Reproductive Flashcards
Chlamydia and Gonorrhoea
Sexually transmitted bacterial infections that left untreated can result in pelvic inflammatory disease as well as infertility and preterm labor complications
These infections are asymptomatic and people often don’t know they are infected and infected other people
Chlamydia and Gonorrhoea Symptoms
When Symptoms are present they can include dysuria which is painful urination as well as discharge from the vagina or penis and possibly the patient could have symptoms of pelvic inflammatory disease
Chlamydia and Gonorrhoea Diagnosis
Urine Test
Swabbing the female cervix or male urethra
Chlamydia and Gonorrhoea Treatment
Antibiotics - Doxycycline for chlamydia
Cephalosporins for gonorrhoea
Chlamydia and Gonorrhoea Nursing interventions
Disease reporting requirements for reportable infections
Chlamydia and Gonorrhoea Patient teaching
Abstinence during treatment
Partner notification and treatment
Safe sex practices
Re-screening. months after treatment
Pelvic Inflammatory Disease
Key complication that can result from a chlamydia or gonorrhoea infection
With PID sexually transmitted bacteria spreads from the vagina to the uterus, Fallopian tubes or ovaries this can lead to infertility as well as sepsis and death
Pelvic Inflammatory Disease Symptoms
Often asymptomatic but when symptoms are present they can include
lower abdominal pain
pelvic pain
mensural irregularities
painful urination
possibly a fever
Pelvic Inflammatory Disease Treatment
Antibiotics as well as analgesics for pain
Heating pad for comfort measures
*Patient teaching
Syphilis
Bacterial infection that left untreated can result in systemic complications as well as death
Stages of Syphilis
Primary stage: appearance of a Genital shanker, this is an ulcer that is typically non-tender
Secondary Stage: Flu-like symptoms, fever, soar throat, rash on hands/feet
Latent stage: Visible signs and symptoms of the infection
Tertiary (Late) Stage: Severe neurological and cardiovascular damage, including vision loss, hearing loss as well as damage to the heart and blood vessels
Syphilis Diagnosis
Blood test
Swab off the ulcer
Syphilis treatment
The administration of antibiotics such as doxycycline
Syphilis Nursing interventions
Nationally notifiable disease as the nurse you need to preform disease reporting requirements and provide patient education
Human Papilomavirus (HPV)
Certain strains of HPV can cause genital warts and others can lead to cancer
Primary risk factor for cervical cancer
Preventable with vaccination, vaccines should be administered prior to first sexual (First dose usually administered Age 11-12 second given 6 months after)
Human Papilomavirus (HPV) Symptoms
Usually Asymptomatic
If genital warts are caused, you may see, white or flesh coloured growths in the anogenital region or oral cavity
Human Papilomavirus (HPV) Diagnosis
Diagnosed using a Pap test, patients who are positive for HPV a colposcopy and cervical biopsy can be used to assess for cancerous or pre-cancerous cells in the cervix
Human Papilomavirus (HPV) Treatment
NO CURE
Wort removal can be done using prescription creams
patient teaching: More frequent Pap tests, yearly
Endometriosis
Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant. Endometriosis can start at a person’s first menstrual period and last until menopause
Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis.
Endometriosis Symptoms
pelvic pain, often associated with menstrual periods.
Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that’s far worse than usual.
Pain also may increase over time.
Painful periods
Pain with intercourse
Pain with bowel movements or urination
excessive bleeding
Infertility
Endometriosis Risk factors
Starting period at early age
Menopause at an older age
one or Moree relatives with endometriosis
Endometriosis Complications
Main causes is impaired fertility
Cancer : Ovarian Cancer
Endometriosis Diagnosis
Pelvic Exam
Ultrasound
MRI
Laparoscopy
Endometriosis Treatment
medication or surgery
Hormone therapy
Hormonal contraceptives
Fertility treatment
Uterine Prolapse
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken until they no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina
Uterine prolapse most often affects people after menopause who’ve had one or more vaginal deliveries.
Uterine Prolapse Symptoms
Mild uterine prolapse is common after childbirth. It generally doesn’t cause symptoms.
Symptoms of moderate to severe uterine prolapse include:
Seeing or feeling tissue bulge out of the vagina
Feeling like the bladder doesn’t empty all the way when you use the bathroom
incontinence
Feeling as if you’re sitting on a small ball
Uterine Prolapse Causes
Vaginal delivery
Age at first delivery (older women are at higher risk of pelvic floor injuries compared with younger women)
Difficult labor and delivery or trauma during childbirth
Delivery of a large baby
Being overweight
Lower estrogen level after menopause
Uterine Prolapse Treatment
Surgery
Sexual Assault
Crime of violence where sexual contact happens with out consent
Number of labs we want to collect
blood
hair samples
Genital Swabs
anal Cultures
Scrapping of material from underneath the victims fingernails
STI screening
Pregnancy testing
We can give
Emergency contraceptives
Post exposure HIV prophylaxis as well as STI prophylaxis
Always get informed consent prior to collected forensic evidence, assess for signs of PTSD, rape trauma syndrome, referrals to mental health specialist
Benign Prostate Hyperplasia
Enlargement of the prostate gland very common disorder in older men and associated with a change in hormone levels
Benign Prostate Hyperplasia Symptoms
Can block outflow of urine and can cause urinary symptoms such as:
Urinary frequency
urinary Incontinence
Urinary urgency
Urinary retention
Post void dribbling
Hematuria
Frequent UTIs
BPH Diagnosis
Digital Rectal Exam, inserts finger into rectum to palpate the prostate to check for enlargement
Prostate specific antigen level will be drawn (expected levels under 4) Over 4 may mean BPH however may also be elevated in the presence of prostate cancer
WBCs may be elevated
Creatinine and BUN may also be elevated
BPH Treatment
Three medications that may be used in the treatment of BPH include
fInasteride: helps decrease size of prostate gland
Tamsulosin: relaxes muscles of prostate gland to help with urine flow
Tadalafil: Erectile dysfunction medication
If medications are unsuccessful then surgery is an option
Purpose of the Mensural Cycle
to release an egg for potential fertilization (from the ovary) so it can implant into the endometrium…hence help develop a baby. If this doesn’t happen, the 28 day cycle starts all over (note cycle days vary among women).
Menstrual Cycle
2 cycles in one working together
Ovarian cycle: hormonal changes trigger the ovaries to release an egg (ovulation)
Uterine cycle: uterus thickens to prepare to house a fertilized egg. If the egg is not fertilized within 14 days the uterus beings to shed causing bleeding
How long is an average cycle
28 days
Follicular Phase
before ovulation
6-14
Hypothalamus releases
GnRH (Gonadotropin releasing hormone)
which releases…
FSH (follicle stimulating hormone)
LH (Luteinizing Hormone)
All these hormones cause ovulation with help of increase estrogen
Luteal phase
After ovulation
Day 15-28
egg goes down into uterus with hopes of being fertilized
Body releases estrogen and progesterone
Ovulation
occurs day 14-28
Two structures that play a vital role in the woman’s reproductive cycle:
Ovary & Uterus (they work together)
Each structure has three cycles (and these cycles correspond with each other)
Sperm life
sperm live approximately 5 days and the egg lives for 24 hours (so fertile cycle days would be days 9 -16).
Role of Progesterone Female Reproductive
stimulates estrogen production
allows the endometrium to receive the fertilized ovum for implantation
stops production of LH and FSH (so possible pregnancy can be maintained) and estrogen inhibits the hypothalamus from releasing GnRH (hence new reproductive cycle….if the ovum is fertilize you want to prevent another menstrual cycle from occuring so pregnancy can occur).
This will help prevent the hypothalamus from releasing GnRH which will prevent LH and FSH from being secreted in case fertilization has occurred.
The end of the third stage of labor is marked by what event?
delivery of the placenta
A client is admitted to the facility with a suspected ectopic pregnancy. When reviewing the client’s health history for risk factors for this abnormal condition, what would the nurse most expect to find?
a history of pelvic inflammatory disease
A client and her partner, both 25 years old, are having trouble conceiving. Infertility in this couple is defined as:
The determination of infertility is based on age. In a couple younger than 30 years old, infertility is defined as failure to conceive after 1 year of unprotected intercourse. In a couple age 30 or older, the time period is reduced to 6 months of unprotected intercourse.
A nurse is assessing a pregnant client who states that she smokes one pack of cigarettes each day. What should the nurse teach the client about smoking and pregnancy?
Smoking can cause a small size baby.
postpartum hemorrhage
Blood loss from the uterus that exceeds 500 ml in a 24-hour period is considered postpartum hemorrhage.
A full bladder can prevent the uterus from contracting completely, increasing the risk of hemorrhage
A primigravid client at 35 weeks gestation is scheduled for a biophysical profile. After instructing the client about the test, which client statement indicates effective teaching about what the test measures?
amniotic fluid volume
The nurse who is assessing the position, presentation, and lie of the fetus of a 9-month-pregnant client performs what action?
Leopold’s maneuvers
A nurse and a licensed practical nurse (LPN) are working in the labor and birth unit. Of the activities that must be done immediately, which should the nurse assign to the LPN?
Perform a straight catheterization for protein analysis.
A primigravid client is admitted as an outpatient for an external cephalic version. Which factor would be a contraindication for the procedure?
multiple gestation
When caring for a client who is a primigravida, how long should the nurse expect the second stage of labor to last?
1 hour
Which client would benefit most from information explaining the importance of receiving an annual Papanicolaou (PAP) test?
A client infected with the human papillomavirus (HPV)
A client is being admitted to the labor and childbirth unit. Her GTPAL classification is 5-2-1-1-2. When providing shift report, which information would the nurse include? Select all that apply.
The client has had four previous pregnancies.
The client has had two full-term children, one premature child, and one abortion.
The client has two living children and is pregnant again.
Detailed information about a client’s obstetric history is described using the GTPAL classification system. G represents gravida, or the number of times the client has been pregnant, including the current pregnancy. T is the number of full-term infants born (after 37 weeks); P is the number of preterm infants born (at least 20 weeks but less than 37 weeks); A is the number of induced or spontaneous abortions; and L is the number of living children. Therefore, this client has had 4 previous pregnancies, has given birth to 2 full-term infants and 1 preterm infant, and has experienced 1 abortion. She has 2 living children.
A client at 24 weeks’ gestation comes to the clinic for a prenatal check-up and reports that she has been “seeing double.” The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem?
preeclampsia
A nurse is caring for a multiparous client in the fourth stage of labor. Assessment reveals a boggy uterus. Which nursing intervention has the highest priority?
massaging the uterus
The client is one day postpartum with an episiotomy. Teaching includes medications commonly used for the local relief of perineal pain due to episiotomy and/or laceration. Which medications does the nurse include in the client’s teaching concerning pain? Select all that apply.
benzocaine
witch hazel
The nurse is caring for a client at 36 weeks’ gestation with a temperature of 101.2°F (38.4°C). Examination indicates that the client is leaking amniotic fluid. What is the nurse’s priority concern based on these findings?
intrauterine infection
A client in labor is given 25 mg of intravenous (IV) meperidine for labor pain. The nurse should monitor the client for which adverse effects of the drug? Select all that apply.
nausea and vomiting
respiratory depression
tachycardia
A client two days postpartum was given a shot of RhoGAM. At the postpartum home visit, the client asks the nurse why she needed RhoGAM. What is the most appropriate response by the nurse?
“RhoGAM suppresses antibody formation in women with Rh negative blood after giving birth to an Rh positive baby.”
A laboring client is experiencing increased pain and asks the nurse when she can have an epidural. Which would be a priority intervention by the nurse to establish whether the client can have an epidural?
Assess cervical dilation.
A primigravid client at 38 weeks’ gestation comes to the labor room because “my water broke.” The health care provider (HCP) asks the nurse to verify spontaneous rupture of membranes using nitrazine paper. The nurse observes that the nitrazine paper turns bright blue. What action should the nurse take next?
Notify the HCP that the membranes are ruptured.
The nurse is caring for a client on her second postpartum day. The nurse should expect the client’s lochia to be
red and moderate.
When instructing a client about the proper use of condoms for pregnancy prevention, the nurse should include which instructions to ensure maximum effectiveness?
Place the condom over the erect penis before sex.
As a nurse begins the shift on the obstetrical unit, there are several new admissions. When anticipating priorities for the shift, the client with which condition would be a candidate for induction?
preeclampsia
When administering spironolactone to a client who has had a unilateral adrenalectomy, a nurse should instruct the client about which possible adverse effect of the drug?
menstrual irregularities
A multigravid client at 34 weeks’ gestation who is leaking amniotic fluid has just been hospitalized with a diagnosis of preterm premature rupture of membranes and preterm labor. The client’s contractions are 20 minutes apart, lasting 20 to 30 seconds. The client’s cervix is dilated to 2 cm. The nurse reviews prescriptions (see chart). Which prescription should the nurse initiate first?
Initiate fetal and contraction monitoring.
The client in preterm labor is admitted to the hospital. To stop the client’s uterine contractions, the nurse anticipates administering which medication?
terbutaline
A primigravid client at 38 weeks’ gestation comes to the labor room because “my water broke.” The health care provider (HCP) asks the nurse to verify spontaneous rupture of membranes using nitrazine paper. The nurse observes that the nitrazine paper turns bright blue. What action should the nurse take next?
Notify the HCP that the membranes are ruptured.
A 15-year-old primigravid client at approximately 16 weeks’ gestation tells the nurse that they have been experiencing an occasional sharp pain from the fundus to the pubic bone on their left side. The nurse determines that the client is most likely experiencing which complication?
round ligament pain
A client is in the first stage of labor. She asks the nurse what the best physical position is to promote labor progression and efficient uterine contractions. What response by the nurse is most appropriate?
“The best option at this stage is to ambulate.”
The nurse is caring for a client who is attempting a trial of labor (attempt a vaginal birth after cesarean). Contractions are 1.5 minutes apart with a duration 75 to 90 seconds. The client reports a “sharp, tearing” pain, and the electronic fetal monitor (EFM) is no longer recording contractions. What is the priority nursing action?
Prepare the client for an emergency cesarean birth.
At what gestational age should a primigravida expect to start feeling quickening?
18 to 20 weeks
The nurse is assessing a 39-year-old client during her 32-week prenatal checkup. The client has attended regular prenatal checkups throughout the pregnancy. Which assessment data is a priority for the nurse to complete?
Blood pressure
A client who is 14 weeks’ pregnant mentions that she has been having difficulty moving her bowels since she became pregnant. Which hormone is responsible for this common discomfort during pregnancy?
progesterone
The nurse is caring for a client who is attempting a trial of labor (attempt a vaginal birth after cesarean). Contractions are 1.5 minutes apart with a duration 75 to 90 seconds. The client reports a “sharp, tearing” pain, and the electronic fetal monitor (EFM) is no longer recording contractions. What is the priority nursing action?
Prepare the client for an emergency cesarean birth.
During a health-teaching session, a pregnant client asks the nurse how soon the fertilized ovum becomes implanted in the endometrium. Which answer should the nurse supply?
7 days after fertilization
During preparation for a parenting class, one of the participants asks the nurse, “How will I know if I am really in labor?” What should the nurse tell the participant about true labor contractions?
“True labor contractions are felt first in the lower back, then the abdomen.”
A pregnant client at 16 weeks’ gestation is scheduled by the nurse for prenatal testing. Which test would the nurse schedule as the appropriate first screening test for congenital anomalies?
marker screening tests
An adolescent client with polycystic ovarian syndrome (PCOS) has been placed on metformin. The nurse determines the client needs more teaching about metformin if they state the medication helps achieve which outcome?
increased insulin levels
A nulliparous client says that they and their spouse plan to use a diaphragm with spermicide to prevent conception. Which should the nurse include as the action of spermicides when teaching the client?
destruction of spermatozoa before they enter the cervix
A 16-year-old primigravida client at 36 weeks’ gestation who has had no prenatal care experienced a seizure at work and is being transported to the hospital by ambulance. What action should the nurse take upon the client’s arrival?
Admit the client to a quiet, darkened room.
A 15-year-old primigravid client at approximately 16 weeks’ gestation tells the nurse that they have been experiencing an occasional sharp pain from the fundus to the pubic bone on their left side. The nurse determines that the client is most likely experiencing which complication?
round ligament pain
The round ligaments, two fibrous muscular cords passing from the body of the uterus near the attachments of the fallopian tubes through the broad ligaments into the inguinal canal and inserting into the fascia of the vulva, act as stays to steady the uterus. If a pregnant client moves quickly, they may pull one of these ligaments and feel a quick, sharp pain.
When the nurse is preparing the room for admission of a multigravida client at 36 weeks’ gestation diagnosed with severe preeclampsia, which item is most important for the nurse to obtain?
padding for the side rails
A client with severe preeclampsia may develop eclampsia, which is characterized by seizures. The client needs a darkened, quiet room and side rails with thick padding. This helps decrease the potential for injury should a seizure occur.
The nurse is caring for a client in labor who has tested positive for gonorrhea. Which will the nurse include in the client’s plan of care?
Administer erythromycin eye drops to the infant after birth.
A client has been trying to achieve a pregnancy for 3 years and has just recently sought the assistance of an infertility specialist. Which test(s) may be conducted to analyze the causes of this client’s infertility? Select all that apply.
semen analysis
hysterosalpingogram
basal body temperature graph
hypothalamic pituitary levels
The nurse is managing a pregnant client’s second stage of labor. The nurse should intervene when observing which action?
closed glottis pushing
Closed glottis pushing, or when a client is told to hold their breath when they push (typically while the nurse counts to 10), creates the Valsalva maneuver and is associated with decreased perfusion. Open glottis pushing, on the other hand, encourages the client to listen to their body cues for when to breathe and when to bear down. “Rest and descent” and squatting have positive influences on the second stage of labor and birth.
A nurse is teaching a client how to use a diaphragm. Which statement about using a diaphragm is appropriate?
“Leave the diaphragm in place for at least 6 hours after intercourse.”
A 24-year-old primigravid client in active labor asks to use the jet hydrotherapy tub to aid in pain relief. Which condition would the nurse consider to be a contraindication for hydrotherapy?
ruptured membranes
A client at 39 weeks’ gestation comes to the labor and delivery suite. The client states the membranes ruptured 12 hours ago. What priority assessment will the nurse perform?
Assess fetal heart rate (FHR).
When membranes rupture, the priority focus should be on assessing the FHR first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. If the membranes are ruptured prior to arrival at the hospital, the nurse should ascertain when the membranes ruptured, the amount of the fluid, and the color of the fluid. To confirm that the membranes have ruptured, a sample of fluid is taken from the vagina via a nitrazine (phenaphthazine) swab to determine the fluid’s pH. Vaginal fluid is acidic, whereas amniotic fluid is alkaline. The alkaline fluid will turn the nitrazine strip blue. The mother’s vital signs should be assessed to determine whether an intrauterine infection exists. Cervical dilation and effacement will be assessed to determine the status of labor.
A client at 24 weeks’ gestation comes to the clinic for a prenatal check-up and reports that she has been “seeing double.” The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem?
preeclampsia
The visual disturbance and proteinuria suggest hypertension that has progressed to preeclampsia.
A nurse is caring for a client who is scheduled for amniocentesis. What will the nurse teach the client about this procedure?
She needs to empty her bladder prior to the procedure.
As a nurse begins the shift on the obstetrical unit, there are several new admissions. When anticipating priorities for the shift, the client with which condition would be a candidate for induction?
preeclampsia
The client with preeclampsia would be a candidate for the induction process because ending the pregnancy is the only way to cure preeclampsia.
A primigravid client at 38 weeks’ gestation comes to the labor room because “my water broke.” The health care provider (HCP) asks the nurse to verify spontaneous rupture of membranes using nitrazine paper. The nurse observes that the nitrazine paper turns bright blue. What action should the nurse take next?
Notify the HCP that the membranes are ruptured.
Nitrazine paper responds to alkaline fluids by changing blue; amniotic fluid is alkaline so the color verifies that the membranes are ruptured. The nurse notifies the provider that membranes are ruptured so that a plan of action can be developed. Rupture of membranes in the absence of labor increases the risk of infection. Vaginal examinations are limited until labor is initiated. Wearing a sanitary pad increases potential for infection. Documentation of the Nitrazine test is completed after notifying the provider.
The nurse would question the prescription for a fetal scalp electrode on which client?
client with an HIV infection
The nurse determines that teaching about the warning signs of preterm labor has been successful when the client states that they will call the health care provider if they have which symptom?
abdominal cramps with diarrhea
A nurse is teaching a young adult female client about self-management of systemic lupus erythematosus (SLE). The client is prescribed ibuprofen, hydroxychloroquine, and cyclophosphamide. The client asks the nurse about the possibility of becoming pregnant while being treated for SLE. What is the nurse’s best response?
“You should speak with your healthcare provider about alternatives to taking cyclophosphamide.”
A nurse is monitoring the contractions of a client in the first stage of labor. Order the phases of a uterine contraction from the beginning of contraction to its conclusion. All options must be used.
increment
acme
decrement
relaxation
A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings contradicts the estimated gestational age of the newborn?
increased amounts of vernix
A client in the second stage of labor who planned an unmedicated birth is in severe pain because the fetus is in the right occiput posterior position. The nurse should place the client in which position for pain relief?
hands and knees
In which phase of postpartum psychological adaption would discharge teaching regarding infant care most likely be successful?
taking hold
A newly postpartum client is asking to go to the bathroom 45 minutes after birth. The client had an epidural for labor and birth and has an intravenous (IV) line infusing, and every 15 minutes assessments are in progress. What should the nurse do to provide the safest care for this client?
Assess the client’s ability to stand and bear weight before ambulating to the bathroom.
A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings contradicts the estimated gestational age of the newborn?
increased amounts of vernix
