Unit 3 Contreception & Infertility + Genetics

IVF-ET

embryo transferred to uterus

what are risks associated with transdermal contraceptive patches?

same as those of oral contraceptives less effective in women greater than 198 lbs

autosomal recessive inheritance requires the individuals to have

2 abnormal genes

what are the risks associated wit both parents being carriers of autosomal recessive inheritance

25% risk baby will be affected 50% risk baby will be a carrier 25% risk baby will not be affected

age greater than (Blank) years can affect fertility

35

what is the risk of autosomal dominant inheritance

50% chance of passing on abnormal gene to each child

A nurse in a health clinic is reviewing contraceptive use with a group of adolescent clients. which of the following statements by an adolescent reflects an understanding of the teaching? A. "a water soluble lubricant should be used with condoms" B. "A diaphragm should be removed 2 hours after intercourse." C. "Oral contraceptives can worsen a case of acne" D. "A contraceptive patch is replaced once a month"

A

A nurse in an infertility clinic is providing care to a couple who has been unable to conceive for 18 months. which of the following data should be included in the assessment? (select all that apply) A. occupation B. menstrual history C. childhood infectious disease D. history of falls E. recent blood transfusions

A, B, C

what are 4 examples of 2nd trimester screenings

AFP (alpha fetoprotein) hCG (human chorionic gonadotropin) uE3 (unconjugated estriol) DIA (dimeric inhibin A) (Detection of NTD, trisomy 21 and 18)

1st trimester screening

Nucal translucency (Ultrasound) + PAPP-A (pregnancy associated protein ) + free beta HCG Detection of risk of Trisomy 13,18, & 21

A nurse in a clinic is caring for a group of female client who are being evaluated for infertility. which of the following clients should the nurse anticipate the provider will refer to a genetic counselor? A. a client whose sister has alopecia B. a client whose partner has von willebrand disease C. a client who has an allergy to sulfa D. A client who had rubella 3 months ago

B

A nurse is teaching a client about potential adverse effects of implantable progestins. which of the following adverse effects should the nurse include. (select all that apply) A. tinnitus B. irregular vaginal bleeding C. weight gain D. breast changes E. gingival hyperplasia

B, C, D

A nurse is caring for a couple who is being evaluated for infertility. which of the following statements by the nurse indicates understanding o the infertility assessment process? A. " you will need to see a genetic counselor as part of the assessment" B. "it is usually the woman who is having trouble, so the man doesn't have to be involved" C. " the man is the easiest to assess, and the provider will usually being there." D. "think about adopting first because there are many babies that need good homes."

C

A nurse is instructing a client who is taking an oral contraceptive about danger signs to report to her provider. the nurse determines the client understands the teaching when the client states the need to report which of the following> A. reduced menstrual flow B. breast tenderness C. Shortness of breath D. Headaches

C

A nurse in a clinic is teaching a client about her new prescription for medroxyprogesterone. which of the following information should the nurse include in the teaching. (select all that apply) A. "weigh loss can occur" B. "you are protected against STIs" C. "you should increase your intake of calcium" D. "you should avoid taking antibiotics" E. "Irregular vaginal spotting can occur"

C, E

a technique used to identify chromosomes by the attachment of fluorescently labeled DNA probes to denatured chromosomal DNA.

FISH

Males Tend to be taller than their fathers and brothers. Four most common conditions males are Sterility Breast development Incomplete masculine body build (rounded body type) /lack of facial & body hair Social and/or school learning problems.

Klinefelter syndrome 47 XXY

Mental retardation - severe Major medical problems Congenital heart disease - approximately 80% of affected infants Omphalocele 10% Holoprosencephaly 60% (an anatomic defect of the brain involving failure of the forebrain to divide properly) Kidney defects 30% Skin defects of the scalp 20%

Trisomy 13

adverse effects of medroxygprogesterone (injectable progestins) can cause (Blank) which would require what type of adequate vitamin supplements

descreased bone mineral density calcium and vitamin D

90% die by age 1 yr Mental retardation physical findings include: prominence to the back part of the head, short eyelid fissures, small mouth and jaw, external ear variations, clenched fist with index finger overlapping the third and 5th finger overlapping the 4th, small fingernails, underdeveloped or altered thumbs, short sternum (breastbone), club feet and redundant skin at the back of the neck. Major medical problems: Congenital heart defects 90% Multiple joint contractures 10% spina bifida hearing loss >50% cleft lip 5-10% birth defects of the eye 10%

Trisomy 18

Mental retardation - variable Poor muscle tone Slanting eyes with folds of skin at the inner corners (called epicanthal folds) Hyperflexibility (excessive ability to extend the joints) Short, broad hands with a single crease across the palm on one or both hands Broad feet with short toes Flat bridge of the nose Short, low-set ears Short neck Small head Small oral cavity 1/3 have cardiac defects

Trisomy 21 (Down syndrome)

Female typically short, achieving an average adult height of only 4'7" variety of associated physical features and medical problems do not have proper ovarian development - may fail to develop secondary sexual characteristics during adolescence and may be infertile as adults not at risk for mental retardation, but they may have learning problems, especially in arithmetic.

Turner syndrome 45 X

chromosomal anomalies are divided into 2 categories

abnormalities in number abnormalities in structure

what are 3 exams of genetic prenatal diagnostic testing

amniocentesis CVS (chorionic villus sampling) Carrier Screening

what two things make birth control less effectives

antibiotics anticonvulsants

temperature can drop slightly at the time of ovulation. this can be used to facilitate conception, or be used as a natural contraceptive

basal body temperature

a woman records her menstrual cycle by calculating her fertile period based on the assumption that ovulation occurs about 14 days before the onset of her next mensural cycle.

calendar method

Non-invasive blood test Screen for fetal sex, fetal rhesus (Rh) blood type and the increased chance for specific chromosome problems, including: Down syndrome (Trisomy 21) Trisomy 18 Trisomy 13 Trisomy 16 Trisomy 22

cfDNA (prenatal cell free DNA screening)

test in which visually examines the amino acid sequence of the chromosomes

chromosomal microarray (CMA)

what are some examples of multifactorial inheritances

cleft palate heart defects spina bifida club foot pyloric stenosis

what are two examples of ovarian stimulation medications

clomiphene citrate letrozole

contains etonogestrel and ethanol estradiol that is delivered at continuous levels vaginally.

contraceptive vaginal ring

what contraceptive method raises the risk of ectopic pregnancy if pregnancy occurs after procedure

female sterilization (bilateral tubal ligation)

the greatest variation from cycle to cycle of ovulation should be in what phase

follicular phase

GIFT

gamete (egg & sperm) intra fallopian transfer

evaluates hypothalamic pituitary ovarian axis to include serum prolactin, FSH, LH, estradiol, progesterone, and thyroid hormones

hormone analysis

outpatient radiological procedure in which dye is used to assess the latency of the fallopian tubes. assess for history of allergies to iodine and seafood prior to beginning of the procedure.

hysterosalpingography

a radiographic procedure in which the uterus is examined for sings of defect, distortion, or scar tissue that can impair successful impregnation

hysteroscopy

requires a minor surgical procedure to subdermally implant and remove a single rod containing etonogestrel on the inner side of the upper aspect of the arm

implantable progestin

procedure of collecting the woman eggs from her ovaries, fertilizing the eggs in the laboratory with sperm

in vitro fertilization

ICIS

intracytoplasmic sperm injection micro manipulation to introduce sperm into the egg

procedure used to place prepared ssperm in the uterus at the time of ovulation.

intrauterine insemination

IUI

intrauterine insemination (insert sperm into uterus at time for ovulation)

a procedure in which gas insufflation under general anesthesia is used to observe internal organs

laparoscopy

an intramuscular or subcutaneous injection given to a female client every 11 to 13 weeks.

medroxyprogesterone (injectable progestins)

chromosomal microarray is the same thing as

molecular karyotyping (MK)

Occurs after fertilization and results in baby with 2 different cell lines - each having a different chromosomal number

mosaicism

caused by an interaction of many genes and environmental factors (cause of most congenital malformations)

multifactorial inheritance

assesses for uterine or vaginal anomalies

pelvic examination

evaluates coital technique and mucus secretions

postcoital test

oral progestins that provide the same action as combined oral contraceptives

progestin only pill

easiest ways to calculate the mathematical probability of inheriting a specific trait - invented by an early 20th century English geneticist named Reginald Punnett

pungent square

in 40% of couples who are infertile, inability to conceive is due to male infertility. this test is the first in an infertility workup because it is less expensive and less invasive

semen analysis

after ovulation, as progesterone increases, the BBT does what

slightly increases

why do you need a full bladder before AMNIO in early gestations

so the MD can access the uterus easier

Based on current evidence = offer CMA as the first-tier genetic test for patients with unexplained: (DD) =developmental delay (ID) = intellectual disability (ASD) = autism spectrum disorders (MCA) = multiple congenital anomalies

the international standards for cytogenetic arrays (ISCA)

insertion of small flexible agent through the vagina and cervix into the fallopian tubes. this results the development of scar tissue in the tubes preventing conception.

transcervical sterilization

contains norelgestromin (progesterone) and ethinyl estradiol, which which is delivered at continuous levels through the skin into subcutaneous tissue.

transdermal contraceptive patch

a transvaginal or abdominal ultrasound procedure performed to visualize female reproductive organs

ultrasonography

what are 3 additional 1st trimester screenings

ultrasound for ducal transluency ultrasound for nasal bone determination maternal blood

what is a black box warning for Depo Provera?

watch bone density return to ovulation may be delayed by 18 months do not massage after IM injection to avoid accelerating medication absorption

ZIFT

zygote intra fallopian transfer