Chapter 19 Flashcards
3 main types of hysterectomy
- partial
- total
- radical
(4th is hysterectomy with bilateral salpingo-oophorectomy)
radical hysterectomy
removal of
- uterus
- cervix
- fallopian tubes
- ovaries
- upper portion of the vagina
- lymph nodes
partial hysterectomy
removal of
- uterus
*cervix left in place
total hysterectomy
removal of
- uterus
- cervix
hysterectomy post op care
- monitor:
-VS
-blood loss
-LOC
-lung sounds - use anti-embolism stockings
- pain relief and assist w/ ambulation (standing)
polycystic ovary syndrome (PCOS)
cysts on the ovaries
- endocrine disorder
- genetic component
women with polycystic ovary syndrome (PCOS) are at risk for:
- Type 2 DM
- cardiovascular disease
- HTN
- cancer
- hyperlipidemia
- pregnancy/birth complications
- sleep apnea
cystocele
- anterior prolapse
- wall btwn vagina and bladder weakens (prolapsed bladder)
- bulging mass in the anterior wall of the vagina
rectocele
- posterior prolapse
- wall btwn vagina and rectum weakens (prolapsed rectum)
- bulging mass in the posterior vaginal wall
s/sx of polycystic ovary syndrome (PCOS)
- infertility
- menstrual disorders
- hirsutism (excess hair on mouth/chin)
- ovarian cysts
- obesity
- pelvic pain
- male pattern baldness
endometriosis
chronic inflammatory disease in which the presence and growth of endometrial tissue is found outside the uterine cavity
endometriosis s/sx
- LBP
- pelvic pressure
- dyspareunia (genital pain)
- infertility
- premenstrual spotting and menorrhagia (heavy/prolonged bleeding)
- diarrhea, pain with defecation, and constipation usually present when there are lesions of the bowel
- bloody urine and dysuria usually present when there are lesions on the bladder
- fixed retroverted uterus
- enlarged and tender ovaries
dyspareunia
genital pain before, during or after intercourse
sexually transmitted infections are primarily transmitted
transmitted through sex
top 3 reported STIs
- chlamydia
- gonorrhea
- syphilis
what population has the highest reporting of STIs
adolescent females
how can someone reduce the risk of an STI?
- know your partner:
-communicate with partner about STI
-have regular pelvic exams, pap smears, HPV tests - be in a monogamous relationship
- be with partner that has been screened and know to be negative
- use condoms or dental dams (correctly)
vaginitis
inflammation of the vagina
common types of vaginitis
- candida vaginitis (yeast infection)
- bacterial vaginosis
- trichomoniasis
candida vaginitis: what is it/causes it
aka yeast infection
*fungus lives on the surface of the body and grows when the vagina ecosystem is disturbed:
- hormone changes
- corticosteroids
- antibiotics
bacterial vaginosis
occurs when normal vaginal flora is disrupted
trichomoniasis
aka trichomonas vaginalis (STI)
*inflammation of the vagina and/or vulva
chlamydia
- transmitted through digital-vaginal/vulva contact
- most common bacterial STI in the US
- most women are asymptomatic
gonorrhea: prenatal complications
premature rupture
- miscarriage
- preterm labor
syphilis
single painless ulcer (chancre) in the genital area, mouth, or point of contact
- transmitted through oral-anal contact
- shows up 10-90 days after contact
- lasts 4-6 weeks
- usually resolves w/out treatment (Penicillin G if needed)
condylomas are also called
genital warts
genital warts
- painless warty growth in the vagina or on the vulva, perineum, or anal areas
s/sx of yeast infection
- itching
- white cheesy discharge
- pain with sex
- burning with urination
treatment of yeast infection
- fluconazole
- clotrimazole
- miconazole
s/sx of bacterial vaginosis
- fishy smelling vaginal odor
- milky discharge that is thin, white or gray in color
treatment of bacterial vaginosis
- metronidazole
- clindamycin
- tinidazole
management of trichomoniasis
- metronidazole
- partner needs to be tested and treated
- condoms used to prevent future infections
how is trichomoniasis confirmed?
microscopic evaluation
what is a clear sign of trichomoniasis?
copious amounts of green discharge
why do we put erythromycin in the baby’s eyes after birth?
to prevent newborn blindness from contraction of gonorrhea through their eyes
s/sx of gonorrhea
- silent, sometimes burning on urination
- backache
- pain during sexual intercourse
name the infection: copious amounts of green discharge
trichomoniasis
name the infection: fishy odor
bacterial vaginosis
name the infection: mucopurulent cervical discharge
chlamydia
name the infection: white cheesy discharge
candidiasis (yeast infection)
name the infection: silent- or burning on urination
gonorrhea
UTI
infection of the urinary system
- bladder, urethra, ureters, kidneys
why are UTIs more common in women?
- shorter urethra in close proximity to the vagina and anus: closer proximity to bacteria that does not belong in the urinary tract system (most common UTIs are cystitis and urethritis)
- more common in older women because of suppressed immune system, weakened bladder muscles (incomplete emptying), decreased estrogen (alters normal vaginal flora- E. coli)
s/sx of UTI
- dysuria
- frequency
- feeling of bladder fullness
- tenderness
- cloudy, foul-smelling urine
- LBP
- low-grade fever
treatment of UTI
antibiotics
- ciprofloxin
- nitrofurantoin macrocrystals
- bactrim
nursing actions for patient with UTI
- drink 2-4 quarts of fluid daily
- void q2-4 hours
- empty bladder pre and post intercourse
- wipe front to back
- wear cotton
- avoid tight fitting clothing
- avoid caffeine and ETOH
- patient teaching: s/sx of UTI
organs are supported by __ , ___ , and ____
muscles, ligaments, and fascia
pelvic organ prolapse
weakened structures (muscles, ligaments, fascia) lead to organ prolapse
common disorders associated with pelvic organ prolapse
- cystocele
- rectocele
risk factors for prolapse organs
- large babies
- vaginal deliveries
- assisted deliveries- forceps or vacuum
- poor repairs of episiotomy or lacerations
- obesity
- low levels of estrogen (menopause)
uterine prolapse
the uterus descends out of the vagina
s/sx of uterine prolapse
- uterine protrusion
- LBP
- heaviness in the pelvis region
- sensation uterus is falling out
treatment of uterine prolapse
- pessary
- surgery
what happens as a result of (s/sx) of cystocele
- stress incontinence
- bladder infections
- fullness/pressure in vaginal area
what happens as a result of (s/sx) of rectocele
- constipation
- irritation of vaginal mucosa
nursing actions for cystocele and rectocele
- teach kegel exercises
- prevent constipation to prevent straining
- avoid heavy lifting
- discuss weight loss strategies
urinary incontinence
loss of bladder control
- stress incontinence
- sudden urge
what is female stress incontinence?
condition in which females fail to control their urination in certain situations
treatment of urinary incontinence
- bladder training
- schedule trips
- limit caffeine and alcohol
- weight loss
- kegel exercises
- pessary or vaginal insert
- surgery
breast disorders
fibrocystic disease
breast cancer
fibrocystic disease
- benign cysts and fibrous tissue develop in the breast
how common is fibrocystic disease
50%
management/teaching for patient with fibrocystic disease
- supportive bra
- avoid caffeine, smoking and alcohol
- apply heat to breasts
- OTC pain meds (NSAIDs, acetaminophen)
- oral contraceptives
how is fibrocystic disease diagnosed
mammogram
s/sx of fibrocystic disease
- cyclic bilateral pain (usually in upper outer quadrants of breasts)
- increased engorgement and density
- increased nodularity
- fluctuation in size of the cystic areas
breast cancer risk factors
- increased age (most invasive form found in 55+)
- defects in the genes BRACA1 & BRACA2
- family hx (2/10 dx)
- dense breasts
- personal hx of breast cancer in at least 1 breast
- exposure to head or chest radiation
- obesity
- early periods, late menopause or hormone treatment
- smoking
- excess alcohol use
breast cancer treatment
- depends on stage
- surgery
-lumpectomy
-partial/segmental mastectomy
-simple mastectomy
-modified radical mastectomy - radiation
- chemotherapy
- hormone therapy
- targeted treatment (trastuzumab)
breast cancer is diagnosed
(** in this order)
- mammogram
- ultrasound
- MRI
- breast biopsy
after a woman has a mastectomy she may choose to do ____, which is done ____ (timing)
breast reconstruction surgery
- done at same time as mastectomy
gynecological cancer (locations)
- cervix
- uterus
- ovaries
- fallopian tubes
- vagina
- vulva
cervical cancer: primary cause
HPV
cervical cancer is diagnosed via
pap smear
growth rate of cervical cancer
typically, slow growing
risk factors for cervical cancer
- HPV
- sex before 16
- smoking cigarettes
- STIs
- multiple sex partners
- birth control more than 5 years
- birth to 3 or more children
s/sx of cervical cancer
- watery, pink/brown bloody or foul smelling discharge
- abnormal bleeding btwn periods
- dyspareunia
- weight loss/gain
- fatigue
- pelvic or back pain
intimate partner violences (IPV) includes
- physical violence
- sexual violence
- stalking
- psychological aggression
who can IPV be committed by?
- current partner
- former partner
risk factors for IPV
- low self esteem
- low academic achievement
- adolescent or young adult
- alcohol or drug abuse
- having low friends
- marital conflict
- partner dominance and control in relationship
characteristics of abusers
- extreme jealousy
- possessiveness
- controlling behaviors
- blaming partner for bad things
- demeaning partner
- controlling what the partner wears
critical signs of IPV
- repeated nonspecific complaints
- overuse of healthcare system
- hesitancy, embarrassment, or evasiveness in detailing hx of injury
- time lag btwn injury and seeking care
- untreated serious injuries
- overly solicitous partner who stays close
- head, neck, face, and areas covered by 1-piece bathing suit (bruises/cuts/harm)
- during pregnancy- injuries to abdomen or breasts
- bruises in various stages of healing
nursing actions if you suspect your patient experiences IPV
- universal screening
- routine assessment
- documentation of abuse
common questions to ask your patient if you suspect (IPV)
- has your partner ever hit you?
- do arguments with your partner result in you feeling bad about yourself?
- do you every feel frightened about what your partner says or does?
- do you feel safe in your current relationship?
licensed HCP are legislatively mandated reporters of ____
- suspected abuse, neglect or exploitation of certain groups of people
s/sx of UTI in older women
**differ from normal s/sx
- confusion/delirium
- agitation
- hallucinations
- poor motor skills/dizziness
- falling
- fever- needs immediate treatment, serious infection
most common bacterial STI in the US & leading cause of infertility and ectopic pregnancies
chlamydia
type of hysterectomy used to treat some cases of reproductive cancer
radical hysterectomy
type of hysterectomy that leaves the cervix in place
partial hysterectomy
