Rasmussen Nursing Maternal Child Care Exam 1

Purpose of GYN exams - ANSWER Screens for pregnancy complications (STI's and cervical/uterine/ovarian cancer) RN role in GYN exams - ANSWER Provide comfort and educate the patient Purpose and function of the uterus ...

Purpose of GYN exams - ANSWER Screens for pregnancy complications (STI's and cervical/uterine/ovarian cancer) RN role in GYN exams - ANSWER Provide comfort and educate the patient Purpose and function of the uterus - ANSWER Organ of implantation/menstruation, receives ova from fallopian tube and furnishes protection for growing fetus. Female genitalia - ANSWER Vulva, labia majora, labia minora, clitoris Male genitalia - ANSWER Perineum, penis, testes and scrotum Fallopian tubes - ANSWER Sperm transport route to egg, site of fertilization, transports egg from ovary. Ovaries - ANSWER Essential female organ, produce ova/eggs required for reproduction, secretes hormones such as estrogen and progesterone which helps to regulate menstrual cycle. Why is it important to talk to mom about bladder? - ANSWER It can interfere with pregnancy and cause issues How often should women perform self-breast exams? - ANSWER monthly (7-10 days after menstruation ends) The influence of progesterone causes breasts to become lumpy. It's better to perform exam when progesterone is out of mom's system and entering a cycle renewed with estrogen. Self-breast exam patient education - ANSWER If you feel a lump, please see your doctor. Painful menstruation, one of the MOST COMMON OB/GYN complaints. - ANSWER Dysmenorrhea Chemical/pharmacologic management of dysmenorrhea - ANSWER Analgesics such as NSAID's (most prevalent) Ex. Ibuprofen/Motrin, Naproxen, Mydol (NSAID/Diuretic) Target of pain management for dysmenorrhea - ANSWER Prostaglandins found in menstrual blood (anti-prostaglandin) Long term management for dysmenorrhea (not for acute onset) - ANSWER Birth Control Non-pharmacologic interventions for dysmenorrhea - ANSWER Heating, pad, diet changes, increase activity, limit alcohol and chocolate Absence of menstruation - ANSWER Amenorrhea Causes of amenorrhea - ANSWER Pregnancy (most common), menstrual cycling issues, hormonal reasons Release of egg from woman's ovaries which takes place 14 days before next period - ANSWER Ovulation Forms of birth control - ANSWER Condoms, oral contraceptives, IUD, Patch, Depo, ring, abstinence, natural family planning and sterilization Condom pt education - ANSWER must know how to use correctly Oral contraceptive pt education - ANSWER take the pill the same time every day IUD education - ANSWER Client should be monogamous because risk of STI's is greater, check placement Patch education - ANSWER Weight, Can have irregular/breakthrough bleeding and body habitus (physique or body build) Hormone/cardiovascular risks of birth control - ANSWER Blood clots, hypertension, severe migraine HA's Patient education for choosing form of birth control - ANSWER Should not use birth control pills with both progesterone AND estrogen (use progesterone only or Depo Provera) * Someone with breast cancer or any type of estrogen-feeding cancers would not want any type of hormone/estrogen pill * If woman's breast feeding is well established the birth control pills may not interfere but initially we don't want to start someone on birth control pills immediately (interferes with prolactin) Disadvantages of natural family planning - ANSWER Most difficult part is being committed to plan, women feel most sexual when ovulating which makes it hard for them to fight off urge PERMANENT!!! (some means of reversal but with risk factors) - ANSWER Sterilization Patient education for emergency contraception - ANSWER Should be given within 72 hours of unprotected sexual intercourse NOT A FORM OF BIRTH CONTROL Over the Counter Does not protect from STI's DOES NOT CAUSE ABORTIONS Minor SE's Encourage young women to consult with their HCP for evaluation of STI's and appropriate method of birth control Pre-conceptional counseling - ANSWER For people with co-morbidities (HTN, diabetes) or to identify genetic risk To help identify and monitor progress Talk about lifestyle, nutrition, immunizations and to report (sooner than later) for close observance Not covered by insurance unless client is high risk Gravid - ANSWER Pregnancy Macrosomia - ANSWER big body, head and chest circumference are equal (chest is larger than it should be) IUGR - ANSWER (Intra-Uterine Growth Restriction) = Baby is smaller, Can be caused by smoking, malnutrition and anything that affects perfusion of baby) Quickening - ANSWER the very first fetal kicks Lightening - ANSWER when the baby is engaged or moves into the pelvis Cervix - ANSWER the bottom of the uterus, the connective tissue that opens during the laboring process Fundus - ANSWER the top of the uterus Vertex - ANSWER position of the baby where the head is down Primigravida - ANSWER first pregnancy Placenta - ANSWER (2 sides) and cord Attached to uterine wall acts to provide oxygen and nutrients to the fetus, whilst removing carbon dioxide and other waste products. It metabolizes a number of substances and can release metabolic products into maternal and/or fetal circulations. Wharton's Jelly - ANSWER Surrounds placenta and protects vessels from squishing each other Amniotic sac with fluid - ANSWER Fluid CUSHIONS fetus and cord Keeps lung tissue from sticking together Water temp (doesn't vary much in range) allows free movement of baby We can see digestive & renal systems function properly by watching amniotic fluid The only thing we must ensure is that mom doesn't suffer any severe trauma or restriction to the blood flow What causes the placenta to shear? - ANSWER severe constriction of blood flow What are the 2 sides of the placenta? - ANSWER Fetal side and maternal side Cord of placenta - ANSWER 3 VESSELS: 2 ARTERIES AND 1 VEIN!!!! Maternal side of placenta - ANSWER Cotyledons (little lobes) Where gas exchange with chorionic villi takes place Baby gets O2 and nutrients Mom gets all the toxins/ waste products back from baby Cotyledons - ANSWER Little lobes of placenta Where does gas exchange with chorionic villi take place? - ANSWER Maternal side of placenta Function of placenta - ANSWER Perfusion Risk factors for decreased blood flow to the placenta - ANSWER smoking, poor nutrition, drugs, diabetes with insulin, alcohol Full term - ANSWER pregnancy that lasts between 39 weeks, 0 days and 40 weeks 6 days. Pregnancy lasts between 1 week before due date and 1 week after due date. These babies have the best chance of being healthy, compared with babies born earlier or later. P in GTPAL (Pre-term) - ANSWER Babies born before 28 completed weeks of pregnancy. Abortion - ANSWER number of pregnancies that were lost for any reason, induced or miscarriages. Stillbirths are not included. The L in GTPAL - ANSWER living children TPAL - ANSWER one of the methods to provide a quick overview of a female's obstetric history Mary, a pregnant 25 y/o has a 2 y/o and 4 y/o, had an abortion at 16 y/o. What is her GTPAL? - ANSWER Gravida= 4 Full term= 2 Pre-term: 0 Abortion= 1 Living = 2