OB Theory Exam 2 Flashcards

What assessments are completed for newborns immediately after delivery?

• Dry the infant.

• Stimulate with a warm blanket.

• Evaluate APGAR.

• Head to toe assessment.

• Make note of vitals, pulses, auscultation.

• Movement and muscle tone.

• Ability to cry.

• Congenital abnormalities.

• Collecting cord blood.

What is APGAR scoring, and what can be done if scoring is abnormal?

APGAR is done immediately after birth, at 1 minute and 5 minutes. Lower scores indicate respiratory distress for the newborn, requiring further interventions to maintain airways (bulb syringe, positive pressure ventilation, warmer). Compressions are given after multiple interventions (until HR is under 60 BPM, other interventions not working).

• 0-3: Severe distress.

• 4-6: Moderate distress.

• 8-10: Normal. 7 depends on the infant.

  • Checks appearance (cyanosis), pulse rate, grimace upon stimulation, activity and movement, and respirations.

Why is skin to skin important for the first hour of life?

Skin-To-Skin: Increases bonding between mother and baby (reducing PDD risk). Oxytocin is released, stimulating milk production and contractions to reduce bleeding after birth. Skin-to-skin also maintains vital signs, temperature, glucose, and regulates stress hormones after birthing.

What is normal and abnormal physiology of the head and face for a newborn?

Assessments: Inspect head shape, symmetry, hair, and palpate suture lines (soft tissue in-between cranial bones) and fontanelles (diamond shape at back of head). Make note of color and temperature of skin, and presence of bruising or jaundice.

• Molding: Head is cone-shaped minutes after birth due to pressure from birthing process.

• Caput Succedaneum: Normal edema of the scalp from birthing. Crosses suture lines.

  • Cephalohematoma: Blood pooling of the brain from ruptured vessels from difficult deliveries. Does not cross suture lines, and firm to touch.

• Milia: Yellow-white, harmless cysts.

• Lanugo: Fine hairs from lack of temperature regulation.

• Vernix: White coating on the outside of baby.

• Congenital Dermal Melanocytosis: Blueish-grey spots from increased melanin.

• Nevi: Stork bites. Pink spots on the skin from increased blood flow.

• Erythema Toxicum: Harmless common rash from developing immune response or from heat rash.

What is normal and abnormal physiology of the respiratory system for a newborn?

Assessments: Inspect chest rise and fall (symmetrical, breathing effort), respirations (full minute), skin color, nasal flaring, capillary refill time (<3 seconds) and O2 as needed.

• Grunting: Low pitched sound at the end of breathing.

  • Retractions: Indicates distress; belly goes “inward” and caves in.

  • Nasal Flaring: Nostrils widen fully with every breath, indicating a lack of oxygenation.

What is normal and abnormal physiology of the cardiovascular system for a newborn?

Assessments: Inspect skin color, auscultate heart rate, regularity, any extra sounds, normal S1 and S2. Heart rate should be between 110-160, but some issues expected within the first 2 hours of life.

• Acrocyanosis: Blue tinge to hands and feet from circulatory system regulation; normal.

  • Central Cyanosis: Blue tinge to body, signaling lack of perfusion; not normal.

• Murmurs: May be normal or abnormal from regulation of circulation and shunts closing. Depends on other symptoms.

How is temperature maintained in newborns?

Babies lose heat easier than they gain too much heat because of less body fat. Any temperature under 97.7 F (36.5 C) is hypothermia. Evaporation (sweating and liquid exposure), convection (cool air), conduction (touching cold things), and radiation (lack of heat sources) are all causes.

Any temperature over 99.5 F (37.5 C) is hyperthermia. Caused from sepsis or inappropriate heating. This is risky given the risk of seizures, heat stroke, and death.

What is normal and abnormal physiology of the chest and back for a newborn?

Assessments: Inspect symmetry, color, and presence of any abnormalities. Ensure umbilical cord has clamp; absence of edema, redness, and drainage (will dry over time).

• Sacral Dimple: A pit above the sacrum that can be considered normal, but larger holes with hair or discoloration may indicate spina bifida.

• Uneven Gluteal Folds: Uneven thigh creases. May indicate hip dysplasia.

What is normal and abnormal physiology of the musculoskeletal system for a newborn? Which reflexes are tested upon newborn examination?

Assessments: Check infant’s movement, flexion, muscle tone, symmetry, number of digits, and reflexes. Flexion indicates arms are going inwards, and extension indicates they are going outwards.

• Babinski Reflex: Fanning of the toes when touched.

• Moro Reflex: Startle reflex when dropped from small height (controlled).

• Palmar Reflex: Grasping hands when touched.

• Rooting Reflex: Touching the inside of the cheek stimulates moving head, which also stimulates sucking.

What is normal and abnormal physiology of the neurological system for a newborn?

Assessments: Levels of alertness (deep sleep, light sleep, drowsy, alert, active, crying). Reflexes are checked.

What is normal and abnormal physiology of the reproductive system for a newborn?

Assessments: External genitalia, urinary and bowel function, presence of the anus. Undisdended testes/ lack of urethra for males (hypospadias opening under penis vs epispadias opening on top of penis), labia and discharge (light bleeding) for females.

What are the benefits of breastfeeding? How often should it occur?

Encouraged for at least 6 months up to 2 years by Healthy 2030. Breastfeeding is important because:

• Breastfeeding increases oxytocin, reducing hemorrhage in short term and helps recovery.

• Increases skin-to-skin for bonding and PPD reduction.

• Passes immune system antibodies to the newborn and other helpful compounds that reduce chronic disease risk.

Feeding should be done every 2-3 hours for newborns due to smaller stomachs (increases in mL each day). Recommended 10-15 minutes on each side. No solid food or water for 4-6 months. To check I+O, 1 void for first 24 hours (to ensure organs working properly).

What is the newborn pain scale (NPASS)?

NPASS is the non-verbal neonate pain, agitation, and sedation scale. This assesses crying upon stimulation, arousal to stimuli, facial expression, tone in extremities, and vital signs. Infants can be sedated, at baseline, or experiencing pain and agitation.

• Swaddle, lay on side, shush, rock, and allow sucking to soothe.

What are the indications, therapeutic effects, adverse effects, and considerations for vitamin K?

Route: IM injection (thigh).

Therapeutic Effects: Vitamin K is needed to produce clotting factors, reducing the risk of hemorrhage.

Adverse Effects: Site pain (redness, sore).

Key Considerations: Needed for circumcision to prevent excess bleeding. Gut produces vitamin K at day 7. Policy needed for parents that try to refuse; not considered a vaccine!

What are the indications, therapeutic effects, adverse effects, and considerations for hepatitis B vaccination?

Route: IM injection (thigh).

Therapeutic Effects: Hepatitis B vaccination at birth, 2 months, 6 months.

Key Considerations: HGIB+ (hepatitis immunoglobulin) given if mother positive for hepatitis B.

What are the indications, therapeutic effects, adverse effects, and considerations for erythromycin ointment?

Route: 1 eye ribbon.

Therapeutic Effects: Reduces bacterial risk of harming eyesight (especially gonorrhea).

Adverse Effects: Eye redness and edema.

Key Considerations: Required by law in some states; parental consent bypassed.

What are the indications, therapeutic effects, adverse effects, and considerations for beyfortus (RSV)?

Route: IM.

Therapeutic Effects: Provides limited immunity against RSV.

Key Considerations: Situation-dependent along with HGIG. Recommended during flu season.

What are some examples of newborn screenings?

Completed at one day of life and recommended for all newborns (also called 24 hour testing). These detect anomalies or serious conditions that newborns have that may not have been detected in pregnancy or ultrasound.

• Transcutaneous Bilirubin Checks - Monitors chest or forehead for bilirubin levels. If high, then serum bilirubin may be needed from heel. This is a marker for jaundice.

• Cardiac Screenings - Inspects for congenital heart defects. Pulse ox around hand and opposite foot to measure heart rate and oxygenation on both sides of the body. Levels need to be above 95, and cannot be more than a 3 point difference between the foot and arm. If abnormal, it’s a failed test, and baby stays for another 24 hours. EKG after another failed test.

• Metabolic Screenings - (PKU). Drops of blood from the baby looks at a variety of different tests.

• Weight Loss Verification - Re-weighing the baby, less than 10% indicates not enough intake.

• Hearing Testing - Puts something over the baby’s ears to see how well they can hear, which can impact their development if untreated.

What causes hyperbilirubinemia in newborns?

Also called jaundice. Bilirubin is a byproduct of broken RBCs, which is excreted through the stool. Gut motility is limited, so it accumulates in the body and goes back into the bloodstream. Babies can produce bilirubin faster than they can clear it out, causing yellow skin. This can cause severe complications and newborn mortality. Occurs 1-5 days postpartum. Testing is completed at 24h. Blue light (increased stool, helps convert it in blood), formula may be a treatment.

• Risk factors include: Bruising (forceps), bleeding, preterm infants (organs are slower and immature), biological (shorter RBC breakdown), breastfeeding (colostrum takes longer, learning to feed).

What causes hypoglycemia in newborns?

Blood glucose should be around 45. Insulin normalizes in infants with in-utero high blood glucose, contributing to hypoglycemia outside of the womb. 1st test is completed within 2 hours of birth. 3 abnormal blood glucose levels prior to feeding (to see if levels are stable) indicates that infants need to go to the NICU. Encouraging feeding can help regulate sugars, glucose gel inside of cheeks.

• Risk factors include gestational diabetes (from baseline), cold stress, preterm infants (require regular screenings), smaller/larger gestational age infant (from higher or lower weight by 10%).

What is endometriosis? What are the interventions?

Endometriosis causes tissue to grow around and outside the uterus, leading to inflammation, bleeding, pelvic pain, dyspareunia (painful sex) and dysmenorrhea. Bleeding and painful voiding can occur. Fertility issues present. Periods stimulates endometrial tissue to make irritation worse through estrogen fluctuations.

• Interventions: Hormone therapy to reduce endogenous estrogen (amenorrhea, decreased pain), NSAIDs, laparoscopic surgery; only definitive cure is total hysterectomy with BSO (ovaries as well) but causes infertility and early menopause without HRT.

What is menopause? What are the interventions?

Menopause causes menstrual irregularities from fluctuating hormone levels; after twelve consecutive months of amenorrhea. This decreases 75% of estrogen (plus progesterone), and may occur due to older age (~51y), removal of ovaries, or certain medications. This results in irregular perimenopausal periods (can be heavier or lighter years before), vaginal dryness, incontinence/UTI risk, dyspareunia, hot flashes, night sweats, mood swings, and muscle/bone loss.

• Interventions: HRT, or estrogen/progesterone. Many different routes of administration, which may cause DVT, stroke, and pulmonary embolism (like birth control). May not be great for them from lots of side effects. Non-pharmacological interventions include calcium and vitamin d supplementation, engaging in physical activity, stress reduction, reducing smoking and alcohol, pelvic floor exercises, and managing weight. Yoga, fans, and hydration may reduce hot flashes.

What is erectile dysfunction? What are the interventions?

Erectile Dysfunction is the inability to achieve or maintain an erection. Caused from physical, neurologic, psychologic, medication-induced (difficulty with adherence) causes, and becomes more likely with age (>50y).

• Interventions: Sildenafil, intracavernosal injections (injected into penis for vasodilation), vacuum devices, and sex therapy.

What are the indications, therapeutic effects, adverse effects, and considerations for sildenafil (viagra)?

Class: PDE5 inhibitor, sympathomimetics.

Mechanism of Action: Inhibits enzyme PDE-5 in vessels, encouraging vasodilation.

Therapeutic Effects: Helps maintain erections. Originally made as an antihypertensive.

Adverse Effects: Priapism (erection longer than 4 hours, leads to ischemia and fibrosis of tissue which results in impotence), hypotension, cyanopsia/blue-blurry vision, GI upset.

Key Considerations: Interacts with other medications that cause hypotension (alpha 1 blockers). Nitroglycerin is the big one (severe hypotension — wait 1-2 days).

What is benign prostatic hyperplasia? What are the interventions?

BPH is due to hormonal shifts, resulting in hyperplasia of the prostate (often non-cancerous). Monitor for lower urinary symptoms for obstruction of bladder. PSAs are done to check to see if it’s cancerous (hard tissue).

• Interventions: Depends on severity and cause. Limit caffeine, alcohol, late night liquids, constipation, and strengthen pelvic floor. Surgical intervention (TURP) carves out tissue blockage, but can cause ED/incontinence.

What are the indications, therapeutic effects, adverse effects, and considerations for alpha 1 blockers (proazosin, tamsulosin)?

Class: Alpha adrenergic blockers.

Mechanism of Action: Relaxes smooth muscle of the bladder neck and prostate.

Therapeutic Effects: Improves flow of urine.

Adverse Effects: Orthostatic hypotension, tachycardia, rare 1% loss of consciousness within the first 24h, erectile dysfunction.

What are the indications, therapeutic effects, adverse effects, and considerations for finasteride (proscar)?

Class: 5-alpha reductase inhibitor.

Mechanism of Action: Prevents testosterone conversion, leading to decreased prostate size.

Therapeutic Effects: Improves flow of urine.

Adverse Effects: Orthostatic hypotension, erectile dysfunction and impotence.

What are the different causes for male and female infertility? What are the interventions?

• Females: Most common cause is ovulatory disorders (from lack of release of the egg). Also reproductive disorders (PCOS, endometriosis, fibroids, PID), thyroid dysfunction.

• Males: Most common causes is issues with sperm. Chromosomal disorders, genetics, environment (heat exposure/scrotal injury).

  • 30+, smoking/alcohol, medications, toxins, hormone abnormalities, STIs, and stress also contribute to both.

  • Interventions: Increasing intercourse frequency, managing health (diet, exercise, weight loss), hormone testing, genetic testing, and physicals. Ovulation stimulation (medication superovulation), intrauterine insemination (inserting sperm into uterus), and in vitro fertilization (3 eggs into uterus in lab).

What are the 5 P’s of sexual history?

• Partners: Gender and number of partners.

• Practices: Types of sexual acts performed (oral, anal, vaginal, toys).

• Protection: If testing has been had, if protection is used.

• Past History: If previous partners have STI testing, drug usage.

• Pregnancy: Types of birth control used.

What is chlamydia and gonorrhea? How is it treated?

Chlamydia and Gonorrhea are bacterial infections and are transmitted through unprotected sex and may be asymptomatic. Can cause abnormal discharge, bleeding, and urination pain. Part of the main 3, including HPV from immature epithelium.

• Pregnancy: Preterm labor, PROM, SAB. Affects fetus through sepsis (gonorrhea), eye infections, and neonatal death.

• Treatment: Antibiotics. Ceftriaxone (rocephin) (IM injection) for gonorrhea, doxycycline for chlamydia unless pregnant (azithromycin). Report to DOH.

What is syphilis? How is it treated?

Syphilis is a type of bacterial infection and is transmitted through unprotected sex. Primary kinds cause painless sores (chancre) on genitalia or mouth; secondary has rash on palms, soles, fever, and fatigue.

• Pregnancy: Preterm labor, SAB, c-section risks. Affects fetus through eye infections, birth defects, and neonatal death.

• Treatment: Antibiotics. Penicillin G (IM). Report to DOH.

What is herpes? How is it treated?

Herpes are a type of viral infection and are transmitted through direct contact with infected area. Type one and type two. Causes fever, malaise, and dysuria at first.

• Pregnancy: Preterm labor, PROM, SAB, c-section risks (___). Affects fetus through sepsis, eye infections, and neonatal death.

• Treatment: Antivirals. Acyclovir for first episode.

What is human papilloma virus? How is it treated?

HPV is a type of viral infection (many types) that are transmitted through direct contact with infected area. Often asymptomatic, but can cause genital warts that are skin-colored. Associated with cervical and penile cancer, recommending vaccine.

• Treatment: No cure. but cryotherapy and medications are used on genital warts (as well as surgery). Vaccination series reduces opportunity for infection in adolescence.

What is hepatitis A, B, and C? How does it affect pregnancy? How is it treated?

Hepatitis A is a type of viral infection from oral-fecal contamination and Hepatitis B and C are a type of bloodborne pathogen from sex or needles. Asymptomatic at first, but causes LFTs to be abnormal (liver function tests), jaundice, abdominal pain, and clay stools.

• Pregnancy: Preterm labor, chronic carrier.

• Treatment: No treatment for HBV, necessitating HGIB for prevention. Hep A and B vaccination is preventative.

What is human immunodeficiency virus? How is it treated?

HIV is a type of bloodborne pathogen from sex or needles. Causes flu-like illness at first, then escalates to fever, night sweats, malaise, HA, larger lymph nodes, and GI upset. Can progress to AIDS. Transmitted during birth and breastfeeding.

• Treatment: Antiretroviral therapy suppresses HIV; PrEP. Report to DOH.

What is trichomoniasis? How is it treated?

Trich is a type of protozoa infection and is transmitted through unprotected sex. Includes foul-smelling discharge (yellow, frothy) and vulvar irritation.

• Treatment: Antiprotozoal/antibacterial. Metronidazole (flagyl).

How are STIs screened?

Most cases are asymptomatic, which is why screening (serum, swabs, urine) is so important. Encourage in sexually active adolescents. Early treatment prevents complications. If positive, partners may require testing and treatment as well (also expedited partner therapy, can get meds without provider seeing first). Abstinence, vaccinations, and condoms are encouraged.

Lack of condoms/unprotected sex is a major risk factor.

What is bacterial vaginosis? How is it treated?

BV is a type of bacterial infection caused from an overgrowth of natural flora. Sexual activity and medications make it more likely. This can cause grey discharge, fishy odor, itching, and pain during urination and sex.

• Treatment: Metronidazole or clindamycin gel.

What is pelvic inflammatory disease? How is it treated?

PID is a type of inflammatory condition that is difficult to detect. Causes abdominal pain, lower uterine bleeding, and tenderness upon palpation. Over time, this can lead to infertility,

• Treatment: Parenteral/IV medication for 24 hours, then IM or PO. Ceftriaxone or doxycycline.