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Nursing 132 Exam # 1 > Exam # 1 OB Review > Flashcards

Exam # 1 OB Review Flashcards

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1
Q

Which 3 auxiliary structures develop simultaneously with fetal growth to sustain the pregnancy and permit normal prenatal development?

A

1) Placenta
2) Umbilical Cord
3) Fetal Membranes

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2
Q

What are the 3 functions of the placenta?

A

1) Metabolic
2) Endocrine
3) Transfer of substances between mother and fetus

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3
Q

Te placenta produces some nutrients needed for the embryo and for its own functions. What are some of the substances synthesized?

A

1) Glycogen
2) Cholesterol
3) Fatty Acids

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4
Q

PO2 of maternal blood in the intervillous space is 50mm Hg while the average blood PO2 in the umbilical vein (after oxygenation) is about 30 mm Hg. Name 3 reasons why the fetus can thrive in this low-oxygen environment.

A

1) Fetal hemoglobin can carry 20% to 50 % more oxygen than adult hemoglobin.
2) The fetus has a higher oxygen carrying capacity because of a higher average hemoglobin (15 to 24 g/dL) and hematocrit value (44% to 70%).
3) Bohr Effect - Hemoglobin can carry more oxygen at low PCO2 levels than it can at high ones.

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5
Q

IGg maternal antibodies can be transferred to the fetus to provide temporary (passive) immunity against what types of diseases?

A

1) Rubella*
2) Tetanus*
* Only if the mother is immune

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6
Q

Give an example of when maternal antibodies can be harmful to the fetus.

A

If maternal and fetal ABO blood types of Rh factors are not compatible, the mother may already have or may produce antibodies against fetal RBCs. The mother’s antibodies then may destroy the fetal RBCs, causing fetal anemia or death.

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7
Q

What role do the following hormones play during pregnancy?

1) Estrogen
2) Progesterone

A

1) Estrogen - Causes enlargement of the uterus, enlargement of the breasts, growth of the ductal systems of the breasts, and enlargement of the external genitalia.
2) Progesterone - Changes endometrium into decidua, reduces uterine contraction, and suppresses maternal reactions to fetal antigens to prevent spontaneous abortion.

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8
Q

What are the two fetal membranes (aka bag of waters), which hold the amniotic fluid, called?

A

1) Amnion - Inner membrane

2) Chorion - Outer membrane

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9
Q

What is the normal range of volume of amniotic fluid at term? Define Oligohydraminos and Polyhydraminos.

A

1) Normal Range @ Term - 500 to 1000 mL
2) Oligohydraminos - Less than 500 mL of amniotic fluid @ term.
3) Polyhydraminos (aka hydraminos) - More than 2000 mL of amniotic fluid @ term.

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10
Q

What are the possible causes of Oligohydraminos and what are the fetal implications of this condition?

A

1) Caused by - Failure of kidneys to develop, fetal urine excretion is blocked, or placental blood flow is inadequate.
2) Fetal Implications - Poor fetal lung development and malformations that result from compression of fetal parts.

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11
Q

What are the possible causes of Polyhydraminos?

A

Caused by fetal CNS or GI tract abnormalities that prevent the normal fetal cycle involving ingestion of amniotic fluid.

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12
Q

Name and describe the 3 shunts in the fetal circulation.

A

1) Ductus Venosis - From placenta to Inferior vena cava. It bypasses the fetal liver and goes to the right atrium.
2) Foramen Ovale - From right atrium to left atrium. It bypasses fetal lungs.
3) Ductus Arteriosus - From the pulmonary artery to the pulmonary vein. It bypasses the lungs as well.

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13
Q

Explain Nägele’s Rule as it is used to calculate a woman’s EDD?
For example - LNMP = October 30, 2012

A

Nägele’s Rule - Subtract 3 months from the 1st day of the LNMP, add 7 days, and correct the year if appropriate.
For example - LNMP = October 30, 2012
Subtract 3 months = July 30, 2012
Add 7 days and correct year = August 6, 2013

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14
Q

What is the normal range for the fetal heart rate?

A

110 to 160 beats per minute

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15
Q

How can you distinguish the fetal side of the placenta from the maternal side?

A

1) Fetal Side - Shiny and smooth in appearance, attached to the amniotic sac.
2) Maternal side - Dark red and rough in appearance.

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16
Q

What complications are common with placentas that have accessory lobes and placentas with velamentous insertion of the umbilical cord?

A

1) Accessory Lobe - Lobe could break off.
2) Velamentous Insertion - Sometimes does not have enough Wharton’s jelly and could rupture. Also, fetal umbilical vessels may be torn, and the fetus can hemorrhage.

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17
Q

What is the term for the two sections (segments) that the placenta is divided into?

A

Cotyledons

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18
Q

Describe the effects of Cold Stress on the infant.

A

1) NST - Metabolism of brown fat. This leads to ⬆ production of free fatty acids, which can lead to metabolic acidosis or jaundice.
2) ⬆ Metabolic Rate - Leads to ⬆ use of glucose and ⬇ production of surfactant. This can lead to hypoglycemia and respiratory distress.
3) Vasoconstriction - Leads to pale, mottled skin and shutdown of pulmonary vessels. This can lead to respiratory distress.

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19
Q

What temperature range provides a thermoneutral zone for the healthy, unclothed, full-term newborn?

A

1) Unclothed - 32 C to 33.5 C ( 89.6 F to 92.3 F)

2) Clothed - 24 C to 27 C (75.2 F to 80.6 F)

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20
Q

What are the normal ranges for the following lab values in the newborn infant?

1) RBCs
2) Hemoglobin
3) Hematocrit
4) WBCs

A

1) RBCS - 4.8 to 7.1 million/mm3
2) Hemoglobin - 15 to 24 g/dL
3) Hematocrit - 44% to 70%
4) WBCs - 9,000 to 30,000/mm3 at birth (12,000/mm3 by 4 to 5 days after birth).

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21
Q

If an ⬆ in WBCs in the newborn does not necessarily indicate an infection, how can you assess for infection?

A

An increase in immature WBCs (bands) indicates infection in newborns.

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22
Q

During which weeks of gestation is brown fat developed?

A

Between weeks 32 and 34

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23
Q

At what serum level does jaundice become visible?

A

5mg/dL to 6mg/dL

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24
Q

What is the normal range of specific gravity and normal urine output for a newborn?

A

1) Specific Gravity - 1.002 to 1.01

2) Urine Output - 2 to 5 mL/Kg/Hr

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25
Q

What is the normal range (for a newborn) for the following items?

1) Weight
2) Length
3) Head Circumference
4) Chest Circumference

A

1) Weight - 2500 to 4000g (5lbs, 8oz to 8lbs, 13 oz)
2) Length - 18-22” or 45 to 55 cm
3) Head Circumference - 13 to 15” or 32 to 38 cm
4) Chest Circumference - 12 to 14” or 30 to 36 cm

26
Q

What are the normal ranges for the following vital signs?

1) Temperature
2) Pulse
3) Respirations
4) BP

A

1) Temperature - 97.9 to 99.1 (Axillary) and up to 99.8 (Rectally)
2) Pulse - 120 to bpm, unless sleeping (100) or crying (180)
3) Respirations - 30 to 60 (apnea is common though)
4) BP - 65 to 95 systolic and 30 to 60 diastolic.

27
Q

Explain the significance of acrocyanosis in newborns

A

Acrocyanosis is normal in newborns but if the baby was pink and then became acrocyanotic, then it’s cold stress.

28
Q

What is the significance of thrush in the baby’s mouth

A

Thrush in the baby’s mouth indicates the mother may have a fungal infection in the breast which feels like broken glass in the breast.

29
Q

What can cause asymmetry or the newborn’s chest?

A

Pneumothorax or Diaphragmatic Hernia

30
Q

(T/F) Murmurs are common in the newborn

A

True - 90% are transient ad considered normal

31
Q

What are normal glucose levels in the term infant?

A

1) 40 to 60 mg/dL on day 1

2) 50 to 90 mg/dL after day 1

32
Q

When does bulging of the fontanelles occur?

A

1) When the infant cries

2) When the infant has intracranial pressure

33
Q

What is the significance of a brick red urine stained diaper on the newborn?

A

Signifies he passage of uric-aid crystals and is an early sign of dehydration.

34
Q

Describe the following reflexes in the newborn.

1) Rooting & Sucking
2) Babinski
3) Palmar & Plantar Grasp
4) Tonic Neck
5) Moro
6) Stepping

A

1) Rooting & Sucking - Turns toward any object touching/stroking cheek, opens mouth and sucks rhythmically when finger/nipple is inserted into mouth.
2) Babinski - Stroking the sole of the foot from heel upward across ball of foot will cause all toes to fan out.
3) Palmar & Plantar Grasp - Pressure on palm/behind the toes, will elicit grasp/flexion.
4) Tonic Neck - Fencing position; Infant will extend extremities of on the side to which head is turned, and flex the extremities on the opposite side.
5) Moro - If the infant’s head is dropped back 30 degrees, they will sharply extend ad abduct the arms, which is then followed by flexion and adduction to the “embrace” position.
6) Stepping - When held upright with one foot touching a flat surface, the infant will step alternatingly.

35
Q

If the baby does not have the Moro reflex, what could have happened to the baby?

A

No Moro reflex usually means the baby suffered asphyxia in utero

36
Q

What is the significance of a yellow-brown or green tinge to the cord, skin or nails after birth?

A

This means that meconium was passed before birth.

37
Q

How do you differentiate tremors from seizures in an infant?

A

Hold the infants extremities, if the shaking stops, then it is tremors. If it continues, then it’s a seizure.

38
Q

Where is the best site to assess the baby’s pulse?

A

Brachial pulse

39
Q

Why would you not circumcise a pre-term baby yet?

A

Because the foreskin may be needed for later plastic surgery to repair a defect.

40
Q

What is the most common Tx used for the correction of Congenital Hip Displasia?

A

A Palvik Harness

41
Q

What is the significance of an infant with only one umbilical artery or defects involving the ear?

A

This infant may have renal anomalies and the nurse should observe carefully for urine output to determine if kidneys are functioning adequately.

42
Q

Why is the New Ballard Score used? What is it based on and what are the components?

A

The New Ballard Score is used to determine gestational age based on:

1) Neuromuscular Characteristics - Posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear.
2) Physical Characteristics - Skin, lanugo, plantar surface, breasts, eyes, ears and genitals.

43
Q

What are the factors that initiate respirations at birth?

A

1) Chemical Factors - Decrease in O2 and and Increase in O2 causes impulses to stimulate the respiratory center in the medulla of the brain.
2) Thermal Factors - Abrupt temperature change sends impulses from skin receptors to the brain’s respiratory center.
3) Mechanical Factors - Fetal chest is compressed during birth, forcing fluid out.
4) Factors that maintain respirations - Surfactant & functional residual capacity.

44
Q

What are the 5 areas of assessment used to determine the Apgar score?

A

1) Heart Rate
2) Respiratory Effort
3) Muscle Tone
4) Reflex Response
5) Color

45
Q

What is the difference between a direct and indirect Coombs test?

A

1) Direct Coombs Test - Umbilical cord blood is taken at delivery to determine the baby’s blood type, Rh factor, and antibody titer.
2) Indirect Coombs Test - An antibody titer to determine if the woman has developed antibodies as a result of previous exposure to Rh positive blood (administered at 28 weeks).

46
Q

What are the SxS of RDS?

A

1) Grunting on expiration
2) Tachypnea
3) Retractions
4) Cyanosis
5) Nasal Flaring
6) Respiratory Acidosis

47
Q

What is the difference between vertical and horizontal transmission?

A

1) Vertical Transmission - In utero, either by passage across the placenta, or during labor, as organisms ascend the vagina.
2) Horizontal Transmission - After birth, from hospital staff or equipment, or family members and visitors.

48
Q

What are the SxS of an infection in a newborn?

A

1) ⬇ temperature
2) Respiratory problems
3) Feeding intolerance
4) Lethargy
5) Hypoglycemia
6) Apnea

49
Q

Explain Periodic Breathing Vs. Apneic Spells

A

1) Periodic Breathing - The cessation of breathing for 5 to 10 secs without other changes (normal for infants).
2) Apneic Spells - Lack of breathing lasting more than 20 secs, or accompanied by cyanosis, pallor, bradycardia, or hypotonia.

50
Q

(T/F) The side laying and prone positions facilitate drainage of respiratory secretions and regurgitated feedings.

A

True - These positions, however, are not recommended for normal newborns because they are associated with an increased risk for SIDs.

51
Q

What are the SxS of inadequate thermoregulation?

A

1) Axillary temp < 97.3F and > 98.4F
2) Abdominal skin temp < 96.8F and > 97.7F
3) Poor feeding
4) Irritability followed by lethargy
5) Weak cry or suck
6) ⬇ muscle tone
7) Skin pale, cool, mottled or acrocyanotic
8) Hypoglycemia
9) Respiratory distress
10) Poor weight gain

52
Q

Describe the appearance of a chest radiograph of RDS

A

Chest radiographs show the ground-glass reticulogranular appearance of the lungs.

53
Q

What are the indications and nursing considerations for administering vitamin k to the newborn?

A

Vitamin K (1mg) is given to the newborn to promote clotting factor formation, and ⬇ the risk of hemorrhagic disease.

54
Q

what are the SxS of Hip Displasia?

A

1) Barlow’s Maneuver will dislocate the joint
2) Ortalani’s Test will produce a Hip click and reduce an out hip joint
3) One leg his shorter
4) Gluteal creases are asymmetrical

55
Q

What are the SxS of Hydatimole (molar pregnancy)?

A

1) ⬆ HCG levels
2) Vaginal bleeding
3) Preeclampsia
4) Large uterus
5) Nausea and vomiting
6) No fetal tones

56
Q

what are the SxS of Spontaneous Abortion

A

1) Cramping
2) Backache
3) Bleeding

57
Q

What are the SxS of an Ectopic Pregnancy?

A

1) Missed Period
2) Abdominal/Pelvic pain
3) Vaginal spotting

58
Q

What is considered a normal level for Bilirubin in a newborn?

A

< 12 mg/dL

59
Q

During which weeks of pregnancy is surfactant produced?

A

Between weeks 34 and 36

60
Q

List some of the causes of pathological jaundice (bilirubin levels > 12 mg/dL in 1st 24 hours).

A

1) Infection
2) Metabolic Disorder
3) Incompatabilities between maternal and fetal blood: Rh and ABO Incompatability

61
Q

TPAL

A

1) Term (delivery between weeks 38 and 42)
2) Premature (delivery between weeks 20 and 36 6/7)
3) Abortions (loss before week 20)
4) Living children

Nursing 132 Exam # 1 (3 decks)

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