lOMoARcPSD|26582732
MEDICAL SURGICAL NURSING NUR 201 STUDY NOTES -EXAM 2
Women’s health sex education for pregnant adolescent
a. Teaching for pregnant adolescence
b. The teaching should be based on the adolescence developmental level
c. Teaching should include
i. Importance
of continued
prenatal and follow
up care
ii. Smoking
cessation iii. Body
weight control
Iv. Interpersonal violence and the need of folic acid
v. Avoiding teratogenic agents
Teratogenic agents
a. Definition of teratogen
b. Any environment substance that can cause physical defects in the
developing embryo or fetus such as alcohol and drugs
c. Infection ( such as rubella or cytomegalovirus), radiation, nutritional
should be avoided by pregnant moms, esp in the embryonic stage ( 2-8 weeks,
when body parts are being formed). This is the period when the fetus embryo is
at the greatest risk
Endometriosis
● Risk for infertility
● Chronic and progressive
● Risk factors: increasing age (30-40), short menstrual cycle (<28days), long menstrual flow
(>1week), young onset of menarche ( before 12yo), few or no pregnancies, high-fat diet, family
hx, hx of pid
● Manifestation o pelvic pain/bloating o infertility
o Pain before and during period – debilitating —> precursor sign o pain during or after
sex (dyspareunia) o chronic pelvic pain
● Diagnostics o pelvic exam – hallmark: presence of tender modular masses o laparoscopic +
biopsy —> definite diagnosis – chocolate cysts
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▪ consent
▪ npo
▪ iv lock
● Management o nsaids
o Oral contraceptives
o Hormone suppression – delicate balance to reduce inflammation and avoiding
amenorrhea
▪ depo-provera, progestogens, antiestrogens, gnrh agonists o surgery-
removal: laser laparoscopy to open tubes – no guarantee for fertility
● Nursing
o Explain condition and testing procedures
o Encourage healthy lifestyle (diet, exercise, sleep, stress management) o refer to
support groups – help deal with infertility o encourage to get second opinion
Contraception
● Abstinence – protects against stis
● Fertility awareness – doesn’t protect against stis o basal body
temperature
▪ most accurate predictor of ovulation
▪ temperature taken on awakening
▪ post ovulation t increased
▪ t rises within day or two after ovulation and remains elevated about 2 weeks
● Avoid unprotected sex until bbt has been elevated for 3 days
● Withdrawal – no sti protection o education for teens:
▪ not safe
▪ no sti protection
▪ 30 % failure rate
● First drops of ejaculate contain highest sperm concentration
● Barrier methods – sti protection o best and most popular o condoms:
▪ 18 % failure rate
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▪ for both male and female
▪ breakage or slippage may occur —> postocoital contraceptive (plan b) needed
▪ non-latex condoms less safe
▪ female condoms are more resistant and thicker than male condoms
▪ teaching – male condoms:
● Buy pre lubricated condoms – don’t add lubricant
● Don’t keep in wallet or car – store in cool, dry place
● Check expiration date before use
● New condom for each sexual act
● Be careful with teeth and fingernails – microscopic punctures possible
● Put on erect penis
● Leave reservoir space (1/2 inch)
● Avoid oil based products – may cause breakage
● Hold condom when withdrawing and remove condom while penis is still
erect
▪ teaching – female condom
● Practice wearing and insertion prior first use
● Can be inserted up to 8h prior
● One-time use only
● No rings and careful with fingernails to avoid tears
● Insert inner ring high in the vagina, against the cervix
● Place outer ring on the outside of the vagina
● Make sure erect penis is placed inside the female condom
● Remove condom after intercourse – avoid spilling ejaculate
o Diaphragm
▪ used in conjunction with spermicidal jelly or cream
● Has to be taken out, washed and jelly has to be reapplied for next
intercourse
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▪ insertion up to 4h prior
▪ must be left in place at least 6h after sex
● Don’t leave in longer—> risk for toxic shock syndrome! ▪ needs rx and
fitting by hcp
● Refitting after pregnancy, abdominal or pelvic surgery, weight loss or
gain of more than 10lb
▪ replace every 1-2 years
▪ teaching
● Avoid use of oil-based products – weakens the rubber
● Wash with soap and water after use and dry thoroughly
● Place back into storage case
● Don’t use with latex allergy
● Always empty bladder prior to insertion
● Hold up to light or fill with water to inspect for holes and tears
● Place spermicide (about 1 tbps) in the dome and around the rim
● Hold between thumb and finger to compress into “figure-eight” shape
● Insert into vagina directing it downwards as far as it will go
● Tuck the front rim behind the pubic bone so that rubber hugs the front
wall of the vagina
● Feel for the cervix through the diaphragm to check for placement
o Cervical cap
▪ only covers cervix – held in place by suction
▪ used with spermicide
▪ insertion up to 12h prior – protection for 48h
▪ must be kept in for 8h after sex —> don’t leave longer – risk for uti and toxic
shock syndrome!
▪ replace every 1-2years ▪
rx and fitting by hcp
Downloaded by NELSON KIIRU ()
MEDICAL SURGICAL NURSING NUR 201 STUDY NOTES -EXAM 2
Women’s health sex education for pregnant adolescent
a. Teaching for pregnant adolescence
b. The teaching should be based on the adolescence developmental level
c. Teaching should include
i. Importance
of continued
prenatal and follow
up care
ii. Smoking
cessation iii. Body
weight control
Iv. Interpersonal violence and the need of folic acid
v. Avoiding teratogenic agents
Teratogenic agents
a. Definition of teratogen
b. Any environment substance that can cause physical defects in the
developing embryo or fetus such as alcohol and drugs
c. Infection ( such as rubella or cytomegalovirus), radiation, nutritional
should be avoided by pregnant moms, esp in the embryonic stage ( 2-8 weeks,
when body parts are being formed). This is the period when the fetus embryo is
at the greatest risk
Endometriosis
● Risk for infertility
● Chronic and progressive
● Risk factors: increasing age (30-40), short menstrual cycle (<28days), long menstrual flow
(>1week), young onset of menarche ( before 12yo), few or no pregnancies, high-fat diet, family
hx, hx of pid
● Manifestation o pelvic pain/bloating o infertility
o Pain before and during period – debilitating —> precursor sign o pain during or after
sex (dyspareunia) o chronic pelvic pain
● Diagnostics o pelvic exam – hallmark: presence of tender modular masses o laparoscopic +
biopsy —> definite diagnosis – chocolate cysts
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
▪ consent
▪ npo
▪ iv lock
● Management o nsaids
o Oral contraceptives
o Hormone suppression – delicate balance to reduce inflammation and avoiding
amenorrhea
▪ depo-provera, progestogens, antiestrogens, gnrh agonists o surgery-
removal: laser laparoscopy to open tubes – no guarantee for fertility
● Nursing
o Explain condition and testing procedures
o Encourage healthy lifestyle (diet, exercise, sleep, stress management) o refer to
support groups – help deal with infertility o encourage to get second opinion
Contraception
● Abstinence – protects against stis
● Fertility awareness – doesn’t protect against stis o basal body
temperature
▪ most accurate predictor of ovulation
▪ temperature taken on awakening
▪ post ovulation t increased
▪ t rises within day or two after ovulation and remains elevated about 2 weeks
● Avoid unprotected sex until bbt has been elevated for 3 days
● Withdrawal – no sti protection o education for teens:
▪ not safe
▪ no sti protection
▪ 30 % failure rate
● First drops of ejaculate contain highest sperm concentration
● Barrier methods – sti protection o best and most popular o condoms:
▪ 18 % failure rate
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
▪ for both male and female
▪ breakage or slippage may occur —> postocoital contraceptive (plan b) needed
▪ non-latex condoms less safe
▪ female condoms are more resistant and thicker than male condoms
▪ teaching – male condoms:
● Buy pre lubricated condoms – don’t add lubricant
● Don’t keep in wallet or car – store in cool, dry place
● Check expiration date before use
● New condom for each sexual act
● Be careful with teeth and fingernails – microscopic punctures possible
● Put on erect penis
● Leave reservoir space (1/2 inch)
● Avoid oil based products – may cause breakage
● Hold condom when withdrawing and remove condom while penis is still
erect
▪ teaching – female condom
● Practice wearing and insertion prior first use
● Can be inserted up to 8h prior
● One-time use only
● No rings and careful with fingernails to avoid tears
● Insert inner ring high in the vagina, against the cervix
● Place outer ring on the outside of the vagina
● Make sure erect penis is placed inside the female condom
● Remove condom after intercourse – avoid spilling ejaculate
o Diaphragm
▪ used in conjunction with spermicidal jelly or cream
● Has to be taken out, washed and jelly has to be reapplied for next
intercourse
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
▪ insertion up to 4h prior
▪ must be left in place at least 6h after sex
● Don’t leave in longer—> risk for toxic shock syndrome! ▪ needs rx and
fitting by hcp
● Refitting after pregnancy, abdominal or pelvic surgery, weight loss or
gain of more than 10lb
▪ replace every 1-2 years
▪ teaching
● Avoid use of oil-based products – weakens the rubber
● Wash with soap and water after use and dry thoroughly
● Place back into storage case
● Don’t use with latex allergy
● Always empty bladder prior to insertion
● Hold up to light or fill with water to inspect for holes and tears
● Place spermicide (about 1 tbps) in the dome and around the rim
● Hold between thumb and finger to compress into “figure-eight” shape
● Insert into vagina directing it downwards as far as it will go
● Tuck the front rim behind the pubic bone so that rubber hugs the front
wall of the vagina
● Feel for the cervix through the diaphragm to check for placement
o Cervical cap
▪ only covers cervix – held in place by suction
▪ used with spermicide
▪ insertion up to 12h prior – protection for 48h
▪ must be kept in for 8h after sex —> don’t leave longer – risk for uti and toxic
shock syndrome!
▪ replace every 1-2years ▪
rx and fitting by hcp
Downloaded by NELSON KIIRU ()
