OB Lecture Exam 1

ch. 4 (assessment and health promotion), ch. 12 (conception and fetal development), ch. 10 (problems of the breast), ch. 9 (infertility), ch. 8 (contraception and abortion), ch. 7 (sexually transmitted and other infections), ch. 6 (reproductive system concerns), ch. 11 (structural disorders and neoplasms of the reproductive system)

ch. 4 - what are the functions of the uterus?

contraction during labor, menstrual bleeding, & location of sperm cells

ch. 4 - at the end of the menstrual cycle, what low levels of hormones stimulate the hypothalamus to secrete GnRH?

estrogen and progesterone

ch. 4 - a marked surge in what hormone precedes the release of the ovum from the Graafian follicle (ovulation in ovarian cycle)?

LH

ch. 4 - what happens if fertilization and implantation does not occur (menstrual cycle)?

progesterone and estrogen levels drop, menstruation, & hypothalamus secretes GnRH

ch. 4 - menstrual phase (endometrial/uterine cycle)

shedding of the endometrium (1-5 days)

ch. 4 - proliferative phase (endometrial/uterine cycle)

building of the endometrium under the influence estrogen; “the builder” (days 6-14)

ch. 4 - secretory phase (endometrial/uterine cycle)

marked swelling and growth due to progesterone; “the maintainer” (days 15-28)

ch. 4 - ischemic phase (endometrial/uterine cycle)

blood supply to endometrium is blocked and necrosis occurs (phase right before menses)

ch. 4 - what are two possible things that occur at the end of the menstrual cycle?

menses or pregnancy

ch. 4 - follicular phase (ovarian cycle)

days 1-14 (can vary in length)

ch. 4 - ovulation (ovarian cycle)

occurs on day 14 in length of cycle, midcycle bleeding, mittelschmerz, & thin cervical mucus

ch. 4 - luteal phase (ovarian cycle)

days 15-28 ends with onset of menses

ch. 12 - conception

one egg and one sperm join, starting pregnancy; creates a cell with 46 chromosomes

ch. 12 - mitosis

how body cells grow, repair, and replace themselves; creates two identical cells

ch. 12 - meiosis

how sex cells are made; it cuts the number of chromosomes in half, from 46 to 23

ch. 12 - oogenesis

the process of making eggs; it starts before birth

ch. 12 - spermatogenesis

the process in males where sperm cells grow and mature into sperm

ch. 12 - scrotum

each part (two parts) holds a testis, an epididymis, and part of the spermatic cord

ch. 12 - testes

the main male reproductive organs; they make testosterone and produce sperm

ch. 12 - epididymis

on the back of each testis; carries sperm from the testes to the vas deferens

ch. 12 - ductus (vans) deferens

a tube that continues from the epididymis and carries sperm to the ejaculatory ducts

ch. 12 - ejaculatory ducts

carry sperm into the urethra and add fluids from the prostate to help sperm work properly

ch. 12 - seminal vesicle

responsible for producing most of the components that make up semen

ch. 12 - prostate

it makes fluid that mixes with sperm and other fluids to form semen

ch. 12 - urethra

runs from the bladder to the penis; it carries semen and sperm out of the body during sex

ch. 12 - how long is ova fertile?

12-24 hours

ch. 12 - how long does sperm survive for?

24-72 hours

ch. 12 - capacitation

the process that makes sperm able to fertilize an egg after entering the female body

ch. 12 - acrosome reaction

when the tip of the sperm releases enzymes to break through the outer layer of the egg

ch. 12 - the process of fertilization

blastomere is divided: embryoblast (becomes baby) and trophoblast (becomes placenta)

ch. 12 - pre-embryonic

days 1-14

ch. 12 - embryo

the stage from the 2nd or 3rd week after fertilization up to the 8th week

ch. 12 - fetus

9th week until 40th week

ch. 12 - what is the order of embryonic development?

cellular multiplication, cellular differentiation, and development of organ systems

ch. 12 - ectoderm (top layer)

makes skin, glands, hair, and nails

ch. 12 - mesoderm (middle layer)

forms bones, teeth, and muscles

ch. 12 - endoderm (bottom layer)

becomes the lining of the lungs and digestive system

ch. 12 - what are the two membranes that surround the fetus?

chorion and amnion

ch. 12 - chorion

outer membrane that comes from trophoblast; the first layer reached during amniotomy

ch. 12 - amnion

the inner membrane that forms from the blastocyst and is closest to the baby

ch. 12 - what are the functions of the amniotic fluid?

maintain temperature, protects fetus, and medium for movement

ch. 12 - what are the functions of the placenta?

endocrine gland function, metabolic functions, and adequate circulation

ch. 12 - fetal maturation

the baby is called a fetus from 9 weeks to the end of pregnancy

ch. 12 - viability

the point when a baby can survive outside the womb

ch. 12 - what is viability age in Texas?

20 weeks or 350 grams

ch. 12 - placental blood circulation is blood that flows between the mother and baby. the umbilical cord contains how many vessels and what kinds?

3 vessels; AVA = artery, vein, artery

ch. 12 - what three shunts does fetal circulation use to move blood?

ductus venosus, foramen ovale, and ductus arteriosus

ch. 12 - ductus venosus

sends blood from the umbilical vein to the inferior vena cava

ch. 12 - foramen ovale

lets blood flow from the right atrium to the left atrium

ch. 12 - ductus arteriosus

connects the pulmonary artery to the aorta, skipping the lungs

ch. 12 - dizygotic (fraternal) twins

2 eggs + 2 sperm, 2 placentas, and 2 amnions and 2 chorions

ch. 12 - monozygotic (identical) twins

1 egg + 1 sperm, share 1 placenta, and may have 1 or 2 amnions/chorions

ch. 12 - what infectious agents can cross the placenta?

rubella, cytomegalovirus, T. gondii (toxoplasmosis), and T. pallidum (syphilis)

ch. 10 - the two goals in the pathologic evaluation of a breast biopsy are to distinguish benign from malignant __________ tumors of the breast and to assess the risk of subsequent breast cancer associated with the lesion.

in situ or invasive

ch. 10 - __________ are dilated ducts with nipple inversion occurring during perimenopausal period and is an acquired condition.

mammary duct ectasia

ch. 10 - one form of nipple discharge not related to malignancy is __________, a bilateral spontaneous, milky, sticky discharge that occurs in women who are not pregnant or breastfeeding.

galactorrhea

ch. 10 - benign lumpiness in both breasts; related to menstrual cycle due to hormone changes; managed with dietary changes and vitamin supplementation

fibrocystic breast disease

ch. 10 - a benign, solid mass of the breast most common in women ages 20-30s; do not increase in size in response to the menstrual cycle; managed with surgery (if symptoms are severe)

fibroadenoma

ch. 10 - what are three risk factors included in the Breast Cancer Risk Assessment Tool?

age of woman, number of first-degree relatives affected, and age of woman at menarche

ch. 10 - current evidence and clinical guidelines suggest that women at increased risk for estrogen receptor positive breast cancer or carriers of BRCA1 or BRCA2 mutations can be offered __________ with either tamoxifen or raloxifene.

chemoprevention

ch. 10 - the rate of breast cancer growth depends on the effects of estrogen and progesterone and other prognostic factors such as __________ status and other variables. for purpose of prognosis, three subtypes are identified: hormone receptor positive, __________ positive, and triple negative.

human epidermal growth factor receptor 2 (HER2)

ch. 10 - what are three clinical manifestations of breast cancer?

painless lump, skin dimpling changes to the nipple, and redness with edema

ch. 10 - the clinical stage helps providers decide how to proceed with treatment of the breast problem. this stage is determined by a combination of the TNM system, the grading system, and a biomarker determination. it sorts stage by size of __________, lymph __________, and whether __________ is involved.

tumor; node; metastasis

ch. 10 - where is the most common site for breast cancer lumps?

the upper outer quadrant of the breast

ch. 10 - includes lumpectomy and segmental or partial mastectomy, involving wide excision of the tumor and surrounding tissue

breast-conserving surgery (BCS)

ch. 10 - total (simple), modified radical, skin-sparing, and nipple-sparing mastectomies, including preventive/prophylactic procedures

mastectomy options

ch. 10 - aimed at restoring symmetry and preserving body image after surgery

breast reconstruction

ch. 10 - destroys remaining tumor cells after surgical manipulation; administered shortly after tumor removal to target micrometastatic disease

radiation therapy; adjuvant systemic therapy

ch. 10 - based on the presence and type of hormone receptors in the tumor; aims to icnrease and improve disease-free survival after initial treatment

hormonal therapy; chemotherapy

ch. 9 - infertility

not being able to get pregnant after one year of unprotected sex

ch. 9 - what are three hormonal and ovulatory female infertility factors?

anovulation, early menopause, and hyperprolactinemia

ch. 9 - what is one tubal and peritoneal female infertility factor?

loss of mobility and patency

ch. 9 - __________ infections and the pH of the __________ and cervix can increase the risk for female infertility.

uterine; vagina

ch. 9 - what are three other causes of female infertility?

obesity, amenorrhea, and cancer treatment

ch. 9 - what are three male infertility factors?

low testosterone levels, undescended testicles, and previous vasectomy

ch. 9 - what are other male infertility factors?

STIs, radiation, and alcohol

ch. 9 - what three factors are assessed when determining ovulation for female infertility?

ovulation kit, progesterone levels one week prior to menses, and basal body temperature

ch. 9 - besides determination of ovulation, how do you assess female infertility?

hormone analysis, imaging (hysterosalpingogram/HSG), and procedures

ch. 9 - a __________ is a radiographic film that allows visualization of the uterine cavity and uterine tubes after instillation of radiopaque contrast material via the cervix.

HSG

ch. 9 - semen analysis, ultrasonography of scrotum, genetic testing, hormonal analysis, and testicular biopsy if indicated

ways to assess male infertility

ch. 9 - psychosocial, nonmedical, and medical therapies are used for couples managing infertility. name an example of each.

provide emotional support, lifestyle changes, and use of fertility drugs

ch. 9 - intrauterine insemination, in vitro fertilization, gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT)

examples of assisted reproductive technology (ART)

ch. 9 - woman must have at least one healthy fallopian tube; ova and sperm are deposited into the tube where fertilization takes place

GIFT

ch. 9 - fertilization takes place in vitro and then placed in fallopian tube during the zygote stage

ZIFT

ch. 9 - oocyte, sperm, and embryo donation; surrogate mothers and embryo hosts; therapeutic donor insemination

examples of ART

end of class review - the ultrasound report for a pregnant client confirms polyhydramnios. as the nurse, what does this data tell you about the fetus?

the fetus may have problems with the GI system

end of class review - what side effects of the combined oral contraceptive pill will you ask the client to report to her provider immediately?

headaches, blurred vision, and elevated BP

end of class review - the nurse assessed a client. which clinical finding indicates syphilis?

ulcer to genitalia

end of class review - a client is seen at the clinic with a vaginal infection. on clinical examination, the provider observes a frothy discharge, an inflamed vulva, and red spots on the cervix. what would the provider suspect?

trichomoniasis

end of class review - condoms protect against pregnancy and some STIs. the provider should not recommend the combined oral contraceptive for a woman with a medical history of DVT. when using the condom, __________ should not be used as a lubricant. a permanent method of contraception is a vasectomy. part of the pre-operative care for a woman scheduled for a bilateral tubal ligation is nothing by mouth for 6-8 hours.

petroleum jelly

end of class review - a client at 39 weeks pregnant is in labor. she was treated 10 weeks ago for herpes simplex. what would be the expected management of her labor and delivery?

a vaginal birth should be expected

ch. 8 - the device or practice used to decrease the risk of conceiving or bearing offspring

birth control

ch. 8 - informed consent is a vital component in educating a client about contraception or sterilization. the mnemonic BRAIDED may be useful. what does it stand for?

B - benefits

R - risks

A - alternatives

I - inquiries

D - decisions

E - explanations

D - documentation

ch. 8 - shallow dome-shaped latex or silicone device with a flexible rim that covers the cervix; available in 4 types and many sizes

diaphragm

ch. 8 - 3 sizes available; made of silicone and fits snugly around the base of the cervix

cervical cap

ch. 8 - small round polyurethane sponge that has N-9 spermicide that fits over the cervix; one size fits all

contraceptive sponge

ch. 8 - insufficient secretion of FSH and LH; ovulation is inhibited; endometrium becomes less favorable for implantation

actions of oral contraceptives (combined estrogen-progestin contraceptives)

ch. 8 - the ACHES mnemonic represents signs of potential complications of oral contraceptives. what does it stand for?

A - abdominal pain

C - chest pain or SOB

H - headaches

E - eye problems

S - severe leg pain

ch. 8 - combined oral contraceptives taken in 3-month cycles; the woman experiences fewer menstrual periods

oral contraceptive 91-day regime

ch. 8 - patch with combined progestin and estradiol; applied weekly on the same day for 3 weeks and then one week without

transdermal contraceptive system