Obstetrical Standards Flashcards
Neonate Standard
What should you be aware of in terms of care?
What kind of problems are you going to be aware of during you primary?
DETERMINE if the neonate pt (3)
Be aware that the mother may also need care
Anything that could arise due to anatomy and physiology
Is term gestation (39 weeks - 40 weeks 6 days)
Has good tone
AND
Has unlaboured breathing
Neonate Standard
If the Neonate does not meet the DETERMINE criteria (3) then you
What about the MOTHER do you attempt to DETERMINE?
Recognize the potential need for neonatal resuscitation in conjuction with the ALS PCS
Hx of pregnancy (gestational length, # of pregnancies, # of births)
Details surrounding labour (the duration)
Details regarding delivery (whether is was precipitated or complicated)
Who delivered the neonatal pt
Neonate Standard
What about the NEONATE do you attempt to DETERMINE?
Guideline - how do you handle head positioning for a neonate?
The pt’s colour, breathing, and activity since delivery
AND
Any clinical care provided since delivery
Use a small towel roll like a face cloth to place beneath the neonatal pt’s SHOULDERS being causious NOT to hyperextend the neck.
Neonate Standard
What do you do if the Neonate has been delivered?
Whether you assisted in delivery or not
Reassess the mother (if required)
Wipe neonate’s nose and mouth (if required)
Clamp and cut the umbilical cord (if not already done) as per ALS PCS
Position the neonate supine on a firm surface with neck slighty extended (to establish an airway)
Neonate Standard
What should you do IMMEDIATELY following the delivery?
What do you do if the neonate does NOT require neonatal resuscitation?
Record the time
Tag/tape the neonate pt with the time AND mother’s name (if time and patient conditions permit it)
Attempt to place the neonatal skin-skin with the mother’s chest or abdomen PRIOR to transport and allow nursing if wished
AND
swaddle the neonatal pt with a blanket
Neonate Standard
What should you ALWAYS recognize about a neonate?
AND what should you do about it?
When do you take APGAR scores? When do you iniate rapid transport?
The pt’s inefficiency at regulating body temperature
Cover/re-cover the neonate during care to maintain a normal temperature
At 1min and 5min post delivery. Initiate rapid transport if the APGAR score is LESS than 7 after 5min.
Neonate Standard
What’s APGAR stand for and break it down for me?
A - Appearance
P - Pulse
G - Grimace
A - Activity
R - Respiration
Pregnancy Standard
What LIFE/LIMB/FUNCTION threats to both the mother and fetus are you considering?
What are the 1st trimester complications? (3)
What are the 2nd+3rd trimester complications? (4)
Pre-eclampsia/eclampsia
Prolapsed umbilical cord
Spontaneous Abortion
Ectopic pregnancy
Gestational trophoblastic disease
Spontaneous abortion
Placental abruption
Placenta previa
AND
Ruptured uterus
Pregnancy Standard - Guideline
When should pre-eclampsia be assumed?
ONLY for patients who are beyond their 20 week gestation AND have a BP of GREATER/EQUAL to 140/90 WITH?
Generalized Edema (face legs)
OR
Non-specific complaints of headache, nausea, abdominal pain with or without vomiting/blurred vision/fatigue/generalized swelling or rapid weight gain
Pregnancy Standard
What assessment and care do you give priority to?
During the primary what should you be aware of?
Guideline - How do you calculate due date?
Maternal (the mother)
Problems that could arise due to anatomic and physiologic changes (preg)
Last menstrual period - 3 months + 7 days
Pregnancy Standard
What pregnacy related hx are you attempting to determine?
When arriving on scene what do you attempt to determine?
Number of previous pregnancies
Number of deliveries
Latest ultrasound findings
History of complications from past pregnancies
AND
Duration of labour from past pregnancies
The due date
Any present problems with preg (infection, bleeding, diabetes, BP, pre-eclampsia)
Presence of:
- Abdominal pain/contractions
- vaginal bleeding/fluid discharge
Severity of Vaginal bleeding/fluid discharge
What (if any) the contractions timing and intensity are
Pregnancy Standard
What do pregnant patients present with in order for you to assess as per the Abdominal (Non-Traumatic) Standard?
If the pt is beyond ? weeks you should?
Guideline - With respect to uterine height what is
The gestational size if the uterus is at the umbilicus?
The gestational size if the uterus is as the costal mergins?
A history indicative of a motor vehicle collision
Abdominal pain, contractions, vaginal bleeding, or cord prolapse
Acceleration/deceleration injuries
Blunt trauma involving the truncal area (regardless of whether there are specific complaints)
Fall injuries
Headache, blurred vision, nausea, or swelling
Malaise (discomfort), weakness, dizziness, light-headedness, seizure, or
shortness of breath
AND/OR
Penetrating trauma to the chest/abdomen
Note uterine height + palpate for contractions
Note fetal movements
20
Note uterine height + palpate for contractions
Note fetal movements
20 weeks
36 weeks
Pregnancy Standard
How do you observe contractions?
What do you do prior to inspection and examination of the perineum?
Manage labour and delivery —
Note the timing and intensity of contractions
Observe for palpable fetal parts/movement
Don sterile gloves
as per the ALS PCS
Pregnancy Standard
What position do you transport the patient?
What if the patient is on a spinal board or beak-away stretcher?
What do you do in terms of informing/reporting/documenting?
Left-lateral
Then tilt the head 30 degrees to the LEFT
Notify the receiving facility of the pt’s and neonate’s status (if applicable) in conjunction with the ‘Reporting of Patient Care to Receiving Facility Standard’
