OB--EXAM 1 Flashcards
♣ The core concept of women and family center care are:
- Dignity
- Respect
- Information sharing
- Participation
- Collaboration
♣ Nurses need to remember that _____ _____ is a key part in effective communication
active listening
• your way is the best way
ethnocentrism
When a person learns about the client’s preferences and their beliefs, a plan of care needs to be made by both the nurse or the family and the nurse and they need to work out certain things that the family is adamant about
Cultural relativism
♣ is a skill.
It involves respecting the differences others may have regarding religion, ethnicity, and ethno culture.
encourages uniqueness and values every culture
cultural competence
o care for the elderly or the infirm
medicare
aid for the poverty or situational crisis
medicaid
The priority in a home visit is to
obtain information that helps to create a comprehensive client profile
home visit usually lasts
1 hour
the 2 most important components of home care.
Safety and infection control
♣ The nurse should regard their personal safety as
priority number one.
what approach in well woman care
holistic
o Includes health needs throughout lifetime
well woman care
o OBGYN for needs as women age
physical exams
age-appropriate screenings
health promotion
o Usually enter for care 1st for
pap test or use of contraceptives.
spacing btwn pregnancies
18-23 months
o Usually one of the main reasons that a woman would seek treatment
menstrual problems
o This is seeking care prior to a pregnancy
preconception counseling and care
• If the mom is drinking during pregnancy,____ may occur.
Fetal Alcohol Syndrome
if mom smokes
low birth weight babies
babies addicted to nicotine
caffeine restriction should be
200 ml per day
fetal organ development occurs how many days after fertilization
17-56
o It is recommended that prenatal care be obtained within
12 weeks.
goals of prenatal counseling
o determining health status of mother and fetus
o Calculate the gestational age
Monitor fetal development
o Once infertility has been diagnosed
refer mom to specialist
o The transitional period to menopause
perimenopause
why do women seek treatment for perimenopause
hot flashes
why do women get hot flashes?
decrease in estrogen
♣ Babies of teens can be at risk because
teenage moms are not as prepared to take care of the baby.
♣ Women past the age of 35: can be more susceptible to
developing diabetes and having babies with Down syndrome.
black women
sickle cell anemia
women btwn ____ can be more susceptible to alcohol issues
21-34
how much folic acid
0.4 mg
food with folic acid
green leafy veggies
whole grains
fruits
when to start folic acid
8 weeks into PG
which method gives you 100% protection against STDs
none
o Directly linked to STDs
♣ Infertility ♣ Ectopic pregnancy ♣ Neonatal death ♣ Genital cancers ♣ AIDS
o These conditions may develop during pregnancy and can cause harm to the woman and unborn baby.
♣ Diabetes
♣ Hypertensive disorders
♣ Seizure disorders
o can cause miscarriage, preterm labor, or problems with fetus.
♣ Can cause infertility
Pelvic inflammatory disesase & endometriosis
o Other conditions could cause miscarriage, preterm labor or problems with the fetus
♣ Incompetent cervix
♣ Bleeding disorders
♣ Uterine fibroids
♣ Abnormalities of the uterus.
♣ Toxoplasmosis can occur when
eating raw or rare meat
handles feces of the cat
♣ Normally the target of the violence is the ______ so bleeding is a health risk.
abdomen
o The problem is greater than statistics show because it is often
unrecorded.
how to ask women you think has been abused why they came in?
o “what brings you here today”?
• Pelvic examination during pregnancy
o Pap test at first prenatal visit
o A pap smear will not be done if the hysterectomy was done _______.
for a benign disease.
mammograms when?
annually after 40
o After age 50 they start screening for
bone density.
o Microscopic test for cancer cells
Papanicolaou (Pap) test
Papanicolaou (Pap) test obtains cell from
cervis
endocervix
mucous membranes
what to instruct women before Papanicolaou (Pap) test
don’t douche
use vag medications
or has sex 24-48 hours prior to exam
o The cycle of violence – 3 phases
- Tension building
- Battery
- Honeymoon period where the man would be very loving, and kind.
- (Today we no longer use this model because it is not thought to be accurate as to exactly what is happening).
♣ Women who survive these beatings often meet the criteria for _____
PTSD
Most homicide occurs once the woman
actually leaves the home.
♣ This is often a time when abuse starts due to the stress
pregnancy
♣ Maternal complications that come from abuse
- Depression
- Suicide
- Infections
- May turn to substances
- Secondary symptoms such as fatigue
ABCDES
alone belief confidentiality document education safety
a broad term that describes many forms of sexual abuse.
sexual violence
the intentional, unwanted, completed or attempted, touching the genitalia of another person.
sexual assault
a legal term, this is used for forced sexual intercourse, or penetration of the mouth, anus or vagina or even a body part, anything that gets penetrated without the woman’s permission.
rape
___% of college women said they were raped at some point in their college career.
25
o this consists of non-coitus sexual activity between a child and an adolescent or an adult.
molestations
o involves the penetration involved in rape to a person 18 or over to a person under the age of consent. The age of consent varies from state to state.
statutory rape
o Why do men rape?
risk factors?
- Raped or molested as a child
- Abused some other way when they were a child
- Been raised to see women as sexual objects
- May have been raised to see women in a hostile way
- May think that the way a woman is dressed is asking to be raped
♣ Three phases of rape trauma victims
acute phase
outward adjustment phase
long-term process: reorganization
when the rape occurs, this phase starts. It can last for several days – up to three weeks. The woman will be in shock, denial, she will be in a state of disbelief. She might feel embarrassed, degraded, angry, fearful and vengeful. She might want to douche or shower to wash away the evidence.
acute phase
• Will look like she has recovered from the event. Might go back to work, continue normal routines. She will probably either buy a weapon, self-defense classes, install an alarm system. She also may not stop talking about the rape at this point, or she may not talk about it at all at this point. She may make radical changes, quit her job, move out of her house, may never want to step out of the house or be alone. She can develop sexual problems where she sees sex as something she does not want.
outward adjustment phase
• When she becomes depressed and anxious. She will discuss the rape one on one with someone at this point; she loses that denial and fear of being alone or in a crowd. She may develop nightmares and eating disorders. Recovery from a rape can take years and it is a very painful process. She no longer blames herself in this phase. These phases can also fluctuate back and forth.
reorganization
- Absence of menstrual flow
* Often a result of pregnancy
amenorrhea
two categories of amenorrhea
primary & secondary
♣ Absence of menses by age 14 with absence of growth and development of secondary sexual characteristics
primary amenorrhea
♣ Absence of menses by age 16 but normal development of secondary sexual characteristics
primary amenorrhea
98% of girls menstruate by age ?
16
causes of primary amenorrhea
• Extreme weight gain or loss • Congenital abnormalities of reproductive system • Stress • Excessive exercise • Hypothyroidism PCOS type 1 DM eating disorders
♣ Absence of menses for 3-6 months in women who have previously menstruated regularly
secondary amenorrhea
causes of secondary amenorrhea
- Pregnancy – most common cause
- Breast feeding
- Emotional stress
- Depression
- Pituitary and endocrine d/o
- Early menopause
management for secondary amenorrhea
- Oral contraceptives
- Nutrition counseling
- Thyroid hormone replacement
- Other tx for underlying d/o
- painful menstruation
- Pain during or shortly before menstruation
- Cyclic perimenopausal pain
- Most common gynecologic problem in women of all ages
- Uterine contractions during all menstrual cycles; more intense/frequent.
dysmenorrhea
Abnormally increased uterine activity – cramps more frequent and intense
Not caused by underlying pathology
primary dysmenorrhea
♣ Increased _____ production by endometrium in ovulatory cycle in primary dysmenorrhea
prostaglandin
prostaglandin levels are highest when in primary dysmenorrhea?
1st 2 days of menses
♣ Usually appears within 6-12 months after menarche when ovulation is established
primary dysmenorrhea
meds to treat primary dysmenorrhea
NSAIDs
ibuprofen
naproxen
why do these meds work at treating primary dysmenorrhea?
it decreases the prostaglandin production
♣ Acquired menstrual pain
Painful menstruation
secondary dysmenorrhea
secondary dysmenorrhea is due to?
♣ due to pelvic or uterine pathology
when does secondary dysmenorrhea develop?
later than primary– after age 25
♣ Average age or a girl starting menstruation
11-13 years.
♣ – the most common cause of secondary amenorrhea, fibroids, pelvic infection (PID), use of an IUD
pain beyond menstruation
endometriosis
managing dysmenorrhea
- exercise
- limit salts to prevent fluid retention
- increase water for diuretic
- increase fiber
- warm showers or heating pads
- take warm showers
- keep legs elevated
- relaxation
- smoking cessation
- used prostaglandin inhibitors
• Cyclic symptoms occurring in luteal phase of menstrual cycle; usually resolve once menses started
PMS
symptoms of PMS
- Abdominal bloating
- Pelvic fullness
- Breast tenderness
- Weight gain
♣ Emotional or behavioral changes
- Depression
- Crying spells
- Irritability
- Premenstrual cravings
- Headache
- Fatigue
- Backache
♣ More severe variation of PMS
o PMDD: (pre-menstrual dysphoric disorder)
sx of PMDD
- Mood changes/disturbances (more severe w/ PMDD)
- Anxiety and fatigue
- Appetite changes
- General sense of feeling overwhelmed
- These often occur during the luteal phase and have more of an emphasis on mood disturbances.
PMDD affects what % of women
3-8
♣ Will affect her ability to function
• Work related issues
• Interpersonal issues
PMDD
• Presence and growth of endometrial tissue outside of the uterus cavity: o Ovaries o Fallopian tubes o Outer surface of uterus o Bowels o Areas between vagina and rectum
endometriosis
sx of emdometriosis
o Dysmenorrhea o Pelvic pain o Dyspareunia (painful intercourse) o Abnormal menstrual bleeding o May have problems with infertility
o tx of endometriosis with Women with mild pain wishing a future pregnancy
NSAIDs
o tx of endometriosis with Women with moderate to severe pain
♣ Treated with continual use of the birth control pill. (shrink endometrial tissue)
tx of endometriosis Women who do not wish to become pregnancy with severe pain
hysterectomy
o Intermenstural bleeding
or bleeding after menopause
metrorrhagia
causes of metorrhagia
BC pill IUD trauma polyps infection ovarian cysts
o Excessive menstrual bleeding in either the duration or amount
menorrhagia (hypermenorrhea)
causes of menorrhagia
infection IUD fibroids polyps CA
treatment of menorrhagia
BC pill
fibroids surgically removed
menopause age?
late 40s-50s
median age for menopause
51-52
• The absence of your menstrual period for one year
menopause
- A period that encompasses transition from normal cycles to cessation of menses
- Marked by irregular menstrual cycles
perimenopause
sx of perimenopause
hot flashes
night sweats
sleep disturbances
tx of perimenopause
8 hrs of sleep balanced diet exercise no caffeine, smoking, or alcohol use of herbals acupuncture biofeedback hypnosis hormone therapy
• Marked by irregular menstrual cycles
osteoporosis
♣ Drop in _____ causes an imbalance between bone formation and resorption and causes a decrease in calcium absorption.
estrogen
who’s at risk for osteoporosis
post menopausal white women
most common areas of the body affected by osteoporosis
vertebrae & hip
sx of osteoporosis
back pain
height loss
stooped posture
tx of osteoporosis
increase calcium in diet
weight bearing exercises
estrogen receptor modulator
menopausal hormonal therapy
ERT & HRT
HRT
Hormonal replacement therapy
Which hormones for HRT
♣ both estrogen and progestins
if pt still has the uterus
5 year treatment with estrogen and progesterone
NO uterus
only estrogen
o The intentional prevention of pregnancy during sexual intercourse.
contraception
o The device and/or practice to decrease the risk of conceiving, or bearing offspring.
birth control
o The conscious decision on when to conceive, or to avoid pregnancy, throughout the reproductive years.
family planning
BRAIDED informed consent
benefits risks alternatives inquiries and questions decisions may change mind explanations documentation
o Look at the advantages and success rate
benefits
o Information about disadvantages and failure rates
risks
o Information about other methods
alternatives
o Answer any questions she may have
inquiries and questions
o The opportunity to work with the woman so she can make the best decision
decisions may change mind
o Information about the particular method and how it’s used
explanation
o The information given to the client as well as her understanding on how to use
documentation
• “pull out method”
coitus interruptus
o Combo of charting s/sx of menstrual cycle with abstinence or contraceptive methods during fertile period.
fertility awareness based methods
o Periodic abstinence
natural family planning
how to tell when you’re ovulating
lutenizing hormone surge in urine 12-24 hours after
♣ Based on monitoring and recording cervical secretions
♣ Woman needs to assess whether or not she noticed cervical secretions today or yesterday and then avoid sexual intercourse or use backup method of BC
♣ If no secretions – the probability of pregnancy is low
two day method
♣ Known as the “Billings Method”
♣ Relies on a woman being able to look at cervical mucus
♣ She needs to check and watch for stretch mucus which indicates her period of maximum fertility because the sperm can stay in this mucus until ovulation
♣ Avoid intercourse for 4 days after estrogen dominant mucus is apparent.
ovulation method
♣ A woman will take temp every morning before she gets up – nothing to eat or drink before
♣ She needs to use a basal thermometer which is more accurate
body temperature method
temp before ovulation
96-98 F
• popular also as a protective measure against spread of STDs
spermicides and barrier methods
o Chemical barriers may reduce the risk of some STDs but are not effective against
chlamydia, gonorrhea or HIV
♣ A physical barrier that has a chemical action on the sperm
♣ Effectiveness in preventing pregnancy depends on its consistent and accurate use
spermicide
when should spermicide be inserted?
no sooner than 1 hour before
♣ Mostly latex and they do provide protection against STDs
Should be used with water based or silicone lubricants
condoms
With the increase of latex allergies, condoms are not being made out of _______ – thinner and stronger than latex – research has been done
polyurethane
- Inserted up to 8 hours before sex – expensive
* This is if the male does not want to use a condom
female condom
what to educate your patient about female condoms
don’t use it with a male condom because it could rip
♣ Covers the cervix preventing sperm from entering
diaphragm
what do you use with diaphragm
spermicidal jelly or cream
when do you need to get the diaphragm refitted?
after pregnancy or a 15lb weight fluctuation
when should diaphragm be inserted and removed?
up to 6 hours prior to intercourse and left in place for 6 hours after
♣ Additional _____ should be used with each active intercourse when using the diaphragm
spermicide
♣ Usually a good choice for women who are lactating and women who cannot or chose not to take the birth control pill and also for older women who smoke
diaphragm
how to reduce the risk of toxic shock syndrome with use of the diaphragm?
remove it 6-8 hours after sex
don’t use it during menses
make them aware of s/sx of TTS
♣ Similar to the diaphragm in effectiveness and insertion
♣ Fit snugly over the cervix
♣ Held in place by suction
cervical cap
do you need to add additional spermicide with the cervical cap?
NOOOO
♣ This may be left in place for up to 48 hours but then should be removed after intercourse
cervical cap
♣ Must be moistened before inserting
♣ These will provide protection for up to 24 hours and numerous instances of intercourse
♣ Also be left in place for at least 6 hours after intercourse
contraceptive sponge
♣ Available in over 30 different hormonal variations
suppresses ovulation
combined estrogen-progestin (the pill)
who can use the pill
non-smoking women until menopause
advantages of the pill
♣ Very effective
♣ Not associated with the act of intercourse
♣ Its controlled by the woman
♣ Very easy and convenient to take the pill
♣ Usually you will see a rapid return to fertility once the pill has been discontinued
♣ A safe form of birth control for older non-smoking women
o Non-contraceptive benefits:
♣ Improvement in a woman’s menstrual characteristics
♣ Offered protection against endometrial cancer
♣ Protection against ovarian cancer
♣ Reduces the incidence of benign breast disease
♣ Improve acne in women
♣ Lowers the rates of ovarian cysts
♣ Helps treat endometriosis
♣ Decrease the risk of ectopic pregnancies
o Disadvantages of the pill
♣ Must remember to take it everyday
♣ Cannot be taken while women are breast feeding because it will interfere with milk production
♣ No protection against STDs
side effects of the pill
nausea headache fluid retentition weight gain breast tenderness
why can’t smoking women take BC pill
blood clots
emergency contraception must be used when?
42 hours to 3 days after unprotected sex
3 emergency contraceptions
high doses of oral progestins
high doses of COCs(combined
oral contraception) or estrogen
insertion of copper IUD
example of oral progestins
plan b one step
plan b two step
over the counter for ages 15 and older
plan b one step
over the counter for 17 & older
need prescription for younger than 17
plan b two step
when to insert the copper IUD
within 5 days after. 99% effective
