OB exam 1

Question 1

1. Amniotic fluid

Answer 1

a. Steady temp around baby, cushions fetus from trauma
b. Helps baby’s lungs grow and develop
c. Helps digestive system develop
d. Exchange of nutrients, water, and chemicals
e. What is in it- water, baby’s urine, nutrients, hormones, and antibodies

Question 2

2. Genetic testing nursing concerns/risk

Answer 2

a. Nurses Role:
i. Beginning the preconception counseling process and referring for further genetic information
ii. Family history, Scheduling genetic testing
iii. Explaining purposes, risks, and benefits of all screening and genetic testing
iv. Answering questions and addressing concerns
v. Discussing costs, benefits, and risks of using health insurance and potential of discrimination
vi. Recognizing ethical, legal, and social issues
vii. Safeguarding emotional reactions after receiving information
viii. Providing emotional support
ix. Referring to appropriate support groups

b. Potential misuse of genetic information
i. PRIVACY AND CONFIDENTIALITY BREACHES

c. Concerns and risks that nurses will discuss-paragraph in book
i. The nurse is likely to interact with the client in a variety of ways related to genetics—taking a family history, scheduling genetic testing, advocating for autonomy and confidentiality in the informed-decision process, explaining the purposes of all screening and diagnostic tests, answering questions, and addressing concerns raised by family members. Nurses are often the first health care providers to encounter women with preconception and prenatal issues. Nurses play an important role in beginning the preconception counseling process and referring women and their partners for further genetic testing when indicated.

Question 3

3. Normal adaptations of pregnancy (integumentary) know normal ? on exam was about what is not normal/what to report to dr

Answer 3

a. Stretch marks (Striae gravidarum)
b. Areola get darker
c. Oily skin/acne
d. Linea nigra (dark line on abdomen)
e. Pregnancy rashes
f. Chloasma: Increase of pigmentation on the face
g. Hair loss
h. Decline in hair and nail growth

Question 4

4. Discomforts for each trimester- SATA on exam know all normal discomforts for 1st

Answer 4

o 1st trimester
▪ Urinary frequency or incontinence
▪ Fatigue: plan rest periods, lay on left side
▪ N/V: dry crackers before rising, avoid an empty stomach, eat small meals, avoid spicy, greasy, fried, or strong odored foods. Drink fluids b/t meals
▪ breast tenderness: bigger bra
▪ Constipation: increase fluids, fiber, activity
▪ Nasal stiffness, bleeding gums, epistaxis: don’t blow nose too hard
▪ Cravings: normal
● Pica: craving of non-food items (soil, clay, laundry detergent)
▪ Leukorrhea (increase in discharge): wear cotton underwear, loose clothes, keep area clean and dry

o 2nd trimester
▪ Backache: good posture, supportive footwear, properly lifting things and not straining your back
▪ Varicosities of the vulva and legs: support hose; avoid knee highs, elevate feet, change positions
▪ Hemorrhoids: prevent constipation; topical anesthetics; avoid straining, sitz baths
▪ Flatulence and bloating: avoid gas forming foods, increase fiber, water, and exercise

o 3rd trimester
▪ Return of 1st trimester discomfort
▪ SOB and dyspnea: expand chest; smaller meals
▪ Heartburn and indigestion: small meals, avoid caffeine, avoid spicy foods, sit up after eating
▪ Delayed gastric emptying-GERD and acid reflux-eat small meals
▪ Dependant edema: support hose; change positions, reduce sodium
▪ Braxton Hicks contractions: come and go; go away when you get up and walk; irregular

Question 5

5. Danger signs for each trimester (2 questions)

Answer 5

a. 1st trimester
i. Spotting or bleeding- Miscarriage
ii. Painful urination- infection
iii. Severe or persistent vomiting- hyperemesis gravidarum
iv. Fever over 100- Infection
v. Lower abdominal pain with dizziness and shoulder pain (sign of ectopic pregnancy)

b. 2nd trimester: Don’t want them to deliver
i. Regular contractions
ii. Pain in calf- blood clot
iii. Gush or leakage of fluid- water breaks, infection, preterm labor
iv. No fetal movement for more than 12 hours- Kick counts

c. 3rd trimester
i. Sudden weight gain- preeclampsia
ii. Periorbital or facial edema- preeclampsia
iii. Severe upper abdominal pain- liver pain, preeclampsia
iv. HA with visual changes- (preeclampsia)
v. Decrease in fetal movement
vi. Any previous warning signs

Question 6

6. GTPAL

Answer 6

a. G-number of pregnancies, including the current one
b. T-number of pregnancies to term (37+ weeks)
c. P-number of preterm pregnancies (before 37 weeks)
d. A-number of abortions or miscarriages (loss prior to 20 weeks)
e. L-number of living children
f. Will be given a scenario
i. Answer to previous test 4,1,1,1,3 unless different than 1st exam
g. Twins counted as one delivery, but 2 living children

Question 7

7. Signs of pregnancy (presumptive, probably, positive)

Answer 7

a. Presumptive: what mother can perceive (subjective), unconfirmed, doesn’t mean a baby is in the uterus
i. Hyperpigmentation of skin (16 weeks)
ii. Uterine enlargements (7-12 weeks)
iii. Food cravings
iv. P- Period Absent- Amenorrhea (4 weeks)
v. R- Really tired; fatigue (12 weeks)
vi. E- Enlarged breast (6 weeks)
vii. S- Sore breast (3-4 weeks)
viii. U- Urination increased (6-12 weeks)
ix. M- Movement perceived (lower abdomen movement) Fetal movements quickening (16-20)
x. E- Emesis and Nausea (4-14 weeks)

b. Probable (Objective): signs detected by physician/ nurse on exam
i. P- Positive pregnancy test (4-12 weeks)
ii. R- Returning of fetus when uterus pushed with fingers “Ballottement”
iii. O- Outline of fetus palpated
iv. B- Braxton Hicks contractions (16-28 weeks)
v. A- A softening of cervix “Goodell’s Sign”
vi. B- Bluish color vulva, vagina, cervix “Chadwick’s sign” (6-8 weeks)
vii. L- Lower uterine segment softening, Hegar’s sign (6-12 weeks)
viii. E- Enlarged uterus- abdominal enlargement (14 weeks)

c. Positive signs: confirm that a fetus is growing in uterus
i. F- Fetal movement felt by clinician (20 weeks)
ii. E- Electronic device detects fetal heart tones; doppler (10-12 weeks)
iii. T- The delivery of baby
iv. U- Ultrasound detects baby (4-6 weeks)
v. S- See visible movement by doctor/nurse

Question 8

8. Fundal height in pregnancy

Answer 8

a. Distance from the pubic bone to the top of the uterus in cm
b. By 24 weeks, fundal height often matches number of weeks you’ve been pregnant; 1cm/week
c. Reaches xiphoid process at 36 weeks
d. By 20 weeks it should be at the middle of the umbilicus

Question 9

9. Nagele’s Rule

Answer 9

a. first day of Last menstrual period plus 7 days plus 9 months
b. Will be given a scenario
i. March 22nd is answer

Question 10

10. Activity in pregnancy

Answer 10

a. Regular, short intervals of moderate aerobic physical activity
b. If pt says she exercised b4 pregnancy they can continue regardless of pregnancy
c. What is recommended, what is allowed?
i. 30 minutes everyday moderate to intense exercise
ii. General rule is don’t start anything crazy if you haven’t been doing it before-continue what you have been doing unless there is something medically preventing you
iii. Intercourse is safe

Question 11

11. Normal cardiovascular changes r/t positioning

Answer 11

a. Laying down on your back is harder to breathe due to vena cava pressure
b. Supine position- bp lowers d/t weight and pressure of the gravid uterus on vena cava, which decreases venous blood flow to ht
c. Maternal hypotn/ fetal hypoxia- dizziness, pallor, clammy skin, lightheaded
d. Encourage client to lay on left side, semi-fowler’s position or if supine place a wedge under one hip

Question 12

1. True versus False labor

Answer 12

True Labor:
Contraction timing: Regular, becoming closer together, usually 4–6 minutes apart, lasting 30–60 seconds
Contraction strength: Become stronger with time, vaginal pressure is usually felt
Contraction discomfort: Starts in the back and radiates around toward the front of the abdomen
Any change in activity: Contractions continue no matter what positional change is made
Stay or go?: Stay home until contractions are 5 minutes apart, last 45–60 seconds, and are strong enough so that a conversation during one is not possible—then go to the hospital or birthing center.

False Labor:
Contraction timing: Irregular, not occurring close together
Contraction strength: Frequently weak, not getting stronger with time or alternating (a strong one followed by weaker ones)
Contraction discomfort: Usually felt in the front of the abdomen
Any change in activity: Contractions may stop or slow down with walking or making a position change.
Stay or go?: Drink fluids and walk around to see if there is any change in the intensity of the contractions; if the contractions diminish in intensity after either or both, stay home.

Question 13

2. Assessment of fetal position- how to tell where baby is in the womb

Answer 13

a. What is most important to know about the position of a baby if mom is laboring?
b. vaginal exam to see what the presenting part is
i. HEAD NEEDS TO BE DOWN
ii. Palpate the stomach for the head-leopold maneuver
iii. LOA is the most favorable position
c. Longitudinal Lie- The best position to deliver
i. Fetal monitoring-heart sounds are best heart over the fetal back
ii. Vaginal exam-can you feel the head or not? WITH GLOVES

Question 14

3. Cause of labor

Answer 14

a. HORMONAL:
i. Progesterone decreases
ii. prostaglandins- increase and aid in uterine contractions, cervical dilation
iii. Estrogen increases
iv. oxytocin-increases w/ onset of labor
b. Uterine stretches, increase in amniotic fluid can signal the body to go into labor
c. Premonitory signs:
i. backache-low dull backache, cervical changes- 10cm dilation and effacement- thinning out of cervix
ii. Bloody show- comes with or w/o mucous plug can have braxton hicks
iii. Spontaneous rupture of membranes- can happen b4 labor, water breaking increase infection risk sterile gloves need to be worn, we wanna know the time the water broke and may need to start labor
iv. Uterine stretching
v. Lightening- presenting part moves into pelvis; (Baby drops into pelvis)
vi. Increased energy level-adrenaline, nesting
vii. Braxton hicks- False contractions, irregular, go away with position change, not strong enough to put mom in labor.

Question 15

Cardinal movements (names and order) 448 SATA KNOW NAMES

Answer 15

d. Engagement
e. Descent
f. Flexion
g. Internal rotation
h. Extension
i. External Rotation (Restitution)
j. Expulsion

Question 16

4. Stages of Labor- gives a scenario and you pick what stage.

Answer 16

100% EFFACEMENT, 10CM DILATED, +2 STATION AND CAN SEE HEAD OF FETUS

a. Dilation- longest stage begins w/ 1st true contraction w/ full dilation and is divided into more phases
b. Stage 1 - includes 3 phases (Latent, Active, Transition) : cervix dilates from 0-10 cm
c. Latent phase- gives rise to familiar s/s of labor, cervix dilates to 6 cm w/ contractions q 5-10 mins lasts 30-45 seconds and are described as mild by palpation by nurse, effaced 0-40%
d. Mom can be up and moving if she is low risk
i. Goal: cervix dilation from 0-10 cm and 100% effacement due to contractions
ii. Facts: longest stage of labor (longer for 1st mothers), starts when true labor starts
iii. Latent (early labor)
1. Cervix dilates 1-4 cm and thins
2. Contractions every 5-30 mins and 30 to 45 secs in length
3. Some mother might now even know they are in this phrase
4. Mother might be excited, nervous and talking
iv. Active
1. Cervix dilates 4-7cm
2. Contractions every 3-5 mins and 45 to 60 secs long, stronger and longer
3. Phase lasts 4-8 hours
4. Water may break
a. Ask what color
b. Meconium
5. Interventions
a. Comfort (non-pharm or pharm)
b. Monitor vs in mom and baby
6. Mother might be in serious pain and anxious
v. Transition
1. Lead into stage 2 where baby will be delivered
2. Cervix dilates 8-10 cm
3. Shortest phase but more intense, 30 mins to 2 hrs
4. Contractions back to back every 2-3 mins and 60 to 90 secs
5. May have pressure but can’t push until fully dilated
6. Interventions
a. Support and encouragement
b. VS (110 to 160 bpm)
c. Assessment of dilation status and effacement
e. Stage 2: the baby is delivered; mom is pushing
i. Starts when cervix fully dilated and 100% effaced and ends after baby is delivered
ii. Baby descending, intense pressure, station 1+ to 5+ crowning, last 1-3 hrs
f. Stage 3: the placenta is delivered
i. Starts with full delivery of baby and ends full delivery of placenta
ii. Lasts 5 to 15 mins.. Longer that stage the increase risk hemorrhage
g. Stage 4: the first 1-4 hours after delivery of the placenta (recovery)
i. Monitoring mom’s health after birth
ii. Assess Fundus of uterus - film midline, near umbilicus, check every 15 mins for 1 hour and every 30 for 2 hours

Question 17

5. Priority assessments-for each stage of labor

Answer 17

a. Stage 1
i. Assessing cervix a lot
ii. Assessing pain and coping mechanisms
iii. Assessing fetus
iv. Assessing dilation progress and fundal height
b. Stage 2
i. Encourage mom to push
ii. Record time of delivery
iii. Immediate newborn care
iv. Assessing rupture of membranes
c. Stage 3
i. s/s of placental separation
ii. s/s of perineal trauma
iii. Newborn assessment
iv. Vaginal bleeding
d. Stage 4
i. Infection
ii. Fundus-to see if it is soft or hard
1. To the side means full bladder-have pt void
iii. Bleeding-peripad and watching for clotting
iv. Vs which is priority and she picked fundal assessment
e. Watching for hemorrhage
i. Decreased BP
ii. HR goes up

Question 18

6. 3rd stage nursing management

Answer 18

a. The third stage is complete when the placenta is delivered.
b. focuses on immediate newborn care and assessment
c. observing for signs of placental separation
d. being available to assist with the delivery of the placenta
e. recording the time of expulsion
f. inspecting the placenta for intactness.
g. The nurse should also be assessing the mother by palpating the uterus before and after placental expulsion.
h. Monitoring placental separation by looking for the following signs:
i. Firmly contracting uterus
ii. Change in uterine shape from discoid to globular ovoid
iii. Sudden gush of dark blood from vaginal opening
iv. Lengthening of umbilical cord protruding from vagina
v. Examining placenta and fetal membranes for intactness the second time (the health care provider assesses the placenta for intactness the first time) (Fig. 14.18)
i. Assessing for any perineal trauma, such as the following, before allowing the birth attendant to leave:
i. Firm fundus with bright red blood trickling: laceration
ii. Boggy fundus with red blood flowing: uterine atony
iii. Boggy fundus with dark blood and clots: retained placenta
iv. Inspecting the perineum for condition of episiotomy if performed
v. Assessing for perineal lacerations and ensuring repair by birth attendant

Question 19

7. Contraction assessment (how, why)

Answer 19

a. How - Assessment of the contractions includes frequency, duration, intensity, and uterine resting tone (see Chapter 13 for a more detailed discussion). Uterine contractions with an intensity of 30 mm Hg or greater initiate cervical dilation. During active labor, the intensity usually reaches 50 to 80 mm Hg. Resting tone is normally between 5 and 10 mm Hg in early labor and between 12 and 18 mm Hg in active labor (Milton, 2019). To palpate the fundus for contraction intensity, place the pads of your fingers on the fundus and describe how it feels: like the tip of the nose (mild), like the chin (moderate), or like the forehead (strong). Palpation of intensity is a subjective judgment of the indentability of the uterine wall; a descriptive term is assigned (mild, moderate, or strong) (Fig. 14.2).
b. INTENSITY- STRENGTH OF CONTRACTION AT ITS PEAK, MILKD MOD, OR STRONG- HOW TO DETERMINE PALPATION ONLY ON FUNDUS(TOP) OF UTERUS
c. Fundus should be firm, midline and at the level of umbilicus- fundal massage is priority intervention
d. Why - Uterine contractions increase intrauterine pressure, causing tension on the cervix. This tension leads to cervical dilation and thinning, which in turn eventually forces the fetus through the birth canal. Normal uterine contractions have a contraction (systole) and a relaxation (diastole) phase. The contraction resembles a wave, moving downward to the cervix and upward to the fundus of the uterus. Each contraction starts with a building up (increment), gradually reaching an acme (peak intensity), and then a letting down (decrement). Each contraction is followed by an interval of rest, which ends when the next contraction begins. At the acme (peak) of the contraction, the entire uterus is contracting with the greatest intensity in the fundal area. The relaxation phase follows and occurs simultaneously throughout the uterus.

Question 20

8. Fetal assessment (including VEAL CHOP and normal)

Answer 20

a. Amniotic fluid analysis
i. Time, cord, color, odor, concern
b. Fetal heart rate monitoring
i. Handheld versus electronic
ii. Intermittent versus continuous
iii. External versus internal
c. Guidelines for assessing fetal heart rate
i. Initial 10-20 minute continuous FHR assessment on entry into labor/birth area
ii. Intermittent auscultation every 30 minutes during active labor for low-risk women and every 15 minutes for high-risk women
iii. During second stage of labor intermittent auscultation every 15 minutes for low-risk women and every 5 minutes for high-risk women
d. Under 32 weeks, 10 by 10 accelerations are expected
e. 37 weeks and above 15 by 15 accelerations are expected
f. Accelerations are GOOD and shows that baby is healthy
g. To be counted as a deceleration it has to go down by 10 and stay down for 10 seconds or longer
h. Variability:
i. Baseline (110-160)
ii. Absent: fluctuation range undetectable
iii. Minimal: fluctuation range observed at <5 beats per minute
iv. Moderate: (normal) fluctuation range from 6 to 25 beats per minute
v. Marked: fluctuation range >25 beats per minute
vi. Don’t need to know categories for the exam

Variable
Early
Acceleration
Late

Cord compression
Head compression
Okay (good)
Placental insufficiency

Move-mom
Identify labor progress
No intervention
Execute actions/delivery

Question 21

9. Fetal resuscitation (nursing intervention to non-reassuring heart tones)= SATA ? don’t put supine, don’t break membranes

Answer 21

a. VEAL CHOP MINE
b. Turn mom to side left side
c. Fluids
d. Call provider
e. Oxygen
f. Prepare for emergency c/s
g. Stop pitocin
h. Give medications to stop contractions

Question 22

● Attachment and bonding behaviors- ? was determine what action is inappropriate and answer was the mom who expresses that baby is wasting her time

Answer 22

o Mom talking to baby
o Seeing how mom acts when the baby cries
o Breastfeeding
o Can the mom handle the baby crying

Question 23

● Menstruation/Ovulation

Answer 23

o Breastfeeding women CAN GET PREGNANT, ask how they plan to prevent pregnancy, mini pill (estrogen pill)
o Non lactating women menstruation returns in 7 to 9 weeks after birth 1st cycle is often anovulatory
o Lactating women menstruation returns anywhere from 2-18 months

Question 24

Lochia

Answer 24

● Lochia: foul-smelling or an unexpected change in color or amount could mean infection or hemorrhage
o vaginal discharge that occurs after birth and continues for approximately 4 to 8 weeks
o Immediately after labor, it is bright red and consists of blood; each day, bleeding should be less and lochia should be lighter in color
o Very bad smell can indicate infection
o Lochia rubra is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 4 days after birth. As uterine bleeding subsides, it becomes paler and more serous.
▪ Primary one that you see in the hospital

Question 25

● Peri Care-Interventions

Answer 25

o Sitz bath
o Tucks
o Witch hazel pads
o Ice packs

Question 26

● Fundal Assessment-how

Answer 26

o Have client empty bladder, use 2 hands w/ pt supine with knees flexed, feel top of uterus with one hand while the other stabilizes it lower
o Fundus should be midline and feel firm
o Boggy is sign of loss of muscle tone
o If fundus above umbilicus its abnormal
o Fundus will be non palpable by 10-14 days postpartum

Question 27

● Non-breastfeeding management

Answer 27

o Wear a tight fitting bra
o Apply cold packs for engorged breasts
o Don’t stimulate the breasts
o Cabbage leaves

Question 28

● Vital signs and output-expected

Answer 28

o How much voiding is expected for mom’s output?
▪ INCREASES a lot which is normal
▪ 3000 out
o Vital signs
▪ Little bit lower
▪ Temperature may remain a little bit elevated for first 24 hours

Question 29

● Danger signs- SATA ? postpartum

Answer 29

Fever more than 100.4°F (38°C)
o Foul-smelling lochia or an unexpected change in color or amount
o Large blood clots, or bleeding that saturates a peripad in an hour
o Severe headaches or blurred vision
o Visual changes, such as blurred vision or spots, or headaches
o Calf pain with dorsiflexion of the foot
o Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites
o Dysuria, burning, or incomplete emptying of the bladder
o Shortness of breath or difficulty breathing without exertion
o Depression or extreme mood swings

Question 30

● Postpartum adaptations

Answer 30

o Diaphoresis-what is normal? A LOT IS NORMAL
▪ Eliminated amniotic fluid through sweating
▪ Body trying to get back to pre-pregnant body fluid levels

Question 31

● Pain interventions- ? when a mom says she has severe uterine pain after labor and what should be done

Answer 31

o	Promoting comfort
o	Cold and heat applications
o	Topical preparations
o	Analgesics
o	Breast care-cold cabbage leaves, breast pads
o	Tucks pads help with perineal pain and hemorrhoids 
o	Sitz bath
o	Tucks
o	Witch hazel
o	Ice packs
o	Numbing spray
o	Peri bottle-take home with you

Question 32

● Safe sleep

Answer 32

○ NO extra bedding, stuffed animals, or bumpers-alternative is a sleep sack
○ On their back
○ Sucking on a pacifier reduces the risk for SIDS
○ Sometimes can have an aspirator (bulb suction) nearby in case of emergencies
○ Co-sleeping is not recommended
○ Have them in the same room for at least the first 6 months-in bassinet next to bed
○ Make sure temperature is not too warm or overheated
○ If parents want to drink alcohol, it is best to have baby with someone else for safety reasons
○ No tobacco or smoking around baby
○ Do not wrap baby too tightly in blanket
○ Baby sleeps about 15 hours a day, naps 2-4 hours at a time

Question 33

● Vitamin K rationale

Answer 33

○ Babies cannot produce enough vitamin K yet so they need it for clotting factors
○ Newborns lack the intestinal flora needed to produce vitamin K, so it is given to prevent bleeding episodes
○ Must sign a waiver to refuse
○ Not a vaccination

Question 34

● Physiologic jaundice assessment

Answer 34

○ Bilirubin levels are increased
○ Happens after the first 24 hour
○ Concerning if it happens in first 24 hours so notify dr
○ Assessment must be performed in a well lit room, preferably with daylight
○ Can be seen by blanching the skin with digital pressure on the bridge of the nose, sternum, or forehead, revealing the underlying color of the skin and subcutaneous tissue
○ Every 8-12 hours reassess baby

Question 35

● Bonding with breastfeeding

Answer 35

○ Give mom time to bond with baby during first breastfeeding experience
○ “Kangaroo care”-skin to skin contact on the chest with mother
○ Put on chest skin to skin to help stim moms milk production
○ Try to get the first breastfeed in within 30 minutes before everyone starts to show up and wants to see baby-parents need that time with the baby!

Question 36

● Expected vital signs

Answer 36

○ HR: 110-160 assess for 1 full minute
○ RR: 30-60 assess for 1 full minute
○ Temperature: 97.7-99.5
○ BP: 50-75 over 30-45
○ Every 30 minutes for first 2 hours and then every 8 hours
○ Take vital signs in order of LEAST DISTURBING to most disturbing (ex: if baby is sleeping, you don’t want to wake them)

Question 37

● Expected assessment findings of newborn

Answer 37

○	Lose 5-10% of weight from birth 
Anthropometric measurements:
Head circumference: 33–37 cm (13–14 in)
Chest circumference: 30–33 cm (12–13 in)
Weight: 2,500–4,000 g (5.5–8.5 lb)
Length: 45–55 cm (19–21 in)

Vital signs:
Temperature: 97–99°F (36.5–37.5°C)
Apical pulse: 110–160 bpm
Respirations: 30–60 breaths/min

Skin
Normal: smooth, flexible, good skin turgor, well hydrated, warm

Head
Normal: varies with age, gender, and ethnicity

Face
Normal: full cheeks, facial features symmetric

Nose
Normal: small, placement in the midline and narrow, ability to smell

Mouth
Normal: aligned in midline, symmetric, intact soft and hard palate

Neck
Normal: short, creased, moves freely, baby holds head in midline

Eyes
Normal: clear and symmetrically placed on face; online with ears

Ears
Normal: soft and pliable with quick recoil when folded and released

Chest
Normal: round, symmetric, smaller than head

Abdomen
Normal: protuberant contour, soft, three vessels in umbilical cord

Genitals
Normal male: smooth glans, meatus centered at tip of penis
Normal female: swollen female genitals as a result of maternal estrogen

Extremities and spine
Normal: extremities symmetric with free movement

Question 38

● Danger signs: newborn

Answer 38

○ Purple lips
○ Not oxygenating-if they are not breathing they are not doing anything else
○ Grunting on exhalation, nasal flarin, chest retractions
○ Cynosis, >60 rr /min
○ Attractions

Question 39

● Pulmonary vascular resistance adaptations

Answer 39

○ Decrease in pulmonary vascular resistance-to allow blood to go into the pulmonary system easily
○ Holes in the heart close
○ Increase in pulmonary blood flow

Question 40

● Cord care/assessment- ?

Answer 40

about mom calling clinic about moist and discharge coming from cord what should mom do? Bring to dr

Question 41

● Alcohol, clamp can be removed after 24 hrs, turns dark brown and shrivel

Answer 41

○ Frequent assessments are needed to see and prevent signs of infection and bleeding
○ If clamp is loosened, it can cause the cord to bleed
○ Observe for bleeding, redness, drainage, or foul odor from the cord stump and report it to your newborn’s primary care provider immediately
○ Avoid tub baths until the cord has fallen off and the area has healed
○ Expose the cord stump to the air as much as possible throughout the day
○ Fold diapers below the level of the cord to prevent contamination of the site and to promote air-drying of the cord
○ Observe the cord stump, which will change color from yellow to brown to black. This is normal.
○ During each diaper change, apply appropriate ointment to prevent infection
○ Never pull the cord or attempt to loosen it; it will fall off naturally
○ Remove the cord clamp approximately 24 hours after birth by using a cord-cutting clamp. However, if the cord is still moist, keep the clamp in place and ensure a referral to home health care so that the home care nurse can remove it after discharge

Question 42

● C/section risks to infant

Answer 42

○ They do not get squeezed/compressed so they do not get their first big deep breathe in to pop alveoli open-respiratory difficulties
○ More pronounced transition phase
○ Hormones happen in labor that mom produces that pass to baby that baby won’t get

Question 43

● Meconium stool- ? described this and tell the mom that its meconium

Answer 43

○ Passed during the first 48 hours after birth
○ Thick, tarry, sticky, dark green
○ Can be difficult to remove from the skin

Question 44

● Normal newborn reflexes

Answer 44

○ If certain newborn reflexes aren’t present in newborns, this could indicate a CNS problem
○ Sucking: gently stimulating the newborn’s lips by touching them. Newborn will typically open the mouth and begin a sucking motion. Placing a gloved finger in the newborns mouth will also elicit the sucking motion
○ Moro (embrace reflex): occurs when the neonate is startled. Place the newborn on their back. Grab the newborns arms and lift, then release the arms suddenly. The newborn should throw the arms outward and flex the knees; the arms will then return to the chest. Initially the newborn is startled and then relaxes to a normal resting position
○ Stepping: hold the newborn upright with the soles of the feet touching a flat surface. The baby should make a stepping motion or walking.
○ Tonic neck (fencing reflex): Have the newborn lie on their back, turn the baby’s head to one side, the arm toward which the baby is facing should extend straight away from the body with the hand partially open, whereas the arm on the side away from the face is flexed and the fist is clenched tightly.
○ Rooting: stroke the newborn’s cheek. The newborn should turn toward the side that was stroked and begin making sucking movements
○ Babinski: stroke the lateral sole of the newborn’s foot from the heel toward and across the ball of the foot, the toes should fan out.
○ Palmar grasp: place a finger on the newborns open palm, the baby’s hand will close around the finger, attempting to remove the finger causes the grip to tighten
○ Plantar grasp: place a finger just below the newborns toes, the toes should curl over the finger
○ Truncal incurvation: run a finger down either side of the spine. This stroking will cause the pelvis to flex toward the stimulated side. This indicates T2–S1 innervation.

Question 45

● Caput

Answer 45

“Cone head” caused by pressure being put on it in labor
○ If it crosses suture line- localized edema on scalp that occurs from pressure of birth appears as poorly demarcated soft tissue swelling

Question 46

● Apgar score

Answer 46

○	Assesses newborn at 1 and 5 minutes, additional done at 10 minutes if the 5 minute score is less than 7
○	A=appearance 
○	P=pulse (HR)
○	G=grimace (reflex ability)
○	A=activity (muscle tone)
○	R=respiratory (respiratory effort)
○	0=absent or poor
○	1=slow or irregular
○	2=normal response 
○	Should be 8-10
○	8 or higher=no interventions needed
○	4-7=moderate difficulty 
○	0-3=extreme distress

Question 46

● Car seat safety

Answer 46

● Don’t use a car seat that is over 5 years old-check expiration dates!
● No newborn can be released from the hospital until they have a carseat
● Select a car seat that is appropriate for child’s size and weight
● Use the cars seat correctly every time the child is in the car
● Use REAR FACING safety seats for most infants up to 2 years of age or until they reach a certain weight allowed by the manufacturer
● Car seats should be in the back of the car
● Make sure the harness is in the slots at or below the shoulders and is SNUG
● Retainer clip placed at the center of the child’s chest in line with the armpits
● Make sure the car seat is secured with a seatbelt and at a good angle so that the child’s head is not flopping around
● Keep away from airbags; if they inflate and hit baby’s head, this could cause major injury
● If your car seat was in a crash, you should not reuse it even if it looks fine because something may still be wrong
● It is not safe to use a used car seat
● Nurses are not certified to check car seat