screening and care of OB and peds patients Flashcards
A pregnant pt comes into your office, what are some questions you may ask her to get general idea of her health ?
- pregnancy complications with previous or current
- MSK issues before or after the preg or with other pregnancies ?
- currently having any urinary or anal incontinence?
- did you stop taking any meds 2/2 preg?
A post partum pt comes into your office, what are some questions you may ask her to get general idea of her health ?
- bed rest during preg?
- type of delivery
- complication during delivery? like an episiotomy ?
- forceps or vacuum extraction used?
- incontinence
- current symps present before or during pregnancy?
What are positions to avoid with pregnancy?
supine - hypotension can occur, decreased CO can also result in decreased uterine BF
Prone- to be avoided in 2ng/3rd trimester as fetus extends beyond pelvic brim
what should be on your checklist for pregnancy?
Depression DI disorders urogenital endocrine cardiovascular MSK
What types of depression can affect a pregnant women, what measure can you use ?
- prenatal
- post partum
Edinburgh post natal depression scale can be used, 10 or higher is +. But this outcome only addresses depression and not anxiety, personality disorder ect
What GI disorders can effect a pregnant women ?
General N/V with reflex
hyperemesis gravidarum
gall bladder
constipation
what is hyperemesis gravidarum
excess vomiting, nausea, electrolyte loss and weight loss
Your patient who is pregnant and shoulder pain listed on her intake form, what Qs will you ask to follow up?
R shoulder?
scapula or thoracic region?
MSK pain can mimic gall bladder pain
why are we concerned about poor motility in preg pts?
discomfort, ab bleeding may occur
strain during BM may lead to pelvic floor dysfxn prolapse or hemorrhoids
what are urogenital disorders that should be included in pregnancy screening ?
UTI acute cystitis (bladder infection) pyelonephritis (kidney infection) urinary/ anal incontinence organ prolapse
is a patient had a UTI, what would they complain of?
pain
urinary frequency
if a patient had a bladder infection, what would they complain of? a kidney infection?
urinary frequency burning/pain while voiding - supra pubic / sacral pain - kidney infection: - fever nausea vomiting costovertebral pain
what are Endocrine Disorders that pregnant patients can experience?
Gestational Diabetes Mellitus -Increased risk of HTN or preeclampsia -May require C-section -Increased risk developing type 2 DM post-partum mgmt = changes to the diet and incorporation of exercise
-CV exercise is more effective than just dietary changes
-If IDDM, monitor blood glucose levels before and after exercise
-Upper body exercise recommended-less stress on the trunk
Blood glucose levels decrease following 4 weeks of CV exercise
what is Supine Hypotension Syndrome
Due to fetal pressure on Inferior vena cava
- Supine/reclined or prolonged standing postures increase lordosis
- More common in third trimester
- Relieve by tilting, propping to one side with pillows
what should you be concerned about regaridng the CV health of a preg patient?
HTN and preclampsia
what is advanced preclmapsia ? what is ecalmpsia ?
Typically > 20th week of pregnancy, about 1/2 way through
- Due to BP and protein in urine (kidney problems)
-Eclampsia – onset of seizure activity
Additional signs: Persistent headache Blurred vision, sensitivity to light Edem Shortness of breath Low back and/or abdominal pain
what MSK disorder to preg pts present with?
- LBP
- make sure to screeen for kindey infection
- provide with LBP postioning and tx techniques
what does SI joint pn present as ?
- Direct/postural pressure in low back/SI region
- Sharp, located in sacral/buttock region
- May refer to LE/knee/foot
what does sacroiliitis present as ?
- inflammation of one/both SI joints
- SI joint stretch = stress, inflammation
- Secondary to UTI
what does Pubic Symphysis Pathology present as ?
- can be inflammed due to pressure late in preg
- separation of 10mm< after delivery=
- Difficult to WB, walk, needs assistance (6 weeks)
- Joint stabilization, controlled mobilization exercises (6-12 weeks)
- Possible external brace, pt ed in transfers and body mechanics
what does or thoracic Spine, Rib Dysfunction Pathology present as ?
Pain from low rib torsion
- Mostly in 3rdtrimester
- Assess in sitting or sidelying
- May persist postpartum
what are types of head aches you should look out for in screening a preg patient ?
XMigraines
- Seldom start during pregnancy, may continue
- Prepregnancy history may decrease due to increased estrogen
Tension
- Postural/mechanical cause
- Stress-induced
Other Causes
- Stress, dehydration, poor sleep, low blood sugar
- Pregnancy-induced HTN/Preeclampsia
- Ischemic/hemorrhagic stroke
- Arterial dissection
Persistent Postpartum
-Possible subdural hematoma s/p spinal anesthesia-
Refer for treatment
what is diastasis recti ?
2+finger width separation between rectus abdominis bellies -Measured via horizontal palpation w/curl-up Intrarater reliability (not interrater) -Transverse abdominis weakness pre-pregnancy linked to DR -Tendinous linea alba, may not return to normal length post partum -Recovery=improved urogenital and musculoskeletal health -Low evidence for exercise and taping to reduce diastasis -Transverse abdominis strengthening
what can a 0-12 month old do?
Most rapid physical development, significant growth rate,
crawl>sit>stand>start walk, explore environment
what can a 1-4 year old do ?
Physical development slows to ½ infancy
growth spurts
neurologic system matures>gross & fine motor skills, language
what growth does a preschooler 4-6 year old undergo?
Doubles birth weight height approx equal weight LE rapidly grow and child thins erect posture advance gait and gross motor
what developmental changes can you expect to see in a 6-12 yr old
- Weight +5-7lb/yr, height +3”/yr,
- continued growth spurts
- normalized gait
- vision 20/20
- inc strength and coordination
- high energy levels
when does puberty begin to start?
10-11 and peaks at 14-16
- after 2 years of puberty, menarche begins and by age of 16
- Critical dietary intake needed to maintain reproductive system, supply energy, promote bone and tissue health, achieve stature, etc.
what is the Female Athlete Triad ?
Decreased bone mineral density
Eating disorders
Amenorrhea
what are some Cardiovascular and Pulmonary risks that children have - up to 40% of them will have..
Obesity Physical inactivity Diabetes Environmental stress Aerobic metabolism 65 to 70% of the total aerobic capacity to that of adults
what is the avg age children are dx’s with cancer
6
what are Specific Adolescent Screens for Cancer
An unusual lump or swelling Unexplained pallor and lethargy Easy bruising An ongoing pain in one area of the body Sudden unexplained weight loss Limping Unexplained fever or illness that doesn’t go away Frequent headaches, often with vomiting Sudden eye or vision change
what are Neoplasms signs and symps
- Constant pain for malignant tumors
- Transient pain for benign tumors
- Local swelling, tenderness and joint pain
- Red flag is onset of pain in the absence of trauma
- located at the end of long bones
what is Osteochondrosis
derangement- ossification in the epiphysis.
May result from:
- Repetitive trauma
- Synovitis
- Infection
- Granulation tissue disrupting blood flow
what is a specific type of Osteochondrosis in the elbow?
panners disease:
Osteochondrosis of the capitulum -Pain, swelling and ROM limitations -Differential Dx Tendon injury at and Ligament injury in the lateral elbow
what is a specific type of Osteochondrosis in the hand?
Kienbock’s Disease:
- Osteochondrosis of lunate bone
- Onset due to repetitive microtrauma
- Pain with end range wrist extension
what is a specific type of Osteochondrosis in the hip?
Legg-Calve Perthes Disease
Painful PROM
ROM restrictions with hip IR
Trendelenburg gait
what is a specific type of Osteochondrosis in the foot?
Freiberg’s Disease
- Osteochondrosis of the distal epiphysis, 2nd/ 3rdmetatarsal
- Pain at MTP joint, increases with WB and toe extension during gait
what is a specific type of Osteochondrosis in the back?
Scheuermann’s
- Different growth rate in vertebra, post>ant
- Resultant kyphosis
- Resolves with approp exercises
- Brace can be used, surgery is rare
Osteochondritis Dissecan- what is it?
Fragment of the epiphysis becomes separated and then avascular
- Most commonly occurs in: Medial femoral condyle
- Posterior surface of the patella
- Femoral head
- Dome of the talus
- Capitulum of the humerus
Conservative vs surgical management:
- Conservative: fragment will eventually be resorbed
- Surgical: Necrotic segment of bone can be surgically removed or repaired
Idiopathic Scoliosis nuggets:
Adams forward bending test is not a reliable test -Curves progress in: 19% of girls Only 1% of boys -Management of Idiopathic Scoliosis
Observation – curve is < 25 degrees
Bracing – curve is progressing beyond 25 –30 degrees
Surgery – curve 45-50 degrees or signs of spinal instability or risk to CV/Pulm systems
