Ch. 26 Female GU

Question 1

Developmental competence: infants

Answer 1

external genitalia engorged because of presence of maternal estrogen
Size recedes in a few weeks.

Question 2

Developmental competence: childhood

Answer 2

ovaries are in the abdomen rather than the pelvis; move into the pelvis at the time of menarche.

Question 3

Developmental competence: pregnancy

Answer 3

cervical and vaginal secretions increase during pregnancy.
20-24 weeks—uterus almost to the liver, displacing intestines superiorly and laterally.
During pregnancy—risk of yeast infection

Question 4

Why do woman have a risk of yeast infection during pregnancy

Answer 4

Increase in glycogen increases risk of candidiasis during pregnancy

Question 5

Developmental competence: aging women

Answer 5

menopause at 48-51 years—cessation of menses
Ovaries stop producing progesterone and estrogen.
Decreased size of the uterus; ovaries atrophy; uterus droops;
Vagina less elastic; atrophies; decreased secretions
Decreased sexual response; decreased vaginal secretions; decreased duration of orgasm and rapid resolution.

Question 6

Cultural issues pertaining to woman re GU

Answer 6

female genital mutilation—removal (partial or total) of clitoris
Aboriginal, Christian, Muslims from East and Southern Asia, Middle East, large areas of Africa

Question 7

Menstrual hx

Answer 7

normal menses q. 28 days; 3-7 days duration

Question 8

obstetric hx

Answer 8

gravida, para, abortions (interrupted pregnancies)

Question 9

Menopause ; ask about symptoms

Answer 9

hot flashes, night sweats, numbness and tingling, headaches, palpitations, mood swings. Discuss reaction to loss.

Question 10

Perimenopause ages?

Answer 10

40-55 y.o.

Question 11

Acute Pelvic Pain - what does this mean?

Answer 11

acute pain that lasts < 3 months; urgent conditions could be PID, appendicitis, ruptured ovarian cysts, ovarian torsion

Question 12

Urinary symptoms - what do you ask?

Answer 12

any problems urinating; frequency and small amts; any burning; cloudy or foul?

Question 13

Vaginal discharge - what to ask

Answer 13

ask about unusual discharge; meds (OCPs or antibiotics); ask about family hx of DM (DM increases glycogen.

Question 14

Vaginal discharge: possible causes, risks, etc

Answer 14

Can suggest vaginal infection; rash can result from irritation, dypareunia occurs occurs with vaginitis of any cause; oral contraceptives increase glycogen content of vaginal epithelium, providing fertile medium for organisms; broad spectrum antibiotics alter balance of normal flora; frequent douching alters pH; feminine sprays have risk for contact dermatitis

Question 15

Urinary symptoms possible

Answer 15

Hematuria can occur with UTI or kidney disease; ask about UI b/c most woman wont discuss.

Question 16

Urinary incontinence - risks associated

Answer 16

UI can decrase quality of life, limit activities, increase fall risk, and fx risk.

Question 17

Distinguish b/w urge and stress incontinence

Answer 17

Urge: musculature
Stress: physical strain, sneezing, coughing leads to UI

Question 18

past hx discussion for Female GU

Answer 18

assess feelings. Some ppl fear loss of sexual response after hysterectomy, which may affect intimate relationships.

Question 19

Sexual hx - why bring it up?

Answer 19

your comfort with discussion prompts person’s interests and possible relief that topic has been introduced.

Question 20

contraceptive use and smoking - risk?

Answer 20

increased r/o vascular problems

Question 21

when is infertility considered?

Answer 21

infertility is considered after 1 year of unprotected sex w/o conceiving

Question 22

STI contact

Answer 22

includes all conditions that can be transmitted during sexual activity

Question 23

External genitalia - normal obj. findings

Answer 23

skin color even; labia minora should be darker pink.

Question 24

when would you consider delayed puberty

Answer 24

if there is no pubic hair or breast dev’t by age 13

Question 25

Dev comp: newborn - normal findings

Answer 25

sanguinous or mucus discharge from vagina is normal during first few weeks b/c of maternal estrogen effect

Question 26

Dev comp: children - abnormal finding

Answer 26

during or after toddler age—foul-smelling discharge occurs with lodging of foreign body, pinworms, or infection.

Question 27

Dev comp: adolescents: STI screening - WHEN

Answer 27

1) With history of multiple sexual partners.
2) With previous STI treatment.
3) Chlamydia and gonorrhea screening annually for sexually active adults.
4) Syphilis screening for teens who trade sex for drugs or money, use IV drugs, or live in a high prevalence neighborhood.

Question 28

Dev comp (objective): adolescents: abnormal

Answer 28

amenorrhea together with bluish bulging hymen indicates imperforate hymen and indicates referral.

Question 29

Additional subj. data for adult

Answer 29

postmenopausal bleeding warrants pelvic exam, transvaginal ultrasonography and referral.
Vaginal itching could indicate atrophic vaginitis
Pressure in genital area, loss of urine with cough or sneeze, back pain or constipation could indicate a weakened pelvic musculature and uterine prolapse.

Question 30

Dev. Comp. Aging Adult - Objective

Answer 30

natural lubrication decreases
menopause and resulting decrease in estrogen cause numerous physical changes
pubic hair decreases
skin is thinner and fat deposits decrease.
Labia is flatter with hanging appearance.
clitoris size decreases after 60 y.o.
anti inflammatory is a good choice before exam to ease arthritis pain, as needed.

Question 31

what is recommendation for cervical cancer screening

Answer 31

woman 65+ should stop cervical cancer screening if they have greater than or equal to 3 consecutive (-) pap tests or greater than or equal to 2 consecutive (-) HPV and pap tests w/in the last 10 yrs . woman w/ total hysterectomy should stop cervical cancer screenings.