OB Test 3 - Study (ADDIE's)

healthy oils

-Olive, Peanut, and Flax seed Oils -Avocado and Walnuts Think healthy fats!

Signs of overhydration in newborn

-Urine output greater than 5 mL/kg/h -Urine specific gravity less than 1.002 -Edema -Weight gain greater than expected -Bulging fontanels -Moist breath sounds -Blood: decreased sodium, protein, and hematocrit levels

An infant has a grade 3 intraventricular hemorrhage (IVH). The nurse monitors the infant for which complication?

. hydrocephalus

Degree of tears during birth

3rd degree tears: 1st degree: little nick at end of vagina. 2nd degree: most common, through some muscle between vagina and perineum. 3rd: vagina to anus (does not include rectal mucosa) 4th: vagina and through anus

5) A 38-week newborn is found to be small for gestational age (SGA). Which nursing intervention should be included in the care of this newborn? 1. Monitor for feeding difficulties. 2. Assess for facial paralysis. 3. Monitor for signs of hyperglycemia. 4. Maintain a warm environment.

4. Maintain a warm environment. Explanation: 4. Hypothermia is a common complication in the SGA newborn; therefore, the newborns environment must remain warm, to decrease heat loss.

Endocervical polyps are most common in which decade of life?

5th or at 50 years

Assessment reveals that a young mother has several risk factors for giving birth to an infant with a neural tube defect. Which laboratory test would the nurse expect to be used to monitor fetus for birth defects?

AEP Alpha-fetoprotein

A nurse is providing breast care education to a client aftermammography. Which information regarding fibrocystic changes in thebreast is important for the nurse to share? a. Fibrocystic breast disease is a disease of the milk ducts and glands in the breasts. b. It is a premalignant disorder characterized by lumps found in the breast tissue. c. Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles. d. Lumpiness is accompanied by tenderness after menses.

ANS: C Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with themenstrual cycle. Fibrocystic changes are not premalignant changes; thisinformation is inaccurate. Tenderness most often occurs before menses

6) The nurse is caring for a 2-hour-old newborn whose mother is diabetic. The nurse assesses that the newborn is experiencing tremors. Which nursing action has the highest priority? 1. Obtain a blood calcium level. 2. Take the newborns temperature. 3. Obtain a bilirubin level. 4. Place a pulse oximeter on the newborn.

Answer: 1 Explanation: 1. Tremors are a sign of hypocalcemia. Diabetic mothers tend to have decreased serum magnesium levels at term. This could cause secondary hypoparathyroidism in the infant.

4) The nurse is caring for an infant born at 37 weeks that weighs 1750 g (3 pounds 10 ounces). The head circumference and length are in the 25th percentile. What statement would the nurse expect to find in the chart? 1. Preterm appropriate for gestational age, symmetrical IUGR 2. Term small for gestational age, symmetrical IUGR 3. Preterm small for gestational age, asymmetrical IUGR 4. Preterm appropriate for gestational age, asymmetrical IUGR

Answer: 3 Explanation: 3. The infant is preterm at 37 weeks. Because the weight is below the 10th percentile, the infant is small for gestational age. Head circumference and length between the 10th and 90th percentiles indicate asymmetrical IUGR.

1) The nurse is caring for the newborn of a diabetic mother whose blood glucose level is 39 mg/dL. What should the nurse include in the plan of care for this newborn? A) Offer early feedings with formula or breast milk. B) Provide glucose water exclusively. C) Evaluate blood glucose levels at 12 hours after birth. D) Assess for hyperthermia.

Answer: A Explanation: A) IDMs whose serum glucose falls below 40 mg/dL should have early feedings with formula or breast milk (colostrum).B) If normal glucose levels cannot be maintained with oral feeding, an intravenous (IV) infusion of glucose will be necessary.C) Blood glucose determinations should be performed by heel stick hourly during the first 4 hours after birth and at 4-hour intervals until the risk period (about 48 hours) has passed.D) Hypothermia is a potential problem for the SGA newborn due to decreased brown fat stores and minimal subcutaneous tissues.

What is a PDA (Patent Ductus Arteriosus)? Who is at risk?

At risk: Premature babies. What will you hear with a PDA: continuous murmur on auscultation.

10. All infants need to be observed for hypoglycemia during the newborn period. Based on the facts obtained from pregnancy histories, which infant would be most likely to develop hypoglycemia? A) an infant whose labor began with ruptured membranes B) an infant who had difficulty establishing respirations at birth C) an infant who has marked acrocyanosis of his hands and feet D) an infant whose mother craved chocolate during pregnancy

B) an infant who had difficulty establishing respirations at birth

11. Which finding would the nurse expect to assess in an infant with hypoglycemia? A) prolonged jaundice B) limpness or jitteriness C) pain along the sixth cranial nerve D) excessive hunger

B) limpness or jitteriness

If person is on vegan diet, what supplement is important

B12

Cephalhematoma

Bleeding between the periosteum and skull from pressure during birth; does not cross suture lines.

What GYN cancer are we concerned about with bleeding after menopause?

Endometrial

Congenital malformations, infections, and placental insufficiency are signs of what?

Fetal Growth restriction

Which dietary source improves outcome of neural tube defect Where do you get these sources from?

Folic acid improves outcomes of neural tube defects: · Dietary sources: spinach, oranges, beans all have folic acid.

Meconium aspiration syndrome:

Infant has passed meconium intrauterine and has swallowed it. There will be mild to severe cases. Mild: baby will need O2. Severe: baby will need ECHMO (extracorpeal membrane oxygenation where blood is pumped to a hear lung machine outside the body and filters out CO2 and send oxygen filled blood back into the body). Nurse must be certified to deliver echmo.

Does cephalohematoma cross suture lines?

NOPE · Increased risk for jaundice in these babies (blood (RBCs) breaks down and we will see jaundice).

If you have a patient who is within reproductive age with lower quadrant pain coming into ER, we will test for?

Pregnancy (need to rule out ectopic pregnancies).

osteporosis and dietary screening for woman?

Prenatal 24 hour dietary recall is great way to assess needs of woman.

Signs that baby is read for nipple feeding

Ready: Rooting •Sucking on gavage tubing, finger, or pacifier •Able to tolerate holding •Respiratory rate <60 breaths •Presence of gag reflex Not ready: •Respiratory rate >60 •No rooting or sucking •Absence of gag reflex •Excessive gastric residuals

Finnegan Scoring System

To monitor for symptoms of neonatal abstinence syndrome/withdrawal (mostly due to drug withdrawals)

BMI (body mass index)

Underweight - Less than 18.5 Normal - 18.5 - 24.9 Overweight - 25 - 29.9 Obese - 30 - 39.9 · Weight gain should be less than typically: 11-20 pounds.

What is endometriosis

When uterine tissue grows outside of the uterus. Mostly seen in pelvic area, uterus, fallopian tubes, bowel, bladder. · Causes pain and discomfort. · Hormones will affect these tissues as well because tissue follows the same cycle regardless.

When do women get screened with a mammogram?

When woman celebrate their 40th birthday, they will also begin getting mammograms with standard risk. · If increased risk of breast cancer, they will start prior.

Now that her baby is 3 months old, Nancy has not lost as much of her pregnancy weight as she had hoped. Before she got pregnant she weighed 125 pounds; now she still weighs 140 pounds. When a woman keeps 7 or more added pounds post-pregnancy, what two conditions is she at risk for in future pregnancies? a. diabetes and hypertension b. breast cancer and hypotension c. atherosclerosis and inflammatory arthritis d. acne and nausea e. heart attack and stroke

a. diabetes and hypertension

Necrotizing Enterocolitis (NEC)

acute inflammation of the bowel that leads to bowel necrosis Occurs in premature and newborn infants. Thought to be infection and or ischemia of the gut. What does NEC stand for? Necrotizing Endoclitics. What will we see? Abdominal distention. We need to do? Baseline abdominal circumference so we can identify inflammation/abdominal cavity expanding. Inflammation leads to: Intestinal tissue or death and potentially leak out into abdominal cavity causing sepsis. What causes NEC: premature babies are at increased risk and when baby is fed too soon. Baby will be on TPN.

Eating disorders:

anorexia, bulimia, binge eating disorder

NAS -Neonatal Abstinence Syndrome

group of medical problems that occur in a newborn who was exposed to addictive opiate or narcotic drugs as a fetus. · A stands for abstinence NOT addicted. · If baby shows signs of withdrawal after delivery, morphine can be used to control signs of withdrawal · Finnigan scale used when: to rate symptoms of withdrawal.

What is a rectocele?

herniation of the rectum into the vagina · Feels like there is lump in the vagina. · Dragging in vagina area.

Gastroschisis

intestines outside of abdomen wall, red & swollen. · When they are put back into abdominal cavity they are put in bag and gravity fed back into the abdominal cavity.

Congenital heart defects: Before baby is discharged, we do _______________ to determine congenital heart defects.

pre and post ductal O2 sats

TTN (transient tachypnea of the newborn)

respiratory distress in a term infant related to to delayed absorbtion of fluid in lungs from delivery. · Risk: c-section, mother with asthma, multiple gestations. · Signs and symptoms: respiratory distress (nasal flaring, retractions, respirations above 60, grunting). · Never feed a baby if respirations are over 60.

gender expression

the way in which a person expresses their gender identity, typically through their appearance, dress, and behavior. Use pronouns

pelvic organ prolapse

women with multiple children ligaments holding uterus stretch - uterus falls and block urethral opening

How is menopaused defined:

· 12 months without menstrual period. · Know signs/symptoms: vaginal dryness (suggest lubricants). · Tx: hormonal tx will help correct the signs/symptoms.

What is GBS? How is It diagnosed? How is it transmitted to fetus/infant?

· ? Diagnosed between week 35-37 weeks. Identified with vaginal/rectal swab (colonization of group B strep bacteria). · How is it transmitted to fetus/infant? The birth canal through transit can pick up bacteria.

What baby is at increased risk for shoulder dystocia?

· Babies who are large for gestational age.

How will baby's will present with congenital heart defect:

· Baby is always sleepy (especially during feedings) · Not feeding well · Also losing weight because of using energy.

What will Moro reflex show with shoulder dystocia baby?

· Baby will not extend arm all the way up.

How to predict ovulation?

· Basal body temperature, cervical mucus, 14 days, ovulation kits. · What day does ovulation often occur in cycle? 14th day.

What is a cystocele?

· Bladder that prolapses into vagina.

Why are babies born to moms with gestational diabetes at increased risk for hyperglycemia?

· Body is used to producing lots of insulin and it takes time for them to adjust. · Takes about 24 hours for them to regulate how much insulin they are producing. FEED THEM FIRST THING

Why is thermal regulation so important?

· Cold stress: · Cold stress can lead to: hypoglycemia, this is our worry. · Manifestations: Weak cry is concern of hypoglycemia. Cry should be vigorous not weak.

S/S of NEC

· Distended abdomen · Red and tender abdomen

Female-female couples who are trying to get pregnant:

· Do not over medicalize natural process of pregnancy. Pay attention to their needs. · It will be common that they become overwhelmed and anxious once they become pregnant (this is not uncommon).

What will we see with eating disorders?

· Erosion of teeth (bulimic due to stomach acid) · fluctuation of weight · Russel signs (abrasions to the hands due to contact with teeth during self-induced vomiting) · irregular menstruation · regular visits to clinic · Hunger

If baby has hypoglycemia (low blood sugar), what will we do to correct it?

· Feed the baby ASAP, breastfeeding is even better.v

Reducing pain during assessment in newborn (i.e. circumcision or heel stick):

· Give sucrose (as effective as morphine). · Breastfeeding, pacifier, kangaroo care. · Swaddling baby.

Why is exercise important in woman's health?

· Improves bone density & bone health. · Improve sleep. · Reduce risk of high blood pressure. · Addresses weight gain.

Why are newborns more susceptible to infection and sepsis? What are some influences?

· Influences: Preterm labor, GBS+, PROM. · GBS can be transmitted through birth canal. · Baby immune system is immature. · Mom with fever puts baby at increased risk.

What can lead to intrauterine growth restriction (IGR)?

· Low perfusion due to nuchal cord or knot (cord wrapped around baby). · Congenital malformations. · Infections.

Stress incontinence:

· Often those with vaginal delivery. · More vaginal deliveries increase risk of stress incontinence.

The difference between Omphalocele with gastroschisis

· Omphalocele: outside organs are contained within a thin sac. · Gastroschisis: organs are free floating.

What do we ask during diet assessment?

· Portion size · Address snacks · Are you taking supplements? · What foods do you eat.

Ventricular hemorrhage: Who is especially susceptible?

· Premature babies. · Blood is pooling in ventricles. · Grade III: Pressure pooling in ventricles can lead to intracranial pressure. There will be a shunt placed due to worry of hydrocephalus. · Grade IV: ventricles fill with blood and seeps into surrounding tissue.

Gestational diabetes may be on insulin or other medications:

· Snacks: carbs and proteins (apple with cheese slices). · Need to get them to eat nutritious meal to get them through.

Gestational diabetes:

· Some will regulate with diet and exercise. · Some will need to take insulin. · Need to increase insulin during 3rd trimester due to: hormones being made in placenta blocking insulin so need will increase.

Common neural tube defect:

· Spina bifida. · Blood test to identify neural tube defects in prenatal period: AFP (alpha fetoprotein) levels could indicate spina bifida.

Post-operative our goal of a patient who has repair of cleft lip/palate:

· We want to address any pain/surgical pain.

Screening for cervical cancer: What do we look for? How do we screen? · Best way to prevent HPV?

· What do we look for? HPV · How do we screen? Papsmears · We start screening at: 21 regardless of sexual activity. · Q3 years if negative until age 30. · Best way to prevent HPV? Vaccinations.

Eye Erythromycin ointment is used to prevent:

· chlamydia

Ovarian cancer:

· silent killer because it is camouflaged. Found in late stages

Signs of dehydration in babies

•decreased urine output (<2 ml/kg/hr), increased specific gravity, weight loss; dry skin & mucous membranes, sunken fontanel, and poor tissue turgor are LATE signs