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OB > OB Exam 2 Pt 2 > Flashcards

OB Exam 2 Pt 2 Flashcards

1
Q

When is the newborn’s first period of reactivity?

A

Up to 30 minutes after birth. ch 23

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2
Q

Page 530 (10th ed.) notes that Once respirations are established, breaths are shallow and irregular, ranging from _____ to ______.

A

30 – 60. ch 23

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3
Q

Apneic periods longer than ____ seconds should be evaluated.

A

20 seconds. ch 23

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4
Q

List several signs of respiratory distress in the immediate newborn period.

A

Nasal flaring; retractions; grunting with exhalation; increased use intercostal muscles, see-saw respiration, rate less than 30 or more than 60. ch 23

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5
Q

Rapid increase in body temperature, hypothermia, hypocalcemia or sepsis.

A

Name 4 things that can contribute to apnea (Pg. 530). ch 23

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6
Q

The average newborn has 300 ml of blood. This can be increased by ____ ml if the cord is not cut immediately but “placental transfusion” is allowed to occur, in which the blood in the cord and placenta is allowed to flow into the baby.

A

100 ml. (Pg. 532) ch 23

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7
Q

Persistent tachycardia may be associated with which disorders?

A

Anemia, hypervolemia, hyperthermia or sepsis. ch 23

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8
Q

Persistent bradycardia may be associated with which disorders?

A

Congenital heart block or hypoxemia. ch 23

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9
Q

Name the four modes of heat loss. (These are often on tests.)

A

Convection, radiation, evaporation, conduction. ch 23

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10
Q

The nurse alert makes the point that the infant must void within ___ hours after birth.

A

24 ch 23

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11
Q

What is the source of bilirubin, which can build up in the blood and cause neurotoxicity?

A

Breakdown of RBCs and the newborn liver’s inability to process this. ch 23

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12
Q

How does feeding help to reduce the serum bilirubin?

A

Feeding stimulates peristalsis, which then causes less bilirubin to be reabsorbed by the gut. ch 23

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13
Q

By what age should infants be able to concentrate their urine?

A

By three months. Pg.535 ch 23

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14
Q

What are Epstein’s pearls and where are they found?

A

Retention cysts, on gum margins and at the juncture of hard and soft palate. ch 23

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15
Q

The intestines are free of bacteria after birth. Once bacteria are established, which 3 vitamins do they help to synthesize?

A

Vitamin K, folate and biotin. ch 23

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16
Q

What is the capacity of the stomach of the newborn in milliliters?

A

30 – 90 ml. ch 23

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17
Q

What color is meconium?

A

Greenish black ch 23

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18
Q

Describe the stools of breast-fed babies

A

Breastfed infants have more frequent and liquid stools; they are yellow and contain small yellow curds. They often smell like sour milk. ch 23

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19
Q

Describe the stools of bottle-fed babies

A

Bottle-fed infants have larger green-brown stool (book says may even be pale yellow) harder or more formed and have a more offensive odor. ch 23

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20
Q

Most normal, term infants pass meconium within ____ to ____ hours.

A

12, 24. Pg. 536 ch 23

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21
Q

How long should the iron stores last in a full-term breast-fed infant vs. in a preterm infant?

A

4 – 6 months vs. 2 – 3 months. ch 23

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22
Q

What is a normal blood glucose level for a newborn in the first several hours after birth?

A

50 – 60 mg.dl. Pg. 537. ch 23

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23
Q

What should blood glucose levels be by the third day of life?

A

60 – 70 mg/dl ch 23

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24
Q

Page 538 in the paragraph beneath the nurse alert, states, “Jaundice is considered to be pathologic if it: _______ (list the 3 criteria given).”

A

(1.) appears before 24 hours of age. (2.) increases more than 5 mg/dl/ in a 24 hour period. (3.) peaks at greater than 15 mg/dl at any time ch 23

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25
Q

Which is the worst of the long-term disorders involving hyperbilirubinemia?

A

Kernicterus. ch 23

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26
Q

Newborns are at high risk for infection, yet do not typically have fevers. What are signs of infection in newborns?

A

Lethargy, irritability, poor feeding, vomiting, diarrhea, decreased reflexes, pale and mottled skin, apnea, tachypnea, grunting or retracting ch 23

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27
Q

What is vernix caseosa? Do term or preterm infants have more of it?

A

Cheese-like whitish substance found on newborn skin that is protective; preterm ch 23

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28
Q

Acrocyanosis is a normal finding in newborns, unlike central cyanosis. How does an infant with acrocyanosis look?

A

Hands and feet appear slightly cyanotic and blue ch 23

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29
Q

What is lanugo?

A

Fine hair on an infant’s face, shoulders and back. ch 23

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30
Q

What do the nevi known as “stork bites” look like and when do they usually fade?

A

Pink, easily blanched; on eyelids, nose, occiput, neck and fades by second year. ch 23

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31
Q

What does erythema toxicum look like and when does it usually fade?

A

Rash-like, red macules, papules or vesicles anywhere on body. It fades by 3 weeks. ch 23

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32
Q

Which hormone is responsible for mucoid vaginal discharge and pseudo menstruation in neonatal girls and breast swelling and “witches milk” in either gender?

A

Estrogen, from the mother’s blood. Pg. 541. ch 23

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33
Q

How does the scrotum of a term male differ from that of a preterm male?

A

Term: testicles palpable, many rugae present. Preterm: testes may not have fully descended; few or no rugae. ch 23

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34
Q

Describe the differences between caput succedaneum and cephal hematoma.

A

Caput succedaneum is edema of the scalp and crosses suture lines. Cephal hematoma is bleeding between the periosteum and skull. It does not cross suture lines. ch 23

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35
Q

Which two tests are used to determine if a newborn has hip dysplasia?

A

Barlow test and Ortolani’s maneuver. ch 23

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36
Q

Your book notes that some crying is actually normal (and does not mean that the caregiver is doing something “wrong” as new parents often think).At what age does the crying peak?

A

At about 2 months of age. Pg. 551. ch 23

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37
Q

Why is the newly admitted baby from L& D considered a source of contamination and handled with gloves? (See the study guide and Pg. 553.)

A

Because they have blood and amniotic fluid, vernix and vaginal bacteria on the skin until bathed. ch 24

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38
Q

What 5 areas are assessed in generating an Apgar Score?

A

Heart rate, respiratory rate, muscle tone, reflex irritability, color. ch 24

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39
Q

When is the all-important alarming ID bracelet attached to the infant’s ankle?(see the study guide.)

A

Before mom and baby are separated after birth. ch 24

40
Q

After the thorough assessment by the newborn nursery admitting nurse, which assessment is done to determine gestational age?

A

New Ballard Scoring. ch 24

41
Q

What two medications may be used to prevent ophthalmia neonatorum?

A

Erythromycin or tetracycline eye ointment. ch 24

42
Q

Injury to the baby may occur when health care providers use which delivery techniques?

A

Forceps-assisted births, vacuum extractors, version and extraction, cesarean sections. Pg. 574. ch 24

43
Q

How well do the new TcB monitors correlate with the serum bilirubin levels?

A

Very well, within 2 – 3 mg/dl. ch 24

44
Q

What is the normal range for total serum bilirubin?

A

1 – 12 mg/dl. Pg. 575. ch 24

45
Q

What glucose measurements in a neonate indicate hypoglycemia? (use values from page 575.)

A

Blood glucose levels of less than 40 - 50mg/dl ch 24

46
Q

List signs/symptoms of hypoglycemia?

A

Jitteriness, irregular respiratory effort, respiratory distress, apnea, hypotonia, feeding difficulties, lethargy, seizures, or no signs at all. Pg. 576. ch 24

47
Q

List signs/symptoms of hypocalcemia?

A

Jitteriness, high-pitched cry, irritability, apnea, intermittent cyanosis, abdominal distension, laryngospasm, or no signs at all. Pg. 576. ch 24

48
Q

What is the best treatment for both hypoglycemia and hypocalcemia?

A

Feeding, as early as possible. Pg. 687 ch 24

49
Q

Where should the infant’s heel be punctured when collecting blood for a lab test?

A

Only on the sides of the heel. Pg. 580 ch 24

50
Q

Which 2 injections should all infants in the NN receive?

A

Vitamin K and Hepatitis B. ch 24

51
Q

Which size needle is used for IM injections in newborns?

A

25 gauge, 5/8 inch needles. ch 24

52
Q

Which muscle is used for injections in newborns?

A

Vastus lateralis ch 24

53
Q

Hyperbilirubinemia can best be prevented by early feeding. But if this is not enough, what treatment modality may be used?

A

Photo therapy ch 24

54
Q

Which methods of circumcision requires use of Vaseline for post care?

A

Gomco or Yellen. (Also Mogen). ch 24

55
Q

How soon should the plastic ring fall off when the plastibell method of circumcision has been used?

A

5 – 7 days. ch 24

56
Q

How long does the yellow exudate on the glans after circumcision last?

A

2 -3 days. Pg. 746. ch 24

57
Q

What is the recommendation regarding immersion baths of a newborn before the cord has fallen off?

A

Sponge baths until cord falls off. ch 24

58
Q

Which position for sleeping is currently recommended?

A

Back to sleep. ch 24

59
Q

What are current cord care recommendations regarding what to clean the cord with?

A

Water or soap and water cleansing. Pg. 597 ch 24

60
Q

What is colic and why do babies get it?

A

We do not have the answers to this question. Pg. 601. ch 24

61
Q

What occurs in the baby before each spurt in development? (according to Dr. Brazleton, a noted authority on child development and treatment)

A

A period of disorganization. Pg. 755. ch 24

62
Q

For how many months should an infant be breastfed exclusively?

A

6 months ch 25

63
Q

Which conditions in the mother or infant are contraindications to breastfeeding?

A

Infants with galactosemia, mothers with HIV or TB or Human T-cell lymphotrophic virus type I or II; mothers receiving radiation or chemotherapy, and mothers using street drugs and certain other meds Pg. 608. ch 25

64
Q

How many calories does human milk contain per ounce?

A

20 Kcal. ch 25

65
Q

Decreased calcium absorption is a problem when cow’s milk is used. Why is this?

A

Because the calcium to phosphorus ratio is low. ch 25

66
Q

Is it true that women with large breasts can produce more milk than those with smaller breasts?

A

No! Size has no bearing and is not an accurate indicator of milk-producing ability. Small breasts have the glands that are necessary. ch 25

67
Q

At how many weeks gestation do the breast begin making colostrum?

A

16 weeks. ch 25

68
Q

How does the body “know” when to make more milk?

A

Increased milk supply is made on a supply-meets-demand basis. More feeding = more milk production. Pg. 612. ch 25

69
Q

Mothers who breastfeed are at decreased risk for which serious postpartum complication?

A

PPH (postpartum hemorrhage). ch 25

70
Q

Why does breastfeeding cause increased afterpains?

A

Increased release of oxytocin with breastfeeding causes more uterine contractions. ch 25

71
Q

Which two hormones prevalent in the postpartum time affect women’s emotions?

A

Prolactin and oxytocin. ch 25

72
Q

When does real milk as opposed to colostrum “come in”?

A

3 – 5 days ch 25

73
Q

Does foremilk contain more fat or protein?

A

Protein (also lactose and vitamins.) ch 25

74
Q

After the first few days, now many wet diapers and stools should an infant have?

A

6 wet diapers and 3 – 6 stools. ch 25

75
Q

What are the 4 breastfeeding positions?

A

Football hold, cradle, modified cradle or across lap, and side-lying. ch 25

76
Q

How much of the areola should the baby’s mouth cover if properly “latched on”?

A

2 – 3 cm. all around areola. ch 25

77
Q

What is demand feeding?

A

The infant determines when feedings occur, i.e., “feed him when he’s hungry.” ch 25

78
Q

How long will the mother feed the baby on each breast once lactation is established?

A

15 – 20 minutes on each side. ch 25

79
Q

How can nursing staff, mothers, and families prevent nipple confusion from occurring?

A

Don’t give supplementary feedings until breast feeding is well-established, about 3 – 4 weeks, and the same for pacifiers. ch 25

80
Q

List 3 benefits of breast milk for preterm infants, given on page 621.

A

Enhances retinal maturation, improves neurocognitive outcomes, and decreases risk of NEC. ch 25

81
Q

How long can breast milk be stored: at room temperature, in the refrigerator, in the freezer, and in the deep-freeze?

A

8 hours; 8 days; up to 6 months; up to12 months. Pg. 623 ch 25

82
Q

How should frozen breast milk be thawed?

A

Either place in refrigerator or in warm water.

83
Q

How soon should breast milk be used after thawing? Should it be re-frozen?

A

Use within 24 hours, do not re-freeze. ch 25

84
Q

Which common appliance should never be used to thaw or heat breast milk, according to the nurse alert?

A

Microwave. ch 25

85
Q

How many additional Kcal does a breastfeeding woman need over her non-pregnant needs?

A

300 - 500 Kcal./day. ch 25

86
Q

True or false? Breastfeeding women should take multivitamin supplements.

A

True ch 25

87
Q

Women with flat or inverted nipples have internal adhesions that make sucking more difficult for babies. Which product may help this, and may even be started early in pregnancy?

A

Breast Shells ch 25

88
Q

Which type of oral contraceptive is not likely to interfere with milk supply? (See the study guide for information on this)

A

POPs (Progesterone-only pills) and other progesterone-based contraceptives. ch 25

89
Q

Can women with breast augmentation surgery breastfeed successfully?

A

Usually they can. ch 25

90
Q

What are signs and symptoms of engorgement?

A

Painful overfilling of breast; breast are firm, tender, hot, shiny, taut, nipples may flatten. ch 25

91
Q

When is engorgement likely to occur?

A

3 – 5 days after birth when milk has “come in”. ch 25

92
Q

How often should the mother with engorgement breastfeed?

A

Frequently, q 2 hours ch 25

93
Q

What interventions are recommended for engorgement?

A

Feed every 2 hours, massage breasts, use breast pump if infant not emptying breast, cold compresses, raw cabbage leaves. ch 25

94
Q

What are causes of sore nipples?

A

Poor positioning, incorrect latch-on, improper suck, monolial infection. ch 25

95
Q

List signs and symptoms of mastitis.

A

Flu-like signs and symptoms like fever, shills aches, headache, along with localized redness and swelling, especially in one quadrant of the breast. ch 25

96
Q

What are the treatments for mastitis?

A

Antibiotics, analgesics, antipyretics, frequent feeding/pumping, warm compresses, rest. ch 25

97
Q

What are the implications/risks of propping a baby bottle rather than holding it for the baby to drink?

A

They can choke and it deprives them of parental interaction. ch 25

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