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Quarter 3 Midterm Study Guide
Terms in this set (55)
Failure to take prenatal vitamins leads to:
Pregnancy related anemia.
If the woman does not take iron
supplements, the fetus will rob the maternal stores to
meet its own needs for iron, resulting in anemia for the
woman—and possibly leading to preterm labor and spontaneous
Meconium aspiration syndrome is trouble breathing (respiratory distress) in a newborn who has breathed (aspirated) a dark green, sterile fecal material called meconium into the lungs before or around the time of birth.
When is a newborn most at risk for meconium aspiration?
Post term pregnancy (baby not born after 42 weeks of gestation)
Parts of the female reproductive system
Ovaries: Produce the female sex cells known as the egg or ovum. Ovaries are suspended in the peritoneal cavity by several ligaments and release the ovum into the peritoneal cavity monthly (ovulation)
Fallopian tubes: Tubes that catch the eggs released by the ovaries via the fimbriae (finger like projections that are the most distal part of the fallopian tubes) and connect to the uterus.
Uterus: The uterus (womb) is the organ where the embryo grows. It is responsible for contractions during labor and ultimately
helps to push the newborn, placenta, and membranes
through the birth canal at delivery.
Vagina: (birth canal) the muscular tube extending from the cervix to the outside of the body. The cervix protrudes into the vagina
Parts of the Uterus
Fundus: Most superior part of the uterus (dome shaped). Superior to where the fallopian tubes connect with the uterus.
Body: Inferior to the fundus and superior to the cervix. Makes up most of the uterus.
Cervix: Most inferior and narrow portion of the uterus and protrudes into the vagina.
The uterine wall is thick, with three layers of tissue:
Perimetrium (outer protective layer)
Myometrium (middle layer)
Endometrium (inner lining)
Neonatal resuscitation including volume resuscitation
Book does not mention volume resuscitation but ALCO does. Book is pretty much identical to ALCO protocol besides that.
V.S changes in pregnancy (Pulse and Respirations)
HR: Heart rate gradually increases during pregnancy, by an average of 15 to 20 beats/min by term.
BP: Systolic and diastolic pressure may decrease until approximately
24 weeks' gestation. Blood pressure may begin to increase
from 24 weeks until birth, and usually returns to the normal prepregnancy level gradually.
O2: Maternal oxygen consumption increase by 20% to 40% above nonpregnant levels because of the oxygen requirements of the fetus and placenta and the increased oxygen requirement of maternal organs
Tidal Volume and minute ventilation: By 8 weeks' gestation, increasing levels of progesterone cause the tidal volume to increase by 30% to 50% of the nonpregnant level. The increase in tidal volume causes minute ventilation to increase by as much as 50% over prepregnancy values
RESPIRATORY RATE: Due to the high level of progesterone, which signals the brain to lower the level of CO2 in the blood; a pregnant woman breathes SLIGHTLY FASTER and more DEEPLY (>TV) to exhale more carbon dioxide and keep the carbon dioxide level low.
Blood volume: increases by about 30% to 50% over
Cardiac output increases by 30% to 50% more than the prepregnancy level, reaching its maximum capacity at about 22 weeks' gestation and then declines to about 20% near term
Normal upper limit fetal heart rate
A normal fetal heart rate
is between 120 and 160 beats/min.
A rate slower than 120 beats/min means fetal distress and signals a dire emergency.
Medication used to treat seizures during pregnancy
Magnesium sulfate (main treatment)
(Hydralazine or Labetalol can also be used to control blood pressure once seizures have stopped, if the patient is still hypertensive.)
Causes of amenorrhea
Amenorrhea: Absence of menstruation.
Most common cause: Pregnancy
- Exercise induced amenorrhea (common in female athletes)
- Amenorrhea may occur when a woman's body fat drops below a certain percentage
- Emotional problems or extreme stress
- Anorexia nervosa; in this case, it is a symptom of the patient's malnutrition and emotional state.
Delay in cutting the cord may result in
A delay in clamping the umbilical cord and keeping the newborn below the level of the placenta may cause more blood to flow into the newborn, which can in turn lead to POLYCYTHEMIA (an abnormally high red blood
cell count). If the newborn is kept above the level of the placenta, reverse blood flow may occur and may cause anemia in the newborn.
Clamping of the cord should be delayed 30 seconds after delivery for most vigorous term and preterm (34-36 weeks) newborns, unless the newborn requires resuscitation
is defined as expulsion of the fetus, from ANY cause, before the 20th week of gestation.
Abortions can be broadly classified as spontaneous (miscarriage) or elective (induced).
Gravida vs para
Gravidity: total number of times a woman has been pregnant regardless of those pregnancies' outcomes, including the current pregnancy.
Para means number of live births.
3 stages of labor
The first stage of labor:
begins with the onset of regular labor pains (crampy abdominal pains), during which the uterus contracts and the cervix effaces (thin or stretch).
The second stage of labor:
The stage of labor in which the newborn's head enters the birth canal, during which contractions become more intense and more frequent.
The third stage of labor:
The stage of labor in which the placenta is expelled.
Cephalopelvic disproportion (CPD)
The head of the fetus is larger than the pelvis and in most cases a C-section will be required to prevent maternal and fetal distress.
Cephalopelvic disproportion may cause massive hemorrhage, along with other postpartum complications.
Delivering multiple babies
The procedure for delivering twins is the same as that for single newborns.
- Clamp and cut the cord of the first newborn approximately 30 seconds following birth and
before the second newborn is delivered.
- The second newborn may deliver before or after the first placenta
- There may be only one placenta, or there may be two.
- If two cords are coming out of one placenta, the twins are "identical"
- If only one cord is coming out of the placenta, then the twins are "fraternal," and there will be two placentas
- Identical twins are of the same sex; fraternal twins may be of the same or different sexes
- Remember, if you see only one umbilical cord coming out of the first placenta, there is still another placenta to be delivered
- If both cords are attached to one placenta, the delivery is over.
Twins may be so small that they look premature; handle them very carefully, and keep them warm.
Treatment of bradycardia in children
See ALCO protocol or PALS
Why is epiglottitis less common now?
Because epiglottitis often results from infection with the Haemophilus influenzae type b virus, this disease's incidence has decreased over time with widespread adoption of the Hib vaccine.
.01mg/kg (.1ml/kg) 1:10,000 IV/IO
Chest compression to ventilation ratio
3:1 for a 90:30 ratio in 1 minute
Attributes of level I trauma center
- Provides highest level of surgical care for traumas
- Regional referral center
- Required to have full range of specialists available 24 hrs a day
- Capacity to provide advanced, tertiary care (Tertiary blast injury occurs when a person is physically thrown by the blast)
- Research program
- Provides public education
primary, secondary, and tertiary blast injuries
Primary: injuries due to the
BLAST WAVE ITSELF
Secondary: injuries due to missiles being propelled by blast force.
Tertiary: Tertiary blast injury occurs when a person is PHYSICALLY THROWN by the blast (usually comes from being thrown by blast wave and then impacting with other objects)
Vehicles vs pedestrian
87% of pedestrians are struck by a vehicles front end.
Adult injuries are generally lateral and posterior injuries because adults tend to turn to the side or away from impact
CHILDREN: face forward into the oncoming vehicle
Head on motorcycle collisions
Motorcycles strikes another object and stops its forward motion.
- Rider continues forward until stopped by an outside force (causes rider to go over handlebars)
- For motorcycles with a low riding seat, gas tank can act as a wedge on the pelvis and cause:
a. severe anterior-posterior compression injuries
b. open pelvic fractures
up & over vs down and under
The lead point is the head. In this sequence, rotation occurs around the ankles with the torso moving in an upward and forward direction. The head takes a higher trajectory, impacting the windshield, roof, mirror, or dashboard, causing compression and deceleration injuries that can include significant head and cervical spine trauma.
- Significant head and cervical spine injuries
- laryngeal fracture
- serious lacerations, and other soft-tissue injury.
- Ejection causing second impact injuries
- Lower leg injury
- Chest injuries
Down and Under:
The down-and-under pathway is traveled by an occupant who slides under the steering column or dash. As the vehicle is decelerating, the occupant continues to travel downward and forward into the dashboard or steering column, led by the knees.
- Fractured/dislocation of knee
- Hip and pelvic fractures
- Hip dislocation
- Spinal injuries
- Rib fractures
- Pulmonary and cardiovascular injuries
most significant injuries occur to patients with falls above which height
A fall greater than 15 feet (5 m) or 2.5 to 3 times the height of the patient will have a greater incidence of morbidity and mortality (although it is usually assumed a fall from four stories may be survivable)
Five stories, survival
Six stories, survival is unlikely.
Seven stories or higher is rarely
P1556 from book
The body's natural blood-clotting
Heart rates and respiratory rates associated with stage 1, 2 ,3 & 4 shock
- Blood Loss (mL): <750
- Blood Loss (%) :<15
- HR: Slightly elevated
- BP: Normal
- RR: 14-20
- Mentation: Anxious
- Skin Signs: Cool, Pink
- Blood Loss (mL): 750-1500
- Blood Loss (%) : 15-30
- HR: 100-120
- SBP: Normal Limits
- RR: 20-24
- Mentation: Mildly Anxious
- Skin Signs: Cool, Moist
- Blood Loss (mL): 1500-2000
- Blood Loss (%) : 30-40
- HR: >120, thready
- SBP: Sig Drop
- RR: Elevated
- Mentation: Anxious and Confused
- Skin Signs: Cool, pale, moist
- Blood Loss (mL): >2000
- Blood Loss (%) : >40
- HR: Severe Tachycardia
- SBP: Sig Depressed
- RR: Significantly Elevated
- Mentation: Confused and Lethargic
- Skin Signs: Cold, Pale
Celox, QuickClot & HEMCon are used for:
All packaged major trauma gauze with coagulates for uncontrolled hemorrhage
Size of a helicopter landing zone
The area should be a hard or cropped grassy level surface that measures 100 feet × 100 feet
(recommended; 30 m × 30 m) and no less than 60 feet × 60 feet (18 m × 18 m).
If the site is not level, the flight crew must be notified of the
steepness and direction of the slope.
Passage of stools containing bright red blood.
Entry vs exit wounds
Entry wound: is characterized by the effects of initial contact and implosion. Skin and subcutaneous
tissues are pushed in, cut, or abraded externally as missile fragments pass and heat is transferred to the body tissues.
Exit wound: The point at which a penetrating object leaves the body, which may or may not be in a straight line from the entry wound. THE EXIT WOUND IS USUALLY LARGER AND MORE RAGGED. THERE MAY BE MULTIPLE EXIT WOUNDS IN THE CASE OF FRAGMENTATION
As a general rule, the entrance wound (usually funnel shaped) is always smaller than the exit wound. Assume cavitation involves internal structures that are not readily visible on your clinical exam
Hallmark sign of mania
"The memory of a patient with mania is usually intact but may be distorted by underlying delusions. The affect is elated (THE HALLMARK OF MANIA)." P1473
^^^ELATED DEFINTION: make (someone) ecstatically happy.
Book definition: A mental disorder characterized by abnormally exaggerated
happiness, joy, or euphoria with hyperactivity, insomnia,
and grandiose ideas.
Pt's report a significant decrease need for sleep. May go days without sleep. Pt's are also easily distracted.
Klonopin and Buspar are used for
Klonopin is a benzodiazepine used for immediate relief of panic attacks.
Rx: anxiety, agitation
Buspar is a long term management anxiolytic with less abuse potential and no drowsy side affect.
Class: anxiolytic, hypnotic
Rx: anxiety, agitation
Effects of histamines
A chemical found in mast cells that, when released,
causes vasodilation, capillary leaking, and bronchiole
constriction; found in large amounts in basophils; increases
Histamine causes dilation of blood vessels, increasing blood flow to the injured area and resulting in a reddened, warm area immediately around the site. Histamine makes capillaries
more permeable, and swelling may occur as fluid seeps
out of these "leaky" capillaries.
Histamine has negative inotropic effects on the heart which in the presence of dilated, leaky capillaries will lead to potentially profound hypotension. The presence of histamine causes white blood cells to produce leukotrienes which compound the effects of the histamine worsening edema and capillary leafiness, bronchoconstriction, vasodilation, and smooth muscle relaxation. Can occur in minutes or hours depending on sensitivity to allergen.
MOA of diphenhydramine
Blocks H1 histamine receptors in the respiratory tract, blood vessels, and GI smooth muscle; Decreases motion sickness. Reverses extrapyramidal reactions.
Treatment of anaphylactic shock
See ALCO protocol
Organic brain syndrome
Temporary or permanent dysfunction of the brain, caused by a disturbance in the physical or physiologic functioning of brain tissue.
Pychosis definition and S/S
A mental disorder characterized by a disconnection from reality.
is a condition that affects the way your brain processes information. It causes you to lose touch with reality. You might see, hear, or believe things that aren't real.
Supine hypotensive syndrome definition and S/S
Low blood pressure
resulting from compression of the inferior vena cava by the weight of the pregnant uterus when
the woman is supine.
Gestational hypertension definition and S/S
Develops after the 20th week of pregnancy in women with previously normal blood pressures and resolves spontaneously in the postpartum
period. It is more commonly experienced by women
who are obese or glucose intolerant. Pregnancy-induced
hypertension may be an early sign of preeclampsia
S/S Pregnancy induced HTN
Ectopic pregnancy definition and S/S
Ectopic pregnancy occurs OUTSIDE the uterus. Ectopic pregnancies are often called tubal pregnancies because most are located in the fallopian tube Other possible sites, although much less common, include the abdominal cavity, on an ovary, or on the cervix.
(1) abdominal pain
(2) delayed menses
(3) abnormal vaginal bleeding (spotting) that occurs about 6 to 8 weeks after the last normal menstrual period
Later Life Threatening S/S:
life-threatening cause of
vaginal bleeding in early pregnancy; therefore will present will signs and symptoms of hypovolemic shock
Gestational diabetes definition and S/S
Diabetes that develops during pregnancy in women who did not have diabetes before pregnancy. It is is the inability to process
carbohydrates during pregnancy. Results from increased carbohydrate intake and cellular decline in insulin sensitivity despite an increase in insulin production by the pancreas.
S/S and treatment:
The patient may be asymptomatic or may exhibit the same signs observed in patients with diabetes mellitus: polyuria,
polydipsia, and polyphagia. Patients usually have hyperglycemia, but not acidosis
Treatment consists of diet
control and oral hypoglycemic medications
Preeclampsia definition and S/S
A condition of late pregnancy that involves gradual onset of hypertension, headache, visual changes, and swelling of the hands and feet; also called pregnancy-induced hypertension or toxemia of pregnancy.
S/S edema, usually
of the face, ankles, and hands; gradual onset of hypertension;
and protein in the urine.
Severe preeclampsia may display S/S of systolic pressure exceeds 160 mm Hg or the diastolic pressure exceeds 110 mm Hg, headache, dizziness, nausea and vomiting, agitation, rapid weight gain, and visual disturbances (floating spots of light).
Eclampsia definition and S/S
Seizures that result from severe hypertension in a pregnant woman.
S/S Seizures caused by hypertension
Hyperemesis gravidarum definition and S/S
A condition of persistent
nausea and vomiting during pregnancy.
- include severe nausea and persistent vomiting, in excess of three or four times daily.
- Vomiting is usually projectile and generally consists of bile
and possibly blood.
- Possibly jaundice
Placenta previa vs Placenta abruptio with S/S
Placenta Previa: A condition in which the placenta develops over and covers the cervix.
S/S The chief complaint of a woman with placenta previa
is usually PAINLESS vaginal bleeding, with the loss of BRIGHT RED BLOOD.
Placenta abrutio: the placenta partially or completely separates prematurely from the wall of the
S/S will present with
a sudden onset of SEVERE ABDOMINAL PAIN, often radiating into the back and DARK RED vaginal bleeding; there will also be decreased fetal movement and decreased fetal heart tones. The abdomen will be
tender and the uterus rigid to palpation. Pt may present with SIGNS OF SHOCK due to severe blood loss
Acute dystonic reaction definition and S/S
A syndrome that may occur
in patients taking typical antipsychotic agents. The
patient develops muscle spasms of the neck, face, and back within a few days of starting treatment
with the medication.
Anaphylaxis vs anaphylactic shock with S/S
Anaphylaxis: An extreme systemic form of an allergic reaction involving one, two, or more body systems.
In anaphylactic shock, it is technically distributive shock where in this situation hypotension is caused by a huge histamine release throughout the body in response to an allergen causing mass vasodilation and leaky blood vessels.
S/S per ALCO:
Wheezing, repetitive cough, tightness in chest, stir, difficulty swallowing, change in voice, dizziness, abdominal complaints, anxiety, lethargy.
S/S of Anaphylactic shock:
Pallor, HYPOTENSION, cool, clammy mottled skin, altered sensorium.
Generalized anxiety disorder definition and S/S
A disorder in which
a person worries about everything for no particular
reason, or in which the worrying is unproductive and the person cannot decide what to do about an upcoming situation.
Epiglottitis definition and S/S
An inflammation of the epiglottis. As the epiglottis swells, it may begin to block the trachea and obstruct the airway.
S/S A child with epiglottitis looks sick and will be anxious, will sit upright in the sniffing position
with the chin thrust forward to allow for maximal air entry,
and may be drooling because of an inability to swallow
secretions. Increased work of breathing, pallor, and cyanosis may be present. They will have a sudden onset of fever and sore throat.
If severe, Stridor heard on auscultation over the neck, a muffled voice, decreased or absent breath sounds, and hypoxia are all signs of a significant airway obstruction.
PID (Pelvic Inflammatory Disease) definition and S/S
An infection of the female reproductive organs (usually caused by STD's such as chlamydia or gonorrhea). This infection will cause an inflammatory response that can lead to peritonitis or development of pelvic abscesses. Sepsis is always a risk as well.
S/S Many women who have PID have no signs or symptoms or
have symptoms but do not seek treatment. If a patient with PID has symptoms, she may report
pain that generally starts during or after normal menstruation. The pain is typically diffuse and is spread over both quadrants of the lower abdomen. It may be described as "achy," and the patient may volunteer that the pain is made worse by walking or by sexual intercourse.
Associative symptoms may include vaginal discharge, fever and chills, and pain or burning
on urination (dysuria).
Meningococcal Meningitis definition and S/S
A type of meningitis caused by the meningococcal bacterium. Meningitis is an inflammation or infection of the meninges, the covering of the brain and spinal cord. Occurs through direct contact with droplets.
S/S sudden-onset fever,
severe headache, stiff neck, Kernig sign (the patient cannot extend his or her leg at the knee when the thigh is flexed because of stiffness in the hamstrings), Brudzinski sign (severe neck stiffness causes a patients hips and knees to flex when the neck is flexed), photosensitivity, and a pink rash that becomes purple.
Gonorrhea definition and S/S
is an infection caused by the gonococcal bacteria, Neisseria gonorrhoeae.
Transmission occurs sexually, by contact with the pus-containing fluid from mucous membranes of infected people. The incubation period is usually 2 to 7 days but may be longer.
Males: Males usually experience a (white/yellow) pus-containing discharge from the urethra and often report pain on urination (dysuria) starting a few days after exposure.
Females: the initial inflammation of the urethra or cervix may be so mild that it passes unnoticed, and the illness may progress to pelvic inflammatory disease (PID), with
signs and symptoms of an acute abdomen.