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Ob Final Flashcards

1
Q

Factors that affect the labor process: 5 P’s?

A

~Passenger (fetus, baby)
~Passageway (birth canal)
~Powers (mother contractions, pushing/effort)
~Position (of mother)
~Psychologic response

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2
Q

Induction of labor criteria

A

~39 weeks or older
~elective induction
~stimulates contraction naturally

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3
Q

Late deceleration cause?

A

uteroplacental insufficiency

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4
Q

On examination, it is noted that a laboring patient’s fetus is in the right occiput anterior position (ROA). Where should the nurse place the ultrasound transducer to obtain a fetal heart tone tracing?

A

Right lower quadrant (fetus back is facing right upper quadrant of mother’s abdomen); RLQ

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5
Q

What is the priority assessment of a newborn?

A

Establishing effective respirations

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6
Q

APGAR scoring: what does APGAR stand for?

A

Appearance
Pulse
Grimace
Activity
Respiration

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7
Q

APGAR score 2

A

Pink,
>100 bpm,
cries and pulls away,
active movement,
strong cry

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8
Q

APGAR score 1

A

Extremities blue,
<100bpm,
grimaces or weak cry,
arms/ legs flexed,
slow/ irregular respirations

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9
Q

APGAR score 0

A

pale or blue,
no pulse,
no response to stimulation,
no movement,
no breathing

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10
Q

Naegele’s rule

A

LMP -3 months + 7 days

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11
Q

Signs and symptoms of pregnancy: Presumptive

A

presumptive (means unconfirmed/speculation):
P: (period absent/no period)
R: really tired
E: enlarged breasts
S: sore breasts
U: ^ urine
M: movement in the abdomen
E: emesis/nausea

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12
Q

Signs and symptoms: Probable

A

Think of signs, preg tests and
B+B: “Braxton hicks and Ballotement”

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13
Q

Signs and symptoms: Positive

A

(evidence/objective signs):
ultrasound, radiography, stethoscope, baby kicking, visible/palpating

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14
Q

GTPAL

A

G- gravidity (#of pregnancies)
T- Term (# of pregnancies carried to 37wks+)
P- Preterm (# of pregnancies 20-36)
A- Abortions (# of losses before 20wks)
L- Living (# of children living)

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15
Q

Mastitis signs

A

fever/chills,
pain/tenderness and tenderness to touch,
inflammation,
redness, pink area on affected breast,
warmth,
generalized aches/fatigue/malaise,
nipples with cracks/fissures/sores,
axillary adenopathy,
purulent drainage from nipple

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16
Q

Ortolani maneuver: what’s the purpose of this assessment on the baby?

A

To assess for developmental dysplasia of the hips

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17
Q

What is cold stress?

A

Extreme loss of heat that results in increased respirations and nonshivering

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18
Q

What are some factors associated with a high risk for cold stress

A

Limited subcutaneous fat
Limited body area in relation to body mass
Limited amount of brown fat
Limited ability to shiver
Thin skin and blood vessels that are closer to the body’s surface

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19
Q

Normal vital signs for newborn?

A

B/P: 60-80 systolic; 40-50 diastolic
HR: 120-160
R: 30-60
Temp: 97.7-99.3 F

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20
Q

Hyperbilirubinemia/jaundice: how do we screen for it?

A

Most common: tcb (transcutaneous bilirubin technique, noninvasive)
Tsb (total serum bilirubin, vasive)

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21
Q

Primary signs of hyperbilirubinemia

A

Jaundice
Poor feeding
Sclera of eyes (yellow)
Lethargy

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22
Q

Do we bathe the baby after delivery?

A

No

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23
Q

Signs of hypoglycemia in newborn?

A

Jitteriness
Apnea
Seizures
Lethargy
Hypothermia

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24
Q

How is hypoglycemia usually resolved in newborns?

A

Resolved with feeding

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25
Q

Circumcised care: how to take care of baby postop/interventions?

A

Check for signs of bleeding on circumcised area and on diaper
Check for signs of infecti
Pain management
Teach parents to wash hands before touching circumcised area
If bleeding, may apply gentle pressure and sterile gauze onto site
Check if baby is urinating after circumcision
Keep diaper clean and dry and use sponge bathing until healed

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26
Q

Bulb suctioning: why do we use it?

A

To clear secretions from oral and nasal passages

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27
Q

Neonatal pain: pharmacological management of pain

A

Local anesthesia (circumcision)
Topical anesthesia (after circumcision)

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28
Q

Non-pharmacological management of pain

A

Swaddling
Cuddling
Holding baby skin to skin
breastfeeding
tucking
pacifier use
oral sucrose

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29
Q

Signs of pain in babies

A

Eyes squeezed
Grimacing
quivering tongue
High pitched/shill cries
Changes in vital (^HR, ^BP or decreased BP, shallow respirations)
Groaning
Mouth opened
Flaccid/ rigidity
Fists tightening

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30
Q

fetal stations: what is it?

A

Where the babys presenting part is located in the pelvis

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31
Q

What is a babys presenting part?

A

Can be the head, foot, etc. Whichever part is closet to the exit of the uterus (cervix/internal os of cervix)

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32
Q

How to measure fetal station?

A

-Assess/measure above and below ischial spine

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33
Q

If the babys presenting part is above the ischial spine line what numbers may it be?

A

minus numbers (-)
-5
-4
-3
-2
-1

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34
Q

If the babys presenting part is below the ischial spine line what numbers may it be?

A

plus numbers (+)
+1
+2
+3
+4
+5

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35
Q

Rationale for fetal station 0

A

refer to baby being “engaged” is it ischial spine line
-happens at 38 wks for first time mothers and as late as time of labor for mothers who have already had babies

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36
Q

PMS physical symptoms

A

“PERIOD SYMPTOMS”
-swollen/tender breasts
-constipation/diarrhea
-bloating
-fluid retention
-cramping
-head+backache
-clumsiness
-low tolerance for light
-aches/pains
-extremity swelling
-weight gain
-change in appetite
-Dizziness
-nausea/vomiting
-fatigue

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37
Q

PMS mental symptoms

A

-irritability/hostile
-mild psychological discomfort
-sleeping too much/too little
-feeling tired
-trouble with concentration/memory
-appetite changes/cravings
-tension/anxiety
-mood swings
-depression
-less interest in sex
-confusion
-social withdrawal

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38
Q

role of nurses in genetics

A

-identify families in need of genetic counseling
-collaborate to make referrals
-emotional support
Nurses need
- working knowledge
-awareness of recent advances
-understanding possible effects on families

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39
Q

Hormones during pregnancy: what are they?

A

hCG
hCS
Insulin
Cortisol
Progesterone
Estrogen
Prolactin
Oxytocin

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40
Q

Hormones during pregnancy: human chorionic gonadotropin (hCG) function

A

stimulates luteum to produce progesterone and estrogen

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41
Q

Progesterone function

A

-prepares the endometrium for implantation. If there is no pregnancy, progesterone levels drop & bleeding occurs. Maintains pregnancy.
■ Suppresses secretion of FSH & LH

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42
Q

Estrogen function

A

induces the shedding of the endometrium which causes bleeding.

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43
Q

Prolactin function

A

prepares breast for lactation/milkproduction

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44
Q

Oxytocin function

A

stimulates contractions and milk ejection from breasts

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45
Q

Human chorionic somatomammotropin hCS function

A

Growth hormone
-breast development

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46
Q

insulin function

A

-^production of insulin due to insulin antagonists in placental hormones
-decrease tissue sensitivity to insulin

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47
Q

cortisol function

A

-^production of insulin
-^peripheral resistance to insulin

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48
Q

Pathologic Jaundice of the neonate is best defined as?

A

clinical disorder appearing 24 hrs of age associated with anemia, RBC enzyme defects and RBC membrane disorders

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49
Q

What is hyperbilirubinemia assocated with?

A

High levels of bilirubin

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50
Q

Physiologic vs pathologic jaundice: which one requires intervention and why?

A

Pathologic jaundice requires intervention (phototherapy) to help treat bc these are even higher levels of unconjugated bilirubin

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51
Q

Phototherapy function

A

phototherapy converts bilirubin to a form that can be excreted via urine and poop

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52
Q

Would should baby wear during phototherapy

A

diaper and something to cover eyes

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53
Q

When phototherapy isnt effective, what may be needed?

A

exchange transfusion (infant blood replacement with donor blood)

54
Q

When does PMS occur?

A

2-3 days before period starts

55
Q

Morning sickness: nursing care/intervention

A

-eat dry, starchy foods like toast/crackers on awakening in the morning
-avoid drinking too many fluids in the morning when nauseated
-eat small amounts frequently like every 2-3 hours
-avoid skipping meals
- get out of bed slowly
-decrease intake of fried foods/fatty foods
-avoid brushing teeth immediately after eating

56
Q

A pregnant woman who is in 3rd trimester, asks the nurse how to know “labor is
getting closer to starting?” Which is an appropriate response?

A

surge of energy

57
Q

As pregnancy advances, weight of the uterus presses on abdominal vessels like vena cava therefore causing low BP. Whats an intervention for this?

A

lay them on their side

58
Q

when planning care for a laboring woman whose membranes have ruptured,
nurse recognized that woman is at increase risk for

A

intrauterine infection

59
Q

fetal tachycardia is most common during which of the following conditions?

A

maternal fever

60
Q

Formula feeding instructions

A

Teach parent:
-15-30mL each feed for first 48hrs
-feed on demand 6-8 feeds per 24hrs
-hold bottle semi-upright while supporting head of baby
-never prop bottle because baby can choke
-burp baby several times to avoid spitting up

61
Q

breastfeeding mom develops engorged breasts 3 days after birth. What action
would help this woman achieve her goal of reducing the engorgement?

A

Breastfeeds infant every 2 hrs!

62
Q

Mastitis: Mother states they should stop breastfeeding due to use of antibiotics and NSAIDS for mastitis. Is this a sign of adequate education or further education needed?

A

Further education needed. Mother should continue to breastfeed depsite antibiotic use

63
Q

Breastfeeding positions?

A

-Football clutch (underarm): recommended for mom to see babys mouth
-Across lap: works for smaller babies
-Cradling: most common for fast latching babies
-Side lying: baby and mom lying down: allows mom to rest

64
Q

Feeding cues: instead of waiting until baby cries, mothers should learn these cues

A

-hand to mouth
-hand to hand movements
-sucking motions
-rooting reflex (if you touch next to their mouth and they turn their head and open their mouth)

65
Q

Uniqueness of human milk:

A

It contains so many beneficial things+ fatty acids for promote brain growth and development

66
Q

Are human milk and formula the same?

A

NO

67
Q

Human milk and digestion

A

Human milk is more easily digested and improves infant response to infection

68
Q

Breast milk is specific to the needs of each infant. Example of this

A

-Milk produced by
moms of preterm infants differs in composition from that of mothers who
gave birth at term.
- Also for twins vs one baby

69
Q

Breastfeeding benefits for mom

A

prevents breast cancer, heart disease, MI, diabetes, and BP

70
Q

Breastfeeding benefits for baby

A

reduced mortality, reduced risk for infections, obesity,
diabetes, & increases intelligence.

71
Q

National recommendations for breastfeeding

A

-Infants should be breastfed for first 6months and should continue for 12 months and thereafter if needed
-complementary foods can be given after 6 months
-According to WHO, infants should be exclusively breastfed for 6mo, receive
complementary foods at 6mo, & continue breastfeeding until 2yo

72
Q

If a baby is being ______,
they need ________

A

Breastfed
Vitamin D

73
Q

Normal vision findings for newborns

A

-pupils react to light
-they can see objects as far as 2.5ft
-clear visual distance is 8-12 inches (distance between mom and baby during breastfeeding)/ baby can have blurry vision until a foot away
-newborn prefer moms face

74
Q

Normal hearing findings for newborns

A

-prefer hearing mom and rhythmic sounds
-they recognize sounds and attempt to find source
-They are used to hearing moms heartbeat so a rhythmic noise is soothing for them (you can place a heartbeat stimulator nearby to help fussy baby)

75
Q

Normal smell findings for newborns

A

-Highly developed sense of smell and can react to odors
-can smell their moms milk

76
Q

Normal taste and touch findings for newborns

A

-Prefer sweet stuff
-Responds to touch
-early skin to skin promotes tactile interaction and stimulation

77
Q

the nurse knows that thermoregulation presents a problem for newborns because

A

the thin layer of subQ fat provides poor insulation

78
Q

Who can perform the Ortolani maneuver?

A

Only doctors and NPs

79
Q

How is the ortolani maneuver performed? What is considered a positive ortolani test?

A

Flex the infant’s hips & knees to 90 degrees & apply pressure over the leg & gently adduct the leg with your thumbs. If the hip was dislocated a clunk will be felt as the hip relocates. This would be considered a positive ortolani test.

80
Q

Normal findings for newborn skin?

A

-Skin is very thin at birth
-Desquamation (skin peeling at few days old, happens more commonly with post term babies)
-vernix caseosa (cheesy white covering on baby serving as protective covering) ; removal of this is followed by desquamation
-Milia (tiny white bumps on nose/forehead; sweat glands)
-Congenital dermal melanocytosis: aka mongolian spots (blue/black areas of hyperpigmentation)
-Nevi/stork bites: common pink areas on baby and require NO INTERVENTION
-Erythema toxicum/newborn rash: looks alarming but requires NO INTERVENTION

81
Q

How to prevent heat loss in babies/interventions:

A

Dont place them on cold surfaces or under air conditioner to prevent cold stress

82
Q

Its important to keep baby warm to prevent cold stress: TRUE or FALSE

A

True

83
Q

Vital signs: newborn baby HR during sleep

A

80-100 BPM (drops)

84
Q

Vital signs: newborn baby HR while crying

A

Can go up to 180 BPM

85
Q

Are murmurs a concern in neonatal period?

A

NO; this is common

86
Q

Placental hormones: what happens with the expulsion of the placenta?

A

Hormones decrease

87
Q

Placental hormones: Action of hormones after expulsion (delivery) of placenta

A

-hCS decreases
-Estrogen and Progesterone decreases ALOT
-estrogen, cortisol and placental enzyme insulinase reverse effects of pregnancy

88
Q

the 2 most common causes of subinvolution in the pp client are

A

retained placental fragments & infection

89
Q

VEAL CHOP MINE: What does veal stand for?

A

Variable decels
Early decels
Acelerations
Late decels

90
Q

VEAL CHOP MINE: What does CHOP stand for?

A

Cord compression
Head compression
Okay✅
Placental insufficiency

91
Q

VEAL CHOP MINE: What does MINE stand for?

A

Move mother
Intervention not necessary
No intervention needed
Evaluate for why: ( stop pitocin, give 02, give fluid, reposition mom, possible c-section)

92
Q

Intervention for late decels:

A

REPOSITION MOM

93
Q

Decelerations criteria

A

has to last at least 15 secs for it to be considered a decel

94
Q

HELLP syndrome: what is it?

A

lab diagnosis for preeclampsia that involves hepatic dysfunction

95
Q

What does HELLP syndrome stand for?

A

Hemolysis
Elevated Liver enzymes
Low Platelets

96
Q

How is HELLP syndrome diagnosed?

A

with Labs

97
Q

What does HELLP syndrome put mom at risk for?

A

Becoming super sick and big risk for maternal death

98
Q

Preeclampsia : what is it?

A

HTN in pregnancy (most common medical condition reported during pregnancy)

99
Q

Preeclampsia criteria?

A

-Hypertension and proteinuria after 20wks gestation in mom with previous normotension
-have to have HTN and proteinuria
-Reflexes increased +3 or +4
-seizures (eclampsia)

100
Q

Does preeclampsia resolve?

A

Yes, usually after placenta is delivered (expelled)

101
Q

Care management for preeclampsia?

A

Admin magnesium sulfate (have calcium carbonate nearby)

102
Q

Gestational vs Pregestational diabetes mellitus: what’s the diff

A

Gestational DM: occurs during pregnancy
Pregestational DM: diabetes before pregnancy

103
Q

Pregestational DM: criteria

A

6-6.5 A1c before pregnancy

104
Q

Diabetes Mellitus: high risk for moms or not?

A

IS HIGH RISK

105
Q

Optimal outcome for gestational and diabetes mellitus in moms

A

strict maternal glucose level of 5-6%

106
Q

When to screen moms for DM?

A

Screen at 24-28 wks with glucose drink
if blood glucose is too high, you have to do a 3hr test and get blood drawn every hour

107
Q

Antepartum care for GDM

A

Diet, exercise
insulin therapy
monitor blood glucose levels
fetal surveillance

108
Q

Intrapartum care for GDM

A

Avoid dextrose solutions
Monitor glucose hourly

109
Q

Postpartum care for GDM

A

encourage breastfeeding to decrease risk of type 2 DM after GDM

110
Q

Screening process for hyperbilinrubinemia

A

Measure total serum bilirubin by getting blood from babies heel of foot (side of heel)

111
Q

Umbilical cord care: why is it done?

A

To prevent infection and hemorrhage because it is at risk for bacterial growth

112
Q

Umbilical cord care: what to clean it with

A

clean with water, no antiseptic solution

113
Q

Umbilical cord care cont: stump care

A

-Plastic cord clamp is removed after the stump is dried after 24-48hrs
-Stump should be assessed for edema, redness, drainage (infection)
-Should be kept clean, dry, open to air and loosely covered

114
Q

Immediate interventions for newborn baby

A

airway maintenance, maintain O2 supply, maintain body
temp, eye prophylaxis (prophylactic eye drops/erythromycin 0.5%), vitamin K prophylaxis, promote parent-infant interaction, & skin to skin contact.

115
Q

Why is erythromycin given?

A

to prevent inflammation of eye aka conjunctivitis caused by STI bacteria via passage through birth canal

116
Q

Newborn screenings: screen for genetic, endocrine, metabolic disorder (why?) and how to screen for this?

A

for early detection of diseases that may result in severe health probs
-screen using heelstick

117
Q

Newborn hearing screening: how is it done?

A

Rubber earpiece is placed in babies ear & in a healthy ear
you can hear an “echo”

118
Q

Newborn critical congential heart disease: how to screen for this?

A

Pulse ox is used to detect hypoxemia; if its at 90% you
need to assess the baby!

119
Q

Physical assessment of newborn: Baby has to be completely unclothed to be weighed; scale has pad or cloth
to prevent heat loss via conduction. TRUE or FALSE

A

True

120
Q

What is assessed/measured during physical assessment of baby

A

general appearance, vitals, weight, head circumference, & neuro assessment

121
Q

Normal head circumference of baby

A

32-36 cm

122
Q

What does the neuro assessment of newborn baby focus on

A

reflexes

123
Q

Newborn should remain skin to skin w mom for at least the first
30 min after birth. TRUE or FALSE

A

FALSE; Newborn should remain skin to skin w mom for at least the first
1-2 hrs after birth.

124
Q

Signs of prolapsed umbilical cord

A

Woman feels cord after membrane rupture

125
Q

Rupture of membranes can lead to…

A

Rupture of membranes can lead to infection & prolapsed cord!!!
○ This can lead to chorioamnionitis so limit vaginal exams

126
Q

Antepartum: 1st, 2nd, 3rd trimester

A

1st:0-13 wks
2nd:14-26 wks
3rd: 27-40 wks

127
Q

Antepartum: when are appts needed

A

○ Appt once a month between weeks 12-28
○ Appt every 2 weeks between weeks 29-36
○ Appt every week between weeks 36-delivery

128
Q

Maternal adaptation hormones

A

○ Progesterone is LOWER than estrogen levels & this allows for uterine muscles to relax
○ Chorion (outer) membrane secrete prostaglandins which stimulate secretion of oxytocin which stimulates contractions
○ Babys adrenal glands secrete large amounts of cortisol during labor & this stimulates uterus & labor processes & contractions

129
Q

cervical ripening methods: promote cervical softening, dilation, & effacement.

A

■ Chemical agents like prostaglandins can soften & thin the cervix
■ Mechanical & physical methods help stimulate release of prostaglandins
● Inserting a balloon catheter can thin out the cervix
● Physical methods like sex bc semen has prostaglandins, nipple
stimulation causes oxytocin release, & walking.
■ Amniotomy which is artificial rupture of membranes; make sure fetus is at
0 station
■ Oxytocin (low dose)

130
Q

First period of reactivity after birth

A

-Lasts up to 30 min
-HR increases to 160-180
then HR decreases after 30 min to baseline 100-120
-Respirations are irregular (60-80)
-Fine crackles can be heard, retractions of the chest can be present but these
cease within the first hour.
-Infant is alert & has spontaneous startles, crying, & head movement.

131
Q

Period of decreased responsiveness: when does it occur? what does this look like

A

occurs after first stage
-lasts from 60-100 mins
-baby is pink
-rapid respirations+shallow (60bpm)
-baby is sleep, relaxed, content

132
Q

Second period of reactivity: when does it occur? what does it look like?

A

follows period of decreased responsiveness
-lasts from 10 min to several hours
-occurs between 2-8hrs after birth
-tachycardia + tachypnea occurs
-meconium passes
-increased muscle tone, changes in skin color and mucus production

n3 (3 decks)

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