Reproductive Health and Gynecological Procedures, Exams of Pneumatics

Download Reproductive Health and Gynecological Procedures and more Exams Pneumatics in PDF only on Docsity!

PN 103 unit 1 exam with complete

solutions 2024/

pap smear - ANSWER ✓✓ -- detects cervical cancer and other abnormal cervical cells (dysplasia)

• starts at 21, get every 2 yrs
• if 30 or older and have had 3 normal tests for 3 yrs in a row, talk to HCP about spacing tests to every 3 yrs
• if over 65, ask HCP if you can stop tests conization (cone biopsy) - ANSWER ✓✓ -- invasive, outpatient surgery with general anesthesia
• large amount of cervical tissue is removed
• procedure used more for removal of tissue rather than diagnosis colposcopy - ANSWER ✓✓ -- inspect cervix under magnification to ID abnormal and potential cancer tissue
• done before cervical biopsy culdoscopy - ANSWER ✓✓ -- invasive surgical procedure with light sedation and local anesthesia outpatient
• visualization of the pelvic cavity thru a small incision in the posterior vagina while patient is in knee-chest position
• purpose is to obtain tissue specimen and ID ectopic pregnancy, pelvic mass, or diagnose cause for infertility or pain laparoscopy - ANSWER ✓✓ -- surgical procedure under local or general anesthesia
• scope is inserted thru a small abdominal incision and gas is inserted to create pocket to insert scope and allow for clear view of organs
• gas is absorbed but shoulder or below the ribcage pain may result

• visualization of abdominal organs
• perform minor surgery dilation and curettage - ANSWER ✓✓ -- diagnostic and treatment of uterine cancer and abnormal bleeding
• performed under epidural or general anesthesia
• outpatient surgery barrier methods - ANSWER ✓✓ -- keep the man's sperm from reaching the woman's egg
• include spermicides, condoms, contraceptive sponges, diaphragms, and cervical caps
• can be good choices for women who cannot use birth control methods that contain hormones condom - ANSWER ✓✓ -what is the only true method for prevention of HIV/AIDS? hormonal methods - ANSWER ✓✓ -- birth control that is similar to the hormones that the body makes naturally
• contain estrogen and progestin: birth control pills, vaginal ring, patch
• contain only progestin: progestin-only pills, injections, implants fertility awareness (natural family planning) - ANSWER ✓✓ -- do not require drugs or devices
• predicts the fertile time in a woman's menstrual cycle
• used to either prevent or plan pregnancy
• does not protect against STDs rhythm method - ANSWER ✓✓ -- does not require drugs or devices
• based on natural family planning
• only method of birth control accepted by the Catholic Church
• 75% effective tubal sterilization - ANSWER ✓✓ -- involves closing off the fallopian tubes
• prevent the egg from moving down the fallopian tube to the uterus and keeps the sperm from reaching the egg
• does not affect a woman's menstrual cycle tubal ligation - ANSWER ✓✓ -- a surgical procedure in which the fallopian tubes are cut and the ends are closed by tying, banding, clipping, or sealing them with an electric current

• permanent, immediate contraception
• reduces the incidence of ovarian cancer
• irreversible
• does not protect against STIs
• RISK: risk of ectopic pregnancy if pregnancy occurs vasectomy - ANSWER ✓✓ -- each vas deferens is blocked
• prevents sperm from being released during ejaculation
• highly effective (less than 1% fail to prevent pregnancy)
• most common cause of failure is unprotected sex too soon after procedure
• often take 2-3 months to work
• can be reversed, but not always successful chlamydia - ANSWER ✓✓ -- most common STD; bacterial
• men s/s: scanty white or clear exudate, burning or pruritus around the urethral meatus, urinary frequency, mild dysuria
• women s/s: vaginal pruritus or burning, dull pelvic pain, low grade fever, vaginal discharge, irregular bleeding
• diagnostic tests: direct fluorescent antibody test, culture with a follow up culture after a week
• treatment: tetracycline, doxycycline, azithromycin, ofloxacin
• CURABLE with treatment
• use standard precautions
• use latex condoms and limit partners
• women can become infertile if left untreated gonorrhea - ANSWER ✓✓ -- second most common STD; bacterial
• men s/s: some asymptomatic; urethritis, dysuria, infection with profuse purulent discharge, edema of affected areas
• women s/s: most asymptomatic; greenish yellow discharge from cervix, urinary frequency, purulent discharge from urethra, pruritus, burning and pain of the vulva, vaginal engorgement and erythema, abdominal pain and distension
• diagnostic tests: culture of site
• treatment: penicillin or ceftriaxone if allergic to penicillin
• women can become infertile if left untreated normal menstrual cycle - ANSWER ✓✓ -- lasts 2-8 days
• 40-100 mL of blood loss metrorrhagia - ANSWER ✓✓ -bleeding with usual amount but irregular intervals (bleeding between menstrual periods)

menorrhagia - ANSWER ✓✓ -excessive amount of menstrual bleeding and duration dysmenorrhea - ANSWER ✓✓ -cramps soon after onset of menses, spasmodic in nature (painful menstruation) mittelschmerz - ANSWER ✓✓ -pain around ovulation or near middle of menstrual cycle endometriosis - ANSWER ✓✓ -- endometrial tissue located outside the uterus

• s/s: lower abdominal pelvic pain, radiate to lower back, legs, and groin
• diagnostic tests: pelvic exam, laparoscopy with biopsy
• treatment: antivulatory medications, synthetic androgens (danazol, lupron, TAH- BSO) menopause - ANSWER ✓✓ -- transition from reproductive to nonreproductive stage of life
• menstrual flow appears on an infrequent cycle for about 2 yrs prior to complete cessation
• begins in most women between 42 and 58 yrs of age
• s/s: infrequent ovulation; decreased menstrual frequency, amount, and duration; spotting; amenorrhea; polymenorrhea
• not considered complete until one yr after the last menstrual period
• diagnostic tests: hormone levels
• treatment: calcium and vitamin D supplements, hormone replacement therapy erectile dysfunction - ANSWER ✓✓ -- a man's inability to attain or maintain an erect penis
• treatment: sildenafil citrate, tadalafil, vardenafil, avanafil, penis pumps, surgery, implants
• risk factors: diabetes, heart conditions, prostate surgery, radiation treatment for cancer, injuries, antihistamines, antidepressants, high BP meds, stress, anxiety, depression, drug and alcohol use placenta - ANSWER ✓✓ -- develops by the third month of gestation to permit exchange of nutrients and waste products between fetus and mother
• produces hormones to maintain pregnancy
• transfer of maternal immunoglobulin to the fetus provides passive immunity to certain diseases for the first few months after birth
• acts as a barrier

umbilical cord - ANSWER ✓✓ -- acts as a connecting life-line between the placenta and the fetus, helping transport blood, oxygen, and nutrients to the baby from the placenta, and transporting waste material and carbon dioxide from the baby to the mother's system for excretion

• 20-22 inches long, 1 inch in diameter
• 2 arteries, 1 vein (AVA)
• bypasses the liver and lungs amniotic fluid - ANSWER ✓✓ -- surrounds, cushions, and protects the fetus and permits fetal movement acting as a cushion against mechanical movement
• maintains the body temperature of the fetus
• allows developing embryo or fetus room for growth
• measure of fetal kidney function
• clear yellow and slightly alkaline
• normal amount = 400 mL (20 weeks) fetal heart tones (FHT) - ANSWER ✓✓ -- auscultate between 10-12 weeks
• norm: 110-160 bpm weeks 2-3 - ANSWER ✓✓ -in what weeks of fetal development does the neural plate become the brain and spinal cord? weeks 4-5 - ANSWER ✓✓ -in what weeks of fetal development does the fetus' heart start to beat? week 12 - ANSWER ✓✓ -in what week of fetal development is the fetus' heartbeat detectable with a doppler and sex is visually recognizable? week 16 - ANSWER ✓✓ -in what week of fetal development have all organ structures been formed and quickening occurs? weeks 19-20 - ANSWER ✓✓ -in what week of fetal development is the fetus' heartbeat detectable with a regular (nonelectronic) fetoscope? week 24 - ANSWER ✓✓ -in what week of fetal development can the fetus hear? week 28 - ANSWER ✓✓ -in what week of fetal development are the lungs developed sufficiently to provide gas exchange and if born at this time, neonate can breathe?

fundal height - ANSWER ✓✓ -- measured to help gauge the fetus' gestational age

• can start around week 16
• during the 2nd and 3rd trimesters, this measurement in centimeters approximately equals the fetus' age in weeks, plus or minus 2 cm ultrasonography - ANSWER ✓✓ -- imaging modality used to outline and identify fetal and maternal structures
• helps to confirm gestational age and estimated delivery date alpha-fetoprotein (AFP) screening - ANSWER ✓✓ -- used to assess the quantity of fetal serum proteins
• an increased level is associated with an open neural tube (e.g. spina bifida) and abdominal wall defects
• decreased levels are associated with Down syndrome percutaneous umbilical blood sampling - ANSWER ✓✓ -- when fetal blood sampling is necessary, a needle is inserted directly into the fetal umbilical vessel under ultrasound guidance
• FHR monitoring is necessary for 1 hr after procedure
• a follow-ip ultrasound to check for bleeding or hematoma formation is performed 1 hr after procedure chronic villus sampling (CVS) - ANSWER ✓✓ -- involves the aspiration of a small sample of chronic villus tissue at 10-13 weeks' gestation
• performed for the purpose of detecting genetic abnormalities
• obtain informed consent amniocentesis - ANSWER ✓✓ -- amniotic fluid is aspirated between 15 and 20 weeks of pregnancy to enable detection of genetic disorders and metabolic defects to aid assessment of fetal lung maturity
• obtain informed consent
• obtain baseline VS and FHR, monitor every 15 min
• position patient in supine during exam and on left side after procedure biophysical profile - ANSWER ✓✓ -- noninvasive
• assessment of the fetus' fetal breathing movements, fetal movements, fetal tone, amniotic fluid index, and FHR patterns all assessed thru the use of a nonstress test
• normal activities indicate that the CNS is functional and the fetus is not hypoexemic

nitrazine test - ANSWER ✓✓ -- used to detect the presence of amniotic fluid in vaginal secretions, which have a pH of 4.5-5.5 and do not affect the yellow strip or swab

• amniotic fluid has a pH of 7.0-7.5 and turns the strip blue
• assess the test strip for a blue-green, blue-gray, or deep blue color, all of which indicate that the membranes have probably ruptured nonstress test (NST) - ANSWER ✓✓ -- performed to assess placental function and oxygenation
• used to determine fetal well-being
• enables evaluation of FHR response to fetal movement
• obtain baseline BP and recheck BP frequently contraction stress test - ANSWER ✓✓ -- used to assess placental oxygenation and function
• helps determine fetus' ability to tolerate labor and reveals fetal well-being
• fetus is exposed to the stressor of contractions to assess the adequacy of placental perfusion under simulated labor conditions
• performed if nontress test finding are abnormal (nonreactive) Rh factor - ANSWER ✓✓ -- conducted to determine the presence or absence of Rh antigen
• if the mother is Rh negative and delivers an Rh positive fetus, an antigen- antibody reaction can occur that causes the destruction of fetal RBCs presumptive signs of pregnancy - ANSWER ✓✓ -- amenorrhea
• N/V
• increased size and feeling of fullness in breasts
• pronounced nipples and darkened areolae
• urinary frequency
• quickening
• fatigue
• discoloration and thickening of the vaginal mucosa
• skin changes probable signs of pregnancy - ANSWER ✓✓ -- uterine enlargement
• softening of the uterus (hegar's sign)
• softening of the cervix (goodell's sign)
• deepened violet-blue color of the cervix and vaginal mucosa (chadwick's sign)
• palpating an organ or floating structure by bouncing it gently and feeling it rebound (ballottement)

• positive result on pregnancy test for HCG
• fetal outline positive signs of pregnancy - ANSWER ✓✓ -- FHR, detectable with a doppler at 10- 12 weeks and with a fetoscope at 18-20 weeks
• active fetal movements palpable by examiner
• outline of fetus on ultrasound nagele's rule - ANSWER ✓✓ -- used to calculate the estimated date of delivery or estimated date of confinement
• take the first day of the last menstrual period, subtract 3 months, add 7 days, add 1 yr G (gravida) in GTPAL - ANSWER ✓✓ -the number of pregnancies, including current one kick count - ANSWER ✓✓ -- guidelines for counting fetal movements
• should begin at 28 weeks' gestation
• goal is to experience 10-12 movements in a 1-2 hr period or as instructed by HCP discomforts of pregnancy - ANSWER ✓✓ -- N/V
• heartburn
• syncope and supine HTN
• urinary urgency and frequency
• breast tenderness
• increased vaginal discharge
• fatigue
• ankle edema
• constipation/hemorrhoids
• backache
• SOB and dyspnea danger s/s during pregnancy - ANSWER ✓✓ -- visual disturbances
• headaches
• edema (face, presacral area, fingers)
• rapid weight gain in excess of normal gain for gestation
• pain (abdominal or epigastric)
• signs of infection
• vaginal bleeding (not matter how slight)
• vaginal drainage (aside from normal mucus)

• persistent vomiting
• muscular irritability or convulsions
• absence or decrease in fetal movement once felt neural tube defects - ANSWER ✓✓ -what does folic acid help to prevent in pregnancy? upper region of fallopian tubes - ANSWER ✓✓ -where does fertilization occur? indications for cesarean section - ANSWER ✓✓ -- concern for placenta previa or abruptio placenta
• fetal distress (bradycardia = hypoxia, tachycardia = infection)
• cephalopelvic disproportion
• infection
• disease process
• choice signs of impending labor - ANSWER ✓✓ -- lightening
• bloody show
• effacement
• backache
• weight loss
• contractions
• energy burst
• GI changes
• cervical ripening station - ANSWER ✓✓ -- relationship of assigned area of the presenting part or landmark to the maternal pelvis
• 0 = at ischial spine
• minus 0 = above ischial spine
• plus 0 = below ischial spine primary powers - ANSWER ✓✓ -- involuntary uterine contractions
• signals the beginning of labor secondary powers - ANSWER ✓✓ -voluntary bearing down efforts by the woman augment the force of involuntary contractions early deceleration of FHR - ANSWER ✓✓ -- slowing of FHR at the start of contraction with return of FHR to baseline at end of contraction

• NORMAL finding
• due to compression of the fetal head resulting from uterine contraction, vaginal exam, and fundal pressure
• no intervention required late deceleration of FHR - ANSWER ✓✓ -- slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended
• typically caused by placental issues resulting in decreased O2 to fetus
• nursing interventions: place mother in side-lying position, discontinue oxytocin if being infused, administer oxygen at 8-10 mL/min via nonrebreather face mask, elevate mother's legs, insert IV and increase rate of fluid administration variable deceleration of FHR - ANSWER ✓✓ -- transitory, abrupt slowing of FHR 15/min or more below baseline for at least 15 seconds, variable in duration, intensity, and timing in relation to uterine contraction
• typically caused by umbilical cord issues (nuchal cord)
• nursing interventions: reposition mother from side to side or knee-chest, discontinue oxytocin if being infused, administer O2 at 8-10 mL/min via nonrebreather face mask, assist with vaginal exam, assist with amnioinfusion of prescribed latent phase - ANSWER ✓✓ -- part of stage 1 of labor
• cervical dilation of 1-4 cm
• uterine contractions every 15-30 min, 15-30 sec in duration and of mild intensity
• mother talkative and eager to be in labor active pahse - ANSWER ✓✓ -- part of stage 1 of labor
• cervical dilation of 4-7 cm
• uterine contractions every 3-5 min, 30-60 sec in duration and of mild intensity
• possible feelings of helplessness on the part of the mother
• restlessness and anxiety as contractions become stronger transition phase - ANSWER ✓✓ -- part of stage 1 of labor
• cervical dilation of 8-10 cm
• uterine contractions every 2-3 min, 45-90 sec in duration and of strong intensity
• mother becomes tired, is restless and irritable, and feels out of control stage 2 of labor - ANSWER ✓✓ -- cervical dilation is complete when this stage begins
• uterine contractions occur every 2-3 min, 60-75 sec in duration and of strong intensity

• increase in bloody show occurs
• mother feels urge to bear down stage 3 of labor - ANSWER ✓✓ -- delivery of the placenta
• occurs 5-30 min after birth of baby
• monitor mother for signs of placental separation stage 4 of labor - ANSWER ✓✓ -the initial 1-4 hrs after delivery betamethasone - ANSWER ✓✓ -- to increase production of surfactant and to accelerate lung maturity in fetuses between 24 and 34 weeks' gestation
• to reduce the risk of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, and neonatal death
• interventions: monitor lung sounds, monitor and treat episodes of hyperglycemia, monitor BP, report manifestations of pulmonary edema
• administration: IM oxytocin - ANSWER ✓✓ -- uterine stimulation
• induction or enhancement of labor near or post term
• treatment of postpartum hemorrhage
• interventions: monitor length, strength, and duration on contractions; for indications of hyperstimulation, turn patient on side, stop infusion, and administer O2; monitor for headache, N/V, and increased BP; monitor I&O and LOC
• administration: IV methylergonovine - ANSWER ✓✓ -- prevention and treatment of postpartum and post-abortion hemorrhage
• interventions: monitor BP, N/V, headache, HR, s/s of seizure activity
• administration: PO, IV terbutaline - ANSWER ✓✓ -- preterm labor inhibition
• interventions: monitor respiratory status, including O2 sat; monitor maternal and FHR and BP; monitor for chest pain; monitor cardiovascular status for 12 hr after discontinuing
• administration: sub Q, IV (less common) magnesium sulfate - ANSWER ✓✓ -- prevent and treat seizure activity in patients with severe preeclampsia or eclampsia
• interventions: check patient before and throughout therapy for headache, dizziness, blurred vision, muscle weakness; report RR of 12/min or less; monitor

DTRs every 1-4 hrs; report crackles; monitor BP, pulse, RR every 15-30 min

• administration: IV
• antidote: calcium gluconate or calcium chloride hemorrhage, shock, and infection - ANSWER ✓✓ -what are the greatest risks during the postpartum period? involution - ANSWER ✓✓ -- returning to pre-pregnancy size
• takes about 6 weeks episiotomy - ANSWER ✓✓ -incision to enlarge the vaginal opening lochia rubra - ANSWER ✓✓ -- bright red
• fleshy odor
• discharge occurring 1-2 days after delivery lochia serosa - ANSWER ✓✓ -- pink to brown color
• discharge occurring 3-5 days after delivery lochia alba - ANSWER ✓✓ -- slight yellow to white color
• discharge occurring 10 days to 2 weeks after delivery breastfeeding conciderations - ANSWER ✓✓ -- increase calories to 500 daily over pregnancy diet
• may need to limit foods creating gas in neonate
• increase water intake up to 64 oz daily
• must feed every 3 hrs
• waste return: yellow to golden, sweet smelling when mature
• may pump and save
• wear firm fitting bra to keep mammary tissue intact
• shower with hot water to assist let down reflex
• apply ice and/or raw cabbage leaf frozen to reduce size and discomfort for engorgement gestational hypertension - ANSWER ✓✓ -- danger of seizures remain during first 72 hrs after delivery of the fetus and neonate
• s/s: BP 140/90 or more, edema of the face and hands, epigastric pain, ketones in urine, increased cranial edema, headache, blurred vision, rapid weight gain, muscular irritability or convulsions 110-160 - ANSWER ✓✓ -normal FHR

30-60 - ANSWER ✓✓ -normal neonate RR 13-15 in - ANSWER ✓✓ -normal neonate head circumference 12-13 in - ANSWER ✓✓ -normal neonate chest circumference apgar scoring - ANSWER ✓✓ -- done at 1 and 5 min after birth

• A: appearance
• P: pulse
• G: grimace
• A: activity
• R: respiration hyperemesis gravidarum - ANSWER ✓✓ -- severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus
• begins in 1st trimester
• 2nd most common cause for hospitalization
• creates weight loss, electrolyte imbalance, nutritional deficiencies, ketonuria ectopic pregnancy - ANSWER ✓✓ -the abdominal implantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube, which can result in a tubal rupture causing a fetal hemorrhage placenta previa - ANSWER ✓✓ -- placenta is implanted in lower uterine segment
• partially or completely covers cervical os
• creates bright red, PAINLESS bleeding in 2nd or 3rd trimester abruptio placentae - ANSWER ✓✓ -- premature separation of the placenta from the uterus, which can be partial or complete detachment
• usually occurs in the 3rd trimester prematurity - ANSWER ✓✓ -- gestational age 20-37 weeks
• lungs don't produce enough surfactant
• circulation may not adapt from fetal to neonatal
• at risk for immaturity of organ systems T (term) in GTPAL - ANSWER ✓✓ -the number of children born at term (longer than 37 weeks' gestation) P (preterm) in GTPAL - ANSWER ✓✓ -the number of children born before 37

weeks' gestation A (abortions) in GTPAL - ANSWER ✓✓ -the number of abortions and/or miscarriages L (living) in GTPAL - ANSWER ✓✓ -number of current living children syphilis - ANSWER ✓✓ -- 3rd most frequent STI

• primary stage: chancre
• secondary stage: moist, raised gray to pink lesions of the genital or perirectal skin, enlarged lymph nodes, fever, fatigue, or infections of the eyes, bones, liver, or meninges
• latent stage: no visible s/s
• tertiary stage: destructive masses on internal organs, dementia, pain or loss of sensation in legs, and destruction of the aorta
• diagnostic tests: blood testing, VDRL, RPR
• treatment: penicillin G but CANNOT reverse damage already present in later stages of disease sildenafil - ANSWER ✓✓ -- increases blood flow and allows an erection in response to sexual stimulation
• side effects: headache, hypotension, dyspepsia
• contraindicated: nitrate drugs (potentiates hypotensive effects), heart disease or HF, hypotension