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NUR 2633 MATERNAL NEWBORN STUDY GUIDE WITH QUESTIONS
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NUR 2633 MATERNAL NEWBORN STUDY GUIDE WITH QUESTIONS
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NUR 2633 MATERNAL NEWBORN STUDYGUIDE 2020 WITH QUESTIONS
Women’s health encompasses breast care, GYN exams, and assessments. Be comfortable with the
parameters of education for
a. Breast education-
b. Fluctuating hormone levels during the monthly cycle cause changes in breast tissue.
i. Following menstruation, when hormone levels are at their lowest, the breast tissue
is smooth and nontender.
ii. As estrogen levels increase mid-cycle, breasts may become more sensitive. Also,
just before menstruation, when progesterone is elevated, the breasts become
swollen and tender, with palpable nodules.
c. The area between the breasts has several oil and sweat glands, creating an atmosphere
conducive to the growth of bacteria.
d. Pregnancy darkens the color of the nipple, which is an enhancement for the breastfeeding
baby. This darker color does not disappear after pregnancy.
e. Mammography (mammogram) - is an MRI of the breast tissue used to detect
abnormalities (tumors and cysts).
i. Routine mammograms should be performed every 2 years for women ages 50-74
ii. Some gynecologists recommend mammograms begin a yearly mammogram
screening at age 40.
Self-breast exams-
iii. Should be performed every 1-3 years for age 20-29 and every year for women
over 40.
iv. Technique:
Breast Self-Examination (ACS, 2011d) p lxix
1) Lie down on your back and place your right arm behind your head. Remember, this step is
done while lying down. In this position, the breast tissue spreads evenly over your chest wall
and is as thin as possible. This makes it much easier to feel all of the breast tissue.
2) Use the pads of your three middle fingers on the left hand to feel for lumps in the right breast.
Use overlapping dime-sized circular motions of the finger pads to feel all of the breast tissue.
3) When feeling the breast tissue, you will use three different levels of pressure. Light pressure
is needed to feel the tissue closest to the skin. Medium pressure allows you to feel a little
deeper, and firm pressure allows you to feel the tissue closest to your chest and ribs.
o Remember, it is normal to feel a firm ridge in the lower curve of each breast. If you
feel anything else out of the ordinary, be sure to tell your health-care practitioner. It is
important to use each pressure level to feel all of the breast tissue before you move on
to the next spot.
4) Move around the breast in an up and down pattern, starting at an imaginary line drawn
straight down your side from the underarm and moving across the breast to the middle of the
chest bone (sternum, breastbone).
o Make sure that you check the entire breast area going down until you feel only your
ribs and then up to the neck or collarbone (clavicle). Using the up and down, or
vertical, pattern is probably the most effective way to examine the entire breast
without missing any breast tissue.
, 5) Repeat step 4 on your left breast, putting your left arm behind your head and using the finger
pads of your right hand to do the exam.
6) Stand before a mirror, place your hands on your hips, and press down firmly. In the mirror,
look at your breasts for any changes of size, shape, contour, or dimpling or redness or
scaliness of the nipple or breast skin. (Pressing down on your hips contracts the muscles of
the chest wall and enhances any breast changes).
7) Sit or stand with your arm only slightly raised so that you can easily feel the underarm area.
Do this on each side, feeling for lumps or thickened areas. (Raising the arm straight up
causes a tightening of the tissue and makes it more difficult to examine).
Normal menstrual cycle –
v. Occurs approximately every 28 days (calculated from the first day of last period
to the first day of the next), lasts for 2-7 days
vi. Bleeding can be light to heavy, or variate between the two depending on stage of
menstruation.
What is the most common complaint with the menstrual cycle, and complications?
vii. Dysmenorrhea-painful menstruation
1. Production of prostaglandins
2. Tx: NSAIDS—prohibit prostaglandins
viii. PMS-fluctuation of estrogen/progesterone, hyperprolactinemia increased
prolactin secondary to breast development.
1. Tx: exercise, rest, sleep, diet-decrease salt, sugar, caffeine
ix. Endometriosis-growth of endometrial tissue outside of the uterus
1. During the ischemic menstrual cycle the misplaced tissue breaks
down/bleeds into surrounding tissue—inflammation—gets trapped causes
cysts.
2. Cycles of this result in scarring, fibrosis, and adhesions—binding organs
together—increased abdominal pain, and infertility
a. S/S: bleeding, pain
b. Dx: palpation, vaginal ultrasound, laparoscopy
c. Tx: pain meds, hormone therapy-shrinks endo tissue, surgery, oral
contraception
• Colorectal screenings, colonoscopy, fecal occult tests are all also important for
women.
STI’s and risks
f. What is HPV?
i. Human papilloma virus (HPV) in an STI which can cause cellular changes of the
cervix- leading to cervical cancer.
ii. HPV can also lead to the development of papillomas- benign growths of the
genital and anal regions.
iii. Vaccine = Gardasil
1. Protects against HPV types 6, 11, 16, and 18. Newly approved vaccine
(Gardasil 9) covers HPV 6, 11, 16, and 18, as well as 31, 33, 45, 52, and
58- which are responsible for 1 in 5 cases of HPV-associated cervical
cancer.
, 2. Consists of 3 IM injections given over 6 months at 1, 2, and 6 months
3. Can be given to females age 9-26 years old, boys can also receive the
vaccine from age 9-15.
4. Nurses- teach the patient to be sure to return on time for each vaccine
series, and continue to have routine cervical cancer screenings.
Contraception - Forms of birth control – good subject for your postpartum patients as well –
know them
g. Natural family planning-
h. Coitus interruptus- ―pull out method‖
i. Abstinence
j. Breast feeding—maintains progesterone levels, keep from ovulating
k. Diaphragm- dome shaped, spermicide gel is placed inside the dome—inserted into
vagina 6 hrs before intercourse and left in for 6 hrs after.
l. Cervical cap- thimble shaped, spermicidal gel placed inside. Placed against cervix
m. Condoms
n. Spermicidal gels
o. Hormonal methods
i. Ethinyl estradiol (estrogen)-prevents the release of FSH from the anterior
pituitary gland. When FSH levels are low the ovarian follicle doesn‘t form and
ovulation is prevented.
ii. Progestins-inhibit LH surge-required for ovulation (used with estrogen)
1. Progesterone only-thickens cervical mucus which creates a hostile
environment and endometrial atrophy so the egg wont implant.
iii. Low-dose progestin only- (mini pill) thickens cervical mucus, can be taken while
breast feeding—won‘t enter breast milk.
Patient teaching for birth control
iv. Takes 7 days to start being effective with the initial pack. So will need to use a 2nd
birth control method.
v. Recheck in 3 months when first started
vi. Take every day at roughly the same time
vii. Begin a new pack on the same day (always) usually a Sunday.
viii. If missed a dose, take 2 pills the following day.
p. Patch-est/prog- 3 weeks patch on, 1 week patch off (in order to have menses).
i. Placed on the abd, buttocks, outer arm, or upper torso (EXCEPT the breast area).
1. Patient education:
a. Rotate sites (weekly or monthly depending on patch)
b. If removed due to damage for longer than 24 hours, replace with a
new patch and use 2nd birth control method x 7 days.
q. Vaginal ring-est/prog- placed on the 5th day of the menstrual cycle. Leave in x3 weeks,
remove x 1 week. Insert new ring at same time of day as the last ring.
r. Emergency contraception- est/prog, or prog only (preferred)
s. Plan B: (levonorgestrel – synthetic progestin) Emergency contraception – know
education.
i. 1 pill OTC, best used when taken within 72 hours, not effective after 120 hours
1. If implantation has occurred, this won‘t work, patient can still become
pregnant.
2. Won‘t harm embryo if taken after fertilization has occurred.
a. Side effects = N/V, breast tenderness, minor vaginal bleeding.
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