Mother/baby Exam 2

Front 1

four threats to the newborn

Back 1

hypothermia

hypoxia

hypoglycemia

infection

Front 2

methods of heat exchange

Back 2

convection

conduction

evaporation

radiation

Front 3

convection heat

Back 3

heat gain/loss by air motion

loss: AC
gain: heated isolette (warm draft)

Front 4

conduction heat

Back 4

loss of heat to cool surface by Direct contact - cool hands, stethescompe, scales

gain: warm blankets, heat isolette pad (like a heating pad)

Front 5

evaporation heat

Back 5

loss: when water changes to vapor (wet from birth, baths, wet clothes, wet diapers)

gain: vapor to water (humidity provided in vent circuit)

Front 6

radiation heat

Back 6

transfer of heat to cooler surfaces through absorption and emission of infrared rays - not direct contact.

loss: laying next to a cold window.
Gain: next to a hot window

Front 7

vernix caseosa

Back 7

waxy cheeselike substance covering body
purpose to protect skin from 9 months of water exposure

starts developing at 28-29wks

Front 8

infant thermogenesis

Back 8

increased metabolic rate
muscular activity
chemical thermogenesis (nonshivering thermogenesis)
- this is unique to newborn. they use brown fat(colored bc it is enriched by blood supply, dense cellular content, abundant nerve endings)
- brown fat appears at 26-30wks and continues to increase until 2-5wks after birth
- brown fat deposited in midscapular area, around neck, in axillas
- deeper placement around tarachea, esoph, abd aorta, kidneys, adrenals

Front 9

consequenses of low temp:

Back 9

cold stress! Temp drops and they try to raise it. Have an increased 02 demand but the blood suply is low so you get hypoxic bc of peripheral and pulmonary vasoconstriction

Front 10

infant stomach can hold

Back 10

~ 30mL

Front 11

if infant is hypoglycemic they might act

Back 11

jittery or lethargic

Front 12

vitamin K injection for newborns

Back 12

give in L vastus lateralis muscle

purpose - clotting. since we need bacteria from the gut to make our own vitamin k, and infants don't make this until they are like 1wk old, we have to give it to them!

Front 13

erythromycin med

Back 13

ointment antibiotic for eyes

purpose - to prevent any opssible infection that baby could pick up on their way down the birth canal.
- gonorrhea and chlamydia can cause vision probs and blindness

Front 14

physiologic wt loss for newbs

term
preterm

Back 14

term - 5-10%
preterm - up to 15%

Front 15

head circumference needs to be about ___ cm _____ than chest circumference

Back 15

2cm larger

Front 16

plethora color

Back 16

red all over not only when crying

Front 17

what does peeling feet mean for a newb?

Back 17

baby is post term

Front 18

apgar score performed when

Back 18

at 1 and 5 mins

Front 19

lanugo

Back 19

soft downy fine hair covering baby beginning around 5 months gestation. usually shed and replaced by vellus at 33-36 wkns gestation. contribues to meconium.

presence is a sign of preemie. best place to see it is on back btwn shoulder blades

Front 20

pathological jaundice

Back 20

never normal

Front 21

acrocyanosis

Back 21

due to poor periph circulation which results in vasomotor instability and cap stasis when baby exposed to cold. common during initial 48h after birth.

if it perisists, think about periph vasoconstircion secondary to sepsis, shock, heart failure

Front 22

central cyanosis

Back 22

advanced hypoxia.
best assessed on tonuge and mucus membranes.
urgent investigation required if it persists beyond first few mins of life

Front 23

circumoral cyanosis

Back 23

bluish around mouth usually occurs in feedings, esp in preemies with poor oromotor coordination and true oxygen desat with feeds.

Front 24

harlequin sign

Back 24

periph cyanosis or pale on one side or one quadrant of body (red in dependent areas, cyanotic/pale in superior aspect). If baby rotates to the other side, skin color reverses. skin of affected area is warm.

seen only in immediate newborn period adn self resolves. may last 1-30 mins. ascribed to "vasomotor instability" which is a temp imbalance of the autonomic regulatory mechanism of the cutaneous vessels

Front 25

mongolian spots

Back 25

normal.

flat bluish/gray marks often mistaken for burises. more common in dark skin. mostly on back/butt

Front 26

erythema toxicum

Back 26

small yellow/white papules, surrounded by red skin. in 50% of all newborns

Front 27

telanictatic nevi

Back 27

flat deep pink localized areas of capilary dilation. Birth marks!

Front 28

cafe au lait

Back 28

cardinal dx feature of neurofibromitosis type 1 if there are 6 or more >5mm before puberty or >15mm after puberty

Front 29

milia

Back 29

baby acne. occurs when dead skin becomes trapped in small pockets at surface of skin. disappears within a few wks, don't squeeze them!

Front 30

caput

Back 30

long labor. disappears in one week
crosses suture line

Front 31

cephalohematoma

Back 31

trauma during birth. may perisst up to 3 months. does not cross suture line

Front 32

anterior fontanel

posterior fontanel

Back 32

diamond. 2-3 x 3-4cm

triangle 1-2cm

Front 33

whorls

Back 33

the crown swirl

develps from same embryonic cells as nervous system. abnormal placement/absence can indicate abnorm brain development.

Front 34

strabismus

nystagmus

Back 34

cross eyed

jerky eye

Front 35

occlude one nostril at a time to check for

Back 35

choanal atresia

Front 36

epstien pearls

Back 36

in 80% newbs

protien filled cysts. harmless but they may worry parents

disappear in 1-2wks of borth. no tx

Front 37

absence of pulses or b/p can raise questions about possible

Back 37

coartation of aorta

Front 38

baby pmi

Back 38

lateral to midclavicular line at 3 or 4 intercostal space

Front 39

neonatal period

Back 39

28 days

Front 40

initial breath

Back 40

estabs pulm ventilation through lung expansion

increase in pulm circulation

Front 41

initiation of breathing

Back 41

chemical, mechanical, thermal, sensory factors

Front 42

chemical stimuli for breathing

Back 42

stimulated to breathe bc of transitory asphyxia (bc cord is cut)

initial breath is a gasp triggered by elevation in pco2 and decrease ph and p02

changes stimulate aortic and chemoreceptors that trigger medullas resp system

catecholamine production critical in changes involved in transition to extrauterine life - stimulate CO and contractility, surfactant release and promotion of pulm fluid clearance

Front 43

mechanical events initial breathing

Back 43

chest is recoiled after birth of trunk which makes a negative intrathoracic pressure (makes small passive insp of air replacing fluid in lungs)

high intrathoracic pressures help distibute air througout lungs and est functional residual capacity (amount of vol left in lungs after exhalation to prevent lung collapse)

Front 44

thermal stimuli

Back 44

dramatic decrease in temp stims breathing! get a teensy bit of cold stress -- > need to control this so it doesn't turn to hypoxia.

skin nerve endings stimulated by cold environment (increases metabolism)

Front 45

sensory stimuli breathing

Back 45

tactile, auditory, and visual stim help start breathing.
- gravity, light, sound, joint movement, touching/handling infant at birth

appropriate tactile stimuli include drying infant, encouracging skin to skin with mom, promoting thermoreg

Front 46

surfactant

Back 46

surface active phospholipids critical for alveolar stability. lower surface tension of alveoli during exhalation.

mature lungs have lecithin and sphingomylein (L/S) ratio of 2:1

Front 47

as p02 rises in alveolii, stimulation of relaxation of _________ occurs so ________ decreases

Back 47

relax of pulm arteries

pulm vasucalr resistance decreases

Front 48

vascular flow in lungs achieves 100% by

Back 48

24h of life

Front 49

delivery of greater blood vol to lung contributes to

Back 49

conversion from fetal circ to newb circ

Front 50

percent hgb that is fetal

Back 50

70-90

Front 51

percent of hgb that is adult

Back 51

10-30

Front 52

fetal hgb has _______ affinity to

Back 52

02

Front 53

periodic breathing

Back 53

pauses 5-15s. should not include skin color or hr changes

Front 54

breathing stopped for longer than ____ = apnea

Back 54

20s

Front 55

resp distress

signs

Back 55

<30 or >60 bpm at rest, dyspnea, cyanosis, nasal flaring, resp grunts, retractions

nasal flarse, intercostal or subcostal retractions, grunts, abd breathing, head bob

Front 56

signs of risk for cv probs in newborn

Back 56

tachycardia - +160. anemia, hypovolemia, hyperthermia, sepsis

bradycardia - less than 100. congenital heart block or hypoxemia

color - pallor. anema, vasoconstriction d/t asphyxia or sepis. prolonged cyanosis other than acrocyanosis can indicate rep and/or cardiac probs

Front 57

lung expansion

increases______-
decreases ___________

Back 57

pulm blood flow

pulm vascular resistance

Front 58

foraman ovale

fetal circ
transition

Back 58

allows oxygenated blood going to RA from inferior vena cava to pass into left atrium so it can bypass pulm circulation. this lets 02 go to other parts of the fetal body esp brain

after the first breath, air pushes into the lungs triggering an increase in pulm blood flow. as a result pressure in left atrium gets higher than right atrium. the increased pressure causes FO to close, allowing output from right vent to flow entirely to lungs

Front 59

ductus aortis

fetal circ
transition

Back 59

protects lungs against circ overload by shunting blood from right to left in descending aorta. patency during fetal life promoted by continual production of prostaglandin (so don't give mom antiprostaglandins in last bit of preg).
want this to stay open form reemies to keep lungs from being overloaded so we give them prostaglandins

closure depends on high o2 content of aortic blood resulting from aerating lungs. pulm vasc resistance decreases so pulm blood flow is increased and 02 exchange occurs.
occurs secondary to increase in p02 coinciding with first breath and umbilical cord occlusion

Front 60

ductus venosis

fetal circ
transition

Back 60

shunts blood from left umb vein to IVC. plays critical role in shunting oxygenated blood to fetal brain.

closes within a few days after birth bc shunting no longer needed bc liver is activated. the liver takes over functions of placenta

Front 61

hematopoietic adaptations of newb

rbc
bv
leukocytes
platelets

Back 61

rbc prod diminishes after birth bc of increase in 02 production causing initial decline in hgb production = phyisologic anemia of infancy

bv 80-85ml/kg of body wt. effected by - delayed cord clamping (get blood from placenta so it's almost like autotransfusion), gestational age (preemies have less bv), prenatal hemorrhage, site of blood sample

leukocytes - wbc of about 18000 at birth and increases to 23000 at day 1. diminishes quickly and returns to birth wbc count. increase may indicate infection but some experience sepsis without a wbc increase

platelets 100,000-300,000 same as adults

Front 62

renal adaptations of newb

Back 62

daily fluid requirement 60-80ml/kg

babies should void within first 24h of life. if they don't in 48h it may indicate renal impairment

may pass uric crystals - brick dust spots. beware dehydration!

Front 63

GI adapts of newb

Back 63

digestion regulated by enzymes present at birth (except amylase and lipase)

newb requires 110 cal/kg/day to gain weight

Front 64

newb iron storage

Back 64

have enough to last 4-6 mo

Front 65

conjuagtion of bili

physiologic jaundice
patho jaund

Back 65

can cross bbb

normal. babes with larger bv are more prone

occurs before 24h or first day. means they have an rh prob
- kernicterus - can cause perm brain damage

Front 66

developmental dysplasia of the hip (congenital hip dislocation)

Back 66

ortolani's manuver - limited hip abduction as seen in flexion

barlow's manuver - middle finger over greater trochanter and thumb on midthigh. hip flexed to 90 degrees adn adducted followed by gentle dowward pushing of femoral head. if hip can be dislocated, femoral head moves out adn you feel a clunk

Front 67

neurmusc adapts of newb

Back 67

almost fully developed at birth. can have transient tremors. muscle tone adn strength directly related.

Front 68

self quieting

Back 68

sensory adaptation. using own resources to quiet and comfort. suckiing on fist or tongue

Front 69

habituation

Back 69

sensory adaptation. ability to process complex sitches. slight startle with stimulius but when repeated, may be able to diminish rxn to stim

Front 70

orientation

Back 70

sensory adaptation. fixate on stimuli like face, black and white images or shapes. when they hear a sound, cardiac rate rises and startle may be seen.
baby able to distinguish mom smell from other mothers.

Front 71

first period of reactivity

Back 71

up to 30 mins after birth. bonding so important!
hr increases to 160-180 but grad decreases.

after this period, they either sleep or have marked decrease in motor activity. this lasts for 60-100 mins

Front 72

second period of reactivity

Back 72

2-8h after birth lasting 10 mins to several hours.
tachycard, tachypnea, increased muscle tone. improved skin color, mucus production, meconium passed

Front 73

gest age assessment completed when?

more comprehensive assessment when?

Back 73

within first hours in a stable baby

within 24h

Front 74

apgar score

0-3
4-6
7-10

Back 74

severe distress

mod difficulty

minimal or no difficulty

Front 75

normal assessment findings on newb

Back 75

temp - 97.7-98.9

hr - 120-160

b not assessed right at birth bc it falls to a min by 3h after nirth then steadily climbs and plateaus at 4-6d after birth

Front 76

BL measurements

wt
head circ
body length

Back 76

5lb 5oz - 8lb 8oz

measure at occiptiofrontal diameter. 32-36.8cm

45-55cm

Front 77

reflexes needed to have proper growth

Back 77

sucking and rooting

Front 78

preterm/premature

Back 78

born before 37w

Front 79

late preterm

Back 79

born btwn 34-36.7wks

Front 80

postterm

postdate

Back 80

after 42 wks

after due date

Front 81

umbilical cord falls off when?

Back 81

10-14days bc of dry gangrene.

assess with each diaper change for edema, redness, purulent drainage

odor alone is not an indicator of ompalitis bc it deteriorates through dry gangrene

some blood can be seen in umbilicus at separation

Front 82

maternal levels of ___ and ____ increase with early ___

Back 82

prolactin and oxytocin

breastfeeding

Front 83

active immunity for newborn begins

Back 83

as infant digests antibodies from mom's colustrum

Front 84

physiologic jaundice

assessment

tcB monitors

high risk if

Back 84

pressure points (forehead and nose)
conjuctiva and buccal mucosa
in natural light
visual assessment not acurate

tcb monitor decresases need for serum bili levels. provides acurate measurements within 2-3 mg if serum level below 15mg/dl. not effective after light therapy started.

gest age <38w, breastfeeding, previous sib with sig jaundice

Front 85

hypoglcemia

s/s

if at risk, you should be assessed withing ______

Back 85

less than adequate to support neuro, organ, tissue function

tx warranted usually <40mg/dl but some recommend <50

concern about neuro injury as result of sever or prolonged hypoglycemia esp in combo with ischemia.

jittery, lethargy, poor feeds, hypotonia, temp instability (hypothermia), resp distress, apnea, siezures

first hour of life

Front 86

maternal risks for hypoglycemia

neonatal risks

Back 86

maternal dm, gest htn, tocolytic therapy

prematurity, lga, sga, perinatal hypoxia, infection (metab increased), hypothermia, congenital malformations

Front 87

hypocalcemia

occurs in

s/s

Back 87

levels <7.8 - 8mg/dl in term infants and 7mg in preemies

infants of moms with dm, perinatal asphyxia or trauma, lbw and preemies

jittery, high pitched cry, irritable, apnea, intermittent cyanosis, abd distention, laryngospasm, asymptomatic

Front 88

early onset hypocalc usually resolves in

hypocalc tx

Back 88

1-3d

human milk or preterm infant formula

Front 89

all states screen for __ and ___

Back 89

PKU and hypothyroidism

Front 90

newborn hearing screening

Back 90

1 in 1000 births. when id'd can help prevent early developmental delays. inital screening done with evoked otoacoustic emissions . auditory brainstem response used as follow up if screening is abnormal

Front 91

heel stick

comp
repeated sticks can cause

Back 91

minimizes pain and maxes accuracy of the test.

necrotizing osteochondritis resulting from lancet penetration to bone

fibrosis and scarring leading to probs with walking later in life

they need to be cuddled and comforted!

Front 92

veinipuncture

can be drawn from _____
these things can affect blood gas values
apply pressure for ______ with ______
observe frequently within ______

Back 92

antecub, saph, superficial wrist, scalp (rare)

crying, fear, agitation

3-5 mins with dry gauze to prevent bleeding

for 1h after assessing for bleeding or hematoma

Front 93

obtaining urine specimen on newborn

Back 93

should be fresh and analyzed within 1h of collection

wash genetalia thoroughly and dry.

24h urine collection - drain into receptacle at intervals and observe skin closely for irritation

Front 94

IM injections on newbs

Back 94

25 gauge, 5/8" needle

they don't tolerate more than 0.5ml injection

use vastus lateralis

insert at 90 degrees.

Front 95

hyperbilirubinemia therapy

best is _____

Back 95

prevention!

Front 96

phototherapy (hyperbili)

Back 96

uses energy light to change shape and structure of unconj bili and convert it to molecules that can be excreted.

closely monitor baby's temp

lights increase rate of insensible water loss -- mon dehydration

monitor urine output - can be decreased or be dark brown or gold

record number and consistency of stools - excretion can increase motility and loose stools which can break down their skin

Front 97

circumcision

Back 97

removes part of prepuce

3rd most common surg in US
there are potential benefits, but not enough to recommend it.
routine analgesia used.

proponents - decreasee UTIs in babies up to 1y, decrease risk penile CA, phimosis, paraphimosis, balantis, decrease stds (hpv and hiv), low rate of comps and no substantial neg effect on sexual funct

opponents - unnatural and unnecessary

risks - hemorrhage, infection, penile injury, long term probs like advers sexual funct/pleasure, acute pain, psych effects

MATTER OF PERSONAL CHOICE

Front 98

Anesthesia used during circumcision

nonpharm methods

Back 98

ring block
dorsal penile block
topical anesthesia
concentrated oral glucose

non nutritive sucking (shular), containment, swaddling

Front 99

postop care for circumsicion

Back 99

check q15-30 mins first h then hourly next 4-6h for bleeding and pain.

if bleeding occurs, gentle pressure with folded sterile gauze. if not able to control, one nurse applies pressure while another calls dr who may have to ligate a vessel

DO NOT USE COMMERCIAL WIPES they have alcohol and that delays healing and causes discomfort!

Front 100

neonatal pain

pysch
physiologic

Back 100

psych - they have the sturctures in place that can transmit pain around 24weeks gest

phys - the pain response can cause low tidal vol, increase demands on cv system, increase metab, neuroendocrine imbalance

Front 101

neonatal infant pain scale: CRIES

Back 101

Crying
Requiring more 02
Increased VS
Expression
Sleeplessness

each scored from 0-2. worst pain possible = 10. pain scale >4 = significant

Front 102

local anesthesia use in babies

topical anesthesia use

Back 102

chest tube insertion, circumcision

circumsicion, LP, veinipuncture, heelstick

Front 103

highest maternal mortality

Back 103

ruptured ectopic and abruptions

Front 104

threatened miscariage

Back 104

unexplained bleeding, cramps, cx closed, no dilation

Front 105

inevitable miscarage

Back 105

mod-heavy bleed, cramps, os dilates

Front 106

incomplete miscariage

Back 106

mod-heavy bleeding, os dilated, poc retained/placenta

Front 107

complete miscariage

Back 107

all poc expelled, uterus contracted, os may close

Front 108

missed miscariage

Back 108

fetus dies, not delivered, growth ceaseed, breast regress, brownish disccharge, cx closed before 20w

Front 109

reucrrent

Back 109

3 losses before 20w

Front 110

septic miscariage

Back 110

presence of infection. rupture and dont know ro rupture and didnt go to dr. (diy abortion years ago)

Front 111

incompetenet cx

Back 111

passive and painless dilation of cx during 2nd trimester

tx - BR, antiboitics, nsaids (indocen, motrin - stop at 32w), progesterone (maintain preg)

Front 112

cerclage

Back 112

11-15w prophylacticlally or rescue
cx <2-2.5 before 23-24w

tx - BR, no sex for few days, tocolytic meds, s/s for PTL, infection, ROM

Front 113

cerclage immediate return to hosp -

Back 113

ctx strong q5m rom, severe peritoneal pressure, urge to push --- rips cx to pieces

Front 114

leading cause of infertility

Back 114

ectopic preg

Front 115

tubal preg

Back 115

abd pain starts as a dull throb, as tube strethces it becomes shar, stabbing pain due to growth.

methotrexate - antimetabolite (interferes with growth) and folic acid antagonit (destroys rapid dividing cells)

NO ALCOHOL, NO FOLIC ACID

Front 116

cullen sign

Back 116

echymotic blueness at umbilicus, hematoperitoneum

Front 117

gest trophoblastic

Back 117

abnorm cells that would become the placenta

hydatiform mole - benign growth of placental trophoblast. grapelike cluster

Front 118

partial molar preg

Back 118

2 sperm and one egg so you get whole extra set of chromosomes

fetal parts and amniotic sac but never baby. often mistaken for incomplete or missed abortion. smaller vessicles.

dx transvaginal us and serum hCG

Front 119

complete molar pret

Back 119

1 or two sperm with empty egg - no dna material.

no fetus, placenta, amniotic membranes or fluid

early on, uterus is sig larger than expected. hypdropic vessicles grow quickly, anemic, excessive n/v, abd cramps from distention

later, prune juice color bleeding. continues for days or intermittently for weeks starting at 4wks and could last till 2nd trimester.

dx at <24wks bc many get preeclamptic

many get hyperthyroidism when having molar preg but tx restores its function

Front 120

placenta previa

Back 120

painless vag bleeding. placenta located in lower uterine segment or over cervical os instead of fundus. can lose upt to 40% blood without displaying signs of shock.

Front 121

placenta acreta

Back 121

chronic vili Attach directly to myometrium

Front 122

placenta increta

Back 122

myomet Invaded

Front 123

placenta percreta

Back 123

myomet Penetrated

Front 124

placental abrubtion-

Back 124

extreme pain, rock hard rigid abdomen. ctx qivering, no resting tone. vag bleeding. 40% get DIC.

Front 125

marginal abruption

Back 125

vag bleeding - passes btwn fetal membranes and uterine wall. separation at periph of placenta

Front 126

central abruption

Back 126

placenta separates centrally. blood trapped btwn placenta and uterine wall. edges intact, bleed behind (concealed)

Front 127

complete abruption

Back 127

massive bleed, presence of almost total separation. baby dead, placenta and him are free floating in uterus

Front 128

velamentous insertion of cord

Back 128

rare. assoc w previa and multiple gestation.
cord vessels branch at membranes then onto placenta.

Front 129

vasa previa

Back 129

presentation of umb blood vessels in advance of baby head

Front 130

battledore placenta

placenta succenturiate

Back 130

connects to one side. thick edge

main placenta and little lobe - still functions bc it has some blood vessels.

Front 131

DIC is always a

Back 131

secondary diagnosis

results from triggering clotting cascade. disruption in hemostasis in response to underlying disease or trauma.

most common cause is abruption. also undelivered fetal demise and anaphylactoid syndrome of pregnancy

tx - volume replacement rapidly!

Front 132

preterm labor and birth

Back 132

labor - 20-37wks gestatioon. 80% effaced, greater than or equal to 2cm dilated

birth - before 37w gest

Front 133

preterm birth

Back 133

length of gestation regardless birth wt

<37w

more dangerous!

causes - spontaneous, indicated (births to resolve maternal or fetal risk, preeclamp, fetal distress, abrubtion, DM, rh sensie)

Front 134

LBW

Back 134

only wt at birth.
2500g or less

Front 135

predicting spontaenous preterm labor and birth

Back 135

biochem marker - fetal fibronectin (glue like protein that you don't have till you'r ein labor. before doing a vag exam, they ask if you have bled in past 24h and had sex in last 24h then they swab till you hit fx. want it to be neg meaning you prob wont deliver in next 2w). cervical length

Front 136

only known cause of preterm labor

Back 136

infection. bacterial cx or uti. periodiontal infection - prostaglandin relase (ripens cx), placental site bleeding - ischemia at decidual layer of placenta may somehow activate PTL

Front 137

PTL symps

Back 137

empty bladder, lie down, tilt to side, drink 3-4c fluid, palpate ctx, warm tub soaks with uterus completely submerged

Front 138

suppresion of uterine activty - tocolytics

yutopar

mag

terbutaline

nifedipine

indomethicin

Back 138

only FDA approved. not used.

competes w calcium bc ca cant get into cells so they cant contract

beta adrenergic agonist - for asthma. use in ob bc it stims SNS

ca blocker, check for low bp

<32w. constircute of ductus arterious, oligo, neonatal pulm htn

Front 139

mag sulfate

levles etc

Back 139

1.6-2.4 is norm but for this case, 5-7 is norm. 4 or 6g loading dose over 20-30 min period. always give piggyback.

causes sedation, decreased reflexes, hypotension!

maintence 2g/h

excreted through kidneys. hyperfunct kidneys = mag just gets excreted.

mag 10 = DTR disappear
mag 12 = resp disappear
mag 25 = cardiac arrest

Front 140

promotion of fetal lung maturity med for PTL

Back 140

adraenal ccs - stresses moms body so it makes baby pruduce surfactant. want mom to stay preg at least 24h after does to take complete effect.

betamethasone or dexamethasone

Front 141

choriomaniionitis

Back 141

horrid smell, green pus. comp of PROM

Front 142

most common indication for c/s

Back 142

dystocia

Front 143

version

A

B

Back 143

A - breech pushed up out of pelvic inlet while head pulled toward inlet

B - head pushed toward inlet while breech pulled upward

do after 37w

Front 144

induction of labor

bishop score
cervical ripening methods

Back 144

higher number = more ripened cx

chemical agents - cytotec: 25-50mcg into cervix. prostaglandin that ripens cx and causes ctx and tachysystole
mechanical/physical - balloon cath - foley into cervical os, fill with 30-40 ml fluid it mechanically dilates cx
other - amniotomy, oxytocin, augment labor

Front 145

forceps assisted birth

outlet
low outlet
midlpelvis

Back 145

scalp visible

head at least +2 station

head engaged, station 0-2

Front 146

meconioum stained amniotic fluid

Back 146

emergency!
dark green - may be caused by norm phys function of maturity, breech. hypoxia, umb cord compression

Front 147

shoulder dystocia

Back 147

apply suprapbic pressure then macroberts manuver

Front 148

insulin ________ cross placenta

Back 148

does not

Front 149

screen for GDM at

Back 149

24-28w if no risk

BS 130+ needs more testing

Front 150

norm preg woman is in resp _______

Back 150

alkaloiss

02 higher, co2 lower

Front 151

gest htn

Back 151

increased bp with no proteinuria. in latter part of preg, resolves by 6w pp

Front 152

preeclampsia

Back 152

new onset htn and proteinuria >20w gestation

Front 153

chronic htn with superimposed preeclamp

Back 153

new onset proteinuria >20w gest. Chtn

Front 154

preeclamp

Back 154

vascular damage.

headaches unrelieved by tylenol, visual probs (spots, floaters, stars), rapid wt gain (5-10lb over night), facial/head edema

Front 155

preeclamp pathophys

Back 155

placental development altered.

endothel cell dysfunction - prostacyclin (vasodilator made by endothel cells, lowers bp).
- thromboxane dominance - PTL causes constrict of vessels and plt to clump together

uterine spiral arteries - vascular remod: widen, thick walled muscular vessels, thinner saclike vessels much larger diameter.

Front 156

leaky vessels fo preeclamp

Back 156

fluid leaks to tissues. hematocrit rises - intravasc dry bc of leakage into 3rd space.

Front 157

preeclamp is a disaseas process affecting blood vessels, ultimately causing

Back 157

leaky vessles, vasospasms, microclotting

Front 158

preeclamp bp levels
proteinuria levels

Back 158

systolic +140. diastolic +90

protien +300mg in 24h urine specimine or 1+ on dipstick

Front 159

preeclamp may damage

kidney
liver
brain
heart
eyes

Back 159

low gfr, oliguria, proteinuria, incerased serum uric acid

increaed liver enzymes

clunus, seizures, edema, hemorrhage, increaseed CNS irritability

Front 160

HELLP

Back 160

hemolysis
elevated liver enzymes
low platelets

Front 161

ASD

Back 161

left to right. most common

Front 162

VSD

Back 162

left to right

Front 163

PDA

Back 163

left to right

Front 164

acyanotic

Back 164

coarction of aorta

Front 165

cyanotic lesion

Back 165

tet of fallot

Front 166

mitral valve stenosis

Back 166

restrict sodium, shortening second stage o flabor

Front 167

mitral valve prolapse

Back 167

midsystolic click and late systolic murmur

Front 168

marfans

Back 168

autosomal dom genetic disorder
gen weakness of CT - joint deformities, ocular lens dislocation, weakness of aorta wall and root

Front 169

peripartum cardiomyopathy

Back 169

CHF with cardiomyopathy

Front 170

take Fe pills when

Back 170

at opposite times of prenatal vitamins bc cells dont allow anymore fe. take with vitamin C to increase absorption