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REPRO
Tamoxifen
Mechanism of Action
Selective Estrogen Receptor Modulator (SERM)
Antagonist on Breast Tissue
Indications
ER-positive Breast Cancer
Side Effects
Decreased Risk of Osteoporosis
Increased Risk of Endometrial Cancer
Increased Risk of Venous Thromboembolism (VTE)
1 min
Breast Cancer Diagnosis
Mammography
Ultrasound
MRI for High Risk Patients
Confirmed with Biopsy
Considerations
Lymph Node Involvement
Receptor Positivity
Estrogen and Progesterone Receptors
HER-2
2 mins
Breast Cancer Interventions
Radiation or Chemotherapy
Hormonal Therapy
Tamoxifen
Lumpectomy
Mastectomy
Avoid BP and Injections Affected Arm
Hand Exercises
Considerations
Grief Related to Body Image
Prosthetics
Reconstruction
Lymphedema
3 mins
Dysfunctional Uterine Bleeding
Assessment
Bimodal Age Distribution
Painless Vaginal Bleeding
Amenorrhea
Menorrhagia (Heavy Menstrual Bleeding)
Metrorrhagia (Bleeding Between Menses)
Interventions
Balloon Thermotherapy
Hormone Medications
Dilation and Curettage (DandC)
Considerations
Monitor for Anemia
3 mins
Menopause Lab Findings
Decreased Estrogen
Lack of Negative Feedback
Increased FSH
Increased LH
Increased GnRH
Small Amount of Estrogen From Androgen Conversion
Increased Androgens = Hirsutism
1 min
Ovulatory Hormones I - Follicular Phase
Characteristics
0-14 Days
GnRH Stimulates FSH and LH
Follicle Secretes Estrogen
Negative Feedback from Estrogen
Increased Estrogen Leads to Positive Feedback
FSH and LH Surge
LH Spike Leads to Ovulation
2 mins
Ovulatory Hormones II - Luteal Phase
Days 15-28
Corpus Luteum
Secretes Progesterone
Negative Feedback inhibits FSH and LH
No pregnancy forms Corpus Albicans
Stops Estrogen Secretion
Endometrial Sloughing - Menses
GnRH secretion produces new follicular phase
2 mins
Endometriosis
Cause
Endometrial Tissue Outside Uterus
Retrograde Menstrual Flow
Assessment
Dysmenorrhea
Cyclic Pelvic Pain
Irregular Vaginal Bleeding
Pain with Defecation
Dyspareunia
Interventions
Medications to Decrease Ovulation
NSAIDs
Surgery
2 mins
Fetal Circulation
Placenta
Umbilical Vein
Ductus Venosus
Right Atrium
Foramen Ovale
Left Atrium
Aorta
Right Ventricle
Ductus Arteriosus
Umbilical Arteries
2 mins
Postnatal Circulation
Infant Breathes
Decreased Pressure in Pulmonary Vasculature
Decreased Right Heart Pressure
Increased Left Atrial Pressure
Closes Foramen Ovale
Increased O2
Decreased Prostaglandins
Closed Ductus Arteriosus
Pharmacologic Intervention of Ductus Arteriosus
Open with Prostaglandins
Closed with Indomethacin
3 mins
Patent Ductus Arteriosus
Continuous
Machine like murmur
Often Due to Congenital Rubella
Prematurity
1 min
Prenatal Nutrition
Prenatal Vitamins
Iron Supplement 30 mg Daily
Folate/Folic Acid 400 mcg Daily
Appropriate Weight Gain Recommendations
340 Calorie Increase
25 gram Protein Increase
Foods and Substances to Avoid
Coffee, Alcohol, Tobacco
Fish Containing High Mercury Levels
3 mins
Prenatal Care
Prenatal Visits
Vital Signs, FHR
Fundal Height
Urine Dipstick
Weight
Prenatal Screening
Laboratory Testing
2 mins
Lab and Diagnostic Tests During Pregnancy
Complete Blood Cell Count
Blood Typing
Rubella Titer
Hepatitis B
HIV Testing
Urinalysis
Diabetes
Pap Smears
2 mins
Lab and Diagnostic Tests During Pregnancy (Other Visits)
Diagnosis
10-13 Weeks
Offer Chorionic Villus Sampling (CVS)
15-18 Weeks
Quad Screen
18-20 Weeks
Ultrasound
Anatomic Screening
24-28 Weeks
One-Hour Glucose Challenge Test
35-37 Weeks
Streptococcus Agalactiae
3 mins
Hyperemesis Gravidarum
Signs and Symptoms
Excessive Vomiting
Significant Weight Loss
Dehydration
Hypotension
Electrolyte Imbalance
Interventions
Antiemetics
Frequent Small Meals
IV Therapy
2 mins
Amniocentesis
Mechanism
Transabdominal Puncture
> 14 weeks gestation
Indications
Genetic and Congenital Anomalies
Fetal Hemolytic Disease
Fetal Lung Maturity
Complications
Miscarriage
Hemorrhage
Infection
Considerations
RhoGAM (Rh Immune Globulin)
2 mins
Contraception
Indications
Preventing Unplanned Pregnancy
Barrier Methods
Spermicides
Diaphragm
Cervical Cap
Contraceptive Sponge
Male Condom
Hormonal Method
Oral Contraceptive
Intrauterine Device (IUD)
Injectable Progestins
2 mins
Infertility
No Conception After 1 Year
Interventions
Artificial Insemination
In Vitro Fertilization (IVF)
Drug Therapy
Clomiphene Citrate (Clomid)
Menotropins
GnRH Agonists
Considerations
Treat Underlying Disorders
Emotional Support
Multiple Gestations
3 mins
Presumptive Signs of Pregnancy
Amenorrhea
Fatigue
Urinary Frequency
Nausea and Vomiting
Breast Changes
Quickening
1 min
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