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ABSN Cohort 19 > OB Exam 3 > Flashcards

OB Exam 3 Flashcards

1
Q

TK: What do do if baby is lethargic? fussy?

A 
Lethargic = unswaddle, stimulate, lights on
Fussy = swaddle, rock, lights out
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2
Q

TK: Feeding well is indicated by how many diapers?

A

6 - 8 . day

Ratio = 1 diaper:day old

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3
Q

TK: Fontanels should be…?

A

Flat, soft, Ø bony outline = dehydration

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4
Q

TK: Medical Malpractice vs. Negligence

A

violation of professional duty, failure to use knowledge

failure to exercise degree of care an ordinary person would

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5
Q

TK: Duty vs. Breach

A

perform professional service as a nurse

failure to carry duty

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6
Q

TK: How to avoid litigation? SOC = ORP meaning?

A

Follow policies and procedures

Standard of Care = Ordinary, reasonable, and prudent Nurse

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7
Q

TK: ATI Breastmilk Storage viability times (4) and how to thaw (2)

A

Room temp = 8 hrs
Refrigerated = 8 days
Freezer = 6 months
Deep Freezer = 12 months

Thaw in fridge for 24 hrs
Place container in lukewarm water

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8
Q

TK: Breastmilk preparation DON’TS (4)

A

Thaw in microwave
refreeze thawed milk
re-use used portions
use old formula

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9
Q

TK: Timing for meat, almond milk, cows milk (+why), and what to mix formula in (+why)

A

Meat = 9 months
Almond/Cows = 1 year
Cows milk is ↑ protein but ↓ carbs, Iron, VitC, Copper, and is hard to digest, doesn’t support growth
Formula in tap water because it has fluoride which helps with development of teeth

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10
Q

TK: American Academy on how long to breastfeed child?

A

6 months

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11
Q

TK: Rice and cereal in bottle?

A

NO, use spoon.

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12
Q

TK: Bottle to bed risks? Replacement fluid?

A

Ear infection and tooth decay, replace with water.

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13
Q

TK: Maternal Adjustment Phases (3)

A

Dependent Taking-in
Dependent-Independent Taking-hold
Independent Letting-go

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14
Q

TK: Taking-in-Phase (time, focus, action)

A

First 12 - 24 hours postpartum
personal needs
Rely on others, excited, talkative, reviews exp.

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15
Q

TK: Taking-Hold Phase (time, focus, action)

A

Day 2 -3 (as long as 10 days/weeks)
Baby care/competency
Wants charge, but still relies, learn/practice care

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16
Q

TK: TK: Letting-Go Phase (focus, action)

A

Family as a unit

Resumption of previous roles

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17
Q

Transition to Parenthood begins and develops with…?

A

During pregnancy

Time (learning process)

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18
Q

Attachment

A

parent ♥ child, child ♥ parent
Maintained by proximity and interaction.
Strengthened by sensual responses

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19
Q

Bonding

A

first minutes/hours postpartum of contact

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20
Q

Mutuality

A

Infant behaviors eliciting corresponding parental behavior

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21
Q

Acquaintance

A

Eye contact, touching, talking, exploring

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22
Q

Claiming

A

Identification of new baby by family
Can be POS or NEG
“Dad’s chin and bad attitude”

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23
Q

Nurse Role during Transition

A

Facilitate attachment and assess/improve coping

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24
Q

Early vs Extended Contact

A

facilitates attachment but NOT ESSENTIAL

rooming-in, optimal for family-centered care

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25
Parent-Infant Communication: | Touch, Eye Contact, Voice, Odor, Entrainment
Kangaroo! Mom temp ↑ 1º to keep baby warm, stabilize HR, calm respirations en face = 20cm, Mal de ojo = Spanish rude admiration can hear in utero @ 24 weeks areola secrete fluid similar to amniotic fluid, attracts baby movement in time with parent's voice
26
Biorhythmicity
Baby is soothed by mom's ♥ beat
27
Reciprocity vs. Synchrony
R - baby cries, mother soothes response (can be POS/NEG) | S - when event is mutually rewarding to both parent and baby
28
Psychologist vs. Psychiatrist
can't prescribe but recommends meds | can prescribe meds
29
Focus of parents during transition
moving towards normal and achieving identity
30
EDINBURGH (EPDS)
Depression screen for mom (0/30) | If less than 10, possible depression.
31
Postpartum Blues (%, r/in if Øtx, time length, counte w/, who to screen?)
10 - 15% Postpartum Depression -> Postpartum Psychosis Up to 1 year naps, limiting visitors, ▲ expectations SCREEN EVERY WOMAN EVER postpartum (during pregnancy if have Hx)
32
Father's experience of Birth, nursing counter
First 4 - 10 weeks similar to mother. Left out/jealous, NORMAL educate and include
33
When is next appt? | Vag Birth vs. Cesarean
6 weeks | 2 weeks, then 6 weeks
34
Sexual adjustment Postpartum
NO sex for 5 - 6 weeks post-delivery | Estrogen r/t breastfeeding r/in dry vagina, lube up.
35
Adolescent vs. > 35 y/o parents
↑ mortality rate (60%) Needs more developmental teaching Educate w/ diff. modalities ↑ disease rate (DM) Sandwich generation
36
Rehabilitation Act of 1973
Hospitals must accommodate the impaired
37
Sibling Adaptation expectation and counter
Regression/Rivalry is NORMAL | Involve kids in preparation of baby and acquaintance
38
Grandparents Adaptation
More involved b/c teen preg, drug abuse, and HIV | Promote continuity w/ inter-generational relationships
39
Infant's First period of reactivity (4) | time, HR, RR, motor
30 min post birth HR ↑ 160 - 180 bpm but drops 30min RR 60 - 80, irregular ↓ motor activity after 60 - 100 min + sleep
40
Infant's Second Period of Reactivity (4) | time, breathing, meconium, ▲s
4 - 8 hours post birth Tachycardia/pnea occur Meconium passes ↑ muscle tone, ▲ skin color, ↑ mucous production
41
Infant Respiratory NOTES (4)
Surfactant is low Abdominal breathers Respiratory distress = flaring, retractions, grunting Liquids squished out of lung during vaginal birth
42
Infant Respiratory FOCUS (3) | initiate, maintain, maintain other 2?
Initiate breathing Maintain O2 Maintain Resp/Temp
43
Infant Hematopoietic NOTES (5) | RBC, Leuko, Platelets, Hct/Iron, VitK
``` 4x RBC of adult (r/o hyperbiliruinemia) ↑ Leukocytes = Platelets to adult ↑ Hct and Iron (enough for 4 - 6 months) Administer VitK cause it takes 3 days to build ```
44
Infant Cardiovascular NOTES (4) | openings, blood volume x2, HR average
3 openings: foramen ovale, ductus venosis, and arteriosis (when arteriosis stays open r/in murmur) Blood volume 300mL (40% weight) Blood volume will ↑ if not cut w/in 2 min birth HR average 120 - 140 bpm, murmur/irregular NORMAL
45
Infant Renal NOTE (2) | diaper output, kidney fx
6 - 8 wet diapers/day | 3 - 4 days, kidneys Ø concentrate urine
46
Infant Thermogenic NOTES (3) | shiver, brown fat, cold stress, birth weight
CAN'T shiver Will consume brown fat if too cold/unfed Cold stress r/in metabolic acidosis Lose 5 - 7% birth weight by day 3 - 5, will regain in 2 weeks
47
Cold Stress Physiology
Cold r/in ↑ O2 consumption r/in ↑ RR r/in vasoconstriciton r/in ↓ O2 uptake/↓ peripheral perfusion r/in Anaerobic Glycolysis r/in ↓ PO2 and pH (metabolic acidosis)
48
4 Ways to Lose Heat (ECCR)
Evaporation - H2O loss Conduction - touching Convection - through air Radiation - next to window/fridge
49
Infant Hepatic NOTES (4) | liver, maternal glucose, coag factor, bruising fx
Liver is 40% abdomen and has enough Iron for 4 - 6 months (which is when they start solids) Ø maternal glucose once cut from mother Ø coag factor b/c gut sterile, need VitK Bruising ↑ r/o bili cause RBC's will be turned into Bili
50
How Bilirubin is created
RBC -> Hbg -> Heme/Globin -> Iron and Bilirubin -> via LIVER GLURONYL TRANSFERASE becomes conjugated in and in feces
51
Kernicterus
When bili passes blood-brain barrier and ↑ r/o mental retardation
52
Infant GI NOTES (3) | poo development (4), cluster feeding, stomach size
meconium (dark tarry) -> green -> yellow OR OJbrown if formula By 2nd week should be feeding q1-2hrs Never feed > 8 oz b/c r/in spitting up
53
Passive Immunity 2 Sources
from mother and from breastfeeding
54
``` Infant Genitalia (3) (NORMAL ♀, ♂, and BOTH) ```
♀ - swollen majora cover it all, mucous/vernix inside ♂ - swollen scrotum, rugae, contracted (opposite w/ premie & transparent) BOTH - swollen breasts b/c estrogen (blood♀/rust powder♂ in diaper)
55
Infant Integumentary NORMAL findings (5)
sweat glands/milia - white dots on nose (pore+vernix) Desquamation - peeling Mongolian spots - dark spots towards buttocks Nevi - birth marks, stork bites, angiomas Erythemia Toxicum - rash first 3 weeks (flea bites)
56
Infant Integumentary NOT NORMAL findings (3)
Caput Succedeneum - edema under scalp Cephalhematoma - blood under scalp (trauma) Subgaleal Hematoma - blood down neck (trauma) when S/S apparent... it's too late.
57
Infant Skeletal NOTES (2) | cartilage vs. bone, hip dysplasia
> cartilage than ossified bone Assess for hip dysplasia by abducting legs (can't do if out of socket/hear click), ALSO assess symmetry of leg length/creases
58
When assessing infant... it is VERY important to also include...?
Pre/Intra/Postpartal periods of mother's pregnancy
59
Tummy Time and HOW TO SLEEP?
SUPERVISED Promotes muscle strength On back (↓ 75% SIDS)
60
Infant Sensory NOTES (3) | vision, everything else, hearing?
blurry, black/white (3 -4 months), short EVERYTHING else more accurate Congenital Hearing loss in 1/301k, catch to intervene
61
Neuro vs. Ballard assessments
Reflexes (moro, rooting, babinski) vs. Gestational Age (Scarf sign, square window, recoil) (out of 50)
62
Sleep-Wake States (6) | DLDQAC
``` Deep sleep Light Sleep Drowsy Quiet Alert (feeding time!) Active Alert Crying ```
63
Mom was on narcotics and baby has ad/fx, treat with...?
Narcan
64
Responses to Stimuli (6) | THCCIC
Temperament - variation behavior to stimuli Habituation - protective accustomization to stimuli Consolability - ability to console self/be consoled Cuddliness - ability to mold to contour of holder Irritability - threshold before crying Crying - signals need, mother learns types, 5 min - 2 hrs
65
APGARs are done @ what 2 times? | Assessment done by what (3) and what time?
1 min and 5 min post-birth Gestational Age, Weight, Circumferences 2 - 3 hours post-birth
66
Nose Bulb Procedure
Cheeks first (not too deep) then nose
67
Umbilical Care
NO tub bathing until cut/circumcision well healed Leave open to air, will fall off in 7 - 10 days Clean like any other wound
68
Erythromycin administration and fx
Ribbon inside out, counters gonorrhea, conjunctivis, and chlamydia
69
↑ 90th percentile, ↓ 10th percentile measurements?
TOO LARGE | TOO SMALL
70
Term Timings (5)
Preterm/mature is ↓ 37 weeks Late preterm 34 - 36 6/7 weeks Term 38 - 42 Postterm > 42 Postmature > 42 w/ placental insufficiency ↑ R/o placental calcification (poor O2) and ↓ amniotic fx
71
Infant Phenoketonuria (PKU) assesses for...? (3)
Hypothyroidism Galactosemia Sick cell anemia
72
Meconium labs vs. Blood
More accurate and allows screening for more drugs
73
Soft tissue injuries and reason.
bruising, lacerations b/c dystocia (obstructed labor) an use of forceps/vacuum.
74
Physiologic Jaundic Kernicterus Jaundice v/a Breastfeeding Breastmilk Jaundice
birth, 80% newborns, look like a pumpkin 1st week, yellow staining in brain cells 2 - 4 days, 10 - 25% breastfed newborns, poor feeding 4 - 6 weeks, 2 - 3% breastfed newborns, bad milk
75
Hypoglycemia and Hypocalcemia ranges
↓ 20 - 40 mg/dL and ↓ 7 mg/dL
76
How to assess Infant bili and safe percentile
TransQBilimeter | 40th - 95th
77
Conjugated Bili/Unconjugated Bili safe ranges
1 - 1.5 / 12 - 15 Blood Volume Fraction (BVF)
78
3 ways to restrain Infants to collect labs, what if restrained?
swaddling femoral for femoral IV side for spinal tap If child is restrained, check hourly.
79
Breast feeding should be...? and normal oz?
On-demand, 2 oz
80
Tx VitK, HepB, Hyperbilirubinemia
Shots for 2 Phototherapy - take I/O b/c dehydration Feeding, exchange transfusion, education
81
Circumcisions (4)
Controversial, medically unnecessary by AAP Gomko or Plastibell procedure Local anesthetic, lidocaine, penile block can be used Tx similar to cord stump
82
Tx Neonatal Pain (2)
swaddling, pacifier, nonnutritive sucking | Tylenol, MorphineSulfate, Fentanyl, Toredol, Local anesthetic
83
Suncreen for baby?
Not until 6 months
84
``` Newborn ranges (temp, RR, feeding (formula/breast), elimination, # and development) ```
36. 5ºC - 37.2ºC 97. 7ºF - 98.9ºF 30 - 60/min q3-4hrs formula, q1-2hrs breast 6 - 8 daipers/day, meconium -> green -> yellow/ojbrown
85
Car seat safety
Backseat | Backwards until > 20 lbs, then forward!
86
Vaccination follow up times
birth, 2 wks, 2, 4, 6, 12, 15 months THEN Kindergarten.
87
Physical Developmental Milestones | 1, 2, 4, 6, 9,12 ,15, 18 months
reflexes, head control, roll over,sits, stand w/ help, stands alone, run/climb, mobile!
88
Baby Oil
non aromatic, mix w/ water inc. allergic rx
89
Food introduction
Solids @ 4 - 6 months, veggies first, then fruits (slowly inc. allergic rx) Meats @ 9 months NO COWS/ALMOND for 1 year
90
AAP says (about breastfeeding)
exclusively for 6 months, continue for 12. | Weaning will happen by mother/infant over time
91
Lactogensis (highest point, basic concept, uniqueness, 2 porteins)
first 10 days postpartum Supply and demand, baby! ▲ with needs of infant Whey (lactalbumin)/Casein (Cud)
92
Breastfeeding also r/in release of what hormone? Which is responsible for what reflexes?
Oxytocin, Milk-Ejection/Let-Down Relfexes
93
Infant Growth spurts @...?
2, 3, 6 weeks, 3, and 6 months
94
Lactogenesis Stage I vs II
1. 16 - 18 weeks, clear yellow w/ IgA (part of passive immunity). ↑ protein ↓ fat 2. 3 - 5 days, copious milk!
95
FOREMILK vs. HINDMILK
F - ↑ fat content, 60% skim 35% whole. lactose, protein, vitamins H - cream, 10 - 20 min into feeding. ↑ calories for more growth
96
Positionings (4)
Football Across lap Cradling Lying sideways
97
Latching Procedure
Manually express a few drops to lubricate and entice, GO DEEP. Should be NOT painful, SMOOTH, HEAR swallowing
98
MER/Let Down S/fx
uterine cramping, accomodating breasts, tingling, NORMAL
99
Mother... | Diet, weight loss, rest, breastcare, meds
``` + 500 extra calories, continue prenatal ↑ weight loss Rest as much as possible, when kid sleeps NO SOAP Meds mostly safe, check HALE if needed ```
100
Boob concerns and tx
Engorgement - Ø simulation, cabbage Sore nipples - latch, lanolin Monilial infx - antifungal Plugged ducts - massage/warm h2o OR antibiotics
101
High Risk Pregnancy counter
proper identification and timely intervention
102
Daily Fetal Movement Counts (DFMC)
Ø movement for 12 hrs = fetal alarm signal
103
NonStress Test
EFM accelerations with contractions, drink OJ or sugar if needed (acoustic too!)
104
Contraction Stress Test
nipple contract/give oxytocin and access for decels
105
Biophysical Profile Tests (5) | UNPAM
Ultrasonagraphy - look @ HR and baby Nuchal Translucency - nape fat (downs) Percutaneous Umbilical Blood Sampling - placental tissue for disease Amniocentesis - amniotic fluid for disease MRI - visual assessment
106
BBP Timings Ultrasound and Nuchal Translucency
U - ♥ @ 6 - 7 weeks, GA 22 weeks | N - 10 - 14 weeks
107
Alpha-Fetoprotein (AFP) and Coombs
maternal serum for neural tube defects (detects 80 - 85% and recommended for all). Produced in liver, ↓ ind. downs Coombs tests Rh compatibility (if mom - and baby +, give Rogam)
108
Biophysical Risks (3)
Genetic Dz, Nutrition, Medical/Obstetric (PMH/Prego) Dz
109
Psychosocial Risks (5)
Smoking, drugs, alcohol, caffeine, psych status
110
Environmental Risks include...?
exposure to chemicals/falling down
111
Uteroplacental Insufficiency (UPI)
gradual decline of delivery related substance by placenta to fetus, threat to fetal growth.
112
Spooky NST, CST, BPP!
Assessments scare family, be therapeutic and educational.

ABSN Cohort 19 (28 decks)

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