NURS 354 Key Review (Amalie!!!)

T/F: birth is viewed as a normal life event rather than a medical procedure

TRUE

Still birth

fetal death after 20 week gestation in the womb

What are the top 5 causes of pregnancy-related deaths?

post partum hemorrhage

post partum infection

preeclampsia/eclampsia

cardiovascular disease

abortion complications

Barriers to healthcare for women

finances, transportation, language/culture, low health literacy

# 1 cause infant mortality

congenital anomaly

# 1 cause maternal mortality

cardiovascular disease

Primary Prevention

preventing disease before it occurs

(folic acid to decrease neural tube defects)

Secondary Prevention

early identification of those who have developed a disease- shortening duration/ reduce severity (pap smears, mammograms, etc.)

Tertiary prevention

treating those who have developed a disease- reduce progression and restore maximum health potential (chronic effects of STIs)

Complementary Medicine (integrative medicine)

a combination of mainstream/conventional medical therapy and CAM therapy

ie. aromatherapy with NSAIDs for pain relief

What is the most common form of CAM?

prayer!

What is an example of CAM used in pregnancy?

ginger lolipops

seabands

acupuncture/pressure

vitamin B6

When is differentiation of external genitalia complete?

12th week gestation

(ovaries-10 wk, testes 7-8w gestation)

Normal vaginal pH

4-5

Anteverted

tilted forward uterus (only cervix is anchored)

Isthmus

divides uterus into 2 unequal parts

Corpus

body of uterus

(3- layers- perimetrium, myometrium, endometrium)

Cervix

lower 1/3 of uterus, opens into vagina

Fundus

uppermost or top portion of uterus

Carnua

narrowed area where fallopian tubes enter the uterus

Uterine contractions are responsible for?

cervical dilation (major force of passage for baby through pelvis and vagina)

T/F: cervical mucous is alkaline

true! (protects sperm from acidic vaginal secretions)

Why does cervical mucous thin at ovulation?

for sperm to enter

Fallopian tube

infudibulum, ampulla, isthmus

T/f: ovaries are attached to the fallopian tube

FALSE (supported by ligaments)

What is the typical lifespan of the egg?

6-24 hours

Follicular Phase (1-ovarian cycle)

begins on day 1 of menstrual cycle, continues until ovulation (day 14)

FSH is released

follicle maturation in ovary and release of mature egg

menstrual cycles vary due to variations in length of this phase

Ovulation Phase (2-ovarian cycle)

release of mature egg

triggered by LH surge

estrogen decreases

egg lives 6-24 hours

spinnbarkheit

mittelschmerz

increased discharge, mid-cycle spotting

increased temperature

Luteal Phase (3-ovarian cycle)

release of LH (days 15-28)

begins when egg leaves follicle

corpus luteum develops and secretes increased amounts of progesterone (causes 0.5-1 F temp increase)

fertilized ovum secretes hCG

unfertilized ovum causes corpus luteum degeneration, estrogen/progesterone fall, endometrial lining shedding

Menstrual Phase (1-uterine cycle)

spiral arteries rupture

estrogen/progesterone levels fall

endometrial lining sloughs

menstrual bleeding occurs

Proliferative Phase (2-uterine cycle)

estrogen levels begin to rise

endometrium thickens

cervical mucous thin, clear, watery, more alkaline for sperm

begins near day 5 of menstrual cycle

ends at ovulation

Secretory Phase (3-uterine cycle)

begins at ovulation

ends approx. 3 days before onset of next cycle

progesterone increases

endometrium thickens, vascularity increases

Ischemic Phase (4-uterine cycle)

occurs 3 days prior to onset of menstrual flow

sharp drop in estrogen and progesterone levels

endometrial vessels spasm

basal layer becomes ischemic

Spinnbarkheit

thin, stretchy slippery mucous produced by cervix at ovulation

What does the ovum secrete that is necessary to maintain the corpus luteum?

Hcg

What is the most important factor in determining age of menarche?

genetics

GnRH

induces release of FSH and LH for ovulation

FSH

ovarian follicle maturation

LH

necessary for final follicle maturation

surge occurs in the hours prior to ovulation

responsible for increased progesterone from the follicle

What causes the uterus to increase in size and weight?

estrogen

Progesterone

calming affect on uterus, maintains pregnancy

high levels necessary for implantation to occur

maintains endometrium

smooth muscle relaxant (inhibits contractions)

stimulate maternal metabolism/breast development

provides nourishment for early conceptus

Pathogenesis of menstrual cramps

prostaglandin F2a (powerful myometrial stimulant/vasoconstrictor)

Tx of choice- NSAIDs

Primary Amenorrhea

no menses by age 15 AND absence of growth and development of secondary sex characteristics

OR

no menses by age 16 with NORMAL growth/development of secondary sex characteristics

Tx: estrogen replacement therapy

Secondary Amenorrhea

absence of menses for 3 cycles

OR

irregular menses for 6 months in women who have previously menstruated regularly

Tx: oral contraceptives

T/f: there is increased evidence in the correlation between decreased menstrual irregulatiry and development of osteoporosis/hip fractures later in life

TRUE

What is the leading cause of absenteeism from work/school?

dysmenorrhea

When does PMS/PMDD occur?

luteal phase!

Tx of PMS/PMDD

vitamin/mineral supplements (VitB, Ca, Mg)

NSAIDs

spironolactone

various herbal supplements

diet

lifestyle

What are the 2 most common symptoms of endometriosis?

infertility and pelvic pain

Definitive diagnosis of endometriosis

laparoscopy

What is gold standard treatment of endometriosis?

laparoscopic lesion excision

What is the most important indicator of male infertility?

semen analysis

What is gold standard assessment of tubal patency?

hysterosalpingography (HSG)

*fallopian tube obstruction one of most common causes of female factor infertility

• Shoot in dye!!

How to improve fertility

normal vaginal pH

promote sperm retention during/after intercourse

promote adequate nutrition/stress reduction

promote patient education to maximize fertilization (time of ovulation/intercourse)

Fertile period total days

6 days- 3 days prior and 3 days after ovulation

Cervical Mucous Method

characteristics near and at ovulation

estrogen dominant (promote sperm survival)

spinnbarkheit

After ovulation, cervical mucous is dominant in what hormone?

progesterone (thick/sticky)

Basal Body Temperature (BBT) method

take and record temp upon awakening each morning

pre-ovulation- estrogen, normal BBT

post-ovulation- progesterone, BBT increases

pregnancy= elevated temp remains

not pregnant= temp returns 1-2 days before menses

Sympto-Thermal method

note and record symptoms and temperature

-spinnbarkeit

-cervical position and firmness (soft, high, deep)

-increase BBT

-mittelschmerz

-breast tenderness

Standard days method

abstain/barrier days 8-19 of cycle

*need a regular cycle to use!

2 day method

presence of cervical secretion = fertile

not present = not fertile

Do spermicides have protection against STI/HIV/AIDS?

NO!

Teach with diaphragm/cervical cap to refit

after childbirth, abortion, weight change, surgery

Timing for Contraceptive methods

once day = pill

once week = patch

once month = ring

What does depo-provera (the shot) increase?

bone demineralization and issues with contraception after!

IUD Use requirements

pap smear for cervical CA, routine testing (chlamydia/gonorrhea), MUST schedule during menses

When is the best time for tubal ligation?

postpartum

Medications for Abortion

mifepristone (associated with bleeding) and misoprostol

In women, STI's contribute to?

cervical CA, chronic pelvic pain, ectopic pregnancy, infertility, death

What is a must for STIs?

cultural sensitivity!

teach: value of testing and treatment if indicated

STI Nursing Mangement

prevention is critical

provide: counseling/education

consider: developmental level

teach: sex development, sexual health, condoms if sexually active, treatment follow up plan if diagnosed

Teaching for Condom Use

use latex as mechanical barrier to STI/pregnancy

use new condom with each act

handle with care to prevent damage

ensure it is stored in cool, dry place

check expiration date

open wrapper carefully

do not use if brittle, sticky, or discolored

hold tip when unrolling

ensure adequate lubricant

withdrawal while still erect

STI high risk population

adolescents

Over age 60 STIs

increased risk, decreased immunity/skin integrity, do not see selves as vulnerable, involved in risky behavior, don't see it in HC setting

Vulvovaginal Candidiasis (VVC)

NOT an STI- thick, curdy, white vaginal wall

Prevent VVC

cotton underclothes

loose non tight clothing

discontinue OCs

avoid douching, vaginal powders, sprays

encourage glycemic control in DM

yogurt/probiotics

Bacterial Vaginosis

most common cause vaginal discharge, watery, grey/white odorous (whiff test- fishy)

increased pH > 4.5

Trich

most curable nonviral STI

70% asymptomatic

yellow/green odorous, vulvar itching

whiff-test: fishy

pH > 4.5 (normal 3.8-4.2)

Chlamydia

leading cause blindness in world (often asymptomatic)

burning/frequent urination, abdominal pain, bleeding easy, micropurulent pain

PID and infertility untreated

**screen: ALL sex-active under 25 (AT RISK), pregnant women first prenatal visit, and 3rd trimester

Chlamydia Newborn w/o Prophylaxis

ophthalmia neonatorum

chlamydial conjunctivitis

chlamydia PNA

Gonorrhea

asymptomatic 70%

abdominal pain, pelvic pain, urination pain, abnormal vaginal discharge

PID and infertility left untreated + disseminated gonococcal infection (brain, liver, joints, heart)

*Screen same as chlamydia

Gonorrhea Newborn w/o Prophylaxis

ophthalmia neonatorum

blindness

pharyngeal infections

PID

pain sharp lower abdominal

fever > 101

flu-like s/sx

vaginal discharge mucopruluent

cervical motion tenderness

PID Diagnostic

chandelier sign (cervical/uterine tenderness with movement)

Genital Herpes

80% asymptomatic

treatable NOT curable

primary after initial exposure

secondary triggered by stress

tingling, itching, pain, usually les severe

Herpes Neonatal Risks

low birth weight

congenital cataracts

neurological damage

tx: acyclovir

Syphillis

curable (VDRL + RDR) or (FTA-ABS & TP-PA)

**screen all pregnant women first prenatal vist and 3rd trimester

c section IF lesions present

neonatal: IUGR, LBW, systems failure

HPV

cause all cervical cancer, treatable NOT curable (focus on prevention)

may be asymptomatic

grayish pink wart, cauliflower vulva,

perineum, vagina, anus

gardasil 9 vaccine- ages 9-26 3 doses over 6 months

Hep B

fever, fatigue, nausea, anorexia

transmission body fluids NOT food/water, etc.

*screen at first prenatal visit

3 vaccines over 6 months for newborn

HIV

transmission blood, intercourse, pregnancy, childbirth, breastfeeding

most maternal-fetal transfer occurs in 3rd trimester or at delivery

delivery: C-section between 37-39 weeks

Mastitis

primarily lactating women (2d-2wk postpartum)

flu-like, red warm breast, upper outer breast common, usually unilateral

risk: milk stasis, nipple trauma

cause: staph aurues

complete emptying, continue feeding, ABX

Engorgement

bilateral, postpartal distension

warm compress, massage, anti-inflammatory, cabbage leaf (bottle feeding)

PCOS

most common endocrine disorder of reproductive age, most common cause treatable infertility

hyperandrogenemia, hyperinsulinemia

When should you screen for intimate partner violence?

at every prenatal visit!

When is gender determined?

fertilization

Where does fertilization occur?

ampulla

Nagele's Rule (Due Date)

first day LMP, subtract 3 months, add 7 days

Term Pregnancy

40 weeks, 280 days

Fertilization Age

two weeks less, 38 weeks, 266 days

Pre-embryonic Stage

day 1 (conception)- day 14

cleavage and morula

blastocyst - embryo

trophoblast - chorion

amnion (thin)- aminotic fluid

chorion (thick)- placenta

^^ make up embryonic membrane