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NSG 309 OBNB
final study guide
| Question | Answer |
|---|---|
| APGAR | 0-2 score per criteria with total 0-10 score - Assess @ 1 min + 5 min post partum -Color: Blue/Pale -> Blue extremities -> Pink -Pulse: Absent -> <100 -> 100+ -Grimace: None -> Grimace -> Cry/Cough -Activity: Limp -> Some flexion -> Active -Respirations: Absent -> Weak/irreg -> Strong cry |
| APGAR score Interpretation | 0-3: immediate resuscitation (PPV, compressions) 4-6: Moderate concern (O2 + stimulation) 7-10: Normal (Routine care) |
| GTPAL | Gravida: total pregnancies including current Term: Births @ 37+ wks Preterm: Births @ 20-36 wks Abortions: Losses <20 weeks (elective or spontaneous) Living: Current living children *Twins = 1 pregnancy* |
| Nagele's Rule | Estimated delivery date = LMP - 3 months + 1 week |
| Copper IUD | Nonhormonal implant lasting 10-12 years - Emergency contraception option within 5-7 day window |
| Progestin IUD | Progestin thickens mucus (stop sperm from reaching egg) - Lasts 3-8 years by type |
| Depo-Provera | Contraception via IM injection Q3 month - Fertility delays up to 9 months |
| Combined Oral Contraceptive Pills | - QD dose - Contraindications: Breastfeeding < 6 weeks, smoker >35 - ACHES signs are dangerous - DVT risk |
| Nexplanon | Subdermal contraceptive implant - 3 year effectiveness - 99% effective |
| Plan B | Emergency - Effective within 72 hours - Not abortion drug |
| Progestin only pill (POP) | - QD dose (AT SAME TIME for effectiveness) - Does not affect breast milk |
| ACHES | Warning sign for oral contraceptive - A: Abdominal pain (liver/pancreas/GB disease) - C: Chest pain/SOB (PE/MI) - H: Headaches (HTN/migraine/impending CVA) - E: Eye/Visual change (HTN/CVA) - S: Severe leg pain (DVT/thromboembolic event) |
| Fetal visit schedule | - Q4 weeks visit (>28 weeks) - Q2 weeks (28-36 weeks) - Qweekly (36+ weeks-delivery) |
| Fetal screening schedule | - 1st visit: ABO/Rh, CBC, HIV, GC/CT, Rubella, HBsAg, UCx, Hgb electrophoresis - 24-28 wks: Glucose tolerance test (1hr) -> 3hr GCT - 35-37 weeks: GBS Cx, HIV repeat |
| Informed Consent | - Provider obtains consent + nurse witness - Pt = A/O x 3 + understands w/ questions answered - NO coercion |
| AMA | - competent adults have right to legally refuse care + leave - Notify provider - Explain risks + AMA form + remove IV/Foley - Restraining = false imprisonment! |
| Cardiovascular Changes (Antepartum) | - Blood volume ↑ 40–45% - RBC ↑ 30% → physiological anemia - HR ↑ 10–15 bpm - BP ↓ 2nd trimester - supine hypotension (compression on ICV) → left lateral position |
| Respiratory Changes (Antepartum) | - Tidal volume ↑ 40–50% - O₂ consumption ↑ 15–20% - diaphragm elevates 5 cm - physiological respiratory alkalosis - epistaxis = normal |
| MSK Changes (Antepartum) | - Relaxin loosens joints - lordosis → fall risk - round ligament pain = brief, positional, benign (teach slow position changes) |
| Organogenesis | - 2-8 weeks (most critical teratogen window) - Folic acid 400 mcg before conception - NO EtOH |
| Fetal milestones | - Neural tube (close D28) - folic acid 400mcg - Heart forms (wks 3-6) - Surfactant production (wk 24) - Testes descend/bone marrow produce blood (wk 28) - Fat deposit/CNS/Lung maturation (wk 29-38) |
| Pregnancy Weight Gain | - <18.5 BMI = 28-40 lbs - 18.5-24.9 BMI = 25-35 lbs - 25-29.9 BMI = 15-25 lbs - >30 BMI = 11-20 lbs |
| Pregnancy Danger Signs | - Severe headache + Visual changes + Facial/hand edema = preeclampsia - Vaginal bleeding - Fluid leaking (PROM/PPROM) - Decrease fetal movement - Severe abd pain - Chest pain/dyspnea |
| Variable Patterns (FHR Monitoring) | Abrupt V shaped pattern + non periodic (d/t cord compression) - Reposition mother + D/C oxytocin - O2 supplementation - IV fluids - Notify provider |
| Early Patterns (FHR Monitoring) | Pattern mirror contractions (benign) - Document + no intervention |
| Accelerations Pattern (FHR Monitoring) | Increased FHR 15+ BPM x 15 sec (reassuring) - Indicate sufficient oxygenation - No intervention + monitor |
| Late Patterns (FHR Monitoring) | Bowl shaped after contraction peak (d/t placental insufficiency) - D/C Oxytocin + reposition - O2 supplementation - Correct hypotension - Notify provider STAT |
| FHR Category I | - Baseline 110-160 HR w/ moderate variability - No late or variable decelerations - Normal |
| FHR Category II | - Does not meet category I or III (indeterminate) - Monitor closely + address correctable cause |
| FHR Category III | Sinusoidal/absent variability w/ late decels/bradycardia - Indicate fetal anemia/hypoxemia = Immediate intrauterine resuscitation - Notify provider STAT - Prepare for delivery |
| NST | Non-stress test = monitor fetal heart rate - Positive result = good - 110-160 HR - Moderate variability (6-25 BPM) - 2 accelerations in 20 min w/o deceleration (early may be present) |
| Cord Prolapse | Sx: Sudden bradycardia s/p ROM (EMERGENCY) - gloved hand inside vagina pushing presenting part UP - Knee chest/trendelenburg position - Supplemental O2 8-10 L/min - NEVER replace cord into uterus Tx: Emergency C-section |
| Asthma in Pre-pregnancy | - SpO2 >95% - Upright positioning - Continue medications - Unresponsiveness to inhaler = Emergency |
| Pregestational Diabetes | - Fetal Risks: Macrosomia, fetal anomalies, polyhydramnios, preeclampsia - glucose control before conception |
| Chronic HTN in Pre-pregancy | - Mild: 140-159/90-109 - Severe: >160/110 Tx: Labetalol, nifedipine - ACE inhibitor contraindicated d/t fetal anomalies |
| Epilepsy in Pre-pregancy | - Continue anti-seizure med (abrupt stop = increase risk) - Folic acid 4!!! mg/day (@ 3 months before fertilization) |
| Obesity in Pre-pregnancy | - Recommend pregnancy weight gain 11-20 lbs - Risks: gestational DM, preeclampsia, C-section, thromboembolism |
| Iron deficiency in Pre-pregnancy | Dx: Hgb <10.5 Tx: Iron + vit C (avoid taking with calcium rich food) |
| AFI | Amniotic Fluid Index - oligohydramnios vs polyhydramnios <4 cm = oligohydramnios -> induce regardless of BPP results if at term |
| BPP | Biophysical Profile (monitor FHR, breathing, muscle tone, body movement, amniotic fluid) - 8-10 = normal - 5-7 = repeat in 24 hours - <4 = deliver |
| Shoulder Dystocia | Fetal head delivery w/ impacted anterior shoulder behind maternal pubic symphysis Risk factor: macrosomia, GDM, obesity - Turtle Sign (fetus head retracts into vagina) - McRobert's Position + suprapubic pressure -> Gaskin maneuver (on hand/knees) if fail - NO fundal pressure b/c worsen impaction - Void bladder - Call provider STAT |
| McRobert's Position | - For shoulder dystocia - Fold legs up against abdomen for better fetal positioning |
| Chorioamnionitis | bacteria infects the membranes (chorion/amnion) and the amniotic fluid around the fetus Sx: Fever, maternal/fetal tachycardia, tender uterus, fould fluid - Blood Cx before ABx Tx: Ampicillin + gentamycin; fetal delivery (tocolytics CONTRAINDICATED) |
| Uterine Rupture | Sx: Sudden pain, contraction cessation, category III FHR - STOP oxytocin -> induce contraction means worsen bleed Tx: Emergency cesarean |
| GBS ppx | - IV penicillin G over 4 hrs before delivery - Alternative with PCN allergy |
| Oxytocin tachysystole | Labor complication - 5+ contractions in 10 mins or >90 sec contractions -> risk of fetal hypoxia - STOP oxytocin - O2 + IV fluids - Notify provider |
| VBAC | vaginal birth after cesarean - Classical (vertical) incision = absolute contraindication for VBAC attempt - Low transverse incision = may attempt VBAC |
| Normal Newborn Considerations | - Heat loss -> dry + skin 2 skin + warm blankets |
| Moro reflex | - Loud noise/drop = arms "hug"/extend symmetrically - Asymmetrical extension indicate fracture or brachial plexus injury |
| Babinski reflex | Stroke lateral foot -> toes fan out - Normal until 12 months |
| Rooting reflex | touching cheeks makes infant turn to stimulus - Birth to 4–6 months |
| Newborn Vital Signs | - HR: 110–160 bpm - RR: 30-60/min (brief apnea ~15 sec normal) - Temp: 36.5-37.5 - Blood glucose: >45 mg/dL (feed + recheck in 30 min if low) - SpO2: 95% after 1st 10 min |
| CCHD screening | critical congenital heart defects - Preductal (hand SpO2) vs Postductal (foot SpO2) = normal within 3% - Repeat if positive - fetal shunts remain open -> risk of decompensation - Notify provider |
| Vitamin K | infants lack vitamin K synthesis (d/t sterile gut) - helps clotting factors to prevent bleed - 0.5-1mg IM within 6 hrs of birth |
| Erythromycin | prophylaxis to prevent opthalmia neonatorum - GC/chlamydia cause |
| Hep B Vaccination | ALL newborns - Hep B IG if maternal positive - Administration within 12 hrs of life |
| Infant phases after birth | - Phase 1 (0-2 hrs) = optimal breastfeeding/bonding window - Weight loss of 5-10 lbs @ 3-5 days -> regain by 2 weeks - Meconium within 24 hrs (notify provider if nothing) |
| Tetralogy of Fallot | - Poor feeding/choking w/ excess secretions - STOP feeds + elevate head - Notify provider STAT |
| Congenital diaphragmatic hernia (CDH) | - Scaphoid abdomen (concave appearance) - hear bowel sounds in chest - INTUBATION (NO bag mask) - Call surgical team STAT |
| Necrotizing enterocolitis | Sx: Abdominal distension, bloody stool, feeding intolerance - NPO - IV ABx - No tocolysis |
| Omphalocele | abdominal organs develop outside the body via opening at umbilicus - Cover herniated contents w/ sterile MOIST dressing - NO manual reduction |
| Neonatal Abstinence Syndrome (NAS) | Sx: High pitched cry + tremors - Minimize stimulus (quiet + dark room) - Swaddle |
| Myelomeningocele | open spina bifida - Leaking membrane = surgical EMERGENCY - Sterile moist dressing - Prone positioning |
| Postpartum Hemorrhage (PPH) | Postpartum emergency - Boggy uterus = fundal massage - Firm uterus = assess laceration or hematoma - >1000 mL (vaginal delivery) vs >1500 mL (C-section) - Hypovolemic shock risk Tx: 2 large bore IV + oxytocin + fluid (first line -> other uterotonics) |
| Uterotonics (w/ contraindications) | - Methergine (CI = hypertension) - Hemabate/Carboprost (CI = ASTHMA!) |
| Hypovolemic Shock | Sx: ↑ HR (early) -> ↓ BP (late after 25% blood loss), oliguria, altered mental status, cool/pale/clammy skin - start 2 large bore IV, foley Tx: IV NS/LR bolus + O2 + blood product - Identify cause |
| disseminated intravascular coagulation (DIC) | - Multi site bleeding (IV site, gum, petechiae, hematuria) - 2/2 PPH vs abruption vs sepsis vs HELLP - O2 + IV fluids + blood products - NO ASA - ICU level tx needed |
| DVT | Sx: calf swelling, warmth, redness - NO MASSAGING - Elevation - Oral anticoag x 6 month |
| Pulm Embolism (PE) | - 2/2 DVT Sx: sudden dyspnea, chest pain, hemoptysis, decrease SpO2 - High flow O2 FIRST - Anticoagulant ppx before confirmation` |
| Endometritis | infection of endometrium (uterus) Sx: Fever postpartum from 0-10 days, uterine tenderness, purulent/foul lochia - 19% of C/S births Tx: broad spectrum IV abx |
| Mastitis | Sx: red warm breast + fever + flu like symptoms - Recommend continue breast feed - Warm compress + NSAID - ABx if 24+ hours |
| Postpartum Blues | - Onset day 2-3 up to 10-14 day resolution - Affects 80% mothers Sx: tearfulness - Reassurance + support |
| Postpartum Depression | - Onset within 4 weeks to 1 year Sx: persistent sadness, inability to bond, suicidal ideation - STAT safety assessment - Mental health referral |
| Postpartum Psychosis | - Rare; psychiatric EMERGENCY Sx: hallucinations, delusions, thought disorganization - Call for help STAT |
| ABCs | - Airway: CDH (intubation w/o bag mask);Tetralogy of fallot (stop oral feed) - Breathing: PE, asthma exacerbation (O2 for SpO2 <95%) - Circulation: PPH, shock, DIC (2 large bore IVs + fluids + uterotonics + blood products) |
| Infection Prevention | - Blood Cx before ABx always - Remove catheters ASAP for CAUTI - Hand hygiene - GBS penicillin G >4 hr prior to delivery - IPV screening when alone |
| IPV | - Screen EVERY visit ALONE - standardized tool - Refer |
| NSAID use in pregnancy | AVOID -> use tylenol instead - cause renal complication in fetus |
| Respiratory Distress Syndrome (RDS) | premature infants (<34 weeks) w/ insufficient surfactant + immature lungs - onset within hours of birth -> resolve within 72 hr Sx: low SpO2, nasal flaring/grunting, tachypnea, retractions (intercostal/subcostal), decrease breath sound - Target 85-95% SpO2 - CPAP or nasal ventilation (PEEP keep alveoli open) - thermoregulation (reduce O2 need) - fluid management (avoid overload) - Surfactant therapy via ET tube (within 30-60 min to 2 hrs of birth) |
| Premature Infant SpO2 target | - Consider for RDS - High O2 supplementation -> suppress retinal vascularization = risk of retinopathy of prematurity - SpO2 target 85-95% in preemies - Low O2 -> neuro impairment (set per provider orders!) |
| Bronchopulmonary Dysplasia (BPD) | Acquired chronic lung disease of prematurity (10+ week early birth; birth weight <2 lb; prior breathing disorder RDS common) - need breathing support at 28 days of life or corrected gestational age - Wean O2/ventilator -> home O2 may be needed - Monitor + titrate SpO2 per order Tx: Caffeine citrate (reduce apnea), Diuretics (reduce pulmonary edema), thermoregulation, high calorie |
| Caffeine citrate | Tx for infant apnea/BPD - stimulates the respiratory centers in the brain -> improve breathing - routine ppx for preemies <28 weeks - Monitor for NEC (abdominal distension, feeding intolerance, bloody stool) |
| Newborn Jaundice/Hyperbilirubinemia | sterile gut + immature liver -> deconjugates conjugated bilirubin = reabsorption -> hyperbilirubinemia - d/t Physiological vs Pathological vs Breast milk vs Breastfeeding failure Tx: Phototherapy, exchange transfusion (severe) - Continue frequent breastfeeding - Check bilirubin Q2 hours (should see 2+ mg/dL drop) |
| Bilirubin | breakdown product of Hgb from RBC destruction - Conjugation by liver for excretion -> body does not reabsorb - NEUROTOXIN - High level = kernicterus |
| Kernicterus | - High levels of bilirubin = brain damage (bilirubin encephalopathy) - Complications: cerebral palsy, sensorineural hearing loss, gaze abnormalities, dental enamel dysplasia Dx: Serum bilirubin >25 mg/dL = severe Tx: Exchange transfusion (remove 85% blood volume for refractory kernicterus) |
| Infant Jaundice Assessment | - jaundice spreads cephalocaudal (face -> feet) - Q8-12 hour visual inspection - Transcutaneous bili screen (TcB) -> confirm w/ total serum Bili (TCB) - Jaundice within 24 hr = pathological (ABO/Rh hemolysis or infection) -> report ASAP |
| Physiological Jaundice | - Normal RBC turnover + immature liver = self limiting jaundice - Onset 3-4 days |
| Pathological Jaundice | ABO/Rh incompatibility hemolysis or infection - Onset ALWAYS within FIRST 24 hr - Report STAT |
| Breast Milk Jaundice | - Breast milk inhibits bilirubin conjugation - Onset @ 3-5 days -> peak @ 2 weeks - Monitor closely (breastfeeding also lowers bili) |
| Phototherapy | light exposure on skin converts bilirubin into water soluble form then excreted via bile - Cover eyes (prevent retinal damage) - Exposed skin + phototherapy -> light increase bilirubin conversion rate - Monitor temperature/hydration |
| Breastfeeding failure Jaundice | Inadequate intake -> slow stool passage = bilirubin reabsorption - 1st week onset - Need to increase feedings |
| Shoulder Dystocia Postpartum Complications | - Newborn: clavicle fracture, Erb palsy (asymmetric Moro), neonatal asphyxia - Mother: PPH, bladder trauma |
| Neonatal Pain | Undertreated pain -> long term neuro harm (cognitive delay + hormonal dysregulation) - Neonatal pain scales (NIPS, CRIES) Sx: high-pitched cry, facial grimacing, clenched fist, arching, tachycardia, increased BP |
| Neonatal Pain Management | - Oral sucrose + pacifier (minor procedure) - Swaddling or skin-skin/rocking - Breastfeeding - Topical anesthesia (needle sticks) - Oral tylenol (mild to moderate procedure pain) - Opioid analgesics (significant surgery/post op pain) - Nerve block (circumcision/large procedure) |
Created by:
sleepingbear