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MIH #1 Flashcards

1
Q

Healthy people 2020-

A

provides family center care goal

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2
Q

Types of families

A

Single-parent family, Nuclear family, Extended family or multigenerational, Married blended family

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3
Q

Single-parent family

A

Most socially vulnerable because of no support system.
Can impact overall health, school achievement, and increase risk of high risk behaviors.

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4
Q

Nuclear family

A

Husband wife children, biological or adopted children.
Live as individual unit but share responsibilities.
Number of nuclear families have decreased

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5
Q

Extended family or multigenerational

A

aunts, uncles, grandparents, cousins.
Provide social support, financial support to one another

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6
Q

Married blended family

A

Married couple with children from pervious relationship

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7
Q

Nursing Theory- Family systems theory:

A

Family pays a vital heath.
A change in one family member impacts the entire family.
Beliefs and values play the most powerful role in the actions of individuals and families.
Significantly patient centered.
Provide respect an include in plan of care- family

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8
Q

Nursing Assessment- Low risk vs high risk family

A

Pregnancy low risk- stable, financial income, bottle level of Maslow’s being met, no comorbidities, no social concerns
High risk family- lack of support, comorbidities, abuse, low income, nutrient, insurance, transportation, communication problem, immigrant, alcoholism, drug abuse

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9
Q

Look at family planning, preconception care, prenatal care, intrapartum care, postpartum care, And

A

care of the infant/newborn through 1 year

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10
Q

Family definition

A

Whoever the patient says is family
Structural unit that functions and society- fundamental social unit.
Assumes responsibility for transmitting cultural background and core values

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11
Q

Culture

A

Communication, Subculture, Acculturation, Assimilation, Ethnocentrism, Family roles, Time orientation

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12
Q

Communication-

A

Interpreters, find out the language they speak, assess teaching (variety of methods). provide privacy. Document utilizing an interpreter.

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13
Q

Subculture-

A

culture within a culture. Mexican America, Asian American.

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14
Q

Acculturation-

A

One culture retains old culture and obtains apart of another culture. Occurs when people from one culture meshes with people from another

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15
Q

Assimilation-

A

Total loss of ones own culture, lose cultural identity become part of larger culture

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16
Q

Ethnocentrism-

A

believing that own culture is they best. Values and belief are the only right way. Hard to navigate during a nurse. Learn to agree to disagree

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17
Q

Family roles-

A

depending on the culture, parents are more involved or not.

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18
Q

Family roles European American family-

A

spouse is more involve in birth

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19
Q

Family roles Hispanic-

A

Maternal grandmother is involved in the care

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20
Q

Family roles Native American-

A

whole family involved in care

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21
Q

Family roles Asian American-

A

father is not involved in child birth practices

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22
Q

Community Health

A

Vulnerable Populations, Care management, Home Care

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23
Q

Vulnerable Populations-

A

Women, racial or ethnic minorities
Adolescent girls- pregnancy, STD risk
Incarcerated women- risk of stds, communicable diseases, influence on drugs. Homeless- increased risk of infectious disease, lack of prenatal care, substance abuse, chronic diseases,

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24
Q

Care management-

A

Assess safety of the home.
Pay attention to infection control

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25
Q

Home Care-

A

Growing need for women’s health.
Utilized for birthing practices.
Nursing home care can shorten hospital stays.
Expensive, what is considered covered, reimbursement concerns.

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26
Q

Levels of Preventive Care

A

Primary, Secondary, Tertiary

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27
Q

Primary-

A

prevent something from happening- immunizations, exercise, care seats, nutrition

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28
Q

Secondary-

A

Screenings come into play, mammogram, breast self exams.
Targeting at risk populations.
Genetic testing- older than 35 yrs old

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29
Q

Tertiary-

A

Pt always has disease.
Tx or rehabilitation to prevent further deterioration

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30
Q

Assessment is key, 51 percent of the population are

A

Women

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31
Q

Rural-

A

vulnerability of readily available access to care

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32
Q

Urban-

A

increased access to care

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33
Q

Family focused concerned about the

A

mom and the baby

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34
Q

What is Maternity and Women’s Health Nursing in the 21st Century?

A

Maternity Care, Women’s Health Care, Role of nurses in Women’s Health care, Significant advances in care AWON

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35
Q

Maternity Care-

A

includes prenatal care intrapartum care and postpartom care

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36
Q

Women’s Health Care-

A

physical aspects and psychological aspects, Within look at social needs-defines Maslow’s

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37
Q

Role of nurses in Women’s Health care-

A

concerned about well being of the woman and infant

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38
Q

Significant advances in care AWON-

A

set forth standards and goals that maternity nurses should meet

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39
Q

Contemporary Issues and Trends- Healthy People 2020 Goals

A

33 of these goals are directly related to maternal, infant and child health.
Overall being of the population. Different aspects. Specific goals that target women and infants. Nurses are involved, starts with us.

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40
Q

Healthy People 2020 Goals Examples include:

A

Reduce the rate of fetal and infant deaths
Reduce the rate of maternal mortality
Reduce preterm births
Reduce cesarean births among low risk women

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41
Q

Goal is to improve access to care and quality of care

A

Healthy People 2020

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42
Q

What determines healthy people goals-

A

mortality rates for infants and women, specified to specific race or ethnicity

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43
Q

Why is there an increase in African American mortality rate-

A

Unconscious bias.
Be aware and individualize patient care.
Data driven it shows high mortality rate in African American women

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44
Q

Contemporary Issues and Trends- Problems with the U.S. health care system

A

Structure of the health care delivery system, Reducing medical errors, High cost of health care, Limited access to care, Health Literacy

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45
Q

Structure of the health care delivery system-

A

fragmented and the structure of it makes it inaccessible to people.
Access to care issue

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46
Q

Reducing medical errors-

A

3rd leading cause of death in the US.

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47
Q

High cost of health care-

A

Economy driven, Intensive care = increases price

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48
Q

Limited access to care-

A

Transportation, Teenage Pregnancies, Child care, Finances, Support, Insurance

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49
Q

Health Literacy-

A

Understanding about their health, simplified education, teach back, demonstrating, describing, interpreter.
People are afraid to advocate for themselves.
Providing basic care we can utilize a lay interpreter.
Any consent for procedure, med info, diagnostics- need a licensed interpreter.
Use resources.

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50
Q

Trends in Fertility and Birth Rates

A

Trends, Low birth weight and preterm birth, Infant mortality in the United States, International infant mortality trends, Maternal mortality trends, Maternal morbidity

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51
Q

Trends:

A

Fertility and rates, c section rates, vary from year to year.
Decrease in unnecessary c sections over the last 5-6 year, comes from patient advocacy.

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52
Q

Low birth weight and preterm birth-

A

Diet, substance use, prenatal care, multiple fetal gestation, comorbidities, ethnicity. Low weight <2500 grams.
Non Hispanic black infants 2x more likely to die in the first year (nonmodifiable risk factor)

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53
Q

Infant mortality in the United States-

A

Can be reflective in care. Congenital issues can arise at any time

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54
Q

International infant mortality trends-

A

US higher occurrence of low birth rates than any other country

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55
Q

Maternal mortality trends-

A

Better access to prenatal care- resources-clinics, certified nurse midwife, OBGYM travel to the location, telemed

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56
Q

Maternal morbidity- Obesity

A

one-third of women in the U.S. are obese.

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57
Q

Obesity Increases the occurrence of diabetes and hypertension-

A

further leads to complications during pregnancy, congenital anomalies, miscarriages, infertility, and fetal death

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58
Q

Trends in Fertility and Birth Rates- Can still have

A

hypertension, infection, hemorrhage, fetal death risk for any healthy individual

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59
Q

Perinatal Health Care Services

A

Ambulatory care, Community-based care, High technology care, Telehealth advances, Disadvantages, Social Media influences

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60
Q

Ambulatory care-

A

Basic care.
Receive for prenatal care.
Notice abnormality or high risk, then progressive higher level of care= more interventions.
Determine higher level of care= assessment

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61
Q

Community-based care-

A

Home health care (bed rest), Income based care.
Planned parent hood. WIC clinic- helps with nutritious food, formula, etc

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62
Q

High technology care-

A

Preconception counseling helps women determine if they are able to have children or risk of fertility, congenital malformations.
Our health care system emphasizes high-technology care because we cannot operate without technology

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63
Q

Telehealth advances-

A

Equipment to care for mom and baby is high tech. Vital signs, contractions, lab tests, genetic screenings. Any time of intensive care= tech

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64
Q

Disadvantages-

A

Need to have phone, laptop, internet. Cannot do Physical assessment, using senses

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65
Q

Social Media influences-

A

Misinformation- don’t believe everything you see, not one size fits all, confirm with HC provider. Nurses are first line of education.

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66
Q

Equipment to care for mom and baby is high tech

A

Vital signs, contractions, lab tests, genetic screenings

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67
Q

Any time of intensive care=

A

High tech

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68
Q

Childbirth Practices

A

Prenatal care, Certified nurse-midwives, Physicians, Family-centered care, Bonding intervention

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69
Q

Prenatal care-

A

Promotes better pregnancy outcomes, supports healthy behaviors, and utilized as early risk assessment tool.
Provided by obstetrician, certified nurse midwife, women’s HC nurse practitioners, physicians assistance specialized in obstetrics care

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70
Q

Certified nurse-midwives-

A

More focused on non invasive interventions.
Associated with lower C section rate.
Midwives who are not nurses.
RN has masters- Certified nurse-midwives.
Lay midwife- did not have formal medical training. Focused on home births.
Doula- another support person, advocate in L&D room.

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71
Q

Physicians-

A

Comorbidities focused

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72
Q

Family-centered care-

A

significant other, siblings, anybody who the women determines is family
When determining family centered care be involved.
Includes education.
Make sure baby within the mom as often as possible.
Skin to skin contact- family centered care.
Promotes bonding encourages breastfeeding’s.

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73
Q

Bonding intervention-

A

skin to skin.
After baby is born woman can let whoever to cut the umbilical cord- family centered care

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74
Q

Other Issues in Women’s Health Nursing

A

Involving consumers and promoting self-management, Domestic violence, International concerns, Women’s health

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75
Q

Involving consumers and promoting self-management-

A

Women are healthy during pregnancy we want them to maintain health.
Encourage well balanced diet and activity, monitor intake, smoking, alcohol drugs.

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76
Q

Domestic violence-

A

Don’t feel safe at home, cannot meet needs, taking care of self or baby, harm to mom and baby.
Leads to fetal death.
Ask with desertion- privacy.

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77
Q

International concerns-

A

Female genital mutilation and human trafficking in the US- sexual assault, miscarriages, sell the baby and stem cells.

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78
Q

Women’s health-

A

Increase risk for hypertension, breast cancer, cardiovascular disease, domestic violence- the incidence battery increases during pregnancy (tension, financial burden, drama)

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79
Q

Standards of Practice and Legal Issues in Provision of Care: What is Standard of Care?

A

Level of care would provide in a similar situation

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80
Q

Standards of Practice and Legal Issues in Provision of Care: Standards defined by several organizations

A

defined by various organizations. Special interest in nursing or W/I health

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81
Q

ANA-

A

American Nurses Association

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82
Q

AWHONN-

A

Association of Women’s Health, Obstetric and Neonatal Nurses

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83
Q

ACNM-

A

American College of Nurse-Midwives

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84
Q

NANN-

A

National Association of Neonatal Nurses

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85
Q

We have to know

A

facility standards

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86
Q

How to know to reference care book if

A

unsure about a procedure

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87
Q

Always reference an experienced nurse but always look at

A

policies and procedures for that facility

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88
Q

Standards of Practice and Legal Issues in Provision of Care: Risk management

A

System of checks and balances. Anytime an adverse effect occurs a risk management nurse looks at the situation. Decreasing risk of harm.

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89
Q

Standards of Practice and Legal Issues in Provision of Care: Sentinel events

A

that should not have happened.
Preventable event.
Fecal impaction is a sentinel event (lack of intervening).
Something that causes pt temporary or permanent harm from lack of intervening.

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90
Q

Standards of Practice and Legal Issues in Provision of Care: Failure to rescue

A

Neglect, ignoring.
Clinical judgement impaired.
Follow Chain of command to report.
Call provider.
When we exhausted all of our intervention and failed to reach out to other people. Document, Advocate.
Medical director is physician not good.
All NSG interventions used then to charge nurse, provider, medical director.

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91
Q

Standards of Practice and Legal Issues in Provision of Care: Quality and Safety Education for Nurses (QSEN)

A

Sets standards for nursing practice.

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92
Q

Standards of Practice and Legal Issues in Provision of Care: Evidence Based Practice

A

Providing care based on data collected that proves to be efficient and effective. Determined by research and clinical trials.

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93
Q

Standards of Practice and Legal Issues in Provision of Care: Outcomes oriented practice

A

compared clinical standards with current care practices

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94
Q

Ethical Issues in Perinatal Nursing and Women’s Health Care

A

Reproductive technology, Allocation of resources, Older-age pregnancies, Third-party payers, Induced ovulation and in vitro fertilization, Multifetal pregnancy reduction, Intrauterine fetal surgery, Treatment of very low-birth-weight infants.

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95
Q

Reproductive technology-

A

Ethical issues, Genetically modification

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96
Q

Allocation of resources-

A

Ethical issues, Prenatal babies have higher risk of respiratory distress in intrauterine life. Who has higher chance of survival. Team effort (opinions). Ethics committee responsible.

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97
Q

Older-age pregnancies-

A

Ethical issues. Higher risk for premature, genetic malformations (down syndrome), Multiples (fertility decreases), increased risk for hypertension, diabetes, obesity.

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98
Q

Induced ovulation and in vitro fertilization-

A

Technology used and cost (expensive)

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99
Q

Multifetal pregnancy reduction-

A

Health of woman vs fetus. Therapeutic or Medically necessary

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100
Q

Intrauterine fetal surgery-

A

Risk for death for mom and fetus. Cost = expensive.

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101
Q

Treatment of very low-birth-weight infants-

A

Allocation of resources

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102
Q

Research in Perinatal Nursingand Women’s Health Care

A

Ethical guidelines for nursing research, How do we analyze benefits and risk in ethical dilemma, Analysis of benefits and risks

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103
Q

Ethical guidelines for nursing research-

A

Prenatal patients= risky

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104
Q

How do we analyze benefits and risk in ethical dilemma-

A

American Nurse Assoication Code of ethics. Autonomy, justice, equality, beneficence

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105
Q

When managing health care for pregnant women at a local prenatal clinic, the nurse should recognize that the most significant barrier for access to care is the pregnant woman’s:

A

Inability to pay

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106
Q

Influences growth and development by

A

hormones

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107
Q

development in the female reproductive system

A

Estrogen and progesterone

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108
Q

Lack of these hormones cause function abnormality

A

Estrogen and progesterone

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109
Q

Holistic nursing care for

A

child bearing women

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110
Q

Preconception needs-

A

child care

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111
Q

Focus on health promotion and prevention

A

Females

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112
Q

We want to focus on preventative health care in all aspects in

A

Health care

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113
Q

muscular organ positioned in the pelvic cavity.

A

Uterus

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114
Q

Where the fertilized egg is received, implanted, and retained.

A

Uterus-

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115
Q

Huge role in child birth process.

A

Uterus-

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116
Q

Responsible for female menstrual cycle.

A

Uterus-

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117
Q

The inner lining of the ___ is what is shed during monthly menstrual.

A

Uterus-

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118
Q

Muscles Actively involved in the birth process.

A

Uterus-

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119
Q

Fallopian Tube-

A

Uterine tubes. Where the ovum is fertilized by sperm.

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120
Q

Endometrium vascular lining of the uterus and is

A

shed during menstruation

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121
Q

Cervix-

A

Made of connective and elastic tissue. It is what dilates or stretches during child birth.

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122
Q

Ovary-

A

Produce ova (female eggs). Responsible for ovulation and hormone production.

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123
Q

Vagina-

A

Lies between the bladder and rectum. Passage way for menstrual flow and pathway for vaginal birth

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124
Q

Vulva-

A

Part of external genitalia

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125
Q

Hormone production

A

decreases as age

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126
Q

Female Reproductive System: Internal Structures atrophy and become

A

less functional

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127
Q

Mammary Gland- Two made up of

A

Lobules

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128
Q

placed between the 2nd and 6th rib

A

Lobules

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129
Q

Same size and shape.

A

Physiologic Alterations of Breasts

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130
Q

Although one is typically larger than one others.

A

Physiologic Alterations of Breasts

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131
Q

Can vary depending on age, hormone production, and hereditary.

A

Physiologic Alterations of Breasts

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132
Q

Nutrition can also influence alterations.

A

Physiologic Alterations of Breasts

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133
Q

Characteristics-Smooth no dimpling or masses (cancer).

A

Physiologic Alterations of Breasts

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134
Q

Estrogen stimulates growth of breast tissue

A

Physiologic Alterations of Breasts

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135
Q

Lactation, sexual arousal, nonmalignant nodules can develop in response to hormonal changes.

A

Breasts Function-

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136
Q

Menarche & Puberty- female first menstruation, typically within first yr there is Anovulation (no ova are released), typical age is

A

13 yrs old onset.

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137
Q

Marker of transition between childhood and puberty.

A

Menarche

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138
Q

Shed the lining of the uterus.

A

Menstrual Cycle

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139
Q

Preparing the uterus for pregnancy.

A

Menstrual Cycle

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140
Q

Periodic uterine bleeding which occurs 14 days after ovulation.

A

Menstrual Cycle

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141
Q

Length of the cycle is typically 28 days.

A

Menstrual Cycle

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142
Q

Varies depending on the pt. bleeding will last 5 days and accumulation of blood loss is about 50 mL, can vary.

A

Menstrual Cycle

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143
Q

Oxygenated fatty acids that function like hormones.

A

Prostaglandins (PGs)

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144
Q

Produced in most organs including the uterus.

A

Prostaglandins (PGs)

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145
Q

Moderate hormonal activity, do play a role in smooth muscle contractility.

A

Prostaglandins (PGs)

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146
Q

Play a key role in ovulation and influence the production of estrogen and progesterone.

A

Prostaglandins (PGs)

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147
Q

Can be influenced by environmental factors, emotions, physical factors.

A

Prostaglandins (PGs)

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148
Q

The release can have effect of organs and system in the body, gi system- diarrhea.

A

Prostaglandins (PGs)

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149
Q

CNS- generalized systemic responses (aches, headaches, increase temp, above baseline)

A

Prostaglandins (PGs)

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150
Q

Menopause 3 stages

A

Climacteric, Perimenopause, Menopause

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151
Q

Climacteric-

A

transition phase between ovarian function and decrease in hormone production.

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152
Q

Occurs before menopause, four year span, during menopause no estrogen is released from the ovaries.

A

Perimenopause

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153
Q

Ovarian function significantly decreases the production of ova also decreases.

A

Perimenopause

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154
Q

Females will have anovulatory menses- still bleeding but no ova are being released.

A

Perimenopause

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155
Q

last menstrual period, noted 1 year after no mensuration.

A

Menopause

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156
Q

Can occur between ages 35-60. Average age of 51.

A

Menopause

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157
Q

Barriers to Seeking Health Care

A

Financial issues, Cultural issues, Gender issues

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158
Q

Such as lack of education is preventing pt from getting jobs or receiving heath care insurance from job

A

Financial issues

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159
Q

Income and social status also. They need healthcare coverage until needed healthcare services. Huge barrier

A

Financial issues

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160
Q

different beliefs.

A

Cultural Issues

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161
Q

Pts may use alternative tx other than evidence based practice.

A

Cultural Issues

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162
Q

Provide pt with facts, respect their religion.

A

Cultural Issues

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163
Q

gender concordance- female pt may want female provider only and vise versa. Can be an issue.

A

Gender Issues

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164
Q

Most providers are male and nurses are female mostly.

A

Gender Issues

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165
Q

May be generational- used to seeing male providers so when seeing female providers they doubt. Still an issue.

A

Gender Issues

166
Q

Sexual orientation or gender identify can cause barriers to HC.

A

Gender Issues

167
Q

How to overcome barriers- educate self on pts perspective.

A

Gender Issues

168
Q

Caring for the Well Woman Across the Life Span

A

Approaches to healthcare:
Preconception
Pregnancy
Family Planning
Menstrual Problems
Perimenopause

169
Q

To take care of them- Proper education, establish rapport and be relatable with them.

A

Adolescents

170
Q

Educate on safe sex practices and how to prevent becoming pregnant.

A

Adolescents

171
Q

Understand that they are still not mature.

A

Adolescents

172
Q

The average age for sexual intercourse is 17 yrs old.

A

Adolescents

173
Q

Female must have first papsmear at 21.

A

Adolescents

174
Q

20-40 yrs old.

A

Young and Middle Adulthood

175
Q

Need care treated to conception

A

Young and Middle Adulthood

176
Q

if they wish to have children, pelvic and breasts’ screening. Pap smears, breast self exam.

A

Young and Middle Adulthood

177
Q

Pregnancy care is related to this age group.

A

Young and Middle Adulthood

178
Q

May have chronic or debilitating conditions. Comorbidities.

A

Parenthood after 35 y/o

179
Q

If they were to become pregnancy at the time, at risk for genetic anomalies esp. down syndrome.

A

Parenthood after 35 y/o

180
Q

Females are born with their eggs which age as the pt ages.

A

Parenthood after 35 y/o

181
Q

Experiences changes as they age. Respect.

A

Late Reproductive Age-

182
Q

Can be experiencing depression because of empty nest syndrome.

A

Late Reproductive Age-

183
Q

Within our scope of practice.

A

Late Reproductive Age-

184
Q

Want to continue screening for cancers. Breast/ovarian/cervical cancer.

A

Late Reproductive Age-

185
Q

Risk Factors to Women’s Health

A

Substance Abuse, Mental Health, Lifestyle, Medical conditions, Exercise, Nutrition problems

186
Q

inappropriate Use of elicit drugs of prescription.

A

Substance Abuse

187
Q

Seen as a biopsychosocial disorder.

A

Substance Abuse

188
Q

Cocaine to caffeine can harm the fetus.

A

Substance Abuse

189
Q

Can have impact of fertility and overall women health.

A

Substance Abuse

190
Q

Depression and anxiety concern.

A

Mental Health

191
Q

Ensure they have appropriate coping mechanisms and provide active listening, refer to support groups.

A

Mental Health

192
Q

Nurses have skill of anticipatory guidance- helping prepare them, giving recourses and support

A

Mental Health

193
Q

Practices, risky behaviors such as sexual, drug abuse, alcohol use.

194
Q

Can lead to potential for human trafficking and domestic violence.

195
Q

Environment or work place can have hazards such as chemical exposure, pathogenic agents, radiation.

196
Q

Common- heart disease, lung breast and colon cancer, chronic lung disease, and diabetes.

A

Medical Conditions

197
Q

Infertility, miscarriages, preterm delivery, ovarian cysts and STI- gynecological and obstetrics concerns

A

Medical Conditions

198
Q

Exercise- can prevent and help manage CVD, arthritis, diabetes, osteoporosis.

199
Q

Recommendation is 20-30 mins 3 times per week.

200
Q

Calcium- decreased bone health problems, at risk for osteoporosis.

A

Nutrition Problems

201
Q

Estrogen activates vitamin d which plays a huge role in activation of vitamin D.

A

Nutrition Problems

202
Q

400 mcg of folic acid daily prior for pregnancy for neural tubes.

A

Nutrition Problems

203
Q

BMI greater than 30- impacts in fertility, health of pregnancy, increase risk for cancers of the repro system.

A

Nutrition Problems

204
Q

Also increases risk for diabetes, CV disease, stroke.

A

Nutrition Problems

205
Q

Eating disorders-anorexia, bulimia, over weight or underweight causes complications

A

Nutrition Problems

206
Q

Best resource is the pt. make sure open needed questions. Make sure they can elaborate.

A

Health History Assessment

207
Q

Make sure sensitive to privacy.

A

Health History Assessment

208
Q

Be direct and let them know exactly what is happening.

A

Health History Assessment

209
Q

If they don’t speak English validate exactly what that are saying.

A

Health History Assessment

210
Q

Quickly develop rapport to create a connection. Be relatable

A

Health History Assessment

211
Q

Women with Special Needs- pt that has a disability, adolescent, or victim of abuse.

A

Women with Special Needs

212
Q

Be aware of situations and interaction.

A

Women with Special Needs

213
Q

Communication needs to be effective.

A

Women with Special Needs

214
Q

Screen all women for abuse, do not ask in front of partners/caregivers.

A

Women with Special Needs

215
Q

Physical Examination-

A

H to T assessment covering all systems

216
Q

Very specific to labor and delivery-To assess cervical dilation.

A

Pelvic Exam

217
Q

Always get consent to examination.

A

Pelvic Exam

218
Q

Prepare patient, change into gown, explain procedure, make them feel comfortable.

A

Pelvic Exam

219
Q

Place in correct position- Lithotomy position.

A

Pelvic Exam

220
Q

Can assess external genitalia without pelvic exam.

A

Pelvic Exam

221
Q

Screening for STIs

A

Laboratory and Diagnostic Procedures

222
Q

Collect specimen from pelvic exam to help identify organisms. Pap smears- pelvic exam, scrape cells from cervix and other mucous membranes, assessed for malignancy.

A

Other Serum lab tests

223
Q

Anticipatory Guidance for Health Promotion and Illness Prevention

A

Nutrition
Exercise
Stress Management
Substance use cessation
Sexual Practices that reduce risks

224
Q

As nurses, we must focus on

A

health screenings, health risk preventions, and health protection.

225
Q

Nurses can make a difference in stopping violence against women and

A

preventing further injury.

226
Q

Question: When obtaining a reproductive health history from a woman, the nurse should:

A

D. Explain the purpose for the questions asked and how the information will be used. To develop rapport, relatable and collect data.

227
Q

Amenorrhea-

A

absence of menstrual flow.

228
Q

Primary Amenorrhea-

A

absence of menses by the age of 15 with normal growth and development.

229
Q

Secondary Amenorrhea-

A

absence of menses within 5 year of breast development or if absence of menses female gets menses then absence for 6 months. Typically caused by underlying disorder.

230
Q

Isnt classified as a disease but is a sign of one.

A

Amenorrhea

231
Q

Common problems that cause Amenorrhea -

A

pregnancy, endocrine disorders.

232
Q

Amenorrhea- Female athlete can experience female athlete triad.

A

1-eating disorders 2- osteoporosis 3- decreased estrogen which is Related to training too hard and poor nutrition.

233
Q

Menstrual Disorders Clinical signs-

A

Growth and development Breasts and labia structures

234
Q

Menstrual Disorders Assessment-

A

Gather through interview process, and rule out any underlying conditions such as pregnancy and thyroid problems.
Look at pregnancy test and CBC, TSH. Prestodol, prolactin and pelvic diagnostic studies.

235
Q

Menstrual Disorders Counseling + Education-

A

Menstrual disorders can diminishes quality of life, effect abelites to conceive.

236
Q

Menstrual Disorders Management-

A

Caused by hypothalamic disturbances- decreasing stress, oral contraceptives, and diet modification. Onset is 13 for menses.

237
Q

Dysmenorrhea-

A

Pain during or shortly before menstruation.
Causes- can impact quality of life, very overlooked.

238
Q

Pain during or shortly before menstruation.

A

Dysmenorrhea

239
Q

Associated with ovulatory cycle

A

Primary Dysmenorrhea

240
Q

Caused by excessive release of prstaglands that cause uterine arterioles to vasospasm,

A

Primary Dysmenorrhea

241
Q

Heat to abdomen causes vasodilation which prevent or control spams, exercise same reason.

A

Tx for Primary Dysmenorrhea

242
Q

Relaxation techniques, low sodium diet, natural diuretics (increase in fluid volume increases abdominal pressure.

A

Tx for Primary Dysmenorrhea

243
Q

Low fat diet, saturated fats can exacerbate inflammation.

A

Tx for Primary Dysmenorrhea

244
Q

Vitamin E supplements are alternative.

A

Tx for Primary Dysmenorrhea

245
Q

Forms of birth control can also tx and the use of NSAIDs which provide optimal relieve (effects prostaglandins)

A

Tx for Primary Dysmenorrhea

246
Q

Develops later in life. After 25 year of age.

A

Secondary Dysmenorrhea

247
Q

Associated with pathology such as endometriosis or fibrates.

A

Secondary Dysmenorrhea

248
Q

Feeling of bloating or pelvic fullness.
Cause back pain that radiates to the legs. Significant.

A

Secondary Dysmenorrhea S/Sx

249
Q

Pelvic ultrasound

A

Secondary Dysmenorrhea Diagnostics

250
Q

Remove fibroids, etc.
can Incorporate interventions for primary but not super effective especially if fibroid is causing the pain.

A

Secondary Dysmenorrhea tx

251
Q

Can have excessive bleeding

A

Menorrhagia

252
Q

Defined as an excessive amount of menstrual

A

Menorrhagia

253
Q

Hormones
Contraception

A

Menorrhagia causes

254
Q

Systemic diseases Systemic diseases- Hypothyroidism, Lupus.

A

Menorrhagia causes

255
Q

Neoplasms cancerous tumors

A

Menorrhagia causes

256
Q

Infection- underlying cause, Endometritis is cause of excessive bleeding.

A

Menorrhagia causes

257
Q

Medications- Contraceptives, chemotherapy agents, and anticoagulants

A

Menorrhagia causes

258
Q

___ is normal amount of blood lost

259
Q

Poorly understood condition (stigmatized and non consitant).

A

Premenstrual syndrome (PMS) Cyclic symptoms

260
Q

Combination of physical, psychological and behavioral symptoms.

A

Premenstrual syndrome (PMS) Cyclic symptoms

261
Q

Fluid retention, pelvic fullness, breast tenderness, weight gain, depression, irritability, impaired concentration, cravings, headache and fatigue.

A

Premenstrual syndrome (PMS) Cyclic symptoms

262
Q

More severe than PMS. In order to be diagnosed-meet criteria.

A

Premenstrual Dysphoric Disorder (PMDD) Cyclic symptoms

263
Q

Five or more affective and physical symptoms present in the week before menses’ and begin to improve in the follicular phase of the menstrual cycle

A

Premenstrual Dysphoric Disorder (PMDD) Criteria

264
Q

At least one of the symptoms is marked affective lability, marked irritability or anger, depressed mood or feelings of hopelessness, self-deprecating thoughts and/or anxiety

A

Premenstrual Dysphoric Disorder (PMDD) Criteria

265
Q

One or more of the following additional symptoms is/are present: decreased interest in usual activities, subjective difficulty concentrating, lethargy, marked change in appetite, hyperinsomnia, insomnia, feeling overwhelmed, physical symptoms of breast tenderness, muscle pain, bloating, weight gain

A

Premenstrual Dysphoric Disorder (PMDD) Criteria

266
Q

Symptoms interfere markedly with work orinterpersonal relationship

A

Premenstrual Dysphoric Disorder (PMDD) Criteria

267
Q

Symptoms are not caused by an exacerbation of anther condition or disorder

A

Premenstrual Dysphoric Disorder (PMDD) Criteria

268
Q

Must confirm that symptoms are occurring, evidenced through daily ratings

A

Premenstrual Dysphoric Disorder (PMDD) Criteria

269
Q

Symptoms are not caused by physiologic effects of a substance if a specific medical treatment

A

Premenstrual Dysphoric Disorder (PMDD) Criteria

270
Q

diet modification, low sodium diet(fluid retention), exercise, smoking cessation, take oil of evening primrose

A

Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Key management tools:

271
Q

Essential fatty acid that converted to precursor for prostaglandins.

A

Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx

272
Q

Relaxation techniques.

A

Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx

273
Q

Calcium and magnesium.

A

Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx

274
Q

Vitamin B6- for nerve irritability, helps with concentration.

A

Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx

275
Q

Vitamin D3- Mood booster

A

Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx

276
Q

Adhesions found throughout the body, vagina, surgical scars, vulva, perineum, bladder gal bladder, heart, everywhere.

A

Endometriosis:

277
Q

presence + growth of endometrial tissue outside of the uterus.

A

Endometriosis:

278
Q

Endometriosis: Symptoms-

A

dysmenorrhea, abnormal uterine bleeding, painful intercourse-depend on location of the adhesions, Infertility

279
Q

NSAIDs, Suppress estrogen meds- be careful bc the S/E can mimic menopausal symptoms (weight gain, vaginal dryness, decreased libido)

A

Endometriosis Management

280
Q

Oral contraceptives- have to be very low in estrogen and progesterone, take for about 6-12 months. It is expected to decrease number of adhesions.

A

Endometriosis Management

281
Q

1 cure is surgical intervention- total hysterectomy.

A

Endometriosis Management

282
Q

Can worsen with each menstrual cycle

A

Endometriosis

283
Q

May not have any S/Sx of it. Can be found on routine exam. Can disappear after menopause

A

Endometriosis

284
Q

Menopause Physiologic Characteristics:

A

Anovulation, Menstrual Cycle Length, Ovulation, Progesterone, FSH

285
Q

Anovulation-

A

No egg development ova

286
Q

Menstrual Cycle Length-

A

Experience cycle longer than 28 days, can be extended weeks or months. Amount of blood can be different.

287
Q

Ovulation-

A

Progressively occur less frequently

288
Q

Progesterone-

A

production decreases. Corpus lutinum progressively diminish production of progesterone.

289
Q

FSH-

A

Values are elevated. Assessed though blood sample

290
Q

Menopause Physical Changes:

A

Bleeding, Genital Changes, Vasomotor instability, Moods/Behaviors,

291
Q

Bleeding-

A

longer bleeding period from light to heavy

292
Q

Genital Changes-

A

vaginal and urethra are estrogen sensitive, atrophy of vagina and urethra which causes sexual discomfort and increase risk of vaginitis. Likely to cause incontinence.

293
Q

Vasomotor instability-

A

Hot flash. Increase in body temperature, educate on management- dress in layers, avoid caffeine and alcohol, drink ice water

294
Q

Moods/Behaviors-

A

Mood swings, significant behavioral changes related to hormonal imbalance.
Emotional changes not tired to hormones- perimenopause to menopause.

295
Q

Health Risks of Perimenopausal Women

A

Osteoporosis-
Coronary Heart Disease-

296
Q

due to loss of one mass, directly related to decrease in estrogen- helps convert vitamin d

A

Osteoporosis-

297
Q

as changes in hormones alter metabolism of lipids.

A

Coronary Heart Disease-

298
Q

Menopausal Hormonal Therapy-

A

estrogen only or estrogen combo with progestin

299
Q

Menopausal Hormonal Therapy Risks-

A

make sure pt taking lowest dose effective.
Does increase risk for breast cancer.
Even five years after stopping the Tx

300
Q

Menopausal Hormonal Therapy Side effects-

A

Headaches, depression, N/V, brown spots on skin. Personal history of breast cancer are at an increased risk to develop again.

301
Q

Menopause Plan of Care

A

Sexual Counseling, Nutrition, Exercise, Medications, Support Groups

302
Q

Decrease production of estrogen causes structures to atrophy- vaginal dryness and painful intercourse and decrease libido which decrease sexual drive

A

Sexual Counseling-

303
Q

Metabolic rates decrease. Foods should be high in giber, nutrients, and calcium/Vitamin D. Moderate in calories and low in fat. Excessive protein avoid.

A

Nutrition-

304
Q

Weight bearing- walking and stair climbing, aerobics and strength training

305
Q

educate risk of medications they are taking and how to take them

A

Medications-

306
Q

Other meds can tx complications of menopause

A

Medications-

307
Q

to decrease vasomotor instability- SSRIs, Gabapentin

A

Medications-

308
Q

Soy and vitamin E can be used to help with vasomotor response too

A

Medications-

309
Q

Develop a supportive network with other women with whom they can share their concerns.

A

Support Groups

310
Q

A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:

A

Endometriosis

311
Q

Benign Conditions of the Breasts-Anatomic variances-

A

Micromastia, Macromastia, Developmental anomalies

312
Q

Micromastia-

A

small underdeveloped breast tissue

313
Q

Macromastia-

A

large heavy breast that causes back or shoulder pain

314
Q

Developmental anomalies-

A

seen with asymmetrical breast size. Significant difference. If the women deicides to breastfeed it is associated in decrease in lactate production

315
Q

Pathophysiology of benign breast disease
Two goals of the initial evaluation:

A
  1. distinguish between benign and malignant lesions
  2. assess patients risk for malignant breast cancer
316
Q

Cystic masses-

A

cystic changes are benign and are the most common type of breast changes

317
Q

Fibrocystic changes etiology-

A

causes cystic masses related to estrogen and progesterone and typically occur in women that are 20-50yrs old

318
Q

Lumps painful or pain less.

A

Fibrocystic changes Clinical Manifestations

319
Q

Experience tenderness with menstrual cycles.

A

Fibrocystic changes Clinical Manifestations

320
Q

Occurs 1 week before menstrual cycle and disappear one week after.

A

Fibrocystic changes Clinical Manifestations

321
Q

The younger the women the more painful the cystic changes.

A

Fibrocystic changes Clinical Manifestations

322
Q

Cystic changes noted are well differentiate boarders, moveable and soft.

A

Fibrocystic changes Clinical Manifestations

323
Q

Diagnosis- palpation of breast. Perform breast self exam.

A

Fibrocystic changes Therapeutic management-

324
Q

Ultrasounds- mass is solid (diet modification, avoid alcohol, smoking cessation and caffeine) or fluid filled(advocate for pt for aspiration of fluid to help shrink the cyst)

A

Fibrocystic changes Therapeutic management-

325
Q

Meds: nsaids to treat discomfort, oral contraceptives(estrogen and progesterone influenced), alternative tx evening primrose oil.

A

Fibrocystic changes Therapeutic management-

326
Q

Breast Pain-

327
Q

Know pattern. Come and go with menstrual cycles.

328
Q

Where is the pain (diffuse or focal) concentrated in one area of the breast?

329
Q

Common for perimenopausal women.

330
Q

Pain management: diet changes-avoiding caffeine, stop smoking, alcohol. Hormonal therapy. Nsaids, evening primrose oil.

331
Q

Cyst can cause breast pain that’s why tx

A

are similar

332
Q

Solid Masses-

A

Fibroadenoma

333
Q

most common type Solid Mass.

A

Fibroadenoma

334
Q

No fluid component.

A

Fibroadenoma

335
Q

Not associated with increase risk in breast cancer. Common in teenagers. Liekly to experience tenderness around menses. Discrete, less than 3 cm. menstrual cycle seen increase in size but otherwise will stay the same size. Doesn’t respond to diet changes or hormonal therapy. Important that the pt has frequent observation of the mass. Evaluation is important to not miss malignancy.

A

Fibroadenoma

336
Q

Common in teenagers.

A

Fibroadenoma

337
Q

Likely to experience tenderness around menses.

A

Fibroadenoma

338
Q

Discrete, less than 3 cm.

A

Fibroadenoma

339
Q

Menstrual cycle seen increase in size but otherwise will stay the same size.

A

Fibroadenoma

340
Q

Doesn’t respond to diet changes or hormonal therapy.

A

Fibroadenoma

341
Q

Important that the pt has frequent observation of the mass.

A

Fibroadenoma

342
Q

Evaluation is important to not miss malignancy.

A

Fibroadenoma

343
Q

Infections of the breast

A

Cellulitis (inflammation of the skin/breast

344
Q

Red inflamed thick warm skin.

A

Cellulitis

345
Q

obesity, diabetes, smoking, and anytime of impairment to the skin(nipple piercings).

A

Cellulitis Risk factors:

346
Q

Can be underdiagnosed and can spread very quickly.

A

Cellulitis

347
Q

Incision and drainage-abscess development.

A

Cellulitis

348
Q

Antibiotics are the first line treatment for abcess or no abcess.

A

Cellulitis

349
Q

to report immediately to get antibiotic(priority) tx. If painful can take NSAIDs

A

Cellulitis Education

350
Q

how are we managing and detecting them.

A

Benign Conditions of the Breast Care Management-

351
Q

90% of lumps are discovered by the pt by utilizing

A

Breast Self Exam.

352
Q

Perform 5-7 days after menses.

A

Breast Self Exam.

353
Q

Best time for hormones in the system(releasing more hormones at the time)

A

Breast Self Exam.

354
Q

Client History and Physical Examination-

A

women’s 20’s- breast exam done by HC provider and early 40’s a mammogram- for early detection.

355
Q
  1. inform pts when screening should take place and how to do BSE (Do the same pattern and position) arm up. Inner to outer or clockwise-do same way each time.
A

Benign Conditions of the Breast Nursing Actions: based on education

356
Q

2.Provide written information

A

Benign Conditions of the Breast Nursing Actions: based on education

357
Q

3.offer therapeutic communication-be sensitive to concerns and fears even if benign

A

Benign Conditions of the Breast Nursing Actions: based on education

358
Q

Malignant Conditions of the Breast Etiology

A

Gender, age, time of menarche, menopause and time of first live birth
Personal History
Geographic differences
First pregnancy after 40

359
Q

Gender, age, time of menarche, menopause and time of first live birth

A

Nonmodifiable

360
Q

Personal History

A

Increases risk for second malignancy

361
Q

Geographic differences

A

Woman from japan- lowest rates
Western counties- equalizes of that of the native population

362
Q

First pregnancy after

363
Q

Malignant Conditions of the Breast
Genetic component Considerations:

A

85% risk of developing breast cancer if pt has both BRCA1 and BRCA2

364
Q

If present Woman receives biannual breast exams with imaging

A

BRCA1 and BRCA2

365
Q

Malignant Conditions of the Breast
Chemoprevention:

A

drugs used to prevent breast cancer.
Taken prophylactically.
To decrease occurrence.
They are toxic and have unpleasant side effects

366
Q

2nd leading cause of death in women

A

Breast Cancer

367
Q

1 in 8 will be diagnosed with ___

A

Breast Cancer

368
Q

Breast Cancer Surviaval rate-

A

83% chance of survival and had increased in the last 10-15 years.
Early detection has played a huge role.

369
Q

Exact cause is unknown

A

Breast Cancer Etiology

370
Q

Discussing differences in the breasts look for

A

lumps or dimples and note any unilateral change=bad(more significant than anything else)

371
Q

early menarchy=<13 yrs

A

Breast Cancer Risk factors:

372
Q

family history of malignancy

A

Breast Cancer Risk factors:

373
Q

White women >50yrs old

A

Breast Cancer Risk factors:

374
Q

African American women in 30s are at increased risk bc it is often missed bc it occurs so early,

A

Breast Cancer Risk factors:

375
Q

Nulliparity- never been pregnant

A

Breast Cancer Risk factors:

376
Q

If occurring on one side why?

A

Breast Cancer

377
Q

Longevity(years after diagnosed)- 80% range survival rate. an have increased chance of getting it again.

A

Breast Cancer

378
Q

Preventative health care and education and better tx options.

A

Breast Cancer

379
Q

___ of cases are male breast cancer

380
Q

Invasive tumors can travel elsewhere in the body

A

Malignant Conditions of the Breast: Pathophysiology

381
Q

All tumors behave and act differently

A

Malignant Conditions of the Breast: Pathophysiology

382
Q

Most common type of breast cancer is ductal carcinoma

A

Malignant Conditions of the Breast: Pathophysiology

383
Q

Rate of breast cancer growth depends on the effects of:

A
  1. estrogen
  2. progesterone
  3. other subtypes hormones and receptors
384
Q

Types of tumors

A

Ductal carcinoma, Lobular carcinoma, Nipple carcinoma

385
Q

Ductal carcinoma-

A

found in ducts of the breast. Invades surround breast tissue. Tumor is Solid, nonmobile and non tender

386
Q

Lobular carcinoma

A

found in lobules in the breast and not palpable.
Diagnosing is specific and can only be done with imaging

387
Q

Nipple carcinoma

A

occurs with ductal carcinoma and at the site we would see draining, bleeding and crusting around the nipple

388
Q

Inflammatory breast cancer-

A

appears as a reddish discolored rash and often misdiagnosed for mastitis.
Extremely aggressive- presents as stage 2 cancer

389
Q

Breast cancer can Metastasize-

A

spread to the bones, blood, lungs, brain and the liver.
Cancer cells enters the blood and traveling to the other areas.

390
Q

Other cancers Can be secondary to the breast cancer.

A

Origination is important

391
Q

Breast cancer screening guidelines

A

Mammography, MRI, Biopsy

392
Q

Mammography

A

gold standard. used for early detection but our gold standard is till ont 100% at detecting breast cancer. Tumor or lesion detection

393
Q

MRI

A

used in combination with a mammogram or ultrasound. Combination imaging beneficial for pts that have silicone breast implants and increased risk for breast caner bc its giving multiple modalities to view tissues or personal history of cancer

394
Q

Biopsy

A

Confirm the diagnosis. Core needle biopsy to diagnose BC. Put in the tumor-punch hole effect

395
Q

Breast Cancer Prognosis

A

Nodal involvement and (large) tumor size are the most significant prognostic criteria for long-term survival.

396
Q

Fibrocystic should still receive

397
Q

Breast Cancer Care Management

A

Surgery, Mastectomy, Breast reduction, Radiation therapy, Adjuvant Systemic Therapy

398
Q

Surgery-

A

common type is a lumpectomy- removal of the tumor and small margin if healthy tissue bc could be residual cancer cells and to not be too close to it so it does not puncture and spread more.

399
Q

Mastectomy-

A

One sided or bilateral- take one breast or bother breasts, determined by risk factors or nodal.
Involvement and size of tumor.
Nsg considerations: cannot obtain bp of extremity on affected side.
Iv or blood sample.
Most invasive-removing entire breast including nipple and areola.

400
Q

Breast Reconstruction-

A

typically performed at the time of the mastectomy.

401
Q

Radiation Therapy-

A

the most conservative approach when utilized when a lumpectomy.
Ensure all cancer cells have been removed to decrease reoccurrence.

402
Q

Radiation-unpleasant s/e-

A

skin irritation, heaviness in breast and fatigue.

403
Q

Adjuvant Chemotherapy-

A

chemotherapy combination with surgery

404
Q

Done with tamoxifen(oral antiestrogen).

A

Hormonal Therapy-

405
Q

Tamoxifen(oral antiestrogen). Unwanted s/e:

A

Need annual pap smear, frequent eye exams, bone density screen every 3 years. Liver Function Tests (LFTs) need to be evaluated every 6 months.

406
Q

Correlate with s/e:

A

can cause cataracts, endometrial cancer, impact activation of vitamin d to absorb calcium at risk for osteoporosis, increase risk for weight gain stroke, hot flashes, DVTs, mood changes

407
Q

Chemotherapy

A

Most common therapy for node-positive and node-negative tumors
High-dose therapy

408
Q

<40 years old make up 12% of population diagnosed with breast cancer.

409
Q

Use same standard of treatments and recognize sexual activities and childbearing capabilities that can be impacted by tx

410
Q

Women 65 and over:

A

The occurrence of breast cancer is declining, but the likelihood of diagnosis increases with age.
Preventative measure in place but even with age the risk will always increase.

411
Q

Survivorship issues- related to anti-estrogen therapy- osteoporosis and chemotherapy, cardiotoxicity, neuropathy

A

Vasomotor symptoms
Sexual dysfunction
Osteoporosis
Weight gain
Cognitive changes
Cancer-related Fatigue
Cardiotoxicity
Neuropathies

412
Q

A woman presents to a health care clinic complaining of a lump in her breast. Which finding is highly suggestive of breast cancer?

A

Newly retracted right nipple (New, should not be retracted) unilaterally

NSG (13 decks)

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