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NRSG 206: OB > [Exam 3] Chapter 25 – Growth and Development of the Newborn and Infant > Flashcards

[Exam 3] Chapter 25 – Growth and Development of the Newborn and Infant Flashcards

1
Q

How do you adjust age example for boy born at 28 weeks and is 6 months old??

A

Subtract 3 months from chronological age of 6 months so adjusted age is 3 months . Is expected to achieve developmental milestones of 3 month old instead of 6

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2
Q

Physical Growth - Weight: Average newborn weights how much at birth?

A

3400 kg (7.5 lb)

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3
Q

Physical Growth - Weight: Physical Growth - Weight: Average weight gain per day? And when do they regain their birth weight?

A

30 g,

Regain by 10-14 days

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4
Q

Physical Growth - Weight: When is weight doubled and tripled?

A

Doubled by 4 months

Tripled by 1 year old

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5
Q

Physical Growth - Height: How is length here?

A

Grows more quickly in first 6 months than next 6.

By 12 months, length increased by 50%

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6
Q

Physical Growth - Head Circumference: Growth by 1 year of age?

A

Average of 10 cm (4-inches)

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7
Q

Organ System Maturation - Neurologic System and State Of Consciousness: What six stages of consciousness will infant go through?

A 
Deep Sleep
Light Sleep
Drowsiness
Quiet Alert State
Active Alert State
Crying
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8
Q

Organ System Maturation - Neurologic System and State Of Consciousness: What occurs in deep sleep?

A

Sleeping with eyes closed and no movement

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9
Q

Organ System Maturation - Neurologic System and State Of Consciousness: What occurs in light sleep?

A

Sleeping with eyes closed; rapid eye movements and irregular movements may be noticed

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10
Q

Organ System Maturation - Neurologic System and State Of Consciousness: What occurs in drowsiness?

A

Eyes may close or be half-liddled; infant may be dozing

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11
Q

Organ System Maturation - Neurologic System and State Of Consciousness: What is the quiet alert state?

A

Infant’s eyes are wide open and body is calm

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12
Q

Organ System Maturation - Neurologic System and State Of Consciousness: What is the active alert stage?

A

Infants eyes open, body movements occur

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13
Q

Organ System Maturation - Neurologic System and State Of Consciousness: What is the crying stage?

A

Infant cries or screams and it is difficult to gain the infants attention

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14
Q

Organ System Maturation - Neurologic System and Brian Growth: Brain weight by 5 months?

A

Half of that of the adult brain

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15
Q

Organ System Maturation - Neurologic System and Brian Growth: Brian growth at 12 months?

A

Weights 2.5x that it did at birth

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16
Q

Organ System Maturation - Neurologic System and Brian Growth: How long doees the anterior fontanel remain open ?

A

Until 12-18 months of age. But may close as early as 9 months of age

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17
Q

Organ System Maturation - Neurologic System and Brian Growth: Myelination of spinal cord and nerves continues for how long?

A

First 2 years

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18
Q

Organ System Maturation - Neurologic System and Reflexes: Selected primitive reflexes present at birth include? And when do they disappear?

A

Moro, root, suck, asymmetric, tonic neck, plantar and palmar grasp, step, and Babinski

All disappear by 6 months except for Babinski at one year

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19
Q

Organ System Maturation - Neurologic System and Reflexes: What are protective reflexes?

A

Gross motor responses related to maintenance of equilibrium. Include righting and parachute reactions

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20
Q

Organ System Maturation - Neurologic System and Reflexes: What indicates a healthy neurologic system here?

A

Appropriate presence and disappearance of primitive reflexes, as well as development of protective reflexes.

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21
Q

Organ System Maturation - Respiratory System: Change in RR?

A

From 30-60 to 20-30 in 1 year old.

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22
Q

Organ System Maturation - Respiratory System: When changes occur here in comparasion to an adult?

A

Nasal passages narrower

Trachea and chest wall more compliant

Bronchi shorter

Larynx more funnel shapes

tongue is larger

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23
Q

Organ System Maturation - Respiratory System: When does this reach maturity level?

A

7 years of age

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24
Q

Organ System Maturation - Respiratory System: Lack of IgA causes what?

A

Lacks in mucosal lining of upper respiratory tract and also contributes to the frequent infections that occur in infancy

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25
Q

Organ System Maturation - Cardiovascular System: Change in heart size over first year?

A

Doubles in size

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26
Q

Organ System Maturation - Cardiovascular System: Pulse rate change in 1 year old?

A

From 110-160 to about 100 bpm.

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27
Q

Organ System Maturation - Cardiovascular System: How does blood pressure change from first year?

A

60/40 to 100/50

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28
Q

Organ System Maturation - GI System and Teeth: When does teeth growth occur?

A

May be born with one or more teeth or develops teeth in the first 28 days of life (termed neonatal teeth)

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29
Q

Organ System Maturation - GI System and Teeth: When does average tooth begin to emerge?

A

By ages of 6-8 months

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30
Q

Organ System Maturation - GI System and Teeth: First teeth to appear?

A

Lower central incisor, followed by upper central incisors. 4-8 teeth by 12 months

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31
Q

Organ System Maturation - GI System and Digestion: Changes in stomach size at 1 year?

A

0.5 oz to 1 oz, while at 1 year, can hold three meals and several snacks per day

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32
Q

Organ System Maturation - GI System and Digestion: What enzyme available in duodenum at birth?

A

Trypsin for protein digestion

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33
Q

Organ System Maturation - GI System and Digestion: What enzyme available in duodenum at around 5 months of age?

A

Amylase (needed for complex carbohydrate digestion)

Lipase (essential for appropriate fat digestion)

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34
Q

Organ System Maturation - GI System and Digestion: What liver functions remain immature during first year of life

A

Gluconeogenesis, vitamin storage, and protein metabolism

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35
Q

Organ System Maturation - GI System and Stools: Appearance of first stol?

A

Dark green to black and sticky

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36
Q

Organ System Maturation - GI System and Stools: Appearance of stool first few days of life for breast feed and formula?

A

Yellowish or tan

Formula : Peanut butter consistency

Breastfed: Looser in texture and appear seedy

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37
Q

Organ System Maturation - GI System and Stools: Changes in stools as as they grow older?

A

Stools decrease, and some infants do not have stools for several days

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38
Q

Organ System Maturation - GI System and Stools: What faces may infant make while pooping?

A

Often grunt, strain, or cry while attemping to have a bowel movement.

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39
Q

Organ System Maturation - GI System and Stools: When should infants contact primary provider about stools?

A

If they are red, white, or black, mucous like frequency

Foul-smelling or hard or if baby vomiting

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40
Q

Organ System Maturation- Urinary System: How much does ECF/ICF account for in infant?

A

35% and 40%. , meaning infant more susceptible to dehydration

Adults are 20/40%

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41
Q

Organ System Maturation- Urinary System: When do glomeruli reach full maturity?

A

By 2 years of age

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42
Q

Organ System Maturation- Integumentary System: In utero, infant covered with what?

A

Vernix caseosa, which protects developing skin.

Infant may be covered with in in early gestational age, and in folds in later age.

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43
Q

Organ System Maturation- Integumentary System: When does acrocyanosis disappear?

A

Decreases over the first few days of life

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44
Q

Organ System Maturation- Integumentary System: Why do infants erperience mottling of skin (pink and white marbled appearance)

A

Because of immature circulatory system.

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45
Q

Organ System Maturation- Hemoatopoietic System: What happens to fetal hemoglobin as infants grows?

A

Production of fetal hemoglobin near ceases and adult hemoglobin produced in steady amounts for first 6 months

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46
Q

Organ System Maturation- Hemoatopoietic System: What may infants experience at age 2-3 months?

A

Physiologic anemia, because fetal hemoglobin has shorter lifespan

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47
Q

Organ System Maturation- Hemoatopoietic System: What happens to iron?

A

Iron stores reclaimed when fetal hemoglobin dies. Sufficient for 6-9 months. Needed for first 15 years of life

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48
Q

Organ System Maturation- Hemoatopoietic System: When is maternal irons tores transferred to fetus?

A

Throughout the last trimester of pregnancy.

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49
Q

Organ System Maturation - Immunologic System: What do know about IgG?

A

Get from mothers. Offers immunity for 3-6 months then synthesize own IgG by 12 months.

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50
Q

Organ System Maturation - Immunologic System: What to know about IgM?

A

Produces in significant amounts after birth, reaching adulting levels by 9 months of age

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51
Q

Psychosocial Development: What developmental theory must crucial by 1 year?

A

Trust vs Mistrust

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52
Q

Psychosocial Development: How to get infant to trust someone?

A

By constantly meeting the infants needs

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53
Q

Psychosocial Development: What activites can promote Eriksons Trust vs Mistrust?

A

Caregivers respond by feeding, changing diapers, cleaning, and touching/holding . As they mature, they realize they are separate from their caregivers

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54
Q

Psychosocial Development: What to know about Piagets theories?

A

Infants learn about themselves and the world through their developing sensory and motor capibilites.

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55
Q

Psychosocial Development: What to know about Freud?

A

Pleasure is focused on oral activites: feeding and sucking

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56
Q

Cognitive Development: When does object permanence occur?

A

Between 4-7 months of age. If object hidden from infants sight, he or she will search for it.

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57
Q

Motor Skill Development - Gross Motor Skills: What does this refer to?

A

The use of large muscles (head control, rolling, sitting, and walking)

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58
Q

Motor Skill Development - Gross Motor Skills: What fashion do gross motor skills develop?

A

In a cephalocaudal fashion (from the head to the tail). They will learn to lift heat before learning to roll over.

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59
Q

Motor Skill Development - Gross Motor Skills: What skills do they learn as they get older?

A

Head contorl, ability to roll over, crawl, pull to stand and walk around 1 year old

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60
Q

Motor Skill Development - Gross Motor Skills: What may indicate problems with motor development?

A

Arms and legs are stiff, child cannot support head, reaches with one hand only, and cannot sith with assistance at 6 months

61
Q

Motor Skill Development - Fine Motor Skills: How do they develop?

A

In a proximodistal fashion (from center to periphery). First bats with whole hand, eventualyl progressing to fingertip grasping

62
Q

Motor Skill Development - Fine Motor Skills: What should a 12 month old be able to do here?

A

Be able to eat with his or her fingers and assist with dresing

63
Q

Sensory Development - Sight: How is the vision for newborns?

A

They are nearsighted, preferring to view objects at distance of 20-38 cm (8-15 inches)

64
Q

Sensory Development - Sight: What will infant be able to recognize by 1 month?

A

Can recognize by sight the poeple he or she knows best

65
Q

Sensory Development - Sight: When are they able to fuse to ocular images into one picture (binocularity)

A

At 6 weeks, and is well established by 4 months

66
Q

Sensory Development - Sight: When does full color vision develop?

A

By 7 months of age

67
Q

Sensory Development - Hearing: When can they recognize sounds of those they know best?

A

By 1 month

68
Q

Sensory Development - Smell/Taste: How quickly is taste developed?

A

7-day-old infant can differentiate the smell of his or her mothers breast milk . Prefers sweet tastes

69
Q

Sensory Development - Touch: Warnings signs that indicate problems here?

A

Does not respond to loud noises, cannot focus on near object, and does not make noises or babble by 4 months

70
Q

Communication and Language Development: How does infant communicate from 1-3 months?

A

Cooes, makes other vocalizations, and demonstrates differentiates crying

71
Q

Communication and Language Development: How does infant communicate at 4-5 months?

A

Makes simple vowel sounds, laughs aloud, and vocalizes in response to voices

72
Q

Communication and Language Development: What happens at 7-10 months?

A

Babbling begins and progresses to strings (mamama, dadada)

73
Q

Communication and Language Development: What happens from 9-12 months?

A

Is able to understand what mamama and dada means.

74
Q

Communication and Language Development: 12 month old has inflection, which is what?

A

Babbling has rhythm and timing of spoken language, but few words make sense

75
Q

Communication and Language Development: Warning signs here?

A

infant doesnt make sound at 4 months, does not laugh or squeal by 6 months, and does not babble by 8 months

76
Q

Social and Emotional Support: What will infant do here at 3-4 months?

A

Will mimic the parents facial movements

77
Q

Social and Emotional Support: What will infant do here 6-8 months?

A

May enjoy games such as patty-cake

78
Q

Social and Emotional Support - Stranger Anxiety: At 8 months, will develop stranger anxiety, which is what?

A

Infant may become clingly and whiny when approached by strangers or people not well known

79
Q

Social and Emotional Support: Warning signs here include?

A

Does not smile at 3 months, refuses to cuddle, does not enjoy people

80
Q

Social and Emotional Support - Temperament: What is this?

A

The child’s nature, the inborn traits that determine how he interacts with the world.

81
Q

Social and Emotional Support - Temperament: This ranges from what?

A

Low or moderatively active, regular and predictable to highly active, more intense.

82
Q

Nurse Role in Newborn Growth: Health care visits through infancy often focus primairly on what

A

anticipatory guidance (educating parents and caregivers about what to expect in the next phase of development)

83
Q

Promoting Growth and Development Through Play: How cna parents promote fine motor development in infants

A

by providing age-appropriate toys

84
Q

Promoting Growth and Development Through Play: When playing with toys , may engage in solitary play, which is what?

A

they do not share with other infants or directly play with other infants

85
Q

Promoting Healthy Growth/Development - Promote Early Learning: reading aloud and sharing books early are critical for development of

A

neural netowrks that are important in later tasks of reading and word recognition.

86
Q

Promoting Healthy Growth/Development - Safety In Car: Car seats should face rear until when?

A

Infant is 12 months old and weight 9 kg (20 lbs)

87
Q

Promoting Healthy Growth/Development - Safety In Home: Why are infant walkers not recommended?

A

Because it may tip over with baby in it or infant may fall down teh stairs with it

88
Q

Promoting Healthy Growth/Development - Safety In Home: How to avoid choking?

A

Use only toy recommended with children from 0-1 yr

Avoid stuffed animals with eyes/buttons

Keep floor free of small items

89
Q

Promoting Nutrition - Breastfeeding: Fluid requirement for newborn?

A

140-160 ml/kg/day

90
Q

Promoting Nutrition - Breastfeeding: Fluid requirements for first 10 kg?

A

100 mL/kg/day

91
Q

Promoting Nutrition - Breastfeeding: Fluid requirements for next 10 kg?

A

50 mL/kg/day

92
Q

Promoting Nutrition - Breastfeeding: Calorie requirement for newborn?

A

105-18 kcal/kg/day

93
Q

Promoting Nutrition - Breastfeeding: Calorie requirement for 1-6 month old?

A

108 kcal/kg

94
Q

Promoting Nutrition - Breastfeeding: Calorie requirement for 6-12 month old?

A

98 kcal/kg

95
Q

Promoting Nutrition - Breastfeeding: What infants should not be breastfed?

A

Those with galactosemia, maternal use of drugs, and few prescription meds, HIV, and untreated TB

96
Q

Promoting Nutrition - Breast Milk Composition: What does this include?

A

Lactose, Lipids, Polyunsaturated fatty acids, and amino acids.

97
Q

Promoting Nutrition - Breast Milk Composition: Why is there a high concentration of fats and the balance of amino acids?

A

Contribute to proper myelination of the nervous sytem

98
Q

Promoting Nutrition - Breast Milk Supply and Demand: What hormone is activated with drop of progesterone?

A

Prolactin, which stimulates production of milk.

99
Q

Promoting Nutrition - Breast Milk Supply and Demand: How long is Colostrum produced for”

A

2-4 days

100
Q

Promoting Nutrition - Breast Milk Supply and Demand: What is contained in colostrum?

A

High in protein and low in sugar and fat

101
Q

Promoting Nutrition - Breast Milk Supply and Demand: What is foremilk?

A

It collects in the lactiferous sinuses, which are small tubules serving as reservoirs for milk behind nipples

102
Q

Promoting Nutrition - Breast Milk Supply and Demand: What is the let-down reflex?

A

Responsible for release of milk from the foremilk reservoirs.

103
Q

Promoting Nutrition - Breast Milk Supply and Demand: How is the let-down relfex activated?

A

Not only by sucking, but by thinking of baby or by sound of baby crying

104
Q

Promoting Nutrition - Breast Milk Supply and Demand: What is hindmilk?

A

The milk produced after the foremilk is let down

105
Q

Promoting Nutrition - Breastfeeding Technique: Why would the mother isnert her finger into the babys mouth when finishing feding?

A

To breask suction and releasing the nipple from the mouth. Prevents infant from pulling on nipple which causes soreness

106
Q

Promoting Nutrition - Bottle-Feeding: Standard infants formula based on what?

A

Cow’s milk and provides 20 kcal/ounce and use lactose as source for carbohydrates.

107
Q

Promoting Nutrition - Bottle-Feeding: Why is regular cow milk not recomended?

A

Does not provide adequate balance of nutrients for growing infant, especially iron

108
Q

Promoting Nutrition - Bottle-Feeding: Formulas that contain what should be used

A

Iron

109
Q

Promoting Nutrition - Feeding Patterns: Overfeeding with bottle increases incidence of what?

A

Spitting up and obesity

110
Q

Promoting Nutrition - Feeding Patterns: What are some early/late signs of hunger?

A

Early: Making sucking m otions, sucking on hands, putting fit into chin

Late: Crying

111
Q

Promoting Nutrition - Feeding Patterns: How much will they consume per feeding initially and after a couple of days

A

0.5-1 oz initially

Eventually 2-3 oz

112
Q

Promoting Nutrition - Feeding Patterns: By 6 months of age, feedings occur how often with how many oz?

A

4-5 x / day with 6-8 oz per feeding

113
Q

Promoting Nutrition - Special Formulas: Who may ned this?

A

Infant who is allergic to a particular compoent of standard formula or has a renal/hepatic/metabolic hisorder

114
Q

Promoting Nutrition - Special Formulas: Premature infant follow-up formulas are designed to provide what

A

additional calories, protein and particular calcium-to-phosphorus ratio as well as the vitamins and minerals needed for adequate catch up

115
Q

Progressing to Solid Foods: When will they switch over?

A

After about six months, usually require the nutrients in solid foods.

116
Q

Progressing to Solid Foods - Assessing Infant Readiness: What needs to be ready here?

A

Tongue Extrusion Reflex needs to be assessed. Infant will stick their tongue out with food out of habit. Once gone, they can eat solid foods

117
Q

Progressing to Solid Foods - Assessing Infant Readiness: Why should fruit juice not be placed in infants diet?

A

It would displace the important nutrients

118
Q

Progressing to Solid Foods - Choosing Appropriate Solid Foods: What is a great first solid-food?

A

Iron-fortified rice cereal mixed with small amount of breast milk or formula.

119
Q

Progressing to Solid Foods - Choosing Appropriate Solid Foods: How often should new food be introduced?

A

Every 3-5 days, allowing for identifcation of food allergies

120
Q

Progressing to Solid Foods - Choosing Appropriate Solid Foods: When should the cup be introduced?

A

At 6-8 months of age.

121
Q

Progressing to Solid Foods - Choosing Appropriate Solid Foods: Why are no-spill sippy cups not recommended?

A

Because they require sucking much like a bottle and do not encourage child to leanr how to dirnk from bottle.

122
Q

Progressing to Solid Foods - Promoting Healthy Eating Habits: Lifelong eating patterns are often established when?

A

In childhood.

123
Q

Progressing to Solid Foods - Promoting Healthy Eating Habits: Why should parents not let the infants eat whateevr they want?

A

This will lead to fights over eating in the future.

124
Q

Promoting Healthy Sleep and Rest: How often to newborns sleep

A

20 hours

125
Q

Promoting Healthy Sleep and Rest: How often to infants sleep by 3 months?

A

7-8 hours per night without waking.

126
Q

Promoting Healthy Sleep and Rest: When should primary caregivr try to sleep?

A

When the baby is sleeping.

127
Q

Promoting Healthy Sleep and Rest: When should a bedtime routine be established?

A

Around 4 months of age, due to infants increased alertness and activity level

128
Q

Promoting Healthy Sleep and Rest: Why should interactiosn be brief at night?

A

So infant learns to fall back to sleep on their own

129
Q

Promoting Healthy Teeth and Gums: How should gums be cleaned?

A

After feeding with a damp washcloth.

130
Q

Promoting Healthy Teeth and Gums: How should newly erupted teeth be cleaned after feeding?

A

A soft clooth and then eventually a small bristled toothbursh

131
Q

Promoting Appropriate Discipline: What does discipline mean?

A

refers to molding of a childs behavior through instruction, practice, and consistency

132
Q

Addressing Common Developmental Concerns - Colic: What is this?

A

Inconsolable crying that lasts 3 hours or longer per day and there is no physical cause

133
Q

Addressing Common Developmental Concerns - Colic: When does this begin and lasts how long

A

By 2 weeks of age, 3-7x per week. More prevelant in evenings and resolves by 3 months when they can console themselves.

134
Q

Addressing Common Developmental Concerns - Colic: Cause of this?

A

Problem with GI or Neurologic System, Temperament, or PArenting Style

135
Q

Addressing Common Developmental Concerns - Colic: Educate parents that normal crying increases by the time infant is what age to when?

A

6 weeks old and diminishes by 12 weeks

136
Q

Addressing Common Developmental Concerns - Colic: What should parents do when faced with this?

A

Develop stepwise approach to check that all of infants needs are met.

This includes reducing stimulation, carrying infant, and taking them for a car ride.

137
Q

Addressing Common Developmental Concerns - Spitting Up: Who is more likely to spit up?

A

Overfed babies on parents schedule or those who burp poorly.

138
Q

Addressing Common Developmental Concerns - Spitting Up: What can parents be taught to prevent this?

A

Feed in smaller amounts ona more frequent basis. Also burp baby 2-3x per feeding and keeping upright for 30 minutes after feeding.

139
Q

Addressing Common Developmental Concerns - Spitting Up: Why is placing in car seat after feeding not recommended?

A

It compresses the stomach.

140
Q

Addressing Common Developmental Concerns - Spitting Up: How should they be placed on bed after feeding?

A

On back with head of bed slightly elevated

141
Q

Addressing Common Developmental Concerns - Pacifier: When should they be weaned off of this?

A

By 1 year of age so that additional needs of sucking naturally decreasing.

142
Q

Addressing Common Developmental Concerns - Teething: Pain results form what

A

inflammation. Teach too apply cold to soothe gums and that infant may chew on a cold teething ring.

143
Q

Addressing Common Developmental Concerns - Teething: What over the counter topical anesthetics may eb used

A

Orejel. Should apply corrently to the gums, avoiding the lips.

144
Q

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse?

“It’s okay to start puréed solids at this age if fed via the bottle.”
“Infants don’t require solid food until 12 months of age.”
“Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own.”
“The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods.”
A

The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods.”

145
Q

The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. The nurse’s best response is:

“She just needs love and attention. Don’t worry; she’s too young to spoil.”
“Consistently meeting the infant’s needs helps promote a sense of trust.”
“Infants need to be fed and cleaned; if you’re sure those needs are met, just let her cry.”
“Consistency in meeting needs is important, but you’re right, holding her too much will spoil her.”
A

“Consistently meeting the infant’s needs helps promote a sense of trust.”

146
Q

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior?

Crying when left with the sitter may indicate difficulty with building trust.
Stranger anxiety should not occur until toddlerhood; this concern should be investigated.
Separation anxiety is normal at this age; the infant recognizes parents as separate beings.
Perhaps the sitter doesn’t meet the infant’s needs; choose a different sitter.
A

Separation anxiety is normal at this age; the infant recognizes parents as separate beings.

147
Q

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant’s oral health?

“Start brushing her teeth after all the baby teeth come in.”
“Use a washcloth with toothpaste to clean her mouth.”
“Clean your baby’s gums, then new teeth, with a washcloth.”
“Rinse your baby’s mouth with water after every feeding.”
A

“Clean your baby’s gums, then new teeth, with a washcloth.”

148
Q

A 9-month-old infant’s mother is questioning why cow’s milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response?

It is permissible to substitute cow’s milk for formula at this age as he is so close to 1 year old.
Cow’s milk is poor in iron and does not provide the proper balance of nutrients for the infant.
As long as the mother provides whole milk, rather than skim, she can start cow’s milk in infancy.
If the mother cannot afford the infant formula, she should dilute it to make it last longer.
A

Cow’s milk is poor in iron and does not provide the proper balance of nutrients for the infant.

NRSG 206: OB (42 decks)

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