The Female Reproductive System

Placental Development

-> Begins at 3rd week -> Forms at site of implantation

Which vaccine would the nurse administer to provide protection from precancerous lesions and cancers of the vulva, cervix, and vagina in young girls and women?

hpv vaccine

The nurse is counseling a 34-year-old client who has requested a prescription for oral contraceptives. Which condition would warrant additional discussion?

hypertension

The nurse teaches a client about side effects that necessitate discontinuation of oral contraceptives. Which statement made by the client indicates that the teaching was effective?

ill stop taking if i have chest pain

The nurse would identify which anomaly as possibly being observed when a fetus is exposed to a teratogen during the embryonic development?

improper development of the organs

Which statement indicates that a pregnant client requires further teaching about fetal growth and development?

the fetus gets nutrients from amniotic fluid

What is the Corpus Luteum?

the opened follicle sac after the ovum has been released

Which surgery is associated with permanent contraception? Select all that apply. One, some, or all responses may be correct.

vasectomy, tubal ligation

What hormones influence the Follicular phase to begin? Fall in ________ & ________ Increase in ________ & ________

Estrogen;Progesterone Follicle Stimulating Hormone (FSH); Luteinizing Hormone

Which intervention would the nurse recommend when a client reports moodiness and anxiety a few days before her period?

Exercise three to four times a week in the luteal phase.

The nurse is obtaining a health history from a client with endometriosis. Which consequence can occur as a result of this disorder? Select all that apply. One, some, or all responses may be correct

Metrorrhagia Impaired fertility Bowel strictures Voiding difficulties

A couple in their late 30s are in the first trimester of pregnancy and have been referred to genetic counseling because of a family history of an inheritable problem and advanced maternal age. They are concerned because they believe that genetic counseling will favor abortion if studies reveal a defective fetus. Which response would the nurse provide regarding genetic counseling?

"Families are helped to understand the diagnosis, the probable cause of the disorder, and how the condition can be managed."

IMPLANTATION

6-10 days after fertilization Placenta will form at site of implantation Normal implantation occurs in the upper uterus -> Better blood supply for placenta -> Less bleeding after delivery -> Placental development over or near cervical opening is problematic

A couple has decided to use the basal body temperature method of natural family planning. Which time period would the nurse teach them is the most fertile period in the menstrual cycle?

72 hours before and 24 hours after ovulation

menopause

Age of menopause Average age for natural menopauseis 51.5. Physiologic changes Decreased estrogen Ovulation ceases 1-2 years prior to menopause Regression/atrophy of reproductive organs Dyslipidemia Bone loss Therapy for menopause Hormone replacement therapy (HRT) Complementary and alternative therapies Diet and nutrition Phytoestrogens Weight-bearing exercises Stress management and relaxation techniques

A 26-year-old woman whose sister recently had a lumpectomy for breast cancer calls the local women's health center and asks for an appointment for a mammogram. Which guidance would the nurse provide the client?

An appointment should be given for history, assessment, and indicated imaging

What is the job of hormones?

Prepare the Endometrium for implantation

Which information is essential for the nurse to explain to the client who has scheduled a vasectomy?

At least 15 ejaculations to clear the tract of sperm must occur before the semen is checked

When does the Proliferative Phase occur?

At the end of mensus. Approximately day 6-8

Preventing fetal exposure

BEGIN BEFORE CONCEPTION Vaccinate, other preventions FDA drug classifications No illicit substances, alcohol (Fetal Alcohol Syndrome), tobacco Avoid radiologic procedures No hot tubs/saunas, high temperatures Report Fevers Manipulating the fetal environment -> appropriate medical therapy for diseases (ex: diabetes) -> 400 mcg of Folic Acid (prevents spinal cord defects) - Mechanical Disruptions to Fetal Development -> Oligohydramnios: amniotic fluid when low can cause club feet, fetal lung development

PMS

Cyclic symptoms that occur after ovulation and prior to menstruation For diagnosis, symptoms must have a negative impact on work, lifestyle, or relationships Etiology Unknown Symptoms Physical and Behavioral Management Diet, Exercise, Stress Management, Sleep and Rest

What day of the Reproductive Cycle is the Proliferative Phase?

Day 1

When does the Follicular Phase begin?

Day 1

When does the Menstrual Phase begin?

Day 1

candidasis

Most common form of vaginitis Fungal or yeast infection Symptoms Female Thick, curdy, white vaginal discharge Itching Dysuria Dyspareunia Male Rash or excoriation of the skin of the penis Possible pruritus, treatment Female OTC intravaginal cream or suppositories - azole

Which statement would the nurse include in a teaching session for pregnant clients regarding fetal growth and development? Select all that apply. One, some, or all responses may be correct.

"Development occurs in a head-to-toe and central-to-peripheral pattern." "Pregnancy includes the preembryonic, embryonic, and fetal stages of development." "During pregnancy the embryo grows from a single cell to a complex physiologic being."

Which statement by a pregnant woman after attending a prenatal education session indicates the need for additional teaching?

"During pregnancy it's safe for me to use my regular herbal remedies."

In which order do the events of the positive feedback mechanism of estradiol chronologically occur?

Estradiol levels are increased during the menstrual cycle. Follicle-stimulating hormone (FSH) production and release is increased. Estradiol levels are increased as a result of follicle-stimulating hormone. Follicle-stimulating hormone levels in serum drop. death of follicle has occured

What hormone stimulates formation of the new Endometrium?

Estrogen

What hormones does the Corpus Luteum release?

Estrogen & Progesterone

Oral contraceptives are prescribed for a client who smokes heavily. Which is a major immediate risk to this client?

blood clots

Which newborn anomaly can occur if rubella is contracted during the first trimester of pregnancy?

cardiac anomalies

A couple interested in family planning asks the nurse about the cervical mucus method of preventing pregnancy. Which quality of cervical mucous would indicate fertility?

clear and stretchable

Which effect would the nurse identify as seen when the fetus is exposed to a teratogen during the embryonic period?

gross malformations

natural barriers

nothing artificial, calendar 14 days, sperm lives w-3 days , cycle must be regular, can be affected by stress, symptothermal- basal body temperature , cervical mucus, ovulatory symptoms

Which phase in the Ovarian Cycle stimulates the Menstrual Phase (of the Endometrial Cycle) to begin?

Luteal Phase

What is the main hormone that stimulates ovulation?

Luteinizing Hormone

Which hormone is crucial for ovulation and complete maturation of the ovarian follicles?

Luteinizing hormone

What are the phases in the Endometrial Cycle?

MPS Menstrual, Proliferative, Secretory

Where does this hormone come from?

Maturing Ovarian Follicles

Which is the best advice the nurse can provide to a pregnant woman in her first trimester?

"Avoid drugs and don't smoke or drink alcohol."

Arrange in order of occurrence the steps involved in the changes during puberty.

1.Triggering of GnRH by the hypothalamus 2.Movement of GnRH through a network of capillaries to the anterior pituitary gland 3.Stimulation of production and secretion of FSH and LH 4.Stimulation of the gonadal response

The nurse is teaching a family planning class about ovulation and conception. For which period of time in hours would the nurse inform the class that the ovum is capable of being fertilized after ovulation?

12-24

How long does the Follicular Phase Last?

14 days

Which time during the menstrual cycle would the nurse stress as the optimal time to achieve pregnancy?

14 days before the next period is expected

What is the Endometrium?

A layer of blood vessels, tissues, & glands on the inside of the uterine wall that thickens during the Proliferative & Secretory Phase of the Reproductive Cycle. The purpose of the Endometrium is to support implantation of a fertilized conceptus

What is a Follicle?

A sack of cells on an ovary that contains a maturing ovum

male factors contributing to infertility

Abnormalities of sperm Abnormal erections Abnormal ejaculation Abnormalities of seminal fluid

Primary amenorrhea

Absence of menses Menstrual periods should begin within 2 years of breastdevelopment. Between the ages of 9-15 years Common systemic cause Low body weight for height Chronic stress Hypothyroidism Drug use

maligant

Cancer of the cervix, endometrium, or ovaries Signs and symptoms May not be diagnosed until it is advanced, symptoms vague Red flags Irregular vaginal bleeding,postmenopausal bleeding Vaginal discharge Painful intercourse Vulvar or vaginal itching, vaginal lesions or discoloration Abdominal bloating or constipation Blood in stool Risk factors dependent on type Cervical: HPV/ STIs, smoking, obesity Uterus: obesity, nulliparity, other cancers Ovaries: early menses, late menopause, nulliparity, other cancers Diagnosis Pap tests, genetic studies,ultrasonography Management Depends on location and extent of disease MALIGNANT

Which infection is characterized by vaginal itching and thick, white, cottage cheese-like discharge along with a laboratory finding of hyphae?

Candida albicans

The primary health care provider has diagnosed the overweight client who is experiencing infertility with the condition polycystic ovarian syndrome (PCOS). Which intervention is the most important?

Discussing weight loss, exercise, and a balanced low-fat diet

female factors contributing to infertility

Disorders of ovulation Abnormalities of the fallopian tubes Abnormalities of the cervix

FRATERNAL TWINS

Dizygotic: two separate ova fertilized by 2 separate sperm No more similar to each other than singly born siblings May be of the same or different sex 2 placentas

At which point during a human pregnancy does the embryo become a fetus?

During the 8th week of the pregnancy

If an ovum is fertilized, it secretes the hormone ________ that causes the persistence of the ________

Human Chorionic Gonadotropin (HCG); Corpus Luteum

Which hormone would the nurse explain as stimulating the release of estrogen and progesterone after fertilization?

Human chorionic gonadotropin (hCG)

The laboratory results of a woman in labor indicate the presence of cocaine and alcohol. Which findings would the nurse associate with fetal alcohol spectrum disorder (FASD) in the newborn? Select all that apply. One, some, or all responses may be correct.

Hypotonia Hypoplastic maxilla Small, upturned nose

To ensure breast health, the nurse teaches a client about prevention and detection practices. Which client statement indicates the need for further teaching?

I will increase my daily meat consumption

What are the phases in the Ovarian Cycle?

FOL Follicular, Ovulatory, Luteal

What happens if an ovum is not fertilized?

FSH & LH fall to low levels and the Corpus Luteum regresses. Corpus luteum no longer produces Estrogen & Progesterone resulting in menstruation

Where does the mature ovum go?

Fallopian Tube

How long does the Luteal Phase last?

From Day 14 to the start of menses. Approximately 14 days

Which factor is most important for the survival of the newborn?

Gestational age and birth weight

When does the Secretory Phase occur?

Last half of the ovarian cycle

assisted technology for infertility

IVF , ISI ( insetion of sperm into egg )

The Ovarian Cycle takes place where?

Ovaries

bacterial vaginosis

Overgrowth of bacteria within the vagina Cause not known,associated with: Tissue trauma from intercourse Multiple sex partners Douching, other femininehygiene products Lack of normal vaginal lactobacilli NOT an STI, though it is associated with sexual activity. Signs and symptoms Thin grayish/white vaginal discharge Fishy odor Treatment Metronidazole (Flagyl),Clindamycin No need to treat partner

Preparation FOR Fertilization

Ovum is released into Fallopian tube -> Viable for 24 hours Sperm is deposited into vagina -> Viable for 48-72 hours (highly fertile for 24 hours)

A primigravida in the first trimester tells the nurse that she has heard that hormones play an important role in pregnancy. Which hormone would the nurse tell the client maintains pregnancy?

Progesterone

How does the Corpus Luteum Maintain an early pregnancy? (what hormones does the Corpus Luteum secrete?)

Progesterone

Considerations for choosing a method

Safety, effectiveness,acceptability,convince,education needed, benefits,side effects , protection from STD

pelvic floor dysfunction

Signs and symptoms Stress incontinence Vaginal fullness Incomplete bladderemptying Cystitis UTERINEPROLAPSE Uterus protrudesdownward (drops) intothe upper vagina,pulling vagina with it. Location of the cervixdetermines extent ofthe prolapse. May extend to belowthe vaginal introitus. Symptoms Dragging sensationin groin andbackache. CYSTOCELE ANDUTERINE PROLAPSE Treatment Pelvic floor strengthening/ Kegel exercises Topical or systemic estrogen Vaginal pessaries Surgery involving hysterectomy and repair of prolapsed vaginal walls Anticholinergic drugs for urinary incontinence

Which direction would the nurse give to a client at 6 weeks' gestation who reports using an over-the-counter herbal product as a health supplement? Select all that apply. One, some, or all responses may be correct

Stop taking the supplement immediately. Discuss the use of the supplement with the health care provider. Discuss the use of any other over-the-counter products with the health care provider

A female client who is undergoing infertility testing is taught how to examine her cervical mucus. After listening to the instructions, the client says, "That sounds gross. I don't think I can do it." Which conclusion would the nurse make from this statement?

The client may be uncomfortable with performing manual examination of the genitals

Which time period would the nurse teach the health education class that fertilization of the ovum by the sperm occurs?

When 1 sperm penetrates the wall of the ovum

A pregnant client asks how smoking will affect her baby. Which information about cigarette smoking will influence the nurse's response?

The resulting vasoconstriction affects both fetal and maternal blood vessels.

Which information would the nurse include as part of the teaching plan for the client requesting information on different methods of contraception?

The rim of a condom must be held in place while the penis is withdrawn from the vagina.

The nurse is teaching a group of young adults about the calendar method of contraception. Which statement made by an adolescent indicates effective learning?

This type of contraception requires a regular menstrual cycle."

Which would the nurse expect to observe in a healthy newborn's cord vessels?

Three vessels: one vein and two arteries

The Endometrial Cycle takes place where?

Uterus

A client states her husband is a fraternal twin and asks about her probability of having twins. Which is an appropriate response by the nurse?

You have no greater probability of having twins than anyone else in the general population."

A client is scheduled for a laparoscopic bilateral tubal ligation. Which information would the nurse include in preoperative teaching?

You will be admitted as an outpatient for same-day surgery."

A 25-year-old female client reports increased vaginal discharge, milky gray in color with a "fishy "odor. A wet smear is performed and the presence of "clue cells "confirmed.Which type of infection would the nurse suspect?

bacterial vaginosis

Which medication is safe to take during pregnancy?

acetaminophen

***know this chart! ***Look at answer key in momentum

answer key in momenteum

Which time in the menstrual cycle would the nurse recommend the client come in for intrauterine device (IUD) insertion?

anytime in the cycle

secondary amenorrhea

had period and no longer had it

Which gland secretes gonadotropin-releasing hormone to help control the events of puberty?

hypothalamus

Which contraceptive method is 99% effective if used correctly?

oral contraceptives

Which term would the nurse use to describe the first fetal movements that a pregnant client feels?

quickening

vaccines

rubella, tb, cholestrol

At the beginning of the Proliferative Phase the Endometrium is very ________

thin

What happens to the Endometrium during the Secretory Phase?

It continues to thicken & prepare to receive a fertilized ovum

Which statements would the nurse include when teaching a client who is considering medroxyprogesterone injection as a form of hormonal birth control? Select all that apply. One, some, or all responses may be correct.

It lasts for 3 months. It can cause nausea and vomiting. Side effects include drowsiness or insomnia and depression. The most severe undesirable effects are liver dysfunction and thromboembolic disorders.

A client seeking advice regarding contraception asks the nurse to explain how an intrauterine device (IUD) prevents pregnancy. How would the nurse respond?

It produces a spermicidal intrauterine environment."

What happens to the Endometrium during the Menstrual Phase?

It sheds

After the birth of a neonate, a parent asks, "What is that white substance over the baby's body?" How would the nurse respond?

"It's expected, and it's called vernix caseosa.

staging

assist with understanding severity , based on tumor, nude, hetasis

infertility

inability to conceive ( unprotected sex for 1 year )

Arrange the physiological events from early puberty to ovulation chronologically.

1. Follicle-stimulating hormone stimulates the ovaries to release estrogen 2.Production of estrogen in large amounts 3.Building of the uterine endometrial lining 4.Development of the follicular phase 5.Release of the ovum from the follicle

Female reproductive cycle

2 Corresponding Cycles Ovarian Cycle - Follicular Phase - Ovulatory Phase - Luteal Phase Endometrial Cycle - Menstrual Phase -> 1-6 days - Proliferative Phase -> 7-14 days - Secretory Phase -> 15-26 days

The primigravida would be taught by the nurse to anticipate quickening in which week of pregnancy

20th week

What is contained inside of a follicle?

Maturing Ovum

What is family planning

Prep to have a family or not have a family

What is the main outcome of the Ovulatory Phase?

Release of Mature Ovum

Which organ produces sex steroid hormones?

ovary

Where is the Corpus Luteum located?

the Ovary

CAUSING AGENTS

Maternal Infectious Agents Drugs Pollutants Ionizing Radiation (is mom an Xray tech?) Maternal Hyperthermia (can be caused by sauna, hot tub, fever, etc.) Maternal Medical Disorders

What occurs during the Follicular Phase?

Maturation of Follicle/Ovum

A client asks the nurse about the most common side effects associated with the use of a copper intrauterine device (IUD). Which answer would the nurse provide?

heavier period

A 28-year-old woman who is a smoker seeks advice about oral contraceptives. Which response by the nurse is appropriate?

"Oral contraceptives can cause thrombophlebitis."

least reliable

breastfreeding , most effective in early postpartum , breast feed on very regular schedule coltus interpertus (withdraw , difficult to control, pre cum contains sperm

16 weeks

- 14cm - Face is human looking - Urine excreted into amniotic fluid - Meconium begins to collect in intestines - Mother may detects fetal movement (quickening)

20 weeks

- 16cm - Myelination of nerves begins - Heartbeat detectable with fetoscope - Fetal movements felt by mother & palpable by examiner - Lanugo & vernix cover body - Brown fat production complete

24 weeks

- 23cm - Alveoli (lives in lungs) developed, surfactant protection (protectant inside the lungs, essentially lube for 02 & Gas Exchange) - Capillaries around alveoli formed but immature - Gas exchange possible - Fetus is active & movements more readily felt - Fetus growing & gaining weight - Fetus can survive if born at this time, but less likely to survive long term

28 weeks

- 27cm - Nervous system begins regulation of some functions - Adipose tissue accumulates - Red blood cells produced in bone marrow - Eyes no longer fused - Sufficient alveoli, surfactant, capillary network for respiration ->Many survive with ICU care - Fetus usually assumes head down position in uterus "vertex"

38 weeks

- 36cm - Weight is about 3000-3600g (6lb 10oz - 7lb 15oz) - Abundant subcutaneous fat - Adequate surfactant is present - Pulmonary system mature - Vernix is in skin folds only - Lanugo is present on shoulders - Ready for Birth!

4 Weeks

- 4-6mm - Neural tube closes - Brain & spinal cord developing rapidly - Limb buds seen **HEART BEGINS FORMING CHAMBERS & BEATS** ->not detectable until 8 weeks - GI/Respiratory system begins as single tube

12 weeks

- 8cm - Heartbeat detectable by Doppler ultrasound - Liver then spleen produce red blood cells - Kidneys produce urine - External genitalia differentiated (gender can be determined) - Lanugo begins forming (very fine hair all over body that protects skin) - First fetal movements begin (not felt by mom)

6 Weeks

-12-13mm -Chambers in heart complete -Respiratory system differentiating -Intestines contained within umbilical cord -Liver & kidneys take up most abdominal space

8 weeks

-3cm -Heartbeat detectable with ultrasound ONLY -Most major organs have formed -Spinal cord stops at end of vertebral column (NO tail) -Testes, ovaries, external genitalia begin developing

placenta fx

-> Gas, nutrient & waste exchange between mom & baby -> Secretion of hormones to maintain. & progress pregnancy

Fetal Period

->Beginning of the 9th week to birth -> Fetus -> Growth & maturation of fetus & major organs

Embryotic Period

->Beginning of week 3 through week 8 ->Embryo ->All major body organs formed (basic) ->Vulnerable to teratogens ->Mother misses her period at week 3

Preembryotic Period

->First 2 weeks after fertilization ->Zygote>Morula>Blastocyst ->Cell division & implantation

toxic shock syndrome

Caused by toxin-producing strains of Staphylococcus aureus High absorbency tampons Mechanical barrier contraceptives

changes in cervical mucus

Cervical mucus is scant, thick, & sticky Just before ovulation, cervical mucus can become thin, clear, & elastic which allows sperm to more easily pass through the cervix at the most fertile time of the cycle

The decree in ________ & ________ hormones stimulate the Menstrual Phase to begin

Estrogen; Progesterone

On a visit to the fertility clinic a couple requests fertility medications because, despite having a 28-day menstrual cycle and temperature readings that demonstrate an ovulatory pattern, the woman has been unable to conceive. Which guidance would the nurse provide to this couple?

An examination of semen will be needed.

begin of reproductive tract

Cervical polyps Small tumors, usually only a few millimeters in diameter Biopsy to rule out cervical cancer Uterine leiomyomas (fibroids) Excessive menstrual bleeding, infertility, s/s dependent on location and size Surgical removal, watch and wait, oral contraceptive for bleeding Ovarian cysts From developing or ruptured follicle Pelvic pain

Which is the most highly sensitive time within the developing embryo for the risk of malformation related to environmental teratogens?

Cleft palate at 8 weeks' gestation

When does the Ovulatory Phase begin?

Day 14

As part of an infertility workup involving both partners, a male client is to have a semen analysis. Which instruction would the nurse give him?

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

endometriosis

ENDOMETRIOSIS Signs and symptoms Pelvic pain Related to menstrual cycle Dyspareunia Painful intercourse Abnormal uterine bleeding Diagnosis confirmed bylaparoscopy ENDOMETRIOSIS Treatment options Surgical removal of visible endometrial tissue Excision Endo coagulation Electrocautery Laser vaporization Surgical removal of uterus and ovaries Women with minimal symptoms Observation, analgesics, nonsteroidalanti-inflammatory drugs Hormonal therapy or oralcontraceptives Suppresses the menstrual cycle Pregnancy must be delayed untiloral contraceptive or hormonal therapy is complete difficulty getting pregnant

moment of fertilization

Egg essentially "shuts down" after 1 sperm enters; preventing more sperm from entering the egg Sex is determined at fertilization

Which would the nurse explain to the newly pregnant primigravida about how and when the fetal heartbeat will first be heard?

Electronic Doppler ultrasonography at 10 to 12 weeks

IMPORTANT HORMONES IN THE CYCLE

Estrogen - If high it will stimulate Endometrium (tissue that lines the uterus) - If low will stimulate Menses (menstruation) - Progesterone - Same as estrogen PLUS - "hormone of pregnancy" - regulates nourishment of embryo - decreases uterine contractions Follicle Stimulating Hormone -stimulates a follicle to grow & mature Luteinizing Hormone -stimulates follicle to release

What hormone does a follicle release?

Estrogen & then Progesterone

long acting reversible contraception

IUD - t shaped inserted into uterine cavity , hostile uterine environment to sperm , hormonal , thickens cervical mucus , prevents transport of sperm, does not cause abortion, contraindications-history of eptopic pregnancy , bleeding disorders, slight risk for uterine perferation or infection , 99.2-99.8% effective, Adavantage-continent, long lasting, nothing do do before , or during sex, hormonal may result in Disadvantage-discomfort, cramping , bleeding increased, know how to locate string, check location weekly, no string , notify dr Nexplanon -subq upper arm , good for 3 years, inhibits ovulation, thicken mucus, 99.95% effective , se- irregular menstural bleeding, immediate return for fertility , do not use with clotting disorder Hormone injections - depo, IM, SUBQ, 94% effective , ovulation for 15 weeks, se - menstural irregulation Of bone density, increase calcium and Vitamin D , discontinue after 2 years, repeat injection every 12-13 weeks , delayed fertility

How does the Ovarian Follicle influence the Proliferative Phase of the Endometrial Cycle?

In the Follicular Phase, the follicle produces Estrogen, which stimulates the Endometrium to begin to re-grow

How does the Ovarian follicle influence the Secretory Phase of the Endometrial Cycle?

In the Luteal Phase, the Corpus Luteum secretes Estrogen & large amounts of Progesterone to continue to thicken the Endometrium

Which information would the nurse include as part of the teaching plan for an anxious client about to have her first routine Papanicolaou (Pap) smear?

Information on how a Pap smear screens for precancerous and cancerous cells of the cervix

A newly pregnant client reports that she is taking isotretinoin. Which statement applies to the care of this client?

Isotretinoin is teratogenic and is associated with major fetal malformations, so the client should stop the medication immediately.

Environmental influences

May be positive or negative Teratogens -> Agents that cause birth defects -> Factors that make it difficult to establish teratogenic potential - Retrospective Study - Timing of exposure - Different susceptibility of organ systems - Uncontrolled fetal exposure - Placental transfer & individual variations - Maternal disorder (uncontrolled)

Why is the beginning of the Menstrual Phase used to mark Day 1 of the reproductive cycle?

Menstruation is the most obvious sign that pregnancy did not occur & the reproductive cycle is starting again

IDENTICAL TWINS

Monozygotic: of the same sex (have the same genetic makeup) Usually have shared placenta Monozygosity is not affected by environment, race, physical characteristics, or fertility

Short-acting hormonal methods

No barrier for Stis , extra protection, effectiveness typical 91% , perfect use 99%, take at same time daily, if you skip a day use an alternative method , high BP , smokers , do not take pills , cause blood loss transdermal - apply weekly 3x , risk for blood clots is higher, less effective in pts that weigh more than 198 lbs, contraceptive ring- risk for vaginitus , expulsion, ring is felt during intercourse, benefits- regular menses , reduced acne , improves endometrosis , risks- thrombosis, PE, MI, stroke, HTN hormonal pt teaching - HCP new meds, yearly bo, no breast , pelvic, or pap required, discuss compliance, report adverse reactions A- abdominal pain C- chest pain sob H-headaches E- eye problems S- severe chest pain

Which recommendation would the nurse provide to a client who is seeking birth control and reports difficulty remembering to take daily medications? Select all that apply. One, some, or all responses may be correct.

NuvaRing Depo Provera Ortho Evra patch Nexplanon system Levonorgestrel T device

PCOS

Polycystic Ovarian Syndrome (PCOS) Complex endocrine disorder of ovarian dysfunction evidenced by: Cysts in the ovaries High levels of male hormones Irregular or skipped periods Obesity Hyperinsulinemia Infertility Signs of androgen excess (hyperandrogenism) Hirsutism Acne Management If pregnancy is not an immediate goal: Combined oral contraceptive(COC) or cyclic progesterone Helps regulate menstrual cycles Provides balance between estrogen and progesterone Protects endometrium anddecreases risk of uterine cance rTreatment goals Decrease effects of hyper and rogenism Restore reproductive functioning for women desiring pregnancy Protect the endometrium Increased risk for uterine cancer Reduce long-term risks Type 2 diabetes Cardiovascular disease

Which hormone is crucial in maintaining the implanted ovum at its site?

Progesterone

When the Menstrual Phase (of the endometrial cycle) begins, which corresponding Ovarian Phase also begins?

Proliferative Phase

Fetal Membrane :

Purpose is to protect the fetus & hold in amniotic fluid

GENETIC COUNSELING

Reasons for Genetic Counseling - Family history of defect -> parent, family member, other children - Maternal age> 35, paternal age > 40 - Previous stillbirth - Known or suspected carriers of disorders Timing - Preconception - Prenatal diagnosis for fetal abnormalities - Postnatal diagnosis (FLK: funny looking kid) - Goals of Genetic Counseling - Identify level of risk - Prevention - Prenatal & Postnatal - provide diagnosis - if possible - Teaching about disorder - Treatment options - Risk of reoccurrence - Services & support available - Emotional support, grief, termination

How does the Luteal Phase in the Ovarian Cycle stimulate the Menstrual Phase to begin?

The Corpus Luteum degrades & stops producing estrogen & progesterone, which causes the uterine lining to break down & shed

Why do these hormones decease?

The Corpus Luteum is degrading because there is no fertilized conceptus to release HCG to stimulate Corpus Luteum to remain

What happens to the Endometrium during the Proliferative Phase

The cell layer thickens, the blood vessels elongate

Long acting and Permanent Methods

Tubal sterilization, highest effectiveness, 99-99.5 , risk for anasthesia complications and infections , convince-continent after birth , education -cut or tie Fallopian tubes, reversal difficult to impossible . Post op care - benefit , no birth control needed, permanent , side effects -discomfort Vasectomy-safer than tubal, smaller risk for infection , 99.9%, convince preformed in office , under local anasthesia, education -rest scrotal support ice , 3 months before complete sterilization, semen analysis at 8-16 weeks , decreased failure rate , more able to reverse than tubal, side effect discomfort, infection

The nurse is assessing a newborn immediately after birth. Which finding indicates normal development?

body weight is 3500 g

emotional support for infertility

assumption of fertility , growing awareness of a problem, seeking help for infertility, importance of having a baby , intimate info, financial resources , involvement in care.

maligant breast disease

breast cancer is a major typr of cancer amoung women , 1 in 8 , highest risk for white woman , men is 1 in 1000

A client is taking an estrogen-progestin oral contraceptive. Which adverse effects from the contraceptive would the nurse teach the client to report to the primary health care provider? Select all that apply. One, some, or all responses may be correct

dizziness, chest pain , calf tenderness

The nurse understands that a teratogen would cause neural tube defects in which stage of pregnancy?

embryonic period

therapies for infertility

evaluation of infertility , pharmocologic management, surgical processes, therapeuic insemination , egg donation, surrogate

Which common side effect associated with the use of a copper intrauterine device (IUD) would the nurse discuss with the client during a teaching session?

excessive menstrual flow

2 parts of placenta

fetal and maternal Placenta has 2 parts: Maternal & Fetal The maternal part is made up of the endometrium which develops into the decidua that separates the mother from fetal tissue The umbilical cord transports blood between the fetus & the placenta There is NOT mixing of maternal & fetal blood There are membranes contained in the placenta that keep the blood separated but allow transfer of nutrients & gases

The nurse would identify which period of pregnancy as the time frame during which functional disabilities in a fetus's brain occur via fetal exposure to a teratogenic agent?

fetal period

Which nutrient would the nurse instruct the client to increase while on oral contraceptives?

folic acid

Which preventive wellness recommendation will the nurse make to a male client who tests positive for the BRCA mutation after his mother and two sisters are found to carry the gene? Select all that apply. One, some, or all responses may be correct.

get a baseline mammogram at 40 get BSE training at 35 get a clinical breast exam every 6 months after 35

PID

inflammation of upper female genital tractCausative organismsChlamydia trachomatisNeisseria gonorrhoeaeScarring of fallopian tubes and infertility PELVIC INFLAMMATORY DISEASES signs and symptomsBilateral sharp, cramping pain in the lower quadrantsFever, chillsPurulent vaginal dischargeIrregular bleedingMalaise, nausea, andvomiting TreatmentOutpatientOral antibioticsInpatientI V fluidsPain medicationI V antibioticsSexual partner should also be treated

A pregnant client is treated with sertraline for depression. Which would the nurse infer about the medication's action?

it will affect both the client and the fetus

Which conclusion about the client's knowledge of condom use would the nurse draw during an acquired immunodeficiency syndrome (AIDS) education class when a client states, "Petroleum jelly works great when I use condoms"?

lack of knowledge related to correct condom application and use

Which is a neonatal effect of maternal smoking during pregnancy?

low birth weight

barrier methods

male condom - 86 % effective, correct placement (over erect penis ), low cost, protects STD , disadvantage- male must still withdraw, safest for woman, female condom- thin sheath that covers the vagina, cervix,, advantage- can be place up to 8 hours before intercourse, std protection, disadvantage - slip/tear, improper removal chemical barriers - 15 minutes to an hour before intercourse , advantage- inexpensive , no rx needed, safe , disadvantage- must use correctly , irritataion cervical caps- cup over cervix, filled with spermicide, 6-8 hours after intercourse, can be reused if washed with soap and water

Risk factors for breast cancer

mutation of BRCA 1 and BRCA 2 genes, mutation of chek-2 gene in women and men , provide emotional support and discharge teaching

The nurse teaches a pregnant client regarding the necessity for a folic acid supplement. Folic acid taken in the first trimester of pregnancy helps reduce the risk for which neonatal disorder?

neural tube defects

screenings

pap smear- form of cervical cytology testing , begin at age 21 or earlier if you are sexually active , exam of cells from cervix, does not test STD , no sex, douching , or hygeine products after PAP , mammography, STD, thyroid fx, colonoscopy, bone density , ultrasound

Emergency Contraceptives

plan B , high dose progestrone, ulipristal acetase , copper IUD, not an abortion because it happens in the prefertilization process, recieve counceling after regular contraceptive methods

A client at the women's health clinic tells the nurse that she has endometriosis. Which factors associated with endometriosis would the nurse anticipate the client will report? Select all that apply. One, some, or all responses may be correct.

rectal pressure, abdominal pain

why health maintenance

reduce incidence through prevention , reduce morbidity , and mortality through early recognition and intervention, identify risk factors

Which instruction would the nurse include when teaching about the correct use of a female condom?

remove the condom before standing up

Which teratogens affecting fetal growth and development would the nurse include in a teaching session for pregnant clients? Select all that apply. One, some, or all responses may be correct.

rubella,varciella, swordfish, phenytoin

Which information about the prenatal client's activities indicates to the nurse that there is a need for toxoplasmosis testing?

the client cares for the neighbors cat