Special Populations 2 Flashcards
Gyn Questions
When was your last period How long is your period normally Anything different Type of bleeding Clots Discharge Smell Pregnancy On birth control Any trauma What is normal for pt How many pads have you gone through in 24 hours
Basic Gyn Tx
Support pt
Position of comfort
O2 if SpO2 low
Hypermenorrhea/Menorrhagia
abnormally heavy bleeding
Polymenorrhea
period more frequent than 24 days
Dysmenorrhea
painful menses
Metorrhagia
spotting that occurs bw periods
Vaginal bleeding <20 weeks
likely spontaneous miscarriage
Vaginal bleeding >20 weeks
Abruptio placenta Placenta Previa
Ectopic pregnancy S/S
Unilower abdominal px
Gradually worsens over few days
Rebound tenderness
diffuse px
may have cullen or grey turner sign
Ectopic pregnancy tx
ABCs Cardiac monitor IV Fluids px management warm and tx for shock
PID S/S
diffuse lower abdominal px
shuffling gait
fever
chills
discharge
px on urination
Sexual assault tx
focus on what hurts and what pt needs tx don’t ask for retelling ask for gender preference in provider don’t examine vagina tx px and anxiety document well
Fetal Circulation
Ductus Arteriosus
allows blood to pass from pulmonary artery directly into aorta t
Gravida
number of times pregnant
Parida
number of births
Nulligravida
never been pregnant
Nulliparious
never given birth
Primigravida
female who is pregnant first time
Multigravida
female who has been pregnant multiple times
Multiparity
given birth multiple times
Grand multiparity
female who has given birth more than 5 times
Hyperemesis gravidarum tx
ABCs
Position of comfort
EKG
500mL NS if hypotensive
Zofran and maybe benadryl
check BGL
PreEclampsia S/S
edema hands, feet, face
seizures
SBP >160
DBP >105
20th week of pregnancy or greater
PreEclampsia Tx
O2
Position of comfort
4-6g of Mag over 15mins
Maintenance infusion of 1-2g
if seizure persists, 4mg of lorazepam
Contact Med control for Labetalol
Abruptio Placenta S/S
dark red blood
lots of px
external blunt trauma most common cause
can be deep in shock with minimal bleeding
Abruptio Placenta Tx
ABC
Shock tx
O2
fluids if hypotensive
Placenta Previa S/S
bright red blood
more minimal px
may be unknown if not receiving prenatal care
bleeding begins towards end of pregnancy
Placenta Previa Tx
ABCs
tx for shock
O2
IV fluids for hypotension
breathe slow and deep through contractions
txp in knee to chest position
pelvis should be highest point
rapid txp
Labor Stages
Stage 1: fully dilated cervix and full effacement signals end of first stage
Stage 2: delivery of child is end of second stage
Stage 3: concludes with delivery of placenta
Labor steps
Mama in semi fowlers with knees drawn up
PPE
Once baby crowns, apply gentle pressure to head
After head delivers, apply downward pressure, check for cord
After first shoulder delivers, apply upward pressure
Be prepared to catch after shoulder delivery
Dry baby and suction mouth/nose
place baby on mama
keep back super warm
APGAR score at 1, 5 minutes
APGAR
Contractions seem to be getting weaker, differential diagnosis?
Uterine rupture
Pre term labor window
20-37 weeks
Prolapsed Cord tx
mama in knee to chest position
pelvis high
keep baby off cord
rapid txp
Nuchal cord
loosen cord if possible
if not possible, clamp in two places and cut in middle
Breech tx
lift ankles towards abdomen
if it doesn’t free head, place fingers on either side of face and press up to allow for baby to breathe
Uterine inversion tx
O2
at least one line
fluid titrated for BP
Oxytocin withheld
Mag sulf can be useful
Postpartum hemorrhage definition
in under 24 hours >500mL in vaginal birth
>1000mL in C section
Postpartum hemorrhage tx
fundal massage
breastfeed
10 unit of oxytocin in 1000 NS over 20-30mins
two large bore IVs
do not pack vagina
Important pregnant trauma question
have you felt the baby move since incident
Baby born, first steps
warm
dry
position
suction
stimulate feet
if no response to this after 30s, oxygenate
central cyanosis with HR >100
blow by O2
if baby pinks up, stop O2
HR <100
nasal flaring
grunting
retractions
head bobbing
see saw respiration
ventilate at rate of 40-60 bpm
*if no improvement in 30s, intubate and CPR
Congenital Diaphragmatic Hernia tx
intubation over BVM
NG or OG tube
rapid txp
Pneumo tx in infant
insert 22g in 2nd intercostal
intubate
Umbilical Catherization Steps
- Clean umbilical cord outward 3cm
- Attach 3-5ml prefilled syringe with 3 way stop cock that is attached to 3.5-5 Fr catheter and flush saline through
- Cut cord bw infant and first cord clamp
- Insert cather into umbilical vein
- advance catheter about 2-4cm into vein until blood aspirated
- do not advance beyond 5cm
- flush catheter and tape into place
Inverted Triangle of Newborn Resuscitation
Warm, Dry, Suction, Stimulate
Oxygen
BVM, ETT
Chest compressions
Medications
Acidosis tx in Newborns
If ventilation, oxygenation, chest compressions not resolving bradycardia, acidosis may be cause. Do not use sodium bicarb. Focus on volume expansion to clear metabolic acids.
Seizure cause in Infants under 3 days old
hypoxic encephalopathy
hypoglycemia
other metabolic disturbances
Seizure cause in Infants over 3 days old
meningitis
epilepsy
intracranial bleeding
birth defects
drug withdrawal
Esophageal atresia
failure of esophagus to develop properly and connect to stomach
frothing, vomiting, choking during feeding
Infantile Hypertrophic Pyloric Stenosis
stomach is unable to empty normally into small intestine
causes projectile vomiting
infants can be dehydrated and hypoglycemic as a result
Intestinal Atresia or Stenosis
narrowing and malformation of upper intestine
projectile vomiting with green tinge
baby avoids eating and has distended stomach
reduced bowel movements
Malrotation
intestines fail to coil properly
bloody vomit
vomit may smell of feces
Meningitis
projectile vomiting
nuchal stiffness
fever
bulging fontanelles
Vomiting tx in infants
ABCs
IV access
BGL
be prepared to suction
look for dehydration
fluid bolus of 10ml/kg x3
antiemetics not indicated
Premature Infant tx
ABCs
keep warm
keep dry
blow by O2
get to hospital
Jaundice tx
IV fluids can dilute bilirubin
txp to hospital
Hypothermia consequences in infants
increased metabolism
hypoglycemia
bradypnea
bradycardia
metabolic acidosis
Acrocyanosis
cyanosis of hands and feet
Ventricular Septal Defect
malformation of septum causing blood flow bw ventricles
leads to pulmonary HTN
leads to decreased SBP
Pulmonary Stenosis
- pulmonary valve is damaged and doesn’t open fully
- right ventricle hypertrophies as result of needing more pressure to move blood through valve to lungs
- pt often presents with JVD and cyanosis, especially during feeding
Tetralogy of Fallot
- combines Pulmonary stenosis, RVH, VSD, and overriding aorta
- aorta receives some deoxy blood from right ventricle
- results in baby who is mostly cyanotic during day but especially while crying eating or active
- have tet spells where become centrally blue and may pass out if working to breathe too hard
Atrial Septal defect
failure of foramen ovale to close so blood shifts bw atria
pt can become cyanotic as result
Patent Ductus Areriosus
failure of ductus arteriosus to close
blood shunted away from lungs
if SpO2 doesn’t increase with O2, this may be issue
can lead to CHF in infant
Truncus Arteriosus
cdxn where pulmonary artery and aorta are single vessel
often have CHF due to massive blood flow to lungs
Tricuspid Atresia
lacks a tricuspid valve
frequently fatal
significantly decreased blood flow to lungs
Transposition of the Great Vessels
- pulmonary artery is connected to left ventricle
- aorta is connected to right ventricle
- this systemic hypoxia can allow ductus arteriosus and foramen ovale to remain open
Stages of Uterine Prolapse
