Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

FNP 1 > Adolescents & Contraception > Flashcards

Adolescents & Contraception Flashcards

1
Q

GAPS

A

guidelines for adolescent preventative services
- screening, vaccines, counseling to pt (health risk and
guidance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Interview method used when taking psychosocial history with adolescent

A

HEEADSSS

Home environment
Education and employment
Eating
Activities, peer-related
Drugs
Sexuality
suicide/depression
Safety from injury and violence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How many hours of sleep per night do teenagers need?

A

8-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Additional history to Ask teens/ parents

A

sleep (causing trouble in school? Driving while sleepy?), food security
healthy eating
exposure to loud music
self & resiliency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PE on teenager

A

PE: scoliosis, breast exam on both genders, height, weight, and BMI, acne, piercings/ tattoos, signs of self injury, acanthosis, visual exam on female genatalia, male = visual inspection + palpate testicles+ inspect for hernia,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What age to start screening for depression?

A

Age 12 (Adolescent PHQ-9)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when should lipids start to be checked?

A

age 9-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when is hearing usually checked in adolescents?

A

Btw 11-14 using audiometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

risk assessment topics to ask adolescents about?

A 
Risk assessment (HIV, STI, oral health, IPV, violence through social media, tuberculosis, )
Tobacco, alcohol, and drug use (ask first about exposure through family and friends); vaping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when is vision screening done in adolescent years? what chart?

A

around age 12- Snellen Chart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vaccines to give/ discuss with adolescents?

A

Flu
Tdap (btw ages 11-12)
HPV
MenACWY (meningococcal. Quadrivalent recommended)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is included in sports physicals?

A

Hx
Cardiac exam
musculoskeletal exam
skin

billing - not covered by health insurance but can be covered if pt has not had a wellness exam within 12 months - usually cash pay with price set by clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What to do with adolescent with acne?

A

ID type and severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

treatment for acne

A

Topical: benzoyl peroxide, antibiotics, retinoids
Oral ABX: should see results in 5 days. topical first (should be mixed with benzoyl peroxide). Limit use to 3 months and if no results send to derm (ABX resistance concern)
Hormonal agents → estrogen-containing contraceptives; spironolactone
Oral isotretinoin (Accutane); must be on birth control
Other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Evaluating for precocious puberty

A

Evaluation:

Bone age x-ray - both hand and wrist recommended
LH/FSH and estradiol levels (females)
LH/FSH and testosterone (males) early morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lack of features of puberty on exam or failure of progression of changes (Tanner Stages) at least age 14

A

Delayed puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how to evaluate for delayed puberty?

A

Bone age x-ray
Free T4 and TSH
Serum prolactin, LH, and FSH`

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Girls should have had their first cycle within __ years of getting breast buds?

A

5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Boys should get to Tanner stage 5 within ____ years of puberty?

A

4-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

6-12 months after menarche
Primary (idiopathic) no underlying pathology
Consider endometriosis if family hx
Sx: cramping, pelvic pain, n/v/d, HA, fatigue
Workup: almost never need pelvic exam
Only really done if family hx or if fail basic tx

A

Dysmenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx options for dysmenorrhea

A

Tx: NSAIDs (do different categories), hormonal contraception may be used
Black cohash, heat, rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Difference between functional and structural scoliosis

A

Functional: curvature without rotation poor posture, pain. Reversible
Structural: rotation of spine with curvature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How to diagnose and examine scoliosis

A

Diagnoses by AP/lat x-ray of spine (at least 10 degree curvature for diagnosis)

If less than 20 degree curve just monitor.

Exam spine, scapula, shoulders, waist
Adam’s test: lean completely forward and drop head low. Observe from front and side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

TBI d/t biomechanical forces, either direct or indirect trauma
Usu rapid onset of short lived impairment of sx
Neuroimaging is usually normal. Most do not lose consciousness
s/s:
HA, nausea, dizziness, vision changes, light/noise sensitivity, concentration

A

Concussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How to evaluate and tx concussion
Evaluation: ACE or scap tool. LOC, posturing, or balance problem immediate remove from the area for further evaluation Rest: physical and brain rest for 24-48hrs (some take 7-14 days) No school, no screens, no reading, no sports Long term issues: HA, anxiety, sleep problems possible
26
12-18 years old May develop into bipolar disorder PHQ-2 or PHQ-9 modified for adolescents Suicide #2 cause of death in adolescents → be straightforward
Depression
27
(male sterilization) → interrupts the vas deferens, preventing the passage of sperm into seminal fluid
vasectomy
28
Advantages of vasectomy
ADVANTAGES: Highly effective, non-hormonal. Preformed in clinic with local anesthetic. Cost effective No effect on sexual function
29
disadvantages of vasectomy
``` DISADVANTAGES Takes 2-4 months for effectiveness Requires f/u Post-procedure discomfort, short term Procedure complications: infection, hematoma, granulation, swelling, persistent pain Non-reversible Not STI protection ```
30
surgery to remove or interrupt patency of fallopian tubes Multiple methods ½ sterilizations completed 48hrs postpartum
Female Sterilization`
31
Advantages of Female Sterilization procedure
Decreased risk of ovarian cancer | No change in menstrual bleeding or pain
32
DISADVANTAGES of Female Sterilization` procedure
Regret Invasive surgical procedure Not STTI protection Complications: Infection, wound separation; hemorrhage viscus injury, anesthesia complications. Vessel injury, mortality CI: obesity, issues with anesthesia, adhesive disease from prior injury
33
Surge in prolactin inhibits ovulation Must be exclusively breastfeeding When menstrual cycle returns patient is fertile, often women ovulates before the return of menses Effective until baby 6 months old
Lactational Amenorrhea Method (LAM) AKA Breastfeeding
34
Fertility beads, calendar methods, cervical mucus, basal body temp method, etc. that help women ID time they are ovulating Monitor cycle, needs to be regular for this to work First year failure rate 12-15% Can be used to help couples become pregnant
Fertility Awareness Methods (FAM)
35
decreased risk of cervical cancer, PID, infertility, STI, and ectopic pregnancy
Male condoms
36
higher failure rate, bulky; makes noise. Can be inserted up to 8hrs before intercourse
Female Condom
37
placed anytime before intercourse, left in for 6-8 hours (up to 48hrs) after intercourse. Used with spermicide. Require fitting, less convenient, less effective after childbirth Dis: No STI protection. These can develop an odor, may be difficult to insert, may increase UTI
Cervical caps and diaphragms
38
sponge filled with spermicide, left in place 6-24 hours after intercourse
Contraceptive Sponge
39
higher failure rate when used alone. Attack sperm to reduce motility. Women HIV positive or at high risk of HIV should NOT use! Some forms require 15 mins before effectiveness Unpleasant taste, irritation possible
Spermicides
40
Coitus Interruptus
Withdrawal method
41
MOA is spermicide Copper ions inhibit sperm motility. Sperm rarely reach fallopian tube NOT considered an abortifacient and does not prevent ovulation Effective for 10-12 years possible/probable protection against cervical/endometrial cancer Rapid return to fertility after removal DISADVANTAGES- may worsen dysmenorrhea
ParaGard Copper IUD
42
Causes cervical mucus to thicken, preventing sperm from entering the reproductive tract May inhibit ovulation in 40% of women
Progesterone-Only BC Methods
43
Taken daily, no hormone-free days Contains no estrogen Cost is higher than combined; used less in US Thickening of cervical mucus occurs 2-4 hours after taking pills and lasts 22 hours (if intercourse occurs within 2 hrs of taking pill it is not as effective) Must take pill same time everyday Need back up method for first 2 days
Mini-Pills/POPS
44
Advantages of Mini-Pills/POPS
``` ↓ menstrual blood loss, cramps, pain 10% amenorrhea May protect against endometrial cancer Rapid return to fertility Poss. reduction in PID No estrogen May be used for smoker over 35 May be used while breastfeeding No thromboembolic complications ```
45
Disadvantages of Mini-Pills/POPS
Irregular menses; amenorrhea- increased spotting days May lead to higher incidence of ovarian follicles No STI protection Unforgiving if pill is late or missed AVOID with active hepatitis, hepatic failure, or jaundice CI if taking meds that enhance hepatic clearance (CYP450) Do not use if conditions that may impair absorption from GI tract (ie coitis) NO Grapefruit juice
46
IM injection q13 weeks OR SQ injection q14 weeks at home
DMPA Injection: Depo
47
``` MOA: suppresses ovulation by inhibiting LH and FSH surge Thickens cervical mucus Slows tubal and endometrial activity Thins lining of endometrium ``` Low failure rate (0.2-6%) Costs 4x greater than pills High discontinuation rate Preferred start within 7 days LMP (no backup needed) If started in different point in cycle need backup for 7 days
DMPA Injection: Depo
48
Advantages DMPA Injection: Depo
Less menstrual blood loss and anemia ↓ menstrual cramps and pain After 1 yr, 50% have amenorrhea, 80% after 5 yrs Allows for spontaneity Reduces endometrial cancer risk ↓ blood loss for women with fibroids Good option if anticoagulated or bleeding disorder Good option if taking anticonvulsant (may decrease seizures) Good option for developmentally and/or physically challenged Sig. reduction of ectopic pregnancies Some reduction PID Private method May be used while breastfeeding
49
disadvantages DMPA Injection: Depo
``` Irregular bleeding and spotting * Return to fertility may be delayed (several years) No STI protection Need to return to clinic for injections Potential for ↓ BMD If used longer than 2 years Reversible when d/c’ed Encourage weight -bearing exercise, optimal calcium intake, don’t smoke SE: HA, acne, hirsutism May experience breast tenderness, bloating, and vasomotor sx Modest weight gain Metabolic effects: Increased glucose & LDL Decrease HDL ```
50
Single implant under skin of upper arm 82% continue to use over 2 years Effective for at least 3 years No studies evaluating failure rates Anti Seizure medications may lower effectiveness Primary MOA: cervical mucus thickening, may also inhibit ovulation Thins endometrium Insertion within 7 days of LMP= no backup; otherwise 7 days of backup Advantages and Disadvantages similar to all other progestin only methods
Implanon and Nexplanon (Newer version- radiopaque)
51
Primary MOA: thicken cervical mucus and prevent sperm from entering reproductive tract Changes in uterotubal fluid can impair sperm motility and ovum migration
Levonorgestrel Intrauterine Systems
52
The 52 mg have some anovulatory effects Does not impact implantation and is not an abortifacient Highly effective, low failure rate If inserted within 7 days of LMP no backup needed Can be used in nulliparous women Can be used in women with multiple partners (concerns for PID d/t string)
Levonorgestrel Intrauterine Systems
53
Mirena: ___ years, ___ mg levonorgestrel Skyla: ___ years , ___ mg levonorgestrel → lower progesterone marketed for nulliparous women Liletta: ___ yrs, ___ mg levonorgestrel Kyleena: ___ years, ___ mg levonorgestrel
Mirena: 7 years, 52 mg levonorgestrel Skyla: 3 years , 13.5 mg levonorgestrel → lower progesterone marketed for nulliparous women Liletta: 3 yrs, 52 mg levonorgestrel Kyleena: 5 years, 19.5mg levonorgestrel
54
PAINS
early warning signs of concerns P: period late (copper IUD), abnormal spotting or bleeding beyond expected A: abd. pain, pain w intercourse I: infection exposure (STI), abnormal vaginal discharge N: not feeling well , fever chills S: string missing or shorter
55
MOA: prevention of ovulation by suppression of FSH and LH secretion Endometrial lining is kept thin Cervical mucus thickens Tubal motility is slowed The 7 placebo pills at the end of the pill pack is a withdrawal bleed, not a period
Combined Hormonal Contraceptives
56
what kind of women should NOT use spermicides?
women at high risk of HIV or who are HIV positive
57
Advantages of Combined Hormonal Contraceptives
↓ blood loss and anemia Can manipulate frequency and timing of bleeding Can ↓ risk of internal hemorrhage from ovulation in women on anticoagulants or with bleeding disorders Can provide progestin for women with anovulation/PCOS to reduce risk of endometrial cancer Allows for sexual spontaneity ↓ risk ovarian, endometrial, and colorectal cancer ↓ risk of benign breast masses; reduced risk of corpus luteum cysts (ovarian) May improve acne (takes up to 6 mos) ↓ vasomotor sx for perimenopausal women Possible ↑ BMD
58
Disadvantages of Combined Hormonal Contraceptives
May spot during first few cycles Lack of withdrawal bleeding can cause concern ↓ libido and anorgasmia are possible Daily pill taking Not as private as other methods No ↑ risk for squamous cell cervical carcinoma, BUT ↑ risk of adenocarcinoma; recommend routine PAP testing ↑ risk of hepatocellular carcinoma in COC users with > 50 ug formulation No protection from STI SE: n/v, weight gain, HA, bloating, breast tenderness, chloasma, varicosities and spider veins
59
COC
Combined Oral Contraceptives
60
COC Complications:
VTE; less risk than when pregnant. Risk is lower with estrogen doses <35mcg MI or stroke: no increased risk using low dose, do not smoke, do not have HTN, and do not have migraines with neurological findings Women at risk: smokers over 35, HTN, DM, dyslipidemia, obesity, migraines with aura (stroke only) HTN : 1% of users develop. Self-corrects 1-3 months after d/c Cholelithiasis: Greater risk with 50mcg estrogen formulations. Use cautiously in gallbladder disease Visual changes: rare retinal thrombosis. Contact lenses may have dry eyes
61
ACHES Mnemonic → warning signs when on COC
``` A- abdominal pain C- chest pain H- headaches E- eye changes S- Severe leg pain ```
62
Initiation of COC: Typical start Sunday start Quick start
No pelvic exam needed prior to initiation if asymptomatic Typical start → first day of next menses, no backup needed Sunday start → first Sunday after start of menses. Backup needed 7 days Quick start → preferred method. Backup needed for 7 days
63
when does ovulation occur in menstrual cycle?
surge of FSH and LH This is where combined hormonal contraceptives work
64
Maintains steady state of hormones, unike COCs, which peak and wane daily one ring up to 42 days Can be removed for intercourse if reinserted within 3 hrs
Vaginal Contraceptive Ring (Nuvaring)
65
Advantages of Vaginal Contraceptive Ring (Nuvaring)
``` No concerns r/t GI absorption Less withdrawal bleeding and spotting Irregular bleeding risk low ↑ compliance Typically not felt Lowest serum estrogen and progestin levels of any combined hormonal method privacy Little weight gain ```
66
Disadvantages of Vaginal Contraceptive Ring (Nuvaring)
Withdrawal bleeding may continue past ring-free interval (spotting) May be uncomfortable with placing and removing Low risk of expulsion
67
Advantages of Weekly Patch (Xulane)
No concerns r/t GI absorption No daily pill May bathe, swim, etc Active up to 9 days
68
Disadvantages of Weekly Patch (Xulane)
``` 20% breakthrough bleeding first cycle No STI protection Application site detachment or skin irritation Potential for skin pigment changes Breast discomfort may be higher WARNING: higher concentrations of circulating estrogen at steady state than COCs 60% higher than with women on 35 mcg EE Increased risk of VTE and CV events Risk estimated to be doubled! ```
69
Failure rate slightly higher than other methods Miss 1 pill in 24-48 hrs; just take another Miss more than 2, use backup method
Combined Oral Contraceptives “The Pill”
70
same levels of estrogen and progesterone in each pill → PREFERRED
Monophasic
71
amounts of estrogen and progesterone varies
Multiphasic
72
Progestin only option when contraception failed or was not used Behind the counter If under 18 → require prescription NOT an abortion pill MOA: Delay or inhibition of ovulation Take as soon as possible, up to 5 days after intercourse
Emergency Contraception → Plan B
73
Regular vs. Extended Use Contraception
Extended use: delay of withdrawal bleeding longer than 28 days No need for withdrawal bleed week Less likelihood of ovulation. Less risk of pregnancy Decreased missed days of work Avoids s/s a/w hormone withdrawal period

FNP 1 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions