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Abdominal and Genitourinary Objectives

Upon completion of this lecture, you will be better able to:

Describe specific parameters for assessing abdominal or GU complaints in students

Describe necessary interventions for selected abdominal or GU problems

Accurately triage students presenting with abdominal or GU complaints

Describe the procedure for emergency childbirth at school and interventions for potential complications affecting the mother and infant

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ABDOMINAL ANDGENITOURINARY

EMERGENCIES

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SPECIAL CONSIDERATIONS

Very common complaintMust take all complaints of

abdominal pain seriouslyHistory, assessment and cooperation

neededPrivacy is essentialWatch facial expression during exam

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TYPES OF ABDOMINAL PAIN

Visceral intermittent cramping

Somatic severe, sharp

Referred felt away from

source

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PQRST - HISTORY

P= Problem (Provoke or palliative)Q= QualityR= RadiateS= Severity (Signs and symptoms)T= Timing

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FOCUSED ASSESSMENT

Inspection Skin color Contour/Symmetry

Auscultation Bowel sounds

PercussionPalpation

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Abdominal Assessment

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TESTS FOR INFLAMMATION

IliopsoasObturatorHeel dropRebound

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TRIAGE EMERGENT

Trauma, rigid abdomen, distention Absent bowel sounds

URGENT Abdominal pain less than 24 hours Tenderness on palpation, guarding

NON-URGENT Gastroenteritis (without signs or symptoms of

hypovolemic shock), constipation, RAP (recurrent abdominal pain)

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SELECTED EMERGENCIES

AppendicitisAcute GastroenteritisConstipationRecurrent abdominal pain (RAP)Trauma

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SELECTED EMERGENCIES

Urinary Tract Infection (UTI)Vaginal BleedingOvarian CystEctopic PregnancyTesticular painPelvic Inflammatory Disease (PID)Sexually transmitted diseases

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Out of Hospital Delivery

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PREGNANCY HISTORY

AgePrior pregnancies and

deliveriesExpected due datePrenatal carePotential for multiple births

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Stages of Labor

There are 3 stages of labor:First stage – begins when contractions become

regular and ends when cervix is fully dilatedSecond stage – begins when cervix is fully dilated

and ends when the infant is fully deliveredThird stage – begins when the infant is fully

delivered and ends with delivery of the placenta

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DETERMINATION OF LABOR PROGRESSION

Presence of mucus plug or bloody show

Rupture of membranesTime between contractionsFeeling of bowel movement

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PREPARATION FOR DELIVERY

Contact EMS and follow school plan for childbirth

Follow universal body substance precautions

Place mother on hard surfaceRemove essential clothingExamine for crowningObtain supplies

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DELIVERYSupport the infant’s headRupture the sac (if not

already broken)Observe for meconium

stainingObserve for the umbilical

cordSuction the infant’s

nose and mouth (mouth before nose)

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DELIVERY

Deliver the shoulders

Cut the umbilical cord once pulsations stop

Deliver placenta

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POSTNATAL CARE OF INFANT

Keep infant warmKeep airway clearAssure adequate responseAuscultate respiratory and heart rateObtain APGAR score at 1 minute and

5 minutes

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APGAR ScoreT A B L E 1 0 – 5 . A P G A R E V A L U A T I O N O F T H E N E O N A T E

S I G N 0 1 2

Appearance (color)

Cyanotic or pallid

Centrally pink, extremities cyanotic

Completely pink

Pulse rate Absent <100 bpm >100 bpm

Grimace (reflex irritability)*

No response Grimace Cough/cry/sneeze

Activity (muscle tone)

Limp Some flexion (extremities)

Active movement

Respiratory effort

Absent Slow/irregular Good; cries

*In response to nasal or oral stimulation

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Resuscitation MeasuresIn most deliveries, the infant will need no other care

beyond maintenance of warmth, airway suctioning and mild stimulation.

Positive-pressure ventilation is indicated if any of the following conditions are present:

Apnea or gasping respirations Heart rate slower than 100 beats/minute Persistent central cyanosis despite 100% oxygen

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POSTNATAL CARE OF THE MOTHER

Position of comfortUterine massageKeep warmFacilitate mother-infant bonding

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SPECIAL SITUATIONSPremature birthMultiple birthsStillbirthBreech birthProlapsed umbilical

cordPregnancy induced

hypertension

Hemorrhage Abruptio placentae Placenta previa Spontaneous abortion

Trauma in PregnancyEpistaxisDrug use during

pregnancy

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PREVENTIONEarly recognition of emergent and urgent

conditions is fundamental to ensure appropriate management of the student with abdominal pain

Educate students about physical changes associated with puberty and encourage adoption of good hygiene and nutritional habits

Encourage safe-sex strategies to reduce the risk of pregnancy and sexually transmitted disease

When pregnancy does occur, students need to understand the importance of prenatal care and anticipate their post-partum needs

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SUMMARYIdentifying the location, intensity and quality of

abdominal pain can assist in determining the most likely underlying condition, which will facilitate accurate triage and appropriate interventions.

If there are pregnant students or staff in your school, be prepared to manage an out-of-hospital delivery. Stock sterile, prepackaged obstetric kits and additional supplies as appropriate. Review delivery procedures so that you will know how to assist the mother if the need should arise.

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ANY QUESTIONS??