Female Reproductive Conditions Flashcards
What is AUB or abnormal uterine bleeding?
Types?
It is any type of bleeding that is irregular.
Menorrhagia
Oligomenorrhea
Polymenorrhea
Metrorrhagia/Intermenstrual
Also each issue could be acute or chronic
Menorrhagia
What may be present due to the excessive bleeding?
How much blood is typically lost?
Heavy menstrual bleeding or that lasts longer
Clots can be present.
More than 80 ml of blood lost per cycle - need to be screened for anemia
What can Menorrhagia or heavy menstrual bleeding lead to
Anemia so check H&H
What causes Menorrhagia or heavy menstrual bleeding
hormone imbalance disease neoplasms or tumors infections IUD contraception
Oligomenorrhea is what?
Major cause?
Not bleeding enough for longer than 35 days OR when there is a decrease in flow at normal intervals
Major cause of Oligomenorrhea is oral contraceptive use since lining doesn’t build up (this isn’t anything unusual tho in this case)
Polymenorrhea
Menstrual cycle is shorter & so there’s more bleeding than usual
Metrorrhagia /instrmentrsual
spotting in between periods
How will they treat AUB?
Treat based on cause and desire to have children
Acute vs chronic bleeding
acute - recent
chronic - longer than 6 months
PALM COEIN
helps determine if something is structural or nonstructural
P- polyps
A- Adenomyosis
L-Leiomyoma
M- malignancy
C- coagulopathy - van willebrand disease as common cause O- ovulatory E- endometrial I- Iatrogenic N- not yet classified
Endometriosis
Tissue found outside the uterine cavity
Endometriosis is commonly found where?
Elsewhere?
Pelvic cavity and causes pain
peritoneal, bladder, lung, spine, brain, & GI
Endometriosis most common symptom?
other symptoms?
Pain increased w menses and is chronic. Chocolate places bleed anywhere they are & the cysts of the tissue swell and become inflamed
dyspareunia (painful intercourse) and abnormal uterine bleeding
etiology of endometriosis?
percentile rate?
unknown
effects 10% of women
T/F
Endometriosis doesn’t affect fertility
False.
Endometriosis is the leading cause of infertility
In fact, it’ll generally only occur in women who happen to not be able to get pregnant due to association. Women who are able to get pregnant won’t have this
What are menses like with endometriosis?
Any GI issues?
GU?
Menses will be abnormal
Diarrhea or constipation
Urinary complaints
How do they diagnose endometriosis?
How is it staged?
Look at history and do physical exam of the uterus for nodules
But the gold standard is a Laparoscopy w biopsy
By severity 1-4
Is there a cure for endometriosis?
No there is not. Just have to control comfort levels.
T/F
Endometriosis tissue growth can be slowed
True! They can do this with medications.
How can you get pregnant with endometriosis?
There are treatments but main point is you’ll want to do this as fast as possible
Treatment for endometriosis
Lesions
Hormones
GnRH
IUD
Presacral neurectomy
Hysterectomy
Remove lesions
Testosterone/Androgen derivative in order to inhibit endometrial growth
- must be short term
GnRH agonist med to antagonize estrogen
- 6 moths
Use IUD to thicken mucus and atrophy endometrium
Presacral neurectomy but only to relieve pain
Hysterectomy - just remove
What are the chocolate cysts in endometriosis?
Old bleeding and endometrial tissue
Pelvic floor relaxation is what?
When support structures of bladder fail
Cystocele
bladder bulging into uterus
Rectocele
Bulge due to rectum wall being weak
Uterine prolapse
Uterus drops into vagina canal
Main causes of pelvic floor issues?
Age
Chronic cough displacing organs
Constipation
Child birth
Symptoms of pelvic floor issues?
Urinary leaks
Constipation
Sexual dysfunction if uterus prolapses
Pelvic floor treatment
kegels
topical or systemic estrogen
pessaries
surgery
pessaries
kegels
pelvic floor treatment that uses implants in vaginal canal to hold vagina up
kegels are just floor exercises that can be done
Toxic shock syndrome
Can this happen after child birth?
staph infection that occurs in childbearing years only during menstruation and is when symptoms develop within 5 days of menses
yes can happen after child birth so wait 6-8 weeks
What was an old cause of TSS?
Absorbent tampons but now they’re safer. Just can’t leave them in for that long 3-6 hrs minimum.
Can you wear a tampon if you’ve had TSS before?
NOOOO. never wear one again
Nurses role in TSS?
Prevention and education
Symptoms of TSS
High fever Rash on trunk Dizzy Hypertensive Slough skin Sepsis Can die
How can someone die from TSS?
What organs should you check?
The staph infection or bacteria can affect multiple/3 organ systems.
Check liver and kidneys
TSS treatment
Meds for TSS?
Treat sepsis is first priority
Next, treat symptoms
May need to use aggressive antibiotics
Cervical Dysplasia
Abnormal cell changes in cervix
Should be smooth and pink
Is cervical dysplasia a fast progressing cancer?
No, it takes years to develop into cancer.
How do they check for cervical dysplasia?
Do pap
Will also check for HPV
Severe dysplasia of cervix
Carcinoma in situ - but it is pre cancerous
What will they do next if they find abnormal pap smears?
Will probably colposcopy or procedure where they turn abnormal cells white with acidic acid. And then they take a biopsy.
What is done in a cervical ECC?
Scrape off the abnormal cells
Endocervical procedure
LEEP procedure
Removal of abnormal cervical cells
Loop Electro surgical incision procedure
Cryosurgery of cervix?
Freeze off abnormal cervical cells
What is the goal of removing any abnormal cells of the cervix?
Remove the abnormal cervix, let the cervix reheal, and have abnormal cells go away
What is an important thing to make sure cervical dysplasia patients know once they receive treatment?
They NEED to follow up. The abnormal cells can regrow.
Cervical cancer
The true malignancy of the cervix
It is prevented w pap smears though.
Leading trigger for cervical cancer?
HPV
How to prevent cervical cancer?
Delay sex Have one partner Don't smoke Increase folic acid in diet vaccination
HPV vaccine name
high risk hpvs strains
Gardasil or Cervarix (lasts 6-8 years)
6 11 16 18 are all high risk
High risk hpv age group
symptoms?
20-50 yrs old
no early symptoms
What referral will you get for cancer?
oncology
Benign growths of the uterus
Uterine fibroids (leiomyomas)
T/F
Second leading cause of GYN surgery
False.
It is actually the first leading cause
risk factors for uterine fibroids
women of color
obesity
Uterine fibroid symptoms
abnormal bleeding
pain in lower regions such as bladder, bowel, abdomen due to displacement of tissues
Do all uterine fibroids need treatment?
No not small ones. If they’re large enough then you may want them removed because they can cause pregnancy complications
They’ll also shrink after menopause bc they are estrogen dependent
How will they treat uterine fibroids if needed?
Will do myomectomy or just remove the muscle myometrium
uterine artery ablation or cut off blood supply (good for people who don’t want to get pregnant)
Hysterectomy (also good for those who dont want pregnancy)
hormones
nsaids for pain
iron for anemia
Where can uterine fibroids be located?
anywhere surrounding the uterus
What is Uterine Cancer?
Endometrial cancer or cancer of the inner lining of the uterus
What age group is this the most common cancer for
50-70
So if these women are post-menopasul and then start bleeding – this is a bad indication but can be ok if found early
What are other risk factors of uterine cancer
obesity high fat diet infertility nulliparity diabetes late onset menopause family hx use of unopposed estrogen or without progesterone
symptoms of uterine cancer
post menopausal bleeding
Testing and treatment for uterine cancer of endometrium
uterine ultrasound to measure thickness of lining
(if its getting thicker or bigger than 4 mm - bad sign)
biopsy for office procedure but can miss stuff
D&C - remove the whole lining and make sure they get it all
hysterectomy of varying degrees
What is polycystic ovarian syndrome?
Hormones?
Endocrine disorder known as PCOS that throws your hormones out of whack
High estrogen, testosterone and LH
Low FSH
Symptoms of PCOS?
irregular menses or amenhorrea
androgen excess so more hair, acne, deep voice
insulin resistance
infertility
obesity
PCOS management
Using BC or progesterone to control menses
Anti-androgens - Spironolactone treats androgen excess
Metformin/glucophage - inhibits glucose production and improve uptake in order to better regulate endocrine system
What is the nursing role in PCOS
1 encourage follow up and long term care
educate
Help women w body image
Refer to support groups
Ovarian Masses
Types?
felt on abdominal exam and palpitation & are benign
Ovarian cyst or fluid filled
Demoid cyst or dermoid material like bones and hair and stuff
Endometriosis or chocolate cysts
Are most cysts benign or cancerous
benign
For any benign mass what do we need to rule out before we agree it is an ovarian cyst?
Ecoptic or tubal pregnancy
Infection
Appendicitis
How long do we observe an ovarian cyst for?
What if it grows to be bigger than 7cm?
1-2 months but most will disappear
Will do laparoscope or laparotomy
Can you get pregnant w one ovary?
Yes
Ovarian cancer . how fatal?
risk factor
Cancer of ovaries and is most fatal female cancer - bc it is difficult to diagnose
family history and advancing age
Ovarian cancer symptoms
Bloating, increased abdomen girth, pelvic pain, can’t eat very much
What other cancers does ovarian cancer increase
breast cancer
How we diagnose ovarian cancer
hx
physical
abdominal exam + sonogram
Treatment for ovarian cancer
surgical laparoscope
radical hysterectomy
relatively poor prognosis
If a woman is passed menopause and there’s a mass on the ovary what is it?
It is cancer bc cysts don’t grow if you don’t have access to estrogen
Procedures for ovarian cancer
Hysterectomy or radical
Salpingectomy or removal of tubes
Oophorectomy or removal of ovary
