Exam #6 - FINAL Flashcards

Question 1

Q

breat self exam

Answer

A

while laying down use three middle fingers and apply 3 levels of pressure in a circular motion. follow an up and down pattern
check for changes with hands on hips and chest muscles flexed
examine under arm while upright with arms slightly raised
start at age 20
perform monthly after menses so there is decreased swelling and tenderness
check the underarm lymph nodes

Question 2

Q

mastalgia

Answer

A

breast pain
most common breast complaint in women, usually benign
usually conincides with menstrual cycle, decreases with menopause
noncyclic mastalgia may be due to trauma, arthritic pain, fat necrosis
wait 7-10 days to see if it goes away. if continuous then look into other things

Question 3

Q

mastitis

Answer

A

inflammation that occurs most frequently in lactating women
s/s; redness, pain, tenderness, fever
tx: antibiotics, continue breathfeeding (if no draining coming out), if it foesnt improve need to evaluate more closely for inflamm breast cancer, can develop into abscess that requires drainage
crack in nipple –> staph enters –> infection
occurs in lots of breatfeeding women

Question 4

Q

breast lumps

Answer

A

most are beign, should be followed up
fibroadenoma: hard, very mobile, teens to 30s, associated with increase in estrogen/progesterone, not cancerous but still check in with doctor
fibrocystic breast disease: multiple lumps that get bigger with menses, late teens to 40s, increase in size during menstruation, will go away after menopause
ductal ectasia: hard lumps with nipple discharge and enlarged lymph nodes, near menopause
intraductal papilloma: bloody nipple discharge, usually no lump, ages 40-55, benign tumors that are soft, clog up milk ducts and increase inflammation and swelling, have to be removed

Question 5

Q

Fibrocystic changes

Answer

A

round, well-delineated, mobile lumps that get bigger before menses
painful, swelling and tenderness
may have nipple discharge that is milky, green, and yellow
not genetic
tx: wait 7-10 days to see if related to menses, breast self exam to watch for changes, cysts can not turn into cancer!, may need aspiration and biopsy to be safe

Question 6

Q

age-related breast changes

Answer

A

pendulous breasts
decreased breast tissue
increased risk of breast cancer above age 60
muscles atrophy
tx: good support bra to decrease back pain, careful palpation of breast tissue, continue with annual mammograms (age 40) and monthly BSEs
mammograms: if 1st degree relative with cancer then make sure to start getting mammograms 10 years before they were diagnosed

Question 7

Q

gynecomastia

Answer

A

enlarged breast tissue in males
decreaesd testosterone levels
meds: digoxin, resperdol, steroids, marijuana, cocaine
tumor on pituitary
can resolve with tx

Question 8

Q

breast cancer risk factors

Answer

A

aging > 60
long menstrual history (early menarche before age 12 and late menopause after age 50)
no pregnancies or first pregnancy after age 30
genetics
may be affected by obesity, high fat diet, high alcohol usage, long term estrogen replacement (not BC pills)

Question 9

Q

Breast cancer

Answer

A

non-cancerous lumps = round, symmetrical, mobile
s/s: fixed, non-round, pus, inverted nipple, skin dimples, changes in skin color/texture
DX: mammogram at 40 x 1 yr, earlier if at high risk; ultrasound if suspicious mammogram; ultrasound is suspicious then do biopsy - open surgical biopsy, fine needle aspiration, stereotactic or ultrasound core biopsy

1) BSE
2) MD appt
3) mammogram
4) ultrasound
5) biopsy

Question 10

Q

fine needle aspiration

Answer

A

gives definitive diganosis
local anesthesia
needle into area and collect cells
may do a 2nd sample just to confirm negative
core needle specimen: collects more tissue and is more accurate

Question 11

Q

stereotactic core biopsy

Answer

A

prone position, spot for breat to hang

- collects thicker core samples of breast tissue

Question 12

Q

prognostic testing

Answer

A

axillary lymph node involvement: most important prognostic factor
lymph mapping and sentinel lymph node dissection: sentinal node is the node that drains first from the tumor site
tumor size and shape: larger tumor = poorer prognosis, more well-differentiated the tumor the less aggressive it is
Estrogen (ER) and progesterone receptor (PR) status: receptor-positive tumors have lower chance of recurrence and are responsive to hormone therapy, tumor positive for estrogen and progesterone is good
HER-2/neu gene expression: if high, tumor tends to grow fast and is resistance to tx (except herceptin)

Question 13

Q

sentinal lymph node dissection

Answer

A

blue dye injected, cut out blue lymph node and channels then sent to determine if cancerous cells in lymph channels as well
if cancerous, all lymph nodes in axillary will be removed
can increase lymph edema

Question 14

Q

lumpectomy

Answer

A

take out tumor and flesh around it
if not enough tissue to salvage then lymphectomy wouldnt be done
remove lump then radiation to breat and tissue area

Question 15

Q

axillary lymph node dissection

Answer

A

cancer in lymph nodes
remove all lymph nodes in that area
risk for lymph edema

Question 16

Q

restoring arm fxn after lymphectomy/mastectomy

Answer

A

immediately post op: HOB 30 degrees, arm up on pillow, support arm when walking, dont walk with hunched back, flex and extend fingers
1st day post op: ball squeezes, flex and extend elbow
later: add exercises
home care teaching: call if fever/inflamm/redness/back pain/weakness/SOB, no lotions/ointments/deoderant at incision, fit prosthesis 6-8 weeks post op, use barrier birth control if taking chemo or radiation

Question 17

Q

lymphedema

Answer

A

post signs: no BP, no IV, no blood draws in that arm - can increase edema
protect from any trauma (sunburn, pinprick)
treatment for active lymphedema: elastic bandages, compression sleeves, massage therapy, exercises, elevate above heart level
can last 5 years post surgery

Question 18

Q

radiation

Answer

A

localized site and some surrounding tissue
done to target basement membrane
5 days a week x 5 weeks
monitor signs of infection
chemo first and then radiation used

Question 19

Q

medications

Answer

A

chemotherapy: affects rapidly dividing cells; side effects = n/v, anorexia, weight loss, weight gain, hair loss, bone marrow supression, fatigue
hormone therapy: tamoxifen; side effects = hot flashes, mood swings, vaginal dryness, increases risk of blood clots, cataracts, vision problems, stroke, endometrial cancer in postmenopausal women; given to pts with estrogen/progesteron-dependent tumors; mimicks menopause
biologic/targeted therapy: herceptin; side effects = heart failure, ventricular dysfunction; given to pts with HER-2 gene
stem cell transplant: increased bone marrow, helps make more new cells

Question 20

Q

reconstruction options

Answer

A

immediate, delayed-immediate or delayed
saline or gel implant
tissue expanders used
flap (autologous): wont restore sensation
will take 3-6 months to see true change in appearance
must continue BSE
must have annual mammograms

Question 21

Q

breast implants and tissue expanders

Answer

A

tucked under pectoral muscles
cancer can still develop in pectoral basement
expander can either expand or work as actual implant
easy recovery, few weeks
increased risk of complicaitons so women should massage and move around implant to prevent fibrin buil-up

Question 22

Q

breast flap procedures

Answer

A

TRAN, Trans abdominal cutaneous flap
abd muscle used to create a breast mound
doctor does a tummy tuck
weeks to months to recover
more natrual
less long term complications

Question 23

Q

breast augmentations

Answer

A

cosmetically create a nipple
tattoo nipple
breat implant under breast tissue or muscle

Question 24

Q

breast reduction

Answer

A

cut around nipple, remove fat and tissue

- helps with back pain

Question 25

Q

STIs

Answer

A

more susceptible if female, young, already have another STI
## can transmit STI even if no s/s

Question 26

Q

STI tx

Answer

A

oral, IM or IV abs; creams will not work
viral STDs are not curable (herpes, HPV)
s/s recur because they are re-infected
must tx all sexual partners for past 30-60 days
no sex for 7 days even with condom, wait for meds to work, skin integrity

Question 27

Q

STI prevention

Answer

A

abstinence is best but latex condom is next best
oral contraceptives increase risk of STDs
spermididal jellies and creams do not prevent STDs

Question 28

Q

STI assessment

Answer

A

recent (last 30-60 days) sexual contacts - most important thing to ask
type of birth control used
condom use
history of STDs
use of IV drugs
sexual activities
oral BC can change PH of vagina

Question 29

Q

STI teaching

Answer

A

take all abx as directed
return for follow up and re-culture
no douching, clean genitals and urinate after sex: can increase risk of pelvic inflamm disease

Question 30

Q

STI info

Answer

A

gonorrhea, syphlis, and often chlamydia are reportable diseases
screening programs are targeted towards women because of vaginal environment, asymptomatic or longer for s/s to show up

Question 31

Q

STI transmission

Answer

A

usualyl through sexual activity
gonorrhea and chlamydia are hand in hand, always give abx for both if a person has one
syphilis: open lesions are highly contageous
herpes: skin to skin contact even if no visible lesions

Question 32

Q

STI s/s

Answer

A

often asymptomatic, especially for women

- throat, mouth, eyes, anus can also become infected

Question 33

Q

lab tests for STIs

Answer

A

urine/discharge cultures, DNA and antigen tests
gonorrhea: smears, gram stains are not helpful for diagnosis in women (women’s natural flora can give false positives)
HPV: no way to test men, only way to tell is if they get worts
syphilis: VDRL or RPR (rapid plasma recongent test) is screening test, must folow with FTA-Abs (fluoresant treponema antibody absorption test) or TPPA (T palidum partico agglutination test) to diagnose
if VDRL or RPR come back positive then must follow up with FTA-Abs/TPPA test to make sure it is not a false positive

Question 34

Q

STI Tx

Answer

A

gonorrhea or chlamydia: 2 drugs for gonorrhea or chlamydia because we are going to treat both: ceftriaxone, cefixine, boxycyclizine or azithromycin
HPV: cryotherapy, heat, chemicals, laser to remove; gardisil vaccine to prevent strains 16 & 18 (commonly linked to cancer or cervical and penile), can be given to age 9-26, preferably before sexual activity, 3 IM shots over 6 month period
herpes: oral acyclovir, can also use as suppression therapy; condoms even if no lesions, no sex if lesions are present, Famcycloviere, Acyclovere, Bancyclovere FAV tx; if HSV2 and 6+ outbreaks then need to be put on FAV
syphilis: penicillin G (IM) or doxycycline PO; wear gloves if pt has lesions!

Question 35

Q

STI Cure

Answer

A

yes: gonorrhea, chlamydia, syphilis. bacterial with abx, can cause systemic issues, pelvic inflamm disease
no: HPV, herpes, HIV. viral, no cure, always a carrier
gonorrhea has some resistant strains, take full course of meds
most common cause of reoccurance is REINFECTION (NOT a tx failure)

Question 36

Q

STI complications

Answer

A

infertility (except for HPV and herpes), Pelvic inflamm disease, ectopic pregnancy, more STIs, HIV infection
HPV: cervical, penile, ovarian cancers
Hepres: keratitis, metastatic lesions, AIDS
syphilis: eyes, heart, brain, bone, skin damage, deat, shut down organs, blindness, aortic anyeurisym, neurosponalis, limp/gait issues

Question 37

Q

STI risks to fetus, newborns

Answer

A

miscarriage, premature birth, eye infections, blindness (can give eye drops prophylaxis for gonorrhea)
HPV: can block birth canal, resp disease
herpes: can be fatal to neonate
syphilis: stillbirth, birth defects

Question 38

Q

benign prostatic hypertrophy (BPH)

Answer

A

occurs in 50% of men > 50, 90% men > 80
doesn’t increase risk of prostate cancer
causes: buildup of tissue in inner part of urethra, endorcrine changes associated with aging
patho: develops in inner part of prostate, enlargement compresses the urethra
risk factors: obesity, physical activity, alcohol, smoking, diabetes, family history of BPH, aging
decrease in testosterone –> increase in estrogen –> increased cell growth and deoxyhydrotestosterone
hypertrophy: size of enlargement is not as significant as lcoation

Question 39

Q

BPH s/s and complications

Answer

A

s/s: gradual onset, worsen as obstruction increases, symmetrically enlarged, firm, smooth prostate
obstructive: decrease in force of stream, difficulty starting stream, intermittency in stream, dribbling
irritative: frequency, urgency, painful urination, bladder pain, nocturia, incontinence
cx: fairly uncommon, but could cause urinary incontinence, UTI that could lead to sepsis, bladder stones (alkalitive urine), renal failure from hydronephrosis (post renal failure), pyelonephrosis, bladder drainage

Question 40

Q

BPH diagnosis-

Answer

A

history and physical exam: look for enlarged, firm, smooth prostate
digital rectal exam
american urinary association survey for BPH
UA with culture to r/o infection
PSA to r/o cancer, normal 0-4
serum creatinine to r/o renal issues
transrectral ultrasound (TRUS) with biopsy to r/o cancer
uroflowmetry to see the extent of blockage
postvoid residual urine volume to see degree of obstruction
cycstoscopy, go up urethra to see if excess tissue

Question 41

Q

BPH treatment

Answer

A

based on how much the symptoms are bothering the patient or presence of complications, NOT based on size of prostate
watchful waiting if mild symptoms: diet changes (decrease caffeine and artificial sweetners, limit spicy/acidic foods), avoid decongestants and anticholinergics (increases constriction), restrict evening fluid intake, drink lots during the day, timed voiding schedule with slightest urge to go to the bathroom

Question 42

Q

BPH Meds

Answer

A

5 alpha reductase inhibitors (proscar, avodart): prevent the conversion of testosterone to dihydroxytestosterone, reduces size of prostate, takes 6 months to be effective, side effects = decreased libido, ED, orthostatic hypotension with use of ED drugs, women shoul dnot handle the tablets
alpha adrenergic receptor blockers (cardura, hytrin, flomax): often used for HTN but for BPH are used to promote smooth muscle relaxation in the prostate, symptomatic relief but no change of prostate size, works within 2-3 weeks, side effects = ortho hypo, dizziness, retrograde ejaculation (backs up into the bladder with cloud urine), nasal congestion

Question 43

Q

BPH minimally invasive treatment

Answer

A

Transurethral microwave thermotherapy (TUMT): use of transurtheral probe to raise the temp of the prostate tissue to 113 F, can cause post procedure urinary retention so need a catheter for 2-7 days
few adverse effects but not as effect for tx
go in through urethra, increase temp and tissue sloughs off and increases urine flow
uses a 3 way flow catheter: 3 L bag to flow into bladder and cause filution and irrigation of bladder and frains into foley bag, prevents clots and mucous from building up and blocking urine flow
good = light pink tinge with small clots bad = bright red with big clots
transurethral needle ablation (TUNA): increases heat but with low-wave radiofrequency, allows more preciison than TUMT have very little pain, some pts require a catheter for short time, may have hematuria for up to a week
local anesthesia and conscious sedation
laser prostatectomy: laser delivered transurethrally through a fiber instrument, several procedures, may need a catheter for 8-48 hours after
intraprostatic urethreal stents: provides relief of symptoms in pts who are poor surgical candidates, can cause some complications

Question 44

Q

BPH invasive treatments

Answer

A

transurethral resection of the prostate (TURP): removal of prostate tissue using a resectoscope inserted into urethra, gold standard with low risk of cx, 1-2 day hospitalization with a 3 way catheter and continuous bladder irrigation for first 24 hours, cx = bleeding, clot retention, dilutional hyponatremia, abnormal electrolyte issues, post renal failure with clots and tissue buildup

Question 45

Q

BPH nursing care

Answer

A

health promotion: DRE > age 50, avoid alcohol and caffeinie, avoid pseudophedrine and phenylephrine, urinate q 2-3 hrs, do not restrict fluid intake
preoperative: must have urinary drainage, abx to treat UTI, high fluid intake to manage UTIs, teach that surgery may affect sexual functioning, retrograde ejaculation with cloudy urine, decreased orgasmic sensations
postop: standard catheter or triple lumen catheter 24 hours post, bladder irrigation done to remove clotted blood from the bladder and ensure urine drainage, can cause painful bladder spasms, if outflow is less than inflow assess for clots, careful aseptic techniques, watch for hemorrhage, blood clots ok 24-36 hours post, give stool softeners to avoid valsalva maneuver, avoid prolonged walking or sitting, remove catheter after 2-4 days, must urinate within 6 hours of catheter removal,
discharge instructions: oral fluids 2-3l day, prevent constipation, no lifting greater than 10 lbs, no driving or intercourse until ok by MD, may have cloudy urine from retrograde ejaculation, may have ED problems, may take 1 yr for sexual fxn, bladder may take 2 months to increase capacity, avoid caffeine/citrus/alcohol to prevent bladder irritation, yearly DRE

Question 46

Q

prostate cancer

Answer

A

one in every 5 men will develop prostate cancer
usually slow growing, men live and die with prostate cancer but not from it
risk factors: age, ethnicity AA, family history, diet high in red meat and high fat dairy with low intake of veggies and fruit
s/s: asymptomatic in early stages, eventually develops s/s like BPH, may have pain in lumbosacral area radiating to hips/legs (indicates metastasis), prostate is hard, nodular, assymetric on exam

Question 47

Q

prostate cancer diagnosis

Answer

A

annual digital rectal exam and PSA for men > age 50 at average risk
elevated PSA does not always mean cancer: aging, BPH, recent ejaculation, prostatitis, long bike rides, foley inserted
biopsy is the definitive test
decrease in PSA is used to determine effectiveness of tx

Question 48

Q

prostate cancer TX

Answer

A

usually curable in early stages
watchful waiting if life expectancy is less than 10 years or tumor is low grade and low stage
radical prostatectomy for stage B or C: remove entire prostate gland, seminal vesicles, part of the bladder neck, also may have lymph node dissection, retropubic or perineal or laprascopic
cx: ED, urianry incontinence
nerve-sparing prostatectomy: decreases risk of ED, not done if cancer if outside of the prostate gland
cryotherapy: cold therapy, done as initial tx or if radiation fails, requires use of transrectal ultrasound probe, no incision done under general or spainl anesthesia
radiation therapy: external beam = most common outpatient 5 days a week for 4-8 weeks, side effects resolve in 2-3 weeks after tx ends but can have delayed complicaitons (GI, diarrhea, skin issues); brachytherapy = radioactive seeds implanted into prostate gland
hormonal: androgen deprovation therapy (ADT)
leutenizing hormone releaseing hormone (LH-RH) agonists and antagonist: antiandrogens, ultimately is a chemical castration, lupron is most common, given SQ or IM regularly and must be taken indefinitely
androgen receptor blockers: compete with circulating androgens at the receptor sites, usually combined with LH-RH agonist; complications is high cholesterol
orchiectomy: bilateral removal of testes – can be done alone or in combo with prostatectomy, also helps relieve bone pain (decreased testosterone causes decreased cancer cells causes decreased pain), used when prostate surgery is not an issue, Side Effects = weight gain, loss of muscle mass
chemotherapy: usually only for late stage disease since its not very effective, only for palliation normally

Question 49

Q

prostate cancer nursing care

Answer

A

same care as BPH
3 way foleys
regular exercise
good survival rate if caught early

Question 50

Q

Prostatitis

Answer

A

acute or chornic
s/s: fever, chills, back pain, perineal pain, acute urinary symptoms, cloudy urine post ejaculation pain, ED
prostate wil be very swollen, tender, firm with exam (chornic has milder symptoms)
can be confused with a UTI

Question 51

Q

prostatitis diagnosis and care

Answer

A

diagnosis: UA with culture, PSA to r/o cancer, micro and culture of prostate secretion
care: oral abx for 4 weeks (Acute) and up to 12 weeks (chronic), antiinflammatories for pain (may need opioids), warm baths, no catheters, no prostatic massage (if acute), masturbation and intercouse are encouraged (gets prostate fluid out and decreases inflamm), increase fluids to 2-3 L/day

Question 52

Q

congenital penis problems

Answer

A

hypospadius: urethral meatus on the ventral surface of the penis; corrective surgery in childhood, complications with urination, ejaculation
epispadius: urethral meatus on the dorsal surface of the penis, often associated with other genitourinary defects, bladder issues

Question 53

Q

prepuce problems

Answer

A

phimosis: tightness or constriction of the foreskin around the head of the penis, usually caused by poor hygein, uncircumcized males with buildup of yeast and bacteria
paraphimosis: tightness of the foreskin resulting in inability to pull it forward from retracted postiion, can get an ulcer, uncircumcized patients with foley or moved skin back without moving it forward, inflammation and foreskin won’t retract back

Question 54

Q

erectile problems

Answer

A

priapism: erection lasting longer than 6 hours, medical emergency; viagra, sickle cell, spinal cord issues; can result in necrosis and nerve issues; tx = give sedatives and smooth muscle relaxers, drain blood
peyronie’s disease: curved or crooked penis caused by plaque formation in the corpus cavernosa, not dangerous but can be embarrasing, not equal blood distribution

Question 55

Q

cancer of the penis

Answer

A

very rare
occurs in men with HPV or men not circumcised as infants
looks lke veneral wart
treatment depends on extent of the disease

Question 56

Q

inflammation of scrotum and testes

Answer

A

epididymitis: acute, painful inflamm of epididymis, usually unilateral and usually STD; tx = abx, bed rest, scrotal elevation, ice packs, analgesics
orchitis: acute inflamm of the testes, usually occurs after bacterial or viral infection (mumps, TB, syphillis, pneumonia), can cause infertillity after mumps

Question 57

Q

congenital problems of testes

Answer

A

cryptorchidism (undescended testes): can occur bilaterally or unilaterally, will cause infertility if not corrected by age 2, increases risk of testicular cancer if not corrected by puberty

Question 58

Q

awuired scrotal and testicular problems

Answer

A

hydrocele: non-tender, fluid-filled mass of the scrotum, caused by impaired lymph drainage, requires no tx if small, visible with transilluminiation
spermatocele: firm, sperm-containing, painless cyst of the epidymis, visible with transillumination, requires surgical removal to distinguish from cancer
varicocele: dilation of the veins that drain the testes, scrotum feels wormlike, surgery if having problems with fertility
testicular torsion: twisting of the spermatic cord, seen in age

Question 59

Q

testicular cancer

Answer

A

rare but more common type of cancer in young men 15-34
more common in white males, more common in right testicle
risk factors: undescended testes, family hx or testicular cancer or anomalies
s/s: may have slow or rapid onset, painless, firm lump in scrotum, scrotal swelling, feeling of heaviness, will not trailluminate when light is shined
dx: ultrasound, labs, chest xray, CT/MRI
tx: orchiectomy, lymph node dissection, chemo, radiation, careful follow up, cryopreservation of sperm

Question 60

Q

testicular self exam

Answer

A

warm area to make testes hang low (bath or shower)
use both hands to feel , roll testes between thumb and first 3 fingers, palpate each testes separately
testes should feel like hard-boiled egg, locate spermatic cord which goes up toward groin, feel for lumps, irregularities and pain
one testi is usually larger than the other, more concerned about texture
examine once a month

Question 61

Q

vasectomy

Answer

A

bilateral surgical ligation of vas deferens to prevent impregnatnion permanently
outpatient under local anesthesia
must use alterna form of contraception 6 weeks after
does not affect hormone production, ability to ejaculate, physiologic ability to have erection or orgasm

Question 62

Q

erectile dysfunction ED

Answer

A

inability to maintain or attain an erect penis that allows satisfactory sexual performance
causes: young men (alcohol or drugs), middle-aged men (diabetes, HTN, renal or CV disease), other (side effects of meds, surgery side effects, trauma, chornic illness, stress, depression)
s/s: gradual onset indicates physiologic factors, rapid onset indicates psychologic issues
dx: physical exam, DRE, international index of erectile function, CV exam, hormone levels, can do several dx tests
tx: no option will restore ejaculation or tactile sensations if they were already absent, want to be sure ED is actually reversible

Question 63

Q

ED tx options

Answer

A

oral drugs: viagra, cialis, levitra – cause increased blood flow, take an hour before sex; do not take with nitrates or if hypotensive
vacuum constriction devices: suction device that pulls blood into the penis, can secure with constrictive band
intraurethral devices: vasoactive drugs, penis injection, medication pellet
penile implants: inflatable implant
sexual counseling: should be done for all pts

Question 64

Q

andropause

Answer

A

gradual decline in androgen secretion as men age
can begin as early as age 40
s/s: loss of libido, fatigue, ED

Answer 65

A

about 33% of cases are due to male problems, pre-testicular causes are rare, testicular causes are 50% most common cauase is varicocele (dilation of vein), remaining causes are unknown
need to do a careful health history and exam
first step is a seme analysis to determine sperm concentration, motility, and morphology
for many men, fertility and masculinity are equated so be sensitive

Answer 66

A

always occurs cyclically before the onset of menstruation, not present at other times of the month
s/s: extremely variable even from one cycle to another, breast tenderness, edema, bloating, binge eating, headache, dizziness, mood swings (loss of seratonin, fluid shifting, hormone changes, increased estrogen and progesterone)
dx: must rule out other possible causes first, no definitive test, need to do a symptom diary for 2-3 months
tx: no single tx, drugs (diuretics, prostaglandin inhibitors, SSRIs, combination BCPs), diet changes (no caffeinie, reduce refined carbs, increase complex carbs with high fiber, vit B6, dairy, pultry, limit salt), reassure the symptoms are real, stress management, exercise, adequate rest
increased progesterone –> increased prostaglandins –> vasoconsriction –> pain (inhibiting these help with pain)

Answer 67

A

primary: no pathology, begins within first few days of menses; s/s = starts 12-24 hours before menses, rarely lasts more than 2 days, lower abd pain radiating to low back/upper thighs, nausea, diarrhea, fatigue, headache; tx = heat, exercise (prevents endometrial buildup), NSAIDs, BCs
secondary: usually caused by pelvic disease, begins age 30-40 after previous pain-free menses; s/s = uniltareal, constant pain that lasts longer than 2 days, can have painful intercourse (dyspareunia), painful defecation, irregular bleeding; tx = depends on the cause

Answer 68

A

age of the woman helps determine the cause
young = spintanous abortion, ectopic pregnancy, clotting disorders
30/40s = leiomyomas (fibroids), endomerial polyps
older = endometrial cancer
amenorrhea: no period
primary: no menses by age 16
secondary: had menstrual ccles but they stopped – pregnancy, anorexia, athlete, BC
need to shed the endometrial lining 4-6 times a years

Answer 69

A

menorrhagia = excessive bleeding, unopposed estrogen and lack of progesterone, increased endometrial tissue and increased estrogen, decreased progesterone causes increased bleeding, increased progesterone helps shed lining
depends on the cause, defree of threat to pts health, desire for children in the future
health history and physical exam first
combined oral contraceptives, fertility drugs, or progesterone
balloon thermotherapy (hot balloon of water inserted into uterus, sits for 8 minutes, then increases sloughing of tissue)
endometrial ablation: cryotherapy takes of tissue
hysterectomy or myomectamy if due to uterine fibroids
dilation and curtage is rarely done

Answer 70

A

bathing and hari washing are safe
can swim, exercise, have intercourse
need to change tampons or pads frequently
beware of toxic shock syndrome (s/s = high fever, vomiting, diarrhea, weakness, myalgia, sunburn-like rash, can lead to sepsis)
with excessive bleeding, record the number and sizeof pads/tampons used and degree of saturation
check fatigue level, BP, pulse

Answer 71

A

life threatening emergency
implantation of a fertilized ovum anywhere outside the uterus
risk factors: Pelvic inflamm disease, prior ectopic, progestin-releasing IUD, progestin-only birth control pills, prior pelvic or tubal surgery, infertility treatments
s/s: abd/pelvic pain, missed period, irregular vaginal bleeding (spotting), if ruptured - pain will be severe and may be referred to the shoulder
if become pregnant while on BC can increase risk
DX: difficult b/c its similar to other disorders, but has to be considered first; serum pregnancy test, serial beta-hcg levels, vaginal ultrasound, CBC
tx: immediate surgery, may need blood transfusion; if bursts then hysterectomy, mehotrexate can be used to get baby out if less than 3mm (causes baby to detach and come out)

Answer 72

A

perimenopause: begins with first chagnes in menses and ends after cessation of menses
menopause: cessation of menses associated with declining ovary fxn, complete after 1 year of no periods
usually occurs age 51 naturally affected by genetic factors, autoimmune conditions, cigarette smoking, racial/ethnic factors
increased FSH, decrease in estrogen
remember culture
remember vaginal bleeding after menopause is a sign of possible endometrial cancer

Answer 73

A

leading up to menopause
normal s/s: irregular vaginal bleeding, vasomotor instability (hot flashes), redistribution of fat, gain weight more easily, muscle/joint pain, loss of skin elasticity, change in hair amount/distribution, atrophy of external genitalia/breast tissue, dysparenunia (painful intercourse), bladder changes (Weakening of muscles)
critical changes: increased risk for CAD (loss of estrogen) and osteoporosis , higher risk of HIB infection if expoesd, increased UTI due to alkalysitc change, vaginal trauma from intercourse
diagnosis should only be made after ruling out other things
tx: hormone replacement therapy – risk of cancer due to increased hormones, low does for 4-6 years if symptoms are really bad

Answer 74

A

take only for short term, 4-5 yrs, relief of severe symptoms
estrogen alone can cause stroke, blood vlots, breast changes, but protects against osteoporosis and heart disease
side effects: nausea, fluid retention, headache, breast swelling
estrogen & progesterone together can cause heart disease, breast cancer, stroke, blood clots, breast changes
do NOT take hormones if you have a history of breast/ovarian/endometrial cancer, heart disease, stroke, liver disease, blood clots or smoke
women who enter menopause after age 45 and arent bothered by menopause symotoms dont need hormones, but should focus on prevention of heart disease and osteoporisis

Answer 75

A

cool environment
limit caffeine and alcohol
relaxation techniques
increase air circulation
avoid beddin that traps heat
loose fitting clothes
kegel exercises
vaginal lubrication
vitamin E, can mimick estrogen
adequate exercise and sleep
adequate calcium and vit D, osteoporosis
diet high in complex carbs and b6, soy, tofu, sunflower seeds
black cohosh: herb, decreases hot flashes
moisturizing soaps, lotion

Answer 76

A

typicaly infection and inflammation related to sexual intercourse
risks: contaminated hands, clothing, douche equipment, intercourse, surgery, childbirth, BCPs, antibiotics, corticosteroids
S/s: abnormal vaginal discharge, red lesions, yeast, thick white curd like discharge, dysuria, bacterial vaginosa, fishy odor, cerbicitis, spotting after intercourse, lichen sclerosis, white lesions with tissue paper appearance

Answer 77

A

history of STIs
microscopy and cultures
abx or antifungals
abstain from intercourse for at least 1 week
douching should be avoided
may need to tx sexual partners
vaginal creams inserted before going to be

Answer 78

A

infection of pelvic cavity (fallopian tubes, ovaries, pelvic peritoneum), often the result of untreated cervicitis

chlamydia and gonorrhea are most common organisms, but is not always from STIs
can cause infertility and chornic pelvic pain
s/s: lower abd pain that starts gradually and becomes constant, movement increases the pain, spotting after intercourse, may have fever and chills
will have adnexal (ovarian or fallopian tube) tnenderness and positive cervical motion tenderness with bimanual pelvic exam (diagnostic) can also do a vaginal ultrasound

Answer 79

A

septic shock
fitz-hugh-cutis syndrome: perihepatitis, inflamation of the liver
peritonitis
thrombophlebitis of the pelvic veins, triggers clots from infection
adhesions of the fallopian tubes
ectopic pregnancy

Answer 80

A

abx
no intercourse for 3 weeks
sexural partners must be treated
phsical rest
lots of oral fluids
must be reevaluated in 48-72 hours to ensure they are improving
if hospitalized: corticosteroids, heat to abdomen or sitz baths, semi-fowlers position to promote drainage by gravity, analgesics, IV fluids, may require surgery

Answer 81

A

normal endometrial tissue located in sites outside of endometrial cavity
not life threatining but causes lots of pain, dysmenorrhea
typical pt: late 20s, early 30s, white, never had a full term pregnancy
s/s: dysmenorhea, after year of pain free periods, infertility, pelvic pain with intercourse, irregular bleeding, backache
cx: bowel obstruction, painful urination

Answer 82

A

definitive diagnosis: laparoscopy, looks for tissue where it shouldn’t be
tx determined by age, desire for pregnancy, symptom severity, extent and location of disease
drugs: NSAIDs, depo-provera, lupron to imitate a state of pregnancy or menopause, lots of side effects, will take 9 months to sthrink the endometrial tissue
surgery = only cure, removal of tissue

Answer 83

A

uterine fibroids, benign smooth-muscle tumors, increased chance with age
seem to depend on ovarian hormones b/c they grow slowly during reproductive years and atrophy after menopause
s/s: generally none, byt may have abnormal uterine bleeding, pain, pelvic pressure
tx: depends on symptoms, age of pt, desire to bear children, lcoation/size of tumor, lots of bleeding or large turmos mean surgery

Answer 84

A

beign lesion on a stalk, seen through the cervical os during a speculum exam – bright cherry red, soft, fragile small

Answer 85

A

many benign cysts on both ovaries, usually occurs in women

Answer 86

A

risks: low socioecon status, early sexual activity (

Answer 87

A

most common gyneco cancer, grows slowly, metastsizes late, curable if diagnosed early
risks: estrogen, increasing age, no pregnancy late menopause, obestiy, smoking, diabetes, history of colorectral cancer
s/s: firs sign is abnoral uterine bleeding in postmenopausal women, pain occurs late
tx: endometrial biopsy total hysterectomy, radiation, progesterone hormonaol therapy (megace) tamoxifen and chemo

Answer 88

A

most have advanced diease at the time of diagnosis
risks: family history, breast cancer, colon cancer, no pregnancies, increasing age, high fat diet, early menses or late menopause, HRT, use of infertikity drugs
reduced risks: use of BCPs, breastfeeding, mult pregnancies, ealy age at first pregnancy
s/s: vague in early stages abd enlargement, daily symotoms for at least 3 weeks (abd pain, blaoting, urianry urgency, diff eating or feeling full quickly), pain is late symptom, baginal bleeding is not a usual symptom
DX: no screening tests other than yearly pelvic exam, NO palpable ovaries if post menopausea, OVA1(can detect wheter a pelvic mass is benign or malignant), if at high risk can test for CA-125 which is a tumor marker
tx: prophylactic oopherectomy and BCPs if at high risk, metastisis often causes pleural effusion and SOB

Answer 89

A

both are relatively rare
treament may be surgery and radiation
vulvar surgery has a high risk of morbidity due to scarring and wound breakdown

Answer 90

A

remocal of the uterus, may total or may not be remove the cervix, removal of fallopian tubes (salpingetctomy), removal of ovaries (oopherectmy), if all = TAH-BSO
can be done vaginally or abd
ligaments that support the uterus are attached to the vaginal cuff to maintain the normal depth of the vagina
nursing care: watch for bleeding, watch for urinary retention, prevent DVTs, assist with grief over loss of fertility, may need HRTs
at discharge: no sex for 4-6 weeks, may have temp loss of vaginal sensation, no heavy lifting for 2 months, no dancing/walking fast, wear a girdle for support

Answer 91

A

vulvectomy: removal of vulva and wide margin of skin
vaginectomy: removal of vagina
post op care: high risk for sepsis, meticuous wound care clean with NS twice daily, use heat lamp or hair dryer, prevent stool straning, lots of discomfort, abulation on 2nd post op day,

Answer 92

A

radical hysterectomy, total vaginectomy, removal of bladder with urainry diversion, resection of bowel with colostomy
anterior = no bowel resection
posterior = no bladder removal
post op care: similar to care after radical hysterectomy, abd perineal resection and ileostomy and/or colostomy, lots of physical, emotional and social adjustments

Answer 93

A

in the OR, places radiation near or into the tumor causing less damage to surrounding normal tissue delivered using wires, capsules, needles, rutes, seeds, left in for 24-72 hours
preparation: cleansing enema to prevent sool straining, indwelling catheter to prevent distended bladder
care: lead lined private room, absolute bed rest, analgesics for uterine contractions, deodorizer, cluster care, nurses can spend no more than 30 mins a day in room, stay at foot of bed, visitors stay 6 feet away from bed and less than 3 hours a day
common to have fould smelling vaginal discharge from destruciton of cells and possibly n/v, diarrhea, malaise
cx: fistulas, cystitis, phlebitis, hemorrhage, fibrosis

Answer 94

A

sex
exposure to infected blood: drug needles, blood products, needle stick (low risk of actually getting it through needle stick, length of time, amt of viral load, amt of blood)
perinatal transmission during pregnancy, delivery, breastfeeding (requires c section, 25% of baby getting it but if given antivirals then only 2% chance)

Answer 95

A

prevent HIv in women: increased risk of getting HIV due to vaginal area
treat HIV during pregnancy with Antiretroviral thearpy (ART), given at 36 weeks (2% risk of transmission to baby)
offer HIV testing to all women
baby given ART after birth

Answer 96

A

antibody tests: 3-8 weeks to deveop antibodies, EIA (enzyme immunoassay) results in 2 weeks, rapid HIV results in 10-20minutes, need 2nd confirmatiory test with western blot test results in 2 weeks
antigen tests (RNA): not as common, more expensive, look for HIV RNA in pts blood, can dianose within 1-3 weeks after infection
PCR (polymerase chain reaction): looks at the genetic material of HIV, can diagnose within 2-3 weeks after inefection, use for babies since they have moms antibodies (babies may have antibodies from mom but no virus)

Answer 97

A

mandatory reporting of AIDS, HIV-related illness, and HIV infection to tstate health department who reports to the CDC
partner notification law: specific to state and/or city
mandatory testing: in co, required for prisoners, occupation exposure, threat to public health, with opt out testing for first trimester pregnancy and delivery
workers are not required to disclose unless it affects their ability to perform their job

Answer 98

A

HIV antibodies and/or antigens in the blood: may not appear for 2 months or more after infection, but can still transmit the virus during this time
CD4 and Tcell counts: normal 800-1200
viral load ( measure of disease progression): can be undetectable but still have the virus and can transmit it; highest at first exposure and then increases with AIDS development
WBC, neutrophils, platelets, RBCs, Hgb/HCt, liver function, hep B, hep C, can also test for ART drug resistence
CD4 and TCell count

Answer 99

A

acute infection: occurs within 2-4 weeks of infection and lasts 1-2 weeks (often mistaken for flu), mono-like symptoms, neuro symptoms, high viral load, decreased CD4 and T cells
chronic asymptomatic infection: generally asymptomatic but spreading the disease b/c they dont know they are infected; may have night sweats, fatigue, headache, low grade temp, lymphadenopathy; low viral load, CD4 and T cells fairly normal (>500); can last up to 10 years depending on how well people take care of themselves
chronic symptomatic infection: symptoms worsen, localized infections, nervous system symptoms, thrush is common, shingles, vaginal candida, oral/genital herpes, bacterial infection, kaposi’s sarcoma, oral hairy leukoplakia, increased viral load CD4 T cells 200-500
late chronic infection - AIDS: immune system is severely compromised, can only make dianosis when specific criterai are met ( have HIV and: CD4

Answer 100

A

no cure, just decreased disease progression
goals: decrease viral load, increase CD4 and T cell count, delay onset of opportunistic disease
must use at least 3 different drugs from 2 different drug classes
critical for the patient to adhere to the drug regimen
drugs interact with many other drugs and herbs
vaccinations are important

Answer 101

A

most impt = patient readiness: can pay for it, will take it every day, will live with the side effects
usually based on CD4 counts:

Answer 102

A

assess for risky behaviors: blood transfusion before 1985, sharing drug equipment, sexual experience, STDs (impairs skin integrity and access to bloodstream/body)
CDC recommends HIV testing for everyone ages 13-64 regardless of risk or perceived risk
drug therapy
promote healthy immune system: good nutrition, decrease alcohol/tobacco/drug use, vaccinate for infectious diseases, good rest and exercise, decrease stress, avoid exposure to illnesses, mental health counseling and support groups

Answer 103

A

due to AIDS or ART Therapy
metabolic disorders that cause fat deposits in abdomen, upper back, breasts and fat loss in arms, legs, face (lipodystrophy)
hyperlipidemia, insulin resistence, hyperglycemia, bone disease, CV disease

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Exam #6 - FINAL Flashcards

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