Exam 1 Flashcards
1
Q
Factors affecting development During
pregnancy
A
Preterm birth
genetic maternal factors (age, race, health status, family history)
Behavioral issues
Nurtition
2
Q
What has the greatest influence on growth and IQ?
A
Nutrition
3
Q
how much folic acid is recommended 1 month before birth?
A
400mcg
4
Q
Erikson’s psychosocial stages
A
trust vs mistrust (0-1)
autonomy vs shame & doubt (1-3)
initiative vs guilt (3-5 yrs)
industry vs inferiority (6-12 yrs)
identity vs role confusion
5
Q
Erikson’s psychosocial stage from 0-1 yr old, infant must learn to trust others to meet their needs so they learn to trust themselves
A
trust vs mistrust
6
Q
Erikson’s psychosocial stage that is from 1-3 yrs old, toddlers demonstrate independence and learn competencies related to self-care “I am a big kid now” can control body functions at this point
A
autonomy vs shame and doubt
7
Q
Erikson’s psychosocial stage that is from 6-12 yrs old, child must learn to master important social and cognitive skills or feel incompetent (following rules and social relationships are important)
A
industry vs inferiority
8
Q
Eriksons psychosocial stage that is from 3-5 yrs old, toddler will learn to initiate activities or become self-critical (know right from wrong)
A
initiative vs guilt
9
Q
Eriksons psychosocial stage that is from 13-20 yrs old, adolescents need to form coherent self-definition or otherwise remain confused about life directions (worried about appearance, what others think, peers are important, establishing their own identity
A
identity vs role confusion
10
Q
piaget cognitive stages
A
Sensorimotor (8-12 months)
sensorimotor/perioperational (2-7 yrs)
concrete operations (7-11 yrs)
formal operations (11-12)
11
Q
Piaget’s cognitive stage from 8-12 months, the infant relies on motor behavior and senses to adapt to the world during first 2 years
A
Sensorimotor
12
Q
Piaget’s cognitive stage from 2-7 yrs, children think symbolically and have not yet mastered logical thinking (golden arches)
A
sensorimotor/perioperational
13
Q
piaget’s cognitive stage from 7-11 yrs, child is able to consider alternative solutions and solve problems
A
concrete operations
14
Q
piaget’s cognitive stage from 11-12 yrs, child thinks systemically and rationally about hypothetical events and abstract concepts
A
formal operations
15
Q
when does the posterior fontanel close?
A
2-3 months
16
Q
in 5-6 months infants weight should _______
A
double
17
Q
in 1 year infants weight should _________
A
triple
18
Q
newborn reflexes
A
stepping
palmer
startle
babinski
moro
gag
sucking
rooting
19
Q
when should baby mature and involuntary reflexes become voluntary?
A
4-6 months
20
Q
head should be ________ length at 1 yr
A
1/4
21
Q
Factors affecting development of children
A
● Environmental factors: adequate nutrition (impacts brain development), living conditions, socioeconomic status, lack of transportation to healthcare facilities, climate
● Family & community stimulating environment, family and community support as it “takes a village to raise a child”
● cultural factors: customs, traditions (nutritional practices, carrying children)
● Media: children are vulnerable to what they see & hear
22
Q
Expected GROWTH during infancy (0-1 yr)
A
o Head ¼ length
o Weight doubles at 5-6 months and triples in 1 yr
o Reflexes
o 6-8 teeth by the end of 1st year
23
Q
Expected motor skills during infancy
A
o Grasp rattle at 4-6 months
o Sits unsupported at 8 months
o Crawls at 8-10 months
o Pincer grasp at 8-12 months
24
Q
Expected sensory milestones for infants
A
o Prefers black and white at birth, geometric designs, and faces
o Touching and hearing at birth
o 4 words by 12 months
25
Expected nutrition for infants
o Breast milk/formula for 12 months
o Wean 2nd 6 months
o Rice cereal and solid food 4-6 months
o 1st teeth at 5-6 months
26
Safety considerations for infants
o back to sleep”
o Rear-facing care seats
o Never leave unattended on table, bed or tub
o Check bath water temp
o Do not prop bottles
o Injury prevention-toys w/o removable parts, falls, poison, ensure parents have poison control #, suffocation, aspiration, burns
27
Expected play for infants
o Solidarity play
o Black and white geometric designs for preemie | newborn mobile
o Sensory, tactile simulation, sounds
o Vocal interaction with people, may “coo” and “babble” in response to talking and singing, mama and dada by 1 yr
o Plays peek-a-boo—evidence of object permanence is developing by 8-12 months
28
Toddler growth milestones
o 50% adult height by 2 yrs
o Anterior fontanel closes by 18 months
o Clumsy; lordosis
29
Motor milestones for toddlers
o Walks without help
o Good hand and finger coordination at 2.5 yrs
o Learning to dress self
30
Sensory milestones for toddlers
o Knows own name by 12 months
o Follows simple directions at 2 years
o Short sentences by 18-24 months
31
Nutrition for toddlers
o Slower growth
o Picky ritualistic eaters
o Avoid larger pieces of food (hotdogs)
o Feeds self by 3 yrs
o 20 teeth by 2-3 yrs
o Begin good dental practices, brushing and dental visit
32
Safety considerations for toddlers
o Car seat rear facing until 1 yr and 20 lbs then can face fron
o Requires constant supervision
o Ensure parents know poison control #
o Injury prevention-falls, poisons, meds (needs to be stored in locked cabinet), suffocation, aspiration
33
Expected play for toddlers
o Parallel play
o Make believe
o Imaginary playmates
o Push and pull toys, wheel toys
o Throws and kick balls
o Repetitive stories, short songs with rhythm
34
Infancy age range
birth to 1 year
35
Toddler age range
1-3 yrs
36
Preschool age range
3-5 yrs
37
Expected growth for a preschooler
more graceful and erect posture
38
Expected motor skills for a preschooler
o Rides tricycle
o Skips and hops at 4 yrs
o Increasing vocabulary and sentences
o Learns to tie shoes, better at dressing and self buttons clothes
39
Sensory expectations for a preschooler
o Visual acuity improves, focus on learning numbers and letters
40
Nutrition for a preschooler
o Food preferences (likes and dislikes)
o By 5 yrs more willing to try new foods
41
Safety considerations for a preschooler
o Car seat until 4 yrs old, 40 lbs then booster seat with seat belt
o Injury prevention- teach safety, traffic, strangers, fire, water, fire arm safety
o Sports safety gear
o Swimming lessons
42
Epected play for a preschooler
o Associative play, plays cars, trains, dolls with friends
o Imitation or pretend play
o Developmental toys, tricycle, legos
o Educational TV, books, puzzles
o “sing alongs”
43
School age age range
6-12 yrs
44
Expected growth in school age children
o Weight gain 5 lbs/yr
o Girls height and weight preceeds boys
o Puberty changes
§ Girls-breast buds
§ Boys-enlarged testicles
o Fast bone growth (greenstick fracture)
45
Epected motor skills in school age children
o Roller skates, blades, ice skates, scooters
o Jump rope
o Bikes
o Foster positive “industry” playing musical instruments and video games
46
Sensory milestones of school age children
o Myopia (nearsightedness) may develop
o Reading
47
Expected nutrition for a school age child
o Risk of obesity
o “Junk foods”
o Secondary sex characteristics
Girls by 10 yrs
Boys by 12 yrs
48
Safety considerations for school age children
o Bike and sports safety
o Firearms
o Smoking education
o Sex education
o Taught to say no to drugs “DARE” programs
49
Expected play for school age children
o Cooperative play
o Comprehend rules of game and team play
o Competition
o Construction toys, legos
o Video and PC games
50
Age range for adolescent
13-20 yrs
51
Expected growth in adolescence
o Growth spurts
§ Girls 2-8”
§ Boys 4-12”
§ Body odor (apocrine glands)
§ Acne
§ Presence of secondary sexual characteristics
· Girls: breast development, pubic hair, menarche (12 ½)
· Boys: enlargement of testes, increased penis and scrotum size, public hair, voice changes, gynecomastia (13 yrs)
52
Expected motor skills of an adolescence
o Sports, gymnastics, reading, TV, computer, video games
53
Nutrition consideration for adolescence
Hollow legs”
o Increased appetite
o “fad diets”
o Diet influenced by peers
o Requires increased calcium for bone and skeletal growth
o Final molars
o Orthodontia
54
Safety considerations for an adolescence
o MVA: leading cause of accidental death
o Drug, alcohol, and sex education
o Lack of impulse control
o Invulnerable
o Self breast examinations, self testicular exams
o Injury prevention (sports, drowning, diving, drivers ed, seat belts)
o Info (body piercings tattoos)
55
Expected play in adolescence
o Peer, group activities, sports, music, dance, movies
o Interest in peer relationships
56
New born reflex that appears at birth and disappears at 4 weeks. Assessed when holding an infant upright with feet touching a flat surface, the infant should make stepping movements
Stepping
57
New born reflex that appears at birth and disappears at 4 months. Touch the palm of the infants hand. Infant grasps the object. Note the strength of the grasp. Strongest between 1 and 2 months.
Palmer grasp
58
New born reflex that appears at birth and disappears between 3 and 4 months. Elicited by turning infants head to one side. The infant extends the arm and leg on that side and flexes the arm and leg on the opposite side.
Tonic Neck
59
New born reflex that appears at birth and disappear at 4 months. Elicited by clapping hands or a loud noise. Observe abducting arms at elbows and hands remain clenched.
Startle
60
New born reflex that appears at birth and disappears at 6 months. Allows the head and trunk to gently fall back to a 30 degree observe symmetrical extension of arms and legs, fingers fan out and form a C arms and legs then abduct.
Moro
61
New born reflex that Appears at birth and disappears at 1 year. Elicited by stroking the outer edge of the sole of the infants foot from the heel upward across the ball of the foot. Fanning or hyperextension of all toes and dorsiflexion of the great toe is a normal response in the newborn. After 24 months is considered an abnormal response indicating a CNS abnormality
Babinski
62
New born reflex that Appears at birth, doesn’t disappear. Can be assessed with pad of index finger when assessing palate, suck include gag
Gag
63
New born reflex that appears approximately 34 weeks gestation, doesn’t disappear. Elicited when an object is placed in newborns mouth or anything touches lips. Able to coordinate sucking swallowing, and breathing.
Sucking
64
New born reflex that Appear at birth, disappears at 4 months. Elicited when newborns mouth or cheek is touched, newborn turns toward that side and open lips to suck.
Rooting
65
Four things that are needed to calculate developmental age and adjusted age
Evaluation date
Date of birth
Formula for calculation
If child was born prematurely and how premature
66
Formula for developmental age and adjusted age
Date of evaluation minus date of birth
67
Factors that increase a childs risk for abuse
• Children born prematurely
• Homes with domestic violence
• Insufficient money
• Lack of knowledge (about child care or development)
• Psychological problems
• Single parenting
• Substance abuse
• Unstable family relationships
• Young immature parents
68
• Social interaction
• Social communication
• Imaginative play
• Distress when routines changed
• Unusual attachments to objects
• Inability to start or continue conversations
• Using gestures instead of words
• Repetitive behaviors:
o Head banging
o Twirling in circles
o Biting themselves
o Flapping hands and arms
• Extreme aversion to touch, loud noises, bright light
• Emotional liability; rapid significant mood changes is common
• Engage in echolalia: compulsive parroting of a word or phrase just spoken by another
All these are symptoms of what?
Autism
69
lack of close attention, difficulty sustaining attention, fails to follow instructions, difficulty organizing tasks, losing things, easily distracted, forgetful, avoids activities requiring mental effort for periods of time
Are all symptoms of what?
Inattentive ADHD
70
fidgets, fails to remain seated, running inappropriately, talking excessively, busy at all times, difficulty remaining quiet
Are all symptoms of what?
Hyperactivity ADHD
71
blurts out answers, difficulty waiting turns, interrupts others, hitting biting shouting decreased attention span
Are all symptoms of what?
Impulsivity ADHD
72
Nursing interventions for a child with cerebral palsy's airway
maintain an open airway, suction oral secretions as needed
73
Nursing interventions for a child with cerebral palsy's nurition?
Assess for aspiration, position correctly for feeding orally or g-tube
74
Nursing interventions for a child with cerebral palsy's mobility
ROM exercises, wheelchairs, standers
75
Nursing interventions for a child with cerebral palsy's skin integrity
Assess skin under splints, turn frequently, keep clean and dry
76
Nursing interventions for a child with cerebral palsy's safety
maintain a safe environment, fasten safety belts, helmets if seizures
77
Seizure medications for children
Diazepam (valium)
phenytoin (Dilantin)
Carbamazepine (tegretol)
Valporic acid (depakote)
Foshphenytoin (cerebyx)
Topiramate (topamax)
Lamotrigine (lamictal)
Clonazepam (klonopin)
78
Seizure medication considerations for children
• A single medication is initiated at a low dose, then gradually increased until seizures are controlled, adding a second medication if necessary
• Take seizure medication at the same time daily
• Be aware of medication and food interactions
• Dose may need to be increased as child grows
• Monitor blood cell counts, urinalysis, and liver function test frequently to monitor organ function
79
Mammograms should begin _____by age ______ then every _____ years at age ______
yearly
40
2
55
80
First step to self breat examination
INSPECT BREASTS IN MIRROR, ASSESSING FOR ANY SIZE, SHAPE, COLOR, DIMPLING, BULGING, REDNESS, RASH, SCALING, SWELLING. SOME MAY SEE RIDGES OR PITS RESEMBLING ORANGE PEELS.
81
second step in self breast examination
RAISE ARMS & LOOK FOR THE SAME CHANGES
82
Third step in self breast examination
CHECK NIPPLES FOR SIGNS OF FLUID, WATERY, MILKY, BLOODY, OR YELLOW
83
Fourth step in self breast examination
FEEL BREASTS WHILE LYING DOWN. USE 3 FINGER TO PALPATE ROUND MOTION ON BREAST FROM COLLARBONE, TO TOP OF ABDOMEN, & INCLUDE ARMPIT.
84
5th step in self breast examination
FEEL BREASTS WHILE IN THE SHOWER – MAY BE EASIER TO DETECT IF SKIN IS WET & SLIPPERY
85
When to do self breast examinations
THE BEST TIME TO DO A MONTHLY SELF-BREAST EXAM IS ABOUT 3 TO 5 DAYS AFTER YOUR PERIOD STARTS. DO IT AT THE SAME TIME EVERY MONTH. YOUR BREASTS ARE NOT AS TENDER OR LUMPY AT THIS TIME IN YOUR MONTHLY CYCLE. IF YOU HAVE GONE THROUGH MENOPAUSE, DO YOUR EXAM ON THE SAME DAY EVERY MONTH.
86
How to take a sexual history
• Provide a welcoming environment
• Ask for permission to ask about sexual history
• The five P’s
o Partners
o Practices
o Protection from STI’s
o Past history of STI’s
o Pregnancy intention
• To end ask patient if they have any questions
87
Five P's when taking a sexual history
o Partners
o Practices
o Protection from STI’s
o Past history of STI’s
o Pregnancy intention
88
amenorrhea
Absence of menstral period
89
no menses by the age of 16 and no secondary sex characteristics or no menses by age 13 with secondary sex characteristics
Is called what
Primary amenorrhea
90
Cause of primary amenorrhea
May be a result of body build (minimal body fat), heredity (family history of delayed menses), pituitary function (lack of secretion of FSH and LH), congenital absence of the vagina, 90% of cases have no identifiable cause.
91
no menses in 3 months in a woman who has had normal menstrual cycles
Secondary amenorrhea
92
Causes of secondary amenorrhea
caused by lack of ovarian production, pregnancy, PCOS, nutritional disturbances, endocrine disturbances, uncontrolled diabetes, heavy athletic activity, emotional distress
93
Primary dysmenorrhea
Painful periods
94
painful menstruation: cramping usually begins 12-24 hrs before onset of flow and lasts 12-24 hrs. May experience chills, nausea, vomiting, headaches, irritability, and diarrhea
Is called what
Primary dysmenorrhea
95
excessive endometrial production of prostaglandin; women with primary dysmenorrhea produce 10 times the amount of prostaglandin. Prostaglandin is a myometrial stimulant and vasoconstrictor
Are all symptoms of what
Primary dysmenorrhea
96
How to manage dysmenorrhea
Prostaglandin inhibitors (ibuprofen)
analgesics
heat to back and lower abdomens
warm bath
exercise
oral contraceptives
diet low in fat and meat products may decrease duration and intensity of the pain
acupuncture.
97
Painful menstruation associated with known anatomic factors or pelvic pathology. Pain can be present at any point of the menstrual cycle.
is called what
Secondary Dysmenorrhea
98
related to endometriosis, pelvic adhesions, inflammatory disease, cervical stenosis, uterine fibroids, adenomyoma
are all symptoms of what
Secondary Dysmenorrhea
99
How to manage secondary dysmenorrhea
Identofy and treat underlying conditions
100
What phase of a period does PMS happen?
Luteal
101
Lower abdominal and back pain
Bloating
Weight gain
Breast tenderness
Joint and muscle pain
Oliguria
Diaphoresis
Constipation
Nausea
Vomiting
Food cravings
Acne
Urticaria
Irritability
Headaches
Vertigo
Fainting
Clumsiness
Mood swings
Depression
Anxiety
Lethargy
Fatigue
Confusion
Tension
Forgetfulness
Sexual arousal or dysfunction
Are all symptoms of what?
PMS
102
What is PMS caused by?
o Caused by hormonal imbalances related to menstrual cycle, estrogen and progesterone imbalance, chemical changes in the brain
103
How to manage PMS
Limit salt intake, caffeine, animal fat, refined sugars, and alcohol
Exercise daily
Get 8 hrs of sleep
Ibuprofen for physical symptoms such as cramps, backaches, and breast tenderness
Herbal remedies such as black cohosh, ginger, and raspberry leaf
Commonly prescribed medications are antidepressants, anti-anxiety, diuretics, and oral contraceptives
104
Women who are at a greater risk for osteoperosis
o Experience early menopause, before the age of 45
o Go on a long time without having a menstrual period
o Have a very irregular periods, indicating that they are not ovulating regularly
105
The relationship between menopause and osteoperosis
• The lack of estrogen, a natural consequence of menopause is directly related to a decrease in bone density. The longer a woman experiences lower estrogen levels, the lower her bone density is likely to be.
106
a fungal infection most often caused by candida albicans. Causes vulvar and vagina pruritis, painful urination from excoriation from itching speculum examination: thick creamy, white cottage cheese like vaginal discharge; vulvar and vaginal erythema and inflammation white patches on vaginal walls
This condition is called what?
Vulvocaginal candidiasis or a yeast infection
107
Treatments for a yeast infection
topical treatments recommended for pregnant patients. Fluconazole diflucan can be prescribed as a single low dose to clients not pregnant or lactating. OTC clotrimazole can be used 3-7 days
108
Education for patient with a yeast infection
avoid tight fitting clothes, wear cotton lined underpants, remove damp clothing as soon as possible, avoid douching, increase dietary intake of yogurt with active cultures rule out diabetes if frequent or reoccurring infections
109
bacterial infection most commonly caused by haemophilus vaginalis or gardnerella vaginalis. Most common vaginal infection in females 14-49. Not related to sexual activity. Is related to reduction in lactobacilli in vaginal flora. If left untreated can cause PID, which could lead to infertility. Can cause preterm labor and preterm birth in pregnant women. thin, white or gray discharge with a fishy odor, especially after sex
Bacterial Vaginosis
110
RARELY HAS MANIFESTATIONS, “SILENT DISEASE”. MALE: PENILE DISCHARGE, DYSURIA, TESTICULAR EDEMA OR PAIN. FEMALE: DYSURIA, URINARY FREQUENCY, SPOTTING/POSTCOITAL BLEEDING, VULVAR ITCHING, GRAY-WHITE DISCHARGE, ENDOCERVICAL DISCHARGE & BLEEDING
Which STI is this?
Chlamydia
111
MOST WOMEN HAVE NO SYMPTOMS BUT MAY HAVE BURNING ON URINATION, INCREASED PURULENT YELLOW-GREEN VAGINAL DISCHARGE, OR BLEEDING BETWEEN PERIODS. RECTAL INFECTION CAN CAUSE ANAL ITCHING, DISCHARGE, AND BLEEDING. MALES EXPERIENCE DYSURIA, TESTICULAR EDEMA/PAIN, PENILE DISCHARGE THAT MAY BE WHITE, GREEN, YELLOW, OR CLEAR & PROFUSE AT TIMES. CAN LEAD TO PID IF UNTREATED.
Which STI is this?
Gonorrhea
112
HAS 3 STAGES: PRIMARY – CHANCRE, A PAINLESS POPULAR LESION AT SITE OF INFECTION, PROGRESSING TO AN ULCERATED AREA. FEMALES MAY REPORT INGUINAL LYMPH NODE EDEMA INDICATING INTERNAL VAGINAL OR CERVICAL LESIONS. SECONDARY – SKIN RASHES ON PALMS OF HANDS & SOLES OF FEET. TERTIARY – INTERNAL ORGAN DAMAGE, DIFFICULTY COORDINATING MUSCLE MOVEMENTS, BLINDNESS.
Which STI is this?
Syphillis
113
GENITAL WARTS THAT CAN EXPAND & OBSCURE THE BIRTH CANAL& IMPACT ABILITY TO URINATE & DEFECATE. MAY HAVE A CAULIFLOWER-LIKE APPEARANCE.
Which STI is this?
Human papilloma virus HPV
114
MALES MAY EXPERIENCE URETHRAL DRAINING, ITCHING, OR IRRITATION; DYSURIA OR PAIN WITH EJACULATION. FEMALES MALODOROUS YELLOW-GREEN VAGINAL DISCHARGE AND VULVAR IRRITATION & DYSURIA. CAN LEAD TO PREMATURE RUPTURE OF MEMBRANE AND PRETERM LABOR.
This STI is called what?
Trichomoniasis
115
What to do for a patient who has just been diagnosed with an STI
• PROVIDE INFORMATION ON STIS.
• PROVIDE EMOTIONAL SUPPORT.
• INSTRUCT THE WOMAN ON CORRECT ADMINISTRATION OF MEDICATIONS AND OTHER TREATMENTS AND IMPORTANCE OF COMPLETING TREATMENT.
• INSTRUCT THE PATIENT ON THE WARNING SIGNS OF COMPLICATION (FEVER, INCREASED PAIN, BLEEDING).
• PROVIDE INFORMATION ON THE IMPORTANCE OF ABSTAINING FROM INTERCOURSE UNTIL THE PATIENT AND HER PARTNER ARE FREE OF INFECTION.
PROVIDE THE PARTNER WITH TREATMENT AS INDICATED.
116
this is an infection of the femail reproductive organs. It most often occurs when sexually transmitted bacteria spread from your vagina to your uterus fallopian tubes or ovaries
Pelvic inflammatory disease
117
• ABNORMAL GROWTH OF TISSUE RESEMBLING THE ENDOMETRIUM THAT IS PRESENT OUTSIDE OF THE UTERINE CAVITY. TISSUE RESPONDS TO CHANGES IN ESTROGEN AND PROGESTERONE LEVELS. THE TISSUE GROWS AND THICKENS DURING THE SECRETORY AND PROLIFERATIVE STAGES OF THE MENSTRUAL CYCLE. THE TISSUE BREAKS DOWN AND BLEEDS INTO THE SURROUNDING TISSUES DURING THE MENSTRUAL PHASE. BLEEDING INTO SURROUNDING TISSUES CAUSES PAIN AND INFLAMMATION. SCARRING, FIBROSIS, AND ADHESIONS RESULT FROM CONTINUED INFLAMMATION.
This is called what?
Endometriosis
118
IS A HORMONAL DISORDER COMMON AMONG WOMEN OF REPRODUCTIVE AGE. WOMEN WITH PCOS MAY HAVE INFREQUENT OR PROLONGED MENSTRUAL PERIODS OR EXCESS MALE HORMONE (ANDROGEN) LEVELS. THE OVARIES MAY DEVELOP NUMEROUS SMALL COLLECTIONS OF FLUID (FOLLICLES) AND FAIL TO REGULARLY RELEASE EGGS.
Is called what?
Polycystic ovarian syndrome
119
testing for infertility for males
Testing for a man often involves a semen analysis (sperm count). This is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. Blood tests for men measure levels of male reproductive hormones. Too much or too little of these hormones can cause problems with making sperm or with having sex. In some cases, an ultrasound exam of the scrotum may be done to look for problems in the testicles.
120
Testing for infertility in females
Laboratory tests may include blood and urine tests. A urine test can tell when and if you ovulate. Blood tests can measure: Progesterone levels (to see if you have ovulated), Thyroid function (problems with the thyroid may cause infertility), Levels of the hormone prolactin (high levels can disrupt ovulation), Ovarian reserve (egg supply), Imaging tests and procedures may include: Ultrasound exam, Sonohysterography, Hysterosalpingography, Hysteroscopy, Laparoscopy
