Midwifery EXAM 2023 QUESTION WITH COMPELETE SOLUTION

MidwApgar - Heart rate, resps, colour, tone, response - ANSWER Heart rate: <60 (0) <100 (1) >100 (2) Resps: none (0) support (1) steady (2) Colour: blue (0) blue extremit(1) pink (2) Tone: floppy (0) sluggish (1) gd mvt (2) Response: none (0) slow(1) alert(2) Neonatal Norms: - ANSWER Heart Rate: 100 - 160bpm; Temp: 36.6 - 37.2 C Resps: 40 - 60 per/min Blood sugar: 2.5-5.5 mmol/L 02 sat: <1250g 88-90%, >1250g 90-94% >2000g >94% Blood pH: 7.26; PCo2: 49-52; Po2: 17 Neonatal Scalp Lactate during labour - ANSWER pH lactate action >7.25 <4.2 observe, ctg 7.2-7.25 4.2-4.8 recheck in 30 mins <7.2 >4.8 deliver asap take cord blood gases after birth Challenges for the Full Term Neonate - ANSWER air, circulation,temp maintained, feeding, maintaining blood sugars, colonising skin, colonising gut, bonding. Neonatal energy triangle - ANSWER warm, pink and sweet - avoid -hypothermia, hypoxia & hypoglycaemia, Placental assessment - ANSWER Cord insertion: central, battledore, succenturate, Velamous, circumvilliate, bi-partite, lobes and membranes complete, 3 vessel cord - AVA Resp Distress Syndrome - Try Really Hard Now, Good Child - ANSWER Tachapnea, Retracted chest, Hyper inflation, Nasal flaring, Grunt on expulsion, Central cynosis (heart defect). Risk factors: hypoxia, hylenated memb disease, cardaic, hypothermia, aspiration, sepsis Neonatal RESUS - ANSWER Airways: open - establish and maintain Breathing: apnea or HR<100bpm - cpap/neopuff 5 rescue, then breathing rate 30 secs Circulation: HR<60bpm - cpap & chest comp 1:3 Drugs -naloxone(pethadine)0.1mg/kg(0.2ml/kg IM); Adrenaline sublingual 1mg/10ml (1ml/kg) Usually airways+ breathing stabilises Iatrogenic birth injuries - ANSWER physical injury from being born: Macrosomic, prem, CPD, malpresent, dystocia, prolonged labour looks like: caput, cephalhaemotomia, bruising, paralysis, fractures, brachial nerve palsy Post natal maternal checks - BUBBLE + - ANSWER breasts, Uterus, Bowel, Bladder, Lochia, Episo(perineum), + contraception, wellbeing, support, Postnatal baby check - - ANSWER Fontanelles, head circumference, eyes, mouth, skin, cord, output, responsiveness, feeding, sleeping. Hips, RER 1 week Metabolic testing NZ: 7 fat aunties and 28 hairy cyber freaks gave blood - ANSWER 7 - major groups of metabolic disorders Fatty acid (lipid) enzymes missing Amino acid (protein) - PKU, Maple syrup, Adrenal hyperplasia- enzyme missing 28 tests.....to date Hyperthyroidism - missing /defective thyroid Cystic Fibrosis - gene >protein=>mucus Glactosemia - enzyme lactose Bionase deficiency - b vitamin Immunisations NZ - ANSWER 6 wks, 3mths, 5 mths, (15mths, 4 yrs....). 2 injects. PCV7 - pneumococcal DTaP-IPV-HepB/Hib -diphtheria,tetanus, pertussis, inact polio,hep b,haemophilus influenze type b. (Hib, MMR, PCV7; Dtap-IPV, MMR) Palpation Findings - ANSWER Fundus, Lie, Attitude,Presentation, Position, Engagement, Denominator Placenta Functions - ANSWER Growth, gas exchange, nutrition, waste removal,hormones, protection, support Placental exchanges - ANSWER tetragens, drugs, environmental influences, hormones, micro-organisms, antibodies, HIV, CMV, Syphilis, listeria, toxoplasmosis, rubella, varicella Antenatal Screening - ANSWER antenatal bloods; Hb, Antibodies, Hep B, Rubella, Syphillis, HIV, along with Fe and often MSU and vag swab. Antenatal Combined Screening - ANSWER Combines maternal risk factors, serum screening for PAPP-A and beta hCG and nuchal thickness scan results to give risk level for metabolic and genetic disorders. Serum - 9-13+6 wks NT scan 11+2 - 13+6 wks Antenatal late screening.. - ANSWER Maternal serum screen - 12 - 20wks - quad test Chorionic villi sampling <14 wks Amniocentesis >14 wks - 1-2/200 miscarry Strep B - ANSWER AB's in labour benzyl penicillin IV stat dose 3g in 500ml norm saline run over 30 mins. 4 hourly until birth - 1.5g reconst in sterile H2O, slow IV push over 5 mins (always check protocol when reconstuiting and IV). Neonate- CBC for toxic ratio(<0.2) - cord bloods Referrals - ANSWER 1: may recommend consultation 2: must recommend consultation 3: must recommend, and refer/transfer care IN CONSULTATION WITH WOMAN! timely manner, include: gest, EDD, relevant Hx, contact details Wound Healing - ANSWER Haemostasis; Inflammation; Proliferation; Maturation. prim, sec & tert intention - defs depend upon state of tissue damage in relation to healing Syntocinon - ANSWER 10 IU Oxytocin per 1ml ampule 2 min onset, control pph, augment/induce labour. causes hypertonic uterus, hypotension Syntometrine - ANSWER 5IU Oxytocin + 0.5mg Ergometrine per 1ml ampule. 3-5 min onset, PPH, not to exceed 3ml in 24hrs caution: Diastolic>90, renal, hepatic & cardiovascular disease. CTG - ANSWER Baseline Variability >5-10, <25bpm Accelerations - present/absent Decelerations - if present what type? Uterine activity -dependant on timing of monitoring eg sleep phase, gestation, 1st or 2nd stage of labour. Maternal Normal Ranges - ANSWER Heart Rate: 64-80 bpm Temp C: 36-37 Resps: 16-24per min BP: 120/80 ( prefer < 130/<90mmHg) Mechanisms of Cephalic Labour - ANSWER Decent, Flexion, Internal rotation, Crowning External rotation, Restitution, Internal rotation (shoulders), External rotation, lateral flexion. Mechanisms of Breech Labour - ANSWER Descent, Internal rotation of butt, Lateral flexion of trunk, Birth of butt,Internal rotation of shoulders, Birth of shoulders, internal rotation of head, birth of head. HANDS OFF THE BREECH - until at very least the umbilicus is born. Lovsett, Smelli-Veit, Burns-Marshall Blood Tubes Order of Draw - ANSWER Cultures (anerobic, aerobic), co-agulation, bio-chem, cbc, group & screen/hold (to Blood Bank handwritten), glucose MRSA - ANSWER Clearance required for birthing centres if prev Hx 3 consecutive negative swabs in 3mth period. Ensure all done during pg & last after 6mth gest Bacterial Vagino ifery EXAM 2023 QUESTION WITH COMPELETE SOLUTION