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
