Family Health Exam 2 Flashcards
Preembryonic stage of fetal development
fertilization through the 2nd week
Embryonic stage of fetal development
3rd - 8th week of fetal development
Fetal stage of fetal development
9th week through birth
1st trimester
conception through 12 weeks
2nd trimester
13 weeks thru 27 weeks
3rd trimester
28 weeks thru 40 weeks
Presumptive signs of pregnancy
fatigue
amenorrhea
frequent urination
nausea or vomiting
breast changes (tenderness / fullness)
quickening (fetal mov’t felt by mother)
Probable signs of pregnancy
Positive pregnancy test (hCG in blood or urine)
Uterine enlargement
Goodwell’s sign (cervix softens)
Chadwick’s sign (cervix and vagina turn bluish or violet)
Hegar’s sign (lower uterine segment softens)
Braxton Hicks contractions
Positive signs of pregnancy
ultrasound of embryo or fetus
fetal heart beat audible
fetal movement palpated by practitioner
FSH
follicle stimulating hormone matures the Graafian follicle, which produces estrogen
LH
Luteinizing hormone promotes the release of a mature ovum
Estrogen
Produced by the ovaries and later by the placenta, maintains uterine lining, increases uterine profusion, and promotes growth of breast tissue
Progesterone
Produced by the corpus luteum and then placenta, maintains pregnancy, inhibits uterine contractions, prepares breasts for lactation.
Human chorionic gonadotropin (hCG)
Produced by the trophoblast, confirms pregnancy, stimulates production of estrogen and progesterone
Relaxin
Produced by the corpus luteum, it lengthens the cervix, inhibits uterune contractions, softens cartilage, joins and ligaments
Prolactin
Maturation of breast tissue and stimulates lactation
Human Placental Lactogen (HPL)
Elevates glucose levels for fetal growth, insulin antagonist
Prostaglandins
Control inflammatory processes so decreased levels may contribute to hypertension. Play a role in induction of labor.
Gravid
the state of being pregnant
Gravidity
number of times a woman has been pregnant, irrespective of the outcome
nulligravida
a woman who has never been pregnant
primigravida
a woman pregnant for the first time
multigravida
woman who has been pregnant 2+ times
Para
the number of births at 20+ weeks, not the number of fetuses
Multipara
a woman who has carried 2+ pregnancies over 20 weeks, regardless of the outcome
Formula to estimate date of birth (EDB)
Determine the first day of the last menstrual period (LMP)
Then subtract 3 months
Then add 7 days
Early term (gestational age)
37 0/7 through 38 6/7
Full term (gestational age)
39 0/7 through 40 6/7
Late term (gestational age)
41 0/7 through 41 6/7
Post term
42 0/7 and beyond
G: Gravida
The number of pregnancies; current pregnancy to be included in the count
T: Term
The number of term gestations delivered between 37 0/7 and 41 6/7
P: Preterm
the number of preterm pregnancies ending >20 weeks and <38 weeks
A: Abortion
The number of pregnancies ending before 20 weeks
L: Living
The number of her biological children currently living
How much weight gain for an underweight (BMI <19) pregnant mom?
28-40 lbs
How much weight gain for an normal weight (BMI 19-25) pregnant mom?
25-35 lbs
How much weight gain for an overweight (BMI 25-30) pregnant mom?
15-25 lbs
How much weight gain for an obese (BMI >30) pregnant mom?
11-20 lbs
Nutrition in pregnancy
Increase of 300 calories / day is recommended in pregnancy.
Prenatal vitamins are often prescribed.
Folic acid supplements are recommended to prevent neural tube defects.
McDonald’s Rule
fundal height measured in cm from the top of the pubic bone to the top of the uterus. The number of cm matches the weeks of gestation
Fundal height at 12 weeks
at the symphysis pubis
fundal height at 16 weeks
Halfway between the symphysis pubis and umbilicus
fundal height at 20 weeks
at the umbilicus
fundal height at 21-38
fundal height in cm matches the weeks of gestation
Leopold’s maneuver
determines fetal position, presentation, lie, and attitude after 24 weeks gestation.
Leopold’s first maneuver
Determines the fetal position
Place both hands at the top of the uterine fundus.
The fetal head is round and hard.
The fetal buttocks is soft and irregular
Leopold’s 2nd maneuver
Determines the fetal positive.
Place both hands on the side of the fundus to feel where the back is.
The back is smooth and hard.
The limbs feel irregular with movement.
Leopold’s 3rd maneuver
Confirms the presenting part.
Place one hand above the symphysis, grasp and confirm the presenting part. Note engagement of the presenting part.
Leopold’s 4th maneuver
Determine the attitude of fetal head.
facing the mother’s feet, place both hands on the lower abdomen. Note the fetal brow or occiput.
Blood type and Rh factor
Blood type screen (A, B, AB, or O)
Rh factor (negative or positive)
Rubella screen
Determines if the mother is non-immune.
Immunization is recommended after birth.
Hep B Screening
If the mother is Hep B surface antigen positive, the newborn will receive Hep B vaccine AND the Hep B IgG within 12 hours of birth.
HIV
If positive, requires counseling and treatment to prevent transmission to the fetus.
Maternal Serum Alpha Feto Protein
Between 15-20 weeks
High levels may indicate neural tube defects or multiples.
Low levels may indicate fetal trisomy syndromes.
GDM screen
Between 24-28 weeks
It’s a glucose tolerance test
Hemoglobin and Hematocrit
Detects iron deficiency anemia
GBS
Vaginal and rectal swabs are taken at 35-37 weeks gestation.
If positive, mother are given antibiotics during labor to avoid transmission to the fetus.
Ultrasound
1st trimester: confirms pregnancy & cardiac activity
2nd trimester: verifies dates, evaluates fetal growth and health, location of the placenta and assesses the amount of amniotic fluid.
3rd trimester: evaluates fetal activity, growth of the fetus and verifies placental position.
Chorionic Villi Sampling
CVS takes a small sample of cells from the placenta if the healthcare provider considers you to have certain risk factors such as already having a child with a known genetic condition, maternal age >35, previous screening indicates high risk for a kid with a genetic condition, family history of a genetic condition.
Amniocentesis
1st trimester: detects genetic disorders
2nd trimester: detects blood sensitization
3rd trimester: assessment of lung maturity
A diagnostic test that removes and tests a small sample of cells from the amniotic fluid in order to determine whether or not the baby has a genetic or chromosomal condition such as Down’s, Edwards’, or Patau’s.
It is usually conducted between 15-20 weeks of pregnancy.
Triple or Quad screen
Between 15-20 weeks
Detects genetic disorders (includes MAFP, hCG, unconjugated estriol, inhibin A)
Nuchal Translucency (NT)
US assessment of the thickness of the fetal nuchal fold.
Abnormalities potentially indicate chromosomal abnormalities.
Oxytocin Challenge Test
OCT is the oxytocin challenge test, which also assesses fetal well-being. It’s a diagnostic tool for suspected placental insufficiency to evaluate the fetal tolerance of uterine contractions.
a negative test = presence of accelerations, lack of decelerations and normal variability. A positive result is late decelerations after more than 50% of contractions.
Non-stress Test
Demonstrates the fetus’ abiity to respond to the environment by acceleration of the FHR with movement.
Reactive NST: at least 2 accelerations above baseline within 20 minutes –> Normal NST is considered reassuring if the FHR increases at least 15 bpm over the baseline, lasting at least 15 seconds, within a 20 minute timeframe.
Nonreactive NST: accelerations are not present, indicating the fetus is at risk or asleep.
Contraction Stress Test
evaluates placenta perfusion and identifies the risk of fetal hypoxia. Standard practice has replaced this with ultrasound and BPP.
Negative CST = 3 contractions present (lasting at least 40s) within 10 minutes and without the presence of late decelerations. These are reassuring results.
Positive CST = repetitive persistent late decelerations present with more than 50% of the contractions. These are not desired results.
Equivocal or Suspicious = nonpersistent late decelerations or hyperstimulation of the uterus. More information is needed.
Biophysical Profile
used to identify a fetus at risk. A score of 8-10 is normal.
A score <4 likely indicates that the provider needs to deliver the baby right away.
Five criteria are scored (normal = 2; abnormal =0) over a 30 minute observation period.
1. NST = normal is reactive (>2 accelerations over 20 minutes)
2. Fetal breathing = normal is >1 episode of breathing movements
3. Fetal tone = normal is >1 active extension and flexion of a limb or hand.
4. Body Movement = normal is >3 discrete limb or trunk movements.
5. Amniotic Fluid = normal is AFI> 5 cm
Placenta Previa
The placenta is implanted in the lower uterine segment or over the internal cervical os. It can be low lying, partial, marginal, or complete implantation.
Onset / bleeding: slow onset. Bleeding may be scant or profuse, bright red bleeding.
Absent preeclampsia.
Uterine tone = soft, relaxed tone, normal uterine contour
Labor pain only
FHT is usually present.
Abruptio Placentae
Premature separation of a normally implanted placenta from the uterine wall.
Can be marginal, central, or complete.
Onset & Bleeding: sudden onset, may be external or concealed, dark-colored bleeding.
Preeclampsia may be present.
Firm to hard abdomen, may enlarge or change shape.
Severe and steady pain.
FHT present or absent.
Tocolytics
Medications to stop preterm labor
Terbutaline
Terbutaline is a beta-adrenergic receptor antagonist
It relaxes smooth muscle in several places: the bronchial tree, blood vessels, and the myometrium.
Contraindications are bronchiospasms (asthma)
Nifedipine
Nifedipine is a calcium channel blocker.
It inhibits calcium influx across cell membranes, thereby decreasing tone in the smooth muscle of the vasculature.
Decreases BP; contraindicated with asthma.
Indomethacin
Prostaglandin inhibitor.
NSAIDs can prevent the body from releasing prostaglandins and cytokines, which delays preterm delivery.
Contraindications are women who have a history of bleeding disorders, gastritis, hepatic disease.
Magnesium sulfate
CNS depressant that is used to treat pre-term labor, pre-eclampsia, and eclampsia.
The antidote to Mag Sulfate is Calcium Gluconate. Too much Mag suppresses PTH, which causes a decrease in Ca2+.
Contraindicated in patients with myasthenia gravis, since it can aggravate muscle weakness and increase the risk of respiratory muscle paralysis.
Betamethasone
Corticosteroid given to increase fetal lung maturity. It’s given antenatally to cause the release of surfactant.
No contraindications.
Preeclampsia
Increase in BP after 20 weeks and proteinuria.
signs of worsening preeclampsia:
BP >160/110 on two occasions.
Proteinuria (5+ in 24 hours)
Oliguria (<500 mL urine in 24 hours)
Visual changes
Severe headache
Nausea vomiting
Hyperreflexia (DTR >2, clonus)
Pitting edema
Epigastric pain
Fetal growth restriction
HELLP Syndrome
Hemolysis of red blood cells (low RBC count)
Elevated liver enzymes (AST, LST high, and protein/creatinine ratio is high)
Low Platelets
Eclampsia
occurrence of a seizure during the antepartum, intrapartum, or postpartum period
(up to 6 weeks after delivery)
Care of eclampsia
Mag sulfate IV bolus or sedative if needed
Antihypertensive agents to reduce blood pressure
Position side lying
Pad the side rails
Lung sounds
Oxygen per face mask
Evaluate fetal heart tones
Bishop Score
prelabor evaluation of the cervix to determine whether or not the mom/cervix are ready for labor.
A Bishop score of 8+ is considered favorable for induction, or the change of a vaginal delivery with induction is similar to spontaneous labor.
A score 6 or less means that cervical ripening agents may be utilized.
Higher scores = more ready for labor.
Criteria:
- Cervical dilation (0-3)
- cervical effacement (0-3)
- fetal station (0-3)
- cervical consistency (0-2)
- cervical position (0-2)
BRAIDED
Benefits of method chosen;
Risk;
Alternatives including abstinence;
Inquiries about the method are the client’s right;
Decision to withdraw is OK;
Explanation of what to do and expect of the method; and
Documentation of the above
ACHES
Pneumonic used for concerning pain while using oral contraceptives:
A = abdominal
C = chest pain
H = headaches
E = eye problems
S = severe leg pain
vaccines with no live virus
Flu
TDap
Rhogam
These can all be given during pregnancy. You don’t give the vaccines with a live virus during pregnancy.
Warning Signs
Spotting/bleeding = miscarriage OR placenta previa/placenta abruption
Abdominal pain, shock = ectopic pregnancy
Folic Acid
prevents neural tube defects (spina bifida)
Contraindications are an allergy to folate or an untreated Vit B12 deficiency.
Prenatal vitamins
have folate and iron and calcium
Calcium Carbonate
helps prevent the loss of bone density / osteoporosis.
Important during pregnancy because of the increased need for Ca2+.
Contraindications are if the mom already has too much calcium in her urine.
Most common adverse effect is hypercalcemia caused by taking too much of the supplement. The patient should report symptoms of weakness, increased urination, and thirst.
ferrous sulfate
iron supplements prevent anemia
30-120 mg/day
Contraindications are history of iron overload.
betamethasone
corticosteroid given to support development of surfactant in preterm babies.
Needs at least 24 hours before delivery; can’t be given in emergency c sections.
2 doses 12 or 24 hours apart of 12mg
A single course is recommended when the pregnant parent is at risk for preterm delivery between 24 and 34 weeks of pregnancy.
A single course is recommended between 34 and 37 weeks for those at risk of preterm birth within 7 days, and who have not already received a course.
A single repeat course of corticosteroids can be considered for those at risk of preterm delivery within 7 days, whose prior course was given more than 14 days prior.
Can exacerbate diabetes.
TORCH screen
TORCH is a blood test that screens for several infections that can be harmful to the fetus:
T = Toxoplasmosis
O = Other(syphilis, Hep B&C, HIV)
R = Rubella
C = Cytomegalovirus
H = Herpes simplex virus
PUBS
PUBS = percutaneous umbilical cord sampling, which assesses the health of the fetus and can also be used to treat fetal disease, particularly fetal blood diseases. It’s a more invasive procedure. The small sample of blood is analyzed for genetic abnormalities, blood disorders, and infections.
PUBS can be used to diagnose:
Toxoplasmosis (Toxoplasmosis is an infectious diseases transferred from mom to baby and can damage the fetal nervous system), Rh disease, nonimmune hydrops, fetal thrombocytopenia.
ectopic pregnancy
Positive pregnancy test, referred shoulder pain, low BP, high pulse, pallor
Glucose Tolerance Test
A GTT is a diagnostic test used to evaluate a woman’s ability to metabolize glucose. Since pregnancy can impact metabolization of glucose, this helps identify gestational diabetes.
It is usually performed between 24-28 weeks.
Fasting blood glucose level <92 mg/dL
One hr blood glucose level <180 mg/dL
Two hour blood glucose level < 153 mg/dL
HELLP Labs
H = hemolysis (low RBC count). Normal range is 120-246 U/L
Bilirubin should be <1.2mg/dL
EL = Elevated Liver Enzymes,
ALT 10-40 U/L
AST 10-34 U/L
LP = Low platelet count (150,-450)
Prothrombin Time
PT is a laboratory test that measures the time it takes for a blood clot to form.
11-13 seconds
BUN / Creatinine
BUN / Creatinine assess kidney function. In pregnancy, they are ordered to monitor renal function and detect any abnormalities.
BUN 6-20 mg/DL
Creatinine 0.4-1.2 mg/dL
DTR / Clonus
DTR = Deep tendon reflexes
DTR & Clonus are neurological tests commonly performed during pregnancy to assess nerve function and risk for preeclampsia.
DTRs are graded on a scale from 0-4, with 2+ being normal.
Clonus is characterized by rhythmic, oscillating movements of the foot when the ankle is dorsiflexed, and is not typically present in healthy individuals.
Ketones in the Urine
A ketone urine screen measures the presence of ketones in the urine. Ketones are produced when the body breaks down fat for energy instead of glucose. In pregnancy, ketone urine screening may be ordered to monitor for gestational diabetes, preeclampsia, and other conditions that can affect glucose metabolism.
NB Morphine sulfate
Morphine Sulfate can be used for pain relief and as one of the pharmacologic agents for the management of an infant with Neonatal Abstinence Syndrome (NAS).
Non-pharmacologic measures (cuddling) are also highly recommended in conjunction with morphine sulfate.
NB Phenobarbitol
Considered adjunctive therapy to Morphine Sulfate if FNAST scores are not controlled despite Morphine at 0.5-0.7 ml/dose.
Nursing pre and post assessment is the FNAST score, baby’s vitals (RR, HR, BP, O2).
NB Surfactant
Surfactant is a mixture of fat and proteins made in the lungs. It coats the alveoli and prevents them from sticking together when the baby breathes out. Premature babies may be born before their lungs make enough surfactant, which leads to poor lung function stiff or collapsible lungs with increased fluid. This is called Respiratory Distress Syndrome.
Surfactant is given to supplement what the baby is able to create and help the baby breathe.
Magnesium Sulfate
Anticonvulsant
Used to treat eclampsia, which is seizures during pregnancy.
Conduct DTR and monitor the RR to rule out toxemia. Toxemia of pregnancy is a contraindication.
Calcium Gluconate
An antidote to too much Mag Sulfate.
Contraindications are hypercalcemia
Antihypertensive meds
Methyldopa, labetolol, and nifedipine are widely considered safe in pregnancy as anti-hypertensive medications.
Nifedipine is contraindicated with asthma.
Oral Hypoglycemic Therapy
Glibenclamide is the most effective in lowering blood glucose in women with gestational diabetes.
PPH Oxytocin
Used for prophylaxis and treatment PPH (among other things, like termination of pregnancy, augmentation of labor, and medical induction of labor)
Contraindications are any situation that would result in a non-vaginal birth.
PPH Methylergonovine
Used for prophylaxis and treatment PPH
contraindications are HTN, toxemia
Check lochia every 15 minutes for 1 hour; every 30 minutes for the next 2 hours; every 4 hours for 48 hours, then daily.
PPH Misoprostol
Used when Oxytocin can’t be used. It’s a prostaglandin analogue.
Used for prophylaxis and treatment PPH
Contraindications include pelvic infection or sepsis, hemodynamic instability or shock, allergy to misoprostol, known bleeding disorder, concurrent anticoagulant therapy, and confirmed or suspected ectopic or molar pregnancy or who have an allergy to prostaglandins.
PPH Carboprost
Carboprost is used for PPH that isn’t responsive to conventional management.
Contraindications are patients with asthma b/c it can cause an asthma attack.
DVT Heparin / WArfarin
For the prophylaxis of DVTs during pregnancy.
Contraindicated for when blood coag tests can’t be performed at necessary intervals.
PTL Nifedipine
Given ST to avoid labor. It’s a Ca2+ channel antagonist that stops the flow of ca2+ ions into the cardiac and vascular smooth muscle, which reduces the contractions in preterm labor.
Don’t eat/drink grapefruits.
PTL Mag Sulfate
Prevents seizures in women.
Also recommended to protect the baby’s brain during PTL.
For women at risk of imminent preterm birth, it should be used for the neuroprotection of the fetus - regardless of the cause of preterm birth and the number of babies in utero.
PTL Terbutaline
Used off label for treating uterine hyperstimulation. Can only be administered by injection or IV in the hospital setting and should not be used beyond 48-72 hours due to severe side effects (including death).
PTL Indomethacin
Indomethacin is an appropriate first-line tocolytic for the pregnant patient in early preterm labor (<30 weeks) or pre-term labor associated with polyhydramnios (too much amniotic fluid).
It slows uterine contractions, delaying delivery.
Serious side effects include constriction of the ductus arteriosus in the fetus, which makes it hard for blood to get through the artery.
Because of the side effects, it is limited to preterm labor prior to 32 weeks gestation in women with normal renal function and normal amniotic fluid volume.
Pulmonary Embolism S&S
Elevated temp, chest pain, dyspnea following surgery
PP Thrombocytopenia S&S
Thrombocytopenia is a deficiency of platelets in the blood, which causes bleeding into the tissues, bruising, nd slow blood clotting after an injury.
oozing of blood from c section incision, petechia, low platelets.
PP hematoma
Severe pain and bulging mass on the perineum
NB - NAS
Incessant crying, tremors, hypertonic, frequent hiccups, frequent bowel movements.
NB Respiratory Distress
Nasal flaring, respiratory rate high, retractions
LGA with High exposure to glucose
leathery skin, weight and length 98th percentile for gestation
Any baby above the 90th percentile for gestational age is LGA. In particular, babies with leathery skin have likely been too exposed to glucose in the womb and are likely to be hypoglycemic after birth. The baby might also have difficulty breathing, birth injuries due to their size (check for broken collar bones), hypertension, obesity, and potentially may develop diabetes.
PKU Screening Test
Reassuring = no PKU
A PKU screening test is a blood test given to newborns 1-3 days after birth. A PKU screening test diagnoses PKU by measuring the amount of Phe in a blood sample. If there is Phe, it indicates that the baby might have a genetic disorder that prevents the baby from breaking down Phe.
Since this test is negative, it indicates the baby doesn’t have this genetic disorder.
Down’s Syndrom
Infant with single, transverse palmar crease, protruding tongue, floppy muscle tone, low set ears.
Positional Plagiocephaly
flattened occiput, asymmetrical facial features
Positional plagiocephaly is a flattening of one side of the head caused by prolonged pressure on that area.
The nurse should educate the parents on how to reposition the infant’s head, provide tummy time, etc to reduce pressure on that area.
A helmet may also be prescribed to help reshape the head.
Follow up visits should be scheduled, and the patients should be educated and supported.
PP fluid retention
weight gain of +6 pounds in one week
Preeclampsia S&S
Edema / fluid retention
Blurred vision
HTN + Proteinuria
Epigastric pain
DTR >3+ and clonus
NB Sepsis
An infection involving the bloodstream in newborn infants <28 days old.
S&S are listlessness, don’t feed well, unstable body temperature, irritability
Incidence is higher in premature infants and LBW infants.
Vaccine HPV
While nearly all sexually active adults have HPV, the Gardasil 9 vaccine prevents 9 different types of HPV that can cause cancer. It is recommended for girls and boys ages 9-26.
Acyclovir
Acyclovir and valacyclovir are the drugs most commonly used for herpes outbreak suppression and treatment during pregnancy.
Neonatal suppression therapy with acyclovir in infants with HSV may improve neurodevelopmental outcomes.
Antiretroviral Therapy
Antiretroviral therapy (ART) uses a combination of drugs to reduce the amount of HIV in the body. While this doesn’t cure HIV, it does reduce the impact and it allows people with HIV to live a comparable lifespan to those with HIV.
Letrozole
Letrozole is normally a breast cancer medication, but it’s used off-label to induce ovulation in women with infertility.
Stop treatment once pregnant, as Letrozole can harm the fetus.
Educate about risks/side effect: Hot flashes, headaches, nausea, fatigue, and risk of bone loss/osteoporosis.
Clomiphene citrate
Infertility treatment to induce ovulation in women with infertility due to anovulation or oligo-ovulation.
Risks: Multiple pregnancies, ovarian hyperstimulation syndrome (OHSS_, hot flashes, mood wings, visual disturbances.
Stop treatment once pregnant, as Clomiphene citrate can harm the fetus.
Hysteroscopy
A hysteroscopy is when a doctor examines the inside of a woman’s uterus using a little lighted flashlight called a hysteroscope that is inserted through the vagina.
It is used for abnormal bleeding (heavy bleeding or bleeding between periods), infertility to investigate if there are fibroids, polyps, or scarring, repeated miscarriages, IUD removal, and biopsy.
Laparoscopy
A laparoscopy is a minimally invasive surgical procedure that allows a surgeon to view the organs inside a woman’s pelvis and abdomen using a laparoscope, which is a thin, lighted tube with a camera on the end.
The reasons to do this are to determine the cause of infertility such as endometriosis, adhesions, or tubal blockages; reasons for abnormal uterine bleeding such as fibroids or polyps; reasons for pelvic pain such as endometriosis, adhesions, or ovarian cysts; and to diagnose ectopic pregnancy.
Hysterosalpingography
HSG is a radiologic procedure that uses a contrast agent and x-rays to examine the uterus and fallopian tubes. It’s done to evaluate the uterus or fallopian tubes for any irregularities that might cause infertility or miscarriages or abnormal bleeding.
The exam must be done on or before day 10 of your menstrual cycle but after your menstruation ends.
A blood pregnancy test must be completed to confirm you’re not pregnant.
5 Ps of STIs
Partners
Practices
Protection
Past history
Prevention of pregnancy
HPV
Genital warts; an STI
There is a vaccine, but no cure.
Surgery, freeze off the warts, electric current or laser treatments to burn off the warts.
Can lead to cancer if it doesn’t go away on it’s own within 2 years.
No evidence that it affects infertility.
Herpes Simplex Virus (HSV)
Herpes is a common infection that can cause painful blisters / ulcers. It primarily spreads by skin to skin contact. It is treatable, but not curable.
People experience tingling, itching, burning, then notice sores or blisters.
Pregnant moms usually have anti-herpes meds (acyclovir) during birth to avoid giving it to their baby.
No evidence that it causes infertility.
Chlamydia
Meds: azithromycin (one dose) or doxycycline (every day for a week)
Chlamydia can easily be cured with antibiotics and should refrain from sex for 7 days after a single dose antibiotics or until completion of a 7 day course of antibiotics.
Untreated, 10-15% of women will develop PID (Pelvic Inflammatory Disease) and fallopian tube infection without any symptoms. This can lead to infertility.
Syphillis
A single injection of long-acting benzathine penicillin G can cure the early stages of syphillis.
Stage 1 - painless sore on the genitals, rectum, or mouth.
Stage 2 = rash, after the sore heals.
Stage 3 = no symptoms, but damage to the brain, nerves, eyes, or heart.
Untreated syphillis can cause infertility in both men and women.
Gonorrhea
Meds: single dose of 500mg IM ceftriaxone
Symptoms include painful urination and abnormal discharge from penis or vagina. Men may experience testicular pain and woman may experience pain in the lower belly.
Left untreated, can cause infertility.
Compartment Syndrome
Edema and swelling cause increased pressure in a muscle compartment, leading to decreased blood flow and potential muscle and nerve damage. If ischemia to the compartment continues, the muscles & nerves may die and the limb may need to be amputated.
S&S:
Edema, severe pain/tenderness, paresthesia/numbness, absent distal pulse, skin discoloration (pallor/cyanosis), renal failure is a late symptom.
Intervention:
Remove the tight cast, fasciotomy, ice, elevation
Fat Embolism Syndrome (FES).
Fat embolism may occur with closed long bone or pelvic fractures. It’s when fat & bone fragments are released into the bloodstream and become lodged.
Respiratory problems are the first symptom, followed by petechial rash on anterior trunk, arms, neck, buccal mucosa, conjunctiva; Purtscher retinopathy (sudden loss of vision), mild fever
Treatment is supportive - O2, etc. 50% of people need mechanical ventilation.
FES is rarely seen in children under 10.
Open Reduction Internal Fixation (ORIF)
Surgical procedure used to internally repair a bone fracture. During open reduction, the bone is placed in correct alignment. Nails, screws, pins, wires, plates, or rods are then inserted into the bone to hold it in place.
Fractures of the long bone are commonly repaired by ORIF.
5Ps of Neurovascular Status
Pain
Pulses
Pallor
Paralysis / Paresis
Paresthesia (a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body)
avascular necrosis
Death of bone tissue due to a lack of blood supply
Viscosupplementation
intra-articular injection of hyaluronic acid.
It’s a treatment for osteoarthritis of the knee that involves injecting lubricating substances directly into the knee.
arthroscopic debridement
A surgical procedure that removes the broken down bits of cartilage and tissues to help reduce pain and improve movement.
It’s most commonly performed to help reduce the symptoms of arthritis so that patients can regain function of their knee while reducing pain.
osteoarthritis
the most common form of arthritis. It’s a degenerative joint disease, or “wear and tear” arthritis. It occurs most frequnetly in the hands, hips, and knees.
The cartilage within a joint begins to break down and the underlying bone begins to change.
X-rays are used to track the disease process, as well as MRI and US.
osteotomy
a procedure that removes a wedge of bone above or below the joint to realign the joint and shift the weight away from the damaged portion of the joint. This procedure is usually performed instead of joint replacement surgery if there is damage to only one side of the joint in healthy, younger adults.
Bone densitometry scan
T<= -2.5 means osteoporosis.
It measures the bone mineral density in different parts of the body.
arthroscopy
surgical procedure used to visualize and treat problems inside a joint.
Arthrography
imaging to look at a joint. Not quite as clear as an arthroscopy.
D Dimer
Normal D Dimer level is <0.5micrograms/mL
Assesses the blood for protein fragments. It indicates a clot.
A blood test used to diagnose/rule out blood clots including DVT and PE.
Indications include suspicion of DVT, monitoring the effectiveness of anticoagulant therapy, evaluation of DIC.
INR, PT, aPTT
INR: 09-1.1
PT: 11-16 seconds
aPTT: 20-36s
Calcium
Calcium is given to people with mobility issues, fractures, or osteoporosis to prevent further bone loss and support bone health/healing.
Contraindications are hypercalcemia, renal failure
Bisphosphonates
Given for osteoporosis
Examples: alendronate
Dexascan T score >= -2.5 indicates osteoporosis.
Contraindications: hypocalcemia, severe renal impairment, esophageal abnormalities or difficulty swallowing.
Virchow’s Triad
Three pathological factors associated with the formation of a DVT: circulatory stasis, vascular damage, and hypercoagulability.
homan’s sign
Checks for DVT, but needs to be confirmed
Push back on the foot and if the patient says that hurts, there’s a risk for DVT
