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Peds/OB > Ch. 4 - Reproductive Sys Concerns > Flashcards

Ch. 4 - Reproductive Sys Concerns Flashcards

1
Q

Reasons why some women seek care - periods not norm (expect be like clockwork - infection or something wrong)
Amenorrhea
Hypogonadotropic amenorrhea
Dysmenorrhea
Premenstrual dysphoric disorder (PMDD)
Alterations in cyclic bleeding

A

Menstrual disorders

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2
Q

No period/bleeding; a - absence of
Not disease but sign of disease
Look at whole body when reproductive organs goes wrong - something way outside causing issues
Primary
Secondary

A

Amenorrhea

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3
Q

Anatomic - born that way; something going on with reproductive internal issues - biconate uterus - two horns - septum through uterus - two separate uterine cavities; something with cervix - nothing come out
Endocrine - T1DM; thyroid gland - ary screw up period
Chronic diseases
Eating disorders - females tend have more than males; be anorexic or bulemic; not eating enough calories: estrogen loves fat and if no fat - low levels estrogen - no period; WELL below body weight average - not high enough estrogen to have periods - delay starting periods
Medications
NEVER HAD A PERIOD
Never started
Apply to teenagers
Menarche: 13
Never had period; still not started period

A

Primary

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4
Q

Had period and all sudden stopped - not had anymore
Pathological thing happened; something wrong with body
Most often result of pregnancy (#1)
A clinical sign of a variety of disorders
PCOS - common occurence - start off having norm periods; PCOS more issue as age - then skip periods; very irregular

A

Secondary

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5
Q

Problem in central hypothalamic-pituitary axis - something thrown off; number one 1 way thrown off - suppress hypothalamus
Results from hypothalamic suppression - extreme exercise
Management

A

Hypogonadotropic amenorrhea

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6
Q

Counseling and education regarding stress, exercise, and weight loss - why having no periods and how help it - back off exercise or eat more calories; has eating disorder later on in life - suppress hypothalamus but extreme exercise number 1 thing that suppresses hypo
Calcium, vitamin D

A

Management - Hypogonadotropic amenorrhea

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7
Q

Dys - painful
Pain during or shortly before menstruation
Primary dysmenorrhea
Secondary dysmenorrhea

A

Dysmenorrhea

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8
Q

Most have some sort of this
Late adolescent - ovulatory cycles and more regular more of this
Biochemical basis - prostaglandins act on endometrium causing it to cramp - sloughing line; making it uncomfy
Referred Pain down back, knees, inside thighs, migraines; affecting QOL
Arises from the release of prostaglandins
Abnormally increased uterine activity
Alleviating discomfort

A

Primary dysmenorrhea

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9
Q

Medications - birth control - dictate when have period; OTC: ibuprofen, aleve, NSAIDs, myodil, pamprin, naproxen, caffeine, red wine, chocolate, fast food
Heat
Thermo patches
Alternative modalities

A

Alleviating discomfort - Primary dysmenorrhea

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10
Q

Acquired menstrual pain associated with pelvic pathology - ie: ascending infection
Not norm; need fix it; often have STIs
Affect if have in periods
Diagnosis and treatment

A

Secondary dysmenorrhea

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11
Q

Pathologic cause of pain
Pelvic examination - offending agent causing it
Endometriosis - extremely painful periods and when not on period, or during intercourse or defectation
Provider do investigation
Not biochem basis - something else going on
Ultrasound examination, dilation and curettage, endometrial biopsy, laparoscopy
Treatment directed to removal of underlying pathology

A

Diagnosis and treatment - Secondary dysmenorrhea

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12
Q

Cyclic symptoms occurring in luteal phase (before start new cycle; after ovulation; second part of it - last two weeks; follicular phase - no symp - building up endometrium and start period - hormones start taking dive in ischemic phase and end menstrual cycles get mad - hormone changes affect women sig) of menstrual cycle
Cluster of physical, psychologic, and behavioral symptoms
30% to 80% of women experience symptoms - huge range women; not every month; sometimes worse than others
Multiple treatment modalities - NSAIDs help with bloating and cramping but not with PMS; just some patience

A

Premenstrual syndrome (PMS)

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13
Q

Cyclic symptoms occurring in the last 7 to 10 days of the menstrual cycle
DSM-5 diagnosis
Mental health diangosis
Most luteal phase - ½-⅔ luteal phase; week+ luteal phase
Huge mood changes
Delusions, hallucinations, SI, homicidal ideations; severe variant PMS; everything sets her off - isolate her off - angry, not sleeping well, seeing things off, horrible intrusive thoughts; soon as on period totally fine
Severe variant of PMS with emphasis on mood affectation
Affects 3% to 8% of women
Treatment similar to that for PMS; plus may warrant counseling, medications, and alternative therapies, such as hypnosis and acupuncture - behavioral variant; SSRIs - 7-10 days - low dose Prozac (10 mg qday - take right before period then stop); talk therapy; holistic therapy
Can be situational; not forever

A

Premenstrual dysphoric disorder (PMDD)

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14
Q

Oligomenorrhea
Hypomenorrhea
Menorrhagia
Metrorrhagia

A

Alterations in cyclic bleeding

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15
Q

(infrequent menstruation) - birth control, IUDs, PCOS

A

Oligomenorrhea

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16
Q

(scant) - birth control

A

Hypomenorrhea

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17
Q

(excessive menstruation) - leiomyomas/uterine fibroids - irritate uterus; toward end childbearing age - hormones go through changes

A

Menorrhagia

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18
Q

(bleeding between periods) - spot when ovulating, all over place with oral contraceptives, breakthrough period

A

Metrorrhagia

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19
Q

Presence and growth of endometrial tissue outside of uterus - on intestines, vagina, abdonimal cavity (periotoneal space); every month when endometrium bigger because estrogen - all lesions outside getting bigger, period - all spots also irritated and trying lose lining - causes scar tissue like crazy; adhesions cause pain and in wrong place
Centered around and just outside uterus - gets outside via fallopian tubes - lesions and scar tissue - not get pregnant - blocked fallopian tubes - fertilized zygote not get through - ectopic pregnancies
Major symptoms
Treatment

A

Endometriosis

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20
Q

Secondary Dysmenorrhea
Even not on period - Deep pelvic dyspareunia (painful intercourse) - hurts really bad; deep penetration hurts bad
Laparoscopy - see where lesions - easily identify them - laser and zap them to kill it - can still come back; hard get pregnant if not want have sex identify where lesions, now try get pregnant because come back soon; until goes through menopause endometriosis is an issue

A

Major symptoms - Endometriosis

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21
Q

Drug therapy - Lupron (#1) - med not have periods - not get pregnant - not hurting at all
Surgical intervention - remove adhesions

A

Treatment - Endometriosis

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22
Q

Sexually transmitted infections (STIs)
Chlamydia
Gonorrhea – Neisseria gonorrhoeae
Syphilis - Treponema pallidum
Pelvic inflammatory disease (PID)
Sexually transmitted viral infections
Herpes simplex virus (HSV)
Hepatitis A (HAV)
Hepatitis B (HBV)
Hepatitis C virus

A

Infections

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23
Q

Geriatrics getting more often
Women get STIs more often - sometimes asymptomatic; moist, dark - bacteria love that; men have business in one hole and on outside; women on inside; wreaking havoc on reproductive organs - asymptomatic; some already know within day or two
Includes more than 25 infectious organisms transmitted sexually
19 million people are affected annually in the U.S.
Prevention strategies

A

Sexually transmitted infections (STIs)

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24
Q

Safer sex practices
Abstinence
Knowledge of partner, reducing partners
Low-risk sex
Condom use
Vaccination
Safe sex in any position

A

Prevention strategies - Sexually transmitted infections (STIs)

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25
Q

Most frequently reported STI
Infections often silent and highly destructive
Difficult to diagnose
Have an itch
Chlamydia and gonorhea common together - drug resistant strains gonorrhea
Screening and diagnosis
Management

A

Chlamydia

26
Q

Screening of asymptomatic and pregnant women - screen all women; need have open conversation
Asymptomatic - test women walking younger than 25 and pregnant women
Comparisons of diagnostic procedures
Mucopurlent discharge - pus; cervix - angry and red - strawberry color

A

Screening and diagnosis - Chlamydia

27
Q

Drug therapy

A

Management - Chlamydia

28
Q

Oldest communicable disease
Aerobic and gram-negative diplococci
Screening and diagnosis
Management

A

Gonorrhea – Neisseria gonorrhoeae

29
Q

Women are often asymptomatic
Men can be asymptomatic - something dripping off end or diff color or hurts

A

Screening and diagnosis

30
Q

Treatment with antibiotic therapy
Drug-resistant strains on the rise

A

Management

31
Q

Transmission by entry in subcutaneous tissue through microscopic abrasions - sexually transmitted
Transplacental transmission may occur at any time during pregnancy - check multiple time; RPR or VDRL - lab check during first appointment and when come into labor - tested
Infection manifests itself in distinct stages
Screening and diagnosis
Management

A

Syphilis - Treponema pallidum

32
Q

Primary: 5 to 90 days
Secondary: 6 weeks to 6 months
Lesions on vulva - not painful - little uncomfy - red and angry but not super painful to touch
Herpes not look angry but extremely painful - lots nerve pain
Secondary rashes - palms hand and trunk and feel like dying; worse lethary and malaise; complaining vaginal discharge - like always do; looked like had flu
Fallopian tubes scarred up

A

Infection manifests itself in distinct stages - Syphilis - Treponema pallidum

33
Q

Pregnant women
Serologic tests
False positives

A

Screening and diagnosis - Syphilis - Treponema pallidum

34
Q

Penicillin - vicillin - thick shot in butt; flagyl
Sexual abstinence during treatment

A

Management - Syphilis - Treponema pallidum

35
Q

Gonorrhea and chlaymidia contracted and not treated - endometrium mad and now have raging infection and extremely painful - secondary dysmenorrhia and menorrhagia (bleeding a bunch because endometrium irritated)
Results from ascending spread of microorganisms from vagina and endocervix to upper genital tract
Caused by multiple organisms
Most commonly involves:
At increased risk for:
Usually younger women
Once PID - lot edu because not want again; more often get, less likely get pregnant - infection in there scarring reproductive organs
Screening and diagnosis
Management

A

Pelvic inflammatory disease (PID)

36
Q

Uterine tubes inflamed (salpingitis)
Uterus (endometriosis) - cause this sometimes; endometritis - inflammation endometrium
Excruciating
High fever; pelvic tenderness and pelvic fullness - extremely painful; US: abscesses in abdominal cavity from infection
Hospitalized and given IV antibiotics and painkillers

A

Most commonly involves: - Pelvic inflammatory disease (PID)

37
Q

Ectopic pregnancy
Infertility
After taken care of: Chronic pelvic pain as a result of this - not find pathology to care for

A

At increased risk for: - Pelvic inflammatory disease (PID)

38
Q

History
CDC routine criteria

A

Screening and diagnosis - Pelvic inflammatory disease (PID)

39
Q

Prevention
Oral or parenteral therapy
Bedrest
Education

A

Management - Pelvic inflammatory disease (PID)

40
Q

Human papillomavirus (HPV)
Can have vaginal delivery - not pass onto baby - tissue so friable that bleeds
Screening and diagnosis
Management

A

Sexually transmitted viral infections

41
Q

20 mil US infected
80 strains
Gardasil - 2 shots and covered 4 worst strains cause cervical cancer - vaccine: newst one covers lot more strains; do early before have intercourse - once exposed to HPV - getting vaccine still help but nearly not as effective; first layer protection - less worried about developing genital warts and cervical cancer
Most prevalent viral STI seen in ambulatory health care settings
Genital warts
More common in pregnant women
Symptoms

A

Human papillomavirus (HPV) - Sexually transmitted viral infections

42
Q

Irritating vaginal discharge with itching - irritation because lesions - often on cervix and not tell unless pap smear - wait until 21 - bodies shed virus - stop screening teenage girls - more conservative with management of woman if just waited because shed virus
Dyspareunia, postcoital bleeding

A

Symptoms

43
Q

History of known exposure
Physical inspection
Pap smear

A

Screening and diagnosis - Sexually transmitted viral infections

44
Q

Cryotherapy, ointments; virus: come back; once got it, it is there; not most comfy - some folks: smell bad because super moist and makes the smell
No therapy has been show to eradicate
Medications for discomfort
Counseling and education

A

Management - Sexually transmitted viral infections

45
Q

Still destructive
Treatment same regardless of type
Prevention critical; initial infection extremely painful
Lesions, fevers, chills, malaise, severe dysuria - acidic urine on lesion - extremely painful
AE on fetus at delivery
Not have vaginal birth if active lesion - does: C-section - kill baby if have herpes - herpetic encephalopathy - if recently healed still risk transmission; if inactive risk transmission low
Herpes simplex virus 1 (HSV-1)-nonsexual - cold sores on mouth - can be transferred onto genitalia
Herpes simplex virus 2 (HSV-2)-sexual
No cure - only suppression

A

Herpes simplex virus (HSV)

46
Q

Acquired primarily through fecal-oral route
Ingestion of contaminated food
Person to person contact
Vaccination is most effective means of preventing HAV transmission

A

Hepatitis A (HAV)

47
Q

Most threatening to fetus and neonate - check women for this
Disease of liver; often a silent infection
Transmitted parenterally, perinatally, orally (rarely), and through intimate contact
Vaccination series

A

Hepatitis B (HBV)

48
Q

Most common blood-borne infection in United States
Risk factor for pregnant women is history of injecting intravenous drugs - IV drug users
Currently there is no vaccine but is interferon cure for Hep C

A

Hepatitis C virus

49
Q

Heterosexual transmission now most common means of transmission in women
Estimated that 23% of new infections occur in women
Severe depression of cellular immune system associated with HIV infection characterizes AIDS
Symptoms include: fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash
Counseling for HIV testing

A

Human immunodeficiency virus (HIV)

50
Q

HIV testing offered early in pregnancy - healthy babies and pregnancies: suppress viral load to almost nothing, risk transmission extremely low to fetus and newborn; cannot breastfeed - ONLY vaginal births
Rapid testing preferred method
Perinatal transmission has decreased
Nurses must consider confidentiality and documentation

A

Counseling for HIV testing

51
Q

Bacterial Vaginosis
Candidiasis – Candida albicans
Trichomoniasis – Trichomonas vaginalis
Group B streptococci

A

Vaginal infections

52
Q

1 most common symptomatic vaginitis

Technically not sexually transmitted
Is a pH imbalance - lot things throw off pH: lot sex (friction getting rid all good bacteria), diff sexual partner, IS sexually associated, after period and get this for couple days, put things there not supposed be there, nuva-ring - foreign that goes up there and changes pH - meds for local estrogen
“Fishy odor” - most disturbing for woman; little itchy and thin, grayish and brown and blood and sometimes itchy but odor drives people crazy; clean more; soap up vagina but making it worse
odor - ammonia and bacteria - mixes with normal flora and offensive odor to it - not get rid stink and spraying stuff down there - showers multiple times and spraying stuff
Constantly cleaning
When on period
Vagina is self-cleaning organ
Preterm birth
One end of pH spectrum
Everytime take antibiotic
Self-limiting; leave alone go away; mild case not get med go away; med - Boric acid suppositories - capsules in vagina and neutralizes pH

A

Bacterial Vaginosis

53
Q

One end of pH spectrum
Sexually associated and vaginal infection
Vaginal infection and treated and Before gone and sex with partner and cont treat it - not bother him but prolong yeast infection
pH imbalance; not sexually transmitted all the time
Everytime take antibiotic
Fungus - candida is fungus
med - Boric acid suppositories - capsules in vagina and neutralizes pH
Common symptoms
Screening and diagnosis
Management

A

Candidiasis – Candida albicans

54
Q

Vaginal pruritus - extremely itchy
Not smell
Cheese-curd discharge - white cottage cheese

A

Common symptoms - Candidiasis – Candida albicans

55
Q

Physical examination
Vaginal pH

A

Screening and diagnosis - Candidiasis – Candida albicans

56
Q

Over-the-counter agents and modalities help that
Boric acid suppositories

A

Management - Candidiasis – Candida albicans

57
Q

STIs
Common cause of vaginal infection
Frothy and bubbly discharge
Screening and diagnosis
Management
Treat: Boric acid suppositories

A

Trichomoniasis – Trichomonas vaginalis

58
Q

Specular examination
Pap smear

A

Screening and diagnosis - Trichomoniasis – Trichomonas vaginalis

59
Q

Sexual transmission must be communicated to infected partner

A

Management - Trichomoniasis – Trichomonas vaginalis

60
Q

Associated with poor pregnancy outcomes - carry GBS - no symptom usually
Colonizes vagina, perineum, rectum - test all women going have vaginal deliveries at 36 weeks see if carry GBS in that area because if baby come in contact with GBS die; if + going give penicillin cross placenta and protect baby from GBS
An important factor in neonatal morbidity and mortality
Screening at 35 to 37 weeks of gestation decreases risk

A

Group B streptococci

Peds/OB (68 decks)

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