OB/Peds Flashcards
Normal QRS size for a pediatric
less than 0.9
Premature rupture of membranes
Amniotic sac ruptures more than an hour before labor. Sac can self heal. Labor will begin within 48 hours. If pregnancy is term or near term there is no concern. If not near term there is risk for infection. Emotional support and transport.
Preterm Labor.
Labor after the 20th week but before the 37th week. Threat is premature birth.
Fetal distress
Difficult to assess in the field. Rely on information provided by the mother such as not as much movement. Best care is care for the mother and rapid transport.
Uterine rupture
Occurs during labor. Greatest risk in patients that are multi para with uterine scar tissue. Sign is woman in active labor reporting weakness, dizziness, and thirst. initial strong painful contractions and then contractions slacked and now there is a strong tearing pain. signs of shock. vaginal bleeding. Treat for shock and rapid transport.
Precipitous labor and birth
Potential for head trauma in the infant.
Post term pregnancy.
fetus is not born after 42 weeks gestation. Potential for fetus to become malnourished due to placenta becoming non functioning. Increased risk of muconium aspiration. Risk of complications during delivery due to larger fetus. Best to be delivered via c section
Meconium staining
The first bowel movement of the fetus after birth that consists of passively digested substances is called meconium. In cases of fetal distress or stress caused by labor and delivery, the fetus may may void the meconium into the amniotic fluid. May result in chemical pneumonia in the fetus. Amniotic fluid should be clear. If it is yellow tinged then meconium has been in the amniotic fluid for a while. if it is green/black color then the meconium is new and is a sign of danger. manage airway.
Fetal macrosomia
Big baby syndrome.
Multiple gestation
Babies can appear pre term. keep track of which is delivered first. call for assistance as it is possible for multiple resuscitation.
Intrauterine fetal death
Death of a fetus during the couse of normal pregnancy. Usually defined as death of the fetus after 20 weeks of gestation or when the fetus weighs 500 grams or more. before this the death is considered a miscarriage. Can be caused by Rh factor, uncontrolled diabetes, hypertension, eclampsia, preeclampsia, infections. do not attempt resuscitation.
Amniotic fluid embolism.
life threatening condition that is extremely rare and hardly ever seen. risk factors: maternal age older than 35, eclampsia, abruptio placenta, placenta previa, uterine rupture, fetal distress. Amniotic fluid and fetal cells enter the womans pulmonary and circulatory system via umbilical veins. S/S: sudden onset of respiratory distress and hypotension. Many of these patients are very cyanotic and have seizures. eventually go into cardiogenic shock. unresponsive, cardiac arrest. if survied they develop coagulopathies(no ability to clot)
Cephalic presentation
Head presentation but in an abnormal position such as face first.
Breech presentations
Anything other than the head presents first. Usually the butt first. Best place for delivery is in the hospital. If impossible to reach hospital then refer to book for delivery procedure.
Shoulder dystocia
“difficulty in delivering the shoulders. McRoberts maneuver: hyperflex the legs toward the abdomen.
Nuchal cord.
umbilical cord wrapped around the fetus’s neck. Attempt to slip the chord over the fetus’s head and shoulders. If unable, then clamp and cut the chord.
Prolapsed umbilical cord
The umbilical chord appears ahead of the fetus.
Position woman supine with hips elevated. administer 100% o2 via NRB, tell woman to pant with each contraction to prevent bearing down, push presenting part(not cord) back into vagina until no longer pressing on cord, while maintaining pressure on the presenting part have partner cover the exposed portion of the cord with moist dressings, maintain that position while urgently transporting.
Uterine inversion
placentia fails to detach from uterine wall when it is expelled, uterus turns inside out. Keep patient recumbent, administer 100% o2 via nrb, start two IV lines, do not attempt to remove placentia from uterus, monitor vitals, treat for shock, consider oxytocin, 10 units IM, make one attempt to replace the uterus. If attempt fails, cover exposed parts in moist dressing and rapid transport.
Postpartum Hemorrhage
average blood lose during third stage is 0.3 pints(150mL) when blood loss exceeds 500 mL during the first 24 hours after birth it is considered post partum hemorrhage. Treatment: continue uterine massage, encourage breastfeeding, 10 units of oxytocin to IV bag(1000mL) infused at 20 to 30mL/min, notify hospital, transport without delay, start another large bore iv, externally manage hemorrhage.
Pulmonary embolism
one of the most common causes of maternal death during childbirth. same as normal PE
Postpartum depression.
Most common in financial or other life hardships during or before pregnancy. can result in thoughts of harming self or fetus after birth or no interest in the fetus after birth.
Fluid resuscitation dosages for pediatrics and adults.
Neonates: 10mL/kg
Pediatrics: 20 mL/kg
Gynecological infections
PID
Pelvic inflammatory disease(PID): infection of a woman’s reproductive organs. Often caused by STD’s such as chlamydia or gonorrhea. organisms enter the vagina usually through sexual intercourse and migrate into the uterine cavity. purulent fluid drips out. May report pain that generally starts during or after normal menstruation. Usually diffuse pain in lower quadrants sometimes made worse by walking or sexual intercourse. Pain can move to the upper right quadrant later when the infection moves to the abdomen.
Gynecological infections Bartholin abscess
two mall ducts just inside the vagina lead to the bartholin glands. These secrete mucus that acts as lubricant. These can cor a cyst and become blocked and sweel bilaterally or unilaterally.
Gynecological infections
Vaginitis
Inflammation of the vagina that is caused by infection. Can spread upward to cause PID. S/S itching, irritation, discharge, odor, painful intercourse, lower abdominal pain. can include yeast infections or vulvovaginitis.
Gynecological Infections
Cystitis
Bladder infection. Cloudy urine, frequent urination, hematuria, dysuria. may lead to pyelonephritis or infection of the kidneys.
Maternal changes in the third trimester.
Can increase RBC by 33% causing increased need for iron, blood volume increase by 30 to 50 %. Heart size increases. Uterus enlarges and can place pressure on the lower GI tract causing constipation. Increased progesteron can cause decrease GI motility which can cause heartburn and burping. Kidney volume can increase by as much as 30% causing increased urinary frequency. Skin color can change along with texture. Fetus can lay on inferior vena cava causing supine hypotension.
Pediatric croup
(laryngotacheobronchitis) is a viral infection of the upper airway. Transmitted via droplets. Primarily affects children between 6 months and 6 years of age. usually affects the subglottic space(the narrowest area of the pediatric airway.) Turbulent airflow through this part of the airway causes stridor. For treatment of mild use steroids to reduce inflamation. For severe use nebulized epi(racemic or L epi). If respiratory failure, BVM will usually overcome obstruction, advanced airway rarely needed.
Pediatric epiglottitis
Infection and swelling of the epiglottis. Swollen pus filled flap can obstruct the glottic opening. Most prevalent in 2 to 7 year olds. S/S will look sick and anxious, sit upright in sniffing position with chin thrust forward, drooling due to being unable to swollow secretions.
APGAR
Apearance: completely pink=2, extremities blue=1, centraly blue=0
Pulse: >100=2, <100=1, >0 or absent=0,
Grimace: cries=2, grimaces=1, no response=0
Activity: active motion=2, some flexion=1, limp=0
Respiratory: strong cry=2, slow and irregular=1, absent=0
Neonate resuscitation pyramid
Warm dry position suction stimulate
oxygen
ventilation
chest compressions
medications
thermal injury calculation for pediatric body surface area.
torso=18 back=18 arms=9 each head=12 legs=16.5 each
Types of seizures
generalized seizure:involves entire brain
partial seizure: part of the brain
tonic clonic:(grand mal) jerking of both arms and legs
Absence seizures: (petit mal) generalized seizures that involve brief loss of attention without body movement
simple partial seizure: focal motor jerking without loss of conciousness
complex partial seizures: focal motar jerking with loss of consciousness.
Treatment of tricyclic antidepressants
antidote is bicarbonate.
Stages of labor
total gestation period: 38 weeks.
Stage 1 of labor: starts with onset of labor pains. These contractions come at 5 to 15 minute intervals. Lasts about 12 hours in nullipara and up to 8 hours in multipara.
Stage 2: begins when the head descends to enter the birth canal(crowning.) Lasts until fetus is fully delivered. Lasts 1 to 2 hours in nullipara and 30 mins in multipara.
Stage 3: after the fetus is fully delivered until the placentia has been fully expelled. The placenta usually delivers spontaneously within 30 minutes after birth.
Positioning for prolapsed cord
position woman supine with her hips elevated as much as possible. instruct the woman to pant with each contraction. push presenting part back until it no longer presses on the cord. hold that position and transport rapid.
pedi et tube sizes.
- 5 uncuffed for infants up to 1 year.
- 0 for children between 1 and 2 years. 4+(age in years /4) for children older than 2
- 0 cuffed for infants
- 5 cuffed for children 1 to 2.
- 5+(age in years/4) cuffed for children older than 2.
S/S preeclampsia
After the 20th week. edema, hypertension, protein in the urine.
Severe preeclampsia= systolic > 160 or diastolic >110. headache, dizziness, nausea/vomiting, agitation, rapid weight gain, visual disturbances. may require mag sulfate to prevent seizures and administer anithypertensive medicaiton.
ET size neonates.
2.5 for premature delivery neonates.
uncuffed 3.5
cuffed 3.0
Fluid bolus dose for peds.
20 mL/kg
Preeclampsia vs eclampsia
eclampsia is seizures in the presence of preeclampsia symptoms.
best blade and size for infants and children
straight miller blades size 0 to 3.
Indications for ET intubation in pediatric patients.
Cardiopulmonary arrest, Respiratory failure or arrest, Traumatic brain injury, Unresponsiveness, Inability to maintain a patent airway, need for prolonged ventilation, Need for ET administration of resuscitative medications.
Treatment of croup
allow the child to assume a position of comfort, use humidified oxygen. A steroid such as dexamethasone may be administered IV or IM to reduce inflammation. For patients with stridor at rest, moderate to severe respiratory distress, poor air exchange, hypoxia or altered appearance, use nebulized epi(racemic epi and L-epi), if respiratory failure then BVM.
Difference between respiratory arrest and respiratory failure
Respiratory failure is when the increased work of breathing is no longer sufficient for adequate perfusion. Respiratory failure is the absence of breathing.
What are the fluid resuscitation dosage for peds over 50kg.
adult fluid dosages
Heart rate for pediatrics that indicates CPR
<60
S/S of meningitis
Bulging fontanel, ALOC, seizures, fever, photophobia, nuchal rigidity, irritability, petechiae, purpura, shock
Where is an egg fertilized by a sperm
fallopian tubes
The umbilical chord has how many veins and how many arteries?
1 vein(oxygenated) 2 arteries(unoxygenated)
Highest apgar score
10
determine if there is crowning or determine time between contractions first?
time between contractions
Complications of gestational diabetes
polyuria, polydipsia, polyphagia
Apgar scoring 7 - 10
normal
APGAR scoring 4 - 6
moderately depressed, needs resus
Methods to prevent heat loss for a newborn
warming hands, drying newborn, prewarmed cap, skin to skin on mother.
method newborns lose the most heat
convection
Placing too much force when performing uterine massage
can cause uterine inversion
Postpartum treatment of eclampsia
Still mag sulfate due to breastfeeding
Predisposing factors for ectopic pregnancy
anything that can cause scarring of the uterus(PID)
Treatment of vaginal bleeding
regardless of the cause all treatment is the same.
left lateral recumbent position 100% o2 nrb rapid transport large bore IV with 250mL fluid bolus 20mL/kg obtain ECG place trauma pads over the vagina.
