OBSTETRIC NURSING Flashcards
What chromosomes do males and females contribute during sex?
• The male sperm contributes an X or a Y chromosome; the female ovum contributes an X chromosome.
How many chromosomes does fertilisation produce in total?
A total of 46 chromosomes, including an XY combination (male) or an XX combination (female).
What happens during first trimester of pregnancy?
• Organogenesis occurs during the first trimester of pregnancy, specifically, days 14 to 56 of gestation.
What occurs after ovum fertilisation?
Implantation in the uterus occurs 6-10 days after…
What is the chorion and its purpose?
The outermost extraembryonic membrane that gives rise to the placenta.
Function of the corpus luteum
Secretes large quantities of progesterone.
At what time are developing cells referred to as fetus?
From the 8th week of gestation through delivery
Define a zygote
Union of male and female gamete which divides into fertilised ovum
Time duration for spermatozoa to remain in vagina after sexual intercourse.
72 hours
What happens when ovum is fertilised by spermatozoon carrying a Y chromosome?
It forms a male zygote
Define implantation
When the cellular walls of the blastocyte implants itself in the endometrium, usually 7 to 9 days after fertilization.
The time period for the beginning of heart development in the embryo.
It begins at 2 to 4 weeks and is complete by the end of the embryonic stage.
What should patients do when they miss their period in the course of taking oral contraceptives as prescribed?
She should continue taking the contraceptive.
What is the first menstrual flow?
Menarche and may be anovulatory (infertile).
What happens when both breasts are used for breastfeeding?
The infant usually doesn’t empty the second breast. Therefore, the second breast should be used first at the nextfeeding.
Factors that reduce a mother’s milk supply.
Stress,dehydration, andfatigue
How do you break suction of a breast feeding infant?
Insert a finger at the corner of the infant’smouth.
Why shouldn’t cow’s milk be given infants less than 1 years?
Because it has a low linoleic acid content and its protein is difficult for infants to digest.
Care for the breasts after feeding.
Rub emollient cream, or few drops of breast milk(colostrum) on nipples and let them air dry to prevent cracking.
Fluid intake for breastfeeding mothers
Should increase their fluid intake to 2½ to 3 qt (2,500 to 3,000 ml) daily.
What should be done after breastfeeding an infant with cleft lip/ palate?
Rinse the mouth with sterile water.
How is HIV transferred to an infant?
Since the virus has been cultured in breast milk, it can be transmitted during breastfeeding by HIV positive mother.
Define Colostrum
This is the precursor of breast milk and it is the first milk to be secreted after delivery.
How long should an infant breastfeeding session last?
Until infant is satisfied, and it ranges from 5 to 20 minutes
What happens to drugs taken by a breastfeeding mother?
They appear in breast milk.
Function of prolactin?
Stimulates and sustains milk production.
How to breastfeed a premature neonate(32 weeks of gestation).
The mother expresses the milk and feed the neonate by gavage.
What disqualifies a mother from breastfeeding?
One with a positive HIV test result.
Function of hot compress.
To relieve breast tenderness after breastfeeding.
Advantage of breast milk as compared to formula.
Contains maternal antibodies
What is the initial weight loss for a healthy infant ?
5% to 10% of birth weight.
Normal hemoglobin value for neonates.
17 - 20 g/dl
The circumference of a neonate’s head in relation to that of the chest.
2-3cm greater than that of the chest
First nursing action after delivery
Establish the neonate’s airway
Specific gravity of a neonate’s urine.
1.003 to 1.030.
A lower specific gravity suggests overhydration; a higher one suggestsdehydration.
During the first hour after birth…
The neonate is alert and awake.
The neonatal period…
Extends from birth to day 28.
AKA the first four (4) weeks or first month of life.
Low birth weight neonate
2,500 g (5 lb 8 oz) or less at birth.
Very low birth weight neonate
1,500 g (3 lb 5 oz) or less at birth.
Consequence of administering high oxygen amounts to neonates.
Causesblindnessas a result of retrolental fibroplasia.
Apgar scores and interpretation.
7 to 10 - no immediate distress,
4 to 6 - moderate distress,
0 to 3 - severe distress.
How to elicit Moro’s reflex.
The nurse holds the neonate in both hands and suddenly, but gently, drops the neonate’s head backward. Normally, the neonate abducts and extends all extremities bilaterally and symmetrically, forms a C shape with the thumb and forefinger, and first adducts and then flexes the extremities.
Assessment for jaundice in a neonate.
Examine the infant under natural window light. If natural light is unavailable, examine the infant under a white light.
Why is vitamin K administered to neonates
To prevent hemorrhagic disorders in neonates as their intestines cannot synthesise vitamin K
Define variability
Any change in thefetal heart rate(FHR) from its normal rate of 120 to 160 beats/minute.
Acceleration is increased FHR; deceleration is decreased FHR.
When does fetal alcohol syndrome present?
First 24 hours after birth and produces lethargy,seizures, poor sucking reflex, abdominal distention, and respiratory difficulty.
When does symptoms of heroin and methadone withdrawal begin in neonates?
Heroin - Several hours to 4 days after birth
Methadone - 7 days to several weeks after birth.
What are the cardinal signs of narcotic withdrawal in neonates?
coarse, flapping tremors;
sleepiness; restlessness;
prolonged, persistent, high-pitched cry; and
irritability.
How long do you count a neonate’s respiration?
1 minute
Treatment for narcotic addiction in neonates
Chlorpromazine(Thorazine)is used
What environment should be provided for a neonate who’s experiencing Narcotic withdrawal ?
Dark quiet environment.
Drugs used to treat withdrawal symptoms in neonates.
Phenobarbital(Luminal), Camphorated opium tincture (paregoric), and
Diazepam (Valium).
Signs of respiratory distress in premature neonates.
Nostril flaring,
substernal retractions, and inspiratory grunting.
What causes Respiratory distress syndrome(hyaline membrane disease) in premature infants?
It develops because their pulmonary alveoli lacks surfactant.
What position should an infant be placed in to sleep?
The parent orcaregivershould position theinfant on the back
What is the percentage of water in a neonate’s body?
78% - 80%
What position is used to perform a nasotracheal suctioning in an infant?
Neck slightly hyper-extended in a sniffing position with chin up and head tilted back slightly
How is the neonate’s umbilical cord tied after birth?
It is tied 1”(2.54cm) from the abdominal wall with a cotton cord, plastic clamp or rubber band.
What parent teaching would you give for umbilical cord care?
Clean the umbilical area with a cotton ball saturated with alcohol after every diaper change to prevent infection and promote drying.
What is ortolani’s sign and what does it indicate?
This is an audible click or palpable jerk that occurs with thigh abduction and it confirms congenital hip dislocation in a neonate.
What is Cutis marmorata and what does it indicate?
Mottling or purple discoloration of the skin.
Transient vasomotor response that occurs primarily in the arms and legs of infants exposed to cold.
What is the first immunization for a neonate and when is it administered?
Hepatitis B vaccine
Administered in the nursery shortly after birth.
What are the symptoms that infants with Down syndrome present?
Marked hypotonia,
Floppiness,
Slanted eyes,
Excess skin on the back of the neck, Flattened bridge of the nose,
Flat facial features,
Spade-like hands,
Short and broad feet,
Small male genitalia,
Absence of Moro’s reflex, and
A simian crease on the hands.
Why would the nurse instill erythromycin in a neonate’s eyes?
To prevent blindness caused by gonorrhea or chlamydia.
What does fever in the first 24 hours postpartum mean in a neonate?
Most likely dehydration rather than an infection.
What intervention is done for preterm neonates who can’t maintain a skin temperature of at least 97.6° F (36.4° C) ?
Receive care in an incubator (Isolette) or a radiant warmer.
In a radiant warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit automatically to maintain the desired temperature.
What disease does a cesarean birth neonate have a higher incidence for?
Respiratory distress syndrome
What should the nurse do when providing phototherapy to a neonate ?
Cover the eyes and the genital area
Why is the narcotic antagonist naloxone (narcan) given to neonates?
To correct respiratory depression caused by narcotic administration to the mother during labour.
What are the symptoms of respiratory distress syndrome in a neonate?
Expiratory grunting or whining, Sandpaper breath sounds, and Seesaw retractions.
Symptoms of cerebral palsy in neonates present as:
Asymmetrical movement,
Irritability, and
Excessive, feeble crying in a long, thin infant.
What should the nurse assess for in a breech birth neonate?
Hydrocephalus, hematomas, fractures, and other anomalies caused by birth trauma.
What indicates post maturity in neonates?
Long brittle fingernails
What is common in postmature neonates?
Desquamation (skin peeling)
How does the average birth weight of neonates born to smoking mothers compare to those born to non smoking ones?
6 oz (170 g) less than that of neonates born to nonsmoking mothers.
What is the name given to neonatal jaundice in the first 24 hours?
Pathological jaundice and it is a sign of erythroblastosis fetalis.
How long does lanugo cover the fetus’ body?
Till 20 weeks of gestation. Then it begins to disappear from the face, trunk, arms, and legs, in that order.
What are the Signs of hypoglycaemia in a neonate?
Temperature instability, hypotonia, jitteriness, and seizures.
Premature, postmature, small-for-gestational-age, and large-for-gestational-age neonates are susceptible to this disorder.
What is the required daily amount of calories for neonates?
50 - 55 cal per pound of body weight daily.
What does variable decelerations mean in fetal heart rate monitoring?
It indicates compression or prolapse of the umbilical cord.
What assessment should be done for a neonate whose mother has diabetes?
Should be assessed for hyperinsulinism.
What is the best technique for assessing jaundice in neonates?
Blanch the tip of the nose or the area just above the umbilicus.
How does Milia occur in a neonate?
Occurs as pinpoint spots over a neonate’s nose.
What is a normal finding in a neonate?
Strabismus
What are milia?
Milia are tiny white or yellowish bumps that can appear on a newborn’s nose, cheeks, forehead, and chin.
They are caused by blocked pores and are common in infants, appearing in up to half of all newborns.
What is strabismus?
Strabismus is a vision disorder that occurs when the eyes do not align properly with each other.
What is the implication of rubella infection in a pregnant woman?
• Rubella infection in a pregnant patient, especially during the first trimester, can lead to spontaneousabortionorstillbirthas well as fetal cardiac and other birth defects.
What is the Apgar score?
This is used to assess the neonate’s vital functions.
It’s obtained at 1 minute and 5 minutes after delivery.
The score is based on respiratory effort, heart rate,muscletone, reflex irritability, and color.
Why is erythromycin given at birth?
To prevent ophthalmia neonatorum (infection that occurs in the eyes of newborn babies.
It is usually caused by exposure to bacteria or viruses during childbirth, typically from the mother’s genital tract.)
What is the normal blood glucose level in neonates ?
45 to 90 mg per DL
When is hepatitis B vaccine and hepatitis B immune globulin given?
Hep B vaccine - Within 48 hours of birth
Hep B immune globulin - within 12 hours of birth.
Why shouldn’t boys with hypospadias be circumcised after birth?
Because the first may be needed for constructive surgery
What does cold stress do to a neonates?
It affects the circulatory, regulatory, and respiratory systems.
What is fetal embodiment?
Maternal developmental task that occurs in the second trimester. During this stage, the mother may complain that she never gets to sleep because the fetus always gives her a thump when she tries.
What are Mongolian spots?
They are bluish gray birth marks that appear at birth or shortly after and can range from brown to blue. Their color depends on how close melanocytes are to the surface of the skin. They most commonly appear as patches across the sacrum, buttocks, and legs.
Mongolian spots are commonly found among which kind of infants?
White infants and they usually disappear at age 2 - 3 years.
What is Vernix caseosa?
A cheeselike substance that covers and protects the fetus’s skin in utero. It may be rubbed into the neonate’s skin or washed away in one or two baths.
Define Caput succedaneum.
This is edema that develops in and under the fetal scalp during labor and delivery. It resolves spontaneously and presents no danger to the neonate. The edema doesn’t cross the suture line.
Define Nevus flammeus, AKA port-wine stain ?
A diffuse pink to dark bluish red lesion on a neonate’s face or neck.
What is The Guthrie test ?
A screening test forphenylketonuria most reliable if it’s done between the second and sixth days after birth and is performed after the neonate has ingested protein.
What should the nurse do to assess the condition of sucking and swallowing?
Observe the neonate’s first breastfeeding or sterile water bottle-feeding.
What should the mother do to establish milk supply pattern?
Breast-feed her infant at least every 4 hours.
During the first month, she should breast-feed 8 to 12 times daily (demand feeding).
What should the nurse do to avoid contact with blood and other bodily fluids ?
Wear gloves when handling the neonate until after the first bath is given.
What indicates that a mother has adequate milk supply?
If a breast-fed infant is content, has good skin turgor, an adequate number of wet diapers, and normal weight gain.
What happens when a pregnant woman is placed in the supine position?
A pregnant patient’s enlarged uterus impairs venous return from the lower half of the body to the heart, resulting in supine hypotensive syndrome, or inferiorvena cavasyndrome.
What are the tocolytic agents used to treat preterm Labour?
Terbutaline(Brethine),
Ritodrine (Yutopar), and
Magnesium sulfate.
What does a pregnant woman with hyperemesis gravidarum require?
Hospitalization to treatdehydrationand starvation.
Why is Diaphragmatichernia an urgent neonatal surgical emergency?
By compressing and displacing the lungs and heart, this disorder can cause respiratory distress shortly after birth.
Common complications of early pregnancy (up to 20 weeks gestation) include:
Fetal loss and serious threats to maternal health.
What should be done when the neonate is stable?
The mother should be allowed to breast-feed within the neonate’s first hour of life.
The normal measurements for a neonate
At birth, a neonate normally weighs 5 to 9 lb (2 to 4 kg),
measures 18″ to 22″ (45.5 to 56 cm) in length,
has a head circumference of 13½” to 14″ (34 to 35.5 cm), and has a
chest circumference that’s 1″ (2.5 cm) less than the head circumference.
Normal neonatal measurement at birth(CON’T)
temperature normally ranges from 98° to 99° F (36.7° to 37.2° C),
apical pulse rate averages 120 to 160 beats/minute, and
respirations are 40 to 60 breaths/minute.
When does the various fontanels close?
• The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months.
The triangular posterior fontanel usually closes by age 2 months.
What are Supernumerary nipples ?
also known as accessory or extra nipples, are small bumps on the skin that resemble nipples and can occur anywhere on the body, They usually appear along a line that runs from each axilla, through the normal nipple area, and to the groin.
What is meconium?
A material that collects in the fetus’s intestines and forms the neonate’s firstfeces, which are black and tarry.
What does the presence of meconium in amniotic fluid indicate?
This Indicates possible fetal distress and the need to evaluate the neonate for meconiumaspiration.
How do you assess the neonate’s rooting reflex?
Touch a finger to the cheek or the corner of the mouth. Normally, the neonate turns his head toward the stimulus, opens his mouth, and searches for the stimulus.
What indicates Harlequin sign ?
This is present when a neonate who is lying on his side appears red on the dependent side and pale on the upper side.
Why does insulin requirements increase during third trimester?
This is due to the anti- insulin effects of placental hormones.
How is gestational age calculated?
Ultrasound measurement of maternal abdominal circumference, fetal femur length, and fetal head size. These measurements are most accurate between 12 and 18 weeks gestation.
What are the most common disorders of infants born to diabetic women?
Skeletal systemabnormalities and ventricular septal defects. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women.
What sign will you see on a patient with preeclampsia?
Puffiness around the eyes and edema of the hands
What are Kegel exercises?
They’re exercises that require contraction and relaxation of the perineal muscles. These exercises help strengthen pelvic muscles and improve urine control in postpartum patients.
Symptoms of postpartum depression range from:
Mild postpartum blues to intense, suicidal,depressivepsychosis.
Why would a preterm neonate require gavage feedings?
Because of a weak sucking reflex, uncoordinated sucking, or respiratory distress.
Why is Acrocyanosis (blueness and coolness of the arm and legs) normal in neonates?
Because of their immature peripheral circulatory system.
To prevent ophthalmia neonatorum (a severeeyeinfection caused by maternal gonorrhea), the nurse may administer:
Either tetracycline, silver nitrate, or erythromycin.
What position should the nurse place a neonate to facilitate mucus drainage?
30-degree Trendelenburg position
