Ovulation, and hormone production ( estrogen, progesterone, and androgen)
What is the uterus responsible for?
Houses fertilized ovum and fetus. It is the organ for reception, implantation, rentention, and nutrition of the fertlized ovum. Also for cyclic menstruation
What is the myometrium and what is it suited for?
It is smooth muscle that goes in three directions. It assists in the birthing process by expelling the fetus, ligating blood vessels after birth, and controlling the opening of the cervical os.
Increases vascularity of breast tissue
-comes from the pituitary gland. It is induced by emptying of the breast, crying and the baby suckling.
causes maturation of mammary gland tissue
What teaching info is important regarding breast self exams (BSE)?
Perform 5-7 days after menses, because changes are minimal at this time. If the woman has discharge from her nipples always call the doctor (unless she just had a baby, duh :) )
What info regarding menstruation should be taught to a group of 10 year old girls?
It is normal for one breast to grow faster/bigger/smaller than the other. Also teach info about breast self exam
Where are hormones such as prostaglandins produced?
In most organs and menstrual blood. Prostaglandins cause smooth muscle contractions and changes in the cervix. Prostaglandin meds are given to ripen the cervix.
Four phases of sexual response?
excitement, pleateu, orgasmic, and resolution
How is the physiologic response analyzed?
2 phases. 1) Vasocongestion- In genitals, vaginal lube and engorgement of the genitals. 2) Mytonia- characterized by increased muscle tension.
What is a physiological sexual response?
A feedback mechanism from the anterior pituitary, hypothalmus, and ovaries. Men and women are more alike than different in physiologic response to excitement and orgasm.
How would the nurse start the sexual health history interview?
Smile, ask patient if they have any concerns, ask questions in a relaxed manner, and make the pt comfortable. Use reflection and empathy when listening to ensure caring and open communication
How can a nurse show cultural competence and sensitivity?
Allow for the patient to wear thier undergarments during the exam.
How can a nurse teach about the importance of annual examinations to a 62 year old woman?
Use a respectful and reassuring approach in women greater than 50, and they will continue to seek healthcare. Allow longer exam/appointment time to give them more time to talk.
Last menstruation period. Can occur as early as 35 years of age. Must have no menstruation periods for one full year. Average age 51.4
Ovarian function and hormone production declines
1st menstruation. Normal age 8-15 years of age
Broad term that is the transitional stage between childhood and sexual maturity
What is important teaching when a client reports finding a lump in her breast?
(During Game)- Tell the patient to come in and make sure the lump is benign.
What is the function of the bony pelvis?
protection of the pelvic structures, accomodation of the fetus, and anchorage of pelvic support.
Average menstrual length?
28 days, although variations are normal.
Variations of the ovarian cycle are due to?
changes in the follicular length
What is the function of the hypothalmic- pituitary cycle?
cyclic release of hormones
Proliferation phase of menstrual cycle?
The phase of rapid growth
Secretory phase of menstrual cycle?
AKA luteal phase! It is the time that is best for fertilization when the endometrium is full and thick.
Ischemic phase of menstrual cycle?
The blood supply is blocked. Necrosis and then menstruation occurs
What is the nurses part in the gynecologic portion of the phyisical exam?
Talk to the patient about promotion, self care, and enhancing wellness. ( wipe front to back, no bubble baths in young girls, etc)
PAP smear (Papanicolaou test)
Microscopic exam performed annually for sexually active people. Used to detect cancer/disease. Educate the patient before they come not to douche, use creams, or have sexual intercourse 24-48 hours before the test. It is also very important for the nurse to teach breathing relaxation techniques to patient during the PAP
What are some causes of amenorrhea?
Menopause, stress, STRENOUS (not moderate) excercise. Most common reason= pregnancy. Autonomic reasons= DM type 1, and hysterectomys.
What are some non pharmacologic interventions for dysmenorrhea?
Heating pad causes vasodilation and minimizes uterine ischemia and promotes muscle relaxation. Excercise, a decrease in red meat in the diet, and an increase in diuretics (asparagus, cranberry juice, peaches, parsley, and watermelon) has also been found to help
S/S of PMS?
Mood swings, cramping, bloating, lower abdominal pain, headache, and nausea. The cause is unknown.
Endometreosis signs and symptoms
Severe abdominal and pelvic pain, pain during intercourse, and difficulty getting pregnant . Lesions on the gallbladder, thoracic cavity, and the heart are also found.
What meds are used for the tx for mild to severe endometreosis?
Nafarelin- 200 mg BID per nasal spray. The side effects are similar to menopause
Statistics for endometreosis?
Equally prevalent in caucasian and african american women, but slightly more prevalent in asian american women.
Excessive bleeding (excessive in duration or amount)
Benign tumors of the smooth muscle of the uterus. Cause is unknown. 25 % of women of reproductive age have these. The fibroids are estrogen sensitive and they shrink as estrogen declines (after menopause).
Bleeding in between periods. Caused by increase of progestin, implants, or injections
What is important to known about dysmenorrhea?
Most common in ages 17-24. The pain can move into the lower back. Smoking and obesity increases dysmenorrhea. Signs and symptoms being with menstruation or a couple hours before flow begins
What is DUB?
dysfunctional uterine bleeding. Occurs when menstral cycle is being established or draws to a close at menopause. It is diagnosed when all other causes of bleeding are ruled out. Treatment is oral/iv estrogen
What is the pharmalogical therapy for pain relief in a patient with primary dysmenorrea?
NSAIDS, 800 mg ibuprofen
What are the risk factors for STI's?
(Game) nurse needs to teach way to enhance the use of condoms. Some men need time to think about condom use if the man is reluctant, the woman may want to reconsider the relationship?
What VIRAL STI affects most people in the USA today
What bacterial ATI affects most people in the US?
Chlaymidia. It is fast spreading with 3 million new cases each year.
S/S of chylamidia?
Vaginal spotting, vulvar itching and watery discharge
Diagnosis of chylamidia
Culture that is intensive and costly. Women with 2 or more risk factors should be tested. Also all pregnant women should be tested during first prenatal visit and 3 weeks later after meds (if positive)
What does the CDC recommend for the tx of HPV?
Prevention/ Abstinence. and the vaccine (Gardasil)
Tx of chylamidia?
Doxicylcline unless pregnant. If woman is pregnant she is treated with azythromycin, amoxicillan and erthyromycin.
What increases the risk for getting a yeast infection (vaginal candiasis)?
antibiotics, DM, pregnancy, obesity, and contraceptives
S/S of vaginal candiasis?
itching, burning, vulvar redness, and thick white lumpy discharge that resembles cottage cheese
Tx for vaginal candiasis?
gluconazole, metronidazole, and clotrimazole (sp?)
What is used to detect HIV?
enzyme aminoassay antibodies
What care should be taken on laboring woman with HIV?
NO vaccuum forceps, internal fetal monitors, episiotomy, or amniocenesis=because these all increase the risk of blood to blood contact. Also the infant should have no injections till after the first bath
How long can HIV take to sh?ow up on a lab test
S/S of genital herpes
multiple painful lesions, chills, fever, general maliase, and severe dysuria
Herpes simplex 1?
If a woman gets infected with a herpes virus during the first trimester of pregnancy what is likely to occur?
usually last 2-3 weeks, and usually the first outbreak is the very worst
TX of herpes?
S/s of PID?
(pelvic inflammatory disease) S/S= infertility and chronic pelvic pain
The best intervention for PID?
What is the most frequent, non reportable serious infection encoutered by women?
Women who suffer from PID are seven times more likely to encouter?
Tx of PID
bed rest, in semifowlers position, broad spectrum antibiotics and women with PID should avoid unessacery pelvic exams
S/S of vaginosis?
fishy odor, profuse thin and white-grey discharge. Mild vulvar irritation and pruritis
TX of vaginosis
What is the oldest of all the reportable communicable diseases?
S/S of gonarrhea
Women can be asymptomatic. If not, Yellow/green discharge, low abodominal pain, dysmenorrhea, and reddened vulva and vaginal wall and rectal problems may be present
Prenatal complications of gonnarrhea
preterm birth, ruptured membranes, neonatal and maternal post partum sepsis
If gonarrhea is not treated it can lead to?
PID, heart disease and arthritis
TX of gonarrhea
Rocephin- IM Azythromycin- PO Alfaxin (sp?) - PO
What is the treatment for the prevention of HIV transmission in the fetus during pregnancys?
Pregnancy is not encouraged in women with HIV, because it can be transmitted through breast milk and the placenta
Trasmission has of HIV to the fetus has been decreased by 67 % because of?
Medical management- Zidovudine= bone marrow suppression and decreased incidence of transmission)
Primary- occurs 5-90 days after infection Secondary- occurs 6 wks = 6 months after Tertiary- can occur 3-7 yrs after intial infection, if tertiary is not treated nuero, cardi and muculoskeletal problems occur
Tx of Syphilis?
Penicillin G- given IM
acute febrile reaction that occurs during the tx of SYPHILIS due to toxins being released intTo the bloodstream after the syphilis bacteria die.
What is HPV?
Used to be known as warts. Now known as human papilloma virus. Lesions are a chronic problem. Its very important to inform clients that multiple partners increases the risk of getting HPV. Women with HPV have a greatly increased risk of getting cervical cancer
Prenatal complications of HPV?
Lesions are common during 1st and 3rd trimesters lead to difficulty in fetal decent, dysuria and difficulty pooping
Tx of HPV?
topical Podofilox- 0.5 % solution or gel
Transmitted fecal/oral. Usually comes from shellfish, milk or polluted water. If a pregnant women gets Hep A she is given immunoglobulins or immune specific vaccines, unless she has already had the vaccine
Has a vaccine. but the vaccine is not effective for everyone. Pregnant women can receive the Hep B vaccine with no risk. Screenings are recommended during the first prenatal visit, because Hep B is more contagious than HIV
Has increased in incidence. There is no vaccine. Symptoms vary greatly but may include: delusions and hallucinations due to encephalopathy
Is an incomplete virus and you can't get hep D without having Hep B
Strep B ?
Normal flora when NOT pregnant. But when a pregnant woman has strep B the baby gets meningitis and can die a few weeks later. It has been linked to prolonged rupture of the membranes. Women are tested during prenatal visits
Tx for strep B
Penicllin G or Amphicillin- given IV
Fibrocystic changes in the breast?
palpable thickening associated with pain and tenderness that fluctuates with the mentrual cycle
Statistics of fibrocystic changes in the breast?
70 % are non proliferative, 26% are increased without atipia, and the rest are with atypical hyperplasia
TX of fibrocystic changes in the breast?
diuretics and decrease of sodium and fluid intake. Smoking and alcohol should be avoided and an increase in the intake of vitamin E . Application of heat to the breast, a good bra, and NSAIDS provide relief from pain
Well delineated, palpable and moveable, discrete usually solitary lumps smaller than 3 cm. These increase in size during pregnancy and decrease in size with age
Teaching info regarding breast cancer?
exact cause is unknown. Women find 90 % of lumps themselves and only 20% of these lumps are cancerous. 1 in 8 women will get breast cancer.
Diagnostic test used to confirm breast cancer?
Fine needle aspiration
CA15 is used to detect what in breast cancer?
Serum tumor marker used to to test for residual disease
What is important to tell patients regarding mammograms?
If at increased risk for breast cancer, annual exams should be performed.
What is the name of the test used to detect a slow-growing or fast-growing cancer?
S phase index
What is a common complication of a transverse rectus abdominis myocutaneous (TRAM) flap?
Delayed wound healing and hematoma
Common side effects of Tamoxifen therapy?
Hot flashes, nausea, vomitting, vaginal bleeding (Tamoxifen is a low dose chem agent)
Info. regarding post op care of a mastectomy?
Avoid tight clothing jewlery or bras. Empty surgical drains regularly do not put arms above head and elevate arm above the right atrium
What are characteristics of intraductal papilloma?
only benign breast mast that is non-palpable!
Mammary duct ectasia?
painful, not well deviated mass that is palable and moveable
At what age do fibrocystic changs occurs?
At the age menses begins
Is performed after a hysterosalpingography. It is a surgical procedure and is done EARLY in the menstrual cycle
When is a hormone analysis done and what does it show?
It is performed on women with irregular or absent mentrual cycles. It shows endocrine function of the hypothamic pituitary ovarian access
It is done post menstruation (2-5 days after) to prevent flushing of potentially fertilized eggs into the periotneal cavity. The procedure is done with dye to determine if there is fallopian tube obstruction or blockage. (Nurse needs to ask the patient if they are allergic to shellfish or iodine)
Which test is used to diagnose the basis of infertility is done during the luteal or secretory phase of the mestrual cycle?
Endometrial biopsy (done after biopsy)
How can you help a couple cope with infertility problems?
Let them express and discuss thier feelings. Monitor side effects for infertility drugs. Advise them about the increased possibility of multiple births and inform about reproductive therapies. Also talk to them about support groups.
What herbal remedies are good for infertility?
nettleleaf, dong quai, vitamin E, and calcium and magnesium
Which herbal preparations to avoid while trying to conceive?
liqorice root, yarrow, wormwood, effedera, phenyl, golden seal (for infection), lavender (relaxation), juniper, flax seed (diet purposes) penny royale, passion flower, wildcherry, cascara, sage, thyme, and periwinkle
In vitro fertilization-embryo trans (IVF-ET) what does the procedure entail?
Eggs are collected from the ovaries, fertilized in a lab with sperm, and placed in the uterus after normal embriotic devlelopment. The patient needs to be talked to about freezing the embryos, and what to do in the event of death, divorce or if either partner doesn't want the embryo anymore
How do women and men perceive infertility?
Women place more importance on it than men
takes a long time to get preggo, but it eventually happens
Fertilization should always occur in ?
The fallopian tubes
What are the donor options that are available?
Donor eggs, donor sperm, donor embryos, or surrogant mothers
The egg is insemenated into the woman.
With regard to the assessment of the female, male and couple for infertility nurses should be aware that?
Sperm count varies from day to day and is affected by emotional, phyiscal and and sexual status. A single analysis is not good enough, minimum of two seperate sperm counts at least 2 wks apart. Also the assessment of both male and female are done systematically and simultaneously.
The most effective and only method with no risk of STI's or pregnancy?
A woman has chosen the calendar method of conception control. During the assessment process it is most important the nurse?
Assesses the woman's level of commitment and also the partner's level of commitment. The patient must have regular periods for 6 months prior to using this method. The patient should avoid sex the 14 fertile days.
A woman is using the basal temperature (BBT) method of conception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurses most appropriate response is?
(Temp usually goes DOWN prior to ovulation) Temp changes can occur from stress, fatigue, alochol, sleeping, and regular temp changes. This is a risky form of contraception
what are fertility awareness methods?
Charting of the menstrual cycle. They rely on avoidance during fertile times. Proper vigilence and adherence to colitis intervals about ovulatory times is key. Only women with regular menstrual cycles should use this method.
Why is it better for a male client to purchase condoms that are not lubricated with nonoxynol-9 ( a common spermicide)?
It doesn't protect against HIV and has been linked to an increased risk in HIV and can cause genital lesions.
Billings method....Spinnbarkait sign?
A form of birth control where women stretch thier membranes between thier fingers. if it is thin and flexible they are ovulating
A woman who has a seizure disorder and takes barbituates and phenytion sodium asks the nurse about the pill as a contraceptive choice. What is important to note?
Anticonvulsants decrease effectiveness of birth control
Injectable progestins ( DMPA, Depo-Provera) are a good contraceptive choice for?
are not commited. Only have to take four times per year (every 3 months). Increased risks for venous thrombosis.
A woman was treated recently for TSS (toxic shock syndrome). She has intercourse occasionally and uses over the counter protection. On the basis of her history, what contraceptive method should she and her partner avoid?
cervical cap, diaphram and sponge
What is important to know about emergency contraceptive?
To minimize nausea the woman can take one antiemetic pill one hour before the emergency pill . The emergency contraceptive must be given within 72 hours to prevent pregnancy. It is 74-90% effective.
What is contraceptive failure rate?
Measure the likelyhood of accidental pregnancy in the FIRST YEAR ONLY. The rate declines over time as people gain expierience with contraceptive use
What is natural family planning?
No sex unless you want kids. It's the only form of contraception practivce accepted by Roman Catholic religion. It is a perodic abstinence method.
Lacation Amenorrhea form of birth control?
The belief that women don't ovulate during breastfeeding. It is a risky form of contraception.
What is an IUD and how does it work?
Small t-shaped device insterted into the uterus. Either copper or progesterone. Copper works as an emergency contraceptive for up to 8 days. Only a .8-2% failure rate. There is an increased risk of PID 20 days after insertion and an increased risk of bacterial vaginosis and uterine perforation with use.
What are medical abortions?
purposeful interruption of pregnancy BEFORE 20 weeks. Done in the first trimester for elective/therapuetic therapy
An abortion done to save mom/ baby
Reversal rate is 90% but only 50% of these reversals are able to reproduce. The Vas Deferens are affected in a vasectomy
Which action should the nurse take first when meeting with a new client to discuss contraception?
The patients level of knowledge about contraception and the patient's level of commitment
If a baby has PKU will the next baby have it? If the father and mother are carriers?
If BOTH parents have PKU there is a 1-4 chance that EACH seperate baby will get it
What can an expectant couple do if they already have a child with triostomy 18?
genetic testing including amniocentesis
Most common type of 2nd trimester abortion?
13-16 wks= D & E (dialation and evacuation)
Hypertonic solutions injected into the uterus as a form of abortion account for?
less than 1% of all abortions
What med is used for 3rd trimester (fetal demise/still born) abortions?
What is an autosomal recessive inherited disorder?
Maple syrup urine disorder, PKU. BOTH genes of a pair must be abnormal
What is reoccurence risk?
The family already has one child with the abnormality
Already at a higher risk for
clarity genetic status of asymptomatic family member
When is genetic counceling encouraged?
if the child is less than 16 years of age or greater than 35 years of age, or if there is a family hx
all the genes a person can pass on to future generations. Individuals genetic make up
pictorial analysis of the #, form, and size of an individuals chromosomes
Observable expression of a genotype (hair or eye color )
How long is an ova fertile for after ovulation?
How long is sperm viable for inside of the woman?
What should the nurse be aware of with regards to estimation and interpretation of the reoccurence risk for genetic disorders?
50% or 1 in 2 chance in dominant disorders. and 1 in 4 chance in autosomical recessive disorders.
Zygote and 1st cell of new individual is formed
penetration of the ovum by the sperm
What is the leading cause of genetic mental retardation?
When do heart anomalies occur during fetal devlopment?
When does a baby jump to sounds inside the uterus?
male baby with female traits
No XX chromosome only an X so this individual can't reproduce
Affects the 21 choromosome (has two of them) Triosmaly. 47 chromosomes all together
What is meconium and what is it produced by?
Green/black tarry waste products produced by the fetus' intestines
What prevents the baby's umbilical cord from being squashed while in the uterus?
intrauterine growth restrictions- comes when mom lays on back and the pressure of the uterus sits on the vena cava
What is chorionic villi
After implantation fingerlike projections develop out of the trophoblast and extend into the endometrium (this forms the placenta)
What antibodies does the baby develop in utero?
IgG and IgM
What ratio of lecithin and sphingomyelin indicates maturity of the lungs?
What hormones are found within the placenta?
estrogen, HGC, HSL, and progesterone
What is amniotic fluid used for?
Source of oral fluid for the baby, also the place for fetus' waste products. It cushions the fetus and maintains a constant body temp. The volume of amniotic fluid changes constantly but can be too low (olgohydromyosis- which is associated with renal abnormalities)
Implantation of the egg occurs?
in the blastocty stage not the morula stage. It attaches here inte endometrium in the uterus
Layer of the blastocyt stage. There are 3 germ layers which eventually develop into the embryo.
What is important to note in relation to the respiratory system regarding hypertension?
It stresses the fetus and causes an increase in the blood level of corticosteroids and thus increasing the lungs workload.
Transitional stage during which ovarian function and hormone production decline and spans from an onset of premenopausal time when symptoms stop
houses the openings to bartholeens glands, vagina, skeen glands and the urethra
Breast keep developing until age?
benign tumors that arise from an overgrowth of smooth muscle and connective tissue in the uterus
What does a mans sperm clumping together mean and what test is needed?
No test needed this is normal.. focus on the WOMAN for the right answer
Major differences between the cervical cap and diaphram?
cervical cap can be inserted hours before intercourse w/o a later need for additional spermicide. Requires less spermicide than a diaphram. No more spermicide is needed for repeated acts of intercourse
28 day contraceptive pack. The nurse should advise againist pregnancy by?
to maintain adequate hormone levels for contraception and enhnace compliance, COC's prevent ovulation and pregnancy cannot occur
ACHES? for the pill
A-abdominal pain may indicate problem with gallbladder or liver C- Chest pain or SOB- clot problem or lungs/heart H- Headaches- may be caused by cardiovascular incident or htn E- eye problems- vascular accident or htn S- Severe leg pain- thromboembolitic problem
used to induce contractions for medical abortions side effects include: NVD, dizziness, fever, and chills
What can an expectant couple do if they already have a child with trisomy 18?
get an aminocentesis
AKA edwards syndrome. Severe mental retardation with poor prognosis. Some only live a few days and can live up to ten years
fetomaternal hemorrage from a pierced plancenta
maternal serum screen
a blood test used to see if a pregnant woman is at increased risk for carryinga fetus with a nuerotube defect or chrosome abnormality such as downs... it is an invasive procedure
what is amniotic fluid for?
helps maintain a constant body temp. and serves as a sournce of oral fluids for the baby and repository for waste
Week 20 gestation?
lanugo covers the entire body. viability now possible at 20 weeks. enal and dentin depositing
24 weeks gestation?
vernix is thick but becomes scant by term. hearing develops. promitive alveoli form. Lecithin begins to appear in amniotic fluid. flood formation increases in bone marrow and decreases in the liver
28 weeks gestation?
the scalp hair is longer than the lanugo. testes begin to descend into thier scrotum. growth to rump measure= 1100 g, 27 cm. lecithin forming on alveloar surfaces.
30 weeks gestation?
baby lays down stores of brown fat in prepartion to cold stress. L/S ratio= 1.2:1. sense of taste is present, aware of sounds outside the woman's body