OB Exam 3 Flashcards
TK: What do do if baby is lethargic? fussy?
Lethargic = unswaddle, stimulate, lights on Fussy = swaddle, rock, lights out
TK: Feeding well is indicated by how many diapers?
6 - 8 . day
Ratio = 1 diaper:day old
TK: Fontanels should be…?
Flat, soft, Ø bony outline = dehydration
TK: Medical Malpractice vs. Negligence
violation of professional duty, failure to use knowledge
failure to exercise degree of care an ordinary person would
TK: Duty vs. Breach
perform professional service as a nurse
failure to carry duty
TK: How to avoid litigation? SOC = ORP meaning?
Follow policies and procedures
Standard of Care = Ordinary, reasonable, and prudent Nurse
TK: ATI Breastmilk Storage viability times (4) and how to thaw (2)
Room temp = 8 hrs
Refrigerated = 8 days
Freezer = 6 months
Deep Freezer = 12 months
Thaw in fridge for 24 hrs
Place container in lukewarm water
TK: Breastmilk preparation DON’TS (4)
Thaw in microwave
refreeze thawed milk
re-use used portions
use old formula
TK: Timing for meat, almond milk, cows milk (+why), and what to mix formula in (+why)
Meat = 9 months
Almond/Cows = 1 year
Cows milk is ↑ protein but ↓ carbs, Iron, VitC, Copper, and is hard to digest, doesn’t support growth
Formula in tap water because it has fluoride which helps with development of teeth
TK: American Academy on how long to breastfeed child?
6 months
TK: Rice and cereal in bottle?
NO, use spoon.
TK: Bottle to bed risks? Replacement fluid?
Ear infection and tooth decay, replace with water.
TK: Maternal Adjustment Phases (3)
Dependent Taking-in
Dependent-Independent Taking-hold
Independent Letting-go
TK: Taking-in-Phase (time, focus, action)
First 12 - 24 hours postpartum
personal needs
Rely on others, excited, talkative, reviews exp.
TK: Taking-Hold Phase (time, focus, action)
Day 2 -3 (as long as 10 days/weeks)
Baby care/competency
Wants charge, but still relies, learn/practice care
TK: TK: Letting-Go Phase (focus, action)
Family as a unit
Resumption of previous roles
Transition to Parenthood begins and develops with…?
During pregnancy
Time (learning process)
Attachment
parent ♥ child, child ♥ parent
Maintained by proximity and interaction.
Strengthened by sensual responses
Bonding
first minutes/hours postpartum of contact
Mutuality
Infant behaviors eliciting corresponding parental behavior
Acquaintance
Eye contact, touching, talking, exploring
Claiming
Identification of new baby by family
Can be POS or NEG
“Dad’s chin and bad attitude”
Nurse Role during Transition
Facilitate attachment and assess/improve coping
Early vs Extended Contact
facilitates attachment but NOT ESSENTIAL
rooming-in, optimal for family-centered care
Parent-Infant Communication:
Touch, Eye Contact, Voice, Odor, Entrainment
Kangaroo! Mom temp ↑ 1º to keep baby warm, stabilize HR, calm respirations
en face = 20cm, Mal de ojo = Spanish rude admiration
can hear in utero @ 24 weeks
areola secrete fluid similar to amniotic fluid, attracts baby
movement in time with parent’s voice
Biorhythmicity
Baby is soothed by mom’s ♥ beat
Reciprocity vs. Synchrony
R - baby cries, mother soothes response (can be POS/NEG)
S - when event is mutually rewarding to both parent and baby
Psychologist vs. Psychiatrist
can’t prescribe but recommends meds
can prescribe meds
Focus of parents during transition
moving towards normal and achieving identity
EDINBURGH (EPDS)
Depression screen for mom (0/30)
If less than 10, possible depression.
Postpartum Blues (%, r/in if Øtx, time length, counte w/, who to screen?)
10 - 15%
Postpartum Depression -> Postpartum Psychosis
Up to 1 year
naps, limiting visitors, ▲ expectations
SCREEN EVERY WOMAN EVER postpartum (during pregnancy if have Hx)
Father’s experience of Birth, nursing counter
First 4 - 10 weeks similar to mother.
Left out/jealous, NORMAL
educate and include
When is next appt?
Vag Birth vs. Cesarean
6 weeks
2 weeks, then 6 weeks
Sexual adjustment Postpartum
NO sex for 5 - 6 weeks post-delivery
Estrogen r/t breastfeeding r/in dry vagina, lube up.
Adolescent vs. > 35 y/o parents
↑ mortality rate (60%)
Needs more developmental teaching
Educate w/ diff. modalities
↑ disease rate (DM)
Sandwich generation
Rehabilitation Act of 1973
Hospitals must accommodate the impaired
Sibling Adaptation expectation and counter
Regression/Rivalry is NORMAL
Involve kids in preparation of baby and acquaintance
Grandparents Adaptation
More involved b/c teen preg, drug abuse, and HIV
Promote continuity w/ inter-generational relationships
Infant’s First period of reactivity (4)
time, HR, RR, motor
30 min post birth
HR ↑ 160 - 180 bpm but drops 30min
RR 60 - 80, irregular
↓ motor activity after 60 - 100 min + sleep
Infant’s Second Period of Reactivity (4)
time, breathing, meconium, ▲s
4 - 8 hours post birth
Tachycardia/pnea occur
Meconium passes
↑ muscle tone, ▲ skin color, ↑ mucous production
Infant Respiratory NOTES (4)
Surfactant is low
Abdominal breathers
Respiratory distress = flaring, retractions, grunting
Liquids squished out of lung during vaginal birth
Infant Respiratory FOCUS (3)
initiate, maintain, maintain other 2?
Initiate breathing
Maintain O2
Maintain Resp/Temp
Infant Hematopoietic NOTES (5)
RBC, Leuko, Platelets, Hct/Iron, VitK
4x RBC of adult (r/o hyperbiliruinemia) ↑ Leukocytes = Platelets to adult ↑ Hct and Iron (enough for 4 - 6 months) Administer VitK cause it takes 3 days to build
Infant Cardiovascular NOTES (4)
openings, blood volume x2, HR average
3 openings: foramen ovale, ductus venosis, and arteriosis (when arteriosis stays open r/in murmur)
Blood volume 300mL (40% weight)
Blood volume will ↑ if not cut w/in 2 min birth
HR average 120 - 140 bpm, murmur/irregular NORMAL
Infant Renal NOTE (2)
diaper output, kidney fx
6 - 8 wet diapers/day
3 - 4 days, kidneys Ø concentrate urine
Infant Thermogenic NOTES (3)
shiver, brown fat, cold stress, birth weight
CAN’T shiver
Will consume brown fat if too cold/unfed
Cold stress r/in metabolic acidosis
Lose 5 - 7% birth weight by day 3 - 5, will regain in 2 weeks
Cold Stress Physiology
Cold r/in ↑ O2 consumption r/in ↑ RR r/in vasoconstriciton r/in ↓ O2 uptake/↓ peripheral perfusion r/in Anaerobic Glycolysis r/in ↓ PO2 and pH (metabolic acidosis)
4 Ways to Lose Heat (ECCR)
Evaporation - H2O loss
Conduction - touching
Convection - through air
Radiation - next to window/fridge
Infant Hepatic NOTES (4)
liver, maternal glucose, coag factor, bruising fx
Liver is 40% abdomen and has enough Iron for 4 - 6 months (which is when they start solids)
Ø maternal glucose once cut from mother
Ø coag factor b/c gut sterile, need VitK
Bruising ↑ r/o bili cause RBC’s will be turned into Bili
How Bilirubin is created
RBC -> Hbg -> Heme/Globin -> Iron and Bilirubin -> via LIVER GLURONYL TRANSFERASE becomes conjugated in and in feces
Kernicterus
When bili passes blood-brain barrier and ↑ r/o mental retardation
Infant GI NOTES (3)
poo development (4), cluster feeding, stomach size
meconium (dark tarry) -> green -> yellow OR OJbrown if formula
By 2nd week should be feeding q1-2hrs
Never feed > 8 oz b/c r/in spitting up
Passive Immunity 2 Sources
from mother and from breastfeeding
Infant Genitalia (3) (NORMAL ♀, ♂, and BOTH)
♀ - swollen majora cover it all, mucous/vernix inside
♂ - swollen scrotum, rugae, contracted (opposite w/ premie & transparent)
BOTH - swollen breasts b/c estrogen (blood♀/rust powder♂ in diaper)
Infant Integumentary NORMAL findings (5)
sweat glands/milia - white dots on nose (pore+vernix)
Desquamation - peeling
Mongolian spots - dark spots towards buttocks
Nevi - birth marks, stork bites, angiomas
Erythemia Toxicum - rash first 3 weeks (flea bites)
Infant Integumentary NOT NORMAL findings (3)
Caput Succedeneum - edema under scalp
Cephalhematoma - blood under scalp (trauma)
Subgaleal Hematoma - blood down neck (trauma) when S/S apparent… it’s too late.
Infant Skeletal NOTES (2)
cartilage vs. bone, hip dysplasia
> cartilage than ossified bone
Assess for hip dysplasia by abducting legs (can’t do if out of socket/hear click), ALSO assess symmetry of leg length/creases
When assessing infant… it is VERY important to also include…?
Pre/Intra/Postpartal periods of mother’s pregnancy
Tummy Time and HOW TO SLEEP?
SUPERVISED
Promotes muscle strength
On back (↓ 75% SIDS)
Infant Sensory NOTES (3)
vision, everything else, hearing?
blurry, black/white (3 -4 months), short
EVERYTHING else more accurate
Congenital Hearing loss in 1/301k, catch to intervene
Neuro vs. Ballard assessments
Reflexes (moro, rooting, babinski) vs. Gestational Age (Scarf sign, square window, recoil) (out of 50)
Sleep-Wake States (6)
DLDQAC
Deep sleep Light Sleep Drowsy Quiet Alert (feeding time!) Active Alert Crying
Mom was on narcotics and baby has ad/fx, treat with…?
Narcan
Responses to Stimuli (6)
THCCIC
Temperament - variation behavior to stimuli
Habituation - protective accustomization to stimuli
Consolability - ability to console self/be consoled
Cuddliness - ability to mold to contour of holder
Irritability - threshold before crying
Crying - signals need, mother learns types, 5 min - 2 hrs
APGARs are done @ what 2 times?
Assessment done by what (3) and what time?
1 min and 5 min post-birth
Gestational Age, Weight, Circumferences
2 - 3 hours post-birth
Nose Bulb Procedure
Cheeks first (not too deep) then nose
Umbilical Care
NO tub bathing until cut/circumcision well healed
Leave open to air, will fall off in 7 - 10 days
Clean like any other wound
Erythromycin administration and fx
Ribbon inside out, counters gonorrhea, conjunctivis, and chlamydia
↑ 90th percentile, ↓ 10th percentile measurements?
TOO LARGE
TOO SMALL
Term Timings (5)
Preterm/mature is ↓ 37 weeks
Late preterm 34 - 36 6/7 weeks
Term 38 - 42
Postterm > 42
Postmature > 42 w/ placental insufficiency
↑ R/o placental calcification (poor O2) and ↓ amniotic fx
Infant Phenoketonuria (PKU) assesses for…? (3)
Hypothyroidism
Galactosemia
Sick cell anemia
Meconium labs vs. Blood
More accurate and allows screening for more drugs
Soft tissue injuries and reason.
bruising, lacerations b/c dystocia (obstructed labor) an use of forceps/vacuum.
Physiologic Jaundic
Kernicterus
Jaundice v/a Breastfeeding
Breastmilk Jaundice
birth, 80% newborns, look like a pumpkin
1st week, yellow staining in brain cells
2 - 4 days, 10 - 25% breastfed newborns, poor feeding
4 - 6 weeks, 2 - 3% breastfed newborns, bad milk
Hypoglycemia and Hypocalcemia ranges
↓ 20 - 40 mg/dL and ↓ 7 mg/dL
How to assess Infant bili and safe percentile
TransQBilimeter
40th - 95th
Conjugated Bili/Unconjugated Bili safe ranges
1 - 1.5 / 12 - 15 Blood Volume Fraction (BVF)
3 ways to restrain Infants to collect labs, what if restrained?
swaddling
femoral for femoral IV
side for spinal tap
If child is restrained, check hourly.
Breast feeding should be…? and normal oz?
On-demand, 2 oz
Tx VitK, HepB, Hyperbilirubinemia
Shots for 2
Phototherapy - take I/O b/c dehydration
Feeding, exchange transfusion, education
Circumcisions (4)
Controversial, medically unnecessary by AAP
Gomko or Plastibell procedure
Local anesthetic, lidocaine, penile block can be used
Tx similar to cord stump
Tx Neonatal Pain (2)
swaddling, pacifier, nonnutritive sucking
Tylenol, MorphineSulfate, Fentanyl, Toredol, Local anesthetic
Suncreen for baby?
Not until 6 months
Newborn ranges (temp, RR, feeding (formula/breast), elimination, # and development)
- 5ºC - 37.2ºC
- 7ºF - 98.9ºF
30 - 60/min
q3-4hrs formula, q1-2hrs breast
6 - 8 daipers/day, meconium -> green -> yellow/ojbrown
Car seat safety
Backseat
Backwards until > 20 lbs, then forward!
Vaccination follow up times
birth, 2 wks, 2, 4, 6, 12, 15 months THEN Kindergarten.
Physical Developmental Milestones
1, 2, 4, 6, 9,12 ,15, 18 months
reflexes, head control, roll over,sits, stand w/ help, stands alone, run/climb, mobile!
Baby Oil
non aromatic, mix w/ water inc. allergic rx
Food introduction
Solids @ 4 - 6 months, veggies first, then fruits (slowly inc. allergic rx)
Meats @ 9 months
NO COWS/ALMOND for 1 year
AAP says (about breastfeeding)
exclusively for 6 months, continue for 12.
Weaning will happen by mother/infant over time
Lactogensis (highest point, basic concept, uniqueness, 2 porteins)
first 10 days postpartum
Supply and demand, baby!
▲ with needs of infant
Whey (lactalbumin)/Casein (Cud)
Breastfeeding also r/in release of what hormone? Which is responsible for what reflexes?
Oxytocin, Milk-Ejection/Let-Down Relfexes
Infant Growth spurts @…?
2, 3, 6 weeks, 3, and 6 months
Lactogenesis Stage I vs II
- 16 - 18 weeks, clear yellow w/ IgA (part of passive immunity). ↑ protein ↓ fat
- 3 - 5 days, copious milk!
FOREMILK vs. HINDMILK
F - ↑ fat content, 60% skim 35% whole. lactose, protein, vitamins
H - cream, 10 - 20 min into feeding. ↑ calories for more growth
Positionings (4)
Football
Across lap
Cradling
Lying sideways
Latching Procedure
Manually express a few drops to lubricate and entice, GO DEEP. Should be NOT painful, SMOOTH, HEAR swallowing
MER/Let Down S/fx
uterine cramping, accomodating breasts, tingling, NORMAL
Mother…
Diet, weight loss, rest, breastcare, meds
\+ 500 extra calories, continue prenatal ↑ weight loss Rest as much as possible, when kid sleeps NO SOAP Meds mostly safe, check HALE if needed
Boob concerns and tx
Engorgement - Ø simulation, cabbage
Sore nipples - latch, lanolin
Monilial infx - antifungal
Plugged ducts - massage/warm h2o OR antibiotics
High Risk Pregnancy counter
proper identification and timely intervention
Daily Fetal Movement Counts (DFMC)
Ø movement for 12 hrs = fetal alarm signal
NonStress Test
EFM accelerations with contractions, drink OJ or sugar if needed (acoustic too!)
Contraction Stress Test
nipple contract/give oxytocin and access for decels
Biophysical Profile Tests (5)
UNPAM
Ultrasonagraphy - look @ HR and baby
Nuchal Translucency - nape fat (downs)
Percutaneous Umbilical Blood Sampling - placental tissue for disease
Amniocentesis - amniotic fluid for disease
MRI - visual assessment
BBP Timings Ultrasound and Nuchal Translucency
U - ♥ @ 6 - 7 weeks, GA 22 weeks
N - 10 - 14 weeks
Alpha-Fetoprotein (AFP) and Coombs
maternal serum for neural tube defects (detects 80 - 85% and recommended for all). Produced in liver, ↓ ind. downs
Coombs tests Rh compatibility (if mom - and baby +, give Rogam)
Biophysical Risks (3)
Genetic Dz, Nutrition, Medical/Obstetric (PMH/Prego) Dz
Psychosocial Risks (5)
Smoking, drugs, alcohol, caffeine, psych status
Environmental Risks include…?
exposure to chemicals/falling down
Uteroplacental Insufficiency (UPI)
gradual decline of delivery related substance by placenta to fetus, threat to fetal growth.
Spooky NST, CST, BPP!
Assessments scare family, be therapeutic and educational.
