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Reproductive Health and Pregnancy, Lecture notes of Nursing

Nova Southeastern University (NSU)Nursing

A comprehensive overview of various aspects of reproductive health and pregnancy. It covers topics such as the treatment of underlying causes of abnormal uterine bleeding, premenstrual syndrome (pms), fertility awareness methods, the menopausal transition, and sexually transmitted infections (stis). The document also delves into the stages of fetal development, the functions of the placenta, the role of amniotic fluid, and the various reproductive changes that occur during pregnancy. It discusses nursing management during pregnancy, including preconception care, reasons for seeking care, obstetric history, laboratory tests, risk profiles, visit schedules, assessments, and the assessment of fetal well-being through various diagnostic procedures. This document could be a valuable resource for healthcare professionals, students, and individuals interested in understanding the complexities of reproductive health and the journey of pregnancy.

Typology: Lecture notes

2019/2020

Uploaded on 06/24/2024

elizabeth-rodriguez-hjm 🇺🇸

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CH 4: Reproductive

Issues

From 14-44- reproductive years

No period during pregnancy, menopause, pre-puberty

Menarchy: first period

Amenorrhea

•Absence of menses during reproductive years

Primaryamenorrheaisdefinedaseitherthe:

1. absence of menses by age 15, with absence of growth and development of secondary sexual

characteristics; or

2. absence of menses by age 16, with normal development of secondary sexual characteristics

multiple causes, including:

Extreme weight gain or loss

Congenital abnormalities of the reproductive system

Stress from a major life event

Excessive exercise

Eating disorders (anorexia nervosa or bulimia)

Cushing disease

Polycystic ovary syndrome

Hypothyroidism

Turner syndrome—defective development of the gonads (ovary or testes)

Imperforate hymen

Chronic illness—diabetes, thyroid disease, depression

Pregnancy

Cystic fibrosis

Congenital heart disease (cyanotic)

Ovarian or adrenal tumors

Secondaryamenorrheaistheabsenceofregularmensesforthreecyclesorirregularmensesfor6

monthsinwomenwhohavepreviouslymenstruatedregularly.

Causes of secondary amenorrhea can include:

Pregnancy

Breastfeeding

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Download Reproductive Health and Pregnancy and more Lecture notes Nursing in PDF only on Docsity!

CH 4: Reproductive

Issues

From 14-44- reproductive years No period during pregnancy, menopause, pre-puberty Menarchy: first period

Amenorrhea

Absence of menses during reproductive years Primary amenorrhea is defined as either the:

absence of menses by age 15, with absence of growth and development of secondary sexual characteristics; or
absence of menses by age 16, with normal development of secondary sexual characteristics multiple causes, including:  Extreme weight gain or loss  Congenital abnormalities of the reproductive system  Stress from a major life event  Excessive exercise  Eating disorders (anorexia nervosa or bulimia)  Cushing disease  Polycystic ovary syndrome  Hypothyroidism  Turner syndrome—defective development of the gonads (ovary or testes)  Imperforate hymen  Chronic illness—diabetes, thyroid disease, depression  Pregnancy  Cystic fibrosis  Congenital heart disease (cyanotic)  Ovarian or adrenal tumors Secondary amenorrhea is the absence of regular menses for three cycles or irregular menses for 6 months in women who have previously menstruated regularly. Causes of secondary amenorrhea can include:  Pregnancy  Breastfeeding

 Chronic prolonged stress  Pituitary, ovarian, or adrenal tumors  Depression  Hyperthyroid or hypothyroid conditions  Malnutrition  Hyperprolactinemia  Rapid weight gain or loss  Chemotherapy or radiation therapy to the pelvic area  Vigorous exercise, such as long-distance running  Kidney failure  Colitis  Chemotherapy, irradiation  Use of tranquilizers or antidepressants  Postpartum pituitary necrosis (Sheehan syndrome)  Early menopause

Dysmenorrhea painful cramps

Primary
- Increased prostaglandin production (primary)- normal ( Prostagandin: hormone that causes contraction of uterus, (vasocontricts)these level are usually 2 days of period)
- Secondary: Endometriosis most common cause of secondary dysmenorrhea

Nursing Management of Dysmenorrhea

Past medical history, sexual history, menstrual history; bimanual pelvic examination (one hand on top of abdomen and one inside vagina)
Manifestations: pain, nausea, vomiting diarrhea, fatigue, fever, headache, dizziness; bloating, water retention, weight gain, muscle aches, food cravings, breast tenderness
Client education
Comfort measures: heat, lifestyle changes, pain relief (mydol, ibuprofen)
At what age, flow (light, heavy), painful sex, do you bleed during sex or before or after?
Heat therapy: dialates and relax

Abnormal Uterine Bleeding (AUB)

Occurs most often at beginning and end of menstrual cycle
Etiology related to hormone disturbance
Treatment involves treating the underlying cause
Painless bleeding that is excessive and irregular
Common cause: polyps, fribromas, ovulatory dysfunction
Correct anemia, diagnose if it’s cancer
BC: balances hormones, treatment, sx is another option
Hysterectomy: removal of uterus (LAST RESORT
It can happen to women at any age

INFERTILITY

Cultural expectations for reproduction Impact of culture, ethnicity, and religion
Male and female risk factors
Therapeutic management: drugs or surgery
Affects male and females (try for a whole year)
Male are easier to test: quality of sperm, #, poor motility Fertility Assessment
Female factor assessment: ovarian function (do they have eggs?), pelvic organs (does she have 2 fallopian tubes)
Laboratory and diagnostic testing: home ovulation predictor kits (pee on stick, LH ) clomiphene citrate challenge test (Clomine med, women’s eggs are there? Quantatity/quality
hysterosalpingogram (inject dye, goes in tube to see patency) laparoscopy
FSH: stimulates ovaries,
LH: tells ovaries to release egg

Nursing Management

Respect for couple
Education, anticipatory guidance, stress management, counseling Fertility awareness methods are based on identifying fertile days in a woman’s cycle and avoiding sexual intercourse during that time. Lactational amenorrhea method (don’t get period) exclusively breastfeeding

MENOPAUSAL TRANSITION

After child bearing years= no more period

Brain: hot flashes; sleep, mood, and memory problems
Heart: lower levels of HDL; increased risk of CVD
Bones: bone density loss; increased risk of osteoporosis
Breasts: duct and gland tissue replaced by fat
Genitourinary: vaginal dryness, stress incontinence, cystitis
GI: less Ca+ absorbed; increased fractures
Skin: skin dry, thin; collagen decreases
- Screening for osteoporosis, cardiovascular disease, and cancer risk
Calcium and vit D supplements

Estrogen cream
Caffeine, spicy foods, hot drinks,
Can last up to 4 years

endocervicitis,(red cervix)
inflammations of the rectum and lining of the eye,
can infect throat.
Treatment= azithromycin 1,000 mg, one time Gonorrhea (bacterial)
Second most commonly reported infection in the United States
Highly contagious and reportable to health departments
Site of infection: columnar epithelium of endocervix may be asymptomatic, dysuria, urinary frequency, vaginal discharge , dyspareunia , endocervicitis, Neonatal conjunctivitis if woman gives birth (erythromycin, so they don’t get this in the eye) arthritis, PID(pelvic inflammation), rectal infection. Left untreated= go inside blood stream, carditis, brain meningitis, and liver toxic hepatitis and arthritis Clamydia and gonorrhea: discharge is yellow/green, if left untreated= infection in bone and affects sterility Screened first trimester pregnancy and last trimester Treatment Rocephin= one time Genital herpes

blister-like genital lesions,
dysuria,
fever, headache,
muscle aches.
We give antiviral (Voutax or Azyclovir )
HSV 1: Oral mucousa, goes to sleep in dorsal ganglia (stress, cold, heat can make outbreak) - Recurrent lifelong viral infection - Kissing, sexual contact, and vaginal delivery - No cure
HSV 2: Genital
- superinfection with candida,
- fever, chills, malaise
- , dysuria, headache,
- genital irritation, inguinal tenderness,
- lymphadenopathy
Syphilis spirochete Treponema pallidum penicillin given (looks like a little ball). No fluid inside vesicle
Therapeutic management o Benzathine penicillin G IM o Doxycycline if allergic to penicillin
Primary: chancre on place of bacteria entrance
Secondary: maculopapular rash, sore throat, lymphadenopathy, flu-like symptoms
Latent: no symptoms; no longer contagious
These three are contagious
Tertiary: tumors of the skin, bones, and liver, CNS symptoms, CV symptoms; usually not reversible
Trichomoniasis (Green and frothy)
Trichomonas : protozoan
may be asymptomatic,
dysuria, urinary frequency,
vaginal discharge,

lower abdominal tenderness, adnexal tenderness (around ovaries), cervical motion tenderness (starts bleeding everywhere)
Hydration, analgesics, Education Complications (ectopic pregnancy, chronic abd pain) Human Papillomavirus (HPV) #
Most common viral infection in the United States Genital warts or condylomata (cauliflower lesions) - : most asymptomatic; visible genital warts Pap smears; HPV test (checking also for cervical cancer - Promotion of vaccines and screening tests (before sexually active) If women has active HPV outbreak= c-section

Ch. 10: Fetal Development and Genetics Stages of Fetal Development

Pre-embryonic stage: fertilization through second week
- Fertilization; cleavage; morula
- Blastocyst and trophoblast
- Implantation
Embryonic stage: end of second week through eighth week
- Basic structures of major body organs and main external features
Fetal stage: end of the eighth week until birth

CH 11: Maternal Adaptation During Pregnancy Signs of Pregnancy

Chadwick’s sign
- Bluish-purple coloration of the vaginal mucosa and cervix
Goodell’s sign
- Softening of the cervix
Hegar’s sign
- Softening of the lower uterine segment or isthmus

Presumptive signs (subjective)= what she feels
Fatigue (12 weeks)
Breast tenderness (3 to 4 weeks)
Nausea and vomiting (4 to 14 weeks)
Amenorrhea (4 weeks) (thin and exercise also)
Urinary frequency (6 to 12 weeks
Hyperpigmentation of skin (16 weeks)
Fetal movements (quickening) (16 to 20 weeks).
Uterine enlargement Probable (objective) signs - Braxton Hicks contractions (16 to 28 weeks). NORMAL - Positive pregnancy test (4 to 12 weeks) - Ballottement (16 to 28 weeks) (finger inside vagina and amniotic fluid kicks back) Positive signs - Ultrasound verification of embryo or fetus (4 to 6 weeks) - Fetal movement felt by experienced clinician (20 weeks) - Auscultation of fetal heart tones via Doppler (10 to 12 weeks) Reproductive changes Uterus - Increase in size, weight, length, width, depth, volume, and overall capacity= expands to hold fetus - Pear shape to ovoid shape; positive Hegar’s sign - Enhanced uterine contractility; Braxton Hicks contractions

Musculoskeletal Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis (open Lordosis Waddle gait Skin: Hyperpigmentation Linea nigra (down the umbilical area) Striae gravidarum “stretch marks”. This is genetic!! Decline in hair growth; increase in nail growth you will shed hair Supine hypotensive syndrome (vena caval syndrome). The gravid uterus compresses the vena cava when the woman is supine. This reduces the blood flow returning to the heart and may cause maternal hypotension.

Pituitary Pituitary gland: enlargement; decrease in TSH, GH; inhibition of FSH and LH (cant get more pgrenant these cause ovulation); increase in prolactin, MSH; gradual increase in oxytocin Thyroid gland: slight enlargement; insulin resistance nutritional:

Need for vitamin and mineral supplement daily
Increase in protein, iron, folate (for neural tube defects) and calories (200-300= apple) AVOID FISH Weight gain:
Healthy weight BMI: 25 to 35 lb
First trimester: 3.5 to 5 lb
Second and third trimesters: 1 lb/wk
BMI <19.8: 28 to 40 lb
First trimester: 5 lb
Second and third trimesters: 1+ lb/wk
BMI >25: 15 to 25 lb
First trimester: 2 lb
Second and third trimesters: 2/3 lb/wk Ch. 12 Nursing Management During Pregnancy Period of Greatest Environmental Sensitivity
17 to 56 days after conception (greatstes impact) Preconception Care

Risk Profile , lifestyle habits, or social concerns that might unfavorably affect pregnancy (smoking or drinking). Encourage folic acid 400 to 800 (At risk) mcg per day Visit schedule

Every 4 weeks up to 28 weeks
Every 2 weeks from 29 to 36 weeks
Every week from 37 weeks to birth
Assessments
Weight and BP compared to baseline values
Urine testing for protein, glucose, ketones, and nitrites
Fundal height
Quickening/fetal movement (10-20 every hr) wake up, drink juice
Fetal heart rate
Teaching: danger signs Assessment of Fetal Well-Being
Ultrasonography
Doppler flow studies (blood is oxygenated)
Alpha-fetoprotein analysis (if high neural tube defect, or multiple gestations) 16-18 weeks
Marker screening tests (down syndrome)
Nuchal translucency screening 11-14 weeks (fold behind baby’s neck)= down syndrome
Amniocentesis 15-20 weeks (chromosomal abnormalities= abortion)
Chorionic villus sampling (CVS) any abnormalities
Percutaneous umbilical blood sampling (PUBS) checking for down syndrome, trisemene, abnormalities
Nonstress test (sugary or candy) naturally seen what mommy feels
Contraction stress test
^^^ 8-10= GOOD, less than 8=bad, if passed her due date
Biophysical profile (NEED TO KNOW CATAGORIES)

First-Trimester Discomforts

Urinary frequency or incontinence
Fatigue
Nausea and vomiting
Breast tenderness
Constipation
Nasal stuffiness, bleeding gums, epistaxis (increased vascularity)
Cravings
Leukorrhea (thick normal discharge) Second-Trimester Discomforts
Backache
Varicosities of the vulva and legs
Hemorrhoids
Flatulence with bloating
Return of first-trimester discomforts
Shortness of breath and dyspnea
Heartburn and indigestion
Dependent edema (concerning if not resolved and generalized)
Braxton Hicks contractions Nursing Management to Promote Self-Care
Avoidance of saunas and hot tubs
Perineal care
Dental care
Breast care DON’T WASH W WATER/SOAP
Clothing Exercise
Sleep and rest
Sexual activity and sexuality

Reproductive Health and Pregnancy, Lecture notes of Nursing

Related documents

Partial preview of the text

Download Reproductive Health and Pregnancy and more Lecture notes Nursing in PDF only on Docsity!

CH 4: Reproductive

Issues

Amenorrhea

Dysmenorrhea painful cramps

Nursing Management of Dysmenorrhea

Abnormal Uterine Bleeding (AUB)

INFERTILITY

Nursing Management

MENOPAUSAL TRANSITION