Lecture 15A Health assessment and health promotion

Question 1

Rugae

Answer 1

1. Transverse folds in the mucosal lining of the vagina - allow the vagina to expand during childbirth.
2. After childbirth, during lactation, and at menopause - estrogen deprivation causes dryness and thinning of the vaginal walls and smoothing of the rugae.

Question 2

Endometrium

Answer 2

The highly vascular lining of the uterine wall - the outer two of its three layers are shed during menstruation.

Question 3

Cells from _ are scraped for the Papanicolaou (Pap) test.

Answer 3

The squamocolumnar junction or transformation zone just inside the cervical os.

Question 4

Three hormones produced by the ovaries

Answer 4

Estrogen, progesterone, and androgen.

Estrogen is dominant in the first half of the menstrual cycle and progesterone is dominant in the second half.

Question 5

Menstruation

Answer 5

The periodic uterine bleeding that begins approximately 14 days after ovulation (the release of a mature ovum from the ovary).

Question 6

Prostaglandins

Answer 6

1. Oxygenated fatty acids classified as hormones; produced by most organs of the body (including the uterus); exert a marked effect on metabolism, particularly on glycolysis.
2. Affect smooth muscle contractility and modulation of hormonal activity; cause sloughing of the endometrium, resulting in menstruation.
3. Increase myometrial response to oxytocin stimulation, enhance uterine contractions, and cause cervical dilation.

Question 7

Menopause

Answer 7

1. Refers only to the last menstrual period; can be dated with certainty only 1 year after menstruation ceases.
2. Occurs on average at 51.4 years, with an age range of 35 to 60 years.

Question 8

Perimenopause

Answer 8

A period preceding menopause that lasts about 4 years, in which ovarian function and estrogen production gradually decline.

Question 9

Period of critical fetal organ development

Answer 9

Between 17 and 56 days after fertilization.

Question 10

Supplemental folic acid

Answer 10

600 mcg taken during pregnancy to reduce the incidence of neural tube defects such as spina bifida and anencephaly.

Question 11

Most women seeking health care during the perimenopausal period do so because of _

Answer 11

Irregular bleeding.

Question 12

Lesbians who have never had children may still be at risk for _

Answer 12

Breast, ovarian, and endometrial cancer.

Question 13

Leading causes of death in women in the United States

Answer 13

1. Heart disease.
2. Cancer.
3. Stroke.

Question 14

Current guidelines suggest that the Pap test should begin _

Answer 14

At age 21 (regardless of a young woman’s sexual activity).

Question 15

Smoking

Answer 15

1. The leading cause of preventable death and illness.

2. Smoking during pregnancy is known to cause a decrease in placental perfusion and is one cause of LBW in infants.

Question 16

Recent research suggests that _ during pregnancy may lessen the effects of prenatal alcohol exposure in the children of women who are unable or unwilling to curtail their alcohol abuse when pregnant.

Answer 16

Multivitamin supplement use.

Question 17

Research suggests that eating disorders are often associated with _

Answer 17

Difficulties in intimate relationships.

Question 18

SCOFF questionnaire

Answer 18

A screening tool for eating disorders; used by nurses to determine whether an eating disorder is likely and whether the woman needs further assessment and possibly psychiatric and medical intervention.

Question 19

Preferred exercises for women

Answer 19

Weight-bearing aerobic exercises such as walking, running, racquet sports, and dancing.

Question 20

Lithotomy position

Answer 20

1. Positioning for a pelvic examination - hips and knees are flexed, with buttocks at the edge of the table, and feet supported by heel or knee stirrups.
2. Avoid asking questions while the woman is in this position; wait until she is upright again.

Question 21

Menarche occurs between _

Answer 21

8 and 16 years of age.

Question 22

Ovarian function ceases between _

Answer 22

40 and 55 years of age.

Question 23

Vaginal screening after hysterectomy

Answer 23

The Pap test is not recommended; sampling of the vaginal walls may still be practiced, every 1-3 years - important for HPV screening.

Question 24

The CDC recommends testing people who were born in 1945 through 1965 for _

Answer 24

Hepatitis C.

Question 25

Pap test important points

Answer 25

1. No douching, use of vaginal medications, or sexual intercourse for 24-48 hours before test.
2. Midcycle is the best time for the test; the woman should not be menstruating.
3. The cytologic specimen is obtained before any digital examination of the vagina is made or endocervical bacterial specimens are taken.
4. Lubrication is not used for the test.

Question 26

Pap test age/frequency recommendations

Answer 26

1. Age 21-29: Every 3 years.
2. Age 30-65 with previous negative Pap test and negative HPV test: Every 5 years.
3. High risk women (DES exposure in utero, previous treatment for cervical cancer, HIV positive) should be tested more frequently.
4. May stop screening: After age 65 + 3 negative tests + no risks and after total hysterectomy for benign disease.

Question 27

Young women who have been treated with excisional procedures for cervical dysplasia have an increase in _

Answer 27

Premature births.

Question 28

MyPlate healthy eating guidelines

Answer 28

Each plate of food should be composed of:

• 1/2 fruits and vegetables
• 1/4 grains
• 1/4 protein

Question 29

Folic acid (maternal intake)

Answer 29

Helps reduce high levels of homocysteine, an amino acid that damages the heart and blood vessels and increases the risk of heart disease, stroke, and dementia.
Citrus fruits, broccoli, spinach, asparagus, peas, lettuce, beans, whole grains, and orange juice.

Question 30

Antioxidants

Answer 30

Thought to be effective in helping to prevent oxidative damage in the body such as cancer, heart disease, and stroke.
Vitamins C and E, selenium, beta-carotenes - fruits, vegetables, and whole grains.

Question 31

Calcium supplements

Answer 31

Best formulation is calcium carbonate with vitamin D (contains the most elemental calcium); prevents fractures in premenopausal women but is associated with a small risk of developing renal stones.

Question 32

Pelvic examination frequency

Answer 32

Annually from the beginning of sexual activity until age 70.

Question 33

An endometrial biopsy is generally conducted _

Answer 33

At menopause for women at risk for endometrial cancer, repeated as needed.

Question 34

Exercise during pregnancy

Answer 34

1. An ongoing exercise regimen can be continued, but intensity and duration should be decreased.
2. Sedentary women should obtain medical clearance to initiate exercise during pregnancy and should begin with low-intensity and low-impact workouts.

Question 35

Kegel exercises

Answer 35

1. Strengthen the muscles of the pelvic floor, providing support for the pelvic muscles and control of the muscles surrounding the vagina and urethra; reduce incontinent urine loss.
2. Teaching: Have the woman pretend she is trying to prevent the passage of intestinal gas or stop the flow of urine in midstream; the pelvic muscles are moved upwards and inward. Hold each contraction for at least 10 seconds and rest for 10 seconds or more between contractions.

Question 36

How would the physiologic process of the sexual response best be characterized?

Answer 36

Myotonia (increased muscular tension) and vasocongestion (resulting in engorgement of the genitals and vaginal lubrication).

Question 37

Which female reproductive organ(s) is (are) responsible for cyclic menstruation?

Answer 37

Uterus. [The uterus is responsible for cyclic menstruation and also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and the production of estrogen.]

Question 38

Which hormone is responsible for the maturation of mammary gland tissue?

Answer 38

Progesterone. [Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue.]

Question 39

Exercise recommendations

Answer 39

1. At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes/week; OR
2. At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes/week; OR
3. A combination of the two.
   * AND* Moderate to high intensity muscle-strengtheningactivity at least 2 or more days per week for additional health benefits.

Question 40

Exercise suggestion for lowering blood pressure and cholesterol

Answer 40

An average of 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week.

Question 41

The 5 As of smoking cessation

Answer 41

Ask
Assess
Advise
Assist
Arrange follow-up

Question 42

HPV vaccine

Answer 42

1. Gardisil (quadrivalent) and Cervarix (bivalent); available between the ages of 9 and 26 and recommended routinely for females at 11 or 12 years of age.
2. Administered in 3 doses over a 6-month period.

Question 43

Pap test results - ASCUS

Answer 43

Atypical squamous cells of uncertain significance.

Question 44

Pap test results - SIL

Answer 44

Squamous intraepithelial lesion - indicates abnormal (precancerous) cells.