Advanced Nurse Practice in Reproductive Health Care, Exams of Nursing

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Advanced Nurse Practice in Reproductive Health Care

1. feminist perspective: A perspective that acknowledges the oppression of women within a patriarchal society that also struggles toward the elimination of sexist oppression and the domination of all human beings. 2. Alcohol Consumption and Women Recommended daily intake limit? Possible Risks?: Alcohol is hazardous for a woman who has either more than 7 drinks per week or more than 3 drinks per day. This amount put's women at risk for developing AUD (Alcohol Dependance Disorder). #Alcoholism
2. Tanner Stages: A scale used to assess the sexual maturity and puberty in both sexes. This scale involves 5 stages that involve development of breast and public hair growth and divides sexual physical maturity that extend from adolescence into adult hood.
3. Tanner Scale Stage One: Stage one: small nipples no breast, no pubic hair, no signs of puberty scrotum, testes, and penis are the same as in childhood
4. Tanner Scale Stage Two: Stage two: Breasts and nipples have just started to grow, the areola has become larger, breast tissue bud feels firm behind the nipple, initial growth of pubic hair that is light in color and not curled. Initial growth of scrotum and testes. The skin on the scrotum has become redder, thinner, and more wrinkled. The penis may have grown a little in length. Few hairs around the root of the penis. the

hairs are straight without curls, and light in color.

6. Tanner Scale Stage Three: Stage Three: breasts and nipples have grown addi- tionally. The aureola is darker and the breasts tissue buds have gotten larger. The public hair is more widespread. The hair is darker, and curls may have appeared. the penis has now grown into length. Scrotum and testes have grown. The skin of the scrotum has become darker and more wrinkled.
7. Tanner Scale Stage Four: Nipples and aerolas are elevated and form an edge towards the breast. The breast has also grown a little larger. More dense pubic hair growth with curls and dark hair. Still not entirely as an adult womens. the penis has grown in both length and width. The head of the penis has become larger. The scrotum and testes have grown more dense curly and dark hair. the hair growth is reaching the inner thighs.
8. Tanner Scale Stage Five: Fully developed breasts. Nipples are protruding. the edge between aerola and breast has disappeared. Adult hair growth.. Dense curly hair extending towards the inner thighs. Penis and scrotum as an adult. Public hair extends upwards up to the umbilicus. It is dense and curly.
9. Primary prevention vs. Secondary Prevention vs Tertiary prevention: Prima- ry prevention: Includes preventative measures that come BEFORE THE ONSET of a disease, illness, or injury, and BEFORE the disease process begins. Examples are, HPV vaccination, Safe sex

practices, immunizations, health education, and counseling. Secondary Prevention: Includes those preventive measures that lead to early diag- nosis and prompt treatment of disease, illness, or injury. Examples are, Pap smears, HIV testing, HPV testing, syphilis testing. routine lab screening for early detection of disease. Tertiary Prevention : Limits the ability and promotes rehab from clinical disease states. (Disease and illness is already here).

10. U.S. Preventive Task Force Who are they? What do they do? what do they recommend?: They are an independent volunteer panel or national experts in disease prevention and evi- dence-based medicine. They work to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.

11. American College of Obstetrics and Gynecologists recommendations: - Membership organization dedicated to the advancement of women's health care and the professional and socioeconomic interests of its members through continuing medical education , practice, research, and advocacy.
12. Preventable causes of death for women: The leading causes of death in women in the U.S. are related to modifiable, behavioral risk factors.

Smokin g Obesity High Blood Pressure

13. Women's Health Statistics What is the leading cause of death in females of all races and all origins?: - Heart disease (21.8%), Cancer (20.7%), and Chronic Lower Respiratory Disease (6.2%).

14. Women Health Statistics-What is the most common gynecological cancer in the U.S.?: Uterine cancer 15. Women's Health Statistics What gynecologic cancer in women causes the most deaths?: Ovarian Cancer

16. Women's Health Statistics What gynecological cancer is the MOST preventable?: Cervical cancer used to be the leading cause of cancer in women however due to regular pap testing cervical cancer has decreased significantly. Cervical cancer is also the MOST PREVENTABLE and the ONLY gynecological cancer with a screening test and a vaccine

17. List all of the possible gynecological cancers for women?: Uterine, Ovarian, Cervical, Vaginal and Vulvar. The HPV vaccination protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers. Recommended for pre teens ages 11-12 but can be given as early as 9 until age 26 ( this range will likely be on test but as of 2020 that range has been extended until the age of 40).
18. What are the advantages of taking an oral contraceptive for more than five years?: Ovarian and endometrial cancers decrease by 40-50%
19. What are the disadvantages of taking an oral contraceptive for more than five years?: Increases risk of breast and cervical cancers, even tho it lowers risk of ovarian and endometrial.
20. Unintended pregnancy Statistics: Unintended pregnancy rates per 1,000 women were highest among women who are 1.18-24 years old 2.Low income, < 100% of federal poverty level

3.Had never completed high school 4.Were Non-hispanic black or african american 5.Were cohabiting but never married. Most unintended pregnancies result from not using contraception consistently or correctly or at al.

21. Cultural Perspective of Women: To create a culture in health care settings where providers must educate themselves about the health needs and concerns of the population and create environments that are welcoming, nonthreatening, and normalized to people of ALL gender, identities, and sexual orientations.
22. World Health Organization (WHO): Who are they and what do they do?: - They are a world health org that plays an essential role in the global governance of health and disease. They establish, monitor, and enforce international norms and standards. They define health as a " state of complete physical, mental, and social well-being and not just the absence of disease or infirmity". ** Definition of Infirmity means physical or mental weakness****
23. HIV Screening Recommendations: The CDC recommends HIV screening as a routine part of clinical care for patients ages 13-64 in ALL health care settings. Patients who present for STI treatments should be screen for HIV at each visit.
24. Screening Guidelines for IPV (Intimate Partner Violence).: All women of childbearing ages 14-46 should be screened for IPV.
25. Factors that put women at risk for IPV: Pregnancy, history of

depression, low self-esteem, poverty, unemployment, controlling partner, and community or family with male dominant forms.

26. Definition of rape: There is still no clinical definition of sexual assault or rape that has gained acceptance. clinicians should become familiar with their states definitions and corresponding laws. The revised UCR definition of rape is: Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.
27. Genital Trauma and Rape Statistics: 1 in 5 women have been raped at one point in there life. Victims of rape are less likely to report their perpetrator if they know the person 80% of assaults are either a former partner, friend, family, member or acquaintance
28. Evidentiary Examination of a Rape Victim: A evidentiary collection kit should be used and instructions on how to collect, preserve, seal, and store samples should be followed. Collection should be done AFTER inspection of the area and prior to palpitation or physical manipulation of the area. STD possibility should be treated prophylactically even if tested negative, pregnancy test should be given and emergency contraception may be given up to 120 HOURS OF THE ASSAULT (A SINGLE DOSE OF LEVONORGESTREL (PLAN B) 1.5 MG.
29. What does the Pneumonic EMPOWER stand for?: It is used for intimate partner violence and stands for... Empathetic listening

Making time to properly document findings Provide information about domestic violence Offering options and choices Working with a domestic abuse specialist Encouraging the planning for safety and support Referring to local services

30. Gravida Para Abortus system GTPAL: Gravidity= the number of pregnancies Para= deliveries aka same thing as term; Ex. G2P1 1 abortion LC 1 vaginal birth Term: Term deliveries (38 weeks or more) Preterm: deliveries up to 37 weeks Abortus/Miscarriages : Abortion (surgical or miscarriage) LC=Living Children P: Para= number of births of viable offspring
31. Healthy People 2020 who they are and why they are important: Devised using a framework that focuses on determinants of health with an extra focus on social determinants (Personal, social, economic). Healthy people focus areas include... 1.Cancer 2.HIV 3.LBGQT health second definition from the CDC's website on healthy people 2020 objectives provides science-based, 10-year national objectives for improving the health of all Americans. Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across communities and sectors; empower individuals toward making informed health decisions; measure impact of prevention activities.

32. American College of Nurse-Midwives (who can they treat?) definition of scope of practice: primary care providers throughout the lifespan with a special emphasis on pregnancy, childbirth, and gynecological reproductive health.
33. Hyperandrogenism: An endocrin disorder that results in excessive levels of androgens ( male sex hormones such as testosterone) in the female body. S/S muscular male like body, deepening voice, clitoromegaly, increased iibido, menstrual irregularity, HTN, Hyperlipidemia, glucose intolerance, hirsutism (aka dark course hair in male like matters on face, chest, back). , alopecia, acanthosis nigricans (discolored dark velvety patches in skin folds and creases (armpits, groin, and neck (underlying obesity, tumor, or cancer causes A.N) oily skin, and acne. Quick Patho: POS --> inc testosterone levels (causes hirsutism (aka facial hair), insulin resistance and hyperinsulemia, -->Inc LH (luteinizing hormone) Causes: Usually POS (polycystic ovarian syndrome causes 80-90% of cases Diagnosis includes Serum Testosterone (normal 20-80) Serum 17a-hydroxyprogesterone (normal <2) dehydroepiandrosterone (normal 250-300) Dexmethasone supression Test,LH, lipid profile
34. BMI Formula what is considered overweight and underweight: Weight

(Lbs) x 703/height (in) squared BMI 19-24=Normal 25- =overwight 30-39= obese

40 extreme obese

35. Screening for Thyroid Dysfunction: TSH screening in all adults ages 35 and repeated tests every 5 years thereafter. If s/s of thyroid problems screened again and if abnormal screenings should be done yearly. Pregnant women should have TSH measured immediately after becoming pregnant goal TSH levels 2.5-3.5. (Women who are pregnant should only use levothyroxine alone and not combined with any other medications for the thyroid especially liothyronin (triostat).
36. Screening for Rubella Immunity: A rubella blood test looks for IgG antibodies made by the immune system and will stay in the blood stream for years. The IgG antibodies are produced by the immune system in response to a recent infection, a past infection, or that you have received the vaccine. Women who do contract rubella when they are pregnant are at risk for miscarriage, still birth, and fetal defects with the most common birth defect being DEAFNESS
37. Osteoporosis screening, risk factors, how to measure risk, the name of the screening test: The USPSTF recommends screening for osteoporosis

with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. Those at risk should be screened at age 60 Risk Factors include... 1.postmenopausal women younger than the age of 65 with atleast one risk factor 2.parental history of hip fracture 3.smoking 4.excess alcohol consumption 5.low body weight. Best way to measure risk is to use a clinical risk assessment tool. Several tools are available to assess osteoporosis risk, such as OST, ORAI, OSIRIS, SCORE, and FRAX. SCREENING

The most commonly used test is central DXA of the hip and lumbar spine this provides measurement of bone mineral density, and most treatment guidelines use central DXA to define osteoporosis and the treatment threshold to prevent osteo- porotic fractures. Other screening tests include peripheral DXA and quantitative ultrasound. The U.S. Food and Drug Administration has approved multiple drug therapies to reduce osteoporotic fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen. The choice of therapy should be an individual one based on the patient's clinical situation and the trade-off between benefits and harms. Other relevant USPSTF recommendations The USPSTF has made recommendations on interventions to prevent falls in com- munity-dwelling older adults and the use of vitamin D, calcium, or combined supple- mentation for the primary prevention of fractures in community-dwelling adults.

38. Screening for Cardiovascular Disease: Blood pressure screening at each health care visit and once a year if low bp. Cholesterol checked every 4-6 years for normal risk if elevated than yearly BMI yearly at annual well visit Smoking and physical activity at each visit If abnormals, EKG and stress tests. EKG yearly if HTN.

Risk factors older age, male sex, high blood pressure, current smoking, abnormal lipid levels, di- abetes, obesity, and physical inactivity. Several calculators and models are available to quantify a person's 10-year risk of CVD events; the USPSTF recommends that clinicians use the Pooled Cohort Equations to assess CVD risk. Treatments Asymptomatic adults at increased risk of CVD events are usually treated with a combination of diet and exercise modifications, lipid- lowering medications, aspirin, hypertension management, and interventions to encourage tobacco cessation. Other relevant USPSTF recommendations The USPSTF has made recommendations on many factors related to CVD pre- vention, including screening for high blood pressure, use of statins, counseling on smoking cessation, and counseling to promote healthful diet and physical activity. In addition, the USPSTF recommends low-dose aspirin use in certain persons at increased risk of CVD events.

39. Why do we screen for TYPE 2 DIABETES but not TYPE 1?: TYPE 1 DIA- BETES Screening for type 1 diabetes is not recommended for the following reasons: patients typically present with an acute onset of symptoms, no established cutoff value is available for antibody tests, no accepted treatment exists for

patients who are asymptomatic, and no medication is available to prevent the disease in persons genetically predisposed to type 1 diabetes TYPE 2 DIABETES Screening is recommended for type 2 diabetes because reliable tests are available, and lifestyle changes and medications reduce progression and adverse sequelae of the disease, even in persons who are initially asymptomatic.

40. Diabetes in women (pregnant and nonpregnant): (USPSTF) recently updat- ed recommendations and suggests screening individuals 40 to 70 years of age who are overweight or obese. Persons with abnormal results should be referred for intensive behavioral counseling interventions focusing on physical activity and a healthy diet. Clinicians should consider screening certain individuals at higher risk. repeat screening every 3 years and a fasting blood glucose yearly. PREGNANT WOMEN-Glucose test is done between 24-28 weeks. The test may be performed earlier if high glucose levels are in the urine or if they had Gestational DM in previous pregnancies.
41. CERVICAL CANCER AND SCREENING: Pap-test 21-65 (cervical cancer screen) New screening interval was recently updated from annually to once every three years if normal Co-testing with HPV via PAP every 5 years for ages 30-65.

42. Colorectal Cancer Screening: USPSTF recommends screening all adults ages 5-75 years old. Early screening in women if a first degree relative had colorectal cancer at a young age. If they have inflammatory bowel disease, or rare genetics such as familial adenomatous polyposis or nonpolypous
43. Use of the Rectovaginal examination: perform with the patient laying in a supine lithotomy position (lithotomy means with legs up in stirrups). Used in a person who has a retroflexed or retroverted uterus. allows palpitation to depth of 2.5 cm's more than transvaginal ultrasound. This is very uncomfortablly and usually omitted unless very necessary.
44. Types and Sizes of speculums: There are three main types of cervical specu- lum: pediatric, Pederson and Graves. They come in plastic and medal. The Pediatric Speculum (smallest most narrow) Shorter in length, the pediatric speculum is intended for use in patients who have never had sexual intercourse and therefore have narrower vaginal canals The Pederson Speculum Flat and narrow, the Pederson speculum is a vaginal speculum used during OB/GYN examinations when women have narrow vaginal canals. This condition can be caused by traumatic injuries and the resulting scar tissue, but is also found in elderly women and women who have never had sexual intercourse. Using this narrow speculum type can

eliminate some of the discomfort of a pelvic exam. (also used in menopausal women, transgender men on testostrone, transgender women with neovagina. The Graves Speculum (resembles a ducks mouth in appearance) The Graves speculum is the most common variety used by OB/GYNs. This vaginal speculum is commonly available in multiple sizes: small, medium and large. Used in Sexually Active Women.

45. Normal vs Abnormal Pap smears: checks for cervical intraepithelial neoplasia. Normal results show negative for cell changes to cervix. Abnormal shows positive for cell changes to cervix
46. Abnormal Uterine Bleeding (Diagnostics and lab tests): The Graves specu- lum is the most common variety used by OB/GYNs. This vaginalspeculum is com- monly available in multiple sizes: small, medium and large. The bills of the Graves speculum, which resemble a duck's mouth, are wider than the bills of the Pederson speculum, and the sides are also curved Diagnostics Pap smear Vaginal culture pelvic ultrasound EMB-Endometrial biopsy

Lab Tests qualitative/quantitative HcG, CBC with platelets, Pt and PTT, FHS, Progesterone, TSH, Iron, and Prolactin (Lab Tests Explained) Prolactin-High levels interfere with the normal production of other hormones such as estrogen and progesterone. This can result in irregular or missed periods, and prevent ovulation. Some women can have high levels and be completely asympto- matic FHS- History (EXTRA INFO TO KNOW) 1.Pelvic pain? think.... Miscarriage, ectopic pregnancy, PID, trauma, sexual abuse or assault 2.Nausea, weight gain, urinary frequency, fatigue? think... Pregnancy 3.Weight gain, cold intolerance, constipation, fatigue? think..... Hypothyroidism

4. Weight loss, sweating, palpitations?..... Hyperthyroidism 5..........................................................Easy bruising, tendency to bleed? think.................................................Coagulopathy 6.Jaundice, history of hepatitis? Think... Liver disease

7. Hirsutism, acne, acanthosis nigricans, obesity? Think Polycystic ovary syndrome
8. Postcoital bleeding (spotting or bleeding after intercourse unrelated to menstrual cycle)? Think... Cervical dysplasia, endocervical polyps
9. Galactorrhea, headache, visual-field disturbance?Think Pituitary adenoma
10. Weight loss, excessive exercise, stress? Think Hypothalamic suppression
11. Thyromegaly, weight gain, edema? Hypothyroidism
12. Thyroid tenderness, tachycardia, weight loss, velvety skin? Think... Hyperthyroidism 13.Bruising, jaundice, hepatomegaly? Think.. Liver disease 14.Enlarged uterus? Pregnancy, leiomyoma, uterine cancer 15.Firm, fixed uterus? Think Uterine cancer 16.Adnexal mass? Think.. Ovarian tumor, ectopic pregnancy, cyst Uterine tenderness, cervical motion tenderness PID, endometritis Laboratory tests Beta-subunit human chorionic gonadotropin

Pregnancy Complete blood count with platelet count and coagulation studies Coagulopathy Liver function tests, prothrombin time Liver disease Thyroid-stimulating hormone Hypothyroidism, hyperthyroidism Prolactin Pituitary adenoma Blood glucose Diabetes mellitus DHEA-S, free testosterone, 173-hydroxyprogesterone if hyperandrogenic Ovarian or adrenal tumor Papanicolaou smear Cervical dysplasia

Cervical testing for infection Cervicitis, PID Imaging and tissue sampling Endometrial biopsy or dilatation and curettage Hyperplasia, atypia, or adenocarcinoma Transvaginal ultrasonography Pregnancy, ovarian or uterine tumors Saline-infusion sonohysterography Intracavitary lesions, polyps, submucous fibroids Hysteroscopy Intracavitary lesions, polyps, submucous fibroids

47. Uterine Adenomyosis: endometerial glnds within the myometrium

--> suspect in a multiparous woman who is more than 40 years old presenting with menorrhagia (heavy bleeding) and dysmenorrhea (painful cramps), chronic pelvic pain. The uterus will be tender to palpation during pelvic exam and the uterus is usually enlarged. Definitive diagnosis requires histological analysis of a hysterectomy specimen, but can diagnose based on transvaginal ultrasound TX: Hysterectomy or uterine artery embolization (if further children are not desired) or if a women desires childen she could benefit from hormonal medications for symp- tom relief such as LEVONORGESTREL- RELEASING IUD OR ORAL DIENOGEST

48. Uterine Fibroids: Most common pelvic tumor in women after age 50. 80% in AA women, 70% in white women). Fibroids are benign monoclonal tumors arising from the smooth muscle cells of the myometrium described by their location in the uterus (submucosal, intramural, subseroal, cervical). ****Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus. Somesubmucosal or subserosal fibroids may be pedunculated — hanging from a stalk inside or outside the uterus.**** S/S: Abnormal uterine bleeding, pelvic pressure and pain, reproductive dysfunction dx: Transvaginal ultrasound Tx: Surgery is usually the preferred method if causing extensive pain

and discom- fort.. Menopause causes relief due to steriod hormones decreasing when the menstrual cycle stops. Postmenopausal hormone may cause the pain to resume or current fibroids to grow but will not cause new fibroid growths.

49. Lichen sclerosus: Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women. s/s thin, white, wrinkled skin localized in the labia minora and majora, but whitening could extend to perineum and around the anus in a keyhole pattern. MOST COMMON SYMPTOMS: Painful defecations, rectal bleeding, dyspareunia, and dysuria. fissuring or epithelia hyperplasia from rubbing is common. In end stages the vulva can become fused midline. TREATMENT: Focused on symptom relief. topical corticosteriod ointment such as clobetasol propionate 0.05% QHS for 6-12 weeks followed by maintenace therapy 2-3x per week if symptoms improve.

50. Endometriosis: Pelvic endometriosis lesions are categorized as superficial peritoneal , ovarian, and deeply infiltrating. These lesions contain fibrous tissue, blood, cysts in addition to endometrial glands and stroma. Patho- S/S-pelvic pain, painful period cramps (dysmenorrhea), dyspareunia (painful sexual intercourse). (occurs typically during reproductive years). LAB: Does not cause lab abnormalities. Imaging will show endometriomas deep nodules of the rectovaginal septum and bladder detrusor and is staged based on severity. Definitive diagnosis is made by biopsy and tissue histology to establish a true diagnosis and rule out other causes