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ob/peds exam 3
| Question | Answer |
|---|---|
| Causes for perinatal loss | congenital abnormalities, Placental abruption or previa Intrauterine growth restriction Maternal conditions (HTN disorders, diabetes) Infection Preterm labor / PROM Asphyxia Unknown/idiopathic stillbirth |
| Perinatal loss therapeutic communication | Validate feelings: “I’m so sorry for your loss” Use the baby’s name if the family has chosen one Avoid clichés Offer keepsakes Support bonding if desired (holding, bathing, naming) |
| End of life care | Provide comfort-focused care (warmth, pain relief, holding) Allow unlimited family time Swaddle and maintain dignity Support family decision-making (autopsy, burial, spiritual care) Provide written grief resources and follow-up support |
| Newborn assessment APGAR | A activity: 2 points for spontaneous motion P pulse: greater than 100 bpm G grimace: crying, movement A appearance: entirely pink R respirations: crying vigorously |
| Nomal temp, hr, rr | 97.7-98.6 120-160 30-60 |
| Anteriro and posterior fontanelle closings | Anterior fontanelle closes 13-24 months Posterior fontanelle 6-8 weeks |
| Birth weight fluctuations | They will lose up to 10% of their birth weight in the first three days and regain by 2 weeks |
| Cold stress can lead to | hypoglycemia, poor feeding, even respiratory distress |
| Caput succedaneum: | is edema on the scalp at birth, crosses suture lines |
| Cephalohematoma: | fluid (blood)accumulates below the periosteum, doesnt cross suture lines |
| Epstein pearls | white cysts in mouth |
| Hypospadias: | meatus is on ventral side |
| Epispadias: | meatus on dorsal side |
| Phimosis | foreskin is small |
| Cryptorchidism: | testes havent descended |
| Erythema toxicum: | rash of yellow or white papules |
| Cord expecations | will fall off in 7-10 days |
| Vitamin K | -in vastus lateralis 5/8 in -prevents hemorrhagic disease -given within 6 hours |
| Erythromycin ointment | -prophylaxis against gonorrhea/chlamydia conjunctivitis -within 24 hrs |
| Hep B vaccine | -given within 24hrs -prevents liver damage |
| Turbutaline | relaxes uterus in cases of fetal bradycarida related to tachysytole |
| Preterm infant findings | Thin, translucent skin Reduced subcutaneous fat Lanugo more abundant Soft ear cartilage Weak or absent reflexes Hypotonia, poor flexion Immature temperature regulation Periodic breathing, apnea More prone to hypoglycemia and infection |
| Full term infant findings | Skin thicker and more opaque More subcutaneous fat, better flexion Strong suck/swallow Well-formed ear cartilage Normal thermoregulation Stable respiratory pattern |
| Methods of heat loss | Evaporation: wet skin exposed to air Conduction: contact with cold surface Convection: air currents moving over the body Radiation: heat lost to nearby cold surfaces |
| Infant abduction precautions | ID bands HUGS security tag locked maternity unit staff wear ID badges parents instructed to not hand baby to anyone without ID never leave baby unattended |
| NB screenings | Blood test: PKU, congenital disorders Hearing and heart screening |
| Circumcision procedure | Done using Gomco clamp, Plastibell, or Mogen clamp Local anesthesia such as dorsal nerve block or topical anesthetic Sweet-ease/oral sucrose for comfort |
| Circumcision educations | Yellow exudate is normal during healing Avoid wiping Plastibell ring; it falls off in 5–7 days Keep area clean with warm water Petroleum jelly with each diaper change (Gomco/Mogen only) Watch for bleeding larger than a quarter, swelling, fever |
| Circumcision assessment | Check for bleeding q15 min for first hour Document voiding within 24 hours |
| Cleft lip and palate assessment | Opening in lip and/or palate visible at birth Difficulty feeding, nasal regurgitation |
| Cleft lip feeding and eduation | Use special bottles (Haberman, Pigeon) Feed upright Frequent burping For cleft lip repair: avoid pacifiers/pressure on suture line Post-op: elbow restraints, clean suture line with sterile water |
| Hip dysplasia s/s | Asymmetrical gluteal folds Limited hip abduction Positive Ortolani/Barlow tests |
| Hip dysplasia testing | Physical exam Ultrasound (infants <4–6 months) X-ray (>6 months) |
| Hip dysplasia treatment | Pavlik harness (maintains hip flexion/abduction) Bryant traction or surgical reduction if older or severe |
| Spina bifida prenatal testing | Elevated AFP (alpha-fetoprotein) Ultrasound detects neural tube defect Amniocentesis if needed |
| Spina bifida assessment | Visible sac (myelomeningocele) Weakness/paralysis of lower extremities Loss of bladder/bowel control |
| Spina bifida treatment | Protect sac with sterile saline dressing Prone positioning Surgical closure within 24–48 hours Monitor for infection |
| Baby blues | Anxiety, irritability, crying, insomnia 2-3 days |
| PPD s/s | Persistent sadness, crying Loss of interest, fatigue Sleep disturbance Feelings of guilt or inadequacy Possible thoughts of harm (emergency) |
| PPD treatment | Counseling/psychotherapy SSRIs Support groups Close follow-up |
| PPD education | Symptoms are not the mother’s fault Importance of sleep and support When to seek help immediately |
| Alcohol effects on fetus/nb | Fetal Alcohol Spectrum Disorders (FASD), growth restriction, facial anomalies, neurodevelopmental deficits |
| Opioid effects on fetus/nb | Neonatal abstinence syndrome (tremors, irritability, poor feeding) |
| Cocaine effects on fetus/nb | Placental abruption, preterm birth, placental abruption |
| Methamphetamine effect on fetus/nb | Low birth weight, irritability |
| Marijuana effect on fetus/nb | Possible neurobehavioral effects, LBW |
| Tobacco/nicotine effect on fetus/nb | fetal growth restriction, preterm birth, placental issues, neurodevelopmental disorders |
| Kernicterus | bilirubin deposits into gray matter of brain |
| How to check contraction intensity | forehead, nose chin |
| What to do for late decelerations | 10 L oxygen, turn patient, start bolus, maybe stop pitocin |
| Cord compression goes with | variable decleration |
| FHR baseline | average bmp excluding variability |
| Minimal variability | can be because of sleep, meds to mom, acidemia |
| Absent FHR variability | sign of compromised fetus |
| Marked variability | baseline is undeterminable and suggests hypoxia |
| Measure accelerations | 15 secs above and 15 bmp |
| Early decelerations cause and intervention | Cause: head compression Intervention: none, normal finding during active labor and head descends, prepare for birth |
| Variable decelerations cause and intervention | Cause: cord compression Interventions: reposition mother, amnioinfusion if ordered, stop oxytocin |
| Late decelerations cause and intervention | Cause: uteroplacental insufficiency, tachysystole, epidural hypotension Interventions: reposition to left side, oxygen, IV fluids, stop oxytocin, notify provider |
| Nursing care for down syndrome | support feeding, monitor cardiac issues, early intervention referrals |
| Autism plan of care | Promote routine and structure Reduce stimulation Use simple, direct communication Support family education and services Early behavioral therapy improves outcomes |
Created by:
yeaitsliv