Week 7 Final Reproductive Ch 4/5 Flashcards
Women’s health is ________ area of health care
Evolving
Role of the nurse in women’s health care
Education, assessment, nursing care
Women’s emphasis on
Health promotion and health education
Health maintenance
- Diet
- Exercise
- Prevention
- Tx
- Healthy eating
Primary female sex hormone is
Estrogen
When is estrogen in high levels?
Childbearing age
Estrogen in high levels in males
False
Estrogen is responsible for
Development of secondary sex characteristics
Helps regulates menstrual cycle by?
- Stimulating proliferation of endometrial lining in preparation of pregnancy
Primary male hormone is
Testosterone
Made in testes - men- ovaries- females
Hormone responsible for the development of the male genital tract and the secondary sex characteristics
Testosterone
In both genders what does testosterone do?
Enhances libido
Increases energy
Boosts immune function
Helps protect against osteoporosis
Menstrual hx and hx of pregnancies
Hx of exposure of medications
Pain with menses or intercourse
Vaginal discharge, odor, itching
Urinary and bowel function
Sexual history, including abuse of sexual and physical
Hx of STDs. STIs, surgeries or procedures
Chronic illness or disabilities
Family or genetic hx
Health Hx and Sexual Assessment
Pelvic Smear
Pap Smear
Colposcopy and cervical biopsy
Cryotherapy and laser therapy
Cone biopsy and LEEP
Endometrial biopsy
Dilation and Cuerttage
Laparoscopy( Pelvic Peritoneoscopy) and hysteroscopy
Diagnostic Examinations and tests
Method of cervical screening used to detect potentially precancerous and cancerous tissues in the cervix ( opening of the uterus or womb)
Pap Smear
Examination of the vagina or cervix using has camera attached for photographs; used to document findings and for follow up treatments
Colposcopy
Views cervix with beam of light
What are the 3 methods of doing cone biopsy of cervix?
LEEP
Cold knife excision
Laser Surgery
Uses a thin wire loop heated by electricity to remove cervical tissue
Loop electrosurgical excision procedure
Uses a surgical knife to remove cervical tissue
Cold Knife excision
Uses a laser 9 intense narrow beam of light to remove the cervical tissue
Laser Surgery
Laser Excision
Method of destroying tissue by freezing, used for treating cervical dysplasia and early cancers
Cryosurgery
Inspection of the abdominal or pelvic cavity with a laparoscope, which is an endoscope used to examine the abdominal and pelvic regions
Laparoscopy
Procedure used to examine inside of the womb(uterus)
Hysteroscopy
Carried out using a hysteroscope
Hysteroscopy
- Narrow telescope with a light and camera at the end
Images are sent to a monitor so the physician or specialist can see inside the womb
Broad term that includes abuse, elder abuse, and the abuse of women and men
Domestic Violence
Abuse can be
- Emotional
- Physical
- Sexual
- Economic
Asking about the abuse is part of comprehensive assessment
Reporting and abuse guidelines
Physical, sexual, or psychological harm or social isolation
IPV
Perpetrated by a current or former partner
Occurs in intimate dating or relationship
Intended to instill fear and to intimidate and control the victim
Worldwide affects 1 in every 3 women
11 million women affected
5 million men affected
Women have 1 in 4 risk of being IPV in their lifetime
IPV
Male abuser with past hx of violence
Violent behaviors occurs early in relationship and progressively worsens
Used to handle conflicts
Used to exert feelings of powerlessness
IPV Characteristics
Affects persons, regardless of: status, ethnicity, educational level, or religious status
IPV Victims
Most often affected are
- Young women
Economically challenged individuals
- No means getting away
- Children living in homes with IPV
Contributing social factors include
Personal family violence
Poverty
Oppression
Unemployment
Difficulty with relationships
Single parent families
Individual risk factors of IPV
Young age
Low self esteem
Low academic achievement
Heavy drugs use
Social isolation
History of abuse
Prior injury from same partner
Economic stress
Tobacco and alcohol
Depression
Relationship risk factors include
Maternal conflict, instability
Relationship dominance by one partner
Poor family functioning
Economic stress
Name IPV indicators
Overuse of health services
Vague complaints
Unexplainable injuries, delay in care
Multiple injuries in various healing stages
Intimate partner refuses to leave, insists on explaining cause of the injury
Forced participation, use of force
Refusal to use condoms
Increased exposure to STDs
Forced undesired pregnancy
Sexual Violence
Maternal injury, increased infections and hospitalizations with pregnant women
Increased preterm births
Low birth weight infants, neonatal death
IPV and Childbearing
Threats and stalking
Involves property and pet destruction
Abuser
Blames the victim for the violence
Seeks to convince children to view victim as instigator of violence
Attempts to convince others of victim’s incompetence
Psychological and Emotional Violence
Social abuse may include
Total isolation from family, friends
Requiring permission to leave home and accounting for all time spent away from home
Denying access to medical care
Forbidding employment or school
Control of victim’s finances
Refusal to share money
Forced accounting for money spent
Forbidding victim employment or taking action to jeopardize the job
Financial abuse
The financial abuse is often what in elder abuse cases?
Taking control of the victim’s money and finances, clearing accounts or incurring large credit bills
May include obtaining power of attorney over victim affairs
ANA endorses universal screening, assessment, documentation in all health settings
Conducting IPV interview
Provide safe setting
Establish trust
Maintain therapeutic communication
Consider use of validated assessment tools
Properly document and report
Screening for Abuse
Nursing Interventions for Abuse
Education and counseling
Support in decision making
Strategies to protect from harm in the home environment
Strategies to facilitate escape to a safe place
Establishment of a victim referral system
Provision for long term follow up
Premenstrual Syndrome
Premenstrual Dysphoric Disorder
Dysmenorrhea- Painful periods
Amenorrhea- No periods
Abnormal uterine bleeding
Menorrhagia- Heavy menstrual bleeding
Metrorrhagia- break through bleeding, spotting
Postmenopausal bleeding- Bleeding that occurs 6 or more months after menopause
Menstrual Disorders
Meno
Menstrual related
Metro
Time
Oligo
Few
A
Without
Rhagia
Excess or abnormal
Dys
Not or pain
Rhea
Flow
Absence of menses by age 14 with the absence of secondary sexual characteristics or absence of menses by age 16 with normal development of secondary sex characteristics
Primary amenorrhea
Absence of menses for 3 cycles or 6 months in women who have previously menstruated
Secondary Amenorrhea
Nursing Care of the Patient with PMS
Assessment: Health hx, nutritional hx, recording of symptoms
Assess for potential for violence, suicide, and refer
Identify pt goals: Improved coping, reduction of anxiety, improved relationships
Interventions and pt teaching
Social support, counseling, and stress reduction
Diet and exercise
Medications
Name PMS Characteristics
Physical, emotional, behavioral changes
Occur during luteal phase
Cease at menses- usually 4 days after onset
Key: Timing of symptoms
Diagnostic Criteria for PMS
Symptoms occur in cyclic pattern
Look for symptoms not caused by underlying physical/ mental condition
Symptoms cause considerable disruption in the woman’s life
Diagnostic criteria for PMS must have one of the following in the luteal phase
Affective Symptoms- confusion, depression, anger, irritability, sleep disturbances
Somatic symptoms or physiologic- Bloating, headache, breast tenderness, weight gain, appetite changes
PMS may be related to what?
Social, cultural, biological, and psychological factors
Condition is estimated to affect up to 75% of women during their childbearing years
PMS
This occurs more often in women between their late 20s and early 40s who have at least one child with a personal or family history of major depression, ppd, or affective mood disorder
PMS
> 80% of women report PMS Symptoms
Become more worse in late 30s and 40s with menopause approaching
As many as 50-60% of women with severe PMS have PMDD ( premenstrual dysphoric disorder, a psych disorder
PMS
When does PMS begin usually?
14 days after the start of menstrual cycle
When does PMS end?
4-7 days after the cessation of the menstrual period
Symptoms of PMS
Include bloating, gas, breast tenderness, clumsiness, constipation or diarrhea, food craving, headache, light or noise sensitivity and irritability
Most severe form of PMS
PMDD
Premenstrual Dysphoric Disorder
Common Symptoms of PMDD
Abdominal bloating
Tension, anxiety, crying episodes
Depression, fatigue, difficulty concentrating
Appetite changes, swelling of extremities
Primary emotional symptoms of PMDD
Anxiety
Depression
Anger
Sadness
Despair
Suicidal ideation
Panic attacks
Extreme sensitivity
Chronic fatigue
Binge eating
Insomnia or hypersomnia
Extreme disruption of personal relationships
Physical Symptoms may include breast tenderness, heart palpitations, headaches, joint pain, bloating, and weight gain
PMDD
Causes of PMDD include
Multifactorial: genetic predisposition plus biological, psychosocial, sociocultural factors
Increased sensitivity to cyclic hormonal changes
Diagnostic Criteria of PMDD
At least 5 symptoms occurring 1-2 weeks premenstrual with relief by day 4 of menses
Major symptom categories at least 1
Anger, anxiety, depression, moodiness
Plus 5 additional symptoms
Difficulty concentrating, fatigue, insomnia, overeating
Treatment of PMS/ PMDD
Healthy lifestyle ( diet, exercise, rest)
Pharmacologic
- Continuous combined oral contraceptives, Depo- Provera
- Spironolactone
SSRIs (PMDD)
( Fluoxetine, sertraline, paroxetine, escitalopram oxalate)
Monophasic oral contraceptives containing drospirenone (progestin) (PMDD)
Treatment Options for PMS and PMDD
Lifestyle changes
Reduce Stress
Exercise 3-5x
Eat balanced diet and increase water intake
Decrease caffeine
Stop smoking and limit intake of alcohol
Attend a PMS or women’s support group
Vitamin and Mineral supplements
Multivitamin daily
Vitamin E 400 units
Calcium 1200- 1600
Magnesium 200- 400
Medications
- NSAIDs taken week prior to menses
- OCs low dose
- SSRIs
- Anxiolytics
- Diuretics to remove excess fluid
- Progestins
- GnRH agonists
- Danazol ( androgen hormone inhibits estrogen production)
Permanent physiologic cessation of menses associated with declining ovarian function
Menopause
Changes in menstruation
Clinical manifestations
Psychological considerations
Medical management : HRT; risks and benefits
Alternative therapy for hot flashes
Menopause
Average age for menopause
51.4 years
Age range is 40- 58 years
Last normal menstrual period
Results from decreased ovarian hormone secretion
Menopause
Time period preceding menopause, usually 2-8 years before final menses
Perimenopause
Onset age of perimenopause
Range 39-51 years
Average lasts 4 years
Characterized by hormonal fluctuations, sporadic ovulation, physical symptoms
Perimenopause
Changes in menstrual cycle
Changes in bleeding patterns
Result from a lack of ovulation
Bleeding may be heavy, prolonged, irregular
Important to rule out other causes
Leiomyomas
Cancer- Cervical
Fibroid aka called
Leiomyomas
Hormonal changes are related to declining ovarian function are which two
Decreased estrogen and progesterone
What physiological feedback loop is lost
Ovaries- hypothalamus- pituitary gland stops
Hormonal changes include increased conversion of
Androgens to estrogens
Physiological changes in menstrual include
Skin, mucous membranes become drier
Shrinkage of fatty layer beneath skin
Decreased elasticity decreased moisture in skin, more wrinkling
Increased body hair growth, scalp hair loss
Shrinkage of breast glandular tissue
Urogenital changes include
Related to estrogen deficiency
Worsen with advancing age
Vaginal symptoms include: itching, burning, bleeding, soreness, atrophic vaginitis
Urinary symptoms: dysuria, frequency, stress incontinence, UTIs more common
Loss of mechanical support of pelvic diaphragm
Bones: Bone density loss; increased risk of osteoporosis
Urogenital changes are related to?
Estrogen deficiency
Worsen with age
Urogenital changes include what vaginal symptoms
Itching, burning, soreness, atrophic vaginitis
Urogenital urinary symptoms include?
Dysuria
Frequency
Stress incontinence
UTIs more common
Loss of mechanical support of pelvic diaphragm
Bones in urogenital changes include what?
Bone density loss
Increased risk of osteoporosis
Vasomotor changes in menopause include
Hot flashes and night sweats
Most common menopausal symptom
Sweeping waves of heat
Hot Flashes
Profuse perspiration and heat radiating from the body at night
Night Sweats
Ways to promote comfort for menopause patients
CAM medicine
Exercise
Dietary strategies
Consumption of “cool” foods
Avoidance of triggers
Clothing strategies
View life as natural change and new phase for potential growth and new activities
Promote general health with diet and exercise
Note fatigue and stress may worsen hot flashes
Nutrition
Address sexual activity and prevention or management of common problems
Nursing teaching for pt approaching Menopause
What is the nutrition for Menopause patients?
Calcium and vitamin D supplementation may be helpful
Decrease fat and calories and increase calcium, whole grains, fiber, fruit, and veggies.
Name two abortions
Spontaneous Abortion
Habitual Abortion
Abortions should include
Medical management
Nursing support for patient
Grief process and dysfunctional grief
Pre abortion counseling
Pelvic examination and lab tests
Use Rhogam and Rh -
Elective Abortion
Different types
Patient teaching instruction with follow up care and information on contraception
Couple’s inability to achieve a pregnancy a pregnancy after 1 year of unprotected intercourse
Infertility
Primary infertility refers to couple who have never had a child
True
At least one conception has occurred but the couple can not achieve pregnancy
Secondary Infertility
Cervical causes of infertility in women include
Abnormal cervical mucous production
Cervical surgery or damage
Causes of infertility in Women
Damage to fallopian tubes
PID
Surgical Intervention
Endometriosis
Hormonal Causes
Failure to synchronize the hormonal factors that lead to preparation of the uterine lining or maturation and release of the ovum
Failure to produce adequate estrogen and progesterone to maintain the pregnancy
Name Uterine causes of Infertility in women
Polyps.
Myomas
Leiomymas- Fibroids
- Uterine Malformation
- Bicornuate uterus
Treatment of Infertility includes
Fertility drugs
Regulate or induce ovulation
How do fertility drugs work?
Like natural hormone
FSH and L trigger ovulation
Risks of infertility include
Multiple gestations
Ovarian Hyperstimulation Syndrome
This syndrome includes enlarged ovaries, pain, GI problems, and SOB
Ovarian Hyperstimulation Syndrome
Name the infertility drugs that stimulate ovulation and stimulate release of FSH and LH and growth of ovarian follicle
Clomiphene Citrate
- Clomid, Serophene
Name drugs that may be used with intrauterine insemination
Gonadotropins
These drugs are used to stimulate ovary directly rather than stimulating pituitary
HMG- Repronex, Meonpur
This drug is used when insulin resistance is known or suspected making ovulation more likely to occur
Glucophage
Lentrozole may induce what?
Ovulation and treat breast cancer
also called Femara
Name surgical interventions for infertility
Tissue removal
Removal of endometrial tissue or pelvic adhesions
Tubal reversal surgery
Tubal surgery to repair obstructive disorders
Remove adhesions, dilate tubes, create new opening in tubes
Salpingectomy
Removal of tube used with Invitro fertilization to improve chances of pregnancy
Salpingectomy
Involves retrieving mature eggs from woman’s ovaries, fertilization with man’s sperm in a dish in a lab, and transfer to the embryos 3 to 5 days after fertilization
Vitro Fertilization
What method increases the chance of multiples?
Vitro
Requires frequent blood tests and daily hormone injections
Name the two hormones responsible for stimulating ovulation
Estrogen and Progesterone
Which hormones are produced by the pituitary gland in a specific pattern during the menstrual cycle
FSH and LH
What can disrupt fertility and can affect ovulation?
Excess physical or motional stress
Very high or low body weight
Recent substantial weight gain or loss - 10%
Disrupt pattern and ovulation
Main sign is irregular or absent period
What is much less common, specific diseases of the pituitary, usually associated with other hormone deficiencies or with the excess production of ?
Hormonal factors
Production of prolactin
Complex changes occur in the hypothalamus, pituitary, and ovary which results in overproduction of males hormones (androgens) which affects ovulation
Polycystic Ovary Syndrome
Associated with insulin resistance and obesity
What defect occurs when the ovary does not produce enough of the hormone progesterone after ovulation.
Luteal Phase Defect
__________________ is vital in preparing the uterine lining for fertilized egg
Progesterone
Disorder is usually caused by autoimmune response, where your body attacks ovarian tissue
Results in loss of eggs in the ovary, as well as decrease in estrogen production
Premature Ovarian Failure
Name Male factors of infertility
Blockage in a man’s reproductive system
Certain medicines
Low sperm count
Sperm abnormally shaped or doesn’t move correctly
Undescended testicles - Due to Temp.
Infections
Underlying medical conditions
Other factors of infertility include
Tobacco smoking, excessive alcohol consumption ad abuse of other illegal drugs, emotional stress, obesity and age- Fertility gradually decreases in men who are older than 35
Sometimes the cause of infertility may not be identified- May be genetic problem
Treatment of Male Infertility
More than half can be corrected and may help couple get pregnant through normal intercourse
Even if can’t, you may not need expensive or invasive treatments to get pregnant
If man needs surgery it can often be done in outpatient
Name common causes of female infertility with Ovulation Disorders
Aging
Diminished Ovarian Reserve
Premature Ovarian Failure
Endocrine disorders
Tubal causes of infertility disorders include
PID
Tubal Surgery
Previous ectopic pregnancy
Salpingectomy
Uterine and Cervical causes of female infertility include
Congenital uterine anomaly
Fibroids
Endometriosis
Poor cervical mucous quantity and quality
Infection
Breast Disorders
Overview anatomy of the breast
Major health problem
215000 women
1450 men
40000 die anually
Surgical management of Breast Cancer
Breast Conservation Treatment or lumpectomy
Total Mastectomy
Modified radical mastectomy
Sentinel node biopsy and axillary lymph node dissection
Breast reconstruction surgery
External beam for breast cancer that is nonpharmacological
Radiation Therapy
Insert a sealed source of radiation right in tumor sight
Brachytherapy
Stop hormones from helping cancer cells grow
Suppress production of hormones that encourage cancer cell growth
Estrogen and Progesterone Assay
Infusion therapy is also known as
Chemotherapy
Inhibit or enhance estrogen action in cells
SERMs
Selective Estrogen Receptor Modulators
Non steroidal estrogen antagonist
Tamoxifen
Name aromatase inhibitors
Anastrazole
Letrozole
Exemestane
Which drugs block production of estrogen or block the action of estrogen on receptors
Aromatase Inhibitors
What therapy blocks the GROWTH of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth
Targeted Therapy
Nursing process assessment for patient undergoing Breast Cancer Surgery
How is this patient responding to diagnosis?
What coping mechanisms may be helpful?
What psychological or emotional supports does she have and use?
Is there support or assist in treatment making decisions?
What are her educational needs?
Is she experiencing any discomforts?
Hand and Arm Care
Potential for lymphedema formation after ALND
Patient Education
Prevention is vital, follow guidelines for rest of life
No blood pressure, injections, or blood draws in affected arm
Perform exercise 3x per day for circulation increase and muscle strength. Prevents stiffness and contractures, and restores ROM
Initial limitation of lifting over 5-10 pounds and activity
Risk Factors for Breast Cancer
Female Gender
age Greater than 50
Personal and family history
Genetic Mutations
Late or no pregnancy
Hormonal Factors
Starting Menopause after 55
Exposure to radiation
History of benign breast disease
Obesity
High fat diet
Alcohol Intake
Other risk factors for breast cancer
Inactivity
Obesity after menopause
Dense breast tissue
Hrt for greater than 5 years after menopause
Certain types of birth control pills
Personal history of benign breast disorders
Women who took des
Guidelines for Early Detection of Breast Cancer
20-30
- Breast exam every 3 years
- Then annual after 40
When do we start for mammography?
Age 40
Women at increased risk may have
Earlier initial screening
Shorter screening intervals
Additional screening procedures such as MRI and ultrasound
Beginning in 20s, teach women benefits and limitations of BSE
When is self breast exam best performed?
5-7 days after 1st day of menses
Once a month for postmenopausal
Review the feel of normal breast tissue or identify changes
Routine BSE will do what for patient?
Familiar with abnormalities of her own normal
Demonstrate the exam technique
Learners should perform BSE demonstration on themselves or a breast model
Teaching BSE
Part of BSE can be done ?
In shower with soapy hand to glide over the breast and focus on underlying tissue
In BSE in is important to include what area?
Between the breast and underarm and underarm itself
Reporting any changes
BSE Exam in 6 Steps
- Stand in mirror and examine the characteristics
- Raise arms and examine and turn
- Put hands on hips and examine
- Compress or squeeze nipple
- Start from collarbone begin to palpate by patting.
- Turn to lying position and examine in previous steps above
Involves X ray tube x ray x ray cassette and compression paddle
Mammography
Diseases that are sexually transmitted from partner to partner
STDs
Include
- Bacterial Vaginosis
- Chlamydia
- Gonorrhea
- Genital Herpes
- Hepatitis
- HIV/ AIDs
- HPV
- PID
- Syphilis
- Trichomoniasis
What has increased by 45% in California?
STD/ STI
Prevention is critical
Oral sex is not a protection from STDs and STIs
How can STD and STIs be passed
Breastfeeding, common use of needles, donor tissue or blood transfusion
