Female Repro Flashcards
What two hormones influence Fibroids (Leiomyomas)
Estrogen and progesterone!!!!!!!
What is the MOST COMMON CAUSE of fibroids (Leiomyomas)???????***
dysfunctional uterine BLEEDING!!!!!!!!!!
(Bleeding, bleeding, bleeding!)
How do we prep for Physical exam???
- Comfort and dignity
- Position: Lithotomy position, and feet in stirrup position
- BOWEL PREP
What is the the 3 pelvic exams?
- PAP Smear
- HPV test
- Bimanual and Rectovaginal exam
What is PAP smear and what is the Timing and Frequency for taking the test?????
- Check for cancerous or precancerous cells
- LUBE with WATER ONLY!!!!
1) Timing:- Between periods
- NO SEX 24 HOURS BEFORE
- NO douche, vaginal meds or DEODORANT
2) Frequency: - Starts at age 21, Q3 yrs from 21 to 29 y/o. (earlier than 21 if they’ve been sexually active early)
- From 30-35 y/o, Q3-5 years
- Discharge screening for low risk women at age 65!
What do you LUBE PAP smear with??????
LUBE with WATER only!!!!!!!
What is HPV testing for???
- Cervical cells are collected
- Check for virus associated with CERVICAL CANCER!!!!
What are the Cervical cancer key points???
- Early stage = none
- Late stage: Bleeding, discharge with odor, pain, and pain with sex
- Risk factors:
1) Multiple sex partners
2) Early sexual activity
3) Having sexual transmitted infections
4) Weak immune system
5) Obesity & smoking - Screenings: PAP smear and HPV
Which screenings would you do for cervical cancer patients????
PAP smear and HPV testing!!!
What are the late stage of cervical cancer????
Bleeding, discharge with odor, pain, and pain with sex.
What are the risk factors of cervical cancer????
Risk factors:
1) Multiple sex partners
2) Early sexual activity
3) Having sexual transmitted infections
4) Weak immune system
5) Obesity & smoking
What is Bimanual and Rectovaginal exam???
- Palpating the tubes, vagina, cervix, uterus, and ovaries
- Rectal exam: Older patients & FOBT
- Limitations: the more fat the patient has, the harder it is for surgeon to palpate!
What are the key points for Endometrial Cancer?????
- Manifestations: Post menopausal bleeding, bleeding between periods, & PELVIC pain
- Screenings: Bimanual exam
- Risk factors: Obesity, Older patients, Estrogen exposure, and TAMOXIFEN!!!
- POST EXAM CONSIDERATIONS:
1) provide wipe for cleaning perineum
2) post procedure spotting is normal!!!
3) Follow up for PAP smear and HPV results!
What are post exam considerations for endometrial cancer???
POST EXAM CONSIDERATIONS:
1) provide wipe for cleaning perineum
2) **post procedure spotting is normal!!!
3) Follow up for PAP smear and HPV results!
What happens if after bimanual exam for endometrial cancer the result show dysplasia???
- Repeat PAP testing
- COLPOSCOPY or cone biopsy
- HPV DNA testing, possible surgery!!
What is a medication that is included in the RISK FACTOR of Endometrial cancer????????????
TAMOXIFEN!!!
What are the key points for OVARIAN Cancer?????
- Early stage: None
- Late Stage: Symptoms are vague! “ABBUW”: Abd & pelvic discomfort, back pain, bowel habit change, urinary frequency, weight loss & fatigue!
- NO SCREENING TEST!
- Risk factor:
1) BRCA 1 & 2 mutations
2) Family hx
3) Obesity
4) Older age
5) Estrogen exposure
6) Endometriosis!
What are the late symptoms of OVARIAN cancer????
Symptoms are vague!
“ABBUW”
1. Abd & pelvic discomfort
2. Back pain
3. Bowel habit change
4. Urinary frequency
5. Weight loss & fatigue!
What are the risk factors for endometrial cancer????
Obesity, Older patients, Estrogen exposure, and TAMOXIFEN!!!
What is Dysmenorrhea???
Pain with menstrual cycle
What is the Primary dysmenorrhea? (What IS IT DUE TO?)****
**Cramp due to Prostaglandins and LEUKOtrienes!!!!!!
1. 1/2 women have it, 10% are incapacitated for 1-3 days
2. GI symptoms: N/V, diarrhea, headache
3. WORSEN WITH SMOKING
WHAT IS Secondary Dysmenorrhea????
- Accompanies with Endometriosis, PID, cysts, and Fibroids!!
What is endometriosis???
- Endometrial tissue OUTSIDE of the uterus!
- Implants bleed/spotting when menstruating
- Backflow of the blood
- Trapped blood cause cysts and scars
What are the NON-pharmacological options for dysmenorrhea???
- Heat pack on the stomach
- Exercise, Calcium, and Mag
- AVOID Smoking and Alcohol
- Exercise lower back and abdomen
WHAT MEDICATION WOULD YOU GIVE TO SOMEONE WHO HAS DYSMENORRHEA??????
NSAIDS (Ibuprofen and Aspirin)!!!!!!!!!!!!
What are the concerns and Patient teachings for NSAIDS (for those who are taking it for their dysmenorrhea)???
Concerns:
1. GI upset
2. Renal failure
3. Bleeding
Patient Teachings:
1. Take it with food
2. HYDRATE!
3. USE for limited amount of time
What are the concerns and patient teachings for CONTRACEPTIVE PILLS (HRT or birth control pills)??????
Concerns:
1. Increase Risk for cancer: Breast and Cervical
2. Increase Risk for CV (BP, clot, lipid)
Patient teachings:
1. Take it at the same time each day!!
2. NO SMOKING**
3. Hydrate well**
4. USE CONDOM OR OTHER BARRIER METHODS***
(KNOW THE DIFFERENCE BETWEEN PERIMENOPAUSE COMPLICATIONS AND MANIFESTATIONS (EXPECTED/NORMAL)! )
What are the complications vs manifestations of perimenopause?????
COMPLICATIONS:
1. Bone loss: osteoporosis, fracture risk
2. Weight gain, dyslipidemia (increase risk for CV)
3. TYPE II Diabetes mellitus
4. Cardiovascular risk
5. Anatomical changes
6. Increase incidence of vaginal and urinary tract infection
7. Decreased libido, and vaginal Dryness
—-
MANIFESTATIONS:
1. Irregular period, that eventually will stop
2. Vaginal dryness
3. HOT FLASHES
4. CHILLS, NIGHT SWEATS
5. Difficulty sleeping
6. Mood changes
7. Weight gain and SWALLOWING metabolism
8. LOSS OF FULLNESS OF BREAST
What are the lab evaluation for menopause?????
- Follicle stimulating hormone (FSH)
- Pregnancy testing
- Prolactin level
- Thyroid panel
- CBC and metabolic panel
- ESTROGEN, PROGESTERON, & TESTOSTERONE LEVELS
- Pregnancy testing
What education would you give to someone with perimenopause??
- Lubricants, vaginal creams (for the vaginal dryness)
- Dietary calcium, Vitamin D (for the bone loss)
- Exercise (for the weight gain)
What are the 3 COMPLICATIONS* in the Changes in the LAXITY of the PELVIC FLOOR that come with aging??
1) Uterine Prolapse:
1. Heaviness & potential bulge from vagina!
2. Urinary & Bowel problems!!!!
3. Sexual concerns!!!
2) Cystocele (bladder tips over and sag into the vagina):
1. Urinary retention
2. Urinary stasis*
3. UTI
4. Overflow incontinence
3) Rectocele (rectum pushes against the vagina wall)
1. Chronic constipation
2. Fecal impaction
3. Patient requires: HIGH fiber/fluid diet, stool softeners, and SPLINTING TO DEFECATE!!!!!!
WOULD patient need to splint to defecate when they have rectocele??????
YES!!!!!!!!!
What are the management of Pelvic Floor Issues/ someone who has changes in laxity of pelvic floor???
- Pelvic floor exercises (PFME, Kegel)
- PESSARY USE*****
- Bladder training
- Fiber & Fluids
- Avoid heavy lifting**
- Avoid weight gain***
AMONG WHO is Polycystic Ovary Syndrome (PCOS) MOST common in?
What is it linked to/causes?
- Most common among women of childbearing age!!!!
What is Polycystic Ovary Syndrome (PCOS) linked to/ what are the causes?
1) EXCESS Insulin (and testosterone) production!!!!
2) CHRONIC LOW-GRADE INFLAMMATION
3) Heredity!!
4) Abnormal fetal growth!
What are the COMPLICATIONS** of Polycystic Ovary Syndrome (PCOS)????
COMPLICATIONS:
1. Metabolic syndrome & Type II Diabetes
2. Steatohepatitis (fatty liver)
3. Cancer of the uterus
4. Gestational diabetes
5. Heart disease & stroke!!!
What are the SYMPTOMS*** of Polycystic Ovary Syndrome (PCOS)?????
- AFTER MENARCHE OR PERIOD OF WEIGHT GAIN
- MOST Common — Alterations in menstrual cycle & weight gain!!!
- Signs of androgen production:
1) Hirsutism
2) Male-pattern baldness
3) Gynecomastia
4) Acne - “Oh..I” Obesity and Infertility***
- Enlarged polycystic ovaries
1) may not be the case
2) use pelvic ultrasound
What are the MOST COMMON SYMPTOMS of Polycystic Ovary Syndrome (PCOS)???????
MOST Common — Alterations in menstrual cycle & weight gain!!!
In what conditions would you see someone with Excess Androgen production??? What are they???
Polycystic Ovary Syndrome!
Signs of androgen production:
1) Hirsutism
2) Male-pattern baldness
3) Gynecomastia
4) Acne
What are the patient care and teaching for Polycystic Ovary Syndrome????****
- DIET and EXERCISE!!!
- Surgical options: Ovarian Drilling!!!
- Menstrual cycle regulation:
1) Hormone manipulation with BCP/birth control pills
2) METFORMIN (GLUCOPHAGE) - Controls insulin levels
- Improves ovulation/regulates menstrual cycle
- DELAYS THE PROGRESSION OF DIABETES
- Teaching?:
- Hypoglycemia
- Contrast issues (can’t combine with contrast dye)
- GI side effects
- Caution with renal impairment
What is Fibroids (Leiomyomas) and what causes it????!!!!*****
Slow growing tumors of uterine muscle wall DUE TO:
Increased smooth muscle cell growth from ESTROGEN AND PROGESTERONE INFLUENCE!!!!!
What increases the risk of Fibroids (Leiomyomas)???? When may it be enlarged and shrink????
AGING!!!!!!!!!!!!!!
May be enlarge during pregnancy and shrink after menopause!
What is the common cause of Fibroids (Leiomyomas)??????**
DYSFUNCTIONAL UTERINE BLEEDING!!!!!!
What ar the medical care for Fibroids (Leiomyomas)?????
Drug-induced menopause, Uterine Artery Embolization or Surgical interventions!!!!
What are the assessment findings of Fibroids (Leiomyomas)?????
“DUH! give me a PIECe!”
1. Dysparenia
2. Urine frequency
3. Heavy bleeding
4. Pelvic pressure
5. Infertility
6. Enlarged UTERUS
7. Constipation!!!!
What do we monitor for in someone who has Fibroids (Leiomyomas)?????
- monitor for Anemia
- GI and/or Urinary tract concerns!!!!
What are the patient teaching for Fibroids (Leiomyomas)?????
- May shrink with menopause
- May enlarge with HRT
- Hydrate
- Fibrate & Fluids
- Dietary supplements: Iron, Vit.B12, and Folate (to treat the anemia)
What are the 2 types of Dysfunctional uterine bleeding????
- Menorrhagia: Heavy & prolonged bleeding
- Metrorrhagia: Between periods!
What are the 4 diagnostics for GYN procedures???? What are the 3 Interventionals???
Diagnostics:
1. Colposcopy (looking at the cervix w a camera)
2. Hysteroscopy (looking deeper into the uterus)
3. Endometrial biopsy (taking samples of the endometrial lining)
4. HysterosalpingOGRAM (using a dye to see the uterus and fallopian tube)
—–
Interventional:
1. Laparoscopy: going in and looking around
2. Laparotomy: opening up/ incision (cut)
3. Dilation & Curettage (D&C): dilating the vagina and scraping the lining of the uterus!
WHAT IS THE #1 MOST COMMON POST-OP OF GYN PROCEDURE that every women experience????
- NAUSEA!!!!!!!!
FOR post-op GYN procedure, what would be the bleeding potential interventions?*
What would you do if there’s lots of blood loss????!!!!
- Report greater than 1 pad in 4 hours Soaked!!!
- ## Turn patient (bc if they’re on period, it’ll drip down to their butt crack when they’re laying down)IF THE PATIENT IS LOSING LOST OF BLOOD:
- ASSESS VS: HR AND BP, LOOK FOR SIGNS OF LOW PERFUSION! AND THEN REPORT/CALL HCP!!!
FOR post-op GYN procedure, What would you do if there’s lots of blood loss????!!!!**
- ASSESS VS: HR AND BP, LOOK FOR SIGNS OF LOW PERFUSION! AND THEN REPORT/CALL HCP!!!
What would you do if patient has Anterior or posterior colporrhapy/repair????
1) Anterior Colporrhapy:
1. Special attention to RETURN OF ABILITY TO VOID!!!
- Posterior Colporrhapy:
- Low fiber initially
- Avoid straining w/ BM
- Pain meds BEFORE BM
- SITZ BATH FOR COMFOT!!!!!!
What is the PELVIC REST CONSIDERATION FOR post-op GYN procedure????
SHOULDN’T be using her vagina!!!!!:
1. No Tampons
2. No Intercourse
3. No Douching!!!
What do you teach patients AFTER TAH? AFTER BSA?
AFTER TAH (Total abdominal hysterectomy) (means uterus is gone!!!!):
1. No more PERIOD!
2. No more CHILDREN!
—-
AFTER BSA (Bilateral Salpingo Oopherectomy) (ovaries are gone!!!!):
1. No more children UNLESS artificially planted!
2. MENOPAUSE AFTER removal of the ovaries = HRT may be needed!!!!!!!!
In which condition would you see signs of Androgen production????
Polycystic Ovary Syndrome
Glucophage??
Metformin (Glucophage)
[FOR POLYCYSTIC OVARY SYNDROME - to manage menstrual alreration]
What are the 3 uses of Metformin (Glucophage)??? WHAT ARE THE TEACHINGS FOR THIS??
Used for those who have Polycystic Ovary Syndrome!!!!!!!
1. Control insulin
2. Improve ovulation/ menstrual cycle
3. DELAY PROGRESSION of DIABETES!!!!!
—-
Teachings:
1. HYPOGLYCEMIA
2. Don’t combine with CONTRAST DYE
3. GI adverse effects
4. Caution with RENAL DYSFUNCTION
What are the 2 things used for menstrual cycle regulation in polycystic ovary syndrome????
- Hormone manipulation with BCP(birth control pills)
- METFORMIN (GLUCOPHAGE)!!!
What hormones influence the increased smooth muscle cell growth of Fibroids (Leiomyomas)!!!!?????
Estrogen/Progesterone!!!!!
What’s the COMMON CAUSE OF FIBROIDS???
Dysfunctional uterine bleeding!!!!!!!
Dysfunctional uterine bleeding can lead to what????
FIBROIDS (Leisomyomas)
risk of developing fibroids increases as you what????
Risk increases as you AGE!!!!!!
For menopause, how many months is the amenorrhea???
12 months of Amenorrhea!!
