Ob Exam 3

Front 1

Very Premature

Back 1

<32 weeks

Front 2

Premature

Back 2

32-34 weeks

Front 3

Late premature

Back 3

34-37 weeks

Front 4

AGA

Back 4

Appropriate for gestational age: 5.7-9.1 lb

Front 5

SGA

Back 5

Small for gestational age: <5.7 lb

Front 6

LGA

Back 6

Large for gestational age: >9.1 lb

Front 7

Low birth weight (LBW)

Back 7

< 2500 grams

Front 8

Very low birth weight (VLBW)

Back 8

<1500 grams

Front 9

Extremely low birth weight

Back 9

<1000 grams

Front 10

Why are preterm neonates at higher risk for intracranial bleed?

Back 10

Small blood vessels; crying > increases ICP > ruptures vessels.

Front 11

What should you avoid putting on a preterm neonate's fragile skin?

Back 11

Alcohol, adhesives.

Front 12

What kind of tape is okay to use on preterm neonates?

Back 12

Tegaderm

Front 13

What are reasons that preterm neonates have trouble with thermoregulation?

Back 13

Large surface area in relation to size, limited brown fat, immature temperature regulation in the brain, decreased/absent capillary reflexes.

Front 14

Why might hyperglycemia occur in a preterm neonate?

Back 14

Immature kidneys secrete glucose slowly.

Front 15

How often do preterm neonates need to be fed and why?

Back 15

q2-3 hours; ~8 times per day. Small stomachs.

Front 16

What are the reasons for anemia of prematurity?

Back 16

Red blood cell life is short; low bone marrow production until ~32 weeks.

Front 17

What is kernicterus?

Back 17

Destruction of brain cells by invasion of indirect bilirubin. [Bili level: ~20]

Front 18

Why are preterm neonates susceptible to kernicterus?

Back 18

Low serum albumin available to bind and excrete direct bilirubin.

Front 19

Why do preterm neonates start with supplements before getting breast milk?

Back 19

It takes ~3 days for mother to begin producing milk.

Front 20

What is persistent patent ductus arteriosus (PDA)?

Back 20

Failure for the PDA to close: blood stays in the pulm. artery which leads to pulm. hypertension, which causes the PDA to persist.

Front 21

What does Indocin (indomethacin) do and what is it?

Back 21

Causes PDA to close; causes uterine relaxation. It is a prostaglandin inhibitor.

Front 22

When can the pregnant woman receive Indocin (indomethacin) and why?

Back 22

>32 weeks gestation, otherwise drug will cause premature PDA closure in the womb.

Front 23

Neonatal Sepsis s/s

Back 23

LOW TEMP, resp. distress, hypotension, tachycardia, tachypnea, lethargy, poor feeding, diarrhea, vomiting.

Front 24

Neonatal sepsis diagnostics

Back 24

CBC with Differential (increased bands, decreased neutrophils, decreased platelets), blood culture.

Front 25

Neonatal sepsis treatment

Back 25

Broad spectrum AB, VS, nutrition, fluids, O2, parental support.

Front 26

What is Retinopathy of Pre-Maturiy (ROP) and what is it caused by?

Back 26

Damage to immature blood vessels in the retina that results in scarring and possible blindness. Caused by high O2 levels.

Front 27

Who is most at risk for retinopathy of pre-maturity?

Back 27

Very low birth weight (VLBW) neonates

Front 28

What is intracranial hemorrhage and what can cause it?

Back 28

Bleeding into ventricles r/t hypoxia, increased BP, increased fluids (pneumothorax), resp. distress syndrome.

Front 29

What is necrotizing enterocolitis (NEC) and what are the risk factors?

Back 29

Bacteria in bowel, leads to infection, which leads to destroyed bowel tissue, which can lead to sepsis. Factors: prematurity and tube feedings

Front 30

Necrotizing enterocolitis (NEC) treatment

Back 30

Stop tube feeding, start IVF + TPN, AB, ventilator, platelet transfusion.

Front 31

Necrotizing enterocolitis (NEC) s/s

Back 31

Abdominal swelling, sepsis, emesis, blood in stool.

Front 32

What is transient tachypnea of newborn (TTN) and what is it related to?

Back 32

Rapid, shallow RR 70-80/min r/t slow absorption of lung fluid.

Front 33

When should amnioinfusion be done? What is no longer accepted practice?

Back 33

Done for late decels. No longer used to dilute meconium staining.

Front 34

How does jaundice spread?

Back 34

Cephalocaudal: from head to toe.

Front 35

Is Hyperbilirubinemia very concerning in a 1-2 day old infant?

Back 35

No, less significant. Need proper nutrition to increase alb binding; parents may place crib near window to expedite bilirubin breakdown.

Front 36

Is hyperbilirubinemia very concerning in a 4-5 hour old infant?

Back 36

Yes, more significant. May rise steadily.

Front 37

Pathologic hyperbilirubinemia treatment

Back 37

Immediate exchange transfusion, phototherapy, frequent bilirubin checks, increased feeding to speed up alb binding.

Front 38

What are important things to remember for an infant under bili lights?

Back 38

Cover eyes and genitalia. Place infant prone or lateral to protect internal organs.

Front 39

What is this called?

Back 39

Gastroschisis

Front 40

What is this called?

Back 40

Omphalocele

Front 41

How is gastroschisis and omphaceles treated?

Back 41

IV + NGT, TPN, silastic "silo" covering over viscera which allows gravity to brings viscera back into cavity, surgical closure after contents returned to abd. cavity.

Front 42

What is bladder extrophy?

Back 42

Extrusion of bladder through abd wall.

Front 43

Normal temperature in a term infant?

Back 43

97.7-99.9

Front 44

What APGAR score would prompt further evaluation by NICU?

Back 44

Less than 7 consistently.

Front 45

APGAR HR: 0

Back 45

Absent

Front 46

APGAR HR: 1

Back 46

<100 bpm

Front 47

APGAR HR: 2

Back 47

>100 bpm

Front 48

APGAR Resp. Effort: 0

Back 48

Absent

Front 49

APGAR Resp. Effort: 1

Back 49

Slow/irregular

Front 50

APGAR Resp. Effort: 2

Back 50

Good cry/good respirations

Front 51

APGAR Muscle Tone: 0

Back 51

Flaccid

Front 52

APGAR Muscle Tone: 1

Back 52

Some flexion

Front 53

APGAR Muscle Tone: 2

Back 53

Active motion

Front 54

APGAR Reflex Irritability: 0

Back 54

None

Front 55

APGAR Reflex Irritability: 1

Back 55

Grimace

Front 56

APGAR Reflex Irritability: 2

Back 56

Strong cry/reflexes

Front 57

APGAR Color: 0

Back 57

Pale/blue

Front 58

APGAR Color: 1

Back 58

Acrocyanosis

Front 59

APGAR Color: 2

Back 59

Pink

Front 60

What is caput succedaneum and is it concerning?

Back 60

Fluid-filled swelling under scalp; Normal variation.

Front 61

What is a cephalohematoma and is it concerning?

Back 61

Hemorrhage of blood between the skull and periosteum; needs to be watched.

Front 62

Bulging fontanels (w/o crying) may indicate:

Back 62

IICP

Front 63

Depressed fontanels (w/o crying) may indicate:

Back 63

Dehydration

Front 64

Normal respiration rate of a newborn

Back 64

40-60/min, may be irregular

Front 65

Normal heart rate of newborn

Back 65

120-160/min

Front 66

What is the point of maximal impulse (PMI) in a newborn?

Back 66

Lower left sternal border

Front 67

A newborn female has red-tinged vaginal discharge. What is this and is it a concern?

Back 67

Pseudomenstruation related to hormones; normal variation.

Front 68

How long is the postpartum phase?

Back 68

6 weeks after birth

Front 69

Define involution

Back 69

Uterus returns to pre-pregnant shape

Front 70

Define afterpains

Back 70

Moderate to severe cramp-like pain r/t involution. More severe in multi-parous women.

Front 71

Define lochia

Back 71

A bloody discharge from the uterus that contains sloughed off necrotic tissue and reflects uterine healing.

Front 72

Define endometrium

Back 72

Mucous membrane that lines the uterus.

Front 73

What is the first intervention for a boggy uterus (assuming bladder is empty)?

Back 73

Massage fundus.

Front 74

By what day is the endometrium fully restored in a postpartum woman?

Back 74

By 16th day.

Front 75

Lochia rubra appearance, duration

Back 75

Red; 1-3 days

Front 76

Lochia serosa appearance, duration

Back 76

Pink, brown-tinged; 3-10 days

Front 77

Lochia alba appearance, duration

Back 77

Yellowish-white; 10-14 days but may last longer

Front 78

What is considered heavy lochia?

Back 78

Saturating 1 pad per hour

Front 79

What is normal blood loss from vaginal delivery?

Back 79

Usually does not exceed 500 ml

Front 80

1 mL blood = ___ gram in weight

Back 80

1

Front 81

What is methergine (methylergonovine)contraindicated in?

Back 81

HTN. BP > 140/90

Front 82

What is hemabate (carboprost tromethamine) contraindicated in?

Back 82

Asthma

Front 83

How does methergine (methylergonovine) work?

Back 83

Stops postpartum bleeding by causing vasoconstriction. Also increases BP.

Front 84

How does hemabate (carboprost tromethamine) work?

Back 84

Stops postpartum bleeding by constricting soft tissues (like the uterus).

Front 85

1st degree laceration/tear

Back 85

Shallow; involves just below or just inside vagina

Front 86

2nd degree laceration/tear

Back 86

Involves skin below vagina, the perineum, and muscles of the perineum

Front 87

3rd degree laceration/tear

Back 87

Extends to anal sphincter

Front 88

4th degree laceration/tear

Back 88

Extends through anal sphincter

Front 89

What should the nurse assess in women with episiotomies or tears?

Back 89

REEDA: Redness, edema, ecchymosis, discharge, approximation

Front 90

How long should the woman refrain from inserting anything into her vagina?

Back 90

6 weeks

Front 91

How soon can a women resume menstruation after birth?

Back 91

usually 7-9 weeks; by 12 weeks

Front 92

How much should a postpartum women be voiding?

Back 92

250-300 mL q4-6 hrs

Front 93

What treatment is available for a spinal headache?

Back 93

Blood patch.

Front 94

What is a spinal headache caused by?

Back 94

Loss of spinal fluid r/t epidural.

Front 95

What is diastatis recti abdominis?

Back 95

Separation of the abd. rectus muscles. Common; should resolve in 6 weeks.

Front 96

Taking-In Phase

Back 96

Focused on self, dependent on others for care, needs assistance, may last for several hours or days. Needs comfort-rest-food.

Front 97

Taking-Hold Phase

Back 97

Focus on infant, self care, responds well to instructions and praise. Lasts from 2 days to 12 week.

Front 98

Letting-Go Phase

Back 98

Giving up previous role, see self as separate from infant, gives up fantasy delivery and baby. Lasts from 1 week on.

Front 99

Who received Rhogam?

Back 99

In Rh-neg women with Rh-pos baby.

Front 100

When is Rhogam given (in relation to birth)?

Back 100

Within 72 hours after birth.

Front 101

What is Healthy People 2020's goal for breastfeeding?

Back 101

95% of mothers breastfeed

Front 102

When does colostrum occur and what does it contain?

Back 102

1-3 days; electrolytes, protein, fat soluble vitamins, IgA, passive immunity via establishment of GI flora.

Front 103

When does transitional milk occur and what does it contain?

Back 103

7-10 days; high protein, low fat, increased H2O content, higher calories than colostrum.

Front 104

When does mature milk occur and what does it contain?

Back 104

About 14 days postpartum; ~20 kcal/oz, primary carbohydrate (lactose), appears similar to skim milk, higher fat content in AM.

Front 105

How often should a woman breastfeed?

Back 105

q2-3 hrs (8 feedings per 24 hrs)

Front 106

Postpartum hematoma s/s

Back 106

Severe pain that cannot be controlled with analgesics, tachycardia, hypotension, heaviness/fullness of vagina or rectal pressure.

Front 107

For Gomco or Mogen clamp: how do you care for the circumcision site?

Back 107

Apply protective lubricant over site after each diaper change for 1st week.

Front 108

Should parents clean any yellow crusts that form after a circumcision?

Back 108

No, this should not be removed or washed.

Front 109

For plastibell: how do you care for the circumcision site?

Back 109

Do not apply lubricant; allow plastic ring to fall off on its own in 7-10 days.

Front 110

How should a car seat be used in infants less than 1 year and less than 20 lbs?

Back 110

Rear-facing, backseat.