Women's and Children's Final Exam PDF

NURS 3431 Blueprint – Cumulative Final Maternal Family Nursing, Selected Women’s Health Issues, Preconception Concerns, Fetal Development Analyze various available contraceptive options in the care of families 4 COITUS INTERRUPT...

NURS 3431 Blueprint – Cumulative Final Maternal Family Nursing, Selected Women’s Health Issues, Preconception Concerns, Fetal Development Analyze various available contraceptive options in the care of families 4 COITUS INTERRUPTUS (Pull out Method) ​ Requires all parties to be on board with the “rules” ​ Patient MUST understand pre-cum can contain sperm so pregnancy is still a risk ​ Super-swimmers can still make it into the vagina so be careful where you ejaculate ​ Still at risk for STI ​ Non-hormonal, good choice for pt with contraindications for hormonal methods NATURAL FAMILY PLANNING ​ Depends on compliance ​ Non-hormonal, good choice for pt with contraindications for hormonal methods ​ Instructions: monitor menses (chart on a calendar), observe for changes in vaginal mucus, daily basal body temperature, avoid sex 4 days before and 3-4 days after ovulation) ​ Still an STI risk CALENDAR RHYTHM METHOD ​ Depends on compliance ​ Non-hormonal, good choice for pt with contraindications for hormonal methods ​ Instructions: record menstrual cycle for 6 months, determine fertile period (beginning of fertile period = subtract 18 days from the length of shortest cycle, end of fertile period = subtract 11 days from length of longest period), avoid sex on those days ​ Requires consistent use ​ Still an STI risk STANDARD DAYS METHOD ​ Depends on compliance and reliability will depend on womens cycle ​ Non-hormonal, good choice for pt with contraindications for hormonal methods ​ Avoid sex days 8-19 of your cycle ​ Okay for women with cycles 26-32 days long but unreliable for women with shorter or longer cycles *(Womens period needs to be basically perfect) BBT (basal body temp) ​ Depends on compliance and reliability will depend on womens cycle ​ Non-hormonal, good choice for pt with contraindications for hormonal methods  ​ Instructions: obtain basal body thermometer that reads in celsius, take temperature immediately after waking up but before getting out of bed every day, at the time of ovulation a drop of about 0.5C may occur, avoid sex day 1 (first day of menses) through consecutive days of elevated temperature ​ Still an STI risk ​ Many factors may affect body temperature example Sickness, hotdrinks, hot temp in house (be careful) CERVICAL MUCUS OVULATION DETECTION METHOD ​ Depends on compliance and reliability will depend on womens cycle ​ Non-hormonal, good choice for pt with contraindications for hormonal methods ​ Instructions: at the time of ovulation the mucus changes to be clear, wet, slippery, stretchy, woman needs to examine cervical mucus daily for several months, avoid sex until the 4th day after the last day of clear, wet, and slippery mucus ​ Requires consistent use ​ Still an STI risk ​ Infections, sex, and medications can also change the mucus SYMPTOTHERMAL METHOD ​ Depends on compliance and reliability will depend on womens cycle ​ Non-hormonal, good choice for pt with contraindications for hormonal methods ​ Avoid medication/vaginal preparations that may alter cervical mucus ​ Combines BBT and cervical mucus methods with awareness of secondary symptoms such as increased libido, spotting, pelvic/vulvar ​ Requires consistent use ​ Still an STI risk BREASTFEEDING: LACTATIONAL AMENORRHEA METHOD ​ This method can be highly effective if all “rules” are followed, however it is only a temporary method ​ How does it work: When an infant suckles at the breast, a surge of prolactin is released. Prolactin inhibits estrogen production and suppresses ovulation and the return of menses. ​ Instructions/Rules: 1. The mother must be exclusively breastfeeding 2. She must have not had a menses since baby's birth 3. The infant must be under 6 months of age 4. The mother must frequently feed (at least every 4 hours during the day and no longer than 6 hours during the night) 5. The mother must nurse the baby for long durations at each feeding 6. The mother must not provide any bottle supplementation  ​ Problems: A woman will not know when to expect that first ovulation post birth. As we know, she will ovulate before she has her first menses, she will not likely be able to accurately predict this time frame; this method is only temporary BARRIER METHODS SPERMICIDES ​ Chemicals that debilitate sperm ​ The most commonly used in the US is a chemical named N-9 ​ Forms: tablet, suppository (vaginal), film, creams ​ Instructions for use: 1. Insert no more than 1 hour before each act of intercourse 2. Insert high into the vagina. 3. Must be reapplied with each act ​ Side effects/warnings: Frequent use (more than 2 times per day) of N-9 or the use of N-9 as a lubricant during anal intercourse may increase the transmission of HIV and cause lesions; use with condoms does not increase effectiveness, may kill good bacteria CONDOMS ​ Male condoms are probably one of the most familiar contraceptive methods. However, proper use is not always consistent. Never assume your patient is aware of proper use technique ​ Side effects/warnings of male condoms: Be aware that condoms may break down with oil based substances such as petroleum jelly and suntan lotion; non-latex condoms do not protect the same as latex condoms against STIs. They have small pores ​ Female condoms are not as widely used or even known about (rubber vaginal sheath that is placed inside of the vagina) ​ Female condom instructions for use: 1.​ The closed end of the pouch is inserted into the vagina and achoired around the cervix, the open ring covers the labia 2.​ Single use only ​ Side effects/warnings of female condoms: may be noise, lubricants can be used to help with the distracting noise during intercourse DIAPHRAGM ​ Dome shaped device that is placed high into the vagina and covers the cervix. Spermicide is placed inside the diaphragm as it holds the spermicide against the cervix. It must be placed prior to intercourse and remain in place for 6 hours after so it can destroy sperm  ​ The diaphragm is most often fitted by a provider initially upon prescription as well as again if there is more than 20% weight loss or gain, term birth, second trimester abortion, or abdominal or pelvic surgery. Although there is a new version that comes in only one size and is sold over the counter ​ Side effects/warnings: Irritation from the spermicide; not good for women with pelvic organ prolapse/pelvic floor weakness or women with recurrent UTIs; TSS ​ Toxic shock syndrome risk patients must remove 6-8 hours after intercourse, do not use during menses, and understand the danger signs of TTS ​ Toxic shock syndrome common side effects: sunburn rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden high fever, vomiting CERVICAL CAP ​ Very similar to the diaphragm in that it works almost the same and looks similar ​ Instructions for use: must remain in place for no less than 6 hours and no more than 48 hours. The longer it is left in the higher the risk for TSS. Can use less spermicide than diaphragm ​ Side effects/warnings: 1.​ Irritation from spermicide 2.​ Women with an abnormal pap, history of TSS, vaginal or cervical infections, those unable to be fitted properly, those who are unable to insert and remove easily, and those allergic to spermicides are not a candidate 3.​ Do not use during menstrual cycle or 6 weeks after birth; Toxic shock syndrome ​ Toxic shock syndrome risk patients must remove 6-8 hours after intercourse, do not use during menses, and understand the danger signs of TTS ​ Toxic shock syndrome common side effects: sunburn rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden high fever, vomiting CONTRACEPTIVE SPONGE ​ Instructions for use: 1.​ Moisten with water 2.​ Insert into the vagina to cover the cervix 3.​ Leave in place for at least 6 hours but no more than 24-30 hours ​ Side effects/warnings: The sponge carries a toxic shock risk as well. Educate patients on Toxic shock syndrome warnings ​ Toxic shock syndrome risk patients must remove 6-8 hours after intercourse, do not use during menses, and understand the danger signs of TTS ​ Toxic shock syndrome common side effects: sunburn rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden high fever, vomiting HORMONAL METHODS COMBINED ORAL CONTRACEPTIVES (COCS): ESTROGEN AND PROGESTERONE ​ Inhibits ovulation, altering cervical mucus, and altering the endometrium ​ Instructions for use: take one pill each day ​ Contraindications: history of thromboembolic disease, CV, CAD, breast cancer, estrogen dependent tumors, pregnancy, impaired liver function, liver tumor, lactation less than 6 weeks postpartum, smokers older than 35 years old, migraine with aura, HTN, diabetes more than 20 years with vascular disease, can cause blood clots ​ The effectiveness can be decreased if taken with anticonvulsants, systemic antifungals, anti-tuberculosis drugs, and HIV meds TRANSDERMAL CONTRACEPTIVE SYSTEM: ESTROGEN AND PROGESTIN ​ “The patch” ​ Instructions for use: 1.​ Place on the skin in lower abdomen, upper outer arm, buttock, or upper torso (not on the breast) 2.​ One patch is worn per week for 3 weeks, then no patch for the 4th week and repeat VAGINAL CONTRACEPTIVE RING: ESTROGEN AND PROGESTIN ​ Instruction for use: 1.​ Once vaginal ring is inserted into the vagina and is worn for 3 weeks and the 4th week it is removed and no ring is worn 2.​ Inserted by the patient 3.​ If it happens to fall out with intercourse-simply reinsert within 3 hours PROGESTIN ONLY CONTRACEPTIVES: PROGESTIN ​ Forms: oral, injectable, and implantable options ORAL PROGESTINS ​ “Mini pill” ​ Instructions for use: 1.​ Take one pill each day a the same time every day 2.​ If taken more than 3 hours late-backup must be used 3.​ Women who are lactating as well as women over 40 often find this option a good choice. Estrogen can decrease milk supply so a progestin option is more favorable for women who are breastfeeding ​ Side effects/warnings: irregular vaginal bleeding INJECTABLE PROGESTINS ​ Depot medroxyprogesterone can either be given subcutaneously or IM  ​ Instructions for use: 1.​ Initiated if possible during the first 5 days of menses or once pregnant can be ruled out (1 negative pregnancy test followed by 2 weeks of abstinence and a repeat pregnancy test 2 weeks) 2.​ Given every 11-13 weeks 3.​ Ok if breastfeeding ​ Side effects/warnings: Irregular vaginal bleeding, decreased bone mineral density (calcium supplementation is recommended during use), weight gain, lipid changes, decreased libido, return to fertility may be delayed (up to 18 months) after discontinuing IMPLANTABLE PROGESTINS ​ A flexible tube is inserted under the skin of a woman's arm ​ Newest name: etonogestrel (nexplanon) ​ Instructions for use: 1.​ Good for 3 years 2.​ Ok with breastfeeding 3.​ Inserted by a provider in office with local anesthetics ​ Side effects/warnings: irregular vaginal bleeding, headaches, nervousness, skin changes, vertigo EMERGENCY CONTRACEPTIVE ​ Comes in a few different oral preparations as well as an IUD form ​ 5 methods available in the US ​ Instructions for use: 1.​ USe within 72-120 hours depending on which form you are using 2.​ Some options are available OTC for women 17 years old and older 3.​ Does not disrupt an implanted pregnancy ​ Side effects/warnings: nausea (may need antiemetic), if no menses in 21 days evaluation is needed, not meant to be used as a long term contraceptive option (needs reliable form of contraception) ​ Medical contraindications: pregnancy, undiagnosed vaginal bleeding IUD ​ Instructions for use: 1.​ All are inserted by a provider in an office setting 2.​ Women can be taught to check for the strings each month at home to check continued placement ​ Types: 1.​ The copper IUD (paragard) is good for 10 years 2.​ The hormonal IUD (mirena) is good for 5 years  3.​ The hormonal IUD (skyla) is good for 3 years 4.​ The hormonal IUD (kyleena) is good for 5 years ​ Side effects/warnings: irregular bleeding the first few months of insertion of a hormonal IUD, all IUDs pose a small risk for uterine perforation, increased risk for PID (must give strong warnings and strongly advise to practice safer sex practices) STERILIZATION ​ There are female and male sterilization procedures ​ Teaching points: procedures are meant to be permanent, reversal is costly and not always effective, if federal funds are used the patient must be 21 years old and wait 30 days after consent is given. A certified interpreter must be used when obtaining consent if needed. Partner consent is not required Describe appropriate screening assessments for the various stages in a woman’s reproductive lifespan 1 MAMMOGRAM ​ Prevention of breast cancer ​ Should begin screening at age 40 (annually or biannually until age 75) ​ If pt has a 1st degree relative who has breast cancer, screening begins 10 years prior to the age the family member was when diagnosed BREAST MRI ​ Usually done to investigate concerns found by other methods - assess tumor locations, ID cancer not detected by other means ​ If high risk for breast cancer have a mammogram and MRI ​ Good with augmented breasts ​ Breast cancer staging - assess the effectiveness of chemotherapy ULTRASOUND ​ May be done for women who are young or have dense breasts DXA SCAN ​ Osteoporosis screening ​ Dual-energy x-ray absorptiometry (DXA) ​ Data obtained from both the femur and AP spine scans are considered gold standards for diagnosing osteoporosis. ​ Usually only 5-10 minutes ​ Begin at age 65 or sooner if you are at high risk PELVIC EXAM  ​ External inspection ​ Speculum inside of vagina ​ Looking at the cervix PAP SMEAR ​ Between 21 and 65 years of age-every 3 years with pap test done ​ Between 30 and 65 years of age-every 5 years if pap test plus HPV test done ​ After 65 years of age and three negative tests and no risks and after total hysterectomy for benign disease- women may choose to stop screening ​ Test for cervical cancer ​ Swab and label with name and date of birth BREAST SELF EXAMINATION ​ Current guidelines recommend BSE as an option. Since physiologic alterations in breast size reach a minimal level about 5 to 7 days after menstruation stops, breast self-examination is best carried out during this phase of the menstrual cycle. Discuss the care of the woman with reproductive disorders and benign breast conditions 2 FIBROCYSTIC BREAST CHANGES *not a disorder just a benign breast problem (cause is uncertain, may be because of hormone changes) ​ Symptoms: lumpiness, achy/heavy breasts, dull pain ​ Symptoms may occur 1 week prior to menses and end 1 week after ​ Treatment: supportive bra, heat/cold therapy, no smoking/drinking, decrease sodium/caffeine, NSAIDS, contraception OSTEOPOROSIS ​ Decreased bone density - reduced bone strength ​ Risk factors: white, asian, petite/thin women, heredity, 12 months) Management ​ Diagnostic evaluation: platelet count and clinical manifestations ​ Therapeutic management: primarily supportive, IV immunoglobulin, anti-D antibody, may need splenectomy ​ Prognosis: self limited course without major complications Epistaxis ​ Isolated and transient epistaxis is common in childhood ​ Recurrent or severe episodes may indicate underlying disease ​ Vascular abnormalities, leukemia, thrombocytopenia, clotting factor deficiency diseases (von willebrand disease and hemophilia) ​ If a nosebleed does not stop in 10-20 minutes, go to the ER Management ​ Remain calm and keep child calm ​ Bleeding usually stops within 10 minutes after nasal pressure ​ Have child sit up and lead forward ​ Apply pressure to the soft lower part of the nose ​ Insert cotton or wadded tissue into each nostril ​ Apply ice or cold cloth to bridge of nose if bleeding persists ​ Should be evaluated by provider if continues Discuss management of common cardio-respiratory (Respiratory) conditions encountered in the pediatric ambulatory setting. 3 Respiratory Assessment ​ Vitals ​ Respiratory effort: rate, depth, ease/labored, rhythm ​ Cough: type, characteristics, position, productive ​ Behavior: restless, appetite, agitated, lethargic, irritable Respiratory Symptoms ​ Cough: congested, dry, whooping, barking ​ Lung sound: wheezing, crackles, rhonchi ​ Other symptoms: grunting, retractions, nasal flaring, stridor, head bobbing Respiratory Management ​ Fluids: small amounts frequently ​ Rest and comfort: keep nasal passages clear ​ East efforts: warm or cool mist, vapor rubs, positioning ​ Bulb suction: teach parents proper use ​ Nebulizers ​ Cough meds: OTC meds for 6 months and older or honey for 12 months and older Acute Nasopharyngitis ​ The common cold ​ S/S: congested cough, runny nose, sore throat, fever ​ Treat the symptoms ​ Parents need education and reassurance Influenza ​ The flu ​ Treat the symptoms ​ Parents need education and reassurance Acute Streptococcal Pharyngitis ​ Strep throat ​ S/S: sore throat, headache, fever, abdominal pain, edematous/red tongue, fine red rash on trunk, swollen glands ​ Antibiotics, Treat symptoms and provide comfort ​ Parents need education about care, hygiene, spread, and complications ​ Very contagious, fever will come on fast Tonsillitis ​ Very common, often occurs with pharyngitis ​ Swollen tonsils, difficulty swallowing/breathing, mouth breathing ​ Usually Viral: treat symptoms and provide comfort ​ Bacterial: treat symptoms and administer antibiotics ​ Parents need education about care, comfort, and postop care Otitis Media  ​ Ear infections,very common ​ S/S: ear aches, pain while lying down, fever, irritability, ear drainage ​ Viral: treat symptoms and provide comfort ​ Bacterial: administer antibiotics ​ Parents need education about care, comfort, antibiotics administration, and post op care if needed Infection Mononucleosis ​ Mono ​ S/S: fever, puffy eyes, headache, malaise, fatigue, sore throat, lymphadenopathy, hepatosplenomegaly ​ Treat symptoms, rest, no contact sports ​ Parents need education about progress and potential complications Croup ​ Common viral illness ​ Barking cough, afebrile, worsens at night, mild respiratory distress, hoarseness ​ Treat symptoms, warm humidified air, cool air, nebulizers ​ Parents need education about progress, care, and potential complications RSV & Bronchiolitis ​ Common viral illness, inflammation of the smaller airways ​ S/S: rhinorrhea, coughing, wheezing, eye drainage, fever ​ Treat symptoms, maintain respiratory function, hydration, nebulizers if needed, suctioning ​ Parents need education about treatments, suctioning, positioning, worsening symptoms Asthma ​ Most common chronic childhood disease ​ S/S: chronic cough (night), wheezing, tripod position, SOB ​ Identify triggers, administer medications, humidification, hydration ​ Parents and children need education about PEFM, proper medication use, recognizing warning signs Status Asthmaticus ​ Life threatening asthma exacerbation ​ S/S: inability to speak, gasping, decreased/absent breath sounds, restlessness ​ Call 911, airway maintenance, rescue treatments Cystic Fibrosis ​ Prevent respiratory complications and infections ​ Provide adequate nutrition for growth and development ​ Treat and prevent intestinal blockage ​ Encourage appropriate physical activity and exercise  Genitourinary, Integumentary, Musculoskeletal, Neurological, Cerebral, Gastrointestinal, and Endocrine Disorders Discuss the nursing strategies for caring for pediatric clients with neurological and cerebral conditions in the pediatric 2 ambulatory setting. Discuss the nursing strategies for caring for pediatric clients with musculoskeletal conditions in the pediatric ambulatory setting. 2 Discuss the nursing strategies for caring for pediatric clients with endocrine conditions in the pediatric ambulatory setting. 3 Discuss the nursing strategies for caring for pediatric clients with integumentary conditions in the pediatric ambulatory setting. 2 Discuss the nursing care strategies for children with gastrointestinal problems in the pediatric ambulatory setting. 2 Discuss the nursing strategies for caring for pediatric clients with genitourinary conditions in the pediatric ambulatory setting. 1 MED CALC 3 TOTAL 50