GODBLESS SA EXAM

ASEPSIS

• absence of microorganism that cause disease

aseptic technique

• methods by which contamination with microorganisms is prevented

ANTIMICROBIAL ACTION

• an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms

PERSISTENT ACTIVITY

• an agent offering persistent activity keeps the bacterial count low under the gloves

SAFETY

• an ideal agent would be non-irritating and non-sensitizing

ACCEPTANCE

• probably most important to achieving compliance in using a new product is its acceptance by the healthcare worker

SURGICAL SITE INFECTION

• is an infection that occurs after surgery in the part of the body where the surgery took place

Preoperative

education given to families from surgeon's clinic about proper hygiene before surgery and bathing instructions for night before or day of surgery

Intraoperative

• appropriate antibiotic dosing

• environmental controls

• maintain a clean environment

• wear clean surgical attire

• surgical skin prep and wound classification

• hand hygiene

• minimize traffic

• adequate sterilization of instruments

Post-operative

• discontinuing antibiotics after 24 hrs

• maintain blood sugar (if diabetic), normothermia (36°c or better) and tissue perfusion with supplemental oxygen 

• hand hygiene for dressing changes and sterile supplies

• education of preventing Surgical Site Infection upon discharge with patient and families

CLEANING

• physical removal or organic material or soil from objects and is usually done by using water with or without detergents

STERILIZATION

• destruction of all forms of microbial life; it is carried out in the hospital with steam under pressure, liquid or gaseous chemicals, or dry heat

DISINFECTION

• defined as the intermediate measures between physical cleaning and sterilization, is carried out with pasteurization or chemical germicides

HIGH-LEVEL DISINFECTION

• can be expected to destroy all microorganisms, with the exception of large numbers of bacterial spores

INTERMEDIATE DISINFECTION

• inactivates mycobacterium tuberculosis, vegetative bacteria, most viruses, and most fungi; does not necessarily kill bacterial spores

LOW-LEVEL DISINFECTION

• can kill most bacteria, some viruses, and some fungi; cannot be relied on to kill resistant microorganisms such as tubercle bacilli or bacterial spores

CRITICAL ITEMS

• are instruments or objects that are introduced directly into the bloodstream or into other normally sterile areas of the body

SEMICRITICAL ITEMS

• items that come in contact with intact mucous membranes, but they do not ordinarily penetrate body surfaces

NONCRITICAL ITEMS

• items that either do not ordinarily touch the patient or touch only intact skin

Steam Sterilization

• most inexpensive and effective method for sterilization

Ethylene Oxide Gas Sterilization

• it is a more complex and expensive process than steam sterilization

• it is usually restricted to objects that might be damaged by heat or excessive moisture

• Rinsing

• Cleaning

• Drying

• Inspection and assembly

• Packaging

• Labeling

• Sterilization

• Storage

• Distribution

Role of CSSD

• ensure delivery room T° is between 25-28 °

• Ensure that there are no air drafts

• Discuss maternal and NB care in the immediate postpartum period

• Perform HANDWASHING

• Arrange instrument and other needs + 0.5 chlorine solution for decontamination

• Prepare equipment and NB resuscitation

Prepare for the Birth

HAND HYGIENE

• single most important method of controlling spread of infection

HANDWASHING

• visibly dirty or visibly soiled with blood or fluids

• 40 – 60 seconds

HAND RUB

• hands are not visibly soiled 

• access to handwashing facilities is not available

Gloving

• To reduce the risk of contamination of hands with blood and other body fluids

Sterile gloves

•  what gloves to use in surgical procedures, vaginal delivery

Non sterile/clean gloves

• what gloves to use in potential for touching blood,  body fluids, secretions, stool/urine and items visibly soiled by above:

• direct patient exposure— examination, handling of patients

• indirect patient exposure— emptying basins, handling instruments, handling waste, cleaning up spills of body fluids

SUPINE HYPOSENSITIVE SYNDROME

• When a pregnant woman is lying flat on her back, the weight of her uterus and its contents compresses the large blood vessel (vena cava) leading from her lower body to the heart.

MCDONALD RULE

• used to determine the age of gestation by measuring the fundus

BARTHOLOMEW RULE

• fundal height is determined by relating to the different landmarks in the abdomen

JOHNSONS RULES

• used to estimate the weight of the fetus in grams

Fetal Heart Rate (FHR) Monitoring

• measuring of the fetus’ heart rate during labor by using special instruments

Tachycardia

• Baseline FHR above 160 bpm

Bradycardia

• Baseline FHR less than 120 bpm

Electronic Fetal Heart Monitoring (EFM)

• an electronic monitor used to continuously measure the fetus's heart rate and using a pressure sensor to monitor the mother's contractions at the same time.

Internal Monitoring

• Measure the heart rate through a wire called (electrode) contains a needle, inserted through the vagina and cervix, and placed under the baby's scalp.

Baseline Variability

• Refer to fluctuation caused by balancing acts of sympathetic (increase FHT) and parasympathetic branches (decreases FHT) of the autonomic nervous system.

Accelerations

• Non Periodic accelerations are temporary normal increases in FHR caused by fetal movement, a change in maternal position, or administration of an analgesic.

Prolonged Decelerations

are decelerations that decrease from the FHR baseline of 15 beats/min or more and last longer than 2 to 3 minutes but less than 10 minutes. They generally reflect an isolated occurrence, but they may signify a significant rent, such as cord compression or maternal hypotension. For this reason they must be reported and documented

Decelerations

• Rate of FHT decreases at the onset of uterine contraction but return to normal before the end of contraction this is normal response of the fetus to head compression caused by umbilical

Variable Decelerations

The pattern of variable decelerations refers to decelerations that occur at unpredictable times in relation to contractions. They may indicate compression of the cord, which can be an ominous development in terms of fetal well-being (Fig. 15.20). Cord compression may be occurring because of a prolapsed cord, but it most often occurs because the fetus is simply lying on the cord. It tends to occur more frequently after rupture of the membranes than when membranes are intact, or with oligohydramnios (the presence of less than a normal amount of amniotic fluid), such as occurs in postterm pregnancy or with intrauterine growth restriction. As a first step, change the woman's position from supine to lateral if she is not already lying on her side. If a prolapsed cord is diagnosed as the cause of the variable decelerations, oxygen will be prescribed as well as changing her position to a knee-to-chest one to help relieve pressure on the cord.

FUNDAL GRIP

palpate the upper abdomen of women in a lie down position. 

LATERAL GRIP

This process is done to identify the location of a fetal back.

PAWLICK'S GRIP

 Palpate the lower part of the abdomen which is just above the symphysis portion.

PELVIC GRIP

• Palpation of the pelvis is performed.

PARTURITION

• correct term for the process of childbirth

1. Labor

2. Birth of the Baby

3. Birth of the Placenta

3 Stages of Childbirth

crowning

• when the head is first visible

Cephalic

head first

breech

•  feet or buttocks first

cesarean section

• also known as c-section where fetus is delivered through a horizontal incision in abdominal and uterine walls, advisable when fetus is improperly aligned (transverse position), multiple fetuses, fetal distress, mother is worn out, or mother has a transferrable genital condition of infection

EPISIOTOMY

• incision through the skin and muscles in the perineum, made during a vaginal delivery

“BEING BORN IN THE CAUL”

• when the amniotic sac has not ruptured during labor or pushing; infant is born with intact membranes

SUTURES

• anatomical lines where the bony plates of the skull join together

• diamond shaped spaces on top, top back, and sides of the skull

Lactation

the hormone oxytocin that started the process of childbirth has several other effects on the body

passage

(a woman's pelvis)

passenger

(the fetus)

 powers

(uterine factors)

psyche,

a woman's psychological state

SUTURE LINES

• The fetal skull is not yet completely ossified at birth and its bones are joined only by membranes so that spaces actually exist between them.

VERTEX

• The area between the two fontanelles 

SINCIPUT

The area over the frontal bone

OCCIPUT

• the area over the occipital bone 

VERTEX POSITION

• Occurs when the head is completely flexed so that the chin touches the chest. It is the most ideal type of presentation because the smallest diameter of the fetal head, occipito bregmatic (9.5 cm), is presented with the posterior fontanel as the presenting part.

SINCIPUT POSITION

• Occurs when the head is partially flexed and the anterior fontanel is the presenting part. The occipitofrontal diameter (12.5 cm) is presented for delivery Also called military position because it gives the appearance of a military person at attention.

BROW PRESENTATION

• Occurs when the head is extended or bent backward causing the occipitomental diameter (13.5 cm) to be presented for delivery

FACE PRESENTATION

• Occurs when the head is sharply extended causing the occiput to come in contact with the back of the fetus. During the course of labor, resistance by the pelvic floor can cause the head to extend further causing neck fracture and damage to the cervical cord.

Shoulder Presentation

In a transverse lie, a fetus lies horizontally in the pelvis so the longest fetal axis is perpendicular to that of the mother.

Chin Presentation

• Occurs when the head is hyperextended with the chin as the presenting part.

Compound Presentation    

• This presentation occurs when there is prolapsed of the fetal hand alongside the vertex, breech or shoulder

Longitudinal Lie

• The long axis of the fetus is parallel to the long axis of the mother, meaning, the fetus is lying lengthwise in the mother's abdomen

Oblique Lie

• This lie is the most unstable. The fetus assuming this lie usually rotates to transverse or longitudinal lie in the course of labor.

Transverse Lie

The long axis of the fetus forms a right angle with the long axis of the mother, which means that the fetus is lying crosswise in the mother's abdomen

FETAL POSITION

refers to the relationship of the presenting part to one of the quadrant of the mother's pelvis

Pelvic Landmarks

The pelvis is divided into several areas in order to locate accurately the position of the presenting part.

Right occiput anterior

Right occiput transverse

Right occiput transverse

Left occiput anterior

left occiput transverse

Left occiput posterior

Right mentum anterior

Right mentum posterior

Left mentum anterior

Left sacrum anterior

Left sacrum posterior