Exam 3 Flashcards
Copper IUD
- Releases what hormones?
- Duration of use
- Benefit
- SE
- Does not contain hormones
- 10 years
- Most effective form of emergency contraception
- Menstrual pain and bleeding may increase at first and bleeding between periods
Benefits of IUDs (3)
1) Provides long term contraception
2) Can be removed any time
3) Highly effective (most effective contraception)
What can trigger reoccurence of Herpes
What may precede outbreaks?
Stress
Prodromal symptoms
Lactobacilli Produce (5)
1) Biosurfactants (inhibit adhesion of pathogens)
2) Coaggregation molecules (blocks spread of pathogens)
3) Bacteriocins (self produced metabolites)
4) Hydrogen Peroxide
5) Lactic Acid
What is a rising issue with Gonorrhea
Decreased susceptibility to (4) Antibiotics
Antimicrobial Resistance! in 20-30% of gonococci
1) Cephalosporin
2) Penicillin
3) Tetracycline
4) Fluoroquinolones
Describe important nursing interventions in umbilical cord prolapse (5)
1) Position
2) Lifesaving measure =
3) Watch out for ____
4) Emergency _____
5) Assessment with ____
1) Knees to chest position
2) Lift presenting part off the cord and hold (LIFESAVING MEASURE!)
3) Monitor baby’s FHR, could have variable or prolonged decels
4) C-Section
5) ROM
Hormonal IUD (____)
- Releases what hormone?
- Duration of use
- Helps alleviate
- SE
(Mirena)
- Progesterone
- 3 years
- Menstrual pain and bleeding
- May cause spotting and irregular bleeding at first, HA, Nausea, depression, breast tenderness
Genital Herpes =
Chronic Viral Infection of HSV-1, HSV-2
Constellation of Symptoms of PCOS (2)
1) Irregular menstrual periods
2) Acne, Face and Body Hair, Male pattern baldness
Progesterone is responsible for what?
Without it there is =
Organized shedding, differentiation and stabilization of endometrium
Excessive proliferation and excessive bleeding
Fetal and Maternal risks of gestational diabetes
Fetal risks: macrosomia, preterm labor, stillbirth
Maternal risks: miscarriage, increased risk for DM postpartum
Dysmenorrhea =
Painful menses
Signs of Placenta Previa =
Rationale for bleeding
How do we confirm it? What should you not use!?
Painless vaginal bleeding in third trimester
-As the lower uterus begins to contract and dilate in the later weeks of pregnancy the placental villi are torn from the uterine wall, exposing the blood filled uterine sinuses at the placental site-bleeding can be scanty or profuse depending on the number of sinuses involved
Sonographic confirmation, NO VAGINAL SPEC EXAM!
Role of LH
Estradiol peak stimulates midcycle surge of LH which stimulates ovulation within 24-36 hours
Test for Genital Herpes
Treatment for Genital Herpes (3)
PCR (assay for HSV DNA) and Typing
Acyclovir, Famciclovir, Valacyclovir
Describe the mechanism of action and the rationale for the medications given in severe preeclampsia and eclampsia
-Preeclampsia
Delivery is only cure
Give labetalol and hydralazine (safe for HTN during pregnancy)
-Eclampsia Magnesium sulfate (anti-epileptic agent) Start during delivery and given 24 hours postpartum
Describe the mechanism of action and the rationale for the medications given in preterm labor
Preterm Labor:
Less than 34 weeks: single dose betamethasone to reduce fetal mortality and complications by accelerates fetal lung maturity. Give tocolytic agents to relax the uterus to delay delivery - allow betamethasone to take effect
If less than 32 weeks, then also give a single dose of magnesium sulfate, which has a protective effect on the brain. (Magnesium sulfate is also a type of tocolytic)
Ectopic Pregnancy occurs in=
Management (2) =
= ampulla of fallopian tubes
Methotrexate (folic acid inhibitor that interrupts proliferation of trophoblast)
Surgery
Placenta Previa vs. Abruptio Placentae
1) Onset
2) Bleeding
3) Color of Blood
4) Anemia
5) Shock
6) Toxemia
7) Pain
8) Uterine tenderness
9) Uterine tone
10) Uterine contour
11) Fetal heart tones
12) Engagement
13) Presentation
Previa vs Abruptio
1) Quiet and Sneaky vs Sudden and stormy
2) External vs External or concealed
3) Bright red vs Dark venous
4) Due to blood loss vs greater than apparent blood loss
5) Due to blood loss vs greater than apparent blood loss
6) Absent vs May be present
7) Only in labor vs severe and steady
8) Absent vs Present
9) Soft and relaxed vs Firm to stony hard
10) Normal vs May enlarge and change shape
11) usually present vs present or absent
12) Absent vs may be present
13) May be abnormal vs No relationship
Polycystic Ovary Syndrome (PCOS) =
Prevalence =
Most common hormonal condition in women of reproductive age characterized by too much LH which causes excess progesterone and androgens
5-10%
Implantation =
Tx/intervention?
= SMALL amount of spotting or bleeding about 10-14 days after fertilization (time of missed period)
-bleeding related to implantation of fertilized egg in decidua
None, just reassure patient
Luteal phase dominated by =
How long does it last? Why does it last that long?
Progesterone
Alway 14 days bc corpus luteum degenerates in 14 days
Identify common and maternal fetal scenarios which would require c-section.
PPPBLANCH
Post Date Placenta Previa Prior C-Section/uterine surgery Breech Transverse Lie Arrested dilation and descent Non-Reassuring fetal status True CPD (small pevlic outlet) Active Herpes infection
Oligomenorrhea =
Causes (2)
Irregular Menses
1) Thyroid problems
2) Starvation
Rationale for giving Rhogam to Rh negative pregnant patient
Give Rhogam to Rh - mothers to prevent isoimmunization if baby is Rh positive. If mom is exposed to baby’s blood, she will build up antibodies which will attack RH positive babies in future pregnancies.
Management of Placenta Previa
Post delivery care there is increased risk of
1) Bed Rest! with bathroom privileges
2) C-section for complete previa
3) Monitor pain, uterine contractility, blood loss (pad count every 4 hours)
4) Maternal vital signs
5) complete lab evaluation
6) Availability of cross-matched blood (Rh-D immunoglobulin)
7) Evaluate FHR, nonstess test
8) Administer IV fluid (BETAMETHASONE)
Hemorrhage
5 P’s of Sexual History
1) Partners
2) Practice
3) Protection
4) Past History of STD’s
5) Prevention of Pregnancy
Hormonal changes that occur during menopause
Estrogen and Progesterone are decreased so GnRH keeps triggering pituitary for release of FSH,LH to the ovary -> but no cycle is happening
Trichomoniasis
1) Appearance
2) Discharge
1) Flagellated organism (protozoa)
2) Frothy, greenish discharge, strawberry cervix
1) 10-15% of women with chlamydia will develop =
2) 18% will experience =
3) 9% will have =
Diagnostic Test =
Treatment (2) =
1) Pelvic Inflammatory Disease
2) debilitating chronic pelvic pain
3) ectopic pregnancy
NAATS (first catch urine, vaginal swab, pap smear)
Azithromycin, Doxycycline
-Azithro (more expensive but has advantage of enabling provison of single dose directly observed therapy when patient adherence is in question)
What symptoms differentiate spontaneous abortion from other causes of early pregnancy bleeding? (2)
Pelvic Backache and Cramping
HSV-1 associated with =
HSV-2 associated with =
Which one is more recurrent?
Oral Lesions
Genital Lesions
HSV-2
MOA of oral contraceptives
Most important mechanism =
+ (3) more
Estrogen induced inhibition of mid-cycle surge
1) Makes endometrium less suitable for implantation
2) Makes cervical mucus less permeable, more hostile for sperm
3) Impairment of normal tubular motility
Abruption Placenta =
Causes (4) =
Risks for (2)
Premature separation of placenta from uterine wall
Largely Unknown but asct with smoking, cocaine, HTN, trauma
Maternal and fetal blood loss, hypoxia
Describe the underlying mechanisms involved in gestational diabetes
- During the second trimester, maternal hormones (progesterone, hPL, cortisol, and GH) are released, which cause increased glucose in mom’s blood, as well as insulin resistance.
- This causes glucose to go to the baby, which causes the baby to release more insulin, which causes the glucose to enter cells, which causes the baby to grow (macrosomia)
Oncogenic Serotypes of HPV (2)
High Risk Manifestations =
16, 18
Low and High grade cervical cell abnormalities that are precursors to cervical, vulvular, vaginal, penile, anal cancers
4 Major causes of Early Pregnancy Bleeding
Early loss is defined as:
1) Spontaneous abortion (miscarriage)
2) Ectopic Pregnancy
3) Implantation
4) Cervical, vaginal, uterine pathology (lesions or infections)
Occurs prior to 20 weeks or fetal weight less than 500 g
Appropriate tx for gestational diabetes
- Start with diet management
- Insulin
- Early screening: 24-28 weeks → glucose tolerance test
Follow-up 6 weeks after delivery
STI Prevention and Education (4)
1) Pre-exposure vaccination
2) Abstinence
3) Reductio in # of sexual partners
4) Condom
Oral Contraceptives
1) Risks/SE
2) Benefits
3) Cons
1) Dizziness, nausea, mood changes, high blood pressure, blood clots, heart attacks, stroke
2) Easy to use, high rate of effectiveness, protection against ovarian and endometrial cancer
3) User must remember to take pill daily, possible undesirable SE, high cost, prescription needed
HPV more than _____ serotypes
1) 30-40 types are:
2) 15-20 types are:
100
1) anogenital
2) oncogenic
Describe the hormonal influences of the female menstrual cycle including the effects of gonadotropins, LH, FSH, estradiol, and progesterone
GnrH is released from the hypothalamus in a pulsatile manner, which stimulates secretion of LH and FSH from the anterior pituitary, which stimulates ovaries to release estradiol and progesterone
PMS/PMDD symptoms
PMDD =
Premenstrual symptoms = bloating, irritability, anxiety, depression, mood swings, headaches
Affective symptoms are more dominant than somatic! Tx SSRI’s
What is the most important indicator for a successful labor?
Favorable cervix
Most common STDs
1) HPV
2) Chlamydia
3) Trichomoniasis
4) Gonorrhea
Explain the statistics and social issues surrounding unintended pregnancy rates in US
1) ___%, ____ of these will end in termination
2) 82% among ______ y/o
3) 64% among ______ y/o
4) 48% among > ____ y/o
5) Rates have been ____ by __%
6) High is what types of populations (3)
7) What states have higher rates?
1) 51%, half
2) 15-19
3) 20-24
4) > 40
5) increasing, 48%
6) Poverty, Color, low education
7) Southern states (NY is in top 10)
Nononcogenic Serotypes of HPV (2) ,
Manifestations (3)
6, 11
- Anogenital Warts
- RRP (Recurrent respiratory papillomatosis)
- Low Risk Benign low grade cervical changes
What disrupts the vaginal flora? (10)
1) Phase of menstrual Cycle
2) STD’s
3) Contraceptives
4) Antibiotics (kill off lactobacilli and natural flora)
5) Sexual activity (dicks, semen, blood make vagina basic)
6) Pregnancy
7) Moisture retention (pads, pantiliners)
8) Obesity
9) Foreign bodies
10) Estrogen lvls
Vaginitis (3)
PH lvl =
1) Bacterial Vaginosis
2) Candida Vulvovaginitis (yeast)
3) Trichomoniasis (protozoa)
PH > 4.5
Menorrhagia =
Cause =
Excessive in amount and duration
Excess Estrogen which causes thickening of lining, progesterone causes dilation of blood vessels in uterus this leads to contraction of myometrium and vasoconstriction of uterine blood vessels
This causes a cascade of chemical mediators that contribute to pain and inflammation
Differentiate between hypertension, gestational hypertension, mild preeclampsia, severe preeclampsia and eclampsia in pregnancy
-Hypertension: HTN that occurs before pregnancy or before 20 weeks gestation
Cause has nothing to do with pregnancy
-Gestational hypertension: HTN that occurs after 20 weeks gestation
Related to the pregnancy.
Should resolve within 12 weeks after birth
-Mild preeclampsia:
High blood pressure, with either proteinuria or end organ damage
-Severe preeclampsia:
End organ damage
-Eclampsia:
When women with preeclampsia has seizures
At highest risk: just before delivery, during delivery, right after delivery
That’s why every woman with preeclampsia is started on magnesium sulfate during later and 24 hours post-partum
Nursing Assessment and Interventions for early pregnancy bleeding
1) Determine ______ stability
2) ___ status/administration of ____ as needed
3) ___ values (2)
4) Possible prep for _____
5) _____ of loss
1) Hemodynamic
2) Rh, Rhogam
3) Labs (CBC, Beta HCG)
4) Surgery for ectopic, missed SA, incomplete SA (teaching, consent, pain management)
5) Recognition of loss
Uterine Pathology: Lesions or infections (5)
1) Polyps
2) Fibroids
3) Cancer (uncommon)
4) Chlamydial infection
5) Vaginal laceration
Chlamydia =
Usuallly _____, often becomes _____
Manifestations can occur at ____
Infection of chlamydia trachomatis, an obligate, intracellular bacteria with gram - wall
ASYMPTOMATIC, Chronic
Any site of infection
4 Major causes of bleeding in later pregnancy
1) Placenta previa
2) Abruptio placenta
3) Placenta accrete
4) Vasa previa
How is the Vagina Acidic?
Normal PH =
Estrogen causes vaginal cells to mature and release glycogen, which feeds the lactobacilli
The lactobacilli metabolize glucose to produce hydrogen peroxide and lactic acid that aids in the vaginal acidity and inhibits pathogen growth
3.8 - 4.5
Health Concerns of PCOS (5)
Obesity Type 2 DM w early onset < 40 Metabolic syndrome Impaired glucose tolerance Infertility, Anovulation, Irregular Menses
Bacterial Vaginosis
1) Appearance =
2) Discharge =
3) Antibiotic =
1) Clue Cells (bacteria enters cells and they have irregular borders + stippled appearance)
2) Green/White
3) Metrogel given intravaginally
Candidiasis Appearance =
Pseudohyphae with budding yeast
Classifications of Spontaneous Abortion (5)
1) Closed (cervical os is closed, threatened spontaneous abortion)
2) Open (inevitable)
3) Incomplete (some discharge of POC but some placenta still retained)
4) Complete (complete discharge of POC and spontaneous abortion happened)
5) Missed (embryonic/fetal death occurred without expulsion)
- For missed: products of conception may be visible at cervix or vagina - otherwise confirmation of type of spontaneous aboriton should be confirmed by transvaginal ultrasound
Placenta Previa =
= Placenta is improperly implanted in lower uterine segment and is overlying the cervical OS (completely or low lying)
Congenital Syphillis
- On the rise
- Implication is to expand prenatal care and testing
Questions you ask while taking Sexual History (7)
1) Are you sexually active? What age did you start?
2) If not have you ever been sexually active?
3) How many sex partner’s have you had in the past 12 months? (Lifetime number?)
4) Men, women, or both?
5) Oral, anal, vaginal?
6) Do you use protection?
7) Have you ever been tested for or been diagnosed with an STD?
Mechanism of C. Trachomatis bacteria
The elementary body , a small infectious particle attaches and invades the (columnar) endocervical or urethral cells to replicate
LH production is then inhibited by:
Progesterone production by the decaying corpus luteum
Risks of IUDs (3)
1) Can perforate wall of uterus
2) Cause PID (Pelvin Inflammatory Disease)
3) If pregnancy does occur, high chance of ectopic pregnancy
Follicular phase dominated by =
How long does it last?
Estrogen
varies based on the person
90% of those seropositive with HSV-2 antibodies are:
What occurs in HSV-2?
Not diagnosed
Asymptomatic, intermittent shedding occurring in the first 12 months
DUB/AUB =
Characterized by absence of?
Results in lack of what hormone?
Causes bleeding to be?
Too much estrogen without the background of a “primed” endometrium
Ovulation, Luteal phase (Anovulatory cycles)!
Progesterone
Abnormal and HEAVY bleeding and excessive proliferation
Classifications of placenta abruptio (4)
1) Marginal or apparent (separation at the edge)
2) Complete (extreme bleeding CS is safest option)
3) Central or concealed (may not have visible bleeding)
4) Mixed or combined
Bishop Score =
Higher or Lower Score is better?
A scoring system to see how favorable the cervix is for induction of labor
Higher score = more favorable for successful induction
Bishop Scoring (0, 1, 2, 3)
1) Dilation =
2) Effacement =
3) Station =
4) Consistency =
5) Position =
1) Closed, 1-2 cm, 3-4 cm, 5 cm or more
2) 0-30%, 40-50%, 60-70%, 80% or more
3) -3, -2, -1, +1 or lower
4) Firm, Moderate, Soft
5) Posterior, Midposition, Anterior
Spontaneous Abortion interventions/diagnostic tests
- Need thorough HISTORY to determine
1) Gestational age
2) Character of bleeding (LIGHT or HEAVY)
3) Intermittent of constant bleeding
4) Pain or Painless
Labs and imaging tests to confirm initial diagnosis
Once established patient needs PE, transvaginal US, and possibly speculum exam and lab eval
Types of IUDs (Intra-Uterine Device) (2)
Works by:
1) Hormonal IUD (mirena)
2) Copper IUD
Preventing fertilization of egg by sperm
HPV (Human Papillomavirus) =
Diagnostic Test =
Tx =
Double stranded DNA virus that belongs to papillomaviridae family
Detection of HPV DNA
Gardicil
Central with Concealed Hemorrhage can cause =
Tx =
Couvelaire uterus (blood clot forms behind placenta) no where to escape so it invades the fiber and can lead to complete uterine anoxia)
Hysterectomy
Role of FSH
- Stimulates growth/maturation of 5-7 of follicles (mature graafian, “antral cells” develop more fluid and granulosa cells) that then stimulate estrogen production
- Estrogen continually increases during the follicular phase until it reaches estradiol peak before mid-cycle surge of LH
LARC (Long Acting Reversible Contraception) includes (3)
IUD, Injections, Implants
Underlying mechanisms/causes of placenta previa (5)
- Damage to endometrium and uterine scarring from previous surgery
- defective blood vessel development
- Multiparity
- increasing age
- prior placenta previa or acreta
PMS( Premenstrual syndrome) PMDD (Premenstrual Dysphoric Disorder) =
To Diagnose must be restricted to:
Important to keep a:
Disruption in daily functioning accompanied by significant affective symptoms that are disabling
Luteal Phase
Diary
Symptoms of menopause
HOT FLASHES (most prominent symptom 85%) most greatest in first 6 months-2 yrs, and may last up to 10 years
- Cycle changes
- Headaches
- Fatigue
- Mood issues
Impact on quality of life
C. Trachomatis causes what in
1) Males and females
2) Adults and neonates
3) Neonates
1) Urogenital infections
2) Conjunctivitis
3) Pneumonia
Most common cause of early bleeding =
Causes (5)
Spontaneous abortion
- Chromosomal abnormalities (esp in weeks 4-8)
- Increased age of mother (50% women over 45)
- Teratogens
- Faulty implantation
- Infections
Describe important nursing interventions in management of a precipitous delivery (6)
- Put gentle counter pressure to fetal head
- Support the perineum
- Place hands on sides of fetus’ head as comes out
- Encourage mother to blow/pant
- Feel for nuchal cord - loosen it or slip off
- Suction baby after delivery
- Never leave patient alone!
Important components of sexual history taking (3)
- Open ended questions
- Non-judgmental, respectful, compassionate language
- Normalizing language
Describe the common presentations and warning signs of preterm labor
- Effacement and dilation
- Regular and increasing contractions
- Back pain or pelvic pressure
- Water breaking (gush or slight trickle)
Amenorrhea =
Causes (3)
Absence of Menses
1) Starvation which causes no GnRH to be released at hypothalmic level
2) PCOS
3) Chronic Illnesses
