Advanced Obstetrics: Thromboembolic - Essay Example

Advanced Obstetrics for Paramedics Question Signs and symptoms of a patient mainly vary depending on the site of ectopic pregnancy, which can be identified anywhere outside the uterus. The most common site of ectopic pregnancy is noted to be in Fallopian tubes, especially in the ampullary or isthmic section of Fallopian tubes. A few of the documented cases of pregnancy were presented outside uterus and tubes, wherein an intrauterine pregnancy is feasible (Patient.co.uk, 2013). It is worth mentioning that as the site of ectopic pregnancy varies from one person to another, the signs as well as the symptoms of a patient also depend on the site of ectopic pregnancy. In certain cases, the signs and symptoms typically occur in 6-8 weeks after the normal menstrual period, but ectopic pregnancy may occur later. In some of the cases, nausea along with breast discomfort, low blood pressure, weakness, dizziness and pale skin can be noticed amid the patient (Stöppler, 2013). Considering the fact that different sites of possible ectopic pregnancy implantation will influence patients’ presentation, it can be ascertained that the treatment of ectopic pregnancy requires implantation and actual removal of the affected parts of a body. In some of these cases, Fallopian tube requires either pharmacologic or surgical management. Pharmacologic management with the doses of methotrexate is necessary for effective treatment. Sometimes, the linear salpingostomy surgery is performed, if a patient desires to become pregnant in future. It is thus anticipated that proper treatment and effective nursing care will certainly help in providing effective and proper treatment to the patients under the circumstance of ectopic pregnancy (American Society for Reproductive Medicine, 2014). The anatomical structure of the fallopian tube, with regards to the ectopic pregnancy implantation, has been depicted in the following. Source: (UNSW Embryology, 2010) The various implantation sites with the differences in history, period of amenorrhea, symptoms and physical signs have been compared in the following tabular representation: Implantation Sites Differences in History Period of Amenorrhoea Symptoms Physical Signs Interstitial Occur in women with a history of pelvic inflammatory disease, pelvic surgery and smoking 2 Weeks Abdominal pain and vaginal bleeding An echogenic line from the endometrial cavity Isthmic Occur in women with a history of previous cesarean section 5 Weeks Vaginal bleeding Narrowest portion of the tube Ampullary History of regular menstrual intervals every 30 x 3-4 days 8 Weeks Fainting or dizziness, bowel or urinary symptoms Ampulla of the uterine tube Fimbrial Women do not have a history of previous pelvic inflammatory disease, prior ectopic pregnancy gest affected 4 Weeks Nausea and fainting Implantation is at the fimbria of the fallopian tube that is closest to the ovary Source: (Scher, 1971) Question 2 It is worth mentioning that the notion of Perinatal morbidity and mortality includes stillbirth and the death of newborn babies within the first 28 days of the birth. According to the latest report of the Australian Bureau of Statistics published in the year 2012, 2,558 perinatal deaths were reported due to Perinatal morbidity and mortality (Australian Bureau of Statistics, 2014). Again, these 2,558 deaths constituted around 1,355 males and 1,203 females. It will be vital to mention in this similar concern that one of the major causes of morbidity and mortality in varied regions of Australia is the haemorrhage from placenta percreta, which results in causing haemoperitoneum, a sign of perinatal morbidity and mortality (Government of South Australia, 2013). Question 3 Incidence Thromboembolic is a disease, which occurs during the time of pregnancy and puerperium. In this regard, Thromboembolism is noted to be the leading reason behind the maternal deaths in most of the nations. Antenatally multiple birth is one of the important risk factors, which emerge in such scenario. Incidence of maternal caused by VTE is approximately 0.48% in per 100,000 and 1.1 per 100,000 delivery cases correspondingly. In relation to the incident of VTE, the statistics reflect that the incidence varies between the ranges of 0.6 to 2.0 per 1000 pregnancy cases (Jacobsen et al., 2008). Risk Factors Women having VTE may experience ante- and postnatal risk. Ante-natal risk factors are significant in creating reproduction and gestational diabetes and the strong postnatal risk factors emerge in preeclampsia sections (James, 2009). Signs and Symptoms People often experiences swelling in legs and often undergoes with the problems like tachycardia, dyspnea and tachypnea during pregnancy (Marik & Plante, 2008). Differential Diagnosis For diagnosis the VTE, clinical suspicion is quite important for controlling thromboembolism during the time of pregnancy and puerperium. The women who are noticed possessing the signs as well as the symptoms of thromboembolism problem are subjected to undergo with various diagnosis tests. Additionally, once the diagnosis was confirmed, a temporary vena caval filter should be placed within the infected patients (Marik & Plante, 2008). While elaborating on differential identification or diagnosis of Thromboembolic, it can be affirmed that multi-slice computed tomography, which is also acknowledged as multi-slice CT or multi-detector CT may prove to be quite beneficial in effectively diagnosing the above stated health issue, which mostly prevail amid pregnant women. Besides, it will be vital to mention that pulmonary angiography may also be regarded as one of the efficient differential diagnosis constituents against the severe health concerns of Thromboembolic (JCS, 2011). Appropriate Management For proper management and appropriate management ‘anticoagulant therapy’, ‘prevention of post-thrombotic leg syndrome’ and ‘postnatal anticoagulation therapy’ is very much needful. In this regard, Anticoagulant therapy includes Low-molecular-weight heparin (LMWH) and Intravenous unfractionated heparin in massive pulmonary thromboembolism with cardiovascular compromise (LMWH or heparinoid, danaparoid sodium or fondaparinux). Thus, the aforesaid approaches can be regarded as the best ways to prevent thromboembolism in pregnancy as well as puerperium by a considerable extent (Agency for Healthcare Research and Quality, 2014). It is worth mentioning that effective conduct of paramedics’ management can ensure accurate diagnosis of Thromboembolic, specifically in the puerperium. This paramedics management can be performed through various ways, which commonly comprise diagnosing any sort of myocardial infarction possessed by the pregnant women, determining the toxicity level and most vitally, identifying the presence of the level of pulmonary along with air embolus within the patients’ body (Royal College of Obstetricians and Gynaecologists, 2011). Question 4 Abortion complications, appendicitis, cervical cancer, dysmenorrhea, early pregnancy loss, hemorrhagic shock, hypovolemic shock and placenta previa were the differential diagnoses that need to imparted in the underline case scenario. It is anticipated that these diagnoses will certainly help in monitoring whether she is having any sign and symptoms of an ectopic pregnancy. Furthermore, the underline differential diagnosis will also assist in identifying the classic harmony of pain, vaginal bleeding and amenorrhea. Moreover, numerous critical situations may also exist due to the persistence of extra-uterine pregnancy. Nevertheless, criticality for more understanding about proper diagnosis methods such as miscarriage, ruptured corpus luteum cyst or follicle, tubo-ovarian abscess, ovarian torsion, pelvic inflammatory disease and urinary calculi may also be taken into concern. Regardless to the underline case scenario, the girl should be asked about the history of any Pelvic Inflammatory Disease (PID), as PID is recognised to be one of the leading causes of ectopic pregnancy. She also need to be questioned regarding the consumption of any anti pregnancy capsules during the course of time, as in certain cases, it can be noticed that women, in order to avoid pregnancy, uses various pills that impose adverse effects on their individual health. Moreover, in relation to the case scenario, it has also been reflected that she was highly conscious regarding the use of condom during the time of sex. Thus, she must be questioned regarding the quality of condom. Consequently, signs along with symptoms like breasts tendering, lower abdominal cramps, vaginal bleeding, tiredness and urinating generally depicts the reasons behind her sickness. The diagnosis of patient suffering from pregnancy significantly requires following various multifaceted approaches by using three diagnostic tools i.e. physical examination, laboratory evaluation and ultrasonography. As per the early feedback and quick analysis of her body, it can be noticed that she might mislead the clinician in some respect, as the early signs and symptoms reflected that she might be pregnant. In the current scenario, her condition might get deteriorated due to certain reasons that entail improper nutrition, regularity in conducting multi-sexual activities in few days and formation of indiscipline sexual relation. In order to manage the patient and improve her condition, it is quite important to critically evaluate her situation in a better way. Moreover, for tracking the further complications of the patient, her physical examination in an in-depth manner is needful. On the other hand, proper conduct of laboratory examination will significantly assist the physicians to gain a detailed understanding about varied complications in much better way. Most importantly, if required, ultrasonography can also be undertaken in future to find the ultimate result. Question 5 List of the Vaccines Benefits Side efects/complications Flu vaccines Keep pregnant women safe from getting sick from flu Redness, soreness, swelling, toughness and itching Tetanus Prevent tetanus problems persisting within the pregnant women Swelling, redness, hives, warmth, rash along with pain near the site of injection, fever and nausea Haemophilus influenzae type b (hib) Eradicate infections caused by bacteria called Haemophilus influenzae type b Swelling and redness as well as soreness in the site of injection Pneumococcal vaccine Prevents in causing lung, blood and brain infections with regards to Streptococcus pneumoniae bacteria Swelling in lips, face, tongue, closing of the throat, difficulty in breathing, dizziness, paleness, hives, weakness and even faster heart beat Meningococcal vaccine Helps in protecting women from meningococcal bacteria, causing meningococcal disease Trouble in breathing, hoarseness, swallowing hives, wheezing, itching, redness, paleness, stomach cramps, skin warmth, diarrhoea, loss of consciousness and weakness Sources: (2Centers for Disease Control and Prevention, 2014; 1RxList Inc., 2014; 3Centers for Disease Control and Prevention, 2014; 2RxList Inc., 2014; WebMD, LLC., 2014; National Prescribing Service Limited, 2012) Question 6 Gynaecological cancers are the cancers that occur in the reproductive system of the females during the time when the abnormal cells grow in a very uncontrollable manner. The list of cancers of the Female Genital Tract affecting Australian women include ovary, vulva, vagina or cervical. During the year 2014, nearly 1,470 Australian women were likely to diagnose ovarian cancer and the risk of developing the same was 1 in 77. Vulva incident was noticed in 2.3 scenarios per 100,000 women. Whereas, vaginal cancer cases were seen in 0.6 in 100,000 women and the risk of having cervical cancer prior to the age of 85 years in Australian women was noted to be 1 in 155 (Cancer Australia, 2014). Each of the above listed cancers is present in emergency settings due to the prevalence of numerous risk factors that impose adverse impact on the health conditions of Australian women. Cervical cancer can only be noticed through screening test and there lay cost-effective treatment in opposition to the same (1Centers for Disease Control and Prevention, 2014). Paramedic departure service is viewed to be one of the integral parts of comprehensive healthcare emergency system, which aids in offering valuable and skilled pre-hospitalization emergency care services to women suffering from the above listed various cancers. Additionally, the service is noted to assist the physicians in keeping constant track on the conditions of the patients, ensuring that staffing and resources are readily available to patients at the time when they arrives in any emergency setting (Minnesota Department of Human Service, 2012). References American Society for Reproductive Medicine. (2014). Ectopic pregnancy. Retrieved from http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ectopicpregnancy_B.pdf Agency for Healthcare Research and Quality. (2014). Thromboembolic disease in pregnancy and the puerperium: Acute management. Retrieved from http://www.guideline.gov/content.aspx?id=11385 Australian Bureau of Statistic. (2014). 3303.0 - Causes of death, Australia, 2012. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0main+features100062012 Cancer Australia. (2014). Ovarian cancer statistics. Retrieved from http://canceraustralia.gov.au/affected-cancer/cancer-types/gynaecological-cancers/ovarian-cancer/ovarian-cancer-statistics 1Centers for Disease Control and Prevention. (2014). Basic information about Gynecologic cancers. Retrieved from http://www.cdc.gov/cancer/gynecologic/basic_info/ 2Centers for Disease Control and Prevention. (2014). Seasonal flu shot. Retrieved from http://www.cdc.gov/flu/about/qa/flushot.htm 3Centers for Disease Control and Prevention. (2014). Hib vaccination. Retrieved from http://www.cdc.gov/Vaccines/vpd-vac/hib/default.htm Government of South Australia. (2013). Maternal, perinatal and infant mortality in South Australia 2011. Retrieved from http://www.sahealth.sa.gov.au/wps/wcm/connect/6833fa0041ffdd8495b6bdf8b1e08c6d/13103.2+Mortality+Report+A5-ONLINE.pdf?MOD=AJPERES&CACHEID=6833fa0041ffdd8495b6bdf8b1e08c6d Jacobsen, A. F., Skjeldestad, F. E., & Sandset, P. M. (2008). Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium: A register-based case-control study. American Journal of Obstetrics & Gynecology, 233e1-233e7. James, A. H. (2009). Venous thromboembolism: Mechanisms, treatment, and public awareness. American Heart Association, 29, 326-331. JCS. (2011). Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Retrieved from http://intranet.santa.lt/thesaurus/no_crawl/PLAUTINE%20HYPERTENZIJA/Guidelines%20for%20the%20Diagnosis,%20Treatment%20and%20%20Prevention%20of%20Pulmonary%20embolism%20and%20Deep%20Vein%20Thrombosis%20(JSC%202009).pdf Marik, P. E. & Plante, L. A. (2008). Venous thromboembolic disease and pregnancy. The New England Journal o f Medicine, 2025-2033. Minnesota Department of Human Service. (2012). Health services medical management. Retrieved from http://mnemscp.org/wp-content/uploads/2012/03/Community-Paramedics-Legislative-Report.pdf National Prescribing Service Limited. (2012). Vaccines for pregnant women. Retrieved from http://www.nps.org.au/medicines/immune-system/vaccines-and-immunisation/for-individuals/who-should-be-vaccinated/pregnant-women Patient.co.uk. (2013). Ectopic pregnancy. Retrieved from http://www.patient.co.uk/doctor/ectopic-pregnancy-pro 1RxList Inc. (2014). Tetanus. Retrieved from http://www.rxlist.com/tetanus-side-effects-drug-center.htm 2RxList Inc. (2014). Pneumovax. Retrieved from http://www.rxlist.com/pneumovax-side-effects-drug-center.htm Royal College of Obstetricians and Gynaecologists. (2011). Maternal collapse in pregnancy and the puerperium. Retrieved from http://www.emedicinafetal.org/Papers/Maternal%20collapse%20in%20pregnancy%20and%20the%20puerperium%20RCOG%202011-3.pdf Stöppler, M. C. (2013). Ectopic pregnancy (cont.). Retrieved from http://www.medicinenet.com/ectopic_pregnancy/page3.htm#what_are_signs_and_symptoms_of_an_ectopic_pregnancy Scher, J. (1971). Symptoms related to the anatomical situation fifty cases of ectopic pregnancy. S.A. Tydskrif Vir Obstetrie En Ginekologie, 75-77. UNSW Embryology. (2010). File: abnormal implantation sites.jpg. Retrieved from http://php.med.unsw.edu.au/embryology/index.php?title=File:Abnormal_implantation_sites.jpg WebMD, LLC. (2014). Meningococcal vaccine for adults. Retrieved from http://www.webmd.com/vaccines/meningococcal-vaccine-for-adults Read More