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OB | Summer 24 | Zakewicz > OB Exam 3 | Summer 24 | Zakewicz > Flashcards

OB Exam 3 | Summer 24 | Zakewicz Flashcards

1
Q

What are the postpartum changes in fluid distribution and Urination?

A

⁍ Fluid Loss ( EBL; vaginal birth 250-500 mL and C-section 500-100mL)

⁍ Increase in diuresis and diaphoresis
⁍ Urine output occurs within 12 hours of birth, 3000 mL or more each day for the first 2-3 days

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2
Q

Postpartum CBC changes

A

⁍ H&H decreased for a few days
⁍ WBC elevated for 4-7 days (20,000-30,000)
⁍ Coagulation factors increased for 2-3 wks ( increase risk for thromboembolism = DVT and PE)

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3
Q

VS postapartum

A

⁍ HR and Bp return to normal within few hours
⁍ o-hTN on first day
⁍ Elevated temp (100.4) within 24 hours
⁍ Postpartum chill - resolves quickly after birth with blankets and warm drink

***Elevated pulse may indicate impending shock

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4
Q

Postpartum Lochia

A

Rubra (red)
⁍ Blood with debris from uterus lining and placenta

Serosa (pink or brownish)
⁍ Old blood, serum, leukocytes, and debris

Alba (White or yellow)
⁍ Leukocytes, bacteria, mucus and serum

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5
Q

Rubra

A

Red

Blood from debris

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6
Q

Serosa

A

Pink or brown

Old blood, debris, and serum

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7
Q

Alba

A

White or yellow

Infection (WBC, bacteria, mucus, and serum)

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8
Q

Postpartum Perineal Trauma Care

A

⁍ Ice pack for initial edema r/t pregnancy

⁍ Hemorrhoids: eventually resolve on own, no straining

⁍ Episiotomy: may take several weeks, depending on severity. No straining (laxative). Assess wound.

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9
Q

Breast care for women who are breastfeeding

A

⁍ Initiate feeding the hour of birth if possible
⁍ Breast milk “comes in” 3-4 days after birth
⁍ Feed 10-12 times a day for 1-3 hours each feed
⁍ Pay attention to latching. Feed until baby stop, then burp, then go to the other breast.
⁍ Engorgement may occur (Edema and venous distention; intervention is to empty breast)

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10
Q

Breast Care for Women who are not breast Feeding

A

⁍ Avoid stimulation of nipples, support breast (snug bra), acetaminophen.
⁍ Engorgement may occur but it should resolve within 24-48 hours

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11
Q

Location of the Fundus on Different days during Involution

A

Involution: Return of the uterus to non-pregnant state
⁍ Fundus goes down 1 cm every 24 hours
⁍ Fundus at the umbilicus on birth day
⁍ Uterus not palpable after 2 wks
⁍ Return to nonpregnant sate by week 6

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12
Q

What is the significance of only 2 vessels in the Umbilical Cord?

A

?????

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13
Q

When is the Apgar Score abnormal?

A

0-3 critical, 4-6. abnormal, 7-10 normal

Appearance, pulse, grimace, activity, respirations

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14
Q

5 screening Tests/Assessment tools for Newborns

A
  1. Universal Newborn Screening (Heel stick and Genetic Testing) - Mandated by US government
  2. Jaundice/bilirubin screens
  3. Critical Congenital Heart Disease (O2 comparison of Rarm and either foot)
  4. Newborn hearing screening
  5. Newborn Screen (PKU, congenital hypothyroidism, glucosemia, maple syrup urine disease, homocystinuria, and sickle cell

Assessment: APGAR, Ballard score, physical, and NIPS pain scale

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15
Q

Caput Succedeneum

A

⁍ Edema of the scalp that crosses the suture line
⁍ Normal and gone in days

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16
Q

Cephalohematoma

A

⁍ Blood between skill bone and periosteum
⁍ Does not cross the suture line

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17
Q

Mongolian spot

A

Darker skin color on the buttock (sometime it stretches to the back), it disappears after months or years.
⁍ You still have to document this finding

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18
Q

Nevi

A

Red spots at the back neck or forehead especially when the baby is crying

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19
Q

Erythema Toxicum

A

Pink rash | Normal

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20
Q

Milia

A

Whitehead (instead of blackheads) at nose, chin, or forehead| normal

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21
Q

Vernix Caseosa

A

Protective, thick, “cheesy” covering of the skin; normally in crease and fold. Usually found in preterm infants.

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22
Q

Sucking and Rooting

A

Turns head toward stimulus

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23
Q

Moro

A

⁍ “Startle” reaction
⁍ Symmetric abduction and extension of extremities with slight tremor

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24
Q

Swallow

A

Coordinated with sucking and breathing. Swallowing usually follow sucking

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25
Q

Stepping/Waling

A

Holding imitated walk

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26
Q

Babinski

A

Flaring of the foot toes

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27
Q

Care for Circumcision

A

⁍ Pain management - Oral Tylenol q6hr
⁍ Observe for bleeding, keep petroleum jelly gauze, and observe for voiding

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28
Q

Umbilical Cord Care

A

Keep Dry
⁍ Clamp stays 24-48 hrs after birth, cord stays outside the diaper and fall off 10-14 days, and sponge bath until cord falls off

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29
Q

Care of a Jittery Baby

A

Get blood glucose level. If hypo glycemic, try to feed. If the baby is too sleepy, use tube feeding or D10W.

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30
Q

Newborn Bath

A

Inner to outer and head to toe. Except for diaper area, clean this area last.

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31
Q

Infant Car Safety

A

⁍ Adjust strap correctly, and nothing in between the straps (just onsie).
⁍ Back seat, rear facing, angle at 45 degree

32
Q

Sleep Safety

A

ABC: Alone, on their Back, and in their Crib

33
Q

Administering medication to a newborn

A

⁍IM Vastus lateralis only
⁍ Use oral syringe for oral administration

34
Q

Care for hypothermia

A

Dry baby off, pre heat surface, skin to skin, and put hat on

35
Q

Care for Hyperthermia

A

Maintain correct balance in warmer, avoid excess clothing/blankets, and sepsis assessment

36
Q

Convection

A

⁍Exchange of heat through air.
⁍⁍Maintain cool temperature in the room or keep in warmer

37
Q

Radiation

A

⁍Heat exchange from body to cooler surfaces
⁍⁍ No direct contact with colder surfaces

38
Q

Evaporation Heat transfer

A

⁍Liquid on body surface evaporates
⁍⁍ Dry baby off

39
Q

Conduction

A

⁍Exchange of heat through direct contact
⁍⁍ Skin to skin

40
Q

Difference Between Physiologic Jaundice and Pathologic Jaundice

A

Physiologic
⁍Appears after 24 hr - peaks at day 3-4
⁍Resolves without treatment
⁍⁍Causes: Immature liver, extra RBC, polycythemia, preterm, dehydration, bruising
⁍⁍Prevention: Early feeding, promote BM, and phototherapy

Pathologic
⁍Appears within 24 of life, or last longer than 4 days
⁍⁍Serum Bili increases quickly or serum exceeds 15 mg/DL
⁍⁍Causes Newborn blood incapability or underlying disease (sepsis, trauma, liver disease)

41
Q

How can you Prevent or Minimize Physiologic Jaundice?

A

Early feeding, promote BM, and phototherapy

42
Q

What are the best practice for breastfeeding?

A

⁍ Initiate feeding within the hour of birth if possible
⁍ Avoid supplement feeding unless indicated
⁍ Avoid artificial nipples
⁍Pay attention to latching
⁍Allow feeding at first breast until baby stop, then burp, then go to other breast, no time limit
⁍Offer breast as soon as feeding cues occur, do not wait until crying, feed 10-12 times a day for 1-3 hours.

43
Q

How do you know the baby is getting enough breast milk?

A

⁍Measure output: same number of wet diapers as the babies age in days, for the first few day
⁍⁍Weight is not the most reliable method since infant lose 7-10% of body weight in the first few days

44
Q

What do you recommend a mastitis breastfeeding

A

Extra rest, empty milk out of breast after each feeding, start breast feeding on unaffected side, thoroughly wash hands prior to breastfeeding, maintain cleanliness of breasts
⁍Infection precaution and monitoring

45
Q

Breast Engorgement Client Education

A

⁍Warm shower, apply warm compress, empty breast after feeding (use pump if needed), cool compress after feeding

46
Q

Nipple soreness Client education

A

Make sure the infant latches right (lathing techniques) and change position of feeding

47
Q

Quality Breastfeeding

A

L: LATCH
A: AUDIBLE SWALLOWING
T: TYPE OF NIPPLE (EVERTED, FLAT, AD INVERTED)
C: COMFORT DURING FEEDING (SHOULD NOT HURT)
H: HELP (How much help does mom need to give the infant with feeding)

48
Q

2 newborn complications due to shoulder dystocia

A

Clavicle Fracture and Erb-Duchenne

49
Q

2 blood type combination incompatible

A

ABO incapability: Mother blood O and baby’s blood type is A, B, or AB

Rh incapability: Rh+ baby and Rh- mother

50
Q

4 signs of newborn sepsis - What happen to the baby’s temperature?

A

Temperature instability

S/S: Poor feeding pattern, central cyanosis, jaundice, irritability, hypotension, and tachycardia.

51
Q

Maternal Diabetes affects on newborn blood glucose

A

Newborn can have a low blood glucose 24-48 hour of life

52
Q

S/S of NAS

A

S/S Poor feeding, jitteriness, tremors, irritability, high pitched cry, hypertonia, seizures, excoriation, and sneezing

53
Q

Medication for NAS

A

Opioid: Morphine

54
Q

NEC - 4 signs

A

Necrotizing enterocolitis: Bacterial inflammatory infection that affects cell death of areas of the intestinal mucosa

Abdominal distention, green vomit or stool, blood in stool

55
Q

Cause of SGA/IUGR and LGA and common complications of each

A

Causes: preterm, genetics, maternal infection/malnutrition, gestational HTN/diabetes, maternal smoking/drug/alcohol use, multiple gestations

Complications: possible stillbirth, hypothermia, polycythemia

56
Q

Preterm babies - week and concerns

A

20-37 wks

Immature organs, LBW, hypotonia
Concerns: RR distress syndrome, aspiration, apnea, bleeding brain, patent ductus arteriosus, NEC

57
Q

Late Preterm - weeks and concerns

A

34-37 wks

Concerns: thermoregulation, hypoglycemia, hyperbilirubinemia, sepsis, and respiratory issues

58
Q

Post term - weeks and concerns

A

42+ wks

Concerns: aspiration on meconium, LGA, toxic appearance, neuro deficit, peeling/cracked skin

59
Q

5 TORCH infection

A

Infections that can cross the placenta

Toxoplasmosis
Other Infections (Hep(s))
Rubella Virus
Cytomegalovirus
Herpes

60
Q

Risk Factors Toxoplasmosis

A

Raw or undercooked meat
Cat feces

61
Q

Risk Factors for Rubella

A

No live viral vaccine during pregnancy
And beware of ppl with rashes!

62
Q

Risk factor for Cytomegalovirus

A

Droplet infection - Cyto is passed through bodily secretion

63
Q

Risk Factors for HSV

A

Oral or genital lesions

64
Q

Common Congenital Anomalies and Nursing Concerns for Each

A

Neurologic: protect membranes, observe for leakage, prevent infection, monitor for increased ICP

Hydrocephalus: repositioning, and monitoring for increased ICP

Patent ductus arteriosus: educate on surgical treatment

Tetralogy of Fallot: prevent infection and respiratory distress through positioning (knee-chest position) and reducing workload on the heart

Cleft lip/palate: monitor for dehydration and maintain airway

65
Q

Signs of TED, prevention, and complication

A

Signs: unilateral calf pain, redness, hardened area of vasculature
Prevention: hydration, ambulation, SCDs, enoxaparin
Complications: superficial venous thrombosis, DVT, acute PE
Cannot use warfarin during pregnancy

66
Q

4 medication to treat postpartum hemorrhage

A

Oxytocin and misoprostol causes hypotension
Oxytocin: monitor for water intoxication
Misoprostol: monitor for fever/diarrhea
Methylergonovine and carboprost causes hypertension
Methylergonovine: use cautiously with asthma as well
Carboprost tromethamine

67
Q

Differentiate between postpartum “blues”, postpartum depression, and postpartum psychosis.

A

Postpartum blues
Symptoms resolve within 3-10 days, no medical treatment
Transient, self limiting

Postpartum depression
Persistent, lasting longer than 2 weeks
Sx: fatigue, frustration, anger, isolation, irritability, alcohol/drug use, somatic disruptions
Intense sadness with severe mood swings

Postpartum psychosis
2 weeks postpartum; very rare
Delusions, hallucinations
Psychiatric emergency

68
Q

Describe management of early and late postpartum hemorrhage.

A

Early management
⁍Stop bleeding, fundal massage
⁍Fundal massage: do not stop until firm
⁍Empty bladder, express clots from uterus
⁍Uterine stimulants as ordered

Late management
⁍Bimanual massage, bakri balloon to put pressure on placental site, IR to plug uterine arteries, ligation of uterine arteries, hysterectomy as life saving measure
⁍If still bleeding lochia rubra 2 weeks later, could be retained placental fragments

69
Q

Nursing care for mastitis

A

Nursing care
Extra rest, empty milk out of breast, start breast feeding on unaffected side, thoroughly wash hands prior to breastfeeding, maintain cleanliness of breasts
Antibiotic treatment

70
Q

Common Congenital Anomalies

A

Neurologic
Hydrocephalus
Patent Ductus Arteriosus
Tetralogy of Fallout
Cleft lip/palate
Down Syndrome

71
Q

Neurologic

A

Protect membranes, observe for leakage, prevent infection, monitor for increased ICP

72
Q

Hydrocephalus

A

Repositioning, and monitoring for increased ICP

73
Q

Patent ductus arteriosus

A

Educate on surgical treatment

74
Q

Tetralogy of Fallot

A

Prevent infection and respiratory distress through positioning (knee-chest position) and reducing workload on the heart

75
Q

Cleft Lip/Palate

A

Monitor for dehydration and maintain airway

76
Q
A

OB | Summer 24 | Zakewicz (2 decks)

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