Ch.24 Gynecologicemergencies Flashcards
Outer fleshy “lips” covered with pubic hair that protects the vagina
Labia majora
Inner fleshy “lips” devoid of pubic hair that protect the vagina
Labia minora
The area of skin between the vagina and the anus
Perineum
In terms of internal structures, the __ are the primary female reproductive organ
Ovaries
The __ are located on each side of the lower abdomen and produce an ovum, or egg, that, if fertilized, will develop into a fetus
Ovaries
The __ connect each ovary to the uterus
Fallopian tubes
The __ is the muscular organ where the fetus grows during pregnancy
Uterus
The narrowest portion of the uterus, the __, opens into the vagina
Cervix
The __ is the outermost cavity of a woman reproductive system and forms the lower part of the birth canal
Vagina
The tubes that connect each ovary with the uterus and are the primary location for fertilization of the ovum
Fallopian tubes
The muscular organ where the fetus grows; also called the womb; responsible for contractions during labor
Uterus
The lower third, or neck, of the uterus
Cervix
When a female reaches_, she begins to ovulate and experience menstruation
puberty
Is the cycle in which the ovum is released
Ovulation
The process in which an ovum is released from a follicle
Ovulation
The onset of menstruation is called ___ and usually occurs between the ages of 11 and 16
Menarche
The first menstrual cycle or onset of the first menstrual bleeding in females
Menarche
Any female who has reached __ is capable of becoming pregnant
Menarche
Women continue to experience the cycle of ovulation and menstruation until they reach__, which marks the end of menstrual activity. Women reach___ at widely varying ages, but it commonly occurs around the age of 50 years.
menopause
The cessation of menstruation, typically in the fourth or fifth decade of life
Menopause
Each ovary produces an ovum during each menstrual cycle, although not necessarily in an orderly pattern that alternates back and forth between each ovary, and releases it into the__. Some women experience minor cramping pain during ovulation when an ovum is released. The pain is sometimes described as a dull pain on one side of the lower abdomen.
fallopian tube
The process of fertilization begins in the vagina, where sperm from the male penis are deposited in the female reproductive tract. The sperm pass through the cervix into the uterus and eventually up the fallopian tubes. As the ovum moves slowly down the fallopian tube, sperm moving up the tube can surround it, and one sperm fertilizes it. When an ovum is fertilized in the fallopian tube, the developing____ travels into the uterus, where the lining of the walls of the uterus has become engorged with blood in anticipation of receiving a fertilized ovum. Here, the___ attaches to the uterine wall and continues to grow.
embryo
The early stage of development after the fertilization of the egg (first 10 weeks)
Embryo
If the ovum is not fertilized in the fallopian tube, it continues to travel into the uterus. When fertilization has not occurred within about 14 days of ovulation, the lining of the uterus begins to separate and menstruation occurs. The menstrual flow consists of blood from the separated lining of the uterus and lasts about 1 week. Female___ produced primarily in the ovaries control the process of ovulation and menstruation.
hormones
____is an infection of the upper female reproductive organs specifically, the uterus, ovaries, and fallopian tubes -that occurs almost exclusively in sexually active women. Disease-causing organisms enter the vagina during sexual activity and migrate through the opening of the cervix and into the uterine cavity. The infection may then expand to the fallopian tubes and can cause scarring that can increase the risk of life-threatening conditions such as ectopic pregnancy or sterility. If the ovaries are affected, it can lead to the development of a life-threatening abscess. Although___ itself is seldom a threat to life, it can lead to an ectopic pregnancy or an abscess, which can cause death. Ectopic pregnancy is a pregnancy that develops outside the uterus, most often in the fallopian tube. The most common presenting sign of___ is generalized lower abdominal pain. Other signs and symptoms include an abnormal and often foul-smelling vaginal discharge, increased pain during sexual intercourse, fever, general malaise, and nausea and vomiting. Risk factors associated with___ include having multiple sex partners and/or a partner who has had sex with multiple people, having an untreated sexually transmitted disease, having a past history of__, being sexually active, being younger than 26 years, douching, and using an intrauterine device for birth control.
Pelvic inflammatory disease (PID)
An infection of the fallopian tubes and the surrounding tissues of the pelvis
Pelvic inflammatory disease
A pregnancy that develops outside the uterus, typically in a fallopian tube
Ectopic pregnancy
____is caused by the bacterium Chlamydia trachomatis. According to the Centers for Disease Control and Prevention (CDC),___ is currently the most commonly reported sexually transmitted disease in the United States.
Although the symptoms of___ are usually mild or absent, some women may report lower abdominal pain, low back pain, nausea, fever, pain during sexual intercourse, and/or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum, leading to rectal pain, discharge, or bleeding. If it is left untreated, the disease can progress to PID. In rare cases,___ causes arthritis that may be accompanied by skin lesions and inflammation of the eye and urethra
Chlamydia
_____is the most common vaginal infection in women age 15 to 44 years, according to the CDC. In this infection, normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms. Symptoms may include itching, burning, or pain and may be accompanied by a “fishy,” foul-smelling discharge. Pregnant women with____ may have premature babies or babies born with low birth weight. If it is left untreated,____ can lead to more serious infections or result in PID.
Bacterial vaginosis
____is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply rapidly in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women and in the urethra in women and men.
The bacterium can also grow in the mouth, throat, eyes, and anus. Symptoms, which are generally more severe in men than in women, appear approximately 2 to 10 days after exposure. Women may be infected with___ for months but not have any symptoms, or only mild ones, until the infection has spread to other parts of the reproductive system. When symptoms do appear in women, they generally present as painful urination, with associated burning or itching; a yellowish or bloody vaginal discharge, usually with a foul odor; and blood associated with vaginal sexual intercourse. More severe infections may present with cramping and abdominal pain, nausea and vomiting, and bleeding between menstrual periods; these symptoms indicate that the infection has progressed to PID. Rectal infections generally present with anal discharge and itching and occasional painful bowel movements with fecal blood spotting. Infection of the throat (for which oral sex is the introducing factor) usually results in mild symptoms consisting of painful or difficult swallowing, sore throat, swollen lymph glands, and fever. Headache and nasal congestion may also be present. If the infection is not treated, the bacterium may enter the bloodstream and spread to other parts of the body, including the brain.
Gonorrhea
Because menstrual bleeding occurs monthly in most women, vaginal bleeding that is the result of other causes may initially be overlooked. Some possible causes of vaginal bleeding include abnormal menstruation, vaginal trauma, ectopic pregnancy, spontaneous abortion (miscarriage), cervical polyps, and cancer. Trauma to the internal female genitalia from any cause other than vaginal penetration is rare because these organs are located deep within the pelvis. Injuries to the vagina and external genitalia are painful and serious because of the large number of nerves and blood vessels in this area.
In contrast, internal bleeding from polyps or cancer, while also serious, may be relatively painless.
Ectopic pregnancy and spontaneous abortion are two conditions that can cause vaginal bleeding in women early in pregnancy who may not realize they are pregnant. These potentially life-threatening conditions are covered in Chapter 34, Obstetrics and Neonatal Care. All cases of vaginal bleeding should be taken seriously, and the patient should be evaluated by a physician for a thorough gynecologic examination.
Vaginal bleeding
The loss of a pregnancy prior to 20 weeks of gestation without any preceding surgical or medical intervention. Often called a miscarriage
Spontaneous abortion
The spontaneous passage of the fetus and placenta before 20 weeks; also called spontaneous abortion
Miscarriage
An old medical axiom states,
“Anyone who neglects to consider a gynecologic cause in a woman of childbearing age who reports abdominal pain will miss the diagnosis at least___ of the time.” Missing the diagnosis may be fatal for the patient.
50%
Excessive internal vaginal bleeding can have many causes and can possibly lead to ___ or shock
Hypoperfusion
Determining the cause of the bleeding should be considered less important than treating for___ and transporting the patient to an appropriate facility. Use sanitary pads on the external genitalia to absorb the blood. Most women will use sanitary pads before you arrive, so you may continue that approach. Document the number of sanitary pads that were saturated with blood.
If the woman has a tampon in place, it is not necessary to have her remove it. Vaginal bleeding is rarely significant enough to cause hemorrhagic__, but the patient should be treated for____ nevertheless. Apply oxygen, keep the patient supine and warm, and promptly transport to the hospital.
shock
The genitals have a rich nerve supply, making injuries very painful. Treat any external lacerations, abrasions, and tears with_____, using local pressure to control bleeding and a diaper-type bandage to hold the dressings in place.
Leave any foreign bodies in place after stabilizing them with bandages. Under no circumstances should you pack or place dressings inside the vagina. Continue to assess the patient while transporting her to the ED. Contusions and other blunt trauma will require careful in-hospital evaluation.
sterile compresses
A patient with___ will report abdominal pain. The pain generally starts during or after normal menstruation, so inquiring about the date of the patient’s last menstrual period is an important detail of the patient’s history. The pain may be described as achey and may be made worse by walking. Other symptoms may include vaginal discharge, fever and chills, and pain or burning on urination. Patients often present with a distinctive gait that appears as a shuffle when they walk.
Prehospital treatment is limited, and nonemergency transport is usually recommended. As stated earlier,___ itself is
seldom life threatening, but it is serious enough to require transport and evaluation in the hospital.
PID
An attack against a person that is sexual in nature, the most common of which is rape
Sexual assault
Unfortunately,_____ and rape are all too common occurrences. According to a government survey, approximately 18% of women (or 1 in 5) in the United States reported being raped during their lifetime, and 1 in every 3 have been sexually abused in some form, often before the age of 12 years. EMTs called to treat a victim of____, sexual abuse, or actual or alleged rape face many complex issues, ranging from obvious medical ones to serious psychological and legal issues. You may be the first person the victim has contact with after the encounter, and how you manage the situation from first contact throughout treatment and transport may have a lasting effect for the patient and you. Being professional, respectful, and sensitive is important.
sexual assault
When performing your assessment, be aware of information suggesting the potential use of date rape or club drugs. The patient may or may not be aware of the use of drugs in the assault but an inability to remember the event should create suspicion. While alcohol is the most frequently used date rape drug, drugs such as Rohypnol (flunitrazepam), known as_______; GHB (gamma-hydroxybutyric acid), known as Liquid Ecstasy; Ketalar (ketamine), known as Special K; Klonopin (clonazepam; MDMA, known as Ecstasy; and Xanax (alprazolam) are drugs typically used during sexual assault and rape for the intended purpose of incapacitating a person.
roofies
Last, remember that you are at a crime scene and the victim’s body is part of that crime scene. Although your job is to treat the medical aspects of the incident and not to collect evidence, you still have a responsibility to preserve evidence. Do not cut through any clothing or throw away anything from the scene. Place bloodstained clothing and anything else that could be evidence in separate___ (not plastic) bags. Obtain evidence bags from the police if necessary. _____allow wet items to dry naturally, whereas plastic allows mold to grow and may destroy biologic evidence.
Paper bags
