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Med surg > Gyne > Flashcards

Gyne Flashcards

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

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2
Q

menarche

A
  • occurs between ages 9-16 yrs
  • avg onset: 12-13 yrs
  • mediated by hormonal activity: hypothalamus, pituitary gland, & ovaries
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3
Q

normal period lasts….

A

2-7 days

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4
Q

normal cycle patterns range…

A
  • from 20-40 days

- may be as short as 17 or as long as 45

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5
Q

menstrual flow

A

varies from 20-80mL per menses

  • dark red
  • less viscious than blood & usually does not clot
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6
Q

shedding

A
  • endometrium
  • blood
  • mucus
  • vaginal cells
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7
Q

clotting

A

may be an indication of heavy flow or vaginal pooling

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8
Q

absence of menarche

A
  • abnormal or irregular
  • pregnant
  • hormonal imbalance
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9
Q

endometrial hyperplasia

A

??

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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
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11
Q

beginning of menstrual cycle

A
  • 1st day of menstruation
  • FSH levels begin to rise
  • follicular phase
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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
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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
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14
Q

menstrual problems

A
  • PMS (premenstrual syndrome)
  • PMD-D (premenstrual dysphoric disorder)
  • dysmenorrhea
  • amenorrhea
  • oligomenorrhea
  • menorrhagia
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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
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16
Q

PMD-D

A
  • type of PMS

- severe mood disorder in addition to PMS

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17
Q

physical PMS symptoms

A
  • breast discomfort
  • peripheral edema
  • abd bloating
  • sensation of weight gain
  • episodes of binge eating
  • HA
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18
Q

PMS symptoms of ANS arousal

A
  • palpitations
  • dizziness
  • anxiety
  • depression
  • irritability
  • mood swings
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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
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20
Q

goal of PMS

A

-reduce severity of symptoms & enhance sense of control & quality of life

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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
Q

s/s of primary dysmenorrhea

A
  • 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
Q

s/s of secondary dysmenorrhea

A
  • 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
Q

mgmt of dysmenorrhea

A
  • 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
Q

tx of primary dysmenorrhea

A
  • heat, massage
  • biofeedback, relaxation
  • mild exercise, avoid fatigue
  • NSAIDs
  • oral contraceptives
  • acupuncture & transcutaneous nerve stimulation
29
Q

non responsive pain mgmt in dysmenorrhea

A

-evaluate chronic pelvic pain

30
Q

tx of secondary dysmenorrhea

A
  • 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
Q

amenorrhea

A

absence of cessation of menstrual flow

32
Q

primary amenorrhea

A

failure of menstrual cycles to being by age 14-16 if secondary sex characteristics are present

33
Q

causes of primary amenorrhea

A
  • **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
Q

secondary amenorrhea

A

-cessation of menstrual cycles once established

35
Q

causes of secondary amenorrhea

A
  • DM
  • TB
  • poor nutrition
  • ovarian tumors
36
Q

diagnosing amenorrhea

A
  • 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
Q

mgmt of amenorrhea

A
  • 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
Q

dysfunctional uterine bleeding

A

bleeding due to a disruption in the menstrual cycle

39
Q

oligomenorrhea

A
  • long intervals between menses (>35 days)

- oligomenorrhea related to anovulation is common in women at the beginning and end of menses

40
Q

anovulation cycles

A
  • 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
Q

menorrhagia

A
  • excessive menstrual bleeding either 7days+ or 80mL +

- mostly related to anovulation

42
Q

in menorrhagia, young women should watch for

A
  • clotting disorders
  • uterine fibroids
  • endometrial polyps
43
Q

tx of menorrhagia

A
  • 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
Q

metrorrhagia

A
  • 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
Q

menometrorrhagia

A

excessive bleeding (irregular intervals)

46
Q

assessment

A
  • pelvic exam
  • pregnancy test
  • coagulation studies
  • hormone levels
  • hgb testing
  • pain
  • vaginal discharge: white, thick, curdy
  • psychosocial
47
Q

surgical interventions

A
  • 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
Q

myomectomy

A

fibroid removal without uterus removal

49
Q

endometrial ablation

A

laser or electrosurgical technique effective tx for menorrhagia

50
Q

nursing mgmt

A
  • 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
Q

s/s or toxic shock syndrome

A
  • high fever
  • n/v/d
  • weakness
  • myalgia
  • sunburn like symptoms

Med surg (11 decks)

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