202 summary slides Flashcards
axillary temp
under armpit
0.5C < oral**
rectal temp
anus
0.5 > oral**
tympanic temp
forehead
oral temp
preferred, under the tongue
pulse assessment considerations
rate
rhythm
elasticity
force
temp normal
35.8-37.3
bp normal
120/80 mmHg
heart rate normal
60-100 bpm
resp rate
12-20 rpm
systolic pressure
top #
pressure against artery during contraction
diastolic pressure
bottom #
pressure at rest when heart recoils btwn contractions
Relaxation of heart
considerations for resp rate
rate, rhythm, depth
atrioventricular
tricuspid (RA=>RV) and mitral (LA=LV)
semilunar
pulmonic (RV=>aorta=>lungs) and aortic (LV=>systemic circulation)
route of blood flow
Inferior/superior vena cava => RA => tricuspid => RV => pulmonic => pulmonary artery => lungs => pulmonary vein => LA => mitral valve => LV => aortic valve => aorta => body
s3
soft, dull, low-pitched sound heard after S2 (Al-Ber-Ta)
norm in children and young adults, not normal in older adults
s1
AV valve closure (LUB-dub); represents start of systole
s2
SL valve closure (lub-DUB); represent end of systole
split s2
aortic valve closes b4 pulmonic (lub-T-DUB) on expiration
s4
very soft, low-pitched sound heart b4 s1 (NEW-Bruns-Wick)
usually abnormal
summation gallop
hearing s4-s1-s2-s3
murmurs
blowing, swooshing sounds arising from turbulent blood flow
arteries
high pressure vessels that deliver oxygenated blood
veins
low pressure, one-way vessels with valves that bring deoxygenated blood back to heart; closer to surface of skin
clubbing
nail bed > 160 degrees, rep poor blood perfusion which causes compensatory increases in blood flow which causes tissue hypertrophy
edema
swelling of skin across bony prominences as fluid in vessels shifts outside vessel walls; graded 1+ => 4+
peripheral arterial disease
narrowing of arteries that carry blood from heart to legs, leads to skin discolouration in extremities, coldness, cramping, and leg numbness/weakness
peripheral vascular disease
narrowing of the vessels that carry blood back to heart, causes numbness, weakness, and pain at rest
deep vein thrombosis
blood clot in extremities when blood is hypercoagulable state with limited blood flow
right lung
3 lobes
shorter and wider to make space for liver
left lung
2 lobes
narrower and longer to make space for the heart
for ped’s w resp
- assess rr for one full min bc of abnormal breathing rates
preg and resp assessment
enlarging uterus elevates diaphragm => SOB, activity intolerance, fatigue, etc
geriatric resp considerations
- less elastic recoil
- decreased residual volume
- may have round, barrel-shaped throacic cage
normal anterior
posterior/transverse diameter should be 1:2 ratio
indrawing
lower chest muscles move inward while taking deep breaths while rest of chest moves out
retractions
intercostal muscles are sucked inward which indicates reduced thoracic pressure
pallor
pale discoloration of skin => reduced perfusion
cyanosis
blue discoloration of skin/mucous membranes => deoxygenated blood
costal margins should be _____ on assessment
90 degrees
tactile fremitus
feeling vibrations w the palms of your hands when patient repeats a specific phase; no vibration indicates obstruction
hyperresonance
booming, low-pitched sound indicating too much air in lungs
dull
flat sound (almost like knocking on wood) indicating abnormal lung densities
Normal Breath Sounds on Auscultation
- Bronchial: high-pitched, loud sounds heard over the neck (trachea, larynx)
- vesicular: low-pitched, quiet sounds heard over peripheral lung fields
- bronchovesicular: moderately pitched, moderately loud noises that are a mix of bronchial and vesicular sounds
Abnormal/adventitious Sounds on Auscultation
- Crackles (rales): sounds like bubbling/rattling; represents fluid in the lungs (e.g. pneumonia)
- Wheezes: high-pitched whistling noise rep reduction in airway diameter (e.g. asthma)
- Stridor: high-pitched crowing noise representing upper airway obstruction
- Pleural friction rub: rasping sound caused by friction of the visceral and parietal pleura against each other
3 layers of skin
- Epidermis: thin, tough upper layer
- Dermis: contains connective tissue
- Subcutaneous: contains adipose (fat) tissue for energy and protection against injury
most significant functions of skin
- Protection
- Sensory perception
- Communication
- Wound repair
- Production of Vitamin D
- Absorption and excretion
Developmental terms for skin/hair: Newborns
- Lanugo: soft, fine layer of hair
- Vernix caseosa: white, cheese-like biofilm that covers the skin
Developmental terms for skin/hair: Puberty
- Sebaceous glands: microscopic glands in hair follicles that secrete sebum (protective oil layer to prevent skin dryness)
- Secondary sex characteristics: physical traits that appear during puberty due to hormonal changes
Developmental terms for skin/hair: Preg
Striae: indentations that occur when layers of the skin experience prolonged periods of stretch
(Stretch marks)
Developmental terms for skin/hair: Geriatrics
- Senile lentigines: hyperpigmented macules that are irregularly shaped, often in sun-exposed areas
- Seborrheic keratoses: benign, hyperpigmented growths that are waxy/shiny and slightly raised
pallor
pale; often related to inadequate perfusion/chronic diseases
erythema
redness; often related to infections
cyanosis
blue discolouration; often related to inadequate perfusion
jaundice
yellow discolouration; often related to buildup of bilirubin
diaphoresis
sweating
exudate
substance secreted by body
annular lesion
circular, ring-like
confluent lesion
circular cascade, connected together
discrete lesion
separate lesions with defined borders
discrete lesion
separate lesions with defined borders
grouped lesion
groups of discrete lesions
gyrate lesion
raised borders
target lesion
“bullseye” lesion with definable zones of discolouration
linear lesion
straight line pattern
polycyclic lesion
incomplete rings/circles; > 1 cyclic component
zosteriform lesion
unilateral, curved lesion common in herpes zoster virus infections
macule
flat lesion < 1 cm
papule
raised lesion < 1 cm
Elevated, solid, palpable lesion
nodule
raised lesion btwn 1-2cm
Slightly elevated lesions on or in the skin
wheal
formed, raised lesion
Suddenly formed elevation of skin surface
vesicle
fluid-filled lesion < 1 cm
cyst
fluid-filled nodule lined by epithelial cells consisting of fluid, tissue, and fats
pustule
collection of free pus, indicates infection
Acne
scale
visible peeling/flaking of outer skin layers
fissure
linear breaks in skin
(Foot cracks)
erosion
partial thickness wound with loss of epidermal tissue
ulcer
deeper, concave, and full thickness loss of tissue
- Pressure injury: wound that occurs with excessive shear/friction over bony prominences; risk is assessed with Braden Scale
(Deeper than erosion lesion)
excoriation
pruritic skin patches with thin crusts and redness from repeated skin picking
scar
pigmentation left on skin indicating prior damage and subsequent healing - Atrophic scar: depressed scar r/t excessive collagen/fat damage
lichenification
thickened, leather, and hyperpigmented appearance of skin with exaggerated borders
keloid
excessive scar tissue growth
hematoma
collection of pooling of blood within tissues
whats in the RUQ
bowel and liver
what in the RLQ
bowel and appendix
whats in the LUQ
stomach, bowel, spleen, pancreas
whats in the LLQ
bowel
epigastric region
(+L/R hypochondriac): stomach, pancreas, aortic artery
umbilical region
(+L/R lumbar): above umbilicus
suprapubic/hypogastric
(+L/R iliac): bladder, pubic bone, female reproductive organs
abdominal developmental considerations: ped’s
- Umbilical cords are really important
- Less muscle tone in the abdomen
- Vomiting/diarrhea/dehydration can kill
abdominal developmental considerations: preg
- Morning nausea related to elevated hormone levels, impaired carbohydrate metabolism, etc. - - - Heartburn and constipation
abdominal developmental considerations: geriatrics
- Fat accumulation
- Less salivation
- Vomiting/diarrhea/dehydration can kill
- Smaller liver => increased gallstones
- Poorer kidney function => drug considerations - Constipation
Order of Assessment for GI
Change of assessment order: IAPP
- Prevents agitating bowel sounds prematurely (which would occur in palpation) - we’re trying
to hear bowel sounds alone to ensure they are present at rest
GI assessment considerations
Stool is extremely important
- Red/black/tarry blood suggests the presence of blood (from a GI bleed, cancer, etc.)
- Colon cancer screening for all pts > 50 every 2 years
- High-risk pts are screened at 40 or 10 years before their most recent family member’s
onset of cancer
- Grey blood can indicate jaundice or liver dysfunction
Different abdominal shapes
Light vs. deep palpation
- Light: detects tenderness
- Deep: detects organs and abnormal masses - Palpate painful regions last
normal bowel sounds
bubbling, clicking sounds every 5-15 seconds in all quadrants
absent GI sound
No bowel sounds present within 5 minutes of listening
- Suggests intestinal obstruction, paralytic ileus, or peritonitis
sluggish bowel sounds
<= 3 BS/min
- Suggests paralytic ileus or intestinal obstruction
hyperactive bowel sounds
excess gurgling (borborygmi) - Suggests increased GI activity
female anatomy; developmental considerations and implications
- Divided into external (visible) and internal genitalia
- Developmental considerations
- Infant/Child: an external exam usually suffices, parental consent
- Adolescent: menarche, physiological leukorrhea, pelvic exams only when required
- Pregnant patients: varicose veins/hemorrhoids, increased venous congestion (hyperemia),
internal exam findings - Geriatrics: hormonal decline, menopause, vaginal friability, uterine/ovarian size, decreased
lubrication - Health promotion
- Cervical cancer screening: Pap smear starting at 21 and every 3 years afterwards to identify
abnormal cell growth/aggregation, HPV vaccinations for patients of all genders - STI screening for sexually active patients
male: developmental considerations and implications
Know your structural anatomy (as always)
Testicular self exams: screening for prostate cancer
- Think TSE: Timing (once/month), Setting (shower), Examination method (one testicle at a time; palpate thumb and finger with both hands, rolling gently; note any structural changes/lumps)
Infants:
- Inspection: Voiding, foreskin
- Palpation: Testicular descent, hydrocele, inguinal bulge
Adolescent puberty is rated through Tanner’s sexual maturity rating
- Adapt your communication based on developmental considerations
- Tanner’s sexual maturity rating scale
Adult/geriatrics:
- Sperm production declines at 40, testosterone declines at 50, changes in sexual response/expression
and penile size
urine assessment/considerations
- Urine amount, colour, and odour can be a predictor of many illnesses
- Normal urine output: 30 mL/hour; 1500 mL/day
- Urge to urinate begins when stretch receptors are activated: 200-250 mL in bladder
- Some patients are catheterized because of inability to void related to obstructions,
decreased mobility, or loss of sphincter control
Want to assess for signs of infection: redness, dysuria, hematuria, fever, leakage around catheter site - Risk factors:
- Prolonged catheterization - Sex: females more at-risk - Diabetes
- Malnutrition
- Age: older adults more at-risk
- Impaired immunity (e.g. infection, autoimmune disorder, etc.)
what are lymph nodes responsible for
- Lymph nodes are responsible for engulfing pathogens to prevent harmful substances from entering circulation
- Lymphatic system helps detect and eliminate foreign substances
Things to consider with pediatrics: for head/eyes/ears/nose/throat
- Fontanelles: Soft depressions in between bony plates that have not yet fused
- Caput succedaneum: Collection of fluid above the periosteum that crosses scalp lines
- Cephalhematoma: Collection of blood under the periosteum that stays within one scapular region
- Skull circumference: macro- vs. micro- vs. normocephalic
- Assessment of pinna for child < 3 - pull pinna straight down
Things to consider with geriatrics: for head/eyes/ears/nose/throat
- Presbyopia: difficulty of lens in focusing light on retina causing nearsightedness
- Glaucoma: medical emergency when optic nerve becomes damaged, often from increased pressure - - Cataracts: clouding of the lens causing blurred vision
- Retinopathy: damage of retinal blood vessels causing blurred vision
accomodation
Accommodation is tested by having patient focus on finger/pen, then moving it towards the nose; would expect pupils to constrict and cornea to converge
pupillary light reflex
pupils should equally constrict when light is shined into eyes
snellen eye chart
Snellen eye chart - visual acuity
- Top number represents pt’s distance from chart during examination (fixed at 20 ft)
- Bottom number represents distance at which someone with healthy, “normal” vision could
read the line that the pt ended on
healthy tympanic membrane characteristics
Healthy tympanic membrane characteristics: shiny, translucent, pearl-grey,
membranes intact
what is the tonsillar grading scale from and too
1+ to 4+
Assessing mental health
important to do for ALL patients, not just ones admitted with psychiatric illnesses
Appearance
Behaviour: pressured speech: rapid speech with few pauses
Cognition
- Labile mood: rapid fluctuation and large range of emotions
- Judgment: ability to recognize that you have an illness
- Insight: how you would react in a situation to protect yourself
Thoughts
- Suicidal: thoughts of deliberately harming yourself
- Homicidal: thoughts of deliberately harming others
- Obsessions: repeated/unwanted thoughts/urges
- Hallucinations: abnormal sensory perception (e.g. seeing ghosts)
- Delusions: firm, fixed belief that is realistically false (e.g. I am the Prime Minister) - Perseveration: fixation on a specific topic (e.g. fixated on the birds in the sky)
- Flight of ideas: erratic speech that jumps between unrelated thoughts
- Blocking: sudden interruption in thought process represented by abrupt pause in speech
- Tangentiality: disorganized, irrelevant responses to posed questions; pt never ends up answering the
question
montreal cognitive assessment (MoCA)
30-pt questionnaire for detecting dementia/delirium/mild cognitive impairments
neuro for ped’s
Pediatrics: assessment based on developmental milestones
- Nipissing District Developmental Screen: determines if a child is meeting developmental
milestones (e.g. walking, standing, holding objects) based on age
neuro for geriatrics
changes in strength and gait, weakened deep tendon reflexes
cerebral cortex + components (7)
Cerebral cortex
- Frontal lobe: personality, behaviour, emotions, intellect
- Parietal lobe: sensory input
- Occipital lobe: vision
- Temporal lobe: hearing, smell, taste
- Basal ganglia: small bands of grey matter that control motor function
- Thalamus: relays sensory messages between brain and spinal cord
- Hypothalamus: homeostatic functions - HR, BP, hormones
brain stem
connects thalamus and hypothalamus to control basic bodily functions needed for survival (e.g. breathing, sleep-wake cycle)
cerebellum
voluntary motor movement and coordination
clonus
uncontrolled, prominent muscle spasms (DTR 4+/5+)
Involves involuntary and rhythmic muscle contractions
tremors
involuntary shaking/trembling
paralysis
loss of voluntary/involuntary motor function due to neurological disturbance
paresis
weakness of voluntary movements
paresthesia
abnormal numbness/tingling
dysarthria
difficulty forming language
syncope
sudden loss of strength with temporary loss of consciousness due to sudden
interruption in cerebral perfusion
vertigo
sensation of rotational spinning
reflexes and infants
presence of some reflexes that aren’t present in adulthood - Unable to assess cranial nerves directly
preschool/school-age reflexes
fine/gross motor skills, balance and walking, developmental milestones
older adult reflexes
decreased strength, tremors, etc.
what does the Glasgow Coma Scale assess
Best motor response
Best verbal response
Best eye contact
- Maximum (fully alert and oriented; full respiratory control) = 15
- Compromised airway protection = 7-8
- Minimum (deep coma/death) = 3
Lower score means worse injury
assessment: increased intracranial pressure
- Brain tissue is enclosed by bony prominences that cannot expand/shrink; small increases in brain size (e.g. swelling) can be fatal
- From blockages in CSF drainage, infection, bleeding, and cerebral edema
- Cerebral perfusion impacted
- S/S: Changes in behaviour, altered LOC, headache, lethargy, weakness, numbness, eye movement problems, diplopia, seizures, vomiting
what format is used for an MSK assessment
- Subjective: aim is to understand patient’s concerns and goals and determine red, yellow, and
blue flags - Objective: includes scan exam, neurological assessment of myotomes, dermatomes, and
reflexes, regional exam of the spine OR peripheral joints, and special tests - Analysis: includes brief patient profile, diagnosis, cause, and stage
- Plan: includes problem list with treatment goals
what does a subjective assessment do
Subjective assessment gathers data for a patient profile
- Patient identifiers (age, sex), social, medical, and surgical history, history of presenting illness
or concern, medications used, aggravating or relieving factors related to presenting concern, and general health
red, yellow, blue flags for MSK
Red Flags: findings which indicate serious medical pathology
- NIFTI is a helpful acronym to recall what findings fall under serious medical pathology
- Neurological deficits, Infection, Fracture, Tumor, Inflammation
Yellow Flags: findings which indicate psychosocial issues including depression and anxiety
Blue Flags: findings that may indicate that litigation (legal action such as a lawsuit) is involved
when to scan for neuro assessment
To Scan or Not to Scan?
- A scan exam should be completed when neurological s/s are present or it is unclear what the
cause of presenting symptoms are (want to r/o neurological cause)
- If indicated, a scan exam should be completed during the objective part of the assessment
objective assessment neuro
- Scan Exam
- Describes an exam completed on the lower OR upper part of the body to r/o neurological
cause - Includes either a cervical OR lumbar assessment, peripheral joint scan, and neurological
assessment of dermatomes, myotomes, reflexes, and irritation - Observation
- Posture, alignment, symmetry, skin quality (temp, colour, texture, tone)
- Active Range of Motion (AROM)
- Any pain present w/ movement and its quality (OPQRST), ROM available and symmetry of this
movement
scan exam movement neuro: spinal joints
- Includes cervical and lumbar (neck and lower back)
- Assess flexion and extension, rotation, repeated movements, and sustained movement;
repeat for peripheral joints
scan exam movement neuro: peripheral joints
- Upper: TMJ, shoulders, elbow, wrist, and hand
- Lower: hip, knee, and foot
- As always, have an understanding of the basic anatomy involved including spinal segments
scan exam neuro: myotomes
Myotomes: refers to a group of muscles innervated by a specific nerve root
scan exam neuro: dermatomes
Dermatomes: refers to an area of the skin innervated by a specific nerve root
scan exam neuro: reflexes
Reflexes: involuntary and (ideally) nearly instant movement in response to a stimulus; includes deep tendon reflexes and upper motor neuron reflexes (Babinski, clonus, and Hoffman)
special neuro tests for scan exam
Special tests: Spurling’s test, cervical distraction test, and straight leg raise/prone knee bend
what nerve/root for bicep
musculocutaneous
C5, (C6)
what nerve/root for radial
radial
C6, (C5)
what nerve/root for triceps
radial
C7
what nerve/root for patellar
femoral
L3-L4
what nerve/root for achilles
tibial
S1-S2
grading of muscle strength
0- no muscle contraction; paralysis
1- muscle contraction is seen or identified w palpation, but it is insufficient to produce joint motion even w elimination of gravity
2- muscle can move the joint it crosses thru a full ROM only if the part is properly positioned so that the force of gravity is eliminated
3- muscle can move the joint it crosses thru a full ROM against gravity but without resistance
4- muscle can move joint it crosses thru a full ROM against gravity but w/o any resistance
5- muscle can move the joint it crosses thru a full ROM, against gravity, and against full resistance applied by the examiner
regional exam:
Spinal or Peripheral?
- Determine if the source of symptoms is coming from the spine; if yes, complete regional
spinal exam, and if no, complete regional exam of peripheral joints
- Assess ROM and strength, perform special tests to test for specific conditions, and palpate
- Strength can be assessed using a grading scale (included in previous slide)
analysis of neuro exam
- Includes a brief statement that includes the patient’s age, sex, purpose of visit, onset of presenting
issue, diagnosis or impression, cause, and stage - E.g. 24 year-old female, RHD, 3-weeks post op ORIF left ankle, developed right scapular pain
and numbness and tingling in her right forearm after 2 weeks of crutch walking. Diagnosed with Long Thoracic Nerve Palsy caused by neural ischemia in the acute stage and acutely progressing
Plan
- A problem list is identified r/t one of four factors:
- Increased pain
- Decreased ROM
- Decreased strength
- Decreased functioning
- Treatment goals are identified
- Long term and short term
Nociception
physiological process which communicates tissue damage to the central nervous system
Transduction
noxious (unpleasant) stimuli cause cell damage signalling release of sensitizing chemicals including prostaglandins, bradykinin, serotonin, substance P, and histamine which generate action potential
Transmission
action potential continues from the site if injury→spinal cord→ brain stem→ thalamus → cortex
perception
conscious experience of pain
modulation
neurons originating in the brainstem descend to the spinal cord and descend to spinal cord and release substances which inhibits nociceptive impulses
Sensory-Discriminative
recognition of a sensation as painful; sensory pain elements include PAIN (pattern, area, intensity, nature)
Motivational-affective
emotional response to pain experience
behavioural reaction to pain
observable actions used to express/control pain (facial expression,
posturing, adjusting social and physical activity)
cognitive-evaluative reactions to pain
beliefs, attitudes, and meaning attributed to pain
sociocultural
includes demographics, support systems, social roles, past pain experiences, and cultural aspects
Nociceptive pain
damage to somatic or visceral tissue (e.g. incision, broken
bone, arthritis)’ typically responsive to analgesic medications
- Somatic: aching or throbbing, localized, and arising from bone, joint, muscle, skin or
connective tissue
- Visceral: tumour involvement or obstruction and arising from internal organs
neuropathic pain
damage to peripheral nerve or central nervous system
- Burning, shooting, stabbing, or electrical
- Sudden, intense, and short-lived or lingering
- Difficult to treat but opioids, anticonvulsant and antidepressant medications can be used
acute pain
- short history of onset and does not last longer than days or weeks
- variable
- if pain is severe pain behaviours (e.g. moaning, rubbing, and splinting) may be prominent features
- features of sympathetic hyperactivity when pain is severe (e.g. tachycardia, hypertension, sweating, mydriasis)
chronic pain
- long history with often poorly-defined onset; duration unknown
- variable
- depression and irritability is prominent feature
- specific behaviour may or may not be present. if pain is severe and for long duration specific behaviours (e.g. assuming a comfortable position) may occur
- usually have one or more vegetative signs such as lassitude, weight loss, insomnia, loss of libido. sometimes these signs may be difficult to distinguish from other disease-related effects
OPQRST
Onset: when it began
Provoking and palliating factors: what makes it worse/better
Quality: qualities of pain
Region and radiation: location and localized or radiates to diff areas
Severity: 0-10
Time: new, old, when it hurts most, etc
tolerance
need for increased dose to maintain same degree of pain control; not synonymous with addiction
physical dependence
expected response to ongoing exposure to pharmacological agents manifested by withdrawal syndrome when blood levels drop abruptly
addiction
a complex disease characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving
Ped’s communication considerations
- be at eye level to child
- make sure to keep kid with parent when possible for comfort
age class for neonate
birth to one month
age class for infant
1-12 months
toddler age class
1-3yrs
preschool age class
3-6yrs
school-age age class
6-12yrs
adolescent age class
12-18yrs
newborn reflexes: rooting reflex
stim: baby’s mouth touches the skin or nipple
response: baby’s head turns toward the stim
0-4 months
newborn reflexes: sucking reflex
stim: roof of baby’s mouth against finger or nipple
response: baby starts sucking finger or nipple
0-7 months
newborn reflexes: moro reflex
stim: baby is startled
response: baby moves their head back, extends their limbs and usually cries
0-2 months
newborn reflexes: fencing reflex
stim: baby’s head is turned left or right
response: corresponding arm extends, the other arm bends
0-7 months
newborn reflexes: grasp reflex
stim: baby’s palm is stroked
response: baby closes their fingers in a grasp
0-5 months
newborn reflexes: strep reflex
stim: baby held upright on solid surface
response: baby appears to be taking steps
0-2 months
sensorimotor
0-2 yrs
coordination of senses w motor responses, sensory curiosity about the world. language used for demands and cataloguing. object permanence is developed
preoperational
2-7yrs
symbolic thinking, use of proper syntax and grammar to express concepts. imagination and intuition are strong, but complex abstract thoughts are still diff. conservation is developed.
concrete operational
7-11 yrs
concepts attached to concrete situations. time, space, and quantity are understood and can be applied, but not as independent concepts
formal operational
11 yrs old and older
theoretical, hypothetical, and counterfactual thinking. abstract logic and reasoning. strategy and planning become possible. concepts learned in one context can be applied to another
pediatric cardiovascular considerations
- location of apex for palpation and auscultation varies depending on age
- in newborns, radial pulse will not be palpable so more central pulses should be used
preg patient: provide prenatal edu
- healthy diet, exercise
- no tobacco or alc or drugs
- recommended folic acid supplementation 3 months prior to conception
- assess dental care
conception and menstruation physiology
1st to 7th day: least fertile
8-9: possible to conceive
10-14: ovulation the fertile window
15-16: possible to conceive
17-28: unlikely to concieve
the body produces what 4 hormones to maintain preg
- hCG (human chorionic gonadotropin)
- hPL (human placental lactogen)
- progesterone
- estrogen
3 categories of signs of preg
- Presumptive: symptoms experienced by the pregnant individual including amenorrhea, nausea, fatigue, and breast tenderness
- Probable: signs detected by examiner including enlarged uterus
- Positive: objective evidence of fetus including auscultation of fetal heart tones, ultrasound
Naegele’s Rule
can be used to determine estimated DOB
- Take the first date of the patient’s last menstrual period, count forward 9 months, and add 7 days
- Alternatively, count back 3 months from the first day of the last menstrual cycle, then add 1 year and
7 days
GTPAL for preg
- Gravida: total number of pregnancies prior plus present pregnancies regardless of
gestational age, type, time, or method of termination/outcome; multiples count as one
pregnancy - Term: total number of previous pregnancies with birth occurring at greater than or equal to
37 completed weeks - Preterm: total number of previous pregnancies with birth occurring between 20+0 and 36+7
completed weeks - Abortus: total number of spontaneous or therapeutic abortions occurring prior to 20+0
weeks; spontaneous abortions include miscarriage, ectopic pregnancy, missed abortion, and
molar pregnancy - Living children: total number of children the patient has given birth to that are currently
living
Antenatal Considerations: Fundal height
- Distance from symphysis pubis to the top of uterus
- Should be equal to the gestational age in weeks after week 18 (e.g. 25 cm = 25 weeks) - Ensure empty bladder prior to assessment
Antenatal Considerations: fetal heart rate (FHR)
- FHR can be determined through auscultation of fetal heart tones on the abdomen
- Ensure to count for one full minute
- Normal values range from 110-160 bpm
Antenatal Considerations: Fetal Movement Count
- Subjective assessment of pregnant individual
- Fetal movement may be felt as early as week 14 and should be present by week 24
- Ask pregnant individual to count the baby’s movement in 2 hours, and there should be a
minimum of 6 movements in 2 hours
Preg trimesters
- First trimester - Weeks 1-12
Second trimester - Weeks 13-27
- Maternal changes include: quickening, palpable fetal movement, breast enlargement and colostrum, linea nigra, striae gravidarum,and increased BP
Third trimester - Weeks 28-birth
- Maternal changes include: blood volume and components, uterine enlargement, edema of the LE, posture and lordosis, varicosities, hemorrhoids, and lightening (dropping)
Preg trimesters
- First trimester - Weeks 1-12
Second trimester - Weeks 13-27
- Maternal changes include: quickening, palpable fetal movement, breast enlargement and colostrum, linea nigra, striae gravidarum,and increased BP
Third trimester - Weeks 28-birth
- Maternal changes include: blood volume and components, uterine enlargement, edema of the LE, posture and lordosis, varicosities, hemorrhoids, and lightening (dropping)
presbyopia
diff of lens in focusing light on retina causing nearsightedness
glaucoma
med emergency when optic nerve becomes damaged, often from increased pressure – cataracts: clouding of lens causing blurred vision
retinopathy
damage of retinal blood vessels causing blurred vision
lanugo
soft, fine layer of hair
vernix caseosa
white, cheese-like biofilm that covers the skin
senile lentigines
hyperpigmented macules that are irregularly shaped, often in sun-exposed areas
seborrheic keratoses
benign, hyperpigmented growths that are waxy/shiny and slightly raised
