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OB Finals Consists of Case Studies and Written Pearson has case studies; look at clinical reasoning
Chapter 20-30, 5-6; Menstrual Cycle & Male Organs (give physiological functions of each)
Chapter 25 Maintenance of stable temperature and maintaining a neutral thermal environment Keep new born’s clothing and bedding dry Double wrap newborn and put on a stocking cap Use radiadnt warmer during procedures Reduce newborn’s exposure to drafts Warm object that will be in contact with newborn Encourage mother to snuggle newborn
Ppx Hep B and Vitamin K (why are you giving that) Vitamin K- to prevent vitamin K deficiency bleeding Hep B - to get immunized and prevent from getting hep B disease
Facilitating early parent and new born attachments
Eye to eye contact skin to skin contact involving in bath
Advantage of breast feeding Disadvantage of breast feeding -reduce risk of developing type 1 and type 2 DM. obesity, lymphoma, asthma -protects from getting respiratory and GI infection such as otitis media -enhanced bonding with baby -provides immunologic such as IGA -high in nutrients such as protein, fat and carbs
-faster to return pre pregnancy weight -no cost -no preparation needed
Feed every 1.5 t 3 hours
-pain with breastfeeding -leaking milk -embarrassment in public -stress from juggling work and breastfeeding -unequal feeding responsibilities -diet restriction such as limit caffeine -limited hormonal birth control pills -vaginal dryness- d/t low level of estrogen while lactating. Temporary. Use water based lubricant during intercourse
Advantage of formula feeding Disadvantage of formula feeding -provides nutrition when mother is not present -both parents can participate -father can assume feeding responsibilities -mother may not be present
Feed every 3-4 hours
-lower in nutrients -overfeeding may occur -may feed less d/t slower to digest -can increase risk of respiratory and GI infection -prep time is time consuming -expensive -no anti-infective properties
Stages of Human Milk (what they look like, what they are high of, what it correlate to NB maturity) C&C
Colostrum Transitional “coming in”^ Mature milk
-initial milk secreted at birth of baby -small in volume -thick, creamy, yellowish fluid -concentrated in protein, fat soluble vitamins and minerals -contain lactoferrin and IGA -has laxative effect that makes the baby pass meconium which decrease the risk of hyperbilirubinemia
-begins 36 and 96 hours postpartum -light yellow but more copious than colostrum -contains more fat, lactose, water soluble vitamins and calories
-white or slightly blue tinged in color -present by 2 weeks postpartum -contain carbs, fat and protein, 87% water
Contraindications of breastfeeding HIV/AIDS Active TB Herpes on breast Infection Drug, smoking, certain medication Breast cancer Baby has galactosemia
Breastfeeding techniques Positioning:
- Modified cradle position- mothers one hand is supporting the head/neck of baby while the other hand is assisting the breast towards the mouth of baby
- Cradle position- the head of baby is on the crook of her arm while the other arm supports the body. Hugging position
- Football- baby is on the side of mother. One hand is supporting the head while other hand holds the breast
- Side lying-
Formula feeding guidelines and techniques p 553-554; concern of water sources Powdered formula - good for 24-48 hours, least expensive, must add water Formula concentrate - more expensive than powder, needs to add boiled water that has been cooled Ready to feed - easiest, doesn’t require mixing, most expensive formula.
Latching on- making sure the baby opens mouth widely and attach lips to areola not to nipple only Formula feeding guidelines: Type of water use No fluoride before 6 months Burp baby frequently Slow nipple for NB, older babies use medium to high flow nipple Nipple shape is important
When parents call MD for her NB care
Baby born to a Diabetic Mom/complication
- Hypoglycemia > 40mg/dl
- Polycythemia (how to they present and define each)
- Hyperbilirubinemia (appear 48- 72 hour after birth)
- (^) Hypocalcemia ( <7mg)
- RDS (d/t cortisol induced stimulation necessary for lung maturity)
- Birth trauma- d/t macrosomic
- congenital birth defect -PDA
Chapter 27 Asphyxia -
r/f asphyxia
non reassuring FHR impaired maternal oxygenation impaired blood flow through placenta intrapartum bleeding difficult/prolonged birth fetal scalp sample less than 7pH narcotic use in labor prematurity meconium in amiotic fluid male baby SGA Infant of diabetic mother Multiple birth Congenital heart disease anemia
RDS -d/t inadequate production of surfactant Prematurity -all premature are at risk for RDS Surfactant deficiency -inadequate lipoprotein that coats the inner surface of alveoli
RDS complications Hypoxia- pulmonary vascular constricts, pulmonary vascular resistance increase, pulmonary blood flow decrease respiratory acidosis- increase PCOs, decrease PH = hypoventilation metabolic acidosis- lack of oxygen at cellular level, begins anaerobic metabolism leading to increase lactate acid
Hyperbilirubinemia Bilirubin RBC destruction Heme convert to bilirubin Unconjugated bili attached to albumin Goes to liver Becomes unconjugated Enters enterohepatic system bacteria in large intestine (unconjugated) if removed then will cause jaundice bilirubin excrete in feces(stercobilirubin), urine(urobilirubin)
erythroblastosis fetalis -occurs when RH negative mother is pregnant with rh positive fetus and maternal antibodies crosses placenta
- Diagnostics-serum bilirubin concentration
Coombs test- determine whether jaundice is because RH or ABO incompatibility Indirect coombs test- measure the amount of RH positive antibodies in mothers blood Direct coombs test - presence of antibody RH positive RBC in new born
ABO incompatibility- mothers blood type is blood O, then baby is type A or B. may cause jaundice
Management of Hyperbilirubinemia phototherapy (highs 25-30 uw/cm2/nm, low 6-12 uw/cm2/nm)
care of NB receiving Phototherapy bilateral eye patch during photolight therapy discontinue phototherapy and check eyes for conjunctiva eye and tactile contact with baby Is encourage support parents as they feel guilty for having jaundice baby
Nursing care plan: new born will not exhibit dehydration and will display appropriate weight gain -offer feeding every 2-3 hours Assess s/s of dehydration Breastfeed on demand Monitor i&O
Early signs of jaundice Yellowing of sclera Skin color-by blanching Yellow pigmentation on oral mucosa
Interventions of phototherapy (nursing care plan) Risk for injury r/t use of phototherapy Covers baby’s eye with patch Make eyelids close before applying the eye patch Inspect eye each shift Observe for bronzing skin Administer thorough perineal cleansing ================================================================================ ========== Involution- rapid reduce in size or returning or size of uterus to non pregnant state. Measuring of involution
Subinvolution (what contributes to it; how to minimize, what nursing care takes place
Lochia- debris discharge after delivery. Total ave volume 25ml Lochia rubra- dark red. Occurs first 2-3 days. Contains epithelial cells, erythrocyte. Few small clots. Lochia serosa- pinkish in color. Occurs 3 rd-10 days. Compose of serous exudate.
lochia alba- “white”final discharge, compose of leukocyte, fat.
Explain when ovulation occurs (can occur anytime in PP period) no mucus changes in PP d/t birth hard to anticipate
In non lactating mother, first ovulation can occur 70-75 days to 6 months. Or as soon after stop of BF
What values are important (Neutrophils) Leukocytosis why it occurs; how high is the level p 654
- s/sx of mastitis
- treating with hand washing, prompt attention to manual expression of milk p 727
- p 734 Post partum psychosis
Chapter 5
- pick from the hat the birth control we are writing about (3 methods) fertility awareness, barrier methods include who’s the best candidate, cost, lifestyle (# of partners, financial resources, # of coitus), her intent to space pregnancy (ex: if woman has had 2 pregnancies, and does not want to look for permanent birth control not sure if want baby in at least 3-5 yrs, give methods what she should use, least intrusive to her lifestyle Answer: IUD, implants, Depo-Provera
- Long acting Birth Control > 5 years
- Rank in terms of effectiveness (what is 99% tubal ligation, vasectomy ■ (^) 98% IUD, Implants, Depo ■ 97% Oral Contraceptives and Condoms plus spermicide ■ 70-80 the rest
- Which method we should recommended for monogamous patient ■ Barriers ■ Spermicides ■ Condoms (how to put it in and out)
- Oral Contraceptive SE p. 88
- What are the advantages of hormonal contraception
- Regulates period
- (^) Decrease r/f ovarian and cervical cancer
- Needs to have MD order
- IUD, Cervical cap, Diaphragm
- No need to have MD order
- CONDOMS, sponge, spermicide
- Peri-Menopause
- Domestic Violence (increased in pregnant woman)
- Date Rape
Chapter 6
- (^) Fibrocystic Breast changes p 106
- Lump d/t cycle more sensitive
- Little cysts of various sizes (differentiated by mobility) ■ Cysts with fluid (can move around, size dissipates with cycle) ■ Lumps (cancerous) – no pain ■ Mastalgia – diet issues, BRA sizes, caffeine drinkers during menstrual period, hydrate prior to menses ■ Galactorrhea – if not pregnant possible cancer of pituitary gland
- Endometriosis (what is it, endometrial lining of the uterus escapes, and ends up in other places, such as fallopian tube, GI tract every time she has menses it proliferates too outside the uterus) - (^) Dull cramping - Pain in sex - More at r/f infertility - Laparoscopic exploration - Tend to create adhesions r/f infertility - Tx: Hysterectomy to remove uterus
- POS
- Toxic Shock
- C&C of VB, trichomoniasis, candiasis (s/sx, tx, define)
- C&C chlamydia, syphilis, Gonorrhea
- C&C of herpes, genital warts, condylomata p 114
- (^) P 120-121 Pelvic relaxation will result to Cystoceles (cough down) & Rectocele (Cough up) stress incontinence to minimize kegels use pessary
- Infertility p 122, possible causes for woman and man
- Assessment of infertile couple (must have unprotected regular intercourse for 1 year with same partner, start with male to do semen analysis (quality, qty, motility in single ejaculation – what to look at p 126), then assess woman, hystosalpingogram, hormonal levels, mucus characteristics; look at male genital tract, analyze premature ejaculation)
- Problem: regularity of intercourse (if they are using hot tubs, saunas, cyclist, truck drivers, motorcyclist, anything that testis be exposed with trauma) ■ Woman infertility: common reason is chlamydia it causes scarring, because it is ASYMPTOMATIC tends to couple with Gonorrhea which can manifest s/sx
- Infertility workup lab p 124 (forget the flowchart)
Picture 4-14 female reproductive (DRAW) p 69
