Midterm Flashcards
1
Q
Adverse socio-economic conditions
A
Discusssion
2
Q
Age less than 17 over 40
A
Discussion
3
Q
Cigarette and/or cannabis use
A
Discussion
4
Q
Grand multipara (5 or more births)
A
Discussion
5
Q
History of substance abuse
A
Discussion
6
Q
History of infant over 4500 g
A
Discussion
7
Q
History of 1 late miscarriage (after 14 weeks) or one pre term birth
A
Discussion
8
Q
History of one small for gestational age infant
A
Discussion
9
Q
Less than 12 mo from last delivery to present date
A
Discussion
10
Q
Poor nutrition
A
Discussion
11
Q
Previous antepartum hemorrhage
A
Discussion
12
Q
Previous postpartum hemorrhage
A
Discussion
13
Q
One documented previous low-segment cesarian section
A
Discussion
14
Q
History of hypertensive disorders of pregnancy
A
Discussion
15
Q
Known uterine malformations or fibroids
A
Discussion
16
Q
History of trauma or sexual abuse
A
Discussion
17
Q
Current medical conditions that may affect pregnancy or are exacerbated due to pregnancy, family history of genetic disorders, hereditary disease or significant congenital anomalies
A
Consultation
18
Q
Pre existing (chronic) hypertension
A
Consultation
19
Q
History of cervical cerclage
A
Consultation
20
Q
History of 3 or more first trimester spontaneous abortions
A
Consultation`
21
Q
History of one or more second trimester spontaneous abortions
A
Consultation
22
Q
History of more than one preterm or one preterm birth less than 34 weeks
A
Consultation
23
Q
History of significant medical illness
A
Consultation
24
Q
Previous myomectomy, hysterotomy or cesarean section other than one documented previous low-segment cesarean section
A
Consulatation
25
Previous neonatal mortality or stillbirth
Consultation
26
Age less than 14 yo
Consultation
27
History of postpartum hemorrhage requiring transfusion
Consultation
28
Current medical condition(s) that may adversely affect or are exacerbated by pregnancy that require specialized medical care (common examples include cardiac disease, renal disease, pre-existing insulin-treated diabetes mellitus)
Transfer
29
No prenatal care before 28 weeks gestation
Discussion
30
14 social determinants of health
1) Education (2) Income and Income distribution (3) Unemployment and Job security (4) employment and working conditions (5) early childhood development (6) food insecurity (7) social exclusion (8) social safety networks (9) health services (10) aboriginal status (11) race (12) gender (13) disability (14) housing
31
BMI
weight (kg) / height (m) ^2 normal 18.5-24.9
32
Naegle's Rul
-3 mo + 7 days, subtract >28, add <28
33
Components of a soap note
Name:
Demographics: Age (gender) GTPAL at _ gestation, in for ____
Subjective : what client says
Objective: what you see
Assessment: Urgent: most pressing first, non urgent: most likely to least likely
Plan: what we need to do next. Include plan for next meeting
34
Setting for Health History
4 Cs
Courtesy: Introduce, Acknowledge, confidentiality, professionalism
Comfort: Sit, eye level, calm, open expression, calm pace, quiet, private, good temp.
Connection: eye contact, listen, language, open ended questions, flexible, know form, nothing b/w you
Confirmation: verbal cues, body language, summarize, ANYTHING ELSE YOU WANT TO TELL ME?
35
Determinants of Health breakdown
Clinical care - 10 %, Social and economic factors 40%
36
Symptoms of pregnancy
Presumptive – experience ie. Tires, sore breasts (client's words)
Probable – enlarged uterus, Hegals sign, urine test (midwive's assesment)
Positive – FHR, BHCG, US with FH activity (tests)
37
Why do we do a history?
(1) Identify medical risk factors (2) Guide care planning for care and consults (3) Learn what we need to know to provide care/build a relationship
38
What's on ANR Part 1?
1) Demographics
2) Allergies and medication
3) EDD and contraceptives
4) OBST history
5) Present pregnancy
6) Family history
7) Medical history
8) Physcosocial
9) Substances
39
(1) Demographics section?
Name, family doc, DOB, Age at EDD, preferred name pronouns, Language, Ethnicity, Indigenous Identity, Highest level of education, Parter's name, Age, occupation, ethnicity, bio donor?
40
(3) EDD and contraception section?
Contraceptives (last used), pregnancy planned, LMP, EDD by LMP, Dating US GA and EDD
41
(2) Allergies and Medication section?
Allergies, Medication - including supplements and herbs, TI folic acid, pre-conception folic acid, Beliefs/practices
42
(4) Obstetrical history section?
GTPAL
(Term being 37 weeks on)
(Abortus being 20 weeks less)
Record all births - Date, Place of birth, GA, duration of labour, Mode of birth, Perinatal complication/comments, Sex, Birth weight, Breastfed, Child's present health
43
(5) Present pregnancy
ART, Bleeding, Nausea, Travel (self/partner), infection/rash/fever, Other
44
(6) Family history
Anaesthetic complications, Hypertension, Thromboembolic, Hiabetes, Mental Health, SUD, Inherited conditions, Other
45
(7) Medical History
Surgery, Anesthetic complications, Neurological, Respiratory, CV, Abdominal/GI, Gynaecological, Hematology, Endocrine, Mental health, Infectious disease, Immunizations, Other
46
(8) Lifestyle/Social
Diet/nutrition, exercise, financial, housing/food security, transportation, safety, gender based violence, relationship/support
47
(9) Substance Use
Alcohol (drinks per week), 4 or more drinks at a time, Quit alchohol when ?, Tobacco, cigarettes [er day, 2nd hand smoke, quit cigarettes?, Cannabis, Other drugs
48
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
49
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
50
Lateral? Medial? Distal? Proximal?
Lateral away from midline, Medial toward the midline, Distal down toward bottom, Proximal up toward top.
51
What are the vital signs?
Oxygen saturation, temperature, heart rate, respiration rate, blood pressure
52
Why Vital signs?
Helps determine need for immediate intervention, urgent reassessment, transfer of care (Blood pressure and respiration rate at all meetings)
53
When vital signs?
Antenatal and postpartum visits, labour assessments, birth, in emergencies repeat frequently
54
Tell about temperature?
Normal range 36-37.5, 38 is fever. Reasons: dehydration, infection, exercise, stress thyroid disorder.
55
Tell about oxygen saturation?
Should ne 95-100 SPO2 AKA O2Sat, Pulse Oxymeter, SAT monitor
56
Where to take heart rate? Normal range?
Radial - in wrist below thumb (EASIEST), Bracheal - in antecubital foss (inside dip of elbow), Carotid- in neck, femoral - where leg and groin meet, Pedal - on top of foot. Normal range 60-89 ,could be 100 in labour.
57
Tell about respiration rate?
Before counting make sure they can talk and breath. Take when not aware for 30-60 seconds, One count cycle full breath in and out. May be elevated dehydtration, anxiety, hypovolemia, infection, asthma 12-16 breaths per minute
58
What is systolic and diastolic and normal range?
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
59
How to take blood pressure?
Appropriate size cuff, automatic or manual
Equipment: Stethescope and sphygmomanometer
Position, sitting, standing, lying down
Which arm: no hx blood clots etc
One step: pump until you do not hear pulse then increase 20
Two step: Feel for pulse then increase 20
Extend arm, supported and relaxed
Palpate brachial artery
Place arrow/ marker 2-5cm above the artery and close velcro
Fit: slide two fingers under, should not be too loose or too tight, or may get inaccurate BP
Make sure you can see sphygmomanometer
Place stethoscope over brachial artery
Close the valve on the pump and inflate until you do not hear the brachial artery anymore
Let it drop slowly
Listen for first sound – systolic
Listen for when the sound stops – diastolic
60
What are some practical steps around trauma informed care?
1. Realizes the widespread impact of trauma and
understands potential paths for recovery;
2. Recognizes the signs and symptoms of trauma
in clients, families, staff, and others;
3. Responds by fully integrating knowledge
about trauma into policies, procedures, and
practices; and
4. Seeks to actively resist retraumatization.
6 principles:
1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice, and choice
6. Cultural, historical, and gender issues
