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