What are the Labia Majora composed of?

Glans, corpus, and crura

on either side of the urethral opening.

(a.k.a. lesser vestibular glands)

on either side of and slightly posterior to the vaginal orifice

(a.k.a Greater vestibular glands)

-allows passage of menstrual flow

-receives penis during intercourse

-lower portion of the birth canal during delivery

1. Outer layer (squamous epithelium & connective tissue)

2. Submucosal layer

3. Smooth muscle

4. connective tissue and vascular network

-under direct influence of estrogen

-contains many mucus-producing cells

-lies in transvers folds called rugae

Description of submucosal layer of vagina

what does it mean if a woman is NULLIPAROUS?

and if she is, what may you find upon examination?

-means she has never had a child

-in terms of the external os, you'll find a small, round opening that appears as a depression

-external os is the junction of the cervix and vagina

-internal os is the junction of the cervix and the isthmus of the uterus

-allows the entrance of sperm into the uterus

-allows the passage of menstrual flow

-seretes mucus

-prevents the entrance of vaginal bacteria

-during childbirth, stretches to allow passage of the fetus

Parts of the Corpus of the Uterus

-fundus (upper portion)

-body

-isthmus (lower portion)

Size of a normal uterus

-endometrium (inner mucosal layer)

-myometrium

-peritoneum

-contain uterine glands which secrete and alkaline supstance that keeps uterine cavity moist

-sheds during menses and childbirth

-develop and release ova

-produce estrogen, progesterone, and testosterone

-happens every 18-45 days

-lasts 3-7 days

-average age of first period in U.S. is 12.5 years, at 106 lb

-occurs earlier in developed countries

-earlier onset in shorter, fatter girls

Definition of infertility

unprotected sex for 1 year without pregnancy

-35% is related to female infertility factors

Lice at the base of the pubic hair that indicates infestation

(a.k.a "crabs")

When are the use of graves and pederson speculums recommended?

-graves are appropriate for most adult women

-pederson are appropriate for virgins and postmenopausal women with narrow vaginal orifice

(Normal finding)

columnar epithelium from within the endocervical canal is everted andappears as a deep red, rough ring around the cervical os

small, yellow, translucent nodules on cervical surface

-may occue with squamous metaplasia

a bulging of the anterior vaginal wall caused by thickening of the pelvic musculature

-bladder prolapses into the vagina

-bulging of the posterior vaginal wall caused by weakending of the pelvic musculature

-part of the rectum portrudes into the vagina

-1st degree: cervix is seen at vaginal opening

-2nd degree: uterus bulges outside vaginal opening

-3rd degree: uterus bulges completely out of vagina

a mucopurulent yellowish discharge from the external os.

*usually indicates chlamydia or gonorrhea*

-a drug used more than 50 years ago to prevent spontaneous abortion and miscarriage

-found to be a teratogen

-causes cervical abnormalities

Findings for Trichomonos Vaginitis

-yellow-green frothy, foul-smelling discharge

-labia may appear red and swollen

=vaginal walls may be red, rough, and covered with petechiae

-pH will be > 4.5

-causes itching and urinary frequency

-occurs after menopause when estrogen is low

-discharge may be blood tinged

-vaginal mucosa is typicaly pale, dry, and contains areas of abrasion that bleed easily

-causes itching, burning, dryness, and painful urination

infection caused by overgrowth of yeast in the vagina

-causes cottage cheese-like discharge

-intense itching and discomfort

-pH of vaginal secretions will be < 4.5

Findings for Bacterial Vaginosis

-cause unknown

-thin, gray-white discharge with fishy smell

-pH > 4.5

-2 cylindrical corpora cavernosa on dorsal side

-1 cylindrical corpus spongiosum on the ventral side

-protective covering for the testes, epididymis, and vas deferens

-helps maintain cooler-than-body temp necessary for production of sperm

serous membrane covering each testis which separates the testis from the scrotal wall

-is double-layered and lubricated to protect testis from injury

-produce spermatozoa and testosterone

paraphimosis

a forskin that once retracted that can't be returned to cover the glans

-when elevation of the testes relieves scrotal pain

-seen when patient has epididymitis

bowel herniates through internal inguinal ring and remains in the inguinal canal or travels down to into the hernia

*MOST COMMON*

bowel herniates from behind and through the external inguinal ring

-most common in adult men over 40

bowel herniates through the femoral ring and canal

-occurs mostly in women

*LEAST COMMON*

-secretes a thin, milkey substance that promotes sperm motility

-neutralizes female acidic vaginal secretions

a peritoneal protrusion into the rectum

-may indicate a cancerous lesion or peritonal metastasis

What is vernix caseosa?

(newborns & infants)

a thick, cheesy, white substance that appears on the baby's skin

-especially prevalent in skin folds

-normal, usually absorbs into the skin

What is plagiocephaly?

(newborns & infants)

Components of the umbilicus

(newborn and infant)

-amniotic portion (covered w/gel-like substance that dries up and falls off within 2 weeks)

-cutaneous portion (covered w/skin and draws back)

Ortolanis test and Barlow's sign is used to test what?

(newborns and infants)

dislocation and/or ease of movement of hips

-positive test shows clicking along with feeling head of femur slip in/out of hip

What does it mean to have rudimentary sensation?

(infants and newborns)

any stimulus must be strong to cause a reaction

-response is not localized (reaction elicits whole-body movements)

What is the Denver Developmental Test?

(newborns & infants)

assesses apporpriate developmental milestones for child's

-gross motor

-language

-fine motor

-personal social development

when does the sensorimotor (piaget) stage occur and what happens during it?

(newborn & infants)

-brith-18 months

*development of intellect and knowledge of the environment gained through the senses

-go from reflexive activity to purposeful acts

-success brings a sense of object permanence

what is erikson's first stage of psychosocial development?

(newborns & infants)

(birth-1 year)

-trust vs. mistrust

what is Freud's first stage of psychosexual development?

(newborns & infants)

-oral stage (birth-18 months)

-erogenous zone= mouth

-sexual activity= sucking, swallowing, chewing and biting

What is an Apgar score and when should it be assessed?

(newborn & infants)

-an assessment of infant's ability to adapt to extrauterine life

-heart rate, respiratory rate, reflex irritability, muscle tone, color

*should be taken at 1 and 5 minutes after delivery

What is the Tonic neck reflex and when does it appear?

(newborns and infants)

-turn baby's head to the side with jaw at shoulder

-extremities on same size extend, extremities on opposite side flex

-appear a 2months

-disappears 2-4 months later

What is craniosynostosis?

(newborns & infants)

premature closing of sutures

-may lead to caput succedaneum (edema from trauma) or cephalohematoma (bleeding into periosteal space)

What is Hypertelorism?

(newborns & infants)

What is diastasis recti?

(newborns & infants)

separation of the abdominal muscles

-midline protrustion from the xiphoid to the umbilicus or symphysis pubis

What is metatarsus varus?

(newborn & infant)

what is talipes equinovarus?

(newborn & infant)

"club foot"

-foot is fixed in adduction of forefoot, inversion of entire foot and equinus (pointing downward)

What is gynecomastia?

(children & adolescents)

What is thelarche?

(children and adolescents)

breast development in females

-first sign of puberty

What influences bone growth?

(children and adolescents)

HORMONES

-pituitary and thyroid

examples of SOFT SIGNS

(children & adolescents)

-short attention span

-poor coordination of position

-hypoactivity

-impulsiveness

-labile emotions

-distractability

-no demonstration of handedness

-language &articulation problems

-learning problems

-people age 85 and older

-poorer health

-more chronic disabilities

-function less independently

what does SPICES stand for?

(frail elderly)

-Sleep disorders

-problems eating

-incontinence

-confusion

-evidence of fall/slips

-skin breakdown