When providing bag-mask ventilations to an infant, you need to be aware that....

an infant’s lungs are fragile. Ventilations that are too forceful can result in trauma from pressure, or barotrauma.

Prior to birth, fetal circulation occurs through...

the placenta

Just after birth, the ductus venosus constricts and closes.

As a consequence... 

the infant’s blood pressure changes, and the foramen ovale, an opening in the septum of the heart, closes

Just after birth the ductus arteriosus constricts and closes, resulting in... 

• circulation through the pulmonary system and the veins and arteries (rather than the placenta)
• increased vascular resistance
• decreased pulmonary resistance.

Pulse

90 to 180

Respirations

30 to 60

BP

50 to 70

Temp

98 to 100

Pulse

100 to 160

Respirations

25 to 50

Blood Pressure

70 to 95

Temp

96.8 to 99.6

Pulse

90 to 150

Respirations

20 to 30

Blood Pressure

80 to 100

Temp

96.8 to 99.6

Pulse

80 to 140

Respirations

20 to 25

Blood Pressure

80 to 100

Temp

98.6

Pulse

70 to 120

Respirations

15 to 20

Blood Pressure

80 to 110

Temp

98.6

Pulse

60 to 100

Respirations

12 to 16

Blood Pressure

90 to 110

Temp

98.6

Pulse

70

Respirations

12 to 20

Blood Pressure

90 to 140

Temp

98.6

Pulse

70

Respirations

12 to 20

Blood Pressure

90 to 140

Temp

98.6

Pulse

70

Respirations

12 to 20

Blood Pressure

90 to 140

Temp

98.6

– the theory that a person’s mental function declines in the last 5 years of life.

Oocyte

Artesia

Luteinizing hormone (LH)

Corpus luteum

Progesterone

Secretory phase

The dome-shaped top of the uterus is called the ______.

Uterus

– a muscular inverted pear-shaped organ, that lies situated between the urinary bladder and the rectum

Fundus 

Body 

Cervix

External Os

Uterine cavity

Cervical canal 

The interior of the vagina is acidic owing the breakdown of glycogen (found in large amounts in the vaginal mucosa), which creates...

The mammary gland (breasts) are _________________.

Milk is carried to the surface of each breast through

Placenta

 – The tissue attached to the uterine wall that nourishes the fetus through the umbilical cord

Blastocyst 

– the term for an oocyte once it has been fertilized and multiplies into cells.

Human chorionic gonadotropin hormone

The placenta serves as ...

Gestational period is the time that is takes for the infant to develop in the utero. It normally takes ________, with significant developmental progress occurring each week. 

Gravid

Para 

primigravida

primipara

multigravida

multipara 

Nullipara

During vaginal delivery, a woman may lose as much as ______ of blood (______  in case of cesarean section)

500 mL

1,000mL

A pregnant woman’s heart rate gradually increases during pregnancy, by an average of _________________.

ECG changes that can occur during pregnancy include __________________, which is often considered normal.

Preeclampsia (also called toxemia of pregnancy) is a condition of late pregnancy that involves that involves gradual onset of....

Preeclampsia manifests after the 20^th week of gestation with the onset of a triad of symptoms such as....

1. edema, usually of the face, ankles, and hands
2. gradual onset of HTN
3. and protein in the urine

Cephalopelvic disproportion

Abortion

Spontaneous abortion

Induced abortion 

Threatened abortion 

Inevitable abortion

Incomplete abortion

Complete abortion

Missed abortion 

Septic abortion

– was once the leading cause of maternal death worldwide.

- In medical literature, a common complication of childbirth was puerperal fever, which was caused by a streptococcal infection of the genital tract.

- Septic occurs when the uterus becomes infected, often by common vaginal bacterial flora, following any type of abortion. 

Abruptio placenta

Placenta previa

Hyperemesis Gravidarum 

Complications of VBAC (vaginal birth after cesarean) can include _________________.

first stage of labor

• Begins with the onset of labor pains–crampy abdominal pains that may radiate into the small of the back and reflect the contractions of the uterus.
• Contractions happen in 5 to 15 minute intervals.
• lasts until the cervix is fully dilated, an average of about 12 hours in a nullipara and anywhere up to 8 hours in a multipara.

second stage of labor

•  Begins as the baby’s head enters the birth canal. 
• The woman’s contractions become more intense and more frequent, now occurring 2 to 3 minutes apart. 
• Pulse rate increases and becomes sweaty. Bears down with contractions. 
• The cervix becomes fully dilated and effaced, crowning occurs. 
• The second stage is concludes when the baby is fully delivered.

third stage of labor 

• AKA the placental stage
• The period from the delivery of the baby until the placenta has been fully expelled and the uterus has contracted. 
• Uterine contraction is necessary to squeeze shut all of the tiny blood vessels left exposed when the placenta separates from the uterine wall.

The average blood loss during the third stage of labor is normally about ______.

When blood loss exceeds ______ during the first 24 hours after giving birth, it is considered postpartum hemorrhage (bleeding after birth).

The first stool the infant passes is called _________, it is an odorless, greenish-black, and has a tar-like consistency

Meconium aspiration syndrome can develop if ...

An infant delivered at less than 37 completed weeks of gestation is considered ______.

an infant born at 38 to 42 weeks of gestation is described as ____.

an infant born at more than 42 weeks of gestation is described as __________________.

To ensure thermoregulation in a healthy newborn...

If the 5-minute Apgar score is __________, the newborn’s condition should be reassessed and a new score assigned every 5 minutes until 20 minutes after birth.

Fewer than ___ of deliveries involve bradycardia that requires treatment with chest compressions.

The most common etiology for bradycardia in a neonate is _______, which is readily reversed by effective ____.

hypoxia

PPV

Bag-Mask Ventilation is indicated when an infant is apneic, has inadequate respiratory effort, or has a _________________________________________ after you clear the airway of secretions, relieve obstruction from the tongue, and dry and stimulate the infant. 

Chest Compressions are indicated if ...

• the pulse rate remains less than 60 beats/min despite positioning
• clearing the airway
• drying and stimulation
• 30 seconds of effective PPV

If  apnea is prolonged (more than 20 seconds), it can lead to _______ and bradycardia.

diffuse rhonchi, rales, and wheezing in an infant or toddler are typical signs of ....

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 ________ because of an inability to swallow secretions. 

• an episode during which an infant becomes pale or cyanotic
• chokes, gags, or has an apniec spell
• loses muscles tone

C - Consistency of the injury with the child's developmental age

H - History inconsistent with injury

I - Inappropiate parental concerns

L - Lack of supervision

D - Delay in seeking care

A - Affect ( of the parent or caregiver and the child relation to the caregiver)

B - Brusin of varying ages

U - Unusual injury patterns

S - Suspicious circumstances

E - Environment

Bereavement 

As friends and family die, elderly persons tend to experience ...

... increasing loneliness and isolation.  These factors shown to have negative effects on health

Changes in the Cardiovascular System for Geriatrics

• the heart hypertrophies (enlarges) with age in response to the chronically increased afterload imposed by stiffened blood vessels. Bigger is not better. 
• Arterioscleosis, the stiffening of vessel walls, contributes to systolic HTN in many older pt’s, which places an extra burden on the heart. 
• number of pacemaker cells in the SA node decreases dramatically as a person ages, leading to bradycardia leading to decline in cardiac output.

Aging brings a widespread decrease in bone mass in men and women, but especially among ___________ _____.

Dementia

Delirium – An acute confusional state characterized by global impairment of thinking, perception, judgment, and memory. Also known as acute brain syndrome or acute confusional state) is a symptom, not a disease. This is a temporary usually reversible condition results in rapid changes in brain function

As _____________ with age, ____________ becomes more difficult

vision declines

reading small print

Untreated and unrecognized ________ is associated with a higher suicide rate in the elderly population than in any other age group

Depression in elderly pt can ...

At highest risk are ____________ who use ________ as their suicide method.

white men 85 years and older

firearms

Pulseless Arrest for PEDS

• Perform good BLS CPR, 
• obtain IV/IO, 
• monitor EKG
• apply the pads
• give Epi
• pulse/rhythm check every two minutes 
• Epi for astystole/PEA 
• defib pulseless v-tach/v-fib
• Small infants: anterior chest wall
• Larger infants and children: anterior-posterior

Wide Complex Tachycardia for PEDS

If the child is stable:

• obtain vascular access
• administer amiodorane (procainamide is an acceptable alternative). Do not give both.

If the pt is unstable:

• then go to synchronized cardiversion. 
• Prior sedation is ideal but not delay Rx to do so. 
• If becomes unconscious, begin CPR.

 Narrow Complex Tachycardia for PEDS

if stable;

• vagal maneuvers
• obtain IV access
• consider Adenosine

For kids with poor perfusion;

• synchronized cardioversion is recommended 

Cardiogenic Shock

The front-line Rx of distributive shock is ...

Decompensated shock is defined as ...

• Dry mucous membranes
• tachycardia
• a sunken fontanelle 

Delivery with meconium-stained fluid

• Determine whether the fluid is thin and green stained versus thick and particulate.

If the baby is crying and vigorous, 

• employ standard interventions.

If the baby is depressed, 

• do not dry or stimulate him or her.
• Intubate the trachea.
• Attach a meconium aspirator and suction catheter.
• Suction the ET tube while withdrawing the tube from the trachea

After suctioning

• Drying and stimulation
• Oxygen and PPV may be necessary.

Rx of cord prolapse, take the following steps:

• Position the woman supine with her hips elevated on pillows
• 100% o2 via NRB
• instruct to pant with each contraction, which will prevent her from bearing down
• with two fingers of a gloved hand, gently push the baby (not the cord) back up into the vagina until the presenting part no longer presses on the cord
• cover the exposed portion of the cord with dressings moistened in normal saline
• maintain that position throughout urgent transport to the hospital

Premature babies cannot produce _________ very well and are at higher risk of resp distress

Extrinsic falls 

Intrinsic falls

Risk factors for SIDS

• Male
• Premature
•  Low birth weight
• Sleeping in prone position, with soft bulky blankets, or on soft surfaces
• Tobacco smoke