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NURS 132 OB/Peds > OB Exam 1 > Flashcards

OB Exam 1 Flashcards

1
Q

What is a full term pregnancy?

A

40 weeks

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2
Q

What is a term pregnancy?

A

Between 38 and 42 weeks

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3
Q

What is an abortion? What 2 types are there?

A

Any pregnancy loss before the 20th week or weighing less than 500 grams.

1) spontaneous
2) therapeutic

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4
Q

What is a preterm birth?

A

A birth occurring after the 20th week and before the 38th week.

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5
Q

What is a late preterm birth?

A

Birth occurring between 34 0/7 and 36 6/7 (71% of preterms)

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6
Q

What is a post term birth?

A

Birth occurring after the 42nd week.

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7
Q

What is the definition of “gravida”?

A

Number of times a woman has been pregnant regardless of duration or outcome.

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8
Q

What is the definition of “para”?

A

Number of pregnancies a woman has completed past 20 weeks, regardless whether infant is born alive or dead. (# of pregnancies not fetuses)

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9
Q

What is TPAL?

A 
T= # of term pregnancies
P= # of premes
A= # of abortions
L= # of living children
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10
Q

What are some important structural characteristics of the placenta?

A
  • 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
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11
Q

What can an undelivered portion of placenta do to mom’s body?

A
  • Sepsis
  • Hemorrhage
  • Delay of milk production
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12
Q

What are the 3 functions of the placenta?

A

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
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13
Q

What does the placenta do at the endocrine level?

A

It produces several hormones necessary for a normal pregnancy such as:

  • HCG (human chorionic gonadotropin)
  • Estrogen
  • Progesterone
  • Human placental lactogen
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14
Q

What is another mechanism of the placenta?

A

It serves as the site of nutrient and O2 exchange as well as fetal waste excretion.

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15
Q

Where is the blood being exchange for oxygenation?

A

It is exchanged in the Intervillous space (area inside placenta) 3 to 4 times per minute.

  • Maternal and fetal blood DO NOT mix *
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16
Q

What happens to fetal waste?

A

CO2, urea, uric acid and bilirubin are readily transferred from fetus to mother for disposal.

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17
Q

What are the main characteristics of the umbilical cord?

A
  • 20 to 22” long, 1” thick
  • Contains 3 vessels = 2 arteries and 1 vein
  • Abnormal # of vessels can indicate affect fetus anomalies
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18
Q

What are the functions of the umbilical cord?

A

It is the lifeline between mother and fetus -

1) Arteries carry “dirty blood” away from fetus
2) Vein carries “clean blood” to fetus

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19
Q

What are the 2 fetal membranes and their function?

A

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

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20
Q

What is the normal volume of amniotic fluid?

A

500-1000 mL at term

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21
Q

What is “oligohydramnios”?

A

< 500 mL –> poor fetal lung development, compression syndrome

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22
Q

what is “polyhydramnios”?

A

> 2000 mL –> associated w/ fetal CNS or GI tract abnormalities

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23
Q

What does a newborn assessment consist of?

A

1) respiratory function –> listen before touching
2) circulatory function –> perfusion, cap refill
3) gestational age
4) comprehensive physical exam

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24
Q

What are the characteristics assessed for a newborn physical appearance?

A
  • Symmetry
  • Obvious deformities
  • Size, smell
  • Muscle tone
  • Posture
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25
Q

What are the assessed characteristics for a newborn behavior?

A
  • Crying
  • Lethargic
  • Responsiveness
  • Reflexes
  • Jittery = can be caused by hypoglycemia or seizures
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26
Q

What are the normal measurements for a newborn?

A

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

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27
Q

What is the normal weight for a newborn?

A
  • 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
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28
Q

What are the normal values for the newborn vital signs?

A

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

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29
Q

What is AOP?

A

Apnea of Premature babies –> can be normal ranging from 5-15 sec

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30
Q

What is “acrocyanosis”?

A

Blue extremities –> will resolve w/in 24h

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31
Q

What are characteristics of Harlequin sign?

A

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
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33
Q

What is milia?

A

Keratin filled epithelial cysts which occur in up to 40% of newborns.

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34
Q

What is “sebaceous hyperplasia”?

A

Referred to as “puberty of newborn” = lesions are more yellow than milia.

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36
Q

What is “erythema toxicum”?

A

Newborn rash = normal finding - apparent first few days of life

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37
Q

What is the first action the nurse should take if presence of forceps marks on newborn?

A

Assess facial nerve integrity and other trauma.

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38
Q

What is a potential risk with “strawberry hemangioma”?

A

The hemangioma can interfere w/ vision when located around the eye.

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39
Q

If the head circumference of a new is above the normal growth curve, what does it indicate?

A

Hydrocephalus = excess CSF in the ventricles causing brain compression against the skull.

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40
Q

What defines “Caput Succedaneum”?

A

Head elongates and presence of edema of the soft tissue - crossing of the sutures.

  • Appears at birth til 12 to 48h
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41
Q

What defines “Cephalohematoma”?

A

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
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42
Q

What can “Caput Succedaneum” and “Cephalohematoma” trigger?

A

Jaundice –> Nurse should assess bilirubin levels

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43
Q

What are the characteristics of the 2 fontanelles?

A

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.
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44
Q

What is “Choanal Atresia”?

A

Narrowing or blockage of the nasal airway by tissue.

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45
Q

What are 2 major birth defects of the head?

A

1) Anencephaly = only brain stem grows - no brain tissue
2) Encephalocele = cranium does not close and meninges protrude out of head

  • Very poor prognosis
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46
Q

What breath sounds are a common finding right after birth?

A

Faint crackles due to left amniotic fluid in lungs

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47
Q

What is a common finding when assessing the heart of a newborn?

A

Heart murmurs are common and not permanent - Listen for 1 full minute.

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48
Q

What needs to be assessed if suspected heart problem?

A

Assess BP in all 4 extremities and check peripheral pulses.

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49
Q

What is “hydrocele”?

A

Enlarged scrotum due to excess fluid.

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50
Q

What would brick reddish uric crystal deposits in diaper indicate?

A

Can be an early sign of dehydration.

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51
Q

What are some signs indicating hip dysplasia?

A
  • One leg shorter

- Gluteal creases are asymmetrical (skin folds)

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52
Q

What are the specific assessments required for the back and buttocks?

A
  • straight spine
  • spina bifida occulta - dimple or tuft of hair
  • Meningocele = sac of fluid only
  • Meningomyelocele = sac of fluid and spinal cord
53
Q

What is an important supplement that the expectant mother needs to take and why?

A

Folic acid = prevents physical abnormalities

54
Q

What are the different reflexes that are assessed in the newborn?

A

1) Moro = arms and legs extend and abduct
2) Palmar grasp
3) Plantar
4) Babinski
5) Rooting
6) Sucking
7) Tonic neck
8) Stepping

55
Q

When does the New Ballard scale need to be assessed?

A

Within the first 4 hours of life.

56
Q

What is the difference between brown fat and white SQ fat?

A

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.

57
Q

What should the nurse if the baby presents with acrocyanosis?

A

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.

58
Q

What is the normal value for blood glucose?

A

> 40 mg/dL

59
Q

What is the normal level for bilirubin?

A

< 12 mg/dL

  • Peaks on 3rd day of life
60
Q

What are 2 medications administered immediately after birth?

A

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
61
Q

How does the fetal circulation function?

A

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.

62
Q

What are the 3 structures helping fetal circulation?

A

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
63
Q

What does the APGAR score measure and when should it be assessed?

A

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
64
Q

What is thermoregulation?

A

The maintenance of the infant body temperature that should range between 97.7 and 99.1 F

65
Q

What are the 4 ways of heat loss?

A

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

66
Q

How does a newborn handle cold stress?

A

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
67
Q

What are the necessary room temperatures needed to maintain baby at right temp?

A
  • If clothed = room at 24-27 C

- If unclothed = room at 32-33.5 C

68
Q

What are the normal hematologic values?

A
  • 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
69
Q

What is a characteristic of the cardiac sphincter in newborns?

A

The cardiac sphincter is relaxed causing a tendency to regurgitate
–> Nursing Implication = Assess swallow reflex

70
Q

What is their digestive system lacking the first 3-6 months of age?

A

1) Amylase = to digest carbs
2) Lipase = for fat absorption
- -> Brest milk contains these enzymes

71
Q

What are the possible causes of meconium being passed in utero?

A
  • Stress
  • Post term babies
  • Should normally be passed w/in the first 24h
72
Q

What an elevated level of bands would indicate?

A

Hight level of bands (immature WBCs) can be a sign of infection.

73
Q

Why is glucose stored in liver the last 4-8 weeks in utero?

A
  • Used for energy of birth
  • Heat production
  • -> and stored until first feelings are taken
74
Q

When is an infant at risk for hypoglycemia?

A

1) blood glucose < 40 mg/dL
2) preterm babies
3) babies from diabetic mothers
4) cold stress
- -> NI: Encourage feelings

75
Q

What is the difference between conjugated and unconjugated bilirubin?

A
  • 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
76
Q

What is hyperbilirubinemia?

A

Excessive levels of bilirubin in blood = > 12 mg/dL

  • Most common neonatal problem
77
Q

What is “Kernicterus”?

A

Brain damage caused by excess of bilirubin.

78
Q

What is a benefit of bilirubin?

A

It is a powerful antioxidant that helps w/ adjustments to environmental O2.

79
Q

What are the 2 types of physiologic jaundice?

A

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

80
Q

What are the nursing care and treatments of hyperbilirubinemia?

A

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

82
Q

What are the causes of jaundice?

A
  • Anything that causes an excessive destruction of RBCs
  • Infection
  • Metabolic disorders
  • Incompatibilities between maternal and fetal blood = Rh and ABO
83
Q

What are the risks with Rh incompatibility?

A

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.

84
Q

What is an efficient treatment for Rh incompatibilities?

A

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.

85
Q

What is another complication w/ Rh incompatibilities?

A

“Erythroblastosis Fetalis” = Hemolytic disease of the newborn
Results in:
- infant born severely anemic and jaundiced
- generalized edema
- CHF
- Ascites
–> High risk for death

86
Q

What are the antibodies that can cross the placenta?

A

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.

87
Q

What are the liver functions for the infant?

Besides glucose storage prior to birth

A
  • 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
88
Q

What happens to the kidney flow after birth?

A

It increases because of ⬇ resistance in renal blood vessels.

–> 1st void usually occurs w/in 24h

89
Q

What could absence of urine indicate?

A
  • Hypovolemia
  • Absence of kidneys
  • Kidney anomalies
  • Usually oligohydramnios is also present when there is a kidney dysfunction.
90
Q

What are the main assessments for the care of the newborn?

A

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

91
Q

How do level of nursery differ from one another?

A
  • 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)
92
Q

What are the causes of respiratory problems in infants?

A

Transient Tachypnea of the newborn (TTN)

–> retained lung fluid because of C section, asphyxia, maternal analgesia, bleeding or diabetes.

93
Q

How does Tachypnea present itself?

A
  • RR as high as 120/min
  • retractions
  • nasal flaring
  • (grunting)
  • mild cyanosis
94
Q

What is a precaution to take in the event of Tachypnea?

A

Refrain from breastfeeding –> Risk of aspiration

95
Q

What are the causes for SGA?

A

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

96
Q

What are some nursing considerations with SGA?

A
  • Hypoglycemia = greater need for glucose for brain development
  • Feedings = early and more frequent
  • Hypothermia
  • Warming measures (blankets, warming units)
  • Temperature monitoring
97
Q

When is an infant considered LGA?

A

Birth weight is above the 90th % at any week of gestation

  • Most commonly infants from diabetic mothers
98
Q

What are some common complications w/ LGA newborns?

A
  • 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
99
Q

What should the nurse assess first with macrosomia?

A
  • 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)
100
Q

What is “Postmaturity syndrome”?

A

Found in post term infants - caused by ⬇ placental functioning, which leads to low O2 levels and nutrition transport.

101
Q

What are the S x S of “Postmaturity syndrome”?

A

1) hypoxia
2) malnourishment
3) loose skin, peeling, cracked
4) long nails
5) meconium stained cord, skin and nails

102
Q

What are some complications w/ the post term newborn?

A

1) Cold stress/ Hypothermia
2) Hypoglycemia
3) Meconium aspiration
4) Polycythemia (hct > 65% and hgb > 22 g/dL) = can ⬆ risk of hyperbilirubinemia
5) Seizures

103
Q

What are the dangers of Meconium Aspiration Syndrome (MAS)?

A
  • Obstruction of airways
  • Trapping of air
  • -> Pneumothorax and/or respiratory distress
104
Q

What interventions are to be implemented with MAS?

A

1) Airway must be cleared at birth:
- suction of mouth and pharynx
- intubation of trachea if necessary

105
Q

What are the main risk factors for premature birth?

A
  • Substance abuse
  • Maternal disease (gestational hypertension, DM, ❤)
  • Maternal age (< 17 and > 35)
106
Q

What is the most common problem in the preterm infant?

A

RDS (Respiratory Distress Syndrome)

  • -> Surfactant development is insufficient - lungs become stiff
  • -> Can lead to Atelectasis and hypoxia
107
Q

What are the S x S of RDS?

A

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

108
Q

What are the appropriate nursing interventions for RDS?

A
  • Mechanical ventilation
  • Correction of acidosis
  • IV fluids
  • Surfactant replacement
109
Q

How does a nurse identify infants at risk because of maternal substance abuse?

A

1) Lack of prenatal care
2) Placental abruption (cocaine, speed or smoking)
3) Abnormal behavior of mother

110
Q

What are the S x S of infants of maternal substance abuse?

A

1) Irritable
2) Jittery
3) Restless
4) Prolonged high-pitched cry
5) Poor feeding
6) Diarrhea
7) Poor sleep patterns
8) Tachypnea
9) Seizures

111
Q

When can S x S of withdrawals be observe in an infant?

A

Usually at least 24h later.

  • Can test meconium or urine for substance abuse
112
Q

What are the 2 ways an infant can acquire an infection?

A

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.

113
Q

What are the S x S of infection in an infant?

A
  • Temperature (*usually low rather than high)
  • Respiratory pbs
  • Feeding intolerance
  • Lethargy
  • Hypoglycemia
  • Apnea
114
Q

When is surfactant apparent in the fetus and when does the fetus have sufficient surfactant to being born?

A

24-25 weeks of gestation

115
Q

When does the fetus have sufficient surfactant to being born?

A

34-36 weeks of gestation

116
Q

What are the appropriate I & O in the newborn from birth to day 5?

A 
Intake = 60-100 mL/kg per day
Output = at least 1 to 2 voids per day
117
Q

What are the appropriate I & O in the newborn AFTER the the first 5 days?

A 
Intake = 150-175 mL/kg per day
Output = 2-5 mL/kg/h or 48-120 mL/kg/24h
118
Q

What is the normal range for specific gravity in the newborn?

A

Specific gravity should range between 1.002-1.010

119
Q

What organisms are able to cross the placenta and cause vertical infection?

A

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

120
Q

What can be used in the management of infection or sepsis?

A

Broad spectrum antibiotics = Gentamicin or Ampicillin

121
Q

What are the recommended interventions when treating Necrotizing Enterocolitis (Poor feeding/ GI infection)?

A
  • Gavage feedings

- NPO w/ TPN and lipids

122
Q

What interventions should be implemented when treating Bronchopulmonary Dysplasia (BPD)?

A
  • Prolonged O2

- Ventilation

122
Q

What is molding of the newborn’s head?

A

It is asymmetry of the head shape caused by the birthing process.

123
Q

What intervention is needed when treating Intraventricular Hemorrhage?

A

Weekly head US

123
Q

What is thrush and where is it found in the newborn?

A

White patchy areas evident on tongue and/or gums (candida albicans)

124
Q

What intervention is needed when treating Retinopathy of Prematurity?

A
  • Treatment laser

- Cryotherapy

124
Q

Is Jaundice a normal finding for the newborn?

A

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.

NURS 132 OB/Peds (4 decks)

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