Female Assessment Flashcards
Follicular Phase
Day 1-14 Menstrual phase (1-5) Proliferative phase (6-14)
Luteal phase
Day 12-28- Secretory phase
Steps of the Clinical Breast Exam
Inspect breast and nipples in 4 views
1) Arms at sides- prominent pores- lymphatic obstruction
2) Arms overhead- dimpling, retraction
3) Hands of hips- Retracts pectoral muscles
4) Leaning forward- Retractions
Position for palpating breasts
Place the patient supine with hands overhead
Vertical strip method
3-5 minutes, go into the axilla (tail of spence), small concentric circles
Assess breasts for
Nodules, tenderness, consistency
Location Size Shape Consistency Delineation Tenderness Mobility
Dysmenorrhea (primary and secondary)
Painful bleeding
Primary- increased prostaglandin
Secondary- endometriosis, polyps, PID
Amenorrhea (primary and secondary)
Absence of period
Primary- Absence of ever starting a period
Secondary- Cessation once menses has been established
Gravida Para
Gravida- number of overall times pregnant Para -Full term -Preterm -Abortion -Living child
Tips for a successful pelvic exam
Avoid putting anything in the vagina for 24-48 hours.
Empty bladder before beginning.
Explain the steps, provide chaperone if needed, drape patient, monitor for comfort
Os
Where specimens are taken during a pap smear
Transformation zone
Risk for dysplasia
Displacement of the Uterus
Anteversion- sits forward Midposition- straight up Retroversion- sits back Anteflexion- Bends forward Retroflexion- bends backward
All patients should be considered pregnant until:
Proven otherwise!
Key Symptoms to ask a Pregnant Patient
Nausea/vomitting Abdominal pain Vaginal bleeding Dysuria/urinary frequency Fatigue Headache/visual changes/swelling Systemic symptoms
Questions to ask about Obstetric History
Gravida, Para
Details of prior pregnancies Complications of pregnancies Antenatal Labor Postnatal Miscarriages/terminations
Past Medical History of a Pregnant Patient
Thromboembolic disease- high risk for further events after pregnancy
Diabetes- tight glycemic control essential r/o congenital defects
Epilepsy- some antiepileptic are harmful
Hypothyroidism- TFTs need close monitoring r/o congenital hypothyroidism
Previous preeclampsia
Hospital admissions
Surgical history- abd/gyn surgeries
Immunizations utd
Leopold’s Maneuvers
Determination of fetal position and readiness for vaginal delivery.
Begin in the 2nd trimester
Assessment of location of upper and lower fetal pole
Maternal side where the back of the fetus is felt
Descent of fetal part into maternal pelvis
Extent of flexion of the fetal head
Frequency of prenatal visits
Monthly until 28 weeks
Bimonthly until 36 weeks
Weekly until delivery
What is checked with each prenatal visit?
Vital signs Weight Edema Uterine size FHR Lab- U/a for protein, glucose, etc.
