NSG222 Exam 1 - Reproductive System and Gynecological Disorders, Exams of Nursing

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NSG222 Exam 1 - OB

Dysmenorrhea

• painful menstruation and is a common problem in adolescence
• aka cyclic perimenstrual pain
• classified as primary (spasmodic) or secondary (congestive Primary dysmenorrhea
• painful menstrual bleedings in the absence of any detectable underlying pathology
• caused by increased prostaglandin production 0: / 0: Brainpower Read More Secondary dysmenorrhea
• painful menstruation due to pelvic or uterine pathology
• caused by endometriosis, adenomyosis, fibroids, pelvic infection, an intrauterine system (IUS), cervical stenosis, or congenital uterine or vaginal abnormalities Endometriosis
• the most common cause of secondary dysmenorrhea
• associated with pain beyond menstruation, dyspareunia, low back pain, heavy or irregular bleeding, bloating, nausea, and vomiting, and infertility Infertility, therapeutic management
• The majority of infertility cases are treated with drugs or surgery
• Treatment options include lifestyle changes, such as weight loss and smoking cessation; taking clomiphene to promote ovulation; hormone injections to promote ovulation; intrauterine insemination; and IVF Barrier methods
• physical or chemical devices that prevent pregnancy by preventing the sperm from reaching the ovum
• Mechanical barriers: condoms, diaphragms, cervical caps, and sponges
• Chemical barriers: creams, jellies, foam, suppositories, and vaginal films
• mechanical & chemical can be used together Condoms
• made for both males and females from latex or polyurethane
• available in many colors, textures, sizes, shapes, and thicknesses Diaphragm
• soft latex dome surrounded by a metal spring
• used in conjunction with a spermicidal jelly or cream, it is inserted into the vagina to cover the cervix
• inserted up to 2 hours before intercourse and must be left in place for at least 6 hours afterward Cervical cap
• smaller than the diaphragm and covers only the cervix
• held in place by suction

• may be inserted up to 36 hours before intercourse and provides protection for 48 hours
• must be kept in the vagina for 6 hours after intercourse and replaced every year contraceptive sponge
• nonhormonal, nonprescription device that includes both a barrier and a spermicide
• a soft concave device that prevents pregnancy by covering the cervix and releasing spermicide
• inserted up to 24 hours before intercourse and should be left in place for at least 6 hours following intercourse Medical abortion
• achieved through administration of medication either vaginally or orally
• use of two different medications, mifepristone and misoprostol Mifepristone blocks progesterone, which is essential to the development of pregnancy. Misoprostol taken 24 to 48 hours later, works to empty the uterus by causing cramping and bleeding Complications of medical abortions incomplete expulsion of uterine contents, uterine infection, and heavy bleeding Menopause effects on brain and central nervous system: hot flashes, disturbed sleep, mood, and memory problems Menopause effects on Cardiovascular lower levels of high-density lipoprotein (HDL) and increased risk of CVD Menopause effects on skeletal rapid loss of bone density that increases the risk of osteoporosis Menopause effects on breasts replacement of duct and glandular tissues by fat Menopause effects on Genitourinary vaginal dryness, stress incontinence, cystitis Menopause effects on Gastrointestinal less absorption of calcium from food, increasing the risk for fractures Menopause effects on Integumentary dry, thin skin and decreased collagen levels Menopause effects on body shape more abdominal fat; waist size that swells relative to hips STI, nursing management
• be willing to discuss sexual habits
• educate on protecting reproductive futures
• encourage to complete antibiotic prescription, postpone sex as long as possible, use barrier methods, avoid multiple partners, drugs/alcohol
• counseling & education on STI prevention Preventing vaginitis · Avoid douching · Use condoms · Avoid tights, nylon underpants, and tight clothes. · Wipe front to back · Avoid powders, bubble baths, and perfumed vaginal sprays.

· Wear clean cotton underpants · Change out of wet bathing suits ASAP · Become familiar with the signs and symptoms of vaginitis · Choose to lead a healthy lifestyle. Chlamydia

• most commonly reported bacterial STI in the United States
• highest rates of infection are among those aged 15 to 19 years
• Worldwide, it is likely the most common infectious cause of infertility in women
• Asymptomatic
• Newborns can develop conjunctivitis from infected mothers Chlamydia, therapeutic management
• antibiotics (doxycycline, ceftriaxone, azithromycin)
• common coinfection with gonorrhea, so a combo of these are prescribed Chlamydia, nursing assessment (risk factors) · Being an adolescent · Having multiple sex partners · Having a new sex partner · Engaging in sex without using a barrier contraceptive (condom) · Using oral contraceptives · Being pregnant · Having a history of another STI Chlamydia, nursing assessment (clinical manifestations) · Mucopurulent vaginal discharge · Urethritis · Bartholinitis (swelling in the lower third of one of the small and large labia) · Endometritis · Salpingitis (inflammation of the fallopian tubes) · Dysfunctional uterine bleeding *diagnosis made through urine testing/swab specimens Herpes simplex virus (HSV), clinical manifestations
• divided into primary and recurrent infections
• Primary: painful vesicular lesions, mucopurulent discharge, superinfection with candida, fever, chills, malaise, dysuria, headache, genital irritation, inguinal tenderness, and lymphadenopathy
• Recurrent: milder & shorter, Tingling, itching, pain, unilateral genital lesions, and a more rapid resolution of lesions
• Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicle Human Papillomavirus (HPV)
• the most common viral infection in the United States
• the cause of essentially all cases of cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers Human Papillomavirus (HPV), therapeutic management
• currently no medical treatment or cure for HPV
• focuses heavily on prevention through the use of the HPV vaccine and education and

on the treatment of lesions and warts caused by HPV

• Two doses are needed for those vaccinated before 15; while three are recommended for older people Mastitis an infection or inflammation of the connective tissue in the breast that occurs primarily in lactating or engorged women Mastitis, nursing assessment
• Assess the client's health history for risk factors for mastitis, which includes poor hand hygiene ductal abnormalities, nipple cracks and fissures, lowered maternal defenses due to fatigue, tight clothing, poor support of pendulous breasts, failure to empty the breasts properly while breastfeeding, or missing breast-feedings
• diagnosis made on history and examination Mastitis, clinical manifestations
• Flu-like symptoms of malaise, nausea, headache, leukocytosis, fever, fatigue, and chills
• Physical examination of the breasts reveals increased warmth, swollen area of one breast, redness, tenderness, and swelling. The nipple is usually cracked or abraded and the breast is distended with milk Breast cancer, Nonmodifiable Risk Factors -female

• 50 y/o

• genetic mutations (BRCA1 & BRCA2 genes)
• Personal history of ovarian/colon cancer
• Increased breast density
• Family history of breast cancer
• White women, but AA women more likely to die
• abnormal breast biopsy (atypical hyperplasia)
• chest radiation
• early menarche (<12 y/o) or late menopause (>55 y/o) Breast cancer, Modifiable Risk Factors
• Not having children at all or after >30 y/o
• Postmenopausal
• Failing to breast-feed
• Alcohol/smoking
• Obesity
• Sedentary Chemotherapy, side effects
• nausea and vomiting, diarrhea or constipation, hair loss, weight loss, stomatitis, fatigue, and immunosuppression.
• most serious is bone marrow suppression (myelosuppression)
• This causes an increased risk of infection, bleeding, and a reduced RBC count, which can lead to anemia Breast cancer, clinical manifestations · Continued and persistent changes in the breast · A lump or thickening in one breast · Persistent nipple irritation

· Unusual breast swelling or asymmetry · A lump or swelling in the axilla · Changes in skin color or texture · Nipple retraction, tenderness, or discharge Breast cancer, immediate postoperative care

• Auscultate lungs (breathing pattern)
• Vital signs, skin color, skin temp
• Alertness, orientation
• Monitor wound for amount and color of drainage
• IV lines for patency, correct fluid, rate
• Drainage tube for color, amount, consistency of drainage Pelvic Inflammatory Disease (PID)
• an infection-induced inflammation of the female upper reproductive tract
• may involve uterine lining (endometritis), the connective tissue adjacent to the uterus (parametritis), the Fallopian tubes (salpingitis), or the serous membrane that lines part of the abdominal cavity and viscera (peritonitis), or it may manifest as tubo-ovarian abscess
• caused by untreated chlamydia or gonorrhea. PID, nursing management
• maintain hydration via intravenous fluids
• administer analgesics as needed for pain
• Semi-Fowler positioning facilitates pelvic drainage
• education to prevent recurrence (use condoms, avoid douching, regular STI screening, antibiotic regimen)
• risk assessment
• explain various diagnostic tests needed
• Sexual counseling
• Have partner go for an evaluation and treatment to prevent recurrence
• Stress barrier contraceptives & follow-up care Urge incontinence vs Stress incontinence Urge - Strong urge, more urine, causes are neurologic, idiopathic, infections Stress - Accidental leakage, small amount, pressure on bladder (sneezing, laughing, coughing), caused by weakened pelvic muscles after childbirth Hysterectomy
• surgical removal of the uterus
• the most effective treatment for symptomatic fibroids with no recurrence
• 3 types: vaginal, laparoscopically assisted, and abdominal vaginal hysterectomy

• uterus is removed through an incision in the posterior vagina
• Advantages: shorter hospital stay and recovery time, no abdominal scars
• Disadvantages: limited operating space and poor visualization of other pelvic organs laparoscopically assisted vaginal hysterectomy
• uterus is removed through a laparoscope
• Advantages: a better surgical field, less pain, lower cost, and a shorter recovery time
• Disadvantages: potential injury to the bladder and the inability to remove enlarged uteruses and scar tissue abdominal hysterectomy
• uterus and other pelvic organs are removed through an incision in the abdomen
• Advantages: able to visualize all pelvic organs, good for malignancy & large uterus
• Disadvantages: the need for general anesthesia, a longer hospital stay and recovery period, more pain, higher cost, and a visible scar on the abdomen Polycystic ovary syndrome (PCOS)
• most common endocrine condition in women of reproductive age
• a heterogeneous condition that involves the presence of multiple inactive follicles within the ovary that interfere with ovarian function
• follicles have a cyst-like appearance
• eggs never mature and ovulation does not occur PCOS Therapeutic Management
• Diagnosis is based on the presence of at least two of the following criteria:

1. hyperandrogenism (evidenced by testosterone excess, hirsutism)
2. ovarian dysfunction (anovulation)
3. polycystic ovarian morphology

• Treatment: Oral contraceptives, antidiabetic agents, and statins, weight loss, surgery
• initiated early to prevent or limit long-term complications such as metabolic syndrome, diabetes, endometrial carcinoma, and infertility
• Goals of therapy: Reduce production and circulating levels of androgens, protect the endometrium against the effects of unopposed estrogens, support lifestyle changes to achieve ideal body weight, lower risk of cardiovascular disease, avoid effects of hyperinsulinemia, and induce ovulation for pregnancy Cancers of reproductive tract, Providing emotional support
• Validate the client's feelings and provide realistic hope, using a nonjudgmental approach and therapeutic communication skills
• focus on the physical, psychosocial, and economic concerns, from diagnosis through treatment Ovarian cancer, educating the client
• risk reduction and health promotion
• factors that reduce risk: pregnancy, use of oral contraceptives, and breastfeeding before age 30
• avoid talc & hygiene sprays on genitals
• test if positive for BRCA1 &2 genes -healthy weight, low fat diet, removal of ovaries Endometrial cancer, nursing assessment
• obtain menstrual history, if taking hormones, personal/family history of breast, ovarian, or colon cancer

• change in bladder/bowel habits
• Physical/pelvic exam, transvaginal ultrasound, endometrial biopsy: discharge, size & shape of uterus & surrounding structures, pain during exam, malignant cells, endometrial hyperplasia >4 mm Cervical cancer, nursing management
• Primary prevention: delay onset of sex, decrease partners, use condoms, get HPV vaccine, never smoke
• Secondary prevention: Reduce or limit area of cervical dysplasia by allowing pelvic area to rest for 1 month and explore alternatives to vaginal intercourse
• Tertiary prevention: minimize disability or spread of cervical cancer through surgery, radiotherapy, and chemotherapy Vulvar cancer, nursing assessment Risk factors:
• exposure to HPV 16

• 50 y/o

• HIV infection
• Herpes simplex
• multiple sex partners
• Hx breast cancer
• Immune suppression
• HTN, DM, obesity, smoking -Symptoms: persistent vulvar itching, burning, edema, masses/thickening of vulvar area, leukoplakic (white patches) on labia The cycle of violence, Violence & Abuse 3 distinct phases:

1. Tension-building phase: drinking, jealousy, hostility, friction; victim thinks it's her fault
2. Physically abusive phase: violence, loss of control, assault/murder; victim denies seriousness of injuries and refuses medical help
3. Honeymoon, or reconciliation phase: calm, loving behavior, genuinely sorry and believes they can control violence; victim wants to believe and feels responsible for partner's well-being SAVE model
4. Screen all patients for violence
5. Ask direct questions in a nonjudgmental way
6. Validate client
7. Evaluate, educate, and refer her Nursing Management of Rape victims

• Sexual assault nurse examiners (SANE) trained to conduct sexual assault evidentiary examinations for rape victims
• Exposure therapy to confront trauma-related memories
• Focus on providing supportive care, collecting and documenting evidence, assessing for STIs, preventing pregnancy, and assessing for PTSD
• Early intervention & immediate counseling Human Trafficking

• Recruit, transport, harbor, or receipt of people by threat, abduction, fraud, or deception to exploit them
• majority in prostitution and sex industry (46%)
• Victims are primarily women and children who lack education, employment, and economic opportunities in their own countries
• nurses should notify local law enforcement and a regional social service organization Embryonic Stage
• development begins at day 15 after conception and continues through week 8
• Basic structures of all major body organs and the main external features are completed during this time Amniotic fluid in embryonic stage
• surrounds the embryo and increases in volume as the pregnancy progresses, reaching approximately 1 L at term
• derived from two sources: maternal blood across the amnion and fetal urine
• help maintain body temperature, permit growth, cushion from trauma, prevents cord from compression, and promotes fetal movement Hydramnios
• When there is too much amniotic fluid (>2,000 mL at term)
• associated with maternal diabetes, neural tube defects, chromosomal deviations, and malformations of the CNS and/or GI tract that prevent normal swallowing of amniotic fluid by the fetus
• threaten premature rupture of membranes Teratogens
• substances that cause birth defects, such as alcohol and drugs, infections (i.e., rubella, cytomegalovirus), radiation, and nutritional deficiencies
• fetus most vulnerable during embryonic stage Multifactorial Inheritance disorders
• common congenital malformations, such as cleft lip, cleft palate, spina bifida, pyloric stenosis, clubfoot, congenital hip dysplasia, and cardiac defects, are attributed to multifactorial inheritance
• caused by genetics & environment Those who may benefit from genetic counseling
• mother >35 y/o
• father > 50 y/o
• family w/inherited disease or disorders
• incest
• abnormal pregnancy screening
• stillborn
• 2 or more pregnancy losses
• exposure to teratogens
• genetic defects, x-linked disorder, autosomal recessive/dominant diseases
• developmental delays or disabilities Signs and symptoms of pregnancy Presumptive Probable Positive

Presumptive signs of pregnancy fatigue, breast tenderness, n/v, amonorrhea, urinary frequency, quickening (fetal movements), uterine/breast enlargement Probable signs of pregnancy Braxton Hicks, positive prego test, enlarged abdomen, ballottement, Goodell, Chadwick, Hegar sign Positive signs of pregnancy Ultrasound verification of embryo/fetus, fetal movement felt by clinician, fetal heart tones heard via Doppler Reproductive system adaptations

• Uterine growth, blood vessels elongate, uterine blood flow to placenta, diameter of uterine artery doubles, Braxton Hicks
• Isthmus (lower portion of uterus) becomes thinner
• Uterus progressively ascends into abdomen after 3 mo.
• supine hypotensive syndrome (dizziness, syncope) Cardiovascular system
• Increase in blood volume (biggest change!) and plasma volume, leading to anemia
• Increase in HR (25%), cardiac output by 30% to 50% and peaks at 25 to 30 weeks' gestation
• Reduced total peripheral resistance
• Iron requirements increase Integumentary System
• changes in vascular supply, skin, hair, nails, and gland functions
• increased production of hormones, esp. progesterone & estrogen
• hyperpigmentation

1. facial melasma ("mask of pregnancy"), blotchy brown patches on forehead & cheeks
2. Linea nigra (in middle of abdomen)
3. Striae gravidarum (stretch marks) Maternal weight gain

• Underweight (BMI less than 18.5) total weight gain range = 28–40 lb
• Normal weight (BMI = 18.5–24.9) total weight gain range = 25–35 lb
• Overweight (BMI = 25–29.9) total weight gain range = 15–25 lb
• Obese (BMI = 30 or higher) total weight gain range = 11–20 lb -1st trimester: gain 3.5 - 5 lb -2nd & 3rd trimester: 1 lb/wk (>1 lb for underwt, 2/3 lb for overwt) Pregnancy and sexuality
• Sexual behavior modifies as pregnancy progresses, influenced by biologic, psychological, and social factors
• produces stress on the sexual relationship
• partner becomes confused
• 2nd trimester: sexual interest may increase
• for comfort: sexual positions, cuddling/ holding, etc. Complications of sex during pregnancy Preterm labor, pelvic inflammatory disease, antepartum hemorrhage in placenta previa, and venous air embolism First prenatal visit

• to reduce the risk of adverse health effects for the woman, fetus, and newborn by addressing modifiable risk factors and providing education about having a healthy pregnancy
• Prenatal care delivered either individually or in a group format (centering)
• (WHO) have all recommended screening at the first prenatal visit for women who are over 25 years old, overweight, have polycystic ovary syndrome, history of gestational diabetes, and a positive family history of diabetes GTPAL Gravida, Term (>38 wks, <42 wks), Preterm (>20 wks, <37 wks), Abortions (<20 wks), Living Fetal movement determination
• fetal movement typically begins in the second trimester and occurs earlier in multiparous women than in nulliparous women
• first perception of fetal movement, termed "quickening," is commonly described as a gentle fluttering
• perform the counts in a relaxed environment and a comfortable position, such as semi- Fowler or side-lying
• fetal kick count charts
• "Count to 10," method most common
• woman focuses her attention on her fetus's movement and records how long it takes to document 10 movements. If it takes longer than 2 hours, the woman should contact her health care provider for further evaluation Measuring Fetal Heart Rate

1. Palpate the abdomen to determine the fetal lie, position, and presentation.
2. Locate the back of the fetus (the ideal position to hear the heart rate).
3. Apply gel
4. Turn on Doppler
5. Listen for HR, moving slightly side to side fo r loudest sound. Compare to Mom's pulse rate & sound, if same, reposition Doppler
6. Count pulse for 1 min & record (110-160 bpm is normal) BPP scoring The following criteria must be met to obtain a score of 2; anything less is scored as 0: · Body movements : three or more discrete limb or trunk movements · Fetal tone : one or more instances of full extension and flexion of a limb or trunk · Fetal breathing : one or more fetal breathing movements of more than 30 seconds. · Amniotic fluid volume : one or more pockets of fluid measuring 2 cm · NST : normal NST = 2 points; abnormal NST = 0 points *30 min must pass for test to be abnormal or get a score of zero BPP interpretation

• A score of 8 to 10 is considered normal if the amniotic fluid volume is adequate
• A score of 6 or below is suspicious, possibly indicating a compromised fetus Teaching guidelines to manage the discomforts of pregnancy
• Urinary freq/incontinence: pelvic floor exercises, empty bladder, avoid caffeine, reduce fluids after dinner
• Fatigue: get full night's sleep, balanced diet, schedule a nap in the early afternoon, pause and rest when tired

• Nausea/Vomiting: avoid empty stomach, eat crackers/toast before getting out of bed, small meals, avoid brushing after eating, wear acupressure wristbands, fluids b/w meals rather than with, avoid greasy, strong odor foods (cabbage, brussel sprouts)
• Backache: use heating pad for small of back, pillow support when sitting, proper body mechanics when lifting, avoid heels, stand w/ shoulders back
• Leg cramps: elevate legs above heart leve, straigthen both legs & flex feet toward body, calcium supplements
• Varicosities: walk daily, elevate legs, don't stand long, avoid constrictive stockings/socks (support stockings okay), don't cross legs
• Hemorrhoids: schedule bowel movements, avoid straining, fluids & fiber, exercise, cool witch hazel compress
• Constipation: fluids, fiber, prunes, tea, brisk walk everyday, reduce cheese in diet
• Heartburn/indigestion: avoid spicy/greasy foods, citrus, soda, & chocolate, elevate head with several pillows when sleeping, stop smoking, avoid caffeine, don't lie down until 3 hrs after meals, sip water, antacids sparingly
• Braxton Hicks: change position or do mild exercise, drink more fluids Nursing Management and Childbirth education
• to promote an internal locus of control that will enable each woman to yield her body to the process of birth
• most effective support from nurse is encouragement and presence
• respect the involvement of the partner and demonstrate concern for their needs throughout labor