OB Final Review
Chapter 4 – Common Reproductive Disorders
Endometriosis – tissues that should grow in the uterus but is actually growing outside of
the uterine cavity
• Etiology: risk factors including not giving birth, starting menstrual cycle <12
years old (can cause infertility); exact cause unknown; still responds to hormones
and grows in relation to that
• Therapeutic Management
Surgery – sometimes to surgically remove
Meds – hormone suppression
o Estrogen and progesterone causes endometrium to grow
o So she is given meds to suppress these hormones so the
endometrium does not grow
• Nursing Assessment
Infertility and pelvic pain – pain during sex *2 hallmark signs
Nonspecific pelvic tenderness – very severe cramps
Tender nodular masses or uterosacral ligaments
Posterior uterus
Ultrasound & laparoscopy for definitive diagnosis
• Nursing Management
o Education – teach about hormone therapy and pros and cons of it
o Healthy lifestyle habits – stroke, DVT, look at family history
o Support groups
Organizations and web resources to assist the client with infertility
RESOLVE: A nationwide network of chapters dedicated to providing education,
advocacy, and support for men and women facing infertility. They provide a helpline,
medical referral services, and a member-to-member contact system
(http://www.resolve.org).
American Society of Reproductive Medicine (ASRM): Provides fact sheets and other
resources on infertility, treatments, insurance, and other issues
(http://www.asrm.org).
International Council on Infertility Information Dissemination (INCIID): Provides
information about infertility, support forums, and a directory of infertility specialists
(http://www.inciid.org).
American Fertility Association: Offers education, referrals, research, support, and
advocacy for couples dealing with infertility (http://www.americaninfertility.org).
Bertarelli Foundation—The Human Face of Infertility: Aims to promote and improve
understanding of infertility by offering resources (http://www.bertarelli.edu).
International Consumer Support for Infertility: An international network engaged in
advocacy on behalf of infertile couples via fact sheets and information
(http://www.icsi.ws)
Contraception: Behavioral Methods
, • Abstinence 100% no risk!
• Fertility Awareness – single ovum released 14 days before next period, lives
about 24 hours, need to have regular periods
Cervical mucus ovulation method
o Assess character of cervical mucus and changes during
menstruation cycle
Basal body temperature
o Temp every morning (because temp is lowest when you first wake
up), temp will rise a day or 2 after ovulation because progesterone
is heat producing, and then will remain elevated for about 2 weeks
o Need regular periods
o Being sick/alcohol intake can raise temperature and give a false
reading
o It shows when ovulation occurred – cannot predict it
Sympohothermal method
o Looks at basal body temperature and cervical mucus changes
Standard days method
o Beaded bracelet with 26-32 days because of how long menstrual
cycle is
o Avoid sex days 8-19
o 95% effective
• Withdrawal (coitus interruptus) – 85% effective
• Lactational amenorrhea method – not 100%
Contraception: Barrier Methods – prevent sperm from reaching the ovum
• Condoms – watch for latex allergy
• Diaphragm (mechanical)
• Cervical cap (mechanical)
• Contraceptive sponge – if you add a spermicide to it, then it’s a chemical barrier
because it actually kills the sperm (cream, jelly, foam suppository) (mechanical)
Contraception: Hormonal Method – work by altering hormones in a woman’s body
• Oral contraceptive
o ACHES – abdominal pain, chest pain/SOB, headache, eye problems /
visual, severe leg pain
• Injectable contraceptives
o Deppo – given every 12 weeks
• Transdermal patches
o Lower abdomen or upper outer arm or buttock and applied weekly for 3
weeks then off for 1 then back on for 3..keep repeating
• Vaginal rings
o Nuva ring
, • Implantable contraceptives
o More long term
o Nexplanon – upper arm, good for 3 years, watch once it is placed to make
sure you can feel it and its still in place (small rod)
• Intrauterine contraceptives –creating a hostile environment so that implantation
can’t happen
o IUD
o Marian
• Emergency contraception – plan B within 72 hours of unprotected sex
Contraception: Sterilization
• TubalLigation
Sterilization for women
Need to sign consent firm, irreversible
A laparoscope is inserted; fallopian tubes are grasped and sealed
Coil is put into the fallopian tube and scar tissue starts to grow, sealing off
the tube
Takes at least 3 months until completely blocked
Essure – tiny little wire placed in fallopian tubes to make hostile
environment and scar tissue forms, blocking the fallopian tubes
C-section and already open – fallopian tubes are grasped and sealed
• Vasectomy
Sterilization for men
Semen no longer carry any sperm
Local anesthesia
Cut the vas deferens (carries the sperm)
Have to wait 6-8 weeks then submit a sperm specimen, 2 specimens with
no sperm before considered effective
Nursing Management of the Woman Choosing a Contraceptive Method *make sure
whatever form is picked the patient UNDERSTANDS, fits their lifestyle. This is patient
specific
Nursing Assessment
• Medical history
• Family history
• OB/GYN history
• Personal history – age, cardiovascular disease, menopause, younger safe sex
focus
• Diagnostic testing
• Physical exam
Nursing Interventions
• Client/couple participation in decision making
, • Client education
Misconceptions
o When lactating can still get pregnant
o None of the methods are 100% except abstinence
Mechanism of action; advantages and disadvantages, danger signs to
report
Method failure and backup method
Menopause – 1 year without a period
• Estrogen levels low
• FSH can be high
• 50-52 years old
• Surgical – remove the ovaries
Impact of Menopause on the Body
• Brain
Hot flashes
Sleep, mood, memory problems (vasomotor irregularities)
These are due to estrogen because levels drastically drop
Look at FSH b/c when estrogen drops, folic increase so FSH increases
Normal levels in reproductive years 2-25 but women hitting menopause
will be >25
Mood changes is fluctuation to hormone
Night sweats – keep room cool, use a fan, 85% of women will have
symptoms of vasomotor symptoms, they can be mild and last a few
minutes
Lifestyle – limit caffeine and alcohol, teach women to dress in layers so
they can take them off easily, drink 8-10 glasses of water a day
• Heart
Lower levels of HDL
Increased risk of CVD
• Bones
Bone density loss
Increased risk of osteoporosis
Fall risk
• Breasts
Duct and gland tissue replaced by fat
• Musk
Less Ca absorbed
Increased fractures
Do weight bearing exercises
Bone density tests with BMD (bone mineral density) evaluation
• GU
Vaginal dryness – local estrogen creams with menopause
Stress incontinence
Chapter 4 – Common Reproductive Disorders
Endometriosis – tissues that should grow in the uterus but is actually growing outside of
the uterine cavity
• Etiology: risk factors including not giving birth, starting menstrual cycle <12
years old (can cause infertility); exact cause unknown; still responds to hormones
and grows in relation to that
• Therapeutic Management
Surgery – sometimes to surgically remove
Meds – hormone suppression
o Estrogen and progesterone causes endometrium to grow
o So she is given meds to suppress these hormones so the
endometrium does not grow
• Nursing Assessment
Infertility and pelvic pain – pain during sex *2 hallmark signs
Nonspecific pelvic tenderness – very severe cramps
Tender nodular masses or uterosacral ligaments
Posterior uterus
Ultrasound & laparoscopy for definitive diagnosis
• Nursing Management
o Education – teach about hormone therapy and pros and cons of it
o Healthy lifestyle habits – stroke, DVT, look at family history
o Support groups
Organizations and web resources to assist the client with infertility
RESOLVE: A nationwide network of chapters dedicated to providing education,
advocacy, and support for men and women facing infertility. They provide a helpline,
medical referral services, and a member-to-member contact system
(http://www.resolve.org).
American Society of Reproductive Medicine (ASRM): Provides fact sheets and other
resources on infertility, treatments, insurance, and other issues
(http://www.asrm.org).
International Council on Infertility Information Dissemination (INCIID): Provides
information about infertility, support forums, and a directory of infertility specialists
(http://www.inciid.org).
American Fertility Association: Offers education, referrals, research, support, and
advocacy for couples dealing with infertility (http://www.americaninfertility.org).
Bertarelli Foundation—The Human Face of Infertility: Aims to promote and improve
understanding of infertility by offering resources (http://www.bertarelli.edu).
International Consumer Support for Infertility: An international network engaged in
advocacy on behalf of infertile couples via fact sheets and information
(http://www.icsi.ws)
Contraception: Behavioral Methods
, • Abstinence 100% no risk!
• Fertility Awareness – single ovum released 14 days before next period, lives
about 24 hours, need to have regular periods
Cervical mucus ovulation method
o Assess character of cervical mucus and changes during
menstruation cycle
Basal body temperature
o Temp every morning (because temp is lowest when you first wake
up), temp will rise a day or 2 after ovulation because progesterone
is heat producing, and then will remain elevated for about 2 weeks
o Need regular periods
o Being sick/alcohol intake can raise temperature and give a false
reading
o It shows when ovulation occurred – cannot predict it
Sympohothermal method
o Looks at basal body temperature and cervical mucus changes
Standard days method
o Beaded bracelet with 26-32 days because of how long menstrual
cycle is
o Avoid sex days 8-19
o 95% effective
• Withdrawal (coitus interruptus) – 85% effective
• Lactational amenorrhea method – not 100%
Contraception: Barrier Methods – prevent sperm from reaching the ovum
• Condoms – watch for latex allergy
• Diaphragm (mechanical)
• Cervical cap (mechanical)
• Contraceptive sponge – if you add a spermicide to it, then it’s a chemical barrier
because it actually kills the sperm (cream, jelly, foam suppository) (mechanical)
Contraception: Hormonal Method – work by altering hormones in a woman’s body
• Oral contraceptive
o ACHES – abdominal pain, chest pain/SOB, headache, eye problems /
visual, severe leg pain
• Injectable contraceptives
o Deppo – given every 12 weeks
• Transdermal patches
o Lower abdomen or upper outer arm or buttock and applied weekly for 3
weeks then off for 1 then back on for 3..keep repeating
• Vaginal rings
o Nuva ring
, • Implantable contraceptives
o More long term
o Nexplanon – upper arm, good for 3 years, watch once it is placed to make
sure you can feel it and its still in place (small rod)
• Intrauterine contraceptives –creating a hostile environment so that implantation
can’t happen
o IUD
o Marian
• Emergency contraception – plan B within 72 hours of unprotected sex
Contraception: Sterilization
• TubalLigation
Sterilization for women
Need to sign consent firm, irreversible
A laparoscope is inserted; fallopian tubes are grasped and sealed
Coil is put into the fallopian tube and scar tissue starts to grow, sealing off
the tube
Takes at least 3 months until completely blocked
Essure – tiny little wire placed in fallopian tubes to make hostile
environment and scar tissue forms, blocking the fallopian tubes
C-section and already open – fallopian tubes are grasped and sealed
• Vasectomy
Sterilization for men
Semen no longer carry any sperm
Local anesthesia
Cut the vas deferens (carries the sperm)
Have to wait 6-8 weeks then submit a sperm specimen, 2 specimens with
no sperm before considered effective
Nursing Management of the Woman Choosing a Contraceptive Method *make sure
whatever form is picked the patient UNDERSTANDS, fits their lifestyle. This is patient
specific
Nursing Assessment
• Medical history
• Family history
• OB/GYN history
• Personal history – age, cardiovascular disease, menopause, younger safe sex
focus
• Diagnostic testing
• Physical exam
Nursing Interventions
• Client/couple participation in decision making
, • Client education
Misconceptions
o When lactating can still get pregnant
o None of the methods are 100% except abstinence
Mechanism of action; advantages and disadvantages, danger signs to
report
Method failure and backup method
Menopause – 1 year without a period
• Estrogen levels low
• FSH can be high
• 50-52 years old
• Surgical – remove the ovaries
Impact of Menopause on the Body
• Brain
Hot flashes
Sleep, mood, memory problems (vasomotor irregularities)
These are due to estrogen because levels drastically drop
Look at FSH b/c when estrogen drops, folic increase so FSH increases
Normal levels in reproductive years 2-25 but women hitting menopause
will be >25
Mood changes is fluctuation to hormone
Night sweats – keep room cool, use a fan, 85% of women will have
symptoms of vasomotor symptoms, they can be mild and last a few
minutes
Lifestyle – limit caffeine and alcohol, teach women to dress in layers so
they can take them off easily, drink 8-10 glasses of water a day
• Heart
Lower levels of HDL
Increased risk of CVD
• Bones
Bone density loss
Increased risk of osteoporosis
Fall risk
• Breasts
Duct and gland tissue replaced by fat
• Musk
Less Ca absorbed
Increased fractures
Do weight bearing exercises
Bone density tests with BMD (bone mineral density) evaluation
• GU
Vaginal dryness – local estrogen creams with menopause
Stress incontinence
