Maternity first exam

Maternity first exam Ch: 3, 5, 6, 9, 10, 11, 47 Definition of family: two or more people who live in the same household (usually), share a common emotional bond, and perform certain interrelated social tasks. Family of orientation (the family one is born into; or oneself, mother, father, and siblings, if any) Family of procreation (a family one establishes; or oneself, spouse or significant other, and children) Family types: - A dyad family consists of two people living together, usually a woman and a man, without children. - Cohabitation families are composed of heterosexual couples, and perhaps children, who live together but remain unmarried; an effective cohabitation arrangement offers psychological comfort and financial security like marriage. - The traditional nuclear family structure is composed of a husband, wife, and children - An extended family includes not only the nuclear family but also other family members such as grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren. - In a blended family, or a remarriage or reconstituted family, a divorced or widowed person with children marries someone who also has children. - Communal family are formed by groups of people who choose to live together as an extended family. - Gay lesbian family are individuals of the same sex live together as partners for companionship, financial security, and sexual fulfillment. Essential for a family to perform to survive as a healthy unit: - Physical maintenance, socialization of family members, allocation of resources, maintenance of order, division of labor, reproduction/recruitment and release of family members, placement of members into larger society, and maintenance of motivation and morale Assessment of family: APGAR: Adaptation, partnership, growth, affection and resolve. Puberty is the stage of life at which secondary sex changes begin. These changes are stimulated when the hypothalamus synthesizes and releases gonadotropin-releasing hormone (GnRH), which in turn triggers the anterior pituitary to begin the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH initiate the production of androgen and estrogen, which in turn initiate secondary sex characteristics. - Adrenarche is the development of pubic and axillary hair because of androgen stimulation (androgen) - Thelarche is The beginning of breast development (estrogen) - Menarche is the first menstrual period usually at 9yrs to 12yrs old. Irregular menstrual periods are the rule rather than the exception for the first year. Menstrual periods do not become regular until ovulation consistently occurs with them (menstruation is not dependent on ovulation), and this does not tend to happen until 1 to 2 years after menarche. This is one reason why estrogen-based oral contraceptives are not commonly recommended until a girl’s menstrual periods have become stabilized or are ovulatory (to prevent administering a compound to halt ovulation before it is firmly established). Spinnbarkeit Test. At the height of estrogen secretion, cervical mucus not only becomes thin and watery but also can be stretched into long strands. This stretchability is in contrast to its thick, viscous state when progesterone is the dominant hormone; midpoint of a menstrual cycle is another way to demonstrate that high levels of estrogen are being produced and, by implication, that ovulation is about to occur. Healthy people 2020 goals: Obstetrics: contraceptives, STD, abortions, breast diseases, gynecological diseases like cervical polyps, ovarian cysts, cysts, uterine prolapse, and leiomyomas (fibroids) Menstrual cycle disorder Cause/symptom Additional information Amenorrhea primary/secondary Amenorrhea refers to the absence of menstrual periods; it may be either primary (meaning a woman never developed menstrual periods) or secondary (absence of menstrual periods in a woman who was previously menstruating). Absent of a period Secondary: excessive exercise, ovary disease, infertility, pregnancy This appears to be associated with their low ratio of body fat to body muscle, which leads to excessive secretion of prolactin. Menstrual cycles usually return to normal within 3 months after discontinuation of strenuous training and conditioning. Menorrhagia abnormally heavy menstrual flows Ask: how long it takes her to saturate a sanitary napkin or tampon. A sanitary napkin or tampon holds approximately 25 mL of fluid. If a pad or tampon is saturated in less than 1 hour, the flow is considered heavier than usual. Usually defined as greater than 80 mL per menses. It may occur in girls close to puberty and it occurs again in women nearing menopause because of an ovulatory cycles. Metrorrhagia Bleeding between menstrual periods. It may also occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. Can be an early sign of uterine carcinoma or ovarian cysts. Spotting may also represent a temporarily low level of progesterone production and endometrial sloughing (dysfunctional uterine bleeding or a luteal phase defect), although this condition most often occurs near the end of the reproductive years. Mittelschmerz Pain around ovulation near middle of their menstrual cycle Dysmenorrhea: Painful menses Primary: no evidence of pelvic abnormality Secondary: pathologic condition is identified Cramps due to vasopressins and prostaglandins from the endometrium contribute tx: NSAIDS, COC pill (birth control), R/O endometriosis If no controlled in 6 months. Can be a preliminary symptom of an underlying illness such as PID, uterine myomas (tumors), or endometriosis (abnormal formation of endometrial tissue). Premenstrual dysphoric disorder (PDD) is a severe form of PMS that includes physical and behavioral symptoms that usually resolve with the onset of menstruation. Is a condition that occurs in the luteal phase of the menstrual cycle and is relieved by the onset of menses. It has both behavioral and physiologic symptoms. Because of the variety of possible symptoms Symptoms that include anxiety, fatigue, abdominal bloating, headache, appetite disturbance, irritability, and depression. Menometrorrhagia Prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal. Combination of metrorrhagia and menorrhagia. It occurs in up to 24% of women ages 40-55 years. Toxic shock syndrome TSS Caused by strains of staphylococcus aureus toxins that can produce shock, coagulation defects, and tissue damage if they enter the bloodstream. Trapping of bacteria in the reproductive tract for prolonged periods of time. s/s: sudden spike in fever, flu like symptoms, hypotension, generalized rash that resembles a sunburn, skin peeling from palms of hands and soles of feet after 1 to 2 weeks of illness. Septic shock – renal, liver, and CNS involvement. Usually result from Use of high absorbency tampons and use of a diaphragm or cervical cap for contraception. Measures to prevent toxic shock syndrome include avoiding feminine hygiene sprays because these products can irritate the vaginal lining. Key is prevention: hand hygiene, change tampons every 4 hours. Do not use super absorbent, use peripads when sleeping, do not use diaphragm or cervical cup during menstrual period. Endometriosis is the abnormal growth of extrauterine endometrial cells, often in the cul-de-sac of the peritoneal cavity or on the uterine ligaments or ovaries. This abnormal tissue results from excessive endometrial production and a reflux of blood and tissue through the fallopian tubes during a menstrual flow. Related to excess estrogen production or a failed luteal menstrual phase. Tissue that resembles the endometrium outside of the uterus. Can cause pain, pressure, and inflammation. Can cause painful sexual intercourse called dyspareunia. Tx: depo-provera causes dysmenorrhea when the abnormal tissue responds to estrogen and progesterone stimulation by swelling and then sloughing its layers in the same manner as the uterine lining. This causes inflammation of surrounding tissue in the abdominal cavity and an even greater release of prostaglandins. Abnormal tissue in the pelvic cul-de-sac can cause dyspareunia (painful coitus) Uterine fibroids or leiomyomas Benign growth of uterine muscle cells. Grow under influence of estrogen causing irregular bleeding, pelvic pressure, dysmenorrhea, and menorrhagia If asymptomatic, observed and reevaluation without tx. For symptomatic: hormones Surgical interventions: Myomectomy: surgical removal of fibroids Embolization: block blood cells to starve fibroids Hysterectomy: surgical removal of uterus …………………………………………..CONTINUED……………………………………………..