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NUR350 Final > Breast and genitourinary assessment > Flashcards

Breast and genitourinary assessment Flashcards

1
Q

What is trauma informed care

A
  • Many of us have experienced trauma in our lives and it may not be so obvious
  • Everybody brings a different kind of trauma to the table
  • We want to provide care that promotes a culture of safety, healing and empowerment
  • As practitioners, we see survivors of trauma in settings that too often re-traumatize and marginalize them
  • Learning to interact with survivors in ways that encourage their resiliency and growth is important
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2
Q

Keys of trauma informed care

A
  • Trauma is common
  • Trauma comes in many forms
  • Care for everyone as though we have all experienced trauma
  • Practice trauma-informed / trauma-aware care
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3
Q

How to provide trauma informed care

A
  • Always ask for consent; including at each step
  • Ask whether the patient would like someone to be with
    them
  • Explain what will be done, how it will be done, and why it is necessary
  • Do not assume that any procedure or examination is routine
  • Observe body language
  • Avoid false reassurances. Offer specific suggestions on how to relax if needed. Discuss in advance. Write things down.
  • If the patient is triggered, speak in calm voice and let them know where they are, that they are in a safe place, and encourage them to look at you, focus, and take breaths.
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4
Q

Considerations for trauma informed care

A

Summary of considerations for physicians when interacting with survivors

  • let the patient lead, but avoid having the patient tell very detail of the trauma, unless they want to
  • use a non-judgemental approach
  • have patient agency
  • be sensitive, attentive,
  • inform before you perform
  • expose one body part at a time
  • inclusive care is important; do not discriminate
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5
Q

Inclusive care

A
  • Discrimination against individuals who identify as LGBTQI2S, or any other SOGIE not listed, has been common in many contexts including healthcare
  • What are some ways we can make people feel welcome, and understood?
  • Don’t assume
  • Ask questions in a way that avoids assumptions

Review your:

  • Clinic space/unit
  • Posters/artwork throughout the clinic
  • Washrooms
  • Documentation
  • Policies & Procedures / Consents / Forms
  • Staff orientation program
  • Health promotion materials
  • Marketing materials / Website
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6
Q

The gingerbread person

A

Four discrete experiences of every person

  • May or may not be the same or related to each other
    1) Gender identity
    2) Attraction
    3) Expression
    4) Sex
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7
Q

Female and male breast/chest assessment

A
  • Both females and males have breasts, mammary glands

- But in makes they are rudimentary throughout entire life

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8
Q

Anatomy of breasts

A
  • Breasts are composed of many tissues
  • Granular, fibrous, and adipose tissues
  • And the proportion changes depending on age, menstrual cycle, pregnancy, lactating, nutritional state, etc.
  • Second rib is were breast tissue starts
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9
Q

Breast landmarks: quadrants

A
  • Have to specify where a mass is
  • Axillary tail of Spence
  • Upper inner quadrant
  • Upper outer quadrent
  • Lower inner quadrant
  • Lower outer quadrant
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10
Q

Breasts and lymphatic drainage

A

Axillary nodes

  • Central
  • Pectoral
  • Subscapular
  • Lateral
  • Lymph flows circulatory around breast then up to axillary area then to clavical
  • This along with venous drainage is very important in the spread of cancer
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11
Q

Age related changes to breasts: children

A

Infancy
- Breast structures present, but only nipple (lactifours duct) is active unit puberty

Adolescence

  • The onset of breast development, begins between ages 8-10
    i. Thelarche (breast development)
    ii. Adrenarche/pubarche (axillary/pubic hair development)
    iii. Height spurt
    iv. Menarche (first period)

Boobs, pubes, grow, flow

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12
Q

Tanner staging: sexual maturity rating in girls

A
  • Good for assessing where someone is in their pubertal development
  • Breast development occurs starting at age 8-13
  • Pubic hair development from 8-14
  • Height spurt from age 9 1/2-14 1/2
  • Menarche from age 10-16 1/2
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13
Q

Average age of pubertal changes

A

Females it beings around 8

Males around age 10-11

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14
Q

Hormones of how puberty works

A
  • The hypothalamus stimulates GnRH, which stimulates the pituitary gland to secrete LH and FSH
  • These stimulate either the testes or ovaries to secrete testosterone or oestrogen respectively
  • Causes subsequent changes in the body
  • We can block puberty with GnRH; fully reversible
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15
Q

Age related breast changes: pregnancy

A
  • Breasts can change quite a bit; can be an early sign of pregnancy
  • Breast/nipple increase in size, blue vascular patten can be seen (default is white woman bias)
  • Can develop stretch marks
  • Nipples become darker and more erect
  • Colostrum can be present at 4 months pregnant
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16
Q

Age related breast changes: lactation

A
  • Biological reason for breasts is to nourish offspring; have become very sexualized
  • Breasts can be both sexual and biological
  • You can incite lactation even if you aren’t the person who just gave birth
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17
Q

Breast/chest feeding

A
  • Trans men can breastfeed depending on top surgery and how much breast tissue has been removed
  • Supplemental nursing system can also be use if breastfeeding is difficult
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18
Q

The breastfeed baby

A

Immune system

  • responds better to vaccinations
  • human milk helps to mature immune system
  • decreased risk of childhood cancer

Eyes
- visual acuity is higher in babies fed human milk

Ears
- breastfed babies get fewer ear infections

Throat
- children who are breastfeed are less likely to require tonsilectomies

Skin
- less allergic eczema in breastfed infants

Higher IQ
- cholesterol and other types of fat in human milk support the growth of nerve tissue

Endocrine system
- reduced risk of getting diabetes

Mouth

  • less need for orthodontics in children breastfeed more than an year
  • improved muscle development of face from suckling at the breast
  • subtle changes in the taste of human milk prepare babies to accept a variety of foods

Respiratory system

  • breastfeed babies have fewer and less severe upper respiratory infections
  • less wheezing, less pneumonia, and less influenza

Heart and circulatory system

  • breastfeed children have lower cholesterol as adults
  • heart rates are lower in breastfed infants

Kidneys
- with less salt and less protein, human milk is easier on babies kidneys

Digestive system

  • less diarrhea, fewer GI infections in babies who are breastfeeding
  • 6 months or more of exclusive breastfeeding reduces risk of food allergies
  • less risk of Crohn’s disease and UC in adulthood

Appendix
- children with acute appendicitis are less likely to have been breastfed

Urinary tract
- fewer infections in breastfed infants

Bowels
- less constipated

Joints and muscles
- juvenile RA is less common in children who are breastfed

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19
Q

The breastfed toddler

A

Hair
- have glossier, healthier hair due to protein from milk

Brain
- higher intellectual and cognitive aptitude

Ears
- better hearing due to lower incidence of ear infections

Eyes
- stronger vision due to vitamin A in milk

Teeth

  • thumb sucking less likely to occur in breastfed toddlers
  • increased duration of breastfeeding improves dental arch

Bones
- calcium requirements met from human milk

Weight
- leaner bodies with less risk of obesity

Limbs
- human milk good painkiller for bruises and bumps

Skin
- smoother and more supple

Hydration
- breastmilk helps keep hydration

Immune system
- antibodies in breastmilk provide protection

Portability
- easier to travel with (with regard to nursing vs carrying bottles)

Taste buds

  • less likely to be fussy eaters
  • taste buds stimulated by range of flavours in milk

Independence

  • breastfeeding helps meet child’s dependancy needs; key to helping them achieve independence
  • lets them do so at their own pace
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20
Q

Age related breast changes: pot menopause

A
  • Due to decrease of estrogen and progesterone
  • Glandular tissue replaced with fibrous connective tissue
  • Fat (adipose tissue) atrophies
  • Breast size and elasticity decrease
  • Lumps may now be palpable
  • Lactiferous duct fibrosis and calcification
  • Importance in breast imaging; a young person’s tumour may be obscured due to density, easier to see in less dense (older) tissue
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21
Q

The male breast

A
  • Rudimentary
  • Thin disc of underdeveloped tissue underlying the nipple
  • Gynecomastia; enlarged breast tissue in males
  • Male breast cancer incidence is about 1%
  • Males have milk ducts
  • Men can produce milk; after extensive stimulation but quality of milk unknown
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22
Q

The 3 most common presenting symptoms of breast issues

A
  • pain
  • nipple discharge
  • palpable breast lump
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23
Q

Subjective assessment of breasts

A

History of Present Illness

  • Onset
  • Chronology
  • Current situation
  • Location
  • Radiation
  • Quality
  • Timing

Review of System

  • Discharge from nipple
  • Skin changes
  • Pain or swelling

Associated symptoms

  • Fever
  • Chills
  • Rigors
  • Malaise
  • Nausea
  • Vomiting

Medical History

Personal and Social history

Family history

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24
Q

Objective assessment of breasts

A

General

  • State of health,
  • Appearance of comfort/distress,
  • Colour (flushed, pale),
  • Nutritional status

Vital signs

Inspection

Palpation

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25
Q

Subjective data: health history of breasts

A

PQRSTU-AAA all of the following:

  • Discharge
  • Lump
  • Pain
  • Rash
  • Swelling
  • Trauma
  • History of breast disease
  • Surgery
  • Routine breast health
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26
Q

LACE: breast examination

A

1) Look
- looking at breast, nipples (retraction, eversion)
- any parts that are stuck down when moving arms
- client seated, breast exposed checking for: symmetry, skin changes, nipple changes, dimpling

2) Arm position
- want to assess while moving arms in different positions
- hands raised above head; check contour
- hands on hips; check for retraction
- breast dangling

3) Check lymph nodes
4) Examine breast tissue

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27
Q

Objective data: inspection

A

General appearance

  • Contour, symmetry
  • Masses or fixation
  • Dimpling/depression, peau d’orange
  • Skin colour, edema, venous pattern
  • Lymphatic drainage areas

Nipples

  • Size
  • Shape
  • Direction, inversion
  • Scaling, crusting or ulcerations
  • Discharge
  • Supernumerary
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28
Q

Supernumerary nipples

A
  • A common, minor birth defect
  • Consists of an extra nipple (and/or related tissue ) in addition to the two nipples that normally appear on the chest
  • Most supernumerary nipples do not cause symptoms or complications
  • They often are small and go undetected
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29
Q

Inspect and palpating the axillae: breast examination

A
  • Can be sitting for lymph node assessment but should be supine for rest of assessment
  • Want to asses up into the armpit for pumps, bumps, masses, skin changes, etc.
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30
Q

Palpating the breasts

A
  • Different patterns; concentric circles, up and down, in to out

Looking at

  • Consistency
  • Elasticity of tissues
  • Tenderness
  • Thickening
  • Lumps or masses
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31
Q

Describing and documenting a mass in the breast

A

Location

  • Drawing and narrative
  • Side (left/right)
  • Clock face location
  • Distance from areolar edge

Size
- 2 measurements in 2 dimensions

Shape

  • Round
  • Oval
  • Irregular

Consistency

  • Soft
  • Firm
  • Rubbery

Margins

  • Well-defined
  • Ill-defined
  • Fixed or Movable
  • Nipple
  • Skin over the lump

Tenderness
- Tender or non-tender

Lymphadenopathy

  • Disease of the lymph nodes
  • They are abnormal in size or consistency
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32
Q

Breast cancer

A
  • Overgrowth of the cells in the breast
  • Likely age: 30-80 years
  • Irreg, star-shaped
  • Hard, dense, fixed
  • Often painless
  • Grows constantly
  • Most common location: upper outer quadrant
  • Late stage: dimpling, nipple retraction/ discharge
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33
Q

Breast cancer and pregnancy

A
  • Breast cancer is the most common cancer diagnosis in pregnancy
  • Occurs in 1/3000 women
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34
Q

Ductal carcinoma vs invasive ductal carcinoma

A
  • Ductal carcinoma is the most common form of breast cancer
  • Ductual carcinoma In situ (DCIS) has not spread out of the mammary ducts; may be a precursor to IDC
  • Invasive ductal carcinoma (IDC) breaks out of the ductal walls and into the surrounding tissue; from there it can penetrate into blood vessels or lymph vessels and spread to other organs and tissues
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35
Q

Paget’s disease

A
  • Rare type of cancer
  • Involving the skin of the nipple and areola
  • Red flag: clustering and ulcers
  • Can occur in men, most common in women
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36
Q

Treatment of breast cancer in pregnancy

A

Modified radical mastectomy: 1st trimester-3rd trimester
Breast conserving surgery or total mastectomy and set lymph node dissection or axillary lymph node dissection: 2nd trimester-3rd trimester
Chemotherapy: 2nd trimester-postpartum
Radiotherapy: postpartum
Endocrine Tx: postpartum

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37
Q

Breast cancer non-modifiable risk factors

A
  • F, age 50-69
  • PHx or FHx breast Ca
  • Dense breasts
  • BRCA gene mutation
  • Ashkenazi Jewish ancestry
  • Prev breast bx w atyp hyperplasia
  • Prev breast irradiation
  • Menarche age 55 (longer exposure to estrogen over lifetime)
  • Tall adult height
38
Q

Breast cancer modifiable risk factors

A
  • Nulliparity or first child >age 30 - Hormonal contraceptive use/HRT (hormone replacement therapy, usually the estrogen and progesterone combines for hormones)
  • Postmenopausal hormone therapy (esp EP)
  • Not breastfeeding
  • EtOH of ≥1 drink daily
  • Obesity
  • High socioeconomic status
39
Q

Breast cancer possible risk factors

A
  • Some association, not a causal effect
  • Physical inactivity
  • Adult weight gain
  • Smoking and second-hand smoke exposure
  • High birth weight
  • Night shift work
40
Q

Breast cancer risk assessment tools

A

• A number of tools exist

  • Some for general public
  • Some for health professionals

• Health professional tools

  • Gail Model
  • Breast Cancer Risk Assessment Tool
  • Tyrer-Cuzick Model – computer program
41
Q

BRCA 1 & BRCA 2

A
  • Tumour suppressor gene
  • Mutation lead to increased risk for cancer
  • BRCA; breast cancer tumour suppressor gene; we all have it
  • It’s people who have the mutation of this gene who are more likely to have breast cancer
  • Not a guarantee that they will get cancer but at a higher risk
  • Screening more frequently
  • Recommended ovaries be removed by 35; breasts removed by 40ish
  • Embryos can be tested for gene mutation to ensure it’s not kept in family
42
Q

Breast cancer in men

A
  • 1% of all breast cancer cases occur in men
  • men usually die faster with breast cancer because they don’t realize that can get it too
  • usually shows up as a lump under or near the nipple
  • signs include: misshaped breasts, non-matching breasts, and nipple discharge
  • similarly treated; can get macestomy
43
Q

OBSP: Be Breast Aware

A
  • Know how your breasts normally look and feel so that you can recognize changes
  • A lump or dimpling
  • Changes in your nipple or fluid leaking from the nipple
  • Skin changes or redness that does not go away
  • Any other changes in your breasts
44
Q

OBSP Breast Screening Guidelines

A

Routine

  • Age 40-49: talk to healthcare provider
  • Age 50-74: mammogram Q2Y

High risk
- Age 30-69: if high risk, yearly mammogram and breast MRI

45
Q

OBSP: Screening for those at high risk

A

Eligible if no acute breast symptoms, are 30-69 years of age and meet of the the following risk criteria:

  • Known to be carriers of a deleterious gene mutation (e.g. BRCA 1, BRCA 2)
  • Are first degree relative of a mutation carrier, and have declines genetic testing
  • Are determined to be at >25% lifetime risk of breast cancer (via IBIS or BOADICEA risk assessment tools, at a genetic clinic)
  • Have received chest radiation treatment (not chest x-ray) before age 30 and at least 8 years previously
46
Q

Canadian Task Force on Preventive Health Care (CTFPHC): recommendations concerning clinical breast exam and breast self exam

A
  • The oppose the OBSP
  • State that women not deemed high risk aged 40-74 should be routinely be performing exams
  • Say the rate is not high enough to make a significant different
  • What about for that one person?
  • Use your own judgement in your clinical practice
47
Q

BREAST Mnemonic

A 
B: breast mass
R: retraction
E: edema (peau d'orange)
A: axillary mass
S: skin (scaly nipple, changes)
T: tender breasts
48
Q

Male genitalia structure and function

A
  • External and internal anatomy
  • External: penis, glands, urethra, foreskin, scrotum
  • Scrotum size controlled by contastor muscle
  • Internal: spermatic cord, epididmis, vast deferenes (vacestomy site)
49
Q

Prostate gland

A
  • Secretes thin milky akaline fluid that helps confirm viability
  • Round, heart shaped
  • 2.4-4cm diameter
  • Grows over time but it always needs to be assessed beyond a certain age
50
Q

Male genitalia and lymphatic drainage

A
  • Penis and scrotum drain into the inguinal lymph nodes

- Testes drain into abdominal lymph nodes

51
Q

Subjective assessment of male genitalia

A

History of Present Illness

  • Onset
  • Chronology
  • Current situation
  • Location
  • Radiation
  • Quality
  • Timing

Review of System

  • Discharge from penis
  • Itching
  • Lesions
  • Genital pain
  • Testicular pain
  • Swelling

Associated symptoms

  • Fever
  • Chills
  • Urinary symptoms
  • Pain

Medical History

Personal and Social history

Family history

52
Q

Objective assessment of male genitalia

A

General

  • State of health
  • Appearance of comfort/distress
  • Colour (flushed, pale)
  • Nutritional status

Vital signs

Inspection

Palpation

53
Q

Subjective data: health history of male genitalia

A
  • Urinary symptoms (frequency, urgency, nocturia, dysuria, hesitancy, straining)
  • Past genitourinary history
  • Penis; any pain or discharge
  • Scrotum; any pain or swelling
  • TSE (self care; timing, shower, exam)
  • Hernias
  • Sexual history
  • History of STIs
54
Q

Objective data: inspection and palpation of male genitalia

A

Skin

  • Colour
  • Lesions
  • Swelling

Peins

  • Glans for smoothness, lesions, discharge
  • Urethral meatus for location, discharge

Inguinal lymph nodes
- Horizontal and vertical chains

Scrotum

  • Testes firm, oval, smooth, movable, mildly tender
  • Shouldn’t be an overt or fixed mass

Spermatic cord
- Palpate up to inguinal ring

55
Q

Objective data: palpation of the scrotum

A

1) Cup one testicle at a time
2) Examine by rolling the testicle between your thumb and finger
3) Assess spermatic cord and epididimyis on back side of testes
4) Assess for irregularities between testicles

56
Q

Describing masses in the testicles

A
  • Size, contour, nodularity
  • Tenderness
  • Proximal / Distal to testis
  • Does it reduce when supine
  • Transillumination; use a flashlight to look at it, illuminate whether there is an actual mass there
57
Q

Inspecting and palpating for hernias

A
  • Inguinal region; stand and strain
  • Palpate external inguinal ring
  • Palpate in Femoral canal area
  • If hernia present, you will feel it against your finger when you are pressing in
58
Q

Palpating the prostate gland

A
  • Press into gland
  • Size: 2.5 - 4 cm
  • Heart shape, palpable groove - Smooth
  • Rubbery
  • Slightly movable
  • Non-tender; but exam itself can be uncomfortable
59
Q

Regional lymphatics: inguinal

A
  • Penis and scrotum drain into the inguinal lymph nodes

- Testes drain into the abdominal lymph nodes

60
Q

Torsion

A
  • Testicle twisted on itself

- Usually around the spermatic cord

61
Q

Inguinal hernia

A
  • Contents of abdominal cavity protruding into the scrotum

- Can be uncomfortable

62
Q

Varicocele

A
  • Gross dilation of the veins draining into the testes
  • Left testicle more commonly affected
  • Feels like “a bag of worms”
63
Q

Epididymitis

A
  • Inflammation of the coiled tube (epididmyis) at the back of the testicle that stores and carries sperm
  • Treated with antibotics
64
Q

Age related male genital changes: children

A

Infant

  • Testes descend along inguinal canal to scrotum before birth
  • When testes have not descended; called cryptorchidism
  • Associated with infertility and lower sperm parameters
  • Important to ask about during assessment
  • Uncircumcised/circumcised (choice)

Adolescent
- Tanner Staging

65
Q

Tanner staging: sexual maturity rating in boys

A
  • The brain determines when puberty starts; usually around age 11 for boys
  • Pituitary gland releases LH and PSH
  • Affects the respective sex glands
  • Testes secrete testosterone (they grow in size)
  • Penis grows at age 12
  • Followed by growth spurt
66
Q

Age related male genital changes: aging

A
  • No definite end to fertility; spermatogenesis decreased over time with aging
  • Amount of pubic hair decreases
  • Penis size decreases; and scrotum can becomes more penedulant over time
  • Testes decrease in size, less firm
  • Slower less intense sexual response; erection takes longer, ejaculation less forceful, less seminal volume
67
Q

Testicular cancer risk factors

A
  • Incidence highest 15-49 y
  • Undescended testicles (late correction)
  • Family history
68
Q

Early symptoms of testicular cancer

A
  • Lump or swelling +/- pain

- ‘Heaviness’ abdomen/ scrotum

69
Q

TSE self exam of testicles

A

T: timing
S: shower
E: examine changes

  • Self exam for testicular cancer
  • Examine entire scrotal content for any changes
  • Encouraged to asses consistently and same pattern each time
  • Monthly ideal
  • Any changes should be reported to HCP
70
Q

Risk factors of prostate cancer

A
  • Age>65
  • Family history of prostate Ca
  • African ancestry
  • Diet high in fat
71
Q

Signs and symptoms of prostate cancer

A
  • Urinary symptoms; because prostate can block the urethra if enlarged due to tumour
  • Frequency, nocturia, hesitiancy, incomplete emptying, pain
  • Painful ejaculation
72
Q

Subjective assessment of female genitalia

A

History of Present Illness

  • Onset
  • Chronology
  • Current situation
  • Location
  • Radiation
  • Quality
  • Timing

Review of System

  • Discharge
  • Skin changes
  • Irritation
  • Bleeding
  • Pain
  • Swelling

Associated symptoms

  • Fever
  • Urinary symptoms
  • Pain (abdominal, back, flank)
  • Constipation

Medical History

Personal and Social history

Family history

73
Q

Objective assessment of female genitalia

A

General

  • State of health
  • Appearance of comfort/distress
  • Colour (flushed, pale)
  • Nutritional status

Vital signs

Inspection

Palpation

74
Q

External genitalia: vulva

A
  • Internal and external anatomy
  • External: vulva
  • Labia majoria (rounded folds of tissue that extends from the mons pubis to the perineum)
  • Labia minora (inside the labia majoria, darker folds of skin)

When we are looking at the vulva, we are looking for:

  • Skin changes
  • Notible discharge
  • Swelling of glands (Barlolin’s gland)
  • Skene’s gland doesn’t usually swell (found underneath clitoral hood)
75
Q

Internal genitalia: vagina

A
  • Just the inside part

- Lots of people confuse the vulva for vagina and call the overall thing vagina

76
Q

Subjective data: health history for female genitalia

A
  • Menstrual history
  • Obstetric history
  • Menopause
  • Urinary symptoms
  • Vaginal discharge
  • GU history (surgery, treatments)
  • Sexual activity
  • Contraceptive use (still ovulating if exposed to sperm need to consider)
  • STI contact
  • STI risk reduction
77
Q

Objective data: physical exam of female genitalia

A
  • Lithotomy position; easiest position to do a pap smear
  • Maintain respect; be careful you aren’t triggering people as you speak to them
  • Communicate; give them an out, they don’t need to do it that day; let them be a feel ready
  • Involve them in the process
78
Q

Objective data: inspection and palpation of female genitalia

A

External Genitalia

  • Skin colour, hair distribution
  • Pubic area for colour, irritation
  • Labia, clitoris, urethral opening and vaginal opening for colour, lesions, masses, discharge
  • Perineum for colour, lesions, masses, scars (episiotomy)
79
Q

Palpation of the female genitalia

A
  • Pubic area; mass, tender
  • Labia; mass, tender
  • Skene’s glands; swelling discharge, pain
  • Bartholin’s glands; swelling, discharge, pain

Pelvic Musculature:

  • Perineum
  • Tone of vaginal opening
  • Vaginal wall for bulging, prolapse, urinary incontinence
80
Q

Speculum exams

A
  • Proper size speculum

- Options and explain to them why you’re using the speculum that you ate

81
Q

Normal variations of the cervix

A
  • There are many variations of normal
  • Nulliparous; never has pregnancy or delivery
  • Parous; after childbirth
  • Unilateral transverse
  • Bilateral transverse
  • Stellate
  • Cervical eversion; sometimes seen on patient who has been on hormonal birth control for a long time
  • Nabothian cysts; yellow cysts present on cervix, normal variation
82
Q

Bimanual exam

A
  • Both hands; one on top to feel uterus/ovaries and other hand in vagina
  • Is it ever necessary?

Looking at:

1) Cervix
- Consistency
- Contour
- Mobility

2) Uterus
- Position

3) Adnexa
- Fallopian area; fullness, tenderness, masses

83
Q

Uterine position

A
  • Variety of normal
  • Anteverted
  • Midposition
  • Anteflexed
  • Retroflexed
  • Retroverted; not a risk factor for infertility, but can cause painful vaginal-penile sex
84
Q

Contraceptive options

A
  • Approaching it; how effective do you need it be be and how often do you have to think about it
  • Also think about what their drug plan can afford
85
Q

Age related female genital changes: children

A

Infant
- Engorgement of external genitalia; due to maternal or parental providing estrogen

Adolescent

  • Tanner Staging
  • Boobs, pubes, grow, flow
86
Q

Age related female genital changes: pregnancy

A
  • Paps are safe in pregnancy; wouldn’t use the broom though, find the right tool for the test that’s right for them
  • Goodell’s sign; cervix softens at 4-6 weeks pregnant
  • Chadwick’s sign; vaginal mucosa and cervix looks a but cynaotic (blue) at 8-12 weeks
  • Hegar’s sign; istmus of uterus softens at 6-8 weeks
  • Uterus increases in size and capacity; 500-1000x it’s non-pregnant state
87
Q

Age related female genital changes: aging

A
  • Menses – irreg then cease; perimenupasual, can be unpredictable or irratic
  • Uterus and cervix shrink
  • Ovaries atrophy
  • Ovulation becomes sporadic
  • Pelvic musculature weakens; sacral ligaments relax, potential for prolapse
  • Vagina shortens, narrows, epithelium atrophies; sexual activity can become uncomfortable due to lack of estrogen
88
Q

Risk factors for cervical cancer

A
  • Sexual intercourse at an early age; cervix still maturing and more susceptible
  • Multiple sexual partners; potential for for HPV exposure
  • History of STIs
  • Increasing age; as we age, can’t fight off HPV as well
  • Compromised immunity (e.g. HIV)
  • Infection with HPV
  • Smoking; increases risk of not clearing HPV from our system
  • Low socioeconomic status; due to not screening as often? Screened too late?
89
Q

Ontario Cervical Screening Program

A
  • Found that a lot of people can clear HPV on their own
  • Screening starts at 21 if you are sexually active
  • Includes digital, oral sexual activity with partner of any sex
  • Screen Q3Yr unless abnormal reading
  • Until age 70; not high rate after that
90
Q

Risk factors of ovarian cancer

A
  • Age >50
  • Personal history of Ca (breast, uterine or colorectal)
  • Family history of ovarian Ca or breast cancer (esp 1 degree, BRCA1 or BRCA2 genes) and a family hx of colon, uterine or pancreatic cancer
  • Nulliparous
  • Fx of ovarian cancer
  • BRCA gene mutation
  • Lynch syndrome; gene mutation that exposed people to colorectal and uterine cancer
  • Never being pregnant
  • Px history of breast cancer
  • Fx of certain cancers
  • Ashkenazi Jewish ancestry
  • Hormone replacement therapy
  • Smoking
  • Asbestos
91
Q

Possible risk factors of ovarian cancer

A
  • Obesity
  • Using talc on genitals
  • Endometriosis
  • Tall adult height

NUR350 Final (17 decks)

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