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286 Cards in this Set

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What 2 hormones does the (GnRH) Gonadotropin Releasing Hormone stimulate to release?
(LH) Luteinizing Hormone& (FSH) Follicle Stimulating
GnRH is released from where and travels to the _________?
Hypothalamus; anterior pituitary gland
Which hormone is responsible for initiating spermatogenesis in males?
Luteinizing Hormone (LH)
Which hormone is responsible for the production of testosterone in males?
(FHS) Follicle Stimulating Hormone
In the female, which hormone is responsible for stimulating the ovaries to secrete estrogen?
(FHS) Follicle Stimulating Hormone
In the female, which hormone is responsible for stimulating progesterone production?
Luteinizing Hormone (LH)
What happens if there are elevated Estrogen levels is regards to the feedback mechanism?
Then the blood will inhibit the secretion of FSH but promote LH secretion
What hormones do the ovaries produce?
Estrogen, Progesterone, and small amts of Androgens
With estrogen,______ controls the ovarian-menstrual cycle. It stimulates the thickening of the uterine wall, maintains pregnancy, and prepares the breasts for milk production by inhibiting Prolactin.
Progesterone
What is estrogen responsible for?
it's a lipid soluble steroid hormone responsible for maturation of female reproductive organs, regulation of the ovarian/mentrual cycle, develepment of female secondary sex characteristics.
What else do the ovaries and estrogen promote?
Maintain bone density by decreasing bone reabsorption and decrease cholesterol and promote HDL.
Who mainly produces Androgens? its function?
The testes: 1)formation of spermatozoa 2)secretion of testosterone which is a chief androgen
What are Androgens responsible for?

*note*
For the development of the male sex organs and secondary sex characteristics.

-some produced by ovaries and adrenal cortex
What happens to the Androgens in post menopausal women?
The androgens are converted to estrogen in the peripheral adipose tissues, becoming their major source of estrogen.
Which hormone is responsible for developing and maintaing male sex organs & secondary sex characteristics? Also, promotes metabolism, growth of muscles, bones, and libido.
Testosterone
What is the 1st episode of menstrual bleeding referred to?
Menarche: It occurs between ages 10-16. It lasts 3-7 days with average flow of 30-100ml
Name the cycle period that occurs from days 1-5
Menstrual (ischemic) phase
Name the cycle period that occurs from days 6-14
Proliferative (follicular) phase
Name the cycle period that occurs from days 14-28
Luteal phase
When does ovulation occur?
approximately 14 days before the beginning of the next cycle
In which cycle should one have tests or procedures done?
In the proliferative stage: the week before ovulation
In which cycle does the endometrial thicken & there is PMS (2 weeks prior to next period??
In the luteal phase
What can the nurse do when taking a sexual history?
1st talk to your pt before asking them to undress. Be aware of your feelings including bias (self-awareness), assure privacy and confidentiality (trust). Start with neutral non-obtrusive questions. Be direct and use objective language, no street lingo.
What are the chief complaints of female pts?
bleeding problems, pain, vaginal discharge, or a mass
What are the chief complaints of male pts?
voiding difficulties, sexual dysfunction, penile discharge, or mass
What are the 2 techniques used in physical assessment of the female pt?
Inspection & palpation
What occurs when a female goes for a gynecologic visit? Place them in order.
V/S & possibly weight. Then the pt is asked to empty the bladder prior to exam. To decrease embarrassment and promote relaxation, she is advised on what to expect. The exam starts with a breast exam, then abdomen palpation. Then later placed in a Lithotomy position for external and internal exam of genitalia.
What should be the normal finding during an inspection breast exam?
On inspection, the breasts should be generally symmetrical in size and shape with nipples soft and intact. No dimpling, no recent inversion of nipples, and no nipple discharge.
What should be the normal finding during palpation of a breast exam?
On palpation, the examiner starts with the uneffected breast. Using distal finger pads, the examiner systematically palpates the breast for a lump or mass. Also, palpates for enlarged nodes in the axilla and the below/above the shoulder blade.
What does the examination of the external genitalia involve?
Assessing for inflammation, lesions, varicosites, and discharge among others.
What does the internal exam involve?
Using a speculum (1st insert then take C/S) then followed by a bimanul exam (left, center, right)
What is the cervix inspected for?
Mobile, non-tender, smooth, firm, no lesions, color, shape, mass, discharge, or bleeding
What should the ovaries feel like?
Firm, somewhat tender, non-palpable in post menopausal women since they atrophy
Are the fallopian tubes palpable?
NO
What should the uterus feel like?
Mobile, non-tender, smooth, firm, appropriate size (increase could be pregnancy, tumor, hyperplasia)
What should the vagina feel like?
On withdrawal of the speculum, the vagina should have no lesion, inflammation, or dryness
What are the new guidelines with the American Caner Society in regards to cervical cancer detection?
Start once sexually active or by 18 yrs old. Then every 3 years until middle age after having 2 negative exams done 1 year apart from eachother.
What are some normal age-related changes in the female?
-Cessation of ovary function, decreased vaginal lubrication, thinning of pubic hair, atrophy or urinary/gential tracts, decreased bone density
-Relaxation of pelvic support; Risk of incontinence, ligaments weaken
What instructions are given to woman prior to them coming for a PapTest?
Do not douche, take tub baths, use vaginal prep, have sex for atleast 24-36hrs prior to test, and do not come if on period
Do you do a PapTest even if a woman has had a hysterectomy?
No, only if the surgery was done for cervical precancer or cancer
Which procedure visualizes the cervix, vagina, and vulva?
Colposcopy
What occurs during a colposcopy?
Diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Provides an enlarged view of the areas, allowing the colposcopist to visually distinguish normal from abnormal appearing tissue and take directed biopsies for further pathological examination
What is the main goal of a colposcopy?
The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and treating them.
When is a biopsy considered?
Areas of the cervix which turn white after the application of acetic acid or have an abnormal vascular pattern are often considered for biopsy. If no lesions are visible, an iodine solution may be applied to the cervix to help highlight areas of abnormality.
What is laparoscopy used for?
To visualize pelvic structures; used for diagnostic or repair!
How is laparoscopy done?
The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome.
Are there any c/o with laparscopy?
Yes, pts have shoulder pain (referred pain) from the intro of Co2 pushes on the phrenic nerve
What is a hysterscopy?
Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention
What are the preparations for these procedures? during what cycle should a woman have them?
Empty bladder & move bowels, general anesthesia can be done with D&C. 2 weeks before ovulation...proliferative
Any complications?
Intro of infection, uterine perforation, abdominal pain
During what phase does PMS appear and when does it disappear?
Appear during the Luteal phase and disappears during menstruation.
What is the cornerstone of management of PMS?
Education on lifestyle modifications: Regular exercise, take Vitamin B6, eat small meals and avoid refined carbs, caffeine, and alcohol in order to reduce mood swings, while limiting salt intake to reduce fluid retention.
Which test involves a mucus sample of the cervix within 2-8 hrs after having intercourse?
Huhner test: determines whether cervical mucus is "hostile" to passage of sperm from vagina into uterus (test for infertility)
What test is an operative procedure that dilates the cervix and allows for curreting the endometrial lining?

What is it used for?
D&C: used in assessment of abnormal bleeding patterns and cytologic evaluation of lining.
What are cultures and smears most frequently used for?
STDs
Gram stain is used for what diagnosis?
Chlamydia
What is a NAAT used for?
Screening of gonorrhea and chlamydia
Which ligament separates the uterus from the bladder and the rectum?
Broad ligmament
Which system is often responsibe for metastasis of a maligant tumor in the breast?
Axillary, infraclavicular, and supraclavicular located in the axilla area
FSH responsible for....
ovulation
Progesterone maintains...
the rich vascular state of the uterus (luteal/secretory phase) in prep for fertilization and implantation
LH in men is responsible for...
production of testosteron by the interstitial cells of the testes & maturation of sperm
Estrogen responsible for...
maintenance of the secondary sex characteristics, the proliferative phase of the menstrual cycle immediately after menstruation, and uterine changes needed for pregnancy
When estrogen levels are low, the hypothalamus is stimulated to increase its production of _____ which then that stimulates the pituitary to to secrete _____ & ______......resulting in higher levels of estrogen

Is this positive or negative feedback control?
GnRH ; FSH & LH= higher levels of estrogen from ovaries

Negative
With increasing levels of circulating estrogen, a greater level of _____ is produced, resulting in an increased level of _____ from the pituitary.

Likewise, lowered levels of estrogen result in lowered level of LH.

Is this positive or negative feedback control?
High estrogen= more GnRH -> more LH

Postitve feedback
What types of drugs can cause missed periods?
phenothiazines (neuroleptic/antipyschotic), opioids, contraceptives
What type of drugs can cause heavy menses?
IUD, anticoagulants, thiazides
During the menstruation period (day 1 of period till about the 3 or 7 day)....what two hormone levels are LOW?

What hormone level begins to rise?
estrogen and progesterone

FSH
Around what day does estrogen levels peak? Then what hormones increases as a result and what occurs?
12th ; LH ; triggers ovulation a day or two later
With ovulation, what hormone level increases? and what phase does this occur?
Progesterone ; Luteal/Secretory
When is menopause considered complete?
When there has been a complete absence of menstruation (amenorrhea) for one year
The occurence of what in young men have been assciated with sterility?
mumps
What disease is a primary concern to women of childbearing age?
Rubella
What are women advised in reference to pregnancy and Rubella?
Get immunization for Rubella d/t congential anomalies; HOWEVER, do not get immunized if already pregnant! Also, do not conceive for atleast 3 months after a Rubella immunization
In men, what health problem can lead to erectile dysfunction or retrograde ejaculation?
DM
What effect do anti-HTN meds have on men?

Name a few...
Erectile dysfunction

amlopipine (Norvasc), lisinopril (Prinivil), propranolo (Inderal), and clonidine (Catapres)
What conditions may contraindicated the use of oral contraceptives?
Hx of cholecystits, hepatitis, & COPD (progesterone thickens resp secretions)
Cigarette smoking may delay what and increase the risk for what?
Delay conception and the use of OC with smoking may cause death and early menopause
What type drugs are generally used for vaginits and gonorrhea? So it's important to assess what?
Sulfonamides and penicillin....Assess ALLERGIES!!!!
Anorexia can cause what?
Amenorrhea l/t osteoporosis. So ensure adequate calcium and Vit D intake
Excessive excerise can lead to what? and because why?
Amenorrhea; decreased estrogen r/t to a low % of body fat because estrogen is stored in fat cells
Pelvic pain is associated with what?

What is dyspareunia?
PID, ovarian cysts, and endometriosis

painful intercourse
What contraceptive may cause an increase in the amount & duration of menses?
IUD
What can man with an undescended testis be at risk for?
testicular cancer or male infertility
What does a grayish green or yellow color; malodorous or "fishy" odor indicate?
Trichomonas vaginalis
How can FSH be measured? What do the levels indicate?
In an 24-hour urine specimen; gonadal failure because of pituitary dysfunction
What is normal finding with PSA (Prostate-specific antigen)?
< 4 ng/ml
What does a wet mount involve?

What are the Nursing Responsibility?
Direct microscopis exam of discharge performed immediately after collection.

Instruct pt not to douche b/4 procedure

Done with glass slide; 10-20% KOH solution (potassium hydroxide), a NaCl solution, and cotton tip applicators
What is the gram stain involve?
Used for rapid dectection of gonorrhea. Presence of gram-negative intracellular diplococci warrants need for Tx; also used for Chlamydia testing
What is an ultrasound used for?

Instruct pt to do what?
Useful for detecting masses greater than 3 cm, such as ectopic pregnancies, IUDs, ovarian cysts, and hydatiform moles. In men, for testicular torsion or masses.

Have a full bladder!!
What invasive test involves instillation of contrast media through cervix into the uterine cavity and then the fallopian tubes? Spot x-rays are taken to detect abnormalities of uterus, ovaries, and tubes.
Hystersalpingogram
What is the Hystersalpingogram used for?
Diagnosis for fertility (detect adhesions near ovary, an abnormal uterine shape, blockage of tubal pathways)
What test is similar to the speculum exam and is used as a follow up study for abnormal Pap smears and exam of women exposed to DEO in utero?
Colposcopy; biopsy may be taken during exam
The screening criteria for assessing prostate cancer include?
Yearly DRE for men over age 50
Estrogen production by the mature ovarian follicle causes?
The release of GnRH and increased secretion of LH
What is the normal menstrual flow amount? usually heaviest when?
20-80 ml/per menses; average is 30 ml;

1st two days
What is menstrual discharge made of?

Clots indicate?
endometrium, blood, mucus, and vaginal cells

indicate heavy flow or vaginal pooling
Is gynecomastia a normal age-related change in men?
No, enlargement of the men's breast is not normal.
What is the normal physical male assessment include?
Diamond shape hair distribution, penis circumcised, no lesions or discharge. Scrotum symmetric, no masses, descended testes. No inguinal hernia.
What is the normal physical female assessment include?
Breasts symmetric without dimpling. Nipples soft, no drainage, retraction, or lesions. No masses or tenderness. No lymphadenopathy.

Triangular hair distribution. Genitalia dark pink, no lesions, redness, swelling, or inflammation in perineal area. No vag discharge. No tenderness with palpation of Skene's ducts and Bartholin's glands
What is an orchiectomy?
Removal of one or both testes
What is a Vasectomy?
Removal of part of ductus (vas) deferens; can be elective procedure for sterlization or contraception
What is an Oophorectomy?
Removal of one or both ovaries
What is a Salpingectomy?
Removal of one or both fallopian tubes
What does tubal sterilization mean?
Ligaiton of the fallopian tubes
What does penile or scrotal erythema with macules and papules indicate?
Scabies or pediculosis
What does a reddened base with painful vesicles or ulcerations in females indicate?
Genital herpes
When should BSE of the breasts be conducted?
For woman with regular periods would be right after their period; when the breasts are not tender.

With irregular periods, the same day each month should be picked so it's easy to remember
At what size is a tumor detectable by physical exam and how long does it take for it to grow this size?
1 cm; takes 10 years or longer
What type of biopsy is used with the breast?
(FNA) Fine Needle Aspiration: insert needle in the lesion and aspirate cellular fluid into syringe. Done in 3-4 passes.
What is mastalgia? most common form?
Breast pain; Cyclic mastalgia: described as tenderness or heaviness that lasts 2-3 days of most of month; pain r/t hormone sensitivity and decrease with menopause.
What hormonal therapy is recommended for mastalgia?

any others?
danazol (Danocrine)

reduce caffeine and fat intake; take Vitamins E,A,B. Evening primrose oil and wear supported bra
What occurs with fibrocystic changes in the breasts?

Does it increase risk of breast cancer?
develop excess fibrous tissue, hyperplasia of lining in mammary ducts, and cysts formation.

Produce PAIN from nerve irritation from edema in CT and fibrosis from pinching of the nerve

No
What drug is helpful for pts with severe breast pain?

s/e?
Danazol: it decreases FSH and LH, resulting in reduced estrogen production so reducing pain and nodularity

acne, edema, hirsutism
Of what conditions has manifestations of one or more palpable lumps that are usually round, well delineated, and move freely within breast?

*found in both breasts*
Fibrocystic changes
Of what conditions is a common cause of discrete benign breast lumps in young women occuring between ages 15-25?

*It is the most freq cause of breast masses in women under age 25*
Fibroadenoma
What is the possibe cause of fibroadenoma?
Increased estrogen sensitivity that's localized in an area of the breast
What are the characteristics of fibroadenoma?
Firm, moveable, non-tender, and well delineated mass usually in one breast
How is fibroadenoma detected?
Easily by physical exam and often visable on mammography and US. Definitive dx requires bx and tissue exam
What is the Tx of fibroadenoma?

any drugs?
Includes surgical excision or by cyroablation: a cyroprobe is inserted into the tumor and extreme cold gas freezes tumor

no radiation or hormone therapy
With fibrocystic changes, what are the manifestations?
Mastalgia, nodularity, breast enlargement during the Luteal phase. The lumps are moveable and found in both breasts; some are fluid filled
What is the management for fibrocystic changes?
With large or freq cysts: surgical removal

Follow up exams for rest of life
BSE, good bra support, diet therapy (low salt, restrict methylxathines (chocolate and coffee), Vit E therapy, analgesics, danazol (Danocrine), diuretics, hormone therapy, and antiestrogen therapy, reduce stress
When should an excisional biopsy be done in fibrocystic changes of breasts?
1) If no fluid is found on aspiration
2) If fluid found is hemorrhagic
3) If residual mass remains
As a nurse, we should tell pts with fibrocystic breasts that.....
she may expect recurrence of the cysts in one or both until menopause and that cysts may enlarge or become painul just before menstruation

Also, that they don't turn into cancer
In who would fibroadenoma occur more frequently in?
younger aged African American women
What is a benign, wartlike growth found in the mammary ducts, usually near the nipple?

*non-palpable mass, usually unilateral*
s/s?

tx?
Intraductal papilloma

Affects women 40-60 yrs & associated with bloodly nipple discharge, a mass or both.

Tx: excision of the papilloma and the involved duct
What is the treatment for Ductal ectasia?
If an abscess develops, warm compresses and ABx with close follow up exams or surgical excision
What is the primary symptom of ductal ectasia?

effects who?
Nipple discharge that is multicolored and sticky. There is a palpable lump behind the areola: initially it's painless but may progess to burning, itching, and pain around the nipple

Perimenopausal woman
What is an inflammatory condition of the breasts that occurs most freq in lactating women?
Mastitis
How does it occur?
the infection develops when organisms, usually staph, gain access to the breast through a cracked nipple.
How is mastitis treated?
In early stages, can be cured with Abx and breastfeeding should continue unless an abscess forms or if purulent drainage is noted
What happens with Lactational breast abscess??

s/s?

tx?
If mastitis persists after several days of ABx therapy: an abscess may have developed

Skin may become red and edematous over the involved breast with mass, pt may have an elevated temp

Tx: ABx will not work alone with an abscess. US-guided drainage of abscess or surgical incision and drainage are necessary: then new C/S done with new Abx therapy
What is a common male breast problem characterized by inflammatory enlargement of one or both breasts?
Gynecomastia: temporary and benign

Cause from disturbance of normal ratio of active androgen to estrogen in plasma or within breast itself OR may drug therapy
What drugs have a S/E of Gynecomastia?
Admin of estrogens and andrgens, digitalis, isoniazid, (INH), ranitidine (Zantac), and spironolactone (Aldactone). Also heroin and marijauna use!
What results from loss of subQ fat, structural support, and atrophy of mammary glands?
Pendulous breasts
What is the management of Gynecomastia in men?
Usually it is self-limiting

Mammoplasty: reduction

Antiestrogen: danocrine (Danazol)
or
tamoxifen (Nolvadex)...which is also used for breast cancer & must be + for E/P
Who is at increased risk for Breast Cancer?
female, age over 50, family Hx, hx of breast, colon, endometrial, or ovarian cancer, early menarche (before 12) or late menopause ( after 55), 1st full term pregnancy after age 30, wt gain & obesity after menopause, exposure to ionizing radiation
Gene mutations of BRCA-1 or BRCA-2 play a role in 5-10% of _______
breast cancer cases
What reduces the risk of breast cancer in women with BRCA-1 and BRCA-2 mutations?
Prophylactic Bilateral oophorectomy (removal of one or both ovaries)
Breast cancer arises from the....

Mostly arise from the....
epithelial lining of the ducts ( ductal carcinoma) or from the epithelium of the lobules (lobular carcinoma)

Arise from the ducts and are invasive!
What factors affect the prognosis of cancer?
Size, axillary node involvement (the more nodes, the worse), tumor differentiation, human epidermal growth factor receptor 2 (HER-2) status, and estrogen & progesterone (E/P) status
How is breast cancer detected?

Where does it occur most often?
As a lump or or mammaographic abnormality in the breast.

In the upper, outer quadrant of the breat because it is the location of most of the glandular tissue. It feels hard, irregular shaped, poorly delineated, nonmobile, and nontender
What is the main complication of breast cancer?
Reoccurence: may be local or regional (closest to the cancer site) or distant (bone, brain, lung, etc & metastic)
An axillary lymph node disection is done to determine if the cancer has spread to the axilla on the other side of the breast. Who has the greatest risk?
Pts with 4 or more postitive nodes
What surgery involves removal of breast, pectoral muscles, axillary lymph nodes, and all fat and adjacent tissue)?
Mastectomy
What stage involves:

Tumor size: < 2cm with no lymph node involvement
Stage I
What stage involves:

Tumor size: any with any type of nodal involvement with the presence of metastasis
Stage IV
What stage involves

Tumor size: no evidence of tumor, ranges to 5 cm with no lymph node, or 1-3 axillary nodes &/or internal mammary nodes with no metastasis
Stage II A
What is an Axillary Node Disection?
a disection on the same side as the breast cancer and involves the removal of 12 to 20 nodes. Helps to determine need for further treatment (chemo, hormone therapy, or both)

*replaced by sentinel lymph node disection
What is the accumulation of lymph in the soft tissue that occurs from the excision or radiation of lymph nodes?
Lymphedema
What are the s/s of lymphedema?
The lymph fluid cannot return to central circulation & accumulates, causing obstructive pressure on veins and venous return.

Experiences pain, heaviness, impaired motor funtion in the arm, and numbness and parasthesia of the fingers
What conditions can occur from lymphedema?
Cellulitis and progressive fibrosis
What is breast conservation surgery called in which involves the removal of the entire tumor alnd with a margin of normal tissue?
Lumpectomy
What follows a lumpectomy?
Radiation therapy to the entire breast, ending with a boost to the tumor bed
What helps the surgeon identify the lymph node(s) that drain first from the tumor site (sentinel node) using a radioiosotope/blue dye that is injected into the tumor site?

*process involves 1-4 axilary nodes*
Lymphatic mapping and sentinel lymph node disection (SNLD)
Which receptive tumors are differentiated, have a diploid (more normal) DNA content, have lower chance for reoccurence, are hormone dependent and are responsive to hormone therpy?
Receptive-positive tumors
Which receptive tumors are poorly differentiated, are aneuploidy (abnormal high or low DNA count), freq reoccurm and are unersponsive to hormone therapy?
Recptive-negative tumors
What are the contraindications to breast conservation surgery?
Too small of breast size in relation to tumor size, masses and calcifications that are multifocal (in same breast quad), masses that are multicentric (in one or more quad), diffuse calcifications in more than one quad, or central location (near nipple)
What surgery involves the removal of the breast and axillary lymph nodes, but preserves the pectoralis muscle?
Modified Radical Masectomy
What are some of the S/E of a Modified Radical Masectomy?
chest wall tightness, phantom breast sensations, arm swelling, sensory changes
How often does a woman need to follow up after breast cancer surgery?
For the rest of her life every 6 months for 2 years then annually thereafter

*should also practice monthly BSE & have yearly mammography
The most common site of local reoccurence is........
at the surgical site
What are the S/E of external beam radiation therapy?
fatigue, skin changes, and breast edema may be temporary

#1 risk for burns
What is an alternative to traditional radiation treatment for early-stage breast cancer in which after placement of many catheters, a radioactive seed is delivered into each catheter to treat target area?
Brachytherapy (internal radiation)
What is the difference between the traditional radiation treatments and the new, high-dose brachytherapy?
Traditional would take 5 to 6 weeks as opposed to the balloon catheter that may take only 5 days.
What is the new chemo drug that is used for treating metastic breast cancer?

It is well tolerated with fewer and milder S/E than other chemo drugs
Vinorelbine (Navelbine)
Which chemo drug do you need to monitor for signs of cardiotoxicity and heart failure (dysrhytmias, ECG changes). Also, instruct pt not have immunizations w/o MD's approval & stay clear from those who recently received a live virus vaccine.
Doxorubicin (Adriamycin)
The most common S/E of chemo are:
s/s of the GI tract, bone marrow suppression, wt. loss, hair loss, NV, fatigue
What is the result of increased prostaglandin or increased sensitivity to it resulting in strong & frequent uterine contractions and tissue ischemia?
Primary dysmenorrhea
How do NSAIDS work this painful mestruation?
By inhibiting prostaglandins and OC work by inhibiting ovulation
What is secondary dysmenorrhea associated with?
Pathological disorders, which may be PID, endometriosis, ovarian cysts, or pelvic adhesions
What is the absence of menstruation by the age 17, or age 14 with secondary sex characteristics present?
Primary amenorrhea
What is Primary amenorrhea associated with?
anorexia nervosa, excessive athletic activity, or polycystic ovary
What is secondary amenorrhea characterized by?
A woman with a reguar menstruation period which has ceased for atleast 6 months.
What is the most common cause of secondary amenorrhea? other causes?
pregnancy

ovarian tumors, hormonal imbalance, anorexia nervosa, & excessive athletic activity
What is scanty menstruation OR long intervals between menses and usually r/t hormonal imbalance?
Oligomenorrhea
What is excessive bleeding often caused by unopposed estrogen state or unterine fibroids that can destabilize the endometrium?
Menorrhagia
What condition is characterized by blood loss, fatigue, and anemia?
heavy menstruation: Menorrhagia
What is spotting or breakthrough bleeding between menstrual periods?
Metrorrhagia
What condition has causes that include: cervical or endometrial polyps, PID, use of contraceptives, and cervical or uterine cancer?
Metorrhagia
What should be immediately investigated because it is associated wtih endometrial cancer?
Bleeding after menopause
What is considered excessive bleeding?
> 80ml or prolonged >than 7 days
What are th diagnosis test used with abnormal bleeding?
CBC, thyroid function tests, endocrine studies, Pap smear, pelvic US, hysterscopy, and endometrial biopsy
What is used to treat abnormal bleeding?
Oral contraceptives or progesterone if birth control is not needed
What surgical interventions are used for abnormal bleeding?
D&C or endometrial ablation
For women who wish not to bear any children can do what for abnorma bleeding?
Have a hysterectomy
What is the average age for menopause?
51
What is perimenopause?
Starts when the 1st signs of hormonal fluctuations are seen and ends one year after the final menstruation period
The manifestations of menopause are....
secondary to erratic fluctuation in estrogen leves and these are irregular cycles, palpitations, (vasomotor: hot flashes and night sweats), (GU: vaginitis, vaginal dryness, urinary incontinence, painful sex), (CV:decrease in good cholesterol and increase in bad cholesterol, VD), (Skin/bone: dry flabby skin, and increased tendency for fractures)

Depression, irritability, and anxiety reactions

most critical changes are Osteoporosis and CVD
What lab tests is indicative of menopause?
FSH greater than 40 IU/mL
What can a woman do to avoid hot flashes?
Avoid large meals alcohol, caffeine, spicy food, and hot drinks

Vitamin D reduces heat production
How much calcium is recommended to minimize bone loss?
1000-1200 mg daily
What are some complementary therapies for management of menopause?
Use of phytoestrogens (found in yams, flax seed, sesame seeds, tofu, and other soy products
Should a woman get a head start by using phytoestrogens in the premenopause period?
NO, this can suppress estrogen production
What natural source can decrease hot flashes and night sweats?
Black cohosh
What is no longer recommended for women with an intact uterus because of the increased risk for endometrial cancer?
Unopposed estrogen: means estrogen without progesterone
What is prescribed for a woman who has had a hysterectomy? and in what form is it available?
ERT (Estrogen only

po, patch, or vaginal insert
What drug helps decrease bone loss and improves lipid levels by competing for estrogen receptor sites?

Example?
Selective estrogen receptor modulator

raloxifene (Evista)
What are some common S/E of raloxifene (Evista)?
hot flashes and leg cramps
What are the contraidications for HRT?
Vaginal bleeding for no known reason,history of breast cancer, history of cancer of the uterus, liver disease, blood clots in the veins or legs, or in the lungs. This includes women who have had blood clots during pregnancy or when taking birth control pills, Cardiovascular disease (diseases of the heart and blood vessels), and pregnancy
What are the S/E of HRT?
Breast pain & enlargement, nausea,
Bloating and fluid retention, depression, irritability, wt gain, HA, increased appetite
What is procidentia?
a complete prolapse of the uterus, which will lie outside the vulva with everted vaginal walls
What can an uterine prolapse cause?

seen commonly in?
backache, pelvic pressure, difficult intercourse, and infertility

menopausal woman
How is uterine prolapse caused?
Decreased estrogen, loss of elasticity in the support ligaments and muscles of the pelvic floor l/t relaxaion and prolapse
What involves the herniation of the bladder through the vagina and is seen as a protrusion of the anterior vagina wall?

also associated with....
Cystocoele

vaginal pressure, retention, UTI, stress (urinary cath), incontinence
What is "sitting on a ball" feeling?
a large cystocoele
How can a cystocoele be controlled?

How is it interpreted as?
By second voiding or by manually reducing the cystocoele before voiding

Incomplete bladder emptying
______ describe a buldge that forms in the posterior wall of the vagina.

What does the pt complain of?
Rectocoele

constipation, incomplete evacuation, hemorrhoids, or fecal incontinence
What is the management of a 1st degree uterine prolapse?
The cervix is still within the vagina, so insertion of a pessary: a device that holds the organs in their correct position
What exercises are the pt taught to do to improve the strength of the pelvic floor, reduce stress incontinence, and prevent further downward displacement of the uterus?
Kegel excercises
What are the implications of a pessary?
pt must be measured for the right size pessary, taught how to insert and remove it, and how to clean it to prevent erosion of the mucosa
What is a surigcal repair for a cystocoele called?
Anterior colporrhaphy
What is a surgical repair for a rectocoele called?
Posterior colporrhaphy
What do the reconstructive procedures (colporrhaphy) do?
Shorten the pelvic muscles and tighten the vagina wall
What does the nurse monitor for post-op in a colporrhaphy?
Adequate voiding (prevent bladder distention) through an undwelling urinary catheter &/or suprapubic catheter. Watched for vaginal bleeding and wound healing.
What is the pt taught before discharge with colporrhaphy surgery?
Avoid lifting more than 5 lbs, avoid sexual intercourse, and strenuous activities for 6 weeks.

Also, the signs of vaginal infection, promotion of a regular BM, and how to care for a urinary catheter
What is the preferred approach for a woman who has had a 3rd degree uterine prolapse?
Hysterectomy
What is the chief manifestation of a vaginal fistula?
Leakage of urine into the vagina (vesicovaginal) or flatus/feces into the vagina (rectovaginal)
How are fistulas diagnosed?

What indicates a negative dx?
By instilling a dye into the bladder or rectum and then observing the vagina for leakage of the dye

If negative, a tampon is inserted, the pt is asked to ambulate and the tampon is inspected for the dye
What is a fistulogram?
It is done to identify the exact location and extension of a fistulapt
What are the pts concerns with a vaginal fistula?
Causes a lot of distress and embarrasment. There is disruption of skin integrity, the pt has to deal with offensive odor, so care with hygiene is important.
Do vaginal fistulas heal spontaneously?
For those with optimal health. For those not, surgical excision is necessary.
What may cause low back pain, dyspareunia, chronic lower abd pain, and menstrual irregularities?
Large ovarian cysts
Is surgery necessary for ovarian cysts?
Most resolve spontaneously (functional cysts) and surgery is indicated if they are > 8cm or if the cysts twist on its own pedicle causing severe pain or rupture causing massive bleeding with excruiating pain
What are the risk factors with Ovarian cancer?

What decreases the risk?
Family hx of ovarian cancer, nulliparity, infertility, BRCA-1 gene mutation, use of fertility drugs, and use of HRT

Low fat diet and reduced number of ovulatory cycles
What are the early S/S of ovarian cancer??
NONE!!!!

Once ascites is noted, the disease has spread
Is there any screening for Ovarian cancer?
There is no general screening method for ovarian cancer but high-risk women may have CA-125 serum levels checked and pelvic US done
What is a fistulogram?
It is done to identify the exact location and extension of a fistulapt
What are the pts concerns with a vaginal fistula?
Causes a lot of distress and embarrasment. There is disruption of skin integrity, the pt has to deal with offensive odor, so care with hygiene is important.
Do vaginal fistulas heal spontaneously?
For those with optimal health. For those not, surgical excision is necessary.
What may cause low back pain, dyspareunia, chronic lower abd pain, and menstrual irregularities?
Large ovarian cysts
Is surgery necessary for ovarian cysts?
Most resolve spontaneously (functional cysts) and surgery is indicated if they are > 8cm or if the cysts twist on its own pedicle causing severe pain or rupture causing massive bleeding with excruiating pain
What are the risk factors with Ovarian cancer?

What decreases the risk?
Family hx of ovarian cancer, nulliparity, infertility, BRCA-1 gene mutation, use of fertility drugs, and use of HRT

Low fat diet and reduced number of ovulatory cycles
What are the early S/S of ovarian cancer??
NONE!!!!

Once ascites is noted, the disease has spread

Has the highest mortality among the gyne cancers: grows rapidly and spreads fast
Is there any screening for Ovarian cancer?

When is the dx made?
There is general screening method for ovarian cancer but high-risk women may have CA-125 serum levels checked and pelvic US done.

Ca-125 which is a tumor marker that is positive in 80% of women with epithelial ovarian cancer.

After laproscopy and then critical staging is done
What is the surgery done for the those with ovarian cancer?

Any follow up procedures?
Total abdominal hysterectomy with bilateral salpingoophorectomy (TAH-BSO)

Then 6-12 months later a second look laparoscopy is done.
When is chemotherapy indicative with ovarian cancer?
Is not curative but used for palliative TX with Stage IV
What is a benign mass of endometrial tissue that is attached to the inner uterine lining by a pedicle. It is a freq cause of spotting.
Endometrial polyp: they bleed easily and is removed by the gynecologist with polyp forceps
What condition is where functioning endometrial tissue produces a mini-menstrual cycle of its own but it's outside the uterus (in/neasr ovaries, ligaments, etc)
Endometriosis

Dx by laproscopy
What does endometriosis cause?
Seen in nulliparous woman, presents with dysmenorrhea, back pain, rectal pressure, dysfunctional bleeding, and dyspareunia.

Lesions l/t scar formation each time they bleed; infertility can be an adverse consequence
How is endometriosis treated?

Drugs?
With drugs that inhibit the release of FSH and L by the anterior pit gland thereby suppressing ovulation.

Lupron (GnRH) and Danocrine (androgen): they are given for several months are not to stopped abruptly
What are the S/E of Lupron?
It suppresses estrogen (causes menopause like symptoms): wt gain, hot flashes, decreased libido, night sweats, depression
What are the S/E of Danocrine?
acne, hair growth
What is the main cause of infertility in women?

Who can they be referred to?
Endometriosis

Resolve: organization that offers support to infetile couple
What surgery is indicated for woman with endometriosis?

What about for a woman who may wish to become pregnant?
Definitive surgery that removes the uterus, ovaries, fallopian tubes, and endometrial implants

A surgical removal with lysis of adhesions
What condition is likely caused by hormones, the majority have no symptoms, and the chief sign is: menorrhagia
Uterine fibroids (Leiomyoma)
What is the most common benign tumors of the female genitalia tract and is more common in African American woman.

It's cause is unknown...
Uterine fibroids (Leiomyoma)
What are the S/S of uterine fibroids (leiomyome)?

How do you dx uterine fibroids?
menorrhagia, pelvic pressure, dysmenorrhea, and anemia

Based on Hx, confirmed by abdominal and pelvic exams, and US
What is the treatment for woman who desire to have children if they have uterine fibroids?

and if they don't care to have children?
Lupron: GnRH: They will reduce the size of the uterine fibroids.

Then she can have a hysterectomy
What is another option for uterine fibroids (leiomyoma)?
Myomectomy remove the myoma (muscle layers of the uterus)
What is the most common gyne cancer occuring most is white women?
Endometrial cancer
What are the risk factors in endometrial cancer?
Nulliparity, infertility, early menarche, late menopause, use of unopposed estrogen, and obesity
Is there there any screening for endometrial cancer?
No, but when a postmenopausal sudden develop vaginal bleeding, she is advised to her physician right away!
How is the dx made? Is there a good prognosis?
The dx is made with an endometrial biopsy or a D&C

The cancer is usually slow growing with a good prognosis?
What is the surgery involved with endometrial cancer?

What is the cancer is Stage II and beyond?
TAH-BSO Total abdominal hysterectomy with bilateral salpingoophorectomy

Radical hysterectomy with bilaternal lymph node dissection
What if the tumor with endometrial cancer is positive for progesterone receptor?

What about use of chemo?
Hormone therapy with progesterone may be done?

Used as a last resort: it's paliative
Why would a woman have an abdominal hysterectomy vs a vaginal hysterectomy?
If the pt has endometrial cancer or if the benign tumor is the size greater than a 12 wk pregnancy, if the pelvic cavity needs to be explored, if there are adhesions and scars, & when the fallopian tubes & ovaries needs to be taken out
When is a vaginal hysterectomy indicated?
Only vaginally if the pt requires a vaginal repair and the uterus is small enough to pass through the vagina
What is the primary nursing care post-hysterectomy?
Monitor for vaginal bleeding
Is there more bleeding expected after a vaginal or abdominal hysterectomy?

What is the EBL (expected blood loss) and when is it examined?
More is expected with a vaginal!

The EBL is less than 1 saturated pad q 4 hours. The pad and/or abdominal dressing are assessed during the 1st 8 hours post op
What are the most important psychosocial needs r/t to a hysterectomy?
Risk of disturbance in body image

Anticipatory grief r/t loss of body part or poor prognosis
What are discharge teaching for a woman with post-op hysterectomy?
No sex, no tub baths, avoid sitting for long periods, avoid stair climbing, avoid lifting more than 5 lbs for 4-6 wks

Teach s/s of complications of hemorrhage, urinary retention, wound infection, and UTI
What is the nursing care for a pt who had a hysterectomy?
Monitor vag bleeding, prevent infection, monitro urinary elimination with a foley cath, prevent DVDs (walk within 24 hrs), monitor for abd distention/ileus, care for incision site, psychosocial needs
What is commonly seen in multiparous woman and who are beyond 40 yrs of age?

*Also it is very fragile so they bleed easily when touched!
Cervical polyps
What are the manifestations of a cervical polyps?
Intermenstrual bleeding, postcoidal bleeding or chronic irritative symptoms of the cervix
What is the treatment for cervical polyps?

What is the pt teaching involved?
A polypectomy-removal of a polyp

Avoid using tampons, avoid douching, and no sex for a sex
What is the second most common gyne cancer and seen most is hispanics, african american, and native americans?
Cervical cancer
What are the risk factors of cervical cancer?
Early and freq sex, multiple sex partners, exposure to STDs such as HPV and HSV, low SES, and smoking
Is there any screening for cervical cancer?
Yes, the Papanicaoloau test PapSmear

Any abnormal pap smear requires further testing such as colpscopy and biopsy
What are the manifestations of cervical cancer?
vaginal bleeding leukorrhea, back pain and wt loss
What type of surgical treatment is done when the cancer involves the lymphatics?
Pelvic exenteration: Involves radical hysterectomy plus total vaginectomy, removal of both the bladder and the bowel with creationof urinary and bowel diversions
What does internal radiation involve?

Are there any radiation precautions?
Involves inserting the radioactive material into the uterus or vagina secured with a vaginal packing. The pt is placed on bedrest with a foley cath.

Pt is monitored for post radiation complications such as vaginal fistula and cystitis
How are vaginal infections acquired?
change in vaginal pH, change in normal flora, dec host resistance, decreased estrogen, poor hygiene, unhealthly sex habits, pregnancy, use of Abx/OC or steriods, and DM
What is an opportunistic infection that is not sexually transmitted? The pt c/o odorless curd-like vaginal discharge with pruritis?

Tx?
Candidiasis

Antifungal agents: clotrimazole or micronazole are available OTC

Have no sex until tx complete, use gloves, and use tx even if on period
What is characterized by a frothy yellow or white foul-smelling discharge with vulvar burning or itching? STD

Tx?
Trichomoniasis

Metronidazole (Flagyl)
What is characterized by watery grayish-white discharge with a fishy odor? STD

Tx?
Bacterial vaginosis

Metronidazole (Flagyl)
What are some things to tell the pt when taking Flagyl?
Their urine will turn reddish brown and should not be combined with alcohol to prevent antabuse-like reactions
What is aka senile vaginitis & affects postmenopausal woman due to decreased estrogen levels. It presents with scant odorless watery discharge?

tx?
Atrophic vaginitis

Estrogen cream
What is aka MPC usually caused by one or more STD pathogens. It is manifested by mucopurulent discharge with post-coidal spotting, pelvic pain or painful urination?
Cervicitits aka
Mucopurulent Cervicitis (MPC)
What is a systemic infection where the pelvic organs are inflammed due to harmful organisms that gain entry to body via sex, pelvic surgery, or STDs?
PID: usually by chlamydia or gonorrhea
What is the pt with PID educated on?
Avoiding coitus for 3 weeks, changing pad q 4 hrs, not to use a tampon, and drink plently of fluids, and complete tx regimen
What toxin is associated with TSS?
Staphyococcus aureus
What are the symptoms presented with TSS?
Abrupt onset of flu-like symptoms, vomitting, diarrhea, hypovolemic shock, and sunburn like rash on face, arms, & trunk.

Labs show increased WBC, elevated BUN and creatinine
What is the treatment for TSS?
Admin of plasma volume expanders, o2, and beta lactamase resistant Abx
What is a woman advised to prevent TSS?
avoid using high absorbency tampons, change tampons several times a day, if using a diaphragm for contraception to remove it within 24 hours, and finally practice good hand washing
What is the pt treated with if the woman cannot adequately ovulate?
Clomid