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OB Level 4
OB/ PEDI
| Question | Answer |
|---|---|
| Expectations of the LVN in Obstretric situations | Manage complications, give intensive support, facilitate the laboring process |
| What is important in immediate assessment? | Birth imminence, fetal and maternal status, factors leading up to hospital visit( i.e. trauma) |
| What is important in non-emergent assessment? | Health history, status of labor ( vaginal exam), birth preferences, labor preferences |
| Labs that are important to OB? | CBC, Blood type and RH, VDRL or RPR, Rubella, ELISA, vaginal culture, and UA. |
| What are you palpating for on the fundus? | Mild contraction- tip of nose Moderate Contraction - chin Strong contraction- forehead |
| What is TOCO? | Device used to measure the contraction frequency and duration. This is to be placed on the hardest spot of stomach. |
| Baseline FHR | Normal 110 - 160 bpm *Tachycardia >160 *Bradycardia <110 Must continue for 2 minutes. NEED VARIABLES |
| Accelerations | -15 X 15 minute window |
| You have a mom in active dilation, what needs to be done by the nurse? | Monitor FHR every hour, maternal status, fetal membranes, and mom's psychi. |
| What is the nurses primary concern during laboring process? | Maternal and fetal safety. |
| The possible signs of pregnacy | Early breast changes, amenorrhea, morning sickness |
| The probable signs of pregnancy | bladder irritability, presence of HCG in blood , and uterine growth. |
| What could the presence of HCG in blood also be due to? | Hydatiform mole |
| Describe Chadwicks sign. | A bluish -purple color of the cervix , vagina, and perineum |
| Describe Goodell's sign. | The softening of the cervix |
| What is the best indication of pregnancy? | Visualization of fetus by ultrasound at 6 weeks |
| Fetal circulation uses three shunts, what are they? | Ductus venosus, foramen ovale, ductus arteriosus. Exchange happens in the intervillus spaces. |
| How does one determine the severity of a defect in a fetus? | Depends upon when during developmenty the conceptus is exposed to the teratogen and the agent to which the fetus was exposed. |
| What infectious agents are considered dangerous to a fetus? | Varicella , cytomegalovirus (CMV), abd Rubella |
| Where do ectopic pregnacies occur? WHY? | 95% occur in the fallopian tubes Caused by blockage or scarring of the fallopian tubes |
| Risk factors for twins | Family history Recent cessation of birth control Tall or large stature of mother African - American Use of fertility medications |
| What four main functions does the amniotic fluid serve? | Physical protection Temperature regulation Provides unrestricted movement Symmetrical growth |
| Where does the baby get its nourishment in utero? | The placenta |
| What are the main functions of the placenta | Exchange of substances Acts as a barrier Producing hormones |
| Umbilical cord | TWO-2 arteries bring deoxygenated blood from the fetus to the placenta. ONE-1 vein carries oxygenated blood and nourished blood from the placenta to the fetus Whartons Jelly surrounds these three. |
| Describe the pre-embryonic period | Cleavage begins 3 Days- morula forms 5 Days- blastocyst form 10th day- blastocyst buries itself in uterine wall. |
| Tell when the embryonic stages begin and end | Lasts from the end of the (2) second week after fertilization until the end of the 8th week |
| Name the three germ layers | Ectoderm-skin, hair Mesoderm- Bones, muscles Endoderm-glands , lungs |
| Describe the fetal stage. | From the beginning of the 9th week after fertilization and continues until birth. Growth and maturation of the organs and bodys systems |
| List menstrual disturbances | Amenorrhea- Absence Menorhagia- heavy bleeding Metrorrhagia- occurs at irregular intervals Dysmenorrhea- painful |
| How much water do newborns require? | 80 - 100 ml/kg/day |
| Advantages of breastfeeding | Rapid uterine involution Less bleeding Weight loss Provides protection against infection |
| Contraindications of breastfeeding | Illegal drug use Active TB HIV Chemo Herpes on the breast |
| What is Galactosemia? | An error of metabolism. Lacks enzymes to break down sugar. Baby requires special formula. |
| When the newborn sucks on the breast what happens? | The pituitary gland releases prolactin and oxytocin. Prolactin stimulates milk production and oxytocin pushes the milk down. |
| What can inhibit the let down reflex? | Alcohol |
| Teaching for infant sleep - wake cycle. | Baby sleeps 16 out of 24 hours. |
| 4 ways to hold the baby | Cradle Colic Football Upright |
| What to watch for in formula fed babies on iron? | Constipation |
| Teaching for mom and dad after circumcision. | Do not clean with alcohol Do not remove the yellow mucus from penis |
| S / S of infant respiratory distress | Nasal flaring Chest retractions Grunting |
| Initial care of newborn | Maintain airway- Keep bulb syringe handy V/S 30 min. x 2, then every hour Thermo regulation- prevent heat loss Prevent infection |
| How to check sucking reflex | Few sips of sterile water Offer the breast |
| What is not present at birth , that must be given at birth? | Vit K - clotting factors 0.5 to 1 mg ( Do not give with Hep B , alternate sites.) |
| Bulging fontanels are signs of | ICP, infection, hemorrhage |
| Moro reflex | Startle, clap hands near baby |
| APGAR | HR 100- 160 RR 30 - 60 Muscle Tone well flexed Reflex Good cry Color completely Pink 0 to 2 |
| Glucose for infant | 40- 60 |
| Bilirubin | greater than 6= jaundice |
| Signs that the baby is not feeding well | Dry mouth Not enough wet diapers Cant wake baby up |
| Assessment of proper breastfeeding | Audible swallowing( clicking) Rhythmic Jaw gliding Mom has uterine contractions |
| Mastitis | Flu-like symptoms, low grade fever But mom can still breastfeed |
| Fore milk | Watery,thin,blue |
| Hind milk | Thick, white, Full of fat |
| Adequate signs of oxygenation | Moist and pink mucus membranes |
| ____________ heat loss is when the babys skin touches a cooler surface causing a heat transfer. | Conduction |
| This refers to the swelling from bleeding under the skull of the neonate resulting from birth trauma. | Cephalhematoma |
| Simian crease | A single straight crease on the palm that is associated with Down syndrome |
| In a postpartum female, ______________ could be a sign of developing pre-eclampsia. A falling ______________ , is suggestive of a hemorrhage. | Elevated blood pressure Falling Blood pressure |
| This occurs the first few days after birth, when the body rids itself of excess fluid. Particularly at night. | Diaphoresis |
| A delay in passing the first meconium may indicate what? | Hirschsprung's disease or Cystic Fibrosis |
| Proper way to reheat breast milk | Place bottle in a sauce pan of hot water. |
| How long should a mother brestfeed exclusively before introducing a bottle of her milk? | 6 weeks |
| What complications come with poorly controlled DM during pregnancy? | Birth defects Still birth HTN Polyhydramnios - excess amniotic fluid Preterm delivery Shoulder dystocia |
| What is macrosomia? | Huge baby |
| What do we not give DM mommies? | Oral insulins, they are teratogenic |
| S/S of hypoglycemia | Anxiety Cold and Clammy Skin Shaky Increased pulse Confusion Headache Hunger |
| S/S of cardiac problems in mom | Tachycardia Dizziness Light headed |
| This is the earliest sign of cardiac decompensation | Persistent rales in the base of lungs and nocturnal cough |
| Common signs of iron-deficiency anemia | Tachycardia tachypnea dyspnea pale low blood pressure fatigue weakness |
| The pregnant woman in status asthmaticus recieves aggressive treatment with ________________ and mechanical ventilation in ICU | Early intubation |
| TORCH | Toxoplasmosis Other- HepB, Syphilis, Varicella,Herpes Rubella Cytomegalovirus |
| S/S of acute HIV | Swollen lymph nodes, feeling tired, weight loss, night sweats, fever, persistant infections, short term memory loss |
| MAin goals of treatment in pregnant HIV | Prevent progression and transmission to fetus |
| What are typical child bearing years? | Ages 15 to 44 yrs |
| Why are pregnant teens at high risk for poor prenatal care? | Body image, no support, and deficient knowledge. |
Created by:
shanda.brown
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