Special Populations Flashcards
An oocyte matures when the anterior pituitary gland releases:
Follicle-stimulatig hormone
___ is the hormone that stimulates the maturation of an oocyte
Follicle-stimulating hormone
___ stimulates the release of the ovum
Luteinizing hormone
What is left of the follice after the egg/ovum has been released becomes the ___
Corpus luteum
The corpus luteum secretes:
Estrogen, progesterone, and inhibin
3 layers of the uterus
Perimetrium, myometrium, endometrium
On implantation, the egg adheres to the ___
Endometrium
Implantation of the blastocyst occurs approximately ___ after fertilization
1 week
The formation of placental tissues stimulates the release of ___
Human chorionic gonadotropin hormone
The ___ carries oxygenated blood from the placenta to the unborn baby
Umbillical vein
Kidney volume can increase as much as ___% during pregnancy
30
Number of live births
Parity
Cardiac output may increase by as much as ___% during pregnancy
30-50
ECG changes that can occur during pregnancy include:
Ectopic beats and SVT
Standard birthing position in the US
Lithotomy position
Elevated BP, facial edema, or hyperactive reflexes strongly suggest the presence of ___ in a pregnant woman
Preeclampsia
Management for supine hypertensive syndrome involves:
Placing the PT in the left lateral recumbent position & treating underlying causes
Uncommon form of heart failure that happens during the last month of pregnancy
Peripartum cardiomyopathy
DBP greater than ___ places the pregnant PT in an increased risk category
110 mmHg
Severe preeclampsia may require administration of ___ to prevent seizures along with emergency antihypertensive meds
Magnesium sulfate
Severe preeclapmsia is defined as a SBP greather than ___ mmHg or DBP greater than ___ mmHg
160; 110
Seizures that result from severe hypertension in a pregnant woman
Ecalmpsia
___ is the recommended treatment for a pregnant PT with seizures, especially when eclampsia is present
Magnesium sulfate
___ and ___ are contraindicated for seizures in a pregnant PT due to their ability to cross the placental barrier
Diazepam (valium) and phenobarbital
Inability to process carbohydrates during pregnancy
Gestational diabetes
The ___ produces hormones designed to support pregnancy until the placenta is fully developed
Corpus luteum
In the ___ week after conception, the egg is officially recognized as an embryo
3rd
Beginnings of the CNS, CV system, spine, and skeletal anatomy begin to appear during the ___ week after conception
3rd
The placenta begins to develop around the ___ week of pregnancy
4th
The placenta acts as an early liver for the unborn baby, synthesizing ___ & ___
glycogen & cholesterol
THe umbillical ___ carries oxygenated blood from the placenta to the baby, while the umbillical ___ carry arteriovenous blood to the placenta
vein; arteries
The ___ connects the umbillical vein and the inferior vena cava in the unborn baby
ductus venosus
The ___ connects the pulmonary artery and the aorta in an unborn baby
ductus arteriosus
The ___ separates the right & left atria of the unborn baby’s heart
foramen ovale
By the end of a full-term pregnancy, the uterus has an internal volume of approximately ___
5,000 mL
Kidney volume can increase as much as ___ during pregnancy
30%
A dark line down the midline of the abdomen that develops during pregnancy in many women
linea nigra
Total number of time a woman has been pregnant
gravidity
Number of live births a woman has had
parity
At term, the uterus normally contains ___ % of the woman’s total circulating blood volume
15 -16%
Shunting of blood back into maternal circulation during uterine contraction
autotransfusion
RBC count may increase by as much as ___% during pregnancy
33%
Cardiac output in a pregnant woman may increase by ___% above pre-pregnancy level
30%-50%
Cardiac output reaches it’s maximum at about ___ weeks gestation
22
At term, a pregnant woman’s HR will increase by an average of about ___ bpm
15-20
SBP & DBP may decrease until approximately ___ weeks gestation
24
By 8 weeks gestation, increasing levels of ___ cause the tidal volume to increase by as much as 30%-50% of the non-pregnant level
progesterone
Increased joint laxity is due to the release of the hormone ___ during pregnancy
relaxin
Hormone which decreases the utilization of insulin by cells during pregnancy
progesterone
A woman who has had 2 or more pregnancies:
Multigravida
A woman who has had 2 or more deliveries
multipara
Irregularly spaced contractions are most likely signs of ___
false labor
If the fundus is palpable just above the symphisis pubis, the gestational age is ___
12-16 weeks
If the fundus is palpable at the level of the umbillicus, the gestational age is ___
20 weeks
Fetal HR less than ___ bpm suggests fetal distress in most pregnancies
120
Maternal hypotension translate into:
placental hypoperfusion
Early signs of supine hypotensive syndrome
Nausea, dizziness, tachycardia, anxiety
PPCM
peripartum/postpartum cardiomyopathy
Triad of symptoms associated with preeclampsia
Edema (face, ankles, hands),
gradual onset HTN,
Proteinuria
Visual disturbances in a pregnant PT may indicate ___
Severe preeclampsia
HELLP stands for:
Hemolysis, Elevated Liver enzymes, Low Platelets
Inability to process carbohydrates during pregnancy
Gestational diabetes
If protocols allow, administer ___ for persistent N/V in pregnant patients
diphenhydramine or ondansetron
___ is the leading cause of life-threatening infections in newborns during their first week after birth
Group B streptococcus
___ is a bloodborne pathogen that can be passed from mother to infant during the birthing process
HIV
TORCH stands for:
Toxoplasmosis, Other agents Rubella Cytomegalovirus Herpes
___ refers to infections that occur in neonates because of organisms passing through the placenta from woman to baby
TORCH syndrome
Member of the herpes family of viruses that pregnant women are at increased risk of contracting
cytomegalovirus
___ occurs naturally in 10-25% of all pregnancies
spontaneous aboriton
3 or more consecutive pregnancies that end in miscarriage
habitual abortion
An abortion that is attempting to take place, may not always lead to abortion of the baby
threatened abortion
Spontaneous abortion that cannot be prevented
imminent abortion
When treating a PT experiencing spontaneous abortion, treatment goals should include:
maintaining BP and preventing hypovolemia
___ occurs when the uterus becomes infected, often by normal vaginal flora
septic abortion
A pregnant woman can lose up to ___% of circulating volume before significant S&S of hypovolemia become apparent
40%
Life-threatening condition in which a fertilized ovum becomes implanted somewhere other than the uterus
ectopic pregnancy
All female PTs of child-bearing age reporting severe, lower abdominal pain should be considered to be experiencing:
ectopic pregnancy
Premature, or incomplete separation of the placenta from the uterine wall
abruptio placenta
Abruptio placenta most commonly occurs during the ___ trimester
3rd
Tender abdomen, rigid uterus, and sudden, severe abdominal pain that radiates to the back, is indicative of:
abruptio placenta
In ___ the placenta is implanted low in the uterus, and partially or fully obscures the cervical canal
placenta previa
Leading cause of painless vaginal bleeding in the 2nd and 3rd trimester of pregnancy
placenta previa
Signs of shock with sudden & severe abdominal pain along with decreased fetal heart tones indicates:
abruptio placenta
Painless vaginal bleeding with bright red blood, and normal fetal heart tones & fetal movement indicates:
placenta previa
Fluid resucitation in a pregnant PT should continue as indicated, up to ___mL/kg, or until SBP reaches ___ mmHg
20; 90mmHg
In pregnancy, a feeling of relief of pressure in the upper abdomen
lightening
___ begins with the onset of labor pains
The first stage of labor
The first stage of labor lasts until ___
the cervix is fully dilated
The second stage of labor begins when:
the head of the baby descends and flexes to enter the birth canal
The 3rd stage of labor is the period that involves:
separation of the placenta from the uterine wall
Vaginal discharge of blood & mucus that occurs following delivery of a newborn
Lochia
Placnetal delivery may be delayed as long as:
30 minutes
Magensium sulfate is classified as a(n):
electrolyte
Magneseium sulfate acts as a ___ when given during pregnancy
CNS depressant
Magnesium sulfate is principally used in pregnancy in the management of ___
eclampsia
Mag sulfate is given to treat/prevent ___ in pregnancy/delivery
seizures
If mag sulfate administration causes respiratory depression, administer ___ as an antidote to counter the effects
calcium gluconate/chloride
Side effects of clacium cholride include:
N/V, syncope, bradycardia, & dysrhythmias
Tocolytic and sympathetic agonist
Terbutaline
Side effects of terbutaline:
HTN, N/V, dizziness, chest pain, dysrhythmias
___ is indicated to treat exclampsia when seizures do not respond to mag sulfate
diazepam/Valium
Principle side effects of diazepam (Valium) administration
N/V,
respiratory depression,
hypotension
___ is also useful in treating hyperemesis gravidarum
Benadryl/Diphenhydramine
Diphenhydramine is classified as an:
antihistamine
Side effects of diphenhydramine
Drowsiness
Headache
Tachycardia
Hypotension
Side effects of Zofran include potential ___
QT segment prolongation
Naturally occurring hormone that triggers uterine contractions
Oxytocin
Preterm labor is that which begins between gestation weeks ___ & ___
20 & 37
___ means that the entire labor time and birth of the infant occurred in less than 3 hours
Precipitous labor & birth
The first stool passed by the unborn baby
meconium
Rare but life threatening condition caused by amniotic fluid and fetal cells entering the woman’s pulmonary & circulatory system via the umbillical veins
Amniotic fluid embolism
Condition in which there is too much amniotic fluid
Hydramnios/polyhydramnios
In ___ the head of the baby is larger than the mother’s pelvis
cephalopelvic disproportion
If 2 chords are coming out of one placenta, the twins are ___
identical
If there are 2 placentas, the twins are ___
freternal
Vaginal presentation of a body part other than the baby’s head
breech presentation
___ occurs after the head has been delivered and the shoulder cannot get past the woman’s symphisis pubis
Shoulder distocia
In ___, one or both feet dangle down through the vaginal opening
footling breech
___ may cause Inefficient contraction of the lower segment of the uterine muscles
Placenta previa
Sudden dyspnea, tachycardia, a-fib, or hypotension in the postpartum state may indicate ___
Pulmonary embolism
A respiratory rate less than ___ breaths/min is not considered adequate ventilation in a pregnant trauma PT
20
A normal fetal heart rate is between _____ bpm
120-160
A fetal heart rate slower than ___bpm means fetal distress
120
The gestational period normally lasts ___ weeks
38
___ is the only distinguishing characteristic that can verify a PT is experiencing eclampsia instead of PPCM
Proteinuria
Gestational hypertension may be an early sign of ___
Preeclampsia
Signs & symptoms of preeclampsia
Face & extremity edema; gradual onset HTN; proteinuria
Visual disturbances as well as elevated BP may suggest the presence of ___ in a pregnant PT
Severe preeclampsia
Painfully itchy hands and feet during pregnancy are the most common symptom of ___
Cholestasis
In a pregnant PT, sporadic contracions, first-trimester bleeding, and menstrual-like cramps are indicative of:
threatened abortion
A pregnant woman who feels a strong urge to move her bowels is in the ___ stage of labor
2nd
Rapid series of events that occur to enable a newborn to breath
Fetal transition
APGAR stands for:
Appearance Pulse rate Grimmace Activity Respiratory effort
A pulse rate less than ___ in a newborn indicates the need for resucitation
100
Cyanosis of the extremities
Acrocyanosis
An OPA should be insterted into a neonate/infant’s airway using this modifier:
Do not rotate the OPA
Artificial ventilation of the newborn is indated in these 3 scenarios:
Apnea
Pulse rate < 100 bpm
Persistant central cyanosis despite 100% oxygenation
Typical tidal volume of a newborn
3-6 mL/kg
Ventilation rate for a newborn
40-60 breaths/min
Chest compressions are indicated in a newborn if the pulse rate remains at:
less than 60 bpm
___ is indicated in a neonate after 60 seconds of CPR if the pulse rate remains less than 60 bpm
Epinephrine
If neonatal bradycardia persists after adequate ventillation, chest compression, and volume expansion, suspect:
metabolic acidosis
A bolus of normal saline for a newborn should equal a volume of:
10 mL/kg
___ is more common in postterm babies
meconium staining
Abnormal opening in the diaphragm
Diaphragmatic hernia
Right-shifted heart sounds, decreased left side breath sounds, and a sunken-in abdomen, is likely indicative of:
diaphragmatic hernia
___ is the single most common risk factor of respiratory distress and cyanosis in the neonate
prematurity
Newborns delivered before ___ weeks gestation are considered premature
37
Newborns weighing less than ___ lbs are considered low birth weight.
5.5
Premature newborns are at greater risk for respiratory distress owing to ___
surfactant deficiency
Type of neonatal seizure characterized by eye deviations, blinking, chewing, episodes of high BP, and apnea, more common in premature infants
Subtle seizures
Persistant posturing of one limb, the neck, or the trunk with horizontal eye deviation is characteristic of what type of neonatal seizure?
Focal tonic seizure
___ seizure activity often involves flexion of the arms of the newborn
Focal myoclonic seizure
One cause of neonatal seizures that has 2 major peaks of incidence, the first being 2-3 days after delivery, is caused by:
hypocalcemia
In full-term or preterm newborns, hypoglycemia is a BGL of less than ___
45 mg/dL
BGL in a healthy newborn during the first 1-2 hours may be as low as ___
30 mg/dL
Limpness or floppiness of a newborn
hypotonia
Feeding intolerance and abdominal distension in conjunction with vomiting in the first 1-2 days after birth may indicate ___ or ___
intestinal atresia or intestinal stenosis
Type of maternally-used drugs that most commonly cause vomiting in newborns
barbiturates
The signle most common cause of seizures in term and preterm newborns
Hypoxic-ischemic encephalopathy
Average normal body temp of a newborn at birth
99.5 F or 37.5 C
A thermogenic tissue unique to the newborn
Brown fat
___ is the primary source of heat production in the newborn
nonshivering thermogenesis
Abnormalities of the heart during development
congenital heart defect
In ____, oxygenated blood is shunted from the left side of the heart to the right side
noncyanotic congenital heart diseases
An abnormal opening in the septum separating the atria
atrial septal defect
Atrial septal defect is caused by failure of the ___ to close after birth
foramen ovale
Narrowing of a section of the aorta
Coarctation of the Aorta
Damage to the pulmonic valve, resulting in decreased blood flow to the lungs
pulmonary stenosis
In ___ the pulmonary artery and aorta are combined into one vessel
truncus arteriosus
In ___ the patient lacks the tricuspid valve
tricuspid atresia
Complete underdevelopment of the left side of the heart
hypoplastic left heart syndrome
Combination of Ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta
Tetrology of Fallot
Bradycardia in a neonate is considered a rate less than:
100 bpm
Increased work of breathing to maintain oxygenation/ventilation
Respiratory distress
partial or complete occlusion of the glottic opening due to swollen glottic tissues
epiglottitis
Acute, bacterial infection of the subglottic area of the upper airway, complicated by thick, pus-filled secretions
bacterial tracheitis
The most common chronic illness of childhood
Asthma
Common & contagious virus that causes bronchiolitis & pneumonia in children
RSV/Respiratory syncytial virus
RSV is spread via:
droplets & contaminated surfaces
Inflammation of the bronchioles
Bronchiolitis
An infant with a first time wheezing episode occurring in late fall or winter is likely experiencing:
bronchiolitis
Infants up to age 1 yr should be intubated with an ET tube size ___
3.5mm
Children ages 1-2 should be intubated with a size ___ ET tube
4mm
Cuffed ET tube size Formula for children older than 2
3.5+(age / 4)
A ___ laryngoscope blade is used to directly lift the epiglottis to view the chords
Miller/straight
Typical blood volume in pediatrics
70 mL/kg
Decreased vascular tone resulting in vasodilation & third spacing of fluids
Distributive shock
First line treatment of pediatric PTs in distributive shock
fluid resuscitation
When fluid resuscitation fails to resolve persistent hypotension in a septic PT, consider:
vasopressors
In children, bradydysrhythmias most often occur secondary to ___
hypoxia
For a stable PT in SVT , consider treating with ___
vagal maneuvers
SVT that persists in a stable PT despite vagal maneuvers should be treated with ___
adenosine
For an unstable PT in SVT, ___ is recommended
synchronized cardioversion
If wide complex tachycardia is suspected in a stable PT, consider ___ to distinguish it from SVT
adenosine
If wide complex VT persists despite treatment with Adenosine, ___ is the medication of choice
Amiodarone
Electricity dosage for sync-cardioversion in a pediatric PT
0.5-1 joule/kg
Condition resulting from impaired circulation & absorption of CSF
Hydrocephalus
A PT who suffered a head trauma who presents several hours later with delayed rapid deterioration is most likely experiencing the effects of:
epidural hematoma
Children rely on ___ to maintain adequate cardiac output
Pulse rate
In pediatrics, Tachycardia usually suggests ___ whereas bradycardia is suggestive of ___
Shock; hypoxia
The ___ & ___ are more likely to be injured in children due to “handlebar” injuries
Duodenum & pancreas
The pediatric assessment triangle consists of:
Appearance
Work of breathing
Circulation to the skin
Most out of hospital pediatric cardiopulmonary arrests are the result of:
Respiratory failure
___ is primarily a cognitive disorder that appears during childhood
Intellectual disability
Inability of sound to travel from the outer ear through to the inner ear
conductive hearing loss
Hearing loss caused by problems with the uptake of sound through the tiny hairs within the ear and subsequent conduction of nerve impulses
sensorineural hearing loss
Inability to interpret sounds, particularly speech, when background noise is present
central auditory processing disorder
Condition characterized by normal function of ear structures without corresponding stimulation of auditory centers in the brain
auditory neuropathy
You should suspect ___ in PTs who experience a sudden onset of unilateral eye or peri orbital pain with visual changes
Acute angle-closure glaucoma
___ is a failure of neurotransmission between the nervous system and muscles of the face & throat that cause impaired speech
Dysarthria
Neurologic impairment of the brain that inconsistently activates muscles needed to form words or sounds
Apraxia
Life threatening condition of paralysis patients, caused by a stress within the body that triggers a release of catecholamines from the ANS that causes vasodilation above the level of a previous spinal cord injury.
Autonomic dysreflexia
Increased sensitivity that may cause a PT to interpret touch as pain
Hyperesthesia
Nonprogressive neurologic disorder that results from injury to brain tissue during brain development
Cerebral palsy
When cerebral palsy effects all four limbs, it is known as:
spastic tetraplegia
Newborns who present with meconium or odd-smelling/-appearing stool should be suspected of having:
Cystic fibrosis
Severe, incurable degenerative disorder in which the myelin sheath of certain nerve fibers is attacked by the body’s immune system
Multiple sclerosis
Category of incurable genetic diseases that cause a slow, progressive degeneration of muscle fibers
Muscular dystrophy
Following delivery of a neonate, small spinal cord openings should be treated by:
covering with a moist, sterile dressing
The gestational period usually lasts ___ weeks
38
The 2nd stage of labor begins when ___
the fetus’ head enters the birth canal
Initial resuscitation efforts for a neonate should include providing ___% oxygen
21 (room air)
O2 monitor placement for a neonate showing signs of hypoxia/poor respiratory effort/apnea
pre ductal (right ear lobe, right hand)
For a neonate with a pulse rate < 60bpm:
initiate chest compressions in addition to PPV
FOr a neonate with a pulse rate < 100bpm:
Initiate assisted ventilation with a BVM (PPV)
Condition characterized by dyspnea and wheezing seen in children younger than 2:
bronchiolitis
Spectrum of lung conditions found in premature infants who required long periods of high-concentration oxygen & ventilator support post delivery
Bronchopulmonary dysplasia
Catheter inserted into the superior vena cava to permit monitoring of central venous pressure & sampling for chemical analysis
Central venous catheter
type of seizure characterized by alteration of consciousness with or without complex focal motor activity
complex partial seizure
Inadequate production of cortisol & aldosterone by the adrenal gland
congenital adrenal hyperplasia
Common disease of infancy/childhood characterized by stridor, hoarseness, & barking cough; caused by upper airway obstruction
Croup
Tube inserted directly into the PT’s stomach through the skin to provide nutrition
gastrostomy tube
seizures manifested in a way that indicates involvement of both cerebral hemispheres
generalized seizures
Abnormal buildup of CSF in the ventricles of the brain, can be acquired or congenital
hydrocephalus
Unusual thickening of the heart muscle wall, requiring the heart to pump harder to eject blood from LV
hypertrophic cardiomyopathy
Group of congenital conditions that cause either accumulation of toxins or disorders of energy metabolism in neonates; characterized by failure to thrive or poor feeding
inborn errors of metabolism
Condition that occurs when there is a twisting of the bowel around its mesenteric attachment to the abdominal wall
malrotation with volvulus
Common congenital malformation of the small intestine, presents with painless rectal bleeding
Meckel diverticulum
Inflammation of the myocardium
myocarditits
Where cartilage is transformed into new bone through calcification
ossification center
Seizure type that involves only one part of the brain
partial seizure
Small, non-blanching spots on the skin
Petechiae
hypertrophy of the pyloric sphincter
pyloric stenosis
Virus that causes pneumonia & bronchiolitis; may affect upper and lower respiratory tracts
RSV/respiratory syncytial virus
Congenital narrowing/blockage of the nasal airway by membranous or bony tissue
Choanal atresia
Neonate injury resulting from stretching of cervical nerve roots during delivery of the newborn’s head
Erb palsy
Septal opening of the heart that closes after birth
foramen ovale
Injury of childbirth affecting spinal nerves C8 to T1
Klumpke paralysis
Congenital anomaly in which the small intestine is found predominantly on the right side of the abdomen
malrotation
Seizure activity that involves more than one site in the cerebrum
multifocal seizure
Decreased volume of amniotic fluid during pregnancy
Oligohydramnios
Failure of the ductus arteriosus to transition to the ligamentum arteriosum
Patent ductus arteriosus
Delayed transition from fetal to neonatal circulation causes:
persistent pulmonary hypertension
Overabundance/overproduction of RBCs, WBC,s & platelets
polycythemia
Too much amniotic fluid
polyhydramnios
Disease of the eye that effects premature infants, can lead to blindness
retinopathy of prematurity
Rare congenital defect in which the pulmonary veins connect to the right atrium
total anomalous pulmonary venous return
Defect in which the great vessels are reversed
transposition of the great arteries
Defect in which the pulmonary artery & aorta are combined
truncus arteriosus
Term for an oocyte once it has fertilized and multiplies
blastocyst
Persistent nausea & vomiting during pregnancy
hyperemesis gravidarium
Situation in which the fetus has died during the first 20 weeks of gestation, but remains in utero
missed abortion
