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CEN > Genitourinary, Gynecology, and Obstetrical Emergencies > Flashcards

Genitourinary, Gynecology, and Obstetrical Emergencies Flashcards

1. Explain concepts related to the assessment of an emergency department patient experiencing a GU/GYN/OB emergency. 2. Describe various patient presentations related to GU/GYN/OB emergencies. 3. List interventions necessary for a patient presenting with a GU/GYN/OB emergency.

1
Q

define renal calculi

A

kidney stone that can lead to renal colic

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2
Q

renal calculi overview

A

80% of stones are Ca

size does not correlate to ain

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3
Q

sx renal calculi

A 
sudden onset
severe, colicky flank pain
pain radiating to genitals
restlessness
CVA tenderness
urgency, frequency
dysuria, hematuria
N/V
diaphoresis, low-grade fever
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4
Q

assessing renal calculi

A

assess bruits, pulsatile masses

r/o aortic, iliac aneurysms

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5
Q

intervene renal calculi

A 
strain urine
fluids
opioids, antiemetics
NSAIDs if Cr normal
possible stent
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6
Q

define urinary retention

A

inability to completely empty bladder

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7
Q

causes of urinary retention

A 
urethral strictures
enlarged prostate
clots, calculi
neurogenic bladder
pelvic organ prolapse
MS
med side effects
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8
Q

sx urinary retention

A

low abd pain

bladder distention

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9
Q

intervene urinary retention

A

Foley

Coude catheter

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10
Q

UTI overview

A 
mostly bladder (acute cystitis) 
usually e.coli
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11
Q

risk of UTI

A

women:

  • higher than men
  • shorter urethra
  • new sexual partner

men:

  • incomplete bladder emptying
  • enlarged prostate
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12
Q

sx UTI

A 
dysuria, urgency, frequency
nocturia
suprapubic pressure
back pain
cloud, foul urine
low grade fever
retention in males
AMS in elderly
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13
Q

abx in UTI

A

trimethoprim and sulfamethoxazole
nitrofurantoin
ciprofloxacin

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14
Q

pain management in UTI

A

NSAIDs

phenazopyridine

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15
Q

urosepsis overview

A

elderly, diabetic, immunocompromised

present atypically: AMS in elderly

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16
Q

dc teaching in UTI

A

fluids

phenazopyridine will make urine orange

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17
Q

define acute pyelonephritis

A

inflammation/infection of kidneys

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18
Q

acute pyelonephritis overview

A

more common in women

can lead to urosepsis

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19
Q

causes of acute pyelonephritis

A

usually bacterial

mechanical obstruction

can be upstream from UTI and ascend down from blood infection

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20
Q

sx acute pyelonephritis

A 
CVA tenderness
F/C, HA
N/V/D
sx of lower UTI
pyuria, hematuria, bacteriuria
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21
Q

intervene acute pyelo

A

fluids, rest
nephrostomy tube possibly
broad-spectrum abx

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22
Q

chlamydia overview

A

chlamydia trachomatis

most common STI

often w/ gonorrhea

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23
Q

sx chlamydia

A

75% asymptomatic

cervicitis
PID
endometriosis
salpingitis

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24
Q

tx for chlamydia

A

azithro PO x 1

dozycycline x 7 days

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25
Q

syphilis overview

A

treponema pallidum

more in females and drug users

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26
Q

sx primary syphilis

A

painless ulcer or chancre on mouth or anogenital area

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27
Q

sx secondary syphilis

A 
4-10 wks after primary infection
myalgia
lymphadenopathy
flu-like sx
rash on palms, soles
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28
Q

sx tertiary syphilis

A

2-19 years later if untreated

psychosis, delirium, dementia

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29
Q

sx for syphilis

A

penicillin IM x 1
doxycycline x 14 days
tetracycline x 14 days

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30
Q

gonorrhea overview

A

neisseria gonorrhoeae
second most common STI

leading cause of cervicitis, PID in females, urethritis in males

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31
Q

complications of gonorrhea

A

infertility, ectopic, chronic pelvic pain

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32
Q

sx gonorrhea

A

UTI sx
mucoid discharge from cervix/penis
men may be asymptomatic

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33
Q

tx for gonorrhea

A

ceftriaxone IM x1
cefixime PO x1
cephalosporin IM x1 + azithro PO x1
doxycycline x 7 days

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34
Q

herpes simplex overview

A

chronic, incurable viral STI with remissions and exacerbations

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35
Q

sx herpes simplex

A

painful vesicles, ulcerations on genitalia

fever, malaise
myalgia
lymphadenopathy
dysuria

70% asymptomatic

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36
Q

dc teaching for all STIs

A 
meds as prescribed
PCP
condoms
inform sexual partners
treat past sexual partners
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37
Q

dc teaching for chlamydia

A

no sex x 7 days after tx

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38
Q

dc teaching for herpes

A

avoid sex during outbreak

increased risk of transmission to fetus - C-section recommended

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39
Q

cremasteric reflex

A

when inner thigh is stroked, cremaster muscle contracts raising ipsilateral testis

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40
Q

testicular torsion overview

A 
urological emergency
can occur in infants
rare after 30 yo
cremasteric reflex absent
US shows ischemia
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41
Q

acute epididymitis overview

A

cremasteric reflex intact

US shows increased blood flow

most common cause of intrascrotal inflammation

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42
Q

define testicular tosion

A

twisting of testicle or spermatic cord, causing strangulation

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43
Q

onset of acute epididymitis vs testicular torsion

A

epididymitis: gradual
torsion: sudden

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44
Q

pain in acute epididymitis

A

mild to severe

unilateral

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45
Q

pain in testicular torsion

A

severe
unilateral
tenderness
swelling, erythema

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46
Q

cause of acute epididymitis

A

infection (chlamydia or gonorrhoeae)

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47
Q

causes of testicular torsion

A

congenital
undescended testicle
cold weather
sex

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48
Q

common ages in acute epididymitis vs testicular torsion

A

epididymitis: sexually active postpubertal males
torsion: 12-18

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49
Q

ureteral discharge in acute epididymitis vs testicular torsion

A

epididymitis: yes
torsion: no

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50
Q

scrotal elevation in acute epididymitis vs testicular torsion

A

epididymitis: may decrease pain
torsion: worsens pain

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51
Q

assessing acute epididymitis

A

scrotal US
ureteral smear
UA, culture

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52
Q

assessing testicular torsion

A

cremasteric reflex

doppler US

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53
Q

intervene acute epididymitis

A

abx

sx management

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54
Q

intervene testicular torsion

A

manual detorsion
uro consult
surgical repair

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55
Q

define priapism

A

prolonged, painful erection

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56
Q

common ages in priapism

A

any age but:
5-10 with SCC
20-50

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57
Q

causes of priapism

A

spinal cord injury
tumors
SCC
meds for ED

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58
Q

sx priapism

A

vaso-oclusive:

  • persistent, painful
  • > 4 hours

non-ischemic:
-erect but nontender

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59
Q

assessing priapism

A

penile doppler
arteriography
CBC if c/f malignancy

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60
Q

intervene priapism

A

analgesia, sedation

inject epi, phenylephrine, pseudoephedrine, or terbutaline into penis

irrigate corpora with NS

uro consult

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61
Q

define phimosis

A

inability to fully retract foreskin over glans penis

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62
Q

define paraphimosis

A

retracted foreskin becomes entrapped, occluding blood flow to glans

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63
Q

sx paraphimosis

A

swollen, painful, edematous glans
tight ring of skin behind glans
discolored, necrotic areas
hx of increasing difficulty advancing foreskin

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64
Q

intervene phimosis/paraphimosis

A

manual reduction

small incision with local anesthesia

encourage consideration of circumcision or dorsal slit

NSAIDs, abx

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65
Q

define caute prostatitis

A

inflammation of prostate gland

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66
Q

common causes of prostatitis

A

bacterial infection that ascended via ureter or refluxed from bladder

associated with acute cystitis

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67
Q

sx prostatitis

A 
sudden onset dysuria, malaise
frequency, urgency
perineal pain
low abd, penile, suprapubic discomfort
f/c
hematospermia
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68
Q

assessing prostatitis

A

UA, cultures
prostate-specific antigen
boggy, tender prostate

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69
Q

intervene prostatitis

A

analgesia
Foley
abx - fluoroquinolones
fluid intake

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70
Q

causes of renal trauma

A

blunt trauma (MVC)
fall w/ lower rib fractures
penetrating trauma

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71
Q

types of renal trauma

A

laceration
contusion
vascular injury

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72
Q

sx renal trauma

A

abd, flank, back pain
flank ecchymosis
hematuria

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73
Q

intervene renal trauma

A

bed rest
observe
fluids
surgery for lacs or uterine extravasation

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74
Q

types of urethral/bladder trauma

A

contusion

rupture

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75
Q

causes of urethral/bladder trauma

A

straddle injury
genital trauma
foreign bodies

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76
Q

what injuries are associated with urethral/bladder trauma?

A

full bladder
pelvic fractures
pediatric patients

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77
Q

sx urethral/bladder trauma

A 
inability, difficulty voiding
suprapubic, perineal, genital pain with voiding
blood at urinary meatus
hematuria
hypovolemia
low abd or peritoneal hematoma
bladder distension
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78
Q

characteristics of urethral/bladder trauma

A

“pop” after blow to bladder
pelvic fx with bony fragment
cystogram
no urine in Foley

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79
Q

intervene urethral/bladder trauma

A

analgesia, abx
cath only by urologist
surgery

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80
Q

reasons for surgery in urethral/bladder trauma

A

hemodynamic instability
renal pedicle damage
most injuries

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81
Q

define penile fracture

A

rupture of tunic albuginea or corpus cavernosa of penile shaft d/t torque

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82
Q

causes of penile fracture

A

during sex
direct trauma
fall

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83
Q

sx penile fracture

A 
"pop" at time of injjry
penile pain, loss of erection
BRB from urethra
ecchymosis
edema
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84
Q

intervene penile fracture

A

surgery w/in 24-36 hours

supportive measures

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85
Q

causes of pelvic pain

A 
ectopic
kidney stones
UTI
Mittelschmerz
ruptured ovarian cyst
endometriosis
PID
diverticulitis
appendicitis
ovarian neoplasm
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86
Q

causes of abnormal uterine bleeding

A 
hormone dysfxn
hemorrhagic cystitis
coagulopathies
neoplasms
trauma
uterine/vaginal foreign body
sexual assault
uterine, cervical polyps
uterine fibroids
urethral prolapse
gyn infections
pregnancy complications
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87
Q

gyn infections causing abnormal uterine bleeding

A

gonorrhea
chlamydia
trich
cervicitis

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88
Q

pregnancy complications causing abnormal uterine bleeding

A 
ectopic
spontaneous abortion
placental abruption
placenta previa
postpartum hemorrhage
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89
Q

define bartholin cyst

A

obstruction of Bartholin duct

unilateral

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90
Q

complications of bartholin cyst

A

infections caused by STI, vaginal organisms

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91
Q

sx bartholin cyst

A

painful, unilateral cystic mass

92
Q

intervene bartholin cyst

A 
warm compress
sitz bath
I and D, drainage
abx
r/o carcinoma if over 40 yo
93
Q

define dysfunctional uterine bleeding

A

irregular uterine bleeding from vagina that occurs in absence of recognizable pelvic pathology, general medical disease, or pregnancy

94
Q

dyspareunia

A

painful bleeding or pain with intercourse

usually associated with endometriosis

95
Q

causes of dysfunctional uterine bleeding

A 
uterine fibroids
trauma
infection
malignancy
coagulopathies
hormone replacement therapy
steroids, androgens
digitalis, anticoags
low caloric diets, obesity
rapid weight change
thyroid, adrenal disorders
cirrhosis
HTN
96
Q

sx dysfunctional uterine bleeding

A

fewer than 21 days between episodes

usually painless

97
Q

normal menses

A

25-60 ml/day for 4-5 days

average tampon holds 20-30 ml if saturated

98
Q

intervene dysfunctional uterine bleeding

A

low dose PO contraceptive
iron supplements
IV fluids
suction, curettage

99
Q

define ovarian cyst

A

pockets on ovaries which may contain fluid, semi-fluid, solid material

100
Q

types of ovarian cysts

A 
follicular
corpus luteum
Mittelschmerz
polycystic ovarian syndrome
chocolate cysts
dermoid cysts
101
Q

follicular cyst rupture

A

with strenuous exercise or sexual intercourse w/in first 2 weeks of menstrual cycle

102
Q

corpus luteum cyst rupture

A

last 2 weeks of menstrual cycle

103
Q

Mitelschmerz cyst rupture

A

mid-cycle, unilateral pain

104
Q

chocolate cyst

A

caused by endometriosis

105
Q

dermoid cyst

A

contains teeth, hair

106
Q

sx ovarian cyst

A 
varies
pain w/ sex
sharp, unilateral
days to weeks of pain
biopsy to r/o uterine CA
hypovolemia if blood-filled cyst
107
Q

intervene ovarian cyst

A

NSAIDs, opioids

surgery

108
Q

complication of ovarian cysts

A

fallopian tube torsion with ovarian ischemia

109
Q

sx fallopian tube torsion

A

sudden, sharp, unilateral pain
fever
dysuria
N/V

110
Q

define sexual assault/battery

A

involuntary sexual act

threatened, coerced, forced sexual contact w/w/o penetration

111
Q

who should assess possible victim of sexual assault/battery?

A

SANE - sexual assault nurse examiner

112
Q

define PID

A

polymicrobial infection of upper genital tract

113
Q

examples of PID

A

endometriosis
salpingitis
tubo-ovarian abscess
pelvic peritonitis

114
Q

common causes of PID

A

gonorrhea

chlamydia

115
Q

risk factors for PID

A 
IUD
previous STIs
multiple partners
substance use
frequent douching
116
Q

sx PID

A

abd pain, dyspareunia
abnormal vag discharge
fever
cervical motion tenderness

117
Q

intervene PID

A 
abx, analgesia
admission for:
-not responsive to tx
-unstable
-tubo-ovarian abscess
-pregnant
118
Q

dc instructions for PID

A

increased risk of ectopic
can result in infertility
PCP in 72 hours

119
Q

define tubo-ovarian abscess

A

complication of PID

surgery emergency if ruptures

120
Q

sx tubo-ovarian abscess

A

ill appearing
severe abd pain
peritoneal signs w/ palpation
fever

121
Q

intervene tubo-ovarian abscess

A

admit
surgery
-hysterectomy, oophorectomy possible
abx

122
Q

define toxic shock syndrome

A

toxin-mediated systemic response usually d/t Staph aureus

123
Q

causes of TSS

A

retained tampon, sponge
strep infections
necrotizing fasciitis
burns

124
Q

sx TSS

A 
sudden onset f/c
hypotension
N/V/D
HA, myalgia
classic rash
confusion
multisystem organ failure
125
Q

intervene TSS

A 
contact iso
ABCs, intubation
fluids, pressors
remove infection
abx
art line, CVC
ICU
126
Q

sx vulvovaginal candidiasis

A

irritation, itching
inflammation
cottage-cheese discharge

127
Q

diagnosing vulvovaginal candidiasis and trich

128
Q

tx vulvovaginal candidiasis

A

OTC creams, suppositores

diflucan PO x 1

129
Q

dc teaching vulvovaginal candidiasis

A

diflucan contraindicated in pregnancy

PCP

130
Q

sx trich

A

vulvar irritation
dyspareunia
“fishy” odor
yellow/green discharge

131
Q

tx trich

A

metronidazole PO x1 or

tinidazole PO x1

132
Q

dc teaching trich

A

no alcohol with metronidazole
treat sexual partners
PCP

133
Q

sx bacterial vaginosis

A

“fishy” odor

gray discharge

134
Q

diagnosing bacterial vaginosis

A

discharge that smoothly coats vaginal wall

clue cells

ph > 4.5

+ “whiff” test

135
Q

tx bacterial vaginosis

A

metronidazole 7 days or
metronidazole gel 5 days or
clinda cream 7 days

136
Q

dc teaching bacterial vaginosis

A

partners don’t need tx
meds as directed
PCP
avoid douching, bubble baths

137
Q

complications with diaphragm

A

unable to remove - use ring forceps

138
Q

complications with IUD

A

unable to remove
lost string
partial expulsion
abnormal cavity migration

139
Q

intervening for IUD complications

A

remove with ring forceps
imaging
additional contraception
poss. exploratory laparotomy

140
Q

define spontaneous abortion

A

death or expulsion of fetus or products of conception before age of viability

15-20% of all pregnancies

141
Q

complications of spontaneous abortion

A

bleeding
vag bleeding should improve and stop
infection

142
Q

causes of spontaneous abortion

A 
first trimester:
-chromosomal
after first trimester:
-infection
-endocrine disorder
-anatomic abnormalities of mother
143
Q

define threatened abortion

A

cervical os closed despite bleeding/cramping

144
Q

define inevitable abortion

A

cervical os open bleeding/cramping membranes ruptured

145
Q

define incomplete abortion

A

cervical os open
tissue in cervix
incomplete expulsion of products

146
Q

define complete abortion

A

complete expulsion of products of conception

147
Q

define missed abortion

A

prolonged retention of dead products of conception after os closed

148
Q

define septic abortion

A

intrauterine infection d/t retained products of conception

149
Q

intervene spontaneous abortion

A 
labs, US
oxytocin, abx
suction curettage
uterine evacuation
psychosocial care
referrals
150
Q

dc instructions for spontaneous abortion

A 
vag bleeding 1-2 weeks
slight cramping x few days
avoid douching, tampons, sex x 2 weeks
rest 2-3 days
temp bid x 5 days
151
Q

reasons to seek medical care after spontaneous abortion

A

fever > 100F
chills
severe N/V, cramps
excessive bleeding

152
Q

define excessive bleeding after spontaneous abortion

A

consistently soaking pad in < 1 hr
bleeding > normal period
clots > quarter sized

153
Q

define ectopic pregnancy

A

embryo implants at site other than endometrium of uterus

154
Q

ectopic pregnancy overview

A

usually in fallopian tube and will eventually rupture

usually 6th week of gestation

2% of all pregnancies

155
Q

locations for ectopic pregnancies

A 
peritoneal
corneal
isthmic tubal
ampullar tuba
fimbric tubal
ovarial
cervical
intramural
156
Q

sx ectopic pregnancy

A 
late, irregular period
abnormal vag bleeding
sudden onset unilateral pelvic pain
palpable pelvic mass
\+ pregnancy
N/V
157
Q

sx ruptured ectopic pregnancy

A

shoulder pain (Kehr sign)
signs of shock
decreased LOC

158
Q

labs in ectopic pregnancy

A

+ hcg

progesterone > 25

159
Q

intervene ectopic pregnancy

A

fluids, Rhogam
surgery if rupture
methotrexate

160
Q

contraindications for methotrexate after spontaneous abortion

A

unstable
bleeding
unreliable patient

161
Q

methotrexate overview

A

cytotoxic
don’t handle if pregnant
wear PPE, chemo gloves

162
Q

pharm overview of methotrexate

A

interferes with DNA synthesis and disrupts cell multiplication

163
Q

define placenta previa

A

implantation of placenta in lower uterine segment or over internal os

164
Q

complications of placenta previa

A

placenta may bleed as fetus grows and uterus expands

associated with life threatening hemorrhage, fetal loss

165
Q

sx placenta previa

A

sudden, painless bleeding
BRB
maternal hemorrhagic shock

166
Q

intervene placent previa

A 
urgent ob consult
recumbent position
IVs, fluids
CBC, T and S, Rh
no vag exam until after US
poss. C-section
167
Q

define abruptio placentae

A

placental separation from uterine wall

168
Q

pathophysiology of abruptio placentae

A

arterial vessel rupture
hemorrhagic, hypovolemic shock
inhibits oxygen, nutrient supply to fetus

most common cause of fetal demise 2/2 maternal trauma

169
Q

sx abruptio placentae

A

backache, painful contractions, abd pain

uterine rigidity

frank, dark-red vag bleeding or concealed bleeding

maternal hemorrhagic shock

abnormal fetal heart tones

170
Q

lab results in abruptio placentae

A

elevated d-dimer

decreased platelets

171
Q

intervene abruptio placentae

A 
continuous fetal heart monitor
OB transport
high flow O2
fluids, transfusion
emergent delivery
172
Q

define hyperemesis gravidarum

A

intractable N/V, dehydration in pregnancy leading to electrolyte imbalances, malnutrition

173
Q

causes of hyperemesis gravidarum

A

suspected elevated hcg

174
Q

define preeclampsia

A

multisystem disorder associated with decreased oxygenation and perfusion

175
Q

preeclampsia overview

A

associated with coagulopathies, liver fxn abnormalities

characterized by gestational HTN, gestational proteinuria

mild to severe

uncommon postpartum

176
Q

sx mild-moderate preeclampsia

A 
SBP >140 or DBP >90
protineuria, oliguria
edema
weight gain 2+ lb/week
HA, N
epigastric, RUQ pain
177
Q

sx severe preeclampsia

A 
SBP>160, DBP>110
proteinuria >2g/24hr
Cr > 1.2
platelets < 100,000
elevated LDH, ALT, AST
persistent HA, visual disturbance, epigastric pain
oliguria
pulm edema
178
Q

intervene preeclampsia

A

minimize stimulation
antiHTN
OB admit
mag sulfate

179
Q

administering mag sulfate for preeclampsia

A

loading dose
VS q5 min
neuro status qh
monitor urine output

180
Q

sx magnesium toxicity (in preeclampsia)

A 
loss of patellar reflexes
SOB, hypoxia
CNS depression
N
treat w/ calcium gluconate
181
Q

define HELLP syndrome

A

life threatening pregnancy complication

considered as a variant of severe preeclampsia that involves liver

182
Q

sx in HELLP

A

H - hemolysis
EL - elevated liver enzymes
LP - low platelets

183
Q

define eclampsia

A

preeclampsia progressing to convulsive state

184
Q

risks of eclampsia

A

delivery only cure

at risk for up to 3 weeks postpartum

185
Q

sx eclampsia

A

preeclampsia sx
generalized SZs
significant HTN
decreased fetal HR

186
Q

intevene eclampsia

A 
ABCs, high flow
continuous fetal monitor
mag sulfate
antiHTN meds
OB admit
187
Q

causes of obstetrical trauma

A

MVCs, falls, domestic violence

188
Q

risks of obstetrical trauma

A

risk of death comparable for pregnant vs non pregnant

risk of death for fetus 5-7x greater with traumatic injury

189
Q

priority with obstetrical trauma

A

maternal resuscitation - provides fetus best chance of survival

190
Q

complications of obstetrical trauma

A 
placental abruption
preterm labor
uterine rupture
fetal skull, liver injuries
perimortem C-section deliery
191
Q

assessing obstetrical trauma

A

fetal US
doppler US for fetal HR
monitor for min 4hours if pregnancy viable

192
Q

intervene obsstetrical trauma

A

ABCs, trauma interventions
left later recumbent position
imaging

193
Q

indicators of fetal stress/distress during obstetrical trauma

A

fetal HR > 160 or < 110
no FHR accels w/w/o contractions
periodic FHR decels w/w/o contractions
decreased fetal movement

194
Q

intervene for fetal distress during obstetrical trauma

A 
O2
life side, manually displace uterus to L
fluids
emergent C-section
maternal steroid injection
195
Q

mechanism of injury in uterine rupture

A

sudden deceleration

severe abd compression

196
Q

complications of uterine rupture

A

usually causes fetal demise

< 1% of pregnant patients with major trauma

197
Q

sx uterine rupture

A 
sudden onset severe abd pain
vag bleeding
fetal parts outside uterus
fetal bradycardia, asystole
maternal hypovolemic shock
198
Q

intervene uterine rupture

A

emergent C-section

possible hysterectomy

199
Q

define preterm labor

A

regular contractions < 37 weeks gestation

200
Q

complications of preterm labor

A

risk for preterm birth

most common OB complication after trauma

201
Q

sx preterm labor

A 
contracts q10 min or less
abd cramping, backache
pelvic pressure
change in vag discharge
onset of vag bleeding
202
Q

assessing preterm labor

A

pelvic exam
fetal monitoring
assess contractions

203
Q

intervene preterm labor

A

terbutaline if viable at 20-35 weeks

204
Q

sx emergent delivery

A 
bloody show
ruptured membranes
frequent painful contractions
bulging membranes
crowning fetal head
205
Q

mother statements during emergent delivery

A

desire to bear down, push
need to have a BM
“the baby is coming”

206
Q

mother interventions for emergent deliery

A

low fowler, knees bent or side lying, buttocks raised

clean perineum

have mother pant to decrease chance of explosive delivery

gentle pressure while delivering head

assess membranes, nuchal cord, position and presentation

direct head down to deliver anterior shoulder and up to deliver posterior shoulder

207
Q

neonate interventions for emergent delivery

A

clamp cord 4-5 cm from abdomen and 4-5 cm towards mother 30 seconds after pulsating stops

thoroughly dry- #1

assess breathing, suction

gentle stimulation, resuscitation if not breathing

APGAR at 1 and 5 min

warm newborn

208
Q

APGAR

A 
appearance (color)
pulse
grimace (muscle tone)
activity (reflex irritability)
resp effort
209
Q

0 points in APGAR

A 
A: blue, pale
P: absent HR
G: limp
A: absent activity
R: absent resp effort
210
Q

1 point in APGAR

A 
A: pink body, blue extremities
P: < 100 bpm
G: some flexion
A: some motion
R: weak cry
211
Q

2 points in APGAR

A 
A: pink
P: > 100 bpm
G: good flexion
A: good motion
R: strong cry
212
Q

APGAR scores indicating outcome

A

7-10: good
4-6: moderate
1-3: poor

213
Q

define prolapsed cord

A

umbilical cord precedes the neonate out of vagina, reducing or eliminating blood flow

214
Q

intervene prolapsed cord

A 
knee-to-chest position
insert hand to elevate fetal head
do not handle or replace cord
wrap exposed cord in saline gauze
immediate C-section
215
Q

characteristics of neonatal resuscitation

A

two-thumb encircling technique
depress 1/2 AP diameter of chest
chest recoil

216
Q

meds for neonatal resuscitation

A

epi
naloxone
glucose
IV fluids 10 ml/kg

217
Q

define postpartum hemorrhage

A

excessive vaginal bleeding after delivery or abortion for up to 6 weeks

218
Q

parameters of postpartum hemorrhage

A

losses > 500 ml w/in 24 hours of delivery

primary postpartum hemorrhage is w/in 24 hours of delivery

219
Q

four Ts of postpartum hemorrhage

A

tone - uterine atony
trauma - vaginal, perineal, rectal tearing
tissue - retained products
thrombin - DIC

220
Q

sx postpartum hemorrhage

A 
steady BRB
nausea
pale, clammy skin
soft, boggy uterus
signs of shock
221
Q

intervene postpartum hemorrhage

A

uterus massage
manual pressure to lacs
treat hemorrhagic shock
oxytocin

222
Q

define postpartum infection

A

fever > 24 hours and up to 10 days postpartum with confirmed infection

223
Q

causes of postpartum infection

A 
endometriosis
laceration
episiotomy
surgical site infection
retained uterine tissue
UTI
mastitis
224
Q

sx postpartum infection

A 
fever
redness
pain, tenderness
foul smelling lochia
drainage from surgical site
erythema, pain, engorgement of breasts
225
Q

risk factors for postpartum infection

A

delivery hx
premature membrane rupture
hx antepartum infection

226
Q

intervene postpartum infection

A

fluids
sepsis protocols
abx

CEN (12 decks)

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