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Maternal Newborn > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is menarche and when does it usually occur?

A

onset of menstruation that usually occurs between ages 8 and 16

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2
Q

length of complete cycle

A

28-29 days

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3
Q

How much does the average woman bleed during menstruation?

A

1-2 oz OR 25-80mL

this varies from person to person and can be more in women with heavier flows

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4
Q

average length of menstrual cycle (days bleeding)

A

4-8 days

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5
Q

perimetrium

A

outer layer of uterus (aka peritoneum)

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6
Q

myometrium

A

middle muscle layer of uterus

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7
Q

endometrium

A

inner mucosal layer of uterus

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8
Q

Which layer of the uterus sheds during menses?

A

the endometrium

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9
Q

What is the purpose of “ligature” for the uterus?

A

ligature are fibers that help the uterus clamp down and return to normal size after pregnancy

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10
Q

What does ligature help prevent after pregnancy?

A

post partum hemorrhage

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11
Q

Functions of the cervix:

A
  1. lubrication of the vagina (helps to wash away microorganisms)
  2. acts as a bacteriostatic environment, which protects from microorganisms
  3. provides an alkaline environment for sperm
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12
Q

What are the three parts of the fallopian tubes?

A

isthmus, ampulla, and fimbria

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13
Q

Location and function of isthmus

A

located closest (proximal) to the uterus and is the site of tubal ligation

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14
Q

location and function of ampulla

A

the “middle” part of the tube where fertilization occurs

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15
Q

What is the fimbria?

A

The fimbria is the distal end of the fallopian tube, which possess “finger-like” projections that need to be free moving for normal function to occur.

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16
Q

What helps move the ovum through the fallopian tubes to the uterus?

A

Tubal peristalsis and ciliary (hairs)

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17
Q

What is present in the fallopian tubes and uterus that helps provide a nourishing environment for the ovum?

A

serous fluid

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18
Q

What complication arises involving the fallopian tubes when recurrent infections are present?

A

Difficulty conceiving.

Rationale: With recurrent infections, the structures are constantly inflamed. This constant state of inflammation means the structures have a harder time transporting the ovum to the ampulla and supporting it once there, making it more difficult to conceive.

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19
Q

How do healthy tubes move and support the ovum?

A

Serous fluid, ciliary, and tubal peristalsis

Rationale: Healthy tubes have plenty of fluid and ciliary to move the ovum towards the ampulla to unite with the sperm.

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20
Q

Function of ovaries

A
  1. store and develop follicles

2. secrete estrogen and progesterone

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21
Q

Estrogen’s function in development

A

helps in the development of secondary female sex characteristics ie. breasts and pubic hair

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22
Q

Estrogen’s function in pregnancy

A

considered “growth hormone of pregnancy” - encourages the growth of the uterus and fetus

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23
Q

Estrogen’s function in the ovarian cycle

A

helps the follicle to mature so it can release a mature ovum during ovulation

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24
Q

Progesterone’s function in pregnancy

A

helps keep you pregnant!!

  1. decreases uterine motility and contractility (quiets the uterus and calms contractions)
  2. causes a relaxation effect during pregnancy (ie. more tired, decreased GI motility –> constipation)
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25
Q

Source of progesterone during ovarian cycle

A

the corpus luteum

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26
Q

Source of progesterone in pregnancy

A

the placenta

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27
Q

As the level of progesterone decreases, what increases?

A

the risk of miscarriage

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28
Q

What are the first 14ish days of the ovarian cycle called?

A

The follicular phase

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29
Q

What occurs during the follicular phase?

A

the oocyte matures into an ovum

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30
Q

When does the graafian follicle appear?

A

by day 14

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31
Q

What is the function of the graafian follicle?

A

acts as a shell around the oocyte

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32
Q

What hormone do graafian follicle cells release?

A

estrogen

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33
Q

Where is the ovum released from during ovulation?

A

the graafian follicle

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34
Q

What is the luteal phase?

A

days 14-28 of the ovarian cycle, begins directly after ovulation

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35
Q

What occurs during the luteal phase?

A

the corpus luteum forms and begins to release progesterone (prepares for PG - if not, menses starts)

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36
Q

What happens to hormone levels during the luteal phase?

A

Estrogen levels decrease and progesterone levels increase

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37
Q

When does the luteal phase end?

A

when menses begins

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38
Q

Where is FSH release from?

A

the pituitary gland

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39
Q

FSH target organ

A

the ovaries

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40
Q

FSH function

A

stimulates the maturation of the follicle or oocyte

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41
Q

High levels of estrogen stimulate

A

the release of LH from the pituitary gland

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42
Q

The peak of which hormone triggers ovulation?

A

LH (ovulation occurs approx. 24hrs after surge)

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43
Q

Prostaglandin E main function

A

helps to stimulate labor

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44
Q

Pg E two specific functions

A
  1. relaxes smooth muscle (opens the cervix)

2. vasodilator

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45
Q

Prostaglandin F main function

A

helps to stop post partum hemorrhage

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46
Q

Pg F specific function

A

strong vasoconstrictor, increases contractility of muscles and arteries

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47
Q

Duration of menstrual phase

A

day 1 to approx. day 5

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48
Q

duration of proliferative phase

A

approx. day 5 (end of menses) through ovulation

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49
Q

How does the uterus change during the proliferative phase?

A
  1. the lining of the uterus thickens (with the help of estrogen)
  2. cervical mucus becomes fertile mucus
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50
Q

duration of secretory phase

A

ovulation to approx. 3 days before menses

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51
Q

Characteristics of the uterine lining during secretory phase

A

the lining of the endometrium is thick and at the peak of vascularity (ready for implantation of zygote)

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52
Q

Job of LH

A

Helps with the formation of the corpus luteum after ovulation occurs

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53
Q

Hormone levels during menstrual phase

A

estrogen levels are low

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54
Q

Hormones levels during secretory phase

A

estrogen levels drop and progesterone increases

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55
Q

Hormone levels during ischemic phase

A

estrogen and progesterone levels are low

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56
Q

Endometrial changes during ischemic phase

A

Necrosis of the lining occurs and the tissue begins to slough off (bleeding begins)

57
Q

Signs of ovulation

A
  1. the amount of mucus increases
  2. appears thin, watery, and clear
  3. Spinnbarkeit (very stretchy and stringy)
  4. ferning pattern appears under microscopic examination
  5. basal body temp increases by 10ths of a degree (post-ovulation)
58
Q

Ovulation mucus

A

abundant, thin, watery

59
Q

Saliva testing for fertility

A

ferning pattern will appear on microscope slide

60
Q

Why does ferning occur during ovulation?

A

Increased levels of estrogen –> increased levels of salt, which causes ferning

61
Q

amenorrhea

A

absence of menses

62
Q

primary amenorrhea

A

menstruation has yet to be established by 16yrs

63
Q

secondary amenorrhea

A

established menses (longer than 3-6 months) ceases

64
Q

Common causes for secondary amenorrhea

A

1 is pregnancy

others: lactation, hormonal imbalances, poor nutrition, low body fat ratios (extreme athletes)

65
Q

dymenorrhea

A

painful menstruation that typically occurs before onset of menstrual cycle

66
Q

primary dysmenorrhea

A

cramps present without disease state

67
Q

most common cause of primary dysmenorrhea

A

prostaglandin release (cause cramping)

68
Q

what else causes cramping with primary dysmenorrhea

A

increased uterine contractility and ischemia (the body is shedding the uterine lining so cramping is needed)

69
Q

secondary dysmenorrhea

A

associated with a disease

70
Q

things that cause secondary dysmenorrhea

A

endometriosis, pelvic inflammatory disease (PID), cysts, tumors, presence of IUD, fibroids

71
Q

When are fibroids most prevalent? Why?

A

during childbearing years (onset of puberty to menopause) r/t estrogen levels

72
Q

What can fibroids (benign uterine tumors) cause?

A

infertility

73
Q

What is the common cause of PID?

A

often caused by an infection that was not resolved or controlled, then spread to the pelvis

74
Q

Treatment of primary dysmenorrhea

A

OCPs, NSAIDs, self care

75
Q

Why are OCPs used for tx of primary dysmenorrhea?

A

OCPs inhibit ovulation, which decreases dysmenorrhea sx and cramping

76
Q

Why are NSAIDs used to tx of primary dysmenorrhea?

A

NSAIDs inhibit the release (or synthesis) of prostaglandins, which cause cramping

77
Q

When should NSAIDs be taken for primary dysmenorrhea?

A

NSAIDs should be taken at the start of menses or 2-3 days prior to menses

78
Q

What are 3 self care measures that can be used to decrease primary dysmenorrhea?

A
  1. regular exercise and pelvic rocking (reduces pelvic congestion)
  2. application of heat
  3. yoga to decrease homocysteine levels and pain
79
Q

Nutritional care for dysmenorrhea

A
  1. increase intake of complex carbs and proteins
  2. restriction of methylxanthine-containing foods ie. chocolate, coffee, cola
  3. restriction of ETOH, nicotine, red meat, animal fats
80
Q

What foods should be avoided the week before menses?

A

Salty foods and refined sugars

81
Q

What nutritional supplements help with dysmenorrhea?

A
  • Vitamin B6 (bloating and irritability)
  • Vitamin E (mild prostaglandin inhibitor)
  • natural diuretics ie. watermelon, cranberry juice, asparagus
82
Q

What is premenstrual syndrome and when does it occur?

A

distressing physical, psychological, and behavioral symptoms that reoccur cyclically during 2nd half of cycle (luteal phase) in 3+ consecutive cycles

83
Q

When is PMS most prominent?

A

the week before menses and typically subsides at the start of menstruation

84
Q

Ages most affected by PMS

A

20s-30s

85
Q

Factors that contribute to PMS

A
  • cyclical hormonal changes
  • serotonin insufficiency
  • stress
  • depressions
  • poor nutrition (lots of salt, caffeine, ETOH)
86
Q

Common psychological symptoms of PMS

A
  • mood swings
  • crying episodes
  • anxiety
  • poor concentration
87
Q

Common physical symptoms of PMS

A
  • fluid retention and wt. gain
  • muscle aches
  • breast tenderness
  • insomnia
  • palpitations
  • fatigue
  • acne

(basically everything that happens to you)

88
Q

Self-care tx for PMS

A
  • increase physical exercise

- modify diet (reduce salt, refined sugar, red meat, caffeine, chocolate)

89
Q

Supplement tx for PMS

A
  • calcium 1200mg
  • magnesium
  • vitamin B6 (tx of anxiety and depression)
  • vitamins D and E
90
Q

Medications for PMS

A
  • SSRIs (if depressions is serotonin related)

- NSAIDs (antiprostaglandins)

91
Q

If suffering from depressions r/t serotonin levels (PMS), what class of medications is recommened?

A

SSRIs (selective serotonin reuptake inhibitors) - they increase levels of serotonin in the brain

92
Q

What is premenstrual dysphoric disorder (PMDD)?

A

a more severe form of PMS, but women experience more mood symptoms

93
Q

How common is PMDD?

A

3-8% of women affected

94
Q

Does PMDD continue during pregnancy or menopause?

A

No. PMDD will not occur without ovarian function.

95
Q

Symptoms of PMDD

A
  • severe depression
  • panic attacks
  • feelings of worthlessness
  • suicidal thoughts
  • trouble concentrating or sleeping
96
Q

Women with PMDD will…

A

show no interest in relationships or ADLs, often feel out of control, tired/fatigued, and severely depressed

97
Q

What is YAZ?

A

YAZ is an OCP that is only approved for the treatment of PMDD

98
Q

How is PMDD treated?

A

prescribed by psychiatric consultant - often given SSRI (Prozac, Zolaf)

99
Q

Do PMS sx become more severe or less severe during menopause?

A

more severe

100
Q

Definition of menopause

A

absence of menstruation for 1 full year and thereafter

101
Q

What is perimenopause?

A

refers to the transition from ovulatory cycles to amenorrhea (starting to s/s of menopause but haven’t fully achieved menopause)

102
Q

What is important to note during perimenopause?

A

Irregular menses coincides with irregular ovulation - tracking and being cautious can help prevent unwanted pregnancies during perimenopause

remember: perimenopause = PAUSE and use PROTECTION

103
Q

When does menopause occur in most women?

A

ages 39-51*

*should be postmenopausal by 59

104
Q

Onset of menopause is affected by…

A
  • overall health
  • weight and nutrition
  • lifestyle and ethnicity
  • genetics
105
Q

How long does perimenopause last?

A

approx. 4-8 years

106
Q

Which ethnicities experience perimenopause earlier than others?

A

African American and Hispanic

107
Q

What happens to FSH levels during menopause?

A

FSH levels increase in an attempt to stimulated estrogen release from the ovaries

108
Q

What happens to estrogen levels during menopause?

A

Estrogen levels steadily decrease, causing the cessation of ovarian follicle production

109
Q

What happens to female reproductive organs/ tissues during menopause?

A
  • endometrium thins

- myometrium, fallopian tubes, and ovaries atrophy

110
Q

Secondary sex changes during menopause

A
  • vaginal mucosa dries and thins
  • vaginal pH increases
  • pubic hair thins and turns grey
  • breasts become pendulous
  • labia shrink and lose pigmentation
111
Q

What happens to pelvic fascia and muscles during menopause? What complications arise as a result?

A

The pelvic fascia and muscles atrophy, meaning support has now been lost for uterus.

Increases the risk for uterine prolapse, cystoceles, etc.

112
Q

Why are post menopausal women more susceptible to urinary frequency and incontinence?

A

the urethra shortens

113
Q

Are postmenopausal women more at risk for UTIs? Why?

A

yes!! r/t the shortened urethra

114
Q

Post menopausal women are at a higher risk for which four diseases?

A
  1. hypertension
  2. CAD
  3. stroke
  4. osteoporosis
115
Q

What is the rationale behind why postmenopausal women are at higher risk for osteoporosis?

A

The formation of new bone is directly r/t the synthesis of estrogen, which is steadily decreasing as the ovaries atrophy. So while bone reabsorption is occurring, bone reformation cannot keep up r/t decreasing levels of estrogen. This results in the bones slowly thinning and becoming more brittle.

116
Q

Hormone therapy is recommended for how long?

A

1-3 years and at the lowest possible dose

117
Q

Risks of hormone replacement therapy

A
  • breast cancer
  • stroke
  • thromboembolic disease
118
Q

Who can be on estrogen-only HRT?

A

women who have had a hysterectomy

119
Q

Who is prescribed estrogen-progesterone HRT?

A

women who still have a uterus

120
Q

Why is estrogen-progesterone HRT ideal for women with uteruses?

A

The progesterone does not allow the endometrium to build up (hyperplasia). It helps shed the lining, which decreases the risk of uterine cancer.

121
Q

How is osteoporosis assessed?

A

Bone mineral density (BMD) testing

122
Q

Who is the targeted group for bone mineral density (BMD) testing?

A

all postmenopausal women:

  • 65yr+
  • w/ fractures
  • or <65, but with multiple risk factors
123
Q

Why are height checks done on postmenopausal women?

A

They detect bone loss leading to vertebra compression.

124
Q

What is Dowager’s Hump?

A

The cervical vertebrae are no longer able to support the upper body and the woman appears slumped.

125
Q

What are 5 ways to prevent osteoporosis?

A
  1. increase calcium intake
  2. weight-bearing exercise ie. walking, stairs
  3. vitamin D supplements
  4. limit ETOH and caffeine
  5. if a smoker, stop smoking
126
Q

How much daily calcium should postmenopausal women on HRT take?

A

1200mg

127
Q

How much daily calcium should postmenopausal NOT on HRT take?

A

1500mg

128
Q

Types of drug treatments for osteoporosis

A
  • bisphosphonates
  • selective estrogen receptor modulators (SERMs)
  • parathyroid hormone
  • salmon calcitonin
  • prolia
129
Q

Why are bisphosphonates used for the tx of osteoporosis?

A

They are calcium regulators and increase bone mass.

130
Q

Examples of bisphosphonates

A

Fosamax and Boniva: oral

Zometa: IV yearly

131
Q

Why are selective estrogen receptor modulators (SERMs) used for the tx of osteoporosis?

A

SERMs do not stimulate the breast or uterine tissues.

They also preserve the beneficial effects of estrogen.

132
Q

Example of a selective estrogen receptor modulator

A

ralaxifene PO - Evista

133
Q

How does parathyroid hormone benefit women with osteoporosis?

A

Increases bone formation

taken SQ daily for up to 2 years

134
Q

Salmon calcitonin and osteoporosis

A

Calcium regulator

nasal spray

135
Q

Prolia and osteoporosis

A

increases bone mass and strength

taken SQ every 6 months

136
Q

What are phytoestrogens?

A

plants with estrogen properties

ex. carrots, wild yams, cherries, black beans, SOY products (increase mineral density in bone)

137
Q

What does acupuncture do for postmenopausal women?

A

helps with hot flashes

138
Q

How long does an egg live after being released?

A

24hrs

139
Q

How long does the corpus luteum stay in place if fertilization occurs?

A

8 weeks, then placenta takes over

Maternal Newborn (6 decks)

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