Week 6 - Gendered Health Flashcards
1
Q
What is endometriosis?
A
Endometriosis is an oestrogen dependent, inflammatory condition, defined by endometrial cells found outside the uterine cavity.
2
Q
Risk factors for endometriosis:
A
- Genetic predisposition - family history
- Long and heavy menstrual periods
- Altered immune function
- Early onset menstruation: before 11 years old
- Frequent periods or short cycles
- Low body weight
3
Q
Pathophysiology for endometriosis:
A
Instead of menstrual blood flowing out of the body as usual, some travels backwards along the fallopian tubes and into the pelvis.
Results in the retrograde movement of endometrial cells with the blood → from the uterus → back up the fallopian tubes → into the pelvic cavity.
The endometrial cells implant on the surface of pelvic organs and lining of the pelvis (peritoneum) and start growing → turning normal pelvic tissue into endometriosis → leads to inflammation and scarring, which can cause painful ‘adhesions’ between pelvic organs that are normally separated
4
Q
Clinical manifestations of endometriosis:
A
- Dysmenorrhoea
- Heavy, irregular menstrual bleeding
- Mid-cycle bleeding
- Bleeding from the bladder or bowel
- Changes in urination or bowel movements
5
Q
How is endometriosis diagnosed:
A
- History and physical examination
- Pelvic examination
- Pelvic ultrasound
- MRI
- Early referral to Gynaecologist
- Laparoscopy
6
Q
Medical management of endometriosis:
A
- Hormone therapy
- Combined oral contraceptive pills
- Laproscopy surgery
- Intrauterine devices
7
Q
What is Polycystic Ovarian Syndrome (PCOS)?
A
A complex hormonal and metabolic imbalance (endocrine disorder) that affects the entire body.
8
Q
Pathophysiology of PCOS:
A
Imbalance in the hormones secreted by the pituitary gland → ↑ levels of insulin → ↑ levels of oestrogen, ↑ luteinising hormone (LH) and ↓ follicle-stimulating hormone (FSH) (called the increased LH:FSH ratio) → ovaries producing excessive androgens (male-type hormones = testosterone but not progesterone) → ovaries become enlarged with multiple fluid-filled cysts which develop within the mature ovarian follicles that have failed to rupture and release an egg → clinical manifestations of PCOS
9
Q
Clinical manifestations of PCOS:
A
- Lower abdominal pain, discomfort and bloating
- Breast tenderness
- Hirsutism (excessive hair growth on the face, chest, back, or buttocks)
- Alopecia (thinning or loss of hair from the head)
- Weight gain
- Fatigue
- Oily skin and acne
10
Q
How is PCOS diagnosed?
A
- History and examination
- Blood tests: androgens, Luteinising Hormone (LH), Follicle Stimulating Hormone (FSH)
- Pelvic ultrasound
11
Q
Medical management treatment goals of PCOS:
A
- Early diagnosis and treatment to improve quality of life
- Decreased weight and increased exercise
- Medications can be used for symptom management
- Oral contraceptive used for menstrual cycle regulation
12
Q
What is ovarian cancer?
A
Complex disease composed of different types and grades = types include epithelial and germ-cell
13
Q
Risk factors of ovarian cancer:
A
- Ageing
- Genetic family history of ovarian, bowel or breast cancer
14
Q
Pathophysiology of ovarian cancer:
A
Ovarian cancer begins with the loss of form and function of ovarian cells as they become cancerous. During ovulation, these cells can then be transported into the ovary where they replicate, with eventual tumour development.
15
Q
Stage 1 of ovarian cancer:
A
Cancer confined to the ovaries
16
Q
Stage 2 of ovarian cancer:
A
Cancer is in one or both ovaries and has spread to the pelvic region such as the fallopian tubes or uterus
17
Q
Stage 3 of ovarian cancer:
A
Cancer is in one or both ovaries and has spread beyond the pelvis to the lining of the abdomen or to the lymph nodes in the back of the abdomen
18
Q
Stage 4 of ovarian cancer:
A
Most advanced, cancer has metastasized (spread) to distant sites such as the spleen, liver, lungs or other organs outside of the pelvic region
19
Q
What are germ cells?
A
The cells within the ovaries that develop into eggs
20
Q
What is Epithelial Ovarian Cancer?
A
Cancer that forms on the outer tissue covering the ovary (epithelium)
21
Q
What is the most common type of ovarian cancer?
A
Epithelial Ovarian Cancer
22
Q
Clinical manifestations of ovarian cancer:
A
- Pain / bleeding during / after sex
- Needing to urinate urgently and frequently
- Indigestion / nausea
- Excessive fatigue
- Unexplained weight loss / gain
- Bleeding after menopause
23
Q
How is ovarian cancer treated?
A
Surgery or chemotherapy
24
Q
What is gestational diabetes?
A
A diagnosis of diabetes during pregnancy, in women with no previous history of diabetes.
25
What are the risk factors for GDM?
- Aged 40 years or over
- Family history of type 2 diabetes or a first-degree relative (mother or sister) who has had gestational diabetes
- Obesity
- Elevated blood glucose levels in the past
- Cultural
- History of PCOS
26
Pathophysiology of T2DM:
Oral intake → glucose absorbed by the digestive tract → glucose transported into the bloodstream → blood glucose levels ↑ → target cells send a trigger signal to the pancreas to release insulin → Beta cells secrete insulin → target cells have developed in ineffective response to this insulin so send additional triggers for more insulin to be secreted → ↑ insulin secretion → hyperinsulinemia
27
Pathophysiology of GDM:
Placenta hormones (especially human placental lactogen and human placental growth hormone) block the effects of insulin → maternal insulin resistance and hyperglycemia → glucose crosses the placenta → foetal hyperglycaemia → foetus produces increased insulin to combat hyperglycaemia → ↑ foetal growth and complicates delivery.
28
Clinical manifestations of GDM:
- Fatigue
- Polydipsia/ polyuria/ polyphagia
- Candida infections
- Nausea/vomiting
- Urinary tract infections
- Weight loss
- Blurred vision
29
What is the gold standard used for diagnosing GDM is the oral glucose tolerance test (OGTT)?
An OGTT tests blood glucose levels at set intervals after the consumption of a syrupy glucose drink (75g of glucose) and after fasting for 12 hours. Pathology will be collected as a base-line prior to drinking the glucose (fasting glucose), then repeated 1 hour and 2 hours post consumption of the oral glucose.
30
Medical management of GDM:
- Lifestyle modification = exercise, healthy diet
- Blood glucose monitoring = may need to be tested up to four times a day (start of the morning and after every meal)
- If necessary, medications such as metformin or insulin will be commenced if life-style modification is not effective in normalising BGLs.
31
Blood glucose levels - hypo, normal and hyper:
```
Hypoglycemia = BGL <3.9mmols/L
Normal = 4 to 8 mmols/L before meals & 6 to 10mmols/L up to 2 hours after meals
Hyperglycemia = >14mmols/L
```
32
Important topics to consider when providing education and support for the patient with GDM and their support persons, include:
- Fluid and dietary regime
- Exercise requirements
- Weight management / smoking cessation, if applicable
- Correct self-monitoring of BSLs - procedure and timing
- Prevention of infection
- Skin care - regularly moisturize to prevent dry skin
33
What is Benign Prostatic Hyperplasia (BHP)?
A non-cancerous growth of the prostate gland.
34
Benign Prostatic Hyperplasia (BHP) risk factors:
- Ageing
- Changes in male sex hormones associated with ageing
- Family history
- Testicular abnormalities
- Obesity
- Sedentary lifestyle
- Increased alcohol consumption
- Smoking
35
Benign Prostatic Hyperplasia (BHP) pathophysiology:
Exact trigger for cell proliferation unknown but is most likely to be multifactorial:
Advancing age → ↓ testosterone secretion (or ↑ oestrogen secretion) and ↑ DHT secretion → nodules form (nodule hyperplasia) on the periureteral gland (inner gland or layers of the prostate closest to the urethra) → glandular cell enlarge (hypertrophy) → continued nodular hyperplasia and cellular hypertrophy → prostate enlargement → obstruction and inflammation → tissue around the prostate compress the urethra → clinical manifestations → BPH
36
Benign Prostatic Hyperplasia (BHP) clinical manifestations:
- Nocturia, usually first symptom that occurs
- Urinary frequency
- Urinary incontinence
- Urinary urgency
- Dysuria
- Haematuria
- Bladder pain
37
Benign Prostatic Hyperplasia (BHP) investigations:
- Digital rectal exam
- Urinalysis
- Blood pathology
- Transrectal ultrasound
- Prostate-specific antigen (PSA) test
38
Complications of Benign Prostatic Hyperplasia (BHP):
- Urinary retention = obstruction of urethra
- Infections from incomplete bladder emptying e.g. cystitis, pyelonephritis
- Development of bladder calculi = residual urine becomes more alkaline
- Hydronephrosis + distension of kidney pelvis calyces
- Erectile dysfunction = related to medication for BPH
39
Nursing management for Benign Prostatic Hyperplasia (BHP):
- Primary and secondary assessments
- Symptom management, e.g. pain
- Restoration of urinary drainage
- Continuous bladder irrigation and associated management
- Early intervention with UTI or other postoperative complications
- Education
40
Pharmacology used to treat Benign Prostatic Hyperplasia (BHP):
Two classes of drugs: alpha-adrenergic blockers, 5 alpha-reductase inhibitors.
41
Selective Alpha-Adrenergic Blockers generic drugs names:
Doxazosin, prazosin, alfuzosin, terazosin, tamsulosin
42
Selective Alpha-Adrenergic Blockers mode of action:
Block alpha 1 receptors, relax smooth muscle in the bladder neck and prostate → ↓ urinary flow resistance → improves urinary flow
43
Selective Alpha-Adrenergic Blockers indication:
- Symptomatic relief of BPH
- Can improve symptoms within 48 hours with full effect taking 4-6 weeks.
- Will also improve urinary flow rates
- Effective regardless of prostate size
44
Selective Alpha-Adrenergic Blockers precautions:
- Increased risk of falls
- Volume depletion → ↑ orthostatic hypotension → ↑ risk of falls
- If also on hypertensive, diuretic or beta-blocking medications → ↑ risk of falls
45
Selective Alpha-Adrenergic Blockers side effects:
- Hypotension / tachycardia /dizziness
- Urinary urgency
- Headaches
- Weakness
- Retrograde ejaculation
- Decreased libido
- Impotence / erectile dysfunction
46
Selective Alpha-Adrenergic Blockers nursing considerations:
- Educate patient on increased risk of falls
- Get up gradually / slower standing
- Sit on side of bed to stabilise before rising
47
5 Alpha-Reductase Inhibitors generic drug examples:
Finasteride, dutasteride
48
5 Alpha-Reductase Inhibitors mode of action:
Inhibits 5 alpha-reductase → ↓ conversion of testosterone to DHT → ↓ size of prostate → ↓ urinary flow resistance → improves urinary flow → ↓ clinical manifestations
49
5 Alpha-Reductase Inhibitors indication
- Treatment of BPH
- An option when the size of the prostate is > 3 cms in diameter
- Improves symptoms
- Reduces rate of urinary retention
- Can take 6 months before symptoms improve, full effect in 12-18 months
50
5 Alpha-Reductase Inhibitors precautions:
- Risk of falls
- Volume depletion → ↑ orthostatic hypotension → ↑ risk of falls
- If also on hypertensive / diuretic / beta-blocking medications → ↑ risk of falls
- Heart failure and coronary artery disease → patients may be adversely affected by a drop in blood pressure.
51
5 Alpha-Reductase Inhibitors side effects:
- Impotence/erectile dysfunction
- Decreased libido
- Ejaculation disorder
- Breast tenderness or enlargement
- Poor semen quality
- Depression
52
5 Alpha-Reductase Inhibitors nursing considerations:
- Education: patient on increased risk of falls, get up gradually / slower standing, sit on side of bed to stabilise before rising
- Symptoms can take up to 6 months to improve
53
What is prostate cancer?
A malignant tumour of the prostate gland: generally slow growing
54
Prostate cancer risk factors:
- Ageing: incidence rises sharply >50 years, most common > 65 years, 1:7 men aged 75 will be diagnosed with prostate cancer
- Ethnicity: African descent may increase risk, may also be due to differences in how ethnic groups participate in screening and access health services
- Family history: first degree relative
- Genetics
55
Prostate cancer pathophysiology:
- Pathophysiological process is multifactorial and exact process remains unknown
- Slow growing, androgen-dependent cancer
- Occuring in the outer zone of the prostate
- Hormonal factors are strongly involved
- Testosterone and dihydrotestosterone (DHT)
- Significant age-dependent alterations in circulating hormones
- ↓ DHT levels
- ↑ oestrogen levels
56
Prostate cancer clinical manifestations;
- Retention
- Dysuria
- Interruption of urinary stream
- Hesitancy
- Dribbling
- Inability to urinate
- Frequency/urgency
57
Prostate cancer investigations:
- Digital rectal examination (DRE)
- Blood pathology
- Prostate-specific antigen (PSA) test will be ↑ with prostate cancer
58
Prostate cancer stage 1:
Found only in the prostate and not felt on the digital exam
59
Prostate cancer stage 2:
Not spread outside of the prostate
60
Prostate cancer stage 3A and 3B:
Spread begins local tissue and organs
61
Prostate cancer stage 4A and 4B:
Widespread metastases to surrounding tissues, organs and bones
62
Prostate cancer treatment:
- Hormone (androgen deprivation) therapy
- High intensity focused ultrasound
- Radiotherapy
- Chemotherapy
63
What are the two main types of testicular cancer?
- Seminoma is the most common type and usually occurs in men aged between 25 and 50 years
- Non-seminoma is more common in younger men, usually in their 20s
64
Risk factors of testicular cancer:
- Family history of testicular cancer
- History of abnormal development of the testicles e.g. undescended testicle
- Orchitis (inflammation of one or both of the testes)
- HIV infection
65
Clinical manifestations of testicular cancer:
- Painless, firm lump in either testicle
- Sudden build-up of swelling in the scrotum
- Feeling of heaviness or dull ache in lower abdomen, perianal area or testicle
- Back pain
- Pain only seen in 10% of cases
66
Transurethral resection of the prostate:
A TURP is an operation to remove the obstructing part of the prostate gland.
Aim of surgery is to reestablish urinary flow and decrease clinical manifestations caused by a prostate growth.
67
Immediate postop complications of Transurethral resection of the prostate:
- Hemorrhage
- Bladder spasms
- Urinary continence/urinary retention
- Infection
- Pain and mild burning to bladder
68
Longer term complications of Transurethral resection of the prostate:
- No semem production during orgasm in 80% of patients
- In 10-20% of cases not all prostatic symptoms will be relieved
- Return of urinary frequency and nocturia
- Erectile dysfunction
- Mostly transient
69
What is a radical prostatectomy?
Surgery to remove entire prostate gland, seminal vesicles, part of the bladder neck (ampulla) and some of the surrounding nerves and blood vessels
70
Immediate postop complications from a radical prostatectomy:
- Infection: perineal access increased risk of infection due to location and close contact with faeces
- Pain
- Haemorrhage
- Bladder spasms
- Urinary retention
- Wound dehiscence
- DVT/PE
71
Adverse outcomes post surgery from a radical prostatectomy:
- Urinary incontinence: can occur for months after surgery
- Erectile dysfunction: depends on age, preoperative sexual function, if nerve-sparing surgery was performed
- Sexual function can return gradually over 24 months
72
What is continuous bladder irrigation?
Used to reduce the risk of clot formation in the bladder following TURP
73
Nursing considerations of continuous bladder irrigation:
- There will be 2 x 2 litre bottles of irrigation (Sodium Chloride 0.9%)
- Only one bag will run at a time
- When one bottle has gone through, the urine bag is emptied and the second bag is started
- Strict fluid balance chart
- Input and output must be accurately recorded
74
Signs and symptoms of a blocked catheter:
- No urine output from the catheter
- Increased pain in abdomen and around catheter as the bladder fills up
- Leaking around the catheter
- The patient may experience symptoms such as diaphoresis (sweating), tachycardia or hypotension if the blockage remains
75
Nursing considerations surrounding a blocked catheter:
- Turn off the irrigation and check the tubes for any kinks or loops, or any clots in the catheter.
- Try “milking” the catheter tubes to encourage the clots to drain into the bag
- Assess the patient for any pain
- If necessary nurse initiate a bladder scan to determine the volume in the bladder
- A bladder washout could also be performed manually
76
2 types of STDs:
Bacterial or viral
77
4 ways you can get an STD:
- Fluid transmission
- Skin to skin contact
- Indirect transmission
- Vertical transmission
78
STD clinical manifestations:
Soreness, itching and abnormal penis, vaginal or anal discharge, with or without lesions on the genitalia and associated mucous membranes.
79
Identify 3 clinical manifestations associated with clinical hyperandrogenism:
Hirsutism, acne, alopecia
80
Identify 4 management areas associated with PCOS:
Fertility, menstrual cycle regulation, clinical hyperandrogenism and cardiometabolic health
81
Identify 3 barriers to the diagnosis of endometriosis:
- Normalisation of pain
- Lack of suspicion by women and health professionals about dysmenorrhoea
- Diversity of symptoms
82
Identify 3 pain management strategies that can be utilized to manage dysmenorrhea in endometriosis:
- Pelvic floor physiotherapy
- Regular physical activity
- Complementary therapies - acupuncture, TENS, magnesium, vit B1 & B6, fish oil
83
What is chlamydia?
Disease you can get from unprotected sex
84
Clinical manifestations of chlamydia:
- Abnormal vaginal discharge
- Bleeding/spotting between periods and sex
- Burning/stinging whilst urinating
85
What is Gonorrhoea?
STI caused by bacteria known as 'the clap', often has no symptoms
86
What is Syphilis?
STI caused by bacteria that can lead to serious health problems, there are 4 stages
87
Clinical manifestations of syphilis:
Symptoms depend on the stage but can include:
- Red rash
- Fever
- Enlarged glands
- Sore throat
- Hair loss
- Headaches
88
What is Herpes simplex virus?
Spread by skin to skin contact with someone who has the HSV virus, usually during genital or oral sex
89
Clinical manifestations of herpes simplex virus:
- Stinging
- Small blisters
- Sores
- Difficulty passing urine
90
What is Human papillomavirus?
STI that causes genital warts
91
Clinical manifestations of human papillomavirus:
- Sores on vagina
- Differences in stream of urine
- Blood in faeces
