UNIT 3- WOMENS HEALTH Flashcards
1
Q
What are some leading causes of death amoung women?
A
Heart disease, cancer, stroke, unintentional injuries (FALLS)
2
Q
What is the number 1 killer of women?
A
Dan… jk
Cardiac disease
3
Q
Why is cardiac disease the number 1 killer in women?
A
Women typically present with atypical symptoms
4
Q
What are some atypical symptoms of cardiac disease?
A
- Pain, pressure in the chest, discomfort in arm,neck and jaw
- Pain in the upper back and or stomach
- Unusual fatigue
- n/v
- Loss of appetite
- Lightheadedness, dizziness, palpitations
5
Q
How do nurses assist women with cardiac disease?
A
Nurses help women identify risk factors and teach women the non classic symptoms of cardiac disease
6
Q
What are warning signs of a stroke?
A
Sudden onset of
1.numbness/weakness of the face/arm and or legs
2.Trouble seeing out of one or both eyes
3.Trouble walking, dizziness, loss of balance or coordination
4.Severe headache with no known cause
7
Q
What is the golden hour?
A
It is 1 hour from onset of stroke symptoms to administer tPA (tissue plasminogen activator)
8
Q
What patient education should we provide about strokes?
A
- Call 911 immediately. Dont wait to see if it will go away
- Teach family and patient to recognize s.s of stroke
9
Q
What preventative counseling can we provide patients?
A
- Healthy weight-reduce health problems
- Balanced diet-calcium & vitamin D (dairy, green leafy veggies and sunlight)
- Physical activity- 30 min/day, weight-bearing 3-4/week
- Avoid smoking & second-hand smoke
- Immunization
- Limit alcohol- 1st drink/day
- Accident & injury (rugs)
- Safe sex
10
Q
What screening procedures should you have done annually esp if there are risk factors?
A
- Pap smear according to ACS (every 3 years unless abnormal)
- Dental (2 cleanings)
- STI
- Fecal occult blood
- UA
- Thyroid annually if signs of dysfunction
- Genetic testing (signs of hibitual aborter)
- Transvaginal ultrasound
- TB
11
Q
When should you have a bone density exam?
A
65 y/o q 2 years
over 45 is starting to be seen more
12
Q
When should you start having labs to check cholesterol?
A
20 or if risk factors
13
Q
When should women have a colonscopy done?
A
50 y/o q 10 years unless its abnormal
14
Q
When should women have there eyes checked?
A
40 y/o q 2-4
65 y/o 1-2 years or annually
15
Q
When should women be tested for there fasting glucose level?
A
45 y/o q 3 years
16
Q
When should women start having their hearing checked?
A
q 10 years until 50 then every 3 years
17
Q
When should women start getting mammos done?
A
40 y/o q 1-2 yrs
18
Q
When should a women be checked for rubella immunity?
A
Childbearing age
19
Q
When should women start doing monthly self breast exams?
A
After onset of putbery and period starts
20
Q
What changes in our monthly self breast exam should we report to our PCP?
A
Lumps, change in skin color or texture, nipple changes (inverted), leaking clear or bloody fluid
21
Q
How often should a ACS-clinical breast exam happen?
MUST KNOW
A
3 years-19-39y/o
Annually- >40 y/o
22
Q
When should we teach women to there monthly self breast exam?
A
After period about a week after.. during your period your breast tend to have lumps due to hormonal changes
23
Q
What is a mammogram?
A
Low dose x-ray during mechanical compression of the breast
24
Q
What are some inidcations of mammogram?
A
- Screening- every 1-2 years after 40
- Diagnostic- abnormal finding- require further testing
25
What education should we provide patients about mammograms?
1. Pre-procedure- avoid underarm deodrants, lotions, and powders
2. Post-procedure- Anticipated time of resuts, mammogram follow-up, and self-breast exams
26
When should women do a monthly vulvar exam?
All women 18 y/o or younger if sexually active
27
How is a vuvlar self exam done?
Systematic manner
1. Inspect & palpate- signs of precancerous conditions or infections
2. Mons,clitoris,labia minor, labia majora, perineum, and anus
Report any abnormalities for follow up- discharge, infection, sores, warts
28
When does the American cancer Society recommend cervical paps?
No longer recommends annual cervical pap smears.. ACS- cervical screening recommendations:
1. 21-29y/o- every 3 years
2. 30-65 y/o every 5 years
3. >65-stop pap- no previous pre cancerious pap in 20 years
29
Pelvic exam includes what
1. External organs exam
2. Speculum exam
3. Bimanual exam
4. Cervical cystoloty or pap smear
5. Rectal examination
30
What should we educate patients on regarding pelvic ecams and papsmears?
1. Scheduled 5 days after menstrual period
2. Nothing inserted vaginally 48 hours prior to the exam
3. Have patient empty their bladder
4. Eduction regarding procedure
5. Provide a hand to hold or mirror so patient can observe
6. Pace in lithotomy position & drape approppriately
- consider semi-fowlers, side lying, with or without stirrups for females unable to lie in lithotomy
7. Special considerations- female genital mutilation-female circumcision- usually done to keep them from being sexually active... can ask if they have had any surgery on genital or infections
31
What is a colposcopy and what are the clinical indications for having one done?
Microscopic exam of vaginal & cervical tissue usually done if a women has an abnormal pap or to treat condyloma
32
What is a cervical biopsy and what are the clinical indications for having one done?
Extensive surgical biopsy usually done if a women has an abnormal pap-atypical or abnormal cells it is performed early phase of the menstrual cycles and tissue is excised and sent for pthological exam
33
What is an endometrial biopsy and what are the clinical indications for having one done?
Endometrial tissue aspirated from the uterus usually done if a women has abnormal or postmenopausal bleeding
34
What is a hysterosalpingography and what are the clinical indications for having this done?
Cervix, uterus, and fallopian tubes are visulized by x-ray after injecting contrast dye usually done to evulate for fibriods tumors, fisturlas or infertility
35
What are our nursing considerations for procedures regarding womens health?
| Pre procedure, intra and post procedure
Pre-procedure
1. obtain menstrual hx-LMP and allergies
2. Administer analgesia prior to the procedure (advil or motrin before they come to help with cramping)
3. Education regarding procedure, discomfort and relaxation
4. Empty bladder, place in lithotomy poisition and drape appropriately
Intra-procedure- offer patient support and assist provider
Post-procedure
1. Provide perineal tissue/pad
2. Education patient regarding s/s to report
- allergies, infection and when to expect results
36
What is a dilation & curettage and what are the diagnnostic and therapeutic reasons it might be done?
Dilate cervix & scrape endometrial tissue (D&C)
Diagnotistc- malignancy,fertility, dysfunctional uterine bleeding
Therapeutic- heavy uterine bleeding, incomplete abortion
37
What is a endometrial ablation?
Removal of endometrial tissue with laser
38
What is laparscopy and what are the diagnostic and therapeutic reasoning for this exam?
Laparoscope insterted for visualization & surgery
Diagnostic- fertility,ectopic, adhesions, cysts, endometriosis or PID
Therapeutic- tubal ligation, IUD, or adhesion removal or egg retrieval
39
What is a hysterectomy?
Surgical removal of the uterus there are different types and which type a women gets depends on reason, age and health
40
What is a total hysterectomy?
| MUST KNOW
Removal of cervix, uterus up to the fundus. Ovaries and fallopian tubes are left
41
What is a subtotal or supracervical hysterectomy?
| MUST KNOW
Take out above the cervix but leave the cervix
42
what is a hysterectomy with salpingo-oophorectomy?
| MUST KNOW
Cervix up to the fundus in addition to the fallopian tubes and ovaries
43
What is a radical hysterectomy?
Take everything and part of the vagina and lymph nodes usually done in cancer that has mets
44
What are clinical indications for a hysterectomy?
| MUST KNOW
Cancer-cervical, endometrial, ovarian
Noncancerous- fibroids tumors, endometriosis, gentral prolapse, PID
45
What are different surgical techniques of performing a hyst
1. Abdominal-transverse (Psfannenstiel)/vertical (low-midline)
2. Vaginal-lithotomy position
3. Larparoscopic assisted vagainal hyst (LAVH)
46
What are risk related to a hyst surgery?
1. anesthesia complications
2. uterine, bladder, or bowel injuries
3. hemorrhage
4. infection
5. DVT-
47
What is our pre-op nursing care for hysts
1.Admission assessment- no anticoagulants, ASA, NSAIDS
2.Pre-op checklist
- H&P
- informed concent
- Labs- cbc, type and cross, UA, Pregnancy
- Remove jewlrey, glassess, contacts
- NPO 8 hours prior to surgery
- EKG- perform and verify
3. Start IV
4. Void, insert cath
5. Pre-op education, anwser questions
6. Emotional suport
48
What is our post op nursing care for a hyst procedure?
1. Assess v/s, blood loss, LOC, I&O, lung & bowel sounds
2. IV therapy
3. Pain managment- meds, positioning, pain pump possible
4. Administer medication- antibiotics, hormone replacement
5. Assist with ambulation
6. DC- IV, catheter 24-48 hours
7. Progress diet
8. Education
9. Emotional support
49
What is fibrocystic breast changes?
Thickening of reast tissue with the formation of cysts
50
When is fibrocystic breast changes seen?
Occurs before menopause
51
What are symptoms of fibrocystic breast?
Pain & tenderness are often bilateral occurs around the menstrual cycle
52
what are diagnostic exams that detect fibrocystic breasts?
1. mammograms
2. ultrasound
3. fine needle aspiration/or core needle biospy
4. Excision of the mass
5. open or surgical biospy
53
What is a key assessment question to ask if you are trying to figure out if a lump found in the breast is fibrocystic breasts or potenitally cancer related?
When was your last menstrual period... if they are currently menstrating tell them to do a self breast exam in 7-10 days if the lump remains call again
54
What is the treatment for fibrocystic breasts?& what’s med might be used
No specific tx proven beneficial. Supportive bra recommended, avoid caffeine, and **danazol** an androgenic medication which suppresses estrogen
| DANZOL is important
55
What is amenorrhea?
Absence of menses
56
What are nursing considerations for benign breast disorders?
Acknowledge a breast mass evokes feeling of fear and anxiety and educate regarding how and when results will be communicated
57
What is the number 1 cause of amenorrhea?
Pregnancy
58
What is primary amenorrhea?
| MUST KNOW
Delayed- no secondary sex characteristics by age 14 OR no menses with secondary sex characteristics by age 16
May be genetic or inherited
59
What is secondary amenorrhea?
Cessation of menstruation-- no menses 3-6 months following normal cycles or there is an underlying cause like pregnancy
60
What is the patho of amenorrhea?
1. Endocrine/pituitary function- lack or hormone production
2. Heredity/congenital- emotional support may be needed
3. PCOS- causes women not to ovulate correctly which causes abnormal periods
4. Nutritional/uncontrolled diabetes- anorexia- body doesnt allow period
5. Heavy athletic activity- people who are training for sports everyday for 8-10hours have no body fat and there body shurts down and it doesnt let them have periods
6. Emotional distress
7. 90% no identifiable cause
61
How do we managage amenorrhea?
Identify and treat the underlying condition
62
What are nursing considerations for amenorrhea?
1. Emotional support- young teen may feel left out
2. menstration is unique funciton of women
3. Absence can create concerns about feminity and having children
4. Adolescent is the time when being diff that you peers is painful
5. Education concerning diet, nutrition and exercise
6. sometimes a change in diet will do the trick
63
What is menorrhagia?
Prolonged or heavy menstrual bleeding
| Think MANNNNYYY pads for MANNNNY bleeding
63
What is metrorrhagia?
Irregular bleeding which often occurs between period or after menopause
| Metro- think metro train in new york and you get on it and off
64
What is menometrorrhagia?
Prolonged or excessive bleeding that occurs irregular and mroe frequent
65
What is the patho of abnormal uterine bleeding (menorrhagia, metrorrhagia, menometrorrhagia)
1. Pregnancy complication- spontaneous abortions
2. Lesions- begnign or malignant of the vagina, cervix, or uterus
3. Drug induced bleeding- hormonal contracepties (may not have correct dosage)
4. systemic disorders- diabetes, hypothyroidism, uterine fibroids
5. Failure to ovulate
66
How is abnormal uterine bleeding (menorrhagia, metrorrhagia, menometrorrhagia) managed?
1. pregnancy test- may be a sign of a missed abortion
2. Hormone levels- determine if ovulation is occuring
3. Lab- CBC, Coagulation studies, liver function
4. Endometrial biopsy
5. Ultrasound or hysteroscopy- assess the uterine linign
6. Oral contraceptive-progestin-estrogen combination- sometimes getting them regulated will help
7. Surgical- D&C, endometrial ablation, hyst
67
What is nursing considerations for abnormal bleeding (menorrhagia, metrorrhagia, menometrorrhagia)?
1. Encourage women to seek immediate medical attention
2. encourage women to record bleeding episodes and amount of loss
3. Importance of nutrition and stress reduction
4. Education about diagnostic procedures
5. Emotions support for women who fear cancer
68
What is premenstrual syndrome (PMS)
Physical and emotional changes related to menstrual cycle
69
What are some syptoms a women may experience with PMS?
1. Musculoskeltal- back pain, join pain
2. Neuro- clumspy, crazy, vertigo
3. GI/GU- bloating weight gain, n/v/d, cravings
4. Mental or emotional
70
What is the patho of PMS?
unknown cause but associated with
Hormonal changes- estrogen-progesterone imblance
chemical changes in the brain
71
What kind of impact does PMS have?
Impacts family- strain on relationships-family conflict, disrupted communication which can lead to the loss of control- child battery, self inflicted injuries and accidents
72
What are our nursing considerations for PMS?
1. Encourage exam and correct dx
2. Education about lifestyle changes-diet, exercise, relaxation, sleep, herbal remedies
3. Education about mediations- ibuprofen, antidepressants, diuretics, oral contraceptives
4. Education and support to the family- family needs to udnerstand this is an actual condition
5. Education concerning planning for feeling of loss of control- whats her plan for the day that kids are misbehaving so that her children dont get hurt
73
What is menopause?
Perment cessation of menstrual cycles
74
When is the onset of menopause usually?
35-58y/o average age is 51 y/o
75
What are the 3 stages of menopause?
1. Perimenopause- 1st year before last menses typically periods start getting further and further apart, hot flashes, mood swings, decline in estrogin and progestrin
2. Menopause- one year after last menses
3. Post menopause- after menopause
76
What is the patho of menopause
Ovaries stop producing eggs and a decline in estrogen and progesterone production
77
What are the s/s of menopause changes
1. Vasomotor- irregular periods/hot flashes/night sweat (1st symptoms typically)
2. GI-Incontinence/vaginal changes- increase pH/dryness/painful sex
3. Psychoslogical- mood swings/sleep changes/ decrease in sleep/fatigue
4. Skeletal- decrease bone density
5. Cardio- irregular heartbeat palpitations decrease in HDL and increase in LDL
6. Dermatologic- decrease skin elasticity/hair loss
7. Reporductive- breast changes, decrease interest in sex
78
What are womens psychological response to menopause?
1. Excited- no longer worry about childbearing
2. Grieve-loss of fertility
3. comes to term with aging
79
What are therapies used for menopause managment?
1. Hormone replacement therapy (HRT)-estrogen-progesterone (UTERUS IN)
- both hormones in this therapy work together and it decreases the chance of cancer because you dont have a complete overload of estrogen with uterus but there is an increased risk for breast and uterine cancer
2. Estrogen replacement therpay (ERT)- estrogen (NO UTERUS)
- risks and benefits must be considered
- may help with symptoms but increases risk of cancer
80
What is our menopause education?
1. life style changes- diet and exercise
2. Hot flashes- avoid alcohol, caffeine, hot drinks, spicy food, smoking; layer clothing
3. Night sweats- cool shower before bed, cotton nightwear, cool room
4. Sleep distrubances- regular bedtime, 8hrs sleep, dark, quiet, cool room
5. Vaginal dryness & sexual discomfort- vaginal lubercants or estrogen cream
6. Complementary/alternative therapy
81
What are the s/s cyclic pelvic pain?
1. Pelvic pain which occurs midway between menstrual periods at the time of ovulation
2. Sharp pain felt in the lower right or left pelvic area
3. last for a few hours up to 2 days
4. slight vaginal bleeding after the discomfort
81
What is primary dysmenorrhea?
| MUST KNOW
Painful, cramping 12-24 hours before menses, that last about 12-24 hours-- consistent usually with every period
82
What is the patho of primary dymenorrhea?
| must know
Excessive endometrial producation of prostaglandin (protaglandin tells your body its time to have menses)
83
What is seocndary dysmenorrhea?
| must know
Painful menses with known anatomic factors/pelvic pathology
84
What is the patho of secondary dysmenorrhea?
| must know
Endometriosis, adhesions, cervical senosis,fibroids
85
What is the managment of dysmenorrhea?
1. Identify and tx underlying conditions
2. Prostaglandin inhibitors- ibuprofen
- For primary- ibuprofen inhibits the production of prostaglandin and it wont be as painful
3. Pain managment- analgesia, heat, warm bath
4. oral contraceptives
5. diet-low fat
6. excersice, relaxation, biofeedback, acupuncture
86
What is endometrosis?
The presence of endometrial tissue outside the uterus
87
What is the patho of endometriosis?
1. Retrograde menstration- uterus should be lined up with vaginal opening but sometimes a women may have a retrograde and the uterus kind of lies lower allowing the menstral cycle to flow back towards the pelvic cavity. The endometrial tissue sticks to structures outside of the uterus and so when its time to have mentral cycle these area will bleed along with
2. Predisposition, immunological changes, hormonal influences
88
What is happening during endometriosis?
1. Tissue repsonds-progesterone & estrogen of the menstrual cycle
2. Thickens and bleeds during cycle
3. Inflammation in surrounding tissues
4. Scarring, adhesion & fibroids on the reproductvie and structures occurs
89
What are s/s of endometriosis?
1. Cyclic pelvic, low back pain, dymenorrhea
2. Infertility-main reason women seek tx
3. Dyspareunia- painful intercourse r/t tissue inflammation
4. Diarrhea, constipation, pain with defacation r/t endometrial tissue can be adhered to the bowel
5. Fixed or retroverted uterus- scarred down in that position and not flexable
6. Enlarged & tender ovaries- endomentrial tissue that as attached to ovaries
90
How is endometriosis managed?
1. pain managment- NSAIDs, analgesia- ibuprofen to help with release of progtaglandins
2. Hormone therapy- birth control, assisted reporduction
3. endometrial biopsy- prior to pregnancy they will scrap off endometrial tissue to help support pregnancy
4. surgical tx
91
What are our nursing actions for endometriosis?
1. Education-endometriosis and pain managment
2. Emotional support esp. if they are suffering from infertility
92
What is PCOS?
Polycysitc ovary syndrome- endocrine disorder, a genetic component causing incorrect/absent ovulation
93
What is the patho of PCOS?
1. Increase in estrogen, testosterone, LH and decrease in FSH
2. Multiple cysts on ovaries produce escessive estrogen
94
What are the risks of PCOS?
1. Diabetes, metabolic syndrome
2. dyslipidemia, hypertension
3. cardiac
4. cancer
5. infertility
6. sleep apnea
If we can identify this they may be able to make changes to prevent some of the risk that heppen later in life. Can be as simple as lifestyle changes
95
What are s/s of PCOS?
1. Menstrual disorders
2. Infertility
3. Pelvic pain- cysts
4. Ovarian cysts
5. obesity
6. oily skin
7. acne
8. hirsutism
9. male pattern baldness
96
What is the medical managment of PCOS?
1. Lifestyle medication-diet/exercise
2. Hormone therapy- low-dose contraceptives
3. fertility therapy
4. diabetic medication METFORMIN
97
What our are nursing actions for PCOS
1.Education-risk factors for PCOS and weight reduction
2.Treatment- hirsutism, acne, oily skin
3.Emotional support, ifertility & psychological effects
98
What are ovarian cysts?
Soild or fluid filled cycts that develope on the ovaries
99
What are the two types of ovarian cysts?
1. Folicular- mature follicle fails to rupture (asymptomatic)
2. Luteal- corpus luteum becomes cystic and fails to reabosrb
- Acute pain, delays next menstrual cycle, may rupture
100
What are the tx for ovairan cysts?
| know
Depends on the type of cyst
1. wait and examine after next menstrual cycle
2. Oral contraceptives
3. surgical removal
101
What is vaginal wall prolapse?
## Footnote
pelvic floor dysfuntion
Loss of support to the pelvic organs- uterus, bladder, rectum
102
What are the risk factors of vaginal wall prolapse?
1. Multiparity
2. Pelvic tearing or trauma during childbirth
3. Obesity
4. Vaginal muscle weakness associated with aging/menopause
103
How is vaginal wall prolapse prevented?
1. Postpartum-kegal excercies
2. Spaced pregnancy
3. Weight control
104
What is a cystolcele?
## Footnote
Pelvic floor dysfunciton
Relaxation of anterior vaginal wall with prolapse of the bladder
105
What are the s/s of a cystocele?
1. Urinary retention
2. Bladder infection
3. Incontinence
4. Stress incontinence- leaking urine with increased intrabdominal pressure
UTI education important
106
What is a rectocele?
## Footnote
Pelvic floor dysfunction
Relaxation of the posterior vaginal wall with prolapse of the rectum
107
What are s/s of rectocele
1. constipation
2. Hemorrhoids
3. Uncontrolled flatus
4. Sense of pressure or need to deficate
constipation prevnetion important
108
What is uterine prolapse?
1. Downward displacement of the uterus into the vagina?
109
What are the symptoms of a uterine prolapse?
1. Fatigue
2. Low backache
3. dymenorrhea
4. pressure, protrusions
5. dyspareunia- painful intercourse
6. Pulling and dragging sensations in pelvis and back
7. symptoms may be worse after prolonged standing or deep penile protrusion
110
What are nonsurgical interventions for pelvic flood dysfunction?
1. Kegal exercises
2. Vaginal pessary- hold uterus, clean with soap and water when you take it out (like a plug)
3. Hormone therapy-intravaginal estrogen
111
What are surgical interventions for pelvic floor dysfunciton?
1. Hysterectomy and anterior & posterior repair
112
What are some nursing considerations for pelvic floor dysfunction?
1. Pessary inesertion, removal, cleaning
2. Prevention of constipation
3. Pre & post op care
113
What is a gential fistula?
An abnormal connection between the vagina and the bladder, urethra or rectum-- may cause them to poo out of the wrong hole
114
What are the risk factors of genital fistulas?
trauma, childbirth sexual violence
115
What is our assessment of of a gential fistual consist of?
1. urine or fecal leakage from the vagina, foul vaginal odor
116
What are the medical managmement of gential fistulas
1. pelvic exam to determine to detmine loctaion and severity
2. small fistulas- resolve on its own
3. larger fistulas- require surgical repair
117
What are nursing considerations for gential fistulas?
education-care of minor fistulaand pre and post op care
118
What is a leiomyomas, fibroids, myomas, fibromyomas or fibromas?
Benign tumors arising from the muscle tissue of the uterus this is more common in nuligravidas and black women with the most common sign being abnormal uterine bleeding and it often disappears after menopause
119
What is the treatment of leiomyomas, fibroids, myomas?
1. Cryosurgery
2. Myomectomy or hyst
3. GnRH hormone regimens to shring the tumor
4. Uterine artery embolization of the blood vessel supplying the fibroid tumor
Uterine scar c-section likely depending on where scar is may need records requested
120
What are nursing interventions for leiomyomas, fibriods, myomas, fibromyomas, fibromas?
1. GnRH- if discontinued expect regrowth of tumors, amenorrhea may occur
2. Preop education-no alcohol, asprin or anticoagulants 24 hours prior to surgery
3. Expect cramping during procedure as polyvinyl alcohol pellets are injected
4. Post op care for cyrosurgery, myomectomy, hysterectomy, uterine artery embolism
5. discharge instructions
- medication as directed
- Report- bleeding, pain, swelling at puncture site, fever, urinary retnention, abonormal vaginal discharge no tampons intercourse or douching for 4 weeks
121
What are s/s of cervical cancer?
Early
1. vaginal discharge, abnormal vaginal bleeding, might be spotting with intercourse
Late
1. Weight loss, fatigue, pelvic pain, vaginal leakage of feces/urine
122
What are risk factors of cervical cancer?
1. History of an STI (HPV)
2. Early onset sexual activity
3. Multiple sex partners
4. Inadequate cervical screenings
123
How is cervical cancer diagnosed?
1. Pap smear- detects dysplasia the precursor to cervical cancer
124
What are the 3 stages of cervical cancer?
1. Early dyplasia
2. Early carcinoma
3. Late carcinoma
125
How is cervical cancer treated?
Treatment depends on the stage and future pregnancy plans
1. Dysplasia- cryosurgery, loop electrocautery excision procedure (LEEP), laser, conization, hyst
2. Early carcinoma- Hysterectomy, intracavity radiation
3. Late carcinoma- External beam radiation with hyst (radical), antineoplastic chemo, pelvic exentreration
126
What are s/s of endometerial cancer?
1. Postmenopausal or abnormal premenopausal bleeding
2. abnormal vaginal discharge
3. difficult or painful urination
4. pelvic pain or pain with intercourse
127
What are risk factors of endometrial cancer?
1. hormone replacement therapy (HRT)
2. Menopause after the age of 52
3. Nuliparity r/t more exposure to estrogen
4. Diabetes, obesity, PCOS r/t irregular period and more exposure to estrogen
128
How is endometrial cancer diagnosed and managed
1. Endometrial biopsy dx
managment- based on size, stage, tumor grade, estrogen effect
1. Radical hyst
2. Chemo
3. Radiation
4. hormone
129
What are the s/s of ovarian cancer?
1. Asymptomatic or vague symptoms make it diffiuclt to diagnose early
130
What are advanced clinical symptoms of ovarian cancer?
1. Pelivc or abominal discomfort
2. low back and leg pain
3. weight changes
4. increased abdominal girth
5. n/v
6. constipation
7. urinary sympotoms- urgency and frequency
8. difficulty eating or feeling full quickly
131
What are risk factors of ovarian cancer?
1. Menses started earlier than 12 y/o
2. nuliparity or 1st child after age of 30
3. Late menopause
4. infertility, infertility drugs
5. Family hx- ovairan, breast, or colorectal ca
6. Personal hx of breast ca
132
How is ovarian cancer dx
laparotomy is primary tool for diagnosis and staging the disease
133
how is ovarian cancer managed?
managment depends on the stage
1. total abdominal hyst
2. biopsy lymph nodes, pelvic and abdominal tissues
3. chemo
134
Reproductive tract infection disorders increase the risk of...
Chronic pain, cancer, systemic infection and infertility
135
Why are older women more susceptiable to UTIs
Supressed immune system, weaker bladder not able to completely empty, decrease estrogen alters normal vaginal flora, e.coli and they dont wipe good
136
In older women what indicates a serious UTI that warrents immediate treatment
Fever
137
What are s/s of a UTI in an older women?
1. Agitation
2. confusion, delirum, hallucinations
3. Poor motor skills or dizziness, falling
4. Fever-immediate tx is indicated
138
What is PID?
Acute inflammation of UPPER female genital tract
139
What is the patho of PID?
1. Bacteria- chlamydia trachomatis, neisseria gonorrhoeae
2. Caused by a variety of aerobic and anaerobic organisms that ascend the vagina, cervix, uterus, fallopian tuves, ovaries and peritoneum
140
What are the consequenses of PID?
Ectopic pregnancy
chronic pelvic pain
infertility
141
What are the symptoms of PID
1. Asymptomatic
2. Vague symptoms
3. severe abdominal, uterine, ovarian pain or tenderness
4. dyspareunia-painful intercourse
5. Purulent vaginal discharge, foul odor
6. Nausea, anorexia
7. Irregular vaginal bleeding
8. Fever 100.4
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How is PID managed?
1. Test & treat STI- ORAL ANTIBIOTIC partner will also need to be treated
2. Analgesia
3. Hospitalization/Iv antibiotic
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What are our nursing considerations for PID
1. medication education-antibiotic complience
2. s/s & consequences
3. risk reduction
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What is toxic shock syndrome?
Rare but potentially fatal- caused by toxin-producing strain of staphyloccous aureus
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What increases your risk for TSS
Tampon, diahragm or cervical cap use
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What are the s/s of TSS
1. flu-like, headache, sore throat, v/d
2. Hypotension
3. generalized rash
4. skin feeping from palms and soles of feet
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How is TSS treated?
1. Stabilize hypotension- fluid replacement, vasopressors
2. antimicrobial therapy
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What are our nursing considerations for TSS
1. Safe tampon, diaphragm and cervical cap usage
2. Changing tampon every 4 hours
3. avoid superaborbent tampons- allow bacteria proliferates
4. use pad at night
5. avoid use of diaphragm and cervical cap during menses
6. removed diaphragm & cervical cap within 24 hours
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What is vaginits?
Vaginal inflammation-discharge, burining, itching, irritation
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What is the patho of vaginitis?
Vaginal flora is disrupted by an overgrowth of yeast or bacteria
1. candida
2. vaginitis bacterial
3. trichomoniasis
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What are factors affecting the vaginal flora
1. Hormonal changes
2. depressed cell-mediated immunity
3. antibiotic use
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What is candidiasis vaginitis?
1. Vaginal ecosystem is distrubed by a **GRAM** positive fungus
- candida albicans (yeast)
- Most common form of vaginitis
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What is the patho of candidiasis vaginitis?
1. Hormonal changes- increased estrogen during pregnancy
2. increases candida vaginites before and after mensis
3. antibiotic
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What are the risk factors for candidiasis vaginits?
1. Antibotics
2. suppressed immune system
3. diabetes
4. pregnancy
5. menopause
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What are s/s of candidiasis vaginitis?
itching & irritation of the vulvar
White, cheesy vaginal discahrge
burning on urination
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What is the medical managment of candidiasis vaginitis?
1. Diagnosis- wet mount & **WIFF TEST**
2. Medications- OTC, prescriptions
| must know wiff
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What are the nursing considerations for candidiasis vaginitis?
1. cotton underwear to decrease risk
2. call provider- recurrent symptoms or bloody discharge, abdominal pain or fever
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What is bacterial vaginosis?
Disruption of the normal vaginal flora there is an overgrowth of gardnerella vaginalis and a decrease in lactobacilli acidophilus
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What are contribution risk factos for bacterial vaginosis
1. Multiple sex partners
2. New sexual partner
3. Lesbians-sharing sex toys
4. douching
5. antibiotic therapy
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What are s/s of bacterial vaginosis?
| MUST KNOW
1. Thin white, gray milky discharge
2. Malodorus (fishy) vaginal discharge
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What are risks of having bacterial vaginosis?
Chorioamnionitis
Premature rupture of membranes
premature labor & delivery
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How is bacterial vaginosis dx
1. Speculum exam to assess vagina and cervix
2. dx **WET mount and whiff test**
| Must know 2
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What medication may be prescribed to tx bacterial vaginosis?
1. Metronidazole, clindamycin
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What is our nursing management for bacterial vaginosis?
1. Medication- Metronidazole- with means and NO ALCOHOL
2. teach risk factors
3. avoid tight fiting clothes
4. cotton underwear
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What are womens risk from untreated STI
1. cervical cancer
2. chronic pelvic pain & PID
3. blocked fallopian tubes- infertility, ectopic pregnancy
4. premature birth
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What causes chlamydia?
Bacteria: chlamydia trachomatis
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what are the s/s of chlamydia in females
1."silent" disease- asymptomatic in 70-75%
2.Fever
3.lower abodminal pain
4.uterine or adnexal tenderness
5.dysuria
6.dyspareunia- painful intercourse
7.Mucopurulent vaginal/cervical discharge
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What should we know about males and chlamydia
Males are leading cause of nongonococcal urethritis
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How is chlamydia dx
Genital culture or enzyme-linked immunosorbant assay (ELISA)
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How is chlamydia treated
| MUST KNOW
1. Azithromycin 1gm orally
2. Doxycyline/Erthromycin
3.Retested in 3 weeks
4.Partner treated to decrease risk of reinfection
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What risks does chlamydia have?
| KNOW
PID, infertility, ectopic pregnancies, premature birth
NEWBORNS: opthalmia neonatorum- erythromycin eye prophylaxis
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What causes gonorrhea?
Bacteria-Neisseria gonorrhoeae
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What symptoms to females have with gonorrhea?
1. Asymptomatic-majority
2. spotting
3. low backache
4. dypareunia-painful intercourse
5. anal itching
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What symptoms do males have with gonorrhea
| KNOW
Dysuria, urinary frequency
Purulent yellow-green ureteral discharge
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How is gonorrhea dx
genital or cervical culture
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How is gonorrhea tx
| KNOW
1. ceftriaxone 250mgs im
2. Azithromycin 1gm oral
3. Retest in 3 months
4. Partners need to be treated to decrease risk of infeciton
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What risks does gonorrhea have for adults and newborn
| KNOW
PID, Infertility ectopic pregnancy
NEWBORN: opthalmaia neonatorum, sepsis-erythromicin eye prophylaxis
178
What causes trichomonas
PROTOZOAN- trichomonas vaginalis
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What are the s/s of trichomonas in a female
1. **profuse forthy green-yellow or brownish gray discharge**
2. Foul smelling odor
3. dyspareunia-painful intercourse
4. erythema, edma, pruritis of external genital
5. Small red ulceration of vagina or cervix "strawberry spots"
| KNOW 1
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What symptoms do males present with when they have trichomonas?
1. Asymptomatic
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How is trichomonas diagnosed?
| KNOW
Wet mount & wiff test (postive)
182
What is the treatment of trichomonas
| know
1. Metronidazole 2gm oral single dose
2. NO alcohol for 25 hours- flusing, n/v, headache and abdominal cramping
3. partner must be treated
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What risks does trichomonas have and adults and newborns?
1. PID, infertility, premature rupture of membranes and L&D
2. NEWBORNS: Low birth weight
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What causes genital herpes?
Herpes simplex virus type 1 or 2
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What are the symptoms of a primary herpes infection?
1. Systemic symptoms-flu-like, malaise, muscle aches, headache
2. Painful genitla lesion-itching, burining
3. Most severe outbreak & last 2-4 weeks
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What are recurrent symptoms of genital herpes?
outbreak lasting 5-10 days
| generally shorter
187
how is genital herpes dx
history and exam
188
How is genital herpes treated?
NO CURE
1. Antiviral-acyclovir, valacyclovir, famiciclovir
2. comfort measures-viscous lidocaine to lesions
3. Partner: condom to prevent spread
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What are the risks of genital herpes?
1. C-section to prevent nenatal herpes
2. Newborn: Primary exposure- 50-60% nenonatal mortality
3. Sepsis or neuological complication
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What cause HPV?
Human papillomavirus
191
What are the symptoms of HPV?
1. Painless genital warts-vagina, vulva, perineum, anus
2. Abnormal cervical changes
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How is HPV dx
history,exam, and pap smear
193
How is HPV treated
| KNOW
1. Podophyllin-topical application by patient
2. Provider- Trichloroacetic acid application or surgical removal usuing laser or cryotherapy
194
What partner education should we provide for a patient with HPV
1. Abstain from sex until lesions are healed
2. wear condom to prevent spread
195
What are the risk of HPV?
Cervical or penile cancer
NEWBORN: resp papillomatosis
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What causes HIV/AIDS
1. Human immunodeficiency virus
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What are the symptoms of HIV/AIDS (early and late)
1. Asymptomatic
2. Early-fever,fatigue,sore throat, rhinitis, rash,lymphadenopathy
3. Late- fever, night sweats, weight loss, dry cough, leukopenia, throbocytopenia
- women- candidasis, BV, PID, menstural changes
198
What are the risks of HIV/AIDs
1. placental transfusion
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How is HIV/AIDS dx
Antibody, antigen/antibody & neucleic acid test
200
What is the tx for HIV/AID
NO CURE
1. HAART(highly active antiviral therapy)
2. Maintain health of HIV postive women
3. Reduce perinatal transmission
4. Partner; test and condoms
5. Pregnancy: placental transmission, deliver prior to ROM
6. Newborn: AVOID breastfeeding, antiretroviral prophylaxis
201
What causes syphilis?
1. Treponema pallidum (BACTERIA)
202
What are the primary, secondary and Tertiary symptoms of syphillis?
Primary (up to 90 days post exposure)
1. Single painless chancre, fever, weight loss, malaise
Secondary (6weeks to 6 months post exposure)
1. fever, fatigue, sore throat, muscle aches, weight loss
2. Rash to hands & feet
Tertiary (10-30 years post exposure)
1. Cardiac, and neurological destruction
2. CNS & multi-organ damage
203
How is syphillis diagnosed?
RPR or VDRL
204
What is the tx of syphillis?
| KNOW
Pen G regimen
partner tested & treated
205
What are the risks of syphillis?
1. PID, infertility, ectopic pregnancy
2. NEWBORN- congenital syphillis, premature birth, neuo complications, stillbirth
206
IPV in pregnancy correlates with maternal, fetal and infant health issues like...
1. uterine rupture
2. Placental abruption
3. Preterm births, low birth weight infants
4. Maternal & neonatal deaths
207
What are characteristics of an abuser?
1. Witness abuse of a mother as a child
2. COntrolling, possessive, jealous, poor impulse control
3. Denies responsibilities for violence and blames the women
208
What are the components of the cycle of violence theory?
1. Tension-buliding phase
2. Acute battering incident
3. Tranquil phase (honey moon phase)
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What are some psychological/emotional acts of violence in IPV
1. Humilation, intimindation, threats
2. Isolation, control
3. Uses others-children
4. Blame, minimize
5. Male privilege, economic abuse
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What are some physical acts of violence that might be seen in IPV
1. Pushing,shoving, slapping
2. Kicking, punching, beating
3. chocking
4. shaking, burning
5. use/threat of weapon- gun, knife
211
What are some sexual acts of violence that might be seen in IPV
1. Forced to engage in sexual activity aginst her will
2. foced use of objects
3. foced to have sex with someone else
4. forced to trade sex for food, money & drugs (sex trafficking)
212
What is sexual assult?
Sexual contact, touch or penetration without consent
213
What are different types of rape?
1. Power, sadistic, stranger, acquaintace, gang, drug facilitated
214
What are characteristics of perpetrators
1. All ethinic, racial, religious, socioeconomic & educational
2. Attitudes toward women, male entiltement
3. Impulsive, antisocial, emotionally unsupportive family
215
What is trauma informed care?
1. SANE/SAFE- special trained officers, physicians, sexual assult nurses or forensic examiner
2. Forensic medical exam-primary purpose- restore dignitiy and then collect evidence
- obtain a history, perform a head to toe and genital exam looking for trauma
- offer STI, HIV & pregnancy prophalaxis medications
- Make referrals for advocasy, couseling, shelters, legal assistance
- Document findings for legal court testimony
216
What do we want to avoid doing to a vitcim of rape
Secondary victimization-2nd rape- by law enforcement, physican and staff
know about rape trauma syndrome- PTSD- varing degrees of intensity, difficult to treat
217
What challanges do we face when caring for victims of violence?
1. Victim is physically/psychologically controlled, often loyal to perpetrator
2. experienced many traumas, drugged, intoxicated or in pain
218
What are some ques that may hint at a patient being a victim of violence?
1. Serious untreated injuries-delayed care
2. Injury not consistent with story, various stages of healing
3. Injuries to head,neck, face, abdomen and breast if pregnant- always look under the clothes
4. Overly protective partner or anxiety when parner is present
219
What are the ABCDES of IPV
1. Alone-universal screening question
2. Believe- reassure it is not thier fault
3. Confidentilality- know the reporting requirements for your state
4. Document- facilitates communication between providers
5. E-education- advocasy, counseling, legal assistence, shelters
6. S-Safety- assess support system- help create a safety plan
220
Risk for homocide is the greatest when
attempted seperation
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