GYN emergencies Flashcards
1
Q
gynecology
A
- deals with diseases and routine care of female reproductive system
- standard care
- some emergencies
- entwined with obstetrics
2
Q
obstetrics
A
- deals with birth
- development of the fetus
- prior the birth, during birth, and post partum
- entwined with gynecology
3
Q
vagina
A
- lower portion of the birth canal
- fetus may pass through
4
Q
ovaries
A
- ovaries have two glands
- there are 2 ovaries
- each ovary contains thousands of follicles
- ovaries at birth have all the eggs required for reproduction
- normally one fallopian tube associated with each ovary -> connecting it to the uterus
5
Q
uterus
A
- muscular organ where the embryo grows
- opens into the cervix
6
Q
the birth canal consists of the:
A
- cervix- opening between uterus and vagina
- vagina
7
Q
menstruation
A
- cyclic and periodic discharge of 25-65 mL of blood, epithelial cells, mucus, and tissue
- duration and frequency varies
- cycle every 28-31 days is “normal”
- cycle is affect by many things (medications, OCP, IUD, hormones)
- the menstrual cycle is composed of phases
8
Q
phases of menstruation
A
- day 1-4- menstrual phase (discharge)- blood and epithelial cells
- day 5-14- proliferative phase
- day 14- ovulation- egg has passes from the ovary somewhere in the fallopian tube and tries to find its way to the uterus
- day 14-28- secretory phase- waiting phase
- you can get pregnant at any time
- starts around 11,12,13 years of age
9
Q
postmenopausal women
A
- due to decreased hormone production postmenopausal women:
- are more susceptible to diseases like osteoporosis
- experience atrophy of genitourinary organs
- lack of hormones/balance
10
Q
patients assessment
A
- obtaining an accurate and detailed patient assessment is very important
- consider a gynecologic cause in women who complains of abdominal pain
- protect the patients modesty -> limit the crowd
- sometimes a witness is necessary
- form a general impression -> assess consciousness
- women with abdominal pain -> always think gynecological
11
Q
asking question: primary assessment
A
- what is the overall presentation of the patient
- are there any obvious life threats
- is she conscious
- are they sick
- does she have breathing difficulty or injury
- in what position did you find the patient
- how many times has she been pregnant
- how many live births has she had
- any complications with pregnancy
- vaginal or cesarean deliveries
- how much time between pregnancies
- any miscarriages or abortions
- any gynecologic problems
- any known medical conditions
12
Q
LORDS TRACHEA
A
- Location
- Onset
- Radiate
- Duration
- Severity - wong baker faces scale (1-10)
- Timing
- Relieve
- Aggravates
- Character- description
- Historic
- Eaten
- Associated details
13
Q
gynecologic history
A
- LMP?
- possibility of pregnancy? -> SA
- contraception use? (STI, pregnancy)
- spermicides, condoms, or a diaphragm?
- implanted devise or an IUD
- what kind of protection
- vaginal bleeding? how many saturated pads over a time period
- if signs of shock are present, a fluid bolus of 100 to 200 mL should improve the status
- vaginal discharge?
- STI?
14
Q
obstetric history
A
- G (gravida)- number of times pregnant regardless of how they ended
- P (para)- number of times delivering a newborn (vaginal or c-section)
- A (abortive history)- number of abortions > miscarriages or elective
- ex. G 8 P 2 -> A is 6
15
Q
secondary assessment: abdomen exam
A
- most common complaint is general abdominal pain in gynecology
- examine the patients abdomen for:
- a flat and flaccid abdomen
- guarding of the abdomen
- rashes or lesions
- a symmetrical abdomen
- an enlarged liver or spleen
- pushing down on abdomen and there is pain -> tenderness
- once you let go -> rebound tenderness
- bowel sounds
16
Q
secondary assessment: palpate the abdomen
A
- start at the quadrant farthest from the pain
- rigid abdomen
- point tenderness
- does the palpation elicit more pain
- rebound tenderness
- masses
- palpate all four quadrants
17
Q
life threatening gynecologic emergencies:
A
- (ruptured) ectopic pregnancy (more of an OB emergency)
- ruptured ovarian cyst
- tubo-ovarian abscess- can lead to sepsis or peritonitis
18
Q
pathophysiology of vaginal bleeding
A
- dysmenorrhea- painful menses
- primary dysmenorrhea occurs with the start of the menstrual flow, lasting 1-2 days**
- secondary dysmenorrhea is present before, during, and after the menstrual flow** (all around that period)
- vaginal bleeding is one of the most frequent reasons that women consult a gynecologist
- hypermenorrhea- flow lasts longer than normal or is excessive
- polymenorrhagia
19
Q
polymenorrhea
A
- flow occurs more often than a 24-28 day interval
- bleeding all throughout the cycle
20
Q
hypermenorrhea
A
flow lasts longer than normal or is excessive
- can be a true emergency
- especially is anemia is there -> may need iron or blood transfusion
- can be ectopic, ruptured cyst, placenta previa etc.
21
Q
endometritis pathophysiology
A
- inflammation or irritation of the endometrium*
- more likely after a baby or miscarriage
- most likely caused by an infection
22
Q
endometritis assessment
A
- symptoms may include:
- malaise
- vaginal bleeding (rarely) or discharge
- lower abdominal or pelvic pain
- decreased bowel sounds
- ultrasound
23
Q
endometritis management
A
- treat with antibiotics
- vaginal culture
- outpatient care
- provide reassurance
- transport in a comfortable position
24
Q
endometriosis pathophysiology
A
- endometrial tissue grows outside the uterus
- organs of the pelvic cavity are the most common locations for growths
- can grow anywhere -> most common is pelvic cavity
- one of the leading causes of infertility
- seek care early
- no real prevention
25
Q
endometriosis assessment
A
- symptoms include:
- pain
- dysuria*
- very heavy menstrual periods
- bleeding between periods
26
Q
endometriosis management
A
- care is based on signs/symptoms
- can have flare ups
- if the patient reports severe pain:
- provide pain relief
- use dressing or towels as needed
27
Q
pelvic inflammatory disease (PID) pathophysiology
A
- infection of the female upper* GU organs
- affects sexually active women most often
- organisms enter the vagina and migrate into the uterine cavity and find a place to grow
- risk factors:
- IUD use- depends on the IUD, how long ago it was placed, how it was placed
- frequent sexual activity with multiple partners
- history of PID
28
Q
pelvic inflammatory disease (PID) assessment
A
- abdominal pain will be present
- during or after normal menstruation
- typically diffuse- hard to pinpoint or describe
- throughout entire abdominal cavity
- be alert for signs or peritoneal cavity irritation-> peritonitis
- PID can lead to sepsis
- peritonitis can lead to sepsis
29
Q
vaginitis pathophysiology
A
- inflammation of the vagina caused by infection
- most commonly vaginal yeast infections
- yeast population may increase if the vagina becomes less acidic
30
Q
vaginitis assessment
A
- symptoms of yeast infections:
- itching/burning
- soreness
- dysuria
- vulvar swelling
- thick, white vaginal discharge- odor
- pain during intercourse
31
Q
symptoms of vulvovaginitis
A
- redness
- pain
- swelling
- discharge
- burning
- itching
32
Q
vaginitis management
A
- outpatient
- if not treated, vaginitis can lead to:
- infertility or preterm birth
- endometritis- infections can travel
- PID
- antibiotics are required for definitive treatment
33
Q
ruptured ovarian cyst pathophysiology
A
- can be life threatening
- fluid filled sac on or within an ovary
- SHARP, STRONG, INTENSE abdominal pain*
- functional cyst is the most common**
- corpus luteum cyst develops if the sac seals itself after release of the oocyte
- cysts arnt bad or life threatening until they rupture
- if the cycle of forming sacs is repeated excessively, polycystic ovaries may develop
- lack of progesterone and high levels of androgens -> imbalance of hormones
- ruptured cyst-possibility of bleeding, horrible pain
34
Q
ovarian torsion
A
- can be life threatening
- ovarian torsion occurs when a cyst does not self-resolve and grows to a significant size
- ovary itself gets cut off from the fallopian tubes from the size of a cyst
- can lead to disconnect of blood flow to ovary and loss of fertility
- sudden onset of severe lower abdominal pain
- nausea and vomiting
- hospitalization
35
Q
tubo-ovarian abscess
A
- life threatening
- tubo-ovarian abscess is encountered secondary to a primary infectious agent
- fallopian tubes or ovaries become blocked by an infectious mass
- removed surgically (sometimes self resolved but not often)
- becomes life threatening when it ruptures and becomes PID, peritonitis
36
Q
ovarian cyst assessment (not ruptured)
A
- a patient with an ovarian cyst may report:
- dull achy pain in the lower back and thighs
- sharp, specific location, intense pain
- abdominal pain or pressure
- nausea and vomiting
- breast tenderness
- abnormal bleeding and painful menstruation
37
Q
a ruptured ovarian cyst usually presents:
A
- lower abdominal pain (sharp)
- intense
- abdominal distention and tenderness
- dizziness
- weakness
- syncopal episode
- surgical emergency
38
Q
a tubo-ovarian abscess may present with:
A
- severe abdominal pain
- guarding and rebound tenderness
- nausea and vomiting
- abdominal distention
- fever* infection 100-101 F**** test
39
Q
ruptured ovarian cyst, ovarian torsion, and tubo-ovarian abscess management
A
- treat a ruptured ovarian cyst or tubo-ovarian abscess the same as an ectopic pregnancy
- surgical emergency until proven otherwise
- for patients with ovarian torsion:
- start an IV for pain medications and dehydration
- administer antiemetics
40
Q
toxic shock syndrome (TSS) pathophysiology
A
- can be life threatening
- a form of septic shock caused by streptococcus pyogenes or staphylococcus aureus
- can include several body systems
- most likely going to start in vagina or uterus
- usually starts from forgotten/retained tampon
- can progress from minor infections
- particularly affects menstruating women
41
Q
toxic shock syndrome assessment
A
- initial symptoms may include:
- syncope
- myalgia
- diarrhea and/or vomiting
- sore throat
- fever
- chills
- signs of shock
- signs of sepsis
42
Q
toxic shock syndrome management
A
- treat like sepsis
- provide:
- high flow supplemental oxygen
- IV therapy
- vasopressors - bc this is a distributive shock state
- cardiac monitoring
- can lead to infertility, death
43
Q
chlamydia
A
- caused by the chlamydia trachomatis
- symptoms:
- lower abdominal or back pina
- pain during intercourse
- bleeding between menstrual periods
- treated with antibiotics
- commonly administered intramuscularly (shot)
- very common
44
Q
genital herpes
A
- infection of the genitals, buttocks, or anal area caused by herpes simplex virus
- type 1: infects the mouth and lips (cold sores)
- type 2- primary cause of genital herpes -> herpes simplex VIRUS for genital herpes*
- if an outbreak, symptoms can last several weeks and may include:
- can be triggered by stress
- tingling or sores where the virus entered the body
- small red bumps that develop into small blisters and painful sores
45
Q
gonorrhea
A
- caused by Neisseria gonorrhoeae
- can grow and multiply in warm, moist areas
- symptoms may include:
- dysuria
- burning or itching
- a yellowish or bloody vaginal discharge
- foul smelling
- treatment should be done early
- antibiotics
- severe infections may progress to PID
- gonococcal pharyngitis- infection of the throat
- if not treated, may enter the bloodstream and other parts of the body -> disseminated gonococcemia (in the bloodstream) -> sepsis
- can cause meningitis
46
Q
genital warts
A
- caused by HPV- causative agent in cervical, vulvar, and anal cancers
- vaccine
- in pregnant women, warts may impede urination or obstruct the birth canal
- some infected people have no symptoms
47
Q
syphilis
A
- caused by treponema pallidum
- mandating reporting*- notify the public health authority bc it is rare
- signs and symptoms mimic other diseases
- manifests in 3 stages
- transmission occurs through direct contacts
- primary stage- appearance of a single sore
- secondary stage- development of mucous membrane lesions and a skin rash
- late stage- internal damage -> memory loss, neurological damage, dementia, CNS damage
48
Q
pregnant women with syphilis may have:,
A
- stillborn babies
- babies who are born blind
- developmentally delayed babies
- babies who die shortly after birth
