chapter 16 female reproduction

Question 1

bartholin’s glands

Answer 1

• 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

Question 2

cystocele

Answer 2

prolapse of anterior vaginal wall and bladder

will see pouching when client strains

Question 3

rectocele

Answer 3

prolapse of posterior vaginal wall and rectum

will see pouching on posterior wall

Question 4

uterine prolapse

Answer 4

cervix at introitus
cervix outside of introitus
whole uterus is outside of introitus -vagina is turned inside out when client strains

Question 5

vaginal environment

Answer 5

• 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

Question 6

trichomonas

Answer 6

• 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

Question 7

bacterial vaginosis

Answer 7

• 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

Question 8

candida vaginitis

Answer 8

• 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

Question 9

lactobacillus

Answer 9

-can overgrow
causes discharge and itching
-often not distinguishable from candida
-look under microscope or send culture
-tx: restore pH
-u/a

Question 10

skene’s glands

Answer 10

-during bimanual exam should not be able to excrete discharge from urethra-if so culture-could be nongonoccocal urethritis

Question 11

prenatal assessment

overall changes to thyroid & cardiovascular

Answer 11

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 down

Question 12

prenatal assessment

overall changes in respiratory

Answer 12

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

Question 13

prenatal assessment

overall changes to musculoskeletal

Answer 13

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

Question 14

prenatal assessment

overall changes in abdomen

Answer 14

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

Question 15

prenatal assessment

overall change in skin

Answer 15

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

Question 16

prenatal assessment

overall changes in reproductive system

Answer 16

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

Question 17

gravity and parity

Answer 17

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

Question 18

Naegle’s rule

Answer 18

used to establish estimated date of delivery

LMP + 7 days -3 months

Question 19

Hegar’s sign

Answer 19

pregnancy sign

softening of uterine segment

Question 20

piskacek’s sign

Answer 20

pregnancy sign

asymmetrical soft enlargement of one uterine cornu

Question 21

chadwick’s sign

Answer 21

pregnancy sign

bluish color of cervix/vagina

Question 22

goodell’s sign

Answer 22

pregnancy sign

softening of cervix