OB Exam 4

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foxyt14
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OB Exam 4
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2014-04-12 20:23:47
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OB Exam 4
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  1. What do you document about a mole at birth?
    • size
    • color
    • elevation
    • texture

    *take a pic for comparison later if changes occur*
  2. Normal color of...
    term baby
    pre term baby
    term=pink/tan

    pre term=dark pink/red
  3. Skin assessment at delivery can tell you what?  By noting for the presence of what?
    if the baby is pre term, on time or post term

    • vernix
    • desquamation
    • lanugo
  4. vernix
    thick white cheesy substance that is absorbed by the skin the closer the fetus gets to term
  5. desquamation
    • skin sloughing/peeling
    • usually seen on hands/feed of post term babies
  6. Lanugo
    soft downy like hair that appears after 20 weeks gestation and covers the entire body.  Begins to vanish as fetus ages....sign of premie
  7. What is the significance of petechiae on the head/neck/face vs. seen all over the body?
    head/neck/face...small capillaries ruptured from pressure during birth

    all over body can be an indication of low platelet count or an infection in the newborn
  8. Central cyanosis/blue lips means
    O2 desaturation
  9. Yellow vernix
    baby had elevated bilirubin levels in utero
  10. Green tinged vernix
    caused by mec staining
  11. Ruddy skin color.....sign of?
    deep purple/red from increased circulating RBC's (polycythemia)

    sign of hemolysis and baby is at risk for jaundice
  12. What is the problem when the skin blanches when you press on it?
    Jaundice
  13. What is typically the problem when you see pallor?
    hypoxia or anemia
  14. When you see acrocyanosis after the normal findings of it from birth....what is usually the issue?
    poor circulation....can be cold too
  15. What does mottling indicate?
    the infant is cold, stressed or overstimulated
  16. What is Harlequin color change and what does it mean?
    it is a distinct color division with one side of the body deep pink or red and the other half is pale. 

    Seen in low birth weight infants, is transient and benign.  Caused by an imbalance of autonomic regulation of vessels.
  17. Nervus Simplex (Stork Bite)
    • flat, hemangioma (from dilated capillaries)
    • blanching with pressure
    • become more prominent when baby cries
    • fade with time
  18. Nevus Flammeus (Port Wine Stain)
    • Flat
    • Purple/dark red lesion
    • No blanching
    • Don't fade with time...remove with laser
  19. IF an infant has a Nevus Flammeus (port wine stain) on his face then
    he needs to see an opthamologist
  20. Nevus Vasculosus (Strawberry Hemangioma)
    • red elevated area
    • will get bigger over the first year of life
    • will gradually fade and disappear by 10yo
  21. Funny thing about Nevus Vasculosus
    estrogen driven so seen mainly in girls
  22. Pigmented Nevi
    MOLE
  23. Café au Lait spots
    PERMANENT light brown areas
  24. What could be a complication if a person has many or a very large café au lait spot?
    Neurofibromatosis-a genetic neural tissue condition that will cause tumors to develop on spinal nerves
  25. Mongolian spots
    • birthmarks that are bluish/grey that resemble bruises.
    • they will disappear after a few years of life, but can stay in to adulthood.
  26. Who will you see Mongolian spots on?
    dark skinned people
  27. When is jaundice commonly seen?
    First week of life....usually with blanching of the skin over the nose or chest
  28. Greenish/brown discoloration of the skin, nail and cord is from.....watch for?
    meconium and stress before birth

    watch for respiratory difficulty
  29. Milia
    small white cysts due to sebaceous glands not functioning yet.  Will disappear within a few months....don't pop
  30. Milliaria
    small raised red papules from sweat retention...unbundle the baby!!  He is too warm
  31. Erythema Toxicum
    red blotchy areas with a white center that looks like a flea bite or acne

    Seen anywhere but palms and soles of feet

    Will disappear within hours/days
  32. Normal RR for first 2 hrs of life....normal after
    60-70 breaths per min

    then...30-60 with transient tachypnea
  33. Describe the newborns breathing
    • Diaphragmatic
    • Shallow
    • Irregular
  34. What two things move together when an infant breathes?
    abdomen and chest
  35. A newborn breathes through his....
    nose
  36. What types of cyanosis are normal for the first few hourse of life?
    circumoral and acrocyanosis
  37. Normal HR for a new born
    120-160 bpm

    sleeping can get as low as 100 and crying as high as 180/200
  38. Describe where the apical pulse is taken on an infant
    Point of Maximal Impulse

    • 3rd/4th intercostal space
    • lateral to the midclavicular line
  39. How and where is cap refill checked?  What is normal?
    depression of the skin over the chest, abdomen or extremity until the area blanches

    color should return in 3-4 seconds
  40. Choanal Artesia
    a blockage/narrowing of one or both nasal passages
  41. How do you check for Choanal Artesia?
    • Close the infants mouth and occlude one nostril at a time
    • observe for breathing and auscultate breath sounds
  42. Circumoral Cyanosis
    • NORMAL
    • a blue tint to the skin SURROUNDING the lips
  43. Central Cyanosis definition and problem
    bluish coloration of the tongue, lips, mucus membranes and skin

    sign of arterial oxygen desaturation
  44. Cyanosis
    blueish color to the lips-HYPOXIA
  45. If I see pallor in an infant what should I do?
    get a CBC  or Hgb/Hct done and give O2
  46. What is the problem if the heart is not positioned at the PMI?
    • can indicate a pneumothorax or dextrocardia
    • (heart position is reversed from normal)
  47. If the brachial and femoral pulses are not equal bilaterally this is a sign of
    coarctation of the aorta
  48. IUGR is indicated when the baby is
    <10% in weight
  49. If a baby is <10% in weight and has symmetrical proportional body parts the problem is caused by
    fetal factors early in pregnancy
  50. Name the fetal factors early in pregnancy which can cause IUGR
    • Genetic anomalies
    • Congenital malformation
    • Congenital infections (Rubella/Cytomegalovirus)
    • Fetal Infections
    • Drug Exposure
    • Multiple Gestation
  51. If a baby is <10% in weight and has asymmetrical proportional body parts the problem is caused by
    maternal factors....usually UPI in 3rd trimester
  52. Describe asymmetric shape of baby
    head circ is larger than expected for birth weight and length
  53. Name the maternal factors that can cause IUGR
    • Advanced maternal age
    • Smoking
    • Drugs/Alcohol/Toxins ingested
    • Chronic or pregnancy induced illnesses
    • Poor nutrition/malnutrition
    • Young maternal age
    • Structural Placental Abnormalities
  54. Name 3 chronic maternal problems which will impair uterine and placental blood flow.
    Result-
    • Chronic Renal Disease
    • Chronic Heart Disease
    • Diabetes Mellitus

    IUGR- causing increase in morbidity and mortality of infant
  55. IUGR is common in with poor nutrition/malnutrition....commonly known as the
    poor
  56. IUGR can be from fetal or maternal factors....however it is also seen due to
    problems intrinsic to the fetus itself
  57. Definition of Asymmetrically growth retarded
    infants who had growth restriction due to factors influencing the LAST part of the pregnancy will have a

    • normal head circumference
    • some reduction in length
    • big reduction in weight
  58. Definition of Symmetrical growth retarded
    this occurs when IUGR begins early in pregnancy.

    Head circumference, length and weight may ALL decrease proportionately.
  59. Who is more likely to have significant intrinsic fetal problems...asymmetrically or symmetrically growth retarded infants?
    Symmetrically
  60. Potential problems faced by IUGR infants
    • Meconium aspiration
    • Low body temp
    • Low sugar levels
    • Low calcium levels
    • Polycythemia
    • Pulmonary Hemorrhage
    • Persistent HTN
  61. Why is a baby with IUGR at risk for low body temp?
    No subcutaneous brown fat for insulation to preserve body heat
  62. Why is a baby with IUGR at risk for low blood sugar levels?
    haven't stored much glycogen in the liver
  63. What is the problem that can happen if a baby with IUGR is born with low calcium levels?
    risk for convulsions
  64. What is the baby with IUGR born with polycythemia at risk for?
    blood clot
  65. Sign that a newborn is cold
    • restlessness
    • cry
    • increased flexion
    • increased activity
  66. What is the infants primary method of heat production?
    • Non shivering thermogenesis....
    • metabolism of brown fat produces heat
  67. Cold stress can cause an increase in fatty acids which can interfere with the transport of bilirubin to the liver, increasing the risk for
    jaundice
  68. 2 ways the body will try to conserve heat
    • vasoconstriction of peripheral vessels (Acrocyanosis)
    • vasoconstriction of pulmonary vessels (RDS)
  69. Temps of a newborn
    • C-36.5-37.5
    • F-97.7-99.5
  70. Blood pressures of a newborn
    highest right after birth, then lowest at 3 hrs of age
  71. Weight and the newborn/baby
    • 6-8lbs
    • loses 5-10% first few days....should regain by 2 weeks
    • double birth weight at 6 months
    • triple birth weight at 1 yr.
  72. Avg. length of a baby
    18-22in
  73. Avg. Head Circumference
    33-35 cm
  74. Chest circumference
    1-2 cm smaller than the head
  75. Molding of the head
    an overlapping of the suture lines during delivery, resolves in first few days of life to 1 week
  76. Caput Succedaneum
    boggy and indistinct swelling in scalp tissue usually over the vertex of the head.

    *Crosses suture line, is soft and resolves in 12 hrs to a few days
  77. Cephalohematoma
    bleeding between the periodsteum and the skull from pressure during birth.

    *ends at suture lines, firm swelling and is NOT present at birth (takes 1-2 days to develop) and takes a few weeks to resolve
  78. Which head injury from birth increases a baby's risk for jaundice?
    Cephalohematoma
  79. When are circumcisions done?
    12-24 hours after birth...not till newborn is stable
  80. Difference between Gomco and Plastibell circumcision
    Gomco (saw)-blood supply is decreased prior to cutting skin, put Vaseline on after

    Plastibell-plastic ring covers glans, sutured on and will fall off in 5-8 days, NO vaseline
  81. Care of penis after circumcision
    • urinate within 6-8 hrs
    • monitor for bleeding/infection
    • few drops of blood ok
    • yellow exudate ok, don't pick off
  82. If mom has poorly controlled GDM and hyperglycemia in the 3rd trimester baby is at risk for
    • fetal macrosomia (large baby)
    • neonatal hypoglycemia
  83. Why is a baby who was born to a mom with GDM at risk for hypoglycemia?
    baby has been making a lot of insulin to combat moms hyperglycemia.  Once he is born, that extra glucose isn't there, but he is still making the same amount of insulin
  84. Assessment of reflexes by nurse....notes
    • symmetry
    • strength
    • diminished means preterm or ill infant
    • absence means neurologic problem
    • asymmetric means trauma during birth that caused nerve injury, paralysis or fracture
  85. When will rooting reflex disappear?
    3 weeks
  86. When will stepping reflex disappear?
    2 months
  87. When will Moro Reflex disappear?
    6 months
  88. When will Babinski reflex disappear?
    8-12 months
  89. What's moro reflex
    sudden head extension produced by a light drop of the head
  90. Startle Reflex
    when an infant hears a sudden noise, he flings out his arms and arches his back and spreads his fingers
  91. With post term pregnancys baby's are at risk for
    • Placental insufficiency and decreased amniotic fluid.....
    • leading to umbilical cord compression=variable decels
  92. How is a post term baby able to small for gestational age?
    cuz the placenta is old and he didn't receive enough o2 and nutrients.....so started to use current fat as nourishment.
  93. What will a post term baby look like when born?
    • apprehensive face, hypoxic, hyper alert, wide eyed
    • thin with loose skin
    • hypoglycemic
    • little or no vernix
    • lots of hair and long nails
    • winkled, cracked and peeling skin
    • meconium passage
  94. What should a post term infant be assessed for?  How compensate?
    hypoglycemia

    feed him early and frequently to compensate for the period of poor nutrition before birth
  95. What will a post term newborn temp be like?
    Intervention?
    hypothermia

    • extra blankets
    • frequent temps
    • teach parents about prevention of cold stress
  96. Birth trauma for LGA infant
    • breech/shoulder dystocia
    • asphyxia
    • fractured clavicle
    • brachial palsy
    • facial paralysis
    • phrenic nerve damage
    • skull fracture/hematoma
    • *increased risk for c section
  97. The GI system and newborn
    immature at birth, and reaches maturity at 2-3 years old
  98. How much will the newborns stomach hold?
    5-7mL....so abdomen becomes distended easily
  99. Where do you place food/nipple on an infant?
    at the back of the tongue
  100. When does sucking typically become coordinated?
    32 weeks
  101. A baby has very little saliva until he is
    3 months old
  102. When will I hear bowel sounds?
    1 hour after birth
  103. Why doesn't a baby have v. K at birth?
    cuz the bowel is sterile and there is no normal flor in the GI system to make it
  104. Rule on cereal and cows milk
    • cereal at 6 months
    • cows milk at 1 year
  105. How long will the newborn live off of mom's iron stores?
    4-6 months....if she took in adequate amounts while prego
  106. Size of a babys stomach....
    3 days
    10 days
    • ping pong ball
    • extra large chicken egg
  107. Why shouldn't newborns eat cereal?
    cuz amylase and lipase aren't present till 3-6 months and this is needed to break down cereal
  108. Describe meconium?
    When will first BM occur?
    Problem time?
    Subsequent stools
    • tar black/green sticky
    • within 24 hours
    • none 36-48 hours...possible obstruction

    • breast=yellow/seedy....3-10/day, more than formula babies
    • formula=pale yellow/brown, firmer
  109. If you see a large protruding tongue this is a sign of
    Downs and hypothyroidism
  110. When is it common to see candidiasis in an infant
    not at birth....but 1-2 days later
  111. When's a good time to inspect an infants palate
    when they cry
  112. First formula feed should be this amount....cuz don't want to overdistend stomach or cause regurgitation
    1oz/30mL
  113. What does Coombs test look for?
    Rh antibodies and incompatibilities
  114. Indirect Coombs vs. Direct Coombs
    Indirect-done on maternal serum at 27 weeks, if negative give rhogam, if positive repeat testing to monitor titer

    Direct-done on cord blood-tests for maternal antibodies in fetal blood
  115. Metabolic disorders come from what type of disorder?
    recessive...one defective gene from EACH parent
  116. If baby has PKU s/s and treatment
    digestive problems, V, seizures, musty odor of urine, mental retardation, behavior disorders, seizures

    strict diet low in phenylalanine, may breast feed or partial breast feed with close monitoring
  117. If baby has galactosemia s/s and treatment
    decreased feedings, lethargy, seizures, mental retardation, death

    eliminate galactose from diet....give rice or soy milk
  118. Problem with galactosemia
    a decrease in the enzyme that converts galactose to glucose
  119. If baby has a congenital hypothyroid s/s and treatment
    mental and motor retardation, short, coarse dry skin/hair, hoarse cry, constipation

    thyroid replacement
  120. Why is the PKU test not done until discharge?
    cuz it isn't reliable until an ample amount of amino acid is ingested, which takes 24-48 hours. 

    Perform test as close to discharge as possible, but no later than 1 week after birth

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