Reading - Ch. 3 Flashcards
Paired mammary glands between second and sixth ribs
Attached to muscle via fascia/CT
Func: lactation; sexual arousal
Breasts - approximately equal in size but not symmetric
Contour is smooth
Estrogen stimulates growth by inducing fat deposition on the breasts, development of stromal tissue, and extensive ductile sys; increases vascularity breast tissue
Prgesterone - maturation of mammary gland tissue: lobules and acinar structures
Each mammary gland composed multiple lobes divided into lobules - clusters acini: saclike terminal part of compound gland emptying through narrow lumen or duct; lined with epithelial cells; modified sweat glands
Ducts from clusters acini form lobules merge to form larger ducts draining lobes; ducts from lobes converge in single nipple: mammary papilla surrounded by areola
Cooper’s ligaments - separate and support glandular structures and ducts; provide support to mammary glands while permitity mobility on chest wall
Nipple surrounded by fibromuscular tissue covered by wrinkled skin: areola
Increasing levels estrogen and progesterone 3-4 days before menstruation increase vascularity breases, induce enlargement of ducts and acini, promote water retention; ducts proliferate; ducts dilate; lobules distend
After menstruation - cellular menstruation begins to regress, acini decrease in size, retained water lost
Physiologic alterations in breast size and activity reach min level about 5-7 days after menstruation stops - BSE carried out now
Breasts
Increase estrogen 8-11 yrs
Menarche - first menstruation
Puberty - broader term denotes entire transitional stage between childhood and sexual maturity
Increasing amounts and variations in gonadotropin and estrogen section develop into cyclic pattern at least 1 yr before menarche
Initially menstraul period - irregular, unpredictable, painless, anovulatory; 1+ yrs later ovary produces adequate cyclic estrogen to make mature ovum ovulatory periods regular; estrogen dominates first half and progesterone second half
Menarche and puberty
Menstruation - periodic uterine bleeding begins 14 days after ovulation; controlled by 3 cycles below; avg cycle: 28 days
Prepares uterus for pregnancy - if not occur: menstraution follows
Age, phys and emotional status, enviornment influence regularity of menstrual cycle
Endometrial cycle
Hypothalamic-pituitary cycle
Ovarian cycle
Other cyclic changes
Menstrual cycle
4 phases: menstrual phases, proliferative phase, secretory phase, ischemic phase
Endometrial cycle
Shedding ⅔ endometrium initiated by periodic vasoconstriction in upper layers endometrium
Basal layer retained
Regeneration begins near end of cycle from cells derived from remaining glandular remnants/stromal cells in layer
Menstrual phase
Period rapid growth 5th day-ovulation; endometrial surface completely restored in 4 days or slightly before bleeding ceases
8-fold to 10-fold thickening occurs with leveling off thickening of endometrium at ovulation
Depends on estrogen stimulatikon derived from ovarian follicles
Proliferative phase
Ovulation to 3 days before next menstrual period
After ovulation: large amounts progesterone produced
Fully matured secretory endometrium reaches thickness of heavy, soft velvet
Luxuriant with blood and glandular secretions - suitable and nutritive for egg
Implanted egg 7-10 days after ovulation
Secretory phase
Hypo and ant pit - production of FSH and LH
Target tissue: ovary: produces ova and secretes estrogen and progesterone
Toward end menstrual cycle blood levels estrogen and progesterone decreases
Marked surge LH and smaller peak estrogen (day 12) precedes expulsion ovum from graafian follicle 24-36 hrs
LH peaks day 13/14
Fertilization and implantation ovum not occurred by this time, regression corpus luteum follows; levels estrogen and progesterone decrease and menstruation occurs
Hypothalamic-pituitary cycle
Have follicular and luteal phase
Postovulatory phase requires 14 days (range 13-15 days)
Corpus luteum reaches its peak functional activity 8 days after ovulation, secreting estrogen and progesterone
Ovarian cycle
Hypothalamic-pit-ovarian axis funcs properly other tissus undergo predictable responses - temp under normal body temp after ovulation; with increasing progesterone levels, temp rises
Changes in cervix and cervical mucus: preovulatory and post: mucus thick; time ovulation: thin and clear - looks, feels, stretches like egg white: localized lower abdominal pain with ovulation
Prostaglandins
Other cyclic changes
Oxygenated fatty acids classified as hormones
Active in minute amts in CV, GI, resp, urogenetial, NS, metabolism (glycolysis)
Smooth muscle contracitiy and modulation hormonal activity
Intro to vagina and uterine cavity from ejaculated semen increases motility of uterine musculature assist transport sperm
Regression corpus luteum and regression and sloughing endometrium, resulting in menstruation
Effects on:
Prostaglandins
Ovulation - not rise with LH search ovum trappen in graafian follicle
Fertility
Changes in cervix and cervical mucus - affect receptivity to sperm
Tubal and uterine motility
Sloughing of endometrium (menstruation)
Onset of miscarriage and induced abortion (spontaneous and induced)
Onset of labor (term and preterm)
Effects on:
Transitional phase during which ovarian function and hormone production decline
Spans the years from onset of premenopausal ovarian decline to postmenopausal time, when symptoms stop
Climacteric
Refers to the last menstrual period
Dated with certainty 1 year after menstruation ceases
Average age 51.4 years old
Range of ages 35 to 60 years old
Perimenopause - period preceding menopause 4 yrs: ovarian func declines; ova slowly diminish and menstrual cycles may be anovulatory resulting in irregular bleeding; ovary stops producing estrogen, eventually menses ceases
Menopause
Females and males achieve physical maturity at approximately age 17 years old
Women and men are more alike than different in physiologic response to sexual excitement and orgasm
Sexual response cycle is divided into four phases:
Time, intensity, and duration for cyclic completion vary for individuals and situations
Sexual response
Physiologic sexual response can be analyzed in terms two processes: vasocongestion and myotonia (increased muscular tension)
Sexual stimulation results in an increase in circulation to circumvaginal blood vessels - lubrication in female; causing engorgement and distention of genitals
Venous congestion is localized primarily in the genitals and to a lesser degree in breasts and other parts of the body
Arousal is characterized by myotonia, resulting in voluntary and involuntary rhythmic contractions
Women and men are more alike than different in physiologic response to sexual excitement and orgasm
Excitement
Plateau
Orgasmic
Resolution
Sexual response cycle is divided into four phases:
Identification of unrecognized probs and potential risks and edu and health promotion needed to reduce them
Health Promotion & Disease Prevention
Caring for women across the lifespan:
Adolescents
Young and middle adulthood
Late reproductive age
Health Promotion & Disease Prevention
Associated with menses, vaginits/leukorrhea, STIs, need for contraception, or pregnancy
At risk for street drugs, eating disorders, stress, depression, anxiety
First enter the healthcare system as young women for the purpose of contraception or women’s health exams
Teenage pregnancies: sexually active who do not use regular contraception has 90% of conceiving in the first year
Adolescents
Contraception: 20-40 need contraception, pelvic and breast screenings, pregnancy care - use gynecologic/OB provider as PCP
Juggling fam, home, career responsibilities
Pelvic and breast screenings - Health maintenance includes these and promotion healthy lifestyle
Young and middle adulthood
40+
Increased time and opportunity for new interests and activities
Health maintenance screening imp because breast disease and ovarian cancer occur during this stage
Increased risks with pregnancy, emergence of chronic diseases
Late reproductive age
Preconception counseling and care
Pregnancy
Fertility control
Infertility
Menstrual problems
Perimenopause
Care at specific stages of a woman’s life
Preconception care - guides how avoid unintended pregnancies, identify and manage risk factors in their lives and enviornment, identify healthy behaviors that promote well-being of woman and potential fetus
Need do healthy activities 17-56 days after fertilization
Minimizes fetal malformations
Preconception counseling and care
Early and consistent prenatal care imp to improve outcomes for both mother and infant
Major goals: define health status; determine gestational age and monitor fetal development; identif at risk women and minimize risk; provide appropriate edu and counseling
Pregnancy
Do not use contraception or contraceptive failure
Edu key
Fertility control
Starting fams later in life
STIs predisopose decreased fertility
Cause emotional pain
Inability produce offspring - feelings failure and places inordinate stress on relationship
Steps to prevent this imp
Infertility
Ireegularities or probs with period most common and cause seek help
May need simple explanation and counseling
History and exam must be completed; lab and diagnostic tests required
Questions applicable to all
Menstrual problems
Natural transition - caused by decrease in estrogen
Experience irregular bleeding; some concerned about vasomotor symp: hot flashes and flushes
Pregnancies can occur - maintain birth control
Perimenopause
Substance use and abuse
Nutritional probs
Stress
Mental health conditions
Sleep disorders
Environmental and workplace hazards
Risky sexual practices
Risk for certain medical or gynecologic conditions
Female genital mutilation
Human trafficking
Identification of risk factors
Prescription drug use
Illicit drug use
Alcohol consumption
Cigarette smoking/Tobacco
Caffeine
Substance use and abuse
Prescription meds bring relief from undesirable conditions
Mind-altering capacity misuse produce psychological and phys dependency in same manner as illicit drugs
Prescription drug use
Marijuana
Cocaine
Opiates
Methamphetamine
Phencyclidine
Other illicit drugs
Illicit drug use
Smoked, eaten
Distored perceptions, difficulty prob solving: thinking and memory, altered state of awareness, relaxation, mild euphoria, reduced inhibition, mood changes
Most frequently used
Marijuana
Tremendous source euphoria
snorted, smoked, injected
Intensely pleasurable high followed by uncomfy low increasing urge to continue
Affects all major body sys
Cocaine
IV injection - can be smoked/snorted
s&s heroin use are euphoria, relaxation, relief pain, nodding out, constricted pupils, nausea, constipation, slurred speech, resp depression
Opiates
Highly addictive
Not expensive
Feel hypersexual and uninhibited
Smoked
Elevated mood, increased energy
Lead to cardiac probs
Methamphetamine
Hallucinogen
Dissociative symp: Distorted perceptions and detached feelings, delusions, hallucinations, anxiety, panic, disodered thinking, high doses cause: seizures, coma, death
Phencyclidine
LSD - hallucinogen; vivid changes in sensation: agitation, euphoria, paranoia, antisocial behavioral; lead to flashbacks, chronic psychosis and violent behavior
Other illicit drugs
More motor vehicle injuries
Higher incidence attempted suicide
Alcohol-related liver damage, cardiac disease, brain disease
Alcohol consumption
CV disease, cancers, chronic lung disease, - pregnancy outcomes
Decrease life span
Nicotine addictive and creates phys and psychological dependence
Impairs fertility
Lower age menopause
Increase risk osteoporosis after menopause
Secondhand smoke - sim risks as smoker
Cigarette smoking/Tobacco
Affect mood and interrupt body funcs = producing anxiety and sleep interruptions
Heart dysrhthmias worsen; interactions with certain meds (Li)
Caffeine
Follow healthy dietary pattern at every stage of life; customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, budgetary considerations; focus on meeting food grp needs with nutrient-dense food and beverages, stay within cal limits; limit foods and beverages high in added sugars, sat fats, Na, limit alcohol
Nutritional deficiencies
Obesity
Eating disorders
Lack of exercise (150 minutes/week of moderate exercise)
Nutritional probs
BMI: weight (kg)/ square height in meters
High cholesterol
Menstrual irregularities
Hirsutism
Stress incontinence
Depression
Complication of pregnancy
Increased surgical risk
Shortened life span
Obesity
Considered mental illness
Anorexia
Bulimia nervosa
Eating disorders
Distored view of bodies and regardless weight perceive self as too heavy
Undertake strict and severe diets and rigorous extreme exercise
Point starvation
Dysrhythmias, amenorrhea, cardiomyopathy, heart failure, death
Med history and phys exam and screening tests
Anorexia
Secret, uncontrolled binge eating alternating with methods to prevent weight gain: self-induced vomiting, laxatives, diuretics, strict diets, fasting, rigorous exercise
2/wk
Early adulthood
Dehydration, electrolyte imbalance, GI abnormalities, cardiac dysrhythmias
Feel shame/disgust; seek help earlier
Bulimia nervosa
Prevention CV disease and management chronic conditions
Stress reduction; weight maintenance
Kegel exercises imp for women - strengthen muscles that support pelvic floor and practiced regularly
20-30 min mod activity 3/week
Lack of exercise (150 minutes/week of moderate exercise)
Trigger phys rxns: rapid HR, HRN, slowed digestion, release additional NT and hormone, muscle tension, weakened immune sys
Psychologic symp: anxiety, irritability, eating disorders, depression, insomnia, substance use associated
May need counseling
Social support and good coping skills imp
Role playing, relaxation, biofeedback, meditation, desenitation, imagery, assertiveness training, yoga, diet, exercise, weight control
Stress
Refer to mental health practitioners when necessary
Extreme risk suicide
Mental health conditions
Correlated with phys and mental health probs
Imp to know ways improve sleep
Sleep disorders
Pathogenic agents
Natural and synthetic chemicals
Radiation
Phys objects
Affect fertility, fetal development, live birth, child’s future mental and phys development
Air pollutants
Environmental and workplace hazards
Undesired pregnancy and STIs
STIs result in: infertility, ectopic pregnancy, neonatal morbidity and mortality, genital cancers, AIDS, death
Behavioral changes must come from within; edu powerful tool in health promotion and prevention of STIs and pregnancy
Risky sexual practices
Certain med conditions present during pregnancy and have effects on woman and fetus: diabetes, UT disorders, thyroid disease, HTN disorders, cardiac disease, seizure disorder
Effects: intrauterine growth restriction, macrosomia, anemia, prematurity, immaturity, stillbirth
Effects woman: severe
At risk for variety issues
Gynecologic conditions contribute negatively to pregnancy: infertility, miscarriages, preterm labor, fetal and neonatal probs
Risk for certain medical or gynecologic conditions
part/all external genitalia removed for cultural/nontherapeutic reasons
Control sexuality
Remove sexual desire so not sexually active until marriage
Comps: bleeding, pain, local scarring, keloid/cyst formation, infection
Female genital mutilation
Form slavery which people forced become part of unpaid labor force
Sex trafficking: commercial sex act perfomed under force, fraud, coercion exchange for something value
In brothels, hotels/motels, truck stops, hostess/strip clubs, streets, escort services
Report minor if suspect it
Human trafficking
Most common form violence
Not random/constant - occur in repeated cycle: tension building, abusive incident, honeymoon phase
Physical or emotional abuse
Sexual assault
Isolation
Controlling all aspects of the woman’s life
Intimate partner violence (IPV)
Pregnancy increases the risk: if abused before likely abused during and will escalate
Physical or emotional abuse
Money
Shelter
Time
Food
Reproductive Coercion
Controlling all aspects of the woman’s life
Careful history and phys exam; responsibility self-management, health promotion, enhancement wellness
History
Physical examination
Pelvic examination
Women with special needs/disabilities
Adolescents (ages 13 to 19 years old)
Assessment of the woman
Interview - integral part hx
Private, relaxed setting
Questions - sensitive, nonjudgemental manner
Body language matches tone
Assure pt of strict confidentiality
Open-ended questions
Facilitation
Reflection
Clarification
Empathic responses
Confrontation
Interpretation
Develop rapport and trust with pats
Screen women for abuse and human trafficking
Alert to any indication of abuse despite not stating it
Therapeutic relationship and skillful interview help pts disclose and describe abuse
Language imp - do not call person victim: are survivor
History
Undress and wear gown; objective datal recorded
Gen appearance
VS
Skin
Head
Eyes
Ears
Nose
Mouth and throat
Neck
Lymphatic
Breasts
Heart
Peripheral vascular
Lungs
Abdomen
Extremities
Genitourinary
Rectal
MS
Neurologic
Physical examination
Placed in lithotomy position
External inspection and palpation
Vulvar self-examination
Papanicolaou test
Pelvic examination
Wear gloves and sits at foot table for inspection external genitalia and speculum examination: inspect sexual maturity, clit, labia, perinium, signs STIs
Before touching explain what going be done and expect feel; labia spread; vaginal orifice examined;
Examiner notes infection
External inspection and palpation
Imp do to prevent cancer
Sit, adequate light, mirror one hand and other expose tissue surrounding vaginal introitus - examines everything else and palpates and notes changes in appearance/abnormalities
Vulvar self-examination
Carcinogenic determined by examination of cervix collected during pelvic exam
Papanicolaou test
Respected and involved to full extent capabilities
Communicate openly, directly, sensitively
Maintain eye contact
May not be comfy with lithotomy position so may do variety positions that work better
Women with special needs/disabilities
Watch for hints risky behaviors, eating disorders, depression
Sexual activity discussed after rapport establishes and when alone with indiv; engage in sensitive manner and use active listening and be nonjudgemental
Injury prevention imp
Use drugs and alcohol included
Major tasks: values assessment, edu and work goal setting, formation peer relationships focus on love and commitment and becoming comfy with seuxality, separation from parents
Adolescents (ages 13 to 19 years old)
Fasting blood glucose (Age 45+)
Total blood cholesterol
Lipid profile
STI
Mammogram (age 40)
Clinical Breast Exam (age 20+)
Tuberculosis skin testing (as needed for high risk)
Pap test (age 21-65)
Pelvic exam (until age 70)
Colon cancer screening (age 45)
Bone mineral density (DEXA scan) (age 65)
Health screening for women across the lifespan
Annually with fam hx DM/gestational DM/obesel every 3-5 all women 45+
Fasting blood glucose (Age 45+)
At 45, if within norm limits, q5yr; more often if abnorm levels or risk factors for CAD
Total blood cholesterol
20 yrs if increased risk heart disease; discuss with HCP
Lipid profile
age <25 and as needed after 25 if sexually active with new or multiple partners
STI
Q1-2y 40-49 or earlier if higher risk
Annually 40+ and 50+
Biennially 50-74
75+ discuss with HCP
Mammogram (age 40)
Q3y 20-39; 40+ annually
Clinical Breast Exam (age 20+)
Annually with exposure to persons with TB or in risk categories for close contact with disease
Tuberculosis skin testing (as needed for high risk)
21-65: q3yr
30-65: q5y if HPV test done
65+ and 3 - tests and no risks and after total hysterectomy for benign disease may choose to stop screening
Pap test (age 21-65)
Annually until age 70
Any woman who has ever been sexually active
Pelvic exam (until age 70)
50-74: fecal occult blood test annually OR flexible sigmoidoscopy q5y OR colonoscopy q10y
Colon cancer screening (age 45)
65+ at least one; repeat PRN; younger women with risk for osteoporosis may need periodic screenings
Bone mineral density (DEXA scan) (age 65)
