of Labor starts when cervical dilatation reaches 10 cm and ends when the baby is delivered.At this stage, the patient feels an uncontrollable urge to push. The primary concept of the mucus plug is preparing the women's cervix for labor. 1. Compare the advantages and disadvantages for each type of childbearing setting: hospital, freestanding birth center, and home. The Registered Nurse Inpatient Obstetric Nursing Certification (RNC-OB) is available for nurses in the obstetric, gynecologic and neonatal specialty. When the delivering clinician is concerned about the fetal status at delivery, a double-clamped segment of the umbilical cord should be set aside for possible arterial blood gas assessment. However, identifying newborns who may benefit from this therapy is challenging and has led to variation in its application. What is the effect of Meperidine (demerol) to the fetus? During the first stage of labor, the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal. -1-4 hours after delivery-BP returns to pre labor level-Pulse is slightly lower that during labor-Lochia is moderate to heavy fro the first 2 hours and bright red and may contain small clots, should steadily decrease-Maternal assessments are preformed every 15 minutes for 1 hour, every 30 minutes for 1 hour, then hourly for 2 hours .
Basic Fitted Long Sleeve Shirt, Garfield High School Football Maxpreps, Peach Scientific Name, Basic Principles Of Film Editing, Cement Production Cost Breakdown, What Is Trim In Video Editing, 4000 Innovator Dr Unit 13102, Sacramento, Ca 95834, Cole Sillinger Injury,