Ebook chapters Flashcards
who should be doing breast self exams
all women over 20
when should breast self exams be performed
it should be performed one week after menstrual cycle and every month to identify changes, can result in a lot of false positives
how is a breast self exam performed
lay on back with right arm behind head using pads of three middle fingers on left hand feel for lumps and right breast move around the breast up and down patterns repeat on the left breast lastly stand in front of a mirror with hands firmly pressed down on hips and assess for changes in shape size contour dimpling redness of nipples/breast
who should be getting clinical breast exam
All women over 25 should be getting clinical breast exams it should be performed every 1-3 years for 25 to 39 year olds then yearly after age 40
who performs clinical breast exams
HCP is needed to perform this because they are trained and specialized in identifying specific breast masses
who gets mamographys and when
It is an individual decision with health care provider based on history and risk for women under 50 and after 50 all women should get one the week after menstrual cycle is the best time,
what is the purpose of mamography
performed because it can detect things before they are palpable
what is the purpose of papsmear and who gets them
Screens for cervical cancer women over 21 to 29 should get one every three years women 30 to 65 should get it every three to five years women over 65 do not need it unless other risk factors are involved
what is amenorrhea
absene of menstration
what is primary amenorrhea
lack of menstration by age 15
what is secondary ammenorrhea
absence of menstral cycle for over 3 months
what could be some causes of ammenorrhea
could be pregnancy, postpartum, lactation, menopause, medications, hormonal imbalances, anorexia, excessive exercising, stress, disease so treatment depends on cause
what is dysmenorrhea
painful cramping in uterus during menstration
what are the ss of primary dysmenorrhea
lower abdominal pain radiating to lower back or legs, headache, n/v, diarrhea, irritability, fatigue, depression
what is secondary dysmenorrhea
pain often occurs after age 20 and associated with GYN conditions (endometriosis, fibroids)
what is the treatment for dysmenorrhea
relaxation, heat, exercise, NSAIDs
who does PMS normally affect
teens
what are the ss of PMS
irritability, mood changes, fluid retention
what is the cause of PMS
normal fluctuation of estrogen and progesterone, hyperprolactinemia, alterations and carbohydrate metabolism
how do you treat PMS
reduce signs and symptoms - 60 minutes or more of physical activity daily, eat well balanced diet, decrease intake of salt, caffeine, sugar, diuretics, NSAIDs, hormonal contraceptives
what is menorrhagia
excess bleeding, 80ml or more lasting greater then 7 days
what is metorrhagia
bleeding at abnormal times during cycle, vaginal bleeding more often then every 21 days
what is menometrohagia
combo of menorrhagia and metororrhagia
what is plymenorrhea
bleeding that occurs at short intervals (less then 21 days)
what is oligomenorrhea
bleeding occurring less frequently then every 35 days
what is postcoital bleeding
bleeding after intercourse
what is spinnberkeit mucus
elasticity of cervical mucus increases (as it reaches closer to ovulation) measure between finger – 8-10cm
what is mittelschemerz mucus
pain/discomfort in lower abdomen on the side that is releasing ovary/ovulation
what is climacteric phase of cessation of menstrual cycle
decline in ovarian function, loss of estrogen and progesterone as age
what is postmenopausal phase of cessation of mensural cycle
proceeding menopause, many cycles during perimenopause are anovulatory
what is menopause
last menstrual period
what is postmenopausal phase
cessation of menstrual cycles for one year usually occurs between 40 and 58 years old
what is peri/postmenopausal characteristics
vasomotor instability (hot flashes ,night sweats), vaginal dryness, decrease in pubic and axillary hair, skin changes (hypo/hyper pigmentation, decreased sweat glands, skin and hair thins), bone thinning/ osteoporosis, anxiety, depression, irritability, libido changes, insomnia
what is contraceptive behavioral method: natural family planning
patient IDs fertile time and avoids intercourse during this time every cycle
what is contraceptive behavioral method: basal body temp
body temp changes used to detect fertile period, Take temp when awaken in the morning same time daily, slight drop then slight raise at ovulation and remains elevated for half of cycle, it’s easier to predict when ovulation has already occurred so it’s too late for birth control
what is contraceptive behavioral method: cervical mucus “billings method”
track changes in cervical mucus
what interferes with billings method
vaginal infection, sexual arousal, recent coitus, antihistamines
what is contraceptive behavioral method: calander/rhythm method
based on fact that ovulation occurs every 14 days before menstrual cycle
what is contraceptive behavioral method: Marquette method
ovulation predictor kits to assess surge in LH occurring 24 to 36 hours before ovulation
what is contraceptive behavioral method: Coitus interruptus
the withdrawal method, a male withdrawing before ejaculation, issues are pre-ejaculation includes sperm, sometimes they can’t withdraw/it’s too late
what is contraceptive behavioral method: Lactational amenorrhea method
most effectively used in underdeveloped countries where moms can only exclusively breastfeed, they must meet three conditions: exclusively breastfed, no menstrual period since giving birth, infant is less than six months old, the issue is you won’t know when you’ve ovulated
what is a barrier method and what is an issue with it
block sperm from reaching ovum, some can protect from STIs – issue is that it requires pre planning before intercourse, or possible latex allergy
how does a cervical cap barrier method work and what is the teach involved
similar to diaphragm but smaller more difficult to place it cannot remain in place for more than 48 hours
how does a contraceptive sponge work and how effective is it
a single use vaginal spermicide fits over the cervix it is 73 to 86% effective it is removed before 30 hours
when should you not use a contraceptive sponge
do not use during menstruation, immediately after abortion or childbirth, or a history of toxic shock syndrome
what is the failure rate for condoms and what is the teaching involved
male condom failure rate is 13%, lubricants you can use with condoms are water soluble, oil based lubricants can break down latex, female condoms are made of polyurethane it is a sheath with rings on each side closed and inserted into vagina and anchored at cervix its failure rate is 20%
what is spermicide and what is the teaching involved
gels, creams, foams, films, suppositories inserted into vagina before 10-15min intercourse it is used to destroy sperm failure rate is 20%
how does hormonal methods work for contraceptives
works by preventing ovulation, thickening cervical mucus to prevent sperm penetration
how do OCPs work and how effective are they
effective 93% of the time take for 21 days and stop or take placebo for seven days
how do estrogen only OCPs work
prevents release of FSH therefore ovulation prevented
how do progestin only OCPs work
“minipill” - thickened cervical mucus often used for breastfeeding moms take at same time every day no days off
how do estrogen and progestorne OCPs work
inhibit LH surge required for ovulation
what are side effects of OCPs
ACHES: abdominal pain, chest pain/shortness of air, headache sudden or persistent, eye problems, severe leg pain other side effects include hypertension, migraines, sickle cell, gallbladder disease
what are contraindications of OCPs
smoking and over 35 years old, DM and over 20 years old, migraines known or suspected breast cancer, DVT
what should you teach when someone is taking an OCP
antibiotics and TB meds decrease effectiveness
how effective is a transdermal contraceptive patch and how does it work
delivers low levels estrogen and progestin absorbed into skin it’s effective 93% of the time applied once a week for three weeks then one week patch free when you would have a cycle can be applied to abdomen buttocks upper outer arm or upper torso
how does a vaginal contraceptive ring and how effective is it
estrogen and progestin effective 97% of the time it’s inserted deep into vagina by fifth day of menstrual cycle and remains three weeks and removed one week for menstrual cycle
how does injectable hormonal contraceptive work
depo-provera - progestin only I am or SQ injection every three months do not massage, first shot within five to seven days of cycle
what are some side effects of injectable hormonal contraceptives
regular bleeding for a few months then amienorrhea, weight gain, headaches, depression, temporary and reversible decreased bone mineral density
how does a subdermal hormonal implant (nexplanon) work and how effective is it
affective 99.9% of the time it’s good for three years contains progestin and barium to be able to see on an X-ray insert at any time in the cycle
what are some side effects of subdermal hormonal implant
bleeding irregularly for a few months then amenorrhea, weight gain, headache, nausea, abdominal pain, loss of libido, vaginal dryness
how do intrauterine devices work and how effective are they
devices inserted into uterus for five to 10 years effective 99% of the time, they create a hostile environment for sperm can be inserted anytime in the cycle (Skyla inserted first seven days of cycle
what are some contraindications of intrauterine devices
contraindications include active pelvic infection, endometritis, pelvic tuberculosis
how long after can you use plan b
120 hours
what are side effects of emergency contraceptives
include bleeding, n/v, headaches, dizziness, fatigue usually resolves in 24 hours you have a 1.2 to 2.1% of still getting pregnant
how does a vasectomy work
small incision and scrotum, vas deferens ligated to interrupt passage of sperm, semen no longer contains sperm, can you use this as only contraceptive for one to three months need 2 ejaculations samples without sperm this performed in an office under local anesthesia with minimal complications
what are the effects of STIs
fallopian tube blockage, increased risk for ectopic pregnancy, chronic pelvic pain, increased liver cancer, death it affects one in five Americans
what are risk factors of STIs
sexual interaction, drug use, blood exchange
what is the most common STI and what is it known to cause
Chlamydia most common STI causing preventable infertility an ectopic pregnancy as well as pelvic inflammatory disease and increased risk for HIV
what are ss of chlamydia
asymptomatic, abnormal vaginal bleeding, frequent urination, dysuria, dyspareunia, postcoital bleeding, cervictis
what are maternal/fetal effects of chlamydia
opthalmia neonatorum (Blindness why we give emycin ointment prophylactic at birth)
how do you diagnose chlamydia
nucleic acidamplification testing
what is the treatment for chlamydia
zithromycin 1dose or doxycycline for 7 days
what is the teaching for chlamydia
No intercourse for treatment and seven days after, all partners need to be treated
what is the second most common type of STI
gonorrhea
what are ss of gonorrhea
asymptomatic, dysuria, vaginal bleeding, irregular menstrual cycle, low back ache, urinary frequency, post coiital bleeding
how are people diagnosed with gonorrhea
screening women 25 years or younger at increased risk (Previous gonorrhea infection, current STD, multiple partners
what is treatment for gonorrhea
ceftriaxone 500mg IM plus azithromycin 1 g PO 1 dose or doxycycline 100mg po BID for 7 days
what are maternal newborn effects of gonorrhea
transfer of chlamydia and gonorrhea may occur during childbirth causing eye infection, scalp absence, rhinitis, anorectal infection
what is pelvic inflammatory disease
acute infection of uterus and fallopian tubes untreated can cause scarring which can cause infertility and tubal pregnancy treated with combined drug therapy
what are the risk factors for pelvic inflammatory disease
history multiple sex partners, new partner in past six months, lower age at first intercourse, lower economic status, vaginal douching, smoking
what are the ss of pelvic inflammatory disease
asymptomatic, severe abdomen/uterine/ovarian pain and tenderness, abnormal bleeding/discharge, low back pain, n/v, fever, chills, elevated white blood cell, ESR
what is the risk for syphilis
unsafe sexual practices, history of STD’s, positive syphilis sex partner, incarceration, sex trades
what is the primary stage of syphilis
10-90 days painless appears at point of contact can heal within four to six weeks
what is secondary stage of syphilis
six weeks to six months fever, sore throat, weight loss, skin rash on trunk and extremities, headache, malaise, mucous patches on genitals and mouth, lymphadenopathy, hair loss, moist flat warts and genital and anal areas heals within two to 10 weeks
what is latent phase of syphilis
having infection over two years without clinical evidence
how do you diagnosis syphilis
RPR,VDRL
what is the treatment for syphilis
penicillin G
what are the maternal/newborn effects of syphilis
syphilis can cause serious fetal anomalies, can have congenital syphilis from maternal to fetal transmission
what are the risk for Trichomonas Vaginalis
unsafe multiple sexual partners, previous history of STD’s, history working in sex trade, recent incarceration, poor hygiene, substance abuse
what are the ss of Trichomonas Vaginalis
asymptomatic profuse frothy grey or yellow-green vaginal discharge with foul odor, dysuria, strawberry cervix, dyspareunia
how do you diagnose Trichomonas Vaginalis
wet prep
what is the treatment for Trichomonas Vaginalis
metronidazole (flagy) 2g po 1 dose, or 500mg po BID for 7 days
what is the teaching for trichomonas vaginalis
partner needs to be treated, avoid drinking alcohol until 24 hours after flagy therapy
what are the maternal and newborn risks of trichomonas vaginalis
baby LBW, increased risk for PROM&P TL
what is HPV caused by
cervical cancer
what are the ss of HPV
asymptomatic, warty cauliflower like growths in vaginal area or mouth, tongue, throat, lips it is painless
what are the risk factors for HPV
multiple sex partners, early age of sexual activity, tobacco and alcohol use, pregnancy, weak immune system
how do you diagnose HPV
visual confirmation of lesions
what is the treatment for HPV
medicated ointment, cryotherapy, electrodesiccation, laser treatment to burn off warts, usually about three months of treatment, encourage pap testing related to risk of cervical cancer
how do you prevent HPV
prevention females 9 to 26 year olds and males 11 to 21 year old should receive Gardasil vaccine
how does someone get herpes
causes genital (type 2), oral (type 1) herpes infection transmitted by genital or saliva secretions type one is usually transmitted in childhood via nonsexual contacts like cold sores virus lays dormant until time of immunocompromised or stressful periods
what are the ss of herpes
minimal to none, first outbreak is usually most severe with flu like symptoms, dysuria, painful blisters on genitals, itching, vulvar edema, hevery watery or purulent vaginal discharge
how is herpes diagnosed
patient history and physical exams or serological testing
what is the treatment for herpes
treatment is antivirals they end in VIR
what are the maternla/newborn effects of herpes
cause fatal infection of herpes lesion and genital tract during childbirth
what are the 3 modes of transmission of HIV
Three modes of transmission direct serum exposure (Iv stick, Iv drug use), unprotected intercourse, maternal/fetal transmission – transmitted by blood, semen, vaginal secretions, breast milk
how do you screen for HIV
CDC recommends Opt-out testing (screening everyone unless the opt out) consent must be obtained verbally, ACOG recommends screening women 19-64 and targeted screening for women with risk factors outside the age range
how is HIV diagnosed
ELISA confirmed with westerb blot test there is no cure can do HAART
what is lactobacillus
the dominant bacterial genus maintains vaginal Ph balance (3.8-4.2 during reproductive years)
what are the causes for alterations in vaginal enviorment
: stress, douching, feminine hygiene products, harsh hoops, increase in sugary/caffeine, sexual intercourse, barrier, mathods of contraceptives, synthetic underwear, scented wipes, chronic metabolic conditions (DM)
what are the maternal/fetal effects of bacterial vaginosis
PTL,LBW
how is bacterial vaginosis diagnosed
wet mount, wiff test – amine odor when discharge sample combined with 10% (KOH)
what are the ss of bacterial vaginosis
symtptomatic, thin white or gray discharge with fishy amine odor gets worse with intercourse, or menstral cycle, pain, buring, itching, dysuria
what is the treatment for bacterial vaginosis
metronidazole PO or vaginally – no flagyl with seizures, no alcohol use 24 hours before or after meals, no use during 1st trimester contraindicated in breast feeding
what is an effective abortion
patient request, easier and safer if done in 1st trimester
what is a therapeutic abortion
performed for maternal or fetal health or disease
what are the differnt methods of abortion
- 1st trimester- vaccum aspiration may need cervical dilation with laminaria 2-24 hours before procedure or mechanical cervical dilation needed between 8-12 weeks, can also do meds like methotresate (7-9weeks)
what are the side effects of abortion
cramping 20-30min following procedure
what are the complications of abortion
uterine perforation, cervical lacerations, hemorrhae, infection, 2nd trimester- cervical dilation and evacuation
what lab value needs to be taken after abortion
Hcg
