Download Signs and Symptoms of Pregnancy and Contraception Methods and more Exams Nursing in PDF only on Docsity!
NR 602 MID TERM
Signs of presumptive pregnancy - Correct answer -Amenorrhea -Nausea & vomiting -Breast enlargement -Darkening of the areolas -Breast tenderness -Fatigue -Slight increase in body temperature: Rise in temperature coincides with luteal phase and is the result of increased progesterone -"Quickening" Mother feels the baby's movements for the 1st time; starts at 16 weeks Signs of Probable pregnancy - Correct answer -Positive urine or blood pregnancy test -PREGNANCY TESTS ARE CONSIDERED PROBABLE BECAUSE B- HCG ALSO PRESENTS IN MOLAR PREGNANCIES & OVARIAN CANCER -Goodell's sign: cervical softening (around 4 weeks) -Chadwick's sign: Blueish coloration of the vagina and cervix (6 to 8 weeks) -Enlarged uterus Signs of positive pregnancy - Correct answer -Palpation of the fetus by the health care provider -Ultrasound and visualization of the fetus -Fetal Heart Tones (FHT) auscultated by the health care provider Fundal height - Correct answer Can provide valuable information on assessing the gestational age of the fetus as well as to monitor fetal growth. Naegele's rule - Correct answer -The Estimated Due Date is calculated by adding 7 days to the first day of the last menstrual period, subtracting 3 months and adding 1 year
-For example, if the patient's last menstrual period was on August 10, 2019, the EDD would be calculated as follows: LMP equals August 10, 2019 plus 7 days equals August 17, 2019, minus 3 months equals May 17, 2019 plus one year equals May 17, 2020. Hematological changes during pregnancy - Correct answer -Blood volume increases by 30 to 50%, or 1,100 to 1,600 mL and peaks at 30 to 34 weeks gestation -The increase in blood volume improves blood flow to the vital organs and protects against excessive blood loss during birth -Fetal growth during pregnancy and newborn weight are correlated with the degree of blood volume expansion -Of the blood volume expansion during pregnancy, 75% is considered to be plasma -The blood volume changes result in hemodilution, which leads to a state of physiologic anemia during pregnancy Hemoglobin changes during pregnancy - Correct answer Normal Hgb 12- 16 g/dL First trimester: 11.6-13.9 g/dL Second trimester 9.7-14.8 g/dL Third trimester 9.5-15 g/dL Progestin-only contraceptives - Correct answer -No hormone free interval -Have minimal effects on coagulation factors, blood pressure, or lipid levels -Considered safer for women who have contraindications to estrogen such as cardiovascular risk factors, migraine with aura, history of VTE -Overall blood loss decreases over time, making progestin only methods protective against iron-deficiency anemia -Likely to improve menstrual symptoms and anemia -Women who are sensitive to even low estrogen pills (nausea, breast tenderness, HTN), may do well on progestin only pills -Depo-Provera injection given IM or subQ every 13 weeks Combined oral contraceptives (COCs) - Correct answer -Most contain 10 to 35 mcg of ethinyl estradiol -Traditional cyclic schedule is 21-24 active COCs followed by 4-7 days of inactive pills or no pills
-Hypertension (systolic >/= 160 or diastolic >/= 100) -Smoking (> 15 cigarettes per day and age 35 or older) -Migraine headache with aura -Major surgery with prolonged immobilization -Current breast cancer -Active viral hepatitis -Severe cirrhosis -Benign or malignant liver tumors -Breastfeeding <6 weeks postpartum "Mini-pills" Progestin-only pills - Correct answer -Currently two formulations norethindrone (Micronor) & norgestrel (Ovrette) -Contraindicated in breast cancer -Must be taken at the same time each day -If a pill is more than 3 hours late, a backup method of contraception should be used for at least the next 48 hours Menstrual cycle physiology - Correct answer -Menarche is most readily evident external event that indicates the end of one developmental stage and the beginning of a new one. -Usually happens between ages 12 and 15. -Continue to age 45 to 55 -Ratio of total body weight to lean body weight is most relevant factor and individuals are are moderately obese (20 to 30% above ideal body weight) tend to have earlier onset of menarche -Normal menstrual cycle is 21 to 35 days with a menstrual flow lasting 4 to 6 days, although a flow 2 to 8 days is still considered normal -Average amount of flow is 50 mL but could be 20 to 80 mL -Menstrual cycles that occur during the first 1 to 1.5 years after menarche are frequently irregular due to the immaturity of the hypothalamic-pituitary axis What is the objective of the ovarian cycle? - Correct answer TO PRODUCE AN OVUM What is the objective of the endometrial cycle? - Correct answer TO PREPARE A SITE TO NOURISH AND MAINTAIN THE OVUM IF IT BECOMES FERTILIZED Ovarian cycle phases - Correct answer -Lasts 28 days
- Follicular phase (1-14 days); Develop ovarian follicles and make egg
- Ovulation (Day 14); Mature ovum released from follicle (LH at peak)
- Luteal phase (Days 15-28); Fertilize or not to fertilize Endometrial cycle phases - Correct answer 1. The proliferative phase- Starts on 4th or 5th day of the cycle and lasts about 10 days; Influenced by estrogen and entails the regrowth of endometrium after the menstrual bleed
- The secretory phase- Begins at ovulation; When part of a 28 day cycle, it usually lasts from day 15-28; Increased progesterone production
- Menstruation- Begins with the initiation of menses and lasts 4-6 days; Prostaglandins initiate contractions and degrade endometrial tissue Vaccines recommended during each pregnancy - Correct answer Influenza (not live)- Any gestation when available Women who are pregnant are at increased risk for flu related complications Tdap - Third trimester (27-36 weeks gestation) After maternal vaccination, antibodies cross the placenta and decreased the risk of pertussis infection in the newborn -DO NOT GIVE HPV, MMR, LIVE INFLUENZA, VARICELLA, ZOSTER, BCG (BACILLUS CALMETTE-GUERIN) Emergency contraception - Correct answer -Plan B One-Step: 1.5 mg single dose -Next Choice: Two doses of 0.75 mg taken 12 hours apart -Used within 120 hours of unprotected intercourse -Levonorgestrel ECPs are available OTC to women and men 17 and over -Women 16 and younger need a prescription -THE YUZPE AND LEVONORGESTREL METHODS HAVE A DRAMATIC DECLINE IN THEIR EFFECTIVENESS WITH TIME AND SHOULD BE USED AS SOON AS POSSIBLE AFTER AN EVENT OF UPI -THE YUZPE REGIMEN HAS LARGELY FALLEN OUT OF FAVOR DUE TO THE HIGH DOSE OF ETHINYL ESTRADIOL What is the most effective oral emergency contraception method? - Correct answer -Ulipristal acetate (ella) -Provided as a single 30 mg dose -THE EFFECTIVENESS OF THIS MEDICATION DOES NOT DECLINE WITHIN THE 120-HOUR WINDOW AFTER UPI
Progesterone challenge test - Correct answer -Produces withdrawal bleeding indicative of functioning ovaries, because bleeding will occur only if a sufficient amount of circulating estrogen is present -IF THE RESPONSE TO THE PROGESTERONE CHALLENGE IS POSITIVE (WITHDRAWAL BLEEDING OCCURS), THE WOMAN DOES NOT HAVE GALACTORRHEA, AND HER PROLACTIN LEVEL IS NORMAL, THE POSSIBILITY OF A PITUITARY TUMOR IS EFFECTIVELY RULED OUT -IN THIS CASE, THE DIAGNOSIS IS ANOVULATION AND THE TREATMENT IS A PROGESTOGEN FOR THE FIRST 10 DAYS OF EACH MONTH OR A CONTRACEPTIVE -ALL WOMEN WITH ANOVULATION REQUIRE MANAGEMENT OF THIS CONDITION: IF LEFT UNTREATED, ENDOMETRIAL CANCER CAN OCCUR, REGARDLESS OF THE WOMAN'S AGE If tests reveal that the ovaries are producing estrogen and the FSH level is normal, what is the diagnosis? - Correct answer CHRONIC ANOVULATION Hyperthyroidism/Hypothyroidism can cause amenorrhea - Correct answer MENSTRUAL CYCLES ALMOST ALWAYS RETURN TO NORMAL ONCE THE THYROID LEVEL IS NORMALIZED What is the treatment of choice for hyperprolactinemia? - Correct answer A DOPAMINE AGONIST People at risk for amenorrhea - Correct answer -Athletic women, particularly long-distance runners -Gymnasts -Professional ballet dancers -Women with anorexia & other eating disorders Who is at highest risk for amenorrhea? - Correct answer Women with a low BMI and low percentage of body fat combined with a high level of intensive physical activity Causes of Secondary Amenorrhea - Correct answer -Pregnancy -Asherman syndrome -Cervical stenosis -Hormonal contraception
-Hyperthyroidism/Hypothyroidism -PCOS -Pituitary tumor -Premature ovarian failure -Menopause -Hypothalamic/CNS disorders (lifestyle stress, eating disorder, extreme athleticism) Causes of Primary Amenorrhea - Correct answer -Pregnancy -Upper genital tract causea -Mullerian genesis (absence of uterus and vagina, normal secondary sex characteristics) -Testicular feminization (absence of uterus, blind ending vaginal pouch, normal breast development, scant pubic and axillary hair) -Lower genital tract causes -Labial agglutination -Imperforate Hymen -Transverse vaginal septae -Hypergonadotropic-hypogonadism -Follicle-stimulating hormone (FSH) > 40mIU/L -Gonadal dysgenesis -Ovarian enzyme disorder -Resistant ovarian syndrome Who should be evaluated for amenorrhea? - Correct answer -No menses by age 14 in the absence of growth or development of secondary sexual characteristics -No menses by age 16 -In women who have menstruated previously, no menses for an interval of time equivalent to a total of at least three previous cycles, or 6 months Laboratory tests to assess estrogen production - Correct answer -Serum estradiol levels -Progestogen challenge test -Measurement of endometrial thickness -Serum FSH concentration Functional hypothalamic amenorrhea Treatment - Correct answer - Generally focuses on weight gain and exercise reduction -Psychological counseling may also be helpful
Abnormal uterine bleeding terminology - Correct answer -An all- encompassing term referring to any uterine bleeding that is irregular in amount, frequency, duration, or timing -May or may not be related to a woman's menstrual cycle -Can occur as a normal physiologic event such as irregular bleeding that often accompanies menarche or perimenopause due to irregular ovulation -Can also signal pathologic, life treating conditions such as an ectopic pregnancy or endometrial cancer Diagnostic studies for breast masses - Correct answer -Screening mammogram usually performed with 2 radiographic views; secondary prevention measure in asymptomatic female to detect presence of early breast cancer -Diagnostic mammogram performed to evaluate a palpable mass; Offers several radiographic views which are best in detecting calcifications and anatomical distortions -Mammograms have less sensitivity in women under 30 because the breast tissue is more radiodense resulting in a less meaningful evaluation -A breast ultrasound should be ordered in conjunction with a diagnostic mammogram which can differentiate between solid and cystic masses Differential diagnosis for pelvic pain in pregnancy - Correct answer 1st trimester: Negative IUP: Ectopic pregnancy, Spontaneous abortion, Early pregnancy Positive IUP: Threatened abortion, Corpus luteum cyst 2nd/3rd trimester: Placenta: Abruption, Previa Other: Uterine rupture, Spontaneous abortion, Labor Ectopic pregnancy - Correct answer -Implantation of a fertilized ovum in locations other than the uterine cavity -Second leading cause of maternal mortality in the United States -Approximately 95% of all ectopic pregnancies occur in the fallopian tube -Growth of the fetus in the Fallopian tube puts the woman who is pregnant at risk for pregnancy loss, tubal rupture, excessive blood loss, and future infertility due to tubal scarring
Clinical signs and symptoms of ectopic pregnancy - Correct answer -Pelvic, abdominal pain, and unexplained vaginal bleeding are the primary symptoms -Pain may be described as vague, sharp, diffuse, or unilateral -May have had a time of amenorrhea, pregnancy may or may not be diagnosed Physical findings include: cervical motion tenderness, a uterus that is not enlarged, adnexal mass, adnexal tenderness Ruptured ectopic pregnancy - Correct answer -Sudden onset of vaginal bleeding and sharp, severe, unilateral abdominal pain -Symptoms of significant blood loss and resulting shock may include hypotension, shoulder pain, breast tenderness Risk factors for breast cancer - Correct answer -Female -Advancing age -Personal history of invasive breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ -Family history of invasive breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ; Especially in first degree relatives -Inherited detrimental genetic mutations -Biopsy confirmed proliferative breast lesions with atypia -Dense breast tissue on mammogram -High-dose radiation to chest, especially during puberty or young adulthood -Menarche before age 12 -Menopause at age 55 or older -Nulliparity (Never had a child) -First full term pregnancy after age 30 -Current use of combined estrogen-progestogen hormone therapy after menopause -Current use of combined oral contraceptives -Weight gain leading to overweight or obese status after age 18 -Physical inactivity -Consumption of one or more alcoholic beverages per day -Jewish ancestry -Place of birth (North America & Northern Europe versus Asia and Africa) Breast cancer screening guidelines (USPSTF) - Correct answer -Decision to start screening mammography in women between 40-49 years should be
Pregnant Women: -Flagyl 500 mg BID x 7 days -Flagyl 250 mg TID x 7 days -Clindamycin 300 mg BID x 7 days Alternative treatment for patients with recurrent Vulvovaginal candidiasis who cannot take Fluconazole - Correct answer TOPICAL AZOLE THERAPY GIVEN INTERMITTENTLY Diagnosis of vaginal masses (Adnexal Masses) - Correct answer - Transvaginal ultrasound remains the first-line imaging modality for evaluation of ovarian masses -Ultrasound will classify a mass as cystic, solid, or complex What is the most common presentation of vulvar cancer - Correct answer - MOST COMMON PRESENTATION IS A WOMAN'S REPORT OF A VULVAR LUMP OR MASS THAT MAY OR MAY NOT BE PAINFUL -Often asymptomatic Diagnosis of vulvar cancer - Correct answer -MADE BY IDENTIFYING A LESION THROUGH VISUAL INSPECTION AND THEN OBTAINING CONFIRMATION WITH A BIOPSY Etiology of vulvar malignancies - Correct answer -Majority are squamous cell carcinomas -Less common forms include malignant melanomas, adenocarcinomas, and basal cell carcinomas -Squamous cell vulvar cancer evolves from two separate types of vulvar intraepithelial neoplasia (VIN) Usual type vulvar intraepithelial neoplasia (VIN) - Correct answer -WARTY, BASALOID, AND MIXED -RELATED TO HPV INFECTION IN MOST CASES AND TENDS TO OCCUR IN YOUNGER WOMEN -May be associated with similar lesions of the cervix and vagina Differentiated-type vulvar intraepithelial neoplasia (VIN) - Correct answer - USUALLY DIAGNOSED IN WOMEN 65-75 YEARS OF AGE
-ASSOCIATED WITH VULVAR DERMATOLOGIC CONDITIONS SUCH
AS LICHEN SCLEROSUS, SQUAMOUS CELL HYPERPLASIA, AND
PAGET'S DISEASE OF THE VULVA
Treatment of vaginal masses - Correct answer -Asymptomatic simple ovarian cysts less than 10 cm have low probability of malignancy and can be followed with serial imaging, generally obtained at 3 or 6 month intervals to establish stability -Many functional cysts will resolve within 3 months -Complex and solid ovarian masses have been shown to resolve spontaneously in as many as 80% of women. However this type of mass does have higher risk for malignancy and patient should be referred to gynecology or gynecologic oncology Nationally reportable infections - Correct answer Cholera Cryptosporidiosis Cyclosporiasis Giardiasis Hepatitis A Legionellosis Malaria Salmonellosis Shigellosis Typhoid fever Vibriosis Yellow Fever Nationally reportable STIs - Correct answer -CHLAMYDIA -GONORRHEA -SYPHILIS -CONGENITAL SYPHILIS -CHANCROID Clinical findings of pelvic inflammatory disease - Correct answer -Occurs in the upper female genital tract and includes any combination of endometriosis, salpingitis, tube-ovarian abscess, and pelvic peritonitis -Historically the abrupt onset of acute lower abdominal pain following menses has been considered the characteristic presenting symptom -More recently, it has been recognized that symptoms can be mild and nonspecific
-Consultation with an infectious disease specialist is warranted when a woman has multiple antibiotic allergies Treatment of pelvic inflammatory disease - Correct answer Doxycycline Ceftriaxone Metronidazole Cervical cancer screening guidelines (USPSTF) - Correct answer -Pap test cervical cytology every 3 years for all women ages 21- -Co-testing with Pap test and HPV testing for women ages 30-65 who wish to extend the screening interval -Recommends against screening women younger than age 21 regardless of risk factors -Recommends against screening women older than age 65 if they had adequate prior screening and are not at risk for cervical cancer -Recommends against screening women who have had a total hysterectomy -Recommends against screening women younger than age 30 with HPV testing alone or with Pap test Primary therapy for HSV - Correct answer -Acyclovir 400 mg orally TID 7- 10 days -Acyclovir 200 mg orally 5 times per day 7-10 days -Famciclovir 250 mg orally TID 7-10 days -Valacyclovir 1 gm orally BID 7-10 days Suppressive therapy for HSV - Correct answer -Acyclovir 400 mg orally BID -Famciclovir 250 mg orally BID -Valacyclovir 500 mg orally once per day (May be less effective than other valacyclovir or acyclovir dosing regiments in patients who have 10 or more episodes per year) -Valacyclovir 1 gm orally once per day Anticipatory Guidance - Birth to adolescent - Correct answer -The aim of primary care for children is to promote health, growth, and development -One mechanism for addressing safety issues and parental concerns ahead of problems is to institute standard anticipatory guidance
-Standard anticipatory guidance should be a routine part of well-childcare and many resources exist for information, such as the Bright Futures program -Anticipatory guidance should be age appropriate and deal with common concerns that can be anticipated at upcoming ages -Topics and needs of anticipatory guidance can vary according to family needs -Limiting media time and pediatric obesity education may be needed for one family, while another may need more education on discipline -Careful history taking is key -Clinicians must take the time to address all standard areas and additional parent concerns, keeping in mind that handouts often go unread by families Growth and Development - Birth to age 17 - Correct answer -To accurately assess growth at each visit, key principles must always be employed: -Each child must be weighed and measured at each visit -For infants, clothing must be removed -Recumbent height measurement (when the child is lying down) is utilized until 2 years of age -Head circumference should be measured until age 3 -Infants should be weighed with no clothes or diaper -In older children, height must be with shoes off, against the wall, and with heels to the wall at every visit -Height and head circumference should be measured three times for congruence and the highest number used -Physical growth parameters should be plotted at each visit and an ongoing record kept -For premature infants born at less than 36 weeks gestation, height and weight documentation should be corrected for by a documented gestational age assessment, completed in the first 24 hours The American Academy of Pediatrics recommends well-child visits at what ages - Correct answer -2 weeks then at 2,4,6,9, 12, 15, 18, & 24 months -Annually up to age 6 -Then every 2 years through adolescence Tanner Staging Pubic Hair Scale - Correct answer Stage 1: No hair Stage 2: Downy hair Stage 3: Scant terminal hair Stage 4: Terminal hair that fills the entire triangle overlying the pubic region
-Maternal diagnosis of cancer and treatment -Maternal HIV infection -Herpetic lesions on the mother's nipples, areolas, or breast (expressed breast milk can be fed to the infant) -Maternal use of cocaine, PCP, and cannabis Situations that require special considerations -Significant maternal or infant illness affecting the ability to feed -Invasive breast surgery, in particular breast reduction in which the areola is removed and reattached Fundal height measurement 12 weeks - Correct answer Uterine fundus first rises above the symphysis pubis Fundal height measurement 16 weeks - Correct answer Uterine fundus is between the symphysis pubis and umbilicus Fundal height measurement 20 weeks - Correct answer Uterine fundus is at the level of the umbilicus Fundal height measurement 25 to 35 weeks - Correct answer -Measure the distance between the upper edge of pubic symphysis and the top of the uterine fundus with a tape measure. -FUNDAL HEIGHT IN CENTIMETERS EQUALS THE NUMBER OF GESTATIONAL WEEKS (+/- 2 CM) -For example, a 28 week gestation fetus should have a fundal height that measures between 26 and 30cm. Fibroadenoma - Correct answer -Benign neoplasm which occurs most frequently in young women, usually within the first 20 years after puberty -Frequency is slightly higher and tends to occur earlier in African American women than caucasian -Usually discovered accidentally and typically present as sold, well-defined masses which are non tender and mobile -Incidence decreases with age, but may still occur in menopause -Etiology is unknown but a hormonal relationship is likely since they can increase in size during pregnancy or with estrogen therapy Breast cyst - Correct answer -Benign fluid-filled sacs that are encapsulated within the breast
-Single or multiple cysts may be breast in one or both breasts -Cysts are most common in women between the ages of 35 and 50, prior to menopause but can be found in women of any age pre and post menopause Breast lipoma - Correct answer -Fatty tumors that can appear anywhere in the body, including the breast. -They are usually not tender and occur in the later reproductive years. Hamartoma - Correct answer -Overgrowth of mature breast cells which may contain fatty, fibrous, and/or glandular tissue -Smooth and painless masses Fat necrosis - Correct answer -Usually the result of breast trauma or surgery -Tenderness may or may not be present -Sometimes indistinguishable from carcinoma -If left untreated, fat necrosis masses usually gradually disappear without intervention Phyllodes tumors - Correct answer -Rare benign breast tumor arising from the fibroepithelial cells -Tumors tend to grow very quickly and become very large -Very rarely can be malignant -REQUIRES BIOPSY Galactorrhea - Correct answer -Considered a physiologic discharge -Frequently the result of prolactin from the pituitary gland which stimulates milk production -Usually bilateral (but can be unilateral) -Multi-ductal and milky appearance in the non lactating adult -Can occur in males and females -In females, absent or irregular menstrual periods are likely Causes of galactorrhea - Correct answer -Idiopathic -Drug induced (Phenothiazines, oral contraceptives, methyldopa, imipramine, amphetamine, metoclopramide, Reserpine) -Fibrocystic breasts -Chest wall lesions (Thoracotomy, Herpes zoster) -Brain lesions (Pituitary adenoma, hypothalamic tumor, head trauma)
