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OB Final Study Guide
1. Acquired disorder: 1. Occur at, or soon after birth
2. Problems or conditions experienced during pregnancy or at birth
3. Possibly no identifiable cause
2. Congenital disorders: 1. Present at birth (can identify on ultrasound)
2. Some type of malformation occurring during the antepartal period
3. Inheritance
4. Complex etiology
3. Pathologic jaundice/hyperbilirubinemia: 1. S/S: lethargy, fever, irritability, jitteriness, hypotonia, poor feeding, apnea,
seizures, and high-pitched cry
- Tx with phototherapy, feeding/fluids, and possibly even exchange transfusion
4. Bronchopulmonary dysplasia (BPD): 1. Referred to as chronic lung disease, associated with newborns who have
lung injury or need continued O2 for initial 28 days of life.
- Most infants improve over 2-4 months
5. BPD s/s: 1. Tachypnea
2. Poor weight gain
3. Tachycardia
4. Sternal retractions
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5. Nasal flaring
6. Bronchospasms (abnormal breath sounds)
7. Abnormal blood gas results (hypoxia)
6. BPD nurse management: 1. Continuous ventilatory and oxygen support
2. Optimal nutrition; administer bronchodilators, anti-imflamm agents and diuretics as needed
3. Monitor resp status
4. Provide high-calorie diet plan
5. Educate parents
7. Retinopathy of prematurity (ROP): 1. High concentration of oxygen causes retinal vasoconstriction that leads to
scarring and results in retinal detachment and eventual blindness
8. Nursing management of Retinopathy of prematurity (ROP): 1. Administer oxygen therapy cautiously-
ensure lowest dose and shortest duration (to keep O2 sat above 90%)
2. Assist with scheduling eye exam; administer mydriatic eye agent 1 hr before appt
3. Protect eyes from light
4. Provide support/ed to parents
9. Transient tachypnea of the newborn (TTN): 1. Caused by failure to clear fluid from the lungs and is most common in
late preterm or post term infants (greater risk in c/s)
2. S/S: tachypnea, nasal flaring, expiratory grunting, retractions, cyanosis
3. Tx: oxygen to keep sat above 90%
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4. Nitric oxide
5. Cluster care
6. Ed
15. Necrotizing enterocolitis (NEC): 1. Ischemic necrosis of the intestines and is a GI emergency for preterm
infants
- First sign of a problem is typically a feeding intolerance or increase abdominal circumference.
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16. S/S of NEC: 1. abdominal distension
2. vomiting
3. resp failure
4. hypotension
5. temp instability
6. absent bowel sounds
7. blood in stool, residuals in feeding
8. signs of infection
9. dilated bowels on x-ray.
*measure abdominal girth before feeds and listen to bowel sounds
17. Nursing management for NEC: 1. Early recognition is key
2. Keep NPO x10 days to allow bowel time to heal
3. Iv fluids, hyperelimination and inralipids
4. Antibiotics
5. NG or OG tube with continuous low suction
4. Surgery to remove necrosed area, if whole bowel, baby wil likely die
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14. Regurgitation
21. Fetal alcohol spectrum disorder: 1. Leads to wide range of physical, mental, and cognitive issues
2. Alcohol is a CNS teratogen.
3. Physical s/s: small eye openings, smooth philtrum, and thin upper lip
4. Interprofessional approach
22. Labs for neonatal infection diagnosis: 1. CBC
2. Blood culture
3. Lumbar puncture
*Tx with broad spectrum antibiotics until we rule out infection
23. GBS: 1. Low risk of baby getting it because of routine maternal screening and antibiotics given during labor
- Early onset is within 24hr, late onset is after 24 hr
24. Congential syphilis: 1. Spread vertically from mother to fetus
2. Result in still birth, prematurity, hydrops fetalis
3. Tx with penicillin G
25. Gonorrhea neonatorum (newborn conjunctivitis): 1. Can cause blindness
- Tx with erythromycin eye drops
26. Herpes (HSV): 1. Can't deliver vaginally if active lesions
2. Mom takes antivirals starting at 36weeks
3. Baby will take for 14-21 days post birth
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27. Hep B: Newborns receive first vaccine within 12 hrs of birth
28. HIV: 1. BF is CI
- Mom does ART to surpress viral load
29. CMV: 1. Can cause microcephaly etc.
- Tx with IV antiviral meds, prevent by washing hands
30. RF for congenitial heart disease: 1. Family hx
2. Genetics
3. Prematurity
4. Certain in utero infections
5. Use of assisted reproductive tech
31. Transposition of great arteries: 1. Pulmonary artery and aorta are switched- so deoxygenated blood goes out to the
body
- Goal is to keep fetal shunts open until corrective surgery
32. Heart disease screening: 1. Done to all babies
- Done after 24 hr of age by pulse ox
33. Anencephaly: An open defect of the cranial neural tube caused by the anterior neural tube failing to close at day 25 post
conception
34. Encephalocele: Brain or meninges protrude through a skull defect called a cranium bifidum. Needs surgical correction
35. Spina bifida: Incomplete closure of the vertebra surrounding the spinal cord. Results from spinal neural tube failing to close
by 28 days after fertilization *prevent by taking folic acid (400mcg dialy)
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42. NICU equipment: umbilical artery catheter: 1. Placed in the umbilical cord stump and threaded
into one of the umbilical arteries and into the aorta.
- Used for monitoring blood gases and BP
43. NICU equipment: umbilical vein catheter: 1. Placed in the umbilical stump and threaded into the ductous
venosus and into the inferior vena cava
- Used for fluid and med admin
44. NICU equipment: PICC: Used when intermedient- term IV access is needed
45. NICU equipment: IVs: Requires additional certification
46. NICU equipment: Nasal cannula: Ditterent sizes and allows for visualization of the baby's face
47. NICU equipment: CPAP: For when NC is not enough. Need pressure to keep airways open
48. NICU equipment: endotracheal tube: Used to attach to vent
49. NICU equipment: oxygen hood: For infant who do not need supplemental O2 pressure. If removed
from hood, apply a NC
50. Characteristics of preterm neonate: 1. Decreased SQ fat
2. Large head as compared to rest of body
3. Decreased brown fat
4. Decreased immune system
5. Decreased surfactant
6. Decreased lung compliance
51. Physical characteristics of preterm neonate: 1. Decreased muscle tone
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2. Decreased reflexes
3. Decreased breast tissue
4. Increased lanugo (soft hair)
5. Limited cartilage in ear
6. Thin, transparent skin
7. Immature genitalia
52. Common problems for pretems: 1. Hypothermia
2. Hypoglycemia
3. Hyperbilirubinemia
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5. May need CPAP or catteine citrate
55. Caffeine citrate admin: 1. For apnea prematurity
2. Stimulates resp center in medulla
3. Loading dose of 20mg/kg, then 5-10mg/kg
4. SE: diuresis
5. AEs: NEC
6. Toxicity: gasping syndrome, Resp distress, metabolic acidosis, gasping, seizures, hypotension, hyperglycemia
56. RDS: 1. Caused by insuflcient surfactant and immature lungs
2. S/S: low O2 sat, decreased lung sounds, nasal flaring, use of expiratory, use of accessory muscles
3. Tx is CPAP or Positive end expiratory pressure (PEEP)
57. Preterm infants: CV considerations: 1. Patent ductus arteriosus
2. Normal closure by 72hr after birth- preterm may have delayed
3. Risk for NEC or intraventricular hemorrhage
4. S/S: systolic murmur, ventricular dilation, cyanosis
5. Tx with ibuprofen or indomethacin
58. Anemia in preterm infants: 1. Caused by decreased production (low EPO), and short cell life
2. S/S: bradycardia, poor weight gain, increase O2 needs. *Hg of less than 7 (normal 15-20)
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3. Tx with iron supp or blood
4. Delayed cord clamping (one minute)
59. IVH: 1. Bleeding into the lateral ventricles of the brain (immature, fragile, blood vessels)
2. RF: <29wks, pre-e, rapid increase in BP
3. Prevention is important: cluster care, limit stimulation, caution with fluid admin, antenatal steroids.
4. Hypoxic insult can lead to increased blood flow to brain
5. S/S: reduced movement, disturbed resp, altered LOC, hypotonia
60. Sepsis in the preterm infant: 1. No IgG until 32 weeks
2. S/S: resp distress, lethargy, hypotonia, glucose instability, jaundice, temp instability, poor feeding, tachycardia, poor perfusion
3. Tx with antibiotics after CBC, blood culture and lumbar puncture
61. Temp considerations in preterm infants: 1. RF: limited brown fat, relaxed posture, immature temp center in
brain
2. S/S: mottled, pale, cyanotic, low temp, resp distress, hypoglycemia
3. Tx with rewarming, isolette
*prolonged cold stress can lead to resp distress, hypoglycemia, reopening or failure to close of ductus arteriosus
62. Preterm: feeding: 1. Feeding is often immature. Nonutritive sucking and mouth sucking assists with initiating
feeds
2. May need enteral or parenteral feeding
3. Tube feeds may be continuous or every 2-3 hrs
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3. Nurse management: resuscitation, blood glucose monitoring/IV dextrose 10% or oral glucose, prevention of heat loss, evaluation
of polycythemia, appropriate support
65. SGA: Intrauterine growth restriction (IUGR):
1. symmetric <28 wks- diflcult to catch up in size
2. Asymmetric >28wks- normal growth potential with optimal postnatal nutrition Contributing
factors:
1. Maternal nutrition, genetics, placental function, environmental factors, maternal HTN
66. Common problems for SGA: 1. Perinatal asphyxia- potential impaired perfusion by placenta
2. Diflculty with thermoregulation
3. Hypoglycemia
4. Polycythemia- fetal hypoxia stimulates EPO and RBC production- hyperbilirubinemia
67. SGA nurse management: 1. Weight, length, circumference
2. Serial blood glucose monitoring
3. VS monitoring
4. Early and frequent oral feedings; IV infusion of D10 if needed
5. Monitoring for polycythemia (HCT>65%)
68. LGA common characteristics: 1. Large body, plump, full-faced
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2. Proportional increase in body size
3. Poor motor skills
4. Difficulty regulating behavioral states
69. RF for LGA: 1. Maternal DM or glucose intolerance
2. Hx of macrosomic infant
3. Post-date gestation
4. Maternal obesity
5. Male fetus
6. Genetics
70. LGA common problems: 1. Shoulder dystocia
2. Hypoglycemia
3. Polycythemia
4. Hyperbilirubinemia
5. RDS
6. MAS
71. LGA nursing management: 1. VS monitoring
2. Blood glucose monitoring
