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OB Module Outcomes Remediation

Terms in this set (56)

External Organs
a) Mons Pubis
- Elevated, rounded, fleshy prominence of fatty tissue that overlay the symphysis pubis;
covered with coarse pubuc hair afte puberty
- Fxn: Protects the symphysis pubis during sexual intercourse
b) Labia majora
- Large and fleshy, has sweat and sebaceous glands; covered with hair after puberty
- Fxn: to protect the vaginal opening and provide cushioning during sexual activity
c) Labia minor
- Delicate, hairless folds of skin; lay inside the labia majora and surround opening to
urethra and vagina; extend upward to protect clitoris and urethra; highly vascular and
high nerve supply
- Fxn: lubricate the vulva, swell when stimulated, highly sensitive
d) Clitoris and prepuce
- Clitoris: small mass of erectile tissue and nerves; highly sensitive and parallel to head of
penis
- Fxn: purely erogenous
- Prepuce: hood-like covering above clitoris of connective tissue of vulva in anterior
junction of labia minora
e) Vestibule
- Oval area closed by labia minora; opening into vestibule are urethra, vagina, and 2 sets of
glands
f) Perineum
- Most posterior part of external female reproductive organs; between vulva and anus

Internal Organs
a) Vagina
- In front of rectum and behind bladder; tubular, fibromuscular organ lined with mucous
membrane that lies in a series of transverse folds (rugae)- allows for extreme dilation of
canal during birth and labor; connects external to cervix; receives penis and sperm and
passageway for menstrual blood and fetus
b) Uterus
- Inverted, pear-shaped, muscular organ at top of vagina; behind bladder and in front of
retcum; site of mensturation, receiving fertilized ovum, development of fetus and
contraction to help fetus and placenta out
- Cervix: lower part of uterus; opening to vagina; has channel that allows sperm to enter
and menstrual discharge to exit; stretches during labor
- Corpus: main body of uterus
c) Fallopian Tubes
- Hollow, cylindrical structure that goes from uterus to ovaries; allows passage of egg to
uterus
d) Ovaries
- Set of paired glands that are the organs of gamete production in females
Menstruation: the normal physiologic where inner lining of uterus if shed by body; monthly; at average starts at 12.8 yrs with range 8-18
- thelarche (development of breast buds), adrenarche (appearance of pubic and then axillary hair, followed by growth spurt) to menarche which occurs 2 years after the start of breast development.

Menstrual Cycle Hormones
- Gonadotropin-releasing hormone (GnRD): secreted from hypothalamus throughout reproductive cycle; pulsates slowly during the follicular phase and increases during the luteal phase; includes release of FSH/LH to help with ovulation
- Follicle-Stimulating Hormone (FSH): secreted by anterior pituitary and is responsible for
maturation of ovarian follicle; highest and most important during the first week of follicular phase
of reproductive cycle
- Luteinizing hormone (LH): secreted by anterior pituitary; required for both final maturation of
preovulatory follicles and luteinization of ruptured follicle, results in decline in estrogen and
continued progesterone
- Estrogen: secreted by ovaries and crucial for development and maturation of follicle; end of
proliferation phase; drops after ovulation; causes uterus to increase in size and weight
- Progesterone: secreted by corpus luteum; increase just before ovulation and peak 5-7 days after; increases swelling and increased secretion of endometrium during luteal phase; reduces uterine
contractions
- Prostaglandins: primary in body's inflammatory process and for normal fxn of female
reproductive system; increase during follicular maturation & key role in ovulation by freeing
ovum; large amounts found in menstrual blood and endometrial fluid
Amenorrhea
- The absence of menses (normal in prepubertal, pregnant, postpartum and postmenopausal
women)
- Primary:
(1) Absences of menses by age 14 with absence of growth and development of secondary sex
characteristics
(a) Intervention: Correction of underlying disorder, estrogen replacement therapy to
stimulate development of secondary sex characteristics
(2) Absence of menses by age 16 with normal development of secondary sexual
characteristics
(a) Intervention: Oral contraceptives, nutrition counseling, gonadotropin-releasing
hormone (GnRH), thyroid hormone replacement
- Secondary
(1) pregnancy/breastfeeding, emotional stress/depression/antidepressants,
pituitary/ovarian/adrenal tumors, hyper/hypothyroidism, malnutrition, rapid weight
gain/loss, chemo/radiation, early menopause, colitis, kidney failure, Sheehan syndrome
- Diagnostic tests: ultrasound, hCG, thyroid fnx test, prolactin level, FSH & LH, 17-ketosteroids
(elevated could mean adrenal tumor), Karyotype (for Turner syndrome)

Dysmenorrhea
- Painful menstruation (cyclic perimenstrual pain)
- Secondary: caused by painful pelvic or uterine patho
- Tests: Blood count, urinalysis, preg test, cervical culture (for STI), Erythrocyte sedimentation
rate, stool guaiac test, pelvic/vaginal ultrasound, laparoscopy/laparotomy
Interventions: NSAIDS, hormonal contraceptives, Selective estrogen receptor modulators
(SERMs), Complementary therapies (Vit B & E, Magnesium, Omega-3), Lifestyle changes
(exercise, limit salt, weight loss, no smoking, relaxation techniques)

Endometriosis
- Most common cause of secondary dysmenorrhea
(1) Associated with pain beyond menstruation, dysmenorrhea, dyspareunia, low back pain,
heavy/irregular bleeding, bloating, n/v, infertility
- Treatment: remove underlying cause
- Intervention: surgical intervention, NSAIDS, oral contraceptives, progesterone, Antiestrogens,
GnRH-a

Infertility
- The inability to conceive a child after 1 yr of regular sexual-intercourse unprotected by
contraception
- Treatment: fertility drugs, surrogacy, donor oocytes or sperm, in vitro fertilization
- Lab tests: home ovulation predictor kits, clomiphene citrate challenge test,
hysterosalpingography, laparoscopy

Premenstrual Syndrome
- A constellation of recurrent symptoms that occur during the luteal phase or half last of the
menstrual cycle and resolve with the onset of menstruation
- Symptoms: anxiety, craving, depression, hydration, hot flashes or cold sweats, nausea, change in
bowel habits, aches/pains, dysmenorrhea, acne breakouts
- Interventions: CAM

Menopause
- Natural process that occurs as part of normal aging
(1) When menses and fertility cease
- Symptoms:
(1) Brain: hot flashes, disturbed sleep, mood and memory problems
(2) Cardio: lower levels of HDL and increased risk of CVD
(3) Skeletal: rapid loss of bone density that increase risk of osteoporosis
(4) Breast: replacement of duct and glandular tissue by fat
(5) GU: vaginal dryness, stress incontinence, cystitis
(6) GI: less absorption of calcium from food, increasing fracture risk
(7) Integumentary: dry, thick skin and decreased collagen
(8) Body shape: more ab fat; waist swells relative to hips
Pre-stage:
- fertilization takes place in ampulla of the fallopian tube
- union of sperm and ovum forms a zygote
- cleavage cell division continues to form a morula
- inner cell mass is called blastocyst, which forms the embryo and amnion
- outer cell mass is called trophoblast, which forms the placenta and chorion
- implantation occurs 7 to 10 days after conception in the endometrium

Embryonic Period: begins at 15 days to 8th week
- Differentiation of cells and rapid growth
- Rudimentary body part formed
- Heart has 4 chambers and begins beating
- Beginning of all major body parts
- External genitalia present but not on ultrasound
- Some jerky limb movements

Fetal period: 9th week to birth
- 9-12 wks​:eyelids fused; teeth and bones begin to appear; kidneys begin to fxn; digestive system
shows some activity; gender there but not able to view
- 13-16 wks: ​much spontaneous fetal movement; rapid skeletal development; sucking motion made
by mouth; lanugo (fine hair) appears over body; Quickening
- 17-20 wks: ​fetal heart tones can be heard with stethoscope; skeleton begins to harden; rapid brain
growth; vernix caseosa appears
- 21-24 wks​: mini baby in appearance; extra uterine life possible (surfactant); skin is red,
translucent; responds to external sounds (moro); very active
- 25-28 wks: ​eyelids are no longer fused; testes begin to decent for males; head-down position; SC
fat deposits under skin more rapidly
- 29-32 wks: ​fat and minerals storage increases; skin loses reddish color; exhibits good reflex
development; rhythmic breathing movements
- 33-40 wks: ​fetal body begins to round out; fetus completely fills uterus; ear cartilage firm on both
ears; lanugo and vernix caesora disappears; high absorption of maternal hormones; ready for birth
38-41 wks
Uterus- 2 oz to 2lbs at term
- Increase in size due to hypertrophy of myometrium cells under estrogen influence
- ⅙ total maternal BV is contained w/in vascular system of uterus by term

Cervix
- Estrogen causes the cervix to become congested with blood (hyperemic) resulting in bluish color
that extends into vagina (Chadwick's Sign)
- Increase vascularity causes cervix to soften (Goodell's sign)
- Increase mucus forms mucus plug to seal off from outside bacteria

Ovaries
- Cease ovum production during preg
- Corpus luteum persists till 12 wks to secrete progesterone until placenta takes over

Vagina
- Increased vascularity and hyperplasia
- Increased vaginal secretions and decrease in pH to prevent infections

Breasts
- Increase in size & nodularity to prep for lactation
- Nipples increase in size, become more erect and more pigmented
- Colostrum- an antibody-rich, yellow fluid can be expressed after the 12th wk; converts to mature
milk after delivery

Resp
- O2 consumption increases by 20-40%
- Tidal volume increased by 40%
- By 3rd trimester, diaphragm is lifted by 4 cm which prevents lungs from expanding fully
- Breathing becomes thoracic rather then abdominal

Cardio
- 50% increase in BV which peaks at 7th month of preg
- 30% increases in total RBC (mostly plasma) which causes the hemodilution of preg in 2nd
trimester
- WBCs increase throughout gestation

GI
- Reflux of gastric contents common due to relaxation of smooth muscle by progesterone
- Ptyalism: excessive salivation
- Constipation
- n/v (morning sickness) is high due to hCG levels from 6-12 wks

Renal
- 50% increase in GFR
- Kidneys and ureter dilate due to high progesterone levels
- Glycosuria is common due to kidneys inability to absorb all the glucose filter by the glomeruli;
increase UTI risk

Integumentary
- Increase in sweat and sebaceous glands = perspiration and acne
- hyperpigmentation - melasma or mask of preg darkens forehead, cheek, nose
- Linea nigra- dark line of pigmentation from umbilicus to the symphysis pubis
- Striae (stretch marks)

Metabolism
- BMR increase to support the additional demands of the growing fetus
- 25-35 lbs is the average weight gain
- Increase in water retention of 7L by term
Stage 1 = true labor through complete cervical dilation (10 cm)
Latent phase = mild contractions, dilation 0-3cm, 0-40% effaced
- very beginning of labor
- the mother is usually at home trying to decide "is this the real deal or not??"
- upright position
Active phase = progressive fetal descent, dilation 4-7cm, 40-80% effaced
- this stage is intense and the woman knowns she's in labor; usually arrives at the hospital during the active phase
Transition phase = increase in fetal descent; dilation 8-10cm, 80-100% effaced
- significant anxiety, restless, irritable, 'can't take anymore'
- contractions 1-2 min. apart
- strong intensity & lasting 60-90 sec
- usually breaks down & asks for an epidural even if the plan was a natural childbirth

Maternal behaviors during transition phase:
Anxiety
Restlessness
Irritability
"Can't take it anymore"
N/V
Backache
Overwhelmed
Diaphoresis

Comfort measures:
-straddling w/ forward leaning over a chair
-walking w/ partner support
-rocking back & forth w/ foot on chair

Stage 2 (pushing stage) = cervix is 10cm dilated and ends w/ birth of infant
- usually < 1hr
- urge to push during this stage
- crowning occurs when fatal head bulges at the vaginal opening & birth is imminent

Stage 3 = birth of infant to placental separation
- 5 min
- shortest stage of labor

Stage 4 = 1-4 hrs after delivery when physiological readjustment of the mother's body takes place
- usually in the LDR room
- uterus remains contracted & in the midline
- bladder may be hypotonic
- vital taken every 15 minutes: bradycardic pulse
- lochia rubra: moderate amount
- emotional state: excited, fatigued, or quiet
Breasts
Uterus
Bladder
Bowels
Lochia
Episiotomy/Laceration
Extremities
Emotional Status

Postpartum: Breasts
-have pt lie flat on the bed
-palpate both breasts for engorgement
-inspect nipples for cracks, fissures
-educate pt about wearing a supportive bra 24hr daily (new research supports not bra-more milk)
-expose nipples to air after breastfeeding
-apply lanolin to nipples to keep soft [does not hurt the baby]

Postpartum: Uterus
-have pt lie flat on the bed
-locate uterus using both hands (one symphysis pubis & one on umbilicus)
-uterus should be in the midline & firm (should feel like a grapefruit)
-should be located near the umbilicus
-usually involutes approximately 1cm/day
-massage fundus, if found boggy
-assess for full bladder if displaced to right/left

Postpartum: Bladder
-tremendous diuresis after delivery & should void >200mL each voiding
-ask pt of she feels she is emptying her bladder each time she voids [a full bladder can displace the uterus to the right/left causing a postpartum hemorrhage]
-palpate bladder to determine residual
-2500mL of fluids daily is recommended--need fluid to make milk

Postpartum: Bowels
-during labor: peristalses ceases
-usually is 24hr post delivery before the client's first BM
-progressive exercise, fluids, fiber & comfort measures are needed to promote good bowel elimination
-hemorrhoids/perineal laceration (check for hemorrhoids while assessing episiotomy)

Postpartum: Lochia
-assess color, amount & odor of lochia
-usually has a 'fleshy' smell; if odor is different mom could have an infection
-Lochia rubra
-Lochia serosa

Postpartum: Episiotomy/laceration
-turn pt to either side to examine area
-have adequate lightening to visualize area
-separate buttocks to expose perineum
-inspect for REEDA
-severe intractable episiotomy pain = hematoma
Newborn: bathing
-undress newborn down to shirt & diaper
-always support the head & neck when moving/positioning him/her
-wipe eyes with plain water, using either cotton balls or a washcloth. Wipe inner corner of eyes to outer.
-wash the rest of the face, then using baby shampoo, wash the hair and rinse with water.
-wash extremities, trunk, and back. Wash rinse, dry, cover.
-wash diaper area LAST.
-put on clean diaper and clean clothes after bath.

Newborn: meds
vitamin K + erythromycin

Newborn: thermoregulation
-pre-warm blankets & infant caps
-keep isolette charged & warmed
-dry newborn completely at birth
-encourage skin-to-skin contact w/mother
-defer bathing until temperature is stable
-promote early breastfeeding to provide fuel

Newborn: Feeding/Nutrition
-Breast feeding
-Formula feeding

Newborn: Cord Care
-let it fall off on its own
-do not try to pull off
-do not give submerged bath until it falls off

General Newborn Safety
-have emergency telephone numbers readily available (emergency medical assistance & poison control center)
-keep small/sharp objects out of reach to prevent them from being aspirated
-put safety plugs in wall sockets within the child's reach to prevent electrocution
-do not leave the infant alone in any room without a portable intercom on
-always supervise the newborn in the tub: a newborn can drown in 2 inches of water
-make sure the crib/changing table is sturdy, without any loose hardware, & is painted w/lead-free paint
-avoid placing the crib/changing table near blinds or curtain cords
-provide a smoke-free environment for all infants
-place all infants on their backs to sleep to prevent SIDS
-to prevent falls, do not leave the newborn alone on any elevated surface
-use sun shields on strollers & hats to avoid overexposing the newborn to the sun
-to prevent infection, thoroughly wash your hands before preparing formula
-thoroughly investigate any infant care facility before using it
Abstinence: refrain from sexual activity. The only sure way to prevent pregnancy or STIs.

Barrier Methods: include male and female condoms. Watch out for latex and spermicidal allergies with barrier method.

Patch: Transdermal patch that releases estrogen and progesterone. Looks like a bandaid and gets dirty over time. Apply every week for 3 weeks then leave off for a week. (Period week) Never apply patch to breast tissue.

Oral Contraceptives: Most popular method of birth control. Low estrogen pills how fewer SE. Overweight women may need higher doses. Use backup method if on antibiotics. Modest risk for blood clots and PE. Increased risk for MI and stroke. Slight increase risk for breast cancer. Use a back up method if not starting the pack on the first day of the menstrual cycle.

Nuva Ring: Vaginal contraceptive ring about 2 inches in diameter that is inserted into the vagina; released estrogen and progesterone. Used when oral contraceptive makes pt. nauseated. Stays in for 3 weeks, removed the 4th week. It can be taken out or up to 3 hours without a back up method. (most often for sex)

Intrauterine Contraceptives: T-shaped device inserted into the uterus that releases copper or progesterone or levonorgestrel. The pt may bleed and cramp with each of the IUCs, the hormonal methods do better at stopping the menstrual period. (Mirena, Skyla, copper) Mirena- good for 5 years. For women who already have children.
Skyla- good for 3 years. For women who have not yet had children. Copper- good for 10 years. Non hormonal.

Depo Provera: An injectable progestin that inhibits ovulation. Be careful in teenagers because it can cause bone loss. Most prevalent of causing weight gain. Shouldn't be prescribed to women who are struggling with their weight. Return visit every 12 weeks.
Chlamydia: Azithromycin (Zithromax), Doxycycline (Vibramycin), Erythromycin (EES), Levofloxacin Ofloxacin (Floxin),. Sexual partners need evaluation, testing, and treatment also. Abstinence form sexual activity until therapy is complete and symptoms no longer present. Retesting in 3 months to rule recurrence.

Gonorrhea: Dual therapy with Ceftriaxone and azithromycin. Sexual partners need evaluation, testing, and treatment also. Abstinence form sexual activity until therapy is complete and symptoms no longer present. Retesting in 3 months to rule recurrence

Herpes type 2: Antivirals used to treat first episode, recurrence and suppression. Acyclovir, valacyclovir, and famiciclovir mainstay in treatment. Does not cure; just controls symptoms. Counseling is important to help adolescent cope and prevent transmission. Sexual partners benefit from counseling. If symptomatic, need treatment.

Syphilis: Benzathine penicillin G injection (if PNC allergy, doxycycline, tetracycline, or erythromycin) Sexual partners need evaluation and testing.

Trichomoniasis: Metronidazole (Flagyl) or tinidazole. Sexual partners need eval, testing, and treatment also. Abstinence commended until therapy completed.

Vereneal warts: Treatment is aimed at removing lesions rather than HPV itself. No optimal treatment has been identified, but there are several ways depending on size and location. Most methods rely on chemical/physical destruction. Freezing, burning, laser treatment, surgical excision. Imiquimod cream.
Pelvic Organ prolapse (from the Latin prolapses, "a slipping forth")- abnormal descent of herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis.
- Structures of the pelvis shift and protrude into or outside of the vaginal canal.

Types of POP:
1. Cystocele-occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall
2. Rectocele- occurs when the rectum sags and pushes against or into the posterior vaginal wall.
3. Enterocele- occurs when the small intestine bulges thought the posterior vaginal wall (especially common when
straining).
4. Uterine prolapse- occurs when the uterus descends through the pelvic floor and into the vaginal canal.
(multiparous women are at particular risk for uterine prolapse)

Etiology of pelvic organ prolapse- dysfunction of levator ani muscle complex and the connective tissue attachments of the pelvic organ fascia (which provide anatomic support)
- Constant downward gravity because of erect human posture
- Atrophy of supporting tissues with aging and decline of estrogen levels
- Weakening of pelvic floor support related to childbirth trauma
- Reproductive surgery
- Family history of POP
- Young age at first birth
- Connective tissue disorders
- Infant birth of more than 4,500 g
- Pelvic radiation
- Increased abdominal pressure secondary to:
- Lifting of children or heavy objects
- Straining due to chronic constipation
- Respiratory problems or chronic coughing
- Obesity

Management of Pelvic Organ Prolapse:
- Kegel exercises
- Hormone replacement therapy
- Dietary and lifestyle modifications
- Pessaries
- Colpexin Sphere
- Surgical Interventions

Nursing Interventions of Pelvic Organ Prolapse:
- Encourage pelvic floor muscle training
- Encourage dietary and lifestyle modifications
- Provide teaching for pessary use must be taken out and cleaned at least every 1-2 weeks!!!
- Promote prevention strategies

Urinary (and fecal) Incontinence- involuntary loss of urine that represents a hygienic or social problem to the individual
- Embarrassment and depression are common
- May decrease social interactions, excursions out of the home, and sexual activity
- More common than diabetes and Alzheimer's disease

Etiology of Urinary Incontinence
- Fluid intake, especially alcohol, carbonated drinks, and caffeinated beverages
- Constipations: alters the position of the pelvic organs and puts pressure on the bladder
- Habitual "preventative" emptying: may result in training the bladder to hold only small amounts of urine
- Menopause and depletion of estrogen
- Chronic disease such as stroke, multiple sclerosis, or diabetes
- Smoking: Nicotine increases detrusor muscle contractions
- Advancing age: age-related anatomic changes provide less pelvic support
- Pregnancy and childbirth: damage to pelvic structures during childbirth
- Obesity: increases abdominal pressure

Management of Urinary Incontinence
- Avoid drinking too much fluid (i.e. 1.5 L total daily limit), but do not decrease your intake of fluids
- Reduce intake of fluids and foods that are bladder irritants and precipitate urgency, such as chocolate, caffeine, sodas, alcohol, artificial sweetener, hot spicy foods, orange juice, tomatoes, and watermelon.
- Increase fiber and fluids in diet to reduce constipation
- Control blood glucose levels to prevent polyuria
- Treat chronic cough
- Remove any barriers that delay you from reaching the toilet
- Practice good perineal hygiene by using mild soap and water. Wipe from front to back to prevent urinary tract infections
- Become aware of adverse drug effects
- Take your meds as prescribed
- Continue to do pelvic floor (kegel) exercises

Nursing Interventions of Urinary Incontinence:
- Encourage women to seek help with troublesome symptoms
- Discuss treatment options with patient
- Provide education about good bladder habits and strategies to reduce the incidence or severity of incontinence
- Provide support and encouragement to ensure compliance
- Review the anatomy and physiology of urinary system and offer simple explanations to help woman cope
with urinary alterations
- Therapeutic listening is important
- Be aware of the courage it takes for a woman to disclose an embarrassing condition
Uterine polyps
- small, usually benign growths
- cause of polyp is not well understood, but they are frequently the result of infection
- most commonly occur in multiparous women
- can appear anywhere but mostly occur on the cervix and uterus

Nursing management of Uterine Polyps: explain condition and rationale for removal and give follow up care instructions (nurse also assists HCP with removal procedure)

Uterine fibroids (aka Leiomyomas)
- benign tumors composed of smooth muscle and fibrous connective tissue in the uterus
- asymptomatic so most women do not know they have them
- usually grow slowly and cells do not typically break away and invade other parts of the body
- peak incidence occurs around age 45; 3 times more prevalent in African American women than
Caucasian women
- MOST COMMON INDICATION FOR HYSTERECTOMY IN U.S.

Nursing management of Uterine fibroids: explain any current treatment options and the implications of a diagnosis of fibroids. Explain meds, SE, and why meds should only be taken for a limited duration of time. If surgery is selected, verbal and written info about it and aftercare should be addressed

Genital fistulas:
- abnormal openings between a genital tract organ and another organ such as the urinary tract or the
gastrointestinal tract
- can result from a congenital anomaly, surgical complications, Bartholin's gland abscesses, radiation, malignancy, but most are related to obstetric trauma and female genital cutting

Nursing Management of Genital fistulas: provide guidance and support. Offer info to help learn about condition and how appropriate intervention could improve her quality of life. Ensure the woman understands female anatomy and why she is having the symptoms she is having. Provide a thorough explanation of each treatment option so she can make an informed decision. Be sensitive about the woman's shame and fear which
could be the reason she delayed seeking care. Address all needs (physical and emotional)

Bartholin cysts
- Swollen, fluid-filled, sac-like structure that results when one of the ducts of the Bartholin's gland becomes blocks
- Most common cystic growths in the vulva

Nursing management
- Be knowledgeable about vulvar cysts and treatment options. The woman may be aware of a vulvar cyst secondary to pain or may be unaware of it if is asymptomatic. A Bartholin's cyst may be an incidental finding during a routine pelvic examination. Explain cause of cyst and assist with cultures if needed. Provide reassurance and support for patient.

Ovarian cysts:
- fluid-filled sac that forms on the ovary
- very common growths which are benign 90% of the time
- asymptomatic in many women
- when cysts grow large and exert pressure on surrounding structures, women often seek medical health

Nursing management: include education about condition, treatment options, and diagnostic test arrangements, and referral surgery if needed.

Provide support and reassurance during diagnostic period. Listen to concerns
about her appearance, infertility, and facial hair growth (hiritism). Encourage patient to make positive lifestyle changes and also educated her on associated risk factors to prevent long-term health problems. Make community referrals to local support groups to help the woman build her coping skills.
Myths
- Battering of women occurs only in lower
socioeconomic classes
- Substance abuse causes the violence
- Men have the right to discipline their partners.
Battering is not a crime
- Violence occurs to only a small percentage of
women
- IPV is a typically a one time, isolated
occurrence
- Women can easily choose to leave an abusive
relationship
- Only men with mental health problems commit
violence against women
- Pregnant women are protected from abuse by
their partners
- Women provoke their partners to abuse them
- Violent tendencies have gone on for
generations & are accepted
- IPV is only a heterosexual issue

Facts
- Violence occurs in all socioeconomic classes
- Violence is a learned behavior and can be changed. The presence of drugs &
alcohol can make a bad problem worse.
- In the past, our patriarchal legal system afforded men the right to physically chastise
their wives & children; we no longer live under that system. Women & kids are no
longer considered the property of men, violence is against them is a crime in every
state.
- One in 4 women will be victims of violence
- Battering is a pattern of coercion & control that one person exerts over another. It is
repeated using a number of tactics, including, intimidation, threats, physical injury,
economic deprivation, isolation, & sexual abuse
- Women stay in the abusive relationship because they feel they have no other option
- Abusers often seem normal & do not appear to suffer from personality disorders or
other forms of mental illness
- 1 in 5 women is physically abused during pregnancy. The effects of violence on
infant outcomes can include preterm delivery, fetal distress, low birth weight, & child
abuse
- Women may be willing to blame themselves for someone else's bad behavior, but
nobody deserves to be beaten
- The police, justice system, & society are being to make IPV socially unacceptable
- There is much IPV in the lesbian/gay/bi/transgender, population as in heterosexual relations with the added psychological abuse of "outing" (when one partner
threatens to disclose the others sexual preference in an effort to maintain power and
control)