Exam 1: Infertility, Breast Disorders, Structural Disorders & Neoplasms Flashcards by Kalyn21Blessing .

inability ot conceive

Sterility

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prolonged time to conceive

Infertility

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Infertility affects about ___% of reproductive-age couples; increases with age (especially over ______ years_

18%
35 years

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Before age 35, couples have _____-_____% chance of conception at each ovulation

25-30%

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Least invasive way to check couple’s fertility

semen analysis

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Cause of female infertility: (3)

-Ovarian factors
-Uterine, tubal, and peritoneal factors
-pre-existing conditions

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Cause of female infertility:
Other factors (pre-existing conditions) (6)

-Nutritional deficiencies (anemia)
-Obesity
-Substance abuse
-Thyroid dysfunction
-Genetic Disorder
-Anxiety/Depression

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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

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Reproductive alternatives (5)

-Ovarian stimulation
-Egg/sperm/embryo donation
-Therapeutic donation insemination (TDI)
-Gestational or surrogate motherhood
-Adoption

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Ovarian stimulation is followed by one of the following (4)

-IUI
-IVF-ET
-GIFT
-ZIFT

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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

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breast self-exams are no longer recommended due to

lack of efficacy

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regular mammograms recommended starting at age

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underdevelopment of breasts

micromastia

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breast hyperplasia

macromastia

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Breast development abnormalities include (2)

-asymmetric breast development
-Supernumerary nipples or breasts along the milk line

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Changes characterized by lumpiness with or without tenderness bilaterally;
Most common benign problem with breasts

Fibrocystic breast disease

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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

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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

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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

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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

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Most common solid mass of breast

Fibroadenoma

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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

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Fibroadenoma
Diagnosis: (4)
Treatment: (2)

D: mammography
-ultrasound
-MRI
-Core needle biopsy

T: observation and surgical excision

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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