Ch. 4 Flashcards
Absence menstrual flow clin sign various disorders
Eval: absence both menarche and secondary characteristics by age 13; absence menses by 15 yrs; absence menstruation with 5 yrs breast development; 6 month+ cessation after secondary amenorrhea
Associated with weight and nutritional status
Sign of a diseasxe
Can be result of pregnancy, anatomic abnormalities,
Hypogonadtropic amenorrhea
Amenorrhea
Prob in central hypothalamic-pit axis
Pit lesion or genetic inability produce LSH/FH
Often results from suppression as result of stress or sudden and severe weight loss
Loss of Ca can occur with this
Assessment: thorough H&P; specific components depend on age, prengnacy test, diagnostic tests, endocrine levels checked, CT scan
Hypogonadtropic amenorrhea
Pain during or shortly after menstruation most common prob
Common in smokers and obese pts
Associated with early menarche, nulliparity, lack of exercise
Primary Dysmenorrhea
Secondary Dysmenorrhea
Dysmenorrhea
Condition associated with ovulatory cycles
Biocmeical basis and arises with release prostaglandins with menses
During luteal phase and subsequent menstrual flow prostaglandin released increasing amplitude and frequency contractions and causing vasospasm of uterine arterioles - resulting in ischemia and lower abdominal cramps
Response: backache, weakness, sweats, anorexia, nausea, vomiting, diarrhea, dizziness, headache, syncope, poor concentration
Onset menstruation and last 12-72 hrs
Appears 6-12 months after menarche (ovulation establish)
Estrogen and progesterone necessary - experienced with ovulatory cycles
Primary Dysmenorrhea
Menstrual pain that develops later than primary - typ after 25 yrs
Associated with pelvic patho
Have underlying symptom to suggest underlying cause
Dull lower-abdominal aching radiating to thigh and back
Bloating or pelvic fullness
Careful pelvic exam, US, D&C, biopsy, laparoscopy
Treatment to remove underlying cause
Secondary Dysmenorrhea
Premenstrual dysphoric disorder (PMDD) - more severe variant - irritability, dysphoria, mood lability, anxiety, fatigue, appetite changes, sense feeling overwhelmed, mood distrubances
PMS - complex and poorly understood - 1+ large number physical and psychological symptom beginning in luteal phase of cycle then symptom-free period; symp:fluid retention, behavioral/emotional changes, cravings, headache, fatigue, backache; ovarian func required for this
Diagnosis PMDD
Premenstrual syndrome
5+ affective and phys symp present before menses and begin improve follicular phase
1 symp marked affective lability, irritability or anger, depressed mood or feelings hopelessness or self-deprecating thoughts, or anxiety
1+ following with total 5: decreased interest usual activities, subj difficulty concentrating, letharge, change in appetite, hypersomnia/insomnia, feeling overwhelmed, breast tenderness, muscle pain, bloating, weight gain
Symp interfere with work or relationships
Symp not caused by another condition/disorder
Woman and HCP confirm symp occurring and evidence through daily rating
Symptom not caused by effects substance/treatment
Diagnosis PMDD
Presence and growth endometrial tissue outside uterus
Contains uterine glands and stroma (CT) and responds to cyclic hormone stimulation in same way uterine endometrium does but often out of phase with it; grows during proliferative and secretory cycle; during or immediately after menstruation - tissue bleeds resulting in subsequent fibrosis and adhesions on adj organs
Symp: pelvic pain, dysmenorrhea, painful intercourse/dyspareunia, chronic noncyclic pelvic pain, pelvic heaviness, pain radiating into thighs, report bowel symptom: diarrhea, pain with defecation, constipation; abnormal bleeding and pain during exercise
Endometriosis
Changes in amt, duration, interval, regularity menstrual bleeding
Infrequent (oligomenorrhea)
Scanty at norm intervals (hypomenorrhea)
Excessive (menorrhagia)
Occurs between periods (metorrhagia)
Alterations in cyclic bleeding
30 organisms that cause infections/infectious disease syndromes primary through intimate contact
Causative organisms: wide spectrum
Direct cause of tremendous human suffering and heavy demands on healthcare sys
Common among young people
⅕ infected with STIs each year; untreated and rates underreported
If untreated - cause long-term consequences
Prevention
STIs
Preventing infection most effective way to prevent adverse consequences
Prompt diagnosis and treatment prevent comps and transmission to others
Identification of risk prevention cousneling
Be motivated understand how serious risk infection is
Ways: abstinence, monogamous relationship
Reduction number of partners, low-risk sex, avoid exchange body fluids, vaccines
Examine partner
Education on influence on drugs and alcohol
Prevention
Chlamydia
Gonorrhea
Syphilis
Pelvic inflammatory disease
Bacterial STIs
Most frequent
Asymptomatic and highly destructive
Increased risk ectopic pregnancy and tubal factor infertility
Causes inflammation on cervix - causes ulcartions increasing risk getting HIV infection
<25 yrs most common
Risky behaviors
Screening and diagnosis
Chlamydia
Obtaining info regarding risk factors
Symptoms - spotting, postcoital bleeding, mucoid or purulent cervical discharge, dysuria
Lab diagnosis - culture, DNA probe, ezyme immunoassay, nucleic acid amplification tests of urine specimens or from endocervix/vagina
Screening and diagnosis - Chlamydia
Oldest communicable disease
Drug-resistant more common
Aerobic, gram-negative
Sexual contact transmission - genital to genital
Teenagers and young adults more common engaging in multiple partners
Asymptomatic - if symptoms: greenish-yellow purulent endocervical discharge or experience menstrual irregularities; pain - pelvic or lower abdominal pain or menses that last longer or more painful than normal
Perinatal comps can occur
Screening and diagnosis
Gonorrhea
Screen pregnant women first prenatal visit
classic/vague/no symp
Cultures from endocervix, rectum and pharynx
Also have test for syphilis
Screening and diagnosis - Gonorrhea
Microscopic abrasions in SQ tissue - occurring during sex - thru kissing, biting, oral-genital sex; trans-placental transmission
Untreated in pregnancy: congenital syphilis
Serious systemic disease and death if not treated
Primary: 5-90 days after infection; painless papule at site inoculation
Secondary: 6wks-6months; widespread, symmetric, maculopapular rash on palms, soles, generalized lymphadenopathy
Fever, headache, malaise
Untreated - enter latent phase - go to tertiary - neurologic, CV, MS, multiorgan sys comps develop
Screening and diagnosis
Syphilis
Diagnosed with another STI/HIV screened for this
All high-risk pregnant women screen in first prenatal visit, again in late third trimester and at time of giving birth
Microscopic exam and serology during latency and late infection
Test for antibodies - not during active infection
False positives not unusual
HIV testing offered
Screening and diagnosis - Syphilis
Infectious process that most commonly involves uterine tubes, uterus, rarely ovaries and peritoneal surfaces
Multiple causative organisms - anaerobic and aerobic
Ascending spread from vagina and endocervix to upper tract
End of or just after menses
Also after miscarriage, induced abortion, pelvic surgery, birth
Risk factors: young age, multiple partners, high rate new partners, hx STIs, IUDs more than 1 sexual partner
Increased risk ectopic pregnancy, infertility, chronic pelvic pain
Symp: vary, pain: dull, cramping, intermittent, severe; report: fever, chills, N&V, increased vaginal discharge, symp of UTI, irregular bleeding, abd pain
Screening and diagnosis
Pelvic inflammatory disease
Diff due to diagnose because variety symp
Recommend treatment for PID in all sexually active women and others at risk STIs and no other causes found: lower abdominal tenderness, bilateral adnexal tenderness, cervical motion tenderness; high temp above 100, abnormal discharge, elevated ESR, elevated CRP (not super reliable), lab doc of cervical infection of gonorrhea
Screening and diagnosis - Pelvic inflammatory disease
HPV
HSV
Hepatitis A
Hep B
Hep C
HIV
Viral
Most common
Variety types
Highest risk of causing cancer of cervix, vagina, vulva, penis, oropharyngeal area
Small lesions
Moist areas - may have fine fingerlike projections
Flat-topped papules most often on cervix - only seen via magnification
Flesh-colored or darker colored
Painless but uncomfy when large, inflamed, or ulcerated
More common in prengnat first-trimester women
Screening and diagnosis
HPV
Symps: profuse, irritating vaginal discharge; itching; dyspareunia; postcoital bleeding; bumps on vulva or labia; hx known exposure imp
Phys inspection vulva, perineum, anus, vagina, cervix
Rotate speculum to see all lesions
Hx, eval s&s, pap test, phys exam used make diagnosis
HPV lesions differentiated
Serologic test for secondary syphilis
Screening and diagnosis - HPV
Painful, recurrent ulcers
Two diff antigen subtypes
Type 2 - sexually - genital lesions; type 1 - not sexual, oral lesions
Younger women more likely if have multiple partners
Recurrent infections more common
Ulcers: tender, itching, inguinal tenderness, lymphadenopathy, heavy watery to purulent vaginal discharge
HSV
Fecal-oral route by ingestion of contaminated food
Influenza-like symptom
Serologic testing
Does not result in chronic infection or chronic liver disease treatment usually supportive
Vaccine and Ig for IM admin effective to prevent
Hepatitis A
Most threatening to fetus and neonate
Screen for active or chronic disease or disease immunity
Blood or sexual contact at risk; found in other bodily fluids
Disease of liver and silent infection
Can be fatal
Symp: arthralgias, arthritis, lassitude, anorexia, n&v, headache, fever, mild abdominal pain, clay-colored stools, dark urine, increased abd pain, jaundice
Hep B
Bloodborn infection
Responsible for 50% chronic viral hep
Transmission to baby in birth process
Risk: IV drug use, STIs, multiple sex partners, hx blood transfusions
No vaccine
Sev drugs treat hep C
Hep C
More Black women
Increasing in transgender people
Severe depression cellular immune sys associated - leads to AIDS
Antibiotics effective
Once enters body, HIV positivity within 6-12 weeks; may be asymptomatic or have influenza-like response
Lab studies: leukopenia, thrombocytopenia, anemia, elevated ESR
Transmission to child in perinatal period
Circ as early as first trimester, labor and delivery, breast milk
Screening and diagnosis
Counsling for HIV testing
HIV
At risk: IV drug use, high risk sex partners, multiple partners, hx multiple STIs
HIV used via antibody tests
Reactive screening tests must be confirmed by an additional test - if confirmed is +
Antibodies seen within 3 months after infection
Screening and diagnosis - HIV
Counseling before and after testing standard
Assess understanding of info
Unless rapid, 1-3 week waiting period - anxious time
Test results communicated in person and told is procedure ahead of time
Explore feelings after result
Emphasis placed in ways to remain HIV free
Referr + woman to creect area
Counsling for HIV testing - HIV
Discharge depends on infection presence
Candiadiasis
Trichomoniasis
Group B streptococcus
Vaginal infections
More common in healthy women than HIV women
Most of yeast infections by albicans - increased steadily
Predisposing: antibiotic therapy (broad spectrum), prengnacy, obesity, diets high in sugars, use corticosteroids, exogenous hormones, immunosuppressed dstate
Tight-fitting clothes and underwear more likely occur
Most common symp: vaginal puritis (mild or intense); feel dru, painful urination; discharge thick, white, lumpy, cottage cheese like; vulva red and swollen; may have yeasty or musty smell
Screening and diagnosis
Interprofessional care
Candiadiasis
Onset and course symp
Hx
Phys exam
Smear and vaginal pH
Screening and diagnosis - Candiadiasis
Antifungal preps
See HCP for first for diagnosis and treatment recommendation
Extensive irriation, swelling, discomfort: sitz baths
Colloidal oatmeal powder to bath
Not wearing underpants to bed
Complete full course treatment
Not use tampons
Avoid sex
Interprofessional care - Candiadiasis
Usually an STI and common cause vaginal infection and discharge
Anaerobic, one-celled protozoan with characteristic flagella
Asymptomatic or yellowish to greenish, frothy, mucopurulent, copious, malodourous discharge; inflammation of vulva/vagina/both; complain of irritation and pruritus
Dysuria and duspareunia common and worsen during and after menstruation
Cervix vaginal walls - strawberry spots; cervix bleed on contact
Screening and diagnosis
Interprofessional care
Trichomoniasis
Hx of current symp; hx sim symp and previous treatment
Thorough sexual hx
Speculum exam
pH greater than 5.0
Screening and diagnosis - Trichomoniasis
Class drugs: nitromidazoles - PO in single dose
Male partner usually asymptomatic - harbers in urethra/prostate; discuss importance of partner treatment with patients; if not treated, infection will recur
Understand sexual transmission of disease
Present without symp for sev months and determining when become infected impossible
Interprofessional care - Trichomoniasis
Normal vaginal flora in someone not pregnant
Associated with poor pregnancy outcomes
Imp fact in perinatal and neonatal morbidity and mortality, resulting in vertical transmission from birth canal of infected mother to infant during birth
Risk factors: + culture; preterm birth less than 37 wks; prelabor rupture; maternal fever >100; + hx for early onset GBS
Decrease risk: screened 35-37 weeks - rectovaginal culture and IV antibiotic prophylaxis for all who test +
Group B streptococcus
