NUR 331 Test 3 Outline
History, Trends, and Introspection
Birth rate: the number of live births in one year per 1,000 population
Fertility rate: births per 1,000 women from ages 15-44 years of age
Infant mortality rate: the number of deaths of infants younger than one year of age per 1,000 live births
Maternal mortality rate: number of maternal deaths per 100,000 live births
Maternal death: death of a woman while pregnant or within 42 days of termination of pregnancy, that’s
regardless of duration of pregnancy, regardless of the site of the pregnancy, and from any cause related to
or aggravated by the pregnancy or its management; but it is not considered a maternal death if she is
pregnant and dies in an automobile accident or any other incidental cause.
Neonatal mortality rate: number of deaths of infants younger than 28 days of age per 1,000 live births
Perinatal mortality rate: the number of stillbirths plus the number of neonatal deaths per 1,000 live births
Low birth weight: newborns weighing less than 2,500 grams
Who is the best resource for finding out the patient’s cultural practices? The patient
Acculturation: cultural modification of an individual, group, or people by adapting to or borrowing traits from
another culture; also: a merging of cultures as a result of prolonged contact.
Who signs the informed consent?
Legal age of consent for sex in TX is 17
In TX, pregnancy makes you an emancipated minor, so you can sign all consents for yourself and newborn,
even if you are 12 years old. Once you deliver you can still sign consents for your newborn, but you can no
longer sign consents for yourself because you are a minor.
Health Screening for Women
Osteoporosis: a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a
result of hormonal changes, or deficiency of calcium or vitamin D; decreased bone density
Risk factors: Middle-age and elderly women; European American or Asian ethnic origin; Small-boned and
thin body type; Low body weight (less than 127 pounds); Family history of osteoporosis; Lack of regular
weight-bearing exercise; Nulliparity (never have borne children); Early onset of menopause; Consistently
low intake of calcium; Cigarette smoking; Moderate to heavy alcohol intake; Use of certain medications
such as anticonvulsants, corticosteroids, or lithium
Prevention/Interventions: early detection, weight bearing exercises 30 minutes 3x per week (ex: yoga,
brisk walking, strength training), smoking cessation, limited alcohol and caffeine intake, adequate dietary
calcium (1200 mg per day) and adequate vitamin D (800-1000 international units per day)
o Bone Mineral Density (BMD) Scan: low-dose x-ray that checks for mineral density; useful in
identifying individuals who are at risk for osteoporosis.
Recommended for women age 65 or older and men 70 years and older; menopausal and
postmenopausal women under age 65 and men ages 50 to 69 with one or more risk
factors; adults over age 50 who have had a fracture
Medications: women taking meds for osteoporosis should have BMD testing 2 years after beginning
therapy and every 2 years thereafter.
o Calcium and vitamin D supplements
o Bisphosphonates: calcium regulators that act by inhibiting bone resorption and increasing bone
mass. Alendronate (Fosamax) and risedronate (Actonel) are commonly prescribed.
Take in the morning on an empty stomach with a glass of water & remain up right for
30 minutes after taking medication.
Must be taken at least one hour a part from calcium supplement.
o Selective estrogen receptor modulators (SERMs): preserve the beneficial effects of estrogen,
including its protection against osteoporosis, but do not stimulate uterine or breast tissue.
Example: raloxifene (Evista)
o Salmon calcitonin: calcium regulator that may inhibit bone loss. Administered as a nasal spray, its
value is less clear than that of the other medications listed.
, o Parathyroid hormone: taken daily as a subcutaneous injection, activates bone formation, which
results in substantial increases in bone density.
Breast Health: Each month, in rhythm with the cycle of ovulation, the breasts become engorged with fluid in
anticipation of pregnancy, and the woman may experience sensations of tenderness, lumpiness, or pain. If
conception does not occur, the accumulated fluid drains away via the lymphatic network. Mastodynia or mastalgia
(premenstrual swelling and tenderness of the breasts) is common.
Breast Self-Awareness (BSA): increased familiarity with normal breast contour
Breast Self-Examination (BSE): Performed monthly starting at age 20 and continue for the rest of life.
Should be performed one week after menses (breasts are less lumpy at this time in the cycle); if no
menses it should be performed on the same day each month.
Clinical Breast Exam (CBE): Performed by a trained healthcare professional; recommended to be done
annually in women age 40 and older and every 1-3 years for women ages 20-39.
o Teaching: Advise patient to reduce caffeine 5-7 days prior to exam. (caffeine can cause lumpy
breasts and breast tenderness)
Mammogram: soft-tissue x-ray of the breast without the injection of a contrast medium. It can detect
lesions in the breast before they can be felt and has gained wide acceptance as a screening tool.
Recommended to be done every 1-2 years on women 40 and older; if a first-degree relative has/had
breast cancer screenings should begin 10 years prior to the age at which the relative was at diagnosis.
o Teaching: Schedule mammogram for about 2 weeks prior to menses; do not wear lotions,
powders, or deodorants under arms or on upper torso on the day of the test.
Ultrasound: Done for young women with dense breasts, to evaluate lumps found on mammogram, and
guided biopsy needle.
Breast MRI: used to investigate concerns found by other screenings (assess tumor locations/ID cancer not
detected by other means); if high risk for breast cancer, pt may have a mammogram and MRI done at
annual screenings; good with augmented breasts; assess breast cancer staging (also assesses the
effectiveness of chemotherapy)
Menstruation over time:
Menarche and Puberty:
o First sign of puberty is usually breast development
o Menarche: first menstrual cycle; usually occurs 2.6 years after the onset of puberty
Menstrual Cycle: periodic bleeding that begins about 14 days after
ovulation; initial cycle maybe anovulatory, irregular,
unpredictable, and painless.
o Spinnbarkeit: the formation of an elastic thread by
mucus of the uterine cervix when it is drawn out; the
time of maximum elasticity usually precedes or
coincides with ovulation.
o Mittleschmerz: one-sided, lower abdominal pain
associated with ovulation; occurs midway through a
menstrual cycle—about 14 days before the next
menstrual period.
o Important Hormones:
Estrogens: control the development of the
female secondary sex characteristics: breast
development (including breast alveolar
lobule growth and duct development),
growth of body hair, widening of the hips,
and deposits of tissue (fat) in the buttocks and
mons pubis; also assist in the maturation of the
ovarian follicles and cause the endometrial
mucosa to proliferate following menstruation. Highest during the
proliferative phase.
, Progesterone: secreted by the corpus luteum and is found in greatest amounts during
the secretory phase of the menstrual cycle. Often called the hormone of pregnancy
because its effects on the uterus allow pregnancy to be maintained.
Vaginal epithelium proliferates; Cervix secretes thick, viscous mucus; Breast
glandular tissue increases in size and complexity; Breasts prepare for lactation;
Temperature rise of about 0.3°C to 0.6°C (0.5°F to 1.0°F) accompanies ovulation
and persists throughout the secretory phase of the menstrual cycle.
Prostaglandins: oxygenated fatty acids that are pro- duced by the cells of the
endometrium; affect smooth muscle contractility; menstrual blood is potent source of
prostaglandins.
Perimenopause: ovarian function wanes and hormonal deficiencies begin to produce symptoms; generally
occurs 2-8 years before the onset of menopause
Menopause: the absence of menses for a full year; average age for menopause in the US is 51 (but can
range from 35-59); does not always need treatment.
o Psychological response: menopause is an adulthood developmental task; the psychological
significance of menopause is tied to culture.
o Physiological response: estrogen levels declines, reproductive organs undergo regression, labia
become thin and pale, vaginal mucosa atrophies, decreased vaginal lubrication, adverse effect on
serum lipids, hot flashes, vasomotor instability, insomnia
o Interventions/Medications:
Lab work: FSH, LH, estrogen, and progesterone may be tested (generally FSH and LH will
be increased and estrogen will be decreased)
Hormone replacement therapy (HRT): estrogen and progesterone for women with a
uterus; estrogen alone for women without a uterus.
Phytoestrogens: plants with estrogen properties (flaxseed, soybeans, yams, chickpeas)
Vitamin and calcium supplements
High fiber, low fat diet
Exercise
o Teaching: HRT risks/benefits (increased risk for CHD, DVT, and breast cancer); Use lowest possible
dose for the shortest possible time; Sleep in a cool room, dress in layers, have a regular bedtime
routine.
Common Menstrual Disorders:
o Amenorrhea: absence of menstrual flow; may be transient, intermittent, or chronic.
Primary: absence of menarche by age 15 in the presence of normal growth and
secondary sexual characteristics; generally caused by genetic or anatomic anomaly
Secondary: absence of menses for more than three months
Causes: Pregnancy, thyroid or endocrine disorders, eating disorders, decreased
body fat, stress, contraceptives or other medications.
Interventions/Medications: treatment depends on the cause of amenorrhea; HCG, TFT,
FSH, and USG may be tested to aid diagnosis; provera challenge (given to cause periods);
contraceptives; surgery (correction of anatomical defects)
Teaching: Decrease stress, nutritional/exercise education, how to keep a menstrual
calendar
o Dysmenorrhea: pain during or shortly before menstruation; most common gyn problem; most
problems occur during the first 3 years of menses; generally improves with childbirth; can be
severe enough to interfere with functioning for 1-3 days a month.
Primary Dysmenorrhea: pain usually begins at menses onset and lasts 8-48 hours
S/S: Backaches, weakness, sweating, GI upset (nausea/vomiting), and CNS
(dizziness, headache, syncope)
Treatment/Teaching: NSAIDs, heating pads, massage, exercise, pelvic tilts, oral
contraceptives, rest
History, Trends, and Introspection
Birth rate: the number of live births in one year per 1,000 population
Fertility rate: births per 1,000 women from ages 15-44 years of age
Infant mortality rate: the number of deaths of infants younger than one year of age per 1,000 live births
Maternal mortality rate: number of maternal deaths per 100,000 live births
Maternal death: death of a woman while pregnant or within 42 days of termination of pregnancy, that’s
regardless of duration of pregnancy, regardless of the site of the pregnancy, and from any cause related to
or aggravated by the pregnancy or its management; but it is not considered a maternal death if she is
pregnant and dies in an automobile accident or any other incidental cause.
Neonatal mortality rate: number of deaths of infants younger than 28 days of age per 1,000 live births
Perinatal mortality rate: the number of stillbirths plus the number of neonatal deaths per 1,000 live births
Low birth weight: newborns weighing less than 2,500 grams
Who is the best resource for finding out the patient’s cultural practices? The patient
Acculturation: cultural modification of an individual, group, or people by adapting to or borrowing traits from
another culture; also: a merging of cultures as a result of prolonged contact.
Who signs the informed consent?
Legal age of consent for sex in TX is 17
In TX, pregnancy makes you an emancipated minor, so you can sign all consents for yourself and newborn,
even if you are 12 years old. Once you deliver you can still sign consents for your newborn, but you can no
longer sign consents for yourself because you are a minor.
Health Screening for Women
Osteoporosis: a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a
result of hormonal changes, or deficiency of calcium or vitamin D; decreased bone density
Risk factors: Middle-age and elderly women; European American or Asian ethnic origin; Small-boned and
thin body type; Low body weight (less than 127 pounds); Family history of osteoporosis; Lack of regular
weight-bearing exercise; Nulliparity (never have borne children); Early onset of menopause; Consistently
low intake of calcium; Cigarette smoking; Moderate to heavy alcohol intake; Use of certain medications
such as anticonvulsants, corticosteroids, or lithium
Prevention/Interventions: early detection, weight bearing exercises 30 minutes 3x per week (ex: yoga,
brisk walking, strength training), smoking cessation, limited alcohol and caffeine intake, adequate dietary
calcium (1200 mg per day) and adequate vitamin D (800-1000 international units per day)
o Bone Mineral Density (BMD) Scan: low-dose x-ray that checks for mineral density; useful in
identifying individuals who are at risk for osteoporosis.
Recommended for women age 65 or older and men 70 years and older; menopausal and
postmenopausal women under age 65 and men ages 50 to 69 with one or more risk
factors; adults over age 50 who have had a fracture
Medications: women taking meds for osteoporosis should have BMD testing 2 years after beginning
therapy and every 2 years thereafter.
o Calcium and vitamin D supplements
o Bisphosphonates: calcium regulators that act by inhibiting bone resorption and increasing bone
mass. Alendronate (Fosamax) and risedronate (Actonel) are commonly prescribed.
Take in the morning on an empty stomach with a glass of water & remain up right for
30 minutes after taking medication.
Must be taken at least one hour a part from calcium supplement.
o Selective estrogen receptor modulators (SERMs): preserve the beneficial effects of estrogen,
including its protection against osteoporosis, but do not stimulate uterine or breast tissue.
Example: raloxifene (Evista)
o Salmon calcitonin: calcium regulator that may inhibit bone loss. Administered as a nasal spray, its
value is less clear than that of the other medications listed.
, o Parathyroid hormone: taken daily as a subcutaneous injection, activates bone formation, which
results in substantial increases in bone density.
Breast Health: Each month, in rhythm with the cycle of ovulation, the breasts become engorged with fluid in
anticipation of pregnancy, and the woman may experience sensations of tenderness, lumpiness, or pain. If
conception does not occur, the accumulated fluid drains away via the lymphatic network. Mastodynia or mastalgia
(premenstrual swelling and tenderness of the breasts) is common.
Breast Self-Awareness (BSA): increased familiarity with normal breast contour
Breast Self-Examination (BSE): Performed monthly starting at age 20 and continue for the rest of life.
Should be performed one week after menses (breasts are less lumpy at this time in the cycle); if no
menses it should be performed on the same day each month.
Clinical Breast Exam (CBE): Performed by a trained healthcare professional; recommended to be done
annually in women age 40 and older and every 1-3 years for women ages 20-39.
o Teaching: Advise patient to reduce caffeine 5-7 days prior to exam. (caffeine can cause lumpy
breasts and breast tenderness)
Mammogram: soft-tissue x-ray of the breast without the injection of a contrast medium. It can detect
lesions in the breast before they can be felt and has gained wide acceptance as a screening tool.
Recommended to be done every 1-2 years on women 40 and older; if a first-degree relative has/had
breast cancer screenings should begin 10 years prior to the age at which the relative was at diagnosis.
o Teaching: Schedule mammogram for about 2 weeks prior to menses; do not wear lotions,
powders, or deodorants under arms or on upper torso on the day of the test.
Ultrasound: Done for young women with dense breasts, to evaluate lumps found on mammogram, and
guided biopsy needle.
Breast MRI: used to investigate concerns found by other screenings (assess tumor locations/ID cancer not
detected by other means); if high risk for breast cancer, pt may have a mammogram and MRI done at
annual screenings; good with augmented breasts; assess breast cancer staging (also assesses the
effectiveness of chemotherapy)
Menstruation over time:
Menarche and Puberty:
o First sign of puberty is usually breast development
o Menarche: first menstrual cycle; usually occurs 2.6 years after the onset of puberty
Menstrual Cycle: periodic bleeding that begins about 14 days after
ovulation; initial cycle maybe anovulatory, irregular,
unpredictable, and painless.
o Spinnbarkeit: the formation of an elastic thread by
mucus of the uterine cervix when it is drawn out; the
time of maximum elasticity usually precedes or
coincides with ovulation.
o Mittleschmerz: one-sided, lower abdominal pain
associated with ovulation; occurs midway through a
menstrual cycle—about 14 days before the next
menstrual period.
o Important Hormones:
Estrogens: control the development of the
female secondary sex characteristics: breast
development (including breast alveolar
lobule growth and duct development),
growth of body hair, widening of the hips,
and deposits of tissue (fat) in the buttocks and
mons pubis; also assist in the maturation of the
ovarian follicles and cause the endometrial
mucosa to proliferate following menstruation. Highest during the
proliferative phase.
, Progesterone: secreted by the corpus luteum and is found in greatest amounts during
the secretory phase of the menstrual cycle. Often called the hormone of pregnancy
because its effects on the uterus allow pregnancy to be maintained.
Vaginal epithelium proliferates; Cervix secretes thick, viscous mucus; Breast
glandular tissue increases in size and complexity; Breasts prepare for lactation;
Temperature rise of about 0.3°C to 0.6°C (0.5°F to 1.0°F) accompanies ovulation
and persists throughout the secretory phase of the menstrual cycle.
Prostaglandins: oxygenated fatty acids that are pro- duced by the cells of the
endometrium; affect smooth muscle contractility; menstrual blood is potent source of
prostaglandins.
Perimenopause: ovarian function wanes and hormonal deficiencies begin to produce symptoms; generally
occurs 2-8 years before the onset of menopause
Menopause: the absence of menses for a full year; average age for menopause in the US is 51 (but can
range from 35-59); does not always need treatment.
o Psychological response: menopause is an adulthood developmental task; the psychological
significance of menopause is tied to culture.
o Physiological response: estrogen levels declines, reproductive organs undergo regression, labia
become thin and pale, vaginal mucosa atrophies, decreased vaginal lubrication, adverse effect on
serum lipids, hot flashes, vasomotor instability, insomnia
o Interventions/Medications:
Lab work: FSH, LH, estrogen, and progesterone may be tested (generally FSH and LH will
be increased and estrogen will be decreased)
Hormone replacement therapy (HRT): estrogen and progesterone for women with a
uterus; estrogen alone for women without a uterus.
Phytoestrogens: plants with estrogen properties (flaxseed, soybeans, yams, chickpeas)
Vitamin and calcium supplements
High fiber, low fat diet
Exercise
o Teaching: HRT risks/benefits (increased risk for CHD, DVT, and breast cancer); Use lowest possible
dose for the shortest possible time; Sleep in a cool room, dress in layers, have a regular bedtime
routine.
Common Menstrual Disorders:
o Amenorrhea: absence of menstrual flow; may be transient, intermittent, or chronic.
Primary: absence of menarche by age 15 in the presence of normal growth and
secondary sexual characteristics; generally caused by genetic or anatomic anomaly
Secondary: absence of menses for more than three months
Causes: Pregnancy, thyroid or endocrine disorders, eating disorders, decreased
body fat, stress, contraceptives or other medications.
Interventions/Medications: treatment depends on the cause of amenorrhea; HCG, TFT,
FSH, and USG may be tested to aid diagnosis; provera challenge (given to cause periods);
contraceptives; surgery (correction of anatomical defects)
Teaching: Decrease stress, nutritional/exercise education, how to keep a menstrual
calendar
o Dysmenorrhea: pain during or shortly before menstruation; most common gyn problem; most
problems occur during the first 3 years of menses; generally improves with childbirth; can be
severe enough to interfere with functioning for 1-3 days a month.
Primary Dysmenorrhea: pain usually begins at menses onset and lasts 8-48 hours
S/S: Backaches, weakness, sweating, GI upset (nausea/vomiting), and CNS
(dizziness, headache, syncope)
Treatment/Teaching: NSAIDs, heating pads, massage, exercise, pelvic tilts, oral
contraceptives, rest
