Test 3 OB/GYN Past Paper Study Guide - PDF

Test 3 OB/GYN :) Study online at https://quizlet.com/_elzsn7 edematous area of the scalp most commonly found on the occiput what is caput?...

Test 3 OB/GYN :) Study online at https://quizlet.com/_elzsn7 edematous area of the scalp most commonly found on the occiput what is caput? that crosses suture lines, from birth trauma a collection of blood between the skull bone and the periosteum, what is a cephalohematoma? typically from birth trauma, does not cross the cranial suture lines why is Vitamin K given to the baby? prevent hemorrhagic disease of the newborn tachypnea that appears soon after birth that occurs when fetal liquid in lungs is removed slowly or incompletely; common in c what is transient tachypnea of the newborn? section babies; resolves over 24-72 hours, not true respiratory distress how many voids per day is normal in the newborn? 6-8 what is normal estimated blood loss for vaginal birth and a c vaginal - less than 500mL section? c section - less than 1000mL tone - uterine atony tissue - retained placenta and clots what are the 5 Ts of postpartum hemorrhage? trauma - vaginal, cervical, or uterine injury thrombin - lack of coagulopathy traction - uterine inversion what is the most common cause of postpartum hemorrhage? uterine atony multiparity, multiple gestation (twins), polyhydraminos, macroso- what are risk factors for postpartum hemorrhage? mia, chronic coagulation disorders, prolonged labor, induction of labor, general anesthesia oxytocin, misoprostol (Cytotec) per rectum, carboprost, what uterotonics may be given to stop postpartum hemorrhage? methergine, transexemic acid (lysteda) what types of patients can't receive carboprost? those with asthma what types of patients can't receive methergine (methyler- patients with hypertension or preeclampsia gonovine)? NSAIDs, tedhose, anticoagulant therapy (heparin), emergency how do you treat a DVT? measures for pulmonary embolism, plenty of fluids what are signs and symptoms of a DVT? unilateral swelling of extremity, very tender, red, hot infection of the endometrium, decidua, and adjacent myomentrium what is metritis? -- aka infection of the uterus after delivery; S&S of tender ab- domen, treat with IV ABX infection of the breast, S&S of red, painful, swollen, warmth in one what is mastitis? breast; treat with ABX and emptying of breast; usually caused by poor latch or breakdown of nipple tissue that becomes infected what does REEDA stand for? redness, ecchymosis, edema, drainage, approximation aka postpartum blues; completely normal; S&S of emotional la- what are baby blues? bility, irritability, insomnia; typically resolves within 2 weeks by postpartum day 10; self limiting typically not normal; major depressive episode associated with childbirth; symptoms last beyond 2-6 weeks and worsen; S&S of hopeless- what is postpartum depression? ness, worthlessness, guilt, anhedonia, loss of libido, feeling sad, greater than 12 on the Edinburgh scale; treat with SSRI as gold standard BAD; surfaces within 3 weeks of giving birth; increased risk with hx of mental illness; S&S of sleep disturbances, fatigue, depression, what is postpartum psychosis? hypomania, hallucinations, delusions; NEVER leave infant alone with mother if this is suspected weigh less than 2500g at term or are below the 10th percentile for whatever gestational age they are; head disproportionately bigger than body, wasted appearance of extremities, loose dry skin, what are small for gestational age newborns? reduced SubQ fat stores, wide skull sutures, thin umbilical cord, prone to hypothermia; common problems of perinatal asphyx- ia, difficulty thermoregulating, hypoglycemia, hyperbilirubinemia, 1/5  Test 3 OB/GYN :) Study online at https://quizlet.com/_elzsn7 birth trauma; feed frequently and early, monitor temps, monitor for polycythemia weight greater than 90th percentile or weight >4000g at term; poor motor skills, difficulty regulating behavioral states, proportional what are large for gestational age newborns? increase in body size, large, plump full faced; #1 risk factor for this is maternal diabetes birth trauma, shoulder dystocia, hypoglycemia, hyperbilirubine- mia, asphyxia, jaundice what are common problems seen in a LGA baby? - treat by monitoring vitals and blood glucose, hydrate, photother- apy for increased bilirubin levels what is a postterm baby? born after 42 weeks what is a preterm baby? born before 37 weeks what is a late preterm baby? born between 34 +0 and 36+6 dry, cracked wrinkled skin, may be meconium stained, long thin extremities, long nails, wide eyed alert expression*, abundant hair what does a postterm baby look like and what are their common on scalp, thin umbilical cord, limited vernix and lanugo; common problems? problems of perinatal asphyxia, hypoglycemia, hypothermia, poly- cythemia, meconium aspiration* what is the most common problem seen in postterm newborns? meconium aspiration what are the 2nd leading causes of infant death in the US? prematurity and low birth weight appearance: weight < 5.5lbs, scrawny, poor muscle tone, minimal subq fat, undescended testes, lots of lanugo, poorly formed ear pinna, soft spongy skull bones, matted scalp hair, absent to few what does a preterm newborn look like? creases in soles and palms, minimal scrotal rugae, prominent labia and clitoris, thin transparent skin, abundant vernix*, fused eyelids hypothermia, hypoglycemia, hyperbilirubinemia, problems related what are common problems seen in a preterm newborn? to immaturity of the systems especially problems breathing and eating since lungs and neurological systems are last to mature what does the nursing management of the preterm newborn in- oxygenation, thermal regulation, nutrition and fluid balance, infec- clude? tion prevention, stimulation, pain management, parental support respiratory distress, hypoglycemia, temperature instability, poor what problems do late preterm babies typically experience? feeding, jaundice, discharge delays failure to establish adequate, sustained respirations after birth what is neonatal asphyxia? - S&S of grunting, nasal flaring, low O2, retractions; treat with immediate resuscitation, blood glucose levels, support T/F: Neonatal asphyxia commonly resolves within 72 hours after False, transient tachypnea of the newborn typically resolves within birth. 72 hours lung immaturity and lack of alveolar surfactant major contributing factors; may see ground glass appearance on x ray which means atelectasis; seen often in premature infants, perinatal asphyxia, what is respiratory distress syndrome? cold stress, or maternal diabetes; S&S of grunting, nasal flaring, chest wall retractions, tachypnea, generalized cyanosis, heart rate greater than 150, fine crackles - supportive care (endogenous surfactant through an ET tube) -close monitoring - ABX for positive cultures how do you manage respiratory distress syndrome in the infant? - correct metabolic acidosis - cluster care - prone or side lying position - fluids and vasopressors, gavage or IV feedings inhalation of particulate meconium with amniotic fluid into lungs, secondary to hypoxic stress; seen most often in postterm infants; what is meconium aspiration syndrome? risk factors of placental insufficiency, cord compression, maternal HTN, oligohydraminos, or maternal drug abuse; S&S of tachyp- 2/5  Test 3 OB/GYN :) Study online at https://quizlet.com/_elzsn7 nea, barrel chest, retractions, cyanosis, atelectasis, end-expirato- ry grunting how do you treat meconium aspiration syndrome? suction at birth, cluster care, neutral thermal environment hypoxic ischemic encephalopathy; deadly and need cooling pro- what is the biggest issue with meconium aspiration syndrome? tocol to preserve brain function T/F: the underlying problem associated with meconium aspiration true syndrome in utero involves hypoxic stress what is the number one symptom seen in infants from diabetic hypoglycemia mothers? full rosy cheeks, ruddy skin, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subq fat, hypo- what are S&S seen in infants from diabetic mothers? glycemia, hypocalcemia, hypomagnesemia, polycythemia, hyper- bilirubinemia what is the most important management of infants from diabetic careful monitoring of serum glucose levels mothers? what is the number one sign of low blood glucose in newborn jitteriness (shivering - remember babies don't shiver to regulate babies? temp) what is the best way to manage infant hypoglycemia? PO breastfeeding or formula what is hypoglycemia in the newborn? less than 40 mg/dL what is the chief complication from any birth trauma that caused hyperbilirubinemia/jaundice bruising? imbalance in rate of bilirubin production and elimination; total what is hyperbilirubinemia? serum bilirubin level > 5 mg/dL more severe, occurs within 24 hours of life, often caused by Rh what is pathologic jaundice? isoimmunization or ABO incompatibility; requires phototherapy or exchange transfusion "normal newborn jaundice", occurs after 24 hours of life usually what is physiologic jaundice? at day 2-3, usually the result of the immature liver's inability to process excess old red blood cells, often resolves on its own phototherapy, early feeding and elimination is key, exchange how do you manage hyperbilirubinemia? transfusions in worst case usually manifests within 24-48 hours after birth, acquired in peri- what is early onset or congenital sepsis? natal period, GBS is most common causative agent, treat with ABX occurs 7-30 days of age, considered to be an infection acquired what is late onset sepsis? in the hospital or community; treat with ABX what is one of the most common causes of neonatal death? neonatal sepsis what is the number one sign of neonatal sepsis? hypothermia - temperature less than 97Ú F low nasal bridge, epicanthal folds, minor ear abnormalities, indis- what are S&S of fetal alcohol syndrome? tinct philtrum, thin upper lip, flat midface and short nose, cognitive and behavior changes and problems throughout life what does a score greater than 8 twice on the Finnegan Assess- means the infant needs supplementary narcotics to wean them off ment Tool mean? safely what does surfactant do? prevents alveolar collapse by reducing surface tension what is the only immunoglobulin to cross the placenta? IgG (Also most abundant) what is a major source of IgA? human breastmilk immunoglobulin that does not cross the placenta and protects what is IgA? mucous membranes from viruses and bacteria - found in gut and respiratory tracts; second most abundant immunoglobulin that is the main source of protection from blood what is IgM? borne infections; does not cross the placenta, levels are low at birth 3/5  Test 3 OB/GYN :) Study online at https://quizlet.com/_elzsn7 how does heat production occur in the newborn? metabolism of brown fat (NOT THROUGH SHIVERING) transfer of heat from object to object when the two objects are in what is conduction (in the newborn)? direct contact with each other: ex. baby on a cold scale flow of heat from body surface to cooler surrounding air or to air what is convection (in the newborn)? circulating over a body surface: ex. baby under a draft loss of heat when a liquid is converted to a vapor: ex. baby after a what is evaporation (in the newborn)? bath loss of body heat to cooler solid surfaces in close proximity but not what is radiation (in the newborn as far as heat)? in direct contact: ex. baby next to a cold window conduction - place infant skin to skin, warm objects like scales or stethoscopes on scales before putting infant on them convection - use blankets and clothing to insulate infant - swad- how do you prevent heat loss through the four mechanisms? dling evaporation - dry newborn immediately after birth and baths radiation - use radiant warmer for long procedures or baths birth to 30 minutes to 2 hours after birth - newborn is alert, moving, what do the first 8 hours of life look like as far as activity of the may appear hungry; 30 to 120 minutes old - period of sleep or newborn? decreased activity; 2 to 8 hours old, newborn awakens and shows interest in stimuli what are the 5 S's of consoling a baby? swaddling, side lying, shushing, swinging, sucking (aka feeding) infant must be at least 12 hours old, infant has received Vitamin K, infant has voided normally at least once since birth, infant what does preop circumcision prep look like? has not eaten for at least one hour prior to procedure, consent documented on chart document 1st void to evaluate for obstruction or edema, assess bleeding every 30 minutes for at least 2 hours, a small streak of blood on diaper is normal but active bleeding is not; instruct par- ents to report foul smelling drainage; apply petroleum impregnated what is post circumcision care? gauze for at least 24 hours; clean with warm water and mild soap; delay submersion baths until after cord falls off bc penis should be healed by this time; instruct parents not to remove yellow exudate that forms around head of penis as this is a normal part of healing* wait to submerge in baths until cord falls off, dry cord completely after each bath and fold back diaper to allow to air dry; observe how do you care for an umbilical cord stump? for redness, drainage, or foul odor; never pull on cord or attempt to loosen it; typically dries and falls off within 7-10 days of life rubra - bright red what are the different types of lochia? serosa - pinkish brown alba - whitish-yellow Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy and per- what does BUBBLEEE stand for? ineum, Extremities, Emotional Status when does volume milk come in? 4-5 days after childbirth wear a tight sports bra, use cabbage leaves and ice packs, face what should a bottle feeding woman do to decrease lactation? away from warm water in shower how often should postpartum women be encouraged to urinate? every 2 to 3 hours to prevent uterine displacement first degree - skin only, no muscle second degree - muscle, no anal sphincter what are the different degrees of perineal lacerations? third degree - external anal sphincter torn fourth degree - anterior rectal wall torn the rapid change in center of gravity that occurs in the postpartum risk for falls mother makes her at risk for what? nonlactating - 7 to 9 weeks after delivery how quickly will menstruation return for nonlactating and lactating lactating - 2 to 18 months, depends on breast feeding frequency women? and duration 4/5  Test 3 OB/GYN :) Study online at https://quizlet.com/_elzsn7 how many calories does a newborn need per day during the first 110-120 calories/kg of body weight 3 months of life? instillation of isotonic fluids into the uterine cavity through an intrauterine pressure catheter, often used to essentially wash out a uterus filled with meconium stained fluid, the instilled fluid then what is an amnioinfusion? flows back out of the body, blockage of this outflow could lead to increased resting tone of uterus and uterine rupture; can be used to replace lost fluid in oligohydraminos, may see cord compression as noted by variable decels - protect the airway - open/suction if necessary what are the steps to treat a seizure? - provide supplemental oxygen if desaturation occurs - maintain safety (side rails up) moms that are Rh negative regardless of if their baby is negative who do we give Rhogam to? or positive, at 28 weeks and in the postpartum period how do you give Rhogam? IV or IM those with a low transverse incision that had a previous c-section who are the best candidates for a VBAC? for a breech presentation previous classical incision, myomectomy, cephalopelvic dispro- what are contraindications to a VBAC? portion, previous c section due to failure to progress what is the risk of a VBAC? uterine rupture decreased blood pressure, decreased urine output*, decreased what are signs of magnesium toxicity? respirations less than 12, and absent or decreased DTRs how often should newborns be fed? every 2-3 hours if breastfed, every 3-4 hours if bottlefeeding 5/5