Maternity 7-2 Flashcards
Endometriosis - symptoms (end the 3 Ds)
Dysmenorrhea
Pelvic discomfort
Infertility
Dyspareunia (pain after sex)
Depression
Endometriosis - how long does it take to get diagnosed?
3-11 years between the onset of symptoms and dx.
Cause unknown
Endometrial tissue responds to cyclical hormonal stimulation
Endometriosis: Risk factors - and what about age? (end early only)
Early age menarche (<12years)
Short menstrual cycles (<28 days)
Nulliparity
Heavy long periods (> 1 week)
Familial component (7-10X’s more likely if a 1st degree relative has it)
Endometriosis: Symptoms (bowel movements?) (end the pain a day before)
Pelvic pain beginning 1-2 days before expected menses
Infertility
Heavy Menses
Fatigue
Dyspareunia
Dysuria
Painful bowel movements during periods
Other gastrointestinal upsets such as diarrhea, constipation, nausea.
Endometriosis - meds (Tu is grrr)
Diagnosed by laparoscopy to allow for visualization and biopsy or ultrasound
Analgesics
Oral contraceptives
GnRH antagonists
Surgery
Menopause
Complete cessation of menses for a period of 12 months resulting in loss of high levels of estrogen and progesterone.
(Average age 51.5 years)
menopause - what happens hormonally?
lower ovarian response to FSH resulting in loss of primary estrogen and progesterone
Symptoms menopause
Vaginal dryness
Vaginal walls become thinner, less elastic
Dyspareunia
lower Libido
Atrophy of the labia
Increase risk of yeast infections
General loss of pelvic muscle tone
Stress incontinence
symptoms menopause (and breasts?)
Anxiety
Sleep disturbances
Depression
Weight gain and bloating
Irregular menses
Mastodynia (breast pain)
Headache
Hot Flashes
Other Health Risks - menopause
Osteoporosis
Cardiovascular Disease
Therapeutic Management and Nursing Care - menopause
Hormonal and Non-hormonal interventions
Recommendations have been changed over the last few years.
Care should be managed individually
Tx should be tailored to history, risk and need of client
Vasomotor Instability (Hot Flashes)
Common, ~ 75-85% incidence
Non hormonal interventions:
Decrease alcohol, hot drinks, spicy foods
Stress management techniques
Layered clothing
Herbs (primrose)
Fluids
bone mass - what is the % of loss?
Bone mass peaks between 25 & 35 years old
Rapid loss of bone mass after menopause
Bone loss in just the few years after onset of menopause may be as high as 20% of lifetime bone loss
Osteoporosis - what is reduced?
About 10 million Americans have osteoporosis.
About 34 million are at risk for the disease
Bone mineral density is reduced.
Are you @ risk for osteoporosis? what drugs cause it? (osteo fights w/ steroids)
Thin frame?
Caucasian or Asian?
Family History
Cortisone-like drugs for asthma, arthritis, or cancer?
Diet low in Calcium (<1000mg/day)?
Are you @ risk for osteoporosis? what drinks cause it?
. Sedentary lifestyle
> 2 drinks with caffeine a day
> 2 drinks of alcohol per day?
Soft drinks may also increase risk
2nd phosphoric acid
Tobacco believed to inhibit the activity of osteoblasts – fill in the cavities
check slide
25
Calcium Absorption decreases with (coffee) (pee out the coffee)
caffeine consumption> increases calcium excretion
medications - osteoporosis (osteo is bi w/ calcitonin)
Bisphosphonates
Selective estrogen receptor modulators (SERMs)
Calcitonin
how do osteoporosis meds work?
Medication either prevents calcium reabsorption or promotes bone formation. All treatments are recommend to be given with:
Calcium
Vitamin D
Diet
Exercise
Fall Prevention
Cardio Vascular Disease - Does hormone therapy help? (cardio won’t help my hormones)
Life style
The importance of healty living before and AFTER menopause
Exercise
Diet
Smoking cessation
Hormone therapy DOES NOT reduce CVD
Hormone Therapy
Previously know as HRT or Hormone Replacement Therapy.
Currently called Estrogen Therapy (ET), Progesterone Therapy (PT) or Hormone Therapy (HT)
hormone therapy - advantages (what about bone?)
To provide relief of vasomotor symptoms (hot flashes)
To reduce the risk of unwanted pregnancy
To avoid the irregularity of menstrual cycles
To preserve bone
To improve quality of life (hot flash relief, improve sexual health)
Hormone Therapy - side effects (4 things) (BBBH)
Bloating
mastodynia
vaginal bleeding
Headaches
Nursing Considerations - hormone therapy - who can’t take hormones?
Risks vs. benefits (e.g. Short term with out risk of CVD)
Lowest dose for shortest duration
Gradual withdrawal
Should not be used by women with hx. Of Ca
Fibrocystic Breast Disease - what type of cysts? (cysts have fluid)
Benign Breast Disease
Effects 50% - 60% women
Overgrowth of fibrous tissue of the breasts accompanied by round, fluid filled cysts.
Fibrocystic Breast Disease - Symptoms (and where is the pain?)
with or without tenderness
lumpy breasts
feeling of fullness, dull heavy
responds to hormones (either better or worse)
Pain and tenderness – often
In upper quadrants
Nursing Care for Fibrocystic Breast Disease - what test?
Steps in the work-up:
Ultrasound - determines if cysts are solid or fluid filled
Nursing Care for Fibrocystic Breast Disease (fiber can’t have caffeine, salt, or cigs)
Decrease Caffeine, salt, smoking
Supportive bra
NSAIDs
OC’s (over the counter drugs)
Fibroadenoma - does it hurt, and what is it? (Aden doesn’t hurt)
Benign Solid Mass
Smooth, round, mobile and painless
Breast Self-Exam - when to do it
1 week after 1st day of menstruation
Shower
Inspect breasts
Use methods
Light pressure
Deep pressure
Malignant Conditions of the Breast
Second leading cause of cancer death in women ages 45-55.
One in eight American women will develop invasive breast cancer in her lifetime.
2.9 million survivors of breast cancer, with statistics indicating a survival rate of 83% at 10 years after diagnosis.
At least 15% of cases are related to a genetic mutation
Types of Breast Cancer - invasive (lob in the 60s)
Invasive ductal carcinoma* - most common
Invasive lobular carcinoma (more in the 60s)
staging of breast cancer (TNM)
Tumor size
Extent of lymph node involvement
Evidence of metastasis
stage 0
early, or in situ
stage 1 - how many inches?
localized, less than 1 inch in diameter
stage 2 - how many inches?
1-2 inches in diameter, usually w/ lymph nodes
stage 3 - how many inches?
2 inches or greater, spread to other lymph nodes and other tissues
stage 4
spread to organs
Risk Factors (modifiable)
High fat diet
Nulliparity or 1st pregnancy >30
Alcohol consumption
Obesity
HRT
Not breastfeeding
Smoking
Sedentary Lifestyle
Risk Factors (non-modifiable)
Age
First degree relative with breast cancer
Early Menarche, late menopause
Genetic mutation (Braca 1 and Braca 2 genes)
Hx of ovarian or colon cancer
Fibrocystic Disease
Signs and Symptoms of Breast Cancer (single breast) and does it hurt?
Lump, often single, firm, and painless
Signs and Symptoms of Breast cancer
lump
Skin appearance
Asymmetry
Superficial veins
Dimple
Nipple D/C
retracted nipple
Diagnosis of Breast Cancer
Ultrasound
Mammography
Magnetic Resonance Mammography
Biopsy
Needle biopsy
Excision biopsy
American Cancer Society Guide- lines for Breast Cancer Detection - when to start mammograms?
Normal Risk:
Annual Mammograms starting age 45 (40-45 optional)
Age 45 – 54 every year
Age 55 and older every other year as long as they are in good health and have life expectancy of 10 years or more.
American Cancer Society Guide- lines for Breast Cancer Detection - high risk
High Risk:
Risk 20-25% based on assessment tools
BRCA1 or BRCA2 gene mutation
1st degree relative with BRCA1 Or BRCA2
Mammograms and MRI’s (in consultation with primary MD)
Magnetic Resonance Mammography (does it use contrast?)
Relatively new
Highly sensitive
Expensive (compliment to Mammograms)
Uses contrast – to evaluate the rate dye enters breast tissue. Malignant lesions show increased distribution of the dye.
Treatment - breast cancer - when
Local or Systemic
Is the tumor invasive or non-invasive?
Size, grade, lymph node involvement
Hormone receptor status
Is there the Braca 1 or Braca 2 genes
Treatment - breast cancer
Surgery
Radiation
Adjuvant Systemic therapy
Chemotherapy: Administered soon after surgical removal of the tumor
Hormonal Therapy : tamoxifen
Targeted Therapy – HER2 protein
Immunotherapy- ER + or PR+
Reconstructive Surgery
Total simple mastectomy
one breast
Nursing Considerations - reconstructive surgery
Emotional support after diagnosis
Preoperative care
Immediate postoperative care
Discharge planning and follow-up care
Teaching needs for client and family undergoing adjuvant therapies
benign growths (polyps or cysts)
Polyps
Fibroids
Genital Fistula
Bartholin Cyst
Ovarian Cysts
Leiomyomas (Fibroids) (lei tu)
Benign tumors of accumulated muscle and fibrous tissue of unknown etiology
Leiomyomas- Signs and Symptoms
Heavy bleeding (which can be heavy enough to cause anemia or painful periods.
Feeling of fullness or pressure in the pelvic area
Enlargement of the lower abdomen
Frequent urination
Pain during sex
Lower back pain
Leiomyomas – Nursing Care
Surgery
Myomectomy
Hysterectomy
Edometrial Ablation –removal of the lining of the endometrius
Myolysis –electric current or freezing of the the fibroid
Uterine Fibroid Emoblization or uterine artery embolization - stops blood flow to the fibroid.
Symptomatic relief
NSAIDS
Iron
Hormones (BCP)
Decrease after menopause
Cancers of the Reproductive Tract
Ovarian Cancer
Endometrial Cancer
Cervical Cancer
Vaginal Cancer
Vulvular Cancer
cycle of abuse - 1-4 (the abuser is a TIRC)
1 - tension building, 2 - incident, 3 - reconciliation, 4 - calm
The ABC’s of Patient Care: A
Alone: reassure the woman that she is not alone, that there have been others in her position before, and that help is available.
D
Documentation.
Descriptive documentation.
A clear statement by the woman about the abuse without subjective opinion
Accurate description of injuries
Photographs, taken with the victim’s permission.
E
education
S
safety. sometimes greatest risk is when womcan tries to leave
calcium absorption and alcohol
alcohol consumption> inteferes with calcium absorbtion
calcium absorption - phosphate? protein?
phosphate consumption
Excessive protein consumption
hormone therapy - what is given w/ progesterone? and why?
Progesterone is given with estrogen to decrease the incidence of endometrial cancer in women at Risk.
hormone therapy - increased risk of (UB on hormones)
uterine CA
breast CA
blood clots
fibrotic breast disease - If lump is solid, what test?
If lump is solid, a mammogram is obtained for > 35 years
fibrotic breast disease - If fluid filled
FNA (fluid needle aspiration)
fibrotic breast disease - If not fluid filled
Core biopsy is done
fibroadenoma - menstrual cycle?
Not sensitive to the menstrual cycle
fibroadenoma - size?
Increase in size in pregnancy and decreases with age
fibroadenoma - how to diagnose? (fibro to the core)
Work up may include a core biopsy.
types of breast cancer - in situ
Ductal carcinoma in situ (confined)
Lobular carcinoma in situ
Inflammatory carcinoma (rare, mimics an infection)
Modified radical mastectomy - (radical, leave me some nodes)
(don’t take all nodes)
Skin- or scar-sparing mastectomy
Nipple- and areola-sparing mastectomy (nerves may be affected)
fibroids and pregnancy and labor
Complications during pregnancy and labor, including a six-time greater risk of cesarean section.
B
Belief: Articulate your belief in the victim, violence is not acceptable in any situation, that the abuse is not her fault and no one deserves to be hurt or mistreated.
C
Confidentiality. Ensure the confidentiality of the information that is being provided and explain the implication of mandatory reporting laws, where applicable.
osteoporosis meds - (osteo is friends w/ covid and esther)
Monoclonal antibodies
Hormonal medications
Estrogen therapy (considered a second-line therapy for osteoporosis)
most common type of breast cancer
Invasive ductal carcinoma
