OB/PEDS EXAM 2

when milk comes in

3-5 days after birth

Uterus after birth should be

firm and midline

height of fundus immediately after 3rd stage of delivery (delivery of placenta) should be

a few cm (2-3) BELOW umbilicus

height of fundus 1hr after birth should

rise to umbilicus

Every 24hr after birth, the height of the fundus should

descend 1cm

BUBBLE assessment

B - breast

U - uterus

B - bowel

B - bladder

L - lochia

E - episiotomy/laceration

Lochia: Rubra

dark red, should last 3-4 days

Lochia: Serosa

pink lemonade color

days 4-10

Lochia: Alba

white/yellow

after day 10

Episiotomy/ Laceration REEDA assessment

R - redness

E - ecchymosis (bruise)

E - edema

D - drainage

A - approximation

Temp can increase to _____ in the 1st 24hrs because of dehydration and is considered normal

100.4

pharm interventions postpartum

oxytocin

RhoGAM

MMR, Varicella, TDaP

Tylenol, IBuprofen

Ferrous sulfate

Docusate sodium

Prenatal vitamins

education if receiving LIVE vaccines after delivery

do NOT get pregnant for a month

How many calories are patients educated to increase per day if breastfeeding

450-500

retained placenta

placenta remans in uterus & prevents uterus from contracting

can lead to atony or subinvolution

causes hemorrhage

Uterine atony

most common cause of hemorrhage

inability of uterus to contract

can be caused by full bladder

subinvolution

uterus remains large w/ discharge

caused by uterine atony, retained placenta, or full bladder

Inversion of uterus

fundus collapses into endometrial cavity

turns uterus partially or completely inside out

LIFE-THREATENING EMERGENCY

cervical laceration

sides of cervix near uterine artery tears immediately after delivery

vaginal laceration

vagina may need to be packed (removed after 24-48hr)

catheter placed

perineal laceration

space btwn vagina and rectum tears

usually from lithotomy position

hematomas

pain w/ out bleeding

collection of internal blood

1st degree perineal laceration

tear of vagina & perineum

2nd degree perineal laceration

vagina, perineal skin, & fascia tear

3rd degree perineal laceration

tear from vagina to rectum but not through the rectum

4th degree perineal laceration

tear from vagina through the rectum

coagulopathies

clotting disorder preventing mom from clotting normally

ex. DIC

Treatment for hemorrhage if UTERINE cause:

massage uterus

empty bladder

weigh pads

IV fluids

VS, O2, elevate legs

Meds: oxytocin, misoprostol, methylergonovine, carboprost, tromethamine, tranexamic acid

oxytocin can cause HTN and

water intoxication

Carboprost side effects & contraindications

side effect: diarrhea

contraindication: asthma

Contraindications for meds used to increase contractions to decrease hemorrhage

HTN

meds that help stimulate contractions to prevent hemorrhage

oxytocin

misoprostol

methylergonovine

carboprost

tromethamine

Treatment for uterine inversion

med: terbutaline

provider will manually replace

labs/ diagnostics postpartum

CBC

Rubella status

Rh status

how often does mom need to breastfeed baby

q 2-3 hrs

how often does mom need to bottle feed baby (if not breastfeeding)

q 3-4hrs

Hemorrhage labs/diagnostic testing

CBC

Coagulation profile

Blood type & crossmatch

uterine causes of postpartum hemorrhage

atony

subinvolution

retained placenta

full bladder

inversion

other causes of postpartum hemorrhage (not uterine)

Surgical

Laceration

Episiotomy

hematoma

Coagulopathies

Mastitis

breast infection

red, swelling, pain

can lead abcesses

interventions: can put ice or cold cabbage after breastfeeding but rewarm before another feed

symptoms of postpartum infection

temp > 100.4

flu symptoms

anorexia, nausea

tachycardia

postpartum infection treatment

teach handwashing

IV access

antibiotics (broad-spectrum)

comfort measures

high protein diet

diagnostics for blood clots

DVT: Doppler ultrasound, CT, MRI

PE: spiral CT, ventilation lung scan, MRA, pulmonary angiogram, embolectomy

D-Dimer blood test

prevention of blood clots care

SCD’s

early ambulation

postpartum blues

first few days till day 10 postpartum

goes away without intervention

postpartum depression

anytime within 1st year after birth

persistent feelings

requires intervention

postpartum psychosis

EMERGENCY

hallucinations, hearing voices

self-harm

thoughts of harming baby

most common symptom reported when determining fetal loss

decreased fetal movement

Newborn bathing teaching

No submerging in water until umbilical cord falls off

Do NOT bathe immediately after feed

Water heater 120.2 degrees or less

Room should be warm

Bath water 98-99 degrees

Wait 12hr after birth

Umbilical cord care teaching

Clamp removed before discharged

Keep clean & dry

Keep diaper folded underneath it

Monitor for redness, moist, foul odor, or drainage

Circumcision education

Monitor for bleeding & voiding

No tub bath until healed (may trickle warm water over penis)

Yellow mucous can form by day 2 (do NOT peel off)

Avoid pre-moistened towels

Notify provider if circumcision site shows

Redness

Discharge

Swelling

Strong odor

Tenderness

Decreased or no urination

Excessive crying

Plastibell technique

String tied over foreskin, falls off with foreskin 7-10 days later

Clamp technique (Mogan/Gomco)

More bleeding

Apply Vaseline to tip of penis to avoid blood sticking to diaper

Car seat safety education

Rear facing until 2yr or until child reaches max height and weight

Prefer middle seat (bc of side airbags)

ABC’s of safe sleep

Alone

On their back

In a crib

Smoke free environment

How much weight loss is normal for an infant after birth, and when should they regain it?

10%

Should regain in 10-14 days

How often should moms breastfeed?

Every 2-3hr for 15-20min each breast (8-12 times per day)

How often should mom’s formula feed?

Every 3-4hr

Start next feed on the breast you

Stopped the last feed on

Breast milk can be stored for

8hr at room temp

8hr in fridge

8 months in freezer

Babies need 400 IU of _______ daily

Vitamin D

If mom does not consume meat or dairy, administer ________ to newborn

B12

Begin iron supplement at

4 months of age

How long can formula be refrigerated for

48hr

How should you hold the baby during formula feeding?

Semi- upright at a 45 degree angle

How should you position the infant after a feed?

On their back

Babies should have _______ wet diapers per day (once moms milk supply comes in)

6-8

Breastfed babies should have ______ bowel movements per day

3 or more

Bottle fed babies have more or less bowel movements than breastfed babies?

Less

Findings to report after birth

Temp > 100.4 or less than 97.7

Poor feeding

Decreased or no urination

Labored breathing

Inconsolable crying

Difficulty waking

Vomiting & diarrhea

Decreased bowel movements

Jaundice & cyanosis

Lethargy

Bleeding/drainage from cord or circumcision

Drainage from eyes

Transition to life outside utero can take up to

10min

What are the two openings in the infant heart that eventually close shortly after birth

Foramen ovale

Ductus arteriosis

Routine suctioning of healthy newborn is

NO longer recommended because the baby can clear their own airway

How do you stimulate the baby to cry after birth

Vigorously rubbing their back or soles of feet

APGAR score is done when?

1min and 5min after birth

Delayed cord clamping

Clamping the umbilical cord once it stops pulsating

Erythromycin

Prophylactic ointment in eyes to prevent blindness from STI’s

Done within 1hr of birth

Vitamin K injection

Done within 1hr of birth to help clotting

Meds/Vaccines given to infant when born

Erythromycin

Vitamin K

Hep B (need consent)

How baby will look once born

Swollen eyelids

Milia (small whiteheads on face)

Mongolian spots (blue spots on back, butt, & legs)

Odd shaped head

Red spots in & on eyes due to broken vessels

Swollen genitals

Acrocyanosis

Wrinkled or peeling skin

Vernix on skin (white cheesy coating)

Normal infant weight

2500-4000g or 5.5-8.8 pounds

Normal infant length

18-22 in or 45-55 cm

Normal infant head circumference

32-36.8 cm or 12.6-14.5 in

Use tape measure at brow line

Normal infant chest circumference

30-33 cm or 12-13 in

Use tape measure at nipple line

How do you test for congenital heart defects?

Get BP on upper and lower body and compare

Normal infant BP

60-80 systolic

40-50 diastolic

On upper and lower body

Normal infant RR

30-60 (count 1min)

Periods of apnea up to 15sec is normal

Normal infant O2 sat

1min - 60-65%

2min - 65-70 %

3min - 70-75%

4min - 75-80%

5min - 80-85%

10min - 85-95%

On upper and lower body

Normal infant temp

97.7 - 99.5

AGA

10th - 90th percentile

Term

38-42 weeks

When will you see the first meconium stool

1st 24-48hr of life

Before moms breast milk comes in, how many voids should baby have per day?

# of voids = # of days old

May see brick dust (little blood in it)

Breast fed stool appearance

Loose, yellow, sweet smelling

Bottle fed stool appearance

Noticeable odor, more formed, NOT yellow

Routine newborn testing

Hearing screen

Bilirubin

Metabolic “newborn” screen

Congenital heart defect screen

When should you do the metabolic newborn screening

24hr after 1st protein feed

Normal newborn glucose level

40-60

Bilirubin levels in newborn

24hr: 2-6

48hr: 6-7

3-5 days: 4-6