Obstetrics and Gynecology Flashcards
1
Q
Internal Anatomy Definition: Ovaries
A
- the gonads of a female, and primary reproductive organ; releases ovum during ovulation
2
Q
Internal Anatomy Definition: Fallopian Tubes
A
- connects ovaries to uterus; fimbriae catch developed follicle/egg and fallopian tubes transport unfertilized egg to uterus
3
Q
Internal Anatomy Definition: Uterus
A
- muscular organ in which the fertilized egg implants itself to begin growth
4
Q
Internal Anatomy Definition: Cervix
A
- opening of the uterus into the vaginal canal; this dilates during childbirth
5
Q
Internal Anatomy Definition: Vagina/Vaginal Canal
A
- opening between the external and internal genitalia
6
Q
External Anatomy Definition: Labia Majora/Minora
A
- outer foldings of tissue that surround the urethra and vagina
7
Q
External Anatomy Definition: Urethral Orifice
A
- exit of the urinary system
8
Q
External Anatomy Definition: Vaginal Orifice
A
- opening of the vaginal canal into the internal reproductive system
9
Q
External Anatomy Definition: Clitoris
A
- erectile organ
10
Q
External Anatomy Definition: Perineum
A
- skin between the anus and vagina
11
Q
External Anatomy Definition: Anus
A
- exit of digestive system
12
Q
Menstruation
A
- endometrium (inner layer of uterus) thickens throughout uterine cycle to prepare for implantation of a fertilized egg into the uterus
- if this does not occur, uterine wall will shed alongside the unfertilized egg as a result of muscle contraction
- menstrual cycle normally lasts 28 days with 7 days of shedding/bleeding
13
Q
Menstruation Terms: Menarche
A
- time period in which a female first experiences menstruation; normally occurs between 11-16 years of age
14
Q
Menstruation Terms: Menopause
A
- occurs when female ceases to menstruate; occurs around 50 years of age
15
Q
Birth Control Terms: Condoms
A
- low risk, protects from most STDs, may cause reaction if allergic to latex
16
Q
Birth Control Terms: Oral Contraceptives
A
- increase likeliness of clots which may lead to further complications (extreme case: pulmonary embolism)
17
Q
Birth Control Terms: NuvaRing
A
- vaginal ring implanted through various times of menstrual cycle; can increase likelihood of clots
18
Q
Birth Control Terms: Implant
A
- hormonal implant usually in the arm; increases likeliness of clots
19
Q
Birth Control Terms: Diaphragm
A
- bendable cup implanted that closes off cervix to prevent pregnancy; no associated risks
20
Q
Birth Control Terms: Intrauterine Device
A
- T-shaped device that is implanted in the uterus; some are made out of varying metals, while others utilize hormones; increase likelihood of PID, perforate through the uterus, and lead to ectopic pregnancies
21
Q
Urinary Tract Infection (UTI)
A
- occur when bacteria enters urethra and begins to infect the urinary tract
- if left untreated, it may begin to infect the renal system and therefore infect the kidneys
- patients will display the frequent need to urinate however when they do so it is in small amounts, hematuria, and cloudy odorous urine
22
Q
Yeast Infections
A
- product of imbalance of vaginal fungus
- extremely common and effect 3/4 women
- causes inflammation of the vagina and surrounding tissue
- patients will display itching/burning sensations, painful urination and intercourse, and thick white “cottage cheese” discharge
23
Q
Sexually Transmitted Infections (STIs)
A
- HIV/AIDS
- Chlamydia
- Gonorrhea
- Genital Warts
- Genital Herpes
- HPV
- Syphilis
- Pubic Lice (crabs)
- be concerned if patients displays itching, burning, painful urination, discharge with unusual odor and color, painful intercourse, fever, flu-like symptoms, abdominal pain, vaginal bleeding
24
Q
Ovarian Cysts
A
- fluid filled or solid pockets that develop in ovary
- commonly occur due to imbalance of hormones, which can be resolved by taking oral contraceptives that regulate hormones
- rupture of cysts can lead to sepsis
25
Endometriosis
- occurs when inner lining of the uterus (endometrium) thickens and grows outside of the uterus
- endometrium will continue to thicken during menstrual cycle, but has no means of exiting which leads to severe inflammation and scarring of surrounding tissues
- can lead to ovarian cysts infertility
- S/Sx: severe pain in abdomen, heavy bleeding, abnormal bleeding in between periods, painful urination/bowel movements, and painful intercourse
26
Pelvic Inflammatory Disease
- infection of the upper female reproductive system, most commonly the result of an untreated infection
- may cause scarring on fallopian tubes and lead to various complications such as infertility and an ectopic pregnancy
- as infection spreads to ovaries, it may lead to formation of abscess which has potential to burst; can lead to sepsis
- S/Sx: severe lower abdominal pain, odorous discharge, painful intercourse, fever/chills, nausea/vomiting, and inability to walk due to pain "PID Shuffle"
27
Non-Menstrual Vaginal Bleeding
- can be many underlying causes, treat as if worst case scenario: cancer, ectopic pregnancy, spontaneous abortion, or vaginal trauma
- ensure you know extent of impact of blood loss on your patients stability during ABC
- if actively bleeding, you can give them an OB pad to hold their vagina
28
Vaginal Trauma
- most commonly the result of penetration
- sexual assault is the primary mechanism of vaginal trauma
- document times and mileage
- communication and emotional support is essential
- have a female perform assessment
- request a SANE nurse 10 minutes before arrival
- encourage patients not to change clothes or wash themselves
- be aware of potential shock
29
Pregnancy Terms: Placenta
- medium for exchange of vital nutrients such as oxygen and carbon dioxide
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Pregnancy Terms: Umbilical Cord
- connects the mother and fetus via the placenta
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Pregnancy Terms: Amniotic Sac/Fluid
- insulates and cushions the fetus
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Pregnancy Terms: Full Term
- 38-40 weeks
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Pregnancy Terms: Premature
- birth before 38 weeks
34
Pregnancy Terms: Postmature
- birth after 42 weeks
35
Pregnancy Terms: Trimester
- stages of pregnancy
36
Pregnancy Terms: Gravida
- amount of times patients has been pregnant
37
Pregnancy Terms: Para
- amount of live births
38
Pregnancy Terms: Abortus
- number of miscarriages, stillbirths, and abortions
39
Pregnancy Terms: Neonate
- any infant under 28 days old
40
Prenatal Development
- Germinal Period/Zygote: fertilized egg is implanting itself into the uterine wall
- Embryo (3-8 weeks): major organs begin forming such as the heart and brain
- Fetal Period (9-38 weeks): Body systems begin to function
- Age of Viability: age range in which fetus is born and still has a chance of surviving and developing normally; 23-25 weeks
41
Major Changes during Pregnancy
- increased blood volume, heart rate, cardiac output, stroke volume, and clot factor
- uterus grows with baby, which compresses organs and may expose fetus to injury
- pressure may be put on diaphragm and make breathing difficult and increase likeliness of vomiting and aspiration when pt. experiences trauma
- prone to falls due to shift in center of gravity
42
Ectopic Pregnancy
- occurs when fetus develops outside of the uterus
- rupture could cause mastic hemorrhaging
- high index of suspicion when we have pt of childbearing age with abdominal pain
- presents with sudden sharp abdominal pain that may be one-sided, heavy vaginal bleeding
43
Preeclampsia
- high BP during pregnancy with proteinuria
- not uncommon due to large increase in blood
- present with headaches, blurred vision, proteinuria, hypertension, and peripheral edema
44
Eclampsia
- S/Sx of preeclampsia with presence of seizures
| - call ALS, lay patient in left lateral recumbent and transport rapidly; get SpO2 and give O2
45
Miscarriages
- spontaneous abortions that occur within 20 weeks of pregnancy
- caused by hormone imbalances, infection/disease, exposure to harmful teratogens, and age of mother
- women over 35 have increased risk of miscarriage, risk after first trimester decreases
46
Stillbirth
- death of fetus after 20 weeks of pregnancy; generally uncommon
47
Abruptio Placenta
- placenta separates from uterus abruptly
- result of high BP and trauma
- presents with port wine vaginal bleeding, abdominal pain, uterine contractions
- may be in shock due to loss of blood
48
Placenta Previa
- placenta forms over cervix due to uterine abnormalities
- patients will have bright red vaginal bleeding, usually painless
- may be in shock due to loss of blood
49
Gestational Diabetes
- occurs in pregnant women who have never experienced diabetes prior to pregnancy
- result of hormones released by placenta that inhibit action of insulin, creating insulin resistance
- increases risk of Type II diabetes in both mother and fetus, as well as obesity and increased birth weight
- increased risk for eclampsia and high BP
- this can be managed by changing diet and other lifestyle factors such as exercise
- treat as general diabetic patients
50
Three Stages of Labor
1. Contractions and full dilation of cervix: longest period of labor; amniotic sac ruptures (water breaks)
2. Complete dilation of cervix to the delivery of infant: baby will be crowning and mother will feel urge to bear down
3. Once baby is delivered to delivery of placenta: may take up to 30 minutes
51
Staging the birth
- if patient is displaying crowning, delivery is immediate
- call for ALS
- BSI: gloves, gown, face shield
- private spot with a flat surface (rig)
- place sheets and towels throughout the floor
- place towels and pillows underneath the patient to elevate their hips 2-4 inches
- take sterile sheet from OB kit and position one underneath the patient, one draped around each thigh that wraps around the back, and one on the abdomen
52
Roles during Birth
- should be clear and defined roles for delivery
- one crew member delivers the baby: continually visualize and check for crowning, apply pressure to avoid peritoneum from tearing
- one coaches patient and monitors well-being: talking them through process, coaching breathing, providing O2 if necessary
- one should be focused on neonate care: APGAR score, post procedural protocols
53
Delivery Procedures
- instruct patient to push during contractions
- support infants head, apply pressure to perineum
- carefully puncture amniotic sac, then ensure it is not covering head or airway of infant
- once head is out, tell patient to stop pushing
- ensure umbilical cord is not wrapped around the neck; try to gently slip it off, if this doesn't work, clamp cord in two places and wait for cord to stop pulsating, then cut cord in-between two clamps
- suction airway if there is an obstruction or ventilations are required; insert bulb syringe in oropharynx no more than 1.5 inches and suction
- once delivered, use a towel to keep infant warm and dry, keep infant in face up position with head lower than the feet level to the vagina until the umbilical cord is cut
- may be green substance called meconium surrounding the infant; report this and ensure airway is not compromised
- cut umbilical cord approx. one minute after birth; place clamps three inches apart and 8-10 inches from infant; wait for pulsating to stop and cut between clamps
- keep infants head warm with hat in OB kit
- give a fundal massage to mother by kneading the abdomen to prepare for delivery of the placenta (encourages uterine contractions, helps promote clots to prevent hemorrhaging)
- if both patients are stable, give infant to mother to hold
54
APGAR Score
- obtain one after birth and one 5 minutes after initial recording
- healthy range is 7-10
- Activity (muscle tone): absent, flexed limbs, active
- Pulse: absent, < 100bpm, > 100bpm
- Grimace: floppy, minimal response to stimulation, prompt response to stimulation
- Appearance: blue pale, pink body blue extremities, pink
- Respiration: absent, slow and irregular, vigorous cry
55
Breech Delivery
- when buttocks present first, rather than the head
- administer high flow O2
- place fingers in a v-shape into birth canal to establish open path for infant to receive air
- elevate hips and transport rapidly
56
Limb presentation
- when limb is presented first during delivery; elevate hips and transport rapidly
57
Prolapsed Umbilical Cord
- cord is presented first during delivery
- elevate hips, palpate cord for pulses
- insert fingers into birth canal to relieve pressure of infant on the cord; do this until you pass off to ED staff
- wrap cord in sterile dressing and sterile water to keep it moist
- transport rapidly
58
Shoulder Dystocia
- when shoulder of infant gets stuck behind patients pubic bone; extreme life threat, can cause mass hemorrhaging in the mother and hypoxia for the infant
- elevate hips and transport rapidly
59
Questions to Ask
- how far along are you?
- when are you due?
- have you ever experienced any complications/are you anticipating them?
- when was the last time you visited your OBGYN?
- have you ever given birth before? Were there any complications?
60
Reflexes
- primate reflexes occur until 4-6 months of age
- Rooting: stroke baby cheek and they will turn towards stimuli
- Moro: if baby feels as if they are falling, they will spread their arms out and try to catch themselves
- Walking/stepping: if you hold baby up, they will feel the need to step
- Sucking: if object touches roof of mouth, it will begin sucking
- Palmar: if you place anything in infants palm, it will grasp onto it
61
Male Anatomy Terms: Penis
- male sex organ
62
Male Anatomy Terms: Testicles
- male gonads that produce hormones and sperm
63
Male Anatomy Terms: Epididymis
- located on top of the testicles and store mature sperm
64
Male Anatomy Terms: Scrotum
- skin that surrounds testicles that aid in thermoregulation
65
Male Anatomy Terms: Prostate
- gland surrounding the urethra, it secretes various fluids that are added semen
66
Testicular Torsion
- one testicle of scrotum rotates and twists, cutting off circulation to other testicle
- present with severe scrotum pain, swelling, fever, abdominal pain
- emergency care to prevent permanent nerve damage to infertility
67
Benign Prostatic Hyperplasia
- prostate gland is enlarged
- prostate can cut off urethra causing inability to urinate, UTIs, kidney stones, and possible kidney damage
- more common in older males with history of heart disease, obesity, and heart diseases
68
Prostate Cancer
- will present with many of the same symptoms of BPH
| - usually associated with pelvic pain, blood in semen, and erectile dysfunction
69
Phimosis
- when foreskin narrows around head of the penis
- usually occurs in infants, but can occur in older males due to infection or inflammation
- presents with difficulty urinating, painful arousal, different secretions that may be stuck under foreskin causing infection or even bleeding
70
Erectile Dysfunction
- often points to a larger medical issue
- seen in patient of oder age
- keep tract of ED medications patient is on and document
71
Neonatal Resuscitation
- once baby is delivered, warm, and dry, stimulate it
- if you believe there is an airway obstruction or you'll need to initiate artificial ventilation, suction oropharynx, CALL FOR ALS
- if infant is apnea or gasping or heart rate is below 100 or infant displays central cyanosis, insert an OPA and BVM at 40-60 breaths per minute
- connect to supplemental O2 of O2 saturation falls below 95%
- take infants apical pulse when assessing heart rate
- after 30 seconds of ventilations, if heart rate is still below 60, begin chest compressions at 120/min
- rate: 3 compressions to 1 breath using any method
- never use AED on a neonate; hearts are underdeveloped and can't withstand electrical current
72
Apical Pulse
- back, little circle of stethoscope on the middle of the chest
