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91 Cards in this Set
- Front
- Back
What is the most common disorder of pregnancy?
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hypertension disorders of pregnancy
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What is the most common medical problem?
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anemia
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What is the 2nd leading cause of maternal death in the US?
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pre-eclampsia
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What is the only cure for pre-eclampsia?
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removal of the placenta
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What are the first three things to assess in a women with suspected pre-eclampsia?
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-is she puffy?
-what is her BP? -what is the TP in her urine? |
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What are the signs of mild pre-eclampsia?
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-BP >140/90 but <160/110 on two separate occasions (6hr apart)
-proteinuria >300mg but <5g/24hr |
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What are the signs of severe pre-eclampsia?
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-BP >160/110 on two separate occasions (6hr apart)
-proteinuria >5g/24hr -oliguria <400ml/24hr -thrombocytopenia -HELLP syndrome -pulmonary edema -eclampsia |
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What are some symptoms of severe pre-eclampsia?
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-HA ** (new onset)
-RUQ pain -visual changes |
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What are the three indicators for magnesium sulfate?
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-PTL
-neuroprotection -severe pre-eclampsia |
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How do you dose magnesium sulfate?
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-4g loading over 20 minutes
-1-2g per hour |
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What kind of nursing care are you giving a patient on magnesium sulfate?
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this drug is dangerous and must have one to one care.
check all the following later: 1. DTR & clonus 2. RR 3. LOC 4. serum level (4-7mEq) |
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What is the antidote for magnesium sulfate?
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CaGluconate 10% IVP immediately
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How long after birth can a mother have an eclamptic seizure?
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up to 42 days after birth
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What is the HELLP syndrome?
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-Hemolysis
-Elevated Liver Enzymes -Low Platelet Count |
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What are the symptoms of HELLP?
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-nausea
-vomiting -malaise -flu-like symptoms -epigastric pain |
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If a patient has high blood pressure > 20 weeks what is it called?
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pre-eclampsia
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If a patient has high blood pressure <20 weeks what is it called?
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chronic hypertension
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What are the maternal risks with Pre-E/Eclampsia?HELLP?
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-CNS (HA, hyperreflexia, seizures, stroke)
-pulmonary edema (3rd spacing: leaky capillaries) -thrombocytopenia -hematoma of liver -acute tubular necrosis -liver capsular swelling & rupture |
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What are the fetal/neonatal risks?
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-preterm delivery
-fetal death/hypoxia from utero-placental insufficiency -still birth -fetal growth restriction -placental abruption -over sedation from maternal meds (mag) |
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What is the pre-eclampsia assessment
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-BP q15mins
-FHR tracing -hourly urine output -urine protein -urine specific gravity -edema -lab tests -pulmonary edema (BS) -DTR -Clonus -placenta abruption (tenderness, pain, uterine tightness) -HA -visual disturbances -LOC -epigastric pain |
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What medications are you giving to a patient coming in with severe pre-eclampsia?
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-magnesium sulfate
-apresoline -corticosteroids |
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What will we see with magnesium overdose?
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1. no DTR
2. RR<10 3. change in LOC 4. respiratory arrest 5. clonus arrest |
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What are your nursing cares for a intrapartum management of eclampsia?
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-emergency
-note time and length -turn patient to side -o2 -suction -may need second loading dose of mag (4-6g IVP) |
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What is the most important thing to check for if a patient has a seizure during labor?
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check to see if baby has delivered in the bed
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What is the worst case scenario with HELLP syndrome?
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DIC
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If your patient is on mag AP how long after birth will she remain on mag?
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24 hours after birth and mother cannot be left alone with baby while on mag
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Most seizures occur when?
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48 hours after birth
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For PIH (pregnancy induced HTN) what labs are we going to go shopping for?
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1. BUN (increase)
2. creatinine (increase) 3. liver enzymes (increase) 4. CBC (decrease) 5. 24 hour TP 6. uric acid (increase) 7. LDH (increase) 8. fibrinogen 9. fibrin split products |
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What will happen to BUN and creatinine typically during pregnancy?
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lower
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What is A1GDM?
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diet controlled GDM
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What is A2GDM?
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insulin controlled GDM
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Prior to pregnancy we want our patients in "tight control" with DM1 and DM2?
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HgbA1c<6.5
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What are the risk factors for GDM?
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-previous GDM
-ethnicity (african american, hispanic, native american) -family history -BMI >25 -Age >25 -previous hx of macrosomia -undiagnosed IUFD in the 3rd trimester |
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With patients who have prior DM1 or DM2 should we give them a glucocola test?
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NO, we should not test them. We should just check their blood sugar.
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When you test a patient with the glucola test, what is the normal value?
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normal is <135mg/dL
if over 135 proceed to diagnostic testing if over 180 pt is overly diabetic |
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How many 3 hour glucose test must be elevated to diagnosis GDM?
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2 elevated values for GDM
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What is the criteria to diagnose a patient with GDM who prior to pregnancy had DM1 and DM2?
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test blood sugar 4x a day for one week and if 20% are abnormal then you are GDM.
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What is definition of anemia during pregnancy?
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<10g/dL pregnant
<12g/dL in non-pregnant (11.5 at our altitude) |
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What can we give to treat IDA?
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ferrous sulfate 325mg tid
add colace teach bowel habits (fruit, water, fiber) |
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How does GDM effect fetal lung maturity?
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hyperglycemia somehow competes at the cellular level for surfactant production and fetal lung maturity
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What are the possible causes of bleeding in the first trimester?
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-SAB*
-TAB -Ectopic* -Hematoma -Infection -Intercourse -Implantation -Exercise |
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What are the possible causes of bleeding in the second trimester?
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-Late SAB
-Late TAB -GTD* (gestational trophoblastic disease) -PTL -Previa -Abruption -Trauma -Incompetent cervix* |
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Is bleeding in the first trimester common?
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yes
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What is the most important for the nurse to do with a SAB?
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provide anticipatory guidance. provide comfort
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What is the implantation of a conceptus in a site other than the endometrial lining of the uterus?
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ectopic pregnancy
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How do we treat an ectopic pregnancy?
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needs medical or surgical treatment to remove
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Where is the most common location for an ectopic pregnancy?
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ampullar tubal
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What are the most common (early) signs and symptoms of eptopic pregnancy?
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-misses menses
-bleeding/spotting or brownish discharge -lower quadrant abdominal or rectal pain -positive hCG test |
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What happens with hCG during normal pregnancy, eptopic and miscarriage?
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-normal: hCG doubles throughout the entire pregnancy
-eptopic: hCG stays about the same -miscarriage: hCG decreases |
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What is a pathologic proliferation of trophoblastic cells?
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gestational trophoblastic disease (GTD)
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A patient with GTD must have the following for follow up?
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-beta hCG for a year
-chest x-ray monthly for a year -good birth control |
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When a woman has GTD and it is removed what is she at risk for?
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PPH
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What is painless dilation of the cervix without contractions because of a structural or functional defect of the cervix before 16-18 weeks gestation?
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incompetent cervix
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What is it when a suture is placed in the cervix to prevent preterm cervical dilation and pregnancy loss?
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cerclage
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What are the nursing duties when performing a cerclage?
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-epidural vs general anesthesia
-OR, sterile environment -mersilene suture -exposure for MD (retractors) -observation for PTL after placement (bleeding, contractions, ROM) -IV & I&O |
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What does TORCH stand for?
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-Toxoplasmosis
-O: Other pathogens -R: Rubella virus -C: Cytomegalovirus -H: Herpes |
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What can TORCH cause?
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congenital anomalies
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What are methods of infection of TORCH?
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-transplacental
-vertical -direct contact |
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How is HIV transmitted to the fetus?
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transplacental
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What should we NOT do with an HIV positive mother?
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-avoid FSE
-scalp pH -forceps -vacuum extraction |
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What are the catastrophic effects to a fetus during the first trimester with a mother who is positive for Rubella?
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-blindness
-deafness -cataracts -heart defects |
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What is the most common viral cause of intrauterine infection?
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cytomegalovirus
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What virus belongs to the herpes family?
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CMV
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What is the prophylaxis treatment for HSV?
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at 35-36 weeks offer prophylactic anti-viral medication, if they have had 2-3 outbreaks during pregnancy. zovirax (acyclovir) 500mg bid
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What are the four T's for PPH?
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-tone (uterine tone)
-tissue (retained products) -trauma (lacerations and hematomas) -thrombo-embolic diseases |
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What are the PPH medications?
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-prostaglandin F2 alpha
-hemabate 250mcg IM -methergine 0.2mg IM -pitocin 10u/1ml IM or 30u/1ml in 500ml NS -cytotec 100mcg tablet x 10 rectally |
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What is the most common cause of PP infection
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endometritis
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What is mastitis typically caused from?
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normal body flora (staph aureus)
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What are the signs and symptoms for mastitis?
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-high fever
-breast tenderness -redness over clogged and infected lobule -RED & HOT |
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What are PP "blues"?
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last 2-3 days after birth (can be quite dramatic)
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What is the most common PP modd change?
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PP blues
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What are the signs and symptoms of PP blues?
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-fatigue
-uncertainty -frustration -hormonal fluctuations -unrealistic expectations -lack of sleep and support |
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What is the treatment for PP blues?
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-rest
-support -reassurance |
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What could possibly be the cause of PP depression?
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-hormones
-chemical imbalance -genetic predisposition -lack of sleep |
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What is the treatment for PP depression?
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-ask
-support groups -anti-depressant safe to use with BF -help at home -reassurance is not alone |
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What does a woman have if there is euphoria with hallucinations before depressive symptoms and severe mood swings?
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postpartum psychosis
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What is the treatment with postpartum psychosis?
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-hospitalization with baby but never left alone
-antipsychotic medications -therapy |
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A mother with pre existing cardiomyopathy will have what 6 months after delivery?
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profound presentation of cardiac decompensation up to 6 months after delivery
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What is the TSB for normal physiologic jaundice?
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4-6mg/dL
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When should normal physiologic jaundice start and end?
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it should not happen within first 24 hours and it should end within 7 days
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When does pathologic jaundice take place?
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within first 24 hours
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What is the TSB for pathologic jaundice?
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greater than or equal to 0.2mg/dL/hr
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What is the number one risk for respiratory distress syndrome in neonates?
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prematurity
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When does BF jaundice take place?
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after 4th day and peaks into 2-3 weeks
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What does a baby in respiratory distress look like?
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-grunting #1
-nasal flaring -tachycardia -tachypnea |
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What is the most common pathogen responsible for sepsis in a neonate?
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group B strep
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What are the signs and symptoms of NEC?
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-gastric residuals >30% of previous feeding
-abdominal distension -blood in stool |
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What is apnea in the preterm defined as?
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cessation of breath x 20 sec during which the neonate exhibits bradycardia, cyanosis, hypotonia & acidosis
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What can we do for the best developmental care of the preterm?
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-nest (positioning)
-contain procedures -observe for clues the preterm is ready for socialization (watches you, sucks on feeding tube) |
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What is the most common cause of death in ventilated neonates?
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intraventricular hemorrhage
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How much folic acid should you take if you are pregnant?
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400mcg daily
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