Ob Test 5

Front 1

Most deaths the first 48hrs after birth are due to inability to establish ------------- ----------------

Back 1

Adequate respirations

*Severe hypoxia = brain damage

Front 2

Anoxia may cause what?

Back 2

CP

Front 3

To counteract respiratory acidocis...

Back 3

Infant must be ventilated

*This is why we want to establish respirations quickly, BEFORE severe resp. acidisis is underway

Front 4

What is the 1st sign you see with respiratory distress?

Back 4

Increased rate, nasal flaring, grunting (closure of glottis, prolonged expiratory time, increased pressure in alveoli)

Front 5

What is the 2nd sign you see with respiratory distress?

Back 5

Increased AP, retractions (clavicular = worst), color change

Front 6

Where is the 1st place you tend to see a baby turn pale/blue when in respiratory distress?

Back 6

Around the mouth

Front 7

What 3 things do you see with severe resp. distress (3rd signs)?

Back 7

Chin tug, abdominal see-saw breathing, and increased apneic periods

Front 8

Would a baby with an apgar of 7-10 need resuscitation?

Back 8

No. Maybe just a bulb syringe (mouth first)

Front 9

Vigorous suctioning can cause what 2 things?

Back 9

Decreased AP, arrhythmias

Front 10

For an Apgar 3-6 (moderately depressed respirations)

Back 10

Clear airway with bulb syringe & DeLee for deeper - May give 02 with Ambu bag

Front 11

How should a baby be positioned to give O2 with an ambu bag?

Back 11

”Sniff” position

Front 12

What do you so 1st for a baby with an apgar of 0-2 (severely depressed) who is blue, limp, and no R or P?

Back 12

Insert laryngoscope to deep suction then E-T tube and O2 with pressure

Front 13

Why should you not give O2 under pressure if meconium hasn’t been fully suctioned?

Back 13

Because it can push meconium further in.

Front 14

If meconium in amniotic fluid -

Back 14

Nose and mouth suctioned before first breath - then visualize for meconium below vocal cords (if present, aspiration has occurred)

Front 15

Position for resp. distress

Back 15

Supine, head elevated in neutral or "sniff" position

Front 16

Administering O2 to a newborn:

Back 16

Isolette (not high O2 -> portholes), O2 hood or NC

*Via ET tube with ventilator for high concentrations

Front 17

Giving O2 in excess of what is needed can cause:

Back 17

Retrolental fibroplasia (atrophy of retina)

* give only amt. needed to keep pO2 normal)

Front 18

Ventilators often used:

Back 18

CPAP & PEEP

Front 19

Special considerations for preemie respirations:

Back 19

Often have difficulty initiating respirations (RDS)

Front 20

True apnea:

Back 20

Lasts > 20 sec. with decreased AP

*touch or flick sole to remind to breathe - no response? resucitate.

Front 21

No cardiac function at birth?

Back 21

Middle and index fingers over middle third of sternum

Depress 1/2 - 3/4 in.at a rate of 100 or more

Ventilate at least 20/min. (5:1)

**No response - give Na bicarb. (decreases acidosis)

Front 22

Ways to keep newborn warm:

Back 22

Isolette
Skin-to-skin
Radiant warmer

Front 23

If newborn cold > increased respiratory distress > change in anaerobic metabolism > increased ---------- which increases the risk of ------------

Back 23

Acidosis/ Kernicterus

Front 24

Radiant warmer temp probe taped to:

Back 24

Back or epigastric area (wamer adjusts to baby's temp)

**Keep skin temp 97-98 degrees

Front 25

Warming baby too quickly causes:

Back 25

Apnea and acidosis (increases metabolism rapidly)

Front 26

Preemies have difficulty maintaining heat due to:

Back 26

Large surface area per pound of weight
Little SC or brown fat
Little movement & not well flexed

Front 27

If high-risk newborn able to suck:

Back 27

Use soft nipple and give small, frequent feedings

Front 28

After 34 weeks gestation - if unable to breast or bottle feed:

Back 28

Give pacifier (sucking reflex fades if not stimulated.)

Front 29

How do you check placement with a gavage tube feeding?

Back 29

Aspiration (return aspirate)

**If excessive, not digesting at all - more chance of vomiting and aspiration)

**Give formula or breast milk slowly

Front 30

What are early signs of dehydration?

Back 30

Decreased output, increased specific gravity, wt. loss

Front 31

What are the later signs of dehydration?

Back 31

Poor turgor, dry mucus membranes, sunken fontanels, increased hct.

Front 32

Early signs of overhydration:

Back 32

Increased output, decreased specific gravity, wt. gain

Front 33

Later signs of overhydration:

Back 33

Edema, rales, decreased hct

Front 34

What are the 2 major problems of TPN?

Back 34

Infection and dehydration

Front 35

What do you need to check the babies urine for?

Back 35

Amount, glucose, protein and specific gravity

Front 36

Do preemies need more or less calories?

Back 36

More

(However, due to small stomach & immature cardiac sphincter - regurgitate & aspirate easily - so small, frequent feedings)

Front 37

.NB specific gravity is ________________ a preemie is seldom ________________

Back 37

1.030/ 1.012

Front 38

Preemies lose more H2O due to:

Back 38

Decreases intake
Inability to concentrate urine
Increased respirations (loss via lungs)

***Dont want preemie to lose > 5% of birth-weight

Front 39

Parents of high-risk newborns often need:

Back 39

A great deal of emotional support

Front 40

Why should a nurse show acceptance (hold & rock) of a baby w/ congenital anomalies?

Back 40

They can set the stage for a good (or bad) parent child relationship

Front 41

Cleft lip defect ranges from:

Back 41

A small notch in the upper lip to total separation of lip and face up to floor of nose

Front 42

Cleft palate may involve:

Back 42

Hard palate, soft palate or both

Front 43

With tracheoesophageal atresia and fistula:

Back 43

Mother often has hydramnios (excessivs aminotic fluid) because fetus can't swallow

Front 44

Protrusion of abdominal contents through abdominal wall at umbilicus covered only by a thin membrane of amnion.

Back 44

Omphalocele

Front 45

Before surgery to prevent infection, drying or damage what do you apply to an Omphalocele?

Back 45

Sterile saline dressing or sterile petroleum dressing and a firm plastic cover.

Front 46

This can be caused by meconium ileus (ileum obstructed by meconium so hard it will not pass)

Back 46

Intestinal Obstruction

Front 47

An intestinal obstruction is often associated with what?

Back 47

Cystic fibrosis

Front 48

A child born with this usually presents with respiratory difficulty, cyanosis, retractions, abdomen sunken, maybe bowel sounds in chest, large or asymmetrical chest.

Back 48

Diaphragmatic hernia

**NPO, NG tube

Front 49

How can you position a baby with diaphragmatic hernia to breath better?

Back 49

Elevate head so intestines fall back AMAP

Front 50

How is an imperforate anus usually discovered?

Back 50

When can't insert thermometer or stool is not passed.

**A surgical emergency

Front 51

Serum alphafetoprotein (done at ____ to ______ weeks) is used to detect open _______ ________ ________ (will be elevated). It is normally elevated with twins, triplets, etc.

Back 51

14-16 / neural tube defects

Front 52

What is spina bifida and how can you tell if a baby has it?

Back 52

The posterior spinal canal fails to close/ you see a depression of skin, often with tuft or hair over depression

Front 53

Meningocele

Back 53

No CNS tissue in pouch

Front 54

Myelomeningocele

Back 54

Pouching of spinal cord, meninges, and cs fluid through a defect in posterior spinal canal. Contains CNS tissue.

Front 55

A Myelomeningocele occurring at back of head or neck also contains brain tissue

Back 55

Encephalocele

Front 56

What is an anencephaly?

Back 56

Where the babies head is small and there is complete or partial absence of brain and overlying skull. Unsurvivable.

Front 57

With this a babies head is usually small but well formed.

Back 57

Microcephaly

Front 58

With exstrophy of the bladder you want to prevent infection > can lead to ___ or _______ ________. Cover with prosthesis or sterile petroleum gauze.

Back 58

UTI or kidney damage

**Apply ointment to surrounding skin to prevent excoriation

Front 59

When the urethral meatus opens on the underside of penis

Back 59

Hypospadia

**infants are not circumcised - foreskin used for repair

Front 60

An abnormal opening between right and left ventricle. Blood forced from left to right ventricle

Back 60

Ventricular Septal Defect (VSD)

**Right side overburdened - CHF

Front 61

Blockage of posterior nares by membrane, cartilage, or bone. Can be unilateral or bilateral.

Back 61

Choanal atresia

**Bilateral causes respiratory problems - newborns are nose breathers

Front 62

What is polydactyly?

Back 62

Extra digits on hands or feet, may be hereditary

**Most don't include bone - ligate and fall off - done soon after birth

Front 63

How is talipes equinovarus (club foot) treated?

Back 63

Shortly after birth successive splints are applied.

Front 64

How much water should a women drink with an abdominal US?

Back 64

1 to 1 and a half quarts of water 2 hrs before the test

Front 65

What is docetaxel?

Back 65

A taxane that interfers with microtubule formation and is used to treat a variety of solid tumors.
Ovary and breast

Front 66

What must the women do 1st before the amnio?

Back 66

Informed consent, Void, U/S to locate placenta & find pool of fluid for needle insertion

Front 67

Amnio is done early is pregnancy is check for what?Later in pregnancy to check for what?

Back 67

Chromosomal problems/ maturity of fetal lungs and kidney function..

Front 68

To check for lung maturity:

Back 68

Check L/S ratio

Front 69

_________ in amniotic fluid is indirect measure of maturity of kidneys

Back 69

Creatinine

Front 70

After amnio:

Back 70

Assess VS, FHT and contractions for 30 min.

**Instruct woman to report: vaginal bleeding, ROM, decreased fetal mvmt. contractions

Front 71

CVS - Chorionic villi sampling

Back 71

Informed consent needed
Usually done 8th-12th week
Results within one week

Front 72

What is a biophysical profile done for?

Back 72

To assess fetal well being.

Front 73

Biophysical profile includes evaluating:

Back 73

Fetal breathing movements
Gross body movements
Fetal tone
Reactive FHR
Qualitative amniotic fluid volume

Front 74

This is seen when membranes rupture > 24hrs before delivery, when baby aspirated vaginal secretions, meconium- stained amniotic fluid, gonorrhea, or chlamydia.

Back 74

Pneumonia

Front 75

Prolonged ROM (>24h before birth)

Back 75

May cause pneumonia & skin infections.
Do cultures of blood and skin (ears, throat, axilla, rectum)

Front 76

Group B hemolytic strep is a major cause of NB infection. Rx mom for GBS with IV antibiotics when __________________ during pregnancy, mom has ROM for ___hrs or has not delivered, a laboring mom who’s temp. is _______ or > a laboring mom is < _______ weeks gestation.

Back 76

GBS bacteria/ 18/ 100.4/ 37

Front 77

Treatment of infection

Back 77

Antibiotic for identified organism

Front 78

Hypoglycemia in NB > Below ______ to ________mg

Back 78

40 -45

*Also decreased BS

Front 79

What are the symptoms of hypoglycemia?

Back 79

Asymptomatic, jittery, tremors, limp, apathy, increased R, cyanotic, poor appetite, convulsions.

Front 80

What’s the treatment for hypoglycemia?

Back 80

Give glucose, formula, or breast milk.

Front 81

What are symptoms of hypocalcemia?

Back 81

Jittery, tremors, muscle twitching, Chevostek’s sign (facial nerve irritability), Trousseau’s sign (carpal spasm w/ tourniquet), seizures, spasm of larynx (high pitched crow or resp. stops).

Front 82

What’s the treatment for hypocalcemia?

Back 82

Increase blood Ca (PO if poss. if not, IV)

Front 83

Polycythemia- Infant ruddy and prone to __________ ________. As extra RBC’s are destroyed, infant is prone to __________

Back 83

Thrombus formation/ Hyperbilirubinemia

Front 84

What is the RX for polycythemia?

Back 84

Don’t let get dehydrated

Front 85

Treatment for anemia

Back 85

Transfusion, maybe iron replacement

Front 86

Transient Tachypnea of NB (TTN)- At birth respirations may be ___when crying , usually within 1hr they slow to _____ to _____

Back 86

80/ 30-60

Front 87

In some infants with TTN, rate remains 80-120 with no cyanosis, just slight ___________

Back 87

Retractions

Front 88

What is TTN due to?

Back 88

Slow absorption of lung fluid which limits amount of alveolar surface available for O2 exchange. (So rate & depth must increase)

*Peaks at 36hrs. gone by 72 hrs.

Front 89

TTN occurs more often in _________and _____________

Back 89

C-section and preterm infants

Front 90

Meconium aspiration syndrome

Back 90

Difficulty establishing respirations, then increased R, retractions, cyanosis

*NO O2 under pressure (bag)until intubated and deep suctioned

Front 91

See respiratory distress, asymmetrical chest, trachea displaced from affected side, cyanosis, abdomen distended from pressure of diaphragm. Heart displaced from affected side

Back 91

Pneumothorax.

Front 92

What is the RX for pneumothorax.?

Back 92

O2 by hood or mask

** NO pressure - increases problem

Front 93

The onset of withdrawal symptoms usually depends on what?

Back 93

When the drug was last taken

** Usually 24-72 hrs. after birth

Front 94

What are some signs of withdrawal in an infant?

Back 94

Poor feeding, jittery, irritable, disturbed sleep patterns, move constantly , tremors, sneeze frequently, shrill high pitch cry, hyperflexia, convulsions, increased R, decreased moro reflex.

*If not treated, progresses to v/d (dehydration)

Front 95

Cocaine often causes what 3 things to occur?

Back 95

Abortion, abruptio placenta, or preterm labor

Front 96

Methadone withdrawal is:

Back 96

More prolonged and severe than heroin withdrawal.

Front 97

RX for infant withdrawal:

Back 97

Little stimuli, no BF by addicted mom

Front 98

What do you tend to see with FAS?

Back 98

Pre and post natal growth retardation, MR, microcephaly, joint and cardiac anomalies (VSD), poor sucks, altered palmer creases, broad nasal bridge, epicanthal folds, short length compared to weight, irritable thin upper lip, ptosis, strabismus

Front 99

Infants of moms who are infected with HIV should be given _____________ drugs beginning ____ to ____ hrs after birth and continued for __ weeks

Back 99

Antiretroviral/ 8-12/ 6

Front 100

What bone is most often Fx during delivery?

Back 100

Clavicle

** See ltd. mvmt. of arm on that side; unilateral Moro reflex of upper extremeties

Front 101

RX for broken clavicle?

Back 101

None - heals self

Front 102

This occurs with excessive stretching of neck during delivery (often with breech)

Back 102

Brachial paralysis

Front 103

If edema or hemorrage responsible for paralysis...

Back 103

Prognisis good & recovery in a few weeks

Front 104

A phrenic nerve injury is due to what?

Back 104

stretching during a difficult breech delivery.

Front 105

If laceration of nerve is responsible for paralysis & healing doesn't return function in a few months...

Back 105

Maybe surgery - still get little or no function

Front 106

Facial paralysis

Back 106

Usually due to improper placement of forceps (blade over facial nerve)

Front 107

Why may seizures be hard to recognize in a NB?

Back 107

May only consist of twitching of head, arms, or eyes and slight cyanosis or apnea.

*Limp and flacid afterwards

Front 108

Weight of infant has a normal range for each gestational week. If any week weight is above _____percentile - LGA If any week weight is below ________percentile - SGA

Back 108

90th / 10th

Front 109

What are some causes of SGA?

Back 109

Placenta doesn't transfer enough nutrients and O2

*Infants ill from malnutrition and decreased O2

Front 110

What are some symptoms of SGA?

Back 110

Wasted appearance, loose skin with poor turgor, decreased muscle mass,alert and active, thin yellow dry, dull cord.

*Better neuro responses, hair texture, sole creases & ear cartilagethan weight suggests (also, no lanugo)

Front 111

SGA after birth:

Back 111

Often forget to breathe (if apnea - first shake gently)
Hypoglycemia (decreased stores)
Hypothermia (decreased sc fat)

Front 112

LGA is often seen in:

Back 112

IDM (Infants of Diabetic Mothers); Multiparity (Larger w/ ea. pregnancy)

Front 113

For an LGA infant - check blood sugar often usually Q________ prone to hypoglycemia used glucose for growth not storage. Check for _______________ if bruised (as blood is reabsorbed)

Back 113

1hrX8/ Hyperbilirubinemia

Front 114

What are some symptoms of a post mature baby?

Back 114

SGA (placenta often loses function) plus dry cracked leather like skin, long fingernails, long thin body

Front 115

Tests done when post term:

Back 115

US, BPP, Estriol, ST/NST

Front 116

Preterm characteristics (doing well in utero - but labor starts too soon)

Back 116

Moves and cries little

Front 117

ESTIMATING GESTATIONAL AGE:

Posture:

Back 117

P - complete extension
T - complete flexion

Front 118

ESTIMATING GESTATIONAL AGE:

Square Window (wrist):

Back 118

P - 90 degree angle
T - 0 angle (hand flat on forearm)

Front 119

ESTIMATING GESTATIONAL AGE:

Ankle Dorsiflexion:

Back 119

P - won't go flat, only 90 deg.
T - goes flat, 0 deg.

Front 120

ESTIMATING GESTATIONAL AGE:

Popliteal Angle:

Back 120

P - complete extn., 180 deg.
T - extn. resisted, 90 deg.

Front 121

ESTIMATING GESTATIONAL AGE:

Heel to Ear:

Back 121

P - toes touch ear, leg completely extended 180 deg.
T - knees flexed, popliteal angle < 90 deg.

Front 122

ESTIMATING GESTATIONAL AGE:

Scarf Sign:

Back 122

P - elbow to opposite arm
T - elbow won't reach mid-chest

Front 123

ESTIMATING GESTATIONAL AGE:

Edema:

Back 123

P - edema of hands, feet & tibia
T - no edema

Front 124

ESTIMATING GESTATIONAL AGE:

Skin Color:

Back 124

P - dark red
T - pale

Front 125

ESTIMATING GESTATIONAL AGE:

Lanugo:

Back 125

P - very early - none, then abundant
T - small amt.

Front 126

ESTIMATING GESTATIONAL AGE:

Plantar Creases:

Back 126

P - none or few
T - deep indentations

Front 127

ESTIMATING GESTATIONAL AGE:

Nipple Formation:

Back 127

P - barely visible - no areola
T - raised, stippled areola

Front 128

ESTIMATING GESTATIONAL AGE:

Breast Size:

Back 128

P - no breast tissue palpable
T - breast tissue both sides > 1cm

Front 129

ESTIMATING GESTATIONAL AGE:

Ear Form:

Back 129

P - pinna flat & shapeless
T - well defined incurving of whole upper pinna

Front 130

ESTIMATING GESTATIONAL AGE:

Ear Firmness:

Back 130

P - pinna soft, no recoil when folded
T - pinna firm, instant recoil

Front 131

ESTIMATING GESTATIONAL AGE:

Genetalia:

Back 131

Female:
P - labia majora widely sepeerated, minora protrudes
T - majora completely covers minora

Male:
P - neither testes in scrotum, few/no rugae
T - at least one teste fully descended, deep rugae

Front 132

Physical and emotional abuse is ___________ in infants separated from mom's at birth for a period of time

Back 132

3x greater

Front 133

What are 10 disorders the premature infant is prone to?

Back 133

Anemia, failure to thrive, hypoglycemia, dehydration, infection (prophylactic antibiotics to all high risk babies), hemorrhage, intracranial hemorrhage (common in preemies b/c they often have hypoxia), Kernicterus (fewer albumin binding sites, often acidotic, brain more succeptible to bili.), neonatal necrotizing enterocolitis (NEC) (common in preemies & those w/ hypoxia), retrolental fibroplasia (ROP), RDS (preemies, give mom cortisone) bronchopulmonary dysphasia (BPD) (difficulty weaning from vent)

Front 134

Autosomal dominant inheritance (example)

Back 134

Polydactyly

Front 135

Recessive gene is abnormal
Each parent must give a recessive gene
Person always homozygous for the trait
25% chance if both carriers

Back 135

Autosomal-recessive inheritance

I.E. CF, Sickle cell, Tay-Sachs, PKU

Front 136

Defective genes on X have no counterpart on Y so traits (recessive or dominant) are always expressed in the male

Back 136

X-Linked Inheritance

I.E. some types of hemophilia, color blindness

Front 137

Treat by eliminating galactose from the diet (NO milk or milk products)
MR if untreated

Back 137

Galactosemia

Front 138

What does someone lack who has Tay-Sachs?

Back 138

They lack the enzyme needed for lipid metabolism. Lipd edposits accumulate on nerve cells --> MR (when they are bain cells) Blindness (when optic nerve)

**Jewish

Front 139

This causes the infant to weigh less than normal at birth, loses usual % of weight after birth, but doesn’t gain it back in the usual 7-10 days.

Back 139

Cystic fibrosis

Tenacious meconium (so much so --> ileus)

Front 140

How is cystic fibrosis diagnosed?

Back 140

By a sweat test at 6-8 wks.

Front 141

3 chromosomes instead of the normal 2 on chromosome #21 *more common in older women

Back 141

Down Syndrome (Trisomy 21)

Front 142

Various degrees of MR, heart defects (check sounds carefully after birth, URI & other infections, sit, walk, talk later, obesity, immune system dysfunction, hearing defects, hypothyroisism, leukemia

Back 142

Down's Syndrome (Trisomy 21)

Front 143

Middle fingers and toes cross over other ones, bottom of feet rounded

Back 143

Trisomy 18

Front 144

FEMALES with XO (instead of XX) can survive.

Short, webbed neck, low posterior hairline, edema of hands and feet, sterile, normal IQ

Back 144

Turner's syndrome