test 4 Flashcards
True or False.
Women with disabilities experience increase risk for abuse.
True
When should a woman get her first pelvic exam?
Age 21 unless a specific complaint
What is the purpose of the Pap smear?
Assess for the abdominal cellular changes that can lead to cervical cancer
Prior to screening, instruct client to avoid?
Douche, sex (48 hours), spermicides
The nurse should make the pelvic examination ___ ____.
Less threatening
Begin screening for cervical cancer begins at what age?
21 years old
Pap test every 3 years if results are normal are during what age range?
age 21-30 years
Pap test every 3 years or Pap test + HPV test every 5 years are done during what age range?
age 31-64 years old
Stop routine screening if results are normal for the previous 10 years are done during what age range?
Age 65 years and older
What is the purpose of a colposcopy?
to magnify the tissue being examined
Application of ___ ___ helps to highlight any areas of suspicious cells.
acetic acid
They should ___ areas of concern to determine a treatment plan
biopsy
The goal of a colposcopy is to prevent ___ ___
cervical cancer
A ___ is visualization of the ovaries, Fallopian tubes, uterus, and small intestines via a lighted tube inserted in the vagina via the cul-de-sac.
culdoscopy
If a patient is having a culdoscopy, they should avoid ___ and ___ for 2 weeks post procedure.
douching, intercourse
A culdoscopy can be used to?
-rule out ectopic pregnancy
-evaluate ovarian disorders
-evaluate pelvic masses
What are the treatment options for cervical dysplasia?
cryotherapy/laser therapy OR cone bx loop electrosurgical excision procedure (LEEP)
A fine wire loop that has a low-voltage electrical current to remove abnormal layer of cervical cells is known as?
Cone Bx Loop Electrosurgical Excision Procedure (LEEP)
Freezing cervical tissue with nitrous oxide is known as?
cryotherapy/laser therapy
Is cervical cancer often symptomatic or asymptomatic?
asymptomatic
What are some S/S of cervical cancer?
painless vaginal bleeding, watery-foul odor (Progressively darken), irregular periods, bleeding between periods
What are the treatment options for cervical cancer?
LEEP, laser therapy, cryotherapy, cervical conization, hysterectomy
What are the indications for a hysterectomy?
uterine fibroids, heavy or unusual vaginal bleeding, uterine prolapse, endometriosis (severe), chronic pelvic inflammatory disease, adenomyosis, cancer
___ ___ is removal of ovaries (with or without the tubes)
Bilateral Oophrectomy
A bilateral oophorectomy and salpingectomy is removal of the ovaries ___ the ___.
with, tubes
What are the different types of hysterectomies?
-total abdominal hysterectomy
-total vaginal hysterectomy
-laparoscopic-assisted vaginal hysterectomy
-bilateral sapling-oophorectomy
-loop electrosurgical excision
-uterine ablation is frequently being used to treat abnormal uterine bleeding
What discharge teaching should be given to a patient after a hysterectomy?
-pelvic rest for 4-6 weeks
-no heavy lifting 8 weeks
-frequent bladder emptying
-bowel regimen
-ambulate
What are risks for women that have a hysterectomy at a young age <45?
- bone loss/osteoporosis
- lack of hormone
- symptomatic vasomotor symptoms
- increased risks for cardiovascular/neurological symptoms or stroke
True or False.
If ovaries are removed before menopause, supplemental estrogen therapy is recommended.
true
HPV vaccine is recommended for ages __-__ for both females and males.
9-26
True or False.
Preteens have a higher immune response to HPV vaccine than older teens.
True
Ovarian ____ are benign tumors that may be associated with pain.
Cysts
Ovarian ___ is the leading female cancer death because it rapidly spreads and has non-specific symptoms
cancer
S/S of ovarian cancer are?
abdominal selling or bloating, pelvic pressure or abdominal pain, difficulty eating
What diagnostics are used for ovarian cancer?
imaging or surgery
What are the treatment options for ovarian cancer?
surgery (primary)
chemotherapy
hormone therapy
radiation
**often 2 or more different types of treatments are used
Who is at risk for ovarian cancer?
increased age, hx of breast cancer, BRCA 1 or BRCA 2 gene mutations, family hx of breast or ovarian cancer
American CA society does not recommend that breast __ __ be presented to women but it does recommend that women be familiar with how their breast normally look and feel.
self exam
__-___ condition is the presence of soft, movable, tender lumps (more common at time of menses)
Non-cancerous
Are fibrocystic breast a pre-cursor to breast cancer?
No they are NOT
What causes fibrocystic breasts?
fluctuating hormones made by the ovaries
What are symptoms of fibrocystic breast?
swelling, tenderness, pain, thickening of tissue, lumps in one or both breasts
What is a mammogram?
Soft tissue x-ray of the breast
*can detect lesions earlier than by using palpation
Annual mammogram and clinical breast examination for all women over the age of __
40
What does a trained professional examiner assess for in a clinical breast exam?
general appearance & symmetry, appearance of nipples, color of skin, check for lumps and texture
What are predisposing risk factors for breast cancer?
-age (older the higher the risk)
-hx of breast cancer
-female gender
-having BRCA 1 or BRCA 2 gene mutation
-family hx of first degree relative
-long term post menopausal combine hormone therapy estrogen/progestin
-alcohol
-no hx of pregnancy or first after 30
-never breast feeding
-long reproductive phase
-hx of high dose radiation to chest
-no physical activity
-smoking
-overweight or obese after menopause
If you have a family history of pre-menopausal breast cancer, when should screening start?
10 years prior to youngest family member with breast cancer
____ ____ is a test for hereditary breast and ovarian cancer syndrome
BRCA analysis
**it does NOT tell if you have cancer it just tests for the mutation
What are the characteristics of breast cancer?
small, immobile, painless lump (unilateral)
Less common: rash, changes in color/dimpling
What are the treatment options of breast cancer?
surgery, radiation, chemo
What is the most important finding on a breast exam?
A painless mass or lump
What are some worrisome findings on a breast exam?
dimpling, new nipple inversion, change in size of breast, change in shape, skin breakdown, lump under arm
What is the clinical therapy for breast cancer?
- stage of cancer
- best treatment for the stage
- age
- personal preference
- risk and benefits
What are the surgical options for breast cancer treatment?
Lumpectomy or radical mastectomy
___ destroys cancer cells or shrink large masses before surgery
radiation
What are some systemic therapy options for breast cancer treatment?
tamoxifen (block estrogen), chemotherapy, ovarian function suppression (prevent estrogen excretion from ovaries)
The goal of surgery is to remove the cancer from the ___ & _______
breasts, lymph nodes
____ is a breast-sparing approach that is often used for stage I & II breast cancer
Lumpectomy- removal of the cancerous tissue plus a rim of normal tissue
____ drug blocks estrogen receptors in breast cancer cells. It stops estrogen from binding to the cancer cells and telling them to grow and divide,
Tamoxifen
Tamoxifen can also be used for ___ ___ by women who are at high risk for developing breast cancer
cancer prevention
What is nursing care for a patient after a mastectomy?
-inspect the incision and dressing for bleeding
-May have JP drains in place-measure & empty
-encourage arm exercises to prevent contracture
-prevent lymphedema
___ is too much protein rich lymph fluid that collects in the interstitial space due to the removal of lymph nodes
Lymphedema
Where does lymphedema usually occur?
arm & hand, breast, underarm, chest, trunk, and/or back
Ways to prevent lymphedema:
Elevate affected _____
Turn to _____ side
Avoid _____ clothes
Avoid ___, IVs, ___ ___
extremity
unaffected
constricting
BP, blood draws
Why should the nurse avoid poking the affected arm in a patient with lymphedema?
it reduces the risk of injury or inflammation to that arm
True or False.
If it is an emergency, it is okay to place an IV in the affected arm in a patient with lymphedema because the benefit outweighs the risk.
True
____ scan generally start at age 50 or at onset of menopause, whichever is first
DXA
What does a DXA scan measure?
how many grams of calcium and other bone minerals are packed into a segment of bone
True or False.
Higher calcium content usually does not mean increased bone strength
False, it does mean increased bone strength
Who is at high risk for osteoporosis?
Older women, tobacco use, adult fractures, petite thin women
Any ___ ___ = diagnosis of osteoporosis and t should be treated as such even if the DXA result is normal
fragility fracture
What is a fragility fracture?
any broken bone from standing height (excluding fingers/toes/face/nose) or any low trauma fracture
Where are the common sites of fragility fractures?
hip, spine, wrist
Approximenately ___% of patients who have a fragility fracture of the hip will die within 1 year
25%
When does colorectal cancer screening begin?
age 45 for those with average risk
The recommended screening for colorectal cancer is?
Colonoscopy every 10 years until age 75
What are preventative measures for colorectal cancer?
-limit red meat
-increased fruit/veggies in diet
-regular exercise
-get screened
-avoid smoking
-get adequate vitamin D and calcium
Those born in ___ have ___ the risk of colon cancer and quadruple the risk of rectal cancer compare to people born around 1950
1990, double
Are adolescent patients considered a diverse population group?
yes
Based on Virginia law, Minor may exercise independent consent for:
____ services
____ services
STD/HIV services
alcohol/____ treatment
___ ___ services
contraceptive
prenatal
drug
mental health
____ is the transition to menopause that can last 10 years, when the ovaries begin to make less estrogen
Perimenopause
_____ is cessation of menses for 12 months and requires a clinical diagnosis
Menopause
What are some S/S of menopause?
irregular menses, breast tenderness, mood changes, hot/warm flashes, night sweats, sleep disturbances
What is the treatment plan for a patient going through menopause?
Hormone therapy
What is the leading post-menopausal cancer?
endometrial (lining of uterus)
What are risk factors for endometrial cancer?
age >55, obesity, irregular periods, use of estrogen after menopause, type 2 diabetes, hypertension
What are some S/S of endometrial cancer?
vaginal bleeding after menopause
bleeding between menses, abnormal discharge, pain
What diagnostics can be used for endometrial cancer?
endometrial biopsy, ultrasound, surgical on pathology
What is the treatment plan for a patient with endometrial cancer?
surgery (recommended), radiation, chemotherapy
When does atrophic vaginitis occur?
after menopause
What are S/S of atrophic vaginitis?
thin, pale, dry vaginal mucosa, itching, dyspareunia (painful sex)
What is the treatment for atrophic vaginitis?
topical estrogen, water-based lubricants
Why are smokers at higher risk of atrophic vaginitis?
impairs blood circulation to the vaginal tissue which leads to thinning
___ ___ are the only method to prevent STI
barrier methods
What are the barrier method options?
external male condom or female condom
What is a possible side effect of using a barrier method?
contact irritation
What is the failure rate for barrier methods ALONE?
18%
it is more effective with spermicides
Should female condoms be used with a male condom at the same time?
NO
they also have a high failure rate of 21%
___ kills or disables sperm
Spermicides
ex: nonoxynol-9
When should one use spermicide?
before each sexual encounter
*can cause contact irritation
What is the failure rate of spermicides without condoms?
With condoms?
W/O- 28%
WITH- 2.5%
____ block ovarian stimulation by inhibiting ovulation by blocking FSH release
oral contraceptives
What is the failure rate for oral contraceptives?
9%
What are some patient education topics for oral contraceptives?
-take at the same time everyday
-use back-up method is miss 2 more more pills
-doesn’t protect against STIs
A ___ oral contraceptive pill contains both estrogen and progestin.
combined
The “minimill” contains only ___
progestin
What are some contraindications of oral contraceptives?
hx of DVT, HTN, hypercoag disorders, age >35 and heavy smoker
What are the risks of oral contraceptive pills?
HINT- ACHES
A-abdominal/pelvic pain (severe)
C- chest pain
H- headaches (sudden & severe)
E- eye changes
S- sudden leg pain and/or swelling
**PT SHOULD STOP USE due to risk for DVT, PE, and STROKE
_____ is an injection of a hormone preventing pregnancy that is given every 3 months
Depo-Provera
The Depo-Provera injection prevents ____
ovulation
What are some side effects of the depo shot?
irregular bleeding, weight gain, may delay return of periods/fertility for up to 1 year
What is the depo failure rate?
0.3%
____ is a matchstick-sized rod that is inserted in the arm that inhibits ovulation and thickens cervical mucus
Nexplanon
What is the most common side effect of a Nexplanon?
irregular bleeding
How long is a Nexplanon effective for?
3 years
What is the failure rate for a Nexplanon?
0.05%
A hormonal IUD provides protection for up to __ years & is progesterone only
5
How does a hormonal IUD work?
it thickens the mucus which traps sperm and stops ovulation
What are some side effects of a hormonal IUD?
menstrual cycle changes, ovarian cysts
A non-hormonal (_____) is good for __ years and has NO hormones
copper IUD
10
Who is a good candidate for a non-hormonal IUD?
-women who can’t have hormones
-preference for no hormones
What is the failure rate of a copper IUD?
0.8%
What is a side effect of a copper IUD?
heavier or more painful menses
___ is a flexible rubber ring with latex that is inserted in the vagina and tucked behind the pubic bone and covers the cervix
Diaphragm
A diaphragm should not be inserted more than ___ hours before intercourse
6
What are permanent sterilization options for both male and female patients?
Female- bilateral tubal ligation (0.5% fail)
Male- vasectomy (0.15% fail)
What are the future (new options) of contraceptives?
-hormones
-microchips
-gels
-pills sharing
What should be documented in an abusive situation?
- extent of injuries
- the woman exact words
- describe the incidence
- take pictures for evidence
- do not refer to DV on any discharge papers
MOST IMP: safety plan
What is considered sexual assault?
-touching or penetration without consent
-unwanted sexual contact
-unwanted touching of an intimate partner
-forced anal, oral, or genital penetration
What are S/S of toxic shock syndrome?
fever, vomiting, diarrhea, drop in BP, sunburn type of rash on palms of hands and doles of feet
____ ____ is an imbalance of or overgrowth of normal vaginal flora
bacterial vaginosis (BV)
What organisms commonly cause BV?
Gardnerella & mycoplasma hominis
What are S/S of BV?
thin, white milk-like discharge, fishy odor, spilled milk look, burning
What is the treatment of BV?
Metronidazole (Flagyl)
**Avoid alcohol with Flagyl
Is BV considered an STD?
No
What symptoms will a patient experience if they drink alcohol while taking Flagyl?
Severe GI symptoms, N/V, flushing, intense abdominal cramping
___ ____ is a fungal or year infection due to Candida albicans
Vulvovaginal Candidiasis (VVC)
What are S/S of VVC?
thick, curdy discharge, intense itching, inflammation, odorless
What is the treatment for VVC?
anti fungal medication (oral or vaginal)
Is VVC considered an STD?
No
What are the most common sexually transmitted infections?
-trichomonas vaginalis
-chlamydia trachomatis
-gonorrhea
-herpes
-syphilis
-HPV
___ ___ is a protozoan parasite infection
trichomonas vaginalis
what are S/S of trichomonas vaginalis?
yellow-green, frothy/foamy doors discharge, vulvar itching, strawberry cervix
**About 70% of ppl infected do not have S/S
What is the treatment of trichomonas vaginalis?
Flagyl for both partners
*abstinence until both are treated
What are the S/S of chlamydia?
thin or purulent discharge, burning and frequency go urination, abdominal/pelvic pain
What is the treatment of chlamydia?
Doxycycline x7 days OR Zithromax
*abstain for 7 days after tx
What are some untreated risks of chlamydia?
pelvic inflammatory disease, ectopic pregnancy due to scarring, chronic pelvic pain, infertility
Chlamydia is known as the ___ ___ because 75% of people are asymptomatic
silent infection
What are the different modes of transmission of Gonorrhea?
vaginal, anal, oral, or maternal-child during delivery
What are S/S of gonorrhea?
dysuria, pelvic pain, bleeding between periods or after intercourse, yellow/green discharge
What is the treatment of chlamydia?
Ceftriaxone (Rocephin) with Azithromycin
*abstain for 7 days after tx
What are newborn risks associated with gonorrhea?
blindness, joint infections, sepsis
What is the 2nd most common STI?
Gonorrhea
Is there a cure for herpes?
No
HSV-1:
1. ___ sore
2. can transmit to the ____
3. can be transmitted giving/receiving ___ sex
cold
genitals
oral
HSV-2:
1. ____ infections
2. very rare for it to be transmitted ___
3. typical appearance of ___ on or around the genitals or rectum
4. reoccurs during times of stress, ___, or menses
genital
orally
vesicles
infection
What is the treatment options for symptoms of herpes?
antivirals *supportive only
What is the nickname of syphilis?
great prentender
How is syphilis transmitted?
direct contact with a syphilitic sure or maternal-child via the placenta
What is the treatment of syphilis?
Penicillin G IM
How many stages of syphilis are there?
4
Syphilis primary stage:
Appearance of a ___ chancre
*firm, round, and painless lesion on genitals that disappears in 4 weeks
single
Syphilis secondary stage:
___ colored rash on palms/soles and a low grade fever
copper
Latent and late stages of syphilis:
can appear ___-___ years after initial infection
____ and CNS dysfunction
10-20
cardiac
Neurosyphilis (final stage):
invasion of the ___ system
headache, altered behavior, movement problems
nervous
Condylomata acuminata is also called?
genital warts
What are genital warts caused by?
HPV
types 16&18 cause most cervical cancer
types 6&11 cause genital warts
How is condylomata acuminate transmitted?
vaginal, oral, or anal sex
What is the treatment of genital warts?
cryotherapy, laser removal, TCA, Podophyllin resin
