Exam 4: Mon.3.28.Obstetrics Flashcards Preview

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Flashcards in Exam 4: Mon.3.28.Obstetrics Deck (54)
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1

What happens with preclampsia?

A little more info than other deck 

  • sudden ↑in BP
  • usually signals kidney damage – cause unknown, although may be pressure in placental blood vessels
  • signals need for immediate delivery
  • HELLP- a severe variant of preclampsia

2

What is HELLP? 

H (hemolysis, which is the breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count)

S/S: 

  • headache
  • N&V
  • malaise
  • nonspecific viral-like symptoms
  • changes in vision
  • shoulder pain when breathing deeplyprotein in urine

3

One thing (out of many, many things) we may need to screen for if a woman complains of abdominal pain

ectopic pregnancy 

4

Some information Dr.T added about Placental abruption

  • Woman may just be put on bed rest
  • Doc with react based on hormone levels, O2 going to baby, and baby's ability to get nutrition. 

5

What do you do if a preganant woman reports she is spotting?

Get her to her OB?GYN or PCP to get check. She may need an ultrasound to find out why she is spotting. 

6

What weeks are the 1st trimester?

Week 1 - 12

7

What weeks are the 2nd trimester? 

Weeks 13 - 27

8

What weeks are the 3rd trimester? 

Weeks 28 - 40

9

Precautions for Exam and Treatment of pregnant women (7)

  1. Positions that involve abdominal compression in mid to late pregnancy (prone flat lying)
  2. Positions in supine for longer than a few minutes after 4th month
  3. Activities that strain the pelvic floor and abdominal muscles
  4. Positions that require rapid balance changes
  5. Vigorous stretching of hip adductors 
  6. Overheating 
  7. Deep heat, electrical stim over trunk

10

why are positions in supine for longer than a few minutes after 4th month a precaution? 

supine hypotension syndrome,

pressure on inferior vena cava

11

Why is vigorous stretching of hip adductors a precaution? 

Due to its impact on the pubic symphasis

12

Why is overheating a precaution? 

fetal health concern with ↑ maternal core temperature

13

Which direction does a pregnant woman's center gravity move?

foward and down

14

General changes that may occur post-partum that require some special consideration with physical therapy (5) PEGS-O

  • Pelvic floor
  • Endurance
  • Generalized ligamentous integrity
  • Strength
  • Other tissues that require special consideration

15

Special Questions to ask a pregnant patient- Table 17.4

Any complications with this pregnancy (e.g., uterine bleeding, premature contractions, incompetent cervix, pregnancy induced hypertenson, preeclampsia, or other need for special tests or bed rest)? 

 

Ramifications

A positive response may alter teh rigor of the PT exam and any exercise prescription given by the PT and may necessitate monitoring of vital signs and symptoms with each visit. 

16

Special Questions to ask a pregnant patient- Table 17.4

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? 

Ramifications

For example, preterm labor in one pregnancy places a woman at risk for a similar outcome in subsequent pregnancies. Monitoring a woman for signs of preterm labor should occur with each visit. 

17

Special Questions to ask a pregnant patient- Table 17.4

Did you have any of your current MSK symptoms during a previous pregnancy and, if so, what was done with them? Was the treatment successful? 

Ramifications

This info can aid the PT in treatment planning

18

Special Questions to ask a pregnant patient- Table 17.4

What meds are currently being taken and what meds did you stop b/c of your pregnancy? 

Ramifications

Meds such as NSAIDs, antidepressants, and migraine prescriptions that are contraindicated in pregnancy can affect symptoms of the MSK system and a patient's pain perception and affect. 

 

19

Special Questions to ask a pregnant patient- Table 17.4

Are you currently having any urinary or anal incontinence? 

Ramifications

Recognition of this condition will aid the PT and patient in treatment before and after delivery. 

20

Special questions to a postpartum patient- Table 17.5

Were you on bed rest during your pregnancy? If so, for how long? 

Ramification

Debilitation may have resulted in prolonged bed rest and may necessitate treatment or modifications

 

21

Special questions to a postpartum patient- Table 17.5

Did any of teh following occur during delivery: regional anesthetic injection; forceps or vacuum extraction; episiotomy or tearsof the perineum; cesarean? 

Ramifications

Debilitation may have resulted from prolonged bed rest and may necessitate treatment or midifications

 

22

Special questions to a postpartum patient- Table 17.5

Do you now have symptoms of urinary or anal incontinence or organ prolapse? 

Ramifications

Referral to a PT with training in rehab of the pelvic floor would be appropriate

23

Special questions to a postpartum patient- Table 17.5

Did you have your current symptoms during your pregnancy or after a previous pregnancy and, if so, was there any treatment that was successful in ameliorating these symptoms? 

Ramifications

A positive response may assist in determining cause, interventions, and prognosis

24

Pregnancy stages:

What happens at month 1? month 2? month 3? 

(sounded like we don't need to have these lists memorized- just general idea of what is going on?) 

Month 1

  • start of first trimester 
  • ovulation and conception
  • during week 4 some home pregnancy tests will detect that you have conceived
  • the embryo is just 2 cells
  • baby is most vulnerable to environmental stressors (drinking, drugs, ect.) 

Month 2

  • signs of pregnancy: extreme fatigue, frequent urination, morning sickness, and hormonal fluctuations
  • The baby's heart is beating
  • The baby's brain is formed
  • Baby is most vulnerale to environmental stressors

Month 3

  • embryo officially becomes a fetus
  • decreased orning sickness
  • fetus is about teh size of a plum

25

Pregnancy stages:

What happens at month 4? month 5? month 6? 

(sounded like we don't need to have these lists memorized- just general idea of what is going on?) 

Month 4

  • start of the 2nd trimester
  • baby's bones are hardening and will now show up on an x-ray
  • baby is about 5 inches long and weighs about 5 ounces
  • mom may start to show 

Month 5

  • you begin to feel the baby start to kick
  • the baby's hearing starts developing
  • Common discomforts during this month: backaches, indegestion, heart burn, headaches, water retention, dizziness, constipation

Month 6

  • This month marks the halfway mark in your pregnancy
  • at the end of teh month, the baby is almost fully formed

26

Pregnancy stages:

What happens at month 7? month 8? month 9? 

(sounded like we don't need to have these lists memorized- just general idea of what is going on?) 

Month 7

  • braxton hicks contractions possible
  • baby's brain is beginning to process sights and sounds
  • baby is about 13 inches long

Month 8

  • the baby is fully formed and putting on weight
  • baby's lungs are almost fully developed

Month 9

  • Common discomforts: braxton hicks contractions, pelvic pressure, difficulty sleeping

27

True or false: Medications, both prescription and OTC, and herbal supplements that cross the placental barrier may be harmful to baby

True

28

Some things a woman should think about with regards to breastfeeding

  • Must discuss medication use with physician
  • if a drug is allowed, should be taken 30-60 minutes after breastfeeding and 3-4 hours before next feed
  • Will need to consider diet, meds, and exercise and it's effect on the breastmilk for as long as the woman breastfeeds

29

What are the categories (just labels) for medications with pregnancy and lactation? 

A

B

C

D

X

30

What does a category A drug mean? 

controlled stdies in human beings have demonstrated no fetal risk

(Not likely to be an RTC since preggo women are not likely to submit to this type of research)