Physiological Changes During Pregnancy

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Questions and Answers

What happens to the tidal volume during pregnancy?

It fluctuates significantly.

It remains unchanged.

It decreases.

It increases. (correct)

How does progesterone affect the respiratory system during pregnancy?

Increases threshold to carbon dioxide.

Causes bronchi to constrict.

Decreases oxygen uptake.

Causes bronchi to dilate. (correct)

What is the average weight gain during pregnancy?

15 lb (6.8 kg)

27 lb (12.3 kg) (correct)

20 lb (9.1 kg)

30 lb (13.6 kg)

Which of the following changes occurs in the uterus at the end of pregnancy?

Weight increases to about 2.24 to 2.6 lb. Signup and view all the answers

What physiological change occurs in the maternal circulation during pregnancy?

Blood volume increases by up to 50%. Signup and view all the answers

What effect does relaxin have on the body during pregnancy?

Softens collagenous tissues. Signup and view all the answers

Which of the following reflects an increase in physiological demand during pregnancy?

Increased demand for carbohydrates. Signup and view all the answers

Which of the following is NOT a physiological change that occurs during pregnancy?

Increase in expiratory reserve volume. Signup and view all the answers

What is the primary sign of abruptio placenta that a patient would report?

Sudden onset of severe abdominal pain Signup and view all the answers

In which condition is painless vaginal bleeding with bright red blood a primary symptom?

Placenta previa Signup and view all the answers

Which management step is critical during the prehospital care of a patient with an ectopic pregnancy?

Fluid administration Signup and view all the answers

What symptom would indicate a possible hypovolemic shock in a patient with bleeding related to pregnancy?

Rapid breath and confusion Signup and view all the answers

Which physical examination finding is associated with abruptio placenta?

Tender abdomen and rigid uterus Signup and view all the answers

What is an important intervention for managing third-trimester bleeding?

Administer IV fluid rapidly Signup and view all the answers

Which of the following is the greatest danger associated with third-trimester bleeding?

Hemorrhage Signup and view all the answers

What immediate action should be taken when treating a patient suspected of having a septic abortion?

Establish an IV line of normal saline Signup and view all the answers

What is a critical factor in assessing a child's condition during the primary survey?

Appearance Signup and view all the answers

Why do children typically rely on pulse rate in emergencies?

To compensate for decreased oxygenation Signup and view all the answers

What should be assessed to determine if a patient has adequate breathing?

Chest rise Signup and view all the answers

During a primary survey, what is the purpose of checking skin color, temperature, and condition?

To evaluate circulatory status Signup and view all the answers

What does the rapid detection and transport of a child in critical condition entail?

Immediate medical intervention Signup and view all the answers

What does the AVPU scale assess during the disability portion of the primary survey?

Level of consciousness Signup and view all the answers

What aspect of breathing is reflected by the work of breathing observed in a child?

Compensation for abnormalities in oxygenation Signup and view all the answers

What is the recommended action if there is potential airway obstruction during the primary assessment?

Position the airway and suction as necessary Signup and view all the answers

What should be done initially when transporting a pregnant woman with no suspected spinal injury?

Transport her on her left side Signup and view all the answers

Which intervention is essential for ensuring the airway of a pregnant trauma patient?

Provide additional ventilation assistance Signup and view all the answers

What is a crucial step in the management of maternal cardiac arrest?

Provide CPR and ALS as for any trauma patient Signup and view all the answers

What minimum items are required for newborn care at birth?

Warm blankets, suction device, clamps or ties, and scissors Signup and view all the answers

What should be done if a newborn remains cyanotic after birth?

Ensure the newborn is vigorous and observe them Signup and view all the answers

What method should be used to assess a newborn's condition at birth?

The Apgar score Signup and view all the answers

What should be done if a newborn's pulse rate is less than 100 beats per minute?

Initiate positive pressure ventilation (PPV) Signup and view all the answers

During the newborn's transition phase, which action is NOT appropriate?

Keep the newborn at a temperature lower than body temperature Signup and view all the answers

What is a key sign indicating a possible pneumothorax?

Jugular vein distention Signup and view all the answers

What is the appropriate first step when assessing a trauma patient?

Perform a thorough scene size-up Signup and view all the answers

In trauma cases, what should be the primary consideration if the patient is at risk for shock?

Prioritize stabilization of ABCs Signup and view all the answers

What complication is associated with traumatic injuries and may require immediate intervention?

Pneumothorax Signup and view all the answers

What is the purpose of placing a cervical collar on a trauma patient?

To stabilize the cervical spine Signup and view all the answers

What does the AVPU mnemonic assist in assessing during trauma management?

Level of consciousness Signup and view all the answers

How does aging primarily affect the respiratory system?

Decrease in vital capacity Signup and view all the answers

Which factor can accelerate the aging process of organs and tissues?

Genetics Signup and view all the answers

What type of hematoma is associated with hemorrhage between the dura and the skull?

Epidural hematoma Signup and view all the answers

Which of the following statements about traumatic brain injury in children is accurate?

Children at low risk can still have significant intracranial injuries. Signup and view all the answers

What does BRUE stand for in pediatric care?

Brief Resolved Unexplained Event Signup and view all the answers

What is the mechanism of injury (MOI) most commonly associated with pediatric traumas?

Blunt trauma Signup and view all the answers

In pediatric injuries, falls from a standing position typically result in which type of injury?

Isolated long bone injuries Signup and view all the answers

When suspecting child abuse related to head trauma, what is a recommended step?

Assume abuse until proven otherwise. Signup and view all the answers

What is a potentially serious sign in an infant experiencing a BRUE?

Cyanosis Signup and view all the answers

Motor vehicle accidents in children can lead to injuries that are influenced by which factor?

Seat position and posture Signup and view all the answers

Study Notes

Special Populations Review

This review covers special populations, focusing on obstetrics, newborns, and geriatrics.

Obstetrics

Physiological changes during pregnancy can alter the normal response to trauma and/or exacerbate or create medical conditions.
The uterus weighs approximately 2.5 oz (70 grams) before pregnancy, and has a fluid capacity of 10 mL.
At the end of pregnancy, the uterus can weigh up to 2.24 to 2.6 lbs (1100 to 1200 grams), with a capacity of about 5,000 mL.
Fundal measurements may indicate developmental problems, including uterine growth issues, breech presentation, or multiples.
Changes in the GI tract: pressure on the intestine and rectum with smooth muscle relaxation in the GI tract, slowing of stomach emptying, kidney and ureter enlargement.
Hormonal changes affecting skin, hair, and eyes.
Circulatory changes: blood volume increase up to 50% more to meet fetal metabolic needs, perfuse maternal organs, and compensate for delivery blood loss.
Circulatory changes (cont'd): red blood cell count increase, clotting factor increase while fibrinolytic factors decrease, heart size increase.
Heart rate increase, Ectopic beats, Supraventricular tachycardia, Slight left axis deviation, Lead II changes.
Sensitivity to body position increases with gestation. Lying supine can compress the inferior vena cava, reducing cardiac output.
The birthing position can stress the cardiovascular system. The lithotomy position is common in the United States.

Respiratory changes

The diaphragm is pushed up by the growing uterus, increasing maternal oxygen demand.
Progesterone decreases the threshold for carbon dioxide and increases bronchi dilation, regulating mucus production.
Expiratory reserve volume, functional residual capacity, and residual volume decrease.
Tidal volume and inspiratory reserve volume increase.

Maternal Metabolism

Weight gain averages 27 lbs (12.3 kg).
Increased blood volume, with intracellular and extracellular fluid increases.
Uterine, placental, and fetal growth.
Increased breast tissue and protein and fat deposits.
Relaxin softens collagenous tissues and relaxes ligamentous system, increasing carbohydrate demand.

Supine Hypotensive Syndrome

The uterus can compress the inferior vena cava.
This can diminish or occlude venous blood return to the heart.
Resulting in significant hypotension and fetal distress.
Management involves placing the patient in the left lateral recumbent position, treating underlying causes, monitoring vital signs, and obtaining an ECG.

Cardiac Conditions

Determining the nature and treatment of any heart condition is crucial.
Assess for cardiac medications, dysrhythmias, heart murmurs, rheumatic fever history, or congenital heart defects.
Monitor for dizziness or lightheadedness.

Hypertensive Disorders

Chronic hypertension: blood pressure equal to or greater than 140/90 mmHg, increased risk of stroke or other cardiovascular problems.
Gestational hypertension: develops after the 20th week of pregnancy and resolves spontaneously.
Preeclampsia: manifests after the 20th week with a triad of symptoms including edema, gradual onset of hypertension, and protein in the urine.
Risk factors for preeclampsia include first pregnancy before 20 years old, advanced maternal age, history of multiple pregnancies, hypertension, renal disease, and diabetes.
Possible complications include liver or renal failure, cerebral hemorrhage, abruptio placenta, and HELLP syndrome.
Requires emergency hypertensive medications as needed.

Seizures

Treatment is difficult due to potential fetal distress from medications.
Magnesium sulfate is the recommended treatment.
Potential complications include abruptio placenta, hemorrhage, and disseminated intravascular coagulation.

Diabetes

Gestational diabetes mellitus is the inability to process carbohydrates during pregnancy.
Treatments for gestational diabetes include diet control and oral hypoglycemic medications.
Diabetes may be affected by pregnancy.
Patients with a history of diabetes should have a blood glucose level test.

Respiratory Disorders

Shortness of breath or dyspnea is a common complaint in pregnancy, often due to hormone-related changes.
Asthma can complicate pregnancy.
Maternal asthma complications include premature labor, preeclampsia, respiratory failure, vaginal hemorrhage, and eclampsia.
Fetal asthma complications include premature birth, low birth rate, growth retardation, and fetal death.

Abortion: expulsion of the fetus before the 20th week of gestation, classified as spontaneous (miscarriage) or elective.
Habitual abortions: three or more consecutive miscarriages due to ovarian issues, uterine malformations, cervical conditions, or infections.
Threatened abortion: vaginal bleeding in the first half of pregnancy, which may progress or subside.
Imminent abortion: spontaneous abortion that cannot be prevented, characterized by severe abdominal pain, vaginal bleeding, and cervical dilation.
Treatment involves IV normal saline, 100% supplemental oxygen, and ECG monitoring; provide emotional support and rapid transport.
Incomplete abortion: products of conception remain in the uterus, with continuous vaginal bleeding and potential shock signs.
Missed abortion: fetus dies in the first 20 weeks, and the uterus feels like a hard mass with no detectable fetal heartbeat.
Septic abortion: uterine infection following an abortion, with fever and bad-smelling vaginal discharge; requires rapid transport, IV normal saline, supplemental oxygen, and ECG monitoring.
Third-trimester bleeding has a high danger of hemorrhage due to the large volume of blood present, requiring compensatory mechanisms.
Ectopic pregnancy: the ovum implants outside the uterus; characterized by severe lower abdominal pain and potential hypovolemic shock.
Abruptio placenta: premature separation of the placenta from the uterine wall; characterized by sudden abdominal pain, cessation of fetal movement, and vaginal bleeding with dark-red blood.
Physical examination may reveal signs of shock, tender and rigid uterus, and absent fetal heart sounds.
Placenta previa: low implantation of the placenta, obscuring the cervical canal; characterized by painless vaginal bleeding with bright red blood and a soft, nontender uterus.

Assessment of Bleeding

Determine the nature of the bleeding.
Use OPQRST to elaborate on the chief complaint.
Evaluate orthostatic vital signs; look for the Grey Turner or Cullen sign.

Management of Bleeding

Keep the woman lying on her left side.
Administer 100% supplemental oxygen.
Provide rapid transport.
Start an IV line of normal saline
Loosely place trauma pads over the vagina.

Cephalic Presentation

Newborn's head is overly extended at birth, leading to face presentation.
Possible presentations include brow presentation, occiput-posterior presentation, or military presentation.
If external rotation is unsuccessful or delivery cannot be completed, offer support for the woman and fetus and rapid transport.

Breech Presentations

A different part of the body other than the head leads the delivery.
Categories of breech presentation include frank, incomplete, and complete.
For imminent breech delivery: position the woman with buttocks at the edge of the bed, legs flexed, and let the buttocks and trunk deliver spontaneously, support the body, and slightly lower the newborn.
To deliver: Once the hairline is spotted, grasp the newborn's ankles and lift upward.
If the head doesn't deliver within 3 minutes, the newborn might suffocate.
Avoid forcibly pulling the newborn.
Other rare presentations include footling breech and transverse presentation.
In abnormal deliveries, don't attempt delivery in the field.

Shoulder Dystocia

Difficulty delivering the shoulders.
Fetus cannot breathe if shoulders do not clear birth canal.
Brachial nerve plexus damage is a concern.
McRoberts maneuver (hyperflexing the woman's legs tightly to the abdomen) might assist with delivery.
Gentle pressure on lower abdomen and gentle pull on fetus's head could be needed.

Nuchal Cord

Umbilical cord wrapping around newborn's neck during delivery.
Attempt to slip the cord over the shoulder and head.
Cut the cord if unsuccessful.

Prolapsed Umbilical Cord

Cord emerges before the fetus, cutting off oxygenated blood from the placenta
Leading to fetal asphyxia.
Treatment includes keeping the woman supine and elevated, administering 100% oxygen, having the woman pant with each contraction, and gently pushing the presenting part back up the vagina

Postpartum Hemorrhage

Hemorrhage occurring within 24 hours from or 24-6 weeks after delivery
A blood loss exceeding 500 mL during the first 24 hours after birth
Causes include lacerations, prolonged labor, or multiple births, retained products of conception, multiple pregnancy, placenta previa, or a full bladder.
Management continues with uterine massage, encouragement to breastfeed, notifying the receiving facility, and immediate transport; give a large-bore IV line in route, and avoid packing dressings into the vagina.

Trauma and Pregnancy

Trauma is the leading cause of maternal death in the US.
Abdominal trauma occurs via the same mechanisms in pregnant and nonpregnant women.
Anatomical changes during pregnancy cause abdominal contents to compress into the upper abdomen, the diaphragm elevates by about 1.5 inches, and the peritoneum stretches.
During the first trimester, the uterus is well protected from trauma.
During the second and third trimesters, the uterus extends into the abdomen and becomes more vulnerable to trauma.
Pregnant patients show different signs than nonpregnant patients.
Signs of hypovolemia may be hidden; the patient has a higher chance of bleeding to death in case of pelvic fractures.
Slow respiratory rate is not adequate.
Fetal injury from trauma may occur from rapid deceleration and impaired fetal circulation.
Fetal heart rate (120–160 beats/min) is the best indication after trauma; <120 beats/min indicates dire fetal distress.
Treatment of the pregnant trauma patient involves limited direct treatment, with transport on the left side to avoid spinal injury.

Neonate

Obtaining patient history and preparing the environment are essential minimum needs.
Essential items include warm, dry blankets, a bulb syringe, two small clamps or ties, and a pair of clean scissors.
In ambulance deliveries: use blankets, confirm ABCs, position the newborn on the mother's chest, suction the mouth, then the nose, and keep the newborn level with her.
Procedures include clamping and cutting the umbilical cord, performing a simultaneous primary survey and treatment intervention, examining skin, head, and eyes for irregularities, and inspecting the umbilical cord for abnormalities.
Newborns are at risk for hypothermia.
Placement on pre-warmed towels (or a radiant warmer) with thorough drying and a cap for the head is needed.
Observation includes checking that babies that were cyanotic after birth, remain vigorous and that they turn pink within 5 minutes; give ongoing observation and maintain thermoregulation with direct skin-to-skin contact with their mother.
The Apgar Score helps record the condition at birth, and a score less than 7 requires repetition of the assessment every 5 minutes up to 20 minutes after birth.
The neonatal resuscitation algorithm follows current guidelines; initial steps, reevaluation, and ventilation occur within the first 60 seconds, and additional oxygen might be needed if the target preductal oxygen saturation level isn't reached.
If the newborn's pulse rate is apneic or less than 100 beats/minute, PPV should be initiated; begin chest compressions if the pulse rate is less than 60 beats/minute.
If ventilation and chest compression efforts do not improve bradycardia, epinephrine should be administered, preferably via IV line.

Geriatrics

The aging process begins in the late 20s or early 30s.
Genetics, preexisting conditions, diet and activity levels, exposure to toxins, are factors that accelerate organ/tissue aging.
Decrease in functional capacity is a normal aspect of aging.
Respiratory system changes include decreased respiratory capacity (vital capacity decreases, residual volume increases), decreased sensitivity to changes in blood gases, restricted lung/chest expansion, impaired ability to modify respiratory rate, and a decreased effectiveness of defense mechanisms.
The cardiovascular system changes include lower efficiency with age and heart hypertrophy, which contributes to conditions such as arteriosclerosis (diabetic and renal compromise, atherosclerosis), increased vascular stiffening (aortic valve thickening due to fibrosis and calcification); and reduced peripheral vessel elasticity.
The electrical conduction system of the heart changes that influence pacemaker cell decrease and potential development of bradycardia or atrial dysrhythmias.
Aging makes the cardiovascular system more vulnerable to dysfunction and potential cardiac problems.
The neurologic system shows changes in neurologic exam that reflect aging; the brain decreases weight and volume. Regulation of respiration, pulse rate, blood pressure, temperature, and hunger/thirst are potentially affected.
Sensory organs decline with age, with possibility of hearing and vision deficits (deafness, blindness) and potential for onset of cataracts, glaucoma and Meniere's disease (vertigo, hearing loss, tinnitus, ear pressure).
Changes in appetite, touch, and smell function are also present. Difficulties in speech production, and body position sense are also possible.
Digestive changes include: reduction in gastric secretions, possible implications for heartburn, indigestion, acid reflux, slight changes in bowel functions, including incontinence and constipation.
Hepatic enzyme changes involve some reduced activity and increased activity, also impacting detoxification of medications.
With renal changes, kidneys lose weight and functioning nephron units; their response to sodium deficiency is reduced, causing electrolyte imbalances.
Increased risk for overhydration with high sodium intake and higher risk for serious/lethal hyperkalemia.
Endocrine system changes include increased ADH/fluid imbalance, or edema.
Impairment of the immune system occurs, increasing risk of infection and secondary complications.
The Integumentary system shows wrinkling and decreased skin resiliency, thinner, and fragile skin, less subcutaneous fat, increased bruising, decreasing elastin and collagen, increased skin tenting, lower sebaceous gland oil production, diminished sweat production, thin/brittle fingernails, and possibly gray or white hair.
Blood vessels impacted by atherosclerosis, decreased oxygen, slower skin regeneration, and potentially thinner/brittle nails and toenails.
Homeostatic capabilities (thirst, temperature, and blood glucose regulation) decline with age.
Changes in the musculoskeletal system (decrease bone density, brittle bones, tendon/ligament elasticity loss, thicker synovial fluids, and decreased cartilage levels) influence height, posture, and strength.
Also affects susceptibility to fractures, difficulties in handling fine motor skills, or with finger strength. Pre-existing issues affect risk of fall, motor vehicle crashes, and other situations related to loss of balance or confidence.

The GEMS Diamond

GEMS diamond (Geriatric, Environmental, Medical, Social) for forming a general impression.

Primary Assessment

Airway and breathing: Geriatric patients have potential airway complications. Ensure airway isn't obstructed and check for breathing.
Circulation: circulatory compromise when assessing older adults; lower heart rates, reduced pulse strength, irregular rhythms, requiring immediate oxygen.
Transport decision: prioritize life-threatening situations. Older individuals may experience rapid decompensation.

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Description

This quiz covers essential physiological changes that occur during pregnancy, including respiratory adaptations, circulatory changes, and hormonal influences. Test your knowledge on the impact of these changes on maternal health and fetal development. It also addresses critical conditions like ectopic pregnancy and abruptio placenta.