Essentials of nursing Care: reproductive health

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things we need to know about nursing reproductive health or the older exam Nursing concepths 3 nursing, reproductive, health, Nursing Theory, Essentials of nursing Care: reproductive health, excelsior

Lochia

substance discharged from the vagina (cellular debris and mucus and blood) that gradually decreases in amount during the weeks following childbirth

**Lochia generally has an odor similar to that of normal menstrual fluid
**Any offensive odor indicates contamination by saprophytic organisms and should be reported to a healthcare provider.
**In the field of obstetrics, lochia is post-partum vaginal discharge, containing blood, mucus, and placental tissue. Lochia discharge typically continues for 4 to 6 weeks after childbirth.

Lochia types

It progresses through three stages.

Lochia rubra (or cruenta)
Lochia serosa
Lochia alba (or purulenta)

Lochia rubra (or cruenta)

Lochia rubra (or cruenta) is the first discharge, red in color because of the large amount of blood it contains. It typically lasts no longer than 3 to 5 days after birth.

Lochia serosa

Lochia serosa is the term for lochia which has thinned and turned brownish or pink in color. It contains serous exudate, erythrocytes, leukocytes, and cervical mucus. This stage continues until around the tenth day after delivery.

Lochia alba (or purulenta)

Lochia alba (or purulenta) is the name for lochia once it has turned whitish or yellowish-white. It typically lasts from the second through the third to sixth week after delivery. It contains fewer red blood cells and is mainly made up of leukocytes, epithelial cells, cholesterol, fat, and mucus.

lochiostasis or lochioschesis

Lochia which is retained within the uterus is known as lochiostasis

** or lochioschesis

Lochiorrhea

Lochiorrhea is the term used when there is abnormal flow of lochia.

How much does plasma increase in pregnency?

By 50%

How much do RBC's increase in pregnency?

By 30% with iron supplementation
By 18% with out iron supplementation

when assessing any PID for men and women
what is important to know

1st ask about the symptoms
2nd ask about the sexual history
with who ie orientation
safe sex or unsafe
what forms of birth control
how often
how many partners and gender of partners

Pt is tired and restless during labor what is nursing diag?

Pt is experiencing exhaustion 2ndary to labor

New Born with fetal alcohol syndrom, what is the nursing diagnosis

Baby is at risk for skin integrity related to hyperactivity

New Born with fetal alcohol syndrom,is experiencing poor skin integrity what is the nursing intervention

The nurse should swaddle the baby

fetal alcohol syndrom

a cluster of abnormalities that occurs in babies of mothers who drink alcoholic beverages during pregnancy, which includes low intelligence, small head with flat face, misshapen eyes, flat nose, and thin upper lip, as well as some defree of intellectual impairment.

Eclampsia

...

nagele's rule

from the last period subtract 3 months and add 7 days
take into account the normal cycle of the mother

.. if it is a 28 day cycle apply this rule

... if 35 day cycle minus 14 days and add those days to the EDD

.. if its is a 21 day cycle then (21-14=7) minus 7 from the EDD because she ovulated early

name the 4 probable signs of pregnency

...

name 3 positive signs of pregnency

...

what are the changes in the ovary during pregnency?

...

Ante

before

antepartum

time before delivery

prenatal

time before birth

gravida

any pregnancy, regardless of duration
**it includes the present pregnency

para

number of births after 20 weeks gestation regardless of whether the infants were born alive or dead

primigravida

a women pregnent for the first time

multigravida

a woman who is in her second or subsequent pregnancy

nulligravida

a woman who has not given birth at more than 20 weeks gestation

primipara

a woman who was given birth to a fetus (dead or alive) that has reached 20 weeks gestation

Multipara

a woman who has given birth two or more times at more than 20 weeks gestation.

stillbirth

a fetus born dead after 20 weeks gestation

amenorrhea

absence or suppression of normal menstrual flow

Braxton Hicks contractions

intermittent and irregular painless uterine contractions that occur throughout pregnancy. They occur more frequently toward end of pregnancy

chloasma

a tan discoloration of a woman's face that is associated with pregnancy or with the use of oral contraceptives

colostrum

milky fluid secreted for the first day or two after parturition

diastasis recti

Separation of the longitudinal muscles of the abdomen (rectus abdominis) during pregnancy.

supine hypotention syndrome

...

Gravida /Para (TPAL) "TPAL" stands for what?

T refers to term births (after 37 weeks gestation),
P refers to premature births
A refers to abortions
L refers to living children

The TPAL is described by numbers separated by hyphens.

***Multiple births (twins, triplets and higher multiples) count as one birth.
*** the "abortions" number refers to the total number of induced abortions and miscarriages or ectopic pregnancies.
*The term "GTPAL" is used when the TPAL is prefixed with gravidity, and "GTPALM" when GTPAL is followed by number of multiple pregnancies*

What is GPA??

Gravida/para/abortus (GPA), or sometimes just gravida/para (GP), is a shorthand notation for a woman's obstetric history.
Gravida indicates the has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this count.
Para indicates the number of viable (>20 wks) births. Pregnancies consisting of multiples, such as twins or triplets, count as ONE birth for the purpose of this notation.
Abortus is the number of pregnancies that were lost for any reason, including induced abortions or miscarriages. The abortus term is sometimes dropped when no pregnancies have been lost.

a woman who has had two pregnancies (both of which resulted in live births) would be noted as??

G2P2

The obstetrical history of a woman who has had four pregnancies, one of which was miscarried, would be noted as

G4P3A1

That of a woman who has had one pregnancy of twins with successful outcomes would be noted as

G1P1.

a pregnant woman who carried one pregnancy to term with a surviving infant; carried one pregnancy to 35 weeks with surviving twins; carried one pregnancy to 9 weeks as an ectopic (tubal) pregnancy; and has 3 living children would have a TPAL annotation of?

T1, P1, A1, L3 or This could also be written as 1-1-1-3.

under what conditions are contraceptives absolutely !!contraindicated !!

Abnormal uterine bleeding with an undiagnosed cause

Diabetes mellitus (or other disorders) with vascular complications

History of estrogen-dependent cancer, coronary artery disease, hepatic adenoma, idiopathic recurrent jaundice of pregnancy, stroke, thromboembolism, deep venous thrombosis, MI, or active SLE (because risk of cardiovascular sequelae is increased)

Hypertension if uncontrolled

Immobilization of a lower extremity if prolonged

Liver disorders if active

Major surgery for 1 month after (and 1 month before if elective)

Pregnancy

Renal insufficiency

Smoking after age 35

Triglyceride levels > 250 mg/dL
From Merk manual of medicine

under what conditions are OCP's are Relatively Contraindicated

Amenorrhea with an undiagnosed cause

Cigarette smoking if heavy in women < 35

Depression

Diabetes (treated)

Family history of blood clots

Fibroids

History of liver disorders with recovery

Hypertension (treated)

Migraines with neurologic symptoms

Obesity

Precancerous cervical lesions (treated)

Premenstrual syndrome

Seizure disorder (drug-treated)

Varicose veins
From Merk manual of medicine

Some Risks of Combination Oral Contraceptives

Benign hepatic adenomas (rare; dose- and duration-related)

Cervical cancer (when OCs are taken > 5 yr)

Deep vein thrombophlebitis (dose-related)

Insulin resistance (related to the progestin dose)

Melasma

Stroke (possibly) in women who take high-dose OCs and have other stroke risk factors
From Merk manual of medicine

Some Risks and Benefits of Combination Oral Contraceptives

Abnormal uterine bleeding

Benign breast disorders

Benign ovarian tumors

Dysmenorrhea

Ectopic pregnancy

Endometrial cancer

Functional ovarian cysts

Iron deficiency anemia

Ovarian cancer

Premenstrual syndrome

Salpingitis
From Merk manual of medicine

No Risks and/or Benefits of Combination Oral Contraceptives are

Breast cancer

Malignant melanoma

Thyroid function
From Merk manual of medicine

Drug interactions of OCP's

Although OCs can slow the metabolism of certain drugs (eg, meperidine), the effects are not clinically important.

Some drugs (eg, cyclophosphamide, rifampin) can induce liver enzymes that accelerate transformation of OCs to less biologically active metabolites; women who take these drugs should not be given OCs concurrently. Whether certain antibiotics (eg, penicillin, ampicillin, sulfonamides) and anticonvulsants (eg, carbamazepine, phenytoin, phenobarbital, primidone, topiramate ) reduce the effectiveness of OCs is less clear. If therapeutic doses of antibiotics are prescribed, using a barrier method in addition to OCs may be prudent. Women who take anticonvulsants should use a 50-μg estrogen formulation because a lower dose often causes breakthrough bleeding.

in a rape victim what is the 1st thing to do

Provide a safe environment for the victim
then..
accept the reaction of the victim and provide emotional support
MAKE SURE TO GET all EVIDENCE From the victim..
ie: secretions

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