N4280: Week 7 - Assessment and Health Promotion, Reproductive System Concerns, Infertility, Contraception & STIs

BATTERING DURING PREGNANCY • Maybe as high as 20% (higher with teens) • Every woman should be screened • Mandate Laws

BATTERING DURING PREGNANCY • Maybe as high as 20% (higher with teens) • (No/Some/Every) woman/women should be screened • Mandate Laws

BREASTS INCLUDE SBE or SELF BREAST EXAM • Skin changes • Dimpling • Symmetry • Scars • Tenderness • Discharge • Masses • Characteristics of nipple/areola Mammography: for family Hx of breast CA - optional between ages of 40 to 44, yearly - recommended between ages 45 to 54 - beyond: every 2 years

BREASTS INCLUDE SBE or ? • Skin changes • Dimpling • Symmetry • Scars • Tenderness • Discharge • Masses • Characteristics of nipple/areola Mammography: for family Hx of breast CA - optional between ages of 40 to ___, yearly - recommended between ages ___ to 54 - beyond: every 2 years

B. Past infection

Hysterosalpingography (HSG) is performed to determine whether a client has a tubal obstruction.The nurse explains to the client that infertility caused by a defect in the tube is most often related to what? A. A tubal injury B. Past infection C. A fibroid tumor D. A congenital anomaly

RECTAL • Sphincter tone • Masses • Hemorrhoids • Rectal wall contour • Tenderness • Stool for occult blood Colonoscopy done every 10 years

RECTAL • Sphincter tone • Masses • Hemorrhoids • Rectal wall contour • Tenderness • Stool for o___ blood Colonoscopy done every ___ years

THE FIVE P'S APPROACH FOR HEALTHCARE PROVIDERS OBTAINING SEXUALHISTORIES • Partners • Practices • Protection from STIs • Past history of STIs • Pregnancy Intention

THE FIVE P'S APPROACH FOR HEALTHCARE PROVIDERS OBTAINING SEXUALHISTORIES • Partners • Practices • ___ from STIs • Past history of STIs • Pregnancy ___

*How do I know if I have gonorrhea?* Gonorrhea often has no symptoms, but it can cause serious health problems, even without symptoms. Most women with gonorrhea do not have any symptoms. Even when a woman has symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Symptoms in women can include: • Painful or burning sensation when peeing; • Increased vaginal discharge; and • Vaginal bleeding between periods. Men who do have symptoms may have: • A burning sensation when peeing; • A white, yellow, or green discharge from the penis; and • Painful or swollen testicles (although this is less common). Rectal infections may either cause no symptoms or cause symptoms in both men and women that may include: • Discharge; • Anal itching; • Soreness; • Bleeding; and • Painful bowel movements.

*How do I know if I have gonorrhea?* Gonorrhea often has no symptoms, but it can cause serious health problems, even without symptoms. Most women with gonorrhea do not have any symptoms. Even when a woman has symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Symptoms in women can include: • Painful or ___ sensation when peeing; • Increased vaginal discharge; and • Vaginal bleeding between periods. Men who do have symptoms may have: • A ___ sensation when peeing; • A white, yellow, or green discharge from the penis; and • Painful or swollen testicles (although this is less common). Rectal infections may either cause no symptoms or cause symptoms in both men and women that may include: • Discharge; • Anal itching; • Soreness; • Bleeding; and • Painful bowel movements.

*IMPLANTABLE* PROGESTINS • Jadelle (2-rods) or Implanon, Nexplanon (single rod) • Nonbiodegradable flexible tubes orrods inserted under arm skin • Progestin • Up to 4 years • Most common side effect = irregular bleeding

*IMPLANTABLE* PROGESTINS • Jadelle (2-rods) or Implanon, Nexplanon (single rod) • Nonbiodegradable flexible tubes orrods inserted under arm skin • Progestin • Up to 4 years • Most common side effect = irregular ___

*INJECTABLE* PROGESTINS • Depot Medroxyprogesterone acetate (Depo-Provera) - 150mg progestin • Give deep IM injection in the gluteal or deltoid muscle • Administer every 3 months • Long-term may cause loss of bone density

*INJECTABLE* PROGESTINS • Depot Medroxyprogesterone acetate (Depo-Provera) - 150mg progestin • Give deep (IM/IV) injection in the gluteal or deltoid muscle • Administer every 3 months • Long-term may cause loss of ___ density

BARRIER METHODS • Pregnancy protection • Protection against STI's Barrier Methods • Diaphragm • Cervical Cap • Condoms • Sponge

BARRIER METHODS • Pregnancy protection • Protection against ___'s Barrier Methods • Diaphragm • Cervical Cap • Condoms • Sponge

D. Deliver the specimen to the laboratory within 2 hours of obtaining it

As part of an infertility workup involving both partners, a male client is to have a semen analysis. What should the nurse include as part of his instructions? A. Obtain the specimen upon awakening. B. Use a condom to collect the semen specimen. C. Ejaculate at least 4 hours before collection to ensure a pure specimen. D. Deliver the specimen to the laboratory within 2 hours of obtaining it

A. Pain with menses

A 37-year-old client with endometriosis visits the women's health clinic because she has dysmenorrhea and dyspareunia. Which statement is the most accurate description of dysmenorrhea? A. Pain with menses B. Hyperplasia C. Between menses D. Heavy bleeding with menses

D. It involves a decrease in bone substance

A nurse is writing a teaching plan about osteoporosis. How would the nurse best explain what osteoporosis is? A. It is avascular necrosis. B. It is caused by pathologic fractures. C. It is hyperplasia of osteoblasts. D. It involves a decrease in bone substance

A. "The calendar method of oral contraception is best suitable for me." C. "Condoms do not offer protection against sexually transmitted infections." D. "Oral contraceptive pills offer protection from sexually transmitted diseases."

A registered nurse is teaching an adolescent female client with irregular menstruation about contraception. Which statements made by the client indicates the need for further education? Select all that apply. A. "The calendar method of oral contraception is best suitable for me." B. "The withdrawal method of contraception has high incidences of failure." C. "Condoms do not offer protection against sexually transmitted infections." D. "Oral contraceptive pills offer protection from sexually transmitted diseases." E. "Three-month injectable contraceptive medications may cause weight gain and decreased bone density."

ABORTION • Purposeful interruption of pregnancy before 20 weeks of gestation • Elective • Therapeutic • Contributing factors • Legal and moral issues • Roe v. Wade, 1973- overturned 2022 First-trimester abortion • Surgical (aspiration) abortion • Medical abortion (painful) • Methotrexate and misoprostol • Mifepristone and misoprostol Second-trimester abortion • Dilation and evacuation • Cervical preparation withprostaglandins • Emotional considerations

ABORTION • Purposeful interruption of pregnancy before ___ weeks of gestation • Elective • Therapeutic • Contributing factors • Legal and moral issues • Roe v. Wade, 1973- overturned 2022 First-trimester abortion • Surgical (aspiration) abortion • Medical abortion (painful) • Methotrexate and miso___ • Mifepristone and miso___ Second-trimester abortion • Dilation and evacuation • Cervical preparation withprostaglandins • Emotional considerations

AKING A SEXUAL HISTORY Explain: Explain purpose of interview Eye: Direct eye contact unless culturally unacceptable Ask: Ask open-ended questions Proceed: Proceed from easier to more difficult topics Clarify: Clarify terminology Use: Use teachable moments to educate

AKING A SEXUAL HISTORY Explain: Explain purpose of interview Eye: Direct eye contact unless culturally unacceptable Ask: Ask (closed/open)-ended questions Proceed: Proceed from (easier/difficult) to more (easier/difficult) topics Clarify: Clarify terminology Use: Use teachable moments to educate

metrorrhagia

ALTERATIONS IN CYCLIC BLEEDING What term is this? bleeding between periods CHOICES: oligomenorrhea hypomenorrhea menorrhagia metrorrhagia

menorrhagia

ALTERATIONS IN CYCLIC BLEEDING What term is this? excessive bleeding CHOICES: oligomenorrhea hypomenorrhea menorrhagia metrorrhagia

oligomenorrhea

ALTERATIONS IN CYCLIC BLEEDING What term is this? infrequent menstruation CHOICES: oligomenorrhea hypomenorrhea menorrhagia metrorrhagia

hypomenorrhea

ALTERATIONS IN CYCLIC BLEEDING What term is this? scanty blood, but normal intervals CHOICES: oligomenorrhea hypomenorrhea menorrhagia metrorrhagia

ALTERATIONS IN CYCLIC BLEEDING • Oligomenorrhea - infrequent menstruation • Hypomenorrhea - scanty blood, but normal intervals • Menorrhagia - excessive bleeding • Metrorrhagia - bleeding between periods • Abnormal uterine bleeding • Dysfunctional uterine bleeding

ALTERATIONS IN CYCLIC BLEEDING (nothing to answer here) • Oligomenorrhea - infrequent menstruation • Hypomenorrhea - scanty blood, but normal intervals • Menorrhagia - excessive bleeding • Metrorrhagia - bleeding between periods • Abnormal uterine bleeding • Dysfunctional uterine bleeding

AMENORRHEA • The absence of menstrual flow • Clinical sign of a disorder *Primary Amenorrhea* • The absence of both menarche & secondary sexual characteristics by age 13 years • The absence of menses by age 16 years, in the presence of normal growth and secondary sexual characteristics *Secondary Amenorrhea* - missing 3 menstrual periods in a row or a 6+-month cessation of having periods after having natural periods Causes: • Chromosomal or genetic abnormalities • Problems with the hypothalamus or pituitary gland • Other

AMENORRHEA • The ___ of menstrual flow • Clinical sign of a disorder *Primary Amenorrhea* • The absence of both menarche & secondary sexual characteristics by age ___ years • The absence of menses by age ___ years, in the presence of normal growth and secondary sexual characteristics *Secondary Amenorrhea* - missing 3 menstrual periods in a row or a 6+-month cessation of having periods after having natural periods Causes: • Chromosomal or genetic abnormalities • Problems with WHAT PART OF BRAIN or pituitary gland • Other

ASSESSMENT AND PREVENTATIVE SCREENINGS FOR THE WOMAN • Preventive health screening is an important part of women's health maintenance • Trust that the woman is an expert on her life, culture, and experiences • If asked with respect and genuine desire to learn, woman will tell nurse how to care for her

ASSESSMENT AND PREVENTATIVE S___ FOR THE WOMAN • Preventive health s___ is an important part of women's health maintenance • Trust that the woman is an expert on her life, culture, and experiences • If asked with respect and genuine desire to learn, woman will tell nurse how to care for her

ASSESSMENT OF MAN'S FERTILITY Semen analysis • For accuracy, specimen is collected after of 2-3 days abstinence • Quality, Quantity, Motility • Hormone analysis • Scrotal ultrasound • Identified and reversible • Obstructions • Varicocele • Identified and irreversible • Congenital absence of vas deferens

ASSESSMENT OF MAN'S FERTILITY Semen analysis • For accuracy, specimen is collected after of __ days abstinence • Quality, Quantity, Motility • Hormone analysis • Scrotal ultrasound • Identified and reversible • Obstructions • Varicocele • Identified and irreversible • Congenital absence of vas deferens

Ceftriaxone Doxycycline is the treatment for chlamydia.

Along with treatment of chlamydia, would be the drug of choice in an adolescent who is diagnosed with gonorrhea during the third trimester of pregnancy? A. Penicillin G B. Ceftriaxone C. Tetracycline D. Erythromycin

CARING FOR WOMEN ACROSS REPRODUCTIVE TRANSITIONS Adolescence: Teen pregnancy Young/Middle Adulthood: Contraception, Pelvic & breast screening, Menstrual problems, Preconception counseling/infertility, Pregnancy care Later Reproductive Age: menopause

CARING FOR WOMEN ACROSS REPRODUCTIVE TRANSITIONS Adolescence: Teen p___ Young/Middle Adulthood: Contraception, Pelvic & breast screening, Menstrual problems, Preconception counseling/infertility, Pregnancy care Later Reproductive Age: m___

CDC RECOMMENDATIONS FOR CHLAMYDIA • Annual screening for sexually active females <25 yrs • Annual screening >25 yrs; if at risk (hx of STI's, multiple partners, etc) • Annual screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia or for populations with a high burden of infection Pregnant women • All women at 1st prenatal visit TREATMENT • *Doxycycline 100 mg po* BID x 7 day (contraindicated if pregnant) Alternative regimen: • *Azithromycin 1 gram po* x 1 in a single dose or • *Levofloxacin* 500 mg po qd for 7 days • Couples should be treated & abstain from sex for 7 days • CDC recommends: pregnant women be treated with azithromycin 1 gram pox1 or amoxicillin 500 mg po TID x 7 days. ***Retest in 4 weeks, 3 months

CDC RECOMMENDATIONS FOR CHLAMYDIA • Annual screening for sexually active females <___ yrs • Annual screening >___ yrs; if at risk (hx of STI's, multiple partners, etc) • Annual screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia or for populations with a high burden of infection Pregnant women • All women at which prenatal visit? TREATMENT • *Doxycycline 100 mg po* BID x 7 day (contraindicated if pregnant) Alternative regimen: • *Azithromycin 1 gram po* x 1 in a single dose or • *Levofloxacin* 500 mg po qd for 7 days • Couples should be treated & abstain from sex for 7 days • CDC recommends: pregnant women be treated with azithromycin 1 gram pox1 or amoxicillin 500 mg po TID x 7 days. ***Retest in 4 weeks, 3 months

CDC RECOMMENDATIONS FOR GONORRHEA • Annual screening for sexually active females <25 yrs • Annual screening >25 yrs; if at risk (hx of STI's, multiple partners, etc) • Annual screening for Men Who Have Sex with Men (MSM) • Pregnant women • All women at 1st prenatal visit

CDC RECOMMENDATIONS FOR GONORRHEA • Annual screening for sexually active females <___ yrs • Annual screening >___ yrs; if at risk (hx of STI's, multiple partners, etc) • Annual screening for Men Who Have Sex with ___ (MSM) • Pregnant women • All women at which prenatal visit?

CDC RECOMMENDATIONS FOR SYPHILIS - Annual screening for sexually active gay men • Persons with HIV • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter • Pregnant women • All women at 1st prenatal visit • Retest early in the third trimester and at delivery if at high risk

CDC RECOMMENDATIONS FOR SYPHILIS - Annual screening for sexually active ___ men • Persons with HIV • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter • Pregnant women • All women at 1st prenatal visit • Retest early in the (first/second/third) trimester and at delivery if at high risk

CERVICAL CAP • Silicone rubber • Fits around base of cervix • Remains in place for 6-48 hours (min of 6hours after intercourse) • Physical barrier & chemical barrier (spermicide)

CERVICAL CAP • s___ rubber • Fits around base of c___ • Remains in place for 6-48 hours (min of 6hours after intercourse) • Physical barrier & c___ barrier (spermicide)

CHLAMYDIA - Chlamydia trachomatis - Most frequently reported bacterial infectious disease in US - Asymptomatic infection is common among both men and women - Incubation = 1-5 days

CHLAMYDIA - Chlamydia trachomatis - Most frequently reported (bacterial/virus) infectious disease in US - (Asymptomatic/Symptomatic) infection is common among both men and women - Incubation = 1-5 days

CHLAMYDIA SYMPTOMS MALE • Discharge from penis • Burning sensation when urinating • Pain and swelling in one or both testicles (less common) FEMALE • Thin or purulent discharge • Burning & frequency of urination • Discomfort or bleeding when having sex

CHLAMYDIA SYMPTOMS MALE • Discharge from penis • Burning sensation when ___ • Pain and swelling in one or both testicles (less common) FEMALE • Thin or purulent discharge • Burning & frequency of urination • Discomfort or bleeding when having ___

COMBINED ESTROGEN-PROGESTIN (COC'S) Oral - Most popular method *• Must take at same time every day • Use backup method for 7-9 days if missed dose* • 21 day & 28 day packaging

COMBINED ESTROGEN-PROGESTIN (COC'S) Oral - Most popular method *• Must take at same time, how often? • Use backup method for 7-___ days if missed dose* • 21 day & 28 day packaging

COMBINED ESTROGEN-PROGESTIN(COC'S) Positive Effects: • Decreased periods • Decreased bleeding (less anemia) • Less cramping • Less acne & hirsutism • Less premenstrual syndrome & premenstrual dysphoric disorder issues Side Effects • N/V, Headache, Bloating, Breast tenderness, Swelling of the ankles/feet (fluid retention), Weight change may occur, Vaginal bleeding between periods or missed/irregular periods may occur, especially during the first few months of use Contraindications • Thromboembolic disease • Cardiovascular disease • Breast cancer • Estrogen-dependent tumors • Smoking (>35yrs) • Diabetes (duration >20yrs) • Migraines • Breastfeeding

COMBINED ESTROGEN-PROGESTIN(COC'S) Positive Effects: • Decreased periods • (Decreased/Increased) bleeding • Less cramping • Less acne & hirsutism • Less premenstrual syndrome & premenstrual dysphoric disorder issues Side Effects • N/V, Headache, Bloating, Breast tenderness, Swelling of the ankles/feet (fluid retention), Weight change may occur, Vaginal bleeding between periods or missed/irregular periods may occur, especially during the first few months of use Contraindications • Thromboembolic disease • Cardiovascular disease • B___ cancer • Estrogen-dependent tumors • Smoking (>___yrs) • Diabetes (duration >20yrs) • M___ • (Breastfeeding/Formula feeding)

Cytomegalovirus (CMV) - Most common congenital infection in US - 1% of all newborns, most are asymptomatic. • 50% of people have had CMV and carry the virus • Recurrent infections are not as serious. • Transmission occurs in utero, during birth, or postnatally though breastmilk. Newborn Assessment: IUGR, Jaundice, Hepatosplenomegaly, Petechiae, Thrombocytopenia Pneumonia, CNS manifestations - lethargy, poor feeding, hypertonia or hypotonia, microcephaly, deafness

Cytomegalovirus (CMV) - Most common congenital infection in US - 1% of all newborns, most are asymptomatic. • 50% of people have had CMV and carry the virus • Recurrent infections are not as serious. • Transmission occurs in utero, during birth, or postnatally though ___. Newborn Assessment: IUGR, Jaundice, Hepatosplenomegaly, Petechiae, Thrombocytopenia Pneumonia, CNS manifestations - lethargy, poor feeding, hypertonia or hypotonia, microcephaly, deafness

DIAPHRAGM • Flexible, dome shaped device that covers cervix • Physical barrier & chemical barrier (spermicide) • Annual GYN appointment to assess fit • Refit after weight loss, birth, miscarriage, surgery • Disadvantages • Messy, failure to insert, latex, UTI's, contraindicated withuterine prolapse or cystocele

DIAPHRAGM • Flexible, dome shaped device that covers c___ • Physical barrier & chemical barrier (spermicide) • Annual GYN appointment to assess fit • Refit after weight loss, birth, miscarriage, surgery • Disadvantages • Messy, failure to insert, latex, UTI's, contraindicated withuterine prolapse or cystocele

DOMESTIC VIOLENCE • Physical • Emotional • Sexual • Isolation • Controlling all aspects of woman's life • Money, food, shelter, time

DOMESTIC VIOLENCE • p___ • e___ • s___ • Isolation • Controlling all aspects of woman's life • Money, food, shelter, time

DYSFUNCTIONAL UTERINEBLEEDING • Abnormal bleeding in any form (amount, duration, timing) • Usually hormone related • Usually anovulatory (no LH surge or insufficient progesterone) • Can be associated with ↑ estrogen conditions (obesity, thyroid, PCOS)

DYSFUNCTIONAL UTERINEBLEEDING • Abnormal bleeding in any form (amount, duration, timing) • Usually ___ related • Usually anovulatory (no LH surge or insufficient progesterone) • Can be associated with ↑ estrogen conditions (obesity, thyroid, PCOS)

DYSMENORRHEA • Pain during or shortly before menstruation • Most common ages 17-24 years • Symptoms may last hours or days • Differentiated as • Primary dysmenorrhea • Secondary dysmenorrhea

DYSMENORRHEA • Pain during or shortly (before/after) menstruation • Most common ages 17-24 years • Symptoms may last hours or days • Differentiated as • Primary dysmenorrhea • Secondary dysmenorrhea

EMBRYO CRYOPRESERVATION • Number of eggs transferred depends on many factors such as maternal age, embryo quality • Under 35, should be offered a single egg transfer • Women 35-37yrs, no more than 2 • Women 38-40yrs, no more than 3 • Excess embryos can be frozen-10-20% do not survive • Many ethical concerns

EMBRYO CRYOPRESERVATION • Number of eggs transferred depends on many factors such as maternal age, embryo quality • Under ___, should be offered a single egg transfer • Women 35-37yrs, no more than 2 • Women 38-40yrs, no more than 3 • Excess embryos can be frozen-10-20% do not survive • Many ethical concerns

EMERGENCY CONTRACEPTION • Can reduce pregnancy by 75% if taken within 72 hours of unprotected sex! • Nausea d/t high hormone doses- antiemetics • EC may delay ovulation, so no unprotected sex in days or weeks following treatment • Plan B & Next Choice available OTC if >17 years. • Ella (Ulipristal) - single dose, 30mg antiprogestin • Plan B One-Step - single dose , 1.5mg levonorgestrel (progestin) • Next Choice - 0.75mg levonorgestrel x two doses, 12 hours apart • COC - 100mcg estrogen & 0.5mg progestin x two doses, 12 hours apart • Copper IUD inserted within 120 hours of intercourse

EMERGENCY CONTRACEPTION • Can reduce pregnancy by 75% if taken within ___ hours of unprotected sex! • Nausea d/t high hormone doses- antiemetics • EC may delay ovulation, so no unprotected sex in days or weeks following treatment • Plan B & Next Choice available OTC if >17 years. • Ella (Ulipristal) - single dose, 30mg antiprogestin • Plan B One-Step - single dose , 1.5mg levonorgestrel (progestin) • Next Choice - 0.75mg levonorgestrel x two doses, 12 hours apart • COC - 100mcg estrogen & 0.5mg progestin x two doses, 12 hours apart • Copper IUD inserted within 120 hours of intercourse

ENDOMETRIOSIS • Presence & growth of endometrial tissue outside of uterus • Tissue grows during proliferative & secretory phases • Bleeds after menstruation = inflammation Symptoms • Pelvic pain • Dysmenorrhea • Chronic non-cyclic pain • Dyspareunia (painful intercourse) • Diarrhea/constipation • Pain with exercise

ENDOMETRIOSIS • Presence & growth of endometrial tissue outside of ___ • Tissue grows during proliferative & secretory phases • Bleeds after menstruation = i___ Symptoms • Pelvic p___ • Dysmenorrhea • Chronic non-cyclic p___ • Dyspareunia (p___ intercourse) • Diarrhea/constipation • p___ with exercise

ENDOMETRIOSIS • Treatment based on severity & pregnancy desires • Medical - suppress estrogen production • Gonadotropin-releasing hormone (GnRH) agonists • Danazol • Combined COC's • Surgical • Laparoscopy • Total abdominal hysterectomy, bilateral tube and ovary removal (TAH with BSO)

ENDOMETRIOSIS • Treatment based on severity & pregnancy desires • Medical - suppress the production of WHAT hormone? • Gonadotropin-releasing hormone (GnRH) agonists • Danazol • Combined COC's • Surgical • Laparoscopy • Total abdominal hysterectomy, bilateral tube and ovary removal (TAH with BSO)

FEMALE CIRCUMCISION/GENITAL MUTILATION/FEMAL GENITAL CUTTING - any procedure that involves partial or total removal of extra female external genitalia or any other injuries for non-medical reasons - increases risk for infection

FEMALE CIRCUMCISION/GENITAL MUTILATION/FEMAL GENITAL CUTTING - any procedure that involves partial or total removal of extra female external genitalia or any other injuries for non-medical reasons - (decreases/increases) risk for infection

FERTILITY AWARENESS • Fertility awareness is knowing and recognizing when the fertile time (when a woman can get pregnant) occurs in the menstrual cycle. • If you are practicing fertility awareness as a birth control method to prevent pregnancy, you need to avoid having sexual intercourse or use a barrier method of birth control, such as a condom, during the fertile period. • If you are trying to get pregnant, you should have sexual intercourse on your fertile days, ideally every day or every other day

FERTILITY AWARENESS (nothig to write here) • Fertility awareness is knowing and recognizing when the fertile time (when a woman can get pregnant) occurs in the menstrual cycle. • If you are practicing fertility awareness as a birth control method to prevent pregnancy, you need to avoid having sexual intercourse or use a barrier method of birth control, such as a condom, during the fertile period. • If you are trying to get pregnant, you should have sexual intercourse on your fertile days, ideally every day or every other day

Female Condom • Barrier to sperm • Prevents STI's (including HIV) • Vaginal sheath

Female Condom • Barrier to s___ • Prevents STI's (including HIV) • Vaginal sheath

GAMETE INTRAFALLOPIAN TRANSFER (GIFT) • Oocytes retrieved laparoscopically, immediately placed in a catheter with sperm • Gametes are place in the fimbriated end of the fallopian tube • Fertilization occurs in fallopian tube • Fertilized egg migrates to uterus through tube, as normal • FALSE: Woman must have at least one normal tube

GAMETE INTRAFALLOPIAN TRANSFER (GIFT) • Oocytes retrieved laparoscopically, immediately placed in a catheter with sperm • Gametes are place in the fimbriated end of the fallopian tube • Fertilization occurs in fallopian tube • Fertilized egg migrates to uterus through tube, as normal • T/F: The woman must have both tubes normal for this procedure to take place.

GENITOURINARY • External genitalia • Perineum • Vaginal mucosa • Cervix - inflammation,tenderness, discharge, bleeding,ulcers, nodules, masses - self exam: vulvar exam, looking at mirror and externally observing for signs of infection The genitourinary exam should be scheduled about 2 weeks after a menstrual period and the client should not have sex at 48 hours beforehand because this can change the results of a Pap test

GENITOURINARY • External genitalia • Perineum • Vaginal mucosa • Cervix - inflammation,tenderness, discharge, bleeding,ulcers, nodules, masses - self exam: v___ exam, looking at mirror and externally observing for signs of infection The genitourinary exam should be scheduled about 2 weeks after a menstrual period and the client should not have sex at 48 hours beforehand because this can change the results of what test?

GONORRHEA • Neisseria gonorrhea (gram negative diplococcus) • Risk factors: adolescence, poverty, single, drug abuse, prostitution, other STI's, lack of prenatal care Symptoms • Usually (asymptomatic/symptomatic) • Green-yellow discharge • Menstrual irregularities • Abdominal pain • Vaginitis

GONORRHEA • Neisseria gonorrhea (gram negative diplococcus) • Risk factors: adolescence, poverty, single, drug abuse, prostitution, other STI's, lack of prenatal care Symptoms • Usually asymptomatic • Green-yellow discharge • Menstrual irregularities • Abdominal pain • Vaginitis

GONORRHEA Treatment: *Ceftriaxone 500 mg* IM x1 and Treatment for Chlamydia (doxycycline 100 mgorally 2 times/day for 7 days) Alternative Regimens: If cephalosporin allergy: - Gentamicin 240 mg IM in a single dose PLUS Azithromycin 2 g po in a single dose - Sexual partners need treated - No sex for 7 days after treatment completed CDC: Pregnant women infected with gonorrhea: ceftriaxone 500 mg IM x 1plus treatment for chlamydia if infection has not been excluded.

GONORRHEA Treatment: *C___ 500 mg* IM x1 and Treatment for Chlamydia (doxycycline 100 mgorally 2 times/day for 7 days) Alternative Regimens: If cephalosporin allergy: - Gentamicin 240 mg IM in a single dose PLUS Azithromycin 2 g po in a single dose - Do sexual partners need treated? - No sex for ___ days after treatment completed CDC: Pregnant women infected with gonorrhea: c___ 500 mg IM x 1plus treatment for chlamydia if infection has not been excluded.

HERPES SIMPLEX VIRUS (HSV) • HSV I = (cold sore) which can cause genital herpes through oral-genital contact • HSV II = usually only associated with genital infections • Symptoms: • painful lesions, fever, chills, malaise dysuria • Itching, inguinal tenderness • Heavy watery to purulent vaginal discharge • After healing, dormant in nerve ganglia of affected area

HERPES SIMPLEX VIRUS (HSV) • HSV I = (cold sore) which can cause genital herpes through oral-genital contact • HSV II = usually only associated with g___ infections • Symptoms: • painful lesions, fever, chills, malaise dysuria • Itching, inguinal tenderness • Heavy watery to purulent vaginal discharge • After healing, dormant in nerve ganglia of affected area

HIV AND PREGNANCY Exposure can occur through maternal circulation in 1st trimester • HIV antibody crosses the placenta • Less than 1% chance of transmitting HIV with proper treatment and adherence to medications Treatment: • Triple-drug antiviral therapy (oral) • Highly active antiretroviral therapy (HAART) • Vaccinations • Fetus/Newborn: • Weekly nonstress test starting at 32 weeks • Serial ultrasounds to r/o IUGR • BPP's • HIV virology assays ASAP • Antiviral prophylaxis immediately if test + (zidovudine (ZDV) X 6weeks)

HIV AND PREGNANCY Exposure can occur through maternal circulation in (1st/2nd/3rd) trimester • HIV antibody crosses the placenta • Less than ___% chance of transmitting HIV with proper treatment and adherence to medications Treatment: • Triple-drug antiviral therapy (oral) • Highly active antiretroviral therapy (HAART) • Vaccinations • Fetus/Newborn: • Weekly nonstress test starting at ___ weeks • Serial ultrasounds to r/o IUGR • BPP's • HIV virology assays ASAP • Antiviral prophylaxis immediately if test + (zidovudine (ZDV) X 6weeks)

HORMONAL METHODS • Combined Estrogen-Progestin • Oral • Transdermal • Vaginal Ring • Progestin-Only • Oral • Injectable • Implantable

HORMONAL METHODS • Combined E___-Progestin • Oral • Transdermal • Vaginal Ring • Progestin-Only • Oral • Injectable • Implantable

HORMONAL METHODS • Inhibits ovulation • Alters uterine lining • Thick cervical mucous

HORMONAL METHODS • Inhibits o___ • Alters uterine lining • (Thin/Thick) cervical mucous

HUMAN IMMUNODEFICIENCY VIRUS (HIV) • Enters body through blood, blood products, body fluids • Affects specific T lymphocyte cells, causing destruction, decreasing the immune system • Once HIV enters the body-seroconversion to HIV positivity in 6-12 weeks • Can see severe depression of the cellular immune system • AIDS = HIV positive + diagnosed opportunistic infection(s) Management: • Education- include contraception • No breastfeeding if HIV positive

HUMAN IMMUNODEFICIENCY VIRUS (HIV) • Enters body through blood, blood products, body fluids • Affects specific T lymphocyte cells, causing destruction, decreasing the ___ system • Once HIV enters the body-seroconversion to HIV positivity in 6-12 weeks • Can see severe depression of the cellular ___ system • AIDS = HIV positive + diagnosed opportunistic infection(s) Management: • Education- include contraception • No ___ if HIV positive

HUMAN PAPILLOMA VIRUS (HPV) • Condylomata acuminata (genital warts) • Prevention: vaccination • Symptoms: • soft, papillary swellings occurring singly or in clusters on the vulva, vagina, cervix, or anus (genital andanal-rectal areas) • May appear as cauliflower-type mass • Lesions usually painless

HUMAN PAPILLOMA VIRUS (HPV) • Condylomata acuminata (genital warts) • Prevention: v___ • Symptoms: • soft, papillary swellings occurring singly or in clusters on the vulva, vagina, cervix, or anus (genital andanal-rectal areas) • May appear as cauliflower-type mass • Lesions usually (painless/painful)

IDENTIFICATION OF RISK FACTORS TO A WOMAN'S HEALTH • Social, cultural, genetic factors • Substance use/abuse • Nutrition/Eating Disorders • Lack of exercise • Stress • Mental Health • Sleep Disorders • Environment/Workplace Hazards • Risky Sexual Practices • Risk for Medical/GYN Conditions • Female Mutilation • Domestic Violence

IDENTIFICATION OF RISK FACTORS TO A WOMAN'S HEALTH (nothing to answer here) • Social, cultural, genetic factors • Substance use/abuse • Nutrition/Eating Disorders • Lack of exercise • Stress • Mental Health • Sleep Disorders • Environment/Workplace Hazards • Risky Sexual Practices • Risk for Medical/GYN Conditions • Female Mutilation • Domestic Violence

IN VITRO FERTILIZATION • Woman's ___ stimulated with medication • One or more oocytes are aspirated with US guidance • Fertilization in lab • Placed in uterus after normal embryo development has begun (3-5days) • Ave. cost is $12,400 per cycle

IN VITRO FERTILIZATION • Woman's ovaries stimulated with medication • One or more oocytes are aspirated with US guidance • Fertilization in lab • Placed in uterus after normal embryo development has begun (3-5days) • Ave. cost is $12,400 per cycle

INTRACYTOPLASMIC SPERM INJECTION • Oocytes retrieved laparoscopically • Single sperm injected into egg • Embryo transferred to uterus in 3-5days

INTRACYTOPLASMIC SPERM INJECTION • Oocytes retrieved laparoscopically • Single ___ injected into egg • Embryo transferred to uterus in 3-5days

INTRAUTERINE DEVICES • Small T-shaped device, through cervix into uterine cavity 2 Types • Copper (Paragard) - up to 12 years • Copper serves as spermicide & inflames endometrium • May increase bleeding and cramps • Levonorgestrel-releasing (Mirena) - up to 7 years • May stop menstruation • Irregular spotting initially - CAN be used as emergency contraception *Both can increase risk of PID*

INTRAUTERINE DEVICES • Small T-shaped device, through cervix into uterine cavity 2 Types • C___ (Paragard) - up to 12 years • C___ serves as spermicide & inflames endometrium • May increase bleeding and cramps • Levonorgestrel-releasing (Mirena) - up to 7 years • May stop menstruation • Irregular spotting initially - (cannot/can) be used as emergency contraception *Both can (decrease/increase) risk of PID*

MENOPAUSE • Absence of menstruation x 12 months • Average age 51.4 yrs (35-60yrs) • Age of onset influenced by • Overall health • Weight & nutrition • Lifestyle & culture • Genetics Changes in reproductive system: • Anovulation • Irregular menstruation, amenorrhea • Follicle-stimulating hormone levels rise • Estrogen decreases • Endometrium thins; myometrium, fallopian tubes, ovaries atrophy

MENOPAUSE • Absence of menstruation x ___ months • Average age 51.4 yrs (35-60yrs) • Age of onset influenced by • Overall health • Weight & nutrition • Lifestyle & culture • Genetics Changes in reproductive system: • Anovulation • Irregular menstruation, amenorrhea • Follicle-stimulating hormone levels rise • Estrogen (decreases/increases) • Endometrium thins; myometrium, fallopian tubes, ovaries atrophy

MOST EFFECTIVE CONTRACEPTION FOR MALES: MALE STERILIZATION • Occlusion of passageway for gametes • No hormonal changes • Male - Vasectomy

MOST EFFECTIVE CONTRACEPTION FOR MALES: MALE STERILIZATION • Occlusion of passageway for gametes • hormonal changes? • Male - v___

Male Condom • Barrier to sperm • Prevents STI's (including HIV) • Latex rubber, polyurethane, natural - animal tissue • Avoid oil-based lubricants • Effective use is a skill

Male Condom • Barrier to s___ • Prevents STI's (including HIV) • Latex rubber, polyurethane, natural - animal tissue • Avoid ___-based lubricants • Effective use is a skill

ORAL PROGESTIN (MINIPILL) • Lower dose of progestin than COC's *• MUST be taken at same time every day (backup if only 3 hours late)* • Effective for • Breastfeeding women • Over 40 years • Frequent complaints of irregular bleeding

ORAL PROGESTIN (MINIPILL) • (lower/higher) dose of progestin than COC's *• MUST be taken at same time every day (backup if only 3 hours late)* • Effective for • (Breastfeeding/formula feeding) women • Over 40 years • Frequent complaints of irregular bleeding

OSTEOPOROSIS • Prevention is primary goal • Height at every visit • Bone Mineral Density • DEXA scan Recommended: • all postmenopausal women >65 • Postmenopausal women with fractures • Postmenopausal women < 65 with at least one risk factor

OSTEOPOROSIS • P___ is primary goal • Height at every visit • Bone Mineral Density • DEXA scan Recommended: • all postmenopausal women >___ • Postmenopausal women with fractures • Postmenopausal women < ___ with at least one risk factor

OSTEOPOROSIS • Prevention • Adequate calcium intake • Vitamin D supplementation • Estrogen • Treatment • Hormone replacement therapy: estrogen & progesterone • Bisphosphonates ( Fosamax , Actonel , Boniva ); may cause abdominal issues • Selective estrogen receptor modulators ( Evista ) • Calcitonin (Miacalcin, Fortical)

OSTEOPOROSIS • Prevention • Adequate ___ intake • Vitamin ___ supplementation • What hormone? • Treatment • Hormone replacement therapy: estrogen & progesterone • Bisphosphonates ( Fosamax , Actonel , Boniva ); may cause abdominal issues • Selective estrogen receptor modulators ( Evista ) • Calcitonin (Miacalcin, Fortical)

PAPANICOLAOU TEST • Women aged 21-29 years should have a Pap test alone every 3 years. • Women aged 30-65 years can have a Pap test and an HPV test (co-testing) every 5 years (preferred). • No screening <21 years • May stop cervical cancer screening after age 65 years if: • No history of moderate or severe abnormal cervical cells or cervical cancer, and • either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.

PAPANICOLAOU TEST • Women aged 21-29 years should have a Pap test alone every ___ years. • Women aged 30-___ years can have a Pap test and an HPV test (co-testing) every 5 years (preferred). • No screening <___ years • May stop cervical cancer screening after age ___ years if: • No history of moderate or severe abnormal cervical cells or cervical cancer, and • either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.

PELVIC INFLAMMATORY DISEASE (PID) • Results from ascending spread of microorganisms from vagina and endocervix to upper genital tract • Caused by multiple organisms • Most commonly involves: • Uterine tubes (salpingitis) • Uterus (endometriosis) • At increased risk for: • Ectopic pregnancy • Infertility • Chronic pelvic pain • Symptoms depend on type of infections: • Acute • Subacute • Chronic

PELVIC INFLAMMATORY DISEASE (PID) • Results from (ascending/descending) spread of microorganisms from vagina and endocervix to upper genital tract • Caused by multiple organisms • Most commonly involves: • Uterine tubes (salpingitis) • Uterus (endometriosis) • At increased risk for: • e___ pregnancy • Infertility • Chronic pelvic pain • Symptoms depend on type of infections: • Acute • Subacute • Chronic

PERI-MENOPAUSE/MENOPAUSE Reproductive system changes: • Thinning, dryness of vaginal mucosa • Vaginal pH rises • Pubic hair turns gray • Labia shrinks, lose pigment • Pelvic fascia, muscles atrophy • Breasts lose density • Sexual functioning declines • "Hot Flashes"

PERI-MENOPAUSE/MENOPAUSE Reproductive system changes: • Thinning, dryness of vaginal mucosa • Vaginal pH (lowers/rises) • Pubic hair turns gray • Labia shrinks, lose pigment • Pelvic fascia, muscles (atrophy/hypertrophy) • Breasts lose density • Sexual functioning declines • "Hot Flashes"

PHARMACOLOGIC AGENTS FOR MANAGING INFERTILITY *Clomiphene Citrate (Clomid)* • Used to induce ovulation if woman has normal ovaries, prolactin level, and an intact pituitary gland • Induces ovulation in 70%of women, 30-40% become pregnant • 10% develop multiple pregnancies, usually twins • Should be limited to 6 ovulatory cycles *Gonadotropins* (Repronex, Menopur, Bravelle) • Indicated for first line for anovulatory women with low to normal levels of gonadotropins (FSH & LH) • Used as second line of therapy if fail to ovulate/conceive with clomid • Used in women undergoing controlled ovarian stimulation with assisted reproduction

PHARMACOLOGIC AGENTS FOR MANAGING INFERTILITY *Clomiphene Citrate (Clomid)* • Used to induce ovulation if woman has normal ovaries, prolactin level, and an intact pituitary gland • Induces ovulation in 70%of women, 30-40% become pregnant • 10% develop multiple pregnancies, usually twins • Should be limited to 6 ovulatory cycles *Gonadotropins* (Repronex, Menopur, Bravelle) • Indicated for first line for anovulatory women with low to normal levels of gonadotropins (what two hormones?) • Used as second line of therapy if fail to ovulate/conceive with clomid • Used in women undergoing controlled ovarian stimulation with assisted reproduction

PID TREATMENT • Ceftriaxone 500 mg IM in a single dose, PLUS • Doxycycline 100 mg orally 2 times/day for 14 days WITH • Metronidazole 500 mg orally 2 times/day for 14 days Pregnant women suspected of having PID are at high risk for maternal morbidity and preterm delivery • Ceftriaxone 1 g IV every 24 hours PLUS • Doxycycline 100 mg orally or IV every 12 hours PLUS • Metronidazole 500 mg orally or IV every 12 hours

PID TREATMENT • C___ 500 mg IM in a single dose, PLUS • D___ 100 mg orally 2 times/day for 14 days WITH • Metronidazole 500 mg orally 2 times/day for 14 days Pregnant women suspected of having PID are at high risk for maternal morbidity and preterm delivery • C___ 1 g IV every 24 hours PLUS • D___ 100 mg orally or IV every 12 hours PLUS • Metronidazole 500 mg orally or IV every 12 hours

B. "Most women try to leave about seven times before they are successful."

PRACTICE QUESTIONA nurse is working with a married woman who has come to the emergency department several times with injuries that appear to be related to domestic violence. While talking with the nurse manager, the nurse expresses disgust that the woman keeps returning to the situation. What is the best response by the nurse manager? A. "She must not have the financial resources to leave her husband." B. "Most women try to leave about seven times before they are successful." C. "There's nothing the staff can do; people are free to choose their own lives." D. "These women should be told how stupid they are to stay in that kind ofsituation."

PREMENSTRUAL SYNDROME(PMS) • 30-80%, mostly women in 20's & 30's • Complex, poorly understood condition • Symptoms during luteal phase • Fluid retention • Emotional/behavior changes • Breast tenderness • Premenstrual cravings • Headache • Fatigue PREMENSTRUAL DYSPHORIC DISORDER (PMDD) • More severe variant of PMS • Symptoms present one week before menses • More emotional issues • Interferes with personal/work relationships MANAGEMENT OF PMS & PMDD • Detailed history • Daily log of symptoms/mood fluctuations • Education • Diet & Exercise • Avoid caffeine, alcohol, smoking, red meat, salt, sugar • Counseling

PREMENSTRUAL SYNDROME(PMS) • 30-80%, mostly women in 20's & 30's • Complex, poorly understood condition • Symptoms during ___ phase • Fluid retention • Emotional/behavior changes • Breast tenderness • Premenstrual cravings • Headache • Fatigue PREMENSTRUAL DYSPHORIC DISORDER (PMDD) • More severe variant of PMS • Symptoms present ___ week(s) before menses • More emotional issues • Interferes with personal/work relationships MANAGEMENT OF PMS & PMDD • Detailed history • Daily log of symptoms/mood fluctuations • Education • Diet & Exercise • Avoid caffeine, alcohol, smoking, ___ meat, salt, sugar • Counseling

PRIMARY DYSMENORRHEA • Associated with the ovulatory cycles • Prostaglandin release • Pain usually begins at onset of menstruation and lasts 8-48 hours • Decreases with age Management: • Heat, Healthy diet, Exercise, Effleurage, Oral Contraceptives, NSAIDS, Back massage

PRIMARY DYSMENORRHEA • Associated with the o___cycles • Prostaglandin release • Pain usually begins at onset of menstruation and lasts 8-48 hours • (decreases/increases) with age Management: • (Cold/Heat), Healthy diet, Exercise, Effleurage, Oral Contraceptives, NSAIDS, Back massage

RISK FACTORS FOR INFERTILITY: FEMALE • Failure to ovulate- 40% (ovarian factors) • Primary anovulation • Secondary anovulation • medications • Structural problems of the reproductive system (tubal/peritoneal factors) • History of PID • Endometriosis • Uterine Factors • Anomalies of uterus • Fibroid tumors • Vaginal-cervical factors • STIs • Cervical mucous • Other factors

RISK FACTORS FOR INFERTILITY: FEMALE (nothing to answer here) • Failure to ovulate- 40% (ovarian factors) • Primary anovulation • Secondary anovulation • medications • Structural problems of the reproductive system (tubal/peritoneal factors) • History of PID • Endometriosis • Uterine Factors • Anomalies of uterus • Fibroid tumors • Vaginal-cervical factors • STIs • Cervical mucous • Other factors

RISK FACTORS FOR INFERTILITY: MALE Conditions that affect sperm formation: • Undescended testicles • Exposure of genitals to high temperature • Mumps after puberty • Exposure to toxic substances • Cigarette or marijuana smoke • Heavy alcohol consumption • Use of prescription drugs for ulcers or psoriasis • Frequent long-distance cycling• STIs Conditions that affect sperm transport • Hernia repair • Erectile dysfunction • retrograde ejaculation

RISK FACTORS FOR INFERTILITY: MALE (nothing to answer here) Conditions that affect sperm formation: • Undescended testicles • Exposure of genitals to high temperature • Mumps after puberty • Exposure to toxic substances • Cigarette or marijuana smoke • Heavy alcohol consumption • Use of prescription drugs for ulcers or psoriasis • Frequent long-distance cycling• STIs Conditions that affect sperm transport • Hernia repair • Erectile dysfunction • retrograde ejaculation

SECONDARY DYSMENORRHEA - Develops later in life (>25 yrs usually) - Associated with pelvic pathology - Other symptoms may suggest underlying cause - Pain is dull lower abdominal aching, radiates Diagnosis • Pelvic examination • Ultrasound • Dilatation & Curettage • Endometrial biopsy • Laparoscopy

SECONDARY DYSMENORRHEA - Develops later in life (>___ yrs usually) - Associated with pelvic pathology - Other symptoms may suggest underlying cause - Pain is (dull/sharp) Diagnosis • Pelvic examination • Ultrasound • Dilatation & Curettage • Endometrial biopsy • Laparoscopy

SIGNS OF ABUSE • Overuse of health services • Vague, nonspecific complaints • Unexplainable injuries • Untreated serious injuries • Injuries not matching the description

SIGNS OF ABUSE • Overuse of health services • Nonspecific or specific complaints? • Unexplainable injuries • Untreated serious injuries • Injuries not matching the description

SPONGE • Small, round, polyurethane sponge • Fits over cervix • Contains N-9 • Moisten with water • Protects for 24-30 hours

SPONGE • Small, round, polyurethane sponge • Fits over cervix • Contains N-9 • Moisten with w___ • Protects for 24-30 hours

SYPHILIS • Bacterium - Treponema palladium • Can cross placenta & infect fetus • Incubation period = 5-90 days (average =21) • Primary Stage-hard, painless sore, "chancre" in vaginal area that lasts about 4 weeks • Secondary Stage - 6 weeks to 6 months after appearance of chancre • Tertiary Stage- untreated leads to neuro, CV, musculoskeletal or multi-organ failure

SYPHILIS • Bacterium - Treponema palladium • Can cross placenta & infect fetus • Incubation period = 5-90 days (average =21) • Primary Stage-hard, painless sore, "c___" in vaginal area that lasts about 4 weeks • Secondary Stage - 6 weeks to 6 months after appearance of c___ • Tertiary Stage- untreated leads to neuro, CV, musculoskeletal or multi-organ failure

SYPHILIS TREATMENT • Syphilis < 1 year = single dose of *PCN, or Penicillin*, G 2.4million units IM X1 • Syphilis > 1 year = single dose of PCN G 2.4 million units IM once a week X 3 weeks *Sexual partners should be treated!*

SYPHILIS TREATMENT • Syphilis < 1 year = single dose of P___ G 2.4million units IM X1 • Syphilis > 1 year = single dose of P___ G 2.4 million units IM once a week X 3 weeks *Sexual partners (should not/should) be treated!*

THERAPEUTIC INSEMINATION • Depositing sperm at the cervical os or in the uterus by mechanical means • Indications: • Oligospermia, Decreased motility, Abnormal morphology, Anatomical defect of male, Unexplained infertility, Cervical factors

THERAPEUTIC INSEMINATION • Depositing ___ at the cervical os or in the uterus by mechanical means • Indications: • Oligospermia, Decreased motility, Abnormal morphology, Anatomical defect of male, Unexplained infertility, Cervical factors

TOXIC SHOCK SYNDROME • Rare, life-threatening complication of certain types of bacterial infections. (Often results from toxins produced by Staphylococcus aureus (staph) or group A streptococcus (strep) bacteria). Symptoms: • characteristic rash • high fever • low blood pressure • malaise • confusion • can rapidly progress to stupor, coma, and multiple organ failure

TOXIC SHOCK SYNDROME • Rare, life-threatening complication of certain types of bacterial infections. (Often results from toxins produced by Staphylococcus aureus (staph) or group A streptococcus (strep) bacteria). Symptoms: • characteristic rash • high ___ • (low/high) blood pressure • malaise • confusion • can rapidly progress to stupor, coma, and multiple organ failure

TRANSDERMAL CONTRACEPTION • Delivers continuous levels of progesterone (150 mcg) & ethynyl estradiol (20 mcg) daily • Apply to upper arm, lower abdomen, buttock, upper torso • Apply weekly X3, then one week with no patch

TRANSDERMAL CONTRACEPTION • Delivers continuous levels of p___ (150 mcg) & ethynyl estradiol (20 mcg) daily • Apply to upper arm, lower abdomen, buttock, upper torso • Apply weekly X3, then how many weeks with no patch?

TRICHOMONIASIS • Trichomonas vaginalis - protozoan with characteristic flagella Symptoms • May be asymptomatic • Copious yellow-green frothy discharge • Malodorous • Inflammation • Itching • Dysuria • Cervix and vaginal wills "strawberry spots" • Bleeding cervix

TRICHOMONIASIS • Trichomonas vaginalis - protozoan with characteristic flagella Symptoms • May be asymptomatic • Copious yellow-green frothy discharge • Malodorous • Inflammation • Itching • Dysuria • Cervix and vaginal wills "___ spots" • Bleeding cervix

A. A 13-year-old with undeveloped secondary sexual characteristics who has not yet reached menarche B. An 18-year-old with normally developed secondary sexual characteristics who has not yet reached menarche

The nurse is reviewing the data of female clients with amenorrhea. Which client may be diagnosed with primary amenorrhea based on the given data?(Select all that apply) A. A 13-year-old with undeveloped secondary sexual characteristics who has not yet reached menarche B. An 18-year-old with normally developed secondary sexual characteristics who has not yet reached menarche C. A 17-year-old who is in her first trimester of pregnancy D. A 20-year-old triathlete whose menstruation ceased three months ago

UTERINE LEIOMYOMAS (FIBROIDS) • Common cause of menorrhagia • Benign tumors of smooth muscle of uterus • 25% of women • Highest rates are in African-American women • Can interfere with reproduction

UTERINE LEIOMYOMAS (FIBROIDS) • Common cause of (oligomenorrhea /hypomenorrhea/menorrhagia/metrorrhagia) • Benign tumors of smooth muscle of uterus • 25% of women • Highest rates are in ___ women • Can interfere with reproduction

VAGINAL INFECTIONS Bacterial Vaginosis • Anaerobic bacteria: Gardnerella or Mobiluncus • Vaginal pH altered • Epithelial cells slough off, bacteria attaches to surface (clue cells) Symptoms • Characteristic "fishy" odor (sniff test) • Thin discharge, white or gray Bacterial vaginosis is associated w/ preterm labor & birth

VAGINAL INFECTIONS Bacterial Vaginosis • Anaerobic bacteria: Gardnerella or Mobiluncus • Vaginal pH altered • Epithelial cells slough off, bacteria attaches to surface (clue cells) Symptoms • Characteristic "___" odor (sniff test) • Thin discharge, white or gray Bacterial vaginosis is associated w/ preterm labor & birth

VAGINAL INFECTIONS Candidiasis • Yeast infection: Candida albicans • Predisposing factors • Antibiotics • Diabetes • Pregnancy • Obesity Symptoms • Itching • Thick, white, lumpy discharge • Red, swollen labia, cervix, vagina

VAGINAL INFECTIONS Candidiasis • Yeast infection: Candida albicans • Predisposing factors • Antibiotics • Diabetes • Pregnancy • Obesity Symptoms • I___ • Thick, white, lumpy discharge • Red, swollen labia, cervix, vagina

VAGINAL RING • Bendable ring inserts into vagina • Delivers continuous levels of progesterone (120 mcg) & ethynyl estradiol (15 mcg) daily

VAGINAL RING • Bendable ring inserts into vagina • Delivers continuous levels of WHAT HORMONE (120 mcg) & ethynyl estradiol (15 mcg) daily

condom

What is a good physical barrier that prevents sexual transmission of HIV and other STI's?

SPECULUM • Allows visualization of cervix • Allows collections of specimens • Papanicolaou Test • Vaginal wall examination

What is the object pictured? • Allows visualization of cervix • Allows collections of specimens • Papanicolaou Test • Vaginal wall examination

bicornuate uterus

What is the term for a uterus with two horns and can contribute to infertility?

tubal ligation

What is the term for female sterilization that is extremely effective as a form of contraception?

sterility

What term is this? an absolute factor preventing reproduction CHOICES: infertility secondary infertility sterility

infertility

What term is this? failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse (woman < 35 years) CHOICES: infertility secondary infertility sterility

secondary infertility

What term is this? unable to conceive after one or more successful pregnancies CHOICES: infertility secondary infertility sterility

Penicillin G

What would be the drug of choice in an adolescent who is diagnosed with syphilis during the first trimester of pregnancy? (any trimester is fine to treat syphilis btw) A. Penicillin G B. Doxycycline C. Tetracycline D. Erythromycin

C. Gardasil

Which vaccine is used to prevent a human papilloma virus infection? A. Varivax B. RotaTeq C. Gardasil D. Hepatitis A vaccine

ZIKA VIRUS • Spread through mosquito bites and sexual contact with semen • Infection increases risk of microcephaly in infants • Avoid travel to areas with known cases

ZIKA VIRUS • Spread through m___ bites and sexual contact with semen • Infection increases risk of (micro/macro)cephaly in infants • Avoid travel to areas with known cases

ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT) • Oocytes retrieved laparoscopically • Fertilized in the laboratory • Resulting zygote is then placed into the fallopian tube • Fertilized egg migrates to uterus through tube, as normal • FALSE: Woman must have at least one normal tube

ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT) • Oocytes retrieved laparoscopically • Fertilized in the laboratory • Resulting zygote is then placed into the fallopian tube • Fertilized egg migrates to uterus through tube, as normal • T/F: The woman must have both tubes normal for this procedure to take place.