FINAL EXAM Maternity Nursing – Flashcards
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Denial
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Refuse to accept the facts; conscious or unconscious
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Anger
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"Why me?"; difficult to care for (doesn't want you close); misplaced feelings of rage or hostility; take out on self and others; NURSE: remain detached and nonjudgemental.
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Bargaining
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"I'll do this if you let me live"; hope that individual can postpone or delay death; usually made with God; Rarely provides a sustainable solution
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Depression
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"I'm so sad. Why bother?"; Hopelessness; what's the point? Why go on?; Begins to understand certainty of death; silent- refuses visitors (disconnect from things of love and affection; acceptance with emotional detachment; dress rehearsal for aftermath of death
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Acceptance
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"it's going to be ok"; make the best of it; comes to terms with reality
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Follicular Phase
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First day of menstruation lasts 12-14 days Graafian follicle is maturing (produces estrogen) under LH and FSH.
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Ovulatory Phase
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Estrogen levels peak and ends with release of the oocyte (egg) from the mature Graafian follicle. Surge of LH levels 12-36 hours before ovulation. Decrease in estrogen levels and increase in progesterone levels before the LH surge.
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Luteal Phase
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Lasts apx 14 days. Cells of the empty follicle undergo changes and form into the corpus luteum. Corpus luteum produces high levels of progesterone along with low levels of estrogen.
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Proliferative Phase
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(Follows menstruation and ends with ovulation) Endometrium is preparing for implantation by becoming thicker and more vascular. Changes are in response to increased levels of estrogen produced by the graafian follicle.
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Secretory Phase
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(After ovulation and ends with onset of menstruation) Endometrium begins to thicken. If pregnancy occurs: endometrium continues to develop- secretes glycogen If pregnancy DOESN'T occur: corpus luteum begins to degenerate and endometrium tissue disintegrates.
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Menstrual Phase
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Occurs in response to hormonal changes and results in the sloughing off of the endometrial tissue.
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Role of Estrogen
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development of breasts; further development of the uterus and vagina; broadening of the pelvis; growth of pubic and axillary hair; increase in adipose (fat) tissue; The rising level of estrogen causes the endometrium to become thicker and more richly supplied with blood vessels and glands;
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Role of Progesterone
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Continues the preparation of the endometrium for a possible pregnancy; inhibits the contraction of the uterus; inhibits the development of a new follicle
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Ovulation
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The release of an egg from the ovary. Often happens around day 14 of the menstrual cycle, although the exact timing may vary among women or even from month to month
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Signs and Symptoms of Ovulation
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Abdominal cramps, change in vaginal secretions (increase in clear, slippery vaginal secretions that resemble raw egg whites), and changes in basal body temperature.
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Amenorrhea
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The absence of a menstrual period in a woman of reproductive age.
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Causes of secondary amenorrhea
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Hormonal disturbances from the hypothalamus and the pituitary gland, from premature menopause or intrauterine scar formation. It is defined as the absence of menses for three months in a woman with previously normal menstruation or nine months for women with a history of oligomenorrhoea. Other causes: exercise, eating disorder, stress, and young age.
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Physical Symptoms of PMS
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fatigue, bloating, breast tenderness, acne, headache, cramps, food cravings
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Psychosocial/ Cognitive Symptoms of PMS
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irritability, moodiness, tearfulness, mood swings, insomnia, short term memory loss, difficulty concentrating, slow thinking
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Treatments of PMS
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Chocolate in moderation, exercise (increase endorphins which helps with fatigue), adequate sleep, support, decrease sodium and caffeine, and increase calcium and magnesium. Medications: Midol, Pamprin, Ibuprofen, Zolaf, Prozac, Pac-sol, birth control.
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What Are the Non-Sexually Transmitted Diseases?
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Cystitis, Bacterial Vaginosis, and Toxic Shock Syndrome
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Cystitis
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Bladder infection
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Risk Factors for Cystitis
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o Epidural anesthesia, overdistended bladder, not emptying bladder completely, use of Foley catheter during labor, neonatal macrosomia, operative vaginal deliveries, and frequent vaginal exams
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Bacterial Vaginosis
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overgrowth of certain bacteria in the vagina
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Treatment for Bacterial Vaginosis
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Metronidazole or clindamycin either orally or vaginally are effective treatment. Antibiotic treatment regime.
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Education on Bacterial Vaginosis
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Minimize vaginal irritation, Don't douche and Avoid a sexually transmitted infection
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Toxic Shock Syndrome
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o Rare illness that happens suddenly after An infection that can quickly harm several different organs such as the lungs, kidneys, and liver. Can be deadly.
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Risks for Toxic Shock Syndrome
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recent strep throat or staph infection (produce exotoxins- absorbed in blood stream); improper tampon use.
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Symptoms of Toxic Shock Syndrome
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temp >102, muscle aches, diarrhea, vomiting, dizziness, sunburn-like rash, sore throat, blood shot eyes.
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Education on STD's (in general)
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Treatment involves you and partner; don't have sex until treatment finished; can be asymptomatic and still pass on to partner; get it from contact with any genital fluid/ tissue
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Prevention of STD's (in general)
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abstinence; safe sex (protection)
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Hepatitis B
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Irritation and swelling (inflammation) of the liver due to infection with the specific virus. Spread through contact with the blood, semen, vaginal fluids, and other body fluids of someone who has infection. Can be passed to an infant during childbirth if the mother is infected.
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Risks for Hepatitis B
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Blood transfusions, direct contact with blood, sexual contact with infected person, tattoo or acupuncture with unclean needles or instruments, shared needles during drug use, shared personal items (such as toothbrushes, razors, and nail clippers) with an infected person, infected with HIV, on hemodialysis, multiple sex partners, men having sex with men, and parents who were born in regions with high infection rates (Asia, Africa, and the Caribbean).
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How can you prevent Hepatitis B infection?
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Hepatitis B vaccination
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Symptoms of Hepatitis B
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Appetite loss, fatigue, low grade fever, muscle and joint aches, nausea, vomiting, and yellow skin and dark urine due to jaundice.
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HPV
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Human Papilloma Virus (Genital Warts); soft growths on the skin and mucus membranes of the genitals, found on the penis, vulva, urethra, vagina, cervix, and around in the anus. Infection spreads through sexual contact involving anus, mouth, or vagina.
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Risks for HPV
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Multiple sex partners, sexually active at a young age, use tobacco or alcohol, have a viral infection such as herpes and are stress at the same time, pregnant, weakened immune system sue to an illness or medication.
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Symptoms of HPV
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Warts may look like flesh-colored spots that are raised or flat and growths that look like the top of a cauliflower, increased dampness in the genital area near the warts, increased vaginal discharge, genital itching, or vaginal bleeding during or after sex.
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Prevention/ Screening of HPV
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safe sex, abstinence; Pap smear
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Symptoms of Herpes
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o Itching/ tingling→ vesicles (blisters (clear/yellow filled)→ erosions/ulcers (pink/red); systemic symptoms (flu like symptoms)
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Symptoms of Gonorrhea
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Silent, yellow-green profuse, malodorous discharge, dysuria, frequency
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Treatment of Gonorrhea
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Treated with antibiotics. Ceftriaxone (rocephen), Cefixime, plus treatment for Chlamydia.
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Symptoms of Syphilis
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The appearance of an ulcer called a Chancre is the first and primary sign (ulcers will appear to be painless, smooth, weeping lesion). Secondary includes systemic symptoms- Malaise, Low-grade fever, headache, muscular aches and pains, sore throat, and a generalized rash. (The rash will often cover the palms of the hand and the soles of the feet). Latent: initially may have recurrence, then no symptoms (more difficult to spread and treat. Tertiary: cardiovascular, neurosyphilis (dementia/ confusion), gummas (painless skin lesions).
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Treatment of Syphilis
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Benzathine penicillin
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Symptoms of Chlamydia
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Dysuria, yellowish discharge, bleeding after sex, and abdominal discomfort
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Causes of PID
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bacteria (germs) move up from her vagina and infect her pelvic organs (most commonly gonorrhea or chlamydia). Can get without having an STD- normal bacteria found in the vagina and on the cervix can sometimes cause this.
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Menopause
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Gradual cessation of menses (without a period for 12 months)
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Perimenopause
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gradual cessation of ovarian function (10 years before menopause starts)
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Symptoms of Menopause
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Irregular periods, Decreased fertility, Vaginal dryness, Hot flashes, Sleep disturbances, Mood swings, Increased abdominal fat, Thinning hair, and Loss of breast fullness.
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Effects of Menopause
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mestrual irregularities, atrophy and dryness of reproductive organs, pelvic, muscle relaxation, vasomotor symptoms (hot flashes/ night sweats), thinning pubic hair, decreased pelvic support, decreased breast firmness, osteoporosis (related to the decrease in estrogen), increased risk for coronary heart disease, increased wrinking (lose collagen), weight gain (basometabolic rate slows down), irritability, mood instability, fatigue, and helplessness.
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Nonpharmacologic Treatments of Menopause
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exercise (weight baring and aerobics), diet (decrease fat and caffeine), and smoking cessation
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Prevention of Osteoporosis
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Three factors essential for keeping your bones healthy throughout your life are: Adequate amounts of calcium, Adequate amounts of vitamin D, Regular exercise
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Nutritional therapy for Osteoporosis
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Adequate amounts of protein, magnesium, vitamin K and trace minerals are needed for bone formation. Calcium and vitamin D should be increased. And patients are to avoid excessive alcohol intake, and caffeine consumption. The promotion of one single nutrient will to treat or prevent osteoporosis. Must use the entire nutritional therapy.
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Risk factors for Osteoporosis
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Women over the age of 65, men over the age of 75, family HX of osteoporosis, HX of low-trauma fractures after the age of 50, Caucasian, Asian ethnicity, low calcium intake, estrogen or androgen deficiency.
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Hormone replacement therapy
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Previously used as a primary treatment to help reduce bone loss (may increase risk for HPT, breast cancer, and DVT). Hormones involved are estrogen and progesterone. (estrogen help uterine wall build up and progesterone keeps uterine lining from building up). Takes away hot flashes and is helpful for some of the symptoms of menopause. Given PO or patch.
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Risks for Ovarian Cancer
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>40, family history, nulliparity, late first birth, Hx of breast or colorectal cancer, infertility, early menarche, late menopause, endometritis, and obesity.
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Symptoms of Ovarian Cancer
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Abdominal pressure, bloating, indigestion, gas, and frequent urination.
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Fibrocystic Breast Disease
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Imbalance of estrogen/ progesterone
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Symptoms of Fibrocystic Breast Disease
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Breast pain and rubbery lumps
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Teaching for Fibrocystic Breast Disease
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wear a firm bra that gives very good support for severe breast pain, avoid caffeine and chocolate, eliminate excessive dietary fat and limit salt intake, take pain relievers for combating pain, increase doses of vitamin E
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Pap Test
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begins at 21; from 21-30: every 2-3 years; After 30: every 3 years if 3 negative, every 5 years if negative HPV test; Over 65: can stop if low risk and previously normal results.
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Mammogram
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every 1-2 years after the age of 40; breast self-examination (early detection is key)
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Assessment for Domestic Violence/ Sexual Assault
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act defensive, submissive to partner, unexplained injuries (or injuries that don't make sense), controlling (abuser or abusee), and remain distant.
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Therapeutic Communication for Domestic Violence or Sexual Assault
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get her alone or talk one on one without significant other; recommend supportive group, help to find a safe house, maintain confidentiality, help plan, access to services, believe her/ validate her, and acknowledge.
