Identification overview Flashcards
Why is it important for midwives to recognize signs of deteriorating illness and refer appropriately?
Midwives are not responsible for making the dx but for performing the right observations at suitably frequent intervals, recording them accurately, giving some initial care and ensuring that the right medical staff respond to review the woman
Plasma volume expands up to 50% during pregnancy this could impact the woman by?
physiological anemia; reduced oxygen carrying capacity; check hemoglobin levels
Heart rate increases by 15-20% BPM the midwife should
Check HR against baseline for individual women; note trends
Because cardiac output and venous return increases by 40-50% by term how does this impact birth
women can tolerate quite large amounts of blood loss postnatal without changes to BP but this will vary; check VS to identify compensatory changes
Uterine blood flow significantly increases during pg of up to 10% of cardiac output thus?
a potential for large volumes of blood loss quickly, particularly around the time of delivery of the placenta
Systemic vascular resistance is decreased in pregnancy due to effects of progesterone, resulting in general vasodilation thus
The response of peripheral vasoconstriction and other features of compensatory mechanisms will mask the features of shock until the women is significantly unwell.
pregnancy is a pro-coagulant state meaning
concentration of clotting factors after delivery and reduced venus return increases risk of venous thromboembolism (VTE)
oxygen consumption is increased by 30% due to metabolic demand of the fetus and increased requirements of pg making the pregnant woman
become more hypoxic more readily; check oxygen saturations
ABCDE summary: A
Assess airway and treat if required
ABCDE summary: B
Assess breathing and treat if required
ABCDE summary: C
assess circulation and treat if required
ABCDE summary: D
assess disability (level of consciousness) and respond as required
ABCDE summary: E
expose and examin the women using traditional midwifery head-to-toe assessment once ABCD are stable. this will include assessment of fetal wellbeing
Signs that hypovolemic shock is occuring
raised RR, HR, peripheral vasoconstriction
Hypovolemic shock is
excessive blood loss reducing circulating blood volume
Severe sepsis is
inflammatory reaction to infection causing vasodilation
Signs that severe sepsis is occuring
Raised RR, HR, lowered BP, peripheral vasoconstriction, raised or lowered temperature
Myocardial infarction
Blockage of coronary artery leading to ischemic damage to heart muscle interfering with the pump action of the heart
Signs that a myocardial infarction is occuring
Raised HR, RR, BP, and peripheral vasoconstriction, pain
Pulmonary embolism (PE)
Blood clot that has traveled from another part of the body that blocks blood flow to part of the lung, causing significant problems with blood oxygenation
Acute asthma
hypoxemia, bronchoconstriction caused by narrowing of airways
Signs of acute asthma
raised respiratory rate, HR, and BP, use of accessory muscles
Pre-eclampsia
endothelial damage leading to multi-organ dysfunction
Signs of pre-e
varied range of symptoms: Raised BP, Protein in urine, edema, headache, visual disturbances, Epigastric pain (often asymptomatic)
Signs of amniotic fluid embolism
SOB, altered mental status, reduced BP, cardiovascular collapse, Disseminated intravascular coagulation (DIC)
Amniotic fluid embolism
anaphylaxis-like inflammatory response to amniotic fluid entering the maternal circulation, causing sudden collapse with impairment of coagulation
Diabetic ketoacidosis
Raised blood sugar due to lack of insulin, cell starvation
Signs of Diabetic ketoacidosis
raised RR (smell of acetone), HR, lowered BP, polyuria, glycosuria
Useful questions about pain
-Describe the pain. it is sharp, dull, aching, hot, tight?
- is is constant or intermittent?
- where is it? put a finger where the pain is worst. does the pain go anywhere?
- does anything bring on the pain?
does anything help the pain? have you taken anything?
Many aspects of initial ABCD assessment can be ascertained by?
Observing the woman and asking the question ‘How are you?’
How does asking the question how are you assess airway?
For the woman to respond verbally she must have a patent airway and circulating oxygenated blood. she also must have reasonable respiratory effort to be able to produce a response and have adequate cerebral function to comprehend and answer
What are observable signs of increased respiratory effort?
- use of accessory muscles
- difficulty in completing sentences or pausing in-between words
-abnormal sounds like a stridor or gurgling, wheezing, etc
what is a respiratory rate that is a sign of concern?
a rate over 20 breaths per min
what is a respiratory rate that is a sign of significant pathology, necessitating immediate action?
rate over 30 breaths per min
At what percentage on a pulse ox is oxygen therapy indicated?
95%
When using a pulse ox what information should be recorded?
If the pt is breathing room air or oxygen
What VS provide vital initial information during a hemorrhage?
- pulse rate
- blood pressure
- assessment of perfusion
- nothing the pt’s general appearance
During a hemorrhage if a pt looks pale what is happening?
displaying signs of sympathetic mediated vasoconstriction` as the body diverts blood away from the peripheries to conserve bp to vital organs
A weak and thready pulse might indicate
hypovolemia
a strong, bounding pulse can be associated with
vasodilation of early stages of sepsis or anaphlaxis
a raised or low temperature can indicate what??
infection, with a low temperature associated with severe sepsis
What does AVPU method assess?
level of consciousness
What could be a cause of confusion and heightened anxiety?
hypotension and hypoxia
what can be the cause of diminished level of consciousness or changes in behavior?
hyperglycemia and hypoglycemia
AVPU classification:
- Alert
- responds to voice
- responds only to painful stimuli
- unresponsive to all stimuli
