exam 3 study guide.docx

8/14/2019 Exam 3 Study Guide.docx

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Exam 3 Study Guide

1.Identify and describe the four phases or the menstrualcycle.

Menstrual First day of menses

Proliferative Period of rapid growth; endometriallayer thickens

Secretory Day of ovulation

Ischemic

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 structuresidentified below?

Uterus

Pair shaped muscle; Fundus is at the top;

Corpus is in the middle; Isthmus is at

the bottom. Functions include: Pregnancy

and Menstruation

Squamocolumnar

Junction

Most likely to grow cancer; this is the

site that cells are scraped for pap smear

Fallopian Tubes

(Four Segments)

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

OvariesFunctions include: Hormone production of

estrogen and progesterone, and Ovulation.

Mons Pubis

Fatty pad that has pubic hair; Function

is to protect pubis bone during sexualintercourse

Labia MinoraHairless folds of skin on either side of

the vaginal orifice

Labia MajoraFolds of skin WITH hair on either side of

the vaginal orifice

Clitoris Function is primarily sexual arousal

Prepuce Equivalent of male foreskin


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3.Last menstrual cycle 7/09/2013. 34-day cycle. Calculatenext 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 th

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 partnerviolence?

RADAR- Routinely ask all patients; Ask directly, kindly, an

nonjudgmental; Document all findings; Assess client safety;

Review options and offer referrals.

5.Identify clues that might alert a health care provider ofpartner 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 forfirst 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

Jealousy, Tantrums, verbal abuse, silent

treatments, threats

Violent

Incident

Emotion, psychological, and physical abuse

occurs

Honeymoon

StageOverly kind and generous gifts, apologetic


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7.Describe (cause, manifestations, diagnostic test, treatmentof the following:

STI NAME CAUSE SYMPTOM DIAGNOSTIC TREATMENT

Chlamydi

aTrachomatis

Clear to

creamy mucoid

drainage

Culture

Mycins

Cyclins

Floxin

Gonorrhe

aNeissearia

Cervical

motion

tenderness

Gram Stain

Suprax

Rocephin

Cipro

Floxin

Report to CDC

SyphilisTreponema

Pallidum

Painless

ulcer or wartRash on palm

and soles

Systemic

SerologyVDRL and

RDR

Cyclin

HPV

DES

Exposure,

sex and

oral

transmission

Single/Cluste

r or lesions

that are

painless

(cauliflower)

in mouth and

throat

Biopsy

(colposcopy

) Pap smear

Prevent with

Gardasil. Trea

with topical

condylox/ardel

ra

Or cryotherapto remove the

lesions

Herpes

Direct

contact

with

lesions

Painful

reoccurring

ulcers,

bleeding

cervix. First

outbreak isthe worst.

Visual

inspection

Culture

Serology

Zovarix

Valtrex

Topical

Acyclovir

Active Lesion

require C-Section

delivery


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STI NAME CAUSE SYMPTOM

DIAGNOSTI

CTREATMENT

Hepatitis

B

Maternal-

Fetal

transmissio

n

Jaundice Serology

If the mothe

is positive

the baby get

HBIG as wel

as HEP B

Vaccine prioto

breastfeedin

HIV

Blood and

body fluids

transmissio

n

Asymptomatic

, flu like

symptoms

Serology

AZT Prenata

IV AZT durin

labor. NO

BREASTFEEDIN

!

VaginitisGardenella

HaemophilusFishy odor

Wet smear

withpositive

clue

cells

Boric acid

suppositoryFlagyl

Avoid alcoho

or

Clindamycin

Candidiasi

s

Yeast

Infection;

steroids,

antibiotics

,

pregnancy,immune

suppression

Cheese like

patches

Itching

Wet smear Nystatin

Trich

Protozoan

that

thrives in

alkaline

environment

Speckled

strawberry

marks on

cervix

Christmas

tree colors

Speculum

examFlagyl

GBS

Once

positive,

always

positive

Asymptomatic

GBS

culture

between

35-37

weeks

Penicillin mg loading

and 2.5 mg

every 4 hour

until birth

Ampicillin

gram loadin

and 1 gram

every 4 hour

until birth


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8.What does BRAIDED stand for? (Contraceptives)B- Benefits

R- Risk

A-AlternativesI- Inquiries

D- DecisionsE- Explanation

D- Documentation

9.What does PAINS stand for? (IUD)P- Period late or abnormal

A- Abdominal pain, pain with intercourse

I- Infection exposure, abnormal discharge

N- Not feeling well, fever or chillsS- Shorter or longer strings

10. What does ACHES stand for? (OCP)A- Abdominal pain, liver area

C- Chest pains or shortness of breath

H- Headaches, persistent rapid onset and unrelieved

E- Eye problems

S- Severe leg pain, blood clot

11. 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 planningNatural 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.


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13. Describe the barrier methods

Spermicides

Trap and immobilize sperm; forms include

foams, tablets, suppositories and creams.

These can cause irritations and allergies

Cervical Cap

Flexible latex cup that fits over the

cervix and remains in place by suction

acting as a barrier between sperm and thecervix. Leave in place 6 hours before and

48 hours after sexual intercourse.

Condom

Intended for one time use only. Leave

FLAT empty space at the tip of penis when

applying condom.

Diaphragm

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.

14. Describe hormonal contraceptive

Oral Contraceptive

Estrogen and progestin or just

progestin only pills. Side effects

include hair loss, weight gain.Patient should report ACHES

symptoms.

Depo Provera Shot

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

Norplant Subdural

Implant

Releases progesterone for 3 years.

Patient should report any abnormal

bleeding

Emergency

Contraceptive

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.


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IUD

Safe contraceptive during lactation;

copper type serves as Spermicides

and inflames the Endometrim. Check

for the presence of strings every

month after menstrual period.

15. What are recommendations for BSE & Mammography?

20-39 years old > 40 years old

BSE

Once a month 2 weeks

prior or 1 week

after period

Same day every month

if no longer having

period

Clinical Exam Every 3 years Once a year

MammographyHigh risk patients

ONLYOnce a year

16. Describe the following:Fibroadenoma

Painless, solid lumps. Ultrasound to

biopsy

Fibrocystic

ChangesPainful, multiple, fluid filled lumps

Lipoma Fatty tumor

Leiomyomas

Fibroid tumor that has heavy bleeding;

Patient will complain of anemia.

Treatment includes stopping ovulation orhysterectomy even though it is not

recommended.

Ovarian CystTreatment includes observation and pain

control

17. Describe newborns transition to extrauterine life.

First period ofreactivity

Lasts up to 30 minutes after delivery; HR

160-180; Fine crackles, audible grunting,

nasal glaring and chest retractions all

demonstrated. Breast feed, but do not

bottle feed during this time.


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Period of

Decreased

Response

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.

Second period

of reactivity

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.


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18. Describe the following menstruation and infertilitydisorders:

Premenstrual

Syndrome

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

Primary

Dysmenorrhea

Teens-20s; prostaglandins overproduction

causes cramping on the first two days of

period. Treatment is with NSAIDS

Secondary

Dysmenorrhea

>25 years old; organic pelvic disorder;

chronic pain of cramping. Treat the

underlying cause and treat

symptomatically.

Endometriosis

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.

Amenorrhea

No bleeding; primary cause is pregnancy.

Always rule out pregnancy before any

further investigation.

Endometrial

Biopsy

Removal of a sample of tissue form

Endometrim for testing; you should be

menstruating to have the procedure. Side

effects: referred shoulder pain.

Semen Analysis

Test indicated for infertility. Clean cup

specimen for semen or condom without

spermicidal for specimen. Avoid extreme

temperatures with specimen.

TDI Sperm donor insemination

GIFT Fertilization occurs in the fallopian tube

ZIFTFertilization occurs outside the body and

transferred into the fallopian tube.

IVF-ET

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


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Gestational

Carrier

No biological connection; embryo host

ONLY

Surrogate

Mother

Biologically connected via the womans egg

and a partners sperm

19. Newborn Physical assessment:Heart Rate 110-160 bpm

Respiration 30-60 breaths/minute

Temperature 97.7-99.5 F

Length 18-22 inches

Head circumference

32-37 cm; about 2 cm larger

than chest circumference.

Report any measurement >2 cm

Chest circumference 30-35 cm

Caput Succadeum

Swelling of tissue crossing

suture lines caused by pressure

on head during delivery

Cephalohematoma

Swelling of the tissue NOT

crossing suture lines caused by

accumulation of blood

Tonic Neck Reflex

When the infants head is

turned to one side, the arm andleg on that side extend while

the extremities on the opposite

side flex (fencing position)

Eyes Clear with bluish white sclera

NoseListen for air movement or look

for snot

Rooting/Sucking Reflex

When side of face is stroked,

newborn turns their head toward

that side and opens their lips

to suck

Epstein PearlsSmall white specks on the

newborns gum lines

Grasp ReflexNewborn will firmly hold finger

placed in palm


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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.

Breasts Witchs milk whitish discharge

Abdomen Soft, may have linea nigra

Cord Care

Two arteries, One vein (AVA)

From moist to dry; cord clamp

in place for 24 hours; usually

falls off by 14 days

Spine

Spine straight and flexible;

Dimple at base of spine is

indicative of Spina bifida

Anus

Patent as evidence by passage

of first Meconium stool; norectal temps prior!

Galant ReflexStroking the spine causes the

pelvis to turn to that side

Male Circumcision Care

Do not wash with soap until

healed by day 5-6; monitor for

bleeding and infection. Keep

area clean!

Female Genitalia

May have psedomeses- blood

tinged mucous noted in diaperas a result of maternal

hormones.

Barlows Maneuver

Newborns thighs are pulled

towards the body and pressure

downward gently. Dislocation

is felt as the femoral head

lips out of the hipbone socket.

Planter Grasp

Finger firmly placed against

newborns foot; resulting in

flexion of the toes

Babinskis Reflex

Newborns toes hyperextend and

spread apart when the foot is

stroked upward from the heel

towards to toes

AcrocyanosisPeripheral cyanosis; blue color

of hands and feet

LanugoFine hair covering body; most

common in preterm infants


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Vernix CaseosaWhiteish sticky, cheese like

substance on skin of newborn


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20.Newborn heat lossConvection

Loss of cooler air

currents

Example: Newborn

exposed to cold room

Radiant

Indirect heat

transfer from body

to cold surfaces

Example: Newborn

loss of heat to cold

window or wall

EvaporationLoss of heat due to

wet skin

Example: Newborn not

fully dried off

after bathing

Conduction

Direct heat transfer

from body to cold

surfaces

Example: Newborn

placed on cold crib

without being warmed

first

21. Integumentary system:

Mongolian Spots

Dark flat pigmented areas noted

usually on buttocks or lower

back

Stork Bites

Pink flat birthmark on

forehead, eyelids, and back of

neck that fade when pressed

upon.

Desquamation Peeling of skin

MiliaTiny white pimples on newborns

face and chin

22.Calculate Apgar score.Sign Score 0 Score 1 Score 2

A Activity Flaccid Some Flexion Active Motion

P Pulse Absent < 100 bpm > 100 bpm

G Grimace None GrimaceSneeze, Cough,

Cry

A Appearance Pale/BlueBlue

ExtremitiesCompletely Pink

R Respiration Absent Weak, Slow Good Cry


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23.Calculate gestational age, neuromuscular score, and physica

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 materna

diabetes, LGA, Perinatal asphyxia, or IUGR. Symptoms

include: blood glucose


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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 Post-Mature Newborns

AgeGestational age < 37

weeks

Gestational age >42

weeks

Physical

Symptoms

Low birth weight,

lanugo, abnormalbreathing patterns,

undescended testes,

poor feeding, less body

fat, thin and shiny

skin

Wasted appearance, dr

cracked skin, long

nails, intrauterine

passage of Meconium,

profuse scalp hair,

absent Vernix Caseos

Respiratory

Function

Monitor for RDS

Give Exogenous oxygen

Administer surfactant

Monitor for RDS

Suction often

Thermoregulation Decreased brown fat Lack of subcutaneoustissue

Nutritional

Status

Unable to suck and

swallow before 34 weeks

Insensible water loss

Macrosomic

Infection

ControlImmature immune system Invasive procedures

ParentalAdaptation

Anticipatory grief

Resuming attachmentAdjusting the home

environment

Anticipatory griefResuming attachment

ConsequencesROP

BPD

Hypoglycemia

Meconium Aspiration

Syndrome

Central Cyanosis


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