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MI Differential Diagnosis > Screening for Obstetric, Geriatric, and Post-Op pts > Flashcards

Screening for Obstetric, Geriatric, and Post-Op pts Flashcards

1
Q

list examinations and treatment considerations for Obstetric pts

A
  1. avoid flat prone lying in mid-late pregnancy
  2. avoid supine positions for longer than a few minutes after 4th month of pregnancy → monitor for nausea, bradycardia, and syncope
  3. avoid activities that strain the pelvic floor/abdominal muscles
  4. avoids positions that involve rapid uncontrolled bouncing or swinging
  5. avoid aggressive stretching of hip adductors
  6. avoid overheating
  7. avoid deep heat modalities or electrical stimulation over the trunk
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2
Q

what is supine hypotension syndrome?

A

occurs due to weight of growing baby pressing onto and obstructing the inferior vena cava

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3
Q

examination and treatment considerations for supine hypotension syndrome

A
  1. Monitor for:
    1. nausea
    2. bradycardia
    3. syncope
  2. suggested positioning:
    1. rotate 30 degrees to L supported with pillow under R side to shift uterus to L and relive caval occlusion
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4
Q

list common medical conditions and symptoms of pregnancy

A
  1. Backache → consider possibility of kidney infection
  2. Carpal tunnel syndrome
  3. HA
  4. muscle cramps
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5
Q

list special questions for pregnant pts

A
  1. any complications with this pregnancy?
  2. any complications with a previous pregnancy or delivery that is placing you at high risk now? Were you considered high risk in a previous pregnancy?
  3. Did you have any of your current MSK symptoms during a previous pregnancy and, if so, what was done for them? Was the treatment successful?
  4. What meds are currently being taken and what meds did you stop b/c of your pregnancy?
  5. are you currently having any urinary or anal incontinence?
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6
Q

list special questions for postpartum pts

A
  1. were you on bed rest during pregnancy? If so, how long?
  2. did any of the following occur during delivery:
    1. regional anesthetic injection
    2. forceps or vacuum extraction
    3. episiotomy or tears of perineum
    4. cesarean
  3. do you now have symptoms of urinary or anal incontinence or organ prolapse?
  4. did you have current symptoms during your pregnancy or after a previous pregnancy and, if so, was there any treatment that was successful in alleviating these symptoms
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7
Q

list common referrals to pelvic health specialists

A
  1. anal or urinary incontinence; urinary urgency
  2. pubic symphyses pain
  3. SI pain
  4. Rib pain
  5. LBP in pregnancy or postpartum
  6. diastasis recti abdominis
  7. pelvic floor muscle tenderness or pain
  8. pelvic floor muscle weakness
  9. postpartum neuromuscular injury
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8
Q

list 7 conditions to screen for in pregnant or postpartum pts

A
  1. preeclampsia
  2. ectopic pregnancy
  3. fetal distress
  4. osteoporosis of pregnancy
  5. DVT
  6. postpartum depression
  7. postpartum psychosis
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9
Q

list S/S of Preeclampsia

A
  1. Symptoms
    1. HA
    2. blurred vision
  2. Signs
    1. edema (sudden onset, may be global)
    2. HTN
    3. proteinuria
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10
Q

List S/S of ectopic pregnancies

A
  1. severe lower abdominal pain
  2. dizziness
  3. lightheadedness
  4. nausea
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11
Q

list S/S of fetal distress

A

decreased fetal movement

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12
Q

list S/S of osteoporosis of pregnancy

A
  1. Symptoms
    1. pain in hip or lower back
    2. pain with WBing
  2. Signs
    1. empty or spasm end-feel in hip flexion
    2. lose of height
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13
Q

list S/S of DVTs

A
  1. localized calf, popliteal or anterior thigh or groin pain
  2. calf of LE swelling
  3. pitting edema
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14
Q

list S/S of postpartum depression

A
  1. severe mood swings
  2. loss of appetite
  3. irritability
  4. withdrawal from family
  5. difficulty bonding with baby
  6. thoughts of harming baby
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15
Q

list S/S of postpartum pyschosis

A
  1. mania and depression
  2. hallucinations/delusion especially concerning the child
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16
Q

what can be used to screen for postpartum depression?

A

Edinburgh Postnatal Depression Scale (EPDS)

a score of 10 or more warrants a referral

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17
Q

what is gestational diabetes?

A

women that have high blood glucose levels during pregnancy that did not previously have DM

usually goes away after pregnancy

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18
Q

gestational diabetes recommendations

A

recommended program including cardiovascular conditioning improves glycemic control better than diet alone

19
Q

gestational diabetes is associated with increased risk for what things?

A
  1. congenital malformations
  2. large/heavy baby for gestational age
  3. perinatal morbidity and death
20
Q

list signs for HTN in pregnancy

A
  1. visual changes
  2. HAs
  3. BP above baseline
  4. sudden onset of edema
21
Q

T/F: venous thromboembolisms are a complicating factor in some pregnancies

A

TRUE

1 in 1000-2000 pregnancies

22
Q

list risk factors for venous thromboembolisms

A
  1. hypercoagulability
  2. venous stasis
  3. vascular damage
  4. changes in coagulation system
23
Q

describe osteoporosis in pregnancy

A
  1. said to be transient
  2. affects lumbar spine, hip and wrist most commonly
  3. compression fractures of spine and sub capital femoral fractures have been reported
24
Q

how is the diagnosis of osteoporosis in pregnancy made?

A
  1. ruling out other mechanical causes
  2. along with not responding to treatment
  3. empty endfeel at hip, spine or wrist
  4. change in height
25
Q

describe pubic symphysis dysfunction in obstetric pts

A
  1. increased incidence in pregnancy and postpartum secondary to increased joint mobility
  2. may result in:
    1. pubic shears
    2. pubic symphysis separation
    3. osteitis pubis
26
Q

list common symptoms of pubic symphysis dysfunction

A
  1. painful gait and weight-shifting
    1. especially with bed mobility
  2. painful abduction of LE
27
Q

what is diastasis recti abdominus?

A

separation of greater than 2 fingertip widths of the two bellies of rectus abdominis muscle at linea alba

28
Q

T/F: diastasis recti abdominus can be very painful

A

FALSE

painless condition

but there is a link to LBP and urinary incontinence secondary to changes of integrity of abdominal wall

29
Q

describe treatment of diastasis recti abdominus

A
  1. resolves spontaneously in most women
  2. some evidence supports that TA strengthening can help resolve separation
  3. referral to women’s health PT appropriate
30
Q

what needs to be screened for in geriatric pts?

A
  1. Polypharmacy
  2. Falls
  3. Abuse
  4. Depression
  5. Dementia
31
Q

follow up questions for medication use

A
  1. Is one MD managing your prescriptions?
  2. Why are you taking these meds?
  3. Have you taken these drugs today?
  4. Do the meds relive your pain/symptoms?
    1. if “yes”, how soon after you take the meds do you notice an improvement?
  5. When did your MD last review these medications?
  6. Are you taking any meds that weren’t prescribed for you?
32
Q

follow up questions for fall risk assessment?

A
  1. do you have any episodes of dizziness?
    1. if yes, does turning over in bed cause or increase dizziness?
  2. do you have trouble getting in or out of bed w/o losing your balance?
  3. Can you/do you get in and out of your tub/shower?
  4. do you avoid walking on grass or curbs to avoid falling?
  5. have you started taking any new meds, drugs or pills of any kind?
  6. has there been any change in the dosage of your regular meds?
33
Q

list warning signs of elder abuse

A
  1. multiple trips to ER
  2. depression
  3. falls/fractures
  4. bruising/suspicious sores
  5. malnutrition/weight loss
  6. pressure ulcers
  7. changing MDs/therapists often
  8. confusion attributed to dementia
34
Q

what can be used to screen for depression in geriatrics?

A

Geriatric Depression Scale: Short form

  • score >5 points suggestive of depression
    • warrants a follow-up comprehensive assessment
  • score of 10 or more is almost always indicative of depression
35
Q

what can be used to assess cognition in geriatrics?

A

Standardized Mini-Mental State Examination (SMMSE)

36
Q

describe cutoffs and how to interpret the SMMSE

A
  1. any score greater than or equal to 27 points (out of 30) indicate normal cognition
  2. severe cognitive impairment = 9 or less points
  3. moderate cognitive impairment = 10-18 points
  4. mild cognitive impairment = 19-24 points
37
Q

List some post surgical concerns

A
  1. DVT/PE
  2. Infection
  3. Acute Compartment Syndrome
38
Q

Risk factors for post-surgical infections

A
  1. smoking
  2. DM
  3. heart conditions
  4. weak immune system
  5. older age
  6. foreign objects in wound
  7. poor nutrition
  8. obesity
39
Q

incidence of post-surgical infections

A

35,000 infections occur every year after ortho surgeries

  • monitor surgical site for changes
  • monitor pt for reports of “feeling bad” overall
40
Q

List signs of infections

A
  1. fever
    1. it is NOT uncommon to have a low grade fever after surgery, if there is just fever and no other S/S it’s not always a red flag
  2. increased pain
  3. erythema/warmth
  4. discharge from surgical incision
  5. swelling
  6. red streaks
  7. odor
41
Q

what is acute compartment syndrome?

A

trauma (history of trauma or crush injury) results in increased pressure in the compartment = insufficient blood supply to the nerves and tissues

42
Q

describe the clinical presentation of acute compartment syndrome

A
  1. severe, persistent leg pain that is intensified with stretching applied to the affected muscle
  2. swelling, tenderness, and palpable tension
  3. paresthesia, paresis, and pulselessness
43
Q

T/F: acute compartment syndrome is a medical emergency

A

TRUE
requires immediate surgical treatment

MI Differential Diagnosis (16 decks)

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