Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Archive for the ‘NS 121 – OB’ Category


Posted by Laura on March 5, 2010

Most common infections of maternal origination to newborn are represented by the acronym TORCH. Until the infant is washed, Standard Precautions should be observed (gloves) for the safety of the caregiver, and in the case of HSV and neonatal infection of Pseudomonas aeruginosa – the infant.

T – Toxoplamosis disease caused by Toxoplasma gondii found in cat feces or raw meat of animals that graze on contaminated soil.  Clinical findings of a newborn many not be noted until later in life, but 85% will have mental retardation before 4 years old. This T is noted with preterm births, IUGR, Petechiae, fever and jaundice, as well as other serious mortality complications.

O – Stands for a grouping of ‘Other’. Other is:

  • Gonorrhea (Neisseeria gonorrhoeae)
  • Syphilis (Treponema pallidum)
  • Varicella (Varicella Zoster Virus)
  • Hepatitis B (HBV)
  • Human Parvovirus (Prvovirus B19)
  • Human immunodeficiency virus (HIV)

Breastfeeding with regards to HBV should be delayed until vaccination of the infant. Erythromycin off 0.5% is applied after birth to prevent ophthalmia neonatorum in the chance of Gonorrhea exposure, and neonatal conjunctivitis with Chlamydia trachomatis, to all infants. Infants born to HIV mothers are not recommended to breastfed.

R – Rubella (German measles or 3-day measles). Infants born with Rubella are isolated until non-contagious. Vaccination does not cross through mother’s breast milk, but mothers must sign informed consent and understand avoidance of pregnancy for 28 days due to teratogenic effects.

C – Cytomegalovirus (CMV) – Most common cause of congenital viral infection in the US. CMV can be transmitted through breast milk. Treatment requires careful monitoring because of the toxicity to the bone marrow.

H – Herpes simplex virus (HSV) – Babies of breastfeeding mothers can nurse as long as there are no lesions on the mother’s breast.

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Weight Loss of Newborn

Posted by Laura on March 4, 2010

If your infant’s weight upon delivery was 2850 gm, and at 26hrs she weights 2550 is your baby at risk? Why?

If you had to supply gavage feedings to your infant – how would you measure the gavage tube?

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Classification of High Risk Infants According to Size

Posted by Laura on March 4, 2010

Low birth weight (LBW) – < 2500 grams or 5.5 lbs.

Very low birth weight (VLBW) – < 1500 grams or 3.3 lbs

Extremely low birth weight (ELBW) – < 1000 grams or 2.2 lbs

Small for gestational age (SGA) or Small-for-date (SFD) – Birth weight less than the 10th percentile for intrauterine growth curves

Appropriate for gestational age (AGA) – Birth weight between 10th and 90th percentile on intrauterine growth chart

Large for gestational age (LGA) – Birth weight greater than the 90th percentile for intrauterine growth curves

Intrauterine growth restriction (IUGR) – Infants who’s intrauterine growth is restricted

Symmetric IUGR – Weight, length and head circumference – all are affected and have growth restriction

Asymmetric IUGR – Head Circumference remains WNL, birth weight falls below 10th percentile for intrauterine growth.

Premature infant< 37 6/7 weeks gestation

Full term Infant> 38 weeks to completion of 42 weeks of gestation

Postmature (postterm infant) – > 42 weeks completion of gestation

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Blue Spots

Posted by Laura on February 28, 2010

After being with some patients, I go home wondering if I did enough, or if I took the right steps. I know things are okay with the nurse on the floor, but I’m still fighting battles in my mind as I learn the ropes. This was the most recent thought process: 

The infants in my limited experience all had what is clinically known as Congenital Dermal Melanocytosis, or Mongolian Spots.

According to Merk’s Manual “Mongolian spots are bluish gray, flat areas that usually occur over the lower back or buttocks. At first glance, they appear to be bruises but are not and should not be mistaken for signs of abuse. They usually occur in black or Asian newborns, tend to appear less noticeable with age, and are of no consequence.”


I feel funny saying mongolian spots. I have since seen it posted elsewhere as ‘blue spots’ or even ‘CDM’. I’ve decided to use these names instead, along with the definition of them being genetic and will most likely disappear as the child gets older. Concern of mothers may be that it was the triple dye leaving a mark on her baby’s skin, or the baby was hurt after birth. A concern of others in the future may be that they are bruises. This makes it important to be sure it is marked in the the baby’s records. (for an image.)

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Saga 2 – Bryan Ethridge & Marcelo Marroquin

Posted by Laura on February 27, 2010

Debra Dickinson (Instructor at AVC), Bryan  and Marcelo during their IV check offs

Getting the tourniquet – Marcelo’s jaw set.

Which vein is the best?

No Stress here!

The teaching process

Okay, maybe a little stress.

In the vein

Moving the cannula up

All done!

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Breastfeeding and Breast Milk

Posted by Laura on February 23, 2010

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Posted by Laura on February 21, 2010

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Math – Hemorrhage

Posted by Laura on February 20, 2010

A.) If 2 grams of blood is loss from a NSVD what is your nursing consideration?

B. ) What if the patient had a decrease in Hct of 3pts with 500mL blood loss?

answer to A & B

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Fetal Blood Circulation

Posted by Laura on February 20, 2010

My understanding of Fetal Blood Circulation. The umbilicus vein from the placenta is bringing oxygen rich blood to the fetu’ss liver where deogenated blood from the lower portion of the fetus is mixed (through the Ductus Venosus) and directed to the heart. The blood now 1/2 & 1/2 or decreased O2 runs through the fetus’s heart mixing more with deoxgenated blood running through the lungs and heart (through the Foramen Ovale), and deoxgenated blood from the upper part of the baby (through the Ductus Arteriosus.) Now this decreased blood  is brought back to the placenta.

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Math – APGAR

Posted by Laura on February 20, 2010

APGAR = Appearance, Pulse, Grimace, Activity, Respiration – for my spanish speaking friends (Apariencia, Pulso, Gesticulación, Actividad, Respiración) – or as figured by my friend Kendra CHaRRM (color, heart rate, respiratory rate, reflex irritability, muscle tone).

The apgar score was created by a Doctor Virginia Apgar, an anesthesiologist, to assess the health of the newborns immediately after being born.  Using the APGAR Score sheet (mine here), figure the score of this newborn.

A newborn was assessment was noted: Acrocyanosis, good cry but only grimacing when applying stimulation to infant. Some muscle tone is noted with an apical heart rate of 101. What is the score?


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GPTAL – Math

Posted by Laura on February 20, 2010

We know GPTAL means:

  • G – gravida or # of pregnancies
  • T – term or # of deliveries after 37 weeks
  • P – preterm or # of deliveries after 20 weeks but before 38 weeks
  • A – abortion or # of deliveries before 20 weeks, either spontaneous or induced
  • L – living or # of living children

A prenatal woman states having 3 young children at home. She says her daughter was born right on time, but her sons were both a month early. Sadly, she lost a baby in her second month. What is her GTPAL?


Posted in Math, NS 121 - OB, Semester II | Tagged: | 3 Comments »

Saturday Math

Posted by Laura on February 20, 2010

So can you come up with the EDC for:

                        4 February 2010     answer

                        30 April 2010           answer

Posted in Math, NS 121 - OB, Semester II | Tagged: , | 2 Comments »


Posted by Laura on February 20, 2010

These are all abbreviations denoting delivery date.

Estimated Date of Confinement  –  EDC

Estimated Date of Delivery  –  EDD

Estimated Date of Birth –  EDB

EDC is an older term meaning the women is confined to the hospital for the birth of her child. As records are noted, the phrase  such as “on the third day of confinement patient…” would be used. This term is used quite a bit today.

EDC is figured by using Naegel’s Rule:

 This method for estimating the expected date of delivery is named after Franz Karl Naegele who was a director and professor in Heidelberg, Germany in the early 1800s. A picture of his forceps along with pictures of an old birthing room in Germany can be found here

His rule takes the last menstrual period (LMP) adds a year, subtracts three months and adds seven days to that date. LMP = 2 May 2007

+1 year = 2 May 2008
-3 months = 2 February 2008
+7 days = 9 February 2008

or +9 months and +7 days only, or according to our book:

Nägele’s (different spelling) rule is “subtract 3 months, add 7 days”. These all come up with a similar estimated date.

Calculator for EDC

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Newborn Assessment Terms

Posted by Laura on February 17, 2010

Reading the various items we are to observe, measure or palpate when doing a newborn assessment, I realized I needed to add a few more words to my vocabulary and understand what they mean. Here is a list of these words. Most of the definitions came from MedicinePlus

caput succedaneum –It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. A caput succedaneum is swelling that occurs in the scalp of a newborn. This means that bruising occurs in the thin layer of tissue between the hair and the skull itself. This typically appears as a puffy spot on the baby’s head, but it can even be so large as to cover the whole top portion of the skull, making the newborn’s head look misshapen. A caput can also cause molding of the head.

cephalohematoma – Slightly similar to a caput, a cephalohematoma can result from a forceful delivery. As the baby’s body is forced forwards either during a natural birth or a specialized extraction process, the scalp sticks to the interior of the birth canal. This results in the tearing of blood vessels connecting the periosteum to the scalp and skull. A cephalohematoma is a collection of blood under this material. While a caput succedaneum typically disappears in a few days, a hematoma of the periosteum can last longer.

subconjunctival hemorrhage (eye) – Subconjunctival hemorrhage is a bright red patch appearing in the white of the eye. This condition is also called red eye. This occurs when blood leaks under the covering of the eyeball due to the trauma of delivery. It’s a harmless condition similar to a skin bruise that goes away after several days, and it generally doesn’t indicate that there has been any damage to the infant’s eyes.

pupil opacity – white spot on the pupil, congenital corneal opacities – cataracts, glaucoma,

epstein’s pearls – Epstein pearls are whitish-yellow cysts that form on the gums and roof of the mouth in a newborn baby. Epstein pearls occur only in the newborn and are very common. They are seen in approximately 80% of newborns. The pearls are protein-filled cysts. The condition is harmless, although it sometimes worries new mothers.

supernumerary nipples – Supernumerary nipples is the presence of extra nipples. Considerations: Supernumerary nipples are fairly common. They are generally unrelated to other conditions or syndromes. The extra nipples usually occur in a line below the normal nipples. They are usually not recognized as extra nipples because they tend to be small and not well formed. Causes: Variation of normal development. Some rare genetic syndromes may be associated with supernumerary nipples. Usually no treatment is needed. The extra nipples do NOT develop into breasts at puberty.

hymenal tag – Sometimes, a small piece of pink tissue may protrude between the labia — this is a hymenal tag and it’s of no significance; it will eventually recede into the labia as the genitals grow

epispadias – Epispadias is a rare congenital (present from birth) defect in the location of the opening of the urethra. Causes: The causes of epispadias are unknown at this time. It is believed to be related to improper development of the pubic bone. In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. However, it is possible for the urethra to be open the entire length of the penis. In girls, the opening is usually between the clitoris and the labia, but may be in the belly area. Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is exposed, inside out, and sticks through the abdominal wall. However, epispadias can also occur alone or with defects.

hypospadias – is a somewhat common birth (congenital) defect in which the opening of the urethra is on the underside, rather than at the end, of the penis. Causes: Hypospadias affects up to 4 in 1,000 newborn boys. Some cases are passed down through families. In other cases the cause is unknown. Symptoms: The condition varies in severity. In most cases, the opening of the urethra is located near the tip of the penis on the underside. More severe forms of hypospadias occur when the opening is at the midshaft or base of the penis. Occasionally, the opening is located in or behind the scrotum. Males with this condition often have a downward curve (chordee) of the penis during an erection. (Erections are common with infant boys.)

polydactyly – Polydactyly is a condition in which a person has more than five fingers per hand or five toes per foot. Considerations: Having an abnormal number of digits (6 or more) can occur on its own, without any other symptoms or disease. Polydactyly may be passed down (inherited) in families. This trait involves only one gene that can cause several variations. African Americans, more than other ethnic groups, can inherit a 6th finger. In most cases, this is not caused by a genetic disease. Polydactyly can also occur with some genetic diseases. Extra digits may be poorly developed and attached by a small stalk (generally on the little finger side of the hand). Or, they may be well-formed and may even function. Poorly formed digits are usually removed. Simply tying a tight string around the stalk can cause it to fall off in time if there are no bones in the digit. Larger digits may need surgery to be removed. The doctor should ask the parents whether there was polydactyly at birth, because a person may

syndactyly – Syndactyly is the most common congenital malformation of the limbs, with an incidence of 1 in 2000-3000 live births.1,2 Syndactyly can be classified as simple when it involves soft tissues only and classified as complex when it involves the bone or nail of adjacent fingers. It is a shared feature of more than 28 syndromes, including Poland, Apert, and Holt-Oram syndromes. Syndactyly is a failure of differentiation in which the fingers fail to separate into individual appendages. This separation usually occurs during the sixth and eighth weeks of embryologic development. The root words of the term syndactyly are derived from the Greek words syn, meaning together, and dactyly, meaning fingers or digits.

club feet – Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby’s foot is twisted out of shape or position. The term “clubfoot” refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Clubfoot is a common birth defect and is usually an isolated problem for an otherwise healthy newborn. Clubfoot can be mild or severe, affecting one or both feet. Clubfoot won’t hinder your child’s development drastically until it’s time for your child to walk. At that stage, the awkward positioning of the foot may force your child to walk on the outside edge of his or her feet.

simian crease – simian crease is a single line that runs across the palm of the hand. People normally have three creases in their palms. The term “simian crease” is not used much anymore since it tends to have a negative meaning (it refers to monkey or ape). The crease is usually just referred to as a single palmar crease.

Considerations: Strong lines (called palmar flexion creases) appear on the palms of the hands and soles of the feet. The palm normally has three of these creases. But sometimes, the horizontal creases join together to form a single one. Palmar creases develop while the baby is growing in the womb, usually by the 12th week of gestation.

A single palmar crease appears in approximately 1 out of 30 people. Males are twice as likely as females to have this condition. Some palmar creases indicate problems with development and are associated with disorders like Down syndrome.

 desquamation – Shedding of the epidermis. The peeling of skin characteristic of post-mature infants.

 milia – Milia are benign, self-limited lesions that manifest as tiny white bumps on the forehead, nose, upper lip, and cheeks of the newborn. Also seen in the baby’s mouth as Epstein’s pearls. Some dermatologist consider them the continuing formation of secretion glands. Do not remove, let them complete on their own.

erythema toxicum – The main symptom is a rash of small, yellow-to-white colored papules surrounded by red skin. There may be a few or several papules. They usually appear on the face and middle of the body, but may also be seen on the upper arms and thighs. The rash can change rapidly, appearing and disappearing in different areas over hours to days. The large red splotches typically disappear without any treatment or changes in skin care.

hemangiomas – A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs. About 30% of hemangiomas are present at birth. The rest appear in the first several months of life. Most hemangiomas are on the face and neck.

The hemangioma may be:

  • In the top skin layers (capillary hemangioma)
  • Deeper in the skin (cavernous hemangioma)
  • A mixture of both


  • A red to reddish-purple, raised sore (lesion) on the skin
  • A massive, raised tumor with blood vessels

telangiectatic nevi – a common skin condition of neonates, characterized by flat, deep-pink localized areas of capillary dilation that occur predominantly on the back of the neck, lower occiput, upper eyelids, upper lip, and bridge of the nose. The areas disappear permanently by about 2 years of age. Also called capillary flames or stork bite.

mongolian spots – is a benign flat congenital birthmark with wavy borders and irregular shape, most common among East Asians and named after Mongolians by Erwin Bälz. It is also extremely prevalent among East Africans, Polynesians, and Native Americans. It normally disappears three to five years after birth and almost always by puberty. The most common color is blue, although they can be blue-gray, blue-black or even deep brown. 

Moro’s Reflex – Moro reflex is type of involuntary response that is present at birth. It normally disappears after 3 or 4 months. Considerations: The Moro reflex may be demonstrated by placing the infant face up on a soft, padded surface. The head is gently lifted with enough support to just begin to remove the body weight from the pad. (Note: The infant’s body should not be lifted off the pad, only the weight removed.) The head is then released suddenly, allowed to fall backward momentarily, but quickly supported again (not allowed to bang on the padding). The infant may have a “startled” look, and the arms fling out sideways with the palms up and the thumbs flexed. As the reflex ends, the infant draws its arms back to the body; elbows flexed, and then relax. Causes: This is a normal reflex present in newborn infants. Absence of the Moro reflex in an infant is abnormal. Presence of a Moro reflex in an older infant, child, or adult is also abnormal. Two-sided absence of the Moro reflex suggests damage to the brain or spinal cord. One-sided absence of the Moro reflex suggests the possibility of a broken shoulder bone or injury to the group of nerves that run from the lower neck and upper shoulder area. Conditions associated with such nerve injury include Erb’s palsy and Erb-Duchenne paralysis. Loss of muscle function on one side of the body may also produce an asymmetrical Moro reflex.

Babinski reflex – occurs when the big toe moves toward the top of the foot and the other toes fan out after the sole of the foot has been firmly stroked. This reflex, or sign, is normal in younger children, but abnormal after the age of 2. Considerations: Reflexes are specific, predictable, involuntary responses to a particular type of stimulation. Babinski’s reflex is one of the infantile reflexes. It is normal in children up to 2 years old, but it disappears as the child ages and the nervous system becomes more developed. It may disappear as early as 12 months. The presence of a Babinski’s reflex after age 2 is a sign of damage to the nerve paths connecting the spinal cord and the brain (the corticospinal tract). This tract runs down both sides of the spinal cord, therefore a Babinski’s reflex can occur on one side or on both sides.

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Simian Crease or Single Palmar Crease

Posted by Laura on February 14, 2010


The hand I drew on the left has normal horizontal creases. The right hand has one horizontal crease called the “simian crease”, but more appropriately known as the Single Palmar Crease. When doing our Newborn Examination, we will be checking the extremities for creases. This sign can be normal or associated with:

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IV Solutions

Posted by Laura on February 13, 2010

I have been working on IV information and was wondering of the osmolarity of the solutions. Especially with the D5W turning hypotonic in the body as the body pulls the dextrose leaving only free water behind with 0 osmolarity. So I made this chart. Here is  a good site for calculating osmolarity of fluids with additives 

if you want to print a copy, click here    IV Solutions       .pdf

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as requested

Posted by Laura on February 12, 2010

My Med Sheet  Updated 022110

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Wow. No posts for 3 days.

Posted by Laura on February 11, 2010

Okay, things got a little busy, a little sneezy, and a little messy – but I’m ready to go again.

3 days of lecture, one check off, one math quiz down. Next week we go to the maternity ward. I like my clinical instructor, I think she will guide us through what we need to learn. So – here it goes again!

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Day One

Posted by Laura on February 8, 2010

`Okay – Day One. Wish us Luck!

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Questions of the Fetal Heart Monitor

Posted by Laura on February 4, 2010

Sticking with the OB theme here, I saw the article in the American Journal of Nursing questioning the use of fetal heart monitors or fetal oxygen monitors relating to reduction of cesarean and improved perinatal care.

Yesterday’s article at Off the Charts, brought me to this 2007 article. Personal experience with this situation does bias my position, but I am slow to disregard the importance of these measures. Isn’t it through evidence-based practice that this standard protocol has allowed health care personnel to understand interventions such as the effects of maternal positioning to enhance uteroplacental blood flow?

Quite often the seed of knowledge remains underground developing its resources until it is the right time to sprout. – my two cents.

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