Common gynecologic problem Flashcards
•Swelling, pain, tenderness, lumpiness of breast tissue
•Benign changes–natural result of aging and hormonal changes
•Common in ages 30-50
•Increased changes/pain premenstrual
•Pain–edema of connective tissue, dilation of ducts, inflammatory response
Menopause fixes this issue
Fibrocystic breast condition
- Multiple, mobile cysts may form
- Fluid filled–milky white, yellow, brownish - aspirate cyst to ensure its not cancer
- If fluid is not blood tinged–likely not malignant
- If cysts develop into atypical cells then moderate increased risk for breast cancer Atypical cells are cancerous
- Dx with complete history, physical exam, imaging studies, biopsy
- Rule out breast cancer
- Specialized breast ultrasound due to pain with palpation
fibro cystic breast condition 2
- cyst aspiration
- good bra with support, day and night
- decrease/eliminate caffeine, chocolate, smoking
- increases symptoms and scarring
- Vitamin E–400 I.U. daily
- aspirin, ibuprofen, local heat/cold
treatment for fibrocystic breast condition
Most common benign tumors of breast -Occur at any age but most common during teens and 20’s •-Signs and Symptoms • Firm, hard, freely movable nodules • Tender or non tender • No changes during menstrual cycle • Upper, outer quadrant of breast • Often more than one is present
Fibroadenoma
• Endometrial tissue is located in other sites, outside of the uterine
cavity
• multiple, small, usually benign implantations
• most common in women age 30-40
• 30-45% of female infertility
• hereditary–higher risk if mother had
• cause unknown
Endometriosis
• Implanted endometrial tissue responds to cyclic ovarian hormone
stimulation and bleeds at sites of implantation
• results in scarring, inflammation, adhesions
• lesions regress during pregnancy, atrophy during menopause
patho of endometriosis
- Heavy throbbing pain of lower abdomen and pelvis
- Radiation of pain down thighs and around back
- Feeling of rectal pressure and discomfort when having BM
- Dyspareunia, dysfunctional uterine bleeding
- Infertility–have kids early in life-less scarring
manifestations of endometriosis
Labs • pelvic ultrasonography • CBC with differential • laparoscopy Pharmacology • NSAIDS--prostaglandin synthesis inhibitor • OCP, progesterone • GRH-gonadotropin releasing hormone agonist & antagonist—interferes with reproductive hormone secretion Surgery • electrocautery of adhesion/endometrial implantations • total hysterectomy
collaborative care for endometriosis
- Pain relief
- evaluate pain severity
- heat, relaxation, exercise
- alternate positions for intercourse
- Anxiety
- Expression of fears
- Education re condition and treatment options
Nursing care for endometriosis
• Failure of ovarian follicle rupture
• Usually asymptomatic, may be found incidentally upon US
• Regression during next menses
like a zit on the ovary
follicular ovarian cysts
• Develops from corpus luteum that fails to regress
• Can cause pain, inhibition of next menses
• Generally relief felt with rupture of cyst
• Distinguish from solid ovarian tumor with US, laparoscopy; removal with
laparotomy for biopsy
luteal ovarian cysts
fibroid
• Most common
• Estrogen dependent
• Develop from uterine smooth muscle cells
Leiomyoma benign uterine tumors
- Increased uterine size
- Increase menstrual bleeding resulting in anemia, fatigue
- Pelvic pressure
- Bloating
- Urinary frequency
signs and sypomtoms of Leiomyoma benign uterine tumors
• Dependent on symptoms and size of fibroids
• Myomectomy—removal of fibroid
• Hysterectomy
• GnRH agonists to reduce size of fibroid
-Unpleasant side effects
• Uterine Fibroid Embolization - New, effective therapy (88% success
rate)
• Medroxyprogesterone acetate (Depo Provera
• Temporarily reduces uterine bleeding and volume of the fibroid
treatment of Leiomyoma benign uterine tumors
End of menstruation – climacteric Average age 51.5 • Natural takes place over 3 to 5 years • Induced – removal ovaries whether through surgery, radiation, chemotherapy
Menopause
Reproduction organs undergo regression • leads to dyspareunia, increased vaginal infections, breast decrease in size •h Low Density Lipoproteins (LDL) i High density lipoproteins • Hot flashes, fatigue • Relief vs. Grieving
physiologic and psychological changes
Hormone Replacement Therapy Benefits: • Decrease climacteric effects • Decrease osteoporosis Estrogen & Progesterone combination • Side effect of increased incidence of breast cancer Estrogen alone • Side effect of increased incidence of stroke
treatment of menopause
• Infection of the upper genital tract
• Without diagnosis and treatment can lead to chronic pelvic pain,
infertility, ectopic pregnancy
• Sexually transmitted infections most common causative factor
pelvic inflammatory disease
Invasion of endocervical canal causes cervicitis
• Bacteria continues up through cervix into endometrium, fallopian
tubes, pelvic cavity
• Inflammation results in tubal scarring and adhesions
pathophysiology of PID
- May be asymptomatic!!!
- Pelvic pain
- Fever
- Purulent vaginal drainage
- N/V
- Irregular menses
- Tenderness with pelvic exam with manipulation of cervix and uterus
signs of symptoms of PID
•History •Physical exam—pelvic, cervical cultures •UA—r/o UTI •Labs -Increased sedimentation rate -Leukocytosis
diagnosis of PID
- Serious infection may require hospitalization
- IV antibiotics
- Laparoscopy to r/o appendicitis, ectopic pregnancy
- Oral antibiotics for less serious infection
- Education regarding sexual practices, STD’s
treatment of PID
• Potentially fatal infection caused by S. aureus toxin
• Risk factors
- Poor hygiene practices
- High absorbency tampons with infrequent changing
- Cervical cap, diaphragm, sponge
•Anything that promotes bacterial growth!
toxic shock syndrome
- Sudden spiking temperature
- Headache, sore throat, vomiting, diarrhea, malaise
- Generalized rash like sunburn
- Hypotension
- Coma and general organ failure
- 1-2 weeks post—peeling palms and soles
signs of symptoms of toxic shock syndrome
•Supportive management with •IV fluids -Vasopressor medications -Antibiotics -Teach preventative measures
treatment of TSS
• Condition in which the normal balance of bacteria in the vagina is
disrupted and replaced by an overgrowth of certain bacteria.
• It is sometimes accompanied by discharge, odor, pain, itching, or
burning.
• Bacterial Vaginosis (BV) is the most common vaginal infection in
women of childbearing age.
• In the United States, as many as 16 percent of pregnant women have
BV.
• BV is not considered a sexually transmitted disease.
bacterial vaginosis (BV)
• Excessive amount of thin, watery, yellow-gray vaginal discharge with
a foul odor (fishy)
• Presence of “clue” cells and absence of leukocytes on a wet-mount
preparation
• + whiff test
S/S of bacterial vaginosis
• In most cases, BV doesn’t cause any problems.
• BV can cause premature delivery and low birth weight
babies
• Increased risk of PID
• Higher risk of getting other STDs. Having BV can increase
the chances of getting other STDs, such as chlamydia,
gonorrhea, and HIV. Women with HIV who get BV increase
the chances of passing HIV to a sexual partner.
complications of bacterial vaginosis
• Two different antibiotics are recommended as
treatment for BV: metronidazole or clindamycin
•Never Douche
•Avoid feminine hygiene sprays, harsh soaps, or
soaps with lots of perfume.
•Avoid clothing that can trap moisture: pantyhose
(wear pantyhose with cotton crotch) or latex
exercise clothing.
treatment and preventions of bacterial vaginosis
Candida albicans (90%)
• Normal organism in vagina
• Infection when Corynebacterium suppressed
yeast infection
- Heat and moisture retaining clothing (e.g. nylon)
- Pregnancy
- Premenstrual phase of the Menstrual Cycle
- Depressed cell mediated immunity
- (e.g. AIDS)
- Obesity
- Broad spectrum Antibiotics
yeast risk factors
• Asymptomatic in 20-50% of women
• Intense vaginal or Vulvar Pruritus (50% of cases), burning, soreness or
irritation
• Thick white curd-like or “cottage cheese” discharge
• No odor
• Dyspareunia and Dysuria
• Vulvar erythema, edema and cottage cheese-like discharge
signs and symptoms of yeast infection
• KOH slide - destroys everything but yeast on slide
• Appearance of cottage cheese-like discharge
• Treatment: Antifungal
- Miconazole
- Clotrimazole (Gyn-Lotrimin, Mycelex G)
diagnosis and treatment of yeast
Cause unknown Risk factors • early sexual experience • multiple sex partners (2-3 fold increase) • Lower socioeconomic class • History of STD: - human papilloma virus (HPV) infections (Gardasil) - genital herpes • cigarette smoking • Uncircumcised male partner
cervical cancer
• Peak age 40-60 years of age
• Range is 20-80 years of age
History of few or no previous pap exam
risk for cervical cancer
• 90% squamous cell carcinoma, begin as neoplasia in cervical
epithelium
• Classified a cervical intraepithelial neoplasia (CIN)
• Can spread by direct invasion of vaginal wall, pelvic wall, bladder,
rectum
patho of cervical cancer
Preinvasive limited to cervix, no other sx Invasive • bleeding • leukorrhea--whitish discharge • referred pain in back or thighs • hematuria • bloody stools • anemia • weight loss
manifestations of cervical cancer
- Goal–eradicate cancer, minimize complications and metastasis
- DIAGNOSTICS
- Papanicolaou (pap)–primary screening tool
- Colposcopy and biopsy of suspicious area
- MRI or CT of pelvis
collaborative care of cervical cancer
• Chemo for tumors not responsive to other therapy
• Radiation therapy more commonly used to treat invasive cancer
-external beam
•- radioactive implants (Brachytherapy)
radiation and chemo for cervical cancer
• Colposcopy with laser surgery–ca limited to epithelium
• Cryosurgery–noninvasive lesions
• Conization–noninvasive, used if colposcopy unable to define limits of
invasion
• Invasive–hysterectomy, salpingotomy, oophorectomy
surgical treatment for cervical cancer
- Educate regarding risk factors, annual pap and
pelvic, s/s to report - Post cares for biopsy, colposcopy, conization
• May feel cramping
• minor bleeding and discharge
• nothing in vaginal canal–intercourse, tampons, douching
• notify if heavy bleeding or s/s of infection
nursing care of cervical cancer
•Most frequently diagnosed cancer in US •Occurs most frequently between ages 50-70 Risk factors • early menarche, late menopause • hx of infertility • failure to ovulate • long-term tamoxifen or estrogen therapy • obesity • diabetes
endometrial cancer
•Most are adenocarcinomas, slow growing
• Tumor growth frequently in fundal area of the
uterus that invades into myometrium
•Metastasis thru lymphatic system, from
myometrium to uterine tubes to peritoneal cavity.
• Target areas: lungs, liver and bone
pathophys of endometrial cancer
-Abnormal uterine bleeding after menopause -Advance disease •lymph node enlargement •pleural effusion •abdominal masses •ascites
manifestations of endometrial cancer
•Physical exam reveals enlarged boggy uterus or presence of discrete mass • Diagnostics •vaginal ultrasonography •CBC for blood loss •Endometrial biopsy, D & C
collaborative care for endometrial cancer
• Pharmacology •progesterone therapy for recurrence •chemotherapy less effective • Surgery--treatment of choice •total abdominal hysterectomy with bilateral salpingo--oophorectomy •node dissection if disease stage II or beyond
collaborative care for endometrial cancer 2
• Silent killer—no preventative diagnostic test, often no s/s until
progression advanced
• Metastasis to adjacent organs common
• Median survival: 32 months
• Five year survival
• Overall five year survival: 40%
• Five year survival for advanced Ovarian Cancer: 20%
ovarian cancer
- All ages are at risk
- Median Age is 24
- Risk Factors:
- Never been pregnant
- Advancing Age
- Family History
- Ovarian, Breast, Colon, Endometrial Cancer
risk factors of ovarian cancer
- Pelvic Pain
- Abdominal Pain
- Increased abdominal size
- Abdominal bloating
- Difficulty eating
- Early satiety
S/S of ovarian cancer
- Chemotherapy, radiation to shrink tumor size
- Oophorectomy—remove ovary—follow with chemo and/or radiation
- Total hysterectomy
treatment of ovarian cancer
