Ob-Peds Test 2

Front 1

When to worry if mom febrile

Back 1

24 h p delivery. May increase first 24 hr r/t dehydration unless >100

Front 2

Vital signs postpartum

Back 2

q15min after delivery, on floor: qh or q30min til stable, then q4h

Front 3

When to use cold compress on breasts

Back 3

NEVER if Breast feeding, ok if not

Front 4

tx for mastitis

Back 4

warm compress and antibiotics (some are c/i for breast feeding). Make sure she continues feeding or pumping to keep milk flowing

Front 5

Postpartum assessment

Back 5

B breast
U uterus
B bowel
B bladder
L Lochia (discharge of what's left in uterus, note details)
E episiotomy (did she have one?) p24h shouldn't be red and swollen, no evisceration
H homan's sign. One hand on knee, other dorsiflexes foot, pain a positive sign (bad)
E emotions

Front 6

Involution of uterus

Back 6

Contractions: reassure that ok, primipara little pain, multipara more painful. Autolysis (d/c of lochia).

Assess firmness, location in FB (24h p delivery, @U, then progresses 1 FB qd, should be midline, empty bladder to check

Front 7

Cervical changes postpartum

Back 7

Soft and swollen, tone improves after 1 week

Front 8

Vaginal changes postpartum

Back 8

Some scratching and bruising normal, poor muscle tone, edema, lacerations, episiotomies.

Front 9

Precipitous delivery

Back 9

Very quick delivery (2-3 hours), not necessarily a good thing->vaginal injury

Front 10

Ovulation

Back 10

Postpartum ovulation can begin 4-6 wks after delivery. Breast feeding does not stop ovulation, wean baby for mom's nutrition in U.S. (may be necessary to continue breast feeding if no clean H2O

Front 11

C-section assessment

Back 11

First 24hr very important to monitor firmness of fundus, give meds 30min a assessment b/c very painful, visually examine incision, OOB w/in first 24h (ideally 8-10)

Front 12

diuresis

Back 12

Removal of excess fluid via urine and sweat

Front 13

Bladder postpartum

Back 13

Void w/in 6-8hr, freq. small voids may indicate retention and overflow.

Front 14

Bowel elimination

Back 14

2-3 days postpartum

Front 15

Lochia (types)

Back 15

Rubra-bright red, heavy bleeding right after delivery ~24hr
Alba (white), more clear
Serosa-like regular discharge

Front 16

Rubin phases

Back 16

Postpartum:
1. Taking in phase, woman laid back and everyone taking care of her. First 8 hr. postpartum
2. Taking hold phase: 8-24h after delivery, pretty independant

Front 17

Postpartum hemmorrhage

Back 17

Can occur at any time, why fundus check is crucial. If boggy, give pitocin and massage.
Early: first 24 hr. post, more common
Late: occur after first 24h-6wks

Front 18

Predisposing factors for postpartum hemorrhage

Back 18

uterine atony (lack of tone->unable to contract), lacerations, retained placenta fragment, over-distended uterus (grand-multipara)

Front 19

Puerperal infections

Back 19

Post partal, after delivery or abortion, an infection of the reproductive tract within the first 10 days after birth or abortion

Front 20

Admission assessment of newborn

Back 20

Airway clearance, vital signs, neuro status, ability to feed, assessment for complications

Front 21

Routine meds for the newborn

Back 21

Antibiotic opthalmic erythromycin to both eyes, aquamephyton IM to vastus lateralis for coagulation, and hep B vaccine

Front 22

Distressed newborn glu level

Back 22

<40

Front 23

VS of newborn

Back 23

HR 120-160
BP 72/47
Resp 30-60
Temp 36.5-37 (keep baby warm)

Front 24

L/S ratio and critical values

Back 24

Measures maturity of fetal lungs. <1.5:1 indicates RDS at birth, admin. intratracheal surfactant. 2:1 a good value->indicates lung maturity

Front 25

Periodic breathing vs. apnea

Back 25

Periodic breathing <15 sec.
Apnea 20+ sec.

Front 26

Circulatory changes in the neonate

Back 26

Shunts: Foramen ovale, ductus areteriosis, and ductus venosus

Front 27

Non-shivering means of producing heat

Back 27

Brown fat located in midscapular area, around neck, axilla, around trachea, esophagus, abdominal aorta, kidneys, and adrenal gland`

Front 28

Means of heat loss in an infant

Back 28

Convection: cool air
Radiation: cool objects near infant
Evaporation: wet skin
Conduction: cool surface exposure on infant

Front 29

Cold stress def.

Back 29

Excessive heat loss resulting in compensatory mechanisms (increased respirations and nonshivering thermogenesis) to maintain core temp.

Front 30

Newborn serum glucose level

Back 30

45-96 mg/dL, assess @ 4hr old

Front 31

Newborn stools and urine

Back 31

Breastfed: 6-8 small, semiliquid, yellow stools qd by 3rd or 4th day after milk production established
Fomula-fed: 1-2 more formed, yellow or yellow brown stools qd
Urine: 5-8 qd

Front 32

Lanugo

Back 32

hair covering fetus, lessens during third trimester

Front 33

Milia

Back 33

little white bumps on newborn

Front 34

Mongolian spots

Back 34

Black/blue spots that appear on back and buttocks of AA, latino, and meditteranean kids

Front 35

Newborn Reflexes

Back 35

Tonic neck
Grasping
Moro: when startled, pull hands and legs in
Rooting: turn head to nipple
Sucking
Babinski: goes away w/in a few wks, absent->neuro deficit

Front 36

APGAR numbers

Back 36

8-10 No intervention
5-7 Bag em
1-4 Rescucitation needed

Front 37

Hypospadius

Back 37

urethral opening on ventral side of penis

Front 38

cryptorchidism

Back 38

failure of teste to fully descend

Front 39

smegma

Back 39

Secretion of sebaceous glands, specifically, the thick, cheesy, odoriferous secretion found under the labia minora about the clitoris or under the male prepuce.

Front 40

SGA, AGA, LGA

Back 40

Small, appropriate, and large for gestational age

Front 41

Immediate care of the newborn

Back 41

clear airway (if merconium present->need RT & Peds), thermoregulation, vit. K (b/c imperfect clotting), opthalmic ointment, initiate first feeding, and attachment facilitation

Front 42

Ongoing newborn care

Back 42

Thermoregulation (due to loss), safety, circumcision (2nd or 3rd day), attachment, care of baby, screening and immunization

Front 43

Caloric needs and fluid intake of the newborn

Back 43

105-108 kcal/kg/day
140-160 cc/day

Front 44

Colostrum

Back 44

yellowish, creamy fluid, thicker than milk, contains protein, fat soluble vitamins, minerals, passive immunity. Lasts for several days after delivery

Front 45

Transition milk

Back 45

Produced from end of colostrum until 2 wks postpartum, contains more fat, lactose, vitamins, and calories than colostrum

Front 46

Mature milk

Back 46

10% solids(CHO, pro, fats) plus water. Foremilk at beginning of feeding contains more water, hindmilk contains higher fat.
20 kcal/oz Recommended for first 6-12 mos.

Front 47

Milk storage

Back 47

Refrigerator 3 days
Freezer Weeks
Never thaw in microwave or hot water

Front 48

Signs of successful breastfeeding

Back 48

Feed 8x's qd (Q3h), 6-8 wet diapers qd (~1 per feeding)

Front 49

Preterm labor

Back 49

labor occuring b/w 20-37 wks, have potential to produce viable fetus outside of body

Front 50

Risk factors for pre-term labor

Back 50

Multiple gestation(twins), multiparity, infection, previous preterm, teen pregnancy, smoking, ETOH, drugs, polyhydramnios, stress, poor diet

Front 51

S/S of preterm labor

Back 51

Same as true labor, just early

Front 52

Tocolytic drugs

Back 52

Attempt to stop uterine contractions, relax uterine muscles. B-adrenergic agonists, terbutaline (relaxes smooth muscle->+chronotrope), mag sulfate (relax muscles for PIH)

Front 53

Mag sulfate S/E and signs of toxicity

Back 53

S/E: relaxes smooth muscles
Signs of toxicity: depression or absence of reflexes, oliguria, confusion, resp. deprssion (relaxes intercostal muscles), circ. collapse

Front 54

Nursing considerations for mag sulfate

Back 54

V.S. and reflexes at least q4h, mag levels q6-8h, urinary output, fetal monitoring, calcium gluconate at bedside.

Front 55

Measures to prevent preterm labor

Back 55

Bedrest w/ BRP, force fluids, don't work, no sex, don't stimulate breasts, stress mgt (w/ or w/o meds)

Front 56

Delivering preterm baby

Back 56

Take to hospital in utero, no analgesia if possible, prepare for resuscitation

Front 57

Diabetes and changes with pregnancy

Back 57

Changes in insulin requir: decr. in first trimester, mom's glu sucked by baby. Second trimester, baby making own glu, mom needs reg. amt. of insulin

May accelerate vascular dz, pregnancy exacerbates DM. The longer she's been diabetic, greater likelihood that kidneys and eyes affected

Front 58

Effects of DM on pregnant woman

Back 58

hydramnios, dystocia (diff. labor that doesn't progress well), infections (exacerbated by pregn.), PIH, retinopathy (change in vascularity)

Front 59

Diabetes effects on baby

Back 59

LGA-hyperinsulinism (as a response to mom) acts as HGH
IUGR-poorly controlled insulin dependant moms->poor vascularity, baby not getting enough O2
Congenital anomalies
Hypoglycemia after birth
Hyperbilirubinemia-hypoglycemia releases fatty acids that dissociate bilirubin from albumin, meds compete w/ bilirubin on albumin->hyperbilirubinemia

Front 60

Etiology of Gestational diabetes

Back 60

hypoglycemic during first trimester->pancreas starts making less insulin->2nd trimester, baby making own insulin->insulin needs go back to normal but pancreas can't make enough or won't->dx w/ GDM->maj. resolve after delivery

Front 61

NST

Back 61

non-stress test. Mom hooked up to fetal monitor->watch fetal activity->give her a cracker->baby moves good!

Front 62

Stress test

Back 62

Two types: nipple stimulation and oxytocin, look to see if labor will be dangerous for fetus. Decels indicate unsafe labor, done late term

Front 63

What happens if Rh abys enter fetal circulation?

Back 63

Sensitivation (hemolysis, generalized edema, CHF, and jaundice)

Front 64

Indirect Coomb's Test

Back 64

Measures number of Rh abys in maternal blood. Negative: fetus at no risk. Positive: fetus at risk

Front 65

Direct Coomb's Test

Back 65

On infant, to detect aby coated Rh+ blood cells

Front 66

Rhogam

Back 66

Given w/in 72 hr. of every birth, IM in deltoid, give w/ abortions too

Front 67

PIH def.

Back 67

An increase in blood pressure after 20 wks. gest. accompanied by proteinuria. Only cure is birth

Front 68

S/S of preeclampsia

Back 68

Edema (dilutional hypoalbuminemia), elevated BP, proteinuria, hyperactive reflexes, no seizures, vasoconstriction->reduction of O2 to fetus

Front 69

S/S of worsening preeclampsia

Back 69

Incr. in edema in AM, worsening ha, epigastric pain (liver involvement r/t hypoxia), visual disturb, decr. output, n/v, bleeding gums, disorientation, not feeling good, hypernatremia

Front 70

Eclampsia

Back 70

Characterized by convulsion or coma (sometimes pass out w/o seizure). May occur antepartum, L and D, or postpartum

Front 71

Mgt. of eclampsia

Back 71

Monitor output qh (Foley), reflexes, maintain airway (turn to side and suction after seizure), prevent injury, mag sulfate, dilantin, prepare for birth

Front 72

HELLP syndrome

Back 72

R/T PIH, coma, VERY high MORTALITY.
H hemolysis
E elevated
L liver enzymes
L low
P platelets

Front 73

Placenta previa

Back 73

Placenta partially or totally blocks cervical os. Can be total, partial, marginal, or low-lying. PAINLESS contractions w/ bleeding

Front 74

Abruptio placenta

Back 74

premature separation of a normally implanted placenta from the uterine wall. Can be partial, complete, or hidden. PAINFUL, some go into shock, bright red bleeding, surgical abdomen

Front 75

Causes of abruptio placenta

Back 75

Smoking (vasoconstriction), incr. maternal age, ETOH, cocaine, short umbilicus, multiparity, trauma

Front 76

Classification of spontaneous abortion

Back 76

Threatened: <20 wks w/ bleeding and contr.
Imminent: contractions don't stop
Complete: all products of conception expelled
Missed: fetal death but no expulsion, do D and C or low-dose chemo
Habitual: 3+
Septic: infection from abortion

Front 77

Ectopic pregnancy causes

Back 77

Tubal obstruction/damage, delayed tubal transport, congenital anomalies, altered hormonal status, scarring of fallopian tubes secondary to STDs, PID

Front 78

S/S of ectopic pregnancy

Back 78

Amenorrhea, breast tenderness, nausea, SHARP, ONE-SIDED PAIN, vaginal bleeding. Usually aborts @6-8 wks, if ruptures->surgical abdomen

Front 79

Interventions for an ectopic pregnancy

Back 79

Methotrexate (low dose chemo), Surgery, rhogam

Front 80

Incompetent cervix and causes

Back 80

Painless dilation of the cervix w/o labor or uterine contractions, habitual abortions->never can carry to term. Caused by previous traumatic delivery, forceful D&C, congenital defect

Front 81

Gestational trophoblastic dz

Back 81

"Molar pregnancy" Placenta develops but fetus does NOT, will never reach viability, will do D&C to remove products of conception

Front 82

S/S of molar pregnancy

Back 82

Brown vaginal bleeding, anemia, hydrophobic vesicles, abnormal uterine enlargement, absence of FHT, marked hCG elevation, hyperemesis R/T Hcg

Front 83

Adolescent pregnancy at risk for...

Back 83

PIH

Front 84

Rubella

Back 84

Titer 1:18 is "rubella immune," pregnant women canNOT be vaccinated

Front 85

Group B strep

Back 85

Give antibiotics, at risk for: Premature labor, PROM, prolonged ROM (>12 hr), fever, hx of GBS

Front 86

Drugs used w/ AIDS infected mom

Back 86

zidovudine

Front 87

CV disorders of baby

Back 87

Congenital heart defects, rheumatic heart dz->valve disorders, peripartum cardiomyopathy, mitral valve prolapse

Front 88

Implications of multiple gestation

Back 88

Spontaneous abortion, HTN, hydramnios, PROM, incompetent cervix, IUGR, PP hemorrhage, abnormal presentation (placental attachment lower, can't all attach at fundus, possibility of prolapsed cord)

Front 89

CV disorders of baby

Back 89

Congenital heart defects, rheumatic heart dz->valve disorders, peripartum cardiomyopathy, mitral valve prolapse

Front 90

Implications of multiple gestation

Back 90

Spontaneous abortion, HTN, hydramnios, PROM, incompetent cervix, IUGR, PP hemorrhage, abnormal presentation (placental attachment lower, can't all attach at fundus, possibility of prolapsed cord)