HAN 416 Quiz 4 Review

hemodynamics

HR increase 15-20 bpm, BP decreases in 2nd trimester, BP increases in 3rd trimester, increase in CO, increase in plasma 40-50%, increase in RBC and WBC

progesterone relaxes smooth muscle

lower esophageal tone + delayed gastric emptying

breathing

increased minute ventilation and reduced functional residual capacity

Functional residual capacity (FRC)

volume of air left in lungs after normal exhalation. Gravid uterus pushes up on diaphragm resulting decreased FRC (20%)

gravidity

\# of times pregnant

parity

delivery of an infant who is alive

Primigravida

a woman who is pregnant for the first time

Primipara

a woman with only one delivery

multigravida

a woman who has had 2 or more pregnancies

Multipara

a woman who has had 2 or more deliveries

grand multipara

a woman who had more than 5 deliveries

Nullipara

a woman who has never delivered

dilation

refers to the extent of cervical dilation as judge by palpating. Full dilation at 10 cm

Effacement

relates to the thickness of the cervix and is expressed as a %

A normal cervix is

2 cm thick and thins during labor. Thus, when thiness to 1 cm the patient is said to be 50% effaced

Station

refers to the fetal head in relation to the mother's ischial spines and is expressed as a - or + and is measure in cm

fetal monitoring baseline

FHTs 120-160

fetal monitoring variability

single most important predictor of fetal well being

fetal monitoring poor variability

Fetal hypoxia, Admin of meds to mother, Smoking, Fetal sleep

signs/symptoms of imminent delivery

Vaginal bleeding, blood show, Frequent contractions, Increasing intensity of contractions, Urge to push, Crowning

Supine hypotensive syndrome

Uterus may compress the inferior vena cava. May diminish or occlude venous blood return to the heart, Can result in significant hypotension and fetal distress

Hypertensive disorders

Preeclampsia, Eclampsia, HELLP, Seizure

Leading cause of neonatal morbidity and is the most common reason for hospitalization during pregnancy

pre term labor

Clinical diagnosis of preterm labor is made if there are

regular contractions and concomitant cervical change

Less than 10% of women with a clinical diagnosis of preterm labor will deliver within

7 days of initial presentation

pre term labor assessment: look for signs of imminent delivery

Status of membranes, Cervical status, Left lateral recumbent, Assess for infection

Maternal medications:

Magnesium, Calcium channel blockers, Terbutaline, Betamethasone

Placental Abruption

Sheer force + moms body folding. Can occur in low mechanism injuries, CT is the imaging of choice, Pts with abdominal or back pain, vaginal bleeding, uterine tenderness or contractions should be evaluated for abruption

Perimortem cesarean delivery (PMCD)

Primary goal is to stabilize the mother first, as fetal outcomes are directly correlated with maternal resuscitation

Initiate PMCD if

maternal spontaneous circulation has not returned within of 4 min of CPR

primary internal female reproductive organ

ovaries

ovaries lie on

each side of lower abdomen

ovaries produce

ovum (eggs)

fallopian tubes connect each ovary with the

uterus

Function of the uterus

uterus is a muscular organ where the fetus grows

Narrowest part of uterus

cervix

Cervix opens into

vagina

Fertilization process

fertilization does not occur within about 14 days of ovulation

in fertilization the lining of the uterus begins to

separate and menstruation occurs for about a week

Process of ovulation and menstruation is controlled by female hormones

The anterior pituitary gland releases: follicle stimulating hormone and luteinizing hormone

AVPU scale

Alert, verbal, pain, and unresponsive

Pertinent secondary assessment findings should include:

Vital signs, Abdomen, Genitourinary, Neurologic

Term birth

means delivery at 37 weeks or greater weeks' gestation

pre term birth

means delivery at 20-36 6/7 weeks' gestation

Abortion

delivery before 20 weeks' gestation. Living children means children who lived beyond neonatal period

Emergency care

Use sanitary pads on the external genitalia to absorb blood, Treat external lacerations with moist, sterile compresses, Do not pack or place dressings in the vagina, Discourage use of tampons to absorb blood flow

Pelvic Inflammatory Disease (PID)

Infection of female reproductive tract; caused by bacterium, virus, or fungus

PID occurs almost exclusively in

sexually active women

Common cause of PID:

gonorrhea and chlamydia

PID can result in

increased risk of ectopic pregnancy or sterility

most common cause of abdominal pain in women of childbearing years

PID

PID has

Foul smelling vaginal discharge often yellow in color, irregular menses

treatment of PID

antibiotics administered intravenously over extended period. Do not perform vaginal exam

Bacterial vaginosis

Most common vaginal infection, Affects women ages 15-44 years, Normal bacteria in vagina are replaced by an overgrowth of other bacteria, Untreated it can progress to premature birth or low birth weight in pregnancy and PID

Rupture ovarian Cyst

When cyst rupture, small amount of blood spilled into abdomen. Can cause abdominal pain and rebound tenderness. May be associated with vaginal bleeding. History of dyspareunia, irregular bleeding, delayed menstrual period

Ovarian Torsion

Ovary become twisted around the tissue that supports it cutting off blood supply to ovary

symptoms of ovarian torsion

severe sudden lower abdominal pain, cramping, nausea, and vomiting

treatment of ovarian torsion

requires surgery to de-torse ovary and restore blood flow. If ovary is dead, it is removed

Endometritis

infection of uterine lining occasional complication of miscarriage, childbirth, gynecological procedures such as D&C

symptoms of endometritis

mild to severe abdominal pain; bloody; foul smelling discharge; fever

Endometriosis

Endometrial tissue found outside uterus; found in abdomen and pelvis. Bleeding causes inflammation, scarring of adjacent tissues, developmental of adhesions, particularly in pelvic cavity. Women between ages of 30 and 40

Endometriosis Signs and Symptoms

Dull, cramping pain related to menstruation; dyspareunia; abnormal uterine bleeding. Not uncommon for endometriosis to be diagnoses when pt evaluated for infertility

Ectopic Pregnancy

Implantation of fetus outside uterus. Common site is within fallopian tubes

Ectopic Pregnancy surgical emergency

ube can rupture, triggering massive hemorrhage

ectopic pregnancy signs and symptoms

Severe unilateral abdominal pain; may radiate to shoulder on affected side, late or missed menstrual period, vaginal bleeding

Menorrhagia

excessive menstrual flow

Non traumatic vaginal bleeding

dysfunctional uterine bleeding, rarely seen in filed unless severe. Most common cause is spontaneous abortion (miscarriage). Cramping abdominal pain; passage of clots and tissues

newborn

within the first few hours after birth

Neonate

within the first month after birth

Skilled care interventions to optimize cardiopulmonary function are required in only

5%-10% of deliveries

Approx 8% of newborns delivered each year weigh less than

5.5 pounds

Approx 1% need intensive

resuscitative measure

Fetal circulation has 3 major blood flow deviations or shunts

ductus venosus, foramen ovale, ductus arteriosus

Pre term period

less than 37 weeks

term period

38 to 42 weeks

post term period

more than 42 weeks

newborn should be suctioned from

mouth to nose

Arrival of the newborn

Skin, head and eyes irregularities (vermex, edema, dicoloraion), Umbilical cord inspections (clamp and cut the umbilical cord), APGAR scale

Apgar scale

Appearance (skin color), Pulse rate, Grimace (irritability), Activity(muscle tone), Respiratory (effort)

if APGAR score is less than 7

redo every 5 minutes until 20 min after birth

Acrocyanosis

Bluish discoloration of the extremities due to decreased amount of oxygen delivered to peripheral part. Additional oxygen may be necessary if the target preductal oxygen saturation value has not been reached

Algorithm for Neonatal Resuscitation

If the newborn's pulse rate is apneic or less than 100 beats/min begin PPV, begin chest compressions if the newborn's pulse rate is less than 60 bpm, If ventilation and chest compression do not improve the bradycardia, administer epinephrine preferably via IV line

Transport to nearest facility once the newborn is

stabilized as much as possible

Transport of a high risk newborn

Physician at referring hospital initiate's request, Mode of transportation is chosen, Transport team is mobilized and equipment assembled, On arrival, transport stream continues to stabilize the newborn

Conditions that should be treated before leaving the referring hospital

Hypoxemia, Acidosis, Hypoglycemia, Hypovalemia

Apnea

respiratory pause greater than 20 seconds

apnea can lead to

hypoxia and bradycardia

Newborn needs respiratory support to

minimize brain and organ damage

Assessment and management of apnea

Careful history to find etiologic risk factors, Perform a physical exam, Differentiate between primary apnea and secondary apnea

Bradycardia most frequently occurs due to

inadequate ventilation

Acidosis

suspect metabolic acidosis if bradycardia persists after adequate ventilation, chest compressions, volume expansion

acidosis treatment

Best treatment is to identify and correct the underlying cause

For acidosis consider administering

a bolus of normal saline to aid in improved perfusion and clearance of acid

Pneumothorax can occur if

infant inhales meconium, lung is weakened by infection

Signs and significant pneumothorax

severe respiratory distress unresponsive to PPV, unilateral decreased breath sounds

Low blood volume

fluid resuscitation may be needed if the newborn has significant depletion due to: abruptio placenta, twin to twin transfusion, placenta previa, septic shock

Signs of hypokalemia

pallor, persistently low pulse rate, weak pulse, no improvement in circulatory status

Hypoglycemia blood glucose level of

45 mg/dL

Hypoglycemia may result in

seizures, brain damage

Hypoglycemia risk factors

disorders related to decreased glycogen stores, increased use of glucose