N330 Exam 1

Endometriosis s/s

Extremely heavy and painful periods, secondary amenorrhea that has gotten worse over the years
Dysparunia - pain during or after intercourse
Abnormal uterine bleeding
Infertility

IUD Side effects

Heavier periods w/ paragard (copper), cramping

Nexplanon side effects

Matchstick rod, most reliable
Releases progestin to keep ovaries from releasing eggs and thickens cervical mucus
Causes irregular bleeding

Progestin-only contraception

Thickens cervical mucus, thins lining of uterus, reduced ovulation
S/e: irregular bleeding, breast tenderness, acne, lower libido, headaches, nausea, ovarian cysts, depression
Failure rate is 9% and must be taken same time very day

Combined oral contraceptives s/e

Supresses hypothalamus and anterior pituitary gland, leading to decreased FSH and LH, inhibiting ovulation. Less endometrial build up. Cervical mucosa remains thicker.
S/e: sore breasts, nausea, spotting, and decreased sex drive

15 CI to COC

Hx of thrombosis
stroke
heart disease/HTN
breast cancer
positive antiphospholipid antibodies
migraines w/ aura
prolonged immobility
diabetes w/ vascular complications
gallbladder disease
hepatic disease or disorder
pregnancy
use of HIV/TB medication
use of some anticonvulsants like Dilantin
<6 weeks postpartum
smoker over 35

Depo-provera s/e

Subq injection q3 months
s/e like COC, weight gain, can lead to bone density loss over 2 yrs

GTPAL

Gravida - total pregnancies, including current one, regardless of outcome
Term - number of pregnancies carried to 37 weeks or more
Preterm - number of pregnancies delivered b/w 20-36 weeks + 6 days
Abortions - number of pregnancies lost before 20
Living children - number of children currently alive

Chylamydia

Difficult to diagnose, asymptomatic
S/s: can lead to abdominal pain if PID occurs

Gonorrhea

Aerobic gram-negative diplococcus
S/s: often asymptomatic, can lead to PID

Pelvic Inflammatory Disease

Symptoms: mucopurulent drainage, cramping, pain
Infections migrate up upper reproductive tract

Syphilis

Complex disease that can lead to systemic problems and even death
S/s: flu-like symptoms, chancres, lesions on genital area and palms of hand soles

Human papillomavirus (HPV)

Most common viral STI
S/s: Genital warts, cervical neoplastic changes that could lead to cervical cancer
Common during pregnancy when immune system lessens

Herpes simplex virus (HSV)

I - nonsexual II - sexual
S/s: multiple painful lesions, fever, chills, malaise, severe dysuria
Chronic, recurring, c-section recommended if visible lesions are present

HIV

Severe depression of cellular immune system associated with HIV
S/s: fever, headache, night sweats, malaise, myalgias, nausea, diarrhea, weight loss, sort throat and rash, generalized lympadenopathy

Signs of breast cancer

Breast pain is rarely a sign of cancer
Solid lumps
Sudden nipple inversion
Abnormal discharge
Diet, weight, lifestyle, heredity
Orange peel appearance

Gravida

Pregnancy

Parity

Number of pregnancies in which fetus or fetuses have reached viability, not number of fetuses born
Whether fetus is born alive or is stillborn
Gestational definition of viability is reaching 20 weeks gestation

Preterm

20-36+6 wk

Presumptive signs of pregnancy

N/V, breast tenderness, fatigue

Probable signs of pregnancy

Chadwick’s - blue color of cervix/mucosa
Hegar’s - softening of lower uterine segment
Goodell’s - softening of the tip of cervix
Postive pregnancy test

Postive signs of pregnancy

fetal movement on ultrasound, fetal heartbeat

Dilutional anemia

Plasma volume increases more than RBC mass
Hgb should not be <11 g/dL

Pregnancy nutritional recommendations

Recommend ~250 more calories a day
Metabolic rate increases
Folate and iron are recommended

Note PICA, cravings, odor or food aversion

Cholecystitis in pregnancy

Due to cholestasis, whic is common due to placental steroids slowing motility

5 considerations for STIs in pregnancy

Penicillin - only treatment for syphilis in pregnancy
Active HSV lesions - c section
HIV - ART and avoid breastfeeding