exam 2: OB + Newborn Flashcards
(81 cards)
1
Q
GTPAL
A
Gravida: # of pregnancies
Term: # born at term
Preterm: # born preterm
Abortions/Miscarriages
Living: # of living children
2
Q
Naegele’s Rule
A
LMP + 7 days + 9 months
3
Q
discomforts during pregnancy
A
- n/v
- syncope
- urinary frequency/urgency
- increased vaginal discharge
- SOB
- fatigue
- heartburn
- edema
- varicose veins
- hemorrhoids
- leg cramps
- back pain
- constipation
4
Q
antepartum diagnostic tests
A
- H&H: may decrease d/t increased plasma volume
- Rh factor/blood type and cross
- ultrasound
- genetic testing
- amniocentesis (rule out genetic disorders, risk for infection)
5
Q
gestational diabetes
A
- if mom has fasting glucose >126 or random higher than 200
- glucose tolerance test (50g glucose): after 1 hour >140, after 3 hours >130-140= positive
6
Q
impact of chlamydia and gonorrhea on fetus/newborn
A
- eye infections
- blindness
7
Q
impact of trichomoniasis on fetus/newborn
A
- premature ROM
- infection
8
Q
impact of syphilis on fetus/newborn
A
- deafness
- congenital abnormalities
- death
9
Q
impact of HSV on fetus/newborn
A
- neonatal infections
- encephalopathy
- death
10
Q
impact of HPV on fetus/newborn
A
- transmission to newborn
11
Q
placenta previa
A
placenta forms in lower portion of uterus and blocks birth canal
may require c-section for delivery
12
Q
signs of placenta previa
A
- painless
- bright red vaginal bleeding
- vital signs and FHR normal
13
Q
interventions for placenta previa
A
- assess for bleeding
- no vaginal exams (makes bleeding worse)
- leave pulse ox on
14
Q
placental abruption
A
premature separation of the placenta
15
Q
signs of placental abruption
A
- painful
- dark red vaginal bleeding
- fetal distress
- shock
16
Q
interventions for placental abruption
A
- immediate delivery
- continuous fetal monitoring
- oxygen for mom
17
Q
abortion
A
loss of pregnancy before 20 weeks
18
Q
fetal death
A
loss of pregnancy after 20 weeks
19
Q
preeclampsia
A
BP disorder diagnosed after 20 weeks
BP >140/90
20
Q
risk factors for preeclampsia
A
- HTN
- diabetes
- obesity
- aging
21
Q
assessment findings for preeclampsia
A
- weight gain
- swelling
- vision changes
- protein in urine
22
Q
interventions for preeclampsia
A
- bed rest
- reduce stimuli
23
Q
5 P’s of labor
A
- passenger
- passage
- powers
- psyche
- positioning
24
Q
impending signs of labor
A
- lightening/dropping
- Braxton Hicks contractions increase
- cervical changes
- nesting
- weight loss
- spontaneous ROM
25
false labor
- contractions go away with activity
- contractions are irregular with no progression
26
true labor
- strong, regular, close contractions
- fetus becomes engages
- cervix begins to dilate and efface
27
baseline for fetal HR
110-160
28
FHR patterns
- accelerations
- variable decelerations
- early decelerations
- late decelerations
29
accelerations
- an increase of FHR by 15 bpm with fetal movement
- normal :)
30
variable decelerations
- cord compression
- irregular shape, duration, and decline
- interventions: d/c oxytocin, turn on left side, give o2
31
early decelerations
- head compression
- uniform shape, mirrors contractions
- no interventions needed
32
late decelerations
- placental insufficiency
- occurs after peak of contraction
- emergent intervention required
33
first stage of labor
latent: cervical dilation 1-4 cm, mild contractions, 15-30 min apart, duration is 30 seconds
active: 4-7cm, moderate contractions, 3-5 min apart, duration is 30-45 sec
transition: 8-10 cm, severe contractions, 2-3 min apart, duration is 45-90 sec
34
interventions for first stage of labor
- encouragement
- discuss birth plan
- keep comfortable
- encourage void
- breathing techniques
- music therapy
- rest
35
second stage of labor
latent: laboring down
active: pushing
- cervical dilation is complete, mom feels like she could push or needs to poo
36
interventions for second stage of labor
- positioning
- be ready for baby
- goal is safe delivery
37
third stage of labor
- expulsion of placenta
- typically occurs 5-30 min after baby delivery
38
interventions for third stage of labor
-ensure placenta is intact
- monitor for signs of PPH
- promote bonding
- assess fundus
39
OB procedures during labor
- induction --> meds such as oxytocin
- amniotomy --> AROM
- episiotomy
- external version
- forceps delivery
- vacuum extraction
- c-section
40
complications of labor
- premature ROM --> infection risk
- prolapsed umbilical cord (MED EMERGENCY)
- vena cava syndrome --> baby and uterus push up against the heart, causing hypotension when laying down
- preterm: 22 weeks-37 weeks --> bedrest, tocolytics
- precipitous labor --> lasts less than 3 hours, higher risk of PPH
- dystocia: prolonged, difficult labor
- uterine inversion: can happen 10-30 min after delivery
41
postpartum period
starts immediately after birth up until 6 weeks after delivery
42
expected changes during postpartum
- fundal height decreases 1 cm per day, not palpable at 10 days PP
- lochia decreases
- distention and engorgement of breasts (milk production)
- changes in urinary patterns (loss of elasticity and tone)
- return of menses 3-6 months
- return of normal stools, hemorrhoids common
43
types of lochia
rubra: bright red, day 1-3
serosa: brownish pink, day 4-10
alba: white day 11-14
44
how long after delivery should breastfeeding be initiated?
1 hour
45
benefits of colostrum
- dense in nutrients
- provides passive immunity to baby
46
BUBBLEE
Breast
Uterus
Bowels
Bladder
Lochia
Episiotomy
Emotions
47
PPH
more than 500 mL blood loss after vaginal birth or more than 1000 mL blood loss after c-section
usually happens within 4 hours after delivery
48
risk factors for PPH
- assistive birth
- large birth weight
- placenta previa/abruption
- multiple pregnancies
- hx PPH
49
assessment findings in PPH
- SOB
- heavy bleeding (bright red blood, clots)
- hypotension
- tachycardia
- restlessness/anxiety
- boggy uterus on fundal massage
50
PPH treatment
- fundal massage (stimulates uterus to contract)
- give blood
- oxygen
- oxytocin (helps firm uterus by causing it to contract)
51
gestational age
-preterm: less than 37 weeks
late preterm: 34-37 weeks
term: 37-41 weeks, 6 days
postterm: more than 42 weeks
52
normal reflexes of newborns
- sucking/rooting
- swallowing
- palmar/plantar grasp
- moro
- startle
- babinski
53
alterations in newborn skin
- vernix: skin protectant, looks like cheese
- lanugo: peach fuzz body hair for extra warmth
- mongolian spot: blue/black pigmentation on low back or booty, common in darker skinned ethnicities
54
s/s of hypoglycemia in newborn
- tremors
- lethargy
- hypotonia
- hypothermia
- weak suck
- diaphoresis
- poor feeding
55
biggest contributor to hypoglycemia in the newborn is ______
cold stress
56
newborn calorie requirement
120 calories/kg/day
57
types of heat loss in newborns
- convection- loss from cooler air (cold room)
- radiation- loss from cooler surface not in direct contact (unwrapped baby nect to window)
- evaporation- loss from wet body (wet diaper, after bath)
- conduction- loss from cooler surface in direct contact (cold scale)
58
nursing interventions for jaundice
- maintain normal skin temp (97.7-98.6)
- monitor stool (best way to eliminate bilirubin is to poo it out)
- encourage feedings
- phototherapy
- monitor for worsening, eating patterns, and number of wet diapers
59
indication for vitamin K injection
activates clotting factors and is found in normal gut flora.
since babies don't have a developed gut flora, they're at a higher risk for bleeding
60
the newborn is likely to demonstrate ___ in response to infection
hypothermia
61
indication for erythromycin at birth
-prevents against eye infections and potential blindness caused by gonorrhea that the baby could've been exposed to during delivery
- state-mandated med, give within an hour of delivery
62
respiratory distress syndrome
respiratory complication in the newborn, especially in premature infants d/t insufficient surfactant in the lungs
63
s/s of RDS
- tachypnea
- nasal flaring
- grunting
- retractions
- apnea
- pallor
- cyanosis
- diminished lung sounds
64
RDS interventions
- monitor ABGs, O2
- reposition
- administer surfactant via ET tube
65
prevention of SIDS
- back to sleep, tummy to play
- no smoking
- immunizations
- firm bedding, no blankets or stuffed animals
- no co-sleeping
- pacifier with sleep
66
cold stress
a period of inadequate temperature regulation
67
what does cold temperature increase
- metabolism
- O2 consumption
68
characteristics leading to heat loss
- little subcutaneous fat
- blood vessels close to the surface
- greater surface area
69
s/s of cold stress
- lethargy
- pallor
- poor feeding
- hypoglycemia
- respiratory distress
70
nonshivering thermogenesis (NST)
- initiated by skin receptors
- stimulation of sympathetic nervous system
- utilization of brown fat
71
evaporation
occurs during birth, bathing, wet linens or clothes, or insensible water loss from moisture on skin
72
conduction
occurs when the infant comes in contact with cold objects or surfaces (ex: scale, cold hands, stethoscope)
73
convection
occurs when drafts come from open doors, air conditioning, or air currents
74
radiation
occurs when the infant is near cold surfaces (ex: window, air conditioner)
75
types of jaundice
- physiologic
- breastfeeding
- pathologic
- breast milk
76
physiologic jaundice
occurs after the first 24 hours of life
77
breastfeeding jaundice
- lack of sufficient intake
- develops in the first few days of life
78
pathologic jaundice
- begins in the first 24 hours
- associated with blood incompatabilities
79
breast milk jaundice
- delayed onset
- related to composition of mother's milk
80
SIDS etiology
- brainstem abnormality
- stressors (sleep position, sleep environment)
- critical development period
- NOT associated with apnea or immunization
81
SIDS risk factors
- sleep position
- bed space (soft surface, fluff)
- sleep environment (temperature, co-bedding)
- exposure to smoke (prenatal, secondhand smoke)
- family hx SIDS
- age (2-4 mo., 90% of SIDS deaths before 6 mo.)
- race (#1: native american, #2: african american, #3: caucasian)
- prematurity/low birth weight
