Term test 1 Flashcards
1
Q
How long is pregnancy
A
40 weeks or 280 days
2
Q
Full term pregnancy
A
37-42 weeks
3
Q
When is the start of pregnancy counted
A
From the 1st day of the last menstrual period
4
Q
Childbearing years are considered
A
14years- 50 years
5
Q
What is the total weight gain during pregnancy
A
25lbs- 35lbs
6
Q
What systems change during pregnancy
A
Circulatory system, respiratory system, genital tract, GI system, metabolism
7
Q
GI changes in pregnancy
A
Increased esophageal pressure, decreased esophageal sphincter tone, increased gastric pressure, delayed gastric emptying, decreased contractility of gallbladder
8
Q
General changes of pregnancy
A
Weight gain, increased BMR, increased water retention, decreased serum Na, K, CA levels
9
Q
Respiratory system changes in pregnancy
A
Increased thoracic diameters, increased tidal volumes, increased minute ventilation, decreased peak expiratory flow rate, decreased residual volume, decreased functional residual capacity, widened forced vital capacity, widened maximum breathing capacity
10
Q
Cardiovascular changes in pregnancy
A
Increased blood volume, increased cardiac output, increased stroke volume, increased heart rate, decreased systemic/ peripheral vascular resistance, decreased Hb concentration
11
Q
Renal changes in pregnancy
A
Dilated renal pelvis and ureters, increased renal plasma flow, increased GFR (glomerular filtration rate), increased creatinine clearance
12
Q
Metabolic changes in pregnancy
A
10%-20% increase in BMR, insulin resistance, fat deposition
13
Q
Abortion definition
A
Expulsion of the fetus, from any cause before 20th week
14
Q
Amniotic sac definition
A
Fluid-filled, bag-like membrane where the fetus grows
15
Q
Antepartum definition
A
Before delivery
16
Q
Ectopic pregnancy definition
A
Any egg that attaches outside the uteruses, usually in fallopian tubes
17
Q
EDD (EDC, EDB) definition
A
Estimated date of delivery (confinement, delivery)
18
Q
Gravidity (grava) definition
A
Number of pregnancies
19
Q
Multip (multipara) definition
A
Person having the second (or more) baby
20
Q
Parity (para) definition
A
Number of live births
21
Q
Primip (primipara) definition
A
Person having their 1st baby
22
Q
SROM/ROM definition
A
Spontaneous rupture of membranes (rupture of membranes)
23
Q
Frequency of contractions
A
Measured as intervals between the time the contraction starts to the start of the next contraction
24
Q
Duration of contractions
A
How long one contraction lasts times from when the contraction starts to when it ends
25
Braxton hicks' contractions
False-labor pains that are uterine contractions that are not felt until the 2nd/3rd trimester.
Body's way of preparing for labor, not indicating that labor has begun
26
Stage 1 of labour
Dilation and effacement
Broken further into two parts: early labor and active labor
Longest of three stages
Uterine contractions gradually increase in frequency, strength, and length, fetus descends into the pelvis, cervix softens/ shortens/ thins/ dilates until full dilation of 10cm
27
Early labor
Mild irregular contractions with unpredictable length that can occur over a few days
Initial cervical changes occur including effacement and dilation up to 3-4cm, bloody show, SROM
28
Active labor
Strong regular contractions with a progressive dilation to 10cm that do not stop until birth occurs often accompanied with bloody show, SROM may not occur
29
Stage 2 of labor
Starts when cervix is fully dilated and pr feels the urge to push, end when baby is born
Frequency 2 min, length 60-90 sec
30
Stage 3 of labor
Lasts from birth of baby until placenta delivers
Lengthening of cord, sudden gush/trickle of blood, uterine contraction
Most dangerous stage of labour
31
Phases of normal delivery
Decent- fetus moves down toward pelvis and becomes engaged
Flexion- fetal chin to chest
Internal rotation- fetal occiput turns down toward the maternal pelvis
Extension- birth with head facing down
Restitution- babys head rotates to the side
External rotation- fetus turns to deliver shoulder
Expulsion- birth of baby
32
Delayed cord clamping
Holding baby below level of placenta increases blood volume and decreases probability of anemia
Clamp cord when it's done pulsating (2 min mark), 15cm from neonates' abdomen and then 5-7cm from first clamp
33
Uncomplicated placenta delivery care
Massage uterus to minimize bleeding, check for bleeding every 5-15min, monitor vitals
34
APGAR- A
Activity- 0- absent, 1- arms and legs flexed, 2- active movement
35
APGAR- P
Pulse: 0-absent, 1-below 100bpm, 2-over 100 bpm
36
APGAR- G
Grimace (reflex irritability): 0- flaccid, 1- some flexion of extremities, 2- active motion (sneeze/ cough/ pull away)
37
APGAR- A (second A)
Appearance: 0- blue, pale, 1- body pink, extremities blue, 2- completely pink
38
APGAR-R
Respiration: 0- absent, 1- slow, irregular, 2- vigorous cry
39
APGAR scores meaning
0-3: severely depressed
4-6: moderately depressed
7-10: excellent condition
40
Maternal risk factors of pregnancy
Older then 35 and younger than 20, smoking, alcohol, twins/ triplets/ etc., history of miscarriage, obesity, anorexia
41
Health conditions that complicate pregnancy
Diabetes, cancer, high blood pressure, STIs, kidney problems, epilepsy, anemia
42
Ectopic pregnancy
Fertilized egg implants outside the uterus in the fallopian tubes, abdominal cavity, or low in the cervix
Diagnosed <12 weeks, often at 6 weeks
One of the most dangerous 1st trimester complications
43
Causes of ectopic pregnancy
Swollen tube, pelvic inflammatory disease, IUD, previous ectopic pregnancy, advanced maternal age, tobacco
44
Signs and symptoms of ectopic pregnancy
Presents with hypotension/shock due to blood in peritoneum, shoulder pain from irritation, bradycardia, abdominal pain, syncope
45
Spontaneous abortion (miscarriage)
Loss of pregnancy naturally before 20 weeks- most happen first trimester
Chromosomal problems cause most miscarriages
Common in 1 in 4 pregnancies
Presents with bleeding (light or with clots and tissue) and cramping for approx. 1 week- can also be massive bleeds with hypovolemia
46
Hyperemesis gravidarum
Severe nausea/vomiting during pregnancy (>3 times per day)
Can lead to dehydration, vertigo, weight loss, preterm labor
Caused by high levels of pregnancy hormones- human chorionic gonadotropin (HCG
47
Preeclampsia
Hypertensive disorder that occurs after 20 weeks, can also develop up to 10 weeks after delivery
48
Signs and symptoms of preeclampsia
BP >140/90, severe headache, blurred vision, upper abdo pain, N/V, proteinuria, edema
49
Risk factors of preeclampsia
History of preeclampsia/ family history, first pregnancy, diabetes, lupus, high blood pressure, kidney disease, obesity (BMI >30), twins/triplets/etc., age (<18/>35)
50
Gestational diabetes
Diabetes caused by pregnancy due to carbohydrate metabolism
Excess glucose is transferred to the fetus and stores as fat (mother doesnt produce/ use all insulin required)
Condition often resolves but can reoccur later in life
51
Gestational diabetes signs and symptoms
Increased thirst, frequent urination, nausea, fatigue, sugar in urine, frequent bladder/skin infections, yeast infections, blurred vision, dry mouth
52
Placenta previa
When placenta partially/fully covers the cervix
Occurs when blastocyte implants to close to the cervix- unable to deliver baby vaginally
53
Signs and symptoms of placenta previa
Bright red, painless bleeding
54
Risk factors of placenta previa
Have had a baby, previous c-section, scars on uterus from previous surgery/procedure, history of placenta previa, IVF, carrying more than one fetus, >35 years, smoking, cocaine
55
Abruptio placenta
Partial/full detachment of placenta at 20 weeks when vascular structures are torn away from uterine lining
Significant bleeding or can present as vaginal bleeding
Leading cause of maternal (5-8%) /perinatal (10%) deaths
56
Risk factors of abruptio placenta
Trauma, multiple fetuses, short umbilical cord, previous c sections, preeclampsia/eclampsia, >35 years
57
Signs and symptoms of abruptio placenta
Possible vaginal bleeding, contractions that do not relax, severe abdominal pain that is described as tearing
58
Amniotic fluid embolism
Amniotic fluid/ fetal cells/ hair enters maternal pulmonary circulation causing cardiovascular collapse
Occurs in labor or 30 min after delivery
59
Risk factors of amniotic fluid embolism
Advanced age, expecting multiples, fetal distress, issues with placenta, preeclampsia/ eclampsia, polyhydramnios, cervical tears, labor induction medications/procedures, c-section delivery, operative assisted deliveries
60
Signs and symptoms of amniotic fluid embolism
Increased WOB, hypoxia, hypotension, possible cardiac arrest
61
Complications of twins
40-50% are preterm, second twin will malpresent due to significant room to move after first delivery, cord prolapse, PPH, higher incidence of blood loss, no delayed cord clamping- unknown if placenta is joined/shared, label first infant delivered, delay cab ne 17-20 min before second
62
Fraternal twins
Two eggs are released, and each egg is fertilized by separate sperm causing each embryo to implant in womb separately- separate placentas and separate inner sacs
63
Identical twins
One egg is released from ovary and fertilized by one sperm:
1. Embryo splits then implants in the womb causing separate placentas and separate inner sacs
2. Embryo implants in womb and then splits causing a shared placenta and separate inner sacs
3. Embryo implants in womb and splits later causing a shared placenta and shared inner sac
64
Premature birth
<37 weeks
Risk of hypothermia, usually require resuscitation, poor lung compliance, no surfactant (starts being produced at 26-28weeks)
65
Nuchal cord
Umbilical cord is wrapped around infants' neck- slip overhead/body
If cord is tight, it will impede delivery so cut/clamp cord and delivery quickly
66
Precipitous labor
Delivery of a baby within 3 hours of regular contractions that can increase risk of perineal lacerations and postpartum hemorrhage from uterine atony
67
Occiput posterior
Posterior in relation to maternal pelvis- “sunny side up”
Abdo exam- lower abdomen is flat, and fetal limbs are palpable anteriorly, heartbeat can be heard in flank
Vaginal exam- anterior fontanelle can be felt if head is deflexed
68
Frank breech
Most common
Hips flexed and legs extended over anterior surface of the body
69
Complete breech
Both hips and knees are flexed causing buttocks and feet to enter cervix first
70
Footling breech
Won't deliver if knees lock on pelvic girdle
One hip and knee flexed while other is straight and enters canal first, risk of cord prolapse is high
71
Breech approach
Position pt ~> push with contractions ~> hands off breech ~> baby is born to umbilicus (4 min to deliver baby from this point forward) ~> consider gentle release of legs if possible ~> hands off breech ~> consider gentle release of arms is possible ~> allow gravity to birth baby ~> hairline visible ~> smellie-veit maneuver
72
Mauriceau-smellie-veit
Lay neonate on forearm with palm on neonate's chest and two fingers on face to increase flexion. Place other hand on back with fingers hooked over shoulders and middle fingers pushing up on occiput to aid flexion. When hairline is visible lift body in an arc to pivot head around symphysis pubis
73
Cord prolapse
Umbilical cord proceeds neonate through cervix causing it to become compressed by following neonate
Leads to fetal hypoxia or death secondary to cord compression between fetus and pelvis/ uterine wall
74
What are the positions a mother should be placed in if there is a cord prolapse
Knee-chest, exaggerated Sims
75
Shoulder dystocia
Impaction of anterior shoulder against the symphysis pubis after delivery of the head or posterior shoulder impacted against sacral promontory
76
Risk factors for an impacted shoulder
Prior shoulder dystocia, gestational diabetes, postdate deliveries, maternal short stature, high pregnancy weight/ weight gain, abnormal pelvic anatomy, previous instrumented delivery
77
Maternal complications of shoulder dystocia
Soft tissue injuries, anal sphincter damage, cervical/vaginal tears, uterine rupture, PPH
78
Neonatal complications of shoulder dystocia
Clavicle fracture, fetal acidosis, humeral fracture, brachial plexus palsy (transient/permanent hypoxic brain injury), death
79
ALARM
A: ask for help
L: lift legs, hyperflex thighs (McRoberts maneuver)
A: adduct shoulder (apply suprapubic pressure)
R: rollover (gaskins maneuver)
M: manually deliver of posterior arm (if visible)
80
Post partum hemorrhage
Occurs right after delivery (<24hrs) or up to 12 weeks later and bleeding can occur over several hours and diluted with urine/fluid
81
Main causes of post-partum hemorrhage
Tone- exhausted uterus that cannot contract
Tissue- parts of placenta still retained and clotting is compromised
Trauma- uterine rupture/lac during delivery
Thrombin- coagulation abnormalities
82
What defines PPH
500ml of blood or more severe PPH is 1 liter
83
How does PPH present
Hypovolemic shock symptoms
84
External uterine massage
Only used when the placenta has been delivered
Smooth circular movement to massage uterus- reassess every 10-15 min
If bleeding continues go to bimanual compression
85
External bimanual uterine compression
Can be started without delivery of placenta
Squeeze symphysis pubis and fundus together for 5-10 min until bleeding stops
86
Meconium
Newborns first stool movement made off cells, proteins, fats, and intestinal secretions
87
Where does gas exchange/ circulation happen in neonates
Placenta
88
What is preferential streaming
Cardiovascular system is adapted to ensure the most highly oxygenated blood is delivered to myocardium and brain
89
Oxygenated/deoxygenated blood in neonates
Oxygenated blood passes via umbilical vein to fetus and deoxygenated blood is carried out via 2 umbilical arteries
90
Ductus venosus
Continuation of umbilical vein which bypassess blood from the liver and connects unblilcal vein to inferior vena cava
91
Foramen ovale
Shunt (opening in septum) allowing blood to travel from right atrium to the left atrium
92
Ductus arteriosus
Artery that joins pulmonary system directly to aorta
93
What happens to the heart and lungs during a baby's first breath
Surface tension on alveoli collapses and opens alveoli for spontaneous oxygenation
Pulmonary resistance decreases and blood flow from placenta stops
Pressure on the right side of the heart becomes greater than the left when fetus is in utero
Pressure in the aorta causes the left side of the heart to increase systemic vascular resistance causing the fetal shunt to close within first few hours
94
Post delivery system- ventilation
Fluid is forced from neonates' lungs to nose/mouth due to compression during delivery, so lungs inflate establishing functional residual capacity within lungs and allows gas exchange to occur
95
Post delivery system- hemodynamics
Pulmonary vascular resistance decreases as lungs are functioning and blood flow increases causing oxygen to be carried throughout the body
96
Post delivery system- temperature regulation
Risk of hypothermia due to large surface area and immature regulation and little fat so compensates with vasoconstriction and an increased metabolism
97
Meconium aspiration
Fetal distress causes gasps when in womb/soon after causing an inhalation of amniotic fluid during labor or when infant is post date
Blocks airways preventing breathing causing distress
Leading cause of severe illness and death in newborns
98
Primary apnea
Absence of spontaneous respirations after birth, often self-limiting/reversed with minimal resuscitation efforts
99
Secondary apnea
Apnea that exceeds 20 seconds and occurs from difficult labor, airway obstruction, hypoglycemia, respiratory muscle weakness, narcotics/ CNS depressants
100
Hypovolemia
Occurs from dehydration, hemorrhage, or trauma
Fails look test appearing hypoperfused (mottled, pale cool skin, lethargic, poor tone)
Sunken fontanelles indicate hypovolemia
Bulging fontanelles indicate increased ICP
101
Hypoglycemia
Risk factors are apnea, pre/eclampsia, smaller babies/twins
Presents with seizure, pale skin, poor tone, lethargy, apnea
102
Simple congenital heart defects
Atrial/ventricular septal defects, patent ductus arteriosus, pulmonary stenosis
May get better without surgery
103
Complex congenital heart defects
Can cause life-threatening symptoms requiring immediate treatment
Tetralogy of fallot
104
Atrial septal defects
Hole in the wall of the heart between left/right atria causing blood to flow from left atrium and mix with right atrium
Hole may close on its own as the heart grows during childhood
105
Ventricular septal defect
Hole in the wall between left and right ventricles causing blood to flow from left ventricle and mix with right ventricle
If hole is large heart/lungs need to work harder to pump blood and can cause fluid to buildup in the lungs
106
Patent ductus arteriosus
Connection between aorta and pulmonary artery does not close properly after birth leaving an opening for blood to flow when it shouldn't
Small openings may close on their own
107
Pulmonary stenosis
Pulmonary valve is too narrow/stiff affecting blood moving from heart to pulmonary artery
108
Tetralogy of Fallot
Pulmonary stenosis, large ventricular septal defect, overriding aorta (aorta is out of place in-between the ventricles causing oxygen poor blood to flow directly into the aorta instead of blood vessels carrying blood to the lungs), right ventricular hypertrophy
109
Signs and symptoms of severe defects
Rapid breathing, cyanosis, fatigue, poor blood circulation
110
Signs and symptoms of heart failure
Shortness of breath/ trouble breathing, fatigue with physical activity, buildup of blood and fluid in the lungs, swelling in ankles/ feet/ legs/ abdomen/ and veins in neck
111
What do you assess in neonates
Term gestation, good muscle tone, breathing/crying
If present with no abnormalities only supportive care is required
112
Vernix
Protective coating on neonates' skin in utero
113
Where should the fetal SPO2 be placed
Right hand (accurate reading), if on left hand or lower limbs it will have lower saturation due to being mixed with poorly oxygenated blood that was shunt
114
MR SOPA
M- mask- good seal
R- respiration airway to mouth using manual maneuvers (sniffing position)
S- suction mouth/nose
O- open mouth using manual maneuvers
P- increase pressure to achieve chest rise
A- alternate airway
115
Chest compressions for a neonate
3:1 and should be depress chest by 1/3
116
PED cardiac arrest- respiratory distress
Abnormal respiratory rate and effort leading to inadequate oxygenation/ventilation
Mild distress- mild tachypnea and increased respiratory effort
Severe distress- marked tachypnea with increased effort, changes in skin colour and LOC
117
PED cardiac arrest- respiratory failure
Inadequate ventilation, oxygenation, or both
Results from delayed or ineffective treatment of respiratory distress
118
PED cardiac arrest- cardiac arrest
Eventual cardiac arrest arrhythmia and potential for arrest
119
Airway differences in pediatrics
Tongue is larger in proportion to mouth, pharynx is smaller, epiglottis is larger and superior, larynx is more anterior and superior (C3-C4) and narrowest at cricoid, trachea narrow and less rigid
Nasal passages easily blocked by secretions
120
Pediatric chest and lungs
Thin with little musculature and subcutaneous fat causing it to be more pliable without as much protection
More vulnerable to pulmonary contusions, cardiac tamponade, and diaphragmatic rupture
Signs of hemothorax/pneumothorax are more subtle
Alveoli clusters develop over the first 8 years of life
121
Pediatric hearts
Myocardium is less contractile making ventricles are less compliant and less tension during contraction
Cardiac output is rate dependent
Vagal sympathetic tone is most dominant- more prone to bradycardias
122
Pediatric abdomen
Distended abdomen due to weak abdo walls and size of organs
Liver/spleen extend below rib cage
123
Pediatric blood volume
~800ml of blood
Great ability to compensate by constricting peripheral vasculature= increase of systemic vascular resistance (maintaining a BP and an increased heart rate)
124
Pediatric central nervous system
Prone to febrile seizures due to influx in temperature regulation
Blood brain barrier is poorly formed so barbiturates, opioids, antibiotics, and bilirubin cross barrier easier with prolonged effects
125
What happens to pediatrics when temperature drops
Respiratory depression, acidosis, decreased cardiac output, increases duration of action of drugs, decreases platelet function, and increase risk of infection
126
How to calculate a pulse of a pediatric patient
150 - (5 x age) = ~rate
127
Blood pressures in pediatrics
Normotension: (2 x age) + 90
Hypotension: (2 x age) + 70
128
Weight calculation of pediatric patients
(2 x age) + 10kg
129
Blood glucose levels of pediatric patients
<2 years: <3.0 mmol/L
>2 years: <4.0 mmol/L
130
Pediatric assessment triangle
Appearance: tone, interactiveness, consolability, look/gaze, speech
Circulation: pallor, mottling, cyanosis
WOB: breath sounds, positioning, retractions, flaring, apnea/gasping
131
TILCS mnemonic
Tone, Interactiveness, Consolability, Loog/gaze, Speech/ cry
132
What does the appearance of a pediatric patient indicate
Adequacy of ventilation, oxygenation, brain perfusion, body homeostasis, and CNS function
133
How to assess pediatric breathing adequacy
Depth, hypoventilation (tidal volume x resp rate), rate, effort
134
Febrile seizures (pyrexia)
Usually <6 but average is 1-2 years
Hx of illness associated with fever spikes
S&S: generalized short tonic-clonic seizures (5 min), full body uncoordinated muscle activity, grunting, incontinence, increased secretions follow by postictal phase
135
Epilepsy
Recurrent seizures unprovoked by illness due to abnormal neuronal firing
Occurs in isolated area of the brain or generalized seizures
Can experience an aura prior
136
Meningitis
Inflammation of the meninges caused by bacteria, viral, or other microorganisms
Presents with fever, decreased LOA, projectile vomiting from increased ICP, petechial rash, headache, or nuchal rigidity (stiff neck)
Can progress to seizure, come, death, or permanent disability
137
Kernigs sign
Loss of ability to flex leg when supine or sitting
138
Brudzinski sign
Involuntary flexion of the arm, hip, knee when neck is flexed
139
Dehydration
Results from any body fluid loss- excessive vomiting/diarrhea, exposure to heat/cold, illness causing poor fluid intake
S&S: poor skin turgor, dry mucous membranes, obvious weight loss, tachycardia >130bpm, depressed fontanelle in newborn, lethargy, irritability
140
Bronchiolitis
Caused by respiratory viruses but most with respiratory syncytial virus
Differentiate from asthma as it proceeds a viral infection and associated with fever
141
Croup
Swelling of the trachea, larynx, and bronchi causing respiratory distress and a barking cough
Parainfluenza
Epiglottitis
Inflammatory condition of epiglottis leading to near/complete airway obstruction
Presents with drooling, dysphagia, distress
142
Kawasaki disease
Acute febrile illness with unknown etiology that affects <5 years of age
143
SIDS
healthy infant that dies of unknown causes
Highest risk in first 6 months but anytime within first year
Risk factors: sleeping prone, co-sleeping, smoking, low birth weight, overeating, lack of breastfeeding, <20 maternal age, no prenatal care
144
What is the leading cause of death among children >1 years
Trauma by MVC, falls, submersions
145
1st impact site of pediatric MVC
Bumper of car- abdomen, pelvis, femurs
146
2nd impact site of pediatric MVC
Hood of car- chest, head, face
147
3rd impact site of pediatric MVC
Ground/ road- striking head
148
Shock in pediatrics
Assess circulation as only sign may be an elevated heart rate
Initiate volume resuscitation and control external bleeding
149
First impressions of a child suffering abuse
Avoiding parent/ caregiver, avoiding eye contact with parent/ caregiver, appears excessively fearful of parent/ caregiver, may be very compliant and easy to examine
150
Physical exam of a child suffering abuse
Unusual scars in unusual areas- old burns, abrasions, bites on back, buttocks, hands, inside of arms/legs, head
Bruising in various stages in unusual areas
Deformed extremities from old fractures
151
Home medical technology
External/internal mechanical device prescribed by a member of a regulated health profession for the purpose of treating a medical condition
152
Novel medication
Self/caregiver administered medication prescribed by a member of a health profession that is required to treat patients with generally rare/unusual complex chronic medical conditions which are often end stage and can be administered through any route
153
Causes of renal failure
Diabetes (most common), hypertension, autoimmune diseases, genetic diseases, nephrotic syndrome
154
Hemodialysis
Process using man-made membrane to remove wastes from the blood to restore proper balance of electrolytes and eliminate extra fluid from the body
155
Fistula
Surgical connection between an artery and vein to increase blood pressure and amount of blood flow through vein
Enlarge veins to be capable of delivering the amount of blood flow necessary to provide an adequate hemodialysis treatment
156
AV graft
Made when veins are not suitable for a fistula
Form of vascular access created by inserting a synthetic tube to connect a vein to an artery in the arm
157
Central venous catheter
Flexible synthetic tube placed in the vena cava used when waiting for a fistula or whe one is not possible
Can be placed in the groin in femoral vein
158
Peritoneal dialysis
Kidney failure that uses lining of abdomen to filter blood inside the body causing excess water/ waste to pass from blood to peritoneum into dialysis fluid to be drained and discarded
159
What drugs does dialysis remove
Barbiturates, lithium, isoniazid, theophylline/caffeine, methanol/metformin, ethylene glycol, Depakote/ dabigatran
160
Symptoms of acute kidney failure
Reduced urine output, swollen legs/ankles/feet, weakness/fatigue, high blood pressure, confusion
161
Symptoms of chronic kidney failure
Abnormal blood/ urine tests, swelling in face/hands/feet, headaches, high blood pressure
162
Fenestrated cannula
Small hole in the cannula allowing increased airflow to the upper airway allowing pt to talk
163
Non-fenestrated cannula
Little to no voicing
164
LVAD
Implantable pump assissting ventricles with patients that have advanced heart failure
Can be pulsatile (pulse similar to human heart) or non-pulsatile (no pulse)
Pump problems are uncommon so treat underlying cause
Mental status, skin color, end tidal, cap refill to assess perfusion
165
Addisons disease
Also called adrenal insufficiency and occurs when body doesn't make enough cortisol and aldosterone
Often have related autoimmune diseases
Results from stress on the body causing glands to make extra cortisol in response
166
What drug is administered to patients in an adrenal crisis
Hydrocortisone
167
Examples of underlying stressors for an adrenal crisis
Hypoglycemia, hypotension, gastrointestinal issues, fractures
168
Behavioral emergencies
Abnormal behavior that threatens a person's health and safety or the health and safety of another
169
Psychiatric emergencies
Person becomes suicidal, homicidal, or psychotic episode and experiences delusions/ hallucinations that result in loss of contact with reality
May undertake risky behaviors or violence
170
Key social determinants of health
Access to health services, culture/race/ethnicity, disability, early childhood development, education, employment/job security/working conditions, food insecurity, gender identity/expression, housing, income/ income distribution, indigenous status, health practices and resiliency, physical environments, sexual orientation, social inclusion/exclusion, social support networks
171
Anxiety
Persistent worry that interferes with daily activities
Traumatic events, inherited traits, underlying health issues, and medication side effects can trigger anxiety
172
Depression
Mood disorder causing a persistent feeling of sadness and loss of interest
Onset during late teens to mid 20s
Signs of depression: suicidal tendency, anxiety, hopelessness, mood swings, change in body weight, uncontrollable emotions, feeling low, insomnia
173
Bipolar disorder
Extreme mood swings that include emotional highs (mania/ hypomania) and lows (depression)
Biological tendencies: physical changes in the brain
Genetics: more common in people with first degree relatives with the condition
Risk factors: first degree relative, periods of high stress, drug/alcohol abuse
Onset: 25 years
174
Schizophrenia
Condition where reality is interpreted abnormally
Risk factors: family hx, pregnancy/birth complications, taking mind-altering drugs during teen years
Onset: late teens
175
Dementia
Loss of cognitive functioning that interferes with persons daily life/ activities
Risk factors: smoking, high blood pressure, diabetes, obesity, lack of physical activity, poor diet, high alcohol consumption, low levels of cognitive engagement
176
Excited delirium
Acute onset of agitation, aggression, distress, and possibly sudden death
Associated with drugs that alter dopamine processing and hyperthermia- meth and cocaine
Believed to be from acidosis, rhabdomyolysis and hyperkalemia
S&S: aggression, panic, screaming, increase pain tolerance, unexpected physical strength, tachypnea, diaphoresis, inappropriate clothing, reflection attraction
177
Can paramedics refuse work
Medics do not have the right to refuse unsafe work when circumstances are due to inherent nature of employment
Pts can be suffering from violent behavior due to a metabolic disorder or substance use
178
What are the BLS scene standards for refusing work
Identify potential hazards, identify route of entry/exit, if no danger secure environment, if danger is present contact assistance for allied agencies
179
Instances when a paramedic can refuse work
Continuing/active ongoing violence, dangerous weapons on scene, fire/ uncontained hazards, directed to do so by FD/PD/ management or CACC
180
Capacity
Deemed to have capacity if they understand relevant information required for decision making and able to appreciate the reasonably foreseeable consequences of a decision/lack of
Ensure decision is not influenced by depression/ psychosis
181
How do tasers work
Produced electrical signals confusing periphreal neuromuscular by overloading the nerve fibers with meaningless signals
Does not damage nervous tissue, CNS, involuntary muscle groups, cardiac tissue or rhythm
182
In what locations are taser darts not removed
Head/face, neck (above clavicles), nipples, groin (scrotum/ genital area), bone, pt <16 years, patient refusal/ no capacity to consent of removal
