Maternity 7-1 Flashcards
Standard of Care - on test
that level of practice that a reasonably prudent nurse would provide in the same or similar circumstances.
Mons Pubis
Mons Pubis: Fatty tissue over symphysis pubis (pubic bone)
Vulva (C LUV vulva)
Vulva: Collective term for labia, head of clitoris, urethral & vaginal openings
uterus - parts (uterus at CCF)
Cervix, Fundus, Corpus
Fundus
Fundus superior muscular portion of uterus
Corpus (corpse)
the body of organ
Uterine layers (end my peri)
endometrium, myometrium, perimetrium
Fallopian Tubes - what is the lumen like?
Fallopian Tubes- location of fertilization, tube which transports ova to uterus, narrow lumen easily scarred
Ovary-contains - and how many mature each month?
400,000 immature oocytes- usually one matures each month
3 phases of puberty (thelma, adrene, and mench are going through phases)
Thelarche, Adrenarche, Menarche
female puberty initated by (what structures)
the hypothalamus, anterior pituitary gland, and ovaries
Female Reproductive Cycle (over every reproductive cycle)
Ovarian Cycle
Endometrial Cycle
Regulating Hormonal Cycle
Cyclic Breast Changes
GnRH: (gonad is friends with fish)
GnRH: Released by hypothalamus. Targets anterior pituitary to release FSH and LH.
FSH (fish is mature) and produced where?
FSH: Produced by Anterior Pituitary. Responsible for egg maturation in the ovary.
LH (the luetenant releases prisoners)
Responsible for release of egg from ovary.
Estrogen (Estradiol) (estrogen liners) and produced where?
Estrogen (Estradiol): Responsible for maintaining uterine lining. Produced by Ovaries.
Progesterone (lining for progeria)
Responsible for maintaining uterine lining.
Hypothalamic-Pituitary-Ovarian Axis - the cycle of menses - the order of it
Hypothalamus- releases GnRH (gonadotropin-releasing hormone) which stimulates the
Anterior pituitary first releases FSH (follicle stimulating hormone) which stimulates graafian primordial follicles to mature
Anterior pituitary then releases LH (luteinizing hormone) which releases the ovum from one follicle
Empty follicle then becomes corpus luteum
Ovarian Cycle:
3 Phases (the ovaries fol)
Follicular Phase (1), Ovulatory Phase (2), Luteal Phase (3)
Endometrial/Uterine Cycle:
4 Phases (menstruate proliferatively w/ secretary ishmael)
Menstrual Phase (1), Proliferative Phase (2), Secretory Phase (3), Ischemic Phase (4)
Uterine Cycle - 3rd phase (the secretary ovulates and hormones increase)
Secretory Phase (3)
Begins with ovulation
Continued endometrial growth (estrogen) Increase in progesterone = endometrial growth + gland growth Increased vascularity If PREGNANCY occurs here, process stops
uterine cycle - 4th stage
Ischemic Phase (4) (if no fertilization):
Corpus luteum degenerates and becomes corpus albicans
Decrease in estrogen, progesterone Necrosis under epithelial lining, small blood vessels rupture, arteries constrict Return to menstrual phase
2nd half of cycle - which hormone is more dominant?
more progesterone dominant
1st half of cycle
more estrogen dominant
LH - when does it start, and what does it do? (the leutenant triggers ava after 24 hours)
triggers ovulation - surge is 24 -36 hours before ovulation
corpus leutium - what does it make? (progesterone corpse)
shell - that makes progesterone
progesterone only around
after ovulation, bc it comes from the corpus luteum, which is the shell after ovulation.
Prostaglandins (prostie clots)
Lipids w/ hormone-like action.
Many roles in body functions including immune/clotting actions.
Cancers of the Reproductive Tract
Ovarian Cancer
Uterine/Endometrial Cancer
Cervical Cancer
Vaginal Cancer
Vulvar Cancer
Ovarian Cancer Symptoms: “Silent Stalker” - symptoms (what about gi?)
General abdominal discomfort/pain
GI disturbance: nausea, diarrhea, constipation
Frequent urination
Feeling of fullness
Weight loss or gain
Vaginal bleeding
Back pain and fatigue
Painful intercourse
Ovarian Cancer: Risk Factors (ava cancer is all about the hormones) (ava is early and late)
Advancing age
Early menarche and late menopause
Having a first child after age 30
nursing care - ovarian cancer
indentify high risk, encourage regular GYN visits, provide emotional and phychological support, prepare for surgery, post surgery follow up care
Endometrial cancer - prognosis?
more frequent than cervical, but better prognosis.
Most common malignancy of reproductive system
Slow-growing and has a good prognosis if diagnosed at a localized stage
Endometrial cancer - risk factors (end the cancer w/ obesity with no children)
Obesity
Nulliparity
Endometrial Cancer:
Signs and Symptoms - just one
Abnormal Uterine bleeding.
Endometrial Cancer:
Diagnosis & Treatment
Endometrial biopsy
Total abdominal hysterectomy: uterus/cervix (TAH)
Bilateral salpingo (fallopian tubes) -oophorectomy (BSO)
Radiation
Radical hysterectomy
tissue)chemotherapy
Cervical cancer - what causes it? (cervical cancer is hip)
Cancer that occurs in the cells of the cervix
Various strains of the human papillomavirus (HPV) play a role in causing most cervical cancer.
Human Papilloma Virus (HPV) - which types cause cancer?
Most common STI, More than 100 types – 5 cause warts, 8 of which may cause cancer, Types 16 and 18 responsible for almost all cervical cancers, Most times resolves spontaneously
CDC recommends routine HPV vaccination for adolescents***on test - what ages can you give it?
CDC recommends routine HPV vaccination for adolescents at age 11 or 12 years. Vaccination can be started as early as age 9 years, and up to 26 years old for females.
HPV
males ages 13 through 21 years,
* females ages 13 through 26 years
gay, bisexual, and other men who have sex with men, transgender people,
persons with certain immunocompromising conditions ages 22 through 26 years
HPV (16, 18)
HPV (16, 18) – responsible for 70-80% of cervical cancers
risk factors of cervical cancer (cervi and birthy control)
Sexually active during adolescence
Multiple sexual partners
STI infections
Using Birth Control > 5 years
HIV
Smoking
Signs and Symptoms of Cervical Cancer
may be asymptomatic, abnormal vaginal discharge, bleeding, pap smear screens for abnormal cervical tissue detects 90% of early cervical changes
Pap screening - do what before the exam?
between menses.
48 hours prior to the scheduled Pap smear, the nurse advises the woman not to:
have intercourse
use tampons
use intravaginal medication
douche
PID is caused by what?
an acute infection of the reproductive organs, generally caused by STIs. Most commonly caused by Chlamydia and Gonorrhea
Pelvic Inflammatory Disease - infertility?
Affects ~ 1 million women annually
1 incidence of PID ~20% of women become infertile
Predisposing Factors for PID - (Pitt has STDs and infections)
Hx untreated STD
Hx of PID
Chronic vaginal infection
Signs and Symptoms of PID - temp and discharge?
(
vary according to severity)
Temperature > 38.3 C (100.9 F)
Abnormal vaginal discharge
PID treatment
Antibiotics
Treatment of sexual partner(s)
Comfort measures
Good perineal care
Semi-fowlers for drainage
Education and prevention
Safer sex
Avoid IUD contraception only if pt. has Hx of PID
cervix
Cervix “neck” effaces and dilates to allow fetus to pass into vagina
fundus
Fundus superior muscular portion of uterus
corpus
Corpus the body of organ
uterine layers
endometrium, myometrium, perimetrium
ovaries produce what? (3 things) ovaries are your enemy
estrogen, progesterone, and androgens
Thelarche
breast buds
Adrenarche
axillary/pubic hair
Menarche
menstruation, average age is 12 in U.S.
GnRH - stimulates what?
Indirectly stimulates progesterone/estrogen production
feedback system
progesterone - fluctuations in levels (progeria rises to the leutenant)
Low levels in follicular phase, rises in luteal phase
where is progesterone produced? (2 places)
Produced in ovary (corpus luteum) and small amount from adrenals.
ovarian cycle - Follicular Phase (follicles first) when does it occur?
Pre-ovulatory first two weeks (on average)
ovarian cycle - ovulatory phase - what day?
Ovulation occurs Day 14 (varies by individual)
ovarian cycle - luteal phase - what days? (leutenant is last)
Post-ovulatory Day 14-28
endometrial cycle - menstrual phase
1-5 days
Endometrial cells shed
endometrial cycle - Proliferative Phase (2) - growth? (proliferative growth 68 times)
Endometrial growth 6-8x
prostaglandins - released how?
Released by tissues throughout body.
prostaglandin - hormonal changes do what? (prostie contracts)
Respond to hormonal changes of menstrual cycle.
Cause muscle contraction during menstrual cycle.
ovarian cancer - risk factors (ava at risk w/ breast and colon)
Personal or familial history of breast or colon cancer
endometrial cancer - risk factors (end the cancer w/ DM and HTN hormones)
DM
HTN
Family History
Hormone imbalance*
endometrial cancer - risk factors (end the cancer with late menopause and Infertility)
Late onset Menopause
Infertility
PID - Increased incidence of
ectopic pregnancy
PID - does what to the body?
scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage;
Long-term pelvic/abdominal pain.
s/sx of PID - pain? (Pitt is low)
Lower abdominal tenderness/pain
menstrual cramping
Dyspareunia (vaginal pain)
PID - smell?
Foul smelling menstrual flow
Malaise
PID - cramping? (Pitt gets crampy once in awhile)
Sub acute: dull intermittent cramping
proliferative phase - glands and mucus (the pH?)
Glands enlarge (estrogen)
Cervical mucus-thin, watery, alkaline, elastic
endometrial cancer - late signs (ending late due to pain)
vaginal discharge
low back pain
pelvic pain
ovarian cancer - risk factors - (ava is early and late w/ drugs and fat)
History of fertility drugs
High fat diet
predisposing factors for PID (Pitt has multiple partners)
IV drug use
Multiple sexual partners or partner with multiple sexual partners
Increased incidence in young women (sexually active and 25 years or younger
predisposing factors PID (Pitt is a douche who uses IUD)
Douche
After IUD placement (3 weeks)
vestibule
area inside inner labia
what hormone triggers puberty?
gnrh
fsh and lh
fish matures and lh releases the prisoner
hgc
tells corpus luteum to keep producing progesterone. if no hgc, progesterone signals gnrh to start the cycle again bc there is no fetus.
Endometrial biopsy
goes through the cervix
Radical hysterectomy
hysterectomy + ligaments, part of vagina, surrounding
Most common STI
HPV
HPV vaccine for males - what ages
13-21
HPV screening
21-24, no screening. 25-29 - every 5 years, age 30-65 - every 5 years, over 65 - no screening, hysterectomy - no screening.
does genital warts cause cervical cancer?
NO
