ob exam 4

symmetric iugr affected by

htn

malnutrition

substance abuse

anemia

asymmetric iugr is caused by

pre eclampsia

poor maternal wt gain

placental infarcts

symmetric iugr sx

organ size

body wt

length

head circumference

asymmetric iugr sx

head bigger than abd

long + thin

decreased subq fat + muscle mass

underdeveloped liver

decreased glycogen

how is iugr identified

ultrasound

when is iugr identified

after 20 wks

symmetrical iugr seen in

2nd trimester

asymmetrical iugr seen in

3rd trimester

maternal factors causing sga

<16 / >40

malnutrition

multiples

heart dx

substances

sga + iugr complications

asphyxia

aspiration syndrome

hypothermia

hypoglycemia

polycythemia

how to look for s&s of sga/iugr

apgar

small body

sga

@ or beloe 10th percentile

lga

@ or above 90th percentile or >4000g

lga is often associated with

maternal dm

lga complications

birth trauma

hypoglycemia

polycythemia

hypocalcemia

nursing care for lga is preventing

birth injury

hypogycemia (<45)

polycythemia → hyperbilirubemia

infants of diabetic mothers tx

heel stick glucose monitor within 4 hrs of delivery

q4 hrs x 48 hrs

early freq. feedings

when do fetal glucose levels reach lowest point + when do they stabilize

1-3 hrs after birth

levels stabilize between 4-6 hrs

post term newborns

>42 wks gestation

post term complications

increased mortality

hypoglycemia

meconiuma aspiration

cold stress

polycythemia

complications of preterm infants

pda/rds

poor thermoregulation

poor gag reflux → NEC

f&e imbalanc

immature liver

risk for infection

when do infants receive passive immunity

3rd trimester

late risk factor of asphyxia

non reassuring fhr

physiological hyperbilirubinemia

after 24 hrs of delivery

disappears within 14 days

physiological hyperbilirubinemia tx

phototherapy

early freq. feedings

phototherapy cares

diaper only/max skin

protect eyes

reposition q2h

pathologic hyperbilirubinemia

appears within first 24 hrs of life

pathologic hyperbilirubinemia labs

serum bili rises >0.2 mg/dL/hr

positive coombs

kernicterus + lab value

bilirubin encephalopathy

@ 25 mg/dl

physiologic hyperbilirubinemia causes

increase in rbcs

immature liver

lack of intestinal motility

poor hydration

transcutaneous bilirubin

increases with age

pre ductal o2 sat

measured on right hand

post ductal o2 sat

on either foot

why check for o2 sats in different locations

screen for congenital heart diseases

abnormal o2 sats

>3% between pre and post ductal

errors of metabolism

pku

maple syrup urine disease

galactosemia

congenital hypothyroidism

pku

lack of enzyme to metabolism phenalalanine

pku, msud, galactosemia tx

specialized formula anchored towards each metabolism disorder

maple syrup disease

lack of enzyme to metabolize 3 amino acids

galcatosemia

lack of enzyme to metabolize galactose

congenital hypothyroidism

maternal drugs/low maternal iodine level causes enzyme defect + destroys/depresses thyroid gland

congential hypothyroidism tx

freq. monitoring of blood levels + thyroid replacement therapy

Bubble he

breasts

bUbble he

uterus

buBle he

bladder

bubBle he

bowel

bubbLe he

lochia

bubblE he

episiotomy/lacerations

bubble He

hemorrhoids/hematoma

bubble hE

emotional/evidence of dvt

hemorrhage definition

blood loss greater than or equal to 1000 ml of blood loss w/ s&s of hypovolemia within 24 hrs

four t’s of post partum hemorrhage

tone

tissue

trauma

thrombin

tone means

uterine atony

tone risk factors

>9 lb, polyhydramnios, multis

prolonged labor

precipitious labor

anesthesia (general)

tocos

bladder distention

trauma means

tears, lacerations, hematomas

trauma risks increase w/

instruments

rapid deliveries

s&s of trauma

slow continuous bright red bleeding

difficult bleeding

disproportionate peri. discomfort

vaginal/peri bulging

when does early/primary pp hemorrhage occur

within first 24 hrs

when does late/secondary pp hemorrhage occur

after 24 hrs to 12 wks after birth

causes of early/primary pp hemorrhage

atony

lacerations

hematomas

uterine inversion

causes of late/secondary pp hemorrhage

retained placental fragments

uterine subinvolution

s&s of pph

excessive/bright red bleeding

boggy fundus

clots

unusual pelvic discomfort

high temp