Sexuality/std Flashcards
Chapter 5 nursing diagnosis
HSBC r/t reproductive functioning Anxiety Pain Body image disturbance r/t 2nd sex Sexual dysfunction Self esteem disturbance Altered sexuality patterns
Nonverbal cues
Over modest
Inappropriate jokes
Any funny effects of medication?
Androgens
Adrenal cortex and gonads
Physical, muscles, sebaceous, body hair
Progesterone
Decreases mucous permeability
Decreases ovum transport
Decreases proliferation
Estrogen
Develops reproductive tract
Stops growth
Fat placement
Suppresses FSH/LH suppressing ovulation
Testes
Descend at 34-38 weeks
Undescended increases cancer risk
GnRH
Released by hypothalamus and influences pituitary
Pituitary
Releases FSH and LH that control ABP
LH
Promotes testosterone release
ABP
Androgen binding protein
Promotes sperm formation
Vulvar blood and nerves
Pudendal V&A
Pudendal, ilioinguinal, genitofemoral nerves
Ovary palpation
Can’t because so low but pain indicates problem in lower quadrants
Nonfunctional ovaries
No breasts
Male like body hair
Estrogen
Prevents osteoporosis
Keeps cholesterol low
Ovary anatomy
Epithelium
Cortex (hormone production)
Medulla
How eggs transport
Mucous
Cilia
Muscular peristalsis
Uterus
Doesn’t mature until 17 (LBW of newborns)
Stays 33% bigger after birth
Isthmus
Enlarges greatly for fetus
Part typically cut for CS
Cervical Os
Relation to is ischial spine determining fetal position
Pap smear
Sample taken between lower cervix and lower cervical canal
Myometrium
Prevents hemorrhaging during menstruation
Keeps Os closed in pregnancy
Contracts equally to expel
Contracts to close vessels postpartum
Uterine nerves
Sensory nerves lower than motor
Epidural stops pain but not contractions
Uterus septums
Present during formation but are supposed to rescind
Vagina
Elastic, strong, vascular
Glycogen rich feeding bacteria that creates lactic acid
Higher pH after menopause
Breast exams
Self Not indicated
Q12months
Breasts
20 lobes and nipple openings
Ampulla provides reservoir
Vascular
Proliferative phase
Immediately after menstruation completes
Rapid cell expansion
1-14
Secretory
Spongy velvet appearance
Glycogen rich
15-22
Ischemic
Pro and Est decrease
Endometrium sloughs off
23-24
Menses
30-80 mL blood
200 mL total
25-end
Cervical changes
During ovulation, mucous becomes thinner
Fern test positive before ovulation
Negative after
Spinnbarkeit test
Estrogen is high so vaginal mucous is stretchy between fingers
Menopause symptoms
Hot flashes, vaginal dryness, osteoporosis, bladder incontinence
HR therapy
Correlation with CVA and cancer
Short term with acute symptoms
Menopause therapies
Low dose estrogen vaginal ring Kegels Calcium nasal spray Calcitonin 1200mg Ca and 400-800U Vit D
Osteoporosis risk factors
Asian Low BMI Genetics Nutrition Cigarettes Age
Preschool identity
Can identify but don’t care
School age identification
Strict M and F separation
Adolescent identity
Strong M or F
Educate
High suicide rate among sexually confused
Spinal cord injuries and sex
Men can achieve both
Woman can typically get pregnant
Homosexual sti risk factors
MwM highest
MwW next
WwW lowest risk
Megan’s Law
Notifying a community of registered sex offenders in the area
Quid pro quo harassment
Sex for personal gain
Hostile work environment
Discomfort or exploited worker
Inhibited sexual desire causes
Medicines Disease Age Depression Menopause
Maternal Unintended pregnancy risk factors
Unmarried
Stalled education
Financially less stable
Child unintended pregnancy risk factors
LBW Abuse Abortion Mortality rate Insufficient resources
Reproductive health tests
Pap
Preg test
Sti screen
CBC
Reproductive health history assessments
PT HX and FX
OB history
Sti history
Sexual history
Reproductive psychological assessment
Knowledge
Desires
Needs
Body image and self esteem
Reproductive ND
HSB Deficient knowledge Spiritual distress Low self esteem Decision all conflict RT pregnancy/choice of contraception Powerlessness/fear/anxiety Ineffective sexuality pattern RF ineffective health maintenance
1st three things for nurse to assess in reproductive health
Nurses own feelings
PT knowledge
Where PT gained knowledge
Contraception assessment
Personal values Clients values HX and future Ability to use correctly Side effects Cost PT relationships
Reproductive education benefits
Fewer unwanted pregnancies
Fewer STI
Fewer abortions
Contraception desired outcomes
Safe 100% effective All aspects are compatible with PT No S/E before, during, or after Easily used and obtained
Rhythm method plan
6 month cycle evaluation
- 18 from shortest cycle
- 11 from longest
BBT method plan
Take temp each morning when waking Temp drops .5 before and rises 1 during ovulation Avoid sex for 3 days 75% effective Meds and exercise affect baseline temp
Mucus method
Mucus thick and sparse until ovulation
Must monitor daily and before sexual activity
Symptomthermal method
Mucus and temp method
3 days after temp
4 days after mucus thinning
Ovulation detection
Detect LH in urine
98%+ accurate
Expensive
Lactation amenorrhea
Natural ovulation suppression while breastfeeding
Use < 3 months
Natural method throughout the lifespan
Committed relationships
Adolescents aren’t as disciplined or regular
Elder women temp and mucus change
Oral contraception
Estrogen/progesterone based
Estrogen suppresses gonadotropins
Progesterone keeps mucus thick and decreases tubal transport
Biphasic coc
Steady estrogen until increasing progestin during last 11 days
Triphasic
Estrogen and progestin vary throughout
Mimics natural cycle
Coc non-contraceptive decreases:
Dysmenorrhea PMS Acne Fe deficiency PID Cancer Osteoporosis and endometriosis
Coc instructions
Start 2 weeks postpartum
Not effective for first week
21 active/ 7 placebo
Take at the same time everyday
Coc side effects
Weight gain Metrorrhagia Depression Hypertension Breast tenderness Nausea
Coc contraindications
Thromboembolic disease CvA or cardiovascular accidents Smoking/over 35 increases clotting risks Cancer Pregnant/Breastfeeding/< 6 weeks postpartum Hypertension Hyperlipidemia Liver problems Diabetes Not regular for at least 2 years Younger adolescent
Coc complications
Angina
SHoB
Acute headache/leg pain
Changes in vision
Mini pills
Progestins thicken mucus
Coc and adolescents
Regular cycle for at least 2 years and done growing
Low compliance
High cost
Discontinuing COC
Pituitary needs 1-8 months to effectively release gonadotropins
Clomiphene restores fertility
Postcoital contraception
Morning after pill
High estrogen inhibits implantation
Causing vomiting
Emergency contraceptive kit
Prevent After sexual assault Urine test and then estrogen/progesterone Up to 5 days after NOT PRIMARY USE
Plan B
Prescription needed under 18
75-85% effective
Started within 72 hrs and repeated in 12
Not common
Subdermal implant benefits
Used during breast feeding
No compliance
3-5 year length
Subdermal disadvantages
Long term
Teratogenic
Injection benefits
Every 12 weeks 99% effective by suppressing ovulation Reduces ectopic, cancer, endo, and sickle cell Breastfeeding Amenorrhea may occur after 12 months
Injection disadvantages
Glucose and Ca malabsorption
Not for adolescents
6-12 month to become fertile again
IUD disadvantages
Doctor needs to implant Dysmenorrhea and heavier flow for first 3-6 months Metrorrhagia TSS risk Spontaneous abortion risk Not for adolescent Can take 6-12 months to become fertile
IUD contraindications
Adolescent/never pregnant
Abnormal uterus
HX of ectopic, dysmenorrhea, menorrhagia, carditis, anemia
Multiple partners
Chemical barrier disadvantages
Leaking
Irritating
20% failure rate
Must prepare
Diaphragm disadvantages
Compliance Left in for 6 hours Healthy/normal uterus needed No adolescent Dislodges Weight loss/gain needs refitting
Diaphragm can cause
TSS
UTI
Allergic reaction
Irritation
Vasectomy disadvantages
Not always reversible
Risk for kidney stones
Body may form antibodies to sperm
Not for adolescents/obese
Tubal ligation disadvantages
Cancer risk increases
Surgical pain/risks
Still have cycle
Symptoms similar to PDD
Elective termination reasons:
Threatens moms life
Fetal defect
Rape/incest
Unwanted
Pre-termination tests
Pregnancy CBC w/ typing Gon/Syph Urinalysis Amnio Pap
Federal termination guidelines
< 12 weeks
State termination rules can include:
Regulate/forbid 2nd 3rd trimester
24 hr waiting
Counseling
Parental approval in adolescents
Mifepristone
Progesterone antagonist preventing implantation Reduces leiomyomas Induces labor Cocaine detox 90-95%
Mifepristone administration procedure
Single dose
Rh- woman receives RhO immune globulin
Misoprostol administered 3 days later causing contractions
Medical termination contraindications
Ectopic IUD Adrenal failure Long term corticosteroids Blood disorder Anticoagulant therapy Allergies
Medical termination advantages
Decreased uterine damage
No anesthesia
Medical termination disadvantages
Return visit for confirmation
NVD
Acute cramping
Menstrual extraction facts
5-7 LMP
Vacuum extraction of uterine lining
Menstrual extraction procedure:
Voids Peri-cleanse Speculum Tenaculum stabilizes cervix Catheter inserted Suction Possible oxytocin Lay supine for 15 min
Dilatation and Curettage procedure
<13 weeks Voids Peri-cleanse Para cervical block Cervix dilated Curette scrapes Oxytocin 1-4 hour stay at hospital
D&C risks
Uterine perforation
Infection
Dilatation and Vacuum extraction procedure
12-16 weeks Dilatation with seaweed or misoprostol Vacuum over 15 min Oxytocin Supine for 15 min
Dilatation and Vacuum risks
Rare uterine perforation
Infection
Prostaglandin/Saline induction procedure
16-24 weeks Misoprostol/laminaria for dilatation Prostaglandin administration Oxytocin for induction Expulsion Oxytocin for hemorrhaging Examination of expelled
Saline induction procedure
Voids
Abdominal anesthesia
Needle into uterus with 100-200mL 20%
12-36 hours until contractions
Hypernatremia symptoms and treatment
Increased pulse
Flushed face
Acute headache
5% dextrose
Hysterotomy when these aren’t working:
Oxytocin
Prostaglandin
Saline
Hysterotomy
> 16 weeks
C-section
< 1% of all abortions
Partial birth is indicated when:
Last trimester
Encephalocele
High meningocele
Other congenital anomalies
Chapter 47 nursing diagnosis
R/F infection Pain RT Disturbed body image RT breast mass Anxiety Fear
Pelvis exam across the lifespan
Not indicated in preadolescent (Use otoscope or ear tip)
Begins when sexually active
18-20 if not sexually active
1st phase of reproductive development
Reproductive differentiation In utero at 8 weeks
2nd period of reproductive development
Maturation and development of sex organs and characteristics
Congenital adrenocortical syndrome
Adrenal gland produces androgen instead of cortisone causing female to look male
Ambiguous genitalia assessment
Karyotyping
Laprascoping abdomen for ovaries
Surgery
Therapeutic considerations for ambiguous genitalia:
Will removal of X affect them later?
Should the surgery be delayed for the child to make or to mature?
Does non working part need to be removed?
Precocious puberty origins:
Tumor
Hypothalamus
Gonads
Precocious puberty signs:
Increased skeletal development
Increased breast development
Menstruation with few other secondary traits
Abnormal growth of male genitals
Precocious puberty treatment:
Leuprolide daily SubQ desensitizes GnRH receptors
D/c at 12-13
Testicular cancer
< 1%
15-35 yr old
Enlargement, heaviness, weight loss, abdominal and back pain
Testicular cancer therapy
Sperm banking if needed
Removal and prosthesis
Chemo or radiation
Mittelschmerz signs
Pain in lower quadrant by ovary
NVD
Scant spotting
Dysmenorrhea signs
Bloating Cramping Pain in LQ Aching in legs, vulva Breast tenderness
Menorrhagia signs
Saturating a tampon an hour or 200mL per flow
Metrorrhagia > 1 cycle can signal:
Cancer or ovarian cyst
Endometriosis causes:
Genetic
Deficient immune response
Excess estrogen
Failed luteal phase
Endometriosis symptoms
Dysmenorrhea
Dyspareunia if culdesac
No/irregular ovulation
Estrogen and endometriosis
Estrogen level stays high and blood gets forced back into Fallopian tubes by tissue
Endometriosis therapies
Coc
Androgen shrinks tissue
GnRH
Laparotomy is last resort
Amenorrhea causes
Extreme dieting
Extreme excercise
Low body fat
Pregnancy
PDD symptoms
Decreased ovary blood supply Vit B deficiency Excess estrogen Water retention Hypoglycemia
Instructions to PT who think they have PDD
Diary of symptoms
Diet high in Vit and Ca
Low salt
Imperforate hymen
Occluded vagina preventing flow
Imperforate hymen symptoms
None until menstruation
Pressure building in vagina/uterus
Abdominal pain
Mass palpable in lower abdomen
Imperforate hymen treatment
Use pictures to describe procedure
Local anesthesia
Incision/removal of hymen
Mild analgesia and warm bath for pain
TSS symptoms
Temp > 102 NVD Hypotension Shock Impaired kidneys/liver/cognition Headache Severe pain
TSS assessments
Pelvic and removal of debris
Culture for S aureus
TSS treatment
Iv fluids Dopamine to elevate BP Removal of debris Penicillanase-resistant antibiotics (Not penicillin) Avoid tampon use
Vulvovaginitis signs
Inflammation Pain Odor Pruritus Discharge Possibly bleeding
Vulvovaginitis in preadolescent
Discharge but no bleeding Vaginal exam Ointment/bath to clean Rule out sexual abuse/precocious puberty/pinworm Culture Staph/EColi
Vulvovaginitis in adolescents
Discharge
Irritation
Odor
PID causes
Chlamydia and Gonorrhea
PID symptoms
Acute abdominal/ovarian/cervical pain
Purulent discharge
Fever
Peritoneal edema
Untreated PID
Scarring Dysmenorrhea Dyspareunia Scarring Metrorrhagia
PID therapies
Analgesia
Broad spectrum
Limit activity
Drain abscesses
Advice to post PID PT
High risk of reoccurrence
No sex with infected partner
Non sex while menstruating
Have kids early
Fibrocystic breast disease treatment
Analgesia
Aspiration
Ultrasound
Mammogram
STI preventative measures
Education Condom Voiding post Washing with soap and water Choose partners wisely
HPV and women
Most likely to contract
Adolescents reviewed for abuse
Yearly Pap recommended
Correlated with cancer
Hpv vaccine
Teenage girls
Shot, 2months, 6 months
Hpv and pregnancy
Warts get bigger and can get infected
No effect on fetus
Herpes symptoms
Vesicles
Painful draining Lesions
Flulike symptoms
Herpes flair up causes:
Illness Prior to menstruation Fever Excessive sunlight/tanning Stress
Herpes treatment
Antiviral ointment
Sitz for comfort
Herpes and pregnancy
Crosses placenta if contracted while pregnant
Given during birth
Vaginal birth preferred if no active lesions
Gonorrhea in males
2-7 day incubation Urethritis Thick yellow green discharge Itching Urination/rectal/testicular pain Can spread and cause sterility
Gonorrhea in females
May be asymtomatic Slight discharge Itching Pain after sex/rectal Can cause sterility through tubal scarring
Gonorrhea assessment
Urine, vaginal, urethral culture
Gonorrhea therapy timeline
Oral/IV treatment
Not contagious in 24 hours
Return in 7 days for follow up
Gonorrhea and antepartum and delivery
Spontaneous miscarriage
Preterm birth
Endometritis postpartum
Can cause blindness if present at birth and not treated
Progression of syphylis
Chancre for 6 weeks then fades
Rash and mucous lesions appears 2-4 weeks later then fades
Latent for years-decades
Finally blindness, paralysis, and cognitive failure
Syphilis tests
Serologic serum Ven Dis Research Lab Automated reagin test Rapid plasma reagin test Fluorescent treponemal antibody absorption tests (confirms VDRL)
Syphilis treatment
Benzathine penicillin IM X2
Oral erythromycin 10-15 days
Cyclines
Jarisch Herxheimer reaction
Caused in adolescents post syphilis treatment Hypotension Fever Tachycardia Muscle aches
Pregnancy and syphilis
Crosses at 18th week
Causes miscarriage, preterm, stillbirth, congenital anomalies
Pregnancy and syphilis tests
Woman tested at 36 weeks
Baby tested with cord blood
Newborns and syphilis
Copper rash on face, palms, feet Rhinitis Pegged teeth Easy tooth decay Same as final stage for adult
Strep and pregnancy
Screened at 35-38 weeks
Babies develop sepsis, pneumonia, meningitis, rds
Erectile dysfunction causes:
Disease- diabetes, neuropathy Injury Substances Low T Decreased nerves sensitivity Hypogonadism
Erectile disfunction risk factors
Age
Trauma
Disease
Substances
Erectile dysfunction drugs:
Viagra and levitra PRN
Cialis daily
No nitrates/cardiac/bottom out
IUD advantages
Long term
Possibly have amenorrhea after 12
Can take ibuprofen
99% effective
Sonohysterography
Saline injected into uterus
Ultrasound inserted vaginally for inspection
Can be done anytime
Hysterosalpingonography
Iodine/radiopaque dye introduced into cervix
If patent, flows through to ovaries and outlines
Hysterosalpingonography disadvantages
Rare infection/allergy
Must be done post menses
Can cause acute cramping
Hysterosalpingonography benefits
Can break up masses
Can increase patency
Male sperm facts
20-200 mil sperm/mL
2.5-5 mL
> 50% mobile
> 30% normal shape
Sex 4 times/week for 6 and 12 months:
6- 50% pregnancy
12- 85%
Subfertility assessments:
Semen analysis
Ovulation analysis
Tubal patency
Sterility
From known condition like absent testicles or uterus
Subfertile causes
Disease
Semen
Ovulation
Patency
Male subfertile causes:
Pancreas, thyroid, pituitary imbalance Substances Thermoregulation/blood flow Long sitting Infection Autoimmune
Female subfertile causes
Nutrition Weight Exercise High Glucose/insulin Stress Poly cystic ovary disease Plumbing
Endometrial biopsy
3 days before menses Anesthesia block Inserted through cervix Sample should look like corkscrew indicating progesterone Call back with next menses
Biopsy contraindications
Current infection
Current STI
Pregnant
Biopsy complications
Bleeding
Infection
Uterine perforation
Pre-therapeutic insemination tasks:
Mucus, BBT, ovulation kit
Blood type/rH factor of donor
IVF procedure
GnRH hormones administered Ultrasound daily to view eggs HCG to cause ovulation in 36-48 hrs Extraction 8 hr incubation Sperm introduced 40 hr incubation 1-2 zygotes introduced back
Al states must report within 24 hours
Gonorrhea
Syphilis
HIV-Aids
Confirmed chlamydia in most states by 7 days
When to get STI tested
Stopping sex relationship and before starting another
Regularly with multiple partners
Any STI symptoms
3 categories of STI
Bacterial
Viral
Parasitic
Candidiasis symptoms
White discharge Itching Burning Dry skin Occasional dsyurea
Chlamydia symptoms
Runny grayish white discharge and dsyurea
Inflammation
Hpv treatments
Gardasil (quadrivalent)
Cervarix (Bivalent)
Gardasil
HPV vaccine mostly in teens
Homosexual men can get until 26
Ed nursing dx
Knowledge deficit
Situational low self esteem
Sexual dysfunction
Coc drug interactions
Acetaminophen
Anti coagulants
Antibiotics
Seizure meds
Depo
Q12 weeks
Im
Permanent birth control methods
Vasectomy
Ligation
Essure block
