chapter 16 female reproduction Flashcards
bartholin’s glands
- located at 4 and 8 o’clock to vaginal introitus
- secretes fluid during intercourse
- should not be able to palapate if enlarged will cause pain
cystocele
prolapse of anterior vaginal wall and bladder
will see pouching when client strains
rectocele
prolapse of posterior vaginal wall and rectum
will see pouching on posterior wall
uterine prolapse
cervix at introitus
cervix outside of introitus
whole uterus is outside of introitus -vagina is turned inside out when client strains
vaginal environment
- delicate ecosystem-easily unbalanced
- pH 3.8-4.2
- first line of defense
- maintained by metabolism of glycogen to lactic acid in vagina by lactobacilli
- normal vaginal discharge is clear/white odorless
trichomonas
- protozoa-small animal
- greenish discharge with foul odor
- may be copious amounts of discharge
- cervix: strawberry d/t irritation
- 2 gm flagyl in single dose-use condoms until both partners treated
bacterial vaginosis
- caused by bacteria normally found in vagina
- odor, pasty grey discharge
- not STI
- may cause itching
- sticks to cervix and vaginal wall
- 50% of women are asymptomatic
- flagyl 500 mg BID for 7 days or 2gm one dose, vaginal creams
candida vaginitis
- albicans most prevalent
- extreme itching/burning
- vulva irritated and reddened
- vagina-thick, clumpy, white discharge, may stick to cervix
- caused by any condition that raises sugar availability-pregnancy, diabetes or caused by depressed cellular immunity
- not sexually transmitted
lactobacillus
-can overgrow causes discharge and itching -often not distinguishable from candida -look under microscope or send culture -tx: restore pH -u/a
skene’s glands
-during bimanual exam should not be able to excrete discharge from urethra-if so culture-could be nongonoccocal urethritis
prenatal assessment
overall changes to thyroid & cardiovascular
overall physical changes:
thyroid-50% enlarged
cardiovascular: 45% increase blood volume
CO 30% increase
-low grade systolic murmur grade 2
HR increase 10 beats/min
BP unchanged
venous pressure increase in lower extremities esp sitting, standing, or laying downprenatal assessment
overall changes in respiratory
respiratory: tidal volume increase
RR increases slightly
O2 consumption increases 20%
thorax widens at base
respiration changes from abdomen to thoracic
dyspnea common
hyperemia and edema of tissues in resp. tract
prenatal assessment
overall changes to musculoskeletal
musculoskeletal: pelvic joints relax-relaxin from ovaries causing hip and pelvic joint pain
change in posture-pulling on back and abd. muscles
abd pn from stretched ligaments
lower back pain and fatigue
less stable balance from 24th week on
prenatal assessment
overall changes in abdomen
muscle stretch
may cause striae
tone diminished in rectus abdomis muscles-may separate
diastasis recti abdomins: abdominal contents to protrude into midline of abdomen-no itervention
prenatal assessment
overall change in skin
melanocytes-active generalized darkening of skin linea nigra chloasma-mask of pregnancy scars/moles-may darken spider nevi-face and upper trunk hypertrophy of gums hair may straighten, oily, curly; loss or increased thickness increase facial/abdominal hair
prenatal assessment
overall changes in reproductive system
breasts: starting at 8 wks
- darken and larger nipples
- sebaceous glands-montgomery tubercles-hypertrophy
- hypertrophy of breast tissue, tenderness-can be severe
- colostrum-may be expressed at 24 wks
- striae on breasts
uterus: hypertrophy 5-6 x
- weight 20x
- capacity up to 5000ml
- hormones stimulate uterine hypertrophy
cervix: hypertrophy of glands in cervical canal
- softening of cervix
- bluish discoloration-increased pelvic vascularity
vagina: mucosa thickens
- connective tissue less dense
- muscular tissue hypertrophy
- secrete more mucous d/t hypertrophy glands
- total vaginal discharge increases and more acidic
gravity and parity
G: total # of pregnancies T: # of full term births P:# of pre-term births (21-37 wks) A: # of abortions (terminated before 20 wks) L: # of living children
Naegle’s rule
used to establish estimated date of delivery
LMP + 7 days -3 months
Hegar’s sign
pregnancy sign
softening of uterine segment
piskacek’s sign
pregnancy sign
asymmetrical soft enlargement of one uterine cornu
chadwick’s sign
pregnancy sign
bluish color of cervix/vagina
goodell’s sign
pregnancy sign
softening of cervix
