NURS 450 Exam 1 comprehensive study guide PDF

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These notes landed me a 100% on the first exam for Prof Niland's first making babies class. Everything important on the slides and information added in the lecture is on this document....

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BASIC A&P, MENSTRUAL CYCLE, CONCEPTION FEMALE ANATOMY DIAGRAMS

MALE ANATOMY DIAGRAMS

FUNCTIONS OF REPRODUCTIVE ORGANS

Female Anatomy Ovaries: ● two small organs, about the size of almonds, set in the pelvic cavity below and to either side of the navel ● produce eggs for reproduction ● once mature, the egg passes into the fallopian tube where it is available for fertilization ● ovaries also secrete hormones, estrogen and progesterone Uterus: ● hollow, pear-shaped organ ● located between the bladder and rectum ● about the size of a fist ● main function is to nourish the developing fetus prior to birth Endometrium ● lining of the uterus ● thickens cyclically in anticipation of the fertilized egg ● implantation is the embedding of the fertilized egg, about 6 days after fertilization ○ developing embryo produces cells which, combined with cells from the endometrium, form the placenta (critical to fetal development) ● if implantation of a fertilized egg does not occur, the endometrium degenerates and sloughs off and menstruation occurs Cervix: ● doughnut shaped opening to the uterus ● located at the lower end of the uterus and the upper part of the vagina ● the os is the pin head sized opening in the cervix, it expands to 10 cm during vaginal birth Vagina: ● passage connecting the external genitalia (vulva, labia, clitoris) to the uterus ● surrounds the penis during heterosexual intercourse ● exit passageway for menstruation and for the baby during vaginal birth Bartholin's glands: ● two glands located slightly below and to the left and right of the opening of the vagina ● secrete mucus to provide lubrication, especially when the woman is sexually aroused, thus facilitating sexual intercourse ● they are homologous to Cowper's glands in males ● first described in the 17th century, by the Danish anatomist Caspar Bartholin the Younger (1655-1738)

Skene's glands: ● located on the upper wall of the vagina, around the lower end of the urethra ● this location is also known as the Gräfenberg spot or G-spot. ● drain into the urethra and near the urethral opening ● homologous with the prostate gland in males ● implicated in vaginal orgasm and “female ejaculation” Female Ejaculation (an aside, for the curious) - In 2002, Emmanuele Jannini of L'Aquila University in Italy showed that there may be an explanation both for the phenomenon and for the frequent denials of its existence. Skene's glands vary in size from one woman to another, to the point where they appear to be missing entirely in some women. If Skene's glands are the cause of female ejaculation and vaginal orgasms, this may explain the observed absence of these phenomena in many women. The clear or milky fluid that emerges (sometimes with force) during female ejaculation has a composition similar to the fluid generated in males by the prostate gland. The liquid is frequently mixed with urine that is sometimes released during the relaxation that occurs during orgasm, and with vaginal lubricating fluid.

Male anatomy Penis: ● ● ● ●

external reproductive sex organ the shaft contains the urethra the glans is the tip of the penis the foreskin is the sensitive skin covering the glans ○ becomes retractable in early childhood ○ circumcision is the surgical removal of the foreskin

Testes: ● two organs contained in the scrotum, the external sac in the groin ● produce sperm and a portion of the seminal fluid that carries sperm ● produce the hormone, testosterone Epididymis: ● long tube located near each testicle ● has a wormy texture ● moves sperm from testes to the vas deferens ● Stores mature sperm

Vas deferens: ● connects the epididymis and the urethra Urethra: ● tube that carries urine out of the body ● carries semen out of the body during “ejaculation” Prostate gland: ● sex gland, about the size of a walnut ● surrounds the neck of the bladder and urethra -- the tube that carries urine from the bladder ● secretes a slightly alkaline fluid that forms part of the seminal fluid, a fluid that carries sperm ● common side effects from removal of prostate include sexual dysfunction and urinary dysfunction Cowper’s Gland (Bulbourethral gland): ● located outside the complex of plumbing which attaches to the prostate ● remains intact when the prostate is removed ● secretes small amounts of a sticky fluid, likely to provide lubrication during sexual activity Seminal vesicles: ● sac-like glands located behind the bladder ● release fluid that forms part of the semen The first stage of the male sexual act, erection, results from nerve impulses from the autonomic nervous system that dilate the arteries of the penis, thus allowing arterial blood to flow into erectile tissues of the organ. During intercourse, contractions in the ducts of the testes, epididymis, and ductus deferens cause expulsion of sperm into the urethra and their mixture with the seminal and prostatic fluids. These substances, together with mucus secreted by accessory glands known as Cowper's glands, form the semen, which is discharged from the penile urethra during ejaculation.

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MENSTRUAL CYCLE & CONCEPTION Typical cycle length is 28 days from the first day of menses to next first day of menses Controlled by hormones: estrogen, progesterone, FSH, LH Follicle develops in ovary, secretes estrogen Estrogen causes a thickening of uterine lining

● Follicle releases egg towards the fallopian tube around day 14 (12-16 days after menses began) ● Egg is either fertilized in the tube or not ● If not fertilized, passes through into uterus, lining sheds, causing menstruation ● If fertilized, makes its way into uterus and implants approx 6 days after fertilization ● Egg lives for 24 hours ● Sperm lives for about 5 days in female reproductive tract ● Implantation occurs approx 6 days after fertilization ● Pregnancy begins at implantation ● HCG produced after implantation ● Progesterone is also produce and is ESSENTIAL to maintaining pregnancy ● MOFI: ○ 1) Menstruation: day 1 of cycle ○ 2) Ovulation: day 14 of cycle ○ 3) Fertilization: within 24 hours of ovulation ○ 4) Implantation: approx 6 days after fertilization

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PREGNANCY TESTS hCG: human chorionic gonadotropin, released when embryo implants into the endometrium (50-250mlU/ml by time menses is missed) Qualitative results: detects the presence of hCG ○ Result is positive or negative (yes or no) ○ Urine test (less common, blood) ○ hCG urines may vary relative to hydration Quantitative results: detects the amount of hCG in blood (to determine how many weeks you’re pregnant) ○ Result is a number value ○ Blood (serum) test only Every 2-3 days, the amount of hCG is doubled (early pregnancy) Concentrated urine is most accurate At day of missed period, tests are 99% accurate, but decrease in effectiveness with increased number of days before expected period Inaccurate results: tested too soon, expired test, test exposed to sunlight, cancer Pregnant result: two lines Not pregnant result: one line Invalid result: no lines Higher-than-Normal levels of hCG: some types of uterine cancer, molar pregnancy, more than one fetus, ovarian cancer ○ Molar pregnancy is the overgrowth of tissue meant to become placenta Lower-than-Normal levels of hCG: fetal dealth, incomplete miscarriage, ectopic pregnancy

○ Ectopic pregnancy is fertilized egg trees to plant into tube STI’s ● ● ● ● ● ●

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*LOOK AT STI CHART* Chance a person will contract an STI during their lifetime: 1 in 4 (half?) In the past 10 years, STIs have become more common among adults in the US Bacterial infections are curable Viral infections are treatable, but not curable Tuskegee study: A study in Alabama that took 600 black men (399 with syphilis and 201 without) that were treated for “bad blood” ○ No informed consent ○ Received: free medical exams, free meals, and burial insurance ○ Projected to last 6 months but went on for 40 years ○ Participants were never told they had syphilis and were never treated with penicillin after it was discovered to cure syphilis in 1947 ○ Study was stopped in 1972 ○ 1997: President Clinton apologizes on behalf of the nation ○ 2004: the last Tuskegee participant died CONTRACEPTION OVERVIEW ⅔ of people who use contraception consistently and correctly account for only 5% of unintended pregnancies Perfect use: always consistent and correct Typical use: not always consistent or correct Most to least effective to prevent pregnancy: LARC, depo-provera, pill/patch/rang, male condom, withdrawal Best to prevent STIs: condoms and abstinence 85% of becoming pregnant within a year without using contraception 45% of pregnancies per year are unintended NON-HORMONAL METHODS Non-Hormonal Methods: behavioral, barrier, sterilization, newer male options Behavioral: abstinence, outercourse, withdrawal, fertility awareness Barrier methods: external condoms, internal condoms, the sponge, diaphragm, cervical cap, spermicide ○ External condom: a sheath of thin latex or plastic worn on the penis during intercourse that collects semen before, during, and after a man ejaculates preventing sperm from entering the vagina. 2-18 pregnancies per 100 users ○ Internal condoms: goes inside of vagina. 5 pregnancies per 100 users ○ The sponge: a soft, two inch round, solid polyurethane “sponge” that contains spermicide covers the cervix blocking sperm from entry and spermicide immobilizes sperm. 12-24 pregnancies per 100 users.

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○ The diaphragm: (Caya is a new contour diaphragm), sits inside vagina and is filled with spermicide. 12 pregnancies per 100 users. ○ Cervical cap: spermicide filled cap sitting around the cervix that blocks sperm from entering the cervix. 14-29 pregnancies per 100 users. ○ Spermicides: better used with other contraceptive methods Sterilization methods: vasectomy, tubal ligation, hysterectomy, essure ○ Vasectomy: cutting the vas deferens to permanently prevent sperm from entering ejaculatory fluid ○ Tubal ligation: cutting the fallopian tubes to prevent passage of sperm/egg ○ Hysterectomy: surgical removal of the uterus (not prefered method) ○ Essure: *NO LONGER AVAILABLE* coils inserted into fallopian tubes to promote tissue growth and blockage HORMONAL METHODS Progestin inhibits ovulation, thickens cervical mucus, and thins uterine lining Estrogen decreases side effects and increases effectiveness Combined options: the pill, the patch, the ring Progestin-only options: the mini-pill, the short, implant, IUD Pill: 91-99% effective at preventing pregnancy; lighter periods and less cramping; 4080% decreased risk of endometrial and ovarian cancer; may prevent ectopic pregnancy; fewer symptoms of PCOS; must take daily; no STI protection; side effects; blood clots, heart attack, stroke; increase risk of breast and cervical cancer; raise blood pressure Patch (Ortho Evra): hormones delivered through skin; changed weekly (3 weeks on, 1 week off); 60% more estrogen; higher risk for blood clots; headaches ○ Twirla: new patch that has ½ the estrogen of Ortho Evra Ring (Nuvaring): disposable, flexible plastic ring embedded with hormones; insert into vagina for 3 weeks and remove for 1 week; increase vaginal irritation/discharge ○ Annovera: new ring that's reusable for one year mini-Pill: progestin only pill that must be taken at same time everyday; less effective than combined methods; used for patients with migraines, risk of blood clots or are breastfeeding; irregular bleeding; acne Depo-injection: injection every 3 months. 6 pregnancies every 100 users. Bone density loss with long term use; delayed return of fertility; weight gain common; irregular bleeding Implant (Nexplanon): progestin embedded rod inserted under skin of upper arm; effective for 4 years; 1 pregnancy/100 users; pain or scarring; weight gain; headache; prolonged irregular periods; acne; mood swings Hormonal IUD (Mirena, Kylena, Liletta, Skyla): progestin, T shaped rod inserted into uterus; lasts 3-5 years; 1 pregnancy/100 users; less cramps; prompt return to fertility; spotting; expulsion; uterine puncture/infection; must check string monthly Non-hormonal IUD (copper IUD Paragard): copper wrapped, T shaped rod inserted into uterus; lasts up to 12 years; thickens cervical mucus, inhibits sperm movement, reduces

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sperm survival, thins lining of uterus; prompt return to fertility; spitting; heavier bleeding/cramps; expulsion; uterine puncture/infection; must check string monthly Emergency Contraception Interrupting the process of ovulation, fertilization or implantation AFTER sex, before pregnancy occurs NOT AN ABORTION PILL Copper IUD as EC: consistently effective if inserted up to 5 days after sex. MOST EFFECTIVE (100%) Ella: prescription required. Consistently effective when taken up to 5 days after sex. As effective regardless of BMI Plan B: over the counter. Very effective if taken ASAP and up to 72 hours after sex. May be used up to 5 days after sex, but less effective. Less effective if higher BMI Dalkon shield: “modern contraceptive” of the 1970s that caused septic abortion, severe PID and infertility “THE PILL” movie John Rock: the OB/GYN who first promoted and prescribed the pill Catherine McCormack: funded research to develop the first birth control pill Margaret Sanger: major birth control activist Gregory Pincus: biologist and researcher who co-invented the combined oral contraceptive pill Too much estrogen in pill caused dangerous side effects Comstock Laws: criminalized the sale of contraceptive devices

UNPLANNED/UNINTENDED PREGNANCY (adoption, abortion) ● Abortion in the first trimester is a low risk and legal option ● Most abortions occur by 12 weeks after LMP ● Unintended pregnancy rate is at its lowest in 30 years due to access to contraception ADOPTION ● Every child deserves a family act: a federal bill that promotes the best interests of children by increasing the number of foster and adoptive homes available to all children in foster care and improving services to LGBTQ and religious minority children. ECDF does so by prohibiting federally funded child welfare service providers from discriminating against children, families, and individuals based on religion, sex, sexual orientation, gender identity and marital status. ● Legal process to transfer parental rights and responsibilities to another family ● Agency adoption: social worker coordinates adoption plans; arranges legal consultation; provides counseling ● Private adoption: attorney coordinates adoption plans; arranges legal consultation; can arrange counselling support

● Open adoption: all parties know each other’s full names and addresses etc. Often have direct contact with each other ● Semi-open adoption: limited access between families. May send pictures/cards and allow for arranged visits. The birth parent(s) received profile of adaptive family but may not choose to ever meet them ● Closed adoption: Birth parent(s) choose adoptive family through an agency/lawyer. The families do not meet. No contact between birth mother and child ● Surrender of parental rights: birth mother is legal guardian of baby until she signs this document within 72 hours after birth and is permanent ● In NH, birth mother is not required to name the father but if she does, he must agree to surrender rights ABORTION ● Roe vs. Wade: (Norma McCorvey) ○ First trimester (LMP-12wk): abortion allowed based on judgment of patient and care provider ○ Second trimester (13-27wk): Each state may choose to regulate the abortion procedure in ways that are ‘reasonable related to pregnant women’s health’. ○ Third trimester (27wk-EDD): State may choose to limit or even prohibit abortion. It may not impose restrictions that interfere with the life or health of the pregnant woman. ● Fetal pain perception is unlikely until the third trimester ● Less abortions because less unintended pregnancies ● RU486 (mifepristone): taken orally at clinics up to 9 weeks LMP, it blocks progesterone causing a breakdown in the endometrium. Within 72 hours, vaginal misoprostol is taken for uterine contractions. Antibiotics may be given to prevent infection. More than ½ abort within 5 hours. 97% effective. Most common medication abortion. ● MTX (methotrexate): taken orally only up to 7 weeks LMP. it is teratogenic to the embryo, meaning it interrupts the development. Requires misoprostol for uterine contractions. Less effective and less common in the US. ● MVA (manual vacuum aspiration): up to 12 weeks LMP and is 99% effective. Low risk. Brief and single visit. Can use sedation if desired. Less private than medical abortion ● D&C (dilation and curettage): up to 14-24 weeks LMP and is 99% effective. Low risk. Brief and single visit. Can use sedation if desired. Less private than medical abortion. Illegal in many states in 2nd trimester. ● Misoprostol: required with both medication aboritions options because it causes uterine contractions (up vagina)

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INFERTILITY Infertility: a person’s inability to reproduce either as an individual or with a partner OR a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (or 6 months if > 35; 3 months if > 40) True infertility: no uterus or no ovaries or no egg follicles OR no sperm Primary infertility: the couple has never achieved pregnancy Secondary infertility: previous pregnancy and unable to conceive again Both genders are at fault for infertility Oligomenorrhea: infrequent or light menstrual periods Amenorrhea: absence of menstrual period Anovulation: absence of ovulation Polycystic Ovarian Syndrome (PCOS): Multiple cysts on ovaries, irregular menses and decreased ovulation, hormonal imbalances, acne, hair growth. (common) Functional hypothalamic amenorrhea (FHA): Improper function of the hypothalamus and pituitary glands. (somewhat common) Premature ovarian insufficiency (POI): Early onset menopause, significantly earlier than the average of 51. Menopause: is the natural cessation of ovulation (early 50s) or, at any age if ovaries are surgically removed. Vulvodynia: chronic pain of the vulva for > 3 months

● Vaginismus: involuntary constriction of the pelvic floor muscles making intercourse difficult or impossible ● Fallopian tube obstruction: scarring from PID (STIs), ruptured appendicitis, abdominal surgery ● Abnormal uterine contour: scars, cysts, fibroids or abnormal congenital structure ● Imperforate hymen: congenital obstruction of vaginal introitus ● Endometriosis: overgrowth of uterine lining tissue flows up the fallopian tubes and grows outside the uterus on the ovaries, fallopian tubes or intestines (pain, menstrual irregularities and infertility) ● Anti-sperm antibodies: attack sperm to decrease motility and survival ● Hostile mucus: cervical mucus with unfavorable acidity or viscosity decreasing sperm motility and/or survival ● Spinnbarkeit test: tests consistency of cervical mucus ● Body temperature decreases then spikes right before ovulation ● Ovulation prediction kits: evaluate bodily fluids for elevated levels of luteinizing hormone (LH) and predict ovulation ○ LH in urine ○ Estrogen in saliva ○ Chloride ions in sweat ● Abnormal hormone levels may be caused by illness, disease, stress, medications etc. may interfere with ovulation ● Post coital test: 1-2 days prior to ovulation within 2-8 hrs after sex: examine cervical mucus. Unfavorable acidity and viscosity of cervical mucus can decrease sperm motility and survival ● Endometrial biopsy: small sample of endometrium is removed to examine tissue for abnormalities or changes ● Transvaginal/pelvic ultrasound: examines cervix, uterus, ovaries and fallopian tubes ● Sonohystogram: ultrasound with saline injected through cervix to example uterus and blockage in fallopian tubes (no iodine or radiation exposure) ● Hysterosalpingogram: x-ray with iodine dye injected through cervix into the reprodu...