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Peds/OB > OB Exam 3 > Flashcards

OB Exam 3 Flashcards

1
Q

Newborn BP range

A

60-80/40-50

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2
Q

Newborn temp range

A

Hyperthermia not common in NB (>99.5)
Hypothermia common and dangerous (cannot constrict and shiver)
Head=1/3 body surface and loses large amounts of heat-cap/hat!

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3
Q

Newborn RR range

A

30-60

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4
Q

Newborn HR range

A

110-160

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5
Q

Newborn O2 range

A

95-100%

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6
Q

Newborn jaundice

A

Pathological vs physiologic
Either can be neurotoxic
-acute bilirubin encephalopathy
-kernicterus

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7
Q

Pathological jaundice

A

Result of underlying disease, appears before 24 hours of age
Bili levels inc by >6mg/dL in 24 hrs or bili level exceeds 15mg/dL
-usually caused by hemolysis

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8
Q

Physiological jaundice

A

Considered benign
-everyone goes through walk outside->sunshine
-unconjugated bilirubin levels 72-120 hr after birth with rapid decline to 3mg/dL 5-10 days after birth

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9
Q

Thermoregulation in newborns-heat loss routes

A

Convection, radiation, evaporation, conduction

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10
Q

Thermoregulation in newborns-interventions

A

Non-shivering thermogenesis- creating heat by metabolism of brown fat

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11
Q

Hypoglycemia s/s in infants

A

Poor feeding (LGA=worst)
-jitteriness/tremors
-hypothermia
-weak cry
-lethargy
-flaccid muscle tone
-seizures/coma
-irregular respirations

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12
Q

Hypoglycemia in infants

A

Glucose levels decrease 30-90 min after birth
-inadequate Gluconeogenesis or inc use of glycogen stores
-asymptomatic at risk NB offered oral feedings to inc levels greater than 45 mg/dL
-symptomatic= IV dextrose (D15 and up=central line)
-frequent oral and/or gavage feedings or continuous parenteral nutrition early after birth to treat

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13
Q

Phototherapy and how it works

A

Tx for jaundice
Reduces unconjugated bilirubin serum by changing molecules to be excreted faster

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14
Q

Signs of NEC in babies and tx

A

bowel death
More premature babies=higher risk
-feeding issues, stomach swelling discoloration and pain, stool changes,hypotension, periods of apnea. Issues with temp regulation
-connection with formula, BF=best

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15
Q

Newborn medications given after birth

A

-Vitamin K prophylaxis (injection IM 0.5-1mg)-prevents bleeding
-Eye prophylaxis: erythromycin, tetracycline or silver nitrate ointment (if eyes=open), mandatory in US, 1-2cm ribbon within 1-2 hrs of brith
-Hep B vaccine?

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16
Q

S/s of NAS in Newborns

A

-high-pitched shrill cry
Irritability, tremors, hyperactivity with inc Moro, inc muscle tone, disturbed sleep pattern
-poor feeding, diarrhea, excessive and uncoordinated constant sucking
-nasal congestion with flaring, frequent yawning, skin mottling, retractions, tachypnea, sweating, temp greater than 99

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17
Q

med for NAS NB

A

Morphine sulfate first, if not working, then phenobarbital

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18
Q

Postpartum diuresis

A

Within 12 hours of birth
-UOP 3,000mL or more each day first 2-3 days
-profuse diaphoresis nightly for first 2-3 days
-urethral swelling and dec bladder tone=high risk for retention
-keep bladder emptied (distension= push uterus up and to the side->excessive bleeding)

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19
Q

Breastfeeding and how it affects hormones

A

Breast feeding increases oxytocin release= increase uterine tone
Infant’s suck also affect prolactin levels

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20
Q

Which hormone produced during breastfeeding for milk production

A

Prolactin
Lactating clients: prolactin elevated and suppress ovulation
Nonlactating: prolactin declines and reaches pregnant level by third week postpartum, menses resume by 12 was PP

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21
Q

Postpartum fundus and how it is measured

A

Fingerbreadths from umbilicus (cm) above or below, midline or displaced to the right/left
U+1, +1, 1/U (above
-1, U-1, U/1(below

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22
Q

Fundal height progression

A

-fundal height descends one finger breadth (1cm)/day
-end of third stage of labor= palpable midline 2 cm below umbilicus
-1hr after delivery=rise to level of umbilicus
-every 24 hr fundus descend ~1-2cm,halfway between symphasis pubis and umbilicus by 6th PP day

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23
Q

What is uterine involution

A

Shrinking to normal size post-birth (trying to go back to the way it use to be)

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24
Q

What is uterine subinvolution

A

Uterus doesnt return to normal size after birth
-causes=infection or retained fragments of placenta
S/S: inc/prolonged Lochia, cramps/abd pain, distended Lower abd,lower back pain

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25
Q

How long is the postpartum phase

A

Traditionally, 6 weeks

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26
Q

Lochia assessment

A

Color, amount (scant, light, moderate, heavy, excessive), consistency
Scant:less than 2.5 cm
Light: 2.5-10cm
Moderate:more than 10 cm
Heavy: one pad saturated within 2 hr
Excessive: one pad saturated in 15 min or less, pooling of blood under buttocks

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27
Q

Lochia rubra

A

dar red color, bloody consistency, flesh odor, small clots
-transient flow inc during BF(inc oxytocin, inc uterine contraction=inc bleeding) and upon rising
-1-3 days post delivery

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28
Q

Lochia serosa

A

Pinkish brown, serosanguinous, small clots and leukocytes
-day 4-days after delivery

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29
Q

Lochia alba

A

Yellowish white creamy color, flesh odor, can consist of icons and leukocytes
-approx. day 10 up to 8 weeks postpartum

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30
Q

Complications of meconium stained amniotic fluid and why does it happen

A
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31
Q

Newborn skin-acrocyanosis

A

Normal, blue/purple hands and feet

32
Q

Newborn skin- milia

A

Look like white pimples on face, go away on own-dont pop

33
Q

Newborn skin-Mongolian spots

A

More common on darker skin, commonly on buttocks

34
Q

Newborn skin-vernix

A

“Cheesy” coating from the womb

35
Q

Caput vs cephalohematoma

A

Caput succedaneum does cross suture lines and a cephalohematoma does not
-Caput=scalp edema over occiput
-Ceph=blood between skull and periosteum, can cause hyperbilirubinemia (inc RBC from bleeding)

36
Q

RDS

A

respiratory distress syndrome

37
Q

Why RDS happens in newborns

A

Result of surfactant deficiency with poor gas exchange and ventilatory failure
-surfactant=aid to alveoli expansion, keeps form collapsing
-atelectasis=inc WOB

38
Q

Risk factors RDS

A

-Preterm gestation
-Perinatal asphyxia(meconium staining, cord prolapse, unchallenged cord)
-maternal DM
- PROM
-maternal use of barbiturates/narcotics
-C section w/o labor
-hypovolemia
-genetics: white males

39
Q

S/S RDS

A

Tachypnea (>60)
Nasal flaring
-expiratory grunting
-retractions
-labored breathing with prolonged expiration
-fine crackles
-cyanosis

40
Q

Meds given for RDS

A

Surfactant
-<27-30 weeks=intubate and round of surfactant then ideally extubate
-resp assess before and after
-suction prior
-assess endotracheal tube placement(listen RR)
-avoid suctioning of endotracheal tube for 1 hr after admin (if ET tube staying in)

41
Q

Actions immediately following birth for mother and infant

A

Baby is dried off and warmed up, bulb suctioning, stimulate baby to breathe, 1 min and 5 min APGAR scoring
-mother delivers placenta, ensure no fragments retained
-skin to skin

42
Q

Postpartum hemorrhage medications

A

Oxytocin, methergine, misoprostol, carboprost

43
Q

PPH-methergine

A

Uterine stimulant
-controls postpartum hemorrhage
-assess uterine tone and vaginal bleeding
-DO NOT admin to clients with HTN

44
Q

PPH-misoprostol

A

Cytotec
(Also used for cervical ripening-topical)
-controls hemorrhage
-assess uterine tone and vaginal bleeding
-tablets

45
Q

PPH meds-carboprost

A

Hemabate (makes clients feel nasty)
-uterine stimulant
Controls hemmorhage
-assess uterine tone and vaginal bleeding

46
Q

Postpartum hemorrhage med side effects-Carboprost

A

Fever, HTN, chills, HA, N/V, diarrhea(most common)

47
Q

Postpartum hemorrhage med side effects-Methergine

A

HTN, N/V, HA

48
Q

PPH-oxytocin

A

Uterine stimulant, promotes uterine contractions
-assess uterine tone and vaginal bleeding

49
Q

Postpartum hemorrhage med side effects-oxytocin

A

Water intoxication (lightheadedness, N/V, HA, malaise)
-rxns can progress to cerebral edema with seizures, coma, death
-hypertonic uterus

50
Q

Postpartum hemorrhage contraindication for meds-methergine

A

DO NOT ADMIN TO CLIENTS WITH HTN

51
Q

What medication is given to Rh- mothers of Rh+ infants

A

Rho-gam immunoglobulin

52
Q

How do we determine infant is getting enough input?

A

Voiding patterns

53
Q

Newborn reflexes

A

Moro, tonic neck (fencing), stepping/walking, sucking and rooting, swallowing, babinski, pull-to-sit, planar grasp, plantar grasp

54
Q

Moro reflex

A

“Startle reflex”
symmetric abduction and Extension of arms and splayed fingers followed by flextion of limbs, slight tremor may be noted

55
Q

Tonic neck(fencing) reflex

A

When head turned to side, same side arm and leg extended and opposite limbs flexed into body

56
Q

Babinski reflex

A

Stroke baby foot from heel to toes on lateral side of foot
-big toe dorsiflexes and other toes splay out and “fan”

57
Q

Plantar grasp

A

Finger on baby’s foot and baby grasps fingers/wraps fingers around

58
Q

Palmar grasp

A

Finger in baby’s palm and baby wraps fingers around

59
Q

Sucking reflex

A

Finger on roof of mouth (hard palate) and baby suckles

60
Q

Rooting/latching reflex

A

Touch lip or cheek and baby turns head to stimulus and attempts to suckle

61
Q

Which reflex assists with latching?

A

Rooting and sucking

62
Q

SGA

A

Below 10th percentile Small for gestational age

63
Q

LGA

A

Large for gestational age
Above 90th percentile

64
Q

What do we monitor for in SGA

A

Respiratory distress, temperature instability, feeding difficulties, hyperbilirubinemia
New Ballard score

65
Q

What do we monitor for in LGA

A

Respiratory distress, temperature instability, feeding difficulties, hyperbilirubinemia
-new Ballard score

66
Q

What actions to take for a postpartum hemorrhage

A

Massage fundus until firm
-monitor amount of blood/cots coming out with massage
-admin meds
-check tone of fundus and position r/t umbilicus

67
Q

Instructions for bulb syringe

A

“M then N”
Suction mouth first then the nose
-depress bulb outside of mouth/nose and insert and release to apply suction
-squeeze contents out off to the side after before depressing bulb again for reinsertion

68
Q

Ballard score

A

Assesses neuromuscular and physical maturity, estimation of gestational age by maturity rating

69
Q

What is Ballard score used for

A

Comparing actual gestational age and the Ballard score= tracking to see if actual neuromuscular and physical maturity is on par for gestational age (are they where they need to be?

70
Q

S/S NB sepsis

A
71
Q

TORCH

A

Complex of infection types in newborns

72
Q

TORCH infections

A

Toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus

73
Q

Toxoplasmosis

A

R/F: consuming raw meat, handling cat feces, manifestations similar to influenza

74
Q

Other infections- TORCH

A

Hep A and B, HIV, parvovirus, syphilis, mumps, varicella-zoster

75
Q

Rubella-TORCH

A

Check immunity-pregnant healthcare workers should avoid
R/F: contracted through children who have rashes or neonates who are born to pts who had rubella during

76
Q

Cytomegalovirus

A

Member of herpes virus family
R/F:
1. transmitted by droplet from person-person, through semen, cervical and vag secretions, breast milk, urine, blood
2.latent virus can be reactivated and cause disease in utero or during vaginal birth

77
Q

Herpes simplex virus

A

Anti-viral prophylaxis, if not high fatality
R/F: direct contact with oral or genital lesions
Transmission to fetus is greatest during vaginal birth w/active lesions

Peds/OB (11 decks)

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