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MC OB Exam 2

M. Collins

outlet between the 2 ischial spines
outlet must be what? 10 cm or more
fully engaged @ what? 0 or ischial spines
which fetal lie do we want? longitudinal
frank breech both feet @ head
complete breech both legs indian style
footling breech feet first
normal altitude flexion
effacement softening thinning shortening of cervical canal
pain relieved by ambulation, change of position, resting, or hot bath/shower is what? false labor
1st stage latent phase beginning of dilation - 3 cm
1st stage latent phase primigravida & multigravida prima: 8 hrs multi: 5 hrs
1st stage active phase 4 cm - 7 cm
1st stage active phase primigravida & multigravida prima: 4 hrs multi: 1 hrs
1st stage transition phase 8 cm - 10 cm
1st stage transition phase primigravida & multigravida prima: 2 - 3 hrs multi: few min
2nd stage 10 cm - birth
3rd stage birth - delivery of placenta
3rd stage time 30 mins or less
4th stage 1 - 4 hrs after birth or until stable
Aquamaphyton dosage 0.5 - 1 mg
ROM monitor temp when q 1 - 2 hr
Vaginal exams are what? Sterile
cord prolapse risks head up high or premies
help to fix prolapsed cord trendelenburg
midline episiotomy easier repair, decrease heal time, bleeding & pain, but increase risk of tear
medio-lateral episiotomy increase risk of bleeding, increase in OB assistance, decrease rectal tear
2nd degree laceration muscle of perineum & fascia
3rd degree laceration anal sphincter
4th degree laceration large, rectal mucosa to lumen of rectum
1st degree most common small skin & vaginal mucosa
3rd stage NI provide immediate newborn care & obtain cord blood
Cord should have what vessels AVA
Oxytocin increase perfusion= increased Hr with continuation decrease HR (fetus) increase HR - no increase SV (fetus)
CI for Oxytocin administration not too freq (increase 90 sec apart) not too long (increase 90 sec)
4th stage NI palpate fundus q 15 min for 1 hr VS q 15 min for 1 hr & q 1 hr for 4 hrs
Fetal HR 110-160 bpm
Narcotics don't give within 2 hrs of delivery
antagonist for narcotics Narcan except with Valium
H1 Receptor antagonist may lead to decrease mom BP & decreased perfusion
Spinal complications hypotension, drug reaction, total spinal neurologic sequelae, spinal headache, N, shivering, urinary retention, ineffective
epidural complications toxic reactions: unintentional placement, excessive amount, accidental IV injection, & spinal headaches
pudendal complications systemic toxic reaction, broad ligament hematoma, perforation of the rectum, trauma to sciatic nerve
general anesthesia fetal depression, uterine relaxation, potential for chemical pnuemonitis
chemical pneumoniitis decrease GI motilitic, acidic gastric secretions
CI for General Anesthesia preterm infant, preeclampsia (causes HTN), diabetes, cardiac, & bleeding
preeclampsia perferred pain control regional
cardiac perferred pain control continuous epidural avoids cardiovascular changes with bearing down
bleeding preferred pain control regional reduction in volume
POTIP Pitocin off O2 by facemask 8-10 L/min Turn pt Increase IV rate (fluids) Prepare for STAT c-section
Pitocin can cause what? too many contractions
acceleration reassuring & no intervention
variable deceleartion no relationship to contraction typically related to cord compression fix by repositioning mom
late deceleartion DONT WANT decrease in HR after peak of contraction & returns baseline after indicates fetal distress
Newborn adaptations cardiovascular increase blood to lungs, increase LA pressure, decrease RA pressure, increase vascular resistance
Newborn adaptations thermoregulation thermogenesis: heat production demand for O2 & glucose brown fat: adipose to NWB
ABCT airway, breathing, circulation, temperature
blood coagulation (Vitamin K) keep hemostasis
Newborn adaptations hepatic blood coagulation iron storage carbohydrate metabolism
Newborn concerns for iron storage maternal anemia or premature
how long is maternal storage for infant 5 months
digestive enzymes for newborn pepcinigin & lipase
indirect bilirubin dead RBC converted from fat soluble to water soluble
direct bilirubin water soluble
physiological hyperbilirubin occurs after 24 hrs of life & resolves with hydration, freq feedings, & phototherapy
pathological jaundice within 1st 24 hrs of life not normal metabolic disorder or deprived of O2
Vitamin K coagulation
Erythromycin clamydia
Erythromycin given what? OU
respirations below 60 are at what risk aspiration
rectal temp if no meconium stool
respirations newborn 30-60 bpm
temperature 97.7-99.0
convection keep baby away from drafts & ducts & O2 must be warmed
radiation cold hands, incubator walls, ice bags
conduction minimize contact of neonate with cold object/hnad
evaporation dry STAT at delivery, 25% loss occurs at delivery, keep diaper & clothes dry
smoking risk LBW
nutritional status risk LBW or HBW
drug use risk LBW or premature
gestational assessment graph estimated gestational age
acrocyanosis extremities
circumoral cyanosis around mouth with feed/cry = NOT GOOD
central cyanosis all over
harlequin color on half of body
plethora red all the time
petechia & ecchymosis are seen with what? rapid descent
erythema toxicum newborn rash (exposure to clothes/blankets)
millia white bumps on cheeks, nose, chin, baby acne from blocked sebaceous glands
telanglectic nevi "stork bites" blanch with pressure. dilated capillaries
mongoloian spots blue gray on butt/back (oriental/african)
nevus flammeus vascular flat purple no enlargement usually on the face. don't enlarge or fade. "port wine stain"
nevus vasculosus raised rough disappear with age "strawberry"
vernix caseosa cream cheese
raised fontanelle with increased ICP
sunken fontanelle with dehydration (DHD)
cephal hematoma doesn't corss suture line doesn't increase in ize with crying appears on day 1-2 disappears in 2-3 wks-1 m collection of blood resulting from ruptured blood vessels between surface of cranial bone & periosteal membrane
caput succedaneum crosses suture line present at birth or shortly after reabsorbed within 12 hrs-few days collection of fluid edematous swelling of the scalp
low set ears is possibly down syndrome
2 vessel cord can be cardiac
PKU measures presence for enzymes penalketeuria
how are PKU measured? by heelstick
PKU not present brain damage
maternal VS measured when during 2nd stage? q 5-15mins
FHR measured when during 2nd stage? q5min
Important nursing intervention during 2nd stage note time of delivery
Transition phase contractions are q 15-30 mins
transition phase maternal VS assessed q 30 min
transition phase FHR assessed q 15-30 min
active phase contractions are 15-30 min
active phase FHR assessed q 30 min
fetal O2 supply is cut off Emergency C-section
latent phase maternal VS q 4 hr unless ROM
latent phase contractions q 15-30 min
latent phase FHR status q 15-30 min
duration of 3rd stage 30 mins or less
2nd stage contractions freq: 2-3 min duration 50-90 sec intensity: strong
transition phase contractions freq: 2-3 min duration: 50-90 sec intensity: strong
active phase contractions freq 2-5 min duration: 45-60 sec intensity: mod-strong
latent phase contractions freq: 5-20 min duration: 30-45 sec intensity: mild
fetal head most common presenting part bones, sutures, fontanels
fetal station relationship of presenting part to mom ischial spine
fetal lie relationship of spinal column of fetus to that of mom
fetal presentation part of fetus entering mom pelvis
fetal position relationship of presenting point to mom pelvis
fetal altitude relationship of fetal body parts to one another
progressive dilation & effacement true
regular contractions increase in freq, duraiton & intensity true
pain starts in back & radiates to abdomen true
pain not relieved by ambulation or resting true
lack of cervical effacement & dilation false
irregular contractions DONT increase in freq, duration & intensity false
contractions in lower abdomen & groin false
pain relieved by ambulation change of position, resting or hot bath/shower false
estrogen role in labor stimulates uterine muscle to contract
dilation opening & enlargement of the cervix
Nitrazine test assess fluid for amniotic fluid. must be blue for baby
what is vital for activation of smooth muscles Ca
Oxytocin must be administer how? IV on a pump
what is endogenous way to release oxytocin? stimulation of the nipples
erythromycin dosage 0.5-1 cm long across lower conjuctival surface of each eye
normal blood glucose for newborn 40-95 mg/dl
a cold baby is a risk for hypoglycemia
safety precautions for bili light therapy frequent temperatures 3-4 hrs, patches over eyes, monitoring levels
gastric capacity on 1st day 30-40cc
gastric capacity 3-4 days 90cc
greenish brown stool transitional stool
black stool meconium
yellow loose seedy stool breastfeeding baby
how many voidings 1st day 4-6
how many voidings after 1st day 20
weight loss in 1st 5-7 days 15%
brick dust uric acids crystals heavy looks like peach color with tiny crystals
igM does not cross placenta & thus gram + infection fight is limited
igA found in colostrum & fights against GI & respiratory infections
hypospadias urinary meatus located on ventral
epispadias urinary meatus located on dorsal surface
2nd period of reactivity for newborn 30 mins of inactivity really goes to sleep for 2-4 hrs
hepatitis B shot administered where? vastus lateralis
low glucose S&S lethargic, tremors, cold stress
APGAR scoring 7-10 okay 6-7 some interventions >5 problem
APGAR scores what? HR, respiratory effort, muscle tone, reflex irritability, & color
APGAR HR scale 0=absent 1=<100 2=>100
APGAR Respiratory scale 0=absent 1=slow irregular 2=good cry
APGAR muscle tone 0=limp 1=some flexion 2=active motion
APGAR reflex irritability 0=no response 1=grimace 2=cry
APGAR color 0=pale 1=body pink & blue extremities 2=all pink
APGAR done when? 1min & 5min
heel sticks done where? on edges of heel to avoid nerves
average length of newborn 50 cm (20 inches)
average head circumference 32-37 cm (12.5-14.5 inches)
significance between head and chest circumference 2 cm head larger
Pseudostrasbismus continuous look cross-eyed & bridge very wide
vision of newborn binocular 9-12 inches best fixate up to 10sec on object
babies obligatory what breathers? nose
if baby is drooling sign of what esophageal atresia
if low set ears what other system do you need to assess kidneys
shift in PMI is hernia or pneumothorax usually
umbilical cord is kept dry
labs of newborn bilirubin, CBC (WBC, RBC, H&H), glucose, PKU
nurses role in circumcision not eligible to get informed consent
care for circumcision never pull off gauze, check for bleeding, report swelling, decrease in urinary output, drainage, or swelling
what is readily available during circumcision bag & mask
plastibell circumcision with no cutting, falls off when done
Created by: midnight1854