Women's Health Flashcards
(347 cards)
1
Q
World Health Organization defines health promotion as
A
the process of enabling people to increase control over, and improve, their health
2
Q
Nursing Care focuses on women’s health promotion
A
Provide women with information and resources
Increase their control over decisions
Enable them to improve their health
3
Q
Social Issues in women’s health
A
Socioeconomic status (men usually make more money, maternity leave, appointments)
Workplace discrimination issues
Social Issues
- Adolescent pregnancy
- Lifespan (longer with less social security than males)
- Elderly abuse
- Discrimination - disability or gender
4
Q
Adolescent Health
A
Physical maturity but not mentally mature
Cognitive maturity
- concrete
- abstract thinking, problem-solving, planning for future
Psychosocial
- sexual identity, developing morals, values & self-worth
5
Q
Major Health Issues in the Adolescent Health
A
Unintentional injuries - violence, suicide & homicide
Unhealthy dietary issues - anorexia, bulimia, & obesity
High-risk behaviors = Tobacco, alcohol, drugs, unhealthy sexual behaviors - STIs, & pregnancy
Self-esteem issues - bullying - electronic
- Menstrual disorders, acne
6
Q
What has made bullying easier in adolescents over the years?
A
cyberbullying
- increases suicide rates
7
Q
School Nurse’s Role in Adolescent Health Promotion
A
Viewed as a safe adult
Education (correct peers’ influence and tell them TV is wrong)
- Sexual information
- Health information
- Risk reduction
Advocate for health resource
Encourage wellness check-ups
8
Q
Lesbian Health
A
Discrimination - provider’s lack of understanding regarding health care needs
Societal stigma
ACOG Opinion - equitable treatment for LGBTQIA women & their families
9
Q
Health issues for lesbians
A
Obesity - Heart disease
Tobacco, alcohol & drug use
Cancer - breast, cervical, endometrial, & ovarian
PCOS - menstrual disorders, infertility, & abnormal insulin production
Intimate partner violence (IPV)
Depression & Anxiety
10
Q
Why do lesbian women have a higher chance of breast, cervical, endometrial, & ovarian cancers?
A
estrogen changes every month due to no pregnancy and exposed to more estrogen over her lifetime
11
Q
What disease is the #1 killer of women?
A
cardiac disease
- USUALLY DON’T SEEK HELP DO TO ATYPICAL S/S
12
Q
What are the atypical s/s of cardiac disease?
A
Pain, pressure in the chest, discomfort in the arm, neck, or jaw
Pain in the upper back and/or stomach
Unusual fatigue
Nausea or vomiting
Loss of appetite
Lightheadedness, dizziness, palpitations
13
Q
What does the nurse do when assisting with cardiac diseases?
A
identify risk factors
14
Q
Leading causes of death in women
A
Heart disease - 24.5%
Cancer - 21.7% (breast/lung/colon)
Stroke - 6.5%
Chronic lower respiratory disease - 5.9%
Alzheimer’s disease - 4.6%
Unintentional injuries - FALLS
Diabetes - 2.8%
Influenza & pneumonia - 2.5 %
Kidney disease - 2 %
15
Q
Stroke Warning Signs
A
Sudden onset of
- Numbness/weakness of the face, arm, and/or leg
- Trouble seeing out of one or both eyes
- Trouble walking, dizziness, loss of balance or coordination
Severe headache with no known cause
16
Q
If the stroke warning signs start, what should the patient do?
A
call 911
17
Q
In strokes, what is the golden hour?
A
1 hour from the onset of symptoms
18
Q
What needs to be given within the 1st hour on stroke symptoms?
A
tPA (tissue plasminogen activator)
19
Q
Health History and Physical on women include
A
Health History
Personal History
Menstrual, sexual & obstetrical history
Family history
Psychosocial history – diet, drugs, alcohol, abuse, mental health (ask the hard questions)
Head to toe exam – look for diabetic sores, bruising, etc.
20
Q
What is the goals of H&P for women
A
identify risk factors & guide preventative care
Early diagnosis allows early treatment
Assessment Prevention is better than a cure
Counsel woman with complex social problems
21
Q
Preventative Counseling
A
Healthy weight - reduce health problems
Balanced diet - calcium & vitamin D
Physical activity - 30 min/day, weight-bearing 3-4/week
Avoid smoking & second-hand smoke
Immunizations
Limit alcohol -1 drink / day
Accident & injury (clean and tidy, no hazards)
Safe sex
22
Q
What foods have Vitamin D?
A
dairy
green leafy
sunlight
23
Q
What are annual screenings needed for women?
A
Dental
STI’s
Fecal occult blood
Urinalysis
Thyroid - signs of dysfunction
Genetic testing (recurrent abortion)
Transvaginal ultrasound (OB)
Tuberculosis
24
Q
What is the age and frequency recommended for a bone density test?
A
65 y/o - q 2 yrs.
25
What is the age and frequency recommended for a cholesterol test?
20 or if risk factors
26
What is the age and frequency recommended for a colonoscopy?
50 y/o q 10 years
27
What is the age and frequency recommended for a vision test?
40 q 2-4 years
65 q 1-2 years
28
What is the age and frequency recommended for fasting glucose?
- 45 - q 3 yrs.
29
What is the age and frequency recommended for a hearing?
q 10 yrs. / 50 - q 3 yrs.
30
What is the age and frequency recommended for a mammogram?
40 y/o q 1-2 years unless HCP recommends otherwise
31
What is the age and frequency recommended for a rubella test?
childbearing age before pregnancy
32
Monthly self-breast exam
report changes of a
Lump
Change in skin color or texture
Nipple changes - inverted
Leaking clear or bloody fluid
33
When should you start doing monthly self-breast exams?
start after puberty
5-7 days after menses
- periods can cause lumps due to elevated hormone levels and disappear afterward
34
Most important for younger women to know their own
breasts
35
Clinical Breast Exam frequency for 19-39 y/o
q 3 years
36
Clinical breast exam frequency for women > 40 y/o
annually
37
Mammogram
low dose x-ray during mechanical compression of the breast
38
What are the indications of mammograms?
Screening - every 1-2 years after age 40
Diagnostic - abnormal finding - require biopsy
39
Mammogram education pre-op
- avoid underarm deodorants, lotions, and powders
40
Mammogram education post-op
- anticipated **time of results** (stay consistent with when the results will be given) , mammogram follow-up, and self-breast exams
41
Monthly vulvar self-exam is for
All women 18 y/o or younger if sexually active
42
Vulvar Self-exam consists of
Inspect & palpate - signs of precancerous conditions or infections(STIs)
Mons, clitoris, labia minor, labia majora, perineum, and anus
- report abnormalities for follow ups
43
You should do a monthly breast and vulvar exam when
5-7 days after periods
44
What are the recommended cervical screenings for 21-29 y/o?
every 3 years
45
What are the recommended cervical screenings for 30-65 y/o?
every 5 hours
46
What are the recommended cervical screenings for>65 y/o?
stop PAP if they do not have a previous pre-cancerous pap in 20 years
47
The pelvic exam consists of?
External organs
Speculum exam (get a sample of the cervix)
Bimanual exam (tumors)
Cervical cytology or pap smear
Rectal examination(polyps)
48
The pelvic and pap smear should be scheduled for
5 days after menstrual period
49
Nothing should be inserted vaginally prior to the pelvic exam for how long?
48 hours
50
Pre-op for pelvic exam
**Scheduled 5 day after menstrual period **
**Nothing inserted vaginally 48 hrs.** prior to the exam
Have patient **empty their bladder**
Education regarding procedure
51
What can you do for the patient during the pelvic exam?
**Provide a hand to hold or mirror so the patient can observe**
Place in lithotomy position & drape appropriately
Consider semi-fowlers, side-lying (cerebral palsy), with or without stirrups
52
What position should they be in for a pelvic exam?
Consider semi-fowlers, side-lying (cerebral palsy), with or without stirrups
“What is the most comfortable position for you?”
53
What is a special consideration for pelvic exams?
female genital mutilation (female circumcision – before puberty) – problems, surgeries, education about taking care of it
54
Colposcopy
- microscopic exam of vaginal & cervical tissue
55
Colposcopy indication
abnormal pap, treat condyloma
(large warts)
56
Cervical Bx is
extensive surgical biopsy
57
Cervical Bx indications
abnormal pap - atypical or abnormal cells
58
Cervical Bx procedure
Performed early phase of menstrual cycle (week after period)
Excised tissue is sent for pathological exam
59
Endometrial Bx
endometrial (uterus lining) tissue aspirated from the uterus
60
Endometrial Bx indications
abnormal or postmenopausal bleeding
61
Hysterosalpingography is the
cervix, uterus, and fallopian tubes are visualized by x-ray after injecting contrast dye
62
Hysterosalpingography indications
evaluation for fibroids, tumors, fistulas, or infertility
63
Before a procedure to examine or Bx the women's pelvic area, what needs to be done first?
Obtain menstrual history - **LMP, and allergies**
Administer analgesia prior to the procedure – **ibuprofen** and tylenol
Education regarding procedure, discomfort, and relaxation
**Empty bladder, place in lithotomy position and drape appropriately**
64
During a procedure to examine or Bx the women's pelvic area, what needs to be done first?
offer patient support and assist provider
65
After a procedure to examine or Bx the woman's pelvic area, what needs to be done first?
**Provide perineal tissue/pad**
Education patient regarding sign and symptoms to report
Injecting allergies, results are ready, infections
66
What procedure can not be done on a woman with iodine, shellfish allergy?
Hysterosalpingography
67
Dilation and Curettage does what
dilate cervix & scrape endometrial tissue
68
D&C can be used to diagnose
malignancy, fertility, dysfunctional uterine bleeding
69
D/C is used for therapeutic reasons
heavy uterine bleeding - PP, incomplete abortion
70
Endometrial ablation
removal of endometrial tissue (Cauterize the tissue)
71
Laparoscopy is
laparoscope inserted for visualization & surgery
72
Laparoscopy dx indications
fertility, ectopic, adhesions, cysts, endometriosis, or PID
73
Laparoscopy therapeutic indications
tubal ligation, IUD or adhesion removal, egg retrieval
74
Hysterectomy is
surgical removal of the uterus
"hysterical"
75
Total hysterectomy
Take the cervix, uterus, and the fundus
Leave fallopian and ovaries with the vaginal
76
Subtotal/Supracervical hysterectomy
Take out everything above the cervix
Cervix has a thought of sexual satisfaction in the past
77
Hysterectomy with salpingo-oophorectomy
Take out from the ovaries to the cervix
78
Radical Hysterectomy
Take everything out with part of the vagina and lymph nodes
- usually CA
79
Indications of a hysterectomy
Cancer - cervical, endometrial, or ovarian
Noncancerous - fibroids tumors, endometriosis – no babies, genital prolapse – uterus falls out with issues, pelvic inflammatory disease – STI inflamed
80
What are the different surgical techniques for a hysterectomy?
Abdominal - transverse (Pfannenstiel) / vertical (low-midline)
Vaginal-lithotomy position
Laparoscopic-assisted vaginal hysterectomy (LAVH) – robot (3 holes)
Better healing and recovery
Not if for a large fibroid
81
Risks r/t Hysterectomy surgical procedure
Anesthesia complications
Uterine, bladder, or bowel injuries
Hemorrhage
Infection
DVT – legs in stirrups for a long time
82
Pre-Op Hysterectomy Care
Admission assessment
**No anticoagulants, ASA, NSAID’s for 1 week before**
H&P, Informed consent, Labs - CBC, Type & Cross, UA, **Pregnancy**
- Remove jewelry, glasses, contacts
NPO - 8 hrs. prior to surgery
**EKG - perform, verify if older**
Start IV
**Void, insert a catheter**
Pre-op education, answer questions
**Emotional support (usually cancer or severe endometriosis, loss of femininity)**
83
Post-Op Hysterectomy nursing Care
Assess
**V/S, blood loss, LOC, I & O**
Lung & bowel sounds
IV therapy
Pain management -meds, positioning
- **Antibiotics
- Hormone replacement**
Assist with ambulation
DC - IV, catheter 24-48 hours
Progress diet
Education
Emotional support – results pathology
84
Fibrocystic breast changes are the
**thickening** of breast tissue with the **formation of cysts**
85
What is a benign breast disorder?
fibrocystic breast
86
fibrocystic breast occurs when
before menopause
- around menstruation as a result of elevated hormones
87
S/S of fibrocystic breast
Pain & tenderness are often **bilateral**
Occurs **around the menstrual cycle**
When was your LMP or what is your cycle?
- wait and see for your next cycle
88
fibrocystic breast dx
Mammograms
Ultrasound
Fine needle aspiration / or core needle biopsy
Excision of the mass
Open or surgical biopsy – cancerous possible
89
fibrocystic breast tx
**no specific treatment proven beneficial**
Supportive bra
NO caffeine - irritation
**Danazol** - androgenic medication which suppresses estrogen
90
fibrocystic breast nursing considerations
Acknowledge a breast mass evokes **feelings of fear and anxiety**
**Education regarding how and when results will be communicated**
91
Amenorrhea
absent of menses
92
Primary amenorrhea
delayed
**No secondary sex characteristics by age 14 – breast buds, no pubic hair)
**No menses with secondary sex characteristics by age 16**
93
Secondary amenorrhea
cessation of menstruation
No menses 3-6 months **following normal cycles**
Underlying cause (pregnancy)
94
What is the #1 reason for amenorrhea?
pregnancy
- 1st thing you do is a pregnancy test
95
Amenorrhea Patho
**Endocrine / pituitary function** - lack of hormone production
Heredity / congenital
PCOS
Nutritional/uncontrolled diabetes (ANOREXIC AND NO BODY FAT)
Heavy athletic activity – no body fat
Emotional distress
90% no identifiable cause
96
Amenorrhea mgmt
identify and treat the underlying condition
97
Amenorrhea Nursing considerations
Emotional **support** (high schoolers – low self-esteem)
Menstruation is a unique function of women
Absence can create **concerns about femininity & having children**
Adolescent is the time when being **different than your peers is painful**
Education concerning diet, nutrition, and exercise
- correcting
98
Menorrhagia -
prolonged or heavy menstrual bleeding “much bleeding”
99
Metrorrhagia -
irregular bleeding which often occurs between period or after menopause “metro train on and off”
100
Menometrorrhagia -
prolonged or excessive bleeding that occurs irregular and more frequent “combination”
101
Abnormal Uterine Bleeding patho
Pregnancy complication - spontaneous abortions
Lesions - benign or malignant of the vagina, cervix, or uterus
Drug induced bleeding - hormonal contraceptives
Systemic disorders - diabetes, hypothyroidism, uterine fibroids
Failure to ovulate - PCOS
102
Abnormal Uterine Bleeding mgmt
Pregnancy test – missed abortion
Hormone levels - determine if ovulation is occurring
Lab - CBC, coagulation studies, liver function
Endometrial biopsy
Ultrasound or hysteroscopy - assess the uterine lining
Oral contraceptive - progestin-estrogen combination
Surgical - Dilation & curettage (D&C), Endometrial ablation, Hysterectomy
103
Abnormal Uterine Bleeding nursing considerations
Encourage women to seek immediate medical attention
Encourage women to **record bleeding episodes & amount of loss**
Importance of nutrition and stress reduction
Education about diagnostic procedures
Emotions support for women who fear cancer
104
PMS (Premenstrual Syndrome) is the
physical and emotional changes related to menstrual cycle
105
What are the different chnage in PMS?
Musculoskeletal – back pain, cramps
Neurological – clumsy, vertigo, irritable
GI/GU - weight gain, cravings
Mental or emotional - drama
106
PMS patho
unknown
Hormonal changes - estrogen-progesterone imbalance
Chemical changes in the brain
107
PMS impact on the family
**Strain on relationships** - family conflict, disrupted communication
**Loss of control** - child battering, self-inflicted injuries, accidents
108
PMS nursing considerations
Encourage exam and correct diagnosis
Education about lifestyle changes - **diet, exercise, relaxation, sleep, herbal remedies**
Education about medications - **Ibuprofen, antidepressants, diuretics, oral contraceptives**
Education and support to the family
Education concerning **planning for feelings of loss of control**
109
PMS diet
Low salt
Decrease caffeine
Low animal fat
Not high sugars
no alcohol
110
Menopause is the
**permanent cessation of menstrual cycles**
111
Menopause onset
Onset - 35-58 y/o - average age 51 y/o
112
Perimenopause
signs & symptoms - 1 yr. before lasts menses
113
Menopause occur
one year after last menses
114
Post-menopause
after menopause
115
Menopause patho
Ovaries stop producing eggs
Decline in estrogen and progesterone production
116
What is the most common s/s of perimenopause?
Hot flashes, mood swings, spaced menses, vaginal dryness
117
What are the general body systems affected by menopause?
Vasomotor
Genitourinary
Psychological
Skeletal
Cardiovascular
Dermatologic
Reproductive
118
S/S of Menopause
vasomotor
**Irregular periods / hot flashes / night sweats**
119
S/S of Menopause
GU
Incontinence/vaginal changes -**high pH / dryness / painful sex**
120
S/S of Menopause
PSYCH
Mood swings / sleep changes / **low REM sleep / fatigue**
121
S/S of Menopause
SKELETAL
**low Bone density** - calcium and vitamin D = osteoporosis
122
S/S of Menopause
CARDIOVASCULAR
Irregular heartbeat / palpitations low HDL / high LDL
123
S/S of Menopause
SKIN
low Skin elasticity/hair loss – thin and bruise easy
124
S/S of Menopause
REPRODUCTIVE
**Breast changes (saggy)** / low interest in sex (lower libido)
125
Psychological responses to menopause
Excited - no longer worry about childbearing
Grieve - loss of fertility
Come to terms with aging
126
Tx for Menopause (Mgmt) without a hysterectomy
Hormone replacement therapy (HRT) - estrogen-progesterone
Not had a Hysterectomy both decrease the risk of CA
127
Tx for Menopause (Mgmt) with a hysterectomy
Estrogen replacement therapy (ERT) - estrogen
Risks & benefits must be considered
Weight the risk as it could improve s/s but could potentiate CA
IF THEY HAVE HAD A HYSTERECTOMY
128
Menopause education for lifestyle changes
diet & exercise - calcium
129
Menopause education for hot flashes
avoid alcohol, caffeine, hot drinks, spicy food, smoking; layer clothing
130
Menopause education for night sweats
cool shower before bed, cotton nightwear, cool room
131
Menopause education for sleep disturbances
regular bedtime, 8 hrs. sleep, dark, quiet, cool room
132
Menopause education for vaginal dryness and sex discomfort
vaginal lubricants, or estrogen cream
133
Menopause education for alternatives
black collage
134
Cyclic Pelvic pain is aka
Mittelschmerz
Dysmenorrhea
Endometriosis
135
Mittelschmerz
pelvic pain which **occurs midway between menstrual periods at the time of ovulation**
136
Mittelschmerz s/s
**Sharp pain** felt in the lower right or left pelvic area
Last for a few hours up to 2 days
**Slight vaginal bleeding** after the discomfort
137
Primary dysmenorrhea s/s
- painful, cramping **12-24 hours before menses, that last about 12-24 hours**
138
Primary dysmenorrhea patho
**excessive** endometrial production of **prostaglandin**
139
Secondary dysmenorrhea s/s
painful menses with **known anatomic factors / pelvic pathology** - change in the pelvis
140
Secondary dysmenorrhea patho
endometriosis, adhesions, cervical stenosis, fibroids
141
Dysmenorrhea mgmt
Identify and treat underlying conditions
**Prostaglandin inhibitors – Ibuprofen q 6hr**
Pain management - analgesia, heat, warm bath
Oral contraceptives
Diet - low fat
Exercise, relaxation, biofeedback, acupuncture, herbal
142
Endometriosis
the presence of endometrial **tissue outside the uterus in the pelvic cavity**
143
Endometriosis patho
is unknown
- Retrograde
- Genetic, immune change, hormone influence
144
Retrograde menstruation
uterus falls back inside the cavity with the cervix lined up – ends up falling into the pelvic cavity
145
How does the tissue respond to endometriosis?
progesterone & estrogen of the menstrual cycle
Thickens & bleeds during the cycle
Inflammation in surrounding tissues
Scarring, adhesion & fibroids on the reproductive & pelvic structures
146
S/S of endometriosis
Cyclic pelvic, low back pain, dysmenorrhea
Infertility - main reason women seek treatment
Dyspareunia – painful intercourse
Diarrhea, constipation, pain with defecation
Fixed (scarred down) or retroverted uterus
Enlarged & tender ovaries
147
What medical mgmt can be done for endometriosis?
Pain management - NSAID’s (ibuprofen), analgesia
Hormone therapy - birth control, assisted reproduction -
Endometrial biopsy - dx
Surgical treatment – get excess tissue out before IVF
148
Nursing education for endometriosis
Education - endometriosis & pain management
Emotional support – especially if infertile
- loss of feminine identity
149
PCOS is
Polycystic Ovary Syndrome
150
PCOS Patho and hormone levels
endocrine disorder, a genetic component
↑estrogen, testosterone, luteinizing hormone, and ↓FSH
**Multiple cysts inside ovaries produce excessive estrogen**
151
Risks for PCOS
Diabetes, metabolic syndrome
Dyslipidemia, hypertension
Cardiac
**Cancer
Infertility**
Sleep apnea
Bullying
152
PCOS S/S
Menstrual disorders - IRREGULAR CYCLES
Infertility
Pelvic pain - rupture and large growing
Ovarian cysts - surgery
Obesity
Oily skin
Acne
Hirsutism – facial hair
Male pattern baldness – receding hair line
Bullied
153
PCOS medical tx
Lifestyle modification - diet/exercise
Hormone therapy - low-dose oral contraceptives
Fertility therapy when they want to be pregnant
**Diabetic medications – Metformin**
154
What nursing actions would you do for a PCOS pt?
Education - risk factors for PCOS & weight reduction
Dermatologist Treatment - hirsutism, acne, oily skin
Emotional support - infertility & psychological effects
155
Ovarian Cysts are
Solid or fluid-filled cysts that develop on the ovaries
- Follicularand Luteal
156
Follicular ovarian cysts
mature follicle fails to rupture
- fluid-filled
157
Follicular cysts s/s
asymptomatic
158
Luteal ovarian cysts
corpus luteum becomes **cystic and fails to reabsorb**
159
Luteal ovarian cysts s/s
Acute pain, delays next menstrual cycle, may rupture (think API)
160
Tx for ovarian cysts
depends on the type of cyst
Wait and examine after the next menstrual cycle
Oral contraceptives
Surgical removal
161
Vaginal wall prolapse
loss of support to the pelvic organs
- uterus
- bladder
- rectum
162
Risk for vaginal wall prolapse
Multiparity
Pelvic tearing or trauma during childbirth
Obesity
Vaginal muscle weakness associated with aging/menopause
163
Prevention of vaginal wall prolapse
Postpartum - Kegal exercises
Spaced pregnancies
Weight Control
164
Cystocele
relaxation of the **anterior vaginal** wall with prolapse of the bladder
165
Cystocele s/s
Urinary retention
Bladder infection
Incontinence
Stress incontinence - leaking urine with increased intraabdominal pressure
166
Cystocele risks
UTIs with s/s
167
Rectocele
relaxation of the **posterior vaginal** wall with prolapse of the rectum
168
Rectocele s/s
Constipation
Hemorrhoids – laxatives, fiber
Uncontrolled flatus
Sense of pressure or need to defecate
- dry and uncomfortable during sex
169
Uterine Prolapse
**downward displacement** of the uterus into the vagina
170
Uterine Prolapse S/S
Fatigue
Low backache
Dysmenorrhea
Pressure, protrusions
Dyspareunia - painful intercourse
Pulling and dragging sensations in pelvis and back
Symptoms may be worse after prolonged standing or deep penile penetration
171
Non-surgical interventions for Pelvic Floor Dysfunction
Kegal exercises
Vaginal pessary – donut to hold the uterus
Take it out and clean
Hormone therapy - intravaginal estrogen
tighten
172
Surgery for pelvic floor dysfunction
Hysterectomy
Anterior & posterior (A&P) repair
173
Nursing Considerations for Pelvic Floor Dysfunction
**Pessary insertion**, removal, cleaning
Prevention of constipation
- **stool softeners, fiber, increased fluids**
Pre & post op care
174
Genital Fistulas is
**abnormal connection** between the vagina and the bladder, urethra, or rectum
- peeing and pooping outside of the vagina
175
risks of Genital Fistulas
trauma - childbirth, sexual violence
176
Genital Fistulas assessments
urine or fecal leakage from the vagina, foul vaginal odor
177
Genital Fistulas medications
pelvic exam to determine location & severity
Small fistulas – resolve itself
Larger fistulas - require surgical repair
178
Genital fistulas Nursing considerations
Education - care of minor fistula (clean genital area)
Pre-op and post-op care
179
Urinary Incontinence
loss of bladder control
180
Stress incontinence due to
↑ intra-abdominal pressure
Sudden urge to void followed by uncontrolled voiding
181
Risk factors of urinary incontinence
Childbirth
Aging - decrease estrogen, weakening muscles
Diabetes, obesity, smoking, chronic cough
182
urinary incontinence assessment
Sudden intense urge to void
Leakage of urine with a cough, sneeze, laugh, lifting
183
urinary incontinence tx
Kegel pelvic exercises, bladder training (urgency and frequency plugging up)
**Medications - estrogen cream (tighten) / anticholinergic drugs**
Medical devices – urethra training
Surgery
184
urinary incontinence nursing considerations
risk reduction education
Avoid heavy lifting
Pelvic exercise, bladder training
Diet
Skin integrity
185
Leiomyomas, Fibroids, Myomas, Fibromyomas, and Fibromas are
benign tumors arising from the muscle tissue of the uterus
186
Leiomyomas, Fibroids, Myomas, Fibromyomas, and Fibromas are more commonly seen in
nulligravida
AA
187
Leiomyomas, Fibroids, Myomas, Fibromyomas, and Fibromas most common sign is
ABNORMAL UTERINE BLEEDING
188
Leiomyomas, Fibroids, Myomas, Fibromyomas, and Fibromas disappear after
menopause
189
Leiomyomas, Fibroids, Myomas, Fibromyomas, and Fibromas Tx
Cryosurgery
Myomectomy or Hysterectomy (possibly when done with babies
GnRH hormone regimens to shrink the tumor
Uterine artery embolization of the blood vessel supplying the fibroid tumor
190
If a patient had Leiomyomas, Fibroids, Myomas, Fibromyomas, and Fibromas treatments, what do you need to know about before they develop their birth plan?
KNOW where the scar is before allowing for a vaginal birth
191
Leiomyomas
benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called fibroid
192
Fibroids
muscular tumors that grow in the wall of the uterus (womb)
193
Myomas
smooth, non-cancerous tumors that may develop in or around the uterus. Made partly of muscle tissue, myomas seldom develop in the cervix, but when they do, there are usually myomas in the larger, upper part of the uterus as well.
194
Fibromyomas
mixed tumor containing both fibrous and muscle tissue
195
Fibromas
noncancerous (benign) tumor or growth consisting of fibrous, connective tissue
196
Fibroids nursing interventions
GnRH - if discontinued **expect regrowth of tumors**, amenorrhea may occur
Pre-op education - no alcohol, aspirin or anticoagulants 24 hrs. prior to surgery
**Except cramping during the procedure as polyvinyl alcohol pellets are injected**
197
Fibroids pts that have D/C GnRH
**expect regrowth of tumors**, amenorrhea may occur
198
Pre-Op for Fibroids and Hysterectomy due to pellets injected
no alcohol, aspirin, or anticoagulants 24 hrs. before surgery
199
Post-op and discharge care for Cryosurgery, Myomectomy, Hysterectomy, Uterine artery embolization
Medication as directed
**Report - bleeding, pain, swelling at the puncture site, fever, urinary retention, abnormal vaginal discharge
No tampons intercourse or douching for 4 weeks when HCP ok**
200
Cervical Cancer S/S early
vaginal discharge, abnormal vaginal bleeding – spotting
201
Cervical Cancer RISK FACTORS
History of an STI - human papillomavirus (HPV)
Early onset sexual activity
Multiple sex partners
Inadequate cervical screening
202
Cervical Cancer S/S late
weight loss, fatigue, pelvic pain, vaginal leakage of feces/urine
Possibly malignant fistulas
Adolescents, Sexual abuse victims, Drug addicts, **LGBTQ**, No access to medical care
203
Cervical CA is diagnosed by
pap smear
- detects dysplasia - precursor to cervical CA
204
What are the 3 stages of cervical CA?
Early dysplasia
Early Carcinoma
Late carcinoma
205
possible Tx for cervical CA dysplasia
Cryosurgery, Loop Electrocautery excision procedure (LEEP), Laser, Conization, Hysterectomy
206
possible Tx for cervical CA early carcinoma
Hysterectomy, Intracavity radiation
207
possible Tx for cervical CA late carcinoma
External beam radiation with radical hysterectomy, Antineoplastic chemotherapy, Pelvic exenteration
208
Endometrial CA S/S
Postmenopausal or abnormal premenopausal bleeding
Abnormal vaginal discharge
Difficult or painful urination
Pelvic pain or pain with intercourse
209
Endometrial CA RISK FACTORS
Hormone replacement therapy (HRT)
Menopause after age 52 – more exposure to estrogen
Nulliparity – more exposure to estorgen
Diabetes, obesity, PCOS
210
Endometrial CA DX
Endometrial Bx
211
Endometrial CA mgmt
Radical hysterectomy
Chemotherapy
Radiation
Hormone therapy
212
Ovarian CA S/S Early
**Asymptomatic or vague** symptoms make if difficult to diagnose early
- whispering disease
213
Ovarian CA S/S late
**Pelvic or abdominal discomfort
Low back and leg pain**
Weight changes - lose
**Increases abdominal girth**
Nausea and vomiting
Constipation
Urinary symptoms - urgency & frequency
**Difficulty eating or feeling full quickly**
214
Ovarian CA risk factors
Menses started **earlier than 12 y/o**
Nulliparity or 1st child after age 30**
Late menopause
Infertility, infertility drugs
**Family history - ovarian, breast or colorectal cancer
Personal history of breast cancer**
215
Ovarian CA dx
Laparotomy is primary tool for diagnosis and staging the disease
216
Ovarian CA mgmt
Total abdominal hysterectomy (salpingo-oophorectomy)
Biopsy lymph nodes, pelvic and abdominal tissues
Chemotherapy
217
Malignant Reproductive Disease education for the patient
**emotional support - patient/family
- chaplain and grief**
Health promotion - **nutrition, rest & sleep after surgery**
Treatment options, procedures, side effects management
Management of chemo & radiation side effects
**Community support groups – referrals**
218
Malignant Reproductive Disease for the care of women undergoing tx
surgery pre and post-op
chemo and radiation
219
Reproductive Tract Infectious Disorders have an increased risk of
chronic pain, cancer, systemic infection, and infertility
220
Reproductive Tract Infectious Disorders types
Urinary tract infections (UTI’s)
Pelvic inflammatory disease (PID)
Vaginitis - candida & bacterial
Sexually transmitted infections (STI’s)
221
UTI S/S
Fever
earliest = **Dysuria**, frequency, urgency
Cloudy, foul-smelling urine
Backache, suprapubic tenderness
222
UTI Patho
Urethra length & location
Escherichia coli's most common cause
Untreated UTI increased risk for pyelonephritis
223
UTI risk factors
Young girl, pregnant or a menopausal woman
Sexual activity
Allergic reaction to soaps, bubble bath, vaginal products
224
UTI dx
urinalysis, culture & sensitivity
225
UTI mgmt
antibiotic therapy
226
UTI nursing education
Education - completing antibiotics
UTI prevention, signs and symptoms to report
- Do not hold pee
- Front to back
- No bubble baths
- Urinate before and after sex
227
UTIs in older women are more susceptible due to
Suppressed immune system
Weaker bladder - risk for incomplete emptying of the bladder
Decrease estrogen alters vaginal flora
E. coli grows in the urinary tract
228
UTI's older women S/S
**Agitation
Confusion**, delirium, or hallucinations
Poor motor skills or dizziness, **falling**
Fever - immediate treatment is indicated
- sick fast and deteriorate, do not empty well
229
If the older woman has a UTI, what indicates UTI and needs immediate tx?
fever
230
UTIs stresses out the older body causing what behavior changes
abrupts
231
PID
acute inflammation of **upper female genital** tract
232
PID Patho
Bacteria - Chlamydia trachomatis, Neisseria gonorrhoeae
Caused by a variety of aerobic and anaerobic organisms
Ascend - vagina, cervix, uterus, fallopian tubes, ovaries, peritoneum
233
PID consequences
Ectopic pregnancy - scarring
Chronic pelvic pain
Infertility – If long
234
PID S/S
Asymptomatic or Vague symptoms
**Severe abdominal, uterine, ovarian pain or tenderness**
Dyspareunia - painful intercourse
**Purulent vaginal discharge, foul odor**
Nausea, anorexia
**Irregular vaginal bleeding**
Fever 100.4°F
235
PID mgmt
Test & treat for STI’s - oral antibiotic
- Patient & sexual partner(s) - STI
Analgesia
Hospitalization / IV antibiotic
236
PID nursing considerations
Medication education - antibiotic compliance
Signs, symptoms & consequences of PID
Risk reduction
237
Toxic Shock Syndrome caused by
toxin-producing strain of Staphylococcus aureus
238
Toxic Shock Syndrome risks by
**Tampon**, diaphragm or cervical cap or sponges use
Leaving in for a long period of time
239
Toxic Shock Syndrome S/S
Flu like - headache, sore throat, vomiting, diarrhea
**Hypotension** (extremely low)
Generalized rash
Skin **peeling form palms and soles of feet**
- similar to a septic pt -
240
Toxic Shock Syndrome Tx
Stabilize hypotension - fluid replacement, vasopressors
Antimicrobial therapy
241
Toxic Shock Syndrome nursing considerations
Safe tampon, diaphragm, and cervical cap usage
**Changing tampon every 4 hours**
Avoid superabsorbent tampons - allow bacteria to proliferate
**Use pad at night**
Avoid the use of the diaphragm & cervical cap during menses
Removed diaphragm & cervical cap within 24 hrs.
Ephedrine and epinephrine
242
Vaginitis
Vaginal inflammation - discharge, burning, itching & irritation
243
Vaginitis patho
Pathophysiology - **Vaginal flora is disrupted** by an overgrowth of yeast or bacteria
Candida - yeast
Vaginitis bacterial
Trichomoniasis - protozoa
244
Vaginitis factors affecting vaginal flora
Hormonal changes
Depressed cell-mediated immunity
Antibiotic use – yeast infection after
245
Candidiasis Vaginitis
A vaginal ecosystem is disturbed by a gram-positive fungus
- candida albicans (yeast)
246
Candidiasis Vaginitis patho
Hormonal changes - ↑ estrogen during pregnancy
Increase candida vaginitis – before & after menses
Antibiotic
247
Candidiasis Vaginitis risk factors
**Antibiotic therapy**
Suppressed immune system
Diabetes
Pregnancy
Menopause
248
Candidiasis Vaginitis S/S
**Itching & irritation of the vulvar**
White, cheesy vaginal discharge “cottage cheese”
Burning on urination
249
Candidiasis Vaginitis Dx
wet mount & whiff test (negative)
250
Candidiasis Vaginitis medications
OTC, prescriptions
251
Candidiasis Vaginitis nursing considerations
Medications
Cotton underwear to decrease risk
Call provider - recurrent symptoms
Bloody discharge, abdominal pain, fever
252
What is diagnosed by the whiff test?
Candidiasis Vaginitis (negative)
Bacterial Vaginosis (positive) - FISHY AND BLUE
Trichomonas (positive)
253
Bacterial Vaginosis patho
disruption of the normal vaginal flora
**Overgrowth of Gardnerella vaginalis
Decrease in lactobacilli acidophilus**
254
Bacterial Vaginosis risk factors
Multiple sexual partners
New sexual partner
Lesbians - sharing sex toys without cleaning
Douching
Antibiotic therapy
255
Bacterial Vaginosis S/S
50 % asymptomatic
**Thin white, gray, milky** discharge
Malodorous (fishy) vaginal discharge
256
Bacterial Vaginosis RISKS IF PREGNANT
Chorioamnionitis
PROM
Premature labor & delivery
257
Bacterial Vaginosis MGMT
Speculum exam to assess vagina and cervix
Diagnosis - wet mount & whiff test - FISHY (positive)
Medication - metronidazole, clindamycin
258
Bacterial Vaginosis dx
wet mount & whiff test - FISHY (positive)
259
Bacterial Vaginosis meds
metronidazole, clindamycin
260
Bacterial Vaginosis nursing mgmt
Medication - **metronidazole - with meals, avoid alcohol 24-48 hours before and after**
Risk factors
Avoid tight-fitting clothes
Cotton underwear
261
metronidazole - with and avoid
meals, avoid alcohol 24-48 hours before and after
262
STIs can be transmitted by
vaginally, anally or orally
263
What are the most reported STIs in the US and most prevalent in adolescents?
Chlamydia & Gonorrhea
264
Women with STIs often have
asymptomatic
265
What risks do women have if they have untreated STIs?
Cervical cancer
Chronic pelvic pain & pelvic inflammatory disease
Blocked fallopian tubes - infertility, ectopic pregnancy
Premature birth
266
Chlamydia caused by
Chlamydia Trachomatis (Bacterial)
267
Chlamydia S/S for females
“Silent” disease - asymptomatic 70-75 %
Fever
Lower abdominal pain
Uterine or adnexal tenderness
Dysuria
Dyspareunia - painful intercourse
Mucopurulent vaginal/cervical discharge
268
Chlamydia S/S for males
leading cause of nongonococcal Urethritis
269
Chlamydia dx
genital culture or enzyme-linked immunosorbent assay (ELISA)
270
Chlamydia tx
Azithromycin 1 gm orally
Doxycycline / Erythromycin
Retest in 3 weeks
Partner: treat to decrease reinfection
271
Chlamydia risks for mother
PID, infertility, ectopic pregnancies, premature birth
272
Chlamydia risks for newborn
ophthalmia neonatorum - Erythromycin eye prophylaxis
273
Gonorrhea caused by
Neisseria gonorrhoeae (bacterial)
274
Gonorrhea female s/s
Asymptomatic - majority
Spotting
Low backache
Dyspareunia - painful intercourse
Anal itching
275
Gonorrhea male s/s
Dysuria, urinary frequency
Purulent yellow-green ureteral discharge
276
Gonorrhea dx
genital or cervical culture
277
Gonorrhea tx
Ceftriaxone 250 mgs IM
Azithromycin 1 gm orally
Retest in 3 months
Partner: treat to decrease reinfection
278
Gonorrhea mother risks
PID, infertility, ectopic pregnancies
279
Gonorrhea newborn risks
ophthalmia neonatorum, sepsis
- erythromycin eye prophylaxis
280
Trichomonas caused by
Trichomonas vaginalis (Protozoan)
281
Trichomonas s/s females
**Profuse frothy green-yellow or brownish-gray discharge**
Foul-smelling vaginal odor
Dyspareunia - painful intercourse
Erythema, edema, pruritus of external genital
Small red ulceration of the vagina or cervix **“Strawberry Spots”**
282
Trichomonas male s/s
asymptomatic
283
Trichomonas dx
wet mount & whiff test (positive)
284
Trichomonas tx
Metronidazole 2 gm orally single dose
No Alcohol for 24 hours
Flushing, nausea, vomiting, headache, abdominal cramping
Partner: treat to prevent reinfections
285
Trichomonas risks for mother
PID, Infertility, Premature rupture of membranes, labor & delivery
286
Trichomonas risks for newborn
low birth weight
287
Genital Herpes caused by
Herpes simplex virus Type I or 2
288
Genital Herpes primary infection s/s
Systemic symptoms - “Flu-like” - malaise, muscle aches, headache
Painful genital lesion - itching, burning
Most severe outbreak & last 2 - 4 weeks
289
Genital Herpes recurrent s/s
Outbreak lasting 5 -10 days
290
Genital Herpes dx
history & exam
291
Genital Herpes tx
**No Cure**
Antiviral - Acyclovir, Valacyclovir, Famciclovir
Comfort measures - Viscous lidocaine to lesions
Partner: condom to prevent spread
292
Genital Herpes risk for mother
C-section to prevent neonatal herpes
293
Genital Herpes for newborns
Primary exposure - 50-60% neonatal mortality
Sepsis or Neurological complication
294
HPV caused by
Human papillomavirus (HPV)
295
HPV s/s
Painless genital warts - Vagina, vulva, perineum, anus
Abnormal cervical changes
296
HPV dx
history, exam, and pap smear
297
HPV tx
Podophyllin - topical application by patient
Provider - Trichloroacetic acid application, or surgical removal using laser or cryotherapy
298
HPV partner tx
Abstain from sex until lesions are healed
Condom to prevent spread
299
HPV prevention
Gardasil immunization
300
HPV risks for parents
Cervical or penile cancer
301
HPV risk for newborns
Respiratory papillomatosis
302
HIV / AIDS caused by
Human immunodeficiency virus
303
HIV / AIDS s/s common
Asymptomatic
304
HIV / AIDS early s/s
fever, fatigue, sore throat, rhinitis, rash, lymphadenopathy
305
HIV / AIDS late s/s
fever, night sweats, weight loss, dry cough leukopenia, thrombocytopenia
306
HIV / AIDS late s/s for women
candidiasis, BV, PID, menstrual changes
307
HIV / AIDS risk
placental transmission
308
HIV / AIDS dx
antibody, antigen/antibody & nucleic acid test
309
HIV / AIDS tx
no cure
HAART (Highly Active Antiretroviral Therapy)
Maintain health of HIV-positive women
Reduce perinatal transmission
310
HIV / AIDS partner
test, condom
311
HIV / AIDS pregnancy
placental transmission, deliver prior to ROM
312
HIV / AIDS newborn
avoid breastfeeding, antiretroviral prophylaxis
313
Syphilis caused by
Treponema pallidum (Bacterial)
314
Syphilis primary s/s
(up to 90 days post exposure)
Single painless chancre, fever, weight loss, malaise
315
Syphilis secondary s/s
(6 weeks to 6 months post exposure)
Fever, fatigue, sore throat, muscle aches, weight loss
Rash to hands & feet
316
Syphilis tertiary s/s
(10-30 years post exposure)
Cardiac, and neurological destruction
CNS & multi-organ damage
317
Syphilis dx
RPR or VDRL
318
Syphilis tx
Penicillin G regimen
319
Syphilis risks for mother
PID
PID infertility, ectopic pregnancies
320
Syphilis risk for newborn
Congenital syphilis
Premature birth
Neurological complications
Stillbirths
321
IPV often escalates and leads to
homicide
70% more likely to be killed when the partner moves to strangulation
322
In 1990, the Joint Comission mandated
**mandated identification risks & treatment protocols**
323
IPV
Pattern of coercive behaviors used to gain control over another individual in an adult intimate relationship - current or former partner or a casual dating partner
- Escalates in frequency and severity during pregnancy and PP
324
IPV in pregnancy correlates with WHAT maternal, fetal, and infant health issues?
Uterine rupture
Placenta abruption
Preterm births, low birth weight infants
Maternal & neonatal deaths
325
IPV is an indication of what life
holds for the unborn child
326
Factors for IPV
Hx, family roles passed down
**"men = power, women = less worthy"**
women are **victimized by marriage, cultural, religious beliefs, and legal remedies**
Cycle of Violence theory
- the children become the parent and protector or imitate their parents in the future
327
Characteristics of the abuser
Witness abuse of mother as a child
Controlling, possessive, jealous, poor impulse control
Denies responsibility for violence & blames the women
328
Cycle of Violence Theory - Walker (1984)
Tension-building phase
Acute battering incident
Tranquil phase (honeymoon period phase)
329
Psych/Emotional IPV S/S
Humiliation, intimidation, threats
Isolation, control
Uses others - children
Blame, minimize
Male privilege, economic abuse
330
Physical IPV S/S
Pushing, shoving, slapping
Kicking, punching, beating
Shaking, burning
Choking
Use/threat of weapon - gun, knife
331
Sexual IPV S/S
Forced to engage in sexual activity against her will
Forced use of objects
Forced to have sex with someone else
Forced to trade sex for food, money, or drugs (Sex Trafficking)
332
Sexual Assault
Sexual contact, touch or penetration** without consent**
“Forced” sexual intercourse - vaginal, anal, or oral
Different types of rape - power, sadistic, stranger, acquaintance, gang
Drug facilitated
333
Characteristics of Sexual Assaulters
All ethnic, racial, religious, socioeconomic, & educational
**Attitudes toward women, male entitlement
Impulsive, antisocial, emotionally unsupportive family**
334
SA Recovery Trauma-informed care
**Secondary victimization - “2nd rape”** - by law enforcement, physician and staff
"you were asking for it"
Rape trauma syndrome - PTSD - varying degrees of intensity, difficult to treat
335
SA Trauma Informed Care
Specially trained officers, physicians, sexual assault nurse or forensic examiner (SANE/SAFE)
Forensic medical exam – primary purpose - restore dignity & then collect evidence
**Obtain a history, perform a head-to-toe and genital exam looking for trauma
Offer STI, HIV & pregnancy prophylaxis medications**
Make referrals for advocacy, counseling, shelters, legal assistance
Document findings for legal court testimony
336
Human Trafficking:
the recruitment, harboring, transportation, provision, or obtaining a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage or slavery.
337
Sex Trafficking:
the commercial sex act induced by force, fraud, or coercion or in which the person induced to perform such act has not attained 18 years of age.
338
If you are under 18, the nurse does
not have to show proof
339
Facts about Sex Trafficking
no mvmt required
often family
vulnerable males and females (12-14 avg age)
*don't see themselves as the victims**
340
Sex Trafficking risks of victims
Age
Poverty
Sexual or physician abuse
Drug abuse - individual, family
Learning disabilities
Sexual identity issues - LBGQT
Runaway, throwaway
Loss of parent, caregiver, or support systems
341
Healthcare providers are vital in___________ victims of violence
rescuing
342
Challenges to assessments for victims of violence
Victim is physically/psychologically controlled, often loyal to perpetrator
Experienced many traumas, drugged, intoxicated or in pain
343
REASONS they might come in if victims of violence
– nonspecific and vague
Serious untreated injuries - delayed care
Injury not consistent with story, various stages of healing
Injuries to head, neck, face, abdomen & breast if pregnant - **always look under the clothes**
Overly protective partner or anxiety when the partner is present
344
If you are 18+ years old, the victim has to say they are
so as nurses we need to
be trustworthy and a safe place
345
Universal screening of all pts for IPV INCLUDES
Alone - universal screening questions
Believe - reassure it is not their fault
Confidentiality - know the reporting requirements for your state
Document - facilitates communication between providers
Education - advocacy, counseling, legal assistance, shelters
Safety - assess support system - help create a **SAFETY PLAN**
346
What is a safety plan?
- important documents
- Change of clothes
- cash
347
Vicarious Trauma
seeing something and internalizing
Gradual internal transformation
Negatively affect commitment to one’s work
Reduce sense of accomplishment
Leads to questioning of personal belief system
Emotions go down
You can not take the trauma home
Say you need a break or move away from that area
