Test 2 Womens Health & Breast Cancer Flashcards
Amenorrhea is absence of menses
Nomal…
Abnormal…
Normal
Before menarche (1st period)
During preggers
Postpartum
During lactation
After menopause
Abnormal;
Thin / eating Disorders
Competitive Athelete Long distance runner / Gymnast
Amenorrhea has an increased risk for osteoporosis r/t…
Decreased estrogen levels
Under ____ % body far wil lose their period
16 %
Primary Amenorrhea
Menses begins within 2 years of breast dev 9 - 15
Considered abnormal if no menses by ….
16.5
Turners syndrome will cause lack of menses.
Describe how a person gets turners syndrome…
Missing 1 (X) chromosome - 45 in total
Causes of primary Amenorrhea (4)
Low body weight, Turners, Radiation/ Chemotherapy
Describe 2ndary Amenorrhea ….
Most common cause…
Cessation of menses for atleast 6 months in a person who regular has menses.
Cause: Preggers, DM, TB, hypothyroidism, low weight, PCOS (polycystic Ovarian cancer)
Dysmenorrhoea (Painful menses) is causes by….
Excessive Prostaglandin production, causes uterine muscle contractions
TX for Dysmenorrhoea…
Oral contraceptives (Decrease endometrium growth)
Prostaglandin inhibitor (NSAIDS, Motrin, Advil, Naprosyn)
Pelvix pain that occurs middle of menstrual cycle, Ovulation
Sharp pain felt on Right or Left side.
Last few hours - 2 days
Possible slight vaginal bleeding
Mittelschmerz
Mittelschmerz
Day 14 of menstrual cycle
Due to…
Rupture of follicle & spillage of folicular fluid / blood into perineal cavity
Presence of tissue outside the uterus that resembles the endometrium in both FORM & FUNCTION…
Endometriosis
_____ stimulus growth of tissue and slough durjng menstruation
Estrogen & Progesterone
Endometriosis
Prostaglandin secreted by the endometral tissue does what to the body…
Bleeding associated with endometriosis causes…
Irritated nerve ending and stimulates uterine contractions
Inflammation & infertility
SS
Pain
Infertility
Dyspareunia (Urine during Sex)
Rectal Pain
Endometriosis
It is recommended that women with endometriosis have children quickly, dont delay.
Goal….
Meds…
Surgery….
Goal: Stop menstrual cycle (Pseudomenoñause)
Meds: Oral contraceptives, progesterone - Counter acts estrogen which drives the disease
danazol, Lupron (GnRh agonist), Synarel
Surgery: Hysterectomy with bilateral salpingo-oophorectomy (Removal 1 or both ovaries & Fallopian tube), Laproscopic removal of lesions
__________ (Phase & days)
What Happens: The uterine lining (endometrium) sheds, resulting in bleeding (menstruation).
Hormones:
Low levels of estrogen and progesterone trigger menstruation.
_________ (Phase & Days)
What Happens: The pituitary gland releases follicle-stimulating hormone (FSH), which stimulates the ovaries to produce follicles. One follicle becomes dominant and matures an egg.
The endometrium starts rebuilding.
Hormones:
Rising levels of estrogen help thicken the uterine lining.
_____ (Phase & Days)
What Happens: A surge in luteinizing hormone (LH) causes the mature egg to be released from the ovary (ovulation).
Key Point: This is the most fertile time in the cycle.
________ (Phase & Days)
What Happens: The ruptured follicle turns into the corpus luteum, which produces progesterone to maintain the uterine lining for a potential pregnancy.
If the egg is not fertilized, the corpus luteum breaks down, progesterone and estrogen levels drop, and the cycle restarts.
Menstrual Phase (Days 1-5):
What Happens: The uterine lining (endometrium) sheds, resulting in bleeding (menstruation).
Hormones:
Low levels of estrogen and progesterone trigger menstruation.
Follicular Phase (Days 1-13):
What Happens: The pituitary gland releases follicle-stimulating hormone (FSH), which stimulates the ovaries to produce follicles. One follicle becomes dominant and matures an egg.
The endometrium starts rebuilding.
Hormones:
Rising levels of estrogen help thicken the uterine lining.
Ovulation Phase (Day 14):
What Happens: A surge in luteinizing hormone (LH) causes the mature egg to be released from the ovary (ovulation).
Key Point: This is the most fertile time in the cycle.
Luteal Phase (Days 15-28):
What Happens: The ruptured follicle turns into the corpus luteum, which produces progesterone to maintain the uterine lining for a potential pregnancy.
If the egg is not fertilized, the corpus luteum breaks down, progesterone and estrogen levels drop, and the cycle restarts.
PMS / PMDD
Cyclic and recurrent in _____ phase of menstrual cycle.
The woman is symptom free during ____ phase
Cause unknown
Cyclic and recurrent in Luteal phase of menstrual cycle. (After ovulation)
The woman is symptom free during Follicular phase (Before Ovulation)
Cause unknown
Which day do you begin counting the menstrual cycle…
first day of menstrual bleeding, which is considered Day 1 of the cycle.
Beginning of the menstrual phase, where the uterine lining sheds and bleeding occurs.
PMS management
Diet…
RX….
Avoid caffeine/ chocolate
Rx:
oral contraceptives
Antidepressants SSRI
Estrogen therapy (migraine)
Danasol (Steroid = breast pain)
Bromocriptine (breast pain)
SS
Hypovolemia
Hypotension
Shock
Sudden fever
Flulike symptoms
Caused by S Auerus. Alters permeability of capillaries allowing intravascular fluid to leak from the membranes.
TOXIC SHOCK SYNDROME
High absorption tampons
Diaphragm
Cervical cap
All may contribute to this infection…
Toxic shock syndrome
Change tampons how often
Atleast q4h
Super adsorption pads will protect from toxic shock syndrome
False
They cause it.
Use a pad
Meds/treatment for TSS
Fluid replacement
Vasopressor drugs
Antimicrobial
Corticosteroids
This hormone production slows down woth menopause…
Estrogen
Perimenopause
Irregular periods
Hot flashes
Sleep issues
Happens when…
10 years prior to Menopause
About 41 / 42
Postmenopausal bleeding may indicate….
Endometeral cancer
Labia thins
Vag dry
Dyspareunia
Smaller breast
Loss bladder tone
Increased LDL (Heart disease)
HDL decrease
Hot flashes
Psych changes
Post menopause symptoms
Estrogen treats postmenopausal SS
Hot flashes
Osteoporosis
Atrophic vag
Risk…
Breast cancer & heart disease
Hormone therapy postmenopausal
With Hysterectomy
Without Hysterectomy
Woth Hysterectomy: Estrogen
Without: Estrogen & Progesterone (Decreased risk of endometrial cancer)
HRT
_____ Reduces risk of endometrial cancer when estrogen is used postmenopausal
Progesterone
Contraindications for Estrogen hormone replacement (7)
Previous Breast, Ovarian, Uterine cancer
Family member with breast cancer
Thromboembolic disease
Stroke
Liver disease
Gallbladder/ Pamcreatic disease
DM
Small boned
Fair skinned White / Asian
Family history
Early menopause
Sedentary lifestle
Smoker / Drinker
Caffeine
Corticosteroids/ Anticonvulsants
Inadequate intake of calcium during youth
Risk factors for osteoporosis
Risk factors for osteoporosis
Small boned
Fair skinned White / Asian
Family history
Early menopause
Sedentary lifestle
Smoker / Drinker
Caffeine
Corticosteroids/ Anticonvulsants
Inadequate intake of calcium during youth
Estrogen Replacement fir osteoporosis
Haults boneless
When to start & stop
Start with in 5 yrs of menopause
And continue for 10 years
Vitamin D Is needed to absorb Calcium
Start at age 25 - 50 What Doseage….
Postmenopausal What Doseage….
1000mg
1200 - 1500 mg
Does broccoli & green leafy veg have calcium?
Yes substantial amount
Management of Osteoporosis
Calcitonin IM, SC, Nasal Spray (Use)
Evista (Use)
Foramen (Use)
Patient teaching…
Calcitonin IM, SC, Nasal Spray
Increase bone mass
Evista (Use)
Increase bone mass
Foramen (Use)
Inhibits bone reabsorption
Patient teaching…
Stop smoking, ETOH, Caffeine
Prevent Falls
Anterior wall prolapse bladder protrude into vag…
Cystocele
Cystocele
Anterior wall prolapse bladder protrude into vag
What can a Cystocele (Anterior wall prolapse bladder protrude into vag) lead to…
What would you teach this patient…
Causes. ..
Incomplete bladder emptying
Cystitis
Stress urinary incontence
Teach: Kegal exercises
Causes: Childbirth/ Menopause
Pouch of Douglas
(Fold of peritoneum that dips down between rectum & uterus)
Is associated with…
Enterocele
Prolapse of the upper Posterior vag wall between vag & rectum (may include loop of the bowel)
Prolapse of the upper Posterior vag wall between vag & rectum
May include loop of the bowel
Enterocele
POSTERIOR vag wall weakness can cause weakness during defecation and allow feces into the vag in this disorder….
Teaching….
Digital pressure required….
Rectocele
Avoid constipation
Maybe digital pressure
Symptoms get worse with standing
SS
Feeling of pelvic fullness
Pelvic pressure
Low back ache
Feeling “ Everything is falling out”
Urine frequency, urgency, incontence
Constipation, flatulence, difficulty defecation
Pelvic floor dysfunction- Uterine Prolapse
Muscle, lig, and fascia are damged/weak. Pelvic organs prolapse into vag….
Pelvic floor dysfunction- Uterine Prolapse
Nursing Management for Uterine Prolapse
Surgery Anterior & Posterior Colporrhaphy (A&P repair)
Sutures supporting the fascia to lift bladder, perineum, rectum
Vag hysterectomy
HRT
Kegels
Graduated weights
Pessary - Devices inserted into vag to keep organs from prolapse
Uterine Leiomyomas aka
Fibroids
Describe the growth of Uterine Leiomyomas….
Estrogen dependent
Grow during Childbearing years / Shrink after menopause (Unless HRT)
PAIN
INCREASE RISK OF MISCARRIAGE/PRETERM BIRTH
maybe no symptoms
Excessive bleeding
Anemia
Weakness
Pelvic pressure
Bloating
Urinary frequency
Uterine Leiomyomas (Fibroids)
Why might Fibroids enlarge during preggers…
Increase Estrogen levels
Myomectomy….
Surgical removal of fibroid
Uterine Fibroids Treatment
Depends on size, location, desire to have babies.
Observation only
Uterine Artery Embolization, occlusion
Myomectomy - Surgical removal of fibroid
Hysterectomy
GnRh agonist
Ablation
TOL after myomectomy…
No
Only uterine surgery with TOL is Lower Transverse Cesarean Section
GnRh agonist…
For….
Gonadotropin releasing hormone Increaser
Treats Uterine Fibroids
Hysterosalpingogram…
Fluid injected into uterus & X-ray taken for Fibroids
Candidiasis aka yeast infection
MOST COMMON FORM OF VAGINITIS - NOT AN STD
Risk factors….
Hallmark signs…
Tx….
Risk
Preggers
DM
Oral contraceptives
Antibiotics
Hallmark sign
Itching
Inflammation vag
Cottage cheese discharge from vag
TX
Doesn’t require RX
Miconazole (Monistat)
Fluconazole (Diflucan)
Candidiasis is an overgrowth of normal flora…
True
Anaerobic Protozoan
SS
Purulent vag discharge
THIN, FROTHY, MALODOROUS, YELLOW/GREEN, VAG ITCHY,
Edema / Redness
DX: Wet Mount
Name problem
Trichomonas
Trichomonas
Anaerobic protozoan
TX……
Avoid sex until cured
TX: Not preggers Metronidazole (Flagyl)
When taking Metronidazole (Flagyl) avoid…
ETOH - Has an antibuse like affect
Inhabits vag of healthy women- Not Always an STD
SS
Thin grayish white vag discharge
Fishy odor
Dx Saline Wet Mount
Bacterial Vaginosis
Treatment of Bacterial Vaginosis…
Metronidazole
Clindamycin cream
Possible causes
Trauma
Frequent vag intercourse
Multiple partners
Douching
Bacterial vaginosis
Most common STD
Chlamydia
Biggest risk with Chlamydia in females…
Infertility
SS
Asymptomatic
Yellowish vag discharge & painful urination.
Infertility if left untreated
Chlamydia
Chlamydia
TX…..
Erythromycin when preggers
Doxycycline
Clindamycin
Azithromycin
Dx of chlamydia
Tissue culture
SS
Maybe Asymptomatic in women
Purulent DC
Risk for progression to PID
DX: GC culture
Tx…..
Cefriaxone
Cefeximine
Ciprofloxin
Syphilis Stages
Primary
Painless chancer on genitls, anus, oral cavity heals in 6 weeks
Secondly
Spirochete causes enlargement of liver, spleen, lymphedema, headache, anorexia, rash, lesions
Describe 3rd stage…
May occur 10 - 30 years later
Damged heart
CNS
Paralysis
Psychosis
DX & TX for Syphilis…
DX
VDRL
RPR Rapid Plasma Reagin
FTA-ABS Fluorescent treponemal antibody absorption
TX; Penicillin
HSV 1&2
Most dangerous to newborn…
Primary (1st) infection during 1st 20 weeks of preggers
HSV 1&2
Dx
Tx
Dx: Culture of fluid from vesicle
Tx: No cure. Acyclovir/ Valores helps with symptoms
Type of precautions with HSV 1&2
Contact until lesions are dry and crusted, then its standard
Condylomata Acuminta ….
Vag warts
Small growths that resemble cauliflower.
Transmitted through skin-skin contact
Associated risk of cervical cancer
How to prevent the cervical cancer…
Condylomata Acuminta aka Genital warts
Semi-annual pap smears
Trichloroacetic acid is used to…
Remove genial warts
As well as other therapy
Number one killer of women…
Cardiovascular
More than all cancers combined
___ provides protective effect againt CV diseases
Estrogen
Postmenopausal is more dangerous for women
Is colon cancer a high risk for women, which age?
Fecal occult test: Avoid what…
Yes, over 50.
NSAIDS, Raw meat, raw fruit & veg, vitamin C, horseradish
At age 50
What screening for colon cancer
Yearly Occult blood
Sigmoidoscopy 3 - 5 yrs
Colonoscopy q10years
Fibrocystic breast changes (Benign)
Thickening of nomal breast tissue ____ menopause
Bilateral pain and tenderness most common during which cycle phase….
Increased risk of breast cancer…
Mammogram, why?
Symptom relief…
Before
Premenstrual phase
Yes increased risk of breast cancer
Mamogram to RO malignant
Symptom relief
Avoid Stimulants
Danazol / Androgenic (Supress estrogen)
Bromocriptine: Prolactin inhibitor
Tamoxifen: Estrogen inhibitor; Usually fir CA tx
Smooth and well delineated
Benign or Matastic
Benign
Tamoxifen….
Estrogen inhibitor
Used for breast CA & Fibrocystic breast changes
Benign tumor that can occur at any age.
Most common in teens & 20s
Firm, movebale, maybe tender, doesn’t change during cycle
Tx: observation, fine needle biopsy, core biopsy, excision
Benign disorder: Fibroadenoma
Goal of breast self-awareness…
Women become aware of their normal appearance and feel by regular breast assessment
When and how often should women do breast self awareness exams…
Week after period
Signs to report from breast self exam
Lump/ Thickening
Skin dimplings
Inverted nipple
Discharge from nipple
Change in texture shape color of skin
Mass firmly fixed & not well delineated
About 50 % of breast cancers are found where…
Upper outer quadrant
Red flag for breast cancer…
Non moveable & not well defined
Why are mammogram not recommended for <39
Due to how thick the breast tissue is
Mamogram screening recommendations
40 - 44
45 - 54
>55
40 - 44: Choice if they want annual Mamogram
45 - 54: Yearly Mamogram
> 55: Option of Yearly or every 2 years
Risk & Modifible risk for breast cancer
1:8 have a chance of developing B CA
Old age
Genetics (BRCA 1&2 / CHEK -2)
Early menarche
Late menopause
Dense breast
Family/personal history
Modifible Risks
Sedentary
Overweight
HRT
1ST preggers >30
Not breastfeeding
Drink alcohol
Tumor, Node, Metástasis
Finding of concern….
Node or Mestasis
Breast cancer surgery depends on Type, Location, Stage of disease
Give the (4) surgical procedures from least to most invasive…
Local Excision Lumpectomy
Quadrantectomy Quadrant of tissue
Simple mastectomy Remove entire breast
Modified Radical Mastectomy: Breast Tissue, Axillary Node, some Chest Muscle
Define
Sentinel Lymph Node Biopsy
Only removes key affected lymphnodes
Avoids issues with lymphedema (Localized swelling caused by accumulation of lymph fluid)
Tracer dye injected near tumor site
Limb care after removal of lymph nodes
No BP on affected arm
AVOID INFECTION
No IV or Blood draws
Keep hands moist
Keep arms clean
Wear protective gloves, thimble, electric shaver, insect repellent
Avoid Burns
Avoid Constriction: Clothing, Straps, Jewelry
Compression Sleeves when flying
ELEVATE ARM ABOVE HEART AS OFTEN AS POSSIBLE
Breast cancer
Adjunctive Therapy
Radiation/Chemo
Hormone Therapy….
Medications to reduce production of estrogen and / or progesterone.
Tumor growth is stimulated by estrogen
TAMOXIFEN is most common
Aromatase inhibitors
Anastrozole
Exemestane
Letrizole
Tamoxifen (Novadex)
Estrogen receptor Antagonist antieoplastic agent
Used in women who had ____ estrogen hormone receptors
Stops growth of breast cancer cells that may still be in body after surgery
SE…..
Dose….
Positive estrogen hormone receptors
SE: Menopause symptoms
Dose: 20mg/day 5 years
Malignant Disorders
Uterine cancer: Risk factors
Cervical cancer: Risk factors
Ovarian cancer: Risk factors
Uterine
Obesity
Nulliparous
Late menopause
DM
HTN
Gallbladder disease
Breast,Colon, Ovarian CA
LT unopposed estrogen therapy
Cervical Cancer
First sex <20
HX STD
Multiple sex partners
Poor
Black
Ovarian CA
White
Menopause
Family history
Nulliparous
Vulvar self-exam
Conduct every month when sex active or >18
Vulva Intrapithelial neoplasia (VIN) is a precancerous condition that affects the vulva
Rates increasing due to ….
HPV
Screening Test
Uterus
Cervix
Ovarian
Uterus: US, Bimanul exam, endometrial biopsy
Cervix: PAP - Screening
Colposcopy - Diagnosis for Cervical cancer
Ovarian: US, CA 125, Bimanual exam
Between periods
No douching / sex 48 hrs before
No topical meds / lube
Empty bladder
Maybe difficulty with hx of abuse
Pelvic exam
What does a pelvic exam consist of…
External organs exam
Speculum
Pap test
STD screening
Cultures
Bimanual exam
( Examines uterus and ovaries inserting fingers into the vagina while simultaneously palpating the abdomen)
Pap test screens for…
Cervicak precancerous changes & HPV testing
ACS Cervical Cytology screening guidlines
Start at 21
21 - 29
30 - 65
>65
Additional screening for ab history and risk factors
21 - 29 Q3 years
30 - 65 Q5 years
>65 No screening if normal pap over last 10 years
Mangt of Malignant cancers if reproductive organs
Cryosurgry, electrosurgery excision, cotización, total hysterectomy, radation, chemo
Hysterectomy, radation, intracavity radition, chemotherapy
Oophorectomy, hysterectomy, chemotherapy
Ovarian, Cervical, Endometrial
Cervical
Cryosurgry, electrosurgery excision, cotización, total hysterectomy, radation, chemo
Endometrial
Hysterectomy, radation, intracavity radition, chemotherapy
Ovarian
Oophorectomy, hysterectomy, chemotherapy
Removal of clit
Removal of part of clit and labia minor
Infibulation….
Piercing, scrapping, or cauterizing the genitals
Female Genital mutilation
Infibulation = Narrowing vag with caustic chemicals
Pain circumstances: can occur during sexual intercourse
Whole body: fatigue, night sweats, osteoporosis, hot flashes, or sweating
Sleep: early awakening or insomnia
Menstrual: absence of menstruation or irregular menstruation
Hair: dryness or loss of scalp hair
Also common: anxiety, dry skin, irritability, moodiness, reduced sex drive, or vaginal dryness
Menopause
Menopause SS
Sex?
Whole body?
Hair?
Sleep?
Misc?
Pain circumstances: can occur during sexual intercourse
Whole body: fatigue, night sweats, osteoporosis, hot flashes, or sweating
Sleep: early awakening or insomnia
Menstrual: absence of menstruation or irregular menstruation
Hair: dryness or loss of scalp hair
Also common: anxiety, dry skin, irritability, moodiness, reduced sex drive, or vaginal dryness
Uterine Cancer Risks…
Obesity
Nulliparous
Late menopause
DM
HTN
Gallbladder disease
Breast,Colon, Ovarian CA
LT unopposed estrogen therapy
Cervical Cancer Risks….
First sex <20
HX STD
Multiple sex partners
Poor
Black
Ovarian CA Risks
White
Menopause
Family history
Nulliparous
FORCE
Facing
Our
Risk
Cancer
Empowered
Coined the term Previvor, define….
Define person/group of people term relates to…
A person who is at risk for developing a disease (breast cancer) but Never Contracted it.
Previvor <40 women with predisposición to BC & taken steps to prevent diagnosis
BRCA 1 & 2
Describe….
Genes that increase odds of getting BC
1: 55 - 65% BC <70
2: 45% BC <70
Breastfeeding can increase risk of breast cancer…
False
Lowers it. The longer you breast feeding the lower the odds BC
Management of BC
Breast MRI every year starting…
25 yrs old
> 40 Mamogram & MRI q1year
Tamoxifen & Raloxifene can prevent breast cancer but with this serious possible SE
Uterine Cancer
Culture with high rate of BC…
Ashkenazi Jews 2.5%
Endometeral Cancer
Risk….
SS…
Risk: Prolonged expose to Estrogen without Progesterone
SS: Postmenopausal vag bleeding
Cervical Cancer
Caused by….
SS….
HPV
Painless vag bleeding
Firm, unmoving, non tender lump describes…
Breast cancer
Pap smears check fir..
Cervical Cancer
Tamoxifen
Does what…
Prescribed for…
antiestrogens
Breast cancer
Mastectomy has this major precaution…
Wear sling while ambulation
No taking BP / IV from affected side
Yes sling. Wear loose fitting long sleves
Fibrocystic breast changes
Occur due to…
Are they cancerous?
Increase estrogen
No cancer
PCOS can cause amenorrhea
True
Endometriosis can cause dysmenorrhoea & pelvis pain…
True
HRT (Estrogen / possibly progesterone) can help with the symptoms of menopause (Osteoporosis, Hot Flashes, Not Sleeping)
But carries these risks…
Increase thrombolytic disorder
Increased breast cancer
Vaginal pessaries are…
Insertable (vag) devices that support vag and prevent Prolapse of uterus, bladder, colon
Are being pregnant/ DM a risk factor for candidiasis (Yeast infection)
Describe appearance of a yeast infection….
Tx…..
Yes as well as:
Oral contraceptives
Antibiotics
Hallmark sign
Itching
Inflammation vag
Cottage cheese discharge from vag
TX
Doesn’t require RX
Miconazole (Monistat)
Fluconazole (Diflucan)
Miconazole (Monistat)
Fluconazole (Diflucan)
Treat…
Candidiasis aka yeast infection
Danazol / Androgenic (Supress estrogen)
Bromocriptine: Prolactin inhibitor
Maybe used for…
Benign fibrocystic breast changes
Acyclovir
Used to treat….
HSV 1&2
Describe chlamydia…
Tx….
Asymptomatic
Yellowish vag discharge & painful urination.
Infertility if left untreated
Erythromycin If pregnancy
Doxycycline
Azithromycin
