exam Flashcards
(102 cards)
1
Q
How is HPV transmitted
A
skin-to-skin contact
2
Q
Signs and symptoms of HPV
A
Wart-like growths, cervical or vulvar CA(women), Anal, throat and mouth CA (men and women)
3
Q
HPV prevention
A
Gardasil 9
4
Q
HPV treatment
A
regular pap smears, TCA, laser or surgical removal for lesions
5
Q
How is Herpes simplex transmitted
A
direct contact with the person shedding the virus
6
Q
Primary HSV outbreak symptoms
A
malaise, muscle aches, headache, painful lesions
7
Q
Treatment for HSV
A
No cure, treat with acyclovir, valacyclovir, or famciclovir to improve quality of life
7
Q
Maternal effects of HSV
A
PTB, dermatological scarring, microcephaly, encephalitis, vaginal birth is contraindicated with active outbreak, neonatal sepsis/death
Mother given suppressive therapy at 36 weeks
7
Q
Chlamydia transmission
A
vaginal, anal, oral sex
7
Q
HIV transmission
A
blood and body fluids
Breast feeding is contraindicated
C-section delivery if viral load is over 1,000
7
Q
signs of chlamydia
A
mucopurulent discharge, dysuria, DUB
8
Q
Maternal/fetal effects of chlamydia
A
Salpingitis, endometritis, PID, infertility, ectopic pregnancy, PROM, PTB, ophthalmia neonatorum, neonatal pneumonia (1-3 months after birth)
9
Q
Treatment for chlamydia
A
Azithromycin 1gm or doxycycline 100mg x 7 days
treat partner and abstain for 7 days after completion
10
Q
Syphilis transmission
A
vaginal and oral
11
Q
Stages of syphilis
A
Primary: painless chancre (round, ulcerated lesion with raised edges)
Secondary: flu-like, sore throat, weight loss, rash on trunk, palms and soles
Latency: asymptomatic, + serology
Tertiary: life-threatening heart and neurological disease
12
Q
Maternal/fetal effects of syphilis
A
Death of untreated, congenital syphilis, PTB, fetal death, pericarditis, jaundice, anemia
13
Q
Treatment for syphilis
A
Penicillin G IM or IV: treatment of choice, specific regimen and duration depends on the length of infection
Kills bacteria and prevents further damage, does not reverse the damage
Re-evaluate at 6-12 months after treatment
14
Q
Bacterial vaginosis symptoms
A
Thin white or grey discharge, fishy odor, vaginal pH greater than 4.5
15
Q
Bacterial vaginosis maternal/fetal effects
A
PTB, LBW(low birth weight), chorioamnionitis, postpartum endometritis, PID
16
Q
Follicular phase
A
day 1-14
17
Q
First day of ovulation & implantation
A
day 14 first day of ovulation, implantation occurs about 3 weeks in the cycle (7 days after ovulation
18
Q
H-P-O axis
A
Hypothalamus secretes: GnRH
anterior lobe of the pituitary secretes: FSH & LH
Ovaries Follicles: Estrogen(increases GnRH) and progesterone (decreases GnRH)
negative feedback loop
19
Q
How long are sperm viable for
A
120hrs (5 days)
20
Q
Primary Amenorrhea
A
Absence of menses by age 15 and no secondary sex characteristics
No menses by age 16 and presence of secondary secondary sex characteristics
21
Secondary Amenorrhea
Absence of menstruation for 3 or more cycles or 6 months
Occurring in those who have previously menstruated (most common cause is pregnancy)
22
Causes for primary amenorrhea
Stress, excessive exercise, extreme weight loss or gain, chronic illnesses, hypothyroid
23
Causes for secondary Amenorrhea
*Pregnancy or lactation
Damage to hypothalamus, pituitary or ovary
*Birth control
Hysterectomy
Disruption in H-P-O axis
*Heavy athletic training
*Rapid weight loss or gain
24
Abnormal uterine bleeding
Any deviation from normal menstruation
Painless bleeding, prolonged, excessive and irregular
Can be ovulatory or anovulatory (ovulate or not)
*Absence of underlying structural or systemic disease
Changing pad every 1-2 hrs (80mL is considered excessive)
25
Treatment for AUB
Determine cause treat with contraception and nutritional counseling.
normalize bleeding
Correct anemia, restore quality of life
Iron replacement
Surgical intervention ( D&C, ablation, hysterectomy)
26
Primary Dysmenorrhea & management
Pain without underlying pelvic pathology. Typically, it begins 6-12 months after menarche, coinciding with ovulatory cycles. Present 12-14 hrs before flow lasting 12-24 hrs once menses begins.
Management: contraceptives(inhibit ovulation decreasing production of prostaglandins), nonpharmacologic, exercise, heat, NSAIDs, vitamin B, E
27
Secondary Dysmenorrhea
*pain can be present at any point during the menstrual cycle
Cause: anatomical factors or *pelvic pathology endometriosis, pelvic adhesions, inflammatory disease, fibroids
28
Premenstrual Syndrome & s/s
Cycle symptoms that occur during the luteal phase (that are severe enough to affect daily living)
Sx: headache, diarrhea, bloating, mood changes. They are relieved by menstruation.
29
Premenstrual dysphoric disorder & treatment
Most severe form of PMS affects up to 5% of childbearing women
Extreme mood shifts that can impact work and relationships (occurs during luteal phase) must have at least 5 symptoms
Tx:Antidepressants(SSRI: fluoxetine, sertriline, Zoloft)
Birth control(may skip menses in pack and start new pack)
Nutritional supplements
Herbal remedies
Diet and lifestyle changes(avoid alcohol, smoking cessation, adequate sleep)
30
IPV
All clients should be screened during preconception visits
31
Clinical behaviors of IPV & pts at risk
Populations at risk: women(pregnant), elderly, children, low income
Clinical Behaviors: may have chronic conditions caused by IPV, may have bruises
Evaluate patient alone, partner may not want to leave
Client may be quiet, vague nonspecific complains, wearing clothing to cover body, make excuses that don’t match
32
Guidance for IPV
somewhere to go, bag packed, phone number to shelters & police, be aware of surroundings, take different routes to work, provide photo to work security, cancel joint accounts, social worker involvement, identify a trusted individual for help if needed
33
Conception
Fertilized egg with sperm occurs in outer 3rd of fallopian tube, produces a zygote
34
Monozygotic
Identical twins
one zygote nucleus splits into two identical embryos
Results from one egg and one sperm
35
Dizygotic
Fraternal
two eggs are fertilized by two different sperm
36
Embryo
conception through the 8th week(at start of 9th week considered a fetus)
4 weeks: heart begins to beat
8 weeks: all organ systems are formed
Neural tube defects highest in this stage, healthy diet and folic acid are important
37
Placenta
function starts at day 21
Used for metabolic and gas exchange, acts as fetal lungs
provides glucose and amino acids for nutrients
Protects from certain medications and pathogens
38
Umbilical vein
goes toward baby carrying oxygenated nutrient rich blood (one)
39
Umbilical Artery
Away from baby carrying deoxygenated blood and nutrient depleted blood to placenta (2)
Maternal blood and fetal blood never mix
40
Umbilical cord
has 3 vessels ( 2 arteries, 1 vein)
Has no sensory or motor innervation
True knot rare but can occur
nuchal cord-encircles the fetal head
41
Amniotic fluid
Comprised of water, proteins, carbohydrates, lipids, electrolytes, fetal cells, lanugo and vernix (made by fetal kidneys during 2-3 trimester)does not provide any nutrients to the baby
Cushions the fetus
Prevents fetus from adhering to membrane
Allows freedom of movement
Provides a consistent warm environment
Helps dilate the cervix once labor begins
Has no nutritional value
42
Infertility
Ages 34 y/o and younger
Failure to achieve a successful pregnancy after 12 months or more of regular unprotected sex
Ages 35 y/o & older
Failure to conceive after 6 months or more of unprotected sex
educate on healthy lifestyle (quit smoking, healthy diet, weight loss if obesity), bimanual exam
43
Prediction of ovulation
Basal body temperature(first thing in the morning prior to getting up)
Ovulation predictor
Assess cervical mucous
44
PCOS & 4 key features
1. Ovulatory and menstrual dysfunction: amenorrhea secondary to anovulation(60-80% have this)
2. Hyperandrogenemia: Elevated levels of androgens(make hormones)
3. Clinical features of hyperandrogenism: hirsutism, acne, male pattern baldness
4. Polycystic ovaries: enlarged ovaries with fluid-filled sacs surrounding the egg
Metformin used to regulate insulin resistance, lifestyle modifcations with low hypoglycemic diet (green leafy veggies and fruit)
45
Endometriosis
presence of growth of endometrial tissue outside of the uterus
Usually on the ovaries and posterior rectovaginal wall
Symptoms: may be asymptomatic, pain starting several days before menstruation(most common), pain during intercourse(dyspareunia)
46
PID s/s
Inflammation of female reproductive organs, related to STI’s
Assessment findings:
1. CMT: cervical motion tenderness; chandelier sign
2. Uterine and adnexal tenderness: structures closely related to the uterus the uterus such as ovaries, fallopian tubes, and surrounding connective tissues
3. Mucopurulent (mucus and pus) vaginal discharge
4. Can lead to ectopic pregnancy or even infertility
47
Behavioral methods of contraceptives
Identify fertile time period and avoiding intercourse during that time
Calendar method
Cycle beads
Basal body temperature(track for a couple of months, pregnancy occurs 2-3 days prior to temp spike)
Cervical mucus(noting color and thickness, cloudy and sticky during fertile days)
48
Barrier methods
Sponge: can insert 24hrs before
Wet with water prior to insertion to activate spermicide
Must be left in for 6 hours after intercourse
Cervical cap
Must be fitted by provider
Should be used with spermicide
Diaphragm
Must be left in for 6 hours after intercourse
Should be used with spermicide(at the time of intercourse max 1 hr) or jelly
Must be fitted by provider
Condoms
Male and female condoms
Water soluble lubricant
Made from a variety of materials
One time use
49
Progestin only methods of contraceptive
Lactation is not impaired, less likely to cause cardiovascular problems. Should not be used for longer than 2 years due to potential side effects of loss of bone mineral(density). Give calcium and vitamin D
May have breakthrough bleeding and weight gain
Minipill
Injectable Depo-Provera (Medroxyprogesterone): given every 3 months
50
Combined (progestin/estrogen) contraceptives
Oral Contraceptive Pill: take daily at the same time
Patch: once per week for 3 weeks. No patch on 4th week
Vaginal Ring: one per month
Contraindications: for women with thrombolytic, Coronary artery disease, smoking, use with caution epilepsy decreased effectiveness, Antibiotics decrease effectiveness(should use backup method)
Prevents ovulation, thickens cervical mucus, prevents implantation
Decrease PMS, blood loss, improvement of acne
51
Warning signs for combined contraceptives
A = Abdominal Pain
C = Chest Pain
H = Severe Headaches
E = Eye problems
S = Severe Leg pain
52
Long-acting contraceptives
Nexplanon: 3 yrs Contraindicated in pregnancy, thrombolitic disease, liver disease, breast CA
May cause irregular bleeding, acne breast pain, osteopenia
May be used during lactation
Intrauterine device (IUD):
Can be used during lactation
Do not prevent STI’s
Contraindications: cooper allergy, pelvic infection, pregnancy
Interfere with sperm transport, increases vaginal mucus
Cooper: effective for 10 years
Side effects: Heavy menses, dysmenorrhea
Hormonal(levonorgestrel): effective for 3-8 years skyla(3 years) Mirena (8 yrs)
Lighter period and possibly no bleeding
53
diagnosis of pregnancy positive sign
Ultrasound confirmation, fetal movement felt by physician at 20 weeks, FHR(beating begins at 4 weeks, start to hear at 12 weeks)
54
Prenatal visits
Monthly up until 28 weeks then every 2 weeks from 28-36. Then weekly after 36 weeks
54
Initial labs
blood type ABO and RH, CBC, rubella/varicella titers, Venereal disease research laboratory or rapid plasma: screen for syphilis, hep B, HIV, pap, hCG (should double, checked every 2-3 days), Gonorrhea & chlamydia cultures, Transvaginal ultrasound(confirms EDC and or viability), genetic screening
Blood volume increases by 50% during pregnancy to perfuse the uterus and the support the pregnancy.
55
TORCh infections
Intrauterine and perinatal infections that can be dangerous to the baby possibly cause mortality.
Toxoplasmosis(from cats don’t change litter box), other (hepatitis), rubella, Cytomegalovirus, herpes simplex virus
If positive may be managed in the third trimester
56
Vaccines Contraindicated in pregnancy
MMR (attenuated)
Measles, mumps and rubella
Varicella (attenuated)
Chickenpox
Rubeola
Form of measles
57
Foods to avoid in pregnancy
Avoid deep sea fish, unpasteurized dairy, undercooked meat, unwashed fruits and vegetables, alcohol.
58
Normal weight gain in pregnancy
For BMI of around 25: Single pregnancy total=25-35lbs
Underweight 28-40 lbs/25 or above overweight variances should gain less 15-25
First trimester 2-4 lbs
second trimester 1lb per week
59
normal findings in pregnancy
Gastrointestinal System: saliva production increases, gastric emptying delayed,
decreased intestinal motility, reflux
Cardiovascular System: 50% increase in plasma, 30-50% increase in cardiac output (will increase HR)
Respiratory System: (RR will increase) enlargement of uterus shift diaphragm higher
Urinary System: bladder tone decreases, bladder capacity doubles
Musculoskeletal System: pelvis tilts forward, increases curvature of spine,
relaxation of joints
Integumentary System: hyperpigmentation of skin
Immune System: enhancement of innate immunity(inflammitory response), suppression of adaptive Immunity (protective response). Will increase the risk for
60
Warning signs in pregnancy when to call the provider
Vaginal bleeding or spotting: treated AB or placenta previa
Dysuria, frequency, urgency: UTI ->pyelonephritis ->PTL
Fever or chills: infection ->PTL
Prolonged nausea and vomiting: -> lead to dehydration ->PTL
Abdominal cramping or pain -> may indicate SAB
Decreased/absent fetal movement
61
kick counts
10 in 2 hours
62
normal FHR
110-160
63
Quickening
Starts at 16-20weeks
64
Coombs
Direct – is done on a sample of RBCs & detects if antibodies are attached to the RBCs
(+) RBCs have antibodies attached
(-) RBCs do not have antibodies attached
Indirect – is done on serum & detects if antibodies are in the bloodstream (if so, they could bind to RBCs)
(-) Pregnant mom has not developed antibodies and Rh sensitization has not occurred
(+) Pregnant mom has antibodies – if baby is Rh + we need to watch mom closely (Rh immunoglobulin)
64
Rhogam
Indication: give to RH-negative women at 28 weeks prophylactically
Also administered to women who had a pregnancy loss, amniocentesis or abdominal trauma
65
Amniocenteses
Aspiration of amniotic fluid for analysis, needle inserted via abdominal wall
Performed after 14 weeks gestation, done with ultrasound
Pt should empty bladder before test (reduces size and prevents puncture)
Pt must notify MD if experiences: fever, chills, leakage of fluid, decreased fetal movement, uterine contractions
RH negative mom should get Rhogam after procedure
Risk include: infection, animotic emboli, damage to fetus, death, PTL, ROm, fetal hemmorhage
66
+ GBS culture
Naturally occurring bacteria
Carried in the rectum or vagina
Life-threatening to newborns
Administer antibiotics during labor (penicillin G) if + administered every 4 hours for duration of labor.
67
Breast feeding benefits
Maternal
Decreased incidence of breast and ovarian cancer
Decreased risk of Type 2 diabetes
Cost effective
Bonding
Promotes gradual weight loss
Infant
Decreased childhood and adult obesity
Decreased risk of type 1 and type 2 diabetes
Decreased risk of SIDS
Decreased food allergies
Bonding
Immunologic properties help prevent infections(passed through breast milk)
68
Hormones related to breast feeding
Oxytocin = letdown of milk(milk flow) as well as cramping
Prolactin=increases as the baby eats to create more milk
Progesterone levels drop when placenta is delivered also stimulating milk production.
Empty bladder before breast feeding
69
SAB
Loss of a baby early before 12 weeks usually chromosomal abnormalities. Late 12-20 weeks maternal conditions.
70
s/s of SAB
VVaginal bleeding, starts as dark blood and changes to bright red
Abdominal pain/cramping
Low backache
Pelvic pressure
1-4 pregnancies end in this
Dx by following serial HCGs monitored weekly until 0
May have a speculum exam(check cervix) and an ultrasound(cardiac)
71
Types of SAB (miscarriage)
Threatened
Any bleeding before 20 weeks, no cervical dilation
Inevitable
Bleeding and dilation, no expulsion of products of conception
Incomplete
Partial expulsion of some but not all products of conception
Complete: Complete expulsion of all products of conception
Missed
Non-Viable embryo retained for at least 6 weeks
Recurrent
3 or more consecutive SABs
72
Treatment for SAB
hysteroscopy D&C, D&E
Rhogam if needed
Monitor for bleeding, infection, and maternal feelings
73
Induced abortion options
D&C or D&E techniques
Oral pills: mifepristone then misoprostol
74
ectopic pregnancy
An implantation of a fertilized ovum in an area outside of the uterine cavity
75
Risk factors of ectopic pregancy
Risk factors: compromised fallopian tube patency
STIs, tubal ligation/surgery, IUD, IVF
Can lead to massive hemorrhage or even death
76
Signs of ectopic pregnancy
Abnormal vaginal bleeding and abdominal pain between 6-8 weeks. Lower back and abdominal pain on affected side. Nausea, breast tenderness,
77
Treatment for ectopic pregnancy
Salpingectomy: removal of ruptured fallopian tube
Salpingostomy: incision into fallopian tube that preserves future fertility
Non-surgical management: methotrexate, chemotherapeutic agent
Rhogam: to Rh negative mother, not already sensitized
78
Nursing management for ectopic pregnancy
Nursing assessment: pain management, monitor bleeding
Nursing considerations: supportive care, allow to grieve, be culturally sensitive, support groups
Avoid pregnancy for 3 months
Will have serial HCG levels followed to 0
79
Hyperemesis Gravidarum
Persistent vomiting
Exact cause unknown
>5% weight loss from pre-pregnancy weight
80
Risk Factors for Hyperemesis Gravidarum
Elevated levels of HCG, elevated estrogen, increased glucose demands, genetics, psychological, GI disease, hyperthyroidism, vitamin B6 deficiency
Dehydration will increase HCG levels in the blood making condition worse
81
symptoms of hyperemesis gravidarum
Severe dehydration, weight loss(insufficient nutrition), ketonuria (break down of fat for energy), emotionally drained
82
Managment of hyperemesis gravidarum
Non-pharmacologic
Acupressure-sea bands
Ginger-pops, chews
Small meals and timing of snacks
Registered dietician
Pharmacologic
promethazine(antihistamine)
Pyridoxine and doxylamine (vitamin B6 and antihistamine)
Antiemetics (ondansetron) used cautiously
IV fluids and electrolytes
83
Twin complications
Maternal complications
Preterm labor, hypertensive disorders, PPROM (preterm pre-labor rupture of membranes), gestational diabetes, hemorrhage
Fetal complications
IUGR (intrauterine growth restriction), PTB, discordant twin growth, congenital anomalies, abnormal cord insertion, fetal demise
84
Oligohydramnios
may be caused by: kidney problems, umbilical cord compression, ROM, placental insufficiency, HTN, Postdates
Too little fluid (<500mL)
Fundal high may be less than expected
Monitor: serial ultrasounds, NST, BPP, maternal report of loss of fluid
85
polyhydramnios
Too much fluid (>2,000mL)
Uterine enlargement, abdominal discomfort, contractions, shortness of breath, lower extremity edema, fundal higher than expected
Monitor: ultrasound s/s of PTL
May be caused by: GDM, fetal anomalies, neural tube defects, down syndrome
86
factors that place mother at risk for GDM
AMA, PCOS, hx of large birth in the past, multiples, hypertension prior to pregnancy, hx of GDM
87
Potential risks related to GDM
polyhydramnios, Macrosomia, cardiac conditions in the baby, infections
88
chronic hypertension
BP's over 140/90 prior to 20 weeks
89
Gestational hypertension
2 BP's over 140/90 after 20 weeks gestation must be a least 4-6 hrs apart
90
pre-eclampsia
increased blood pressure + protein in urine
Vasospasm (results in increased BP) and hypoperfusion: causes reduced blood flow
91
pre-eclampsia workup
Urinalysis – proteinuria
Liver enzymes (ALT, AST)
Elevation indicates liver injury
Serum Creatinine/Uric acid (increased)
Increased serum level with kidney disfunction
CBC
Thrombocytopenia(less than 100,000)
Decreased H&H
92
pre-eclampsia + seizures
Delivery
Oxytocin, mag sulfate, BP medication
93
s/s of magnesium toxicity
absent deep tendon reflexes
decreased respirations/respiratory distress, decreased urine output
Antidote for toxicity: Calcium Gluconate
levels over 8 are considered toxic
94
Antihypertensive medication for pre-eclampsia
labetalol (beta blocker, lowers BP and HR),
hydralazine(vasodilator),
nifedipine (Ca channel blocker)
Lasix: if needed for edema
95
HELLP syndrome
Hemolysis
Due to fragmented RBCs trying to pass through narrowed vessels
Elevated liver enzymes
Due to endothelial damage and fibrin deposition in liver=necrosis
Low platelets
Due to vascular damage, vasospasm, aggregation at sites of damage
Can lead to DIC
96
Causes of PTL
Bleeding: placenta previa, placental abruption
Uterine stretching: polyhydramnios, multiples, large for gestational size, uterine abnormalities
Infections/inflammation: STIs, UTIs, amniotic fluid
Maternal/fetal stress: stress hormones trigger contractions
Unknown cause 40% of the time
