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OB > Comprehensive Final Exam > Flashcards

Comprehensive Final Exam Flashcards

1
Q

Which hormone begins follicle maturation?

A
  • Follicular phase: days 1-14
  • FSH causes maturation of the immature follicle
  • There are also increased amounts of estrogen present
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2
Q

Which hormone is responsible for final maturation, and thus ovulation?

A
  • LH is responsible for final maturation and ovulation

- Luteal phase: days 15-28, in a 28-day cycle

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3
Q

Estrogen

A
  • hormones associated with “femaleness”
  • Estrone, B-estradiol, estriol
  • secreted by the ovaries, then placenta
  • regenerates endometrial mucosa after menstruation
  • inhibits FSH
  • stimulates LH
  • influences myometrium contractility, blood flow, and uterine mass
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4
Q

Progesterone

A
  • secreted by corpus luteum, then placenta
  • responsible for vaginal epithelium proliferation and thickening of cervical mucus
  • hormone of pregnancy (relaces smooth muscle; maintains implantation; prevents rejection of the fetus)
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5
Q

Human Chorionic Gonadotropin (hCG)

A
  • secreted by the trophoblast in early pregnancy
  • stimulates progesterone and estrogen production by the corpus luteum to maintain the pregnancy until the placenta can take over
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6
Q

Human Placental Lactogen (hPL)

A
  • also called human chorionic somatomammotropin
  • produced by the syncytiotrophoblast
  • An antagonist of insulin
  • it increases the amount of circulating free fatty acids for maternal metabolic needs
  • decreases maternal metabolism of glucose to favor fetal growth
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7
Q

Relaxin

A
  • detectable in the serum of a pregnant woman by the time of the 1st missed period
  • inhibits uterine activity
  • diminishes strength of uterine contractions
  • aids in the softening of the cervix
  • has the long-term effect of remodeling collagen
  • primary source is the corpus luteum, but small amounts are believed to be produced by the placenta and uterine decidua.
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8
Q

How long are ova and sperm viable/fertile?

A

Ova: fertile for 24 hours
Sperm: can survive for up to 72 hours; sperm can survive in the female reproductive tract for 48 to 72 hours, but are believed to be healthy and highly fertile for only about 24 hours.

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9
Q

Summarize the 3 shunts unique to fetal circulation

A

-Ductus venosus: fetal blood vessel that carries oxygenated blood between the umbilical vein and the inferior vena cava, bypassing the liver; it becomes a ligament after birth.
-Ductus arteriosus: a communication channel between the main pulmonary artery and the aorta of the fetus. It is obliterated after birth by rising PO2 and changes in intravascular pressure in the presence of normal pulmonary functioning. It normally becomes a ligament after birth but sometimes remains patent
Foramen ovale: special opening between the atria of the fetal heart. Normally, the opening closes shortly after birth; if it remains open, it can be repaired surgically.

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10
Q

Describe placental circulation

A

Maternal uteroplacental circulation:
-maternal BP via the endometrial arteries, spurts blood into the intervillous space
-maternal and fetal blood are very close facilitating gas exchange
-maternal blood bathes fetal chorionic villi
-maternal deoxygenated blood returns into maternal circulation via endometrial veins
Fetal placental circulation:
-fetal blood is well oxygenated from maternal “bathing” of O2
-it flows from the chorionic villi into the single large umbilical vein of the umbilical cord
-the umbilical cord vein takes the blood to the fetus
-the deoxygenated blood from the fetus is carried back to the placenta by 2 umbilical arteries
-these arteries divide into the arteriovenous system of the chorionic villi
-the maternal blood bathes the deoxygenated blood from the fetus and the process is started over

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11
Q

What is the venous structure of the umbilical cord?

A

2 arteries

1 vein

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12
Q

In the umbilical cord, what carries oxygenated blood and what carries deoxygenated blood?

A

Arteries carry deoxygenated blood

Vein carries oxygenated blood

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13
Q

What are some teratogens

A 
Medication
tobacco
alcohol
caffeine
illicit drugs
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14
Q

When are teratogens most harmful and why?

A

Most harmful during the embryonic stage because “everything is forming.”

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15
Q

Subjective signs of pregnancy

A
  • Presumptive
  • amenorrhea, N/V, excessive fatigue, urinary frequency, changes in breasts, quickening (perception of fetal movement by mother)
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16
Q

Objective signs of pregnancy

A
  • Probable
  • changes in pelvic organs, enlargement of abdomen, Braxton Hicks contractions, changes in skin pigmentation, uterine soufflé, fetal outline, positive hCG
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17
Q

Diagnostic signs of pregnancy

A
  • Positive

- Fetal HR, fetal movement, visualization of the fetus

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18
Q

What are expected maternal weight gains during pregnancy?

A

Underweight: BMI < 18; 24-80 lb gain
Normal weight: BMI 18.5-24.9; 25-35 lb gain
Overweight: BMI 25-29.9; 15-25 lb gain
Obese: BMI >30; 11-20 lb gain

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19
Q

Define gravida, para, and GTPAL

A

Gravida: number of pregnancies
Para: birth after 20 weeks gestation
GTPAL: Gravida, Term, Preterm, Abortion, Living
Gravida: number of pregnancies
Term: infants born 37-42 weeks
Preterm: infants born 20-36 weeks
Abortion: pregnancies ending in either spontaneous or therapeutic abortion
Living: number of living children
**Multiples: gravida/abortions refer to # of pregnancies and are counted as 1; term/preterm/living refers to the actual number of infants

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20
Q

What is GBS?

A
  • Group B streptococcus
  • found in the vagina or rectum of 10 to 30% of pregnant women
  • GBS causes severe, invasive disease in infants
  • Signs of illness include pneumonia, apnea, and shock
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21
Q

When is GBS test done?

A

35-37 weeks gestation

-rectal and vaginal swab of the mother

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22
Q

What does + GBS result mean?

A
  • mother is positive

- given antibiotic prophylaxis at the onset of labor or the rupture of membranes

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23
Q

Describe the 5 variables of the biophysical profile (BPP)

A
  1. fetal breathing movements
  2. fetal movements of body/limbs
  3. fetal tone (extension/flexion of extremities)
  4. Amniotic fluid volume
  5. Reactive NST
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24
Q

How is each section of the BPP scored?

A
  • Normal scored 2; abnormal scored as 0
  • 8-10 reassuring (cannot be related to abnormal volumes of amniotic fluid)
  • 6 equivocal; term-deliver; preterm-reassess in 24 hrs
  • 4 or less; consider delivery
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25
Q

What would be the expected management with a reassuring, equivocal or non-reassuring BPP score?

A

Reassuring: continue pregnancy; reevaluate PRN
Equivocal: term-deliver; preterm-reassess in 24 hours
Non-reassuring: deliver the baby

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26
Q

Describe the prenatal screening of maternal serum alpha-fetoprotein (MSAFP/AFP)

A
  • this is a screening tool; NOT diagnostic
  • may be collected as part of the quad screen
  • measures specific hormones and proteins in the maternal serum to help detect NTD or chromosomal abnormalities (trisomy 18/21)
  • AFP is produced by the fetal liver
  • most accurate if performed between 15-20 wks
  • important to know accurate dates
  • obtain hCG level
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27
Q

Nuchal translucency testing (NTT)

A
  • also referred to as nuchal testing (NT) or nuchal fold testing (NFT)
  • performed between 11- 13 6/7 weeks gestation
  • used to screen for chromosomal abnormalities
  • ultrasound scanning is used to observe the back of the fetal neck
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28
Q

What do altered levels suggest with MSAFP/AFP and NTT?

A

MSAFP/AFP: high levels of AFP may suggest NTD; low levels of AFP may indicate trisomy 18 or 21 (down synd)
NTT: 3mm or greater are at risk for trisomy disorder

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29
Q

Define gestational diabetes

A

A form of diabetes of variable severity with onset or first recognition during pregnancy

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30
Q

What 2 ways should GDM be screened/diagnosed?

A
  • Screening: 1st prenatal visit to asses risk and again via OGTT at 24 to 28 weeks gestation
  • Diagnosis: 50g 1 hr OGTT: 50g oral solution given at any time of day; glucose levels are obtained 1 hour later; levels increased more than 130-140 mg/dL require 3 hr OGTT. 100g 3 hr OGTT: 100g oral solution following 8 hours of fasting; diagnosed if any of the following are exceeded: Fasting 93 mg/dL, 1 hr 180 mg/dL, 2 hour 155 mg/dL, 3 hour 140 mg/dL
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31
Q

Summarize insulin needs during pregnancy & postpartum.

A
  • 1st trimester decreased
  • 2nd/3rd trimester increased
  • Postpartum decreased
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32
Q

Define preeclampsia

A

Toxemia of pregnancy, characterized by hypertension, albuminuria, and edema; diagnosis is increased blood pressure equal to or greater than 140/90, that is first noted in pregnancy, after 20 weeks gestation, with an absence of proteinuria.

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33
Q

What defines preeclampsia without severe features?

A

BP greater than or equal to 160 SBP and/or 110 DPB

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34
Q

What defines preeclampsia with severe features?

A

Thrombocytopenia < 100,000
Impaired liver function (increased liver enzymes)
Renal insufficiency (serum creatinint > 1.1 mg/dL)
Pulmonary edema
cerebral/visual disturbances (HA, clonus, increased DTR)

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35
Q

Describe the process of Rh alloimmunization

A

It occurs when an Rh negative mother carries an Rh positive fetus and red blood cells from the RH+ fetus enter the circulation of an Rh- mother, antibodies are formed. Most commonly, blood mixes at birth; 1st infant usually not affected

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36
Q

What would be the blood type of the mother and fetus with Rh alloimmunization?

A

Mother Rh -

Fetus Rh +

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37
Q

What medication is given to prevent Rh alloimmunization?

A

RhoGAM

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38
Q

Describe the steps of Leopold’s maneuver.

A

1- palpate the fundus. The fetal head is firm, hard and round, the buttocks is softer and has bony prominences. Should be able to start feeling at about 30 weeks gestation.
2- Determine location of fetal back. The fetal back will feel firm and smooth; the fetal extremities will feel small and knobby.
3- determine which fetal part is lying in the pelvic outlet. Grasp abdomen just above the symphysis pubis, should confirm opposite what was found with 1st maneuver.
4- attempt to locate the cephalic prominence. A fetal head that is well flexed, will have the cephalic prominence on the opposite side of the back.

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39
Q

Since most infants are in the cephalic/vertex presentation, what would you feel if the infant is LOA, ROA, LOP, ROP?

A

LOA: head down, face down (toward mom’s spine), back of head in mom’s left side of pelvis
ROA: head down, face down (toward mom’s spine), back of head in mom’s right side of pelvis
LOP: head down, face up (toward mom’s tummy), back of head in mom’s left side of pelvis
ROP: head down, face up (toward mom’s tummy), back of head in mom’s right side of pelvis

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40
Q

Explain FHR baseline

A

The baseline rate refers to the average FHR rounded in increments of 5 beats/minute observed during a 10-minute period of monitoring. This excludes periodic or episodic changes, periods of marked variability, and segments of the baseline that differ by more than 25 beats/minute. You need at least 2 minutes w/in the 10 minutes and they do not need to be consecutive. Normal FHR ranges from 110-160.

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41
Q

Explain FHR variability

A

-The amplitudes of peak and trough in bpm are defined as:
Absent- amplitude undetectable
Minimal- amplitude detectable but less than 5 bpm
Moderate (normal)- amplitude 6 to 25 bpm <– desired
Marked- amplitude greater than 25 bpm
**Reduced variability is the best single predictor for determining fetal compromise. Fetal acidosis and subsequent hypoxia are highest in fetuses that have absent or minimal variability.

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42
Q

Why is moderate variability so important?

A

Moderate variability tells us that the baby is doing well and is well oxygenated.

43
Q

Fetal acceleration

A

An abrupt increase of at least 15 bpm in FHR above the baseline that lasts at least 15 seconds.
**In pregnancies less than 32 weeks, accelerations are defined as an increase of 10 bpm or more above baseline which lasts 10 seconds or more.
A prolonged acceleration is for 2 or more minutes during a 10 minute period. Accelerations that are 10 minutes or longer are considered a baseline change.

44
Q

Fetal decelerataions

A

Early: ok/good; Late: bad; Variable: bad; Prolonged: bad
-Early decel: defined as a usually symmetrical, gradual decrease in FHR and return to baseline associated with uterine ctx. Nadir of the deceleration usually occurs at the same time fo the peak of the ctx. Usually caused by head compression.
-Late decel: define as a usually symmetrical, gradual decrease in FHR and return to baseline associated w/ uterine ctx. The nadir of the deceleration usually occurs after the peak of the contraction. This is a sign of uteroplacental insufficiency.
-Variable deceleration: defined as an abrupt decrease in FHR below the baseline which may or may not be associated with uterine ctx. These can occur at any time. These are U, V, or W shaped. This is a sign of cord compression.
-Prolonged deceleration: defined as a decrease in FHR below the baseline. A prolonged deceleration that is sustained for more than 10 minutes is a baseline change.
Variable —> Cord compression
Early —> Head compression
Accel ——-> OK!
Late ———> placental insufficiency
-Sinusoidal: smooth, sine-like undulating wave pattern with 3 to 5 bpm lasting for at least 20 minutes. This is a sign of m/f hemorrhage, twin to twin transfusion, ruptured umbilical vessels. Pseudo sinusoidal pattern is due to fetal thumb sucking and meds like stadol and fentanyl.

45
Q

Are any decelerations ok?

A

Yes, early are ok as long as there is a return to baseline and nadir is in line with uterine ctx.

46
Q

What defines category 1, 2, & 3 tracings?

A
  • Category 1: things are ok! Normal FHR range, normal variability in the moderate range, absence of late decelerations, accelerations may be present or may be absent, early decelerations may be present or may be absent and they do not represent a nonreassuring status.
  • Category 2: This category means that we may need to provide an intervention.
  • Category 3: This category means we are rushing to C-section. Absent variablility in baseline FHR with recurrent late decelerations, recurrent variable decelerations, and/or bradycardia. Also, sinusoidal FHR patterns.
47
Q

How do we manage non-reassuring fetal heart rate tracings?

A

They require prompt evaluation. Depending on the clinical situation, efforts to expeditiously resolve the abnormal FHR pattern may include, but are not limited to, provision of maternal oxygen, change in maternal position, discontinuation of labor stimulation, and treatment of maternal hypotension. If they are not immediately corrected, hypoxia will occur, therefore birth is required via the fastest route possible.

48
Q

Describe the characteristics of contractions. How do we interpret frequency, duration & intensity?

A

Contractions are characterized by their frequency (minutes), duration (seconds; beginning of contraction to end of contraction), and intensity (measured intensity of the contraction during the acme). They are timed from beginning of contraction to beginning of contraction. You want 5 or less contractions per 10 minutes.

49
Q

Differentiate true and false labor.

A
  • True labor: produces progressive dilation and effacement of the cervix, ctx occur regularly, they increase with frequency, duration, and intensity. They start in the back and radiate to the abdomen, they are not relieved by ambulation.
  • False labor: does not produce progressive dilation and effacement of the cervix, usually irregular, do not increase in frequency, duration and intensity. Usually felt in the lower abdomen and groin, relieved by ambulation, position changes, hydration and rest.
50
Q

Differentiate placenta previa and abruption placentae.

A
  • Placenta previa: the placenta is implanted in the lower uterine segment rather than the upper portion of the uterus.
  • Abruption placentae: the premature separation of a normally implanted placenta from the uterine wall.
51
Q

What are tocolytics?

A

Medications used in an attempt to stop labor. Drusgs currently used as tocolytics include the B-adrenergic agonists, magnesium sulfate, cyclooxygenase inhibitors, and calcium channel blockers.
-Brethine and magnesium sulfate are the most widely used tocolytics.

52
Q

What are some of the side effects of tocolytics?

A
  • Maternal: pulmonary edema, myocardial ischemia, hyperglycemia, hypokalemia
  • Fetal: hypotonia, lethargy that persists for 1 or 2 days after birth, respiratory depression
53
Q

Methods of pain relief during labor.

A
  • Non-pharmacological/Physical comfort: back rub, counter pressure, showers/tub, cool cloths, ambulation/position change, hypnobirth
  • Systemic medications: (analgesia) Stadol/dutorphanol (don’t give with HTN), Nubain/nalbuphine, Demerol/meperdine, sublimaze/fentanyl, morphine.
  • Regional anesthesia: provide temporary loss of sensation by preventing nerve impulse transmission. Most common meds used are Buplvacaine hydrochloride (Marcaine) and Roplvacaine (Naropin).
  • Pudendal block: provides perineal anesthesia for the latter part of the 1st stage of labor, the 2nd stage, birth, and episiotomy repair. Does not provide relief from the pain of contractions.
54
Q

What is good for mothers going “all natural” without an epidural?

A

Non-pharmacological/physical comfort and a pudendal block.

55
Q

What would you do if a mother is experiencing “back labor?”

A

Counter pressure

56
Q

What are the 4 stages/phases of labor?

A

-Premonitory (early) signs of labor: lightening, Braxton hicks contractions, cervical changes, ROM, nesting, increased backache, weight loss of 1 to 3 pounds, diarrhea, indigestion, N and/or V.
-First Stage-
**Latent phase: begins with the onset of regular ctx that increase. Ctx are about 10 to 30 minutes apart and mild (nose) upon palpation. Cervix dilated 0 to 3 cm. Mom is usually anxious but excited.
**Active phase: ctx become more frequent and increase to moderate (chin) intensity. Ctx may occur less than every 5 minutes. Cervix is dilated 4 to 7 cm. Mom may feel she has to focus and work through the ctx. She may feel she is losing control.
**Transition phase: ctx have increased to every 1.5 to 2 minutes apart and are strong (forehead) upon palpation. Cervix is dilated 8 to 10 cm. Mom may feel increased rectal pressure and the need to bear down/push. She may feel very restless and cannot get comfortable. She is focused internally and exhausted, often she is terrified to be alone, yet she wants to be “left alone.”
-Second stage: (pushing)
Begins with complete cervical dilation (10cm) and ends with birth of the infant. Average length of 2nd stage is Primip: 2-3 hours and Multip: 15 to 30 minutes. Crowning. Despite exhaustion from the 1st stage of labor, mom often has a new found strength and sense of purpose.
-Third stage: (placenta)
Begins with delivery of the infant and ends with delivery of placenta. This stage should not last for more than 30 minutes.
-Fourth stage: (recovery)
1 to 4 hours after birth. Mother’s body beings to recover. VS return to normal. Increased hunger and thirst r/t exhaustion from labor. Shaking r/t physical exertion.

57
Q

During what stage would you note crowning?

A

2nd stage of labor.

58
Q

Describe proper technique for pushing during labor.

A

Encourage a gradual expulsion of the infant at the time of birth by encouraging the mother to “push, take a breath, push, take a breath” thereby easing the infant out slowly.

59
Q

Describe Reval Rubin’s taking-in and taking-hold theory of the postpartum period.

A

Soon after birth, the woman tends to be passive and somewhat dependent. The new mother follows suggestions, is hesitant about making decisions, and is still rather preoccupied with her needs. She may have a great need to talk about her perceptions of her labor and birth. This “taking-in” period helps her work through the process, sort out the reality fro her fantasized experience, and clarify anything that she did not understand. Food and sleep are major needs!
By day 2 or 3 after birth, the new mom is often ready to resume control of her body, her mothering, and her life in general. This is termed the “taking-hold” period. She requires assurance that she is doing well as a mother.

60
Q

Describe the steps of the postpartum BUBBLE-EE assessment.

A 
Breasts
Uterus
Bladder
Bowel
Lochia
Episiotomy/Lacerations
Extremities
Emotional status
61
Q

Normal fundal assessment

A
  • Midline; if displaced check for full bladder
  • Degree of involution; U/U, U/1, U/2; will be U/U 24 hours after delivery then down one finger width each additional 24 hours.
  • If midline, but higher than expected (1/U, 2/U) there may be clots in the uterus
  • Firm vs boggy: massage to firm!
  • Afterpains: given pain meds PRN
  • Immediately after birth, at level of umbilicus (U/U)
  • Gradually decreases 1cm/1 finger width Q 24 hrs (PP1: U/1, PP2: U/2, etc)
  • Uterus reaches the pelvis in 10 days; pre-pregnant size and location within 5 to 6 weeks.
62
Q

Normal lochia progression.

A 
-Rubra (rubra past 2 wks often r/t late PPH)
Birth - 3 days
bright red, small clots ok
-Serosa
pinkish color
days 3 - 10 
-Alba
whitish, creamy
may continue until 6 wks PP
63
Q

Postpartum blues

A
  • Normal and common
  • if persistent past 2 wks, need to seek help
  • Educate partner to watch for signs past 2 wks
  • Do not leave infant alone with postpartum psychosis mom!!
64
Q

What are some postpartum nursing care interventions for discomfort?

A

-Pericare
1st 24 hours - use ice to decrease swelling
After 24 hrs - use sitsbath to increase circulation
Peri-bottle - spray from front to back, blot dry
Anesthetic spray - Dermoplast
Tucks pads, anusol cream
Pain medications
Narcotics
NSAIDS
-Breast/nipple pain
Breast shields
Lanolin cream
Ice after feeding and heat before feeding

65
Q

How can nurses promote mother/father/infant attachment?

A
  • Promote skin to skin, ASAP
  • “Rooming in”
  • Direct teaching to BOTH parents
  • En face positioning
66
Q

What is the normal estimated blood loss (EBL) for a vaginal and cesarean delivery?

A

Vaginal 500 mL

C-section 1000 mL

67
Q

What are some early risk factors for PPH?

A
  • Uterine Atony: 50% of PPH cases are attributed to uterine atony
  • Lacerations of the genital tract
  • Retained placental fragments
  • Vulvar, vaginal, & pelvic hematomas
  • Uterine inversion
  • uterine rupture
  • Problems of placental implantation
  • Coagulation disorders
68
Q

What are some late risk factors for PPH?

A
  • Subinvolution of placental site
  • Failure to return to normal size
  • Retained placenta; MOST COMMON cause of late PPH
69
Q

What are some commonly used uterotonics?

**what are some contraindications to keep in mind?

A

Oxytocin: none for PPH
Methergine: Do not give to elevated BP; will cause further increase in BP
Hemabate: Do not give to asmatics (S/E: diarrhea)
Cytotec: Hx of allergy to prostaglandins
Prostin E2: avoid if hypotensive, has asthma, or acute inflammatory disease

70
Q

Combined oral contraceptives (COCs)

A
  • combined estrogen & progestin
  • Monophasic, biphasic, triphasic, quadraphasic
  • Inhibits ovulation and endometrial maturation and thickens cervical mucus
  • comes in 21 days with placebo pills or no pills the last 7 days; 24 days and placebo pills or no pills for 4 days, and extended-cycle pack that’s taken for 84 days and thent ake placebo pills or no pills for 7 days.
  • Advantages: lower risk for ovarian, endometrial, and colorectal cancers, Mittelschmerz eliminated, relief of menstrual symptoms, lower flow and cramps, more regularity, and it treats acne.
  • Disadvantages: must be taken at the same time each day, don’t take while breastfeeding or at least wait 30 days until breastfeeding is established. DO NOT TAKE IF HX OF DVT/HTN or if SMOKER!
71
Q

Combined Contraceptive; Vaginal Ring

A
  • NuvaRing
  • low dose, sustained release hormonal contraceptive.
  • soft flexible ring placed for 3 weeks; removed 1 wk and menses occurs, one size fits all
  • Replacement rings kept in the fridge
  • Advantage: you don’t have to remember to take a pill every day.
  • Disadvantage: it’s not for women who are uncomfortable touching their genitals
72
Q

Combined Contraceptive; Transdermal Patch

A
  • OrthoEvra
  • applied weekly for 3 weeks on abdomen, trunk, buttocks, or upper/outer arm
  • patch free week is when menses occurs.
  • Advantage: you do not have to take a pill
  • Disadvantage: it is not for women weighing more than 198 pounds
73
Q

Progestin only contraceptive (oral)

A
  • mini pill
  • thickens cervical mucus and suppresses endometrial maturation.
  • for BF mothers it dies not interfere with breast milk production or for people who have side effects or a contraindication to estrogen.
74
Q

Progestin only contraceptive (injection)

A
  • Depo-Provera
  • suppresses ovulation and thickens cervical mucus, given IM or SQ q 3 months
  • Advantage: it is estrogen free so it can be given to breastfeeding mothers and it is convenient
  • Disadvantage: causes menstrual irregularities, headaches, weight gain, breast tenderness, and depression.
75
Q

Progestin only contraceptive (implant)

A
  • Implanon
  • prevents ovulation and thickens cervical mucus, administered subdermally in the upper arm via a minor surgical procedure
  • Advantages: is lasts 3 years and is estrogen free
  • Disadvantages: spotting, irregular bleeding/amenorrhea, ovarian cysts, weight gain, fluid retention, acne, mood changes, hair loss, depression
76
Q

Why choose one hormonal contraceptive over another?

Think side effects

A 
-Watch for signs of complications
A - abdominal pain (liver/gallbladder problems)
C - chest pain/SOB (pulmonary emboli)
H - Headaches (HTN, stroke)
E - Eye problems (HTN)
S - Severe leg pain (DVT)
77
Q

What education should nurses provide regarding hormonal contraception?

A
  • Take the same time every day
  • do not protect from STDs
  • Not effective if on antibiotics
78
Q

Summarize nursing care for intrauterine fetal demise/stillbirth.

A
  • Mother and family informed by primary provider, but nurse is major support person
  • Allow the family to dictate their own experience
  • Avoid clichés; can be harmful
  • Utilize active listening; sit in silence with them
  • Resist offering explanations
  • Refer to the baby by name
  • Facilitate mourning process
  • Prepare the family for birth & death
  • Offer to move to a different floor after delivery
  • Postmortem care
  • Community referrals
  • Note date and time of deliver/death
  • Appropriate forms
  • Private burial
  • Hospital burial
  • Autopsy
  • Bathe/cleanse baby carefully
  • Wrap & place hat on baby
  • Name cards and baby bracelets
  • Foot/hand prints
  • Weight/length measurements
  • Memory box
  • Pictures
  • Lock of hair
  • “certificate of being”
79
Q

Describe the APGAR score.

A

-Performed immediately after birth (1 & 5 min)
-evaluates condition of the newborn & how well he/she is adjusting to extrauterine life
-should improve over time
Score 7-10: newborn in good condition; bulb suctioning, blow’by O2
Score 4-6: need for stimulation
Score 3 or less: resuscitation may be needed

80
Q

What are the 5 factors for APGAR and how is each scored?

A

HR: 0-absent; 1- less than 100bpm; 2- over 100 bpm
RR: 0-absnet; 1- slow; irregular; 2- good breathing/cry
Muscle tone: 0-flaccid; 1-some flexion; 2-active mvmnt
Reflex response: 0-absent; 1-grimace; 2-vigorous cry, cough, sneeze, pulls away when touched
Skin color: 0-pale/blue; 1- pink body/ blue extremities; 2- pink body and extremities

81
Q

Describe the steps of the Ballard tool.

A 
Assess posture
Square window (wrist)
Arm recoil
Popliteal angle
Scarf sign
Head to ear
**Determines gestational age of newborn
82
Q

What are things we are concerned about for the preterm newborn?

A

Mother’s antibodies do not cross over until 3rd trimester

Immature lungs r/t decreased surfactant

83
Q

What would suggest a postterm newborn?

A

Skin is dry, cracked, leathery
Popliteal angle < 90
Meconium aspiration (could indicate)

84
Q

What are normal VS of the newborn?

A 
HR: 110-160
RR: 30-60
Temp: 97.5-99 F
BP: not routinely assessed
SBP: 50-70
DBP: 30-45
85
Q

What are normal measurements of the newborn?

A

Weight: 2500-4000g (5lb 8oz - 8lb 13 oz)
Length: 48-52 cm ( 18-22 in)
Head circ: 32-37 cm (12.5-14 in)
Chest circ: 30-35 cm (12-14 in)

86
Q

Acrocyanosis? How will we determine capillary refill?

A

Normal for 1st 24 hours, bluish discoloration of hands and feet
Capillary refill < 3 seconds
NOTE: blanch skin on sternum to determine capillary refill

87
Q

Fontanelles

A

Openings at the junction of cranial bones

  • Anterior: diamond shaped, closes w/in 18 mos
  • Posterior: triangle shaped, closes w/in 8-12 weeks
88
Q

Cephalohematoma

A
  • collection of blood b/t the surface of cranial bone & periosteal membrane.
  • scal feels loose and edematous
  • DOESN NOT cross suture line
89
Q

Caput

A
  • collection of fluid r/t long/difficult labor or vacuum extraction
  • CROSSES suture line
90
Q

Why do infants nose breathe?

A

So they can suck and breathe at the same time.

91
Q

Murmurs

A
  • 90% murmurs transient r/t shunts closing
  • transient murmurs common as transition from fetal to neonatal circulation occurs
  • usually involve incomplete closure of the ductus arteriosus or foramen ovale
92
Q

Palmar & Plantar grasp

A

Elicited by stimulating newborn’s palm with finger or object. Newborn grasps and holds firmly.

93
Q

Tonic neck/ Fencer position

A

Elicited when newborn is supine and head turned to one side, extremities on same side straighten, opposite side they flex. May not be present right away after birth but once present stays until 3 months.

94
Q

Stepping

A

When held upright with one foot touching a flat surface, newborn puts one foot in front of the other and “walks.” Most pronounced at birth and is lost about 4-8 wks.

95
Q

Moro

A

Startle reflex

Present until about 6 months of age

96
Q

Rooting

A

Elicited when side of newborns mouth or cheek is touched, newborn turns toward that side and opens lips to suck.

97
Q

Sucking

A

Elicited when an object is placed in the newborns mouth or anything touches the lips.
Disappears at about 12 months

98
Q

Babinski

A

Gentle stroking of the sole of each food elicits a fanning and extension of the toes.

99
Q

Crib safety

A

back to sleep

no blankets, stuffed animals, or pillows

100
Q

Car seat safety

A
  • Rear-facing until 2 years of age

- turn airbag off on same side as car seat

101
Q

Breastfeeding/bottle feeding

A

Feed baby q 3-4 hrs

Bottle at 45 degree angel; reduces risk of air in the bottle

102
Q

Infant voiding/stooling patterns

A

Meconium: usually passed w/in 24 hrs; thick, tarry, black
Transitional: lasts 1 to 2 days; thin brown to green
BF stool: yellow to green; liquid, seedy; more frequent
Formula: paler and thicker

103
Q

How do you know if the baby is eating enough?

A
  • baby is feeding 8-12 times a day
  • mothers breasts are soft after feeding
  • infant has 6-8 wet & dirty diapers per day
  • weight loss has not exceeded 10% of birth weight.

OB (5 decks)

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