Chapter 5,9,10,11,12,39,40 Flashcards
Identification with and understanding of another’s situation, feelings and motives
Empathy
The exchange of common symbols - written, spoken, or other kinds such as signing and body language.
Communication
To create a message
Encode
To interpret a message
Decode
A response to a message
Feedback
At birth, the heart rate ranges from____ to _____ beats per minute during the first 30 min of life.
100-180
The infants head is equal to _______ % of total body weight.
25
The _____ ______ a blood vessel that connects the pulmonary artery and the aorta in the fetus, constricts after birth.
Ductus arteriosus
The ____ _____ which is sometimes referred to as the “startle reflex” is the characteristic reflex of newborns.
Moro reflex
_____ parents encourage independence but will enforce rules.
Authoritive
In this stage of moral development, children are concerned with interpersonal norms, seeking the approval of others and developing the “good boy” or “good girl” mentality.
Conventional reasoning
Birth to 12 months
Infant
12 to 36 months
Toddler
3 to 5 years
Preschool age
6 to 12 yrs old
School age
13 to 18 yrs old
Adolescent
A _______ airway is shorter, narrower, less stable and more easily obstructed than that at any other stage in life.
Infants
Infants double their weight in ____ to _____ months
4 to 6
Infants triple their weight by the _____ to _____ month.
9 to 12
A reflex in the newborn which is elicited by placing a finger firmly in the infants Palm
Palmar grasp
Percussion sounds: booming and loud is?
Hyperresonance
Percussion sounds: hollow and loud is ?
Resonance
Force of blood against arteries when ventricles contract
Systolic blood pressure
Force of blood against arteries when ventricles relax
Diastolic blood pressure
Discoloration around the umbilicus suggestive of intra - abdominal hemorrhage
Cullen’s sign
Discoloration over the flanks suggesting intra - abdominal bleeding.
Grey Turner’s sign
An accumulation of fluid in the peritoneal space and in the abdomen
Ascites
The branch of medicine that deals with the health maintenance and the diseases of women, primarily of the reproductive organs.
Gynecology
The branch of medicine that deals with the care of women throughout pregnancy.
Obstetrics
Painful menstruation
Dysmenorrhea
Painful sexual intercourse
Dyspareunia
The most common complaints of women in the childbearing years are?
Abdominal pain and vaginal bleeding
Term used to describe the number of times a woman has been pregnant including if the woman was pregnant now.
Gravida
Refers to the number of deliveries
Para or parity
Refers to any pregnancy that ends before 20 wks of gestation regardless of cause
Abortion
Last menstrual cycle commonly abbreviated to
LMP ( or LNMP for last menstrual period)
Cyanosis and pallor may indicate?
Shock or gas exchange problem
A flushed appearance is more indicative of?
Fever
An acute infection of the reproductive organs that can be caused by a bacteria, virus or fungus
Pelvic inflammatory disease (PID)
Gynecological emergencies can be generally divided into two categories
Medical and trauma
Probably the most common cause of nontraumatic abdominal pain is
Pelvic inflammatory disease (PID)
The most common cause of PID is
Gonorrhea or chlamydia
Fever, chills, nausea, vomiting or even sepsis may accompany?
PID
Fluid filled pockets are ?
Cyst
Infection of the urinary bladder
Cystitis
Painful urination often associated with cystitis
Dysuria
Abdominal pain associated with ovulation
Mittelschmerz
Infection of the endometrium
Endometritis
Commonly used term to describe a pregnancy which ends before 20 wks gestation.
Miscarriage
Condition in which endometrial tissue grows outside of the uterus
Endometriosis
The implantation of a developing fetus outside of the uterus often in a Fallopian tube
Ectopic pregnancy
_______ is a life threatening condition.
Ectopic pregnancy
Excessive menstrual flow
Menorrhagia
The most common cause of spontaneous bleeding is?
Spontaneous abortion ( miscarriage )
Vaginal injuries are most often?
Lacerations due to sexual assault
Do not examine the external genitalia of a sexual assault victim unless there is?
Life threatening hemorrhage
Psychological and emotional support are the most important elements of care for the?
Sexual assault victim
Intrauterine pregnancy, at 3 months the uterus is barely palpable above the
Symphysis pubis
Intrauterine pregnancy at 4 months the uterus is palpable midway between the
Umbilicus and symphysis pubis
Intrauterine pregnancy at 5 months approx (20 wks) the uterus is palpable at the
Level of the umbilicus
The time from conception until delivery of the fetus
Prenatal period
The release of an egg from the ovary
Ovulation
The organ that serves as a lifeline for the developing fetus.
Placenta
The placenta and accompanying membranes that are expelled from the uterus after the birth of a child.
Afterbirth
Structure containing 2 arteries and one vein that connects the placenta and the fetus.
Umbilical cord
2 feet in length and 0.75 inch in diameter
Umbilical cord
The membranes that surround and protect the developing fetus throughout the period of intrauterine development.
Amniotic sac
Clear, watery fluid that surrounds and protects the developing fetus
Amniotic fluid
Amniotic sac sometimes called the
“Bag of waters”
After the 20th week of gestation, the volume of water in the sac varies from?
500 to 1000cc
The vascular system of the uterus contains about______ of the mothers total blood volume
1/6 16%
The approximate day the infant will be born
Estimated date of confinement (EDC)
The maternal heart rate increases by
10 to 15 bpm
Occurs when the gravid uterus compresses the inferior vena cava when the mother lies in a supine position causing decreased venous return to the right atrium which lowers blood pressure.
Supine hypotensive syndrome
Renal blood flow ______ during pregnancy
Increases
Peristalsis is ______ , so delayed gastric emptying is likely and bloating or constipation is common.
Slowed
Blood pressure ________ slightly during the first 2 trimesters
Decreases
Loosened pelvic joints caused by hormonal influences account for the
Waddling gate
The child’s sex can be determined visually at
16 wks
The umbilical vein connects directly to the inferior vena cava by a specialized structure called the
Ductus venosus
The fetus’s heart has a hole between the right and left atria termed the
Forman ovale
Number of pregnancies carried to full term
Parity
A woman who is pregnant for the first time
Primigravida
Diabetics are at an increased risk of developing
Preeclampsia and hypertension
Many patients develop diabetes during pregnancy called
Gestational diabetes
Babies born to diabetic mothers are also at increased risk of
Congenital anomalies (birth defects)
During pregnancy cardiac output increases up to
30%
If the fundus is just palpable above the symphysis pubis the pregnancy is about _____ to _____ gestation
12 to 16 weeks
When the uterine fundus reaches the umbilicus the pregnancy is about
20 wks
As pregnancy reaches full term the fundus is palpable near the
Xiphoid process
The bulging of the fetal head past the opening of the vagina during a contraction.
Crowning
Termination of pregnancy before the 20th week of gestation.
Abortion
Causes of bleeding during pregnancy:
- abortion
- Ectopic pregnancy
- placenta Previa
- abruptio placentea
Most common cause of bleeding in the first and second trimesters of pregnancy
Abortion
Occurs as a result of abnormal implantation of the placenta on the lower half of the uterine wall resulting in partial or complete coverage of the cervical opening
Placenta Previa
The onset of painless bright red vaginal bleeding which may occur as spotting or recurrent hemorrhage is the hallmark of
Placenta Previa
The premature separation of a normally implanted placenta from the interior wall posing a potential life threat for both mother and fetus
Abruptio placentea
Hypertensive disorders of pregnancy, which include preeclampsia and eclampsia occur in approximately ________ of all pregnancy.
5%
The most common hypertensive disorder seen in pregnancy
Preeclampsia
The thinning and shortening of the cervix during labor
Effacement
The process of stopping labor
Tocolysis
The time period surrounding the birth of the fetus
Puerperium
The time and process that occur during childbirth
Labor
Newborn infant
Neonate
Abnormal deliveries
- Breech presentation
- prolapsed cord
- Limb presentation
- Occiput posterior
In what age group does normal body temperature become that found in adults
School aged
During the first week of life, the infants weight is expected to
Decrease by 5 to 10 %
The anterior Fontanelle closes between
9 and 18 months old
The process of learning used by children in which they build upon what they already know is called
Scaffolding
The weight of a toddlers brain is approximately what percentage of the weight of the adult brain?
90 %
Children begin to develop magical thinking at about
2 to 3 yrs old
The school aged child gains about _____ per year
3 kg
The female generally stops growing at
16 yrs old
Peak physical condition occurs in
Early adulthood
Focus on airway, breathing and circulation, monitor for shock as needed. Administer oxygen initiate IV access, consider fluid resuscitation and monitor the?
Heart
Place PT in a position of comfort ______________ is the preferred position after the 24th week.
Left lateral recumbent
Generally the lay people think of abortion as termination of pregnancy at maternal request and of _________ as an accident by nature.
Miscarriage
Signs and symptoms of an abortion include:
- Cramping
- abdominal pain
- backache
- vaginal bleeding often accompanied by passage of clots and tissue
Treat the patient suffering from an abortion as you would any patient at risk for
Hypovolemic shock
Refers to the abnormal implantation of the fertilized egg outside of the uterus
Ectopic pregnancy
Assume that any female of child bearing age with lower abdominal pain is experiencing an
Ectopic pregnancy
Third trimester bleeding should be attributed to either __________ or ___________ usually presents with sharp pain with or without bleeding
Placenta Previa or abruptio placentae
Because of the potential for profuse hemorrhage, always treat the patient with suspected placenta Previa for_________. Transport immediately since the definitive treatment is delivered by cesarean section.
Shock
Signs and symptoms of abruptio placentae vary. With a marginal abruption there will be _____________. With a central abruption there will be _____________ and stiff, boardlike abdomen. Complete abruption will result in_____________.
- Bleeding but no pain
- Sharp tearing pain
- Massive hemorrhage
Seizures (or coma) develop in its most severe form known as
Eclampsia
Preeclampsia is defined as an increase in systolic blood pressure by ______ and/or diastolic increase of ________
30 mmHg
15 mmHg
The most serious manifestation of the hypertensive disorder of pregnancy is characterized by generalized tonic-clonic (major motor) seizure activity
Eclampsia
Hypertension is considered chronic when the blood pressure is greater than ________ before pregnancy or the 20th week of gestation or if it persists for more than 42 days postpartum
140/90
Preeclampsia and eclampsia are life threatening. Keep the pt calm. Dim the lights place the pt in a left lateral recumbent position and transport quickly w/o lights and siren. Administer _________ to control seizures if they occur. Medical direction may request administration of antihypertensive or sedative drugs.
Magnesium sulfate 2 gm in 10-20 min
.25 mg sub Q 45 degrees prevents contractions
Brethene
Albuterol (Proventil)
Class: sympathomimetic bronchodilator
B 1+2 stimulant
5 mg nebulized
Combi
2.5 mg when mixed with Atrovent .5 mg Atrovent
If you are unable to control the seizures with Magnesium sulfate, consider
Diazepam ( Valium ) or other sedative
Supine - hypotensive syndrome usually occurs in the
Third trimester
Supine hypotensive syndrome occurs when the gravid uterus compresses the inferior vena cava when the mother lies in a
Supine position
Treatment for supine hypotensive syndrome is
Left lateral recumbent position or elevate right hip
Monitor fetal heart tones and maternal vital signs
If volume depletion is evident, start IV with normal saline
In the last 20 wks placental hormones cause an increased resistance to insulin and a
Decreased glucose tolerance
If blood glucose is below 60 mg/dl
Draw red top tube of blood
Start an IV
Administer 25g of D50
If blood glucose is above 200 mg/dl
Draw a red top tube of blood
Start IV
Administer 1 to 2 liters of normal saline
As early as the _______ week of gestation the uterus contracts intermittently
13th
Painless, irregular contractions are known as
Braxton hicks contractions
In terms of fetal development the fetus is not considered to be full term until the _____ week
38th
The process by which delivery occurs is called
Labor
The patient with suspected preterm labor should be
Transported immediately
Stages of labor:
Stage one: dilatation
Stage two: expulsion
Stage three: placental
Time contractions from the beginning of one contraction until the
Beginning of the next contraction
The first stage of labor begins with the onset of true labor contractions and ends with the
Complete dilatation and effacement of the cervix
The second stage of labor begins with the complete dilatation of the cervix and ends with the
Delivery of the fetus
The contractions are very strong, occurring every 2 min and lasting for
60-75 sec
The most common presentation is for the fetus to be delivered
Head first, face down (vertex position)
The third and final stage of labor begins immediately after the birth of the infant and ends with the
Delivery of the placenta
A drop in the fetal heart rate to less than 90 bpm indicates
Fetal distress and requires immediate transport w mother in left lateral recumbent position
As the head crowns control it with
Gentle pressure
Don’t be alarmed if baby’s extremities remain dusky after birth, this is called ________ and is very common in the first hours of life.
Acrocyanosis
The average neonatal respiratory rate should average
30 to 60 breaths per minute
APGAR scoring system is a means of evaluating the status of a newborns vital functions at
1 minute and 5 minutes after delivery
APGAR stands for
Appearance ( skin color )
Pulse rate
Grimace ( irritability )
Activity ( muscle tone )
Respiratory effort
If the infants respirations are below 30 per min and tactile stimulation does not increase the rate to a normal range immediately
Assist ventilations using BVM with hi flow O2
If heart rate is below 60 and does not respond to ventilations
Initiate chest compressions and transport to NICU
Acess the HR using a stethoscope to auscultate the apical pulse by feeling the pulse at the base of the umbilical cord or palpating
The brachial or femoral artery
Newborn HR should be between 100-180 with _________ being optimal
140-160 bpm
If the infant starts to breath with its face pressed against the vaginal wall
Form a V with index and middle finger on either side of infants nose and push vaginal wall away from infants face
occurs when the umbilical cord precedes the fetal presenting part
Prolapsed cord
If the baby is in a transverse lie across the uterus an arm or leg is the presenting part, this is called
Limb presentation
If mother presents with prolapsed cord or limb presentation place patient in the
Knee chest position, administer oxygen and transport
With multiple births usually one presents vertex while the other is
Breeched
Twins may share one placenta or there may be two, after delivery of the first baby
Clamp and cut the cord them deliver the second baby
Occurs when the infants head is too big to pass through the maternal pelvis easily. This may be caused by an over sized fetus
Cephalopelvic disproportion
The usual management of cephalopelvic disproportion is
C section
Occurs when the infants shoulders are larger than its head.
Shoulder dystocia (“ turtle sign “)
The loss of more than 500cc of blood immediately following delivery
Postpartum hemorrhage
The most common cause of postpartum hemorrhage is
Uterine atony or lack of muscle tone
When there is a loss of more than 500cc of blood immediately following delivery administer
O2 and begin fundal massage
2 large bore IVs of normal saline
Treat for shock as necessary
Diazepam ( valium )
Seizure activity 5 mg over 2 min IV every 10-15 min prn.
Anticonvulsant
* relatively weak anticonvulsant and of short duration.
Class: benzodiazepine, hypnotic, anticonvulsant
Midazolam ( Versed )
- RSI - 5 mg
- Behavioral - 2.5 mg
- Cardioversion - 2.5 mg start with 1-2 mg and titrate up to 2-3 mg doses every 1-2 min based on response and effect.
Class - Benzodiazepine sedative ~ hypnotic
Indications : • Cardioversion • behavioral emergencies • transcutaneous pacing • RSI • Seizures
Fentanyl ( sublimaze )
Faster acting
Class: synthetic narcotic analgesic
Dose:
• pain
- 100 mcg repeated @ 50 mcg to a max of 250
• RSI
- 500 to 750 mcg q 3-5 minutes repeated once; BP 90 systolic
- analgesia for burns, fractures ect
- Cardioversion
- sedation and pain management during RSI
Morphine
Vasodilator
Class: Narcotic analgesic
Dose: 1-4 mg slow IV over 1-5 min titrate to effect
Indications:
- chest pn associated with MI
- CHF with pulmonary edema w or w/o chest pn, pressure
• pain management in :
- burns
- sickle cell crisis
- fractures
Succinylcholine ( Anectine )
Class: Neuromuscular Blocker ( Depolarizing )
Onset: less than 1 minute
Dose: 1 to 1.5 mg/kg rapid IV, repeat if needed
Indications: to facilitate endotracheal intubation (RSI)
Duration 4 - 10 min
Methylprednisolone ( Solu-medrol)
Class: Glucocorticoid
Dose: 125 mg IV
- spinal cord injury
- initial dose is 30 mg/kg IV bolus followed by an infusion of 5.4 mg/kg/he for 23 hrs
Onset: 1-2 hrs
Indications:
anaphylaxis / allergic state
Inhalation of hot smoke and gases
Bronchodilator - unresponsive asthma COPD
Shock / (controversial)
Acute spinal cord injury / (controversial)
anti inflammatory not smooth muscle
Epinephrine
Cardiac arrest 1 mg
Respiratory .3 - .5 mg sub Q
Bradycardia 2 - 10 mcg/min
Physical exam techniques:
- inspection
- palpation
- percussion
- auscultation
Body language , consist of gestures, mannerisms and posture by which a person communicates with others.
Nonverbal communication
In the United States the socially acceptable distance between strangers is
4 - 12 ft
Arms extended, open hands, relaxed large muscles and a nodding head characterize an
Open stance
Nothing builds trust and rapport or calms patients faster than the power of
Touch
Effective communication with pediatric pt’s depends on
Age
Newborns do not
Shiver
Magnesium sulfate
Class: electrolyte / anticonvulsant
Dose:
• Asthma: 1 to 2 g in 50 mL over 5 to 20 min
• Eclamptic Seizures: 2 to 5 g over 10-15 min
Indications: seizures of eclampsia
Asthma
Torsades de pointes
Epinephrine
Class: sympathomimetic
Dose:
•Cardiac arrest - IV 1 mg q 3-5 min
ET 2-2 1/2 times the IV dose via ET
~ repeat every 3-5 minutes
•Anaphylactic reaction
~ mild reaction 0.3-0.5 mg (1:1,000) SubQ
~ moderate reaction 0.3-0.5 mg (1:10,000) slow IV 1-2 min
•symptomatic Bradycardia
~ infusion of 2-10 mcg/min titrated to response
Indications :
anaphylaxis
All forms of cardiac arrest
Reactive airway disease ( asthma, COPD)
Number of pulses felt in 1 minute
Pulse rate
Pattern and equality of intervals between beats
Pulse rhythm
Strength, which can be weak, thready , strong or bounding
Pulse quality
May indicate an increase in parasympathetic nervous system stimulation
Bradycardia
Exhalation is the _________process of the respiratory muscles elastic recoil
Passive
A measure of systemic vascular
Diastolic BP
Difference between systolic and diastolic pressures
Pulse pressure
Hypertension is defined in adults as a pressure higher than
140/90
The difference between the systolic and diastolic pressures
Pulse pressure
In the tilt test, a positive sign for Hypovolemia is
BP drops by 10 to 20 mmHg
Pulse rate rises by 10 to 20 bpm
Each narrow line on a sphygmomanometer represents what pressure difference
2 mmHg
which pulse point is recommended with small children
Brachial
The sphygmomanometer should be inflated to what level beyond the point at which the patients radial pulse disappears
30 mmHg
Real time measurement of exhaled carbon dioxide concentrations
Capnography
Abnormal facial hair grown on women
Hirsutism
Light crackling, popping , non musical sounds usually heard during inspiration
Crackles
Continuous high pitched musical sounds similar to a whistle
Wheezes
Continuous sounds with a lower pitch and a snoring quality
Rhonchi
Predominantly inspiratory wheeze associated with laryngeal obstruction
Stridor
The squeaking or grating sound of the pleural linings rubbing together
Pleural friction rub
The simplest and often most neglected form of standard precaution is
Hand washing
Cleansing agent that is toxic to living tissue is
Disinfectant
Drug administered through the mucous membrane of the ear canal is an
Aural medication
The female external genitalia are known collectively as the ____ or ______.
Vulva or pudendum
The external genitalia consist of the
Perineum, mons pubis, labia and clitoris
Muscular tissue that separates the vagina and the anus
Perineum
Fatty layer of tissue over the pubic symphysis
Mons pubis
Structures that protect the vagina and urethra, including the labia majora and the labia minora
Labia
Hollow thick walled muscular inverted pear shaped organ that connects with the vagina
Uterus
The primary function of the uterus is to provide
A site for fetal development
The rounded uppermost portion of the uterus is the
Fundus
The fist 2 weeks of the menstrual cycle are known as the
Proliferative phase
Sloughing of the uterine lining (endometrium) if a fertilized egg is not implanted. It is controlled by the cyclical release of hormones.
Menstruation
During the menstrual phase the ischemic endometrium is shed along with a discharge of blood mucus and cellular debris, a process known as
Menstruation
Big toe dorsiflexes and the other toes fan out when the sole is stimulated
Babinski’s response
A child in severe respiratory distress may exhibit a __________ type pattern in which his sternum and abdomen rise and fall in opposition to each other.
Sea-saw
Auscultate for breath sounds with the bell of your stethoscope at the
Midaxillary line
Evaluation of the skin you want to evaluate its
Color, moisture, temperature as well as texture mobility and turgor and check any lesions
Light crackling, popping, non musical sounds that may be heard usually during inspiration
Crackles
Progressively deeper, faster breathing alternating gradually with shallow, slower breathing indicating brainstem injury
Cheyene-stokes respirations
Rapid deep respirations caused by severe metabolic and central nervous system problems
Kussmaul’s respirations
Etomidate ( Amidate )
Class: hypnotic
Dose: 0.1 to 0.3 mg/kg over 10 to 20 sec
Duration: 3 to 5 min
Indications: RSI
Rocuronium Bromide (Zemuron)
Class: neuromuscular blocker (non-Depolarizing)
Dose: 0.6 mg/kg
Duration: 15-45 min
Indications: •To provide long term paralysis as a part of the RSI process
• To manage post resuscitation hypothermia through the prevention of shivering
Vecuronium (Norcuron)
Class: neuromuscular blocker (non-Depolarizing)
Dose: 0.1 mg/kg over 1 to 2 min
Duration 15 to 45 min
Indications: To provide long term paralysis as part of the RSI process
To manage post resuscitation hypothermia through the prevention of shivering
Viewing one’s own life as the most desirable, acceptable or best and acting in a superior manner to another culture’s way of life.
Ethnocentrism
Naloxone ( Narcan )
Class: synthetic narcotic antagonist
Dose: 0.5 to 2 mg IV/IM/,SQ,ET / repeat at 5 min intervals
Indications: for the complete or partial reversal of CNS and respiratory depression induced by narcotics.
Ipratroprium Bromide ( Atrovent )
Class: parasympatholytic bronchodilator
Dose: 0.5 mg nebulized, can be mixed with Albuterol
Indications: • Bronchial asthma • Chronic bronchitis / COPD • Inhalation of hot gasses • Often used with Albuterol
Abnormal clarity of patients transmitted voice sounds
Bronchophony
The infant receives its blood from the placenta by means of the
Umbilical vein
