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173 Cards in this Set
- Front
- Back
Anatomy and Physiology: |
The symphysis pubis is covered by a pad of adipose tissue called the mons pubis or mons veneris, which in the postpubertal female is covered with coarse terminal hair
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Anatomy and Physiology:
External Genitalia: Vulva: Labia Majora/Minora |
Extends downward and backwards from the mons pubis.
Two folds of adipose tissue covered by skin Labia majora Vary in appearance depending on the amount of adipose tissue present, The outer surface of the labia majora is also covered in hair in the postpuberal female Labia minora Lying inside and usually hidden by the labia majora are the labia minora, two hairless, flat, reddish folds. The labia minora meet at the anterior of the vulva, where each labium divides with two lamellae, the lower pair fusing to form the frenulum of the clitoris. |
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Anatomy and Physiology:
External Genitalia: Vulva: Clitoris |
The labia minora meet at the anterior of the vulva, where each labium divides with two lamellae, the lower pair fusing to form the frenulum of the clitoris.
Tucked behind the frenulum and the prepuce is the clitoris, a small bud or erectile tissue, the homolog of the penis and the primary center of sexual excitement, |
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Anatomy and Physiology:
External Genitalia: Vulva: Vestibular glands |
Skene, Bartholin ducts
Produces lubrication Prone to infection Skene ducts Skene ducts drain a group of urethral glands and open onto the vestibule on each side of the urethra Bartholin ducts Located posteriorly on each side of the vaginal orifice, open onto the sides of the vestibule in the groove between the labia minora and the hymen During sexual excitement, bartholin glands secrete mucus into the introitus for lubrication |
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Anatomy and Physiology:
External Genitalia: Vulva: Vaginal Vestibule |
The labia minora enclose the area designated as the vestibule, which contains six openings
The urethra The vagina Two ducts of bartholin glands Two ducts of skene glands |
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Anatomy and Physiology:
External Genitalia: Vulva: Vaginal oriface |
Interiotus
During sexual excitement, bartholin glands secrete mucus into the introitus for lubrication Aka vaginal orifaces The vaginal opening occupies the posterior portion of the vestibule and varies in size and shape Surrounding the vaginal opening is the hymen, a connective tissue membrane that may be circular, cresentric, or fimbriated, After the hymen tears and becomes permanently divided, the edges either disappear or form hymenal tags, |
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Anatomy and Physiology:
External Genitalia: Vulva: Uretheral Opening |
The lower two thirds of the urethra lie immediately above the anterior vaginal wall and terminate below the clitoris.
Skene ducts drain a group of urethral glands and open onto the vestibule on each side of the urethra. The ductal openings may be visible. |
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Anatomy and Physiology: Internal Genitalia: VAGINA
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Musculomembranous tube that is transversely rugated during the reproductive phase of life.
Inclines posteriorly at an angle of approx. 45 degrees with the vertical plane of the body, The anterior wall of the vagina is separated with the bladder and the urethra by connective tissue called the vesicovaginal septum. The posterior vaginal wall is separated from the rectum by the rectovaginal septum Usually, the anterior and posterior walls of the vagina lie in close proximity, with only a small space between them. The upper end of the vagina is a blind vault into which the uterine cervix projects. The pocket formed around the cervix is divided into the anterior, posterior, and lateral fornices. These are of clinical importance because the internal pelvic organs can be palpated through their thin walls. Vagina carries menstrual flow from the uterus, serves as the terminal portion of the birth canal, and is the receptive organ for the penis during sexual intercourse. |
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Anatomy and Physiology: Internal Genitalia: UTERUS
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Size of patient’s fist
Thick and fibrous Sits in the pelvic cavity between the bladder and rectum. It in an inverted pear-shaped, muscular organ that is relatively mobile. Uterus is covered by the peritoneum and lined by the endometrium, which is shed during menstruation. The rectouterine cul-de-sac (pouch of douglas) is a deep recess formed by the peritoneum as it covers the lower posterior wall of the uterus and upper portion of the vagina, separating it from the rectum. Uterus is flattened anteroposteriorly and usually inclines forward at a 45 degree angle, although the size may be anteverted, anteflexed, retroverted, or retroflexed. Uterus is divided anatomically into two parts Corpus Consists of the fundus, which is the convex upper portion between the points of insertion of the fallopian tubes; the main portion of the body; the isthmus, which is the constricted lower portion adjacent to the cervix Cervix The cervix extends from the isthmus into the vagina. Distal part The uterus opens into the vagina via the external cervical os. |
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Anatomy and Physiology: Internal Genitalia: UTERUS: CORPUS
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Consists of the fundus, which is the convex upper portion between the points of insertion of the fallopian tubes; the main portion of the body; the isthmus, which is the constricted lower portion adjacent to the cervix
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Anatomy and Physiology: Internal Genitalia: UTERUS: CERVIX
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The cervix extends from the isthmus into the vagina.
Distal part The uterus opens into the vagina via the external cervical os. |
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Anatomy and Physiology: Internal Genitalia: ADNEXA
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Adnexa of the uterus comprise
Fallopian tubes Ranges from 8-14 cm long and is supported by a fold of a broad ligament called the MESOSALPINX The isthmus of each fallopian tube ends in the uterine cavity The fimbriated end opens into the pelvic cavity, with a projection that extends to the ovary and captures the ovum Ovaries Pair of oval organs resting in a slight depression on the lateral pelvic wall at the level of the antereosuperior iliac spine. Approx. 3 cm long, 2 cm wide, and 1 cm thick in the adult woman during the reproductive years, Ovaries secrete estrogen and progesterone, hormones that have several functions, including controlling the menstrual cycle and supporting pregnancy. Uncommon to be able to palpate ovary. |
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Anatomy and Physiology: Internal Genitalia: ADNEXA: FALLOPIAN TUBE
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Ranges from 8-14 cm long and is supported by a fold of a broad ligament called the MESOSALPINX
The isthmus of each fallopian tube ends in the uterine cavity The fimbriated end opens into the pelvic cavity, with a projection that extends to the ovary and captures the ovum |
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Anatomy and Physiology: Internal Genitalia: ADNEXA: OVARIES
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Pair of oval organs resting in a slight depression on the lateral pelvic wall at the level of the antereosuperior iliac spine.
Approx. 3 cm long, 2 cm wide, and 1 cm thick in the adult woman during the reproductive years, Ovaries secrete estrogen and progesterone, hormones that have several functions, including controlling the menstrual cycle and supporting pregnancy. Uncommon to be able to palpate ovary. |
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Anatomy and Physiology: Menstrual Cycle: MENSTRUAL PHASE
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Days 1-4
ovary Estrogen levels begin to rise, preparing follicle and egg for next cycle. uterus Progesterone stimulates endometrial prostaglandins that cause vasoconstriction Upper layers of endometrium shed CNS hormones Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels decrease Symptoms Menstrual bleeding may vary, depending on hormones and prostaglandins |
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Anatomy and Physiology: Menstrual Cycle: POST MENSTRUAL PHASE
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Days 5-12
Proliferation Ovary Ovary and maturing follicle produce estrogen; follicular phase—egg develops within follicle Uterus Proliferative phase-uterine lining thickens Breast Parenchymal and proliferation (increased cellular activity) of breast ducts occurs CNS hormones FSH stimulates ovarian follicular growth |
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Anatomy and Physiology: Menstrual Cycle: SECREATORY PHASE
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Days 15-20
Ovary Egg (ovum) is moved by cilia into the uterus Uterus After the egg is released, the follicle becomes a corpus luteum; secretion of progesterone increases and predominates CNS hormones LH and FSH decrease |
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Anatomy and Physiology: Menstrual Cycle: PREMENSTRUAL PHASE: LUTEAL PHASE
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Days 21-28
Ovary If implantation does not occur, the corpus luteum degenerates; progesterone production decreases, and estrogen production drops and then begins to rise as a new follicle develops Uterus menstruation occurs around day 28, which begins day one of the menstrual cycle breast alveolar breast cells differentiate into secretory cells CNS hormones increased levels of gonadotropin-releasing hormone cause increased secretion of FSH symptoms vascular engorgement and water retention may occur |
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Bony pelvis during pregnancy
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the bony pelvis is important in accommodating a growing fetus during pregnancy and in the birth process
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Anatomy and Physiology: Bony Pelvis: FOUR BONES
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Two innominate (ilium, ischium, pubis)
Sacrum Coccyx |
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Four pelvic joints
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Symphysis pubis
Sacrococcygeal Two sacroiliac |
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Pelvic joints during pregnancy
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Pelvic joints that don’t move much
during pregnancy, increased levels of circulating hormones estrogen and relaxin contribute to the strengthening elasticity of public ligaments and softening of the cartilage as a result, the public joint separate slightly, allowing some motility |
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Anatomy and Physiology: Infants/Children: Vagina
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the vagina of the female infant in a small narrow tube with fewer epithelial layers than that of the adult
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Anatomy and Physiology: Infants/Children: Cervix
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the cervix constitutes about two thirds of the entire length of the uterus
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Anatomy and Physiology: Infants/Children: Ovaries
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the ovaries are tiny and functionally immature
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Anatomy and Physiology: Infants/Children: labia majora
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hairless
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Anatomy and Physiology: Infants/Children: Hymen
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Hymen intact
Flap of tissue a thin diaphragm just inside the introitus, usually with a crescent shaped opening |
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Anatomy and Physiology: Infants/Children: Genitalia growth
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during childhood, the genitalia, except for the clitoris, grow incrementally at varying rates.
Anatomic and functional development accelerates with the onset of puberty and the accompanying hormonal changes |
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Anatomy and Physiology: Adolescents
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Puberty - functional maturation of reproductive organs
Increase in external genitalia during puberty, the external genitalia increase in size and begin to assume adult proportions Clitoris becomes erectile Pubic hair develops Vagina lengthens/secretions become acidic Uterus/ovaries/tubes increase in size Uterine musculature/vascular supply increase Endometrial lining thickens the endometrial lining thickens in preparation for the onset of menstruation (menarche), which on average occurs between 11 and 14 years of age United States just before menarche, vaginal secretions increase |
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functional maturation of the reproductive organs is reached during __________
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functional maturation of the reproductive organs is reached during PUBERTY
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Anatomy and Physiology: Pregnant Women: INCREASE IN WHAT HORMONES
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estrogen and progesterone
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Anatomy and Physiology: Pregnant Women: UTERUS
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Enlarged elastic uterus
the high levels of estrogen and progesterone that are necessary to support pregnancy are responsible for uterine enlargement during the first trimester after the third month, uterine enlargement is primarily the result of mechanical pressure of the growing fetus as the uterus enlarges, the muscular walls strengthens and become more elastic as the uterus becomes larger and more ovoid, it rises out of the pelvis; by 12 weeks of gestation and reaches into the abdominal cavity. |
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Anatomy and Physiology: Pregnant Women: PELVIC CARTILAGE AND LIGAMENTS
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hormonal activity (relaxin and progesterone) is responsible for the softening of the pelvic cartilage and strengthening of the pelvic ligaments
as a consequence, the public joint separate slightly, allowing more mobility; this results in the characteristic "waddle" gait |
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Anatomy and Physiology: Pregnant Women: PELVIC CONGESTION
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during pregnancy, and increasing uterine blood flow in live causes pelvic congestion and edema.
As a result the uterus, cervix, and Isthmus soften, and the cervix takes on a bluish color |
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Anatomy and Physiology: Pregnant Women: VAGINAL WALLS
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both the mucosa of the vaginal walls and the connective tissue thickened, and smooth muscle cells hypertrophy
these changes result in an increased length of the vaginal walls, so that at times it can be seen protruding from the valvular opening |
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Anatomy and Physiology: Pregnant Women: VAGINAL SECRETIONS
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the vaginal secretions increase and have an acidic pH due to the increase in lactic after production by the vaginal epithelium
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Anatomy and Physiology: Older Adults
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Menopause
one year without menses during this time, estrogen levels decrease, causing the labia and clitoris to become smaller the labia majora also becomes flatter as body fat is lost External/internal genitalia decrease in size Tissue loses elasticity/tone the ligaments and connective tissue of the pelvis sometimes lose their elasticity and tone, thus weakening the support of slaying of the public contents the vaginal walls may lose some of their structural integrity Pubic hair turns gray Decrease in libido both adrenal androgens in ovarian testosterone levels markedly decreased after menopause, which may account in part for decreased libido and in muscle mass and strength Vagina narrows/loses lubrication the vaginal introitus gradually constricts the vagina narrows, shortens, and loses its rogation; and the mucosa becomes thin, pale, and dry, which may result in dyspareunia tissue for intercourse for menopausal women recommend lubricant |
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Metrorrhagia
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Vaginal bleeding at anytime other then during the period
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Menorrhagia
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Excessive bleeding with period
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Menarche
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age of first period
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Amenorrhea
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no menses
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Dysmenorrhea
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pain with the period
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Dysperunia
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pain with intercourse
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Post Coital
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after intercourse
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Threaten Miscarriage
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when you have vaginal bleeding within the first 20 weeks of pregnancy. It suggests that a miscarriage may happen. Miscarriages that occur during the first 3 months of pregnancy are usually due to a problem in the way the baby develops.
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Miscarriage
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diagnosed by ultrasound
A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. (Pregnancy losses after the 20th week are called preterm deliveries.) |
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Fetal Demise
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the death of a baby in the uterus, during pregnancy and before birth.
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Related History: Present Problem: ABNORMAL BLEEDING
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Character
shortened interval between periods (less than 19 to 21 days), lengthened interval between. (More than 37 days), amenorrhea, prolonged menses (more than seven days), bleeding between periods; postmenopausal bleeding Change in flow nature of change, number of pads or tampons used in 24 hours (tampons/pads soaked?), Presence of clots Temporal sequence onset, duration, precipitating factors, course since onset Associated symptoms pain, cramping, abdominal distention, pelvic fullness, change in bowel habits, weight loss or gain Medications oral contraceptives; hormones; tamoxifen |
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Related History: Present Problem: PAIN
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Temporal sequence
date and time of onset, sudden versus gradual onset, course since onset, duration, reoccurrence Character specific location, type, and intensity of pain Associated symptoms vaginal discharge or bleeding, gastrointestinal symptoms, abdominal distention or tenderness, pelvic fullness Association with menstrual cycle timing, location, duration, changes Aggravating/relieving factor Previous medical treatment Efforts to treat Medications analgesics |
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Related History: Present Problem: VAGINAL DISCHARGE
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Character
amount, color, odor, consistency, changes in characteristics Occurrence acute or chronic Douching Clothing habits use of cotton or ventilated underwear in pantyhose, tight pants or jeans Symptoms in sexual partner Use of condoms Associated symptoms itching; tender, inflamed, or bleeding external tissue; dyspareunia; dysuria or burning on urination; abdominal pain or cramping; pelvic fullness Efforts to treat antifungal vaginal cream Medications oral contraceptives, antibiotics |
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Related History: Present Problem: PREMENSTRUAL SYMPTOMS
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Symptoms
headaches, weight gain, edema, breast tenderness, irritability or mood changes Frequency Every period? Interference with ADLs Relief measures Aggravating factors Medications analgesics, diuretics |
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Related History: Present Problem: MENOPAUSAL SYMPTOMS
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Age at menopause
Symptoms menstrual changes, mood changes, tension, left lashes Postmenopausal bleeding Sign of endometrial cancer Feelings about menopause self-image, affected intimate relationships Mother’s experience Medications hormone therapy serum estrogen receptor modulators; soy, other natural estrogen products; black cohosh |
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Related History: Present Problem: INFERTILITY
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Time attempting pregnancy
infertility is defined as one year of trying to get pregnant but not be able to Sexual activity pattern Knowledge of menstrual cycle Physical abnormalities vagina, cervix, uterus, fallopian tubes, ovaries fallopian tube scarring-cause of infertility. Also increases the chance of ectopic pregnancy Contributing factors stress, nutrition, chemical substances Partner factors Diagnostic evaluation to date |
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Related History: Present Problem: URINARY SYMPTOMS
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Character
acute or chronic; frequency of occurrence; last episode; onset; for since onset; feel like bladder is empty or not after voiding; pain at start, throughout, or at cessation of urination Urine description color, presence of blood or particles, clear or cloudy Associated symptoms vaginal discharge or bleeding, abdominal pain or cramping, abdominal distention, pelvic fullness, flank pain Medications urinary tract analgesics, anti-spasmodic |
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Related History: Past Medical History: MENSTRUAL HISTORY
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Menarche
LMP date of last normal menstrual period: first day of last cycle Days in cycle Character of flow amount (number of pads or tampons used 24 hours on heaviest days), duration, presence and size of clots Dysmenorrhea characteristics, duration, frequency (occurs with each cycle?), Relief measures Intermenstrual bleeding/pain severity and duration, timing; Association with ovulation Premenstrual symptoms headaches, weight gain, edema, breast tenderness, irritability or mood changes, frequency (occur with every period?), Interference with activities of daily living, relief measures |
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Related History: Past Medical History: SEXUAL HISTORY
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Current sexual activity
Contraception Barrier protection Prior STDs Satisfaction with relationship |
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Related History: Past Medical History: OBSTETRIC HISTORY
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G
gravida: the total number pregnancies P Para-number of viable pregnancies (last 24 weeks) # number of term pregnancies # Preterm pregnancies # number of abortions, spontaneous or induced # Living children |
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Related History: Past Medical History: MENOPAUSAL HISTORY
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Age of menopause
Associated symptoms menstrual changes, mood changes, tension, hot flashes Postmenopausal bleeding Birth control Feelings about menopause self-image, effect on intimate relationships Mother’s experience Medications hormone therapy; does induration, related side effects; breast tenderness, bloating, vaginal bleeding; estrogen receptor modulators, related side effects; hot flashes, breast tenderness |
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What is a sign of endometrial cancer
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postmenopausal bleeding
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Related History: Past Medical History: GYNECOLOGICAL HISTORY
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Prior Pap smears
Past/recent GYN procedures/surgery STDs PID Fallopian tube or ovarian inflammation- can cause abscess Shuffling gait Vaginal infections Diabetes Changes flora of the vagina Cancer of reproductive organs |
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Related History: FAMILY HISTORY
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Diabetes
Cancer of reproductive organs Mother have DES while pregnant Multiple pregnancies Congenital anomalies |
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Related History: PERSONAL/SOCIAL HISTORY
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Cleansing routines
use of sprays, powders, perfume, antiseptic soap, deodorants, or ointments Contraceptive history current method: length of time used, effectiveness, consistency of use, side effects, satisfaction with methods previous methods: duration of use for each, side effects, and reason for discontinuing each Douching history frequency: length of time since last douche; number of years douching method solution used reason for douching Sexual history current sexual activity: number of current and previous partners; number of their partners; gender of partner (S), sexual preference method (S) of contraception; current and past; satisfaction with use of barrier protection for sexually transmitted infections prior sexually transmitted infections satisfaction with relationships, sexual pleasure achieved, frequency problems: pain and penetration (entry are deep); decreased lubrication, lack of orgasm Date last pelvic exam/Pap smear Use of alcohol, drugs |
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Related History: Infants/Children: BLEEDING
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Character
onset, duration, precipitating factor if known, course since onset Associated symptoms pain, change in crying of infant, child feel for parent or other adults Parental suspicion about foreign objects Suspicion about sexual abuse |
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Related History: Infants/Children: PAIN
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Character
type of pain, onset, course since onset, duration Location Associated symptoms vaginal discharge or bleeding, urinary symptoms, gastrointestinal symptoms, child fearful parents or other adults Contributory problems use of bubble bath, irritating soaps, or detergents; parental suspicion about insertion of foreign objects by child or about possible sexual abuse |
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Related History: Infants/Children: VAGINAL DISCHARGE
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Relationship to diapers
use of powder or lotions, how frequently diapers or changed Associated symptoms pain, bleeding Contributory problems parental suspicion about insertion of foreign objects by child or about possible sexual abuse |
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Related History: Adolescents
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Same questions as any adult female
Talk with teen in private |
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Related History: Pregnant Women
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EDC
Estimated date of confinement Obstetrical history GPTAL, prenatal complications, infertility treatment Birth history length of gestation at birth, birth weight, fetal outcome, length of labor, fetal presentation, type of delivery, use of forceps, lacerations and/or episiotomy, complications (natal or postnatal) Menstrual history Surgical history prior uterine surgery and type of scar Family history diabetes, multiple births, preeclampsia, and genetic disorder Involuntary fluid leakage (may result in rupture of membranes) determine onset, duration, color, odor, amount, and it still leaking Bleeding character: onset, duration, precipitating factor if known (e.g., intercourse, trauma), course since onset, amount associated symptoms GI symptoms nausea, vomiting, heartburn |
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Related History: Older Adults: MENOPAUSAL HISTORY
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Menopausal history
Age of menopause Associated symptoms Postmenopausal bleeding Birth control Feelings about menopause Mother’s experience Medications |
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Related History: Older Adults: SYMPTOMS ASSOCIATED WITH AGE
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Itching
Dyspareunia Urinary problems |
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Related History: Older Adults: SEXUAL CHANGES
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Desire
Behavior |
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Exam & Findings: External Exam Inspection: Labia majora
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Symmetry
Redness/swelling we appeal swelling, redness, or tenderness, particularly if unilateral, may be indicative of a batholin gland infection Excoriation/rashes/ lesions Discoloration Varicosities Stretching Trauma |
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Exam & Findings: External Exam Inspection: Labia Minora
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Symmetry
may be symmetric or asymmetric Moisture moist Color dark pink Inflammation indicates vaginal infection or poor hygiene Excoriation indicates vaginal infection or poor hygiene Discharge indicates vaginal infection or poor hygiene Ulcers sign of sexually transmitted infections |
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Exam & Findings: External Exam Inspection: Clitoris
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Size
generally 2 cm or less in length and 0.5 cm in diameter enlargement may be a sign of a masculinizing condition Atrophy Adhesions/inflammation |
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Exam & Findings: External Exam Inspection: Urethral Oriface
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Discharge
Polyps/caruncles/ fistulas a carnucle is a bright red polypoid growth that protrudes from the urethral meatus; most urethral carnucle cause no symptoms Irritation/inflammation suggest repeated urinary tract infections or insertion of foreign objects ask questions about any finding that a later time-not during the pelvic examination when the woman feels most vulnerable |
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Exam & Findings: External Exam Inspection: vaginal introitus
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Moisture
moist Swelling Discoloration Discharge Lesions/fistulas/fissures |
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Exam & Findings: External Exam Inspection: Perineum
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Scarring
Inflammation Fistulas/lesions/ growths |
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Exam & Findings: External Exam Inspection: ANUS
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Color
darkly pigmented, and the skin may appear course Scarring/skin tags Excoriation Fissures, lesions |
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Exam & Findings: External Exam PALPATION: SKENE/BARTHOLIN GLANDS
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Discharge
if discharge occurs, note is color, consistency, and odor entertainment culture discharge from the SKENE gland usually indicates an infection-most commonly, but not necessarily, gonococcal discharge from the bartholin gland is usually gonococcal are staphylococcal in origin is pus filled Tenderness Swelling Masses Temperature |
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Exam & Findings: Internal Exam PALPATION: PERINEUM
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Consistency
should be smooth Thickness episiotomy scarring may be evident women who have borne children the tissue will fill thickened smooth and in nulliparous woman it will be thinner and rigid and multi-parous women Pliability |
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Exam & Findings: Internal Exam: CERVIX: COLOR
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the cervix should be pink, with the color evenly distributed
a bluish color indicates increase vascularity, which may be a sign of pregnancy symmetric, circumscribed redness around the os is an expected finding that indicates expose columnar epithelium from the cervical canal a pale cervix associated with anemia |
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Exam & Findings: Internal Exam: CERVIX: POSITION
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the anterior-posterior position of the cervix correlate the position of uterus
a cervix that is pointing anteriorly indicates a retroverted uterus; one pointing posteriorly indicates anteverted uterus a cervix in the horizontal position indicates a uterus in the position the cervix should be located in the midline. Deviation to the right or left may indicate a pelvic mass, uterine adhesions, or pregnancy the cervix may protrude 1 to 3 cm into the vagina. Projection greater than 3 cm may indicate a pelvic or uterine mass |
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Exam & Findings: Internal Exam: CERVIX: SIZE
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the cervix of a woman of childbearing age is usually 2 to 3 cm in diameter
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Exam & Findings: Internal Exam: CERVIX: SURFACE CHARACTERISTICS
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the surface of the cervix should be smooth
some squamo-columnar epithelium of the cervical canal may be visible as a symmetric red circle around the os columnar epithelium from the cervical canal appears as shiny red tissue around the os that may bleed easily |
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Exam & Findings: Internal Exam: CERVIX: DISCHARGE
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note any discharge
determine whether the discharge comes with the cervix itself, or whether it's vaginal origin and has only been deposited on the cervix usual discharges odorless; may be creamy or clear; may be thick, thin, or stringy; and is often heavier admit cycle or immediately before menstruation the discharge of bacterial or fungal infection will more likely have in order and will vary in color from white to yellow, green, or gray |
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Exam & Findings: Cervical os
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Size
Nulliparous woman- size is small and round or oval Multiparous woman-usually a horizontal slit or maybe a regular and stellate Shape |
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Exam and Findings: Tests
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Pap smear
Gonococcal culture DNA probe Wet mount- CLUE CELLS come out when there is a yeast infection, WBC, Trichomonas. |
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Exam & Findings: Bimanual Exam: CERVIX PALPATION
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Position
should be midline and may be pointing anteriorly or posteriorly Movement grasp the cervix gently between your fingers and move it from side to side observe the patient for any expression of pain or discomfort with movement (cervical motion tenderness) ultrasound should be ordered for high suspicion of public problem chandeliers sign-positive cervical motion tenderness-pelvic inflammatory disease the cervix should move 1 to 2 cm in each direction with minimal or no discomfort Nodules Tenderness grasp the cervix gently between your fingers and move it from side to side observe the patient for any expression of pain or discomfort with movement (cervical motion tenderness) ultrasound should be ordered for high suspicion of public problem chandeliers sign-positive cervical motion tenderness-pelvic inflammatory disease Open or Closed If os is open during pregnancy- miscarriage External and internal sphincter. External sphincter may be open after first pregnancy but internal sphincter should be shut. |
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Exam & Findings: Bimanual Exam: UTERUS PALPATION: FUNDUS
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The fundus of the uterus is the top portion, opposite from the cervix.
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Exam & Findings: Bimanual Exam: UTERUS PALPATION: POSITION
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anteverted or anteflexed
place the Palmer surface of your other hand on the abdominal midline, midway between the umbilicus in the symphysis pubis place the intravaginal fingers in the anterior fornix slowly slide the abdominal hand toward the pubis, pressing downward and forward with a flat surface of your fingers at the same time, push inward and upward with your fingertips of the intravaginal hand while you push downward on the cervix the backs of your fingers if the uterus is anteverted or anteflexed (the position of most uteri), you will feel the fundus between your fingers of your two hands at the level of the pubis retroverted or retroflexed if you do not feel the uterus to the previous maneuver, placed the intravaginal fingers together in the posterior for next, with the abdominal hand immediately above the symphysis pubis press firmly downward with the abdominal hand while you press against the cervix inward with the other hand a retroverted or retroflexed uterus should be felt with this maneuver should be located in the midline regardless of his position deviation to the right or left is indicative of possible adhesions, public masses, or pregnancy |
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Exam & Findings: Bimanual Exam: UTERUS PALPATION: MOBILITY
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gently move the uterus between the intravaginal hand and abdominal and to assess for mobility and tenderness
the uterus should be mobile in the antero posterior plane a fixed uterus indicates adhesions |
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Exam & Findings: Bimanual Exam: UTERUS PALPATION: TENDERNESS
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tenderness on movement suggests a pelvic inflammatory process are ruptured tubal pregnancy
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Exam & Findings: Bimanual Exam: ADNEXA
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Ovaries palpation
palpate the adnexal areas and ovaries place the fingers of your abdominal hand on the right lower quadrant with the intravaginal hand facing upward, placed both fingers and the right lateral fornix press the intravaginal fingers deeply inward and upward toward the abdominal hand, while sweeping the flat surface of your fingers of the abdominal hand deeply inward and obliquely downward toward the symphysis pubis palpate the entire area by firmly pressing the abdominal he handed intravaginal fingers together repeat this maneuver on the left side the ovaries, if palpable, should be firm, smooth, ovoid, and approximately 3 x 2 x 1 cm in length Tenderness the healthy ovary a slightly to moderately tender on palpation marked tenderness, enlargement, and nodularity are unexpected Swelling Hard to palpate usually no other structures are palpable except for round ligaments fallopian tubes are usually not palpable, so a problem may exist that they are felt you are also palpating parade adnexal masses, and if they are found they should be characterized by shape, size, location, consistency, and tenderness the adnexa are often difficult to palpate because of their location and position in the presence of excess adipose tissue and some women if you're unable to feel anything in the adnexal area with thorough palpation, you can assume that no abnormality is present, provided no clinical symptoms exist |
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Exam & Findings: Rectovaginal Exam: ANAL SPHINCTER
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place your index finger in the vagina, and press your middle finger against the anus and asked the patient to bear down
as she does, slipped the tip of your fingers into the rectum and just past the sphincter palpate the area of the anorectal junction and just above it ask the woman to tighten and relax or anal sphincter observe sphincter tone Tone an extremely tight sphincter may be the result of anxiety about the examination; may be caused by scarring; or may indicate spasticity caused by fissures, lesions, or inflammation a lax sphincter suggest neurologic deficit, whereas in absent sphincter may result from improper repair of third-degree perineal laceration after childbirth or trauma |
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Exam & Findings: Rectovaginal Exam: RECTAL WALLS
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slide both your vaginal and rectal fingers in as far as they will go, then asked the woman to bear down
this will bring in additional centimeter within the reach of your fingers rotate the rectal finger to explore the anterior rectal wall for masses, polyps, nodules, strictures, irregularities, and tenderness Masses/polyps/nodules/ strictures Irregularities Tenderness the walls should feel smooth and uninterrupted |
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Exam & Findings: Rectovaginal Exam: STOOL
|
as you withdraw your fingers, rotate the recto finger to evaluate the posterior rectal wall just as you did earlier for the anterior wall.
Gently remove your examination finger and observe for secretions and stool note: Color Blood |
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Exam & Findings: Rectovaginal Exam: RECTOVAGINAL SEPTUM
|
palpate the rectovaginal septum along the anterior wall for thickness, tone, and nodules
Tone Thickness Nodules |
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Exam & Findings: Rectovaginal Exam: UTERUS
|
press firmly in deeply downward with the abdominal hand just above the symphysis pubis while you position the vaginal finger in the posterior vaginal fornix, and press strongly upward against the posterior side of the cervix
palpate is much is the posterior side of the uterus possible, confirming your findings from the vaginal examination regarding: Location/position Size/shape/contour Consistency Tenderness it's this maneuver is particularly useful in evaluating a retroverted uterus |
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Exam & Findings: Infants
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Inspect/palpate external genitalia only
the newborn genitalia reflects the influence of maternal hormones Expected swelling Milky discharge a mucoid, widest vaginal discharge is commonly seen during the newborn. And sometimes as late as four weeks after birth the discharges occasionally mixed with blood this is a result of passive hormonal transfer from the mother and is an expected finding parental reassurance is often necessary Enlarged clitoris the clitoris may appear relatively large; this usually has no significance true hypertrophy is not common; however, in newborns, an enlarged uterus must alert the clinician to the possibility of congenital adrenal hyperplasia Ambiguous appearance any ambiguous appearance or unusual orifice in the vulvar vault or perineum must be expeditiously explored before gender assignment occurs Adhesions between labia minora thin but difficult to separate adhesions between them labia menorah are often seen during the first few months or even few years of life sometimes a completely cover the vulvar vestibule there may be just the smallest of openings through which urine can escape these may require separation, using the gentlest of teasing or the application of estrogen creams |
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Exam & Findings: Children: EXTERNAL GENITALIA
|
for the well child, the examination includes only inspection and palpation of the external genitalia
the internal vaginal examination is performed at a young child only when there is a specific problem such as bleeding, discharge, trauma, or suspected sexual abuse Inspect/palpate external genitalia Redness/irritation vaginal discharge often irritates the perineal tissues, causing redness and perhaps excoriation other sources of peritoneal irritation include bubble baths, soaps, detergents, and urinary tract infections Swelling swelling of vulvar tissues, particularly if accompanied by bruising or foul smelling discharge, should alert you to the possibility of sexual abuse and must always be suspected if a younger child has a sexually-transmitted infection or if there is injury to the external genitalia injuries to the softer tissues of the external genitalia are not caused by bicycle seats a straddle injury for bicycles feet is generally evident over the symphysis pubis with the structures are more fixed injuries resulting from sexual abuse are generally more posterior and may involve the perineum grossly such findings cannot be ignored, careful questioning of the parent or guardian is mandatory, as well as a report to the appropriate social service agencies for further investigation in most cases of sexual abuse, the physical examination is normal. Abnormal examination does not rule out sexual abuse if there is a suspicion Discharge/bleeding a foul odor is more likely indicative of a foreign body (particularly in preschool children), especially if the secondary infections present vaginal discharge may also result from Trichomonal, gonococcal, or monolial infection vaginal bleeding in children is often the result of unintentional injury, experimentation with a foreign body (e.g., doit), or sexual abuse rarely there may be an ovarian tumor carcinoma of the cervix's |
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Exam & Findings: Children: INTERNAL GENITALIA
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Bleeding
Discharge Trauma/abuse |
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Exam & Findings: Children: Sexual abuse signs
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General neglect/abuse
Trauma/scarring of genitals/anus Unusual coloring of genitals/anus STD presence Anorectal problems Genitourinary problems Behavioral manifestations/problems |
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Exam & Findings: Adolescents
|
all adolescent female should have a pelvic examination within three years of initiating sexual intercourse, including a Pap smear with cervical cytology evaluation and sexually-transmitted infection evaluation
young women who are not sexually active should have their first examination by age 21 years Allay anxiety for what may be first exam Use Small Speculum a pediatric speculum with plates that are 1 to 1.5 cm wide can be used in should cause minimal discomfort if the adolescent is sexually active, a small adult speculum may be used Inspect/palpate Tanner Stages as the girl ghost of puberty, you will see the match racial changes of sexual development just before menarche there is a physiologic increase in vaginal secretions the hymen may or may not be stretched across the vaginal opening by menarche opening should be at least 1 cm wide as the adolescent matures, the findings are the same as those for the adult |
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Exam & Findings: Pregnant Women
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gynecologic examination further pregnant woman follows the same procedure as that for nonpregnant adult woman
assessment of pregnant women include gestational age examination, uterine size and contour, public size estimates, and cervical dilation and length examination also includes fetal assessment: growth, position, and well-being during labor, fetal station and had position are also assessed Inspect/palpate for expected changes Softening cervix Increased vascularity Bluish color Full/soft/flexible fundus Lateral uterine bulge Increasing size - bony pelvis/uterus Cervical dilation Fetal position Leopold maneuver |
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Exam & Findings: Older Adults
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Inspect/palpate for age-related changes
Smaller labia labia appears flatter and smaller, corresponding with the degree of loss of subcutaneous fat elsewhere in the body Dry skin/membranes the skin is dryer and shinier than that of the younger adult Gray/sparse pubic hair pubic hair is gray and may be sparse Less mobile cervix Hard to palpate uterus the uterus diminishes in size and may not be palpable Nonpalpable ovaries ovaries are rarely palpable due to atrophy ovaries that are palpable should be considered suspicious for tumor and additional workup, such as ultra sound, to exclude cancer is required Diminished rectal tone |
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Exam & Findings: Women with Disabilities
|
Alternative positions for pelvic exam
the woman is the best charge for of which position will work for her and how to use assistants most effectively these decisions should be made by the patient and clinician together examples knee chest position diamond shaped position obstetric stirrups position M-shaped position V-shaped position Transfer methods to exam table Special concerns Spasticity Hyperreflexia Hypersensitivity Bowel/bladder functional alterations |
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Common Abnormalities: PMS
|
Definition
a collection of physical, psychological, and mood symptoms related to a woman's menstrual cycle Pathophysiology etiology unclear; likely causes include hormonal factors and responses to hormonal factors usually begins in the woman's late 20s and increases in incidence and severity as menopause approaches subjective data symptoms may include breast swelling and tenderness, acne, bloating and weight gain, headache or joint pain, food cravings, irritability, difficulty concentrating, mood swings, crying spells, and oppression symptoms occur 5 to 7 days before menses (luteal phase) and subside for the onset of menses objective data none diagnosis based on symptoms and temp oral relationship to menstrual cycle |
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Common Abnormalities:Infertility
|
Definition
the inability to conceive over a period of one year of unprotected sexual intercourse Pathophysiology many causes, including both male and female conditions contributing factors in the women include abnormalities of the vagina, cervix, uterus, fallopian tubes, and ovaries male infertility can be caused by insufficient non-motile, or immature sperm; ductal obstruction of sperm; and transport related factors factors influencing infertility in both women and men in could stress, nutrition,, go substances, chromosomal abnormalities, certain disease processes, sexual and lesion should problems, and hematologic and immunologic disorders subjective data unsuccessful attempts to become pregnant objective data varies the underlying cause often no findings of physical examination |
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Common Abnormalities: Endometriosis
|
Definition
the presence of growth of endometrial tissue outside the uterus Pathophysiology pathogenesis not definitive thoughts to be due to retrograde reflux of menstrual tissue from the fallopian tubes during menstruation subjective data pelvic pain, dysmenorrhea, and heavy or prolonged menstrual flow objective data no findings on bimanual examination, tender nodules may be palpable along the uterosacral ligaments diagnosis confirmed by laparoscopy |
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Common Abnormalities: STD: vaginitis
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Trichomonos
|
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Common Abnormalities: STD: cervicitis
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Chlamydia: DNA Probe, Gonnorhea: DNA Probe
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Common Abnormalities: STD: PID
|
Definition
infection of the uterus, fallopian tubes, and other reproductive organs; a common and serious complication of some sexually transmitted infections pathophysiology often caused by Neisseria gonorrhoeae and chlamydia tachomatis may be acute or chronic subjective data symptoms may be mild or absent unusual vaginal discharge that may have a foul odor symptoms include painful intercourse, painful urination, a regular menstrual bleeding, and pain in the right upper abdomen objective data acute PID produces very tender, bilateral adnexal areas; the patient guards and usually tolerate bimanual examination symptoms of chronic PID or bilateral, tender, a regular, and fairly fixed adnexal areas Lower abdominal Tenderness Cervical Motion Tenderness Adnexal Tenderness |
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Common Abnormalities: STD: Vulvovaginitis
|
Vulvovaginitis: Bacterial vaginosis: Caused by overgrowth of anaerobes and garderella (tx with flagyl), Yeast Infection: Candida albicans (cottage cheese-itching) tx with fluconazole/nystatin/clotrimazole
Bubble baths |
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Common Abnormalities: STD: Foreign Body
|
x
|
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Common Abnormalities: STD: Genital Warts
|
Definition
watery lesions due to sexually-transmitted infection with HPV. Spreads with contact (Wart touches other skin surface and spreads) Pathophysiology HPV invades the basal layer of the epidermis; virus penetrates through skin and causes mucosal micro-abrasions latent viral phase begins with no signs or symptoms and can last for a month to several years following latency, viral DNA, capsids, and particles are produced; host cells become infected in develop the characteristics skin lesions subjective data soft, painless, wartlike lesions history of sexual contact objective data flesh colored, whitish pink to reddish brown, discrete, soft growths on labia, vestibule or perianal area lesions may occur singly or in clusters and may enlarge to form cauliflower like masses |
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Common Abnormalities: STD: Molluscum Contagium
|
Definition
viral infection of the skin and mucous membranes; considered a sexually-transmitted infection in adults, in contrast to the common non-sexually-transmitted infections occurring in young children Molluscum Contagium: umbilicated small papular lesions, very contagious Pathophysiology caused by poxvirus, the virus enters the skin through small breaks of hair follicles spreads through direct person-to-person contact and through contact with contaminated object genital lesions are sexually-transmitted incubation period is from 2 to 7 weeks subjective data painless lesions and genital area sexually active objective data white or flesh colored, dome shaped papules that are round or oval surface has a characteristic central umbillication from which a thick creamy core can be expressed lesions may last from several months to several years diagnosis usually based on the clinical appearance of the lesions direct microscopic examination of stained material from the core will reveal typical molluscum bodies within the epithelial cell |
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Common Abnormalities: STD: Dysperunia
|
x
|
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Common Abnormalities: STD: Lesions: Herpes
|
Pathophysiology
most commonly caused by the herpes simplex virus 2 virus (HSV-2) most transmission of HSP occurs when individual shed virus in the absence of symptoms subjective data painful lesions and genital area history of sexual contact may report burning or pain with urination objective data superficial vesicles in the genital area; internal or external; may be eroded initial infection is often extensive, whereas reoccurring infection is usually confined to a small localized patch on the vulva, perineum, vagina, or cervix |
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Common Abnormalities: STD: Lesions: Syphillis
|
Syphilis: RPR, VDRL
Definition skin lesion associated with primary syphilis Pathophysiology sexually-transmitted infection caused by the bacterium treponema pallidum transmitted through direct contact with the syphilis sore lesion of primary syphilis generally occurs two weeks after exposure Tinker last 3 to 6 weeks, heels without treatment subjective data often no lesion noted, as may be internal painless genital ulcer sexually active objective data solitary lesion; firm, round, small, painless ulcer lesion has indurated borders with a clear base scrapings from the ulcer, examined microscopically, show spirochetes. |
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Common Abnormalities: STD: Hepatitis
|
x
|
|
Common Abnormalities: STD: HIV
|
x
|
|
Painful lesions
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herpes
|
|
Painless lesions
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syphillis
|
|
Common Abnormalities: Vulva/Vagina: Inflammation of Bartholin Gland
|
Pathophysiology
commonly, but not always, caused by niesseria gonorrhea may be acute or chronic subjective data pain and swelling in the growing objective data hot, red, tender, fluctuant swelling of the bartholin gland that may drain pus chronic inflammation results in a non-tender cyst on the labium |
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Common Abnormalities: Vulva/Vagina: Cystocele
|
Bladder wall is relaxed
|
|
Common Abnormalities: Vulva/Vagina: Rectocele
|
Rectal wall is relaxed
|
|
Common Abnormalities: Vulva/Vagina: Carcinoma
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indurated
|
|
Common Abnormalities: Cervix; Lacerations
|
x
|
|
Common Abnormalities: Cervix; Infected nabothian cysts
|
cysts to cervix
goes away by itself |
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Common Abnormalities: Cervix; cervical carcinoma
|
Definition
classified according to the type of tissue from which the cancer arises squamous cell carcinoma and the adenocarcinoma; there are a few other rare types of cervical cancer Pathophysiology typically originates from the dysplastic or premalignant lesion present at the active squamocolumnar junction lesions gradually progress through recognizable stages before developing into invasive disease the transformation from mild dysplastic to invasive carcinoma generally occurs slowly over several years HPV is now recognizes the most important causative agent cervical carcinogenesis at the molecular level HPV vaccines available subjective data usually asymptomatic many report unexpected vaginal bleeding or spotting objective data often no findings on physical examination a hard granular surface at or near the cervical os lesion can evolve to form an extensive irregular cauliflower growth that bleeds easily early lesions are indistinguishable from ectropian precancerous in early cancer changes are detected by Pap smear, not by physical examination |
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Common Abnormalities: Uterus: Uterine prolapse
|
Definition
dissent or herniation of the uterus into her beyond the vagina pathophysiology result of weakening of the supporting structures of the pelvic floor, often occurring concurrently with a cystocele or rectocele uterus becomes progressively retroverted and descends into the vaginal canal subjective data sensation the pelvic heaviness and/or uterus falling out tissue protruding from vagina may report urine leakage or urge incontinence, difficulty having a bowel movement, or low back pain objective data first-degree prolapse: the cervix remains within the vagina second-degree prolapse: the cervix is at the introitus third-degree prolapse: the cervix and vagina drop outside the introitus |
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Common Abnormalities: Uterus: myomas
|
definition
common, benign, uterine tumors mass or tumor inside muscle of uterus pathophysiology arise from the overgrowth of smooth muscle and connective tissue in the uterus may occur singly or in multiples and may vary greatly in size subjective data fibroid symptoms are related to the number of tumors, as well as their size and location; symptoms may include the following heavy menses abdominal cramping usually felt during menstruation urinary frequency, urgency, and/or incontinence from pressure on the bladder constipation, difficulty defecation, or rectal pain from pressure on the colon abdominal cramping from pressure on the small bowel generalized pelvic and/or lower abdominal discomfort objective data firm, a regular nodules in the contour of the uterus on bimanual examination uterus maybe enlarged |
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Common Abnormalities: Uterus: endometrial cancer
|
Pathophysiology
occurs most often in postmenopausal women nearly all endometrial cancers are cancers of the glandular cells found in the lining of the uterus; most known risk factors for endometrial cancer are linked to the balance between estrogen and progesterone in the body women taking tamoxifen are at increased risk subjective data postmenopausal vaginal bleeding-red flag for endometrial cancer objective data diagnosed by endometrial biopsy |
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Common Abnormalities: Ovaries: Torsion
|
UNILATERAL
OFTEN ASSOCIATED WITH OVARIAN CYST ALMOST ALWAYS WITH N/V Definition Twisting of the ovary on the fallopian tube Causes ischemia/infarction of the ovary Usually younger ages average 26 20% are pregnant 50% of the time associated with an adenexal mass Can occur in postmenopause and after hysterectomy Presentation Non Specific Findings Sudden onset of lower abdominal pain on the involved side. Radiation to the back, pelvis and thigh. Nausea/Vomiting The patient may describe a prior history of similar episodes |
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Common Abnormalities: Ovaries: Mittelschmertz
|
German for “Middle Pain”
Associated with ovulation Typically pain lasts for hours (2-4 hours-goes away-if lasts longer then consider something different) |
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Common Abnormalities: Ovaries: Ovarian Cysts
|
Definition
fluid filled sac in the ovary Pathophysiology follicle undergoes varying rates of maturation in this can occur as a result of hypothalamus-pituitary dysfunction or because of native anatomic defects in the reproductive system can occur unilaterally are bilaterally most ovarian cysts occur during infancy and adolescence, which are hormonally active. The development most are functional in nature and resolve with minimal treatment Egg not released and continues to grow Ruptured a small vessel when released If arterial can produce significant bleeding. subjective data usually asymptomatic may report lower abdominal pain; sharp, intermittent, setting, and severe sudden onset of abdominal pain may suggest cyst rupture objective data pelvic mass may be palpated cervical motion tenderness may be elicited often an incidental finding during ultrasound performed for other reasons |
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Ectopic Pregnancy
|
Definition
ectopic pregnancy occurs outside the uterus pathophysiology most common site is in one of the fallopian tubes but can occur in other areas ectopic pregnancy usually caused by condition that boxer slows the movement of the fertilized egg through the fallopian tube to the uterus may be caused by physical blockage in the tube; most cases from scarring caused by past ectopic pregnancy, past infection in the fallopian tubes, pelvic inflammatory disease, or surgery of the fallopian tubes subjective data abnormal vaginal bleeding low back pain mild cramping on one side of the pelvis pain in the lower abdomen or public area if the area of the abnormal pregnancy ruptures and bleeds, symptoms may worsen feeling lightheaded or syncope pain that is felt in the shoulder area severe, sharp, and sudden pain in the lower abdomen objective data marked pelvic tenderness, with tenderness and rigidity of the lower abdomen cervical motion tenderness; a tender, unilateral adnexal mass may indicate the site of the pregnancy tachycardia hypotension reflect hemorrhage of the ruptured tubal pregnancy into the peritoneal cavity and impending cardiovascular collapse a ruptured tubal pregnancy is a surgical emergency Accounts for 10-15% of maternal mortality in 1st trimester. Presentation Lower abdominal pain to associated side. Usually 6-10 weeks after conception (fetus grows to the point where it outgrows the fallopian tube) Risk Factors History of PID Multiple Partners especially at a young age Infertility Treatment Pelvic Surgery Previous History of same Smoking METHOTREXATE-CHEMOTHERAPY CAN BE GIVEN TO TREAT (KILLS RAPIDLY DEVELOPING CELLS) |
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Positive pregnancy test_______ after implantation
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Positive pregnancy test 5 days after implantation
|
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If BHCG is greater then _____ should see a gestational sac on ultrasound
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If BHCG is greater then 2000 should see a gestational sac on ultrasound
|
|
Fetal Heart Beat _____ should be seen by ultra sound.
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Fetal Heart Beat 6-7 weeks should be seen by ultra sound.
|
|
Fetal Heart Tones heard by doppler at ________
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Fetal Heart Tones heard by doppler at 8-10 weeks
|
|
Fetal Movement (quickening) at _______
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Fetal Movement (quickening) at 16-20 weeks
|
|
Fetal Viability is _____ gestation
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Fetal Viability is 24 weeks gestation
|
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After _____ the fetus is mature enough to survive if necessary
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After 34 weeks the fetus is mature enough to survive if necessary
|
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IF clear vaginal secretions have a pH of greater then _____ consider it to be amniotic fluid.
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IF clear vaginal secretions have a pH of greater then 6.5 consider it to be amniotic fluid.
|
|
Pregnancy: first trimester: Hyperemesis Gravidarum
|
Vomiting
Resolve after 1st trimester Ketouria Monitor Ketouria is due to catabolism, digesting fats for calories. You need sugar to stop that, that is why you need to give some sugar containing fluid. Dehydrated IV fluids 0.9 NS D5 .9 NS Antiemetic |
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Pregnancy: first trimester: Bleeding
|
Spotting to Heavy with Clots
Trauma Consider abuse Rule out ectopic pregnancy Labs QHCG Type & Rh CBC Anxiety 50% can go to normal delivery Education Not parents fault Don’t forget father Rest Pelvic Rest No intercourse |
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Pregnancy: First Trimester: Miscarriage
|
Miscarriage
No cardiac activity with ultra sound Labs CBC QHCG Type & Rh If mom is Rh negative need shot of rhogam to prevent sensitization. If mom becomes sensitized a Rh positive child will cause an immune response and kill the fetus through hemolysis of the fetuses blood. The moms body produces antigens to the Rh. Explain findings simply Your child is dead Caution using terms like passed away, eternal sleep, gone to heaven. People hear what they want to hear. You need to make it simple to understand. Always ask if they have questions and did understand what you said. Don’t Forget the parents just lost a child Offer condolences Not parents fault If available offer religious support If tissue passed ask about baptism |
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If quantitative HCG is 2000 and there is no visible uterine pregnancy...suspect.?
|
ECTOPIC PREGNANCY
|
|
Pregnancy: 2nd Trimester: PIH (Pregnancy Induced Hypertension)
|
7% of pregnancy
7% of pregnancies are associated with hypertension Unknown cause, believed to be associated with vascular response to endogenous vasopressors in the pregnant women. Risks: Young age less then 20 years old, primagravidas, twins or molar pregnancies, and family history of PIH Proteinuria BP > 140/90 Usually with a diastolic under 100 Edema Look for end organ involvement Headaches Visual changes Abdominal Pain Increased liver function tests Sign of preeclampsia Increased Uric Acid Level Sign of preeclampsia |
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Pregnancy: 2nd Trimester: Preeclampsia
|
One type of PIH-more severe
Believe it is a relative increase in various substances including prostaglandins associated with vasconstriction and platelet aggregation. This may results in vascular injury which causes the symptoms of preeclampsia Must look for it Bedrest is the only demonstrated means to reduce BP Diastolic Blood Pressure 100 or above Proteinuria 2+ or more consistently Edema Usually involving the face and hands End organ damage Visual changes, headaches Hyperreflexia |
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Pregnancy: 2nd Trimester: Eclampsia
|
Seizures
All the symptoms of preeclampsia are also present Magnesium Sulfate Dosage: 6g IV (20% solution) over 15 minutes, then 2g IV per hr. Consider getting a CT scan to rule out cerebral pathology Rule out other causes of seizure, trauma, hypoglycemia, overdose Initial Treatment Get labs Acucheck IV access Monitor Urine Output Close monitoring of patients vitals Emotional Support |
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Pregnancy: 2nd Trimester: Abruptio Placenta
|
30% cause of vaginal bleeding
May have only acute abdominal pain. Can be associated with blunt trauma or happen spontaneously Usually at triage patient over 24 weeks with abdominal pain go directly to the OB department for initial treatment for fetal monitoring and evaluation by OB. Painful vaginal bleeding Dark red bleeding May be minor or no bleeding Hard/Tender Uterus Risks HTN, High maternal age, smoking and cocaine use |
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Pregnancy: 2nd Trimester: Placenta Previa
|
20% cause of vaginal bleeding
Placenta inserts itself low in the uterus and communicates with the cervical os. The vessels begin to rupture as the uterus elongates or when cervical dilitation starts. Digital exam can exacerbate bleeding. If needed only a brief speculum exam to determine if the blood is coming from the os or some other area. Risks: c section history, previous hx of same Painless vaginal bleeding Bright red Caution doing pelvic exam No digital exams |
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Common Abnormalities: Infants/Children: Ambigious Genitalia
|
Definition
the newborn genitalia are not clearly either male or female Pathophysiology presence or absence of male hormones controls the development of the sex organs during fetal development; male genitalia develop because of male hormones from the fetal testicles; in the female fetus, without the effects of male hormones, the genitalia develop as female a deficiency of male hormones in a genetic male fetus results in ambiguous genitalia; in a female fetus, the presence of male hormones during development results in ambiguous genitalia most causes of ambiguous genitalia are due to genetic abnormalities subjective data family history of genital abnormalities known congenital adrenal hyperplasia unexplained deaths in early infancy infertility and close relatives abnormal development during puberty objective data ambiguous genitalia in a genetic female: an enlarged clitoris that has the appearance of a small penis the urethral opening anywhere along, above, or below the surface of the clitoris fused labia resembling scrotum a lump of tissue is felt within the fused labia, making it look like a scrotum with testicles ambiguous genitalia and the genetic male a small penis that resembles an enlarged clitoris urethral opening anywhere along, above, or below the penis; or as low as on the peritoneum, further making the infant appeared to be female small scrotum with any degree of separation, resembling labia undescended testicles commonly accompany ambiguous genitalia |
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Common Abnormalities: Infants/Children: Hydrocolpos
|
Hydrocopos: inperferate hymen. Amenorrhea.
Definition distention of the vagina caused by accumulation of fluid due to congenital vaginal obstruction Pathophysiology obstruction usually caused by imperforate hymen or, less commonly, a transverse vaginal septum subjective data none objective data small midline lower abdominal mass or small cystic mass between the labia condition may resolve spontaneously or may require surgical intervention abdominal sonography is helpful in making a correct diagnosis, showing a large midline translucent mass placing the bladder forward |
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Common Abnormalities: Pregnant Women: Premature ROM
|
Definition
the spontaneous premature rupture of membranes in a preterm pregnancy carries a high risk for perinatal morbidity and mortality, as well as maternal morbidity and mortality pathophysiology cause of premature rupture of membranes is not known; however, certain conditions such as infection and hydramnios has been implicated; some healthcare professionals also consider the rupture of membranes before the onset of labor in a term pregnancy to be premature rupture of labor does not begin in 12 hours subjective data during pregnancy prior to term, premature passage of fluid from the vagina physical findings premature rupture of membranes should be verified with a sterile speculum examination to collect fluid for testing with nitrazine paper and microscopic examination amniotic fluid has a pH of 7.15 and will turn nitrazine paper blue-green amniotic fluid place in the slide and air dried will have a “fern” pattern ultrasound evaluation of fluid will reveal decreased or absent amniotic fluid |
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Common Abnormalities: Pregnant Women: Prolapse for umbillical cord
|
X
|
|
Common Abnormalities: Pregnant Women: Vulvar Varicosities
|
X
|
|
Common Abnormalities: Older Adults: Atrophic Vaginitis
|
Definition
inflammation of the vagina due to thinning intriguing of the tissues as well as decreased lubrication pathophysiology caused by lack of estrogen during perimenopause and menopause subjective data vaginal soreness or itching discomfort or bleeding with sexual intercourse objective data vaginal mucosa is dry and pale, although it may become right-handed develop petechiae and superficial erosions accompanying vaginal discharge may be white, gray, yellow, green, or blood tinged can be thicker watery and, although it varies in amount, rarely profuse |
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Common Abnormalities: Older Adults: Urinary Incontinence: Stress
|
Coughing, sneezing, laughing
Stress: sphincter insufficency |
|
Common Abnormalities: Older Adults: Urinary Incontinence: Urge
|
Sudden urge to urinate
Urge: Uninhibited bladder, unable to control urge to urine |
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Common Abnormalities: Older Adults: Urinary Incontinence: Overflow
|
Overdistention of bladder
Overflow: neuropathy or outflow obstruction |
|
Common Abnormalities: Older Adults: Urinary Incontinence
|
Can’t make it to the toilet
Functional: Unable to make it to bathroom in time. New enviroment, diuretics or other meds |
|
Which of the following findings indicates a possible gonococcal infection?
|
Discharge from urethra or Skene glands
|
|
Which one of the following is a proper technique for use of a speculum during a vaginal examination?
|
Press introitus downward; insert closed speculum obliquely
|
|
What structures are located at the 5-o’clock and the 7-o’clock positions of the vaginal orifice and open onto the sides of the vestibule in the groove between the labia minora and the hymen
|
Bartholin glands
|
|
The adnexa of the uterus are composed of the
|
fallopian tubes and ovaries
|
|
The conventional definition of menopause is
|
1 year with no menses
|
|
The presence of cervical motion tenderness may indicate
|
pelvic inflammatory disease
|
|
Which risk factor is associated with cervical cancer?
|
Multiple sex partners
|
|
Pregnancy-related cervical changes include
|
softening and bluish coloring
|
|
The female patient should ideally be in which position for the pelvic examination?
|
Lithotomy
|
|
Prolonged menses is usually defined as bleeding for longer than _____ days
|
7
|