OB Flashcards
What are the symptoms of Menopause and what causes them?
*Primary Symptoms: related to fluctuating hormones. Vasomotor instability: hot flashes and night sweats. Menstrual irregularity due to fluctuating levels of estrogen and progesterone. Vaginal Dryness.
*Secondary symptoms: related to primary symptoms and prolonged. lowered levels of estrogen. Insomnia, irritability, labile moods and increased risk of osteopenia, osteoporosis and heart disease.
What are some discomforts of menopause and what can I suggest?
*Hot flashes: light, layerable clothing, regular exercise (walking included), set thermostat lower.
*Osteoporosis: Calcium & Vit D supplements, Weight bear everyday, decrease caffine.
- Falls: Decrease clutter, slippers with treads, night lights, and low beds.
*Vaginal Dryness: Use water soluble lube with sexual activity.
*Pelvic floor issues: Hydrate well & urinate often, Kegal Exercises.
What are Uterine Fibroids?
Bengin, estrogen tumors of the uterine wall (Do not migrate to other parts of the body)
What can be done about Uterine Fibroids?
Medications: gonadotropins (FSH, LH) may decrease the size of fibroids.
Surgery:
*Myomectomy- remove fibroids (can still get pregnant)
*Hysterectomy- remove uterus
What causes Uterine Fibroids?
Age over 45
Genetics
Hypertension
African Americans
Nulliparity - a woman who hasn’t given birth to a child.
Obesity
What are the life long complications of Uterine Fibroids?
*Pain: Pelvic pain prior to menses, pain with menses, pain with micturition, low back pain.
*Infertility
What is Endometriosis?
A disorder in which tissue similar to the tissue that lines the uterus grows outside the uterus in places where it doesn’t belong.
What causes Endometriosis?
Increased age
Family history
Short menstrual cycle <28 days
long menstrual cycle >1 week
Nulliparous or one to two pregnancies
High dietary fat content
How can we manage Endometriosis?
CAN’T BE CURED
Suppress estrogen level: danazol - pseudo menopause, OCPS - pseudo pregnancy, Euproolide/ Lupron - antineoplastic hormones to decrease levels of estradiol.
Surgery to reduce the number of cyst
NSAIDs - pain
Excisions or ablation of lesions
Hysterectomy
Cycle of violence
Phase 1: Tension building- the first and sometimes the longest phase of the cycle. Tension builds in the relationship. May be accelerated with drinking, drugs, and strained relations.
Phase 2: Acute Battering- the explosion and the actual violence. May abuse physically or emotionally. The victim refuses to believe it happened, often deny the episode and will often refuse medical help.
Phase 3: Honeymoon stage- the recovery period where they are apologetic, calm, and loving. May be extremely sorry for his/her actions. The victim hopes that he/she changes, sometimes believes it is her/his fault.
Who is at risk for abuse?
All women are at risk for IPV (no discrimination on age, weight, marital status)
IPV against women causes more injuries or deaths than automobile accidents, rapes or assaults combined!
Crosses all boundaries (races, sexual orientation)
LGBT are often the neglected victims due to targeting screenings and interventions toward the heterosexual community.
IPV can occur in men as well and is often under reported due to social stigma involved.
What to look out for signs of abuse?
*Overuse of health services
*Vague, nonspecific complaints
*Repeated missed appointments
*Unexplained injuries
*Untreated serious injuries
*Significant delay between the injury and the presentation for care
*Injuries that do not match the patient’s description of how they were incurred
*Evidence or a history of previous injuries
*Bilateral or multiple injuries in various stages of healing
*Intimate partner who refuses to leave the patient’s side
*Intimate partner who insists on explaining how the injury was incurred
*Not speaking when talked to
*Bruising in hidden spots
*Poor or little eye contact
How to take care of someone who has been absued?
Goal: reduce incidence/severity of abuse/trauma related to violence and injury
*Remain with victim at all times
*Obtain consents for care and evidence retrieval
*Complete History and Physical
*Assess verbal and non-verbal components of interactions
*Collect forensic specimens
*Labs – cultures, RPR, HIV, UA/C&S, hCG
*Antibiotic prophylaxis
*Emergency contraception
Discomforts during pregnancy and how to manage them?
*Nausea & Vomiting: dry crackers before arising, avoid
fried, greasy, spicy foods
*Heartburn: several small meals, antacids
*Backache: good body mechanics/ exercise
*Urinary Frequency: kegel’s exercises
*Varicosities: avoid constricting clothes/support hose, leg elevation
*Constipation: >fluid intake, >fiber in diet, >activity
*Leg Cramps: Exercise/ stretching, Calcium/ phosphate balance
*Edema: Elevation, Watch high sodium intake
Hyperemesis Gravidarum
*Frequent emesis, persistent beyond first trimester.
*Leads to hypovolemia and electrolyte imbalance which can cause:
Tachycardia,
Hypotension,
Decrease urinary output
Increased BUN,
Protein and vitamin deficiencies
*Treatment: antiemetics, rehydration, TPN
Pregnancy induced Hypertension
*Most often seen in primigravidas, adolescents, diabetics, and multiple pregnancy
*Progressive hypertension, vasoconstriction, decreased urine production, edema
*Mild to severe preeclampsia as condition progresses
Pre-eclampsia
*Mild – B/P greater than 140/90, edema above the waist, weight gain > 1 lb/wk, Urine protein 1+ or greater
*Severe – B/P > 160/110, anasarca, weight gain > 2 lb/wk, proteinuria, headache, blurred vision, epigastric pain, hyperreflexia, irritability
*May progress rapidly to eclampsia and/or HELLP syndrome
*Can lead to placental infarction – IUGR, acute hypoxia, preterm delivery and possible fetal death
Eclampsia we are worried about?
Seizures
Coma
Uterine contractions
Reduce BP, prevent seizures and deliver
HELLP Syndrome
Liver damage
H – hemolysis
EL – elevated liver function tests
LP – low platelets
Results in ischemia, tissue damage and potential post delivery hemorrhage
Mild management of Preeclampsia
Mild preeclampsia – home management, modified bedrest, high protein and moderate sodium diet, antihypertensives may be used
Severe preeclampsia management
hospitalize, IV magnesium sulfate, deliver and continue for 24-48 hours after delivery to reduce risk of seizure (Ca carbonate is antidote)
Gestational Diabetes Mellitus
*Abnormal glucose metabolism from increased need for insulin
*hPL from placenta leads to increased resistance to insulin
*Diabetic client is at increased risk for PIH and ketoacidosis
*Fetus – macrosomia
*Newborn – hypoglycemia in the first 2-4 hours after delivery
What are warning signs of pregnancy to be reported to the provider?
Vaginal bleeding, with/without discomfort
Rupture of membranes
Swelling of the fingers, hands, feet, puffiness of the face or around the eyes
Continuous pounding headache
Visual disturbances (blurred vision, dimness, spots)
Persistent or severe abdominal pain
Chills or fever
Painful urination
Persistent vomiting
Change in frequency or strength of fetal movements
Signs of True labor
Progressive cervical effacement and dilatation
Regular contractions
Increased intensity with ambulation
Radiate from lower back to lower abdomen
Continue despite comfort measures
Signs of False labor
No significant cervical change
Irregular contractions
Often stop with ambulation
Usually just back or upper abdominal pain
Often stop with comfort measures
Phases of contractions
*Latent Phase: Onset to 4cm, 5-10 hrs
UC’s every 10-15 min, increasing to every 5 minutes, duration 30-40 seconds, mild to moderate intensity, she is excited, but still sociable
*Active Phase-4-8 cm, 3-14 hours
UC’s every 3-5 min., 60-90 sec., mod to strong, focused, increasing discomfort
*Transition Phase-8-10 cm, 1-2 hours
UC’s every 1 ½ to 3 min., 90 sec., strong with urge to push, irritable, restless, angry
Pushing during transition can cause swelling and cervical lacerations. Mom needs to be fully dilated and effaced before pushing.
Risk of a Cesarean Birth
MATERNAL
One of the safest major surgical procedures. But it is a major surgical event so carries all the risks of surgery along with uterine hemorrhage.
INFANT
Diagnostic studies are often done to ensure that fetal lungs are mature when C/S birth is planned. Clearance of fetal lung tissue is slowed related to lack of push of contractions.
Risk of Preterm delivery?
Preterm Contractions/ Labor/ Delivery
Contractions prior to 37 weeks but after 20 weeks
Cervical change denotes labor
Use of Morphine sulfate and Cortisones
Consequences of prematurity:
Lung maturation not complete
Prolapsed Cord
Emergency condition
Late, deep fetal heart decelerations with little or no recovery
Decreased to no variability
Put mother in Trendelenburg or knee-chest position to take pressure off cord
Nurse puts hand in cervix to push up on the baby’s head to keep cord from being compromised
Emergency delivery possibly by cesarean section
Expected Cardiovascular assessment of mom after birth.
*Assess VS (similar to post op VS)
Every 15 min x 1hour
Every 30 min x 2
Every 4 hrs x 24 hrs
After 24 hrs, every 8 hrs
*BP should be baseline
May have orthostatic hypotension
*Temp
May have low grade temp (100.4 F) 1st 24 hours possibly from dehydration
*Pulse
May be bradycardic ( 50-60) for first 48 hours
*Tachycardia would be symptom of blood loss and needs to be reported immediately
Perineal Assessment
*Assess:
Healing of episiotomy
Tears/ lacerations
Hematomas
Hemorrhoids
*Episiotomy: 1–2-inch surgical incision made in muscular area between vagina & anus (perineum) to enlarge vaginal opening before birth.
*Normal findings: intact with tissue edges closely approximated, mild edema, minor ecchymosis, mild to mod pain.
*Use the REEDA Scale for episiotomy
Redness
Edema
Ecchymosis
Discharge
Approximation
Nursing care for sore nipples?
Ensure proper latch-improper placement of baby’s mouth on breast is major cause of nipple soreness
Apply small amount of breast milk or pure lanolin cream to sore nipples
Wear breast shields in bra
Avoid trauma to nipples
Avoid tight bra
Ensure good latch-roll flat nipples between fingers just before breastfeeding to help them become more erect.
Notify provider if still sore and cracked after 4 weeks
Nursing management for Mastitis?
Frequent BF or pumping to empty ducts.
Encourage mother to continue to BF while on oral antibiotics (Complete entire course of antibiotics).
Bed rest during acute phase- plenty of fluids (>3000ml/day)
Supportive bra
Ice or heat application on affected breast
Analgesics.
Note: Usually resolves 24-48 hours, mom can BF on both sides, infant may refuse affected side because of changes in composition (still need to pump).
Explain the respiratory and cardiovascular changes that occur during transition to extrauterine life.
Oxygen exchange between placenta and fetus switches to pulmonary gas exchange
Ductus venosus-constricts at birth. More blood to the liver
Ductus arteriosus-closes and more blood goes to lungs
Foramen ovale-closes and more blood goes to lungs
Tips for proper latching.
Put the baby to the breast immediately after delivery
Mother and baby should room in together.
Artificial nipples (bottles or pacifier) should not be given to the baby
No restriction on length of feedings or frequency.
No supplements of water, sugar water or formula.
Proper positioning and latching on are crucial
SIDS
Contributing factors: age (2-4 months) , winter, low birth weight (LBW)
Manage: supine for sleeping (back to sleep)
Newborn Hypoglycemia
Risk for hypoglycemia
May be preterm but large for gestational age
Manage: frequent heel sticks for blood glucose levels, IV glucose
Neonatal substance abuse
Fetal alcohol syndrome and neonatal substance withdrawal
Manage: supportive: gentle rocking, decrease sensory stimuli, small, frequent
feedings. Monitor I and O; benzodiazepines for seizures
S/S of Chlamydia Trachomatis
Up to 75 % are asymptomatic or vague
Men–white or clear discharge, burning, itching, urinary frequency, dysuria
Women—vague-yellow vaginal discharge, itching, dysuria, pelvic pain, low-grade fever, vaginal bleeding
S/S of Gonorrhea
Many are asymptomatic
Urethritis
Purulent discharge
If anal: pain with defecation
If pharyngeal, throat is sore
S/S of Syphilis
*Primary Stage: Firm and hard at first but within 3-7 days it becomes a painless, weeping lesion
Found on genitalia, lips, mouth, on the anus, in the rectum, on the nipples and on the hands and fingers
Chancre disappears without treatment in 6 weeks but the spirochete spreads systemically
Chancres are highly infectious
*Secondary Stage: Systemic symptoms-
Malaise, lymphedema, fever , headaches and pains, sore throat, nausea and general flu- like symptoms
Defining characteristic of secondary stage:
Non-tender rash and skin lesions
Can take several forms, often begins with papules and pustules
Rash crosses the palmar and pedal surfaces, which is unique to syphilis.
Condylomata lata - characteristic gray white genital lesions on the labia, perineum and anus
Lesions are highly contagious
Rash subsides spontaneously in 2 - 6 weeks but may reoccur
*Latent Stage: No symptoms
Disease is not transmitted by sexual contact during this phase
Transmission can occur via blood and from mother to fetus
Can last up to 20 years
*Tertiary Stage: Terminal at this stage if not treated but systemic damage is not reversible even if treated
Develops in 4-20 years
Significant morbidity and mortality rates due to damage on internal organ systems
“Gummatous lesions” develop
Benign lesions of the skin and mucous membranes which are contagious. Can occur on any part of body
Symptoms:
Cardiovascular changes-aneurysms, aortitis, heart failure
Neurological changes-
Central nervous system problems- called neurosyphilis include mental illness, ataxic gate, paralysis, senility and loss of judgment
Not infectious in this stage
HIV transmission
Sexual: intimate sexual contact
Parenteral: sharing needles with drug use
Perinatal: Passes from mother to fetus during:
Pregnancy and/or delivery
Breast feeding
Transfusion of blood products
HPV/ Genital Warts Management
*Medical Management:
No vaccine or antibiotic but immunization now available
Characterized by exacerbations and remissions
Cytotoxic agents: topical cream agents that treat the virus
treatment can take as long as eight weeks
*Surgery:
Carbon Dioxide Laser Surgery
Crytotherapy with liquid
nitrogen
Electrocautery
Surgical excision
*Nursing Care:
All partners should be treated concurrently to avoid reoccurrence
Abstain from sexual intercourse while lesions are present
Condoms should be used at all times because virus can shed even without lesions
Cause of ED (Erectile Dysfunction)
Diabetes (35-50% of men with diabetes have ED)
Hypertension
Vascular disease-Insufficient blood flow to the penis
Atherosclerosis (hardening of the arteries from plaque)-50-60% of ED cases in men 60 and older
Damaged nerves to the penis
Hormonal disorder
Certain drugs
Psychologic issues
Risk Factors of ED (erectile dysfunction)
Obesity and overweight
High cholesterol
Kidney disease
Smoking
Alcohol
Use of recreational drugs
Exercise
Stress
Depression
ED (erectile dysfunction) Myths
ED is an unavoidable consequence of aging.
Tight underwear causes ED.
Medical Specialist that manage this disorder with men?
Urologist
Self-testicular exam
Should begin at adolescence
Done monthly after a warm shower or bath, in front of a mirror
Examine each testicle, one at a time, using both hands
Scrotum palpated for nodules, masses or inflammation
Normal for one testes to be larger than the other
Epididymis is located on back of testicle
Inspect and palpate penis along both spermatic cords for nodules, masses, inflammation, and discharge
If uncircumcised, retract foreskin for visualization of glans penis
Causes for epididymitis?
Men younger than 35: most likely due to STI such as chlamydia and gonorrhea.
Men older than 35: most likely caused by infection with urinary tract pathogens
E coli and pseudomonas
Symptoms: unilateral pain and swelling, develops over 24-48 hours. Erythema and edema of the scrotum
Treatment: Antibiotics, rest, scrotal support, analgesics
How to teach someone with BPH to empty bladder?
Void often and assist bladder emptying by leaning forward on the toilet “bearing down” (valsalva maneuver) or pressing down on the bladder while on the toilet.
Drink frequent small volumes of oral fluids so the bladder doesnt become extremely full at one time
Limit alcohol and caffine, which increases urgency to urinate.
Limit cough, cold, allergy medications that contain decongestants which can interfere with urination.
Note any s/s of acute urinary obstuction and urinary infection indecate the need for medical attention.
