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Maternal Infant Health > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Nearly have of pregnancies in the U.S. are what?

A

Not planned

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2
Q

Among 75% of adolescents that become pregnant did not _____ ______.

A

Plan it.

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3
Q

The U.S. has the highest rate of what?

A

Teen pregnancy

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4
Q

What is contraception?

A
  • It is keeping the egg and the sperm apart.

* The intentional prevention of pregnancy during sexual intercourse

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5
Q

What is birth control?

A

A device or a practice that decreases the risk for conceiving

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6
Q

What is family planning?

A

The conscious decision on when to conceive throughout the reproductive years

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7
Q

The decision to practice conception should be a decision made by who?

A
  • A woman

* A woman and her significant other

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8
Q

What is part of initiating conception?

A

Informed consent

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9
Q

What is informed consent?

A 
BRAIDED
•Benefits: birth control
•Risk: Always
•Alternatives: may not a med
•Inquiries: chance to ask questions
•Decisions: who decides w/ HCP
•Explanations 
•Documentation
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10
Q

What is the cornerstone of the nursing care plan and planned Interventions?

A

Education

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11
Q

What are methods of contraception?

A
  • Fertility Awareness Based Methods (FABs)

* Consider cultural and religious beliefs

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12
Q

What is the only form of birth control that is recognized by the roman catholic church?

A

Natural Family Planning

•Avoid intercourse during fertility periods

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13
Q

What does a woman know when she is fertile?

A
  • Ovulation test strips

* Basal temperature

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14
Q

What are calendar based methods?

A
  • Track when cycles are
  • Lasting of menstrual cycle
  • Symptoms
  • Ovulating or not (increase in cervical mucous)
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15
Q

What are methods of contraception?

A
  • Spermicides

* Barrier Methods

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16
Q

What are spermicides?

A
  • Nonoxynol-9 (N-9) which reduces sperm motility

* Typical failure rate in first year of spermicidal use alone is 29%

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17
Q

Are spermicides effective?

A

No

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18
Q

What barrier methods are used?

A
  • Condoms: M&F (vaginal sheath)
  • Diaphram: 4 types
  • Cervical caps:FemCap available in U.S.
  • Contraceptive sponge: Today Sponge
  • Toxic shock syndrome: risks are present w/ diaphragms, cervical caps, and sponges
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19
Q

What do condoms also protect against?

A

STDs

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20
Q

Do spermicides, intrauterine devices, and oral contraceptives protect against STDs?

A

No

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21
Q

What does a woman have to do for a diaphram?

A
  • Get fitted for it.

* Needs to be refitted if she’s had any significant changes in weight or if she was pregnant

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22
Q

How are hormonal methods available?

A
  • In varying formulations and administration; >100 different formulations available
  • Combined estrogen-progestin oral contraceptives (COCs)
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23
Q

What is the point of oral contraceptives?

A
  • To inhibit ovulation by preventing the formulation of a follicle.
  • We are suppressing the surge of the leutinizing hormone.
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24
Q

How are combined estrogen-progestin oral contraceptives administered?

A
  • Injection
  • Transdermal (patch placed on weekly for 3 weeks and on the 4th week no patch)
    * Rotate sites
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25
Q

What is a vaginal ring?

A
  • Combo contraceptives

* Nuva ring

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26
Q

What is a Nuva ring?

A
  • Inserted into the vagina in the first 5 days of the cycle
  • Important that women have backup contraceptives for 7 days after insertion
  • Removed every 3 weeks so they are ring free for one week
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27
Q

What are warning signs to teach patients starting or taking COCs?

A

ACHES
•Abdominal pain may Indicate a problem with the liver of gallbladder
•Chest pain or SOB may Indicate possible clot problem within the lungs or heart
•Headaches (sudden or persistent) may be caused by cardiovascular
•Eye problems may indicate vascular accident or hypertension
•Severe leg pain may Indicate a thromboembolic

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28
Q

What is not ideal for patients with underlying cardiac issues?

A

Oral contraceptives because of the risk

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29
Q

What is very common with the Nuva ring?

A

•Severe leg pain (DVT) blood clots

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30
Q

What are some other adverse effects that we need to educate our patient on with methods of contraception?

A
  • MI
  • Stroke
  • Suedomenstruation
  • Birth control won’t work while on antibiotics
  • Related to increase in estrogen:
    • N/V
    • Dizziness
    • Fluid retention
    • Leg cramps
    • BP unexpectedly high
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31
Q

What is pseudomenstruation?

A
  • Happens on off week of cycle
  • Occurs monthly
  • Occurs during the 7 day of hormone free period
  • Mimics the 28th day menstrual cycle
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32
Q

What is Progestin-only contraception?

A
  • Contains no estrogen
  • Safer
  • Decreases the risk of cardiovascular side effects
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33
Q

What are some common side effects of Progestin-only contraception?

A
  • Irregular bleeding and spotting
  • Depression
  • Mood changes
  • Decreased libido
  • Weight gain
  • Recurrent yeast infections
  • Acne
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34
Q

What kind of Progestins are there?

A
  • Oral (Mini pill)
  • Injectable
  • Implantable
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35
Q

What is the failure rate for users that use Progestins (Mini pill)?

A

•9%

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36
Q

What is Progestin?

A
  • Has to be taken at the same time every day
  • Good option for breast feeding mom’s because progesterone won’t effect milk supply
  • Inhibits conception by increasing viscosity of survical mucous
  • Inhibits the surge of Lh
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37
Q

What is the injectable Progestin called?

A
  • Depot vera
    • Highly effective due to its action
    • Lasts 11-13 weeks
    • Thickens cervical mucosa
    • Decreases motility of fallopian tubes
    • Fertility may be delayed after taking (3 months)
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38
Q

What are implantable Progestins?

A
  • Rods that are implanted

* Last up to 3 years

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39
Q

What is a Intrauterine device (IUD)?

A
  • Device planted into uterus
  • Small T shaped
  • Lasts 3-10 years depending on brand
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40
Q

What are the 4 IUDs?

A
  • ParaGard Copper T
  • Mirena
  • Liletta
  • Skyla
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41
Q

How long is the ParaGard Copper T 380A effective for?

A

Up to 10 years

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42
Q

What does the Mirena release and how long is it effective for?

A
  • Levonorgestrel

* Effective up to 5 years

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43
Q

What does Liletta release and how long is it effective for?

A
  • Releases levonorgestrel

* Up to 3 years

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44
Q

What does Skyla release and how long is it effective for?

A
  • Releases levonorgestrel

* Up to 3 years

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45
Q

What is the typical failure rate of IUDs in the first year?

A

0.2%

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46
Q

Do IUDs offer protection against STIs or HIV?

A

No

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47
Q

What is it important that we educate our patients on?

A

ACHES (signs of potential complications)

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48
Q

What are other methods of contraception?

A
  • Permanent sterilization
    * Female sterilization: Tubule occlusion
    * Male (Vasectomy): interruption of bad deferens
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49
Q

When is the best day to start a contraceptive?

A

The first day a woman experiences menstrual flow

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50
Q

What is a quick start with contraceptives?

A

Can start at anytime but would need backup for 7 days and pregnancy HAS to be ruled out

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51
Q

What happens if someone has a missed dose of contraceptive and they are taking the combo (estrogen-progestin)?

A
  • Take the next tablet and next scheduled tablet
  • If more than 3 doses or 3 doses is missed she needs to discontinue the pack and allow for withdrawal bleeding and start a new pack
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52
Q

What happens if someone has a missed dose of contraceptive and they are taking Progestin only contraceptives?

A

•Take that pill as soon as we realize it’s missed and backup contraceptives is needed for 48 hours

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53
Q

What is the breast feeding method of contraceptive?

A
  • Lactational Amenorrhea (LAM)
  • Temporary
  • For breast feeding mom exclusively breast feeding around the clock
  • Not effective if mom is pumping
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54
Q

What is conception?

A

Ovum is released during ovulation then the sperm enters the female reproductive system and the egg and sperm join

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55
Q

Where do the sperm and egg join?

A

Outer 1/3th of the fullopian tube

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56
Q

How long is sperm fertile for?

A

48 hours

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57
Q

How long are ovum fertile?

A

24 hours

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58
Q

When and where does implantation occur?

A
  • The endometrium
  • Occurs 6-10 days after fertilization
  • Bleeding or spotting may occur
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59
Q

What is the first layer that is made?

A 
Fetal membranes 
   •Chorion
   •Amnion 
Chromosomes 
•XX- Female
•XY- Male
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60
Q

How is sex determined?

A

By the father of the baby

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61
Q

What does amniotic fluid do for the fetus?

A
  • Space for movement and protection
  • Thermoregulation
  • Nutrients and fluid
  • Protection
  • Prevents umbilical cord suppression
  • Prevents amnion adhering to the fetus
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62
Q

What can the amniotic fluid be tested for?

A

•Genetic studies

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63
Q

How much amniotic fluid should be present at birth?

A

800-1200mL

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64
Q

What is polyhydromnios?

A

Too much amniotic fluid >2000mL

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65
Q

What can too much amniotic fluid indicate?

A

GI malformations

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66
Q

What is Oligohydramnios?

A

Not enough amniotic fluid (<300 mL)

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67
Q

What can Oligohydramnios indicate?

A

•Renal malformations

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68
Q

What is the umbilical cord?

A
  • Lifeline between mom and baby
  • Protected by Wharton’s Jelly
  • No pain receptors
  • Has 3 vessels:
    • 2 arteries: carries deoxygenated blood and waste away from baby
    • 1 vein: carries oxygenated and nutrient rich blood to fetus
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69
Q

What is the placenta considered?

A 
An endocrine gland because it secretes:
HPL
hCG
Estrogen
Progesterone
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70
Q

What is detected in maternal serum 10 days after conception?

A

hCG

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71
Q

What is needed for fetal growth and development?

A

HPL

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72
Q

What is secreted by the placenta?

A

Estrogen

Progesterone

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73
Q

When does the placenta develop and fully function?

A
  • 3 weeks

* 12 weeks

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74
Q

What does the placenta regulate?

A

Regulates transport of gases, nutrients, and waste

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75
Q

Towards the end of pregnancy the placenta begins to what?

A

Age

Less effective of transportation of gas and nutrients

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76
Q

What is the maternal side of the placenta called?

A

The dirty dunkin

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77
Q

What is the fetal side of the placenta called?

A

The shiny shultz

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78
Q

What is the pre-embryonic stage?

A
  • Conception to day 14
  • Rapid cell division
  • All tissues and organs will develop from
  • Primary germ layer and the embryonic membranes form
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79
Q

What is the embryonic period?

A
  • Period where defect most likely occurs week 3-5
  • Day 15 to week 8
  • Structures of major organs are complete
  • Organ systems are functioning
  • Teratogens!!! (Harmful to fetus and can cause defects) are greatest threat during this period
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80
Q

What are examples of teratogens?

A
  • Radiation
  • Lead
  • Chemotherapy
  • CMV (A virus)
  • MMR vaccine: rule out pregnancy first and ensure she avoids pregnancy 28 days after vaccine; is safe for breastfeeding mother’s
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81
Q

What is the period of time for the fetus?

A

Week 8 to birth

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82
Q

What months are the 1st trimester?

A

Months 1,2,3

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83
Q

What happens to the fetus during the 1st trimester?

A
  • Limb buds
  • Hematopoiesis (blood cell formationweek 3)
  • Day 25 the heart is beating
  • The 4th week the GI system is functioning
  • Formation of liver, thyroid, bones, muscles, epidermis
  • Neutral tube: start of CNS
  • Folic acid is important for women of child bearing to take
  • Fetus is 1/2 inch <1 oz
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84
Q

What are good sources of folic acid?

A
  • Green leafy vegetables
  • Orange juice
  • Fortified cereals
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85
Q

What is the first functioning system?

A

Cardiac system

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86
Q

What happens in the 2nd month of the 1st trimester?

A
  • Ears, ankles, wrists
  • Eyelids-SHUT
  • Hematopiesis continues
  • 5th week swallowing and voiding
  • Brain has 5 lobes
  • Rh FACTOR>6 weeks
  • Fetus is 1 in <1 oz
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87
Q

What is the second most important factor when looking at blood type?

A

Rh factor
ABO
A+

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88
Q

Rh are what?

A

•found as proteins on red blood cells

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89
Q

What happens during month 3 of the 1st trimester?

A 
•Fingers and toes
•Soft nails
•Baby teeth
•Doppler
•Renal function
•Moving
•Adrenal cortex producing hormones
•Sex characteristics
•Lanugo covers the body of the baby (Fine hairs)
Vernix casiosa (cheese like coating)
•2.5 inches >1 oz
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90
Q

What hapoens during the 4th month of the 2nd trimester?

A
  • Moves, kicks, swallows
  • Handprints 16 weeks
  • Forming meconium
  • Placenta is fully formed
  • 6-7 inch 5 oz
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90
Q

What hapoens during the 4th month of the 2nd trimester?

A
  • Moves, kicks, swallows
  • Handprints 16 weeks
  • Forming meconium
  • Placenta is fully formed
  • 6-7 inch 5 oz
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91
Q

What hapoens during the 5th month of the 2nd trimester?

A
  • Sleep/ wake intervals
  • Week 20: insulin
  • 8-12 inches 1/2 lb
  • Actively felt by mom
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92
Q

What hapoens during the 6th month of the 2nd trimester?

A
  • Lanugo all over
  • Eyes open
  • 11-14 inches 1-1.5 inches 1-1.5 lb
  • 24 weeks
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93
Q

What trimester is the fetus viable?

A

The end of the 2nd trimester

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94
Q

What does viable mean?

A

The baby is more likely to survive outside of mom

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95
Q

What happens during the 7th month of the 3rd trimester?

A
  • Open and close eyes
  • Responds to light and sound
  • Storing fat
  • Testes descended into scrotum
  • 15 inch 3 lbs
96
Q

What happens during the 8th month of the 3rd trimester?

A
  • Rapid brain growth
  • Skull is soft/flexible
  • Mature GI system
  • Fe stored
  • 18in 5lb
97
Q

What happens during the 9th month of the 3rd trimester?

A
  • Full term 37-40
  • Brain 1/4 size of adult
  • Gains 1/4-1/2 per week [6-9 lb 9-21 in]
98
Q

What three structures are involved in fetal circulation?

A
  • Fetal heart
  • Placenta
  • Fetal Tissues
99
Q

What are the three purposes of fetal circulation?

A
  • Good blood flow to the head and heart
  • Decrease blood flow to the lungs
  • Direct blood to the placenta
100
Q

What will the fetus do to the lungs while in utero?

A

**•Shunt blood
**•No perfusion to the lungs
•Once baby is born and starts to breath the shunt is no longer needed and perfusion will go to the lungs

101
Q

How do we know if a baby circulation is compromised while in utero?

A
  • Not growing like we think
  • Monitor fetal HR (doppler)
  • Low HR!!
102
Q

How do we increase the fetal heart rate while it’s in utero?

A

Perform interventions on mom

•Turn mom on side increases fetal circulation

103
Q

Where is surfactant produced?

A

In the lungs

104
Q

What does surfactant do?

A
  • It reduces surface tension

* Allows lungs to inflate which decreases the effort to breath.

105
Q

When is surfactant being produced?

A

20-24 weeks and stabilizes the alveoli

106
Q

When are alveoli matured?

A

35-37 weeks

107
Q

What should the L/S ratio be?

A

2:1: indicated lung maturity

108
Q

What can stimulate the production of L/S?

A

Maternal use of steroids

109
Q

Anytime a women is pregnant with more than one fetus what is it considered?

110
Q

How do you diagnose multifetal pregnancy?

A
  • Polyhydramnios
  • Asychronous FHR
  • US evidence
111
Q

What is the likelihood of a multifetal pregnancy?

A
  • Family history of dizygotic twins in Female history

* Use of fertile drugs

112
Q

Often multifetal pregnancy will end in what?

A

Prematurity

113
Q

What is Monozygotic?

A
  • The fertilization of a single ovum by one sperm
  • Identical twins
  • Congenital malformations are more common
114
Q

What is Dizygotic?

A
  • Fertilization of 2 ova by two sperm

* Fraternal/nonidentical

115
Q

What is gravidity?

A

A pregnancy

116
Q

What is a term birth?

A

A birth that is completed after 37 weeks

117
Q

What’s is preterm?

A

A baby that was born prior to 37 weeks

118
Q

What is an abortion?

A
  • A termination of a fetus
  • Spontaneous
  • Medical
119
Q

What is a spontaneous abortion?

A
  • Stillborn

* Miscarriage

120
Q

What is a medical abortion?

A

Use of surgical interventions

Medications

121
Q

What is living?

A

The number of children that the woman has that are alive

122
Q

What is nulligravida?

A

Never been pregnant

123
Q

What is primigravida?

A

A woman who is pregnant for the first time

124
Q

What is a multigravida?

A

A woman who has been pregnant multiple times.

125
Q

What is the five digit system?

A
  • Gravity
  • Term
  • Preterm
  • Abortion
  • Living
126
Q

What are signs of pregnancy?

A
  • Presumptive
  • Positive
  • Probable
127
Q

What is presumptive signs of pregnancy?

A 
•Subjective data
Amenorrhea
Fatigue 
Breast changes
Breast heaviness
Darker pigment to aerola 
Nausea
Increase urinary frequency
Quickening: movement of fetus; week 16-20
128
Q

What are probable signs of pregnancy?

A 
Observed by the examiner
•Goodell sign
•Chadwick sign
•Hegar sign
•Uteran fundas
•HCG pregnancy test 4-12 weeks 
•Ballottment week 16-28
129
Q

What is the goodell sign?

A
  • Note as early as 5 weeks after conception

* Softening of the cervix

130
Q

What is the Chadwick sign?

A
  • Occurs between week 6-8

* A bluish purple discoloration to the cervix

131
Q

What is the Hegar sign?

A
  • Between week 6-12

* Softening of the lower segment of the uterus

132
Q

What does the uterus fundus do?

A

It presses on the bladder so the globular shape of the uterus is gonna press on the woman’s bladder

133
Q

What are positive signs of pregnancy?

A

Definent evidence of positive that are only accountable to a fetus being present
•Ultrasound 5-6 weeks
•Fetal HR 6 weeks
•Palapation of fetal movement
•Leopold maneuver: palpating outline of fetus

134
Q

What happens with the womans reproductive system when she is pregnant?

A

•Uterus increases in size and weight 12-14 weeks above sympathise pubis palpation then moves up to umbilical 22-24 weeks

  • Cervix increases in vascularity, softens, increase in mucous production
  • Mucous plug acts as a barrier against infection

•Vagina increased in secretions (Leukorrhea b/c increase in estrogen and progesterone)
Chadwick sign

•Perineum: supports pelvic structure in child birth

135
Q

What happens with the womans cardiovascular system when she is pregnant?

A

•The heart is displaced to the left
•Cardiac volume and output increases 30-50%
•Vital signs
HR 10-15 Beats above baseline
BP same during 1st trimester; BP with drop 20
•Changes in periphery is edema
There are changes of the iliac veins and inferior vena cava by the uterus!
•Coagulation factors increase (hypercoaguable state)

136
Q

What are the breasts?

A
  • Intricate system of tissues that manufactures and stores breast milk
  • Stimulated by hormones to prepare for lactation
  • Colostrum : before milk 16 weeks
  • Stria gravida
137
Q

What happens with the womans respiratory system when she is pregnant?

A
  • Anatomical changes with the diaphragm and RR unchanged
  • Functional changes
  • Slight hyperventilation
  • Oxygen consumption Increases 15-20% from baseline
  • Dyspnea
  • Nasal stuffiness and epistaxis
  • Respiratory system is more vascular in response to estrogen
138
Q

What happens with the womans renal system when she is pregnant?

A

•Anatomical changes
Bladder has a reduced capacity
Ureters/kidneys increase in size
•Bladder more sensitive because uterus is pressing against the bladder

•Functional Changes
Urine formation is slightly increased
Nocturia

139
Q

What happens with the womans integumentary system when she is pregnant?

A 
•Vascular changes related to hormones and stretching
Melasma
Linea Nigra 
Striae Gravidarum
Angiomas
Palomar erythema
140
Q

What is Melasma?

A
  • Blotchy brown mask in females with dark complexion

* Fades after birth

141
Q

What is linea nigra?

A

extends above umbilicus to pubic bone
midline
no clinical significance
fades after child birth

142
Q

What is angiomas?

A

Spider veins

Remain after birth

143
Q

What is Palmar erythema?

A

pink reddish palms
no clinical significance
disappear after birth

144
Q

What happens with the womans musculoskeletal system when she is pregnant?

A 
•Exaggerated Lordosis
•Hormonal Influences
Pelvic expression
Increased softening and elasticity of ligaments 
Abdominal muscles stretch
•Muscle cramps
145
Q

What happens with the womans neurological system when she is pregnant?

A

•Carpel Tunnel
R/t edema pressure on median nerve
Usually occurs in late third trimester
May need PT even after pregnancy

Parasthesia, pain, swelling, and edema to wrist

146
Q

What happens with the womans GI system when she is pregnant?

A
  • Increase salivation
  • Increased appetite
  • Nausea and vomiting: related to hormones
  • Delayed gastric emptying and intestinal motility
  • GERD: increase in softening to esophagus related to increase of progesterone
  • Delayed gallbladder emptying
  • Pica: non-food craving
147
Q

What happens with the womans endocrine system when she is pregnant?

A
  • Estrogen: acne
  • Progesterone: maintains pregnancy
  • hCG: responsible for morning sickness
  • Oxytocin
  • Thyroid gland: increase in size
148
Q

What happens with the womans endocrine system when she is pregnant?

A

Pancreas
•Fetus relies on maternal glucose and pulls from maternal supply
•Depletes maternal stores
•Dusting 1st trimester results in a decrease in maternal blood glucose
•2nd trimester maternal tissue sensitivity to insulin begins to decline

149
Q

***What two major effects does higher blood glucose levels have?

A
  • It makes more glucose available for fetal energy

* It stimulates the pancreas of a healthy woman to make more insulin

150
Q

Does maternal insulin cross the placenta?

151
Q

If mom is hyperglycemic then the baby’s blood glucose is too what?

152
Q

When do women usually find out they are pregnant?

153
Q

When does prenatal care start?

A

Preconception to 1 year after birth

154
Q

What is the prenatal period?

A

•Period of physical and psychological preparation for birth and parenthood
•Pregnancy diagnosis
EDD/EDC:Estimated due date/estimated due date of confinement
Nagaeles Rule

155
Q

When do most women deliver their baby?

A

Plus or minus 2 weeks from EDD

156
Q

What is Nagaele’s rule?

A

•Assumes every female has a 28 day menstrual cycle
•Sperm and egg got together on day 14
•Add 7 to the first day of the last menstrual period
Subtract 3 from the month
Add 1 to year if applicable

157
Q

Adaptions to Pregnancy

A 
•Mood swings for mom 
•Acceptance
Identifying as a mother
Establishing a relationship w/ fetus
Preparation for childbirth
158
Q

What is the adaption of pregnancy that is paternal?

A

Couvade syndrome

159
Q

What is a huge milestone with a pregnant women?

A

Say she is pregnant

160
Q

What is couvade Syndrome?

A

When the dad experiences pregnancy like symptoms:
Nausea
Cravings
Weight gain

161
Q

What is included in a prenatal interview?

A 
Health history
Drug use
Family history
History of abuse 
Physical exam
Lab tests: CBC, Anemia, Urine
Need to know about spinal disorders 
History of sexual abuse
Pica 
Genetic disorders 
History of twins 
Mental status
162
Q

What is included in a fetal assessment?

A

Fundal height: How big uterus is growing
FHTs: fetal heart tones; HR
EGA : estimated gestational age; how many weeks?
Labs: genetic testing
Education: child care, how to feed baby, 20 weeks plus if baby isn’t moving as much then notify HCP

163
Q

What labs are performed on every woman?

A 
HIV: Informed consent 
Syphilis
Gaunarea
Chlamydia
GBS: swab performed between week 35-37
    •Swab that goes from the vaginal canal to rectum 
    •Thrives in this area
    •Can be passed to baby 
    •Not an STD
164
Q

What is preterm labor?

A 
Labor that occurs prior to 37 weeks
Want mom to know normal/abnormal discomfort
•Nausea NORMAL
•Vomiting NORMAL
•Back pain NORMAL
•Bright red bleeding ABNORMAL
•Uterine contractions ABNORMAL
•Changes in fetal movement ABNORMAL
165
Q

Do women have a decrease or Increase in libido and when?

A

Increase in 2nd trimester

166
Q

Pregnant women can not have any of what kind of vaccine?

A

Live vaccines viruses

No MMR or varicella

167
Q

What vaccines are okay for mom to get?

A

Hepatitis B
Flu shot
Tdap

168
Q

What medications are not safe during pregnancy?

169
Q

Who is least likely to receive prenatal care?

A

Adolescents

•EDUCATION

170
Q

What is considered advanced maternal age/delayed childbearing?

A

35 years and older

Usually have to take fertility drugs (can cause twins)

171
Q

What are alterations in pelvic support usually a result from?

A

Child birth

172
Q

What is uterine displacement and prolapse?

A

This is where the uterus prolapse posteriorly and the cervix rotates anteriorly
•Usually 2 months after child birth the ligaments go back to normal
•In 1/3rd of women they don’t go back to normal

173
Q

What do patients complain about with uterine displacement and prolapse?

A

Pelvic or back pain
PMS
Intercourse will be painful

174
Q

What is a cyctocele?

A

The protusion of the bladder into the vagina

175
Q

What are causes of cyctocele?

A

Child birth
Obesity
Age

176
Q

How do people feel with cyctocele?

A

Heaviness in vagina

Urinary incontenance

177
Q

What is rectocele?

A

When anterior rectal wall is herniated through vaginal tissue

178
Q

What is the management for rectocele and cyctocele?

A

Surgical repair

Pelvic physical therapy

179
Q

What are genital fistulas?

A

Preparations between the genital track organs

180
Q

What are signs and symptoms of genital fistulas?

A

Depend on location
Leaking of urine
Gas
Feces in the vagina

181
Q

What is management of genital fistulas?

A

Surgical repair- may not always work

182
Q

What percentage of females does urinary incontenance effect?

183
Q

What are ovarian cyst (benign neoplasms)?

A

•Dependent on hormonal influences associated with menstrual cycle

184
Q

What is a follicular cyst?

A
  • Most common in normal ovaries of younger females
  • No signs or symptoms unless ruptures then she will have pelvic pain
  • If no rupturing it will shrink and disappear after 2-3 menstrual cycles
185
Q

What is the treatment of follicular cysts?

A

NSAIDS
Oral contraceptives: suppressing ovulation
Surgery for larger cysts.

186
Q

What is polycystic ovarian syndrome?

A
  • PCOS
  • Relates to an endocrine imbalance due to an increase in estrogen, testosterone, LH, decrease in FSH
  • Multiple follicular cysts (increase of estrogen)
187
Q

What do we recommend for PCOS?

A

Diet
Weight loss
Medications (Oral contraceptives, metformin)

188
Q

What clinical manifestations happen with PCOS?

A 
Obesity
Hirsutism
Irregular menses
Infertility
Glucose intolerance
Hyperinsulinism
189
Q

What nursing interventions are used for PCOS?

A

•Address physical and psychological concerns

190
Q

What are uterine polyps?

A
  • Benign
  • Originate in the endometrium or cervix tissue
  • Tumors arise from muscosa
  • May be removed if in cervix
  • Most common age group is multiparous women older than 40
191
Q

What is education that should be given after removing a uterine polyps?

A

No tampons
No sex for a week
Signs and symptoms of infection
Notify provider if they experience any heavy bleeding

192
Q

What are Leiomyomas?

A
  • Aka fibroid tumors, fibromas, myomas, or fibromyomas
  • Most common type of benign tumor
  • Common in african american, women who have never been pregnant, and obese
  • Rarely becomes malignant
  • Typically asymptomatic
  • If big: back ache, abdominal pressure, constipation, Dysmenorrhea
193
Q

Are Leiomyomas slow growing?

194
Q

Where do Leiomyomas originate from in the muscle?

195
Q

Growth of Leiomyomas is influenced by what?

A

Ovarian Hormones

196
Q

Why do Leiomyomas spontaneously shrink?

A

After menopause because ovarian hormones decrease

197
Q

What are Leiomyomas heavily influenced by?

A

Estrogen!

It can affect implantation And maintenance of pregnancy

198
Q

Women with Leiomyomas that are undiagnosed can experience what?

A
  • Miscarriages
  • Preterm labor
  • Difficult labor
199
Q

What is medical management of Leiomyomas?

A
  • NSAIDS
  • Oral contraceptives
  • Growth hormone agonists because they will decrease the size of the fibroid
  • Uterine artery embolization: block the blood supply to the thyroid to shrink it
200
Q

What is surgical management for Leiomyomas?

A

Laser or operative removal
•Laser destroys small fibroids
Operative removal
•If large enough the entire uterus may need to be removed
•Severe bleeding or obstructing other organs

201
Q

What are nursing interventions for surgical management of Leiomyomas?

A

Assisting the patient with coping with fertility issues
Consent has been signed
They may have concerns related to child bearing
Monitor for bleeding

202
Q

Surgical management of hysterectomy

A 
In hospital for 1-2 days 
Pain because of surgery 
Experience fatigue
Depression
Pelvic rest 
Can have sex after healed
203
Q

Surgical management of hysterectomy

A 
In hospital for 1-2 days 
Pain because of surgery 
Experience fatigue
Depression
Pelvic rest 
Can have sex after healed
204
Q

What is the most common malignant neoplasm is what?

A

Endometrial cancer

205
Q

What are risk factors with endometrial cancer?

A 
Obesity
Nulliparity
Infertility
Late onset menopause
Diabetes
Hypertension
PCOS
Familia history of ovarian or breast cancer
Tamoxifen (antiestrogen agent)
206
Q

Is endometrial cancer slow growing?

207
Q

If endometrial cancer is localized then there are what?

A

Treatment options:
Hysterectomy (Removal of uterus)
Chemo (advanced stage)
Antiestrogen agents

208
Q

What is the most significant risk factor for endometrial cancer?

A

Hormone Imbalance

209
Q

What is the cardinal sign of endometrial cancer?

A

Abnormal uterine bleeding

210
Q

How is endometrial cancer diagnosed?

A

Pap smear: collection of cells
Biopsy of endometrium: confirms
Pelvic exam to discover tumor

211
Q

What are signs and symptoms of endometrial cancer?

A

Vaginal discharge: pinkish
Lower back pain
Pelvic pain

212
Q

How many females are diagnosed endometrial cancer?

A

100,000 annually

213
Q

What is the most common characteristic with endometrial cancer?

214
Q

What is the 2nd most common malignant cancer?

A

Ovarian cancer

215
Q

What symptoms of ovarian cancer are there?

A 
Vague 
Most under diagnosed cancer of all
Seen signs:
Urinary urgency
Urinary frequency
Abdominal bloating
Increase in abdominal girth
Pelvic and abdominal pain
Feeling of fullness after eating
216
Q

Are there definitive screenings/tests for ovarian cancer?

217
Q

What is the cause of ovarian cancer?

218
Q

What are risk factors for ovarian cancer?

A 
Nulliparity
Infertility
Previous breast cancer
Family history
Ethnicity (Northern american/european decent)
219
Q

What is the treatment for ovarian cancer?

A 
Surgical removal: ovary or radical hysterectomy
Cyctoreductive surgery: debulking tumor
Antineoplastic surgery 
Chemotherapy
Radiation
220
Q

What is cancer of the cervix?

A
  • Third most common malignancy to reproductive system
  • Begins as a lesion on the cervix
  • Can spread
221
Q

Where can cancer of the cervix spread?

A

Vaginal mucosa
Pelvic wall
Bowel
Bladder

222
Q

The incidence of cervical cancer is highest in what race?

A

Hispanic women

223
Q

What are 90% of cervical cancers caused by?

224
Q

What is the diagnosis of cervical cancer?

A

Pap smear!!! Detects 90% of malignancies
Colposcopy: magnify cervix
Biopsy: remove cervical tissue to see if cancerous

225
Q

Does cervical cancer have symptoms?

A 
No
Could see:
Abnormal bleeding after intercourse
Rectal bleeding
Hematuria
Back and leg pain
Anemia
226
Q

What is medical surgical management of cancer of the cervix?

A

Radiation
Laser ablation
Hysterectomy if invasive
Chemotherapy

226
Q

What is medical surgical management of cancer of the cervix?

A

Radiation
Laser ablation
Hysterectomy if invasive
Chemotherapy

227
Q

What is cancer of the vulva?

A

4th most common GYN cancer
Slow growing
Spreads late
90% survival rate

228
Q

What is the most common site for cancer of the vulva?

A

The labia majora

229
Q

What is treatment for cancer of the vulva?

A

Laser surgery
Cryosurgery
Electrosurgical excision
Vulvectomy

230
Q

What is cancer of the vagina?

A

1%-3% of GYN cancer

231
Q

Where do 50% of cases occur between what ages?

A

70-90 years

232
Q

What are potential causes of cancer of the vagina?

A

Vaginal irritation
Vaginal trauma
Genital viruses

233
Q

What is the occurrence of cancer and pregnancy?

A

1 out of 1000 women

234
Q

What is the occurrence of cancer and pregnancy?

A

1 out of 100 women

235
Q

What types of cancer occurs during pregnancy?

A 
Breast
Cervical
Leukemia
Hodgkin
Melanoma
Thyroid 
Colon
236
Q

How long should the women wait to have another baby after cancer treatment?

Maternal Infant Health (2 decks)

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