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Med Surg 2
Reproduction
| Question | Answer |
|---|---|
| What happens in the first step in menses? | Anterior pituitary releases follicle-stimulating hormone (FSH) |
| What happens in the second step in menses? | Egg matures within graafian follicle |
| What happens in the third step in menses? | Estrogen from maturing graafian follicle causes vascularization of uterine lining |
| What happens in the fourth step in menses? | Anterior pituitary gland releases luteinizing hormone (LH) |
| What happens in the fifth step in menses? | Corpus luteum is formed from old follicle |
| What happens in the sixth step in menses? | Corpus luteum releases estrogen & progesterone |
| What happens in the seventh step in menses? | Corpus luteum disintegrates, causing a decrease in progesterone |
| What is the final step in menses? | Lining of uterus is shed as menses |
| What are factors that may be associated with early menopause? | Smoking, family history, living in high altitudes, and surgical interventions |
| What factors may contribute to older women being reluctant to seek medical care for problems of reproductive system? | Embarrassment, cultural factors, and lack of knowledge |
| What is a pelvic exam? | Visualization of external organs; vulva, perineum, & vagina |
| What is a bimanual pelvic exam? | Visualization & palpation of internal organs; vagina, cervix, ovaries, and uterus |
| What is a colposcopy? | Direct visualization of cervix & vagina |
| What is a Papanicolaou Test (Pap Smear)? | Simple way to detect cervical abnormalities in women |
| What is a biopsy? | Samples of tissue are taken for evaluation to confirm/locate lesion |
| What is the simplest way to detect cervical cancer? | Papanicolaou Test (Pap smear) |
| When should women begin regular pap exams? | Within 3 years of becoming sexually active, no later than age 21 |
| What would occur if a pap exam revealed abnormal findings? | Colposcopy with biopsy |
| Why would a biopsy be performed? | To confirm or locate a lesion |
| What is a hysterogram /hysterosalpingogram? | Images of the uterus and fallopian tubes to confirm tubal abnormalities, presence of foreign bodies, congenital malformations & leiomyoma's, and traumatic injury |
| How is a hysterography / hysterosalpingography performed? | Patient is placed in lithotomy position, speculum is inserted into vagina, contrast medium is injected through cervical cavity, uterus, & fallopian tubes; images are viewed & taken w/fluoroscope |
| What discomfort may arise from air being injected to facilitate visualization during hysterogram/hysterosalpingogram? | Air may travel through the tissue causing pain in shoulder from diaphragmatic irritation |
| What is amenorrhea? | Absences of menstrual flow |
| What is dysmenorrhea? | Painful menstruation |
| What is menorrhagia? | Bleeding that is excessive in amount and duration |
| What is metrorhagia? | Bleeding between menstrual periods |
| What is Climacteric? | Phase of the aging process in men & women who are transitioning from reproductive to non-reproductive stage of life |
| What is perimenopause? | Experienced by most women as they near middle adulthood, level of estrogen begins to fall |
| Why is hysterosalpingography/hysterography done? | To determine whether or not the fallopian tubes are open or occluded |
| What is pelvic inflammatory disease (PID)? | Any acute, subacute, recurrent, or chronic infection that may involve the cervix, uterus, fallopian tubes, or ovaries, and may extend to connective tissues |
| What is toxic shock syndrome (TSS)? | Acute bacterial infection caused by staphylococcus aureus |
| Why does TSS occur? | Women who use superabsorbent tampons which are left in too long, allowing staph infection to absorb into blood stream |
| What are the signs and symptoms of TSS? | Elevated temperature (102 F), vomiting, dizziness, headache, diarrhea, myalgia, hypotension, and signs suggesting onset of septic shock |
| What subjective data would you collect assessing a patient for TSS? | Determine whether the patient has recently used tampons & how long she used a single tampon before changing it |
| What is the cause of endometriosis? | Endometrial tissue appears outside of the endometrial cavity |
| What is the medical treatment for endometriosis? | High dose hormones, pregnancy, laparoscopy to remove endometrial implants & adhesions, surgical removal of uterus, ovaries, and fallopian tubes |
| What is a potential side effect of Lupron? | Irregular vaginal bleeding |
| What is the cause of vaginal fistula formation? | Ulcerating process resulting from cancer, radiation, weakening of tissue by pregnancies a surgical interventions |
| What problems are associated with relaxed pelvic muscles? | Displaced uterus, prolapsed uterus, cystocele, urethrocele, rectocele, enterocele |
| What is a fistula? | Abnormal opening between two organs |
| What types of fistula's are there? | Urethrovaginal, vesicovaginal, and rectovaginal |
| What is a cystocele? | Bladder prolapse into the vagina because vaginal walls relax |
| What is a rectocele? | Rectum prolapse into the vagina because vaginal walls relax |
| What is the postoperative care for a patient who underwent a colporrhaphy? | Check v/s and observe for hemorrhage. Foley is placed, small amounts of stool softeners, early ambulation, and no sex for 6 weeks |
| Why is a foley placed in a patient who had a colporrhaphy? | Foley allows for bladder to remain empty to prevent pressure on the sutures |
| What factors place women at greatest risk of cervical cancer? | Women who are sexually active in their teens, who smoke, have multiple sex partners, and who have hx of chronic infections & erosions of cervix |
| What is Gardasil? | Vaccine that reduces the incidence of cervical cancer due to infection with the HPV types |
| Who is Gardasil given to? | Men & women |
| What is the age of administration for Gardasil? | 11-18 yrs |
| When should Gardasil be given? | Prior to the start of sexual activity |
| What is the timing of administration of Gardasil injections? | 3 injections over 6 month period |
| What is the patient teaching for Gardasil? | Complete entire series of vaccinations, and seek prompt medical advice for any abnormal vaginal bleeding |
| Who does cancer of the endometrium affect? | Postmenopausal women, usually an adenocarcinoma (tumor originating from the glandular epithelial cells) |
| What is the first sign of endometrial cancer? | Abnormal bleeding in uterus (premenopausal & postmenopausal women) |
| What are symptoms for ovarian cancer? | Vague abdominal discomfort, flatulence, mild gastric disturbances, pressure, bloating, cramps, sense of pelvic heaviness, feeling of fullness, and change in bowel habits |
| What type of exam may help to identify pelvic mass? | Bimanual pelvic exam |
| What is the difference between a total abdominal hysterectomy and laparoscopic hysterectomy with bilateral salpingo-oophorectomy? | Surgeon can visualize and assess entire pelvic cavity with abdominal procedure; Surgeon has limited view of pelvic cavity with laparoscopic procedure |
| What is a panyhysterosalpingo-oophorectomy? | Removal of uterus, fallopian tubes, and ovaries |
| When is a vaginal hysterectomy not advised? | Ovaries & fallopian tubes have to be removed & when there is a need to visualize intrapelvic & intra-abdominal organs |
| What is the post operative assessment for a patient that had an abdominal hysterectomy? | Performed every 4hrs, assess v/s, lung sounds, bowel sounds, & urine output. Encourage patient to splint incision, turn, cough & deep breathe, us I/S, early ambulation to prevent thrombus, assess incision for exudate & infection |
| Why is the placement of a foley so important following a hysterectomy? | Trauma to the bladder is unavoidable & incidence of urinary retention is higher than any other type of surgery |
| What are the benefits of early ambulation? | Prevents thrombus and promotes bowel activity |
| What is post op patient teaching re: vaginal drainage the nurse should provide to the patient who has had a hysterectomy? | Report any unusual bleeding to HCP (normal drainage will occur 2-4 weeks post op) |
| What is post op patient teaching re: weight bearing activities the nurse should provide to the patient who has had a hysterectomy? | Restrict heavy lifting, no more than 10lbs, no walking up & down stairs, no prolonged riding in cars (may cause pelvic pooling & development of thrombus in legs) |
| When should pre-menopausal women complete BSE? | Monthly, preferable 1 week after menses, starting at age 20 |
| When should post-menopausal women complete BSE? | Monthly, on the same day of the month |
| Why is mammography less sensitive in younger women? | Breast tissue in younger women is of greater density |
| What does Tamoxifen do? | Blocks estrogen receptor sites of malignant cells |
| What are the side effects of Tamoxifen? | Hot flashes, nausea, vomiting, vaginal discharge |
| What position is best to place a patient who has undergone a modified radical mastectomy once their v/s are stable and why? | 45 degree fowlers position to promote drainage |
| What is patient teaching re: elevation of are on operative side following mastectomy? | Patient can elevate on a pillow with hand and wrist higher than elbow, and the elbow higher than shoulder joint |
| Why must a patient who has had a mastectomy avoid BP's, injections, or blood draws in the operative arm? | Lymph nodes have been removed; it increases the risk of lymphedema, and defense mechanisms are lessened |
| How does exercise help reduce lymphedema? | Isometric exercises are helpful for increasing the circulation and developing the collateral lymph system |
| How is grief experienced following a mastectomy? | Occurs as the result of the loss of a body part; this is an acute crisis that may last 4-6 weeks |
| When will the symptoms of epididymitis may occur? | Can occur after trauma to the genital area, after instrumentation of the urethra & cystoscopy & after physical exertion or prolonged sexual activity |
| How do you distinguish a hydrocele from a cancerous testicular mass? | Strong light is directed from a point behind the scrotum. If light passes through, it is a hydrocele. If light does not pass through, it indicates a solid mass |
| Describe varicocele? | Occurs when veins within the scrotum become dilated, usually following internal spermatic vein reflux |
| What age group does testicular cancer frequently affect? | 15-35 |
| What age is best to start self testicular exam (STE)? | Monthly at onset of puberty |
| When is the best time to perform the STE? | After warm shower/bath when scrotal sac is relaxed |
| What are normal visual findings during a STE? | Color, contour, & skin breaks |
| What are normal palpable findings during a STE? | Firm, resilient, smooth & mobile |
| Who is most at risk of contracting a sexually transmitted infection? | Young, single, urban, poor, male, & homosexual |
| What are the signs and symptoms that often accompany primary genital herpes? | Vesicles may rupture & develop into shallow, painful ulcers, marked by erythematous with marked edema & tenderness |
| What is patient teaching re: transmission of genital herpes? | Sex during outbreak increases risk of transmission & is painful. Patients should inform HCP & future sexual partners of recurring or latent infections. Condoms should be used. Stress, poor nutrition & insufficient rest can increase recurrences |
| What are signs of gonorrhea? | Urethritis, purulent discharge, edema, dysuria, yellow discharge from cervix, urinary frequency, purulent discharge from urethra, pruritus, burning & pain in vulva, vaginal enlargement, abdominal pain & distention, muscular rigidity & tenderness |
| Why is it important form patients with STI's to contact present and past sexual partners? | All sexual contacts can be treated simultaneously to avoid the "Ping-Pong" effect (re-exposure) |
| When is a women considered free of gonorrhea? | Women has had three consecutive negative smears of the cervix & Bartholin's & Skene's glands are obtained |
| What is Flagyl used for? | Treatment of trichomoniasis |
| What is the patient teaching for the use of Flagyl? | Avoid alcohol and urine may turn brown |
| What are the signs and symptoms of cervicitis? | Vaginal pruritus/burning, dull pelvic pain, low grade fever, vaginal discharge, and irregular bleeding |
| What is chlamydia? | Gram negative, intracellular bacterium, causes several common STI's. Cervicitis and urethritis are most common, but like gonococci, chlamydial organisms also cause epididymitis in men and salpingitis in women |
| What is the prognosis for patients with chlamydia? | With treatment, infection is curable. Reinfection occurs is sexual partners are not treated simultaneously. Infections can be transmitted to infants during delivery, causing conjunctivitis & pneumonia |
Created by:
tandkhopkins
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