Thorpe final exam Flashcards
What breast cancer screening measures are recommended
Clinical Breast exam ( CBE) and mammography
Do BRCAI 1 and BRCAI 2 increase
A woman’s risk for developing breast cancer
What characteristics are considered when determining breast cancer staging
Size of tumor
Extent and number of lymph nodes
Distant metastasis
What 2 tests are the best indicator of breast cancer diagnosis
MRI
Needle core biopsy
Mammography
What treatment would be most appropriate for a woman newly diagnosed with stages 1or 2 Breast cancer
Breast conservation ( lumpectomy) followed by irradiation
What 2 stages of cancer are curable
Stages 1&2
What does the SERM ( selective estrogen receptor modulator) tamoxifen do
Counteracts the effects of circulating estrogen in the body to reduce the risk for return or spread of cancer
What should the nurse caution about when administering the Aromatase inhibitor (AI) letrozole ( femara)
Signs of blood clots in her leg
Joint pain and stiffness
Intermittent chest pain
List risk factors for cancer of the vulva
Smoking
HPV infection
HIV infection
Immunosuppression
List risk factors for cancer of the vagina
Previous cervical cancer In uterine exposure to diethylstilbestrol (DES) Previous vaginal or vulvar cancer Previous radiation therapy HX of HPV
What are risk factors for cancer of the cervix
Hx of dysphasia. Family hx
Multiple sexual partner Smoking/ exposure to 2nd hand
Sex with uncircumcised men. Coitus less than 16
Early childbearing. Nutritional deficiencies
Exposure to HPV types 16&18. Use of chemotherapy
Overweight. Chronic cervical infection
What are risk factors for cancer of the uterus
Obese White woman Cumulative exposure to estrogen Infertility Diabetes Use of tamoxifen
What is tamoxifen used for
Treatment and prevention of breast cancer
For cancer of the vulva what are good diagnostic tools
VSE vulvar self examination
Ultrasound
For cancer of the vagina, what diagnostic tool can be used
Colposcopy
Cervical and vaginal cultures
Pap smear
Ultrasound
For cancer of the cervix, what diagnostics can a nurse use
Colposcopy Cervical and vaginal cultures Endometrial biopsy Pap smear Cultures LEEP D&C Ultrasound
Name 8 risk factors that predispose a woman to breast cancer
Age Female Hx of previous breast cancer Mutation of BRCAI genes Family hx Alcohol consumption Obesity Nulliparity
What are risk factors for cancer of the ovaries
Family hx Obesity Older than 40 Early menarche Late menopause
For cancer of the uterus, what are good diagnostic tests
Endobiopsy Pap smear LEEP Ultrasound D&C Hysteroscopy
For cancer of the ovary, what are good diagnostic tests
BRCA1 and BRCA2 gene Mutation screening
Laparoscopy
Ultrasound
What is a good diagnostic test for the diagnosis of cancers of the Fallopian tubes
Hysteroscopy
Ultrasound
Based on the Bethesda system for classifying Pap smears, what ones describe epithelial cell abnormalities of glandular cell type.
Atypical glandular cells ( NOS)
Atypical endocervical cells, favor neoplatic
Endocervical adenocarcinoma in situ
What bests describes stage 2 ovarian cancer
It is a cancer that is contained within the ovary or ovaries if both are initially infected
List clinical manifestations of cervical cancer
Persistent vaginal discharge Abnormal bleeding between menses or post menopause Abnormal cells on pap smear Anorexia Pelvic pain
List clinical manifestations of cancer of the uterus
Irregular bleeding and pain Prolonged flow Dysuria Dyspareunia Pelvic pain Enlarged uterus ( rule out fibroids, pregnancy, obesity)
List clinical manifestations of cancer of the vulva
Pruritis/ soreness Enlarged lymph nodes in groin Bleeding Smelly discharge Wart like lesions, itching, sores, ulcers, change in skin color/ texture.
List clinical manifestations for cancer of the vagina
Dysuria Dyspareunia, Pelvic pain Lump or swelling of vagina Pain Discharge Bleeding after intercourse
What abnormal findings should a woman report upon completion of a vulvar self exam
Redness, severe itching, and lump on labia minora
Ulcer of the labia majora that does not heal
Severe pain with vaginal penetration during intercourse
A patient has undergone total abdominal hysterectomy ( TAH) and bilateral salpinoophorectomy for stage 2 ovarian cancer is receiving the prescribed chemotherapy with intravenous Paclitaxelm( Taxol) and Carboplatin ( Paraplatin). She asks the nurse what toxic effects she may experience. The nurse states she may experience the following;
Leukopenia Alopecia Anaphylactic shock Neurotoxicity Fever
True or false
Endometriosis is a benign condition characterized by the presence of endometrial tissue outside the uterine cavity….
True, it can arise anywhere
What are risk factors for endometriosis
Early onset of menarche
Woman with a menstrual cycle of less than 27 days and flow lasting more than 7 days
Name some pathophysiological factors of endometriosis
Familial predisposition Shorter menstrual cycle Outflow obstruction Younger age at menarche Misplaced endometrial tissue Retrograde menstruation
What clinical manifestations are currently assoc with endometriosis
Abdominal and pelvic pain
Dysmenorrhea and dyspareunia
Painful defecation during menstruation
What test provides a definitive diagnosis of endometriosis
Direct visualization of glandular lesions during laparoscopy
What med is commonly prescribed for woman who are diagnosed with mild endometriosis and symptoms
NSAIDS
What is The medication Leuprolide ( Lupron) used for?
Moderate to severe endometriosis
How does the medication Leuprolide ( Lupron) work
It suppresses the menstrual cycle through estrogen antagonism
What meds can be used to treat breast cancer
Hormone therapy Tamoxifen SERMS Aromatase inhibitors Herceptin Analgesics
List the 4 stages of the Rape Trauma Syndrome and list them in order of occurrence
Acute phase or disorganization Outward adjustment or denial phase Reorganization phase Integration and recovery phase Silent reaction phase
What are diagnostic tests for CHD
Lipid profile
EKG
stress test
Name 3 problems of menopause that result for the decline in estrogen levels
Osteoporosis- loss of bone density and quality
CHD- coronary heart disease
Changes in HDL and LDL ratio because of declining estrogen
What tests may be done to confirm the diagnosis of menopause
Analysis of FSH and LH
What are positive signs of pregnancy
Fetal heart beat
Fetal movement
Visualization of the fetus
What are sources of folic acid
Fresh leafy vegetables
OJ
citrus fruits and juices
Red meats,mush, poultry, legumes
What are risk factors for osteoporosis
Personal hx of fracture after age 50
Low bone mass, hx of fracture in 1st degree relative
Female, thin ( weighing less than 127 or having a small frame)
Advanced age, family hx of osteoporosis, abnormal absence of menses
Early onset of menopause,anorexia, low lifetime of calcium intake
Vitamin D deficiency, cigarettes smoking, excessive alcohol use
Inactive lifestyle, being Caucasian or Asian
Use of corticosteroids, chemotherapy, or anticonvulsants
What are risk factors for CHD in woman
Family hx of heart disease Advancing age over 55 or postmenopausal Overweight and obese Cigarette smoking Sedentary lifestyle, HTN, diabetes, elevated cholesterol, African American
What meds are available to treat or prevent osteoporosis
Biphosphonates-
SERMS ( selective estrogen receptor modulators)
Salmon calcitonin
Parathyroid hormone
What are biphosphonates
They are an alternative to estrogen, they are the gold standard in alleviating post menopausal osteoporosis
It is taken in the morning on an empty stomach with a large glass of water. Woman should stand or sit upright for 30 min afterward
What is zoledronic acid ( Zometa)
It is a intravenous biphosphonate approved for the use in txt of metastatic bone cancer
What are SERMS
Selective estrogen receptor modulators, an alternative to estrogen that has estrogen like properties.
What is raloxifene ( evista)
It’s a SREM approved for tx in prevention of osteoporosis
Whatnots salmon calcitoni
A calcium regulator that may inhibit bone loss and is approved for tx I. Woman who are 5 yrs post menopausal. It comes as a nasal spray
What is parathyroid hormone
A daily subQ injection that activates bone formation
What is the recommended calcium intake dosage for postmenopausal woman
1200 mg or 1500 if they are not on hormone therapy
What are fasting levels for a pregnant woman
Fasting 95 1 hr 180 2 hr 155 3 hr 140 The woman should remain seated and not smoke throughout the test. Gestational diabetes is diagnosed if 2 or more values are met or exceeded.
What is glycosulated hemoglobin (HbA1c)
It is a lab test that loosely reflects glucose control over the previous 4-8 weeks. It measures the % of glycohemoglobin in the blood.
What are complications at delivery for a mother with Candida albicans
If the infection is present at birth and the fetus is born vaginally, the fetus may contact thrush
What are complications at delivery for a mother who had BV
PROM
PTL
Intravenous- amniotic infection
And endometritis postpartally
What are complications at delivery for a mother who has trichomonas
Increased risk for PROM
preterm birth
Low birth weight
What are complications at delivery for a mother who has chlamydia
The newborn may develop newborn conjunctivitis, which may be treated with erythromycin eye ointment ( but not silver nitrate)
Infant may also develop chlamydial pneumonia. May be responsible for premature labor and fetal death
What complications at birth can arise because of syphillis
Syphillis can be passed transplacentally to the fetus.
If untreated one of the following may occur; second trimester abortion, stillborn infant at term, congenitally infected infant, uninfected live infant
What may complications of gonorrhea cause at delivery
Ophthalmia neonatorum
What discomforts are experienced during the first trimester
N/V {r/t increased levels of hCG, changes in carbohydrate metabolism,emotional factors, fatigue}
Urinary frequency { r/t pressure of the uterus on bladder in both the 1st & 3rd trimesters}
Fatigue
Breast tenderness { r/t increases in levels of estrogen and progesterone}
Increased vaginal discharge { r/t hyperplasia of vaginally mucosa and increased production of mucus by the endocervical glands due to the increase in estrogen levels}
Nasal stiffness and epitaxis { r/t elevated estrogen levels}
Ptyalism ( excessive, often bitter salivation)
What are discomforts that arise in the 2nd and 3rd trimesters
Heartburn (pyrosis)
Ankle edema, varicose veins, hemmoriods, constipation, backache, lag cramps
How much weight should a pregnant woman gain
28-40 pounds for a underweight woman
25-35 pounds for a normal weight woman
15-25 pounds for a overweight woman
11-20 pounds for a obese woman
How is nägele’s rule calculated
Begin with the FIRST day of LMP, subtract 3 months, add 7 days and 1 yr.
What is McDonald’s rule
Measure the distance in centimeters from the top of the symphysis pubis over the curve of the abdomen to the top of the uterine fundus
What is true of fetal development at 4 weeks of life
The fetal heart begins to beat
What is true of fetal development at 8 weeks of life
All body organs are formed
What is true of fetal development at 8-12 weeks of life
Fetal heart times can be heard by Doppler device
What is true of fetal development at 20 weeks of life
Heartbeat can be heard with fetoscope
Quickening, babies develops a regular schedule of sleeping, sucking, and kicking
Hands can grasp, baby assumes a fav position in utero
Vernix and lanugo appear
Head hair, eyebrows, and eye lashes are present
What is true of fetal development at 24 weeks of life
Weighs 780g (1pound 10 ounces)
Activity is increasing
Fetal respiratory movements begin
What is true of fetal development at 28 weeks of life
Eyes begin to and close
Baby can breathe
Surfactant needed for breathing is formed
Baby is two thirds its final size
What is true of fetal development at 32 weeks of life
Baby has fingernails and toenails
Subcutaneous fat is being laid down
Baby appears less red and wrinkled
What is true of fetal development at 38+ weeks of life
Baby fills total uterus
Baby gets antibodies from mother
What tests are done to detect osteoporosis
BMD
WAIST TO HIP RATIO want ratio to be under 0.8
Ht
Calcium And phosphate levels to see if their decreased
What are side effects of ERT estrogen replacement therapy
Headaches
Brown spots on skin
N/V
Swelling, wt. gain,eye problems, risk for thromboembolism
Estrogen replacement therapy is contraindicated in who
Hypertensive patients, cardiac patients, breast cancer patients, hx of thromboembolism
What are the 3 phases of the menstrual cycle
Proliferation phase days 7-14
Secretory phase days 15-26
Ischemic phase days 27-28
List the 2 hormones produced by the pituitary gland which influences the female reproductive cycle
FSH
LH- aids in the final maturation of follicle
State the 3 major hormones produced by the ovary and describe there functions
- Estrogen, increase size of uterus contractions increases
- Progesterone, decreases contractility helps maintain pregnancy
- Prostaglandins, affect metabolism, play a role in glycolysis,made the smooth muscle contractility, affect ovulation and changes in cervix
Play a role in inhibition of labor by increasing contractions
Describe 3 changes that occur at ovulation
Increase in progesterone levels
Increased temp
Change in cervical mucus becoming clear and thin
Slight spotting
