OB Exam 1 Flashcards
What is a full term pregnancy?
40 weeks
What is a term pregnancy?
Between 38 and 42 weeks
What is an abortion? What 2 types are there?
Any pregnancy loss before the 20th week or weighing less than 500 grams.
1) spontaneous
2) therapeutic
What is a preterm birth?
A birth occurring after the 20th week and before the 38th week.
What is a late preterm birth?
Birth occurring between 34 0/7 and 36 6/7 (71% of preterms)
What is a post term birth?
Birth occurring after the 42nd week.
What is the definition of “gravida”?
Number of times a woman has been pregnant regardless of duration or outcome.
What is the definition of “para”?
Number of pregnancies a woman has completed past 20 weeks, regardless whether infant is born alive or dead. (# of pregnancies not fetuses)
What is TPAL?
T= # of term pregnancies P= # of premes A= # of abortions L= # of living children
What are some important structural characteristics of the placenta?
- Divided into segments called cotyledons
- Size 6-10” long and 1” thick weighing 1-1 1/2 lbs
- 2 sides: Fetal –> shiny and smooth w/ amniotic sac attached
Maternal –> dark and red and rough appearance
What can an undelivered portion of placenta do to mom’s body?
- Sepsis
- Hemorrhage
- Delay of milk production
What are the 3 functions of the placenta?
1) metabolic = glycogen, cholesterol, fatty acids are synthesized in placenta.
2) transfer of substances between mother and fetus = maternal antibodies (immunoglobulins) are passed to the fetus –> passive immunity (ex: Measles)
3) endocrine = hormones secretion
- Most bacteria and viruses are too large to pass through placenta
What does the placenta do at the endocrine level?
It produces several hormones necessary for a normal pregnancy such as:
- HCG (human chorionic gonadotropin)
- Estrogen
- Progesterone
- Human placental lactogen
What is another mechanism of the placenta?
It serves as the site of nutrient and O2 exchange as well as fetal waste excretion.
Where is the blood being exchange for oxygenation?
It is exchanged in the Intervillous space (area inside placenta) 3 to 4 times per minute.
- Maternal and fetal blood DO NOT mix *
What happens to fetal waste?
CO2, urea, uric acid and bilirubin are readily transferred from fetus to mother for disposal.
What are the main characteristics of the umbilical cord?
- 20 to 22” long, 1” thick
- Contains 3 vessels = 2 arteries and 1 vein
- Abnormal # of vessels can indicate affect fetus anomalies
What are the functions of the umbilical cord?
It is the lifeline between mother and fetus -
1) Arteries carry “dirty blood” away from fetus
2) Vein carries “clean blood” to fetus
What are the 2 fetal membranes and their function?
1) Amnion - Inner membrane, next to fetus
2) Chorion - Outer membrane next to mother
–> to house the fetus for duration of pregnancy = offers protection from outside world
What is the normal volume of amniotic fluid?
500-1000 mL at term
What is “oligohydramnios”?
< 500 mL –> poor fetal lung development, compression syndrome
what is “polyhydramnios”?
> 2000 mL –> associated w/ fetal CNS or GI tract abnormalities
What does a newborn assessment consist of?
1) respiratory function –> listen before touching
2) circulatory function –> perfusion, cap refill
3) gestational age
4) comprehensive physical exam
What are the characteristics assessed for a newborn physical appearance?
- Symmetry
- Obvious deformities
- Size, smell
- Muscle tone
- Posture
What are the assessed characteristics for a newborn behavior?
- Crying
- Lethargic
- Responsiveness
- Reflexes
- Jittery = can be caused by hypoglycemia or seizures
What are the normal measurements for a newborn?
1) Length = 18-22” or 45-55 cm
2) Head circumference = 13-15” or 32-38 cm
3) Chest circumference = 12-14” or 30-36 cm
What is the normal weight for a newborn?
- 2500-4000 grams or 5 lbs 8 oz - 8 lbs 13 oz
- Assess blood sugar for
1) SGA = may be low
2) LGA = may be high
What are the normal values for the newborn vital signs?
1) Temp = 36.5-37.3 C or 97.7-99.1 F
2) Pulse = 120-160 bpm
3) Resp = 30-60
4) BP = Systolic: 65-95
Diastolic: 30-60
What is AOP?
Apnea of Premature babies –> can be normal ranging from 5-15 sec
What is “acrocyanosis”?
Blue extremities –> will resolve w/in 24h
What are characteristics of Harlequin sign?
Baby’s body is separated by a vertical lign (one side red one side normal)
–> Can be a sign of cardiac problem or sepsis
- Harlequin = presence of excessive amounts of dry surface scales
What is milia?
Keratin filled epithelial cysts which occur in up to 40% of newborns.
What is “sebaceous hyperplasia”?
Referred to as “puberty of newborn” = lesions are more yellow than milia.
What is “erythema toxicum”?
Newborn rash = normal finding - apparent first few days of life
What is the first action the nurse should take if presence of forceps marks on newborn?
Assess facial nerve integrity and other trauma.
What is a potential risk with “strawberry hemangioma”?
The hemangioma can interfere w/ vision when located around the eye.
If the head circumference of a new is above the normal growth curve, what does it indicate?
Hydrocephalus = excess CSF in the ventricles causing brain compression against the skull.
What defines “Caput Succedaneum”?
Head elongates and presence of edema of the soft tissue - crossing of the sutures.
- Appears at birth til 12 to 48h
What defines “Cephalohematoma”?
Hemorrhage into the cranial bone, swelling and bluish color on side of the head - Does not cross the suture line.
- Appears w/in 24-48h –> can last 2 weeks to 3 months
What can “Caput Succedaneum” and “Cephalohematoma” trigger?
Jaundice –> Nurse should assess bilirubin levels
What are the characteristics of the 2 fontanelles?
1) Anterior fontanelle closes at about 18 months old
2) Posterior fontanelle closes at about 2-3 months
- Assess fontanelles for signs of overhydration or dehydration.
What is “Choanal Atresia”?
Narrowing or blockage of the nasal airway by tissue.
What are 2 major birth defects of the head?
1) Anencephaly = only brain stem grows - no brain tissue
2) Encephalocele = cranium does not close and meninges protrude out of head
- Very poor prognosis
What breath sounds are a common finding right after birth?
Faint crackles due to left amniotic fluid in lungs
What is a common finding when assessing the heart of a newborn?
Heart murmurs are common and not permanent - Listen for 1 full minute.
What needs to be assessed if suspected heart problem?
Assess BP in all 4 extremities and check peripheral pulses.
What is “hydrocele”?
Enlarged scrotum due to excess fluid.
What would brick reddish uric crystal deposits in diaper indicate?
Can be an early sign of dehydration.
What are some signs indicating hip dysplasia?
- One leg shorter
- Gluteal creases are asymmetrical (skin folds)
What are the specific assessments required for the back and buttocks?
- straight spine
- spina bifida occulta - dimple or tuft of hair
- Meningocele = sac of fluid only
- Meningomyelocele = sac of fluid and spinal cord
What is an important supplement that the expectant mother needs to take and why?
Folic acid = prevents physical abnormalities
What are the different reflexes that are assessed in the newborn?
1) Moro = arms and legs extend and abduct
2) Palmar grasp
3) Plantar
4) Babinski
5) Rooting
6) Sucking
7) Tonic neck
8) Stepping
When does the New Ballard scale need to be assessed?
Within the first 4 hours of life.
What is the difference between brown fat and white SQ fat?
Brown fat is only located midline torso and neck, between shoulder blades and over kidneys.
Brown fat also generates more heat than white SQ
–> blood passing through brown fat is warmed and carries heat to the rest of the body.
What should the nurse if the baby presents with acrocyanosis?
If the baby is born with acrocyanosis it is usually a oral sign.
If the baby has pink extremities and then become acrocyanotic, it is due to “cold stress” and the baby should be warmed.
What is the normal value for blood glucose?
> 40 mg/dL
What is the normal level for bilirubin?
< 12 mg/dL
- Peaks on 3rd day of life
What are 2 medications administered immediately after birth?
1) Vitamin K 1 mg injection IM = to compensate with the lack of flora in GI and clotting factors
2) Erythromycin ophthalmic ointment = to protect from Gonorrhea and Chlamydia
- Neonates exposed to Hep B should receive HBIG
How does the fetal circulation function?
Blood leaves the fetal heart to the placenta for exchange of oxygen and waste products, then back to the fetus for delivery to fetal tissues.
What are the 3 structures helping fetal circulation?
1) Ductus Arteriosus = pulmonary artery to aorta
2) Foramen Ovale = right atrium to left atrium
3) Ductus Venosus = umbilical vein to inferior vena cava
- All structures will close soon after birth
What does the APGAR score measure and when should it be assessed?
1) Heart rate
2) Respiratory effort
3) Muscle tone
4) Body color
5) Reflex irritability
APGAR needs to be assessed at 1 min and then again at 5 min after birth.
- Scoring is from 0-2
0 = very poor
2 = excellent
What is thermoregulation?
The maintenance of the infant body temperature that should range between 97.7 and 99.1 F
What are the 4 ways of heat loss?
1) Evaporation = direct contact - wet diaper, milk on shirt, wet hair
2) Convection = indirect contact - cold air brushing over baby
3) Radiation = indirect contact, when infant is near cold surfaces - heat leaves baby to get absorbed by cold objects
4) Conduction = direct contact to cold objects or surfaces
How does a newborn handle cold stress?
1) Non-Shivering Thermogenesis = metabolism of brown fat which leads to ⬆ production of free fatty acids
- -> can result in metabolic acidosis and jaundice
2) ⬆ Metabolic Rate = ⬆ use of glucose and ⬇ surfactant
- -> can lead to hypoglycemia and respiratory distress
3) Vasoconstriction –> leads to pale, mottled skin and shut down of pulmonary vessels = respiratory distress
- Can lead to a reopening of the structures
What are the necessary room temperatures needed to maintain baby at right temp?
- If clothed = room at 24-27 C
- If unclothed = room at 32-33.5 C
What are the normal hematologic values?
- Hemoglobin = 15-24 g/dL
- Hematocrit = 48-69%
- WBCs = 15,000 mm3 (9,000-30,000) at birth (Bands: immature WBCs)
- RBCs in newborns have a shorter life span –> more hemolysis –> ⬆ risk for jaundice
What is a characteristic of the cardiac sphincter in newborns?
The cardiac sphincter is relaxed causing a tendency to regurgitate
–> Nursing Implication = Assess swallow reflex
What is their digestive system lacking the first 3-6 months of age?
1) Amylase = to digest carbs
2) Lipase = for fat absorption
- -> Brest milk contains these enzymes
What are the possible causes of meconium being passed in utero?
- Stress
- Post term babies
- Should normally be passed w/in the first 24h
What an elevated level of bands would indicate?
Hight level of bands (immature WBCs) can be a sign of infection.
Why is glucose stored in liver the last 4-8 weeks in utero?
- Used for energy of birth
- Heat production
- -> and stored until first feelings are taken
When is an infant at risk for hypoglycemia?
1) blood glucose < 40 mg/dL
2) preterm babies
3) babies from diabetic mothers
4) cold stress
- -> NI: Encourage feelings
What is the difference between conjugated and unconjugated bilirubin?
- Bilirubin is released in its unconjugated form = fat-soluble and gets absorbed by SQ fat resulting in jaundice
- It becomes conjugated by action of the liver = water-soluble bilirubin which gets excreted through urine and stool
- Immature liver results in poor amount conjugation of bilirubin
What is hyperbilirubinemia?
Excessive levels of bilirubin in blood = > 12 mg/dL
- Most common neonatal problem
What is “Kernicterus”?
Brain damage caused by excess of bilirubin.
What is a benefit of bilirubin?
It is a powerful antioxidant that helps w/ adjustments to environmental O2.
What are the 2 types of physiologic jaundice?
1) Breastfeeding jaundice = happens w/ babies w/ poor suck - insufficient intake of colostrum that helps to clear and pass meconium.
2) Breast milk jaundice = related to milk composition - late onset
What are the nursing care and treatments of hyperbilirubinemia?
1) Phototherapy (eyes and genitals are covered)
2) Feedings = to promote ⬆ in stooling and urination (can use supplement formula)
3) IV fluids = in case of significant dehydration
What are the causes of jaundice?
- Anything that causes an excessive destruction of RBCs
- Infection
- Metabolic disorders
- Incompatibilities between maternal and fetal blood = Rh and ABO
What are the risks with Rh incompatibility?
Scenario A)
If mom is Rh - she will develop antibodies to fight against Rh +
–> if second baby is Rh + her antibodies will recognize baby as foreign and attack it.
Scenario B)
If mom is Rh +, no matter what baby is, nothing will happen.
What is an efficient treatment for Rh incompatibilities?
Rhogam is given after the 28th week if Rh -
If baby is Rh + mom will receive another dose of Rhogam w/in 72h of birth to prevent antibody formation.
What is another complication w/ Rh incompatibilities?
“Erythroblastosis Fetalis” = Hemolytic disease of the newborn
Results in:
- infant born severely anemic and jaundiced
- generalized edema
- CHF
- Ascites
–> High risk for death
What are the antibodies that can cross the placenta?
IgG = present if mom is type O and baby type A, B or AB
–> antibodies will cause hemolysis of fetus.
IgM are usually the ones formed = safer than Rh incompatibilities.
What are the liver functions for the infant?
Besides glucose storage prior to birth
- Iron storage = enough iron for up to 6 months (til iron source in solid foods @ 6 months of age)
- Metabolism of drugs = immaturity of liver causes poor metabolism of drugs - * Caution w/ what mother takes
What happens to the kidney flow after birth?
It increases because of ⬇ resistance in renal blood vessels.
–> 1st void usually occurs w/in 24h
What could absence of urine indicate?
- Hypovolemia
- Absence of kidneys
- Kidney anomalies
- Usually oligohydramnios is also present when there is a kidney dysfunction.
What are the main assessments for the care of the newborn?
1) Check blood sugar for:
- all SGA and LGA
- low temp babies
- stressful deliveries
- infants of diabetic mothers
2) Circumcision
- parent teaching (pros/cons)
- S x S of infection
3) Bathing
- after 1st bath sponge bath til cord falls off (~ 10 days)
- awareness of thermoregulation
How do level of nursery differ from one another?
- Level 1 = NB care for minor pbs (jaundice, hypothermia)
- Level 2 = care of preterms 32 weeks or > w/ mild PBS
- Level 3 = care of severely preterm and infants w/ long term pbs
- Level 4 = “Tertiary” –> Special care (ie: ❤ surgery)
What are the causes of respiratory problems in infants?
Transient Tachypnea of the newborn (TTN)
–> retained lung fluid because of C section, asphyxia, maternal analgesia, bleeding or diabetes.
How does Tachypnea present itself?
- RR as high as 120/min
- retractions
- nasal flaring
- (grunting)
- mild cyanosis
What is a precaution to take in the event of Tachypnea?
Refrain from breastfeeding –> Risk of aspiration
What are the causes for SGA?
1) Maternal factors = smoking, lack of prenatal care, age extremes
2) Maternal disease = ❤ disease, substance abuse, sickle cell anemia, PKU, PIH, DM
3) environmental factors = high altitude, exposure to X-rays, smoking, alcohol
4) Placental factors = small, abnormal cord insertion, placenta previa
5) Fetal factors = congenital infections, chromosomal syndromes
What are some nursing considerations with SGA?
- Hypoglycemia = greater need for glucose for brain development
- Feedings = early and more frequent
- Hypothermia
- Warming measures (blankets, warming units)
- Temperature monitoring
When is an infant considered LGA?
Birth weight is above the 90th % at any week of gestation
- Most commonly infants from diabetic mothers
What are some common complications w/ LGA newborns?
- Birth trauma –> C section (to avoid shoulder distocia, fx clavicles, facial paralysis, hematomas)
- Hypoglycemia
- Polycythemia = ⬆ of RBCs to supply ⬆ O2 demand
- RDS “Respiratory Distress Syndrome” = surfactant production ⬇
- Congenital birth defects
What should the nurse assess first with macrosomia?
- Fx clavicles, brachial palsy, facial nerve
- Hypoglycemia = BG
- Respiratory functioning = rate, effort, breath sounds
- Hypertrophy of liver, spleen and heart (when from mothers w/ DM)
What is “Postmaturity syndrome”?
Found in post term infants - caused by ⬇ placental functioning, which leads to low O2 levels and nutrition transport.
What are the S x S of “Postmaturity syndrome”?
1) hypoxia
2) malnourishment
3) loose skin, peeling, cracked
4) long nails
5) meconium stained cord, skin and nails
What are some complications w/ the post term newborn?
1) Cold stress/ Hypothermia
2) Hypoglycemia
3) Meconium aspiration
4) Polycythemia (hct > 65% and hgb > 22 g/dL) = can ⬆ risk of hyperbilirubinemia
5) Seizures
What are the dangers of Meconium Aspiration Syndrome (MAS)?
- Obstruction of airways
- Trapping of air
- -> Pneumothorax and/or respiratory distress
What interventions are to be implemented with MAS?
1) Airway must be cleared at birth:
- suction of mouth and pharynx
- intubation of trachea if necessary
What are the main risk factors for premature birth?
- Substance abuse
- Maternal disease (gestational hypertension, DM, ❤)
- Maternal age (< 17 and > 35)
What is the most common problem in the preterm infant?
RDS (Respiratory Distress Syndrome)
- -> Surfactant development is insufficient - lungs become stiff
- -> Can lead to Atelectasis and hypoxia
What are the S x S of RDS?
1) Grunting on expiration
2) Tachypnea
3) Retractions
4) Cyanosis
5) Nasal flaring
6) Respiratory Acidosis
What are the appropriate nursing interventions for RDS?
- Mechanical ventilation
- Correction of acidosis
- IV fluids
- Surfactant replacement
How does a nurse identify infants at risk because of maternal substance abuse?
1) Lack of prenatal care
2) Placental abruption (cocaine, speed or smoking)
3) Abnormal behavior of mother
What are the S x S of infants of maternal substance abuse?
1) Irritable
2) Jittery
3) Restless
4) Prolonged high-pitched cry
5) Poor feeding
6) Diarrhea
7) Poor sleep patterns
8) Tachypnea
9) Seizures
When can S x S of withdrawals be observe in an infant?
Usually at least 24h later.
- Can test meconium or urine for substance abuse
What are the 2 ways an infant can acquire an infection?
1) Vertical transmission = In utero, passage across placenta or during labor –> * 3rd stage of labor, as placenta separates, active exchange of fetal and maternal blood can occur.
2) Horizontal transmission = After birth, nosocomial or from family and visitors.
What are the S x S of infection in an infant?
- Temperature (*usually low rather than high)
- Respiratory pbs
- Feeding intolerance
- Lethargy
- Hypoglycemia
- Apnea
When is surfactant apparent in the fetus and when does the fetus have sufficient surfactant to being born?
24-25 weeks of gestation
When does the fetus have sufficient surfactant to being born?
34-36 weeks of gestation
What are the appropriate I & O in the newborn from birth to day 5?
Intake = 60-100 mL/kg per day Output = at least 1 to 2 voids per day
What are the appropriate I & O in the newborn AFTER the the first 5 days?
Intake = 150-175 mL/kg per day Output = 2-5 mL/kg/h or 48-120 mL/kg/24h
What is the normal range for specific gravity in the newborn?
Specific gravity should range between 1.002-1.010
What organisms are able to cross the placenta and cause vertical infection?
In Utero:
1) Rubella
2) Cytomegalovirus
3) Syphilis
4) HIV
5) Toxoplasmosis
6) Chickenpox/ Shingles
During labor and birth:
1) B streptococci (GBS)
2) Herpes
3) Hepatitis
What can be used in the management of infection or sepsis?
Broad spectrum antibiotics = Gentamicin or Ampicillin
What are the recommended interventions when treating Necrotizing Enterocolitis (Poor feeding/ GI infection)?
- Gavage feedings
- NPO w/ TPN and lipids
What interventions should be implemented when treating Bronchopulmonary Dysplasia (BPD)?
- Prolonged O2
- Ventilation
What is molding of the newborn’s head?
It is asymmetry of the head shape caused by the birthing process.
What intervention is needed when treating Intraventricular Hemorrhage?
Weekly head US
What is thrush and where is it found in the newborn?
White patchy areas evident on tongue and/or gums (candida albicans)
What intervention is needed when treating Retinopathy of Prematurity?
- Treatment laser
- Cryotherapy
Is Jaundice a normal finding for the newborn?
For the full-term baby = Jaundice appears AFTER the first 24h
For the preterm baby = Jaundice appears AFTER the first 48h
- Jaundice occurring prior (pathological jaundice) may indicate hemolysis and should be reported to the physician.
