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foxyt14
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prolapsed cord
s/s
displacement of cord in front of presenting part
- visible cord
- palpable cord
- fetal bradycardia
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Nursing considerations of a woman with a prolapsed cord
- check FHT's at ROM and after nxt contraction
- D/C pit
- vaginal exam for palpable cord
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If find a prolapsed cord I....
- exert upward pressure on presenting part
- call for help
- knee chest position
- admin O2
*if protrudes vagina, place sterile moistened gauze over it
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S/S of uterine rupture
- abdominal pain/tenderness
- chest pain
- hypovolemic shock
- fetal distress
- absent FHTs
- cessation of UC's
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What causes a uterus to rupture
- previous uterine incision
- blunt trauma
- intense labor contractions
- Intrauterine manipulation (forceps/IUPS)
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How do you treat a woman whose uterus has ruptured?
- c section
- volume replacement
- O2
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Amniotic Embolism
when amniotic fluid is drawn in to maternal circulation and is carried to the lungs causing obstruction and vasoconstriction
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S/S of amniotic fluid embolism
- abrupt respiratory distress
- heart failure
- circulatory collapse
- DIC
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What causes amniotic fluid embolism?
- ROM
- strong labor with tetanic contractions...causing high intrauterine pressure forcing amniotic fluid in to open uterine or cervical veins
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How do you prevent amniotic fluid embolism?
- prevent tetanic contractions AROM
- no Jacuzzi after ROM
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Perimortem Cesarean 4 minute rule
when a mom crashes during birth CPR is not initiated until 4 minutes after she has been down
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Infertility
- the inability to conceive after 1 year of regular intercourse (2-3x/week) without contraception.....OR
- any involuntary inability to conceive at the time desired
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What causes impotence/abnormal erections
- CNS dysfunction from....
- drugs like antihypertensives
- psych disturbances
- chronic illnesses like DM
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What causes abnormal ejaculation...can be slow, absent or retrograde in to the bladder
- from DM
- neuro surgery impairing nerves
- drugs-antihypertensives, psychotropic
- anatomic abnormalities
- alcohol
- illicit drugs
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Varicocele
- Bag of Worms
- blocked ducts carry sperm to penis and changes temperature of ducts carrying the sperm
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Turner's Syndrome
failure of ovaries to respond to the pituitary gland....complete or partial absence of the secondary sex chromosome
causing infertility (ovaries cant make eggs or female hormones) and endocrine issues
to have kids must adopt or have an egg donated
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How do you treat Turners Syndrome
- growth hormone started at 2-5yo
- hormone replacement started at 12-15yo...and continued to prevent CAD and osteoporosis
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Klinefelter's Syndrome
sex linked male defect...they have an extra X chromosome....female characteristics
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How is infertility evaluated?
- Semen analysis is first...no sex for 3 days before
- need more than 1 specimen
- delivered to Dr. within 2 hrs
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What do you look at to see if a woman has fertility issues?
- Good hx and exam
- look ovulation prediction measurement
- pelvic US looking at organ structure, ovarian follicles and relase of ova
- Hysterosalpingography-xray of uterus and tubes with contrast
- Postcoital test to see how sperm reacts to cervical mucus
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How can you tell a woman is ovulating?
temperature starts to increase 14 days prior to period starting.
increase is 0.3-0.5 degrees
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When should a woman start breast self exams?
20s
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When do you do a breast self exam?
one week after her start of period cuz it is less glandular, most comfortable
done every month
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Clinical Breast exam rules
- 20's and 30's a part of a regular health exam <3 years
- 40's it should be done every year
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Baseline mammogram done at age...... then.....and older q 1yr
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Mammogram shows
abnormalities of breast
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Breast US shows
picture of the tissues in the breast, and areas closest to the chest wall.....which is hard to see on a mammogram
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Breast MRI
used for special higher risk populations....NO RADIATION in this test
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When should pelvic exams start?
once becomes sexually active or 21 yo or if have symptoms of a disorder like amenorrhea or STD
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3 stages of pap smear
- Bethesda System
- WNL
- Squamous cells
- Glandular cells...adenocarcinoma
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what happens if cellular changes are found on a pap smear?
- evaluate further with colposcopy and biopsy
- treat with cryotherapy
- excise a part of the cervix
- rarely....hysterectomy
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