Exam 1: Infertility, Breast Disorders, Structural Disorders & Neoplasms Flashcards
inability ot conceive
Sterility
prolonged time to conceive
Infertility
Infertility affects about ___% of reproductive-age couples; increases with age (especially over ______ years_
18%
35 years
Before age 35, couples have _____-_____% chance of conception at each ovulation
25-30%
Least invasive way to check couple’s fertility
semen analysis
Cause of female infertility: (3)
-Ovarian factors
-Uterine, tubal, and peritoneal factors
-pre-existing conditions
Cause of female infertility:
Other factors (pre-existing conditions) (6)
-Nutritional deficiencies (anemia)
-Obesity
-Substance abuse
-Thyroid dysfunction
-Genetic Disorder
-Anxiety/Depression
Causes of male infertility (5)
-poor sperm quality
-structural and hormonal disorders
-genetic disorders
-decreased libido
-impotence r/t alcohol, antihypertensives, or anti seizure meds
Reproductive alternatives (5)
-Ovarian stimulation
-Egg/sperm/embryo donation
-Therapeutic donation insemination (TDI)
-Gestational or surrogate motherhood
-Adoption
Ovarian stimulation is followed by one of the following (4)
-IUI
-IVF-ET
-GIFT
-ZIFT
Goals of initial breast evaluation: (2)
-distinguish benign from malignant in situ or invasive tumors of the breast
-assess the risk of subsequent breast cancer associated with lesion
breast self-exams are no longer recommended due to
lack of efficacy
regular mammograms recommended starting at age
45
underdevelopment of breasts
micromastia
breast hyperplasia
macromastia
Breast development abnormalities include (2)
-asymmetric breast development
-Supernumerary nipples or breasts along the milk line
Changes characterized by lumpiness with or without tenderness bilaterally;
Most common benign problem with breasts
Fibrocystic breast disease
Fibrocystic breast disease
Etiology:
Manifestations: (4)
E: estrogen and progesterone fluctuations
M:
-lumpiness bilateral breasts
-single cyst may occur
-dull heavy pain
-sense of fullness and tenderness (upper outer quadrant) with premenstrual period
Fibrocystic breast disease
diagnosis:
treatment: (6)
D: ultrasound to determine fi lump is fluid filled or solid
T: aspiration of fluid filled cysts
-oral contraception
-danazol, bromocriptine, tamoxifen
-evening primrose oil
Mastalgia
Etiology:
Assess:
E: hormonal, cystic, trauma, surgery
A: character and pattern of breast pain to determine whether pain is cyclic or noncyclic, diffuse or focal
Mastalgia:
Diagnostics (4)
Treatment (4)
D: serological tests for prolactin and hCG
-ultrasound
-mammography
-aspiration and biopsy of cysts
T: dietary changes
-NSAIDS
-hormone treatment
-evening primrose oil
Most common solid mass of breast
Fibroadenoma
Fibroadenoma characteristics (3)
-discrete
-solitary lumps less than 3 cm in diameter that can be tender during menstruation
-no changes in size or shape over time
Fibroadenoma
Diagnosis: (4)
Treatment: (2)
D: mammography
-ultrasound
-MRI
-Core needle biopsy
T: observation and surgical excision
Mammary duct ectasia
Characteristics
Signs (5)
C: dilated ducts and nipple inversion during perimenopausal period
S: pain
-redness of skin
-nipple inversion
-green nipple discharge
-may have fever or abscess
Bilateral, spontaneous, milky, sticky discharge r/t increased prolactin levels
Galactorrhea
Galactorrhea diagnostic test: (4)
prolactin level
thyroid profile
pregnancy test
mammogram
concerns about single breast nipple discharge
increase concern of breast cancer
Intraductal papilloma signs
serous, serosanguineous, or bloody nipple discharge that is unilateral and spontaneous
Intraductal papilloma
diagnostics:
treatment:
D: ductogram
mammography
core biopsy
T: surgical excision recommended
most common breast infection:
cellulitis with or w/o abscess formation
breast infection
-Risk (7)
-Pathogenesis (2)
R: obesity
large breasts
surgery
radiation
sebaceous cysts
smoking
diabetes
P: Staph aureus
-MRSA
Breast infection
Signs: (5)
Diagnostics: (2)
Treatment: (2)
S: pain, red skin, thickening of skin, warm skin, abscess
D: ultrasound
-fluid collection
T: aspiration of abscess
-antibiotic therapy
Second leading cause of cancer death in women ages 45-55
Breast cancer
Nonmodifiable risk factors for breast cancer (8)
-gender
-age
-time or menarche
-menopause
-time of first live birth
-personal hx of breast cancer
-fibrocystic changes
-estrogen level
Modifiable risk factors for breast cancer (7)
-body weight
-diet
-regular exercise
-high saturated fat consumption
-high alcohol consumption
-oral contraception
-HRT use
Genetic risk for breast cancer:
BRCA1 & BRCA 2 creates 85% chance of developing breast cancer
Chemoprevention drugs:
tamoxifen
raloxifen
Most common form of malignant breast disease; originates in lactiferous ducts
Invasive ductal carcinoma
S/S or invasive ductal carcinoma: tumor is:(5)
-unilateral
-not well delineated
-solid
-nonmotile
-contender
malignant breast disease that originates in lobules of breasts
lobular carcinoma
S/S of lobular carcinoma (2)
-nonpalpable
-appears small on imaging studies than actual size
Malignant breast disease that originates in the nipple and usually occurs with invasive ductal carcinoma
Nipple Carcinoma (Paget disease)
S/s of Nipple Carcinoma: (3)
-bleeding
-oozing
-crusting of the nipple
Clinical manifestation of Breast cancer (2)
-palpable lump or ill-defined thickening of breast without pain
-nipple retraction, skin dimpling, or skin changes (redness with edema, pitting of skin)
Diagnosis of Breast Cancer
-Screening mammogram recommended yearly
-diagnostic mammogram or ultrasound used to f/u on irregularities; MRI can also be used
-Biopsy used for pathology; staging follows
Staging of breast cancer goes off
-TNM system
-Grading System
-Biomarker testing
Treatment of breast cancer (4)
-Surgery
-Radiation
-Chemotherapy
-Plastic surgical reconstruction
Breast cancer intervention chosen based on: (2)
-staging
-characteristics of abnormality
removal of the small tumor and a rim of healthy tissue around it to ensure clearance of margins
lumpectomy
wide excision of a region of the breast to remove tumor
segmental (partial) mastectomy
complete removal of the breast, including the nipple and areola
Mastectomy
Types of mastectomys (5)
-total simple
-modified radial
-skin-sparing
-nipple sparing
-preventive/ prophylactic
Nurse interventions dealing with breast cancer
-provide emotional support
-explain treatment and provide pre-operative and post-operative education
Variation of normal uterine placement, most commonly posterior displacement, retroversion, retroflexion, and anteflexion
Uterine displacement
serious type of displacement in which uterus protrudes down into vagina
uterine prolapse
the protrusion of the bladder downward into the vagina when supporting structures in vesicovaginal septum are injured
Cystocele
Herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum
Rectocele
Perforations between genital tract organs, most commonly between bladder and genital tract, urethra, and vagina, or rectum and vagina
Genital fistula
sudden increase in intra-abdominal pressure causing involuntary urine loss
Stress UI
urgency to void without adequate location or time to avoid incontience
Urge UI
Involves both stress and urge UI with multifactorial causation
Mixed UI
Benign Neoplasms
-Ovarian cysts
-Polycystic ovarian syndrome (PCOS)
-Uterine Polyps
-Leiomyomas
types of leiomyomas (4)
Fibroid tumors
Fibromas
Myomas
Fibromyomas
Functional ovarian cysts are dependent on
hormonal influences r/t menstrual cycle
Uterine polyps are common in:
multiparous women <40 years of age
Most common benign tumors of the reproductive system; often occur after ______ yrs old
leiomyomas
50 yrs old
Most at risk for Leiomyomas (3)
-alcoholic women
-women who have never been pregnant
-overweight women
Malignant Neoplasms
Incidence:
Greatest risk:
consideration:
I: 110,00 women dx with gynecological cancer in 2018
GR: obesity
C: delay of 2 years from end of cancer therapy to conception
Most common malignancy of the reproductive system
endometrial cancer
second most frequently occurring reproductive cancer
ovarian cancer
third most common reproductive cancer
cervical cancer
Recognized as the most curable gynecological malignancy
Gestational Trophoblastic Neoplasia
