Ob Test 3

Front 1

Best position for mucous drainage after birth

Back 1

Trendelenberg & to side

Front 2

Umbilical vasculature

Back 2

Two arteries (deox. blood away from fetus) One vein (oxy. blood to fetus)

Front 3

Eyedrops for the newborn (1 hr. post-birth to allow for bonding) are to prevent

Back 3

Transmission of STDs to infant (ie gonorrhea)

Front 4

What to do before first bottle feeding:

Back 4

Give a small amount of water first to test swallow ability (less trouble if the infant aspirates water)
*Breast milk also less of a problem than fornula if aspirated

Front 5

Instructions for the PKU test (Guthrie blood test) if the mother is going home

Back 5

Baby must feed for 24 hrs. or the test is not accurate

*If positive, low phenylalanine diet for rest of life or at least 6 yrs. and no breast feeding

Front 6

Small white/gray patches on newborn tongue which bleed when touched

Back 6

Thrush (often occurs after 4-7 days)
Can be caught from mother's yeast infection or infected hands, linen, etc.)

Front 7

To prevent sore nipples:

Back 7

Change nursing positions so baby sucks on different parts of nipple
*baby must grasp nipple and most of areola

Front 8

To increase breast milk supply

Back 8

Breast feed more and drink 64-80 oz. of fluid daily
*Also 500 extra calories intake daily

Front 9

Telangiectasis nevi "stork bite"

Back 9

Pink, easily blanched birthmark.
Appears most often on eyelids and nape of neck

FADES IN 1-2 YRS.

Front 10

Strawberry hemangiomas

Back 10

Dilated, newly formed capillaries.
Raised, red, rough.
75% on head

CAN REMAIN UNTIL SCHOOL AGE (SOME LONGER)

Front 11

Nevus flammeus

Back 11

Group of newly formed capillaries.
Red-purple, non-blanchable
Not rough or raised

CAN BE SURGICALLY REMOVED LATER IN LIFE

Front 12

Cephalohematoma

Back 12

Pool of blood under skull bone periosteum - does not cross suture lines, not immediately apparent, black and blue, takes weeks to absorb & may cause jaundice

Front 13

Caput succedaneum

Back 13

Scalp edema at presenting part of head - crosses suture lines, present at birth, gone in 3 days

Front 14

Mongolian spots

Back 14

Gray patches on lower back or buttocks (usually). Seen in dark-skinned babies.

FADES OVER MONTHS OR YEARS

Front 15

When a baby gets cold...

Back 15

It diverts glucose and oxygen from brain cells and cardiac function (via crying and kicking)

Front 16

An increased risk with c/s babies...

Back 16

Breathing difficulties r/t more fluid in the lungs (not squeezed out in the birth canal)

Front 17

Newborn Hct:

Back 17

57-58

*generally Hct = Hgb x 3

Front 18

Newborn Hgb:

Back 18

17-19

*generally Hct = Hgb x 3

Front 19

Newborn WBC:

Back 19

15,000 - 18,000

* look for other signs of infection

Front 20

Newborn Vit K levels:

Back 20

Decreased (due to intestinal sterility)

Front 21

Newborn BP:

Back 21

Avg. 80/42 (changes minute to minute with crying, etc.)

*seldom done unless cardiac problem suspected

Front 22

A pinkish color to the first void is...

Back 22

Normal (r/t uric acid crystals)

Front 23

Birthweight loss in a newborn is normally:

Back 23

5-10%

Front 24

With infant prone, touch along paravertebral area; infant will flex trunk and swing pelvis toward touch

Back 24

Trunk incurvation reflex

Front 25

When prone, infant should:

Back 25

Put arms and legs under and elevate stomach (preemie can't)

Front 26

In full-term infant, elbow won't reach mid-chest; in preemie it will

Back 26

Scarf sign present

Front 27

When object is placed in palm, newborn will grasp it

Back 27

Palmer grasp reflex

Front 28

Straighten legs and release - legs should...

Back 28

Return to a flexed position

Front 29

When object touches sole at base of toes, infant grasps it with the toes

Back 29

Plantar grasp reflex

Front 30

Stroke sole in a J curve from the heel upward, infant fans toes

*opposite in adult

Back 30

Babinski reflex

*r/t immature CNS

Front 31

Apply pressure to soles while supine, infant pushes against pressure

Back 31

Magnet reflex

Front 32

Hip Abduction - Thighs flexed and abducted as much as possible - should abduct to...

Back 32

90 degrees (>60 - 70 is abnormal)

Front 33

Support lower leg with hand and dorsiflex foot 2-3 times by pressure on sole of foot

Back 33

Ankle clonus (1-2 continued movements are normal; rapid alternating contracting and relaxing (clonus) is abnormal)

Front 34

Stroke near corner of mouth, infant will turn head in that direction

Back 34

Rooting reflex

Front 35

Anything placed on the back of tongue will be swallowed/anterior tongue - extruded

Back 35

Swallowing reflex/Extrusion reflex

Front 36

With infant on back, turn head to one side, arm and leg on that side extend, opposite arm and leg contract

Back 36

Tonic neck reflex

Front 37

Hold infant vertical & touch feet to hard surface; infant will take a few steps

(STUDENT DOES NOT DO)

Back 37

Step in place reflex

(STUDENT DOES NOT DO)

Front 38

Touch anterior surface of leg to hard surface; infant will make a few quick lifting motions

(STUDENT DOES NOT DO)

(STUDENT DOES NOT DO)

Back 38

Placing reflex

(STUDENT DOES NOT DO)

Front 39

Startle infant by jarring crib or loud noise, or hold baby in hands and quickly lower about 1 inch - infant abducts and extends arms and legs, fingers assume C position, then embraces arms and draws up legs

(STUDENT DOES NOT DO)

Back 39

Moro reflex (fades in 3-4 mos.)

(STUDENT DOES NOT DO)

Front 40

Suspend infant in prone position, infant attempts to hoild spine in horizontal plane

(STUDENT DOES NOT DO)

Back 40

Landau reflex

(STUDENT DOES NOT DO)

Front 41

While infant supine, extend leg and irritate sole; infant will raise and extend other leg

(STUDENT DOES NOT DO)

Back 41

Crossed extension reflex

(STUDENT DOES NOT DO)

Front 42

Decrease in estrogen after birth can cause this

Back 42

Pseudo-menstruation - spotting (bloody drainage) in a baby girl

Front 43

Bilirubin production and excretion:

Back 43

RBC -> Hgb -> Indirect bilirubin -> attaches to albumin in plasma -> broken down in liver -> Direct bilirubin -> water soluble, excreted in urine & stool

Front 44

Factors that cause hyperbilirubinemia:

Back 44

*Increased RBC destruction (fetus does not need as many as newborn, fetal RBCs are shorter-lived, trauma/bruising)
*Hepatic immaturity (worse in preemies)
*Inadequate albumin binding sites (fatty acids produced during cold stress or resp. distressuse up sites, also mom taking sulfa, ASA, oxytocin)
*Delayed feedings = delayed stool passage = bilirubin reabsorption (also inadequate maintenance of albumin level)

Front 45

Occurs in 50% of term babies and 80% of preemies

Back 45

Physiological jaundice

Front 46

Time period in which physiological jaundice appears

Back 46

Second or third day of life - gone in a week (never present in the first 24 hrs - THIS WOULD BE A BLOOD INCOMPATIBILITY)

Front 47

High levels of bilirubin can cause...

Back 47

Staining of brain tissue (kernicterus) -> brain damage

*Can occur at lower blilrubin levels in preemie or LBW

Front 48

Often bilirubin peaks at...

Back 48

6-7 mg/dl on day 3 - is down to 3 mg on day 5 - down to normal 1 mg by end of second week

Front 49

Jaundice is seen when bilirubin reaches...

Back 49

5 mg

Front 50

Severe jaundice as a newborn can cause...

Back 50

Hearing problems when older

Front 51

Rx for physiological jaundice

Back 51

Frequent feedings and maybe phototherapy

Front 52

Rx for severe, rapidly rising bilirubin...

Back 52

Exchange transfusion

Front 53

Pathological jaundice defined as...

Back 53

Jaundice first 24 hrs; bilirubin increases by > 5 mg/day; indirect bilirubin goes above 12 mg; direct bilirubin goes above 1.5 mg

Front 54

Causes of pathological jaundice

Back 54

***Most Common: Rh incompatibility
Also
*Excess destruction of RBCs (i.e. Rh or ABO blood incompatibility [Mom O + Fetus A or B] between mother and child)
*Infection
*Metabolic problem

(can be made worse with delayed feedings, cold stress, reps. problem)

Front 55

Rx for pathological jaundice

Back 55

Phototherapy, maybe exchange transfusion

Front 56

Assesment for jaundice

Back 56

Check sclera
Press
Dark urine

Front 57

Jaundice starts at the head and goes down. So...

Back 57

Face jaundice - 5 mg bilirubin
Abdomen jaundice - 10 mg bilirubin
Palms jaundice - 20 mg

Front 58

Rh- mom - not sure of husband...

Back 58

Give RhoGam at 6 weeks

Front 59

RhoGam is given to unsensitized Rh- women...

Back 59

Within 72 hours after delivery of every Rh+ fetus

Front 60

Newborn vomiting > 8hrs.

Back 60

Report immediately (dehydration)

Front 61

Rh incompatibility occurrs when...

Back 61

Mom is Rh- and fetus is Rh+

*Dad must be Rh+

Front 62

Umbilical cord blood taken at birth to check the infants Rh factor and antibody titer

Back 62

Direct Coombs Test

Front 63

Rhogam is given to all unsensitized Rh- women ...

Back 63

During the 28th week of pregnancy (in case of accidental mixing) after any amnio, abortion or miscarriage

Front 64

Tells us if the mother has built up antibodies against Rh+ blood

Back 64

Indirect Coombs Test

Front 65

What to do for a phototherapy baby

Back 65

Eyepatches
Mask as diapers
Turn baby
Check temp. for overheating
Give increased fluids

Front 66

25% of baby size is...

Back 66

Head

*Head is larger than chest

Front 67

What to do for colic

Back 67

Decrease stimuli
Have BF mom eliminate milk products and gassy foods
Change to soy formula or Nutramigen
Burp often
Swaddle
Heat/massage to abdomen
Walk w/ baby on abdomen
Swing, car ride, fennel tea, Myclon drops, anti-colic pills
Parents go out!

Front 68

Who signs consent for the baby of a 15 y.o. mom?

Back 68

The mom

Front 69

Baby doesn't respond after repeated exposures to stimulation

Back 69

Habituation

Front 70

Cardiovascular changes after birth:

Back 70

Ductus arteriosis constricts and closes after a few days
(due to lung inflation - decreased pressure in pulmonary artery and increased O2 pressure)
Closeure of foramen ovale within weeks up to a year
Umbilical arrteries/vein, ductus arteriosis and ductus venosus atrophy & convert to ligaments

Front 71

Infant blood volume

Back 71

100ml/Kg first few days - doubles by 1 year

Front 72

Infant heart rate

Back 72

110-160 (100 if sleeping 180 if crying)

Front 73

First thing to do after birth

Back 73

Clear airway (mouth first)

*Then keep warm

Front 74

Milk production

Back 74

Prolactin

Front 75

Let-down reflex

Back 75

Oxytocin

Front 76

Infant respiratory rate

Back 76

30-60 at rest

*often irregular till 24 hrs. old

Front 77

Infants are nose breathers; reflex to open mouth not present until ------------- weeks old.

Back 77

3

Front 78

Newborn has ------------------- of inflammatory & immune response. So they're at risk for -------------- for the first few months

Back 78

Hypofunction / infection

(major cause of NB illness & death)

Front 79

How often should a newborn feed if being breast fed? Bottle fed?

Back 79

q 2-3hrs. / q 3-4hrs.

Front 80

Stool present around days 2-3. Its thin, slimy, brown-green.

Back 80

Transitional

Front 81

What does stool look like on day 4 if BF? Bottle fed?

Back 81

Loose, golden yellow, sweet smelling / soft, pale yellow, odorous

Front 82

What color is the stool if the baby is under photo therapy lights?

Back 82

Bright green

Front 83

Blueish tint around the mouth (a sign of a respiratory problem) is called….

Back 83

Circumoral cyanosis

Front 84

Occasionally when infant lies on side, dependent side red and upper side pale. Goes away with position change. This is called…

Back 84

Harlequin sign

Front 85

What are 4 ways a baby can loose heat?

Back 85

Conduction, convection, evaporation, and radiation

Front 86

Infant loses 5-10% of birth weight during the 1st few days after birth. This is due to…

Back 86

Lower calories, and no maternal hormones which are salt and fluid retaining.

Front 87

Vitamin K should be give after a circumcision. True or False?

Back 87

False (It should be done before)

Front 88

How do you care for a circumcised penis?

Back 88

Apply Vaseline every diaper change until the end of the penis is the same color as the rest. Never pull on bandage if it wont come off!

Front 89

What is the main reason for Hyperbilirubinemia?

Back 89

Increased RBC destruction

Front 90

Jaundice is seen when bilirubin reaches ----- mg

Back 90

5

Front 91

With physiological jaundice bilirubin doesn’t increase by greater than --- mg per day, indirect bilirubin doesn’t go above ------mg, and direct bilirubin doesn’t go above --------- mg

Back 91

5/ 12/ 1.5

Front 92

Sacral tuft of hair

Back 92

Spina Bifida

Front 93

If mom doesn’t receive RhoGam all future Rh+ babies will be affected. True or False?

Back 93

True

Front 94

What is it called when a mom does form antibodies after a birth of a baby and did not receive RhoGam and her second Rh+ baby's RBC are being destroyed by her antibodies?

Back 94

Erythroblastosis fetalis

Front 95

What should you do to keep the breast from obstructing the babies breathing?

Back 95

Pull the babies legs closer

Front 96

When should you burp the baby when BF?

Back 96

Between breasts and after done feeding

Front 97

How should you remove a baby from your breast?

Back 97

Stick a finger in babies mouth to break suction. Don’t just pull baby off!

Front 98

What color is breast milk?

Back 98

Bluish white

Front 99

Breast begin to feel full and tingly. What has just happened?

Back 99

Let down reflex

Front 100

What can you do for inverted nipples?

Back 100

Nipple rolling, use the pump to pull out nipple

Front 101

What can you do for plugged ducts?

Back 101

Massage and add heat

Front 102

When weaning, how many feedings do you want to omit a day?

Back 102

1 feeding

Front 103

Don’t prop bottles or feed flat because this can cause...

Back 103

Increased ear infections