OB integrated Kaplan review

How many wet diapers/day should infants have?

• 6-8

• ensures good feeding

What is the most common sexually transmitted infection (STI)?

Chlamydia

How is chlamydia transmitted?

1. Unprotected vaginal sex

2. Unprotected anal sex

3. Unprotected oral sex

4. Sharing contaminated sex toys

5. From mother to baby during childbirth

What are some signs and symptoms of chlamydia in women?

1. May be asymptomatic (no symptoms)

2. Painful urination (dysuria)

3. Thick vaginal discharge, may have odor

4. Fever

5. Pain during sex

6. Bleeding between periods

How is chlamydia diagnosed?

1. Urine sample

2. Vaginal swab

3. Nucleic acid amplification test (NAAT)

How is chlamydia treated?

1. Antibiotics: azithromycin (single dose), or doxycycline

2. Partner(s) should also be tested and treated

What should you teach patients about chlamydia treatment?

1. Complete all prescribed antibiotics

2. Abstain from sex until treatment is finished (usually 1 week)

3. All recent sexual partners should be tested and treated

4. Use condoms to prevent future infection

How can chlamydia be prevented?

1. Use condoms during sex

2. Limit number of sexual partners

3. Get regularly tested

4. Ensure new partners are tested

5. Avoid douching

What are possible complications of untreated chlamydia in women?

1. Pelvic inflammatory disease (PID)

2. Infertility

3. Chronic pelvic pain

What are important nursing interventions for chlamydia?

1. Administer prescribed antibiotics

2. Provide pain relief as needed

3. Educate about safe sex practices

4. Counsel on treatment adherence

5. Help notify partners if appropriate

What is the #1 nursing action with a patient who is actively hemorrhaging postpartum?

1. Immediately assess the fundus (uterine firmness/location)

2. If boggy (soft), perform a fundal massage to stimulate uterine contraction and reduce bleeding

3. Notify the provider and call for help if not already present

4. Ensure IV access for fluids/medications

5. Begin monitoring vital signs closely

What vital sign changes are typical in a patient experiencing postpartum hemorrhage?

1. hypotension

2. tachycardia

3. tachypnea

4. May appear pale, cool, or clammy

When should you call the healthcare provider if worried about jaundice in a baby?

1. Yellowing of skin or eyes (sclera)

2. Press down on baby's skin—if it stays yellow, call HCP

3. If yellowing gets worse

4. If baby is not stooling (pooping) well

Which mothers need a RhoGAM shot?

1. Mothers who are Rh-negative

2. Father or baby is Rh-positive (or unknown)

When should RhoGAM be given during pregnancy and after delivery?

1. At 26–28 weeks of pregnancy

2. Within 72 hours after delivery if baby is Rh-positive

3. After any event where blood might mix (bleeding, trauma, miscarriage, amniocentesis)

Why do Rh-negative mothers need RhoGAM?

1. Prevents mother’s immune system from attacking Rh-positive blood cells of the baby

2. Protects future pregnancies from Rh disease

What are ways to help prevent yeast (candida) infections?

1. Practice good hygiene (clean and dry the area)

2. Wear breathable cotton underwear and loose clothing

3. Control blood sugar if you have diabetes​

4. Limit sugar in your diet

5. Eat foods with probiotics (like yogurt)​

6. Change out of wet clothes quickly

7. Avoid douching, scented soaps or bubble baths​

8. Take antibiotics only when necessary

What are ways to help prevent UTIs?

1. Wipe front to back after using the bathroom​

2. Urinate after sex

3. Drink plenty of water​

4. Avoid holding urine for long periods

5. Good hygiene (wash and dry the genital area)

6. Wear cotton underwear and loose clothes

7. Avoid using irritating feminine products (sprays, powders, scented pads)

When does ovulation usually happen in the menstrual cycle?

1. About 14 days before the next period starts​

2. Timing can vary if cycles are longer or shorter

How soon after ovulation can fertilization happen?

1. 12 to 24 hours after ovulation​

2. Having sex within 72 hours after ovulation increases chances of conception

What are some signs that ovulation is happening?

1. Clear, stretchy (“egg white”) cervical mucus

2. Increase in basal body temperature (usually rises slightly after ovulation)​

3. Mild pain or cramps on one side of the abdomen (sometimes)

How can you check for ovulation?

1. Menstrual cycle tracking (calendar method)

2. Hormone tests or ovulation predictor kits

3. Check cervical mucus changes (looking for clear, stringy mucus)

4. Basal body temperature tracking (looking for a small rise after ovulation)

What is one way you can assess fetal well-being at 20 weeks gestation?

Fetal heartbeat can be heard with a Doppler

What can the pregnant person feel at 20 weeks?

Can feel fetal movement ("quickening")

How developed is the fetal brain at 20 weeks?

Brain is fully developed

What happens to the nose, ears, and sternum at 20 weeks?

1. Nose and ears begin to ossify (harden)

2. Sternum ossifies

What happens to the nose and breathing at 20 weeks?

1. Nostrils reopen

2. Primitive breathing-like movements begin

What new body features appear at 20 weeks?

1. Lanugo (fine hair) appears on the skin

2. Legs lengthen

What behavioral milestone starts at 20 weeks?

Fetus develops a sleep cycle

What are common symptoms of an incomplete (partial) abortion?

1. Persistent heavy vaginal bleeding

2. Abdominal cramping or pain

3. Passage of some, but not all, pregnancy tissue

4. May have signs of infection: fever, chills, foul discharge

How is an incomplete abortion usually treated?

1. IV fluids or blood if bleeding is severe

2. Medications such as oxytocin to contract the uterus

3. Surgical options: suction (vacuum aspiration) or D&C (dilation & curettage)

What follow-up is needed after treating an incomplete abortion?

1. Monitor for continued bleeding or infection

2. Ultrasound or labs (hCG levels) to ensure all tissue is expelled

3. Counseling and support; contraception if not desiring pregnancy soon

What are common symptoms of a complete abortion?

1. Previous bleeding and cramping that has now improved

2. All pregnancy tissue has passed

3. No retained tissue on exam or ultrasound

4. Bleeding now light or stopped

5. Symptoms (like pain) resolve

Nagel's Rule

• estimated due date

• -3 mo.; add 7 days; add a year if needed

What signs or symptoms during pregnancy should prompt you to call your healthcare provider?

1. Lack of fetal movement (baby not moving or fewer than usual after 28 weeks)

2. Painful or burning urination (could indicate UTI)

3. Bleeding or leaking fluids from the vagina

4. Preterm contractions (regular contractions before 37 weeks)

5. Severe headache that doesn’t go away or worsens

6. Persistent vomiting or inability to keep food/liquids down

7. Fever or chills (especially over 100.4°F / 38°C)

8. Swelling in face, fingers, or hands (could signal preeclampsia)

9. Blurred vision, dizziness, or fainting

10. Severe abdominal or pelvic pain

11. Chest pain or difficulty breathing

If membranes rupture and FHR drops, what should you suspect and assess for?

• Suspect umbilical cord prolapse

• Immediately assess for visible or palpable cord in the vagina

What should you do first if you suspect cord prolapse?

• Do not leave the patient alone

• Call for help; have someone notify the provider immediately

How do you relieve pressure on the cord if prolapse is confirmed?

1. Put on a sterile glove

2. Insert two fingers into the vagina

3. Gently push the presenting fetal part upwards to relieve pressure on the cord​

4. Keep hand in place until delivery or provider arrives

What positions help reduce cord compression?

1. Place patient in knee-to-chest position, or

2. Extreme Trendelenburg (head down), or

3. Modified Sims (side-lying with one knee drawn toward the chest)

If the cord is outside the vagina, how should you protect it?

1. Loosely wrap the visible cord in a sterile towel or gauze

2. Moisten towel with warm, sterile saline

3. Do not attempt to push the cord back into the cervix

What supportive nursing measures should you initiate if prolapse is confirmed

1. Administer O₂ by non-rebreather mask at 8–10 L/min​

2. Start or increase IV fluids

3. Monitor fetal heart rate continuously

4. Prepare for emergent delivery, typically C-section

What is a reticulocyte?

• Immature red blood cell (RBC)

• Made in the bone marrow, released into blood before becoming mature RBCs.

What does a reticulocyte count show?

• Measures bone marrow’s ability to make new RBCs

• Helps determine if bone marrow is working properly after blood loss, anemia, or treatment

What change do you want to see in reticulocyte count after bleeding?

• Increase in reticulocyte count

• Shows bone marrow is responding and producing new RBCs to replace those lost.

What changes in vaginal discharge might indicate preterm labor?

• Discharge becomes watery, mucus-like, or bloody

• Notice an increase in amount or change in type of discharge

What pelvic or lower abdominal symptoms suggest preterm labor?

• Pelvic or lower abdominal pressure

• Menstrual-like or mild abdominal cramps (with or without diarrhea)

What kind of pain often occurs with preterm labor?

• Constant low, dull backache

• May also be accompanied by pelvic pain

What is a major preterm labor warning sign related to fluids?

Ruptured membranes (water breaks): gush or trickle of fluid from the vagina

Menopause for women

• decrease in hormone production (estrogen)

• hot flashes, irregular/nonexistent menstrual cycle, mood changes

What is neonatal abstinence syndrome (NAS)?

• Group of withdrawal behaviors in newborns

• Happens after exposure to opioids (or other drugs like alcohol) in the womb​

When do symptoms of NAS usually appear?

1. Begin 12–24 hours after birth

2. Can show up as late as 7–10 days after birth

What are common symptoms of NAS?

1. High-pitched cry, irritability

2. Sneezing, stuffy nose, yawning

3. Seizures, tremors, increased muscle tone

4. Fever, sweating (diaphoresis)

5. Poor feeding, vomiting, diarrhea, dehydration

6. Mottled/blotchy skin

7. Frantic, uncoordinated sucking

8. Trouble sleeping

What are key non-pharmacologic nursing interventions for NAS?

• Reduce stimulation: Dark, quiet room

• Swaddle or wrap baby snugly

• Rock or hold baby gently

• Feed small, frequent, high-calorie meals

• Monitor parent/child interaction and support bonding

• Provide fluids if risk for dehydration

What medications might be used for severe NAS?

1. Morphine or methadone (most common)

2. May add phenobarbital or clonidine for extra symptoms

3. Gradually decrease (wean) dose of medicine over time

Why do we want the pt. to walk after surgery?

• prevent DVT

• help w/ lung expansion and prevent pneumonia

1st system to make sure is working correctly in newborns?

• Respiratory

• cardiac

What is a “reactive” nonstress test?

1. Indicates a healthy fetus

2. Baby has two or more heart rate accelerations (15 bpm above baseline, lasting at least 15 seconds) in 20 minutes

3. Acceleration usually happens with fetal movement

4. Result is “reassuring”

What Is a Nonreactive NST?

1. Does not have at least two FHR accelerations in 20 minutes

2. Baby’s heart rate doesn’t increase as expected

3. Needs further evaluation (could repeat NST, do biophysical profile, or CST)

What does a nonstress test measure?

• Fetal heart rate in response to movement

• Assesses fetal wellbeing in late pregnancy (after 28 weeks)

What does a contraction stress test do?

1. Checks baby’s heart rate response to contractions

2. Contractions are triggered using oxytocin or nipple stimulation

3. Used to see if baby can handle the stress of labor

What is a “negative” (normal) CST?

1. No late decelerations with contractions

2. At least three contractions in 10 minutes

3. Means baby is likely to tolerate labor

What is a “positive” (abnormal) CST?

1. Late decelerations occur with at least 50% of contractions

2. Means placenta may not be delivering enough oxygen

3. Indicates fetal compromise—needs further testing or intervention​

Why is MAGNESIUM SULFATE given to pregnant women?

eclampsia to help with seizures

How often should a newborn breastfeed?

• Every 2–3 hours, or 8–12 times in 24 hours​

• On demand, when the baby shows hunger cues (restless, rooting, sucking)

How long should a baby nurse at each breast?

15–20 minutes per breast (some babies may do less or more)

How much breast milk does a newborn need?

About 60–80 mL/kg/day (average)

What are signs a baby is ready to feed?

1. Rooting (turning head toward touch)

2. Sucking on hands or lips

3. Restlessness or mouth movements (not just crying as that is a later cue)​

What are some good positions for breastfeeding?

1. Football hold

2. Modified cradle

3. Cross-cradle

4. Side-lying

How do you know breastfeeding is effective?

1. Baby latches and unlatches easily

2. Baby sucks in bursts of 15–20 times

3. Has 6–8 wet diapers per day

4. You feel an increase in milk, uterine contractions, and thirst

What are ways to gently wake a baby to feed?

1. Unwrap baby from blankets

2. Gently massage or change diaper

3. Talk and play with baby

How should breast milk be stored?

• In refrigerator: up to 72 hours (some sources say 5–8 days)

• In freezer: 6–12 months​

What should moms do to support milk production and health?

1. Eat 500 extra calories/day

2. Clean nipples with water only (no soap)

3. Let nipples air-dry

4. Position baby so the mouth covers a large part of areola

What should a mother know about medications and breastfeeding?

1. Most medications cross into breast milk

2. Always check with provider before taking new drugs

How do you prepare bottles and nipples for formula feeding?

1. Wash hands before handling bottles and formula

2. Sanitize bottles and nipples before first use, then clean after each use

When should prepared formula be used, and what do you do with leftovers?

1. Use prepared formula within 2 hours (or within 1 hour after starting feeding)

2. Throw away any leftover formula after a feeding—do not reuse​

How often should a baby be formula fed?

Every 3–4 hours (newborns may need to eat every 2–3 hours in first weeks)

How do insulin needs change in pregnancy for someone with Type 1 diabetes?

1. Pregnancy increases insulin resistance, so as pregnancy progresses, more insulin is usually needed

2. Your provider will adjust insulin doses frequently, sometimes every week

How is glucose monitored during pregnancy with Type 1 diabetes?

1. Frequent blood glucose checks are needed (often before/after meals, at bedtime, sometimes overnight)

2. Continuous glucose monitoring (CGM) may be recommended for the most accurate tracking

What are key risks of Type 1 diabetes in pregnancy?

1. Higher risk of infections and high blood pressure (preeclampsia)

2. Greater risk for birth defects/anomalies, prematurity

3. Hydramnios (too much amniotic fluid) and macrosomia (large baby)

4. More overall prenatal care needed

Why is vomiting a concern in pregnant patients with Type 1 diabetes?

• Can cause unstable blood sugars and ketones

• Makes it harder to manage diabetes effectively

What does good diabetes management in pregnancy require?

1. More glucose monitoring (sometimes 6–10 times a day or more)

2. More/frequent insulin dosing as directed

3. Healthy, balanced diet with consistent carbs

4. Extra prenatal care visits and coordination with multidisciplinary team (OB, endocrinology, nutrition, etc.)

What are common blood sugar/A1C goals for pregnancy with Type 1 diabetes?

• A1C goal is usually below 6–7%; as close to normal as possible without hypoglycemia

• Typical blood glucose targets:

  • Fasting: 60–99 mg/dL

  • 1-hour post-meal: 100–129 mg/dL

What are we worried about with oral contraceptives and smoking?

DVTs

What should we drink to help with the uptake Iron (ferrous sulfate)?

OJ

Why do babies need surfactant?

1. Lowers surface tension in the alveoli (tiny air sacs in the lungs)

2. Makes it easier to keep alveoli open when breathing in and out

3. Prevents alveoli from collapsing after exhalation

4. Critical for effective gas exchange and stable breathing, especially in preterm infants

What happens if a baby doesn’t have enough surfactant?

1. Lungs become stiff and hard to expand

2. Alveoli collapse (atelectasis)

3. Leads to trouble breathing, poor oxygen levels, and respiratory distress syndrome (RDS)

What is given to infants who don’t have enough surfactant?

• Antenatal steroids can be given to the mother before birth to help baby make their own surfactant if preterm birth is likely.​

• After birth, surfactant replacement therapy is given directly into the baby’s lungs for severe cases

What are anterior and posterior fontanels? Where are they found, and what is their purpose?

1. "Soft spots” at the junctions of newborn skull bones

2. Anterior fontanel: Top, front of head; diamond-shaped

3. Posterior fontanel: Back of head; triangle-shaped

4. Usually flat and open

What do changes in the fontanel shape tell you?

• Bulging: may indicate increased intracranial pressure

• Sunken/depressed: may indicate dehydration

When do fontanels normally close?

• Posterior: By 2–3 months of age​

• Anterior: By 7–19 months (most close by 18 months; may vary by source)

Where do you place a tocodynamometer for fetal monitoring?

• Place over the uterine fundus (the upper, active part of the uterus)

• Measures strength and timing of contractions

What are some risk factors for cervical cancer?

1. Multiple sex partners

2. Early sexual activity/first partner before age 20

3. Early childbearing

4. Exposure to HPV

5. HIV infection

6. Smoking

7. Low socioeconomic status

8. Family history

What should you know about HIV patients and pregnancy?

1. Can get pregnant and breastfeed (follow provider advice; breastfeeding risks vary by region/resource)

2. Usually deliver by C-section

3. It takes time to confirm HIV status in the infant

Why take folic acid in pregnancy, and how much?

1. Reduces risk of neural tube defects (like spina bifida)

2. Take 0.4–0.8 mg daily

3. Good sources: green leafy vegetables, liver

What is Pitocin used for in labor and delivery?

1. Induces or strengthens contractions

2. Used to start or progress active labor

3. Helps control postpartum bleeding

How should Pitocin be administered and monitored?

1. Always use an IV pump for precise control

2. Closely monitor contractions, fetal heart rate, and maternal vitals

3. Stop if contractions are less than 2 minutes apart or last over 60–90 seconds

What are typical signs and physical findings in a post-term infant?

1. Born after 42 weeks

2. Dry, peeling, cracked skin

3. No vernix or lanugo

4. Long fingernails

5. Profuse scalp hair

6. Long, thin body shape

What complications can occur with post-term infants?

1. Meconium aspiration syndrome: baby breathes in first stool, causing lung problems​

2. Hypoglycemia

3. Perinatal asphyxia

4. Cold stress

5. Birth injuries (large size increases risk)​

6. Placental insufficiency

What are signs and when does postpartum depression (PPD) typically develop

1. Tearfulness, sleep trouble, poor appetite

2. Often begins 3–7 days after birth

3. Can be triggered by drop in estrogen/progesterone

What should nurses encourage or assess in suspected PPD?

1. Encourage verbalizing feelings

2. Monitor for persistent depression or thoughts of self-harm

3. Promote family/friend support

4. Refer for further assessment and intervention if needed