Signs/Symptoms of female reproductive tract infection
...PID?
placenta previa
the placenta develops over and covers the cervix
Causes of first trimester bleeding
spontaneous abortion
Complications of traction on an umbilical cord
tearing or occlusion of the cord which can cause hypoxia to infant
abruptio placentae
patient often complains of severe pain and vaginal bleeding later in pregnancy
Medical terminology for abnormal delivery complications
complicated delivery: Breech delivery, Presentation complication, Spina Bifida, Abortion
Medical terminology for describing a pregnant female
primigravida (1st pregnancy) or multigravida (previous pregnancies experienced)
Signs and symptoms of an ectopic pregnancy
sudden stabbing and usually unilateral pain in the lower abdomen. A history of pelvic inflammatory disease, tubal ligation, or previous ectopic pregnancies should make you suspicious
Signs and symptoms of a uterine rupture
severe abdominal pain, severe bleeding, hemorrhagic shock
Signs and symptoms of placenta previa
vaginal bleeding later in pregnancy without pain
Signs and symptoms of postpartum complications
Vaginal bleeding that exceeds 500mL & shock (usually due to prolonged labors or multiple births), pulmonary embolism w/ sudden difficulty breathing (due to mothers increase in clotting
ability while pregnant).
breech delivery
Butt first
presentation complication
Limb presentation, prolapsed umbilical cord
spina bifida
exposed spine on infants back
abortion (usually early in pregnancy)
vaginal bleeding
Signs of abuse
bleeding, miscarriage, premature births, low birth weight, infection, uterine rupture
Signs of substance abuse
fetal alcohol syndrome, meconium in amniotic fluid
Other signs of pre-delivery emergencies
multiple gestation, premature infant
Signs and symptoms of pre-eclampsia
pregnancy induced hypertension; headache, seeing spots, swelling of hands & feet, anxiety
difference between eclampsia and preeclampsia
eclampsia includes seizures that occur as a result of hypertension
Supine Hypotensive Syndrome
Dizziness and a drop in blood pressure caused by the weight of pregnant uterus compressing the inferior vena cava, reducing return of blood to the heart and cardiac output.
Transporting a female with supine hypotensive syndrome
on left side
Assessing uterine contractions
sign of the onset of labor; initially not at regular intervals & may feel like back pain
true labor
contractions that last 30-60secs at regular intervals, pain starts in lower back wraps around lower abdomen, bloody show is pink or red with mucus, amnioic sac breaks before or during contractions with a sweet smelling fluid that continues to leak
Braxon-Hicks labor
contractions are not regular and do not increase with intensity, contractions come and go, pain starts and stays in lower abdomen, bloody show is brownish, some leakage of fluid but is usually urine and smells like ammonia.
Methods for suctions a newborns airway
Suction mouth 1st then each nostril. Always squeeze bulb before entering airway then release when inside airway then expel fluid away from infant and mother.
Methods for measuring Ped oral airway
place the airway next to the face with the flange at the level of the central incisors or corner of the mouth and the tip of the airway should reach the angle of the jaw
The Broselow Tape
can also be used to determine all the appropriate sized equipment for peds
Resuscitating a bradycardic newborn
bradycardia is <120bpm. place infant with head down and suction airway, stimulate infant by flicking the feet or rubbing back, BVM with ratio 3:1, Chest compressions with ratio 15:2, transport quickly
Signs and symptoms of respiratory distress in a neonate
skin is blue or pale, no crying or reaction to stimulus, limp w/ no muscle tone, absent resp
Pelvic inflammatory disease (PID)
Generalized lower abdominal abnormal and foul smelling discharge from the vagina. Increased pain with intercourse, fever, general malase and nausea and vomiting
Toxemia
characterized by pre-eclampsia then eclampsia.
Signs and symptoms of toxemia
Severe persistent headache, vomiting, abdominal pain, pregnant, not eating, low urination, high blood pressure
Infant birth complications
Infant heart rate should be above 100 beats/min and not breathing adequately begin ventilations 40-60/min. If heart rate does not improve to greater than 80 beats/min begin CPR
Imminent birth
Contractions closer than 2 mins apart are intense and last from 30-90 secs
Signs and symptoms of Epiglottitis
Fever, pain on swallowing, Drooling, mouth breathing
Signs and symptoms of Croup
fever, coughing
CPR for 6 year old child
Chest wall should be compressed 1/3-1/2
Infants and children 0-8
assess pulse at the brachial Artery
Children
1-8 years old
Infants
0-1 years old
New born Heart Rate
140-160
Infant Heart Rate
120-140
Children Heart Rate
100-120
Adults Heart Rate
60-100
Geriatric Heart Rate
80-100
Pediatric Assessment Triangle
Appearance, Work of Breathing, Circulation. Quick assessment tool (less than 30 sec)
Pregnant Spinal Immobilization
To avoid Supine Hypotensive Syndrome; Left Lateral Recumbent
Pediatric Spinal Immobilization
Pad voids around PT; neck especially. Do not press down on head if in carseat; pad sides only.
Geriatric Spinal Immobilization
Be wary of fragile bones, voids
Anatomical Differences in Pediatrics
Smaller airway, tongue larger in ratio to pharynx than adult, smaller reserve of everything (blood volume, O2, electrolytes, glucose, homeostasis), more flexible (don't break bones as often), compensate better but for a shorter time and decompensate quick
Indications for suctioning a newborn
Meconium (suction aggressively), amniotic fluid after birth, anything in airway
Expected Anatomical Physiological Changes for First Trimester
Menstruation ceases, increased fluid in uterus, hormone changes, ectopic pregnancy
Expected Anatomical Physiological Changes for Second Trimester
Decreased depth of breathing/increased respirations, increased blood volume, increased urination, uterus is at/above belly button; increases danger of fetal injury.
Expected Anatomical Physiological Changes for Third Trimester
Mother's heart rate increases up to 20% or 20 beats more/minute, cardiac output significantly increased, increased chance of cardiac complications, GI tract under pressure causes increased chance of vomiting, joints less stable and increased bodyweight ca
Dysfunctional bleeding in a Pregnant Patient
Ectopic pregnancy, abruptio placenta, placenta previa, miscarriage (spontaneous abortion)
Dysfunctional pregnant bleeding Tx
Shock, left side, hi flow O2, sterile pad, transport
Meningitis Signs/Symptoms
Stiff neck in children (stretches meninges; causes pain), fever, ALOC (mild/severe headache, lethargy, confusion, inability to understand commands/interact appropriately), child may experience seizure, infants younger than 2 to 3 months can have apnea, cy
Pathophysiology of a Febrile Seizure
Most common in ages 6mo-6y/o, usually generalized tonic-clonic seizures that last less than 15 min and has short/no post-dictal state. Can be a sign of a more serious problem like Meningitis.
Febrile Seizure Tx
ABCs, cool with tepid (room temp) water. Cool until PT begins to shiver. Transport.
First stage of Delivery
Dilation of cervix (positioning of baby into birth canal)
Second stage of Delivery
Delivery of baby
Third stage of Delivery
Delivery of placenta
Abruptio Placenta Signs/Symptoms
Vaginal bleeding, signs of shock
Abruptio Placenta Tx
O2, apply sterile pad, Transport ASAP
Placenta Previa Signs/Symptoms
Placental presentation
Placenta Previa Tx
Transport ASAP
cardiac arrest situations for the pediatric population
Absence of central pulse indicates CPR
Treating a child with foreign body airway obstruction
Encourage coughing, provide O2 NRB if tolerated, abdominal thrusts if severe.
Depth of chest compressions; infant
1/3 diameter; about 1.5
Depth of chest compressions; child
1/3 diameter; about 2
See Saw Respirations
chest and abdominal muscles alternately contract
Treating a cyanotic newborn
Blow-by O2
Complications from newborn respiratory arrest
Cardiac arrest. BVM at 40-60 breathes/min
Indications for resuscitation of a newborn
Heartrate is most important; RR, skin color, movement of extremities.
Special considerations for obtaining vital signs
Brachial artery/umbilical; increased normal rates
Treatment for a pulseless extremity
Do not use specialized splinting equipment i.e. traction unless PT is large enough
Special considerations for the pediatric airway
Smaller, tongue larger, head must be lower if PT supine to be open
Pathophysiology of Pediatric abnormal breath sounds
Grunting; "Uh" sound during exhalation; indicative of inadequate oxygenation.
Treating a child with a toxic ingestion
Call Hazmat, poison control; find out what substance was.
Assessing a dehydrated infant
Ask how many wet diapers vs. normal
Treating an infant with respiratory distress
Do NOT put anything in their mouth
Signs and symptoms of an upper airway infection
Tripoding, drooling (epiglottitis)
Purpura
purple/red discolorations (meningitis)
Pathophysiology of a febrile seizure
Typically occur on first day of febrile illness, last less than 15 min, short/no postictal state
Treating a postictal child
Check airway, cool with tepid water, c-spine, O2, transport, check BS, check temp