Module 7- Medical Emergencies II Flashcards

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1
Q

Describe the pathophysiology and the signs and symptoms associated with appendicitis

A
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2
Q

Describe the pathophysiology and the signs and symptoms associated with gastrointestinal bleeding

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3
Q

Describe the pathophysiology and the signs and symptoms associated with esophageal varices

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4
Q

Describe the pathophysiology and the signs and symptoms associated with abdominal aortic aneurysm.

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5
Q

Explain the technique of restraining a combative patient.

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6
Q

Describe the pathophysiology, the signs and symptoms, treatment, and evidence preservation associated with sexual assault.

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7
Q

Describe the pathophysiology, signs and symptoms, and treatment associated with esophageal varices

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8
Q

Recognize indications for physical restraint of a patient and follow principles of safe physical restraint of patients

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9
Q

Describe emergency medical care for a heat emergency patient with moist, pale, normal-to-cool skin

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9
Q

Define poisoning:

A

is any substance—liquid, solid, or gas—that impairs health or causes death by its chemical action when it enters the body or contacts the skin.

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10
Q

Describe special considerations in assessing and managing patients with Carbon Monoxide Poisoning:

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11
Q

Describe the important steps in managing a poisoning patient, regardless of the specific poison or route of exposure:

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12
Q

Describe each of the 4 routes by which poison can enter the body

A
  • Ingestion
  • Inhalation
  • Injection
  • Absorption
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13
Q

Describe the basic anatomy and physiology of the female reproductive system

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14
Q

Describe the pathophysiology of drowning, important assessment questions, and management of drowning patients

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15
Q

Describe the signs and symptoms and the emergency medical care for anaphylactic shock resulting from a bite or sting

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16
Q

Recognize the signs and symptoms associated with all types of hyperthermia:

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17
Q

Describe the anatomy and physiology of the retroperitoneal structures:

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18
Q

Explain actions you should take to protect your own safety when responding to a water emergency:

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19
Q

Describe the pathophysiology and the signs and symptoms associated with pelvic inflammatory disease:

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20
Q

Understand the difference between visceral, parietal, and referred pain

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21
Q

Describe the emergency care for a heat emergency patient with hot skin that is moist or dry

A
  • Ingestion
  • Inhalation
  • Injection
  • Absorption
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22
Q

Recognize behavioral characteristics of paranoia, schizophrenia

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23
Q

Describe the association between shallow water diving and spinal injuries

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24
Q

Understand the meaning of tolerance, withdrawal, dependence, adverse reactions, and delirium tremens, and overdose

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25
Q

Describe the pathophysiology and the signs and symptoms associated with endometriosis:

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26
Q

Explain the pathophysiology of lightning strike injuries and the associated emergency medical care

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27
Q

Describe the signs and symptoms associated with hypothermia

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28
Q

Explain the pathophysiology of decompression sickness

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29
Q

Describe special considerations in assessing and managing patients experiencing emergencies associated with huffing

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30
Q

Describe the signs and symptoms and the emergency medical care for a bite or sting

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31
Q

Understand the purpose of performing a Markle test on a patient complaining of abdominal pain and how the properly perform this test

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32
Q

Describe the pathophysiology and the signs and symptoms associated with kidney stones, urinary tract infection, and kidney failure

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33
Q

Explain the importance of recognizing and responding to patients suffering from behavioral emergencies

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34
Q

Describe the indications, contraindications mechanism of action, side effects, dosage, and administration of activated charcoal

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35
Q

Describe the emergency care for patients with generalized hypothermia and localized cold injury

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36
Q

Recognize factors that contribute to a patient’s risk for urban hypothermia

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37
Q

Given a scenario involving a patient who has absorbed a poison, describe the steps of assessment-based management

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38
Q

Describe the pathophysiology and the signs and symptoms associated with peritonitis

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39
Q

Discuss basic principles related to the assessment and management of patients with behavioral emergencies

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40
Q

Sensitization is the process by which the​ body:

A

produces antibodies to combine with antigens and destroy them.

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41
Q

What organs are in the LUQ?

A

stomach, spleen, left kidney, part of the pancreas; in the right lower quadrant

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42
Q

What organs are in the RUQ?

A

liver, gallbladder, right kidney, part of the pancreas, and duodenum; in the left upper quadrant

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43
Q

What organs are in the LLQ?

A

descending colon, sigmoid colon, left ovary (in females)

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44
Q

What organs are in the RLQ?

A

cecum, appendix, part of the small intestine, right ovary (in females); and in the left lower quadrant

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45
Q

Somatic pain is:

A

pain that originates in the body’s soft tissues, such as the skin, muscles, tendons, joints, and bone

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46
Q

Parietal pain is:

A

a type of abdominal pain that occurs when the parietal peritoneum, the lining of the abdominal cavity, is irritated

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46
Q

What are the four quadrants?

A

RUQ (Right upper quadrant), RLQ (Right lower quadrant), LUQ (Left upper quadrant), LLQ (left lower quadrant)

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46
Q

What are the 9 abdominal regions?

A
  1. Right Hypochondriac
  2. Epigastric Region
  3. Left Hypochondriac
  4. Right Lumbar
  5. Umbilical cord
  6. Left Lumbar
  7. Right Illiac
  8. Hypogastric Region
  9. Left Illiac
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47
Q

tachypneic, tachycardic, Bradycardia,

A

Tachypnea: Rapid breathing
Tachycardia: A fast heart rate
Bradycardia: A slow heart rate

48
Q

Define Antigen:

A

Foreign substances

49
Q

Define Allergen:

A

Specific type of antigen

50
Q

What are the 4 ways antigens can enter your body?

A
  • Injection
  • Ingestion
  • Inhalation
  • Contact (absorption)
51
Q

When the body detects antigens it releases ________.

A

Antibodies

52
Q

What is the treatment for a mild allergic reaction?

A

Benadryl (diphenhydramine) or topical anti-inflammatory (Hydrocortisone)

53
Q

What is the treatment for anaphylactic reaction or anaphylaxis?

A
54
Q

If cardiovascular collapse and hypotension are present during a severe allergic reaction, this life-threatening response can be referred to as:

A

anaphylactic shock

55
Q

The type of antibody that is produced specific to anaphylaxis is called

A

Immunoglobulin E (IgE)

56
Q

What is hypersensatization?

A

State of the body that reacts to the antigen, that causes a allergic reaction reactions to that substance

57
Q

What is sensitization?

A

exposure that results in hypersensitization to a specific antigen

58
Q

What is the treatment for anaphylactic reaction?

A

First line treatment: Epinephrine

Swelling in upper airway:

  • Inset airway adjunct

Swelling at the larynx:

  • PPV with high air flow

Unresponsive, inadequate breathing, etc.

  • PPV with high flow oxygen
  • endotracheal Intubation
59
Q

What are the early signs of anaphylaxis?

A
  • Rhinitis (stuffy, runny, itchy nose)
  • Tachycardia
  • Pruritus (itching)
  • Faintness or light headness
  • Warm, flushed skin
  • Agitation or anxiousness
  • Urticaria (Hives)
  • Edema (swelling of the skin)
  • abdominal cramping
60
Q

Most anaphylactic reactions are apparent within _______ minutes after exposure to the antigen

A

20 minutes

61
Q

Signs of anaphylactic reaction by body system :

A

Skin:

  • Warm, tingling feeling in the face, mouth, chest, feet, and hands (early symptom)
  • Intense itching (pruritus), especially of hands and feet (hallmark symptom)
  • Hives (urticaria) (hallmark sign)
  • Flushed or red skin
  • Swelling to the face, lips, neck, hands, feet, and tongue
  • Cyanosis (severe cases
           Respiratory System:
  • Patient complaints of a “lump in the throat”
  • Tightness in the chest
  • High-pitched cough
  • Tachypnea (increased breathing rate)
  • Labored breathing
  • Noisy breathing (wheezing, stridor, or crowing)
  • Impaired ability to talk or hoarseness
  • Excessive amounts of coughed-up mucus
  • Partially or completely occluded airway
  • Difficulty in breathing
  • Cardiovascular System
  • Tachycardia (increased heart rate)
  • Hypotension (decreased blood pressure)
  • Irregular pulse
  • Absent radial pulse (severe shock)
        Central Nervous System: 
  • Increased anxiety
  • Light-headedness
  • Unresponsiveness
  • Disorientation
  • Restlessness
  • Seizures
  • Headache
     Gastrointestinal System:
  • Nausea/vomiting
  • Abdominal cramping
  • Diarrhea
  • Difficulty in swallowing
  • Loss of bowel control
          Genitourinary System:
  • Urgent need to urinate
  • Cramping of the uterus
  • Generalized Signs and Symptoms
  • Itchy, watery eyes
  • Runny or stuffy nose
  • Sense of impending doom
  • Complaints of “not feeling well”
  • General weakness or discomfort
62
Q

three key categories of signs and symptoms that specifically indicate a severe anaphylactic reaction:

A

Airway and respiratory compromise:

Airway occlusion; respiratory distress or respiratory failure with possible wheezing or stridor

Shock (hypoperfusion):

Absent or weak pulses; tachycardia; decreased blood pressure (<90mmHg systolic BP); deteriorating mental status.

Gastrointestinal (GI) signs and symptoms:

Vomiting, diarrhea, abdominal cramping, and abdominal pain are common GI signs and symptoms seen in anaphylaxis

63
Q

What steps are needed in a severe systemic anaphylactic

A
  • Maintain patent airway
  • Suction any secretions
  • Maintain adequate oxygenation
  • Be prepared to assist ventilation
  • Administer epinephrine
  • consider ALS
  • Initiate rapid transport
64
Q

When is considered anaphylactic shock instead of anaphylactic reaction?

A

If cardiovascular collapse and hypotension are present

65
Q

Epinephrine:

Indications
Contraindications
Medication Form
Dosage
Administration
Actions
Side Effects

A

Indications:
Anaphylactic reaction or shock

Contraindications:
N/A

Medication form:
Liquid drug

Dosage:

  • Adult: 0.3 mg
  • Child/infant: 0.15 mg

Administration:
- IM for 3 seconds and rub for 10 seconds

Actions:

  • Mimics the response of the sympathetic nervous sys.
  • Alpha properties constrict blood vessels
  • Beta 2 prosperities relax the smooth muscles in the bronchioles to improve breathing & alleviate wheezing dyspnea
  • Beta 1 increases heart rate and contractibility
  • takes effects within seconds and last for 10-20 minutes

Side Effects:

  • Increased heart rate
  • pale skin
  • Dizziness
  • Chest pain
  • headache
  • nausea and vomiting
  • excitability and anxiousness
66
Q

What is a anaphylactic reaction ?

A

severe allergic reaction that is an exaggerated immune response to a foreign substance known as an antigen

67
Q

What are the signs and symptoms of poisons?

A
  • History of ingestion
  • Swelling of mucosal membranes
  • Nausea
  • Diarrhea
  • Altered mental status
  • Abdominal pain, tenderness distention, and/or cramps
  • Burns or stains around mouth, pain in mouth/throat and pain during swallowing
  • Unusual breath/body odors
  • Respiratory distress
  • Altered heart rate
  • Altered blood pressure
  • Dilated or constricted pupils
  • Warm/dry/cool/moist skin
  • Seizures
68
Q

Activated Charcoal:

Indications
Contraindications
Medication Form
Dosage
Administration
Actions
Side Effects

A

Indications:
May be used for PT who has ingested poison by mouth, upon medical direction

Contraindication:
- PT has altered mental status
- swallowed acids or alkalis
- unable to swallow
- overdose on cyanide

Medication form:
- Premixed in water
- Powder

Administration:
- consult medical direction
- Shake in container well
- no icecream, sherbet or milk

Actions:
- AC absorbs poisons in stomach, prevents absorption, and helps elimination from body
- not used for alcohol, kerosene, gasoline, caustics, metals, acids, alkalis

Side Effects:
- blackening of stools
- nausea/vomitting

69
Q

Primary assessment: What do you closely assess for breathing for a suspected PT with inhaled poison?

A

Adequate rate and depth of respirations

70
Q

Define bradypnea, hypopnea:

A
  • Bradypnea: slow breathing
  • Hypopnea: shallow breathing
71
Q

If PT has respiratory distress due to Alcohol, CNS , or depressants what treatment are provided?

A
  • inadequate breathing, PPV with supplemental O2 (10-12 / minute )
  • if adequate breathing, administer supplemental O2
72
Q

What are the 6 signs and symptoms of a high priority PT of alcohol and drug emergencies?

A
  • unresponsiveness
  • respiratory difficulties
  • fever
  • tachycardia , bradycardia, irregular pulse
  • voting with altered mental status
  • seizures
73
Q

CNS stimulants do what?

A

Excite the nervous system

74
Q

CNS stimulant signs and symptoms:

A

Excitability, elevated mood, agitation, uncooperativeness, tachycardia, tachypnea, dilated pupils, dry mouth, sweating, increased BP, loss of appetite, lack of sleep

75
Q

CNS depressants do what?

A

Depress the nervous system

76
Q

CNS signs and symptoms:

A

Euphoria, drowsiness, sleepiness, decreased breathing rate and depth, bradycardia, hypotension, dilated pupils that are sluggish to respond to light

77
Q

Narcotics are:

A

CNS depressants are derived from opium (opiates) or synesthetic opium (opioids)

78
Q

Narcotic signs and symptoms :

A

Bradycardia, hypotension, inadequate breathing rate and depth, cool clammy skin, lethargy, constricted pupils, nauseappssible respiratory distress and arrest can

79
Q

Hallucinogens signs and symptoms :

A

Motor disturbances, paranoia, anxiety, visual or auditory hallucinations, tachycardia, hallucinations, tachycardia, dilated pupils, flushed face, poor perception of time and distance,

80
Q

What are the 4 stages of alcohol withdrawal ?

A

Stage 1. This occurs within approximately and is characterized by nausea, insomnia, sweating, and tremors.

            Stage 2. This occurs within  to  and is characterized by a worsening of stage  plus hallucinations.
          
            Stage 3. This can occur as early as  following the last alcoholic beverage and is characterized by major seizures.
          
            Stage 4. This is characterized by delirium tremens which can occur  to  days after the last drink
81
Q

what is an opiod?

A

is any natural, synthetic, or semisynthetic agent that mimics the effects of morphine

82
Q

what is Fentanyl?

A

is a synthetic opioid pain reliever that is 50 to 100 times more powerful than morphine.

83
Q

What are the signs from opioid ?

A

-CNS depression
- Respiratory depression (decreased respiratory rate and tidal volume)
- Miosis (constricted pupils)

also

  • seizures
  • psychomotor delay
  • Dysarthria (speech delay from paralysis of face)
  • Ataxia
  • Tremors
  • Crackles
  • Hearing loss
  • Crackles from acute pulmonary edema
  • nausea and vomiting
  • Hypotension
  • Bradycardia
  • urinary retention
  • Pruititus
  • Hypoglycemia
  • Hypothermia
84
Q

Activated Naloxone:

Indications
Contraindications
Medication Form
Dosage
Administration
Actions
Side Effects

A

Indications:
for suspected or known opioid intoxication

Contraindications:
Hypersensitivity to Naloxone

Medication Form:
intravenous, subcutaneous, intramuscular, intranasal, or endotracheal route

Dosage:
typical dose is total 2 mg with in 1 mg each nostril.

Administration:
1. obtain medical direction offline/online
2. confirm medication
3. make sure each nostril is clear
4. consider restraining PT prior to treatment
5. Draw up 1 mg for needle
6. assemble nose spray device
7. spray in each nostril

Actions:
-Naloxone is a pure opioid antagonist with a rapid onset of action.
-It competitively binds opioid receptors and can block opioid from attaching to receptor sites

Side Effects:
- Acute opioid withdrawal
- Increased blood pressure
- Headache
- Musculoskeletal pain
- Nasal dryness, edema, congestion or inflammation

85
Q

What are the symptoms of

A

Long-term cannabis use over years, daily to weekly use of marijuana

  • Severe nausea and vomiting, often in the morning
  • vomiting that occurs in a cyclic pattern over months
  • Colicky (crampy) abdominal pain
  • Periumbilical or epigastric abdominal pain
  • Relief of symptoms with a hot shower or bath
  • Elimination of symptoms after stopping the use of cannabis
86
Q

What are the symptoms of HEP B & C?

A

Fatigue
Nausea and loss of appetite
Abdominal pain
Headache
Fever
Yellowish color of skin and whites of eyes (jaundice)
Dark urine

87
Q

What are the signs and symptoms of Tuberculosis?

A

Fever
Cough (often coughing up blood)
Night sweats
Weight loss

88
Q

What are the 3 categories of COVID-19 and what characterizes them?

A

Stage 1: Asymptomatic the first 1-2 days

Stage 2: over next few days virus replicates and 80% of those infected will have upper & airways

Stage 3: Remaining 20% will develop more serious symptoms as virus makes it way down to the alveoli

89
Q

What is a hollow organ ?

A

contain some type of substance that might leak into the abdominal cavity if the organ is perforated or injured

90
Q

List the 9 examples of hollow organs?

A

appendix
bladder
common bile duct
fallopian tubes
gallbladder
intestines
stomach
uterus
ureters

91
Q

What is solid organs?

A

are vascular (contain many vessels and a large amount of blood)

92
Q

What are 5 examples of solid organs?

A

kidneys
liver
ovaries
pancreas
spleen

93
Q

abdominal pain results from 3 of following mechanisms?

A
  • Mechanical forces (stretching)
  • Inflammation
  • Ischemia (organ and tissue hypoxia, or oxygen deficiency)
94
Q

Signs and symptoms of appendicitis:

A
  • Pain in RLQ
  • nausea and vomiting
  • low grade fever and chills
  • lack of appetite
  • abdominal guarding
  • Positive markle
95
Q

What is the “Markle Test” and how do you peform it?

A

a simple bedside test to check for appendicitis and other inflammation in the abdomen

  • Stand with their knees straight, with or without shoes
  • The clinician stands on their toes for a few seconds, then suddenly relaxes and comes down with their full weight onto their heels
  • The patient then does the same
95
Q

What are the Common Signs and Symptoms of Gastrointestinal Bleeding?

A
  • Hematemesis
  • Hematochezia
  • melena
  • altered mental status
  • Tachycardia
  • pale, cool , clammy skin
  • abdominal pain or tenderness
96
Q

Common Signs and Symptoms of AAA (abdominal aortic aneurysm)

A
  • Gradual onset of lower lumbar, groin, and abdominal pain
  • Rupture associated with sudden onset of severe, constant abdominal pain. Can radiate to the lower back, flank, or pelvis.
  • Testicular pain in the male patient
  • Possible nausea and vomiting
  • Mottled or spotty abdominal skin
  • Pale, cool, clammy, and possibly cyanotic skin in legs from decreased blood and perfusion
  • Absent or decreased femoral or pedal pulses
  • If the abdomen is soft and thin, a pulsating abdominal mass may be felt. If the aneurysm has burst, the abdomen will be rigid and tender.
  • If the aortic aneurysm is starting to rupture, the skin below the waistline can become cyanotic, cold, and mottled
97
Q
A
98
Q

S/S of GI bleeding:

A
  • Hematemesis (vomiting blood)
  • Hematochezia (red undigested blood in bowel movement)
  • Melena (dark tarry bowel movement, indicative of digested blood)
  • Dyspepsia (indigestion)
  • Hepatomegaly (enlarged liver)
  • Jaundice (yellowing of sclera and skin, indicative of liver problems)
  • Constipation or diarrhea
  • Agitation
  • Dizziness
  • Inability to find a comfortable po
99
Q

What is treatment for GI bleeding in Elderly look like?

A
  • Establish and maintain adequate airway
  • Be prepared to treat for shock

If SpO2 is less than 94%, start with Nasal cannula O2 with 2 lpm and titrate up to achieve 94%

If 6 lpm is not enough, switch to NBM with 10-15 lpm O2

100
Q

When assessing PT for Abdominal pain, what is a sign of internal bleeding?

A

Difference between Systolic and diastolic BP :

If it is narrow—along with tachycardia, and pale, cool, clammy skin—it can be a sign of internal bleeding.

Pale oral mucosa- can mean longer internal bleeding

101
Q

What is the emergency care for Abdominal pain?

A
  1. Keep airway patent
  2. place PT in position of comfort
  3. if breathing is inadequate, began PPV
  4. if breathing is adequate, maintain oxygenation and consider using supp. O2
  5. never give anything by mouth
  6. calm and reassure PT
  7. if signs of hypoperfusion are present treat for shock
  8. Initiate quick transport
102
Q

S/S of Sickle cell crisis :

A

Bone pain

            Joint pain
          
            Fever
          
            Chest pain
          
            Shortness of breath
          
            Fatigue
          
            Pale skin
          
            Tachycardia
          
            Jaundice (yellowed sclera and skin)
          
            Ulcers on the lower legs
          
            Excessive thirst
          
            Priapism
          
            Frequent urination
          
            Sudden blindness in one eye
103
Q

What is treatment for “sick cell crisis”?

A

Ensure an adequate airway, ventilation, oxygenation, and circulation.

104
Q

What is pulmonary embolism?

A

a blockage in a lung artery caused by a blood clot that travels from a vein in the body to the lungs

105
Q

What are the female organs and their function?

A

vagina, uterus, ovaries, and fallopian tubes

Vagina:
Birth canal for baby, canal for penis during intercourse, passageway for menstrual cycle

Uterus:
organ that provides an appropriate site for egg implantation and fetal development during pregnancy

Ovaries:
excrete hormones and develop and release eggs that are needed for reproduction

Fallopian Tubes:
Where fertilization of egg occurs

106
Q

Common Signs and Symptoms of a Spontaneous Abortion:

A

Lower abdominal or pelvic pain

            Abdominal tenderness
          
            Vaginal bleeding
          
            Rapid pulse
          
            Signs and symptoms of shock (rare)
107
Q

dysmenorrhea:

A

severe pain or cramps during mensuration

108
Q

mittelschmerz :

A

abdominopelvic pain during middle of menstrual cycle that is associated with ovulation

109
Q

Common Signs and Symptoms of an Ovarian Cyst:

A
  • Unilateral abdominopelvic pain that can radiate to the back
  • Abdominal tenderness
  • Vaginal bleeding that can be irregular or abnormal
  • Pain during sexual intercourse or bowel movements
110
Q

Emergency Medical Care for abdominopelvic pain or vaginal bleeding:

A
  1. establish spine restriction if necessary
  2. keep airway patent
  3. if breathing is inadequate start PPV
  4. if breathing is adequate, maintain oxygenation and consider using supp. O2
  5. Control any major vaginal bleeding if present
  6. place PT in position of comfort
  7. calm patient
  8. reassure PT
111
Q

What are 3 Common Genitourinary/Renal Conditions:

A

Urinary tract infections

Kidney stones

Kidney failure

112
Q

Common Signs and Symptoms of Urinary Tract Infections:

A

Abdominopelvic pain or tenderness

Blood in the urine (hematuria)

Urine with cloudiness or a foul or strong odor

Pain or burning with urination or sexual intercourse

Frequent or urgent need to urinate

Genital or flank pain

Fever or chills

Nausea or vomiting

Altered mental status

113
Q

Common Signs and Symptoms of Kidney Stones:

A

Abdominopelvic pain or tenderness

Flank or back pain that is colicky and severe

Groin pain

Abnormal urine color

Pain with urination

Frequent or urgent need to urinate

Fever or chills

Nausea or vomiting

114
Q

Common Signs and Symptoms of Kidney Failure:

A

Blood in the urine or stools

Altered mental status

Edema of the feet, ankles, and legs

Decreased urine output or cessation of urination

Hypertension

Swelling or easy bruising

Anorexia

Tachycardia

115
Q

What are some adverse effects and life-threatening complications from Dialysis?

A

Hypotension

Muscle cramps

Peritonitis (especially in peritoneal dialysis)

Nausea and vomiting

Hemorrhage (especially from the access site)

Infection at the access site

Irregular pulse or cardiac arrest

Sepsis

Difficulty breathing

116
Q

Treatment for dialysis emergency:

A

Maintain the airway, breathing, and circulation.

Support ventilation as needed.

Provide high-concentration oxygen.

Stop any bleeding from the shunt or access site as needed.

Position the patient. If the patient has signs of shock, place him in a supine position. If the patient has pulmonary edema, place him upright.

Transport.

117
Q

signs and symptoms associated with a genitourinary or renal emergency

A

Urine with an abnormal color, consistency, or odor

            Abdominopelvic pain or tenderness
          
            Nausea and vomiting
          
            Fever or chills
          
            Syncope or altered mental status
          
            Pain or burning during sexual intercourse, urination, or a bowel movement
          
            Flank, groin, or back pain
          
            Frequent or urgent need to urinate or decreased urine output
          
            Blood in the urine (hematuria)
          
            Edema of the feet, ankles, and legs
          
            Hypertension
          
            Anorexia
          
            Tachycardia
          
            Signs of shock
118
Q

What is the “Heel Jar test”?

A
119
Q

What are two types of test that can check for appenditicis?

A
  • Markle test
  • Heel jar test
120
Q
A