Skills/midwifery/newborn

Front 1

When you think there might be placenta fragments, cotyledons, or membranes retained in the uterus after the placenta has been expelled, What must be performed?

Back 1

Intrauterine exploration
(Varney4-1271)

Front 2

When performing an Intrauterine Exploration, What do you know for sure?

Back 2

That the bladder must be emptied
That only one gauze should be used at a time
That the whole hand (including the thumb) is placed inside the uterus
The other hand has to grasps the uterus externally
Must use the back of your hand to sweep the inside the uterus(Cupping hand helps hand to conform to inner contour of the uterus)
Tips of fingers is used to separate any cotyledons, etc.
(Varney4-1271)

Front 3

What is the procedure for a Bimanual Compression and why is it done and when?

Back 3

one hand is placed in the anterior Fornix (Palmar side UP)
At the same time the other hand presses deeply into the abdominal behind the uterus (Palmar side Down)
Top and is massaging in and down
The vaginal fist is doing an in and upward thrust
Bimanual compression is one action used for controlling immediate PPH
(Varney4-1273)

Front 4

Go through the steps for Manually Removing the Placenta-

Back 4

Make sure the bladder it empty
Whole hand(including thumb must be placed inside the Uterus by following the cord to the placenta
One hand must grasps the uterus(fundus) externally through the abdominal wall
The other hand inside the uterus - must use the back of the hand against the uterine wall,
The finger tips sweep back and forward to detech the decidua
Must have the entire placenta in your hand before you bring it out
(Varney4-1269-70)
Last step is to make sure you give oxytocins
(Varney4-1270)

Front 5

Vaginal Mucosa
Posterior Fourchette
Perineal Skin
WHAT LACERATION DEGREE IS THIS?

Back 5

First Degree laceration
(Varney4-1290)

Front 6

WHAT DEGREE LACERATION IS THIS?
Vaginal Mucosa
Posterior Fourchette
Perineal Skin
Perineal Muscles

Back 6

SECOND DEGREE LACERATION
(Varney 1290)

Front 7

Vaginal Mucosa
Posterior Fourchette
Perineal Skin
Perineal Muscles
External Anal Sphincter
What Laceration is this?

Back 7

Third(3) Degree Laceration
(Varney4-1290)

Front 8

______tears are a type of second degree laceration in which the vaginal mucosa and underlying tissue _______ along one(unilateral) or both(bilateral) sides of the _______ column of the _______ instead of up the middle.

Back 8

SULCUS tears are a type of second degree laceration in which the vaginal mucosa and underlying tissue LACERATE along one (unilateral) or both (bilateral) sides of the POSTERIOR column of the VAGINA instead of up the middle
(Varney4-1290)

Front 9

True or False
The episotomy is made when the perineum is bulging, when 3 to 4 cm diameter of fetal scalp is visible during a contraction, and when the presenting part will be delivered with the next three to four contrations.

Back 9

TRUE
(Oxorn-514/Varney4-1279)

Front 10

What are the three types of episiotomies?

Back 10

Mildline
Mediolateral
Lateral (Which is no longer used)
(Oxorn 514)

Front 11

Vaginal mucosa
Subcutaneous
Subcuticlar
periurethral lacerations
ARE REPAIRED WITH WHAT TYPE OF SUTURE?

Back 11

3-0 Chromic
(Varney4-1285)

Front 12

Anterior wall of the rectum in fourth degree laceration
Repair of clitoral lacerations
ARE REPAIR WITH WHAT SIZE SUTURE?

Back 12

4-0 Chromic
(Varney4-1285)

Front 13

External Anal sphincter
Cervical Lacerations
Lateral vaginal wall lacerations
Deep interrupted stitches of pelvic muscles
ARE REPAIRED WITH WHAT SIZE SUTURE?

Back 13

2-0 Chromic
(Varney4-1285)

Front 14

What is the normal resp for a NB?
30 to 60
40 to 100

Back 14

Average rate 40bpm
Range 30 - 60 bpm
(Varney4-963)

Front 15

When assess the NB you notice intercostal retractions, retactions of the xyphoid, flared nostrils and grunting on expiration
IS THIS NORMAL?

Back 15

Intercostal retractions, retractions of the xyphoid Flared nostrils and grunting on expirations are all ABNORMAL RESPIRATORY RESPONES FOR THE NB
(Varney4-963)

Front 16

When thinking about the NB:
Cold Stress can cascade quickly into effects that included ___________, _______, and ________.

Back 16

Cold Stress can cascade quickly into effects that included HYPOGLYCEMIA, HYPOXIA, and ACIDOSIS
(Varney4-965)

Front 17

What is the normal OFC (occipital-frontal circumference) in a term infant?

Back 17

The normal OFC for a term infant is 31 to 38 cm.
(Phy Assess. of the NB)

Front 18

At what month does the Anterior Fontanel of the NB close?

Back 18

The AF normally closes by 6 to 24 months of age
(Phy. Assess. of NB p56)

Front 19

When does the posterior fontanel close on a NB?

Back 19

The PF is small and closes by approximately 2 to 3 months of age.
(Phy. Assess. of NB p. 57)

Front 20

Your NB that you birth , 30mins ago began to MEC
What is this telling you?

Back 20

The presence of stool alone, however, does not indicate that peristalsis is present.
It only indicates that the anus is patent.
MUST LISTEN FOR BOWEL
SOUNDS which should be present 30mins after birth.
(Varney4-976)

Front 21

The Ballard Score can date NB of gestational ages as low as WHAT?

Back 21

The NBS can date NBs of gestational ages as low as 20 weeks
(Varney4-1002)

Front 22

Assess the popliteal angle and it reads 180 degrees: Is this infant a premie?

Back 22

Yes!
(Varney4-1003)

Front 23

Your are measuring a Square window on a NB and it reads 90 degrees--Is this NB premature?
What numer would represent a postterm NB?

Back 23

Yes!
(Varney4-1003)
0 degress would represent a postterm NB.

Front 24

True or False
Breastfed babies will not need iron supplementation until 4 to 6 months of age,

Back 24

True;
that is when the prenatal stores are used up because of rapid growth
(Varney4-1022)

Front 25

Woman who was GBS positive
calls the office c/o her NB 10days old- not sucking right, seem to be lethargic and sometimes have color changes with apnea occiasionally-SHE ASK YOU HAS A PROVIDER SHOULD SHE BE CONCERN?

Back 25

Signs of late-onset bacterial infection (7 days to 3 months) are problems with feeding such as a disinterested suck, lethargic,, color changes, occasional apnea, and temperature lability
YES! SHE NEED TO TAKE HER NB TO THE PEDIATRICAN OR THE ER
(Varney4-1033)

Front 26

Woman who was GBS positive
calls the office c/o her NB 10days old- not sucking right, seem to be lethargic and sometimes have color changes with apnea occiasionally-SHE ASK YOU HAS A PROVIDER SHOULD SHE BE CONCERN?

Back 26

Signs of late-onset bacterial infection (7 days to 3 months) are problems with feeding such as a disinterested suck, lethargic,, color changes, occasional apnea, and temperature lability
YES! SHE NEED TO TAKE HER NB TO THE PEDIATRICAN OR THE ER
(Varney4-1033)

Front 27

Extend transversely from the posterior fontanelle
Separates the Occipital bone from the two parietals
WHAT SUTURE IS THIS?

Back 27

LAMBDOIDAL SUTURE
(Varney4/Oxorn)

Front 28

Is between the two frontal bones and is an anterior continuation of the sagittal suture
It extends from the glabella to the bregma
WHAT SUTURE IS THIS?

Back 28

Frontal Suture
(Oxorn p 44)

Front 29

Extend transversely from the anterior fontanelle
Lies between the parietal and frontal bones
WHAT SUTURE IS THIS?

Back 29

Coronal Sutures
(Oxorn p 44)

Front 30

Lies between the parietal bones
It runs in an anteroposterior direction between the fontanells and divides the head into left and right halves
WHAT SUTURE IS THIS?

Back 30

Sagittal Suture
(Oxorn p 42)

Front 31

In a NB color changes, irregular respiration, irritability or lethargy, and vomiting are all behavior of WHAT for the NB?

Back 31

Best describes the appearance and behavior of an overstimulated infant
(Certif. Review guide p 330)

Front 32

During breast exams your client should be sitting or standing? and WHY?

Back 32

The woman should be seated-with her arms resting freely at her sides. The breast needs to hang freely at a level that enables good visualization
(Varney4-1136/Gyn pg 111)

Front 33

No matter what palpation technique you do for the Breast exam - you must remember to WHAT?

Back 33

It does not matter which method you use to cover the breast as long as you palpate every square inch. The inch you miss may have a lesion
(Varney4-1140

Front 34

When doing your Leopold's maneuver, what part of the hand are you using?

Back 34

You are using the flat palmar surface of your fingers for palpating--not your fingertips
(Varney4-1151)

Front 35

You have a young girl who just start having sex and now needs a speculum exam.
With this in mind, what speculum will you pick?
Virginal, Graves,or Pederson and WHY?

Back 35

The smallest speculum is the virginal speculum. It has short, narrow, flat blades. It is used in young girls and in women who have had little or no coitus.
(Varney4-1175)

Front 36

What speculum is the standard and largest speculum
This standard size is most commonly used, since it is most appropriate for women who are sexually active or who have had a baby. The large size is used with women who have collapsing vaginal walls, generally grand multiparas or very obese women.
NAME THIS SPECULUM

Back 36

The Graves Speculum
(Varney4-1175-76)

Front 37

So you have a sexually active woman, who has a very narrow vagina is a G0P0-What speculum would be appropriate?

Back 37

The Pederson speculum is as long as the Graves speculum but has more narrow blades. Also, its blades are flat rather than curved. This one is used on women who may be sexually active but tight and who have never had a baby.
(Varney4-1176)

Front 38

Doing a Speculum exam, you noted that the cervix is located anteriorly is indicative of a WHAT KIND OF A UTERUS?

Back 38

Retroverted Uterus
(Varney4-1180)

Front 39

On spec exam you noted that the cervix is posterior, which indicates that the uterus is in what Postion?

Back 39

A posterior cervix indicates an ANTEVERTED UTERUS
(Varney4-1180)

Front 40

A cervix found in the horizontal midline indicates a uterus is in the WHAT position?

Back 40

A cervix in the horizontal midline indicates a Uterus in MidPosition
(Varney4-1180)

Front 41

When doing a Pap exam
you must be sure to scrape the cervical canal and be sure that squamocolumnar junction is visble,and scrape it throughout the full circle. WHY?

Back 41

Cells from the squamocolumnar junction should be included for cytological study because cervical cancer most frequently begins at the squamocolumnar junction
(Varney4-1196)

Front 42

Etiology of polyhydramnios is associated with:
Fetal amnomalies of GI tract
or
Fetal anomalies of Cardiovascular system

Back 42

The most common GI abnormalities associated with polyhydramnios are esophageal atresia and duodenal atresia
(Phy Assess. of NB pg 97)

Front 43

True or False
Blood oxygen level(PO2) and pH and an increase in blood carbon dioxide level (PCO2) cause impulses from these receptors to stimulate the resp. ctr. in the medulla.

Back 43

True
(Norm NB Processes of Adapation Chap 19-451)

Front 44

Oxygenated blood from the placenta enters the fetal circulation through the Umbilical vein.
TRUE OR FALSE

Back 44

True
(Varney4/Normal Newborn)

Front 45

DV- Ductus Venosus shunt blood away from WHAT?

Back 45

Shunts 50% of blood from umbilical vein to inferior vena cava and Away from the Immature LIver!=(Norm.NB chap 19-453)
closes in 1 to 2 weeks after cord is clamped

Front 46

FO-Foramen Ovale
open between RA and LA so blood can WHAT?

Back 46

So blood can by pass the nonfunctioning lungs
(goes to the LV)
Only goes from R to L d/t high pressure
Can take upto 9mths to close
(NB Adapation-chap 19-453)

Front 47

DA-Ductus Arteriosus
Carries blood from the PA to Aorta and avoid nonfunctional lungs-So what keeps it open doing utero?

Back 47

Prostaglands from placenta &
decrease low O2 - keeps DA Open
(Normal NB chap 19-453)

Front 48

Core(rectal) temps are usually slightly higher (0.4c) than axillary;(True or False)

Back 48

True
Core temps are usually slightly higher (0.4C) than axillary temps and can be up to 2 degrees higher
(Varney4-965)

Front 49

Axillary temps may be falsely elevated in a cold-stressed infant scondary to metabolism of brown fat
TRUE OR FALSE

Back 49

True
(Varney4-966)

Front 50

NB with intrauterine growth retardation, posterm infants, preterm infants, and infants experiencing fetal distress are at particular risk for WHAT?

Back 50

Hypoglycemia
(Varney4-966)

Front 51

Does IgG cross the placenta?

Back 51

YES!
IgM and IgA cannot cross the placenta.Finding them in the cord blood is an indication that the fetus has actively responded to an infection while in utero.
(Varney4-971)

Front 52

PKU and Hypothyroidism
is tested at 48hrs of life
But What do you know about the PKU?

Back 52

The PKU is taken after the NB has established feeding
The screening for hypothyroidism (T4 and TSH) can be done at any time
(Varney4-979)

Front 53

Most common reasons for resuscitation of the NB
T A M M S S

Back 53

Trauma
A fetal Asphyxia
M Maternal Medication
M Malformation
S Sepsis
S Shock
(Varney4-987)

Front 54

What happens to MG newborn since she is HBsAg positive?

Back 54

The NB will receive the hep B immune globulin within 12 hrs of birth
(Varney4-1012)

Front 55

Exteroceptive reflexes

Propriceptive reflexes

Back 55

E- sucking rooting grasping
P- Moro gross motor
(Varney4-1014)

Front 56

BB ask, "When will my baby's cord fall off?"
The Provider response should be

Back 56

"The cord should continue to dry and will most likely fall off in 2 weeks!"
(Varney4-1018)

Front 57

When talking about jaundice in the NB; JJ had a forcep delivery not even 24 hrs ago and her NB looks yellow.
Has a Provider What are you thinking?

Back 57

JJ NB might have possible Patho Jaundice ( It needs to be tested now!
(Varney4-1026)

Front 58

BB calls the office concern about her infant's color.
"My baby is 4 days old and I have been breast feeding, but she looks a little yellow to me, should I be concern?"
As a Provider what do you tell BB>

Back 58

"Breastfed babies have a higher incidence of physiological jaundice than bottle fed babies- Your baby need to be tested- Please feed your infant more frequently and Place your infant in the sun light-Make sure to bring your NB in in the AM for a bilirubin test.
(Varney4-1027)

Front 59

Not visible in first 24hrs
Rises slowly and peaks at day 3 or 4 of life
Total bilirubin peaks at less than 13mg/dL
Lab tests reveal predominance of unconjugated bilirubin
Not visible after 10 days
WHAT TYPE OF JAUNDICE IS THIS?

Back 59

Physiological Jaundice
(Varney4-1026)

Front 60

Visible during first 24hrs
May rise quickly: >5mg/dL in 24hrs
Total bilirubin greater than 13mg/dL
Greater amounts of conjugated bilirubin
Visible jaundice persists after one week
WHAT TYPE OF JAUNDICE IS THIS?

Back 60

PATHOLOGICAL JAUNDICE
(can occur due to Forceps, c/section, trauma)
Varney4-1026)

Front 61

On average how long does TTN (transient tachypnea) last?

Back 61

The principal signs of TTN include tachypnea, rales or rhonchi on auscultation, and sometimes nasal flaring or intercostal retractions. TTN lasts only 48 to 72 hours.
(Varney4-1032)

Front 62

What is the most common heart defect in the NB?

Back 62

The most common heart defect in NBs is a Ventricular Septal Defect -
If large enough, the defect involes left to right shunting where by oxygenated blood crosses over the opening in the septum and recirculates through th lungs-(Cyanotic defect)
(Varney4-1034)

Front 63

In assessing a NB you noted that there is bleeding under the periosteum- WHAT IS THIS?

Back 63

A cephalhematoma is a collection of blood under the periosteum. Can be singular or bilateral. The blood does not cross the suture lines
(Varney4-1034)

Front 64

After should dystocia of a NB you noted on assessment that the NB has a "waiter tip sign"- what is this?

Back 64

Erb-Duchenne paralysis include a generalized loss of movement in the affected arm with a adduction of the lower part of the arm. (Waiter's tip- internal rotation of the lower portion of the arm with the finger and wrist flexed.
The grasp reflex is intact but the moro reflex is weak on the affected side.
(Varney4-1035)

Front 65

On assessment of a NB you notice that the NB head is circumference is above the tenth percentile and its weight is below the tenth percentile
This is a 40 week gestation NB so what is this called?
The mom had preeclampsia.

Back 65

Asymmetric Growth Restriction
can be caused by any condition that causes decreased placenta blood flow or decrease oxygenation of the fetus.
(Varney4-1039)

Front 66

What happens to the SVR when the cord is clamped ?

Back 66

SVR increases when blood flow to the placenta ceases with cord clamping.-occurs at the same time when the newborn takes its first breath
(Varney4-963)

Front 67

Where will you find this condition?
Promiinent vasculature of the anterior lens capsule

Back 67

On a relatively immature gestational age NB
(certif. Review Guide/)

Front 68

Respiratory OPPOSITE

METABOLIC-Equal

Back 68

pH Low/pCO2 High

pH Low/ pCO2 Low