Exam 2 Flashcards
(238 cards)
1
Q
Nearly have of pregnancies in the U.S. are what?
A
Not planned
2
Q
Among 75% of adolescents that become pregnant did not _____ ______.
A
Plan it.
3
Q
The U.S. has the highest rate of what?
A
Teen pregnancy
4
Q
What is contraception?
A
- It is keeping the egg and the sperm apart.
* The intentional prevention of pregnancy during sexual intercourse
5
Q
What is birth control?
A
A device or a practice that decreases the risk for conceiving
6
Q
What is family planning?
A
The conscious decision on when to conceive throughout the reproductive years
7
Q
The decision to practice conception should be a decision made by who?
A
- A woman
* A woman and her significant other
8
Q
What is part of initiating conception?
A
Informed consent
9
Q
What is informed consent?
A
BRAIDED •Benefits: birth control •Risk: Always •Alternatives: may not a med •Inquiries: chance to ask questions •Decisions: who decides w/ HCP •Explanations •Documentation
10
Q
What is the cornerstone of the nursing care plan and planned Interventions?
A
Education
11
Q
What are methods of contraception?
A
- Fertility Awareness Based Methods (FABs)
* Consider cultural and religious beliefs
12
Q
What is the only form of birth control that is recognized by the roman catholic church?
A
Natural Family Planning
•Avoid intercourse during fertility periods
13
Q
What does a woman know when she is fertile?
A
- Ovulation test strips
* Basal temperature
14
Q
What are calendar based methods?
A
- Track when cycles are
- Lasting of menstrual cycle
- Symptoms
- Ovulating or not (increase in cervical mucous)
15
Q
What are methods of contraception?
A
- Spermicides
* Barrier Methods
16
Q
What are spermicides?
A
- Nonoxynol-9 (N-9) which reduces sperm motility
* Typical failure rate in first year of spermicidal use alone is 29%
17
Q
Are spermicides effective?
A
No
18
Q
What barrier methods are used?
A
- Condoms: M&F (vaginal sheath)
- Diaphram: 4 types
- Cervical caps:FemCap available in U.S.
- Contraceptive sponge: Today Sponge
- Toxic shock syndrome: risks are present w/ diaphragms, cervical caps, and sponges
19
Q
What do condoms also protect against?
A
STDs
20
Q
Do spermicides, intrauterine devices, and oral contraceptives protect against STDs?
A
No
21
Q
What does a woman have to do for a diaphram?
A
- Get fitted for it.
* Needs to be refitted if she’s had any significant changes in weight or if she was pregnant
22
Q
How are hormonal methods available?
A
- In varying formulations and administration; >100 different formulations available
- Combined estrogen-progestin oral contraceptives (COCs)
23
Q
What is the point of oral contraceptives?
A
- To inhibit ovulation by preventing the formulation of a follicle.
- We are suppressing the surge of the leutinizing hormone.
24
Q
How are combined estrogen-progestin oral contraceptives administered?
A
- Injection
- Transdermal (patch placed on weekly for 3 weeks and on the 4th week no patch)
* Rotate sites
25
What is a vaginal ring?
* Combo contraceptives
| * Nuva ring
26
What is a Nuva ring?
* Inserted into the vagina in the first 5 days of the cycle
* Important that women have backup contraceptives for 7 days after insertion
* Removed every 3 weeks so they are ring free for one week
27
What are warning signs to teach patients starting or taking COCs?
ACHES
•Abdominal pain may Indicate a problem with the liver of gallbladder
•Chest pain or SOB may Indicate possible clot problem within the lungs or heart
•Headaches (sudden or persistent) may be caused by cardiovascular
•Eye problems may indicate vascular accident or hypertension
•Severe leg pain may Indicate a thromboembolic
28
What is not ideal for patients with underlying cardiac issues?
Oral contraceptives because of the risk
29
What is very common with the Nuva ring?
•Severe leg pain (DVT) blood clots
30
What are some other adverse effects that we need to educate our patient on with methods of contraception?
* MI
* Stroke
* Suedomenstruation
* Birth control won't work while on antibiotics
* Related to increase in estrogen:
* N/V
* Dizziness
* Fluid retention
* Leg cramps
* BP unexpectedly high
31
What is pseudomenstruation?
* Happens on off week of cycle
* Occurs monthly
* Occurs during the 7 day of hormone free period
* Mimics the 28th day menstrual cycle
32
What is Progestin-only contraception?
* Contains no estrogen
* Safer
* Decreases the risk of cardiovascular side effects
33
What are some common side effects of Progestin-only contraception?
* Irregular bleeding and spotting
* Depression
* Mood changes
* Decreased libido
* Weight gain
* Recurrent yeast infections
* Acne
34
What kind of Progestins are there?
* Oral (Mini pill)
* Injectable
* Implantable
35
What is the failure rate for users that use Progestins (Mini pill)?
•9%
36
What is Progestin?
* Has to be taken at the same time every day
* Good option for breast feeding mom's because progesterone won't effect milk supply
* Inhibits conception by increasing viscosity of survical mucous
* Inhibits the surge of Lh
37
What is the injectable Progestin called?
* Depot vera
* Highly effective due to its action
* Lasts 11-13 weeks
* Thickens cervical mucosa
* Decreases motility of fallopian tubes
* Fertility may be delayed after taking (3 months)
38
What are implantable Progestins?
* Rods that are implanted
| * Last up to 3 years
39
What is a Intrauterine device (IUD)?
* Device planted into uterus
* Small T shaped
* Lasts 3-10 years depending on brand
40
What are the 4 IUDs?
* ParaGard Copper T
* Mirena
* Liletta
* Skyla
41
How long is the ParaGard Copper T 380A effective for?
Up to 10 years
42
What does the Mirena release and how long is it effective for?
* Levonorgestrel
| * Effective up to 5 years
43
What does Liletta release and how long is it effective for?
* Releases levonorgestrel
| * Up to 3 years
44
What does Skyla release and how long is it effective for?
* Releases levonorgestrel
| * Up to 3 years
45
What is the typical failure rate of IUDs in the first year?
0.2%
46
Do IUDs offer protection against STIs or HIV?
No
47
What is it important that we educate our patients on?
ACHES (signs of potential complications)
48
What are other methods of contraception?
* Permanent sterilization
* Female sterilization: Tubule occlusion
* Male (Vasectomy): interruption of bad deferens
49
When is the best day to start a contraceptive?
The first day a woman experiences menstrual flow
50
What is a quick start with contraceptives?
Can start at anytime but would need backup for 7 days and pregnancy HAS to be ruled out
51
What happens if someone has a missed dose of contraceptive and they are taking the combo (estrogen-progestin)?
* Take the next tablet and next scheduled tablet
* If more than 3 doses or 3 doses is missed she needs to discontinue the pack and allow for withdrawal bleeding and start a new pack
52
What happens if someone has a missed dose of contraceptive and they are taking Progestin only contraceptives?
•Take that pill as soon as we realize it's missed and backup contraceptives is needed for 48 hours
53
What is the breast feeding method of contraceptive?
* Lactational Amenorrhea (LAM)
* Temporary
* For breast feeding mom exclusively breast feeding around the clock
* Not effective if mom is pumping
54
What is conception?
Ovum is released during ovulation then the sperm enters the female reproductive system and the egg and sperm join
55
Where do the sperm and egg join?
Outer 1/3th of the fullopian tube
56
How long is sperm fertile for?
48 hours
57
How long are ovum fertile?
24 hours
58
When and where does implantation occur?
* The endometrium
* Occurs 6-10 days after fertilization
* Bleeding or spotting may occur
59
What is the first layer that is made?
```
Fetal membranes
•Chorion
•Amnion
Chromosomes
•XX- Female
•XY- Male
```
60
How is sex determined?
By the father of the baby
61
What does amniotic fluid do for the fetus?
* Space for movement and protection
* Thermoregulation
* Nutrients and fluid
* Protection
* Prevents umbilical cord suppression
* Prevents amnion adhering to the fetus
62
What can the amniotic fluid be tested for?
•Genetic studies
63
How much amniotic fluid should be present at birth?
800-1200mL
64
What is polyhydromnios?
Too much amniotic fluid >2000mL
65
What can too much amniotic fluid indicate?
GI malformations
66
What is Oligohydramnios?
Not enough amniotic fluid (<300 mL)
67
What can Oligohydramnios indicate?
•Renal malformations
68
What is the umbilical cord?
* Lifeline between mom and baby
* Protected by Wharton's Jelly
* No pain receptors
* Has 3 vessels:
* 2 arteries: carries deoxygenated blood and waste away from baby
* 1 vein: carries oxygenated and nutrient rich blood to fetus
69
What is the placenta considered?
```
An endocrine gland because it secretes:
HPL
hCG
Estrogen
Progesterone
```
70
What is detected in maternal serum 10 days after conception?
hCG
71
What is needed for fetal growth and development?
HPL
72
What is secreted by the placenta?
Estrogen
| Progesterone
73
When does the placenta develop and fully function?
* 3 weeks
| * 12 weeks
74
What does the placenta regulate?
Regulates transport of gases, nutrients, and waste
75
Towards the end of pregnancy the placenta begins to what?
Age
| Less effective of transportation of gas and nutrients
76
What is the maternal side of the placenta called?
The dirty dunkin
77
What is the fetal side of the placenta called?
The shiny shultz
78
What is the pre-embryonic stage?
* Conception to day 14
* Rapid cell division
* All tissues and organs will develop from
* Primary germ layer and the embryonic membranes form
79
What is the embryonic period?
* Period where defect most likely occurs week 3-5
* Day 15 to week 8
* Structures of major organs are complete
* Organ systems are functioning
* Teratogens!!! (Harmful to fetus and can cause defects) are greatest threat during this period
80
What are examples of teratogens?
* Radiation
* Lead
* Chemotherapy
* CMV (A virus)
* MMR vaccine: rule out pregnancy first and ensure she avoids pregnancy 28 days after vaccine; is safe for breastfeeding mother's
81
What is the period of time for the fetus?
Week 8 to birth
82
What months are the 1st trimester?
Months 1,2,3
83
What happens to the fetus during the 1st trimester?
* Limb buds
* Hematopoiesis (blood cell formationweek 3)
* Day 25 the heart is beating
* The 4th week the GI system is functioning
* Formation of liver, thyroid, bones, muscles, epidermis
* Neutral tube: start of CNS
* Folic acid is important for women of child bearing to take
* Fetus is 1/2 inch <1 oz
84
What are good sources of folic acid?
* Green leafy vegetables
* Orange juice
* Fortified cereals
85
What is the first functioning system?
Cardiac system
86
What happens in the 2nd month of the 1st trimester?
* Ears, ankles, wrists
* Eyelids-SHUT
* Hematopiesis continues
* 5th week swallowing and voiding
* Brain has 5 lobes
* Rh FACTOR>6 weeks
* Fetus is 1 in <1 oz
87
What is the second most important factor when looking at blood type?
Rh factor
ABO
A+
88
Rh are what?
•found as proteins on red blood cells
89
What happens during month 3 of the 1st trimester?
```
•Fingers and toes
•Soft nails
•Baby teeth
•Doppler
•Renal function
•Moving
•Adrenal cortex producing hormones
•Sex characteristics
•Lanugo covers the body of the baby (Fine hairs)
Vernix casiosa (cheese like coating)
•2.5 inches >1 oz
```
90
What hapoens during the 4th month of the 2nd trimester?
* Moves, kicks, swallows
* Handprints 16 weeks
* Forming meconium
* Placenta is fully formed
* 6-7 inch 5 oz
90
What hapoens during the 4th month of the 2nd trimester?
* Moves, kicks, swallows
* Handprints 16 weeks
* Forming meconium
* Placenta is fully formed
* 6-7 inch 5 oz
91
What hapoens during the 5th month of the 2nd trimester?
* Sleep/ wake intervals
* Week 20: insulin
* 8-12 inches 1/2 lb
* Actively felt by mom
92
What hapoens during the 6th month of the 2nd trimester?
* Lanugo all over
* Eyes open
* 11-14 inches 1-1.5 inches 1-1.5 lb
* 24 weeks
93
What trimester is the fetus viable?
The end of the 2nd trimester
94
What does viable mean?
The baby is more likely to survive outside of mom
95
What happens during the 7th month of the 3rd trimester?
* Open and close eyes
* Responds to light and sound
* Storing fat
* Testes descended into scrotum
* 15 inch 3 lbs
96
What happens during the 8th month of the 3rd trimester?
* Rapid brain growth
* Skull is soft/flexible
* Mature GI system
* Fe stored
* 18in 5lb
97
What happens during the 9th month of the 3rd trimester?
* Full term 37-40
* Brain 1/4 size of adult
* Gains 1/4-1/2 per week [6-9 lb 9-21 in]
98
What three structures are involved in fetal circulation?
* Fetal heart
* Placenta
* Fetal Tissues
99
What are the three purposes of fetal circulation?
* Good blood flow to the head and heart
* Decrease blood flow to the lungs
* Direct blood to the placenta
100
What will the fetus do to the lungs while in utero?
**•Shunt blood
**•No perfusion to the lungs
•Once baby is born and starts to breath the shunt is no longer needed and perfusion will go to the lungs
101
How do we know if a baby circulation is compromised while in utero?
* Not growing like we think
* Monitor fetal HR (doppler)
* Low HR!!
102
How do we increase the fetal heart rate while it's in utero?
Perform interventions on mom
| •Turn mom on side increases fetal circulation
103
Where is surfactant produced?
In the lungs
104
What does surfactant do?
* It reduces surface tension
| * Allows lungs to inflate which decreases the effort to breath.
105
When is surfactant being produced?
20-24 weeks and stabilizes the alveoli
106
When are alveoli matured?
35-37 weeks
107
What should the L/S ratio be?
2:1: indicated lung maturity
108
What can stimulate the production of L/S?
Maternal use of steroids
109
Anytime a women is pregnant with more than one fetus what is it considered?
High risk
110
How do you diagnose multifetal pregnancy?
* Polyhydramnios
* Asychronous FHR
* US evidence
111
What is the likelihood of a multifetal pregnancy?
* Family history of dizygotic twins in Female history
| * Use of fertile drugs
112
Often multifetal pregnancy will end in what?
Prematurity
113
What is Monozygotic?
* The fertilization of a single ovum by one sperm
* Identical twins
* Congenital malformations are more common
114
What is Dizygotic?
* Fertilization of 2 ova by two sperm
| * Fraternal/nonidentical
115
What is gravidity?
A pregnancy
116
What is a term birth?
A birth that is completed after 37 weeks
117
What's is preterm?
A baby that was born prior to 37 weeks
118
What is an abortion?
* A termination of a fetus
* Spontaneous
* Medical
119
What is a spontaneous abortion?
* Stillborn
| * Miscarriage
120
What is a medical abortion?
Use of surgical interventions
| Medications
121
What is living?
The number of children that the woman has that are alive
122
What is nulligravida?
Never been pregnant
123
What is primigravida?
A woman who is pregnant for the first time
124
What is a multigravida?
A woman who has been pregnant multiple times.
125
What is the five digit system?
* Gravity
* Term
* Preterm
* Abortion
* Living
126
What are signs of pregnancy?
* Presumptive
* Positive
* Probable
127
What is presumptive signs of pregnancy?
```
•Subjective data
Amenorrhea
Fatigue
Breast changes
Breast heaviness
Darker pigment to aerola
Nausea
Increase urinary frequency
Quickening: movement of fetus; week 16-20
```
128
What are probable signs of pregnancy?
```
Observed by the examiner
•Goodell sign
•Chadwick sign
•Hegar sign
•Uteran fundas
•HCG pregnancy test 4-12 weeks
•Ballottment week 16-28
```
129
What is the goodell sign?
* Note as early as 5 weeks after conception
| * Softening of the cervix
130
What is the Chadwick sign?
* Occurs between week 6-8
| * A bluish purple discoloration to the cervix
131
What is the Hegar sign?
* Between week 6-12
| * Softening of the lower segment of the uterus
132
What does the uterus fundus do?
It presses on the bladder so the globular shape of the uterus is gonna press on the woman's bladder
133
What are positive signs of pregnancy?
Definent evidence of positive that are only accountable to a fetus being present
•Ultrasound 5-6 weeks
•Fetal HR 6 weeks
•Palapation of fetal movement
•Leopold maneuver: palpating outline of fetus
134
What happens with the womans reproductive system when she is pregnant?
•Uterus increases in size and weight 12-14 weeks above sympathise pubis palpation then moves up to umbilical 22-24 weeks
* Cervix increases in vascularity, softens, increase in mucous production
* Mucous plug acts as a barrier against infection
•Vagina increased in secretions (Leukorrhea b/c increase in estrogen and progesterone)
Chadwick sign
•Perineum: supports pelvic structure in child birth
135
What happens with the womans cardiovascular system when she is pregnant?
•The heart is displaced to the left
•Cardiac volume and output increases 30-50%
•Vital signs
HR 10-15 Beats above baseline
BP same during 1st trimester; BP with drop 20
•Changes in periphery is edema
There are changes of the iliac veins and inferior vena cava by the uterus!
•Coagulation factors increase (hypercoaguable state)
136
What are the breasts?
* Intricate system of tissues that manufactures and stores breast milk
* Stimulated by hormones to prepare for lactation
* Colostrum : before milk 16 weeks
* Stria gravida
137
What happens with the womans respiratory system when she is pregnant?
* Anatomical changes with the diaphragm and RR unchanged
* Functional changes
* Slight hyperventilation
* Oxygen consumption Increases 15-20% from baseline
* Dyspnea
* Nasal stuffiness and epistaxis
* Respiratory system is more vascular in response to estrogen
138
What happens with the womans renal system when she is pregnant?
•Anatomical changes
Bladder has a reduced capacity
Ureters/kidneys increase in size
•Bladder more sensitive because uterus is pressing against the bladder
•Functional Changes
Urine formation is slightly increased
Nocturia
139
What happens with the womans integumentary system when she is pregnant?
```
•Vascular changes related to hormones and stretching
Melasma
Linea Nigra
Striae Gravidarum
Angiomas
Palomar erythema
```
140
What is Melasma?
* Blotchy brown mask in females with dark complexion
| * Fades after birth
141
What is linea nigra?
extends above umbilicus to pubic bone
midline
no clinical significance
fades after child birth
142
What is angiomas?
Spider veins
| Remain after birth
143
What is Palmar erythema?
pink reddish palms
no clinical significance
disappear after birth
144
What happens with the womans musculoskeletal system when she is pregnant?
```
•Exaggerated Lordosis
•Hormonal Influences
Pelvic expression
Increased softening and elasticity of ligaments
Abdominal muscles stretch
•Muscle cramps
```
145
What happens with the womans neurological system when she is pregnant?
•Carpel Tunnel
R/t edema pressure on median nerve
Usually occurs in late third trimester
May need PT even after pregnancy
Parasthesia, pain, swelling, and edema to wrist
146
What happens with the womans GI system when she is pregnant?
* Increase salivation
* Increased appetite
* Nausea and vomiting: related to hormones
* Delayed gastric emptying and intestinal motility
* GERD: increase in softening to esophagus related to increase of progesterone
* Delayed gallbladder emptying
* Pica: non-food craving
147
What happens with the womans endocrine system when she is pregnant?
* Estrogen: acne
* Progesterone: maintains pregnancy
* hCG: responsible for morning sickness
* Oxytocin
* Thyroid gland: increase in size
148
What happens with the womans endocrine system when she is pregnant?
Pancreas
•Fetus relies on maternal glucose and pulls from maternal supply
•Depletes maternal stores
•Dusting 1st trimester results in a decrease in maternal blood glucose
•2nd trimester maternal tissue sensitivity to insulin begins to decline
149
***What two major effects does higher blood glucose levels have?
* It makes more glucose available for fetal energy
| * It stimulates the pancreas of a healthy woman to make more insulin
150
Does maternal insulin cross the placenta?
No
151
If mom is hyperglycemic then the baby's blood glucose is too what?
High
152
When do women usually find out they are pregnant?
Week 6-8
153
When does prenatal care start?
Preconception to 1 year after birth
154
What is the prenatal period?
•Period of physical and psychological preparation for birth and parenthood
•Pregnancy diagnosis
EDD/EDC:Estimated due date/estimated due date of confinement
Nagaeles Rule
155
When do most women deliver their baby?
Plus or minus 2 weeks from EDD
156
What is Nagaele's rule?
•Assumes every female has a 28 day menstrual cycle
•Sperm and egg got together on day 14
•Add 7 to the first day of the last menstrual period
Subtract 3 from the month
Add 1 to year if applicable
157
Adaptions to Pregnancy
```
•Mood swings for mom
•Acceptance
Identifying as a mother
Establishing a relationship w/ fetus
Preparation for childbirth
```
158
What is the adaption of pregnancy that is paternal?
Couvade syndrome
159
What is a huge milestone with a pregnant women?
Say she is pregnant
160
What is couvade Syndrome?
When the dad experiences pregnancy like symptoms:
Nausea
Cravings
Weight gain
161
What is included in a prenatal interview?
```
Health history
Drug use
Family history
History of abuse
Physical exam
Lab tests: CBC, Anemia, Urine
Need to know about spinal disorders
History of sexual abuse
Pica
Genetic disorders
History of twins
Mental status
```
162
What is included in a fetal assessment?
Fundal height: How big uterus is growing
FHTs: fetal heart tones; HR
EGA : estimated gestational age; how many weeks?
Labs: genetic testing
Education: child care, how to feed baby, 20 weeks plus if baby isn't moving as much then notify HCP
163
What labs are performed on every woman?
```
HIV: Informed consent
Syphilis
Gaunarea
Chlamydia
GBS: swab performed between week 35-37
•Swab that goes from the vaginal canal to rectum
•Thrives in this area
•Can be passed to baby
•Not an STD
```
164
What is preterm labor?
```
Labor that occurs prior to 37 weeks
Want mom to know normal/abnormal discomfort
•Nausea NORMAL
•Vomiting NORMAL
•Back pain NORMAL
•Bright red bleeding ABNORMAL
•Uterine contractions ABNORMAL
•Changes in fetal movement ABNORMAL
```
165
Do women have a decrease or Increase in libido and when?
Increase in 2nd trimester
166
Pregnant women can not have any of what kind of vaccine?
Live vaccines viruses
| No MMR or varicella
167
What vaccines are okay for mom to get?
Hepatitis B
Flu shot
Tdap
168
What medications are not safe during pregnancy?
Ibuprofen
169
Who is least likely to receive prenatal care?
Adolescents
| •EDUCATION
170
What is considered advanced maternal age/delayed childbearing?
35 years and older
| Usually have to take fertility drugs (can cause twins)
171
What are alterations in pelvic support usually a result from?
Child birth
172
What is uterine displacement and prolapse?
This is where the uterus prolapse posteriorly and the cervix rotates anteriorly
•Usually 2 months after child birth the ligaments go back to normal
•In 1/3rd of women they don't go back to normal
173
What do patients complain about with uterine displacement and prolapse?
Pelvic or back pain
PMS
Intercourse will be painful
174
What is a cyctocele?
The protusion of the bladder into the vagina
175
What are causes of cyctocele?
Child birth
Obesity
Age
176
How do people feel with cyctocele?
Heaviness in vagina
| Urinary incontenance
177
What is rectocele?
When anterior rectal wall is herniated through vaginal tissue
178
What is the management for rectocele and cyctocele?
Surgical repair
| Pelvic physical therapy
179
What are genital fistulas?
Preparations between the genital track organs
180
What are signs and symptoms of genital fistulas?
Depend on location
Leaking of urine
Gas
Feces in the vagina
181
What is management of genital fistulas?
Surgical repair- may not always work
182
What percentage of females does urinary incontenance effect?
75%
183
What are ovarian cyst (benign neoplasms)?
•Dependent on hormonal influences associated with menstrual cycle
184
What is a follicular cyst?
* Most common in normal ovaries of younger females
* No signs or symptoms unless ruptures then she will have pelvic pain
* If no rupturing it will shrink and disappear after 2-3 menstrual cycles
185
What is the treatment of follicular cysts?
NSAIDS
Oral contraceptives: suppressing ovulation
Surgery for larger cysts.
186
What is polycystic ovarian syndrome?
* PCOS
* Relates to an endocrine imbalance due to an increase in estrogen, testosterone, LH, decrease in FSH
* Multiple follicular cysts (increase of estrogen)
187
What do we recommend for PCOS?
Diet
Weight loss
Medications (Oral contraceptives, metformin)
188
What clinical manifestations happen with PCOS?
```
Obesity
Hirsutism
Irregular menses
Infertility
Glucose intolerance
Hyperinsulinism
```
189
What nursing interventions are used for PCOS?
•Address physical and psychological concerns
190
What are uterine polyps?
* Benign
* Originate in the endometrium or cervix tissue
* Tumors arise from muscosa
* May be removed if in cervix
* Most common age group is multiparous women older than 40
191
What is education that should be given after removing a uterine polyps?
No tampons
No sex for a week
Signs and symptoms of infection
Notify provider if they experience any heavy bleeding
192
What are Leiomyomas?
* Aka fibroid tumors, fibromas, myomas, or fibromyomas
* Most common type of benign tumor
* Common in african american, women who have never been pregnant, and obese
* Rarely becomes malignant
* Typically asymptomatic
* If big: back ache, abdominal pressure, constipation, Dysmenorrhea
193
Are Leiomyomas slow growing?
Yes
194
Where do Leiomyomas originate from in the muscle?
Uterus
195
Growth of Leiomyomas is influenced by what?
Ovarian Hormones
196
Why do Leiomyomas spontaneously shrink?
After menopause because ovarian hormones decrease
197
What are Leiomyomas heavily influenced by?
Estrogen!
| It can affect implantation And maintenance of pregnancy
198
Women with Leiomyomas that are undiagnosed can experience what?
* Miscarriages
* Preterm labor
* Difficult labor
199
What is medical management of Leiomyomas?
* NSAIDS
* Oral contraceptives
* Growth hormone agonists because they will decrease the size of the fibroid
* Uterine artery embolization: block the blood supply to the thyroid to shrink it
200
What is surgical management for Leiomyomas?
Laser or operative removal
•Laser destroys small fibroids
Operative removal
•If large enough the entire uterus may need to be removed
•Severe bleeding or obstructing other organs
201
What are nursing interventions for surgical management of Leiomyomas?
Assisting the patient with coping with fertility issues
Consent has been signed
They may have concerns related to child bearing
Monitor for bleeding
202
Surgical management of hysterectomy
```
In hospital for 1-2 days
Pain because of surgery
Experience fatigue
Depression
Pelvic rest
Can have sex after healed
```
203
Surgical management of hysterectomy
```
In hospital for 1-2 days
Pain because of surgery
Experience fatigue
Depression
Pelvic rest
Can have sex after healed
```
204
What is the most common malignant neoplasm is what?
Endometrial cancer
205
What are risk factors with endometrial cancer?
```
Obesity
Nulliparity
Infertility
Late onset menopause
Diabetes
Hypertension
PCOS
Familia history of ovarian or breast cancer
Tamoxifen (antiestrogen agent)
```
206
Is endometrial cancer slow growing?
Yes
207
If endometrial cancer is localized then there are what?
Treatment options:
Hysterectomy (Removal of uterus)
Chemo (advanced stage)
Antiestrogen agents
208
What is the most significant risk factor for endometrial cancer?
Hormone Imbalance
209
What is the cardinal sign of endometrial cancer?
Abnormal uterine bleeding
210
How is endometrial cancer diagnosed?
Pap smear: collection of cells
Biopsy of endometrium: confirms
Pelvic exam to discover tumor
211
What are signs and symptoms of endometrial cancer?
Vaginal discharge: pinkish
Lower back pain
Pelvic pain
212
How many females are diagnosed endometrial cancer?
100,000 annually
213
What is the most common characteristic with endometrial cancer?
Obesity
214
What is the 2nd most common malignant cancer?
Ovarian cancer
215
What symptoms of ovarian cancer are there?
```
Vague
Most under diagnosed cancer of all
Seen signs:
Urinary urgency
Urinary frequency
Abdominal bloating
Increase in abdominal girth
Pelvic and abdominal pain
Feeling of fullness after eating
```
216
Are there definitive screenings/tests for ovarian cancer?
No
217
What is the cause of ovarian cancer?
Unknown
218
What are risk factors for ovarian cancer?
```
Nulliparity
Infertility
Previous breast cancer
Family history
Ethnicity (Northern american/european decent)
```
219
What is the treatment for ovarian cancer?
```
Surgical removal: ovary or radical hysterectomy
Cyctoreductive surgery: debulking tumor
Antineoplastic surgery
Chemotherapy
Radiation
```
220
What is cancer of the cervix?
* Third most common malignancy to reproductive system
* Begins as a lesion on the cervix
* Can spread
221
Where can cancer of the cervix spread?
Vaginal mucosa
Pelvic wall
Bowel
Bladder
222
The incidence of cervical cancer is highest in what race?
Hispanic women
223
What are 90% of cervical cancers caused by?
HPV
224
What is the diagnosis of cervical cancer?
Pap smear!!! Detects 90% of malignancies
Colposcopy: magnify cervix
Biopsy: remove cervical tissue to see if cancerous
225
Does cervical cancer have symptoms?
```
No
Could see:
Abnormal bleeding after intercourse
Rectal bleeding
Hematuria
Back and leg pain
Anemia
```
226
What is medical surgical management of cancer of the cervix?
Radiation
Laser ablation
Hysterectomy if invasive
Chemotherapy
226
What is medical surgical management of cancer of the cervix?
Radiation
Laser ablation
Hysterectomy if invasive
Chemotherapy
227
What is cancer of the vulva?
4th most common GYN cancer
Slow growing
Spreads late
90% survival rate
228
What is the most common site for cancer of the vulva?
The labia majora
229
What is treatment for cancer of the vulva?
Laser surgery
Cryosurgery
Electrosurgical excision
Vulvectomy
230
What is cancer of the vagina?
1%-3% of GYN cancer
231
Where do 50% of cases occur between what ages?
70-90 years
232
What are potential causes of cancer of the vagina?
Vaginal irritation
Vaginal trauma
Genital viruses
233
What is the occurrence of cancer and pregnancy?
1 out of 1000 women
234
What is the occurrence of cancer and pregnancy?
1 out of 100 women
235
What types of cancer occurs during pregnancy?
```
Breast
Cervical
Leukemia
Hodgkin
Melanoma
Thyroid
Colon
```
236
How long should the women wait to have another baby after cancer treatment?
2 years
