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exam Flashcards

1
Q

How is HPV transmitted

A

skin-to-skin contact

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2
Q

Signs and symptoms of HPV

A

Wart-like growths, cervical or vulvar CA(women), Anal, throat and mouth CA (men and women)

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3
Q

HPV prevention

A

Gardasil 9

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4
Q

HPV treatment

A

regular pap smears, TCA, laser or surgical removal for lesions

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5
Q

How is Herpes simplex transmitted

A

direct contact with the person shedding the virus

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6
Q

Primary HSV outbreak symptoms

A

malaise, muscle aches, headache, painful lesions

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7
Q

Treatment for HSV

A

No cure, treat with acyclovir, valacyclovir, or famciclovir to improve quality of life

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7
Q

Maternal effects of HSV

A

PTB, dermatological scarring, microcephaly, encephalitis, vaginal birth is contraindicated with active outbreak, neonatal sepsis/death

Mother given suppressive therapy at 36 weeks

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7
Q

Chlamydia transmission

A

vaginal, anal, oral sex

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7
Q

HIV transmission

A

blood and body fluids

Breast feeding is contraindicated

C-section delivery if viral load is over 1,000

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7
Q

signs of chlamydia

A

mucopurulent discharge, dysuria, DUB

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8
Q

Maternal/fetal effects of chlamydia

A

Salpingitis, endometritis, PID, infertility, ectopic pregnancy, PROM, PTB, ophthalmia neonatorum, neonatal pneumonia (1-3 months after birth)

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9
Q

Treatment for chlamydia

A

Azithromycin 1gm or doxycycline 100mg x 7 days
treat partner and abstain for 7 days after completion

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10
Q

Syphilis transmission

A

vaginal and oral

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11
Q

Stages of syphilis

A

Primary: painless chancre (round, ulcerated lesion with raised edges)
Secondary: flu-like, sore throat, weight loss, rash on trunk, palms and soles
Latency: asymptomatic, + serology
Tertiary: life-threatening heart and neurological disease

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12
Q

Maternal/fetal effects of syphilis

A

Death of untreated, congenital syphilis, PTB, fetal death, pericarditis, jaundice, anemia

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13
Q

Treatment for syphilis

A

Penicillin G IM or IV: treatment of choice, specific regimen and duration depends on the length of infection
Kills bacteria and prevents further damage, does not reverse the damage
Re-evaluate at 6-12 months after treatment

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14
Q

Bacterial vaginosis symptoms

A

Thin white or grey discharge, fishy odor, vaginal pH greater than 4.5

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15
Q

Bacterial vaginosis maternal/fetal effects

A

PTB, LBW(low birth weight), chorioamnionitis, postpartum endometritis, PID

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16
Q

Follicular phase

A

day 1-14

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17
Q

First day of ovulation & implantation

A

day 14 first day of ovulation, implantation occurs about 3 weeks in the cycle (7 days after ovulation

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18
Q

H-P-O axis

A

Hypothalamus secretes: GnRH
anterior lobe of the pituitary secretes: FSH & LH
Ovaries Follicles: Estrogen(increases GnRH) and progesterone (decreases GnRH)

negative feedback loop

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19
Q

How long are sperm viable for

A

120hrs (5 days)

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20
Q

Primary Amenorrhea

A

Absence of menses by age 15 and no secondary sex characteristics
No menses by age 16 and presence of secondary secondary sex characteristics

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21
Q

Secondary Amenorrhea

A

Absence of menstruation for 3 or more cycles or 6 months
Occurring in those who have previously menstruated (most common cause is pregnancy)

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22
Q

Causes for primary amenorrhea

A

Stress, excessive exercise, extreme weight loss or gain, chronic illnesses, hypothyroid

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23
Q

Causes for secondary Amenorrhea

A

*Pregnancy or lactation
Damage to hypothalamus, pituitary or ovary
*Birth control
Hysterectomy
Disruption in H-P-O axis
*Heavy athletic training
*Rapid weight loss or gain

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24
Q

Abnormal uterine bleeding

A

Any deviation from normal menstruation
Painless bleeding, prolonged, excessive and irregular
Can be ovulatory or anovulatory (ovulate or not)
*Absence of underlying structural or systemic disease
Changing pad every 1-2 hrs (80mL is considered excessive)

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25
Q

Treatment for AUB

A

Determine cause treat with contraception and nutritional counseling.
normalize bleeding
Correct anemia, restore quality of life
Iron replacement
Surgical intervention ( D&C, ablation, hysterectomy)

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26
Q

Primary Dysmenorrhea & management

A

Pain without underlying pelvic pathology. Typically, it begins 6-12 months after menarche, coinciding with ovulatory cycles. Present 12-14 hrs before flow lasting 12-24 hrs once menses begins.

Management: contraceptives(inhibit ovulation decreasing production of prostaglandins), nonpharmacologic, exercise, heat, NSAIDs, vitamin B, E

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27
Q

Secondary Dysmenorrhea

A

*pain can be present at any point during the menstrual cycle
Cause: anatomical factors or *pelvic pathology endometriosis, pelvic adhesions, inflammatory disease, fibroids

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28
Q

Premenstrual Syndrome & s/s

A

Cycle symptoms that occur during the luteal phase (that are severe enough to affect daily living)
Sx: headache, diarrhea, bloating, mood changes. They are relieved by menstruation.

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29
Q

Premenstrual dysphoric disorder & treatment

A

Most severe form of PMS affects up to 5% of childbearing women
Extreme mood shifts that can impact work and relationships (occurs during luteal phase) must have at least 5 symptoms

Tx:Antidepressants(SSRI: fluoxetine, sertriline, Zoloft)
Birth control(may skip menses in pack and start new pack)
Nutritional supplements
Herbal remedies
Diet and lifestyle changes(avoid alcohol, smoking cessation, adequate sleep)

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30
Q

IPV

A

All clients should be screened during preconception visits

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31
Q

Clinical behaviors of IPV & pts at risk

A

Populations at risk: women(pregnant), elderly, children, low income

Clinical Behaviors: may have chronic conditions caused by IPV, may have bruises
Evaluate patient alone, partner may not want to leave
Client may be quiet, vague nonspecific complains, wearing clothing to cover body, make excuses that don’t match

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32
Q

Guidance for IPV

A

somewhere to go, bag packed, phone number to shelters & police, be aware of surroundings, take different routes to work, provide photo to work security, cancel joint accounts, social worker involvement, identify a trusted individual for help if needed

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33
Q

Conception

A

Fertilized egg with sperm occurs in outer 3rd of fallopian tube, produces a zygote

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34
Q

Monozygotic

A

Identical twins
one zygote nucleus splits into two identical embryos
Results from one egg and one sperm

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35
Q

Dizygotic

A

Fraternal
two eggs are fertilized by two different sperm

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36
Q

Embryo

A

conception through the 8th week(at start of 9th week considered a fetus)
4 weeks: heart begins to beat
8 weeks: all organ systems are formed
Neural tube defects highest in this stage, healthy diet and folic acid are important

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37
Q

Placenta

A

function starts at day 21
Used for metabolic and gas exchange, acts as fetal lungs
provides glucose and amino acids for nutrients
Protects from certain medications and pathogens

38
Q

Umbilical vein

A

goes toward baby carrying oxygenated nutrient rich blood (one)

39
Q

Umbilical Artery

A

Away from baby carrying deoxygenated blood and nutrient depleted blood to placenta (2)
Maternal blood and fetal blood never mix

40
Q

Umbilical cord

A

has 3 vessels ( 2 arteries, 1 vein)
Has no sensory or motor innervation
True knot rare but can occur
nuchal cord-encircles the fetal head

41
Q

Amniotic fluid

A

Comprised of water, proteins, carbohydrates, lipids, electrolytes, fetal cells, lanugo and vernix (made by fetal kidneys during 2-3 trimester)does not provide any nutrients to the baby
Cushions the fetus
Prevents fetus from adhering to membrane
Allows freedom of movement
Provides a consistent warm environment
Helps dilate the cervix once labor begins

Has no nutritional value

42
Q

Infertility

A

Ages 34 y/o and younger
Failure to achieve a successful pregnancy after 12 months or more of regular unprotected sex
Ages 35 y/o & older
Failure to conceive after 6 months or more of unprotected sex

educate on healthy lifestyle (quit smoking, healthy diet, weight loss if obesity), bimanual exam

43
Q

Prediction of ovulation

A

Basal body temperature(first thing in the morning prior to getting up)
Ovulation predictor
Assess cervical mucous

44
Q

PCOS & 4 key features

A
  1. Ovulatory and menstrual dysfunction: amenorrhea secondary to anovulation(60-80% have this)
  2. Hyperandrogenemia: Elevated levels of androgens(make hormones)
  3. Clinical features of hyperandrogenism: hirsutism, acne, male pattern baldness
  4. Polycystic ovaries: enlarged ovaries with fluid-filled sacs surrounding the egg

Metformin used to regulate insulin resistance, lifestyle modifcations with low hypoglycemic diet (green leafy veggies and fruit)

45
Q

Endometriosis

A

presence of growth of endometrial tissue outside of the uterus
Usually on the ovaries and posterior rectovaginal wall
Symptoms: may be asymptomatic, pain starting several days before menstruation(most common), pain during intercourse(dyspareunia)

46
Q

PID s/s

A

Inflammation of female reproductive organs, related to STI’s
Assessment findings:
1. CMT: cervical motion tenderness; chandelier sign
2. Uterine and adnexal tenderness: structures closely related to the uterus the uterus such as ovaries, fallopian tubes, and surrounding connective tissues
3. Mucopurulent (mucus and pus) vaginal discharge
4. Can lead to ectopic pregnancy or even infertility

47
Q

Behavioral methods of contraceptives

A

Identify fertile time period and avoiding intercourse during that time
Calendar method
Cycle beads
Basal body temperature(track for a couple of months, pregnancy occurs 2-3 days prior to temp spike)
Cervical mucus(noting color and thickness, cloudy and sticky during fertile days)

48
Q

Barrier methods

A

Sponge: can insert 24hrs before
Wet with water prior to insertion to activate spermicide
Must be left in for 6 hours after intercourse

Cervical cap
Must be fitted by provider
Should be used with spermicide

Diaphragm
Must be left in for 6 hours after intercourse
Should be used with spermicide(at the time of intercourse max 1 hr) or jelly
Must be fitted by provider

Condoms
Male and female condoms
Water soluble lubricant
Made from a variety of materials
One time use

49
Q

Progestin only methods of contraceptive

A

Lactation is not impaired, less likely to cause cardiovascular problems. Should not be used for longer than 2 years due to potential side effects of loss of bone mineral(density). Give calcium and vitamin D
May have breakthrough bleeding and weight gain

Minipill
Injectable Depo-Provera (Medroxyprogesterone): given every 3 months

50
Q

Combined (progestin/estrogen) contraceptives

A

Oral Contraceptive Pill: take daily at the same time
Patch: once per week for 3 weeks. No patch on 4th week
Vaginal Ring: one per month
Contraindications: for women with thrombolytic, Coronary artery disease, smoking, use with caution epilepsy decreased effectiveness, Antibiotics decrease effectiveness(should use backup method)
Prevents ovulation, thickens cervical mucus, prevents implantation
Decrease PMS, blood loss, improvement of acne

51
Q

Warning signs for combined contraceptives

A

A = Abdominal Pain
C = Chest Pain
H = Severe Headaches
E = Eye problems
S = Severe Leg pain

52
Q

Long-acting contraceptives

A

Nexplanon: 3 yrs Contraindicated in pregnancy, thrombolitic disease, liver disease, breast CA
May cause irregular bleeding, acne breast pain, osteopenia
May be used during lactation

Intrauterine device (IUD):
Can be used during lactation
Do not prevent STI’s
Contraindications: cooper allergy, pelvic infection, pregnancy
Interfere with sperm transport, increases vaginal mucus
Cooper: effective for 10 years
Side effects: Heavy menses, dysmenorrhea
Hormonal(levonorgestrel): effective for 3-8 years skyla(3 years) Mirena (8 yrs)
Lighter period and possibly no bleeding

53
Q

diagnosis of pregnancy positive sign

A

Ultrasound confirmation, fetal movement felt by physician at 20 weeks, FHR(beating begins at 4 weeks, start to hear at 12 weeks)

54
Q

Prenatal visits

A

Monthly up until 28 weeks then every 2 weeks from 28-36. Then weekly after 36 weeks

54
Q

Initial labs

A

blood type ABO and RH, CBC, rubella/varicella titers, Venereal disease research laboratory or rapid plasma: screen for syphilis, hep B, HIV, pap, hCG (should double, checked every 2-3 days), Gonorrhea & chlamydia cultures, Transvaginal ultrasound(confirms EDC and or viability), genetic screening
Blood volume increases by 50% during pregnancy to perfuse the uterus and the support the pregnancy.

55
Q

TORCh infections

A

Intrauterine and perinatal infections that can be dangerous to the baby possibly cause mortality.
Toxoplasmosis(from cats don’t change litter box), other (hepatitis), rubella, Cytomegalovirus, herpes simplex virus
If positive may be managed in the third trimester

56
Q

Vaccines Contraindicated in pregnancy

A

MMR (attenuated)
Measles, mumps and rubella
Varicella (attenuated)
Chickenpox
Rubeola
Form of measles

57
Q

Foods to avoid in pregnancy

A

Avoid deep sea fish, unpasteurized dairy, undercooked meat, unwashed fruits and vegetables, alcohol.

58
Q

Normal weight gain in pregnancy

A

For BMI of around 25: Single pregnancy total=25-35lbs
Underweight 28-40 lbs/25 or above overweight variances should gain less 15-25
First trimester 2-4 lbs
second trimester 1lb per week

59
Q

normal findings in pregnancy

A

Gastrointestinal System: saliva production increases, gastric emptying delayed,
decreased intestinal motility, reflux
Cardiovascular System: 50% increase in plasma, 30-50% increase in cardiac output (will increase HR)
Respiratory System: (RR will increase) enlargement of uterus shift diaphragm higher
Urinary System: bladder tone decreases, bladder capacity doubles
Musculoskeletal System: pelvis tilts forward, increases curvature of spine,
relaxation of joints
Integumentary System: hyperpigmentation of skin
Immune System: enhancement of innate immunity(inflammitory response), suppression of adaptive Immunity (protective response). Will increase the risk for

60
Q

Warning signs in pregnancy when to call the provider

A

Vaginal bleeding or spotting: treated AB or placenta previa
Dysuria, frequency, urgency: UTI ->pyelonephritis ->PTL
Fever or chills: infection ->PTL
Prolonged nausea and vomiting: -> lead to dehydration ->PTL
Abdominal cramping or pain -> may indicate SAB
Decreased/absent fetal movement

61
Q

kick counts

A

10 in 2 hours

62
Q

normal FHR

A

110-160

63
Q

Quickening

A

Starts at 16-20weeks

64
Q

Coombs

A

Direct – is done on a sample of RBCs & detects if antibodies are attached to the RBCs
(+) RBCs have antibodies attached
(-) RBCs do not have antibodies attached
Indirect – is done on serum & detects if antibodies are in the bloodstream (if so, they could bind to RBCs)
(-) Pregnant mom has not developed antibodies and Rh sensitization has not occurred
(+) Pregnant mom has antibodies – if baby is Rh + we need to watch mom closely (Rh immunoglobulin)

64
Q

Rhogam

A

Indication: give to RH-negative women at 28 weeks prophylactically
Also administered to women who had a pregnancy loss, amniocentesis or abdominal trauma

65
Q

Amniocenteses

A

Aspiration of amniotic fluid for analysis, needle inserted via abdominal wall
Performed after 14 weeks gestation, done with ultrasound
Pt should empty bladder before test (reduces size and prevents puncture)
Pt must notify MD if experiences: fever, chills, leakage of fluid, decreased fetal movement, uterine contractions
RH negative mom should get Rhogam after procedure
Risk include: infection, animotic emboli, damage to fetus, death, PTL, ROm, fetal hemmorhage

66
Q

+ GBS culture

A

Naturally occurring bacteria
Carried in the rectum or vagina
Life-threatening to newborns
Administer antibiotics during labor (penicillin G) if + administered every 4 hours for duration of labor.

67
Q

Breast feeding benefits

A

Maternal
Decreased incidence of breast and ovarian cancer
Decreased risk of Type 2 diabetes
Cost effective
Bonding
Promotes gradual weight loss
Infant
Decreased childhood and adult obesity
Decreased risk of type 1 and type 2 diabetes
Decreased risk of SIDS
Decreased food allergies
Bonding
Immunologic properties help prevent infections(passed through breast milk)

68
Q

Hormones related to breast feeding

A

Oxytocin = letdown of milk(milk flow) as well as cramping
Prolactin=increases as the baby eats to create more milk
Progesterone levels drop when placenta is delivered also stimulating milk production.
Empty bladder before breast feeding

69
Q

SAB

A

Loss of a baby early before 12 weeks usually chromosomal abnormalities. Late 12-20 weeks maternal conditions.

70
Q

s/s of SAB

A

VVaginal bleeding, starts as dark blood and changes to bright red
Abdominal pain/cramping
Low backache
Pelvic pressure
1-4 pregnancies end in this
Dx by following serial HCGs monitored weekly until 0
May have a speculum exam(check cervix) and an ultrasound(cardiac)

71
Q

Types of SAB (miscarriage)

A

Threatened
Any bleeding before 20 weeks, no cervical dilation
Inevitable
Bleeding and dilation, no expulsion of products of conception

Incomplete
Partial expulsion of some but not all products of conception

Complete: Complete expulsion of all products of conception

Missed
Non-Viable embryo retained for at least 6 weeks

Recurrent
3 or more consecutive SABs

72
Q

Treatment for SAB

A

hysteroscopy D&C, D&E
Rhogam if needed
Monitor for bleeding, infection, and maternal feelings

73
Q

Induced abortion options

A

D&C or D&E techniques

Oral pills: mifepristone then misoprostol

74
Q

ectopic pregnancy

A

An implantation of a fertilized ovum in an area outside of the uterine cavity

75
Q

Risk factors of ectopic pregancy

A

Risk factors: compromised fallopian tube patency
STIs, tubal ligation/surgery, IUD, IVF
Can lead to massive hemorrhage or even death

76
Q

Signs of ectopic pregnancy

A

Abnormal vaginal bleeding and abdominal pain between 6-8 weeks. Lower back and abdominal pain on affected side. Nausea, breast tenderness,

77
Q

Treatment for ectopic pregnancy

A

Salpingectomy: removal of ruptured fallopian tube

Salpingostomy: incision into fallopian tube that preserves future fertility

Non-surgical management: methotrexate, chemotherapeutic agent

Rhogam: to Rh negative mother, not already sensitized

78
Q

Nursing management for ectopic pregnancy

A

Nursing assessment: pain management, monitor bleeding

Nursing considerations: supportive care, allow to grieve, be culturally sensitive, support groups
Avoid pregnancy for 3 months
Will have serial HCG levels followed to 0

79
Q

Hyperemesis Gravidarum

A

Persistent vomiting
Exact cause unknown
>5% weight loss from pre-pregnancy weight

80
Q

Risk Factors for Hyperemesis Gravidarum

A

Elevated levels of HCG, elevated estrogen, increased glucose demands, genetics, psychological, GI disease, hyperthyroidism, vitamin B6 deficiency
Dehydration will increase HCG levels in the blood making condition worse

81
Q

symptoms of hyperemesis gravidarum

A

Severe dehydration, weight loss(insufficient nutrition), ketonuria (break down of fat for energy), emotionally drained

82
Q

Managment of hyperemesis gravidarum

A

Non-pharmacologic
Acupressure-sea bands
Ginger-pops, chews
Small meals and timing of snacks
Registered dietician

Pharmacologic
promethazine(antihistamine)
Pyridoxine and doxylamine (vitamin B6 and antihistamine)
Antiemetics (ondansetron) used cautiously
IV fluids and electrolytes

83
Q

Twin complications

A

Maternal complications
Preterm labor, hypertensive disorders, PPROM (preterm pre-labor rupture of membranes), gestational diabetes, hemorrhage

Fetal complications
IUGR (intrauterine growth restriction), PTB, discordant twin growth, congenital anomalies, abnormal cord insertion, fetal demise

84
Q

Oligohydramnios

A

may be caused by: kidney problems, umbilical cord compression, ROM, placental insufficiency, HTN, Postdates
Too little fluid (<500mL)
Fundal high may be less than expected

Monitor: serial ultrasounds, NST, BPP, maternal report of loss of fluid

85
Q

polyhydramnios

A

Too much fluid (>2,000mL)
Uterine enlargement, abdominal discomfort, contractions, shortness of breath, lower extremity edema, fundal higher than expected

Monitor: ultrasound s/s of PTL

May be caused by: GDM, fetal anomalies, neural tube defects, down syndrome

86
Q

factors that place mother at risk for GDM

A

AMA, PCOS, hx of large birth in the past, multiples, hypertension prior to pregnancy, hx of GDM

87
Q

Potential risks related to GDM

A

polyhydramnios, Macrosomia, cardiac conditions in the baby, infections

88
Q

chronic hypertension

A

BP’s over 140/90 prior to 20 weeks

89
Q

Gestational hypertension

A

2 BP’s over 140/90 after 20 weeks gestation must be a least 4-6 hrs apart

90
Q

pre-eclampsia

A

increased blood pressure + protein in urine

Vasospasm (results in increased BP) and hypoperfusion: causes reduced blood flow

91
Q

pre-eclampsia workup

A

Urinalysis – proteinuria
Liver enzymes (ALT, AST)
Elevation indicates liver injury
Serum Creatinine/Uric acid (increased)
Increased serum level with kidney disfunction
CBC
Thrombocytopenia(less than 100,000)
Decreased H&H

92
Q

pre-eclampsia + seizures

A

Delivery
Oxytocin, mag sulfate, BP medication

93
Q

s/s of magnesium toxicity

A

absent deep tendon reflexes
decreased respirations/respiratory distress, decreased urine output

Antidote for toxicity: Calcium Gluconate

levels over 8 are considered toxic

94
Q

Antihypertensive medication for pre-eclampsia

A

labetalol (beta blocker, lowers BP and HR),

hydralazine(vasodilator),

nifedipine (Ca channel blocker)

Lasix: if needed for edema

95
Q

HELLP syndrome

A

Hemolysis
Due to fragmented RBCs trying to pass through narrowed vessels

Elevated liver enzymes
Due to endothelial damage and fibrin deposition in liver=necrosis

Low platelets
Due to vascular damage, vasospasm, aggregation at sites of damage

Can lead to DIC

96
Q

Causes of PTL

A

Bleeding: placenta previa, placental abruption

Uterine stretching: polyhydramnios, multiples, large for gestational size, uterine abnormalities

Infections/inflammation: STIs, UTIs, amniotic fluid

Maternal/fetal stress: stress hormones trigger contractions

Unknown cause 40% of the time

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