Well Women Healthcare Flashcards
How often are well women exams recommended?
- Minimum: periodic health maintenance
visits every three years for adult patients
≤49 years without chronic conditions, and
annually for adults ≥50 years - Best: annually
- 1st reproductive health visit- age 13-15
- preventive health care services, educational
information, and guidance, in addition to
problem-focused care
Early detection of conditions in well woman exams
- Diabetes
- UTI
- Urinary tract tumor
- Obesity
- Malnutrition/eating disorders
- Thyroid dysfunction
- Thyroid tumor
- Breast, abdominal, pelvic tumor
the number of times a woman has been pregnant
Gravidity
the of number of times a woman has given birth to a fetus with a
gestational age of 24+ weeks
Parity
TPAL
Term pregnancies (37 wks+)
Premature deliveries (20-36 weeks)
Abortions (loss before 20 weeks)
Living children
Menstrual history and pattern:
● Age of menarche
● Day of most recent menses
● Interval between menses
● Duration of menses
● Mid-cycle pain,
intermenstrual bleeding,
dysmenorrhea
Obstetric history:
● History of all previous pregnancies
● Live births and spontaneous or elective
abortions
Visual Examination of breasts
● With the patient seated, inspect breasts
for symmetry
● Ask patient to sit with arms lifted
overhead and then leaning forward with
her hands on her waist
● Examine the anterior chest wall
● Assess pigmentation changes, surface
irregularities
● Inspect for symmetry in the recumbent
position
Breast Exam palpation
● Best performed with patient in a recumbent position with her arm raised above her head
● A small pillow under her upper back may help distribute the breast tissue over the chest wall
● Palpate using the base of the fingertips in small circular motions with variable depth
● Various methods:
○ Vertical stripes
○ Wedges
○ Circles
● Each nipple should be gently squeezed to assess for nipple discharge
● Palpate all sides of the pyramidal-shaped axillae
● When the patient is sitting, perform a regional lymph node examination
USPSTS grading of mammography in women aged 40-74
B
Mammography recommendation given family history
often recommended to start screening 10 years younger
than the first-degree relative was at the time of her diagnosis
Recent study from ACS: screen 5-8 yrs younger than relative’s age at
diagnosis if <45
PAP Smear USPSTF Guidelines
USPTF/ACOG: Start at age 21
- 21-29 years: every 3 years with cervical cytology alone
- 30 to 65 years: every 3 years with cervical cytology alone, every 5
years with high-risk human papillomavirus (hrHPV) testing alone,
or every 5 years with hrHPV testing in combination with cytology
(cotesting).
- No screening for <21, hysterectomy including cervix for
noncancerous reasons, 65+ with negative prior testing
Assemble all necessary supplies prior to
starting the pelvic exam, including:
-Speculum
-Lubricant
-Light source
-Gloves
-Swabs
-Pap brush/bottle, if performing a Pap
smear
-STD testing, if necessary
Technique for Pap Smear (for broom sample in liquid prep)
● Insert the broom-like instrument into the endocervical canal until the lateral
bristles fully bend against the ectocervix.
● Maintaining gentle pressure, the broom is rotated in a clockwise
direction 360º for a total of 5 times.
● The broom is then rinsed in the specimen vial and discarded.
● Follow manufacturers’ directions specifically.
Bimanual Exam:
The index and middle fingers of the dominant hand are
normally used to examine the vagina and uterus.
○ The abdominal hand should be used to sweep the pelvic organs downward,
while the vaginal hand is simultaneously elevating them. Assess uterus and
adnexal areas
Rectovaginal Exam:
Using gloves and lubricant, place one finger inside the
patient’s vagina, the other in the rectum. Assess for abnormalities
Inconclusive Pap-smeal results: ASC-US
atypical squamous cells of undetermined significance Results may be referred to as inconclusive.
75% of women with an ASC-US result have no abnormal cells on their cervix.
PAP Smear Results- Abnormal:
Abnormal results indicate that cell changes caused by HPV are present.
Most women with abnormal cells do not have cancer, but more severe abnormal
cells may progress to cancer over time
Abnormal results can be referred to as dysplasia, cervical intraepithelial
neoplasia (CIN) or squamous intraepithelial lesions (SIL)
Low-grade squamous intraepithelial lesion (LSIL) or CIN1:
mildly
abnormal cells that usually go away on their own.
High-grade squamous intraepithelial lesion (HSIL), CIN2 or CIN3:
moderate to severe abnormal cells. CIN3 also may be referred to as
carcinoma in situ.
PAP Smear Results
CIN-1: involves the lower 1/3 or less of the epithelium; About 60% of CIN-1 will
regress to normal after 1 year
CIN 2: high risk for developing invasive cancer, although the average time for
progression is still several years. Ex: colposcopy with a biopsy every 6 months,
treated if it progresses to CIN 3 or does not go away in 1 to 2 years.
CIN 3: treat right awa
Screening Recommendations during well women exam
● Well-Woman Examination (WWE)
● Comprehensive skin exam
● Endometrial biopsy
● Sexually transmitted infections (STIs)
● Mammography
● DEXA scanning (Osteoporosis screening)
● Colonoscopy
● PAP smear
DEXA Scanning recommendations
Screening for osteoporosis to prevent osteoporotic fractures
USPSTF: recommends
screening for 65 years+
Postmenopausal women
<65 years at increased
risk of osteoporosis
