Female Reproductive Cycle

Reproductive System Adaptations

*Uterus Increase in size, weight, length, width, depth, volume, and overall capacity Pear shape to ovoid shape; positive Hegar's sign Enhanced uterine contractility; Braxton Hicks contractions Ascent into abdomen after first 3 months Fundal height by 20 weeks' gestation at level of umbilicus; 20 cm; reliable determination of gestational age until 36 weeks' gestation *Cervix Softening (Goodell's sign) Mucous plug formation Increased vascularization (Chadwick's sign) Ripening about 4 weeks before birth *Vagina Increased vascularity with thickening Lengthening of vaginal vault Secretions more acidic, white, and thick; leukorrhea. *Ovaries Enlargement until 12th to 14th week of gestation Cessation of ovulation *Breasts Increase in size and nodularity to prepare for lactation; increase in nipple size, becoming more erect and pigmented Production of colostrum: antibody-rich, yellow fluid that can be expressed after the 12th week; conversion to mature milk after delivery

What happens to body temp in regards to ovulation?

- temp increases 0.5 to 1.0 degrees in 24 to 48 hours after ovulation occurs and remains elevated until menstruation

What happens if fertilization does occur?

- the corpus luteum continues to release progesterone and estrogen until the placenta matures and assumes this function

What happens if fertilization doesn't occur?

- the corpus luteum degenerates and levels of estrogen and progesterone decrease, this triggers an increase in FSH and LH and menstruation beginsPenis Organ of copulation Outlet for urine and sperm Scrotum Sac surrounding and protecting testes Climate-control system for testes

What happens during the secretory phase

- the endometrium continues to thicken - the primary hormone during this phase is progesterone secreted by the corpus luteum

What happens during the proliferative phase?

- the endometrium is preparing for implantation by becoming thicker and more vascular - responsible for the increasing levels of estrogen produced by the graafian follicle

3 phases of the Ovarian cycle

1. Follicular phase 2. Ovulatory phase 3. Luteal phase

2 cycles that make up the menstrual cycle

1. Ovarian cycle 2. Endometrial cycle

Gonorrhea

2nd most commonly reported infection in U.S. Highly contagious and reportable to health departments Cause: aerobic gram-negative intracellular diplococcus Site of infection: columnar epithelium of endocervix Almost exclusively transmitted via sexual activity Therapeutic management: antibiotic therapy

How long is the ovum fertile after being picked up by the fallopian tube?

6-24 hours

Bacterial Vaginosis

A third common infection of the vagina is bacterial vaginosis, caused by the gram-negative bacillus Gardnerella vaginalis. It is the most prevalent cause of vaginal discharge or malodor, but up to 50% of women are asymptomatic. Bacterial vaginosis is a sexually associated infection characterized by alterations in vaginal flora in which lactobacilli in the vagina are replaced with high concentrations of anaerobic bacteria. The cause of the microbial alteration is not fully understood but is associated with having multiple sex partners, douching, and lack of vaginal lactobacilli. Bacterial vaginosis can increase a woman's susceptibility to other STIs such as HIV, herpes, chlamydia, and gonorrhea (CDC, 2012d). Research suggests that bacterial vaginosis is associated with preterm labor, premature rupture of membranes, chorioamnionitis, postpartum endometritis, and pelvic inflammatory disease

breast

Accessory organs - specialized for milk secretion after pregnancy Nipple Areola Lobes Alveolar and lactiferous glands During pregnancy, placental estrogen and progesterone stimulate the development of the mammary glands. Because of this hormonal activity, the breasts may double in size during pregnancy. At the same time, glandular tissue replaces the adipose tissue of the breasts.

Groups at High Risk for STIs

African American youths Abused youths Homeless youths Young men having sex with men Gay, lesbian, bisexual, and transgendered youths

Maternal Emotional Responses

Ambivalence: mixed feeling Introversion Acceptance Mood swings Changes in body image Maternal Role Tasks Ensuring safe passage throughout pregnancy and birth Seeking acceptance of infant by others Seeking acceptance of self in maternal role to infant ("binding in") Learning to give of oneself (see Box 11.4)

nursing management during pregnancy. Prenatal Care and Diagnostic Testing

Amniocentesis Biophysical profile Chorionic villus sampling (CVS) Natural childbirth Perinatal education Preconception care Goals of Preconception Care Promote the health and well-being of a woman and her partner before pregnancy Identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management intervention

Premenstrual Syndrome

Any of a complex of symptoms (including emotional tension and fluid retention) experienced by some women in the days immediately before menstruation, and usually resolves its own. premenstrual dysphoric disorder (PMDD) is a more severe variant of PMS affecting 3% to 6% of premenopausal women. Etiology: unknown Therapeutic management Multidimensional approach Vitamin supplements, diet changes, exercise, lifestyle, medications. Medications used in treating PMDD may include antidepressant and antianxiety drugs, diuretics, anti-inflammatory medications, analgesics, synthetic androgen agents, oral contraceptives, or GnRH agonists to regulate menses.

Nursing Assessment

Assess the client for clinical manifestations of bacterial vaginosis. Primary symptoms are a thin, white homogeneous vaginal discharge and a characteristic "stale fish" odor. the typical appearance of bacterial vaginosis. To diagnose bacterial vaginosis, three of the four criteria must be met: Thin, white homogeneous vaginal discharge Vaginal pH >4.5 Positive "whiff test" (secretion is mixed with a drop of 10% potassium hydroxide on a slide, producing a characteristic stale fishy odor) The presence of clue cells on wet-mount examination

Nursing Assessment

Assess the client for clinical manifestations of trichomoniasis, which include: A heavy yellow/green or gray frothy or bubbly discharge Vaginal pruritus and vulvar soreness Dyspareunia Cervix may bleed on contact Dysuria Vaginal odor, described as foul Vaginal or vulvar erythema Petechiae on the cervix

Nursing Assessment

Assess the client's health history for predisposing factors for vulvovaginal candidiasis, which include: Pregnancy Use of oral contraceptives with a high estrogen content Use of broad-spectrum antibiotics Diabetes mellitus Obesity Use of steroid and immunosuppressive drugs HIV infection Wearing tight, restrictive clothes and nylon underpants Trauma to vaginal mucosa from chemical irritants or douching

Impact of Menopause on the Body

Brain: hot flashes; sleep, mood, and memory problems Heart: lower levels of HDL; increased risk of CVD Bones: bone density loss; increased risk of osteoporosis Breasts: duct and gland tissue replaced by fat Genitourinary: vaginal dryness, stress incontinence, cystitis GI: less Ca+ absorbed; increased fractures Skin: skin dry, thin; collagen decreases

Probable (objective) signs

Braxton Hicks contractions (16-28 weeks) Positive pregnancy test (4-12 weeks) Abdominal enlargement (14 weeks) Ballottement (16-28 weeks) Goodell's sign (5 weeks) Chadwick's sign (6-8 weeks) Hegar's sign (6-12 weeks)

Respiratory System Adaptations

Breathing more diaphragmatic than abdominal due to increase in diaphragmatic excursion, chest circumference, and tidal volume Increase in oxygen consumption Congestion secondary to increased vascularity

Syphilis

Can be passed in utero Can result in fetal or infant death Congenital syphilis symptoms include skin ulcers, rashes, fever, weakened or hoarse cry, swollen liver and spleen, jaundice and anemia, various deformations

Most Common Causes of Vaginitis

Candida: fungus Trichomonas: protozoan Gardnerella: bacterium

Signs of Pregnancy

Chadwick's sign Bluish-purple coloration of the vaginal mucosa and cervix Goodell's sign Softening of the cervix Hegar's sign Softening of the lower uterine segment or isthmus

function of the External Female Reproductive Organs

Collectively called the "vulva" "covering" Protects urethra and vaginal openings Highly sensitive to touch to increase female's pleasure during sexual arousal

Herpes type II (genital herpes)

Contamination can occur during birth. Newborn may develop skin or mouth sores Mental retardation, premature birth, low birthweight, blindness, death

Types of Contraceptive Methods

Contraceptive methods can be divided into four types: behavioral methods, barrier methods, hormonal methods, and permanent Methods. Women must decide which method is appropriate for them to meet their changing contraceptive needs throughout their life cycles. Nurses can educate and assist women during this selection process. This part of the chapter will outline the most common birth control methods available.

Syphilis

Curable bacterial infection caused by spirochete Treponema pallidum Serious systemic disease Therapeutic management Benzathine penicillin G IM Doxycyline if allergic to penicillin Reevaluation with serologic testing

Endometrial cycle

Cycle in which menstration occurs. pertains to the changes in the endometrium of the uterus in response to the hormonal changes that occur during the ovarian cycle

HIV

Diagnosis Therapeutic management: HAART Nursing management Education about drug therapy Compliance Prevention Care during pregnancy and childbirth Referrals

Renal/Urinary System Adaptations

Dilation of renal pelvis; elongation, widening, and increase in curve of ureters Increase in length and weight of kidneys Increase in GFR; increased urine flow and volume Increase in kidney activity with woman lying down; greater increase in later pregnancy with woman lying on side

Nutritional Needs

Direct effect of nutritional intake on fetal well-being and birth outcome Need for vitamin and mineral supplement daily Dietary recommendations Increase in protein, iron, folate, and calories (see Table 11.5) Use of USDA's Food Guide MyPlate (see Figure 11.5) Avoidance of some fish due to mercury content

Dysmenorrhea

Dysmenorrhea refers to painful menstruation. This condition has also been termed cyclic perimenstrual pain. Uterine contractions occur during all periods, but in some women these cramps can be frequent and very intense. Dysmenorrhea is classified as primary (spasmodic) or secondary (congestive).

Nursing Management

Education Healthy lifestyle habits Support groups

Nursing Management of Herpes and Syphilis

Education (see Teaching Guidelines 5.3). Referral to support group Coping skills Options for treatment and rehabilitation

Preventing STIs

Education about safer sex practices Behavior modification Contraception

The uterine wall is relatively thick and composed of three layers:

Endometrium: innermost layer Lines the uterine cavity in nonpregnant women Myometrium: muscular middle layer Makes up the major portion of the uterus Composed of smooth muscle linked by connective tissue Perimetrium: outer serosal layer Covers the body of the uterus

1st Prenatal Visit

Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and laboratory tests Comprehensive Health History Reason for seeking care Suspicion of pregnancy Date of last menstrual period Signs and symptoms of pregnancy Urine or blood test for hCG Past medical, surgical, and personal history Woman's reproductive history: menstrual, obstetric, and gynecologic history

ESTROGEN

Estrogen is secreted by the ovaries and is crucial for the development and maturation of the follicle. Estrogen is predominant at the end of the proliferative phase, directly preceding ovulation. After ovulation, estrogen levels drop sharply as progesterone dominates. In the endometrial cycle, estrogen induces proliferation of the endometrial glands. Estrogen also causes the uterus to increase in size and weight because of increased glycogen, amino acids, electrolytes, and water. Blood supply is expanded as well.

Male Sexual Response

Excitement Plateau Orgasm Resolution

labor and birth process

Factors Influencing the Onset of Labor

labor and birth process

Factors Influencing the Onset of Labor Uterine stretch Progesterone withdrawal Increased oxytocin sensitivity Increased release of prostaglandins Premonitory Signs of Labor Cervical changes (cervical softening, possible cervical dilation) Lightening Increased energy level (nesting) Bloody show Braxton Hicks contractions Spontaneous rupture of membranes

Factors Placing Teenagers at Risk for STIs

Females' anatomy predisposing them to STIs (columnar epithelial cells sensitive to invasion) Teenagers' feelings of invincibility Unprotected intercourse Partnerships of limited duration Obstacles to using the health care system

Contraception: Behavioral Methods

Fertility awareness Cervical mucus ovulation method Basal body temperature Symptothermal method Standard days method Withdrawal (coitus interruptus) Lactational amenorrhea method. Barrier Condom (male and female) Diaphragm Cervical cap Sponge Hormonal Oral contraceptive Injectable contraceptive Transdermal patch Vaginal ring Implantable contraceptive Intrauterine contraceptive Emergency contraceptive Permanent Methods Tubal ligation for women Vasectomy for men

candida

Genital/vulvovaginal candidiasis is one of the most common causes of vaginal discharge. It is also referred to as yeast, monilia, and a fungal infection. It is not considered an STI because Candida is a normal constituent in the vagina and becomes pathologic only when the vaginal environment becomes altered.

Obstetric History

Gravida: a pregnant woman Gravida I (primigravida): first pregnancy Gravida II (secundigravida): second pregnancy, etc. Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more Primapara: one birth after a pregnancy of at least 20 weeks ("primip") Multipara: two or more pregnancies resulting in viable offspring ("multip") Nullipara: no viable offspring; para 0 Terminology *G (gravida): the current pregnancy *T (term births): the number of pregnancies ending >37 weeks' gestation, at term *P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks *A (abortions): the number of pregnancies ending before 20 weeks or viability L (living children): number of children currently living

GI System Adaptations

Gums: hyperemic, swollen, and friable Ptyalism Dental problems; gingivitis Decreased peristalsis and smooth muscle relaxation Constipation + increased venous pressure + pressure from uterus = hemorrhoids Slowed gastric emptying; heartburn Prolonged gallbladder emptying Nausea and vomiting

Maternal Weight Gain

Healthy weight BMI: 25 to 35 lb 1st trimester: 3.5 to 5 lb 2nd & 3rd trimesters: 1 lb/week BMI < 19.8: 28 to 40 lb 1st trimester: 5 lb 2nd & 3rd trimesters: 1+ lb/week BMI > 25: 15 to 25 lb 1st trimester: 2 lb 2nd & 3rd trimesters: 2/3 lb/week

Hepatitis A and B

Hepatitis A spread via GI tract Hepatitis B via saliva, blood, semen, menstrual blood, and vaginal secretions Therapeutic Management: prevention through immunization Nursing Assessment: hepatitis A manifestations; hepatitis B manifestations Nursing Management: screening, vaccination.

Nursing Management

Hydration Analgesics Education to prevent recurrence (see Teaching Guidelines 5.4) Risk assessment Sexual counseling

Integumentary System Adaptations

Hyperpigmentation; mask of pregnancy (facial melasma) Linea nigra Striae gravidarum Varicosities Vascular spiders Palmar erythema Decline in hair growth; increase in nail growth

Preconception Care

Immunization status Underlying medical conditions Reproductive health care practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system

Cultural Considerations

Impact of culture, ethnicity, and religion on perceptions and management of infertility Multiple known and unknown factors affecting fertility Male and female risk factors

Estrogen

In the follicular phase of the ovarian cycle, increasing levels of what hormone are secreted from the maturing follicular cells and the continued growth of the dominant follicle cell induce proliferation of the endometrium and myometrium (thickening of the uterus).

Cardiovascular System Adaptations

Increase in blood volume (50% above prepregnant levels) Increase in cardiac output; increased venous return; increased heart rate Slight decline in blood pressure until midpregnancy, then returning to prepregnancy levels Increase in number of RBCs; plasma volume > RBC leading to hemodilution (physiologic anemia) Increase in iron demands, fibrin & plasma fibrinogen levels, and some clotting factors, leading to hypercoagulable state

cdc classification of STI

Infections characterized by vaginal discharge Vulvovaginal candidiasis Trichomoniasis Bacterial vaginosis Infections characterized by cervicitis Chlamydia Gonorrhea Infections characterized by genital ulcers Genital herpes simplex Syphilis Pelvic inflammatory disease (PID) Human immunodeficiency virus (HIV) Human papillomavirus infection (HPV) Vaccine-preventable STIs Hepatitis A Hepatitis B Ectoparasitic infections Pediculosis pubis Scabies

Nursing Management

Instruct clients to avoid sex until they and their sex partners are cured (i.e., when therapy has been completed and both partners are symptom-free) and also to avoid consuming alcohol during treatment because mixing the medications and alcohol causes severe nausea and vomiting

Risk Factors for Adverse Pregnancy Outcomes

Isotretinoins Alcohol misuse Anti-epileptic drugs Diabetes (preconception) Folic acid deficiency HIV/AIDS Hypothyroidism Maternal phenylketonurea Rubella seronegativity Obesity Oral anticoagulant STI Smoking

Etiology and Risk Factors

It is not currently known why endometrial tissue becomes transplanted and grows in other parts of the body. Several theories exist, but to date none has been scientifically proven. However, several factors that increase a woman's risk of developing endometriosis have been identified: Increasing age Family history of endometriosis in a first-degree relative Short menstrual cycle (less than 28 days) Long menstrual flow (more than 1 week) High dietary fat consumption Young age of menarche (younger than 12) Few (one or two) or no pregnancies

Trichomoniasis

Low birthweight, increased risk of PROM, and preterm birth

InFertility Assessment

Male factor assessment: semen analysis, sexual characteristics, external and internal reproductive organ examination, digital prostate examination Female factor assessment: ovarian function, pelvic organs Laboratory and diagnostic testing: home ovulation predictor kits, clomiphene citrate challenge test, hysterosalpingogram, laparoscopy

Venereal warts

May develops warts in throat (laryngeal papillomatosis); uncommon but life-threatening.

Menstrual History

Menstrual cycle Age at menarche Days in cycle Flow characteristics Discomforts Use of contraception Date of last menstrual period (LMP) Calculation of estimated or expected date of birth (EDB) or delivery (EDD) Nagele's rule Use first day of LNMP 11/21/07 Subtract 3 months 8/21/07 Add 7 days 8/28/07 Add 1 year 8/28/08 = EDB Gestational or birth calculator or wheel (see Figure 12.3) Ultrasound is best method of dating a pregnancy

chlamydia; nursing assessment;

Nursing Assessment Risk factors: adolescence, multiple sex partners, new sex partner, sex without condom, oral contraceptive use, pregnancy, history of another STI Manifestations: mucopurulent vaginal discharge, urethritis, bartholinitis, endometritis, salpingitis, dysfunctional uterine bleeding Urine testing or swab specimen culture, immunofluorescence, EIA, or nucleic acid amplification

Menopausal Transition

Nursing Assessment Screening for osteoporosis, cardiovascular disease, and cancer risk Lifestyle to plan strategies to prevent chronic conditions Nursing Management Health maintenance education; risk reduction Lifestyle modifications Stress management.

Vulvovaginal Candidiasis

Nursing Management Teaching preventive measures Cotton underwear Avoidance of irritants Good body hygiene Avoidance of douching or super-absorbent tampons

Nursing Assessment

Nursing assessment for the young girl or woman experiencing amenorrhea includes a thorough health history and physical examination and several laboratory and diagnostic tests.

Nursing Assessment

Primary episode (most severe and prolonged): multiple painful vesicular lesions, mucopurulent discharge, superinfection with candida, fever, chills, malaise, dysuria, headache, genital irritation, inguinal tenderness, lymphadenopathy Recurrent infection (more localized and quicker resolution): tingling, itching, pain, unilateral genital lesions (more localized) Diagnosis confirmed via viral culture of fluid from vesicle

Nursing Assessment

Primary: chancre, painless bilateral adenopathy Secondary: flu-like symptoms, rash on trunk, palms, and soles, alopecia, adenopathy Latency: absence of manifestations, positive serology Tertiary: life-threatening heart disease, neurologic disease Tests: VDRL and RPR; FTA-ABS, TPPA, and TPHA

Genital Herpes Simplex

Recurrent lifelong viral infection Transmission via contact with mucous membranes or breaks in skin with visible or nonvisible lesions Kissing, sexual contact, and vaginal delivery Therapeutic management No cure Antiretroviral therapy to reduce or suppress symptoms, shedding, and recurrent episodes

Nursing Management of Infertility

Respect for couple Education, anticipatory guidance, stress management, counseling Assistance in decision making; advocacy Assistance with financial strategies

Pelvic Inflammatory Disease

Result of ascending polymicrobial infection of upper female reproductive tract Frequently from untreated chlamydia or gonorrhea Complications Therapeutic Management Empiric broad-spectrum antibiotics Oral fluids Bed rest Pain management

Nursing Assessment

Risk factors Manifestations: lower abdominal tenderness, adnexal tenderness, cervical motion tenderness Diagnosis: endometrial biopsy, transvaginal ultrasound, laparoscopic examination

nursing Assessment

Risk factors: low socioeconomic status, urban living, single status, inconsistent use of barrier contraceptives, age <20 years, multiple sex partners Manifestations: most asymptomatic; abnormal vaginal discharge, dysuria, cervicitis, abnormal vaginal bleeding, Bartholin's abscess, PID Neonatal conjunctivitis if woman gives birth

Ectoparasite Infections

Scabies: intensely pruritic dermatitis with lesions Pubic lice: pruritus with lice or nits Treatment: permethrin cream or lindane shampoo; decontamination of bedding and clothing; treatment of family members and sexual partners 3-tiered approach: eradicate infestation, remove nits, prevent spread or recurrence Education (see Teaching Guidelines 5.5.

Musculoskeletal System Adaptations

Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis Postural changes: increased swayback and upper spine extension Forward shifting of center of gravity Increase in lumbosacral curve (lordosis); compensatory curve in cervicodorsal area Waddle gait

Therapeutic Management

The majority of infertility cases are treated with drugs or surgery.

Therapeutic Management

Therapeutic management of the client with endometriosis needs to take into consideration the following factors: severity of symptoms, desire for fertility, degree of disease, and the client's therapy goals. The aim of therapy is to suppress levels of estrogen and progesterone, which cause the endometrium to grow. Treatment can include surgery or medications such as oral contraceptives, Depo-Provera, synthetic testosterone, and GnRH agonists

nursing management

Therapeutic management: primary prevention via vaccine and education; treatment of lesions and warts; secondary prevention via education Nursing Management Teaching about prevention Promotion of vaccines and screening tests Education about link between HPV and cervical cancer.

Endocrine System Adaptations

Thyroid gland: slight enlargement; increased activity; increase in BMR Pituitary gland: enlargement; decrease in TSH, GH; inhibition of FSH & LH; increase in prolactin, MSH; gradual increase in oxytocin with fetal maturation.Oxytocin is a hormone secreted by the posterior pituitary gland. Pancreas; insulin resistance due to hPL and other hormones in 2nd half of pregnancy (see Box 11.2) Adrenal glands: increase in cortisol and aldosterone secretion Prostaglandin secretion Placental secretion: hCG, hPL, relaxin, progesterone, estrogen (see Table 11.3)

Human Immunodeficiency Virus

Transmission AIDS due to HIV infection Fetal and neonatal effects HIV and adolescents increasing; most exposed via sexual intercourse Manifestations: acute phase; asymptomatic with viral replication, immunosuppression with opportunistic infections, AIDS.

Nursing Management: Chlamydia and Gonorrhea

Treatment strategies Referrals Preventive measures Education and counseling Sexual history Public education Safe sex practices

Trichomoniasis

Trichomoniasis is another common vaginal infection that causes a discharge. The woman may be markedly symptomatic or asymptomatic. When symptoms are present, they include vulvar itching and a malodorous foamy vaginal discharge. Men are asymptomatic carriers. Although this infection is localized, there is increasing evidence of preterm birth and postpartum endometritis in women with this vaginitis (CDC, 2012c). Trichomonas vaginalis is an ovoid, single-cell protozoan parasite that can be observed under the microscope making a jerky swaying motion.

Assess the client for clinical manifestations of vulvovaginal candidiasis.

Typical symptoms, which can worsen just before menses, include: Pruritus Vaginal discharge (thick, white, curdlike) Vaginal soreness Vulvar burning Erythema in the vulvovaginal area Dyspareunia External dysuria

Nutrition Promotion

USDA Food Guide MyPlate Client education (see Teaching Guidelines 11.1) Special considerations Cultural variations Lactose intolerance Vegetarianism Pica

Assessment of Fetal Well-Being

Ultrasonography (see Figure 12.6) Doppler flow studies Alpha-fetoprotein analysis Marker screening tests Nuchal translucency screening Amniocentesis (see Figure 12.7) Chorionic villus sampling (CVS) Percutaneous umbilical blood sampling (PUBS) Nonstress test; contraction stress test Contraction stress test Biophysical profile

Positive signs

Ultrasound verification of embryo or fetus (4-6 weeks) Fetal movement felt by experienced clinician (20 weeks) Auscultation of fetal heart tones via Doppler (10-12 weeks)

Laboratory Tests

Urinalysis Complete blood count Blood typing Rh factor Rubella titer Hepatitis B surface antigen HIV, VDRL, and RPR testing Cervical smears Ultrasound Visit schedule: Every 4 weeks up to 28 weeks Every 2 weeks from 29 to 36 weeks Every week from 37 weeks to birth Assessments Weight & BP compared to baseline values Urine testing for protein, glucose, ketones, and nitrites Fundal height (see Figure 12.5) Quickening/fetal movement (see Box 12.4) Fetal heart rate (see Nursing Procedure 12.1) Teaching: danger signs

1st Trimester Discomforts

Urinary frequency or incontinence (see Teaching Guidelines 12.1) Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea 2nd Trimester Discomforts Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating 3rd Trimester Discomforts Return of 1st trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edema Braxton Hicks contractions

Physical Examination

Vital signs Head-to-toe assessment Head and neck Chest Abdomen, including fundal height if appropriate Extremities Pelvic examination Examination of external and internal genitalia Bimanual examination Pelvic shape: gynecoid, android, anthropoid, platypelloid Pelvic measurements: diagonal conjugate, true (obstetric) conjugate, and ischial tuberosity

Mittelschmerz

abdominal discomfort on the side where ovulation occurs

Luteal phase

begins immediately after ovulation and ends with the start of menstruation of the next cycle. It typically occurs on days 15 through 28 of a 28-day cycle. After the follicle ruptures as it releases the egg, it closes and forms a corpus luteum.

CONTRACEPTION

birth control is the act of preventing pregnancy. Contraception is any method that prevents conception or childbirth, including oral contraceptives, sterilization of the female, and the male condom, which are the most popular methods in the United States. "Abstinence"

During the Luteal phase, FSH and LH levels ___________________

decrease. FSH and LH are generally at their lowest levels during the luteal phase and highest during the follicular phase.

female reproductive cells

eggs or ova contains an organ (uterus) in which development of the fetus takes place;

What hormone does the graafian follicle produce?

estrogen

The cycle is driven by what?

feedback loop between the anterior pituitary and ovaries

What hormone does the fertilized egg secrete

hCG (human chorionic gonadotrophin)

When are a woman's eggs available for maturation?

present at birth

What is the purpose of the corpus luteum?

secretes large amounts of progesterone and low amounts of estrogen to prepare the endometrium for a fertilized ovum

male reproductive cells

the male reproductive system produces the male reproductive cells (the sperm) and contains an organ (penis) that deposits the sperm within the female.

Ovarian cycle

the ovarian cycle, during which ovulation occurs. the ovarian cycle begins when the follicular cells (ovum and surrounding cells) swell and the maturation process starts. The maturing follicle at this stage is called a graafian follicle. The ovary raises many follicles monthly, but usually only one follicle matures to reach ovulation.

Ovulation

the release of the oocyte

chlamydia

Most common bacterial STI in the U.S.; majority asymptomatic Cause: Chlamydia trachomatis (intracellular parasite) Therapeutic Management Antibiotics (doxycycline, azithromycin) Combination regimen if gonorrhea also present Screening

Human Papillomavirus

Most common viral infection in U.S. Genital warts or condylomata Nursing Assessment Risk factors Manifestations: most asymptomatic; visible genital warts Pap smears; HPV test

Treatment of candidiasis includes one of the following medications:

Most of these medications are used intravaginally in the form of a cream, tablet, or suppositories for 3 to 7 days. If fluconazole (Diflucan) is prescribed, a 150-mg oral tablet is taken as a single dose. If vulvovaginal candidiasis is not treated effectively during pregnancy, the newborn can develop an oral infection known as thrush during the birth process; that infection must be treated with a local azole preparation after birth.

Pregnancy and Sexuality

Numerous changes, possibly stressing sexual relationship Changes in sexual desire with each trimester Sexual health and link to self-image pregnancy and partner Family-centered emphasis Partner's reaction to pregnancy and changes Couvade syndrome, ambivalence Acceptance of roles (2nd trimester) Preparation for reality of new role (3rd trimester) pregnancy and siblings Age-dependent reaction Sibling rivalry with introduction of new infant into family Sibling preparation imperative

External Male Reproductive Organs

Penis Organ of copulation Outlet for urine and sperm Scrotum Sac surrounding and protecting testes Climate-control system for testes

Preparation for Labor, Birth, and Parenthood

Perinatal education Childbirth education Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques Options for birth setting Hospitals: delivery room, birthing suite Birth centers Home birth Options for care providers Obstetrician Midwife Doula Feeding choices Breast-feeding: advantages and disadvantages Bottle feeding: advantages and disadvantages Teaching Final preparation for labor and birth

Nursing Management to Promote Self-Care

Personal hygiene Avoidance of saunas and hot tubs Perineal care Dental care Breast care Clothing Exercise (see Teaching Guidelines 12.2) Sleep and rest Sexual activity and sexuality Employment (see Teaching Guidelines 12.3) Travel (see Teaching Guidelines 12.4) Immunizations and medications (see Box 12.5)

Signs and Symptoms of Pregnancy. presumptive signs.(subjective)

Presumptive Signs (subjective) Fatigue (12 weeks) Breast tenderness (3-4 weeks) Nausea and vomiting (4-14 weeks) Amenorrhea (4 weeks) Urinary frequency (6-12 weeks) Hyperpigmentation of skin (16 weeks) Fetal movements (quickening) (16-20 weeks) Uterine enlargement (7-12 weeks) Breast enlargement (6 weeks)

LUTEINIZING HORMONE

Luteinizing hormone (LH) is secreted by the anterior pituitary gland and is required for both the final maturation of preovulatory follicles and luteinization of the ruptured follicle. As a result, estrogen production declines and progesterone secretion continues. Thus, estrogen levels fall a day before ovulation, and progesterone levels begin to rise

menstrual cycle hormones functions

Luteinizing hormone (LH) rises and stimulates the follicle to produce estrogen. As estrogen is produced by the follicle, estrogen levels rise, inhibiting the output of LH. Ovulation occurs after an LH surge damages the estrogen-producing cells, resulting in a decline in estrogen. The LH surge results in establishment of the corpus luteum, which produces estrogen and progesterone. Estrogen and progesterone levels rise, suppressing LH output. Lack of LH promotes degeneration of the corpus luteum. Cessation of the corpus luteum means a decline in estrogen and progesterone output. The decline of the ovarian hormones ends their negative effect on the secretion of LH. LH is secreted, and the menstrual cycle begins again.

External Female Reproductive Organs:The structures that make up the vulva include

Mons pubis: The skin of this fatty tissue is covered with public hair after puberty. The mons pubis protects the symphysis pubis during sexual intercourse. Labia majora: contains sweat and sebaceous glands; protects the vaginal opening Labia minora: highly vascular and abundant in nerve supply; lubricates the vulva and swells with stimulation and are highly sensitive. Clitoris: small cylindrical mass of erectile tissue and nerves; function is sexual stimulation Prepuce: hood-like covering over the clitoris; also site of female circumcision practiced in some cultures The hood-like covering over the clitoris is the site for female circumcision, which is still practiced in some countries by some cultures. Vestibule: oval area enclosed by the labia minora laterally located inside the labia minora and outside the hymen perforated by six openings Opening into the vestibule: urethra from the urinary bladder, vagina, and two sets of glands Opening into the vagina: introitus Fourchette: half-moon area behind the opening Glands: Bartholin's and Skene's glands secrete mucus to keep the opening moist The vaginal opening is surrounded by the hymen (maidenhead). The hymen is a tough, elastic, perforated, mucosa-covered tissue across the vaginal introitus. In a virgin, the hymen may completely cover the opening, but it usually encircles the opening like a tight ring. Perineum: The perineum is the most posterior part of the external female reproductive organs. This external region is located between the vulva and the anus. It is made up of skin, muscle, and fascia.

EFFECTS OF SEXUALLY TRANSMITTED INFECTIONS ON THE FETUS OR NEWBORN Chlamydia

Newborn can be infected during delivery Eye infections (neonatal conjunctivitis), pneumonia, low birthweight, increased risk of premature rupture of the membranes (PROM), preterm birth, and stillbirth.

What is the skin-covered region between the vaginal orifice and the anus that extends from the symphysis pubis anteriorly to the coccyx posteriorly? What can be torn during child birth?

Perineum

ISCHEMIC PHASE

Phase of endometrial cycle that only occurs if fertilization does not occur. If fertilization does not occur, the ischemic phase begins. Estrogen and progesterone levels drop sharply during this phase as the corpus luteum starts to degenerate. Changes in the endometrium occur with spasm of the arterioles, resulting in ischemia of the basal layer. The ischemia leads to shedding of the endometrium down to the basal layer, and menstrual flow begins.

Etiology

Primary Increased prostaglandin production by the endometrium in an ovulatory cycle. This results in increased rhythmic uterine contractions from vasoconstriction of the small vessels of the uterine wall. This condition usually begins within a few years of the onset of ovulatory cycles at menarche. Secondary Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. It may be caused by endometriosis, adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities. Adenomyosis involves the ingrowth of the endometrium into the uterine musculature. Endometriosis involves ectopic implantation of endometrial tissue in other parts of the pelvis. Endometriosis is the most common cause of secondary dysmenorrhea and is associated with pain beyond menstruation, dyspareunia, low back pain, and infertility. Treatment is directed toward removing the underlying pathology. it happens when a women didnt had before, and develops it later in life due to problems with her reproductive tract.

Female Sexual Response

Sexual stimulation leading to vasocongestion Vaginal expansion and elongation Secretion of mucus by vestibular glands Estrogen (preservation of vascular function) and testosterone (hormone of sexual desire in women) Orgasm (zenith of stimulation) Rapid dissipation of vasocongestion and muscle contraction. With sexual stimulation, tissues in the clitoris and breasts and around the vaginal orifice fill with blood and the erectile tissues swell. At the same time, the vagina begins to expand and elongate to accommodate the penis. As part of the whole vasocongestive reaction, the labia majora and minor swell and darken. As sexual stimulation intensifies, the vestibular glands secrete mucus to moisten and lubricate the tissues to facilitate insertion of the penis. Adequate estrogen and testosterone must be available for the brain to sense incoming arousal stimuli. Testosterone is needed to stimulate sexual desire in women. The zenith of intense stimulation is orgasm, the spasmodic and involuntary contractions of the muscles in the region of the vulva, the uterus, and the vagina that produce a pleasurable sensation to the woman. Typically the woman feels warm and relaxed after an orgasm. Within a short time after orgasm, the two physiologic mechanisms that created the sexual response, vasocongestion and muscle contraction, rapidly dissipate.

Contraception: Sterilization

Sterilization is an attractive method of contraception for those who are certain they do not want any, or any more, children. Sterilization refers to surgical procedures intended to render the person infertile. Sterilization is a safe and effective form of permanent birth control. Tubal ligation: is a medical sterilization procedure for women who are sure they don't want a future pregnancy. A laparoscope is inserted through a small subumbilical incision to provide a view of the fallopian tubes. They are grasped and sealed with a cauterizing instrument or with rings, bands, or clips or cut and tied. transcervical sterilization, offers several advantages over conventional tubal ligation: general anesthesia and incisions are not needed, thereby increasing safety, lowering costs, and improving access to sterilization. A tiny coil (Essure) is introduced and released into the fallopian tubes through the cervix. The coil promotes tissue growth in the fallopian tubes, and over a period of 3 months, this growth blocks the tubes. This less-invasive technique has become increasingly popular. Vasectomy: Male sterilization is accomplished with a surgical procedure known as a vasectomy. It is usually performed under local anesthesia in a urologist's office, and most men can return to work and normal activities in a day or two. The procedure involves making a small incision into the scrotum and cutting the vas deferens, which carries sperm from the testes to the penis. Complications from vasectomy are rare and minor in nature. Immediate risks include infection, hematoma, and pain. After vasectomy, semen no longer contains sperm. This is not immediate, though, and the man must submit semen specimens for analysis until two specimens show that no sperm is present. When the specimen shows azoospermia, the man's sterility is confirmed

Secretory phase

- The secretory phase begins at ovulation to about 3 days before the next menstrual period. Under the influence of progesterone released by the corpus luteum after ovulation, the endometrium becomes thickened and more vascular (growth of the spiral arteries) and glandular (secretion of more glycogen and lipids). This phase typically lasts from day 15 (after ovulation) to day 28 and coincides with the luteal phase of the ovarian cycle. In the absence of fertilization by day 23 of the menstrual cycle, the corpus luteum begins to degenerate and consequently ovarian hormone levels decrease.

Follicular phase

- it is when the follicles in the ovary grow and form a mature egg. This phase starts on day 1 of the menstrual cycle and continues until ovulation, approximately 10 to 14 days. The hypothalamus is the initiator of this phase. Increasing levels of estrogen secreted from the maturing follicular cells and the continued growth of the dominant follicle cell induce proliferation of the endometrium and myometrium. This thickening of the uterine lining supports an implanted ovum if pregnancy occurs.

In the follicular phase, what is maturing? what aids in maturation?

- the graafian follicle is maturing - luteinizing hormone (LH) and follicle-stimulating hormone (FSH), two pituitary hormones

3 phases of the endometrial cycle

1. Proliferative phase 2. Secretory phase 3. Menstrual phase

Endometriosis

A disorder in which tissue that normally lines the uterus grows outside the uterus. also, it is most commonly found on other organs of the pelvis, attached to the ovaries, fallopian tubes, the outer surface of the uterus, the bowels, the area between the vagina and the rectum (rectovaginal septum). Endometrial tissue found outside the uterus responds to hormones released during the menstrual cycle in the same way as endometrial lining within the uterus. In short, the woman with endometriosis experiences several "mini-periods" throughout her abdomen, wherever this endometrial tissue exists.

Nursing Assessment

A full medical history should be taken from both partners, along with a physical examination. The data needed for the infertility evaluation are very sensitive and of a personal nature, so the nurse must use very professional interviewing skills.

chapter 4 Common Menstrual Disorders

Amenorrhea Dysmenorrhea Dysfunctional uterine bleeding (DUB) Premenstrual syndrome (PMS) Premenstrual dysphoric disorder (PMDD) Endometriosis

Ovulation phase

At ovulation, a mature follicle ruptures in response to a surge of LH, releasing a mature oocyte (ovum). This usually occurs on day 14 in a 28-day cycle. When ovulation occurs, there is a drop in estrogen. Typically ovulation takes place approximately 10 to 12 hours after the LH peak and 24 to 36 hours after estrogen levels peak Ovulation symptoms also include vaginal spotting, an increase in vaginal discharge giving the woman a "feeling of wetness," an increased libido leading to more desire to be intimate, a slight rise in basal body temperature, and lower abdominal cramping. The one constant, whether a women's cycle is 28 days or 120 days, is that ovulation takes place 14 days before menstruation.

Manifestations of Common STIs

Chlamydia: may be asymptomatic, vaginal discharge, endocervicitis, inflammations of the rectum and lining of the eye, can infect throat Gonorrhea: may be asymptomatic, dysuria, urinary frequency, vaginal discharge, dyspareunia, endocervicitis, arthritis, PID, rectal infection Genital herpes: blister-like genital lesions, dysuria, fever, headache, muscle aches

who is risk for STI?

During adolescence and young adulthood, women's columnar epithelial cells are especially sensitive to invasion by sexually transmitted organisms, such as chlamydia and gonococci, because they extend out over the vaginal surface of the cervix, where they are unprotected by cervical mucus; these cells recede to a more protected location as women age.

Menstruation

Expulsion of inner uterine lining occurring monthly Marks the beginning and end of each menstrual cycle Menarche: establishment of menstruation in females Menopause: naturally occurring cessation of regular menstrual cycles Frequency variable: 21 to 36 days; average 28 days

GONADOTROPIN-RELEASING HORMONE

Gonadotropin-releasing hormone (GnRH) is secreted from the hypothalamus in a pulsatile manner throughout the reproductive cycle. It pulsates slowly during the follicular phase and increases during the luteal phase. GnRH induces the release of FSH and LH to assist with ovulation.

Nursing Assessment

If a contraceptive is to be effective, the woman must understand how it works, must be able to use it correctly and consistently, and must be comfortable and confident with it. If a client cannot comply with taking a pill daily, consider a method used once a week (transdermal patches), once every 3 weeks (transvaginal ring), or once every 3 months (Depo-Provera injection). Another option may be a progesterone intrauterine device that lasts 3 to 5 years and reduces menstrual flow significantly. Nursing Interventions Client/couple participation in decision making Client education Misconceptions Mechanism of action; advantages and disadvantages, danger signs to report Method failure and backup method

Gonorrhea

Newborn can be infected during delivery. Increased risk of miscarriage, PROM, and preterm birth Rhinitis, vaginitis, urethritis, inflammation of sites of fetal monitoring Gonococcal ophthalmia neonatorum can lead to blindness and sepsis (including arthritis and meningitis)

Common Women's Reproductive Disorders: Infertility

Not getting pregnant despite having carefully timed, unprotected sex for one year. The cause of infertility may be difficult to determine but may include inadequate levels of certain hormones in both men and women, and trouble with ovulation in women. The main symptom is an inability to get pregnant. In many cases, there are no additional symptoms. Secondary infertility is the inability to conceive after a previous pregnancy. Many people take the ability to conceive and produce a child for granted

Nursing Management of the Woman Choosing a Contraceptive Method

Nursing Assessment Medical history Family history OB/GYN history Personal history Diagnostic testing Physical exam Motivation Cost Cultural and religious beliefs Convenience Effectiveness Side effects Desire for children in the future Safety of the method Comfort level with sexuality Protection from STIs Interference with spontaneity

nursing assessment and nursing management

Nursing Assessment Past medical history, sexual history, menstrual history; bimanual pelvic examination Manifestations: pain, nausea, vomiting diarrhea, fatigue, fever, headache, dizziness; bloating, water retention, weight gain, muscle aches, food cravings, breast tenderness Client Education Comfort measures: heat, lifestyle changes, pain relief

etiogoly

Primary amenorrhea has multiple causes: Extreme weight gain or loss Congenital abnormalities of the reproductive system Stress from a major life event Excessive exercise Eating disorders (anorexia nervosa or bulimia) Cushing's disease Polycystic ovary syndrome Hypothyroidism Turner syndrome—defective development of the gonads (ovary or testes) Imperforate hymen Chronic illness—diabetes, thyroid disease, depression Pregnancy Cystic fibrosis Congenital heart disease (cyanotic) Ovarian or adrenal tumors. Causes of secondary amenorrhea can include: Pregnancy Breast-feeding Emotional stress Pituitary, ovarian, or adrenal tumors Depression Hyperthyroid or hypothyroid conditions Malnutrition Hyperprolactinemia Rapid weight gain or loss Chemotherapy or radiation therapy to the pelvic area Vigorous exercise, such as long-distance running Kidney failure Colitis Use of tranquilizers or antidepressants Postpartum pituitary necrosis (Sheehan syndrome) Early menopause.

The two categories of amenorrhea are primary and secondary amenorrhea.

Primary amenorrhea is defined as either the: Absence of menses by age 14, with absence of growth and development of secondary sexual characteristics, or Absence of menses by age 16, with normal development of secondary sexual characteristics. Secondary amenorrhea: absence of menses in women who previously menstruated that is related to another condition or disorder

PROGESTERONE

Progesterone is secreted by the corpus luteum. Progesterone levels increase just before ovulation and peak 5 to 7 days after ovulation. During the luteal phase, progesterone induces swelling and increased secretion of the endometrium. This hormone is often called the hormone of pregnancy because of its calming effect (reduces uterine contractions) on the uterus, allowing pregnancy to be maintained.

PROSTAGLANDINS

Prostaglandins are primary mediators of the body's inflammatory processes and are essential for the normal physiologic function of the female reproductive system. They are a closely related group of oxygenated fatty acids that are produced by the endometrium, with a variety of effects throughout the body. Although they have regulatory effects and are sometimes called hormones, prostaglandins are not technically hormones because they are produced by all tissues rather than by special glands. Prostaglandins increase during follicular maturation and play a key role in ovulation by freeing the ovum inside the graafian follicle. Large amounts of prostaglandins are found in menstrual blood.

Abortion

Surgical abortion Medical abortion Methotrexate followed by misoprostol Mifepristone followed by misoprostol

Manifestations of Common STIs (cont'd.)

Syphilis: disease is divided into four stages: Primary: chancre on place of bacteria entrance Secondary: maculopapular rash, sore throat, lymphadenopathy, flu-like symptoms Latent: no symptoms; no longer contagious Tertiary: tumors of the skin, bones, and liver, CNS symptoms, CV symptoms; usually not reversible. Trichomoniasis: may be asymptomatic, dysuria, urinary frequency, vaginal discharge, dyspareunia, irritation of genital area Genital warts: wart-like lesions that are soft, moist, or flesh-colored and appear on the vulva and cervix and inside; also surrounding the vagina and anus, sometimes appear in cauliflower-like clusters, and are either raised or flat, and small or large

Internal Male Reproductive Organs

Testes Sperm production Testosterone synthesis Ductal system Vas deferens (sperm transport) Spermatic cord Urethra Accessory glands Seminal vesicles Prostate gland Bulbourethral glands

Female Reproductive Cycle

The female reproductive cycle involves two cycles that occur simultaneously: the ovarian cycle, during which ovulation occurs, and the endometrial cycle, during which menstruation occurs. Hormonal regulation Cyclical breast changes Menstruation (absence of fertilization)

What day is counted as day 1 of the menstrual cycle?

The first day of the menstrual period

Internal Female Reproductive Organs

The internal female reproductive organs consist of the vagina, uterus, fallopian tubes, and ovaries vagina: organ of intercourse, menstrual flow, & birth canal. female internal organs uterus: provides a protected and sterile environment for the fetus to grows, the womb.. fallopian tube: protects the egg provides a suitable environment for fertilization. If the egg is fertilized, it will divide over a period of 4 days while it moves slowly down the fallopian tube and into the uterus ovaries: hormone- estrogen sex cell- egg. The ovaries are not attached to the fallopian tubes but are suspended nearby from several ligaments, which help hold them in position. The development and the release of the ovum and the secretion of the hormones estrogen and progesterone are the two primary functions of the ovary. The ovaries link the reproductive system to the body's system of endocrine glands, as they produce the ova (eggs) and secrete, in cyclic fashion, the female sex hormones estrogen and progesterone. After an ovum matures, it passes into the fallopian tubes.

Menstrual Cycle Hormones

The menstrual cycle involves a complex interaction of hormones. The predominant hormones include gonadotropin-releasing hormone, FSH, LH, estrogen, progesterone, and prostaglandins

Menstrual phase

The menstrual phase begins as the spiral arteries rupture secondary to ischemia, releasing blood into the uterus, and the sloughing of the endometrial lining begins. If fertilization does not take place, the corpus luteum degenerates. As a result, both estrogen and progesterone levels fall and the thickened endometrial lining sloughs away from the uterine wall and passes out via the vagina. The beginning of the menstrual flow marks the end of one menstrual cycle and the start of a new one. Most women report menstrual bleeding for an average of 3 to 7 days. The amount of menstrual flow varies, but averages 1 ounce or a range of approximately 2/3 to 2 2/3 ounces in volume per cycle

Proliferative phase

The proliferative phase starts with enlargement of the endometrial glands in response to increasing amounts of estrogen, causing endometrium to increase in thickness. Phase of endometrial cycle in which cervical mucus becomes clear, thin, stretchy, and more alkaline. The proliferative phase starts on about day 5 of the menstrual cycle and lasts to the time of ovulation. This phase depends on estrogen stimulation resulting from ovarian follicles, and this phase coincides with the follicular phase of the ovarian cycle.

nursing management

The treatment of primary amenorrhea involves the correction of any underlying disorders and estrogen replacement therapy to stimulate the development of secondary sexual characteristics. If a pituitary tumor is the cause, it might be treated with drug therapy, surgical resection, or radiation therapy. Surgery might be needed to correct any structural abnormalities of the genital tract. Dopamine agonists are effective in treating hyperprolactinemia. In most cases, this treatment restores normal ovarian endocrine function and ovulation. Therapeutic interventions for secondary amenorrhea can include: Cyclic progesterone, when the cause is anovulation, or oral contraceptives Bromocriptine to treat hyperprolactinemia Nutritional counseling to address anorexia, bulimia, or obesity Gonadotropin-releasing hormone (GnRH), when the cause is hypothalamic failure Thyroid hormone replacement, when the cause is hypothyroidism

Etiology and Risk Factors

female risk factors: Overweight or underweight (can disrupt hormone function) Hormonal imbalances leading to irregular ovulation Uterine fibroids Tubal blockages Cervical stenosis Reduced oocyte quality Chromosomal abnormalities Congenital anomalies of the uterus Immune system disorders Chronic illnesses such as diabetes, thyroid disease, asthma STIs Age older than 27 Endometriosis Turner syndrome History of PID Smoking and alcohol consumption Multiple miscarriages Exposure to chemotherapeutic agents Psychological stress Risk factors for infertility in men include: Exposure to toxic substances (lead, mercury, x-rays, chemotherapy) Cigarette or marijuana smoke Heavy alcohol consumption Use of prescription drugs for ulcers or psoriasis Exposure of the genitals to high temperatures (hot tubs or saunas) Hernia repair Obesity is associated with decreased sperm quality Cushing syndrome Frequent long-distance cycling or running STIs Undescended testicles (cryptorchidism) Mumps after puberty

Nursing assessment

infertility and pain; nonspecific pelvic tenderness; tender nodular masses on uterosacral ligaments, posterior uterus, or posterior cul-de-sac

Dysfunctional Uterine Bleeding

is a disorder that occurs most frequently in women at the beginning and end of their reproductive years. Defined as irregular, abnormal bleeding that occurs with no identifiable anatomic pathology. it is frequently associated with anovulatory cycles, which are common for the first year after menarche and later in life as women approach menopause. Similar to and may overlap with other uterine bleeding disorders Etiology related to hormone disturbance. With anovulation, estrogen levels rise as usual in the early phase of the menstrual cycle. In the absence of ovulation, a corpus luteum never forms and progesterone is not produced. The endometrium moves into a hyperproliferative state, ultimately outgrowing its estrogen supply. This leads to irregular sloughing of the endometrium and excessive bleeding. Treatment involves treating the underlying cause Nursing management involves client education.

FOLLICLE-STIMULATING HORMONE

is secreted by the anterior pituitary gland and is primarily responsible for the maturation of the ovarian follicle. FSH secretion is highest and most important during the first week of the follicular phase of the reproductive cycle.

Amenorrhea

is the absence of menses during the reproductive years. Amenorrhea is normal in prepubertal, pregnant, postpartum, and postmenopausal females. The uterus, endometrial lining, ovaries, pituitary, and hypothalamus must function properly and in harmony for a menstrual cycle to occur.

Under the influence of LH, what happens to the corpus luteum?

it develops from the ruptures follicle

Estrogen does what to the cervical mucus?

makes it thin, clear, and watery which makes it more receptive to sperm

symptoms

symptoms are assigned to PMS, but irritability, fatigue, bloating, tension, and dysphoria are the most prominent and consistently described. Mood disorders: main symptoms of PMDD A—anxiety: difficulty sleeping, tenseness, mood swings, and clumsiness C—craving: cravings for sweets, salty foods, chocolate D—depression: feelings of low self-esteem, anger, easily upset H—hydration: weight gain, abdominal bloating, breast tenderness O—other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout.