Exam 4 Flashcards
menarche
first menses; marks reproductive age
menopause
- occurs 46-50 years
- reproductive system shuts down
amenorrhea
absence of menstruation
primary amenorrhea
no periods by age of 16
secondary amenorrhea
no periods for at least 3 months in women who had periods before
causes of amenorrhea
- menopause
- pregnancy
- excessive exercise
- low body fat
- PCOS
- thyroid disorder
how many women are affected by amenorrhea?
up to 5% of women of childbearing age
dysmenorrhea
medical term for menstrual cramps
primary dysmenorrhea
common and normal
secondary dysmenorrhea
signal reproductive tract disease
symptoms of primary dysmenorrhea
- occurs on 1st day of period
- lasts 8-72 hours
- in lower abdomen, may radiate to lower back and legs
- improves with age
symptoms of secondary amenorrhea
- occurs 1-2 days before period
- lasts > 3 days
- in lower abdomen and may radiate to lower back and legs
- tends to worsen with age
causes of primary dysmenorrhea
natural uterine contractions due to high prostaglandin concentration, aimed at shedding its lining
causes of secondary dysmenorrhea
- endometriosis
- uterine fibroids
- PID
what can help dysmenorrhea?
- diet and exercise
- herbal supplements
- home remedies
- medications and surgery
- heating pads/hot baths
- pelvic rock exercises/yoga
- meditation
- decrease salt and refined sugar 7-10 days before menses
- natural diuretics: asparagus, cranberry juice, peaces, watermelon
- medications: prostaglandin inhibitors, oral contraceptive agents
PMS
period symptoms prior to menses after ovulation
symptoms of PMS
- bloating
- headache/bachache
- irritability, mood swings, anxiety, depression
- fatigue/sleeping disturbances
- constipation or diarrhea
- appetite changes
how can we help PMS?
- be active throughout the month
- eat healthy every day
- get plenty of sleep
- don’t smoke or vape
- keep track of period
3 common symptoms of endometriosis
- painful intercourse
- heavy menstruation
- infertility
what is endometriosis?
- endometrial tissue outside of uterus
- no portal of exit
what is gorserelin (zoladex) used for?
to reverse endometriosis
- gonadotropin-releasing hormone agonist
- suppresses pituitary gonadotropin secretion
- FSH and LH stimulation declines
- women may experience menopause symptoms
complications of STIs
- preterm labor
- low birth weight
how can we prevent STIs?
- identify risk factors
- change risky behaviors (reduce # of partners)
- use condoms
5 P’s for sexual history
- Partners
- Prevention of pregnancy
- Protection form STIs
- Practices
- Past history of STIs
risk reduction measures for STIs
- abstinence of activities with fluid exchange
- avoid practices that increase tissue damage, direct contact with lesions, increased # of partners
- knowledge of partner’s sexual history
- vaccinations
4 main bacterial infections
- gonorrhea (often asymptomatic)
- chlamydia (often asymptomatic)
- syphilis
- bacterial vaginosis
*all are reportable communicable diseases (except bacterial vaginosis)
common treatments for all bacterial infections
- antibiotics
- both partners much be treated even if asymptomatic (except bacterial vaginosis)
- abstinence during treatment
how can gonorrhea be spread?
- primarily genital to gential contact
- can also be spread by oral-genital and anal-genital
- may be transmitted to newborn during birth
clinical manifestations of gonorrhea
- often asymptomatic
- diagnosis requires a culture
- menstrual irregularities
- greenish-yellow purulent endocervical discharge
- chronic or acute severe pelvic of lower abdominal pain
- vaginitis
most prevalent STI in USA
chlamydia
how is chlamydia diagnosed?
- difficult to diagnose and complications are highly destructive
- often asymptomatic
- expensive to culture
how is syphilis spread?
- enters body through small breaks in skin or mucous membranes
- kissing, biting, oral-genital sex
- can be spread to fetus via transplacental transmission during pregnancy
- can lead to stillbirth, deformed bones, anemia, enlarged spleen and liver, blindness, jaundice
secondary stage of syphilis
- systemic
- 6 weeks - 6 months after chancre is seen
- maculopapular rash on palms and soles
- fever, alopecia, headache, lymphadenopathy
what kind of complications can the tertiary stage of syphilis cause?
cardiovascular, neurological, musculoskeleta
what is the most common type of vaginitis?
bacterial vaginosis
what is bacterial vaginosis associated with?
preterm labor and birth
symptoms of bacterial vaginosis
- thin grayish-white discharge
- woman complains of fishy odor
do sexual partners need to be treated in bacterial vaginosis?
no
how do we treat viral infections?
no curative treatments available ~ treat only symptoms
what do we teach patients to avoid viral infections?
use condoms, hygiene, vaccines, being tested, avoid bodily fluids
one of the most common STIs
herpes simplex virus
HSV 1
- transmitted non-sexually
- fever blisters
HSV 2
- usually transmitted sexually
- usually vaginal
localized symptoms of HSV
- painful lesions that progress from macules to papules to vesicles
- typically lasts 4-15 days before crusting
systemic symptoms of HSV
- typically appear 3-4 days after lesions
- fever, malaise, headache, photophobia
suppressive therapy for HSV
famvir, valtrex, zovirax (acyclovir)
what would happen if a mom has herpes and experiences tingling or there are lesions present near time of delivery?
a C/S will be perfromed
HPV
- genital warts
- most prevalent viral STI
- linked with cervical and vulvar cancer
- cauliflower-like
how do we treat HPV
- difficult to treat
- vaccine (gardasil)
- topical: TCA, cryotherapy, electrocautery, laser therapy
when should vaccination occur for HPV?
ideally, before youth become sexually active
HAV
- acquired primarily through fecal-oral rout
- influenza-like symptoms
HBV
- most threatening to fetus and neonate
- transmitted parenterally, perinatally, orally (rare) and through intimate contact
- vaccination series
HCV
- most common blood-borne infection
- risk factor for pregnant women is history of injecting IV drugs
HIV
- heterosexual transmission now most common means of transmission in women
- occurs through exchange of body fluids
2nd most common type of vaginal infection
yeast/candidiasis (not an STI)
signs of yeast infection
- itching
- odorless, thick, cheesy vaginal discharge
- dysuria
if someone constantly gets yeast infections what can we consider?
diabetes or HIV
GBS
- considered normal flora in non-pregnant women
- a concern in pregnancy: inc. risk for preterm and transmission to newborn
PID
bacterial infections including gonorrhea and chlamydia
symptoms of PID
- abnormal vaginal discharge
- pain in lower abdomen
- pain in upper right abdomen
- abnormal menstrual bleeding
- fever and chills
- painful urination
- N/V
- painful intecourse
what can PID lead to?
- infertility
- ectopic pregnancy
- abscess formation
- chronic pelvic pain
how do we manage PID?
- prevention: education regarding STI prevention
- antibiotics
- abstain from intercourse until treatment is done
physiologic jaundice
jaundice that is due to liver immaturity
what should jaundice levels never exceed?
12
main way to treat hyperbilirubinemia
- early feedings: facilitates removal of bilirubin through stools
- breastfed infants have inc. incidence of jaundice
what does phototherapy do?
use light therapy that will break down bilirubin in skin into substances that can be excreted in feces and urine
nursing care in phototherapy
- infant is unclothes
- eyes must be protected by an opaque mask
- infants’ temp should be monitored
- feedings should be adequate to prevent dehydration
- amount of output should be monitored
criteria for physiologic jaundice
- jaundice appears after 24 hours
- disappears by end of 7th day
- levels should not exceed 12 in term and 15 in preterm
- if the above does not fit, then could be pathologic problem
what can untreated pathologic jaundice lead to?
- sensorineural hearing loss
- mild cognitive delays
- kernicterus
kernicterus
- bilirubin encephalopathy
- caused by deposits of bilirubin in the brain
- will pass BBB
- may cause necrosis of brain neruons
- bilirubin levels 20-25 places full term infant at risk
signs of kernicterus
- decreased activity
- lethargy
- irritability
- hypotonis
- seizures
potential complications
- respiratory (most common): distress, apnea, ROP
- hematologic: anemia
- cardiovascular: PDA
- temperature: heat loss/temp maintenance
- neurologic: bleeding in brain
- nutritional: feeding difficulties
- GI/hepatic: necrotizing enterocolitis, hyperbilirubinemia
causes of respiratory distress in preterm infants
- dec. number of functional alveoli
- deficient surfactant levels
- smaller lumen
- weak or absent gag reflex
- immature capillaries in lunghs
clinical manifestations of respiratory distress WETFROG
Wheezing
Effort
Tachypnea
Flaring (nasal)
Retractions
Oxygenation
Grunting
hypothermia and hypoglycemia lead to
respiratory distress
how is surfactant administered?
via ET tube directly to lungs
apnea
pause in respirations longer than 20 seconds with accompanying bradycardia
why is apnea common in preterm babies
- fatigue easily
- immature respiratory mechanisms
how can we prevent apnea?
- maintain body temperature
- gentle handling to avoid fatigue
- avoid vagal stimulation
- observe after feedings: full stomach will put pressure on diaphragm
why do intracranial hemorrhages happen in newborns?
they have fragile capillaries rupture whenever there is a change in cerebral BP
how can we prevent intracranial hemorrhages?
- recognize events that may precipitate hemorrhage
- maintain O2 levels
- avoid rapid IV infusions
- monitor BP closely
- monitor for pneumothorax
- position infant with HOB elevated slightly
why do preterm infants have difficulties with intake?
- lack of coordination suck/swallow reflex
- inability to suck due to congenital anomaly
- respiratory distress requiring ventilator
- lack of O2 reserves
how are preterm newborns metabolism rate?
it is accelerated
how many calories do preterms need vs terms?
- preterm: 115-140 calories per kg
- term: 100-110 calories per kg
non-nutritive sucking
- gavage or parenterally fed
- pacifier is provided during feeding times
- may improve oxygenation and decrease energy expenditure
what is preferred OG tube or NG tube?
OG because infants are nose breathers
necrotizing enterocolitis (NEC)
- inflammation of the intestines
- acute inflammatory disease of GI mucosa
- may result in ulcerations and perforation
major cause of NEC
- intestinal ischemia: from hypoxia at birth
- bacterial or viral infection
- immature gut
nursing management of NEC
- supportive
- NPO
- OG tube for decompression
- strict infection control
- antibiotics
- surgical resection may be necessary
- main thing is to keep GI tract empty!!!
common complications of IDM
- congenital anomaly/cardiomyopathies
- macrosomia
- perinatal asphyxia/RDS
- hypoglycemia
- polyhydramnios
- polycythemia leading to hyperbilirubinemia
if skin blanches, what might it be?
mongolian spots
if skin doesn’t blanch, what might it be?
petechiae or bruising
erb-duchenne paralysis
- brachial paralysis of upper arm
- caused from stretching or pulling head away from shoulder
clinical manifestations of erb-duchenne paralysis
- flaccid arm with elbow extended and hand rotated inward
- absence of moro reflex on affected side
- intact grasp reflex
- loss of sensation over lateral aspect of arm
clinical manifestations of sepsis in preterm
- respiratory: WETFROG
- cardiovascular: tachycardia, hypotension, decreased perfusion
- CNS: temperature instability, lethargy, hypotonia, irritability, seizures
- GI: decreased suck strength, increased residual, abdominal distention
- integumentary: jaundice, pallor, mottling, petechia
clinical manifestations of sepsis in preterm
- respiratory: WETFROG
- cardiovascular: tachycardia, hypotension, decreased perfusion
- CNS: temperature instability, lethargy, hypotonia, irritability, seizures
- GI: decreased suck strength, increased residual, abdominal distention
- integumentary: jaundice, pallor, mottling, petechia
how do we assess sepsis in a NB?
blood cultures, CBC, vital signs
how do we treat sepsis in a NB?
- IV antibiotics
- O2 or other respiratory aids
- breast feeding
when do we treat GBS?
during labor
NAS symptoms
- jitteriness and hyperactivity
- shrill and persistent cry
- yawn or sneeze frequently
- hyperactive tendon reflexes
- poor feeding and sucking
- abnormal sleep cycles
definition of postpartum hemorrhage
- loss of > 500 mL after vaginal birth
- loss of > 1000 mL after C/S
- 10% change in hematocrit
most critical postpartum time
the first hour after to check for hemorrhage
uterine atony
- hypotonia of uterus
- uterus does not contract
how many cases of postpartum hemorrhage does uterine atony count for?
> 90%
most common cause of excessive postpartum bleeding
uterine atony
nurses role in uterine atony
- maintain good uterine tone
- prevent bladder distention
what could cause increased bleeding in uterine atony?
if the bladder is full
if the uterus is palpated higher than expected and deviated to the right, what can we suspect?
a full bladder
common causes of uterine atony
- high parity
- polyhydramnios
- macrosomic fetus
- multifetal gestation
- use of pitocin
- prolonged labor
1st nursing action in management of uterine atony
firm massage of uterine fundus (uterus will most likely feel “boggy”
what else can we do to help with uterine atony?
- express any clots that may be in uterus
- eliminate bladder distention
- medications: IV oxytocin, IM hemabate, IM methergine, cytotec
- bimanual compression
when might we suspect a laceration?
if bleeding continues despite a firm fundus
causes of laceration
- large baby
- labor was too quick
- position of baby coming out
- use of forceps or vaccuum
- weakened area
classifications of perineal lacerations
- 1st degree: skin and structures superficial to muscle
- 2nd degree: through muscle of perineal body
- 3rd degree: through anal sphincter muscle
- 4th degree: involves anterior rectal wall
subinvolution
uterus that does not return to a non-pregnant state
why might involution process be delayed?
- excessive analgesia use during labor
- exhaustion from prolonged or difficult labor
- multiple gestation
- grand multiple parity
when does late PP hemorrhage usually occur?
- 24 hours after delivery
- < 6 weeks PP
what is subinvolution cause from?
- retained placental fragments
- infection
S/S of subinvolution
- prolonged lochial discharge
- uterus does not decrease in size as expected
- irregular or excessive bleeding
- possibly hemorrhage
most common cause of subinvolution
retained placenta
non-adherent retained placenta
small piece of amniotic membrane or a large part of placenta
adherent retained placenta
abnormal adherence of entire placenta at implantation
with an adherent retained placenta why might attempts to remove it be unsuccessful?
may result in tearing of cord, placenta or uterine lining
treatment of adherent retained placenta
surgical removal
inversion of uterus
- turned inside out
- life threatening
- may be partial or complete inversion
what medications can be given for an inverted uterus?
oxytocin, methergine, hemabate, cytotec, broad spectrum antibiotics
what can occur if hypovolemic shock is not fixed?
death may occur
symptoms of hypovolemic shock
- RR rapid and shallow
- pulses rapid, weak, irregular
- BP decreases (late sign)
- skin cold, clammy, cool
- urinary output decreased
- LOC-lethargy-coma
- mental status-anxiety-coma
- central venous pressure decrease
thromboembolic disease
- blood clots inside blood vessel
- major causes: venous stasis, hypercoagulation
clinical manifestations of DVT
- pain and tenderness in lower extremity (unilaterally)
- positive homan’s sign
- warmth, redness
anticoagulant therapy for DVT
- heparin IV
- lovenox SQ
- PO anticoagulant therapy
symptoms of PE
hypoxia, fatigue, confusion, crackles in lungs, coughing, chest pain, tachypnea, dyspnea
what drugs do we use for PE?
- IV heparin
- PO anticoagulant therapy
- heparin and warfaring are both safe if breastfeeding (warfarin teratogenic if she becomes pregnant)
first symptom of infection
fever (over 100.4 for two consecutive days during first 10 days PP)
why don’t we count any fevers that occur during first 24 hours PP?
it is normal, dehydrated from labor - give fluids
when does mastitis usually occur?
between week 2 and 4 PP
clinical manifestations of mastitis
- obstruction flow of milk in lobe
- fever and chills
- breast tenderness
- malaise
- redness and axillary adenopathy
how do we manage mastitis?
- prevention through education
- antibiotics
- breastfeed or use a breast pump every 2-4 hours
- heat/cold therapy
- hydration
management of uterine prolapse
- kegel exercises several times a day
- pessaries support uterus and holds it in position
- hysterectomy if all else fails
cystocele
opening from vaginal canal to bladder
rectocele
opening from rectum to vaginal canal
clinical manifestations of cystocele
- “something in my vagina”
- urinary frequency/retention/incontinence
- bulging of anterior wall of vagina
management for cystocele
- vaginal pessary
- surgical repair
