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EXAMS 2 REVIEW
CONCEPT: Human development:
Exemplars:
Attention Deficit Hyperactive Disorder (ADHD): → genetic disposition (chronic disorder)
ADHD is a neurodevelopment disorder of childhood that is characterized by developmentally
inappropriate levels
 Hypersensitivity
 Impulsivity
 Inattention
Signs & Symptoms: R/T
Attention: Impulsivity: Hyperactivity
 Trouble sustaining  Difficulty waiting  Fidgeting
attention  Blurting out comments  Excessive talking
 Trouble organizing tasks  Interruptions or  Excessive running
 Appearing to not hear intruding in others  Inability to engage in
when spoken to conversations or quiet activities
 Losing items necessary activities
to complete task  Safety concerns when
exhibits impulsive
behaviors
Diagnosis:
 According to American psychological association:
 Behaviors present before 7 years old & continue for at least 6 months
 Behaviors occur in more than one setting
Interventions:
 Provide parents w/information about disorder/treatment plan
 Encourage support group for parents
 Treatment includes:
o Behavioral therapy → prevent undesirable behavior
o Medication
o Maintaining consistent environment → home, classroom environment, & physical safety
measures
o ↓ stimuli in the environment
o Appropriate classroom placement
o Provide regular breaks, use verbal commands and/or visual cues
 Promote self esteem
MEDS: →
• Atomoxetine/Strattera → non stimulant/non-narcotic → non addictive
STIMULANT MEDS: → Monitored q3 months
 Methylphenidate/Ritalin → stimulant
 Dextroamphetamine-amphetamine/combination drug(Adderall → stimulant
 Dextroamphetamine/dexadrine → stimulant
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S/E: Stimulants
o Appetite suppressions → offer frequent/high nutritional value snacks
o Weight loss → height/weight at each DR visit/charted
o Rebound (irritability when the medication wears off)
o Nervousness
o Tics
o Insomnia
o ↑ B/P
o Stunt growth
o MONITORED Q3 MONTHS
Non stimulants → Atomoxetine/Strattera
MEDS:
Methylphenidate/ Ritalin: (77 ATI) focus on task, ability to self-control
Toxicity: Hypertension, dizziness, palpitations, seizures, BRUISING
Diagnose → established on the basis of self-reports, parents, teachers and use of assessment tools
SE: WEIGHT LOSS → 2-4 LBS IN TWO WEEKS CALL DR, anorexia, anemia
LABS; CBS
Educate:
o Child/parent about medication administration and the need for follow up
o Do not chew or crush
o Importance to take on regular schedule
o ADHD not cured w/ med but helps with symptom
o Controlled substance > handwritten only
o If lose
Atomoxetine/ Strattera:
 NON-NARCOTIC, NON-STIMULANT
 Daily dose in morning or divide dose → 1 dose in am & 1 dose in afternoon w/meals
 Controls impulsivity
 Therapeutic effects → 1-3 weeks
 Monitor child’s behavior
 Daily dose or split in two doses
Contraindications:
 Not for patients with eating disorders/seizure disorders
 Cardiovascular/hepatic disorders
 Hypertension/hypotension
Teaching:
 ↓ appetite = weight loss
 Report hepatotoxicity → yellow skin
 Minimal side effect
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Autism Spectrum Disorders (ASD):

Neurodevelopmental disorder that manifest in early childhood as young as 12 months; and as late as
kinder-1st grade
Onset noticed by 3 years of age
Social Communication: Behavior:
o Abnormal/lack of o abnormal nonverbal o Attachment to object,
comfort-seeking communications (does not range of interest
behavior use gestures to communicate) restricted
o Abnormal or lack of o Lack of imaginative play o Self-injurious→
social play ___________________________ irritability/aggression
o Impairment in peer Language: toward self & others
relationships o Delayed or lack of o Must maintain routine →
o Lack of awareness of the expressive language change =distress, anger
existence or feelings of o Failure to initiate or rage
others conversation o Repetitive body
o Abnormal or lack of o Parroting of spoken movements → rocking
imitation of others words of others or head banging,
o Refusal to hug/cuddle clapping, finger flicking,
o Prefer to be alone hand flapping
o No eye contact/facial o Walk on tiptoes
expression
Risk factors;
 Genetic syndrome
 Parental schizophrenic
 Maternal depression
 Advancing age
 Premature birth < 26 weeks
 Viral infection during 1st trimester
 Maternal rubella during pregnancy
 Maternal diabetes, hypertension or obesity
Interventions:
 PRIORITY: ensure SAFE environment for child w/Autism
 Keep environment & routine the same as home → they need stability, structure, things to look
the same
 Determine routines, habits, preferences, and maintain consistency as much as possible
 Determine specific ways in which the child communicates and use methods
 AVOID placing hands on child > introduce slowly
 Avoid placing demands on child
 Implement SAFETY precautions for self-injurious behaviors → head banging
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 Initiate referrals to special programs → mental health clinician, speech/language pathologist,

dietician, occupational therapist, support groups
 Provide support to parents
 Offer restroom
Diagnosis:
Exhibit deficits in communication/social interactions and restricted, repetitive behaviors interest and
activities
Diet:
 Avoid repetition of familiar food
 Keep pictures of liked foods on display → reminds child that he/she enjoyed food before
 Never force to eat
 Allow to smell, touch and play w/new food
 Allow accepting new food (weeks)
 Use divider plates
 Play soft music during mealtime= calm environment and block distracting sound
Red flag:
 ↑ risk for sexual/physical abuse
 Early signs of ASD → Poor eye contact and failure to respond to name
 Extreme anxiety and react negatively/aggressively to noisy environment or new situations

Social Anxiety Disorder:

Chronic anxiety disorder marked by fear and excessive self-conscious in public
Risk factors:
 Early childhood anxiety
 Low self esteem
 Poor coping skills
 Low income
Nursing implications:
Medications
 Selective Serotonin Reuptake Inhibitors (SSRIs): →used anti-depressant SSRIs include
fluoxetime (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine
(Paxil), and fluvoxamine (Luvox).
 Benzodiazepines: → sedative and anti-anxiety medication: benzodiazepines include diazepam
(Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax).

Developmental Delay
Child has not reached their milestone in the expected time period
Failure to thrive
Can be non- organic or organic
Nonorganic failure to thrive: related to psychosocial environment such as neglect, inadequate and
underdeveloped parenting skills, history of parental mental health problems
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● Sudden deceleration in the growth curve

● Can cause delay in reaching developmental milestones
● ↓ muscle mass
Treatments:
● Nutrition and family therapy
Risk factors for Developmental delay:
● Genetics → genetic or chromosomal abnormality; down syndrome
● Environmental → poor maternal nutrition, exposure to lead or toxins, infection passed from
mother to baby
Warning signs:
Behavioral:
o Signs of aggression toward others
o self-harm
o repetitive body movements
o lack of social interaction
o does not make eye contact
Gross Motor Skills:
o Clumsy
o does not develop hand-eye coordination
o Stiffness or floppiness of arms and legs.
Visual
● Difficulty following object or people with their eyes
● rubbing of eye frequently
● Turn tilt of hold head in a strange or unusual position when trying to look at an object
● Difficulty finding or picking up small objects found on the floor after 12 mon
● Difficulty focusing or making eye contact
● Closes one eye while trying to look at distant objects
● Eyes cross or turned
● Being objects to close to eyes to see
● One or more eyes appear abnormal in size and color
Hearing
● Talk in a very loud or soft voice
● Difficulty responding when called from across room
● Body posture: turning of the body so the same ear is always turned towards sound
● Difficulty understanding and following directions of what has been said after the age of 3 or
older
● No startle to loud noises
● Ears small or deformed
● Failure to develop sounds or words that are age appropriate
If a child has not developed certain skills in a certain time frame it is important to notify the physician to
conduct a more specific assessment be completed
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How to identify a delay is occurring

● Developmental screening → general assessment of child’s skills
● Formats the screening test:
o A questionnaire to a parent or child care provider that ask about the child
developmental milestones
o A test given to the child by a healthcare educational professional
o CAN'T DIAGNOSE BY ONLY A SCREENING TEST, you need to refer for developmental
evaluation.
Therapeutic Management: → early intervention services most effective
● To learn the developmental skills in a consecutive fashion
● Helps advance in all areas of development
● Good self esteem
Menopause: → 45-55
 Permanent end of ovulation and menses
 Life transition
 Complete cessation of menses for 1 year >
 Climacteric → right before menopause
Symptoms:
 Hot flashes/night sweats → estrogen replacement therapy (ERT) form women w/uterus
 Redness of face/neck
 Night and day sweats
 Sleep disturbances → difficulty falling asleep, frequent awakening throughout the night
 Hair, skin eye changes
 Mood changes/memory problems
 Weight changes → more fat on body d/t lack of estrogen
Medications:
Estrogen replacement therapy (ERT) therapy (women w/uterus)
 Estrogen and progesterone must be used together → unopposed estrogen=abnormal cell
growth in uterine lining = risk for endometrial cancer
Hormone therapy (HT) for women without uterus
 Estrogen alone
Treatment for vaginal symptoms:
 Topical vaginal estrogen
 Lubricants or moisturizers
 Vaginal stimulators → increase circulation to vaginal area and improve overall sexual functioning
Aging:
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Aging is individualized → can still learn but at a SLOWER rate

Psychological changes:
 Heart slows down
 Fragile skin
 High meds d/t age
Advanced age pregnancy → going through menopause
 Very important to continue contraceptive after the start of menopause 1 year after d/t higher risk of birth defects → down
syndrome
Assessment:
 Consider possible biological, psychological, sociocultural & sexual changes that occur in the aging process
 Assess as a unique individual
Nursing considerations:
 Protection from injury caused by age related physical changes or altered thought process r/t cerebral changes
 Preservation of dignity/ self-esteem who has come independent on others
 Self-care deficit → encourage independence to the best of clients ability
 Reminisce therapy is encouraged

CONCEPT: SEXUALITY: factors that facilitate an individual’s gender identity as well as their ability to experience and express
themselves.
EXEMPLAR:
SEXUALLY TRANSMITTED DISEASE (STI): REPORT to county health department → gonorrhea, syphilis & chlamydia
CHLAMYDIA GONORRHEA HERPES SYPHILIS HPV HIV
Bacterial Bacterial Virus Bacterial HUMAN Viral
Most common 2nd most freq. No cure Spirochete PAPILLOMA VIRUS Virus can lead to AIDS
Curable w/antibx # 1 cause -infertility 2-12 days primary inf treponema Formerly known as
Curable w/antibx pallidum genital wart MANIFESTATIONS:
Organism: 2 types: Curable w/antibx Flu-like symptoms
Chlamydia Organism: HSV1 →above the Virus & will remain
trachomatis: gram Neisseria waist primary stage: in body for life Hallmark: swollen
negative gonorrhoeae HSV2 → below the most highly lymph nodes →
*Gram neg waist infectious Transmission: infection of blood
transmission: diplococcus Triggers: canker (open sore Sexual contact or cells attacking in the
sex Stress, fatigue, lesion) small hard perinatal body
birth Incubations period: general illness, painless →penis, (C-section) *Weight loss
3-7 days immunosuppressant, vulva, mouth, *Malaise
sunburn, menses vagina, rectum Vaccines do not *Dry cough
Manifestations:
May be Manifestations: prevent HPV, BUT *White spot on
asymptomatic in may be Manifestations: Second stage: prevent CERVICAL tongue, mouth, throat
both sexual partners asymptomatic for Tingling, local Appears 2 weeks -6 cancer *Recurring fever
both inflammation, weeks after chancre *lymphadenopathy
Men: burning, itch, cold healed Manifestations:
Men: sores Flu like sym:
*Dysuria *Urethritis “drip” Small papillary Passes from mother to
“clap” Genitals: painful , Fever, sore throat, growth=large baby during
*white or clear reddened vesicles symmetric rash on
discharge from *Dysuria cauliflower preg/breastfeeding
*Purulent discharge ( blisters) flu/like trunk, palms, sole Men: penis,
urethra → sym of feet, exudate
nonspecific green/yellow scrotum, anus, Diagnosis:
*Joint pain infectious urethra
urethritis Still infectious *Western blot
If asymptomatic Women: inner *Immunofluorescence
Women: w/no lesions STILL thigh, vulva, vagina, Assay
Women: infectious Latent stage : cervix
*Yellowish cervical *joint pain *Serology to detect
*redness/vulva No symptoms, not antibodies
discharge infectious after 4
*Vaginal bleeding *inflame/cervix Meds: Vaccines:
*dysuria Acyclovir/zovirax ↓ years 3 IM doses in 6
*Dyspareunia Zidvidine
*Lower abd/back *discharge yellow symptoms months Management:
pain Valcyclovir/Valtrex: Tertiary Stage: Gardisil/cervarix Support immune
MEDS: *Headache, N/V (late) →prevents HPV system
C’s DX. → CULTURE Not infectious, but *CD4 count →the >
Diagnostic: starts to affect
Gold standard → Cephalosporin Girls/boys ages 11- CD4=Stronger
Cefixime/supprax 1ST PRIMARY organ. Cannot be 12, but can start at 9 immune system
CULTURE reversed
Ceftriaxone OUTBREAK →
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*1x dose= manage pain *brain

Nucleic acid compliance *tremor
amplification test *no alcohol Important nursing *heart
*paralysis Cryotherapy
(NAAT) → 1ST urine interventions: Freezing /burning
catch COMMONLY SEEN *General hygiene Salicylic acid
W/CHLAMYDIA: *Loose cotton Hutchinson Liquid nitrogen:
Direct fluorescent treated undergarment teeth=ridges on Topical
antibody (DEA) Test w/doxycycline & *Keep lesion incisor A/E:
Ceftrizone for 7 clean/dry Pain, blistering,
days *Prevent → condom Congenital scarring, skin
Enzyme *No sex w/lesion
Immunoassay (EIA) syphilis=born w/it irritation
Check 4-7 days after Educate:
treatment & 6 Diagnosis: Strict adherence to
MEDS: months tx regimen
Azithromycin VDRL test/part of
0 sex til neg culture torch titer No sex during tx
1x dose=compliance Complete med
Treat sex partner
Amoxicillin TID 7 Med:
days Penicillin G
Dx: Fetracycline,
Culture Doxycycline
Doxyclycline
Complications: Report within 90
Teach: PID days
Abstinence for 7 Ectopic preg
days after treatment Infertility
Remember:
Syphilis: sore, rash,
Complications: Neonate at risk for internal organs
PID → Infertility ophthalmic (including brain)
neonatorum→ treat
w/ Erythromycin

Remember:
Gonorrhea: “clap”
or “drip”

STI:
 Both sexual partners need to be treated
 VIRAL → NOT curable, but stays in body
 All STI → risk for fetus/newborn if mom is infected

Erectile Dysfunction
 The inability to attain or maintain erection sufficient for satisfactory intercourse
Younger male’s r/t alcohol, psychological stress
Older males r/t ↓ testosterone, ↓ sperm, ejaculation is weaker
 ED can cause
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 Distress
 ↓ Self esteem
 Difficulty in relationships/perceived
Risk factors for psychogenic ED:
 Chronic depression
 Anxiety
 PTSD
 Interpersonal/intimacy issues
 Strict upbringing in sexual matters
 Inadequate sex education
 Other life stressors

Indications of medical conditions:

 Diabetes mellitus
 Cardiovascular disease
Treatments:
 Constriction rings, vacuum devices
 testosterone replacement therapy
 surgical implantation
 Oral phosphodiesterase (PDE-5) Inhibitors → CONTRAINDICATED: nitroglycerin/nitrate
Caution using PDE-5: → vasodilators
 Alpha-adrenergic blockers
 Myocardial infarction in past 6 months
 Resting hypotension
 Uncontrolled hypertension
 Unstable angina
 Positive exercise stress test or exercise intolerance
Meds: PDE-5: –fil
 sildenafil/Viagra
 tadalafil/Cialis:
o treats erectile dysfunction & enlarged prostate (BPH) at same time
o long lasting → stays in body for 2 days
 ananafil/Stendra
S/E:
 Headache
 Dyspepsia
 Flushing
 Nasal congestion
Why? Vasodilator
Interventions: goal satisfactory sexual relationship
 Monitor for depression
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 Monitor suicidal ideation

 Maintain pt safety
 Request for referral to mental health clinician if → depression, anxiety or other conditions
Education:
 No alcohol
 No nitrates = hypotensive effect
Immediate medical attention:
 Penile blood/discharge
 Painful sexual intercourse
 Priapism → erect for hours in the absence of stimulation or after stimulation has ended
 > 4 hours erect
 Vision change, hearing loss
 Lifestyle modifications → weight loss, smoking cessation, ↑ physical activity
Other treatments:
 Intra-urethral vasoactive drugs: gels/pallets ↑ blood cell= erection
 Vasoconstrictive device: (vacuum pump) blood pulled to penis & band at end of penis →
maintain erection
 Implants
Gender Dysphoria/Body Image:
 Psychological disorder characterized by:
 Persistent discomfort over assigned gender
 “Gender incongruence” / manifestation:
 A strong desire to be of a gender other than one's assigned gender
 A strong desire to be treated as a gender other than one's assigned gender
 A significant incongruence between one's experienced or expressed gender and one's sexual characteristics.
 Cross-gender identification → many do not consider abnormal
 Etiology unknown
Treatment:
First step is counseling before anything/ psychotherapy
Altered Libido → altered sexual desire
Can happen to men or women
Causes:
 Advancing age
 ↓ Energy levels
 Trauma
 Drugs/alcohol
 Anti-depressants → Paxil, Prozac
 Anti-hypertensive medication
Treatments:
 Hormone replacements → estrogen, progesterone TQ;
 Lifestyle changes:
 Exercise
 Stress management
 Support groups
 Healthy diet
 Counseling for issue in relationships
 Improving communications
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Dyspareunia:
Recurrent or persistent genital pain before, during after sexual intercourse
 Present in either sex → more prevalent in females
 Common in postmenopausal women → declining estrogen 
 May disrupt sexual relationship
Causes to pain:
Physiological: (superficial pain)
 Estrogen deficiencies (after menopause) = dryness of the vaginal tissues
 Drugs ↓ natural vaginal lubrication → antihistamine, amphetamines
 After childbirth/breastfeeding
 Injury/trauma
 Episiotomy
 Improper fit of diaphragms/cervical caps
 Allergies to reaction to birth control products
Factors to deep pain:
 Pelvic inflammatory disease (PID)
 Endometriosis
 Bladder prolapse
Men causes for painful intercourse:
 Infection
 Inflammation of testis, urethra, foreskin, prostate
 Aging
Risk factors:
 Anxiety
 Depression
 Hx of rape/sexual abuse
 PTSD
 Negative feelings of feelings of sex
Educate:
 Changing positions
 ↑ Foreplay/ slow pace of intercourse
 Clearly communicate w/partner
 Avoid scented bath products/douching → increases risk for recurrent yeast infection/chronic
vaginal discomfort & pain

Medications: (how to manage)

 Women → hormone replacement MEN → Testosterone replacement
 Transdermal
 Vaginal estrogen preparations
 Lubricants (water soluble gels → KY jell
CONCEPT: REPRODUCTION
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EXEMPLAR:
CONTRACEPTION/FAMILY PLANNING
Natural family method:
 Calendar/rhythm or standard days Method
Hormonal:
Oral contraceptive:
If at risk for breast cancer → should not be on BC = ↑estrogen @ risk
for blood clots:
“pill” combination of estrogen/progesterone
Be effective: take every day/same time
 One pill missed → take ASAP
 Benefits:
 ↓ menstrual blood loss, regulate cycle
 ↓ Fe deficiency anemia
Progesterone only: (mini pill)
norethindron, medroxyprogesaterone
 ideal for breastfeeding moms
 has no estrogen

Complications of oral contraceptive

ACHES
A: abdominal pain
C: chest pain → clot PE
H: Headache migraine → stroke
E: Eye problem → problem from renal thrombosis/stroke
S: severe pain/swelling calf or thigh → clot

Patch:
 Applied once a week
 Has both hormones
Shot/injection:
(Depot) medoprogesterone acetate IM/Subq q3months
At risk:
 osteoporosis → calcium, vit D, weight bearing exercise
 ↑ weight
 No menstrual period = endometriosis cancer
Vaginal ring:
 Small, flexible ring that inserts into her vagina for 3 weeks;
removed for 1 week, then New ring is inserted
 ↓ ectopic pregnancy,
 SE: N/V bleeding between period

Implantation Device:
 Implantable rod
 IUD: intrauterine device
Vaginal implant (protects 3, 5, 10 years
Stopping sperm from reaching and fertilizing eggs.
Risk:
• implant in uterine wall= hysterectomy
• Not recommended for high risk for infection
(promiscuity) since it’s already prone to
infection.
• PID
Contraindications→ multiple sex partner → At risk for STI
Check for STRING placement, if shorter → IUD shift
Can shift if pt gains/losses weight
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Permanent:
Tubal ligation (minilaparotomy):
 Permanent birth control
 Fallopian tubes are cut, tied or blocked to permanently
prevent pregnancy
 Does not affect menstrual period
 Does not protect from STI
Vasectomy:
 Surgical ligation & resection bilaterally of the vas deferens
 Incision in the scrotum
 1 week to several months to clear out vas deferens
 2 negatives to be considered infertile →semen analysis to
check for sperm in your semen
 20 ejaculations
 Use contraception for 3 months after
 Post : swelling → ice
Ensure system (trans cervical sterilization)
 Scar tissue blocks pregnancy
 No anesthesia
 99.8 % effective
 Non reversible
 No protection from STI
Emergency contraceptive:
 “morning after pill”
Plan B one step or Next step
• Loses effect after 72 hours
• One step dose of high dose progestin
Other option:
High dose of oral estrogen
Barrier:
 Contraceptive sponge
 Diaphragm
dome shape rubber device that fits over the cervix
Refit Q2 years & after pregnancy
 Cervical cap
Rubber or latex silicone cap that fits snuggly over the
cervix
Use w/ spermicide → keep 6-8 hours after sex
Reuse: wash w/soap & water/ corn starch on cap
Risk: toxicity syndrome
 Cervical shield
 Female condom: disposable
Male condom:
• prevent infection,
• can rupture & leak
• if develops rash hour after sex = allergic reaction to
condoms
Unreliable methods:
Withdrawal:
 Coitus interruption
 Withdrawal of penis before ejaculation
 Cheap
 Least effective
 Male partner control
Abstinence:
 100% effective
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INFERTILITY:
Inability to conceive after 1 year of regular, unprotected sexual intercourse (coitus)
For women > 35 or w/known risk factor, recommendation is for 6 months
Common factors:
Male:
 ↓ Sperm production → sperm ejaculation < 2ml, low count < 2o count (20 million/ml), slow
mobility of sperm (normal semen density > 20 million/ml
 Sperm autoantibodies caused by trauma, infection, or surgical occlusion
 Enlarged veins in the testes (varicocele) can also affect the quality of sperm. → Surgery:
Varicocele that can affect fertility; Treatment does not always restore fertility.

Men are considered infertile if they:

o Produce too few sperm cells
o Produce sperm cells that are atypical
o Have chronic problems with ejaculation

Females: Most cases of infertility are d/t problems with ovulation or problems with fallopian tubes
 Endometriosis → growth of the uterine lining tissue; tissue outside the uterine cavity cause both
fallopian tube and ovarian scarring
 Ovulation of disorder
 Tubal occlusion
 Coital factors: use of lubricants or douche= change of pH =infection
 Chronic pelvic & vaginal infections
 STI can lead to infertility if not treated = PID = scar tissue in the fallopian tubes
Assess:
 Childhood infection
 Occupation hazards → radiation, chemicals, herbicide, pesticides
 Menstrual hx → can identify hormone related patterns such as: anovulation, pituitary disorder,
endometriosis
Diagnostic procedures:
Males:
 Semen analysis → avoid ejaculation for 2-5 days → transport to office within 2 hours (no
chilling/warming of semen: Key: 1st step in infertility assessment, less invasive,
 Ultrasonography → visualize testes and scrotum
Female:
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 Pelvic exam
 Hormone analysis → LH, Progesterone (peaks 8 days after LH surge)
 Chlomophine citrate challenge test (CCT)
 Post-coital test → to check if sperm is compatible with partner’s cervical mucus
 Fertilization test → determine how well the sperm can penetrate an egg
 Basal body temperature → temperature rises at ovulation
 Blood test → to measure hormone levels
 Endometrial biopsy –→to see if ovulation is causing changes in the lining of the uterus
 Hysterosalpingography (HSG) → contrast x-ray of the uterus and fallopian tubes → asses for
allergy to iodine or seafood

Treatment:
Lifestyle:
• Changing the timing of sexual activity
• Avoiding excessive heat, such as steam rooms and saunas
• Avoiding tobacco, marijuana, and excessive alcohol use
• Wearing looser fitting shorts and pants
• Maintaining a healthy weight
• Decreasing stress
Surgery:
If fallopian tubes are blocked may need surgery to open them
 Ovarian cysts
 Uterine fibroids
 Scar tissue (from endometriosis, pelvic infections, or scar tissue from previous abdominal or
pelvic surgery
MEDS:
• clomiphene citrate – in combination with vitamin E, may help increase sperm count and
improve sperm movement
o ovarian stimulant to stimulate ovary to produce follicles
o ↑ Secretion of FSH & LH which stimulates follicle growth
o Given daily 5 days, begin on day 5 of menses → supplement low dose of ESTROGEN
o SE: Vasomotor flushes, abdominal discomfort, N/V, breast tenderness
 Human menopausal gonadotropin (hMg) / Pregnyl→ used when clomiphene fails to stimulate
ovulation
o Promotion of ovulation
o SE: irritability, headache, fatigue, restlessness
o Inform couple to have intercourse day of injection and for the next 2 days
 Metformin → insulin sensitizing agent given to women w/Polycystic ovarian syndrome (PCOS)
which induces ovulation (MAY BE GIVEN W/ CLOMIPHENE)

Assisted reproductive technologies (ART)

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 Intrauterine insemination /artificial insemination

o Sperm placed in uterus at time of ovulation
 In vitro fertilization/IVF-embryo transfer (ET) :
• collection of eggs from ovaries
• fertilized w/ sperm (2 or 3 day embryo)
• transfer embryo to uterus
 GAMETE INTRAFALLOPIAN TRANSFER (gift) or zygote intrafallopian transfer (ZIFT
o Removing a woman's eggs, mixing them with sperm, and immediately placing them into
a fallopian tube (The egg and sperm mixture or a 2-3 day old embryo is then placed in
the fallopian tube)
 Blastocyst intra-fallopian transfer:
o Egg is removed from the woman’s body, injected with sperm, and allowed to develop. It
is later implanted into the uterus.
 Intracytoplasmic sperm injection:
o A single sperm is injected into the egg. The resulting embryo can be implanted into the
uterus or frozen for later use.
Complications:
 Ectopic pregnancy → ovum implants in fallopian tube d/t endometrial tissue
 Multiple gestations

GENETIC:
DOWN SYNDROME: → genetic disorder

Chromosomal disorder; extra chromosome 21/trisomy 21

Present at birth, genetically transmitted and hereditary / 47 chromosomes instead of 46

Risk:
↑ w/Maternal age → 35/older stay on contraceptive 1 year after menopause
Characteristics:
Phenotype → how they look
Genotype → gene
Assessment:
 Small head
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 Flat face
 Epicanthi folds
 Slanted eyes
 Small saddle nose
 Small low set ears
 Protruding tongue
 Short broad neck
 Small penis, cryptorchidism
 Short stubby fingers; simian cease (transverse palmar cease)
 Developmental delay
 Cognitive impairment → don’t understand certain level
Comorbidities:
 Congenital heart disease
 Hypothyroidism
 Chronic constipation
 Hearing/vision impairment
 Celiac disease
 Obesity
 Ear infection
 Sleep apnea
DX testing:
 DNA analysis
 Fetal nuchal translucency

HUNTINGTON disease:
 Degenerative inherited neurologic disease
 Patho: Neuronal cell death occurs in the brain
 No cure
 Onset at 30-40
 Death occurs 15-20 years after symptoms
 Every child of a parent with HD has a 50/50 chance of inheriting the expanded gene.
 If the child has not inherited this expanded gene, he or she will never develop the disease and
cannot pass it on to their children.
 Dominant gene → can only get the gene if direct ancestor had it (parents or grandparents)
s/s:
 Involuntary jerking movement’s → eye twitching, strange facial expression and flailing arms/legs
 Cognitive abnormalities → memory, concentration, judgement
 ↑ falling, stumbling or clumsiness, slow awkward movement

 Slurred/slowed speech → drooling, dysphagia, garbled speech

 Behavior/mental health → anxiety, irritability, apathy agitation, depression, anger, impulsive
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Nursing considerations:
 Fall risk precaution
 Assess for suicidal risk
 Assist w/ADL
 Provide adequate hydration/high calorie intake
 Assess anxiety levels/coping ability of pt/fam
 Refer to social worker

BREAST CANCER:
Women who carry BRCA1 OR BRCA2 gene mutation → at high risk:
 Breast cancer
 ovarian cancer
 fallopian tube cancer
 peritoneal cancer
Hormone therapy= risk for breast cancer
Nursing considerations:
 Provide support
 Remind of screening appointment
 Educate on how to ↓ risk
Referrals → nutritionists, mental health, OB/GYN
Treatment: Bilateral Mastectomy and/or oophorectomy (removal of ovaries)
○ Primary: Screening: Surgeries: Self-Breast Exams
○ Secondary: Treating the Cancer
○ Tertiary: Continuing Support
SICKLE CELL ANEMIA:
Autosomal recessive inheritance/ gene fully expressed
Genetic mutation = abnormal type of hemoglobin S
Body destroys RBC more quickly = ↓ RBC = ANEMIA

SICKLE CELL TRAIT VS SICKLE CELL ANEMIA

SICKLE CELL TRAIT SICKLE CELL ANEMIA
RECESSIVE GENE INHERITED, but not expressed in RECESSIVE GENE INHERITED from each parent,
individual expressed in the individual
 Inherit hemoglobin S gene from ONE  Inherit hemoglobin S gene, one from each
parent & a normal hemoglobin gene from parent
another parent  Gene is fully expressed in affected
 People with sickle cell trait have enough individual
normal hemoglobin in their red blood cells symptoms and complications:
to prevent the cells from sickling.  Periods of pain that can last a few hours to
 Asymptomatic but can be transmitted to a few days.
child  Blood clots.
 Swelling in hands and feet.
 Joint pain that resembles arthritis.
 Life-threatening infections.
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 Anemia (decrease in red blood cells).