CHAPTER REVIEW: PERRY, CHAPTERS 1 TO 10

Chapter 1Contemporary Maternity Nursing

TERMS integrative health care complementary alternative therapies conventional Western treatment evidence-based practice. standard of care sentinel event. Risk management. Failure to rescue. Midwife Joint Commissions Do Not Use list of abbreviations. Low birth weight preterm birth health disparities Healthy People 2010 family-centered care

2The Family and Culture

the family stress theory family systems theory Genogram. Acculturation. Ethnocentrism. Assimilation. cultural competence O
v Community and Home Care 3 a _________________________________________________________ Infant r mortality rate. Maternal morbidity rate. i primary level of prevention e secondary level of prevention s tertiary level of prevention , Clinical integration of services warm lines t ailments for which homeless women are at higher risk h Compare and contrast childbirth and pregnancy beliefs and practices in several different cultures eHealth Promotion and Illness Prevention 4

_______________________________________ preconception care f Explain the effects of the following on mother and developing fetus: e methamphetamine m
a l e r

Heroin PCP Alcohol Cocaine Kegel exercises Body mass index Sexual assault intimate partner violence (IPV) abuse assessment screen Entrainment. Synchrony. Reciprocity. Biorhythmicity. Recent trends in childbirth practice U.S. birth rate trends to unmarried barrier to access to care for the pregnant woman infant mortality best method of preventing or controlling risk factors associated with infant mortality. mandatory state reporting laws intimate partner violence (IPV) Physical abuse Sexual abuse Emotional abuse

Psychologic abuse Economic abuse Economic coercion ________________________________________________________

5Health Assessment
1. two primary functions of the ovary
The Ovaries are small, lumpy, almondshaped organs near the lateral walls of the pelvic cavity. The ovaries perform three main functions: (1) produce immature female eggs, or oocytes, (2) secrete female sex hormones, including e

strogens and progestins, and (3) secrete inhibin, involved in the feedback 2. control of pituitary FSH production

3. uterine myometrium
The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells (also called uterine myocytes[1]), but also of supporting stromal and vascular tissue. Its main function is to induce uterine contractions.

4. Estrogen.
Any of a group of steroid hormones that primarily regulate the growth, development, and function of the female reproductive system. The main sources of estrogen in the body are the ovaries and the placenta

5. Prolactin.
A hormone that helps the breast prepare for milk production during pregnancy.

6. Testosterone.
Male hormone produced by the testes and (in small amounts) in the ovaries. Testosterone is responsible for some masculine secondary sex characteristics such as growth of body hair and deepening voice

7. Progesterone.
A steroid hormone secreted by the corpus luteum and by the placenta, that acts to prepare the uterus for implantation of the fertilized ovum, to maintain pregnancy, and to promote development of the mammary glands. Also called corpus luteum hormone, luteohormone, progestational hormone.

8. breast self-examination (BSE)

The best time to do a self breast exam is about 3 - 5 days after your period starts. Your breasts are not as tender or lumpy at this time in your monthly cycle. If you have gone through menopause, do your exam on the same day every month. Begin by lying on your back. It is easier to examine all breast tissue if you are lying down.

 Place your right hand behind your head. With the middle fingers of your left hand, gently yet firmly press down using small motions to examine the entire right breast. Next, sit or stand. Feel your armpit, because breast tissue goes into that area. Gently squeeze the nipple, checking for discharge. Repeat the process on the left breast. Use one of the patterns shown in the diagram to make sure that you are covering all of the breast tissue. Next, stand in front of a mirror with your arms by your side. Look at your breasts directly and in the mirror. Look for changes in skin texture, such as dimpling, puckering, indentations, or skin that looks like an orange peel. Also note the shape and outline of each breast. Check to see if the nipple turns inward.

9. Menstruation is the periodic uterine bleeding that begins approximately 14 days after ovulation, it is controlled by a feedback system of three cycle: endometrial, hypothalamic-pituitary, and ovarian. The avarage length of a menstrual cycle is 28 days and last around 5 days, but variations are normal 10. fertilization
The joining of the sperm and the egg; conception

11. Prostaglandins are oxygenated fatty acids classified as hormones, prostaglandins are produced in most organs of the body, including the uterus. Menstrual flow is a potent PG source. Indirect evidence indicates that PG have an affect on ovulation, fertility, changes in the cervix and cervical mucous that effect receptivity to sperm, tubal and uterine motility, sloughing and endometrium (menstruation), onset of miscarriage and induced abortion, and onset of labor (term and preterm) and it plays a key role in ovulation. 12. climacteric it is a transitional phase during which ovarian function and hormone production decline 13. Menopause. Refers only to the last menstrual period, and can be dated with certainty only 1 year after menstruation ceases 14. Menarche.
The first menstrual period, usually during puberty

15. Puberty. Is a broader term that denotes the entire transitional stage between childhood and sexual maturity

happens to most girls of 13 years old. 16. Perineum.

The area between the opening of the vagina and the anus in a woman, or the area between the scrotum and the anus in a man

17. Vaginal vestibule.

The Vulval vestibule (or "Vulvar vestibule") is a part of the vulva between the labia minora into which the urethral opening and the vaginal opening open

18. Bony pelvis.

the ring of bone formed by the sacrum and the first few coccygeal vertebrae as the roof, the pubis and ischia as the floor and the ilia and the acetabular part of the ischia as the walls.

19. Fourchette.
a small fold of integument or mucous membrane that limits the movements of an organ or part.

20. Bimanual palpation.

the examination of a woman's pelvic organs in which the examiner places one hand on the abdomen and one or two fingers of the other hand in the vagina. The size, shape, and consistency of the cervix, uterus, and adnexa are then assessed and noted

21. Papanicolaou (Pap) test

This is a screening test for cancer of the cervix. Cells are scraped from the cervix, smeared on a glass plate, and sent to a laboratory to examine for any abnormal cells or dysplasia. This test may also detect other cells seen in certain vaginal infections.

22. Rectovaginal palpation an exam where the index finger is inserted into the vagina and the middle finger is inserted into the rectum

6Common Health Problems

__________________________________________________1. amenorrhea
The absence of menstrual periods

2. dysmenorrhea
painful cramps during menstruation

3. premenstrual syndrome (PMS)

symptoms that occur between ovulation and the onset of menstruation. The symptoms include both physical symptoms, such as breast tenderness, back pain, abdominal cramps, headache, and changes in appetite, as well as psychological symptoms of anxiety, depression, and unrest. Severe forms of this syndrome are referred to as premenstrual dysphoric disorder (PMDD). These symptoms may be related to hormones and emotional disorders.

4. Endometriosis.
Endometriosis is a condition in which bits of the tissue similar to the lining of the uterus (endometrium) grow in other parts of the body. Like the uterine lining, this tissue builds up and sheds in response to monthly hormonal cycles. However, there is no natural outlet for the blood discarded from these implants. Instead, it falls onto surrounding organs, causing swelling and inflammation. This repeated irritation leads to the development of scar tissue and adhesions in the area of the endometrial implants

5. uterine fibroids
Uterine fibroids (also called leiomyomas or myomas) are benign growths of the muscle inside the uterus. They are not cancerous, nor are they related to cancer. Fibroids can cause a wide variety of symptoms, including heavy menstrual bleeding and pressure on the pelvis.

6. Menorrhagia
Excessively heavy menstrual flow with cycles of normal length. It is also called hypermenorrhea.

7. Dyspareunia.
Difficult or painful sexual intercourse.

8. cyclic perimenstrual pain and discomfort (CPPD) is a concept developed by a nurse science team for a research project for the association of women's health, obstetrics and neonatal nurses which includes dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder. 9. Oligomenorrhea.
Medical dictionaries define oligomenorrhea as infrequent or very light menstruation. But physicians typically apply a narrower definition, restricting the diagnosis of oligomenorrhea to women whose periods were regularly established before they developed problems with infrequent flow. With oligomenorrhea, menstrual periods occur at intervals of greater than 35 days, with only four to nine periods in a year.

10. Anovulation dysfunctional uterine bleeding (DUB) is caused by anovulation when there is no LH surge or if the corpus luteum does not produce suffiecient progesterone to support the endometrium, it will begin to involute and shed. 11. sexually transmitted infections (STIs) Signs, symptoms, effects on developing fetus and medications used to treat these disorders: Gonorrhea. a venereal disease involving inflammatory discharge from the urethra or vagina
women run a 60-90% chance of contracting the disease after just one sexual encounter with an infected male. The disease can also be transmitted from an infected mother to her infant during delivery.

Symptoms of gonorrhea in women

As many as 80% of women with gonorrhea show no symptoms. If present, symptoms may include the following: bleeding between menstrual periods chronic abdominal pain painful urination vaginal discharge, often cloudy and yellow in the case of oral infection, there may be no symptoms or only a sore throat. anal infection may cause rectal itching or discharge.

Because women often do not show any symptoms, complications are more likely to occur as the disease progresses. The most common complication is pelvic inflammatory disease (PID). PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, a pregnancy developing outside the uterus (ectopic pregnancy), or sterility. If an infected woman is pregnant, gonorrhea can be passed on to her newborn through the birth canal during delivery. These infants may experience eye infections that could lead to blindness.

Chlamydia. a very small parasitic bacterium that, like a virus, requires the biochemical mechanisms of another cell in order to reproduce. Bacteria of this type cause various diseases including trachoma, psittacosis, and nonspecific urethritis.
The symptoms of sexually transmitted chlamydial infections may be mild; hence this is sometimes called the silent STD. Victims may not be aware they have the disease and may not seek treatment until serious complications and unwitting transmission to other persons have occurred.

Women may suffer itching and burning in the genital area, an odorless, thick, yellow-white vaginal discharge, dull abdominal pain, and bleeding between menstrual periods. C. trachomatis causes about half of all PELVIC INFLAMMATORY DISEASE. Symptoms can appear from a week to five weeks after exposure to the bacteria, during which time almost all sexual contacts become infected.

Chlamydial infection during PREGNANCY can increase the risk of stillbirth or premature birth. The newborn is at risk for infection from its mother and may suffer from inclusion conjunctivitis. Chlamydial infection can also lead to pneumonia some weeks after birth, probably because of infectious material from the eye draining through the nasolacrimal ducts and being aspirated into the lungs.

Syphilis.
Syphilis is an infectious systemic disease that may be either congenital or acquired through sexual contact or contaminated needles. Syphilis has both acute and chronic forms that produce a wide variety of symptoms affecting most of the body's organ systems. The range of symptoms makes it easy to confuse syphilis with less serious diseases and ignore its early signs. Acquired syphilis has four stages (primary, secondary, latent, and tertiary) and can be spread by sexual contact during the first three of these four stages. The prognosis for early congenital syphilis is poor: about 54% of infected fetuses die before or shortly after birth. Those who survive may look normal at birth but show signs of infection between three and eight weeks later. Syphilis is treated with antibiotics given either intramuscularly (benzathine penicillin G or ceftriaxone) or orally (doxycycline, minocycline, tetracycline, or azithromycin).

Candidiasis.
Candidiasis is an infection caused by a species of the yeast Candida, usually Candida albicans. This is a common cause of vaginal infections in women. Also, Candida may cause mouth infections in people with reduced immune function, or in patients taking certain antibiotics. Candida can be found in virtually all normal people but causes problems in only a fraction. In recent years, however, several serious categories of candidiasis have become more common, due to overuse of antibiotics, the rise of AIDS, the increase in organ transplantations, and the use of invasive devices (catheters, artificial joints and valves)all of which increase a patient's susceptibility to infection. Most women with vaginal candidiasis experience severe vaginal itching. They also have a discharge that often looks like cottage cheese and has a sweet or bread-like odor. The vulva and vagina can be red, swollen, and painful. Sexual intercourse can also be painful. In most cases, vaginal candidiasis can be treated successfully with a variety of over-the-counter antifungal creams or suppositories. These include Monistat, Gyne-Lotrimin, and Mycelex. However, infections often recur. If a women has frequent recurrences, she should consult her doctor about prescription drugs such as Vagistat-1, Diflucan, and others.

Herpes simplex virus type 2 (HSV-2). HSV-2 is usually transmitted sexually gives genital lesions. It is categorized by multiple painful lesions, fever, chills, malaise, and severe dysuria it may last 2 to 3 weeks women may experience

itching, inguinal tenderness, and lymphadenopathy, severe vulvar edema may develop. During pregnancy maternal infection can have adverse effects on bothe the mother and the fetus it will increase miscarriage rates. Human papillomavirus (HPV).
A large family of viruses, some of which cause genital warts; HPV can be transmitted to a fetus during birth. Lesions are found in the buttocks, vulva, vagina, anus, and cervix. Vaginal lesions are often multiple. Flat topped papules, 1 to 4 mm in diameter, are seen most often on the cervix. Warts are usually flesh colored or slightly darker on Caucasian women, black on African American women and brownish on Asian women. The lesions are painless but uncomfortable. Chronic vaginal discharge, pruritus, or dysparenuria can occur. Lesion may become so large during pregnancy that they effect urination, defecation, mobility, and fetal descent, although birth by cesarean is rarely necessary it may be performed when extensive growth are present.

Human immunodeficiency virus (HIV

Human immunodeficiency virus, the virus that causes AIDS. The risk of acquiring AIDS is increased by the presence of gonorrhea or other sexually transmitted diseases. Transmission occurs through semen, blood, or vaginal secretions. Once HIV enters the body, seroconversion to HIV positivity occurs within 6 to 12 weeks. Symptoms include fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash. Transmission to baby can occur throughout the perinatal period exposure can occur to the fetus as early as the first trimester, and then through maternal milk.

Bacterial vaginosis (BV).

Bacterial vaginosis (BV) is a type of vaginal infection in which the normal balance of bacteria in the vagina is disrupted, allowing the overgrowth of harmful anaerobic bacteria at the expense of protective bacteria. The main symptom of BV is a thin, watery or foamy, white (milky) or gray vaginal discharge with an unpleasant, foul, fish-like or musty odor. The odor is sometimes stronger after a woman has sex, when the semen mixes with the vaginal secretions. Burning or pain during urination can also be present with BV. Itching on the outside of the vagina and redness can also occur, but are seen less frequently. However, many women with BV do not exhibit any symptoms. BV is treated with prescription antibiotics such as metronidazole or clindamycin creams or oral metronidazole (both are antibiotics that can also be used by pregnant women. Pregnant women with BV often have babies of low birth weight (less than 5.5 pounds) or who are premature

Trichomoniasis.
Trichomoniasis refers to an infection of the genital and urinary tract. A woman is most susceptible to infection just after having completed her menstrual period. In women, the symptoms of trichomoniasis include an unpleasant vaginal odor, and a heavy, frothy, yellow discharge from the vagina. The genital area (vulva) is often very itchy, and there is frequently pain with urination or with sexual intercourse. The labia (lips) of the vagina, the vagina itself, and the cervix (the narrowed, lowest segment of the uterus which extends into the upper part of the vagina) will be bright red and irritated.

acute pelvic inflammatory disease (PID)

Soon after the initial infection with the human immunodeficiency virus (HIV), your bodys self defense mechanisms kick into action. Your autoimmune system begins the process of developing antibodies to attack the invading virus. This process is called seroconversion. During seroconversion, you may not have detectable levels of HIV antibodies in your blood. An HIV blood test during this time could result in a false negative.

Seroconversion is the period of time during which HIV antibodies develop and become detectable. Seroconversion generally takes place within a few weeks of initial infection. It is often, but not always, accompanied by flu-like symptoms including fever, rash, muscle aches and swollen lymph nodes. These symptoms are not a reliable way to identify seroconversion or to diagnose HIV infection.

seroconversion to HIV safe sex practices fibrocystic changes in breasts are palpable thickenings in the breat usually associated with pain and tenderness. The pain and tenderness fluctuates with the menstrual cycle and can become progressively worse until menopause Mammogram
An x-ray image of the breast produced by mammography..

 Women age 40 and older should have mammograms every 1 to 2 years. Women who are at higher than average risk of breast cancer (for example, because of a family history of the disease or because they carry a known mutation in either the BRCA1 or the BRCA2 gene) should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.

Mastectomy
Mastectomy is the surgical removal of the breast for the treatment or prevention of breast cancer.

_______________________________________

7Infertility, Contraception, and Abortion

infertility
Infertility is the failure of a couple to conceive a pregnancy after trying to do so for at least one full year. In primary infertility, pregnancy has never occurred. In secondary infertility, one or both members of the couple have previously conceived, but are unable to conceive again after a full year of trying

sperm count the basic test for male infertility it studies the effects of cervical mucus on sperm forward motility and survival, and evaluation of the sperms ability to penetrate an ovum, the male has to be from 2 to 5 day of abstinence from ejaculation, and has to take the collection into the laboratory within 2 hours after collection semen volume 2.5ml semen concentration/density - >20 million/ml normal morphology >30%; normal shaped heads >14% motility number of cells >50% quality of movement (rated 0-4) >2 liquefaction <20 minutes

infertility workup In vitro fertilization-embryo transfer (IVF-ET) a woman's eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryo development has occurred. Indications: tubal or blockage; severe male infertility, endometriosis; unexplained infertility; cervical factor; immunologic infertility calendar method of conception control practice of the calendar method is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after accurately recording the lengths of menstrual cycle for 6 months, it is estimated by subtracting 18 day from the length of the shortest cycle shortest cycle, 24 18 = day 6 longest cycle, 30 11 = day 19 to avoid conception the would abstain during the fertile period, days 6-19 basal body temperature (BBT) method of contraception this is the lowest body temperature of a healthy person, taken immediately after waking and before getting out of bed. BBT usually varies from 36.2 to 36.3 c during menses and for approximately 5 to 7 days after

fertility awareness methods (FAMs) depends of identifying the beginning and end of the fertile period of the menstrual cycle there are three phases - infertile phase; before ovulation - fertile phase; about 5 to 7 days around the middle of the cycle, including several days before and during ovulation and the day afterward - infertile phase; after ovulation nonoxynol-9 (a common spermicide) this works by reducing the sperm's mobility; the chemical attack the sperm flagella and body, thereby preventing the sperm from reaching the cervical os. It is the most commonly use spermicidal chemical in the USA, is a surfactant that destroys the sperm cell membrane; although, data now suggest that frequent use may increase the chances of contracting HIV. Injectable progestins (DMPA, Depo-Provera) this method impair infertility by inhibiting ovulation, thickening and decreasing the amount of cervical mucus, thinning the endometrium, and altering cilia in the uterine tubes. diaphragm and spermicide for contraception

this is a shallow, dome shaped latex silicone device with a flexible rim that covers the cervix and impairs sperm passage. cervical cap this is a cap that you put to cover the cervix, it should be left in place for 6 hours after intercourse and not more than 48 hours at a time intrauterine device (IUD). Disadvantages of IUDs this is a small T-shaped device with bendable arms for insertion through the cervix into the uterine cavity. There are two usda approved -the copper T380A and mirena which is effective for 5 years. Disadvantages of an IUD include increase risk of pelvic inflammatory disease in the first 20 days after insertion and risk of bacterial vaginosis and uterine perforation. The IUD offers no protection against STD's PAINS Dilation and evacuation (D&E).
A surgical procedure in which the cervix is dilated and the early products of conception are removed from the uterus.

D&E can be performed at any point up to 20 weeks of gestation, although it is performed from 13 to 16 weeks oral contraceptives oral contraceptive pills (COCs), emergency contraception this is also known as plan B should be taken as soon as possible but within 72 hours of intercourse coitus interruptus
Sexual intercourse deliberately interrupted by withdrawal of the penis from the vagina prior to ejaculation. Also called onanism.

natural family planning

Biological birth control Any FP that does not rely on artificial agentseg, OCs, 'morning-after' pill, spermicidal foam, RU-486 or deviceseg, condoms, diaphragms, IUDs to prevent conception Methods Rhythmcalendar method, coitus interruptus, prolonged breast feeding.

Barrier methods
contraceptive methods, such as condoms and diaphragms, in which a plastic or rubber barrier blocks passage of spermatozoa through the vagina or cervix.

tubal ligation
Tubal ligation is a permanent voluntary form of birth control (contraception) in which a woman's Fallopian tubes are surgically cut or blocked off to prevent pregnancy.

medical abortions it is available in US for up to 9 weeks after the last menstrual period. Methotrexate, misoprostol, and mifepristone are drugs used in the current regimens to induce early abortions

8Genetics, Conception, and Fetal Development

________________________________ phenylketonuria (PKU). trisomy 18 genetic counseling amniocentesis maple syrup urine disease (MSUD). autosomal recessive inherited disorder Human Genome Project genetic disease alpha-fetoprotein Down syndrome. autosomal recessive disease karyotyping Genotype congenital gestation meconium umbilical cord Decidua basalis Germ layer Blastocyst Chorionic villi lecithin in relation to sphingomyelin (L/S ratio) : used to determine fetal lung maturity conception Implantation amniotic fluid structure and function of the placenta multiple births Fraternal twins Dizygotic twins (two fertilized ova)

fertility drugs Identical twins Conjoined twins monozygotic congenital malformations teratogens neural tube defect (NTD). multifactorial inheritance ______________________________________________________________________________

9Assessment for Risk Factors

Ultrasound examination Maternal serum alpha-fetoprotein screening (MSAFP) Amniocentesis Nonstress test (NST) fundal height Contraction stress test (CST) Daily fetal movement counts Kick counts intrauterine growth restriction (IUGR), multigravida Biophysical profile (BPP) Percutaneous umbilical blood sampling (PUBS) cervix tocolytics dilate efface Transvaginal ultrasound grade of placenta nipple-stimulated contraction stress test (CST) fetal heart rate (FHR) high risk pregnancies shake test, or bubble stability test four categories of threats to the health of the woman and the outcome of pregnancy. Oligohydramnios. Postterm pregnancy. Polyhydramnios. Chromosomal abnormalities. pregnancy-related risk factors Premature rupture of membranes

10Anatomy and Physiology of Pregnancy

gravidity and parity using the GTPAL system Over-the-counter (OTC) pregnancy tests Chadwicks sign. Positive pregnancy test. Hegars sign. presumptive, probable, and positive signs of pregnancy.

Braxton Hicks contractions. Quickening. fundus Chadwicks sign McDonalds sign Goodells sign Cardiovascular system changes during pregnancy Skin changes in pregnancy, all terms; permanenet vs. temporary Chloasma Striae gravidarum musculoskeletal system changes that occur during pregnancy respiratory changes in pregnancy gastrointestinal changes in pregnancy Ptyalism. Pica. Pyrosis. decreased peristalsis endocrine changes in pregnancy: hormones, where produced, function in pregnancy/labor Estrogen. Human chorionic gonadotropin (hCG). Oxytocin. Progesterone. fetus Primipara. Multipara. Primigravida. Nulligravida Viability Preterm-pregnancy Postdate-pregnancy Term-pregnancy Lightening uterine souffle Ballottement. Montgomerys tubercles Colostrum Lactation contractions proteinuria