OB Exam 4 Nuggets

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Author:
foxyt14
ID:
270538
Filename:
OB Exam 4 Nuggets
Updated:
2014-04-15 21:22:42
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Nugs
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Description:
OB exam 4 Dustin's part and nuggets
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  1. If a baby is experiencing cold stress I will
    put him under the radiant warmer till the temp is 36.5-37.5 or 97.7-99.5
  2. How long does it take for these head abnormalities to fix themselves?
    Molding
    Caput Succedaneum
    Cephalohematoma
    • few days to 1 week
    • 12 hrs to few days
    • few weeks
  3. Why is the Ballard Assessment done?  What does it look at?
    it determines a baby's gestational age by looking at neuromuscular and physical characteristics
  4. Ballard score -10 to 50...
    • -10 is 20 weeks gestational age
    • 35 is 38 weeks gestational age
    • 40 is 40 weeks gestational age
    • 50 is 44 weeks gestational age
  5. 6 areas looked at for the neuromuscular portion of the ballard assessment
    • Posture
    • Square window
    • Arm Recoil
    • Popliteal Angle
    • Scarf Sign
    • Heel to Ear
  6. Posture for Ballard
    extended = younger, flexion like a frog means older
  7. Square window for Ballard
    >90 angle for young and full flexing of hand to wrist is older
  8. Arm recoil for Ballard
    little recoil (180) is young where <90 angle and arms recoil back up is older
  9. Popliteal angle for Ballard
    do it by taking the thigh to the abdomen then extend the lower leg.....

    very flexible and can extend leg all of the way is younger, less flexible when older (like me)
  10. Scarf sign for Ballard
    younger will be able to put arm all of the way above the midline and up like a scarf, where older are less flexible and can only get it across the midline
  11. Heel to ear for Ballard
    can bring toes to nose for younger and less flexible for older babies
  12. 7 areas you look at for physical maturity with Ballard
    • Skin
    • Lanugo
    • Plantar Surface
    • Breast
    • Eye/Ear
    • Genitals-male
    • Genitals-female
  13. Skin of Ballard assessment
    young is sticky and transparent, older is leathery cracked and wrinkled
  14. Lanugo of Ballard
    hair appears at 20 weeks and will be mostly gone by 32-36 weeks gestation
  15. Plantar Surface of Ballard
    younger is not much of a crease, older has creases over entire sole of foot
  16. Breast of Ballard
    younger you cant see any signs of breast.....older they will have a full areola and bud
  17. Eye/Ears of Ballard
    younger the lid is fused and pinna is flat and stays folded, older the eyes are open and the ear cartilage has instant recoil
  18. When do the eye lids open
    26-28 weeks gestational age
  19. Ears have very little cartilage in them until when?
    24 weeks gestation
  20. Male Genitalia and Ballard
    younger the scrotum will be flat and smoothe....older the testes will have descended and will have rugae (wrinkles)
  21. Female Genitalia and Ballard
    younger the clitoris is exposed with a flat labia....when older the labia majora will cover the clitoris and labia minora
  22. phimosis
    tightening of the prepuce that prevents retraction and requires circumcision
  23. Nevus Flammeus
    • doesn't Fade
    • if on the Face, opthamologist
    • Doesn't blanch

    Port Wine Stain
  24. Nevus Vasculosus
    • elevated
    • enlarges (1st yr of life)
    • estrogen driven

    Strawberry Hemangioma
  25. Nevus Simplex
    • blanches
    • fades
    • prominent when baby crys

    Stork Bite
  26. Which marking do you need to take a picture of so you don't get accused of child abuse?
    Mongolian Spot
  27. Erythema Toxicum
    red, blotchy area with white center
  28. When is the best time for infant bonding and promotion of nursing?
    First period of Reactivity....first 2 hours of life
  29. First period of reactivity the baby will be
    • wide awake
    • alert
    • energetic
    • interested in surroundings
  30. What happens during the Period of Sleep...how does the baby act?
    • deep sleep
    • pulse and RR decrease to normal rates
    • temp drops

    lasts 4-6 hrs
  31. What happens during the 2nd period of reactivity
    • infant is awake and interested in eating
    • poops mec
    • increased RR, HR,  and secretions
    • may gag or have regurg
  32. quiet sleep
    • deep sleep
    • no movement
    • difficult to arouse
    • respirations are quiet, regular and slow
  33. Active Sleep
    • light sleep
    • extremities move
    • stretch
    • facial expressions
    • REM
    • likely to startle
  34. Drowsy
    half asleep/awake
  35. Quiet Alert
    focus on objects, people and surroundings

    minimal body movements because focused on surroundings
  36. Which behavior state is a good time to have bonding with the baby
    Quiet Alert
  37. Active Alert
    • fussy
    • increased RR
    • expressing feelings of discomfort
    • less focused on visual stimuli
  38. Crying State
    • CRYING
    • comforting is required before the infant can move to another state
  39. Describe habituation for an infant
    noisy house....adapts to it and isn't bothered by it

    pre term infant or one with CNS damage cant do this
  40. Describe how a baby self consoles?
    sucks thumb....sick, pre term and drug exposed infants cant do this
  41. Describe parents response to infants behavior
    they learn what different cries mean
  42. Conjugated bilirubin =
    excretion of billirubin
  43. Describe physiologic jaundice
    • normal
    • happens after 24 hrs/usuall 2-3 days
    • serums at 5-7mg
  44. How do you treat physiologic jaundice
    increase feedings
  45. Describe breast milk jaundice
    • Normal-something in breast milk interferes with conjugation of billi
    • happens at 3-5 days
    • serum billi is 12mg
  46. How do you treat breast milk jaundice?
    • increase feeds
    • phototherapy
    • d/c breast feedings for 24-48 hrs
  47. Describe pathologic jaundice
    • abnormal
    • happens in 1st 24 hrs of life
    • serum billi is above 12mg
  48. How do you treat pathologic jaundice
    • NICU
    • IV therapy
    • phototherapy
    • exchange transfusion
  49. Examples of problems that cause pathologic jaundice
    • ABO incompatabilities
    • RH incompatabilities
    • Infection-sepsis
    • metabolic disorder
  50. Clinical findings of a baby with jaundice
    • head to toe progression
    • yellow blanching over bony prominences
    • dark concentrated urine
    • changes in behavior
  51. Describe changes in behavior of a baby with jaundice
    • lethargy
    • irritable
    • anorexia
    • vomiting
    • hypoactive reflexes
    • increased tone
    • MR
  52. On a dark skinned infant where do we check for jaundice?
    cunjunctiva and buccal membranes
  53. If a mom has GDM what do we do to monitor her?
    • Teach her to start counting kicks at 28 weeks
    • US regularly to monitor fetal growth
  54. Fore milk vs. hind milk
    • fore is watery
    • hind is fatty.....best
  55. Breath sounds of a baby in first hour of life
    not unusual to hear moisture, especially in a c section baby.

    make sure you document and report
  56. APGAR
    • Appearance
    • Pulse
    • Grimace
    • Activity
    • Respiration
  57. Grimace of APGAR
    • no response
    • grimace
    • sneeze, cough, pulls away
  58. Activity of APGAR
    • absent
    • arms/legs flexed
    • active movement
  59. Respiration of APGAR
    • absent
    • slow/irregular
    • good cry
  60. Weeks
    Preterm
    Term
    Post Term
    • less than 38 weeks
    • 38-41 weeks
    • 42 +

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