Week 1: Women in Health (articles) Flashcards
More frequent surveillance, colposcopy, and treatment are recommended for patients at progressively higher risk
vs. lower risk?
can defer colposcopy, undergo follow-up at longer surveillance inter-vals, and, when at sufficiently low risk, return to routine screening.
Recommendations are based on risk, not results.
Recommendations of colposcopy, treatment, or surveillance will be based on a patient’s risk of CIN 3+ determined by a combination of current results and past history (including unknown history).
The same current test results may yield different management recommendations depending on the history of recent past test results
Colposcopy can be deferred for certain patients.
Repeat HPV testing or cotesting at 1 year is recommended for patients with minor screening abnormalities indicating HPV infection with low risk of underlying CIN 3+ (e.g.,HPV-positive, low-grade cytologic abnormalities after a documented negative screening HPV test or cotest).
Guidance for expedited treatment is expanded (i.e.,treatment without colposcopic biopsy)
or non-pregnant patients 25 years or older, expedited treatment, defined as treatment without preceding colposcopic biopsydemonstrating CIN 2+, is preferred when the immediate risk of CIN 3+ is≥60%, and is acceptable for those with risks between 25% and 60%.
Expedited treatment is preferred for nonpregnant patients 25 years or older with high-gradesquamous intraepithelial lesion (HSIL) cytology and concurrent positive testing for HPV genotype 16 (HPV 16)
(i.e.,HPV 16–positive HSIL cytology) and never or rarely screened patients with HPV-positive HSIL cytology regardless ofHPV genotype.*
Shared decision-making should be used when considering expedited treatment, especially for patients with concernsabout the potential impact of treatment on pregnancy outcomes
Excisional treatment is preferred to ablative treatment for histologic HSIL (CIN 2 or CIN 3) in the United States. Excision isrecommended for adenocarcinoma in situ (AIS).
Observation is preferred to treatment for CIN 1
Histopathology reports based on Lower Anogenital Squamous Terminology (LAST)/World Health Organization (WHO) rec-ommendations for reporting histologic HSIL should include CIN 2 or CIN 3 qualifiers,i.e.,HSIL(CIN 2) and HSIL (CIN 3)
All positive primary HPV screening tests, regardless of genotype, should have additional reflex triage testing performed fromthe same laboratory specimen (e.g.,reflex cytology
Additional testing from the same laboratory specimen is recommended because the findings may inform colposcopypractice. For example, those HPV-16 positive HSIL cytology qualify for expedited treatment.
HPV 16 or 18 infections have the highest risk for CIN 3 and occult cancer, so additional evaluation (e.g.,colposcopywith biopsy) is necessary even when cytology results are negative.
If HPV 16 or 18 testing is positive, and additional laboratory testing of the same sample is not feasible, the patient shouldproceed directly to colposcopy.
Continued surveillance with HPV testing or cotesting at 3-year intervals for at least 25 years is recommended after treatment and initial post-treatment management of histologic HSIL, CIN2, CIN 3, or AIS.
Continued surveillance at 3-year intervals be-yond 25 years is acceptable for as long as the patient’s life expectancy and ability to be screened are not significantly compro-mised by serious health issues.
The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease.
New evidence indicates that risk remains elevated for at least 25 years, with no evidence that treated patients ever return to risk levels compatible with 5-year intervals.
Surveillance with cytology alone is acceptable only if testing with HPV or cotesting is not feasible.
Cytology is less sensitive than HPV testing for detection of precancer and is therefore recommended more often
Cytology is recommended at 6-month intervals when HPV testing or cotesting is recommended annually.
Cytology is recommended annually when 3-yearintervals are recommended for HPV or cotesting
lesbians often present with
-being sexually active
-using no contraception
-having no way of becoming pregnant
-
cultural safety is defined as
the effective nursing practice of a person or family from another culture & is determined by that person or family
lesbians have higher rates of obesity than heterosexual women
true or false
true
BUT more likely to engage in regular exercise
No increase in CVD in
bisexual or lesbian women
Risk factors for CVD in lesbians are?
obesity
smoking
alcohol use
less intake of fruits & veggies
True or false
all women regardless of sexual preference are at risk for cervical cancer
true
There is a false belief that lesbians are not at risk for cervical cancer & do not need pap smears
BUT
there is still a risk of cervical cancer
HPV causes 90% of cervical dysplasia & can be transmitted between women
lesbians have higher rates of breast cancer because
they are less likely to seek preventative mammograms compared to straight women
lesbians at risk for developing cancer because of
nullparity
smoking
alcohol use
obesity
what do NP’s need to teach lesbians?
-perform monthly self breast exams
-have regular cancer screening visits
-having mammograms
True or false lesbians have a higher rate of developing ovarian cancer
true
lesbians are less likely to be tested for STDs than straight women
NPS need to teach lesbians about safe sex
1.avoid contact with genital lesions
2. cover sex toys that penetrate (do not share sex toys)
3. use barrier during oral sex
4.use latex or lub for any manual sex that might cause bleeding
Lesbians importance of knowing HIV status
potential for transmission through period
NPS are responsible for creating a safe & caring atmosphere for each patient
What are the 4 factors for a safe and caring environment?
- reflection - the provider needs to examine their own feelings & biases
- environment-nondiscrimatory environment
like- office appreciates diversity of all race, age, gender,marital status etc
posters of same sex in office examples - language-inclusie, non-judgemental open ended Q’s
- knowledge-comptency, understanding health risk of lesbians, & need to possible refer patients to other providers
3 essential qualities a healthcare needs for a lesbian?
- awareness
- attitudes
- medical knowledge
