ch. 4 assessment and health promotion Flashcards
female reproductive system: breasts
1) located between 2nd/6th ribs
2) upper 2/3 overlies pectoralis muscle
3) lower 1/3 overlies serratus anterior muscle
4) estrogen:
- stimulates growth of breasts
- increases vascularity of breast tissue
5) progesterone:
- causes mammary gland maturation
6) mammary gland is made up of a number of lobes divided into lobules
7) lobules are clusters of acini
- acinus: saclike terminal part of a compound gland emptying through a narrow lumen or duct; lined with epithelial cells that secrete colostrum and milk
8) change in size and nodularity in response to cyclic ovarian changes throughout reproductive life
9) physiologic alterations in breast size reach minimal level 5-7 days after menstruation stops
- BSE best carried out during this phase of menstrual cycle (7-14 days)
10) function:
- lactation
- sexual arousal in mature adult
self breast exam
1) 90% breast cancers are discovered by the woman herself or her partner
2) 1/8 women will have breast cancer during their lifetime
3) need to improve BSA
4) patient education of SBE:
- size/shape of breasts
- shape/direction of breasts
- color/thickening, edema, venous patterns
5) assessment:
- redness/inflammation (maititis)
- blue hue with marked venous pattern -> may be due to increased blood supply to tumor
- skin edema (thickened skin with enlarged pores “orange peel” may be due to tumor)
- skin dimpling. puckering, or retraction may be due to tumor
- striae (stretch marks) normal
6) recommedations:
- CBE Q1-3Y women 25-39
- CBE annually for women >40y
SBE how to
1) examine your breasts in the shower
2) stand and press your fingers on your breast, working around the breast in a circular direction
3) squeeze your nipples to check for discharge
- check under the nipple last
4) examine your breasts in the mirror with your arms down, up, and on your hips
5) lie down and repeat step 3
TIP:
- axillary -> lymphatic system
menstruation and menopause
1) menarche/puberty:
- average age of menses: 13 years
- changes begin from 8-11 years
2) menstrual cycle:
(a) hypothalamic pituitary cycle
- FSH - follicular phase (menses to ovulation)
- LH - luteal phase (ovulation to next menses)
(b) ovarian cycle
- 1-30 follicles in the ovary begin to mature
(c) endometrial cycle
(d) other cyclic changes (e.g. elevation of temp at ovulation)
menstruation/menopause: prostaglandins (PGs)
1) oxygenated fatty acids classified as hormones
2) affect smooth muscle contractility and modulation of hormonal activity
3) play a key role in ovulation
4) increase the motility of uterine musculature
5) tubal and uterine motility
6) sloughing of endometrium: menstruation (if NOT pregnancy)
7) initiation and maintenance of labor
menstruation/menopause: climacteric and menopause
1) climacteric:
- transitional phase during which ovarian function and hormone production decline -> can begin as early as age 30
- spans years from onset of premenopausal ovarian decline to postmenopausal time when symptoms stop
2) menopause:
- last menstrual period: mean age 52
- dated with certainty only 1 year after menstruation ceases
3) perimenopause:
- a period preceding menopause that lasts about 4 years (2-8 years)
- influenced by lyomas and fibroids
- decreased estrogen/progesterone
- decreased ovarian function
- hot flash
- insomnia
- night sweats
sexual response
1) females/males achieve physical maturity at approximately age 17 years (need to mature)
2) women/men are more similar than different in their physiologic responses to sexual excitement and orgasm:
- glans clitoris/glans penis are embryonic homologs
- little difference exists between female/male sexual responses
3) 4 phases of sexual response cycle:
(a) excitement phase: someone finds someone physically attractive
(b) plateau phase: foreplay
(c) orgasmic phase: orgasm
(d) resolution phase: post orgasm
reasons for entering the health care system
1) preconception counseling/care
2) pregnancy
3) menstrual problems
4) well/sick care
5) fertility control and infertility
6) termination of unwanted pregnancy
barriers to seeking health care
1) social determinants to health
- environment, education, family, economics, community, etc.
2) financial issues: local health department
3) cultural issues: fear deportation
4) gender identity and sexual orientation
- gender identity of health care provider
- sexual orientation may also be a barrier
- providers need to develop an approach that does NOT assume that all clients are heterosexual
TIP:
- seek to understand
the need for health promotion and disease prevention across the life span
1) adolescents: teens who enter the health care system usually do so for screening or because of a problem such as an episodic illness or an accident
- teenage pregnancy
2) young/middle adulthood
3) parenthood after age 35
4) late reproductive age (40/50)
approaches to care at specific stages of a woman’s life
1) preconception counseling and care
2) pregnancy
3) fertility control and infertility
4) menstrual problems
5) perimenopause
identification of risk factors to women’s health
1) social, cultural, economic, and genetic factors
2) substance use and abuse:
(a) prescription drug use
(b) illicit drug use:
- marijuana
- cocaine
- opiates
- methamphetamine
- phencyclidine
- other illcit drugs
(c) alcohol consumption
(d) smoking cigarettes, vaping, marijuana, water pipes
(e) caffeine-coffee, energy drinks
3) nutrition problems and eating disorders:
(a) nutritional deficiencies
(b) obesity
(c) eating disorders:
- anorexia nervosa
- bulimia nervosa
4) lack of exercise
5) medical conditions (crohns, IBS, DM, HTN)
6) stress
7) spirituality
8) depression, anxiety, and other mental health conditions
9) sleep disorders
10) environmental and workplace hazards
11) risky sexual practices
12) risk for certain medical conditions
13) risk for certain gynecologic conditions (cervical cancer)
14) female genital mutilation (FGM)
15) human trafficking
16) intimate partner violence
17) battering during pregnancy
health based nursing care
1) women’s health
- holistic view of women & their health related needs
2) women making majority of the health care decisions for the family
3) health care needs change over time:
(a) young girl: menstruation, sexuality, personal responsibility
(b) teenager: reproductive choices, safe sexual activity, BSE, regular PAP smears
(c) mature women: self care issues, physical changes with childbirth & aging
health assessment
1) history
2) physical exam:
- general appearance, VS, skin, head, eyes/ears, nose/mouth.throat, neck/lymphatic, breasts, heart, peripheral vascular, lungs, abdomen, extremities, GU, rectal, musculoskeletal, neurologic
health assessment: pelvic exam/labs
1) external inspection/palpation:
- teaching vulvar self examination (VSE)
2) internal examination:
- collection of specimens (candida)
- papanicolaou test (pap smear) - cervical cancer screen
- vaginal wall examination
3) bimanual palpation: 2 fingers vagina + feel top uterine fundus
4) rectovaginal palpation
5) pelvic examination during pregnancy
6) pelvic examination after hysterectomy
7) lab/diagnostic procedures:
- STI testing
- other serum lab tests
