MY OB TEST 2

Lochia serosa

Press firmly on the fundus (She may have clots)

Loss of increased blood volume associated with pregnancy

Blood loss of 1000mL (FYI: hemorrhage after vaginal birth is 500mL, and 1000mL with CS. A pad saturated in 1 hour IS NOT hemorrhage. If the Hct is >25, it IS NOT hemorrhage)

Operative hemorrhage (when forceps, vacuum applied)

Fundal massaging

Methergine IM stat (FYI: this should not be given if patient has a HTN disorder or HR>120)

The patient has a steady trickle of bright red blood (FYI- her uterus will be firm)

Apply TED hoses??

Pt given oral anticoagulant with treatment & possible SEs. If SQ given, taught how to give & rotate site. Taught how to prevent bleeding: use of soft toothbrush & an electric razor. Follow up with DR to monitor clotting times. Use of reliable form of contraceptive (if warfarin taken - teratogenic)

elevating extremity (No ice or massage! Can apply warm, moist heat)

a healthy appetite (pt will have a decreased appetite)

• Persistent sadness
• Loss of interest or pleasure in activities
• Feelings of guilt
• Appetite changes & wt loss
• Insomnia, fatigue
• Difficulty concentrating
• Thoughts of suicide, death

• Hallcinations
• Delusions, phobias
• Emotional lability
• Bizarre or violent behavior
• Changes in appetite
• Pyschomotor agitation
• Suicide or infanticidal ideation

Maternal administration of mag sulfate

• RR
• HR
• T
• BP (FYI-BP not usually done unless indicated, such as with heart murmur which can be heard on a preterm baby)

Caput succedaneum (this is an accumulation of fluid not blood that will be broken down into heme and build more bilirubin)

the affected side eye will not shut

Frequent feeds (will cause increased urine, stooling that will push excess bilirubin out the body)

Eyeshields(class debated that we should assume that the baby is under bili-lights to assume the best answer is “eyeshields”)

see-saw motion is a danger sign

Use petroleum jelly dressings (yes, the other big things are to watch for bleeding and infection)

• 1st period of reactivity:1st hour baby is most alert and RR ishigher
• Period of decreased reactivity
• 2nd period of reactivity:

homozygous

Impaired gas exchange (abdominal contents displace lung)

• Stillbirth at 33 weeks gestation spontaneous abortion at 7 weeks gestation
• therapeutic abortion,
• and infant with cleft lip. **The correct answer was all choices. Trick question. Remember that a perinatal loss is not just fetal demise. It can be a birth that does notmeet expectations. **

Previa.(Other options are uterine atony, abnormal adherence of placenta, fundalpressure)

Bluish discoloration of the vulva (another option was something about the patient having pain, but patient’s epidural still working because the affects usually won’t wear off for 1-2 hours after birth)

Give the family the clothing the infant wore in the pics taken in the hospital. (other options were: share your experience of loss with the family, tell the family they can try for another baby)

Assess the fundus for firmness and clots, THEN assist the patient to the restroom if she tells you she needs to void.

Prolonged laying (avoid this so that the baby does not suffocate. Another option was not to leave blankets in the crib)

• Body cold to touch
• Temp <97.7F
• Tachycardia
• Tachypnea
• Jitterness
• Restlessness
• Hypoglycemia
• Lethargy

An overvigorous suck

• Enfamil 30cc PO now,
• then recheck blood sugar (Blood sugar should be over 40, so the option to recheck blood sugar is incorrect)

Call the doctor!!!!

• Provide warmth,
• position correctly
• give O2 PRN,
• dry and stimulate,
• (wanna place baby in warm bed after its delivered, lay them on their back and give O2 if needed, dry and stimulate them if not crying, O2 prn)

peripheral vasodilation (other options were hypoxia, metabolic acidosis, increased O2 consumption)

• Pre-eclampsia
• PROM
• Chorioamnionitis
• Severe preeclampsia
• Maternal medical diseases (DM, renal dis, chronic pulmonary dis
• Suspected fetal jeopardy
• Fetal Demise
• Postdate pregnancy (after 42 wks)
• STOP syndrome

• Greater incidence of cesarean birth
• Tachystole (too many contractions)
• Non-reassuring FHR patterns
• Failure to progress in labor
• Induced labors generally longer than spontaneous
• Increased costs of care

• Pg Gel (cervical ripening agent): 0.5-3mg into cervica os or posterior vaginal fornix
• Cervidil (cervical ripening agent): 0.3mg/hr inserted in the into posterior vaginal fornix for 12hrs
• Cytotec (cervical ripening agent): 25mcg into posterior vaginal rpt q 3-6hrs up to 6 doses in 24hrs
• Oxytocin: 0.5-1.0 milliunits/min, then titrate 1-2mU//min q15-30 min, titrate to ctx, Max dose: 40 mU/min

• Call for Help!
• Supplies: gloves, bulb syringe, scissors, cord clamps
• **Emergency steps* ROM prn, Deliver head with Ritgen manuever
• Gently rotate head to one side
• Bulb suction nose, then mouth
• Check for nuchal cord: Attempt manual reduction or clamp & cut if not reducible
• Hook finger gently under ANT shoulder & deliver shoulder
• Then gently Hook finger gently under POS shoulder & deliver shoulder
• Suction mouth prn

• Call for help!
• Notify MD immediately
• Exert upward pressure against the presenting part to relieve compression on the cord
• Modified Sims or knees to chest
• O2 by mask
• IVF bolus
• Turn off pitocin
• If cervix is dilated, forceps/vacuum assisted birth may be performed or else CS is necessary

• Lower HOB
• Call for help
• McRobert's maneuver (Knees to ears)
• Suprapubic pressure (NVR FUNDAL PRESSURE
• Gaskin maneuver (Pt is on Knees leaning over bed)
• CHART

• Oxytocin:
• Analgesia/Anesthesia
• Sleeping meds (Ambien)

• Action: stimulates uterine smooth muscle. also has a vasopressor and antidiuretic effect
• Use: labor induction & PP control of bleeding
• Maternal SEs: uterine tachystole & water intoxication (causes Na retention & H2O retention)
• Fetal/Neonatal SEs: Iatrogenic prematurity, Hyperbilirubinemia
• Discontinue tx if TACHYSYSTOLE occurs - <60 sec relaxation between ctx, >5 ctx in 10min, Ctx >2 min duration, Ctx doubling/tripling may signal of onset

• Lacerations
• Retention of placental fragments
• Disorders of coagulation - thrombin
• Trauma during delivery - genital tract trauma
• Uterine inversion
• Uterine atony

• Assess fundus
• Fundal massage
• Frequent VS
• Initiate IVF/oxytocics
• Pad count: 1 gram = 1 ml

• Breast binder or well fitted supportive bra
• Ice packs
• Mild analgesics
• Fresh cabbage leaves

• Oxytocin: watch for water intoxication, N, V
• Methylergonovine: HTN, N, V, HA
• Prostagladins: HA, N,V, F, D, tachycardia, HTN,
• Misoprostol: HA, N,V,D

• Postpartum Blues: onset 3-4 dys after birth, Transient no tx, S/SX: mood swings, weepiness, anorexia, fatigue
• Postpartum Depression: onset 1-6 mos after birth, risk factors: hx pyschiatric disorders, poor social support, stressful life events. S/Sx: PERSISTENT SADNESS, loss of interest/pleasure in activities feelings of guilt, hopelessness, thoughts of death/suicide. TX: SSRIs-linked to PPH in neonate, Tricyclics, MAOIs, Pyschotherapy
• PP Psychosis: onset w/in days, S/SX: hallucinations, delusions, phobias, emotional lability, bizarre/violent behavior, chg in appetite, sleep pattern, suicidal/infanticidal ideation, TX: prevention w/estrogen postpartum, hospitalization, antidepressants, psychotherapy

LOWER GENITAL TRACT INFECTION: F, Site red, warm to touch, drainage, dysuria, pain localized, edema, WBCs >30,000 (UTIs, Vag Infection)

UPPER GENITAL TRACT: (ENDOMETRITIS) PP Fever day 3/5, Uterine tenderness & lower ab pain, Tachycardia, Uterine subinvolution, Malaise, Chills, HA, bckache, FOUL SMELLING LOCHIA, wound dehiscence, GBS infection prior to deliver

• Strict bed rest
• Elevate extremity
• Apply heat
• Analgesics, sedatives
• Antiocoagulant tx (Hep given 24-48 hrs, the Coumadin)
• Antibiotics
• Ted Hose
• Educations

• Convection: flow of heat from the body surface to cooler air - SHIELD baby from drafts
• Radiation: loss of heat from the body surface to a cooler SOLID surface - KEEP baby away from cold objects and outside walls
• Conduction: loss of heat from the body surface to cooler surfaces in direct contact - Keep surface warm & padded.
• Evaporation: loss of heat that occurs when a liquid is converted to a vapor - Keep baby dry and wrapped

• Body cold to touch
• Temp <97.7F
• Tachycardia
• Jitterness
• Restlessness
• Hypoglycemia
• Lethargy

• DRY infant well - PREVENTS heat loss by evaporation
• Use warm blankets - PREVENTS heat loss by conduction
• Radiant Warmer with probe
• Wrap infant well
• Skin to skin contact with mom or dad

• BG: 40-60
• VS: HR 100-160 beats/min, RR 30-60 breaths/min, T: 96.8-99F, BPl 73/55 mm Hg
• Posture
• Peripheral Pulses
• Chest
• Skin
• Head
• Eyes
• Nose
• Ears
• Face
• Mouth
• Neck
• Abdomen
• Genitalia
• Extremities
• Back
• Anus
• Gestational Age determination

• Erythromycin opthalmic ointment - prophylactic measure to protect against gonorrhea & C. trachomatis
• Vitamin K - prophylaxis & treatment of hemorrhagic disorders
• Hep B - prevent Hep B, consent form required

• Gaze aversion
• Hiccuping
• Gagging
• Regurgitation of food
• Holding hands in front of face
• Frowning, worried expression
• Stiffening & extending limbs
• Facial grimace
• Irritability
• Irregular RR
• Increased HR

• Total bilirubin rise >0.2mg/dl per hour
• Jaundice persisting more than 1 week
• Jaundice in first 24 hours

• Breakdown of fetal hemoglobin at birth
• Limited hepatic bilirubin clearance
• Immature enzyme systems
• Increased enterohepatic shunting

• Occurs in term/post term newborns, meconium in the lungs
• Respiratory distress
• Tachypnea
• Cyanosis
• Retractions
• Nasal flaring
• Grunting
• Crackles
• Rhonchi
• NB's nails, skin, & umbilical cord may be stained yellow
• Pneumothorax
• Chemical Pneumonitis

• Occurs following intrauterine asphyxia & with CS
• Failure to clear airway after birth
• Tachypnea noted by 6 hrs of age & peaks about 36 hrs of age

Serious lung disorder caused by immaturity & inability to produce surfactant, resulting in HYPOXIA & ACIDOSIS

• TOXOPLASMOSIS: caused by parasites toxoplasma gondii acquired by: eating undercooked meat, exposure to cat feces, raw goat's milk, & insects in contact with cat feces.
• OTHER (gonorrhea, syphilis, varicella, hepatitis, HIV)
• RUBELLA
• CMV (Cytomegalovirus): common herpes virus transmitted by blood & body fluids, most common congenital infection
• Herpes simplex virus: genital herpes

• Injury to upper Brachial plexus due to stretching or pulling the head away from the shoulder
• S/SX: flaccid arm with elbow extended & hand rotated, Absence of Moro reflex on affected side, Sensory loss over lateral aspect of arm, Intact grasp reflex

• Damage to lower brachial plexus
• S/SX: Wrist & hand flaccid, DTRs present, dependent edema & cyanosis, ABSENT grasp reflex

Replenishes surfactant & restores surface activity to the lungs to prevent & treat RDS

• Lethargy, irritability, hypotonia
• Color change
• Temp instability
• Feeding intolerance
• Tachycardia, then apnea, bradycardia

• Swaddling
• Pacifier
• Music
• Positioning strategies
• Care clustering
• Mother

• Evaluate pain by physiologic & behavioral responses
• Increased HR
• Rapid, shallow respirations
• Decreased O2 sats
• Increased muscle tone
• Increased ICP
• Crying
• Grimacing
• Rigidity
• Changes in sleep/wake cycle
• Listlessness
• Flaccidity
• Brow bulge
• Eye squeeze
• nasolabial furrow

• FREQUENCY: 8-12 feedings per 24 hrs, 2-3hrs during the day & 3-4hrs during the night
• LENGTH: avg of 30 minutes
• OUTPUT in stools/urine: 6-10 dirty diapers w/in 24hrs & urine is light colored. 2 to 3 stools per day / 3-4 golden yellow curdy stools per day

• FREQUENCY: 6-8 feedings per 24 hrs, q 3-4 hrs
• LENGTH: 15- 30 ml per feeding
• OUTPUT in stools/urine: 6-10 dirty diapers w/in 24hrs & urine is light colored. 1 - 2 malodorous soft stool every 2-3 days

• Neonates under 2500 (SGA) or over 4000 grams (LGA)
• IUGR
• Prematurity
• Asphyxia
• Maternal DM

• Scalp edema that extends the suture lines
• Resolves within 3-4 days

• Collection of blood between skull bone and periosteum caused by pressure from maternal pressure or OVD
• Does not cross suture line
• Resolves in 2-3 wks