TOPIC 8 - female reproductive disorders

Question 1

cervical cancer early vs late symptoms

Answer 1

early : none
late : unusual discharge, AUB or postcoital bleeding (thin and watery, dark and foul smelling as disease advances), vaginal bleeding and spotting that becomes heavier and more frequent, pain is a late symptom and is followed by weight loss, anemia, and cachexia

Question 2

risk factors for cervical cancer

Answer 2

(1) infection with high-risk strains of human papillomavirus (HPV) 16 and 18
(2) immunosuppression
(3) low socioeconomic status
(4) chlamydia infection
(5) smoking.

Question 3

diagnostic studies

Answer 3

pap test : identifies changes in cervical cells that may indicate precancerous changes
(for 21-29 years old every 3 years
30-65 years old every 5 years)
HPV testing : identify high risk HPV types 16 and 18
(vaccinate at age 9-12)

Question 4

treatment options for cervical cancer

Answer 4

surgery (biopsy)
combination of chemo and radiation

Question 5

terminal cervical cancer manifestations

Answer 5

anemia, cachexia, weight loss

Question 6

meds to control symptoms of endometriosis

Answer 6

oral contraceptives

Question 7

early vs late signs of endometrial cancer

Answer 7

early: abnormal uterine bleeding
later: pain during urination or intercourse

Question 8

risk factors for endometrial cancer

Answer 8

exposure to estrogen
Obesity is a risk factor because adipose cells store estrogen, thus increasing the amount of circulating estrogen
Increasing age
never being pregnant
early menarche
late menopause
Smoking
diabetes mellitus
personal or family history of hereditary nonpolyposis colorectal cancer

Question 9

primary diagnostic test for endometrial cancer

Answer 9

endometrial biopsy

there is no routine screening test, most cases are diagnosed early because of postmenopausal bleeding

Question 10

treatment for endometrial cancer

Answer 10

total hysterectomy and bilateral salpingo-oophorectomy with lymph node biopsies

external radiation either to the pelvis or abdomen or internal radiation (brachytherapy) intravaginally if there is local or distant metastasis.

Question 11

polycystic ovary syndrome

Answer 11

disorder that includes ovulatory dysfunction, polycystic ovaries, and hyperandrogenism.It most commonly occurs in women under 30 years old and is a cause of infertility.

Question 12

what is the thought to be cause of PCOS

Answer 12

ovaries producing estrogen and excess testosterone but not progesterone.

Question 13

risk factors for ovarian cancer

Answer 13

Family or personal history of ovarian, breast, or colon cancer
Personal history of hereditary nonpolyposis colorectal cancer
Hormone replacement therapy
Mutant BRCA
Early menarche and late menopause
Increasing age
Never been pregnant or nulliparity
High-fat diet

Question 14

vague and non specific symptoms of ovarian cancer

Answer 14

pelvic or abdominal pain
bloating
urinary urgency or frequency

Question 15

late symptoms of ovarian cancer

Answer 15

Difficulty eating or feeling full quickly
Abdominal enlargement with ascites
Unexplained weight loss or gain
Menstrual changes

Question 16

hysterectomies can be used to treat …

Answer 16

cancers of the uterus, ovaries, and fallopian tubes, endometriosis, and abnormal uterine bleeding

Question 17

education for post-op hysterectomy patients

Answer 17

intercourse should be avoided for 4-6 weeks
vaginal sensation should return within a few months
bathing in a tub should be avoided for at least 1 month to prevent infection
avoid heavy lifting for 6 weeks
menstruation should immediately stop

Question 18

risk factors for breast cancer

Answer 18

Female gender
Advancing age
Family history - especially if the involved family member also had ovarian cancer, was premenopausal, had bilateral breast cancer, or is a first-degree relative (i.e., mother, father, sister, brother, daughter).
Genetic link - BRCA1andBRCA2(BRCA stands forBReastCAncer).
Prior breast cancer
Past history of thoracic radiation therapy
Atypical findings on a prior breast biopsy
First period before age 12
Menopause after age 55
Dense breast tissue
Age of 50 or more
Benign breast disease with atypical biopsy
Weight gain and obesity
Alcohol consumption
Exposure to ionizing radiation

Question 19

manifestations of breast cancer

Answer 19

lump or thickening in breast
abnormal mammography
often in upper, outer quadrant
nipple discharge or retraction

Question 20

sites of breast cancer recurrence and metastasis

Answer 20

Skin, chest wall
Lymph nodes
Spinal cord
Brain
Pulmonary
Liver
Bone marrow

Question 21

diagnostic studies for breast cancer

Answer 21

Mammography
Digital mammography
Three-dimensional (3D) mammography
Biopsy of breast tissue

Question 22

types of breast tissue biopsies

Answer 22

FNA biopsy
Core (core needle) biopsy
Stereotactic mammography
Vacuum-assisted biopsy
Axillary lymph node biopsy

Question 23

when is there a greater risk for recurrence

Answer 23

when more nodes are involved

Question 24

primary treatment for breast cancer

Answer 24

surgery
either :
-lumpectomy (early stages : tumors smaller than 5cm)
-mastectomy (total or simple removes the entire breast and axillary lymph nodes but preserves the pectoralis major muscle)

Question 25

when are clients usually discharged from the hospital

Answer 25

within 24-48 hours
(may have JP drains - teach about dressing and drain care)

Question 26

what does in situ mean

Answer 26

cancer is currently noninvasive within the duct

Question 27

lymphedema (complication)

Answer 27

accumulation of lymph within soft tissue

occurs from lymph removal from biopsy, surgery, or radiation

results in tissue no longer being able to drain fluid

Question 28

client education for lymphedema

Answer 28

Teach measures to prevent and reduce lymphedema
no BP readings, venipuncture, or injections on the affected arm
Affected arm should not be dependent for long periods.
Caution should be used to prevent infection, burns, or compromised circulation on the affected side
use compression sleeves
IF ACUTE : decongestive therapy with a pneumatic sleeve

Question 29

what is the purpose of post op radiation therapy

Answer 29

to prevent local breast cancer recurrences after breast conserving surgery, prevent local and lymph node recurrences after mastectomy, relieve pain caused by local/regional/or distant spread of cancer

Question 30

how often is radiation therapy done

Answer 30

for 5 days a week for 5-7 weeks

Question 31

common side effects of doxorubicin (chemo drug)

Answer 31

involve rapidly dividing cells in the gastrointestinal tract (nausea, anorexia, weight loss), bone marrow (anemia), and hair follicles (alopecia).

monitor cardiotoxicity (SOB, pedal edema, decreased activity, dysrhythmias)