Chapters 4, 6, 7, 8, 9 Flashcards
a natural process that occurs in all women’s lives as part of normal aging. “haulting month” point in time at which menses and fertility cease
-Explain further
Menopause
-one year without period
the transition from a woman’s reproductive phase of her life to her final menstrual period
Menopausal transition/ perimenopause
the period of life starting from the decline in ovarian activity until after the end of ovarian function
Climacteric
time when menopause approaches
-how long?
perimenopause (2 to 8 years before cessation)
Impact of menopause to the brain:
- ) hot flashes
2. ) sleep, mood, and memory problems
- ) Impact of menopause to Heart
- )” “ Bones
- )” “ breasts
- ) low HDL and increased risk for CVD
- ) bone density loss; osteoporosis risk
- )duct and gland tissue replaced by fat
- ) impact of menopause to Genitourinary:
- ) “ “ GI
- ) Skin
- ) vaginal dryness, stress incontinence, and cystitis.
- ) low Calcium absorption and increased fractures
- ) dry skin thin, and decrease in collagen
the state of diminished bone density.
Osteoporosis
Risks of osteoporosis:
- Small frame, asian, white, women
- sedentary lifestyle, low calcium and Vit D
- post menopausal
screening test that calculates the mineral content of the bone at the spine and hip
Dual-energy x-ray absorptiometry (DEXA)
Pharmacologic treatment for Osteoporosis
- ) Alendrolate
- )Risedronate
- )Denosumab
- ) Zoledronic acid
- ) Calcium and Vit D
Nursing assessment for Menopausal transition
- screenings for osteoporosis, CVD, and Cancer
- assess lifestyle (diet, weight, Calcium intake, use of drugs, smoking and alcohol, and exercise)
Fibrocystic breast changes
- ) discharge
- ) site
- ) treatment
- ) can be positive or negative
- )bilateral
- ) limit caffeine, supportive bra, ibuprofen
fibroandenomas
- ) discharge
- ) site
- ) treatment
- ) none
- ) unilateral nipple area)
- ) expectant therapy, surgical excision
Mastitis
- ) discharge
- ) site
- ) treatment
- ) none
- ) unilateral
- ) antibiotics, warm shower, express milk, supportive bra
- ) Response of breast tissue to monthly estrogen and progesterone levels (AKA)
- ) when is it most common and least common
- ) Fibrocystic breast changes (Benign breast disease)
2. ) most common in ages 20 to 50 and least common postmenopausal women.
Therapeutic techniques for Fibrocystic breast changes
- diet, healthy lifestyle, supportive bra, drugs for severe cases.
- educate about breast self examination
Nursing assessment for fibrocystic breast changes
-what methods to use and when?
- lumpy tender beasts (week before menses)
- dull aching fullness
- drainage that is usually yellow
- fibrosis (thickening early on) formation of cysts come later
- triple touch, a week after menses
- mammograph and ultrasound
difference between cysts and Cancerous lesions
- cysts tend to be mobile and tender and do not cause skin retraction
- cancerous lesions are fixed, painless, and cause skin retractions
- ) benign sold breast tumors
- ) when most common in women?
- ) treatment
- ) Fibroadenomas
- ) 15 to 25 years
- ) expectant therapy because it goes away on its own (if not, then surgically removed)
- )Signs and symptoms of Fibroadenomas
2. ) nursing management for Fibroadenomas
- ) - firm lumps, rubbery and freely mobile
2. ) reevaluate in 6 months, educate to perform monthly BSE, and annual CBE
- )is an infection or inflammation of the connective tissue in the breast that occurs primarily in lactating or engorged women.
- ) two types and main difference
- )mastitis
- )-lactational, often caused by staph. aureus.
- non lactational is often caused by duct ectasia
milk ducts become congested with secretion and debris
duct ectasia
Theraputic techniques for mastitis
- antibiotics, milk expression, warm compress,
- nursing assessment for mastitis
- risk factors
- unilateral inflammation, fever, flu-like symptoms
- poor hygiene, incomplete or infrequent breast feedings
neoplastic disease in which normal body cells are transformed into malignant ones. Most common cancer in women
Breast cancer
Breast cancer that have not extended beyond their duct, lobule (AKA)
Noninvasive (situ)
most common breast cancer
invasive ductal carcinoma
breast cancer originating from terminal lobular units of breast ducts
invasive lobular carcinoma
How are breast cancers staged
- tumor size, extent of lymph node, evidence of metastasis
Stages of breast cancer
0 - in Situ, early type
I - localized with <1 in tumor
II - Tumor 1-1 in, spread to axillary
III - 2 in or larger, spread to lymph and tissue
IV - cancer has metastasized to other parts
nonmodifiable risks to breast cancer
- gender (female)
- > 50 years old
- genes, history of cancer
- early menarche or late menopause
Modifiable risks
- not having children or not having children before 30
- use of estrogen and progestin
-failing to breastfeed for up to a year after pregnancy
alcohol, smoking, obesity, sedentary life style
diagnostic tests for breast cancer
- mamograms (50 to 74 yrs)
- fine needle aspiration and biopsy
- DNA ploidy status
Therapeutic treatments for Breast cancer:
- Surgical
- Breast conserving surgery
- Mastectomy
- Adjunct therapy
surgery to remove the suspicious mass along with tissue free of malignant cells to prevent recurrence.
-Breast conserving surgery
- ) removal of all breast tissue, the nipple, and the areola.
- ) involves removal of breast tissue, and a few positive axillary nodes.
- ) simple mastectomy
2. )modified radical mastectomy
a common surgical procedure with women undergoing it with implants for a variety of reasons ranging from aesthetic to reconstructive surgery following a mastectomy
breast augmentation
- ) therapy is supportive or additional therapy that is recommended after surgery
- ) uses high-energy rays to destroy cancer cells that might have been left behind in the breast
- ) refers to the use of drugs that are toxic to all cells and interfere with a cell’s ability to reproduce.
- ) objective is block or counter the effect of estrogen.
- ) used as an adjunct to surgery, represents an attempt to stimulate the body’s natural defenses to recognize and attack cancer cells.
- ) adjunctive therapy
- ) radiation
- ) chemotherapy
- ) Endocrine therapy
- )immunotherapy
Breast cancer breast changes to look for?
- breast changes and changes in color and texture
- lump in one breast
- nipple irritation, retraction, and discharge
- breast swelling and asymmetry
post op nursing interventions for breast cancer
- elevate affected arm and exercise full ROM (no treatments or draw labs from arm)
- wound care
What to teach about breast cancer
- prevention
- early detection (BSE, CBE, mammography
- screenings
- dispel myths and fears
positions when doing visual part of BSE
What motion when doing tacticle part of breast exam
What to look for when doing visual part of breast exam
- arms up behind the head, arms down at the side, and bending formward
- circular rubbing motion (Light, medium, hard)
- Change in shape, size, contour, or symmetry. discoloration. sores or scaly skin. discharge
- how long are breast implants usually guaranteed
- Risks
- 10 years
- capsular contracture, rippling, implant rupture, infection, or hematoma
- ) refers to the abnormal descent or herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis.
- ) what does it affect
- ) Pelvic Organ Prolapse
2. ) micturition, defecation, sexual activity
- ) occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall
- ) occurs when the rectum sags and pushes against or into the posterior vaginal wall.
- ) occurs when the small intestine bulges through the posterior vaginal wall (especially common when straining).
- )occurs when the uterus descends through the pelvic floor and into the vaginal canal. Multiparous women are at particular risk for uterine prolapse
- ) cystocele
- )rectocele
- ) Enterocele
- ) Uterine Prolapse
Classifications of Uterine Prolapse
0 - no descent during straining
I - descent is > 1 cm above hymenal ring
II - organs are 1 cm below hymenal ring
III - organs extends 2 to 3 cm below hymenal ring
IV - vagina is inverted or prolapsed organ is > 3 cm below hymenal ring
Therapies for pelvic organ prolapse
- Kegel exercises (pelvic floor muscle exercise)
- hormone replacement therapy
- diet and lifestyle changes (smoking cessation, avoid heavy lifting bladder irritants and constipation.)
- Pessaries
- surgical interventions
precipitous loss of urine preceded by a strong urge to void, increase bladder pressure, and detrusor contraction
Urge incontinences
leakage of urine due to increased pressure from coughing, sneezing, laughing, or physical exertion
- when do it occur usually
stress incontinences (40s to 50s due to weakened muscles)
therapeutic techniques for :
- ) urge incontinence
- ) stress incontinence
- ) bladder training, kegel exercise, pessary ring, and surgery only if other methods fail
- ) weight loss, smoking cessation, avoiding constipation, pessaries, periurethral injections, estrogen replacement therapy.
Is UI a normal part of again
it is not inevitable “No”
benign growth often resulting from infection
Polyps
- ) cervical polyps often appear when
- )endocervical polyps often appear when
- ) Endometrial polyps often appear when
- ) after menstruation
- ) age 40 to 60
- ) gradually decline after menopause
Therapeutic techniques for polyps
-removal via forceps , laser vaporization
benign tumors composed of smooth muscle and fibrous connective tissue in the uterus. AKA
- what makes it different from cancerous tumors
- Uterine Fibroids ( Leiomyomas)
- it grows slow and do not break away and invade other parts
describe growth and decline of fibroids
- grows rapidly in child bearing years due to all the estrogen
- shrinks during menopause
- )pharmacological therapies for fibroids
2. ) other therapies
- GnRH agonists, progestin antagonists
- Artery embolization, myomectomy, surgery hysterectomy
- ) abnormal openings between a genital tract organ and another organ,
- ) communication between bladder and genital tract
- )communication between urethra and vagina
- )communication between rectum or sigmoid colon and vagina
- )Genital fistula
- )Vesicovaginal
- )Urethrovaginal
- )Rectovaginal
Therapeutic management for genital fistulas
for small fistulas, it usually heals with minimal to no treatments
for large fistulas, it would require surgical repair
a swollen, fluid-filled, sac-like structure that results when one of the ducts of the Bartholin gland becomes blocked
Bartholin Cysts
Therapeutic techniques for Bartholin Gland Cyst
- small cysts typically do not require treatment.
- sitz bath
- surgery
Nursing assessment for bartholin Cysts
- asymptomatic if cysts are small
- infection S&S
- protrusion of tender labial mass
a fluid-filled sac that forms on the ovary
a fluid filled sac that forms on the ovary
1.) commonly found in the ovaries of prepubertal girls and women of reproductive age, and in most cases, they are of no clinical significance.
Follicular cyst
forms when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days
Corpus Luteum cysts
Prolonged abnormally high levels of human chorionic gonadotropin (hCG) stimulate what?
Theca Lutein Cysts
is the most common endocrine condition in women of reproductive age. It is a heterogeneous condition that involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function
polycystic ovaria syndrome
- )Therapeutic techniques for cysts
2. ) for PCOS
- Transvaginal ultrasound is useful in distinguishing fluid-filled cysts from solid masses.
- Laparoscopyif large
- if small, monitoring
- contraceptives
2.) drug and nondrug therapy, lifestyle changes
S&S of PCOS
- hirsutism
- alopecia
- virilization
- menstrual irregularity and infertility
- insulin resistance
- acne
Ovarian cysts lab test
-why would you do pregnancy test?
- pelvic exam
- pregnancy test to rule out ectopic pregnancy
- ultrsound
Risk for cancer:
- early menarche, late menopause
- STD
- hormonal agents
- infertility
- family history of cancer
- unhealthy lifestyle
Warning signs for reproductive cancer
- Blood in bowel
- Unusual vaginal discharge or chronic vulvar itching
- Persistent abdominal bloating or constipation
-Irregular vaginal bleeding
Persistent low backache
- Elevated or discolored vulvar lesions
- Bleeding after menopause
- Pain or bleeding after intercourse
management of cervical cancer during pregnancy depends on which factors:
- stage of disease
- nodal status
- subtype of tumor
- term of pregnancy
- whether the patient wishes to continue with the pregnancy
- woman’s desire for future pregnancies
Ovarian cancer is malignant neoplastic growth of the ovary
- how common
- what is the most important part to know
ovarian cancer
- 8th most common disease
- 55 to 75 years of age
- extent of disease
The screenings and detection of ovarian cancer
- often undiagnosed until stage III or IV
- there is no adequate screening test
1.) early symptoms of ovarian cancer
- ) -vague complaints
- bloating, vague abdominal pain
- early satiety
- urinary frequency
- diarrhea and constipation with unexpected weight loss or gain
Late symptoms of Ovarian Cancer
- anorexia,
- dyspepsia,
- ascites,
- palpable mass,
- pelvic and back pain
Therapeutic technique for Ovarian cancer
- laparoscopy for diagnosis and staging
- hysterectomy, salpingooophorectomy
- chemotherapy is recommended for all stages
is malignant neoplastic growth of the uterine lining
-how common
- endometrial cancer
- 4th most common
compare type I and type II carcinoma of Endometrial Cancer
Type I begin as endometrial hyperplasia and progress to carcinomas.
Type II appear spontaneously
Assessment for Endometrial Cancer
- after menopause report any bleeding to provider
- biopsy
Therapeutic techniques for endometrial cancer
- surgery (hysterectomy and salpingo-oophorectomy)
- radiation and chemo therapy
- removal of tubes and ovaries
cancer of the uterine cervix
cervical cancer
precursor to cervical cancer
cervical dysplasia
screening for cervical cancer
when is recommended start
pap test
- 21 years old every 3 years. stopped at >65
- HPV test from ages 30 to 65 every 5 years
therapeutic techniques for cervical cancer
- surgery
- radiation if not superficial
- chemo is done if tumors are large or anything beyond cervix
a rare malignant tissue growth arising in the vagina
-vaginal cancer
S&S of vaginal cancer
- often asymptomatic
- painless vaginal bleed (often after sexual intercourse )
- abnormal vaginal discharge, dyspareunia, dysuria, constipation, and pelvic pain
Therapeutic technique for vaginal cancer
- radiation
- laser surgery
an abnormal neoplastic growth on the external female genitalia including the clitoris, vaginal lips, and opening to the vagina
- which type of cell?
- when it common?
Vulvar cancer (squamous cell carcinoma)
-most common in mid 60s to 70s
screenings for Vulvar cancer
- annual vulvar exams
- vulvar itching
Therapeutic techniques vulvar cancer
- laser surgery,
- cryosurgery, or electrosurgical incision;
- radical vulvectomy
Types of abuse to watch out for being done to elderly women
- physical abuse
- neglect
- emotional abuse
- sexual abuse
- financial or exploitational abuse
Types of sexual violence
- intimate partner violence
- human trafficking/ prostitution/ bondage
- incest
- genitelia cutting
- infanticide
- sexual assult
penetration of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person without the consent of the victim
Rape
: forced sex by a person the victim knows
Acquaintance rape
assault occurs within a dating or marriage situation
date rape
sexual activity between an adult and person under 18 years
statutory rape
statistics about sexual assult
- 3 in 10 women or 1 in 10 men have experienced rape
- 40 to 60 % of murders in NA are committed by an intimate partner
phases of rape
- Acute phase (shock,fear, disbeliefe, nightmares, sobbing)
- outward adjustment (appearing composed and going to school and work, unwilling to discuss assault and denies need for counseling
- reorganization (changes habits and making adjustments in life cause denial does not work)
- Integrity and recovery (starts to feel safe and trust others)
Nursing managements for rape
- Early intervention and immediate counseling
- Supportive care
- Evidence collection and documentation
- STI assessment
- Pregnancy prevention
- PTSD assessment
Types of genital cutting
Type I - removal of clitoris
Type II -cutting clitoris and labia minora
Type III - cutting labia minora and majora, clitoris, and suturing tissue leaving only a small opening for urination
SAVE model
screen for violence
Ask direct questions
Validate
Evaluate
