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33 Cards in this Set
- Front
- Back
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Give a definition of pulse using physiology |
- Pulse is the rhythmic expansion and recoil of the elastic arteries as the left ventricle of the heart ejects blood into the circulation - It represents the expansion and recoil of the elastic arteries during the cardiac cycle - Pulse can be palpated wherever the artery passes near to the skin over a bony or firm surface - 1 pulse = 1 heart beat |
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What is the normal pulse rate? |
In children under the age of 1: 110 -160 bpm In adults: 60 - 100 bpm *Tachycardia = >100 bpm *Bradycardia = <60 bpm |
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Changes in pulse during pregnancy? |
Heart rate increases by 15-20 bpm due to increase in cardiac output and stroke volume caused by increased blood volume. |
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[Pulse] Indications in midwifery care: |
Mum: - On hospital admission (as a baseline) - Any signs of illness or accident - During labour - During and after surgery - Postnatally, if indicated - When auscultating the foetal heart - Pre-labour rupture of membrane - Treatment of pre-term labour Baby: - After delivery - Any signs of cyanosis, irritability, infection or illness |
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What to look out for when measuring the pulse: |
- Rate: number of waves in 60 seconds - Volume/Strength (Amplitude): indicates cardiac function - Rhythm: is it regular or not? -*<2 years: instead of finding the pulse, take note of apex beats. - *pulse may be found via direct palpation |
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What is the procedure for taking a pulse? |
- Informed consent - Wash hands (prevents cross infection) - Position fingers lightly on anterior aspect of client's arm on the inner wrist below thumb (Do not use your thumb to take the pulse as thumb has pulse of it's own and can affect reading) - Press firmly until pulse is felt - Count each pulse for a full 60 seconds - Record pulse - Discuss findings and refer as appropriate. |
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Give a definition of temperature using physiology: |
Temperature is the balance between heat gain and heat loss. Heat is gained via cellular metabolism Heat is lost via convection, conduction, radiation, and evaporation. Temperature is controlled via the thermoregulatory centre in the hypothalamus. Input is taken from thermoreceptors in the skin and around vital organs. |
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What is normal temperature?: |
Normothermia/Apyrexia = 36 - 37 C * Pyrexia = 37.5 - 38 C * Hyperpyrexia = Above 41 C * Hypothermia = Below 35 C (Severe is below 33 C) |
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When to monitor temperature: |
- Post operatively - Collapse/ unconsciousness - Burns/ trauma - Signs of pyrexia or hypothermia |
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[Temperature] Indications in midwifery care: |
- Hospital admission (as a baseline) - Labour every 4 hours (NICE 2014) - After delivery for both mum and baby (NICE 2014) - As per clinical condition requires - Pre-term labour - Known infection - During blood transfusion - Loin/abdominal pain |
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Where to take temperature: |
- Tympanic (in ear) - Oral (in mouth) - Axilla (under arm) Less common: - Rectum - Pulmonary artery (taken in HDU) - Skin (taken in NNU) Note: same site, same equipment, and document to maintain consistency of measurements |
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What is the procedure to take someone's temperature? |
- Gain inforemd consent - Wash hand (prevents cross infection) - Place disposable cover on the thermometer - Turn it on and allow scanner to calibrate - Place the thermometer in to client's ear and direct scanner towards their opposite eye - Press scan button - Remove thermometer when alarm sounds and read findings. - Dispose of cover and wash hands. - Document and discuss findings - Refer as appropriate. |
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Tympanic temperature? |
Tympanic membrane shares same blood supply as hypothalamus so reading is more accurate. There is a reduced risk of cross infection due to disposale covers, it is economic, children tolerate it well, and insertion technique is easy and causes less disruption in patient. |
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What are the indications for undertaking urinalysis in pregnancy? |
- Booking visit - MSU (mid stream urine sample) - Part of antenatal examination - During labour - O/A to hospital - Specific maternal conditions - Diabetes, renal disease, PIH, Pre-eclampsia - Any clinical symptoms - Painful micturition - Frequency micturition |
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Give a physiological explanation as to why pregnant women are more susceptible to urinary tract infections? |
- The ureters are displaced laterally, this means that the angel the ureters enter the bladder allow reflux. This increases the risk of bacterial growth and lead to a urinary tract infection (UTI). - The traces of glucose in the urine due to glucose exceeding the renal threshold in pregnancy. Glucose encourages bacterial growth and therefore causes a UTI. - The bladder enlarges so more urine can be held for longer periods of time. Thisleads to stagnant urine where bacteria are more likely to grow and lead to a UTI. |
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Identify the steps of undertaking urinalysis |
- Gain informed consent - Wash hands - If patient does not have urine sample with them, ask them to the toilet and explain how to obtain a MSU. - Once MSU is obtained, label it, dip urinalysis stick into urine and take it out and place on to a tissue. - Wait until urine reacts with the tabs on the stick as per the instructions on the container. - Compare colours on the stick to the urinalysis colour chart. Document findings. - Recognise any abnormal results? - send MSU to laboratory and document - Discuss findings and refer as appropriate. |
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What is the normal respiration rate? Use physiology to explain |
Supplying cells and tissues with oxygen and excreting carbon dioxide out of body requires respiration, and body does this by breathing. Respiration is controlled by respiratory centre in the medulla oblongata. Chemoreceptors in blood vessels detect CO2 levels and composition of gases in blood. Normal respiration in adults = 12 - 18 BPM (breaths per minute) *Tachypnoea - >20 BPM *Bradypnoea - <8-10 BPM Normal respiration in children under 1 years = 30-40 BPM |
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[Respirations] Indications in midwifery care |
MUM - On hospital admission with any respiratory complaint (ie: asthma) - During active resuscitations - Before, during and following surgery BABY - At birth - Any signs of cyanosis, sternal depression, nasal flaring, grunting - During active resuscitations - Following Naxalone administration |
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What is the procedure of taking someone's respirations? |
- Listen and count for a full 60 seconds - Rate and depth, regular, quiet and effortless - Observing respiration: 1.General observation of the patient, e.g. skin colour 2. Effort 3. Sound 4. Sputum 5. Chest movement – pregnant women tend to use their upper chest only to breath. 6. Rhythm - Record and act accordingly NOTE: If you rest the woman’s hand across the chest as you take the pulse you can avoid her altering her breathing pattern as she will be less conscious of you watching her and counting. |
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What is the definition of blood pressure? |
The force exerted by blood on the blood vessel walls. |
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What is the normal range of blood pressure in the pregnant woman? |
- 100-140 mmHg systolic - 60-90 mmHg diastolic |
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What factors influence arterial blood pressure? |
- Blood volume - Heart rate - Age - Time of day - Weight - Alcohol - Smoking - Eating - Stress, fear and anxiety - Exercise - Distended bladder - Disease |
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[Blood Pressure] Indications in midwifery practice |
- Initial consultation to establish a baseline reading - At each antenatal visit (NICE 2008) - During labour, initially and then 4 hourly (NICE 2014) - Following each epidural top-up - As clinical condition indicates - Gestational hypertension - Blood transfusion - Before, during and after surgery |
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What is the procedure to take someone's blood pressure? |
- Informed consent - Encourage the woman to empty her bladder - Wash hands - If the woman has been active, allow her to rest for at least five minutes. - Consider the effects of smoking, exercise, eating, drinking coffee or alcohol has on the blood pressure. These should be avoided 30 minutes prior to a recording. - Collect and check equipment – clean ear pieces and diaphragm of stethoscope with alcohol-impregnated swab. - Remove any tight or restrictive clothing from the patients arm. - Measure the cuff against the patients arm. The bladder of the cuff should cover 80-100% of the arm circumference. - Position the sphygmomanometer so that the base is level with the woman’s heart, whenever possible - Expose the woman’s upper arm, ensuring no constriction from tight clothing - Support her arm, and ask her to turn the palm of her hand upwards - Locate the brachial artery by palpation and apply cuff snugly 2-3cm above the antecubital fossa, with the centre of the bladder over the artery. - Ensure the valve is closed - Palpate the brachial with the fingertips of one hand and with the other hand inflate the cuff rapidly until the pulse disappears, continue to inflate the cuff 30mmHg above this -Slowly deflate the cuff by opening the valve slightly, taking note when the pulse reappears – approx systolic pressure - Quickly deflate cuff fully and wait 30 seconds before re inflating it. - Place ear pieces of the stethoscope into your ears and place the diaphragm of the stethoscope over the brachial artery at the antecubital fossa. - Inflate cuff to 30 mmHg above the estimated systolic. - Slowly deflate the cuff (at a rate of 2-3 mmHg per second) listening for the appearance of the first clear sound (Korotkoff 1) - Read the needle position (systole) - Continue to deflate the cuff slowly until the sounds become absent - When the sounds are no longer audible(Korotkoff V), read the needle position (diastole), then rapidly deflate the cuff fully - Assist the woman into a comfortable position, removing the cuff and adjusting her clothing - Discuss the findings and document. - Refer as appropriate - Clean equipment - Wash hands |
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List how a midwife can undertake accurate blood pressure recording |
-Arm should be at the level of the heart - Legs should not be crossed – falsely high recording - The bladder in the cuff needs to be over the brachial artery - Do not stop deflating the cuff between the systole and diastolic readings or reinflate the cuff to recheck the systolic reading – blood will flow into lower arm and reduce intensity - If reading abnormal, repeat twice more 2 mins apart - If unsure of reading – get it checked |
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Why is blood pressure taken in pregnancy and what should a midwife do with the results? |
To detect any blood pressure changes that deviate from normality. Accurate blood pressure is essential to prevent serious consequence for mother and fetus/baby. High blood pressure indicator for pre-eclampsia/eclampsia Results are documented and discussed. Any abnormal results such be referred as appropriate. |
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What are the principles of safe administration of drugs? |
- Wash hands to prevent cross-infection - Informed consent. - Check if drug is due and has not been given already: Consult prescription sheet, (correct complete, and legible.) - Is prescription valid, signed and dated? - Apply a non touch technique - put oral meds in pots, use gloves for injections - Pour medicines away from label. - Check 5R's: 1. Right medication - right drug name? expiry date? 2. Right time - check prescription sheet 3. Right dose - right calculation, cross check with another competent midwife 4. Right route - orally, injection etc? 5. Right individual - check arm band for same NHS number and DOB as well as names to prevent drugs error. - Document appropriately, full drugs name in capital letters, black ink, dosage, start aand finish dates. |
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Describe the principles of administering an intra-muscular injection? |
- Ensure 5 rights and gain patients co-operation - Choose the correct needle size (Usually Green) - Assist patient into required position-expose site of injection - Clean site with isopropyl swab and allow to dry - Stretch skin around injection site - Holding needle at 90° quickly insert into skin - Leave 1/3 of needle shaft exposed - Pull back plunger-if no blood aspirated depress plunger at approximately 1ml/10seconds - Wait 10 seconds prior to removing needle-allow drug to permeate into tissues - Withdraw needle and apply pressure - Dispose of sharps and record administration - If blood appears-withdraw needle completely and stop bleeding with pressure. - Explain to patient that you will start procedure again. |
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Describe the principles of administering a subcutaneous injection? |
- Ensure 5 rights and gain patients co-operation - Choose the correct needle size (usually orange) - Expose the sight of injection-clean with alcohol swab - Gently pinch the skin into a fold - Insert needle into skin at 45°angle (e.g heparin)If giving insulin 90° angle - Release skin and slowly inject the drug - Withdraw needle rapidly-apply pressure to any bleeding - Dispose of sharps and record administration |
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What is an intramuscular injection? |
- Deep injection into the muscle - Can make the muscle feel sore - Rate of absorption slow in comparison to intravenous route - 90 Degree Angle |
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What is a subcutaneous injection? |
- Injection in to subcutaneous tissue under the skin - Slower rate of absorption than IM - Smaller lumen and length of needle - 45 Degree Angle |
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Sites of intramuscular injections? |
- Upper, outer quadrant of buttock - Rectus femoris - middle 1/3 of thigh |
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Sites of subcutaneous injections? |
- Do not inject heparin near to a caesarean section scar- can lead to excess bleeding and haematoma formation - Deltoid muscle - less than 2mls injection - Mid deltoid - 2mls or less |
