OB exam 3 power points

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OB exam 3 power points
2015-11-02 21:36:56
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  1. Admission procedures for newbron
    • review history
    • Charting, L& D, Newborn Record (nurse)
    • Initial assessment (nurse)
    • Parent-infant interaction (nurse)
    • Weight in grams and pounds
    • Obtain vitals
    • If at risk- hematocrit and bg
  2. How to maintain neutral thermal enviornment
    • dry off and discard wet linens
    • provide warmth 
    • skin to skin
    • hat
    • radient warmer
  3. Comprehensive assessment done when
    first 4 hours
  4. When is the ideal time to breast feed?
    after delivery because baby is alert
  5. Early breast feeding is especially important for
    infants at risk for hypoglycemia 

    make sure infant is stable first
  6. When are formula fed babies usually fed?
    by about 5 hours of age

    early if at risk for hypoglycemia
  7. What should baby be dressed in after birth
    • tshirt
    • sleeper
    • hat

    Recommend to parents to dress infant in one more layer of clothing than adults in a comforable room
  8. If infants are overheat they are at increased risk for
    crib death
  9. A cold baby can be at risk for
    respiratory disress due to increased oxygen use

  10. If newborn temperature drops below 97
    place back in radient warmer
  11. how much to formula fed infants eat and when?
    25-35 mL/3 hrs during the first 48 hrs
  12. Infants are ___________ in the first 24-48 hrs
  13. first void when?

    first stool?
    • within 24 hrs
    • within 48 hours
  14. weight should be taken when?

    how much weight loss normal?
    same time, every day

    No more than 10%
  15. Spitting of ________ common in first 48 hrs
    clear mucous
  16. Meconium
    • sticky, thick, green 
    • normal passage in 48 hrs
    • breast feeding stools looser than formula
  17. After 48 hours, breast fed stools vs formula
    • formula green seedy
    • breast fed yellow seedy
  18. Danger signs for hydration and nutrition
    • failure to pass meconium
    • abdominal distention
    • bilious vomiting
  19. Danger signs for Umbilical cord
    • bleeding
    • drainage ( may be urine )
    • Omphalitis
  20. Omphalitis
    • umbilical infection
    • redness
    • foul smell
    • induration
    • can be fatal
  21. What is included on the ID band
    • dr name
    • dob
    • time
    • mothers name
  22. what is the only exercise a newborn gets
  23. ________ must be done before circumcison
    vit k
  24. Advantages of circ
    • Easy to care for
    • perceived as normal in society
    • desire to have infant appear same as father or sibling
    • prevent trauma if necessary later in life
    • possibly may decrease penile cancer
  25. After Gomco or Mogan
    • Wrap penis in vasaline gauze
    • apply vaseline to diaper for first 24 hrs
  26. after care for plastibell
    • keep dry and clean
    • no special care
    • allow bell to fall off on its own (about a week)
  27. dont retract foreskin until
    3-5 years old for baths
  28. Infant cannot leave hospital without
    • metabolic screening
    • state required 

    • multiple screans
    • special training
    • must have screen done on full feedings, off iv fluids
    • results after 14 days
  29. Hearing screening is or is not state mandadited
    • state mandated
    • Can not leave without it
  30. if hearing screen is abnormal
    BAER after discharge
  31. Critical Congenital Heart disease
    • state law
    • Must be done prior to discharge
    • should be done after 24 hours
    • must be off oxygen
    • Done using pulse ox
    • pass/fail
    • if fails, obtain echo
    • not necessary if infant had an echo
  32. SGA
    • hypothermia
    • hypoglycemia
    • delays in growth and development
    • polycythemia
  33. LGA
    • hypoglycemia
    • poor feeding
    • traumatic injury
    • jaundice
  34. ideal place for assessment
    in room, nursery
  35. 1st glance assessment
    • skin color
    • muscle tone
    • behavior state
    • remove clothing- radient warmer ideal
  36. bili must be ______ to see jaundice
  37. Jaundice begins on
  38. plethora
    • polycythemia
    • red baby

  39. acrocyanosis is seen in _____________
    hands and feet

  40. harlequin sign
    normal- line below midline and one side is pink, one side is pale

    abnormal- if line transverse and upper body pink, lower body pale (serious heart disease)
  41. melanor pustulosis
    slightly pigmented stpots when rubbed off 

  42. milia
    raise wite spots on the face

    no treatment necessary
  43. mottling
    lacy pattern of dilated blood vessels

    may be r/t cold, poor perfusion, apnea, sepsis
  44. blueberry muffin baby
    • cytomegalic virus (CMV
    • profuse petechia
    • jaundice
  45. bathing trunk nevus
  46. erythema toxicum
    firm, yellow/whit papule of pustules

  47. forcep marks
    reddened areas over cheeks, jaws, eyes

    disappear within 1-2 days
  48. port wine stain
    associated with sturge-webber syndrome

    delayed development and trigeminal nerve damage
  49. stork bites
    pale, pink/red spots found on eyelids, nose, lower occiptial, and nape of neck

  50. strawberry marks
    • hemangioma
    • raised, dark red, rough-surfaced birth mark

  51. mongolian spots
    bluish black or gray-blue spots found on back and butt

    common in hispanics and blacks

  52. cafe au lait spots
    coffee colored spots

  53. sucking blisters
    blisters on lips, fingers or hands

  54. collodion baby
    epidermis bullosa

    skin peels off when touched


  55. Candid diaper rash
    scattered leasions on diaper area 

    takes 1-2 wees to develop

  56. if >6 cafe au lait spots
  57. herpes lesions
    several blisters

    not on hands
  58. Head
    • 1/4 size of adult head
    • anterior and posterior fontanel
    • molding-change in skull shape d/t overlapping sutures

    caput-generalized head edema (under scalp)
  59. subgaleal hemorrhage
    mushy at first then feels like a water balloon

    • measure head circumferance every 8-12 hours
    • serial H&H

  60. cephalohematoma
    bleeding b/w cranial bones and periostium
  61. Cutis aplasia
    punched out place in head

    associated with trisomy 21
  62. Epstein pearls
    small glistening white specks that feel hard to the touch on hard palate and gums
  63. choanal atresia
    blue at rest and pink white crying
  64. nose
    • fairly flat
    • obligat nose breathers
    • can smell
    • frequent sneezing
  65. eyes normal
    • iris blue
    • clear drainage in 1st day
    • conjunctival hemmorhages
    • sclera= white or bluish
    • stabismus common

    red light reflex
  66. Upward slanted palpebral fissures-epicanthal folds indicitave of
    down syndrome
  67. downward slanted palpebral fissues
    • aperts syndrome
    • associated with cranial bone malformations
  68. ears should be
    same level as eyes

    open canal
  69. crepitus in clavicles meansq
    their broken
  70. torticollis
    neck to one side

    means damage to sternocladomastoid muscle
  71. webbed neck
    turner syndrome or inbreeding
  72. normal breathing pattern
    30-60 bpm

  73. Chest
    • symmetrical
    • flexible ribs
    • protrusion of lower end of sternum common
    • engourged breast common
  74. HR
    110-160 bpm
  75. murmurs common in ____ of all newborns
  76. Abnormal chest
    • retractions
    • expiratory grunting
    • nasal flaring
    • increased AP chest diameter
    • Rales/rhonchi (except within first hour of life)
    • stridor
  77. diaphragmatic hernia
    life threatening

    intubate and OG suction
  78. Absent s2 sound
    heart disease
  79. Bounding pericardium against chest
    heart working overtime

    patent ductus arteriosis
  80. upper and lower extremity pulses not equal
    think heart disease
  81. overall weak pulses
  82. absent pulses
    hypoplastic left heart
  83. no LE pulses
    coartation of aorta
  84. bounding pulses
    patent ductus arteriosis
  85. Do not palpate what kind of mass
  86. umbilical cord will fall off when
    7-10 days

    granulated tissue may form (normal)
  87. if umblicial cord has only one artery
    renal anamoly
  88. where to take pulses
    • upper- brachial
    • lower- fem or posterior tib
  89. Liver
    1-2 cm below the RCM
  90. dastasis recti
  91. normal genitalia girls
    • rust, brick colored urine (uric acid crystals)
    • vaginal or hymenal tag
    • white mucous, blood streaked
    • edematous at birth
  92. Abnormal geitalia girls
    • bulging mass
    • enlarged clitorus
    • labial fusion
  93. do not circ a boy who has a

    • Put sign on chart in red
    • Put note on crib
    • Explain to mother/father
  94. Testicular torsion
    • twists on spermatic cord
    • surgerical emergency
  95. Hydrocele
    sac of fluid, lights up with transiliumination
  96. Ambiguous genitalia
    say sex organs are not fully developed
  97. polydactyly next to thumb

    next to pinky
    chromosomal abnormalities

    familial. String
  98. Syndactyly
    webbing of fingers/toes

    uncommon in fingers
  99. brachial palsy
    partial/complete paralysis of arm
  100. Erb's palsy
    • damage to upper arm
    • usually resolves with PT
  101. single palmer crease

    r/t trisomy 21
  102. rock bottom feet
    • heel round like rocker
    • trisomy 18
  103. Barlow
    push legs together and down
  104. ortalini
    rotate legs out
  105. tuft of hair on sacral dimple
    • get US for tethered cord
    • sinus tract to spinal canal
  106. jitteriness
    movement stops with passive flexion and typically seen with stimulation
  107. seizures
    movement continues despite passive flexion and not caused by stimulation
  108. habituation
    stop responding to repeated stimuli

  109. neuromuscular
    • can turn to voices
    • can follow with eyes
    • can see 6-12 inches
  110. Late preterm
    34-36.6 weeks

    increased long term handicaps- neuro, cerebral palsy, behavioral

    increased infant mortality 3x