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