Unit 3 Flashcards
What are the two phases of the ovarian cycle?
Follicular (first 7 days) and Luteal phase
What are the predominant gonadotropic hormone levels in each phase of the ovarian cycle?
Follicular: FSH Luteal: LH
Describe the ovarian hormone levels in the ovarian cycle
During follicular phase, estrogen levels rise and peak around day 13 During luteal phase, progesterone levels rise and peak around day 20 (and inhibin peaks around day 22)
Describe the endometrial changes during the ovarian cycle
Days 1-7: Menses Days 8-14: Repair and regeneration Days 15-28: Secretion of endometrial glands
Describe changes in basal body temperature during the ovarian cycle
BBT rises approximately 1 degree (0.3 C) during luteal phase
Menarche
Age of first period
Menopause
Amenorrhea for one year (average age 51.9)
Metrorrhagia
Off-schedule bleeding
Menorrhagia
Excessive, profuse menstrual flow
Dysmenorrhea
Painful menstruation Primary: Cramping w/o prostaglandin disease Secondary: Associated pathology
Dyspareunia
Pain with intercourse
Amenorrhea
Absence of menstruation Primary: Not started by age 14/16 Secondary: Ceases for 6 months
When does PMS occur?
During luteal phase (resolves with menses)
What bacteria causes toxic shock syndrome?
S. aureus
What is endometriosis?
- Endometrial tissue found outside of uterus - Chronic and progressive - Causes infertility, dyspareunia, pain
What is polycystic ovarian syndrome?
Multiple inactive ovarian follicles that interrupt ovarian function (irregular periods)
At what time would one best measure their basal body temperature?
When first waking up
What are the most effective (99%) birth control methods?
Sterilization, IUD, implant
What are “very effective” (90-99%) birth control methods?
OCP, injectables, patch, ring
What are “moderately effective” (80-90%) birth control methods?
Condoms (M or F), sponge, diaphragm
What are “effective” (80%) birth control methods?
Fertility awareness, cervical cap, spermicide
What is transcervical sterilization?
Essure - flexible springs in proximal ends of fallopian tubes
What is the warning acronym for IUD/IUC devices?
PAINS P - period late, pregnancy, spotting or bleeding A - Abdominal pain, dyspareunia I - Infection exposure, abnormal discharge N - Not feeling well, fever, chills S - String length (check if missing)
What is the warning acronym for oral contraceptives?
ACHES A - Abdominal pain (liver or gallbladder) C - Chest pain or SOB H - Headaches E - Eye problems S - Severe leg pain
How soon must the emergency contraceptive be used?
Within 72 hours
What type of medications might reduce the effectiveness of OCP?
Seizure medications and antibiotics
Who should not use OCP?
Smokers - increased risk of MI, stroke, HTN
Who should not use the weekly patch?
Women over 198 pounds
How long after a vasectomy will a man be sterile?
About 36 ejaculations (recheck at 6 and 12 months)
For what ages does the USPTSTF recommend mammograms?
50-74
Who should not use HRT?
Hx of breast cancer, blood coagulation disorders, smokers, HTN, diabetics, CAD, renal or liver disease
What are risk factors for osteoporosis?
Increased age, small frame, white/asian, family hx, rheumatoid arthritis
What are some ways to manage osteoporosis?
Weight bearing exercises, no smoking or alcohol, calcium, vitamin D, medications (calcitonin, HRT, SERMS, bisphosphonates)
Infections characterized by vaginal/penile discharge
Trichomoniasis, bacterial vaginosis
Infections characterized by cervicitis
Chlamydia, gonorrhea
Infections characterized by genital ulcers
Herpes, syphilis
Vaccine preventable STIs
Hep A/B, HPV
Describe system for naming parity
GTPAL Gravida Term births (38-42 weeks) Preterm births (20-37 weeks and viable) Abortions (<20 or viability) Living children
What is Nagele rule?
- First day of LMP – 3 mo + 7 days + 1 year = EDD - Margin of error is +/- two weeks – any birth within this timeframe is considered a normal range
What are presumptive signs of pregnancy?
- Presumptive (subjective) – signs that the mother can see
- Absence of menstruation (most obvious sign), nausea, fatigue, breast tenderness, and urinary frequency
What are probable signs of pregnancy?
- Probable (objective) – can be detected upon physical examination by a provider
- Hegar’s sign – Softening of the lower uterine segment or isthmus
- Goodell’s sign – softening of the cervix
- Chadwick’s sign – a blueish-purple coloration of the vaginal mucosa and cervix
-
Pregnancy test – tests for human chorionic gonadotropin (hCG) in serum
- 5% test positive by day 8
- 98% test positive by day 11
- hCG levels double every 48-72 hours and peak 60-70 days after fertilization, then decrease and plateau around 100-130 days of pregnancy
- Low levels of hCG are associated with ectopic pregnancies
- Higher levels are associated with molar or multiple gestational pregnancies
- Elevated hCG corresponds to morning sickness of 6-12 weeks
What are positive signs of pregnancy? (How many are there?)
- Three positive signs of pregnancy
- Positive – performed by healthcare professional
- Visualizing fetus by ultrasound
- Palpating for fetal movements
- Hearing a fetal heartbeat
When do Braxton-Hicks contractions start?
They can start the first trimester, but get stronger towards the end of pregnancy. “Practice” contractions that help efface (thin) cervix.
Would white discharge from the vagina be concerning during pregnancy?
Only if painful/itching
What causes ovulation to cease during pregnancy?
Elevated estrogen and progesterone levels
What does the corpus luteum secrete and for how long after fertilization? What takes over?
Progesterone - for the first trimester then the placenta takes over
What does progesterone do to the intestine?
Causes smooth muscle relaxation –> constipation
What happens to blood pressure during pregnancy?
Typically goes down - any increase should be reported
(Progesterone causes vasodilation)
What are the psychological changes during pregnancy?
- Ambivalence – 1st trimester
- Introversion – 1st and 3rd trimesters
- Acceptance – 2nd trimester
- Mood swings/Emotional liability – common throughout pregnancy
- Changes in body image – common and vary from woman to woman
What is it called when the man experiences pregnancy symptoms? What are the most common symptoms he experiences?
Couvade syndrome - nausea, vomitting, and weight gain
What are milemarkers for the fundus during pregnancy?
- 12 weeks can be palpated and is at symphysis pubis
- 16 weeks midway to umbilicus
- 20 weeks at the umbilicus
- 36 weeks just below xyphoid process
Discuss assessment of edema during pregnancy
- May indicate gestational hypertension if noted early in pregnancy
- Dependent edema normal in third trimester
- Ask about pain with ambulation, which can indicate DVT (increased risk caused by increased estrogen levels)
What are factors for a high risk pregnancy?
- Previous child with congenital anomaly
- Hx of gestational diabetes or polyhydramnios
- Family hx of diabetes
- Corticosteroids or antipsychotics
- Age 35+
- Polycystic ovarian syndrome
- Multiple pregnancy (twins, triplets)
- Previous infant over 9 pounds
- Previous unexplained neonatal death
- Maternal obesity (BMI >30)
- HTN before or during early pregnancy
- Hispanic, Native American, Pacific Islander, or African American
- Recurrent non-responsive monilial infections
- Polyuria, polyphagia, polydipsia, fatigue (signs of glucose intolerance)
- Glycosuria or proteinuria
What vaccine cannot be given while pregnant?
Rubella (will be given after birth)
What are the FDA recommendations for eating fish during pregnancy?
- Avoid fish with moderate to high mercury 6-12 months before conception
- Avoid shark, swordfish, king mackerel, orange roughy, ahi tuna, and tilefish (high mercury levels)
- Eat up to 12 ounces (two meals) weekly of low-mercury fish – shrimp, canned tuna, salmon, pollock, and catfish
What are best practices for a woman to avoid listeria during pregnancy?
- Hot dogs, lunch meat, and deli meat should be reheated until steaming hot – do not eat cold
- Avoid getting fluids from the above on cooking surfaces, utensils, etc.
- Do not eat soft cheeses such as feta, Brie, Camembert, and blue-veined cheeses
- It is safe to eat hard cheeses and semi-soft cheeses (mozzarella, processed cheese slices and spreads, cream cheese, and cottage cheese)
- Do not eat refrigerated pate or meat spreads
- Do not eat refrigerated smoked seafood unless it is an ingredient in a casserole
- It is safe to eat canned fish or shelf-stable smoked seafood
- Use all refrigerated perishables as soon as possible
- Use a refrigerator thermometer to ensure temperature is 40F (5C) or below
- Do not eat store-bought salads such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad
- Clean your refrigerator regularly
Nursing interventions for urinary frequency or incontinence
- Pelvic floor exercises
- Empty bladder when you first feel full
- Avoid caffeinated drinks, which stimulate voiding
- Reduce fluid intake after dinner to reduce nighttime urination
Nursing interventions for fatigue during pregnancy
- Attempt to get a full night’s sleep
- Eat a healthy and balanced diet
- Schedule a nap in the early afternoon daily
- When you feel tired, rest
Nursing interventions for nausea and vomiting during pregnancy
- Avoid an empty stomach always
- Eat crackers/toast in bed before getting up
- Eat several small meals
- Don’t brush teeth immediately after eating to avoid gag reflex
- Acupressure wristbands
- Drink fluids between meals not with meals
- Avoid greasy/fried foods and strong-smelling foods (cabbage, Brussels sprouts)
Nursing interventions for sore back during pregnancy
- Change positions often
- Heating pad
- Back pillows
- Proper body mechanics
- Avoid excessive bending/lifting/walking
- Avoid high heels
- Stand with shoulders back
What are common discomforts for each trimester
- First Trimester
- Urinary frequency and incontinence
- Fatigue
- Nausea and vomiting
- Breast tenderness
- Constipation
- Nasal stuffiness and bleeding gums (bleeding nose)
- Cravings
- Leukorrhea (increased vaginal discharge – should not burn or itch)
- Second Trimester
- Backache
- Leg cramps
- Varicosities of the vulva and legs
- Hemorrhoids
- Flatulence with bloating
- Third Trimester
- Shortness of breath and dyspnea
- Heartburn and indigestion
- Dependent edema
- Braxton Hicks Contractions
What are warning signs for each trimester?
- First Trimester
- Spotting or bleeding (miscarriage)
- Painful urination (infection)
- Severe persistent vomiting (hyperemesis gravidarum)
- Lower abdominal pain with dizziness and shoulder pain (ruptured ectopic pregnancy)
- Second Trimester
- Regular uterine contractions (preterm labor)
- Pain in calf, often increased with foot flexion (DVT)
- Sudden gush or leakage of fluid from vagina (premature rupture of membranes)
- Absence of fetal movement for more than 12 hours (possible fetal distress or demise)
- Third Trimester
- Sudden weight gain, facial edema, severe upper abdominal pain, or headache with visual changes (gestational hypertension or preeclampsia)
- Decrease in fetal daily movement for more than 24 hours (possible demise)
- Any previous warning signs can also be present in the third trimester
What type of exam is performed when confirming endometriosis?
Laparoscopy
What hormone is contained in the implantable contraceptive?
Synthetic progestin
What type of scan is done for osteoporosis?
DEXA scan
What are some benefits of oral contraceptives?
- Reduced risk of endometrial cancer (uterine)
- Protection against pelvic inflammatory disease
- Improvement if acne
What transmits syphilis to a fetus?
The placenta
What are symptoms of secondary syphilis?
Rash, sore throat, and flu-like symptoms
How long should infants be in rear-facing car seats?
2 years old or outgrow the seat
