Women's Health Flashcards
Women’s Health
A holistic view of women and their health-related needs
within the context of their everyday lives.
Nursing Role Advocacy Collaboration Educator Manager of Care
Health Promotion Health history Physical Assessment Preventative counseling Screening
Health History Risk factors Gender Age Family hx Genetics Environment Assessment Psychosocial assessment
Physical Assessment
Preventive Counseling
Self-care
Screening
Prevention
Early Diagnosis
Heart Disease
1 in 4 women die of heart disease
64% of women who die of heart disease have had no previous symptoms
Coronary heart disease
Ischemic stroke
Hypertension
Heart failure
Breast Disorders
Benign
Teens-20s
Fibroadenoma
20s-50s Fibrocystic breast changes Near/During menopause Ductal ectasia Intraductal papilloma
Malignant
Ductal Carcinoma in situ – Noninvasive
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Breast Disorders: Malignant
Risk factors
Psychosocial Considerations
Major type of cancer among women of all races
Risk factors
Mutation of the BRCA1 and BRCA2 genes
Mutation of CHEK-2 gene in men and women
Changes in body image – mastectomy, hair loss, chemo
Effect on sexuality
Side effects of treatment
Menstruation
Secondary sex characteristics = 9/10 years
Menarche ~ 12 y/o
Amenorrhea
Primary – not established by age 16
Secondary – cessation of regular menses (pregnancy, hormonal/endocrine disorders, strenuous athletic activity)
Dysmenorrhea
Primary – cramps NOS
Secondary – pathology Polyps, Fibroids (Leimyomas), Cysts Endometriosis Polycystic Ovarian Syndrome Infections
Endometriosis
Excessive endometrial production +
Reflux of blood and tissue to fallopian tubes
Dysmenorrhea
Dyspareunia
Tx
Oral contraceptive – decrease tissue can cause bleeding and bleeding can cause pain
Synthetic androgen
Invasive tx
Laparotomy with laser excision
Polycystic Ovarian Syndrome
Hyperinsulinism – increased androgen production
Follicular ovarian cysts dont mature – anovulation
Lack of ovulation
Increase in testosterone
Higher risk for infertility
Mustache, hair on cheeks, increased weight gain
Treatment for PCOS
Treatment
Oral contraceptive
Metformin
Spironaldactone to decrease hair growth
(antiandrogen)
Clomid for infertility
Health Promotion – Aging Women
Menopause
Perimenopause
Hormone replacement therapy (HRT) - Increase risk for breast cancer
Complementary/alternative therapy
Osteoporosis
Urinary incontinence
Pelvic floor dysfunction
Kegel exercises
Pelvic floor dysfunction
Cystocele – prolapsed bladder
Rectocele – prolapsed rectum
Prolapsed uterus
Infection and Inflammation
Not an STI
Complications of STI
Not an STI
Bacterial Vaginosis – fishy-smelling white discharge infection stemming from decrease in normal flora
Candidiasis – cottage cheese-like white discharge yeast infection from a change in vaginal ph
Function of changes that may occur over a certain time in a women’s reproductive system
Complication of an STI
Pelvic Inflammatory Disease – chronic inflammation from exposure to multiple microorganisms
Ectopic Pregnancy Infertility
Sexually Transmitted Infections
Acquired immunodeficiency syndrome
Condylomata Acuminata
(HPV & vaccine)
Chlamydia
Gonorrhea
Herpes genitalis
Syphilis
TrichomoniasisInitial Assessment - Infertility
Sterility
Reproduction not possible
Infertility
Lack of conception after 12 mos (34 yrs and
Potential Effects of Infertility (4)
Emotional stress
Feelings of disappointment and failure
Sense of loss and grief
Intercourse changes to goal-oriented procedure
Challenges of Diagnostic Testing and Treatment (4)
Embarrassing
Ethics
Commitment
Expensive
Diagnostic testing (5) Male
Semen analysis Endocrine P postcoital test Ultrasonography Testicular biopsy
Diagnostic Testing (8) Female
Thyroid function test Glucose tolerance test Serum prolactin levels Specific hormonal assays Ultrasonography Endometrial biopsy Hysterosalpingography Laparoscopy
Treatment Options—Infertility (4)
Lifestyle Behavior Medications --- clomid Increase sperm count & motility Induce ovulation Facilitate cervical mucous formation Reduce antibody concentration Suppress endometriosis
Surgical treatment
Repair of variocele, ducts
Repair of tubes
Advanced reproductive technologies (ART)
In vitro Fertilization
Reproductive Alternatives
Oocyte Donation
Embryo Donation
Therapeutic Insemination
Surrogate Mother
Surrogate mother’s egg
Surrogate mother’s uterus
AdoptionEthical/Legal
Considerations
Factual information—advantages and limitations
Informed consent for donor sperm and donor eggs.
Donor confidentiality
Ongoing education and counseling
Promoting Sexual & Reproductive Health
Assess Establish trust Obtain sexual history Nursing diagnosis and Outcome identification Plan Implement care Evaluate
Teaching About Contraception
The role of the nurse
Types of contraception available Risks and benefits of each Proper use of each method What to do if an error is made Emergency contraception (EC) Backup methods Change of methods Questions and concerns
Hormonal
ACHES
Oral contraceptives – combined and; mini Monophasic, biphasic, triphasic Low-dose progestin-only Subdermal implant, injection Vaginal contraceptive ring Transdermal patch
Abdominal pain – severe
Chest pain – severe, with cough, SOB, or on deep inspiration
Headache – severe, dizziness, numbness, esp if one side
Eye – vision loss, blurring, speech problems
Severe leg pain – calf or thigh
Contraindications - BCP (5)
Smoking and age greater than 35 years
Moderate/severe hypertension (BP 160/100)
Undiagnosed uterine bleeding
Diabetes of more than 20 years’ duration or with vascular complications
History of embolism or thrombosis
Contraindications – subdermal, injection (5)
Breast cancer, current or previously Undiagnosed uterine bleeding Liver disease History of embolism or thrombosis Breastfeeding (Category 2) – ok after 6th wk
Side Effects - BCP (7)
Diminished menstrual flow Breast tenderness Irritability Nausea Headaches Cyclic weight gain Increased vaginal yeast infections
Adverse Effects - BCP
3
Hypertension
Myocardial infarction
Thrombophlebitis
Side Effects – subdermal, injection (9)
Irregular menstruation or amenorrhea
Acne
Headaches
Depression
Weight gain
Increased vaginal yeast infections
Scarring or injection at insertion site (subdermal)
Risk of decreased bone density (injection) – limit Rx to 2 yrs
Injection required q 3 months – reminders necessary
Intrauterine Device (IUD) (4)
PAINS
No continued expense
No daily attention
No interference with intercourse
May decrease risk of endometrial CA
Period late Abdominal pain, pain with intercourse Infection exposure or vaginal discharge Not feeling well, fever, or chills String – missing, shorter, or longer
Contraindications/Side Effects for IUD
Current STI
Genital tract cancer
Uterine anomalies, fibroids
Side Effects
Irregular bleeding
Amenorrhea
Pelvic infections
Barrier Methods
Diaphragm, cervical cap
Risk for Toxic Shock Syndrome; Rare; Staphylococcus aureus
Condoms (male and female)
Latex allergies
Contraceptive sponge
Spermicides
Sterilization
Female
Tubal ligation, c/s or hysteroscopic
Essure
Male
Vasectomy
“Natural Family Planning”
Fertility Awareness
Methods: Periodic Abstinence Menstrual bleeding Cervical mucus Basal body temperature Calendar Rhythm
Symptothermal
Cervical mucus
Basal body temperature
Secondary sx -> increased libido, mittelschmerz, midcycle spotting, pelvic tenderness, vulvar fullness.
Emergency Postcoital Contraception
“Morning After” pill
Plan B
Copper-releasing intrauterine device IUD
Clinical Termination of Pregnancy
Therapeutic Abortion = elective procedure
Medical
Medication inducing uterine contractions (RU-486)
Up to 63 days of gestation
Surgical Menstrual extraction, endometrial aspiration 5 to 7 weeks gestation Vacuum aspiration Up to 12 weeks gestation Dilatation extraction (D/E) 2nd trimester – up to 16 weeks
Spontaneous Abortion = “miscarriage” at any gestation
Nursing Care for abortion
Assessment Emotional support Observe for complications Common: excessive bleeding, cramping Rare: hemorrhage, incomplete abortion, infection,
Postabortal Syndrome (a form of PTSD) Asherman syndrome: uterine adhesions Schedule follow-up visits Ultrasonography hCG levels
AIDS
asymptomatic
Not cured
antiretroviral
Chlamydia
Asymptomatic or yellow discharge, painful urination
Cured
Azithromycin, coxycycline
Condylomata
HPV warts
Not cured
TCA, cryotherapy
Gonorrhea
Purulent discharge, painful urination
Cured
Azithromycin, coxycycline
Herpes
Painful vesicles
No
Acyclovir
Syphillis
Painless chancre
Yes
Penicillin
Trichomoniasis
Discharge/pain
Yes
Metronidazole
