Ch. 11 nurses role in women's health Flashcards
Screening test are
not diagnostic, identify if more test are needed
what screening is done for detection of breast cancer
- monthly self exam
- annual professional exam
- mammography as needed
Who should perform BSE
all women after 20
When is the best time for BSE
1 week after start period
when should professional breast exams be done
yearly for all women over 20
How are mammograms performed
very low doses of x-ray
what can reduce the discomfort of mammograms
having them done after menstrual period
Who should get mammograms
all women 40 or older
Who should do vulvar self exams
women over 18
What should women do before pelvic exams
don’t douche or have sex for at least 48 hrs before
What do pelvic exams check for
- tumors
- discharge
- infections
- unusual pain
How often should women get pap smears:
- age 21-39
- age 30-65
- over 65
- every 3 years
- every 5 years
- not needed if normal for past 10 years
Amenorrhea
no periods
when is amenorrhea normal
- before menarche
- during pregnancy
- after menopause
Primary amenorrhea
don’t menstruate by age 16 or by age 14 if no secondary sex characteristics have developed
Secondary amenorrhea
no period for at least 3 cycles or 6 months
what increases risk of polycystic ovaries
obese teens
why would women who have low body fat experience amenorrhea
fat is needed to make estrogen
Metrorrhagia
normal bleeding but happens irregularly
Menorrhagia
bleeding a lot
how much blood does the average woman lose
35 mL
what is considered an excessive amount of blood
> 80 mL/month
How does menorrhagia manifest
- soaking through a pad or tampon in 1 hour sever times
- clots the size of a quarter
- gushing sensation that leaks through protection
Common causes of abnormal bleeding
- bleeding disorders
- pregnancy complications
- lesions
- breakthrough bleeding from oral contraceptives
- endocrine disorders
- failure to ovulate or respond to hormones
laser ablation
permanently removes uterine lining without hysterectomy
mefenamic acid
- what drug class
- what does it treat
- NSAID
- menorrhagia
Tranexamic acid
- what drug class
- what does it treat
- when is it used
- antifibrinolytic
- menorrhagia
- when hormones are contraindicated
what can reduce menstrual flow when taken daily
NSAIDs
Mittelschmerz
pain around ovulation near the middle of the cycle
Dysmenorrhea
painful cramps
when does dysmenorrhea occur
after period starts
nulliparas
never been pregnant
Primary dysmenorrhea
no evidence of abnormality
Secondary dysmenorrhea
pathological condition found
when does the pain from dysmenorrhea start and how long does it last
- starts no more than a few hours before period
- last no more than 72 hours
secondary dysmenorrhea common causes
- endometriosis
- IUD
- pelvic inflammatory disease
- uterine polyps
- ovarian cyst
what hormones effect dysmenorrhea
Vasopressin and Prostoglandins
drugs that reduce prostaglandin secretion
- include
- used for
- ibuprofen
- naproxen
- oral contraceptives
- dysmenorrhea
endometriosis
tissue that resembles endometrium outside the uterus
what can endometriosis cause
- pain
- pressure
- inflammation to adjacent organs
dyspareunia
painful sex
what meds treat endometriosis
- danazol
- agonsit of ganadotropin (nasal)
- lupron (IM)
what are women with endometriosis at increased risk for
osteoporosis
serum lipid changes
infertility
what are surgical treatments for endometriosis
hysterectomy
laser ablation
what causes PMS and PMDD
serotonin responses to normal changes in estrogen
Symptom criteria used for PMDD
- happens between ovulation and period
- improves after period
- 5 of the common symptoms occur
common symptoms of PMDD
- depression
- anxiety
- irritable
- difficulty concentrating
- lethargy
- food cravings
- change in sleep
- breast tenderness
- bloating
- weight gain
- headache
treatment for PMDD
- diet high in complex carbs and fiber
- stress management
- exercise
meds for PMDD
- oral contraceptives
- diuretics during luteal phase
- NSAIDs
- SSRIs 2 weeks before period and stopped when it starts
Vaginal epithelium at birth
- controlled by
- rich in
- pH
- estrogen from the mother
- glycogen
- 3.7 to 6.3 (low)
Vaginal epithelium during childhood
- atrophies
- contains little glycogen
- pH 7
When does estrogen influence come back after the mothers leaves
puberty
Interactions of glycogen and estrogen in the vaginal epithelium results in
growth of lactobacilli
what does lactobacilli do
produces bacteriostatic action and drops pH to 3.5-4.5
what factors predispose vagina to infection
- antibiotics
- douching
- sex
- uncontrolled diabetes
normal vaginal secretions are made up of
- creamy white epithelial cells
- mucus from cervix, skene glands and bartholin glands
what is mucus like during ovulation
clear and slippery with spinnbarkeit
spinnbarkeit
stretching without breaking
what is mucus like after ovulation
cloudy and sticky
what can temporarily change the vagina’s pH
- deodorant soap
- perfumed toilet tissue
- douching
- spermicides
- tampons
- hot tubs or swimming pools
- tight synthetic clothes
what are the classes of gynecological infections
- toxic shock
- STI
- pelvic inflammatory disease
what micro-organism causes toxic shock
staphylococcus aureus
what does staphylococcus aureus cause if it enters the blood
- shock
- coagulation defects
- tissue damage
what factors increase the risk for TSS
- high-absorbency tampons for prolonged periods
- diaphragm or cervical caps esp. after childbirth
symptoms of TSS
- sudden fever
- flulike symptoms
- hypotension
- sunburn like rash
- skin peeling on palms and soles 1 to 2 weeks after illness
how often should tampons be changed
q4h
what is the treatment for TSS
hospitalization
- vasopressor drugs
- antimicrobial meds
- fluid replacement
Candidiasis
yeast infection
symptoms of candidiasis
- itching
- burning on urination
- inflammation
- cottage cheese discharge
how is candidiasis diagnosed
id of spores
How does candidiasis effect babies
can infect them at birth
what is the treatment for candidiasis
- monistat (miconazole nitrate)
- gyne-lotrimin (clotrimazole)
- mycostatin (nystatin)
- diflucan (fluconazole)
Symptoms of Trichomoniasis
- discharge green, thin, smelly
- itching
- edema
- redness
Trichomoniasis is diagnosed by, how long does it take
- under microscope
- 10 min
How does Trichomoniasis effect baby
doesn’t but, can cause postpartum infection
Treatment for Trichomoniasis
=Flagyl (metronidazole) not during 1st trimester
-Gyne-lotrimin (clotrimazole) symptoms during first trimester
what kind of enviorment is best for trichomoniasis
alkaline
How is trichomoniasis spread
sex
what should be avoided during treatment with Flagyl
alcohol
symptoms of bacterial vaginosis
thin, fishy, grayish discharge
how is BV diagnosed
microscope and rapid detection tests
How does BV effect baby
preterm delivery
what is the treatment for BV
- Flagyl (metronidazole) for symptoms
- restore normal flora
What STI are all pregnant women screened for
BV
Chlamydia symptoms
- yellowish discharge
- painful urination
- often asymptomatic in women
Diagnosis of chlamydia
- culture
- DNA from urine
- NAAT
how does chlamydia effect baby
- transmitted via birth
- conjunctivitis
- pneumonia
Treatment for chlamydia
- Azithomycin
- doxycycline
- erythromycin
- eye care for all newborns
what are the complications of chlamydia
scarring of Fallopian tubes
Gonorrhea symptoms
- purulent discharge
- painful urination
- dyspareunia
diagnosis of gonorrhea
- culture
- NAAT
- results in hours
how does gonorrhea effect baby
transmits to eyes during birth causing blindness
treatment for gonorrhea
- eye care for all newborns
- cefriaxone
- azithromycin
complications of gonorrhea
pelvic inflammatory disease with tubal scarring
Symptoms for primary stage syphilis
painless chancre on genitals, anus, lips
symptoms of secondary syphilis
- 2 months after primary
- enlarged spleen and liver
- headache
- anorexia
- rash
- warlike growths
symptoms of tertiary syphilis
- may be years after secondary
- heart dmg
- blood vessel dmg
- nerve dmg
diagnosis of primary syphilis
- scrapings of chancre
- serology tests
diagnosis of secondary or tertiary syphilis
- serology test
- rapid plasma reagin
- FTA-ABS
how does syphilis effect baby
- crosses placenta
- congenital syphilis
- stillbirth
- miscarriage
Treatment for syphilis
- Benzathine penicillin G
- tetracycline (not in pregnancy)
- erythromycin
how is syphilis spread
- most contagious in primary or secondary
- sex
- sharing needles
Herpes genitalis is caused by what
herpes simplex virus 1 and 2
Symptoms of Herpes
- clusters of painful vesicles
- vesicles rupture after 1-7 days
- Heal in 12 days
Herpes is diagnosed by
viral culrture antibodies
DNA rapid test
How does herpes effect babies
- miscarraige
- stillbirth
- active infection needs C-section
- CNS problems
Treatment for herpes
- no cure
- Zovirax (acyclovir)
- Valtrex (valacyclovir)
- sitz baths
- wearing loose cotton underwear
Condylomata acuminatat
HPV
what are the symptoms of Condolyomata acuminatat
-dry warlike growths
What HPV cause warts
6 & 11
What HPV cause cervical disorders
16 & 18
how does hpv effect babies
- obstruct birth canal
- laryngeal papillomas
At what age is the HPV vaccine given
11-26
Treatment for HPV
cryotherapy
electrocautery
laser
podophyllin
Diagnosis of HPV
Pap test
HIV early symptoms
- no symptoms at first
- weight loss
- night sweats
- fever and chills
- fatigue
- enlarged lymph nodes
- rash
- diarrhea
HIV late symptoms
- immune suppression
- infections
- malignancies
Test for HIV
- serology test
- ELISA
- positive western blot test
How does HIV effect babies
- transmitted before birth
- must be bottle fed
Treatment for HIV
- no cure
- antiretrovirals
How is HIV transmitted
- blood
- sex
- mother to child
Who is at higher risk for HPV
women who douche
How is Hep B transmitted
sex (especially anything rectal)
Symptoms of Hep B
- malaise
- anorexia
- nausea
- fatigue
- liver failure
when is the hep B vaccine given
if you are exposed
what is pelvic inflammatory disease
infection of the upper reproductive tract
What is the most common cause of PID
- asymptomatic STIs
- N. gonnorrheae
- chlamydia trachomatis
What are the complications of PID
- Scarring of fallopian tubes
- ectopic pregnancy
- infertility
Symptoms of PID
- vary by effected area
- fever
- chronic pain
- abnormal discharge
- nausea
- anorexia
- irregular bleeding
- tenderness
- elevated leukocytes
- elevated sedimentation rate
Treatment for PID
antibiotics
antimicrobias
what does douching increase the risk of
- PID
- bacterial vaginosis
- ectopic pregnancy
- infection
what is the optimum timing between pregnancy
12-24 months
Natural family planning is
using protection or not having sex while fertile
Ovum is viable for how long
24 hrs after ovulation
How long is sperm viable
48-72 hours
Failure rate of natural family planning
20%
When is basal body temp taken
on waking up before activity
How does basal temperature change during ovulation and how long does it last
raises about 0.2 C (0.4 F) and remains higher for the last half of cycle
What can interfere with the accuracy of BBT
- poor sleep
- illness
- jet lag
- sleeping late
- alcohol evening before
- heated blankets or water beds
Billings method uses
the character or amount of mucus
What factors interfere with billings method
- antihistamines
- infection
- contraceptive foams or jellies
- sexual arousal
- sex
What is the benefit of Billings method
can be used in women whose cycles are irregular
When does ovulation occur
days before period
How long is a woman fertile
5 days before and 1 day after ovulation
Contraceptive effects
- prevent ovulation
- makes mucus thick and resistant to spern
- makes uterus less hospitable
The pill contains
estrogen and progestin
the mini pill contains
only progestin
who should avoid the mini pill
hispanic women with gestational diabetes who are breast feeding
How long after delivery can the pill be taken
3 weeks, but the mini pill helps with lactation
How are multiphasic pills different
the hormones change during the cycle to mimic natural hormone activity
induced amenorrhea are
extended-dose contraception
with extended-dose pills how is the period effected
only have one once every 3 months
what form of the pill is most effective
extended-dose
Common side effects of birth control pills
- nausea
- headache
- breast tenderness
- weight gain
- spotting
- amenorrhea
Who should be not take birth control pills
- blood clots
- heart problems
- estrogen dependent cancer
- breast cancer
- smokes more than 15 cigarettes a day and older than 35
- poor liver function
- pregnant
- undiagnosed vaginal bleeding
Why shouldn’t birth control be given after delivery
- high risk for blood clots
- can cause problems with lactation
how does breast feeding effect ovulation
women who feed 10x per day don’t ovulate for 10 weeks after labor
ACHES is used for
-what does it mean
- warning signs that need to be reported for birth control
- Abdominal pain (severe)
- Chest pain, dyspnea, bloody sputum
- Headache (severe). weakness or numbness of limbs
- Eye problems
- Severe leg pain or swelling, speech disturbance
what reduces the effectiveness of birth control pills
- antibiotics
- anticonvulsants
- rifampin
- barbiturates
Implanon does not affect
bone density
failure rate of implanon
0.05%
Medroxyprogesterone acetate
depo-provera
how long does depo last how long can you take it
3 months for 2 years
how long does it take for fertility to return with depo
1 year
failure rate of depo
6%
what are the benefits of depo
- can be taken with antiseizure meds
- reduces blood loss for those with coagulation problems or sickle cell
How effective is the IUD
98%
What is Paragard
small T-shaped copper containing plastic device with no hormones
how long is ParaGard good for
12 years
How does ParaGard work
makes a hostile enviorment
What is Mirena
IUD with progestin or levonorgestrel
How does Mirena work
makes the mucus too thick and sometimes prevents ovulation
How often does Mirena get replaced
every 3 to 6 years
How long til fertility last after IUD removal
rapidly
What are the side effects of IUD
- cramping and bleeding on insertion
- increased menstuation
- dysmenorrhea
What is important for he woman with an IUD
check the string weekly for the first 4 weeks then monthly
Who should use an IUD
only those without infection and in monogamous relationships
Ortho-Evra
transdermal patch containing norelgestromin/ethinyl-estadiol
When should ortho-evra be applied
once a week for 3 weeks then 1 week without
Who can use the patch
women who weigh less than 90 kg or 198 pounds
how does nuvaring work
releases estrogen and progestin
How long is nuvaring work
3 weeks with 1 week break
Failure rate of nuvaring
9%
Diaphragms and cervical caps
rubber domes that fit over cervix and use spermacide
failure rate of diaphragms and cervical caps
12%
How long should diaphragms be left in place
6 hours after sex
When should diaphragms be refitted
after each birth
after weigh change of 10 lbs or more
When should the cap be refitted
yearly and after birth, abortion or surgery
FemCap
latex-free cap
Lea’s shield
silicone reusable shield used with spermacide
how long can vaginal sponge be left in place
up to 24 hours after sex
What are adverse effects of vaginal sponge
dryness and irritation
Failure rate of condoms
18%
Bikini-panty style female condom
pouch that fits inside the vagina
how long before sex can the bikini-panty style female condom be inserted
up to 8 hours
Failure rate of female condoms
21%
how long are films and suppositories good for
1 hr
How long do you have to wait to douche if using spermicides
6-8 hrs
failure rate of spermicide
21%
spermicides may cause
irritation and increased risk of infection
Plan B
- contains
- most effective if used
- may be effective if used
- progestin levonorgestrel
- 72 hrs
- 120 hrs
who is plan b not effective for
women over 165 lbs
Ulipristal acetate
- requires
- how does it work
- taken within
Ella
- prescription
- prolonging ovulation
- 5 days
coitus interruptus
pull out method
how does vasectomy work
cutting each vas deferens
How long before sterile with vasectomy
1-3 months
how long does it take to do a vasectomy
20 minutes under local anesthetic
Tubal ligation
blocking or ligating the fallopian tubes via electrocautery or clips
Minilaparotomy
- AKA
- how does it work
- band-aid surgery
- incision near belly button right after labor or above pubis other times
laparoscopic surgery
ligation through laparoscope
traditional approach tubal ligation
done during abd surgery usually a C-section
how long does it take to recuperate from tubal ligation
1-2 days
hysteroscope
saline fills uterus and essure microinsert is put in fallopian tubes through the vagina
How after hysteroscope before effective
3 months
depo can provide amenorrhea for how long
5 years
menopause
cessation of periods for 1 year because of changes in estrogen levels
Climacteric
the time before menopause last 2-8 years
when does menopause occur
age 45-50
decreased estrogen increases risk for
- osteoporosis
- arteriosclerosis
- increased cholesterol
menopause may be induced at any age by
- surgery
- pelvic irradiation
- extreme stress
what signs should be reported while on hormone replacement therapy
- headache
- vision changes
- signs of thrombophlebitis
- cardiac symptoms
contraindications to HRT
- estrogen dependent breast cancer
- endometrial cancer
- thromboembolic disease
- history of melanoma
- chronic liver disease
- severe hypertriglyceridemia
- gallbladder disease
- seizure disorders
Ginseng
helps relieve menopausal symptoms
Soy products
thought to reduce hot flashes and convert vit D into calcitonin
Vitamin E
stabilize estrogen lvls
Black cohosh
remifemin
reduce luteinizing hormone
signs of osteoporosis
- height loss
- dowager’s hump
- upper spine curve
- fractures
how much Vit D and calcium should women take for menopause
- 1200mg cal
- 600 to 800 mg D
Fosamax (Alendronate)
prevents potential fractures
Prolia (Denosumab)
reduces bone loss
