U1 - STI, PERI/POSTMENOPAUSE/REPRODUCTION Flashcards
1
Q
what is the labia majora?
A
2 folds lateral to genitals & protect the tissue btwn them
2
Q
How does labia minora differ from the majora?
A
- Smaller
- Moist, NO hair follicles
- Resemble muscus membrane
- Sebaceous glands for lubrication & bacteriocidal secretions
3
Q
where are the skene & batholin glands contained?
A
vestibule
4
Q
education about the vestibule area?
A
contains opening to urethra/vagina
very sensitive to chemical irritants
- EDU about potential discomfort using dyes/perfumes in soaps/feminie hygeine products
5
Q
where is the urethral (urinary) meatus?
A
midline of vestibule & approx 0.4/1inch below clitoris
6
Q
what is the purpose of Skene glands/Where?
A
Located on each side of urethra
- Produce mucus to help lubricate vagina
- NOT readily visible
7
Q
where are the Bartholin’s glands & what do they do?
A
Located deep w/in posterior of vestibule (near posterior vaginal intro)
Secrete a clear mucus that moistens/lubricates during sexual arousal
8
Q
where is the Perineum?
A
region btwn vagina/anus (skin covered)
9
Q
what hormones do the ovaries secrete?
A
progesterone & estrogen (menstrual cycle regulation)
10
Q
what is Oogenesis?
A
Process of meiosis for egg cell formation –> formation of mature eggs w/in ovary
11
Q
how often does Oogenesis occur?
A
regular (usually monthly) intervals
12
Q
Oogenesis process?
A
Begin: In ovaries regulated by FSH which initiates ovarian follicle growth.
FSH stimulates follicles to secrete estrogen - promote ovum maturation
13
Q
what is a graafian follicle?
A
mature ovarian follicle containing secondary oocyte
14
Q
what does “patent” mean r/t fallopian tubes?
A
tubes that are open/free of blockages
15
Q
where is the safe/usual spot of fertilization in fallopian tube?
A
outer 1/3
16
Q
what/how can infections impact fallopian tubes/ovaries?
A
Residual scarring can narrow tubes
Increase risk for tubal pregnancy/infertility
17
Q
what type of muscle is the vagina composed of?
A
smooth muscle
Distention during childbirth & collapse post labor
18
Q
what does the vagina “do’?
A
- Provide lubrication to faciliate intercourse
- Stimulate penis during intercourse
- Receptacle for semen
- Transport blood/tissue from body during menses
19
Q
typical vaginal pH during reproductive years?
A
4.5-5.5 (acidic)
20
Q
pH effect?
A
Acidic environment can be harmful to sperm
Protect genital tract from pathogens
21
Q
what is the Gynecoid pelvic type?
A
typical/traditional best suited for childbirth
Inlet is round/oval laterally
Sacrum is wide/deep
Subpubic arch is wide/round
22
Q
what is the Android pelvic type?
A
Resembles a male pelvis
Inlet is triangular/heart shaped - laterally narrow
Bony prominences
= difficult fetal descent
23
Q
what is the Anthropoid pelvic type?
A
Oval shaped inlet but in ant/post not laterally.
Fetal descent likely in posterior (facing womans front) rather than anterior (facing womans back)
24
Q
what is the Platypelloid pelvis type?
A
Broad/flat
Inlet is wide laterally w flat A/P plane
Fetal descent is usually transverse & not allow for a vaginal birth
25
what hormones & from where encourage breast growth?
Estrogen/Progesterone
From ovaries/placenta
26
R/t breast tissue, Estro/Prog do what?
Increase gland/duct size
Prep for milk production
27
Post placenta delivery, E drops & triggers what?
Prolactin from A.Pituitary --> Oxytocin (P.Pituitary) to release milk from alveoli
28
what are the hormones released by the Hypthalamus called?
"releasing factors"
they stimulate release of other hormones
29
Ex of hormones released by hypothalamus
GnRH
CRH (corticotropin-releasing)
GH-RH (growth releasing)
TRH (thryotropin)
PIF (Prolactin inhibiting)
30
what does GnRH stimulate? when released?
Release FSH & LH from A.pituitary
Released on decrease in E/P (ovarian hormones)
31
what does GnRH affect in PREmenopausal female?
Follicular growth, ovulation & corpus luteum
32
when is RH released? what does it do?
By pregnant women & embryo soon after implantation
Provide protective action of minimizing mom immune rejection (decrease miscarraige)
33
what stimulates uterine contractions/release of milk from milk ducts?
Oxytocin (P.P)
Synthetic form can be given to enhance uterine contractions
34
how does progesterone regulate menstrual cycle?
decreasing uterine motility/contractility
prep uterus for implantation
readies breast for lactation (preg)
35
What is hCG (human chorionic gondaotropin)?
Important in early preg to maintain corpus luteum
keeps levels of P/E elevated till placental development
serum/urine levels measured to diagnose pregnancy
36
what do prostglandins do?
affect ovulation, fertility & cervical mucus
premenstural: contractions = dysmenorrhea
37
Thelarche is?
occurs at roughly 13
first signal ovarian function has begun - followed by pubic hair growth
38
by using what can nurse determine a patients stage of puberty?
the tanner scale
(measurement of secondary sex characteristics)
39
in the uterine(endo) cycle what are 4 phases?
Menstural (1-6)
Proliferative (7-14)
Secretory (15-26)
Ischemic (27-28)
40
when/what is the menstrual phase?
time of vaginal bleeding
day 1-6
onset of menses = beginning of follicular phase (ovarian)
41
what triggers menstruation?
Decreasing levels of estrogen/progesterone (by the corpus luteum) = bad o2 supply = sloughing of endo tissue
42
what is menstrual fluid composed of?
endo tissue
blood
cervical/vaginal secretions
leukocytes/prostaglandins
43
prostglandins can cause what in the menstrual phase?
dysmenorrhea (painful mens) - cramps
treat with NSAIDS
44
whats the importance of folic acid for pregnant patients?
Important for neural tube development
45
what cardiac change is expected during 1st trimester?
decreased BP
46
GI complication from progesterone?
constipation
( P = slows smooth muscle)
47
at 28 wks, what fundal height would = a problem?
24
48
if a women in her 2nd trimester reports vaginal bleeding, what is the next step?
immediate to PCP
49
based on Naegele's rule, what would be the due date based on a LMP of May 20?
feb 27
50
what are the probable signs of pregnancy?
Ballottement
Chadwick
Goodell
Hegar
Piskacek
51
describe Ballottement
Passive movement of unengaged fetus
fetus moves away from the tap of uterus
52
describe chadwicks sign
Violet/blue color of vaginal mucous/cervix
53
describes Goodell's sign
Softening of tip of cervix
54
describe hegars sign
Softening of lower uterine segment
55
what medication is commonly used to treat infertility by inducing ovulation
Clomiphene Citrate
56
describe piskacek sign
uterine asymmetry w/ soft prominence on implantation side
57
development of breast and pubic hair in a 12 year old is due to what hormone?
Estrogen
58
which phase of the menstrual cycle does the endometrium prepare for potential implantation of fertilized egg?
Secretory
59
which STI requires lesions to be present for transmission?
Herpes
60
what is the primary concern with placenta previa?
bleeding
61
in preterm labor what is nifedipine given for?
inhibit contractions
62
what is a side effect of magnesium sulfate therapy for preeclampsia?
Respiratory depression
63
what is a risk associated with HT in postmenopausal women?
breast cancer
64
what may happen to insulin requirements in a pt with gestational diabetes?
increased doses in 2nd/3rd trimester
65
primary source of toxoplasmosis?
raw/undercooked meat
Cat feces
exposure to insects/gardening
66
what is the purpose of Rhogam in a Rh neg pregnant woman?
prevent maternal sensitization to Rh postive fetal blood
67
which sx would = mg sulfate toxicity in a preeclamptic pt?
Decreased deep tendon reflex
68
what are the s/sx of placental abruption?
Painful rigid abdomen
Dark red vaginal bleeding
69
s/sx of placenta previa?
BRIGHT red vaginal bleeding
NO contractions/pain
70
what is the priority intervention for placental abruption
Place large bore IV
71
what is the timing classified as preterm labor?
20-37 wk
72
what measurement can be assesed for prevention of pre term labor?
cervical length/funneling (ultrasound)
73
what is measurement of cervical length associated with preterm labor?
less than 25mm
74
what oral med has been shown to help reduce risk of preterm labor?
PO progesterone
75
s/sx of preterm labor?
Backache
menstural like cramps
increased vaginal discharge
pelvic pressure
urinary freq
76
how is diagnosis of PTL made?
regular uterine contractions & cervical dilation
regular contractions & @ least 2cm dilation
77
what STI's have been associated with PTL?
Chlamydia
Gonorrhea
Group B strep
78
what is Nifedipine?
Ca channel blocker used to inhibit PTL (decrease smooth muscle contration)
79
Nifedipine interactions/
If given with Mg sulfate/erythromycin = sudden cardiac arrest
80
what is Tocolysis?
Use of medication to inhibit uterine contractions
81
how effective is tocolytic therapy?
NO medication has been identified to effective stop PTL
works for 48 hr
82
who should receive tocolytic therapy?
those who fetus would benefit from 48 hr delay
83
what is the limit of use for Toclytics?
34 wk
84
edu about mg sulfate admin?
85
monitor what with tocolytic therapy?
BP, Pulse & RR Q 15min
86
what BP would indicate alerting the dr w/ tocolytic therapy?
systolic >140 or <90
diastolic >90 or <50
87
what is gestational diabetes?
Development of HTN after 20wk WITHOUT proteinuria
88
what is preeclampsia?
Increase in BP (140/90=or+) after 20wks WITH proteinuria
89
what is the measurement of proteinuria for pre-eclampsia?
300mg/24hr
90
what is Eclampsia?
New onset grand mal seizures in women w/ preeclampsia
91
what body systems does pre-eclampsia target?
cardio
hemtaological
hepatic
renal
CNS
92
pneumonic for pre-eclampsia pt care?
S: Sig Bp changes
P: Proteinuria is serious = renal involvement
A: Arterioles leak into IS = edema
S: Sig lab changes (LFT & platelet)
M: Multiple organ sys (CV. Hep, R, CNS)
S: S/sx after 20 wk
93
what is the platelet count for sx of pre-eclampsia?
thrombocytopenia = less than 100,000/L
94
where would pain be presented in pre-eclampsia?
RUQ persistent pain (R/T impaired liver function)
or
epigastric pain unresponsive to medication
95
what labs would be run for pre-eclampsia?
LFT
Platelets
Creatintine > 1.1mg/dL
96
"odd s/sx of pre-eclampsia"
bleeding gums
"just not feeling right"
97
concerning edema in pre-eclampsia presents where?
HANDS/FACE
98
cure of pre-eclampsia?
delivery
99
Edu at home for pre-eclampsia
lay L lateral = less vena cava pressure/increase venous return
100
what is the seizure prophylaxis with pre-eclampsia?
Mg sulfate
101
Mg sulfate dosage & reversal
Loading dose: 4-6G/15min
Maint: 1-3 (2)G/hr
Rev: 10% Ca gluconate (10mL/2min)
102
give what med for severe pre-eclampsia BP (160/110+)
Labetalol (antihypertensive)
103
what mg level would you call PCP & why?
above 5 (5-10 ECG change)
(8+ = loss of reflex)
104
which deep tendon reflex is assessed before mg dose?
patellar
105
daily assessment of pre-eclamp pt?
Listen to lung, heart & breath sounds
edema degree
s/sx pulm edema (tachycardia/pnea)
106
What is HELLP syndrome?
Hemolysis Elevated Liver enzyme Low Platelet
107
result of HELLP?
liver tissue ischemia & hemorrhagic necrosis
108
s/sx HELLP
N/V
epigastric pain
vision changes
renal failure
DIC
Resp fail
109
what makes up TORCH infections?
Toxoplasmosis
Other (hep b)
Rubella
Cytomegalovirus
Herpes
contraction in first 12wk - fetal anomalies
110
s/sx toxoplasmosis?
Fatigue, muscle pain, myocarditis & swollen lymph nodes
111
s/sx of Hep b?
Low grade fever
anorexia
jaundice
hepatomegaly
pre term birth
112
Criteria for Rhogam?
- mom & + baby
113
what supplement should a women with pregestational diabetes be given?
folic acid (prevent neural tube defects)
114
why does the fetus increase its own insulin production in pregestational diabetes?
@10wk & bc insulin doesnt cross placenta but glucose does
115
in the 1st trimester what is a pregestational diabetes pt at risk for
hypoglycemia r/t hormone changes
(hyperinsulinemia)
116
screening/diagnosis for gestational diabetes?
Glucose challenge test @24 & 28 wk
130-140mg/dL = further testing
117
education about 3 hr glucose test
avoid caffeine & no smoking 12 hr befre test
118
norm values for 3hrGT?
fasting <95
1hr <180
2hr< 155
3hr<140
119
glyburide is what?
hypoglycemic that doesn't cross placenta to treat GDM.
120
edu about glyburide?
stop 2 wk before delivery date
can cause fetal harm - use only if mom diab is real bad
121
drawbacks to fertility awareness based planning?
requires months of cycle charting prior
may interfere w/ sexual spontaneity
requires a lot of motivation & education
122
what hormone develops uterine lining
progesterone
123
lowest portion of true pelvis?
pelvic outlet
124
what can prevent pelvic fracture?
fat pad in front of pelvis
125
when on clomiphene citrate (clomid) what sx = immediate intervention?
chest pain worse w inspiration
126
best time to get preg based on cycle?
12-48 hr after ovulation
127
what is DKA?
Diabetic Ketoacidosis
body breaks down fat too fast releasing ketones = acidic blood
life threatening problem
128
which diabetes is more @ risk for DKA?
type 1
129
what changes in preg can predispose a diabetic pt to DKA?
Increased insulin resistance
dehydration 2nd to emesis (v)
stress
130
s/sx DKA?
Low BP
polyuria
rapid breathing (sweet smelling)
131
s/sx of SAB (spont abort)
bleeding
cramping/abd pain
cervical changes (dilation)
132
sx assessment for SAB?
time/onset of bleeding
character/amount
passing of tissue
133
what is the most common management for incomp, inev & missed SAB's?
D&C (dilation & curettage)
134
define complete abort?
expulsion of all POC before 20 wk
135
define incomp abort?
partial POC expulsion before 20 wk
136
define invetiable abort?
No expulsion
bleeding and cervix dilation
137
what is a threatened abort?
Sx of SAB present
intrauterine bleeding
no dilation & fetus alive/attached to uterus
138
mangagement for inc, inev, missed abortions?
D&C
139
what is the fetal biological profile?
noninvasive fetal examination thats most accurate at predicting fetal wellbeing
140
5 components of FBP?
Nonstress test
fetal breathing
fetal movement
fetal tone
amniotic fluid vol
141
scoring for FBP?
normal is a 2
8-10 w/normal amni vol = good
6 w/ normal amni = reassess in 24 hr
6> or nonreactive = immediate delivery
142
normal range for amniotic fluid?
5-24
143
what is the nonstress test?
measures fetal HR & uterine activity/contractions for 20 min
144
reactivity to nonstress test is based on what?
gestational age (32-34wk)
145
what is the contraction stress test?
evaluates fetal HR response to uterine contractions
146
if no contractions are produced in the 20 min window, what is given to stimulate uterine in the contraction test?
IV Oxytocin @ 0.5mu/m
increase dose by 0/5mu in 15-30min intervals
147
necessary contraction #/timing for IV oxytocin to have "worked"
3 contractions of 40s w/in 10min
148
how is the CST evaluated?
Presence or absence of late fetal HR decels
149
what is a late decel indicative of?
fetal hypoxia
begins @ peak of contraction & goes to after the end of contraction
150
what would be indicative of a postive (abnorm) CST?
late decels w/ 50% of contractions
even if less than 3 in 10 min.
151
performing NST procedure
ask pt to void
place pt in semi-fowlers/lat tilt
leopold maneuvers to asses fetal placement
obtain maternal V/S
152
the NST is measured by the what of the fetus?
HR acceleration of at least 15 bpm above baseline
153
3 procedures for antepartum fetal assessment
chorionic Villi sampling
Percutaneous umbilical blood sampling
amniocentesis
154
what does chorionic villi sampling test for/how?
Congenital deformity/genetic makeup & blood type
done by ultrasound guided needle to amni sac/chorionic villi
155
when is chorionic v sampling done?
early preg
8-13wk
156
risk of chorionic v sampling?
high risk r/t spontaneous miscarriage & limb reduction
157
what is percutaneous umbilical blood sampling?
Needle into umbilical cord to diagnose inherited blood disorders
158
what is amniocentesis?
Needle aspiration of amniotic fluid to determine chromosone analysis
159
when is amniocentesis performed?
15-20wk
160
how much amniotic fluid is needed for amniocentesis?
20-30cc
161
risks of amniocentesis?
spontaneous miscarriage
vaginal bleeding
amniotic fluid leak
162
what does the fundal height measurement correlate with?
weeks of gestation from 22-34wk (wk=cm)
163
approximate fundal height at 28wks?
11 in (28cm)
164
how to measure fundal height?
tape measure w/ end of tape measure (0) on superior border of symphysis pubis
abd midline is guide
165
how much is maternal blood volume expected change near term?
increase by 40-50%
138/82 is ok
166
how often are prenatal visits?
Q 4 weeks until 28/32 wk
Q2wk until 36
167
if a woman who gave birth 2 months ago says her hair is falling out in large amounts, whats the appropiate response?
hair will grow back w/in a year
this is norm
168
what is the harmful fetal effect of meth?
spontaneous abortion
169
what is the harmful fetal effect of ecstacy?
cleft palate
170
what is the harmful fetal effect of marijuana?
intrautertine growth restriction
171
3 POSITIVE sx of pregnancy?
Fetal HB
Visualization of fetus
Fetal mvmt palpated by examiners
172
what type of s/sx is a pos pregnancy test?
probable
173
what is a common CV change w/in 1st trimester?
BP remains same the decreases until 20 wks
174
what CV syndrome can result from pregnant woman laying on back?
supine hypotension
175
what heart changes are common in preg but often resolve by 2wk post partum?
exaggerated 1/3 heart sound
systolic murmurs
176
how is respiratory impacted by preg?
Tidal volume (amt air breathed in) increases 30/40%
caused by increase of progesterone/estrogen
177
urinary changes in preg?
increased risk of UTI from progesterone relaxation
progesterone increase kidney size = less effective --> excretion of glucose & protein
178
179
what medication(s) are given for placenta previa/abruption?
Tocolytics
(INMT)
180
what is trisomy 13? & what does it look like
Patau syndrome
poor prognosis
3 copies of chromosone 13
181
what does trisomy 13 look like
spinal cord abnorm
very small eyes
cleft lp
weak muscle tone
182
what is the recommended weight gain in pregnancy from a normal weight (18.5-24.9bmi)
25-35 lbs
183
examples of food with folic acid?
eggs, oranges, beans, peas and liver
184
what can you recommend for pt with stretch marks?
mositurizer
185
when would amniocentesis be preformed?
before 12 wk
186
