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53 Cards in this Set
- Front
- Back
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Health Hx and Sexual Assessment
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*Menstrualhistory and history of pregnancies *Historyof exposure to medications *Painwith menses or intercourse *Vaginaldischarge, odor, or itching *Urinaryand bowel function *Sexualhistory, including sexual or physical abuse *Historyof STDs, surgeries or procedures *Chronicillness or disabilities which affect health/self-care *Familyand genetic history |
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Sexual Assessment
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*Includesubjective and objective data. *Purposeis to obtain information to picture a woman’s sexuality and sexual practices topromote sexual health. *Maymove from less sensitive areas of general health history/assessment to moresensitive areas. *Askfor permission to discuss these issues. *Donot assume sexual preferences. *Askingthe patient to label herself as married, single, etc. may be interpreted asinappropriate; asking about current meaningful relationships may be lessoffensive. |
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Diagnostic Tests and Exams
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*Pelvicexamination with Pap test Box 32-3 page 898 *DiagnosticTests indicated by an abnormal pap test *Colposcopy (portable microscope) and cervical biopsy *Cyrotherapy (freezing cervical tissue with nitrous oxide)and laser therapy *Conebiopsy and loop electrosurgical excision (LEEP); LEEP utilizes a laser beam |
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Uterine Diagnostic Tests |
*Endometrialbiopsy *Dilationand curettage *Laparoscopy *Hysterectomy *US *CT *MRI *Table32-7 page 903 |
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STIs- definition, portals of entry, health edu
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*Are acquired through sexual contact with an infected person *Portals of entry - skin and mucosal linings of the urethra, cervix,vagina, rectum, and oropharynx *Health education- address risk factors and behaviors that can leadto infection |
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Syphilis
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*Spirochete Treponema pallidum *Three stages: Primary, secondary, and tertiary *Affects many body systems if untreated *A single dose of penicillin G benzathine IM *refer for further STI testing *education |
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Chlamydia and gonorrhea
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*The most commonly reported STIs *Frequently do not cause symptoms inwomen *Chlamydia- doxycycline (Adoxa) or azithromycin (Zithromax) *Gonorrhea- ceftriaxone (Rocephin) or Suprax *Complications for women- PID, ectopic pregnancy, endometritis, and infertility *Complications for men- epididymitis, infertility |
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HPV
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*50% of sexually active peopleacquire HPV *May be unaware they have it *More than 100 strains *Some cause cervical cancer (70% ofcases) *Women should have regular Pap smears forscreening *Genital warts-Topical medications *Vaccine available |
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Herpesvirus Type 2
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*genital itching and pain *progressing to vesicles and ulcers *Treatment aimed at relievingsymptoms: Antivirals: acyclovir (Zovirax) valacyclovir (Valtrex) *Patient education |
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Pelvic Inflammatory Disease
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*Infection ascends upward from the vagina *Often STI or post procedure *Cervix, uterus, fallopian tubes, ovaries,peritoneum * Intensive therapy - bed rest, IV fluids, and IV antibiotics *Complications: abscess, recurrent disease,peritonitis, strictures, fallopian tube obstruction, ectopic pregnancy,infertility |
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Bacterial Vaginosis
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*Caused by an overgrowth ofanaerobic bacteria and Gardnerella vaginalis (normally found in the vagina) andan absence of lactobacilli *Fishy odor *metronidazole (Flagyl) or clindamycin (Cleocin) *BV is not considered an STIexclusively, but is associated with sexual activity |
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Trichomoniasis
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*Trichomonas vaginalis-flagellated protozoan *Women- foul vaginal discharge, itching,burning *urethritis in men (men are oftenasymptomatic) *metronidazole or tinidazole-one time loading dose *Nursing- education |
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Male Reproductive Infections Associated with Sexual Activity
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*Epididymitis: Usually descends from aninfected prostate or urinary tract *Orchitis: An inflammation of the testes(testicular congestion) caused by bacterial, viral, spirochetal, parasitic, traumatic, chemical,or unknown factors |
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Reproductive Disorders - Amenorrhea
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Amenorrhea *May be primary or secondary *Treated with hormones |
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Reproductive Disorders - Dysmenorrhea
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Dysmenorrhea *Primary type: Crampy abdominal and/or lower back painjust before the onset of bleeding *Secondary type: Associated withunderlying pathology *NSAIDs and hormonalcontraceptives are the mainstay of treating primary dysmenorrhea |
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PMS
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*PMS is a cluster of behavioral,emotional, and physical symptoms that typically occur the week prior tomenstruation |
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PMDD
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*PMDD is a more severe form of PMS *No known cause of PMS/PMDD- hormonelevels?? *Treated with CAM, lifestylemodifications, oral contraceptives, or SSRIs *Nurses must address the physiological andpsychological |
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Vulvovaginal Infections- BV
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*Bacterial vaginosis (BV): *May be asymptomatic; may cause foulvaginal discharge *Usually treated with metronidazole |
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Vulvovaginal Infections- Candidiasis
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*Candidiasis: *Causes vulvar pruritus, usually caused byC. albicans *Risk factors include broad-spectrumantibiotics, exogenous hormones, and corticosteroids *Treated with antifungals |
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Uterine Leiomyomas
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*Unknown cause- ? Estrogen,genetic *Myomas or fibroids; benign, slowgrowing solid tumors of uterus *Asymptomatic or abnormalbleeding as most common symptom *pelvic pressure, constipation,urinary frequency or retention, dyspareunia *Tumors usually shrink withmenopause |
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Hysterectomy
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*Total abdominal- required for large tumors *Total vaginal – can be done when fibroidsare small *Laparoscopic assistedvaginal |
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Myomectomy
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*removal of fibroid laser- performed inproliferative phase to minimize blood loss *Uterine arteryembolization |
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Postop care- hysterectomy/myomectomy
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General posop care FC Assessvaginal bleeding – less than 1 saturated pad in 4 hours Perinealcare in vaginal hysterectomies – sitz bath or ice packs |
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Endometriosis- what is it?
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•Endometrial tissue outside of the uterine cavity •Responds tohormonal changes •Leads to scarring, cysts, infertility |
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Endometriosis- symps
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•Lower abdomen •Pain with defecation •dyspareunia •Peaks just beforemenstrual flow
Hypermenorrhea |
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Endometriosis- non surgical mgmt
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hormonal therapies- •Contraceptives-Depoprovera •Syntheticandrogen- Danocrine •Gonadotropinreleasing hormone agonists– cause amenorrhea leuprolide(Lupron) Pain relief- •Mild analgesics or NSAIDS •ComplementaryTherapies –Heatingpad to sacrum, relaxation techniques, yoga, & biofeedback |
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Surgical tx of endometriosis
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•CO2 laser to vaporize adhesions andendometrial implants •Removalof uterus and ovaries if pregnancy is not desired |
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Prolapse: Cystocele
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herniation of the bladder into the anterior vagina |
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Prolapse: rectocele
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the extrusion of the rectum into the posterior vagina
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Prolapse: Enterocele
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the descent of the small intestine into the vaginal vault
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Prolapse: Uterine prolapse
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downward descent of the uterus into the vagina
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Prolapse: vault prolapse
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top of the vagina prolapses after a hysterectomy
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Urogenital displacement and prolapse
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•Occurs with relaxation & descent of the pelvic organs adjacent tothe vagina •With menopause and loss of estrogen, support structures of the pelvicfloor lose elasticity •Other risk factors include multiparity,childbirth trauma, chronic straining |
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Cystocele: due to and tx
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•Due to weakened pelvic structures •Tx: Pessary, estrogen, Kegel’s •Anterior colporrhaphy |
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Uterine Prolapse due to and tx
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•Conservative Tx with pessary •Surgical procedure – vaginal hysterectomy |
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Rectocele def
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Posterior repair |
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Ovarian Cysts
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Non-functional- sloughed off endometrial tissue Dermoid- embryonic cells Polycystic ovaries- chronic anovulatory |
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PCOS |
Endocrine disorder Androgen excess Insulin resistance Imbalance of LH and FSH Type 2 diabetes, acne, hirsuit, obesity, hyperlipidemia, oral contraceptives, metformin-helps to reduce testosterone |
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Fibrocystic Breast Changes
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Fibrosis, adenosis, hyperplasia Mastalgia- breast pain Pain, nodules, tenderness |
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Erectile Dysfunction - Causes
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Psychogenic and organic causes Vascular, endocrine, renal failure, surgeries, neuro disorders, trauma, meds |
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ED treatment
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Penile implants and vacuum erection devices may be appropriate for some pts Nursing care- empathy, communication |
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Conditions affecting the penis- Phimosis |
A condition in which the foreskin is constricted so that it cannot be retracted over the glans- corrected by circumcision |
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Conditions affecting the penis- Priapism |
*urologic emergency *the corpora may be irritated with an anticoagulant or a shunt placed |
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BPH definition |
Benign Prostatic Hyperplasia -Increase in the number of cells (hyperplasia) that results in hypertrophy -Obstructs flow of urine -Common in older men -Effects on bladder |
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BPH effects on the bladder
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Urinary retention Overflow incontinence Stasis results in UTI |
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BPH signs and symps
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nocturia |
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BPH MGMT |
Slow prostate growth= 5 alpha reductase inhibitor, Proscar, Avodart Relax prostate muscle= alpha 1 adrenergic blocker, Flomax, Hytrin |
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BPH Surgical MGMT
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TUIP- transurethral incision of prostate Transurethral microwave heat tx Transurethral needle ablation Laser Balloon Open prostatectomy |
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BPH Surgical MGMT
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Continuous bladder irrigation with 3 way Foley Urine blood-tinged with small clots and tissue debris |
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TURP Postop Care |
Irrigation with NS Empty drainage bag often Catheter removed about PO Day 2, monitor voiding |
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BPH Postop Complications |
Arterial bleeding- bright red with clots: notify physician Monitor Hgb and HCT |
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BPH Postop- Spasms and Urethral stricture
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Stricture- more common with TURP |
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