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Womens Health > Womens Health Across the Lifespan II > Flashcards

Womens Health Across the Lifespan II Flashcards

1
Q

The Nurses Role:

A
  • Is secure about own sexuality.
  • Develops an awareness of feelings, values and attitudes about sexuality.
  • Has knowledge about the structure and function of female and male reproductive systems.
  • Has accurate and up-to-date information.
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2
Q

Taking a Sexual History

A
  • Explain purpose of interview
  • Use direct eye contact unless it is culturally unacceptable
  • Ask open-ended questions!!
  • Clarify terminology
  • Proceed from easier to more difficult topics
  • Listen and react in a nonjudgemental manner
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3
Q

Taking a Sexual History

A
  • Use teachable moments to educate
  • Do not assume the woman is heterosexual
  • Be respectful
  • be alert to body language
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4
Q

Counseling the Premenstrual Girl

A

Menarche- the start of menstruation

  • average age is 12.5 years old
  • Maturity level and self-concept influence a girls comfort level
  • Most critical factor in succesful adaption is correct information and prepardness
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5
Q

Educational Topics

A

Following basic information is helpful for young clients:

  • cycle length- first day of one menses to the first day of the next
  • Amount of flow
  • Heavy menstrual flow is the leading cause of anemia in women
  • Length of menses- Lasts from 2-8 days
  • Normal variations
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6
Q

Educational Topics

A

Pads and Tampons:

  • Change pads and tampons regularly
  • Do not use deodorants in pads and tampons
  • Do not flush
  • Wash hands!!!
  • Do not use vaginal sprays or douching
  • Keep the perineum clean
  • Wipe from front to back
  • When to contact a doctor!
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7
Q

Female Hormones: Estrogen

A

Control the development of female sex characteristics

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8
Q

Progesterone

A

Maintains pregnancy

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9
Q

Prostaglandins

A

Think pregnancy and what they do!

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10
Q

GnRH- Gonadotropin-releasing hormone

A

Causes anterior pitutiary to relsease FSH and LH

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11
Q

FSH-Follicle Stimulating Hormone

A

Maturation of Follicle

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12
Q

LH- Lutenizing hormone

A

Releases mature follicle

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13
Q

Female Reproductive cycle

A

Composed of the:

  • Ovarian Cycle- ovulation occurs
  • Menstrual Cycle- Menstruation occurs
  • TWO cycles take place at the same time
  • Takes place monthly
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14
Q

Female Reproductive Cycle:

A

Ovarian Cycle

  • Follicular phase- Day 1 to day 14
  • Luteal phase- Day 14 to 28 - Ovulation takes place during this time
  • Mature follicle appears about the 14th day under the influence of FSH and LH
  • Some women experience pain during ovulation called mittelschmertz
  • Some women experience increased discharge or spotting during ovulation
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15
Q

Female Reproductive Cycle: Menstrual Cycle:

A

Menstrual phase (days 1-6): estrogen levels are low and endometrium is shed

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16
Q

Menstrual Cycle:

A

Proliferative phase (days 7-14)- estrogen peaks just before ovulation and ovulation occurs

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17
Q

Menstrual Cycle

A

Secretory phase (days 15-26)- estrogen drops and progesterone dominates and uterus is ready for implantation

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18
Q

Menstrual Cycle

A

Ischemic phase (days 27-28)- both estrogen and progesterone fall and endometrium becomes pale

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19
Q

Hesi Hint

A
  • The menstrual cycle varies in length in most women
  • Between ovulation and the beginning of the next menstrual cycle there are usually exactly 14 days
  • In other words, ovulation occurs 14 days before the next menstrual period.
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20
Q

Amenorrhea: Primary

A

-Menstruation has not been established by 16 years of age

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21
Q

Amenorrhea: Secondary

A
  • When established menses ceases

- What is the biggest reason? Because they are pregnant - best guess in a women of child bearing age

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22
Q

Amenorrhea Causes:

A

–Hypothalmic dysfunction – most often triggered by systemic stress related to marked weight loss, excessive exercise, and severe or prolonged stress.
–Pituitary dysfunction – pituitary disease and pituitary tumors.
–Chronic anovulation or ovarian failure – ovarian failure related to exposure to radiation, chemo, viral, genetic or surgical removal of ovary.
–Anatomic abnormalities.

23
Q

Dysmenorrhea:

A
  • Painful menstruation that occurs at the onset and disappears by the end of menses
24
Q

Primary Dysmneorrhea:

A
  • Cramps without underlying disease

- Caused by increased prostaglandinins, which increase contractability and cause ischemia

25
Q

Secondary Dysmenorrhea:

A

-Associated with pathology of the reproductive tract and occurs after menstruation is established

26
Q

Primary Dysmenorrhea Treatment:

A

–Nonsteroidal anti-inflammatory which are also prostaglandin inhibitors – Advil, motrin.
–Oral contraceptives (inhibit ovulation).
–Regular exercise.
–Rest.
–Application of heat.
–Good nutrition.

27
Q

Secondary Dysmenorrhea: Causes

A

–Endometriosis.
–PID.
–Uterine fibroids or cysts.
–Benign or malignant tumors of the pelvis.

28
Q

Secondary Dysmenorrhea: Treatment

A

–Continuous oral contraceptive therapy.

–Hysterectomy.

29
Q

Self Care for Dysmenorrhea

A
  • Restriction of foods containing Methylaxthaines- chocolate, cola and coffee.
  • Restriction of alcohol, nicotine, red meat, salt and refined sugar.
  • Increase in complex carbohydrates and protein and fresh fruits and veggies.
  • Vitamins B and E.
  • Soothing heat and massage.
30
Q

Premenstrual Syndrome

A
  • Symptom complex associated with the luteal phase of menstrual cycle (2 weeks before).
  • 20 to 40% of all women experience.
  • A diagnosis of PMS is made when women report at least 1 affective (emotional) and 1 somatic (physical) symptom for 3 consecutive cycles.
31
Q

PMS Symtoms

A
  • Psychologic – irritability, lethargy, depression, sleep disorders, crying spells, decreased concentration.
  • Neurologic – migraine, vertigo, syncope.
32
Q

PMS Symptoms

A
  • Respiratory – runny nose, hoarseness.
  • GI – N/V, constipation, bloating, increased appetite and food cravings.
  • Urinary – retention and oliguria.
  • Derm – acne.
  • Mammary – swelling and tenderness.
  • Musculoskeletal – joint or muscle pain.
33
Q

Premenstrual Dysphoric Disorder (PMDD):

A
  • Affects 3 to 8% of women.
  • Must experience 5 or more symptoms.
  • Relieved by menstruation.
  • Occurs in most cycles over last year.
  • Interferes with work, school and relationships.
34
Q

PMS Cont:

A 
•Cause in unknown.
•Treatments:
–Selective serotonin reuptake inhibitors (SSRI’s).
–Lifestyle changes.
–Vitamins.
–Prostaglandin inhibitors.
–Diuretics.
•Diagnosis is generally made after looking at calendar record for 3 months.
35
Q

Menopause

A 
•Absence of menstruation for 1 full year.
•Climacteric – change of life.
•Usually occurs between 45 and 52 years. 
•Influenced by:
–Overall health.
–Weight and nutrition.
–Lifestyle and culture.
–Genetic factors.

•Perimenopause – period of time before menopause that lasts 2 to 8 years.

36
Q

Menopause

A

•Characterized by decreasing ovarian function, unstable endocrine physiology, and highly variable, unpredictable hormone profiles.

•Symptoms can be quite bothersome:
–PMS.
–Hot flashes.
–Irregular periods.
–Insomnia.
–Mood changes.
37
Q

Psychological Aspects of Menopause

A

•Contraception is major concern until women is actually in menopause.
•Adaptation is multifactorial:
–Dealing with “empty nest”.
–Can be dealing with caring for aging parents.
–Acceptance or lack of acceptance.
–Personal factors affecting ability to cope.
–Fatigue from insomnia and/or night sweats.
•Women will live 1/3 of her life after menopause.
•Some happy with freedom, some depressed.

38
Q

Menopausal Changes

A
  • Anovulation.
  • Irregular menstruation.
  • Amenorrhea.
  • FSH levels rise.
  • Estrogen decrease.
  • Endometrium thins.
  • Fallopian tubes and ovaries atrophy.
  • Thinning and dryness of vagina.
  • Skin looses elasticity.
  • Pubic hair thins.
  • Labia shrink.
  • Pelvic muscles atrophy.
  • Breasts become pendulous.
  • Hot flashes.
  • Increase risk for hypertension, CAD, stroke.
  • Changes in cognitive function.
  • Increase chance of osteoporosis.
39
Q

Osteoporosis

A
  • Decrease in bone strength due to decreased bone density and quality.
  • 20% of Caucasian and Asian women have and 52% have the beginning of bone loss or osteopenia.
  • Change is due to decreased estrogen levels.
  • Puts an individual at increased risk for fractures of the hip, forearm and vertebrae.
40
Q

Risk factors for Osteoporosis

A
  • Middle-aged and elderly women.
  • European American or Asian ethnic origin.
  • Small-boned and thin body type.
  • Low body weight (less than 127 lb).
  • Family history.
  • Lack of weight-bearing exercises.
  • Nulliparity.
  • Early onset of menopause.
  • Low intake of calcium.
  • Cigarette smoking.
  • Moderate to heavy drinking.
  • Use of anticonvulsants, corticosteroids, and lithium.
41
Q

Assessment of Osteoporosis:

A

•Bone mineral density testing (BMD). Is recommended for:
–All postmenopausal women aged 65 or older.
–All postmenopausal women with fractures.
–Postmenopausal women under 65 with risk factors.
•Women’s height at each visit because a loss of height is often an early sign that vertebrae are being compressed.
•Dual-energy x-ray absorptiometry (DEXA) scan.

42
Q

Treatment of Osteoporosis

A
  • Prevention is a primary goal.
  • Maintain an adequate calcium intake – 1200mg/day.
  • Vitamin D intake.
  • Regular exercise.
  • Modest alcohol and caffeine.
  • Stop smoking.
43
Q

Medications for Osteoporosis

A
  • Bisphosphonates – reduce bone loss. Most common Fosamax and Actonel. New one Zometa – IV once a year.
  • Selective estrogen receptor modulators (SERMs) – acts like estrogen, Evista.
  • Salmon calcitonin – calcium regulator that may inhibit bone loss and stabilizes bone mass;nasal spray.
  • Parathyroid hormone – daily SQ infection that activates bone formation.
  • Ultra-low-dose estrogen patches.
44
Q

Menopausal Hormonal Therapy:

A
  • Administration of specific hormones to alleviate symptoms associated with menopause.
  • Estrogen Replacement Therapy (EPT) – given to women who have undergone hysterectomy.
  • Hormonal Replacement Therapy (HRT) – Both estrogen and progestins; used for women with an intact uterus for the relief of symptoms.

•Estrogen alone in a woman with a uterus increases the
risk of endometrial cancer 8-fold.

45
Q

HRT CONT:

A
  • In 2002 the women’s Health Initiative (WHI) suggested the risks of HRT outweigh its benefits, especially in long-term use.
  • Increased risk of breast cancer, clots and strokes.
  • HRT is the most effective short-term therapy for women with severe symptoms but the woman needs to understand the risks!
46
Q

Womens Health Initiative

A

•Recommendations :
–Treatment of symptoms is the primary indication.
–Progestogen is to be given to women with uterus.
–No ET should be used to prevent CAD.
–HRT has been used for prevent osteoporosis, but because of the risks, alternatives should be considered.
–Limited to the shortest duration and dose.
–Therapy should be individualized.

47
Q

Absolute Contraindications:

A
  • Endometrial cancer.
  • Known or suspected breast cancer.
  • Undiagnosed vaginal bleeding.
  • Venous thrombosis.
  • Active liver disease.
  • Cardiac dysfunction or CAD.
  • Pregnancy.
48
Q

Use with Caution:

A
  • Uterine fibroids
  • Unstable hypertension.
  • Poorly controlled diabetes.
  • Conditions aggravated by fluid retention, such as migraines and epilepsy.
  • All women considering ERT or HRT must understand that studies on MHT are ongoing, and there is still much to be learned.
49
Q

Risks of HRT:

A
  • Breast cancer.
  • Endometrial cancer.
  • Increase in venous thrombosis & stroke.
  • Aggravation of fibrocystic breast disease, fibroids, migraines and endometroisis.
  • Increase risk of gall bladder disease.
  • Hypertension CAD.
50
Q

Side Effects of HRT

A
  • Breast tenderness.
  • Headaches.
  • Bloating.
  • Nausea and vomiting.
  • Impaired glucose tolerance.
51
Q

Signs and Symptoms to report STAT and to stop taking HRT

A
  • Severe headaches.
  • Visual changes.
  • Leg pain.
  • Chest pain.
  • Any signs of MI.
52
Q

HRT can be Presribed as following:

A 
–Orally.
–Transdermally (patch).
–Topically as a gel.
–Lotion.
–Vaginal creams.
–Vaginal rings.
53
Q

Alternatives to HRT:

A
  • Natural plant estrogens found in food and herbs.
  • Balanced diet: decrease foods high in saturated fats, caffeine and alcohol.
  • Vitamins: E & B are helpful with hot flashes.
  • Good hydration: at least 8 glasses a day.
  • Vaginal lubricants for genital atrophy.
  • Exercise regularly: weight bearing exercises at least 5 days per week.
  • 1200mg of calcium with 400-800 IU of vitamin D.

Womens Health (6 decks)

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