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Nursing 531 (Womens Health) > Week 2: Periods Suck (part 2) > Flashcards

Week 2: Periods Suck (part 2) Flashcards

part 2 (menstrual irregularities)

1
Q

___ is the painful menstruation associated with ovulation

A

dysmenorrhea

**This can be a dx and or a symptom

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2
Q

Facts on dysmenorrhea (painful menstruation from ovulation)

A

-affects 50%
-5-10% miss school or work
-Primary or secondary

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3
Q

What is the patho for primary dysmenorrhea?

A

-Absence of pelvic pathology and must occur with ovulatory cycles.

-Result of excessive endometrial prostaglandin production

-Prostaglandin F2-alpha

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4
Q

What would the secondary cause of dysmenorrhea be?

**Secondary from a pathological cause

A
  1. PCOS
  2. cancer
  3. endometriosis
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5
Q

Dysmenorrhea:

Subjective data?
Questions?
What common symptoms?

A

Add OLDCARTS for the characteristics of pain** look up

location?
does it radiate?
any associated symptoms?

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6
Q

Dysmenorrhea

Objective data?
Exam
Differentials?

A

Exam will be the same

Differentials:
-endometrioisis
-fibroids
-GI pain

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7
Q

Dysmenorrhea:

Plan?
Psychosocial interventions?
Medications?
Surgeries?
Follow up?

A

-psych- discuss the plan & interventions usually BC pills 6-12 months

-NSAIDS instead of BC is ok if does not want BC or trying to get pregnant
*** can be taken 3-4 days before the onset of their cycle & then stop 2 days after they start bleeding
(to manage the pain)

Follow up of all indications, risks, side effects, NSAIDS take them with food, signs of toxicity, include maximum dose to not go over in the daily amount

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8
Q

Abnormal bleeding

A

Any uterine bleeding that does not result from normal menstruation.

Anovulatory bleeding 95% of all AUB between 16-17

-Decreases during childbearing years
-Increases during perimenopause

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9
Q

how long can perimenopause last before stopping having periods?

In smokers its how long?

A

10 years

5 years shorter

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10
Q

Ovulatory abnormal bleeding

A

-10% of women of all ages
-50% have midcycle bleeding/breakthrough bleeding

Underlying causes:
Prolonged progesterone production
Corpus luteum insufficiency (can make it hard to get pregnant)
Luteal phase defect (can make it hard to get pregnant)

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11
Q

IUP (intrauterine pregnancy) bleeding

Highest incidence between 18-35 y/o

Bleeding occurs in 1 out of 5 pregnancies

A

Medication problems
Birth control pills
MAIOs
Opiates
Thyroid medication
Etc (see handout

** Can cause this

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12
Q

PID

A

Suspect in any woman with abdominal pain, abnormal bleeding, leukocytosis, low-grade fever, and pelvic tenderness

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13
Q

Neoplasms can cause abnormal bleeding

A

20% occurring in girls under 11
Benign and malignant growths

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14
Q

Abnormal bleeding

A

Trauma
Rape
Abuse
Lacerations

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15
Q

Blood dyscrasias (blood clotting disorder)

A

10% have abnormal uterine bleeding

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16
Q

How can tell if ovulation or anovulation?
History
What do you need to know?

A

Are they having pain? They have to be ovulating to have pain with bleeding!!! **

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17
Q

How can tell if ovulation or anovulation?

Menstrual Problems

A

Remember this is a disease of exclusion!!***

Subjective data?
Will depend on client age

If prepuberty consider foreign body trauma or abuse

If childbearing age – multiple causes including IUP, infections, abuse

If perimenopausal or menopausal – consider endometrial hyperplasia or neoplasm

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18
Q

Puberty & Teens
Menstrual Irregularities

Subjective data?

A

Subjective data
Must have a detailed menstrual history!
Medication
FH
PMH
Experiences with bleeding
Associated S/S
Description of bleeding (OLDCARTS)
Ask questions to determine if ovulatory/anovulatory (is she having pain)
Social history

19
Q

Puberty & Teen
Menstrual Irregularities

Objective Data

A

Objective data

Complete PE (physical exam)
Pallor not associated with tachycardia
Signs of hypovolemia
Pelvic masses
Fever
Leukocytosis
Pelvic tenderness
Fine or thin hair
Hypoactive reflexes
bruising

20
Q

Assessment differentials (there can be a lot of them)

PLAN

for Puberty & Teen:

Menstrual Irregularities

A

Plan

Labs
CBC
UA
Pap
Pregnancy test
STDs
Thyroid function
Coagulation disorders
others

21
Q

Menstrual Irregularity Plan for Puberty & Teen

A

Plan

Treat underlying cause if present (if treat cause & it stops NO FURTHER treatment)

Psychosocial interventions - let pt. know plan & outcomes
Surgery
Medication- BC pills

22
Q

Primary childbearing years: period problems

A

Most common causes are contraceptive causes and pregnancy
Same history
Same physical
Labs
Endometrial biopsy
Plan
Treat underlying cause

23
Q

Age 40 and older

A

Anovulatory bleeding accounts for 90% of cases of abnormal bleeding in this age group but always consider cancer until you rule it out!

grade 5- can do an endometrial biopsy

24
Q

Age 40 and older: Subjective

A

Menopausal symptoms
Personal and family history of malignancy
History of ERT (estrogen replacement therapy)

25
Q

Age 40 and older: Objective

A

Objective

Same
Labs

Endometrial biopsy
Must do if endometrium is greater than 5-6 mm!!**

on a postmenopausal woman
Plan
Refer to physician- for abnormal endometrial result OR if result is normal but pt. continues to have bleeding
Must treat the woman with a mass aggressively

26
Q

Abnormal bleeding before age 11

A

Never overlook the possibility of malignant genital tract tumors in young girls

27
Q

Abnormal bleeding frequently manifests sexual abuse of children or young teenagers

A

One in four female children are sexually abused

28
Q

Pad counts are not accurate for blood loss but more than 25 pads or 30 tampons per period is too much

A

Pad must be completely soaked through

How many pads do they change a day?

How often or frequent do they change a tampon?

**A pad must be completely soaked through

29
Q

Do not use a rectal bimanual exam

True or False

A

True

30
Q

In a nonpregnant patient, a pelvic mass requires

A

aggressive evaluation

31
Q

Perform endometrial sampling in all women over 30 and in those over 20 with frequent or exceptionally heavy bleeding before

A

beginning HRT including BC pills

32
Q

Perform hysteroscopy before endometrial sampling to find any abnormalities the sampling may miss

A

Women treated with Tamoxifen (used in breast cancer) have the same endometrial cancer rate as women treated with unopposed estrogen;

about 7x the rate for untreated women

33
Q

PMS

A

-A combination of physical and psychological symptoms that occur in the luteal phase of the menstrual cycle.

-Includes any physical, psychological, or behavioral changes distressing enough to impair to ADL or relationships

-There are about 150 symptoms associated with or attributed to PMS

34
Q

A woman comes into the office c/o saying that their husband wanted me to talk about? She is in the luteal cycle

What is she most likely experiencing?

A

PMS

35
Q

PMS symptoms: LONG LIST

A

Abdominal bloating Anxiety
Change in libido
Depression
Dizziness or fainting
Fatigue
Food cravings
Hostility
Inability to concentrate
^appetite
Ins
Insomnia
Irritability
Lethargy
Mood swings
Panic attacks
Paranoia
Withdrawal from others
Acne
ETOH intolerance
Breast engorgement
Clumsiness
Constipation/D
Decreased urination
HA
^risk of minor infections
Peripheral edema
Weight gain

36
Q

How prevalent is PMS

A

Prevalence

-5-10% have severe to disabling symptoms
-50% moderately distressing
-All women suffer from this at some point during the lifespan
-May differ in symptoms from cycle to cycle

37
Q

Patho of PMS

A

The end result of abnormal tissue response of nervous, immunologic, vascular, and GI symptoms to the normal changes of the menstrual cycle

38
Q

PMS

A

Runs in families

Research has discovered a relationship between severity or frequency of PMS with feelings of poor health, family conflicts, history of abuse, history of affective disorder, and lack of proper exercise or diet

39
Q

subjective for PMS

A

The same as previous BUT

  1. need to know how often it is?
  2. Is this every cycle?
  3. which days before the cycle?
  4. how long does it last?
40
Q

objective data for PMS

A

Do a complete physical exam

Objectives

41
Q

Treatment for PMS

A

Treatment based on relief of symptoms
SSRIs
Birth control pills
Anxiolytics
Lifestyle changes

42
Q

A woman comes into the office c/o of PMS and wants hormone levels checked is this standard protocol?

A

No- treatment is more based on the symptoms

usually zofoft or prozac is given - use 1-2 weeks prior to starting period, BC pills

43
Q

PMS varies for every woman so the provider must?

A

-listen to pt.
-be open to what the pt. thinks is moderate to debilitating

**finding the right treatment plan for them is essential

Nursing 531 (Womens Health) (10 decks)

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