Exam 3 Study Guide

1. Identify and describe the four phases or the menstrual cycle. Menstrual Proliferative Secretory Ischemic First day of menses Period of rapid growth; endometrial layer thickens Day of ovulation Functional layer separates after blood supply is cut off and necrosis develops; right before menses begins

2. What is the significance or function of the structures identified below? Pair shaped muscle; Fundus is at the top; Corpus is in the middle; Isthmus is at the bottom. Functions include: Pregnancy and Menstruation Most likely to grow cancer; this is the site that cells are scraped for pap smear Infundibulom is closest to the cervix; Ampula is the site of fertilization; Isthma is the portion of the tube that tubal ligation occurs within; Interstitial is closest to the uterus Functions include: Passageway and Fertilization Functions include: Hormone production of estrogen and progesterone, and Ovulation. Fatty pad that has pubic hair; Function is to protect pubis bone during sexual intercourse Hairless folds of skin on either side of the vaginal orifice Folds of skin WITH hair on either side of the vaginal orifice Function is primarily sexual arousal Equivalent of male foreskin

Uterus Squamocolumnar Junction

Fallopian Tubes (Four Segments)

Ovaries Mons Pubis Labia Minora Labia Majora Clitoris Prepuce

3. Last menstrual cycle 7/09/2013. 34-day cycle. Calculate next menses and the probable date of ovulation Next menses is calculated by adding the cycle days to the LNMP: 7/09/2013 + 34 days = 43. There are 31 days in July therefore next menses will be on 8/12/2013. Next ovulation date is calculated by subtracting 14 from the cycle days: 34 days 14 days = 20; than by adding the LNMP to this number: 20 + 7/09/2013 = 7/29/2013 therefore next ovulation date will be 7/29/2013. 4. What is the nurses role in identifying intimate partner violence? RADAR- Routinely ask all patients; Ask directly, kindly, and nonjudgmental; Document all findings; Assess client safety; Review options and offer referrals. 5. Identify clues that might alert a health care provider of partner abuse. The abuser will get defensive easily, they will not want to leave their partners side and they will answer questions for their partner. 2nd trimester is the most common time for first abuse, abdominal pain of unknown origin, and injuries in different stages healing. Safety is priority! 6. List and describe the cycle of violence. Tension Building Violent Incident Honeymoon Stage Jealousy, Tantrums, verbal abuse, silent treatments, threats Emotion, psychological, and physical abuse occurs Overly kind and generous gifts, apologetic

7. Describe (cause, manifestations, diagnostic test, treatment) of the following: STI NAME CAUSE SYMPTOM DIAGNOSTIC TREATMENT Mycins Cyclins Floxin Suprax Rocephin Cipro Floxin Report to CDC

Clear to Chlamydi Trachomatis creamy mucoid a drainage

Culture

Gonorrhe a

Neissearia

Cervical motion tenderness Painless ulcer or wart Rash on palm and soles Systemic

Gram Stain

Syphilis

Treponema Pallidum

Serology VDRL and RDR

Cyclin

HPV

Single/Cluste DES r or lesions Exposure, that are Biopsy sex and painless (colposcopy oral (cauliflower) ) Pap smear transmissio in mouth and n throat Painful reoccurring ulcers, bleeding cervix. First outbreak is the worst.

Prevent with Gardasil. Treat with topical condylox/ardele ra Or cryotherapy to remove the lesions Zovarix Valtrex Topical Acyclovir Active Lesions require CSection delivery

Herpes

Direct contact with lesions

Visual inspection Culture Serology

STI NAME

CAUSE

SYMPTOM

DIAGNOSTI C

TREATMENT If the mother is positive, the baby gets HBIG as well as HEP B Vaccine prior to breastfeeding AZT Prenatal IV AZT during labor. NO BREASTFEEDING ! Boric acid suppository Flagyl Avoid alcohol or Clindamycin

Hepatitis B

MaternalFetal transmissio n

Jaundice

Serology

HIV

Blood and body fluids transmissio n

Asymptomatic , flu like symptoms

Serology

Vaginitis

Gardenella Haemophilus Yeast Infection; steroids, antibiotics , pregnancy, immune suppression Protozoan that thrives in alkaline environment

Fishy odor

Wet smear with positive clue cells

Candidiasi s

Cheese like patches Itching

Wet smear

Nystatin

Trich

Speckled strawberry marks on cervix Christmas tree colors

Speculum exam

Flagyl

GBS

Once positive, always positive

Asymptomatic

GBS culture between 35-37 weeks

Penicillin 5 mg loading and 2.5 mg every 4 hours until birth. Ampicillin 2 gram loading and 1 gram every 4 hours until birth

8. What does BRAIDED stand for? (Contraceptives) B- Benefits R- Risk A- Alternatives I- Inquiries D- Decisions E- Explanation D- Documentation 9. What does PAINS stand for? (IUD) PAINS10. ACHES11. Period late or abnormal Abdominal pain, pain with intercourse Infection exposure, abnormal discharge Not feeling well, fever or chills Shorter or longer strings What does ACHES stand for? (OCP) Abdominal pain, liver area Chest pains or shortness of breath Headaches, persistent rapid onset and unrelieved Eye problems Severe leg pain, blood clot Describe coitus interruptus.

Coitus interruptus is also known as the PULL OUT method; know that pre-ejaculation fluid still contains sperm and there is no STD or HIV protection. 12. Describe natural family planning

Natural family planning involves avoidance of intercourse during fertile periods. In order to use this method, one must know their ovulation period so they must keep track of their length of cycles with a calendar method for 6-12 months, chart their temperature prior to getting out of bed each morning, and monitor their cervical mucus discharge.

13.

Describe the barrier methods Trap and immobilize sperm; forms include foams, tablets, suppositories and creams. These can cause irritations and allergies Flexible latex cup that fits over the cervix and remains in place by suction acting as a barrier between sperm and the cervix. Leave in place 6 hours before and 48 hours after sexual intercourse. Intended for one time use only. Leave FLAT empty space at the tip of penis when applying condom. Shallow dome-shaped rubber device with a flexible ring that covers the cervix. Needs to be washed with soap and water after every use; inserted up to 6 hours prior and 6 hours after last intercourse. Should be replaced every 2 years; and should be replaced if significant weight loss >15 pounds occurs.

Spermicides

Cervical Cap

Condom

Diaphragm

14.

Describe hormonal contraceptive Estrogen and progestin or just progestin only pills. Side effects include hair loss, weight gain. Patient should report ACHES symptoms. Do not rub site after injection. Administer within 5 days of cycle. Lasts 90 days. Works by delaying fertility. Side effects include weight gain, decreased libido. Patient should have adequate Vitamin D and Calcium intake Releases progesterone for 3 years. Patient should report any abnormal bleeding PLAN B pill. Effective only 12-72 hours after sexual intercourse. Common side effects include nausea and vomiting so take an antiemetic an hour before taking each pill. Basically a high dose oral contraceptive.

Oral Contraceptive

Depo Provera Shot

Norplant Subdural Implant

Emergency Contraceptive

15.

Safe contraceptive during lactation; copper type serves as Spermicides IUD and inflames the Endometrim. Check for the presence of strings every month after menstrual period. What are recommendations for BSE & Mammography? 20-39 years old Once a month 2 weeks prior or 1 week after period Every 3 years High risk patients ONLY > 40 years old Same day every month if no longer having period Once a year Once a year

BSE Clinical Exam Mammography 16.

Describe the following: Painless, solid lumps. Ultrasound to biopsy Painful, multiple, fluid filled lumps Fatty tumor Fibroid tumor that has heavy bleeding; Patient will complain of anemia. Treatment includes stopping ovulation or hysterectomy even though it is not recommended. Treatment includes observation and pain control

Fibroadenoma Fibrocystic Changes Lipoma

Leiomyomas

Ovarian Cyst 17.

Describe newborns transition to extrauterine life.

Lasts up to 30 minutes after delivery; HR 160-180; Fine crackles, audible grunting, First period of nasal glaring and chest retractions all reactivity demonstrated. Breast feed, but do not bottle feed during this time.

Period of Decreased Response

Second period of reactivity

Lasts 60-100 minutes after delivery; HR 100-120; Infant is sleeping or has decreased motor activity during this time; infant is pink, respirations are rapid, shallow and unlabored up to 60 breaths/minute; audible bowel sounds present; This is a difficult time to feed but a good time for kangaroo care and parent bonding. Occurs 2-8 hours after delivery; Brief periods of tachycardia and tachypnea, increased muscle tone, increased mucus production; Meconium is commonly passed during this time.

18. Describe the following menstruation and infertility disorders: PMS cannot occur in women who do not ovulate; rule out psych disorders and depression. Keep calendar for symptoms. Treat symptoms with SSRI, OCP, and decrease salt and sugar intake Teens-20s; prostaglandins overproduction causes cramping on the first two days of period. Treatment is with NSAIDS >25 years old; organic pelvic disorder; chronic pain of cramping. Treat the underlying cause and treat symptomatically. Over growth of endometrial lining anywhere else in the body; Primary symptom is pain. Treatment includes pain medication, OCP, and annovulations to cease ovulation. Risk factors include obesity, 20-40 short cycles, heavy bleeding, and Caucasian. Diagnostic tests involve ultrasound, hysteroscopy, and laparoscopy. No bleeding; primary cause is pregnancy. Always rule out pregnancy before any further investigation. Removal of a sample of tissue form Endometrim for testing; you should be menstruating to have the procedure. Side effects: referred shoulder pain. Test indicated for infertility. Clean cup specimen for semen or condom without spermicidal for specimen. Avoid extreme temperatures with specimen. Sperm donor insemination Fertilization occurs in the fallopian tube Fertilization occurs outside the body and transferred into the fallopian tube. Egg is produced and then retrieved from ovary; a sperm sample is provided; the eggs and sperm are then mixed together in a Petri dish to allow fertilization and the fertilized eggs are reintroduced into the uterus

Premenstrual Syndrome

Primary Dysmenorrhea Secondary Dysmenorrhea

Endometriosis

Amenorrhea Endometrial Biopsy

Semen Analysis TDI GIFT ZIFT

IVF-ET

Gestational Carrier Surrogate Mother 19.

No biological connection; embryo host ONLY Biologically connected via the womans egg and a partners sperm

Newborn Physical assessment: Heart Rate Respiration Temperature Length Head circumference Chest circumference Caput Succadeum 110-160 bpm 30-60 breaths/minute 97.7-99.5 F 18-22 inches 32-37 cm; about 2 cm larger than chest circumference. Report any measurement >2 cm 30-35 cm Swelling of tissue crossing suture lines caused by pressure on head during delivery Swelling of the tissue NOT crossing suture lines caused by accumulation of blood When the infants head is turned to one side, the arm and leg on that side extend while the extremities on the opposite side flex (fencing position) Clear with bluish white sclera Listen for air movement or look for snot When side of face is stroked, newborn turns their head toward that side and opens their lips to suck Small white specks on the newborns gum lines Newborn will firmly hold finger placed in palm

Cephalohematoma

Tonic Neck Reflex

Eyes Nose Rooting/Sucking Reflex

Epstein Pearls Grasp Reflex

Moro Reflex

Startling the newborn elicits responding with flexion of thighs, fanning of fingers, clenching of fist, arms thrown out and then brought together again. Witchs milk whitish discharge Soft, may have linea nigra Two arteries, One vein (AVA) From moist to dry; cord clamp in place for 24 hours; usually falls off by 14 days Spine straight and flexible; Dimple at base of spine is indicative of Spina bifida Patent as evidence by passage of first Meconium stool; no rectal temps prior! Stroking the spine causes the pelvis to turn to that side Do not wash with soap until healed by day 5-6; monitor for bleeding and infection. Keep area clean! May have psedomeses- blood tinged mucous noted in diaper as a result of maternal hormones. Newborns thighs are pulled towards the body and pressure downward gently. Dislocation is felt as the femoral head lips out of the hipbone socket. Finger firmly placed against newborns foot; resulting in flexion of the toes Newborns toes hyperextend and spread apart when the foot is stroked upward from the heel towards to toes Peripheral cyanosis; blue color of hands and feet Fine hair covering body; most common in preterm infants

Breasts Abdomen Cord Care

Spine Anus Galant Reflex

Male Circumcision Care

Female Genitalia

Barlows Maneuver

Planter Grasp

Babinskis Reflex

Acrocyanosis Lanugo

Vernix Caseosa

Whiteish sticky, cheese like substance on skin of newborn

20.

Newborn heat loss Convection Radiant Loss of cooler air currents Indirect heat transfer from body to cold surfaces Loss of heat due to wet skin Direct heat transfer from body to cold surfaces Example: Newborn exposed to cold room Example: Newborn loss of heat to cold window or wall Example: Newborn not fully dried off after bathing Example: Newborn placed on cold crib without being warmed first

Evaporation

Conduction

21.

Integumentary system: Mongolian Spots Dark flat pigmented areas noted usually on buttocks or lower back Pink flat birthmark on forehead, eyelids, and back of neck that fade when pressed upon. Peeling of skin Tiny white pimples on newborns face and chin

Stork Bites Desquamation Milia 22. Calculate Apgar score. Sign Score 0 Flaccid Absent None Pale/Blue Absent

Score 1 Some Flexion < 100 bpm Grimace Blue Extremities Weak, Slow

Score 2 Active Motion > 100 bpm Sneeze, Cough, Cry Completely Pink Good Cry

A P G A R

Activity Pulse Grimace Appearance Respiration

23. Calculate gestational age, neuromuscular score, and physical maturity. Gestational age is calculated by using the chart to determine neuromuscular maturity and physical maturity than adding the two together to determine gestational age in weeks. 24. Describe hypoglycemia in a newborn. Hypoglycemia in the newborn is generally caused by maternal diabetes, LGA, Perinatal asphyxia, or IUGR. Symptoms include: blood glucose <40 for term infants and <25 for preterm infants in the first 72 hours of life. Newborns appear cyanotic, lethargic, jittery, diaphoretic; have unstable temperature, increased respiration rate and twitching. 25. Describe sepsis in a newborn. Neonatal sepsis is generally caused from GBS or Pneumonia; Antibiotics should be given as soon as diagnostic tests are performed. Symptoms include: respiratory distress syndrome, hypothermic, instable thermoregulation, seizures, jaundice, metabolic acidosis, hypo or hyperglycemia. IV fluids and IV antibiotics treat sepsis in the newborn 26. Describe the following: Abnormal development of the blood vessels in the retina seen in preterm infants associated with administration of high levels exogenous oxygen A lung condition that affects newborn who receive high levels of oxygen for extended periods of time or newborns placed on a ventilator >28 days

Retinopathy of prematurity ROP

Bronchopulmonary Dysplasia BPD

Necrotizing Enterocolitis NEC

The death of intestinal tissue most likely due to decreased blood flow to the intestines; newborn will have abdominal distention, upset GI, unable to tolerate feedings, and diminished bowel sounds. Encourage strict breastfeeding to prevent NEC;

27. Differentiate between premature and post mature newborns. Pre-Mature Newborns Age Post-Mature Newborns

Physical Symptoms

Gestational age < 37 Gestational age >42 weeks weeks Low birth weight, Wasted appearance, dry lanugo, abnormal cracked skin, long breathing patterns, nails, intrauterine undescended testes, passage of Meconium, poor feeding, less body profuse scalp hair, fat, thin and shiny absent Vernix Caseosa skin Monitor for RDS Give Exogenous oxygen Administer surfactant Decreased brown fat Unable to suck and swallow before 34 weeks Insensible water loss Immature immune system Anticipatory grief Resuming attachment Adjusting the home environment ROP BPD Monitor for RDS Suction often Lack of subcutaneous tissue Macrosomic Invasive procedures Anticipatory grief Resuming attachment Hypoglycemia Meconium Aspiration Syndrome Central Cyanosis

Respiratory Function Thermoregulation Nutritional Status Infection Control Parental Adaptation

Consequences