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MC OB Exam 2
M. Collins
| Question | Answer |
|---|---|
| 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
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