ob mini test

what is intimate partner violence?

what is intimate partner violence?

physical, sexual, or psychological harm or social isolation by a current or former partner

what is the scope of intimate partner violence?

50% of female homicides are related to IPV

what are the different types of intimate partner violence?

physical: injuries, abuse

sexual: coercion, forced sex, humiliating or degrading sex, forced sex with others

emotional: threats to self/partner/family/pets, stalking, coercion, verbal abuse, degradation, expressions/gestures to instill fear

isolation: needing permission to leave home, odometer checks, needing detailed accounts of time spent away, listening to conversations with others

economic: controlling finances, refusal to share money, inability to work, jeopardizing work

what is the nurse’s role in achieving goals related to intimate partner violence?

adolescents: mandatory reporting

adults: give resources for reporting but give them the choice to wait until they’re ready to leave to report it

how is an intimate partner violence screening & assessment conducted?

screening tools: abuse screening, HITS, STaT, HARK, childhood trauma questionnaire, ongoing abuse & violence assessment

assessment: use quotes, description of abuser, injuries with description & photos, patient coping & responses, types of injuries, safety measures taken

with sexual violence, SANE nurse & rape kit; prophylaxis (STI, plan B)

what is the nurse’s role in providing care for victims of intimate partner violence?

interventions: education, counseling, safety cards (screening & education), consultation & referrals, treatment & follow-up

trauma-informed care (you’re not alone, it’s not your fault, it’s not acceptable, confidentiality will be maintained; education on cycle of violence)

what is the difference between premenstrual syndrome & premenstrual dysphoric disorder?

PMDD has to involve a psychological component

what is the nurse’s role in caring for a patient with a premenstrual disorder?

consider SI (may need counseling), rule out other illnesses, consider cyclical timing of symptoms

diagnostics: medical/psychosocial/psychosexual history, history of substance abuse, physical exam, lab tests (rule out hypothyroidism, etc.), journal of symptoms for 3 months

patient care: exercise, nonpharmacological treatment (heating pad, stretching, diet, hot baths, etc.), NSAIDs (Alieve, Midol, ibuprofen), birth control (symptom management), antidepressants (depending on underlying mental health conditions), vitamin D

what are some physiological changes that occur with the menopausal period?

hormonal: insulin resistance

menstrual: decrease in periods until 12 months without bleeding (don’t want to see any bleeding after this)

somatic: hot flashes, night sweats, sleep disturbances

vaginal: dryness, pain with intercourse

genitourinary: repetitive UTIs are common

skin/hair: thinning, dryness

breasts: size changes, decreased fullness

cardiovascular: increased BP & cholesterol, atherosclerosis

musculoskeletal: bone loss, osteoporosis

what are some self-care strategies that promote health during midlife & the later years?

healthy habits: diet, exercise, stress relief

herbal supplements: phytoestrogen supplements (soy, sweet potato), hormone regulating supplements

mind/body practices: acupuncture, massage, reflexology, aromatherapy

what are some risk factors for cardiovascular disease?

high BP, atherosclerosis

what are some risk factors for osteoporosis?

low bone density, fractures, back pain, slipped disc issues

what is some education on performing a breast self-examination?

use pads of fingers & press on the breast in a circular motion or up & down

press near the armpit while raising your arm

check nipple for discharge

do this once a month at the same time each month (typically day 3-7 of cycle) in a hot shower

what are some breast abnormalities?

breast cysts: fluid-filled, solid

fibrocystic changes: familial, tender, fluctuate in size with cycle (primrose oil, vitamin E, lower caffeine to manage)

fibroadenomas: fatty fibrous tissue

lipomas: fatty tissue that becomes solid, causes pain due to pressure on surrounding tissue

intraductal papillomas: small white growths in the lining of milk ducts

mammary duct ectasia: inflammation of ducts behind the nipple

what is the nurse’s role in promoting breast health?

clinical breast examination by a trained professional

teach self exam

encourage positive lifestyle: moderate alcohol consumption, weight maintenance (estrogen is stored in fat), avoid smoking, diet of lean meat & anti-inflammatory foods

what is amenorrhea?

lack of menstruation

primary: never started menstruating

secondary: menses starts then stops (for at least 3 months if menses was regular; for at least 6-12 months if menses was irregular) - caused by stress, eating disorder, pregnancy, lactation, thyroid dysfunction, Cushing’s syndrome, etc.

what is dysmenorrhea?

painful menstruation

primary: intrinsic & early onset - hormonal causes

secondary: physical causes (ex: endometriosis)

what is menorrhagia?

abnormally heavy bleeding during periods

*assess for anemia

what is metrorrhagia?

bleeding in between periods; cycle less than 21 days

what is menometrorrhagia?

heavy bleeding during period & bleeding between periods

*assess for anemia

what is polymenorrhagia?

frequent periods; cycle less than 21 days

what is intermenstrual bleeding?

inconsistent bleeding

what is oligomenorrhea?

cycle greater than 35 days

what is postcoital bleeding?

bleeding after sex

what are signs of bacterial vaginosis & how is it diagnosed & treated?

discharge, odor, pain, itching

diagnosis: wet prep with positive clue cells

treatment: Flagyl BID for 7 days (NO ALCOHOL)

what are signs of candidiasis, what causes it, & how is it treated?

itchy, white cheese-like discharge

causes: warm/wet environment, antibiotics, scented soaps

treatment: Diflucan, vaginal suppository (use a probiotic staggered with antibiotics for prevention)

what are signs of toxic shock syndrome, what causes it, & how is it treated?

rash, lethargy, vomiting, headache, fever, confusion, diarrhea

causes: tampon use for over 6-8 hours; staph/strep

treatment: antibiotics

what are signs of a urinary tract infection, what causes it, & how is it diagnosed & treated?

lower back/flank/pelvic pain, burning, urinary frequency/urgency

causes: E.coli, chlamydia

diagnosis: UA midstream with positive nitrites & leukocytes

treatment: Bactrim (early treatment for pregnancy since it can cause miscarriage)

what is endometriosis & what are some of its clinical manifestations?

growth, adhesion, & progression of endometrial glands & tissue outside of the uterine cavity

symptoms: cramping, pain with sex, heavy periods, fatigue, increased inflammatory processes, risk of infertility due to scarring

what causes endometriosis?

retrograde menstruation into fallopian tubes

how is endometriosis diagnosed & treated?

diagnosis: scope

treatment: pain relief, birth control, surgical removal of scar tissue

what are leiomyomas & what are some of their clinical manifestations?

also called fibroids

solid pelvic tumors in uterine muscle

symptoms: dysmenorrhea, abnormal bleeding, pain, increased risk of PPH

how are leiomyomas diagnosed & treated?

diagnosis: scope, ultrasound

treatment: uterine artery embolization, myomectomy (fibroid removal), hysterectomy, laser cauterization

what is abnormal uterine bleeding, what causes it, & how is it treated?

heavy, light, or irregular bleeding

causes: structural - PALM (polyps, adenomyosis, leiomyomata, malignancy), nonstructural - COEIN (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not classified)

treatment: dependent on cause (ex: take out structural cause after an initial uterine biopsy to rule out endometrial cancer)

what are ovarian tumors/cysts, the different types, & their treatment?

follicles containing eggs swell & become cysts

dermatoid: originate from potential germ cell (abnormal)

follicular: maturing egg that would be ovulated; develops during first half of menstrual cycle

corpus luteum cysts: feeds pregnancy or should absorb & go away; form from corpus luteum during second half of menstrual cycle

treatment: birth control to prevent ovulation

what is PCOS & what are some of its clinical manifestations?

polycystic ovarian syndrome; insulin-resistant metabolic disorder

symptoms: apple-shaped abdomen, moderate obesity, trouble losing weight, hirsutism (harder to diagnose now because not all PCOS patients have these symptoms)

what causes PCOS, what are some risk factors, & how is it treated?

causes: endocrine imbalance results in higher levels of estrogen, testosterone, & LH or lower secretion of FSH

risks: DM, heart disease, HTN, endometrial cancer, infertility

treatment: birth control

what are vulvar condylomas, what causes them, & how are they prevented & treated?

growth that resembles a wart of the mucous membrane on the genitals or anus

causes: strains of HPV

prevention: wear cotton underwear, keep area clean & dry, avoid douching, perform vulvar self-exams

treatment: burn off/cauterize

what is a hysterectomy, what are the different types, & what are its indications?

removal of the uterus

types: abdominal (if enlarged), vaginal or laparoscopic (preferred), robotic (decreased risk of infection & faster recovery)

indications: leiomyomas/fibroids, abnormal uterine bleeding, endometriosis

what is chlamydia trachomatis & what are some of its clinical manifestations?

bacterial infection; leading cause of preventable infertility and ectopic pregnancy

symptoms: typically asymptomatic with increased discharge & UTI

how is chlamydia trachomatis diagnosed & treated?

diagnosis: GC/chlam swab
treatment: 1 dose of azithromycin, test of cure 1 week later

what is neisseria gonorrhea & what are some of its clinical manifestations?

bacterial infection

symptoms: painful urination, abnormal discharge, vaginal bleeding

how is neisseria gonorrhea diagnosed & treated?

diagnosis: GC/chlam swab
treatment: 1 dose of ceftriaxone (Rocephin; makes urine dark orange), 1 dose of azithromycin, test of cure 1 week later

what is pelvic inflammatory disease & what are some of its clinical manifestations?

acute infection of uterus & fallopian tubes; can progress to systemic infection
symptoms: cervical motion tenderness (pain with pap smear)

what causes pelvic inflammatory disease & how is it treated?

causes: untreated chlamydia & gonorrhea
treatment: antibiotics, follow up in 72 hours

what is syphilis & what are some of its clinical manifestations?

bacterial infection, can be passed from mom to baby in utero/childbirth/breastfeeding

primary: painless sore on the mouth, anus, or genitals

secondary: 30 days to 6 months, flu-like symptoms

latent: up to 50 years dormant, asymptomatic with exacerbations with stress

late: shows up all over & inside the body, affects mental & physical state

how is syphilis diagnosed & treated?

diagnosis: RPR blood test

treatment: primary or secondary- one shot of penicillin G

what is trichomoniasis & what are some of its clinical manifestations?

parasitic, most common curable disease in the US

symptoms: distinct odor, itchy, yellow/green discharge, strawberry cervix

how is trichomoniasis diagnosed & treated?

diagnosis: wet prep, strawberry cervix
treatment: Flagyl

what medication should you not drink alcohol with?

Flagyl (metronidazole)

what is pediculosis pubis & what are some of its clinical manifestations?

parasitic infection, aka pubic lice or crabs

symptoms: itchy, eggs & bugs visible

how is pediculosis pedis diagnosed & treated?

diagnosis: visualization of lice or eggs
treatment: cream, treat every partner for the last month, wash all items on hot

what is HPV & what are some of its clinical manifestations?

viral, can cause cervical & throat cancer

symptoms: warts/condylomas, abnormal pap smear

how is HPV diagnosed & treated?

diagnosis: visualization of warts, pap smear
treatment: treat warts; the actual virus has no cure; vaccination for prevention

what is HSV & what are some of its clinical manifestations?

viral

symptoms: painful sores on mouth or genitals

how is HSV diagnosed & treated?

diagnosis: blood test

treatment: antivirals, minimize viral load

what is the pathophysiology of HIV & AIDS & what are some of its clinical manifestations?

HIV turns to AIDs when CD4 drops low enough
symptoms: sore throat, fever, swollen lymph nodes, night sweats, chills, mouth ulcers, rash, muscle aches

how is HIV/AIDS diagnosed & treated?

diagnosis: antigen/antibody test

treatment: PEP (post-exposure prophylaxis), PrEP (pre-exposure prophylaxis), barrier contraceptive method, keep low viral load

what are some safer sex strategies?

use protection, only have sex with partners you trust, get STD tested once a year if sexually active under 25

what is the nurse's role in STD counseling & eduction?

provide basic information, sexual decision-making skills, education about the body, encourage active participation in own health care, strategies for sage choices in intimate relationships, emphasize protection provided by condoms

what symptoms are related to cervical carcinoma?

no symptoms early on, possible postcoital bleeding

what symptoms are related to ovarian carcinoma?

no symptoms until metastasis

early symptoms include abdominal distention & bloating

late symptoms include abdominal/back pain, cramping, & bleeding

what symptoms are related to endometrial carcinoma?

post-menopausal bleeding

all organs - estrogen and progesterone; only 1 organ - estrogen

what symptoms are related to vulvar carcinoma?

itchy, irritated, grey/shiny skin

Paget’s disease - thick, scaly

what are some methods of cervical cytology screening?

pap smear: sample of cervical epithelium

coloscopy: illuminated magnified view of cervix (vinegar turns abnormal cells white)

endocervical sampling: scrapes off cells of cervical mucosa

what are some treatments for preinvasive conditions of the cervix?

cryosurgery: freezing of cervical tissue (can make cervix stenotic and harder to dilate)

laser ablation: high energy light beam vaporizes abnormal tissue (can make it harder to carry a baby)

conization: excision of a cone-shaped wedge from uterine cervix

what are some risk factors for HPV?

number of sexual partners, age (warts more common in children), weakened immune system, damaged skin, contact with someone with HPV

what is the link between HPV & cervical cancer?

when the body’s immune system can’t get rid of an HPV infection, it can linger over time & turn normal cells into abnormal cells, then leading to cancer

what are some risk factors for cervical cancer?

sex partner more 2 years older, more than 3 lifetime partners, a new sex partner in the last year, intercourse with alcohol or drug use, never being married & being sexually active, having a male partner who is uncircumcised