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NURS 5432 TEST 1 STUDY GUIDE
PAP smear - Answers - start at 25year per ACS, HPV every 5 years , cotesting every 5 years, cytology every 3 years Breast cancer screening - Answers - Average risk: if chest radiation therapy before 30 year, genetic mutation of BRCA, family/pt history of CA 40 - 44yr: have option to start mammogram screening every year 45 - 54yr: SHOULD get mammogram every year 55 and up: can do every other year or q year until they are in good health to live 10 more years high risk: Family history of breast cancer, non-BRCA1 or BRCA2 mutation, head radiation therapy to chest, Li-Fraumeni Syndrome, Cowden Syndrome, Banayan-Riley Ruvalcoba syndrome Overdiagnosis - Answers - finding cancer that wouldn't have been a problem if you not found it ACS recommend AGAINST MRI if cancer chance is <15%c cervical dysplasia - Answers - the growth of abnormal cells in the cervix can be premalignant cervical disease called cervical intraepithelial neoplasia (CIN) CIN 1: mild dysplasia with low grade lesion. Cellular change in lower 1/3rd of squamous epithelium CIN 2: moderate dysplasia with high grade lesion. Cellular change in lower 2/3 of squamous epithelium CIN 3 or Carcinoma in situ: severe dysplasia with high grade lesion. Cellular change in full thickness of squamous epithelium
- Squamous epithelium increase during pregnancy but reduces postpartum
- Endocervical curettage is contraindicated during pregnancy
- Unless cancer is identified/suspected treatment for CIN is contraindicated during pregnancy Digital Breast Tomosynthesis - Answers - provides 3D images from a mammogram machine which rotates around the breast Fibroadenoma - Answers - a round, firm, rubbery mass that arises from excess growth of glandular and connective tissue in the breast Fluctuation in size with pregnancy or menstrual cycle NO nipple discharge lesions >5cm= giant fibroadenoma
Fibroadenoma Diagnosis and Treatment - Answers - Diagnosis:
- Palpation
- Mammogram or MRI
- US to differentiate cyst from mass
- fine needle aspiration Bx Treatment:
- Surgery fibrocystic breast disease "nodular sensitivie breast" - Answers - the presence of single or multiple benign cysts in the breasts mastoplasia - Answers - thickening of breast tissue in a ropelike manner that predominate during menstrual cycle Non pharm management for fibrocystic BD - Answers - Cold compress, supportive bra 24 hours a day, sodium restriction 10 days before onset of menstruation, decrease or eliminate caffeine, reduce dietary fat pharm management for fibrocystic BD - Answers - vitaminD 2000 IU day spironolactone for swelling (25-200mg PO daily; start with 100 IU daily) vitamin E 200 IU twice daily or 500 IU daily evening primrose oil 2-4g daily oral contraceptives Intraductal papilloma (IDP) - Answers - Benign tumor within the ductile system (ductal epithelium and myoepithelial cells) of the breast that may occur alone or as multiple tumors. Most common in women ages 35 to 50 years. Ductal ectasia is often associated with IDP For bilateral nipple discharge - Answers - Check for TSH (hypothyroid), prolactin (pituitary tumor)
- medications: spironolactone, antihypertensives, antidepressants, antidopaminergics, estrogen OCPs, opioids, marijuana, methyldopa, H2 receptor antagonist Breast cancer screening per ACS - Answers - Anual between 45 and 54 years, then every two years after age 55 Breast Cancer - Answers - 2nd most cause of CA death in USA women Malignant neoplasm of cells native to breast epithelial, glandular, or stoma Hormone replacement therapy is a RISK FACTOR for Breast CA - Answers - (combination estrogen-progestrone and estrogen only agent) during perimenopause increases breast cancer risk for 10 years after medication discontinued
- Take the rest of the active pills, skip the placebo pills and start the next pack of pills without interruption and use condom or abstinence for seven days. OR
- take the pills as in the pack and use condom or abstinence until she has taken seven of the pills in the pack Prenatal Visits - Answers - every 4 weeks until 28 weeks every 2 weeks until 36 weeks every week until born First trimerster - Answers - 0 - 12week S/S: urinary frequency, breast tenderness, nausea, vomiting, fatigue, amenorrhea Physical Exam findings:
- softening of cervix (Goodwell's sign)
- Cervical cyanosis (chadwicks sign)
- softening of cervicouterine junction (Hegars sing),
- Breast enlargement,
- Fetal heart tone If mom on thyroid medication, dose needs to be doubled the 1st trimester for fetus cannot produce their own at this time Second trimester - Answers - 13 - 27 wk S/S: fetal movement, round ligament pain [abdominal discomfort secondary to stretching], changing skin color such as Cholasma (brown or gray-broen patch in face), syncopal episode Physical Exam findings:
- stria on breast, hips, abdomen (steroid cream helps)
- fundus palpable at umbilicus at 20 wk
- Leopold maneuvers at 20wk (to identify the position/presentation of baby) Amniocentesis at 15-20wk if family abnomalitlies Triple OR Quad screen at 16-20wk Repeat CBC, US third trimester - Answers - 28 - 40wk S/S: abdominal girth, return of urinary frequency with descent of presenting part, increased respiratory effort, Braxton-Hicks contraction(d/t/ dehydration) Physical exam findings:
- Lightning made a girl up to 3 to 4 weeks prior to labor
- loss of mucous plug/bloody show prior to labor by approximately one week
- may experience increasing Braxton-hicks contractions/rupture of membranes {within 24 - 48hr delivery needs to happen d/t infection chance} Tests:
Repeat CBC RhoGam at 28wk hg/hct US repeat gonorrhea/ chylamadia Group A beta hemolytic strep culture Diabetes screening - Answers - Done at 24 to 28 weeks gestation. Diabetes screening if plasma glucose is greater than 130 to 140mg/dL Positive screening; hundred G glucose load administered, and glucose values are measured fasting, at one hour, two hours, and three hours. If two of the three values are abnormal a diagnosis of gestational diabetes is made Naegele's Rule - Answers - LMP subtract 3 months, add 7 days Leopold's Maneuvers - Answers - Palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds. Head=hard, round, movable object Buttocks=soft and irregular shape Back=smooth, hard surface felt on one side of the abdomen Irregular knobs and lumps on opposite side of abdomen may be hands, feet, elbows, and knees Expected weight gain during pregnancy - Answers - - Underweight - 28 - 40 lbs
- Normal - 25 - 35 lbs.
- Overweight - 15 - 25 lbs.
- Obese 11-20 lbs Nutrition for pregnant women - Answers - Calories: increase of 300 kcal/day folic acid: 0.4mg/day Elemental iron: 30mg/day Calcium: 1200mg/day Common Pregnancy issues - Answers - Always refer to PLLR when recommending pharmacologic managements. Ankle edema: keep legs elevated, warm compress. Acetaminophen is okay, NO ASPIRIN OR NSAIDS. Be cautious with muscle relaxants. Constipation: d/t increased progestrone level and comrpession of the lower bowel d/t uterus enlargement. Reduce iron supplement as indicated, mild laxatives (prune juice, milk of Mg, Psyllium, docusate sodium, docusate calcium, senokot) are okay. DON'T DO Harsh laxatives or enema for it can induce labor. NO mineral oil it reduce nutrition absorption. Gerd: d/t increased progestrone.
dysgeusia: lack of taste, hyperolfaction: super smell, hyperosmia: overwhelming sensitivity to smell. Check: UA (ketones and specific gravity for starvation), urine culture (UTI), electrolytes (hypokalemia), hematocrit, total protein(decrease), liver enzymes (hepatitis) amylase/lipase (pancreatitis), TSH, Ultrasound (trophoblastic disease). intractable vomiting, dehydration, ketonuria, weight loss of 5% prepregnancy weight. Pharm: Diclegis, eliminate meds with iron, antihistamines, phenothiazine antiemetics, ondasetron, herbs (ginger/peppermint), methyprednisolone (but before 10th week use with caution d/t oral cleft in fetus) Ectopic pregnancy - Answers - any conceptus implants outside of uterine cavity. 95% occur in fallopian tube S/S: amenorrhea, dark brown to tarry bleeding unilateral lower back/abdomen/shoulder pain tender adnexa with palpable mass, +ve cervical motion tenderness, uterine enlargement with hegars signs, signs of rupture and bleeding Diagnostics: serum hcg, CDC, Rh, US abortion - Answers - pregnancy termination before week 24. 1st trimester: d/t chromosomal abnormalities 2nd trimester d/t cervical incompetence, infection or uterine abnormalities s/s: vaginal bleed, cramp, low back pain, rupture of membrane, hCH, US, cbc, coagulation Treatment:
- surgical abortion: vacuum D and C to 12 wk, D and E 13-14wk to 20-22wk, hysterectomy
- medical: Mifepristone (Mifeprex) AKA RU 486=ABORTION Prostaglandin (Misoprostol) pregnancy-induced hypertension (PIH) - Answers - potentially life-threatening disorder that usually develops after the 20th week of pregnancy BP>140/90 or rise in systolic >30mmhg contributing factors: pre-existing hypertension, renal, cardiovascular disease, diabetes, lupus, auto immune disorders, multiple gestation, primigravida, personal or family history of PIH, preeclampsia, maternal age at the end of reproductive timeline
testing: cbc, 24hr protein urine, creatinine/creatinine clearance, Non-stress test. (NST) if post 32 wk pregnancy rest at home, rest on left lateral recumbent position, fetal surveillance at home Preeclampsia - Answers - a complication of pregnancy characterized by pregnancy induced hypertension + edema + proteinuria Progression from digital and mild facial edema to generalized frontal or occipital headaches, weight gain, visual disturbances HTN: >140/90 or >30/ Proteinuria trace to +1 to +2 with worsening condition edema: 1+ to >3-4+ Weight gain: greater than 2lb per week to 6lb in 1 month, lagging fundal height reflexes: WNL to 3-4+ with worsening conditions Eclampsia - Answers - preeclampsia + seizures S/S: sever headache, RUQ pain, BP consistently over 160/100, tonic-clonic seizure, Oliguria to anuria, fetal distress in utero, visual changes (blindness, blurry, spotty vision) Testing: CBC, uric acid, 24 hour protein urine, creatinine/creatinine clearance, cbc, coagulation, LFT, fetal surveillance at hospital TX: Magnesium sulfate (MgSo4) to break seizure (valium if ineffective); the IV drip to stabilize. Delivery ASAP once mother is stable HELLP syndrome - Answers - hemolysis, elevated liver enzymes, low platelets s/s: Preeclampsia + nausea +jaundice +extreme fatigue, ill feeling PE: hepatomegaly, tenderness in RUQ to epigastric, jaundice, ascites tests: thrombocytopenia below 50,000 not unusal, clotting factors reduced, elevated LFT, proteinuria Hospitalize, deliver baby ASAP once mother stable placenta previa - Answers - implantation of the placenta over the cervical opening or in the lower region of the uterus Cervical os can be marginal, partial or completely covered usually caused by sex in 2nd and 3rd trimester Risks: previous c-section or uterine sx, multiparity, malpresentation (breech/transverse lie), Hx of placenta previa Bleeding is painless, occur after sex, no uterine tenderness
Group B Strep (GBS) - Answers - Group B strep (GBS) is the most common cause of life-threatening infection in newborns, including sepsis, meningitis, and newborn pneumonia. Premature infants have a higher risk of GBS infection, but most cases occur in full-term infants. About half of the cases occur during the first week of life, and most of these cases are preventable by giving intravenous antibiotics to patients in labor who are infected with or at high risk for GBS. Patients with group B strep bacteriuria during their current pregnancy or who previously gave birth to an infant with early-onset group B strep disease should receive intrapartum antimicrobial prophylaxis. Current guidelines for GBS screening recommend universal prenatal screening for vaginal and rectal group B strep colonization (a culture swab is inserted into the vagina, along the perineum, and into the rectum, and then sent to the lab) of all pregnant patients at 36 0/7-37 6/7 weeks' gestation. It is not standard practice to perform urine screening for GBS. If positive, penicillin is the first-line agent for intrapartum antibiotic prophylaxis, with ampicillin an acceptable alternative if penicillin is unavailable.
