Test 4 (OB)

Normal weight loss is __-__ lbs/month w/ BF -Order __ (SS) PRN -Give rubella if titer is less than __ -PP Blues peak at __ day -After c birth: VS q __ minsx4, then per protocol -Brown fat around __, __ glands, neck, back, __; develops from __-__ wks, 3-5 wks after birth -Foramen ovale, DA, DV -Bilirubin is initially unconjugated, __ __ is needed for conjugation; jaundice peaks around day __ at home; jaundice r/t poor __ -If formula fed, give __-___ oz, burp after 15 -Test PKU at __ hrs after they've fed -Striabismus normal up to __-__ mos b/c muscles aren't strong enough; can see color at __-__ mos -Don't do __ __ until circ heals; do a little __ if bleeding after circ -Ortalani's -Breech at r/f __ __ -__ crease: DS -Suction from __ -Void/BM in first __ hrs -BSE 1 wk __ pd - __ __ can cause preterm labor; also familial connection to PTL - __ increases surfactant production; can caus e__ __ and __ in mom -If prolapsed cord, maintain fingers in vag to relieve compression, put them in __ __ *REVIEW: output sheet, BC, reflexes

1-2, ducosate 1:10 kidneys, adrenal, scapular, 26-28, - Closure of fetal structures o Foramen ovale-in fetal circulation is the opening between the right and left atria whereby most of the fetal blood bypasses the lungs. Closure-blood returning from the lungs to the left atrium from the lungs pushes against the one way valve closing it. o Ductus arteriosus- in fetal circulation is the shunt between the pulmonary artery and the arch of the aorta. Oxygen entering the lungs closes this structure. The result of this closure is that all blood goes to the lungs. o Ductus venosus - in fetal circulation the ductus bypasses the liver carries the blood between the umbilical vein and the inferior vena cava. Mechanical pressure of clamping the cord closes the shunt. glucuronyl transferase, 5, BF 15-30 24 3-4, 3-12, tub bath, pressure Ortalani's manuever-to detect congenital hip dislocation. Knees and hips are flexed then abducted. If dislocated, movement of the head of the femur is felt to slip forward and out of the hip socket and a click may be audible. hip dysplasia DS side 24 after periodontal betamethasone, pulmoary edema, hyperglycemia knee chest

-Gestational diabetes can be controlled by diet along if they can maintain 2 hour post prandial below __ and fasting below __; if not, use insulin -Can't BF w/ __; breastfeeding maintains lower __ requirements -1st, 2nd, 3rd, labor; recheck at __ wks -If preexisting diabetes: do A1c q __-__ wks, BGL at every visit, __ every visit, __ __ w/ 24 hr creat clearance q __, retinal exam in __ trimester, NST/BPP at __ wks (2x/wk), __ for lung maturity, ultrasound/fetal __ -24-28 wks: __ g oral glucose at any time in the day, if over 140, do 3 hr (can't eat, drink, smoke for __ hrs before the test) -Signs of GDM: previous __ defects in stillborn baby, __, recurrent __ __, macrosomia -Hyperinsulinemia decreases __ production, which is needed for __ -Increases r/f intrauterine __, __ disabilities, __ later in life -Keep postprandial between __-__; 2-4 am between __ and __; A1c less than __ -6 daily activities - Rapid (preferred b/c it is faster and has a __ duration, doesn't cross __), short, intermediate -__ g of fiber/day (whole grains, fruits, veggies), small breakfast (less than __ of daily calories w/ whole grains and __ to help control sugar) -Less than 60, take __ g of carbs -Insulin requirements __ during labor, monitor maternal glucose __; during labor, run this: -Insulin requirements decrease __ during PP, monitor BGL __x/day, if breastfeeding, increase calories to __ cal; insulin doesn't cross __ __ -__ g 2 hr OGTT at 6 wk PP checkup and BGL test yearly

120, 95 glyburide, insulin no increase, increase b/c of placental hormones, insulin needs double or triple, insulin decreases, 6 4-6, urinalusis, kidney function, visit, first, 28, amniocentesis, echo 50, 8 congenital, vaginal moniliasis, cortisol, surfactant, death, learning, obesity, 120-129, 60-99, 6 BGL monitoring, urine testing (for ketones over 200), diet, insulin, stress management, exercise, fetal activity moinitoring shorter, placenta; rapid-lispro/aspart, short- regular, intermediate- NPH/lente (bedtime) 28, 10%, protein, 20 decrease, hourly, D5LR, D51/2NS dramatically, 4, 800, breast milk 75

Menstrual conditions -Amenorrhea: primary (menstruation hasn't bee established by __ y.o. or within __ yrs of breast development), f/u to determine cause; secondary r/t __, lactation, __ -Dysmenorrhea: painful menstruation; occurs at, or a __ before, the onset of menstruation and disappears by end of menses; primary- cramps w/o underlying __, often caused by __ and __, as they increase uterine __ and decrease __ __ flow, causing ischemia; tx w/ __ to block __; secondary occurs after menstruation has been established, r/t __, residual __, cervical stenosis, uterine fibroids -PMS: occurs w/ __ phase of menstrual cycle (__ wks prior to onset of menses), symptoms must occur between ___ and onset of __; includes irritability, anxiety, migraine, __, __ pain; most pronounced __-__ days prior to menstruation; teach to restrict intake of __, alcohol, sugar; supplement __ vits for anxiety/depression

16, 4, exercise, pregnancy day, cause, prostaglandins F, F2, contraction, uterine artery, NSAIDs, prostaglandins, endometriosis, PID luteal, 2, oculation, menses, acne, joint, 2-3, B

Hematopoetic system: avg Hgb in cord blood is ___; hgb should increase in first several __ after birth b/c of __ movement from intravascular to extravascular space -O2 transport: transport of O2 to __ tissues depends on type of Hgb in RBCs (__ hgb has greater affinity for O2 than __ hgb, so SpO2 of a NB is greater than an adults, but release of O2 to __ is less (high O2 in blood makes __ hard to recognize) -High O2 levels at birth shuts down __ temporarily; resumes when levels of EPO rise in response to low __ and tissue __ needs, but this uses iron stores, so __ supplements are needed -Platelet count is comparable to adults; blood volume is __ mg/kg for term NB -Delayed cord clamping: if cord is left unclamped for short pd of time after birth, some of the blood from the __ passes to the NB (__ transfusion) to increase baby's blood __ and improve blood flow to NBs __; clamp __-__ s after birth; increases levels of __, decreases iron deficiency anemia and ___ -Coagulation: platelets comparable to an adult, but NB may have diminished platelet __; neonatal __ may occur in NBs born to moms w/ severe __ or __ ; certain coag factors need vit __ for final steps of synthesis; leukocytosis normal b/c of __ of birth

17, hours, plasma peripheal, fetal, adult, tissues, hypoxia, EPO, Hgb, O2, oxygen, iron 86 placenta, placental, volume, organs, 30-60, hgb, NEC function, thrombocytopenia, hypertension, HELLP, K, stress

Multiple gestations Visualization of __ gestational sacs at __-__ wks, fundal height greater than expected; auscultation of FHR that differs by at least __ bpm, elevated __, severe N/V More frequent prenatal visits; if inital ultrasound at __-__ wks is normal, serial ultrasounds performed q __-__ wks are used to assess growth of fetus __ __ placentation is significant risk factor that requires the use of __ to monitor fetal growth Do ultrasound q _--__ wks to detect twin to twin transfusion syndrome, which results in abnormal placental __ __ in which one twin gets more __, perfusion, nutrients than other twin Avoid __, have __ __ lifestyle, start testing at __-__ wks (NST/BPP), NST q __-__ days until birth or nonreactive, BPP weekly (__ is good score) Daily intake of __ kcal minimum and __ g of protein for woman w/ normal weight twins, __ kcal and __ g of protein if underweight twins; prenatal vit and __ mg of FA daily; total weight gain of __-__ lbs, __ lbs gained by __ wks

2, 5-6, 10, AFP 18-20, 304 monochorionic, diamniotic, ultrasound 2-3, vascular, anastomoses, O2 sex, low actibity, 32-37, 2-3, 8 35--, 175, 4000, 200, 1, 40-45, 24, 24,

Preexlampsia/Eclampsia: preeclampsia is the increase in BP after __ wks gestation accompanied by __ in previously __ woman; eclampsia is the occurence of a __ in a woman w/ preeclampsia; most often, preeclampsia occurs in the last __ wks of gestation, during labor, or in first __ hrs after birth Pathophysiology: -Normal pregnancy causes inc resistance to __ _, but in preeclampsia, resistance is lost and angiotensin causes ___ -Prostacyclin, which causes __, __ in preeclampsia -Decreased levels of __ __ -In preeclampsia, renal __ is decreased, which reduces __ (BUN and __ increase), sodium is __ causing edema, stretching of cap walls in glomerular endothelial cells allows the large __ molecules, primarily __, to escape in urine, decreasing serum __

20, proteinuria, normotensive, seizure, 10, 48 angiotensin II, vasoconstriction vasodilation, decreased NO perfusion, GFR, creat, retension, protein, albumin, albumin

Hypoglycemia: if values are less than __-__, treat w/ IV D10W to get BGL back over __; preterm babies haven't been in utero long enough to store __ and __, so they can't carry out __ -Manifestations: lethargy, poor __, pallor, __, apnea, hypotonia, __, high pitched cry, exaggerated __ -Monitor all at risk groups with __-__ mins after birth and before feedings or when signs are abnormal (within __ mins if IDM) -Enteral feedings are increased to maintain adequate __ and __ intake and to maintain normal __ -Pain relief through swaddling, __ sucking, sucrose solution (causes __ __ release) Anemia: if Hgb is less than __ mg/dl (term) and __-__ mg/dl (preterm); excessive hemolysis r/t blood group incompatibilites -Physiologic anemia of infancy: r/t normal gradual drop in __ (bone marrow stops production of RBCs in response to higher __ levels; reaches low point at __-__ mos, at which time the bone marrow restarts production of __, anemia disappears) -Mild or chronic anemia can be tx w/ __ supplements or __ __ formulas, folate and vit __ may need to be supplemented, may need to tx w/ __ and recombinant __

20-25, 45, glycogen, fat, gluconeogenesis feeding, hypothermia, hyperrflexia, Moro 30-60, 30 caloric, glucose, BGL nonnutritive, endogenous opioid 11, 7-9, hgb, O2, 2-3, RBCs iron, iron fortified, E, transfusions, EPO

Diabetes: -Diet: during first trimester, normal weight mom requires __ kcal/kg of her ideal weight, during 2nd/3rd trimesters, __ kcal/kg; 33-40% of cals should come from __ __, 20% from __, __% from fats; 3 meals, __ snacks; use insulin, __, glyburide -Assess: may need weekly fasting sugar/__ sugar checks -Labor: start IV w/ 5% dextrose, another w/ __ (attach insulin as needed, but insulin requirements __ during labor); within __ hrs PP, insulin requirements drop (probably won't need insulin PP if __, but if elevated glucose drops, treat it, reassess at __ wks PP, then q__ yrs) -Barrier methods (diaphragm, __ __, condom) w/ spermicide are safe, effective, preferred with ___, can also use __ and __ only pill -Teach : monitor at fasting time and __-__ hrs after a meal; maintain fasting levels at less than __, less than __ 2 h after each meal; if sugar is less than __, have mom drink 1/2 c of __, eat __-__ pieces of hard candy, or consume 1 __ of honey, recheck in 15 mins

30, 35, complex carms, protein, 40, 3, metformin postprandial saline, decrease, 24, GDM, 6, 3 cervical cap, IDDM, depo, progesterone 1-2, 95, 120, 60, OJ, 4-5, tbsp

Preterm labor: labor that occurs between __-__ wks gestation -Don't stop labor if following re present: severe __, __, hemorrhage, maternal __ disease, poorly controlled diabetes or __, fetal anomalies incompatible w/ life, __ fetal status -Tocolysis: use of meds to stop labor (__ __ __ (terbutaline, mag sulfate; can cause maternal peripheral __/__, maternal/fetal __, maternal fetal __, dysrhythmia), and CCBs, like __ (can cause dizziness, __ sensation, headache, weakness, ___ upset)) -__ supplementation is helpful to reduce preterm births in women w/ hx of at least 1 preterm birth less than __ wks, give __ injection weekly, beginning between __-__ wks (only if 1 baby, not multiples) -If mom gets __, she also gets corticosteroids (__, given in 2 __ doses) for fetal lung development, especially between __-__ wks; also prevents __ and __ -Tell pt to be alert for contractions that occur q __ mins or less, w/ or w/o __ pain, pd cramps felt low in abd, ROM, change in vag d/c; mom should assess contractions 1-2x/day by laying on __, putting fingertips on __, feel for __ hr (cervix dilates if more frequent than q __ mins); keep woman in hospital on BR, __ side, __ FHR monitoring -Prevention: rest on __ side 2-3x/day, drink __-__ qts of water/day, avoid lifting, avoid __ stimulation

30-36, preexlampsia, chorioamnionitis, cardiac, thyrotoxicosis, nonreassuring beta adrenergic agonists, vasodilation, hypotension, tachycaardia, hypoglycemia, nifedipine, flusing, GI progesterone, 34, hydroxyprogesterone, 16-21, tocolytic, betamethasone, IM, 24-34, NEC, IVH 10, back, left, fundus, 1, 10, left, continous left, 2-3, nipple

PROM- ROM before onset of labor, PPROM is rupture prior to __ wks; both may be r/t previous hx of this, __, polyhydraminos, __ pregnancy, UTI; can cause __ (intraamniotic infection), may cause __ placenta and hemorrhage; can cause fetal __ r/t __ pathogens, nonreassuring FHR, risk of __; good outcome if PROM at __, still have good chances from __-__ wks, but before that, NEC and RDS are common -Confirm ROM w/ nitrazine (turns __ __), amniosure (__ lines), ferning test; assess FHR/___; gestational age and presence of __ determines tx of __; if infection, immediately start ___, deliver regardless of age, put baby on __ -If PPROM w/ no infection, put in hospital on __ __, do CBC, CRP, __ on admission; do __ to determine gestational age and AFV; regular __/__ to determine well being; assess maternal VS q __ hr, avoid __ exams; maternal __ admin to promote fetal __ maturity and prevent RDS -Give __ __ if PROM between 23 6/7 and 31 6/7 wks gestation for its prevention of __ __; loading dose is __-__ g followed by __ g/hr for __ hrs or until birth occurs, stop is no birth within __ h, but continue if preterm labor starts again; loading dose can cause __, headache, __, dizziness, lethargy, __ __; may cause fetal __ and __ if delivered

37, infetion, multiple, chorioamniotis, retained, infection, ascending, RDS, term, 32-36 dark blue, 2, BPP, infection, PROM, abc, abc bed rest, urinalysis, BPP/NST, 4, vag, corticosteroid, lung mag sulfate, cerebral palsy, 4-6, 2, 12, 24, flushing, nustagmus, pulmonary edema, hypotonia, lethargy

Preemies (before 37 wks) -Cardiac/Resp: lungs can't take over gas exchange until __-__ wks; inadequate surfactant, which decreases ability to expand __ and leads to progressive __, causing ineffective gas exchange and hypoxia; muscular coat of pulmonary BVs is not fully developed, so pulmonary __ don't __ well in response to dec O2; DA may remain open, which increases blood __ to lungs, causing pulmonary __ and inc resp effort - Thermoregulation: dec heat production r/t dec availability of __ in liver and amount of brown fat, which appear in the __ trimester; preterm has high ratio of __: __; have thinner skin, which leads to more __/__ loss; baby is __, not __ -GI: r/f aspiration r/t poor __, poor sucking/swallowing, small stomach __, can't meet caloric needs; can't handle inc __ of formula b/c of kidney immaturity; can't absorb __ fats b/c of dec bile salts and enzymes; can't digest lactose initially; feeding intolerance and NEC r/t dec blood flow and tissue __ to intestinal tract

37-38, alveoli, atelectasis, arterioles, constrict, floow, congestion glycogen, third, surface area, body weight, heat, water, extended, flexed gag, capcity, osmolarity, saturated, perfusion

Possterm pregnancy: increases risk for __, increased incidence of instrument assisted birth, inc r/f __, dec __ __, oligohydraminos, __ __, low __ min APGAR -Dysmaturity syndrome: __ environment becomes __ for growth, uteroplacental insufficiency occurs, neonate loses __ mass and subcutaneous - Therapy: some will induce at __ wks, others will do __ and __ (esp AFV) 2-3x/wk; if they're at the hospital, put on __ to assess for __ r/t __ Macrosomia (birth weight over __ G); can cause CPD, __ labor, laceration, PPH, asphyxia, shoulder dystocia (after birth of head, __ shoulder fails to deliver; marked by presence of __ sign, in which fetal head emerges and then quickly __ as shoulder gets wedged under pubic bone, can lead to __ if unresolved); __ __ injury and clavicle fx; __ and hyperbilirubinemia -Estimate fetal size w/ __ measurements, ultrasounds; do c birth if over __ g; __ decels may indicate size disproportion at __ inlet, watch for lack of descent; mom may have __ problems after birth

42+ wks, LGA, placental perfusion, 5, intrauterine, unfavorable, muscle, fat 42, NST, BPP, FHR, variable decels, oligohydraminos 4500, prolonged, anterior, turtle, anterior, death, brachial plexus, hypoglycemia C-R, 4500, early, pelvic, contraction

Neonatal transition: first __ hrs of life in which NB stabilizes __ and __ functions Respiratory: -Fetal lung development: __-__ wks: development is limited to __ of pulmonary, vascular, lymphatic structures, 20-24 wks: __ __ appear, 24-28 wks: __ appear, and the cells differentiate into type __ and __ (synthesizes __, critical to alveolar stability); type __ cells increase from 28-32 wks, but surfactant production peaks at __ wks; if L:S is less than __:__, baby will have RDS; during intrauterine development, lungs are full of fluid, which stretches the lung and stimulates __ growth -Fetal circulation: __ __ __ is very high d/t the fluid filled fetal lungs, so more than 60% of __ __ output bypasses the lung and flows through __ __ (connects pulmonary artery to __ __) to descending aorta, leading to poorly __ blood to all other parts of the body; R and L ventricles work __ rather than sequentially

6, respiratory, cardiac 0-20, differentiation, alveolar ducts, alveoli, 1, 2, surfactant, 2, 35, 2:1, alveoli pulmonary vascular resistance, RV, descending aorta, oxygentaed, simultaneously

Fertility Awareness methods: -Female monitors her __ window (day __-__ of cycle), use barriers during this time; female is most fertile __ days before ovulation and __ day post ovulation so if a woman abstains from sex after her fertile window is closed, she is using __ __ __ -Standard days method: good for females w/ __ menstrual cycles between __-__ days; avoid sex or use barrier between days __-__ -Calendar rhythm method: based on the assumption that ovulation tends to occur __ days (+/- __ days) before the start of the next menstrual pd; woman must record cycle for __ mos to identify the shortest/longest cycles; fertile phase is calculated from __ days before the end of the shortest recorded cycle through __ days from the end of the longest recorded cycle, abstain from sex during this phase -Billings ovulation method: at time of ovulation, mucus is __, more __ (__), more permeable to sperm; during luteal phase, mucus is more __/__, making it hard for sperm to pass; assess mucus __ (peak day of wetness and clear/stretchable is assumed to be time of __ (avoid sex) -Basal body temp: use basal body thermometer, record before getting up in the morning, temp __ just before ovulation, almost always __ and remains __ for several days after (stop sex on day of temp __ and for __ days after)

8-19, 5, 1, natural family planning regular, 26-32, 8-19 14, 2, 6, 18, 11, thinner, stretchable, spinnbarkeit, thick, sticky, daily, ovulation drops, rises, elevated, rise, 3

-Crack/cocaine: malformations of GU tract, low __, neuro disturbances, IUGR, __ head, __ infarcts, short body, altered brain development; can cause cerebral __ in mom, inc incidence of __, abruptio placentae, ___; cocaine crosses BM and can cause extreme __ and __, diarrhea, __ pupils, apnea (NO BF) -Heroin: r/f __ aspiration, IUGR, __, irritable, __ sucking, vomit/seizures; signs of withdrawal in __ hrs, can last for several days, but inconsolability lasts for __ mos; __ to tx withdrawal; __ is used most commonly to help withdrawal, but it crosses the __ and is associated w/ __ __ -Give __ because __/__ can ppt withdrawal -Rapid HIV tests have high __ and __, confirm positive result w/ __ _; ARV combo therapy most effective at preventing __; initially assess __ levels, start IV __ at onset of labor (avoid scalp electrode, __, __) then give __ within 6 hrs for __ wks; if viral loads ar higher than __ copies/ml, do c birth at __ wks

APGAR, small, cerebral, hemorrhage, miscarriage, stillbirth, irritability, comiting, dilated meconium, hypoxia, fist, 72, 3, bupenorphine, methadone, placenta, pregnancy complications epidural, nubain/stadol sensitivity, specificity, western blot, transmission, cd4, ZDV, vaccuum, forceps, ZDV, 6, 1000, 38

Heart disease: pregnancy results in inc __ __, HR, blood volume; normal heart can adapt w/o problems, but heart disease causes adaptation problems - Women w/ __ __ are an an inc r/f complications -Women w/ __ __ are at greater risk for developing HF; mitral valve prolapse women handle pregnancy well, some may have __ __ and dyspnea r/t arrhythmias (tx w/ __) -Peripartum __ develops in pregnancy or first __ mos PP in people who don't have heart problems, mimics __, tx w/ rest, __, __, and there's a 50% chance heart will return to normal within 2-6 mos, but avoid __ __ regardless -Class 1: __, no limitation of activity; 2: slight __, __ at rest, symptoms w/ normal activity, 3: marked limitations, comfortable at rest, symptoms w/ less than __ activities; 4: no physical activity w/o __, even at rest; 1, 2 can go into __ labor, 3,4 must be __ and will need to be hospitalized beforehand to provide cardiac __ and they require invasive cardiac __ during labor -__ is safe for pregnancy b/c it doesn't cross placenta; antiarrhythmics and __ are safe -Diet high in __, protein, nutrients; low in __; frequent rest pds; assess q __ wks in first trimester to assess cardiac function, esp important at __-__ wks when blood volume is at max -PP: as ECF returns to bloodstream for excretion, __ and blood __ increase, which places great strain on heart and can lead to decomp, esp in first __ hrs after birth

CO, chronic cyanosis mitral stenosis, CP, propanolol myopathy, 5, HF, vasodilators, diuretics, future pregnancies asymptomatic, limitation, asymptomatic, normal, discomfort, spontanous, induced, stabilization, monitoring, hep, diuretics iron, sodium, 2, 28-30, CO, volume, 48

SGA/IUGR baby: common when moms have __ or smoke -Factors: maternal factors, maternal disease, environmental factors, placental factors, fetal factors -Term SGA baby has better than than preterm __ baby b/c of __ maturity Patterns of IUGR: intrauterine growth depends on both cell __ and cell size; if this occurs during critical pd of __ development in fetus, fewer __ are formed, organs are __, organ weight is below normal; if this occurs later in pregnancy, it doesn't affect the total number of cells, only their __ -Symmetric IUGR: caused by long term __ condition or fetal __ abnormalities; chronic prolonged restriction of growth in size of __, weight, length, __ __ -Asymmetric IUGR: associated w/ acute compromise of __ blood flow r/t placental __, preeclampsia, poor __ gain; growth restrictions not evident until __ trimester because although weight is decreased, length and __ __ remain appropriate for that gestational age; after __ wks in normal NB, the __ circumference gets larger than the head circumference, but in IUGR, the head remains __; early indicator is decrease in growth rate of __ __; weight below __ percentile, head circumference between __-__ percentiles -Symmetric- baby looks normal, just small, but asymmetric babies look __, thin, emaciated, loss of __ _ and muscle, loose skinfolds, __ skin, meconium staining, head appears __

HTN primiparity, multiple gestation pregnancy, lack of prental care, low socioeconomic status heart disease, substance abuse, sickle cell, PKY, pyelonephritis, lupus high altitude, exposure to x rays, excessive exercise, hypterthermia small placenta, infarcted areas TORCH infections, syphilis, 2 umbilicval vessels number, organ, cells, small, size maternal, genetic, organs, head circumference uteroplacental, infarcts, weight, third, head circumfere,ce, 36, abd, large, abd circumference, 10, 10-90 long, subcut fat, loose, large

Herpes simplex virus: primary infection poses great risk to mom and baby (can cause miscarriage, __, preterm birth), transmission to fetus almost always occurs after __ and virus ascends or during birth through infected __ canal -Risk to fetus varies w/ route of birth and status of __ at time of birth -Infected NB is asymptomatic at birth, but develops __, jaundice, seizures, __ __ any time after birth and up to __ wks; may develop __ skin lesions -Diagnose by culturing __ -Tx w/ __ (mom should take this throughout pregnancy) GBS: causes bacterial infection found in lower __ or __ tract -Early onset (0-1 wk PP): signs of serious illness, including __, apnea, __ -Late onset (1+ wks PP): meningitis, __ -Long term __ problems occur w/ both types -Give abx if previous baby w/ GBS infection, give if gestation is less than __ wks, ROM for ___ hrs, temp is over __ -Abx: ___, can also use __ (or erythromycin/clindamycin if allergic to PCN)

LBW, ROM, vag lesions fever, poor feeding, 4, vesicular lesions acyclovir GI, urogenital, pneumonnia, shock pneumonia neuro 37, 18+, 100/4, PCN G, ampicillin

Spermicides: __ is available as a cream, jelly, foam, __; insert into vag before intercourse, disrupts __'s cell membrane; insert high in vagina, remain __; minimally effective, doesn't protect against STIs IUD: copper- copper over __ and __, words for __ yrs; has a local inflammatory effect on __, preventing sperm from functioning; mirena- reservoir that releases __ gradually, works for __ yrs; skyla- releases __ for __ yrs Nexplanon: implant into upper underarm, impregnated w/ __, works for __ yrs, prevents __, stimulates __ mucus to inhibit sperm penetration Diaphragm: must be fitted for it, recheck size after gaining/losing __-__ lbs; place __ tsp of spermicide jelly on rim and in the cup, insert through __, will cover __, push edge of diaphragm under __ pubis, which may cause popping sensation; center of diaphragm should be over __, which can be felt through the cup; leave in for __ hrs after sex; cap works the same way Sponge: soft, absorbent sponge containing __, loop for easy __, moisten w/ water before insertion to activate __, leave in for __ hrs after sex, can leave in for __ hrs

N-9, suppository, sperm, supine arms, stem, 10, endometrium, levonorgestrel, 5, levonogestrel, 3 progestin, 3, ovulation, thick 10-15, 1, vagina, cervix, symphysis, cervix, 24 spermicide, removal, spermicide, 6, 24

PP Psych -Adjustment rxn w/ depressed mood: aka __ __; characterized by __ depression w/ some __ feelings; r/t alterations in __ after birth, challenges of new motherhood; commonly feel overwhelmed, unable to cope, fatigued, irritable, __; key feature is episodic __ and rapid __ shifts w/o identifiable reason -PPD: clinical depression; can occur within first PP ___, but is most common around __ wk, just before initiation of __; for woman at high risk, f/u earlier than __ wks; assess w/ PPD scale; tx w/ group or individual __ and antidepressants (typically continue for __ yr, most are safe to BF) -PP mood episodes w/ psychotic features: can include sleep __, confusion, __; may think she needs to kill herself/baby; may need __ or __ meds, but babies have immature __ and __ systems and more __ BBB, so they might be vulnerable to side effects, esp when younger than __ mos, premature, exposed in ___ -PTSD: traumatic events during birth; feel __, seem __, intrusive thoughts, difficulty __, avoiding others; debrief mom after __ experience -Edinburgh Postnatal depression screen (above __ indicates depression); PP depression screening scale is most sensitive and can predict depression risk early by assessing fatigue level over phone at __ wks PP (admit to hospital for minimum of __ hrs if suicidal)

PP blues, mild, happy, hormones, oversensitive, tearfulness, mood year, 4, menses, 6, psychotherapy, 1, disturbances, hallucinations, lithium, psychotropic, liver, kdiney, permeable, 2, utero distant, dazed, sleeping, traumatic, 12, 2, 48

Trichomoniasis: if pregnant, this increases the risk for __, preterm labor, __ infant; most are asymptomatic, but some have __/__ frothy, odorous d/c accompanied by __ of vagina, cervix; __, dyspareunia; diagnose by __, vag pH of __, positive __ test, OSOM __ __ __ results in 10 mins, Affirm VP III (results in __ mins); tx w/ __, don't take w/ alcohol Chlamydia: most reported STI, responsible for __ (preventable blindness) -Males: nongonocccoal __ -Females: infections similar to those associated w/ gonorrhea, PID; s/s: thin or __ d/c, burning/frequency of urination, cervix that __ easily (__), lower abd pain, often __ -Diagnose w/ _ __ amplification testing or __ assay -Tx: __ or __; abstain from sex for __ days; testing if sexually active __-__, 25+ if high risk, first prenatal visit Gonorrhea: if not pregnant, this increases r/f __; if infected after __ mos of pregnancy, mucous plug blocks in and infection remains __ until __; often asymptomatic -Males: __, dysuria -Women: purulent, __/__ d/c, dysuria, urinary frequency, __ cervix that secretes __ smelling d/c -Diagnose by culture of __ specimens or ___; tx w/ IM __ or single dose of __

PROM, LBA, yellow, green, inflammation, dysuria, microscopy, 5+, whiff, tricomonas, rapid, test, 45, metronidazole trachoma urethritis purulent, bleeds, friable, asympotomatic uncleic, PCR azythromycin, docycycline, 7, 20-25, PID, 3, local, ROM urethritis yellow, green, swollen, foul swab, NAAT, certraizone, azithromycin

Anaphylactoid syndrome of pregnancy (aka __ __ __, occurs where there's a small tear in __ or __ high in uterus, so amniotic fluid may leak and enter the maternal system to maternal __ (more debris (__), more problems); sudden __ __, circulatory collapse, acute __, cor pulmonale (__ failure); if showing signs of CP, dyspnea, __ __, tachycardia, hypotension, do birth ASAP, need to stabilize mom (__, __ __) CPD: __ and __ pelvises are predisposed to CPD; suspect when labor is __, dilation/effacement are __, lack of descent, and engagement of presenting part is delayed Lacerations: 1st degree: limited to the __, __ skin, and vaginal mucous membrane; 2nd degree: involved __ skin, vag mucous membrane, underlying __, __ of perineal body (may extend upward on side of vagina); 3rd degree: extends through __ skin, vag MM, perineal body, involves __ __, may extend up anterior wall of __; 4th degree: same as 3rd degree, but extends through rectal __ to __ of rectum Placenta accreta: when CV attach directly to __ of uterus; placenta increta: myometrium is __; placenta percreta: myometrium is __; adherence itself may be total, __, or focal, depending on amount of placental involvement; can lead to __ and failure of placenta to separate after birth

amniotic fluid embolism, chorion, amnion, lungs, meconium, resp distress, hemorrhage, RV, frothy sputum, CPAP, blood transfusion platypellid and android, prolonged, slow, forchette, perineal, perineal, fascia, mucsles, perineal, anal sphincter, rectum, facsia, tissue myometrium, invaded, penetrated, complete,hemorrhage

PP Thromboembolic disease -Can occur during __, but is generally PP complication; when thrombus is formed in response to __ in the vein wall, it is termed __; Virchows triad; change in mom's clotting system in pregnancy contributes to __ - superficial leg vein disease: clot involves one of the __ veins; symptoms become apparent in PP day __ or __ and include tenderness in a portion of the __, some local __/__, normal temp or __ grade fever, occasional slight elevation of __, may have palpable __; tx w/ local __, elevate, rest, __, stockings -DVT: s/s- edema of __ and __; initial low grade fever followed by __ temp and chills, tenderness/pain, __ cord, changes in limb __, difference in limb circumference greater than __ cm; diagnose w/ __ and __ __ assay; tx w/ anticoagulants (__ or __), continue until INR is at __ or __; strict bedrest and elevation of bad leg; may need __ __ filtering device; keep __ __ available in case hep needs to be reversed -Warfarin is compatible w/ __ __, limit foods high in __ __, cranberry juice __ effectiveness, additional anticoagulants should be avoided, bleeding bad if longer than __ mins

antepartum, inflammation, thrombophlebitis, venous stasis, hypercoagulability of blood, injury to epithelium of blood vessel, hypercoagulability, saph, 3, 4, vein, heat, redness, low, pulse, cord, heat, analgesics angle, leg, high, palpable, color, 2, ultrasound, dimer, UH, LMWH, 2, 3, vena cava, protamine, sulfate breast milk, vit K, increases, 10

UTI: ___ in presence of symptoms; asymptomatic __ becomes bad in pregnant woman if untx b/c it can cause __ and __ infant; if pregnant woman gets acute UTI w/ __ temp, te __ __ might get infected -Lower: __ (bladder inflammation)- initial symptom is __ at the end of urination, __/__, __ grade fever, hematuria; urine often has __ and bacteria; __ is common 1st line therapy, or __-__ -Upper: __-common during latter part of pregnancy or early PP; increases risk for __ birth and __; acute has sudden onset w/ __, __ temp, __ pain, N/V, general malaise, temporary suppression __ __, low __; __ as 1st line tx; should return to normal within __-__ days, no bacteria in urine after this Hysterectomy: surgical removal of __ through surgical incision is called total __ __ and removal of both fallopian tubes and ovaries is called a bilateral __; can be removed through vagina too (__ or __); do abdominal if __ (better exploration), large __, severe __; vaginal for __ __, uterine bleeding, __ fibroids; vaginal decreases __ time, but increases risk for damage to the __

bacteriuria, bacturiea, pyelonephrisis, LBW, high, amniotic fluid cyctisis, dysuria, uregency, frequency, low, WBCs, nitrofurantoin, trimethoprim-sulfamethoxazole pyelonephritis, preterm IUGR, chills, high, flank, urinary output, Crcl, fluoroquinolones, 2-3 uterus, abdominal, hysterectomy, salpino oophrectomy, TVH, laproscopic, cancer, fibroids, endometriosis, pelvic relaxation, small, recovery, bladder

-Fibrocystic breast changes (__ breast disease): fibrosis is a __ of normal breast tissue, __ formation may accompany this later in condition; not risk factor for __ __; pain, tenderness, swelling that occurs __; breasts may feel __/lumpy, may have __; cysts differentiated from tumor b/c cysts are __/__, not associated w/ __ __ in surrounding tissue; can __ to diagnose/tx; may need to take __ in week before pd to reduce tenderness -Fibroadenoma: common __ tumor seen in early teens/20s; freely __, solid, well __ tumors, round, __ texture -Best to use __ in women under __ w/ palpable mass b/c of dense tissue -Galactorrhea- d/c if not __ TSS: caused by __ __ -Diagnose based on fever over __, hypotension (SBP __), rash, multisystem involvement; rash/fever first, then __ of skin, especially on palms/soles, which usually occurs __-__ wks after the onset of symptoms -Systemic symptoms include __, myalgia, inflamed _ __ -Elevated __, AST, ALT, low __

benign, thickening, cyst, cyclically, dense, d/c, mobile, tender, skin retraction, aspirate, diuretic benign, mobile, delineated, rubber, ultrasound, 35, BF staph aureus, 102, 90, desyamation, 1-2 vomiting, mucous membranes BUN, platelets

HIV -Pathophysiology: HIV-1 enters body through __, __ products, body fluid (__, BM, vag fluid); HIV affects specific __ cells, decreasing body's __ responses; body makes __ once infected that can be detected w/ __ __ -Fetal risks: HIV transmission can occur during pregnancy, but it is believed that infections primarily occur during __ and __; start __ immediately in NB if HIV __ assays come back positive -INitial testing done w/ __, confirmed w/ __ __; put mom on __(combo therapy most effective); assess mom regularly for disease progression, which would be indicated by ___ __ lymphocyte count, which counts # of __ T cells (if less than __, then mom is at r/f __ infection); monitor for weight loss, fever in __/__ trimesters, look for __, auscultate for pneumonia, look for hepatosplenomegaly; NST weekly starting at __ wks; avoid invasive testing to decrease r/f __

blood, blood, semen, T, antibodies, western blot labor, birth, ARV, virologic ELISA, WB, ARV, cd4+ T, helper, 200, opportunistic, 2nd/3rd, leukoplakia, 32, transmission

-Central abruptio placentae: placenta separates __, blood gets __, concealed bleeding; __ abd pain, may have __ blood; after placenta breaks from uterine wall, there is no blood going to baby, must deliver within __ mins; may be r/t drugs (__); start bilateral IVs, assess fetal status and resting uterine tone q __ mins, monitor for signs of __, measure abd girth __ -Fibronectin: protein produced in fetal tissue, mainly in __ and __ __, used to adhere __ to endometrium; shouldn't be found after __ wks in normal vag secretions (if positive, they'll go into labor in ___ wks) -Transvaginal ultrasound: cervical length should be __-__ mms, __ is preferred; if __-__, its a positive indicator for PTL -Vaginosis increases r/f PTL, teach them to prevent -For PTL; give tocolytic; durg of choice is __ __ (relaxes smooth muscle of uterus by substituting itself for __); give loading dose of __-__ g/100 m:, infuse over 20-30 mins, then do __ g/1000 mL at 2-4 g/hr; this could lead to __, muscle weakness, pulmonary __, __ __; check lungs, RR, reflexes (reverse mag toxicity w/ __ __); mag sulfate helps prevent __ __ in baby; NEVER use with __ -Terbutaline is a __ __ tocolytic; can also use __ synthesis inhibitors like __ -IPV -Most ovulate on day __ or __ day cycle -If woman smokes, she can't have __

centrally, trapped, severe, dark, 30, cocaine, 15, DIC, hourly placenta, amniotic fluid, blastocyst, 22, 2 10-50, 35, 18-20 no douching, no multiple partners mag sulfate, calcium, 4-6, 40, headache, edema, blurred vision, calcium gluconate, CP, nifedipine short term, prostaglanding, indocin tension building, abuse, honeymoon, 14, 28 mirena

Herpes: 1- __ __, can cause genital herpes if oral-genital contact; 2- __ infections; __ like vesicles that appear a few hours to __ days after exposure and rupture to form __, ulcerated lesions, which disappear in __-__ wks; after healing, the virus enters a __ phase, residing in the __ __ of the affected area; recurrences are less severe than the first episode, can be triggered by __; diagnose by appearance, culture, __ identification; no cure exists, but tx w/ __ Syphilis: early stage- __ appears where T. __ entered the body, causing slight __, weight loss, malaise (chancre lasts for __ wks); secondary- __ wks-__ mos, skin eruptions called __ __ resemble wartlike plaques and are highly __, appear on vulva, rash on __/__, acute arthritis, hepatosplenomegaly, chronic __ __; can be transmitted through __, fetus gets secondary symptoms; diagnose w/ __, __; tx w/ __ Condylomata acuminata (__ __): caused by __, which is almost always the cause of cervical cancer; soft, gray/pink __ like lesions on penis or in __ area; incubation pd following exposure is __ wks-__ yrs; tx w/ __, cryotherapy, surgical removal

cold sore, genital, blister, 20, painful, 2-4, dormant, nerve glanglia, stress, PCR, acyclovir chancre, palladium, fevere, 4, 6-6, condylomata lata, infection, hands, feet, sore throat, placenta, VDRL, RPR, PCN veneral warts, HPV, cauliflower, genital, 3-3, podofilox

-BBT? -Candidiasis: can be r/t __, immunosupressants, abx; thick, __ d/c; can cause thrush in baby -Vaginosis: more common if sexually active, frequent __; thin, __ d/c, __ odor; nonpregnant use __, avoid alcohol; increases r/f ___, PROM -Trichomonas: motile __, both partners get tx w/ __; single __ g dose or 7 day regimen -Chlamydia: both partners w/ __ (2x/day for 1 wk), __/ampicillin if pregnant; diagnose w/ NAAT -Hard to distinguish between __ and __, tx for both, as they both can cause __ -Diagnose herpes w/ __ and __ __ based specific assays; can cause fatal fetal infection if vag birth; may get __ during third trimester -Syphylis: primary: __ at site of entry, flulike symptoms; secondary: __ wks-__ mos- chancre disappears, replaced w/ __ lesions; __ transmission can occur; baby may be asymptomatic at birth and will show problems within __ mos (blind, deaf, intellectual disability); can cause __; diagnose w/ __ __ exam for __; give single dose of PCN -PID: often r/t __ or __, usually produces tubal __ (__); can scar __ __ and cause infertility

contraceptives, cheesy douching, white, fishy, flagul, PTL protozoan, flagul, 2 doxycycline, asythromycin, gonorrhea, chlamydia PCR, glycoprotein G, acyclovir chancre, 6-6, warte, transplacental, 3, stillbirth, dark field, spirochetes chlamydia, gonorrhea, infection, salpingitis, fallopian tubes

-Cephalohematoma: collection of blood r/t ruptured BVs between the surface of a __ bone and the __ membrane, scalp in these areas feels loose and slightly __, doesn't cross __ lines, disappears in __ wks-__ mos; jaundice r/t inc __, can cause anemia and __ -Caput: sustained pressure of presenting part against the __ results in compression of local blood vessels and venous return is slow, increased __ __, causing swelling; reabsorbed within a few __ -Sucking (__) pads are located in the cheeks and a __ tubercle (__ __) is frequently found in the center of the __ __ - Eyes: usually __ during first few days b/c of pressure from birth; __ hemorrhages found on sclera, r/t changes in vascular __ or ocular pressure during birth; go away in few __, not a problem -Dolls eye r/t underdeveloped __/_ coordination -Absence of red reflex r/t __ (caused by __ or __) -No tears because of immature __ structures at birth; excessive tearing r/t clogged __ __ or __ withdrawl -React to strong odors by __ or __

cranial, periosteal, edematous, suture, 2-3, RBCs, hypotension cervix, tissue fluids, days fat, labial, sucking callus, upper lip edematous, subcunjunctival, tension, days hand eye cataracts, chlamydia, rubella lacrimal, lacrimal, narcotic turning, blinking

Diabetic mom: baby requires close observation for first few __ of life -Baby may be SGA r/t maternal __ problems, but its more typical to have __, macrosomic baby that is __ in color, has excessive fat tissue, __ UC, large placenta -These babies have decreased total __ __, particularly in __ spaces -Inc weight r/t weight of __ organs, cardiomegaly, increased body __, brain is unaffected -Excessive maternal glucose passes the __, baby increases __ production and __ cell formation -Complications: __ occurs sooner/with increased __ and to lower levels in IDM baby (they continue to produce high levels of __ after birth and have dec ability to release __ and __, which stimulate __ breakdown) -Hypocalcemia r/t inc incidence of __ (aeb tremors) -Hybilirubinemia (48-72 hrs after birth, r/t slightly dec __volume, which increases __ levels, which facilitates an increase in __ breakdown, thus increasing __; immature liver function impairs __) -Polycythemia (hyperglycemia and hyperinsulinemia cause inc __ consumption, which causes hypoxia) -RDS (insulin antagonizes __ synthesis necessary for lung maturity, also decreases __, which is needed for surfactant) -Test BGL w/ heelstick q hours for first __ hrs after birth and then at __ hr intervals for 2 days; if below __, give breast/bottle if not maintained, give IV glucose

days vascular, LGA, ruddy, thick body water, eextracellular visceral, fat placenta, insulin, beta hypoglucemia, frequency, insulin, glucagon, catecholamies prematuirty, ecf, hgb, rbc, bilirubin, conjugation O@ lecithin, PG 4, 4, 40

Cardiopulmonary adaptation: during late gestation, lung fluid secretion __; labor stimulates production of __, causing fetal pulmonary cells to reabsorb fluid from __ __; cold at birth stimulates proper __; initial breath drives fluid from lungs and causes alveoli to fill w/ __; pulmonary vascular resistance __ w/ __ O2 concentrations, leading to more blood flow to lungs; ___ increases when cord is clamped, increasing pressure in __ and decreasing pressure in __ __ -Major actions of cardiopulomnary adaptation: inc __, dec __ __ __; closure of __ __, closure of __ __, closure of __ __ -Maintaining respiratory function: ability of lungs to maintain ventilation and oxygenation is dependent on lung __ and airway __; compliance influenced by __ __ (NB has rigid ribcage, large __, large abd); resistance __ in NBs -Characteristics of NB respirations: __-__ breaths/min; initial resps may be shallow/irregular; __ breathing common (pauses in resp movements that last for up to __ s alternating with breathing), __ to convert breathing patterns; periodic breathing w/ __, no associations w/ changes in __ patterns or skin color changes; __ common for first 24 hrs, __ breaths/min common for first 2 hrs -Characteristics of cardiac function: HR- can drop to __-__ bpm during deep sleep -BP: highest immediately after birth, descends to lowest at __ hrs, rises back to normal by day __-__ -Murmurs: __ are transient, no cause for concern; murmurs r/t PDA or VSD aren't noticed until __-__ wk f/u -Workload: before birth, the RV does __ of cardiac work, resulting in inc size/thickness; after birth, __ has increase in volume and it has to increase in size/thickness

decreases, catecholamines, alveolar space, breathing, air, decreases, increased, SVR, aorta, pulonary arterty SVR, pulmonary vascular resistance, formane ovale, ductus arteriosus, ductus venosus compliance, resistance, heart, increases 30-60, periodic, 20, stimulate, REM, acroocyanosis, 70 80-100 3, 4-5, 90%, 4-6, 2/3, LV

Alcohol: CNS __; birth defects can occur in first __-__ wks gestation, often before woman knows she pregnant; FASD have characteristic __ and __ abnormalities that vary in __; chronic abuse of alcohol can be bad for maternal health bu causing __ (esp folic acid and __ deficiencies), __ __ suppression, increased incidence of __ and liver disease; can have withdrawal seizures __-__ hrs in intrapartum pd; __ __ may occur PP, baby may suffer withdrawal Crack/cocaine: cocaine acts in nerve terminals to prevent reuptake of __ and __, which results in vasoconstriction, __, HTN; placental vasoconstriction decreases blood flow to __; crack=__ __, water, cocaine (makes a rock, smoke it for quicker/better high); get really hyper, then depressed when it wears off in __ mins; causes seizures, __, _ _, heart problems; increased r/f __, miscarriage, _ _, preterm birth, stillbirth; babies are irritable, exaggerated __ reflex, inc r/f __, feeding problems MDMA (ecstasy): high doses can cause __ by interfering w/ baby's temp regulation, which can cause __ __ and death; motor/mental delay see at __ yr Heroin: inc incidence of malnutrition, anemia, __; inc r/f preterm birth, IUGR, __ aspiration, withdrawal symptoms (__ pitch cry, irritable, __ sucking, vomiting, __) appear in __ hr, last for a few days; can use __ (agonist/antagonist, decreases severity of __ in baby) to dec dependence on heroin

depressent, 3-8, physical, mental, severity, malnutrition, thiamine, bone marrow, infections, 12-48, DTs dopamine, norepi, tachycardia, uterus, baking soda, 30, hallucinations, pulmonary edema, IUGR, abruptio placentae, startle, SIDS hyperthermia, organ failure, 1 preeclampsia, meconium, high, fist, seizures, 72, buprenorphine, NAS

Psych disorder Bipolar: experience symptoms of depression during __ phase, during __ phase, they may engage in behaviors that are dangerous to herself or her fetus, including drugs/__ Schizophrenia: may have difficulty managing __, interacting with healthcare team, or thinking __; woman may be acting __ or __; many schizophrenic meds are __ (heart defects); can cause __, preterm birth, __

depressive, manic, alcohol emotions, clearing, crazy, withdrawn, teratogenic, LBW, SGA

LGA: commonly r/t __ in mom; increase in LGAs body size is characteristically __, although head circumference and body length are in the __ __ of intrauterine growth; macrosomic NBs have poor __ skills and have difficulty regulating __ states; can have birth trauma r/t __ __, complications of __, polycythemia, and __ Postterm: start to lose __, but usually have normal __ and __ __; commonly have __ from nutritional deprivation, meconium aspiration r/t __ and hypoxia; cold stress r/t loss of __ __; NB w/ postmaturity syndrome appear very __, dry/__ skin, fingernails are __, scalp hair is profuse, baby appears long and __, skin is loose, fat layers are __

diabetes, proportional, upper limits, motor, behavioral, CPD, hyperviscosity weight, length, HC, hypoglycemia, stress, subcut fat, alert, cracked, long, thin, nonexistent

Dystocia (__ __) r/t dysfunctional uterine contractions Tachysystolic labor patterns: pattern of more than __ contractions in __ mins, averaged over 30 min window, contractions lasting __ mins or more, contractions of normal duration occurring within __ minute of each other or no __ tone between contractions (resting tone is greater than __ mmHg w/ IUPC) -Can cause __ __, dehydration, increased incidence of __ if labor is prolonged, __ fetal status, prolonged __ on fetal head -D/C __, turn on side, give IV bolus of __-__ mL of LR, __-__ lpm O2, __ .25 mg; if tachysystole resolves in __-__ mins, you can restart oxytocin at __ the last dose given Hypotonic labor patterns: usually develops in __ phase, after labor has been well established; characterized by fewer than __-__ contractions in __ minute period; may occur when uterus is __ -Can cause maternal __, PPH, __ __, fetal __ from ascending pathogens -Can increase contractions w/ __, amniotomy, __ stimulation; void q __ h, monitor for infection

difficult labor 5, 10, 2, 1, resting, 20 placental abruption, infection, nonreassuring, pressure pitocin, 250-500, 8-10, terbutaline, 20-30, 1/2 active, 2-3, 10, ovedistended exhaustion, intrauterine infection, sepsis oxytocin, nipple, 2

Pelvic relaxation: -Cystocele: __ displacement of bladder, which appears as __ in anterior vaginal wall; symptoms of __ __ are common, vag fullness, __ sensation may be noticeable; if mild, __ can restore tone; __ , a balanced __ and __ decreases stress incontinence; can use __ __ -Rectocele: may develop when __ vag wall is weakened, __ develops, stool gets stuck and causes __ -Uterine prolaspe: occurs when uterus protrudes __ into upper vag, pulling vag with it; may have __ sensation in groin and backache over sacrum, which is caused by pulling of __ ligaments; symptoms commonly relieved by __ __; can use __ or hysterectomy Infertility: failure to achieve a successful pregnancy after __ mos or more of unprotected sex; subferility- couples who both have __ fertility; primary- women w/ no __; secondary- can't get pregant after successful __ -Improve fertility: elevate hips for __-__ mins after sex, don't shower for an __; have sex every other day during __ pd, which can go from cycle day __-__ (day 1 is start of pd) -Test: first test __, then test woman

downward, bulge stress incontinence, draggine, kegels, duloxetine, SSRI, norepi, vag pessary posterior, pocket, constipation downward, pulling, uterosacral, lying down, pessary 12, reduced, pregnancies, pregnancy 20-30, hour, fertile, 7-17, sperm

Endometriosis (characterized by __ tissue outside of __ cavity) -Can be found in vagina, __, cervix, CNS; most commonly found in __ cavity; the endometrial tissue responds to __ changes of menstrual cycle and bleeds in __ fashion, which causes __, scarring of peritoneum, and formation of __ -Pelvic pain (either __ or __), often thought to be __; __ (painful sex) and abnormal uterine bleeding -Diagnose: __ exam reveals fixed, tender, __ uterus and palpable __ in cul de sac; diagnose w/ __ -Tx: observation, __, surgery to remove tissue/__, BC to supress __, danazol (__ derivative to suppress __ and cause amenorrhea), GnRH analogs like __ (nasal spray) or __ (Lupron) suppress menstruation by acting as __ analog PCOS -S/s: amenorrhea/__ (r/t anovulation), __ (hirisutism, acne, __ __), obesity, __, infertility -Decrease effects of __, restore __ function, protect __ (increased r/f __ cancer); reduce long term risks like T2 DM and __ -Tx menstrual irregularities w/ __ _, which also balances estrogen/progesterone to protect the __; antiandrogens like __ can decrease symptoms of __ excess; __ improves tissue sensitivity to __, inhibits glucose production, and promotes glucose __ by fat/muscle, improves __ function, restores normal __, improves weight loss

endometrial, endometrial lungs, pelvic, hormonal, cyclic, inflammation, adhesions dull, crmaping, dysmenorrhea, dyspareunia, bimanueal, retroverted, palpable, laproscope NSAIDs, adhesions, menstration, testosterone, ovulation, naferline, leuprolide, estrogen oligomenorrhea, hyperandrogenism, deep voice, hyperinsulinemia androgens, ovulatory, endometrium, uterine, CVD BC, uterus, spironolactone, androgen, metformin, glucose, uptake, ovarian, ovvulation

Diabetes -In early pregnancy, the rise in serum levels of __, progesterone stimulates inc __ production and increase tissue response to insulin (__ state) - in second half of pregnancy, placenta secretes human __ __ and __ as well as elevated cortisol and __ levels, which causes resistance to __ and decreases glucose tolerance, leading to catabolic state (__ is broken down more quickly during fasting pds b/c __ is sent to fetus; may cause __ in mom) -Diabetogenic effect of pregnancy -During 1st trimester, insulin needs __, levels of __, an insulin antagoinst are low, fetal needs are minimal - By late first trimester, insulin requirements __; may increase more by the end of pregnancy b/c of placental __ and __ production; insulin requirements drop after delivery of __, risk for DKA increases -Can dec r/f __ problems by maintaining tight __ control, no excessive hypoglycemia (fasting should be __-__; peak after meal should be __-__)

estrogen, insulin, anabolic, placental lactogen, prolactin, glycogen, insulin, fat, glucose, ketons system of checks and balances of glucose use/production is stressed by growing fetus, who derives energy from glucose taken from maternal tissues decrease, hpl, increase, maturation, hpl, placenta congenital, glucemic, 60-99, 100-129

- HG: vomits __ she eats, __ in between meals; leads to all problems of vomiting; increased __ and BUN, dec __ output; starvation causes muscle __ and severe protein/vit deficiencies; __ is only FDA approved tx of N/V during pregnancy (give on __ stomach) -Chronic HTN: exists when BP is ___, see regularly for prenatal care (q __-__ wks during 1st 2 trimesters, then weekly until birth); tell her to rest frquently on __ side, limit __, give antihypertensive meds if over ___ (labetalol, __, methyldopa) - Gestational HTN: HTN occurring for first time __ pregnancy w/o __; make diagnosis if __ doesn't develop and BP returns to normal within __ wks following birth (diagnose w/ chronic HTN if it lasts longer than __ wks)

everyting, retches, HCT, urine, wasting, diclegis 140/90 , 2-3, left, sodium, 160/105, nifedipine mid, proteinuria, preeclampsia, 12, 12

Estimation of gestational age: based on __ __ characteristics and __ development -Neuro: baby's NS is unstable for first __ hrs of life, so neuro eval findings based on __ or assessments dependent on __ brain centers may not be reliable; can aid in assessing gestational age of less than __ wks (neuro changes between __-__ wks are significant, but significant __ changes are less evident) -Ballard tool: max score is __, which corresponds to gestational age of __ wks; postnatal gestational age assessment tools can overestimate preterm newborns of less than __ wks or can underestimate postterm of more than __ wks -NBs of moms that have preeclampsia on __ __ may have poor correlation w/ neuromuscular criteria involving __ __ __ and edema; babies w/ RDS tend to be __ and __, affecting the neuro score -View __ network of __ w/ opthalmoscope; amount of vascularity present over surface of lens assists in identifying NBs __-__ wks gestation -SGA: below __ percentile (__ lbs); LGA: above __ percentile (__ lbs)

external physical, neuro 24, reflexes, higher, 24, 26, 24, physical 50, 44, 28, 43 mag sulfate, muscle tone, edematous, flaccid vascular, cornea, 27-34, 10, 6, 90, 9

Perinatal infection: most likely to cause harm to embryo if exposed in __ trimester when organs are developing; infections that occur later in pregnancy can create other concerns like __ __, preterm birth, __ changes; ___ is most common infections Toxoplasmosis: can get from raw/undercooked __, unpasteurized goat milk, __ __ -IN mild cases, __ (inflammation of retina/choroid) may be only recognizable damage and other manifestations may not appear until __; severe neonatal disorders associated w/ congenital infections include __, coma, microcephaly, __; NBs are often blind, deaf, and severe __ disabilities -Diagnose: test antibody titers (__ and __); toxoplasmosis __ test of amniotic fluid; if infected, women should get __ in first and early 2nd trimester in addition to __/__ and __ acid after 18th wk of pregnancy -Incubation pd is 10 day, mom may be asymptomatic or may develop __, malaise, rash, __, enlarged posterior __ nodes; disappear in few days/weeks

first, growth restriction, neuro, TORCH meat, cat feces retinochoroditis, adolescence, hydrocephalus, convulsions, intellecual IgG, IgM, PCR, spiramycin, pyrimethamine, sulfadiszine, folinic, myalgia, splenomegaly, cervical

-Breasts: become engorged w/ __ around time of pd; __/__ (premenstrual tenderness/swelling) is common, lasts __-__ days before pd; after menopause, adipose tissue __ and is replaced by __ tissue, leading to sagging -BSE: stand/sit in front of a mirror, inspect when both arms are at the __, both arms are __, both hands on __; palpate while lying down, put one arm behind your __, move __ and __, repeat while sitting up w/ hand behind __, squeeze and look for __ -Mammogram: soft tissue XR w/o injection of __ medium; can detect __ in the breasts before they can be felt; begin at __ if avg risk and do q yr until __; start at __ and do MRIs if high risk; q 2 yrs for people __-__ -Pap smear: used to detect __ abnormalities; uses brush to get cells from opening of __ (cervical _); brush is swished in water to release cells, and specimen is sent to a lab to prepare/examine a slide; screening with cytology q __ yrs if 21-29, screen w/ cytology and HPV q __ yrs if 30-65; 65+, not high risk, don't screen -Menopause: absence of menses for a whole __; climacteric refers to psychologic and __ alterations that occur around the time of menopause; avg age is __; perimenopause: time before menopause when ovarian function wanes and __ deficiencies begin to produce symptoms, which include __, hot flashes, irregular __, insomnia, dec __, still need __; ovulation ceases __-__ yrs before menopause, ovaries gradually __, less __ produced; menopausal women often have __ __ and night sweats, which can occur __-__x/day, last __-__ mins

fluid, matodynia, mastalgia, 3-4, arophies, connective, side, raises, hips, head, up, down, head, d/c contract, lesions, 45, 64, 30, 50-74 cervical, cervix, os, 3, 5, year, physical, 51, hormone, PMA, periods, libido, contraception, 1-2, atrophy, estrogen, hot flashed, 20-30, 3-5

Physical maturity: -Resting posture: assess as they lie undisturbed; __ term exhibits __ flexion of all extremities -Skin: preterm appears __, transparent, __ prominent; as NB approaches term, skin appears __ b/c of inc __ tissue; disappearance of protective __ __ promotes __, commonly seen if postterm -Lanugo: __ hair decreases as __ age increases (greatest at __ wks, then disappears, starting from __, then extremities/__; most abundant on __) -Sole (plantar) creases: reliable indicator of age in first __ hrs of life, but then the foot starts to __ and __ creases appear; development of sole creases begins at __ of sole and proceeds to __ with gestational progression -Areola/bud tissue: apply __ and __ finger to breast area and measure the tissue between them; at term gestation, the tissue measures between __ and __ cm; breast bud and areolae __ w/ age; LGA may have large breast tissue b/c of __ deposits; SGA may have little breast tissue because they used the __ to __ in utero, so this wouldn't be accurate -Ear: NB less than __ wks has little ear cartilage, so ear __ on itself and remains this way; __ wks- some cartilage, __ of __ pinna, pinna springs back __ when folded; by term, pinna springs back __

full, hypertonic thin, veins, opaque, ssubcut, vernix caeosa, desquamation fine, gestational, 30, head, trunk, back 12, dry, superficial, top, heel forefinger, middle, .5-1, enlarge, fat, fat, survive 34, folds, 36, incurving, upper, slowly, quickly

-Uterine atony: __ __, express clots, add oxytocin, give __ .2 mg IM q __-__ h (CI w/ HTN), prostaglandins (__, prostin, misoprostol) -Blood transfusion: __ G, must start within __ mins after leaving blood bank, complete transfusion within __ h, transfusion rxn s/s are present within first __ mins -Early PPH: most commonly r/t uterine atony, if not controlled by usual methods, give __ .25 mg IM for up to __ doses - Endometritis is common with __ birth; inflammation of endometrium; s/s: __ __ d/c, scant or profuse, bloody; do __, treat with triples -Mastitis caused by __ __, prevent with __ -DVT: give hep until PTT is ___ and INR is ___; __ indicated for 3-6 mos after Iv heparin; ptt outpatient is normal at ___ s -Majority of PP psychosis is r/t __ -Grand miltip -Cervix is open __ cms after delivery, takes __ wks to close -_ _ on 3rd day PP -Should have BM within __ hrs PP -Ovulation returns in __-__ wks if not BF, __ mos minimum if exclusively BG -EBL is __-__ w/ vag birth, up to __ mL w/ c birth -Coag factors elevated for __ days PP -TEmp in first __ hrs may be up to __, __-__ w/ primary engorment -Can use __ for sore nipples

fundal massage, IM, 2-4, hemabate, 18, 30, 4, 15 prostin, 6 c, foul smelling, culture, amp, gen, clindamycin s. aureaus, handwashing 1/5-2, 203, coumadin, 30-90 bipolar 5+ 3,2, primary engorgement 48 4-6, 12, 200-500, 1000 7 24, 100/4, 100-102 lanisol

-Breech: fetal head is in __; can be associated w/ __ birth, placenta previa, hydraminos, __ gestation, uterine/fetal anomalies; increased r/f __ cord, asphyxia, birth __; attempt ECV at __-__ wks gestation as long as woman isn't in __; eval: commonly auscultate FHR above __, passage of meconium into amniotic fluid d/t __ of fetal intestinal tract; don't let mom ambulate after __ until r/o prolapsed cord; maintain complete BR if fetus is not __ and monitor continuously - Transverse lie (__ presentation) of single fetus: can occur w/ poor abd __, excessive __ __, placenta previa; if this is discovered before term, just observe fetus' __, attempt ECV is still present at __ wks gestation (induce if ECV is successful) to reduce risk for __ cord; intrapartum ECV might also be successful in __ labor, thus decreasing need for c birth; on inspection, abd looks __, on palpation, no fetal part is found in __; FHR auscultated below __ of umbilicus -Compound: 2 presenting parts (ex); usually resolves itself

fundus, preterm, multiple, prolapsed, trauma, 36-38, labor, umbilicus, compression, ROM, engaged shoulder, tone, amniotic fluid, presentation, 37, prolapsed, early, wide, fundus, midline hand+hand, hand+foot

-to prevent __ and __, give erythromycin, apply in __ conjunctival sac, ensure spread of ointment; can wipe away excess after __ mins; can cause chemical conjunctivitis, but it will go away in __-__ hrs -Be alert for distress in first __ hrs after birth; look for signs of resp distress (may need to __ or stimulate by __ __); common cause of neonatal distress is early onset __ __ __ disease -Facilitating early attachment: __ to __ contact is really important, esp in first pd of __, when baby's __ are open -early feedings promote __ __ and increase peristalsis, thereby decreasing the potential for __ by decreasing the amount of time fecal material is in contact w/ the enzyme that frees the __ from the feces -First void should occur in __ hrs, first stool within __ hrs; weight loss up to __ for term babies is normal within first week (loss of __, meconium, limited __); cease stimulation when signs of __ appear -Remove cord clamp __-__ hrs after birth to reduce chance of __ injury to area; allow cord to __ dry; fold diaper to prevent __, promote drying; cord should look __/___ before falling off -Circumcision: prepuce, __ layer covering the tip of the penis, is separated from the __ penis and is excised to promote exposure of the __ for easier cleaning; don't do on __ or kid with genitourinary defect, like __/__, as they require foreskin for surgery; can use __ __ NB or __ cream

gonorrhea, chlamydia, lower, 1, 24-48 24, suction, stroking spine, group b strep eye to eye, reactivity, gastric emptying, hyperbilirubinemia, bilirubin 24, 48, 10%, ECF, intake, fatigue 24-48,. tension, air, infection, dark/dry epitherlial, glans, glans, preemies, hypo.epispadias, dorsal penile, EMLA

-Engorged breasts usually occur in both male and female NBs r/t maternal __ influences (__ days to __ wks); may also have __ secretion, don't massage or squeeze b/c this can cause an __ -Cry: high pitch r/t __ disorder or __ -most murmurs r/t __, which closes 1-2 days after birth -Hollow abd may be r/t __ hernia; bowel sounds may be present by __ hr after birth -Brachial palsy: paralysis of part of the arm r/t __ birth; __-__ paralysis involves damage to __ arm and is most common, NBs arm will lie limply to side, can't elicit __ reflex on afflicted side -Spine should appear __ b/c lumbar/sacral __ don't appear until baby sits -Jitteriness distinguished from __ b/c it can be stopped by NB sucking on the extremity or by nurse __ it; NB seizures involve simple movements (like __) b/c of CNS __ -Excessive drooling r/t __ __

hormonal, 3-2, white, acscess neuro, hypoglycemia PDA diaphragmatic, 1 traumatic, erb duchenne, upper, moro flat, curves seizures, holding, swallowing, immatuirty esophageal atresia

Diabetes -Maternal: commonly have __ (may be r/t excessive fetal __ r/t __), which can lead to __, preeclampsia occurs more often, macrosomia, __ -Fetal: in presence of untreated maternal __, the risk of death is high; increases r/f __ abnormalities (heart, CNS, skeletal (___ ___)); LGA (increases r/f __ __ and traumatic birth injuries); once cord is cut, baby's beta cells are still __, so they're at risk for hypoglycemia __-__ hrs PP; RDS from high levels of fetal __ which inhibit enzymes necessary for __ production; __ r/t dec O2, leads to __ -Diagnose: A1c over __, fasting glucose over __, over __ during OGTT; prenatal screening: if 1 hr is over __, do 3 hr, which involves eating an __ diet, at least __ g of carbs per day for __ days prior to test, then ingest __ g solution in morning after overnight fast, measure BGL at __, __, __ h, diagnose if 2+ are met: fasting __, 1 hr- __, 2 hr-__, 3 hr- __; 1 step approach: in the morning following an overnight fast, ingest -_ g glucose, diagnose if any of following are met: fasting __, 1 hr __, 2 hr __

hydraminos, peeding, hyperglycemia, PROM, UTI ketoacidosis, congenital, sacral agenesis, shoulder dystocia, hyperactive, 2-4, insulin, surfactant, polycythemia, hyperbilirubinemia 6.5, 126, 200 140, unrestrictedd, 150, 3, 100, 1,2,3, 85, 180, 155, 140 75, 92, 180, 153

Opiates cause intrauterine asphyxia (result of fetal withdrawal r/t maternal withdrawal, leads to __, resulting in increased __ consumption), intrauterine infection, IUGR, low APGARS -Complications include: resp distress (r/t _ _ and transient tachypnea), neonatal jaundice (common w/ __l less common in heroin or cocaine because these substances lead to early __ of the liver), congenital anomalies, behavioral abnormalities (coke leads to poor state __, have problems engaging in __); withdrawal starts in first __ hrs, lasts __ days -During first 2 yrs of life, coke babies demonstrate susceptibility to behavior __ and the inability to express strong feelings, like __, anger, __, or separation, so they have poor __ skills and trouble __; they're at higher risk for __ development problems and expressive language skills -weight baby q __ hrs, give sedative in combination w/ __, swaddle w/ hands near __ to minimize injury and achieve more organized __ state (give binky for __, excessive sucking); tell parents to expect jitteriness and __, which lasts from __ days-8 wks Tobacco: CO reduces O2 carrying capacity of blood, so baby gets __, polycythemia, hyperviscotity, which can further impair blood flow; more commonly have __; use of __ patches may increase baby's __

hyperactivity, O2, methadone, matuirty, organization, stimuli, 24, 21 lability, pleasure, distress, social, sleeping, motor 8, opiate, mouth, behavioral, nonnutritive, irritability, 6 hypoxia, IUGR, weight

Temperature regulation: NBs are homeothermic (they attempt to stabilize their __ body temps within narrow range in spit of significant temp variations in their __; depends on __ consumption and __ rates); within a specific environmental temperature range (__ __ __), the rates of __ consumption and __ are normal, maintaining internal body temps In NBs, heat transfer from __ to __ is increased compared to adults b/c of decreased __ __ and large BSA:__ ratio; blood vessels are __ to skin in NB; __ position decreases SA exposed to environment, preterm NBs have increased heat loss via __ b/c of increased total body water and __ skin Heat loss: baby has thermal __ r/t heat loss rather than inadequate heat __; convection, radiation, evaporation, conduction Heat production: thermogenesis via increased basal metabolic rate, muscular __, chemical thermogenesis (___ thermogenesis) -NST: skin receptors perceive cold, transmit sensations to stimulate __ NS; NST uses stores of __ fat to provide heat (this increases in fetus at __-__ wks and continues to increase until __-__ wks after birth; brown b/c of rich __ ___ and __ __); brown fat promotes rapid __, heat __ and heat transfer to peripheral circulation, but this increases __ consumption; NB can't shiver until the metabolic rate has __; metabolism increases b/c of inc __ consumption

internal, enviornment, O2, metabolic, neutral thermal enviornment, O2, metabolism organs, skin, subcut fate, weight, closer, flexed, evaportaion, thin instability, production; loss of heat from warm body surface to cool air currents (AC); heat transfers from heated body surface to cooler surfaces and objects not in direct contact w/ body (cold walls); loss of heat incurred when water is converted to a vapor (amniotic fluid after birth); loss of heat to cooler surface by direct skin contact (cold hands, cold scale) activity, nonshivering synpathetic, brown, 25-56, 3-5, vascular supply, nerve endings, metabolism, generation, O2, doubled, O2

Meconium aspiration syndrome: asphyxia causes inc __ __ and relaxation of the __ __; presence of meconium in lungs leads to __ __ of airways (air trapping, overdistended alveoli, pneumothorax common), chemical __, inactivation of natural __ -Manifestations include fetal __ in utero (sudden __ in activity, followed by __ activity, slowing FHR, loss of __), signs of distress at birth, __ __ is common, auscultation revels diminished air movement, XR shows __ -If NB has HR less than __, or poor muscle tone, do __ suction to remove meconium beneath the __; give high levels of O2, high __, surfactant (b/c meconium inactivates __), ECMO PRN Cold stress: excess heat loss resulting in use of compensatory mechanisms (___, inc RR); ability of NB to do NST is impaired by __, ICH, CNS abnormalities, __ (MUST maintain __ for baby)) -Cold stress increases __ requirements, __ use, acids are released into blood stream, __ production decreases -__ is initial response to cold stress, so monitor __ temp b/c it will be first to drop, then test __

intestinal peristalsis, anal sphincter, mechanical obstruction, pneumonitis, surfactant hypoxia, increase, dec, variability, resp distress, hyperinflation 100, tracheal, glottis, ventilation, surfactant NST, hypoxemia, hypoglycemia, NTE O2, glucose, surfactant vasoconstriction, skin, BGL

Mastitis (infection of __ CT in breast): onset __-__ wks PP; ranges in severity from local __ to abscess and __; infectious mastitis causes __, chills, headache, __ muscle aches and malaise, __/__/painful areas on breast, often __ shaped b/c of __ ___ division of breast; most common pathogenic organisms come from baby's __ and __; when candida is causative organism, baby will often have __, mom will have late onset nipple pain and __ of nipple, stabbing pain of breast, skin might be __, flaking __; must __ or else it will return Associated factors: milk __, actions that promote access/multiplication of __, breast/nipple __, obstruction of __, failure to __ breasts, lowered maternal __ r/t fatigue and stress Diagnose based off of s/s, __ and __ if pd doesn't respond to abd (culture __ __ milk specimen) Tx: complete/frequent __, get more rest, increase __ intake, supportive bra, local application of warm, __ heat or ice packs, analgesics, __ for inflammation and fever; change abx if no response in __ hrs Tx candida w/ __ cream, tx baby w/ oral __ for 2 wks; can have abscess formation usually in __ quadrants, tx w/ __ and __

intralobular, 2-8, inflammation, septicemia, fever, flulike, red, warm, wedge, CT, nose, mouth, thrush, buring, shiny, itchy, treat stasis, bacteria, trauma, ductus, empty, defenses culture, sensitivity, mid stream feedings, fluid, moist, NSAIDs, 48 antifungal, nystatin, upper, cut, drain

Hepatic Adaptations Iron storage/RBC production: as RBCs are destroyed after birth, their __ content is stored in liver until needed for new __ production; newborn iron stores are determined by total body __ content and length of gestation Glucose homeostasis: glucose not immediately needed is converted to __; after cord clamping, the BGL falls and peaks around __-__ hrs of age; in these first few hrs after birth, the neonatal brain metabolizes the NBs abundant stores of __, so that even though the glucose concentration is __, the neonatal brain isn't deficient; hepatic __ is depleted rapidly if NB isn't fed early Bilirubin conjugation: conjugation- turning bilirubin into an __ form (turns it from __, __ soluble pigment into __ soluble pigment); if left unconjugated, it would accumulate in the tissues; total bilirubin=__ (conjugated) and __ (unconjugated) Fetus doesn't need to conjugate b/c the __ excretes bilirubin; total bilirubin @ birth is less than __ mg/dL; normal rise in bilirubin after birth b/c __ must begin to conjugate the bilirubin; activity of __ enzyme results in attachment of __ bilirubin to __ acid, producing __, which gets excreted in stools Physiologic jaundice (nonpathologic __ __) is visible when serum bili is greater than __-__ mg/dL

irone, RBCs, Hgb glucogen, 1-2, lactate, low, glycogen excretable, yellow, fat, water, direct, indirect placenta, 3, liver, UDPGT, unconjugated, glucuronic, conjuagted bili, unconjugated hyperbilirubinemia, 6-7

Miscarriage: -Threatened abortion: embryo or fetus is __ by unexplained bleeding, cramping, __, cervix is __; bleeding may persist for __ and can be followed by partial/complete __ of products of conception or it may __ w/o harming fetus -Imminent: bleeding/cramping increases, cervix __, __ rupture -Complete: all products of conception are __ -Incomplete: some products of conception (most often __) are retained, cervical __ dilated -Missed: fetus dies in utero, not __, may have __ d/c, cervix is closed; if fetus is retained for more than __ wks, the breakdown of fetal tissue results in release of __ and __ develops -Recurrent pregnancy loss: loss of __+ consecutive pregnancies -Pelvis __/__ are reliable indicators of miscarriage, symptoms are usually absent in bleeding r/t other disorders; put pt on __, abstain from sex -If abortion is imminent and incomplete, go to hospital to complete __ and get IV __; if missed abortion, the products of conception are expelled __, but get hospitalized if this doesn't happen in __-__ wks

jepardized, backache, days, evacuation, pass dilations, membranes expelled placenta, os expelled, brown, 4, thromboplastin, DIC, 3 cramping, backache, BR evacuation, fluid, spontanouesly, 4-6

Physical assessment: -General appearance: head disproportionately ___, neck looks __, prominent __, sloping __, narrow hips, round chest, body appears long w/ __ extremities; __ hands, feet usually __ after breeched -Measurements: normal __ white baby is __ lbs, __ oz; other ethnicities smaller at term; after first week and for first __ mos, NBs weight increases about __ oz daily; __% of weight is water; usually __-__ cm long and will grow __ inch a month for next __ mos; head circumference is approximately __ cm greater than chest circumference (usually __-__ cm; measure over nipples) -Temp: monitor q __ mins until the NBs status has remained stable for __ hrs, after that check q __ hrs (more if exposed to ___); normal skin temp w probe is __-__; temperature instability (change of more than __ deg G) from one reading to the next may indicate and __; __ increases temp; NBs respond to overheating by increased __ and eventually by __ after __-__ mins, which starts on head and then on chest (if no perspiration, they increase __ and __)

large, short, abd, shoulders, short, clenched, dorsiflexed 7, 8, 6, 7, 75, 46-56, 1, 6, 2, 30-35, 30, 2, 8, GBS, 96.8-97.8, 2, infection, dehydration, restlessness, perspiration, 35-30, RR, HR

Placenta previa: placenta is implanted in __ uterine segment, as lower uterine segment contracts and dilates in later weeks of pregnancy, the __ __ are torn from uterine wall, exposing the uterine sinuses at the placental site, causing __; classified as marginal, low lying, __, __ -Prognosis of fetus depends on extent of placenta previa; if lowlying/marginal, woman might be allowed to __, but if partial/complete, do a c section b/c risk for __ hemorrhage is high; changes in __ or __ __ may be apparent -Locate placenta through __, don't do vag exam on bleeding pregnant woman until ___ ___ is r/o b/c the fingers could perforate the placenta if cervical dilation has occured -Care of late gestation, __ bleeding depends on week when bleeding first occurs, amount of bleeding; if less than __ wks, delay birth to __ wks and do bed rest with __, no __ exams, evaluate __, give IVF; if baby is well take VS q __ hrs; if bleeding/labor/bad maternal VS/__ placenta previa before __ wks, do __ __ - If no bleeding, good fetal status after __ wks, __ labor if low lying/marginal, __ cervix, make sure presentation is __ -Most diagnostic sign is __, bright red vag bleeding especially in last __ mos; 1st episode usually __, uterus remains __, usually __ lie; monitor mom's VS q __ mins if bleeding, q __ mins if not bleeding

lower, placental villi, bleeding, partial, complete lavor, intrapartum, FHR, meconium staining ultrasound, placenta previa, painless, 37, 37, BRP, vag, FHR, 4, cpmplete, 37, c birth 37, vag, faborable, cephalic painless, 3, scanty, soft, transvers, 5, 15,

Congenital Hydrocephalus Choanal atresia Cleft lip/Palate Tracehoesophagel fistula Diaphragmatic hernia Omphalocele Gastroschisis Prune belly syndrome

measure/plot head circumference daily, check fontanelles, get imaging studies causes RDS, noisy breathing, difficulty breathing during feeding; assess patency of nares, put airway in mouth to prevent RDS feed w special nipple, burp frequently, clean w/ sterile water/feed in upright position, use special nipple Excess drooling, periodic choking, immediate regurgitation, can't pass NG tube, elevate HOB, prevent crying, give BS abx for aspiration pneumonia gaspiring respirations, nasal flaring, chest retractions, barral chest, assymtetric expansion; initiate gastric decoempression, place tube, put in high semi-fowlers position put NB in sterile bag, inititae gastric decomrpession, BS abx (intesines outside of body, but encased) viscera outside of abd, usually to right side; maintain hydration and temp, give NS, place in sterile bag, don't cover defect w/ wet saline gauze, initiate gastric decompression, give BS abx absence of one or more layers of abd muscle, so abd is shapeless; associated w/ urinary abnormalities, skin hangs loosely and is wrinkely; give BS abxm place cath

-Can be at home if __; must monitor BP, weight, urine __ daily (weight gain over __lbs/day or __ lbs in 3 days is bad), NSTs __x/wk; if mom is in the hospital for mild preeclampsia, keep her on BR on her __ side, check weight and urine daily, BP __x/day, diet high in protein (__-__ mg/day), sodium moderate -Do ultrasound q __-__ wks to assess growth -Doppler __ starting at __-__ wks to screen for fetal compromise -If severe, they'll be hospitalized; do BR, high __, moderate __ diet; anticonvulsant (__ __), __ to help fetal lungs, antihypertensives if SBP is over __, DBP is over __ -Tx w/ __ (CI w/ __, HF), hydralazine via boluses; can also use __ (CI w/ CAD) and nitroprusside (__ only) -Eclampsia: bolus __-__ g of mag sulfate in __ mL NS over 20-30 mins followed by __g/hr IV; antihypertensives to keep DBP between __-__; sedative if seizures aren't controlled w/ mag; __ if pulmonary edema -Induce labor w/ __ (can give mag sulfate simultaneously); watch for signs of __, which include diminished reflexes, dec __ __; assess BP and HR q __ hrs when they're in hospital

mild, protein, 3, 4, 2, left, 4, 80-100, 3-4 velocimetry, 30-32, protein, sodium, ag sulfate, corticosteroids, 160, 110, lavetalol, asthma, nifedipine, emergency 4-6, 100, 2, 90-100, oxytocin, hypermagnesemia, RR, 4

Rubella: infection begins in the first trimester and may persist for __ after birth; defects are rare if infected after __ wks, but before __ wks, baby gets congenital __, __ deafness, PDA, intellectual disability, CO; diagnose w/ elevated rubella __ antibody titer after birth; __ babies if infected; mom may be __ or show signs of maculopapular rash, lymphadenopathy, muscular achiness, joint pain CMV: belongs to __ group and causes congenital/acquired infections that are referred to as __ __ disease -Can be transmitted via __ or cervical route; virus passed through all body fluids; commonly __ if a child or pregnant, but virus will persist over many __ - diagnose w/ amniotic fluid via __ or viral culture; ultrasounds may show fetal __, growth restriction, polyhydraminos, cardiomegaly, fetal __; - Intellectual disability, learning disability, __ loss - for fetus, this infection can result in extensive __ __ damage that leads to fetal death or survival with __, hydrocephaly, CP, or __ damage, or possible no damage at all - usually __ -no tx, but prevent by avoiding high concentration of children

months, 20, 20, cataracts, sensorineural, IgM, isolate, asymptomatic herpesvirus, cytomegalic, inclusion, placenta, PCR, hydrops, ascites, hearing intrauterine tissue, microcephaly, intellecual, SGA

Perinatal loss: death of fetus from time of conception through end of NB period -Most common cause of stillbirth include maternal __, maternal __, maternal smoking/substance abuse, primiparity, __, HTN, diabetes -Prolonged retention of dead fetus can cause __ in mom (after release of __ from dead fetus into maternal bloodstream, the __ __ is activated, triggering formation of multiple tiny __), inc infection (__ or sepsis) -When fetal death has occurred, __ XR exam may reveal a __ sign, an overriding of fetal __ bones, maternal __ levels fall; confirm death w/ lack of HR; may use __ (cytotec) or __ if they have a favorable cervix -After delivery, culture __ __ and draw IgM and __ to test for acute __ -Phases of grief: denial, __, bargaining, __, acceptance - Maternal death: HTN, hemorrhage, __, infection -Let mom see dead baby to help w/ __, but tell mom what she is going to see; let mom dress baby, give option for early d/c (_-__ h after birth)

obesity, age, SGA DIC, thromboplastin, clotting system, clots, endometritis abd, spalding, cranial, estriol, misoprostol, oxytocin, amniotic, IgG anger, depression embolism denial, 6-8

Fetal malposition; persistent __ __ position is the most common malposition, can be r/t poor __, abnormal __ of head, inadequate maternal pushing efforts r/t epidurals; increases r/f __ -Therapy: monitor maternal/fetal status to determine which form of birth is safer; most are born __, may need __ (can be used to rotate to __ position-__ maneuver) -S/S: severe __ pain during labor r/t compression of __ nerves, __ labor b/c head doesn't put enouch pressure on __, arrest of __, arrest of descent, feel the __ fontanelle w/ vag exam -Ask mom to lay on __ and move to other side as fetus rotates; __ __ position provides downward slant to vag canal, making fetal head __; all 4s __ the fetus Nonreassuring fetal status: most common initial signs are variations from normal __ pattern and dec fetal __; may have persistent __/__ decels or prolonged decels; if this is present, start __ resuscitation, which are measures to optimize the __ exchange within the maternal/fetal circulation; correct maternal __ by turning mom on side and increasing __, decrease __, give __ if needed; can try to stimulate the baby

occiput posterior, contractions, flexion, tearing vaginally, forceps, OA, scanzoni back, sacral, prolonged, cervix, dilation, anterior side, knee chest, descend, rotates HR, movement, late, variable, inrtauterine, O2, hypotension, IV, oxytocin, terbutaline

Alcohol abuse: -FASD babies have delay in __ feeding development but have normal progression of oral __ function; will nurse poorly and will have persistent vomiting until __-__ mos, difficulty adjusting to solids -CNS problems: __, dec ability to block out __ stimuli, impulsive, cognitive imapairment, speech/language abnormalities -Growth is restricted, distinctive facial features include __ __, small jaw, thin __ __; also might have __ defects, hearing loss, skeletal dysplasias -First week of life (common for first month): baby will have __, excessive arousal states, inconsolable crying, abnormal __, jitteriness -Withdraw symptoms appear in __-__ hrs, last __ mos HIV: may take infected babies __ mos to develop their own antibodies to HIV; preferred test in NBs is __ PCR and HIV __ assay, positive result by __ hrs suggests in utero transmission; repeat testing at __-__ days, 1-2 mos, __-__ mos; give ART prophylactically __ mg/kg/dose PO q __ hrs for 6 wks, change to __ therapy if tests are positive; HIV causes SGA, __, hepatosplenomegaly, interstitial pneumonia, recurrent GI/urinary tract infection

oral, motor, 6-7, hypertonicity, repetative, flat nose, upper lip, cognitive sleeplessness, reflexes, 3-1, 18 6, DNA, RNA, 48, 14-21, 4-5, 2, 6, combo, FTT,

Hormonal contraception: Combined estrogen/progestin: inhibits release of an __, creates __ endometrium, maintains __ cervical mucus to slow sperm transport and inhibits process that allows sperm to __ ovum - combined oral contraceptives: (BC), CI w/ hx of __, liver disease, __, diabetes, heavy __; can be applied __ through a patch that's applied weekly for __ wks to abd, butt, __ outer arm, or trunk, pd occurs during __ wk when patch is removed, put patch back on on first day of __ -Nuvaring: flexible soft ring into vagina that's left for __ wks, removed for __ wk, one size fits all Progestin only: used when __ b/c it doesn't interfere w/ __ __ production, also used by women who have CI to estrogen component (hx of __, __); can cause amenorrhea or __ bleeding; __ provera via injection, provides effective contraception for __, with subsequent injections q __-__ wks, suppresses ovulation, return of fertility may be delayed for __ mos, can cause bone deminiralization (take __ _)

ovum, atrophic, thick, fertilize HTN, thrombophlebitis, smoking, transdermally, 3, 4, pd 3,1 lactating, breast milk, HTN, thrombophlebitis, irregular, depol 3 mos, 10-14, 10, vit D

Cervical insufficiency: __ dilation of cervix w/o __ d/t structural or functional defects of cervix -Woman is usually unaware of _ and presents w/ advanced __ and __ and bulging membranes; risk increases w/ __ pregnancies, previous __ births, short labors, elective abortions - Do close surveillance of cervical length beginning in __-__ wks (risk for preterm birth if cervical length is less than __ cm, less than __ mm are at risk within next __ days) -Can also test fetal __, if positive, there's a risk for __ birth -If risk for preterm birth based on __ __, give progesterone until __ wks -Decreased risk for preterm birth d/t placement of cervical cerclage (__ is placed in cervix to prevent spontanous __ or __ birth; do __ if transvaginal is impossible b/c of __ or __)

painless, contractions, contractions, effacement, dilation, multiple, preterm, 16-24, 33, 15 fibronectin, preterm cervical shortening, 36 stich, abortion, preterm, transabdominal, shortening, effacement

- all babies have __ tinge to skin from increased __ concentrations in blood vessels and limited __ fat -cyanosis while resting, pink while crying indicates __ atresia (congenital blockage of passageway between __ and __) - If crying increases cyanosis, suspect __/__ problems -Harlequin sign shows deep __ color on one side of body r/t __, pale on other r/t __; lasts __-__ mins, not concerning -Jaundice is first detectable on the __, late onset may be r/t __ __; detect by pushing on __ of nose, forehead, sternum, __ mucosa -Erythema toxicum is an eruption of lesions in area surrounding __ __ that are firm, vary in size from __-__ mm and consist of white or pale __ papules/pustules w/ __ base; appears suddenly on trunk/diaper area; widespread, peaks __-__ hrs after birth, no cause/no tx, goes away in a few days - __ are exposed __ glands; will clear spontaneously -Telangiectatic nevi (__ __) appear as pale __ or __ spots found on eyelids, nose, low __, nape of __; common with light complexions, usually fade in 2 yrs, no problems -congenital dermal melanocytes (__ __): macular areas of blue/black/gray on __ area or butt, common in Asians, blacks, hispanics; fade by __ yrs -Nevus flammeus (__ __ __): capillary angioma directly below the __, nonelevated, red/purple area of dense __; commonly of face, doesn't fade/__/__ -Nevus vasculosus (__ __): capillary hemangioma, consists of newly formed and enlarged caps in __ and __ layers; raised, dark red, rough birth mark on __, grows until __ mos, then shrinks -Yellow vernix r/t __ staining -Cracked skin r/t SGA, postterm, __ incompatibility, metabolic/__ dysfunction

pink, RBCs, subcut chonal, pharynx, nose heart/lung red, vasodilation, vasoconstriction, 1-20, head, breast feeding, bridge, buccal hair follice, 1-3, yellow, erythematous, 24-28, milia, sebacous, stork bites, pink, red, occiput, neck Mongolian spots, sacral, 2 port wine stain, epidermis, capillaries, grow, blanch straberry mark, dermal, subdermal, head, 6 meconium, blood, kidney

Amniotic fluid problems -(__)hydraminos: AFV over __ mL; commonly r/t __ problems and __(in which baby __ excessively); when present in __ twins, it's because the twin with increased __ volume pees excessively; chronic- increases, problem in __ trimester vs. acute- rapid increase over pd of __ between __-__ wks; can be r/t maternal __, ___, herpes, rubella; can cause __ cord; fluid can be removed vaginally or via __ -Oligohydrminos: less than __ mL; diagnose when the largest vertical pocket of AFV is __ cm or less; found in cases of __, maternal __, IUGR, fetal renal problems; if it occurs early in pregnancy, fetal parts can __ together; because of limited fluid for fetus to develop lungs, pulmonary __ may develop; cord __ likely; on exam, fetus won't be __; schedule induction once fetus is __, monitor continuously b/c they're at risk for demise

poly. 200, swallowing, ancephaly, pees, monozygotic, blood, thrid, days, 20-24, diabetes, CMV, prolapsed, amniocentesis 500, 5, postmaturity, HTN, adhere, hypoplasia, compression, ballotable, term

SGA/IUGR complications: -Hypoxia, which can cause ___ -Aspiration syndrome (in utero __ can cause fetus to gasp during birth, resulting in aspiration of _ _ into lower airways, can also lead to relaxation of anal sphincter and release of __) -Hypothermia, which can lead to hypoglycemia (increased __ rate in response to heat loss, also reduced hepatic __ and reduced enzymes for gluconeogenesis) IUGR/SGA babies born before __ wks have poor prognosis b/c of congenital malformations, __ __, continued growth difficulties, cognitive difficulties (learning difficulties, __, ADD, poor __ coordination); __ IUGR babies can catch up in weight if given to proper __

polycythemia hypoxia, amniotic fluid, meconium metoblic, glycogen 37, intrauterine infections, ADHD, muscle, adymmetric, environment

- Postcoital emergency contraception: __ only pill, single pill; placement of __ IUD within __ days after unprotected sex is the most effective postcoital contraceptive available -Vasectomy: removal of __ __ in both sides of scrotum, it takes __-__ wks after surgery and __-__ ejaculations to clear the sperm from the _ _; recheck in __-__ mos to make sure fertilization has not been restored via __; - essure method of sterilization for women involves a __ to place a stainless steel microinsert into __ tubes, causing benign tissue response within __ mos that blocks off the tubes, confirm occlusion w/ __ -Medical abortion: combination of __ (anti-progesterone) and __ (causes smooth muscle to contract); surgical abortion safer in __ trimester than in __; completed by __ and __, minisuction, or vacuum; 2nd trimester may involve __ and __, __ saline, systemic __, and __ prostaglandins Prenatal planning: all women of childbearing age should consume __ mcg of folic acid daily; women who take BC should have __--__ normal pds before attempting to conceive to allow natural __ __ to return; wait __ month after IUD is removed

pprogestin, copper, 5 vas deferens, 4-6, 6-36, vas deferens, 6-12, racanalization hysteroscopy, proximal, 3, hysterosalpingogram mifepristone, misoprostol, 1st, 2nd, dilation, cutterage, dilation, evacuation, hypertonic, prostaglandins, itrauterine 400, 2-3, hromone cycle, 1

Fetal malpresentation -Brow: forehead of fetus is __ part, in __ position the fetal head is between __ and __, in occipitomental presentation, the fetal head enters the birth canal w/ __ diameter of head in foremost; common in __ r/t lack of abd tone; can __ labor, can compress fetal __ and cause death; do c birth if position doesn't change to __ or __ position; don't convert position w/ vacuum, forceps, oxytocin; watch for fetal hypoxia aeb __ decels and __; facial edema will subside in __-__ days - Face: face of fetus is presenting part, fetal head is __ more than brow position; common in __, preterm birth, __; can do vag birth is mentum is __, c birth if mentum is __; w/ leopold maneuvers, a large furrow is palpated between the fetal __ and __

presenting, sinciput, flexion, extension, widest, multiparas, prolong, neck, occipital or face, late, bradycardia, 3-4 hyperexxtended, multiparas, ancephaly, anterior, posterior, back, occiput

-Abortion/ectopic- give __ if mom is Rh-, don't need to test baby -R/f ectopic with __ and __ -Hydatiform mole is the abnormal development of __, loss of pregnancy -HG: high urine __, check for __; give __ fluids, KCl, vit __ -RH alloimmunization: first child isn't affected, only __ pregnancies when rh __ enter fetal circulation, causing __ of fetal RBCs (__ __-->marked fetal edema (hydrops), __ __ __, jaundice) -ABO incompatibility: mom has type __ blood, infant has A, B, or AB; __ and __ antibodies occur naturally, causing __ of fetal RBCs, so it will cause __ (tx this, no other tx); not linked to past/future pregnancies; can;t be ___ -GBS: IV __ q __ hrs until childbirth (risk if less than __ wks gestation, PROM for __+hours, temp more than __)

rhogam PID, endometriosis, placenta SG< ketones, IV subsequent, antibodies, hymolysis, erthryoblastosis fetalis, CHF O, anti-A, anti-B, hemolysis, jaundice, prevented PCN, 4, 37, 18. 100.4

-Male genitals: size of scrotal __, presence of __, descent of __; before 36 wks: little __, testes are __ in inguinal canal; 36-38: testes are in __ scrotum, rugae have developed over __ portion of scrotum; term: testes in __ scrotum (pendulous w/ __) -Female genitals: depends on __ deposits; 30-32 wks, clitoris is __, labia majora is __, widely separated; 36-40 wks: majora covers __; 40 wks: majora covers __ too -Vernix: covers __ NB (no vernix on __ NB) -Hair: preterm NB has hair in __ rather in __ __, like term NB -Skull firmness: __ as fetus matures; in term NB, the bones are __ and sutures aren't easily displaced

sac, rugae, testes, rugae, palpable, upper, anterior, lower, rugae fat, prominent, small, cliitoris, minora preterm, postterm bunches, silky strands increases, hard

Early __ trimester is best time to operate because of less chance of miscarriage or early labor; shield baby if __; often need __ tube b/c breathing through nose is tube If maternal trauma, do fetal monitoring if __ hrs if no fetal complications; if CPR on mom, deliver baby after __ mins Rh alloimmunization: if mom is Rh- and baby is Rh+, an __ response can occur and the person forms __ __ and is said to be sensitized -Subsequent exposure to __ blood can cause serious reaction that results in __ an d__ of RBCs -Rhogam= __ __ -If Rhogam isn't initiated, the __ resulting from this disorder can cause marked fetal __, called __ __, which can lead to CHF and marked jaundice -If antibody screen obtained at 28 wks is __, the woman is giving an IM injection of __ mcg of Rhogam, which provides passive __ against Rh __

second, XR, ET 4, 5, antigen-antibody. anti-RH agglutin Rh+, agglutination, hemolysis, RH immune globulin anemia, edema ,hydrops fetalis, negative, 300, antibodies, antigens

-HELLP may be associated w/ __ preeclampsia; stands for __ (macroangiopathic __ anemia--> RBCs get __ during passage through small, damaged BVs), elevated __ enzymes, low __ count); need to give birth __ -Preeclampsia can cause maternal __, headache, seizures, __; can cause SGA r/t __ and __ -Mild preeclampsia may have few symptoms, elevated BP over __, __ proteinuria, __ enzymes elevated -Severe: BP over __ (at least 2x, 6 hrs apart), proteinuria __ or higher in __ hrs or __ on random urine samples; oliguria (less than __ mL in 24 hrs), visual disturbances, pulmonary edema/__, RUQ pain, impaired liver function (ALT/AST __ normal level)

severe, hemolysis, hemolytic, fragmented, liver, platelet, ASAP hyperreflexia, thrombocytopenia, hypoxia, malnutrition 140/90, +1, liver 160/110, 6g/L, _3, 500, cyanosis, 2x

-Spotting is common throughout pregnancy and usually occurs following __ __ or __ b/c of trauma to highly vascular cervix, but still report bleeding -Ectopic pregnancy- implantation of a __ ovum in site other than __ b/c fertilized ovum is prevented/slowed in its passage through the __; symptoms of pregnancy (__, breast tenderness, nausea, __ in blood/urine) may be present - When embryo outgrows the space, the tube __ and there is bleeding into the abd cavity (sharp, __ sided pain, syncope, referred ___ shoulder pain, lower abd pain); bleeding is __, but abd gets rigid/tender -Serial measurements of serum __ values are taken q __ days (values rise much slower than they would in normal pregnancy) -Tx w/ __ if mom wants future pregnancies and the baby is ruptured, less than __ cm, no fetal heart motion, stable condition -Methotrexate is __ __ antagonist and interferes w/ proliferation of __; give IM, may have abd pain for __-__ days, assess hcg as they should __ after methotrexate -If surgery is necessary, do laparoscopic __ to preserve tube, but must do laparoscopic __ if tube is ruptured

sexual intercourse, exercise fertilizeed, uterus, tube, fatigue, hcg, ruptured, one, fight, slow hcg, 2, methotrexate, 4, FA, trophoblast, 102, decrease salpingostomy, salpingectomy

-Scarf sign: NB supine, pull arm across chest to opposite _ until resistance is met (locate elbow in relation to __ of chest; preterm NBs elbow will cross __, term NB won't cross __ -Heel to ear extension: NB supine, draw foot to __ on same side until resistance is felt (allow knee to __); assess proximity of foot to ear, degree of knee __; preterm will have __ leg, foot to ear or __; term demonstrates increasing __ -Ankle dorsiflexion: assess angle formed by foot and __ leg (intrauterine position can alter this) -Head lag (neck __): total lag common up to __ wks; term NBs can support their heads __ -Ventral suspension (__ position): hold NB prone on your hand; note degree of __ of arms and legs, position of head and back; some flexion of arms/legs indicates __-__ wks; term: fully __ extremities, head/back even

shoulder, midline, midline, midline ear, bend, flexion, straight, beyong, resistance inner, flexor, 34, horizontal, flexion, 36-38, flexed,

- If necessary, use bulb suction or wall suction to remove mucus from __ to prevent possible __; delayed for __-__ mins after birth if possible to reduce the potential for severe __ __ __ -Axillary temps have wide range (__-__); VS for healthy term NB should be monitored at least q __ mins until NBs condition is stable for __ h; __ breathing expected and normal -Maintaining NTE: essential to minimize the NBs need for inc __ consumption and use of __ to maintain heat in optimal range of __-__; if NB gets hypothermic, the body's response can lead to metabolic __, hypoxia, and __ -Perform assessments under __ warmer, which is controlled by sensor on __; only wash off __ and __ w/ first bath, massage __ into skin; bathe under __; recheck tempp after bath, place under warmer if less than __; chilling increases likelihood of NB __ -Preventing vit __ deficiency bleeding: can occur because of low __ levels in first few days of life; give __-__ mg IM in middle ___ of ___ __ (25G, ___ in needle); may need additional dose if mom got __ during pregnancy (__-__ hrs after first injection)

stomach, aspiration, 10-20, vasovagal, reflex apnea 97/5-99, 30, 2, periodic O2, calories, 97/7-99, acidosis, shock, radiant, abd, blood, flluid, vernix, 97/7, jaundice K, prothrombin, .5-1, 1/3, vastus lateralis, 5/8, anticoagulants, 6-8

RDS: r/t inadequate production of __, which keeps alveoli from collapsing, thus preventing __ which leads to hypoxia and __; RDS leads to hypxia and as a result, pulmonary vasculature __, PVr increases, and pulmonary __ __ is reduced (may also cause a return to fetal circulation) -XR would appear as __ __ or white out; on assessment, the skin will be __, jaundiced (metabolic alterations of RDS predispose the NB to dissociation of __ from __ binding sites and deposition into __ and CNS); __ is easiest detectable sign of RDS after birth -Transient tachypnea: some NBs, primarily __ and late preterm babies, can develop progressive respiratory distress that resembles __; give O2, may need __; usually NB experiences __ difficulty at the onset of breathing, but shortly after birth, __ __, nare flaring, __ retractions, desaturation, mild cyanosis may be noted in NB breathing __ __; tachypnea usually presents by __ hrs of age; may appear identical to RDS, but the XR shows a __ of lungs and __ diaphragm

surfactant, atelectasis, acidosis, constricts, blood flow, glass shards, cyanotic, bilirubin, albumin, tissues, tachypnea LGA, RDS, surfactant, no, expiratory grunting, 6, hyperinflation, flat

PID: inflammatory disorders of __ female genital tracts that includes any combo of __, __ (tubal infection), tubo-ovarian abscess, pelvic __; common w/ __ and __; s/s: bilateral sharp, cramping in __ quadrants, fever, chills, __ vaginal d/c, irregular bleeding, __ w/ palpation, cervical/uterine tenderness w/ movement (__ sign); tx w/ __/__, remove IUD 24-48 hrs after symptoms - Abnormal pap smears: use __ system to report pap smear results; __ (visualization of cervix) usually done if abnormal pap smear -Ovarian masses: can be palpated, most are __ __; may have feeling of __/__ in lower abd, dyspareunia, irregular bleeding, delayed menstruation; diagnose w/ ___, can also use __ or radiography; can give __ __ to suppress ovarian function for __-__ mos, if mass is still present after 60 days or is larger than __-__ cm, remove it - Endometrial polyps are __ overgrowths of the endometrium, commonly cause __ bleeding/spotting, bleeding/spotting after __, prolonged period bleeding - fibroid tumors (__) are benign, often __; may have __, pelvic pain, infertility; diagnose w/ __; tx w/ __ __ for bleeding, GnRH like __ to reduce size/bleeding, __ guided ultrasound to focus sound waves on fibroids, causing them to ___, __ (removal of fibroids) -Endometrial cancer hallmark sign is __ __ in postmenopausal women not cured with __; tx with ___ and __

upper, endometritis, salpingitis, abscess, gonorrhea, chlamydia, lower, purulent, tenderness, chandiliers, ceftriaxone, doxycycline, bethesda, colposcopy, benign cycst, fullness, crmaping, palpation, MRI, birth control, 1-2, 6-7 pedunculated, midcycle, sex, leiomyomas, asymptomatic, bleeding, MRI, birth control, lupron, MRI, necrose, myomectomy vag bleeing, HRT, TAH, BSO

-Feamel genitals: may have __ discharge composed of thick, __ mucus; can be tinged with __ and is called __ r/t withdrawal of maternal __; smegma commonly found between the __, don't remove -Male: hypospadias is when meatus is located on __ surface of penis; epispadias- measure is on __ surface of glans; phimosis- opening of forskin (__) is small and foreskin can't be pulled back over glans (can interfere w/ __); cryptorchidism- __ testes, palpate scrotum; __ common in NBs Brazelton Neonatal Behavioral Assessment Scale: identify NBs responses to environment and also evaluate the NBs neurologic capabilities; do on __ day of life b/c first __ days are behavioral disorganization; observe __/__ patterns and include the rapidity with which the NB moves from one state to another, ability to be __, ability to diminish the impact of disturbing __; tests __, orientation to __ and __ visual/auditory stimuli (observe how often and whether NB attends to stimuli, should turn head to voice at __ days after birth), motor activity, __ __ activity (NBs w/ __ deficit can't comfort themselves), cuddliness/social behavior (need to be held and how often they __)

vaignla, white, blood, psuedomenstruation, lavia ventral, dorsal, prepuce, urination, undescended, hydrocele 3, 2, sleep/wake, consoled, stimuli, habituation, inanimate and animate, 3, self quieting, neuro, smile

-R/f for preeclampsia: parity, genetics, age, __ disease, __ gestation, obesity -Preeclampsia pathophysiology: stage 1: fetal __ invasion in maternal endometrium supply, uterine __ __ fail to __ and increase in diameter, so blood flow is __ throughout placenta, causing placenta __; stage 2 (maternal syndrome): all of maternal organs are affected by __ __, damage to maternal __ because of release of __ __ (this damage increases sensitivity to __) -Dec __ perfusion increases liver enzymes, dec __ perfusion increases protein in urine -Mild: BP=__, protein=__, reflexes=__, no __, unchanged labs; eat __-__ g of protein, __ mg of calcium -Severe: hospitalize; bp q __, reflexes, __, edema/weight, __ edema, hourly output (greater than __ ml), proteinuria, labs (x2), __ is the only cure -Edema:+1-+4 -Labs: Renal, Liver, hematologic -Give __ 20 mg IV if HTN; mag causes __ and __ -Mag loading dose vs maintenance dose; monitor respirations, reflexes, urine output, serum mag (___ mg/dl normal), FHR -Seizure starts w/ __ __, goes full body, lasts __ min, mom stops breathing -__ is complication of HELLP r/t activation of __ system, continues to bleed b/c of __ __

vascular, multiple blastocyst, spiral arteries, dilate, decreased, hypoxia, dec blood flow, endothelium, free radicals, vasopressors liver, renal 140/90, +1, +2 (normal), 80-100, 1200, hour, clonus, pitting, 30, liver/renal, birth 2 mm, 4 mm, 6 mm, 8 mm elevated BUN/creat, dec CrCL, elevated AST/ALT, elevated Hct, dec platelets (below 100,000 is bad) labetalol, flushing, weakness 4-6 gm over 15-20 minutes vs 2 gms/hr (1000 LR w/ 40 grams) 4-8 face twitch, 1, DIC, clotting, low platelets