Exam 1 Flashcards
1
Q
How does age impact Sexuality? (4)
A
- Age does not affect the woman’s capacity to have an orgasm
- intensity of orgasm may decrease as women age.
- sexuality does not decrease with age
- lower testosterone and estrogen w/ age
2
Q
4 definitions of Sexuality
A
- sexual expression
- gender expression (masculinity and femininity)
- sexual attraction
- central aspect of being human
3
Q
5 Phases of sexual response
A
Motivation (desire, libido) – affected by medications, personality, temperament, medical conditions, lifestyle, environmental stressors
Arousal: a state of release of neurotransmitters
Genital congestion (autonomic response): increased blood flow; clitoral swelling and vulvar engorgement, vaginal lubrication; in males, erection
Orgasm: rapid contraction of pelvic muscles
Resolution: wellbeing, neurotransmitters prolactin, ADH, oxytocin released
4
Q
6 components of positive sexual attitudes and behaviors
A
Being present: thinking to stop, arousal to take over, ”utter immersion and intense focus”
Authenticity: being able to be fully oneself with partner
Connection: heightened intimacy during sexual encounter
Sexual and erotic intimacy: deep sense of caring
Communication: verbal and nonverbal (touch)
Transcendence: heightened mental, emotional, physical, relational, and spiritual states of mind.
5
Q
5 types of sexual dysfunction
A
- hyposexual activity
- sexual aversion
- sexual arousal disorder (orgasmic disorder)
- sexual pain disorder (low estrogen = vaginal dryness, pain, irritation)
- erectile or ejaculatory dysfunction
6
Q
6 medication categories that cause sexual dysfunction
A
- Antihypertensives (ACEI, beta blockers, beta agonists, diuretics)
- Antiulcer medications (omeprazole,cimetidine)
- Antidepressants
- Antipsychotics
- Anticonvulsants
- Narcotics
7
Q
3 things that impact significance of sexual dysfunction
A
- patient age
- patient interest in sex
- whether issue is chronic or temporary
8
Q
4 populations at high risk for altered sexual function
A
- Adolescents: Early sexual activity, risk for AIDS/HIV, limited knowledge
- Disabilities: ignorance (not acknowledging their need for information about sexual health), poor decision making, developmental issues
- Newly unpartnered: new sexual paradigm; HIV/AIDS, STIs
- LBGTQ: high-risk behavior, men-men sex higher risk for AIDS/HIV
9
Q
What role does CBT play in Sexuality?
A
CBT helpful b-c Fear, anxiety, stress, fatigue can impair sexual function
10
Q
How are the following concepts related to reproduction and sexuality?
- Pain (2)
- Gas exchange
A
Pain
- contributes to sexual dysfunction
- positive touch & sexual intimacy increase endorphins which negate pain response
- Gas exchange: respiratory problems can cause sexual Dysfunction
11
Q
5 domains of SDOH
A
- Neighborhood and Built Environment
- Social and Community Context (including impact of racism)
- Health Care Access and Quality
- Education Access and Quality
- Economic Stability
12
Q
6 Health Disparities for LGBTQ Community
A
- higher risk for smoking and substance abuse
- higher risk for violence
- higher risk for chronic conditions (obesity, diabetes, asthma, PCOS, heart disease)
- higher risk of uninsured status
- higher risk of miscarriage, preterm birth, LBW, and stillbirth
- higher risk for breast and reproductive cancers
13
Q
4 health disparities related to racism for women
A
- Black women and American Indian/Alaska native 3-4x higher maternal mortality rate
- Black women and American Indian 2x higher severe maternal complications (cardiomyopathy, embolism, eclampsia, LBW, preterm birth)– even if college educated compared to white high school graduates
- Black infants 2x higher infant mortality
- biological weathering (elevated cortisol, increased BP, shortening of telomeres) due to systemic racism -> maternal complications (hypertension, early onset chronic conditions, preterm births)
14
Q
5 Ps of Sexual health history
A
Partners: Number and gender of sexual partners; particularly > 1 partner in 12 months or a partner with other partners
Practices (sexual behavior)
Protection from infection
Past hx of infection
Pregnancy Prevention (assess contraception use and desire for pregnancy)
15
Q
4 Factors of Cultural Humility
A
- Open communication with the patient about their cultural beliefs, values and what they desire in terms of care (understand pt may prefer same-sex examiner or not to disrobe completely)
- emphasize critical self-reflection and lifelong learning
- create mutually beneficial nonhierarchical partnerships
- create institutional alignment and accountability
16
Q
What is intimate partner violence (IPV)? How often to screen for IPV?
A
- Actual or threatened physical, sexual, psychological, emotional, or stalking abuse by an intimate partner (current or former spouse or nonmarital partner)
- All women should be screened in private for IPV during prenatal visits and with each hospital admission or well-woman visit.
17
Q
7 Signs of IPV
A
- Repeated nonspecific or vague complaints
- Overuse of the healthcare system OR time lag b/w injury and care seeking
- Hesitancy, embarrassment, or evasiveness in relating history of injury
- Untreated serious injury
- Overly SOLICITOUS partner who STAYS CLOSE to the woman and attempts to answer FOR her
- Injuries of the head, face, neck and areas covered by a one-piece swimsuit( breast and abdomen during pregnancy)
- Bruises at various stages of healing
18
Q
6 Nursing Responsibilities for IPV
A
- Assure total privacy when interviewing and assessing patient.
- Ask permission to involve social work.
- Listen in non-judgmental way
- Give pt resource info in a safe way (i.e., put hot line number in phone under another name)
- report gun violence or abuse of minor
- reassure patient that IPV is not their fault
19
Q
4 factors contributing to maternal and infant mortality rates
A
- quality and access to healthcare
- overall maternal health (obesity and preeclampsia)
- public health practices
- socioeconomic conditions
20
Q
6 Healthy People 2030 goals related to Maternal and Infant health
A
- Reduce maternal deaths to 15.7
- Reduce fetal deaths at 20 or more weeks to 5.7
- Reduce C/S, preterm births, LBW
- Increase early and adequate prenatal care (Increase folic acid intake)
- increase infants who sleep on their backs,
- increase exclusively breastfed infants for at least 6 months
21
Q
Difference b/w the following terms:
- Infant Mortality
- Neonatal Mortality
- Maternal Mortality
- Perinatal Mortality
- Stillbirth
A
- Infant Mortality - death of a live birth between birth and the first birthday
- Neonatal Mortality - death of a live birth between birth and < 28 days
- Maternal Mortality - maternal deaths from live births, complications of pregnancy, or postpartum within 42 days of pregnancy
- Perinatal Mortality - includes stillbirths
- Stillbirth - an infant @ birth who demonstrates no signs of life such as breathing, heartbeat or muscle movements
22
Q
5 ethical concepts in neonatal care
A
- Beneficence: obligation to do good
- Fidelity: being accountable and responsible, loyal to commitments
- Veracity: Being truthful
- Autonomy: self-determination, respect parental decisions, facilitate communication and collaboration (fetus does not have autonomy, Pregnant Woman does)
- Justice: allocation of resources and use of resources equitably (what is equitable can be subjective and cause conflict, example: Organ transplantation)
23
Q
5 Leading Causes of infant mortality
A
- congenital malformations (birth defects)
- short gestation and LBW
- SIDS
- accidents
- r/t maternal complications of pregnancy
24
Q
5 consequences of teen pregnancy (for child)
A
o Higher IMR if mom less than 15
o Health problems due to prematurity or LBW
o Behavioral problems
o Lower educational attainment
o Increased risk of teen pregnancy, incarceration, foster home placement
25
4 consequences of teen pregnancy (for mother)
* Decreased educational attainment (and for father)
* Increased poverty and welfare usage
* Increased chance of 2nd child as teen which decreases ability to complete school and have good jobs
* Increased risk of STIs, hypertensive disorders during pregnancy
26
IPV during pregnancy increases risk for: (6)
- substance abuse
- depression/suicide
- PTSD
- inadequate weight gain
- LBW, preterm, or small for gestational age baby
- neonatal death
27
3 systemic disparities for women of color in healthcare setting
o Reduced diabetes screening in postpartum period
o Less pain meds given during labor and postpartum
o lower rates of epidural admin
28
4 health promotion for LGBTQIA+ community
- Advocate for policy changes to remove legal discrimination
- Create gender-affirming environments via signage, inclusive forms (and EHRs), nondiscrimination policies
- Provide staff training on proper care of LGBTQIA+ patients
- Recognize that Medicare and Medicaid facilities must allow patients autonomy irrespective of sexual orientation, gender identity or marital status
29
Follicular phase of the Ovarian Cycle (3)
- 1st day of menstruation and lasts 12-14 days
- Graafian follicle matures due to Luteinizing and follicle-stimulating hormones (LH and FSH)
- Graafian follicle produces estrogen
30
Ovulatory phase of Ovarian cycle (3)
- Begins when estrogen levels peak and end with release of oocyte(egg) from graafian follicle
- LH increases 12-36 hrs before ovulation
- Before LH increases, estrogen decreases and progesterone increases (prep of corpusm luteum)
31
Luteal phase of Ovarian cycle (4)
- Begins after ovulation and lasts 14 days
- Cells of empty follicle form corpus luteum (high levels of progesterone and low levels of estrogen)
- If pregnancy occurs, corpus luteum releases high levels of progesterone and low levels of estrogen until placenta matures
- If no pregnancy, corpus luteum degenerates, progesterone decreases, and menstruation starts
32
Stage of the endometrial cycle: proliferative phase (2)
- After menstruation and preparation for implantation
- Endometrium becomes thicker and more vascular (due to increased estrogen))
33
Methods of Contraception: Abstinence
Type
Advantages (4)
Disadvantage
Type: natural
Advantages
- No fail rate
- No contraindications
- No exposure to STIs
- Readily available
Disadvantages
- requires consistency to be effective
34
Methods of Contraception: Natural Family Planning/ Fertility awareness methods
Type
Advantages (3)
Disadvantages (3)
Type: natural
Advantages
- No side effects OR contraindications
- Acceptable in catholic church
- Low-to-no cost
Disadvantages
- Need regular menstrual cycle
- Strict record keeping (Must frequently monitor body functions: temperature, vaginal mucus production and consistency)
- complete abstinence needed during fertile periods
35
Methods of Contraception: Withdrawal/ coitus interruptus
Type
Advantages (2)
Disadvantages (3)
Type: natural
Advantages
- no costs
- no contraindications
Disadvantages
- Does not protect against STIs
- Disrupts sexual intercourse
- High failure rate
36
Methods of Contraception: Lactational Amenorrhea Method (LAM)
Type
Advantages (2)
Disadvantages (2)
Type: natural
Advantages
- no costs
- no contraindications
Disadvantages
- Must exclusively breastfeed or do infant suckling
- More effective with barrier method
37
Methods of Contraception: Condoms (male or female)
Type
Advantages (3)
Disadvantages (5)
Type: barrier
Advantages
- Available OTC
- Protects against STI (and labia in female condoms)
- No systemic effects
Disadvantages
- Allergic reactions possible
- Must be applied at time of intercourse (may be disruptive)
- More effective with spermicides
- need proper size and not expired
- female condoms difficult to place
38
Methods of Contraception: Vaginal sponge
Type
Advantages (2)
Disadvantages (2)
Side effects (3)
Type: barrier
Advantages
- Placed before intercourse and left up to 30 hours (can protect against repeated intercourse)
- OTC
Disadvantages
- Must leave in place 6 hrs post-intercourse
- Increased infection risk
Side effects: irritation, discomfort, allergic reactions
39
Methods of Contraception: Cervical cap
Type
Advantages (2)
Disadvantages (2)
Type: barrier
Advantages.
- No systemic effects
- Leave in up to 48 hrs for repeated intercourse
Disadvantages
- Leave for 6 hrs after coitus
- Limited availability (size based on OB history)
40
Methods of Contraception: Diaphragm
Type
Advantages (3)
Disadvantages (3)
Side effects (3)
Type: barrier
Advantages
- size based on provider exam
- No systemic or hormonal effects
- Leave in up to 24 hrs for repeated intercourse
Disadvantages
- Need additional spermicide for repeated intercourse
- Leave for 6 hrs after coitus (place 6 hrs prior
- Not good with allergies due to spermicide
Side effect
- increased risk of yeast infection, cystitis, and toxic shock syndrome if used > 24 hrs
41
Methods of Contraception: Spermicidal gel, cream, foam
Type
Advantages (2)
Disadvantage
Side effects (2)
Type: barrier
Advantages
- Available OTC
- Foam can be emergency contraceptive
Disadvantages
- Frequent use contraindicated if at risk for HIV
Side effects: allergic reaction, irritation
42
Methods of Contraception: Combo estrogen and progesterone OC
Type
Advantages (3)
Disadvantages (3)
Type: hormonal
Advantages
- Suppresses ovulation
- Reduces risk for endometrial and ovarian cancer
- reduce risk of benign breast disease, anemia, acne, painful menses
Disadvantages
- prescription only
- side effects
- must be taken daily
43
Methods of Contraception: Progestin only
Type
Advantage
Disadvantages (3)
Type: hormonal
Advantages
- Can be used during lactation
Disadvantages
- prescription only
- side effects
- One pill a day at same time each day
44
Methods of Contraception: Depo-provera (medroxyprogesterone acetate)
Type
Advantages (3)
Disadvantages (3)
Type: hormonal
Advantages
- Can be used during lactation
- One injection, 4 times a yr.
- stops menses
Disadvantages
- Prescription only
- Delayed fertility return (1 yr)
- shot every 12 wks (compliance needed)
45
Methods of Contraception: Depo-provera and Progestin
6 side effects
- weight gain
- bleeding abnormalities
- decreased bone density
- headache
- mood changes
- breast tenderness
46
Methods of Contraception: Contraceptive patch
Type
Advantages (2)
Disadvantages (3)
Type: hormonal
Advantages
- New patch applied each week for 3 weeks then removes for 1 week (greater compliance)
- Usually applied anywhere but the breast
Disadvantages
- Prescription only
- Less effective for obese women
- Need backup if patch removed more than 24 hrs
47
Methods of Contraception: vaginal ring
Type
Advantages (2)
Disadvantages (2)
Type: hormonal
Advantages
- Ring inserted in vagina for 3 weeks then removed one week
- May be left in 28 days w/ immediate replacement after removal
Disadvantages
- Prescription only
- may cause vaginal irritation or discharge
48
Methods of Contraception: Emergency Contraceptives
Type
Advantages (4)
Disadvantages (2)
Type: hormonal
Advantages
- Reduces risk of pregnancy from one unprotected coitus but does not induce abortion
- OTC for women over 17 yrs. (prescription for younger)
- Suppresses ovulation
- only contraindication is confirmed pregnancy
Disadvantages
- Cannot be regular birth control
- Must take within 72-120 hrs of intercourse
49
Methods of Contraception: Emergency contraceptives
5 side effects
- nausea (may need antiemetic), vomiting, diarrhea
- headache
- fatigue
- abdominal pain
- change in menstrual bleeding
50
Methods of Contraception: Oral Combo, vaginal ring, patch
8 common side effects
- nausea, vomiting
- headache
- spotting
- weight gain (edema)
- breast tenderness
- chloasma
- increased risk for clotting, heart disease, stroke
- mood swings (change in libido)
51
Methods of Contraception: Oral Combo Contraceptives and patch
9 Contraindications
- hx of DVT, pulmonary emboli, CAD
- uncontrolled hypertension
- liver disease
- clotting disorders
- active cancer
- smoker (>35 yrs.)
- undiagnosed abnormal bleeding
- migraines with aura
- pregnancy
52
Methods of Contraception: Oral Combo Contraceptives and patch
7 serious side effects to report (Achhess)
- Hepatic mass or abdominal RUQ pain
- Severe pains in chest, left arm, neck
- Headache, Unilateral numbness, weakness, tingling
- Hemoptysis
- Eye problems- Loss of vision, proptosis, diplopia, papilledema
- Severe pains, tenderness, swelling, warmth in legs
- Slurring of speech
53
Methods of Contraception: IUD (copper or hormonal)
Advantages (6)
Advantages
- Can be placed during postpartum period and during lactation
- Highly effective (3-5yrs for hormonal, up to 10 yrs for copper)
- Copper can be emergency contraceptive within 7 days of intercourse
- Useful for teens or women with contraindications to other hormonal methods
- Quick return to fertility
- Often stops menses
54
Methods of Contraception: IUD (copper or hormonal)
Type
Disadvantages (4)
Type: Long-acting reversible contraceptive
Disadvantages
- Low risk for uterine perforation
- Contraindicated w/ pelvic inflammatory disease within 3 months
- preferred for monogamous women
- Increased cramping and bleeding in 1st few cycles
55
Methods of Contraception: Hormonal implants (Nexplanon- subdermal
Type
Advantages (4)
Disadvantages (3)
Type: Long-acting reversible contraceptive; hormonal but progestin-only
Advantages
- Minimal discomfort once placed
- Can be placed during postpartum period and during lactation
- Lasts several years (up to 3 yrs)
- More effective than sterilization
Disadvantages
- Must be removed eventually
- minor surgical procedure
- irregular menses bleeding
56
Methods of Contraception: Vasectomy
Type
Advantages (2)
Disadvantages (3)
Type: sterilization
Advantages
- Highly effective
- safe and easy recovery
Disadvantages
- Discomfort for 2-3 days
- Need another contraceptive for 2 days until sperm tests indicate procedure success
- Difficult to reverse
57
Methods of Contraception: Tubal Ligation (bilateral salpingectomy)
Type
Advantages (2)
Disadvantages (3)
Type: sterilization
Advantages
- Highly effective
- Immediately effective (unless tubal occlusion then 3 months till effective)
Disadvantages
- Surgical procedure
- Bleeding at incision site
- Difficult to reverse
58
What is an Abortion?
spontaneous (miscarriage), induced, therapeutic elective termination of pregnancy prior to 20 weeks’ gestation
59
Combo mifepristone-misoprostol OR methotrexate and misoprostol
Indication
Side effects (5)
Precautions (5)
- Indication: medical abortion within 70 days of gestation; takes days to weeks to be complete
- Side effects: heavy bleeding, severe cramping, nv, fever, chills
- Precautions: not recommended with ectopic pregnancy, IUD in place, long-term corticosteroid use or adrenal failure, anticoagulant therapy, porphyria
60
When is medical abortion preferred over surgical abortion? (4)
- uterine fibroids
- congenital uterine anomalies
- introital scaring
- asthma (acts as weak bronchodilatory
61
4 signs and symptoms to report to HCP post-abortion
- heavy bleeding (>2 maxi pads soaked in an hr. for 2 hrs straight)
- severe abdominal or back pain—may be products of conception retained
- foul-smelling discharge
- fever (above 100.4 F, 38 C)-- infection
62
Surgical abortions
- suction curettage/aspiration (3)
- dilation and evacuation (3)
Suction curettage/aspiration
- most common abortion
- Only for first trimester
- Cervix is dilated and thin plastic tube inserted in uterus and suctions pregnancy out
Dilation and evacuation
- 2nd trimester after 13 weeks of pregnancy
- Fewer complications than medical abortion
- Anesthesia is used then fetus is removed through vagina then suction removes excess tissue
63
Health Promotion for women
Diet (2)
Activity
Weight
Substance use (2)
Skin cancer prevention (3)
Diet
- Healthy diet low in saturated fat and sodium
- diet high in calcium to prevent
Activity (150 minutes of moderate physical activity (brisk walking, swimming, biking, dancing)
Maintain healthy weight (BMI over 30 is obese)
Substance use
- Avoid cigarettes, secondhand smoke, and e-cigarettes
- Limit alcohol consumption to 1 drink per days
Skin Cancer prevention
- Minimize UV radiation exposure (can lead to skin cancer, liver spots, actinic keratoses, solar elastosis, premature aging)
- Wear sun protective clothing, hat, sunglasses, SPF 15 sunscreen
- avoid sun b/w 10am and 2pm
64
Breast Cancer Screening Recommendations (4)
- Mammograms (annual from age 40 yrs or 10 yrs prior based on fam risk)
- MRI screening and mammogram for high-risk w/ known BRACA1 or BRACA2 mutation or family hx
- Monthly self-breast exam (done after menses starting at puberty)
- Clinical breast exam (annual from 40 yrs)
65
5 breast signs of breast cancer
- lump (usually in duct vs lobe, bump, hard lump)
- skin dimpling
- change in skin color or texture (red, sores, growing vein)
- nipple changes (inversion, pulling inward, crust)
- clear of bloody fluid leaking out nipple
66
4 Rs of trauma informed Care
- Realize the widespread effect of trauma and understand potential paths for recovery.
- Recognize the signs and symptoms of trauma in patients and families.
- Respond by fully integrating knowledge about trauma into your care and practice.
- Re-traumatization should be avoided; seek to actively resist re-traumatization (ask before touching, shift vs remove clothes)
67
Cervical Cancer Screening Recommendations (4)
- Pap tests every 3 years for 21-29 yrs.
- Pap test and HPV test every 5 years for 30-65 yrs.
- Women > 65 can stop cervical cancer screening if they have not had any precancerous cells found in the previous 10 years.
- Women w/ total hysterectomy can stop screening unless hysterectomy due to cervical precancer or cancer.
68
Women screening recommendations for the following:
- Colonoscopy
- Eye exam
- Hearing test
- Colonoscopy every 10 years for 50-75 then based on risk
- Eye exam at 40 yrs. then every 2-4 yrs, 1-2 yrs. for 65+
- Hearing test every 10 years till 50 then every 3 year
69
Women screening recommendations for the following:
- Blood pressure
- Type 2 diabetes
- DXA scan (for osteoporosis)
- Cholesterol
- STI tests
- Blood pressure every 1-2 yrs
- Type 2 diabetes yearly if overweight or over 45 yrs
- DXA scan (for osteoporosis) and Cholesterol based on hx
- STI tests yearly if sexually active and under 24, if new or multiple partners, or pregnant
70
Perimenopause/ climacteric period (5)
- typically when menopausal signs and symptoms begin
- lasts 4-8 yrs
- Pregnancy possible in this period
- Quality and quantity of ova decline gradually in late thirties leading to decreased estrogen and progesterone
- may have dysfunctional uterine bleeding/endometrial hyperplasia in obese
71
4 Situations of early menopause
- women who smoke
- women w/ shortened cycles (q21 days)
- women who have surgical removal or medical ablation of the ovaries (hysterectomy)
- Premature ovarian failure if menopause prior to age 40
72
Menopause (2)
- 12 months after last menstrual period
- natural phase of life
73
8 Signs and Symptoms of Menopause
- Irregular periods (longer or shorter cycles, change in flow; may be anovulatory)
- Hot flashes and night sweats due to vasomotor response to hormone levels
- Sexual dysfunction (decreased libido, dyspareunia (due to vaginal dryness), vaginal atrophy (thin and dry))
- Weight gain
- Dry skin and nails; loss of skin elasticity
- Food cravings
- irregular heartbeat or palpitations
- Psychological signs: mood swings, anxiety, lethargy, panic attacks, forgetfulness, difficulty coping, depression, irritability
74
4 Prevention/treatment of Hot flashes in Menopause
* Avoid alcohol, hot or spicy foods, caffeine, or stress
* Dress in layers and use fans
* Avoid wool or synthetic clothing
* Low-dose antidepressants (fluoxetine), antiseizure (gabapentin), antihypertensive (clonidine)
75
3 Prevention of Night Sweats in menopause
* Sleep in cotton nightwear and on cotton linen
* Sleep in cool room with fan
* Take cool shower prior to bed
76
6 Prevention of sleep disturbances in menopause
* Regular bedtime (get 8 hrs)
* No TV, cell phone, computer use in bed
* Keep room dark, quiet, and cool
* Wear loose fitting garments
* Eat dinner early (balanced diet and exercise
* No alcohol or caffeine close to bedtime
77
3 Treatment for sexual dysfunction due to menopause
* Use water-based lubricant (never oil based)
* Vaginal moisturizers and Estrogen vaginal cream
* Flaxseeds and soy flour decrease vaginal dryness
78
Menopausal Hormone Replacement Therapy (transdermal recommended)
Types (2)
Benefits (3)
Risks (2)
Two types
- Estrogen-only for women w/o uterus
- Estrogen and progesterone for women w/ uterus to reduce risk of endometrial cancer
Benefits
- relieve vasomotor symptoms (night sweats, flushing) and most other symptoms
- osteoporosis prevention
- decrease risk for colon cancer
Risks
- increased breast cancer risk
- increased CVD, DVT risks
79
9 risk factors for osteoporosis
o White women
o Thin, small-boned (BMI < or equal to 20)
o Fam hx of hip fractures
o Smokers
o Inactive lifestyle
o 3 or more alcohol drinks daily
o Certain meds: corticosteroids (> 3 months), Proton pump inhibitors, aromatase inhibitors
o Hx of eating disorders (anorexia), weight loss surgery
o Deficient calcium and vitamin D
80
Risk reduction for osteoporosis (5)
- Diet high in calcium and vitamin D starting at age 9 (Calcium food: sardines, yogurt, cheddar cheese, milk, salmon)
- Weight bearing exercise 3-4 times a week (walking, jogging, dancing, weightlifting)
- Avoid smoking and limit alcohol
- fall prevention (esp > 65)
- HRT (estrogen can prevent osteoporosis)
81
6 specific health concerns for adolescents
- Menstrual disorders (irregular periods common)
- Acne
- Eating disorders (obesity, anorexia, bulimia)
- STIs (esp. chlamydia and gonorrhea)
- teen pregnancy
- Mental health issues i.e., self-esteem, sadness (suicide 3rd leading cause of death)
82
5 Prevention/treatment of Dry skin in Older adults
* Increase fluid intake to 8 or more glasses
* Apply moisturizers or lotions daily.
* Use a humidifier in dry climates.
* Use mild soaps and warm water instead of hot water.
* sun exposure hygiene (Limit time in the sun, use sunscreens, and wear protective clothing when in the sun)
83
Best time to start contraception (2)
- when on menses
- if started at any other point, use condom for 2 weeks
84
5 Methods/Interventions to decrease STI risk for sexually active
- Monogamous relationship w/ partner who has been screened for STIs and is not infected
- Use dental dam or condoms every time you engage in sexual activity
- Pt discuss w/ partner the preferred method for staying safe before sexual activity AND past hx of STI
- Get regular pelvic, Pap, and HPV testing
- Nurse should provide info on transmission and treatment of STIs (even asymptomatic poses risk for transmission)
85
STI: Chlamydia
Etiology (2)
Diagnostic (2)
Treatment
Complications(2)
Etiology: most common STI, bacterial
Diagnostic: swab test (infected area of throat, rectum, urethra), urine test
Treatment: antibiotics (doxycycline; azithromycin) and treat partner
Complications: infertility, ectopic pregnancy
86
STI: Chlamydia
Symptoms (8)
Symptoms: usually asymptomatic (mucopurulent cervical discharge, dyspareunia, spotting, fever, urethritis, lower abdominal pain, nausea)
87
STI: Gonorrhea
Etiology
Diagnostic (2)
Symptoms (7)
Treatment
Etiology: bacterial
Diagnostic: swab test of infected area, home test
Symptoms: asymptomatic, vaginal discharge, abnormal uterine or postcoital bleeding, low backache, urinary frequency, dysuria, and pain during coitus
Treatment: antibiotics (IM ceftriaxone w/ azithromycin or doxycycline) and treat partner
88
STI: Trichomoniasis
Etiology (2)
Diagnostic (3)
Treatment
Etiology: protozoan, symptoms usually appear 5-28 days of exposure
Diagnostic: microscopic eval, rapid test, small red ulcers in vagina or on cervix
Treatment: antibiotics (metronidazole (disulfiram-like effects)) and treat partner
89
STI: Trichomoniasis
Symptoms (4)
- Usually asymptomatic
- frothy gray or yellow-green vaginal discharge with foul odor
- erythema, edema, pruritus of the external genitalia
- pain during coitus
90
STI: Syphilis
Etiology
Diagnostic (2)
Treatment
Etiology: bacterial
Diagnostic: rapid plasma regains, venereal disease research laboratory
Treatment: antibiotics (Doxycycline or Tetracycline) and treat partner
91
Primary syphilis (3)
- Symptom: single, painless ulcer (chancre) in the genital area, mouth, or point of contact.
- Chancer appears 10–90 days after contact.
- Chancre lasts 4–6 weeks and usually resolves w/o treatment.
92
Secondary syphilis
Symptoms (7)
Time period
What happens if not treated?
- Symptoms: skin rash, fever, sore throat, lymphadenopathy, muscle aches, weight loss, and fatigue
- 6 weeks-6 months after appearance of chancre.
- If not treated, the symptoms resolve within 2–10 week
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Tertiary syphilis
What happens if not treated?
W/o treatment, bacteria spreads throughout body, and symptoms related to internal organs damage
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3 Common symptoms of breast diseases
- Pain (usually from hormonal changes i.e., perimenopause OR cysts)
- Discharge from nipple (not common symptom of breast cancer)--Spontaneous (needs further eval); Elicited (normal if milky color and nonbloody)
- Palpable Breast masses (common and benign but evaluate to rule out malignancy)
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6 Modifiable risk factors for Breast Cancer
- Women who did not breastfeed
- Exposure to head or chest radiation
- Excess weight/ obesity or sedentary lifestyle
- Excess estrogen exposure through use of hormone therapy(including OCs)
- Excessive use of alcohol
- Exposure to diethylstilbestrol (DES)
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6 Nonmodifiable risk factors for Breast Cancer
- Increasing age (more common around menopause)
- BRCA1 or BRCA 2 defects
- Family hx of breast cancer (1st degree)
- Personal hx of breast cancer in at least one breast
- Dense breasts
- Excess exposure to estrogen through early onset of menarche or late menopause
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Diagnostics for Breast Cancer
4 diagnostics for breast cancer
What test is ideal?
- Mammogram(x-ray): give info on size and character of mass
- Ultrasound: determine if area of concern is fluid-filled cyst or solid mass
- MRI: differentiates benign from malignant tissue
- Biopsy: differentiate benign from malignant (ideal test w/ fine-needle aspiration)
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Diagnostics for Breast Cancer
When is MRI preferred over mammogram? (3)
Best for dense, fibroglandular breast, scar tissue from previous surgery, or new tumors in women w/ previous lumpectomy
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4 Surgeries for Breast Cancer
- Lumpectomy: lump and some of surrounding normal tissue removed. (Usually followed by radiation and is Breast conserving)
- Partial or segmental mastectomy: tumor, surrounding breast tissue, a portion of the lining of the chest wall, and some of the axillary lymph nodes removed. (Usually followed by radiation therapy)
- Simple mastectomy: All the breast tissue along with the area surrounding the nipple and areola are removed. (May be followed by radiation therapy, chemotherapy, or hormone therapy.)
- Modified radical mastectomy: entire breast and several axillary lymph nodes are removed; the chest wall is left intact.
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Radiation therapy
When done?
Two types
- usually 3 to 4 weeks after surgery
Types
* External radiation: machine aims radiation toward the tumor (5 days a week for 5-6 wks.)
* Internal radiation (mammo site): radioactive substance sealed in needles, seeds, wires, or a catheter placed directly into or near the tumor. (BID for 5 days i.e., 10 sessions)
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Chemotherapy (ex. Anthracyclines, taxanes, docetaxel, 5-fluorouracil (5-FU), Cyclophosphamide, Carboplatin)
Indication
Big side effects (8)
Indication: usually used for advanced metastatic cancer or prevention of recurrence of cancer after Oncotype DX test done to determine if likely to benefit
Side effects: NVD, myelosuppression (anemia, thrombocytopenia, neutropenia), loss of appetite, constipation, hair loss, nail changes, mouth sores (mucositis and stomatitis), fatigue
102
Tamoxifen, toremifene- antiestrogen medication
Indication
Action
Side effects (4)
Indication: used hormone therapy in breast cancer
Action: bind to protein receptors on estrogen-receptor positive cells, blocking estrogen binding and reducing influence of estrogen on tumor.
Side effects: fatigue, hot flashes, vaginal dryness or discharge, mood swings
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Fulvestrant
Indication (2)
Indication: treat hormone receptor (HR)-positive metastatic breast cancer in postmenopausal women OR HR-positive, HER2-negative advanced breast cancer.
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Anastrozole, letrozole, exemestane-- Aromatase inhibitor
Indication
Action
Side effects (3)
Indication: used as hormone therapy in postmenopausal women w/ estrogen-receptor positive cancer
Action: Interferes w/ amount of estrogen produced by the woman’s body tissue (not the ovaries) by blocking the conversion of androgens into estrogens.
Effects: muscle pain, joint stiffness, bone thinning
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Trastuzumab (Herceptin)
Indication
Action
Side effect
Indication: targeted therapy for breast cancer that overproduces HER2
Action: monoclonal antibody that directly targets the HER2 protein of breast tumors
Side effect: heart problems(CHF)
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8 Risk factors for cervical cancer
- Primary cause is HPV (most common STI)
- Early onset of sexual activity (before age 16)
- Cigarette smoking
- Immunocompromised
- Multiple sex partners
- In utero exposure to DES
- Use of oral contraception for 5 or more years
- Multiparity (3 or more)
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Two main diagnostics for Cervical Cancer
- Pap smear for early screening (If abnormal Pap test or HPV screening, further eval done)
- Colposcopy (visual exam w/ biopsy) = definitive diagnosis by APRN or OB-GYN
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Progression of Cervical Cancer (3)
- typically, slow growing
- Begins with dysplasia (precancerous condition that is treatable w/ cryotherapy)
- If dysplasia not treated, cervical cancer develops and metastasize
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8 Signs and Symptoms of cervical Cancer
- None in early stage
- Vaginal discharge (watery, pink, brown, bloody, or foul-smelling)
- Leaking of urine or feces from the vagina
- Abnormal vaginal or uterine bleeding b/w periods, after intercourse, or after menopause
- Dyspareunia (pain w/ intercourse)
- Loss of appetite or weight
- Fatigue
- Pelvic, back, or leg pain
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7 Medical management options for cervical cancer
- LEEP (burn off cervix; may leave scar tissue which can impair fertility)
- Conization (cervical cone biopsy)
- Cryosurgery
- Total or radical hysterectomy
- Radiation
- Chemotherapy (if metastasized or recurrence)
- Targeted therapy (Angiogenesis inhibitors (bevacizumab)) for advanced cervical cancer – adjuvant to chemo)
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Nursing Management of Reproductive Cancers (6)
- Provide emotional support to patient and family including opportunities for patient to share feeling and concerns
- Encourage patient to consider all options and seek opinions multiple professionals
- Provide info on optimizing nutrition (to prevent malnutrition)
- Recommend community resources (Breast cancer support or body image programs)
- Encourage sleep and rest to promote healing.
- Provide info on alt modalities to reduce side effects of treatment i.e., imagery, journaling, hypnosis
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Patient education for radiation therapy (4)
- Teach importance of skin care to decrease risk of tissue breakdown.
- Check w/ HCP on types of lotions and creams to use.
- Avoid the use of adhesive tape on the treatment area.
- Expose treatment area to air, when possible, to promote skin integrity.
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5 male causes of infertility
- Endocrine (Pituitary diseases or tumors, hypothalamic diseases, Low levels of LH, FSH, testosterone or high levels of estrogen and cortisol decrease sperm production)
- Gonadotoxins (facts that interfere with spermatogenesis)
- Sperm antibodies (produce immune reaction and decrease sperm motility; seen in vasectomy reversal or after testicular trauma)-- not common)
- Sperm transport factor (missing or blocked structures in male anatomy that interfere w/ sperm transport, i.e. vasectomy, prostatectomy, inguinal hernia, congenital absence of vas deferens)
- Intercourse disorders i.e., erectile dysfunction, ejaculatory dysfunction (retrograde or premature ejaculation), anatomical abnormalities (hypospadias, varicocle, torsion), or psychosocial reasons
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6 Gonadotoxins
- Drugs (chemotherapeutics, CCBs, heroin, alcohol, marijuana, smoking)
- Infections (prostatitis, STIs, mumps after puberty)
- Systemic illness
- Prolonged heat exposure to testes (hot tubs, tight underwear, frequent bike riding)
- Pesticides
- Radiation to pelvic region
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3 major factors contributing to female infertility
- Ovulatory dysfunction (anovulation or inconsistent ovulation)
- Tubal and pelvic factors (Damage to fallopian tubes due to previous PID or endometriosis; Uterine fibroids, benign growths of muscular wall of uterus narrow uterine cavity -> spontaneous abortion)
- Cervical mucus factors (interfere w/ ability of sperm to enter or survive in uterus)-- Infection; Cervical surgery (cryotherapy- treats cervical dysplasia)
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What is infertility?
What is most effective way to get pregnant?
Who diagnoses infertility?
- Infertility: inability to conceive after 12 months (6 months if >35) of unprotected sexual intercourse
- Most effective way to get pregnant: sex every other day after menses OR when you know you’re fertile
- women diagnosed by obgyn or repro endocrinologist; urologist diagnoses men
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8 Tests for infertility
- STI screening
- Lab tests for hormonal levels (TSH, FSH, LH, anti-Mullerian hormone (AMH), testosterone)
- Semen analysis and penetration assay (may need multiple; cheap)
- LH surge test (ovulation predictor test b-c LH surges 36 hrs before ovulation)
- Ovarian reserve test
- Sonohysterogram or hysteroscopy evaluates uterus
- Hysterosalpingogram (HST)
- scrotal ultrasound
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Ovarian reserve Test
Purpose
Process (2)
Purpose: determine size of remaining egg reserve for Infertility
Process
- On day 3 of menstrual cycle, blood drawn to evaluate levels of FSH, estradiol, and AMH
- On same day, transvaginal ultrasound done to assess ovarian volume and antral follicle count
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Hysterosalpingogram
Purpose
What is it useful for?
Purpose: radiological exam with dye to give info on endocervical canal, uterine cavity, and fallopian tubes for infertility analysis
Useful to detects tubal problems such as adhesions, occlusions, or uterine abnormalities (fibroids, bicornate uterus, and uterine fistulas)
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Semen analysis (may need multiple; cheap)
Purpose
Procedure (2)
Purpose: analyze volume, sperm concentration, motility, morphology, WBC count, immunobead, and mixed agglutination reaction test to determine fertility
Process
- Man abstains for 2-3 days then masturbates to provide semen sample
- Specimen provided at site of testing or within 1 hr. of collection at home
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2 Surgical treatments for Female Infertility
- Open the fallopian tubes if tubal abnormalities are present
- Myomectomy: Removal of uterine fibroids
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3 lifestyle modifications for infertility due to anovulation or abnormal sperm count
- stress reduction
- improved health (weight control, daily exercise, proper nutrition)
- Abstinence from alcohol, nicotine, recreational drugs
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7 drugs used to stimulate ovulation
* Clomiphene citrate (very high success rate)
* Letrozole-ovulation induction
* Injectable gonadotropins (HCG, FSH)
* Gonadotropin-releasing hormone [GnRH] pump
* Progesterone
* Bromocriptine
* Metformin- restores cyclic ovulation and reduces insulin levels
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Clomiphene citrate
Indication
Side effects (8)
Indication: stimulate ovulation; high success rate
Side effects (generally safe): hot flashes, blurry vision, breast discomfort, headaches, insomnia, bloating, nausea, vaginal dryness
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4 Treatments for Male Infertility
- Hormonal therapy for endocrine factors
- Corticosteroids to decrease sperm antibodies
- Repair of varicocele or inguinal hernia to facilitate sperm transport
- Transurethral resection of ejaculatory ducts to treat disorders related to intercourse
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5 Options for Patients dealing with infertility
- Drug therapy, lifestyle modifications, or surgery to resolve cause (if known)
- Adoption
- Gestational surrogate (another women carries baby)
- cryopreservation (freezing eggs)
- Assisted reproductive technologies (ART): surgical removal of oocytes and combination of them w/ sperm in lab (many ethical questions)
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Virus vs infection (in repro world)
Two things they have in common
How do the differ?
Common: contagious, can harm fetus
virus is unable to be cured and has recurrent flares; while infection is treated and cured
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STI: Herpes (HSV2)
Risk factors (2)
Diagnostic
Symptoms (2)
Implications for fetus
Risk factors: unprotected sex; recurrence w/ stress, pregnancy, immunocompromised
Diagnostic: definitive w/ culture of active lesion
Symptoms: multiple, shallow, tender vesicular ulcers; tingling sensation in vagina (if ulcers inside)
Implication for fetus: cesarean birth if lesions in vaginal canal or cervix at time of birth
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8 Causes of ovulatory dysfunction leading to infertility
- hormonal imbalances
- hyper or hypothyroidism
- high prolactin
- PCOS
- premature ovarian failure (menopause before 40 yrs.)
- Eating disorders
- Chronic conditions (diabetes, obesity, autoimmune)
- excessive exercise
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4 reasons to consider prophylactic mastectomy or oophorectomy
- Mutated BRCA genes found by genetic testing
- Strong family history (such as breast cancer in several close relatives)
- Lobular carcinoma in situ (LCIS) detected on biopsy
- Previous cancer in one breast (especially in someone with a strong family history)
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STI: HPV
Risk factor(2)
Symptoms
Prevention (2)
Risk factors
- age 16, 18, 45 (common in sexually active but usually reverts in 6-12 months)
- cigarette smoking
Symptoms: genital wart lesion on skin
Prevention of new disease (not treatment): Gardasil – HPV vaccine – from age 11-26 in US x2 doses if <15, 3 doses if >15; condom use
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3 Components needed for Unassisted Human Conception
- sperm and egg for fertilization (hormonal balance, adequate sperm # and motility to travel 12-24 hrs to ova)
- cervix and uterus for housing (cervix that is open enough for sperm to enter; Uterus must be receptive to implantation)
- fallopian tubes for transportation ( must be open and able to allow transfer of the ovum)
133
Prostaglandin (2)
- A hormone that oxygenates fatty acids
- affects ovulation, fertility, changes in cervix and mucus, tubal and uterine motility, menstruation, miscarriage, and labor
134
Side effects of radiation therapy (10)
Side effects: diarrhea, skin changes (redness or bruising), fatigue, fertility issues, urinary and bladder issues, breast pain, infection, breakdown of fatty tissue in the breast, fracture of the ribs (rare), diarrhea
135
Stages of the endometrial cycle: menstrual cycle
Sloughing off and expulsion of endometrial tissue if no pregnancy)
136
Stages of endometrial cycle: secretory phase (4)
- After ovulation until menstruation onset
- Endometrium thickens more (primary hormone is progesterone)
* If pregnancy occurs, endometrium develops more and secretes glycogen (energy source for blastocyst)
* If pregnancy does not occur, corpus luteum degrades and endometrium degenerates
