OB--EXAM 1 Flashcards Preview

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Flashcards in OB--EXAM 1 Deck (175):
1

♣ The core concept of women and family center care are:

• Dignity
• Respect
• Information sharing
• Participation
• Collaboration

2

♣ Nurses need to remember that _____ _____ is a key part in effective communication

active listening

3

• your way is the best way

ethnocentrism

4

When a person learns about the client’s preferences and their beliefs, a plan of care needs to be made by both the nurse or the family and the nurse and they need to work out certain things that the family is adamant about

Cultural relativism

5

♣ is a skill.
It involves respecting the differences others may have regarding religion, ethnicity, and ethno culture.

encourages uniqueness and values every culture

cultural competence

6

o care for the elderly or the infirm

medicare

7

aid for the poverty or situational crisis

medicaid

8

The priority in a home visit is to

obtain information that helps to create a comprehensive client profile

9

home visit usually lasts

1 hour

10

the 2 most important components of home care.

Safety and infection control

11

♣ The nurse should regard their personal safety as

priority number one.

12

what approach in well woman care

holistic

13

o Includes health needs throughout lifetime

well woman care

14

o OBGYN for needs as women age

physical exams

age-appropriate screenings

health promotion

15

o Usually enter for care 1st for

pap test or use of contraceptives.

16

spacing btwn pregnancies

18-23 months

17

o Usually one of the main reasons that a woman would seek treatment

menstrual problems

18

o This is seeking care prior to a pregnancy

preconception counseling and care

19

• If the mom is drinking during pregnancy,____ may occur.

Fetal Alcohol Syndrome

20

if mom smokes

low birth weight babies

babies addicted to nicotine

21

caffeine restriction should be

200 ml per day

22

fetal organ development occurs how many days after fertilization

17-56

23

o It is recommended that prenatal care be obtained within

12 weeks.

24

goals of prenatal counseling

o determining health status of mother and fetus

o Calculate the gestational age

Monitor fetal development

25

o Once infertility has been diagnosed

refer mom to specialist

26

o The transitional period to menopause

perimenopause

27

why do women seek treatment for perimenopause

hot flashes

28

why do women get hot flashes?

decrease in estrogen

29

♣ Babies of teens can be at risk because

teenage moms are not as prepared to take care of the baby.

30

♣ Women past the age of 35: can be more susceptible to

developing diabetes and having babies with Down syndrome.

31

black women

sickle cell anemia

32

women btwn ____ can be more susceptible to alcohol issues

21-34

33

how much folic acid

0.4 mg

34

food with folic acid

green leafy veggies
whole grains
fruits

35

when to start folic acid

8 weeks into PG

36

which method gives you 100% protection against STDs

none

37

o Directly linked to STDs

♣ Infertility
♣ Ectopic pregnancy
♣ Neonatal death
♣ Genital cancers
♣ AIDS

38

o These conditions may develop during pregnancy and can cause harm to the woman and unborn baby.

♣ Diabetes
♣ Hypertensive disorders
♣ Seizure disorders

39

o can cause miscarriage, preterm labor, or problems with fetus.

♣ Can cause infertility

Pelvic inflammatory disesase & endometriosis

40

o Other conditions could cause miscarriage, preterm labor or problems with the fetus

♣ Incompetent cervix
♣ Bleeding disorders
♣ Uterine fibroids
♣ Abnormalities of the uterus.

41

♣ Toxoplasmosis can occur when

eating raw or rare meat

handles feces of the cat

42

♣ Normally the target of the violence is the ______ so bleeding is a health risk.

abdomen

43

o The problem is greater than statistics show because it is often

unrecorded.

44

how to ask women you think has been abused why they came in?

o “what brings you here today”?

45

• Pelvic examination during pregnancy

o Pap test at first prenatal visit

46

o A pap smear will not be done if the hysterectomy was done _______.

for a benign disease.

47

mammograms when?

annually after 40

48

o After age 50 they start screening for

bone density.

49

o Microscopic test for cancer cells

Papanicolaou (Pap) test

50

Papanicolaou (Pap) test obtains cell from

cervis
endocervix
mucous membranes

51

what to instruct women before Papanicolaou (Pap) test

don't douche

use vag medications

or has sex 24-48 hours prior to exam

52

o The cycle of violence – 3 phases

• Tension building
• Battery
• Honeymoon period where the man would be very loving, and kind.
• (Today we no longer use this model because it is not thought to be accurate as to exactly what is happening).

53

♣ Women who survive these beatings often meet the criteria for _____

PTSD

54

Most homicide occurs once the woman

actually leaves the home.

55

♣ This is often a time when abuse starts due to the stress

pregnancy

56

♣ Maternal complications that come from abuse

• Depression
• Suicide
• Infections
• May turn to substances
• Secondary symptoms such as fatigue

57

ABCDES

alone
belief
confidentiality
document
education
safety

58

a broad term that describes many forms of sexual abuse.

sexual violence

59

the intentional, unwanted, completed or attempted, touching the genitalia of another person.

sexual assault

60

a legal term, this is used for forced sexual intercourse, or penetration of the mouth, anus or vagina or even a body part, anything that gets penetrated without the woman’s permission.

rape

61

___% of college women said they were raped at some point in their college career.

25

62

o this consists of non-coitus sexual activity between a child and an adolescent or an adult.

molestations

63

o involves the penetration involved in rape to a person 18 or over to a person under the age of consent. The age of consent varies from state to state.

statutory rape

64

o Why do men rape?
risk factors?

• Raped or molested as a child
• Abused some other way when they were a child
• Been raised to see women as sexual objects
• May have been raised to see women in a hostile way
• May think that the way a woman is dressed is asking to be raped

65

♣ Three phases of rape trauma victims

acute phase

outward adjustment phase

long-term process: reorganization

66

when the rape occurs, this phase starts. It can last for several days – up to three weeks. The woman will be in shock, denial, she will be in a state of disbelief. She might feel embarrassed, degraded, angry, fearful and vengeful. She might want to douche or shower to wash away the evidence.

acute phase

67

• Will look like she has recovered from the event. Might go back to work, continue normal routines. She will probably either buy a weapon, self-defense classes, install an alarm system. She also may not stop talking about the rape at this point, or she may not talk about it at all at this point. She may make radical changes, quit her job, move out of her house, may never want to step out of the house or be alone. She can develop sexual problems where she sees sex as something she does not want.

outward adjustment phase

68

• When she becomes depressed and anxious. She will discuss the rape one on one with someone at this point; she loses that denial and fear of being alone or in a crowd. She may develop nightmares and eating disorders. Recovery from a rape can take years and it is a very painful process. She no longer blames herself in this phase. These phases can also fluctuate back and forth.

reorganization

69


• Absence of menstrual flow
• Often a result of pregnancy

amenorrhea

70

two categories of amenorrhea

primary & secondary

71

♣ Absence of menses by age 14 with absence of growth and development of secondary sexual characteristics

primary amenorrhea

72

♣ Absence of menses by age 16 but normal development of secondary sexual characteristics

primary amenorrhea

73

98% of girls menstruate by age ?

16

74

causes of primary amenorrhea

• Extreme weight gain or loss
• Congenital abnormalities of reproductive system
• Stress
• Excessive exercise
• Hypothyroidism
PCOS
type 1 DM
eating disorders


75

♣ Absence of menses for 3-6 months in women who have previously menstruated regularly

secondary amenorrhea

76

causes of secondary amenorrhea

• Pregnancy – most common cause
• Breast feeding
• Emotional stress
• Depression
• Pituitary and endocrine d/o
• Early menopause

77

management for secondary amenorrhea

• Oral contraceptives
• Nutrition counseling
• Thyroid hormone replacement
• Other tx for underlying d/o

78

• painful menstruation
• Pain during or shortly before menstruation
• Cyclic perimenopausal pain
• Most common gynecologic problem in women of all ages
• Uterine contractions during all menstrual cycles; more intense/frequent.

dysmenorrhea

79

Abnormally increased uterine activity – cramps more frequent and intense

Not caused by underlying pathology

primary dysmenorrhea

80

♣ Increased _____ production by endometrium in ovulatory cycle in primary dysmenorrhea

prostaglandin

81

prostaglandin levels are highest when in primary dysmenorrhea?

1st 2 days of menses

82

♣ Usually appears within 6-12 months after menarche when ovulation is established

primary dysmenorrhea

83

meds to treat primary dysmenorrhea

NSAIDs
ibuprofen
naproxen

84

why do these meds work at treating primary dysmenorrhea?

it decreases the prostaglandin production

85

♣ Acquired menstrual pain

Painful menstruation

secondary dysmenorrhea

86

secondary dysmenorrhea is due to?

♣ due to pelvic or uterine pathology

87

when does secondary dysmenorrhea develop?

later than primary-- after age 25

88

♣ Average age or a girl starting menstruation

11-13 years.

89

♣ – the most common cause of secondary amenorrhea, fibroids, pelvic infection (PID), use of an IUD


pain beyond menstruation

endometriosis

90

managing dysmenorrhea

1. exercise
2. limit salts to prevent fluid retention
3. increase water for diuretic
4. increase fiber
5.warm showers or heating pads
6. take warm showers
7. keep legs elevated
8. relaxation
9. smoking cessation
10. used prostaglandin inhibitors

91

• Cyclic symptoms occurring in luteal phase of menstrual cycle; usually resolve once menses started

PMS

92

symptoms of PMS

• Abdominal bloating
• Pelvic fullness
• Breast tenderness
• Weight gain

93

♣ Emotional or behavioral changes

• Depression
• Crying spells
• Irritability
• Premenstrual cravings
• Headache
• Fatigue
• Backache

94

♣ More severe variation of PMS

o PMDD: (pre-menstrual dysphoric disorder)

95

sx of PMDD

• Mood changes/disturbances (more severe w/ PMDD)
• Anxiety and fatigue
• Appetite changes
• General sense of feeling overwhelmed
• These often occur during the luteal phase and have more of an emphasis on mood disturbances.

96

PMDD affects what % of women

3-8

97

♣ Will affect her ability to function
• Work related issues
• Interpersonal issues

PMDD

98

• Presence and growth of endometrial tissue outside of the uterus cavity:
o Ovaries
o Fallopian tubes
o Outer surface of uterus
o Bowels
o Areas between vagina and rectum

endometriosis

99

sx of emdometriosis

o Dysmenorrhea
o Pelvic pain
o Dyspareunia (painful intercourse)
o Abnormal menstrual bleeding
o May have problems with infertility

100

o tx of endometriosis with Women with mild pain wishing a future pregnancy

NSAIDs

101

o tx of endometriosis with Women with moderate to severe pain

♣ Treated with continual use of the birth control pill. (shrink endometrial tissue)

102

tx of endometriosis Women who do not wish to become pregnancy with severe pain

hysterectomy

103

o Intermenstural bleeding

or bleeding after menopause

metrorrhagia

104

causes of metorrhagia

BC pill
IUD
trauma
polyps
infection
ovarian cysts

105

o Excessive menstrual bleeding in either the duration or amount

menorrhagia (hypermenorrhea)

106

causes of menorrhagia

infection
IUD
fibroids
polyps
CA

107

treatment of menorrhagia

BC pill
fibroids surgically removed

108

menopause age?

late 40s-50s

109

median age for menopause

51-52

110

• The absence of your menstrual period for one year

menopause

111

• A period that encompasses transition from normal cycles to cessation of menses

• Marked by irregular menstrual cycles

perimenopause

112

sx of perimenopause

hot flashes
night sweats
sleep disturbances

113

tx of perimenopause

8 hrs of sleep
balanced diet
exercise
no caffeine, smoking, or alcohol
use of herbals
acupuncture
biofeedback
hypnosis
hormone therapy

114

• Marked by irregular menstrual cycles

osteoporosis

115

♣ Drop in _____ causes an imbalance between bone formation and resorption and causes a decrease in calcium absorption.

estrogen

116

who's at risk for osteoporosis

post menopausal white women

117

most common areas of the body affected by osteoporosis

vertebrae & hip

118

sx of osteoporosis

back pain
height loss
stooped posture

119

tx of osteoporosis

increase calcium in diet

weight bearing exercises

estrogen receptor modulator

120

menopausal hormonal therapy

ERT & HRT

121

HRT

Hormonal replacement therapy

122

Which hormones for HRT

♣ both estrogen and progestins

123

if pt still has the uterus

5 year treatment with estrogen and progesterone

124

NO uterus

only estrogen

125

o The intentional prevention of pregnancy during sexual intercourse.

contraception

126

o The device and/or practice to decrease the risk of conceiving, or bearing offspring.

birth control

127

o The conscious decision on when to conceive, or to avoid pregnancy, throughout the reproductive years.

family planning

128

BRAIDED informed consent

benefits
risks
alternatives
inquiries and questions
decisions may change mind
explanations
documentation

129

o Look at the advantages and success rate

benefits

130

o Information about disadvantages and failure rates

risks

131

o Information about other methods

alternatives

132

o Answer any questions she may have

inquiries and questions

133

o The opportunity to work with the woman so she can make the best decision

decisions may change mind

134

o Information about the particular method and how it’s used

explanation

135

o The information given to the client as well as her understanding on how to use

documentation

136

• “pull out method”

coitus interruptus

137

o Combo of charting s/sx of menstrual cycle with abstinence or contraceptive methods during fertile period.

fertility awareness based methods

138

o Periodic abstinence

natural family planning

139

how to tell when you're ovulating

lutenizing hormone surge in urine 12-24 hours after

140

♣ Based on monitoring and recording cervical secretions
♣ Woman needs to assess whether or not she noticed cervical secretions today or yesterday and then avoid sexual intercourse or use backup method of BC
♣ If no secretions – the probability of pregnancy is low

two day method

141

♣ Known as the “Billings Method”
♣ Relies on a woman being able to look at cervical mucus
♣ She needs to check and watch for stretch mucus which indicates her period of maximum fertility because the sperm can stay in this mucus until ovulation
♣ Avoid intercourse for 4 days after estrogen dominant mucus is apparent.

ovulation method

142

♣ A woman will take temp every morning before she gets up – nothing to eat or drink before
♣ She needs to use a basal thermometer which is more accurate

body temperature method

143

temp before ovulation

96-98 F

144

• popular also as a protective measure against spread of STDs

spermicides and barrier methods

145

o Chemical barriers may reduce the risk of some STDs but are not effective against

chlamydia, gonorrhea or HIV

146

♣ A physical barrier that has a chemical action on the sperm
♣ Effectiveness in preventing pregnancy depends on its consistent and accurate use

spermicide

147

when should spermicide be inserted?

no sooner than 1 hour before

148

♣ Mostly latex and they do provide protection against STDs

Should be used with water based or silicone lubricants

condoms

149

With the increase of latex allergies, condoms are not being made out of _______ – thinner and stronger than latex – research has been done

polyurethane

150

• Inserted up to 8 hours before sex – expensive
• This is if the male does not want to use a condom

female condom

151

what to educate your patient about female condoms

don't use it with a male condom because it could rip

152

♣ Covers the cervix preventing sperm from entering

diaphragm

153

what do you use with diaphragm

spermicidal jelly or cream

154

when do you need to get the diaphragm refitted?

after pregnancy or a 15lb weight fluctuation

155

when should diaphragm be inserted and removed?

up to 6 hours prior to intercourse and left in place for 6 hours after

156

♣ Additional _____ should be used with each active intercourse when using the diaphragm

spermicide

157

♣ Usually a good choice for women who are lactating and women who cannot or chose not to take the birth control pill and also for older women who smoke

diaphragm

158

how to reduce the risk of toxic shock syndrome with use of the diaphragm?

remove it 6-8 hours after sex

don't use it during menses

make them aware of s/sx of TTS

159

♣ Similar to the diaphragm in effectiveness and insertion
♣ Fit snugly over the cervix
♣ Held in place by suction

cervical cap

160

do you need to add additional spermicide with the cervical cap?

NOOOO

161

♣ This may be left in place for up to 48 hours but then should be removed after intercourse

cervical cap

162

♣ Must be moistened before inserting
♣ These will provide protection for up to 24 hours and numerous instances of intercourse
♣ Also be left in place for at least 6 hours after intercourse

contraceptive sponge

163

♣ Available in over 30 different hormonal variations

suppresses ovulation

combined estrogen-progestin (the pill)

164

who can use the pill

non-smoking women until menopause

165

advantages of the pill

♣ Very effective
♣ Not associated with the act of intercourse
♣ Its controlled by the woman
♣ Very easy and convenient to take the pill
♣ Usually you will see a rapid return to fertility once the pill has been discontinued
♣ A safe form of birth control for older non-smoking women

166

o Non-contraceptive benefits:

♣ Improvement in a woman’s menstrual characteristics

♣ Offered protection against endometrial cancer

♣ Protection against ovarian cancer

♣ Reduces the incidence of benign breast disease

♣ Improve acne in women

♣ Lowers the rates of ovarian cysts

♣ Helps treat endometriosis

♣ Decrease the risk of ectopic pregnancies

167

o Disadvantages of the pill

♣ Must remember to take it everyday
♣ Cannot be taken while women are breast feeding because it will interfere with milk production
♣ No protection against STDs

168

side effects of the pill

nausea
headache
fluid retentition
weight gain
breast tenderness

169

why can't smoking women take BC pill

blood clots

170

emergency contraception must be used when?

42 hours to 3 days after unprotected sex

171

3 emergency contraceptions

high doses of oral progestins

high doses of COCs(combined

oral contraception) or estrogen
insertion of copper IUD

172

example of oral progestins

plan b one step
plan b two step

173

over the counter for ages 15 and older

plan b one step

174

over the counter for 17 & older

need prescription for younger than 17

plan b two step

175

when to insert the copper IUD

within 5 days after. 99% effective