Gyne Flashcards
(51 cards)
1
Q
menstruation
A
periodic shedding of the endometrium at approximately monthly intervals, accompanied by blood loss, that identifies the reproductive years of a woman’s life
2
Q
menarche
A
- occurs between ages 9-16 yrs
- avg onset: 12-13 yrs
- mediated by hormonal activity: hypothalamus, pituitary gland, & ovaries
3
Q
normal period lasts….
A
2-7 days
4
Q
normal cycle patterns range…
A
- from 20-40 days
- may be as short as 17 or as long as 45
5
Q
menstrual flow
A
varies from 20-80mL per menses
- dark red
- less viscious than blood & usually does not clot
6
Q
shedding
A
- endometrium
- blood
- mucus
- vaginal cells
7
Q
clotting
A
may be an indication of heavy flow or vaginal pooling
8
Q
absence of menarche
A
- abnormal or irregular
- pregnant
- hormonal imbalance
9
Q
endometrial hyperplasia
A
??
10
Q
menstrual problems
A
- women may experience menstrual cycles that fall outside of the norm
- missed period
- change in length of cycle
- changes in flow, color, or consistency
- other menstrual symptoms
11
Q
beginning of menstrual cycle
A
- 1st day of menstruation
- FSH levels begin to rise
- follicular phase
12
Q
follicular phase
A
- single follicle matures fully under FSH stimulation
- mature follicle stimulates estrogen production causing a negative feedback resulting to decreased FSH
- when estrogen level peaks at 12th day of cycle, a surge of LH is produced triggering ovulation in 1-2 days
- complete follicular maturation & ovulation occurs only in the presence of LH though initial stage is stimulated by FSH
13
Q
luteal phase
A
- blood vessels begin to coil, increasing the surface area of the vascular supply
- glandular tissue matures & secretes a glycogen (rich substances), & glandular ducts dilate
- if the corpus luteum regresses, estrogen & progesterone level falls the endometrial lining cannot be supported resulting to blood vessels contracting & tissue begins to slough
14
Q
menstrual problems
A
- PMS (premenstrual syndrome)
- PMD-D (premenstrual dysphoric disorder)
- dysmenorrhea
- amenorrhea
- oligomenorrhea
- menorrhagia
15
Q
PMS
A
- complex of symptoms during luteal phase
- usually occurs < 35 yrs
- repetitive symptoms
- not present other times of month
- biological trigger with compounding psychological factors
- serotonin involved
- imbalance of estrogen & progesterone
- nutritional deficiencies (vit B6 or mag)
- occurs before menstruation
16
Q
PMD-D
A
- type of PMS
- severe mood disorder in addition to PMS
17
Q
physical PMS symptoms
A
- breast discomfort
- peripheral edema
- abd bloating
- sensation of weight gain
- episodes of binge eating
- HA
18
Q
PMS symptoms of ANS arousal
A
- palpitations
- dizziness
- anxiety
- depression
- irritability
- mood swings
19
Q
diagnosing PMS
A
- eliminate possible causes: thyroid dysfunction, uterine fibroids, depression
- no definitive diagnosis test for PMS
- based on symptom analysis: encourage diary recording for 2-3 months
20
Q
goal of PMS
A
-reduce severity of symptoms & enhance sense of control & quality of life
21
Q
nursing care in PMS
A
- assessment & supportive counseling
- dietary guidance
- stress mgmt
- vitamin supplementation
- pharm. tx
22
Q
dysmenorrhea
A
- affect 50% of all women
- painful menstruation: painful abd cramping
23
Q
primary dysmenorrhea
A
- excessive prostaglandin or increased sensitivity
- teens to mid 20s: happens a few years after menarche when regular ovulatory cycles begin
- related to ovulation
24
Q
secondary dysmenorrhea
A
- underlying causes: endometriosis, PID, uterine fibroide
- occurs mostly at 30-40 yrs old
25
s/s of primary dysmenorrhea
- starts 12-24 before onset of menses
- pain more sever 1st day, rarely lasts 2 days
- lower abd pain (colicky), frequently radiates to lower back & upper thighs
- n/v/d, fatigue, HA, light headedness
26
s/s of secondary dysmenorrhea
- occurs after a problem free period
- unilateral pain, generally more constant, but continues longer than primary
- depending on cause: dyspareunia, irregular bleeding, painful defecation
27
mgmt of dysmenorrhea
- distinguish what type
- complete health hx: special attention to menstrual & gyne hx
- teaching
- drinking hot beverages, warm baths
- proper nutrition, exercise, avoid constipation, good body mechanics
- reduce stress & fatigue
- stay active
28
tx of primary dysmenorrhea
- heat, massage
- biofeedback, relaxation
- mild exercise, avoid fatigue
- NSAIDs
- oral contraceptives
- acupuncture & transcutaneous nerve stimulation
29
non responsive pain mgmt in dysmenorrhea
-evaluate chronic pelvic pain
30
tx of secondary dysmenorrhea
- depends on cause
- some will be helped by similar interventions as primary
- depending on underlying causes, additional drug or surgical interventions may be used
31
amenorrhea
absence of cessation of menstrual flow
32
primary amenorrhea
failure of menstrual cycles to being by age 14-16 if secondary sex characteristics are present
33
causes of primary amenorrhea
* **pregnancy
- Turner's syndrome: when girls have only one normal X chromosome
- hormonal imbalances
- systemic diseases
- hypothalamic pituitary abnormalities
- excessive exercise, malnutrition, anorexia nervosa/bulimia, & tumors result to decreased ovarian hormones
34
secondary amenorrhea
-cessation of menstrual cycles once established
35
causes of secondary amenorrhea
- DM
- TB
- poor nutrition
- ovarian tumors
36
diagnosing amenorrhea
- pregnancy test: urine test of hCG
- hormonal levels: hCG; prolactin levels high, estrogen levels low
- tumor markers: may rise before disease is evident: AFP, CA 125, hCG
37
mgmt of amenorrhea
* depends on the cause
* tx to improve timing of cycle
- relaxation tx
- increase diet
- decrease exercise
- hormonal tx for eating disorders
- psychological support for congenital & fertility abnormalities
- emotional support
38
dysfunctional uterine bleeding
bleeding due to a disruption in the menstrual cycle
39
oligomenorrhea
- long intervals between menses (>35 days)
| - oligomenorrhea related to anovulation is common in women at the beginning and end of menses
40
anovulation cycles
- corpus luteum fails to get formed and thus no progesterone
- results to unopposed estrogen causing excessive buildup of the endometrium, increasing risk for endometrial CA
- progesterone or BC ordered to ensure endometrial lining
41
menorrhagia
- excessive menstrual bleeding either 7days+ or 80mL +
| - mostly related to anovulation
42
in menorrhagia, young women should watch for
- clotting disorders
- uterine fibroids
- endometrial polyps
43
tx of menorrhagia
- monitor blood loss & replacement if H&H is low
- oral progesterone & estrogen to stabalize endometrium
- balloon thermotherapy
- fertility drug if pt wants to get pregnant, otherwise BC
- tramexamic acid
44
metrorrhagia
- irregular bleeding or bleeding between menses (spotting)
- mostly related to ectopic pregnancy or spontaneous abortion
- may be related to cervical or endometrial polyps, infection, CA
- common during 1st cycles of using BC and with long acting progestin tx
- must rule out endometrial CA in postmenopausal women
- HRT of exogenous estrogen is a common cause
45
menometrorrhagia
excessive bleeding (irregular intervals)
46
assessment
- pelvic exam
- pregnancy test
- coagulation studies
- hormone levels
- hgb testing
- pain
- vaginal discharge: white, thick, curdy
- psychosocial
47
surgical interventions
- D&C: only done if unable to get info from endometrial biopsy & US
- US or hysteroscopy
- myomectomy
- endometrial ablation
- hormonal regimens & embolization
- consider: desire for children?
48
myomectomy
fibroid removal without uterus removal
49
endometrial ablation
laser or electrosurgical technique effective tx for menorrhagia
50
nursing mgmt
- teach characteristics of menstrual cylce
- discuss myths related to activity, bathing, swimming, exercise, sex
- assess for s/s of anemia
- changing of tampon r/t toxic shock syndrome
51
s/s or toxic shock syndrome
- high fever
- n/v/d
- weakness
- myalgia
- sunburn like symptoms
