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OB > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Signs of respiratory distress in a newborn
Signs
_____________ (>60 reps. per min)
G_________
Nasal _________
Significant ___________
A__________

A

Tachypnea
Grunting
Flaring
Retractions
Apnea

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2
Q

Nursing actions related to respiratory distress
Antenatal nursing actions
- Administer ________________ (steroid) for fetal lung maturity
Goal antenatally
- Prevent ________ delivery
Post natal nursing environment
- Neutral __________ environment
- ____________ support
- H_____________ and C________ needs

A

Betamethasone
Preterm
Thermal
Respiratory
Hydration, Caloric

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3
Q

Erythema Toxicum is an innocuous ______ popular rash of ___________ cause with superimpose vesicles. It appears within ______-_____ hours after birth and resolves _______________ within a few days

A

pink
unknown
24-48
spontaneously

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4
Q

Milia are tiny ______ papules appearing on the ______ of a newborn as a result of ____________ sebaceous glands; disappears __________ after a few weeks

A

white
face
unopened
spontaneously

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5
Q

Vernix caseosa is a protective, _________-like, whitish substance made up of _______ and ______________ epithelial cells that is present on the fetal skin

A

cheese
sebum, desquamated

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6
Q

Lanugo is fine, downy ______ found on the ________ parts of fetus, with the exception of the palms of the _________ and ________ of the feet, after ____ weeks gestation

A

hair
body
hands
soles
20

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7
Q

Harlequin Sign rare _______ change that occurs between the ___________ halves of the NB’s body, such that the ___________ half is noticeably pinker than the superior half when the baby is placed on the one side; it is of no ____________ significance

A

color
longitudinal
dependent
pathologic

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8
Q

Acrocyanosis is cyanosis of the __________ (hands and feet)

A

extremities

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9
Q

Mongolian Spot is macular areas of _________-_________ or _______-_______ pigmentations found on the ________area of the ____________ of newborns

A

bluish-black
gray-blue
dorsal
buttocks

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10
Q

Cafe au lait Spot is a congenital _____________ present at birth

A

birthmark

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11
Q

Epstein Pearls are small ________ blebs found along the _____ margins and at the junction of the hard and soft ___________; commonly seen in the newborn as a __________ manifestation. No ____________ is needed. Resolves spontaneously.

A

white
gum
palates
normal
intervention

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12
Q

Newborn Teeth are teeth with little _______ structure. This ___________ require intervention

A

root
does not

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13
Q

Where should the fundus be approx. 8hrs postpartum?

A

Fundus will be at the level of the umbilicus 12 hours postpartum

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14
Q

Describe ABO blood incompatibility

A

When a mother’s blood type is O and her baby’s blood type is A or B

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15
Q

Why does ABO blood incompatibility occur?

A

Mother and baby have different blood types, the mother’s immune system may react and are antibodies against her baby’s RBCs

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16
Q

ABO incompatibility in the newborn generally present as neonatal jaundice due to a Coombs positive hemolytic anemia (TRUE OR FALSE)

A

True

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17
Q

Can ABO incompatibility be prevented? Is so, how?

A

Yes. Intramuscular injection of Rh immune Globulin (called Rhogam) at 28 weeks gestation, after delivery of Rh+ baby, any early pregnancy bleeding, TAB, injury, amniocentesis/ CVS test

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18
Q

The Barlow maneuver is a test designed to detect subluxation or dislocation of the ____. A dysplastic joint will be felt to be is located as the femur leaves the acetabulum. ** _____________** hips

A

hips
ADDUCT

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19
Q

The Ortolani maneuver is a manual procedure performed to rule out the possibility of developmental dysplastic hip. _________ hips

A

ABDUCT

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20
Q

What do positive Barlow and Ortolani tests indicate?

A

Hip dysplasia/ dislocation — follow up when head of femoral head relocates into acetabulum

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21
Q

What is a normal blood glucose for a NB?

A

45 or higher

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22
Q

What is considered an abnormal blood glucose for a NB? How would a nurse treat this?

A

Anything less that 45 is considered abnormal (hypoglycemia)
Early feedings
Assess BS glucose levels per guidelines (1-4hr intervals)
Oral glucose
IV infusion of dextrose solution

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23
Q

What should lochia look and smell like during the first 7 days PP?

A

Lochia rubra is bright red (first 2-3 days). It will have fleshy odor. (Small clots are common < nickel size)
*Lochia serosa is pink (day 3-10)
Lochia alba is white (continues until the cervix is closed
** There should never be a foul odor — sign of infection

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24
Q

Lochia amount is documented as:

A

scant
small
moderate
heavy

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25
Q

What assessment findings would cause the RN to suspect an infection such as Endometritis?
- infection of the __________ caused by _________ vaginal flora or gram __________ organisms
-S/S: ________ first 24-72 hours PP, pain/tenderness in pelvis, tachycardia, _________ vaginal discharge, paleo, leukocytosis, uterus is ____/________/ or _______
-TX: broad spectrum __________ given ___ until afebrile for ____ hours

A

decidua
normal
negative
fever
purulent
soft/large/tender
antibiotics, IV, 48

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26
Q

**Polycythemia is when the baby’s blood has more ______ than normal with increased __________ consumption, thicker blood travels slower, can lead to ________
-S/S: ruddy/dusky color, sluggish, poor feeder, seizures
-TX: hydration, observation, ___ fluids, partial exchange transfusion (severe), maintain normal __________

A

RBC
Oxygen
hypoxia
IV
hydration

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27
Q

Kernicterus is _______ damage caused by untreated jaundice; ________ is so high that it can move out of the blood into the _____ tissue levels greater that 20-25

A

brain
bilirubin
brain

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28
Q

stages of hyperbilirubinemia
stage 1: jaundice in _____ especially ____
stage 2: jaundice in ______ and chest
stage 3: jaundice in _______
stage 4: jaundice in _____ and ______ of hands

A

face, eyes
arms
thighs
legs, palms

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29
Q

why do we have IV pitocin after a normal vaginal delivery?

A

Pitocin helps the uterus contract after birth and prevent excess bleeding (aka postpartum hemorrhage)

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30
Q

What do you suspect has occurred if you assess the fundus at 4hrs PP, and discover it +2cm and deviate to the left? What intervention would you implement?

A

Ask patient when the last time she voided and put patient in supine position.

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31
Q

Nursing actions if nurse discovers boggy fundus, clots, and bleeding on a PP woman
- uterine _______ if a soft boggy uterus is detected
-frequent VS
- Assess ______and __________ often
- Encourage frequent ___________ or ____________ the woman. Vascular access
- Assess abnormalities in __________ levels
- Assess urinary output. Encourage rest and take safety precautions

A

massage
fundus, bleeding
voiding, catheterize
hematocrit

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32
Q

Erythroblastosis fetalis occurs when an Rh _________ mother is pregnant with an Rh _________ fetus and maternal antibodies cross the _________; maternal antibodies destroy fetal RBC.

A

negative
positive
placenta

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33
Q

Neonatal sepsis is a ________ infection of infants younger than _____ days old

A

blood
90

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34
Q

What are the signs and symptoms of neonatal sepsis?
- ______________ instability
- poor __________
- Vomiting
- Diarrhea
- Lethargy
- C___________ activity
- Lack of _______ gain
- Dehydration

A

Temperature
sucking
Convulsive
weight

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35
Q

What are the nursing interventions for neonatal sepsis?
- Control the _______________ (temperature, allow quiet time)
- Encourage __________
- A______________

A

environment
bonding
Antibiotics

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36
Q

What care do you anticipate for the RN of an infant of an insulin dependent diabetic?

A

Glucose level
Monitor for hypoglycemia
Start early feedings
IV infusion of glucose if needed

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37
Q

Describe the care for a client with a small hematoma
- _____ bath after the first ____ hours will aid fluid absorption once bleeding has stopped and promote comfort. Use of __________ agents
** Conservative treatment**
- ______ pack
- Observation
- _______ management
- ________ drainage

A

Sitz
12
analgesic
ice
pain
bladder

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38
Q

What would be the treatment for a large hematoma?

A

Incision and drainage

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39
Q

How frequently should a new mother put a newborn to the breast ?

A

Every 1/2 - 3 hours (as infant demands)

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40
Q

Pre-term
- Born less than ______ completed weeks of gestation ; respiratory ____________ deficiency, maturational deficiency( ____ storage, ______ regulation, ____________ of the organ system)

A

37
surfactant
fat, heat, immaturity

41
Q

Extremely Pre-term
-born less than ___ weeks gestation. At risk for long term __________, neurocognitive, visual and _______ delevopments

A

28
respiratory
auditory

42
Q

Babies that are born pre-term are at risk for:
- ____________ problems
- ______ loss
- _____________/Absorption problems
- Fluid / ___________ imbalance
- Increased susceptibility to _____________

A

respiratory
fluid
digestive
electrolyte
infections

43
Q

Necrotizing Enterocolitis is where the wall of the _____________ are invaded by bacteria causing local ____________/ inflammation that can destroy the wall of the __________ (perforation of the intestines)

A

intestines
infection
bowel

44
Q

Who is Necrotizing Enterocolitis most common in?

A

premature infants

45
Q

** Signs and symptoms of necrotizing Enterocolitis**
- __________ intolerance
- _______- colored vomit
- _______________ distension
- Bloody ________
- Temperature instability
- Lethargy

A

feeding
bile
abdominal
stool

46
Q

**Nursing care of NB’s with Necrotizing Enterocolitis **
- Stop ______ ___________; insert NG tube (24-48 hours)
- ABX and IV fluids
- TPN or small oral feedings
- Handle infant __________ (be cautious with tight _________)

A

oral feedings
carefully, diapers

47
Q

When is Necrotizing Enterocolitis commonly seen?

A

4-10 days after feeding have started

48
Q

Mastitis is a painful infection of ________ ___________of the _________ tissue.
Risk Factors:
- ______ nipples
- _________ nipples
- blocked ______ duct
- yeast of breast or _________ of infant

A

staph aureus, breast
sore
cracked
milk
mouth

49
Q

Treatment and prevention of Mastitis
- Improving BF __________
- A_____________/ antifungals (if Candida present)
- Optimize BF
- Appropriate _______
- Hand washing
- Supportive ______
- Prompt attention to blocked _______ _______

A

techniques
antibiotics
latch
bra
milk ducts

50
Q

Can a breast feeding mother continue to breastfeed while being treated for mastitis?

A

YES, the breast milk is not contaminated

51
Q

An Intraventricular Hemorrhage is __________ inside or around the ________ in the brain. Bleeding can occur because blood vessels in premature baby’s brain are very fragile and break easily. Nearly all IVH occurs within the first few days of life. RF include weight less than _______ grams and less than ______ weeks gestation.

A

bleeding
ventricles
1500
34

52
Q

What are the long term outcomes for a NB with Intraventricular hemorrhage?
- No problems
- ___________ delays
- Hydrocephalus
- Long term _______ injury
- Death

A

developmental
brain

53
Q

What kind of treatment is provided for IVH?

A

Mainly supportive, rarely requires shunt placement

54
Q

Babinski reflex is where babies younger than 6 months of age in which the great toe ____________ when the sole of the foot is stimulated
_______/_______ reflex is where flexion of the NB’s thighs and knees accompanied by the fingers then fan, then clench, as the arms are simultaneously thrown out and then embracing something
Sucking reflex is performed by inserting a _________ or nipple in NB’s mouth. resulting in forceful rhythmic sucking
Tonic neck/fencing reflex is when the baby is lying down and their head is turned to the right or left, the corresponding arm _________ while the other arm bends next to their ______
** Grasp reflex** is performed by stimulating the _______ with a finger or object, resulting in the NB firmly holding on to the finger or object

A

dorsiflexes
moro/startle
finger
extends, head
palm

55
Q

What is the correct site to administer IM injections to a newborn?
- IM injections are administered in the ________ ___________ muscle
- DO NOT inject the anterior aspect of the thigh in the term neonate as this location of neurovascular structures may be damaged

A

Vastus lateralis muscles

56
Q

What are the 4 Ts factors that increase risk for PP hemorrhage, what do you anticipate her labs will look like?

A

Trauma (Genital tract)
Thrombin (Clotting factors)
Tissue (Retained placenta)
Tone (Uterine Atony)
**majority of her labs will be low

57
Q

Endometritis is the ___________ of the decidua (Pregnancy endometrium). The common pathogen for this infection is of the normal vaginal flora or gram-________ organisms.
Signs and symptoms
- ________ (first 24-72 hours)
- ______/___________ in pelvic area
- _______cardia
- ___________ vaginal discharge
Treatment included **_________-_________ ___________ given IV until women are afebrile for ___hrs

A

infection
negative
fever
pain/tenderness
tachy
purulent
Broad-spectrum antibiotics, 48

58
Q

Uterus rapidly decreases in size to pre-pregnancy size in a process called ______________

A

involution

59
Q

What is the leading cause of blindness in premature infants?

A

Retinopathy of Prematurity

60
Q

In retinopathy of prematurity, high concentration oxygen leads to preemie infants’s retinal vessels to constrict causing blindness (TRUE OR FALSE)

A

true

61
Q

Retinopathy of prematurity of more common with oxygen concentrations >______% or used longer than _____-_____ hours

A

40
48-72

62
Q

Prevention of retinopathy of prematurity
- Use minimum ________ necessary
- Monitor ______ levels (maintain WNL)
- Administer vitamin _____ (thought to affect tissue response to oxygen)
Treatment
- Laser tax
- Virectomy ( remove vitreous humor from the eye)
- scleral buckle ( repair the retina)

A

oxygen
Po2
E

63
Q

When does menstruation return in the non-breastfeeding woman?

A

7-12 weeks

64
Q

With breastfeeding women, their menstruation may not return the entire time while BF, but they are still ____________. Ovulation usually occurs within ____ ____ days

A

ovulating
70-75

65
Q

Breastfeeding mothers should increase their intake by ____ calories in addition to the ____ calories from pregnancy (total of 500 calories additional per day)

Non-breastfeeding mothers decrease their intake by ____ calories (return to pre-pregnancy caloric intake)

A

200
300
300

66
Q

Breastfeeding mothers should not consume alcohol for at least __hrs before nursing. Alcohol consumption should be limited to occasional use

A

2

67
Q

Vaginal delivery blood loss is usually around _____-______mL
C-section delivery blood loss is usually around ______ ______mL
For every _____mL blood loss = Hemoglobin 1-1.5. Hematocrit 3-4%
**1gm = 1mL blood

A

200-500
700-1000
500

68
Q

What assessment findings on the infant would support the gestational age of 43 weeks and 3 days?
- ____ and _______ skin without vernix/lanugo
- Long ____________
- Excessive scalp _____
- Long, thin body with loose _______ no fat
- ______________ staining (nails, skin, cord)

A

dry,cracking
fingernails
hair
skin
Meconium

69
Q

How does the nurse prevent heat loss in a NB?
- ______ off
- Place in the _________
- _____-__-______ contact
- Prevent ________

A

dry
warmer
skin to skin
drafts

70
Q

____________ is the heat loss or gain via conduction occurs through direct contact with a surface with a different temperature . Such as cold mattress or scales. Direct transfer of heat occurs from the newborn to this surface ( being on a cold spot makes you cold)
** _____________** is where heat is transferred by convection when when air currents carry heat away from the body surface. If the infant’s body surface is warmer than the surrounding air ( as is almost always the case in the delivery room)
______________ occurs when water is lost from the skin. During evaporation, water is converted from a liquid to a gas, causing approximately 0.6 calories of heat to be lost for every 1 gram of water lost from the body
_____________ is the loss or gain of this “radiant” energy is proportional to the temperature difference between the skin and the radiating body; heat may be lost from the infant’s body to a nearby cold wall or window

A

Conduction
Convection
Evaporation
Radiation

71
Q

Physiologic jaundice appears after ____ hours of life. It usually resolves in the first ___ days of life.
Treatment
- Frequent _____________
- Frequent _______
Causes of physiologic Jaundice
- Delayed ______ clamping
- Inadequate _________ intake
- Defect in _________ excretion (not pooping)
- Increased reabsorption of bilirubin from the intestines

A

24,7
feedings
stools
cord
nutrition
bilirubin

72
Q

Pathologic jaundice appears during the first ___ hours of life. May last for more than ___ days in full-term and ____ days for preterm infant. Infant may show symptoms or signs of a serious illness early after birth.
Causes
- Hemolytic Disease
- R_________ (isoimmunization
- **ABO __________________ - mom O baby type A, B, or AB

A

24
7,10
Rhesus
Incompatibility

73
Q

Is physiological or pathological jaundice more dangerous?

A

Pathological

74
Q

Postpartum after pains are a sign that the uterus is cramping and shrinking back to its re-pregnancy size . This is more common in the ______parous patient or during nursing (Release of oxytocin) This typically lasts __-__ days.
Treatment
- Lying on __________
- Ambulation
- Heat
- Mild ___________

A

multi
2-3
abdomen
analgesia

75
Q

What is the rationale for administering Vitamin K to the newborn? How does normal bowel flora influence this practice? What is the correct dose and site?
- Administration of Vitamin K is done via _____ injection
- Vitamin K promotes the ______ formation of _________ factors
- The newborn does not have bacteria in the GI tract to synthesize Vitamin K
- Only __mL volume
- By __-__ days after birth, it is formed
Muscle preference
- Full term: _________ ____________
- Pre-term: ________ __________

A

IM
liver, clotting
1
5-8
vastus lateralis
Rectus femoris

76
Q

________ positioning for a preterm newborn decreases the amount of __________ effort, facilitated chest expansion

A

Prone
Respiratory

77
Q

The benefits of circumcision include
- prevent ___s
- Transmission of _____s
- Penile _________

A

UTIs
STIs
Cancer

78
Q

Apply petroleum _______ with each diaper change. Do not remove yellow _______ that may form over the head of penis. If the diaper sticks, get the diaper ____.

A

gauze
crust
wet

79
Q

After ___ hours of detecting a murmur, suspect a _____________ condition. The CCHD is a screen to check and see if there are any congenital heart defects. Done after___ hours. Pass over 94

A

12
congenital
24

80
Q

PP depression often starts within __-__ weeks of having a baby
Symptoms
- Crying for no reason
- Feeling hopeless/ overwhelmed
- Excessively moody or irritable
- Panic or excessive worry
- Scary thoughts of self harm or harm to infant
- Can not complete activities of daily living including newborn care
- Risk of ________

A

1-3
suicide

81
Q

PP psychosis is an acute _____ disorder or psychotic reaction following child birth ___-___ months of delivery
Symptoms
- Sleep disturbances
- Agitated and/or paranoid
- Delusions of hallucinations
- Impulsive
- Depersonalization:Unaware/distant from immediate family/environment
- Risks of ___________ or ___________
** Considered a psychiatric emergency that requires hospitalization**

A

mental, 1-3
suicide, infantcide

82
Q

When does the ductus arterious close?
- Closed by seventy two ________ after birth
** When does the foremen Ovale close?**
- Functionally closed 1-2 ________ after brith
** When does the ductus venous close?**
- Closes with clamping or cord and is completely closed by end of _______ week

A

hours
hours
first

83
Q

Small for Gestational age
- Infants who are less than ____th percentile for birth weight
- Causes
- poor _________
- Mild ______
- _____________ abuse
- Small baby d/t small parents

A

10
nutrition
HTN
Substance

84
Q

Intrauterine Growth Restriction occurs when the fetus did not _______ at a normal rate inside the womb
Causes
- _____-___-____ transfusion
-__________ disease
- _________ abnormalities
- HTN
- DM
- Chronic abruption
** Accounts for ___% of stillbirths and ____% of infants with SIDS

A

grow
twin to twin
kidney
placental
20
30

85
Q

Complications of IUGR
- Low __________
- ______ APGAR
- _______glycemia
- Temp instability
- Congenital malformations
- Cognitive delays

A

Oxygen
Low
HYPO

86
Q

Large for gestational age: Newborns whose birth weight is at or above ____th percentile
- Associated with maternal __________: Majority of causes are unclear *more common in males
Common Complications
- Birth trauma due to cephalopelvic disproportion
- ______glycemia
- _______cythemia

A

90
diabetes
HYPO
POLY

87
Q

What are some signs and symptoms of an infected umbilical cord?

A

redness
streaking
drainage
foul odor
fever

88
Q

Normal newborn temperature

A

97.6-99.3

89
Q

Normal Newborn Pulse

A

110-160bpm

90
Q

Normal NB Respirations

A

30-60

91
Q

NB’s initial RR may be diaphragmatic, shallow, and irregular in depth and rhythm. (TRUE OR FALSE)

A

true

92
Q

Abnormal Respirator Effort in NB
- Retractions: pulling the chest in at the _____, below the breastbone
- Grunting: moan or sigh when __________
**Trying to keep air in lungs to build of level of O2
- Nasal flaring: nostrils that ________ with each inhaled breath
- Cyanosis: lips, tongue, mucous membranes, trunk
- See-saw respirations: prevents movement of O2 can lead to severe ______________ disturbances

A

ribs
exhaling
widen
cardiovascular

93
Q

What is the function of surfactant?
- Increases pulmonary _____________ (expansion of the lungs )
- Prevent __________ (Collapse of the lung)
- Facilitate recruitment of collapsed lungs (re-__________ of the lungs)
Negative s/e of Surfactant administration?
- Risk for __________ ____________ to remain open which = increased pulmonary pressure = HTN
Administration
- Directly into the _______ via _____ tube
- Place infant on one side then rotate to other side to coat both lungs ** Betamethasone can be administered to STIMULATE surfactant production

A

compliance
atelectasis
expansion
ductus arteriosus
lungs, ET

94
Q

What is the purpose of an episiotomy?

A

Used to augment difficult deliveries and avoiding potentially dangerous vaginal lacerations. The tissue between the vaginal opening and anus is cut

95
Q

common types of episiotomy
- M_________
- J-_________
- M_______________
- L_________
Nursing care after episiotomy
- 1st 12 hrs offer _____ packs (pain/swelling)
- Keep area _____ and ____ (infection)
- Frequent ______ bath (3-4 times a day)
- Clean after voiding and stooling with peri bottle with _______ water

A

Median
J-shaped
Mediolateral
Lateral

ice
clean, dry
sitz
warm

96
Q

Caput succedaneum is the _____________ of the scalp that ________ the suture line. This occurs due to the head hitting up against mom’s cervix. Resolves within ____ hours of birth and there is no treatment needed.
Cephalohematoma is __________ between the periosteum and the skull of NB; DOES NOT ______ the suture line. (More common with vacuum and forceps). This resolves within __-__ weeks or months to resolve. This increases the risk of developing __________ or ________. There is no treatment needed for this

A

swelling
crosses
12

bleeding
cross
2-3
jaundice, sepsis

97
Q

What is the treatment plan for a NB who has HSV?

A

Antiviral (acyclovir) for 21 days

98
Q

Patent Ductus arteriosus is failure of the ductus to ______ within the first _________ of life. This leads to continued blood flow from the aorta to the pulmonary artery.
S/S
- ______cardia
- ______pnea
- Bounding peripheral ________
- Widened pulse pressure
**A harsh continuous machine-like murmur can be heard

A

close
weeks
tachy
tachy
pulses

OB (5 decks)

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