(Test Bank) Paramedic Care: Principles & Practice, Vols. 1-5

Bledsoe,Porter,Bledsoe,Cherry, 5

Medicine

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5th Edition

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Test Bank for Paramedic Care: Principles & Practice, Vols. 1-5, The downloadable file consists of 469 pages, and the total size of the file is 7.11 MB. Purchase now only for highly discounted price.

Author(s): Bledsoe, Porter, Bledsoe, Cherry

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©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 1 Detailed Lesson Plan Chapter 1 Gynecology 85–110 Minutes Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture . 5 II. Introduction A. The term gynecology is derived from Greek gynaik , meaning wom an. B. Branch of medicine that deals with health and diseases of women and their reproductive organs C. Obstetrics is the branch that deals with care of women throughout pregnancy . D. Most patient s experience abdominal pain or vaginal bleeding . 15 III. Anatomy and Ph ysiology A. Understanding of anatomy and physiology of the female reproductive system will allow better understanding, recognition, and treatment of emergencies as they arise B. Female Reproductive Organs 1. External genitalia have accessory functions and include the perineum, mons pubis, labia majora and minora, clitoris, and urethra . a. Perineum – skin-covered tissue that separates the vagina and anus; term may include entire vulvar area; may be torn during childbirth or sexual assault b. Mons pubis – fatty layer over t he symph ysis pubis that protects symph ysis pubis during intercourse c. Labia majora – structure that is located laterally and protects Teac hing Tip s Use an anatomic model, picture, etc. to show students the female reproductive system, which will allow them a visual of how close all organs are to each other and why internal bleeding can be hidden. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities  Points to Emphasize  Knowledge Application ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 2 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes vagina and urethra d. Labia minora – structure that is located medial and protects vagina and urethra e. Clitoris – highly innerva ted, major site of sexual stimulation f. Urethra – located superior and anterior to vagina; drains the urinary bladder; owing to decreased length, females are more susceptible to bladder infections 2. Internal organs are located within pelvic cavity and include ovaries, fallopian tubes, uterus, and vagina . a. Vagina – three functions : female organ of copulation, final passageway during childbirth, and outlet for menstrual blood and tissue b. Uterus – primary function : to provide site for fetal development; muscle of pr egnancy that has a body (fundus) and neck (cervix); innermost layer called endometrium, middle layer called myometrium, and outer layer called perimetrium c. Ovaries – primary female sex glands that are situated laterally on either side of uterus; two functio ns: secretion of estrogen and progesterone and development and release of eggs for reproduction d. Fallopian tubes – flexible tubes that extend from uterus to each ovary; function of tubes : to conduct egg from ovary into uterine cavity using peristalsis 15 IV. The Menstrual Cycle A. Hormonal cycle gener ally occurring every 28 days B. Prepares uterus to receive fertilized egg C. Onset of menstrual cycle, menarche , usually begins between 10 and 14 years of age. D. A normal menstrual cycle varies for each woman, so it is important to inquire as to the normal length for the woman in question . E. Female sex hormones estrogen and progesterone control the ovarian menstrual cycle, pregnancy , and lactation (estrogen and progesterone Teaching Tip s Cover with students the various hormones related to the female cycle, explaining which hormones are secreted by the ovaries and which by the pituitary. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 3 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes secretion controlled by follicle -stimulating hormone [ FSH] and luteinizing hormone [ LH] secre tion). F. Proliferative Phase 1. First two weeks of menstrual cycle 2. Dominated by estrogen, which causes lining of uterus to thicken 3. Ovulation takes place due to surge of LH at day 14 . a. Immature ovarian follicles, graafian follicles , are present in female at birth and gradually used up during lifetime . b. Follicle reaches maturity due to FSH and increased estrogen . c. Follicle ruptures and discharges egg through ovary . d. Ruptured follicle develops the corpus luteum (body of cells) . e. If not fertilized, corpus luteum will atr ophy within 3 days. f. If fertilized, corpus luteum produces progesterone until placenta takes over . G. Secretory Phase 1. Stage immediately surrounding ovulation 2. If egg is not fertilized, estrogen levels drop while progesterone dominates . 3. Uterine vascularity incre ases in anticipation of fertilized egg . H. Ischemic Phase 1. If fertilization does not occur, estrogen and progesterone levels drop 2. Endometrium undergoes vascular changes that cause small blood vessel rupture . I. Menstrual Phase 1. Ischemic endometrium is shed . 2. Menstr ual flow usually lasts 3–5 days. 3. Average blood loss is 50 mL . 4. Premenstrual syndrome can be experienced, and includes physical changes related to changing hormone levels . 5. Absence of a menstrual cycle in a sexually active woman of child - bearing years should raise suspicion of pregnancy . J. Premenstrual Dysphoric Disorder (PMDD) 1. Condition similar to premenstrual syndrome, but symptoms more ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 4 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes severe 2. Include s a wide range of physical and/or emotional symptoms K. Menopause 1. Cessation of menses , marks cessation of ovarian function 2. Menses declines around 45 –55 years old, until menses stops 3. End of reproductive life 4. Sexual hormones decline 15 V. Assessment of the Gynecologic Patient A. Most common complaints are abdominal pain and vaginal bleeding 1. Dysmenorrhea – severe discomfort during menstrual periods 2. Dyspareunia – painful sexual intercourse B. Complete primary and secondary assessments; specific questions must be asked regarding reproductive function and dysfunction C. History D. OPQRST for chief complaint E. SAMPLE for past medical history F. Any associated symptoms? G. Obstetrical history H. Last menstrual period I. Sexually activity J. Possibility of pregnancy K. Contraceptive use L. Physical exam M. Exam limited in the field N. Patient comfort guide’s exam O. Always have a chaperone if an examination is necessary . and explain to the patient what you will be doing . P. Indicators during the assessment inc lude: 1. Mental status 2. Skin, mucous membranes 3. Pulse rate, blood pressure 4. Orthostatic changes in vital signs 5. Evidence of vaginal bleeding (how many vaginal pads used?) Class Activities Have students break into groups , and ask the specific questions that would be related to the gynecologic patient . Afterward , discuss whether any students were uncomfortable asking the questions, and discuss ways to lessen this discomfo rt. Obtain several types of feminine care products (various size maxi/mini pads, tampons). Using blue - or green -tinted water and a 100 -cc syringe, place water on each item in 10 - to 20-cc increments until the item is saturated. This allows students to have an estimated approximation of the amount of blood these items can hold, allowing a better idea of blood loss when asking the patient , “How many pads have you gone through?” ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 5 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes 6. Abdominal examination; palpate, auscultate 7. NEVER perform an internal vaginal exam in the fie ld 5 VI. Management of Gynecologic Emergencies A. Majority of care will be supportive . B. Primary assessment survey will guide care decisions . 1. O2, EKG, IV, analgesics, etc . C. Monitor and evaluate serious bleeding; do not pack vagina with dressings . D. Patient positioning may include left lateral recumben t with knees bent, which decreases tension on p eritoneum . E. Transport for evaluation F. Psychological support Discussion Topics Discuss with students why the left lateral/knees bent position may be most comfortable and why bleeding in the abdomen may cause shoulder pain . 30 VII. Specific Gynecologic Emergencie s A. Medical Gynecological Emergencies 1. Pelvic inflammatory disease: infection of reproductive tract a. Bacterium, virus , or fungus b. Most common cause of nontraumatic abdominal pain c. Common causes : gonorrhea , chlamydia d. Signs and symptoms include diffuse abdominal p ain, shuffling gait, fever, chills, nausea, vomiting, vaginal discharge . e. Treatment includes ABCs, supportive care, comfort, transport, antibiotics . 2. Ruptured ovarian cyst: fluid -filled pockets on ovary that rupture a. Cyst that ruptures may spill small amount of blood into abdomen . b. Signs and symptoms include moderate to severe unilateral abdominal pain, pain that may radiate to back, dyspareunia, irregular bleeding, delayed menstrual period . c. Treatment includes ABCs, supportive care, comfort, transport, surgical interventions . 3. Cystitis: urinary bladder infection Discussion Topics Ask students why they think their patient may be uncomfortable with the gynecologic emergency and/or exam. Discuss with students ways to make the patient more comfortable . Knowledge Application Create a chart with each emergency listed. Have three column s: for Definition, Signs and Symptoms , and Treatment. Have stude nts complete th e chart for homework. Points to Emphasize Stress to students how their behavior in treating a sexual assault patient could cause further harm to the patient. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 6 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes a. Common cause of abdominal pain b. Signs and symptoms include abdominal pain, urinary frequency, dysuria, low -grade fever, hesitancy in urination, blood in urine . c. Treatment include s ABCs, supportive care, com fort, transport, antibiotics . 4. Mittelschmerz – midcycle abdominal pain at ovulation a. Peritoneal irritation due to follicle rupture b. Signs and symptoms include unilateral lower quadrant pain, midcycle spotting, low -grade fever (although body temperature norma lly increases during ovulation) c. Treatment includes ABCs, supportive care, comfort, transport 5. Endometritis – infection of uterine lining a. Occasional complication from miscarriage, childbirth, dilation and curettage (D&C ) b. May mimic pelvic inflammatory disease (PID) c. Complications can include sterility, sepsis, death . d. Signs and symptoms include lower abdominal pain ; bloody, foul - smelling discharg e; fever (101 –104°F); appearance of symptoms 48–72 hours after gynecologic event . e. Treatment includes ABCs, supportive care, comfort, transport, antibiotics, surgical interventions . 6. Endometriosis – endometrial tissue found outside of uterus a. Most commonly found in abdomen and pelvis but can be found anywhere b. Tissue responds to hormone changes, causing cyclic inflammation, scarring of tissues, adhesions . c. Signs and symptoms include dull, cramping pelvic pain usually related to menstruation, dyspareunia, abnormal vaginal bleeding, painful bowel movements . d. Treatment includes ABCs, supportive care, comfort, transport, hormones, a nalgesics, anti -inflammatory drugs, surgery . 7. Ectopic pregnancy – implantation of fetus outside of uterus a. Most common site is fallopian tube ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 7 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes b. Surgical emergency c. Signs and symptoms include severe unilateral pain, radiation of pain to shoulder on affected side , late or missed period, possible vaginal bleeding . d. Treatment includes ABCs, supportive care, comfort, transport, surgical intervention . 8. Nontraumatic vaginal bleeding – vaginal bleeding not associated with menstruation a. Called dysfunctional uterine bleeding b. Most common cause is spontaneous abortion (miscarriage) c. Other causes include uterine fibroids (noncancerous tumors in uterus), cancerous lesions, PID, onset of labor . d. Signs and symptoms include vaginal bleeding, abdominal pain . e. Treatment includes ABCs, su pportive care, comfort, transport, possible surgical interventions . 9. Management for medical gynecological emergencies may include oxygen, IV and fluids, electrocardiogram (ECG) , transport (remember to NEVER pack vagina with dressing ), absorb bleeding with p ads. B. Traumatic Gynecological Emergencies 1. Causes of gynecologic trauma include straddle injuries, sexual assault, blunt force to lower abdomen, direct blows to perineal area, foreign body insertion, self -attempts at abortion, lacerations following childbirt h. 2. Management for gynecologic traumatic includes direct pressure over laceration or chemical cold pack to hematoma, oxygen, IV and fluids for signs of shock, transport, possible surgical intervention . 3. Sexual assault a. Most rapidly growing crime in America b. No “typical” victim c. Common element is sexual contact without consent, resulting in crime of violence with serious physical and psychological implications . d. Assessment: unique patient with unique needs i. As a rule, do not question about the incident in ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 8 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes the field. ii. Confine questions to physical injuries . iii. Patient may be withdrawn, hysterical, in denial, angry, or fearful . iv. Be calm and professional in your approach . v. Do not examine genitalia unless life -threatening hemorrhage is present . vi. Look for possible signs of “dat e-rape” drug symptoms . e. Management: In most situations, psychological and emotional support it the most important help you can offer . i. Try to use same -gender paramedic for care . ii. Disturb crime scene as little as possible . iii. Bag clothing or other evidence in paper bags . iv. Do not allow patient to change clothes or bathe . f. Documentation: state patient remarks accurately, state observations, document evidence, do not include opinions . 5 VIII. Summary A. Majority of gynecologic emergency patients will present with abdomi nal pain and/or bleeding B. This area of care may be uncomfortable for patient, but a detailed history is beneficial to care . C. Best historian is patient . D. Very few things paramedic can do for gynecologic emergencies, outside of ABCs, O 2, IV/fluids if necessary, ECG, comfort , and transport . E. Treat patient symptomatically and with dignity . 5 IX. Case Study Class Activities Discuss the case with the students now that they are familiar with the chapter. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 9 Chapter 1 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guidelines . Minutes Content Outline Master Teaching Notes 5 X. You Make the Call Class Activities Read and discuss the ca ll and questions as a group. 5 XI. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them . Go over the questions again after the lecture to a ssess students’ understanding of the information. ©2017 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 1 Detailed Lesson Plan Chapter 2 Obstetrics 220–230 Minutes Chapter 2 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guideline s. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture . 5 II. Introduction A. The f ocus of this chapter is pregnancy, childbirth, and pote ntial complications B. Pregnancy is a natural, normal process that occurs daily and normally requires only the most basic assistance 5 III. The Prenatal Period A. Prebirth period from time of conception until delivery of fetus B. Significant changes in mother, along with fetal development C. Health care visits during this period are referred to as prenatal visits or prenatal care . 10 IV. Anatomy and Physiology of the Obstetric Patient A. Ovulation 1. Release of egg from ovary, which , if fertilized, becomes implanted in uterus and pregnancy begins 2. Ovulation usually occurs on average 14 days from menstrual cycle, but may vary by several days B. Fertilization 1. Ovum begins cellular division . 2. Becomes blastocyst (hollow ball of cell s), and implants in uterine lining C. Placenta 1. Organ of pr egnancy Teaching Tip s Use an anatomy and physiology model s o students can visualize the structures of pregnancy. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities  Knowledge Application ©2017 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 2 Chapter 2 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guideline s. Minutes Content Outline Master Teaching Notes 2. Develops on ut erine wall at site of blastocyst attachment 3. Temporary structure that transfers heat, exchanges O 2 and CO 2, delivers nutrients, carries away wastes, serves as endocrine gland during pregnancy, serves as protective barrier against some harmful substances 4. When expelled following delivery of child, referred to as afterbirth D. Umbilical Cord 1. Connects placenta to fetus 2. Flexible, rope -like cord that is 2 f eet in length 3. Normally contains two arteries and one vein 4. Vein transports oxygenated blood to fetus, and arteries return deoxygenated blood to placenta E. Amniotic Sac 1. Fetus develops within this sac, which is filled with amniotic fluid . 2. Referred to as “ba g of waters” F. Amniotic Fluid 1. Surrounds and protects fetus during development 2. Volume of fluid by 20th week of gestation : 500–1,000 mL 3. Allows fetal movement 4. Secretions from fetus (lungs and urination) contribute to fluid 5. Rupture of membranes usually occurs during labor, with flow of fluid from vagina 10 V. Physiologic Changes of Pregnancy A. Due to altered hormonal state, mechanical effects of enlarging uterus and vascularity, and increasing metabolic demands on mother B. Reproductive System 1. Most signific ant change occurs in uterus . 2. By end of pregnancy, uterus will weigh 1 ,000 g rams. 3. Vascular system of uterus contains 1/16 of mother’s total blood volume during pregnancy . 4. Formation of mucus plug in cervix, which protects fetus and prevents infection, and is expelled when cervical dilation begins 5. Estrogen causes thickened vaginal mucosa, increased vaginal secretions , and loosens connective tissue to allow for delivery . 6. Breasts enlarge as mammary glands prepare for lactation . Class Activities As you discuss the changes that pregnancy causes for each body system, ask your students what aspects of their assessment and care need to be altered, if any, for a pregnant patient. ©2017 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 3 Chapter 2 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guideline s. Minutes Content Outline Master Teaching Notes C. Respiratory System 1. Maternal oxygen demand increases . 2. Decrease in airway resistance as a result of progesterone 3. 20% increase in O 2 consumption and 40% increase in tidal volume 4. Slight increase in respiratory rate 5. Diaphragm pushed up by enlarging uterus D. Cardiovascular System 1. Cardiac output in creases by 30 –50% throughout pregnancy, peaking at 6–7 L/minute by pregnancy term . 2. Systemic vascular resistance decreases . 3. Maternal blood volume increases 45% . 4. Relative anemia occurs, due to slightly more plasma increase than RBC increase . 5. Due to increase in blood volume, mother may suffer an acute blood loss of 30 –35% without significant changes in vital signs . 6. Maternal heart rate increases 10 –15 beats/minute . 7. Blood pressure is slightly decreased during first two trimesters, then rises to normal levels dur ing third trimester . 8. Supine hypotensive syndrome occurs when the uterus compresses the inferior vena cava while mother lies in the supine position . E. Gastrointestinal System 1. Nausea and vomiting are common in first trimester due to hormone levels . 2. Delayed gas tric emptying is present, resulting in bloating or constipation . 3. As the uterus grows, abdominal organs are compressed . F. Urinary System 1. Renal blood flow increases . 2. Glomerular filtration rate (GFR ) increases 50% 3. Urinary bladder displaced, causing urinary freq uency G. Musculoskeletal System 1. Loosened pelvic joints results from hormonal influences, giving mother a waddling gait . 10 VI. Fetal Development A. Begins immediately after fertilization and is complex ©2017 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 4 Chapter 2 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guideline s. Minutes Content Outline Master Teaching Notes B. Normal duration of pregnancy is 40 weeks from first day of mother’s last menstrual period, equaling 280 days . C. Estimat ed birth date is called due date, or estimated date of confinement . D. Pregnancy is divided into three trimesters, each three calendar months long . E. Preembryonic stage: first 14 days after conception F. Embryonic stage: day 15 and ends at 8 weeks G. Fetal stage: 8 w eeks until delivery H. Sex of infant is usually determined by 16 weeks of gestation . I. Fetal heart tones are detected by stethoscope by 20 weeks of gestation, and mother has felt movement . J. Infant may be able to survive by 24 weeks of gestation, and if born afte r 28 weeks, there is an excellent chance of survival . K. Baby is considered term by 38 th week of gestation . L. Most fetal organs develop during first trimester, which is when fetus is most vulnerable to development of birth defects . 10 VII. Fetal Circulation A. Fetus receives O 2 and nutrients from mother through placenta . B. Fetus does not need respiratory or gastrointestinal ( GI) tract while in utero . C. Fetal circulation shunts blood around lungs and GI . 1. Umbilical vein connects directly to inferior vena cave by ductus ve nosis , allowing blood to enter right atrium and pass through tricuspid and into right ventricle, exiting right ventricle and traveling through pulmonic valve into pulmonary artery . 2. Fetal heart has a hole between right and left atria, called the foramen ovale, allowing oxygenated blood in right atrium to mix with blood leaving left ventricle, which is bound for aorta . 3. Oxygenated blood now in pulmonary artery will enter the ductus arteriosus , which connects pulmonary artery with aorta, cau sing blood to bypass the uninflated lungs . D. Fetal circulation changes immediately at birth . 1. First breath of fetus causes lungs to inflate, decreasing pulmonary vascular resistance, and closure of specialized circulation structures occurs . Teaching Tip s Use an anatomic model to explain the specialized structures of fetal circulation. Discussion Topics Discuss with students what they might see in a newborn when the specialized structures of circulation do not close appropriately. ©2017 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. 5 Chapter 2 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instructional Guideline s. Minutes Content Outline Master Teaching Notes 20 VIII. General Assessment of the Obstetric Patient A. Primary Assessment 1. Same as for nonobstetric patients 2. Special attention is paid to the developing fetus . a. SAMPLE history b. General information to include gravidity, parity, length of gestation, estimated due date, any known GYN/OB complications in past, any current prenatal care, medications/allergies, and so forth B. Preexisting or Aggravated Medical Conditions 1. Diabetes a. May become unstable during pregnancy b. Mother may develop gestational diabetes (diabetes developed during pregnancy) . c. Poorly controlled diabetes ca n result in large infants and possibl y birth defects . 2. Heart disease a. Congestive heart failure ( CHF) may develop in a mother who has serious preexisting heart disease due to the increased cardiac output . 3. Hypertension (HTN) a. Preexisting HTN is aggravated by pr egnancy . b. Preeclampsia may contribute to maternal HTN . c. Persistent HTN can affect placenta, compromising fetus . 4. Seizure disorders a. Most patients with seizure disorders are controlled by medication and have uneventful pregnancies . 5. Neuromuscular disorders a. Disor der may be aggravated by pregnancy, but more likely mother will experience remission of symptoms . 6. Pain a. Determination of when pain started, character of pain, location, duration, radiation is of utmost importance . 7. Vaginal bleeding a. Vaginal bleeding or spotti ng is major concern in obstetrics . b. Color, amount, duration of bleeding, events prior to event, passing Teaching Tips Go over all of the special vocabula ry related to pregnancy . Class Activities Have students break into groups and perform an obstetric assessment.