Reading - Ch. 3 Flashcards by Kelsey Klipfel

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

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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

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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

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4 phases: menstrual phases, proliferative phase, secretory phase, ischemic phase

Endometrial cycle

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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

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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

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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

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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

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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

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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

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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

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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:

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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

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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

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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

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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

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Excitement
Plateau
Orgasmic
Resolution

Sexual response cycle is divided into four phases:

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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:

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Adolescents
Young and middle adulthood
Late reproductive age

Health Promotion & Disease Prevention

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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

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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

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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

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Preconception counseling and care
Pregnancy
Fertility control
Infertility
Menstrual problems
Perimenopause

Care at specific stages of a woman’s life

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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

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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)