OB Exam 3

When is the Postpartum period (puerperium)?

6 weeks following childbirth

What should be taught about baby blues?

it is normal and temporary (self-limiting), normally lasting for the first 2 weeks and resolves

What is Afterpains?

cramping of uterus from oxytocin release from nipple stimulation

What is Uterine involution?

shrinking of the uterus to return to pre-pregnancy size

What is the normal uterine involution?

uterus shrinks 1cm per day starting 24 hrs postpartum

What is Subinvolution?

uterus doesn’t fully return to pre-pregnancy

What is Lochia?

postpartum “gook” from uterus

What are the different lochia and the days they occur?

Lochia rubra (red) - first 3 days

Lochia serosa (pink) - day 3 to 10

Lochia alba (white) - day 10 to 21

What should you suggest if the client reports return of bright red bleeding after progressing to Alba or foul odor?

Infection or pieces of placenta left behind (placental fragments)

What can prevent nipple trauma?

Latching techniques

What are the S/S of Mastitis?

redness, warmth, and *flu-like symptoms*

What are the S/S for DVT?

swelling of extremities, warm skin, and leg pain (homan’s sign)

What is a positive sign of Homan’s sign?

Dorsiflexion of foot causes calf pain

What is normal weight loss in Mothers and why?

10-13 lbs because baby, placenta, and amniotic fluid weight has been lost

What is S/S of respiratory distress?

Nasal flaring, grunting, and retractions

What is molding?

normal occurrence where a baby's head shape changes during and after childbirth due to pressure in the birth canal

What is Vernix?

Cheesy substance that covers the skin surface, plays a key role in temp regulation and bacterial defense

What should you check if the baby has jaundice?

Bilirubin levels

What can you indicate when there is absence of reflexes?

birth trauma like brachial plexus injury

What are the benefits of breastfeeding?

Rich in antibodies

Promotes uterine involution and reduces hemorrhage

What is Fore and Hind milk?

Fore: hydrating

Hind: calorie rich

What is the frequency and duration of breastfeeding?

Every 2-3 hrs and 15-20 mins per breast

How should Concentrated liquid formula be made?

Mixed with equal parts of water (little water can strain kidneys and too much water can dilute the nutrients)

How long can Formula last?

2 hrs at room temps and 24 hrs refrigerated

What is the frequency for Formula feedings?

Every 3-4 hrs. 15-30 mL for initial feedings

What is the rule of thumb for Formula Feedings?

150/200mL/kg/day

What is Uterine Atony?

Occurs when the uterine muscles don’t contract enough after childbirth to close the placental blood vessels

How much blood loss is considered hemorrhage?

>500mL (vaginal) or >1000mL (c-sec)

What is used to measure blood loss?

Weight scale

What are the S/S of hypovolemia?

Pallor, Low BP, Tachycardia (first sign), Dizziness, and Delayed Cap refill

What can MAP tell you and what is the normal value?

Adequate perfusion and should be >65

What to do if mother is two day postpartum with SOB?

Give O2, start IV, and call physician

What are Puerperal infections?

infection within first 10 days (excluding first 24 hrs) postpartum

What is the prevention for Puerperal infections?

proper hand hygiene

What should a mother with mastitis be taught?

Continue to breastfeed/pump to clear the infection and prevent abscess

What is the hallmark sign for uterine atony, which can lead to hemorrhage?

Boggy uterus

What is normal finding in a term newborn?

Transient murmurs and acrocyanosis

What is the Moro Reflex and when does it disappear?

Startle response and disappears by 3-6 months

What is Rooting Reflex and when does it disappear?

turning head towards touch and disappears by 3-4 months

What is Grasp Reflex and when does it disappear?

Gripping objects tightly and disappears by 3 months

What is Tonic Neck Reflex and when does it disappear?

Turn baby head to one side and the arm on the side follow (fencing position) and disappears by 5-7 months

What is Stepping Reflex and when does it disappear?

Walking motion and disappears by 4-5 months

What is normal head circumference?

32-36 cm

What is the normal length?

46-56 cm (19-21.5 in)

What is the normal weight?

2722-4082 g (6-9 lbs)

What are Mongolian Spots?

Bluish marks common in darker skin (normal)

What is Milia?

white pinpoint “pimples” (do not pick at it)

What is Umphalitis?

umbilical cord infection

What is the stomach capacity of a baby on the first week?

90 mL and 5-10 mL on the first day

What does green vernix indicate?

meconium passed before birth

What can 2 or more green watery stools be concerned for?

infection

What can green forceful vomit indicate?

bowel obstruction

What can Jaundice lead to?

Kernicterus

What is Kernicterus?

Brain damage due to high levels of bilirubin in blood

What is Retinopathy of prematurity (ROP)?

serious eye condition linked to abnormal blood vessel growth in retina

What are S/S of Hydrocephalus?

Enlarged head size, Bulging fontanelles, Dilated scalp veins, and Downward gaze of eyes (setting sun appearance)

What is Cleft lip?

Opening in upper lip

What is Cleft palate?

Opening in roof of mouth

What is indicated when milk is coming out of a baby’s nose?

Cleft palate

What is the surgical repair for cleft lip and palate?

Cheiloplasty

What are the S/S of Down Syndrome?

Upward slanting of eyes, Flat facial features, single transverse palmar crease, and low muscle tone (hypotonia)

What is Phenylketonuria (PKU)?

Cannot process phenylalanine in protein

How to treat PKU?

requires special diet low in protein that had low phenylketonuria

What is Galactosemia?

Cannot process milk sugar (galactose)

How to treat Galactosemia?

requires lactose-free diet

What is the treatment for Hemolytic Disease like Rh incompatibility?

RhoGAM for Rh-negative mothers

Phototherapy to break down bilirubin

What is Transient Tachypnea of the Newborn (TTN)?

rapid breathing after birth over 60 breaths/min sustained and revolves within 72 hrs

What is Meconium Aspiration Syndrome?

Inhaled meconium during delivery causes breathing problems

What may be needed to treat Meconium Aspiration Syndrome?

May require intensive care like putting an ET tube down throat and O2

What are the S/S of PE?

Chest pain, Hypoxia, Dyspnea, Anxiety, Restlessness