Olds Maternal-Newborn Nursing Chapter 4

Front 1

menstrual cycle length

Back 1

determined from the first day of one menses to the first day of of the next menses.

once established cycle length is 21-35 days.

Front 2

amount of flow

Back 2

on average 25-60 mL

blood loss over 80 mL is considered abnormal

Front 3

length of menses

Back 3

2-8 days

Front 4

hypomenorrhea

Back 4

short duration of menstrual flow or, in other words, uterine bleeding at normal intervals but in decreased amounts.

Front 5

hypermenorrhea

Back 5

an abnormally long or heavy menstrual flow at normal intervals (sometimes used interchangeably with menorrhagia).

Front 6

oligomenorrhea

Back 6

bleeding, often irregular, occurring in intervals greater than 40 days.

Front 7

polymenorrhea

Back 7

bleeding, either regular or irregular, occuring at intervals of less than 22 days.

Front 8

menorrhagia

Back 8

bleeding that is excessive in amount and duration, which occurs at regular intervals

Front 9

metrorrhagia

Back 9

bleeding, usually of a normal amount, occurring at irregular intervals.

Front 10

menometrorrhagia

Back 10

bleeding that is excessive in amount and duration, which occurs at either regular or irregular intervals.

Front 11

intermenstrual bleeding

Back 11

bleeding occurring between regular menstrual cycles.

Front 12

amenorrhea

Back 12

the absence of menses. primary or secondary.

Front 13

primary amenorrhea

Back 13

menstruation has not been established by age 16

Front 14

secondary amenorrhea

Back 14

an established menses (of longer than 3 months) ceases.

Front 15

Causes of amenorrhea

Back 15

1. hypothalamic dysfunction
2. pituitary dysfunction
3. chronic anovulation or ovarian failure
4. anatomic abnormalities

Front 16

dysmenorrhea

Back 16

painful menses. occurs at or a day before, the onset of menstruation and disappears by the end of menses. primary or secondary.

Front 17

primary dysmenorrhea

Back 17

defined as cramps without underlying disease. prostaglandins F2 and F2a which are produced by the uterus in higher concentrations during menses, are the primary cause. they increase uterine contractility and decrease uterine artery blood flow causing ischemia. the end result is the painful sensation of cramps.

Front 18

secondary dysmenorrhea

Back 18

associated with pathology of the reproductive tract and usually appears after menstruation has been established.

Front 19

causes of secondary dysmenorrhea

Back 19

1. endometriosis
2. residual pelvic inflammatory disease (PID)
3. cervical stenosis
4. uterine fibroids
   
5. ovarian cysts
6. benign or malignant tumors of the pelvis or abdomen
7. presence of an IUD (intrauterine device)

Front 20

premenstrual syndrome (PMS)

Back 20

a symptom complex associated with the luteal phase of the menstrual cycle. 70-90% of women report physical or emotional changes premenstrually. diagnosis is made when symptoms appear for three consecutive cycles.

Front 21

premenstrual dysphoric disorder (PMDD)

Back 21

affects 3-8% women must experience five or more symptoms in the given time frame, which are relieved with menstruation and have occurred during most cycles during the previous year. markedly interferes with work, school, and relationships and must not merely be worsened symptoms of another disorder such as major depressive disorder, panic disorder, or personality disorder.

Front 22

psychologic symptoms of PMS

Back 22

irritability, lethargy, depression, low morale, anxiety, sleep disorders, crying spells, hostility, decreased concentration

Front 23

neurologic symptoms of PMS

Back 23

classic migraine, vertigo, syncope

Front 24

respiratory symptoms of PMS

Back 24

rhinitis, hoarseness

Front 25

gastrointestinal symptoms of PMS

Back 25

nausea, vomiting, constipation, abdominal bloating, increased appetite or food cravings

Front 26

urinary symptoms of PMS

Back 26

retention and oliguria

Front 27

dermatologic symptoms of PMS

Back 27

acne

Front 28

mammary symptoms of PMS

Back 28

swelling and tenderness

Front 29

musculoskeletal symptoms of PMS

Back 29

joint or muscle pain

Front 30

menopause

Back 30

defined as the absence of menstruation for 1 full year, is a time of transition for a woman, marking the end of her reproductive abilities. occurs between 45-52 years, average age is 51.3.

Front 31

climacteric

Back 31

change of life refers to the host of psychologic and physical alterations that occur around the time of menopause.

Front 32

perimenopause

Back 32

refers to the period of time before menopause during which the woman moves from normal ovulatory cycles to cessation of menses.

Front 33

What kind of risks are there for a pregnancy when a woman is over 40?

Back 33

• hypertensive disorders
• diabetes
• placenta previa
• placental abruption
• over 50% heightened risk of SAB
• preterm birth
• IUGR
• 2x greater risk of pregnancy related death than younger women.

Front 34

non-contraceptive benefits of oral contraceptives during perimenopause:

Back 34

Healthy non-smokers benefit by

• regulation of menses
• treatment of anovulatory bleeding
• relief of symptoms of estrogen deficiency and variability such as hot flashes, sleep disturbances, menorrhagia, and vaginal dryness.

Front 35

what types of cancer will oral contraceptives decrease the risk of during perimenopause?

Back 35

endometrial and ovarian

Front 36

what are other factors that may contribute to the psychological aspects of menopause?

Back 36

• "empty nest"
• caring for aging parents

Front 37

what factors influence how a woman copes with climacteric changes?

Back 37

• self-concept
• physical health
• marital stability
• relationship with others
• cultural values

Front 38

on average, how much of a woman's life will be lived after menopause?

Back 38

1/3

Front 39

beginning 2-8 years before menopause, women experience:

Back 39

• episodes of anovulation
• reduced fertility
• decreased or increased flow
• irregular frequency of menses
• amenorrhea

Front 40

physical changes in the reproductive system include:

Back 40

• thinning of the endometrium
  
• atrophy of the myometrium
• atrophy of the fallopian tubes and ovaries
• loss of elasticity in the vaginal mucosa, which becomes thinner and smoother.
• loss of cervical gland function
• vaginal pH increases, increases risk of vaginal infections
• decrease in number of Doderlein's bacilli

Front 41

vasomotor changes

Back 41

80-90% of women who are perimenopausal or menopausal experience hot flashes, typically described as a feeling of heat rising from the chest and spreading to the neck. can happen up to 20-30 times a day. some women also experience dizzy spells, palpitations, and weakness.

Front 42

osteoporosis

Back 42

a decrease in bone strength related to diminished bone density and bone quality, is a major health concern for women

Front 43

lowered estrogen causes:

Back 43

osteoporosis

Front 44

risk factors for osteoporosis

Back 44

• middle-aged and elderly women
• european american or asian ethnic origin
• small-boned and thin body type, low body weight
• family history of osteoporosis
• lack of regular weight-bearing exercise
• nulliparity, early onset of menopause
• consistently low calcium intake, cigarette smoking
• moderate to heavy alcohol intake
• use of certain medications such as anticonvulsants, corticosteroids, lithium

Front 45

number one killer of women

Back 45

cardiovascular disease (CVD) 300,000 women die each year from coronary heart disease. six times higher than those deaths caused by breast cancer.

Front 46

metabolic syndrome

Back 46

is a major predisposing factor for coronary heart disease and is defined through a collection of risk factors. clinical characteristics are weight measurement greater than 35 inches, triglycerides grater than 150 mg/dL, HDL less than 50, blood pressures over 130/85, and fasting glucose levels greater than 110 mg/dL.

Front 47

risk factors for CHD in women

Back 47

• family history of heart disease
• advancing age - over 55 or postmenopausal
• overweight and obesity
• cigarette smoking, and/or tobacco use
• sedentary lifestyle
• hypertension
• diabetes
• elevated cholesterol
• race (highest incidence in African American women)

Front 48

Alzheimer's disease

Back 48

most commonly occurring form of dementia, estimated to affect 4.5 million Americans. new cases are projected to double between 2010 and 2050

Front 49

spontaneous premature menopause

premature ovarian insufficiency

Back 49

is a devastating event and is not well understood, although family history is a major influencing factor. it occurs in 1% of women under age 40 and is demonstrated by the development of amenorrhea, a sharp decline in estrogen levels, and a rise in follicle-stimulating hormone (FSH). 5-10% of cases will spontaneously reverse.

Front 50

treatment of premature menopause

Back 50

estrogen and progesterone therapy until the usual age of menopause.

Front 51

premature menopause can also be caused by:

Back 51

anorexia, chemotherapy or radiation treatments, and oophorectomy (surgical removal of the ovaries.

Front 52

hormone replacement therapy (HRT)

Back 52

refers to the administration of specific hormones to alleviate symptoms associated with the changes of menopause.

Front 53

estrogen therapy

Back 53

given to women who have undergone a hysterectomy.

Front 54

combined estrogen-progesterone therapy

Back 54

used for women with an intact uterus for the relief of vasomotor symptoms and urogenital and vaginal symptoms, as well as osteoporosis prevention.

Front 55

why is progesterone added to HRT for women with an intact uterus?

Back 55

unopposed estrogen increases the risk of endometrial cancer by eightfold and therefore is never given without progesterone in these women.

Front 56

modes of HRT delivery:

Back 56

orally, transdermally (patch, gel, lotion), vaginal creams, or vaginal ring.

Front 57

the primary indication for HRT

Back 57

treatment of menopausal symptoms such as hot flashes and urogenital symptoms is the primary indication for HRT and estrogen therapy (ET)

Front 58

HRT cannot prevent:

Back 58

coronary heart disease (CHD)

Front 59

methods of CHD prevention:

Back 59

weight control, regular exercise, no smoking, healthy diet, etc.

Front 60

testosterone may be added to HRT to:

Back 60

improve sexual desire, responsiveness, and frequency.

Front 61

bioidentical hormones

Back 61

structurally identical to the hormones produced by the ovaries. may be safer and more effective.

Front 62

what should be done prior to beginning HRT?

Back 62

a through history, physical examination, pap smear, measurement of cholesterol, lipids, and liver enzyme levels; baseline mammogram. endometrial biopsy for those at heightened risk of endometrial cancer and if excessive, prolonged, or unexpected bleeding occurs.

Front 63

women who are on HRT should report these symptoms immediately

Back 63

• headaches
• visual changes
• signs of thrombophlebitis
• signs of myocardial infarction

Front 64

ACOG recommends bone mineral density (BMD) testing for:

Back 64

• all postmenopausal women over age 65
• all postmenopausal women with fractures
• postmenopausal women under age 65 with one or more risk factors

Front 65

BMD testing may also be indicated for:

Back 65

pre or postmenopausal women with certain medical conditions:

• eating disorders
• thyroid disorders
• leukemia
• rheumatoid arthritis
• multiple sclerosis
• those taking corticosteroids or anticonvulsants

Front 66

biophosphonates

Back 66

reduce bone resorption and bone loss by inhibiting osteoclast activity. the two most common, alendronate (Fosamax) and risedronate (Actonel) are both taken upon arising in the morning on an empty stomach with a full glass of water.

Front 67

selective estrogen receptor modulators (SERMs)

Back 67

have estrogen-like properties. the SERM approved for osteoporosis treatment, reloxifene (Evista), acts like estrogen by protecting against osteoporosis but does not stimulate uterine or breast tissue. does not relieve other menopausal symptoms and may increase hot flashes, so it is indicated in asymptomatic women who want preventative therapy for osteoporosis.

Front 68

salmon calcitonin

Back 68

a calcium regulator that may inhibit bone loss and is approved for use to treat osteoporosis in women who are 5 years postmenopause. administered as a nasal spray, its value is less clear than that of other medications listed.

Front 69

parathyroid hormone

Back 69

a daily subcutaneous injection, activates bone formation, which results in substantial increases in bone density

Front 70

ultra-low-dose estrogen patches

Back 70

Menostar have proven to treat osteoporosis and can be used with out a progestogen. these small doses are found to demonstrate effective prevention of fracture without the increased side effects or risks of endometrial stimulation found in larger dose estrogen patches

Front 71

signs of myocardial infarction in women

Back 71

• pain in the neck, back or epigastric region
• loss of appetite
• shortness of breath
• nausea or vomiting
• weakness in the shoulder, arms, and chest

Front 72

phytoestrogens

Back 72

plant products that have estrogen-like properties and may help relieve some menopausal symptoms, although it is not clear whether relief comes from estrogens or other substances in plants. foods include carrots, yams, and soy.

Front 73

herbal supplement phytoestrogens

Back 73

black cohosh, dong quai, red clover, soy isoflavones, ginseng, and kava