OB/PEDS Final Exam

Infant Age

Birth - 1 year

Toddler Age

1-3 years

Preschool Age

3-6 years

School Age

6-12 years

Adolescence Age

12-18 years

Infant VS

HR 100-160

RR 30-60

BP 50-75/30-45

Toddler VS

HR 70-110

RR 20-30

BP 90-105/55-70

Preschooler VS

HR 65-110

RR 20-25

BP 95-110/60-75

School Age VS

HR 60-95

RR 14-22

BP 100-120/60-75

Adolescent VS

HR 55-85

RR 12-18

BP 110-125/65-85

Sensorimotor

Birth - 2 years

• causality & object permanence

Preoperational

2-7 years

• take what you say literally

Concrete Operational

7-11 years

• Cannot think hypothetically; must use visual demonstration

• Have them explain things back to you

Formal Operational

11 years to adulthood

• Start to understand disease processes and outcomes

• Things can be explained with words/without visual demonstration

Trust v. Mistrust

Infant

Autonomy v. Shame & Doubt

Toddler

Initiative v. Guilt

Preschool

Industry v. Inferiority

School Age

Identity v. Role Confusion

Adolescent

GTPALM

G - # of Pregnancies including current

T - # of Pregnancies that have gone to term (20 weeks)

P - # of Preterm births

A - # of Abortions

L - # of Living children

M - # of Multiple pregnancies

Normal Fundal Height for Gestational Age

Presumptive Signs of Pregnancy

• Subjective (felt by woman)

P - Period absent

R - Really tired

E - Enlarged breasts

S - Sore breasts

U - Frequent urination

M - Fetal movement felt by mom

E - Emesis & nausea

Probable Signs of Pregnancy

• Objective (Observed by HCP)

P - Positive pregnancy test or Pigment changes

R - Leukorrheal thick discharge

O - Outline of fetus palpable

B - Ballottement (return of the fetus when tapped)

A - A softening of the cervix (Goodell’s sign)

B - Blueish color of the cervix (Chadwick’s sign)

L - Lower uterine segment softens (Hegar’s sign)

E - Enlarged uterus/abdomen

Positive Signs of Pregnancy

F - Fetal movement felt by HCP

E - Electronic detection of Fetal Heart Tones

T - The delivery of the fetus

U - Ultrasound

S - Movement seen by HCP

Naegele’s Rule

First day of LMP - 3 months + 7 days

Preterm Labor Risk Factors

• Hx of preterm labor

• African American

• IVF

• Intimate partner violence

• Late or no prenatal care

• Strenuous job

• Lack of support

• Alcohol or drugs

• Infection

Preterm Labor Management

• Antenatal steroids for fetal lung development

• Tocolytics - reduce contractions

• Magnesium Sulfate

Preterm Premature Rupture of Membranes (PRROM) Management

Between 34-36 weeks:

• Labor induction

• Abx therapy

Before 33 weeks:

• Bed rest

• Corticosteroids - Betamethasone

• Abx therapy

• Amnioinfusion

• No cervical checks if mom is not in active labor

Gestational Hypertension Manifestations and Labs

• no multisystem disturbances consistent with preeclampsia

• BP is > or equal to 140 systolic AND 90 diastolic at two separate appointments

• No proteinuria

Preeclampsia Manifestations

• > or equal to 160 systolic and/or 110 diastolic at two separate appointments

• Edema of the face, upper extremities and lungs with increased pitting edema in lower extremities

• Proteinuria, oliguria (<30ml/hr)

• Kidney and liver damage

• Weight gain of >2lbs/week

Eclampsia Manifestations

Cerebral edema in brain causing

• Headache

• Visual disturbances

• Seizure, hyperreflexia

• Coma

HELLP Syndrome Manifestations

• Malaise

• N/V, RUQ tenderness

• Bruising, petechia, edema

• Headache, visual disturbances

Preeclampsia, Eclampsia & HELLP Syndrome Labs

• Thrombocytopenia (<100000)

• Decreased RBC

• Creatinine >1.1

• Increased AST & ALT

CBC, BMP, LFT, Urinalysis

Gestational Diabetes - Glucose Tolerance Testing

1 hour glucose tolerance test

• if it is 140 or higher schedule 3 hours glucose tolerance test

3 hour glucose tolerance test

• must have two of the 4 glucose levels in the chart for a diagnosis

3-Hour Glucose Tolerance Test
Test time	Pregnant glucose level
Fasting	≥ 95 mg/dL
1 hour	≥ 180 mg/dL
2 hours	≥155 mg/dL
3 hours	≥ 140 mg/dL

Hyperemesis Gravidarum S/S

Persistent vomiting leading to dehydration and electrolyte imbalances

• Poor skin turgor, dry mucus membranes

• Weak, dizzy, lightheaded

• Low BP, high HR, decreased urine output, concentrated urine

Hyperemesis Gravidarum Treatment

• Ginger or peppermint

• Reduce odors

• IV hydration

• monitor lab values

• NPO

• Meds: Antihistamine H1 receptor blockers, ondansetron, and B6 or B12

Iron-deficiency Anemia S/S

• Pallor, fatigue, weakness, and malaise

• Reduced exercise tolerance and dyspnea

• Anorexia, pica

• Edema

• Hemoglobin below 10-11

• Hematocrit below 33%

Menstruation

Episodic uterine bleeding in response to cyclical normal changes that brings ovum to maturity and renews uterine tissue bed.

• 3-7 days, 5 on average

• Starts from 9-16 years old, average of 12

• Average of a 28 day cycle with ovulations typically occurring 14 days before next menses

• Involves hypothalamus (LHRH/GnRH), Anterior pituitary glad (FSH & LH), Ovaries (progesterone & estrogen), and the uterus

Conception

Usually occurs in the outer third fallopian tube and must occur quickly

• Ovum viable for 24-48 hours

• Spermatozoon viable for 48-72 hours

Causative Factors of Male Infertility

• Hormone deficiencies

• Gonadotoxins

• Impaired sperm transport

Risk Factors of Male Infertility

• Excessive alcohol use

• Marijuana or cocaine use

• Advanced age

• STI

• SmokerA

Causative Factors of Female Infertility

• Anovulation

• PID, endometriosis, or uterine fibroids

• Cervical mucus factor

• Vaginal problems

• Acidic pH kills sperm

Risk Factors of Female Infertility

• Diabetic

• Excessive alcohol use

• Obesity

• Advanced age

• STI

Oxytocin Challenge Test / Contraction Stress Test

A small amount of oxytocin is administered to trigger contractions to see how FHR responds to contractions

• Mom is hooked to EFM and TOCO

• Baseline FHR is taken before beginning procedure

• Mom should have 3 contractions that last 40-60 seconds within a 10 minutes period

• If baby has decels during half the contractions it can indicate baby is not well-oxygenated

• Monitor mom for 30 minutes post-procedure

Non-stress Test

Mom is put in semi-fowlers and hooked up to EFM and TOCO and Mom presses clicker when she feels fetal movement and it is marked on the EFM

• Done after 28 weeks

• Measures the FHR in response to fetal movement

• 2 Accels occur with fetal movement within a 20 minute period indicated baby is well oxygenated

• Less than 2 accels in a 40 minute period is a non reassuring result

• If result is non reassuring try to stimulate/wake baby by eating or using VAS

Amniocentesis

A needle is inserted into the amniotic sac to draw up and evaluate amniotic fluid color and test for genetic disorders

• Performed between 15 and 20 weeks

• Ultrasound to find where to place needle

• Mom hooked up to EFM and TOCO and observed until 30 minutes post-procedure

• Can be used to treat polyhydraminos

Chorionic Villus Sampling

Cell sample from placental villi that can be used to detect chromosome abnormalities, genetic disorders, and be used for DNA testing

• Performed week 10-12

• Rh negative moms should receive rhogam after procedure

Kick Count Education

Recommended to record daily kick counts starting at 28 weeks

• Baby should kick at least 4 times per hour or 10 times in 2 hours

• If baby kicks less than 3 times in one hour or less than 4 times in two hours see HCP

WBC for Pedi

5000-13000

RBC for Pedi

3.2-5.2

Hemoglobin for Pedi

11-12.5

Hematocrit for Pedi

35-45%

Bilirubin for Newborns

1-12

Creatinine for Pedi

0.4-1.2

Phenylalanine

3-9

Chloride Sweat Test

20

>60 = Cystic Fibrosis

Iron Level

7-14

Lead Level

<9

Thyroid Levels