GU-2

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Author:
atmu
ID:
173985
Filename:
GU-2
Updated:
2012-09-28 21:57:42
Tags:
GU
Folders:

Description:
Test 2
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  1. Lower Estrogen causes:
    • 1. Hot flashes
    • 2. Atrophic vaginitis (dry pussy)
    • 3. Bone density loss
    • 4. Interrupted sleep
    • 5. Urinary symptoms
    •     -atrophic changes = stress and urge incontinence
    •     -dysuria, urgency and frequency
  2. Treatment of Hot Flashes
    • 1. Lifestyle mods
    • 2. Estrogen (most effective, highest risk)
    • 3. Progestins (synthetic estrogen)
    • 4. SSRI anti-depressants
    •    -decrease incidence and severity
    •    -dosage less than needed for depression
    •    -side effect: sexual dysfunction, dry mouth, nausea
    • 5. Gabapentin
    • 6. Biologic agents
    •    -phytoestrogens (soy, chick peas, lentils, red clover)
    •    -black cohosh (plant)
    •    -evening primrose (flower)
  3. effect of menopause on the vagina
    • 1. decrease vaginal elasticity, shorted vaginal canal
    • 2. appears pale
    • 3. can become irritated, dry
    • 4. increase pH of vagina --> increase bacterial vaginitis
  4. Osteoporosis Preventative Measures
    • 1. Weight bearing exercise
    • 2. Adequate daily calcium and vit D
    • 3. Treat vit D deficiency, which is common
    • 4. decrease smoking
    • 5. decrease excessive alcohol
    • 6. counsel if amenorrhea due to low body weight
  5. Rx for Osteoporosis
    • 1. Biphosphonates - decreases osteoclastic activity
    • 2. Denosumab - osteoclast inhibitor
    • 3. Teriparatide - parathyroid hormone
  6. Combination Therapy (Progestin + Estrogen) - Adverse Effects
    • 1. Additional progestins cause headache, fatigue, fbloating, cramps, bleeding
    • 2. Cyclical progestins cause cyclical bleeding
    • 3. Continuous progestins causees unpredictable light bleeding x6 months

    Combo therapy INCREASES risk for heart disease and breast cancer; risk arises 5-7 yrs after start
  7. When to use Estrogen
    • -If menopausal Sx are severe, disabling
    •      *limit use to short term (1-2 years)
    •      *before prescribing, obtain med hx, breast exam, pap, mammo
  8. Relative contraindication to estrogen therapy
    • 1. Uterine leiomyoma
    • 2. Endometriosis
    • 3. History of migraine
    • 4. History of pregnancy-related or OCP-related thrombosis
  9. Absolute Contraindications to Estrogen Therapy
    • 1. Undiagnosed vaginal bleeding
    • 2. Suspicion or hx of breast CA
    • 3. Suspicion or hx of endometrial CA
    • 4. Active venous thrombosis
    • 5. Malignant melanoma
  10. Preconception counseling
    • 1. Folic acid - supplement reduce neural tube defects by 50%
    • 2. Rubella status - need vaccine to baby doesn't get it
    • 3. Diabetes (preconception) - causes high birth defects
    • 4. Hypothyroidism - can be treated w/ Levothyroxine, which promotes proper neurologic development
  11. Frequency of Visits
    • 1. Every 4 weeks until 28 weeks
    • 2. Every 2 weeks 28-36 weeks
    • 3. Every week after 36 weeks
  12. Contractions of False Labor
    • 1. irregular intervals
    • 2. intensity unchanged
    • 3. no change in cervical dilation
    • 4. discomfort mainly in lower abdomen
    • 5. relieved by sedation
  13. Contractions of True Labor
    • 1. Regular intervals
    • 2. Interval gradually shortens
    • 3. Intensity gradually increases
    • 4. Cervix dilates
    • 5. Discomfort in back and entire abdomen
    • 6. no relief with sedation
  14. Pelvic Exam of Labor
    • 1. Dilation (expressed in cms)
    • 2. Effacement (process of thinning out; expressed in percentage from 0% to 100% = paper thin)
    • 3. Station (-3 to +3 = baby head coming out)
  15. Stages of Labor
    • 1. First stage = onset of contractions to fully dilated
    • 2. Second stage = fully dilated to delivery of baby
    • 3. Third stage = birth to delivery of placenta
    • 4. Fourth stage = post partem care (recovery of mom)
  16. Pain management in Labor
    • 1. First stage
    •    -regional: epidurals, spinal, combined
    •    -systemic: opoids (morphine, fentanyl, meperidine)
    • 2. Second stage
    •    -local for episiotomy
    •    -pudendal block for episiotomy, instrumentation
  17. Indication of episiotomy
    • 1. facilitate delivery
    • 2. inevitable tear
    • 3. forceps/vacuum/breech delivery
  18. Perineal Lacerations
    • 1. 1st degree - vaginal mucosa or perineal skin
    • 2. 2nd degree - subepithelial tissues of the vagina with or without perineal body
    • 3. 3rd degree - anal sphincter
    • 4. 4th degree - rectal mucosa exposin the lumen of the rectum

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