NUR 2633 MATERNAL NEWBORN EXAM 1
STUDY GUIDE PART 1
NUR 2633 – Study Guide Exam 1/50 questions
Women’s health encompasses breast care, GYN exams, and assessments. Be
comfortable with the parameters of education for
a. Breast education-
b. Fluctuating hormone levels during the monthly cycle cause changes in breast
tissue.
i. Following menstruation, when hormone levels are at their lowest, the
breast tissue is smooth and nontender.
ii. As estrogen levels increase mid-cycle, breasts may become more
sensitive. Also, just before menstruation, when progesterone is
elevated, the breasts become swollen and tender, with palpable
nodules.
c. The area between the breasts has several oil and sweat glands, creating an
atmosphere conducive to the growth of bacteria.
d. Pregnancy darkens the color of the nipple, which is an enhancement for the
breastfeeding baby. This darker color does not disappear after pregnancy.
e. Mammography (mammogram) - is an MRI of the breast tissue used to detect
abnormalities (tumors and cysts).
i. Routine mammograms should be performed every 2 years for women
ages 50-74
ii. Some gynecologists recommend mammograms begin a yearly
mammogram screening at age 40.
Self-breast exams-
iii. Should be performed every 1-3 years for age 20-29 and every year for
women over 40.
iv. Technique:
Breast Self-Examination (ACS, 2011d) pg lxix
1) Lie down on your back and place your right arm behind your head. Remember,
this step is done while lying down. In this position, the breast tissue spreads
evenly over your chest wall and is as thin as possible. This makes it much easier
to feel all of the breast tissue.
, 2) Use the pads of your three middle fingers on the left hand to feel for lumps in
the right breast. Use overlapping dime-sized circular motions of the finger pads
to feel all of the breast tissue.
3) When feeling the breast tissue, you will use three different levels of pressure.
Light pressure is needed to feel the tissue closest to the skin. Medium pressure
allows you to feel a little deeper, and firm pressure allows you to feel the tissue
closest to your chest and ribs.
o Remember, it is normal to feel a firm ridge in the lower curve of each
breast. If you feel anything else out of the ordinary, be sure to tell your
health-care practitioner. It is important to use each pressure level to feel
all of the breast tissue before you move on to the next spot.
4) Move around the breast in an up and down pattern, starting at an imaginary line
drawn straight down your side from the underarm and moving across the breast
to the middle of the chest bone (sternum, breastbone).
o Make sure that you check the entire breast area going down until you feel
only your ribs and then up to the neck or collarbone (clavicle). Using the
up and down, or vertical, pattern is probably the most effective way to
examine the entire breast without missing any breast tissue.
5) Repeat step 4 on your left breast, putting your left arm behind your head and
using the finger pads of your right hand to do the exam.
6) Stand before a mirror, place your hands on your hips, and press down firmly. In
the mirror, look at your breasts for any changes of size, shape, contour, or
dimpling or redness or scaliness of the nipple or breast skin. (Pressing down on
your hips contracts the muscles of the chest wall and enhances any breast
changes).
7) Sit or stand with your arm only slightly raised so that you can easily feel the
underarm area. Do this on each side, feeling for lumps or thickened areas.
(Raising the arm straight up causes a tightening of the tissue and makes it more
difficult to examine).
Normal menstrual cycle –
v. Occurs approximately every 28 days (calculated from the first day of
last period to the first day of the next), lasts for 2-7 days
vi. Bleeding can be light to heavy, or variate between the two depending
on stage of menstruation.
What is the most common complaint with the menstrual cycle, and complications?
vii. Dysmenorrhea-painful menstruation
1. Production of prostaglandins
, 2. Tx: NSAIDS—prohibit prostaglandins
viii. PMS-fluctuation of estrogen/progesterone,
hyperprolactinemiaincreased prolactin secondary to breast
development.
1. Tx: exercise, rest, sleep, diet-decrease salt, sugar, caffeine
ix. Endometriosis-growth of endometrial tissue outside of the uterus
1. During the ischemic menstrual cycle the misplaced tissue
breaks down/bleeds into surrounding tissue—inflammation—
gets trapped causes cysts.
2. Cycles of this result in scarring, fibrosis, and adhesions—
binding organs together—increased abdominal pain, and
infertility
a. S/S: bleeding, pain
b. Dx: palpation, vaginal ultrasound, laparoscopy
c. Tx: pain meds, hormone therapy-shrinks endo tissue,
surgery, oral contraception
Colorectal screenings, colonoscopy, fecal occult tests are all also
important for women.
STI’s and risks
f. What is HPV?
i. Human papilloma virus (HPV) in an STI which can cause cellular
changes of the cervix- leading to cervical cancer.
ii. HPV can also lead to the development of papillomas- benign growths
of the genital and anal regions.
iii. Vaccine = Gardasil
1. Protects against HPV types 6, 11, 16, and 18. Newly approved
vaccine (Gardasil 9) covers HPV 6, 11, 16, and 18, as well as
31, 33, 45, 52, and 58- which are responsible for 1 in 5 cases of
HPV-associated cervical cancer.
2. Consists of 3 IM injections given over 6 months at 1, 2, and 6
months
3. Can be given to females age 9-26 years old, boys can also
receive the vaccine from age 9-15.
4. Nurses- teach the patient to be sure to return on time for each
vaccine series, and continue to have routine cervical cancer
screenings.
Contraception - Forms of birth control – good subject for your postpartum patients
as well – know them
g. Natural family planning-
h. Coitus interruptus- “pull out method”
, i. Abstinence
j. Breast feeding—maintains progesterone levels, keep from ovulating
k. Diaphragm- dome shaped, spermicide gel is placed inside the dome—
inserted into vagina 6 hrs before intercourse and left in for 6 hrs after.
l. Cervical cap- thimble shaped, spermicidal gel placed inside. Placed against
cervix
m. Condoms
n. Spermicidal gels
o. Hormonal methods
i. Ethinyl estradiol (estrogen)-prevents the release of FSH from the
anterior pituitary gland. When FSH levels are low the ovarian follicle
doesn’t form and ovulation is prevented.
ii. Progestins-inhibit LH surge-required for ovulation (used with
estrogen)
1. Progesterone only-thickens cervical mucus which creates a
hostile environment and endometrial atrophy so the egg wont
implant.
iii. Low-dose progestin only- (mini pill) thickens cervical mucus, can be
taken while breast feeding—won’t enter breast milk.
Patient teaching for birth control
iv. Takes 7 days to start being effective with the initial pack. So will
need to use a 2nd birth control method.
v. Recheck in 3 months when first started
vi. Take every day at roughly the same time
vii. Begin a new pack on the same day (always) usually a Sunday.
viii. If missed a dose, take 2 pills the following day.
p. Patch-est/prog- 3 weeks patch on, 1 week patch off (in order to have
menses).
i. Placed on the abd, buttocks, outer arm, or upper torso (EXCEPT the
breast area).
1. Patient education:
a. Rotate sites (weekly or monthly depending on patch)
b. If removed due to damage for longer than 24 hours,
replace with a new patch and use 2nd birth control method
x 7 days.
q. Vaginal ring-est/prog- placed on the 5th day of the menstrual cycle. Leave
in x3 weeks, remove x 1 week. Insert new ring at same time of day as the
last ring.
r. Emergency contraception- est/prog, or prog only (preferred)
s. Plan B: (levonorgestrel – synthetic progestin) Emergency contraception
– know education.
STUDY GUIDE PART 1
NUR 2633 – Study Guide Exam 1/50 questions
Women’s health encompasses breast care, GYN exams, and assessments. Be
comfortable with the parameters of education for
a. Breast education-
b. Fluctuating hormone levels during the monthly cycle cause changes in breast
tissue.
i. Following menstruation, when hormone levels are at their lowest, the
breast tissue is smooth and nontender.
ii. As estrogen levels increase mid-cycle, breasts may become more
sensitive. Also, just before menstruation, when progesterone is
elevated, the breasts become swollen and tender, with palpable
nodules.
c. The area between the breasts has several oil and sweat glands, creating an
atmosphere conducive to the growth of bacteria.
d. Pregnancy darkens the color of the nipple, which is an enhancement for the
breastfeeding baby. This darker color does not disappear after pregnancy.
e. Mammography (mammogram) - is an MRI of the breast tissue used to detect
abnormalities (tumors and cysts).
i. Routine mammograms should be performed every 2 years for women
ages 50-74
ii. Some gynecologists recommend mammograms begin a yearly
mammogram screening at age 40.
Self-breast exams-
iii. Should be performed every 1-3 years for age 20-29 and every year for
women over 40.
iv. Technique:
Breast Self-Examination (ACS, 2011d) pg lxix
1) Lie down on your back and place your right arm behind your head. Remember,
this step is done while lying down. In this position, the breast tissue spreads
evenly over your chest wall and is as thin as possible. This makes it much easier
to feel all of the breast tissue.
, 2) Use the pads of your three middle fingers on the left hand to feel for lumps in
the right breast. Use overlapping dime-sized circular motions of the finger pads
to feel all of the breast tissue.
3) When feeling the breast tissue, you will use three different levels of pressure.
Light pressure is needed to feel the tissue closest to the skin. Medium pressure
allows you to feel a little deeper, and firm pressure allows you to feel the tissue
closest to your chest and ribs.
o Remember, it is normal to feel a firm ridge in the lower curve of each
breast. If you feel anything else out of the ordinary, be sure to tell your
health-care practitioner. It is important to use each pressure level to feel
all of the breast tissue before you move on to the next spot.
4) Move around the breast in an up and down pattern, starting at an imaginary line
drawn straight down your side from the underarm and moving across the breast
to the middle of the chest bone (sternum, breastbone).
o Make sure that you check the entire breast area going down until you feel
only your ribs and then up to the neck or collarbone (clavicle). Using the
up and down, or vertical, pattern is probably the most effective way to
examine the entire breast without missing any breast tissue.
5) Repeat step 4 on your left breast, putting your left arm behind your head and
using the finger pads of your right hand to do the exam.
6) Stand before a mirror, place your hands on your hips, and press down firmly. In
the mirror, look at your breasts for any changes of size, shape, contour, or
dimpling or redness or scaliness of the nipple or breast skin. (Pressing down on
your hips contracts the muscles of the chest wall and enhances any breast
changes).
7) Sit or stand with your arm only slightly raised so that you can easily feel the
underarm area. Do this on each side, feeling for lumps or thickened areas.
(Raising the arm straight up causes a tightening of the tissue and makes it more
difficult to examine).
Normal menstrual cycle –
v. Occurs approximately every 28 days (calculated from the first day of
last period to the first day of the next), lasts for 2-7 days
vi. Bleeding can be light to heavy, or variate between the two depending
on stage of menstruation.
What is the most common complaint with the menstrual cycle, and complications?
vii. Dysmenorrhea-painful menstruation
1. Production of prostaglandins
, 2. Tx: NSAIDS—prohibit prostaglandins
viii. PMS-fluctuation of estrogen/progesterone,
hyperprolactinemiaincreased prolactin secondary to breast
development.
1. Tx: exercise, rest, sleep, diet-decrease salt, sugar, caffeine
ix. Endometriosis-growth of endometrial tissue outside of the uterus
1. During the ischemic menstrual cycle the misplaced tissue
breaks down/bleeds into surrounding tissue—inflammation—
gets trapped causes cysts.
2. Cycles of this result in scarring, fibrosis, and adhesions—
binding organs together—increased abdominal pain, and
infertility
a. S/S: bleeding, pain
b. Dx: palpation, vaginal ultrasound, laparoscopy
c. Tx: pain meds, hormone therapy-shrinks endo tissue,
surgery, oral contraception
Colorectal screenings, colonoscopy, fecal occult tests are all also
important for women.
STI’s and risks
f. What is HPV?
i. Human papilloma virus (HPV) in an STI which can cause cellular
changes of the cervix- leading to cervical cancer.
ii. HPV can also lead to the development of papillomas- benign growths
of the genital and anal regions.
iii. Vaccine = Gardasil
1. Protects against HPV types 6, 11, 16, and 18. Newly approved
vaccine (Gardasil 9) covers HPV 6, 11, 16, and 18, as well as
31, 33, 45, 52, and 58- which are responsible for 1 in 5 cases of
HPV-associated cervical cancer.
2. Consists of 3 IM injections given over 6 months at 1, 2, and 6
months
3. Can be given to females age 9-26 years old, boys can also
receive the vaccine from age 9-15.
4. Nurses- teach the patient to be sure to return on time for each
vaccine series, and continue to have routine cervical cancer
screenings.
Contraception - Forms of birth control – good subject for your postpartum patients
as well – know them
g. Natural family planning-
h. Coitus interruptus- “pull out method”
, i. Abstinence
j. Breast feeding—maintains progesterone levels, keep from ovulating
k. Diaphragm- dome shaped, spermicide gel is placed inside the dome—
inserted into vagina 6 hrs before intercourse and left in for 6 hrs after.
l. Cervical cap- thimble shaped, spermicidal gel placed inside. Placed against
cervix
m. Condoms
n. Spermicidal gels
o. Hormonal methods
i. Ethinyl estradiol (estrogen)-prevents the release of FSH from the
anterior pituitary gland. When FSH levels are low the ovarian follicle
doesn’t form and ovulation is prevented.
ii. Progestins-inhibit LH surge-required for ovulation (used with
estrogen)
1. Progesterone only-thickens cervical mucus which creates a
hostile environment and endometrial atrophy so the egg wont
implant.
iii. Low-dose progestin only- (mini pill) thickens cervical mucus, can be
taken while breast feeding—won’t enter breast milk.
Patient teaching for birth control
iv. Takes 7 days to start being effective with the initial pack. So will
need to use a 2nd birth control method.
v. Recheck in 3 months when first started
vi. Take every day at roughly the same time
vii. Begin a new pack on the same day (always) usually a Sunday.
viii. If missed a dose, take 2 pills the following day.
p. Patch-est/prog- 3 weeks patch on, 1 week patch off (in order to have
menses).
i. Placed on the abd, buttocks, outer arm, or upper torso (EXCEPT the
breast area).
1. Patient education:
a. Rotate sites (weekly or monthly depending on patch)
b. If removed due to damage for longer than 24 hours,
replace with a new patch and use 2nd birth control method
x 7 days.
q. Vaginal ring-est/prog- placed on the 5th day of the menstrual cycle. Leave
in x3 weeks, remove x 1 week. Insert new ring at same time of day as the
last ring.
r. Emergency contraception- est/prog, or prog only (preferred)
s. Plan B: (levonorgestrel – synthetic progestin) Emergency contraception
– know education.
