Female Reproductive Disorders Flashcards
1
Q
Pelvic Inflammatory Disorder
A
- = infectious condition of the pelvic cavity
- may involve infection of cervix, fallopian tubes, and pelvic peritoneum
- tuba-ovarian abscess may form
- may be “silent” when women do not perceive any symptoms; others will be in acute distress
2
Q
PID: Etiology
- often the result of…
A
untreated cervicitis
3
Q
PID is caused by what organisms and how to they gain entrance
A
Chalmydia and Neisseria Gonorrhea
- anaerobes, mycoplasma, streptococci, enteric Gram-negative rods
- organisms gain entrance during sexual intercourse and after pregnancy termination, pelvic surgery, or childbirth
4
Q
testing for PID
A
- women at risk for chlaydial infections should be routinely tested
- often asymptomatic & can lead to infertility
5
Q
Pain with PID
A
- up to 1/3 of women have chronic pelvic pain after PID
- 6 months or longer in duration in region below umbilicus and between hips
6
Q
Clinical manifestations PID
A
- Lower abdominal pain (starts gradually & becomes constant. Varies from mild to severe. Pain with intercourse)
- fever & chills
- spotting after intercourse
- less acute syndrome (increased cramping pain with menses, irregular bleeding, some pain with intercourse)
- purulent cervical or vaginal discharge
- may be undiagnosed & untreated if mild
7
Q
PID - Diagnosis
A
- based on S&S
- bimanual portion of pelvic exam
- abnormal discharge
- cultures (C&S)
- pregnancy test to rule out ectopic pregnancy
- vaginal U/S
- pelvic examination and palpate abdomen (tender abdomen, fallopian tubes, and ovaries)
8
Q
PID complications
A
- Septic Shock
- Fitz-Hugh-Curtis syndrome (PID spreads to liver - RUQ pain with normal LF test)
- Pelvic or generalized peritonitis
- Embolisms
- Adhesions & strictures in fallopian tubes
- Increased risk of ectopic pregnancy (10x)
- Risk of recurrent infection
- Infertility
9
Q
PID Collaborative Care: Usually treated as outpatient
A
- Broad spectrum antibiotics (cefoxitin & doxycycline)
- no intercourse for 3 weeks
- examination & treatment of partner
- rest
- oral fluids
10
Q
PID Collaborative Care: Hospitalization if abscess present
A
- high doses of antibiotics
- corticosteroids (improve fertility and aid in fast recovery)
- Bed rest in semi-Fowler’s position
- Drainage of abscess
- Hysterectomy
Re-evaluated every 48-72 hr
11
Q
PID Collaborative Care: Hospitalization if abscess present
A
- high doses of antibiotics
- corticosteroids (improve fertility and aid in fast recovery)
- Bed rest in semi-Fowler’s position
- Drainage of abscess
- Hysterectomy
Re-evaluated every 48-72 hr
12
Q
Endometriosis
A
presence of endometrial epithelial and/or stromal cells in sites outside the uterine cavity
13
Q
Most frequent sites of endometrial cells
A
- in or near the ovaries, uterosacral ligaments, & uterovesical peritoneum
- can also be in other locations: stomach, lungs, intestines & spleen
14
Q
Endometriosis tissue
A
Tissue responds to hormones of ovarian-cycle & undergoes a “mini-menstrual cycle” similar to the uterine endometrium
15
Q
Most common population to get endometriosis
A
typical patient is late 20s or early 30s, white, never had a full-term pregnancy.
16
Q
Dangers of Endometriosis
A
- Not life-threatening but cam cause considerable pain
- increased risk of ovarian cancer
17
Q
Etiology of Endometriosis - poorly understood etiology
A
retrograde menstrual flow passes through fallopian tubes carrying viable endometrial tissues into pelvis –> tissue attaches to various sites
- undifferentiated embryonic peritoneal cavity cells remain dominant in pelvic tissue until ovaries produce sufficient hormones to stimulate their growth
- genetic predisposition
- altered immune function
18
Q
Most common clinical manifestations of Endometriosis
A
- secondary dysmenorrhea
- infertility
- pelvic pain
- painful coitus
- irregular bleeding
19
Q
Less common clinical manifestations of Endometriosis
A
- backache
- painful bowel movements
- dysuria
20
Q
Diagnosis of Endometriosis
A
- history and physical
- pelvic exam
- laparoscopy, U/S, MRI
21
Q
Conservative approach to endometriosis
A
Watch & wait
22
Q
Drug therapy: Endometriosis
A
- NSIADs
- oral contraceptives
- Danazol (cyclomen) - a synthetic androgen that inhibits anterior pituitary (ovarian suppression –> pseudomenopause)
- Gonadotropin-releasing hormone agonists - create hypoestrogenic state & amenorrhea
23
Q
Benign Ovarian Tumours: Cysts
A
- soft; surrounded by thick capsules
- detected during reproductive years
24
Q
Benign Ovarian Tumours: Neoplasms
A
- cystic or solid
- small or extremely large
- may originate from germ ells & can conatin bits of any type of body tissue (e.g., hair, teeth)
25
Benign Ovarian Tumours are...
- often asymptomatic until large enough to cause pressure in pelvis
- may require surgery (immediate surgery necessary for ovarian torsion)
26
Ovarian Cancer
- acute onset of bloating that is persistent
- problems with urinating and having BM
- GI workup because symptoms are so nonspecific
- No good screening test for ovarian cancer
- family history - genetic testing to follow up based on results
- Advocate if you feel like something is not right
27
Ovarian Cancer: Risk
- Family history - breast or colon cancer
- BRCA1 and BRCA2 gene mutations
- Nulliparity (women who have not given birth yet), age, high-fat diet, increased ovulatory cycles
28
Ovarian Cancer: etiology/pathophysiology
About 90% are epithelial carcinomas, 10% germ cell tumours
29
Ovarian Cancer: collaborative care/therapy
- chemotherapy, radiation and surgery
30
Cervical Cancer
- 2nd most common female cancer in the world --> 83% in under-resourced countries
- initially asymptomatic - slowly growing
- most important risk factor is infection with HPV
- Vaccines against HPV (Gardasil) prevent types that cause 70% of cervical cancers
- number of deaths has decreased with regular screening (Pap test) which can pick up precancerous changes
- treatment depends on stage of tumour, patients age & general health
31
BC Cancer Agency Cervical Cancer Screening Policy
- Average Risk
Start at age 25
Every 3 years
Stop at age 69 if results have always been normal
- higher than average risk
treated for dysplasia or immunocompromised
annual testing
32
Guidelines based on best evidence
- Invasive cervical cancers in women < 25 years are rare
- screening is relatively ineffective in younger women
- women < 25 years have a higher prevalence of lesions that often clear without treatment
- there are risks associated with unnecessary follow-up & treatments, including long-term consequences for pregnancy or cause undue anxiety & stress
33
HPV
- includes > 100 different types of related viruses:
- 15 of these may cause anogenital cancer
- very common: will affect almost all individuals at some point
- most infections clear on their own
- Long-term infection with high-risk HPV can cause precancerous changes to cells of cervix --> can lead to cervical cancer if left undetected or untreated
34
HPV Vaccine
- 3 prophylactic HIV vaccines have been developed and approved for use in Canada
- protect against HPV types 16 and 18 which cause approx 70% of cervical cancers. 80% of anal cancers & a significant proportion of other cancers.
- also protect against HPV types 6 and 11 which cause approx. 90% of anogential warts
- 2nd generation HPV vaccine approved by Health Canada in 2015. which covers 5 more high risk types (90% of cervical cancers)
- not currently used in BC school-based HPV vaccination program; available for private purchase
- Same screening process applied to vaccinated & unvaccinated individuals
- Reduces # of women with cervical dysplasia --> reduced women with abnormal cervical cancer results & associated follow-up & treatment
- HPV9 vaccine is used for both males and females
- HPV2 vaccine is only approved for use in females
35
Cancer of the reproductive system - nursing care
- Nursing diagnosis
1. anxiety r/t to cancer diagnosis
2. acute pain
3. disturbed body image r/t cancer process or treatment
4. ineffective sexuality pattern
5. grieving
Interventions
- teach about the disease and treatment options
- do not give false hope
- provide emotional support
