Kathleen Midterm Flashcards
What is pain?
Pain is whatever the experiencing person says it is, and whatever they say it does.
What is pathologic pain ?
Pain that persists after the usual time for healing that serves no useful purpose.
What is acute pain?
Pain that occurs with an injury and dissipates as it heals.
What is chronic pain?
Pain that is associated with a disease process, or when it persists after an injury.
What are the somatosensory receptors for pain called?
Nociceptors. They are found in all tissues except the central nervous system
What are the mechanisms that lead to the perception of pain?
Transduction, transmission, perception and modulation
What is the time range for pain to be chronic?
Chronic pain is defined as lasting for more than 3 months and could last for years
What is neuropathic pain?
Neuropathic pain results from a pathology or disease of the somatosensory system. It is pathologic.
What are the consequences of untreated pain?
Untreated pain affects the endocrine, respiratory, cardiovascular and physical functions of the body as well as causing fear, anxiety, anger, depression, etc.
How do we assess for pain?
PQRSTU
Provocation, Quality, Region, Severity, Timing, Understanding
What is in the hierarchy of pain measures?
Conduct an analgesic trial, evaluate physiological indicators, observe behavior, consider underlying pathology/conditions, attempt self-report
Why is surgical pain a problem?
Surgical pain is caused by trauma, muscle spasms, anxiety and fear, breathing, moving, position changes.
How often should we assess surgical pain?
Every 2 hours, when the patient reports it, before and after analgesics.
What is considered an acute and a chronic infection?
Acute is days to weeks, chronic is 12+ weeks
What is the process of infection?
Pathogen -> susceptible host -> reservoir -> portal of exit -> mode of transmission -> portal of entry
What is Otitis Media?
A middle ear infection, most prevalent in early childhood, primarily caused by malfunctioning Eustachian tubes.
What are risk factors for otitis media?
Second hand smoke, facial abnormalities, premature birth, lack of vaccines.
What are the treatments for otitis media?
Antibiotics, surgery, analgesics
What are the types of UTI’s?
Acute cystitis, painful bladder syndrome, acute/chronic polynephritis
Who is at risk for UTI’s?
People with female genitalia,premature newborns, prepubescent children, those with catheters, Diabetics, and those with urinary/bladder issues
How do we diagnose UTI’s?
Urine culture and sensitivity are preformed.
What is cystitis?
Cystitis is inflammation of the bladder.
What does the lower urinary tract have to do with UTI’s?
The lower urinary tract is the most common site of UTI’s.
What is the difference between cystitis and painful bladder syndrome/interstitial cystitis ?
Often causes pain and bothersome frequency, symptoms of cystitis but negative urine cultures with no other known etiology.
What is pyleonephritis?
Infection of the kidneys usually caused by other infection or obstruction.
How do we diagnose pyleonephritis?
Urinalysis, IV pyelography, ultrasound
What is perfusion?
The flow of blood through arteries and capillaries which delivers nutrients and oxygen to cells
What is an artery?
Arteries take oxygenated blood from the heart and deliver it to organs
What are veins?
Veins take de-oxygenated blood from organs to the heart
What are capillaries?
Tiny vessels that connect arteries and veins
What is ischemia?
Blood flow is restricted, therefore oxygen is restricted
What is an infarction?
Death of tissue resulting from a lack of blood supply, typically caused by obstruction or clot
What are modifiable risks for impaired perfusion?
Smoking, elevated serum lipids, sedentary lifestyle, obesity, diabetes, hypertension
What are unmodifiable risks for impaired perfusion?
Age, gender, race, genetics
What are some treatments for altered perfusion?
Vasodilators, vasopressors, diuretics, anticoagulants, antiplatelets, defibrillation, pacemaker, heart valve replacement, cardiac transplant
What is the typical first warning sign of congenital heart defects?
Abnormal oxygen sat level
What are the two rules of hemodynamics?
Blood flows from high pressure areas to low pressure areas.
Blood takes the path of least resistance
What are the three obstructive congenital heart defects?
Aortic Senosis: narrowing of entrance to pulmonary artery
Pulmonic stenosis: narrowing of entrance to pulmonary artery (blood mixes in the artery)
Coarctation of Aorta: Localized narrowing near insertion of ductus arteriosus
What are the four mixed congenital heart defects?
Transposition of great arteries: pulmonary artery and aorta are switched, no communication between systemic and pulmonary circulation. Life threatening, requires surgery.
Hypoplastic left heart syndrome: underdevelopment of the left side of the heart. Blood mixes between oxygenated and deoxygenated, palliative care or patient needs a new heart.
Total anomalous pulmonary venous connection: failure of pulmonary veins to join left atrium. Needs surgery
Truncus Arteriosus: single semilunar valve instead of two. Needs surgery
What are the decreased pulmonary blood flow causing congenital heart defects?
Tetralogy of fallot: ventricular septal defect, pulmonic stenosis, overriding aorta, right vent hypertrophy. Blood is shunting left to right. Cyanosis noted, may be instinctively squatting to increase aortic pressure.
Tricuspid Atresia: Tricuspid valve fails to develop. Can be managed by meds, may need surgery
What congenital heart defects increase blood flow?
Atrioventricular canal defect: two septum defects, more common in people with Down syndrome.
Patent ductus ateriosus: duct fails to close when you’re born or a few days later, left untreated child will have shorter lifespan.
Atrial septal defect: abnormal opening between atrial, usually symptomatic at 20-30 years own. Can close on its own unless it grows
Ventricular septal defect: most prominent congenital heart disease.
What is the most prominent congenital heart defect?
Ventricular septal defect
What are the symptoms of increased blood flow heart defects?
Tachycardia, tachypnea, murmur, CHF, poor weight gain, diaphoresis, periorbital edema, respiratory infections
What are symptoms of decreased blood flow heart defects?
Cyanosis, poor weight gain, polycythemia
What are symptoms of mixed congenital heart defects?
Cyanosis, poor weight gain, pulmonary congestion, CHF
What are symptoms of obstructed heart defects?
Diminished pulses, poor colour, delayed cap refil, decreased urine output, CHF, pulmonary edema
How do Ventricular Septal Defects present?
Fatigue, low level of consciousness, edema, murmur, CHF. In babes they can sweat while eating, struggle to thrive, high HR and RR.
How are you ventricular septal defects diagnosed?
Chest X-ray showing increased pulmonary vascular markings. Echocardiograms identifying multiple VSD’s and direction of shunting. When VSD is severe it can reverse shunting.
What occurs during severe VSD?
More blood pools in the right ventricle, right ventricle pressure increases and exceeds left pressure. Shunt direction is reversed, deoxygenated blood is delivered to tissues and organs.
What is Digoxin?
A medication used in heart failure that increases contractility, decreases heart rate. Have to monitor pulse for one full minute prior to administration. Look for signs of toxicity and potassium levels.
What are the 3 approaches to clinical judgement?
1.Standards based approach
2.Evidence based approach
3.Interpretivist
What are the steps in clinical judgment?
Noticing —> Interpreting —> Responding —> Reflecting
Is clinical judgement always required?
No, clinical judgement isnt always required to know appropriate care, it does take clinical judgement to recognize abnormal findings and take action.
What are the frequencies for monitoring EWS (early warning signs)
EWS total 0: 8-12 hours
EWS 1-4: 4-6 hours
EWS 3 in one category: 1 hour
5 or more: every 30 mins & input output
7 or more: continuous vitals
What are the scores for CHEWS (child’s EWS) (stop signs)
0-2 green stable
3-4 yellow decompensation
>5 red critical
What does SBAR stand for?
S - Situation
B- Background
A- Assessment
R- Recommendation
Do you need a physicians order to hold medication?
Yes
What are the 10 rights of medication administration?
Right drug, right dose, right patient, right time, right route, right reason, right documentation, right evaluation, right education, right to refuse
Define reproduction
The total process by which organisms produce offspring. There is sexual and asexual reproduction
What is the physiological process of reproduction?
Gametogenesis, Ovulation, Fertilization, Cleavage, Implantation, embryo and fetus
What is gestation?
The time between conception and birth when the embryo is developing in the uterus
What is Antepartum?
The time between conception and the onset of labor
What is intrapartum?
The time from the onset of true labour until the birth of the infant and placenta
What is postpartum?
The Time from birth until the woman’s body returns to an essentially pre-pregnant condition
What is the timespan of antepartum?
Spans 9 calendar months, divided into first second and third trimesters.
What length is each trimester?
First: 1-13 weeks
Second: 14-26 weeks
Third: 27 weeks through to gestation
What is considered a preterm pregnancy?
A pregnancy between 20 weeks and 36 weeks gestation
What is a term pregnancy?
Pregnancy beginning from 37 weeks of gestation until 40 weeks gestation
What is viability?
The capacity to live outside the uterus, occurring about 22 to 25 weeks of gestation
What is a stillbirth?
A neonate born dead after 20 weeks gestation
What is abortion?
Spontaneous loss or termination of pregnancy prior to 20 week or fetus weighing less than 500 g
What is gravidity?
Pregnancy
What is Gravida?
A person who is pregnant
What is primigravida?
A person who is pregnant for the first time
What is multigravida?
A person who has had two or more pregnancies
What is nulligravida?
A person who has never been pregnant and is not currently pregnant
What is parity?
The number of pregnancies in which fetus or fetuses have reached 20 weeks gestation
What is para?
A woman who has produced one or more viable offspring
What is Nullipara?
A person who has not completed a pregnancy with a fetus or fetus beyond 20 weeks gestation
What is Primipara?
A person who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks gestation
What is multipara?
A person who has completed two or more pregnancies to 20 weeks gestation or more
What does GTPAL mean in obstetric history?
G- Gravida: current pregnancy to be included in count
T- Term: number of pregnancies ending at term
P- Preterm births : pregnancies ending between 20 and 36 weeks
A- Abortions: pregnancies ending before 20 weeks
L- Living children : current living children
What is Nageles rule for estimated date of birth?
Determine first day of last menstrual period, add seven days to it and then count forward nine months.
How do STI’s effect pregnancy?
STI’s are responsible for significant morbidity and mortality, consequences include infertility and sterility.
How does group B streptococcus affect pregnancy?
GBS May be normal flora in non pregnant women. GBS Infection in pregnant women is associated with poor pregnancy outcomes. Important in perinatal and neonatal morbidity due to transmission during birth.
What is ectopic pregnancy?
When the fertilized ovum is implanted outside the uterine cavity. 95% of ectopic pregnancies occur in the fallopian tube. Most cases are diagnosed based on abdominal pain, delayed menses, abnormal vaginal bleeding.
What is hyperemesis gravidarum?
When vomiting during pregnancy becomes excessive enough to cause weight loss, electrolyte imbalance and nutritional deficiencies. Etiology is not well understood.
What is intrapartum?
The time from the onset of labour until the birth of the infant + placenta
What are the 5 factors affecting labor? (5 P’s)
Passenger, passageway, powers, position, psychological response
What is considered the passenger?
The fetus and the placenta
Describe the fetal skull?
Largest and least compressible structure.
What are fontanels?
The areas where more than two bones meets. Palpation of the fontanels during vaginal examination reveal the fetal presentation, position and attitude.
What is fetal presentation?
The part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term.
What are the main presentations of fetal passengers?
Cephalic (96% of births), Breech (3% of births), Shoulder (less than 1%)
What is fetal lie?
Lie is the relation on the long axis (spine) of the fetus to the long axis (spine) of the mother
What are the two primary fetal lies?
Longitudinal (vertical) and Transverse (horizontal)
Vaginal birth cannot occur when the fetus stays in a transverse lie
What is fetal station?
The relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines. The placement of the presenting part is measured in centimetres above or below the ischial spines.
What is the passageway and what does it consist of?
The passageway is the birth canal, it is composed of:
Mothers rigid bony pelvis, soft tissues of the cervix, pelvic floor, vagina, introitus
What is the Ferguson Reflex?
Maternal urge to bear down
What are signs of preceding labor?
Lightening or dropping 2-4 weeks before term, bloody show
What are the stages of labor?
1st: from onset of uterine contractions to full dilation of cervix, divided into latent and active phases.
2nd: from the time there cervix is fully dilated to the birth of the fetus, divided into latent & active phases
3rd: from birth of fetus until placenta is delivered
4th: lasts 2 hours after the delivery of the placenta
What is uterine activity?
Contractions
What are the parameters and phases of contractions
Parameters: frequency, duration, intensity
Phases: building up, max height, letting up
What is important to remember about uterine activity?
That uterine activity must be documented in conjunction with fetal heart rate
