Unit 5 - Female Repro Disorders

Question 1

Malignant Breast Conditions Prevention

Answer 1

Exercise and breastfeeding

Question 2

Malignant Breast Conditions Risk Factors

Answer 2

Gender: female
Increased age: >60
Genetics: BRCA 1/2
Hormones: Contraceptive use, early period, late menopause, no pregnancies/no full term pregnancies, geriatric pregnancy, long term estrogen/progesterone use
Hx of breast cancer
Obesity
Alcohol

Question 3

Malignant Breast Conditions S/S

Answer 3

Lump
Skin dimpling
Change in skin color/texture
Change in nipple appearance
Clear/bloody d/c from nipple
Atypical: redness, swelling, pain, warmth

Question 4

Dx of breast cancer: Mammogram

Answer 4

Avg risk: q 1-2y at 40yo

High risk: HCP preference

Question 5

Dx of breast cancer: Breast exams

Answer 5

q 3 y age 20-39

q y after age 40

Question 6

Dx of breast cancer: MRI

Answer 6

Implants

Dense breast tissue

Question 7

Dx of breast cancer: breast bx

Answer 7

Preferred method for dx

Needle or surgical

Question 8

Dx of breast cancer: labs

Answer 8

Estrogen (ER) and progesterone receptor (PR) assays

Question 9

Malignant breast conditions: protective factors

Answer 9

Maintain normal weight
Physical activity
Avoid/limit alcohol
Breastfeeding for a year or longer
Medications: Chemo prevention for high risk

Question 10

Ducts carcinoma in situ (DCIS)

Answer 10

Cancer cells on milk ducts without spread into tissues
Best cure rate
Localized

Question 11

Lobular carcinoma in situ (LCIS)

Answer 11

Marker with tissue changes that show increased risk for cancer

Question 12

Invasive ductal cancer

Answer 12

Mist common and deadly
Spreads rapidly
Invasive

Question 13

Invasive lobular breast cancer

Answer 13

About 10-15% of breast cancers dx

Question 14

Breast cancer prognosis/tx

Answer 14

Depends on tumor size and lymph node involvement

TMN - tumor, metastasis, nodes

Question 15

Breast cancer sx: lumpectomy

Answer 15

Removal of lump

Bx sentinel node

Question 16

Breast cancer sx: total/simple mastectomy

Answer 16

Removal of breast, bx sentinel node

Question 17

Breast cancer sx: modified radical mastectomy with sentinel node bx/lymph node dissection

Answer 17

Removal of breast and lymph nodes

Question 18

Breast cancer sx: radical mastectomy

Answer 18

Removal of breast, lymph nodes, muscle

Question 19

Breast cancer: radiation types

Answer 19

External beam: skin changes, radiation to outside only, not radioactive
Internal: radioactive, bed rest, limit visitors

Question 20

Breast cancer: systemic therapy

Answer 20

Neoadjuvant: shrinks tumors
Adjuvant: destroy all cells, immunocompromised

Question 21

Breast cancer: biologic therapy

Answer 21

growth promoting protein that targets specific cell (HER2/neu)

Question 22

Breast cancer: hormonal therapy

Answer 22

hormone receptor positive cancer: tamoxifen and anastrozole (postmenopausal)

Question 23

Breast cancer: chemotherapy

Answer 23

Depends on size of tumor, lymph node involvement, amount of HER2/neu present

Question 24

Internal radiation considerations

Answer 24

Time - direct care (w/in 3 foot distance) no more than 30 min in 8h
Distance - stay 6 ft away from pt when not providing direct care (pain assess. Or admission ?s)
Shielding - wear lead apron and dosimeter
Use forceps and lead container if dislodged
Limit visitors

Question 25

External radiation care

Answer 25

Patient is not radioactive

Question 26

Care of skin after radiation

Answer 26

``` Mild soap and minimal rubbing Avoid perfumed soaps/deodorant Use hydrophilic lotions for dry skin Use Aveeno soap if pruitis occurs Avoid tight clothes, underwire bras, excessive temps Minimize sun exposure and use sunblock ```

Question 27

Hand and arm care after axillary lymph node dissection

Answer 27

``` Prevent lymphedema/lymphangitis No BP/sticks on affected side No heavy lifting with affect arm No tight clothing, jewelry Elevate affected arm Don’t sleep on arm Sunscreen and insect repellant Gloves for gardening Cooking kit when removing objects from oven Electric razor for armpit, avoid chemical hair remover No cutting cuticles - push them back If break in skin, wash with soap and water then apply antibacterial ointment Observe for 24h ```

Question 28

Reconstruction sx: tissue expander or external breast prosthesis

Answer 28

Used for implant to be inserted later

Question 29

TRAM flap

Answer 29

Uses fat, skin, blood vessels, and muscle from abdomen | Increased risk of hernia

Question 30

DIEP Flap

Answer 30

Uses fat, skin and blood vessels from abdomen | No muscle removed, decreased risk of hernia

Question 31

Types of pelvic organ prolapse (POP)

Answer 31

Cystocele: s/s UTI or incontinence Recticele/enterocele: constipation, fecal incontinence, bloating Uterine prolapse: dyspareunia, backache, bulge

Question 32

Management of POP

Answer 32

Pelvic floor rehab: Kegel exercises Pessary (push up and hold in place) - must be fitted and cleaned Reconstructive pelvic sx: A-P repair (make everything tighter)

Question 33

Cervical cancer: risk factors

Answer 33

``` Intercourse with uncircumcised male Early age of first coitus Multiple sex partners High parity STIs Cigarette smoking Exposure to HPV ```

Question 34

Cervical cancer screening

Answer 34

Q 2-3y depending on age/risk | High risk per HCP

Question 35

Cervical cancer S/S (3)

Answer 35

Vaginal bleeding Pelvic pain Dyspareunia

Question 36

Cervical cancer management (3)

Answer 36

Colposcopy with bx Cervical conization/LEEP: more precise, can be tx if found early enough Hysterectomy - has spread to uterus

Question 37

Endometrial cancer: FUNDL

Answer 37

``` Family hx Unopposed estrogen use Nulliparous Diabetes, PCOS, obesity Late menopause (>50) or early onset menarche (<12) ```

Question 38

Endometrial cancer S/S (1)

Answer 38

Abnormal vaginal bleeding

Question 39

Endometrial cancer Management (4)

Answer 39

Chemo Radiation Hysterectomy - additional procedures of metastasis (fallopian tubes, cervix, vagina) Hormone therapy - progesterone (slow growth of endometrial tissues), tamoxifen (prevents estrogen and cancer from growing)

Question 40

Ovarian cancer risk factors: BONAFIDE

Answer 40

``` Breast cancer Obesity Nulliparous Age over 40 or post-menopause Family hx Infertility meds Descent northern American/European Endometrial cancer ```

Question 41

Ovarian cancer: vague symptoms

Answer 41

Bloating General abdominal discomfort Change in bowel/bladder habits

Question 42

Ovarian cancer tx (3)

Answer 42

Sx (depends on metastasis) Chemo Radiation

Question 43

Types of hysterectomy

Answer 43

Partial/Supra cervical - removal of uterus, cervix left intact Total hysterectomy - uterus and cervix Total with salpingo-oophorectomy - uterus, ovary, Fallopian tubes Radical- used for gyn cancer; all reproductive organs (uterus, cervix, upper third of vagina, parametrium)

Question 44

Hysterectomy management

Answer 44

Monitor for bleeding, atelectasis. DVT, ileus, infection Encourage ambulation (pain med prior) Pain mgmt

Question 45

Hysterectomy discharge education

Answer 45

Pelvic rest 4-6wks Avoid heavy lifting Wear pad for vaginal d/c Monitor for s/s infection, malaise, drainage