Obstetrics and Gynecological Conditions - NCLEX-PN

Increment is the beginning or rise of the contraction. Acme is the peak of the contraction. Decrement is the fall of the contraction. Frequency is measured from the beginning of one contraction to the beginning of another, so it should be measured from the increment of the first contraction to the increment of the second contraction.

The nurse must suspect rupture of the membranes (amniotic sac). Assess fetal heart rate if rupture of the membranes may have occurred. With rupture comes the potential for cord prolapse. Assess fetal heart rate for baseline variability. Marked variability may be cause for concern and the nurse should monitor the patient for signs of infection.

The alpha-fetal protein (AFP) test is the only test that can predict neural tube defects in a fetus during pregnancy. CVS can detect fetal karyotype, sickle-cell anemia, phenylketonuria (PKU), Down syndrome, and Duchenne muscular dystrophy. Amniocentesis can detect genetic disorders and lung maturity. Ultrasounds provide images of the fetal position, measurements of the fetus and placenta, and can confirm pregnancy and gestational age. Non-stress tests (NST) are used to record fetal heart rate to assess fetal well being after 28 weeks gestation.

It is important for the obstetric registered nurse to recognize the following danger signs of pregnancy: profuse vaginal bleeding, severe headaches/visual disturbances/abdominal pain, persistent vomiting, fever, chills, or swelling in the face or fingers. These may be signs of placental abnormalities, hypertensive disorders or pregnancy, maternal infection, or hyperemesis. Increased urination may be concerning to some women, but during pregnancy, the increased mass of the uterus induces pressure upon the bladder.

ASC-US or LSIL in women age 21-24 should be managed by repeat cytology in one year. Neither cervical conization nor LEEP (loop electrosurgical excision procedure) would be appropriate in a patient of this age or presentation.

Premature ovarian failure is the loss of ovarian function in an individual under the age of 40. A and would be indicative of this condition.

The most common symptoms of ectopic pregnancy are moderate to severe abdominal pain and vaginal bleeding. Pain may be cramping or sharp. Bleeding can be heavy and the individual can even begin to bleed into their abdominal cavity. Ectopic pregnancy is not consistent with fetal survival and requires treatment with methotrexate or, in the case of bleeding, surgery may be indicated.

The most likely cause of her rash is pruritic urticarial papules and plaques of pregnancy (PUPPP), a condition affecting about 1 in every 200 pregnancies. While she could be having an allergic reaction (dermatitis herpetiformis or urticaria) or an inflammatory eruption such as heat rash, these are less likely due to their absence before pregnancy and the absence of any significant changes in her diet or lifestyle.

In the average normal pregnancy, the GFR increases by upwards of 50%. This correlates with an overall 50% increase in blood plasma volume.

In placenta previa, the placenta develops in such a way that all or part of it is positioned in the lower one-third of the uterus, placing it between the fetus and the cervix. This can cause the placenta to tear and bleed. The most common sign is painless vaginal bleeding in the third trimester (generally after week 32).

Hegar's sign is indicated by a softening of the portion of the uterus between the uterus and a portion of the cervix. The remaining choices are all examples of various skin discolorations commonly associated with pregnancy.

75 to 90% of cases of pelvic inflammatory disease are caused by neisseria gonorrhoeae and/or chlamydia trachomatis infections. This condition, typified by adhesion formation in the uterus and fallopian tubes, can result in serious issues such as infertility, ectopic pregnancy, or reproductive cancer.

The criteria for diagnosis of PID are as follows: fever, cervical motion tenderness, abdominal pain, leukocytosis, elevated ESR, and purulent cervical discharge.

The primary risk in rubella infection during pregnancy is to the fetus. The rubella virus is able to cross the placenta, and acts as a teratogen by inducing apoptosis in fetal cells. This is termed congenital rubella syndrome. Birth defects can include deafness, ocular damage, cataracts, congenital heart defects, hepatomegaly, and developmental disability or delays.

Rh sensitization can be prevented by treatment of an Rh negative mother with Rho(D) immunoglobulin at 28 weeks, then again within 72 hours of delivery. This is a solution of IgG antibody to Rh-D, which is able to destroy any fetal red blood cells that enter the mother's bloodstream before her own immune system is able to form develop a sensitization.

A Shirodkar procedure involves sewing a suture in and around the cervix to hold it closed. This is usually performed within the first trimester and later removed when the risk of miscarriage has lessened.

Oxytocin is often used to help augment labor by inducing contractions. This hormone is naturally made in the body and works as an anti-diuretic hormone (thus promotes the excretion of water). In labor, this hormone also works to stimulate uterine contractiity.

Yoga once per week (light exercise) is the least likely of the above to cause a change in regular menstruation. Cross country or long distance running (vigorous exercise) is more likely to cause changes to a woman's cycle. Poor lifestyle choices such as eating habits and health issues such as kidney disease can also cause irregular menstruation. Likewise, pharmaceuticals can have the same effect.

There are many different ways to treat painful periods (dysmenorrhea). Ibuprofen and naproxen are anti-inflammatory agents that do not require a prescription and can be very effective. They have relatively few side effects. Lifestyle modification (such as exercise) is another good alternative. The use of oral contraceptives are also frequently used to give women lighter and milder periods. Percocet is not generally used because it is an opioid analgesic and not recommended for long term use because they carry potential for addiction.