peds/ob exam 1

What are the main functions of amniotic fluid?

* maintain consistent temp
* prevent tangling
* cushioning for fetal movement
* measures kidney function
* makes sure there is symmetric growth
* place for waste
* source of oral fluid

What should amniotic fluid look like?

* should be clear
* but can range from clear to color of pea soup

What is olgiohydramnios?

* less than 300ml of amniotic fluid, indicates renal abnormalities

What is polyhydramnios?

* more than 2 liters of amniotic fluid, indicates GI abnormalities

What can amniotic fluid be tested for?

* lung function
* chromosomal abnormalities

What is amniotic fluid?

baby pee

What are the hormones of the placenta?

* progesterone: maintains pregnancy
* estriol or estrogen: stimulates uterine growth and mammary glands
* hPL: decreased insulin sensitivity which may cause gestational diabetes
* hCG: used in pregnancy test and starts 4-11 days

How many arteries supply blood through the umbilical cord?

2

How many veins take blood away through the umbilical cord?

1

How long should you leave the umbilical cord?

15-20 minutes, helps for an easier transition outside the body

What happens to the umbilical veins and arteries once the umbilical cord is clamped?

they close, baby may have a heart murmur but is benign

What is the ductus arteriosus?

connects to the aorta bypassing fetal lungs

What is the foramen ovale?

connects to IVC and is the septal opening between atria of the heart

What is the ductus venosus?

oxygen rich vein that bypasses the liver

What are presumptive signs of pregnancy?

* amenorrhea (no menses)
* n/v
* fatigue
* breast changes
* quickening
* urinary frequency
* thinning/softening of nails
* positive home pregnancy test

What are probable signs of pregnancy?

* Goodell’s (softening of cervix)
* Chadwick’s
* Hegar’s (softening of
* McDonald
* striae or stretch marks
* darker pigmentation of areola, facial chloasma
* positive serum pregnancy test

What are positive signs of pregnancy?

* fetal heartbeat
* visualization via ultrasound
* movements felt by examiner

How should a pregnant patient lay in bed?

on their left side to prevent supine hypotension, increased weight puts pressure on vena cava

What do pregnant patients have an increased risk of?

* utis
* yeast infection

What can UTIs cause?

preterm labor

What can increased hCG levels cause?

n/v

What to teach a pregnant women on how to prevent constipation?

* increase fiber
* increase fluids
* exercise
* prenatal vitamins with iron

What can cause hemorrhoids in pregnant women?

increased pressure on rectal blood vessels

What level of hCG indicates a negative pregnancy test?

below 5

What level of hCG indicates a positive pregnant test?

above 25

How to treat ankle edema?

* elevate legs during rest periods
* compression socks

How can you treat cramps in the feet?

dorsiflex when sitting or standing for long periods of time

What shouldn’t a pregnant patient wear?

tight, constrictive clothing

How often should a pregnant patient move around?

every 1-2 hours

Does asthma get better, worse, or stay the same in pregnant patients?

it depends on who

What is facial chloasma?

darkening of nose and around cheeks, looks like freckles

What is linae nigra?

line that goes up and down belly button, will eventually fade away

Why do hair and nails grow faster but get softer and thinner?

prenatal vitamins

Why do the nipples darken?

to help the baby see the booby

Where else are prostaglandins found in?

sperm, so have sex before labor

What foods contain folic acid?

* dark leafy greens
* fresh fruit
* whole grains
* beans
* peanuts

What foods contain iron?

* nuts
* oats
* dried fruits
* dark leafy greens
* sweet potato

How much weight should a pregnant patient gain during their pregnancy?

25-35 pounds,

How much folic acid does a pregnant women need per day?

0\.4mg

How long after one pregnancy should you wait to get pregnant?

a year

Assessment findings of iron deficiency anemia

* listlessness
* fatigue
* exercise intolerance
* pica
* extertional dyspnea or tachycardia if severe
* pallors in the conjuctiva or eyes

Management of iron deficiency anemia

* well balance diet
* prenatal vitamins with additional iron supplements
* avoid coffee and tea
* increase foods with ascorbic acidH

How many more calories per day does a pregnant woman need to consume?

300 calories

How many more calories does a mom need to consume if she’s breastfeeding?

at least 500 calories per baby

What psychosocial responses may a pregnant patient have in the first trimester?

* ambivalence (mixed feelings)
* concerns about finances
* career goals changed?
* role changes
* grief maybe

What psychosocial responses may a pregnant patient have in the second trimester?

* quickening occurs
* feelings of acceptance after feeling the baby
* ambivalence weansW

What psychosocial responses may a pregnant patient have in the third trimester?

* introverted
* selfish
* mean to partner >:(

What psychosocial responses may a pregnant patient have throughout pregnancy?

* mood swings
* super sensitive
* strained relationship with partner

How many ounces of caffeine is okay for a pregnant patient to consume per day?

8 ounces

Can a pregnant person have alcohol?

no

What can smoking cause?

* preterm labor
* low birth weight

How many months actually is there of pregnancy?

10

What needs to be assessed during the first prenatal visit for real?

* medical status
* OBGYN care
* immunizations

What is gravida?

number of times a woman has been pregnantWh

What is parity or para?

number of times the fetus has reached 20 weeks

What is TPAL?

* T: to term pregnancies born over 37 weeks
* P: pregnancies that were born 20-37 weeks
* A: abortions of miscarriages prior to 20 weeks
* L: living children

When is Group B streptococcus treated?

\

* in labor
* if given to baby use penicillin to treat

When is fundal height measurable?

at 8 weeks

How often do you go for prenatal visits during the first 28 weeks?

once a month or every 4 weeksH

How often do you go for prenatal visits after 28 weeks?

every 2 weeks until 36 weeks

How often do you go for prenatal visits after 36 weeks?

every week until delivery

Where should the fundus be at if a pregnant patient is 20 weeks?

at the umbilicus

How do you calculate the EDD?

LMP-3months+7days

What should you do if the baby hasn’t moved by 20 weeks?

go in!!!

How many times should a baby move in the belly?

10 times in 2 hours

What is Lamaze?

* mind over matter
* practiced relaxation to take mind off painWhat

What is Bradley?

* partner coached childbirth
* avoidance of all meds and interventionsWha

What is LeBoyer?

* birth without violence
* being quiet as hell
* dim lights, decrease noise, warm bath if not in hospital

How should pregnant women wear their seatbelts?

across the shoulder and under the belly

Should pregnant women be lifting?

* no
* if they do use the legs not the tummy

Can pregnant women use hot tubs, saunas, or whirlpool tubs?

no, messes with amniotic fluid

Can pregnant women have sex?

yes

Should pregnant women exercise?

yes! can help with ankle edema, constipation

Can pregnant women fly?

depends on the airline

How often on a road trip should you stop with a pregnant woman?

every 8 hrs

What discomforts are common during the first trimester?

\

What happens during week 3 of fetal development?

* beginning development of brain, spinal cord, heart, GI tract
* legs and arms bud and grow out
* neural tubes form to become spinal cord

What happens during week 4?

* brain differentiates
* limb buds grow and develop more
* stomach, pancreas, liver form

What happens during week 5?

* heart beats regularly
* eyes and ears form
* some cranial nerves visible
* muscles innervate

What happens during week 6?

* lungs form
* fetal circulation established
* liver produces RBCs
* brain continues to develop
* skeleton form
* CNS form
* brain waves detectable

At 6 months how much should the infant’s weight increase?

double the birth weight

What should you do if the infant is underweight or overweight?

* ask about diet, stools, diapers
* encourage to not give bottle everytime baby cries

At 12 months how much should the infant weight increase?

triple

When should hearing be checked?

before leaving the hospital

What kind of colors are best in a nursery?

* primary colors
* black and white

When does object permeance start?

at 5 months and continues into school age

What reflexes should a 12 month old infant have?

* able to hold head up on tummy at 2mo
* uses hand to support self while sitting at 6mo
* pull themselves to stand at 12mo

When does a baby start to walk?

between 9-12mo

What should you do to the home environment at 9 months?

begin babyproofing

What kind of play do infants participate in?

solitary play

What is the rule of thumb regarding toys?

if it can fit through a toilet roll don’t give it

What shouldn’t be given to an infant?

* anything beside milk first 4 months
* cow’s milk first 12 months
* no honey first 12 months

What is the first choice of fluids for an infant?

breast milk first 6 months

When should solids be introduced?

* 4-6 months of age
* one food at a time every 4-7 days to identify allergies
* should be eating finger foods at 9 months
* eat with baby, watch for choking hazardWhen

What is back to sleep?

* place baby on back
* no blankets, toys, pillows
* no cosleeping

When should infants start going to the dentist?

12 months

How many teeth does an infant have by 12 months?

6-8 teeth

How do you brush an infant’s teeth?

* 2 times a day or after every feeding
* with a rag
* may stimulate teeth, soothe sore gums, get used to brushing

What to do about a colic baby?

* let them cry
* put them down
* call a friend
* put in another room
* will eventually learn how to self soothe

What is Holy Rollers Do Have PI?

* Hep B
* Rota
* dTap
* HIB
* Pneumonia
* IBV