Final Flashcards
How to set up for a PE?
1) Hand hygiene and PPE (2) Consent before and during (3) Setting comfortable including language (4) Clothing, drape (5) Check equipment
Lateral? Medial? Distal? Proximal?
Lateral away from midline, Medial toward the midline, Distal down toward bottom, Proximal up toward top.
What is systolic and diastolic and normal range for pregnant person
Systolic (TOP) - pressure in the arteries when the hear beats and pushes blood out into the body normal 90-140
Diastolic (BOTTOM) the pressure in teh artiers when the hear rests between beats normal 60-90
Hypertenstion can result from stress, smoking, salt intake.
Worry over 140/90
What are some practical steps around trauma informed care?
- Realizes the widespread impact of trauma and
understands potential paths for recovery; - Recognizes the signs and symptoms of trauma
in clients, families, staff, and others; - Responds by fully integrating knowledge
about trauma into policies, procedures, and
practices; and - Seeks to actively resist retraumatization.
6 principles:
- Safety
- Trustworthiness and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice, and choice
- Cultural, historical, and gender issues
What causes a heart murmer and describe some. Where would you hear an S1 murmer? S2?
- valves that are slower to shut / shutting slightly asynchronously
- a septal defect
- a foramen ovale or ductus arteriosus that hasnt closed
Results in a ‘whoosing’ sound at some point of the cardiac cycle, it is not simply lub/dub
S1 murmer - when one of the AV valves mitral/tricuspid valves is off. nearer the apex of the heart at S1 zone
S2 murmer - when one of the semilunar valves (Aortic/Pulmonic) valves are off. nearer the base of the heart
What are the 5 bones of pelvis, joints,
Normal range non-pregnant? HR, BP, Temp, Oxsat?
Heart Rate 60-80 bpm
Blood Pressure 120/80
Resp. Rate 12-16
** Temperature 36.5-37.5
O2 Saturation 95-100%**
Normal range pregnant? HR, BP, Resp rate, Temp, Oxsat?
Heart Rate 60-100 bpm
Resp. Rate 12-20 **
Blood Pressure 90-140
60 – 90
** Temperature 36.5-37.5
O2 Saturation 95-100%
Normal range baby? HR, Temp, Resp, Rate,Oxsat?
Heart Rate 100-160 bpm
Resp. Rate 40-60
** Temperature 36.5-37.5
O2 Saturation 95-100%**
2-3 deep tendon reflexes? What are they testing and how they are measured? How to landmark?
Palpate before you hit!
bicep: flex patient’s arm to 45 degrees at elbow. Palpate the biceps tendon in the antecubital fossa– place thumb over the tendon and fingers under elbow, strike thumb not tendon, contraction of biceps causes visible or palpable flexion of elbow.
patellar: flex patients knee to 90 degrees, lower leg hands loosely. strike patellar tendon just bellow the patella. Contraction of the quadriceps muscle causes extension of the lower leg.
**tricep: **flex patients arm at elbow up to 90 degrees supporting the arm proximal to elbow put. Palpate triceps tendon and strike it directly with the reflex hammer… contraction of triceps muscle causes visible or palpable extension of the elbow.
between 0-5
2+ = normal/healthy reflex, depends a lot person to person.
2-3 skin lesions?
Macule: flat area of altered colour less thatn 1.5 cm in diameter (ex. freckle)
Patch: flat area of altered colour more thatn 1.5 cm in diameter (ex. port-wine birthmark)
Papule a solid raised palpable lesion less than .5 cm in diameter (ex. PUPPS, measles)
What is S1 and S2 heart sound and when and where is it heard?
The “lub” is the first heart sound, commonly termed S1, and is caused by turbulence caused by the closure of mitral and tricuspid valves at the start of systole. APEX AV valves close, semilunar valves open
S1 - S2 is ventricular systole
The second heart sound, “dub” or S2, is caused by the closure of the aortic and pulmonic valves, marking the end of systole. BASE semilunar valves close, AV valves open
Adventitious lung sounds? Listen and understand why.
**stridor **= musical wheezing heard in inspiration from possible obstructed trachea or larynx.
wheezes: high pitches and continuous upon exhale, could be from asthma, chronic bronchitus, pulmonary edema.
crackles: from fluid in lungs heard in late inspiration, could be from congestion, interstitial lung disease, bronchitis, asthma.. sounds are discontinuous and sound like crackling, popping, rice krispy.
How to document normal, ex. heart and lung?
Bilateral air entry, no adventitous lung sounds detected, clear and regular S1S2, no murmers detected.
2-3 lymph zone?
Submental: felt from underneath chin,
submandibular: underneath mandible (jaw), lateral to the trachea and more in line with the ears, axillary (in armpit)
Preauricular- roll your finger in front of the ear, against the maxilla
What are the 2 hip maneuvers and how do you do them? What are we
Both of these are assessing the function of the hip joint and possible instabilities of developmental hip dysplasias.
**Barlow ** IN AND DOWN baby’s thighs are adducted, brought together at midline, and light downward pressure is applied kind to the knee, force is directed posteriorly. IF the hip dislocates posteriorly from the acetabulum (which is palpable), it is a positive test… diagnosis is confirmed by Orotolani’s maneuver. Attempting to dislocate the femoral head.
The Ortolani OUT thigh is lifted upwards, and the hip is abducted fully 90 degrees. Hips are examined one at a time (or together, apparently), flex hips and knees at 90 degrees, thigh is gently abducted bringing femoral head from its dislocated posterior position from the barlow. poditive test is when the femoral head reduces into the acetabulum and there is a palpable and audible clunk as hip reduces.
What are you looking for when palpating a baby’s head?
symmetry, shape, presence of lesions, caput (swelling just under the skin, crosses suture lines, squishy, from pressure of vaginal delivery, can be at different angles depending on head position at time of birth, resolves within 24 hrs), cephalohematoma (blood is present in layers of baby’s scalp, adds pressure to baby’s brain, does not cross suture lines, may take months to resolve and contribute to jaundice). Also feeling for fontanelles (one anterior in the middle of the coronal suture where the sagittal suture crosses, one posterior in the. middle of the lamboid suture where the sagittal suture crosses). and the suture lines (3 of them): coronal, lamboid, sagittal.
REMEMBER: 5”things” on a babys head…. 3 sutures, lamboid, coronal, sagittal, 2 fontanelles, anterior and posterior.
Cirumference should grow: 0.5cm/week for the first 6 weeks
Pelvic exam - certain details of how to do the pap test - what is the technique, what is it looking for, why is it important to do it this way? Practical things.
Purpose: To look for abnormal/precancerous cells. it is done by taking a sample from the transitional zone of the cervix, just around/outside of the os. The sample is collected by doing a 360 degree spin around the cervix and then a half turn for the brush in the transitional zone with the spatula. The spatula and /or brush are rinsed into a liquid medium. Important to do it this way so you get both the squamous and the columnar cells tio have a greatest chance of seeing a precancerous / abnormal cell. Also, the location of the squalocolumnar junction is dependant on the person’s age, parity, hormonal status
Understand the procedures people have done to remove cancerous cells (LEEP etc) for history.
cryosurgery: procedure to freeze and destroy abnormal tissue in cervix
LEEP - uses a wire loop heated by electrical current to remove cells
cone biopsy: removes cone shaped piece of tissue from the cervix (closes to vagina and part of the pathway from uterus to vagina).
What would you do to set up a gender inclusive / queer welcoming relationship with a client?
- Gender inclusive langauge
- identify my pronouns and use their pronouns appropriatly
- Ask what type of language is preferred for the various body parts
- Don’t make assumptions about conception: what was you fertility/conception journey?
- Don’t make assumptions about parters/family?
- Mirror language used by client
All of these approaches are part of gender inclusive/queer safe care and they benefit all clients.
What do you do for a breast/chest exam?
- breast tissue spokes of a wheel, grid - cover all the breast tissue.
- Use same palpation as lymph nodes, pads of 2 fingers in circles.
- Covers all the way to the sternum, close to the 5th intercostal space, middle of auxila (armpit)
- START WITH HISTORY, breast surgery? Etc, inspection - lift arm up, what can you see (discoloration, dimple, bulge, redness, inflamation), palapation (what are you palpating for?) - it’s lumpy ! How do you differentiate b/w what is normal or concerning?
- **Lump **- cyst, soft fluid filled, normal and hard masses are more concerning. If it’s mobile, then it’s less concerning - fixed in one place (esp to chest wall), tender or not tender. Hard/soft, fixed/mobile, tender/not tender, size, history?
- concerning: hard, immovable, fixed to chest wall, jagged/rock-like, bloody discharge from nipple
- Different chest surgeries and their future plans on chest/breastfeeding in the depth of the slides.
- Depends whether the implant is in the pectoral muscle or on top of the pectoral muscle.
- Reduction - removal of some of the milk producing tissue. Placement of the nipple is changed in the reduction - if there has been a complete severing of the ducts…. But surgeons now are more able to keep the duct intact.
What can you do to test neuro? What are some cranial nerves that are being tested?
smile squinch their face, hearing, sight
CRANIAL NERVE 7 - Facial expression eyebrows
VRANIAL NERVE 3 - occular motor (papillary reflex)
Cranial nerve 1 - smell
Cranial nerve 2 - sight
What are you looking for head to toe in newborn exam?
(keep bb warm is important - skin to skin, hat, heating pad, warm blankets, warm room)
General obs; vitals and APGAR; head and neck; chest and abd; hip, genitals, anus, limb spine & CNS
1) Vitals and APGAR
2) General appearance - GA
3) Head - skull, ears, face, mouth, eyes
4) Heart and lungs (landmarks same as adult), pulse umbilical cord, lungs (some wetness normal)
5) Upper limbs - hands, arms
6) Abdomen and umbilical cord
7) Lower limbs (symmetrical folds)
8) hip exam RANGE OF MOTION
9) Spine and back
10) Neuro (reflexes)
11) Skin (throughout)
How do you assess GA of newborn?
Ballard score is a way to assess gestational age at the time of delivery.
It is a range of -1 to 4 or 5, and assesses
1. skin,
2. lanugo,
3. plantar surface,
4. breast,
5. ear-eye, genitals, and
6. 6 different neuromuscular activity assessments - posture (flexiom at rest old), square window (wrist) (fold flat old), arm recoil (hold arms down, recoil old), popliteal angle, scarf sign (wrist across body further older), heel to ear.
HIGHER Ballard score = older gestational age for the infant, lower = younger.
Some examples of what might be assessed would be square window neuromuscular assessment… a higher score would indicate that the infant’s fingers can touch the inside of its forearm when the hand is pressed towards the arm (wrist very flexible), whereas a ‘square frame’ would indicate a younger GA.
Older GA = less vernix
Older GA = chubby arm cannot reach around neck in scarf sign
