Benign Disorders of Female Reproductive Tract Flashcards
**Benign Valvular **(both sets of labia, clitoris, urethra opening, and vagina opening)
&
Vaginal Problems
- Conditions of Vulva, Vagina, & Cervix: Vaginitis, Vulvitis, Bartholin cyst/ab – Excluding STIs
- Benign Structural Disorders & Other
- Uterine displacement/prolapse
- Cystocele/ Rectocele
- Genital Fistulas
- Benign Neoplasms (cysts, polyps, tumors)
- Toxic Shock Syndrome
Name the 3 Vulva Conditions
- Vulvodynia
- vulvitis
- Vulvar Dystrophy
Which Vulva condition am I?
Chronic vulvar pain syndrome
Vulvodynia
Vulvodynia may occur with other disorders such as
- 18-25 Yrs.
- Multifactorial (many factors)
- Depression
- IBS (irritable bowel syndrome- affects GI tract)
S/S of Vulvodynia
Burning, stinging, irritation, or stabbing, pain
Rx for Vulvodynia
- Topical
- TCAs
- Hygiene
- Biofeedback
- Psychotherapy
- Dietary change
Which Vulva condition am I?
Inflammation of vulva
Vulvitis
Vulvitis May occur WITH OTHER DISORDERS such as
- DM
- Skin problems
- Poor hygiene
- Irritation
S/S of Vulvitis
Burning, stinging, irritation, or stabbing, pain
same as Vulvodynia
Rx for Vulvitis
- ABT-if infection
- Hygiene
Which Vulva condition am I?
Dry thickened skin
VULVAR DYSTROPHY
VULVAR DYSTROPHY May occur WITH OTHER DISORDERS such as
- Benign dystrophies lichen planus
- Lichen simplex chronicus
- Lichen sclerosus
- Squamous cell hyperplasia
- Vulvar vestibulitis
s/s for Vulvar dystrophy
- Whitish papules
- Fissures
- Macules
- Itching
RX for Vulvar Dystrophy
- Biopsy
- Annual follow-up
- Topical steroids-2 to 3 wks.
- Petrolatum jelly (OTC lubes)
- Lanolin or hydrogenated vegetable
- Sitz baths DONOT overuse
Name the 3 VULVO-VAGINAL CONDITIONS
- CANDIDIASIS (VULVO-VAGINAL)
- BV (BACTERIAL VAGINOSIS)- AKA VAGINITIS
- ATOPIC VAGINITIS
What is the CAUSE of Candidiasis (vulco-vaginal)
- Fungal Or Yeast
(Candida A.)
S/S FOR CANDIDIASIS (VULVO-VAGINAL)
- Pruritis
- White thick
- Cottage cheese like
- Dysuria, Dyspareunia
- Vulvar Irritation or Excoriation
- Vaginal inflammation
DX FOR CANDIDIASIS (VULVO-VAGINAL)
- Microscopic - spores & hyphae
- Ph 4-5 or less
RX FOR Candidiasis
(Vulvo-vaginal)
- Topical
- Miconazole, Nystatin
- Clotrimazole, Terazol - Fluconazole – PO (150 mg)
What is the cause for BV (vaginitis)
- Anaerobic bacteria & Gardnerella vaginalis
- An absence of lactobacilli
S/S FOR BV (VAGINITIS)
- Usually, asymptomatic
- Copious clear, gray or white color
- Fishlike odor – post-coital OR during menses
- Vulva Unaffected
*
DX FOR BV (VAGINITIS)
- Microscopic - “clue cells.”
- Whiff Test – Fishy (KOH)
- Vaginal Ph >4.7
RX FOR BV (VAGINITIS)
- Metronidazole (Flagyl) PO BID x 1 wk.
- Clindamycin vaginal cream
- No need to treat partner
- Use of condoms
What causes Atopic Vaginitis?
- Lack of Estrogen
- Glycogen Deficiency
S/S FPR ATOPIC VAGINITIS
- Discharge
- IrritatioN
DX FOR ATOPIC VAGINITS
Alkaline Ph
RX FOR ATOPIC VAGINITIS
- Vaginal estrogen
- Relieve dryness
RISK FACTORS FOR VAGINAL CONDITIONS
Allergies
Diabetes, HIV infection
Long-term or repeated antibiotics use
Low estrogen levels
Oral–genital contact (yeast) & GI Tract)
Perimenopause/Menopause
Poor personal hygiene, Frequent douching
Pregnancy
Pre-menarche
Sex with infected partner
Synthetic clothing
Tight undergarments
Use of oral contraceptives
NURSING MANAGEMENT FOR VAGINAL CONDITIONS
PIC
2 TYPES OF VAGINAL CYSTS
- BARTOLIN (VULVAR) CYSTS
- OVARIAN CYST
WHICH TYPE OF VAGINAL CYST AM I?
Swollen, fluid-filled, sac-like structures that result when one of the ducts of the Bartholin gland becomes blocked.
BARTOLIN (VULVAR) CYSTS
Causes for Bartholin Cysts?
- Infection
* Gonococcal
* E-Coli
* Staph Aureus
Bartholin (vulvar) Cysts RISK
- Women > 40yrs
- Increase risk of MALIGNANCY
S/S OF Bartholin (vulvar) Cysts
- Non-infected, small (<5cm – no S/S)
- Redness, Localized pain
- Difficulty sitting or walking
- Unilateral Swelling (posterior vulva)
- Cysts brown or sanguineous
- Inguinal lymphadenopathy
OTHER VULVAR CYSTS
- SKENE DUCT CYSTS
- VESTIBULAR CYSTS
Skene Duct Cysts may result in
(s/s)
- pressure
- dyspareunia
- altered urinary stream
- pain
Vestibular cysts are located INFERIOR to
hymen.
RX for Bartholin (Vulvar) Cysts
*Typically, benign
*NEED evaluation if postmenopausal
- Spontaneous rupture in 72 h.
- Cultures
- Moist heat or sitz baths
- Laser, ablation - silver nitrate
- I&D or word catheter
- Marsupialization (make small pouch)
- Gland removal
Bartholin (Vulvar) Cysts Complications include
Abscess
3 Most common benign Ovarian Cysts are
- Follicular cysts
- Corpus Luteum cysts
- Theca-Lutein Cysts
Is Cyst pain Acute or chronic?
Acute pain when ruptured.
Describe Follicular Cysts
- Follicle doesn’t rupture at ovulation
- Rarely >5 cm diameter
- Prepubertal & during reproductive age
- Rare after menopause.
Describe Corpus Luteum Cysts
- Fails to degenerate after 14 D
- Cystic or hemorrhagic
Describe THECA-LUTEIN cyst
- least common
- associated with HYDATIDIFORM MOLE.
- Abnormally HIGH LEVELS of hCG
- Associated with hydatidiform mole, choriocarcinoma, PCOS, & Clomid therapy.
S/S FOR OVARIAN CYSTS
- Acute or chronic abdominal pain, Bloating
- Irregular menses
- Infertility
- Acute pelvic pain
S/S FOR LARGER CYSTS
- Pressure on abdominal organs
- Ruptured cyst SIMILAR TO Ruptured appendix
HOW TO DX OVARIAN CYSTS
ULTRA SOUND
RX FOR OVARIAN CYST
- Self-limiting & Resolve spontaneously
- OCPs
SURGERIES FOR OVARIAN CYSTS INCLUDE
- D&C- dialation and curettage (removes tissue from INSIDE uterus (ENDOMETRIUM)
- Cryotherapy- freeze
- TAH- total abdominal hysterectomy
- BSO- bilateral salpingo-oophorectomy
What am I?
- presence of multiple inactive follicles within the ovary that interfere with ovarian function.
- eggs never mature and ovulation does not occur.
- immature follicle and eggs are not removed and stay behind as fluid filled sacks knwn as Cysts.
Polycystic Ovary Syndrome
(PCOS)
What causes PCOS
- Hyperandrogenemia- excess production of MALE hormones (ie testosterone)
- Hyperinsulinemia- high amnts of inuslin
Clinical Manifestations of PCOS include
(observable symptoms)
- Hirsutism
- Alopecia
- Virilization – Elevated androgen
- Polycystic ovaries (12 or more)
- Obesity
- Insulin resistance
- Metabolic Syndrome (group of condition raising risk for coronary heart disease, DM, stroke, etc)
-Abdominal obesity (waist >35in)
-Triglyceridemia >150mg/dl
-HLD <50 mg/dl
*Psychological impact
*Follicular atresia
*Amenorrhea, Anovulation, Infertility
*DM-2, HTN
DX for PCOS
- TWO of the following criteria:
* Hyperandrogenism (testosterone excess, hirsutism)
* Ovarian dysfunction (anovulation)
* Detection of PCO morphology - Pregnancy test - Ectopic pregnancy
- Elevated LH
- Elevated C-reactive protein
- Prothrombotic state - Elevated PAI-1 & fibrinogen levels
- Gonorrhea & chlamydia – abscess
- Transvaginal US – Diff. fluid-filled cysts from solid masses.
PCOS COMPLICATIONS INCLUDE
- Uterine fibroids
- Depression
- Adverse pregnancy outcomes
- Neonatal complications
- DM, CVD (cardiovascular disease)
- Cancer – endometrial, ovarian, breast
Managing PCOS
- Oral contraceptives: to treat menstrual irregularities and acne
- Mechanical hair removal (shaving, waxing, plucking, or electrolysis): to treat hirsutism
- Glucophage (metformin): which improves insulin uptake by fat and muscle cells, to treat hyperinsulinemia;
- thiazolidinediones (Actos, Avandia): to decrease insulin resistance
- Ovulation induction agents (Clomid): to treat infertility
- Lifestyle changes (e.g., weight loss, exercise, balanced low-fat diet)
- an infection-induced inflammation of the female upper reproductive tract.
- an ascending polymicrobial infection of the upper female reproductive tract (all parts), frequently caused by untreated chlamydia or gonorrhea
- it is not always an STD - often results from untreated cervicitis;
PELVIC INFLAMMATORY DISEASE (PID)
Endometriosis
uteral lining
Parametritis
Connective tissue
salpingitis
Fallopian tubes
oophoritis
Ovaries
Risk factors for Pelvic inflammatory Disease (PID)
- Adolescence or young adulthood
- Multiple sex partners
- Early onset of sexual activity
- History of PID or STI
- Sexual intercourse at an early age
- Alcohol or drug use
- Contact partner – untreated
- Recent insertion of an IUC
- Nulliparity
- Cigarette smoking
- Recent termination of pregnancy
- Lack of consistent condom use
- Lack of contraceptive use
- Douching
- Prostitution
Clinical Manifestations for PID
(ALL MUST BE PRESENT)
*** Lower abdominal tenderness
* Adnexal tenderness
* Cervical motion tenderness. **
* Mucopurulent discharge
* Temp. >101° F
* Prolonged or heavy mens. bleeding
* Dysmenorrhea
* Dysuria
* Dyspareunia
* Nausea
* Vomiting
PID Dx include
- Elevated ESR
- Elevated CRP
- N. gonorrhoeae or C. trachomatis
- WBCs on vaginal smear
Definitive Dx for PID
- Endometrial biopsy
- Transvaginal US
- Laparoscopi
Managing PID
- Rocephin 1 gm single injection IM
- Doxycycline 100 mg bid X 14 D
- Pregnancy - cefotaxime, azithromycin, & metronidazole -14 days
- Hospitalization
-If severely ill, high fever
-Tubo-ovarian abscess
-Immunocompromised
-Protracted vomiting - IV ABT (antibiotics)
- Increase oral fluids
- Bed rest
- Pain management.
- Follow-up - to Validate NO infection
PID COMPLICATION INCLUDE
- Ectopic pregnancy
- Pelvic abscess
- Subfertility
- Recurrent or chronic
- Chronic abdominal pain
- Pelvic adhesions
- Depression
NURSING MNGMT FOR PID.
WILL EDUCATE PATIENTS ON
- Educate
- Medications - completing antibiotic therapy
- Prevention
- Proper perineal care
- F/U after IUC
- Nutrition, exercise, weight control, & safer sex practices
- Symptoms TO REPORT health care provider:
-Pelvic pain or abnormal discharge
-(Post-coital, childbirth, or pelvic surgery) - Unusual vaginal discharge or odor
- S/S of ectopic pregnancy)
- DEEP pelvic Pain
-Abnormal bleeding
-Delayed menses
-Faintness, dizziness, and shoulder pain - Yearly Well women Exam
- Sources of support (e.g., friends, relatives, faith community).
What is TOXIC SHOCK SYNDROME (TSS)
- INFLAMMATORY RESPONSE SYNDROME
- Rare but serious condition that is casude by infection with certain types of bacteria.
- Staph Aureus
- MRSA
- Streptococcus pyogenes - Acute, life-threatening condition
What happens to the body when its going into shock
Shutting down.
What causes TOXIC SHOCH SYNDROME (TSS)
- Tampon use (Don’t USE >4 to 8 hrs- USE (lowest absorbency)
- Surgical wound infections
- Nonsurgical local infections
- Post partum & nonmenstrual vaginal conditions
- Diaphragm- vaginal contraceptive sponge
- Affects women <30- higher risk.
- Occurs when somthing is UNTREATED
S/S for Toxic Shock Syndrome
- Sudden temp. 102.0° F [38.9° C] or HIGHER)
- Pharyngeal infection; strawberry tongue
- Hypotension
- AMS (altered mental status)
- Macular erythroderma (generalized or local)
- Peripheral edema (legs, feet)
- Vaginal hyperemia & purulentvaginal discharge
- Cardiac arrhythmias
- Pericarditis- infection; enters blood and travels to other body parts.
- Oliguria- low urine output
- Organ failure
Is Toxic Shock Syndrome (TSS) acute or chronic?
Acute
DX for Toxic Shock Syndrome (TSS)
- Vaginal dischargeculture
- UA (pyuria, myoglobinuria, increased WBCs)
- Increased BUN
- Low Serum albumin, Ca, Phos
- Leukocytosis or leukopenia
- Thrombocytopenia
- Prolonged PT, aPTT
- Increased cr. (serum)
- Increased LFTS
- Positive blood culture
- CXR
How to Manage Toxic Shock Syndrome
- General
- Diet
- Activity - Bed rest
- Medications
- IV antibiotics (in COMBO)
- Dopamine orvasopressin
- Immune globulin intravenous
- Aggressive fluid resuscitation
- Electrolyte replacement therapy
- Fresh frozen plasma or platelet
- Antipyretics
- Analgesics for pain
Types of SURGERIES for Toxic Shock Syndrome (TSS)
- Examination and irrigation of recent surgical wounds
- Debridementof infectious tissue
What consists of Pt Education for Toxic Shock Syndrome (TSS)
Prevention!
- Sanitary pads instead of tampons
- Change tampons q 3-6 hrs
- Avoid super absorbent tampons
- Hand washing/ perineal hygiene
- Follow instructions for contraceptive products (sponges, diaphragms)
- Know the s/s of toxic shock and remove tampon if s/s occur
What are GENITAL FISTULAS
- abnormal openings between a genital tract organ and another organ, such as the urinary tract or the gastrointestinal tract.
- A fistula can result from a congenital anomaly, surgical complications, Bartholin gland abscesses, radiation, or malignancy
- The majority of fistulas that occur worldwide are related to obstetric trauma and female genital cutting
DIFFERENT GENITAL FISTULAS
- Vesicovaginal - Bladder & vagina
- Rectovaginal – Rectum & vagina
- Urethrovaginal: Urethra & vagina
Name of fistula indicates 2 areas that are connected abnormally
Howo to Manage Genital Fistulas.
- Fix fistula - Surgery
- Treat infection
- Treat excoriation (scrapd, abraded)
- Proper nutrition
- Cleansing douches, & enemas
- Rest & antibiotics
What Vaginal Abnormality am I?
- Benign tumors- common growths of the uterus
- Grow slow, responding to Estrogen levels (ESTROGEN-DEPENDENT)
- Are not cancer, and they almost never turn into cancer.
- Vary in number and size. You can have a single or more than one.
- Does NOT invade other parts of the body.
LEIOMYOMAS
(Uterine Fibroids)
Where do Leiomyomas grow?
- Intracavitary (lining of uterus)
- Intramural (within muscle wall)
- Serosal (outside surface of uterus)
Things to know about Leiomyomas
- Affects Age 25 & 40 yrs.
- Related to Anovulatory cycles & High levels of unopposed estrogen
Risk Factors.
WHos at Risk?
- Age (late repro. yrs.)
- Genetic predisposition
- African American ethnicity
- Hypertension
- Nulliparity
- Polycystic ovary syndrome
- Diabetes
- Obesity
Manifestations for Leiomyomas
(observable symptoms)
- Chronic pelvic & Low back pain
- Bloating, Constipation
- Infertility (IF large)
- Dysmenorrhea, menorrhagia
- Miscarriage
- Sciatica
- Dyspareunia
- Urinary frequency, urgency, incontinence
- Pelvic heaviness
Dx tests for Leiomyomas
- Diagnosis:
- Pelvic exam
- Bimanual Exam (enlarged, irregular uterus)
- MRI, Ultra sound (US)
How to Manage Leiomyomas
- Watch closely - minimal symptoms
- Medications- help shrink fibroids (limited use)
* Pain medications
* Birth control pills
* GTRH agonists leuprolide (Lupron)- stop ovulation & production of estrogen
* Low-dose mifepristone, a progestin antagonist - Uterine Artery Embolization (UAE) - block circulation to fibroid
- Magnetic resonance-guided focused ultrasound (MRGFUS) -creates coagulative necrosis, which destroys fibroids by using high-intensity ultrasound that directs focused ultrasound waves through the skin.
- Surgical
* Myomectomy
* Laser Surgery
* Hysterectomy
Type of suregery that:
*Removes the uterus
* No longer have periods
* No more pregnancies.
* Sexual intercourse will be normal following healing
*Ability for orgasm should not change.
Hysterectomy
Name 6 reasons for Hysterectomy
- Cancer, non-malignant growth,
- Pelvic relaxation and prolapse
- Injury to uterus
- Dysfunctional uterine bleeding
- Endometriosis
- Large fibroids
2 Types of Hysterectomy
- Total hysterectomy (removal of uterus & cervix)
- TAH-BSO (Total abdominal hysterectomy with bilateral salpingo-oophorectomy)
pTypes of Hysterectomy Aproaches
- Vaginal
- Laparoscopic
- Robotic assisted
- Abdominal
Role of the Nurse for PREoperative CAre
- Instruct about procedure & postop. care
- interventions to reduce anxiety
- Teach turning, deep breathing, & coughing
- Encourage expression of feelings
Role of the Nurse for POSToperative Care
- Provide comfort measures.
- Administer analgesics & antiemetics
- Position frequently
- Assess incision, dressing, vaginal bleeding
** (REPORT soaking 1pad/1hr.)** - I & O
- VTE prophylaxis
- Monitor vital signs
Discharge Teaching for Hysterectomy
- Avoid fatigue & increase activity slowly
- Pelvic rest (nothing in vagina) for 6 wks.
- Avoid heavy lifting or straining for 6 wks.
- Teach S/S of infection.
- Showers, NO tub baths
- Eat a healthy diet
- Encourage fluids & fiber
- Change her perineal pad frequently
- Follow-up care
- Community resources
What Vaginal Disorder am I?
*Abnormal descent or herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis.
*Occurs when structures of the pelvis shift and protrude into or outside the vaginal canal.
Pelvic Organ Prolapse
(POP)
4 Most common types of PELVIC ORGAN PROLAPSE
(POP)
- Cystocele
- Rectocele
- Enterocele
- Uterine Prolapse
The four most common types of pelvic or genital prolapse are cystoce
What is the cause for Pelvic Organ Prolapse (POP)
same for all 3 types
- Trauma from childbirth: prolonged 2nd stage of labor
- Instrument assisted
- Lacerations and/or episiotomies
- heavy lifting, obesity, aging and congenital anomalies
- hormone may also contribute
Type of PELVIC organ Prolapse:
*occurs when the bladder drops into the vagina.
Cystocele
S/S FOR CYSTOCELE
- Difficulty emptying bladder
- feeling of fullness
- frequency/urgency
- REcurrent UTIs
- Stress incontinence
RX FOR CYSTOCELE
2 options
- Pessary: Surgery for severe symptoms—Designed to tighten the vaginal wall
- Anterior Colporrhapy.
GRADED BASED ON SEVERITY OF 1-3 SCALE
Type of Pelvic organ Prolapse:
- occurs when the rectum sags and bulges into the vagina.
Rectocele
S/S for Rectocele
- Asymptomatic
- Constipation
- Hemorrhoids
- Impaction
- Rectal or Vaginal fullness
- Rectal bleeding
- weakening between the front wall of the rectum and vagina resulting in the rectum ballooning into the vagina during defecation.
- Causes: difficult childbirth, weakening of pelvic support structures
RX FOR RECTOCELE
- POSTERIOR COLPORRHAPHY
- PERINEORRHAPHY
Type of Pelvic organ Prolapse:
- occurs when the small intestine bulges into the vagina.
Enterocele
S/S for Enterocele
- Pelvic fullness
- Pressure or Pain
- Back Pain eases when lying
- Soft bulge in vagina
- Vaginal Discomfort
- Painful intercourse.
RX FOR ENTEROCELE
- Pessary: Surgery for severe symptoms—Designed to tighten the vaginal wall
- SUREGERY
Type of Pelvic Organ Prolapse:
- occurs when the uterus drops into the vagina.
- Multiparous women are at particular risk f
UTERINE prolapse
Name the STAGES OF PROLAPSE
0: No descent during straining
I: prolapsed organ is >1 cm above hymenal ring
II: prolapsed organ 1 cm below hymenal ring
III: prolapsed organ 2 to 3 cm below hymenal ring
IV: prolapsed organ >3 cm below Hymenal ring
In the book this falls under UTERINE PROLAPSE. P238.
CAUSES of UTERINE PROLAPSE
- Constant downward gravity
- Atrophy & weakening of pelvic support
- Reproductive surgery
- Instrumental childbirth
- Multiparity
- Uncontrolled rapid birth
- Family history of POP
- Young age at first birth
- Connective tissue disorders
- Infant birth weight of >4,500 g
- Pelvic radiation
- Increased abdominal pressure R/T
* Heavy lifting
* Straining (constipation, coughing)
* Obesity
Sexual Symptoms associated with Pelvic Organ Prolapse
- Inability to have frequent intercourse
- Dyspareunia
- Incontinence during sexual activity
OTHER local symptoms
- Pressure or heaviness in vagina
- Vaginal or perineal ’PAIN’
- Low back pain AFTER prolonged standing
- Palpable bulge in vaginal vault
- Difficulty in walking
- Difficulty inserting or keeping a tampon in place
- Vaginal/Cervical mucosa (hypertrophy, excoriation, ulceration, bleeding)
- Abdominal pressure or pain
Assessment for Pelvic Organs Prolapse
PHYSICAL EXAMS:
- Perform the Valsalva maneuver (bearing down)
* Note which organ prolapses first
* Any urine leakage - Bimanual exam - ask to contract PELVIC muscles
* Assess strength & symmetry of contraction. - Determine postvoid residual with a catheter.
* > 100 ml of retained urine - refer urologist
Common DX for Pelvic Organ Prolapse
UA- Infection
Pt Management for Pelvic Organ Prolapse
FIRST-LINE
1. Conservative
* Pelvic floor muscle exercises (PFMEs) or * Kegel
* Weight loss
* Avoidance of straining
* Avoid heavy lifting heavy
* Rx chronic cough & constipation
* Abdominal Binder
* Avoid high-impact aerobics, jogging, or jumping
2. Estrogen replacement therapy
3. Dietary & lifestyle modifications
4. Use of a pessary
5. Surgery
* Anterior or post. colporrhaphy (cystocele or rectocele)
* Vaginal hysterectomy (uterine) 1st degree prolapse
Nursing Management for Pelvic Organ Prolapse
(ring1. Promote prevention strategies
2. Encourage pelvic floor exercises
3. Encourage dietary & lifestyle modifications
4. Provide teaching for PESSARY (plastic device- lifts bladder or compresses urethra)
* Side effects - increased vaginal discharge, UTI, vaginitis, odor
* Reduce odor – douch with dilute vinegar or hydrogen peroxide
* Postmenopausal - use estrogen cream
* Remove pessary twice weekly & clean with * soap & water
* Using a lubricant for insertion
5. Regular F/U Q6 to 12 M
Nursing care Plan 7.1
image of PESSARY devices.
Test question:
The nurse is caring for a patient who reports vaginal discharge that is thick with a white, cottage cheese-like appearance, along with pruritus and irritation. What medication would the nurse expect to be in the plan of care?
a.Clindamycin
b. Fluoxetine
c. Metronidazole
d. Fluconazole
D
Test Question:
The nurse is caring for a patient after a hysterectomy. The patient presents with increased HR, decreased BP, weak pedal pulses, & decreased UOP. Which complication of a hysterectomy would the nurse be concerned about?
a. Bladder dysfunction
b. Hemorrhage
c. Pain
d. Venous thromboembolism
B.
Type of Hormone:
Secreted From: Anterior Pituitary
FSH- FOLLICLE-STIMULATING HORMONE.
FUNCTION OF FSH HORMONE.
- STIMULATES FOLLICULAR GROWTH
- STIMULATES ESTROGEN SECRETION (FROM DEVELOPING FOLLICLES)
TYPE OF HORMONE:
SECRETED FROM OVARIES (DEVELOPING FOLLICLE)
ESTROGEN
FUNCTION OF ESTROGEN HORMONE.
- DEVELOPMENT OF ENDOMETRIUM
- STIMULATES LH SECRETION (FOLLICULAR PHASE)
- INHIBITS LH AND FSH (LUTEAL PHASE)
TYPE OF HORMONE:
- SECRETED FROM ANTERIOR PITUITARY (2ND TYPE)
LH- luteinizing hormone
FUNCTION OF LH HORMONE
- Surge causes ovulation
- Development of corpus luteum
- Stimulates progesterone Secretion
Type of hormone:
Secreted from the OVARIES- corpus luteum
Progesterone
Function of PROGESTERONE
- THICKENING OF ENDOMETRIUM
- INHIBITS LH AND FSH (LUTEAL PHASE)
WHAT AM I?
Intentional prevention of pregnancy
CONTRACEPTION
Contraceptive methods can be divided into four types:
- Behavioral methods
- Barrier methods
- hormonal methods
- permanent methods.
Explain Behavioral Contraceptive Method.
*** Days 8–19 MOST fertile
**
1. Abstinence
2. Fertility awareness–based (FAMs) - Cost very little to use.
-Calendar (Rhythm)
-Standard days method
-Avoid days 8-19 of cycle
-Basal body temperature (BBT)
-Cervical mucus—Ovulation
3. Withdrawal (coitus interruptus) – 18-20% Failure
4. Lactational amenorrhea method (LAM)
2 MAIN Types of Barrier Methods
- CHEMICAL BARRIERS
- MECHANICAL BARRIERS
WHAT BARRIERS FALL UNDER CHEMICAL BARRIERS
- Spermicides
- Creams, gels, foams, foaming tablets, suppositories & vaginal films
- Must be applied before intercourse & wait 15 min but NOT > 60 min.
What barriers fall under MECHANICAL barriers.
- Male condom—Watch for latex allergy
- Female condom—(Vaginal Pouch)
- Sponge—Contraception for 24 hrs.
-
Diaphragm—soft latex or silicone - Up to 2 hrs. before & at least 6 hours after
-Refit for weight loss or gain of 10 lb. or more.
-Should be replaced every 1 to 2 years
-Must be prescribed & fitted by HCP -
Cervical cap
-Smaller than diaphragm
-Place: Up to 36 hrs. before sex & 6 hrs. after sex
-Provides protection for 48 hrs.
-Replaced YEARLY
-Must be fitted by HCP
TYPES OF HORMONAL CONTRACEPTIVES
- Oral Contraceptives (OCPs)
- Contraceptive vaginal ring - NuvaRing
- Transdermal contraceptive patch - Ortho Evra
- Hormone injections - Depo-Provera (Q3 mths)
- Long-acting Reversible Contraceptives (LARCs)
-Nexplanon & IUS - Emergency contraceptive - Plan B “the morning after pill”
BENEFITS of hormonal contraceptives.
RISKs for HORMONAL CONTRACEPTIVES
WHAT DOES ORAL CONTRACEPTIVES DO?
Suppress ovulation by adding estrogen & progesterone to a woman’s body thus mimicking pregnancy.
- This hormonal level stifles GnRH, which in turn suppresses FSH and LH and thus inhibits ovulation.
- Cervical mucus also thickens, which hinders sperm transport into the uterus.
- Implantation is inhibited by suppression of the maturation of the endometrium and alterations of uterine secretions
2 pill types of Oral contraceptives.
- Combination Pill
- Progestin ONLY Pills (POPs)
Explain what the Combination Pill does
- Prescribed as ‘Monophasic pills’ or ‘Multiphasic Pills’
- ‘Monophasic pills’ - Deliver fixed **dosages **of ESTROGEN and PROGESTIN
- ‘Multiphasic Pills’ alter the amount of progestin and estrogen each cycle.
women age 35 or women who smoke CAN NOT take combination pill- has estrogen
Explain What the PROGESTIN ONLY PILL (POP) does.
- Contain progestin only
- sometimes called MINI-PILLS
- appropriate for women who CANNOT or should not take estrogen in combined OCs
- Thicken of the cervical mucus to prevent penetration of the sperm and make the endometrium unfavorable for implantation.
**Which type of women can CANNOT or **SHOULD NOT **take ESTROGEN?
- Women age 35
- Women who smoke.
When teaching patients, what should be stated regarding Oral Contraceptives
- Take at same time everyday
- Interactions - effectiveness decreased with ABT
- What to do if a pill is missed?
Postpartum & Lactation Considerations with Oral Contraceptives.
- Increased risk for VTE (Venous thromboembolism- blood clot forms in vein)
- Avoid OC for 3-6 wks.
- progestin does not affect milk production
Which Side Effects should be REPORTED when taking Oral Contraceptives (estrogen and progestin)
Remember ACHES:
- Abdominal pain: may indicate liver or gallbladder problems
- Chest pain or shortness of breath: may indicate a pulmonary embolus
- Headaches: may indicate hypertension or impending stroke
- Eye problem: may indicate hypertension or an attack
- Severe leg pain: may indicate a thromboembolic event
What is the trade name for Injectible contraceptive
Depo-Provera
Is Depo-Provera combination or Progestin only?
Progesterone only
What to know about Depo-Provera
- Injectible every 3-months via IM
- works at the hypothalamic/pituitary level to stop the hormonal cycle.
- supresses production of FSH & LH in pituitary increasing the viscosity of cervical mucus and causing endometrial atrophy.
- FDA warning: Usage of Over 2 years may impact bone mineral density (bone loss)
Side Effects of Injectable Contraceptive
- Menstrual cycle disturbances
- Depression
- Acne
- Weight gain
- Loss of bone mineral density
*
Explain Transdermal PAtches
(Ortho Evra)
- 2-in square adhesive that contains ethinyl estradiol and norelgestromin- absorbed by the skin.
- applied weekly for 3 weeks followed by a patch-free week when withdrawal bleeding occurs.
- The patch delivers continuous levels of progesterone and estrogen.
- Adherence > OCs.
- RISKS:
-decrease effectiveness for Overweight & obese women >198 lb.
-low Effectiveness & high VTE & wt gain RISK
Side effects of Transdermal PAtches
(Ortho Evra)
VTE- Venous Thromboembolism
What to know about Vaginal Rings
- Name: Nuva Ring
- Contains both estrogen and progesterone
- flexible, soft, transparent ring that is inserted by the user for a 3-week period of continuous use followed by a ring-free week to allow withdrawal bleeding
- Ethinyl estradiol and etonogestrel (medicines) are rapidly absorbed through the vaginal epithelium and result in a steady serum concentration.
- Provides effective cycle control as well as symptom relief for women with AUB (abnormal uterine bleeding) and Polycystic ovary syndrome (PCOS).
- No need for fitting or HCP- PT can place it themselves.
Side effects of Vaginal Rings
- Erosion of vaginal wall
- Ring expulsion
- vaginal discharge
- Interference with coitus
- Unpleasant ring odor
- Vaginal discomfort
Two Types of LONG-ACTING REVERSIBLE CONTRACEPTIVES (LARCs) aka Implants
“Forgettable methods of contraception”
- Implant Nexplanon
- Intrauterine systems (IUC’s)
What to know about Nexplanon Implant
- 4cm long and 2mm diameter
- subdermal time-release method that delivers synthetic progestin that inhibits ovulation
- lasts 3 yrs of continuous delivery
- inhibiting ovulation and thickening cervical mucus, so sperm cannot penetrate.
- Fertility restored quickly after removal
- Require a MINOR surgical procedure
- NO STI protection
Side effects of Nexplanon implant
- Medical - Irregular Bleeding, Headaches, Weight Gain, Acne, Increased Appetite, Breast Tenderness, And Depression.
- Surgical – Peripheral nerve Injury
What to know about the IUCs (intrauterine contraceptive (IUC)
- 4 diff types used in US - only learning 3.
- Small **T-shaped **object that is placed inside the uterus to provide contraception
- Classified as either hormonal or nonhormonal
-Both types prevent pregnancy via inhibition of sperm mobility and sperm viability and change the speed of transport of the ovum in the fallopian tube. - Inhibiting sperm & ovum meeting
- Periods are lighter, shorter, & less painful
Some of the IUCs release 2 different substance.
What are they
- One IUC releases COPPER IONS- which alone are spermicidal.
- Three devices release LOW dose of progestin- causing thinning of the endometrium and thickening of cervical mucus, which inhibits sperm entry into the upper genital tract.
A. Name of Copper releasing IUC.
B. Name Progesterone IUCs
A. Copper ParaGard-TCu-380A – Lasts 10 yrs.
B. Progesterone:
1. levonorgestrel-releasing IUS
(Mirena & Kyleena) – lasts 5 yrs.
2. LNG-IUD (Jaydess) – Low-dose – lasts 3 yrs.
What should be reported with LARCs
remember PAINS:
Which CONTRACEPTIVE AM I?
Reduces risk of pregnancy AFTER unprotected intercourse or contraceptive failure
EMERGENCY CONTRACEPTIVE (EC)
Name 4 Emergency Contraceptives (EC)
- Ulipristal Acetate (UPA) – PO progesterone receptor agonist–antagonist (Ella)
- Levonorgestrel (LNG)-PO progestin (plan B one-step)
- Copper intrauterine device (Cu-IUD)
- Off-label combined OCPs - PO (Yuzpe method)
What to educate about for Emergency Contraception
- Used within 72 to 120 hrs.
- Sooner INGESTION more effective
- NO protection against STIs or future pregnancies.
- Should NOT be used as a regular birth control method
- May delay next menses
- CHECK PREGNANCY if NO menses within 3 wks. after use
- Report any SEVERE abdominal pain to HCP immediately
- ECs can be regular birth control pills given at a Higher Dose
- ECs are contraindicated if pregnant
Which type of Condoms have a HIGHER risk of Pregnancy and STIs?
Latex or Non-LAtex condoms?
NON-LATEX
TYPES OF CONTRACEPTIVE:
MOST effective
- Abstinence
- Male & female sterilization (permanent)
- IU contraception
- Implant
TYPES OF CONTRACEPTIVE:
VERY effictive
- Injectable contraceptive
- patch
- ring, & pills
TYPES OF CONTRACEPTIVE:
LESS effective
- Male & female condoms
- diaphragm
- fertility awareness
What should be used to REDUCE THE RISK of STIs?
Condoms.
What to think about BEFORE choosing Contraceptive.
- Safety
- Protection from STIs
- Effectiveness
- Acceptability
- Convenience
- Benefits
- Side Effects
- Effect on Spontaneity
- Availability
- Expense
- Preference
- Religious & Personal Beliefs
- Informed Consent-Because some methods have potentially dangerous side effects, it is necessary for the woman to sign an informed consent form to show that she received and understands information about the risks and benefits.
Things to know about PERMANENT contraceptives
- Known as Sterilization: procedure to Permanently prevent reproduction
* safe, and highly effective - Ex include: Laparoscopic, abdominal, hysteroscopic
- REVERSAL surgery is difficult, expensive, & sometimes unsuccessful.
Types of FEMALE STERILIZATION (permanent contraceptive)
- Tubal Ligation (tubes are modified)
- Two types: **Mini-laparotomies **(incission in pubic area done after childbirth- easier access) **& laparoscopies **(a lil more invasive)
* Sealed with a cauterizing instrument or with rings, bands, or clips, or cut and tied
Types of Male Sterilization
(permanent contraceptive)
- Vasectomy - cutting the vas deferens
* Semen no longer contains sperm
Things to know about Vasectomy for males.
- Complications - infection, hematoma, & pain
- Semen analysis 8 to 16 wks AFTER procedure until two specimens show no sperm is present. - due to procedure not being immediate.
