Exam 1: NSG222/ NSG 222 (Latest 2024/ 2025 Update) Family Nursing | Review with Questions and Verified Answers| 100% Correct| Grade A- Herzing
Exam 1: NSG222/ NSG 222 (Latest 2024/
2025 Update) Family Nursing | Review with
Questions and Verified Answers| 100%
Correct| Grade A- Herzing
Q: Barrier Methods of Contraception
Answer:
Condom
Cervical Cap
Sponge
Diaphragm
Q: Diaphragm Contraceptive Method
Answer:
The diaphragm is a soft latex dome surrounded by a metal spring. Used in conjunction with a
spermicidal jelly or cream, it is inserted into the vagina to cover the cervix. The diaphragm may
be inserted up to 2 hours before intercourse and must be left in place for at least 6 hours
afterward. Diaphragms are available in a range of sizes and styles. The diaphragm is available
only by prescription and must be professionally fitted by a health care provider.
Q: Cervical Cap Contraceptive Method
Answer:
The cervical cap is smaller than the diaphragm and covers only the cervix; it is held in place by
suction. Caps are made from silicone or latex and are used with spermicide. The cap may be
inserted up to 36 hours before intercourse and provides protection for 48 hours. The cap must be
kept in the vagina for 6 hours after the final act of intercourse and should be replaced every year
of use.
Q: Sponge Contraceptive Method
Answer:
The contraceptive sponge is a nonhormonal, nonprescription device that includes both a barrier
and a spermicide. It is a soft concave device that prevents pregnancy by covering the cervix and
releasing spermicide. Unlike the diaphragm, the sponge can be used for more than one coital act
within 24 hours without the insertion of additional spermicide, and it does not require fitting or a
prescription from a health care provider.
To use the sponge, the woman first wets it with water, squeezes it until it is thoroughly wet and
foamy, and then inserts it into the vagina with a finger, using a cord loop attachment. It can be
inserted up to 24 hours before intercourse and should be left in place for at least 6 hours
following intercourse. The sponge provides protection for up to 12 hours, but should not be left
in for more than 30 hours after insertion to avoid the risk of TSS
Q: Medical Abortion
Answer:
Medical abortions are achieved through administration of medication either vaginally or orally.
The administration of medication occurs in the clinic or doctor’s office, may require more than
one office visit, and costs between $500 and $800.
Q: Two Drugs used in Medical Abortion
Answer:
The most common regimen in the United States involves the use of two different medications,
mifepristone and misoprostol. Mifepristone blocks progesterone, which is essential to the
development of pregnancy. Misoprostol, taken 24 to 48 hours later, works to empty the uterus by
causing cramping and bleeding. A follow-up visit is scheduled later to confirm the pregnancy
was terminated via ultrasound or blood test
Q: SAVE Model
Answer:
S:
Screen all of your clients for violence by asking: Within the last year have you been physically
hurt by someone? Do you feel you are in control of your life? Within the last year, has anyone
forced you to engage in sexual activities? Can you take about your abuse with me? How is your
present relationship?
A:
Ask direct questions in a nonjudgmental way: Normalize the topic with women, make eye
contact, stay calm, never blame the woman, do not dismiss anything she tells you, do not use
formal technical language, and be direct.
V:
Validate the client by telling her believe her story, you do not blame her, it is brave of her to tell
you, and there is help for her.
E:
Evaluate, Educate, and refer client by asking: what type of violence? Is she is danger right now?
How is she feeling? Does she know that there are consequences to violence? Is she aware of her
resources?
Q: Urge Incontinence: Definition, Symptoms, and Cause
Answer:
Urge Incontinence: Precipitous loss of urine preceded by a strong urge to void with increased
bladder pressure and detrusor contraction. Urgency, frequency, nocturia, and large amount of
urine loss. Causes: neurologic, idiopathic, or infectious
Q: Stress Incontinence: Definition, Symptoms, and Cause
Answer:
Stress Incontinence: Accidental leakage of urine that occurs with increased pressure on the
bladder from coughing, sneezing, laughing, or physical excretion. Involuntary loss of a small
amount of urine in response to physical activity that raises intra-abdominal pressure. Causes:
Develops commonly in women in their 40s and 50s usually as a result of weakened muscles and
ligaments in pelvis following child birth.
Q: Steps to Prevent Vaginitis
Answer:
Avoid douching to prevent altering the vaginal environment.
Use condoms to avoid spreading the organism.
Avoid tights, nylon underpants, and tight clothes.
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Dysmenorrhea Definition Dysmenorrhea refers to painful menstruation and is a common problem in adolescence
Primary Dysmenorrhea & Cause Primary dysmenorrhea refers to painful menstrual bleedings in the absence of any detectable underlying pathology. It is caused by increased prostaglandin production by the endometrium in an ovulatory cycle. This hormone causes contraction of the uterus, and levels tend to be higher in women with severe menstrual pain than women who experience mild or no menstrual pain. Dysmenorrhea is caused by an excess of prostaglandin production. These levels are highest during the first two days of menses, when symptoms peak
Secondary Dysnmenorrhea & Cause Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. It may be caused by endometriosis, adenomyosis, fibroids, pelvic infection, an intrauterine system (IUS), cervical stenosis, or congenital uterine or vaginal abnormalities.
Therapeutic Management of Infertility As noted earlier, the main causes of infertility are female-factor (e.g., anovulation, tubal damage, endometriosis, ovarian failure), male-factor (e.g., low or absent numbers of motile sperm in the ejaculate, erectile dysfunction), or unexplained. The test results are presented to the couple and different treatment options are suggested. The majority of infertility cases are treated with drugs or surgery.Treatment options include lifestyle changes, such as weight loss and smoking cessation; taking clomiphene to promote ovulation; hormone injections to promote ovulation; intrauterine insemination; and IVF. Various ovulation-enhancement drugs and timed intercourse might be used for the woman with ovulation problems. The woman should understand a drug’s benefits and side effects before consenting to take it. Depending on the type of drug used and the dosage, some women may experience multiple pregnancies. If the woman’s reproductive organs are damaged, surgery can be done to repair them
Barrier Methods of Contraception CondomCervical CapSponge Diaphragm
Diaphragm Contraceptive Method The diaphragm is a soft latex dome surrounded by a metal spring. Used in conjunction with a spermicidal jelly or cream, it is inserted into the vagina to cover the cervix. The diaphragm may be inserted up to 2 hours before intercourse and must be left in place for at least 6 hours afterward. Diaphragms are available in a range of sizes and styles. The diaphragm is available only by prescription and must be professionally fitted by a health care provider.
Cervical Cap Contraceptive Method The cervical cap is smaller than the diaphragm and covers only the cervix; it is held in place by suction. Caps are made from silicone or latex and are used with spermicide. The cap may be inserted up to 36 hours before intercourse and provides protection for 48 hours. The cap must be kept in the vagina for 6 hours after the final act of intercourse and should be replaced every year of use.
Sponge Contraceptive Method The contraceptive sponge is a nonhormonal, nonprescription device that includes both a barrier and a spermicide. It is a soft concave device that prevents pregnancy by covering the cervix and releasing spermicide. Unlike the diaphragm, the sponge can be used for more than one coital act within 24 hours without the insertion of additional spermicide, and it does not require fitting or a prescription from a health care provider.To use the sponge, the woman first wets it with water, squeezes it until it is thoroughly wet and foamy, and then inserts it into the vagina with a finger, using a cord loop attachment. It can be inserted up to 24 hours before intercourse and should be left in place for at least 6 hours following intercourse. The sponge provides protection for up to 12 hours, but should not be left in for more than 30 hours after insertion to avoid the risk of TSS
Medical Abortion Medical abortions are achieved through administration of medication either vaginally or orally. The administration of medication occurs in the clinic or doctor’s office, may require more than one office visit, and costs between $500 and $800.
Two Drugs used in Medical Abortion The most common regimen in the United States involves the use of two different medications, mifepristone and misoprostol. Mifepristone blocks progesterone, which is essential to the development of pregnancy. Misoprostol, taken 24 to 48 hours later, works to empty the uterus by causing cramping and bleeding. A follow-up visit is scheduled later to confirm the pregnancy was terminated via ultrasound or blood test
SAVE Model S: Screen all of your clients for violence by asking: Within the last year have you been physically hurt by someone? Do you feel you are in control of your life? Within the last year, has anyone forced you to engage in sexual activities? Can you take about your abuse with me? How is your present relationship?A:Ask direct questions in a nonjudgmental way: Normalize the topic with women, make eye contact, stay calm, never blame the woman, do not dismiss anything she tells you, do not use formal technical language, and be direct.V:Validate the client by telling her believe her story, you do not blame her, it is brave of her to tell you, and there is help for her.E:Evaluate, Educate, and refer client by asking: what type of violence? Is she is danger right now? How is she feeling? Does she know that there are consequences to violence? Is she aware of her resources?
Urge Incontinence: Definition, Symptoms, and Cause Urge Incontinence: Precipitous loss of urine preceded by a strong urge to void with increased bladder pressure and detrusor contraction. Urgency, frequency, nocturia, and large amount of urine loss. Causes: neurologic, idiopathic, or infectious
Stress Incontinence: Definition, Symptoms, and Cause Stress Incontinence: Accidental leakage of urine that occurs with increased pressure on the bladder from coughing, sneezing, laughing, or physical excretion. Involuntary loss of a small amount of urine in response to physical activity that raises intra-abdominal pressure. Causes: Develops commonly in women in their 40s and 50s usually as a result of weakened muscles and ligaments in pelvis following child birth.
Steps to Prevent Vaginitis Avoid douching to prevent altering the vaginal environment.Use condoms to avoid spreading the organism.Avoid tights, nylon underpants, and tight clothes.Wipe from front to back after using the toilet.Avoid powders, bubble baths, and perfumed vaginal sprays.Wear clean cotton underpants.Change out of wet bathing suits as soon as possible.Become familiar with the signs and symptoms of vaginitis.Choose to lead a healthy lifestyle.
Common Symptoms of Menopause Hot flashes or flushes of the head and neckDryness in the eyes and vaginaPersonality changesAnxiety and/or depressionLoss of libidoDecreased lubricationWeight gain and water retentionNight sweatsAtrophic changes—loss of elasticity of vaginal tissuesFatigueIrritabilityPoor self-esteemInsomniaStress incontinenceHeart palpitations
Menopause Effects of Brain & CNS Brain and central nervous system: hot flashes, disturbed sleep, mood, and memory problems
Menopause Effects on Cardio Cardiovascular: lower levels of high-density lipoprotein (HDL) and increased risk of CVD
Menopause Effects on Skeletal Skeletal: rapid loss of bone density that increases the risk of osteoporosis
Menopause Effects on Breasts Breasts: replacement of duct and glandular tissues by fat
Menopause Effects on Genitourinary Genitourinary: vaginal dryness, stress incontinence, cystitis
Menopause Effects on Gastrointestinal Gastrointestinal: less absorption of calcium from food, increasing the risk for fractures
Menopause Effects on Integumenrary Integumentary: dry, thin skin and decreased collagen levels
Menopause Effects on Body Shape Body shape: more abdominal fat; waist size that swells relative to hips
Presumptive Sypmtoms of Pregnancy Definition Presumptive signs are those signs that the mother can perceive
Presumptive Sypmtoms of Pregnancy: Symptoms Fatigue (12 wks)Breast Tenderness (3-4 wks)Nausea & Vomiting (4-14 wks)Amenorrhea (4 wks)Urinary Frequency (6-12 wks)Hyperpigmentation of Skin (16 wks)Fetal movements (16-29 wks)Uterine Enlargement (7-12 wks)Breast Enlargement (6 wks)
Probable Symptoms of Pregnancy Definition Probable signs of pregnancy are those that can be detected on physical examination by a health care provider
Probable Symptoms of Pregnancy: Symptoms Braxton Hicks Contractions (16-28 wks)Positive Test (4-12 wks)Abdominal Enlargement (14 wks)Ballottement (the examiner pushes against the woman’s cervix during a pelvic examination and feels a rebound from the floating fetus) (16-28 wks)Goodells Signs (softening of the cervix ) (5 wks)Chadwick’s Sign (a bluish-purple coloration of the vaginal mucosa and cervix ) (6-8 wks)Hegar’s Signs (softening of the lower uterine segment or isthmus ) (6-12 wks)
Positive Symptoms of Pregnancy: Definition The positive signs of pregnancy confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy a certainty.
Positive Symptoms of Pregnancy: Symptoms Ultrasound Verification (4-6 wks)Fetal Movement by Clinician (20 wks)Auscultation of Fetal Heart with Doppler (10-12 wks)
Those who may benefit from genetic counseling Maternal age 35 years or older when the baby is bornPaternal age 50 years or olderPrevious child, parents, or close relatives with an inherited disease, congenital anomalies, metabolic disorders, developmental disorders, or chromosomal abnormalitiesConsanguinity or incestPregnancy screening abnormality, including alpha-fetoprotein, triple/quadruple screen, amniocentesis, or ultrasoundStillborn with congenital anomaliesTwo or more pregnancy lossesExposure to drugs, medications, radiation, chemicals, or infectionTeratogen exposure or riskConcerns about genetic defects that occur frequently in their ethnic or racial group (e.g., those of African descent are most at risk for having a child with sickle cell anemia)Abnormal newborn screeningCouples with a family history of X-linked disordersCarriers of autosomal recessive or dominant diseasesChild born with one or more major malformations in a major organ systemChild with abnormalities of growthChild with developmental delay, intellectual disability, blindness, or deafness
How does female body adapt to baby? Reproductive system adaptations: The growing uterus in the abdomen leads to…..Liver pushed upStomach CompressedBladder CompressedThe uterus remains in the pelvic cavity for the first 3 months of pregnancy, after which it progressively ascends into the abdomen
Supine Hypotensive Syndrome: the heavy gravid uterus in the last trimester can fall back against the inferior vena cava in the supine position, resulting in vena cava compression, which reduces venous return and decreases cardiac output and blood pressure, increasing orthostatic stress. This occurs when the woman changes her position from recumbent to sitting to standing. This acute hemodynamic change, termed supine hypotensive syndrome, causes the woman to experience symptoms of weakness, light-headedness, nausea, dizziness, or syncope
Common Laboratory Tests Done for Pregnancy Complete Blood CountBlood Typing: Determines women’s blood type and Rh status to rule out any blood incompatibility issues early.Rubella Titer: Detects antibodies for the virus that causes German measlesHepatitis B: Determines if the mother has hepatitis B by detecting antibodies in her bloodHIV Testing: Detects HIV antibodies and if positive requires more specific testing, counseling, and treatment during pregnancy with antiretroviral medications to prevent transmission to fetus.STI Screening: Detects STIs so that treatment can be initiated early to prevent transmission to fetusCervical Smears: detects abnormalities such as cervical cancer or infections such as gonorrhea, chlamydia, or GBS
11 Steps to Measure Fetal Heart Rate Measuring Fetal Heart RatePurpose: To assess fetal well-being 1. Assist the woman onto the examining table and have her lie down.2. Cover her with a sheet to ensure privacy, and then expose her abdomen.3. Palpate the abdomen to determine the fetal lie, position, and presentation.4. Locate the back of the fetus (the ideal position to hear the heart rate).5. Apply lubricant gel to abdomen in the area where the back has been located.6. Turn on the handheld Doppler device and place it on the spot over the fetal back.7. Listen for the sound of the amplified heart rate, moving the device slightly from side to side as necessary to obtain the loudest sound. Assess the woman’s pulse rate and compare it to the amplified sound. If the rates appear the same, reposition the Doppler device.8. Once the fetal heart rate has been identified, count the number of beats in 1 minute and record the results.9. Remove the Doppler device and wipe off any remaining gel from the woman’s abdomen and the device.10. Record the heart rate on the woman’s medical record; normal range is 110 to 160 bpm.11. Provide information to the woman regarding fetal well-being based on findings.
BPP Definition A biophysical profile (BPP) uses a real-time ultrasound and NST to allow assessment of various parameters of fetal well-being that are sensitive to hypoxia. A BPP includes ultrasound monitoring of fetal movements, fetal tone, and fetal breathing as well as ultrasound assessment of amniotic fluid volume with or without assessment of the fetal heart rate.
How is BPP Scored? The BPP is a scored test with five components, each worth 2 points if present. A total score of 10 is possible if the NST is used. Thirty minutes are allotted for testing, though less than 10 minutes is usually needed. The following criteria must be met to obtain a score of 2; anything less is scored as 0 1. Body movements: three or more discrete limb or trunk movements2. Fetal tone: one or more instances of full extension and flexion of a limb or trunk3. Fetal breathing: one or more fetal breathing movements of more than 30 seconds.4. Amniotic fluid volume: one or more pockets of fluid measuring 2 cm5. NST: normal NST = 2 points; abnormal NST = 0 points
Interpretation of BPP Score Interpretation of the BPP score can be complicated, depending on several fetal and maternal variables. Because it is indicated as a result of a nonreassuring finding from previous fetal surveillance tests, this test can be used to quantify the interpretation, and intervention can be initiated if appropriate. A maximum score of 10 can be achieved and the test is complete once all of the variables have been observed. Overall, a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate. A score of 6 or below is suspicious, possibly indicating a compromised fetus; further investigation of fetal well-being is needed.
First Prenatal Appointment Focuses on What 3 Areas? The initial health history typically includes questions about three major areas: the reason for seeking care; the client’s past medical, surgical, and personal history, including that of the family and her partner; and the client’s reproductive history.
What is done in the first prenatal appointment? A comprehensive health history is obtained, including age, menstrual history, prior obstetric history, past medical and surgical history, psychological screening, family history, genetic screening, dietary habits, lifestyle and health practices, medication or drug use, and history of exposure to STIs
1st Prenatal Visit: Reason for Seeking Care Ask the woman for the date of her last normal menstrual period (LMP). Also ask about any presumptive or probable signs of pregnancy that she might be experiencing. Typically, a urine or blood test to check for evidence of human chorionic gonadotropin (hCG) is done to confirm the pregnancy.
1st Prenatal Visit: Past History Ask about the woman’s past medical and surgical history. This information is important because conditions that the woman experienced in the past (e.g., urinary tract infections) may recur or be exacerbated during pregnancy. Also, chronic illnesses, such as diabetes or heart disease, can increase the risk for complications during pregnancy for the woman and her fetus. Ask about any history of allergies to medications, foods, or environmental substances. Ask about any mental health problems, such as depression or anxiety. Gather similar information about the woman’s family and her partner
1st Prenatal Visit: Reproductive History The woman’s reproductive history includes a menstrual, obstetric, and gynecologic history. Typically, this history begins with a description of the woman’s menstrual cycle, including her age at menarche, number of days in her cycle, typical flow characteristics, and any discomfort experienced. The use of contraception is also important, including when the woman last used it
Maternal Weight Gain During the first trimester, for women whose pre-pregnancy weight is within the normal weight range, weight gain should be about 3.5 to 5 lb. For underweight women, weight gain should be at least 5 lb. For overweight women, weight gain should be about 2 lb. Much of the weight gained during the first trimester is caused by growth of the uterus and expansion of the blood volume.During the second and third trimesters, the following pattern is recommended: For women whose prepregnancy weight is within the normal weight range, weight gain should be about 1 lb per week. For underweight women, weight gain should be slightly more than 1 lb per week. For overweight women, weight gain should be about 2/3 lb per week
Pregnancy & Sexuality Sexuality is an important part of health and well-being. Sexual behavior modifies as pregnancy progresses, influenced by biologic, psychological, and social factors. The way a pregnant woman feels and experiences her body during pregnancy can affect her sexuality. Giving permission to talk about and then normalizing sexuality can help enhance the sexual experience during pregnancy and ultimately the couple’s relationship. If avenues of communication are open regarding sexuality during pregnancy, any fears and myths the couple may have can be dispelled.
Multifactorial Inheritance Disorders Many of the common congenital malformations, such as cleft lip, cleft palate, spina bifida, pyloric stenosis, clubfoot, congenital hip dysplasia, and cardiac defects, are attributed to multifactorial inheritance. These conditions are thought to be caused by multiple gene and environmental factors. That is, a combination of genes from both parents, along with unknown environmental factors, produces the trait or condition.
Therapeutic Management of Chlamydia Antibiotics are the only treatment currently available, however, with high rates of reinfection, there is mounting pressure to develop Chlamydia vaccines. Antibiotics are usually used in treating this STI. The CDC treatment options for chlamydia include doxycycline 100 mg orally twice a day for 7 days or azithromycin 1 g orally in a single dose. Additional CDC guidelines for client management include annual screening of all sexually active women; screening of all high-risk people; and treatment with antibiotics effective against both gonorrhea and chlamydia for anyone diagnosed with a gonococcal infection
Risk Factors of Chlamydia Assess the health history for significant risk factors for chlamydia, which may include:Being an adolescentHaving multiple sex partnersHaving a new sex partnerEngaging in sex without using a barrier contraceptive (condom)Using oral contraceptivesBeing pregnantHaving a history of another STI
Symptoms of Chlamydia The majority of women (70% to 80%) are asymptomatic. If the client is symptomatic, clinical manifestations include:Mucopurulent vaginal dischargeUrethritisBartholinitisEndometritisSalpingitisDysfunctional uterine bleedingThe diagnosis can be made by urine testing or swab specimens collected from the endocervix or vagina.
STI Nursing Management Nurses working with adolescents need to convey their willingness to discuss sexual habits. Provide effective guidance that promotes sexual health so that primary and/or repeat infections can be avoidedEncourage the client to complete the antibiotic prescription (specific management for each type of STI is discussed further in the chapter).Identify risk factors and risk behaviors and guide the adolescent to develop specific individualized actions of prevention. The nurse’s interaction and conversation with the adolescent needs to be direct and nonjudgmental.Encourage adolescents to postpone initiation of sexual intercourse for as long as possible, but if they choose to have sexual intercourse, explain the necessity of using barrier methods, such as male and female condoms. For teens who have already had sexual intercourse, the clinician can encourage abstinence at this point. If adolescents are sexually active, they should be directed to teen clinics where contraceptive options can be explainedEncourage adolescents to minimize their lifetime number of sexual partners, to use barrier methods consistently and correctly, and to be aware of the connection between drug and alcohol use and the incorrect use of barrier methods.
Nursing Assessment Primary HSV Episode The first or primary episode is usually the most severe, with a prolonged period of viral shedding. Primary HSV is a systemic disease characterized by multiple painful vesicular lesions, mucopurulent discharge, superinfection with candida, fever, chills, malaise, dysuria, headache, genital irritation, inguinal tenderness, and lymphadenopathy. The lesions in the primary herpes episode are frequently located on the vulva, vagina, and perineal areas. The vesicles will open and weep and finally crust over, dry, and disappear without scar formation. This viral shedding process usually takes up to 2 weeks to complete.
Nursing Assessment Recurrent HSV Infection episodes are usually much milder and shorter in duration than the primary one. Tingling, itching, pain, unilateral genital lesions, and a more rapid resolution of lesions are characteristics of recurrent infections. Recurrent herpes is a localized disease characterized by typical HSV lesions at the site of initial viral entry. Recurrent herpes lesions are fewer in number and less painful and resolve more rapidly
HSV Diagnosis Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicle. Papanicolaou (Pap) smears are an insensitive and nonspecific diagnostic test for HSV and should not be relied on for diagnosis
HPV Therapeutic Management: Vaccines & Goal of Treatment There is currently no medical treatment or cure for HPV. Instead, therapeutic management focuses heavily on prevention through the use of the HPV vaccine and education and on the treatment of lesions and warts caused by HPVThe CDC recommends that children start receiving two doses of the HPV vaccine around 11 or 12 years old. Two doses are needed for those vaccinated before 15; while three are recommended for older people.The goal of treating genital warts is to remove the warts and induce wart-free periods for the client. Treatment of genital warts should be guided by the preference of the client and available resources. No single treatment has been found to be ideal for all clients, and most treatment modalities appear to have comparable efficacy. Because genital warts can proliferate and become friable during pregnancy, they should be removed using a local agent. A cesarean birth is not indicated solely to prevent transmission of HPV infection to the newborn, unless the pelvic outlet is obstructed by warts
Mastitis Assessment Assess the client’s health history for risk factors for mastitis, which includes poor hand hygiene ductal abnormalities, nipple cracks and fissures, lowered maternal defenses due to fatigue, tight clothing, poor support of pendulous breasts, failure to empty the breasts properly while breastfeeding, or missing breast-feedings.The diagnosis of mastitis is made clinically on the basis of a localized, unilateral area of erythema with associated fever. Assess the client for clinical manifestations of mastitis, which include flu-like symptoms of malaise, nausea, headache, leukocytosis, fever, fatigue, and chills. Physical examination of the breasts reveals increased warmth, swollen area of one breast, redness, tenderness, and swelling. The nipple is usually cracked or abraded and the breast is distended with milkUltrasound scans can be undertaken to differentiate between the types of mastitis or abscesses, but typically the diagnosis is made based on history and examination.
Non-Modifiable Risk Factors for Breast Cancer Gender (female)Aging (older than 50 years old)Genetic mutations (BRCA1 and BRCA2 genes)Personal history of ovarian or colon cancerIncreased breast density increases the risk three- to fivefoldFamily history of breast cancerPersonal history of breast cancer (three- to fourfold increase in risk for recurrence)Race/ethnicity (higher in White women, though African American women are more likely to die of breast cancer)Previous abnormal breast biopsy (atypical hyperplasia)Exposure to chest radiation (radiation damages DNA)Previous breast radiation (12 times normal risk)Early menarche (younger than 12 years old) or late onset of menopause (older than 55 years old), which represents increased estrogen exposure over the lifetime
Modifiable Risk Factors for Breast Cancer Not having children at all or not having children until after age 30; this increases the risk of breast cancer by not reducing the number of menstrual cyclesPostmenopausal use of estrogens and progestins; the Women’s Health Initiative study reported increased risks with long-term (longer than 5 years) use of HRTFailing to breast-feed for up to a year after pregnancy; increases the risk of breast cancer because it does not reduce the total number of lifetime menstrual cyclesAlcohol consumption; boosts the level of estrogen in the bloodstreamSmoking; exposure to carcinogenic agents found in cigarettesObesity and consumption of high-fat diet; fat cells produce and store estrogen, so more fat cells create higher estrogen levelsSedentary lifestyle and lack of physical exercise; increases body fat, which houses estrogen
Hysterectomy A hysterectomy is the surgical removal of the uterus. It is the most effective treatment for symptomatic fibroids with no recurrence.Fibroids are the most common indication for hysterectomy in the United States. The peak incidence occurs around age 45, and they are three times more prevalent in African American women than in White women
PCOS Therapeutic Management Diagnosis is based on the presence of at least two of the following criteria: hyperandrogenism (evidenced by testosterone excess, hirsutism); ovarian dysfunction (anovulation); and the detection of specific polycystic ovarian morphology. Treatment is centered on the clinical manifestations and should be initiated early to prevent or limit long-term complications such as metabolic syndrome, diabetes, endometrial carcinoma, and infertility. Oral contraceptives, antidiabetic agents, and statins are some of the common therapies used to address the symptoms of this complex hormonal condition. Weight loss and surgery may also be beneficial as nondrug options. Oral contraceptives are often prescribed to suppress gonadotropin levels, which may help resolve the cysts. Pain medication is also prescribed if needed.Medical management of PCOS is aimed at the treatment of metabolic derangements, anovulation, hirsutism, and menstrual irregularity. This includes both drug and nondrug therapy, along with lifestyle modifications.
Providing Emotional Support for Cancer of Reproductive Tract Once the diagnosis is made, provide the woman and her family with emotional support. Validate the client’s feelings and provide realistic hope, using a nonjudgmental approach and therapeutic communication skills during all interactions. Nurses can be invaluable when assisting women who are coping with the uncertainty of their future by providing positive communication and support. Nurses need to focus on the physical, psychosocial, and economic concerns, from diagnosis through treatment and, if applicable, until the end of life, for all of the women for whom they care
Providing Patient Education for Ovarian Cancer This teaching involves risk reduction and health promotion. Teach the woman about risk reduction strategies; for instance, pregnancy, use of oral contraceptives, and breastfeeding reduce the risk of ovarian cancer. Instruct women to avoid using talc and hygiene sprays on their genitals. Review the lifetime risks related to BRCA1 and BRCA2 genes and options available should the woman test positive for these genes. Help promote community awareness of ovarian cancer by educating the public about risk-reducing behaviors.Instruct the woman about the importance of healthy lifestyles. Stress the importance of maintaining a healthy weight to reduce risk. Encourage women to eat a low-fat diet. Factors associated with a reduced risk of ovarian cancer include the use of oral contraceptives for 3 years or longer, maintaining a healthy weight range, pregnancy and breastfeeding before the age of 30, bilateral tubal ligation, and removal of the ovariesFor the woman who is diagnosed with ovarian cancer, describe in simple terms the tests, treatment modalities, and follow-up needed
Nursing Assessment Endometrial Cancer Obtain a thorough history from the woman, ascertaining her primary complaint. Most commonly, the major initial symptom of endometrial cancer is abnormal and painless vaginal bleeding. Obtain a menstrual history and inquire if the woman is taking any hormones. Also ascertain if she has a personal or family history of breast, ovarian, or colon cancerAssess the woman for additional manifestations, such as dyspareunia, low back pain, purulent genital discharge, dysuria, pelvic pain, weight loss, and a change in bladder and bowel habits. These may suggest advanced disease.Perform a physical examination or assist with a pelvic examination as appropriate. Observe for vaginal discharge. Note any changes in the size, shape, or consistency of the uterus or surrounding structures or client reports of pain during examination. Anticipate the need for transvaginal ultrasound to identify endometrial hyperplasia (usually greater than 4 mm) and endometrial biopsy if needed to identify malignant cells.
Nursing Management of Cervical Caner The nurse’s role involves primary prevention by educating women about risk factors and ways to prevent cervical dysplasiaNurses also can advocate for clients by making sure that the Pap smear is sent to an accredited laboratory for interpretation. Doing so reduces the risk of false-negative results. The identification and treatment of early precancerous lesions is critical to prevention of cervical cancer. Prevention measures should include educating women that the risk of infection can be reduced by delaying the onset of sexual activity, decreasing the number of sexual partners, using condoms consistently, receiving the HPV vaccine, and never smoking.
Vulvar Cancer Nursing Assessment Begin the history and physical examination by reviewing for risk factors. Although direct risk factors for the initial development of vaginal cancer have not been identified, associated risk factors include advancing age (over 60 years old), previous pelvic radiation, exposure to diethylstilbestrol (DES) in utero, vaginal trauma, history of genital warts (HPV infection), HIV infection, cervical cancer, chronic vaginal discharge, vaginal adenosis, consuming alcohol, long-term use of vaginal pessaries causing chronic irritation, smoking, and low socioeconomic levelQuestion the woman about any symptoms. Most women with vaginal cancer are asymptomatic. Those with symptoms have painless vaginal bleeding (often after sexual intercourse), abnormal vaginal discharge, dyspareunia, dysuria, constipation, a mass in the vaginal wall that can be palpated, and pelvic pain. During the physical examination, observe for any obvious vaginal discharge or genital warts or changes in the appearance of the vaginal mucosa. Anticipate colposcopy with biopsy of suspicious lesions to confirm the diagnosis.
Cycle of Violence Phase 1 “Tension building: Verbal or minor physical abuse occurs. Almost any subject, such as housekeeping or money, may trigger the buildup of tension. There is a breakdown of communication. The victim attempts to calm the abuser. Victim feels like “”walking on egg shells”” around the abuser.”
Cycle of Violence Phase 2 Physically abusive phase: Characterized by uncontrollable discharge of tension. Violence is rarely triggered by the victim’s behavior; she is physically abused no matter what her response. The start of the episode is unpredictable and beyond the victim’s control.
Cycle of Violence Phase 3 Honeymoon (reconciliation)/calm phase: First, the abuser is ashamed of the behavior. The abuser tries to minimize the abuse and blame it on the partner. The abuser becomes loving, kind, and apologetic and expresses guilt. Then the abuser works on making the victim feel responsible. This loving behavior strengthens the bond between partners and will probably convince the victim, once again, that leaving the relationship is not necessary.
Prevention of Pelvic Inflammatory Disease Advise sexually active girls and women to insist their partners use condoms.Discourage routine vaginal douching, as this may lead to bacterial overgrowth.Encourage regular STI screening.Emphasize the importance of having each sexual partner receive antibiotic treatment.
Nursing Management of PID If the woman with PID is hospitalized, maintain hydration via intravenous fluids, if necessary and administer analgesics as needed for pain. Semi-Fowler positioning facilitates pelvic drainage. A key element to treatment of PID is education to prevent recurrence.Sexual counseling should include practicing safer sex, limiting the number of sexual partners, using barrier contraceptives consistently, avoiding vaginal douching, considering another contraceptive method if she has an intrauterine system (IUS) and has multiple sexual partners, and completing the course of antibiotics prescribed.
Breast Cancer Immediate Postoperative Care Assess the client’s respiratory status by auscultating the lungs and observing the breathing pattern. Assess circulation; note vital signs, skin color, and skin temperature. Observe the client’s neurologic status by evaluating the level of alertness and orientation. Monitor the wound for amount and color of drainage. Monitor the intravenous lines for patency, correct fluid, and rate. Assess the drainage tube for amount, color, and consistency of drainage.Pain ManagementElevate affected arm to promote lymph drainageWound careMobility ROMAssist with turning, coughing, and deep breathing every 2 hours. Explain that this helps to expand collapsed alveoli in the lungs, promotes faster clearance of inhalation agents from the body, and prevents postoperative pneumonia and atelectasis.
Embryonic Stage & Amniotic Fluid The embryonic stage of development begins at day 15 after conception and continues through week 8. Basic structures of all major body organs and the main external features are completed during this time period Amniotic fluid surrounds the embryo and increases in volume as the pregnancy progresses, reaching approximately 1 L at term. Amniotic fluid is derived from two sources: fluid transported from the maternal blood across the amnion and fetal urine. Its volume changes constantly as the fetus swallows and voids.
Too much or too little anmiotic fluid The volume of amniotic fluid is important in determining fetal well-being. It gradually fluctuates throughout the pregnancy. Alterations in amniotic fluid volume can be associated with problems in the fetus.Too little amniotic fluid (<500 mL at term), termed oligohydramnios, is associated with uteroplacental insufficiency, fetal renal abnormalities, and a higher risk of surgical births and low-birth-weight infants.Too much amniotic fluid (>2,000 mL at term), termed hydramnios, is associated with maternal diabetes, neural tube defects, chromosomal deviations, and malformations of the central nervous system and/or gastrointestinal tract that prevent normal swallowing of amniotic fluid by the fetus. Hydramnios may threaten premature rupture of membranes due to uterine over distention.
Nursing Management of Rape Victims Nursing care of the rape survivor should focus on providing supportive care, collecting and documenting evidence, assessing for STIs, preventing pregnancy, and assessing for PTSD. Once initial treatment and evidence collection have been completed, follow-up care should include counseling, medical treatment, and crisis intervention. There is mounting evidence that early intervention and immediate counseling can accelerate a rape survivor’s recovery. Early intervention means implementation in the initial hours, days, or weeks after the traumatic event
Human Trafficking The United Nations defines human trafficking as the recruitment, transportation, transfer, harboring, or receipt of persons by means of the threat or use of force, abduction, fraud, or deception to achieve the consent of a person having control over another person for the purpose of exploitationVictims of human trafficking are exposed to serious and numerous health risks such as rape; physical injury such as cigarette burns, fractures, and bruises; tuberculosis; pregnancy; torture; HIV/AIDS; STIs; cervical cancer; violence; hazardous work environments; malnourishment; and drug and alcohol addiction
Cardiovascular Changes in Pregnancy Cardiovascular changes occur early during pregnancy to meet the demands of the enlarging uterus and the placenta for more blood and more oxygen. The changes include an increase in heart rate (25%); an increase in cardiac output by 30% to 50% and peaks at 25 to 30 weeks’ gestation; reduced total peripheral resistance; increased blood volume; and increased plasma volume, which leads to physiologic anemia.
Blood Volume Changes in Pregnancy Blood volume increases by approximately 1,500 mL, or up to 50% above nonpregnant levels, by the 32nd week of gestation and remains more or less constant thereafter
Blood Pressure Changes in Pregnancy Blood pressure, especially the diastolic pressure, declines slightly during pregnancy as a result of peripheral vasodilation caused by progesterone. It usually reaches a low point mid-pregnancy and thereafter increases to prepregnancy levels until term.
RBC Changes in Pregnancy The number of RBCs also increases throughout pregnancy to a level that is 20% to 30% higher than nonpregnant values, depending on the amount of iron available. This increase is necessary to transport the additional oxygen required during pregnancy.In pregnancy, because the plasma increase exceeds the increase of red blood cell production, normal hemoglobin and hematocrit values decrease. This state of hemodilution is referred to as physiological anemia of pregnancy
Integumentary Changes in Pregnancy There are a variety of integumentary changes that are associated with pregnancy including changes in pigment, vascular supply, connective skin tissue, hair growth, nail structure, and gland functions. Increased activity of the maternal adrenal and pituitary glands, along with a contribution for the developing fetal endocrine glands, increasing cortisone levels, accelerated metabolism, and enhanced production of progesterone and estrogenic hormones, are responsible for most skin changes in pregnancyThe skin of pregnant women undergoes hyperpigmentation primarily resulting from estrogen, progesterone, and melanocyte-stimulating hormone levels. These changes are mainly seen on the nipples, areola, umbilicus, perineum, and axilla. Although many integumentary changes disappear after giving birth, some only fade. Many pregnant women express concern about stretch marks, skin color changes, and hair loss.The skin in the middle of the abdomen may develop a pigmented line called the linea nigra, which extends from the umbilicus to the pubic area
T/F Recurrent infection episodes of herpes simplex virus are usually less severe and prolonged than the initial episode True The primary episode of herpes simplex is usually the most severe and uncomfortable that ones to follow. They tend to last longer as well.
Which infection is characterized by a vaginal discharge that has a stale fish odor? Bacterial Vaginosis Also known as BV. BV has a vaginal PH >4.5, a greyish-white vaginal discharge and a fishy like odor.Normal vaginal PH is 3.8-4.5PH with vaginal yeast infection is > 4.5
When assessing a women for premenstrual syndrome, which of the following would the nurse be least likely to find? Weight Loss Most women tend to report weight gain, bloating and water retention with PMS.
T/F Endometriosis is the most common cause of secondary dysmenorrhea True The extra growth of endometrial tissue in the body can cause pain with menstrual cycles.
T/F Primary amenorrhea occurs in women who have previously menstruated regularly FalsePrimary amenorrhea is the absence of menses by age 14 with the absence of secondary sexual characteristics, or absence of menses by age 16 with normal development of secondary sex characteristics. Secondary amenorrhea is the absence of menses for three cycles or 6 months in women who have previously menstruated.
List of Discomforts of Pregnancy Urinary Frequency and IncontinenceFatigueNausea/VomitingBackacheLeg CrampsVaricositesHemorrhoidsConstipationsHeartburn/IndigestionBraxton Hicks Contractions
Teaching to manage the discomforts of pregnancy: Urinary Frequency or Incontinence Try pelvic floor exercises to increase control over leakage.Empty your bladder when you first feel a full sensation.Avoid caffeinated drinks, which stimulate voiding.Reduce your fluid intake after dinner to reduce nighttime urination
Teaching to manage the discomforts of pregnancy: Fatigue Attempt to get a full night’s sleep, without interruptions.Eat a healthy balanced diet.Schedule a nap in the early afternoon daily.When you are feeling tired, pause and rest.
Teaching to manage the discomforts of pregnancy: Nausea & Vomiting Avoid an empty stomach at all times.Eat dry crackers/toast in bed before arising.Eat several small meals throughout the day.Avoid brushing teeth immediately after eating to avoid gag reflex.Acupressure wristbands can be worn daily.Drink fluids between meals rather than with meals.Avoid greasy, fried foods or ones with a strong odor, such as cabbage or Brussels sprouts.
Teaching to manage the discomforts of pregnancy: Backache Avoid standing or sitting in one position for long periods.Apply heating pad (low setting) to the small of your back.Support your lower back with pillows when sitting.Use proper body mechanics for lifting anything.Avoid excessive bending, lifting, or walking without rest periods.Wear supportive low-heeled shoes; avoid high heels.Stand with your shoulders back to maintain correct posture.
Teaching to manage the discomforts of pregnancy: Leg Cramps Elevate legs above heart level frequently throughout the day.If you get a cramp, straighten both legs and flex your feet toward your body.Ask your health care provider about taking additional calcium supplements, which may reduce leg spasms.
Teaching to manage the discomforts of pregnancy: Varicosites Walk daily to improve circulation to extremities.Elevate both legs above heart level while resting.Avoid standing in one position for long periods of time.Don’t wear constrictive stockings and socks.Don’t cross the legs when sitting for long periods.Wear support stockings to promote better circulation.
Teaching to manage the discomforts of pregnancy: Hemorrhoids Establish a regular time for daily bowel elimination.Avoid constipation and straining during defecation.Prevent straining by drinking plenty of fluids and eating fiber-rich foods and exercising daily.Use warm sitz baths and cool witch hazel compresses for comfort.
Teaching to manage the discomforts of pregnancy: Constipation Increase your intake of foods high in fiber and drink at least eight 8-oz glasses of fluid daily.Ingest prunes or prune juice which are natural laxatives.Consume warm liquids (tea) on rising, to stimulate peristalsis.Exercise each day (brisk walking) to promote movement through the intestine.Reduce the amount of cheese consumed.
Teaching to manage the discomforts of pregnancy: Heartburn or Indigestion Avoid spicy or greasy foods and eat small frequent meals.Sleep on several pillows so that your head is elevated 30 degrees.Stop smoking and avoid caffeinated drinks to reduce stimulation.Avoid lying down for at least three hours after meals.Try drinking sips of water to reduce burning sensation.Avoid foods that trigger symptoms—fried foods, citrus, soda, chocolate.Take antacids sparingly if burning sensation is severe.
Teaching to manage the discomforts of pregnancy: Braxton Hicks Contractions Keep in mind that these contractions are a normal sensation. Try changing your position or engaging in mild exercise to help reduce the sensation.Drink more fluids if possible.
Nursing management and Childbirth Education “The overall aim of any method is to promote an internal locus of control that will enable each woman to yield her body to the process of birth. As the woman gains success and tangible benefits from the exercises she is taught, she begins to reframe her beliefs and gains practical knowledge, and the impetus will be there for her to engage in the conscious use of the techniques. Nurses play a key role in supporting and encouraging each couple’s use of the techniques taught in childbirth education classesEvery woman’s labor is unique, and it is important for nurses not to generalize or stereotype women. The most effective support a nurse can offer a couple using prepared childbirth methods is encouragement and presenceOffering encouraging phrases such as “”great job”” or “”you can do it”” helps reinforce their efforts and at the same time empowers them to continue. Using eye contact to engage the woman’s total attention is important if she appears overwhelmed or appears to lose control during the transition phase of labor.Nurses play a significant role in enhancing the couple’s relationship by respecting the involvement of the partner and demonstrating concern for their needs throughout labor. Offering to stay with the woman to give the partner a break periodically allows them to meet their needs while at the same time still actively participating. Offer anticipatory guidance to the couple and assist during critical times in labor. Demonstrate many of the coping techniques to the partner and praise their successful use to increase self-esteem. Focus on strengths and the positive elements of the labor experience. Congratulating the couple for a job well done is paramount.Throughout the labor experience, demonstrate personal warmth and project a friendly attitude. Frequently, a nurse’s touch may help prevent a crisis by reassuring the mother she is doing well.”