ch. 18, 19 & 67

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heart attack warning signs

  • Uncomfortable pressure, squeezing, fullness, or pain in the center of the chest.
  • Pain or discomfort in one or both arms, back, neck, jaw, and/or stomach.
  • Shortness of breath with or without chest discomfort.
  • Newly developed exercise intolerance.
  • Episodic nausea/indigestion.
  • Palpitations.
  • Abdominal pain.
  • Light-headedness.
  • Sweating.

stroke warning signs

  • Sudden onset of numbness or weakness in the face, arm, and/or leg, especially on one side
  • Sudden onset of trouble seeing out of one or both eyes
  • Sudden onset of trouble walking, dizziness, loss of balance, or coordination
  • Severe headache with no known cause

reccommended immunizations

  • Influenza, Tetanus and diphtheria, MMR, Varicella, Herpes Zoster, HPV
  • HPV most common sexually transmitted virus

how should we prevent stroke or heart attack?

  • Avoid cigarette smoking
  • Limit alcohol consumption
  • Prevent injury from accidents
  • Prevent sexually transmitted diseases

what should we promote for healthy lifestyle?

  • Healthy diet and exercise
  • Breast cancer screening
    • screening q2years >age 50
  • Cervical cancer screenings
    • PAP smear and HPV
    • q3 yrs >21yrs
    • q5yrs >30yrs


  • Sexual maturity
  • Onset usually between ages 8 and 13
  • Triggered by gonadotropin-releasing hormone
  • Gonadotropings stimulate production of estrogen

what happens:

  • Enlargement of breasts
  • Growth of body hair
  • Widening of hips
  • Onset of menarche
  • Approximately 2-2.5 years after onset


  • marks permanent cessation of menstrual activity
  • onset between 35-58
  • 3 stages:
    • Perimenopause
    • Menopause
    • Postmenopause

signs and symptoms of menopause

  • Irregular periodsHot flashes
  • Sleep disturbances
  • Sexual dysfunction
  • Psychological changes
  • Mood swings, irritability, anxiety, panic attacks, depression

Other symptoms

  • Thinning of hair, food cravings, dry skin, weight gain, irregular heartbeat

hot flashes treatment

  • Avoid alcohol, hot beverages, warm rooms, smoking
  • Dress in layers, use fans
  • Some medications have been used off label
    • Fluoxetine, gabapentin, and clonidine

night sweats treatment

  • Sleep in cotton nightwear
  • Use cotton linens
  • Take cool shower before bed

sleep disturbances treatment

  • Establish regular bedtime schedule
  • Do not watch tv before bed
  • Leave cell phone in another room

sexual dysfunction treatment

  • Use water based lubricants
  • Adding soy and flaxseeds in the diet may decrease vaginal dryness

physiological treatment

  • Establish daily exercise program
  • Limit alcohol consumption
  • MHT may be prescribed
  • Psychotherapy and medications for depression and anxiety

what is osteoporosis

loss of bone mass that occurs when more bone mass is absorbed than the body creates


risk factors of osteoporosis

  • Caucasian
  • Thin
  • Current smokes
  • Sedentary lives
  • Vit D and Ca deficiencies
  • Increased alcohol consumption
  • History of eating disorders
  • Weight loss surgery

risk reduction for osteoporosis

high calcium and vit D diet

increased weight bearing exercise

avoid smoking

limit alcohol


calcium rich foods

  • Canned sardines (3 oz.): 325 mg
  • Plain low-fat yogurt (4 oz.): 310 mg
  • Cheddar cheese (1.5 oz.): 307 mg
  • Orange juice, calcium fortified (8 oz.): 300 mg
  • Cheddar cheese (1.5 oz.): 307 mg
  • Milk, 2% milk fat (8 oz.): 300 mg
  • Almond milk, rice milk, or soy milk: 300 mg
  • Salmon (3 oz.): 181 mg
  • Kale, frozen (8 oz.): 180 mg


Inhibits resorption of bone, the process where breakdown of bone and release of minerals occurs with the resulting transfer of calcium from the bone fluid to the blood.

Adverse effects: Musculoskeletal aches and pains, gastrointestinal irritation, and esophageal ulcerations.


teaching for bisophosponates

  • To reduce side effects and to enhance absorption of the oral medication, the woman should:
  • Take the medication in the morning on an empty stomach at least 30 minutes before breakfast.
  • Take the medication with at least 8 oz. of water (do not take with juice, coffee, or tea, as these can ↓ absorption of medication).
  • Take the medication in a sitting or standing position to decrease the risk of the pill becoming lodged in the esophagus where it can cause ulcerations and scarring.
  • Remain upright for at least 30 minutes to decrease the risk of reflux of the pill into the esophagus

adolescent health

  • Physical
    • Sexual maturity, increases in height and weight, completion of skeletal growth
  • Cognitive
    • Concrete to abstract thinking, logically problem solve, moral and social issues become a concern
  • Psychosocial development
  • Working toward role identity, develop moral and ethical values, greater sense of self-esteem
  • Accidents and suicide
  • Sexually transmitted illnesses
  • Teen pregnancy
  • Eating disorders

what is important to teach adolescent

  • pregnancy prevention
  • STI prevent
  • safe sex
  • eating disorders

signs that driving is no longer safe

  • Has trouble seeing or following traffic signals, road signs, and pavement markings.
  • Stops at green lights or when there is no stop sign.
  • Gets confused by traffic signals.
  • Runs stop signs and red lights.
  • Gets lost in familiar locations.
  • Finds dents and scrapes on the car, fence, mailbox, and garage doors.
  • Responds more slowly to unexpected situations.
  • Has trouble moving foot from gas to brake pedal.


  • Most common major surgeries for women
  • Can be done for several different reasons
    • Cancer, endometriosis, abnormal uterine bleeding, PID

partial hysterectomy

removes uterus but leaves cervix


total hysterectomy

removes uterus and cervix


Hysterectomy with bilateral salpingo-oophorectomy-

removes uterus, cervix, fallopian tubes, and ovaries


Radical hysterectomy

removal of uterus, fallopian tubes, ovaries, upper portion of vagina, and lymphnodes


risks related to surgery

  • Complication related to anesthesia
  • Injury to ureters, bladder, and/or bowel
  • Hemorrhage
  • Infection
  • Deep vein thrombosis/venous thromboembolism

instruct the woman to notify health care provider post operative if

  • Increased pain or pain that is not relieved by medication.
  • Drainage, bleeding, redness, or swelling from the incisional site or increased bleeding from the vagina.
  • Leg/calf pain, swelling, and/or redness.
  • Fever 102.2°F (39°C) or higher, or as instructed by physician

causes of chronic pelvic pain

  • Reproductiv
    • PID, adhesions, endometriosis, IUD
  • Urological
    • Kidney stones, chronic UTI
  • Musculoskeletal
    • Poor posture, fibromyalgia
  • Gastrointestinal
    • Crohn’s, celiac, colitis, IBS
  • Neurological
    • Shingles, herniated disk
  • Psychological
    • Depression
  • Other
    • Sexual/physical abuse

Polycystic Ovary Syndrome (P C O S)

Impacts 10% of childbearing women


PCOS increase risk of

  • Type 2 diabetes
  • Cardiovascular disease
  • Hypertension
  • Cancers
  • Infertility
  • Pregnancy and birth complications
  • Sleep apnea
  • Metabolic syndrome

s/s of PCOS

  • Infertility
  • PCOS is most common cause of infertility
  • Menstrual disorders
  • Hirsutism
  • Ovarian cysts
  • Obesity
  • Oily skin
  • Pelvic pain
  • Male-pattern baldness

nursing actions for PCOS

  • Risk factors
  • Weight reduction
  • Treatment options for hirsutism, acne, and oily skin
  • Fertility concerns
  • Psychological effects due to body changes


  • Chronic inflammatory disease
  • Causes lesions that respond to changes in estrogen and progesterone
  • Can either be asymptomatic or has distressing symptoms

s/s of endometriois

  • One-third are asymptomatic
  • Pelvic pain and dysmenorrhea begin a few days before menses
  • Other symptoms include
  • Low back pain
  • Pelvic pain
  • Dyspareunia
  • Infertility
  • Spotting and menorrhagia
  • Diarrhea and pain with defecation
  • Bloody urine
  • Enlarged and tender ovaries
  • Emotional impact

what happens with endometriois

  • Abnormal growth of tissue resembling the endometrium that is present outside of the uterine cavity.
  • Tissue responds to changes in estrogen and progesterone levels.
  • The tissue grows and thickens during the secretory and proliferative stages of the menstrual cycle.
  • The tissue breaks down and bleeds into the surrounding tissues during the menstrual phase.
  • Bleeding into surrounding tissues causes pain and inflammation.
  • Scarring, fibrosis, and adhesions result from continued inflammation.


vaginal discharge that can be malodorous, depending on the causative agent; burning; irritation; or itching.

The most common types of vaginitis are candida vaginitis, bacterial vaginosis, and trichomoniasis


leiomyoma of the uterus

  • Also known as uterine fibroids
  • Benign fibroid tumors
  • Common, asymptomatic, or painful
  • Blood loss can cause anemia.
  • Surgical treatment

s/s of leiomyoma of the uterus

  • Pelvic pressure from the enlarging mass
  • Dysmenorrhea, metrorrhagia, menorrhagia, including risk for anemia related to menorrhagia
  • Pelvic pain, backaches, and/or leg pain
  • Urinary frequency and urgency when myomas are pressing on the bladder
  • Palpation of tumor during bimanual pelvic examination

assessment finding for prolapse, incontinence and fistulae

  • Protrusion of uterus into the vagina
  • Low backache
  • Sensation of heaviness in the pelvis or vagina
  • Sensation that the uterus is falling out
  • Difficult or painful intercourse

nursing actions for prolapse, incontinence and fistulae

  • Explain the importance of Kegel exercises for improving pelvic muscle strength and teach the woman how to do Kegel exercises.
  • Instruct the woman on the treatment and prevention of constipation, such as a high-fiber diet and increased fluid intake. This will help in reducing straining during defecation and decrease stress on existing POP.
  • Instruct the woman to avoid heavy lifting to decrease stress on pelvic organs.
  • Explain the relationship between increased weight and increased risk of prolapsed uterus and discuss weight reduction strategies.
  • Provide postoperative care for women having a hysterectomy.

risk factors for cancer



risk factors for breast cancer

  • Increasing age: The most invasive form of breast cancer is found in women aged 55 and older
  • Defects in breast cancer genes BRCA1 or BRCA 2.
  • Two out of 10 women diagnosed with breast cancer have a family history of breast cancer
  • Dense breasts
  • Personal history of breast cancer in at least one breast.
  • Exposure to head or chest radiation.
  • Excess weight.
  • Exposure to estrogen through early onset of menarche, late menopause, or use of hormone therapy.
  • Smoking.
  • Exposure to carcinogens.
  • Excessive use of alcohol.
  • Exposure to diethylstilbestrol (DES).

what are gynecological cancers

  • Cervical cancer
  • Endometrial cancer
  • Ovarian cancer

signs of intimate partner violence

  • Repeated nonspecific complaints
  • Overuse of health care system
  • Hesitancy, embarrassment, or evasiveness in relating history of injury
  • Time lag between injury and presentation for care
  • Untreated serious injuries
  • Overly solicitous partner who stays close to the woman and attempts to answer questions directed at her
  • Injuries of head, neck, face, and areas covered by a one-piece bathing suit; during pregnancy, the breasts and abdomen are particular targets of assault.
  • Presence of bruises at various stages of healing

Common questions asked in an IPV screening tool are:

  • Has your partner ever hit you?
  • Do arguments with your partner result in you feeling bad about yourself?
  • Do you ever feel frightened by what your partner says or does?
  • Do you feel safe in your current relationship?


  • very common
  • more than 100 known types
  • leads to cervical cancer
  • asymptomatic
  • looks like cauliflower
  • TX- removal of wart

first line test for cervical cancer

The Papanicolaou (Pap) test remains the most cost-effective tool to screen females for cervical cancer. It is the first-line test to detect an abnormal growth in the cervix or vagina


teaching for HPV

Educate the patient on prevention, manifestations, transmission of S T I’s, reducing the number of partners, and the use of barrier methods — Safe sex will help to decrease transmission of HPV to another person and thus the overall prevalence.

Encourage healthy practices (e.g., healthy diet, limit drinking, no smoking) and routine gynecological and primary care — Improve health outcomes and well-being

Encourage completion of the full series of HPV vaccinations — Vaccination will reduce the risk of the acquisition of HPV-related cancers and disease.

Instruct the patient to report any history of infection to partners — The partner may be at risk and/or may need to be treated. Early treatment can reduce complications of infection.

Instruct the patient on the appropriate application of gels, creams, or ointments as indicated for genital warts — Proper application will maximize benefit and minimize adverse effects.

Call provider if experiencing worsening pain and/or vaginal discharge — May be an indication of a worsening condition or complication



  • complex chronic infection that has the ability to acutely or chronically infect every organ of the body in a very subtle manner
  • lesions last 3-6 weeks
  • caused by the anaerobic spirochete Treponema pallidum

where is syphilis mostly located

vulva, vagina, anus, penis, rectum, lips, and oral pharynx


what med is given for syphilis



s/s of ALL STIs

  • history of other S T I’s
  • early age of sexual intercourse
  • MSM practices
  • multiple partners
  • low socioeconomic status
  • immune-compromised individuals.

genital herpes

  • transmitted easier from males to females
  • very contagious
  • majority of people dont know they have it
  • PAIN is leading cause of the pt getting checked
  • no cure

prevention of STIs

reducing the number of partners, and barrier methods — Safe sex can help decrease the transmission and occurrence


Neisseria gonorrhoeae (gonorrhea)

  • second most common bacterial S T I, after chlamydia
  • Transmitted by skin/mucous membranes
  • Perinatal transmission during delivery
  • Dual therapy with cephalosporins and azithromycin

Chlamydia trachomatis (chlamydia)

  • most common sexually transmitted bacterial infection
  • primarily infects the urethra and cervix
  • Doxycycline
  • Azithromycin
  • Chlamydia may be asymptomatic, but may result in dysuria

PID- pelvic inflammatory disease

  • acute infection that originates from the vagina or cervix and ascends to the upper genital tract, infecting the uterus, fallopian tubes, and ovaries
  • polymicrobial infection caused by an S T I such as chlamydia or gonorrhea or by other pathogenic microorganisms

if a pt is prescribed flagyl (metronidazole)



dosage calculations for children should be

double checked by another nurse or pharmacist


less than 10 kg



10-20 kg

1000ml/day PLUS 50 ml/kg for each kg over 10


OVER 20 kg

1500ml/day PLUS 20ml/kg/day for each kg



1 tsp



1 tbsp


macrobore tubing

(tubing with a drop factor of 10, 15, or 20 drops per milliliter) can allow large volumes of fluid to be infused if an IV under manual control is not closely watched

designed for adults


microbore tubing

drop factor of 60 gtts/ml

use volume control sets

for peds

ALWAYS use a pump on manual control


pediatric infusion pumps are designed to

deliver fluids at a lower psi than adults


To prevent children from receiving an accidental fluid bolus

the burette is filled with no more than two or three times the hourly flow rate


broselows tape

emergent color tape used to measure peds in ER for the crash cart


safe guidelines for breastfeeding mothers

  • Administer once-daily doses right before the infant’s longest sleep period.
  • Have the mother breastfeed the infant immediately before or after the dose is taken when medications are given multiple times daily.
  • Refer to a reliable reference before administering or using medications. Those that are safe in pregnancy are not necessarily safe in lactation