Download CCTC NUR 220 Units 4-7 (Test 3) - Questions & Answers and more Exams Nursing in PDF only on Docsity!
CCTC NUR 220 UNIT 4, 5, 6, & 7 (TEST 3)
Questions and answers with 100% correct solutions |
A+ Grade
Tx of trichomonas vaginalis ✔✔-Metronidazole or tinidazole -tx patient and partner -avoid intercourse until cured
Nursing interventions for metronidazole: ✔✔-NO ALCOHOL OR ALCOHOL PRODUCTS for 24 hours after completing metronidazole (mouthwash, aftershave, deodorant, and bath splashes)
Side effects of metronidazole: ✔✔headache dry mouth fatigue metallic bitter taste GI distress
chlamydial infection ✔✔-bacterial infection -caused by chlamydia trachomtis -transmission occurs through vaginal sex
a strain of chlamydia trachomatis is responsible for? ✔✔trachoma (world's leading cause of preventable blindness)
Newborn of a woman with untreated chlamydia is at risk of: ✔✔-developing ophthalima neonatorum, which responds to erythromycin ophthalmic ointment prophylaxis at birth
-chlamydia pneumonia
S/S of chlamydia: ✔✔Women
-often asymptomatic
-may have thin or purulent discharge
-burning and frequency of urination
-friable cervix (bleeds easily)
-lower abdominal pain
Dx chlamydia with: ✔✔nucleic acid amplifiction testing (most sensitive)
-polymerase chain reaction assay
-antigen detection
Tx for chlamydia: ✔✔-single dose of azithromycin orally or doxycycline 100 mg orally twice daily for 7 days (doxycycline not during pregnancy)
-treat sexual partners
-abstain from sex for 7 days
Gonorrhea: ✔✔-bacterial infection
-caused by neisseria gonorrhoeae
s/s of herpes genitalis: ✔✔-inguinal lymph node enlargement
-flulike symptoms
-genital pruritis or tingling
-primary episodes last the longest (2-4 weeks); recurrent episodes not as severe
Dx of herpes genitalis: ✔✔clinical appearance
culture of lesion
PCR identification
HSV specific glycoprotein G2 and glycoprotein G1 assay
Tx for herpes genitalis: ✔✔oral acyclovir (can be used during pregnancy), valacyclovir, or famciclovir
-Acyclovir can decrease incidence of herpes if used from 36 weeks gestation to birth
Nursing interventions with herpes genitalis: ✔✔-keep genital area clean and dry, wear loose clothing, wear cotton underwear or none at all to help promote healing
-c/s delivery if lesions visible when labor begins
Syphilis: ✔✔-Caused by spirochete Treponema pallidum
-acquired through vaginal, oral, or anal sex. Can be transmitted transplacentally. When infected in utero, the newborn exhibits secondary-stage symptoms of syphilis.
-transplacentally transmitted syphilis may cause IUGR, preterm birth, still birth
-divided into early and late stages
Early (primary) stage of syphilis: ✔✔-can last about 4 weeks
-chancre appears at the site where T. pallidum organism entered the body
-Symptoms: slight fever, loss of weight, and malaise
-Chancre persists for about 4 weeks and then disappears
P = Painless lesion R = Regional lymphadenopathy E = Exudate S = Single lesion S = Sexual contact can cause
Secondary Stage of syphilis: ✔✔-occurs in 6 weeks to 6 months
-skin eruptions called condylomata lata, which resemble wartlike plaques and are highly infectious, may appear on the vulva.
-Symptoms: rash on the palms and soles of feet, acute arthritis, enlargement of the liver and spleen, nontender enlarged lymphnodes, iritis, and a chronic sore throat w/ hoarseness.
C = Condyloma lata
A = Acute infection symptoms (fever, sore throat, malaise, weight loss)
M = Mucocutaneous lesion, mucous patches
P = Papules, Pustules
Symptoms of Condylomata Acuminata: ✔✔Soft, grayish-pink cauliflower like lesions
Tx of condyloma acuminatum ✔✔-Podofilox solution or gell
-imiquimod cream
-sinecatechin ointment
-cryotherapy w/ liquid nitrogen
-trichloroacetic acid (TCA)
-bichloracetic acid
-surgical removal by tangential scissor excision, shave excision, curettage, or electrocautery
-laser surgery
Nursing intervention with imiquimod, sinecatechins oinment, and podofilox: ✔✔-not used during pregnancy (teratogenic; associated w/ fetal death)
-Imiquimod and sinecatechin ointment must be washed off after specified time period.
Vaccine for HPV: ✔✔Gardasil and Cervarix
-recommended for girls ages 11-12 but can be given at 9, and for 13-26 y/o females who did not receive or complete the 3 dose vaccine series.
-boys 11-12 now recommended to get it to protect against HPV and help provide indirect protection of women by reducing HPV transmission.
HIV/AIDS: ✔✔-viral infection
-transmitted through blood, blood products, semen, vaginal fluid, breast milk
-affects t-cells, decreasing immune responses
-AIDS is HIV plus with an opportunistic infection
-No cure
Symptoms of HIV/AIDS: ✔✔-can be asymptomatic
-weight loss
-fatigue
Female
-recurrent vaginal yeast infection
-diarrhea
-oral thrush
Dx HIV/AIDS with: ✔✔ELISA, Western Blot test, CD4 counts
tx of HIV/AIDS: ✔✔-Antiretroviral medications - zidovudine (Retrovir)
-ZDV oral during pregnancy, IV during labor & birth,
-Infant - ZDV for 6 weeks
-c/s before ROM
-Avoid breastfeeding
pelvic inflammatory disease (PID) ✔✔-clinical syndrome of inflammatory disorders of the upper female genital tract that includes any combination of endometritis, salpingitis (tubal infection), tubo-ovarian abscess, pelvic abscess, and pelvic peritonitis
-CBC w/ differential
-RPR or VDRL to check for syphilis
-may have elevated C-reactive protein and sedimentation rate
-Abdominal tenderness on palpation, cervical and uterine tenderness on movement (chandelier sign), palpable mass.
-ultrasound
-laparoscopy (confirms diagnosis)
Tx of PID: ✔✔-Inpatient - IV fluids, pain meds, IV antibiotics - cefoxitin or cefotan w/ doxycycline or clindamycin and gentamicin
-Outpatient - ceftriaxone w/ doxycycline w/ or w/o metronidazole
-Treat sexual partner
-Remove IUD 24 - 48 hours after starting antibiotics
-Counseling for medications, sexual activity, possible infertility
Symptoms of Ovarian masses: ✔✔-can be asymptomatic
-Cramping, abdominal fullness feeling, dyspareunia, irregular bleeding, delayed menses
Dx of ovarian masses: ✔✔basis of palpable mass w/ or w/out tenderness and other related symptoms. Radiography or u/s may be used to assist in the dx
tx of ovarian masses: ✔✔Oral contraceptives, surgery considered for large masses
Risk factors for Ovarian Masses: ✔✔-white women
-50 and older
-early menarche
-late menopause
Endometrial polyps: ✔✔pedunculated (growing on a stalk) over-growths of the enometrium. They can occur as single or multiple growths.
-accompanied by symptoms of midcycle bleeding or spotting, bleeding or spotting after sex, or prolonged bleeding or spotting with menstrual cycles.
-tx: dilation and curettage (D&C) using a hysteroscope for visualization
fibroid tumors (leiomyomas) ✔✔-most common benign disease in women
-most are asymptomatic and require no tx. Sometimes seek tx for bleeding and pain
-symptoms: pelvic pain, menstrual irregularities, and infertility
Endometrial cancer: ✔✔most common disease in postmenopausal women
-high cure rate if detected early
Hallmark sign of endometrial cancer: ✔✔Vaginal bleeding in postmenopausal women not tx with hormone replacement therapy
Dx of endometrial cancer: ✔✔Endometrial biopsy, transvaginal ultrasound, posthysterectomy pathology of uterus
Tx of endometrial cancer: ✔✔-Total abdominal hysterectomy (TAH)
-urinary urgency
-urinary frequency
-low-grade fever(101 F (38.3 C) or lower)
-hematuria
-abnormal number of leukocytes and bacteria
Tx of cystitis: ✔✔-nitrofurantoin (first line tx),
-TMP-SMZ,
-fluoroquinolones (such as levofloxacin (Levaquin) for more serious infection
Cystitis in pregnancy may lead to: ✔✔amniotic fluid infection
retard growth of placenta
Dx cystitis with: ✔✔Urine culture
Pyelonephritis: ✔✔inflammation of the renal pelvis and the kidney. Often preceded by lower UTI (cystitis)
Symptoms of pyelonephritis ✔✔-High fever
-chills
-flank pain
-N/V
-malaise
-may have frequency, burning, urgency w/ urination
-edema of kidney & ureters (severe, colicky pain, vomiting, dehydration, ileus of large bowel)
Dx of pelonephritis: ✔✔-Increased diastolic blood pressure
-positive fluorescent antibody titer (FA test)
-low creatinine clearance
-bacteremia in urine
-pyuria
-white blood cell casts
Tx of UTI: ✔✔-Inpatient - IV hydration, IV antibiotics, Urinary analgesics - phenazopyridine(Pyridium)- orange pee, pain medications, antipyretics for fever, urinary catheterization if indicated
-Outpatient - IV antibiotic for 1 dose, Oral antibiotics - fluoroquinolones (ciprofloxacin, levofloxacin), ceftriaxone or gentamicin
Nursing management of UTI: ✔✔-Sexual & medical history
-Clean-catch urine specimen
-Teach - s/s UTI, hygiene practices, cotton underwear, void frequently, increase fluid intake, follow-up care
Cystocele- ✔✔Relaxation of anterior vaginal wall with prolapse of bladder into vaginal wall
Symptoms of cystocele: ✔✔-Stress urinary incontinence w/coughing, sneezing, laughing, sudden exertion
tx of uterine prolapse: ✔✔Topical or systemic estrogen
Vaginal pessary: gellhorn provides support for 2nd-3rd degree. Donut for 3rd degree. Ring for 1st and 2nd degree
Surgery
When is total vaginal hysterectomy preferred? ✔✔for small fibroids, abnormal uterine bleeding
Advantages and disadvantages of total vaginal hysterectomy: ✔✔Advantages: earlier ambulation, less postop pain, less anesthesia and operative time, less blood loss, no visible scar, short hospital stay
Disadvantages: increased risk of trauma to bladder
When is Total abdominal hysterectomy preferred? ✔✔cancer is expected, large fibroids, severe endometriosis, chronic PID, and adenomyosis
nursing interventions with hysterectomy: ✔✔Teach s/s of menopause, resume intercourse in 6 weeks, use of vaginal lubricants, estrogen replacement creams
Infertility- ✔✔failure to achieve a successful pregnancy after 12 months or more of regular, unprotected sex
Contributing factors to infertility: ✔✔-decrease sperm production
-endometriosis
-ovulation disorder
-tubal occulusions
Factors associated w/ physical inabilities to conceive: ✔✔-expense
-impact on couple's relationship
-lack of family support
Investigation of infertility: ✔✔least invasive first
-semen analysis
-Female pelvic examination
-ultrasounds (transvaginal or abdominal)
-hysteroscopy (exam uterus)
-Laparoscopy
diagnostic procedures with infertility: Preliminary investigation- ✔✔-Information about most fertile times for intercourse
-Explanation of basic infertility workup
-Basic assessments:
Ovarian function
Cervical mucus adequacy
Semen analysis (#1)
Tubal patency
General condition of pelvic organs
-coital problems
-other
Pharm intervention for infertility management: ✔✔-clomiphene citrate (Clomid, GnRH) Ovulation- induction agents
-Luveris - Human Menopausal Gonadotropins
-bromocriptine (Parlodel) - prolactin inhibitor
-glucophage (Metformin) for PCO
-danazol (Danocrine) for endometriosis
Therapeutic insemination: ✔✔-depositing of semen at the cervical os or in the uterus by mechanical means
Therapeutic insemination indicated for: ✔✔-seminal deficiencies as oligospermia (low sperm count), asthenospermia (decreased motility), and teratospermia (low percentage, abnormal morphology)
-Anatomic defects accompanied by inadequate deposition of semen (hypospadia)
-ejaculatory dysfunction
-cases of unexplained infertility
-female factor infertility
In vitro fertilization: ✔✔mature eggs are collected from ovaries and fertilized by sperm in a lab. The fertilized egg or eggs are implanted in your uterus
In vitro fertilization indications: ✔✔-Tubal or Mucus abnormalities
-Male infertility
-Male & female immunologic infertility
-Cervical factors
Infertility psychological problems: ✔✔-Development of lack of spontaneity of sex. Constant attention to temp. charts. Instructions about their sex life from an outsider
-Feelings of loss of control
-Feelings of reduced competency
-Loss of status and ambiguity as a couple - infertility often becomes central focus for role identity
Infertility Psychsocial Problems: ✔✔-Sense of social stigma. Feelings of guilt or shame
-Stress on marital and sexual relationship. Heighten feelings of frustration or anger between partners
-Strained relationship with healthcare providers
stages of Freud's theory of psychosexual development ✔✔-oral (birth-1 year): the infant derives pleasure largely from the mouth, w/ sucking and eating as primary desires
-anal (1-3 years): the child's pleasure is centered in the anal area, w/ control over body secretions as a prime force in behavior
-Phallic (3-6 years): sexual energy becomes centered in the genitalia as the child works out relationships with parents of the same and opposite sexes
-Latency (6-12 years): sexual energy is at rest in the passage b/t earlier stages and adolescence
-Genital (12 years- adulthood): mature sexuality is achieved as physical growth is completed and relationships with others occur
