EXAM #1 Flashcards
What is climacteric & when does it begin?
A transitional time in a woman’s life marked by declining ovarian function and decreased hormone production.
-Begins at the onset of ovarian decline and ends with the cessation of postmenopausal symptoms.
What is menopause? When is it certian?
Refers to the last menstrual
period and can be dated with certainty when there has been
at least 1 whole year without menstruation
Define Premenopause
The time up to the beginning of perimenopause, but the term is also used to define the time up to the last menstrual period.
Define perimenopause
Perimenopause is the time preceding menopause, usually starting between 2 and 8 years before menopause and lasting an average of 4 years
Postmenopause
Begins when ovarian estrogen terminates, ovulation ceases, and menstrual periods have stopped for 12 consecutive months
Where is estrogen produced during postmenopause?
The Adrenal Glands
During perimenopause, what happens to the ovarian follicles?
The responsiveness to gonadotropins are decreased and responsive follicles do not develop as quickly as before.
During perimenopause the cycles can become anovulatory (no ova released) which leads to:
-Irregular bleeding
-Skin changes & decrease in hair distribution
-Vasomotor instablility leads to night sweats and hot flashes.
How long should Hormone Therapy be prescribed for and what does it help?
A short period of time for the reduction of menopause symptoms
What does Estrogen-progestin therapy increase the risk of?
VTE, Factor V Leiden, and Breast Cancer when used for longer than 3 to 5 years
What kind of Hormone Therapy is used after a hysterectomy & why?
Estrogen with NO progesterone facilitates the shedding of the endometrial lining (reduces the risk of endometrial cancer)
Patient education for hormone therapy
- Vaginal bleeding and spotting are most likely to
occur in the first 3 months after initiation of therapy. - Follow-up visits should be scheduled at 1 and
3 months—and improvement in symptoms should
be noted at that time. - It is important to promptly report the following
symptoms: persistent bleeding; bleeding that stops
but then starts again; or the presence of blood clots
in the vaginal discharge
Contraindications for patients who are on estrogen therapies
- Known or suspected estrogen-dependent cancer
- Known or suspected history of breast cancer except
in appropriately selected patients being treated for
metastatic disease - Undiagnosed abnormal genital bleeding
- Active or history of deep venous thrombosis,
pulmonary embolism - Active or recent (within the past year) arterial
thromboembolic disease (e.g., stroke, myocardial infarction) - Liver dysfunction or disease
- Known or suspected pregnancy
- Known hypersensitivity to ET/EPT
What hormone affects secondary sexual characteristics such as linear growth spurts?
Testosterone (androgen)
What is the ouside of the womens’ reproductive part called?
Vulva
What hormones are released from the Anterior pituitary gland?
Gonadotropins (LH & FSH)
What hormones do the ovaries produce?
Estradiol (estrogen) & Progesterone
What is the function of FSH (folicle stimulating hormone)?
-Initiates development of ovarian follicles & causes it to mature
-Stimulates secretion of estrogen by follicle cells
What is the function of LH (Luteinizing hormone)?
-Causes the release of the ovum for ovulation
-Converts the ruptured ovarian follicle into the corpus luteum
-Stimulates secretion of progesterone by the corpus luteum
What is the function of Estrogen?
-Promotes maturation of ovarian follicles
-Promotes growth of blood vessels in the endometrium
-Initiates development of the secondary sec characteristics (breast development, widening of hips, and deposition of fat onto hips)
What is the function of Progesterone?
-Promotes successful implantation of the embryo in the endometrium
-Promotes further growth of blood vessels in the endometrium and storage of nutrients
What occurs during the menstrual phase?
The beginning of the follicular phase
-Menstruation is triggered by the declining levels of estrogen & progesterone produced by corpus luteum
-Leads to a decrease of nutrients and oxygen leading to sloughing off of the endometrial lining
What occurs during the proliferative phase?
-The end of menses through ovulation
-Estrogren levels are low but gradually increase
-Uterine smooth muscle grows
-Endometrial receptor sites for progesterone are developed
What occurs during the secretory phase?
-The time of ovulation to just before menses
-Increasing amounts of progesterone (creates highly vascular secretory endometrium that is suitable for implantation)
-Endomertial growth ceases
-Progesterone also causes: thining of vaginal mucosa, increased thickness of cervical mucosa, increase in glandular growth of the breast.
What occurs during the ischemic phase?
-From the end of the secretory phase to onset of menstruation.
-Estrogen and progesterone are low & uterine spiral arteries constrict
-Endometrium becomes pale and blood vessels rupture (1st day of next cycle)
What type of discharge is best for getting pregnant during ovulation?
Clear phase (10-14 days) appears as raw eggwhite stretchy and slippery
How is chlamydia transmitted?
Bacterial through sexual activity and birth
Signs and symptoms for Chlamydia
Asymptomatic; mucopurulent drainage
How do we treat Chlamydia?
Penicillin or Erythromycin.
How is Gonorrhea transmitted?
Bacterial, through sexual activity and birth
What are signs and symptoms of Gonorrhea?
Asymptomatic; greenish/yellow discharge
What is the treatment for Gonorrhea?
Ceftriaxone IM, doxycycline PO, cefixime PO
How is Syphilis transmitted?
-Bacterial, through sexual activity
-If not tx before the 18th week of pregnancy it can infect the fetus
What are signs and symptoms of Syphilis?
Chancre sores (10-90 days), palmer/pedal rashes, multi-organ involvement
What is the tx for Syphilis?
Penicillin
How is HPV (human Papillomavirus) transmitted?
Viral, through sexual activity and transplacentally to the fetus
What are signs and symptoms of HPV?
Genital warts
What is the tx for HPV?
No cure, management of warts with trichloroacetic acid or dichloroacetic acid, cryotherapy; surgery.
How is HIV/AIDS transmitted?
Viral, through unprotected sex, transplacentally to the fetus late in pregnancy or at birth and through breast milk
What are signs and symptoms of HIV/AIDS?
Flu-like symptoms, fatigue, weight loss, night sweats
What is the tx for HIV/AIDS?
No cure, HAART highly reactive antiretroviral therapy, and c section to reduce transmission to the infant.
What are presumptive signs of pregnancy?
Amenorrhea
Fatigue
Nausea and vomiting
Breast tenderness
Urinary frequency
Quickening: 1st fetal movement
What are Probable signs of pregnancy?
Hegar’s sign
Goodell’s sign
Chadwick’s sign
Positive pregnancy test
Braxton hicks contractions or ballotmen
What are positive signs of pregnancy?
Hearing fetal heart tones
Visualization of the fetus
Palpation of fetal movements by examiner
Chadwick’s Sign:
Pregnant woman’s cervix will be dark-bluish cervix due to increase in vascularity
Hegar’s Sign:
Compressibility & softening of cervical ISTHMUS in first 4-6w
Goodell’s Sign:
Softening of the cervix in the first 4-8w
Ballottement:
Fetus can float up and back down. Found in EARLY pregnancy
T or F? Fundus height in cm is consistent with # of weeks?
True. May be +/-2 after 20 weeks (normal)
What week of pregnancy is the top of the fundus at the umbilicus?
20w
How to measure the fundal height:
-From symphysis pubis to fundus
-Measured in centimeters
-Indicative of fetal growth
-Measurement of + or – cms compared to gestational age requires further assessment
- Magic number is 2, +2 or -2 compared to expected weeks gestation is a concern
What findings or changes occur to the integumentary system during pregnancy?
- Change in pigmentation
- Linea nigra
- Chloasma: pregnancy mask
- Hyperactive sweat and sebaceous glands
- Striae gravidarum: stretch marks
- Angiomas; palmar erythema
- New hair growth
- Stronger nails
What changes occur to the neurological system during pregnancy?
-Decreased attentions, concentration, memory
-Carpal tunnel syndrome
-Syncope
-Altered sleep pattern
What changes occur to the cardiovascular system?
-Supine Hypotension: no perfusion to the uterus=no perfusion to the placenta
-B/P should stabilize around 20W. Monitor for pre-eclampsia.
-Increased cardiac output/volume
-Diluted blood: increased need for iron
-Varicose veins
What changes occur with the respiratory system during pregnancy?
-Decreased lung capacity (exacerbation of asthma)
-Increased mucus production: postnasal drip & sore throat
What changes occur to the GI system during pregnancy?
-Constipation
-Decreased motility
-Increased risk for periodontal disease: infection, plaque, and carries
-Increasd urination
-N/V
-Increased saliva production
-Pyrosis (heartburn)
What changes occur to the endocrine system during pregnancy?
-Decreased TSH
-Prolactin
-FSH & LH
-Oxytocin
-
What changes occur to the musculoskeletal system during pregnancy:
-Relaxation
-Diastasis recti
-Lumbar lordosis
-Separation of pubis symphysis
How to differentiate ligament pain Vs contractions:
-Ligament pain is constant
-Contractions come and go
What maternal tasks are experienced during pregnancy?
-Acceptance of pregnancy & child
-Reordering relationships
-Seeking safe passage
What paternal tasks are experienced during pregnancy?
-Announcement phase
-Moratorium phase: relaxation
-Focusing phase
How often should a mother go to their prenantal appointment for 28-32 weeks pregnant?
Monthly
How often should a mother go to their prenantal appointment for 28-32 to 36 weeks pregnant?
Q 2 weeks
How often should a mother go to their prenantal appointment for 36 weeks until delivery?
Weekly
How to calculate Nagele”s Rule:
-Add 7 days, subtract 3 months from the date of the patient’s first day of their last manstural (LMP)
-Add a year
Gravida:
Number of pregnancies
Para:
Number of deliveries of 20 weeks and beyond no matter the outcome
Term:
Number of babies born 37 weeks and beyond
Preterm:
Number of babies born 24 week to 36/37w
Abortion
Any pregnancy that occurs before 20 weeks
Living:
Number of living children
Chemical pregnancy:
Positive test followed by late menstrual period with heavy bleeding probably indicates brief, nonviable pregnancy
Which vaccine should be avoided during pregnancy that has not been given before?
Rubella
What tests are done during pregnancy?
-Blood type & RH factor
-VDRL (Syphilis)
-CBC
-HIV
-Sickle Cell
-STIs
-Cervical cancer
How many more calories are needed per day during pregnancy?
300
How much folic acid is needed per day during pregnancy?
400mcg
What position should a pregnant person lay on during breast exam?
Recumbent/left side
What is considered normal on a breast examination during pregnancy?
-Nodularity, striae, enlargement, and hyperpigmentation
What is considered advanced maternal age?
Over 35 years of age, can cause chromosomal abnormalities
triple screening
Quadruple screening
What is an essential macronurtient during pregnancy?
Protien is essential for growth and repair
What vitamins are essential for pregnancy? Include examples of foods
-Calcium & Vitamin D: diary
-Iron: Liver
-Vitamin C: Citrus
-Folic Acid: Peas (legumes)
-Protein
Common complaints for pregnant women?
-N/V
-Dyspepsia
-Flatulence
-Constipation
-Nasal Congestion
-SOB
-Backache
-edema
-Vaicosities
-Leg cramps
Dangerous sign and symptoms to report during the first trimester:
-N/V
-Bleeding-spontaneous abortion, pain, emotional support
-Infection
Dangerous sign and symptoms to report during the second trimester:
-Preeclampsia
-PROM
-Pre-term labor
Dangerous sign and symptoms to report during the third trimester:
-Preeclampsia
-PROM
-Pre-term labor
-Gestational Diabetes
-Bleeding
Signs and symptoms of ectopic pregnancy:
-Unilateral pain
-Abdominal tenderness
-Referred shoulder pain
-Bleeding
Diagnosis for ectopic pregnancy
-+ HCG but low for gestation
-Increased WBC
-US
Surgical mangement of ectopic pregnancy
Laparoscopic surgery & Methotrexate = termination
What change happens to blood pressure during first trimester?
True or False, any bleeding beyond first trimester is an emergency
True
What is Clomiphene citrate used for?
Infertility, increases growth of folicles
Clomiphene citrate How is it administered and what are the signs and symptoms?
Subq injection
-Irritability, mood swings, multiple babies.
What are signs and symptoms of ectopic pregnancy?
-Unilateral pain
-Refered shoulder pain
-Bleeding
-Positive but low HCG gestation
Education for molar pregnancy (gestational trophoblastic disease)
Do not get pregnant for 1 year
signs and symptoms of placenta previa
-Bright, red painless bleeding
Management for placenta previa and placental abruption:
Patient must have may an immediate c section and no vaginal exams
Signs and symptoms for placental abruption:
-Painful, dark red bleeding in the 3rd trimester
What is DIC (Disseminated intravascular Coagulation)?
Secondary disorder of coagulation that occurs as a complication of abruption, previa and trauma.
Signs and symptoms of DIC (Disseminated intravascular Coagulation):
Petchiae, purpura, bleeding from openings in skin (IV & Surgical site), GI bleed, hypotension
