Ch. 4 - Reproductive Sys Concerns Flashcards
Reasons why some women seek care - periods not norm (expect be like clockwork - infection or something wrong)
Amenorrhea
Hypogonadotropic amenorrhea
Dysmenorrhea
Premenstrual dysphoric disorder (PMDD)
Alterations in cyclic bleeding
Menstrual disorders
No period/bleeding; a - absence of
Not disease but sign of disease
Look at whole body when reproductive organs goes wrong - something way outside causing issues
Primary
Secondary
Amenorrhea
Anatomic - born that way; something going on with reproductive internal issues - biconate uterus - two horns - septum through uterus - two separate uterine cavities; something with cervix - nothing come out
Endocrine - T1DM; thyroid gland - ary screw up period
Chronic diseases
Eating disorders - females tend have more than males; be anorexic or bulemic; not eating enough calories: estrogen loves fat and if no fat - low levels estrogen - no period; WELL below body weight average - not high enough estrogen to have periods - delay starting periods
Medications
NEVER HAD A PERIOD
Never started
Apply to teenagers
Menarche: 13
Never had period; still not started period
Primary
Had period and all sudden stopped - not had anymore
Pathological thing happened; something wrong with body
Most often result of pregnancy (#1)
A clinical sign of a variety of disorders
PCOS - common occurence - start off having norm periods; PCOS more issue as age - then skip periods; very irregular
Secondary
Problem in central hypothalamic-pituitary axis - something thrown off; number one 1 way thrown off - suppress hypothalamus
Results from hypothalamic suppression - extreme exercise
Management
Hypogonadotropic amenorrhea
Counseling and education regarding stress, exercise, and weight loss - why having no periods and how help it - back off exercise or eat more calories; has eating disorder later on in life - suppress hypothalamus but extreme exercise number 1 thing that suppresses hypo
Calcium, vitamin D
Management - Hypogonadotropic amenorrhea
Dys - painful
Pain during or shortly before menstruation
Primary dysmenorrhea
Secondary dysmenorrhea
Dysmenorrhea
Most have some sort of this
Late adolescent - ovulatory cycles and more regular more of this
Biochemical basis - prostaglandins act on endometrium causing it to cramp - sloughing line; making it uncomfy
Referred Pain down back, knees, inside thighs, migraines; affecting QOL
Arises from the release of prostaglandins
Abnormally increased uterine activity
Alleviating discomfort
Primary dysmenorrhea
Medications - birth control - dictate when have period; OTC: ibuprofen, aleve, NSAIDs, myodil, pamprin, naproxen, caffeine, red wine, chocolate, fast food
Heat
Thermo patches
Alternative modalities
Alleviating discomfort - Primary dysmenorrhea
Acquired menstrual pain associated with pelvic pathology - ie: ascending infection
Not norm; need fix it; often have STIs
Affect if have in periods
Diagnosis and treatment
Secondary dysmenorrhea
Pathologic cause of pain
Pelvic examination - offending agent causing it
Endometriosis - extremely painful periods and when not on period, or during intercourse or defectation
Provider do investigation
Not biochem basis - something else going on
Ultrasound examination, dilation and curettage, endometrial biopsy, laparoscopy
Treatment directed to removal of underlying pathology
Diagnosis and treatment - Secondary dysmenorrhea
Cyclic symptoms occurring in luteal phase (before start new cycle; after ovulation; second part of it - last two weeks; follicular phase - no symp - building up endometrium and start period - hormones start taking dive in ischemic phase and end menstrual cycles get mad - hormone changes affect women sig) of menstrual cycle
Cluster of physical, psychologic, and behavioral symptoms
30% to 80% of women experience symptoms - huge range women; not every month; sometimes worse than others
Multiple treatment modalities - NSAIDs help with bloating and cramping but not with PMS; just some patience
Premenstrual syndrome (PMS)
Cyclic symptoms occurring in the last 7 to 10 days of the menstrual cycle
DSM-5 diagnosis
Mental health diangosis
Most luteal phase - ½-⅔ luteal phase; week+ luteal phase
Huge mood changes
Delusions, hallucinations, SI, homicidal ideations; severe variant PMS; everything sets her off - isolate her off - angry, not sleeping well, seeing things off, horrible intrusive thoughts; soon as on period totally fine
Severe variant of PMS with emphasis on mood affectation
Affects 3% to 8% of women
Treatment similar to that for PMS; plus may warrant counseling, medications, and alternative therapies, such as hypnosis and acupuncture - behavioral variant; SSRIs - 7-10 days - low dose Prozac (10 mg qday - take right before period then stop); talk therapy; holistic therapy
Can be situational; not forever
Premenstrual dysphoric disorder (PMDD)
Oligomenorrhea
Hypomenorrhea
Menorrhagia
Metrorrhagia
Alterations in cyclic bleeding
(infrequent menstruation) - birth control, IUDs, PCOS
Oligomenorrhea
(scant) - birth control
Hypomenorrhea
(excessive menstruation) - leiomyomas/uterine fibroids - irritate uterus; toward end childbearing age - hormones go through changes
Menorrhagia
(bleeding between periods) - spot when ovulating, all over place with oral contraceptives, breakthrough period
Metrorrhagia
Presence and growth of endometrial tissue outside of uterus - on intestines, vagina, abdonimal cavity (periotoneal space); every month when endometrium bigger because estrogen - all lesions outside getting bigger, period - all spots also irritated and trying lose lining - causes scar tissue like crazy; adhesions cause pain and in wrong place
Centered around and just outside uterus - gets outside via fallopian tubes - lesions and scar tissue - not get pregnant - blocked fallopian tubes - fertilized zygote not get through - ectopic pregnancies
Major symptoms
Treatment
Endometriosis
Secondary Dysmenorrhea
Even not on period - Deep pelvic dyspareunia (painful intercourse) - hurts really bad; deep penetration hurts bad
Laparoscopy - see where lesions - easily identify them - laser and zap them to kill it - can still come back; hard get pregnant if not want have sex identify where lesions, now try get pregnant because come back soon; until goes through menopause endometriosis is an issue
Major symptoms - Endometriosis
Drug therapy - Lupron (#1) - med not have periods - not get pregnant - not hurting at all
Surgical intervention - remove adhesions
Treatment - Endometriosis
Sexually transmitted infections (STIs)
Chlamydia
Gonorrhea – Neisseria gonorrhoeae
Syphilis - Treponema pallidum
Pelvic inflammatory disease (PID)
Sexually transmitted viral infections
Herpes simplex virus (HSV)
Hepatitis A (HAV)
Hepatitis B (HBV)
Hepatitis C virus
Infections
Geriatrics getting more often
Women get STIs more often - sometimes asymptomatic; moist, dark - bacteria love that; men have business in one hole and on outside; women on inside; wreaking havoc on reproductive organs - asymptomatic; some already know within day or two
Includes more than 25 infectious organisms transmitted sexually
19 million people are affected annually in the U.S.
Prevention strategies
Sexually transmitted infections (STIs)
Safer sex practices
Abstinence
Knowledge of partner, reducing partners
Low-risk sex
Condom use
Vaccination
Safe sex in any position
Prevention strategies - Sexually transmitted infections (STIs)
Most frequently reported STI
Infections often silent and highly destructive
Difficult to diagnose
Have an itch
Chlamydia and gonorhea common together - drug resistant strains gonorrhea
Screening and diagnosis
Management
Chlamydia
Screening of asymptomatic and pregnant women - screen all women; need have open conversation
Asymptomatic - test women walking younger than 25 and pregnant women
Comparisons of diagnostic procedures
Mucopurlent discharge - pus; cervix - angry and red - strawberry color
Screening and diagnosis - Chlamydia
Drug therapy
Management - Chlamydia
Oldest communicable disease
Aerobic and gram-negative diplococci
Screening and diagnosis
Management
Gonorrhea – Neisseria gonorrhoeae
Women are often asymptomatic
Men can be asymptomatic - something dripping off end or diff color or hurts
Screening and diagnosis
Treatment with antibiotic therapy
Drug-resistant strains on the rise
Management
Transmission by entry in subcutaneous tissue through microscopic abrasions - sexually transmitted
Transplacental transmission may occur at any time during pregnancy - check multiple time; RPR or VDRL - lab check during first appointment and when come into labor - tested
Infection manifests itself in distinct stages
Screening and diagnosis
Management
Syphilis - Treponema pallidum
Primary: 5 to 90 days
Secondary: 6 weeks to 6 months
Lesions on vulva - not painful - little uncomfy - red and angry but not super painful to touch
Herpes not look angry but extremely painful - lots nerve pain
Secondary rashes - palms hand and trunk and feel like dying; worse lethary and malaise; complaining vaginal discharge - like always do; looked like had flu
Fallopian tubes scarred up
Infection manifests itself in distinct stages - Syphilis - Treponema pallidum
Pregnant women
Serologic tests
False positives
Screening and diagnosis - Syphilis - Treponema pallidum
Penicillin - vicillin - thick shot in butt; flagyl
Sexual abstinence during treatment
Management - Syphilis - Treponema pallidum
Gonorrhea and chlaymidia contracted and not treated - endometrium mad and now have raging infection and extremely painful - secondary dysmenorrhia and menorrhagia (bleeding a bunch because endometrium irritated)
Results from ascending spread of microorganisms from vagina and endocervix to upper genital tract
Caused by multiple organisms
Most commonly involves:
At increased risk for:
Usually younger women
Once PID - lot edu because not want again; more often get, less likely get pregnant - infection in there scarring reproductive organs
Screening and diagnosis
Management
Pelvic inflammatory disease (PID)
Uterine tubes inflamed (salpingitis)
Uterus (endometriosis) - cause this sometimes; endometritis - inflammation endometrium
Excruciating
High fever; pelvic tenderness and pelvic fullness - extremely painful; US: abscesses in abdominal cavity from infection
Hospitalized and given IV antibiotics and painkillers
Most commonly involves: - Pelvic inflammatory disease (PID)
Ectopic pregnancy
Infertility
After taken care of: Chronic pelvic pain as a result of this - not find pathology to care for
At increased risk for: - Pelvic inflammatory disease (PID)
History
CDC routine criteria
Screening and diagnosis - Pelvic inflammatory disease (PID)
Prevention
Oral or parenteral therapy
Bedrest
Education
Management - Pelvic inflammatory disease (PID)
Human papillomavirus (HPV)
Can have vaginal delivery - not pass onto baby - tissue so friable that bleeds
Screening and diagnosis
Management
Sexually transmitted viral infections
20 mil US infected
80 strains
Gardasil - 2 shots and covered 4 worst strains cause cervical cancer - vaccine: newst one covers lot more strains; do early before have intercourse - once exposed to HPV - getting vaccine still help but nearly not as effective; first layer protection - less worried about developing genital warts and cervical cancer
Most prevalent viral STI seen in ambulatory health care settings
Genital warts
More common in pregnant women
Symptoms
Human papillomavirus (HPV) - Sexually transmitted viral infections
Irritating vaginal discharge with itching - irritation because lesions - often on cervix and not tell unless pap smear - wait until 21 - bodies shed virus - stop screening teenage girls - more conservative with management of woman if just waited because shed virus
Dyspareunia, postcoital bleeding
Symptoms
History of known exposure
Physical inspection
Pap smear
Screening and diagnosis - Sexually transmitted viral infections
Cryotherapy, ointments; virus: come back; once got it, it is there; not most comfy - some folks: smell bad because super moist and makes the smell
No therapy has been show to eradicate
Medications for discomfort
Counseling and education
Management - Sexually transmitted viral infections
Still destructive
Treatment same regardless of type
Prevention critical; initial infection extremely painful
Lesions, fevers, chills, malaise, severe dysuria - acidic urine on lesion - extremely painful
AE on fetus at delivery
Not have vaginal birth if active lesion - does: C-section - kill baby if have herpes - herpetic encephalopathy - if recently healed still risk transmission; if inactive risk transmission low
Herpes simplex virus 1 (HSV-1)-nonsexual - cold sores on mouth - can be transferred onto genitalia
Herpes simplex virus 2 (HSV-2)-sexual
No cure - only suppression
Herpes simplex virus (HSV)
Acquired primarily through fecal-oral route
Ingestion of contaminated food
Person to person contact
Vaccination is most effective means of preventing HAV transmission
Hepatitis A (HAV)
Most threatening to fetus and neonate - check women for this
Disease of liver; often a silent infection
Transmitted parenterally, perinatally, orally (rarely), and through intimate contact
Vaccination series
Hepatitis B (HBV)
Most common blood-borne infection in United States
Risk factor for pregnant women is history of injecting intravenous drugs - IV drug users
Currently there is no vaccine but is interferon cure for Hep C
Hepatitis C virus
Heterosexual transmission now most common means of transmission in women
Estimated that 23% of new infections occur in women
Severe depression of cellular immune system associated with HIV infection characterizes AIDS
Symptoms include: fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash
Counseling for HIV testing
Human immunodeficiency virus (HIV)
HIV testing offered early in pregnancy - healthy babies and pregnancies: suppress viral load to almost nothing, risk transmission extremely low to fetus and newborn; cannot breastfeed - ONLY vaginal births
Rapid testing preferred method
Perinatal transmission has decreased
Nurses must consider confidentiality and documentation
Counseling for HIV testing
Bacterial Vaginosis
Candidiasis – Candida albicans
Trichomoniasis – Trichomonas vaginalis
Group B streptococci
Vaginal infections
1 most common symptomatic vaginitis
Technically not sexually transmitted
Is a pH imbalance - lot things throw off pH: lot sex (friction getting rid all good bacteria), diff sexual partner, IS sexually associated, after period and get this for couple days, put things there not supposed be there, nuva-ring - foreign that goes up there and changes pH - meds for local estrogen
“Fishy odor” - most disturbing for woman; little itchy and thin, grayish and brown and blood and sometimes itchy but odor drives people crazy; clean more; soap up vagina but making it worse
odor - ammonia and bacteria - mixes with normal flora and offensive odor to it - not get rid stink and spraying stuff down there - showers multiple times and spraying stuff
Constantly cleaning
When on period
Vagina is self-cleaning organ
Preterm birth
One end of pH spectrum
Everytime take antibiotic
Self-limiting; leave alone go away; mild case not get med go away; med - Boric acid suppositories - capsules in vagina and neutralizes pH
Bacterial Vaginosis
One end of pH spectrum
Sexually associated and vaginal infection
Vaginal infection and treated and Before gone and sex with partner and cont treat it - not bother him but prolong yeast infection
pH imbalance; not sexually transmitted all the time
Everytime take antibiotic
Fungus - candida is fungus
med - Boric acid suppositories - capsules in vagina and neutralizes pH
Common symptoms
Screening and diagnosis
Management
Candidiasis – Candida albicans
Vaginal pruritus - extremely itchy
Not smell
Cheese-curd discharge - white cottage cheese
Common symptoms - Candidiasis – Candida albicans
Physical examination
Vaginal pH
Screening and diagnosis - Candidiasis – Candida albicans
Over-the-counter agents and modalities help that
Boric acid suppositories
Management - Candidiasis – Candida albicans
STIs
Common cause of vaginal infection
Frothy and bubbly discharge
Screening and diagnosis
Management
Treat: Boric acid suppositories
Trichomoniasis – Trichomonas vaginalis
Specular examination
Pap smear
Screening and diagnosis - Trichomoniasis – Trichomonas vaginalis
Sexual transmission must be communicated to infected partner
Management - Trichomoniasis – Trichomonas vaginalis
Associated with poor pregnancy outcomes - carry GBS - no symptom usually
Colonizes vagina, perineum, rectum - test all women going have vaginal deliveries at 36 weeks see if carry GBS in that area because if baby come in contact with GBS die; if + going give penicillin cross placenta and protect baby from GBS
An important factor in neonatal morbidity and mortality
Screening at 35 to 37 weeks of gestation decreases risk
Group B streptococci
